Problems of Social Hygiene,
Public Health and History of Medicine

In the series of original articles is analyzed formation of pharmaceutical information market in Russia. It emerged from two sources: fragments of the Soviet system of circulation of pharmaceutical information and as result of consequences of business projects. The informational segment, being “sectoral” or “internal” for pharmaceutical market, formed over time infrastructure of production, distribution, storage and consumption of its goods. Initially considered as auxiliary one, it turned out into autonomous market with its own rules of the game, leading players and prices for services. The fourth report deals with formal rules of market of pharmaceutical information, history of achievement of agreements regarding official and marketing information about medications.

The article considers results of studying dynamic shifts in morbidity of the population attached to the N. A. Semashko Northern Medical Clinical Center of the Federal Medical Biological Agency of Russia over ten-years period. The results testify increasing of morbidity of the attached contingent during studied period. In overall, the number of registered diseases increased by 4 866 cases (49.5%) as compared to the level of 2014, that is 1.5 times higher than the initial level. In quantitative terms, diseases of the eye and its appendage (2097±29), digestive organs (1671±173), circulatory system (1154±100) predominated. The analysis of gender differences testifies that percentage of neoplasms in the structure of morbidity of women (4.5%) is significantly higher than the one of men (1.4%) (p<0.001). However, the rate of increase of oncological diseases was significantly higher among men (73.3%) as compared with women (20.7%)/ The rate of increase of endocrine diseases among men made up 714.0% and among women 210.3%. The study results can be used in planning the organization of medical care of population attached to the medical institution mentioned above.

The role of technical regulation during import of production products is difficult to overestimate since it is just on quality of tests carried out regarding goods for conformity with requirements of normative documents depends safety of consumer health. Nowadays, technical regulation system is undergoing large-scale changes related to digitization and application of risk-oriented approach to selection of objects for control that undoubtedly will improve situation with falsification of test protocols. However, there is still impressive percentage of production that do not meet the regulated requirements. So, in production destined for children, after verification activities, discrepancies related to chemical, physical and toxicological parameters were found. The exceeded standards content of heavy metals, phthalates and formaldehyde can result into such irreversible negative effects on health of socially vulnerable consumers as allergic reactions, intoxications, derangement of hormonal status, disorders of kidney and digestive system. It is very important to eliminate problematic aspects of technical regulation system with purpose of non-admission to inner market production that can be unsafe for health of citizens. The article presents recommendations for improving technical regulation system both from point of view of supervisory functions and differentiation and hardening of sanctions with respect to testing laboratories.

The health care system of the Kyrgyz state, in conditions of market and transition economy, underwent significant changes, including reform of primary health care and peopleware. However, becoming of the primary care system over past three decades regarding provision of full-fledged accessibility of health care system to population brought no significant changes into situation both in whole country and Bishkek. The purpose of the study was to analyze problems of training medical personnel to provide primary health care organizations and to develop ways to solve them. The study uses data from the National Statistical Committee of the Kyrgyz Republic and the database of the Republican Center for Electronic Health. The estimated indicators of the population provision with medical personnel in the country and Bishkek during the sovereign period of the country were evaluated. The obtained materials were processed using statistical and analytical methods. In the post-Soviet period, fundamental health care reforms took place. The Semashko model underwent complete restructuring with emphasis on development of primary health care that resulted in decreasing of the number of medical organizations, especially district hospitals. However, ratio between sectors of primary, secondary and hospital had no changes against the background of reduction of the number of physicians in health care system, especially at primary level that affected quality of medical services for population. The medical education system constantly undergoes transformation without consideration of world practices and does not meet needs of health care due to absence of mechanisms of intersectoral cooperation under planning of medical personnel training. The current resource situation of the healthcare system associated with the optimization of medical organizations and human resources, shows a deterioration in the availability of medical care to the population both in the whole country and in the metropolitan area. The reforms implemented over the past three decades were insufficient, as there was a lack of sustainable planning policies by organizations to strengthen the primary care system and priorities for training medical personnel and sustainable financing of the health sector. The modern resource condition of health care system related to optimization of medical organizations and human resources potential points out to deterioration of accessibility of medical care of population on national level and in conditions of metropolitan city. The implemented reforms turned out incomplete since there were no sustainable policy of planning primary health care system and priorities in medical humn resources training. Also sustainable financing of health care system was absent. The primary health care and its human resources support are be considered as main subsystem of state health care that plays leading role in facilitating and accessing medical care in interests of health of country's citizens. At that, effective mechanisms of intersectoral cooperation on sufficient investment are to be created to optimize primary health care and entire health care system, taking into account regional characteristics and the needs of population.

