Health care reform in Russia

The break-up of the former Soviet Union has created a greater realisation of the health and health care deficiencies of what are now independent states and the need for reform. The purpose of these two papers is to describe these deficiencies and set the scene for the establishment of some form of national health insurance in Russia and the other states in the near future. The level of infant mortality across the former Soviet Union in 1990 was 21.8 per thousand. This average disguised wide regional variations, from 32 to 55 per thousand in the rural areas of Middle Asia to 11 to 18 per thousand in the more economically developed areas of the Baltic Republics, Russia, Byelorussia and the Ukraine. Average life expectancy in 1989 was 69.5 years, 64.6 years for men and 74 years for woman, and there were significant regional variations. The major cause of death is cardio-vascular disease and there is evidence not only of late diagnosis of disease but also of a large proportion of chronic diseases being undetected. During the 1980s the health service expanded: more doctors were employed, the hospital bed stock increased and outpatient clinic capacity rose. The rate of hospitalisation is high and the utilisation of facilities us poor e.g. average length of stay exceeds 15 days. Any reforms will need to change the funding of health care and im prove the efficiency of the delivery system. Thus reformers are discussing the decentralisation of management functions away from the centre to the regions, improvements in management training, and improved coordination between the primary and secondary parts of the health care system. Experiments involving decentralising budgets being related to activity and outcome goals have been carried out in various parts of Russia. In Russian, legislation has been passed to introduce health insurance from January 1st 1993. The fine detail of this scheme, even at this late stage, is still undecided. Furthermore the infrastructure to collect and distribute funds has not been created. Further legislation has been introduced which separates consumers, purchasers and providers. The health and health care problems in Russia and other parts of the former Soviet Union are great and the ambitions for reform are well articulated at the level of principle. However, the translation of these principles into practice, when the economy is facing high levels of inflation and decreasing output, and when the administrative structures to facilitate the finance and management of the proposed decentralisation system are absent, is a mammoth task. These papers demonstrate that Russian academics and policy makers recognise these problems and are rising to the challenge of resolving them.Russia, Soviet Union

Economic aspects due to injury deaths at the regional level

The purpose of the study - the study of economic aspects due to death from injury. Material and methods. The research material included an analysis of data from the Chelyabinsk Regional Bureau of Forensic Medicine. Used mathematical and analytical research methods. Results. Economic efficiency as a result of the reduction of mortality from injuries in the Chelyabinsk region in 2018 compared to 2012 reached 265.7 million rubles, and by reducing the lost years of the forthcoming life of 6 billion 273 million rubles. The enhanced economic effect was not only an absolute reduction in deaths, but also a change in the age structure of the dead, where there is a decrease in the proportion of people of working age up to 30 years, which, in turn, has a positive effect on reducing PYLL even with a slowdown in the decline in injury mortality.Цель исследования - изучение экономических аспектов вследствие смертности от травматизма. Материал и методы. Материал исследования включил анализ данных Челябинского областного бюро судебно-медицинской экспертизы. Использовались математический и аналитический методы исследования. Результаты. Экономическая эффективность в результате снижения смертности от травм на территории Челябинской области в 2018 году в сравнении с 2012 годом достигла 265,7 миллионов рублей, а за счет снижения потерянных лет предстоящей жизни 6 миллиардов 273 миллиона рублей. Усиленный экономический эффект оказало не только абсолютное снижение смертей, но и изменение возрастной структуры погибших, где наблюдается уменьшение доли лиц трудоспособного возраста до 30 лет, что, в свою очередь, благоприятно сказывается на снижении ПГПЖ даже при замедлении динамики снижения смертности от травм

