District Doctor Research Articles

Hay diseases in Iceland

Diseases due to work in hay dust have long been known in Iceland and the first written records of them appear in the beginning of the 17th century. At the end of the 18th century, a district doctor alleges that they cause many deaths in the country. In the latter part of the 20th century, research was started to investigate the causes and nature of hay diseases in Iceland. Studies of allergens showed high levels of storage mites in hay. Highest levels were of Tarsonemus sp., Acarus farris and Lepidoglyphus destructor. A several micro-fungi were also found, most commonly Rhizopus sp., Penicillium sp. and Aspergillus sp. Micropolyspora faeni was also found in all hay samples. A study was done on people aged 6-50 years in two districts in Iceland. In one district farmers used almost exclusively dry hay and in the other they used 80-90% silage. There was no difference in IgE-mediated allergy between the provinces, but most had positive skin tests for L. destructor and cattle. Those with symptoms connected with hay dust most often reported nasal symptoms (79%), eye symptoms (63%), cough (41%), dyspnea (32%) and fever (21%). Those who had positive skin reaction complained most often of nose and eye symptoms. A study was also conducted on subjects aged 16-87 years from the same regions investigating precipitin tests for M. faeni, Thermoactinomyces vulgaris and Aspergillus fumigatus. Pulmonary symptoms and lung function were also investigated. Precipitin tests were almost exclusively positive for M. faeni, and 5 individuals were positive for A. fumigatus and none for T. vulgaris. The precipitin tests were significantly more often positive in those working almost exclusively with dry hay (72.9% vs. 23.9%). They had also more commonly obstructive pulmonary disease (FEV1/FVC%<70: 24.8% vs. 9.5%) as well as dyspnea when walking on level ground. There was a positive correlation between positive precipitin tests for M. faeni and dyspnea walking on level ground. The sensitivity and specificity of positive precipitin tests for M. faeni were investigated to detect farmer’s lung. The sensitivity was 82% and specificity was only 49%. A survey of emphysema in patients in the only Pulmonary Clinic in the country showed that farmers had more often emphysema than the rest of the country population, and 58% of farmers with emphysema had smoked compared to 94% of other emphysema patients.

Medical and sanitary service of northern part of Bukovyna after the First World War (1918-1928)

The article deals with the main trends in the restoration and development of the medical and sanitary service in the territory of Northern Bukovyna in 1918-1928, during which martial law continued here, after which the territory became part of the Kingdom of Romania.In the first post-war period the population of the region found itself almost entirely without healthcare. Collapsed health system could not fight the spread of epidemic diseases through the region that also led to a complicated demographic situation in the post-war Bukovyna. The enduring spread of diseases among the population and, to a certain extent, the wish of Romanian authorities to use medicine for propaganda purposes forced the start of a comprehensive work to improve health and sanitary conditions in the region. The primary task that had to be urgently solved by the health service in the early post-war years has become the overcoming of the epidemics of infectious diseases that at the end of World War I led to great mortality among the population. Quite common among the residents of the region were dysentery, typhoid, typhus, relapsing fever, tuberculosis, and a number of pediatric respiratory infections – scarlet fever, measles, whooping cough, diphtheria, contagious parotitis, varicella and others. Some years there was an urgent need for the establishment of health centres, dispensaries. According to the law of 1923, the Health Service was divided into two parts: sanitary and hospital. The Sanitary Service was engaged in supervision, control and study of the health status of the settlements, the use of general and special preventive measures and prevention of epidemics, to provide medical care outside hospitals, educate the population about prevention and treatment of social diseases etc. The Hospital Service was responsible for hospital treatment and medical supervision of patients in hospitals. Bukovyna along with Khotyn district and the northern part of Moldova was included in the VIII sanitary region under the guidance of General Sanitary Inspectorate. For the operation of health service, Bukovyna was divided into five health areas, each headed by a Chief Physician. Areas were divided into sanitary districts. At the head of each one was the district doctor who had assistants, district midwives, and health agents. The duty of medical personnel was to countercheck social diseases. In this regard, 9 infirmaries and 27 dispensaries were founded in Bukovyna within 10 years (1918-1928).To avoid the spread of infectious diseases from abroad – an official centre «Grigore Ghica Vodӑ» was created to examine travellers at the border at the railway station in Nepolokivtsi.Also, in the first post-war decade for health services of the land the Sanitary Inspectorate has founded in Chernivtsi: Regional warehouse of medical instruments and devices; Regional warehouse of drugs, serums, vaccines and bandages, and the Institute of Hygiene.Compulsory preventive vaccination against smallpox and other infectious diseases was introduced. Doctors held free consultations in towns and villages both at home and in hospitals. At the same time, in the first post-war decade a decrease of doctors and paramedical staff is observed.Taking into consideration the shortage of a sufficient number of hospitals, clinics, doctors, nurses, lack of medicines, vaccines, therapeutic sera in Bukovyna, it should be ascertained that the state of epidemic diseases in the region in the early post-war years remained extremely hard. Only in the mid-20s such diseases as smallpox, typhus, and dysentery had been largely overcome thanks to vaccination, organizational and educational measures taken by the authorities. However, there remained high death rate from heart diseases, pneumonia, tuberculosis, due to difficult living conditions and inaccessibility of health care to the most.

