Journal «MEDICINA» 1/2023

The aim. To study the organization of home-based medical care for patients with a coronavirus infection (COVID-19) in the Russian Federation. Material and methods. A review of regulatory documents on the organization of medical care at home for patients with a coronavirus infection (COVID-19) adopted by the Ministry of Health of the Russian Federation in 2020-2022 was carried out. Based on publications, the provision of medical care at home to patients with a coronavirus infection (COVID-19) in some regions of the Russian Federation was analyzed. Since 2019, in the statistical reporting form № 14ds «Information on the activities of day hospitals of medical organizations», combined data on the work of day hospitals of medical organizations providing assistance on an outpatient basis and hospitals at home have been filled in. In 2021, a special study conducted made it possible to collect information on the work of hospitals at home treating patients with a coronavirus infection (COVID-19) in the Russian Federation and its constituent entities. The methods used were: content analysis, analytical, statistical. Results and discussion. In Russia the activities of medical organizations providing outpatient medical care to patients with a coronavirus infection (COVID-19) is regulated by the Ministry of Health of the Russian Federation, defining the basic principles for such care. The work of medical organizations in the constituent entities of Russia providing home-based care to patients with a coronavirus infection (COVID-19) was regulated by the order of the Ministry of Health of the Russian Federation of May 19, 2020 № 198n. The scientific publications on the organization of home-based medical care for patients with a coronavirus infection (COVID-19) were studied. An analysis was made of the performance indicators of hospitals at home for the treatment of patients with a coronavirus infection (COVID-19) in the Russian Federation and its constituent entities in 2021 (number of patients treated, average duration of treatment). Patients with coronavirus infection (COVID-19) were treated in hospitals at home in 19 subjects across the country. The number of patients treated was 0,3 per 1000 population. The highest proportion of patients treated with COVID-19 at home per 1000 people was observed in the Republic of Adygea, in the Sverdlovsk, Voronezh regions, in the Primorsky Territory, in the Tyumen Region. The average duration of treatment is 11,3 days. Conclusions. In the constituent entities of the Russian Federation, provision of medical care on an outpatient basis has been organized for patients with a coronavirus infection (COVID-19) in accordance with the algorithms. One of the forms of providing are hospitals at home, in which 43,9 thousand patients with a coronavirus infection (COVID-19) or 14,7% of all those treated in hospitals at home were treated in 2021. In the city of St. Petersburg, in the Sverdlovsk region and the Republic of Adygea, hospitals at home were mainly deployed to treat patients with a coronavirus infection (COVID-19).

Key words: coronavirus infection (COVID-19), patient, medical care at home, hospital at home

Responsible self-treatment in chronic diseases involves adjustment of the drug’s dose depending on monitoring data. The aim of the study was to simulate the adjustment of dosage of drugs in responsible self-treatment of chronic diseases and to find methods for calculating current dosages. The methodological basis of the work were methods of mathematical modeling and control theory. The case of discrete control with the introduction of a feedback loop is considered. A method for calculating the dosage of a drug is proposed, taking into account the individual sensitivity of the patient and external uncontrolled influences. The use of the proposed method will improve the quality of control and, accordingly, the effectiveness of the treatment process.

Key words: dose adjustment, drug, responsible self-treatment, chronic disease, modeling

Myopia continues to be a serious public health problem due to the steady increase in the prevalence of the disease and the presence of serious complications leading to the loss of vision. The aim of the study was to investigate the prevalence of myopia among medical students. Materials and methods. A self-reported questionnaire was used to collect the myopia-related data in the 1st-6th year students of various faculties of Kazan State Medical University. The prevalence of myopia was assessed using the medical record of a patient receiving medical care on an outpatient basis. 352 medical records were processed, 323 of them were included in the study. Results. Myopia was detected in 69% of students, 2% had other eye diseases. 42% of students had mild myopia, 21% – moderate myopia, 6% – high myopia, 29% of respondents did not suffer from any eye diseases. According to our data, the prevalence of myopia among female students was 69%, among males – 66%. It was estimated that among students who use vision correction devices, 17% of students started wearing glasses/contact lenses at the age of 10, 43% – at the age of 10 to 15 years, 34% – at the age of 15 to 20 years, 6% of students started using vision correction devices being older than 20 years. Conclusion. The high prevalence of myopia among students of Kazan State Medical University (69%) was revealed. In most cases, myopia developed before entering the university; this demonstrates the need in prophylaxis of nearsightedness not only in students, but also in schoolchildren.

Key words: myopia, myopia, prevalence

The issues of an integrated approach to the forensic psychiatric assessment of persons who have committed sexual crimes by information and telecommunication technologies are considered. The main stages of decision-making are identified and analyzed. The features of the formation of ideas about the problem being solved, decision-making strategies, and the choice of alternatives are considered. Approaches to assessing the subject's ability to comprehend and regulate legally significant behavior are defined. An algorithm for forensic psychiatric assessment is formulated, according to which the most significant are the severity and nature of the leading psychopathological symptoms and the degree of its influence on the cognitive and volitional components of behavior regulation.

