Problems of Social Hygiene,
Public Health and History of Medicine

The article presents the results of analysis of indices of total morbidity of population of the Central Federal Okrug (CFD) of the Russian Federation in 2010-2017. The significant differences in indices of total morbidity between the CFD subjects in certain ICD-10 classes were established. The indices of total morbidity of population during study period (8 years) in the Central Federal District factually didn't altered, while dynamics of indices in other subjects was characterized by multidirectionality. The gap in levels of total morbidity of population in the subjects was significant: from 115,123.6 per 100,000 of population in the Kursk Oblast to 194,404.1 per 100,000 of population in the Orel Oblast. The significant difference in rates of increase/ decrease of indices is noted. Thus, in Moscow decrease rate made up to 10%, while in the Orel Oblast morbidity increased up to 13.1%. Besides, in 2017, the Orel Region took a leadership in rate of increasing of total morbidity in such classes of diseases as infectious and parasitic diseases (39.3%), diseases of blood and blood-forming organs (49.1%), diseases of endocrine system (59,1%), diseases of nervous system (26.8%), diseases of respiratory system (28.2%), diseases of musculoskeletal system (16%), malformations (56%). It is very likely that this trend developed under influence of demographic situation in the subject due to significant increasing of percentage of people older than able-bodied age.The city of Moscow occupies leading position in decreasing of rate of prevalence of diseases and last but one place in level of total morbidity being inferior only to the Kursk Oblast. Thus, in Moscow was noted the most significant decreasing of morbidity in classes of infectious and parasitic diseases (26%) and diseases of digestive system (20.6%). The diseases of blood and blood-forming organs (235.2 per 100,000 population) and mental disorders (2353.5 per 100,000 population) were registered the less.The main contribution into trends of increasing or decreasing of indices is made by persons aged 18 years and older (74.1%).

The bronchial asthma is a common pathology among children of different countries, Russia included. However, comparative studies of the incidence of bronchial asthma in children in urban and rural areas are factually absent.The purpose of study is to analyze children morbidity of bronchial asthma in urban and rural areas of the Belgorod Oblast.The official statistics data was used to analyze primary and total morbidity of children with bronchial asthma in cities and rural areas of the Belgorod Oblast in 2012-2017. The continuous retrospective technique was applied.The level of primary morbidity of bronchial asthma in children is factually the same in urban and rural areas (P>0.05). However, total morbidity of bronchial asthma in children population is significantly higher in cities of the Oblast.

The professional burnout of physicians is a common world problem that has significant negative impact on quality of medical care and decreases effectiveness of human resources policy in health care. The first step in solving the burnout problem is to identify the most common provoking and protective factors (predictors) of this phenomenon. The study was targeted to determine and categorize the key factors associated with burnout of physicians and to provide prevention and treatment of the condition in the future. The participants of the study completed a questionnaire targeted to evaluating professional burnout levels and establishing key factors of its development and prevention. The sampling of 1668 physicians from the Tomsk Oblast participated in the study. The moderate or high levels of professional burnout were found in more than half of respondents and only 1% of them had no predictors of this syndrome. The correlation and multiple regression analysis were applied to classify various factors impacting on professional burnout as negative (resulting in professional burnout) or protective (preventing development of professional burnout). The results of the study demonstrated the importance of integrated approach in effective solving of the problem of professional burnout in Russia. The study will assist in finding practical applications of its results in preventing and reducing the risk of development of professional burnout.

The transformation of values and dissemination of consumerism ideology, associated with active implementation of market mechanisms of functioning in the Russian health care system, significantly affected processes of implementing moral aspects of activities of medical workers. The transition of physician and patient to buying and selling relationships initiated the situation when the life and health maintenance is considered not as an ultimate purpose of medical profession, but as a service supplied for particular fee. Moreover, quality of medical care supplied is considered as directly proportional to its cost. This fact results, from one hand, in corruption in health care system initiated by patients themselves because unofficial fee is significantly lower than the established one. From the other hand, it results in the fact that service supplied to patient for free in state polyclinics is provided untimely and not always is has needed quality due to lacking of necessary resources. As a result, the moral purpose of medical profession becomes minor, yielding to commercial relationships. However, these occurrences do not disprove the fact that the patient, in case of visiting physician, remains completely dependent on one's professionalism and responsibility, despite the abundance of private medical institutions and the formal freedom of choosing type of medical service and medical specialist providing it. The high moral culture was and continue to be an obligatory characteristic of successfulness and professionalism of physician. In the new economic conditions, it can become a competitive advantage, since every patient wishes to see in physician not only competent specialist, but also a person capable to empathize and responsibly treat with responsibility another life that was trusted to him.

