Problems of Social Hygiene,
Public Health and History of Medicine

The article is devoted to the study of motivation of medical organization employees to work. A competent system of motivation of medical personnel, focused on building long-term goals and development conditions, supporting the organizational climate and increasing the involvement of medical workers in their work, solves most of the problems that any medical organization faces. In addition, the policy of the medical institution, the values of the management itself and a favorable psychological climate are important factors in motivating doctors and nurses. In this regard, the purpose of this study is focused on identifying a group of motivational factors that encourage medical professionals to effectively perform their work duties. On the base of the developed sociological tool - a questionnaire for a mass survey - there were collected and analyzed data on the factors which affect the motivation to work of medical workers. As a result of the conducted research, the most significant motivational triggers were identified, which allow to assess the health of medical workers, as well as to identify problematic points that make it difficult to perform the duties in a high-quality manner. These data formed the basis of the method proposed by the authors, which allows any medical organization to identify a group of system-forming factors of motivation to work, on the basis of which the management of medical institutions has the opportunity to assess the motivation of the personnel for further decision-making in the framework of effective management.

This article presents the results of a study on the relationship between indicators of accessibility of citizens to primary health care (PHC), based on the data of the Unified medical informational analytical system of Moscow (EMIAS) and the results of the survey of physicians of medical institutions of the state healthcare system, providing primary care to adults. The analysis of scientific publications has shown that when assessing the availability and quality of medical care, taking into account public opinion, the main attention is paid to sociological surveys of citizens and less often the opinion of medical personnel who provide medical care to citizens is studied.The analysis of the information from foreign sources has shown that the availability of primary health care is a hot topic in many countries all over the world, including the countries with a high level of GDP per capita.The survey of medical men, which was attended by more than 500 doctors, was conducted in six medical organizations in Moscow that provide primary health care to adults. The questionnaire contained 26 questions, the answers to which reflect the personal opinion of doctors about their attitude to the improvement of their professional skills, satisfaction with working conditions, the organization of PHC and its accessibility to the population, etc. EMIAS The data were used to calculate individual indicators that characterize the population's access to PHC.The results of this scientific study confirmed the existence of a high correlation between the responses of doctors and indicators calculated on the basis of EMIAS data, which indicates the feasibility of using the opinion of medical personnel to make timely and effective management decisions aimed at optimizing organizational processes to ensure public access to medical care.

Accuracy of statistical registration of mortality in Russia, especially in times of crisis, is a pressing and relevant issue; this problem was challenging Moscow in the 2000s: until recently, the capital was a complete outsider in terms of accuracy of statistical registration of mortality. The purpose of the study was to identify peculiar features of evolution and the structure of mortality from an event of undetermined intent among Moscow working-age population in the 2000s against the background of the processes taking place in Russia. The article analyzes mortality from an event of undetermined intent among Moscow population of young and old working age in the 2000s, as well as its nosological aspects in 2011-2018, when certain events of undetermined intent were separated as individual nosological units. A sharp decline in indicators in 1999-2000 and their growth in 2015-2017 have been identified. It is shown that these shifts were due to all leading events of undetermined intent (falls/jumps from a high place, hanging/strangulation/suffocation, medicament, alcohol and drug poisoning as well as specified and unspecified events). As a result, the structure of mortality after 2015 has significantly changed due to a sharp increase in the significance of alcohol, medicament and especially drug poisoning. It should be emphasized that in the 2010s the significance of latent suicide in all age and gender groups of Moscow working-age population is significantly higher than in Russia.

The article discusses the prospects for the institutionalization of mentoring in health care, including difficulties arising along this path and tools to minimize them. The relevance of the study is justified by the increased attention in recent years to the problem of insufficient use of mentoring by the government and the scientific community and plans to legislatively consolidate the possibilities of using this mechanism in medicine. The article is based on the results of a number of field studies conducted in 2019-2020 together with the NIIOZMM DZM team, including a mass questionnaire survey of Moscow medical workers, a series of interviews with experts, a questionnaire survey of experts and a case study of best mentoring practices in all regions of Russia. In 2019, a questionnaire survey was conducted among doctors and nurses (551 respondents) and a series of in-depth structured interviews with the chief doctors of the respective organizations, representatives of medical colleges, universities and institutions of additional professional education (15 interviews). In 2020, an expert survey was conducted (using a specially designed questionnaire) of the chief doctors of medical organizations subordinate to DZM (31 experts), a series of in-depth structured interviews with the head physicians (8 interviews), as well as a case study of the best mentoring practices in all regions of the Russian Federation . The research was aimed at identifying opportunities, limitations, and tools for institutionalizing mentoring in health care. The research results show that, despite a number of limitations - a high burden on medical staff, lack of regulatory support, etc. - nevertheless, it is possible to implement and consolidate an effective mentoring system, including the tools presented in the article.

