Free Care Research Articles

Taking a novel approach to educating staff on infection prevention

Amy Griffiths and Pasqua Fitzgibbon, Harm Free Care Nurse Specialists, Newcastle upon Tyne Hospitals NHS Foundation Trust ( amy.griffiths15@nhs.net ), achieved a Bronze award in the Infection Prevention Nurse of the Year category of the BJN Awards 2023

DETERMINING COMMITMENT TO THE UNIVERSITY CLINIC OF O. O. BOGOMOLETS NATIONAL MEDICAL UNIVERSITY

Introduction. The article reveals the role of university clinics (hereinafter - UC) in the system of healthcare institutions in Ukraine and their role in implementing the right of every citizen to receive free medical care in state and communal healthcare institutions at the expense of the state budget under the program of medical guarantees. The results of a medical and social study to determine patients' attitudes towards UCs and identify risk factors for non-acceptance are presented.
 The aim. To determine the place of the University Clinic of the O.O. Bogomolets National Medical University in the medical-industrial cluster system of Kyiv city, conduct a medical and social study of patient attitudes towards the university clinic, and identify the main factors of non-acceptance.
 Materials and methods. The study was conducted on the principle of systematicity, using medical-statistical methods, methods of anonymous questionnaire survey, and analytical generalization. The construction of the sample of respondents is based on the fact that, based on the study of their opinion, it is possible to draw conclusions about the public opinion of potential clients.
 The results of the study show that university clinics, as a component of the healthcare system, meet the needs of citizens in terms of the effectiveness of services provided and accessibility to the population. With innovative equipment and the involvement of highly qualified specialists from the University's departments in the diagnostic and treatment process, university clinics are increasingly gaining the trust and support of patients.
 The results of the survey confirm that the university clinic of the National Medical University named after O.O. Bogomolets has successfully integrated into the medical-industrial cluster of Kyiv, establishing cooperation with the university, the Ministry of Health, other ministries and agencies, as well as with patients.
 Analysis of the socio-demographic indicators of the respondents in 2022 showed a significant volume of services provided by the clinic to the population of Kyiv and other regions of Ukraine (with the highest number of visits from pensioners - 83, and civil servants - 57 out of 213 surveyed), thus ensuring the implementation of the state program of medical guarantees for citizens. The risk of low probability recommendations by the clinic is influenced by increasing age (p=0.013) and decreasing educational level (p=0.040) of patients. The risk of low satisfaction with the comfort of the clinic increases (p=0.002) when patients visit the medical facility on the recommendation of acquaintances (patients of the clinic).
 Conclusions. The positive conclusion of the survey is the absence of a risk of probability of re-appealing to the UC based on the analyzed characteristics.

Abstract 96: When Canada is a Under-Resourced Country: Patient-Oriented Research on Optimizing Rational Decision-Making for Bladder Cancer

Abstract Purpose: To identify gaps between the ideal and current approaches to Non-Muscle Invasive Bladder Cancer (NMIBC) in Canada, and determine what should be done short- and long-term to address those gaps. Methods: Prompted by a patient diagnosed with NMIBC in July 2022, we first searched the global literature for the most-effective preventive, screening, diagnostic, and therapeutic approaches to NMIBC, and also examined sites such as Bladder Cancer Canada and professional societies’ sites for clinical recommendations. We next conducted written and oral interviews with urologists, researchers, primary care physicians, and manufacturers of related interventions to understand and synthesize the literature and determine the best clinical course of action. Results: Our approach produced prompt and free care, of quality ranging from poor to outstanding. It required substantial patient resilience and advocacy, much of which is likely easily remediable, some of which will require policy changes. Care quality gaps of particular concern that were identified included: Conclusion: Treatment of NMIBC in Canada is not currently provided in an optimized or rational fashion. Several improvements that are without meaningful associated cost have been identified that we conclude should be immediately implemented. Other interventions should be considered immediately by policymakers to reduce unnecessary morbidity, mortality, suffering, and other societal costs. Citation Format: Erica Frank. When Canada is a Under-Resourced Country: Patient-Oriented Research on Optimizing Rational Decision-Making for Bladder Cancer [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 96.

