[The social hygienic aspects of reproductive behavior of women aged 40-45 years].

In the context of forecasted decreasing of natality, actuality of studying its causes for organizational decision-making increases. The purpose of the study was to determine factors affecting reproductive behavior of women aged 40-45 years residing in areas with different natality levels in 2020-2021. The cohort, analytical, sociological methods were applied. The results of study demonstrated that in areas with high natality level most of urban women with higher education and high income resides in conditions of dormitory or mortgage flat and working in profile of their specialty. They are characterized by belated marriage that results in postponed child-bearing. The areas with low natality are characterized by dwelling of rural women with secondary or secondary specialized education. They reside in their own homes and work in other occupations than their specialty. The analysis of social status of women of different age groups will permit more selective approach in developing measures of increasing natality in modern conditions.

[Is vTAPP for small ventral hernias a potential «gold standard¼ for less than 24 hours hospitalization?] / Operatsiya vTAPP pri nebol'shikh ventral'nykh gryzhakh ­ potentsial'nyi «zolotoi standart¼ dlya dosutochnoi gospitalizatsii?

OBJECTIVE: To evaluate clinical efficacy and cost-effectiveness of vTAPP for small/M3W1 hernias compared to IPOM. MATERIAL AND METHODS: We retrospectively analyzed a prospectively recruited group of patients. Study objects were patients undergoing ventral laparoscopic transabdominal preperitoneal hernia repair (vTAPP) for primary Midline/Lateral Small hernias up to 2 cm. The control group comprised patients after IPOM procedure. RESULTS: We analyzed 179 patients: vTAPP (n=132) and IPOM groups (n=47). The vTAPP group was characterized by significantly shorter hospitals-stay (Q1-Q3: 8-70 hours, p<0.001), fewer relapses (n=2, p=0.047) and slightly longer surgery (Q1-Q3: 40-80 min, p=0.037). Cost-effectiveness analysis revealed 3.39 times more profitable vTAPP compared to IPOM. CONCLUSION: Laparoscopic preperitoneal hernia repair is a safe and effective method not requiring special tools and consumables. This approach is applicable as an outpatient (or <24h hospital-stay) method.

[The functioning of call-center in conditions of COVID-19 pandemic].

In conditions of persisting high morbidity of COVID-19, issues related to prompt and timely medical care of population remains actual ones. The purpose of the study to analyze activities of the call-center of the Ministry of Health Care of the Udmurt Republic related to organization of medical care of COVID-19 patients in the Udmurt Republic. MATERIALS AND METHODS: The statistical (descriptive statistics) and descriptive methods were applied. The indicators of functioning of the call-center of the Ministry of Health Care of the Udmurt Republic in 2020-2022 were analyzed. The psychological characteristics of telephone counseling were studied. The satisfaction of medical organizations and citizens with services of call-center operators was assessed. THE RESULTS: The main principles of telephone counseling are confidentiality, maintenance of framework of working conversation, respect to personality of addressee. In 2020 the call center phone line received 34160 calls, in 2021 - 128339 calls, in 2022 - 65618 calls. In 25 months of operation the call-center operators received 228,117 calls from citizens related to issues of new coronavirus infection. The number of patient calls to the hot-line increases significantly when incidence of new coronavirus infection increases (r=0.885; p<0.05). Most frequently (25.1%) citizens contacted the call-center of the Ministry of Health Care of the Udmurt Republic due to inability to reach the polyclinic and on issues related to primary before-doctor care. The second place in terms of frequency (18.5%) took issues related to PCR-test results. The third place (14.1%) took issues related to duration of quarantine for patients and persons residing with them, possibility for children to attend preschool and educational institutions. The number of outgoing calling in 2020 was 16146, in 2021 - 89269 and in 2022 9936 calls. During 25 months of operation, call-center operators made 204,782 calls to citizens to monitor their health status and invite them to vaccinations and health screenings. More than half of outgoing calls (58.3%) were related to audio-monitoring of patients undergoing outpatient treatment with making-up of electronic protocol. CONCLUSIONS: During the period of increasing of COVID-19 morbidity, the call-center becomes an independent structural unit of organizing patient care. The medical organizations and citizens are satisfied with functioning of the call-center of the Ministry of Health Care of the Udmurt Republic organized in order of improving the organization of medical care of patients with COVID-19.

