Access To Medical Care Research Articles

930. COVID-19 symptom and viral load rebound among individuals reporting nirmatrelvir/ritonavir use compared to propensity score matched individuals not taking COVID-19 treatment

930. COVID-19 symptom and viral load rebound among individuals reporting nirmatrelvir/ritonavir use compared to propensity score matched individuals not taking COVID-19 treatment

Approaches to improve management of patients with multiple chronic non-communicable diseases (literature review)

A large fraction of adult patients has two or more chronic diseases (multiple chronic diseases, MCD). There are often questions about the quality and availability of medical care for patients with MCD, which could drastically be improved using information technologies (IT). 
 The purpose of this work was to study medical care management for MCD patients abroad using IT. 
 This study was carried out by searching the Google system and PubMed. 
 MCD patients are characterized by a high heterogeneity. Effective processing of the flow of medical information (electronic patient registers, digital medical records, scientific knowledge, etc.) is usually feasible with the help of artificial intelligence technologies and supercomputers. To improve health care delivery to adult MCD patients there are described three dimensions for the IT development including 1) development the algorithms to support clinical decision making; 2) coordination of medical care delivery; and 3) attainment of patient self-management. 
 The presented results confirm the important role of IT in medical care. The number of scientific reports devoted to this issue is growing. The use of IT in medicine demonstrates the promise of the principles of automated analysis and the provision of additional information directly at the point of care delivery. This can improve medical processes and, to some extent, clinical outcomes, including indicators of patients’ quality of life.
 Conclusion. Additional studies based on data from real-life clinical settings are required to make 
 a comprehensive assessment of the areas of IT applicability.

The brief characteristic of manpower potential in health care of Greece, Spain, Bulgaria

The article presents brief descriptive review of manpower resources in health care of Greece, Spain and Bulgaria. It is noted that countries differ in redundancy of specialists at relative deficiency of general practitioners. The medical personnel of analyzed countries are characterized by aging, tendency to migration to other countries, deficiency of paramedical personnel and excess of required number of dentists that is especially pronounced in Bulgaria. Furthermore, accessibility of medical care is reduced by limits of number of patients per one physician established for specified time period in Greece. The salary level of physicians in these countries varies from minimal (Greece, Bulgaria) to maximal in Spain. At that, training of medical personnel is implemented according to Bologna system (bachelor course, magistracy, etc.) and is characterized by long period (4-5 years) of training physician for independent work.

The medical demographic indicators and health preservation of rural population of the Russian Federation

For the last 20 years of analysis, mortality rate of rural population was higher than that one of entire population; in 2020, increasing of mortality due to COVID-19 was noted.The indicators were 15.4 per 1000 population for rural population, and 14.3‰ for urban population. In 2021, the indicators increased up to 17.5 and 16.5‰, respectively. The birth rate of rural population over last 20 years tended to increasing. In 2013, mortality and birth rates became equal (14.5‰). In subsequent years, birth rate decreased and in 2021 amounted to 9.6‰ and in 2022 to 9.5‰. In 2021, the indicator of general morbidity of rural population of the Russian Federation was 124941.0‰oo For entire population the indicator was higher - 167713.8‰oo. In 2021, the highest rates of general morbidity of rural population were in the classes of diseases of the respiratory system - 34470.2‰oo and the circulatory system - 21588.2‰oo. In 2021, the ranking of general incidence of rural population in the Federal districts of the Russian Federation demonstrated difference in indicators by 1.5 times and in the subjects of the Russian Federation it reached 5.3 times. The highest indicator was noted in the Nenets Autonomous District - 278926.7‰oo, the lowest one in the Magadan Oblast - 52441.5‰oo. In 2021, the incidence of COVID-19 in rural population amounted to 2151.9‰oo. In 2021, the indicator increased by 2.8 times up to 6056.8‰oo. There is 2.4-fold increase in incidence of COVID-19 in rural population from 3391.1‰oo (2020) to 8085.7‰oo (2021). The ranking of incidence rates of rural population of COVID-19 in the subjects of the Russian Federation demonstrated difference in 15.6 times. The highest indicators were noted in the Republic of Khakassia - 14104.1 per 100 thousand population and the lowest in the Magadan region - 902.9‰oo. Conclusions. The unfavorable medical and demographic situation in the countryside indicates the low availability of medical care, the need for financial support of rural areas at the municipal, regional and Federal levels.

