Problems of Social Hygiene,
Public Health and History of Medicine

The comparative analysis of effectiveness and efficiency of health care systems functioning causes a number of difficulties due to different indicators applied in countries as assessment tools, different data collection mechanisms and differences in nature and dimension of determining indicators. To ensure comparability of absolute values of various indicators and possibility to compare activities of single medical organizations and effectiveness of health care system of both various Subjects of the Russian Federation and health care system as a whole, it is possible to apply different rating techniques.
The article presents comprehensive comparative analysis of activities of health care systems based on construction of rating using integral indicators of public health: indicators of key functioning of health systems (financial support and infrastructure development), total mortality from non-communicable diseases, probability of dying at the age of 30 to 70 years from any of cardiovascular diseases, cancer, diabetes or chronic respiratory diseases, universal health coverage index, life expectancy (at birth and at the age of 60).
The comprehensive comparative analysis of results permitted to to conclude that the greatest financial costs for health care and best level of infrastructural support (beds and medical personnel) in countries with health insurance system. At that, according to ranking results and all selected integral public health indicators, health insurance system took the first place.

The article presents systematic review of National and foreign publications concerning strategy of digital society development, definitions and concepts of digital twins in health care. The analysis of development of digital twins of patients and application of digital twins of human organs in medicine is presented. The experience of digital twins functioning in health care management system in Russia and abroad is presented.

The paper analyses publications data related to issues of application of AI and machine learning systems in medical science and practice. The particular attention is paid to key points of AI application in health care: diagnostics, telemedicine, development of new medications, medical rehabilitation and management decision-making process. Despite broad perspectives of applying the given systems in clinical practice and pharmaceutical industry, there are a number of such unsolved problems as ensuring information security, risk of making erroneous decisions and necessity to change existing normative legal base of health care.

The current geopolitical situation raised pointed question of developing new supply chains and looking for rolling stock to develop newly formed cargo flows, including medicinal preparations transportation. Considering necessity in timely and safe supply of medicines, it is necessary to develop set of measures permitting to implement export of this production of national industry to ensure ultimate independence from unfriendly states. The article considers main indicators of import and export operations of medicinal preparations and measures taken by the state to support industry in current conditions, requirements for international transportation of this category of goods. The measures increasing exports within the framework of the Pharmaceutical Industry Development Strategy until 2030, such as expansion of fleet of autonomous refrigerated containers, use of consolidation warehouses in Turkey and Kazakhstan to ensure decreasing of cost of multi-modal transportation of medicinal preparations, as well as validation of rolling stock in accordance with GDP requirements.

Various dietary supplements are used as prevention, and in some cases treatment, of a large number of pathological processes in the human body. The purchase of such dietary supplements on various online platforms, including marketplaces, as evidenced by the results of monitoring the Russian online market for 2021-2022, turned out to be the riskiest for human life and health: the components actually contained do not correspond to the declared ones, the presence of Dietary supplement of prohibited substances, lack of a state registration certificate, the presence of which confirms the safety of such dietary supplement for use. The listed violations in the conditions of complete lack of control during the sale of dietary supplements on marketplaces confirm the danger to health, and in some cases, to human life. Uncontrolled use of such products can lead to serious side effects and complications: allergic reactions, kidney failure, liver failure, complications from the gastrointestinal tract, nervous system and genitourinary tract. In this regard, issues related to ensuring the safety of human health and life in the event of their purchasing dietary supplements on marketplaces are relevant.
The analysis carried out in the study confirmed the existence of a problem of unreliable declaration of imported dietary supplements on marketplaces by participants in foreign economic activity. In this regard, this article examines the requirements of technical regulations that must be observed when importing dietary supplements into the territory of the EAEU, studies in detail the issue of the possibility of selling imported dietary supplements on marketplaces, and formulates appropriate conclusions and recommendations for eliminating identified problems, which will eliminate possible sales of low-quality products on the marketplace. and prohibited products and identify sellers selling dietary supplements with violations.

According to official figures, almost 1 billion people suffer from mental disorders worldwide, including adolescents 10–19 years old account for about 13% of the global burden of disease in this age group. The current state of the problem of mental health of children and adolescents, which is formed under the influence of environmental factors and is critical for the personal, social and socio-economic development of a person in subsequent stages of life, is considered.
The results of monitoring the mental health of the children's population of the Russian Federation, differentiated at the age of 0–14 and 15–17 years, including under the influence of the COVID-19 pandemic, which were the basis for improving the complex of measures for the prevention of mental disorders and disorders of the contingent's behavior. The terminology used is analyzed.
The purpose of the study is to analyze the leading trends in recent years of the state and dynamics of statistical indicators of mental health of children and adolescents with an emphasis on understanding the basic conceptual apparatus, theoretical aspects of the problem from the standpoint of specialists in the field of public health and healthcare.

