Problems of Social Hygiene,
Public Health and History of Medicine

The article presents analysis of mortality because of injuries, poisonings and other consequences of impact of external causes in able-bodied population of the Russian Federation. In 2016, the study identified 18 subjects of the Russian Federation, where these causes of death occupied first rank, leaving behind mortality of blood circulatory system diseases.The optimization of medical care of persons injured by external causes should be implemented by three main directions: traumatological orthopedic one with organization of traumatological centers; сombustiological one with organization of burn centers; toxicological one with organization of toxicological centers.The established differences in mortality rates between subjects of the Russian Federation testify the necessity of complex and substantive measures of organizing and developing medical care support of persons injured by external causes, considering climatic geographic features of regions, as well as availability of “endemic” zones within the territories of subjects that will make it possible to propose valid recommendations related to organization of new centers and optimization of routing of patients based on actual operating medical organizations and their structural subdivisions.

The evaluation of satisfaction of population with medical care has become widespread in practice of medical institutions as an obligatory criterion of assessing quality of their functioning.The study objective is to determine degree of satisfaction of population Russia with health care and role of particular factors in its formation.The study applied questionnaire survey of residents of 9 subjects of the Russian Federation using representative sampling of 1457 observations. The Pearson contingency indicator and the Chuprov-Cramer indicator of association between two nominal variables were determined. The ranking of signs according their influence strength was carried out.The most significant role in evaluation of satisfaction with health system functioning is played by satisfaction with medical care. Among the factors characterizing consumers of medical services, self-assessment of one's health status, social status of respondents, residence demonstrate the most effect. The priority factors in formation of positive public opinion about health care are identified.It is proved that positive opinion about health care depends on quality and accessibility of popular types of medical care, organization of functioning of primary health care medical organizations according expectations of population. The level of satisfaction with health care system is lower than in case of rendered medical services.

The article presents the results of questionnaire survey of patients' opinions about out-patient medical care. The survey was carried out using the Doctors' Interpersonal Skills Questionnaire during 12 months. The sampling consisted of 14.712 respondents. The lowest rates out of 11 parameters analyzed received parameters Q5 (Could the doctor reassure you?) and Q7 (Did the doctor help you to express your feelings and fears?). Such a situation was common for all medical specialties. Unexpectedly, combination of low estimate of mentioned parameters with their low correlation and resultant satisfaction with medical care was established. The resultant satisfaction with medical service by general practitioners (family doctors) was less dependent from physician's respectful attitude to patient than attention of physician to personal circumstances of patient choosing treatment. The patients of endocrinologists noted that the least input into resultant satisfaction with medical care was related to ability of physician to assist them to express their fears, and the greatest input was given to first impression from manner and mode of how physician received patient. The least input into resultant satisfaction of patients with medical services by cardiologists was made by respectful attitude of physician and the most input was attributed to way of how physician considers patient’s personal circumstances in treatment selection. The patients of gastroenterologists mentioned physician's ability to reassure patient as least input into resultant satisfaction with medical care, and attention to way of how physician considers patient’s personal circumstances in treatment selection as most input.

The diseases of skin and subcutaneous tissue are an actual medical and social problem. The purpose of study was to analyze dynamics of incidence and prevalence of diseases of skin and subcutaneous tissue in population of the Republic of Bashkortostan in 2008-2017. The average rates of incidence and prevalence of these diseases in the Republic of Bashkortostan were significantly higher than relevant data in the Russian Federation and Volga federal district. In the Republic of Bashkortostan the study established increase in incidence rate of atopic dermatitis (primary morbidity increased up to 18.6%, total morbidity increased up to 20.2%) and psoriasis (total morbidity increased up to 3%). The low level of dispensary observation of patients with dermatitis in the medical organizations of the Republic of Bashkortostan was established. In 2017 full coverage with dispensary observation was established in case of children aged 0-14 years with discoid lupus erythematosus. The low level of dispensary observation of children with atopic dermatitis (42%) and adults with psoriasis (30.6%) was established. The study demonstrated necessity of further studying of total and primary morbidity of diseases of skin and subcutaneous tissue and also indices of dispensary observation of patients according nosologies and age groups, identification of corresponding risk factors, development and implementation of measures improving medical care at all stages of its rendering.

