[The disorder of cerebral circulation in patients of able-bodied age].

The study was organized to evaluate influence of risk factors on hospital mortality in patients with acute stroke because incidence of stroke in patients of able-bodied age is increasing. All cases of in-patient care of patients of able-bodied age with acute stroke (n=4118) in the Tyumen Oblast clinical hospital № 2 during 2010-2018 were analyzed. The study was based on sampling data from hospital medical records. During the analyzed period, decreasing of in-patient lethality up to 34.9% in patients of able-bodied age was observed. During the period of "therapeutic window" 60% of patients of able-bodied age admitted died. The multivariate analysis was applied to assess influence of different factors on in-patient mortality. The presence of coronary heart disease increases risk of mortality up to 47.5%, Exp(Beta)=1.475, employment - up to 66.8%, Exp(Beta)=1.668 as compared to baseline risk. The presence of arterial hypertension and remoteness of symptom onset in ln (hours) (hospital admission) decreases mortality risk up to approximately 39.7%, Exp (Beta)=0.603 and up to 24.0%, Exp (Beta)=0.760, respectively (specificity - 75.86%, sensitivity - 72.18%; overall diagnostic accuracy - 75.23%). In patients of working age the presence of coronary heart disease and elder age are risk factors of stroke. The presence of coronary heart disease and employment are risk factors of in-patient mortality. Whereas presence of hypertension and employment decreases risk of lethal outcome.

[The motivation of participants of the "Zemstvo doctor" program in the Tyumen oblast and evaluation of their satisfaction with conditions of work and life in rural territory].

The article presents the results of the second stage of the study of the motivation of participants of the "Zemstvo Doctor" program, working in medical organizations in rural municipal districts of the Tyumen region (without okrugs) and the evaluation of their satisfaction with labor and living conditions. The sociological questionnaire survey was carried out in 2016-2017 with purpose of evaluating effectiveness of the "Zemstvo Doctor" program and the risks of medical personnel support of rural health care system. During the first stage of study, participants of the program in Tyumen municipal district were interviewed and the results were published. While analyzing the reasons of dismissal from previous job and moving to countryside for employment, the main motives of participating in the "Zemstvo Doctor" program were identified. The analysis of satisfaction with conditions of program implementation, as well as social, labor and living conditions in rural areas was implemented. The results made possible to assess the risks associated with medical personnel support of health organizations, both in process of implementing the program, and after completion of a five-year period, which the specialist must work for. The implemented analysis permitted to reveal factors of labor motivation and satisfaction with living conditions in rural areas. In general, the participants of program are satisfied both with its availability and conditions of its implementation. The results of the research can be used by the authorities in managerial decision making related to organization of conditions for attraction and keeping specialists in rural areas.

[About redirection of calls of acute medical care service because of emergency conditions in territorial medical organizations].

The article considers the results of functioning of the Surgut station of emergency medical care concerning redirection of calls of acute medical care service because of emergency conditions in territorial medical organizations in 2013-2016. The analysis demonstrated that the redirection of 10% of overall calls resulted in decreasing of day load of emergency medical care team from 15.8 calls in 2013 up to 13.3 calls in 2016. The timely qualified medical care support resulted in increasing of number of successful reanimation activities that testifies the increase of efficiency of emergency medical care service in case of life-threatening conditions.

[On Day and Night Teams of Emergency Medical Care].

The article considers the results of sociological survey of patients related to functioning of day and night teams of emergency medical care.Out of all respondents, 97.9% were fully satisfied of functioning of team of emergency medical care. As cause of calling emergency medical care 57.5% of respondents mentioned instant acute disease, 21.5% - exacerbation of chronic disease. Out of number of called because of exacerbation of chronic disease 77% prefer emergency medical care over visit to territorial polyclinic. The received material testify that emergency medical care service is used by population as an alternative to out-patient polyclinic that indicates necessity of further activities on development of organization of emergency medical care.

[A regional experience of the optimization of neurological care for the rural population]. / Regional'nyi opyt optimizatsii nevrologicheskoi pomoshchi sel'skomu naseleniiu.

At present, the problem of disparity of healthcare, including neurological care, in urban and rural settings is highly relevant. Medical care after acute stroke or other chronic disabling diseases (epilepsy, Parkinson's disease) in rural settings is quite challenging due to the lack of access to specialized medical treatment facilities, low level of resources in medical and obstetric centers, low quality of healthcare, personnel turnover in rural healthcare and insufficient coverage of population with outpatient follow-up services. The most promising optimization approaches, which proved to be effective both abroad and in the Russian Federation, including Tyumen district, are the development of multidisciplinary mobile teams and telemedicine. Introduction of these approaches provides an increased access of rural population to specialized medical care, which leads to improvement in overall population health status.

[Screening for congenital adrenal hyperplasia in pregnancy: results and perspectives].

The purpose of the present study was to study the time course of changes in the levels of dehydroepiandrosterone sulfate (DHEAS) and 17-hydroxyprogesterone (17-HOP) in pregnant women in relation to the gestational time from the results of the screening made in Tyumen. The study analyzed 2,817 medical charts of pregnant women. The levels of DHEAS and 17-HOP had been determined in 1,485 (52%) and 230 (8.2%) women, respectively. Analysis of the results of hormonal tests for DHEAS indicated that this hormone was increased in 71% of the women. At the same time, the elevated levels of 17-HOP were observed only in 15% of the examinees. No correlation was found between the levels of DHEAS and 17-HOP. In all trimesters of pregnancy, the median and 95 percentile were above the normal range with their This study has shown that the level of DHEAS cannot be used as the only diagnostic criterion for the non-classical form of 21-hydroxylase deficiency in pregnant women and that there is some doubt as to whether the normal laboratory value of this parameter is absolute significant throughout the pregnancy.

[Complex treatment of vertebrogenic pain syndrome in women during pregnancy]. / Kompleksnoe lechenie vertebrogennogo bolevogo sindroma u zhenshchin vovremia beremennosti.

The proposed system of non-pharmacological treatment has been tried in 325 pregnant women with pain syndrome associated with spinal lesions (osteochondrosis, scoliosis, malformations, sequela of compression vertebral fractures, spondylolisthesis). The treatment combined orthopedic aids, relaxing massage, muscular relaxation, mobilization of functional blocks of intervertebral joints and pelvic junctions, therapeutic exercises. The above non-pharmacological system relieved vertebral pain syndrome partially or completely in 82% of the treated pregnant women.