State Guarantees Research Articles

Подходы в совершенствовании нормативной базы в отношении применения мультифокальных интраокулярных линз при хирургическом лечении катаракты

Ultrasound phacoemulsification with intraocular lens (IOL) implantation is the “gold standard” for cataract treatment. Considering the existing requirements for the quality of vision after surgery, there is an increasing demand from patients for IOL implantation, which provides comfortable vision not only at a long distance, but also at a short one without the use of reading glasses (IOL with multifocal properties). The analysis of the existing regulatory framework regarding the possibility and obligation of using this medical product in the provision of specialized medical care – surgical treatment of cataract within the framework of the state guarantee program shows the possibility of using this consumable material without the obligation of the medical organization to consider the wishes of the patient. The change in the structure of the payment tariff for medical care for patients with cataract in 2023, the reduction in the tariff for providing specialized medical care to patients with uncomplicated forms affected the availability of multifocal IOL for patients without specifying the way to obtain this type of service, which makes it relevant to analyze approaches to improving the regulatory framework regarding the use of multifocal intraocular lenses in cataract surgical treatment. There are unsettled clinical, organizational, and economic issues regarding the use of multifocal intraocular lenses (artificial lenses) in the surgical treatment of cataract. There are various approaches (clinical-organizational, economic, legal, information) to improving the regulatory framework, but the approach of decision makers should be complex based on a comprehensive assessment of the economic, clinical, and technological components. Approaches are only a means to achieve a goal: the development of a multifunctional system of state guarantees in the provision of medical services, rational use of available resources.

Protection of the rights of foreign investors during the state of war in Ukraine

The article is devoted to the study of the protection of the rights of foreign investors during the state of war in Ukraine. The author focuses on the fact that this topic is currently relevant due to the fact that the reconstruction of Ukraine will become necessary. The war caused the outflow of foreign investments from our country. In addition, corruption, pressure from the authorities, and unfair justice are the reasons why foreign investors leave Ukraine. Every investor aspires to work in a state where law and justice reign, so Ukraine, which aspires to membership in the European Union, should create just such a state. Therefore, its primary task is to create a favorable business climate for foreign investors to carry out their activities. Current Ukrainian legislation guarantees compensation and indemnification of losses to a foreign investor, guarantees are also provided in case of termination of investment activity; state guarantees for the protection of foreign investments are defined. In accordance with the Law of Ukraine «On State Support of Investment Projects with Significant Investments in Ukraine», the state provides support to large investment projects. In connection with the introduction of the state of war in Ukraine in 2024, the Law of Ukraine on the insurance of investments against war risks entered into force. The Cabinet of Ministers of Ukraine established a credit agency that provides investment insurance. Although the war made Ukraine unattractive to foreign investors, the authorities are taking all possible measures to improve the country’s investment climate. The author draws attention to the need to study and transpose the experience of successful countries in this regard. For example, Australia offers quite good conditions to foreign investors - consistent economic growth, highly qualified labor force, strategic location, efficient administration and judicial system, and good infrastructure. Mexico is also attractive to foreign investors, the «Invest in Mexico» business center has been created to assist investors. The war is an accelerant for positive changes in the state, and after its end, the reconstruction of Ukraine is an important task, therefore the efforts of all branches of government should be directed at overcoming all obstacles to the effective work of foreign investors in our state.