Nowadays, focus of research is shifted to epidemiology of non-communicable diseases. Hence, actuality of study purpose to investigate epidemiological characteristics of endocrine diseases. The data of population appealability to medical organizations in the Perm region during last 20 years was used. The levels and structure of morbidity were calculated. The dynamic process was evaluated. The trend prognostication was proposed. In 2017, total endocrine system morbidity in the Perm region made up to 88.1 cases per 1000 population. During last 20 years, primary and total morbidity has tripled. In 2006, 2013 and 2015 maximal levels of primary morbidity are conditioned by adoption of a number of legal acts targeted to detection of pathology. The pathology of diseases of the endocrine system is determined by diabetes mellitus, thyroid diseases and obesity in 87.1% of all cases. According the data of population appealability to medical organizations, the rate of prevalence of obesity in 2017 made up to 10.6, diabetes mellitus - 26.6, thyroid diseases - 23.4 per 1000 of population. During last 20 years, incidence of diabetes mellitus increased up to 2 times, and obesity up to 4.8 times. The females suffered of obesity 1.2 times and of thyroid diseases 7.4 times more often than males.

The drug abuse is one of the most important medical and social problems of the youth. The problems with illegal and dangerous using of psychoactive drugs of different chemical categories by schoolchildren are caused by common social and psychological risk factors. Thus, in many research studies, all drugs and solvent substances are covered by general concept of “narcotic substances”.The study purpose is to develop an evidence database related to efficiency of common prevention measures and to development of sound recommendations of its management.The study included sociological survey of representative sampling of 445 schoolchildren aged from 14 to 17 years. The relationship between participation in preventive activities (factorial sign) and development of objective concepts about harm of drug abuse and possibilities of narcology (resulting sign) are studied using calculation of relative risk and its confidence interval.The study proves the positive effect of lecturing of specialists, psychological lessons and trainings, review of thematic video materials. The involvement of schoolchildren into development of agitation materials concerning healthy life-style and into reading of special literature is considered as effective in case of their implementation after target group received initial knowledge about problems of drug abuse and toxicomania. The study proved the negative effect of independent search of information about drugs in Internet, fabrication agitation materials about harm of drugs by adolescents, discussions based on opposite opinions and all forms of communication with patients with drug addiction. The necessity of widespread implementation of target advanced training of managers of preventive measures application.

The problem of refusal of immunodiagnostic of tuberculosis has a significant public resonance in Russia, but it is not widely covered by research.The purpose of study is to determine causes of refusal of legitimate representatives of children to carry out measures for mass immunodiagnostic of tuberculosis and to suggest possible ways of adjusting this negative phenomenon.In a cross-sectional study, the results of a questionnaire survey of 269 respondents - legal representatives of children who systematically refused to carry out immunodiagnostic of tuberculosis, are being studied.Results. The main reasons for the refusal included distrust of quality of the test (31.6%), insufficient semantic motivation (23.0%), fear of adverse reactions, complications (17.8%), negative information received from Internet (13.4%) or mass media (12.3%). Denial of the problem of tuberculosis or its displacement into a remote social environment was demonstrated by 60.6% of respondents (95% CI 54.7-66.3). Respondents are characterized by a high percentage of people (46.8%, 95% CI 40.9-52.8) who have not undergone chest X-ray examinations for more than two years, as well as individuals whose children are not vaccinated with BCG (11.9%, 95% CI 8.3-16.0). Replacement of the regulated method of detection of latent tuberculosis infection by the method chosen by the respondent will allow to examine children about half (52.4%) of the respondents. However, that will require a change in regulatory framework of the Russian Federation.The greatest part of refusals from immunodiagnostic of tuberculosis is associated with defects in sanitary education, resulting in distrust of the quality of tests and insufficient semantic motivation for implementing tests. The respondents are characterized by denial of the problem of tuberculosis. The significant percentage of respondents demonstrate risky behavior regarding the transmission of tuberculosis behavior. They have not been tested for a long time on tuberculosis, and their children are not vaccinated with BCG. The acuteness of the problem can be reduced through greater flexibility in choosing the survey technique and activation of sanitary education of population.

In conditions of increased population migration, studying the situation on incidence of infectious and parasitogenic diseases is an actual problem. Particularly relevant is the analysis of newly detected incidence in the dynamics, which will allow to assess the well-being of the epidemiological situation in the region. Purpose of the study is to analyze the situation with incidence of some infectious and parasitogenic diseases and their share in the structure of other classes of diseases. The data from the Federal statistical monitoring in 2010-2017 were used related to the Russian Federation and the North Caucasus region.It is demonstrated that the incidence of diseases in the North Caucasus Federal District and the Stavropol region increased while it decreased at the National level. At that, there was a decreasing of incidence of some infectious and parasitogenic diseases both in the Russian Federation and in the North Caucasus Federal District with instability of indices in the Stavropol Krai. In the structure of primarily diagnosed diseases, infectious and parasitogenic diseases both in the the Russian Federation and in the North Caucasus Federal Okrug occupy the in the ranking table tenth point and sixth point in the Stavropol Krai.The results of the study demonstrated multi-directional trends in the dynamics of morbidity in the Russian Federation and the North Caucasus Federal Okrug. The decrease in the percentage of infectious and parasitogenic diseases testifies the improvement of epidemiological situation in overall.