Key words: Internet, sexual disorders, virtual crimes, paraphilias, abnormal sexual behavior, forensic psychiatric examination, forensic psychiatric evaluation

The article considers the activities within the framework of the national healthcare project aimed at attracting foreign patients to receive planned medical care in the Samara region. The goals and objectives of the regional concept and project for the export of medical services are disclosed. The actual data are presented in the context of profiles and packages of medical services. The prospects of development and the problems being solved in this field in connection with the current situation in the Russian Federation are evaluated.

Key words: medical service, medical care, healthcare, medical tourism

A unified methodological approach is proposed to describe the nosological structure of polymorbidity, to systematize its clinical and epidemiological properties and patterns, as well as for the phenomena associated with it. A probabilistic model is used to describe at the phenomenological level the picture of the formation of the resulting statistics of polymorbidity in a population. The ergodic hypothesis underlies the model of morbidity in the population. The results have the meaning of ensemble averages. The microscopic (internal) states of the system can take on all possible values compatible with the given values of the macroscopic (external) parameters. Of all the possible microscopic states, those that have the highest statistical weight are realized with the maximum probability. The real system defines the block diagram of the model. Those aspects of the system that correspond to the objectives of the study are displayed. The direct task is to draw up an epidemiological picture according to the clinical parameters of the disease. The inverse task is the formation of an individual (clinical) description of nosology based on epidemiological (population average) data. A special state probability linear regression method is proposed to compare theoretical results with observations. The test allows estimating the parameters of the real distribution. The adequacy of the model is checked when it is «fitted» to the observational data. The fitting parameters rationally characterize polymorbid pathology – the structure and incidence rate.

Key words: polymorbidity, modeling, statistics, ergodic hypothesis, linear regression

Background. Alcohol abuse has a direct negative impact on many health-related problems. Materials and methods. Screening self-questionnaires (AUDIT-4) and a highly sensitive and specific marker of chronic alcohol intoxication phosphatidylethanol (PEth), were used to study the spread of alcohol-attributed pathology in acutely ill patients of the neurological department of a multidisciplinary city clinical hospital. The study was based on the data, collected at the Moscow site of a joint Norwegian-Russian observational, cross-sectional study conducted by the University Hospital of Oslo and Moscow Scientific and Practical Center for Addictions. Statistical analysis was performed using IBM SPSS Statistics 25.0 software. Results of the study. 25,5% of patients in the neurological department demonstrated harmful use of alcohol (AUDIT-4 threshold ≥5 for women and ≥7 for men). PEth levels, indicating excessive alcohol consumption during 2-4 weeks before hospitalization, were noted in 24,5% of patients. 15,9% of patients admitted the fact of alcohol consumption past 24 hours. The largest proportion of patients with PEth levels equal to or exceeding 0,3 µmol/l was observed in the diagnostic group «Polyneuropathies and other lesions of the peripheral nervous system» (G60-G64) – 78,2%, followed by «Episodic and paroxysmal disorders» (G40-G47) – 47,3%, «Cerebrovascular diseases» (I60-I69) – 21,7% and «Other pathologies» – 16,7%. Conclusions. Our data confirm the need for short-term interventions by primary contact physicians, especially if an alcohol-attributed or alcohol-associated disease is diagnosed. This requires screening for alcohol consumption, preventive interventions and involvement of relevant professionals. The correct definition of the genesis of the disease will provide the patient with the most effective assistance and properly place emphasis in the composition of therapeutic programs.

Key words: AUDIT-4, phosphatidylethanol, hospitalization, alcohol-attributed disease, alcohol-associated disease, neurological disease, brief intervention

The article analyzes the problem of combating cardiovascular diseases in the Republic of Mordovia for the period 2017-2021, based on industry statistics. Mortality from diseases of the circulatory system in 2021 amounted to 477.3 per 100 thousand people, which is 4% lower than the previous year and 17.6% higher than in 2017. In the structure of mortality from diseases of the circulatory system, coronary heart disease occupies the first place – 44.6%. An analysis of the general morbidity of the population of the Republic of Mordovia with diseases of the circulatory system over a five-year period showed an increase in morbidity by 22.9%. The primary incidence of the population of the Republic of Mordovia with diseases of the circulatory system increased by 20.3% compared to 2017. In the structure of both general and primary morbidity of diseases of the circulatory system for 2021, hypertension occupies a leading position – it accounts for 53% (44% in primary morbidity). Emphasis is placed on improving the efficiency of medical care for patients with cardiovascular diseases by further improving the complex of organizational and preventive measures.

Key words: cardiovascular disease, morbidity, mortality, Republic of Mordovia