[The system of criteria and indicators of accessibility of laboratory diagnostic in the Subject of The Russian Federation].

The modern health care is characterized by constant increasing need in laboratory tests. The quality and accessibility of laboratory diagnostics becomes one of key determinants of social well-being in aspect of maintaining population health. The purpose of the study is in developing system of criteria and indicators of accessibility of laboratory diagnostics applicable in organization of health care at the level of the Subject of the Russian Federation. The methods. The study was carried out based on principles of system approach. The methodological approach developed by Professor O. Yu. Alexandrova was applied. The analytical research methods (analysis, synthesis) were implemented. The results and discussion. The set of criteria, including three groups of measurable indicators, applicable in the field of laboratory diagnostics was developed. The original approach to determine time indicators of laboratory tests accessibility was proposed. The system can be applied as organizational technology permitting to establish specific requirements for laboratory diagnostics accessibility at the level of the Subject of the Russian Federation. These requirements can be included in local normative legal acts. The conclusions. The developed system of criteria and indicators of laboratory diagnostics accessibility can be used in development of medical care system that meets the best of characteristics and needs of particular Subject of the Russian Federation.

[The suicides in the Russian Federation: review of national studies].

The epidemiological data of suicide rate, protective and risk factors is required to evaluate suicide losses, to develop appropriate interventions and to determine their effectiveness. Despite stable decreasing trend in suicide rates over the past three decades, the burden of suicides is determined by loss of young working-age population. In the post-Soviet Russia, fluctuations in suicide mortality indicators are associated with complicated periods of social economic transformations and radical changes of public policy. The risk factors also include economically depressive territories of residence, unemployment, psychoactive substance abuse, childhood and adolescence, family ill-being, incarceration, particular professional groups, physical illnesses, etc. The review established researchers' aspirations for topics improving understanding of suicide risk factors in population of Russia and needs of vulnerable groups. Such works are to result in better strategies of suicide prevention and development of new crisis care technologies. They identify problems in program implementation and provide important stimulus for determining global priorities in research and development areas.

The gender and age differences of persons with suicidal behavior.

The study examines cohort of people with suicidal behavior in the light of gender and age differences. The archive materials of the Kaluga Regional Psychiatric Hospital for the period of 2017-2018 were studied. The allocated 435 cases of hospitalizations with suicidal behavior are allocated to admissions with suicidal ideation and hospitalizations with suicidal attempt and self-harm with specified suicidal intentions. The data obtained was processed using the Microsoft Excel software applying the Yule's coefficient of association and Pearson's contingency coefficient, Pearson's χ2 test and Student's t-test. The results of study established no differences in suicidal manifestations adjusted for gender, but allow to distinguish risk age intervals. Thus, mean age in the group of admission with suicidal ideation was in the range of 29.8-35.2 years and 36.0-41.4 years in the group of suicidal attempt. In the age cohort of 5-19 years, probability of admission with suicidal ideation was higher than with suicidal attempt and self-harm. On the contrary, in the age range of 25-44 years, admission with suicidal attempt and self-harm prevailed. This information complements scientific evidence and points out directions for further research concerning prevention of mortality from external causes (suicide) in this area of public health theory.

[The strategic management of laboratory diagnostic service: analysis of organization models].

The modern trends in health care (strategies of optimizing costs, value-oriented medical care) require systematic development of laboratory services for administrative territories. The study was carried out to provide support for decision-making by systematizing models of laboratory services on the basis of principles of systematic approach. Four basic models (centralization, outsourcing, horizontal integration, point-of-care) were analyzed. The study applied such research methods as analytical and strategic SWOT-analysis. The SWOT-analysis was implemented using list of standard characteristics for each model of laboratory service organization. Each model is distinguished by complex combination of strengths, weaknesses, lines of functioning and development. The availability of implementing particular model depends on delicate balance of opportunities and risks against the background of local characteristics of administrative subject. The dynamics of the social economic and infrastructural development of administrative subject can significantly affect effectiveness of model implementation. The objective set of characteristics was obtained for each model of laboratory service organization. Actually it is impossible to select particular model for specific administrative subject. Hence, scientific substantiation of "flexible" model is needed to implement.

[The intermediate outcomes of delegation of obligations of medicinal support of patients with rare diseases to the Federal level in 2019-2020].

Lately, in case of a number of life-threatening and chronic progressive rare (orphan) diseases, resulting in decreasing of life expectancy of citizens or their disability, the powers to support patients with medications were transferred from regional to federal level. Among these diseases are hemolytic uremic syndrome, mucopolysaccharidose type I, II, VI, juvenile arthritis with systemic onset, unspecified aplastic anemia, hereditary deficiency of factors II (fibrinogen), VII (labile), X (Stuart-Prauer). The article considers data concerning hemolytic uremic syndrome, mucopolysaccharidosis type I, II, VI, juvenile arthritis with systemic onset - the diseases for which medication support provision was transferred to Federal level in the first place and for which at the time of preparation of the article there were sufficient data to analyze.

