Problems of Social Hygiene,
Public Health and History of Medicine

Within the framework of the 2030 Agenda for Sustainable Development, goals were formulated, including those targeting to improve quality of life of people all around the world. The task was formulated to ensure universal coverage of health services. In 2019, the United Nations General Assembly noted that at least half of world's population have no access to basic health services. The study developed methodology to carry out comprehensive comparative analysis of values of individual public health indicators and amount of population payments for medications to confirm possibility of applying these indicators to monitor public health, including possibility of international comparisons. The study demonstrated inverse relationship between share of citizens' funds to pay for medications, index of universal health coverage and life expectancy. The stable direct relationship between such indicators as overall mortality rate from non-communicable diseases and likelihood of dying at the age of 30-70 years from any of cardiovascular diseases, cancer, diabetes or chronic respiratory diseases.

The diseases of circulatory system take leading position in structure of mortality. The efficiency of development of scientifically-proved and modern models of medical care support is to be based on data of monitoring of level, dynamics and structure of corresponding pathology. The accessibility and timeliness of high-tech medical care support directly depends on degree of influence of relevant regional characteristics.The purpose of study was to estimate demand and accessibility of specialized high-tech medical care to residents of the Astrakhan Oblast related to leading nosological forms of diseases of circulatory system.The monographic, statistical, logical and system analysis methods were applied. The research was carried out applying continuous methodology and included data from reporting forms № 12 and № 14 in the Astrakhan Oblast in 2010-2019. The Absolute and average values, extensive indicators that model structure as well as methods of dynamic numbers derivation were applied. The mathematical methods based on specialized statistical software STATISTICA 10 were implemented too.The indicator of circulatory system general morbidity decreased up to 8,5% in 2010-2019. The leading positions are taken by cerebrovascular diseases (29,2%), ischemic heart diseases (23,8%) and diseases characterized by increasing of blood pressure (17,8%). The indicator of general morbidity of these nosological forms increased up to 16,9% and primary morbidity up to 43,9%. The average long-term level of prevalence comprised 55,3±1,23%0. At that, specialized medical care within the mentioned direction decreased from 44,9% to 30,0% and implementation of high-tech medical care increased from 2,2% to 4,0%.

In Russia, the orphan diseases for many years are the object of intent attention both of the national legislation and health care system. The lower prevalence of these diseases in population causes predicaments to timely diagnosis, drug provision and medical care. Besides, absence of integrated approach to issues of diagnosis and treatment of rare diseases contribute nothing to fast solving of actual problems in this field. Frequently, impossibility to get necessary course of treatment forces patients with orphan diseases to seek for alternative sources. The article assesses current situation with medications support of patients suffering from diseases included in the list of life-threatening and chronic progressive rare (orphan) diseases that result in shortening life-span or disability and diseases included in the Federal Program “The 14 high-cost nosologies”. The issues of keeping record of patients and financing medications purchase are touched upon. The study results identified problems of organization of medication support of patients with orphan diseases associated with complexity of accounting their number and absence of integral system of preferential medication support.

The assessment of prevalence of acute cerebral circulation disorders in persons with arterial hypertension, together with study of awareness of primary health care physicians about methods of assessing risk of stroke, allows to judge effectiveness of measures preventing acute cerebral circulation disorders and to outline further ways preventing cerebrovascular complications of hypertension.The purpose of study was to investigate morbidity of acute cerebral circulation disorders and awareness of primary care physicians about clinical and instrumental methods assessing risk of stroke in persons with arterial hypertension.Materials and methods included official statistical materials on morbidity of intracerebral bleeding and cerebral infarction in population of Russia, the Chelyabinsk Oblast in 2008-2020, totals of survey of internists and emergency physicians in six regions of Russia.It was established that morbidity of intracerebral bleeding and cerebral infarction in 2008-2020 in the Chelyabinsk Oblast has not changed, while morbidity of intracerebral bleeding and brain infarction in Russia significantly (p<0.05) increased. At the same time, poor awareness of internists about clinical and instrumental criteria of assessing risk of stroke was revealed.The conclusion is made that stabilization of morbidity of acute cerebral circulation disorders in the Chelyabinsk Oblast, increasing of morbidity in Russia are combined with poor awareness of physicians about clinical and instrumental diagnostic of risk of development of stroke.