The study provides an analysis of the results of the questionnaire survey of physicians in the Russian Federation with the purpose of determining the competences of medical specialists and practice of palliative care and emerging problems. This article presents and discusses the data obtained during the study.

The assessment of medical care quality of different strata and groups of population is a priority direction of preventive medicine and public health. Nowadays, application of the riskometry theory considering external modifying factors is relevant. The registration of risk indices in the process of development of model of health preservation can be considered as a criterion of medical care quality.The purpose а study was to optimize managerial decisions in the area of increasing medical care quality related to special contingent on the basis of evaluation of carcinogenic danger and reproductive risk in conditions of anthropogenic impact. The study applied such modern research methods as social hygienic, biochemical and statistical techniques.The methodological basis of assessing reproductive risk for population in conditions of anthropogenic impact can serve as a criterion of assessing level of impact and developing management decisions in area of improving health care quality. The public health and health care organization are the fields of application of study results.

The article presents the results of external auditing on the section “The organization of emergency and urgent medical care in hospital. Organization of admitting office functioning” in 30 medical organizations of the Russian Federation based on “The proposals (practical guidelines) of Roszdravnadzor for organizing internal quality control and safety of medical activity in medical organization (hospital)”. The level of compliance with requirements of the Proposals is determined. The complex and structural problems of organization of rendering of emergency and urgent medical care.

The concept of health progression through treatment of patient received no justification as significant deterioration of population health in last years is an obvious evidence. The practical medicine is to be focused on both ill and healthy people. The characteristics of modern structure of morbidity and mortality in Russia force to admit priority of caring health of healthy people. In the post-Soviet period the existed then system of preventive care of schoolchildren, representatives of main professions and groups of population factually was destroyed. This kind of activities is to be restored in medical sanitary units.However, the analysis of practice of clinical examination revealed the presence of a number of organizational and methodological costs that decreases efficiency of applied resources does not allow to fully achieve established goals. The article presents analysis of dispensarization of population in the Russian Federation and evaluation of efficiency of functioning of the Health Centers. The experience of youth-friendly clinics is evaluated. The organizational structure of preventive work at the level of primary medical sanitary care and its interaction with specialized services in health care.

The article describes and analyzes the first day of the Constituent Session of the USSR Academy of Medical Sciences held on December 20, 1944. During this meeting the People's Commissar of Health of the USSR, G. A. Miterev, academicians A. I. Abrikosov and L. A. Orbeli, the full member of the USSR Academy of Medical Sciences S. S. Yudin made their speeches devoted to organizational tasks facing the USSR Academy of Medical Sciences during the war and post-war time, as well as to questions of morphology and physiology that require priority attention. The Yudin's report was emotional, patriotic and reflected the achievements of Soviet surgery in the mid-twentieth century. Analysis of the reports demonstrated that they contained many provisions that influenced the further development of medicine and public health in the USSR.

The article presents analysis of mortality because of injuries, poisonings and other consequences of impact of external causes in able-bodied population of the Russian Federation. In 2016, the study identified 18 subjects of the Russian Federation, where these causes of death occupied first rank, leaving behind mortality of blood circulatory system diseases.The optimization of medical care of persons injured by external causes should be implemented by three main directions: traumatological orthopedic one with organization of traumatological centers; сombustiological one with organization of burn centers; toxicological one with organization of toxicological centers.The established differences in mortality rates between subjects of the Russian Federation testify the necessity of complex and substantive measures of organizing and developing medical care support of persons injured by external causes, considering climatic geographic features of regions, as well as availability of “endemic” zones within the territories of subjects that will make it possible to propose valid recommendations related to organization of new centers and optimization of routing of patients based on actual operating medical organizations and their structural subdivisions.

The evaluation of satisfaction of population with medical care has become widespread in practice of medical institutions as an obligatory criterion of assessing quality of their functioning.The study objective is to determine degree of satisfaction of population Russia with health care and role of particular factors in its formation.The study applied questionnaire survey of residents of 9 subjects of the Russian Federation using representative sampling of 1457 observations. The Pearson contingency indicator and the Chuprov-Cramer indicator of association between two nominal variables were determined. The ranking of signs according their influence strength was carried out.The most significant role in evaluation of satisfaction with health system functioning is played by satisfaction with medical care. Among the factors characterizing consumers of medical services, self-assessment of one's health status, social status of respondents, residence demonstrate the most effect. The priority factors in formation of positive public opinion about health care are identified.It is proved that positive opinion about health care depends on quality and accessibility of popular types of medical care, organization of functioning of primary health care medical organizations according expectations of population. The level of satisfaction with health care system is lower than in case of rendered medical services.

