Vol 30, No 3 (2023)
ORIGINAL STUDY ARTICLES
Performance of management of the health system (on the example of the Arkhangelsk region)
Abstract
BACKGROUND: Currently, health care occupies an exceptional place in a socially oriented economy. To assess the effective functioning of the health care system, it is necessary to constantly monitor performance indicators that allow you to determine the level of saving the health of the population.
AIM: Determine the degree of effectiveness of health system management based on a comparative analysis of certain target indicators with their actual values.
MATERIALS AND METHODS: An analysis of the indicators contained in the State program of the Arkhangelsk region "Health care development in the Arkhangelsk region" was carried out. The following parameters were chosen as targets: life expectancy at birth; maternal mortality per 100 000 live births; infant mortality per 1000 live births; total fertility rate; number of doctors per 10 000 population; number of average medical personnel per one doctor. Analysis period — 2010–2020. The study is retrospective, descriptive, not randomized. The level of performance was calculated from the ratio of target and actual indicators and their subsequent integration. The analysis of dynamic series for the presence of anomalous values (outliers) was carried out by the Irwin method.
RESULTS: The main indicators that ensure the level of performance are maternal mortality and availability of doctors. The availability of doctors per 10,000 population was significantly higher than the target indicators over the entire time period by an average of 32.8%. The target indicators of maternal mortality were lower than the actual ones on average by 50.1%, which seems to be due to overestimation of the target indicator.
CONCLUSION: Target indicators of health care system performance tend to overestimate against the background of the lack of a clearly defined methodological apparatus for their calculation, which, in most cases, leads to a mismatch between their dynamics and the dynamics of actual indicators, increasing the calculated level of health care system management performance.
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Assessment of benzo(a)pyrene soil contamination in Khabarovsk
Abstract
AIM: To assess the level of benzo(a)pyrene contamination of the functional areas of Khabarovsk in comparison with other cities of the Far East and other regions of the Russian Federation.
MATERIAL AND METHODS: Benzo(a)pyrene concentration was assessed in the surface soil layer in the industrial, agro-residential and residential areas of Khabarovsk using a liquid chromatography with a multi-wave fluorescence detector Waters HPLC 2475 (Waters, USA) in accordance with the Operations Guidelines (MUK) 4.1.1274-03. In total, 78 soil samples were studied, 48.7% and 41.0% of them were collected in residential areas and industrial areas, respectively. Assessment of the pollution level was carried out by the hazard ratio and in accordance with SanPiN (Sanitary Norms and Regulations) 1.2.3685-21. Boxplots methods in MS Excel software were used for statistical analysis of the data.
RESULTS: Benzo(a)pyrene concentration was below the detection limit in 35.9% of the samples while in 33.3% of the samples it exceeded Maximum Permissible Concentration (MPC). The average benzo(a)pyrene content in Khabarovsk soils was 0.07955±0.04310 mg/kg while the highest was 0.776 mg/kg (38.8 MPC). Benzo(a)pyrene content was 0.005–0.145 mg/kg in 86% of samples, in residential areas 81.5% of samples fall within the range of 0.005–0.215 mg/kg, in industrial areas 90.5% of samples — within the range of 0.007–0.157 mg/kg. According to SanPiN (Sanitary Norms and Regulations) 1.2.3685-21, 62.8% of samples are classified as “clean”, 12.8% — “permissible”, 15.4% — “hazardous”, 9.0% — “extremely hazardous”. Benzo(a)pyrene distribution in the soil surface layer is characterized by the presence of technogenic anomalies with hazard ratios varying from 9.7 to 38.8. Residential areas located within the impact zone of the largest stationary sources of emissions have the greatest levels of pollution.
CONCLUSION: The average benzo(a)pyrene concentration in the soils of Khabarovsk is higher compared to the cities in the Far East and in the European part of the Russian Federation. This situation can be at least partly explained by poor urban planning ignoring aerogenic inflow of pollutants and their accumulation in the soil in esidential areas.
181-198
The role of anthropogenic dermatotoxicants in the etiology of acne in adolescents
Abstract
BACKGROUND: As urbanization continues to increase, so do the detrimental impacts of anthropogenic toxic substances on human health.
AIM: to study the role of toxic elements in the etiology of acne in adolescents.
MATERIALS AND METHODS: In total, 595 adolescents from different settings of the Moscow region participated in a cross-sectional study. Of them, 301 had acne. The reference group consisted of 294 healthy and acne-free children. Spectrometric, cytogenetic, biochemical and immunological research methods were used in the study. Concentrations of essential and toxic trace elements in hair samples were estimated. A micronuclear test was performed in buccal epithelial cells. The testosterone level and the immunoregulatory index were assessed. Discriminant analysis was used for development of the algorithm to predict acne in adolescents.
RESULTS: Elevated concentrations of lead, cadmium and mercury were observed in 23% of adolescents with acne, respectively, while in the reference group the corresponding proportions were 10, 5 and 8% all p <0.01). Decreased concentration of selenium and zinc were found in 22 and 16% of adolescents, respectively, compared to the 6% in the reference group (p <0.01). Micronucleus test revealed signs of genetic instability in 42% of adolescents with acne vs 19% in the acne-free group. Positive correlations were observed between genotoxic disorders and hear concentrations of lead and mercury.
CONCLUSIONS: Low concentrations of selenium and zinc combined with high concentrations of mercury and lead in hair samples as well as with increased number of micronuclei in the buccal epithelium suggest predominantly toxic etiology of acne. Adolescents with a predominantly hormonal etiology of acne were characterized by an increase in testosterone levels and a decrease in the immunoregulatory index. Discriminant analysis allows classification of acne by predominant etiology.
