Category: Nevin Manimala

Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med. 2022 Mar;30(2):275-280. doi: 10.32687/0869-866X-2022-30-2-275-280.

ABSTRACT

The private health care sector in the Russian Federation is developing and its role in providing not only paid, but also free medical care is increasing. The issues of cooperation between state and private health sectors becomes more actual. The purpose of the study is to investigate current research and practical issues of private health care in the Russian Federation and to identify shared and specific problems with state sector and to develop proposals for evolution of intersectorial interaction and partnership. The study used analytical, sociological and statistical methodologies. The sociological survey covered 409 executives of state and private medical organizations. It was established that current and prospective research and practical problems of state and private health care are mostly shared. The statistically significant differences in opinions of respondents were determined. The list of most actual research and practical problems of private health care was composed. The commonality of derived valuations confirmed trend to integration. The identified sporadic differences are explained by greater social orientation of state health care and directness on competition of private health care. The generalization of national and foreign experience permitted to formulate proposals on partnership between state and private health care. The trend to integration of state and private health care can be transformed into active process of development of long-term partnership cooperation in health recovery and maintenance that will result in ensuring active longevity of population of the Russian Federation.

PMID:35439389 | DOI:10.32687/0869-866X-2022-30-2-275-280

Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med. 2022 Mar;30(2):270-274. doi: 10.32687/0869-866X-2022-30-2-270-274.

ABSTRACT

The primary health care is characterized by its directivity to population health, while general practitioner is key figure in its organization and is responsible for assigned population health. The Russian Federation continues to suffer from overspecialization of medical care in outpatient health care. At that, the number of unreasonable visits to medical specialists is too high. The general practitioner, with appropriate training, can appoint patients by 11 specialties and in conditions of municipal polyclinic can undertake up to 81% of visits to medical specialists. The purpose of the study is to evaluate primary health care functioning in Moscow and to formulate proposals for reforming health care, considering development of general medical practices in a metropolis. The study was focused on analysis of morbidity of population of Moscow, on support of out-patient health care with physicians before and after implementation of three-level system of ambulatory polyclinic care, on evaluation of preventive activities of general practitioners and on development of proposals for improving organizational forms of activities with emphasis on health preservation. In the study were applied such methods as statistical, direct observation, sociological. The analysis was applied to forms of federal statistical observation i.e. form № 30 in Moscow and the Russian Federation for 2010-2019. The population sociological surveys concerning satisfaction with medical care were carried out. The research base was Moscow. The analysis demonstrated that results of Moscow health care system reformation is economically effective because of shortage of medical personnel primarily of administrative staff and its rational employment. The reformation results were positively assessed by patients, whose satisfaction with medical care made up to 95.6%. The general practitioner is to be responsible for health status of attached population and is called upon not only to carry out treatment and preventive activities, but also to coordinate organization of medical care of attached population at all stages of its provision. The implementation of general medical practice in conditions of municipality is to calculate complete transition of medical organizations providing out-patient medical care to general medical practice, that will result to certain extent, in reduction of staff positions of medical specialists. It is necessary to expand duties of medical nurse in general practice. The optimal model of joint work of general practitioner with feldsher and medical nurse of general practice. The complex general practice team can include medical registrar. The proposed perspective models permit to implement integrating role of general practitioner and to increase accessibility and efficiency of primary health care.

PMID:35439388 | DOI:10.32687/0869-866X-2022-30-2-270-274

Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med. 2022 Mar;30(2):264-269. doi: 10.32687/0869-866X-2022-30-2-264-269.

ABSTRACT

One of important directions in improving effectiveness of out-patient surgical medical care is development of in-patient replacement forms. The purpose of the study. is to investigate volume of surgical work performed in medical organizations providing outpatient care in the Russian Federation in 2010-2019. To evaluate changes in dynamics of number and structure of implemented surgical operations, number of operated patients in subdivisions of medical organizations providing outpatient medical care and in conditions of day-stay hospitals, data from the Federal statistical observation form № 30 for 2010-2019 was analyzed. The statistical and analytical methods were applied. It was established that in the Russian Federation, during 10 years, in subdivisions of medical organizations providing outpatient medical care, the number of implemented operations decreased from 5,639,983 to 4,962,020 (by 12.0%), and the number of operated patients – from 5,277,077 to 4,580,195 (by 13.2%). The structure of surgical interventions performed in medical organizations providing outpatient care has practically not changed (operations on the skin and subcutaneous tissue, oral cavity and maxillo-facial region, female genital organs, musculoskeletal system, organ of vision). The structure of surgical interventions practically had no changes (operations on skin and subcutaneous tissue, oral cavity and maxillo-facial region, female genital organs, musculoskeletal system, organ of vision). During the studied period, the number of operations performed in day-stay hospitals of medical organizations providing outpatient medical care increased from 181,659 to 720,633 (4.0 times), the number of operated patients – from 168,188 to 650,196 (3.9 times). Mainly in day-stay hospitals, operations are performed on organ of vision, female genital organs, skin and subcutaneous tissue. In 2010-2019, the percentage of operations performed in subdivisions of medical organizations providing outpatient medical care, decreased from 96.9% to 87.3%, and in day-stay hospitals increased from 3.1% to 12.7%. The study results testify expansion of volumes of surgical work in day-stay hospitals of medical organizations providing outpatient medical care.

