Problems of Social Hygiene,
Public Health and History of Medicine

This article considers the main approaches to assessing the sustainability of the health care system in the development of emergencies of different nature. Based on the analysis and synthesis of data from foreign publications, the most significant factors affecting the efficiency of functioning of national health care systems, as well as the characteristics of their resilience to crisis phenomena are systematised. Experts consider flexible resource management, training of qualified and motivated medical personnel, the possibility of redistribution of powers within the system, both horizontally and vertically, as well as intersectoral cooperation in overcoming crisis situations as the most obvious solutions to improve the viability of the health care system.

The relevance of the study is as follows. Traditional methods of pedagogy do not allow objective and continuous monitoring of the emotional state of each student. The teacher usually relies on subjective observations — facial expressions behavior in a group — which may be inaccurate. At the same time modern technologies provide new opportunities: cameras and sensors backed by AI algorithms are able to automatically recognize facial expressions voice intonations and other signs of an emotional state. There are already commercial solutions for facial emotion recognition which have been used in marketing and security. Their potential application in education is an important topic as automated emotion analysis could provide educators with objective data on how engaged a group is whether students are overworked and who is experiencing difficulties or stress. It is the problem of mass learning fatigue and emotional burnout according to empirical studies that makes the introduction of such systems modern and practically significant and is the topic of this article. The article notes that the introduction of AI systems that can monitor both behavioral and physiological indicators opens up new opportunities for objective registration of cognitive states. For example sensors and wearable devices can measure heart rate heart rate variability brain activity and other parameters related to the level of concentration and mental stress. Computer vision can track eye gaze direction blinking frequency and posture which indirectly indicates the level of attention or fatigue. The study presents the results of a psychometric testing study using validated tools for emotional involvement in the educational process and a study of the factors of burnout and knowledge fatigue among full-time students at the Novorossiysk branch of the Financial University under the Government of the Russian Federation. The sample consisted of 125 respondents.

The article considers aging as a complex socio-cultural and existential phenomenon that goes beyond the exclusively biological process. The purpose of the study is to analyze aging as a multidimensional phenomenon, including social, cultural and philosophical aspects, as well as to substantiate the need for an integrative approach to its study. The paper shows that old age is socially constructed through norms, values, and institutional practices that determine the status and role of older people in society. At the same time, aging is revealed as an important stage of the existential formation of a personality, associated with a reassessment of life experience, comprehension of time, finiteness and the meaning of existence. Special attention is paid to the concept of active aging, the problem of ageism, the phenomenon of life review, the search for the meaning of life in later life, existential loneliness and identity transformation. Based on the analysis of philosophical and gerontological approaches, it is concluded that aging should be understood not as a period of loss exclusively, but as a significant stage of life with its own value, meaning and potential. The necessity of forming a more humanistic model of attitude to old age in the context of demographic aging of the population is substantiated.

The quality of healthcare is a complex, interdisciplinary category. Current approaches to assessing quality of life are typically based on statistical data, medical statistics, and subjective assessments obtained through mass population surveys. Using expert surveys as a method not only for assessment but also for a deeper professional understanding of processes occurring in the healthcare system, predicting their consequences, and identifying the causes of changes in public opinion appears most appropriate, particularly for regional healthcare systems. Experts from regional communities are most immersed in issues related to their local context. The research methodology was based on the «structure, process, result» (Donabedian) approach and included a survey of experts from regional professional communities in the regional capital of the Kursk border region (n = 40). The experts included representatives from healthcare management, business, science and education, medical professionals, opinion leaders, and political scientists. The results of the expert survey revealed contradictions in regional healthcare management, which are exacerbated by a significant outflow of professional personnel.

The article analyzes the legal regulation of working hours of medical workers in Russia. The relevance of the study is due to the increased social significance of the MR's work, which is carried out in special conditions associated with high psychoemotional stress, responsibility for the life and health of patients, and the need to ensure round-the-clock availability of medical care. The purpose of the work is to identify systemic contradictions and gaps in the legal regulation of MR's working hours and to develop proposals for improving current legislation. The research applied general scientific methods (system analysis, synthesis, comparison) and private scientific methods (formal legal, comparative legal, legal modeling method). The author applies an integrated approach when considering the institution of MR working time as a complex, multicomponent phenomenon located at the intersection of labor, administrative and medical law. The paper identifies and characterizes the specifics of the application of the general norms of the Labor Code of the Russian Federation in relation to MR, analyzes the special norms enshrined in subordinate regulatory legal acts, and determines their relationship with the constitutional principles of health protection and the right to favorable working conditions. As a result of the research, the types of working time accounting used in medical organizations (daily, cumulative) are systematized, the specifics of establishing reduced working hours are detailed, and the legal working hours at night, weekends, and non-working holidays are analyzed. The key problems of law enforcement practice related to violations of standard working hours, failure to account for overwork, and a formal approach to shift schedules have been identified. Specific proposals have been formulated to improve legislation aimed at optimizing legal mechanisms for regulating working hours, taking into account the need to maintain a balance between the interests of patients (continuity and quality of care) and the rights of MR (occupational safety, recreation, prevention of professional burnout).

