Forms Of Statistical Observation Research Articles

Analysis of morbidity in hospitals

The article presents an analysis of morbidity in hospitals and the average length of stay by disease classes and individual nosology in Russia for the period from 2016 to 2021. The aim of the work was to analyze the indicators of morbidity in hospitals among the adult population of Russia for the period 2016-2021. Statistical and analytical research methods were used in the work. The data on the number of discharged adult patients (18 years and older) from medical organizations providing inpatient care as well as on the number of bed-days discharged were used from the federal statistical observation form № 14 'Information about the activities of units of medical organizations providing care in inpatient settings' for 2016-2021. The morbidity in hospitals rate decreased from 205.5 to 196.0 per 1000 people of the corresponding age, the average duration of stay in a hospital bed decreased from 11.7 to 10.6 days. The downward trend in morbidity in hospital is traceable for almost all classes of diseases. Since 2020, due to the pandemic of the new coronavirus infection COVID-19 and the reprofiling of most hospitals to infectious diseases hospitals, there has been a change in the structure of morbidity in hospital in adult patients by disease class.

Incidence of cerebrovascular diseases in the Russian Federation in 2010–2022

Background. Mortality from cerebrovascular diseases in Russia is one of the highest in the world.
 Aim. To determine trends in the incidence of cerebrovascular pathology, including in connection with the pandemic of the new coronavirus infection COVID-19.
 
 Material and methods. The structure, indicators of primary and general incidence of cerebrovascular pathology in 2010–2022 in Russia as a whole according to statistical observation form No. 12 were analyzed. Intensive, extensive, and standardized indicators were calculated and regression analysis was performed.
 Results. The share of newly diagnosed cerebrovascular diseases in the structure of circulatory system diseases in Russia during the study period decreased from 21.7 to 17.4%. The overall incidence of cerebrovascular pathology ranged from 4371.1 to 4938.1, primary — from 599.8 to 791.2 per 100 thousand population. The primary incidence rate of stroke in the period from 2010 to 2019 increased from 270.1 to 296.6 per 100 thousand population, with a subsequent decrease in 2022 to 275.3 per 100 thousand population. When standardizing the primary incidence of stroke by age, no significant changes in the indicator were detected over the entire observation period. During the COVID-19 pandemic, the incidence of cerebrovascular diseases (general and primary), as well as the incidence of their individual units, decreased or deviated from the upward trend. The proportion of strokes not specified as hemorrhage or infarction decreased from 10.2 to 1.8%. During the pandemic period (2020–2022), there was an increase in the risk of developing cerebral infarction compared to intracranial and intracerebral hemorrhages (from 1.7:1 to 1.9:1; p=0.0000). The primary incidence of hemorrhagic and ischemic strokes increased from 161.3 (2010) to 238.1 (2019) per 100 thousand population; in 2022 it was 225.7 per 100 thousand population. During the study period, there was no trend towards an increase in the standardized incidence of strokes.
 Conclusion. From 2010 to 2019 in Russia there was an increase in the primary incidence of cerebrovascular pathology, a decrease in overall and primary incidence in 2020–2022.

Incidence Among Infants in Moscow Including the COVID-19 Statistics

The study presents the data on incidence among infants in Moscow. The author analyzed the indicators of overall incidence, the characteristics of disease distribution, and the level of follow-up care in children of the given age group. The data was obtained from the open sources of Federal State Statistics Service of the Russian Federation (Rosstat) and from the Federal Statistical Observation Form No. 12 “On the number of diseases registered in patients residing in the service area of a medical organization” from 2016 to 2022.
 The author evaluated the impact of COVID-19 pandemic on the pre-COVID incidence trends in general and by specific disease categories, as well as on the distribution of diseases common to infants. The results show a decrease in overall incidence and specifically of infectious diseases, respiratory diseases, injuries, poisonings, and other external causes in all age groups. While overall incidence was decreasing between 2020 and 2022, the number of cases requiring the follow-up care was constantly growing. The absence of herd immunity and newborn vaccination due to the age characteristics of the group has led to an explosion of COVID-19 cases in the last three years. The study also revealed the variation in indicators for certain diseases, which warrants further investigation of the dynamics in these nosological groups.

The Federal Project "Fighting Cardiovascular Diseases": Dynamics of quantitative indices during the COVID-19 pandemic

Aim to analyze the dynamics of indicators of the Federal Project "Fighting Cardiovascular Diseases" and to suggest improving the project management methods in healthcare.
 Material and methods. The data was collected from Federal statistical observation form No. 14 "Data on activity of divisions of the medical organizations providing in-hospital medical care", form No. 30 "Data on the medical organization". The target indicators were selected from the Passport of Federal Project "Fighting Cardiovascular Diseases". The data on mortality rate was collected from the Rosstat reports on the number of population and the number of deaths by different diseases.
 Results. In Russia, the frequency of endovascular interventions in acute coronary syndrome is growing essentially exceeding the target values of the Federal Project. Several regions are leading in the intensity of performing these operations (taking into account the population size) leaving behind many developed countries. At the same time, the death rate from cardiovascular diseases in Russia remains one of the highest in the world. The problem of medical care quality is still acute. The in-hospital lethality rates from cerebrovascular accident and acute myocardial infarction have significantly exceeded the target values during the entire period of observation.
 Conclusion. During the infectious pandemics, the actions and target indicators of federal projects in healthcare should be revised. The healthcare model focusing on disease prevention, conservative treatment and telemedicine is preferable.

