Problems of Social Hygiene,
Public Health and History of Medicine

The population awareness about merits of mandatory medical insurance (MMI) continues to be inadequate. The study purpose was to investigate opinion of Moscow Oblast residents about MMI system. The sociological survey was carried out according standard technique using specially developed genuine questionnaire. The public opinion was studied in 2013 (584 respondents) and 2017 (709 respondents) on the basis of sampling of visitors of medical organizations. The survey established that percentage of positive responses of respondents concerning their awareness about which medical insurance company they belong slightly increased in 2017. However, every thirteenth still was unaware of it. Only every sixth respondent addresses to insurance company when occur problems related to medical care support. The right to choose insurance company, medical organization and physician was used by 17-22% of respondents in both surveys. In 2013 20% of respondents addressed nowhere due to absence of problems with health services support. In 2017, number of addresses to administrations of medical institutions increased up to 35%. The number of addresses to insurance companies and MMI foundations increased up to 13% and 27% correspondingly. The percentage of respondents with positive answers about being constrained to pay for medical services unofficially decreased up to 18% in 4 years and reached 12,6% in all sampling. Thus, activities concerning population information about changes occurring in health care system, including development of citizen rights is inadequate still. The citizens in number of cases are not interested to obtain necessary information and ignore it down to name of insurance company mentioned on their insurance policy.

Since the publication of the reports of the Institute of medicine “To Err is to Human” and “Crossing the Quality Chasm” considerable attention in medical organizations all over the world is paid to improving quality medical care and safety of patients. The improvement of quality can consolidate health care delivery systems, improve efficiency of health sector and accelerate achievement of health-related goals. Therefore, quality improvement nowadays occupies meaningful position in health care policy programs in countries with different income levels.

The indices of population health exhibit tendency to deteriorate with age. The high level of morbidity, prevalence of chronic diseases, polymorbidity, atypical course of disease, continuous rehabilitation period, frequent complications and exacerbations are specific for individuals over able-bodied age.The purpose of study is to analyze dynamic, structure and characteristics of morbidity of population over able-bodied age in the Russian Federation. The study established specific features in dynamics and structure of morbidity of elderly population during 2012-2018. They are associated with high prevalence of cardiovascular diseases, diseases of musculoskeletal system and connective tissue. Furthermore, there is variety in morbidity rates of neoplasms, endocrine, nutritional and metabolic diseases, mental and behavioral disorders, diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism, diseases of the eye and adnexa, diseases of ear and mastoid process and also symptoms, signs and abnormal clinical and laboratory findings, not classified in other rubrics.The analysis of indices of primary and common morbidity of pneumonia in elderly population of different regions of the Russian Federation was carried out.

The article presents characteristics of limitations of life activities of the disabled older than able-bodied age due to Parkinson's disease and considering clinical data, stages of illness, severity of disability and disorders of functions of organism. The highest percentage in the structure of life restrictions was taken by restrictions of first, second and third degree related to self-service, movement, labor activity (12.1%, 9.5% and 10.5% respectively). The lowest percentage of restrictions of first, second and third degree related to education, control and communication.

The purpose of study is to evaluate associations of polymorphism of genes encoding components of renin-angiotensin system and indices of echocardiography in examined patients with rheumatic heart disease (RHD). The sampling consisted of 128 patients with RHD and average age 58,96±0,34 years. The echocardiography was implemented using Philips Affinity 50 machine. The genetic typing was carried out according polymorphic markers Thr174Met, Met235Thr and А1166С by polymerase chain reaction in real-time with electrophoretic scheme of detecting the result of “SNP-EXPRESS”. The heterozygosis of Thr174Met results in larger dilatation of left sections of heart. The Thr174Thr homozygotes characterized by large linear dimensions of right heart. The Thr235Thr homozygotes characterized by minimal parameters reflecting hypertrophy of left ventricle of heart. There was no significant difference in echocardiography indices in patients with A1166A polymorphism. The mutations in codon 235 and 174 did not affect distance of 6-minute walk test. The statistically significant difference in the distance of 6-minute walk test was obtained only for А1166С: the minimum distance indicators is in the group of A1166C heterozygotes - 291,46 (273,83-309,09) meters and the maximum distance in С1166С homozygotes - 357,20 (309,21-405,19) meters. In patients with RHD, Thr174Met heterozygosis can lead to dilatation of left heart camera, while homozygosis for Thr174Mr leads to dilatation of right heart camera and left ventricular hypertrophy. The Met235Thr heterozygosis, on the contrary, are characterized by minimal sizes of left atrium and right ventricle. Polymorphism of the A1166C gene encoding angiotensin type I receptor had practically no effect on echocardiography indices in patients with RHD.