Susceptibility to antimicrobial preparations of Klebsiella pneumoniae strains isolated from patients in a multidisciplinary hospital

Introduction. The extraordinary genetic potential of microorganisms has benefited from human overuse antibiotics to develop multiple resistance mechanisms. The large size and heterogeneity of the Russian population, the presence of territories with significant differences in demographic, cultural, and socio-economic indicators, the features of the management and availability of medical care are significant factors influencing the spread of resistance genes to antibacterial therapy of some strains of microorganisms.
 Materials and methods. Susceptibility to twenty one antimicrobial agents of one hundred twenty eight Klebsiella pneumoniae isolates, isolated from various loci of patients in a multidisciplinary hospital, including 16% of strains from the lower respiratory tract, 44% from wounds and wound discharge, and 40% from urine, was assessed.
 Results. Among isolates from urine, 20% of isolates were found to have the multidrug resistance (MDR) phenotype, 42% had the extreme resistance phenotype (XDR). Among the isolates of Kl. pneumoniae from purulent wounds, 18% had the MDR phenotype, and 43% had the XDR phenotype. Among the isolates of Kl. Рneumoniae from the lower respiratory tract, 37% had the MDR phenotype, 40% had the XDR phenotype. There are no pan-resistant strains in all groups. 
 The presence of genes for metallo-beta-lactamase (VIM, IMP, NDM groups) and serine carbapenemase (bovine and OXA-48) in molecular genetic study by real-time PCR of isolated Kl. pneumoniae was found in 73.4% of cases. 
 The results of determining the sensitivity of the isolates revealed a low activity of amoxicillin / clavulanic acid, III and IV generation cephalosporins (ceftazidime, cefotaxime, cefepime). 86.7% of isolates are resistant to drugs of the aminoglycoside group (amikacin), and 100% to gentamicin. Of the group of carbapenems, meropenem showed the highest activity – 26.6%, about 7% were sensitive to ertapenem. From the group of fluoroquinolones, sensitivity ranged from 20 to 30%. The highest activity of all drugs was shown by ticarcillin/clavulanate – 33.3%.
 Limitations. The criteria for inclusion in the group of examination and selection of biomaterial were the presence of previous massive antibacterial therapy in the anamnesis, the presence of catheters, drains, etc.
 Conclusions. There was established a high proportion of strains Kl. pneumoniae with the phenotype of multiple antibiotic resistance.

International students’ adjustment to the educational environment of the Russian university: medical and psychological aspect of socio-cultural integration

Introduction. The increase in the number of academic exchange programmes for students contributes to a significant growth in the number of international students in Russian universities who often experience a sense of dislocation and have to adjust to new academic and cultural environments. The key problem of integrating international students into the Russian educational environment is their psychological adjustment, which determines not only their academic attainment, but also indicators of their health and social well-being. The purpose of this article is to identify psychological and medical factors and manifestations of adjustment to the educational environment of the Russian university for international students, as well as to assess their satisfaction with medical and psychological support during their studies at university. Materials and Methods. The study has been conducted on the basis of an anthropo-systemic methodological approach, which implies a focus on improving constructive strategies and resources for students that allow them to overcome various difficulties more effectively, as well as on developing intercultural communication skills, creating internal and external conditions for self-fulfillment. Questionnaires designed to study medical and psychological aspects of the international students’ adjustment to the educational environment of the Russian university were used as research methods. Results. The study has revealed that 33 per cent of participating international students demonstrated ‘low’ and ‘below average’ levels of adjustment. ‘Above average’ and ‘high’ levels of adjustment were revealed in 56 per cent of participants. Only 11 per cent of the sample demonstrated the ‘average’ level of adjustment. At the same time, international students showed a low degree of self-determination in relation to the future career and prospects for personal development and a high demand for assistance in understanding the importance of professionalization and revealing students’ abilities for self-development and self-determination. The analysis of the demand and experience of receiving medical services by international students revealed that about 80% of the participants sought medical help. About 73% of them were fully or partially satisfied with the quality of medical services provided, 10% were dissatisfied with the quality, and 17% found it difficult to assess the quality of medical care. The study reveals the following drawbacks in the complex work implemented by university departments responsible for optimizing psychological and medical indicators of international students’ adaptation: time-limits for the examination of patients by a medical worker, difficulties in communication between a specialist and an international student determined by language and cultural barriers, as well as the fact that ‘supporting’ university staff insufficiently take into account the above-mentioned low degree of international students’ self-determination. Conclusions. The conducted research has identified a range of degrees in international students’ adjustment to the Russian educational environment with a small number of individuals with an average degree of adjustment. The main unfavorable psychological factor in the international students’ adjustment is low level of their professional self-determination and insufficient formation of personal development prospects. The level and availability of medical care provided to international students in Russia satisfy most of them. The key problem that reduces international students’ satisfaction with the quality of medical services is difficulties in social communication with employees of medical institutions.