Satisfaction with the quality of outpatient care of medical students as an element of the assessment of the current system of medical care

Introduction. This article discusses the problems of the quality of outpatient care for medical students. Most of the students prefer not to seek medical help from specialists even in difficult situations, and in most cases they self-medicate. This is caused by an insufficient degree of quality service by the outpatient polyclinic service of the attached contingent. The existing state system of medical care is imperfect: there is no unified approach to the organization of student polyclinics; medical organizations do not take into account the age and social specifics of students; low continuity in the rehabilitation and treatment of patients; there is insufficient preventive work among students.Aim: To determine the level of satisfaction with the quality of medical services provided to medical students.Material and Methods. The sociological method included a survey of medical students (1026 respondents) according to a specially designed questionnaire that contained questions about the scope, nature, quality of work and satisfaction with the conditions of the polyclinic institution. The logistic method consisted in the analysis of personnel, resource provision, as well as the activities of the medical institution.Results. Most of the medical students encounter organizational obstacles (appointment, waiting lists at the registry, waiting lists at the day hospital, waiting lists at the reception, etc.). 38.0% of respondents noted that when health problems appear, it is easier for them to go to the medical office of the college than to the district doctor. Moreover, 64.3% of respondents do not have information about the district doctor. Satisfaction depends on a number of factors such as: waiting time for a doctor’s appointment at the office (p < 0.001), availability when making an appointment with a doctor at a polyclinic (p < 0.001), preference when contacting a doctor when health problems appear (p < 0.001), the presence of organizational difficulties to get an appointment or treatment in a polyclinic (p < 0.001), the location of the registry and specialist offices, the terminal for making an appointment (p < 0.001), as well as the conditions of stay in a medical facility (p < 0.001).Conclusion. The necessity of introducing feedback into the practice of working with a contingent of medical students, using available screening technologies to actively identify the most significant factors and risk groups of the most common pathology, taking measures to reduce the impact of controlled factors, as well as annual preventive examinations and medical examinations has been identified.

Satisfaction of the legal representatives of children with the provision of medical care in urban health centers

Aim: To study the opinion of legal representatives of children on the quality of medical care provided in urban health centres.Material and research methods. The study is based on a survey of official representatives of children from 0 to 6 years old. One hundred sixty questionnaires containing 28 questions and 125 answers were analyzed.Results and discussion. Relatively low respondents’ satisfaction with various aspects of medical services in urban health centres (53%) was revealed. The reasons for dissatisfaction were: long waiting time for appointments (20,5%), difficulty in obtaining consultations with narrow profile doctors due to their absence in the centre (32,5%), the unsatisfactory sanitary condition of rooms (16%), the low technical infrastructure of health centres (23,2%). The reasons for dissatisfaction with the district doctor included a rushed examination (36.4%), insufficient attention to the child (22.7%), superficial examination (12.3%), prescription of expensive drugs (18.2%), and incompetence of the doctor (11.4%). Almost half of the patients (43.2%) turned to fee-for-service medicine for more qualified care. The survey results showed a high need for paediatricians (86.4%).Conclusion. The data obtained during the internal audit in a medical institution, in order to identify negative factors, can be used as an algorithm for action, i.e. to develop ways to improve the quality of medical services, with their subsequent adjustment and, as a consequence, to increase patient satisfaction with medical care.

