Socio-Hygienic Aspects of Trauma in Rural Areas and Organization of Medical Care for Injuries

The dissertation is dedicated to a comprehensive study of the socio-hygienic and medical-organizational aspects of trauma among the rural population of the Russian Federation (in particular, the Republic of Bashkortostan). The work analyzes the levels and structure of trauma, mortality, and disability from injuries depending on the sex, age, and marital status of the victims, as well as the seasonal dynamics of trauma. Special attention is given to the organization of medical care for injuries at the pre-hospital and hospital stages in rural areas, including outpatient-polyclinic and inpatient care. The research identifies the main causes of trauma — deterioration of socio-economic well-being, low sanitary culture, alcohol abuse, and failure to observe precautions — and substantiates measures for trauma prevention and improvement of medical care for the rural population.

Research Relevance: Injuries, poisonings, and other consequences of external causes are a source of high mortality, disability, and prolonged temporary disability of the population. If the problem of trauma is considered from a socio-economic perspective and the cost of unproduced output due to lost working time is calculated (even without taking into account the cost of treatment), the damage will be colossal. The population of the Russian Federation loses up to 170 billion rubles annually (Gafarov Kh.Z., Murugov V.S., 1999; Berg J. et al., 2005). The social significance of the problem of injuries and accidents will increase even further if one takes into account the associated disability, the severe psychological state of the victims and their relatives, emotional shock, physical suffering, the material factor, and the complexity of organizing treatment (especially in our time), which sometimes lasts very long (Starodubov V.I. et al., 2003). In the Republic of Bashkortostan (RB), an increase in population mortality from injuries, poisonings, and other consequences of external causes has been observed in recent years. In rural areas, this indicator deteriorates at a more significant rate than in urban areas. From 1987 to 2002, the mortality rate from external causes in rural areas increased by 35.0%. According to R.M. Mustafin (2004), among the urban population, the mortality rate from injuries and accidents was 172.1 per 100,000 population in 2004, while among the rural population it was 229.6. The provision of medical care for injuries and its effectiveness in rural areas depend on timeliness, staging, and the use of adequate methods, and are associated with significant economic costs not only for treating patients but also for rehabilitation and social support (Kaparulin A.N., 2004). Most injuries in rural areas are a consequence of the deterioration of the socio-economic well-being of the population, low sanitary culture, consumption of alcohol in large doses and often of poor quality, and failure to observe precautions in daily life and industrial safety during agricultural work. Primary medical and sanitary care for the rural population is most often provided by mid-level medical workers and in most cases is untimely. From the above, it follows that it is necessary to substantiate measures for trauma prevention in rural areas and the improvement of medical care for injuries. In this regard, the goal and objectives of the research have been determined by us. Research Objective: Based on the study of socio-hygienic and medical-organizational aspects of trauma among the rural population, to substantiate measures for the prevention of injuries and accidents and the improvement of medical care for the injured. Research Tasks: 1. To study the prevalence of injuries in rural areas and their structure by causes and types. 2. To conduct an analysis of mortality resulting from injuries and other consequences of external causes among the rural population and to study their socio-hygienic aspects. 3. To assess the organization of medical care for the rural population for injuries at the pre-hospital and hospital stages. 4. To provide a socio-hygienic characterization of those injured and to study their opinions on the causes of trauma in rural areas and on the organization of medical care. 5. To develop measures for trauma prevention and the improvement of medical care for injuries in rural conditions. Scientific Novelty: The scientific novelty lies in the fact that, for the first time, the socio-hygienic aspects of trauma in rural areas have been studied according to such criteria as the prevalence of injuries, disability, and mortality from injuries depending on the sex, age, and marital status of the victims; the dynamics of trauma in rural areas by season has been determined; the volume and types of medical care for the rural population for injuries and the main evaluation indicators of outpatient-polyclinic and inpatient care for the injured have been assessed; the level of awareness of the rural population about the causes of injuries and measures for trauma prevention has been determined, and an expert evaluation of their opinions on the organization of medical care for injuries has been provided. Practical Significance: The results of a comprehensive assessment of the socio-hygienic aspects of trauma in rural areas made it possible to establish the level and structure of trauma among the rural population, identify the main causes of trauma, and assess the role of the human factor as a cause of injuries, which made it possible to substantiate measures for trauma prevention aimed at preventing domestic and industrial injuries and eliminating the causes of their occurrence. Data on the organization of medical care for injuries at the stages of rural healthcare formed the basis for measures to improve medical care for the rural population for injuries. Methodological recommendations "Trauma Prevention in Rural Areas" (Ufa, 2005) have been developed. Implementation of Research Results: The results of the research have been accepted for implementation by the Ministry of Health of the Republic of Bashkortostan, implemented by the central district hospitals of the Sharansky and Dyurtyulinsky municipal districts of the RB, and are used in the educational process at the Bashkir State Medical University. Validation of the Research Results: Separate sections of the dissertation work were reported and discussed at: the republican scientific-practical conference dedicated to the Year of Sports and Healthy Lifestyle and the 20th anniversary of the establishment of the Department of Safety of Life Activities and Environmental Protection at Bashkir State University (Ufa, 2004), the republican conference of young scientists of the Republic of Bashkortostan "Medical Science-2005," dedicated to the Year of Prevention of Drug Addiction, Alcoholism, and Smoking and Medical Worker Day (Ufa, 2005). Publications: Based on the research materials, 6 works have been published, including 2 articles in the central press. Main Provisions of the Dissertation to be Defended: 1. The level and structure of trauma, mortality, and disability from injuries and their socio-hygienic aspects in rural areas as an information base for taking measures to increase the effectiveness of prevention. 2. The main indicators of the organization of medical care for injuries in rural areas for identifying factors affecting their volume and types and for substantiating measures for the improvement of medical care for injuries. 3. The study of public opinions on factors affecting trauma and satisfaction with medical care in order to determine priority directions for trauma prevention in rural areas. Volume and Structure of the Dissertation: The dissertation is presented on 154 pages of typed text and consists of an introduction, a literature review, a chapter reflecting the research program and methodology, three chapters of original research results, a conclusion, conclusions, proposals for implementing the research results in practice, and a bibliography (207 sources, of which 180 are domestic and 27 are foreign authors). The work is illustrated with 15 figures, 1 scheme, and statistical data presented in 23 tables.