Saratov JOURNAL of Medical and Scientific Research

№4, 2020, volume 16

Technology for optimizing medical decision-making

Year: 2020, volume 16 Issue: №4 Pages: 944-949
Heading: public health Article type: Original article
Authors: Korshever N.G., Pomoshnikov S.N.
Organization: Saratov State Medical University

The objective of the study is the development of optimization techniques for making management decisions in healthcare institutions. Material and Methods. We combined the research findings obtained earlier and interviewed two groups of healthcare managers (49 set the optimization principles for making management decisions, 79 tested the technology we designed). Methods of analytical, logical, sociological, content-analysis of official and medical documentation, flow charts, organizational experiment, statistical were used. Results. We established the optimization principles for making management decisions in healthcare institutions: goal orientation, system approach (isomorphism and multiparameter interaction), prospectivity, use of adequate criterial and diagnostic apparatus, flexibility, differentiation, competence, democratization. These enabled designing and testing of the optimization technology guided by the authors' automated multicriterial assessment of successfulness for the studied approach; it provided making and implementing the management decisions that were the most appropriate for achieving results of the medical institution (number of institutions) performance. Conclusion. The technology considered in the study enables setting the trend and implementing goal-oriented measures for optimization of the management decisions in healthcare institutions.

Keywords: optimization technology, medical organization, management decisions

Prevalence of risk factors of chronic non-communicable diseases among medical students with different levels of physical activity

Year: 2020, volume 16 Issue: №4 Pages: 940-943
Heading: public health Article type: Original article
Authors: Apoyan S.A., Guryanov M.S., Pozdeeva A.N.
Organization: "Nizhny Novgorod Regional Center for the Prevention and Control of AIDS and Infectious Diseases", Privolzhskiy Research Medical University

The purpose is to identify the prevalence of the leading risk factors for the occurrence of chronic non-infectious diseases among medical students, depending on their physical activity. Material and Methods. Screening-diagnostics of the main risk factors were carried out, taking into account the commitment of students to sports: students (326 people) who do sports regularly, and students (1014 people) who do not have physical activity, except for physical education at a university. Results. Students who are not committed to sports are characterized by a low level of physical activity (76.6%), a high frequency of stress — 34.7% compared to student who do sports regularly 16.2%, (p<0.01) and smoking (15.9 and 5.6%, respectively, p<0.05). Violations of the eating regime and an unbalanced died were recorded in both study groups (with a frequency of 39.2 and 55.5 per 100 respondents, p<0.05), however, low physical activity contributes to the appearance of deviations in body weight in 24.6% of students not committed to sports. The ranking of the most frequently encountered risk factors showed that the leading places among the non-athlete students belong to low physical activity, inadequate diet, low sleep duration and high stress levels. Conclusion. Authors emphasize that a higher prevalence of risk factors for the development of chronic non-communicable diseases was found among medical students who do not have physical activity on the regular basis, which may indicate a possible positive effect of sports on reducing the frequency of discovering risk factors for chronic non-communicable diseases among the soon-to-be doctors.

Keywords: physical training, sport

Потенциальный риск для здоровья сельского населения, связанный с потреблением местных продуктов питания, содержащих остаточные количества тяжелых металлов

Year: 2020, volume 16 Issue: №4 Pages: 934-939
Heading: Hygiene Article type: Original article
Authors: Chekhomov S.Yu., Eliseeva Yu.V., Pichugina A.A., Eliseev Yu.Yu.
Organization: Saratov State Medical University

