Dispensary Observation Research Articles

Asthenic syndrome in the convalescents of ixodid tick-borne borrelioses

Aim to study the catamnesis of patients with ixodid tick-borne borreliosis in the period of convalescence who presented the signs of asthenic syndrome.
 Material and methods. The study was based on the data of prospective dispensary observation of 37 in-patients diagnosed with "ixodid tick-borne borreliosis, erythemic form, moderate severity, acute course" who received treatment at the Clinic of Infectious Diseases of the SamSMU in 2016-2019. The subjects were divided into 3 groups according to their age: the first age-group from 18 to 35 years included 12 people, the second group ranged from 36 to 55 years and included 15 people, the third age-group from 56 to 75 years consisted of 10 people. The examination of patients was carried out after discharge from the hospital on the 14th day, after 3, 12 and 36 months. The MFI-20 asthenia scale (the Multidimensional Fatigue Inventory) was used to analyze the asthenic syndrome in the participants.
 Results. The duration of asthenia after ixodid tick-borne borreliosis may be up to 3 years. Patients require the closest observation in the first 2 weeks of the convalescence period. Indicators of physical and psychological health in convalescents return to the norm depending on their age and place of residence. Mental asthenia prevails in people living in rural areas and persists much longer than in urban residents. Older people (from 56 to 75 years) are more susceptible to general and physical asthenia.

Availability of medical care for the rural population with diseases of the skin and subcutaneous tissue in the Republic of Bashkortostan

The morbidity rate of the rural population is lower than that of the urban population for all classes of diseases, which is due to the low availability of medical care (MC) for rural residents, including those with diseases of the skin and subcutaneous tissue (DSST). The purpose of our study was to study the accessibility of MP to the rural population of the Republic of Bashkortostan with DSST and determine ways to improve it.Materials and methods. An analysis was made of the incidence of the rural population of DSST, resource provision of dermatovenereological care and the volume of primary health care and specialized, including high-tech MC, based on reporting data for the Republic of Bashkortostan (RB) in comparison with the indicators of the Russian Federation (RF) and the Volga Federal District (VFD).Results. For the period 2013–2020 in the RB, there are high average annual incidence rates of the rural population with DSST, exceeding similar data for the RF and VFD. The provision of dermatovenerologists has decreased (the rate of decrease is 16.2 %), the number of dermatovenereological rooms has decreased (the rate of decrease is 9.3 %). In terms of the number of dermatological beds, the republic ranks frst among other regions of the VFD, and second in terms of the level of provision. The share of rural residents who received high-tech MC in 2020 amounted to 38.5 % of the total quota.Conclusion. As a result of the study, the need to increase the role of nursing staff of central district hospitals in conducting dispensary observation of patients with chronic dermatoses, creating algorithms for constant interaction between dermatovenereologists of the consultative and diagnostic department of the Republican dermatovenerologic dispensary and doctors and / or nurses of districts, creating a republican register of patients with chronic dermatosis, increase in the volume of high-tech medical care with the use of genetic engineering biological therapy. The priority in increasing the availability of medical care for the rural population with DSST is systematic work consisting in the development and implementation of a set of organizational solutions.

The adaptation of methodology of expert selection of indicators for integral evaluation of effectiveness and efficiency of organization of medical care support at the level of subject of the Russian Federation at the "pediatrics" profile

The adaptation of methodology of expert selection of indicators for integral evaluation of efficiency of organization of medical care on profile "pediatrics" at the level of the Subject of the Russian Federation. The study was organized as expert survey using structured interview technique. At the first stage, primary selection of indicators carried out. At the second stage, selection of experts in accordance with inclusion criteria and assessment of level of expert competence was organized. Then, criteria of expert evaluation of significance of selected indicators in accordance with international principles applied in of bench-marking systems construction were formulated. The Kendall's concordance coefficient (W) was calculated for quantitative assessment of degree of agreement between the experts answers. The non-parametric Friedman test was applied to evaluate significance of differences. The indicators with high degree of agreement between opinions of experts and availability of statistical significance according concordance coefficient are recommended as indicators for assessment of efficiency of organization of medical care of children at the level of the Subject of the Russian Federation. The following indicators satisfy these requirements: mortality of children aged 0-17 years (per 100 000 of population of corresponding age), mortality of children aged 0-1 year (per 1000 live births), mortality of children aged 0-4 years (per 1000 live births), support of population with beds for children, percentage of children aged 0-17 years under dispensary observation with diagnosis established for the first time. The study permitted to select indices (indicators) that can be applied both for integral rating of the Subjects of the Russian Federation and in formation of Federal projects or departmental target programs in pediatrics. The study results can also be applied in development of system of monitoring efficiency of implementation of these projects and programs.