The article presents the results of questionnaire survey of patients' opinions about out-patient medical care. The survey was carried out using the Doctors' Interpersonal Skills Questionnaire during 12 months. The sampling consisted of 14.712 respondents. The lowest rates out of 11 parameters analyzed received parameters Q5 (Could the doctor reassure you?) and Q7 (Did the doctor help you to express your feelings and fears?). Such a situation was common for all medical specialties. Unexpectedly, combination of low estimate of mentioned parameters with their low correlation and resultant satisfaction with medical care was established. The resultant satisfaction with medical service by general practitioners (family doctors) was less dependent from physician's respectful attitude to patient than attention of physician to personal circumstances of patient choosing treatment. The patients of endocrinologists noted that the least input into resultant satisfaction with medical care was related to ability of physician to assist them to express their fears, and the greatest input was given to first impression from manner and mode of how physician received patient. The least input into resultant satisfaction of patients with medical services by cardiologists was made by respectful attitude of physician and the most input was attributed to way of how physician considers patient’s personal circumstances in treatment selection. The patients of gastroenterologists mentioned physician's ability to reassure patient as least input into resultant satisfaction with medical care, and attention to way of how physician considers patient’s personal circumstances in treatment selection as most input.

The diseases of skin and subcutaneous tissue are an actual medical and social problem. The purpose of study was to analyze dynamics of incidence and prevalence of diseases of skin and subcutaneous tissue in population of the Republic of Bashkortostan in 2008-2017. The average rates of incidence and prevalence of these diseases in the Republic of Bashkortostan were significantly higher than relevant data in the Russian Federation and Volga federal district. In the Republic of Bashkortostan the study established increase in incidence rate of atopic dermatitis (primary morbidity increased up to 18.6%, total morbidity increased up to 20.2%) and psoriasis (total morbidity increased up to 3%). The low level of dispensary observation of patients with dermatitis in the medical organizations of the Republic of Bashkortostan was established. In 2017 full coverage with dispensary observation was established in case of children aged 0-14 years with discoid lupus erythematosus. The low level of dispensary observation of children with atopic dermatitis (42%) and adults with psoriasis (30.6%) was established. The study demonstrated necessity of further studying of total and primary morbidity of diseases of skin and subcutaneous tissue and also indices of dispensary observation of patients according nosologies and age groups, identification of corresponding risk factors, development and implementation of measures improving medical care at all stages of its rendering.

Nowadays, focus of research is shifted to epidemiology of non-communicable diseases. Hence, actuality of study purpose to investigate epidemiological characteristics of endocrine diseases. The data of population appealability to medical organizations in the Perm region during last 20 years was used. The levels and structure of morbidity were calculated. The dynamic process was evaluated. The trend prognostication was proposed. In 2017, total endocrine system morbidity in the Perm region made up to 88.1 cases per 1000 population. During last 20 years, primary and total morbidity has tripled. In 2006, 2013 and 2015 maximal levels of primary morbidity are conditioned by adoption of a number of legal acts targeted to detection of pathology. The pathology of diseases of the endocrine system is determined by diabetes mellitus, thyroid diseases and obesity in 87.1% of all cases. According the data of population appealability to medical organizations, the rate of prevalence of obesity in 2017 made up to 10.6, diabetes mellitus - 26.6, thyroid diseases - 23.4 per 1000 of population. During last 20 years, incidence of diabetes mellitus increased up to 2 times, and obesity up to 4.8 times. The females suffered of obesity 1.2 times and of thyroid diseases 7.4 times more often than males.

The drug abuse is one of the most important medical and social problems of the youth. The problems with illegal and dangerous using of psychoactive drugs of different chemical categories by schoolchildren are caused by common social and psychological risk factors. Thus, in many research studies, all drugs and solvent substances are covered by general concept of “narcotic substances”.The study purpose is to develop an evidence database related to efficiency of common prevention measures and to development of sound recommendations of its management.The study included sociological survey of representative sampling of 445 schoolchildren aged from 14 to 17 years. The relationship between participation in preventive activities (factorial sign) and development of objective concepts about harm of drug abuse and possibilities of narcology (resulting sign) are studied using calculation of relative risk and its confidence interval.The study proves the positive effect of lecturing of specialists, psychological lessons and trainings, review of thematic video materials. The involvement of schoolchildren into development of agitation materials concerning healthy life-style and into reading of special literature is considered as effective in case of their implementation after target group received initial knowledge about problems of drug abuse and toxicomania. The study proved the negative effect of independent search of information about drugs in Internet, fabrication agitation materials about harm of drugs by adolescents, discussions based on opposite opinions and all forms of communication with patients with drug addiction. The necessity of widespread implementation of target advanced training of managers of preventive measures application.

