Problems of Social Hygiene,
Public Health and History of Medicine

The article is devoted to the history of the creation and activities of the N. A. Semashko National Research Institute of Public Health. On the basis of the analysis of archival materials and scientific works of the staff of the Institute, the main results of the Institute work for 75 years are presented. The contribution of the Institute to the development of science and health care in the USSR and the Russian Federation is investigated.

The article presents an assessment of the economic damage associated with smoking for the period of 2009-2016. The obtained data on the prevalence of tobacco dependence for 2009-2016 showed, on the one hand, a decrease in tobacco dependence among the population surveyed, and on the other hand, an increase in the share of consumer spending on tobacco products and of an index of the physical volume of retail sales of tobacco products. The study included an analysis of the incidence of diseases associated with smoking, as well as an analysis of the attendance of medical care for patients with tobacco-related diseases.

The Moscow residents are prone to lead a healthy lifestyle (29% follow most principles of a healthy lifestyle and 56% follow some of them).During the study six main aspects of a healthy lifestyle were selected and described in detail from the perspective of Muscovites’ self-assessment. Factor analysis revealed two types of behavior that characterize attitudes toward a healthy lifestyle by Muscovites: an “active healthy lifestyle” (nutrition, physical activity, work and rest regime) and a “passive healthy lifestyle” (attitudes towards smoking and alcohol). The mental health factor was examined separately. Statistical analysis of the data showed that the respondents well-being is primarily related to sport and ability to cope with stress (p <0,001). The study also identified risk groups for each aspect of a healthy lifestyle based on differences in the main socio-demographic characteristics.Additionally, the aspect of rational medical behavior was analyzed. The analysis showed that not enough attention is paid to this aspect.The results of the study can be considered in developing priority directions of work in the field of the formation of a healthy lifestyle. The specificity of the approach taken in this study is that recommendations are based on determining the main aspects of a healthy lifestyle and their interrelation, as well as discovering risk groups for each of them and their connection to health self-assessment.

The article based on the analysis of foreign experience of commercialization of health care and introducing management methods typical for business into the work of medical organizations, shows the difficult conflict of interests within the medical community itself, as well as the clash of organizational cultures of doctors and managers. As a result, the population suffers as it either cut of from medical care or pays for imposed medical services. And the doctors suffer because of the pursuit of their leadership for economic efficiency and productivity without taking into account the specifics of the medical profession, and this leads to overwork, stress and early professional burnout. Based on a survey of Russian experts, the authors show that while in the West they come to a conclusion about the need for a management revolution that returns doctors to their priority role and prioritizes not patient's profits, but patient interests, Russia is rapidly moving along the path of unrestrained health care commercialization and fetishization indicators in the medical industry. The article describes a system of economic and organizational-legal factors that provoke a conflict of interest that arise management and staff, and also reveals the absence of mechanisms that are designed to contain its negative consequences and to some extent operate in countries whose approaches to organization Russia is rapidly adopting in health care. In addition, the opinions and arguments of the experts are given in relation to the new question for Russia as to whether the head of the medical organization should be a clinician or a manager.

The problem of estimating the frequency of the use of and their effectiveness is considered on the example of the subjects of the Central Federal District of the Russian Federation. The results of analysis of official statistics are presented, which made allowing to establish, that the activity of subjects of the Russian Federation in the use of assisted reproductive technologies has significant differences in the frequency of procedure and their effectiveness. The criteria for comparative assessment of the effectiveness of the organization of medical care for infertility with the use of ART at the territorial level are proposed.

The article presents the features of the influence of social interactions on the social activity of older people and people with disabilities and their choice of types of social services. The Laboratory of Social Projects of the Belgorod National Research University in February - June 2018 conducted a sociological survey among the elderly and disabled of the Belgorod Region of Russia (240 people) to reveal knowledge about dental health and the prevention of dental diseases. The research methods were, firstly, the content analysis of individual social rehabilitation cards for the elderly and the disabled, and secondly, the survey of the elderly and the disabled.The results of the study showed: that the more elderly and disabled are included in social interactions, the more often they choose dental services among the entire list of types of social services; people who are not included in social interactions seek dental services in cases of acute pain or severe physical limitation of chewing function; socially active elderly and disabled people seek dental services for a large list of reasons (psychological, aesthetic); self-esteem by the elderly and disabled their dental health was more positive than that of the dentist; the elderly and disabled living in inpatient organizations have better dental health and are more likely to receive dental services than people living at home.