THE EVOLUTION OF PROACTIVE DISPENSARY MONITORING IN THE MOSCOW HEALTHCARE SYSTEM

Economic and social losses due to epidemics of non-communicable diseases have put prevention and control of them on the first line in the field of sustainable development of the United Nations. The tasks of combating NCDs and risk factors within the framework of the Sustainable Development Goals require targeted actions on the part of States in the field of policy and legislation and provision of health systems with appropriate resources. In the Russian Federation, such work is being implemented within the framework of the national project "Healthcare", federal programs to combat oncological and cardiovascular diseases. Each subject takes into account the peculiarities of economic development, staffing, implementation of informatization processes, etc. The rapid pace of transformation of Moscow healthcare, its unique institutional structure allowed to form the basis for the effective development of a system of proactive dispensary monitoring of patients suffering from chronic diseases. The authors describe the process of formation of preventive work and organization of dynamic dispensary observation in Moscow. The paper presents in detail the organizational, administrative and technological resources used to create a unique system of dynamic dispensary observation. In addition, the article illustrates the personalized subsystem of dynamic dispensary observation in EMIAS and the institute of "physician assistant". The introduction of a proactive dispensary monitoring system will reduce premature mortality and disability among residents of the city. Moscow through an individual monitoring program and motivation for the responsible attitude of metropolitan patients to their health.

СИСТЕМНЫЕ КРИТЕРИИ ДИФФЕРЕНЦИАЛЬНОЙ ЭКСПРЕСС-ДИАГНОСТИКИ ДОНОЗОЛОГИЧЕСКИХ НАРУШЕНИЙ ПРОФЕССИОНАЛЬНОГО ЗДОРОВЬЯ РАБОТНИКОВ ОБЪЕКТОВ ИСПОЛЬЗОВАНИЯ АТОМНОЙ ЭНЕРГИИ

Purpose: Development of complex criteria of differential express-diagnostics of pre-dosological disorders of occupational health of employees of nuclear facilities. Material and methods: The study object was male workers of the main production facilities of the Electrohimpribor Combine undergoing periodic medical examinations and psychophysiological examinations. The state of health was assessed according to the employee’s belonging to the dispensary observation group in accordance with Order No. 404n of the Ministry of Health of the Russian Federation of April 27, 2021. The psychophysiological state was assessed using a hardware-software complex for group psychophysiological examination APK PFS-CONTROL. Additional testing techniques included assessment of vibraimage parameters, evaluated using computer programs HealthTest and VibraMI, developed in ELSIS (St. Petersburg). Totally 943 man-surveys were carried out with different combination of testing methods. The average age of the workers was (42.0 ± 1.7) years, total work experience was (23 ± 1.3) years, and work experience in the specialty was (13.0 ± 1.8) years. Results: As a criteria of prenosological health disorders we used the characteristics of the worker’s adaptation to the factors of life activity. Adaptation disorders are evaluated according to three specific criteria: 1) assessment of the functional state of the cardiovascular system according to HRV data; 2) rapid assessment of the psychophysiological state according to vibraimage parameters; 3) assessment of personal and special abilities according to multiple intelligence assessment. For each of the criteria a “traffic light” of states and decisive rules of their formalized identification were developed. Characteristics of unfavorable states are given. Complex express-diagnostics of pre-dosological disorders of occupational health is carried out using integral index, which is a weighted sum of private “traffic light” indexes with a ball score. The formalized express-diagnostics of premalignant disorders is carried out using linear discriminant functions with an average recognition accuracy of 96.4 % or a probabilistic nomogram, which allows to graphically estimate the risk level of health disorders. Conclusion: Improvement of medical-psychophysiological support of employees of nuclear facilities is connected with introduction of methods and criteria of differential express-diagnosis of prenosological disorders of health. The developed criteria of express-diagnostics of pre-dosological disorders of occupational health expand the existing methodological and criteria base of periodic medical examinations of nuclear industry workers, strengthen their preventive orientation with the purpose of timely application of medical, psychophysiological, organizational and other measures on preservation and maintenance of occupational health of personnel.