МЕДИКО-ДЕМОГРАФИЧЕСКАЯ СИТУАЦИЯ В МОСКВЕ И РОССИЙСКОЙ ФЕДЕРАЦИИ В УСЛОВИЯХ ПАНДЕМИИ COVID-19

Highlights Higher rates of COVID-19 morbidity and mortality compared to Russia as a whole were noted in Moscow during the COVID-19 pandemic and after it (2020-2021). We have reached the conclusion that it is necessary to develop regional prevention and rehabilitation approaches for COVID patients. Aim. To analyze health and demographic indicators of Moscow, Russia and its constituent entities in the context of the COVID-19 pandemic to develop regional prevention, management and rehabilitation programs for COVID patients.Methods. The study incorporated statistical, analytical, and observational methods. The data of the Federal State Statistics Service, and reports of the Central Research Institute of Healthcare of the Ministry of Health of Russia for 2012–2022 were used for the analysis.Results. General morbidity of the population in Moscow (2021) amounted to 148 906.0 per 100 000 population. The highest rates were noted in the following classes of diseases: diseases of the respiratory system, circulatory system, diseases of the musculoskeletal and connective tissue, genitourinary system, etc. In the Russian Federation, the overall incidence rate in 2021 was 167 713.8‰00, which is 11.6 % higher compared to Moscow. In 2019 (before the COVID-19 pandemic) the frequency of primary morbidity in Moscow was 65 818.1‰00, in 2020 the frequency decreased to 63 204.4‰00, and in 2021 it increased to 71 523.9‰00, which is 8.7% higher than in 2019. Between 2019 and 2021, there was an increase in primary morbidity rates in the following classes of diseases in Moscow: mental and behavioral disorders by 12.1%, diseases of the blood, hematopoietic organs and disorders involving the immune mechanism – by 5.3%, diseases of the nervous system – by 2.1%, etc., which indicates the need for rehabilitation of patients with this pathology. In 2021 the incidence rate of COVID-19 in Moscow increased to 8 976.0‰00, in the Russian Federation the incidence rate was lower – 8 085.7‰00. The difference in indicators between the constituent entities of the Russian Federation is quite high and amounts to 11.8. The pandemic has exacerbated the demographic situation in Russia. Mortality rates (for 2019–2021) increased in the Russian Federation from 12.3‰ to 13.6, and in Moscow the increase was more significant – from 9.5 to 16.7‰. The results of the analysis indicate the need to improve preventive and management programs for COVID patients, even more so in Moscow. In Moscow and Russian Federation as a whole higher rate of general morbidity in children and adolescents compared to total and adult population morbidity over 10 years (2012–2021) points to the importance of prevention and management programs of this population.Conclusion. The results of the study reaffirm the need to develop regional prevention, management and rehabilitation approaches for COVID patients.Основные положенияОтмечены более высокие показатели заболеваемости COVID-19 и смертности населения в Москве, чем в РФ, в ковидный и постковидный периоды (2020–2021 гг.). Определена необходимость разработки на региональном уровне управленческих решений по усилению профилактической диспансерной работы и реабилитации пациентов. Цель. Анализ медико-демографических показателей в Москве, РФ и ее субъектах в условиях пандемии COVID-19 для разработки управленческих решений по профилактике коронавирусной инфекции, диспансеризации и реабилитации пациентов в постковидном периоде на региональном уровне.Материалы и методы. Статистический, аналитический, непосредственного наблюдения. Использованы данные Федеральной службы государственной статистики, статистические материалы ЦНИИОИЗ Минздрава России 2012–2022 гг.Результаты. Уровень общей заболеваемости населения в Москве (2021 г.) составил 148 906,0 на 100 тыс. населения. Наибольшие показатели отмечены в классах: «болезни органов дыхания», «болезни системы кровообращения», «болезни костно-мышечной и соединительной ткани», «болезни мочеполовой системы» и др. В РФ показатель общей заболеваемости (2021 г.) составил 167 713,8‰00, что выше на 11,6%, чем в Москве. Частота первичной заболеваемости в Москве в доковидном 2019 г. составила 65 818,1‰00, в 2020 г. показатель снизился до 63 204,4‰00, в 2021 г. возрос до 71 523,9‰00, что больше, чем в 2019 г., на 8,7%. За период (2019–2021 гг.) в Москве отмечен рост показателей первичной заболеваемости в классах: «психические расстройства и расстройства поведения» – на 12,1%, «болезни крови, кроветворных органов и отдельные нарушения, вовлекающие иммунный механизм» – на 5,3%, «болезни нервной системы» – на 2,1% и др., что определяет необходимость реабилитации пациентов с этой патологией. Частота заболеваемости COVID-19 (2021 г.) в Москве возросла до 8 976,0‰00, в РФ в 2021 г. показатель был ниже – 8 085,7‰00. Разница в показателях в субъектах РФ велика (в 11,8 раза). Пандемия обострила демографическую ситуацию в РФ. Показатель смертности (за 2019–2021 гг.) в РФ вырос с 12,3‰ до 13,6, в Москве рост показателя более значительный – с 9,5 до 16,7‰. Результаты анализа свидетельствуют о необходимости усиления профилактической и диспансерной работы с населением, а также определяют особую значимость активизации этой работы в мегаполисе (Москве). В Москве и РФ в целом за 10 лет анализа (2012–2021 гг.) отмечены более высокие показатели общей заболеваемости детей и подростков, чем всего и взрослого населения, что определяют значимость профилактики и диспансеризации этого контингента лиц.Заключение. Результаты исследования следует использовать руководителям органов управления на региональном уровне для разработки управленческих решений по профилактике коронавирусной инфекции, диспансеризации и реабилитации пациентов в ковидный и постковидный периоды