The article presents the results of research and practical social pedagogical activities carried out jointly by Laboratory of Social Projects of Belgorod State University, Borisovka Psycho-Neurological Boarding School and the non-governmental public organization of social initiatives “Faith”. The project was implemented during March - November 2018 in the Belgorod Oblast of the Russian Federation. The study implemented such methods of collecting primary sociological data as monitoring of educational and social activities of individuals with mental health problems residing in psycho-neurological boarding school; half-structured interview of experts - employees of psycho-neurological boarding school and teachers. Actually, social adaptation of individuals with mental health problems is an acute social problem. They belong to the most vulnerable population group wrapped with complex of social stereotypes and various signs of social deadaptation. The social adaptation of such personalities is achieved by involvement into social educational activities. The study results demonstrated that there are a number of psychological and pedagogical difficulties in face-to-face training for individuals with mental health problems. Among them are serious emotional reactions in response to actions of teacher or other students; behavior disorders, decreasing of education motivation, inadequate self-assessment. The remote education permits to avoid these and other difficulties. The individual with mental health problems while in appropriate comfortable conditions can receive effective education, support themselves materially and be useful member of society. The study established such most effective methods of remote education for individuals with mental health problems as information-receptive method; reproductive method; method of cognitive visualization of case studies from practice and research method.

For the reproduction of healthy society, it is necessary to pay special attention to self-preserving behavior of population, since health is not only medical, but also and social category. The health acts both as result of interaction of individual and the social environment, and as key condition for successful implementation of social statuses and roles, viability of social system as a whole. The spontaneous “health-saving” socialization, and, as a result, lacking of formation of behavioral patterns related to maintaining and strengthening health, imitation practices of self-care, which are demonstrated by different social demographic groups, especially young population, form danger of development of chronic diseases, further deterioration of national health indices, including decreasing reproductive potential of the state and increasing risks of for demographic policy in the future. This dictate needs for systematic analysis of factors and causes that lead to weak behavioral activity of Russian population in matters of “health-saving”, determining their significance and relationship with health indices. The expert survey was carried out that allowed to identify configuration of main factors and risks in the system “environment - health”, significantly affecting development of patterns of behavior in relation to it. The participation of experts representing various areas of professional activity (health care, physical education, ecology, state and municipal administration, education and science) proves high reliability of results and makes it possible to consider localization of main external dangers with highest rates of negative impact on development of self-preservation attitudes. The overall pattern of significance of various factors determining possible variations and main line of behavior of population of the central regions of Russia in context of health conservation allows to bring to foreground personal factors associated with willingness to ensure reproduction of one's own health, infrastructural and socio-economic factors that determine individual and group opportunities for Russia population to use potential of “health-saving” attitudes as well as factors of trust acting as an impulse, activating relationship of population and health care system.

The legal base framework regulating provision of palliative care in the Russian Federation was updated. In particular, the Federal law was amended to expand definition of “palliative care” and determine conditions for its provision. The completely new regulation of organization of palliative care has also come into force, including the procedure of interaction between medical organizations, social service organizations and public associations and other non-profit organizations operating in the field of health care. The publication uses data from genuine research on hospitalization in palliative care unit the needs of patients of older age groups in palliative care and long-term care activities are discussed.

The information about disease, its cause, prognosis, methods of diagnostics, treatment and prevention is always very important for patient and relatives. The article presents the results of questionnaire survey of 412 patients with chronic dermatitis residing in Moscow.The purpose of study was to evaluate awareness of patients with chronic dermatitis and residing in the capital of Russia about medical services provided and their rights to receive them.It was established that the information most frequently provided to patient by physician relates diagnosis. According to the survey, physicians always provide information about diagnosis in 84.9% of cases. The second place is for information about treatment methods and possible complications during treatment (82.0%). More rarely, physicians inform patients about the examination methods, possible unpleasant sensations and complications, side effects of medications and patient’s right to refuse examination and treatment, as well as the consequences of such a refusal. Absolutely all patients indicated the need to protect the rights of patients in case of their violation in the process of providing medical care. Moreover, 59.6% of them were sure about necessity to appeal to the administration of medical institution, 16.3% of patients considered it necessary to complain to insurance companies, 15.7% of patients to the Ministry of Health and 8.3% of patients to the court.

The chronic obstructive disease of lungs is considered as important problem of modern public health system. The disease is increasingly keenly reflected in agenda of our society, economic and social sphere of the state. The steadily progressing course of disease, disability and increasing economic costs assigns task of finding and improving diagnostic methods in real clinical practice. The purpose of the study is to assess the medical social significance of new approaches to studying functional status of patients with chronic obstructive disease of lungs in routine clinical practice. The sampling of 105 males were examined: 64 patients with chronic obstructive disease of lungs and 41 volunteers from control group without any diseases of respiratory system. All examined patients underwent spirometry, sixth minute step test, analysis of heart rate variability and test with external peripheral vascular occlusion. The study results established high level of importance of complex assessment of functional status of patients in routine clinical practice. The patients with chronic obstructive disease of lungs with respiratory failure demonstrated persistent hyperactivity of ergoreflex during test with external peripheral vascular occlusion. Therefore, method of assessing ergoreflex according to heart rate variability indices is applicable in clinic and has perspectives of implementation as mode of additional diagnostics of functional disorders.

