Problems of Social Hygiene,
Public Health and History of Medicine

The role of patient, especially at early stages of disease, is decisive one in relation to disease outcome. Therefore, it is extremely important to analyze typical and deviant forms of one's behavior in interaction with health care system. The purpose of the study is to analyze models of behavior of patients with diseases of digestive system in interaction with the health care system. Three comparison groups were formed for analysis. The first one included patients undergoing planned out-patient treatment (n=531), the second one — patients undergoing planned in-patient treatment (specialized Gastroenterology Department) (n=822). The third one — patients admitted for in-patient treatment at the Emergency Medical Care Hospital on emergency basis (n=147) on account of complications of primary disease (pathology of digestive organs). The groups were compared using such non-parametric criteria as the association coefficient (Cass) and the χ2 criterion. It is established that at choosing physician, the most frequently used source of information by patients is opinions of ones who have already was treated by particular physician. In all three groups, this source of information was used most frequently. The second source most frequently used was one's own previous experience of visiting this physician. The third most important criterion of choice was patient own opinion. At that, no reliable differences in using of information sources by patients included in first and second groups were found. The significant differences in behavior models were found among patients of third group that significantly affects possibility of complications requiring emergency hospitalization. The main criterion for choosing medical organization, if such an opportunity exists, is availability of competent specialists that is considered much more important than good reputation of medical organization. The geographical accessibility is also of great importance for patients, especially for ones receiving medical care in out-patient conditions. The specific characteristics of the models of behavior patterns of patients in each group should to determine other general characteristics of behavior associated with interaction of patient and the health care system.

The constantly increasing measures of sanctions impact contribute to advancing development of political conflict of Russia with unfriendly countries, that results in increasing economic pressure on sectors of the Russian consumer market that are the most import-dependent ones. Currently, the European Union, the United States, Japan and other states that received status of unfriendly ones, are actively applying secondary sanctions originally developed as tool to curb schemes of circumventing existing bans against Russia, of which legalization of parallel imports, introduced in 2022, was among the most effective ones. By their content, secondary sanctions imply possibility of imposing prohibitive measures on foreign counter-agents from countries that are friendly for Russia, that cause additional difficulties with registration, making payments and increased delivery time. Of course, all the circumstances mentioned above could not help but affect export and re-export of medical devices to Russia. The detailed analysis of content of imposed sanctions measures established that currently there are no direct bans on export and re-export of medical equipment, as well as components and consumables, parts and accessories. The only exception are medical devices classified as dual-use goods and fairly large number of complex technological equipment, including its components, that fell under measures of strengthening export control imposed by the United States. Despite the fact that there are no formal sanctions against medical equipment and articles, in practice they are actively used, and given absence of unified methodology, issue of their implementation becomes even more ambiguous and problematic that makes the topic under consideration relevant. The article examines in detail main content of the prohibitive and restrictive measures taken within the framework of the sanctions impact from unfriendly states in relation to export and re-export of specialized medical equipment and components. Also are considered the listing of goods classified as of dual-use in terms of medical devices. The detailed list of medical products for which the US requirement to issue an export license for their export applies is presented. The practical recommendations are formulated to address main problematic issues.

The article considers system of measures improving efficiency of anti-tumor medicinal therapy, surgical and radiation treatment of patients with oncological diseases, including development of proposals for their improvement. The sampling included 485 experts (practicing oncologists). The expert survey was carried out using expert questionnaire to develop proposals improving organization of medical care of patients with oncological diseases. The Kendall's concordance coefficient (W) was calculated to quantify degree of concordance of answers of experts. The significance of differences was assessed by non-parametric Friedman criterion. The reliability and validity of questionnaire scale was carried out by calculating the Cronbach's alpha coefficient. The results demonstrated that in order to formulate proposals improving organization of oncological medical care management, current indicators and implemented measures of organization of medical care of oncological patients are be taken into account, including percentage of patients with oncological diseases, who underwent examination and/or treatment during current year out of those under dispensary observation, the percentage of malignant neoplasms detected at stages I-II and organization of reference centers that use histological, immunohistochemical, pathomorphological and Xray methods of research. The following indicators are recommended to apply for improving organization of cancer medical care: control compliance of drug therapy with clinical recommendations; increasing surgical activity and availability of surgical interventions by increasing volume of medical care; adding new results and outputs targeted to increase the number of molecular researches when prescribing targeted anticancer drugs; centralization of the cancer medical service. The indicators, that can be used to formulate and prioritize proposals for improving organization of cancer medical care, and to form Federal projects or departmental special-purpose program, were selected. The results of the study can be used in development of system to monitor efficiency of implementation of these projects and programs.

