Vol 32, No 12 (2021)

The article is devoted to topical issues of communication between a doctor and a patient in difficult situations. Special attention is paid to communication with cancer patients. Recommendations for informing the patient about the diagnosis of a life-threatening disease are presented. The tactics of the doctor when conducting conversations with patients, regarding their sexual problems, as well as communication with LGBT patients are described.

The article deals with the «healthy worker effect» phenomenon that is understood as organized (by the employer) and/or unorganized (self-selection by workers due to their functional capabilities and health status) professional selection of healthier workers under unfavorable working conditions remaining in the profession. This effect is one of the most important problems in epidemiological studies in occupational medicine. The paper analyzes the scientific and medical terminology used when studying the problem of the «healthy worker effect», taking into account the possible inversion of the impact of harmful and unfavorable working conditions, taking into account this phenomenon, as well as the intensity of the «healthy worker effect» in various occupational cohorts.

Osteoarthritis (OA) is a chronic progressive joint disease that poses a serious general medical and social problem. The disease is associated with an increased risk of death and requires the earliest possible appointment of therapy. According to modern recommendations, the treatment of patients should include non-pharmacological and pharmacological methods. The article discusses the basic therapy of OA, including symptomatic delayed-action drugs (SYSADOA), paracetamol, nonsteroidal anti-inflammatory drugs, intra-articular administration of hyaluronic acid and glucocorticosteroids, as well as issues of anesthesia for severe pain syndrome. Total knee replacement is recommended only for patients with the last stage of OA.

Cancer incidence in the world and in Russia continues to grow. It is possible to stop the growth of morbidity only by cancer prevention measures. These measures implementation and realization of their cancer prevention capabilities significantly depends on health literacy and motivation of people to follow prevention recommendations. Objectives: The purpose of the work is to study the spread of some cancer risk factors and to evaluate people's knowledge about cancer causes and risk factors. Methods: The study was conducted on a random sample of the adult population of Moscow numbering 310 people aged 20-79years. The main method of research is personal interviewing using a unified and structured questionnaire regarding the presence of bad habits, some characteristics of nutrition, physical activity and knowledge about cancer causes and cancer prevention and early diagnosis methods. Results: In the adult sample study, the percentage of all persons who ever smoked was 62.2% among men and 24.6% among women. The percentage of people who consumed alcoholic beverages 2 times a week or more often was 252% (95% Cl 17%-33%) among men and 4% (95%CI 3.3%-4.7%) among women. Only 16% surveyed respondents followed the healthy diet recommendation. Recommended as prophylactic against cancer regime of physical activity was observed by less than half of all persons, 45.5%. Majority, 53.8% the respondents were unaware of cancer causes or named only one true cause. 37.9% (95% Cl 32%-43%) respondents did not know about measures for the prevention of cancer diseases. About methods of early diagnosis of tumors, the majority, 60.0% (95%CI 55%-65%) respondents did not know anything or gave incorrect answers. Conclusions: Most of the respondents in a random sample of the population did not know or had incorrect or insufficient knowledge about the cancer causes, measures for their prevention and early diagnosis. It is necessary to organize active education of the population on the relevant topic using all available types and channels of information.

The paper presents the experience with telemedicine information technologies, which has allowed obstetric facilities in the Sverdlovsk Region to use the telemonitoring of the health status in pregnant and puerperant women, including those with asymptomatic and mild novel coronavirus infection during outpatient treatment (at home).

Modern industrial noise has its own characteristics, one of which is the tendency to increase the contribution of high-intensity low-frequency and infrasonic components to the spectrum of noise, which has a more pronounced pathological effect. The classical presentation of noise-induced sensorineural hearing loss (SNHL) was considered only as a result of exposure to high-frequency industrial noise. In 2004, infrasound was included in the list of occupational diseases that cause hearing loss. However, there is no clinical presentation of occupational infrasound-induced SNHL (OSNHL), which creates difficulties in establishing an association between diseases and working conditions. Studying the clinical presentation of SNHL due to the impact of high-intensity noise containing high-intensity low-frequency acoustic vibrations (LFAVs) in the spectrum, the authors revealed the features of its formation and development, which allows its identification as a special form and its use in practice. When making a diagnosis of OSNHL, it is necessary to take into account not only the length of working with noise, but also to pay attention to the noise spectrum. OSNHL due to the combined effect of noise and LFAVs requires the consideration of its clinical characteristics and expert judgment.

Objective: to evaluate the effectiveness of postoperative analgesia with a fixed combination of paracetamol 325 mg + tramadol 37.5 mg in trauma patients over 18 years of age with moderate and high intensity pain syndrome (PS). Subjects and methods. The study included 60 traumatological patients in the early postoperative period with PS aged over 18 years. Postoperative anesthesia was carried out from the first day with a fixed combination of Paracetamol + Tramadol (Organica) film-coated tablets 325 mg + 37.5 mg. Daily and single doses were selected individually, according to the instructions. The anesthesia regimen varied in taking a fixed combination of paracetamol and tramadol: 1 tablet from 1 to 4 times a day or 2 tablets 4 times a day. Pain assessment before and after anesthesia was carried out according to the visual analog scale (VAS) of pain intensity. Results and discussion. The duration of anesthesia varied from 1 to 5 days depending on the pathology and averaged 2.9 days. The groups did not differ statistically by gender, age and concomitant pathology. The male sex prevailed in the trauma departments. The average age of patients was 48.75 years. In 100% of cases, effective anesthesia was observed - according to VAS, the score values after taking the painkiller in three centers varied from 0 to 3. The results of the study showed statistically significant differences in the score values on the VAS scale before and after taking the painkiller in three centers. The average score on the pain scale VAS before taking the painkiller was 6.400 in 1 center, 6.440 in 2 center and 6.467 in 3 center, after taking the painkiller - 1.650 (p=0.0012), 1.48 (p=0.0004) and 1.333 (p=0.0078), respectively. Side effects when using a fixed combination of paracetamol and tramadol (in the recommended maximum daily dosages of tramadol up to 400 mg): dizziness, nausea, vomiting, were not observed in patients in this study. Hypotension was observed in two patients (3.45% of the sample size) aged over 70 years while taking painkiller, the manifestation of which was stopped by intravenous administration of dexamethasone. Conclusions. The results of the study indicate that the fixed combination of Paracetamol 325 mg + Tramadol 37.5 mg produced by AO «Organica» (Novokuznetsk) allows for effective and safe therapy of moderate and high intensity PS and is an effective alternative to invasive medicinal forms of painkillers, while achieving a significant reduction in the side effects of the active components included in its composition.

The features of adolescent smoking behavior have been studied and its dominant types have been established. The authors have undertaken an analysis of a number of scientific works considering the problem of adolescent smoking and established the risk of chronic diseases caused by smoking.