Problems of Social Hygiene,
Public Health and History of Medicine

Nowadays, the most important place in medicine is occupied by ethical and legal aspects of organization of medical care and the provision of qualitative medical services to citizens. The main mechanism of functioning of the patient-centric health care system is implementation of the rights of patients as described in our country within the framework of international legal acts, the Constitution of the Russian Federation, the Civil, the Civil Procedure and Criminal Codes of the Russian Federation, as well as the Legislation on the protection of health of citizen.Since the mid of twentieth century, in many countries was widely discussed possibility of ensuring one of the most controversial and non-obvious rights of patient - the right to death. In medical practice, the mechanisms implementing this right are the acts of euthanasia, the assisted suicide, the voluntary death (refusal of water and food), “murder out of sympathy”, terminal sedation and the phenomenon of “double effect” as well.The article presents review of scientific publications presented in national and international databases, highlighting prerequisites of implementation of euthanasia into practice and international experience of applying this mechanism of demise as well.

The gene therapy is totally new approach to treatment of patient. It has significant therapeutic potential for wide range of diseases, including those caused by genetic disorders. The in vivo therapy is one of types of gene therapy meaning that impact on gene apparatus of somatic cells occurs straight within organism of patient. Among significant advantages of of this kind of therapy is potential opportunity of treatment of diseases which previously had no effective therapy or only supportive symptomatic therapy was administered. The article describes international approaches to classification of gene therapy preparations. The review of in vivo gene therapy preparations currently registered in different countries. Also, the features of their development, production and registration are analyzed. For many in vivo gene therapy preparations, due to small number of patients, clinical evidence base is limited, especially in terms of long-term clinical effect that complicates process of registration and economic evaluation for subsequent their inclusion in the system of state funding. It should also be noted that gene preparations currently registered abroad have extremely high cost that limits their widespread implementation into clinical practice. The production of gene therapy preparations requires a number of additional measures targeted to supporting product quality that complicates process of their production and registration. Due to absence of necessity in large production capacities, gene therapy preparations are produced centrally that results in their logistic complexities. It is actual to analyze international experience of distribution of in vivo gene therapy preparations in order to optimize approaches to regulation, assessment and financing of gene technologies in the Russian Federation.

The article analyzes the demographic situation in the Republic of Dagestan and presents analysis of indices of population mortality and life expectancy. It is established that number of deaths per 1000 people of the Republic of Dagestan is one of the lowest not only in the Northern Caucasus, but in the country at large. At the same time, high mortality indices are determined in elder age groups both in Dagestan and on average in Russia. The main causes of death in the Republic of Dagestan are diseases of circulatory system and respiratory system, neoplasms, accidents, poisoning and traumas, which account almost three quarters of all cases of deaths. However, mortality indices in Dagestan from diseases of circulatory system, neoplasms, digestive system diseases, infectious and parasitic diseases are significantly lower as compared to the national average level. In Dagestan, one of the highest indices of life expectancy is observed as compared with other subjects of the Russian Federation (2nd place in the Russian Federation) - on 6 years exceeding the national average level (in males, difference in values of indicator amounted to 7.5 years). In Dagestan, during analyzed period, life expectancy at birth increased more than on 5 years.

The study was organized to evaluate influence of risk factors on hospital mortality in patients with acute stroke because incidence of stroke in patients of able-bodied age is increasing. All cases of in-patient care of patients of able-bodied age with acute stroke (n=4118) in the Tyumen Oblast clinical hospital № 2 during 2010-2018 were analyzed. The study was based on sampling data from hospital medical records. During the analyzed period, decreasing of in-patient lethality up to 34.9% in patients of able-bodied age was observed. During the period of “therapeutic window” 60% of patients of able-bodied age admitted died. The multivariate analysis was applied to assess influence of different factors on in-patient mortality. The presence of coronary heart disease increases risk of mortality up to 47.5%, Exp(Beta)=1.475, employment - up to 66.8%, Exp(Beta)=1.668 as compared to baseline risk. The presence of arterial hypertension and remoteness of symptom onset in ln (hours) (hospital admission) decreases mortality risk up to approximately 39.7%, Exp (Beta)=0.603 and up to 24.0%, Exp (Beta)=0.760, respectively (specificity - 75.86%, sensitivity - 72.18%; overall diagnostic accuracy - 75.23%). In patients of working age the presence of coronary heart disease and elder age are risk factors of stroke. The presence of coronary heart disease and employment are risk factors of in-patient mortality. Whereas presence of hypertension and employment decreases risk of lethal outcome.