Клінічні аспекти гострої кропив’янки в дітей у практиці лікаря первинного та вторинного рівня надання медичної допомоги

Purpose - to study the existing approaches of doctors to the diagnosis and treatment of acute urticaria in children at different stages of medical care. Materials and methods. Generalized experience of acute urticaria was presented in 89 children: retrospective analysis of medical records of 74 inpatients (group I) and 15 outpatients (group II). The data of anamnesis, complaints, objective examination of patients, results of laboratory research methods, composition of emergency therapy, treatment measures, monitoring of the dynamics of clinical symptoms were studied in detail. Results. The age structure of hospitalized patients is represented mainly by children of the first three years of life (43.24%), among whom infants of the first year of life predominated - 46.87%. Instead, among outpatients were mostly preschoolers and schoolchildren. The causes of urticaria were dominated by infectious factors (group I - 45.95%, group II - 40.0%), idiopathic variants were in 21.62% and 26.67% of cases, respectively. 36 patients (48.64%) of group I were taken to the clinic by the emergency medical team; parents of 13 children (17.57%) sought help on their own, the other were referred by a district doctor. However, 44.22% of patients were not diagnosed with urticaria at the initial examination. Combinations of urticaria with angioedema in both groups were not numerous (25.67% and 13.33%, respectively). It was found that parenteral taking of corticosteroids (80.55%) and first-generation of antihistamines (37.93%) was often used in children of group I at the prehospital stage. A similar situation occurred in patients with urticaria, which arose during hospital treatment for acute respiratory infections. In patients of group II, the appointment of second-generation antihistamines dominated (80.0%). Complete regression of urticaria in the first two days was observed in 56.8% of children of group I and 86.67% - group II. Conclusions. The generalization of the experience of managing children with acute urticaria demonstrates difficulties in making a differential diagnosis, in determining the indications for hospitalization, the choice of emergency medication by primary care physicians and emergency medicine. The high commitment of primary and secondary care physicians to the choice of parenteral route of appointment of emergency care (corticosteroids, first-generation antihistamines) is alarming. Provisions of international guidelines based on evidence-based medicine regarding the appointment of second-generation antihistamines as a first-line emergency, which have a good clinical effect and have no serious side effects, should be actively implemented. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests were declared by the authors. Key words: acute urticaria, children, emergency care, diagnosis.

In memory of Professor N. A. Gerken

Professor Nikolai Alexandrovich Gerke n is a native of Kazan province. He was born on December 18, 1863 in the family of a small landowner. He received his secondary education at the Kazan gymnasium, which he graduated from in 1882. In the same year he entered the Physics and Mathematics Faculty of St. Petersburg University, but for "freethinking" he was expelled from the capital to Kazan, where in 1883 he entered the Faculty of Medicine After graduating from the latter in May 1888, NA Gerken entered the district doctor in the Spassky district of Kazan province, where he worked as a district doctor until 1891, focusing mainly on surgical and eye diseases.

Syphilis and liver cancer

The physician-therapist constantly has to meet with two diseases, the clinical picture of which is extremely similar to one another, but the prognosis of which, in most cases, is sharply different, if at the time the diagnosis is made and the appropriate treatment is undertaken. I mean here liver cancer and its tertiary luetic changes. Differential diagnosis of these two diseases is sometimes difficult even for a well-equipped clinical institution, represented by sufficiently large therapeutic forces, especially since it may not be within the power of a young district doctor.

Sachs-Georgi reaction at the site

One of the difficulties in the work of a district doctor is the impossibility, for a number of reasons, to use even such laboratory research data, which, in the conditions of large city medical institutions, are an integral part of a patient's clinical examination. Forced, therefore, when making a diagnosis and subsequent treatment based solely on the existing picture of the disease and anamnesis, the district doctor is thus pushed back decades ago from his urban colleagues, who have the opportunity to use in their daily work many of the most valuable achievements of scientific medicine of the last decades requiring an appropriate laboratory environment. One such achievement is undoubtedly Wassermann's reaction, without which every doctor working in the countryside often has to spend a lot of work and try out methods of treatment before establishing the true etiology of the suffering he is using. The presence of such cases in district practice is all the more inevitable because, as can be judged on the basis of the literature, typical exvisit forms of syphilis in recent years have begun to occur much less frequently, giving way to various manifestations of visceral lues.