Purpose: hygienic assessment of the potential health risks of consuming local food products produced in ecologically poor areas and containing residual amounts of heavy metals. Material and Methods. Based on the established concentrations of heavy metals (HM): lead (Pb), cadmium (Cd), mercury (Hg) and arsenic (As) in local food products of the Saratov region, the potential risk to the health of the rural population associated with their consumption was assessed. The median and 90th percentile of HM content in local foods were used to calculate exposure, hazard coefficient (HQ), total hazard indices (HI), individual carcinogenic risk (CR), and population carcinogenic risk (PCR). Results. Indicators of the HQ values calculated at the level of the median HM content in food products of the regional districts indicated the acceptable level of their impact. In some areas of the region at the concentration of HM at 90 percentile calculated HQ and total HI of contamination of the HM exceeded the value of 1.0, which required in-depth evaluation of the exposure. Bread and dairy products made the greatest contribution to the level of HM contamination in the majority of the studied areas. Conclusion. High level of CR forthe health of the population of some districts of the Saratov region was associated with contamination of food products As calculated at the 90th percentile. The high PCR forthe population of the same regions of the region, associated with contamination of local food products As, was due to a specific level of the carcinogenic potential factor (SFo=1.5), which sharply increased the likelihood of cancer development with oral exposure to this carcinogen.

Keywords: health risk, heavy metals, pollution of food products

Complex hygienic assessment of labor conditions in the modern production of dairy products

Year: 2020, volume 16 Issue: №4 Pages: 927-934
Heading: Hygiene Article type: Original article
Authors: Novikova Т.А., Lutsevich I.N., Baregamyan L.A., Aleshina Yu.A.
Organization: Saratov Hygiene Medical Research Center of Federal Scientific Center for Medical and Preventive Health Risk Management Technologies, Saratov State Medical University

Aim: to conduct a comprehensive hygienic assessment of working conditions of the main professional groups of workers in the modern production of dairy products. Material and Methods. The object of the research icluded labor conditions of the workers of the dairy plant typical for modern milk processing enterprises. The factors of the working environment (microclimate, illumination, noise, vibration) and the labor process were studied using standard methods, equipment and measuring instruments. A total of 3740 studies of working environment factors, 39 professional studies were carried out. Results. Working conditions in the production of dairy products are harmful with varying degrees of deviation from the current hygiene standards. Take place increased (27.5-28.8°C in the cold and 29.5-29.8°C in the warm seasons) and low (4.5-18.35°C) air temperatures, exceeding the maximum permissible level (MPL) noise (by 1.6-9 dBA), insufficient artificial and natural lighting, physical overloads due to excessive dynamic and static physical load, lifting and moving loads manually (one-time 20 kg), maintaining uncomfortable and forced working positions (up to 50% and up to 25% shift time, respectively), body inclinations (440±28 times per shift). The overall assessment of working conditions corresponded to classes 3.1-3.3. Conclusion. Harmful working conditions pose a low to high health risk to workers. Priority measures have been identified to improve working conditions and prevent health disorders of workers: normalization of the microclimate and light environment, noise reduction, and a decrease in labor severity.

Keywords: harmful working conditions, occupational health risk, preventive, workers in the dairy production

Characteristics of morphofunctional status of students of agrarian university

Year: 2020, volume 16 Issue: №4 Pages: 923-926
Heading: Hygiene Article type: Original article
Authors: Latyshevskaya N.I., Levchenko N.V., Kanishcheva E.V.
Organization: Volgograd Medical Scientific Center, Volgograd State Medical University

Objective: To give a hygienic assessment of the morphofunctional state of students of the agrarian university of various age groups. Material and Methods. Across-sectional study was carried out: 448 students of the 1st, 3rd and 5th courses were examined. The level of students' motor activity, a complex of anthropometric and physiometric indicators were determined according to traditional methods. The functional state was assessed according to the results of the Stange test, body mass index (by Ketle's formula), Erisman index, life and strength indices. Results. Research has shown that the majority of students (46.4-59.2%), regardless of the year of study, have an average level of physical activity. Comparative analysis of anthropometric and physiometric indicators of students of different courses did not reveal differences in growth indicators, chest circumference, blood pressure level, values of the Stange test. Senior students showed higher values of body weight and muscle strength of the hands (p<0.05), both in boys and girls. For senior students, higher values of indices characterizing the physical development of boys and girls are also characteristic: Erisman index, life index, strength index. At the same time, the values of body mass index were comparable in students of all observation groups. Conclusion. The main trends of changes in the morphofunctional status of students of the agrarian university with increasing age have been established. To clarify the patterns of changes in the morphofunctional status of students, prospective studies are needed in the dynamics of years of study.