ЭПИДЕМИОЛОГИЧЕСКАЯ ХАРАКТЕРИСТИКА И ПРОФИЛАКТИКА КЛЕЩЕВОГО ВИРУСНОГО ЭНЦЕФАЛИТА НА ПРИАРКТИЧЕСКИХ ТЕРРИТОРИЯХ ЕВРОПЕЙСКОГО СЕВЕРА

Current: In the subarctic territories of the European North, a combination of system-forming factors shaping an increased risk of morbidity has been accumulated: climatogeographic, ecological, ethnic, social. These factors can become triggers for the spread of natural focal infections, including tick-borne viral encephalitis. They require a special approach in the organization of healthcare. The aim of this study was to study of the features of the incidence of tick-borne viral encephalitis among the population of the subarctic territories for the period from 2012 to 2021 and evaluation of measures for the implementation of specific prevention. Materials and methods. The data taken from the federal forms of statistical observation (statistical reporting form No. 2 "Information on infectious and parasitic diseases", statistical reporting form No. 5 "Information on preventive vaccinations") were used in the territories of the Arkhangelsk, Murmansk regions, the Republic of Karelia, the Komi Republic. A comparative study was conducted between them, as well as with the average statistical values for the Russian Federation. The results of the study and their discussion. over the past decade, a decrease in the incidence of tick-borne viral encephalitis has been observed in the studied subarctic territories. At the same time, in the Arkhangelsk region, the Republics of Karelia and Komi, it remained higher in comparison with the average values for the Russian Federation. In the last 2 years, there has also been a decline in cases of infection, but this down-fall is much slower than in the country as a whole. Some positive trends are determined by the results of the implementation of preventive measures. Among them, the main importance was played by full-fledged vaccination of the population in endemic regions (the Arkhangelsk region, partly the Komi Republic and Karelia), thanks to which a sufficient pool of antibodies to the causative agent of tick-borne encephalitis is created in the body. It exceeded the all-Russian indicators in scale. In addition, in areas with a wide spread of vector ticks, powerful nonspecific prevention is carried out, aimed at the destruction of vectors or treatment with repellents.

Organization of Mass Vaccine Prevention in the Conditions of a Modern Megapolis

Relevance. Thanks to decisions taken at the national level, many countries have managed to significantly increase coverage with preventive vaccination and reduce mortality from vaccine-preventable diseases. However, the COVID-19 pandemic has recaptured the relevance of organizing mass vaccination. Based on the current epidemiological situation, characteristics of the population, peculiar features of infrastructure, available resources in individual country, and individual city, various organizational vaccination solutions have been developed and implemented. The Moscow-based experience of vaccinating against influenza at mobile vaccination sites near the Moscow metro stations in 2016 became the starting point in the development of new organizational forms and technologies for mass vaccination in a megapolis, that have been successfully adapted to the new conditions of the COVID19 pandemic.Aims. is to summarize foreign and Russian (exemplified by Moscow) experience in organizing mass vaccination.Material and methods. The study is based on the publication search results in Google and PubMed. The authors selected materials published in 2017– 2023. The implemented analysis of the long-term dynamics in the influenza incidence in the Russian Federation, the Central Federal District (CFD) and Moscow was based on data of the Federal State Statistical Observation Form No. 2 «Information on infectious and parasitic diseases» for 2013–2019.Results and discussion. The analysis of foreign experience shows that the development and implementation of new forms of mass vaccination cannot become a "standard project". In each region of the world, it is organized with due regard to the local economic, legal, social, medical, organizational and even cultural conditions. Vaccination of the population against influenza at mobile vaccination sites near the Moscow metro stations contributed to a 42.3% decrease in the incidence of influenza (from 24.6 in 2016 to 14.2 per 100,000 population in 2017). In 2019, the incidence of influenza in Moscow was 28.8% lower than the CFD one and 62.2% lower than the Russian rate. The recognized successful experience of deploying mobile vaccination sites near the metro stations has been significantly expanded to control the COVID-19 pandemic with mobile teams, vaccination sites in shopping centers, etc.Conclusion. The conducted research and literature data substantiate the deployment of additional vaccination sites to ensure the necessary coverage with vaccination within a short period of time.