The article presents modern data on non-communicable diseases (NCDs) and their risk factors. The tendency of increasing mortality from NCDs due to increase in the number and aging of the population is noted. The data is presented testifying that, in addition to biological risk factors, influence of environmental factors is increasing, including atmospheric and household air pollution, the levels of which are high in a significant number of countries. It is emphasized that “green spaces” (e.g., trees, grass, forests and parks) and “blue spaces” (e.g., lakes, rivers, ponds, etc.) provide beneficial effect on human health, being in fact protective factors for NCDs. The NCD risk factors are found to interact closely with each other: air pollution, depression, tobacco smoking, high blood pressure and obesity have been linked to all NCDs. The evidence is provided that presence of behavioral risk factors for NCDs exacerbates severity of infectious pathology, particularly COVID-19 and other infectious diseases (influenza, HIV, tuberculosis, hepatitis, etc.). Given that NCD risk factors can occur in early childhood, promoting healthy lifestyles among expectant mothers and adolescents should be a priority to reduce NCD risks, especially in low- and middle-income countries.

In Russia, mortality from major non-communicable diseases accounts for more than 2/3 of total mortality of population. The purpose of the study is to investigate prevalence of main risk factors of development of chronic non-communicable diseases (NCDs) among patients. The study was carried out in 2023–2024 at the basis of the Republican Health Center of Makhachkala of the Republic of Dagestan. The prevalence of risk factors for non-communicable diseases was analyzed using results of sociological survey of 465 respondents and outpatient card data. The low physical activity, high cholesterol, overweight, obesity and high blood pressure are more common among persons with higher education. The smoking, excessive salt intake and insufficient consumption of fruits and vegetables are more common among persons with secondary and secondary specialized education. The highest percentage of smokers was detected in groups of 41–50 age old (24.7%) and 31–40 years old (20.7%). The insufficient awareness about one's level of cholesterol was detected in 17.8% of males and 23.9% of females and about one's level of blood sugar in 34.6% of males and 38.1% of females. The prevalence of main risk factors for NCDs was established for high blood pressure — 30.1%, overweight — 29.2%, obesity — 14.9%, smoking — 18.1%, elevated cholesterol — 41.5%. This data is to be taken into account in developing regional educational preventive programs.

The work of crew members of sea crafts is associated with numerous occupational risk factors that can contribute to development of chronic diseases, including urolithiasis. This article considers main causes and mechanisms of development of urolithiasis among seamen, conditioned by characteristics of their professional activity: unbalanced diet, use of distilled water, physical loads, prolonged confinement in limited spaces and stress factors. The statistics of prevalence of urolithiasis in Russia and globally are presented. The complicacy of diagnostics and provision of medical care aboard ships is analyzed too. The special attention is paid to such preventive measures as diet management, maintenance water intake schedule, stress management and dispensary monitoring.The approaches to metaphylaxis and role of sanatorium-resort therapy in prevention of disease relapses are discussed. The conclusion is made about importance of comprehensive approach to prevention and treatment of urolithiasis among seamen as significant medical and social problem.

Since 2006, a world trend began to develop concerning smoking of various electronic cigarettes, which gained enormous popularity due positioning by manufacturers as “safe” alternative to traditional cigarettes, combined with attractive design and many variations of flavor additives. The electronic cigarettes and their components referred to nicotine-containing products are imported to Russia from other countries. The most of this group of goods is counterfeit. The component composition of liquids and tobacco mixtures used in electronic cigarettes demonstrates presence of admixtures and substances that are not safe for human life and health and can ruinously affect cardiovascular and respiratory systems, mucous membrane of colon, nervous, endocrine and reproductive systems. The research study permitted to identify shortcomings in current legislation concerning import of electronic cigarettes to Russia, in terms of compliance with technical regulation measures in order to ensure safety of life and health of citizens. The various modifications of electronic cigarettes are considered. The analysis of normative legal documents regulating circulation of nicotine-containing production on territory of Russia was implemented. The shortcomings in legislation are established. The appropriate recommendations for their elimination are formulated.

The review is devoted to medical social problems of early and late postoperative period in patients with malignant tumors of rectum. the analysis of publications provided information testifying that from the first days after surgery, adaptation difficulties affect not only patient, but also one's family. the physiological difficulties in adapting to new living conditions are associated not only with such general negative factors as traumatic nature of operation, blood loss and operational stress, but also with peculiarities of new anatomical status of gastrointestinal tract. The presence of colostomy, stool and gas incontinence often result in social isolation of patient at the level of both family and society. A number of ethical and deontological problems are noted in interaction of the operated patient with attending oncologist at inpatient and outpatient stages of treatment. It is concluded that only comprehensive and complex understanding of medical, psychological and social aspects of problems of the postoperative period can lead to development of programs for their effective solution.