Keywords: anthropometric and physiometric indicators, index method, physical activity, students of the agrarian university

Social and hygienic aspects of doctors' access to health care (review)

Year: 2020, volume 16 Issue: №4 Pages: 917-923
Heading: Hygiene Article type: Review
Authors: Bochkov M.M., Shelekhova T.V., Lutsevich I.N., Ruta A.M., Zaitseva M.R.
Organization: Saratov State Medical University

We come across the regular publications that identify the importance of improvement of doctor's access to health care by the way of reducing various kinds of barriers. However, despite a wide range of expert opinions in this, the existing barriers are not clearly defined. The purpose of our review work is to systematize the accumulated materials in this area, 44 sources of foreign literature were analyzed in the electronic databases MEDLINE® (1981-2016) and CINAHL (1982-2010). Analysis of the literature shows that there is not enough information, despite the importance of studying the adherence of doctors to treatment in order to establish cause-and-effect relationships and scientific justification of preventive measures. When studying the compliance of foreign doctors, it is likely to extrapolate the results of research to the doctors of our country.

Keywords: doctor compliance, medical care for doctors, occupational diseases

Surgical treatment of glioblastomas with various MR characteristics

Year: 2020, volume 16 Issue: №4 Pages: 912-916
Heading: neurosurgery Article type: Original article
Authors: Lakhina Yu.S., Gulyaev D.A., Krasnoshlyk P.V., Mitrofanova L.B., Petrov A.A., Belov I.Yu., Chirkin V.Yu.
Organization: The Almazov National Medical Research Centre, Head of Second Cerebral and Spinal Cord Tumors Department, Doctor of Medical Sciences

Objective: To justify the need for intraoperative monitoring (IOM) for surgical treatment of glioblastoma (GB) with various magnetic resonance characteristics. Material and Methods. 59 patients aged 24-76 years operated on for GB were studied. There were 3 observation groups according to the GB type: 1st — without non-contrasting zone (nCEZ) (n=18); 2nd — with non-contrasting part, hyperintensive in T2 FLAIR mode, corresponding to Sawaya I (n=26); 3rd — with hyperintensive in T2 FLAIR mode zone, corresponding to Sawaya II (n=15). Results. In the 1st and 3rd observation groups, all patients managed to achieve radical removal of the tumor, regardless of the use of IOM. In group 2, total removal was achieved in 69.2% of cases. Analysis of the progression-free period in the three groups showed no significant differences (p=0.05). There was a tendency to increase the progression-free period when using IOM (p=0.07). Using IOM significantly increased overall survival (p=0.04). Conclusion. The use of IOM for the surgical treatment of GB with nCEZ infiltrating functionally significant areas of brain contributes to the radical removal of such tumors. Given that the tissue corresponding to the hyperintensive area in the T2 FLAIR mode contains cancer stem cells, has a high potential compared to other components of the tumor and is most often a source for continued growth, the totality of its resection provides the highest duration of the progression-free period.

Keywords: cancer stem cells, functionally significant glioblastoma zone, non-contrasting glioblastoma zone

Significance of estimation criteria in pediatric flatfoot

Year: 2020, volume 16 Issue: №4 Pages: 905-911
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Sertakova A.V., Rubashkin S.A., Timaev M.Kh., Dokhov M.M., Korshunova G.A., Zvereva K.P., Agafonova N.Yu.
Organization: Saratov State Medical University