The most consecutive statement of biomedical ethics principles within educational process and the correct analysis of its problems in the context of rapid development and expansion of a scope of medical technologies are possible only on the basis of synthesis of philosophical, culturological, historical and theological knowledge. Otherwise, biomedical ethics could be substituted for deontology which utilitarian value is indisputable, but which has no sufficient universality in relation to various historical periods and sociocultural conditions. It becomes especially obvious during a globalization era when the states with various experience of cultural-historical development and level of economic potential are forced to create large regional associations for the benefit of the sustainable development. However the synthetic concept can exist only based on serious humanitarian preparation which it isn't necessary to for medical community even of developed countries within the existing educational standards. Dialectic approach, being «cleared» of the known ideological excesses, could become the compact, available and at the same time universal tool for forming of complete view of students on biomedical ethics, the analysis of its problems and implementation of its principles in dynamically changing conditions of modern society. Russian Federation naturally applying for a leader role of various regional political structures, in particular - in extremely diverse and therefore very difficult Asia-Pacific region, could offer foreign colleagues the general agenda in the field of biomedical ethics based on dialectic approach. Fields of Eastern Economic Forum which is annually held on the base of Far Eastern Federal University in Vladivostok could become the platform for the presentation of this agenda.

The article defines the main trends of the market of medical anti-aging services and prospects of aesthetic medicine. The paper presents the data of research on the impact of contextual advertising in social networks on the decision of patients of middle and retirement age on the use of anti-aging cosmetology and treatment for the provision of cosmetic services of an aesthetic nature.The article presents the analysis of the main options of Internet advertising of a medical nature for anti-aging subjects, in addition, describes the methodology that is developed for commercial medical organizations, and analysis of anti-aging medical procedures in the aspect of aesthetic medicine and the search for the necessary information on anti-aging medicine in social networks. The article draws an important conclusion that an important factor affecting the medical market of aesthetic medicine services is the decrease in consumer activity and solvency of the population, which requires a revision of the price and assortment policy of clinics.The article demonstrates the results of obtaining valuable data on popular requests and effective advertising sources, conversion into circulation from different advertising channels and from different devices, the activity of consumers of medical aesthetic services during the week and day. Special attention was paid to the advertising of anti-aging aesthetic medicine in social networks.

Atopic dermatitis and contact dermatitis are most common in all age groups of the population. In this regard, the study of the epidemiological situation of these nosological forms is highly relevant. The aim of the study was to study the indicators of general and primary morbidity in diseases of the skin and subcutaneous tissue and their structure. Material and methods. The data of official statistics on the general and primary incidence of diseases of the skin and subcutaneous tissue in the Stavropol Territory for the period from 2010 to 2017 have been studied. Results. Analysis of the incidence of diseases of the skin and subcutaneous tissue taken into account in official statistics showed an increase in the overall incidence of diseases of the skin and subcutaneous tissue by 21.5%, including contact dermatitis, other dermatitis, psoriasis and psoriatic arthritis. The overall incidence of lupus erythematosus and localized scleroderma has decreased. The highest rates of newly detected incidence of contact and atopic dermatitis were noted. Contact and atopic dermatitis prevailed in the structure of both the general and newly diagnosed diseases of the skin and subcutaneous tissue. Conclusion Despite the decrease in newly detected incidence, during the analyzed period there was an increase in the overall incidence of diseases of the skin and subcutaneous tissue. In the structure of both the general and newly detected incidence of diseases of the skin and subcutaneous tissue, the main part is occupied by contact and atopic dermatitis.

Anemia is a clinical hematological syndrome and also a risk factor for the adverse outcome of many chronic somatic diseases. To assess effectiveness of out-patient polyclinic care for patients with anemia, the computer program “Patient Monitoring System with Anemic Syndrome” was used. The study included 1498 patients (males - 491; females - 1007) aged from 18 to 80 years old, who were under medical observation by general practitioners. The prevalence of anemic syndrome in different age and gender groups varied from 11 to 58%. Statistically significant differences between subgroups of men and women were found in the categories 18-30 years, 31-40 years and 41-50 years. In adult patients of working age, anemic syndrome during routine examination was detected in 37% of cases of seeking outpatient medical care (anemic syndrome in women was three times more common than in men). In patients older than working age, the prevalence of anemic syndrome was lower and averaged 25.7%.In the structure of anemia, 48.4% are hypochromic, 5.4% are hyperchromic, 46.2% are normochromic. The study for serum iron was prescribed in 33.9% of cases of hypochromic anemia, in 22.5% of cases of normochromic anemia and in 11.1% of cases of hyperchromic anemia. Serum iron was detected in every second patient with diseases of the urogenital system, every third patient with neoplasm. Therapy with iron preparations was prescribed in 30.6%, and the administration of vitamin B12 - in 1.4% of cases.