Life satisfaction for adolescents with developmental and behavioral disabilities during the COVID-19 pandemic.

This study aimed to identify contextual factors associated with life satisfaction during the COVID-19 pandemic for adolescents with mental, emotional, behavioral, and developmental (MEBD) disabilities. Data were collected from a sample of 1084 adolescents aged 11-21 years from April 2020 to August 2021. This cross-sectional study used a sequential machine learning workflow, consisting of random forest regression and evolutionary tree regression, to identify subgroups of adolescents in the Environmental influences on Child Health Outcomes (ECHO) consortium who demonstrated enhanced vulnerability to lower life satisfaction as described by intersecting risk factors, protective factors, and MEBD disabilities. Adolescents with a history of depression, anxiety, autism, and attention-deficit/hyperactivity disorder were particularly susceptible to decreased life satisfaction in response to unique combinations of stressors experienced during the COVID-19 pandemic. These stressors included decreased social connectedness, decreased family engagement, stress related to medical care access, pandemic-related traumatic stress, and single-caregiver households. Findings from this study highlight the importance of interventions aimed specifically at increasing adolescent social connectedness, family engagement, and access to medical support for adolescents with MEBD disabilities, particularly in the face of stressors, such as a global pandemic. Through a machine learning process, we identified contextualized risks associated with life satisfaction among adolescents with neurodevelopmental disabilities during the COVID-19 pandemic. The COVID-19 pandemic resulted in large-scale social disruptions for children and families. Such disruptions were associated with worse mental health outcomes in the general pediatric population, but few studies have examined specific subgroups who may be at heightened risk. We endeavored to close that gap in knowledge. This study highlights the importance of social connectedness, family engagement, and access to medical support as contributing factors to life satisfaction during the COVID-19 pandemic for adolescents with neurodevelopmental disabilities.

COVID-19 impact on the management of head and neck cancer: a French single-centre experience.

The COVID-19 pandemic has caused unprecedented pressure on medical care resources and access. The aim of this study was to evaluate the time between the cancer symptoms' onset and the first ENT specialist consultation for patients with head and neck (HNC) and salivary glands cancers during the pandemic. The outcome measures evaluated were time to diagnosis, and time to treatment onset, as well as the COVID-19 impact on the proportion of both cancer patient groups: asymptomatic and advanced stages. This is single-centre retrospective cross-sectional study, including 473 patients who were treated in our University Hospital for HNC and salivary gland cancers, 171 in the COVID-19 pandemic group (C +), and 302 patients in the pre-pandemic group (C-). There were no significant between-group differences in the delays between cancer symptoms' onset and ENT consultation, diagnostic workup and initial treatment onset, respectively. There was a suggestive reduction in the number of diagnostic panendoscopy performed in the C + group (62%) compared to the C- group (73%) as well as a suggestive increase in the delay to adjuvant radiotherapy onset. The median delay between cancer symptoms' onset and ENT specialist consultation was not affected by the COVID-19 pandemic in our centre. Our results suggest an 11% decrease in diagnostic procedures performed independently, a decrease in the delay between the ENT consultation and surgical treatment onset and a 10-day increase in the delay to adjuvant radiotherapy onset.

Analysis of Concentrated COVID-19 Outbreaks in Elderly Facilities in Suita City, Osaka Prefecture, Japan.