Neurotrauma Emergencies during the SARS-CoV2 Pandemic at a Tertiary Medical Center: Analysis of Incidence and Outcome.

We assess the impact of lockdown in Germany due to the COVID-19 pandemic on the incidence and outcome of neurotrauma emergencies at a tertiary medical center. All neurosurgical emergencies from March 16, 2020 (first lockdown in Germany) to January 31, 2021 were included and compared with a longitudinal case-cohort. Cases were descriptively recorded and retrospectively analyzed with respect to incidence and outcome. All emergencies defined as polytrauma referred to our center decreased by 10% during the pandemic (n = 226), whereas neurosurgical emergencies increased by 18.4% (764 vs. 905 cases). The number of specific neurotrauma emergencies increased by 44.4% (63 vs. 91 cases), yet statistically not significant (p = 0.245). The duration of treatment in the intensive care unit (ICU) extended from 621 to 1,056 days (p = 0.34). The reasons for the increase in the number of neurotrauma emergencies were the following: (1) many surrounding smaller care providers were canceled during this time and (2) there was a lack of free intensive care capacities in other hospitals, urging primarily maximum care providers to deal with more referrals. Both these facts and the prolonged treatment on ICUs strengthen the necessity for maximum care providers to keep ICU capacities for non-COVID patients. Specialized neurosurgical expertise should maintain in tertiary medical centers, even or particularly in exceptional circumstances such as the current pandemic.

Labor relations and social security: separate problems of legal regulation

The conclusion of an employment contract by an employee and the exercise of labor activity is associated with the acquisition by an employee of insurance and work experience, including special work experience, the acquisition of which then becomes the basis for the acquisition of social security rights, in particular, the right to receive pensions, benefits; citizens have the right to receive free medical care, social services, etc. One of the legal facts entailing the emergence of social security relations between an employee and the state (state-authorized bodies), or an employee and nongovernmental organizations may be social security contracts. Problems, defects in the legal regulation of this kind of social security relations should be taken into account by specialists in the field of personnel records management.

MANAGEMENT OF FINANCIAL SECURITY OF THE ACTIVITIES OF MEDICAL INSTITUTIONS OF UKRAINE

The economic essence of such categories as «management», «financial resources»and «financial support»in the medical field was studied, which allowed us to generalize the main characteristics inherent in them. Certain characteristic features of financial support, which are specific to medical institutions in order to maintain their effective activity and further development, are considered.The original provisions of the Concept of the reform of the financing of the health care system, adopted in 2017, which played a key role in the reform of the medical industry, were considered. An analysis of the financing system of health care institutions was carried out, starting from 2018 (transition period) until 2021.It was determined that the goal of financial support is the formation of a new model of financing health care institutions, which is determined by transparent state guarantees of providing free medical care to citizens, improving the financial protection of the population in case of illness, effective and fair distribution and use of public funds and reducing informal payments, application incentives for improving the quality of providing medical services to citizens by medical institutions of all forms of ownership. Therefore, the problem of improving the process of managing the financial support of medical institutions is the most urgent.The positive consequences of the medical reform have been proven, namely: medical institutions apply market principles of functioning; use methods of rational management of financial flows (incoming and outgoing); the autonomy of medical institutions and the possibility of self-sufficiency and self-financing, obtaining the status of an enterprise, are increasing; the effectiveness of medical institutions increases due to market orientation, purposefulness and responsibility for their activities; the institution's competitive advantages increase.

Unplanned pregnancy and the association with maternal health and pregnancy outcomes: A Swedish cohort study.

