Одним із важливих показників стану громадського здоров'я нації, її демографічної перспективи, що має високу чутливість стосовно соціально економічних факторів, стану репродуктивного здоров'я населення та ефективності діяльності закладів охорони здоров'я, є перинатальна смертність. Мета -провести ретроспективний аналіз і оцінити динаміку перинатальної смертності та її основних компонентів, визначити залежність перинаталь ної смертності від стану здоров'я матерів і новонароджених.
The health of newborns creates the conditions for optimal physical and mental development of future generations. The presence of any pathology in the neonatal period may in the future lead to increased morbidity, reduced efficiency, reduced life expectancy and therefore significant economic losses. Purpose - to identify the characteristic trends in the health of newborns in Ukraine according to indicators of their physical development morbidity and mortality. Materials and methods. A retrospective analysis and assessment of the dynamics of newborn health in Ukraine in the XXI century according to state and industry statistics, perinatal audit according to the WHO methodology «MATRIX - BABIES». Methods of system approach, statistical, graphic image are applied. Results. Decrease in the number of newborns born in the institutions of the Ministry of Health of Ukraine from 387.9 thousand in 2000 up to 283.6 thousand in 2020 was accompanied by a negative trend of the generalized objective criterion of their health - an increase in the frequency of underweight children from 5.39% to 5.66%, OR with 95% CI 1.19 (1.16-1.21), respectively, with a stable excess of the number underweight over premature infants by 20.2-9.2%. At the same time, there is a positive trend in the survival of newborns in the first 168 hours of life - 99.36% and 99.7%, which is mainly due to an increase in this indicator, respectively, in newborns with body weight at birth 500-999g from 22.95% to 65.86%, OR with 95% CI 7.19 (5.9-8.7) and with a body weight of 1000-1499g from 84.43% to 91.87%, OR with 95% CI 2.12 (1.5-2.8) and an increase in the newborn health index from 72.0% in 2000 to 81.7% in 2020, OR with 95% CI 1.66 (1.64-1.58). Dynamic analysis of the frequency of sick newborns showed a consistent decrease from 272.1‰ in 2000 to 183.3‰ in 2020, OR with 95% CI 0.6 (0.59-0.61), due to the reduction of such pathologies as intrauterine hypoxia and asphyxia (from 111.67‰ up to 13.6‰), cases of growth retardation and malnutrition (from 72.67‰ to 18.3‰), birth injuries (from 34.75‰ to 20.79‰), congenital anomalies, deformities and chromosomal abnormalities (from 30.7‰ up to 26.8‰). At the same time, the negative dynamics of severe, causing disability of children, perinatal conditions - congenital pneumonia (with 3.18‰ in 2000 is alarming to 5.82‰ in 2020), sepsis of newborns (from 0.09‰ to 1.21‰, respectively), and for the period from 2010 - other violations of the cerebral status of the newborn (from 18.5‰ to 33.86‰), from 2015 - neonatal jaundice (from 31.11‰ to 49.65‰). The key markers of neonatal health - the levels of neonatal and early neonatal mortality were positive and were in 2000 and 2020, respectively 6.7‰ and 4.45‰, OR with 95% CI 0.68 (0.64-0.73), and 4.7‰ and 2.98‰, OR with 95% CI 0.65 (0.6-0.7). At the same time, according to the perinatal audit, the real level of early neonatal mortality in general was underestimated by 2.1-2.3 times and its proportional indicator was exceeded by 1.5 times among infants with body weight at birth over 1500 g. Conclusions. Systematic analysis of newborn health indicators shows that in order to strengthen it, it is advisable to optimize the quality of medical care at all levels of its provision based on a dynamic analysis of its condition. No conflict of interest was declared by the authors. Key words: newborns, weight categories, survival, morbidity, early neonatal, neonatal mortality.
Актуальность. В период политических и экономических изменений, длительных военных действий в Украине возник ряд и медико-экологических проблем, которые представляют угрозу для здоровья различных групп населения, в первую очередь детей, состояние здоровья которых является одной из самых острых социальных проблем в Украине. Цель: проведение ретроспективного анализа оказания первичной медицинской помощи детскому населению Украины за период 1990–2018 гг. Материалы и методы. В статье представлены данные ретроспективного анализа оказания первичной медицинской помощи детскому населению в Украине за период 1990–2018 рр. по данным государственной и отраслевой статистики. Применены методы системного подхода, статистическая обработка материала, использованы графические изображения. Результаты. Проведенный анализ показал, что изменения в звене первичной медицинской помощи детскому населению обусловлены состоянием демографической ситуации в стране и реформированием здравоохранения. Установлено, что за годы суверенитета в Украине сохранена доступность медицинских услуг детям на первичном уровне (11,6 посещения на 1 ребенка в год), их профилактическая направленность, достаточный охват лечением детей в условиях дневных стационаров, полнота выявления патологии при профилактических осмотрах, обеспечена положительная динамика грудного вскармливания младенцев. Выводы. В условиях реформирования здравоохранения, развития и внедрения новых медико-организационных технологий, с одной стороны, и дефицита специалистов педиатрического профиля — с другой, приемлемой является комбинированная модель сотрудничества семейных врачей и педиатров. Охрана здоровья детей должна быть определена как приоритетное направление для обеспечения эффективного финансирования этой важной области медицины, усиления внимания к воспроизводству населения и сохранения здоровья поколения, которое рождается. На этом пути разработка и внедрение государственного плана действий «Здоровье детей — старт на всю жизнь» будет существенным вкладом в улучшение демографической ситуации в стране и здоровья детского населения.
In order to provide the best possible care for patients, medical professionals must constantly learn. Exactly through continuing education that medical workers improve their professionalism in practice. The key link in the system of continuing medical education (CME), continuous professional development (CPD) is a provider or organizer of educational activities, an organization that plans, organizes and conducts educational events for medical professionals. The main requirements for the activities of providers or organizers of CME-CPD are impartiality, independence in planning, preparing and conducting educational events on a regular basis, at a high professional level with the involvement of highly qualified specialists. Purpose — to describe the role of providers in the CME-CPD system, their responsibility in complying with the requirements and standards of accredited education, the peculiarities of their activities during the reform of medicine in Ukraine and integration into the international community in the field of CME-CPD. The recommendations, provided in the article, can be used by CME-CPD participants or stakeholders who are aimed at actively participating in the implementation of a new accreditation system, namely, provider accreditation with its subsequent support and development. On the way to achieving stable results in the organization of CME-CPD, it is important for Ukraine to join the international community of organizations working in the field of CME-CPD, by introducing a new accreditation system, namely, provider accrediting and achieving it substantial equivalence to international standards. No conflict of interest were declared by the author. Key words: continuing professional development, continuing medical education, accreditation, provider, medical specialists, educational activities.
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