[The world experience of monitoring of satisfaction with medical care: the analytical review]

The satisfaction of patients is one of key indicators used to assess quality of medical care and its effectiveness from point of view of achieving patient-oriented results. Nowadays, the tools assessing patient satisfaction with medical care are largely applied all over the world. The world experience of monitoring satisfaction of population with medical care is necessary for better understanding of dynamics of indicator and possible forecasting of its level in Russia. The purpose of the study is to analyze existing national systems of monitoring satisfaction of patient with medical care and to identify particular established trends. The search for free access publications was implemented using such databases as PubMed, Google Scholar, ResearchGate and eLibrary. The keywords patient satisfaction, national monitoring, satisfaction trends, The sampling included 55 publications. The analysis established that in many countries measurement of degree of satisfaction of patient with medical care become routine practice and integral part of of evaluation of efficacy of both medical organizations and health care in a whole. The initial level of satisfaction with medical care depends on multitude of population variables, including predominant race, culture and nationality of population, gender and age structure, social economic conditions, level of incomes and prevalence of urban or rural population. The dynamics of satisfaction level in most countries demonstrates steady, but slow and statistically insignificant increasing of indicators, though different in various domains of satisfaction. The identified factors are to be considered both at the Federal level to formulate correct conclusions and at the regional level to develop corresponding measures.

[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 calling a doctor in: what an optimal model can be? (publications review)

The primary health care represent the most common segment of medical care in many countries and provides prevention and treatment of diseases, dynamic monitoring of patients with chronic diseases and medical rehabilitation. There is substantial shortage of health personnel to meet health needs all over the world, especially in primary health care. The COVID-19 pandemic exacerbated this problem. It changed workload in primary health care and demonstrated need for new organizational solutions to increase access to primary health care. One of the new transformations in general practice can be redistribution of medical work in primary health care. In this research, five options for organizational models of primary home care were identified. We used "performer (doctor / nurse)", "payment method for the home visit", "frequency of patient visits per week" as indices. There is lack of unified approach in the way how home visits are organized so optimal organizational model of primary home medical care is needed. This will increase access of most demanded type of medical care and ensure rational use of human resources at the primary health care level, especially during COVID-19 pandemic.

[The medical nurses: the factors of professional burning-out]

Nowadays, the professional burnout of paramedical personnel becomes a serious health care problem, resulting in productivity loss and medical care costs increase. The most effective mean to prevent the mentioned burnout is elimination of risk factors. The study purpose is to identify such factors (both positive or negative ones) and to quantify their contribution into development of professional burnout as exemplified by paramedical personnel in the Tomsk Oblast of Russia. The study sampling included 2,486 paramedicals as respondents. The sociological survey was carried out using questionnaire that included the Maslach Burnout Inventory tool and questions to assess corresponding factors of social, professional, economic and physical spheres of life. The study established high prevalence of high degree (29.57%) and extremely high degree (37.01%) of professional burnout in respondents. The following factors were associated with decrease in likelihood of burnout: advanced age (r = -0.089), married status (OR = 0.7; 95% CI 0.6-0, 9), higher number of children in family (r = -0.088), adequate sleep (r = -0.046), amount of time spent on sports per day (r = -0.167). The following factors were associated with increase in the likelihood of burnout: self-reported lack of sleep (OR = 2.1; 95% CI 1.8-2.5), frequent night shift work (r=0.082). The multiple linear regression analysis was applied with selection of model using the Akaike criterion: two mathematical models were formed for the integral value of professional burnout and its "Emotional exhaustion" sub-scale. The models described 15% and 20% of dispersion, respectively. The models allow both to quantify particular contributing factors to development of this syndrome and to develop programs of strengthening positive factors and mitigate negative ones. This will prevent development of professional burnout in paramedical personnel in the Tomsk Oblast.