The article presents the results of a psychological study of patients with principal disabling pathologies that form the main structure of disability in the Russian Federation due to malignant neoplasms: diseases of the circulatory system; diseases of the musculoskeletal system and connective tissue; diseases of the endocrine system and metabolic disorders (diabetes mellitus of the first and second types). The article presents the results of studying a sample of patients by various psychological parameters, provides statistical comparisons of psychological characteristics of patients depending on the specifics of their social situation, in which patients either claim to be disabled and are under conditions of medical and social expertise, implying the possibility of changing social status, or patients of the same nosological categories, who do not claim to be disabled and who are rehabilitating on the basis of their own personal and socio-environmental resources outside of the “disabled” status.Psychological techniques are presented, the specificity of emotional and personal parameters is analyzed and characterized, including personality frustration and experience of the significance of the disease in the spheres of life, self-esteem indicators, identification characteristics, strategies that provide rehabilitation adherence, which characterize the activity of patients in the compared groups in many ways. The conceptual position that defines the activity of patients as «rehabilitative» has been substantiated. The results of the study revealed statistically significant differences in psychological indicators in the compared groups of patients rehabilitating outside the “disabled” status and patients claiming to be disabled. The indicators obtained in the study indicate that the personal self-regulation of patients rehabilitating outside the «disabled» status qualitatively differs from the self-regulation of patients claiming disability, in terms of stable self-esteem and belief in the ability to realize life in significant areas of social functioning, in the ability of perspective planning of the future, in active self-realization of social roles, active participation in interpersonal, leisure, professional, household and other spheres, high responsibility for one's health, against the background of stable emotional perception of the current social situation of the disease.

The aim of the study was to study excessive daytime sleepiness (EDS) among the residents of Chuvashia. 2161 residents of the republic were interviewed (men - 1007, women - 1154) aged 18 to 70 (average - 36.5 ± 13.8 years old). The Epworth Sleepiness Scale and NoSAS test were used to assess the risk of obstructive sleep apnea syndrome (OSAS). Mathematical and statistical processing included descriptive statistics, one-way analysis of variance and calculation χ2-distribution.EDS was detected in 846 people (39.2%), without any gender difference and their place of residence. The respondents with EDS were older and had a larger body mass index. With age, the number of individuals with EDS rate increased, reaching the maximum in the age group of 61-70 years. EDS was more often observed in respondents with diseases, sleep disturbances, regular alcohol consumption, smokers, as well as snoring, respiratory arrest in sleep, increased blood pressure and/or treatment for it, and tiredness during the day. The probability of OSAS by NoSAS was determined in 295 people (13.7%), in 21.4% of men and 6.9% of women; EDS was present in 45.4% of the respondents with OSAS.The spread of EDS in the population makes it possible to recommend doctors of various specialties to pay attention to this act as well as to the described risk factors in patients as highly probable grounds for qualifying OSAS, its targeted diagnosis and treatment, as well as comorbid pathology.

One of the main duties of the Russian Federation is to respect and protect the rights and freedoms of its citizens. In addition, the Russian Federation as a social state the activities of which are designed to provide a decent life and a high level of social protection for all categories of the citizens, without exception, by regulating social, economic and other spheres of society provides social support to all segments of the population, paying special attention to certain categories of citizens which, due to life circumstances or health conditions, need social assistance and special support from the state. The main massif in the category of socially unprotected layers of the population are people with physical disabilities. Comprehensive support for the above category of citizens is carried out, among other things, based on the decision of the medical and social examination. However, the current situation has greatly complicated the on-site examination of disabled people and predetermined the correspondence order as the only possible mechanism for medical and social examination during the coronavirus pandemic. Thus, in fact, conditions close to emergency sent medical and social expertise to the path of telemedicine.