Possibilities of dispensary observation in reducing mortality from coronary heart disease

Dispensary observation of patients with coronary artery disease can significantly reduce the likelihood of cardiovascular complications onset. Active outpatient monitoring allows to correct the main risk factors for cardiovascular complications, to estimate the risk of unfavorable cardiovascular events onset and to identificate patients who will get benefit of coronary revascularization. The introduction of a comprehensive assessment of cardiovascular risk and the development of remote monitoring technologies will improve the long-term results of outpatient follow-up of patients with coronary artery disease at high cardiovascular risk.

Modern clinical, functional, and ophthalmo-ergonomic features of phacoemulsification in patients with visual-intense labor with bilateral cataract: a systematic review

A systematic review was performed using databases of RSCI and PubMed, and the following keywords were used for the literature search: Cataract, Phacoemulsification, PEC, Visual-stress work, VSW, Anisometropia, and Quality of life. Articles were selected based on the criteria for prospective or retrospective studies. A total of 684 sources were analyzed, further using systematic review filters and authors knowledge of the topic. The retrospective analysis covered the period from 2016 to 2022. Data indicate that the current state of the problem of PEK in patients with VSW with bilateral cataracts during traditional sequential (on different days) surgery (especially if the interval between operations increased by more than 710 days) is accompanied by the emergence of clinical, functional (pain syndrome, anisometropia, diplopia, and impaired stereoscopic vision), and ophthalmo-ergonomic (insufficient level of visual performance) adverse manifestations after the first surgery. To eliminate them, sequential bilateral cataract surgery received increasing attention (both operations within the same day), characterized by fewer hospital visits for the patient, faster recovery of vision, and lower healthcare costs. Thus, the stated provisions in the dispensary observation of patients with VSW with bilateral cataracts must be considered.

Социально-значимые инфекции у мигрантов в Республике Татарстан

The purpose — to present the frequency of detection of socially significant infections (HIV infection, tuberculosis, syphilis) in a group of foreign citizens undergoing a medical examination at the regional level. Material and methods. We used forms 089u/kv, a register of infectious diseases (form 060/u), information on the number of infectious diseases that pose a danger to others identified in foreign citizens and stateless persons who arrived on the territory of the Republic of Tatarstan in 2013–2022. Mathematical, analytical and descriptive methods of statistical analysis are used. The data were processed in Microsoft Excel 2010 and using the OpenEpi online calculator. Results. The incidence rates of socially significant infections (HIV infection, tuberculosis, syphilis) in the Republic of Tatarstan have been declining in recent years. Medical examination of foreign citizens with a wide range of clinical, laboratory and instrumental methods of examination makes it possible to annually identify persons with socially significant infections; 25% of syphilis registered among the population of the Republic of Tajikistan is syphilis among foreign citizens. Conclusion. The annual registration of socially significant infections (syphilis, HIV infection, tuberculosis) among foreign citizens determines their importance in maintaining the epidemic process as sources, which determines the need for their examination, treatment and dispensary observation. The results obtained demonstrate the high efficiency of the modern organizational model of medical examination of labor migrants on the basis of Republic Clinical Dermatovenerologic Dispensary in a «single window» regime, which makes it possible to significantly increase the efficiency of the timely detection of socially significant infections and the implementation of anti-epidemic measures.

АЛГОРИТМ ОЦЕНКИ РИСКА РАЗВИТИЯ МИКРОСОСУДИСТЫХ ОСЛОЖНЕНИЙ У ПАЦИЕНТОВ С САХАРНЫМ ДИАБЕТОМ 2 ТИПА ДЛЯ СИСТЕМЫ ПОДДЕРЖКИ ПРИНЯТИЯ РЕШЕНИЙ ВРАЧА