[The factors associated with development of professional burning-out in physicians]

The professional burnout of physicians is a common world problem that has significant negative impact on quality of medical care and decreases effectiveness of human resources policy in health care. The first step in solving the burnout problem is to identify the most common provoking and protective factors (predictors) of this phenomenon. The study was targeted to determine and categorize the key factors associated with burnout of physicians and to provide prevention and treatment of the condition in the future. The participants of the study completed a questionnaire targeted to evaluating professional burnout levels and establishing key factors of its development and prevention. The sampling of 1668 physicians from the Tomsk Oblast participated in the study. The moderate or high levels of professional burnout were found in more than half of respondents and only 1% of them had no predictors of this syndrome. The correlation and multiple regression analysis were applied to classify various factors impacting on professional burnout as negative (resulting in professional burnout) or protective (preventing development of professional burnout). The results of the study demonstrated the importance of integrated approach in effective solving of the problem of professional burnout in Russia. The study will assist in finding practical applications of its results in preventing and reducing the risk of development of professional burnout.

Frequency of risk factors for chronic noncommunicable diseases among physicians in Russian Federation on the model of Tomsk Region

Aim. To determine the frequency and structure of risk factors (RF) for chronic noncommunicable diseases (CNCDs) among physicians in the Tomsk Region.

Material and methods. The questionnaire was compiled based on the methodological guidelines “Monitoring of risk factors for chronic noncommunicable diseases in practical healthcare”. The questionnaire was provided in electronic format and posted on the site http://www. golosaonline.ru/medto.

Results. Doctors of the Tomsk region revealed a high frequency of such RF for CNCDs as chronic as hypodynamia (45,7%), improper feeding (67,6%) and overweight (34,7%).

Conclusion. The study showed that the frequency of RF for CNCDs in a Tomsk region was lower than the same one in general population. However, there is a need to develop practical guidelines for healthcare workers.

THE PREVALENCE OF CHRONIC NON-COMMUNICABLE DISEASES RISK FACTORS AMONG MEDICAL STAFF

In the review, the results provided of clinical and epidemiological trials confirming high prevalence of the risk factors of chronic noncommunicable diseases among medical workers, common comorbidity and hence adverse influence on the health. Analysis of literature data underscores the necessity of further long term populational studies of epidemiology, age range, relation to occupation positions, for the main risk factors. Organization of various preventive events is required, that obviously will impact not only health state and life quality, but furthermore, will increase medical care in general.

[Comparison Study of Oropharyngeal Microbiota in Case of Bronchial Asthma and Chronic Obstructive Pulmonary Disease in Different Severity Levels]

BACKGRAUND

The result of comparative study of oropharyngeal microbiota taxonomic composition in patients with different severity level of bronchial asthma (BA) and chronic obstructive pulmonary disease (COPD) is presented in this paper.

AIMS

To compare oropharyngeal microbiota composition in case of bronchial asthma and chronic obstructive pulmonary disease in different severity levels.

METODS

138 patients, 50 with BA and 88 with COPD were studied. For each patient was collected anamnesis vitae, swab from the back of the throat and performed physical examination. High-throughput 16S ribosomal RNA gene sequencing and bioinformatic analysis was employed to characterize the microbial communities.

RESULTS

As a result of the study wasfound a number of differences on various taxonomic levels in microbiota's composition within group of patients with different severity level of BA and group of patients with different severity level of COPD and between those groups. COPD patients with GOLD 1-2 in comparison with GOLD 3-4 patiens are marked by prevalence of species Brevibacterium aureum, genus Scardovia, Coprococcus, Haemophilus, Moryella, Dialister, Paludibacter and decrease of Prevotella melaninogenica species. BA patients with severe uncontrolled asthma in comparison with patients which have mild persistent asthma are marked by decrease of Prevotella and increase of species Bifidobacterium longum, Prevotella nanceiensis, Neisseria cinerea, Aggregatibacter segnis and genus Odoribacter, Alloiococcus, Lactobacillus, Megasphaera, Parvimonas, Sneathia. Patient's microbiota in BA group in comparison with COPD group is characterized by the prevalence of Prevotella melaninogenica and genus Selenomonas, Granulicatella u Gemella, and decrease of Prevotella nigrescens, Haemophilus influenza and genus Aggregatibacter, Alloiococcus, Catonella, Mycoplasma, Peptoniphilus u Sediminibacterium. There are no differences between microbiota composition in case of severe uncontrolled BA and very severe COPD.

