Problems of Social Hygiene,
Public Health and History of Medicine

The article considers the historical features of development and theoretical approaches to defining the concept of “pandemic” in social sciences. The approaches of demographic science to the study of the consequences of pandemics are outlined. The prerequisites of occurrence of major pandemics at various historical stages of humankind development are highlighted. The particular attention is paid to pandemics in the XXI century. The demographic and social economic consequences of pandemics for the countries all over the world, including the countries on post-Soviet territory, are considered. The characteristics of the COVID-19 pandemic are highlighted from the standpoint of social demographic consequences, including the impact on fertility and mortality. The key directions of pandemics control in some countries of the world are designated.

The article considers issues of health education in educational institutions during COVID-19 pandemic. The importance of educating health-preserving attitude and sanitary hygienic culture in students is emphasized. In the context of pandemic, the priority task is to develop in students epidemiological culture as a background of healthy behavior. The special educational programs are to be developed to support sanitary-hygienic security in in educational standards.The article determines that the need to discuss issues epidemiologically safe learning environment is due to the fact that currently a large number of students experience unstable and uncomfortable conditions that impede implementation of educational requirements. Hence, development of reluctance to visit school. Among reasons are the conditions of quarantine and self-isolation affecting their perception of society either scaring and forcing self-isolation or inducing considerations about keeping hygiene rules in conditions of pandemic crisis. The students are not aware enough or don't want to seek important sanitary hygienic basics of health promotion to establish personal parameters of anti-infection and anti-virus safety and to improve sanitary and hygienic culture.The article makes an important conclusion that the solution of the problems of implementing sanitary measures in conditions of epidemiological crisis is in planning and carrying out activities developing health promotion culture, familiarizing with epidemiological security standards, creating conditions to achieve sanitary security, to understand issues of personal epidemiological security both during and outside educational process, especially in public areas.

The medication support of population is an integral part of health care system reflecting the state of social and economic sectors in conditions of national pharmaceutical market development that as opposed to markets of other goods has such specific characteristics as wide scale, large selection of assortment, science linkage, durational cycle of medication development.Lately, intensive work was implemented improving national medication supply system. The normative base passed through significant changes. The percentage of costs of medication support in total costs of health care increased. The preparation of pilot project concerning system of reimbursement of appropriated medications proceeds. However, despite all these actions, availability of medications does not improve. The components of medicinal availability can be structured as physical, spatial temporal, assortmental and infrastructural ones. The article presents overall analysis of most acute challenges in the area of medication supply. The proposals were formulated concerning development of system of medication support of population.

The article analyzes the achievement of the prognostic indices of the Concept of the federal system of training citizens for military service for the period up to 2020 (to reduce the number of citizens who do not meet the requirements of military service due to health and physical conditions; to increase the rate of fitness for military service of citizens who have arrived at draft commissions; to ensure the availability of the first sports category or sports rank for citizens who are subject to military service draft). The causes and factors preventing the achievement of the target values of the Concept are considered. The set of measures targeting to improve medical support of the youth of military draft age is proposed.

The article presents the results of study of in-family (child-parents) relationships in families with children suffering with diagnosed diabetes mellitus type I. The purpose of study is to investigate the disorders of family relationships in families of such kind. The established disorders allow to develop psychotherapeutic measures both for children and their parents. Materials and methods. The study covered 30 families with children of primary school age (7-10 years old) with diabetes mellitus. The families with children with severe concomitant diseases and broken families were excluded of the sampling. The control group consisted of 30 relevant families with healthy children. The in-family relationships were explored using a number of psychological tests applied to children and their mothers. The results. In mothers of the studied families prevailed authoritarian type of upbringing, which was expressed in tendency to hyper-protect and to over-control. The phobia of losing child and the tendency to reject it were also established. The children suffered from high level of anxiety. They had more positive attitude to mother than to father. The conclusion. The established disorders of in-family relationships in families with children with diabetes mellitus can serve as targets for psychotherapeutic activities both with children and their parents.