ТЕПЛОВЫДЕЛЯЮЩИХ СБОРОК ОТ АКТИНИДНЫХ ЗАГРЯЗНИТЕЛЕЙ МЕТОДОМ ИНДУКЦИОННО-ШЛАКОВОЙ ПЕРЕПЛАВКИ В ХОЛОДНОМ ТИГЛЕ

«New atomic energy technologies» federal program is being realized in Russia. This program includes experimental energy complex development and building, which contains: - a natural safety lead coolant fast reactor «BREST-300»; - a spent fuel recycle facility including fuel fabrication and re-fabrication, radioactive waste immobilization and discarding in accordance with radioactively-equivalent state. The current recycle facility preliminary design involves dry operation of spent fuel elements disassembly using steel shell dissolution by liquid zinc. Fuel element shells are made of special radiation-proof steel «EP-823» containing the following amounts of elements (%): C - 0.2; Мn - 0.8; Si - 1; S - 0.01; Р - 0.015; Сr - 12; Ni - 0.5; Мо - 0.9; V - 0.2; N - 0.05; Fe - 84.325. After dissolution zinc liquid containing steel elements is distilled. Still zinc is sent back to shells dissolution. The bottom product is destructurized particulate with the composition corresponding to original steel. Actinides steel shell and bottom product contamination was predicted using computer modeling. In accordance with the project technical specification actinide content in the disposable materials must be under 0.0001%. Thus, the bottoms product should be purified. Oxidative slag cold crucible induction melting purification was chosen and tested in laboratory scale. The following slag types were investigated: Al2O3-SiO2, B2O3-SiO2, Al2O3 - CaO. It was found that the most appropriate slag is B2O3-SiO2, and the optimal process temperature is about 1600°C.В настоящий момент в России реализуется федеральная целевая программа «Ядерные энерготехнологии нового поколения» Программа подразумевает разработку и создание опытно-демонстрационного энергокомплекса, включающего: - реактор на быстрых нейтронах со свинцовым теплоносителем, обеспечивающий естественную безопасность, «БРЕСТ-300»; - пристанционный модуль переработки, включающий фабрикацию и рефабрикацию топлива, иммобилизацию и удаление РАО в радиационно-эквивалентном состоянии. В настоящее время эскизный проект модуля переработки включает операцию сухого растворения оболочек ТВЭЛ жидким цинком. ТВЭЛы изготовлены из специальной радиацинно-стойкой стали марки ЭП-823, состоящей из следующих элементов (%): C - 0.2; Мn - 0.8; Si - 1; S - 0.01; Р - 0.015; Сr - 12; Ni - 0.5; Мо - 0.9; V - 0.2; N - 0.05; Fe - 84.325. После растворения цинк подвергают дистилляции и направляют обратно в процесс растворения оболочек ТВЭЛ. Кубовый остаток дистилляции представляет собой крупку, химический состав которой соответствует исходной стали. Как показали результаты компьютерного моделирования, материал оболочек ТВЭЛ и, соответственно, кубовый остаток будут загрязнены актинидами. В соответствии с техническим заданием проекта содержание актинидов в утилизируемых материалах не должно превышать 0.0001% масс., в связи с чем кубовый остаток должен быть очищен. Для очистки был выбран и опробован в лабораторном масштабе метод окислительной индукционно-шлаковой переплавки в холодном тигле. Опробованы следующие типы флюсов: Al2O3-SiO2, B2O3-SiO2, Al2O3 - CaO. Как показали эксперименты, наиболее эффективным оказался флюс на основе боросиликатного стекла B2O3-SiO2 при температуре процесса около 1600°C