Aim: to estimate the quality and availability of medical care for patients with ulcerative colitis (UC) and Crohn’s disease (CD), to assess the impact of the economic burden of these diseases on the healthcare budget of Russia and to systematize the main problems in the organization of medical care and drug supply for patients with inflammatory bowel diseases (IBD).Regional IBD databases (2016-2018), official statistical databases, costs of treatment and results of expert interviews with specialists in IBD were used in the study.The analyzed databases showed 104,668 patients with UC in Russia in 2018 (prevalence rate 71 per 100,000 people) and 66,647 patients with CD (prevalence rate of 45 per 100,000 people). The economic burden including agents for biologic therapy (ABT) for the UC was 39.54 billion rubles a year (495 rubles per capita), and CD - 32.98 billion rubles a year (378 rubles per capita). It requires an additional 9.87 billion rubles annually for UC and 9.20 billion rubles annually for CD patients to provide the complete supply with ABT.The annual burden of IBD is 72.52 billion rubles, which is comparable to the costs of other socially significant diseases, including malignant tumors. It shows the high social and economic value of IBD for the country. The main problems of medical care and drug supply for IBD patients are the mismatch of official statistical data and real IBD prevalence in Russia due to absence of comprehensive register and the insufficient supply with ABT due to limited funding. A federal center for IBD should be founded for better quality of registration, for the precise monitoring and for the active management of personal drug supply.

Evaluate the cost-effectiveness of various options for the supply of direct antiviral agents for patients with chronic viral hepatitis C.An analysis of the data of Moscow Department of Health on the drug supply of patients with chronic hepatitis C antiviral drugs at the expense of budgetary funds in Moscow was carried out. The direct medical costs of the urban healthcare system for the use of direct antiviral action drugs for the period from 2017 to 2019 were calculated.For the period from 2017 to 2019, 6,936 patients with chronic hepatitis C received medication with antiviral drugs at the expense of budget funds in Moscow. An increase in the number of patients compared to the base (2017) year was noted by 76%, as well as an increase in the volume of interferon-free antiviral therapy sets against the background of an increase in budget expenditures by 212%. The average level of cost for all sets with direct antiviral drugs amounted to 689,844 rub. The most commonly used set is Dac + Asu. The average cost of this set per patient treated as part of the first-line antiviral therapy was 58,899 rub. cheaper than a set of 3D, and 58,861 rub. more expensive than the Grz/Elb set, while the need for retreatment for the Dac + Asu set was 8.4%, and for the 3D, Grz/Elb and Gle/Pib sets, 0.58%, 0% and 0%, respectively. An even greater excess of the average was recorded for the Sof + Dac, Sof + Sim sets: which naturally entailed the excess of the costs of treating one patient with this distribution of treatment sets and financial resources by 253,236 rub. and 189,173 rub., respectively, which is 1.36 and 1, 27 times the average cost of all prices for antiviral treatment sets. Most often, re-medication was provided to patients who were initially provided with Sof set (33%), followed by Sim + Dac set (18.6%), 8.4% of re-medication cases were registered in patients who received Dac + Asu set as the first line of therapy. Budget costs for the second and subsequent sets of therapy increased by 92,739,115.30 rub.

This article presents the results obtained during the analysis of different types of health technology assessment (HTA). In the world HTA agencies can be organized at the national (federal), regional or local levels; they can have various levels of dependence on public authorities (independent, public, dependent), various sources of financing (state, mixed). The nature of the tasks and the range of powers of the institutions for HTA differ: regulatory, organizational or advisory. They themselves can initiate HTA (proactive), or they can conduct HTA at the suggestion of the applicants and analyze the quality of the HTA reports provided (reactively). HTA can be focused on economic assessment, comparative clinical assessment, as well as balanced, both on economic and comparative clinical assessments. HTA may be conducted on drugs, medical devices, and other medical technologies. The methods for conducting HTA significantly depend on its subject. In terms of the scope of the assessment, it is possible to single out full OMT, mini-OMT and express-OMT, as well as fast-track-OMT, proposed by the HTA agency in the UK. The final users of HTA (administration, suppliers, patients) and its perceptions (instrumental, conceptual, or formal) are specified. The impact of HTA on decision-making is progressively increasing, as the number of medical technologies that should be assessed to maintain budget discipline is increasing. The versatility of HTA indicates its universality and can contribute to the further expansion of its application at various levels of medical care around the world.