Unplanned pregnancies are common and associated with late initiation and inadequate antenatal care attendance, which may pose health risks to mother and child. How pregnancy planning relates to maternal health and delivery in Sweden, a country with free antenatal care and free abortion, has not been studied previously. Our aims were to study whether pregnancy planning was associated with antenatal care utilization and pregnancy outcomes in a Swedish setting. Data for 2953 women, who answered a questionnaire when recruited at antenatal clinics in Sweden and later gave birth, was linked to the Swedish Medical Birth Register. The degree of pregnancy planning was estimated using the London Measure of Unplanned Pregnancy. Unplanned (comprising unplanned and ambivalent intention to pregnancy) was compared to planned pregnancy. Differences between women with unplanned and planned pregnancy intention and associated pregnancy outcomes were analyzed using Fisher's exact test and logistic regression. There were 31% unplanned (2% unplanned and 29% ambivalent) pregnancies, whereas most woman (69%) reported their pregnancy to be planned. Women with an unplanned pregnancy enrolled later to antenatal care, but there was no difference in number of visits compared with planned pregnancy. Women with an unplanned pregnancy had higher odds to have induced labor (17% versus 13%; aOR 1.33 95% CI 1.06-1.67) and a longer hospital stay (41% versus 37%; aOR 1.21 95% CI 1.02-1.44). No associations were found between pregnancy planning and pregnancy-induced hypertension, gestational diabetes mellitus, preeclampsia, epidural analgesia use, vacuum extraction delivery, Caesarean section or sphincter rupture. Unplanned pregnancy was associated with delayed initiation of antenatal care, higher odds for induction of labor and longer hospital stay, but not with any severe pregnancy outcomes. These findings suggest that women with an unplanned pregnancy cope well in a setting with free abortion and free health care.

Association of Nationwide Water Fluoridation, changes in dental care legislation, and caries-related treatment needs: A 9-year record-based cross-sectional study

ObjectivesThe implementation of Nationwide Water Fluoridation in Israel in 2002 led to a significant reduction in caries among children. However, this practice was discontinued in 2014 due to a change in legislation. In 2010, as part of the Israeli National Health Insurance Law, free dental care for children under 10 years of age was legislated. This policy was gradually extended to include adolescents under 18 years of age in 2018. We examined the association between these efforts and changes in the caries-related treatment needs of young adults over the course of two decades. MethodsThis cross-sectional study analyzed data on the need for dental restorations, root canal therapy, and extractions that were retrieved from dental records of 34,450 soldiers recruited into military service between 2012 and 2021. These data were cross-matched with the subjects' year of birth to determine whether the implementation of water fluoridation, dental care legislation, or both were associated with changes in the need for and provision of dental care. Sociodemographic data, including sex, age, socioeconomic cluster (SEC), intellectual capability score (ICS), body mass index, and place of birth, were also extracted. ResultsA multivariate generalized linear model (GLM) revealed that male sex, older age, low ICS, and low SEC were significant predictors for greater caries-related treatment needs (P < 0.001). Our findings indicated that subjects exposed to fluoridated water during their childhood had significantly lower rates of caries-related treatment, regardless of access to free dental care. ConclusionMandatory water fluoridation was associated with significantly lower caries-related treatment needs while national dental health legislation providing free dental care to children and adolescents was not. Therefore, we suggest that water fluoridation should be continued to maintain the observed reduction in treatment needs. Clinical significanceOur findings provide support for the effectiveness of water fluoridation in preventing caries, whereas the impact of free dental care programs focused on clinical intervention remains to be determined.

Ultrasound-guided fluid resuscitation versus usual care guided fluid resuscitation in patients with septic shock: a systematic review and meta-analysis

