Sociology of Medicine

BACKGROUND: Modern strategic planning for the development of the health care system in the region involves regular monitoring of problem areas for the timely identification of emerging problems, as well as monitoring the effectiveness of measures designed to eliminate the identified problems. Based on this, within the framework of the 5th level of medical and sociological monitoring of the results of strategic planning for the development of regional health care, which involves studying the opinions of regional experts, a study was conducted focused on studying the main problems and prospects for the development of the health care system in the Moscow Region on the most important ones from the standpoint of its strategic planning directions.

AIM: To determine the degree of relevance of problems for the health care system of the Moscow Region and for the next medium-term strategic planning of measures for its development, as well as to evaluate the indicators from the standpoint of their significance, which will serve as the basis for compiling the archetype of the health care system in the territory of the municipal formation of the Moscow Region in order to adopt further management decisions, including taking into account municipal features.

MATERIALS AND METHODS: A survey was conducted of experts from among the heads of regional medical organizations of the Moscow Region, their deputies for the medical profile of activity, as well as the main freelance specialists of the Ministry of Health of the Moscow Region. A total of 126 people were interviewed using formalized structured interviews and questionnaires.

RESULTS: In the course of the study, a range of the most pressing problems of the health care system of the Moscow Region was determined today. In addition, activities were identified, the strategic planning of which is most relevant for the formation of the next medium-term program “Health of the Moscow Region”. The study also made it possible to streamline the list of indicators characterizing the archetype of the health care system in the territory of the municipality of the Moscow Region, according to the degree of their importance in making and implementing management decisions in the framework of medium-term strategic planning for health care development.

CONCLUSION: The study demonstrated the sustainability of some problems in the health care system of the Moscow Region that currently need to be addressed.

BACKGROUND: Russian society needs mechanisms to reduce social tension, including with the participation of the “third sector” in the implementation of its characteristic intermediary functions. Intermediaries represented by non-profit organizations (NPOs) in healthcare can become an important element in resolving social conflicts.

AIM: To justifycation the the possibility of integrating mediation technologies into the activities of public organizations that protect the rights and interests of patients when receiving medical and pharmaceutical care, based on an analysis of the mediation functions they already perform.

MATERIALS AND METHODS: 9 in-depth interviews with leaders of NPOs that protect patients’ rights were conducted.

RESULTS: One of the tasks of NPOs in healthcare is mediation between patient communities and the public health system at its various levels.

CONCLUSION: NPOs in healthcare can become the subject of conflict resolution using the mediation procedure. It is proposed to expand the powers of these public associations with the function “to prevent and resolve disputes and conflicts in the field of health care” by amending paragraph 2 of Article 28 of the Federal Law of November 21, 2011 No. 323.

BACKGROUND: The article analyzes the idea that such a concept as “body” is an interesting and complex phenomenon, an integral part of human life, which philosophers, thinkers and theologians have reflected on throughout human history, describing its significance and role depending on ideological attitudes prevailing at one time or another.

AIM: Studying the features of the presentation and reflection of the “dualistic” and “holistic” attitude towards the human body in the works of scientists and thinkers of different eras.

RESULTS: The explanation of the essence of the first approach is based on an analysis of the features of church doctrine, which saw in the body only a “shell” of the soul and considered it worthy of contempt and death, and to understand the essence of the second approach, the author turns to the ideological attitudes of the Late Middle Ages, the Renaissance and the early Modern Times, which “rehabilitated” the body in the context of a return to the Roman and Greek classics of philosophical thought. Consequently, on the one hand, the medieval religious and political ideal of universalism and ways of “healing” (improving) the body as a social unity (“the body of society”) are analyzed, and, on the other hand, the author reflects on ways to free man from the yoke of church authority that regulates every aspect human life, related to the body, and also describes the history of the emergence of a new understanding of the human body — both as a symbol of beauty (in the understanding of kalokagathia by the Greeks), and as a machine working according to certain laws.

CONCLUSION: Understanding how “body” and “corporality” became the guidelines of medieval corporatism in its secular and ecclesiastical (papal) versions (taking into account the duality of the monarch’s body) requires a comprehensive study — not only from a philosophical, psychological, sociological, but also from a medical point of view. Changing approaches to understanding the body as a physical, cultural, social phenomenon allows us to more deeply understand the characteristics of society and people’s attitude towards life and death, suffering of body and soul, as well as the role of public discourse in shaping the population’s attitude towards these phenomena.

BACKGROUND: The relevance of the study is due to the insufficient study of the requirements for digitalization in healthcare.

AIM: The aim of this research is the scientific substantiation of requirements for digitalization of optimization technologies in healthcare, and their approbation on the model of management decision-making in medical institutions.

MATERIALS AND METHODS: An anonymous survey involved 32 teaching experts from organizational departments and the Department of Philosophy, Humanities and Psychology of Saratov State Medical University named after V.I. Razumovsky, where optimization technologies have been rapidly developed and introduced into teaching and practice. Experts were asked to use a 10-point scale to evaluate the list of requirements for digitalization of optimization technologies in healthcare, and their significance. As the data distribution did not correspond to the binomial Gauss–Newton curve, the assessment of the reliability of differences was performed using the nonparametric Mann–Whitney criterion.

RESULTS: A list of seven requirements for the digitalization of optimization technologies in healthcare, relevant to information support, automated evaluation of the initial state, implementation of the provisions of flexible changes methodology, virtualization of the optimization goal, cyclic optimization process, unified information space, organization of professional training was designed. Since the significance of all these requirements is essential (more than 8.0 points), we can suggest that when assessing the compliance of a particular technology, the entire list should be implemented. It turned productive to use the results of designing the technology for optimization of managerial decision-making in medical institutions for approbation of reasonable requirements.

