2024, volume 20

Among the Saratov doctors, sincerely concerned about the state of school medicine, was the doctor of medicine E.A. Bonvech. The article provides biographical information about Emanuel Andreevich Bonvech, reflecting his practical contribution to the development of school (children's) medicine in the city of Saratov in the second half of the XIX — early XX centuries.

Objective: to determine the metabolic predictors of maladaptation of the body of water transport workers in Yakutia. Material and methods. A survey of 224 male workers of water transport in Yakutia was conducted. The adaptive potential (AP) is calculated on the basis of anthropometric and functional indicators of the body. Biochemical (lactate dehydrogenase (LDH), alkaline phosphatase, creatine phosphokinase, creatine kinase-MV, gamma-glutamyl-transferase, aspartate and alanine aminotransferases, glucose, total protein, albumin, triglycerides, urea, creatinine, uric acid, total cholesterol, high-density lipoprotein cholesterol) and hormonal (free fractions of triiodothyronine, thy-roxine, thyroid stimulating hormone, cortisol, testosterone) serum parameters. Low and very low density lipoproteins were calculated using the formula. Results. By the method of multiple linear regression analysis indicators as significant predictors of maladaptive processes: 4 biochemical — cholesterol ((3=0.234; p=0.001), glucose ((3=0.192; p=0.003), LDH ((3=0.170; p=0.009), triglycerides ((3=0.150; p=0.023), and 1 hormonal —testosterone ((3—0.308; p=0.002). Conclusion. Elevated cholesterol, glucose, LDH and triglyceride levels, and decreased testosterone levels have been identified as significant predictors of maladjustment in water transport workers.

Objective: to identify reference values of thymus mass of foetuses and neonates of the early neonatal period depending on body weight. Material and methods. We analysed 922 autopsy reports of fetuses of 18-42 weeks of gestation and newborns of the first 7 days of life: group 1 — those who died of infectious diseases (n=67); group 2 — those who died of non-infectious diseases (n=855). Thymus mass, body weight were studied, thymic index was calculated. Spearman's criterion (R) was used to assess the correlation. A polynomial regression model using the Splines method was compiled. Results. We present data on thymus mass over a range of fetal and neonatal body weights from 300 to 5500 g. Thymus mass ranges from 1.1 to 1.48 g (for fetal masses of 300-500 g) to 12.36-15.09 (for neonatal masses of 400-5500 g). Organ weight increases with increasing gestational age, decreasing by the third day of newborn life. Median thymic index values for groups 1 and 2 were 0.32 and 0.28 (p=0.2). Regardless of the type of pathology, gestational age, and life expectancy, thymus mass correlated with body weight (Я?=0.88; p<0.001). The dynamics of changes in thymus mass (y) depending on the decimal logarithm of body weight (x) is described by the following polynomial regression equations: y=13.937x2-75.662x+104.47 for group 1 and y=16.65x2-93.487x+133.56 for group 2. Conslusion. Reference values of thymus mass of foetuses and neonates of the early neonatal period depending on body weight are were presented. It was found that there is a direct strong correlation between thymus mass and body weight.

Objective: to develop and scientifically validate the feasibility of applying a lean intraocular lens (IOL) inventory management system under conditions of geopolitical instability. Material and methods. The study consisted of the steps of analyzing the distribution of IOL optical power, creating a mathematical model of the institution's need for lOLs, implementing the developed system, and evaluating its effectiveness under geopolitical instability from January 2022 to December 2023. Results. As a result of implementing the proposed approach, the volume of IOL purchases made in addition to planned orders decreased from 4.5% of requests in 2014-2015 to 0.2% in 2022-2023 (p<0.001). The inventory management system steadily ensured the availability of lOLs of the required optical power, facilitated organizational decision-making, eliminated the need for orders for urgent delivery and exchange of lOLs with the supplier, freed up labor resources and contributed to the availability of specialized medical care for cataract patients during the period of disruption of previously established logistics chains. Conclusion. The developed lean system of IOL inventory management demonstrated high efficiency, saving labor and material resources of the medical organization, ensuring the continuity of the treatment process and resisting the risks associated with geopolitical instability in the world.

Objective: to determine the specifics of information and psychological security of digital relations in healthcare as an institutional parameter for the development of the digital loop in healthcare. Methodology for writing a review. The research method was a theoretical analysis of the scientific literature, which made it possible to detect the integration of the problems of information and psychological security in communication processes into the understanding of institutional changes in the field of healthcare. A literary review and analysis of information conducted in modern electronic bibliographic databases PubMed, Google Scholar, e-Library, Web of Science, and CyberLeninka. A total of 96 sources were studied, of which 38 works published between 1989 and 2024 were included in the review. Conclusion. An important stage in the study of digital relations in healthcare was the understanding of information and psychological security as a necessary condition for their institutionalization. A conceptual idea of the types and functions of information and psychological security determines the possibilities of its projection to the level of agents of digital relations. The key characteristic of information and psychological security is the communicative competence of medical personnel and its formation as a strategic task of a modern higher medical school.

