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TOPICAL PROBLEMS OF DIAGNOSIS AND TREATMENT OF UROGENITAL INFECTIONS
CONSOLIDATION OF SPECIALISTS FOR THE IMPROVEMENT OF REPRODUCTIVE HEALTH IN RUSSIA
E. K. Aylamazian 1, E. V. Sokolovskiy 2, A. M. Savitcheva 1 (savitcheva@mail.ru), M. Domeika 3, A. M. Kulikov 4, V. L. Emanuel 2, P. N. Krotin 5, O. Y. Kuznetsova 4, M. M. Safronova 4, V. L. Petrov 6, A. V. Ignatovskiy 2, V. D. Badikov 4, T. V. Ababkova 7
1 D. O. Ott Research Institute of Obstetrics and Gynecology, St. Petersburg, Russia;
2 Pavlov State Medical University, St. Petersburg, Russia
3 Uppsala University, Uppsala, Sweden;
4 Medical Academy of Postgraduate Studies, St. Petersburg, Russia;
5 Municipal Consultative and Diagnostic Center for Children — "Juventa", St. Petersburg, Russia;
6 Health Ministry of Karelia, Petrozavodsk, Russia;
7 Dermato-venereology dispensary, Arhangelsk, Russia;
The reproductive health of the population during the past years is one of the most severe problems in Russia. Deterioration of the demographic situation has caused particular concern. This situation is related to a number of economic and social problems that have emerged over the past few decades.
Russia is in the eighth place in the world with respect to population size, and during the past 12 years exists in a situation of depopulation. The female population of the country is 76.8 million. The number of women of reproductive age (i. e. 18 - 49 years old) is 39.4 million (51.7 %), which is 27.7 % of the total population. The number of children below 18 years is 29 million.
During recent years, a low level of birth rate has been noted, i. e. 9.8, 10.4 and 10.2 births per 1000 inhabitants during 2003, 2004 and 2005, respectively. The number of repeated births has decreased from 51 to 41 %. At the same time, the total death rate reached 16.1 per 1000 population, which is 1.6 times more than the birth rate. Rates of maternal and infantile death in recent years tended to decrease; however, they are still 3 - 4 times higher than the average rate in Europe.
Great concern over the decreased number of pregnancies has been expressed by the Russian government and others. In 2002, there were 3.2 million pregnant women in the country and in 2004 3.16 million. The number of infertile married couples remains high reaching 4 - 5 million. At the same time, the number of abortions is extremely high (e. g., in 2004, 1.6 million were registered. About 10 % of legal abortions involve teenagers. At the same time, the prevalence of sexually transmitted infections (STIs) is high. According to statistics, the annually STI clinics are attended by 739 000 persons.
According to the definition of the World Health Organization (WHO), the reproductive health is "a status of complete physical, mental and social
well-being, and not merely the absence of disease or infirmity, in all matters relating to the reproductive system and to its functions and processes". Reproductive health, therefore, means that people are able to have a satisfying and safe sexual life and that they have the ability to reproduce and the freedom to decide if, when and how often to do so. Implicit in this last condition is the right of men and women to be informed and to have access to safe, effective, affordable and acceptable methods of regulation of pregnancy that are not against the law, and the right of access to appropriate health care services that will enable women to go safely through pregnancy and childbirth and provide couples with the best chance of having a healthy infant.
The present situation requires urgent change. The aim of the national project "Health" is to improve the present situation. Today, the large number of medical specialties is involved in activities related to reproductive health, including dermato-vene-reologists, obstetricians, gynecologists, urologists, general patricians, neonatologists, pediatricians, andrologists, genetics, specialists in laboratory diagnostics and others. Collaboration among these specialists is crucial. The establishment of Association for Protection of the Reproductive Health has been initiated in order to integrate all these specialties that are engaged in management of reproductive health issues.
One of the aims of the association can be the consolidation and coordination between physicians of various specialties in the field of protection of reproductive health. To achieve this goal participation of association members is necessary in the development and implementation of unified protocols of diagnostic, management and consulting patients with reproductive tract infections, and in particular STIs.
A primary aim in solving many teenage problems is to develop a network of centers in order to protect
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VOL LVI SUPPLEMENT may/2007
ISSN 1684-0461
TOPICAL PROBLEMS OF DIAGNOSIS AND TREATMENT OF UROGENITAL INFECTIONS
139
the reproductive health of teenagers. However, even if bound by common interests, actions of specialists are often uncoordinated and sometimes even contradictory. Such a lack of integrated and harmonious operations is caused by an absence of instruments for effective interaction. The establishment of an association that consolidates individuals professionally involved in solving the problems of reproductive health may become such an instrument.
At present, there are no unified protocols or algorithms for the diagnosis, management and counseling patients for the majority of STIs. Existing protocols do not consider territorial differences in Russia, such as insufficient laboratory equipment in different regions, varying access to specialized medical care, use of antibacterial therapy taking in consideration local antimicrobial susceptibility patterns.
When developing methodological materials within the association, it is extremely important to have in mind that the number of specialists providing health care in this area has increased. Thus, this development will require defining the role of each specialist.
Implementation of adequate laboratory diagnoses could also be considered and discussed by the association. Region-adopted solutions need to be established.
The participation of the association in the development of effective criteria in the control over the use of implemented documents could be another task of the association. The existing health care quality control system is sub-optimal. Most of the control mechanisms are very formal and therefore the methods used for diagnosis and treatment are difficult to evaluate, making further improvement difficult.
The expertise of an independent specialist on the quality of health care could serve as a mechanism for further developments. The association could also be involved in the training of experts, developing new methods of teaching and training (and
in improving available ones), as well as participating in the attestation and certification of physicians. Higher education of experts is only possible if high quality educational materials are used. Such materials could also be prepared by the members of the association and reviewed by the association. The organization of a school of young specialists is still another important task of the association.
The association could also be engaged in the organization of congresses, symposiums and conferences, providing closer interaction and information interchange. At the same time, within the framework of the association it would be necessary to provide an opportunity of professional dialogue between specialists both inside the country and with foreign colleagues.
Propagation of ideas of the association and the development of an effective interaction with specialists in different regions can be carried out through regional representative offices and branches. The diverse epidemiological situations in different regions can require the development of a differentiated approach of patient management based on the characteristics of each region. This work will be most effective only under condition that regional groups would be established within the framework of the association. Regional groups could inform the association about their specific needs.
Concurrently, another direction should be to organize help for young people by establishing and expanding the functions of youth centers, i. e. action that is reflected in the federal program "The prevention and management of socially significant diseases for 2007 - 2011". These factors should promote the further development and optimization of methods dealing with young persons.
In conclusion, the establishment of a professional association of specialists involved in the protection of the reproductive health of our young people is an urgent and extremely relevant issue.
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VOL LVI SUPPLEMENT may/2007
ISSN 1684-0461 ■