The assessment of the article “The efficiency of X-Ray endovascular care in decreasing of population mortality from acute coronary syndrome and acute disorder of cerebral circulation” (published in the Journal “The Problems of Social Hygiene, Health Care and History of Medicine” 2024;32(3):420–6) revealed that the title of the article does not correspond to its content. The authors broke the rules of both application of correlation analysis and work with intensive statistical indicators that turned out to be significantly distorted.

The purpose of the study is to analyze the impact of informal employment on formation of structural deficiency of mandatory medical insurance in Russia. The methodology is based on the balance sheet method for estimating informal employment by comparing Rosstat data on average annual and average listed number of employees across economic sectors in 2023, followed by calculation of fiscal losses using established mandatory medical insurance contribution rate of 5.1%. The study revealed direct budget losses of the Federal mandatory medical insurance Fund at the rate of 127.1 billion RUB annually, with highest concentration in trade (36.4 billion RUB), construction (19.3 billion RUB) and manufacturing (15.8 billion RUB). It is established that structural deficiency of the Federal mandatory medical insurance Fund and chronic under-financing of health care (4.5% of GDP) against in average of over 9% in OECD countries are directly related to scale of informal sector. The conclusions testify the necessity of comprehensive reformation of the system? including diversification of sources of the Federal mandatory medical insurance Fund, measures of legalization of labor relations and restoration of confidence to institutions of social insurance as conditions of financial sustainability.

The review was based on analysis of 180 sources from databases PubMed, eLibrary, Cohrane Library, MEDLINE for 2015–2025 using keywords "precision medicine", "personalized medicine", "neuro-oncology", "oncology", "cranio-cerebral injury", "neuro-trauma", "neuro-proteomics" and "AI". The purpose of the study was to demonstrate, on the basis of analysis of publications on precision medicine application in neurosurgery, the significance and perspectives of mentioned approach in modern neurosurgical practice. The methods of precision medicine, digital revolution and progress in multi-modal Big Data processing permit to better understand of tumor genesis, their clinical heterogeneity, functional effects and causes underlying their resistance to treatment. The precision medicine methods provide valuable information on pathophysiological mechanisms underlying neuro-trauma through analysis of complex protein interactions and changes. The future of precision medicine in neurosurgical practice is in permanent enhancement of AI and machine learning, permitting rapid and accurate decision-making based on comprehensive molecular data. The future of neurosurgery lies in harmonious integration of such interdisciplinary approaches as precision medicine and clinical neurosurgery to discover new possibilities of targeted and personalized therapy.

The article considers functions and practical directions of activities of the Russian Sailors Trade Union in ensuring health-preserving environment for female sailors in the maritime industry. The analysis was applied to role of trade unions in protecting labor rights with emphasis on specific features of maritime environment, conditioned by global character of employment, multi-nationality of crews and complexity of jurisdictions. The article presents review of international initiatives concerning gender inclusion, in particular priorities of the International Transport Workers Federation and recommendations of the International Labor Organization and also reflects practical implementation of these initiatives through activities of the Russian Sailors Trade Union. On the basis of normative documents, collective agreements, trade union practices and empirical data key directions of trade union activities are examined. The study identified main barriers to efficiency of trade union measures, including insufficient representation of women in trade union structures, persistent gender stereotypes and “culture of concealment” and difficulties of cross-border jurisdiction. The following practical recommendations were formulated to strengthen the role of the Russian Sailors Trade Union: active involvement of women in leadership and membership, strengthening gender-sensitive provisions in collective agreements and development of international cooperation for unification of standards and practices exchange. The study results substantiate conclusion that at purposeful strategy and coordination of actions, the trade union is capable to act as central subject of health-preservation of female sailors promoting their safety, health care and and professional firmness.

The article presents results of comparative analysis of modern telemedicine technologies and organizational models of their implementation in health care system. On the basis of study of national and international experience, the rationale for perspective model of geriatric telemedicine contact center is presented. Its role and place in the structure of remote medical care support in the Russian Federation is determined. The article considers key directions application of areas of telemedicine: synchronous and asynchronous tele-consultation, remote methodological support, tele-training and tele-monitoring. The elderly patient usually has difficulty with moving on long distances. Therefore, special attention is paid to development of out-of-office and home tele-monitoring using wearable devices, expert systems, and soft hardware complexes permitting to automatize processes of diagnostic and correction and to apply remote interaction as well. The original model of geriatric telemedicine contact center includes front-office for primary reception and routing of requests, counseling module with involvement of accredited experts, methodological module for supporting various categories of users and monitoring module for dynamic control of indicators of life activity. The model is primarily directed toward elderly patients with limited mobility that is conditioned by high need of this category of citizens for accessible and continuous medical care. The economic efficiency of telemedicine solutions capable to decrease treatment costs, to reduce the number of hospitalizations and to unload hospital sector. In conclusion, expediency of organization of Federal profile center instead of multiple territorial divisions to optimize resources and to ensure uniform standards of remote geriatric care on national basis is substantiated.