The thyroid cancer is the most prevalent oncologic disease of endocrine organs, characterized by multi factorial risk of development. The purpose of the study was to analyze dynamics of indices of thyroid cancer morbidity of population of the Russian Federation, considering gender and age differences in 2008-2018. The increase of “rough” indicator of thyroid cancer morbidity of male population made up to 56.6%, and of female population - 48.3%. The dynamics of standardized indicator in gender contingents was characterized by increasing up to 48.7% in males and up to 43.9% in females. There is an increasing of thyroid cancer morbidity with age and prevalence of the morbidity in females as compared with males in all age categories. The highest morbidity was established in male population aged 65-69 years (8.3 per 100,000 population) and in females aged 55-64 years (27.3 per 100,000 population). In the territories of the Russian Federation, in the gender aspect, variations in thyroid cancer morbidity were established. both in male and female populations, maximal thyroid cancer morbidity was established in the North Western and Siberian Federal Okrugs, and morbidity below national level was registered in the Privolzhskiy and North Caucasian Federal Okrugs. It is necessary to take into account differentiation of the territories of the Russian Federation in terms of the thyroid cancer morbidity in different gender and age groups for development of rational measures of early identification of risk factors, diagnosis and treatment of patients.

In actual conditions health care priority is in increasing population size and its life expectancy including duration of healthy life, reducing morbidity, mortality and disability of population, observance of rights of citizens related to health protection that can effectively be achieved by adherence of healthy lifestyle.In order to determine possibility of improving motivation of population to lead healthy lifestyle, through formation of leadership qualities in medical specialists, the study applied such methods as expert evaluation, questionnaire survey, interview, monographic and statistical techniques. The sampling consisted of 46 employees of the I. M. Sechenov First Moscow State Medical University as experts, 107 students of this educational organization were involved in questionnaire survey and interviewing, and 68 of them were included in the group with pronounced leadership qualities, and 39 respondents consisted the control group.Involving population into healthy lifestyle is priority task of all medical specialists that is regulated by work functions of their professional standards. The effective direction of this work is to influence internal motivation of citizens. The presence of leadership qualities in future medical specialists increases their ability to motivate the population to lead healthy lifestyle at the level of theoretical training by 33.3% and practical training by 65.5% as compared to control group. The main directions of improving motivational work to involve population into healthy lifestyle by future medical specialists is refusal by students’ bad habits, teaching them specialized topics in all related disciplines, formation of students' leadership potential. To develop student’s leadership skills, training program can be applied in the laboratory of excellence “Factory of health leaders”, implemented at the N. A. Semashko Department of public health and health care.

Every year number of eye diseases among children and adolescents is steadily increasing. The most possible causes of this process are sedentary life-style, computerization of society and school curriculum characteristics. The survey of 209 parents of children and adolescents was organized and carried out. The study established that modern children spend much more time at screens than it is recommended by regulatory documents. The pathology of eye was diagnosed in 46.9% of children, 39.2% of children are regularly observed by ophthalmologist. 53.6% of children are regularly observed by an ophthalmologist. Among parents whose children are monitored by ophthalmologist, 55.3% mentioned inaccessibility of medical appointments, that makes impossible regular corresponding medical check-ups and results in progressing of diseases present and development of new ones. The ophthalmologist plays key role in maintaining visual analyzer health. To effectively prevent visual organ pathology, it is necessary to achieve comprehensive interaction of ophthalmologist, teachers (preschool teachers), parents and children themselves.

The article presents basic methods of assessing and calculating production potential of medical organization. providing specialized medical care in round-the-clock hospital. The described techniques are used to develop standards of provision of medical care as part of territorial program of state guarantees of free medical care for citizens and to improve organizational processes of provision of medical car that allows to more efficiently apply available resources of medical organization.

