Problems of Social Hygiene,
Public Health and History of Medicine

Within the framework of the national development goal of the Russian Federation “preservation of population, health and well-being of people” the target indicator “the increase of life expectancy up to 78 years” is to be achieved by 2030. The achievement of this value is also directly affected by functioning of of health care system.
In 2015, the United Nations, within the framework of the Sustainable Development Goals for the period up to 2030, formulated the task that implies ensuring of universal health services coverage “including financial risk security, access to qualitative essential medical and sanitary services and access to safe, effective, qualitative and inexpensive essential medications and vaccines for all”.
In the course of the study, methodology was developed that permitted to calculate values of performance indicators of main health care systems (financial support and infrastructure development) and to conduct comprehensive comparative analysis with values of particular public health indicators. The study results confirmed possibility of such comparisons. The stable direct relationship between such indicators as “current health expenditure (CHE) per capita”, “current health expenditure (CHE) as percentage of gross domestic product (GDP)”, “UHC Service Coverage Index”, “life expectancy” was revealed. The inverse dependency between such indicators as “out-of-pocket expenditure as percentage of current health expenditure (CHE)” and “UHC Service Coverage Index” as well as between “UHC Service Coverage Index” and “total NCD mortality rate” and “probability of premature dying from non-infectious diseases“ was determined.

In the context of forecasted decreasing of natality, actuality of studying its causes for organizational decision-making increases. The purpose of the study was to determine factors affecting reproductive behavior of women aged 40–45 years residing in areas with different natality levels in 2020–2021. The cohort, analytical, sociological methods were applied. The results of study demonstrated that in areas with high natality level most of urban women with higher education and high income resides in conditions of dormitory or mortgage flat and working in profile of their specialty. They are characterized by belated marriage that results in postponed child-bearing. The areas with low natality are characterized by dwelling of rural women with secondary or secondary specialized education. They reside in their own homes and work in other occupations than their specialty. The analysis of social status of women of different age groups will permit more selective approach in developing measures of increasing natality in modern conditions.

The protection of privacy of patient that is applying for medical care, diagnostics and treatment is one of the main pillars of implementation of medical activities. However, despite sufficient volume of legal regulation of lifetime respect of privacy of examination, observation and facts of medical intervention, in practice occur situations when privacy ceases to be such after death of the patient.
The article is based on results of content-analysis of normative legal acts (n = 11), scientific publications (n = 52), cases of judicial practice (n = 8).
The problem of non-observance of privacy becomes especially actual after death of person whose name is widely known. Having no possibility to impact on causes and modes of obtaining and propagating such specific information, the deceased, one's illness, stages of treatment, struggle for life, resources spent, clinics and specialists involved become object of close attention of various subjects (mas media, Internet communities) that use obtained information for speculative purposes at the expense of fixation of inhumane public replicas and increase of number of browsing. Despite prohibition provided for by law of dissemination of information constituting privacy of applying for medical care, after death of patient and application of measures of legal liability for fact of such a disclosure, information leak occurs regularly and information that got into common access frequently discredit good name of the deceased or develop other problems that are subjects to legal protection, for family members and legal successors. Yet, circumstances of transfer of information of limited access by medical organization (data leakage) or by intent of medical worker are difficult to be proved. Therefore, in judicial practice there are practically no such cases. At that, after death of famous people, juristic community regularly faces problems of protecting personal rights and non-material values from the side of relatives, legal successors and other interested persons.
On the basis of formal logical method and system analysis method of disputable situations, possible perspectives of applying for judicial protection, procedural characteristics of procedure of applying for protection and possible composition of participants are presented.

Against the background of sanction policy and escalation of political conflict of Russia with unfriendly countries, trade relations with many foreign suppliers degraded. The current situation affected supply of medical goods, most of which were imported from countries of the European Union. At the state level, it was decided to legalize parallel import. As regards medical articles practical implementation of this mechanism met large number of exceptions that resulted in delays and disruptions of supplies. Indisputably, main problem remains inability to provide necessary amount of medical goods by national industry. The national market of medical articles and its components always significantly depended on import and found oneself completely unprepared for rupture of trade relations with unfriendly countries. It resulted in legalization of parallel import for particular categories of medical goods that seems to be possible solution of current problem. The article examines in detail basic principles of exhaustion of exclusive right to intellectual property objects. The analysis is presented concerning classification groupings of medical articles for customs purposes under the Customs Code of the EAEU. Also is analyzed structure of lists of products that are subject to legalization of parallel import in retrospective view. The main problematic aspects in analyzed issue were identified and recommendations for their elimination were formulated.

The negative effect of oil vapors and oil products on health of crew of tanker fleet is a large-scale problem of shipping since safety of life and health of seamen is declared as essential value in implementation of production activity. The inert gases emitted during handling and transportation of oil products, in view of their toxicity, may result not only in acute intoxication but also in development of chronic diseases when inhaling harmful substances in moderate concentrations. The article considers main professional industrial factors that affect crew members of bulk-oil fleet, symptomatology of intoxication and initial care of crew members, application of personal cover when working with this type of cargo. The special attention is paid to chronic diseases developing against the background of negative effect of oil products on health of seamen. The recommendations of prevention and timely detection of their development are proposed.

