Problems of Social Hygiene,
Public Health and History of Medicine

At all levels of society, almost polarizing attitudes towards coronavirus are manifested, ranging from panic and empty store shelves to complete denying the existence of coronavirus problem. The wave of coronavirus parties and as well as demonstrations against restrictive measures related to infection swept the world. In addition, protests against arrivals from COVID risk areas are known. Stigma and fear can severely impede efforts to manage the spread of COVID outbreak. The predisposing factors in development of COVID stigma are lack of knowledge, rapid virus spreading, relatively higher mortality and absence of effective treatment. Meanwhile, at the level of society, particular processes are taking place, when not only infected ones, but also healthy members of society become subject to stigmatization, that can be determined as “probably” infected. The article supplements information to improve actual knowledge among specialists concerning various approaches and methods of preventing mental disorders due to stress epidemiological situation in the world.

The COVID-19 pandemic impacted tourist business on global scale dramatically. The medical tourism always was considered as the most stable and the least subjected to external circumstances. However, spreading of coronavirus infection shortened both number of arrivals and volume of medical services provided within the framework of their export. The article presents data reflecting COVID-19 pandemic impact on development of medical tourism market.

The article considers the problem of attitude of the youth to vaccine prevention of influenza. The study was organized on the basis of qualitative research methods (focus groups) of students of two universities in the Central and Volga Federal Okrugs. The data about attitudes towards vaccination and refusal motivation was obtained. The need in increasing awareness of the youth about vaccine prevention as an actual health-preserving technology was substantiated.

The attitude to high physical loads on organism in the middle and older age groups is ambiguous, from optimistic to completely pessimistic, associated with possibility of development pathological processes because of high physical activity. The purpose of the study is to evaluate health status of people aged 40 years and older involved in sports . The health data was obtained through interviewing athletes aged 40 years and older competing in track and field events at distances of 10 kilometers or more. In total, 1800 questionnaires were distributed, and 1649 completed questionnaires were returned. The analysis of health status was implemented on the basis of self-rated health and objective characteristics (medical care appealability, acute diseases incidence, chronic diseases availability, fact of medication intake). The very high level of health self-rate was established in individuals involved in sports, that persisted along age increasing. No gender differences were revealed (4.00-4.07 for males and 3.89-4.08 for females). According to survey results, less than half of male respondents consulted physician during a year. The level of appealability was stable in all age groups surveyed. The average rate of acute diseases per year in athletes of older age groups did not exceed 1.16 diseases per year and was slightly higher in females. With age, the indicator tended to decrease in males and to increase in females. The prevalence rate of chronic diseases was low in both males and females and with age it tended to increase in males and remained almost stable in females. The rate of regular medication intake was lower than rate of chronic diseases, this difference was especially significant in females. According to respondents, sport activities, despite heavy loads and age, contribute to organism health enhancement. This opinion was specific for more than 90% of athletes, regardless of their gender. In the oldest age group (60 years and older) 94.3% of respondents expressed reported that their health improved after starting running. However, sufficient number of athletes are concerned about potential risk of training that is the reason to organize system of medical monitoring of athletes, especially in older age groups.

The growth of population older than working age with specific age characteristics and problems inevitably results in increasing number of their visits to physicians both in out-patient and in-patient organizations. The purpose of the study is to evaluate indices of hospital medical care of patients older than working age based on the beds profile in the Russian Federation during 2012-2019. The comprehensive study was organized to investigate dynamics of the main indices of inpatient medical care of people older than working age residing at specialized hospital beds (hospitalization rate, hospital mortality, average length of stay in bed). The forms of the Federal statistical observation form № 47 and 30 for the Russian Federation in 2012-2019 were used. The statistical and analytical research methods were applied. During these 8 years, the hospitalization rate of patients older than working age increased up to 4.5% (from 27.36 to 28.6 per 100 of population of corresponding age), the hospital mortality rate - from 3.42% to 3.95%The average length of bed stay of patients decreased from 13.4 to 10.85 days that may be associated with intensification of treatment and diagnostic process. The rates of hospitalization of patients older than working age as compared with adults of able-bodied age were higher by 1.5-8.9 times for certain types of specialized medical care (ophthalmology, palliative care, nursing, cardiology, cardiac surgery, radiology, neurology, vascular surgery, oncology).