The relevance of inclusive education in higher education institution is determined not only by moral imperatives, but also by pragmatic needs of modern society. The modern labor market requires variety of talents and competencies. The inclusion forms conditions for disclosure of potential of those students who traditionally excluded from educational process. The article draw attention to such key issues of increasing inclusiveness of higher education as attention to social and social cultural components of socialization of the youth that university can provide. Many physical and information barriers that traditionally prevented the disabled to obtain higher education can be eliminated by digital technologies. The digitization erases geographical boundaries and creates equal opportunities for everyone, regardless of place of residence and health status. The specialized software, assistive devices, online platforms can significantly facilitate learning for students with disabilities. However, it is important not just to implement technologies, but to train students and teachers to apply them effectively.

The article presents design of historical study of the Russian pharmaceutical market, setting timeline in the nineties — the time of formation of social and cultural characteristics of this phenomenon. At the same time, the authors return to the post-Soviet period and the nineties to see starting positions as well as mutations of original idea. The article is structured by the framework format of dissertation abstract. This frame contains the following elements: research questions, assessment of state of research field, working hypotheses, the author's vision of social and scientific significance of the study being conducted and observations made. The definition of the research genre as dystopia is explained by its deconstruction of the palimpsest of memory testimonies of pharmaceutical market actors.

The article presents results of studying archival sources and periodicals that reveal history of development of medical social care to the blind in the Irkutsk Governorate-General. The blindness was especially common among residents of the northern districts of Eastern Siberia. The glaucoma, traumatic and inflammatory affections of the cornea were the causes of development of blindness in conditions of absence of specialized medical care. But much more often it was caused by trachoma, which became widespread. The events are displayed in chronological order. The organization of public institutions, role of charitable capital, eparchy bodies and local authorities in resolving financing issues, attraction of public attention to problem of blind children were examined. The leading role in this process played most various categories of philanthropists, from principal patrons of arts to ordinary physicians providing free medical care. The organization of flying ophthalmological squads became prototype of organization of specialized medical care. The role of guardianship movement of helping blind children in Eastern Siberia is demonstrated. The article presents history of organization of school for blind children in the main city of the Gubernia, founded with funds from testamentary capital of the widow of Ivan Stepanovich Khaminov. This school became the first such institution in the Eastern Siberia. The organization of the pedagogical, educational and labor process for blind children in the school is studied in detail.

The emergency medical care is an important form of medical care of population which is applied outside medical organization, in in-patient and out-patient conditions. In the Russian Federation, over the last decade, modernization of functioning of emergency medical care in in-patient settings is in process, on the basis of organization of such new structural units as in-patient emergency medical care departments. The purpose of the study is to analyze indicators of performance of emergency medical care in in-patient conditions in the Russian Federation in 2014–2023. The normative legal documents approving organization of emergency medical care in in-patient conditions were studied. The analysis of indicators of performance of emergency medical care in in-patient conditions was was implemented according to the data of the Federal statistical observation form №30 in 2014–2023. The content analysis, analytical and statistical methods were applied. As a result of modernization of emergency medical care in in-patient conditions over last 10 years, an increase of indicators of provision of emergency medical care beds was established from 2.84 to 6.25 per 1 million of population, the rate of hospitalizations to emergency medical care beds — from 0.8 to 2.51 per 1000 of population, bed turnover — from 262 to 332 days, decrease in average duration of patient's stay in a bed — from 1.05 to 0.63 days, average bed occupancy per year — from 277 to 207 days.

The social economic status of population evidently affects health. Actually, in National research studies wide enough spectrum of approaches to determining and choosing indicators of social economical status in health studies is applied. The purpose of the study is to investigate and systematize parameters applied in studies of health of of different groups of population of the Russian Federation. The methodology of Cochrane Rapid Reviews Methods Group was applied to implement rapid review. The express review was implemented on the results of publications searches in data bases of the National Electronic Library and the Electronic Scientific Library in “Health Sciences” and “Medicine and Health Care” domains from 2017 to 2023. The results demonstrate that the most widespread parameter of social economical status is “education” followed by “income”, “line of business” and “urban/rural residence locality”.

The article considers issues of disability of male population of the Russian Federation as one of the most significant negative factors of socio-psychological and economic national situation. In the conditions of the most complicated demographic situation, special attention is to be paid to young males with acquired disability who are to become special target group in the strategy of achieving demographic sustainability in the Russian Federation.

The issue of national demographic well-being of population is the most actual task in the national state programs of social economic development and security. The tools implementing these tasks at state level are the current Concept of Demographic Policy of the Russian Federation for the period up to 2025, the Decree of the President of the Russian Federation “On the National Development Goals of the Russian Federation for the period up to 2030 and in perspective up to 2036” and also a number of other normative legal acts. The study of regional characteristics permits to identify specifics of demographic problems and to develop targeted measures considering local conditions and needs of population. The presented results can be used as basis for assessing demographic trends at level of the Regions of Russian Federation and can be considered as development of theoretical propositions in the field of demographic process management at Federal and Regional levels. Besides, the results of analysis and modeling make it possible to assume that demographic processes in the Regions are determined not only by the level of morbidity of population, but by a number of other factors of social, economic and institutional nature that can be assumed as basis for subsequent studies of this issue.