[The algorithm of planning the needs in medical care provided in out-patient conditions to elderly age groups of population using mathematical models]

The purpose of the study is to develop algorithm for planning the need in medical care provided in out-patient conditions to elderly groups of population based on mathematical modeling methods. Research materials and methods. As a source of information, data on cases of medical care provided to the population of elderly age groups (60 years and older) were used. The probability of access was studied in each one-year age interval, starting from the age of 60 years. The principle of mathematical modeling was based on functional approach applying algebraic functions by least squares method (regression analysis). The final choice of mathematical model was made in favor of mathematical function having largest value of approximation coefficient. The degree of influence of analyzed variable "age" was evaluated by residual variance calculation.It is established that overall need for out-patient care is higher in women. The maximum consumption in both women and men falls on the age of 76 years. After this age, frequency of visits decreases regardless of gender. Minimal levels of need are observed in the oldest age groups (95-100 and older). The variability of the indicator is higher in men, both at the area of need increasing and at the stage of need decreasing. The existence of common mechanisms and factors underlying the formation of the need for out-patient care confirms the use of the identical functions in modeling process. The character of modeling function has no gender differences. The age dynamics is described optimally by polynomial functions. The proposed models of age dynamics of out-patient visit rates of representatives of elder age groups in more than 90% describe existing fluctuations using non-smoothed data.

[The effect of education level on intensity of using medical care by women of reproductive age]

The education is often considered as one of the basic social determinants of population health, but its impact on the need for medical care is to be studied. The purpose of the study is to analyze effect of education as health social determinant on intensity of medical care consumption by women of reproductive age. The sampling consisted of 566 non-pregnant women aged 18-49 years residing in Samara and being monitored in municipal antenatal clinics. The level of territorial accessibility of medical care for all women participating in the study did not differ reliably. The data was obtained using anonymous survey with adapted questionnaire "Research of social determinants of health". The first comparison group included 306 women with higher or incomplete higher education (high educational status). The second comparison group included 260 women with secondary or specialized secondary education (lower educational status). Each of the groups was divided into four subgroups based on age characteristic (18-25, 26-34, 35-42, 43-49 years). In the group of women with a high educational status, volume of consumption of out-patient medical care were higher and decreasing of health self-rating was accompanied by decreased rate of visits to ambulatory physicians (r = -0.67). Whereas in women with low educational status, decreasing of health self-rating is accompanied by decreased rates of visits to ambulatory physicians (r=0.5). With age increased, volume of out-patient medical care consumption in group of women with high educational status increases, while in group of women with low educational status this volume decreases. The lower rate of out-patient medical care consumption results in increasing of volume of in-patient medical care consumption in the group of women with low educational status. Despite the same increasing dynamics of volume of consumption of in-patient medical care in women with different educational statuses, gain rate of demand is significantly higher in group of women with low educational status (1.42% versus 2.54% of annual gain in consumption). More significant increase in consumption of emergency medical care was observed in group of women with low educational status (annual increase 3% versus 0.22%).

[The analysis of health condition of individuals aged 40 years and older and going in for sports]

The attitude to high physical loads on organism in the middle and older age groups is ambiguous, from optimistic to completely pessimistic, associated with possibility of development pathological processes because of high physical activity. The purpose of the study is to evaluate health status of people aged 40 years and older involved in sports. The health data was obtained through interviewing athletes aged 40 years and older competing in track and field events at distances of 10 kilometers or more. In total, 1800 questionnaires were distributed, and 1649 completed questionnaires were returned. The analysis of health status was implemented on the basis of self-rated health and objective characteristics (medical care appealability, acute diseases incidence, chronic diseases availability, fact of medication intake). The very high level of health self-rate was established in individuals involved in sports, that persisted along age increasing. No gender differences were revealed (4.00-4.07 for males and 3.89-4.08 for females). According to survey results, less than half of male respondents consulted physician during a year. The level of appealability was stable in all age groups surveyed. The average rate of acute diseases per year in athletes of older age groups did not exceed 1.16 diseases per year and was slightly higher in females. With age, the indicator tended to decrease in males and to increase in females. The prevalence rate of chronic diseases was low in both males and females and with age it tended to increase in males and remained almost stable in females. The rate of regular medication intake was lower than rate of chronic diseases, this difference was especially significant in females. According to respondents, sport activities, despite heavy loads and age, contribute to organism health enhancement. This opinion was specific for more than 90% of athletes, regardless of their gender. In the oldest age group (60 years and older) 94.3% of respondents expressed reported that their health improved after starting running. However, sufficient number of athletes are concerned about potential risk of training that is the reason to organize system of medical monitoring of athletes, especially in older age groups.

[The particular aspects of improvement of laboratory service of region]

The analysis of various needs in medical laboratory services among physicians of the Samara oblast is targeted to further improvement of laboratory service at oblast level. It is established that effectiveness of laboratory service depends on the needs of customer of service sector which are both physicians and patients. Ignoring their needs results in an increasing both of number of unsatisfied customers and level of mistrust individual operators and laboratory service itself. On the contrary, client-centric approach facilitates dialog of all participants of process of providing laboratory services.