Objective: to evaluate the changes in the achievement level of the criteria for the «New Model of Organization of Medical Care» (New Model), which occurred in 2023, against the context of the transformation in the management system for the federal project «Development of Primary Health Care» (FP), and the increased coverage of lean production training (LP). Material and methods. An assessment and comparison of the achievement of the criteria of the New Model in medical organizations (MOs) in the first and fourth quarters of 2023 was conducted. The impact of LP training on the achievement of these criteria was also assessed. Results. In the quarter 4 of 2023, a significant increase in the Percentages of the MOs was established, which reached criteria 2 for managing patient flows (p<0.001; p<0.001), criteria 3 for organizing the MOs space (p<0.001; p<0.001; p<0.001), criteria 4 for organizing pre-appointment and admission of patients by a doctor (p<0.001; p<0.001; p<0.001; p<0.001). An increase in the coverage of LP training contributes to an increase in the Share of MOs who have reached criteria 2 for managing patient flows (p=0.023; p=0.012), criteria 3 for organizing the MOs space (p=0.015; p<0.001; p=0.012), criteria 2 for the organizing pre-appointment and admission of patients by a doctor (p=0.016; p=0.03). Conclusion. Against the context of the transformation of the FP management system and the increase in the coverage of LP training in 2023, a significant increase in the level of achievement of the criteria of the New model was established.

Objective: to identify professional burnout and to assess the quality of life (QoL) of physicians in the regional health care system. Material and methods. In the study of the influence of professional burnout on the QoL of physicians, 594 physicians from medical organizations of the region and 327 physicians working in rural health care of the Saratov region took part. The questionnaire «Emotional burnout» by V. V. Boyko was used to assess the level of professional burnout. The respondents' QoL was assessed using the standardized World Health Organization Quality of Life-100 questionnaire (WHOQoL-100). Results. In regional healthcare 52.6% of physicians suffer from professional burnout, in rural healthcare — 79.8%. In regional health care 29.8% of physicians have the resistance stage, 19.3% — the exhaustion stage; in rural health care the distribution by stages of emotional burnout was 22.9% and 52.9% of physicians, respectively. The main indicators of the QoL of physicians with different phases of professional burnout in rural healthcare are recorded in subspheres: F2 «Life activity, energy and fatigue», F12 «Ability to work», sphere «Environment». Conclusion. The majority of physicians in regional health care suffer from professional burnout, to a greater extent in rural health care. Professional burnout of the majority of physicians in rural healthcare is determined in the phase of «exhaustion». The main indicators of the QoL of physicians suffering from professional burnout in rural health care of the region are highlighted.

Objective: to substantiate the importance of quality of life indicators in the formation of an individual trajectory of palliative medical care at the outpatient stage. Material and methods. A survey of patients (n=150) in need of palliative medical care at the outpatient stage was conducted using the WHO Quality of Life 100 questionnaire for the period 2022-2023. The Dembo — Rubinstein test was used to determine the level of aspirations and self-assessment of patients. Clinically healthy respondents (n=130) served as a control group. Results. Patients in need of palliative care report a decrease in the quality of life in all areas of life. A significant decrease in quality of life indicators was noted in the areas of "Physical sphere" (p=0.004), "Psychological sphere" (p=0.031), "Level of independence" (p<0.001), there is a tendency for indicators to worsen as the disease progresses. Conclusion. Subspheres have been identified, the values of which determine the trajectories of interaction between the patient and the attending physician. The quality of life indicator can be integrated into the process of providing palliative medical care and be of key importance in the formation of an individual trajectory of palliative medical care at the outpatient stage.

Objective: to determine the awareness of the adult population of the Sakha Republic (Yakutia) about viral hepatitis and measures for its prevention. Material and methods. An anonymous survey of the population of the Sakha Republic (Yakutia) (n=226, 128 women and 98 men aged 18-76 years) on risk factors and prevention of viral hepatitis was conducted using a specially prepared questionnaire. Results. A low level of awareness of the population about viral hepatitis and measures for its prevention was established, only 22.4% of respondents consider their knowledge of viral hepatitis sufficient, a third of respondents did not know whether they are vaccinated against viral hepatitis, 49.3% of respondents noted that they do not know the possible complications that arise with chronic viral hepatitis. Gender differences in public awareness were recorded, the respondents were willing to receive additional information about viral hepatitis (76.8% of respondents), with 63.2% of respondents indicating health workers as the main source of information. Conclusion. Low awareness of respondents from the Republic of Sakha (Yakutia) about viral hepatitis and measures for its prevention was established; knowledge about the routes of infection, typical symptoms, outcomes and measures for the prevention of hepatitis is fragmented; there are statistically significant differences in the awareness of men and women.

Objective: from the standpoint of preventive medicine, clarify the trigger mechanisms of the main carcinogenic factors of an unhealthy lifestyle involved in the development of cancer in the population. Methodology for writing a review. 46 scientific papers published in 2013-2023, posted in the databases Web of Science, Scopus, PubMed, CyberLeninka, eLibrary.ru. Electronic search was carried out using a combination of keywords: "carcinogenic factors of an unhealthy lifestyle," "bad habits," "smoking," "passive smoking," "use of smokeless tobacco products," "alcohol consumption," "artificial sources of ultraviolet radiation," "cancer." Conclusion. An analysis of the scientific literature showed that the leading trigger mechanisms for the development of cancer in the population associated with an unhealthy lifestyle include: when drinking alcohol —the toxic effect on the body of the alcoholic beverage metabolite — acetal-dehyde; with active, passive smoking — exposure to highly active volatile N-nitrosoamines and, especially, dimethylni-trosoamine and benzopyrene; when using smoking vapes, vaporous propylene oxide compounds, formaldehyde and acetaldehyde; when using smokeless tobacco products, the presence in them of compounds of non-volatile tobacco-specific nitrosoamines (TSNA), which are indicators of genotoxicity; the use of artificial ultraviolet radiation sources for tanning is accompanied by sequential reactions of the formation of photoproducts consisting of cyclobutane pyrimidine dimers (CPDs), damaging genomicDNAand causing mutations with dysregulation of epidermal metabolism, apoptosis processes and immune mechanisms.