The problem of refusal of immunodiagnostic of tuberculosis has a significant public resonance in Russia, but it is not widely covered by research.The purpose of study is to determine causes of refusal of legitimate representatives of children to carry out measures for mass immunodiagnostic of tuberculosis and to suggest possible ways of adjusting this negative phenomenon.In a cross-sectional study, the results of a questionnaire survey of 269 respondents - legal representatives of children who systematically refused to carry out immunodiagnostic of tuberculosis, are being studied.Results. The main reasons for the refusal included distrust of quality of the test (31.6%), insufficient semantic motivation (23.0%), fear of adverse reactions, complications (17.8%), negative information received from Internet (13.4%) or mass media (12.3%). Denial of the problem of tuberculosis or its displacement into a remote social environment was demonstrated by 60.6% of respondents (95% CI 54.7-66.3). Respondents are characterized by a high percentage of people (46.8%, 95% CI 40.9-52.8) who have not undergone chest X-ray examinations for more than two years, as well as individuals whose children are not vaccinated with BCG (11.9%, 95% CI 8.3-16.0). Replacement of the regulated method of detection of latent tuberculosis infection by the method chosen by the respondent will allow to examine children about half (52.4%) of the respondents. However, that will require a change in regulatory framework of the Russian Federation.The greatest part of refusals from immunodiagnostic of tuberculosis is associated with defects in sanitary education, resulting in distrust of the quality of tests and insufficient semantic motivation for implementing tests. The respondents are characterized by denial of the problem of tuberculosis. The significant percentage of respondents demonstrate risky behavior regarding the transmission of tuberculosis behavior. They have not been tested for a long time on tuberculosis, and their children are not vaccinated with BCG. The acuteness of the problem can be reduced through greater flexibility in choosing the survey technique and activation of sanitary education of population.

In conditions of increased population migration, studying the situation on incidence of infectious and parasitogenic diseases is an actual problem. Particularly relevant is the analysis of newly detected incidence in the dynamics, which will allow to assess the well-being of the epidemiological situation in the region. Purpose of the study is to analyze the situation with incidence of some infectious and parasitogenic diseases and their share in the structure of other classes of diseases. The data from the Federal statistical monitoring in 2010-2017 were used related to the Russian Federation and the North Caucasus region.It is demonstrated that the incidence of diseases in the North Caucasus Federal District and the Stavropol region increased while it decreased at the National level. At that, there was a decreasing of incidence of some infectious and parasitogenic diseases both in the Russian Federation and in the North Caucasus Federal District with instability of indices in the Stavropol Krai. In the structure of primarily diagnosed diseases, infectious and parasitogenic diseases both in the the Russian Federation and in the North Caucasus Federal Okrug occupy the in the ranking table tenth point and sixth point in the Stavropol Krai.The results of the study demonstrated multi-directional trends in the dynamics of morbidity in the Russian Federation and the North Caucasus Federal Okrug. The decrease in the percentage of infectious and parasitogenic diseases testifies the improvement of epidemiological situation in overall.

The study provides an analysis of the results of the questionnaire survey of physicians in the Russian Federation with the purpose of determining the competences of medical specialists and practice of palliative care and emerging problems. This article presents and discusses the data obtained during the study.

The assessment of medical care quality of different strata and groups of population is a priority direction of preventive medicine and public health. Nowadays, application of the riskometry theory considering external modifying factors is relevant. The registration of risk indices in the process of development of model of health preservation can be considered as a criterion of medical care quality.The purpose а study was to optimize managerial decisions in the area of increasing medical care quality related to special contingent on the basis of evaluation of carcinogenic danger and reproductive risk in conditions of anthropogenic impact. The study applied such modern research methods as social hygienic, biochemical and statistical techniques.The methodological basis of assessing reproductive risk for population in conditions of anthropogenic impact can serve as a criterion of assessing level of impact and developing management decisions in area of improving health care quality. The public health and health care organization are the fields of application of study results.

The article presents the results of external auditing on the section “The organization of emergency and urgent medical care in hospital. Organization of admitting office functioning” in 30 medical organizations of the Russian Federation based on “The proposals (practical guidelines) of Roszdravnadzor for organizing internal quality control and safety of medical activity in medical organization (hospital)”. The level of compliance with requirements of the Proposals is determined. The complex and structural problems of organization of rendering of emergency and urgent medical care.

