Problems of Social Hygiene,
Public Health and History of Medicine

The study was carried out to evaluate the dynamics of monthly numbers of cases, deaths, tests and case fatality ratio worldwide during three phases of the COVID-19 pandemic.Material and methods: Twenty-three sets of databases, dated the 22nd of each month from January 2020 to November 2021, for 213 countries were collected from the Worldometer website. The number of cases, deaths, tests, case fatality ratio, infection fatality ratio, etc. were counted for various periods of time for each of the 213 countries, then the results related to different periods of time were compared.The analysis of main epidemiological parameters resulted in division of three phases of the global pandemic evolution. The first phase (23.01.20-22.07.20), the second phase (23.07.20-22.01.21) and the third phase (23.01.21-22.07.21) were different in terms of the number of tests performed, new cases and mortality due to COVID-19. By the end of second phase, the worldwide statistics indicated imminent end of the pandemic, but the third phase was characterized by sudden rise in the number of new cases and deaths that could not be explained rationally. The most dramatic evolution of epidemic curve occurred in the countries where physicians had successfully confronted COVID-19 during the first two phases of the pandemic.Despite the decrease in the overall numbers deaths during the latest months analyzed, additional study is necessary to identify the cause of increasing in the number of new cases and deaths during the third phase of the pandemic.Presumably, there are several causes of negative evolution of the current pandemic, including over-reliance on polymerase chain reaction tests, application of non-specialized premises for quarantine and treatment, non-professional management, following therapeutic protocols applied in countries with high number of deaths, ignoring preventive treatment, and decreasing in mass and individual immunity.It can be suggested that the use of drugs modulating T-cell immunity is necessary, and preventive and therapeutic protocols should be changed from the 'standard' to 'personalized' types.

The COVID-19 pandemic came out as an imperative of large-scale transformations in higher education system, including higher medical school. At that, introduction of self-isolation regime in the spring 2020 highlighted the task of organizing education in remote format with maintaining education quality. The article presents results of sociological survey with purpose of studying perception of students of medical university of transition to remote learning format at the COVID-19 pandemic outset. The majority of respondents perceived remote learning format as an emergency measure to maintain continuity of education process, that, however, cannot completely replace full-time practice-oriented teaching “at the bedside of the patient”. Understanding the special tasks of training medical specialist required new solutions from higher school and additional efforts from all subjects of educational process - restructuring organizational infrastructure ensuring communication of teaching staff and students, solving organizational problems of access to educational content, adapting to practice of digital medical education, expanding use of AR, VR, mixed reality and simulation learning technologies. The students, highly assessing quality of digital content, noted difficulties of self-organization in “home” format due to a lot of distracting factors (family, domestic life, etc.) that had key impact on motivation of their learning activities. Nevertheless, among respondents of medical university, a number of students formed subgroup that considering personal experience of remote learning assumed that this format is actual and effective and allows one to fully master university curriculum. The transition to remote learning format in university as emergency measure during pandemic, will obviously be consolidated as an invariant standard of organizing educational process.

The preservation and promotion of population social health is one of actual global problems worldwide. The various phenomena currently associated with coronavirus pandemic, threats to individual human physical and mental health put the whole world on dangerous brink of self-destruction that actualize studying of human vital forces and human social health. The versatility of this problem is based on unity of personal vital forces, social health and social values where human is to be the highest value of state social policy. The article represents analysis of scientific publications, proposes genuine concept of harmonious personality modeling and substantiates need in studying human social health and individual vitality as complex interdisciplinary problem.

The article considers results of studying the quality of life of disabled patients because of diseases of peripheral nervous system. The significantly low level of indices of quality of life self-assessment was established on all scales of SF-36 questionnaire that are from 3 to 7 times lower than similar indices in population of Russia. The assessment of quality of life of disabled patients is necessary to determine effectiveness of applied rehabilitation measures and application of obtained results in planning further rehabilitation and habilitation activities.