Quarantine for pandemic influenza control at the borders of small island nations

Background: Although border quarantine is included in many influenza pandemic plans, detailed guidelines have yet to be formulated, including considerations for the optimal quarantine length. Motivated by the situation of small island nations, which will probably experience the introduction of pandemic influenza via just one airport, we examined the potential effectiveness of quarantine as a border control measure. Methods: Analysing the detailed epidemiologic characteristics of influenza, the effectiveness of quarantine at the borders of islands was modelled as the relative reduction of the risk of releasing infectious individuals into the community, explicitly accounting for the presence of asymptomatic infected individuals. The potential benefit of adding the use of rapid diagnostic testing to the quarantine process was also considered. Results: We predict that 95% and 99% effectiveness in preventing the release of infectious individuals into the community could be achieved with quarantine periods of longer than 4.7 and 8.6 days, respectively. If rapid diagnostic testing is combined with quarantine, the lengths of quarantine to achieve 95% and 99% effectiveness could be shortened to 2.6 and 5.7 days, respectively. Sensitivity analysis revealed that quarantine alone for 8.7 days or quarantine for 5.7 days combined with using rapid diagnostic testing could prevent secondary transmissions caused by the released infectious individuals for a plausible range of prevalence at the source country (up to 10%) and for a modest number of incoming travellers (up to 8000 individuals). Conclusion: Quarantine atthe borders of island nations could contribute substantially to preventing the arrival of pandemic influenza (or at least delaying the arrival date). For small island nations we recommend consideration of quarantine alone for 9 days or quarantine for 6 days combined with using rapid diagnostic testing (if available). © 2009 Nishiura et al; licensee BioMed Central Ltd.published_or_final_versio

Interagency in health care children and adolescents: WHO recommendations and Russian realities

The article presents the materials of systematization and scientific study of the main international and Russian normative documents in the field of healthcare and rights of children and adolescents aged 0-17, and of the practical implementation of an intersectoral/interdepartmental approach in relevant programs. A set of modern methods of socio-hygienic and medical-organizational research, including statistical, historical insights, expert evaluation, study of departments experience, and others was applied, with an emphasis on analysis. Based on the model of the younger generation, the authors consider the current problems of implementing an interdepartmental approach to healthcare and protection of the rights of children and adolescents, recommended in recent years by leading international organizations, primarily The United Nations (UN): and the World Health Organization (WHO). The authors analyze the leading Russian normative documents based on international policy and illustrates the state of the approach in the Russian Federation, which is considered to be the leading, most effective mechanism for achieving the goals of strategies and integrated programs in this area, with an emphasis on preventive measures and the organization of primary healthcare as the most accessible and affordable to the public. The results of a comprehensive analysis of federal and international official documents actualized the need for intersectoral activities in healthcare, education, social protection and other systems to strengthen the health promotion of the younger generation, which is considered to be the less protected group of population from the perspective of health and social well-being. The article shows the importance of further improvement of comprehensive research on the scientific justification of optimal, real and effective for the federal and territorial levels of organizational methods for interdepartmental healthcare of the younger generation in Russia.</jats:p