The treatment of women aged 35 years and older with infertility applies assisted reproductive technologies (ART) in every third case. The purpose of the study is to analyze impact of maternal health on health of children who were delivered by women aged 35 years and older after application of ART. The analytical, direct observation, sociological (questioning), and statistical methods were applied. To study health status of children born after application of ART methods in women aged 35–45 years, representative main group of 648 preschool children (4–6 years old) was selected. The second control group included 649 preschool children (4–6 years old), who were as identical as possible to children from the main group, selected according to following characteristics: mother’s age at birth of child (35–45 years), age (from 4 to 6 years), all were observed in same medical organization, birth from a singleton, full-term (37 weeks or more) pregnancy. The main and control groups differed from each other only in presence or absence of ART methods. The children born preterm, from egg donor programs and multiple pregnancies were excluded from study. The children health was studied according to medical examinations, medical records, child development history, and mothers questionnaire data on children health. The course of pregnancy and childbirth, morbidity and lifestyle characteristics of mothers were studied according to their questionnaires and copies of data from their outpatient medical records. It was established that there is direct correlation between health of child and health of mother (r = 0.571; p < 0.01, t = 3). At that, it was revealed that differences in level of general morbidity of children after ART and children from spontaneous pregnancy are achieved within account of significant differences in subgroup of children of mothers aged 38–45 years (3353.7‰ and 2341.8‰ control group).

The professional development of personnel is one of highest priority task of development of both medicine as science and health system as mechanism protecting health of citizens. The public organizations are professional communities of medical specialists specializing in particular sectors of medicine that actively participate in implementation of educational measures and other initiatives targeted to support opportunities for professional growth and improving competence level of participants of these communities. The article considers examples of such initiatives as exemplified by foreign and Russian public organizations of pulmonologists and dentists.

The article analyses level and dynamics of morbidity of diseases of ear and mastoid in the Sakha Republic (Yakutia) in 2020–2021 and availability of otorhinolaryngological care. The methods of comparative statistics and mathematical analysis were applied to analyze official data provided by the Yakut Republic Medical Information and Analytical Center, the specialized Department of Otorhinolaryngology, the Republic Hospital № 2 — Center for Emergency Medical Care and the Federal State Statistics Service of Russia. The study established increasing trend of increasing morbidity of these diseases in both the adult and child population. In 2021, the growth rate of overall morbidity of adult population reached 17.7% and 8.8% in children, as compared to 2020. The primary morbidity of adults made up to 22.3%, in children — 15.7%. The comparative analysis demonstrated higher rates of general morbidity in the Republic: by 0.5% as compared with the Russian Federation and by 14.1% as compared with the Far Eastern Federal Okrug. The level of primary morbidity was lower than similar indicators of the compared territories by 17.1% and 3.0%, respectively. It is worth noting that analyzed morbidity of diseases of ear and mastoid reflects prevalence of ENT diseases in the region only indirectly, as the statistical data do not allow to estimate separately rate of upper respiratory tract lesions. Meanwhile, respiratory diseases rank first in the structure of population diseases in Yakutia. The growth of disability in children due to diseases of ear and mastoid requires attention. Among children of 0–17 years old, the indicator of primary disability increased from 0.38 to 0.8 per 10,000 of children population (increase of 110.5%); in children 0–3 years old — from 0.9 to 2.3 per 10,000 of the child population (an increase of 155.6%). The analysis of the number of beds in otorhinolaryngology wards established that that the bed capacity per 10,000 population was 0.6 that is significantly lower than the established standards. The article emphasizes need to adjust the Federal standards for hospital bed capacity, taking into account climatic and geographical conditions of the region, which contribute to spread and chronization of ENT diseases.

The psycho-emotional status of women after radical surgery for breast cancer was assessed. The international questionnaire FACT-G and module FACT-B module were applied to investigate life quality of 186 women under dispensary monitoring concerning breast cancer of stage I–II. The respondents were aged 30–40, 41–50, 51–60, 61–70 and 71 years and older. In women who underwent radical surgery for breast cancer, psycho-emotional status is manifested most vividly as compared with other perceptions in the postoperative period and decreases quality of life. The overwhelming majority of women with breast removal experiences feeling of inferiority and depression, despair, fear of health deterioration and death that increase with age. The percentage of women satisfied with their coping with illness is 64.8% among 30–41 years old, 45.8% among 51–60 years old and 4.2% among 70 years and older. The impact of stress on disease is most felt in women of 51–60 years old (63,6%) and 61–70 years old (58,8%). No reliable differences in level of emotional condition of urban and rural respondents was established. The attitude of women to methods of postoperative correction through formation of breast lost depends on their age, place of residence, level of education. More than 60% of respondents under age of 50 years consider solution of aesthetic problem in endoprosthesis replacement with implants. Among respondents aged 51–60 years, 25.0% preferred simultaneous mastectomy and breast reconstruction and 10.1% — breast plastic surgery. The endoprosthesis replacement is more often resorted by women older 60 years and rural residents. The choice of mode of breast correction often depends on financial possibilities of patients. The study of quality of life of women with post-mastectomy syndrome is valuable component of integrated approach to dispensary monitoring that individualizes rehabilitation measures. The effectiveness of psychological rehabilitation of women requires involvement of clinical psychologists and medical social services.

