Problems of Social Hygiene,
Public Health and History of Medicine

Over the last decades, with purpose of increasing efficiency of medical and preventive activities, the search, development, implementation and improvement of new methods and models of health care system functioning and management of medical organizations is carried out.Purpose of the study - to analyze mechanisms of implementing strategies of medical prevention in the Russian Federation.The publications on implementation of strategies of medical prevention in the Russian Federation were analyzed.The data analysis testifies that improvement of preventive activities at the level of ambulatory polyclinic care is initiated in many subjects of the Russian Federation. However, efficiency of these innovations remains relatively low.The conclusion is made that high morbidity and mortality of non-communicable diseases testify the most urgent need in optimizing prevention system.

The article explores relationship between health capital and efficiency indices of regional health systems. The correlation analysis of relationship between individual subjective assessments of health capital and objective indices of health care system functioning in the regions and the Federal Okrugs of the Russian Federation based on application of Minmax technology was carried out. The determination of level of health capital was implemented according to results of population survey and subsequent modeling. The effectiveness of regional health care systems was assessed using indices of healthy life expectancy, percentage of the disabled and per capita health care expenditures in the regions. It is established that 1/3 of subjects of the Russian Federation have high level of health care efficiency. However, the high level of health capital was noted in 12.5% of subjects, while in 40% of them its level was low. There are pronounced regional differences in the stock of health capital. The highest level of health capital was established in the subjects of the North Caucasian Federal Okrug that is conditioned by higher healthy life expectancy and higher efficiency of health care system at lower per capita costs. The statistically significant differences between subjective and objective factors affecting assessment of health capital are presented. The lower per capita health care costs and high percentage of the disabled have no significant impact on health capital of the population in the regions of Russia. The differences between health capital and regional health system performance indices are conditioned by subjective nature of health capital estimates that are determined by individuals within social groups and are characterized by persistent systematic differences between regions.

The purpose of the article is to study influence of various forms of physical activity on physical and psychological health of the elderly on the basis of content analysis of publications, secondary analysis of results of sociological studies of national and foreign researchers. The scientific novelty of studied question consists in critical comprehension of risk factors of development of somatic and mental diseases depending on degree of physical activity and also in elaboration of classification that included such macro- and micro-factors determining its dynamics as social cultural, social demographic, geographic, individual personal or motivational, promotional and managerial ones. The emphasis is made on necessity of additional research in this subject field to lay the foundation for making important management decisions concerning social protection and support of the elderly.

In 1960s, the fundamental normative planning research of health care needs differentiated according age, medical care and its resource support depending on various profiles including “phthisiology” has been carried out regularly. After the budget insurance model of medical care was implemented, the attention to renewal of normative base decreased that resulted in significant regional disproportions between planned (normative) and factual volumes of medical care, including its application to children population on profile “phthisiology” in hospital conditions.The purpose of the study. To compare normative, factual and estimated rate of hospitalization to provide medical care of children population on profile “phthisiology” in hospitals of the subjects of The Russian Federation.Materials and methods. Such methods as analysis of statistical information, normative and analytic technique, method of ratios and proportions, correlation analysis were applied.The results. The data on number of patients with active tuberculosis were used to estimate need in mentioned medical care by 14 groups of patients that made up to 0.2 cases per 1000 children that is three times less than factual (0.6) and four times less than normative (0,8) indices. In the comparison groups, deficiency of factual vs. normative volumes of medical care increases as group morbidity increases. However, there are no signs of unmet needs in medical care. Thus, as bed occupancy rate is below approved level in all study groups. There is no correlation between bed occupancy rate and factual vs. normative admission rates ratio (Kendall's tau_b=0,178, р=0,101).Conclusion. The mismatch between factual and normative admission rates on profile “phthisiology” demonstrates both uneven provision of medical care in the subjects of The Russian Federation and overestimation of approved (normative) medical care that is four times higher than the estimated rate. To validate the obtained results special study of health care in question is needed with focused on primary data combined with expert assessment of validity of hospitalization.

The current state of health care and medical support of seamen during their residence on board has a number of disadvantages. The sea vessel is not only a source of increased danger both for other ships and port infrastructure, but also an extremely traumatic area. The unification and harmonization of legal regulation of this segment of public relations becomes even more actual in current conditions. The organization of medical unit on ships of merchant fleet is regulated by a number of international treaties, whose provisions are considered and analyzed in the article. The study permitted to identify a number of disadvantages occurring when seamen seek medical care while on board. The health and medical care of seamen on board is not limited to treatment of the sick and the injured, but covers preventive measures with particular emphasis on development of health care and health education programs. In any shipping company, the important preventive aspect of ship medicine is struggle against drug and alcohol consumption among crew members. The directions of overcoming the considered problems are proposed. It is emphasized that their solution should be of systemic unified nature, since legal basis of organization of medical unit on ships is grounded on international conventions.