Обеспеченность службы медицинской статистики квалифицированными кадрами

The implementation of the tasks of the medical statistics service is an integral part of the health care management process, as well as methodological support of the management vertical in the system [2, 3]. The quality of medical statistical and analytical data depends primarily on the personnel component of the medical statistics service. Currently, medical statistics are developing in the context of significant organizational changes in the healthcare system [1], which determines the priority of providing the service with qualified personnel [5]. The purpose of the study: to study the availability of qualified personnel engaged in professional activities in medical statistics. Materials and methods. The data of the Federal statistical observation form No. 30 “Information about a medical organization” were used for the study. Statistical and analytical methods were used in the study. Results. The Medical Statistics Service performs one of the key roles in the management of a medical organization and the healthcare industry as a whole. In medical organizations, statistical document management is carried out by specialists of departments (offices) of medical statistics, which make up the medical statistics service as a whole. The key specialists of the service are statisticians and medical statisticians. The analysis of the indicator of the availability of qualified personnel of the medical statistics service shows its stable decline. Thus, in the dynamics of the total indicator of the provision of statisticians and medical statisticians per 10 000 population in the Russian Federation from 2015 to 2021, there is a decrease in its level by 18,6% or from 0,86 0/000 to 0,700/000, including in outpatient settings by 24,4% or from 0,450/000 to 0,34 0/000, in stationary by 11,8% or from 0,34 0/000 to 0,30 0/000. By the end of 2021, the shortage of qualified specialists of the medical statistics service amounted to 44,3% of their total needs. A similar situation is observed in medical organizations for outpatient and inpatient medical care (45% and 42,6%, respectively). Simultaneously with the decrease in the staffing of the medical statistics service, an increase in the load on the specialist was revealed. Thus, in medical organizations providing medical care in outpatient and inpatient settings, the average load on a statistician and medical statistician is almost 1,5–2 times higher than the average standard. Conclusions. The analysis of personnel changes in the medical statistics service indicates the need to improve approaches to the training and use of qualified personnel engaged in professional activities in medical statistics.

Analysis of Infectious Incidence in the Republic of Dagestan for 2019–2021

Relevance. Over the past two decades, due to the effectiveness of anti-epidemic measures, the incidence of infectious diseases in the Republic of Dagestan (RD) has been declining. However for some nosologies it is considerably higher than the Russian Federation average.Objective. To analyze the incidence of infectious diseases in RD in 2019–2022 in order to identify areas for preventive and anti-epidemic measures to be strengthened.Material and methods. The data on morbidity taken from federal statistical observation form No. 2 «Information on infectious and parasitic diseases», State reports on sanitary and epidemiological well-being of the population for 2019, 2020, 2021, 2022, prepared by Rospotrebnadzor and the Department of Rospotrebnadzor for Dagestan Republic were analyzed. A descriptive epidemiological method was used, which does not require statistical data processing.Results and discussion. In 2022, in the Republic of Dagestan, the infectious disease incidence was 7492.2 per 100 thousand of the population, which is 22.2% lower than in 2021, but higher than the long-term average (6149.4). In 2022, compared to 2021, there was a decrease in the incidence of 10 nosoforms of infectious diseases in the RD and 6 in the Russian Federation. Along with a decrease in morbidity, there is an increase in morbidity, in particular Sonne dysentery by 5.1 times, аcute intestinal infections (established etiology) by 39.3%. chronic hepatitis B by 97.9%, chronic hepatitis C by 2.14 times, whooping cough by 5.1 times, chicken pox by 18.6%, mumps by 2.2 times, brucellosis by 24.4%, HIV-infection by 36.3%, influenza 43.4 times. In the structure of infectious and parasitic diseases in 2022, as in previous years, acute infections of the upper respiratory tract and аcute intestinal infections prevailed.Conclusions. Despite the ongoing systematic work aimed at reducing the incidence of infectious diseases and the progress made in improving the situation with a number of infections, more measures are needed to combat acute intestinal infections, hepatitis B and C, HIV-infection, brucellosis.

High-Tech Heart Surgery in Elderly Patients in Russia

Diseases of the circulatory system for many decades in Russia occupy a leading place in the structure of the causes of morbidity, disability and mortality. Therefore, the priority direction of the state policy in healthcare is the fight against cardiovascular diseases. The aim of our paper is to analyze the performed high-tech heart surgeries of elderly patients in Russia. The research methods are used in the work: analytical, statistical (calculations of extensive indicators, ratio indicators), content analysis and data from the federal statistical observation form № 14 «Information on the activities of departments of medical organizations providing medical care in inpatient conditions» for elderly patients (women aged 55 years and older, men - 60 years and older) for 2011-2019. The results of the federal project «Fight against cardiovascular diseases» allowed to increase the number of heart surgeries performed by 3.1 times, including with the use of high medical technologies – by 3.6 times, to reduce the frequency of postsurgical heart complications from 2.41 to 1.18%, with the use of HTMC - from 2.65 to 1.19%.