Actually, there is constant increase of number of patients with coloproctological diseases, including corresponding malignant neoplasms. At that, issues of improving organization of specialized care of patients of this kind still remain unresolved in many positions.The retrospective analysis of regional coloproctological morbidity of adult population was carried out as exemplified by the Perm Kray. To forecast onset of colorectal cancer multiple logistic regression analysis was applied. To assess relationship of particular factors and morbidity, the Spearman rank correlation method was implemented. The ROC-analysis was applied using MedCalc software.The study established strong relationship between the presence of colorectal cancer and colon polyps (87.2%, Somers' D = 0.868). According to ROC analysis data, colon polyps are risk factor of development of colorectal cancer in 93.4% of cases. The pronounced relationship is demonstrated for presence of colon polyps and colorectal cancer detectability (OR 225.85, CI 61.5 - 829.15, p <0.0001).The results of analysis of regional coloproctological morbidity of adult population in 45 municipalities of the Perm Kray testify significant variability of territorial features. The study revealed that level of coloproctological morbidity in municipalities depends on such indices as provision of physicians and hospital beds and average salary. The study results testify necessity to consider territorial characteristics of Perm Kray in planning complex coloproctological care of population.The identified interrelationships of population morbidity, activities and resource support are to be taken into account in planning organizational measures to modernize treatment and preventive care of coloproctological patients, including early diagnosis of coloproctological cancer in combination with other measures to reduce overall level of coloproctological morbidity on territory of Perm Kray and to improve quality of life of patients.

The problem of abortion is actual in all spheres of public life. Despite the fact that in Russia, according to the Ministry of Health, the number of abortions has decreased by 30% over the past five years, there is demand from society and public authorities to strengthen the national demographic security, to search for corresponding reserves and to strengthen positive dynamics of demographic indices on permanent long-term basis. The abortions significantly and negatively affect birth rate and woman health. To make proper managerial decisions in this area requires analyzing such complex social phenomenon as abortion behavior and its alternatives, including contraceptive behavior based on family planning technologies.The purpose of study is to analyze characteristics of abortive and contraceptive behavior and their relationship with matrimonial and reproductive behavior in Russia to strengthen national demographic security.The official public data of Rosstat, Minzdrav of Russia, etc. was used. Also the data of the All-Russian sociological study “Demographic well-being of Russia” was attracted. The methodology included questionnaire survey in late 2019 - early 2020 carried out in 10 Subjects of the Russian Federation: Moscow, Republic of Bashkortostan, Republic of Tatarstan, Vologda Oblast, Volgograd Oblast, Ivanovo Oblast, etc. The total sampling consisted of 5 616 respondents. The study implemented such scientific research methods as: analysis, synthesis, generalization, statistical analysis, sociological analysis.The state policy implementation related to the decrees of the President of the Russian Federation “On measures to implement the Demographic Policy of the Russian Federation” (2012): “On national goals and strategic objectives of the development of the Russian Federation for the period up to 2024” (2018, national project “Demography”), Government orders “On approval of the Concept of State family Policy in the Russian Federation for the period up to 2025” (2014), “On the basics of State youth policy of the Russian Federation for the period up to 2025” (2014), etc. On national level, it resulted in decreasing of the number of abortions and increasing attention of society and the public authorities to problems of the family. in Russia, since 2007, the absolute number of abortions has been declining, and from 2015 to the present, the absolute number of abortions has decreased below the millionth value. The leaders in positive rate of abortions decreasing are the North Caucasus, the Central and Southern Federal Okrugs. The higher rates of abortions remain In the Far Eastern, Siberian and Ural Federal Okrugs. It is established that abortion and reproductive behavior depends on aging of motherhood, low contraceptive culture at early start of sexual life and various social economic factors. A significant part of Russian population is characterized by low awareness of reproduction issues and contraceptives. The study revealed certain relationship between contraceptive and matrimonial and reproductive behavior. The hypothesis was confirmed for the Republics of Bashkortostan and Tatarstan. The additional research in this area is required to identify effective measures to fully implement demographic potential of the Russian family. Even though the official statistics of Russia indicate positive trends in population abortion behavior, abortions make up significant part of reproductive losses. For majority of Russians, abortion remains acceptable mean of regulating childbearing. Russia has the highest rate of abortions in the age ranges of 30-34 and 35-39 years.In Russia, improvement of medical and contraceptive literacy and formation of responsible health self-attitude will increase quality of life, implement population's demographic potential and improve demographic security.

The Maritime industry plays one of the key role in world economy, occupying central position in becoming unified system of global transportations. At that, crew members ensure necessary vessel seakeeping and high-quality and safe delivery of cargo under contract of sea transportation. In accordance with requirements of the legislation any employer is obliged to insure health and life of employees under professional duties performance. However, this issue has its own specific aspects in shipping. The article considers in detail procedure of insuring health and life of the crew members, considering current trends in medical care support under professional duties performance on voyage. The key problematic aspects are identified. The corresponding recommendations are proposed.