Abstract Background Ultrasound is widely used in critical care for fluid resuscitation in critically ill patients. We conducted a systematic review to assess the relationship between ultrasound-guided fluid resuscitation strategies and usual care in septic shock. Methods We searched PubMed, Embase, Cochrane Library, Web of Science, and registers for randomized controlled trials to evaluate the prognosis of ultrasound-guided fluid resuscitation in patients with septic shock. Results Twelve randomized controlled studies with 947 participants were included. Ultrasound-guided fluid resuscitation in patients with septic shock was associated with reduced mortality (risk ratio: 0.78; 95% confidence interval [CI]: 0.65 to 0.94; P = 0.007) and 24-hour fluid volume (mean differences [MD]: −1.02; 95% CI: −1.28 to −0.75; P &lt; 0.001), low heterogeneity (I 2 = 29%, I 2 = 0%), and increased dose of norepinephrine (MD: 0.07; 95% CI: 0.02–0.11; P = 0.002) and dobutamine dose (MD: 2.2; 95% CI: 0.35–4.04; P = 0.02), with low heterogeneity (I 2 = 45%, I 2 = 0%). There was no reduction in the risk of dobutamine use (risk ratio: 1.67; 95% CI: 0.52 to 5.36; P = 0.39; I 2 = 0%). Inferior vena cava–related measures reduced the length of hospital stay (MD: −2.91; 95% CI: −5.2 to −0.62; P = 0.01; low heterogeneity, I 2 = 8%) and length of intensive care unit stay (MD: −2.77; 95% CI: −4.51 to −1.02; P = 0.002; low heterogeneity, I 2 = 0%). The use of the passive leg-raising test combined with echocardiography to assess fluid reactivity was superior. Ultrasound-guided fluid resuscitation did not significantly change the length of the free intensive care unit stay (MD: 1.5; 95% CI: −3.81 to 6.81; P = 0.58; I 2 = 0%). Conclusion Ultrasound-guided fluid resuscitation in patients with septic shock is beneficial, especially when using inferior vena cava–related measures and the passive leg-raising test combined with echocardiography.

"Actual problems and the role of the Prosecutor's Office in the implementation of the human rights function related to the rights of minors to social security"

In fulfillment of the State task, the protection of children is put first in the field of education, receiving free medical care, housing, etc. The task of protecting the rights of adolescents to social security is reflected in the guiding documents: the Declaration of the Rights of the Child[1] and the Convention on the Rights of the Child [2], also in the Optional Protocol to the Convention on the Rights of the Child[3]. Difficulties in the process of protecting the rights of minors arise due to imperfections of legislation, gaps in law, contradictions of federal and regional legislation. In this regard, the processes of formation and development of the institute for the protection of children's rights in Russian law, the definition and expansion of opportunities for prosecutorial control over the performance of duties to protect the rights of adolescents are very important. These factors determined the choice of the topic and its relevance.The object of the study is the rights of minors to social security. The subject of the study is the role of the Prosecutor's Office in the implementation of the human rights function for the observance of the protection of the rights of minors.The purpose of the study is to study theoretical issues, as well as practical proposals for improving legislation, which are aimed at improving the work of the prosecutor's office to protect the rights of adolescents to social security. The methodological basis of the research is a set of general scientific and private scientific methods of knowledge, specifically: observation, comparison, study and synthesis, induction and deduction. The practical significance of the scientific work lies in the fact that the results of the study can be applied in the practice of prosecutors to protect the rights of adolescents, in law-making work to improve legislation that regulates the issues of prosecutorial control over the performance of duties to protect the rights of adolescents.

In Case You Haven't Heard…

Antidote Health, a telehealth company that views accessible, affordable health care as a fundamental human right, and the Charles Antetokounmpo Family Foundation (CAFF), a global foundation created by the Antetokounmpo Family that provides necessary resources and funding to partner organizations that help people and communities thrive, have announced the “Leave No One Behind” campaign. The campaign endeavors to deliver free mental telehealth care services provided by board‐certified physicians to the people of Milwaukee and is being made possible by a $1 million commitment from Antidote and CAFF, the companies reported in a news release through Business Wire on March 9. Under the terms of the “Leave No One Behind” program, eligible Wisconsin residents will receive free mental health care treatment conducted via teleconference with a board‐certified physician. No‐charge services included in the program are an evaluation, clinical diagnosis, medication management and follow‐up visits, plus up to $30 per month assistance with out‐of‐pocket drug expenses. Sign‐up will remain open until capacity is reached. “By leveraging CAFF's support and providing our leading mental health care to the people of Milwaukee — the city Giannis himself calls home — at no cost through Antidote's platform, we are getting incrementally closer to realizing that common goal,” said Avihai Sodri, co‐founder and CEO of Antidote Health, referring to NBA superstar Giannis Antetokounmpo, one of the co‐founders of CAFF and a brand ambassador for Antidote Health, noted the press release.

