Problems of Social Hygiene,
Public Health and History of Medicine

The article considers, on the basis of application of modern information analytical systems, the sequential stages of analysis and evaluation of indices of resource support of medical organizations and technological process of medical care provision. The results of the study permit to discover particular patterns of the course of disease in different gender and age groups,in terms of clinical manifestations and results of instrumental and diagnostic tests. The dependence of results and outcomes of treatment on set and quality of resources of medical organizations is established. The prognostic indices of functioning of medical organization under various alternatives of patients' flows organization as associated with hospitalization level.

The pandemic of the new corona-virus infection COVID-19 will be over only when population immunity will be developed. This condition can be achieved by both vaccination and surviving disease in natural way. The WHO recommends the first mode for achieving population immunity, since immune response to vaccine is similar to that one developed while surviving natural infection, but with minimal risks to health and life. The article presents the results of sociological survey organized with purpose of studying the attitude of Russians to vaccination against COVID-19 infection. The results of the survey demonstrated that at present, 22% of respondents are ready to be vaccinated i.e. they responded positively to the corresponding question. The following main factors determining population attitude to vaccination were identified. First, there is statistically significant correlation between vaccination readiness and education level: respondents with higher level of education are more likely to be vaccinated against COVID-19. Secondly, in general, the population is quite positive about the response of the National health care to the corona-virus pandemic. However, the percentage of population that is positive about vaccination can be higher if it would be possible to apply foreign-made vaccines in Russia. Thirdly, still there is large percentage of population believing that vaccination with medications that have not passed long-term clinical trials can result in health negative consequences. Fourthly, the majority of respondents experienced various manifestations of the pandemic on themselves: either they have been ill themselves, or their relatives and friends were ill or died and almost all of them somehow limited their common mobility.The survey results did not established statistically significant differences in distribution of responses among males and females. We assume that in order to develop positive attitude of population to vaccination, and specifically to Russian-made vaccines, more extensive information campaign is needed to be implemented. Also, significant increase of percentage of vaccinated population can be achieved if clearly defined requirements for availability of COVID-19 vaccination would be adopted on the international level. Actually, this is key condition for restoring international mobility and removing restrictions in national economies.

The article demonstrates that the restrictions introduced during the coronavirus pandemic affected the dynamics of mutual settlements between the territorial funds of the mandatory medical insurance (MMI, TFMMI). According to the results of the first nine months of 2020, medical institutions of a number of subjects were not able to earn even a half of the amount of sum that was presented for payment in 2019 on medical care support of patients from other regions. It was established that besides such relevant features of the Russian health care system as large territory, fragmentation of population, necessity to maintain a number of state medical institutions, there is also a number of factors that during the pandemic were most aggravated in those “weak” places in the MMI system that have been stagnating for a long time. Among them, insufficiently large listing of medical services covered by MMI, inability to provide medical services to all those in need due to shortage of equipment, working areas, qualified care, etc. It is noted that among the general trends of MMI, the Russian medical insurance system (not only that it is not a classical one), especially during the pandemic, is broken out of social insurance: two funds, structures, costs of informatization, etc. However, in Russia, even in such conditions, health care is funded through the MMI system up to 50%. The pandemic demonstrated that no private sector, no paid services, no commercial insurance companies can cover the whole spectrum of health care complicities during the pandemic crisis. Namely, the MMI system bore the brunt of the survival of medicine during the pandemic. It is concluded that namely the need in medical institutions with sufficient reserve of bed fund with MMI services can input into development of necessary stable basis for survival in difficult conditions of pandemic crisis. The proposal of the Audit Chamber of the Russian Federation of further reforming of the mandatory medical insurance system is considered reasonable and logical especially in difficult situation of struggle against COVID-19. The article also presents data concerning the state of MMI in 2020, at the height of the pandemic crisis in the regions of the Russian Federation.