Relevance: most experts agree that regular and high-quality dispensary monitoring of patients with diabetes mellitus at the outpatient stage is a necessary condition for preventing the development of vascular complications. The solution of this problem is closely connected with the development and widespread clinical implementation of digital healthcare tools, automated workplaces of doctors, decision support algorithms. Objective: to improve the quality and effectiveness of outpatient care for patients with type 2 diabetes mellitus by digitalizing outpatient admission, using the software of the automated workplace of an endocrinologist (AWPE DM), developing an algorithm for assessing the risk of microvascular complications as an element of a decision support system. Materials and methods: based on the analysis of the results of clinical experience in the use of ARME DM, an algorithm for assessing the risk of microvascular complications has been developed, which allows optimizing the complex of measures for dispensary observation of patients with type 2 diabetes mellitus. Results: demonstrated an increase in the efficiency and quality of medical care for patients with type 2 diabetes mellitus when using AWPE DM in clinical practice; developed a digital algorithm for assessing the risk of microvascular complications, providing stratification of the risks of their development according to the selected criteria for each of the classes; determination of a sufficient minimum of dispensary laboratory and instrumental studies, taking into account the level of credibility of recommendations; personalized correction of therapeutic goals of treatment taking into account the individual characteristics of the patient, including the stage of chronic kidney disease and diabetic retinopathy. Conclusions: the clinical application of the algorithm for assessing the risk of vascular complications, developed taking into account current domestic and foreign clinical recommendations, allows objectively in numerical values to assess the probability of progression of certain classes of microvascular complications of diabetes mellitus in a particular patient, to determine the activities of a personalized program of dispensary observation and rehabilitation. For laboratory and instrumental verification, examinations with the greatest diagnostic significance and suitable for storage and processing in digital format are proposed. Based on the results of the risk assessment directly during the outpatient appointment, the algorithm forms recommendations for the differentiated choice of therapeutic treatment goals, which makes it possible to optimize the personalized program of dispensary observation of the patient.

ДИНАМИКА ПОКАЗАТЕЛЕЙ ОБЩЕЙ ЗАБОЛЕВАЕМОСТИ ДЕТЕЙ, НАХОДЯЩИХСЯ В ТРУДНОЙ ЖИЗНЕННОЙ СИТУАЦИИ, ПО ИТОГАМ ДИСПАНСЕРИЗАЦИИ ЗА 5 ЛЕТ

A specific method of healthcare practice, which combines the tasks of preventive and therapeutic measures, is a medical examination, which in Russia is carried out annually among children in difficult life situations, staying in stationary institutions. The purpose of the study is to evaluate the effectiveness of medical examinations in terms of the dynamics of general morbidity in children staying in hospital in the Arkhangelsk region. Methods. A statistical study was carried out using the method of documentary observation, the calculation of incidence rates per 1000 examined children aged 0-17 years; assessment of growth (loss) rates of indicators. Results. The long-term average for 2016-2020 is the overall morbidity rate - 3480.23 (per 1000), an increase in 10 classes of diseases, the maximum for infectious diseases, neoplasm, blood diseases, a decrease in 5 classes, the maximum for diseases of the circulatory system, dispensary observation coverage decreased from 60.9 to 51.5%. Conclusions The low effectiveness of medical examination of children in difficult life situations for 5 years was revealed in the form of an increase in the overall morbidity rate (from 3145.0 to 3800.0 per 1000) and a decrease in the initially low coverage of dispensary observation.

Analysis of the health status of medical workers based on the results of mandatory periodic examinations

Objective: to analyze the results of periodic medical examinations of employees of a large medical organization in dynamics, according to the final acts. Materials and methods: the research material was the final acts (2019–2021), compiled based on the results of periodic medical examinations of employees of the Novosibirsk Regional Clinical Hospital of War Veterans (Novosibirsk Regional Clinical Hospital of War Veterans). For the analysis, data on the structure of diseases for 2019–2021 were also used, with which medical workers underwent treatment courses in the day hospital of the hospital. Results: in just 3 years, 546 hospital employees under-went periodic medical examination, 489 of them women. The results of the studies have shown that in the dynamics of three-year follow-up, the number of persons subject to additional examination, treatment and dispensary observation has sharply increased, which may indicate a certain effectiveness of PMT. The detectability of chronic somatic diseases according to the results of the PMT has increased by more than 10 times in dynamics. 69 medical workers underwent treatment courses on the basis of the GNOCGV day hospital for 3 years. Of these, 22 medical workers were treated and rehabilitated in a day hospital with the consequences of a new COVID-19 coronavirus infection. Conclusion: when analyzing the final acts based on the results of the PMOS of GNOCGV employees for the period from 2019 to 2021, it was found that the efficiency and quality of inspections has increased dramatically.