CONCLUSION: The requirements for digitalization of optimization technology in healthcare have been substantiated. It has been proved that the technology of optimizing managerial decision-making in medical institutions is digitized. The findings of this study can be used in both assessing the degree of digitalization of optimization technologies in healthcare and the professional training of healthcare managers.

BACKGROUND: The inclusion of the method of noninvasive ventilation in the list of high-tech medical care has both a social and economic aspect and needs financial justification.

AIM: To justify the cost of medical care for patients with chronic obstructive pulmonary disease, when using the method of noninvasive lung ventilation, to prove the need to include this method of treatment in the list of high-tech medical care with calculations of financial support for this area of medical activity and its social significance.

MATERIALS AND METHODS: The article presents research data implemented using the following methods: interdisciplinary, comparative, qualitative and quantitative content analysis.

RESULTS: The cost of medical care for patients with chronic obstructive pulmonary disease is calculated, when using the method of noninvasive ventilation of the lungs, one of the generalizing methods for calculating the economic efficiency of a clinical hospital in the system of compulsory medical insurance in order to improve the health of patients and ensure the availability of high-tech medical care provided by the federal medical organization.

CONCLUSION: The medical and sociological analysis of the economic activity of a medical organization allowed us to justify the wider use of medical care standards, propose ways to improve them not only to control the quality of medical care provided, but also to strengthen the economic foundations of healthcare organizations and increase the effectiveness of both the treatment methods themselves and state financing of innovations.

BACKGROUND: Traumatic brain injury (TBI) is a global public health problem and one of the leading causes of mortality and disability. The prevalence and increase in the number of cases of TBI, high percentage of complications, disability, uncertain medical and social prognosis determine the relevance of studying this medical and social problem, the most significant in which are the consequences of craniocerebral trauma, often acquiring a chronic course, affecting the quality of life of the patient and his family.

AIM: To study the influence of financial deprivation on the quality of life of patients with post-TBI.

MATERIALS AND METHODS: The study of quality of life in patients with a post-TBI event was conducted using the WHOQOL-100 questionnaire. The study randomly sampled 414 respondents of working age (93.6% men). 54% of the respondents had suffered TBI within 1 to 5 years. The control group included clinically healthy subjects. The Dembo–Rubinstein test was used to diagnose the adequacy of respondents’ self-assessment with TBI. In the study of the impact of financial deprivation on the quality of life of the respondents, 4 degrees of deprivation correlated with the level of income per patient’s family member were considered.

RESULTS: The study of the impact of financial deprivation on the quality of life of patients with TBI identified 4 deprivation groups of respondents. The study obtained evidence of the effect of deprivation on the quality of life of respondents with TBI. The indicators of quality of life of patients included in the study significantly increase when moving from the group with degree 4 of deprivation to the group with degree 1 of deprivation. The greatest decrease in quality of life indicators was observed in respondents with degrees 2–4 of deprivation.

CONCLUSION: A multicomponent assessment of the results of TBI takes into account quality of life, a somatic and socially determined criterion of a patient’s social functioning that has prognostic value. The definition and typology of predictors of quality of life will allow the development of prognostic models of quality of life after TBI of different severity.

BACKGROUND: The interdependence of a person's creative abilities and the features of his life order, behavior, state of health, building social communications is widely discussed in literature, art, sociology, psychology, narrative medicine and the history of medicine (in particular, the question of the impact of health and disease on the possibilities of creative work and the reflection in the images and characters of the diseases suffered by the writer, the experience of overcoming the disease is discussed). At the same time, in public discourse, creative abilities are often present (and connected) in the contour of psychological and mental health disorders.

AIM: To study the image of a writer of the 20th century, expressed in modern cinema, as the equivalent of the perception by public consciousness of the characteristics of the behavior and thinking of the writer.

MATERIALS AND METHODS: The study was carried out by the method of quantitative content analysis of popular movies and biographies of foreign writers of the 20th century (n=10). The facts and features of deviant behavior and thinking of writers recorded in biographical works and the representation of the writer's image in cinema were compared.

RESULTS: The content analysis of the biographies and image of the writer presented in films for the 10 most frequently encountered psychopathological symptoms reflects a much more pronounced frequency of demonstrating the symptoms of the writer's mental health disorder in films (with the exception of the subcategory “depressive thoughts”) than in the actual data of his biography, and the severity of psychopathological symptoms is higher in film images of writers who have never received psychiatric care. Manifestations of maladaptation are shown in films in 9 out of 10 main characters, while the fact of maladaptation of 6 out of 10 writers is actually confirmed. At the same time, the deviant psychological features confirmed in the biography are much less often presented in films, and the greatest discrepancy is observed in the subcategories “feeling depressed” and “excessive impulsiveness”. However, a comparison of the ratio of the frequency of cases of positive, indifferent and negative perception/attitude towards the writer reflected in his biography and presented in films shows that society actually has a more positive attitude towards the writer than is shown in cinema.

CONCLUSION: The peculiarities of the behavior and creative thinking of writers in the public consciousness are still perceived in many cases as manifestations of mental pathology, while creative people are assigned a special social status that “justifies” the deviation of their lifestyle and behavior from accepted standards. The robustness of the stereotype about the correlation between creative abilities and the presence of psychopathology is largely formed by the heuristics of accessibility.