Prof. M. S. Malinovsky and Prof. M. G. Kushnir. Manual on operative obstetrics. Gosmedizdat. 1931, p. 480, c. 5 p.

After the publication of the last edition of "Operational obstetrics" prof. Many years have passed by Fenomenov, and thus a major defect has arisen in the supply of a practicing obstetrician with a guide to operative obstetrics, which would more or less satisfy the needs of obstetric medical practice. This defect is now becoming even more noticeable for two reasons: 1) the almost complete absence of solid manuals on obstetrics in general, which, for example, should be fully considered "Obstetrics" by prof. V.S.Gruzdev and 2) a significant progressive increase in the number of doctors who have to pay great or exclusive attention to this type of medical care (doctors of special obstetric departments, consultations, medical specialists in large hospitals in factories, factories, state farms, collective farms, district doctors). The lack of manuals and textbooks on obstetrics is especially acute in medical universities, where the mastery of the discipline by students often occurs only "from the words" of the teacher and where, therefore, the activation of teaching methods is reduced to replacing lectures with group tutoring conversations. This is why the release of the peer-reviewed Guideline. However, we think that the work that has appeared should be welcomed also because in itself it is of great value and not only for the student, - the future district doctor, as the authors thought when compiling the Guide, but also for a practical doctor. in his day-to-day obstetric work, and for the postgraduate obstetrician at the Postgraduate Postgraduate Institutes, and for the teacher.

Изучение временных потерь пациентов при получении медицинских услуг в амбулаторно-поликлинических условиях

The study of the patient’s temporary losses when receiving medical services in an outpatient clinic and their minimization contribute to an increase in patient satisfaction with the quality of medical care. Objective of the stud y: to assess the temporary losses of patients when visiting outpatient clinics of the city municipality. Methods and materials. The temporary losses of patients were studied by analyzing route maps compiled using a special technique. The analysis of the questionnaires made it possible to assess the patient’s satisfaction with the conditions of providing medical services, the information received in the healthcare institution and the attitude of the nursing staff to the visitor. Statistical processing of the results was carried out using the programs Statistica 5.0 and Microsoft Office Excel. Results. As a result of the conducted research, significant time costs of patients were identified when receiving medical care in polyclinics of the district center: when visiting a district doctor, a registry, a treatment room and a laboratory, which directly affected the results of assessing their satisfaction with the temporary criteria for visiting a medical organization. Scope of the results. The data obtained during the study can be used as basic information when developing measures to optimize key processes in outpatient health care institutions.

Recurrence of pain after appendectomy

Inflammation of the appendix is such an important department in the pathology of the abdominal cavity and so often not only a clinician, but also an ordinary district doctor has to deal with it, that there is nothing surprising in the stream of articles and whole monographs on this issue that have been filling the medical press in recent times not only in our country, but also abroad.

Why is it important to involve people with lived experience in the development of the educational programs in suicide prevention?

Blekinge Family Postvention is a grief facilitator-home-visiting postvention giving early support to families after a suicidal loss since 2015. It helps families overcome shock, pain, anger, guilt, suffering and other extreme emotions caused by suicide. Such situations should be treated not as a disorder. Medication should be used only as a last resort to treat individuals not responding to early family support, followed by individual sessions if needed. Everyone needs to express feelings and thoughts on all aspects of the suddenly interrupted relation. To achieve this, a person experienced in those issues must be leading all of the meetings. The conversations should start during the first days, frequently continuing for at least 3-5 weeks depending on the family needs. Helping the family bear each other and find coping strategies ease their pain, mourning and give them hope instead of prolonged grief. In this way, the family gradually finds new ways to overcome a never-ending negative looping that eventually can cause, e.g. post-traumatic stress disorder and depression. The support to the family after suicide loss should be a governmental matter. Today all work is done voluntarily. The close relatives need debriefing right after the district doctor has stated the death or the police informed the family about suicide. The military, the police, rescue services and healthcare professionals gets debriefing when a rescue operation has failed. This presentation discusses how to organise early family support and the Ellipse project’s interviews with survivors about their experiences of needed or received support if any.DisclosureDISCLAIMER The E-Lifelong Learning In Prevention of Suicide In Europe (ELLIPSE)-project is co-funded by the European Union’s Programme Erasmus+ (Project ID: 2019-1-SE01-KA203-060571). The EU Commission’s support for this project does not mean that the Com