CONCLUSION

Lack of differences in oropharyngeal microbiota taxonomic composition between patients with severe uncontrolled BA and very severe COPD allow us to suggest a similarity of bronchopulmonary system condition in case of diseases' severe stages.

[Vitamin D--A New Vector of Cancer Prevention?]

Currently, a great number of research projects are focused on finding new treatment methods for cancer and carcinogenesis predictors, as well as the ways to dicrease cancer development risks. This article provides an overview of research on vitamin D as cancer prevention factor. The results of independent experiments and in vitro tests explaining the mechanisms of protective effect of vitamin D and its derivatives on cancer are illustrated. The review of epidemiological survey results obtained from different countries and various populations that were focused on the association of vitamin D use with various cancer pathologies incidence was performed.

[Clinical and Functional Phenotypes of Chronic Obstructive Pulmonary Disease, the Effect on the Severity of the Disease and Prognostic Value in Assessing the Risk of Disease Progression]

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is characterized by progressive limitation of airflow rate, hyperergic inflammatory response of the respiratory tract, and systemic manifestations. Prognosis of the disease depends on the severity of these pathogenetic components. FEV1 which characterizes the speed limit airflow do not allow predicting the rate of COPD progression.

AIMS

Comparison of the prognostic significance of such clinical parameters as frequency of exacerbations and the development of comorbid diseases to assess the nature of COPD progression by using different classification approaches.

MATERIALS AND METHODS

The prospective comparative study included 98 patients with COPD. In the framework of the study protocol, 2 visits were required when a practitioner recruited patients who met inclusion/exclusion criteria, obtained the signed informed consent, collected the anamnestic data, and performed basic procedures of the study: spirometry, 6-minute stepper test, assessment of dyspnea on questionnaire mMRC, body plethysmography, lung diffusion capacity study, dopplerechocardiography, tomography of the chest. Visit 2 was conducted in 12 months after the first one to assess the dynamics of the disease. The dynamics of the disease was considered negative if, upon repeated examination, the patient was referred to the group with more severe COPD.

RESULTS

Our study demonstrates that comprehensive assessment of such factors as the frequency of COPD exacerbations in the preceding 12 months and the presence of comorbid diseases in a patient is reasonable for assessment of disease severity and determination of disease prognosis. At the same time the frequency of COPD exacerbations as one of the evaluated factors is most strongly associated with disease progression.

CONCLUSIONS

Thus, a practitioner is recommended to use the proposed additional clinical criteria to assess the severity and degree of progression of COPD.

[Genetic determinants of antibiotic resistance in oropharyngeal streptococci in patients with chronic obstructive pulmonary disease and in those with asthma]

AIM

To identify oropharyngeal Streptococcus species and to analyze the genetic determinants of antibiotic resistance in patients with asthma and in those with chronic obstructive pulmonary disease (COPD).

MATERIAL AND METHODS

An experimental diagnostic Streptopol+ (Lytech Co. LTD) panel based on a multiplex real-time PCR was applied to investigate the representation of antimicrobial resistance genes (mef and ermB) and the species composition of streptococci isolated from oropharyngeal swab samples from 89 patients with stable COPD and from 51 patients with asthma.

RESULTS

In the stable disease period, the oropharyngeal swabs were found to contain Streptococcus pneumoniae in 7.8% of the patients with asthma and in 6.74% of those with COPD; the common feature of these groups was a tendency towards a severe disease course and recurrent exacerbations requiring antibiotics. S. pyogenus was detected in 42.9% of the oropharyngeal swabs from COPD and asthma patients without exacerbations. The oropharyngeal swabs showed the mef gene in 100% of the patients with asthma and in 100% of those with COPD; the ermB gene was encountered in 91% of the patients with COPD and in 82.4% of those with asthma. The COPD patients displayed a direct correlation between the representation of the ermB gene and sputum production and smoking index. The mef and ermB genes were directly correlated with the frequency of exacerbations in patients with COPD.

