Socio-Hygienic Characteristics of the Health of Students of Secondary Specialized Educational Institutions of the Social Sphere in the Republic of Sakha (Yakutia) and Justification of Approaches to Improving Medical Care

The dissertation is devoted to the socio-hygienic characteristics of the health of students of secondary specialized educational institutions of the social sphere in the Republic of Sakha (Yakutia) and the justification of approaches to improving medical care. The research is conducted in one of the most remote regions of the Russian Federation with the harsh climatic conditions of the Far North, where morbidity among the population has specific features determined by climate-geographical, ecological, and socio-economic factors as well as by the characteristics of daily life and nutrition of the indigenous population. The work comprehensively examines the health status of students preparing specialists for institutions of the social sphere, analyzes the organization and quality of medical service for this population group, the socio-hygienic aspects of their lifestyle, and their level of medical activity.

Relevance of the Problem. The Republic of Sakha (Yakutia) is one of the most remote regions of the Russian Federation with harsh climatic conditions. Morbidity among the population has specific features determined by climatic, geographical, socio-economic, and ecological factors, as well as by the characteristics of daily life and nutrition of the indigenous population of the republic (Egorov I.Ya., 2000; Popov V.S., Ivanov A.I. et al., 2000).

Radical socio-economic transformations in Russia have led to changes in lifestyle and deterioration of the population's health (Shchepin O.P., 1996; Denisov I.N., 1997; Starodubov V.I., 1998; Shabrov A.V., Polakov I.V., 2000; Vishnyakov N.I., 2001; Orel V.I., 2002; Medik V.A., Yuryev V.K., 2003, et al.). These processes are characteristic also of the population of the Republic of Sakha (Yakutia) (Egorov I.Ya., 2000).

To the greatest extent, the negative consequences of these changes have been reflected in the health of young people. At present, the preservation and strengthening of the health of children and adolescents has become one of the priority directions of the state policy of the President and the Government of the Republic of Sakha (Yakutia) (Sivtseva I.S., 2000). In this regard, the search for approaches to the optimization of youth health is one of the important tasks of modern health care.

Researchers have carried out a considerable number of studies on the health of the child population in the Republic of Sakha (Yakutia) (Zakharova A.A., 1974; Khanda M.V., 1967, 1997; Timofeev L.F., 1992; Naumov A.A., 1996; Aleksandrov L.V., 1999); however, socio-hygienic studies of the health of students of secondary specialized educational institutions preparing specialists for work in institutions of the social sphere — an important sector of the national economy of the republic — are absent. The quality of functioning of the social sphere largely determines the overall state of and satisfaction of the population with the level of social assistance and protection. The social significance and specificity of the future professions of this category of students necessitate the search for optimal organizational forms of health protection.

Against the background of ongoing health care reform, research devoted to solving problems associated with increasing the efficiency of medical care for various population groups, including students (Chicherin L.P., Lindenblatt A.L., 2001), which are addressed in different ways across the regions of the country, are highly relevant.

Objective of the Research: Scientific justification of a complex of measures for the optimization of the system of medical care for students of secondary specialized educational institutions of the social sphere of the Republic of Sakha (Yakutia) based on the study of their health status, socio-hygienic aspects of their lifestyle, and the analysis of the organization and quality of their medical service.

Tasks of the Research:

- to analyze the features of the natural-climatic and socio-hygienic living conditions in the Republic of Sakha (Yakutia); the dynamics of the main medico-demographic indicators of the health of the republic's population;

- to conduct an analysis of the dynamics of morbidity among students of secondary specialized educational institutions based on data on utilization of medical care, results of periodic medical examinations, and self-assessment;

- to investigate the socio-hygienic aspects of the lifestyle of students of secondary specialized educational institutions of the social sphere of the Republic of Sakha (Yakutia);

- to identify a complex of medico-social and psychological factors negatively affecting the health status of this group of students;

- to assess the level of organization and quality of medical care provided to students of secondary specialized educational institutions of the social sphere;

- to develop a scientifically justified complex of measures for the optimization of medical care for students of secondary specialized educational institutions.

Scientific Novelty and Practical Significance. For the first time in the Republic of Sakha (Yakutia), an analysis was conducted and the specific features of morbidity among students of secondary specialized educational institutions of the social sphere were identified; the volume and character of ambulatory and inpatient care were studied; the level of organization of targeted medical examinations was investigated; the socio-hygienic and psychological aspects of the lifestyle of students and their level of medical activity were studied; and a sociological study of students' opinions on the state of organization of medical care was conducted. A complex of negative socio-hygienic factors influencing the health status of students living in the conditions of the Far North was identified; the role of educational institutions in the organization of medical-rehabilitative care was determined. An organizational model for the provision of curative-preventive and rehabilitative care for students of secondary specialized educational institutions in the city of Yakutsk was developed.

The practical significance of the work consists in the fact that approaches to the optimization of the system of medical support for students of secondary specialized educational institutions in the conditions of Yakutia at the present stage of its social and economic development have been justified. The proposed measures of systematic prevention make it possible to conduct targeted health-improving work in secondary specialized educational institutions taking into account the climate-geographical conditions of the Far North, to realize continuity in the activities of various medical institutions, to improve the system of medical informing, education, and the level of socio-medical activity.

