Clinical, Social, Organizational, and Ethical-Legal Foundations of the Prevention of Sexually Transmitted Infections
- 14.00.33
Description
The dissertation is devoted to a comprehensive study of the clinical, social, organizational, and ethical-legal aspects of the prevention of sexually transmitted infections (STIs) in the Russian Federation. The research analyzes the current state of STI morbidity, the personnel and resource provision of the dermatovenerological service, as well as the characteristics of the sexual and reproductive behavior of adolescents as a high-risk group. Special attention is given to the assessment of the quality of medical care in outpatient-polyclinic settings, the level of professional training of dermatovenerologists, and the ethical-legal problems of providing assistance to patients with STIs. On the basis of the obtained results, scientifically substantiated directions for the optimization of medical-social STI prevention are developed from the standpoint of an integrated and interdepartmental approach.
Table of contents
- INTRODUCTION
- CHAPTER 1. MODERN CLINICO-SOCIAL PROBLEMS
- 1.1. Brief Historical Overview
- 1.2. Legal Regulation of the Problem
- 1.3. Official Statistics and Research Materials on the Prevalence of STIs
- 1.4. Modern Organizational Technologies and Program-Targeted Approach to STI Prevention
- CHAPTER 2. RESEARCH PROGRAM, SCOPE, AND METHODOLOGY
- CHAPTER 3. DISEASE PREVALENCE AND ORGANIZATION OF MEDICAL-PREVENTIVE CARE FOR THE POPULATION OF THE RUSSIAN FEDERATION WITH STIs
- 3.1. The Problem of STI Registration
- 3.2. Morbidity by Healthcare Utilization
- 3.2.1. Syphilis
- 3.2.2. Gonorrhea
- 3.2.3. Trichomoniasis
- 3.2.4. Chlamydia
- 3.2.5. Urogenital Herpes
- 3.3. The Significance of Preventive Examinations for STI Detection
- 3.4. Personnel and Resources of the Dermatovenerological Service of the Russian Federation
- CHAPTER 4. ADOLESCENTS AS A HIGH-RISK GROUP FOR STIs
- 4.1. Characteristics of the Conditions and Lifestyle of Adolescents with STIs
- 4.1.1. Social-Hygienic Characteristics of Families and Living Conditions of Adolescents
- 4.1.2. Lifestyle Characteristics of Adolescents with STIs
- 4.2. Life Values and Attitudes of Adolescents
- 4.3. Sexual and Reproductive Behavior of Adolescents. Level of Knowledge about STIs, Contraception, and Personal Practice
- 4.3.1. Characteristics of Adolescent Sexual Behavior
- 4.3.2. Adolescent Awareness of Contraception, STI Prevention, and Personal Sexual Practice
- 4.3.3. Characteristics of the Pattern of Adolescent Infection with Sexually Transmitted Infections
- 4.4. The Influence of Risk Factors on Adolescent STI Morbidity
- CHAPTER 5. ETHICAL-LEGAL ASPECTS OF MEDICAL CARE FOR DERMATOVENEROLOGY PATIENTS
- 5.1. Theoretical Foundations of Ethical-Legal Health Protection of the Population
- 5.2. Basic Ethical-Legal Principles in the Work of Dermatovenerologists
- 5.3. Ethical-Legal Problems of Medical Care Provision from the Perspective of Healthcare Service Consumers
- CHAPTER 6. ASSESSMENT AND CONTROL OF PROFESSIONAL KNOWLEDGE OF DERMATOVENEROLOGISTS
- 6.1. General Characteristics of Resident Physicians
- 6.2. Assurance and Control of Professional Knowledge
- 6.3. Criteria and Results of Professional Knowledge Assessment
- 6.3.1. Syphilis
- 6.3.2. Gonorrhea
- 6.3.3. Urogenital Trichomoniasis
- 6.3.4. Urogenital Chlamydia
- 6.3.5. Urogenital Mycoplasmosis
- 6.3.6. Urogenital Candidiasis
- 6.3.7. Genital Herpes
- 6.3.8. Condylomata Acuminata
- 6.3.9. Bacterial Vaginosis
- 6.3.10. Prevention of Sexually Transmitted Infections
- CHAPTER 7. SCIENTIFIC JUSTIFICATION FOR THE OPTIMIZATION OF STI PREVENTION
- 7.1. Expert Assessment of the Quality of Medical Care for Patients with STIs in Outpatient-Polyclinic Settings
- 7.2. Main Directions for the Optimization of Medical-Social STI Prevention
Introduction
The high level of sexually transmitted infections (STIs) poses urgent tasks for Russian healthcare and society as a whole, related to preventing the detrimental impact of this pathology on public health, including reproductive health (A. A. Kubanova, 2002, 2003; V. I. Kulakov, 2000; O. Klosova, T. A. Kravets, 2001; Yu. K. Skripkin, V. A. Akovbyan, 1997; Yu. K. Skripkin, L. I. Tikhonova, A. A. Kubanova, 1999; Wallace, N. M., 1998).