PMID:35439387 | DOI:10.32687/0869-866X-2022-30-2-264-269

Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med. 2022 Mar;30(2):232-238. doi: 10.32687/0869-866X-2022-30-2-232-238.

ABSTRACT

The diseases of digestive apparatus significantly contribute into premature mortality of population. In the Republic of Buryatia, the diseases of digestive apparatus occupy third place in the structure of primary morbidity of population (6.7%) and fourth place in the structure of total mortality (6.6%). The purpose of the study is to establish characteristics of structure and dynamics of morbidity and mortality of population because of diseases of digestive apparatus in the Republic of Buryatia in 2009-2018. The analysis was based on data from state statistical reporting forms and official reports of the Territorial Authority of the Federal State Statistics Service in Republic of Buryatia for 2009-2018, reporting and accounting forms of medical organizations. The study was carried out using statistical, analytical methods, as well as elements of comparative analysis. The analysis testifies increasing of indicator of primary morbidity of diseases of digestive apparatus from 4051.0 to 4226.1 per 100 thousand of population and of mortality of diseases of digestive apparatus in the Republic of Buryatia from 60.6 to 62.5 per 100 thousand of population. The main causes of increasing of morbidity and mortality from diseases of digestive apparatus in the Republic of Buryatia are liver diseases, in particular liver fibrosis and cirrhosis because of alcoholization of population, undue diagnostics and treatment of liver pathology in the group “older than able-bodied age”.

PMID:35439381 | DOI:10.32687/0869-866X-2022-30-2-232-238

Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med. 2022 Mar;30(2):185-194. doi: 10.32687/0869-866X-2022-30-2-185-194.

ABSTRACT

The article presents current trends in reproductive demographic process economically developed countries. Today, the total fertility rate in all European countries is below the minimum required to ensure population reproduction in long term – 2.1 children per woman during her life. According statistic data, 4.167 million children were born in the EU in 2019 that corresponds to 9.3 births per 1000 of population. In the EU, 1.53 children went to one woman in 2019 (in 2018 – 1.54). The lowest total fertility rates in 2019 were registered in Malta (1.14), Spain (1.23) and Italy (1.27). In the United States, fall of rate of childless women with higher education disputes well-established observation of positive relationship between education and childlessness. The infertility affects approximately 8-12% of couples worldwide, at that in developed countries, up to 15% of all couples are infertile. In connection with the problem of birth rate reduction in developed countries, researchers highlight such problems as increasing of average age of mothers at delivery (30-35 years and older) and intervals between labors, development of subsidiary reproductive technologies, pregnancy outcomes, newborns health in short and long perspective. The global COVID-19 pandemic resulted in resources deficiency, complexities with medical services support related to reproductive health, risks for maternal and perinatal outcomes in pregnant women with COVID-19. However, actually still there is no complete picture of pandemic impact on global indices of reproductive demographic process.

PMID:35439373 | DOI:10.32687/0869-866X-2022-30-2-185-194

Arthritis Care Res (Hoboken). 2022 Apr 19. doi: 10.1002/acr.24897. Online ahead of print.

ABSTRACT

OBJECTIVE: Early diagnosis and tight control improve outcomes of rheumatoid arthritis (RA). However, it is not known whether establishing an Early Arthritis Clinic (EAC) is sustainable for national health systems. This analysis aims to compare effectiveness and costs of an EAC compared to patients followed as for standards of care.

METHODS: A retrospective study on administrative health databases of patients with a new diagnosis of RA was conducted: 430 patients followed in an EAC were enrolled, and 4 non-EAC controls were randomly matched for each of them. During two years of follow up, the mean healthcare costs (outpatient, inpatient, pharmaceutical and global) and 3 effectiveness measures (number and length of hospitalization and quality of care) of EAC and non-EAC were estimated. The incremental cost-effectiveness ratio was calculated as well as the cost-effectiveness acceptability curve.