The article presents the results of psychological study of characteristics of food behavior in young people in the conditions of forced self-isolation and COVID-19 coronavirus infection pandemic. The common research methods were applied to establish actual food disorders and intensification of their symptoms during isolation. The food behavior of each individual can be considered as network of interactions between various natural factors (physiological, psychological, economic, sociocultural ones). It is conditioned by stress level due to pandemic. The comparative analysis of study results concerning specifics of food behavior in conditions of self-isolation in young and middle-aged people demonstrated that there is significant relationship between external, emotionogenic food behavior, restrictive food behavior and age of subjects. The correlation analysis established statistical significance of a number of scales. In sample of middle-aged objects, relationships between external and emotionogenic food behavior were established. The emotionogenic condition was associated with dissatisfaction with one's own body, and body image - with restrictive food behavior. The direct statistical significance of dependence of restrictive behavior from age was revealed. In all cases, more intensive manifestation of food disorders was detected in sampling of young people that confirms hypothesis that middle-aged people are inclined to other types of food disorders as compared with young people. The severity of disorders is also less pronounced. The actuality of the analyzed problem is determined by both trends in development of scientific knowledge and existing needs of social practice.

The article considers issue of substantiation of the anti-systemic dimension of pandemic. The combination of biocenosis, anthropocenosis and technology within the framework of systematic approach is demonstrated. The outline of structural aspects of pandemic as negative medianess, catastrophic extreme situation and antagonism of entropy and neg-entropy is presented. The analysis of constitutive character and structural aspects of anti-systemic dimension of pandemic is proposed. On the examples of pandemics of cholera, SARS, Ebola fever the occurrence of pandemic as a result of human technogenic intervention in environment is demonstrated. The concept of pandemic as specific version of anti-system is proposed. It is concluded that pandemic is a system with negative level of systemacy, that, firstly, occurs as a result of direct or indirect interference of anthropocenosis in biocenosis, resulting in mutual antagonism. Secondly, it manifests itself as mass disease. Thirdly, it is targeted to annihilation of all discrete and rigid structures, open and closed systems of anthropocenosis and biocenosis. Fourthly, it is described through negative medianess, extreme catastrophic situation and antagonism of entropy and neg-entropy.

The analysis of mortality because of external causes in persons older than able-bodied age in the Russian Federation permitted to determine their high level and significant contribution into formation of age profile of mortality of persons of older age groups. The comparison of mortality rates from injuries, poisoning, and some other consequences of external causes effect in persons older than 65 years in the Russian Federation and the European countries was carried out. The high mortality due to external causes of persons older than able-bodied age in the Russian Federation emphasizes vulnerability of this age group of population and is characterized by increased victimization.

The purpose of the study is to systematize theoretical models of demographic family policy approved in publications included into database SCOPUS in 2019-2020 and developed using empirical data obtained by analysis of methods and practices of increasing natality in certain countries of EU, BRICS and the New World. The France, Sweden, Great Britain, Norway and Denmark are oriented to expand measures of social support of citizen and regulation of occupation of women with children with purpose to increase natality. In the countries of South-Western Asia and North Africa the measures are targeted to decreasing level of natality and to implement family planning policy.

The article presents the results of pilot study implemented to determine cognitive disorders in patients taking “Spice”.The purpose of research is to identify targets of psychological correction interventions to prevent cognitive deficiency in patients addicted to synthetic cannabinoids.The pilot sampling consisted of 30 patients taking “Spice”. The control group consisted of 30 healthy individuals. Along with social consequences, one of the important focuses of the study was investigation of cognitive sphere of patients. A number of pathopsychologic tests was applied. The study established that patients demonstrated disorders of various functions of memory, attention, mental pace and thinking. In particular, disorders of short-term, long-term and mediate memory and mental tempo were revealed. Also, reduced activity of attention took place. The distortion and decreasing of generalization and poor prehension occurred reliably more often as compared with control group. The established cognitive disorders in patients taking “Spice” can be considered as targets for psychological correction interventions to prevent cognitive deficiency in patients addicted to synthetic cannabinoids.

