Medical-Social Conditions of Life and Health of Women Operated for Thyroid Diseases and Ways of Improving Medical-Preventive Care

The dissertation is devoted to a comprehensive socio-hygienic research of conditions of life and health of women operated for thyroid diseases in the Kuzbass — the largest industrial and goiter-endemic region of the country. In the work, a program and methodology for conducting such research were developed, the overall morbidity and reproductive health of the studied contingent of women before and after operative treatment were analyzed, and the features of gynecological morbidity, pathology of the mammary glands, and the course of pregnancy and childbirth among these patients were identified.

On the basis of the conducted research, methodological recommendations were developed for the improvement of medical-preventive care for women with surgical thyroid pathology, encompassing hygienic education and upbringing, a differentiated approach to health preservation taking into account the socio-demographic and socio-hygienic peculiarities of the contingent. The results of the work have been implemented in the practice of a number of medical institutions of the Russian Federation and are used in the educational process of medical universities.

Leading domestic scholars in the field of public health and healthcare convincingly demonstrate the multifaceted influence of socio-hygienic conditions and lifestyle on human health. Therefore, in the development of measures for social planning and medical service, comprehensive socio-hygienic research of major population groups holds considerable importance. Such research enables the development and implementation of specific preventive measures that yield the greatest effect per unit of investment [51, 117, 230, 231, 232]. One such group may be identified as women with thyroid diseases.

Being the bearer of population reproduction, a woman determines the present and future of any country, any society [200, 212]. Overall morbidity among women has increased in Russia by 7.5% in recent years, while the share of endocrine system diseases has risen by 24.1% [113].

Thyroid pathology is the most prevalent among endocrine diseases. The trend toward a further steady increase in the prevalence of thyroid diseases, including those requiring surgical treatment, persists [57, 198].

It is well established that both the thyroid pathology itself and the alteration of its function following operative treatment exert an influence on the health of women [1, 39, 184, 304].

However, to date, the principal indicators of conditions of life and health of women operated for thyroid diseases, both before and after operative intervention, have not been studied; a system of preventive and rehabilitative measures aimed at preserving the health of this population group has not been developed.

The questions concerning the formation of surgical thyroid diseases, the role of socio-hygienic factors in the development of this pathology under contemporary socio-economic conditions, and the development of new directions for prevention remain insufficiently investigated.

In the Kuzbass, the most industrialized and urbanized region of the country, possessing its own socio-economic, ecological, and climatic features, no such research has been conducted whatsoever.

The above indicates that the study of principal indicators of conditions of life and health of women before and after operative treatment of thyroid diseases, as well as the development of preventive and rehabilitative measures aimed at preserving the health of women who have undergone thyroid gland surgery, are of considerable relevance.

Research objective: On the basis of a comprehensive socio-hygienic research of conditions of life and health of women operated for thyroid diseases, to develop scientifically grounded recommendations for the preservation of their health, the improvement and enhancement of medical-preventive care.

In accordance with the research objective, the following tasks were set:

1. To formulate a program and methodology for a comprehensive socio-hygienic research of women with surgical thyroid pathology;

2. To study the medical-social aspects of conditions of life of women with this thyroid pathology;

3. To analyze the overall morbidity of women with surgical thyroid pathology;

4. To assess the state of reproductive and menstrual functions, to identify features of gynecological morbidity, pathology of the mammary glands, and to establish the peculiarities of the course of pregnancy and childbirth in women operated for thyroid diseases, before and after operative treatment;

5. To develop scientifically grounded recommendations for the preservation of health, the improvement and enhancement of medical-preventive care for women operated for thyroid diseases.

The present work is a constituent part of the comprehensive scientific topic "Socio-Hygienic Aspects of the Scientific Grounding of Innovative Technologies of the Regional System of Organization and Management of Medical Care, the Quality of Medical Services, and the Health of the Population," carried out at the Department of Healthcare Organization, Public Health, and Medical Informatics of the State Educational Institution of Higher Professional Education "Kemerovo State Medical Academy of the Federal Agency on Healthcare and Social Development" (state registration number 01.20.00.02543).

The scientific novelty of the research consists in the fact that in a large industrial region of the country endemic for goiter, namely the Kuzbass, for the first time:

• a program and methodology for comprehensive socio-hygienic research of conditions of life and health of women with surgical thyroid pathology were formulated;

• a comprehensive socio-hygienic research of conditions of life and health of women with thyroid diseases was conducted;

• levels of overall morbidity of women with surgical thyroid pathology were determined;

• the state of reproductive and menstrual functions was assessed, features of gynecological morbidity and pathology of the mammary glands were identified, and the peculiarities of the course of pregnancy and childbirth in women operated for thyroid diseases, before and after operative treatment, were established.

The practical significance of the work lies in the development of methodological recommendations aimed at improving medical-preventive care for women operated for thyroid diseases.

