Problems of Social Hygiene,
Public Health and History of Medicine

The pandemic of new coronavirus infection (COVID-19) directly effected medical statistics service. The amendments to the Federal Law “On the Official Statistical Accounting and the System of State Statistics in the Russian Federation” adopted in December 2020, regulated the provision of primary statistical data according forms of Federal and industrial statistical observation in the format of electronic document signed with electronic signature. This required the development of system of collecting and processing statistical data at the Federal level applying new technological solutions.The purpose of the study. To analyze the changes in the system of collecting and processing annual reporting on medical statistics for 2020 during the pandemic of new coronavirus infection COVID-19.The analysis was made concerning both normative legal base regulating implementation of information systems and system of receiving annual reports for current and previous years. Also content analysis was applied and materials distributed Internet were used.In conditions of new coronavirus infection (COVID-19) pandemic, instead of classical system of informational interaction at face-to-face coordination of annual report data, in extremely short terms new model of informational interaction of remote coordination and processing of annual report data was developed. The updated technological scheme was applied that included data transmission, remote coordination in VKS format, informing thriugh Telegram-channels and signing finalized forms with enhanced electronic digital signature.The complicated epidemiological situation regarding morbidity of new coronavirus infection (COVID-19) and as well as adoption of amendments in Federal legislation regarding provision of statistical observation forms in format of electronic document signed with electronic signature, required revision of format of statistical reports reception in 2020. The application of developed technology of collecting and processing annual reports data on medical statistics in online format permitted to dispense with both provision of hard copies versions of forms and reports and business trips of specialists from the subjects of the Russian Federation to Moscow that reduced expenses of the subjects of the Russian Federation when submitting annual reports. The developed mechanism of signing with unqualified electronic digital signature permitted to control data integrity. The applied mechanism for signing finalized concerted forms with enhanced electronic digital signature of public authority of the subject of the Russian Federation in the field of health protection ensured juridical significance of document provided. The establishment of base for further modernization of system of collecting statistical information from primary data, including subsequent implementation of structured electronic medical documents is proposed.

The article considers essential theoretical methodological approaches of studying problematics of social capital presented in corresponding modern publications. The key results of conducted empirical studies were analyzed too. It is noted that in conditions of spread of COVID-19 pandemic, occurs increasing of risk of “social distancing” that affects intensification of psychological anxiety feeling and decreasing of level of interpersonal and institutional trust. The presented results testify that topic of social capital becomes one of the most important in the study of processes of pandemic course. The conducted studies permitted to identify relationships between various components of social capital and scale of pandemic spread, forms of population's counteraction to pandemic. The review of scientific publications on problematics of social capital and functioning of organizations in conditions of intensification of risks of pandemic spread and developing crisis processes in economics also permits to establish particular trends in respect of developing corresponding strategies of adaption to new reality.

The actuality of considered problem is in the fact that many medical social problems of preserving and improving population health can be resolved by the family and with its support. The purpose of the study is to substantiate scientifically priority of family approach in development of National health preservation system in actual conditions. Materials and methods. The national and foreign electronic databases were investigated to find publications concerning transformation of matrimonial relations, effect of family on health and need in health preservation technologies at each stage of its development. Results. It is demonstrated that implementation of family-oriented technologies of health preservation based on knowledge of trends in family health, matrimonial relations and demographic shifts in its structure is one of the priority directions of preserving and strengthening population health. Moreover, in modern socioeconomic conditions, the categories of families that are in special need of medical social protection and health preservation such as socially problematic families, families where violence is practiced, families of the unemployed and migrants are shown up. Hence, one of the priority scientific tasks is to substantiate conceptual model of health preservation technologies for various types of families. Conclusion. The family and its health should become priority object of medical observation and research studies from the standpoint of public health and health care.

The purpose of the study is to analyze the application of I50.9 code as initial cause of death (PBC) in various subjects of the Russian Federation in 2013-2019.The Rosstat data (Annual forms C41 and C51) based on the “Brief Nomenclature of Causes of Death of Rosstat” (KNPSR) in 2013-2019. The standardized mortality rates (SPS) were determined using corresponding software (state registration number 216661114), coefficient of variation (Cv) and the max/min ratio.In 2013-2019, the regional average value of the SCR from cardiac failure (code I50.9) decreased up to 4 times (from 6.3 ± 10.3 to 1.5 ± 3.5; p <0.0001), but Сv of regional SCR increased by almost 1.5 times (162% and 230%). The percentage of regions where cardiac failure was not indicated as PPP, increased from 8% in 2013 to 19% in 2019. However, only in the Yaroslavl Oblast and the Republic of Buryatia no case of indicating I50.9 code as PPP was registered. In five regions, less than 10 cases were registered in 7 years, in 3 regions an unstable tendency to increase in SDR from HF was established. In 36 regions, more significant variability of RMS from year to year was recorded. From our point of view, the indices are affected in parallel by teo processes: changes in mortality rates associated with chronic heart failure and changes in mortality rates due to approaches to filling out the MSS and coding PPP.To determine the contribution of cardiac failure into population mortality, it is necessary to separate concepts “chronic cardiac failure syndrome” and “cardiac failure as death mechanism” and to introduce uniform rules of indicating chronic cardiac failure syndrome in the MSS.