The article considers issues of communication between physicians and patients and presents several models of corresponding relationships. The importance of involving patients in therapeutic partnership is emphasized. The barriers to effective communication between physician and patient and ways to overcome them are considered. The attention is paid to rules of effective listening to patients. The problem of receiving from patients their informed consent for particular procedures is considered, including rules of effective conducting “difficult conversation”.

The article presents review of scientific publications from databases of CyberLeninka and RSCI related to Moscow health care reforms within the framework of the Moscow State program “The Development of Moscow health care (Metropolitan health care) for 2012-2020”. The analysis established that during reforms positive shifts in Moscow health care system occurred, expressed by significant improvement in material and technical base of institutions, implementation of new diagnostic and treatment technologies, increasing of salary of medical workers, implementation of information technologies. However, the Moscow health care system continues to encounter challenges from problems related to staffing (especially the district service), high workload of medical personnel, insufficient level of motivation and low level of qualifications of medical workers. The implemented system of general medical practice did not contribute into strengthening the role of district physician as coordinator of patient flows. The fragmentation and lack of continuity in functioning of health care institutions remains too. The hospital-replacing technologies, designed to compensate reduction in beds, have not received development in primary health care. because of lacking of economic incentives for institutions and low tariffs. The serious problems associated with shortcomings in organization of functioning of medical institutions are established that requires further improvement of methods of analyzing functioning of medical institutions and organizational activities at all levels, considering effectiveness of activities implemented.

In the contemporary complicated social economic conditions managerial decision-makings in health care are to consider specific characteristics of corresponding implementation in medical institutions. This is also true for informational support as a basis of adequate managerial decision-making. The purpose of the study is to investigate impact of medical institutions inspections on informational support of managerial decision-making. The expert survey of 32 health care administrators was carried out. This study proceeds previous ones concerning structure of managerial information sources dominated by results of inspections of medical institutions, completes them and presents new facts. The significant impact of implementation of inspection for acquiring information for further decision-making in medical institutions was established. The study results are a kind of link between inspections of medical institutions and subsequent managerial decision-makings and can be applied in health care administrators daily routine activity as well as for their professional training.

The article presents analysis of changes in attitudes of medical practitioners toward professional self-education and barriers to increasing level of education in system of continuing medical education from beginning of its implementation in 2013 to 2020. The most important factor for medical workers motivation is internal factor: more than 90% of respondents indicated acquiring new knowledge and personal development as motivation both in 2020 and in 2014. However, in 2020, 63% of respondents are not ready to pay for their own education. So, medical workers are less interested to invest in their own professional development while interest in obtaining new knowledge and personal growth was soundly expressed. The alarming trend is in the fact that proportion of medical practitioners who consider professionally oriented reading necessary for self-education decreased in 2020. The medical workers also noted mistrust and several subjectively perceived barriers for professional development in the system of continuing medical education.

The medical rehabilitation in all areas of medicine is developing actively and rapidly. In cardiology, medical rehabilitation contributes to prevention of recurrent myocardial infarction and other complications in patients with myocardial infarction. The study evaluated impact of anaerobic exercise and strength rehabilitation program on hemodynamics in patients with myocardial infarction using the David back concept mechanotherapy method.

The third report, which is a continuation of article on the Russian pharmaceutical branch in the 1990s, analyses corresponding conceptions of internal observers (participators of production and distribution of medications), including their assessments of normality of emerging market. The conclusion is made that the Russian pharmaceutical market grew from chaos that resulted from wreckage of the Soviet medication supply system in 1994-1998. The general dominance of generics over patented medications, distributors over manufacturers, weak interest of state authorities to long-term cooperation with pharmaceutics for the sake of development of own national production, low legal culture were generic characteristics of its infrastructure.

The progress in development of the Soviet penicillin industry in the late 1940s was associated with implementation of foreign experience. The article, on the basis of analysis of declassified archival documents, demonstrates that one of the initiators of development of industry on the basis of foreign technologies was N. M. Borodin, doctor of biological sciences. N. M. Borodin, while on scientific assignments in England, provided the USSR with important scientific and technical information and producers for production of penicillin and streptomycin. It is established that familiarity of N. M. Borodin with arrangement of scientific research and organization of antibiotics production abroad resulted in his plan of developing the Soviet penicillin industry that was noted by the USSR leadership.