The increased access to effective anti-retroviral treatment (ART) has made HIV comparable to chronic disease in terms of life expectancy. The advances in scientific knowledge and, in particular, in management of HIV-infected pregnant woman have reduced the risk of mother-to-child transmission of HIV. The analysis of current research demonstrates that HIV has been a problem in terms of sexuality and reproduction. The needs related to sexuality and reproduction are crucial ones to overall health and well-being of HIV-infected population. The future research is to focus not only on how sexual relations and relationships of HIV-positive women are manifested, but also on how health care system is to provide adequate support to women in relation with sexuality and reproduction. The purpose of study was to apply analysis of current research on sexuality, sexual and contraceptive behavior and implementation of reproductive function in HIV-infected women and the conditions affecting this realization. The review of national and international scientific publications concerning such areas as gynecology, reproductive health, sexuality and reproductive behavior of HIV-positive women from indexed on-line journals and relevant websites using such search engines as PubMed and Google in 1997-2019. The sample included 34 peer-reviewed qualitative studies, which covered 9523 HIV-positive surveyed women. The technique of interpretative meta-synthesis was applied to generalize and evaluate how experiences of HIV-positive women in sexuality and reproduction behavior have been described in qualitative studies. The effective anti-retroviral treatment has made HIV comparable to chronic disease in terms of life expectancy. The analysis of current research on this topic established that HIV was a problem in terms of sexuality and reproduction. The conditions that make the burden of HIV more severe are: HIV is an obstacle for starting and continuing relationship, providing sense of fear and loss. At the same time motherhood, spiritual beliefs, and supportive relationships made the burden of HIV easier. The HIV-positive test in women makes their sexual and reproductive health more complicated because of HIV status. Therefore, women face such unique challenges as problems in partnerships, sexual satisfaction and childbearing. The study results are important for developing optimal medical care to alleviate the burden of HIV infection. In addition to medical care, health care workers should consider social and psychological needs to support HIV-positive patients in improving their health and their sexual and reproductive health as well.

The article analyzes topical issues of organization of patronage medical care of patients with restricted mobility in Moscow, considering ongoing organizational measures at various stages of implementation of new organizational form of medical sanitary care of patients of different age groups. The results of analysis of effectiveness of its functioning are presented.

Nowadays, in Russia number of problems is present in effective personnel policy in health care. The National Concept of personnel policy in health care (2002) expired in 2010 and no new one was developed. However, corresponding program documents were adopted at the level of subjects of the Russian Federation. The purpose of study was to compare evaluation of program documents of subjects of the Russian Federation related to issues of personnel policy in health care. The continuous sampling technique was applied to study these documents, which were valid in the territories of all subjects of the Russian Federation in 2002-2019. The comparative assessment was performed. It is demonstrated that the most informative document in this area is only the corresponding specialized Concept. However, this document was adopted only in 8.2% of the subjects of the Russian Federation, and they were valid only in two subjects. The concepts of health care development in the subjects of the Russian Federation, addressing medical personnel policy were adopted in 44.7% of the subjects of the Russian Federation. However, these legal documents operate only in 15.3% of territories. At the same time, the availability of appropriate specialized program document is a prerequisite of development of coherent and effective medical personnel policy in health care at all its levels.

The article analyses financial and statistical aspects of materials from the Interdepartmental Commission for the Revision of Medical Legislation (the G. E. Rhein Commission). The brief analysis of structure, composition and mechanisms of functioning of the Commission is presented. The specificity of the Commission materials is discussed. The information sources are established which were used as background for statistical calculations of the Commission. The calculations themselves are briefly discussed. The particular attention is paid to methods of calculating financial losses in the Russian Empire due to diseases. The study focuses on state health statistics projects and on the financial foundations of the new health care system as well as on their perception by the participants of the Pirogov Society. The data obtained by the Commission was used for devising plans for optimization and centralization of health care, according to which sanitary statistics were to be subordinated to the state. However, financial support to local self-government bodies for sanitary needs was mentioned. Although the physicians from the Pirogov Society had critical attitude to most ideas of the Commission, in the matter of financing they were not only agreed upon with main proposals of the Commission but were also ready to go even further.

The article is devoted to the academician I. D. Strashun, constitutor of the USSR Academy of Medical Sciences, prominent scientist, hygienist, historian of medicine and notable specialist in the field of medical education and health care organization. During the years of restoration of national economy after the end of the Great Patriotic War, the extremely important issue in the activity of the Academy of Medical Sciences of the USSR was implementation of ideological political work with scientists, also supposing unmasking false scientists worshiping bourgeois science. The academician I. D. Strashun too got into millstones of the “struggle against cosmopolitanism”. The article uses materials from the personal files of academician I. D. Strashun belonging to the scientific archive of the Russian Academy of Medical Sciences.