The purpose of the study is to to identify key social and medical problems of childhood psychiatry by analysis of statistical and clinical data of Moscow health care institutions. It is established that actual problems are related to increasing of incidence of morbidity of mental disorders in children, their late detection, absence or unavailability of diagnostic techniques with high evidentiary effect, inability to use modern achievements of psychopharmacotherapy, close relationship of mental disorders with social factors, as well as with high stigmatization of mental health sphere. It is necessary to intensify research in studying etiopathogenetic factors, elaborating strategies of mental disorders prevention in childhood, clinical trials targeted to expand age range of application of medications and to icrease activities on destigmatization and psychoeducation in society.

The current world-wide trend of increasing of mental diseases morbidity requires active development of corresponding enhanced public legal measures. On one hand, it is necessary to ensure implementation of all civil rights of mentally ill persons. On the other hand, it is necessary to ensure safety of society, protecting it as much as possible from illegal behavior of mentally ill people. According to the WHO data, number of people with mental disorders is on average about 450 million people and this figure is constantly increasing. According to the Constitution of the Russian Federation, the state guarantees equality of human rights and freedoms of person and c itizen regardless of any circumstances. The protection of rights and legitimate interests of mentally ill people causes a number of difficulties, therefore they are vulnerable to community. The article identifies principal problems existing in this field and suggests possible means of eliminating them by introducing changes into current National legislation on mental care.

The problems of professional advancement of medical personnel, their professional formation and professional career have enduring importance in connection with development and improvement of medical care system in any society. The purpose of the study is to investigate characteristics of influence of type of organizational culture of medical organizations on career orientations of medical personnel. The study covered sampling of 7 364 employees of medical organizations. The complex of psycho-diagnostic techniques was applied that permitted to examine prevailing type of organizational culture of medical organizations (The R. Harrison questionnaire adapted by S. A. Lipatov), preferences of medical personnel in building up their professional career (E. Schein questionnaire “Carrier Anchors”), and their concepts about competitive medical worker (semantic differential - 16 opposite personality characteristics). The statistical methods included standard procedures of primary mathematical processing of empirical data (frequency and percentage distribution, calculation of mean group indices, standard deviation and dispersions), comparative analysis using Student's test (correctness of criterion application was checked by the Libya test), Spearman correlation analysis.It is established that under developed organizational culture of medical organization, its orientations towards task and personality, with team cohesion and high level of value-orientated unity of their members, medical workers have consistency of concepts concerning career and a unity of career orientations targeted to professional competence and service to other people that determines quality of medical care.

The medical personnel of mobile teams of emergency medical care are exposed to factors of working environment that affect health state and results in development of occupational diseases. The purpose of study is to analyze morbidity of medical personnel of mobile teams of emergency medical care according data of temporary disability and results of medical check-ups. The analysis was made according information from certificates of incapacity for work and the final acts of periodic medical examinations for five-year period. The study established significant increase of rate and duration of primary and general morbidity with increase of age and length of service of workers, higher susceptibility to diseases of physicians as compared with paramedics and employees of pediatric teams and specialists of other clinical profiles. In the structure of morbidity according to results of medical examinations, diseases of the eye and its accessory apparatus, the circulatory system and the musculo-skeletal system prevailed.

The elimination of cervical cancer is one of the leading international public health problems that is associated with corresponding high morbidity and mortality among women of able-bodied and reproductive age. In the Russian Federation, in 2018, in more than 17.5 thousand women cervix malignant neoplasms were diagnosed and more than 6 thousand of them died. Cervical cancer is preventable disease that can be eliminated if the targets of the WHO Global Strategy to Eliminate Cervical Cancer as Public Health Issue will be achieved. The purpose of the study is to analyze indices of timely cervical cancer diagnostics in the Russian Federation and in its subjects in 2007-2018. Despite favorable trend of increasing of active detection of cervical cancer, this indicator (41.8%) continues to be low, both in the country in whole and in most of the subjects of the Russian Federation. The cervical cancer in situ stage is detected only in 25.3 cases per 100 cases of cervix cancer and stages I and II of disease are detected in 66.1% of cases. More than a third of all cases of cervical cancer (32.6%) are detected at III-IV stages of oncologic process. The percentage of patients died within the first year after cervical cancer was diagnosed decreased significantly from 19.0% in 2007 to 13.8% in 2018.

