Problems of Social Hygiene,
Public Health and History of Medicine

The article considers, on the basis of results of sociological research, consequences of pandemic impact on social health of citizens of the Eurasian Economic Union states. The comparative analysis was applied to two groups of labor migrants from the EAEU states in Moscow and Russian citizens of the same age. The measures taken by the EAEU to maintain population social health in conditions of COVID-19 pandemic are considered.

The article presents analysis of legal regulation of medical technologies in Russia. The proper development of medicine and health care is impossible without permanent improvement and implementation of new medical technologies. The upcoming decades will be an era of development of bio-technologies, cellular and gene technologies included. The proposed analysis is focused on conceptual set, analysis of actual normative legal base regulating mentioned relationships and identification of perspectives of development of medical technologies. The adequate and competent legal regulation creates enabling environment developing new technological capabilities. The legislation should avoid inhibiting retributive mode and apply particularly permitting and regulating approach determining framework not to be violated. Undoubtedly, these activities should be carried out in conjunction with professional medical community to develop legislation ensuring the highest possible level of development of health care practice.

The organizational (corporate) culture is relevant to beliefs and values existing in the organization during long time and also to behavior practices of personnel effecting attitude to work and interpersonal communications. The healthy corporate culture promotes development of positive reputation of physicians, trust and loyalty of patients and medical personnel. It also supports higher compliance to therapy, culture of treatment and forms corresponding behavior of patient (increasing of preventive activities). The purpose of study is to consider opportunities of organizational culture of medical institutions in promoting loyalty of personnel and decreasing of stuff turnover.

In The Russian Federation, increasing of life expectancy and decreasing of mortality related to diseases of circulatory system are the priorities of state policy. The purpose of study was to develop approaches to the classification of cardiovascular diseases by severity degree within the framework of development of general health management model based on health care activities at the regional level. The article describes methodology of calculating indices of cardiovascular diseases severity based on statistical data of appealability for out-patient, in-patient and emergency medical care. The set of balancing coefficients reflecting input of rate of accessing for various types of medical care, as well as aggravating input of concomitant pathology, based on expert evaluation of cardiologists involved is presented. On the basis of analysis of distribution of severity index in standard region of the Russian Federation, the system of criteria was developed to classify cardiovascular diseases (according to ICD-10 sub-classes) on four degrees of severity. The approbation of the proposed method demonstrated adequacy of the results obtained to judging of experts (cardiologists). So, in standard region of the Russian Federation, in the class of diseases of circulatory system (I00-I99), 79.6% of all cases are of first degree of severity, 8.6% of cases are of second degree of severity, 3.8% of cases are of third degree, and 8% of cases are of fourth degree. The methodology is unified and can be applied to classify entire spectrum of diseases by degree of severity. Besides, the proposed methodological approaches are suitable to be applied in population health management at the municipal, regional and national levels in the Russian Federation.

The formation of code of normative legal documents ensuring activities of perinatal service is one of the most important, basic organizational technologies that determine activities of obstetrics and childhood services, contributing to increasing of natality, decreasing of maternal and infant morbidity, and maternal and childhood health care in general. The article presents analysis of formation of normative legal base that regulates functioning of perinatal service in the Russian Federation in 2000-2020. Actually, there is no objective prerequisites for fundamental alterations in the three-level system of medical care of women during pregnancy, labor, postpartum period and newborns. However, the regulatory adjustment of the system, improvement and refinement of models of profile patients' routing, development of medical care of pregnant women, parturient women and puerpera will proceed.

The analysis of opinions of district pediatricians about state and perspectives of development of primary medical sanitary care for children in the Kabardino-Balkarian Republic permitted to obtain competent assessment of quality of polyclinic medical care. The positive tendencies in activities of children polyclinics were established. However, the problem of achieving higher quality of medical care of children continues to be actual. According to survey results, character and direction of organizational managerial decision making concerning improvement of material and technical equipment of children polyclinics in accordance with modern requirements (37.6%), elimination of defects in organization of free medication support (63.6%), improvement of organization of free nutrition supply of children (50%), etc. Among the priority tasks of pediatric service is the solution of the medical personnel issue and full staffing of pediatric districts with physicians (66.7%), paramedical personnel (29.6%) and medical specialists (61.7%), as well as the need to include in staff of the polyclinic positions of child psychologist (54.0%) and social worker (31.5%). One of the main problems of primary medical sanitary care of modern pediatric service remains high work overload of district pediatricians that which undoubtedly impacts quality of medical and preventive activities. The low readiness of district pediatricians to active acceptance of innovative transformations in functioning of children polyclinic, requiring psychological readjustment of medical personnel is established. This was most strikingly manifested by process of implementing information technologies and the National project “Lean Polyclinic”. All issues identified by sociological survey significantly strained during coronavirus pandemic in 2020. The pandemic inputted its own adjustments in medical care support of children in the region. Despite the fact that disease did not affect children to large extent, due to prolonged absence of physicians suffering from coronavirus, quality of dynamic monitoring and treatment of children suffered. Factually, no dispensarization activities were implemented and prevention measures as well. The results of survey contributes to the formation of monitoring of quality of out-patient care of children at the regional level and makes the research data highly relevant.