The article presents the results of comparative analysis of indices of physical development of school-age children residing in various regions of the Republic of Kyrgyzstan. The statistically significant relationship between body length and body mass of examined children from territories of their residence was established. The children from Bishkek had significantly higher values as compared to children from villages of highlands and the south and the north of the country as well. The statistically significant dependence of body length and body mass of examined children on gender was revealed, explained by higher anthropometric indices in boys, as compared with girls in age categories of 7-8 years and 15-17 years. The multivariate variance analysis established that territorial factor statistically significant affected anthropometric indices in all studied age categories. At that, input of this factor into indices dispersion did not exceed 10%. The input of sex assignment to variance of body height and body mass in children under age of 14 years was insignificant. However, in the age of 15 years and older effect of this factor on anthropometric indices increased significantly, reaching its maximum by the age of 17 years and significantly predominating over influence of territorial factor.

The purpose of the study. To assess the social economic factors of development of morbidity of psoriasis in adult population within a separate region as exemplified by the Republic of Bashkortostan.Materials and methods. The non-linear dynamic prognostic regression model with panel data was applied to establish role of social economic factors in development of morbidity of psoriasis in adult population. The model-based indicator is rate of total adult morbidity of psoriasis in 51 municipalities and 7 urban districts in 2014-2018. The factor space was generated by ten groups.The results. The regression coefficients (elasticity) were obtained for every group of social economic factors. With increasing of factor of harmful emissions into atmosphere by 100.0%, morbidity of psoriasis in all municipalities can increase on average by 7.0% (elasticity coefficient -0.07). With increasing of economic well-being and incomes of population by 1.0%, a decrease of morbidity of psoriasis by 1.55% is possible. With changing of number of workers employed in harmful production by 100.0%, morbidity of psoriasis in adult population decreases on average by 3.9% (elasticity coefficient -0.39). The specific number of unemployed population (the unemployed, pensioners) and factor of social psychological stress in society turned out to be insignificant. The elasticity factor of level of support of population with public health resources was 0.08. At theoretical opportunity of increasing health care resources up to 100.0%, morbidity of psoriasis in adult population of municipalities can increase on average by 8.0%.Conclusion. The overall morbidity of psoriasis in adult population of the Republic of Bashkortostan is positively affected by economic development of municipality and level of urbanization. The unfavorable environmental factors have impact negatively. The increasing of volume of health care resources (provision of population with medical personnel, number of beds of day-and-night and daytime stay, capacity of polyclinic institutions, etc.) may result in increasing of morbidity of psoriasis in municipalities as consequence of increased accessibility of medical care. The study results can be applied in planning health care within the framework of medical care support of patients with chronic dermatitis in the Republic of Bashkortostan.

The research in the field of regional trends and risk factors related to population morbidity is considered as background of management decision-making in health care.The article presents the results of analysis of medical demographic indices and population health status in the Jewish Autonomous Oblast in 2000-2019. It is established that in in the Jewish Autonomous Oblast population size reduced by 35 100 people to 2019. The negative migration dispositions facilitate losses of population size from 0.5% to 1.23% annually. The gradual increase of number of the elderly brought to ratio working/non-working people 100 to 128. The infant mortality rate decreased from 20.2 in 2000 to 9.2 per 1000 newborns in 2019 and continues to decrease. The total morbidity increase (diagnosed for the first time) of cardiovascular diseases and neoplasms is probably related to preventive measures efficiency. In the structure of malignant neoplasms leading positions are taken by tumors of bronchopulmonary system, skin affections and breast cancer. In the Jewish Autonomous Oblast, mortality of cardiovascular diseases comprised 807.32±22.87 per 100 000 of population. In the last decade, this most important indicator decreased up to 2.12%. The mortality of malignant neoplasms made up to 217.31±15.25 per 100 000 of population. The mortality due to consolidated causes “Traumas, poisonings and some other consequences of external causes exposure” made up to 16.19±3.28 per 100 000 of population. In 2019, the average life interval made up to 68.8 years, having increased by 6.2 years since 2000. The evaluation of medical demographic indices and population health status demonstrate necessity of adjusting medical organizational measures targeting to improve medical care of population considering regional characteristics.