ЭФФЕКТИВНЫЕ ПРОГРАММЫ В ВОССТАНОВИТЕЛЬНОМ ЛЕЧЕНИИ ДЕТЕЙ С НАРУШЕНИЕМ ОСАНКИ НА ФОНЕ НАСЛЕДСТВЕННЫХ ИЗМЕНЕНИЙ РАЗВИТИЯ СОЕДИНИТЕЛЬНОЙ ТКАНИ В УСЛОВИЯХ ГОРОДСКОЙ ДЕТСКОЙ ПОЛИКЛИНИКИ

The purpose of the study. To show the importance of effective programs in the rehabilitation treatment of children with posture disorders against the background of hereditary disorders of connective tissue development in the conditions of the city children's polyclinic. 60 patients took part in the research work. All were diagnosed with hereditary disorders of connective tissue development. 30 patients were included in the main group and 30 in the comparison group.Under observation were 30 healthy children who made up the control group. According to gender and age, patients in groups were distributed equally. Patients were dynamically observed on the basis of the city children's polyclinic in the period from 2013 to the present. At the time of the beginning of dispensary observation, the average age of patients was 5.5±0.46 years. In dynamic observation in patients of the main group, laboratory parameters were positively stabilized. In the future, the number of complications decreased by the age of 14. These are scoliosis, kyphosis, other pathological deformities of the spinal column, osteochondropathy of the spine, the development of early osteochondrosis. This was not observed in patients of the comparison group (p = 0.024).

COVID-19 AMONG TUBERCULOSIS PATIENTS IN MOSCOW

Introduction. In connection with the emergence of a new coronavirus infection COVID-19, since 2020, a set of measures has been carried out in Moscow to ensure the identification, isolation and organization of the treatment process of patients with tuberculosis combined with COVID-19. Based on the data of the TB/COVID-19 co-infection monitoring system created in Moscow, the study analyzed all 430 confirmed cases of COVID-19 among TB patients registered or followed up in Moscow in 2021 in groups I and II of dispensary observation. Aim. To study the incidence of COVID-19 in tuberculosis patients in 2021 and to identify epidemiological features among tuberculosis patients in the second year of the pandemic. Results. The analysis showed that with an increase in the territorial incidence and an increase in the total number of newly diagnosed TB patients in the capital in 2020–2021, the number of confirmed cases of TB/COVID-19 co-infection decreased by 212 cases. Among all 430 patients, 52.3% are permanent residents of the city, 22.3% are residents of other subjects of the Russian Federation, 12.3% are homeless persons and 13.1% are foreign citizens. In 80.5% of cases, the diagnosis of coronavirus infection caused by the COVID-19 virus was established based on the results of etiological laboratory diagnostics (detection of SARS-CoV-2 RNA by PCR in smears with mucosa from the nasopharynx and oropharynx), and in other cases - only according to radiation diagnostics (computed tomography of the chest). More than half of those with combined tuberculosis/COVID-19 infection – 59.8% were unemployed and 14.4% were old-age pensioners. In 2021 in among tuberculosis/ COVID-19 patients, 63.3% (272 people) were newly diagnosed tuberculosis patients, of which: – 53.3% were permanent residents of Moscow, – 19.1% residents of other subjects of the Russian Federation, – 14.7% are homeless, – 9.9% are foreign citizens. For new tuberculosis cases, the maximum number of patients, co-infected with a new coronavirus infection was at the age of 31–45 years, which was somewhat different from the age characteristics of the incidence for other patients. Because of treatment of coronavirus infection, 84% of patients cured of COVID-19 already in 2021, 12.1% (52 people) died. The created tuberculosis/COVID-19 co-infection monitoring system in Moscow allows for a full assessment of the course of a new coronavirus infection in tuberculosis patients, patient routing, analysis of the incidence of COVID-19 among tuberculosis patients, the effectiveness of their treatment and the causes of mortality.

