Problems of Social Hygiene,
Public Health and History of Medicine

In children population, infectious diseases propagate rather rapidly and they have their own peculiarities in course. The COVID-19 coronavirus infection was no exception in it and created new challenges in organization of medical care and prevention of its spread. The purpose of the study was to investigate dynamics of general and primary morbidity in children aged 0–14 and 15–17 years and characteristics of organization of medical care in conditions of the COVID-19 pandemic. The analytical and statistical methods, including descriptive statistics, were applied. The software MS Excel 2007 and Statistica 10 were applied to process data.
It was established that in 2017–2022 total children morbidity aged 0–14 years decreased up to 18.0%, primary morbidity up to 19.3%, in children aged 15–17 years up to 3.8% and 4.2% respectively. Despite implemented anti-epidemic measures morbidity of COVID-19 in children increased annually. The medical care of children was provided according to the Procedure of provision of medical care by profile “Pediatrics” but due to COVID-19 propagation, adjustments were applied. This affected state medical organizations re-profiled for medical care of patients with confirmed COVID-19 corona-virus infection.
Despite increasing of general and primary children morbidity against the background of the COVID-19 pandemic during study period indicators decreased. At that, respiratory diseases increased that determined decision-making in management of medical care organization of patients.

The population morbidity is one of leading indicators of public health. On the basis of morbidity, not only population needs in various types of medical care are determined, but also development of medical organizations network is prognosticated and effectiveness of health care system is assessed. This approach permits to adjust functioning of population medical care services in each Subject of the Russian Federation. Hence, studying dynamics of adult population morbidity by disease classes and considering regional characteristics continues to be actual.
The purpose of the study is to analyze dynamics of general and newly registered (primary) morbidity of adult population in the Russian Federation, Federal Okrugs and Subjects of the Russian Federation in 2016–2022.
The research materials and methods included calculation of dynamic series indicators (visibility indicators, growth rates, growth/loss rates), direct ranking method. The indicators of total and newly registered (primary) morbidity per 100,000 of adult population (aged 18 years and older) in dynamics in 2016–2022 were calculated. The research materials are the statistics collections of the Ministry of Health of the Russian Federation and the Federal State Budget Institution “The Central Research Institute for Health Organization and Informatics” of Minzdrav of Russia of adult population morbidity of the Russian Federation. The software Microsoft Excel was applied to process statistical data.
The results. The analysis of total morbidity of adult population in the Russian Federation in 2016–2022 demonstrated that in 2022 value of this indicator made up to 159,545.4 per 100 thousand of population that is 9.0% more than in 2016. The increase of total morbidity is observed in 66 Subjects of the Russian Federation that consists 77.65% of total number of the Subjects. The level of primary morbidity in the Russian Federation increased by 21.9% (from 55227.3 per 100 thousand adults in 2016 to 67326.6 in 2022). The increase of primary morbidity is observed in 81 Subjects of the Russian Federation that consist 95.3% of total number of the Subjects.
The analysis of morbidity demonstrated that in 2016–2019 its indicators had no significant changes. In 2020–2022, sanitary and epidemiological well-being of population in the Russian Federation was determined by epidemic situation and global challenge associated with the new corona-virus infection. As a result, in 2020, occurred decreasing of morbidity registration for all classes of diseases, except respiratory diseases. In 2021, began to show increasing of registration of morbidity that proceeded in 2022 in most classes of the ICD-10.

The general medical practice in modernized primary health care units of Moscow medical organizations by its generalized statistical indicators takes the leading place in rating of health care organizations of the Subjects of the Russian Federation. The research study revealed problems in achieving target indicator — level of patient satisfaction with quality of medical care provided by general practitioners/family doctors made up to 54.3%. One of the causes was higher degree of physician burnout (34.1%). To elaborate efficient prevention program,a set of organizational technologies to prevent burnout was developed and tested. The purpose of the study was approbation of developed organizational technologies preventing burnout of general practitioners in the pilot project.
The methodology of pairwise survey permitting to simultaneously obtain answers of respondents — patients and general practitioners — to objectify results of the study, characterizing factors under study at fixed period of time — the last 12 months. The sociological survey was applied on the basis of two international questionnaires — EUROPEP (to study patient satisfaction) and COSPOQ III to evaluate psycho-social state of general practitioners).
The developed organizational technologies of burnout prevention permitted to increase index of patients' satisfaction with medical care up to 30.33%, and cumulative efficiency on blocks of questionnaire up to 26.97%. Conclusion. The efficiency of preventive measures reached 27.28%.