The article presents analysis of primary disability in the Northern Region as compared with The Russian Federation. The dynamics and structure of disability due to occupational injuries and diseases is presented. In 2008-2018, in the Arkhangelsk Oblast the level of disability for the analyzed group of causes decreased up to 9.3 times. The proportion of population of able-bodied age makes 83.4%. The occupational injuries input the largest contribution to disability structure.

The article considers the results of sociological study that was carried out to determine vector of dynamics of indices regulating duration of life of the Russian population, including the expected one. The method of secondary analysis of statistical and sociological information data was applied. Results. Against the background of decreasing of birth rate, “aging of population”, migration inflows and transformation of value systems the reduction of population size in The Russian Federation (natural loss) dominates, though life expectancy itself is slightly increasing. The high value of indicator of «death external causes» is established. The trend of steady decreasing of infant mortality in Russia over the past 27 years is marked. The groups of factors affecting life expectancy of the Russian population is identified. The main characteristics are revealed that are fundamentally important to ensure higher life expectancy of Russians. One of the demographic behavior models in modern Russia is described. The approaches to solve demographic problems in the Russian Federation, proposed by state bodies on the basis of policy documents (Concept of demographic development of the Russian Federation for the period up to 2025, etc.) are considered. The importance of health-preserving projects (such as “Moscow longevity”, etc.), is determined.

The article considers the results of legal regulation analysis of medical care support including medication maintenance of adult patients suffering from rare diseases exemplified by life-threatened and chronic progressed rare (orphan) diseases resulting in life expectancy decrease and or disability (“List-24”). Materials and methods. Law database was analyzed in terms of current orders of medical care provision, standards of medical care, and clinical guidelines for rare diseases from “List-24” regarding to adult patients. Results. It is concluded that there are no determined rules of medical care provision to adult population in case of rare diseases from “List-24”. There are standards of medical care on 6 rare diseases (25% of total diseases amount) from this list for adult patients. However, based on content analysis data of approved standards it was established that there are only 3 from 11 standards (27.28%) for primary medical care support, 4 standards (33.34%) for medical care provision in planned condition, and only 1 standard (9.09%) had appropriate legal basis for its development (clinical guidelines availability). Nevertheless, there is negative prognosis for this the only standard due to legal necessity of all clinical guidelines revision till the end of 2021. Conclusion. Revision and creation of clinical guidelines and standards of medical care afterwards are needed for adult patients treatment with rare diseases from “List-24”. The conclusion was made in terms of medical care standardization improvement for adult patients suffering from rare diseases from “List-24” based on its alignment with current legal regulation.

The education institutions, ensuring implementation of the rights of the disabled to higher education, adapt their environment to their needs. The universities, to organize such an accessible environment, as a rule, apply formal approach, focusing on regulatory requirements. The certification of accessible environment for the disabled is based on the same approach, when only objective indicators are considered. The opinion of those ones who have to use this environment is not taken into account. As a result, the University environment is formally considered accessible, but in practice it has many barriers that create real difficulties for disabled students. To improve the quality of the available environment, a combination of objective and subjective indicators is necessary. We need to analyze the opinions of people: employees, teachers, and students of an educational institution who use the possibilities of an accessible environment. The article offers method to diagnose availability of the University environment using specific set of indices that allow to give subjective assessment of availability of the University environment. The diagnostic method was tested on the basis of the Russian state social University, which is the flagship of inclusive education. The results of the study permitted to identify the causes of dissatisfaction with the state of accessible environment by employees, teachers and students.