199-211
Results of a pilot study of presenteeism using the Stanford Presenteeism Scale among the working population in the Russian Federation
Abstract
BACKGROUND: The health status of the population and the economic development of the country are interrelated. The economic costs of compensatory payments associated with an increase in the incidence of diseases among company employees are constantly growing. The indirect costs of employers related to the health of employees are made up of absenteeism and presenteeism of employees. Determining the prevalence of frequency and level of presenteeism requires a special approach.
AIM: To assess the level of presenteeism among employees in the Russian Federation using the Stanford Presenteeism Scale.
MATERIALS AND METHODS: In 2020, experts from the National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Health of Russian Federation developed a set of tools (a questionnaire for employers and a questionnaire for employees). The 5-block employee questionnaire includes a translated and adapted version of the Stanford Presenteeism Scale. This unit assesses the degree of decline in productivity due to health conditions and, accordingly, when planning health promotion programs, calculate the opportunities to reduce presenteeism and increase productivity.
RESULTS: Pilot testing of the developed package of tools took place in the spring of 2020 in 28 regions of Russia. The study included workers from the Yamalo-Nenets Autonomous Okrug (44.9%, n=248), the Republic of Karelia (18.8%, n=104), the Udmurt Republic (17.5%, n=97), the Sakhalin Region (13.7%, n=76) and Altai Territory (5.1%, n=28). As a result, 553 completed questionnaires were returned. Among the interviewed employees, 33.5% were men (n=187) with the mean age of 39.8±10.7 years. Women (n=366, 66.5%) had the average age of 42.6±11.1 years. Most employees had an average level of presenteeism (n=271, 57.3%), while low and high levels were observed in 41.2% (n=196) and 1.5% (n=6), respectively. The average level of presenteeism was observed in 96 men (59.9%) and 175 women (55.9%). Presenteeism was the most prevalent among employees aged 40 to 49 (33.2%, n=157), and the least prevalent among employees aged 60 years and older (5.7%, n=27). The lowest level of presenteeism was observed among technical specialists (6.1%, n=29), as well as among managers (10.1%, n=48).
CONCLUSION: The results of this pilot study revealed high prevalence of presenteeism among workers warranting further research in other regions. Studies aimed at reducing the level of presenteeism are also needed.
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Effects of short-term speleotherapy exposure on the bioelectric activity of a healthy brain
Abstract
BACKGROUND: Speleotherapy is a non-drug therapeutic approach that involves spending time in underground caves or mines with health promotion purpose. However, adaptation mechanisms of the human body and the effects of speleotherapy in healthy brain remain largely unknown.
AIM: To study changes in the functional state of the brain of a healthy person in terms of EEG activity parameters under the speleotherapy exposure.
MATERIALS AND METODS: The study involved a group of 25 student volunteers who were informed about the study’s purpose, agreed to participate in the experiment and sighen the informed consent. In the experimental group, EEG registration was carried out before and after a 2-hour speleotherapeutic exposure using the “Encephalan-EEGR-19/26” electroencephalograph-recorder. In the control group, EEG was taken before and after a 2-hour rest in a switched off speleological chamber. EEG rhythm ratio indices were calculated as ratios of the power of alpha/theta, alpha/beta1, and (theta + alpha)/beta1 rthythms. Data analysis was carried out using MS Excel and IBM SPSS Statistics v. 26.0 software.
RESULTS: Significant changes in the EEG alpha/theta index in P4, T6 and O2 leads were observed in the experimental group, but not in the control group. The alpha/theta index appeared to be the most sensitive to speleotherapy. No other significant differences between the groups were found.
CONCLUSION: There were no significant differences in the alpha/beta1 and (theta + alpha)/beta1 indices in the subjects undergoing the speleotherapy procedure, while there were significant changes in these indices in O2 derivation in the control group. The alpha/theta index is the most sensitive indicator for assessing the effect of speleotherapy on the healthy human brain.
223-230
Functional activity of the brain among elderly women with different autonomic tones in the Arctic zone of the Russian Federation
Abstract
AIM: To identify the distinctive features of brain activity based on the distribution of DC-potential levels among elderly women across different autonomic tones in the Russian Arctic.
MATERIALS AND METHODS: In total, 121 60–74 years old women permanently living in Arctic Russia participated in a cross-sectional study. Differences in the indicators of DC-potential levels were measured in three groups of elderly women with different levels of autonomic tone, namely, in vagotonics, normotonics and sympathotonics. Registration of the DC-potential levels of the brain was carried out using a 12-channel “Neuro-KM” diagnostic equipment. The assessment of the autonomic regulation of the heart rate was carried out using the “VNS-spectrum” equipment.
RESULTS: Greater total and average indicators of DC-potential distribution were observed in the sympathotonic group compared with the two other groups. For all monopolar leads, a clear trend towards an increase in neuroenergometabolism of the brain in elderly women with predominant activity of the sympathetic part of the ANS was observed. The dome-shaped principle was violated in both sympathotonics and vagotonics. In the group of normotonics and vagotonics, the leading factors were the functional activity of the central and frontal regions of the brain, while in the group of sympathotonics, the greatest proportion was determined by the factors regulating brain activity of the right temporal and frontal regions.
CONCLUSION: The study of the functional activity of the brain in elderly women with different autonomic tones demonstrates the presence of specific changes in the distribution of values of the constant potential level, which may indicate some change in the mechanisms characterizing the state of cerebral energy exchange. The most pronounced changes were observed in women with the sympathotonic type of ANS, which may characterize the processes of incomplete adaptation.
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