Cases of childbirth with dropsy of the HEAD

On 4 /XII 96 I was summoned from the city of Novaya Ladoga by the district doctor A.A. Yatsunsky to the county for joint assistance in childbirth. Upon arrival, the following appeared.

Механизм уведомления участкового врача в медицинской информационной системе при поступлении нового медицинского документа в региональную медицинскую информационную систему

Механизм уведомления участкового врача в медицинской информационной системе при поступлении нового медицинского документа в региональную медицинскую информационную систему

Dr. Franc Tiplič: lenarški zdravnik med fikcijo in zgodovino

Category: 1.01 Original scientific paper Language: Original in Slovene (Abstract in Slovene and English, Summary in English) Key words: Tiplič, Slovenske gorice, Lenart, Kontrolor Škrobar, Alojz Kraigher, national political struggle Abstract: This piece presents the life and work of dr. France Tiplič, the first Slovenian doctor who served as a district doctor in Lenart from 1900 until his death in 1918. In his novel Kontrolor Škrobar, Tiplič's long-time friend and fellow inhabitant Alojz Kraigher describes the turbulent political life and the national struggle between Germans and nationally conscious Slovenians in Slovenske gorice and especially in Lenart on the eve of the First World War. He implemented real historical events into his novel; the names of literary characters bear names with a noticeable extra-literary reference behind which are real and recorded historical persons. Among others, the character of dr. Njivar was modelled after France Tiplič. The authors give a historiographical outline of the national frictions in Lenart and a description of the political activity of France Tiplič. What is more, they analysed the literary representation of events with historical facts, reinforced with archive materials, correspondence and existing scholarly literature.

Pyotr Andreyevich Zagorsky - Russian anatomist, rector and Professor Emeritus of the St. Petersburg Medical-Surgical Academy, Academician of the Imperial Academy of Sciences
 (on the 255th anniversary of birth)

Pyotr Andreyevich Zagorsky was born in 1764 in the Novgorodseversky governorship in the family of a priest. He studied at the Chernigov College, Medical-Surgical School. In 1785, P.A. Zagorsky was promoted to healers and began working as an anatomy prosector at the Department of Anatomy, Physiology and Surgery of the St. Petersburg General Hospital. In 1790 he moved to the Shlisselburg district to the post of city and district doctor, and in 1793 he was transferred as a head-doctor to the Cuirassier Regiment. In 1794-1795 Peter Andreevich took part in the military campaign of Suvorov. In 1797 he was appointed adjunct anatomy. P.A. Zagorsky wrote the first Russian textbook on anatomy (1801), for the first time in Russia he introduced compulsory classes on corpses, suggested Russian anatomical terminology (1802), created a classification of deformities. In 1805, P.A. Zagorsky received the title of adjunct of anatomy and physiology, and since 1807 - an extraordinary academician, in 18091833 - academician of the Imperial Academy of Sciences. In 1808, he was appointed rector of the Medical-Surgical Academy. Since 1817, he is an honorary member of the Imperial Moscow Society of Naturalists. His school passed I.V. Buyalsky, P.A. Naranovich, I.D. Knigin, P.S. Kareisha, IB. Petrov, D.M. Vellansky, A.I. Fedorovsky and others. P.A. Zagorsky - the author of more than 150 scientific papers. Peter Andreevich Zagorsky died in 1846 at the age of 82 years.