Can beneficiary information improve hospital accountability? Experimental evidence from a public health insurance scheme in India

We study the role of hospital compliance in the effectiveness of government health insurance in India. Using patient surveys, we document that participating hospitals charge unauthorized fees to poor patients eligible to receive free care. Average out-of-pocket payments (OOPP) for chronic kidney care patients are $43 per month, or 25% annual GDP per capita, and are high at both public and private hospitals. Awareness of program benefits is low despite patients having used insurance for several months. We conduct a randomized experiment to test whether phone-based information about program benefits can enable insurance beneficiaries to hold hospitals accountable and lower OOPP. The intervention effectively increases program awareness by 0.17 standard deviations but has no effect on OOPP overall. However, effects differ dramatically by hospital sector: patients at private hospital see no change in OOPP despite increased bargaining and search; monthly OOPP among patients visiting public hospitals, who are poorer and lower caste, drop by $12 (35%), because they are able to negotiate to get more of their benefits at the hospital instead of paying for them off-site. The findings suggest that patient-driven accountability can meaningfully improve public service delivery, even in the context of specialized tertiary care, but may not substitute for top-down monitoring of private agents.

A qualitative study of patients' and carers' perspectives on factors influencing access to hypertension care and compliance with treatment in Nigeria.

We explored patients' and carers' perspectives on factors influencing access to hypertension care and compliance with treatment. This was a qualitative study using in-depth interviews with hypertensive patients and/or family carers receiving care at a government-owned hospital in north-central Nigeria. Eligible participants were patients who had hypertension, receiving care in the study setting, were aged 55 years and over and had given their written/thumbprint consent to participate in the study. An interview topic guide was developed from the literature and through pretesting. All the interviews were held face-to-face by a member of the research team. This study was conducted between December 2019 and February 2020. NVivo version 12 was used to analyse the data. A total of 25 patients and 13 family carers participated in this study. To understand the barriers to compliance with hypertension self-management practices, three themes were explored, namely: personal factors, family/societal factors and clinic/organization factors. Support was the key enabling factor for self-management practices, which were categorized to emerge from three sources namely: family members, community and government. Participants reported that they do not receive lifestyle management advice from healthcare professionals, and do not know the importance of eating low-salt diets/engaging in physical activities. Our findings show that study participants had little or no awareness of hypertension self-management practices. Providing financial support, free educational seminars, free blood pressure checks, and free medical care for the elderly could improve hypertension self-management practices among patients living with hypertension.

Analysis of sources of financing of medical care in the Russian Federation

The subject of the study is the sources of financial support for state guarantees of free medical care to citizens in the Russian Federation. Particular attention is paid to the analysis of the composition and structure of the financial support of state guarantees of free medical care to citizens (including the volume of contributions received by the budget of the Federal Compulsory Medical Insurance Fund for working citizens and for non-working citizens). The authors also assessed the potential volume of MHIF budget revenues from the payment of insurance premiums and compared the results obtained with actual data. Research methods used: structural and dynamic analysis, synthesis, comparison, as well as graphical presentation of the results obtained. Based on the results of the study, it was revealed that contributions for the non-working population are paid from regional budgets. Taken together with the use of funds from the federal budget for the implementation of the program of state guarantees for the provision of free medical care to citizens, this allows us to conclude that the budgetary financial mechanism is predominantly used in financial support for the implementation of state guarantees of free medical care to citizens in Russia. In order to maximize the volume of funds for solving problems in the field of healthcare, as well as ensuring their more efficient use, the authors propose expanding the list of objects subject to insurance premiums, as well as a more reasonable approach to establishing various preferential regimes that reduce the volume of budget revenues of the Federal Compulsory Health Insurance Fund. The author’s calculations showed that the actual revenues of the MHIF budget are approximately half of the potential ones.