There are several types of facilities for elderly individuals in Japan. Infection control efforts, such as care provision and medical care access, differ according to the type of facility. Elderly individuals at these facilities who were infected with coronavirus disease 2019 (COVID-19) experienced severe illness and mortality. This study aimed to determine the characteristics of concentrated COVID-19 outbreaks that occurred in nursing homes and care facilities in Suita City. During this study, twenty-five elderly facilities in Suita City with a capacity of 40 or more individuals where an outbreak occurred during the sixth or seventh wave of infection were included. We investigated whether there was a difference in the COVID-19 incidence and the percentage of positive cases according to the type of facility. We also investigated the relationship between the facility capacity and positive case rate and that between the number of positive cases and outbreak duration. The incidence rate of COVID-19 was significantly different according to the facility type (p < 0.001). No association was found between the facility capacity and positive case rate. The outbreak duration increased as the number of positive cases increased (p = 0.004).

Оценка влияния внедрения телемедицины в сферу здравоохранения.

It has been revealed that telemedicine significantly improves the availability of medical care, especially in remote and sparsely populated regions. It has been determined that the integration of telemedicine can improve the quality of medical care due to prompt consultation of specialists and reduction of time for diagnosis. A direct relationship has been found between the use of telemedicine and patient satisfaction. The key factors influencing the effectiveness of telemedicine are identified: the quality of the Internet connection, the training of medical personnel, and the level of patient awareness. It has been established that the use of the DEMATEL method allows one to deeply penetrate the structure of relationships in the telemedicine system and identify potential growth points. Purpose of the study is to determine the complex relationships and interactions within the telemedicine system in the context of healthcare. Materials and methods. The study is based on the application of the DEMATEL method for analyzing cause-and-effect relationships in a telemedicine system. This method allows you to penetrate deeply into the structure of relationships, identify key factors, and highlight causes and consequences. Results. The study results confirm that the integration of telemedicine improves the availability and quality of medical care. The main cause-and-effect relationships influencing the effectiveness of telemedicine in the healthcare context were identified. It has been revealed that telemedicine significantly improves the availability of medical care, especially in remote and sparsely populated regions. It has been determined that the integration of telemedicine can improve the quality of medical care due to prompt consultation of specialists and reduction of time for diagnosis. A direct relationship has been found between the use of telemedicine and patient satisfaction. The key factors influencing the effectiveness of telemedicine are identified: the quality of the Internet connection, the training of medical personnel, and the level of patient awareness. It has been established that the use of the DEMATEL method allows one to deeply penetrate the structure of relationships in the telemedicine system and identify potential growth points. Findings. The importance of using analytical methods such as DEMATEL in the healthcare system has been confirmed. The use of such methods may be the key to optimization and further development of telemedicine in the digital economy.

Алгоритм работы с обращениями граждан: опыт регионального офтальмологического центра.

Relevance. At present, the institution of citizens’ appeals is a dynamically developing model of interaction between the population and state and municipal authorities, including medical organizations. In the legislation of the Russian Federation, for the purpose of a comprehensive, timely and objective procedure for considering citizens’ appeals related to receiving medical care, a three-level hierarchy of regulatory legal regulation has been formed. Determination of the officials of the organization, forms and methods of working with appeals, analysis of the results of consideration of citizens’ appeals and the introduction of measures that correct the activities of employees of a medical organization (medical and non-medical personnel), the implementation of organizational and legal changes are an indispensable element of an effective management system of a modern healthcare institution. The purpose of the study: аnalysis of the organization and conduct of work with citizens’ appeals related to obtaining medical care for the adult population in the field of «ophthalmology» in the regional center of the Republic of Tatarstan – the state autonomous healthcare institution «Republican Clinical Ophthalmological Hospital of the Ministry of Health of the Republic of Tatarstan named after Professor E. V. Adamyuk» (GAUZ “RKOB MH RT named after prof. E. V. Adamyuk”), and the development of measures to improve the efficiency of the ophthalmological clinic. Materials and methods. The analysis of modern requirements of normative legal acts of quality control and safety of medical activity has been carried out, the main tools used in conducting external audits in the system of compulsory medical insurance have been systematized. We used mathematical and statistical analytical methods (quantitative, comparative, structural, expert). Results. A routing scheme for citizens’ appeals is presented, taking into account the channels of their receipt, and an algorithm for working with written appeals sent to the regional ophthalmological center of the Republic of Tatarstan. The trend of modern feedback services with applicants is noted, characterized by the active use of new Internet resources, social networks and instant messengers, various mobile applications for registering citizens’ appeals, and «fan» distribution of complaints about the activities of a medical organization. According to the statistics for 2021–2022 in the structure of the reasons for written appeals of the GAUZ “RKOB MH RT named after prof. E. V. Adamyuk” were in the lead in requests for the provision of medical documentation, which amounted to 2021. 45,4%, 2022 – 55,9% of all received applications. In second place were issues related to the organization of medical care, the share of which amounted to 2021 in 2021. 32,5%, in 2022 – 26,3%. Requests for assistance in the provision of medical care were made in 2021. 12,1%, in 2022 – 8,4% of the total considered appeals. Conclusions. Based on the results of consideration of citizens’ appeals by officials of the GAUZ “RKOB MH RT named after prof. E. V. Adamyuka, managerial decisions are made to increase the satisfaction of the adult population of the Republic of Tatarstan with the quality and availability of medical care in the field of ophthalmology, including changes in the organization of the clinic, the implementation of measures that correct the activities of medical and non-medical personnel.