EVOLUTIONARY TRANSFORMATION OF THE QUALITY ASSURANCE SYSTEM OF DEFENSE GOODS, SERVICES AND WORKS IN UKRAINE

It is inadvisable to limit the quality assurance system for defense-related goods/services/works solely to a set of mechanisms; it must necessarily encompass vertical and horizontal connections both among the relevant functional blocks (subsystems) and between the entities involved in their operation. In the context of not only geopolitical challenges but also the ongoing daily struggle against an aggressor state, it is critically important to establish an effective and efficient system for controlling the quality of defense-related goods/services/works. This article is dedicated to the systematization of the characteristics of transformational changes and the outlining of methodological foundations for the effective functioning of the quality assurance system for defense- related goods, works, and services in Ukraine. A conceptual three-level model of the quality assurance system for defense-related goods, services, and works has been formulated by distinguishing the essential parameters of their operation at the global, national, and micro levels. The peculiarities of forming a quality assurance system for defense-related products at both the micro and macro levels have been justified. It has been emphasized that the effectiveness of the evolutionary transformation of the quality assurance system for defense-related products at all levels of its representation should be characterized by the penetration of market forces into the mechanism of its operation. Attention has been drawn to the substantive directions for implementing the requirements of NATO standards in the AQAP series (AQAP 2110) within the framework of a corporate quality management system in accordance with ISO 9001. Since there are no legal or legislative requirements mandating the implementation of quality management systems, the enhancement and improvement of the efficiency of internal business and production processes should be a direct concern of the enterprise itself, driven by market forces. At the same time, the state should create stimulating mechanisms, for instance, by employing soft regulation; in military procurement specifications, it should mandate the presence of a certificate of compliance with AQAP requirements for the enterprises involved. The expected effects of the transformation of the studied system include economic, organizational, and worldview effects. A comparative analysis of the evolutionary transformation of the quality assurance system for defense-related goods, services, and works has been conducted based on the following criteria: the object and subject of control; the function performed by the control subject; the breadth of the controlling institution’s functionality; the perimeter of the controlling institution’s authority; the level of depth of control; and the level of subordination of the controlling institution to the Ministry of Defense. Despite the complexity of the task declared at the state level regarding the functioning of the state guarantee system for the quality of defense-related products, which is influenced not only by objective factors but also by worldview factors, its implementation has the potential to significantly enhance the quality of Ukraine’s defense products and substantially improve Ukraine’s rankings in terms of transparency, institutional maturity, and the ecological soundness of economic relations in the defense sector.

Improving the organization of medical care for patients in the specialty of medical rehabilitation in the Tomsk oblast

More than a third of the total population of the planet needs medical rehabilitation and the need will increase in the future. The prospective increase in life expectancy by the middle of the 21st century will be accompanied by an increase in the share of malignant neoplasms and diseases of the circulatory system in the morbidity structure, and the level of injuries will remain unchanged. These factors will negatively affect a person’s functional capabilities and will contribute to an increase in disability, increasing the relevance of medical rehabilitation. In Russia, according to the current procedure, there is a three-stage organization of medical rehabilitation. The implementation of these stages is carried out within the regional territorial programs of state guarantees (TPSG) of free medical care to citizens, which limits the financial accessibility of the completed cycle of medical rehabilitation for patients, due to budgetary allocations and the compulsory health insurance program, negatively affecting the quality of care provided. The article assesses the volume of medical rehabilitation provided in inpatient settings in the TPSG of the Tomsk oblast for the period of 2019–2022. Currently, three medical organizations in the region of different forms of ownership provide medical rehabilitation. In total, over a four-year-period, 8,804 cases in the specialty of medical rehabilitation were completed in the amount of 378.9 million rubles. An underfulfillment of the volume and costs of medical care during medical rehabilitation approved by the TPSG was recognized, as well as an outflow of patients for treatment to other regions (1,864 people during the study period). The most popular clinical and statistical groups (CSG) for which residents of the Tomsk oblast need rehabilitation measures have been identified, and organizational ways to improve the profile of this medical care have been substantiated.

Организационно-финансовые аспекты выбора интраокулярных линз при хирургии катаракты в условиях ценностно-ориентированной системы здравоохранения.

Relevance. In modern conditions, value-based healthcare provides for the provision by medical organizations of medical care of appropriate quality with mandatory control of its cost. Treatment outcomes that are important to the patient become no less significant than clinical performance indicators and payment for medical services, regardless of the profile of medical care. The gradual change in paradigms of healthcare systems from a paternalistic to a person-centric model required changes in organizational, legislative and financial approaches when introducing health-saving healthcare technologies. Purpose of the study: analysis of the current organizational, legal, financial and clinical models of surgical treatment of patients with age-related cataracts, astigmatism and development of proposals for the implementation of the patient’s right to choose intraocular lenses, taking into account his modern expectations from the results of treatment. Materials and methods. Statistical and analytical methods were used (content analysis methods, expert assessment methods, analysis and synthesis methods). Results. An analysis of the legislation in organizing the provision and financing of medical care to the adult population in the field of ophthalmology is presented, and state guarantees for the use of medical products – types of intraocular lenses implanted into the human body for the surgical treatment of senile cataracts and astigmatism – are considered. Clinical models of the disease are systematized, taking into account the frequency and frequency of provision of medical services and the list of medical devices implanted into the human body, professional, medico-economic, medico-legal and reputational risks are described when exercising the patient’s right to choose intraocular lenses in the treatment of ophthalmological pathology. Proposals have been developed to change clinical recommendations, standards of medical care for senile cataracts and astigmatism, and improve payment for ophthalmological care. Conclusions. The transition to value-based healthcare requires the consolidation of the efforts of all structures of the healthcare industry to achieve the best results in the treatment of ophthalmic diseases and increase the clinical effectiveness associated with the choice of intraocular lenses in the surgical treatment of adults in the field of ophthalmology.

