Problems of Social Hygiene,
Public Health and History of Medicine

The traumatism, including children traumatism, is one of priority problem of health care in the Russian Federation. The indices of children traumatism and disability because of injuries are the most important indices of children health. They characterize quality of child care in family, depend on common norms of public behavior, reflect cases of aggression and violence in relationship of adults and children and in children communities. The available comparative data permitted to analyze impact of the pandemic on structure and level of children traumatism as exemplified by the Kursk Oblast.

Lately, in case of a number of life-threatening and chronic progressive rare (orphan) diseases, resulting in decreasing of life expectancy of citizens or their disability, the powers to support patients with medications were transferred from regional to federal level. Among these diseases are hemolytic uremic syndrome, mucopolysaccharidose type I, II, VI, juvenile arthritis with systemic onset, unspecified aplastic anemia, hereditary deficiency of factors II (fibrinogen), VII (labile), X (Stuart-Prauer). The article considers data concerning hemolytic uremic syndrome, mucopolysaccharidosis type I, II, VI, juvenile arthritis with systemic onset - the diseases for which medication support provision was transferred to Federal level in the first place and for which at the time of preparation of the article there were sufficient data to analyze.

The article presents results of analysis of changes of official requirements to health of male youths with diseases of circulatory organs (Regulation of military medical expertise, revision of 1995, 2003, 2013). The sections I and II of the Articles 42-48 of the Schedule of diseases of this Regulation are considered from the point of view of category of physical fitness for military service on conscription. The complex of measures is proposed to level consequences of mitigation of requirements to health status of future servicemen for particular nosology.

The article presents the results of analysis of repeated disability because of thyroid cancer in adult population of Moscow in 2015-2019. The study established negative dynamics of increasing of the number of individuals with repeated disability because of thyroid cancer in all essential age contingents (young, middle and elderly age) of adult population. The similar trend was revealed in gender contingents of individuals with repeated disability because of thyroid cancer (in males, increase was made up to 112.5% and in females up to 196.3%).In the gender and age structure of repeated disability because of thyroid cancer, predominated females and the elderly. The study established dynamics of decreasing of percentage of individuals with repeated disability because of thyroid cancer of the disability groups I and III and corresponding increasing in disability group II. The percentage of individuals with repeated disability because of thyroid cancer in disability groups I and II was higher in males as compared with females. Most individuals with disabilities because of thyroid cancer don't work.The study results make available spectrum of disorders of main functions of organism, their degree and types and intensity of limitations in vital activity of individuals with repeated disability because of thyroid cancer. The organized database of characteristics of repeated disability because of thyroid cancer in adult population can be used in implementation of personalized approach to medical social rehabilitation of increasing number of disabled individuals with malignant damage of the most important organ of endocrine system.

Health status is one of the most valuable parameters of assessing well-being of elderly generation. It is advisable to study attitude of individuals older than able-bodied age to their own health as instrument adding to awareness of diseases or their symptoms, data concerning psychological and social well-being, degree of satisfaction with their own capabilities. Thus, in conditions of population aging, studying health self-assessment to determine prognosis of life and health of the elderly is of special actuality.

The deterioration of health status of female population is recognized as one of the important medical social problems. On its resolution depends reproduction of population and improvement of social demographic indices in the Russian Federation. The female health can be considered as one of the indices of physical, spiritual and social well-being of family. One of significant aspects of considering importance of female health status is her attitude to issues of her own health. The situation is aggravated by increase of asocial behavior in young women, accompanied by decreasing of quality of life and significant loss of moral values. Besides, organization of treatment and prevention measures for early detection and reduction of gynecological morbidity does not meet modern requirements. The economic conditions and ecological situation negatively contribute to deterioration of female health. Such social factors as lack of work or threat of losing it, low per capita income, inadequate housing and poor-quality nutrition, harmful habits deteriorate health status of female population. The status of one's own health and disease prevention are in last place in female population. In modern conditions, due to employment overload, women pay no due attention to their own health, do not undergo medical examinations, rarely visit physicians as study results confirm. The female health protection is facilitated not only by medical and diagnostic measures, but also by wide range of preventive activities, formation of healthy lifestyle, favorable conditions for education, work and life, legal and social support of women during child-bearing and child-rearing. The female health protection goes far beyond scope of medical problem and requires corresponding management decision-making and inter-departmental measures on legal and financial support of motherhood and childhood. Therefore, protection and promotion of female health, including reproductive health, are necessary conditions of achieving national security and improving demographic indices of the Russian Federation.

The article reflects main problems and opinions of social workers about possibilities of improving medical social care of population and providing social medical services. This group of specialists is forced to implement significant amount of work that is not regulated by their official duties. The lack of necessary competencies does not allow social workers to provide medical social assistance to consumers of medical social services to sufficient extent. To ensure interaction between medical and social workers largely falls on shoulders of the latter ones. They have to undertake a number of medical functions (examination, temporary stop of bleeding, blood pressure measurement, etc.). It conceives appropriate to transfer some of functions of junior and paramedical staff to social workers. The study results can be applied as methodological basis of increasing accessibility of medical social care and provided social and medical services to various groups of population.