The article considers results of study of the R&D sector directions development in system of Russian medical higher education in the context of digitization. The analysis made it possible to substantiate timeliness and importance of solving problems of improving medical services quality against the background of necessity for medical workers to systematically master breakthrough digital technologies in current medical practice. This conditions importance to ensure efficiency of R&D in Russian higher medical education in the context of digitization. The main models of organization of activities in the field of R&D are characterized, taking into account sources of financing and staffing. Based on on-line surveys of students in Google docs about their attitude to their further participation in R&D during education and after graduation, weak motivation to be engaged in R&D during their university education was revealed that is justified by non-obviousness of prospects of financial remuneration. Along with this, study established high degree of interest among students to mastering breakthrough digital technologies in order to further apply them in medical practice together with the latest medical technologies.

The article describes system of compulsory medical insurance and voluntary medical insurance in the Kyrgyz Republic nowadays. The becoming of medical insurance as system of access for citizens to preferential medical services and medications is considered. The State Guarantees Program offers equal conditions for entire population to access free medical services and particular medications, especially for certain category of citizens with chronic, age-related or individual physical characteristics.

One of modern methods of estimating health losses under malignant neoplasms in economic terms, characterizing number of deaths and age of death are lost years of potential life. The cumulative losses from premature cancer mortality made up to 29 217.5 man-years in 2013 and 39 710 man-years in 2021. The number of years lost over 9 years increased by 10 492.5 man-years despite decreasing of mortality across all ages. The rate of lost years of potential life during this period increased from 5.3 to 6.2 years. The maximal contribution to lost years of potential life was made by population groups 45–59 years old. Total losses from premature mortality from cervical cancer were 2682.5 man-years and 2411 man-years in 2013 in 2021. The number of years lost decreased by 271.5 man-years. The rate of lost years of potential life during this period increased from 0.5 to 3.7 years. The greatest contribution to lost years of potential life was made by population groups 60–64 and 40–49 years old.
The calculation demonstrated that there are significant reserves for reducing population mortality from malignant neoplasms in most vulnerable age population groups that is important for organization of oncological care and planning of target prevention programs.

The year of 1992 is very important milestone in history of Russian pharmaceutical market. It began not in January 1922, but in December 1991, when the President and Government enactments to open free market for medications were promulgated. The advisers of B. N. Yeltsin considered market economy as reliable mean to overcome medicinal deficiencies, corruption and bureaucratic monopoly. However, panacea did not work. Moreover, it caused completely new problems. The human and state security implies protection from threats of dependencies. The unprepared dive into market plunged Russians and the country into severe dependence on import of medications and foreign pharmaceutical companies.
The proposed study expands our publications in this journal and in journal “Pharmacy” in 2022. At that time, analysis of medication scarcity was implemented on the basis of published sources and relied on journalistic evidences. The current study is carried out on the basis of archival documents of the Ministry of Health Care of the Russian Federation and authors interviews of representatives of regulator. The second report reconstructs the sequence of the emergence and correlation of the structural elements of the Russian pharmaceutical market.

The article considers evaluation of works of colleagues and contemporaries of N. P. Kravkov, the creator of “Russian narcosis” with hedonal. The hidden and explicit, objective and subjective factors that prevented spreading of application of discovery of Russian scientists, both in Russia and abroad, are established. The dependence of self–esteem of Russian surgeons of XIX — early XX centuries on recognition of their scientific efforts in Germany is emphasized.

The scientific biography of Vasily Dmitrievich Shervinsky, the classic of Russian therapy is described in a number of articles and monographs. However, uncovered materials and results of our studies require to specify certain aspects of his biography and his scientific school.

The publication is the only monograph in Russia devoted to description of history of development of irreversible non-selective inhibitors of mono-amine oxidase. It is the first group of antidepressants becoming available for physicians to be applied in clinical practice. The necessity of such publications is obvious because information presented through history perspective permits to better understand process of formation of modern practical guidelines of applying psychotropic drugs.
The monograph presents well structured thorough systematization and detailed analysis of data of history of irreversible non-selective inhibitors of mono-amine oxidase. The text includes multitude of facts of scientific interest. For example, application of drug in the USSR, Russia and other countries of post-Soviet space, input of specialists from these countries into development of psycho-pharmacotherapy, experience of using inhibitors of mono-amine oxidase in treatment of somatic diseases. In addition, every chapter presents many historical excursus into important general psychiatric and even general medical issues. The monograph undoubtedly will arise interest among psychiatrists, neurologists, pharmacologists, etc.