[The specialized medical care of children with rare diseases].

The article presents the results of analysis of specialized medical care of children with life threatening and chronic progressive rare (orphan) diseases resulting in life span shortening or disability. The possibility of medication support of children with rare diseases. The development of patient routing system considering characteristics of particular disease and possibilities of the subjects of the Russian Federation is one of most important directions of enhancement of needed medical care support.

[TO THE QUESTION OF IMMUNOPROPHYLAXIS OF PERSONS PARTICIPATING IN THE PROVISION OF MEDICAL CARE IN THE CONDITIONS OF COVID-19].

Immunoprophylaxis is one of the pressing health problems. The safety of those involved in the provision of medical care acquired particular importance during the period of the introduction of the high alert regime. Regulatory norms determine the need for the prevention of infectious processes, including among this group of workers. However, at the moment there are not fully regulated organizational and legal aspects, including the issue of vaccination against coronavirus infection caused by the SARS-CoV-2 virus.

[The resource support of medical organizations providing medical care in twenty-four-hour hospital under new corona-virus infection COVID-19].

The article considers, on the basis of application of modern information analytical systems, the sequential stages of analysis and evaluation of indices of resource support of medical organizations and technological process of medical care provision. The results of the study permit to discover particular patterns of the course of disease in different gender and age groups,in terms of clinical manifestations and results of instrumental and diagnostic tests. The dependence of results and outcomes of treatment on set and quality of resources of medical organizations is established. The prognostic indices of functioning of medical organization under various alternatives of patients' flows organization as associated with hospitalization level.

[The normative legal regulation of medical care support of rare (orphan) diseases in adult population of The Russian Federation].

The article considers the results of legal regulation analysis of medical care support including medication maintenance of adult patients suffering from rare diseases exemplified by life-threatened and chronic progressed rare (orphan) diseases resulting in life expectancy decrease and or disability ("List-24"). MATERIALS AND METHODS: Law database was analyzed in terms of current orders of medical care provision, standards of medical care, and clinical guidelines for rare diseases from "List-24" regarding to adult patients. RESULTS: It is concluded that there are no determined rules of medical care provision to adult population in case of rare diseases from "List-24". There are standards of medical care on 6 rare diseases (25% of total diseases amount) from this list for adult patients. However, based on content analysis data of approved standards it was established that there are only 3 from 11 standards (27.28%) for primary medical care support, 4 standards (33.34%) for medical care provision in planned condition, and only 1 standard (9.09%) had appropriate legal basis for its development (clinical guidelines availability). Nevertheless, there is negative prognosis for this the only standard due to legal necessity of all clinical guidelines revision till the end of 2021. CONCLUSION: Revision and creation of clinical guidelines and standards of medical care afterwards are needed for adult patients treatment with rare diseases from "List-24". The conclusion was made in terms of medical care standardization improvement for adult patients suffering from rare diseases from "List-24" based on its alignment with current legal regulation.

[The approaches to planning of medical infrastructure and bed stock in medical organizations in conditions of development and spread of coronavirus infection COVID-19].

The article presents key approaches to methods of assessing and prognosticating the need both for bed stock, considering level of morbidity and epidemiological process in conditions of development and prevalence of coronavirus COVID-19 infection, and as well the regional network of medical organizations of public and municipal health care that should be reoriented to medical care support during pandemic according to 14 evaluation criteria.

[The cost of specialized medical care of children under spinal muscular atrophy in Moscow].

The spinal muscular atrophy is neuromuscular disease caused by mutations in SMN1 gene. The clinical picture of disease is characterized by progressive muscular weakness and atrophy associated with degeneration of spine, and in severe cases by affection of motor neurons of lower bulbar cells. The spinal muscular atrophy progressing course resulting in disability and infant mortality. Actually, specific treatment is at the stage of clinical trials. However, patients are needed in permanent symptomatic arresting of manifestations and pathogenetic treatment preventing development of disease. The article presents calculations of direct medical costs for treatment in pediatric patients (0-17 years old) in Moscow with the main types of spinal muscular atrophy. It is established that the cost of specialized medical care of children with spinal muscular atrophy per single under age patient in Moscow consisted 7,131,185.84 rubles annually, including primary diagnostic, treatment and rehabilitation and medicinal treatment. In total, according to data for 2020 in Moscow, where number of children patients is 144, the cost of specialized medical care of children with spinal muscular atrophy is estimated as 1,024,580,269.16 rubles. At that, data takes into account only direct medical costs for out-patient and in-patient care of children with spinal muscular atrophy, excluding number of exacerbations of disease. Taking into account average numbers of hospitalizations per year because of illness, the cost of in-patient care of single child amounts to 7,844,304.42 rubles annually and 1,127,018,732.08 rubles for all children with spinal muscular atrophy in Moscow (according data of 2020).

