Keeping pace of development of the Russian health care system requires improving the efficiency of spending. In developed countries, an important role in this task plays a multilevel system of evaluation and control of cost-effectiveness and results of operations of the health system and its individual members, supported by the use of evaluation findings in political and administrative decisions in the health sector, financial incentives and information support of participants in the evaluation. Effective today in Russia, the system for monitoring the effectiveness of the health system is largely a formality and does not meet modern political tasks. The most acute problems in assessing the effectiveness of the country include the lack of evaluation of individual elements, first of all, health technology assessment; the poor quality of data collected, the weak development of mechanisms for the implementation of evaluation results, in particular, the development of public policies promoting health care providers, informing the public about the quality of services provided. The aim of the present work is the development of basic mechanisms for assessing the efficiency and effectiveness of the Russian health care system, taking into account the best international and domestic experience.
In the review there are given current data of theories and neurophysiological aspects of motor control and pathological motor synergies. Attention has been focused on the discussion of certain mechanisms of pathological synergies based on anatomical and physiological upper limb characteristics. Synergistic pattern transformation hypothesis in patients with spastic hemiparesis are described and highlighted. The analysis of modern theories of pathophysiologic backgrounds of pathological synergies formation is based on neuroimaging and non-invasive brain stimulation research data. The problem of pathological synergies correction and transformation in rehabilitation practice has been reviewed. Special attention is paid to clinical and instrumental evaluation of synergies. Data has been proved by clinical scales and instrumental techniques such as movement video analysis, electromyography, magnetic and wireless tracking systems and virtual reality technology.
More than half of all deaths in Russia in 2011-2014 were subjected to pathologic or forensic autopsy, as a result of which the cause of death was not identified for 3.8 percent of the cases. More than 147,000 unproductive autopsies which left the cause of death unknown were carried out. Such a large number of cases cannot be explained by the state of the cadavers at the moment of the autopsy. Another 161,000 deaths (4.1% of autopsies) were classified as events of undetermined intent. This paper attempts to find a rational explanation for such a high proportion of uncertain autopsy conclusions concerning the cause of death. The methods applied include an analysis at the macro-level (regions), with the help of factor analysis and clustering techniques, and multinomial logistic regression at the micro-level, using anonymous individual records. The study is based entirely on Russian state statistics data. There are large interregional differences in the practices of determining the cause of death based on autopsy. Practices of diagnosing external causes also vary greatly by region. In regions where the proportion of unspecified causes is higher, the share of events of undetermined intent is also higher. These differences are not connected with the peculiarities of mortality in each region. The analysis suggests that the large number of cases in which the cause of death remains unknown after an autopsy is due to the lack of incentives to clarify the cause of death after the issuance of the preliminary medical death certificate. Moreover, the existing system of relations between forensic bureaus and law-enforcement agencies makes no provision for apprising forensics experts of the final conclusions concerning the external causes of death. From 2011 to 2014 the number of forensic autopsies of persons who had died from disease increased by 20 percent, but there are doubts that the information obtained as a result of the autopsies is effectively used by the health care system.
The paper addresses the issues of organization of medical care in the Russian Federation and explores the case of specialized medical care restructuring. The new approach towards specialized medical care povision is suggested as an alternative to the prevalent understanding of the restructuring such as reduction of hospital beds, hospitals and their staff for financial reasons. The new approach includes (1) a four-level system of medical aid, (2) the expansion of disease prevention, (3) the introduction of standardized approaches in routine work, (4) a thorough quality control at all levels of medical care.
The pilot project of the restructuring of urologic medical care started in 2010 in Voronezh region. The empirical data were provided by the Institute of Urology (Moscow) and Voronezh Regional Health Department.
The implimentation of a new approach revealed poor performance of the primary medical care provision. The outcomes of the pilot project were an increase in detecting diseases and in the availability of specialized outpatient and inpatient care. The overcoming of the previous system’s flaws caused the need to increase health care costs. However, the introduction of new organizational technologies, providing urological care, resulted in lower unit costs by 21.7% over four years.