The reliable statistical information is undoubtedly an important point in making any management decisions. The main instrument for recording and analyzing health data is international statistical classification of diseases and related health problems, 10th revision. The article presents results of study of quality of coding information concerning hospital morbidity and mortality of patients of palliative care department of multidisciplinary hospital.

The achievements of modern medicine resulted in an increase of number of patients living with chronic diseases that turned out as significant burden for national economics. The oncologic diseases are one of the most widespread ones, determining patient vital prognosis. The modern achievements in medicine determine possibility of optimizing clinical prognosis and chronic course of disease. In modern Russia, the health care system functions in accordance with model of urgent, fragmented medical care that does not meet current needs of patients with chronic diseases.In Russia, actual procedures of medical care of oncologic patients do not consider interdisciplinary continuum scenario. Therefore, the need for its conceptualization. The article proposes model of continuum of oncologic care of patients in the context of an integrated health care system, that presupposes complex interdisciplinary follow-up of patients with chronic disease in situations of disease.

The personnel policy is one of priority areas of developing national health care. Its effective implementation requires evidence-based development of relevant program documents, the most important of which is the Concept of health care personnel policy that currently exists only in a number of regions of the Russian Federation. In this regard, the purpose of the study was to develop approaches to scientific justification and development of the Concept of health care personnel policy at the level of region of the Russian Federation, as exemplified in the Irkutsk oblast. The article describes progress of this large-scale and lengthy study, its main results included. The developed approaches resulted in comprehensive organizational technology of development corresponding Concept. The results of this experience can be implemented in other regions of the Russian Federation. Therefore, it is of scientific and practical interest for all potential developers of similar program documents and wide range of specialists in health care organization.

The article considers main directions of health care reform in the USSR during first post-war decades. The brief description of the state of health and health care in the USSR on the eve of the reform is presented. The main transformations implemented in 1945-1965 are adduced and analyzed. The corresponding impact on changes in medical demographic indices is demonstrated.

The article is devoted to the history of organization and functioning of the section of physician everyday life at the sessions of the Congress of the Society of Russian Physicians in memory of N. I. Pirogov (Pirogov Society). The section, going beyond everyday life and occupational problems, considered issues related to economic and legal status of physicians. The section, having no hope in government assistance, tried to organize public organizations protecting interests and rights of physicians and loan-society as well.

Nikolai Olegovich Milanov, the academician of the Russian Academy of Medical Sciences, leading Russian surgeon, Merited Scientist of the Russian Federation, is one of the pioneers of development of reconstructive microsurgery in our country. He made immense contribution to development of modern plastic and reconstructive microsurgery. He is the author of unique developments that inputted significantly into successive achievements in treatment of traumatic and iatrogenic tissue defects and congenital pathology. The priority areas of his research were replantation of fingers, hands and larger segments of limbs in adults and lower extremities in children, abjuncted because of wheeled traumas, auto-transplantation of revasculized tissue complexes in post-traumatic, congenital and acquired pathologies in adults and children, in oncologic diseases, in extensive tracheal defects, reconstructive microsurgery of blood and lymph vessels and peripheral nerves, reconstructive microsurgery in male and female infertility. He introduced to clinical practice great number of new surgical interventions based on micro-surgical auto-transplantation of various tissue complexes. He achieved brilliant successes in scientific and practical activities during 39 years of work. He was the first in the world who underwent a successful re-implantation of lower limb, amputated at the level of upper third of leg by train wheel in 2.5-year-old child. He also was the first surgeon who performed unique operation of simultaneous replantation of two limbs, amputated at the level of middle third of leg in 7-year-old child. N. O. Milanov used the micro-surgical technique of applying direct lymphatic venous anastomoses in lymphatic edema. He developed innovative methods of multiple transplantation of toes to hand and transplantation of omentum, for example, to close defects of the scalp in basal cell carcinoma. This brilliant surgeon can be called the founder of clinical auto-transplantology. He actively participated in resolving problem of “prefabrication” of various tissue complexes with desired properties for their subsequent auto-transplantation. Under the direction of N. O. Milanov, the new scientific school was formed that included such well-known surgeons as R. T. Adamyan, A. I. Nerobeev, I. V. Reshetov and many others.