RESULTS: The cohorts included patients with a mean age of 55.4 years and 1506 (70%) females. Mean pharmaceutical (2602 versus 1945 €) and outpatient (2447 versus 1778 €) costs were higher in the EAC cohort. Conversely, a higher rate of non-EAC patients had a low adherence to quality-of-care indicators. The expected number of hospitalizations and the length of stay were statistically significant higher in non-EAC versus EAC.

CONCLUSION: Despite an expected increase in outpatient costs (visits and diagnostic tests) and pharmaceutical costs, the reduction in terms of number and length of hospitalizations and the higher adherence to international quality of care guidelines support the effectiveness of the EAC model.

PMID:35439369 | DOI:10.1002/acr.24897

Dermatol Ther. 2022 Apr 19:e15524. doi: 10.1111/dth.15524. Online ahead of print.

ABSTRACT

BACKGROUND: Recent knowledge on the key role of interleukin (IL)23/17 axis in psoriasis pathogenesis, led to development of new biologic drugs. Risankizumab is a humanized immunoglobulin G1 monoclonal antibody specifically targeting IL23. Its efficacy and safety were showed by both clinical trials and real-life experiences. However, real life data on effectiveness and safety of risankizumab in patients who previously failed anti-IL17 are scant.

OBJECTIVES: To assess the efficacy and safety of risankizumab in patients who previously failed anti-IL17.

METHODS: A 52-week real-life retrospective study was performed to assess the long-term efficacy and safety of risankizumab in patients who previously failed anti-IL17.

RESULTS: A total of 39 patients (26 male,66.7%; mean age 50.5±13.7years) were enrolled. A statistically significant reduction of Psoriasis Area Severity Index (PASI) and Body Surface Area (BSA) was assessed at each follow-up (PASI at baseline vs week52: 13.7±5.8 vs 0.9±0.8,p<0.0001; BSA 21.9±14.6 vs 1.9±1.7,p<0.0001). Nail Psoriasis Severity Index improved as well, being statistically significative only at week16 and thereafter [9.3±4.7 at baseline, 4.1±2.4(p<0.01) at week16, 1.4±0.8(p<0.0001) at week52]. Treatment was discontinued for primary and secondary inefficacy in 1(2.6%) and 3(7.7%) patients, respectively. No cases of serious adverse events were assessed.

CONCLUSION: Our real-life study confirmed the efficacy and safety of risankizumab, suggesting it as a valuable therapeutic weapon among the armamentarium of biologics, also in psoriasis patients who previously failed anti-IL17 treatments.

PMID:35439341 | DOI:10.1111/dth.15524

J Athl Train. 2022 Apr 1;57(4):352-359. doi: 10.4085/1062-6050-0330.21.

ABSTRACT

CONTEXT: Care-seeking behaviors for sport-related concussion (SRC) are not consistent across demographic subgroups. Not only may these differences stem from health inequities, but they can perpetuate disparities in care for SRCs.

OBJECTIVE: To determine whether racial differences existed in the care pathway from injury to SRC clinic of adolescent athletes.

DESIGN: Retrospective cohort study.

SETTING: Regional SRC center.

PATIENTS OR OTHER PARTICIPANTS: Of 582 total athletes, 96 (16.5%) Black and 486 (83.5%) White adolescent athletes were diagnosed with SRC and evaluated within 3 months at the SRC clinic.

MAIN OUTCOME MEASURE(S): Race was the defined exposure, dichotomized as Black or White. The 4 primary outcomes were (1) location of the first health system contact, (2) time from injury to the first health system contact, (3) time to the in-person SRC clinic visit, and (4) whether the athlete established care (>1 visit), was released immediately to an athletic trainer, or was lost to follow-up.

RESULTS: Black and White athletes mostly presented directly to the SRC clinic (61.5% versus 62.3%) at a median (interquartile range) of 3 (1-5) and 4 (1-8) days, respectively (P = .821). Similar proportions of Black and White athletes also first presented to the emergency department (30.2% and 27.2%) at a median of 0 (0-1) versus 0 (0-1) days, respectively (P = .941). Black athletes more frequently had care transferred to their athletic trainer than White athletes (39.6% versus 29.6%) and less frequently established care (56.3% versus 64.0%), respectively; however, these differences were not statistically significant (P = .138). Loss to follow-up was uncommon among Black (4.2%) and White (6.4%) athletes alike.