The tuberculosis is the most important medical and social problem among globally dangerous epidemiological phenomena. the tuberculosis ranks 9th place in the structure of mortality and disability of population and 1st place among causes of death from single infectious agent.The purpose of the study was to analyze dynamics of total morbidity and mortality because of tuberculosis against the background of the implementation of telemedicine clinical organizational technology in phthisiology care 2007-2021.The official Regional and Federal data of Rosstat for 2007-2021 were used. The indicators of total morbidity and mortality of population caused by tuberculosis in the Sverdlovsk Oblast were established. The research methods were content analysis, dynamic series analysis, graphical analysis, statistical differences analysis.In the Sverdlovsk Oblast, the morbidity and mortality of tuberculosis exceeded national average indicators by 1.2-1.5 times. In 2007-2021, as a result of implementation of clinical organizational telemedicine technology in managing phthisiology care, total morbidity and mortality of population caused by tuberculosis decreased up to 2.275 and 2.97 times respectively. The rate of decrease of analyzed epidemiological indicators generally correlated with national average data with statistical validity of difference t≥2.In regions with unfavorable epidemiological indicators of tuberculosis, application of innovative technologies in management of clinical organizational processes is required. The development and implementation of clinical organizational telemedicine technology for managing regional phthisiology care contributes to significant reduction of morbidity and mortality of tuberculosis and optimizes sanitary and epidemiological well-being.

The article presents the results of analysis of issue of disability because of ovarian cancer in female population of the Chechen Republic. The object of study was total number of women, for the first time and repeatedly recognized as disabled ones. The analysis was applied to three age groups (the young, the middle aged and the elderly) in 2014-2020. It is established that dynamics of disability was characterized by negative trends of increasing of number of the disabled. The clear-cut age differentiation was revealed:the elderly disabled predominated. The study established that the disabled suffer of persistent malfunction of blood circulation system and of immune system that resulted in such life activity limitations as moving, self-service and work functions. The characteristics of structure of ovarian cancer disability according its severity were established. The disabled with second group of disability prevailed in all age groups. At that, percentage of women with first group of disability was higher in the middle-aged disabled. The results of the study testify actuality of optimization of onco-gynecological screening of female population for the purpose of early detection of risk factors and diagnosis of malignant process at initial stages of development. This is rational way to organ-preserving treatment and medical and social prevention of primary ovarian cancer disability. The results of the study can consider as scientific practical base for both targeted routing of preventive and therapeutic and rehabilitation measures.

At the actual stage of becoming of Russian stomatology, the problem of sustainable development of rural stomatological care, as system of local formations of complex medical social nature belongs to national priorities and is considered as one of most important directions of public social policy. The stomatological health of rural population is to be considered as indicator of national stomatological health. This is confirmed by spatial structure: rural territories (inhabited territories outside cities) cover 2/3 of territory of the Russian Federation with population of 37.3 million or 1/4 of total population. The spatial structure of the Belgorod Oblast is reliably similar to the all-Russian one. The number of national and foreign studies proved that accessibility, quality and timeliness of insurance (state) stomatology is lower for rural residents that can be considered as one of signs of social inequality. Depending on the social economic status of region, signs of social inequality in the stomatology field are conditioned by broad spectrum of factors. Some of them are discussed in the article.

The article presents the results of examination of opinions of residents of the North Caucasus Federal District concerning healthy urban planning issues. The most residents of large cities are satisfied with infrastructure of their city, while residents of small towns are less satisfied with it. The prioritization of importance of solving various problems of urban life, opinions of residents are not solidary and differ depending on age and place of residence of respondents. For example, construction of playgrounds is a priority for residents of reproductive age from small towns. Only one out of ten of respondents would like to participate in strategy of development of their cities of residence.