The results of implementation of developed approaches to medical support of ceremonies of opening and closing international sport competitions are demonstrated by the example of the XXVII Summer World Student Games in Kazan in 2013. The ceremonies took place at the venue with capacity of 45,000 spectators. The number of requests for medical assistance during the opening and closing ceremonies was 5.1 and 2.5 per 1000 spectators and accredited participants, respectively. Six individuals were evacuated to hospitals (0.1 cases per 1000 spectators and accredited event participants). The experience of organization of medical support of opening and closing ceremonies of international sport competitions is of practical significance in the framework of preparation and holding of international events in Russia.

The analysis of level and structure of general and primary morbidity according to medical care appealability of Moscow population during implementation of the State program “The Development of the City of Moscow Health Care (Metropolitan Health Care) in 2012-2020” was carried out according to the data from collections of main indices of functioning of medical organizations subordinated to the Moscow Health Care Department and health indices of Moscow population. The decreasing of both primary and general morbidity indices is established. At that, increasing of the life expectancy indices was marked. At the same time, population morbidity indices according to medical care appealability are not sufficiently reliable in assessing degree of achievement of results of any measures of improving population health due to their dependence on multitude of factors.

The article presents the original system of indices for comprehensive assessment of level of intersectorial collaboration in palliative medical care support of population. The system was developed on the basis of and considering requirements of normative legal acts of the Russian Federation. The proposed indices can be applied in analysis of functioning and subsequent optimization of medical institutions network and social service institutions in the subjects of the Russian Federation, including involvement of non-profit organizations and public associations.

The ongoing process of reforming national health care system determines associated search for systems of adequate decision-making based on comprehensive and objective analysis of activities of sector objects. The results of many years research demonstrate that one of the most effective such systems is system of assessing compliance of medical activities with established requirements. It is a methodology that permits to implement systematic comprehensive analysis of health care objects and make necessary decisions on its basis. This approach is extremely important for improving control and authorization-based mechanisms, justifying necessary resource support and developing comprehensive programs of development of isolated institutions, services and industry as whole.The term “conformity assessment” was introduced for the first time in the Federal Law № 184 of 27.12.2002 “On Technical Regulation”. The given law defines concept of conformity assessment as direct or indirect compliance with requirements imposed on the object. The concept presented in this law regulates industrial activity to objects and subjects of technical regulation. It is this ideology that became a basis of actual study, in which methodology and organizational technology was developed and experimentally tested to assess compliance of medical organizations and individual health services with requirements established by current legislation.Within study framework, development and experimental testing of system of assessing compliance of medical activities with requirements of regulatory documents was carried out. The object of the study was medical organizations and their structural divisions.The significant increase was established in specially developed integral compliance coefficients for studied objects for 2016-2020: from 76.5% to 82.0% for a number of medical profiles selected for the study and from 72.0% to 78.0% for medical organizations. The data obtained indicate that on the basis of a set of balanced indices, administration of monitoring objects made adequate management decisions.

The article presents experience of reforming of primary health care in the Belgorod Oblast in 2016-2019. In the course of reforming the original organizational model of interaction between doctors and patients developed and implemented. The measures were applied to strengthen the material-technical base and personnel potential of primary medical care. The offices of General Practitioners were arranged within step accessibility for patients. The continuous training of family physicians was organized at the workplace. The unified regional medical information system was developed and implemented enabling corporate conference communication, remote consultations, population feedback and remote arrangement of making appointment with physician. The differentiated approach to medical personnel remuneration of labor was brought on the basis of key performance indices that permitted to increase their salary and quality of work. As a result of the reforms, the percentage of people covered by family physicians dispensary observation increased by 13%, number of emergency calls decreased by 3.3% and number of calls because of illness reduced by 17%. The mortality rate of people older than able-bodied age began to decrease and population life expectancy reached prognosticated numbers of 74 years in 2019.

The article presents the results of analysis of educational activities of a medical University. Among the issues that need to be resolved, quality of professional selection of applicants to medical universities, backwardness in time management skills, stress coping and leadership qualities in students are noted. The mechanisms for solving these issues are proposed on the basis of “puzzle technology” - embedding in existing matrix those activities that are capable to qualitatively change the situation in a particular field of higher education. Based on functioning of cluster technologies in the SEMC “Northern Caucasian”, joint measures are developed to optimize educational activities not only in educational organizations subordinated to the Ministry of Health of the Russian Federation, but also those in the structure of the Ministry of education and science of the Russian Federation that include medical faculties and/or institutes. The conclusion is made that the inclusion of educational organizations of any departmental affiliation into scientific educational medical clusters has positive effect on quality education of future physicians.

The article is devoted to discussion of organizational problems of military medicine at the Pirogov congresses of physicians during the First World War. A number of speeches of military physicians at the meetings of the military section of the congresses in 1914-1918 are analyzed. The ideas sounded at the Pirogov congresses were considered in the process of developing the Soviet health care system. The study of the materials of the congresses gives a notion of burning questions of military medicine of the studied period.