The concept of health progression through treatment of patient received no justification as significant deterioration of population health in last years is an obvious evidence. The practical medicine is to be focused on both ill and healthy people. The characteristics of modern structure of morbidity and mortality in Russia force to admit priority of caring health of healthy people. In the post-Soviet period the existed then system of preventive care of schoolchildren, representatives of main professions and groups of population factually was destroyed. This kind of activities is to be restored in medical sanitary units.However, the analysis of practice of clinical examination revealed the presence of a number of organizational and methodological costs that decreases efficiency of applied resources does not allow to fully achieve established goals. The article presents analysis of dispensarization of population in the Russian Federation and evaluation of efficiency of functioning of the Health Centers. The experience of youth-friendly clinics is evaluated. The organizational structure of preventive work at the level of primary medical sanitary care and its interaction with specialized services in health care.

The article describes and analyzes the first day of the Constituent Session of the USSR Academy of Medical Sciences held on December 20, 1944. During this meeting the People's Commissar of Health of the USSR, G. A. Miterev, academicians A. I. Abrikosov and L. A. Orbeli, the full member of the USSR Academy of Medical Sciences S. S. Yudin made their speeches devoted to organizational tasks facing the USSR Academy of Medical Sciences during the war and post-war time, as well as to questions of morphology and physiology that require priority attention. The Yudin's report was emotional, patriotic and reflected the achievements of Soviet surgery in the mid-twentieth century. Analysis of the reports demonstrated that they contained many provisions that influenced the further development of medicine and public health in the USSR.

The article presents analysis of mortality because of injuries, poisonings and other consequences of impact of external causes in able-bodied population of the Russian Federation. In 2016, the study identified 18 subjects of the Russian Federation, where these causes of death occupied first rank, leaving behind mortality of blood circulatory system diseases.The optimization of medical care of persons injured by external causes should be implemented by three main directions: traumatological orthopedic one with organization of traumatological centers; сombustiological one with organization of burn centers; toxicological one with organization of toxicological centers.The established differences in mortality rates between subjects of the Russian Federation testify the necessity of complex and substantive measures of organizing and developing medical care support of persons injured by external causes, considering climatic geographic features of regions, as well as availability of “endemic” zones within the territories of subjects that will make it possible to propose valid recommendations related to organization of new centers and optimization of routing of patients based on actual operating medical organizations and their structural subdivisions.

The evaluation of satisfaction of population with medical care has become widespread in practice of medical institutions as an obligatory criterion of assessing quality of their functioning.The study objective is to determine degree of satisfaction of population Russia with health care and role of particular factors in its formation.The study applied questionnaire survey of residents of 9 subjects of the Russian Federation using representative sampling of 1457 observations. The Pearson contingency indicator and the Chuprov-Cramer indicator of association between two nominal variables were determined. The ranking of signs according their influence strength was carried out.The most significant role in evaluation of satisfaction with health system functioning is played by satisfaction with medical care. Among the factors characterizing consumers of medical services, self-assessment of one's health status, social status of respondents, residence demonstrate the most effect. The priority factors in formation of positive public opinion about health care are identified.It is proved that positive opinion about health care depends on quality and accessibility of popular types of medical care, organization of functioning of primary health care medical organizations according expectations of population. The level of satisfaction with health care system is lower than in case of rendered medical services.

The article presents the results of questionnaire survey of patients' opinions about out-patient medical care. The survey was carried out using the Doctors' Interpersonal Skills Questionnaire during 12 months. The sampling consisted of 14.712 respondents. The lowest rates out of 11 parameters analyzed received parameters Q5 (Could the doctor reassure you?) and Q7 (Did the doctor help you to express your feelings and fears?). Such a situation was common for all medical specialties. Unexpectedly, combination of low estimate of mentioned parameters with their low correlation and resultant satisfaction with medical care was established. The resultant satisfaction with medical service by general practitioners (family doctors) was less dependent from physician's respectful attitude to patient than attention of physician to personal circumstances of patient choosing treatment. The patients of endocrinologists noted that the least input into resultant satisfaction with medical care was related to ability of physician to assist them to express their fears, and the greatest input was given to first impression from manner and mode of how physician received patient. The least input into resultant satisfaction of patients with medical services by cardiologists was made by respectful attitude of physician and the most input was attributed to way of how physician considers patient’s personal circumstances in treatment selection. The patients of gastroenterologists mentioned physician's ability to reassure patient as least input into resultant satisfaction with medical care, and attention to way of how physician considers patient’s personal circumstances in treatment selection as most input.

