Optimization of Medical-Social Assistance to Young Men of Pre-Conscription Age in Pediatric Clinics of a Large City

The dissertation is devoted to the problem of optimization of medical-social assistance to young men of pre-conscription age in the conditions of pediatric polyclinics of a large city. The research is conducted on the material of Saint Petersburg and is related to the task of increasing the country's defensibility through improving the health status of persons of conscription age. In the work, the health status of young men of pre-conscription age is comprehensively studied, the types of chronic pathology reducing their level of medical fitness for military service are identified, and the organizational aspects of medical assurance for the preparation of young men for military service in pediatric outpatient-polyclinic institutions are analyzed.

The research includes a medical-statistical and medical-social analysis of the contingent of conscripts, their families, and students of various types of educational institutions, as well as an assessment of the opinions of medical workers regarding the state of organization of assistance to conscripts. On the basis of the obtained results, a complex of measures for the optimization of medical-social assistance was developed and substantiated, aimed at increasing the fitness indicator of youth for military service through strengthening primary and secondary prevention, systematic dispensary observation, and the formation of a healthy lifestyle among adolescents.

Relevance of the Problem. Preserving and strengthening the country's defensibility is one of the paramount tasks of the state. In the Address of the President of the Russian Federation to the Federal Assembly of May 10, 2006, a course was proclaimed toward creating a professional and mobile army. The necessity of reviving pre-conscription training was specially emphasized, and recommendations were given to the government to adopt a program on this subject. The President noted that today a large number of young people of conscription age have chronic illnesses, a propensity for alcohol, smoking, and in some cases even drugs.

Indicators characterizing the health status of adolescents have acquired consistently unfavorable trends in the last decade. New risk factors and social problems among Russian youth are continually emerging. Insufficient societal attention, declining control by family and school over adolescent behavior further aggravate the situation (Shchepin O.P., 2003; Mikirtichan G.L., 2003; Lisitsyn Yu.P., 2004; Chicherin L.P., 2005). It is precisely for this reason that the health status of persons of conscription age acquires medical-social significance and requires urgent measures to improve it (Luckevich V.S., 2003; Vishnyakov N.I., 2005; Erman L.V., 2005; Minyaev V.A., 2005; Orel V.I., Kim A.V., 2005).

The indicators of fitness of young men for service in the Armed Forces have been steadily declining. If in the 1980s every twentieth young man was recognized as unfit or limitedly fit for military service, then in the 1990s — every fifth (Chicherin L.P., Yadchuk V.N., 2005). At present, the proportion of young men exempted from conscription due to low health indicators already amounts to 30–35%. Two-thirds of young men have various restrictions on military service. Among adolescents, weak psychological motivation to fulfill their military duty and to form a healthy lifestyle is observed (Tezga V.Yu., 2003; Orel V.I., Kim A.V., 2005; et al.).

Questions of health upon conscription to military service acquire particular importance, since over the last period the level of health of schoolchildren in modern conditions is determined by a high prevalence of functional disorders (38.0–45.0%), chronic diseases of internal organs (45.0–61.0%), and violations of physical and mental development. The overwhelming majority have functional and chronic impairments affecting 2–5 or more organ systems (Yadchuk V.N., Kovalsky O.N., Kvasovka V.V., Pashkovsky R.D., 2005). Overall morbidity in the adolescent population grew by more than 30% over 1996–2002 due to the accelerated transition of acute forms of disease into relapsing and chronic forms, and the increase of primary chronic pathology. Almost 50% of secondary school graduates have various chronic diseases and restrictions in the choice of professions based on health status (Albitsky V.Yu., 1993; Alexander D., 1994; Baranov A.A., 1998; Andrushina E.V., 1995; Lebedkova S.E. et al., 2001; Kuchma V.R., 2001).

In Saint Petersburg in 2005, at the stage of initial enrollment in military records (IEMR), the proportion of young men having various restrictions on fitness for military service due to health status amounted to 55.9%, including 31.8% of young men having restrictions on military service for various military-accounting specialties. 1.1% of adolescents, through military-medical examination (MME), were recognized as unfit for military service, and 13.3% of young men — limitedly fit. The proportion of persons granted deferral from conscription on health grounds primarily for the purpose of verifying the underlying disease amounted to 9.7% (Kim A.V., 2005).