[The common morbidity of children population in conditions of propagation of new coronavirus infection COVID-19 in 2017-2019].

The health of children population is one of the indicators of the social and epidemiological well-being of society. The purpose of the study was to study main trends of propagation of various classes of diseases in children population in conditions of propagation of the new coronavirus infection. The data of Rosstat for the Udmurt Republic covering the pre-COVID period (2017-2019) and the period of COVID-19 propagation (2020-2021). The analytical method, descriptive statistics technique, the calculation of intensive and extensive indicators were applied. It is established that in 2017-2019, general morbidity of the children population aged 0-7 years decreased by 8.7%, while in conditions of higher propagation of COVID-19 (2020-2021) there was an increase by 11.0 %. In the children population aged 0-14 years, general morbidity decreased by 10%, and hereinafter it increased on 12.1%. At that, in the pre-COVID period in children population aged from 0 to 17 years, morbidity rate decreased for 14 classes of diseases, for 15 classes in children population aged from 0 to 14 years. During the period of higher propagation of COVID-19 morbidity rate for only 5 classes of diseases decreased in both age groups of children population.

[The essential changes of demographic processes in the Vologda Oblast].

The demographic situation is one of markers of well-being of society. The purpose of the study was to establish main trends in demographic process in the Vologda Oblast. The Rosstat data on the Vologda Oblast for 2008-2019 were analyzed using analytical, parametric and non-parametric statistics, descriptive statistics and prognostic estimate, calculation of intensive and extensive indicators. It is demonstrated that demographic situation in the Vologda Oblast is characterized by decreasing of fertility coefficient (-20.0%) and increasing of negative natural growth of population. In rural areas, at low fertility, high mortality of population is registered and its related mostly to suicides. The relationship of random drowning with suicides and murders (R = +0.66 and R = +0.78, respectively), random alcohol poisoning with suicides (R = +0.57) and suicides with murders (R = +0.76) is established. The strong feedback between murder and random alcohol poisoning was revealed too.

[Clinical and morphological characteristics of corneal epithelial dystrophy (clinical observations)]. / Kliniko-morfologicheskie kharakteristiki epitelial'noi distrofii rogovitsy (klinicheskie nablyudeniya).

This paper presents clinical observations that can be regarded as degeneration of the basement membrane of the corneal epithelium. Difficulties in identifying such forms of corneal dystrophies, on the one hand, are associated with limitation and polymorphism of the clinical picture, and, on the other hand, with insufficient information content of the basic diagnostic methods (i.e. the methods used during the initial examination). The presented clinical cases allow singling out the alarming and pathognomonic signs of the disease in the diagnostic algorithm. In the first case, attention should be paid to biomicroscopic changes in the superficial layers of the cornea and the optical defects, which can be regarded as a manifestation of an irregularity of corneal refraction. Identification of pathognomonic signs of the disease is possible on the basis of a detailed, close-to-morphological study of the structure of superficial corneal layers using confocal microscopy and optical coherence tomography. At the same time, the localization of the detected changes at the level of epithelial basement membrane and its basal sections is of crucial significance for substantiating the diagnosis. In addition, according to the literature data, recurrent erosions of the cornea of unclear etiology should be attributed to presumptive signs of degenerative changes in the basement membrane of the epithelium.

[The general and primarily diagnosed morbidity of diseases of skin and subcutaneous cellular tissue in the Stavropol kraii].