CONCLUSIONS: Within an established SRC referral network and multidisciplinary clinic, no racial disparities were observed in how athletes were initially managed or ultimately presented to the SRC clinic despite racial differences in school type and insurance coverage. The SRC center assimilation and affiliation with school systems may be helpful in improving access and providing equitable care across diverse patient demographics.

PMID:35439315 | DOI:10.4085/1062-6050-0330.21

Cancer. 2022 Apr 19. doi: 10.1002/cncr.34230. Online ahead of print.

ABSTRACT

BACKGROUND: Immune checkpoint inhibitors (ICIs) can cause immune-related adverse events (irAEs) that range from mild to life-threatening. Age itself does not seem to be a predictor for the occurrence of irAEs. It is unknown whether frailty plays a role in the occurrence of irAEs. Therefore, the authors assessed whether irAEs and their sequelae occur more often in frail patients than in fit patients according to the Geriatric 8 (G8) assessment.

METHODS: Patients with melanoma aged 70 years and older who were about to start ICI therapy and were screened with the G8 assessment were enrolled in this prospective, observational study. Patients were classified by the G8 as either fit or frail. The primary outcome was the occurrence of grade ≥3 irAEs.

RESULTS: In total, 92 patients were included for statistical analyses, 26 (29%) of whom were classified as frail. Grade ≥3 irAEs occurred in 20% of patients. There was no significant difference in the occurrence of grade ≥3 irAEs between fit and frail patients (17% vs 27%; P = .26). Frail patients were admitted to the hospital because of irAEs significantly more often than fit patients (29% vs 54%; P = .02) and showed a trend toward increased length of hospitalization (5 vs 8 days; P = .06) and more frequent use of immunosuppressants or ICI discontinuation for irAEs (36% vs 58%; P = .06).

CONCLUSIONS: Although frailty appears to be unrelated to the occurrence of severe irAEs, it is an indicator of irAE-related adverse sequelae, such as hospital admission. Screening for frailty can be of added value in the shared decision-making process for older patients who qualify for ICI treatment.

PMID:35439334 | DOI:10.1002/cncr.34230

J Athl Train. 2022 Apr 1;57(4):325-333. doi: 10.4085/1062-6050-0407.20.

ABSTRACT

CONTEXT: Return-to-activity (RTA) assessments are commonly administered after anterior cruciate ligament reconstruction (ACLR) to manage the patient’s postoperative progressions back to activity. To date, few data are available on the clinical utility of these assessments to predict patient outcomes such as secondary anterior cruciate ligament (ACL) injury once the athlete has returned to activity.

OBJECTIVE: To identify the measures of patient function at 6 months post-ACLR that best predict RTA and second ACL injury at a minimum of 2 years after ACLR.

DESIGN: Prospective cohort study.

SETTING: Laboratory.

PATIENTS OR OTHER PARTICIPANTS: A total of 234 patients with primary, unilateral ACLR completed functional assessments at approximately 6 months post-ACLR. Of these, 192 (82.1%) completed follow-up at ≥2 years post-ACLR.

MAIN OUTCOME MEASURE(S): The 6-month functional assessments consisted of patient-reported outcomes, isokinetic knee-flexor and -extensor strength, and single-legged hopping. We collected RTA and secondary ACL injury data at ≥2 years after ACLR.

RESULTS: Of the patients who were able to RTA (n = 155), 44 (28.4%) had a subsequent ACL injury, 24 (15.5%) to the ipsilateral graft ACL and 20 (12.9%) to the contralateral ACL. A greater proportion of females had a secondary injury to the contralateral ACL (15/24, 62.5%), whereas a greater proportion of males reinjured the ipsilateral ACL graft (15/20, 75.0%; P = .017). Greater knee-extension symmetry at 6 months increased the probability of reinjury (B = 0.016, P = .048). Among patients with RTA at <8 months, every 1% increase in quadriceps strength symmetry at 6 months increased the risk of reinjury by 2.1% (B = 0.021, P = .05). Among patients with RTA at >8 months, every month that RTA was delayed reduced the risk of reinjury by 28.4% (B = -0.284, P = .042). Descriptive statistics of patient function stratified between the early and delayed RTA groups can be found in the Supplemental Table (available online at http://dx.doi.org/10.4085/1062-6050-0407.20.S1).

CONCLUSIONS: Patients with more symmetric quadriceps strength at 6 months post-ACLR were more likely to experience another ACL rupture, especially those who returned to sport at <8 months after the index surgery. Clinicians should be cognizant that returning high-functioning patients to activity at <8 months post-ACLR may place them at an increased risk for reinjury.

PMID:35439312 | DOI:10.4085/1062-6050-0407.20