CONCLUSION

The identified streptococci are a reservoir of antimicrobial resistance genetic determinants - the mef and ermB genes encoding the mechanisms of streptococcal macrolide resistance. The representation of the above genes directly correlates with the frequency of exacerbations and the number of antimicrobial drug uses.

[The airways microbial community composition in healthy individuals and bronchial asthma patients]

This review summarizes the results of studies on the composition of microbial communities in the airways of healthy individuals and patients with asthma. Modern molecular genetic technology of the microbial identification, which are based on a sequence determination of encoding proteins genes conserved regions. These regions form the 16s-subunit ribosomal RNA in microorganisms of different species. These genes are detected by sequencing markers characteristic of individual microorganisms and their phylogenetic groups, and allow to perform a deep analysis of the microbiota in healthy volunteers and patients with chronic bronchoobstructive diseases. So, apparently healthy human bronchial tree is characterized by low bacterial contamination (most typical representatives here are the genera Pseudomonas, Streptococcus, Prevotella, Fusobacteria and Veilonella, much less potentially pathogenic Haemophilus and Neisseria are represented). In bronchial asthma patients the lower respiratory tract microbiota undergoes a qualitative transformation: as compared to healthy individuals the number of Proteobacteria increases and the number of Bacteroidetes decreases. Severe asthma in children is associated with significant respiratory tract Staphylococcus spp. insemination. Association between the asthma developing higher risk in young children and organisms such as Haemophilus, Moraxella and Neisseria spp. It is of considerable interest to determine the role of the microbiome in the development of human diseases of the bronchopulmonary system, and to understand the impact of the microbes communities as a course of disease and the important factor for the development of resistance to therapy.

[Composition of microorganism community in the airways of patients with chronic obstructive pulmonary disease]

This review summarizes results of research on the composition of microorganism community in the airways of patients with chronic obstructive pulmonary disease. Modern technologies for molecular genetic identification of microorganisms provide a deep insight into the microbiota of patients with chronic broncho-obstructive diseases for the better understanding of bronchopulmonary pathology in man and effect of microbiotic communities on the clinical course of diseases and formation of resistance to antibiotics.

Genome-wide association study of body mass index in 23 000 individuals with and without asthma

BACKGROUND

Both asthma and obesity are complex disorders that are influenced by environmental and genetic factors. Shared genetic factors between asthma and obesity have been proposed to partly explain epidemiological findings of co-morbidity between these conditions.

OBJECTIVE

To identify genetic variants that are associated with body mass index (BMI) in asthmatic children and adults, and to evaluate if there are differences between the genetics of BMI in asthmatics and healthy individuals.

METHODS

In total, 19 studies contributed with genome-wide analysis study (GWAS) data from more than 23 000 individuals with predominantly European descent, of whom 8165 are asthmatics.

RESULTS

We report associations between several DENND1B variants (P = 2.2 × 10(-7) for rs4915551) on chromosome 1q31 and BMI from a meta-analysis of GWAS data using 2691 asthmatic children (screening data). The top DENND1B single nucleotide polymorphisms(SNPs) were next evaluated in seven independent replication data sets comprising 2014 asthmatics, and rs4915551 was nominally replicated (P < 0.05) in two of the seven studies and of borderline significance in one (P = 0.059). However, strong evidence of effect heterogeneity was observed and overall, the association between rs4915551 and BMI was not significant in the total replication data set, P = 0.71. Using a random effects model, BMI was overall estimated to increase by 0.30 kg/m(2) (P = 0.01 for combined screening and replication data sets, N = 4705) per additional G allele of this DENND1BSNP. FTO was confirmed as an important gene for adult and childhood BMI regardless of asthma status.