The recovering of reproductive health of women is one of prospective means to stabilize fertility. The purpose of the study is to investigate medical, demographic and social risk factors of discontinuing screening and treatment of infertility in women of the Tambov Oblast. The materials and methods. The comparative data analysis of women who discontinued infertility screening and treatment prior to referral to auxiliary reproductive technologies (n = 239) and women who were factually referred to these technologies (n = 206). The results of the study. The risk factors for women of discontinuing screening and treatment of infertility included age (OR = 1.070; 95% CI 1,035-1,105; p <0.001), residence in rural areas (OR = 2.059; 95% CI 1.592-2.663; p < 0.001), secondary education (OR = 2.593; 95% CI 1.767-3.805; p < 0.01), low level of financial security (OR = 2.524; 95% CI 1,720-3,703; p <0.01), secondary nature of infertility (OR = 1.587; 95% CI 1.065-2.364; p =0.023), occurrence of sexually transmitted diseases in anamnesis (OR = 2.736; 95% CI 1,722-4,346; p<0.01). Discussion. The study results demonstrate that the most effective measures improving compliance of women to screening and treatment of infertility are the reorientation of medical care to the second-level regional centers from the regional center that will bring medical care, including active detection of infertility at younger age, more comprehensive regular preventive examinations and health education to preserve reproductive health, closer to remote areas. The conclusions. The medical, demographic and social risk factors of discontinuing testing and treatment of infertility in women are established to be applied in improving the organization of medical care for this category of patients.

The increasing of longevity and quality of life and population health are considered as the most important component of human development index. The diseases of blood circulation system have leading rank in morbidity, disability and mortality of population of Russia representing one of the most actual problems of health care.The diseases of circulatory system negatively effect on physical and mental health, emotional conditions and social components of life activities. All the mentioned results related to cardiovascular diseases can be detected and measured through evaluation of indices of life quality of patients.In Russia, the directive documents and national programs concerning health care modernization were adopted to rectify the unfavorable medical demographic situation on national level through decreasing of mortality, morbidity and disability due to diseases of circulation system.The purpose of the study is to analyze social hygienic characteristic and life quality of patients with diseases of circulation system during 5 years prospective cross-sectional medical statistical study in the Nizhni Novgorod Oblast at the base of the “Specialized Cardio-surgery Clinical Hospital” of Nizhni Novgorod. The study included all patients with certain corresponding criteria of involvement being at hospital treatment in the pilot medical organization. The sampling included 420 patients. The life quality inventory SF-36 and questionnaire were applied to respondents during their first and control (5 years later) visits. The questionnaire covered social and working status, presence of risk factors of cardiovascular diseases.The study demonstrated that among respondents made no control of cholesterol level 40.3%, arterial blood pressure - 16% that determines necessity of amelioration of sanitary education activities of population. The low level of income (less than 6000 rubles per one member of family) was marked by 42% of respondents. At that, 77% had financial problems with medications purchasing that testifies necessity in co-financing with the state. The results of the study testify the positive impact of implementation of target programs of prevention of cardiovascular diseases on the life quality of patients in the pilot subject of The Russian Federation.The original technique of sociological surveys and evaluation of life quality of patients can be applied at the regional level in development of managerial decision making.

The article discusses the main social factors that can positively effect on increasing the longevity of healthy life in the elderly. The main principles are based on the results of applied studies carried out by the authors in Moscow, Kursk, Velikiy Novgorod and Simferopol in 2019-2020. The respondents were both the elderly themselves and the specialists providing them social services support. The emphasis is made on the factors of healthy lifestyle of the elderly and first of all on feasible physical activity and productive creative activity. The considerable attention was paid to internal resources of the elderly person (general condition of physical and mental health and ability to maintain it, capacity for self-care and physical activity, positive frame of mind, personal persuasion in the need to properly use the opportunities available to elderly people). The following external factors are distinguish - constructive relationship with closest relatives, development of infrastructure for leisure activities, physical exercises and sport activities, accessibility for the retired of health care institutions. Among the means of maintaining active and healthy longevity of the elderly are marked informing about possibilities of using their potentials, appropriate consultations, provision of technical means of rehabilitation, involvement into constructive activities, giving positive examples and persuasion. The importance of individual approach to each retired is emphasized, taking into account their physical capabilities, health status and chronic diseases. The types of “activities” are marked useful for physical and spiritual health of elderly person, available to them at home that is especially actual in conditions of self-isolation due to prevention of coronavirus infection.