Dynamic observation of women operated for thyroid diseases, active work with them in the course of the research, contributed to the enhancement of the level of hygienic education and, as a consequence, to an increase in the demand for medical-preventive care.

The practical value of the scientific research is confirmed by the implementation of the results and proposals of the completed work.

The methodological recommendations "Socio-Hygienic Characteristics of Women Operated for Thyroid Diseases and Ways of Improving Medical-Preventive Care," approved by the Department of Population Healthcare of the Kemerovo Region, were sent to the healthcare administrations of the subjects of the Russian Federation, the healthcare administrations of cities and central district hospitals of the Kemerovo Region, as well as to medical-preventive institutions providing medical care for thyroid pathology.

The proposals set forth in the methodological recommendations found practical application in the work of the Ministry of Healthcare of the Republic of Khakassia (Implementation Act dated 19.05.2005), the Department of Population Healthcare of the Kemerovo Region (Implementation Act dated 13.06.2005), the Vladivostok Branch of the Far Eastern Scientific Center of Physiology and Pathology of Respiration of the Siberian Branch of the Russian Academy of Medical Sciences, the Research Institute of Medical Climatology and Rehabilitation (Implementation Act dated 26.06.2005), the Department of Healthcare of the Administration of the Moskovsky District of St. Petersburg (Implementation Act dated 23.09.2005), the Municipal Medical-Preventive Institution "City Clinical Hospital No. 1 of Novokuznetsk" (Implementation Act dated 16.05.2005), and the Federal State Institution of Healthcare "Center for Hygiene and Epidemiology in the Kemerovo Region" (Implementation Act dated 26.05.2005).

On the basis of the materials of the conducted research, and in accordance with the decision of the Central Methodological Council of the State Educational Institution of Higher Professional Education "Kemerovo State Medical Academy of the Federal Agency on Healthcare and Social Development," educational-methodological recommendations "Organization of Comprehensive Socio-Hygienic Research of Selected Population Groups" were developed and published, which are applied in the educational process.

The present methodological recommendations are used in the training of physicians at State Educational Institutions of Higher Professional Education: "Kemerovo State Medical Academy of the Federal Agency on Healthcare and Social Development" (Implementation Act dated 23.04.2005), "Omsk State Medical Academy of the Federal Agency on Healthcare and Social Development" (Implementation Act dated 16.05.2005), and "Siberian State Medical University of the Federal Agency on Healthcare and Social Development" (Implementation Act dated 29.06.2005).

The principal propositions put forward for defense:

1. Methodological approaches to comprehensive socio-hygienic research of conditions of life make it possible to establish the principal factors exerting an adverse influence on the health status of women operated for thyroid diseases;

2. Women operated for thyroid diseases have peculiarities in the principal socio-demographic and socio-hygienic indicators, which attests to the necessity of a differentiated approach in the system of their health preservation;

3. Taking into account the socio-hygienic characteristics of the contingent, proposals and recommendations for the improvement of health of women who have undergone operative treatment of the thyroid gland should provide for the enhancement of medical-preventive care, hygienic education, and upbringing.

Validation of the work and the author's personal contribution to the development of the topic.

The results of the research were reported and received approval at the scientific-practical conference of young scientists of the Kuzbass "Problems of Medicine and Biology" (Kemerovo, 2002); the interregional scientific-practical conference dedicated to the 60th anniversary of the Kemerovo Region (Kemerovo, 2003); the interregional scientific-practical conference dedicated to the 40th anniversary of the Medical-Preventive Faculty of KGMU "Problems of Hygiene and Epidemiology in Siberia" (Kemerovo, 2003); the All-Russian scientific-practical conference "Multidisciplinary Hospital: Problems and Solutions" (Leninsk-Kuznetsky, 2003); the international scientific-practical conference "Modern Medical Technologies in Healthcare as an Effective Path to Improving the Quality of Medical Care" (Expo-Sibir, Kemerovo, 2004); the interregional conference of young scientists (Kemerovo, 2004); the regional scientific-practical conference of young scientists dedicated to the 50th anniversary of the Kemerovo State Medical Academy (Kemerovo, 2005).

The principal propositions of the dissertation were published in 13 printed works, including 2 methodological recommendations.

All scientific results presented in the work were obtained personally by the author: the program and methodology of research were formulated; statistical forms were compiled for the extraction of necessary data; information collection was carried out; tables and graphs were compiled; statistical processing and interpretation of the obtained scientific results were conducted.

Volume and structure of the work.

The dissertation consists of an introduction, five chapters, a conclusion, conclusions, proposals, a section "Materials Confirming the Practical Use of the Results of the Research," a list of references used (235 domestic and 89 foreign authors), and an appendix. The volume of the dissertation amounts to 168 pages of computer text. The author's own research is presented on 149 pages. The dissertation is illustrated by 1 scheme, 8 figures, and 45 tables.