Experience of the structural reform presented in the article shows that in cases where inefficiency of the health care system is associated not only with unreasonably high costs for treatment of diseases, but also with insufficient or delayed detectability of diseases, introduction of new approaches to the organization of health care does not lead to saving costs, but to increasing effectiveness and efficiency of health care provision.
The author of the article: - highlights the main aspects of struggle against drugs; - gives the general characteristics of drug abuse treatment of the population of the regions of the Russian Federation; - describes the system of the indicators of development of the service of drug abuse help; - disclosures methodological approach to the synthesis of integral indicators of the drug abuse treatment network in the regions of the Russian Federation.
In a method for synthesizing control of a nonlinear object with a quadratic quality functional is considered, based on the acceptance of the "extended linearization" of the initial mathematical model of the object. In this case, the parameters of the nonlinear regulator are determined by solutions of a matrix equation of Riccati type with parameters that depend on the state of the object. It is noted that the main problem of implementing such a regulator is the complexity of finding the solution of this equation at the pace of the object's operation. To solve it, a method based on the search for regulator parameters for each time interval of the control interval is proposed. The developed method of synthesis and implementation of control of a nonlinear object is suggested to be checked by constructing a strategy for the introduction of drugs in the treatment of cancer using a mathematical model of the dynamics of the growth of cancer tissue and its interaction with normal and immune cells. The results of mathematical modeling performed to check the effectiveness of the solutions obtained are presented.
Road traffic injuries and their consequences are increasing global problem. In 2014, Russia ranked first in the number of deaths from traffic accidents per 1 million population among the countries of the Economic Commission for Europe (UNECE). Objective: to identify the age and sex characteristics and dynamics of the burden of road traffic deaths in Russia. Methods: Non-clinical observational study, the object of which is the years of life lost due to premature mortality due to road accidents in Russia, calculated as the product of the numbers of deaths from road accidents, based on impersonal Rosstat data, and standard life expectancy (LE) on the annual age group for men and women between 2000 and 2012. Results: For men aged 20-34 years accounted for 50% of the total number of years of life lost due to a traffic accident in 2012; for women aged 20-34 - 37%.Reducing the number of years of life lost per 1000 men / women occurred in all age groups over the period. The sharp decline in the rate of increase in losses between 2007 and 2009 ended in 2010. The pace of growth of losses began to increase in almost all age groups after 2010. The pace of growth of losses for men aged 15-19 was so significant that the number of years of life lost per 1000 males in 2012 (29.8 per 1,000 men), almost back to the level of 2000 (30.8 per 1,000 men).
In Russia road-traffic accidents are one of the main causes of injury of the population. In 2016 more than 220,000 people were injured in road accidents, whereas 20,000 people died. Published review of injury epidemiology in the UK and Europe found that many studies relied solely on mortality rates from injury to describe epidemiology while deaths comprise only the top of the injury pyramid. It could lead to erroneous estimates of the total burden of injury.
This study is designed to assess both the years of life lost due to premature mortality and disability caused by road traffic fatal and non-fatal injuries, using integrated indicators of the population health. We use methodology of disability-adjusted life years (DALY), as well as an empirical database of the State Traffic Safety Inspectorate, medical statistics (№ 57) and statistics on deaths from vital registration system.
In the most Russian papers the years of life lost due to premature mortality were estimated, whereas in this study we estimated the whole burden of road-traffic accidents caused by fatal and non-fatal injuries in Russia in 2012. Our estimates of DALY due to road-traffic accidents in Russia in 2012 are close to WHO’s estimates, exceeding them by 4.5%. It indicates the ability of using Russian medical statistics to assess DALY without using different international models.
In the internal medicine wide spectrum the gastroenterology is one of the chapters, less enlightened by the scientific evidence. It does not mean that the practice of the grasntroenterology may ot be improved by the systematic use of the approaches of the evidence based medicine