COVID-19: urgent questions for estimating morbidity, prevalence, case fatality rate and mortality rate

During epidemics, the usual statistical approaches will not allow determining the readiness of the public health system to take urgent measures to counteract the increase in morbidity, spread and mortality of the population. The quality of the medical, socio-economic and managerial decisions at all levels will depend on the accuracy of statistical data and the possibility of creating adequate prognostic models. However, there are still problems with the identification of COVID-19 cases and the diagnostic accuracy of the methods used. Complex analytical efforts require in order to determine the COVID-19 impact on the health status and case fatality rate/mortality rate.

[The dynamics of morbidity and mortality of malignant neoplasms of blood system а population of St. Petersburg]

The morbidity of hematologic malignant neoplasms increases all over the world, while mortality rate decreases slowly that causes significant economic losses in society due to blood system tumors. It also proves relevance of research of morbidity and mortality of these diseases both in the Russian Federation and certain regions. The goal of the research was to analyze dynamics of indicators of primary morbidity and mortality of hematologic malignant neoplasms among residents of St. Petersburg in 1990-2017. the study was based on Federal statistical accounting forms and official state statistics. It was established that in 2017 St. Petersburg took the 2nd place among all territories of the Russian Federation in terms of primary morbidity and mortality of hematologic malignant neoplasms. Morbidity and mortality rates of males was higher than in females. The highest morbidity rates were established in the age group of 70-79 years. The same group also had the highest mortality rates. Over the research period, the incidence rate increased by 78.2%. The maximum increase in the incidence rate was registered for the group of active able-bodied age. The mortality rates decreased by 43.4%. The results of the research demonstrated that the need for oncologic hematological medical care will increase in case that actual tendencies of mobility and mortality continue. It proves that this type of medical care is be made more available to population through its active development. Also, comprehensive disease prevention program must be developed.

[The experience of application of standard values of condition of laboratory services in the subjects of the Russian Federation]

The article presents information to assess possibility of using on-line questionnaires to obtain statistic data concerning activities of laboratory services in the region. The sets of standardized statistical indicators were obtained for assessing performance of such regional services as the structure of laboratory research; comparative standardized values of availability of examinations per 1000 of population; comparative standardized values of equipment support in the regions of the Russian Federation and employment rates and staffing with medical personnel of laboratories.

[The medical social portrait of consumer of laboratory services of medical organizations]

The article presents information about various medical and social characteristics of the population of the Samara region cities. The survey of respondents was held by the network commercial laboratory, which treatment rooms were opened simultaneously in several cities of the region. The conducted study allowed to compile a medico-social portrait of the customer of laboratory services of medical organizations. It was discovered that laboratory services of commercial laboratories are most commonly used by women (78.1%) between the ages of 18 to 40 years. It was revealed that 54.9% of all patient admissions were repeated, and 56.0% of the patients were tested on their own initiative. The initial application is male-dominated 56.2%. Geographically the most often service was provided in Togliatti city (63.8%). Most prone to doctor's recommendation, to apply for paid medical analyses are patients between ages of 18 to 50 years old. Based on the obtained data a set of measures was proposed aimed to improve the quality of medical laboratory services.

[The Medical Social Efficiency of Joint Confinement of Mother and Child in Place of Imprisonment]

The article, on the basis of the results of study of 2016, analyzes a comparative medical social effect of conjoint and separate residing of mother and child in the Children's Homes of the Penal Enforcement System. The materials of study consisted of original observations while working in the given system, data of reports of the Federal Penitentiary Service of Russia concerning medical care of women and children in 2011-2015 and data of address requests to the Children's homes under correctional facility in 2013 and 2015. The experience of functioning of the Children's homes of penitentiary system is summarized. The positive effect of conjoint keeping to indices of coverage with breast feeding is established. The coverage of natural and mixed feeding amounted to 65% in Children's Homes, including 83% in Children's Homes with conjoint residing of mother and child in Children's Homes and in other Children's Homes -- 43% (p<0.05). In 2015, a single refusal of child by condemned mother occurred in Children's Homes, while in 2013 there were 4 of such refusals (p<0.05). In Children homes with extended department of conjoint residence primary morbidity of children made up to 1,679‰ and in comparison, group -- 2014‰ that is reliably higher (p<0.05). According data of primary morbidity occurred decreasing of pool of diseases of respiratory organs from 1,002 to 872 per 1,000 children due to brining into operation of dormitory of conjoint residence of mother and child. This occurrence resulted in decreasing per 12% of number of hospitalizations by emergency indications. The conjoint residence of condemned mother and newborn results in harmonious growth, physical, neuropsychic development of child and also in development of motherhood feelings that is an important factor of re-socialization of the condemned woman. It is proposed to introduce normatively obligatory conjoint residence of mother and child in Children's homes of the Penal Enforcement System.

[The maternity and childhood care in penal executive system of Russia]

The Russian Federation pays particular attention to maternity and children care. During the last three years, slight decreasing of number of women held in detention together with children of tender age was marked. This tendency is related to policy of humanization of penalty determination and execution of punishment. At that, number of women with pregnancy at the moment of adjudgement of conviction of court increases. Annually, 3% of women residing in institutions of penal executive system are observed because of pregnancy that results with delivery in curative preventive institutions of the penal executive system in 35% and in medical institutions of municipal and state health care systems in 65% of cases. The newborns of women serving a sentence by way of deprivation of freedom enter Home of Child. The Federal penitentiary service of Russia comprise 13 Homes of Child in female correctional institutions where about 700 children are brought up. The article considers issues of development of organization of medical sanitary support of children of tender age in homes of Child of the penal executive system.