The article describes complex of organizational legal aspects of oncological screening for gynecological and urological diseases. These types of screening can be considered as preventive measure not only preventing development of malignant tumors of genitourinary system, but preserving male and female reproductive health, since protection of reproductive health is also preservation of public health of population.

The students morbidity becomes more and more serious problem due to increasing demands of modern educational process. There is a need to more carefully monitor implementation of medical care of students, to carry out regular preventive examinations, to provide students with appropriate psychological assistance to create environment conducive to learning. To resolve problem of student morbidity is important both for maintaining health of young population and for their favorable academic advancement.
The article consider effect of such environmental factors as stress, lack of sleep, poor nutrition, low physical activity contributing into increase of students morbidity in conditions of modern educational process.The Russian and foreign publications were analyzed to identify the most significant ones to be included into review.

The social economic crisis and international sanctions significantly affected health care system that requires implementation of new organizational approaches with medical, social and economic benefits. Currently, up to 80% of budgetary funds for health care are spent on in-patient care, although 20–50% of patients could be effectively treated in less expensive short-stay hospitals. The purpose of the study is to assess efficiency of specialized care in maxillofacial surgery in conditions of short-stay hospitals. In maxillofacial surgery, implementation of in-patient substitution technologies is justified that ensure availability of minimally invasive surgeries and reduction of treatment time. The analysis of data of 2,022 patients hospitalized in the Maxillofacial Hospital for War Veterans of the Moscow Health Department from January 1 to December 31 2023 demonstrated that 1,518 patients (65.37%) were treated in the 24-hour in-patient department and 504 patients (34.63%) in the short-stay in-patient department. Among them, 738 males (36.3%) and 1,284 females (63.7%), average age of patients was 42.5 ± 17.82 years. In the 24-hour in-patient department, females accounted for 62.85% and males 37.15%. In short-stay in-patient department, females accounted for 65.48%, males for 34.52%. The average stay in 24-hour hospital was 5.6 bed days and in short-stay hospital — 6–8 hours.
The economic efficiency of short-stay hospitals was demonstrated in significant savings of medications and services. The level of patient satisfaction is higher in short-stay hospital (8.4 points versus 8.1 points in 24-hour hospital).
The development of short-stay hospitals in maxillofacial surgery contributes into improving of quality and accessibility of medical care, modernizing medical infrastructure and optimizing budget expenditures.

In the context of modern competition, project management approach can ensure higher speed and quality of achieving strategic objectives set for health care industry at minimal cost and risk.
Due to the need to implement regional projects with higher speed and quality, the problems of algorithmization of project management processes becomes relevant. The complex multi-level system of project implementation in health care industry, instability of external environment and variety of needs of stakeholders requires finding algorithm to implement management processes.
The purpose of the study was to find prototype model for managing processes of medical organization project, built on formalized data of functional components of project and algorithms obtained during stage-by-stage modeling of the system.
In the process of development of operation of the system its elements and presentation of data were iteratively refined and in accordance with data algorithms were synchronously refined too.
To build prototype model of management processes in regional medical organization for subsequent digitization it is necessary to formalize variables, to determine in accordance with size of the range of values that variable can take for subsequent effective algorithmization of management processes.
The stages of project management processes were correlated with classification characteristics of models to establish stages of their construction and modeling of working model of prototype project. To establish optimal prototype of project management processes its immediate integration with project environment of medical organization is required using machine learning methods.
The study results confirmed necessity to proceed search for project management tools increasing efficiency of operational activities of medical organizations implementing regional projects in health care industry.

