Journal «MEDICINA» 1/2013

The authors conduct a comprehensive analysis of the current Russian public health legislation. Key problem considered is informing the patient about alternative treatment options. In their view, the federal laws regulating legal aspects of medical practice require a health professional to conduct treatment aiming to achieve the best possible result and mandatory inform patient on all possible forms of treatment for a particular disease.

Key words: treatment options, medical intervention, informing, health care, patient rights

Background. Perinatal mortality in Russia remains considerably higher than in western industrialised countries yet the underlying reasons have been subject to relatively little detailed research. This study takes advantage of a unique information system implemented in an otherwise typical Russian region to explore the determinants and consequences of adverse pregnancy outcomes. Aim. To describe the distribution of pregnancy outcomes (birthweight, ponderal index, pre-term delivery) in a Russian region, in 2000, comparing them with other industrialised countries and identifying their socio-demographic determinants. To assess the impact of the distribution of birthweight on perinatal mortality. Methods. The study included all births and perinatal deaths recorded as occurring in Tula oblast, Russia, in year 2000. There were 11,172 births, including 116 stillbirths and 74 dying within 7 days. Results. Perinatal mortality in Tula in 2000 was 16.8/1,000 births, slightly higher than the figure for Russia overall. The frequency of low birthweight, low ponderal index and pre-term birth were higher in Tula than in other industrialised countries. Mean birthweight increased with increasing education and was higher in married than single mothers, and ethnic Russians than others. After adjustment for maternal age, parity and baby’s sex, birthweight was 250 g less in those with secondary or less education compared with those with university education. The gradient was steeper than in other industrialised countries. Ponderal index behaved similarly, although the association was only significant for maternal education. Once born, survival is substantially lower at all birthweights than in Sweden, chosen as it has the lowest perinatal mortality in Europe. However, had the Swedish birthweight distribution applied, the perinatal mortality rate would only have fallen to 14.4/1,000, although disaggegation by birthweight reveals fewer than expected deaths at under 1,000 g. If this is adjusted for, the estimated perinatal mortality rate for Tula would be 21/1,000. Conclusions. A new system for collecting data on obstetric care in Russia has provided valuable information that can be used to inform the development of effective policies, and which could usefully be implemented elsewhere. At present, despite the introduction of international definitions of birth outcomes, Russian data appear still to underestimate perinatal mortality, even in an Oblast with enhanced data collection. There are wide inequalities in foetal development, especially in relation to maternal education, and the adverse outcomes seen in Russia appear to be due to a combination of both an adverse profile of foetal development, implying the need for policies that improve the health of prospective mothers, and poor survival, implying the need for more effective care for new-born infants.

Bedspace efficiency study was based on data from therapeutic, neurological, and gastrointestinal branches of one of the city hospitals in Kursk. Authors come to the conclusion on the need of continuous monitoring of admissions and patient days based on their research techniques. It is also necessary to change health professionals attitudes to the validity of hospitalization. The difficulty to study substitute to hospitalization methods of rendering care in the situation of their absence is noted. At the same time, their adoption will help to determine optimal cuts in bedspace. The authors consider promising reduction in low intensity care beds replacing them partly with long-term stay beds manned with a higher number of nurses and paramedics, and partly with high-tech beds for those in need for comprehensive care.

Key words: bedspace, optimization, hospitalization, substitute methods of rendering care

Objectives: Mathematical modeling is used widely in economic evaluations of pharmaceuticals and other healthcare technologies. Users of models in government and the private sector need to be able to evaluate the quality of models according to scientific criteria of good practice.

This report describes the consensus of a task force convened to provide modelers with guidelines for conducting and reporting modeling studies.

Methods: The task force was appointed with the advice and consent of the Board of Directors of ISPOR. Members were experienced developers or users of models, worked in academia and industry, and came from several countries in North America and Europe. The task force met on three occasions, conducted frequent correspondence and exchanges of drafts by electronic mail, and solicited comments on three drafts from a core group of external reviewers and more broadly from the membership of ISPOR.

Results: Criteria for assessing the quality of models fell into three areas: model structure, data used as inputs to models, and model validation. Several major themes cut across these areas. Models and their results should be represented as aids to decision making, not as statements of scientific fact; therefore, it is inappropriate to demand that models be validated prospectively before use.

However, model assumptions regarding causal structure and parameter estimates should be continually assessed against data, and models should be revised accordingly. Structural assumptions and parameter estimates should be reported clearly and explicitly, and opportunities for users to appreciate the conditional relationship between inputs and outputs should be provided through sensitivity analyses.

Conclusions: Model-based evaluations are a valuable resource for health-care decision makers. It is the responsibility of model developers to conduct modeling studies according to the best practicable standards of quality and to communicate results with adequate disclosure of assumptions and with the caveat that conclusions are conditional upon the assumptions and data on which the model is built.

Key words: mathematic modeling, pharmacology, health care, pharmacoeconomics, models

Compiling the survey on antioxidants and prevention of major human diseases, the authors performed information retrieval in the main biomedical databases. The emphasis was made on the research meeting the principles of evidence-based medicine. Upon analyzing the sources, the authors conclude that further research in this vital area of medicine is necessary. At the same time they confidently assert that antioxidants should not be used by healthy people for prevention of cardiac diseases and cancer.

Key words: antioxidants, prevention of diseases, cardiovascular diseases, cancer

The author reasons on the delicate matter of moral and ethical aspects of paid medical care. He polemically analyzes and typologizes different forms of profiting from patients regardless of the declared free nature of public health system. The conclusion is drawn on the necessity of abandonment of paid by patient healthcare replaced by free of charge services with the expenses covered by federal and local budgets.

Key words: compulsory health insurance, paid medical services, free medical services, profit