Обращаемость детей в медицинские организации, как критерий медицинской активности родителей.

An important component of the lifestyle of the population is medical activity, which plays a significant role in maintaining and strengthening the health of not only the adult population, but also children. Purpose of the study: evaluation of the influence of the social characteristics of families in the Chechen Republic on the appeal of children to medical organizations. Materials and methods. The collections “The incidence of the Russian child population (0–14 years old) with a diagnosis established for the first time in life” of the Federal State Budgetary Educational Institution of Central Research Institute of Health and Human Health for 2017–2021 were analyzed. A subjective assessment of children’s referral to medical organizations was carried out on the basis of the results of a survey of 536 parents, which was carried out using the «Questionnaire of the parents of a child under the age of 7 years» in 2021 in 9 districts of the Chechen Republic. Mathematical data processing was carried out using spreadsheets of the MS Office‑2016 software package (Word, Excel) and the StatSoft-Statistica 10.0 statistical software package. Results. Primary morbidity, according to the data on the appealability of the children’s population of the Chechen Republic, is 3.7 times lower than the national average. The number of children in the family, the education of the parents and the financial situation of the family influence the number of children in the family. In families with 5 or more children, parents are less medically active in terms of seeking medical care than in families with 1–2 children and 3–4 children (p&lt;0.05). Families where the mother or father have an incomplete secondary education compared to families where the father or mother has a complete secondary or higher education, including incomplete higher education, parents are significantly more likely to show less medical activity (p&lt;0.01). Families where the funds for the normal material support of the child are not fully enough or not enough at all, more often do not seek medical help or seek medical help only in case of a serious illness of the child, compared with financially secure families (p &lt;0.01). The medical activity of parents is not affected by the age of the parents, family residence in the city or countryside, whether the child is organized or not, and he is also brought up in a family where mothers work or are housewives (p&gt; 0.05). Conclusion. One of the most significant subjective reasons for low attendance to medical organizations in the event of a child’s illness is the low medical activity of parents, which largely depends on the social characteristics of the family. Families with 5 children or more, families where one of the parents has an incomplete secondary education, and families with a low financial situation are more likely to show poor medical care. Scope of the results. Development of organizational measures aimed at improving the quality and availability of medical care in organizations of the children’s healthcare system.

Accessibility of medical care for adult cancer diseases using off-label drugs: clinical recommendations and standards of medical care analysis

Accessibility of medical care for adult cancer diseases using off-label drugs: clinical recommendations and standards of medical care analysis

Artificial Intelligence in Healthcare: Risks and Opportunities

Today, one of the primary drivers of global economic growth is digital transformation. Artificial intelligence tools, cloud solutions and telemedicine technology seem to be critical components in the growth of different economic sectors, including healthcare. Like other developed countries, Russia believes that artificial intelligence can enhance access to high-quality and affordable medical care. The relevance of this topic is further supported by the President of Russia’s recent statements delivered at the opening events of health facilities around the country, where he emphasized the importance of incorporating artificial intelligence into all aspects of healthcare, including management, medicine, patient care, to ensure technological sovereignty. However, along with the obvious advantages, digital technologies particularly artificial intelligence, represent certain risks that are to be eliminated in order to achieve the core goal of improving the quality and accessibility of medical care.