Atopic dermatitis and contact dermatitis are most common in all age groups of the population. In this regard, the study of the epidemiological situation of these nosological forms is highly relevant. The aim of the study was to study the indicators of general and primary morbidity in diseases of the skin and subcutaneous tissue and their structure. Material and methods. The data of official statistics on the general and primary incidence of diseases of the skin and subcutaneous tissue in the Stavropol Territory for the period from 2010 to 2017 have been studied. Results. Analysis of the incidence of diseases of the skin and subcutaneous tissue taken into account in official statistics showed an increase in the overall incidence of diseases of the skin and subcutaneous tissue by 21.5%, including contact dermatitis, other dermatitis, psoriasis and psoriatic arthritis. The overall incidence of lupus erythematosus and localized scleroderma has decreased. The highest rates of newly detected incidence of contact and atopic dermatitis were noted. Contact and atopic dermatitis prevailed in the structure of both the general and newly diagnosed diseases of the skin and subcutaneous tissue. Conclusion Despite the decrease in newly detected incidence, during the analyzed period there was an increase in the overall incidence of diseases of the skin and subcutaneous tissue. In the structure of both the general and newly detected incidence of diseases of the skin and subcutaneous tissue, the main part is occupied by contact and atopic dermatitis.

[The primary morbidity of infectious and parasitic diseases in the structure of all diseases registered for the first time in life in the Russian Federation and the Northern Caucasian Federal okrug].

In conditions of increased population migration, studying the situation on incidence of infectious and parasitogenic diseases is an actual problem. Particularly relevant is the analysis of newly detected incidence in the dynamics, which will allow to assess the well-being of the epidemiological situation in the region. Purpose of the study is to analyze the situation with incidence of some infectious and parasitogenic diseases and their share in the structure of other classes of diseases. The data from the Federal statistical monitoring in 2010-2017 were used related to the Russian Federation and the North Caucasus region. It is demonstrated that the incidence of diseases in the North Caucasus Federal District and the Stavropol region increased while it decreased at the National level. At that, there was a decreasing of incidence of some infectious and parasitogenic diseases both in the Russian Federation and in the North Caucasus Federal District with instability of indices in the Stavropol Krai. In the structure of primarily diagnosed diseases, infectious and parasitogenic diseases both in the the Russian Federation and in the North Caucasus Federal Okrug occupy the in the ranking table tenth point and sixth point in the Stavropol Krai. The results of the study demonstrated multi-directional trends in the dynamics of morbidity in the Russian Federation and the North Caucasus Federal Okrug. The decrease in the percentage of infectious and parasitogenic diseases testifies the improvement of epidemiological situation in overall.

Working time costs of doctors-therapists of divisionals on a patient.

AIM: The aim of this article is to establish a weighted average costs of the workflow of the doctor-the therapist of the district, providing primary health care to the population in the outpatient setting to determine the costs when you visit one patient. MATERIALS AND METHODS: Held fotohronometra working process research 39 physicians in the 17th precinct pilot areas from all Federal districts. Within fotohronometra research conducted 6474 measurement. RESULTS: The average time a physician of the district while visiting a patient in a medical organization made up of 15.30±2.0 min, while visiting at home - 32.5±2.0 min the Largest proportion of the working time of the doctor-the therapist of the district while visiting a patient in the outpatient setting is necessary to work with medical records (47.31%). On core activities while visiting a patient in the practitioner, the district spends to 45.54% of the time. For other activities - 7.15%. CONCLUSION: As a result fotohronometra research workflow of doctors-therapists of district, providing primary health care in outpatient settings, set the average time a physician of the district while visiting one patient (15.30±2.0 min), while visiting at home (32.5±2.0 min).

[The provision with infectiologists in the Russian Federation in 2013-2017].

The staffing of medical specialists plays an important role in modern rendering of specialized medical care of population. Despite amelioration of life conditions in developed countries, infectious diseases continue to be the most dangerous ones on the side of epidemiology. The organization of specialized medical care of population is implemented according standards of provision of medical care in case of infectious diseases. Nowadays, high load of physicians is noted that indicates necessity of analyzing provision with infectiologists and their activities. The purpose of study is to analyze provision with infectiologists and their activities in the Russian Federation for organizational decision-making. The study used national data from the Federal statistical monitoring "The information of medical organization" (Form 30) in 2013-2017. The study applied such research methods as statistical, analytical, descriptive techniques. Factually, in all Federal okrugs increasing of provision with infectiologists is traced at decreasing of staffing with out-patient paramedical personnel that correspond to all-Russian trend. Also decreasing of number of visits per one job position of infectiologist. At that, during last three years of the mentioned period, a stability of indicator of visits because of diseases is observed.

