Vol 23, No 2 (2024)

BACKGROUND: Understanding the relationship between self-assessment of health status and quality of life, and social and demographic factors and population health indicators is essential to identify risk groups and provide rationale for the healthcare development in the region.

AIM: To substantiate the relationship between self-assessment of quality of life and satisfaction with health status, and social and demographic factors and actual health indicators for residents of the Grodno Region aged 60 and older.

METHODS: We analyzed the demographics and healthcare statistics, a database of 1,270 individuals aged 60 and older representative of the Grodno Region of the Republic of Belarus by sex, place of residence, and age. A short quality of life questionnaire issued by the World Health Organization was used, and nonparametric statistical methods were applied.

RESULTS: Life expectancy in the Grodno Region is close to the national average, with men in rural areas showing the lowest values across all regions. Heart diseases are by far the leading cause of death. In self-assessment of the quality of life, the predominant options selected by the respondents are “Good” or “Neither bad nor good,” while in self-assessment of the health status satisfaction, the predominant options selected by the respondents are “Neither satisfied nor dissatisfied.” Men (as compared with women), rural residents (as compared with urban residents), unmarried people (as compared with married people) have lower ratings of their quality of life. The hypothesis that children have a positive impact on the respondent’s quality of life is confirmed, while the hypothesis that old-age pension affects it is not confirmed. Health status satisfaction shows tolerance to social and demographic factors. A positive average correlation of health status satisfaction and self-assessment of quality of life is identified in all social and age groups. The higher the age, the lower the self-assessment of the quality of life, and the health status satisfaction is even lower.

CONCLUSION: Men aged 60 and older living in rural areas are at risk based on low self-assessment ratings of quality of life in relation to low life expectancy. However, no gender differences were found in health satisfaction ratings.

Chronic non-communicable diseases are the leading pathologies of the 21^st century. Prevention and risk verification of chronic non-communicable diseases are among the most urgent tasks for contemporary healthcare.

Inflammatory bowel diseases, including ulcerative colitis and Crohn’s disease, are characterized by a chronic and recurrent course. Inflammatory bowel diseases of unknown etiology are considered to multifactorial, affecting both psychological and social well-being, and significantly reducing patients’ quality of life.

This review aims to explore environmental risks in the development of inflammatory bowel disease, based on the literature. The review was conducted on the materials of Russian and foreign scientometric, abstract, and full-text databases. The period of publications included in the analysis spanned from 1980 to 2023. A total of 44 publications were analyzed.

Current medical practice acknowledges the association of risk factors and the development of multicausal diseases. The probability of disease occurrence is determined by the impact of certain risk factors, with social factors being of particular importance. A combination of factors, including an improved socioeconomic status of newly industrialized countries, which trigger environmental dynamics, increases the risk of inflammatory bowel diseases. The impact of environmental risks may be a potential missing link in understanding the etiology and increasing prevalence of inflammatory bowel diseases in recent years.

Investigating the relationship between environmental factors and inflammatory bowel diseases may improve understanding of the etiopathogenesis, identify strategies for disease prognosis and prevention, and prepare the healthcare system for the growing burden of this group of chronic non-communicable diseases.

BACKGROUND: Over the past decade, reforming primary care in the Russian healthcare system has become a top priority for the state. The government is creating conditions to improve healthcare accessibility, as instructed by the President. A decision was made to expand the primary care development program in rural areas, small towns, and villages.

AIM: To analyze the training and challenges faced by young doctors in primary care practice following university graduation.

METHODS: To analyze the issues and omissions in the young doctor training system, a survey was conducted with general practitioners from the Young General Practitioner School who graduated from the General Medicine Department (as per Federal State Educational Standard-3) and started working immediately after graduation. The survey involved 128 general practitioners from the Stavropol Territory, who graduated from a medical school in 2018–2020.

RESULTS: The study identified the key challenges faced by early-career doctors. These include the lack of hands-on training before independent practice, lack of mentorship for most graduates, insufficient workplace equipment, limited computer access (especially in rural areas), shortage of nurses, and an excessive patient load for a general practitioner. The professional difficulties of graduates are associated with insufficient hands-on training in the 5^th/6^th year at university and the cancellation of internships.

CONCLUSION: The analysis of the most common issues faced by graduates in primary care today showed challenges related to their transition to independent practice, and the need for better mentorship by more experienced peers.

BACKGROUND: Healthcare financing is essential for achieving the Government's social objectives and ensuring the strategic maintenance of population health capital. The statutory health insurance (SHI) scheme accounts for more than 48% of guaranteed healthcare financing.

AIM: To analyze the relationship between basic integral indicators of population health capital and the level of healthcare financing provided by the SHI scheme.

METHODS: The study employed regression correlation analysis, time series analysis, and comparative analysis of quantitative and qualitative indicators.

RESULTS: As part of the SHI scheme in 2011–2022, healthcare financing showed significant underfunding and a reduced coverage of the population with timely and high-quality healthcare. Government expenditures as part of the SHI scheme are determined by the changes in the gross domestic product per capita. The amount of guaranteed healthcare expenditures does not directly determine the life expectancy, birth rate, or disability levels. The scale of financing as part of the statutory health insurance scheme only partially mediates the variation of such health capital indicators as natural population growth and general morbidity.