Nikolay Nikolaevich ELANSKY - outstanding surgeon, organizer of military field surgery, honored scientist of the RSFSR
 (to the 125th of birthday)

N.N. Elansky was born in 1894 in the Voronezh Province. In 1913 he graduated from the Borisoglebsk gymnasium, in 1917 - the Military Medical Academy and was sent to the South-Western Front as a senior regimental doctor. Since 1918 - the district doctor of the Makaryevsky rural hospital of the Voronezh province. In 1919, N.N. Yelansky, together with V.N. Shamov and I.R. Petrov, prepared the first standard serums in the USSR for determining blood groups. Since 1921, Nikolai Nikolayevich returned to the faculty surgical clinic of the Military Medical Academy, having passed the way from an intern to a senior lecturer. In 1924, he defended his doctoral dissertation, in 1932 - became a professor, in 1934 - head of the department of faculty surgery at the Leningrad Pediatric Institute. In the years 1937-1938. He headed the Department of General Surgery and Military Field Surgery of the Military Medical Academy. Nikolai Nikolayevich participated in the organization of surgical care on the Khalkhin-Gol River (1938) and in the Soviet-Finnish War (1939–1940). During the Great Patriotic War, N.N. Yelansky consistently served as chief surgeon of the North-West, 2nd Byelorussian, 2nd Ukrainian and Trans-Baikal fronts. After the war, Nikolai Nikolayevich continued to work as head of the department of general surgery. In 1942, on the initiative of N.N. Yelansky was created by a special front-line group with the aim of a comprehensive study of traumatic shock. In 1942 he was awarded the title Honored Scientist of the RSFSR. In 1944, N.N. Elansky became lieutenant-general of the medical service. From 1947 to 1955 He was the chief surgeon of the Soviet Army and at the same time the head of the department of faculty surgery I of the Moscow Medical Institute. N.M. Sechenov, which he headed until 1964. From 1955 to 1959 he was a professor and consultant of the Military Medical Administration. He studied specific issues of blood transfusion, gastro-surgery, urology, traumatology, oncology and neurosurgery. In 1959 N.N. Yelansky organizes an artificial kidney department in the faculty surgical clinic I of the Moscow Medical Institute for the treatment of patients with acute renal failure. Nikolay Nikolayevich was a member of the editorial board of the Surgery and Military Medical Journal journals. He edited the 15th and 16th volumes of the multivolume work "The Experience of Soviet Medicine in the Great Patriotic War of 1941-1945."He was the editor of the Surgery department of the 2nd edition of the Big Medical Encyclopedia, etc. He was a member of the board of the All-Union and All-Russian Scientific Surgical Societies, an honorary member of the International Association of Surgeons, the Surgical Society. N.I. Pirogov, Surgical Society of Czechoslovakia, Vice-President of the Society of Soviet-Belgian Friendship. He trained 9 doctors and over 30 candidates of medical sciences. He has published about 140 scientific papers. For services to the motherland N.N. Elansky was awarded fifteen orders and medals of the Soviet Union. N.N. Elansky died on August 31, 1964 and was buried in Moscow at the Novodevichy Cemetery.

State Interest and Public Health: The Case of the Poisoning of the Peasant Maiden Marfa, Daughter of Petrov

This article uses the case of the “poisoning of the peasant maiden Marfa, the daughter of Petrov”, heard in the courts of Yekaterinburg in 1791, to demonstrate how practices of social disciplining based on Western European ideas of “medical Enlightenment” and “medical policy” might have worked in a Russian province. The prerequisite for the perception of such ideas was a fairly high educational level among the local officials involved into this case. But this is not the sole reason: a no-less-important role was played by a solid and (in many respects) unique communication field built on formal and informal networks that emerged due to the special status Yekaterinburg enjoyed as capital of the Ural mining industry, a regional educational centre and communications junction. Thus, at the end of the 18th century visiting professional elites and local mining and state officials were not only connected through work, but also through shared leisure activities. It is very likely that with these “agents of Enlightenment” the views and knowledge that existed in Europe and the country’s capitals (including those about the “right” medicine) permeated into the provinces. As a result of this, the judges and the district doctor showed some legal ingenuity: in their struggle against unofficial medical treatment, they decided to achieve maximum disciplinary effect by mitigating the sentence. Therefore, they applied legislation not immediately related to the case. This was done in order to stigmatise illegal healing, since the few representatives of official medicine were incapable of withstanding competition from omnipresent quacks and sorcerers, who offered services to the common people by relying on their experience and intuition.