The preservation and promotion of health of citizens is largely determined by professional activity of both medical and pharmaceutical workers, as well as their coordinated interaction with active involvement of patient that confirms the relevance of research on improving organizational technologies for medical and pharmaceutical care of patients. The article presents an overview of international experience of controllable medical and pharmaceutical care of patient. The main interdisciplinary collaboration concepts of medical and pharmaceutical specialists from the point of view of patient health preservation is described. The main trends of professional implementation of interdisciplinary interaction in the practice of national health care are presented. The need to develop integrated medical and pharmaceutical component of pharmaceutical care of patients is justified. The definition “pharmaceutical patronage of patients” is proposed. The original methodological foundations to implement pharmaceutical patronage, including purpose, tasks and significance of the proposed service for optimizing medical and pharmaceutical care of elderly patients are discussed. It is noted that the implementation of the proposed methodology is combinatorial and variable and it may alter depending on capabilities of the pharmaceutic organization and the needs of patients. The systematized list of the main factors determining the structure and variability of functional and applied implementation of the proposed methodology in a specific territory (city, district) and / or in a specific organization is presented. It is emphasized that the key factor in implementing the methodology is the qualification of pharmaceutical specialists that justifies the need in training personnel meeting the tasks of new component of pharmaceutical care. To resolve professional tasks related to medical and pharmaceutical observation of patients, the need to introduce an additional job position with operable title «Clinical Pharmacist» into the nomenclature of positions of specialists with higher pharmaceutical education.

The need for changes in the primary health care system in the Russian Federation that is based on the principles of general medical practice is without any question. But, even after more than thirty years, there is no full-fledged reform still. The objective. To assess the state of general medical practice in the Russian Federation to identify its strengths and weaknesses, and to determine further ways of its development. The tasks. To analyze the volume and pace of development of general medical practice; to identify its impact on key demographic, medical and social indices; to assess foreign experience in this field; to elaborate proposals on intensifying process of its development in the Russian Federation. Material and methods. The analytical, sociological (n=1,573) and statistical methods were applied. The results. Since 2007, the number of general practitioners in the Russian Federation and corresponding support of the population increased. During the same time period, population size, natality, mortality, morbidity of tuberculosis, essential hypertension and cataract had positive dynamics. The morbidity of malignant neoplasms, diabetes type II, glaucoma, coronary heart disease and cerebrovascular diseases had negative dynamics. The strong negative relationship of the population's general practitioners support was established only in case of all-cause mortality and morbidity of lungs tuberculosis. The population was more satisfied with support of general practitioner than district physician. Discussion. The general practitioner support of the population of the Russian Federation continues to be insufficient and its role in public health management insignificant. The proposals are formulated to improve primary health care and its further development based on the principles of general medical practice on the basis of corresponding best international experiences and national specificity. Hence, in Russia, the national health care requires a set of measures targeted to strengthen the position of general medical practice system throughout ll territories.

In Russia, the oncological diseases significantly impact public health. The study of oncological medical care organization in the Saratov Oblast, that has a number of territorial demographic and medical social characteristics, affecting oncological situation, was carried out. The purpose of the study is to verify systemic factors determining specific characteristics of the oncological medical care organization in the Saratov Oblast. Materials and methods. To elaborate objective comprehension of specific characteristics of the oncological medical care organization in the Saratov Oblast medical and sociological focus groups study was carried out, involving sampling of 12 experts oncologists and health care organizers. The results. The original guide scenario developed for the focus group study included expert discussion on trends in oncological medical care organization at the Oblast level and directions of improving continuum of oncological care. The study data analysis was implemented in accordance with specified scenario. Conclusion. The focus group study elaborated objective understanding of the specific characteristics of oncological medical care organization in the Oblast and predetermined verification and ranking of systemic factors that significantly impact the continuum of oncological care.