At present, Russia is experiencing an STI epidemic. Although its peak in 1999 has already passed, morbidity remains at a high level. Thus, in 2002, Russia registered 935,306 patients, or 658.7 cases per 100,000 population. A yearly decline is observed in the number of registered patients with syphilis, gonorrhea, and trichomoniasis, while an increase is noted in chlamydia, anogenital warts, and genital herpes.
It is precisely at this time that the social component of the problem has become extremely acute, for in the epidemiology of STIs, social, economic, cultural, and demographic changes are playing an increasingly significant role, including societal instability, military, civil, and national conflicts, a sharp increase in migration processes, the appearance of refugees, persons without a fixed place of residence or occupation, and the lumpenization of society (L. I. Tikhonova, 1995; Yu. P. Lisitsyn, 1996; N. V. Polunina, 1996; V. I. Prokhorov, 2001; O. P. Shchepin, 2000–2002; T. M. Maximova, 2002).
The relevance of STIs is primarily determined by their ability to exert a significant influence on reproductive health. It is important to emphasize that these diseases harbor a deferred danger that may manifest itself many years later: primary and secondary infertility, failure to carry a pregnancy, complications during childbirth, and, associated with this, a decrease in birth rate amid various urogenital infections; the birth of substandard offspring, severe visceral lesions in syphilis, and the like (N. V. Luzan, 1999; T. L. Gasanova, 2001; L. V. Bobrik, 2002; O. V. Tikko et al., 2002; A. A. Baranov, 2003; E. R. Araviysky et al., 2003; N. V. Kungurov et al., 2003; L. Gilbert, L. Alexander, 1998; F. L. Fridman, 1998; M. Taylor Seehafter, L. Rew, 2000).
An analysis of literary data convinces us that among all risk groups with respect to STIs, the most vulnerable group is adolescents, which is determined by a number of characteristics inherent to this age period of human development. The significant prevalence of STIs among adolescents is especially alarming in connection with the high risk of developing complications in them, leading primarily to impaired reproductive function. All this dictates the necessity of expanding research to identify high-risk groups in need of medical-social protection and a differentiated approach.
In recent years, the extensive path of healthcare development against the background of insufficient financing has led to a discrepancy between the level of medical care and the needs of the population. Therefore, for the further improvement of the organization of dermatovenerological care, the expert assessment of the quality of medical care and the professional readiness of physicians are highly relevant.
Also beyond the scope of the study remain the ethical-legal problems of providing medical care to patients with STIs, in particular the preservation of medical confidentiality, the anonymity of treatment and examination, the relationships between physician and patient, and the like.
All of the above convincingly demonstrates how relevant the presented problem is and dictates the necessity of a comprehensive study of the nature and prevalence of STIs in interrelation with the personnel-resource provision of healthcare, the level of professional training of physicians, the quality of rendered medical care, and ethical-legal problems.
Questions and answers
- What is the goal of the dissertation research?
- The goal of the research is the assessment of the current situation with sexually transmitted infections (STIs) in the Russian Federation and the scientific substantiation of measures for their medical-social prevention.
- Which population groups are identified in the work as the most vulnerable with respect to STIs?
- Adolescents are recognized as the most vulnerable group, which is due to the characteristics of the age developmental period, the high prevalence of STIs among them, and the significant risk of developing complications leading to impaired reproductive function.
- What tasks are set within the framework of the research?
- The research sets seven tasks: to study the age-sex characteristics of STI prevalence; to characterize the system of organization and personnel-resource potential of dermatovenerological care; to study the lifestyle, reproductive behavior, and knowledge of adolescents about contraception and STIs; to characterize the STI problem from the standpoint of biomedical ethics; to assess the level of professional training of dermatovenerologists; to analyze the state and quality of medical care for patients with STIs in outpatient-polyclinic settings; and to develop proposals for the protection of reproductive health and STI prevention.
- What constitutes the scientific novelty of the dissertation?
- The scientific novelty lies in the results of a comprehensive clinical-social and medical-organizational analysis of the STI situation in the Russian Federation, which made it possible to identify the age-sex characteristics of infection prevalence, characterize the personnel-resource provision of dermatovenerological care, study the conditions and lifestyle of families of adolescents with STIs, reveal the leading ethical-legal problems of medical service for patients with STIs, and substantiate approaches to the integrative activities of various healthcare services in STI prevention.
- What practical results were obtained in the course of the research?
- The research results made it possible to develop and implement the textbook 'Sexually Transmitted Infections in Adolescents: Social and Psychological Problems,' prepare an analytical review 'Problems of Diseases Transmitted by Sexual Contact,' and create the textbook 'Legal and Ethical Foundations of Health Protection of Children and Youth.' The dissertation materials were used in the work of the Committee on Health Protection of the State Duma of the Russian Federation and in the preparation of an industry meeting of leaders of maternal and child health protection services.