Sources of Information on the Healthy Lifestyle, Prevention and Treatment of Cardiovascular Diseases: Supply, Selection Criteria, Population Truth

The article is devoted to the analysis of the choice of ways to find sources of information about a healthy lifestyle and prevention and treatment of cardiovascular diseases (CVD) by people of working age. The aim is to identify and characterize the preferences of residents of the Dnipropetrovsk region regarding the selection of channels for obtaining medical information, the degree of trust in them, as well as the need for additional sources based on the results of a two-stage sociological study
 The method of in-depth interviews (N 20) and the method of personalized formal interviews (N 2000) have been used. The survey among the representative sample of the population of working age was carried out according to a specially developed methodology of qualitative and quantitative research stages and data collection tools. The research was conducted in 2017 on request of the Dnipropetrovsk Regional State Administration with the financial support of the World Bank.
 It is shown that the most popular source of knowledge on the prevention and treatment of cardiovascular diseases and healthy lifestyle are medical professionals: almost half of the polled (46.0%) reported receiving the necessary information from them, mainly from a family doctor or a district doctor (32.8%); twice less than cardiologists (16.0%); sometimes from doctors of other specialization and other medical workers (10.5%). The criterion for selecting a source is trust in him, while the overwhelming majority entrusts it to medical workers.
 The expediency of developing a special Internet resource devoted to the issues of preserving and strengthening the health of the population, reducing the risk factors, prevention, diagnosis and treatment of CVD and other diseases has been proved.

Results of expert evaluation of problems of organization of ambulatory-polyclinic assistance

Introduction. An important role in health care management was taken by the service of managing the volume of medical care for this population group and the progressive development of the opportunities of the district doctor and GP for most of the population which requires only general medical assistance while maintaining all the possibilities for the consultant to get this patient’s advice. Materials and methods. An expert assessment of the organization’s problems, prospects for development and the main directions for optimizing the outpatient care were conducted among the heads of health authorities, state outpatient clinics and the oblast’s top specialists (111 experts). Results. An expert assessment of the problems and perspectives of the organization of out-patient and polyclinic care in the territorial polyclinics obtained the following results. At present, the health of the population is monitored by: citizens themselves – 23,1%; District doctors – 7,9%, medical specialists – 1,2%, no one follows – 67,8%. At the same time, according to experts, citizens themselves should monitor citizens’ health – 81,3% and district doctors – 18,7%. With a deterioration in health status or an exacerbation of the disease, patients most often turn to: the district doctor – 84,1%; The average medical worker working on the site – 2,7% and the specialist doctor – 13,2%. At the same time, according to experts, patients with worsening health or exacerbation of the disease most often need to contact the local doctor – 88,3% and the average medical worker working on the site – 11,7%. The share of unreasonable visits is: a district doctor – 28,1%, house calls – 56,4%, doctors-specialists – 37,3%. Thus, according to experts’ estimates, the share of unjustified visits of district doctors is 28,1%, of the doctor’s call at home – 56,4%, and of specialist doctors – 37,3%, which indicates a low level of organization of work of polyclinics. The proportion of visits by patients to district doctors that could be resolved: on pre-hospital admission, is 24,7%, by telephone consultation, is 24,5%. Thus, the share of visits to district doctors, which could be resolved at a pre-hospital reception and by telephone consultation, is almost half (49,2%). The proportion of visits by patients to medical specialists that could be resolved by telephone consultation: between the district doctor and medical specialists is 11,2%, the number of patients by telephone by medical specialists is 12,4%. Thus, the share of visits by specialist doctors, which could be resolved by telephone consultation between the district doctor and specialist doctors and patient consultations by telephone by specialist doctors, is almost a quarter of all visits (23,6%). Discussion. The data obtained are in some ways consistent with the results of a number of authors who are optimizing outpatient care in terms of the unreasonableness of visits, the possibility of transferring part of the functions of primary general medical reception to specially trained middle medical personnel, using telephone consultations between patients and between doctors, etc. Conclusion. The results of the expert assessment of the organization of outpatient care helped to identify some approaches to optimizing its delivery in the territorial polyclinics. This is optimization of the work of district doctors; Transfer of a certain part of the functions performed by district doctors to district nurses and paramedics; The development of a system for counseling patients and district doctors by medical specialists of polyclinics and other medical organizations.