[Civil, administrative and criminal liability of medical workers].

From the point of view of legislation, medical care refers to the provision of services, however, the issues of legal responsibility of a medical worker, which is imposed in case of violation of the rights of a patient, are quite difficult and are characterized by controversial points for assessment. Today, a large number of complaints from patients are filed against doctors, requiring consideration by the competent authorities. The article considers the features of civil, administrative and criminal liability applied to medical workers.

[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.

[The assuring of rights of of medical workers within the framework of modernization of primary health care legislation].

The more active implementation of innovative medical technologies, digital transformation in medical sphere, sanction restrictions resulted in complication of already existed problems in medical law and raised new questions. The necessity in improving medical legislation is obvious. The number of lawsuits concerning medical organizations and medical workers is invariably increasing. Hence request of adoption of normative legal regulations and decisions supporting effective functioning of industry and protection of rights and interests of medical organizations and medical workers. The purpose of the research is to study and to analyze current issues of ensuring rights of medical workers as one of the main aspects of modernization of modern medical law. The main normative legal acts of modern medical law were studied. The analysis, comparison, generalization and systematization of published statistical data, judicial practice, national and foreign sources of scientific publications, devoted to topical issues of modernization of legislation regulating health care and rights of health workers were implemented. The content analysis was applied to acts regulating legal responsibility and protection of rights of medical workers. The protection of rights of physicians in system of medical care of population at the present stage was investigated. A number of problems related to legal regulation of activities of health workers was established. The proposals for its improvement was summarized. The legal regulation of medical care support by multitude of normative acts makes actual issues of systematization of normative documentation. the assignment of independent sector of medical law where legal status of medical worker is to become its main institute.

[The characteristics and problems of professional activity of medical workers in conditions of COVID-19 pandemic].

The article is based on the results of sociological survey of medical workers of the Republic of Bashkortostan in 2021. The approaches to issues of their professional activities are analyzed. It is argued that the COVID-19 pandemic has aggravated a number of systemic problems accumulated in health care system in last years. The main difficulties are associated with shortage of medical personnel, increased workload, low remuneration of labor of medical workers, unpractical work organization decreasing quality of medical care, etc. The majority of respondents (68.4%) are not satisfied with their salaries. The highest percentage of negative assessments is fixed among physicians and paramedical personnel. The amount of average monthly salary of junior medical personnel is so low that it does not correlate with the minimum wage accepted in the Republic. The study discovered sufficiently high occupational risk, determined by biological production factor related to possibility COVID-19 contamination. The assessment of occupational morbidity demonstrated that at present the most widely-spread occupational pathologies in medical workers are infection with COVID-19 (70.2%) and emotional burnout syndrome (67.2%). Such measures as annual dispensarization, provision of medical workers with sanatorium-and-spa vouchers are obviously insufficient. Only 14.1% of respondents could underwent annual medical examination. Only 13.8% of respondents had opportunity to take advantage of sanatorium-and-spa vouchers. The study revealed deficiency of personnel in medical organizations among paramedical and junior medical personnel and physicians as well.

[The World Health Organization: Project of novels in the field of controlling international medical sanitary regulations].

The article considers draft of new edition of the International Health Regulations. The possible risks associated with changing of the document are evaluated from perspective of member countries, in whose territories occur or supposedly occur emergency situations in field of public health having international importance.

The association between fear of malpractice and burnout among Chinese medical workers: The mediating role of legal consciousness.

BACKGROUND: As a major reason for defensive medicine, the status and effect of "fear of malpractice" among Chinese medical staff is an important topic that needs to be studied. Our study investigated fear of malpractice among Chinese medical workers, assessed its association with burnout, and explored the mediating role of legal consciousness between these factors. DESIGN: A quantitative, cross-sectional study. SETTING: All respondents were investigated using a self-report questionnaire. Demographic characteristics and measurements including a fear of malpractice scale, and a burnout and legal consciousness scale were employed. The effect of fear of malpractice on burnout was examined by carrying out a binary regression analysis. A mediation model was used to test the mediating role of legal consciousness. PARTICIPANTS: The study sample included 1031 doctors and nurses (297 male and 734 female; age = 36.3 ± 8.98). RESULTS: The average score of fear of malpractice was 20.97 ± 5.34. Respondents with higher levels of fear of malpractice were more prone to burnout ([OR] = 2.865; 95% CI 1.942-4.226). Legal consciousness partially and negatively mediated the effect of fear of malpractice on burnout. CONCLUSION: High levels of fear of malpractice were found among Chinese medical workers, and this fear had a significant effect on burnout. Legal consciousness may be a resource that can alleviate burnout.