Among the causes contributing to the deterioration of adolescent health, most authors cite socio-economic deprivations, unemployment, inadequate nutrition, migration from rural areas to cities, alcohol abuse and dependence, drug addiction, smoking, underestimation of the significance of their own health, deterioration in the quality and accessibility of medical care, and others (Borodin S.E., 1996; Leshevich I.A., 1995; Egorov V.V., 1998; Chicherin L.P., 1999; Starodubov V.I. et al., 1999; Averyanova V.I. et al., 2001; et al.). A national calamity became the spread among adolescents of drug addiction, alcoholism, toxication, sexually transmitted infections, and tuberculosis. All this points to the necessity of forming a complex of organizational measures aimed at improving the quantitative and qualitative characteristics of medical assurance of adolescents, based on a goal-oriented approach (Dyukareva A.M., 1995; Lisitsyn Yu.P., 1996; Vaghanov N.N., 1997; Larionov V.N., 1997; Skvortsova E.S., 1997; Zimin E.V., 1998; Orel V.I., 1998; Brui B.P. et al., 1999; Kim A.V., 2005).

An important component in the assessment of the health status of conscripts is the study of adolescent health in dynamics. In this regard, an individual-personal approach is necessary: taking into account not only age-related but also individual features of the development of each adolescent (Ilyin A.I., 1999; Rapoport I.K., 2000, et al.).

The transfer of the adolescent population under the supervision of pediatric polyclinics was a positive development in the organization of medical care for adolescents. At the legislative and directive level, the basic principles and approaches to the organization of medical-social assistance were formulated, and mechanisms for controlling the quality of medical-social services provided to adolescents in the conditions of pediatric polyclinics were developed (Chicherin L.P., 2000; Kuchma V.R., 2003; Baranov A.A., Albitsky V.Yu., 2005).

The accumulated experience of serving adolescents in the conditions of pediatric polyclinics made it possible to identify a number of organizational, social, and clinical problems associated with the preparation of youth for military service. The established organization of medical assurance for the preparation of young men for military service does not correspond to modern requirements, either in the volumes of medical care or in its effectiveness (Sharapova O.V., 2006; Starodubov V.I., 2006).

In works devoted to the problems of adolescent health preservation, the authors set an important socio-economic task of developing and improving medical-social rehabilitation (Veselov N.G., 1996; Ivanovskaya O.D., 1996; Surovenko T.N. et al., 2001; Shubochkina E.I. et al., 2001; Cristophersen E.R., 1986, Strax T.E., 1991, Lum S.K., Korenman S.J. 1994).

Thus, the development and implementation of organizational technologies aimed at timely diagnosis and correction of pathological conditions limiting the fitness of young men for military service, and the health improvement of future soldiers, are relevant tasks of public health and healthcare.

Goal of the Research

On the basis of a comprehensive study of the health of young men of pre-conscription age, to develop measures for the optimization of medical-social assistance in the conditions of pediatric polyclinics, aimed at increasing the fitness indicator of youth for military service.

Tasks of the Research:

1. To present a medical-statistical characteristic of the health of young men and to identify the types of chronic pathology reducing the level of fitness of young men for military service.

2. To provide a comparative medical-social characteristic of students of various types of educational institutions and their families, and to identify the features of behavior of young men of pre-conscription age regarding concern for their own health and preparation for military service.

3. To conduct an analysis of the activities of pediatric polyclinics in the organization of medical assurance for the preparation of young men for military service.

4. To study the opinions of physicians regarding the state of organization of medical-social assistance to young men of pre-conscription age in pediatric polyclinics of a large city and the ways of its improvement.

5. To propose a complex of measures for the optimization of medical-social assistance to young men of pre-conscription age in pediatric polyclinics, aimed at increasing the fitness indicator of youth for military service.