The primary health care is characterized by its directivity to population health, while general practitioner is key figure in its organization and is responsible for assigned population health. The Russian Federation continues to suffer from overspecialization of medical care in outpatient health care. At that, the number of unreasonable visits to medical specialists is too high.The general practitioner, with appropriate training, can appoint patients by 11 specialties and in conditions of municipal polyclinic can undertake up to 81% of visits to medical specialists.The purpose of the study is to evaluate primary health care functioning in Moscow and to formulate proposals for reforming health care, considering development of general medical practices in a metropolis.The study was focused on analysis of morbidity of population of Moscow, on support of out-patient health care with physicians before and after implementation of three-level system of ambulatory polyclinic care, on evaluation of preventive activities of general practitioners and on development of proposals for improving organizational forms of activities with emphasis on health preservation.In the study were applied such methods as statistical, direct observation, sociological. The analysis was applied to forms of federal statistical observation i.e. form № 30 in Moscow and the Russian Federation for 2010-2019. The population sociological surveys concerning satisfaction with medical care were carried out. The research base was Moscow.The analysis demonstrated that results of Moscow health care system reformation is economically effective because of shortage of medical personnel primarily of administrative staff and its rational employment. The reformation results were positively assessed by patients, whose satisfaction with medical care made up to 95.6%.The general practitioner is to be responsible for health status of attached population and is called upon not only to carry out treatment and preventive activities, but also to coordinate organization of medical care of attached population at all stages of its provision.The implementation of general medical practice in conditions of municipality is to calculate complete transition of medical organizations providing out-patient medical care to general medical practice, that will result to certain extent, in reduction of staff positions of medical specialists. It is necessary to expand duties of medical nurse in general practice. The optimal model of joint work of general practitioner with feldsher and medical nurse of general practice. The complex general practice team can include medical registrar.The proposed perspective models permit to implement integrating role of general practitioner and to increase accessibility and efficiency of primary health care.

The article considers actual aspects of participation of private clinics in implementation of territorial program of mandatory medical insurance from position of development of mechanism of interaction at micro-level. The principles of public-private partnership are gaining more popularity in social sphere, especially in health care. In Russia, private clinics developed their own motives to participate in implementation of territorial program of mandatory medical insurance, but mechanism itself is not always elaborated considering regional characteristics. Therefore, medical organizations encounter problems concerning implementation of mechanism of public-private partnership: application deadline, normative legal base, positioning of executive and regulatory authorities, etc. The situation is aggravated by lacking of municipal health care departments in region that could inform private business about its corresponding rights and obligations. The problems of implementing public-private partnership are analyzed and mechanism of participation of private clinics in implementation of program of mandatory medical insurance (as exemplified by the Krasnodar Kray). The study permitted to determine detailed algorithm of participation of private medical organizations in program of mandatory medical insurance. The study results permitted to scope regional features of development of interaction between state and business.

The colorectal cancer remains one of leading problems of modern coloproctology and oncology. The polyps are one of pathology of colon widespread in population and predictor of colorectal cancer. Their timely detection and removal is considered as only effective measure of prevention of colon malignant neoplasms. The morbidity of colon malignant neoplasms in the Perm Kray was monitored in 2004-2018. Its structure and dynamics were evaluated. The software is described that allows both physicians and patients to evaluate probability of detecting colon neoplasms that contributes to expansion of the research database of coloproctologic studies. The ways of increasing effectiveness of predicting incidence of colorectal cancer and colon polyps were proposed on the basis of neural networks, that permit to increase detection of corresponding pathology by personalizing screening.

One of the most important tasks in transition to primary accreditation of health care professionals is increasing manning of primary health care section. It is achievable at the expense of opportunity for graduates of medical universities to find employment as district physicians and pediatricians without residency training. The purpose of the study was to assess impact on increasing of number of physicians of primary health care section of their admission to professional activities after primary accreditation. The study was carried out in the Irkutsk State Medical University provided objective quantitative evaluation of this occurrence. It was revealed that only every fifth graduate in specialty “General Medicine” and “Pediatrics” is employed as district physician, in half of cases combining this work with residency training, that subsequently results in leaving primary health care section. Only one out of ten continues to work in this position during 3-5 years.

The article considers activities of the Kursk State Medical University directed to organization and development of student volunteer teams. The model of training volunteers in conditions of the university is presented. The necessity of developing altruistic motives of medical students engaged in volunteer activities is substantiated. The organizational motivational model of volunteer training in medical university is presented.

The article proceeds to explore history of the pharmaceutical branch in the 1990s. The changes in system of medicinal supply in Russia are demonstrated through infrastructural transformations and their assessment by political figures and regulators of pharmaceutical market.

The article is devoted to one of the founders of sanitary and demographic statistics in Russia. The works of S. A. Novoselsky covering issues of natality, total and child mortality, average life expectancy attained blaze of publicity and until present time keep their significance. S. A. Novoselsky developed for the first time both complete Russian population mortality tables and first the USSR population mortality tables.