The important direction of the National Project “Health Care” are improvement of primary health care system, including introduction of hospital-replacing technologies.The purpose of the study is to evaluate functioning of hospital-substituting form of home medical care (home hospitals) to population of the Russian Federation in 2006-2020.The normative legal documents regulating activities of stationary-substituting form of home medical care (home hospitals) for adults and children, reporting forms of sectoral statistical observation № 14ds for 2006-2018 were analyzed. In 2019-2020, unified data on functioning of day hospitals and home hospitals and composition of patients treated there of medical organizations providing medical care on out-patient basis was filled in form № 14ds. The in-depth analysis permitted to extract information about activities of home hospitals for adults and children and to study their functioning in dynamics for 15 years. The content analysis, statistical and analytical methods were applied.The examination of data for 2006-2020 established increasing of number of treated adult patients in home hospitals up to 27.9% and children up to 15.0%.The distribution of the number of treated adults and children in hospitals at home per 1000 of the corresponding population by subjects indicates their significant fluctuation.For 15 years, it has been established that in the structure of treated adult patients, the proportion of people with diseases of the circulatory system has decreased from 62.2 to 31.5%, the musculoskeletal system and connective tissue - from 11.7 to 7.4%; in children - with respiratory diseases from 81.9 to 63.4%, some infectious and parasitic diseases - from 7.7 to 3.0%, diseases of the digestive system - from 3.6 to 3.2%.In the country for 2019-2020 in hospitals at home, the number of treated adults significantly increased by 1.8 times, children - by 2.3 times, the composition of those treated has changed, which is associated with the treatment of patients with a new coronavirus infection COVID-19 in them under conditions re-profiling of the majority of medical organizations into infectious diseases hospitals.

The article considers interaction of the USSR with foreign scientists and international organizations in the process of mastering production of penicillin and establishment of penicillin industry. The analysis of archival documents demonstrated that despite influence of unfavorable foreign policy factors, various forms of this interaction were one of the decisive conditions of establishment of large-scale antibiotic production in the USSR by the end of the 1940s.

The first ten years of the reign of Tsar Alexei Mikhailovich were distinguished by extreme turbulence. The unsuccessful actions of the “government” of the boyar Morozov provoked chain of city riots which reached their apogee in famous “Salt Riot” in the capital. After that, religious feuding began that in near future resulted in the Schism. Afterwards, Russia, after long hesitation, entered the war with the Polish-Lithuanian Commonwealth that as it turned out, prolonged 13 years. Finally, in 1654, after long break, the plague again visited Russia. The plague pestilence of 1654-1655 was relatively transient (it began in summer and gradually faded away with the onset of winter), however very deadly and shook both the Russian state and Russian society to the ground. It disrupted habitual regular way of life and unsettled all and everything. The authors propose original version of origin of this epidemic and reconstruct its course and consequences on the basis of evidence of contemporaries and extant documents.

The review considers the book “The Soviet health care at international arena in 1920-1940: between “soft force” and propaganda (the Western Europe and the USA)” by Ratmanov P. E. The author, on the basis of rich range of historical sources for the first time introduced into scientific turnover, minutely examines phenomenon of the presentation of “The Semashko model” in the international arena. The main array of events described in the book is chronologically divided by two periods - the 1920s and the 1930s. Each of these periods is characterized not only by various forms of presentation of the Soviet health care, but also by directions of cooperation with partner countries. The monograph demonstrably shows that effectiveness of the Soviet medical propaganda was affected by composition of the audience, place and time. Besides, interest in the West to the Soviet model in many ways depended on personal sympathy and political beliefs of representatives of medical community. The author of the book considers the promotion of samples of the Soviet model of medicine as “trade of the future”, i.e. demonstration of common values of the ideology of the Soviet health care, its local successes and promises of major achievements in the future. The monograph is to be recognized as an important step in the study both of the history of scientific medical diplomacy and the role of science in cultural agenda of the Soviet state.