The article considers value determinants of social immunity of subjects in conditions of expanding Russian space. The issue is raised concerning formation in children and youths of social immunity and improvement of social immunity in representatives of middle-age and elderly population as barrier to harmful invasion of alien foreign cultural elements into life of Russians). It is determined that they negatively affect social and psychological components of human health and are manifested in occurrence of new diagnoses and exacerbation of chronic ones.
The current situation is complicated by intensification of attempts to negatively impact by foreign entities on Russians, including residents of the Donetsk People's Republic, Lugansk People's Republic, Zaporozhye Oblast, Kharkov Oblast and Kherson Oblast as well as migrants temporarily staying in other regions of Russia.
It is indicated that for residents of the territories mentioned above as well as migrants temporarily located in other regions of Russia, an important direction of functioning of state authorities is to increase accessibility for population high-quality health care services, daily living comfort, infrastructure development, housing support in regions. It is concluded that in current conditions, key value basis of population social immunity is one's health.

In conditions of sanctions policy and escalation of political conflict of Russia with unfriendly countries occurs constant increase of economic pressure on Russian market through introduction of bans and restrictions of various kind. Currently, countries of the European Union are developing the fourteenth package of sanctions measures that targets even more concentration of implementing measures on identification and suppression of schemes to circumvent existing prohibitions against Russia. Unconditionally, such approach impacts supply of goods of medical purpose that in order to bypass imposed restrictions imposed were imported within the framework of legalization of parallel import. It is worth to note that based on analysis of consumer market by the Ministry of Industry and Trade, limited number of medical supplies were included in list of goods falling under parallel import mechanism. At that, most of components for medical equipment at customs clearance are classified as separate goods without identification of their medical purposes and therefore such goods were imported under similar legalization scheme. The situation with organization of supplies of goods within the framework of medical support began to worsen with introduction of principle of extraterritoriality of sanctions, which implies possibility of imposing prohibitive measures on foreign contractors from friendly countries for Russia that makes actual considered topic. The article examines in detail main trends in development of sanctions policy, considers structure of goods with medical purpose for which parallel import legalization is being implemented and reveals concept of extraterritoriality of sanctions that complicates re-import of prohibited goods. The practical recommendations on their bypassing for Russian counterparts and their foreign partners partners from friendly countries were formulated.

The article considers actual issues of attraction of medical workers to juridical responsibility according to norms of civil and administrative law in the Russian Federation. The purpose of the study is to consider peculiarities of attraction of medical workers to civil and administrative responsibility in cases of violation of defense of life and health of citizen. The professionalism, ethics and responsibility for health of patients of medical workers are integral elements of efficient health care system. However, cases of improper implementation of professional responsibility, violation of ethical norms and legal acts occur in medical practice quite often. Because of this situation attraction of medical workers to civil and administrative responsibility becomes an actual issue.
The conclusion is made that justified attraction of medical workers to responsibility is an integral part of health care system, targeted to support safety and quality of medical care. The combination of efforts to increase legal literacy, to intensify control and defense of rights of patients permits to develop responsible and efficient medical system ensuring safety and well-being of patients.

The article analyzes problems occurring at initial stage of commencing criminal suit, where victim is person who was subjected to sexual violence. The special attention is paid to aspects of collection of biological objects — exhibits of unlawful acts against sexual inviolability and personal sexual freedom. The article systematically analyzes available methods and modes of collecting exhibits of biological origin within the framework of investigation of crimes against sexual inviolability, needed for forensic medical expertise in judicial systems of the Russian Federation and foreign countries. Among other things, correlation of mental condition of victim and complete evidence base are demonstrated. The results of the study permitted to propose means to solve identified problems in form of development of new expert techniques of collecting exhibits of biological origin and their implementation into system of expert and medical institutions of the Minzdrav of Russia.

The problem of timely final diagnosis, early initiation of treatment and optimal management of patients with malignant neoplasms is very actual. The purpose of the study is to analyze experience of managing patients with malignant neoplasms in the largest private medical organization. The sociological survey of 412 oncologists, surgeons, including coloproctologists and obstetrician-gynecologists working in clinics of Medsi Group of Companies in Moscow and Moscow Oblast was carried out.
In 2023, in all clinics of Medsi Group of Companies functioning in Russia, after establishment of diagnosis of malignant neoplasm, 45.7% of these patients continued examination and treatment within the framework of this medical organization. In Moscow, Medsi Group of Companies JSC organized specialized competence center for patients of oncological profile where specialists determine further tactics of patient management. In each clinic of Medsi Group of Companies, position of senior oncologist is allocated, ensuring control of timely clinical diagnosis and routing of patients to the next stage of treatment. The patient transition to each of subsequent stages of treatment or refusal of patient to continue treatment is recorded on oncological desktop in the medical information system “Medialog”.
Thus, is minimized probability of losing control over patient management in medical organization.