Approaches to Defining Health Risk Areas Using Quality Indicators of Drinking Water Supply

Introduction: There are currently no generally accepted criteria for ranking territories according to a set of indicators characterizing the quality of drinking water supply, which requires the development and verification of criteria for classifying regions. Objective: To develop approaches to ranking territories of the Russian Federation based on indicators characterizing the state of drinking water supply and identifying health risk areas. Materials and methods: We have analyzed tap water quality indicators and characteristics of water supply systems in 15 regions of the Russian Federation included in the Arctic zone and the Northwestern Federal District based on data retrieved from the Federal Statistical Observation Form 18 “Information on the sanitary condition in the region” for 2021. A discriminant and correlation analysis were performed to verify the correctness of area classification. Results: We ranked the study regions based on 31 tap water quality indicators. The results of the discriminant analysis showed that six regions (Novgorod Region, Republic of Karelia, Arkhangelsk Region, Nenets Autonomous Area, Republic of Sakha (Yakutia), Chukotka Autonomous Area) were risk areas, 93.3 % of the original grouped observations were classified correctly. Poor chemical indicators of tap water quality in rural areas made a significant contribution to the classification of the regions as risk territories. Discussion: The selected quality indicators of drinking water supply are appropriate and sufficient for the regional level thanks to their universality for all territories. This fact is also confirmed by a strong statistical inverse correlation between the proportion of the population provided with quality tap water from centralized water supply systems and the calculated total score characterizing the state of drinking water supply. Conclusions: The study proved correctness of the choice of indicators characterizing the quality of drinking water supply for the classification of regions. Ranking of territories will allow developing management solutions to improve the quality of drinking water and identify regions that need priority measures aimed at preserving health of the population.

Tuberculosis combined with HIV infection in Russia in the period before — and during the COVID-19 pandemic

Objective. Analysis of the main epidemiological indicators characterizing the situation of tuberculosis combined with HIV infection in Russia during the period before and during the COVID-19 pandemic.Materials and methods. Information from Federal Statistical Observation Forms No. 8, No. 33 and No. 61 for 2012–2021. Rosstat data on the number of patients who died from tuberculosis and HIV infection, and the average annual population of Russia, for 2011–2021. Information from the Federal statistical Observation form No. 30 on the population of Russia covered by screening aimed at early detection of tuberculosis for the period from 2018 to 2021.Results and discussion. The COVID-19 pandemic has had a noticeable impact on the implementation of the Tuberculosis Eradication Program in Russia in less than two years, breaking the 10-year stable rate of decline in tuberculosis morbidity and mortality. The reduction in screening time during the pandemic led to an increase in the number of people with common forms of tuberculosis, which could have been sources of tuberculosis infection among the population for a long time, and especially among people infected with HIV infection. During the COVID-19 pandemic, the proportion of patients with tuberculosis combined with HIV infection increased in the structure of the incidence of tuberculosis and HIV infection. Treatment of patients with HIV infection combined with tuberculosis with multiple and broad resistance of the pathogen is of considerable complexity and creates a high risk of death and an increase in mortality among patients of this group.

Species spectrum of nonpolio enteroviruses in KhMAO–Yugra during the prepandemic and pandemic periods

BACKGROUND: The characteristics of the regional features of the etiological structure of nonpolio enterovirus infection before and during the coronavirus disease 2019 (COVID-19) pandemic were evaluated.
 AIM: To assess the monitoring of the etiologies of enterovirus infection in the prepandemic and pandemic periods.
 MATERIALS AND METHODS: Data from the forms of statistical observation for 20132022 and the results of molecular genetic studies of nonpolio EVI were used.
 RESULTS: The dynamics of the incidence of enterovirus infection in the KhantyMansi Autonomous Okrug before the COVID-19 pandemic was characterized by high activity levels of the epidemic process, exceeding the average for the Russian Federation by 56 times. The urban population, with a predominance of children aged 6 years, mainly contributed to the total incidence of enterovirus infection. During the period with the highest incidence rates in 2017 and 2019, Coxsackie A6 viruses in combination with ECHO30, Coxsackie A9 dominated, and during the period of their decline, the proportion of enterovirus A71, Coxsackie A16 increased. During the pandemic, the calculated trends of dynamics for 2022 were confirmed for dominant viruses and enterovirus A71. In the same year, Coxsackie B2 and ECHO6 viruses were increasingly identified, which were previously circulated irregularly and in isolated cases. The prevalence of CV-A6 in the epidemic process was accompanied by clinical manifestations of infection, mainly as enterovirus vesicular stomatitis, with a high frequency of ECHO30, computer cases were recorded in most cases.
 CONCLUSION: Based on the results of monitoring the etiological structure of nonpoliomyelitis enterovirus infection in the prepandemic period, a further increase in morbidity in enterovirus infection is predicted in the KhantyMansi Autonomous Okrug. Genotyping of the detected strains makes it possible to determine the spectrum of enterovirus strains endemic to the territory and predict their prevalence, which is necessary to prevent the spread of enterovirus infection and ensure sanitary and epidemiological well-being in the region.