The report form "On the Activities of Health Posts of Secondary Specialized Educational Institutions Republic of Sakha (Yakutia)" developed in the course of the research, methodological recommendations for its use in compiling annual (semi-annual) statistical reports on the activities of health posts, as well as planning measures for improving the provision of medical-rehabilitative care to students, were approved at a meeting of the Scientific and Technical Council of the Ministry of Health of the Republic of Sakha (Yakutia) (protocol No. 10 dated December 30, 2003, registration No. 2).

The informational letter "Procedure for Granting Academic Leave on Medical Grounds to Students of Secondary Specialized Educational Institutions of the Republic of Sakha (Yakutia)" was approved at a meeting of the Scientific and Technical Council of the Ministry of Health of the Republic of Sakha (Yakutia) on December 30, 2003 (protocol No. 10, registration No. 3).

The materials of the dissertation research were introduced into the practical activities of polyclinic No. 1 of the city of Yakutsk, the Yakut Basic Medical College, the Republican (Republic of Sakha (Yakutia)) Dermatovenereological Dispensary. The results of the research were also used by the Center for Employment of the Population of the city of Yakutsk in the organization of training of unemployed persons in specialty 14467 "Junior Medical Nurse in Patient Care"; by the Department for Affairs of Peoples and Federal Relations of the Republic of Sakha (Yakutia) in the preparation of paramedical workers for 12 Arctic uluses of the Republic of Sakha (Yakutia); by the Ministry of Labor and Social Development of the Republic of Sakha (Yakutia), the Yakut Trade-Economic College of Consumer Cooperation, and Yakut Pedagogical College No. 1 in the organization of medical support of students and training them in the fundamentals of medical care. They are used in the training of students at the Faculty of Advanced Training of Specialists of the Saint Petersburg State Medical Academy named after I.I. Mechnikov.

The main provisions of the dissertation were published in 17 scientific works.

Presentation of the Research Materials. The results of the research and the main provisions of the dissertation were presented and discussed at:

- the III International Scientific and Practical Conference "Health and Education in the XXI Century" (Moscow, 2002);

- the X Russian-Japanese International Medical Symposium "Yakutia 2003" (Yakutsk, 2003);

- the III International Scientific and Methodological Conference "Quality of Education: Concepts, Problems" (Novosibirsk, 2000);

- the Scientific and Practical Conference of the State Scientific Center of Social Health of the Russian Academy of Medical Sciences "The Role of Health Care in the Protection of Public Health" (Moscow, 2004);

- the Scientific and Methodological Conference "Specialist of the Model in the XXI Century" (Yakutsk, 2000);

- the Republic Scientific and Practical Conference "Psychology in the Education System: Experience and Directions of Activity" (Yakutsk, 2001);

- the Scientific and Practical Conference Dedicated to the 60th Anniversary of Prof. A.I. Ivanov and the 60th Anniversary of Prof. A.S. Grigoriev (Yakutsk, 2001);

- the Regional Scientific and Practical Conference "Public Health: Strategy of Development in the Regions of Siberia" (Novosibirsk, 2003);

- the Republic Scientific and Practical Conference "Comprehensive Approach to the Problems of Rehabilitation of Disabled Persons: Medical, Social, and Professional Aspects" (Yakutsk, 2002);

- the Conference Dedicated to the 160th Anniversary of the Founding of the City Hospital "Current Issues of Protection of Public Health" (Yakutsk, 2003).

Personal Contribution of the Author. The author personally conducted the literature review, composed the plan and developed the program, conducted the medico-social and clinical-statistical research (contribution 100%). With the participation of the author, the collection of scientific information by extracting data from primary medical documentation and questioning students was conducted (contribution 85%), and its analysis was performed (contribution 85%). Overall, the personal contribution of the author exceeds 95%.

Main Propositions to Be Defended:

- the study of the health status, socio-hygienic aspects, and lifestyle of students is an important link in the educational process and makes it possible to develop a complex of measures aimed at improving medical-preventive care for students and forming a healthy lifestyle in secondary specialized educational institutions;

- a multifaceted analysis of morbidity trends among adults, adolescents, and separately among students of secondary specialized educational institutions of the Republic of Sakha (Yakutia), taking into account the socio-economic changes occurring in it, the climate-geographical conditions, national traditions, and the specifics of the socio-hygienic environment;

- the patterns of influence of socio-hygienic factors and the lifestyle of students of secondary specialized educational institutions of the social sphere living in the conditions of the Far North on their health, as well as the results of a medico-sociological study of the level of medical activity, hygienic awareness, and attitudes toward a healthy lifestyle;

- a multifaceted characterization of the personality of students of secondary specialized educational institutions of the social sphere, which included emotional, socio-hygienic, and intellectual data as an objective factor influencing the success of health-improving work among students;

- the results of a comprehensive study of the system of provision of curative-preventive care for students of secondary specialized educational institutions of the social sphere, taking into account an assessment of its efficiency; the existing medical documentation does not allow a full reflection of the multifaceted work in the field of health protection of students;

- the main directions for the improvement of the system of health protection of students of secondary specialized educational institutions.