CONCLUSION: The absence of a clear positive correlation between SHI financing and health capital indicators during the 2011–2022 period highlights the need for improving the efficiency of resource allocation and the performance of healthcare processes.

The implementation of state healthcare policies in the Republic of Belarus requires readily accessible health information for the population. Such information must meet specific criteria to serve as the foundation for the knowledge, skills, and abilities necessary for successful interaction with the healthcare system. Terms like “health awareness” and “health literacy” (HL) may be used to characterize this phenomenon. Both terms are used frequently and often employed interchangeably, despite representing distinct concepts. Awareness involves a one-way flow of information and its quantitative assimilation, while literacy can be understood as the feedback on the results of information, and its practical application. Given that differences in understanding are already evident at the definitional level, this ultimately leads to a lack of uniformity in study and assessment approaches.

An analytical review of published literature and online sources, including the Russian Science Citation Index, Springer, World Health Organization (WHO) portal, and other open-access databases, was conducted to substantiate the methodology employed in studying and evaluating health awareness and HL among the population, explore potential advancements in this scientific field, and consider global trends and applications of the findings.

The review shows the economic and social significance of HL of the population and the areas of practical application of the results of its research. The paper analyzes the conceptual apparatus and methodology of studying health awareness and HL, the history of development of the approach unified by the WHO, and the transformation of understanding of various components of HL as a complex phenomenon. Methodologically, HL was found to be a dynamic construct. Approaches to its measurement and assessment vary, and its definition undergoes transformation. Contemporary study methods distinguish between mandatory and optional components. An isolated study of only the mandatory component provides insight into the availability of a specific piece of medical information for a given population; however, it does not account for any subsequent use. Consequently, this component, most frequently referred to as “general HL”, can be defined as health awareness. Analyzing both principal and supplementary components provides a comprehensive view of HL, taking into account national and social contexts. It also allows for extension to digital, organizational, vaccine, and other forms of HL. Despite the WHO’s efforts to unify methodologies, HL studies remain specific to national, cultural, and social contexts. The flexibility of the HL concept allows for incorporating new elements into research tools, which should be designed with practical applicability in mind. The study of population HL is promising from the organizational, medical, and social points of view. The research process itself motivates respondents to engage in health-saving behaviors.

BACKGROUND: Modern society is witnessing a marked increase in the influence of online sources on communication within the medical field as a social institution.

AIM: To assess the impact of online sources on trust relationship between doctor and patient.

METHODS: A survey was conducted in healthcare organizations in the Nizhny Novgorod Region using proprietary questionnaires for patients and doctors. The study involved 521 patients and 240 doctors.

RESULTS: Among patients, 32.3±2.1% rarely or never, 32.5±2.1% infrequently, 25.9±1.9% occasionally, and only 9.2±1.2% always search for or double-check the diagnosis and doctor’s prescriptions through online sources. Despite this, 82.8±1.6% of patients stated that they prioritize trust in their doctor over information found on websites. For doctors, 61.5±3.1% occasionally encounter patients who have formed opinions about their diagnosis from online sources, 15.0±2.3% always face such situations, 17.5±2.5% rarely do, and only 6.0±1.5% never experience this. Regarding patient reliance on online information, 51.7±3.2% of surveyed doctors take a negative view of the fact that patients double-check the diagnostic criteria and doctor’s prescriptions on websites, 24.9±2.3% support patients in studying information on their condition, and 23.4±2.7% are indifferent. According to 87.8±2.1% of doctors, patients trust information provided by a doctor rather than by online sources.

CONCLUSION: The study shows that 67.6±2.1% of patients access websites to check the accuracy of medical opinions. However, 82.8±1.6% of patients and 87.8±2.1% of doctors believe that information provided by a doctor is of primary importance for patients compared to online sources.

Medical arbitration tribunals intended to resolve medical malpractice disputes emerged in the United States of America more than forty years ago. However, they have been relatively little known in our country. The problem of the study is the legal nature of medical disputes, its object is medical arbitration as a medical and legal phenomenon, its subject is the effectiveness of arbitration in resolving medical disputes. In medical arbitration, the issue of arbitrability is critical: the arbitration clause is often challenged on the grounds that the patient could not reasonably express their will due to a medical condition. Despite conceptual issues, medical arbitration has been actively developing in the United States since the 1980s. Advocates argue that arbitration offers several benefits over traditional litigation, including faster proceedings, broader compensation for patients, lower legal fees, and improved patient safety. However, critics point to several disadvantages: the potential low professional level of arbitrators, the simplification of legal proceedings to mere compensation, the lack of contribution to healthcare quality improvement, and the transformation of trials into administrative procedures, with large corporations "privatizing" the arbitration process. In some countries (South Korea, Indonesia, Mexico), the arbitration is in place, but it shows quite meager results. In Russia, medical disputes are very complex due to some regulatory limitations. Alternative dispute resolution procedures are barely used, and medical arbitration is directly prohibited by the Civil Procedure Code.