The article considers the problem of patient aggression during medical care provision. The purpose of the study was to estimate factual prevalence of patient aggressive behavior versus medical practitioners (with emphasis on primary health care) and specification of such manifestations. The anonymous survey of 508 physicians practicing in Moscow and the Moscow Region was carried out. The original questionnaire included 9 items regarding particular forms of patient aggression, its frequency and personal harm received. The feeling of personal safety at workplaces was evaluated according to 10-point scale. The study revealed that 412 respondents (81.1%) reported about episodes of patient aggressive behavior during performance of professional duties. In the year prior to the survey 66 respondents (16.0%) regularly experienced aggression from patients, 85 respondents (20.6%) recalled more than 5 such cases, 176 respondents (42.8%) - from 2 to 5 cases and 85 respondents (20.6%) - 1 case. The forms of aggression and damage suffered due to the aggressive behavior of patients were described. The physicians do not feel themselves safe at their workplaces regardless of their gender, professional experience, medical specialty and practice setting. The respondents assess their average feeling of safety in 5.4±2.5 points. The study established that 251 respondents (40.6%) considered patient aggressive behavior as manifestation of specific features developed in response to impact of present somatic disease. The study results demonstrated that physicians are exposed to aggressive actions from their patients more often than this is commonly considered and prefer to conceal such kind of incidents. The most common form of patient aggression was verbal abuse though physical aggression also took place. The application of preventive measures and management of conflict are key practical skills for any physician.

The article presents the results of the study of factors effecting on professional deformation of stomatologists and its relationship with their personal characteristics, labor experience and medical specialization. the information is compiled with purpose of elaborating comprehensive recommendations on diagnostics of phases of development of syndrome of emotional burnout in this category of medical specialists at the initial stages of its occurrence and proposing measures of its adjustment including social and personal prevention.

The purpose of the study is to determine therapeutic effectiveness of the pulsed high intensity optical irradiation device “Zarya” exemplified by treatment of model wounds in laboratory animals and to compare with traditional methods of wound treatment.The prototype of “Zarya” device was used whose operating principle was based on pulsed irradiation of affected areas with high intensity optical radiation in continuous spectrum generated by pulsed xenon lamp. The therapeutic effect of the “Zarya” device was compared with effectiveness of the certified medical ultraviolet irradiator based on low-pressure mercury lamp and also with known wound-healing and antibacterial medication Levomekol ointment. The mature male rats of Wistar line were used in the study. The animals were distributed to 4 groups: group 1 was irradiated by “Zarya” device, group 2 was irradiated by low-pressure mercury lamp, group 3 was treated with Levomekol ointment and group 4 was exposed to no exposure. The linear wound was modeled according to the standard method under ether anesthesia. The therapeutic procedures were applied daily during 7 days. The bactericidal effect was studied on the basis of smears from wound onto flora on the 2nd, 5th and 7th day. On the 8th day the animals were subjected to euthanasia.It was established that “Zarya” device application permits to reduce considerably both duration of therapeutic procedures and therapy course in general and also to achieve more pronounced bactericidal effect. The obtained data is supposed to be used for development of program of clinical trials.

The article analyzes modern approaches to the rating of medical organizations based on national and foreign publications. The study identified groups of indices that are responsible for effectiveness of health care organizations from the point of view of consumers of medical services and state boards of public health management.According analyzed publications, rating values consider effectiveness of particular processes, rather than organization as a whole. This became the basis for scientific search for assessment system that can reflect the performance of medical organization contributing into its sustainable development. In 2012-2018, the Novosibirsk State Medical University carried out the study of potential of sustainable development of health care organizations. On the basis of normative legal analysis, sociological and expert survey of opinions of managers, the key areas of activities that contributed to improving efficiency of medical organizations were identified.The article presents the original approach to comparative assessment of health care organizations that provide various types of care of population based on concept of sustainable development using the T. L. Saati hierarchy analysis methodology.The strategy of sustainable development presumes achievement of long-term goals of medical organization, including not only indices of patient satisfaction with quality of medical care and organization of safe environment for their stay in health care institution, but also optimization of all processes, rational resource support, monitoring and analysis of internal environment of organization for continuous development of functioning, personnel training, implementation of organizational innovations.The medical organizations implementing strategy of sustainable development demonstrated the best results in such areas as resource management, increasing consumer satisfaction with quality and safety of medical care, optimization of processes of increasing number of treated patients. Thus, health care organizations having clear-cut plan of actions and set of management practices to achieve long-term goals acquire ability to improve both medical social indices and population health indices.