The issues of protecting the health of the children and adolescent population of Russia require detailed study of the regional characteristics of the indices of physical development, determined by anthropometric growth and weight criteria. The purpose of the study is to analyze the regional characteristics of average height and weight anthropometric indices of children of school age (7-17 years) living in various regions of the Russian Federation.The assessment of statistically significant differences in average height and weight anthropometric indices children of school age was carried out to establish the basis of developing normative indices of 10 regional “Standards of physical development of children of school age (7-17 years old)” covering such Federal Okrugs as the Central (Kostroma), North-West (St. Petersburg), North Caucasian (Makhachkala, Grozny, Vladikavkaz), Privolzhsky (Kazan, rural areas of the Republic of Tatarstan, Cheboksary ) and Far East (Yakutsk, Yuzhno-Sakhalinsk).For the first time the statistical analysis considered simultaneously the anthropometric data of the population sample of the examined children of health groups I and II (healthy and practically healthy). Namely, 41030 persons were allocated to conditional age groups: junior (7-9 years), middle (10-14 years) and senior (15-17 years old) school age. The differences in regional height and weight indices of physical development of children were statistically significant only in groups of comparison of indices of height and body weight of schoolchildren in the older age group.

In Moscow, the improvement of primary health care home support of patients with limited mobility is implemented since 2017, through the new organizational form “The primary health care support of groups of population with limited mobility” - “Patronage at home”. In this regard, the “evaluation of performance efficiency” of this novation is of particular importance.The purpose of the study was to substantiate approaches to implementation of such an assessment applying developed with consideration of experts' opinions “The system of criteria and indices” as well as using the data of registry of patients in need of home patronage. The acquisition of information with specified mean will both allow to objectively assess in dynamics the effectiveness of functioning of new organizational form of “primary health care support of patients with limited mobility at home” in Moscow and contribute to improving its management.

The article discusses the experience of Israel, Canada, the USA and the European countries in training nurses with higher nursing education. The considerations concerning the need to change previously established standards of professionalization of graduates with higher nursing education in health care reform are analyzed. The purpose of the study is to consider a possibility of organizing a model of partnership relationship between physician and medical nurse with higher nursing education in conditions of the reform of health care system in The Russian Federation. The study was organized in two stages. At the first stage, the results of the study carried out by The Research Institute of Health Care Organization and Medical Management of the Moscow Health Care Department were analyzed. It was established that in the conditions of modern Russian health care, there is no distinct understanding among physicians how the relationship between physicians and medical nurses should be built. At the second stage, the sociological survey was carried out based on specially developed original questionnaire covering 150 physicians in Moscow medical organizations in 2019. The survey demonstrated that physicians reconsidered the role of medical nurse and would like to expand competencies of medical nurses. However, this requires to revise the legal base to allow medical nurse with higher nursing education to fill the position “The academic medical nurse - organizer of treatment process”. The results of the study demonstrated that in medical organization the majority of physicians see in the new educational training of medical nurses a prospective area of implementing the model “The organizer of treatment process - certified medical nurse with higher nursing education”. The results of study will facilitate transition of the medical nurse business to the new professional level that will permit to improve the specialty over whole career.

In clinical practice the identification of the dynamics of course of focal epilepsies on the basis of available clinical and neurophysiological indices (prognostication) is of great importance. The purpose of the study is the short-term prognostication of the course of focal frontal and temporal epilepsy.The materials and methods. The control (42 patients) and clinical (70 patients) groups were examined. The complex clinical physiological examination was carried out using electroencephalography, cognitive evoked potential, cardiac rhythm variability and the Schulte test. The cluster analysis was applied to allocate the observable patients into groups according to the dynamics of seizures frequency. The artificial neural networks technology based on physiological characteristics was applied to classify patients into groups with different course of disease.The results. The spectral characteristics of electroencephalographic signal had the greatest value for short-term prognostication of course of disease in the group of patients with focal frontal epilepsy. In patients with focal temporal epilepsy, the most significant predictors were the characteristics of cognitive evoked potential and characteristics of function of coherence of electroencephalogram. The conclusions. The developed algorithm of prognostication of unfavorable course of focal frontal epilepsy has high sensitivity, but lower specificity. Contrariwise, in case of temporal epilepsy, high specificity of the proposed algorithm is demonstrative, but its sensitivity is lower. It is recommended to apply these algorithms and to accentuate attention on characteristics of potential parameters at organization of diagnostic process in case of focal epilepsy.