The international research studies demonstrate stable relationship between disability status and multiple social economic factors conditioning inequity and disintegration of this category of citizen. The purpose of the study is to review foreign research publications concerning issues of inequity, stigmatization and social disintegration of the disabled with limited health possibilities. The conclusion is made that perception of disability is an important construction impacting not only well-being of people with limited possibilities but also social economic stability of society. The negative attitude to disability deprives forces people with limited possibilities and results in their social isolation and disintegration at labor market. On the contrary, healthy society encourages positive attitude to people with limited possibilities and facilitates their social integration.

Actually, in many medical organizations there is an inexpedient structure of labor costs of medical workers, in many respects associated with large time spent on making up medical documentation. The very important aspect is proper formulation of clinical diagnosis and its coding according to the International Classification of Diseases of the 10th revision that in most cases is performed in tradition mode (so called manual coding). The article presents results of functional and cost analysis of application of automated system of coding support in various departments of the Medical Sanitary Unit of of the Ministry of Internal Affairs of Russia at the Moscow Oblast. The study established significant difference in time spent and cost of coding process before and after implementation of automated system. The automated coding of diagnosis permits to reduce six-fold time and cost of coding process, as well as up to 12.6% reduce number of coding errors. The results of functional and cost analysis serve as an objective justification of economic expediency of implementing automated system of diagnosis coding support in multidisciplinary hospital.

The article presents the results of analysis of specialized medical care of children with life threatening and chronic progressive rare (orphan) diseases resulting in life span shortening or disability. The possibility of medication support of children with rare diseases. The development of patient routing system considering characteristics of particular disease and possibilities of the subjects of the Russian Federation is one of most important directions of enhancement of needed medical care support.

In order to study attitude of graduates of medical specialties to employment in primary health care system and to postgraduate medical education, anonymous survey was carried out on sampling of 188 graduates of medical institute of the Belgorod State National Research University in 2020-2021. The analysis established that married students more often than single ones seek permanent job with guaranteed salary and social protection. The advanced graduates easier get their future specialty than weak and satisfactory ones. The graduates-foreign citizens and stateless ones consider themselves under-prepared for medical practice as compared with graduates-residents of city and oblast. The youths more often than girls meet future employers. the weak graduates meet the employers less often than advanced graduates. The satisfactory graduates, as compared with weak and advanced graduates, more often have close relatives among medical workers. By the time they graduate, youths more often than girls get experience of practical medical activity. The advanced graduates also more frequently get practical medical experience than weak and satisfactory graduates.

The motivation of work is based on personnel needs. The directivity of organization management to meeting needs of employees of any professional group is capable to increase their labor motivation and job satisfaction creating at that favorable working environment.The purpose of the study is to determine value of motivational factors-needs for employees of professional groups of medical organization and to justify application of obtained motivational complexes of factors-requirements for increasing labor motivation of personnel.The continuous anonymous survey of 603 employees of six departmental medical organizations was carried out. The respondents were distributed in such professional groups as Administration (42); Experts (97); Nurses (257); Other professionals (86) and Paramedical staff (121). The group Specialists included subgroups Surgical (13) and Therapeutic (84 people) profiles. The group Other specialists included subgroups with higher (51 people) and secondary education (40 people). The factors-needs determining work motivation were estimated by P. Martin and S. Ritchie “Motivational profile Test”. The statistical data processing was carried out using “Statistica-10” software. The criteria of Kruskal-Wallis, Kolmogorov-Smirnov and Kendall τ-criterion were applied.The motivational value of factors-needs in employees of professional groups of medical organization, including characteristics of estimates of needs respondents with different work experience considering their gender and marital status is defined.The hierarchical structure of factors-needs according to degree of their motivational value in employees of each professional group can be represented in form of group motivational complex. The indices of motivational value of factors-needs of complex correspond to specific expectations of employees of professional groups.The derived motivational factors-needs complexes can be applied in determining directions of management activities targeted to increasing of work motivation of personnel, creating favorable social and psychological work environment and establishing social responsibility of organization in terms of personnel.

The article considers activity of medical societies in 1860s related to theoretical development of problems of organization of Zemstvo medicine, sanitary statistics, medical topographical studies, preventive course of public medicine. It is demonstrated that results of these activities hereinafter were widely applied in the course of health care reforms of the second half of XIX century.

The review analyzes the reconstruction by Daria Sambuk of the development of system of medicine administration in Russia and the role in this process of social groups . The monograph is an interdisciplinary study on junction of social history of medicine and new imperial history. This review is focused on problematic comprehension of the subject of monograph. In addition to that, the questions are formulated for further discussion.