The diseases of skin and subcutaneous tissue are an actual medical and social problem. The purpose of study was to analyze dynamics of incidence and prevalence of diseases of skin and subcutaneous tissue in population of the Republic of Bashkortostan in 2008-2017. The average rates of incidence and prevalence of these diseases in the Republic of Bashkortostan were significantly higher than relevant data in the Russian Federation and Volga federal district. In the Republic of Bashkortostan the study established increase in incidence rate of atopic dermatitis (primary morbidity increased up to 18.6%, total morbidity increased up to 20.2%) and psoriasis (total morbidity increased up to 3%). The low level of dispensary observation of patients with dermatitis in the medical organizations of the Republic of Bashkortostan was established. In 2017 full coverage with dispensary observation was established in case of children aged 0-14 years with discoid lupus erythematosus. The low level of dispensary observation of children with atopic dermatitis (42%) and adults with psoriasis (30.6%) was established. The study demonstrated necessity of further studying of total and primary morbidity of diseases of skin and subcutaneous tissue and also indices of dispensary observation of patients according nosologies and age groups, identification of corresponding risk factors, development and implementation of measures improving medical care at all stages of its rendering.

Nowadays, focus of research is shifted to epidemiology of non-communicable diseases. Hence, actuality of study purpose to investigate epidemiological characteristics of endocrine diseases. The data of population appealability to medical organizations in the Perm region during last 20 years was used. The levels and structure of morbidity were calculated. The dynamic process was evaluated. The trend prognostication was proposed. In 2017, total endocrine system morbidity in the Perm region made up to 88.1 cases per 1000 population. During last 20 years, primary and total morbidity has tripled. In 2006, 2013 and 2015 maximal levels of primary morbidity are conditioned by adoption of a number of legal acts targeted to detection of pathology. The pathology of diseases of the endocrine system is determined by diabetes mellitus, thyroid diseases and obesity in 87.1% of all cases. According the data of population appealability to medical organizations, the rate of prevalence of obesity in 2017 made up to 10.6, diabetes mellitus - 26.6, thyroid diseases - 23.4 per 1000 of population. During last 20 years, incidence of diabetes mellitus increased up to 2 times, and obesity up to 4.8 times. The females suffered of obesity 1.2 times and of thyroid diseases 7.4 times more often than males.

The drug abuse is one of the most important medical and social problems of the youth. The problems with illegal and dangerous using of psychoactive drugs of different chemical categories by schoolchildren are caused by common social and psychological risk factors. Thus, in many research studies, all drugs and solvent substances are covered by general concept of “narcotic substances”.The study purpose is to develop an evidence database related to efficiency of common prevention measures and to development of sound recommendations of its management.The study included sociological survey of representative sampling of 445 schoolchildren aged from 14 to 17 years. The relationship between participation in preventive activities (factorial sign) and development of objective concepts about harm of drug abuse and possibilities of narcology (resulting sign) are studied using calculation of relative risk and its confidence interval.The study proves the positive effect of lecturing of specialists, psychological lessons and trainings, review of thematic video materials. The involvement of schoolchildren into development of agitation materials concerning healthy life-style and into reading of special literature is considered as effective in case of their implementation after target group received initial knowledge about problems of drug abuse and toxicomania. The study proved the negative effect of independent search of information about drugs in Internet, fabrication agitation materials about harm of drugs by adolescents, discussions based on opposite opinions and all forms of communication with patients with drug addiction. The necessity of widespread implementation of target advanced training of managers of preventive measures application.

The problem of refusal of immunodiagnostic of tuberculosis has a significant public resonance in Russia, but it is not widely covered by research.The purpose of study is to determine causes of refusal of legitimate representatives of children to carry out measures for mass immunodiagnostic of tuberculosis and to suggest possible ways of adjusting this negative phenomenon.In a cross-sectional study, the results of a questionnaire survey of 269 respondents - legal representatives of children who systematically refused to carry out immunodiagnostic of tuberculosis, are being studied.Results. The main reasons for the refusal included distrust of quality of the test (31.6%), insufficient semantic motivation (23.0%), fear of adverse reactions, complications (17.8%), negative information received from Internet (13.4%) or mass media (12.3%). Denial of the problem of tuberculosis or its displacement into a remote social environment was demonstrated by 60.6% of respondents (95% CI 54.7-66.3). Respondents are characterized by a high percentage of people (46.8%, 95% CI 40.9-52.8) who have not undergone chest X-ray examinations for more than two years, as well as individuals whose children are not vaccinated with BCG (11.9%, 95% CI 8.3-16.0). Replacement of the regulated method of detection of latent tuberculosis infection by the method chosen by the respondent will allow to examine children about half (52.4%) of the respondents. However, that will require a change in regulatory framework of the Russian Federation.The greatest part of refusals from immunodiagnostic of tuberculosis is associated with defects in sanitary education, resulting in distrust of the quality of tests and insufficient semantic motivation for implementing tests. The respondents are characterized by denial of the problem of tuberculosis. The significant percentage of respondents demonstrate risky behavior regarding the transmission of tuberculosis behavior. They have not been tested for a long time on tuberculosis, and their children are not vaccinated with BCG. The acuteness of the problem can be reduced through greater flexibility in choosing the survey technique and activation of sanitary education of population.

