Vol 18, No 2 (2019)

The chronic kidney diseases are recognized as one of leading problems of modern health care due to high prevalence and unfavorable prognosis. The article considers modern classification of predictors of chronic kidney diseases. It is emphasized that none of known modern classifications of chronic kidney diseases predictors don't take into account medical care accessibility to patients in disease condition as a predictor. It is proposed to consider accessibility of medical care from perspective of macrolevel social factors that represent the most widely background health predictors. The original typology of accessibility of nephrological medical care to patients with chronic kidney disease is proposed, which is implemented through prevention and/or minimization of predictors of the onset of chronic kidney diseases, management of disease progression and nephroprotection modifiable predictors, and renal replacement therapy for patients with chronic kidney disease. The one of reasons of limited accessibility of renal replacement therapy for patients with chronic kidney diseases is transportation problem that is solved in the Saratov region through organization of transportation of dialysis patients and development of domiciliary methods of renal replacement therapy. The restriction of medical care accessibility to patients is considered as an obligatory predictor of the onset, progression and unfavorable prognosis of chronic kidney diseases.

The problem of drug abuse in various territories of the Russian Federation continues to be critically important. The availability of large administrative territory uniting numerous regions with diverse characteristics results in polarization of drug abuse indicators. The purpose of study is to analyze regional characteristics of drug abuse in the Russian Federation to develop general scope of drug abuse spreading to propose effective anti-drug policy meeting challenges of current drug abuse situation. The regions of the Russian Federation that suffer, according to official statistics data, maximum and minimum indices of drug abuse are considered. The results of analysis of current medical statistics (indices of number of people with first-time established drug dependence syndrome, as well as number of people with first-time established diagnosis of "harmful drug abuse", number of cases of acute drug intoxication, etc.), law enforcement statistics (indices of number of established crimes related to illicit drug trafficking, structure of the most common drugs, etc.). The analysis of related publications, as well as research data from sociological studies of deviant behavior implemented by the Federal Center of Theoretical and Applied Sociology of the Russian Academy of Sciences was also implemented. The conclusions are presented concerning most risky regional characteristics in drug abuse sphere, as well as regional particularities that function as a kind of protective factors against the drug abuse prevalence.

Health is the fundamental value of every individual, and its violations, especially those that are burdened by risk of disability, are the key factor of reducing quality of life of individual. The extent of prevalence of hearing impairment in population, accompanied by multiple problems in organization of social, professional and family life of patients, determines high social importance of the issue. The article presents results of medical and sociological study (focus group) of quality of life of patients with diagnosis "sensorineural hearing loss" (as exemplified by patients of Moscow multi-field hospital). The onset of disease, in addition to problems of physical well-being (pain, dizziness, disorientation, etc.) causes person sensorineural hearing loss reducing quality of life, and, above all, resulting in multiple communication problems at the level of everyday personal and social interaction. Despite the fact that the study participants believe that there is no negative attitude and stigma towards people with hearing loss among Russians, the respondents noted prevalence of general intolerant attitude towards disabled people. The widespread of sensorineural hearing loss among able-bodied population is accompanied with low level of public awareness of principles of prevention of hearing loss, the need for timely corresponding treatment, as well as peculiarities of interaction with people suffering hearing loss. The majority of respondents indicate high ability to work with adequate treatment and selection of hearing device and make adjustments to organization, and the support of family and working community.

The article presents results of analysis of concepts “health” and “disease” to identify patterns of changes in their meaning and content which resulted into increasing of technologization of modern medicine. Every of considered ways of interpreting concept of “disease” contains certain image of human and one's attitude to internal (natural) and external (natural, social) environment and determines the degree of necessity, direction and character of impact on human body. The modifications of ways these categories are interpreted reflect evolutionary transition of successive changes in three paradigms of medicine: biocentric - sociocentric - technocentric. There is no clear demarcation between pathological and normal states of organism in the biocentric paradigm. The medical standard is identical to biological one; its criterion is viability. In the sociocentric paradigm, social factors of human activity dominate natural ones. The concept of “disease” acquires negative meaning and begins to be defined as “failure”, violation of adaptation of human organism. The natural consequence of this approach is increasing of spectrum and intensity of medical intervention: medical technologies begin to be applied to eliminate biologically normal conditions of patient's body. The main feature of technocentric paradigm is its constructivist character: biomedicine seeks to create new states of human body and psyche that do not exist in the nature. Understanding health as “well-being” leads to relativity of medical standards that becomes depended on constantly changing individual standards.

The social institute of medicine, which has been developing steadily throughout the existence of mankind, covers not only clinical aspects of health, but also socio-economic, cultural, organizational and other components of population health protection. Nowadays, at the "digitalization" stage of society development, health care system is being rebuilt on the basis actual requirements. The condition of the "catching-up" development of industry is implementation of modernization measures targeted to updating material and technical components of health care system, as well as expansion of skills of medical personnel with modern medical equipment and programs. The article presents the results of medical and sociological study (pilot survey) of peculiarities of perception of results of modernization of health care system by medical specialists (as exemplified by the personnel of Krasnogorsk multi-field hospital). The most medical specialists working with equipment received under the state program of modernization of the health care perceived modernization positively (especially personnel working in medicine more than ten years) and believe that measures applied contributed into improving quality of medical care of patients. However, in order to increase efficiency of application of new medical equipment, it is necessary to include into health care modernization program position of mandatory training of medical staff.