DESIGN TASK IN THE MODERN CONDITIONS OF INVESTMENT AND CONSTRUCTION PROJECTS

The article is devoted to the organizational aspect of solving the urgent problem of shortening the terms of implementation of investment and construction projects in modern conditions at the stage design The article examines the procedure for drawing up a design task by the customer at the stage of preparing tender documentation for construction objects in Ukraine, the financing of which is carried out with the involvement of budget funds, funds of state and communal enterprises, institutions and organizations, loans provided under state guarantees and defined and disadvantages The provisions of regulatory and technical documents regulating the procedure for drawing up a design assignment and its content have been reviewed. The list of problems that arise at the design and construction stage during the implementation of investment and construction projects due to the uncertainty and variability of data for project development, provided by the customer in the design task, is defined. The analysis of open sources of information regarding the procurement of design works showed that customers fill out the design task form, defined by the regulatory framework, on a formal basis, without actually expressing their real requirements for the future construction inspection. In "design and build" projects, the design task occupies a special place, since the contractor, on the basis of the customer's technical task, can determine not only the cost of the design work, but also the price of the construction work for which he is willing to perform it, while this price depends on technical and economic parameters of the building, which has not yet been designed, from the applied finishing materials, engineering systems, structural solutions, etc. An analysis of completed contracts for the purchase of construction works on "design and build" schemes was carried out, and they were divided into groups depending on the sufficiency of information in the design task. The foreign experience of organizing design works was analyzed, in particular, when implementing the "design and build" approach. It is proposed to improve the organization of the design process by separating the process of drawing up the design task into a separate procedure with a toolkit based on digital technologies, formulating the customer's requirements for design solutions and checking the validity of the customer's requirements. The feasibility of developing a toolkit based on digital technologies, which can be applied by the customer for drawing up a design task in investment and construction projects.

ЭВОЛЮЦИЯ ПРОГРАММЫ ГОСУДАРСТВЕННЫХ ГАРАНТИЙ: МОДЕЛИ И МЕХАНИЗМЫ ОРГАНИЗАЦИИ БЕСПЛАТНОЙ МЕДИЦИНСКОЙ ПОМОЩИ ГРАЖДАНАМ РОССИИ НА РЕГИОНАЛЬНОМ УРОВНЕ

This publication is the first of the two papers on the Program of State guarantees of free medical care for the population. It presents a review and analytical evaluation of the Program development until the transition to middle-term planning (from 1999 to 2012 inclusive); analysis of the Program as a regulatory legal act which determines improvement of administrative and financial models and mechanisms of medical aid, as well as innovative and priority aspects of the health care development which were regulated for the first time by this document.

Pork barrel spending: The missing link between electoral clientelism and political budget cycles

Pork barrel spending used in the political budget cycles literature via a preference approach is identified as the link tying clientelism to political budget cycles. This paper looks at the supply and demand sides of electoral clientelism using the case study of shipyards in Croatia. The strategic, symbolic and everyday importance of the shipbuilding industry in Croatia is evident to the general public, but even more so to politicians. This paper examines the supply side – whether incumbents increase central budget funds (state guarantees) in election years (pork barrel spending) toward shipyards in Pula, Rijeka, Kraljevica, Trogir and Split – and the demand side – whether voters reward incumbents who engage in these pork barrelling practices. The theoretical foundations of the paper are based on the literature on clientelism, political budget cycles and the political economy of fiscal policy. Panel data analysis conducted on a sample of 5 shipyards over the 2001-2022 period confirms the existence of pork barrelling but does not confirm voters’ reactions to them. The empirical exercise identified the share of shipyard workers in the manufacturing industry at the county level as the main mechanism of electoral clientelism in Croatia.