Observational study of antibody levels after second and third SARS-CoV-2 vaccinations in medical workers.

BACKGROUND: Countries around the world are actively promoting vaccination against COVID-19. We observed the changes in serum neutralizing antibody titers in medical workers vaccinated with inactivated COVID-19 vaccine, in order to explore the necessity of a third dose of vaccination. METHODS: A total of 62 medical workers in our hospital were observed. Novel coronavirus neutralizing antibody titers in serum were detected by ELISA (enzyme-linked immunoassay). Neutralizing antibody tests followed in four batches according to the different time periods after three vaccinations. Sixty-two observers participated in the first batch of testing for neutralizing antibody, and 18 of them participated in all four batches. Fasting venous blood was taken from all the participants in the morning to detect serum neutralizing antibody titers. RESULTS: Sixty-two medical workers were divided into age groups of 21-30, 31-40, and >40 years, and the antibody titer in the oldest group was significantly lower than that in youngest group (p = 0.0137). There was a gradual decrease in antibody titers over time at around 1, 3, and 6 months after the second dose of vaccine (p < 0.0001). The antibody positive rate also decreased gradually (p = 0.0003). The neutralizing antibody titer around 1 month after the third dose was significantly increased (p < 0.0001). Unexpectedly, three participants with negative neutralizing antibody after the first and second dose produced neutralizing antibody with a measurable titer after the third dose. CONCLUSIONS: The neutralizing antibody titer in serum increased significantly after the third dose of vaccine. A third immunization even produced neutralizing antibody in previously negative individuals.

[The confidence limits of self-education of medical workers in matters of competences to provide quality and safety].

The article considers possible risks according analysis of comprehension by workers of necessary competencies ensuring quality and safety of medical activities at performing their duties as well as assessment of factors affecting completeness of choice. It is proposed to apply corporate training as component targeted to improving quality and safety of medical activities by addressed training of necessary competencies within the framework of continuous medical education, supplementing existing self-education.

Post-COVID-19 Epidemic: Allostatic Load among Medical and Nonmedical Workers in China.

BACKGROUND: As the fight against the COVID-19 epidemic continues, medical workers may have allostatic load. OBJECTIVE: During the reopening of society, medical and nonmedical workers were compared in terms of allostatic load. METHODS: An online study was performed; 3,590 Chinese subjects were analyzed. Socio-demographic variables, allostatic load, stress, abnormal illness behavior, global well-being, mental status, and social support were assessed. RESULTS: There was no difference in allostatic load in medical workers compared to nonmedical workers (15.8 vs. 17.8%; p = 0.22). Multivariate conditional logistic regression revealed that anxiety (OR = 1.24; 95% CI 1.18-1.31; p < 0.01), depression (OR = 1.23; 95% CI 1.17-1.29; p < 0.01), somatization (OR = 1.20; 95% CI 1.14-1.25; p < 0.01), hostility (OR = 1.24; 95% CI 1.18-1.30; p < 0.01), and abnormal illness behavior (OR = 1.49; 95% CI 1.34-1.66; p < 0.01) were positively associated with allostatic load, while objective support (OR = 0.84; 95% CI 0.78-0.89; p < 0.01), subjective support (OR = 0.84; 95% CI 0.80-0.88; p < 0.01), utilization of support (OR = 0.80; 95% CI 0.72-0.88; p < 0.01), social support (OR = 0.90; 95% CI 0.87-0.93; p < 0.01), and global well-being (OR = 0.30; 95% CI 0.22-0.41; p < 0.01) were negatively associated. CONCLUSIONS: In the post-COVID-19 epidemic time, medical and nonmedical workers had similar allostatic load. Psychological distress and abnormal illness behavior were risk factors for it, while social support could relieve it.

FORMS OF CRIMINAL LIABILITY IN CASE OF DEATH OF THE PATIENT.