[Disc hernia regression as a natural course of discogenic lumbosacral radiculopathy]. / Regress gryzhi diska kak estestvennoe techenie diskogennoi poiasnichno-kresttsovoi radikulopatii.

Disc herniation with radiculopathy is a common cause of severe back pain leading to significant disability and a decrease in patients' quality of life. The authors report a case of 38-year-old female patient with radiculopathy of the first sacral root due to a large (11 mm) sequestered disc herniation between the fifth lumbar and the first sacral vertebrae. Conservative treatment with fluoroscopically-guided epidural steroid injection provided a significant clinical improvement, the patient was able to return to normal daily and professional activity in a short time. MRI in 9 months showed the regression of disc herniation. Possible predictors and timing of disc herniation regression are discussed, as well as the proposed mechanisms, the main one of which is considered to be immune-mediated lysis.

[The significance of EEG in the evaluation of arterial hypertension treatment]. / Znachenie pokazatelei élektroéntsefalogrammy pri otsenke kachestva terapii arterial'noi gipertenzii v praktike nevrologa.

AIM: To assess the efficacy of the treatment of patients with arterial hypertension (AH) using electroencephalography (EEG). MATERIAL AND METHODS: Arterial pressure (AP) was recorded in 250 patients with AH, along with simultaneous recording of EEG with electrocardiography (ECG), computed CT of the brain, which did not reveal any pathological changes. Patients were examined during AH elevation and after its normalization and improvement of general health state. RESULTS AND CONCLUSION: Normalization of EEG parameters depended only on the AH level was observed in systolic AH <140 mm hg and diastolic AD <90 mm hg in the improvement of general health state during 1-2 month. AH normalization led to disappearance of monophasic spikes, synchronized to ECG R wave, an increase in α-rhythm index, absence of bilateral synchronized spikes. The method of simultaneous recording of AH, ECG and EEG can be used for assessment of AH treatment efficacy and medical-social expertise of patients. The method of biofeedback is effective only when used together with pharmacological treatment of AH according to current treatment standards.

[The Prevalence of Sexually Transmitted Infections Depending on Social Belonging of Population].

The sexually transmitted infections represent an actual medical social problem. The purpose of study is to analyze characteristics of their prevalence in various social groups of population. The data from annual reports on morbidity in the Republic of Udmurtia in 2006-2015 is analyzed. The analysis of morbidity of sexually transmitted infections during the mentioned period demonstrated the highest morbidity of chlamydia infection (from 135 in 2006 to 194,8 in 2015 per 100 000 of population) and trichomoniasis (from 63.5 in 2006 to 183.4 in 2015 per 100 000 of population). In the structure of morbidity in 2006 trichomoniasis went to 25.6±1.2%, chlamydia infection -- 19±0.9%, syphilis -- 17.6±0.8%. In the end of analyzed period, chlamydia infection was in the lead in overall structure of morbidity. The analysis of morbidity subject to social belonging demonstrated that in relation to syphilis and trichomoniasis preponderance the diseased was in the direction of non-working population while in case of other infections in the direction of workers of middle and minor business. The results of study demonstrated the necessity of development of activities in area of primary prevention among working population, workers of middle and minor business and student youth.

[Age women health specialities in peri- and postmenopausal period].

Analysis of the health status of 500 women in the period of perimenopause and postmenopause (age groups 44-49 and 50-64 years) living in a region with special climatic and geographical conditions and low population density, as well as a study of 411 460 reasons for seeking medical help, showed the presence at each woman had an average of up to seven somatic abnormalities in the anamnesis (p≤0,005) developing during the aging process. The results of the analysis testify to the need for the post of obstetrician-gynecologist with knowledge of the age-related pathology of women in perimenopause and postmenopause. Knowledge of the aggregates of age-related changes in women's health determines the individual approach to the provision of medical care in the middle and old age, and the necessity of updating the module for training obstetricians and gynecologists in age-related pathology (somatic and gynecological).

[The Personnel Problem in Specialized Opthalmologic Care].