The network form of implementation of educational programs in health care or network form of education, is an innovative approach to educational process that is actively applied in medical and adjacent universities to improve quality of future specialists training. This approach implies cooperation of various educational and scientific institutions, such as universities, research institutes, medical organizations, as well as application of electronic resources and remote technologies. The article considers legislative regulation of implementation of online form of educational programs and application of online form of education in the field of health care in the Russian Federation. The results of study carried out in scientific and educational laboratory of Educational Development of the Siberian State Medical University that allows to evaluate implementation of individual educational programs in medical schools in Russia are considered. The Russian projects of online forms of interaction in health care that significantly contribute into development of health care are considered in terms of training professional personnel.

The article presents analysis of normative and factual number of stomatologists in the Irkutsk Oblast. The comparison was carried out in relation to stomatologists employed in state medical organizations as well as taking into account private sector in stomatological service that is conditioned by high proportion of specialists employed in it. In the Irkutsk Oblast, significant discrepancy between factual number of stomatologists and staffing standards is established if apply exclusively state sector of stomatological service for comparison (39.9%). However, the total number of physicians in state and private medical organizations corresponds to standards to much greater extent (79.1%). Also significant dispersion of indicator of compliance of factual number of stomatologists with staffing standards between municipalities of the Irkutsk Oblast, excessive concentration of specialists in regional center, exceeding value recommended by standards by 2.3 times for stomatologists in general practice and stomatological therapists was revealed. Based on the study results, the number of proposals formulated to improve staffing standards of recommended number of stomatologists.

The article presents general analysis of national health care system of the Kirghiz Republic, including particular problems government agencies encounter, role of non-communicable diseases in increasing of total mortality, morbidity and disability of the population. The data is presented concerning economic losses associated with decreasing of labor productivity because of non-communicable diseases morbidity. The priority measures to strengthen primary health care organizations and ways of resolving existing problems in national health care are discussed.

The archives of Ministry of Health of Russia, journal publications, interviews and memoirs testify that issue of quality of medications was key one in life of Russian Pharma in 1992–2004. The drug safety support considered not only as part of social policy, but also as rules that could be used to reformat“wild bazaar” into “controlled market”. The media disputes, departmental justifications, political bills and memoirs give idea about “price of the issue” — tension of emotions, ambitions, financial losses. Furthermore, depending on one who would determine quality (therefore evaluate all players in Pharma market) depended where center of power would be located in the market. In series of reports results of historical reconstruction of building materials, architects and technologies of Russian regulatory system and market rules are presented.
The first report considers differences in modes of resolving problems of quality of medications in so-called “socialist” and “capitalist” worlds. Accordingly, what kind of controlling infrastructure inherited modernized Russian state from the USSR is demonstrated. The efforts of Ministry of Health of Russia to preserve and to strengthen this inheritance are presented as struggle for impacting market in conditions of resource-deficient space.

Georgy Andreyevich Miterev, after leaving the post of Minister of Health of the USSR, worked as Director of the F. F. Erisman Central Research Sanitary Institute from 1947 to 1954. In 1948, after ruefully known the VASKHNIL August session and broadened meeting of Presidium of the USSR Academy of Medical Sciences, he announced reorganization of hygienic science on basis of materialistic principles of Michurin biology and Pavlov physiological doctrine. Proceeding from idea of unity of environment and organism, he believed that among methods of hygienic research main place should be occupied by methods of physiological observation of man, experiment on animals, joint observation with clinicians of effect of environmental factors on health, as well as development of data of general and occupational morbidity. Thus, G. A. Miterev, on basis of quite dubious ideology, organized scientific work of the Sanitary Institute entrusted to him quite rationally.