The neurosurgery is one of the most innovative and hi-tech directions of scientific and clinical activity that significantly contribute into improvement of health and improvement of quality and longevity of human life. This positioning specifies actuality of implementing on regular basis the analysis of trends of its development with purpose to improve corresponding indices of its efficiency, to develop conditions for continuity of medical process, to ensure equal accessibility of specialized neurosurgical medical care to population in the Regions of the Russian Federation.The purpose of the study was to describe and to analyze indices of neurosurgical service functioning to support decision making related to development of professional partnership and ensuring for population of different regions of Russia equal access to profile specialized medical care.The data of 2015-2019 was collected from 85 Subjects of the Russian Federation contained in the forms of state statistical observation “Data on activity of divisions of medical organization providing medical care in hospital conditions” and “Data on medical organization”. The analysis of the collected data was implemented using such statistical tools as simple (unweighted) arithmetical mean values, specific weight of indices values, mean-root-square (standard) deviation from average values, coefficient of variation (mean-square distance and average value ratio). The data set considered as homogeneous if coefficient of variation did not exceed 33%.The study revealed that in the Russian Federation, at the mean, provision of beds of neurosurgical profile to population in 2015-2019 decreased from 9.22 to 8.83 beds per 100 000 of population. In 2019, intensity of hospitalization made up to 2.77±1.06 cases per 1000 of population. The average duration of treatment for five years decreased for 1 day and in 2019 made up to 8.47 days (9.96±2.3 days on beds for adults and 7.00±2.1 on beds for children). The mean annual occupancy of one bed of neurosurgical profile for adults decreased from 319.6±31.3 days in 2015 to 311.7±29.8 days in 2019 and for children from 305.4±28.3 days in 2015 to 289.0±29.1 days in 2019. The total hospital lethality of neurosurgical beds in 2019 consisted 1.22±1.19% that is 22.7% less than in 2015 (1.50±1.37%). The number of implemented surgical operations increased from 146.4 in 2015 to 179.1 thousand in 2019, i.e. for 22.4% and made up to 2.7 operations per 1000 of population. The postoperative lethality decreased from 9.63±7.07% in 2016 to 8.19±4.48% in 2019. In 2019, there were 1.91±0.61 neurosurgeons (natural persons) per 100 000 of population. The total number of established posts of neurosurgeons in 2019 made up to 4792.25 units (in 2015 - 4629.75 units) and out of them 4318 units are occupied (in 2015 - 4264 units). The occupied units covered 2923 neurosurgeons as natural persons. On average, per one neurosurgeon (natural person) in the Subjects of the Russian Federation fall 4.7±1.30 beds of neurosurgical profile (from 2.6 to 10.7), 54.7± 24.6 surgical operations on nervous system per year (from 14 to 162), 137.8±41.1 cases of neurosurgical beds hospitalization (from 60 to 300). In five years, the structure of types of surgical operations on nervous system changed insignificantly. The surgeries in case of degenerative diseases of spline prevail and their specific weight increases.In Russia, significant differentiation of the Regions in level of resource support of medical care of neurosurgical profile continue to remain. At that, the Russian neurosurgeons in average implement three times less operation per year than their respective colleagues from Western Europe. In Russia, the main portion of neurosurgical operations is implemented in case of degenerative diseases of spine while in the developed foreign countries in case of cerebral stroke that is one of the main causes of death all around the world. To ensure equal access of population of different Subjects of Russia to profile specialized medical care an integration of clinical and administrative processes (vertical integration) is needed. The important role in solution of this task belongs to National medical research centers organized in Russia on the basis of leading Federal state scientific medical organizations.