The chronic kidney disease takes a special place among chronic non-communicable diseases because it is characterized by wide prevalence worldwide. However, its detection rate among Moscow adult population is 1%, though in the European countries this indicator is significantly higher and is made up on average to 6%. At the terminal stage of chronic kidney disease, quality of life of such patients decreases dramatically, that result in working capacity loss and disability. These patients often require expensive methods of programmed hemo- and peritoneal dialysis. The corresponding mortality is much higher as compared with total mortality. Among the frequent causes of hospitalization and mortality of such patients, complications of blood circulation system diseases are registered. The existing problem of low detection of kidney pathology in the population is the main cause of untimely treatment start. The rapid disease progression results in higher indices of premature mortality and increased costs of treatment of patients with this pathology. The timely diagnosis of disorders of carbohydrate and lipid metabolism permits to identify chronic kidney disease at an early stage and to start to carry out adequate treatment and prevention measures. The purpose of the study is to implement the technology of improving efficiency of detection of chronic kidney disease. Methods. The organizational experiment, analytical, mathematical and statistical research methods. Results of the study. The detection rate of chronic kidney disease amounted to 8%. Among the respondents with chronic kidney disease diagnosed, more than 80% had initial stages of disease (I-III). In this case, appropriate therapy and prevention can prolong kidney functioning and reduce velocity of disease progression. At the same time, 16.3% of patients at the late stage of diseases progression (stages IV-V) were identified.The detection rate for all stages of chronic kidney disease increases with age Conclusions. The level of detection of chronic kidney disease in the base territory is comparable with the indices established in the European countries. The need to improve quality of diagnostic and prevention of chronic kidney disease was proven. To improve overall prognosis and prevention of development of terminal renal failure is possible only in case of brigade approach to treatment including active interaction of cardiologist and nephrologist, endocrinologist and nephrologist or of all these three specialists. Scope of the results. The established higher detection rate of chronic kidney disease (8%), as compared to actual one (1%), permits to claim that with systematic improvement of diagnosis, the detection of chronic kidney disease will increase iteratively and population need for nephrologic medical care will significantly increase that will require increasing in resource support and revising of planned and normative indices for this type of medical care.

The article presents legal characteristics of the legislation of the Russian Federation in the field of health protection of pregnant underage females. The legal basis for providing medical care to the underage pregnant females during pregnancy and childbirth in antenatal clinics, maternity hospitals and perinatal centers is discussed. The conclusion is made related to legal eligibility of providing medical care to this category of female patients in second-level medical institutions, except the cases of female patient with somatic pathology requiring medical care on the basis of particular clinical profiles license, THAT requires referral to third-level medical institution.

The article presents the results of comparative analysis of educational potential of participants of the scientific and educational medical cluster «North Caucasus». The differences in average unified state examination score of students of educational institutions - participants of the cluster, teaching staff with academic degrees, educational literature and other indices are examined. It is noted that the toughening of unified state examination procedure implementation and increase of number of applicants entering through target admission, resulted in certain decrease of average score of unified state examination in entrants. At the same time, measures undertaken by the cluster members targeting the improvement of the values of indices of educational organizations functioning monitored by Rosobrnadzor alter the trend in condition of educational potential of the cluster “North Caucasus” in a positive way.

The article analyzes negative changes in the USSR population health in the era of stagnation. These changes are traced on the basis of statistical indices of physical development, morbidity of infectious and mental diseases, mortality and life expectancy. The mentioned data are compared with indices of ecological pollution, drinking water and foodstuff quality. The study results are explained by political decisions on reclamation of unsettled territories, developing of all-Union constructions, (anti)alcohol campaigns.

On the basis of declassified materials from the Russian State Archive of Economics and State Archive of the Russian Federation, for the first time, the history of the United Nations Relief and Rehabilitation Administration (UNRRA) project for the supply of penicillin factories in the post-war years to two republics of the USSR - Ukraine and Belarus is considered. It is shown that the project initially had political significance, since the demonstration of humane intentions served to strengthen the political authority of the United States. However, despite the declaration, the Anglo-American leadership of UNRRA approached the implementation of the project formally and hardly planned its completion. This was expressed in non-compliance with requirements for completeness of equipment, violation of delivery deadlines, constant attempts to reduce and contain them, in non-supplying adequate technical documentation and specialists for setting up production. The delay in the delivery time of equipment resulted in its rapid moral obsolescence. The modernization of partially supplied factories was impeded by embargo on the export of advanced industrial equipment from the United States having strategic importance. The incompleteness of the project contributed to further split in international relations.