АНАЛИЗ РЕЗУЛЬТАТОВ СУДЕБНО-МЕДИЦИНСКИХ ЭКСПЕРТИЗ ТРУПОВ, СОДЕРЖАЩИХ ЭКЗОГЕННЫЙ ЭТАНОЛ В БИОЛОГИЧЕСКИХ ЖИДКОСТЯХ

Every year Russia performs about 700’000 forensic medical examinations and postmortem assessments which is about a third of all deaths. In line with the current legislation, suspected violent deaths (due to external causes) are the reason for a forensic medical exam. Determination of the presence and quantitative content of exogenous ethanol in the corpse’s biological fluids is mandatory in all cases of violent death. In turn, alcohol consumption is one of the leading risk factors affecting mortality in Russia, especially among working-age men. Calculating alcohol consumption in population is challenging, since part of the available alcohol is unregistered (moonshine, alcoholic surrogates), yet there are many indicators that are considered reliable and characterize the level of alcohol consumption in population. This study has attempted to analyze causes of death of those with exogenous ethanol in biological fluids. These indicators are necessary for developing and implementing the most effective health policy, saving health and increasing life expectancy in Russia. The purpose of the study is to analyze causes of death based on the results of forensic medical examinations of corpses with ethanol in biological fluids. Material and methods. The material of this paper is data on forensic medical examinations collected by the Russian center of forensic medical examination of the Ministry of Health of the Russian Federation using the statistical observation form #42 “Forensic pathologist’s report, the Burau of forensic medical examination”. The study uses the method of descriptive statistics and correlation analysis. The share of deaths from various causes with ethanol in biological fluids was analyzed based on the results of forensic medical examinations by region and cause of death in 2003-2022. Results. The share of deaths with ethanol in biological fluids equaled to 46% of all forensic medical examinations in 2003, followed by a gradual decrease to 19% in 2022. The maximum was registered in external causes of death. Over the study period (2003-2022) the share of deaths with ethanol in biological fluids among deaths due to external causes decreased from 60% to 47, and from 31% to 14% among non-violent deaths. The share ranged from 36% to 45% among deaths attributed to symptoms, signs and ill-defined conditions without a tendency towards decreasing. For a number of external causes of death, this indicator consistently accounted for more than half of all forensic medical exams. Over the period under study, most regions of Russia witnessed a noticeable decrease in the share of deaths with ethanol in biological fluids, however, in some regions like the Republic of Buryatia, Sakhalin Region, Trans-Baikal Territory, Magadan Region, Nenets Autonomous Area and Murmansk Region, there is no noticeable decrease. The minimum was registered in the Chechen Republic and Republic of Ingushetia. However, in the North Caucasian republics, in general, there are low rates of forensic medical examinations of all deaths (less than 10%). Conclusion. Results of forensic medical examinations can potentially supplement and refine complex estimates of the contribution of alcohol consumption to the Russian mortality.