OBJECTIVE: The aim: Establishing the forms of criminal liability in case of death of the patient and the presence of such a condition as the desire of the relatives of the deceased to reconcile with the subject of the criminal offense. PATIENTS AND METHODS: Materials and methods: In the course of the study, 62 court judgements were used. Comparative, systematic, analytic, and empiric research methods have been used in this research. RESULTS: Results: The position of the victims - relatives of the deceased - has a direct influence on the choice of the form of criminal liability. A medical worker who is the subject of a criminal offense may reconcile with the relatives of the deceased patient and enter into a reconciliation agreement. It is the parties of the agreement who consent to the punishment and the possible exemption from it. At the same time, the court cannot exempt a medical worker from criminal liability in case of a patient's death. This thesis is based on the fact that the possibility of such exemption is directly related to the reconciliation with the victims who are patients that were provided with medical service. Besides, death is a consequence that is irreversible. CONCLUSION: Conclusions: The exemption from criminal liability according to the reconciliation of the guilty person with the victim in case of death of a patient is stated to be impossible. At the same time, the possibility of concluding a reconciliation agreement in this case has been established.

DIFFERENTIATION OF CRIMINAL LIABILITY OF MEDICAL PROFESSIONALS.

OBJECTIVE: The aim: Determining the need to differentiate the criminal liability of medical workers for damage caused in the course of professional activity. PATIENTS AND METHODS: Materials and methods: This following research is based on an analysis of laws (21 laws), court judgments and case files (108 judgments and 8 case files), judgments of the European Court of Human Rights (4) and the legal doctrine of criminal law. Comparative, systematic, analytic, and empiric methods have been used in this research. During the preparation of this article the results of personal experience of the scientific work (17 years), the experience of advocacy (11 years), and the experience of the Supreme Court's judge have been applied. RESULTS: Results: The analysis of case files, thoughts of scientists and lawyers-practitioners allowed to propose criteria and indicators influencing increasing or decreasing of social dangerousness of actions committed by medical professionals. It is noted that the necessity of the legislator to consider the close interrelation of professional medical services and influence on the health of persons who demand medical services or need health care during differentiation of criminal liability. CONCLUSION: Conclusions: The necessity of differentiating approach to the criminal liability of medical professionals who inflict health damages or death is stated in comparison with the liability of general subjects of a crime.

FEATURES OF CRIMINAL LIABILITY OF A MEDICAL PROFESSIONAL FOR FAILURE TO PERFORM OR IMPROPER PERFORMANCE OF THEIR PROFESSIONAL DUTIES IN UKRAINE.

OBJECTIVE: The aim: Research of features of criminal responsibility of the medical worker for failure to performe or imptoter perfomance of their professional duties in Ukraine. PATIENTS AND METHODS: Materials and methods: The article uses general scientific and special scientific methods of cognition, which provided an objective analysis of the research goal. CONCLUSION: Conclusions: Criminal law, which provides for liability for improper performance of duties by a healthcare professional or pharmacist, must have a perfect design to ensure the rights and interests of both the patient and the medical worker.That is why, the existing construction of article 140 of the Criminal code of Ukraine requires a number of changes and additions.

[The Problems of Socially Dangerous Acts of Medical Workers in Sphere of Biomedical Technologies].

The complex problem is considered related to socially dangerous acts of medical workers in the sphere of biomedical technologies covering, besides "traditional" iatrogenic crimes, other risks of application of the mentioned technologies for criminal purposes. The study uses the results of original observations and theoretical findings and data of information content analysis of 2012-1017, data of analysis of medical and judicial practice and also result of sociological survey of experts-medical workers of various profiles professionally related to application of biomedical technologies (n=278). The social legal status of medical worker conditions a potential possibility of application of corresponding abilities, skills, competences, official position and authority to commit crimes in the sphere of their professional activities. The backlog of legal regulation of the sphere of biomedical technologies causes both possibility for committing by medical workers socially dangerous acts and so-called gray zones of responsibility that significantly impacts on potential of applying the given technologies for criminal purposes. The risks of criminal application of biomedical technologies by medical workers are related first of all to such most criminogenic spheres of medical activity as transplantology (mentioned by 79% of respondents), extra-corporal insemination (67%), implementation of various biomedical examinations involving patient (59%), bio-pharmaceutics (55%). The article emphasizes that risks of criminal application of biomedical technologies by medical workers is to be considered both from position of established actual medical legal practices and taking into account potential of biotechnological development of medicine in the future.