Methodology of forming a model of diagnosis-related groups for cases of medical care using surgery performed by laparoscopic access

Background. A wide range of endosurgical treatment methods in various medical care profiles and the need for uniformity of calculations required developing a unified approach to the formation of diagnosis-related groups (DRGs) for cases of surgical medical care provided by laparoscopic access.Objective: to develop a methodology for the formation of a DRG model for cases of medical care using surgery performed by laparoscopic access in the context of the following medical care profiles: “coloproctology”, “urology”, “surgery (abdominal)”, “obstetrics and gynecology”, “pediatric urology-andrology”, “pediatric surgery”.Material and methods. The methodology for the formation of DRGs to pay for cases of medical care using surgery with laparoscopic access included the implementation of several stages: analysis of scientific and methodological documents, analysis of regulatory legal documents on the research topic, standardized expert survey of federal and regional medical centers (carried out in August 2023), formation of DRGs in the context of each profile, and calculation of cost-intensity coefficients.Results. Due to significant increase in the cost-intensity coefficient in nine newly formed DRGs to pay for cases of medical care provided by surgery with laparoscopic access, financial support of this type of surgical medical care almost doubled. The formed DRGs with appropriate cost-intensity coefficients were included in the Program on State Guarantees to Deliver Free Medical Care to the Citizens for 2024 and for the planning period of 2025 and 2026.Conclusion. The methodology of forming DRGs to pay for cases of medical care using surgery performed by laparoscopic access with a unified methodology for calculating costs for medical care provided an integrated approach to the process of forming DRGs for cases of surgical medical care, and unification of calculations for different medical care profiles.

Incidence of Diabetes Mellitus in the Kyrgyz Republic and the World. Factors Influencing Its Course

In recent years, large-scale studies based on data from administrative databases have reported changes in diabetes incidence over time. Different countries show various trends: stable incidence, decreases, and increases. High-income countries have seen a decline in diabetes incidence, possibly linked to changes in diagnosis and screening practices. The number of children and adolescents with diabetes, particularly type 2, is increasing, significantly impacting society. Diabetes is a cause of premature mortality and disability, negatively affecting the economy. In the USA, premature mortality is estimated to cost 19.9 billion dollars annually. In Kyrgyzstan, the burden of non-communicable diseases, including type 2 diabetes, is growing. Measures to combat diabetes in the country include free provision of insulin and medications, the approval of clinical guidelines and protocols, and the implementation of national prevention and control programs. The State Guarantee Program ensures free medication assistance for diabetes patients. Despite these efforts, issues with funding and resource efficiency remain. Improving the quality of medical care, intersectoral cooperation, and increasing accountability for public health are necessary. Enhancing the quality of pharmaceutical care and the efficient use of public funds are also priorities for improving the diabetes situation in Kyrgyzstan. Early diagnosis and treatment of diabetes complications, as well as the implementation of new prevention strategies, are crucial for reducing incidence and improving the quality of life for patients.

Роль федерального учреждения МНТК «Микрохирургия глаза» в работе региональной детской офтальмологической службы.

One of the main tasks of the children’s ophthalmological service in any region is to ensure the availability of high-tech medical care, however, personnel and technological shortages can negatively affect this indicator. Using the resources of a federal specialized clinic at the regional level can help resolve this issue. The goal is to reflect the participation of the federal specialized clinic in the work of the regional children’s ophthalmological service. Material and methods. The data used to assess the state of provision of ophthalmological care to children was taken from the electronic database of medical records of patients who received ophthalmological care at the Kaluga branch of the S. Fyodorov Eye Microsurgery Federal State Institution in the period from 2017 to 2023. Results. In 2005, a pediatric surgical department was organized at the Kaluga branch of the S. Fyodorov Eye Microsurgery Federal State Institution. The work of the department’s ophthalmologists is primarily aimed at providing modern surgical treatment for children with various ophthalmological diseases. The leading scientific and practical direction is retinopathy of prematurity. To ensure optimal accessibility of specialized medical care, implementation of a system for early diagnosis and monitoring of the vision status of children, in the fall of 2020, a Children’s Ophthalmological Diagnostic Center (DOC) was opened within the structure of the Kaluga branch of the MNTK. The priority direction of the DOC is the introduction into clinical practice of innovative medical technologies aimed at early detection and formation of stages in the treatment of eye diseases in children and adolescents, and the determination of recommendations for preventive measures. From 2017 to 2023, the volume of ophthalmological care provided by the Kaluga branch of MNTK was within the range of 1,400–3,000 operations per year. Every year, ophthalmological care is provided directly to more than 1000 children at the Children’s Center. In total, over the entire period of operation of the center, conservative treatment was carried out in 3552 cases of amblyopia, myopia and other forms of ametropia, including severe forms. Using the new treatment method, 809 courses of treatment have been carried out at the Amblyokor complex since September 2020. During the work of the Center, 1908 orthokeratology lens sets were selected and issued. In addition to accepting patients living in the Kaluga region, we are actively accepting children from other regions. Conclusion. Thanks to the work of the branch of the MNTK «Eye Microsurgery» in the Kaluga region, the shortage of highly qualified medical personnel is compensated, the effective use of complex and unique diagnostic and treatment equipment is concentrated and implemented, the widespread introduction of progressive treatment methods into practice is ensured, the optimal route for patients is developed, taking into account the structure of medical organizations, participating in the implementation of the program of state guarantees of providing free assistance to the population. It should be noted that ophthalmological care for the children’s population through the Kaluga branch of the S. Fyodorov Eye Microsurgery Federal State Institution is largely provided at the interregional level, affecting the territories of neighboring regions.