Генетический полиморфизм воспалительных цитокинов в крови пациентов с инвазией Opisthorchis felineus

Aim: To research the relationship between laboratory and instrumental manifestations of pathology and polymorphisms of inflammatory cytokine genes in patients with Opisthorchis felineus invasion. Design. During 2022, we conducted a comparative study of patients who were hospitalized for etiotropic therapy of O. felineus invasion. Materials and methods. 139 patients with O. felineus invasion were examined. All patients underwent clinical and biochemical blood tests, ultrasound of the abdominal organs and liver elastometry with an assessment of liver fibrosis according to the METAVIR scale. Genotyping of single nucleotide polymorphisms of the IL28b, IL6, TNFA, and IFNG genes was performed using real-time PCR. Results. In patients with opisthorchiasis, liver fibrosis was associated with the presence of the minor allele A of the rs1800630 TNFA polymorphism and the TC genotype of rs2069705 IFNG. Polyps in the gallbladder were associated with the CC genotype of rs1800630 TNFA, while an increase in alkaline phosphatase and an increase in the proportion of eosinophils in the blood were associated with the CC genotype of rs2069705 IFNG. We did not find differences in the studied parameters depending on the genetic polymorphisms rs12979860 IL28b and rs1800795 IL6 in patients with O. felineus invasion. Conclusion. The obtained regularities should be used to increase the efficiency of dispensary observation in order to prevent the development of complications of parasitic invasion. Keywords: Opisthorchis felineus, single nucleotide polymorphism, cytokines, liver fibrosis.

Диспансеризация как важный вектор определения и профилактики сердечно-сосудистого риска в амбулаторных условиях

Aim: To assess the importance of dispensary follow-up in the prevention and determination of risk factors for cardiovascular complications in hypertension. Design: A retrospective study. Materials and methods. Dispensary observation cards of 98 patients were analyzed. The average age of patients was 45 ± 5.8 years. Risk factors for the development of cardiovascular diseases were determined (body mass index (BMI), levels of glucose and total cholesterol in the blood, blood pressure (BP) were studied), and the risk was calculated according to the SCORE scale in two formed groups of people: 1st — regularly undergoing medical examinations (n = 47), 2nd — have not passed it for more than 2 years (n = 51). Results. In the 1st group, the maximum increase in average blood pressure was recorded in patients 60–80 years (151/95 ± 5/2.3 mm Hg. Art.), in the 2nd — 60–80 (179/100 ± 3/5.4 mm Hg) and 40–60 years (171/98 ± 5/3.8 mm Hg). Overweight in the 1-st group was more often detected in patients 40–60 years old — in 37.5% cases (n = 18), obesity of 1–2 degrees — in persons 40–60 and 60–80 years old (n = 27, 57.4%). In the group of patients who have not undergone clinical examination for more than 2 years, overweight was determined in persons 40–60 and 60–80 years old (n = 21, 41.2%), grade 1 obesity was detected among patients 40–60 years old (n = 21, 41.2%), obesity of the 2nd degree — in persons 60–80 years old (n = 9, 17.6%). Hyperglycemia in the 1st group was recorded in 2 (4.3%) cases, in the 2nd group it was noted in 24 (47.1%) patients 60–80 years old. Hypercholesterolemia was diagnosed among persons 60–80 years old: in the 1st group — up to 6.4 ± 0.64 mmol/l, in the 2nd — up to 7.8 ± 0.64 mmol/l. In patients 40–60 years old in the 1st group, the average value of total cholesterol was 4.8 ± 0.64 mmol/L, in the 2nd group — 6.2 ± 0.64 mmol/L. In patients who have not undergone clinical examination for more than 2 years, compared with persons regularly participating in it, a statistically significant increase in hyperglycemia by 2 times (p < 0.001), total cholesterol increase by 1.5 times (p < 0.001), the average value of systolic BP increase by 1.5 times (p < 0.001), cases of very high (4 in the 1st group vs 17 in the 2nd (p < 0.001) and extreme (0 vs 14 (p < 0.001) cardiovascular risk in the second group. Positive correlations of mean strength between systolic blood presure, glycemia and total cholesterol were established (r = 0.41, p < 0.001 and r = 0.49, p < 0.001, respectively). Conclusion. Regular medical examination will make it possible to timely identify the risk of developing cardiovascular complications in hypertension and carry out prevention. Keywords: medical examination, arterial hypertension, prevention

Цифрлық дәуірде артериялық гипертензиямен ауыратын науқастарды қашықтықтан бақылау және басқару