[The Risk Zone As A Factor Of Professional Burn-Out Of Medical Workers].

The article presents the results of study of risk zones and factors of professional burn-out of medical workers. The theoretical foundation of syndrome of emotional burn-out, features of professional activity and individual characteristics of public health professionals are revealed. The original study used the Maslach-Jackson technique adapted by N.E. Vodopyanova to determine levels of burn-out depending on age and career pattern. The risk zones of everyday professional activity include such external factors as unregulated duration of working time and high load per single specialist due to deficiency of physicians, inadequate level of social support and legal safety, absence of market mechanisms of compensation of health damage, absence of national patient-oriented system within the framework of health care modernization, unpredictability of behavior of patients. The given priorities and difficulties are studied on the example of the Republic of Mari-El. The Republic takes measures concerning training of physicians (a special faculty is organized) social support and stimulation of medical workers in rural area is developed. However, there is deficiency of physicians, load per single physician increases, level of salary did not fit requirements of the May decrees of the President of the Russian Federation. The reduction of risk zones of professional burn-out will favor development of national patient-oriented health care system, introduction of automated work places for physicians and increasing of their qualification, development of comfortable environment and atmosphere of friendliness in medical organizations.

[The Labor Motivation Features of Employees of State Medical Institutions].

The article considers basic concepts, categories, types of labor motivation of medical professionals of state health care institutions. The possibilities and risks are demonstrated related to implementation of effective contract into functioning of multi-sectoral health care institution as a method of stimulation of increasing of medical care quality and efficiency of its activities.

[About Development of Programs of Struggle with Tobacco Smoking in Medical Workers].

The article presents a review of prevalence of smoking among physicians and medical nurses suffering from nicotine dependence. The most of smoking medical workers began to smoke already during student years. they don't relate their diseases with smoking. The incomplete awareness of true causes of one's own diseases is manifested in ignoring preventive activities and healthy life-style. The actuality of necessity of development of program of prevention tobacco dependence in medical workers suffering from tobacco dependence is demonstrated.

Occupational well-being in medical workers in Inner Mongolia after the Normalized Epidemic Prevention and Control Strategy: A cross-sectional study.

Little is known about the status of occupational well-being among the Chinese medical workers after the implementation of Normalized Epidemic Prevention and Control strategy as most studies are performed during the COVID-19 pandemic. This study was designed to investigate the occupational well-being among the medical workers in our city in the COVID-19 after the release of Normalized Epidemic Prevention and Control Strategy since May 7, 2020 in mainland China. We included the medical workers involved in the front-line of COVID-19 that were randomly selected from 7 hospitals in Inner Mongolia Autonomous Region, China. The occupational well-being among medical workers was evaluated using the modified occupational well-being scales and the symptom Checklist-90 (SCL-90) scale. Then Logistic regression analysis was given to identify the risk factors that may affect the occupational well-being among the medical workers. Our data showed that hospital type (p < 0.01), hospital grade (p < 0.01), marital status (p < 0.01) and monthly income (p < 0.01) were independent risk factors for the occupational well-being among the medical workers. Obsessive-compulsive disorder, somatization, phobic anxiety, depression and interpersonal sensitivity were risk factors for poor occupational well-being. Therefore, attention should be given to the occupational well-being of the medical workers. Meanwhile, appropriate measurements are necessary to improve their working quality.

Post-traumatic stress disorder in medical workers involved in earthquake response: A systematic review and meta-analysis.

Introduction: Medical workers involved in responding to the earthquake are exposed to frightening scenes and witness dead bodies and severely injured moaning people, predisposing them to multiple mental health consequences. This study was aimed to determine the prevalence of Post-Traumatic Stress Disorder (PTSD) after earthquakes among medical workers using a systematic review and meta-analysis. Materials and methods: The review study was performed following PRISMA guidelines, and the study's protocol was registered in PROSPERO with the code CRD42022333069. The data resources of Google Scholar, Science Direct, Web of Science, PubMed, and Scopus were searched to specify the related studies. To perform meta-analysis, the random effects model was utilized, and the I2 index was considered to assess heterogeneity between studies. The STATA software was used for data analysis. Results: In the initial data resources search, 1399 articles were identified. From these articles, 13 were finally chosen for meta-analysis and quality assessment. The meta-analysis results indicated that the prevalence of post-earthquake PTSD among medical workers involved in the earthquake response was 16.37% (95% CI: 11.63-21.11, I2 = 97.33%, p = 0 < 0.001). Conclusion: The medical workers involved in response to the earthquake have a relatively high risk of PTSD in the short and long term. Therefore, medical workers involved in response to disasters should undergo screening for mental health disorders before and after disasters and receive the necessary training with regard to stress management, psychological resilience, and how to express their feelings and emotions.