The Right to Health And Barriers to Health Services for Refugees and Internally Displaced Persons: Review of Foreign Literature

All over the world, the number of people forced to flee their homes due to conflict, violence, and persecution is now higher than at any time in human history. Migrants, refugees, and other citizens belonging to the category of internally displaced persons have the right to health and medical care in the host country based upon the basic principles of humanitarian law and a number of international legal documents. However, the practice of providing medical care in the host country varies depending on the legislation and resources of the national healthcare system.&#x0D; The purpose of this study was to consider the barriers to the accessibility of medical care for migrants, refugees, and other internally displaced persons.

Report on Cardiovascular Health and Diseases in China 2022: an Updated Summary

In the past 30 years, the accessibility and quality index of medical care have made remarkable progress in China, ranking the first among middle-income countries. Many cardiovascular technologies are at or near the world’s leading level, and significant progress has been achieved in China solving the problem of “treatment difficulty” of cardiovascular diseases (CVD). However, due to the prevalence of unhealthy lifestyles among Chinese residents, a huge population with CVD risk factors, accelerated population aging, and other reasons, the incidence and mortality rate of CVD are still increasing, and the turning point of the decline in disease burden has not appeared yet in China. In terms of proportions of disease mortality among urban and rural residents, CVD still ranks the first. In 2020, CVD accounted for 48.00% and 45.86% of the causes of death in rural and urban areas, respectively; two out of every five deaths were due to CVD. It is estimated that the number of current CVD patients in China is around 330 million, including 13 million stroke, 11.39 million coronary heart disease, 8.9 million heart failure, 5 million pulmonary heart disease, 4.87 million atrial fibrillation, 2.5 million rheumatic heart disease, 2 million congenital heart disease, 45.3 million peripheral artery disease, and 245 million hypertension cases. China has entered a new stage of transformation from high-speed development to high-quality development, and the prevention and control of CVD in China should also shift from previous emphasis on scale growth to strategies focusing more on strategic and key technological development in order to curb the trend of increasing incidence and mortality rates of CVD.

Analysis of the trend in the morbidity of the population of the Russian Federation considering the factors affecting the availability of general medical services

Introduction. The morbidity is one of the key indicators used to assess the level of public health and demonstrating the level of accessibility of medical care to the population and the effectiveness of primary health care. &#x0D; The aim was to analyze the trend in the morbidity of the population in the Russian Federation, considering factors affecting the availability of general medical services, in the context of the subjects of the Russian Federation. &#x0D; Material and methods. The study based on information from the federal static observation form No. 12 “Information on the number of diseases registered in patients living in the service area of a medical organization” for 2018–2021. &#x0D; Results. In the Russian Federation from 2018 to 2021, general morbidity increased by 2.6%, while newly identified morbidity increased by 9.4%. The Ivanovo region had the largest rate of rise in general morbidity (24.9%), Stavropol Krai — the highest newly identified morbidity (34.7%). When assessing the influence of various factors on the level of morbidity using the method of stable regression, the level of provision of the population with doctors was revealed to have the greatest influence, which is confirmed by the presence of a strong direct dependence.&#x0D; Limitations. The data from the federal static observation form No. 12 “Information on the number of diseases registered in patients living in the service area of a medical mamnagement” for 2018–2021 for 85 subjects of the Russian Federation were examined to determine the morbidity of the population of the Russian Federation that is able-bodied and over the working age.&#x0D; Conclusion. The morbidity rate in the Russian Federation during the period under review tends to increase. It is an integral indicator of the availability of medical care and the detection of diseases, which influenced by a variety of factors, including the availability of primary care doctors, the strength of the medical managemorganization, the degree of hospitalization, the average number of visits to doctors.

Analyzing the Impact of Decreasing Out-of-Vehicle Time of Public Transportation Travel on Accessibility to Tertiary Hospitals