The article examines the concept of hospitality in the context of medical tourism from a semiotic and intercultural perspective. The host medical environment is considered as a system of signs through which patients form perceptions of safety, trust, and quality of medical care. Particular attention is paid to the mechanisms of interpreting cultural codes, visual and verbal communication strategies, as well as the interaction between the "foreign" and the "familiar" within the medical space. Based on a comparative analysis of practices in Russia and other countries, the study identifies key features of the representation of hospitality and its role in shaping the experience of medical tourists. The article argues that hospitality in medical tourism functions as a complex semiotic system that facilitates patient adaptation within a different cultural and institutional environment.

The relevance of the topic is determined by data from numerous studies indicating a significantly higher prevalence of stigma toward individuals using psychoactive substances compared to patients with other mental disorders. Stigma is recognized as a key problem in modern healthcare systems and is defined as a systemic factor shaping the entire ecosystem of narcological care. It frequently affects the professional activities of mid-level medical personnel manifesting at interconnected levels and forming a vicious cycle that deteriorates treatment quality and outcomes while undermining the health of the staff themselves. Stereotypical and negative perceptions of patients with addictions among mid-level medical personnel lead to discriminatory care practices: ignoring pain complaints unfounded suspicions and the use of derogatory language in communication and documentation. It is stigmatizing treatment that inflicts the most severe psychological trauma becoming the primary barrier to seeking help again. Intra-organizational stigma directly contributes to adverse clinical outcomes increased relapses and mortality. Combating stigma must become the cornerstone of professional support and training programs for mid-level medical personnel as well as efforts to improve the overall quality of narcological care.

The article presents an analysis of the dynamics in the number of healthcare organizations of various forms of ownership in the Russian Federation for the period from 2009 to 2024. The study was conducted using statistical and analytical methods of time series data processing. Opposite trends in the development of the public and private healthcare sectors have been identified. In the public sector, a reduction in the number of hospital organizations by 27.66% was recorded, alongside a simultaneous increase in the number of outpatient clinics by 23.63%, reflecting the optimization processes in the inpatient sector and the strengthening of primary health care. The private sector demonstrated exponential growth: the number of hospital organizations increased almost fourfold, and outpatient clinics more than doubled. The capacity of private outpatient clinics increased more than fourfold. All identified trends are confirmed by statistical significance. The results obtained indicate the transformation of private medicine into a significant element of the national health protection system, capable of filling the deficit niches of the public sector.

The study aimed to assess the impact of key parameters of the organizational and clinical environment on the formation of the primary professional identity and emotional well-being of a young doctor in order to identify priority areas for changing organizational support. It is concluded that the successful professional development of a medical university graduate, which involves the integration of value-motivational, operational-role, and socio-communicative components, is a critical condition for ensuring the quality of medical care, the emotional well-being of young doctors, and the staff sustainability of the healthcare system as a whole. It is substantiated that overcoming the adaptation crisis requires shifting the focus from the individual competencies of the young specialist to the organizational conditions of his or her work. An important direction for modernizing the human resource policy of healthcare institutions should be the purposeful design of a professionally enriching environment, which includes: reducing bureaucratic dissonance; transforming organizational culture towards a supportive, collegial model; institutionalizing “safe” spaces for professional reflection; rethinking the role of mentoring as an element of the organizational system; and shifting the focus of managerial key performance indicators from formal metrics to indicators of sustainable professional development.