[The integrated approach to implementation of expertise of medical interventions].

The article analyzes and systematizes legislative rules of the medical care quality expertise. The paramount place of clinical recommendations in development of legal acts regulating expertise and assessment of medical care quality, quality control and safety of medical activity is determined.

[To the question of the possibility of using selective chromotherapy for allergic diseases in children]. / K voprosu o vozmozhnosti primeneniya selektivnoi khromoterapii pri allergicheskikh zabolevaniyakh u detei.

Allergic diseases are a common pathology in childhood. In the comprehensive medical rehabilitation of children with allergic pathology, non-drug methods of treatment are widely used, which help to reduce the number of drugs used, achieve and prolong the remission of the disease, favorably affect the clinical and functional indicators. THE PURPOSE OF THE STUDY: Is the scientific justification for the use of selective chromotherapy in children with bronchial asthma (BA) and atopic dermatitis (AD). MATERIAL AND METHODS: The study included 120 children with allergic diseases (BA and AD). Among 100 patients with BA, the main group included 50 children, who received exposure to monochromatic polarized green light on biologically active zones for 10 days, 50 - a comparison group that did not receive physiotherapy. The main group of children with AD included 10 patients who received selective blue chromotherapy for foci of skin lesions; the comparison group included 10 children who used only moisturizers without physiotherapy methods. In order to assess the effectiveness of the impact of physical factors in all patients, clinical and functional studies were conducted in the dynamics before and after treatment. RESULTS AND DISCUSSION: The results of clinical and functional examinations showed high therapeutic efficacy of the use of monochromatic polarized green light in children with BA (92.0%). The effectiveness of treating children with blood pressure AD using monochromatic polarized light (blue) was 80%. Indications for the use of selective chromotherapy in children with allergic diseases have been developed. For children with BA, selective chromotherapy of the green spectrum is indicated in the presence of a mild to moderate course of the disease, a period of incomplete remission, and an increased level of anxiety. It is advisable to prescribe selective chromotherapy of the blue spectrum to children with a moderate and mild course of AD. CONCLUSION: The positive effect of selective chromotherapy of the green spectrum on the clinical course of BA in children, bronchial patency, the functional state of the central nervous system and its autonomic part, and the psychoemotional status of children have been identified. The use of selective blue spectrum chromotherapy in children with AD helps to decrease the severity of objective symptoms, reduce the intensity of itching and sleep disturbance, as well as a marked decrease in the area of skin lesion.

[Main methodological approaches to the identification and diagnosis of monogenic hereditary diseases and problems in the organization of medical care and unified preventive programs].

In order to optimize economic and organizational technologies for the provision of medical care to the population and to increase the effectiveness of preventive programs, an analysis of the accumulated morbidity and prevalence of monogenic hereditary diseases (MHDs) has been carried out in 13 federal subjects of the Russian Federation representing 11 ethnic groups: Russians of 6 regions, Tatars, Maris, Chuvashs, Bashkirs, Udmurts, Abazins, Adygeans, Nogays, Circassians and Karachays. The study of the population was carried out according to the developed protocol of complex genetic and epidemiological studies in the Research Center for Medical Genetics, which remains unchanged throughout the study. Here we have studied the structure of the genetic load and diversity of MHDs depending on the prevalence of diseases and in accordance with the classification by organ and system types of disease: neurological, ophthalmological, genodermatosis, skeletal, hereditary syndromes, and other hereditary pathology (metabolic hereditary diseases, disorders of blood, hearing, etc.). It is shown that the maximum number of patients (61.81%) falls in the group of frequent forms of MHDs, which differ by federal subjects / ethnic groups of the Russian Federation. There are frequent forms of MHDs for all populations, and "specific" forms for particular federal subjects of the Russian Federation/ethnic groups. Only for a small group of hereditary diseases there is treatment. Most of the detected diseases-psychiatric, neurological, hematological, and hereditary syndromes-significantly reduce life expectancy. Hereditary diseases of the skeleton, eyes, ears and metabolism affect the quality of life, adaptation in society and public health. On average, 65% of patients are diagnosed with MHDs for the first time. This situation implies changes in medical thinking, changes in education and development of both common for all regions and specific prevention programs. Thus, fundamental research in medicine can improve the quality of medical services and contribute to the improvement of public health.