General taxes or insurance premiums: a comparison of funding sources for public health care in OECD countries

The subject of the study is a comparison of funding sources for public health care in OECD countries. The authors consider in detail the sources of financial support for the implementation of state guarantees for the provision of free medical care to citizens: transfers from state internal revenues (primarily general taxes: mandatory payments that do not have a target link) and insurance premiums (mandatory payments with a specific target link). The authors grouped the OECD countries depending on the share of sources of financial support for the implementation of state guarantees for the provision of free medical care to citizens. Particular attention is paid to the advantages and disadvantages of insurance and budgetary financial mechanisms for financial support for the implementation of state guarantees for the provision of free medical care. The main conclusions based on the results of the study are as follows: in the modern world, issues of improving the healthcare system as one of the key factors in improving the quality of life of citizens are being actively raised; no matter how actively the budgetary financial mechanism is currently used in the country, its use by public authorities in OECD countries is constantly increasing; the use of the budgetary financial mechanism, despite the existing shortcomings, has a number of advantages compared to the insurance one (primarily, due to the smaller direct impact during periods of reduction in the number of employees and wages, as well as economies of scale in the administration of revenues in the form of general taxes compared to insurance contributions). The results obtained can be used in the practical activities of the Federal Assembly of the Russian Federation, the Government of Russia, the Federal Compulsory Medical Insurance Fund, as well as public authorities from other countries when modernizing the state policy in the field of healthcare.

Sickle Cell Disease Knowledge and Reproductive Decisions: A Saudi Cross-Sectional Study.

Sickle cell disease (SCD) is an autosomal recessive disorder. Decisions following premarital screening results might be influenced by several factors. Thus, this study aims to assess the knowledge and beliefs toward SCD and reproductive decisions. A cross-sectional study was conducted among adults in the eastern province of Saudi Arabia. Data was collected using a web-based questionnaire. Participants were divided into two groups based on their knowledge scores. A total of 390 participants were recruited with a mean age of 28.6 years. The majority (90.5%) of participants had general knowledge about the disease mode of inheritance however, 66.9% had poor knowledge about the disease overall. Regarding knowledge level, there was no statistically significant difference between the non-healthy group (diseased and carrier) and healthy participants (P=0.304). Moreover, the participants' decisions about choosing future partners were more likely to be affected among those with prior knowledge about the disease (p=0.008). However, 152 (91.6%) male participants with prior knowledge would change their decision about selecting a future partner compared to 225 (92.4%) female participants. Regarding reproduction, only 38.5% of participants were aware of in vitro fertilization (IVF) as an assistive reproductive technology. Furthermore, female participants believed that IVF is a way to have healthy babies and would consider it despite the cost more than male participants (p=0.0001, p=0.007 respectively). SCD is an inherited disease with economic, physical, and psychological burdens. However, curative options are costly, and hence, prevention is key. Therefore, healthcare decision-makers should consider implementing policies to minimize the financial burden that may still affect society despite the availability of free medical care. This study warrants extensive community-based education programs that may contribute toward cost savings. It also highlights the importance of premarital counselling for disease and carrier people including alternative reproduction options.

Impact of community strategy package on uptake of reproductive tract infections health services among young street females in the municipality of Eldoret, Kenya

BackgroundDespite the intervention of free medical care services for street children by a dedicated clinic in Eldoret municipality, health care service of young street females (YSFs) is still deficient. The...

Management of orofacial clefts in Africa, insufficient management centers, and workforce.

Management of orofacial clefts in Africa, insufficient management centers, and workforce.