On the issues of additional public support of workers involved in medical care support during period of COVID-19

The article considers issues of organizational and legal progress of social protection of workers involved in medical care during period of COVID-19. The purpose of the study is to analyze regulatory legal documents that define state guarantees that provide social protection for persons involved in the provision of medical care during COVID-19. The attempt was made to analyze international and national information on relevant morbidity, mortality and disability of health care workers, but respective data was not readily available in open admission. The analysis of international documents (the WHO, CDC, JHU reports), public documents of the Russian Federation, information from official websites of the President of the Russian Federation and the executive authorities of the Russian Federation (state reports on sanitary and epidemiological well-being of the population in the Russian Federation in 2020-2022) demonstrated the following. The whole world faced with the problem of protecting health care workers from contamination with new corona-virus infection. In the Russian Federation, unprecedented measures were taken to ensure social protection for this category of workers, including provision of additional social benefits.

Updating of Standard Performance Indicators of Polyclinics in the Context of Value-Based Healthcare

The key to providing high-quality and affordable health care to all citizens of the Russian Federation is to efficiently use the funds allocated within the state guarantee programs for free medical care. It is also one of the main tasks for optimizing the healthcare funding process. It is considered that medical organizations, especially those of primary care (i.e., providing outpatient services), must operate in an efficient way. This principle lays the foundation for value-based healthcare, which puts people first in the healthcare system. The list of performance indicators for medical organizations financed under the per capita funding standard by the number of attached persons was provided as a mandatory annex to the tariff agreement concluded in the Russian regions. The article discusses the relevance of laying down the criteria for evaluating the effectiveness of medical organizations in a regulatory document. The changes made by the Ministry of Health of the Russian Federation in the requirements for the structure and content of such documents are addressed. The adjustments to the list of indicators depicting the effectiveness of outpatient polyclinic care were assessed, and additional criteria were given.

ЭТАПЫ ПРЕДИНВЕСТИЦИОННОЙ ФАЗЫ МЕГАПРОЕКТНОГО ФИНАНСИРОВАНИЯ ЭКОНОМИКИ

The article offers the author's description of the stages of the pre-investment phase of mega-project financing of the economy. The launch of this process was preceded by a thirty-year transformation of the socio-economic system of the Russian Federation. During these transformations, the previously functioning organizational and economic mechanism was deactivated. Its viability until the start of the special military operation was due to the ongoing policy of Reaganomics, closely related to the principles of the Washington Consensus. Determining a new vector of economic development, the Government of the Russian Federation selected 11 technological sovereignty projects for the first time in December 2023. Among them are port infrastructure projects, shipbuilding, energy, mechanical engineering, infrastructure projects, and instrument engineering. By designating banks as subjects of financing megaprojects, the state thereby promotes the development of economic relations using such a financial instrument as a state guarantee. To make a decision on their participation in large-scale investment projects, authorized government bodies organize the calculation of all performance indicators, incl. budgetary, financial, economic, social. If we are talking about projects that have passed the examination and are significant for the constituent entities of the Russian Federation, its initiators determine the structure of financing. When participating in projects of commercial banks, according to established practice, the Ministry of Finance of the Russian Federation may offer a state guarantee of the federal budget as security. In this case, issues of the effectiveness of a particular project fade into the background. Reason: if negative results are obtained from the implementation of the investment project, the commercial bank will write off from the treasury account all existing debt on loans issued to the megaproject operator. But in this case, the amount of debt on the loan will be lost from the federal budget. To prevent this from happening, it is important to maintain a balance of interests of all participants in the megaproject. The role of the state remains two-pronged. When identifying “positive” and “negative” aspects of state activity, the gradation assumes the presence of the following structure: a) the “negative” aspect was determined by the acceleration of economic growth and was the basis of structural transformation; b) the “positive” aspect was that set of socio-political circumstances that determine growth from the fundamentally possible potential to the real.