The formation of a prototype of the organizational functional model of competences of the “ideal” health care manager and availability of objective assessment of its activities are of considerable practical interest. In any medical organization there is a need for trained, experienced and motivated administrators - managers capable effectively achieve their goals. This need can be met by developing and improving managerial competencies in managers at all levels. The competences of manager can be developed on the basis of organizational functional model and in accordance with personal responsibilities, work status, goals of medical organizations and professional standard.The purpose of the study. was to develop a prototype of “ideal” organizational functional model of competencies of administrator - health care manager.Materials and methods. On the basis of data content analysis, evaluation of experimental results and logical and comparative technique a prototype of the “ideal” organizational functional model of health care manager was developed and tested. The development of model of administrators competences was based on comparative parameters of the professional standard “The specialist of health care and public health,” personal managership of administrators of medical organizations, in accordance with the work status and objectives proposed in the course of the study organized in the Chelyabinsk Regional Children's Clinical Hospital (n = 26).The results. The analysis of the factors affecting quality of management functions performed by managers, presented in t professional publications and based on the results of competence model testing, permitted to conclude that the requirements of the professional standard “The specialist of Health Organization and Public Health” are not sufficient to completely assess the activities of administrator - manager. To improve comprehensiveness of assessment of managers and the development of “ideal” model of executive manager competence the listing of requirements in the professional standard is to be supplemented with “The necessity of satisfaction with own work”, “The necessity of conscious motivation to work at managerial position”, “The necessity of abilities to perform management activities”.

The research activity of Medical University lecturers is related to pedagogical and medical activities. Nowadays, more attention is paid namely to scientific component in activities of the faculty. The article presents the results of the survey of the faculty of the Medical University concerning various aspects of their scientific activities. It is established that the younger generation of Medical University lecturers lose interest to scientific activities due to material and moral incentives lacking. Yet another reason of low activity of lecturers according their opinion is poor knowledge of foreign languages.

The analysis of the declassified documents of the Russian State Archive of Economics and the State Archive of the Russian Federation made it possible to establish that the project of the United Nations Relief and Reconstruction Administration was not a priority in the USSR for supplying equipment for penicillin factories to the two Soviet republics. Of greater interest was the acquisition in the United States of expensive high-performance plant equipped with the latest machinery, albeit for cash payment. This prioritization affected time-frame and implementation progress of the UNRRA penicillin project and facilitated manipulation on part of the United States. In aggregate with distrust of the USSR in quality of the supplied equipment and the hope for alternative sources of obtaining necessary scientific and technical information, this resulted in loss of interest to this project. The turned out situation affected correspondingly on the attitude of the Soviet Government to the UNRRA missions operating on the territory of the Soviet Republics and to the leadership of the organization itself and contributed to the further exacerbation the of Soviet-American relations.

The article is devoted to the history of the emergence and functioning of departmental medical statistics in the German states in 1800-1871. The authors, on the basis of the analysis of German historiography, identify main actors, goals, methods of administration and representation of health statistics. Starting from the specifics of German terminology concerning the umbrella term “medical statistics” (“medizinische Statistik”, “Medizinalstatistik”, “sanitäre Statistik”, “Gesundheitsstatistik”), the authors elaborate in detail on the cases of the Bavarian and Prussian kingdoms. By the beginning of the XIX century, the mechanisms of building modern state were started up in these countries. In its functioning, it was primarily based on statistical surveys of people and territories. The gradual institutionalization of medical statistics, its complexification and enhancement are considered in the context of state bureaucratic system reforming. The analysis of historical research results permitted to generate cumulative picture of becoming and development of medical statistics in Bavaria and Prussia. The study of transformation of reporting forms allowed to see how the bureaucratic institutions, by means of statistical methods, sought to rate the “death” and “health” of population.