ОЦЕНКА ГОТОВНОСТИ СТАЦИОНАРОВ К РАБОТЕ В УСЛОВИЯХ ЧРЕЗВЫЧАЙНЫХ СИТУАЦИЙ

Significance. The COVID-19 pandemic has led to a crisis in society and seriously challenged healthcare capabilities around the world. The industry's lack of preparedness for such a large-scale and rapid spread of the virus around the world was one of the major factors in the fight against the pandemic faced by medical organizations and health services around the world. During the pandemic, the Russian Federation (hereinafter referred to as the RF) has radically restructured activities of medical organizations, re-equipped them with modern medical equipment, and intensively developed digitalization, making it possible to prevent the collapse of the industry and ultimately successfully cope with the pandemic. Analysis of the results and consequences of the restructuring the entire industry, medical organizations providing medical care of various types and in different conditions, allows us to assess emergency preparedness of hospitals and develop recommendations for the future. The purpose of the study was to assess hospital emergency preparedness in the Russian Federation based on the analysis of dynamics in bed capacity, structure of beds and utilization indicators in 2019-2022. Material and methods: comparative analysis of the number of beds, its structure and utilization indicators in the pre-COVID period, the pandemic period and the early post-COVID period based on the federal statistical observation form No. 30 “Information about medical organization” in the Russian Federation and in the constituent entities of the Russian Federation. Methods included descriptive statistics, comparative analysis and analytics. Results. A long-term trend towards reducing bed capacity and availability of beds was once interrupted in 2020, with the trend towards reducing the number of beds in rural areas remaining interrupted. In general, during the observation period, the total number beds decreased by more than 30 thousand, the population-to-bed ratio decreased by 3%, and the hospitalization rate dropped by 7%. The shortage of adult infectious disease beds at the beginning of the pandemic associated with the prior reduction of bed capacity against the background of the network restructuring was met by repurposing other beds to serve as infectious disease ones, and deploying additional infectious disease beds in and outside medical organizations to treat patients with COVID-19. The number of adult infectious disease beds increased 7.5-fold by the end of 2020. However, the number of adult infectious disease beds then started to decrease reaching a 59,4% increase by 2022 compared to 2019, but their share in rural areas decreased from 14% to 8%. The number of pediatric disease beds increased against the background of competing dynamics. Overall, during the period, the total number of pediatric and adult infectious disease beds increased by 27%. In the structure of adult infectious disease beds, the share of COVID-19 beds varied from 92% in 2020 to 34% in 2022; additionally deployed COVID-19 beds were also in operation. Over the observation period, the average bed length of stay and average bed occupancy decreased, while hospital mortality increased. Significant variability in hospital performance indicators across regions was registered. Conclusion In 2021-2022, hospital facilities in the Russian Federation were prepared to meet the increased incidence of infectious diseases. However, the renewed processes of bed capacity reduction necessitated forecasting sustainability of hospitals in emergency situations. The undertaken analysis shows that a cut in the number of round-the-clock beds should not be guided by the mere process of reduction. The decision to change the bed capacity and structure should be preceded by a thorough preliminary analysis of specialized care availability by each specialty planned to be reduced. Reducing planned hospitalizations and postponing treatment of patients with chronic non-communicable diseases turned out to be not fully justified, which was confirmed by other studies. Infectious disease beds must function in optimal numbers to cope with the increased flow of patients in early stages of an emergency. The areas where infectious disease beds are deployed must be sufficient to realize the possibility of quickly increasing the capacity of an infectious disease hospital to the required level. Planning a network of hospitals should ensure a comprehensive specialized care delivery to patients with chronic non-communicable diseases during emergencies including planned care. Scope of application: Hospital capacity and structure planning.

Assessment of the composition of adult patients hospitalized in Russian hospitals

The article presents an analysis of the distribution of adult patients discharged from medical organizations providing inpatient care, hospitalized morbidity, and the average length of stay by disease classes and nosology in Russia for the period from 2016 to 2020. The aim of the work was to assess the composition of adult patients hospitalized in Russian hospitals over 5 years (2016–2020). Statistical and analytical research methods were used in the research. The data on the number of discharged adult patients (18 years and older) from medical organizations providing inpatient care as well as on the number of bed-days discharged were obtained from the federal statistical observation form no. 14 “Information on the activities of units of medical organizations providing inpatient care” for 5 years. The number of discharged adult patients from hospitals decreased by 15,4 %, the hospitalized morbidity rate decreased from 205,5 to 175,8 per 1000 people of the corresponding age, the average duration of stay in a hospital bed decreased from 11,7 to 11,0 days. A downward trend in hospitalized morbidity is traced for all classes of diseases. Since 2020 there is a change in the structure of hospitalized morbidity of adult patients by disease classes, which can be explained by the pandemic of a new coronavirus infection COVID-19 and the reprofiling of most hospitals to infectious diseases hospitals.

АНАЛИЗ ГОСПИТАЛИЗИРОВАННОЙ ЗАБОЛЕВАЕМОСТИ БОЛЕЗНЯМИ СИСТЕМЫ КРОВООБРАЩЕНИЯ НАСЕЛЕНИЯ СТАРШЕ ТРУДОСПОСОБНОГО ВОЗРАСТА РОССИЙСКОЙ ФЕДЕРАЦИИ

Significance: The fact of population ageing, including the associated rise in cardiovascular diseases, leads to a higher care seeking by people of post-working age and, as a result, an increase in the number of hospital admissions. The analysis of admission rate makes it possible to evaluate advanced cases and severity of conditions associated with the admission to hospital. The purpose of the study is to analyze dynamics in changes in the indicator of admission rate for diseases of the circulatory system among post-working age population in the Russian Federation. Material and methods. The composition of post-working age patients with diseases of the circulatory system and individual nosologies discharged from hospital was analyzed according to the federal statistical observation form No. 14 “Information on activities of departments of medical organizations providing inpatient care” for the period 2010-2021 (divided into two periods due to the changed retirement age). Research methods included: statistical, analytical. Results. In 2010-2019 in the Russian Federation, the highest increase in admission rate was registered for other heart diseases - 2.4 times including a 2.64-fold rise in fibrillation and atrial flutter cases, an 80.8% increase in past myocardial infarction, a 25.9% increase in hypertensive heart disease, a 20.2% rise in cerebrovascular diseases, including a 28.6% rise in other cerebrovascular diseases. Over a decade, the admission rate for all diseases increased from 269.7 to 294.1 per 1000 post-working age population (women aged 55+, men aged 60+) (by 9.1%), including a rise in diseases of the circulatory system from 105.3 to 107.5 per 1000 population of the corresponding age (by 2.1%). The share of admissions for diseases of the circulatory system among post-working age population in the structure of all diseases decreased from 38.9% to 36.5%. The admission rate among post-working age population in 2020-2021 increased from 77.6 to 78.35 per 1000 population of the corresponding age (women aged 56+, men 61 +). Conclusion: In 2010-2019, the admission rate for diseases of the circulatory system increased by 2.1%. The share of the discharged patients admitted for emergency care due to diseases of the circulatory system increased from 43.65 to 53.0%. During the second period under study (2020-2021), the indicator of admission for diseases of the circulatory system increased by almost 1.0% with a slight decrease in the share of the discharged patients admitted for diseases of the circulatory system from 60.2 to 58.7%.