Since January 1, 2019, the Russian Federation has entered the global medical tourism market thanks to the approved federal project “Development of the export of medical services”. The level of attractiveness of a country as a global destination for medical tourists is determined by a number of factors: the level of medical technology, transport accessibility, proximity to donor countries of foreign patients; the level of realization of export potential, international reputation, medical marketing; the level of healthcare organization, international staff training, etc. Among the factors determining the success of the country as the destination of medical tourism, a special place is held by the recreational complex, spa treatment. The level of development of the recreational complex within the framework of medical tourism performs several tasks at once: it provides a full cycle of medical assistance to foreign medical tourists - from outpatient admissions and in-patient treatment to rehabilitation and recovery; sanatorium-resort treatment and rehabilitation are considered not only as an integral part of the complex of medical services, but also as an independent promising direction for the export of medical services by domestic health resorts. Also, the fight against the consequences of COVID-19, when hundreds of thousands of neighboring states citizens need qualified rehabilitation, can become a driver for the development of the sanatorium-resort complex of Russia. The purpose of the study is to identify bottlenecks in the development strategy of the recreational potential of the regions of the Russian Federation and make suggestions for its improvement. The number of foreign patients who received medical care from January to May 2020 in the federal districts is 729,000. This indicator was achieved during the pandemic, and therefore does not reflect the true potential of rehabilitation as an element of the full cycle of medical care for foreign patients. The target audience for rehabilitation programs is up to 100,000 foreign patients.

The efficiency of health care and the quality of medical care can be improved by implementing modern management methods and technologies. It requires modern and high-quality training of medical management personnel. Qualified personnel are the key factor in the organization and transformation of the health system. Human resources ultimately ensure the efficiency and effectiveness of the entire health sector. Requirements to economic management methods are changing and increasing, and specialists with skills in managing medical organizations at different levels of the healthcare system are becoming in demand. At the level of the constituent entities of the Russian Federation, the role of medical personnel who possess strategic methods of healthcare management is increasing. Available training programs in leading higher educational institutions of medical profile do not fully fulfill these tasks due to limited time, a large volume of lecture material, and frequent changes in the conditions and tasks of health care. These problems can be solved by optimizing training programs for retraining and advanced training of health care organizers, introducing active training methods such as business games, case methods, and project activities into the curriculum. The paper describes the system of training students for training courses in the field of healthcare and public health through planning and implementation, project management in the context of military educational organizations of the Ministry of Defense of the Russian Federation, the statistical analysis of the training effectiveness, the factors that influence the success of development programs.

More and more often, medical workers have to provide assistance to patients with HIV infection with acute disorders of vital functions who require intensive care and resuscitation. The main task of clinicians is to quickly stop the symptoms of secondary diseases that have led to the complications (specific and nonspecific) so that the patient can start or continue antiviral therapy. The aim of this work was to present the first experience of successfully treatment of a patient with progressive HIV infection using stenting of the main bronchi with their critical tumor stenosis in complex treatment. Conducting temporary endoscopic recanalization of the lumen of the large airways made it possible to avoid transferring the patient to artificial ventilation of the lungs, to carry out the necessary complex of diagnostic and therapeutic procedures, to restore ventilation and aeration of the lungs, which led to an increase in blood oxygenation and some improvement in the patient's general well-being.

The purpose of the study is to determine the relationship between risk factors for the development of chronic non-communicable diseases and first-time preliminary diagnoses during the medical examination of the adult population of Eastern and South - Eastern administrative districts of Moscow.Determine the risk factors that cause the most significant effect for the development of diseases of the endocrine system and eating disorders and metabolic disorders. The analysis of the medical examination data with a comprehensive assessment of the data from industry statistical reports, including the report form N 131, approved by the order of the Ministry of Health of the Russian Federation.It was found out that the risk factors identified during the medical examinations cause the development of chronic non-communicable diseases and the dynamics of indicators for the identified risk factors for obesity and established preliminary diagnoses of obesity from endocrine system diseases, eating disorders and metabolic disorders are equally directed.These percentages of preliminary diagnoses established during the medical examinations can be used for rapid assessment of the quality of the medical examinations and the adoption of cross-sectoral connections and measures aimed at preventing the development of this pathology at the regional level, with a broader implementation of preventive measures to improve public health, including monitoring and measures to reduce the impact of risk factors associated with insufficient physical activity, poor nutrition through the involvement of agencies, responsible for maintaining urban planning and transport policies and requirements for the urban environment, as well as the availability of medical care.