The purpose of the study was to analyze organization of medical care of crews of passenger ships of inner water transport of the Russian Federation and to examine morbidity according to appeal for medical care of the crew during navigation.The analysis of organization of medical care in inner water transport covered the corresponding normative legal base of the late 1980s to present times. The search and analysis of available publications concerning issues of organization and provision of medical care to passenger river transport crews during and out of navigation was carried out. The estimation of morbidity statistics was implemented according data of medical log journal of out-patient reception of members of the crew of river cruise ship during navigation.The normative legal base of provision of medical care to crews of water river transport during navigation and on shore, and training and employment systems of ship physicians requires substantial revision. On average, 1.5 initial visits for medical assistance during navigation is for 1 crew members. The repeated visits accounted for significant proportion (48.0%) of all crew visits. The largest percentage of visits was related to rank-and-file staff (74.0%). In the structure of causes of visiting out-patient medical unit on board the first place is for injuries (22.0%), respiratory diseases follow (18.0%) and diseases of musculoskeletal system are third (11.0%).In the Russian Federation, the system of medical care support of the crews of water passenger transport requires a serious improvement. The structure of morbidity of the crew of a passenger river vessel during navigation (the prevalence of injuries, respiratory diseases, diseases of the musculoskeletal system) is determined by unfavorable factors of professional activity of sailors and dictates the specifics of training of ship physicians. It is necessary to work further the normative legal base regulating medical care of the crew during navigation and on the coast, training and employment of ship medical personnel, and developing and approval of unified quality standards for organizations (institutions) involved into medical support of inner water transport workers.

The article considers the organization of postgraduate education and clinical activities within the framework of functioning of the North-Caucasian Scientific and Educational Medical Cluster. The analysis of obtained data revealed shortcomings in training of physicians at all stages of their professional career, as well as inadequately effective mechanisms of employment of graduates from medical faculties. To eliminate these shortcomings, the measures have been developed within the framework of NOMK that include computer programs for operational monitoring of public health indices, innovative technologies of education and advanced training of of physicians, exemplified by the Tutor project. The conclusion is made that scientific and educational cluster is an effective tool in area of training and retraining of physicians .

The article presents, on the basis of archival documents and literature sources, the distribution and placement of hospital staff, staffing of physicians and nurses, support of population with medical personnel and medications, changes in beds stock, equipment of hospital institutions on the unoccupied territories of the USSR. An increase of workload, volume and intensity of labor of personnel of civil health care during the first two years of the Great Patriotic War was established. The unreadiness of the Narkomzdrav (the USSR People's Commissariat of Health Care) for making optimal decisions concerning the rational application of human resources in the beginning of the war is proved.

The article reconstructs and describes, considering as a background the social political events that took place in the USSR during 1930s-1950s, the scientific biography and input into clinical medicine of professor V. N. Vinogradov (1882-1964), the prominent Soviet therapist, the Hero of Socialist Labor, the USSR State Prize winner (posthumously), the holder of five Orders of Lenin, the Honored Man of Science, the Head of the Chairs of Faculty Therapy of the I. V. Stalin Second Moscow State Medical Institute (1935-1942) and the I. M. Sechenov First Moscow Medical (1943-1964), the full member of the USSR Academy of Medical Sciences. The facts of participation of V. N. Vinogradov in the political trials on “The case of the Trotskyst block” (1938, on the side of the prosecution) and on “The case of physicians” (1952-1953, as the accused one) are presented. The issues of existence of the scientific clinical school of V. N. Vinogradov (in a sense, the united school of V. N. Vinogradov-V. G. Popov can be considered) and the phenomenon of leadership of V. N. Vinogradov among the therapeutic elite of the USSR are discussed. This phenomenon consists in dedication to the cause he served and in consecutive implementation of the priority directions of the clinic of internal diseases, developed by the teams of the departments and clinics headed by him in different years.