The analysis of application of telemedicine technologies in the Russian Federation in 2019-2022

Over the past five years, development of telemedicine was accompanied by many changes. Despite the need for remote medical care, development of telemedicine technologies was not uniformly intensive, both in different countries and in regions of a single state (such as Russia). The purpose of the study is to evaluate dynamics of volume of medical care and number of types of services using telemedicine technologies in regions of the Russian Federation. The retrospective analysis was applied to data retrieved from the Form of the Federal Statistical Observation № 30 of 2019-2021, from documentation of territorial programs of state guarantees of free medical care of population and tariff agreements in regions of the Russian Federation in 2021-2022 and from the Federal Telemedicine System in 2021. The study established that total number of telemedicine consultations increased in 2021 by 23% as compared with 2020. The percentage of consultations financed by the Compulsory Health Insurance Fund also increased from 6.95% in 2020 to 11.72% in 2021. The number of patients being on remote monitoring increased in 2021 up to 44% as compared to 2020. In addition, percentage of patients receiving medical care through remote monitoring and financed by the Compulsory Medical Insurance Fund increased from 6.55% in 2021 to 19.96% as compared with 2020. In the territorial programs of state guarantees for seven regions of the Russian Federation the number of types of telemedicine services fixed in tariff agreements increased in 2022 as compared to 2021. However, it decreased in ten regions. The most common medical care profiles for which telemedicine consultations in the "physician-physician" format were provided by Federal medical organizations in 2021 were: oncology (55 regions of Russia requested consultations on this profile), pediatrics (45 regions), and intensive-care medicine (39 regions). The telemedicine solutions are in high demand, as it is demonstrated by increasing both of volume of remote medical care and of percentage of consultations financed by the Compulsory Medical Insurance Fund. The COVID-19 pandemic had rather strong impact on development of telemedicine. The alignment of market for telemedicine services in public health sector began in 2021 and it is confirmed by decreasing of total number of consultation types in tariff agreements in 2022. In terms of remote interaction in "physician-physician" format, situation continues to be stable. In the nearest future one should expect more gradual development of telemedicine in Russia with appearance of individual initiatives in terms of pilot projects and experimental law modes.

Risk factors for hospitalization at the pediatric intensive care unit among infants and children younger than 5 years of age diagnosed with infectious diseases.

Children hospitalized with infectious diseases may develop severe, life-threatening conditions, often requiring admission to pediatric intensive care unit (PICU). The objectives of this study were to identify independent risk factors for PICU hospitalization with an infectious disease in children <5 years of age. In southern Israel, two populations live side by side: the middle-high income Jewish population and the low-income Bedouin population, both receiving equal and free medical care at the only tertiary medical center in the area. The study population included all children born in southern Israel and hospitalized at PICU with an infectious disease during 1991-2012. Risk factors for PICU hospitalizations were retrospectively studied by Kaplan-Meier and Cox proportional hazard survival analyses. 9951 Jewish children and 18,002 Bedouin children were enrolled; overall, 1135 episodes of PICU hospitalizations with an infectious disease were recorded (879, 77.4% Bedouin and 256, 22.6% Jewish patients). Bedouin children had a higher risk for PICU hospitalization with an infectious disease compared with Jewish children (adjusted Hazard Ratio [adj. HR] 1.7, 95% CI 1.5-2.0); maternal multiparity and low-birth weight (<2500g) were additional risk factors for PICU hospitalization with an infectious disease compared to firstborns (adj. HR=1.2, 95% CI 1.0-1.5) or to children with a birth weight ≥2500g (adj. HR=1.5, 95% 1.2-1.9). Older age was a protective factor for PICU hospitalization (adj. HR=0.98, 95% CI 0.97-0.99). Children hospitalized with a central nervous system infection had the highest risk of PICU hospitalization (adj. HR 6.8, 95% CI 5.5-8.4), followed by those with urinary tract infections (UTI, adj. HR 3.1, 95% CI 2.5-3.8) and those with lower respiratory tract infections (LRTI, adj. HR 2.9, 95% CI 2.4-3.4). Bedouin ethnicity, low birth weight, maternal multiparity and younger age were significant risk factors for PICU hospitalizations with an infectious disease. Among the infectious diseases analyzed, CNS infection had the highest risk for PICU hospitalization, followed by UTI and LRTI.