In conditions of increased population migration, studying the situation on incidence of infectious and parasitogenic diseases is an actual problem. Particularly relevant is the analysis of newly detected incidence in the dynamics, which will allow to assess the well-being of the epidemiological situation in the region. Purpose of the study is to analyze the situation with incidence of some infectious and parasitogenic diseases and their share in the structure of other classes of diseases. The data from the Federal statistical monitoring in 2010-2017 were used related to the Russian Federation and the North Caucasus region.It is demonstrated that the incidence of diseases in the North Caucasus Federal District and the Stavropol region increased while it decreased at the National level. At that, there was a decreasing of incidence of some infectious and parasitogenic diseases both in the Russian Federation and in the North Caucasus Federal District with instability of indices in the Stavropol Krai. In the structure of primarily diagnosed diseases, infectious and parasitogenic diseases both in the the Russian Federation and in the North Caucasus Federal Okrug occupy the in the ranking table tenth point and sixth point in the Stavropol Krai.The results of the study demonstrated multi-directional trends in the dynamics of morbidity in the Russian Federation and the North Caucasus Federal Okrug. The decrease in the percentage of infectious and parasitogenic diseases testifies the improvement of epidemiological situation in overall.

The study provides an analysis of the results of the questionnaire survey of physicians in the Russian Federation with the purpose of determining the competences of medical specialists and practice of palliative care and emerging problems. This article presents and discusses the data obtained during the study.

The assessment of medical care quality of different strata and groups of population is a priority direction of preventive medicine and public health. Nowadays, application of the riskometry theory considering external modifying factors is relevant. The registration of risk indices in the process of development of model of health preservation can be considered as a criterion of medical care quality.The purpose а study was to optimize managerial decisions in the area of increasing medical care quality related to special contingent on the basis of evaluation of carcinogenic danger and reproductive risk in conditions of anthropogenic impact. The study applied such modern research methods as social hygienic, biochemical and statistical techniques.The methodological basis of assessing reproductive risk for population in conditions of anthropogenic impact can serve as a criterion of assessing level of impact and developing management decisions in area of improving health care quality. The public health and health care organization are the fields of application of study results.

The article presents the results of external auditing on the section “The organization of emergency and urgent medical care in hospital. Organization of admitting office functioning” in 30 medical organizations of the Russian Federation based on “The proposals (practical guidelines) of Roszdravnadzor for organizing internal quality control and safety of medical activity in medical organization (hospital)”. The level of compliance with requirements of the Proposals is determined. The complex and structural problems of organization of rendering of emergency and urgent medical care.

The concept of health progression through treatment of patient received no justification as significant deterioration of population health in last years is an obvious evidence. The practical medicine is to be focused on both ill and healthy people. The characteristics of modern structure of morbidity and mortality in Russia force to admit priority of caring health of healthy people. In the post-Soviet period the existed then system of preventive care of schoolchildren, representatives of main professions and groups of population factually was destroyed. This kind of activities is to be restored in medical sanitary units.However, the analysis of practice of clinical examination revealed the presence of a number of organizational and methodological costs that decreases efficiency of applied resources does not allow to fully achieve established goals. The article presents analysis of dispensarization of population in the Russian Federation and evaluation of efficiency of functioning of the Health Centers. The experience of youth-friendly clinics is evaluated. The organizational structure of preventive work at the level of primary medical sanitary care and its interaction with specialized services in health care.

The article describes and analyzes the first day of the Constituent Session of the USSR Academy of Medical Sciences held on December 20, 1944. During this meeting the People's Commissar of Health of the USSR, G. A. Miterev, academicians A. I. Abrikosov and L. A. Orbeli, the full member of the USSR Academy of Medical Sciences S. S. Yudin made their speeches devoted to organizational tasks facing the USSR Academy of Medical Sciences during the war and post-war time, as well as to questions of morphology and physiology that require priority attention. The Yudin's report was emotional, patriotic and reflected the achievements of Soviet surgery in the mid-twentieth century. Analysis of the reports demonstrated that they contained many provisions that influenced the further development of medicine and public health in the USSR.