The article analyzes dynamics of main indices of disability in population older than able-bodied age in the Rostov Oblast. The trend of decreasing of scope of examinations of individuals of the mentioned age group, including decreasing the number of first and iteratively recognized as the disabled, against the background of increasing in the population structure of percentage of individuals older than able-bodied age. At the same time, increasing of accumulated disability was established in the studied category of population.

Actually, one of the world trends in social policy in the field of health care is self-preserving behavior of population as readiness of each member of society to take responsibility for maintenance of one's own health and prolongation of life activity. The value of health becomes not only human, personally significant, but also social capital, without which it is impossible to achieve high indices of social development, as well as ensuring national security of the state. The measures of public policy of the Russian Federation are targeted to developing culture of self-preserving behavior of Russians, that is reflected in the national projects “Health care” and “Demography”. To assess the self-preserving behavior of Russians, it is necessary to achieve such asks as identification of the need in longevity and the degree of its implementation in various social demographic groups; assessment of features of self-preserving behavior in the context of motives of achieving longevity; determination of the response in various social demographic groups to demographic policy targeted to preserve population health and to decrease mortality; analysis of popular practices of self-preserving behavior. The article presents the results of sociological survey on the subject “Demographic well-being of Russia”, carried out by the Institute of social political research of the Russian Academy of Sciences in 2020-2021, in terms of the use by Russians of various practices of self-preserving behavior.

The article considers the issue of alternative dietary intake in children of vegetarian families, both in Russia and abroad. The types of vegetarianism, its advantages and limitations are highlighted on the basis of empirical studies of national and foreign researchers. The emphasis is made on the risks to physical and mental health of children in case of unbalanced diet and on the need for regular consultations with pediatricians and nutritionists as well.

The article presents the results of clinical economical analysis, based on “cost-effectiveness” technology, of MALDI-TOF MS, innovative medical technology of express identification of microorganisms, calculation of incremental indicator and application of notion “willingness-to-pay-threshold”.Due to the extension of sanctions against the Russian Federation, this medical equipment for national laboratories becomes difficult to access and expensive, that conditions necessity to scientifically substantiate economical effectiveness of implementation of expensive innovative MALDI-TOF MS technology as instrument to contain global antibiotic resistance increase. The understanding of importance of express identification of microorganisms as well as other positive effects that can be achieved by using modern medical equipment on the basis of mass spectrometry results in improving medical care quality, increasing reputation level of medical institution, greater commitment of physicians and patients to microbiological analysis with purpose of prescription of rational antibiotic therapy and improving population health.

In accordance with the Russian Federal Law No. 350 of January 2019 the retirement age for Russians is increased for men from 60 up to 65 years, for women from 55 up to 60 years that requires implementation of organizational technologies of health-preserving, promotion of life and labor potential of population of late able-bodied age. In this regard, the role of day hospitals (DH) functioning directed at maximal possible prolongation of autonomous life and working capacity of elderly population increases. Besides, DH also presents additional reserve of optimization of medical care costs. The purpose of the study is to elaborate guidelines of improving activities of DH for population of late able-bodied age, for the purpose of preventive hospitalization. The study was organized on the basis of pilot medical organization of the Moscow Oblast, consisted of hospital of 600 beds and day hospital of 120 beds. The methods applied included sociological survey, expert judgment, statistical direct observation. The primary data was obtained from the forms of federal and sectorial statistical monitoring for 2014-2018. The analysis of medical documentation concerning pilot medical organization functioning during the year of the study was applied. The sociological surveys of patients of late able-bodied age (5 years before retirement according to the new legislation - men 60-65 years old, women 55-60 years old) who received treatment in day hospital. The results. The analysis of main indices of round-the-clock functioning in-patient and day hospitals in the Russian Federation in 2014-2018 established trend towards improvement of using hospital beds due to development of day hospital. However, bed capacity of hospitals is used ineffectively and experts assume that more than 1/3 of patients could receive medical care or aftercare in day hospitals. The experimental study of planning hospitalization of patients with chronic diseases at out-patient level demonstrated that 11.5% of population of able-bodied age need planned and preventive hospitalization in day hospital. The cost of treatment of patient with chronic pathology is 2-3 times lower in day hospital than in common hospital at the stage of exacerbation. It is reliable to apply at the out-patient level experience of planning hospitalization of patients with chronic pathology in day hospitals followed by performance control. The organization of functioning of day hospital and common hospital requires particular enhancement, including issues of succession, , financing of the DS, the remuneration of medical personnel through effective contract determining interest of physician in early discharge of patient to aftercare in day hospital. The day hospital functioning is to be implemented in 2-3 turns. The day hospital is to be located in detached placement and the departments of base medical institution are to used in fullness. The day hospital is be used more actively for purpose of health preservation of population of late able-bodied age who. This contingent suffers of chronic pathology and is in need of preventive and health-promoting therapy in conditions of day hospital.