In health care, as in other sectors of the public sector, introduced a new system of remuneration (NSOT). However, as the analysis of practice shows, the consequences of its implementation are ambiguous. Despite the growth of the average salary of all categories of medical personnel, its size does not correspond to the planned indicators in most regions of the Russian Federation. The presence in public health organizations of various organizational and legal forms has put institutions in unequal conditions of formation and distribution of funds of the wage Fund. As a result, medical personnel in one region receive different salaries for the same functions. These trends lead to the outflow of personnel from public health institutions in other industries and activities against the backdrop of increased intensification of labor of workers, an increase in the number of functions performed, a significant bureaucratization of their activities. Thus, one of the most important goals of the NSOT to attract and retain specialists in public health has not been achieved. There are serious shortcomings in the construction of basic salaries on the basis of professional qualification groups, due to which the size of the permanent part of the earnings of low-skilled workers in public health may be lower than the minimum wage in the region. One of the most important elements of the new wage system is an effective contract, the introduction of which has led to the fact that the share of variable wages in public health care is unreasonably overstated. It should be noted that in the medical institutions of the public sector there are often no indicators to assess the quality and results of work of employees and the organization as a whole, which leads to problems in determining the criteria for the effectiveness of personnel. Thus, in order to improve the new system of remuneration, it is necessary to eliminate these shortcomings, to develop methodological approaches to the formation of official salaries taking into account the requirements of labor legislation, all decisions in the field of remuneration should have a financial basis.

The formation of the number of medical personnel, the establishment of labor standards, the rational distribution and use of personnel are the most significant components of the system of labor rationing in health care. Standard norms of working time for TB doctors are not developed. There is an uneven workload and a plan implementation indicator in different offices and cabinets. The timing of the working process of phthisiatricians providing outpatient care to adults and children was carried out; work time was spent on individual elements of the labor process of district phthisiatricians accepting adults and children and a phthisiatrician without district work receiving patients in the office tuberculosis care for HIV patients. The concept of “visitation” is defined as applied to the working conditions of the TB service. According to the results of time-keeping observations, technological operations performed by TB doctors, including additional sections of work that are not related to the admission of patients, are highlighted; the normative indicator of the function of the medical post of the district TB specialist and the normative indicator of the time spent on one visit are determined.

The article considers expedience and the need to develop an integrative assessment methodology of medical organizations. Presented to the successive stages of the evaluation and the results of approbation of the suggested methodological principles for evaluating the activities of the three-example conditional medical organizations.

The article presents information about various medical and social characteristics of the population of the Samara region cities. The survey of respondents was held by the network commercial laboratory, which treatment rooms were opened simultaneously in several cities of the region. The conducted study allowed to compile a medico-social portrait of the customer of laboratory services of medical organizations. It was discovered that laboratory services of commercial laboratories are most commonly used by women (78.1%) between the ages of 18 to 40 years. It was revealed that 54.9% of all patient admissions were repeated, and 56.0% of the patients were tested on their own initiative. The initial application is male-dominated 56.2%. Geographically the most often service was provided in Togliatti city (63.8%). Most prone to doctor's recommendation, to apply for paid medical analyses are patients between ages of 18 to 50 years old. Based on the obtained data a set of measures was proposed aimed to improve the quality of medical laboratory services.

The article describes and analyzes the second day of the Constituent Session of the USSR Academy of Medical Sciences held on December 21, 1944, during which the elections of academic - secretaries and members of the bureau of branches took place at three parallel meetings. I. P. Razenkov was elected the academician-secretary of the department of biomedical sciences (OMBN), V. F. Zelenin - оf the Department of Clinical Medicine (OKM) , F. G. Krotkov - of the Department of Hygiene, Microbiology and Epidemiology (OGME). The surprise was the election of V. F. Zelenin as the OKM academician- secretary instead of N. I. Grashchenkov. Directors of 5 out of 8 OMBN institutes, 5 out of 10 OKM and 2 out of 7 OGME institutes were also approved. Total - 12 out of 25. The composition of the Presidium of the Academy of Medical Sciences of the USSR was also discussed, the election of which was postponed to December 22. The question of by-election of full members (40 people) and corresponding members (200 members) was resolved and postponed to the next session of the General Assembly of the Academy (1945).

The article discusses the government's policy towards the Zemstvo self-government bodies, the influence of increased administrative and political oversight on the establishment and development of Zemstvo medicine, the achievements of the zemstvo doctors in the struggle for public, qualified assistance to the population despite the government policy of limiting the independence of Zemstvo institutions.