CONCLUSIONS AND CLINICAL RELEVANCE

DENND1B was recently identified as an asthma susceptibility gene in a GWAS on children, and here, we find evidence that DENND1B variants may also be associated with BMI in asthmatic children. However, the association was overall not replicated in the independent data sets and the heterogeneous effect of DENND1B points to complex associations with the studied diseases that deserve further study.

[Molecular and pharmacogenetic mechanisms of severe asthma]

This review summarizes the results of studies to identify the dominant mechanisms of development and persistence of inflammation in severe asthma and results of pharmacogenetic studies of determination response to drugs. These mechanisms could potentially be used for diagnostic purposes and become the new targets of asthma therapy. Pharmacogenetic information will enable the use of a personalized approach to the asthma management which will adjust the therapy technology and increase the possibility of achieving disease control.

[The prevalence of food allergies in children in world nidus of opisthorchiasis: background and study methodology of epidemiological survey EuroPrevall]

Accordingly to numerous surveys food allergy affects up to 2-6% of population in different countries and varies due to numerous factors including the prevalence of helminths infestation. The food allergy prevalence data in Russia are based on official medical statistics. The study was performed as part of "The Prevalence, Cost and Basis of Food Allergy Across Europe" (EU funded project No FP6-2006-TTC-TU-5 Proposal 045879 EuroPrevall). The aim is to create the concept offood allergy in children in opisthorchiasis endemic area based on epidemiological study of the prevalence, risk factors and clinical features. The main objective of the study will be the working out of the food safety regulations. This article describes the study design and its methodology.

[The number of life years lost (DALYs) due to premature mortality in the population of Tomsk region in 2012]

AIM

To calculate the index of years of life lost population due to premature death in the Tomsk region in 2012, and the contribution of various groups of diseases in the total indicator DALY among males and females.

MATERIALS AND METHODS

In the calculation of DALY used the number and the gender and age structure of the population of Tomsk region by 01.01.2012, according to Rosstat. To conduct the calculation of DALY used the methodology presented by the world Bank in the report "Investing in health" in 1993 According to the methodology, the DALY is the number of years of life of the population, lived with disability or other health problems, and lost due to premature death.

RESULTS

The total loss of DALYs in the Tomsk region by the end of 2012 amounted 112,3, per 1000 population (11.6 +/- 8.9). In the structure of DALYs by cause of death 1st place is occupied by diseases of the circulatory system, 2nd injury and poisoning, 3rd neoplasms.

CONCLUSIONS

The indicator DALY in the Tomsk region are significantly lower than the Russian Federation as a whole (according to S.A. Leonov--1.25 times, according to G. Yang--2 times). The relatively low level of DALYs in the Tomsk region is associated with favourable compared with other regions of the age structure (younger populations). It should also be noted that more than 70% of population live in urban areas, where, as is known, the availability of medical care are higher than in rural.

[Genome-wide association study of allergic diseases in Russians of Western Siberia]

Genome-wide association studies are currently considered as one of the most powerful tools to establishing the genetic basis of complex diseases. A number of such studies were carried out for allergic diseases; however, in Russian population this analysis has not been performed so far. For the first time, we performed genome-wide association study of allergic diseases in Russian inhabitants of Western Siberia. Two new loci associated with childhood bronchial asthma were identified (20q13.12, rs2425656, P = 1.99 x 10(-7); 1q32.1, rs3817222, rs12734001, P = 2.18 x 10(-7) and 2.79 x 10(-7), respectively) as well as one locus, associated with allergic rhinitis (2q36.1, rs1597167, P = 3.69 x 10(-7)). Genes located in the loci, YWHAB and PPP1R12B for asthma and KCNE4 for allergic rhinitis, are new genes for these diseases. It was found that BAT1 (6p21.33), MAGI2 (7q21.11) and ACPL2 (3q23) genes are, likely, common (syntropic) genes of allergic disease and a topic sensitisation. It was shown that RIT2 (18q12.3) and (5q31.1) genes can be involved in the control of lung function. The results of the study enlarge the body of data on genetic factors of allergy and expand the list of genes underlying these diseases.