Stressful events induce long-term gut microbiota dysbiosis and associated post-traumatic stress symptoms in healthcare workers fighting against COVID-19.

OBJECTIVE: The microbiota-gut-brain axis is a key pathway perturbed by prolonged stressors to produce brain and behavioral disorders. Frontline healthcare workers (FHWs) fighting against COVID-19 typically experience stressful event sequences and manifest some mental symptoms; however, the role of gut microbiota in such stress-induced mental problems remains unclear. We investigated the association between the psychological stress of FHW and gut microbiota. METHODS: We used full-length 16S rRNA gene sequencing to characterize the longitudinal changes in gut microbiota and investigated the impact of microbial changes on FHWs' mental status. RESULTS: Stressful events induced significant depression, anxiety, and stress in FHWs and disrupted the gut microbiome; gut dysbiosis persisted for at least half a year. Different microbes followed discrete trajectories during the half-year of follow-up. Microbes associated with mental health were mainly Faecalibacterium spp. and [Eubacterium] eligens group spp. with anti-inflammatory effects. Of note, the prediction model indicated that low abundance of [Eubacterium] hallii group uncultured bacterium and high abundance of Bacteroides eggerthii at Day 0 (immediately after the two-month frontline work) were significant determinants of the reappearance of post-traumatic stress symptoms in FHWs. LIMITATIONS: The lack of metabolomic evidence and animal experiments result in the unclear mechanism of gut dysbiosis-related stress symptoms. CONCLUSION: The stressful event sequences of fighting against COVID-19 induce characteristic longitudinal changes in gut microbiota, which underlies dynamic mental state changes.

Comparison of the gut microbiota of short-term and long-term medical workers and non-medical controls: a cross-sectional analysis.

OBJECTIVES: The hospital environment has been implicated in the enrichment and exchange of pathogens and antibiotic resistance, but its potential in shaping the symbiotic microbial community of hospital staff is unclear. This study was designed to evaluate the alteration of the gut microbiome in medical workers compared to non-medical controls. METHODS: A prospective cross-sectional cohort study was conducted in the intensive care unit (ICU) and other departments of a centre in north-eastern China. Faecal samples of 175 healthy medical workers-short-term (1-3 months) workers (n = 80) and long-term (>1 year) workers (n = 95)-and 80 healthy non-medical controls were analysed using 16S rRNA amplicon sequencing. The hospital environmental samples (n = 9) were also analysed. RESULTS: The gut microbiomes of medical workers exhibited marked deviations in diversity and alteration in microbial composition and function. Short-term workers showed significantly higher abundances of taxa such as Lactobacillus, Butyrivibrio, Clostridiaceae, Clostridium, Ruminococcus, Dialister, Bifidobacterium, Odoribacter, and Desulfovibrio and lower abundances of Bacteroides and Blautia than the controls. Long-term workers showed higher abundances of taxa such as Dialister, Veillonella, Clostridiaceae, Clostridium, Bilophila, Desulfovibrio, Pseudomonas, and Akkermansia and lower abundances of Bacteroides and Coprococcus than the controls. The medical workers' department (ICU versus non-ICU) and position (resident doctor versus nursing staff) also impacted their gut microbiome. Compared with the non-ICU workers, workers in the ICU showed a significant increase in the abundances of Dialister, Enterobacteriaceae, Phascolarctobacterium, Pseudomonas, Veillonella, and Streptococcus and a marked depletion of Faecalibacterium, Blautia, and Coprococcus. In contrast with the nursing staff, the resident doctors showed a significant increase in Erysipelotrichaceae and Clostridium and a decrease in Bacteroides, Blautia, and Ruminococcus in the gut microbiome. Moreover, we found that the microbiota of hospital environments potentially correlated with the workers' gut microbiota. CONCLUSIONS: Our findings demonstrated structural changes in the gut microbial community of medical workers.