Objective: to analyze a set of versatile criteria for assessing flatfoot in children and identify the most significant for flatfoot diagnosis. Material and Methods. We conducted a cross sectional study that involved 150 patients with flatfoot diagnosis (mean age 9.5 ±0.8 у. o.) and 50 patients with neutral feet (mean age 10.1 ±1.3 у. o.). The examination of the children suggested a set of methods including the clinical one, quality-of-life questionnaire survey, X-ray and computed tomography, biomechanical and electroneuromyography (ENMG) methods. The findings of the conventional diagnostic tests underwent clustering and mathematical simulation. Results. The statistically significant X-ray indicators for flatfoot diagnosis are: astragalus horizontal angle (p<0.001), longitudinal arch angle (p=0.038), arch height (p=0.053). The valid biomechanical indicators are the foot transfer time (p=0.044) and the support time (p=0.042) as the temporal characteristics of the gait. Electroneuromyography detected significant changes in the M-response and F-waves as well as F/M ratio with the calf muscle. In most cases, high-amplitude M-responses (13.4±1.6 mV, 7.7±0.8 mV in health) and F-waves (1603±235.4 mV, 360±115 mV in health) were registered from the calf muscles, exceeding the data in healthy children 5 times. 8 statistically significant indicators of 18 X-ray and 13 biomechanical criteria were assigned; they provide 77.3% of the correct diagnosis when used for the mathematical model. Conclusion. We established the most sensitive and statistically significant criteria for the flatfoot diagnosis in children. They enable the assessment of the changes severity in flatfoot and designing the medical decision making support system for choosing the proper treatment method when these criteria are used for the data base and the artificial intelligence predicative model.

Keywords: childhood, diagnostic criteria, flatfoot

Retrospective of hypotheses on pathogenesis of posttrau-matic knee osteoarthrosis (literature review)

Year: 2020, volume 16 Issue: №4 Pages: 900-904
Heading: Traumatology and Orthopedics Article type: Review
Authors: Zubavlenko R.A., Ulyanov V.Yu., Belova S.V., Scherbakov A.A.
Organization: Saratov State Medical University

This study is a retrospective review of the investigation of the pathogenesis of posttraumatic knee osteoarthrosis. We analyzed eLibrary, PubMed online databases as well as the scientific literature in the library of the Scientific Research Institute of Traumatology, Orthopedics and Neurosurgery, Federal State Budgetary Educational Institution of Higher Education 'V. I. Razumovsky Saratov State Medical University' of the Ministry of Healthcare of the Russian Federation (50 sources of 1986 through 2020). The research also includes findings of the experiments we performed on animals.

Keywords: osteoarthrosis, pathogenesis, posttraumatic

Retrospective analysis of retinal laser coagulation outcomes in diabetic retinopathy

Year: 2020, volume 16 Issue: №4 Pages: 895-899
Heading: Ophtalmology Article type: Original article
Authors: Goydin А.Р., Fabrikantov O.L., Shutova S.V., Lev I.V., Manaenkova G.E.
Organization: S. Fyodorov Eye Microsurgery Federal State Institution, Tambov State University n. a. G.R. Derzhavin

Purpose: to analyze clinical and functional results of panretinal laser coagulation (PRLC) in patients with Diabetic retinopathy (DR) and diabetes mellitus type II. Material and Methods. We performed a retrospective 4-year analysis of the results of pattern PRLC in diabetic retinopathy in 1326 patients (1646 eyes) with diabetes mellitus type II. All patients were divided into groups: group I with PRLC only, group II —with additional PRLC, group III with vitreoretinal surgery, distributing by the groups with best-corrected visual acuity (BCVA). Results. The distribution of the observed cases in three groups depended on the initial visual acuity, approximately uniform distribution by groups with BCVA with a decrease above 0.8 was noted in group I, in group II on the contrary — the greater number of cases in the group above 0.8, and in group III — in groups under 0.4. The analysis of BCVA within the follow-up showed that in group I visual acuity stayed the same within two years, in group II — within 12 months, in group III — up to 6 months with a subsequent significant decrease. By difference in losses of BCVA in group I and II losses did not exceed 1 line in 60%, and in group III only in 44%. Conclusion. PRLC in diabetic retinopathy in patients with diabetes mellitus type II allowed preserving high visual acuity with a loss of not more than 0.2 line within 4-year follow-up in 72% of cases, and in cases of timely treatment by a single PRLC — in 79%. PRLC allowed stabilizing DR within 4 years in 69% of cases, preserving high visual acuity in 72%. In DR progression 22% required additional PRLC and 9% —vitreoretinal surgery that was associated with the late treatment.

Keywords: best-corrected visual acuity, diabetic retinopathy, panretinal laser coagulation