Unequal distribution of healthcare resources can lead to many fundamental problems, including the accessibility and equity of care in different regions. Existing studies often focus on administrative divisions, street zones, and conducting analyses of healthcare accessibility, but there is a lack of research on healthcare accessibility analysis specifically targeting apartment complexes. Furthermore, there is insufficient consideration of the impact of out-of-vehicle time on healthcare accessibility through public transportation. Taking Beijing’s 5th Ring Road area as an example, we used multiple data sources to construct a framework for the accessibility of medical care in apartment complexes using public transportation. We assumed two scenarios of 1/2 and 1/3 reduction in out-of-vehicle time. We compared and analyzed the changes in accessibility and equity under the two scenarios to investigate the impact of out-of-vehicle time on accessibility and equity of medical care in apartment complexes. The results show that (1) reducing out-of-vehicle time does not guarantee increased accessibility to all apartment complexes. (2) Under both scenarios, the accessibility of most apartment complexes within the fourth and fifth rings increased, and the accessibility of most apartment complexes within the Daxing District increased; otherwise, the accessibility of most apartment complexes in other areas decreased, and the decrease in accessibility was more significant for the scenario with a 1/2 reduction in out-of-vehicle time than for the scenario with a 1/3 reduction in out-of-vehicle time. (3) In both scenarios, the Gini coefficients of residential accessibility were calculated separately for inter-ring and administrative divisions, and the equity of residential accessibility increased in each division; the equity of accessibility increased more with a 1/2 out-of-vehicle time reduction than with a 1/3 out-of-vehicle time reduction. The framework proposed in this paper allows us to analyze the impact of out-of-vehicle time of public transportation on accessibility to medical care for apartment complexes.

ОЦЕНКА ЭФФЕКТИВНОСТИ МОДЕЛИ МЕДИЦИНСКОЙ ПОМОЩИ ДЕТЯМ С САХАРНЫМ ДИАБЕТОМ 1 ТИПА, ПРОВОДИМОЙ С ПРИМЕНЕНИЕМ МОБИЛЬНОГО ПРИЛОЖЕНИЯ И ДИСТАНЦИОННЫХ КОНСУЛЬТАЦИЙ: АДРЕСНАЯ ПОМОЩЬ ДЕТЯМ-ИНВАЛИДАМ С САХАРНЫМ ДИАБЕТОМ И ИХ СЕМЬЯМ В РАМКАХ ПРОГРАММЫ «АЛЬФА-ЭНДО»

Telemedicine technologies in pediatric patients with type 1 diabetes mellitus (T1D) is an effective approach that have begun to be used recently. The purpose of this research was to evaluate the possibility and effectiveness of remote observation and training of children with newly diagnosed T1D in selected Russia regions. Materials and methods used: a multicenter prospective open uncontrolled experimental clinical study involved 92 children aged 1 to 18 y/o with T1D receiving intensified insulin therapy who were divided into two groups: G1 of 60 patients with T1D manifestation of less than 12 weeks prior to the inclusion in the study, and G2 of 32 children with T1D manifestation lasting over 12 weeks prior to the inclusion with poor disease control (glycated hemoglobin at 8% and above) from troubled families. The main indicator for evaluating the effectiveness was the glycated hemoglobin (HbA1c) level. Results: median age was 9.2 (6.2-11.2) y/o, 47 boys/45 girls. A total of 401 remote consultations had been carried out in various forms. The HbA1c level decreased statistically significantly by the end of the study by 3.5% and 0.6% (p&lt;0.001) in G1 and G2, respectively. Statistically significant (p&lt;0.001) increase in the number of patients with HbA1c at the level of less than 7% was reached, with most of them (52%) reaching the target glycemic control parameters. Telemedicine technologies therefore represent the effective (in terms of glycemic control) addition to the traditional dispensary observation, which in its turn increases the availability of medical care for children with endocrine diseases.

Some aspects of ensuring patients' rights and accessibility of medical care in Austria, Belgium, Germany and Estonia

The article devoted to ensuring the rights of patients and the availability of medical care in Austria, Belgium, Germany and Estonia notes the experience of creating an institute of independent ombudsmen who plays an important role in this issue. Basically, in these countries, the choice of a medical organization and a doctor is possible, and in Belgium the right to choose an insurance organization is granted. Patients in these countries are given the right to control the process of providing them with medical care, including its payment and joint decision-making with the doctor on treatment tactics. The State also ensures the patient's right to receive preventive and restorative services provided to children free of charge, and compensated for adults in 80% of cases. It is impossible not to recognize the high percentage of citizens of these countries, reaching 98%, satisfied with the medical services provided to them. However, in some countries there is an imbalance in the availability of medical care, which is expressed by high availability of family doctor services and low availability of specialist services, as in Estonia. Nevertheless, this does not cause an increase in the level of corruption in the medical spheres of these countries, which is below the European average. According to the totality of indicators of the availability of medical care, Germany is the leader among the analyzed countries.