The article considers such new approaches to information maintenance of medicinal preparation in package as requirements for presentation of information, its location according its importance, availability of warning information. The article focuses on necessity of updating format of information maintenance of medicinal preparation and its inclusion in registration dossier.

The inclusion of public health and health care measures in labor functions of professional standards of medical specialists increased significance of mastering of these standards by students during specialty training, since on this depends their successful completion of primary accreditation of specialists and implementation of job descriptions in the course of daily activities. The purpose of the study was to analyze factors determining qualitative of mastering the discipline “Public health and Health Care” by students of medical educational organizations. The analytical, logical, statistical, questionnaire survey and direct ranking methods were applied. The sampling of 316 students of the Sechenov University was involved in survey using questionnaire of 17 closed questions. The study established that the determining factors effecting quality of mastering by students the discipline “Public health and Health Care” are the need to use by physicians this knowledge in the course of their daily activities; the need of students to pass profile exam; the determination of up to 40% of trainees to work as heads of structural units or professionals of health care and public health; the dedication of student; organization of educational process at the Chair; the professionalism of faculty; the application of active learning methods in classroom; organization of career guidance among students.

The serologic epidemiological analysis of intensity of anti-diphtheria and anti-tetanus post-vaccination population immunity in the Republic of Kyrgyzstan was carried out. The presence of immune defense was determined in 453 residents by detecting IgG to diphtheria and tetanus by enzyme-linked immunosorbent assay using test system RIDASCREEN Diphtherie IgG and RIDASCREEN Tetanus IgG (Germany, R-Biopharm). It was established that the level of antibodies depends on the age of individuals. The highest immune defense against diphtheria is present in adult population aged 20-29 years (100%) and 30 years and older (100%). The lowest level is detected in the group of children of 1-4 years old and is up to 30.6%. The proportion of individuals with protective titer of antibodies ≥ 0.10 for diphtheria was 88.5%. The population intensity of post-vaccination tetanus immunity high antibody titers were established in age groups of 15-19 years (92.9%), 20-29 years (93.3%) and 30 years and older (94.8%). There is relationship between level of antibody titers and the age. Thus, in children age group of 5-9 years, high level of protection was established, that amounted up to 60.4%, in adolescents of 10-14 years old this indicator was 40%, and the lowest level in children aged of 1-4 years old was 39.6%.

The article considers issues of actual discussion about “death of history of medicine”. For a long time, history of medicine was set out the task to substantiate triumph of one national model and tradition over another one and “to place the past at the service of the future”. For example, Richard Horton, the editor-in-chief of The Lancet, believes that historians of medicine in no way respond to such problems of today as commercialization of medicine, drug abuse, paralysis in public health, catastrophic failures in patient care. He assumes this fact being true sign of that the history of medicine “is creeping towards scientific cemetery”. Another reason for appearance of “obituaries” of history of medicine is the regular fact that classical courses almost exclusively consisted of narratives about great physicians and progress of medical science and practice. Moreover, the “medical” history of medicine if is not killed then is severely wounded by arrows flying from all sides - accusations in mistakes, indications on blind spots, myths and deliberate distortion of facts. The analysis of above-listed problems the proposals were developed concerning possible ways of revising academic course according modern requirements: training in the field of critical thinking, communication skills, oral speech and written language, academic writing. These tasks can be achieved by involving materials from museums of history of medicine, museums of universities and medical institutions, by collaboration with historical sources, databases of scientific publications and by engaging invited lecturers of various specialties working with historical and medical topics within the framework of other methodologies.

The article analyses the process of establishment of medical knowledge concerning territories of the Russian Empire in XVIII century on the basis of written heritage of the Prussian physician Johann Jacob Lerche (1708-1780). The analysis is focused on forms of actual medical geographical studies practiced by European doctors and Lerche himself, first of all on his meteorological observations. The Lerche's interpretations of local natural and social phenomena in construction of medical characteristics of particular corners of the Empire in manuscript about endemics in Russia and Persia are analyzed. The assumption is proposed that studies of Russia implemented by Lerche are constructed on the analogy of summarizing academic descriptions of naturalists of XVIII century. Thereby, the works of Prussian physician seems to be participated in process of development of language of systematization and ranking of diseases and endowed category of “disease” with function of inherent to region characteristic such as climate, flora and fauna.