Scientific Novelty of the Work

The scientific novelty lies in the fact that in the work, for the first time:

- the health status of young men of pre-conscription age and the prevalence of certain types of chronic pathology reducing the level of medical fitness of young men for military service were studied;

- a medical-social characteristic of students of various types of educational institutions and their families was presented, and the specifics of the behavior of young men of pre-conscription age regarding concern for their own health and preparation for military service were demonstrated;

- the volumetric indicators of the activities of pediatric polyclinics characterizing the state of medical assurance for the preparation of young men for military service were analyzed;

- the opinions of physicians regarding the features of the organization of medical-social assistance to conscripts in the conditions of pediatric polyclinics and the ways of its improvement were studied;

- a complex of measures for the optimization of medical-social assistance to young men of pre-conscription age in pediatric polyclinics, aimed at increasing the level of fitness of youth for military service, was developed.

Scientific and Practical Significance of the Research

The scientific and practical significance of the research is determined by its results, which make it possible to present to government authorities and management bodies, and institutions of practical healthcare, a complex of scientifically grounded recommendations for the optimization of medical-social assistance to young men of pre-conscription age in pediatric polyclinics of a large city. The objective information obtained in the course of the research was used in the following informational-analytical publications: "Basic Indicators of the Health of Young Men of Pre-Conscription and Conscription Ages. System of Medical Assurance for the Preparation of Youth for Military Service" edited by Prof. V.I. Orel (approved by the Committee on Healthcare of the Government of Saint Petersburg and the Military Commissariat of Saint Petersburg) — SPb., 2005; "Health Service of Mother and Child of Saint Petersburg in 2004" edited by Prof. V.I. Orel and Prof. A.S. Simakhodsky (approved by the Committee on Healthcare of the Government of Saint Petersburg) — SPb., 2005; in the informational letter "Improvement of Medical Care for Sexually Transmitted Infections" (approved by the Ministry of Healthcare of the Kaliningrad Region) — Kaliningrad, 2006.

The results of the research were implemented in the activities of a number of healthcare and preventive institutions (HPI) of the Krasnogvardeisky, Tsentralny, and Nevsky districts of Saint Petersburg, and are used in the teaching of departments of social pediatrics and healthcare organization of postgraduate education (PE) and advanced training (AT), humanitarian disciplines and bioethics of the Saint Petersburg State Pediatric Medical Academy, as confirmed by corresponding implementation certificates.

Eight scientific works were published on the topic of the dissertation.

Defense of the Work. The main provisions and results of the work were presented at the X Congress of Pediatricians of Russia "Actual Problems of Pediatrics" (Moscow, 2006), reported and discussed at the interregional scientific-practical conference "Actual Problems of Pediatrics" (Orenburg, 2004), at the scientific-practical conference "New Methods of Diagnosis, Treatment, Prevention, Rehabilitation and Medical-Organizational Problems of Pediatrics" (SPb, 2003), and a number of other scientific-practical conferences of various levels.

Personal Contribution of the Author. The research program was developed by the author. Intermediate results were systematically verified by the supervisor. The personal participation of the author in the collection of materials constitutes no less than 85%. The processing of the obtained results, the formulation of conclusions, and practical recommendations on the optimization of medical-social assistance to young men of pre-conscription age in pediatric polyclinics were carried out entirely by the author.

Main Propositions to be Defended:

1. The following factors affect the degree of fitness for military service: the health status of conscripts, lifestyle, attitude toward their own health and fulfillment of military duty, social risk in families, and the level of physical and military-patriotic training in educational institutions.

2. The development of measures for the optimization of medical-social assistance to young men of pre-conscription age assigned to a pediatric polyclinic should be based on objective information about the health status of this contingent, medical-social characteristics of their families, the results of sociological surveys of conscripts, and medical-sociological monitoring of the opinions of medical workers regarding the organization of medical assurance for the preparation of youth for military service.

3. The proposed complex of measures for the optimization of medical-social assistance to young men of pre-conscription age in pediatric polyclinics is aimed at improving the quality and effectiveness of primary and secondary prevention of diseases, the system of dispensary observation of young men of pre-conscription age with the aim of preserving, restoring, and strengthening the health of future soldiers.

Structure and Volume of the Dissertation.

The dissertation consists of an introduction and 5 chapters, conclusion, summaries, proposals, bibliography, and appendices.