Medical and Social Aspects of Socially Significant Diseases in Rural Areas

The dissertation by Araslanova Svetlana Akhatovna is dedicated to a comprehensive study of the medical and social aspects of socially significant diseases — drug addiction, HIV infection, and syphilis — among the population of rural areas of the Republic of Bashkortostan. The research encompasses the analysis of the epidemiologic situation and dynamics of morbidity, the social-hygienic characterization of patients, the assessment of the organization of medical care, and the level of awareness of rural youth about these diseases and methods of their prevention. Based on the conducted comprehensive study, measures for the prevention of socially significant diseases have been developed, including a program for informing schoolchildren and a brochure for rural residents.

Socially significant diseases (HIV infection, drug addiction, sexually transmitted infections, and others) are among the most pressing issues of the present day and have become one of the primary threats to public health, particularly among adolescents and young people. The social significance of these diseases necessitates the involvement not only of medical professionals but also of the public, government authorities, education, culture, and other sectors for the conduct of effective prevention. Youth is precisely the most vulnerable population group that is rapidly drawn into the epidemic process. Drug addiction, HIV infection, and sexually transmitted infections are closely interrelated. Thus, one of the leading areas in venereological work is the study of the role of drug addiction and prostitution in the formation of foci of venereal diseases. This topic was virtually not discussed until recently. The urgency of the problem is compounded by the fact that the proportion of minors in the age structure of venereological morbidity increases year by year. The causes of the increase in socially significant diseases among adolescents are various but similar factors: social maladaptation, low levels of hygienic knowledge, environmental conditions, early onset of sexual activity, and others [Korchagina G.A. et al., 2004; Ramazanov R.S., 2005; Suslin S.A., Galkin R.A., 2006]. The expansion of connections between rural and urban residents due to the development of transport networks, trade, and increased migration has led to the rapid spread of socially significant diseases in rural areas. The risk of illness among rural residents is higher than among urban residents because they are less informed about how to protect themselves against HIV infection, drug addiction, and sexually transmitted infections. When ill, they have fewer opportunities to seek timely and appropriate medical care. Drug addiction at present in Russia, as in many Western countries, has acquired the character of a pandemic. Narcotization is engulfing ever larger segments of the population. It has had ups and downs that were always associated with significant social shifts. Drug addiction is 'younging'; women and residents of small settlements are being drawn into drug abuse, whereas previously this primarily concerned men over 18–20 years of age, residents of large and port cities (Pyatnitskaya I.N., 1996). The problem of drug addiction is especially acute among young people who are socially less protected [Baikov I.R. et al., 1999; Yuldashov B.JL, 2005]. Socially significant diseases represent colossal damage to society, associated with the loss of temporary and permanent work capacity, the necessity of enormous expenditures on prevention, treatment, and rehabilitation, premature mortality, and criminality. All of the above testifies to the relevance and necessity of in-depth research into this problem. The prevalence and medical and social aspects of socially significant diseases are sufficiently widely discussed in the press; however, the study of this problem in rural areas of the Republic of Bashkortostan has not been conducted. Objective of the research: to substantiate measures for the prevention of socially significant diseases among the rural population based on a comprehensive study of their medical and social aspects. Research tasks: 1. To analyze the level and dynamics of morbidity among the rural population with socially significant diseases. 2. To provide a social-hygienic characterization of patients with drug addiction, HIV infection, and syphilis living in rural areas and to evaluate the organization of medical care. 3. To evaluate the lifestyle of patients with socially significant diseases and the behavioral factors determining them. 4. To study the awareness of rural youth about socially significant diseases and methods of their prevention. 5. To develop measures for the prevention of socially significant diseases in rural areas. Scientific novelty of the research. For the first time, an in-depth assessment of the epidemiologic situation of socially significant diseases among the rural population is provided. The social-hygienic characterization of patients with drug addiction, syphilis, and HIV infection made it possible to identify the most significant risk factors for socially significant diseases. A clinical-statistical assessment of patients with drug addiction and syphilis who received inpatient treatment in specialized institutions is given, and an assessment of the awareness of rural schoolchildren about socially significant diseases has been conducted. Scientific and practical significance of the research. The data obtained on the prevalence of socially significant diseases in rural areas, and the social-hygienic characterization of patients (lifestyle, including behavioral factors), made it possible to develop a complex of measures for their prevention among rural youth. A program for informing schoolchildren about socially significant diseases has been compiled, and a brochure for rural residents has been prepared. Implementation in practice. The results of the research are used by preventive and treatment institutions and educational institutions of the Republic of Bashkortostan and by the Bashkir State Medical University. An informational and methodological letter titled 'Medical and Social Aspects of Socially Significant Diseases in Rural Areas' has been developed and published, approved by the Ministry of Health of the Republic of Bashkortostan. The following provisions are presented for defense: • The results of the analysis of the level and dynamics of morbidity among the rural population with drug addiction, HIV infection, and syphilis make it possible to conduct a comparative assessment with data for the republic as a whole and to use them for substantiating measures for their prevention, organization of medical care, and resource planning. • The social-hygienic characterization of patients with drug addiction, HIV infection, and syphilis made it possible to identify separate significant factors of lifestyle and behavior of rural residents affecting the onset of diseases. • Data on the low awareness of rural youth about socially significant diseases and methods of their prevention have been used in compiling a program for informing rural schoolchildren. Validation of the work: The results of the research were reported at: the republican conference of young scientists of the Republic of Bashkortostan 'Medical Science - 2002' (Ufa, 2002); the inter-university student conference on problems of youth health dedicated to the Year of Health and the 70th anniversary of the Bashkir State Medical University (Ufa, 2002); the republican conference of young scientists of the Republic of Bashkortostan 'Medical Science - 2003' (Ufa, 2003); the republican conference of young scientists of the Republic of Bashkortostan 'Medical Science - 2004' (Ufa, 2004); the 70th jubilee final republican scientific conference of students and young scientists with international participation 'Issues of Theoretical and Practical Medicine' (Ufa, 2005). Publications. Based on the materials of the research, 6 works have been published, and an informational and methodological letter has been issued. Volume and structure of the dissertation. The dissertation is presented on 150 pages of typed text and consists of an introduction, a literature review, a chapter reflecting the volume and methods of research, 6 chapters, a conclusion, findings, proposals for the implementation of research results in practice, and a bibliography (221 sources, of which 129 domestic and 92 foreign authors). To illustrate the research results, 13 figures and 2 schemes were used, and statistical data are presented in 26 tables.