УЧАСТКОВАЯ ПЕДИАТРИЧЕСКАЯ СЛУЖБА: ТРЕНДЫ КАДРОВОГО ОБЕСПЕЧЕНИЯ В УСЛОВИЯХ КРУПНОГО АГРОПРОМЫШЛЕННОГО РЕГИОНА

Significance. Timely monitoring over human resources makes it possible to identify reserves for improving accessibility, quality and effectiveness of pediatric primary care delivery. The purpose of the study. To evaluate dynamics in staffing with district pediatricians in the Krasnodar Territory. Material and methods. The material included data of the state statistical observation form No. 30 “Information about a medical organization” in 2010-2021, depersonalized data from the register of the assigned population of the Krasnodar Territory and the regional register of medical workers as of 01.01.2022. Statistical and analytical methods were used. Results. In the Krasnodar Territory there are 76 medical organizations with the position of district pediatrician. The total staffing of the district service with pediatricians equals to 1,307 positions, staffed by 1,071 individuals (81.9%). The estimated deficit between the number of positions and the number of individual district pediatricians is 250 specialists. The share of specialists of the pre-retirement and retirement age is high. During the period under review, against the background of a general decrease in the number of individual doctors in the region by 5.1% (p<0.001), there was a 12.6% (p<0.001) increase in the number of district pediatricians. The growth rate of the pediatric population in the region exceeded the one among individual district pediatricians, resulting in a 6.0% decrease in the population-to-doctor ratio(p<0.001). The undertaken in-depth analysis shows that 34% of the district pediatricians have a 1.5-fold and higher workload than the recommended one. In conditions of excessive workload of district pediatricians, primary care services are provided to about 620,000 children. The mean age of a district pediatrician in the Krasnodar Territory equals to 47 ± 0.3 years, however, about half of all doctors in the analyzed group are specialists of the pre-retirement and retirement age. A combined analysis of the age structure of pediatricians and size of the facility catchment areas shows that 30.8% the of district doctors aged over 60 have a workload that is higher than the recommended standards. Conclusion. A wider range of methods to monitor the population-to-district pediatrician ratio and the use of both traditional and advanced methods of analysis based on the register of the assigned population and the register of medical workers will make it possible to identify problem areas in the industry and promptly meet the changing staffing needs of the district pediatric service. Scope of application. The study results can be used to plan and implement personnel programs aimed at eliminating personnel shortages and imbalances.

ДИНАМИКА КАДРОВОГО ОБЕСПЕЧЕНИЯ МЕДИЦИНСКИХ ОРГАНИЗАЦИЙ В АСПЕКТЕ ДОСТИЖЕНИЯ ЦЕЛЕВЫХ ПОКАЗАТЕЛЕЙ РЕАЛИЗАЦИИ ФЕДЕРАЛЬНОГО ПРОЕКТА

Sufficient number and level of training of medical personnel largely determine the availability and quality of medical care. The federal project “Providing medical organizations with qualified personnel” is aimed at eliminating the problem of personnel shortage. Solutions to the personnel problems should be based on the results of continuous monitoring with a detailed analysis of statistical data. The purpose of the study is to analyze and evaluate dynamics in staffing of medical organizations in 2017-2021. Material and methods. The study was carried out on the basis of the information database of the Russian Research Institute of Health, based on the federal statistical observation form N30 for 2017-2021. The study used analytical, statistical methods and the method of comparative analysis. Results. The number of full-time medical positions in first years of the federal project implementation has been reduced, probably with the aim of achieving the required level of staffing of full-time positions by individuals with the full-time to part-time ratio of no more than 1.2. Simultaneously with the reduction in the number of full-time positions, the number of individual doctors increased, therefore, the indicator of staffing of full-time positions with natural persons was increasing until 2019 with a decline in the full-time to part-time ratio. A significant increase in the number of full-time medical positions during the pandemic has negated the previous reduction. The difference in the growth rate of the number of individual doctors and the number of full-time positions has led to decreased staffing level in general across all medical organizations, mainly due to a significant reduction in the indicator in units providing inpatient care. However, the indicators of staffing and staffing level of units providing outpatient care are higher compared to inpatient settings. Discussion. Analysis of the dynamics in indicators of doctor staffing in the period from 2017 to 2021 does not allow us to project achievements of the target staffing level in units providing outpatient care with the full-time to part-time ratio of 1.2 by 2024. Conclusion. Dynamics in the staffing level tends to reverse compared to the planned one under the Federal project, the full-time to part-time ratio remains high, especially in inpatient settings. The imbalance of staffing remains. Additional measures are needed to solve the personnel problem and promptly resolve the issue of salaries of medical workers to achieve a certain material security without a secondary job.