The relevance of studying the relationship between sociocultural identity and social immunity in young people stems from the need to find adaptive mechanisms in the context of contemporary sociocultural turbulence. Sociocultural identity, understood as the process and result of an individual's self-identification with a historically rooted system of traditional values, normative codes, and behavioral patterns, is a key mechanism for the reproduction and integration of society. It ensures the continuity of values and semantics and serves as the basis for the development of social immunity a property of a social system that allows it to maintain integrity and stability, protecting itself from destructive external influences. In the context of youth, this identity performs a dual function: it serves as a psychological buffer, reducing the traumatic impact of external instability, and simultaneously becomes a source of meaning and strategies for actively confronting challenges. The nonlinearity of modern identification processes, characterized by the multiplicity and variability of self-determination, does not negate this function; rather, it complicates and enriches the mechanisms of immunity, creating new opportunities for personal development and forming an adaptive resource for society as a whole. The possibilities of developing youth social immunity are examined from the perspective of a socio-technological approach, which views strengthening the positive socio-cultural identity of youth as a constructive task, solved through the implementation of reproducible and measurable social practices. The target outcome of these technologies is the development of a resilient adaptive complex in the new generation, including skills for critically assessing information, resistance to destructive influences, and the ability to maintain social health.

Ensuring adequate staffing levels for psychiatrists-narcologists and district psychiatrists-narcologists amid the observed shortage of healthcare personnel across all sectors and burnout among medical workers represents one of the primary pathways to improving the performance of psychoneurological services. Analysis of the new order from the Russian Ministry of Health on the «psychiatry-narcology» profile reveals that the document includes certain measures to strengthen preventive efforts by introducing the position of a medical psychologist in the office for the prevention of substance use disorders. However, in our view, certain provisions of the document require revision in the following directions: transitioning to commonly accepted indicators for labor norms in outpatient care, namely statistical data on population size and its contingents; and excluding staffing numbers from the normative provision for ensuring round-the-clock operations of medical personnel.

The study provides a summary of the main provisions of the Fundamental Scientific Research Program of the Russian Federation for the long-term period (2021—2030), provides its general quantitative characteristics, highlighting the leading areas of knowledge and areas of science. For the field of scientific knowledge «Medical Sciences», a detailed statistical and substantive analysis is provided, as a result of which leaders and anti-leaders are identified in the context of areas and sections of fundamental and exploratory scientific research.

The article explores the current issue of medical support for merchant ship crews working in conditions of prolonged professional isolation, limited access to qualified medical care, and specific risk factors of the maritime environment. The author conducts a systematic analysis of modern digital healthcare technologies, such as wearable biometric devices, telemedicine platforms, mobile medical applications, and cloud-based data storage systems, in terms of their applicability for continuous monitoring of seafarers' health during voyages. The paper presents an original methodology for assessing the comprehensive effectiveness of the implementation of digital monitoring systems, based on a multi-criteria weighted matrix, where the components correspond to medical, technical, ergonomic (household), economic, and compliance with standards. A target efficiency threshold of 0.85 has been established, which provides for a 15% reserve for possible technical failures, human factors, and unforeseen circumstances. Based on the analysis, a set of practical recommendations has been formulated for shipping companies and regulatory authorities. The results of the study allow for the optimization of health-saving strategies in the maritime industry, reducing occupational risks, improving the availability of medical care, and minimizing economic losses associated with crew illnesses during voyages. The proposed methodology can be adapted for other industries with similar working conditions.

A comprehensive analysis of the situation is needed to effectively address Russia's demographic problems. The aging population and low birth rate pose serious challenges for the country. The purpose of the study is to identify and analyze the social determinants that determine the choice of a small family model, followed by the development of recommendations for optimizing the demographic situation in the country.

In the context of modern socio-economic transformations and global challenges to systemic healthcare, the problem of an objective assessment of the quality of life of the population is of paramount importance. Traditional economic indicators (for example, GDP per capita) do not fully reflect the state of public health and social well-being. In this regard, the development of integrated assessment tools synthesizing heterogeneous data is becoming a key task for substantiating management decisions in the field of social and demographic policy. A special role in such systems is played by medical and demographic indicators, which act as objective markers of the quality of human potential. The study is based on data from Rosstat and the Ministry of Health of the Russian Federation for the period 2015—2024 for 85 regions of the Federation. The purpose of the study is to theoretically substantiate and test in practice the methodology of integrated assessment of the quality of life of the population of the subjects of the Russian Federation using a system of key medical and demographic indicators, to determine their structural contribution to the final index.

The article examines the constitutional and civil law grounds for compensation for damage caused to the patient's life and health during the provision of medical care. The relevance of the study is due to the increased social importance of protecting the health of citizens, enshrined at the constitutional level, and the presence of significant problems in law enforcement practice related to the conflict of public and private principles in regulating medical activities. The provision of medical care, being an activity aimed at preserving and improving human health, is inherently associated with an increased risk of harm. The purpose of the work is to identify a systemic relationship between constitutional principles and the norms of civil legislation that form an integral mechanism for protecting the rights of the patient.