АНАЛИЗ ПОКАЗАТЕЛЕЙ ОРГАНИЗАЦИИ ТРУДА НА ПРЕДПРИЯТИЯХ С ХИМИЧЕСКИМ ФАКТОРОМ ПРОИЗВОДСТВЕННОЙ СРЕДЫ

The article is devoted to the analysis of labor organization indicators in sectors of the na-tional economy with a chemical factor of the production environment. The concepts of working conditions and the chemical factor of production are considered. The spheres of activity for which the impact of the chemical factor of production on workers is most characteristic are identified. Such indi-cators as labor productivity; the state of labor conditions and safety at the enterprise, the level of occupational morbidity; the amount of wages and its dynamics; the state of labor discipline; the availability of state guarantees and compensation to employees are studied. The most problematic issues of labor organization have been identified, and directions for the subsequent development of measures to minimize them have been identified.

Problematic aspects of the implementation of legal guarantees of human and citizen rights in Ukraine

The article describes the basic rights and freedoms of a person and a citizen, which are inalienable rights and freedoms enjoyed by a person from birth. They form the basis of the legal status enshrined in the state constitution and enjoy the highest legal protection. The most important and complex relations between people and the relations between the state and the person in legal form are regulated by formulating the rights, freedoms and obligations underlying the legal status of a person, which is one of the most important not only legal, but also juridical. also political categories. The most important features of the rights and freedoms of a person and a citizen are: naturalness, continuity, equality, social justification, respect for international standards, state guarantee. The problem of guaranteeing the rights and freedoms of a person by giving them a real character is not only of a practical nature. In the modern context of the development of the rule of law and civil society, it is important to develop a holistic scientific concept of human rights and freedoms, which covers a wide range of theoretical provisions regarding the essence and content of rights and freedoms, their structure and mechanism. Local self-government bodies play an important role in ensuring constitutional rights and freedoms. A real environment for the existence of human rights is possible in the conditions of a democratic state governed by the rule of law. Democracy, rule of law and human rights are inseparable. The rule of law is a guarantee of the reality of human rights in terms of protection from violations by the authorities, and human rights are the main condition and characteristic of democracy, the humanistic and human dimension of the rule of law. The article concludes that the basis of democracy in the state is the guarantee of the rights and freedoms of man and citizen by the Constitution of the state, not only formally, but also in practice. Therefore, taking into account the individual shortcomings of state bodies in regulating the system of human and citizen rights, the number of human rights organizations is growing day by day, both at the national and international levels. At the same time, the article concludes that it is impossible to build a legal state in a society with developed legal nihilism. And respect for the rights of society can be caused only by concern for the same rights of people and citizens.

Questionnaire on Public Satisfaction with Dental Services under the State Guarantee Program