ДИНАМИКА ОБЕСПЕЧЕННОСТИ ВРАЧЕБНЫМИ КАДРАМИ В ГОСУДАРСТВЕННЫХ МЕДИЦИНСКИХ ОРГАНИЗАЦИЯХ РОССИЙСКОЙ ФЕДЕРАЦИИ В ПЕРИОД С 2018 ПО 2022 ГОД

Significance. The issue of staffing with medical specialists is in current focus at all levels, since efficiency of the healthcare system depends on the labor resource. A retrospective analysis of the actual staffing makes it possible to develop and adjust measures aimed at eliminating the shortage of medical workers. The purpose of the study was to analyze dynamics of the number of doctors in medical organizations of the Russian Federation in 2018-2022. Material and methods. The paper used data extracted from the Federal statistical observation form # 30 "Information about a medical organization" on the number of doctors in medical organizations of the Russian Federation, federal districts and constituent entities of the Russian Federation for the period from 2018 to 2022. Analytical and statistical methods were used. Data processing was performed using Excel 2019 spreadsheets. Results. The results of the analysis of data on the number of doctors for the past 5 years indicate a 0.5% decrease. In the Russian Federation, significant territorial disparities in the doctor-to-population ratio (per 10,000 population) have been identified, which can be traced throughout the study period. Thus, a comparative analysis in the context of the districts of the Russian Federation showed that the highest doctor-to-patient ratio is registered in the North-Western Federal District (43.9 0/000), and the lowest one - in the Southern Federal District (33.1 0/000), a 1.3-fold difference. There is an increase in the staffing with individuals, so in 2022 in the Russian Federation the indicator was 63.6% with a part-time ratio of 1.3. The average age of doctors in country as a whole equaled to 43.5 years. Conclusion. The doctor-to population ratio in country as a whole decreased by 0.5%, while 71 constituent entities of the Russian Federation show a favorable situation in terms of staffing. The indicator of staffing of full-time positions with individuals increased to 63.6%, with a decrease in the part-time ratio to 1.3. The average age of medical personnel over a five-year period decreased by 0.26 years. Scope of application. The study results can be of interest to health officials, practitioners, residents and graduate students of medical universities.

УРОВЕНЬ И СТРУКТУРА АБОРТОВ В РЕСПУБЛИКЕ БАШКОРТОСТАН ЗА 2017-2022гг.

Significance. Despite the decline in the frequency of abortions, they remain an urgent problem due to the decline in the birth rate and deterioration of the reproductive health of the female population. The purpose of the study is to determine the structure and frequency of pregnancy termination among women in the Republic of Bashkortostan for 2017-2022. Material and methods. The main sources of information were the official statistical materials of the Ministry of Health of the Republic of Bashkortostan, federal statistical observation form No.13 (“Information on pregnancy with an abortive outcome”), as well as information from the state health information system of the Republic of Bashkortostan on termination of pregnancy among women. Results. From 2017 to 2022 in the Republic of Bashkortostan there was a 41.5% decrease in the frequency of abortions among women of reproductive age (from 14.7 per 1000 women of reproductive age in 2017 to 8.6 per 1000 women of reproductive age in 2022). Medical abortions prevailed in the structure of pregnancy termination up to 12 weeks (52.8% in 2017 and 41.1% in 2022), and spontaneous abortions prevailed in the structure of pregnancy termination from 12 to 22 weeks (44.1% and 40.6%, respectively). Abortion rates decreased among both urban and rural women, but were higher among rural women compared to urban women. The highest abortion rates were observed in the age groups of 20-24 years, 25-29 years, 30-34 years and 35-39 years. It should be noted that the prevalence of abortion was higher among rural women (9.3‰ and 6.5‰ respectively) than urban women (4.4‰ and 2.8‰ respectively). The average women age who terminated pregnancy was lower among rural women. Abortions up to 12 weeks prevailed in the structure of pregnancy terminations. Conclusions. From 2017 to 2022, the Republic of Bashkortostan registered a decrease in the abortion rate, the majority of pregnancies were terminated until 12 weeks of gestation, the prevalence of abortion is higher among rural women, the average age of rural women who terminated pregnancy was lower compared to urban women.