[Dynamics of functional parameters in different schemes for bronchial asthma therapy: results of the STRELA-ACT multicentre study]

Different strategies for disease control in real clinical practice are compared in terms of dynamics of functional parameters in patients with persistent bronchial asthma. This prospective multicentre surveillance study was carried out in 19 Russian clinics using the common protocol. The patients were divided in 3 groups in accordance with the changes of basal antiinflammatory therapy during the study period. Group A--stepwise increase in the extent of combined salmoterol/fluticason therapy, group B--long-term stable-dose salmoterol/fluticason therapy, group C--salmoterol/fluticason therapy with gradual decrease of the dose and/or transition to an alternative variant. Statistical analysis using Statistica 6.0 program included data from 543 patients. The results suggest that the two first modalities increased the level of control (ACT test) and improved characteristics of external respiration throughout the study period. Strategy 3 was associated with a decrease in the external respiration function and the level of control.

[Epidemiology of allergic rhinitis in children residing in the city of Tomsk and rural areas of the Tomsk region]

The present paper is designed to report results of a clinico-epidemiological study that had the objective to elucidate the prevalence of allergic rhinitis among 8,311 first- and eighth-grade schoolchildren from the city of Tomsk and rural areas of the Tomsk region. The investigation was undertaken in the framework of the International Study of Asthma and Allergy in Childhood (ISAAC). It has demonstrated that clinical symptoms of allergic rhinitis (AR) in the region of interest occurred in 36.7% of the children including 35.6% and 38.9% of those attending urban and rural schools respectively. Positive skin test response to the selected panel of allergens was documented in 45.41% and 16.09% of the children in these groups. They most frequently reacted to the cat's hair, birch tree pollen, and a mixture of tick allergens and domestic dust. Only urban community-dwelling children proved sensitized to cockroach (15.62%), wormwood (6%), saltbush (8%), and ragweed (10.93%) allergens. It may be hypothesized that epidemiological characteristics of allergic rhinitis are generated not only under the influence of the urban environment but also depend on other endemic ecological factors.

[The clinicofunctional characterization of the phenotypes of severe uncontrollable bronchial asthma]

The aim of the study was to compare the clinical characteristics and the inflammatory process activity in the airway of patients with severe therapy-sensitive and therapy-resistant bronchial asthma (TSBA; TRBA). The subjects were 171 patients with severe bronchial asthma (BA) aged 18 to 60; the diagnosis was established prior to the study according to GINA 2002 criteria. There were 50 TSBA patients, 121 TRBA, and 50 controls. According to a range of criteria, BA in TRBA was more severe than that in TSBA. TRBA patients displayed significantly higher indices of inflammatory process activity, such as absolute and relative number of eosinophiles and neutrophiles in induced sputum (IS), and IS level of IL-5. Evaluation of IS inflammatory markers in patients with severe BA allowed substantiation of the central role of persistent inflammation as a risk factor of TRBA development.

[Life quality control in patients with severe bronchial asthma]

The aim of the study was to evaluate life quality (LQ) of patients with severe bronchial asthma (BA) in connection with the degree of the disease control. Seventy two BA outpatients were divided into two groups: 50 patients with uncontrolled BA, and 22 patients who had achieved full BA control thanks to combined therapy with salmeterol plus fluticasone propionate in a dose of 1000 mg per day during 3 months. Clinical symptoms, respiratory parameters, and daily requirement of broncholytics were under study. General and specialized questionnaires (SF-36; AQLQ) were used to evaluate LQ. The study revealed that full BA control lead not only to improvement of clinical symptoms and positive changes in the respiratory function, but to significant increase of LQ as well. Thus, achievement of full BA control as a complex goal of treatment increases patients' LQ, especially in social sphere.