The purpose of the study is to determine directions of strategy of intersectoral interaction in preventing drug consumption in the Kabardino-Balkarian Republic based on the Foresight approach and scenario modeling of arising trends in society narcotization. The Foresight methodological tools were used (PESTLE analysis, scenario forecast, drivers and bifurcation points identification, the Popper diamond). The data base for analysis included statistical data from narcologic services, the reports of the WHO, the UNODC, the Main Directorate for Drug Control of the Ministry of Internal Affairs of the Russian Federation and expert assessments. The analysis of study results permitted to identify key trends (increase of poly-narcomania, intensification of synthetic drugs, rejuvenation of drug addicts and drug market digitization). The probable and possible scenarios of development such as inertial, optimistic, crisis and innovative ones were determined. The drivers and bifurcation points capable radically change trajectory of drug situation were identified. The necessity of transition from predominantly repressive approach to preventive and rehabilitative one, integration of digital monitoring technologies (WBE, Big Data) and development of individual plan of prevention set-back are substantiated. The conclusions are made that the Foresight analysis in the field of anti-narcotic prevention is efficient tool of proactive risk management that permits to coordinate Federal and regional strategies. For the Kabardino-Balkarian Republic, special importance acquires development of "meso-strategy" based on intersectoral cooperation, use of ethno-confessional resources and educational and cultural potential. The scenario modeling provides opportunity to be prepared for potential menaces and to develop sustainable trajectory of reducing drug risks and promoting public health by 2030.

In conditions of deficiency of medical personnel and high social significance of profession, effective career guidance work with schoolchildren in the field of medicine becomes key element of future specialists training. The purpose of the study is to analyze and to identify the most effective strategy of career guidance work with students targeted to development of sustainable interest to medical profession choosing. The study used results of analysis of scientific pedagogical literature available in Med Line, Cochrane Library and eLibrary.ru databases, normative legal base in sphere of career guidance work and original experience of authors. The article presents analysis of strategies of career guidance for schoolchildren targeted to deliberated choice of profession. The main attention is paid to characteristic of the adaptation method that is used in career guidance activities among schoolchildren by teachers of the Medical Faculty of the Federal State University of Education. The article emphasizes the necessity of integrated approach and development of adaptation strategy with purpose to develop in university entrants ability to build constructive, successful relationships with new elements of educational environment of medical university.

The labor activity of sailor is constantly passes under permanent impact of multitude of negative factors and requires not only professionalism, but also high concentration and increased emotional resistance to various stressful situations. Among many activities targeted to to achieve these conditions the pre-voyage medical check-up of all crew members is mandatory as a tool of timely detection of health menaces. The particular attention is paid to preservation of mental and psychological health of sailor. Nevertheless, cases of suicide conditioned by conflict situations at workplace and other reasons are still recorded in the navy. In this regard, it is important that social health of sailors of merchant navy remains practically unexplored. Hence, measures preserving health will increase social immunity of sailors and will create more favorable conditions for working activity. On the basis of survey results and conclusions of researchers in this field recommendations oriented on enhancing social health of crew members of a marine vessel.

The article considers history of searching for solutions of problems of smallpox vaccination in the Irkutsk Gubernia in 1887–1892. It is demonstrated that smallpox outbreaks served as a basis for issue of the municipal Duma resolution about organization of Irkutsk smallpox vaccination room and calf barn, along with determination of costs for maintenance of smallpox vaccination cabinet. The expansion of supply of detritus to Okrugs, including the Yakutsk Oblast and the Primorye, determined necessity of reorganization of the Irkutsk smallpox vaccination department. It is noted that organization of the Commission for reorganization of the Irkutsk Vaccination Department, collaboration between city Uprava members, city physicians, sanitary physician, veterinarian permitted to organize activity of smallpox vaccination department in accordance with needs of the territory. The analysis of the minutes of the Commission and City Duma meetings demonstrate that the Commission defined the duties of physician and smallpox vaccinator and approved book of control of income and expenditure of materials for vaccination. The article demonstrates formation of costs according expenses on salaries of department personnel, requirements to calf housing conditions and the cost of their upkeep. The income and expenditure receipt for smallpox vaccination was introduced. The conclusion notes progressive role of authorities and medical Uprava in reduction of population morbidity with smallpox.