The article considers organizational issues of cervical cancer screening in the Russian Federation. In particular, experience of implementation of the Project “HPV testing within the framework of combined cervical cancer screening (HPV and cytologic screening) in the Republic of Bashkortostan is considered. The cervical cancer is a widespread disease that requires early diagnosis and timely medical care. The main aspects of organization of medical care of patients with gynecological diseases in relevant normative legal regulatory documents are described. The algorithm and scheme of routing patients with suspected cervical cancer and with this disease are presented.
The study covered more than 60,000 women aged 30–39 years from 14 medical organizations of Ufa. Such methods as sociological, statistical, analytical, content-analysis and organizational experiment were applied.
The study permitted to substantiate and to approve both the Project “HPV testing as part of combined screening for cervical cancer (HPV screening and cytologic screening) and the algorithm of combined screening of cervical cancer during preventive examinations of female adult population aged 30–39 years of the Republic of Bashkortostan. The scheme was developed for routing patients with suspected cervical cancer or diagnosed disease to medical organizations for timely medical care support.
By implementing developed routing and screening scheme for patients at risk of developing cervical cancer, as well as those who already suffer this pathology, it is possible to improve quality of organization and delivery of medical care, to reduce morbidity, mortality and disability because of this pathology and to assure early diagnosis and prevention of cervical cancer.

The skin malignant neoplasms constitute one of significant problems of public health. The increasing of morbidity and mortality of melanoma and other types of skin cancers is registered. The early detection of disease assures mortality decreasing and increases survival of patients.
The purpose of the study is to develop optimal model of organizational and preventive measures of early diagnostic of malignant skin tumors. The comprehensive study was carried out, which included assessment of survey of patients using questionnaire “Melanoma Diagnosis Day”. Also it included identification of level of awareness of physicians about screening, medical records of patients during COVID-19 pandemic, risk groups identification and effectiveness of selecting patient for screening. The total number of observations is 21 581. The selective and continuous observation method was applied and parametric and non-parametric methods as well. The study determined that during COVID-19 pandemic in 2020, there was significant reliable uncompensated decrease in the number of patients with diagnosis of ICD D23, L82, C44 and decrease in the number of detected diseases. The melanoma, basalioma and other skin malignant neoplasms are reliably more common in patients of medium-high risk group, aged 60 years and older and in persons sunburned at the age of 18 years. The assignation of separate specialist to diagnose skin neoplasms allows statistically reliably increase rate of morphological confirmation of malignant neoplasms as compared to common reception by dermatologist. The sociological survey of physicians revealed statistically reliable difference in knowledge between dermatovenereologists, oncologists and physicians of other specialties concerning screening issues. The results of the study permitted to develop complex of organizational measures to improve screening. The model of organizational and preventive measures for early diagnostic of skin malignant tumors in outpatient conditions was proposed.

The state health care policy in Russia is directed at improving medical care quality and population satisfaction with it. The functioning of medical organizations beloning to national health care system has determinative impact on population health. The increasing of level of organization of their functioning is imposible without target manpower policy, upgrading qualification and professionalism of health care workers.
The purpose of the study was to analyze personnel potential of Oblast clinical hospital, as one of leading health care institutiond of the Astrakhan Oblast.
The methodologies of statistical, logical and system analysis were applied. The study used method of continuous sampling and was carried out in 2012–2021. The information sources included forms of the Federal statistical monitoring № 30 “Information on the medical organization” and № 17 “Information on medical and pharmaceutical workers”. The absolute and mean values, extensive parameters modeling structure and methods of dynamic series construction were applied.
The study revealed positive dynamics of increasing of number of established posts on 33.7%. The number of physical persons of hospital medical personnel (the basic increase made up to 40%) increased. It resulted in decreasing of combining jobs coefficient and in increasing of staff efficiency employment. The women consisted 65.2% of all working physicians. The mean age made 43.2 years among phycians and 41.7 years among paramedical personnel. The ratio 1.5:1 of paramedical personnel to physicians in staff list is negative factor. Alongside, ratio of physical persons of paramedical personnel and physicians decreases. It testifies necessity of increasing both established posts and involvement of more physical persons to work on paramedical personnel rates.

The article presents, on the basis of analysis of foreign publications, review of models and approaches to organization and management of the system of medical social services in a number of foreign countries. The experience of the USA, Canada, Great Britain, Switzerland, Japan, New Zealand and some other states is considered.

The development of national clinical medicine in Russia in XX century is related not only to evolution of scientific schools, but also to such historical phenomenon as clinical elites. In the article definition of therapeutic elites is proposed. The destiny of therapeutic elites and their role in institutionalization of national clinical disciplines is discussed.

The endometriosis is a chronic gynecological disease, etiology and pathogenesis of which are not fully clear to science. Its consequences are hardest burden for health care, society and every female patient and her family. The presented review tries to answer in historical aspect the question of interest to all scientists — why endometriosis, known to science for more than 300 years, still remains “disease of riddles and assumptions”?
The search of publications was implemented in such databases as Web of Science, eLibrary, Scopus, PubMed/MEDLINE. The search was based on keywords “history”, “endometriosis”, “review”, “myths”, “authorship”, “infertility”, “reproductive dysfunction”. The study covered full-text sources and publications reviews related to subject under study. The articles having no direct relation to the topic of endometriosis were excluded from the review.
The review demonstrated that as before pathogenesis of endometriosis remains enigmatic and complex. The more and more evidences appear that endometriosis is part of syndrome of uterus reproductive dysfunction. Hence necessity in further research and experimental designs in this area. Perhaps in nearest future scientists nevertheless will find the clue to single etiopathogenetic mechanism of development of endometriosis which at a later date will be successfully applied by physicians in diagnostic and treatment of this disease.