The article presents results of analysis of staffing with ophthalmologists in ambulatory polyclinic section in the Russian Federation and the federal okrugs in 2007-2012. The significant variations in analyzed indices are established and also increasing of moonlighting among specialists against the background of increasing of morbidity of diseases of eye and its adnexa and aging of population. The most unfavorable situation emerged in the south Federal okrug where deficiency of ophthalmologists made up to 11.7%. Alongside with that, staffing with specialists of this profile drastically decreased up to 6.7% in the Dalnevostochnii Federal okrug.

[The acute tetraparesis as a rare presentation of Chiari malformation]. / Ostroe razvitie tetrapareza kak redkoe proyavlenie anomalii Kiari I tipa.

The authors present a case-report of a 25-year-old patient who developed symptoms of transversal injury of the spine. The patient was followed-up for 2 years and had a stable course of Chiari malformation I and syringomyelia. Motor disorders and deep sensory disorders developed without external cause and continued to increase during 2.5 weeks with the further development of pelvic disorders. After the urgent cranial/vertebral decompression with the plastics of the dura mater by a fragment of a wide fascia of the thigh, there was an increase in muscle power (with the complete recovery in hands), regress of deep sensory disorders in hands and pelvic disorders. A literature review on case-reports of acute neurological symptoms in Chiari malformation I and syringomyelia in presented.

[The hospitalized morbidity of the population older than working age of the Russian Federation].

The article presents the distribution of patients older than working age, retired from the hospital, analyzed the hospitalized morbidity by classes of diseases and separate nosology in the Russian Federation for the period 2010-2014 years (according to the form of Federal statistical observation № 14). During the study period, the number of persons of retirement age, people released from hospital care, increased by 13,45 % reported a slight increase in the rate of hospital morbidity by 0,14 %. The main reasons for treatment in hospital organizations are diseases of the circulatory system, neoplasms, diseases of the digestive system, respiratory system, eye and adnexa, etc. The average duration of stay on the bed of patients older than working age in hospitals were analysed accordingly classes of diseases. Over 5 years the indicator decreased by 1,3 days (from 14,2 to 12,9 days).

[Russian and regional performance indices of local therapists].

AIM: To analyze the statistical indicators of a local therapist's performance in the Russian Federation and its districts in the 2008- 2012 period. MATERIALS AND METHODS: The authors analyzed staffing and understaffing in the federal districts with respect to the Russian Federation, a doctor's actual function and its deviation ratio, staffing of local therapists, secondary employment coefficient, and the total number of physician visits with the ratio of the number of home/polyclinic ones. RESULTS: The staffing of local therapists was steady-state in the country as a whole in the period analyzed. At the same time, there was a decline in staffing. The performance of doctors everywhere is greater than the recommended one since 2009. There was a reduction in the number of visits to local therapists in both the country as a whole and its regions, with more visits being made by rural dwellers. CONCLUSION: The current approach to the standards for the load and number of physicians should determine needs for specialists of this profile and become a major part to solve the problem of delivering available and high-quality primary outpatient care to the population of Russia.

[Simultaneous resection of the two tracheal fragments for cicatrical stenosis].

Treatment of multifocal and extended tracheal stenosis is associated with considerable difficulties in comparison with local lesions. Resection with restoration of respiratory lumen by using of direct intertracheal anastomosis substantially entered into common clinical practice. But these interventions in patients with two-level lesion are performed rarely. Among 900 operated patients with cicatrical tracheal stenosis resection of two tracheal segments with forming of anastomoses was performed only in 5 patients. We presented an experience of single-stage resections of different segments of respiratory tract for nonneoplastic cicatrical stenosis. Indications and contraindications are defined. Technical features of resection are discussed. Our data show that such operations are possible and safe. All patients recovered. Their breath was completely restored. Risk of postoperative complications after similar operations is not higher than after one-level resection. But at present time these techniques may be used by specialists and institutions with serious experience in tracheal surgery.

[Modern molecular approaches to diagnosis and treatment of high-grade brain gliomas].

The review analyzes the current state of the problem of diagnosis and therapy of high-grade gliomas on the basis of the most promising present-day approaches. The diagnostic and treatment perspectives of the molecular genetic analysis of glioblastoma markers located on the tumor cell surface are considered. Gene therapy and the use of dendritic cells and oncolytic viruses are considered as the most interesting approaches to therapy of high-grade gliomas.