The use of active remote monitoring of patients with AH receiving antihypertensive therapy helps to achieve target BP values with subsequent monitoring of health indicators, as well as to provide timely medical care. Remote monitoring and treatment using information and communication technologies has been proposed to improve the quality of medical care. The introduction of remote BP monitoring will significantly improve the existing model of diagnostics and treatment of patients with chronic diseases, increase the number of observed patients at each therapeutic site without increasing the time for dispensary observation, as well as attract the working-age population to primary prevention of cardiovascular diseases. Taking into account modern trends in medical care for the working population and progress in information technologies, there is currently an opportunity to build a new model, which, while maintaining the main levels and stages of medical care, should ensure compliance with uniform standards of medical care, which can be ensured through the introduction of telemedicine and mobile components. The new elements of the system include: retrofitting medical stations of enterprises with medical and telecommunication equipment, connecting them to medical information systems; application of patient-oriented personal hardware and software systems for prevention, treatment monitoring and rehabilitation; use of mobile medical and telemedicine complexes; building up the material, technical and human resource capacity of emergency medical aid and medical evacuation services; development of digital communication systems between hospitals and medical centers in remote areas; and development of a new system of medical and telemedicine services. Organizational solutions in the field of digital and mobile medicine can serve as a basis for building a promising model of medical support for the working population in remote areas, ensuring proper quality and accessibility of medical care. The article considers the main aspects of using remote blood pressure monitoring as one of the methods of telemedicine health control. The regulatory and legal framework regulating the provision of medical care with the use of remote blood pressure monitoring is presented. The main technical aspects and technological models of telemedicine monitoring of BP in patients with arterial hypertension are analyzed. The review of publications devoted to clinical and economic efficiency of remote monitoring of blood pressure is given.

Особенности нарушений пищевого поведения у больных сахарным диабетом 2 типа

Aim: to establish the features of eating disorders in patients with type 2 diabetes mellitus. Material and methods. Examination of 536 women with complicated T2DM aged 50–80 years was carried out on the basis of the endocrinology department of the State Budgetary Healthcare Institution “PKKB”, Perm. The DEBQ questionnaire was used to identify eating disorders. Results. Emotional type of eating behavior was observed in 2.4% of DM2 patients, external — in 13%, restrictive — in 21%. All three eating disorders were present in 7.1% of patients, emotiogenic in combination with external — in 14.3%, restrictive in combination with emotiogenic — in 6.2%, restrictive in combination with external — in 14.6%. The emotiogenic type of eating behavior correlated with age (r = –0.598; p = 0.006), duration of diabetes (r = –0.536; p = 0.0148), body mass index (r = 0.363; p = 0.008), waist size (r = 0.384; p = 0.0361), total cholesterol (r = 0.741; p = 0.0079). A connection has been established between xternal type of eating behavior and body mass index (r = 0.567; p = 0.009), high-density lipoprotein cholesterol (r = –0.7; p = 0.0014), glycated hemoglobin level (r = 0.780; p = 0.022), triglycerides (r = 0.348; p = 0.0164). The dependence of the restrictive type of eating behavior on age (r = 0.879; p = 0.048), body mass index (r = 0.321; p = 0.021), glycemia level (r = –0.6; p = 0.01) and lipoprotein cholesterol was revealed. low density (r = –0.663; p = 0.013). Conclusion. Established eating disorders have shown an impact on metabolic control in women with type 2 diabetes. Their detection and prevention should be considered as a priority in the dispensary observation of this category of patients. Keywords: eating disorders, type 2 diabetes mellitus, women, metabolic control.

РЕТРОСПЕКТИВНОЕ ИССЛЕДОВАНИЕ КАЧЕСТВА ЖИЗНИ ПАЦИЕНТОВ С РЕДУЦИРОВАННЫМИ АЛЬВЕОЛЯРНЫМИ ОТРОСТКАМИ, В РЕАБИЛИТАЦИИ КОТОРЫХ БЫЛИ ИСПОЛЬЗОВАНЫ МЕТОДЫ КОСТНОЙ ПЛАСТИКИ И ДЕНТАЛЬНОЙ ИМПЛАНТАЦИИ