This article presents a study on the awareness of the program of state guarantees and public satisfaction with the quality of dental services provided in Bishkek. Awareness of primary health care to the population within the framework of the State Guarantees Program will help to receive preventive dental services in a timely manner, which is one of the effective mechanisms for improving the quality of dental care. Increasing satisfaction with the quality of dental care is one of the main tasks facing any medical institution. The results of the study of satisfaction with the quality of services provided accurately reflect positive and negative trends and allow us to identify factors that reduce patient satisfaction with medical care. To this end, a sociological survey of the population was conducted on awareness of oral hygiene, on the Program of state guarantees and satisfaction with the quality of dental services. According to the results of the study, the predominance of parents of children under 10 years old (79%), pregnant women (6%) and pensioners was revealed among the categories of persons according to PGG15 (%). Awareness of GHG among parents of children under 10 years of age (34%) and (66%) are not informed. Among the surveyed parents of children under 10 years old (66%) expressed satisfaction with dental services, (34%) were not satisfied with the services. Pregnant women are informed about PGG (53%) and (47%) are not informed. According to the results, pregnant women are satisfied with dental services (72%) and (28%) are not satisfied. Pensioners over the age of 70 are informed about PGG (26%) and (74%) are not informed. Satisfaction with dental services (63%) and (37%) are not satisfied. It is noted that it is necessary to develop and implement a unified standardized questionnaire for patients using the services of dental organizations to control the quality of care provided, which will help identify shortcomings in the work and recommend measures to solve problems.

Measuring the perceived wellbeing of hemodialysis patients: A Mind Genomics cartography.

Chronic Kidney Disease patients under hemodialysis have high morbidity rate, which tends to considerably affect their health-related quality of life. Multiple studies that have made use of different questionnaries report the poor life quality of this patient group. The research in hand implemented the Mind Genomics Approach as a method to asses the health-related quality of life of hemodialysis patients, while relying on conjoint measurements to group individuals with similar patterns of responses to a certain mindset. The study is conducted in 3 clinics with 219 patients. It uncovers three clusters or mindsets: Mindset 1- Feels guardedly optimistic but worried about money, Mindset 2-Feels strongly positive because the state guarantees and the family supports, Mindset 3-Feels positive only about money. Based on the analysis of the collected data, the findings of this study suggest that the quality of life in hemodialysis patients is highly correlated to their financial status. The current study is one of the few first attempts to apply Mind Genomics in medical settings and the first, to our knowledge, in hemodialysis centers. This technology might enable healthcare proffesionals to provide personalized psychological treatment and additional social support to patients, which in turn could improve their clinical outcomes. The study is an example of using technology as a service.

Time to treatment start as a survival predictor for reproductive system cancer: a population-based study

Objective: To evaluate the effect of the time from morphological confirmation of the diagnosis to the start of specialized treatment (time to treatment start: TTS) on cancer-specific survival (CSS) of patients with cancer of the female reproductive system (CFRS) using the data from the regional cancer registry of the Arkhangelsk region (ARCR) over the period 2000 to 2022. Material and methods. depersonalized data on all cases of breast (BC), cervical (CC), corpus uteri (CUC) and ovarian (OC) cancers were obtained from the ARCR for the period 2000–2022. We compared survival with TTS of 0–7 days (recommended by the state guarantee program), 2–4, 5–8, 9–12 weeks, and 3–6, 7–12 months. Cancer-specific survival was calculated using the life tables and Kaplan-Meier methods. The Cox proportional hazard model was used to correct for other prognostic factors. Results. A total of 19321 cases were analyzed. The ministerial recommended TTS of ≤7 days was observed in 61.9 %, 28.5 %, 27.3 % and 55.9 % of patients with BC, CC, CUC and OC, respectively. the five-year CSS for BC, CC, CUC and OC was 73.9 %, 66.5 %, 73.0 % and 52.1 %, respectively. The TTS of ≤7 days compared to longer TTS was associated with the highest 5-year CSS rate in breast cancer (74.3 vs 45–4-67.0 %) and CC (80.2 vs 63.1–75.0 %); no significant differences were found in CUC and OC. The risk of death from CFRS was the same for TTS of ≤2 months in breast cancer and ≤12 months in other CFRS. Conclusion. Clinical practice shows that the time before the start of special treatment in accordance to state guarantees may be insufficient. early treatment initiation is often possible in the early stages of CFRS. The time to treatment start of < 8 weeks after morphological verification does not worsen survival. The identification of individual groups of patients who need earlier treatment is warranted.

Loans and guarantees granted by the state in the context of competition policy in the Republic of Moldova and the European Union

The object of research of this article is the analysis of state loans and guarantees in terms of normative acts and practices in the field of competition in the Republic of Moldova and at European Community level. Despite the fact that state interventions with loans and state guarantees are known in practice as a way to encourage the economy, lending and state guarantees can also have negative effects on the normal competitive environment. That is why the current trends in the practice of granting loans and state guarantees in the Republic of Moldova, as well as at the community level, are to reduce the share of state aid in GDP.