In recent years, more and more attention has been paid to the problems of using dental implants in complex anatomical conditions due to bone deficiency. The probability of a favorable outcome after the treatment is quite high, which in turn is supported by the long-term results obtained after using various approaches in the rehabilitation of patients with a reduced volume of jaw bone tissue. Of course, the rehabilitation of such patients is difficult not only in terms of surgical preparation, but also in terms of orthopedic benefits, which impose restrictions on the capabilities of the patient's chewing and speech apparatus. In turn, the patient is faced with the task of maintaining as long as possible the result that the doctor originally sought, namely, using various methods of bone grafting, to create the necessary amount of bone tissue for the installation of implants, which are later used for orthopedic constructions, largely replenishing the functional characteristics. previously lost dentition. There are many studies that are devoted to modern methods of rehabilitation of patients with reduced alveolar processes of the jaws, however, only a small part affects the observation of delayed results of treatment of patients using bone grafting methods in combination with dental implantation. One of the advantages of this study is the ability to follow in dynamics what happens to these patients over a time period of up to 10 years, how strong the adaptive capabilities of the body are after major surgical interventions, what patient management tactics turned out to be the most effective. The assessment of the quality of life of such patients makes it possible to fully determine the feasibility of the operations and techniques to restore the function of the masticatory-speech apparatus. The duration of the positive result obtained directly depends on the further interaction between the doctor and the patient. The key point is the dispensary observation of the patient, as a result of which the doctor gains clinical experience, and therefore the ability to predict further complications with one or another approach to the rehabilitation of patients in this category. On the other hand, for an objective assessment of the treatment performed, it is necessary to determine a common denominator that reflects the quality of life of our patients, therefore, the article presents the results of chewing assessment, as a fundamental criterion for the quality of life for most of these patients, using the SF-36 questionnaire, which is a kind of translator between subjective feelings of the patient and an objective assessment of the doctor.

Ischemic heart disease in the evacuated adult population as a cause of health loss in the long term after the Chernobyl accident. Results of epidemiological studies 1988-2016

Ischemic heart disease (CHD) is one of the most common diseases of the circulatory system, which is the main cause of death in Ukraine. The purpose of this study was to analyze the incidence, disability, mortality from ischemic heart disease, its individual nosological forms in the adult population evacuated from the 30 km zone of the Chernobyl nuclear power plant in the post-accident period, taking into account the age at the date of the accident, sex and time after the accident for further improving the system of dispensary observation evacuees and reducing the risk of cardiovascular complications. The study used epidemiological surveillance data (1988-2016) for the category of the adult evacuated population (18-60 years old as of the date of the accident) with a population of 42 982 people, of which 58.7% are women according to the data of the State Register of Ukraine of persons injured in as a result of the Chernobyl disaster (GRU). The research results were assessed both in general for ischemic heart disease and the main nosological forms according to ICD-9 and ICD-10. In the study, epidemiological, analytical, mathematical and statistical methods were used, as well as the method of internal comparison (with indicators of 1988-1992). As the results of the study have shown, in the structure of the causes of morbidity, disability and mortality of the adult evacuated population from diseases of the circulatory system, IHD takes a leading place. The statistically significant influence of age, calendar observation period, gender was established. Among nosological forms, chronic CHD is in the lead. Evacuees at the age of 18–39 years show an increase in the incidence of coronary artery disease with a maximum rate after 17 years, and at the age of 40-60 years – at the beginning of the observation with a subsequent noticeable decrease since 2003. In recent years (2013-2016), there has been a significant decrease in the incidence of coronary artery disease at the age of 40-60 years by 9.3 times, and at the age of 18-39 years, on the contrary, an increase by 3.8 times. During the post-accident period, the level of disability and mortality of the studied contingents from ischemic heart disease has significantly increased. High rates of growth of disability in recent years in persons aged 18-39 at the date of the accident. The mortality rate of the evacuees in recent years has increased in comparison with the early observation period by 5.8 times, higher mortality rates in men compared to women. Further more in-depth studies are required to assess the contribution of non-cancer diseases to the total radiation damage to human health.

To the Question of Reparative Regeneration in Children

The commentary touches upon the interpretation of the term refracture and discusses the hemodynamic features in the area of the emerging fusion in primary and repeated fractures in children. In particular, not only the role of methods for studying blood circulation in the diagnosis of disorders of reparative processes is considered, but attention is also focused on the risk of complications in the conservative and surgical treatment of fractures of the long bones of the extremities in children. It is emphasized that in order to minimize the risks of refractory development, it is necessary to take into account the individual characteristics of a pediatric patient, the method of fixing a fracture, rehabilitation and dispensary observation. The commentary provides a brief overview of publications by domestic and foreign authors on this problem.