The article presents results of assessment of the algorithm of interdepartmental interaction related to complex security during mass events as exemplified by experience of the Department of Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing (Rospotrebnadzor) in the Republic of Tatarstan (Tatarstan) during the preparation and holding of matches of the FIFA world Cup 2018 and the FIFA Confederations Cup 2017 in Kazan. The structure of management and interaction concerning security issues included three levels: the Federal level, the subject regional level and the regional departmental level. The vertical interaction was carried out on the departmental level as well as between the interdepartmental operational headquarters and regional interdepartmental operational headquarters through their heads. The horizontal interaction was carried out between departments at the subject regional level. The parallel transmission of information on the horizontal and vertical levels of interaction between the headquarters was previously worked out in Kazan conditions of mass events in 2013 and 2015. The model of interdepartmental horizontal interaction at the level of the constituent entity of the Russian Federation provided algorithm of coordination of activities of security on the part of responsible Agency. For operational prevention of possible security menaces and implementation of planned tasks ensuring comprehensive security directly during the mass events the operational interdepartmental management centers composed of representatives of all interested departments in the subject of the city-participant were created. The key areas of activities ensuring security during preparation and holding of the matches of the FIFA World Cup 2018 and the FIFA Confederations Cup 2017 in Kazan were included into interdepartmental plans of actions since the establishment of the coordinating body and at the end of the event, as well as in the minutes of meetings of the established interdepartmental body. The regulations of activities of interdepartmental operational bodies allowed to implement effective interaction in reaching objectives of safety in the subject of the Russian Federation.

The development of new medications increasing bio-availability and efficacy of existing pharmaceuticals is considered as an alternative to implementation of new medications that can significantly reduce time-frame and costs of bringing medication to the market, acquired in recent decades high practical and scientific importance.The new effective medications include trans-dermal therapeutic systems (TTS) that are capable of providing a controlled release of the active pharmaceutical ingredient (API) through the skin into the bloodstream at a therapeutically optimal rate for a long time. The application of TTS is painless and convenient. It eliminates losses associated with metabolism in the gastrointestinal tract and liver and allows wide variation of dosage and to discontinue treatment at any moment.The key problem of trans-dermal delivery is difficulty in penetrating API through the skin, which has complex multilayer structure. The understanding of all aspects affecting permeability of API through the skin is crucial for the development of new TTS and is a subject of special research interest in modern pharmacological science.

The global health care market demonstrates a steady annual development. According to VISA study, in 2016 the market size was 100 billion US dollars, by 2025 it will reach 3 trillion US dollars and up to 4% of the world's population will receive medical care outside their countries of permanent residence. Exports of medical services are becoming part of government programs. The obvious advantages of developing export of medical services are, first of all, in improving medical infrastructure and quality of patient medical care and organizing additional jobs in many related sectors of national economics as well. The purpose of the study is to identify opportunities and to assess the socio-economic effects of the development of medical services exports in the Russian Federation. As a result of the study, the possibilities of the health care system for more efficient use of available resources, increasing the volume of medical care, as well as the formation of additional financial revenues for solving organizational and managerial tasks of providing material incentives for medical workers, updating the material and technical base, and introducing new medical technologies were revealed.

To identify the most effective areas of out-patient care of children, an in-depth sociological study was carried out in the Kabardino-Balkaria Republic. The questionnaire allowed to get answers on satisfaction of parents with the quality, volume and availability of out-patient care, as well as to study the social status of respondents. The survey included 495 mothers aged of 18-45 years. Out of them, 70.0% had 1-2 children, 30.0% had 3 or more children. The orientation of the majority of families to the birth of 1-2 children formed one of the lowest in the republics of the North Caucasus total fertility rate of 1.61. The results of the study of parental satisfaction with the level of medical care of children in out-patient settings established that the main problem is sufficiently correlated with the data of similar studies in different regions of Russia. According to the data obtained, 61.0% of the respondents were satisfied with the overall health care in the clinic, and only 12.0% of the respondents were fully satisfied. At the same time, a quarter of the respondents expressed their dissatisfaction with various aspects of medical care. The main reasons for dissatisfaction are the low level of examination, organizational issues that need to be addressed, a significant workload of doctors, often the lack of doctors of narrow specialties. According to parents opinion, the clinic is lacking continuity in the work and dynamic monitoring of a sick child, as well as awareness of patients about the ongoing therapeutic and preventive measures. The low efficiency of preventive work is established. The dissatisfaction with the availability and quality of medical care of children is the basis for the necessary measures to improve functioning of the children's clinic, including introduction of new and effective organizational and medical technologies, improvement of material and technical equipment, improvement of the professionalism of medical personnel. The prerequisite for the success of the clinic is also compliance with ethical principles in Pediatrics. The results obtained on the basis of the analysis of the parents' opinion are valuable for development of the perspective programs of development and improvement of primary health care of children in the Republic of Kabardino-Balkaria.

The article considers the statistical justification of the need to minimize the load on the spine of students, both in Russia and in foreign countries and the main directions and multi-aspect regulation of optimizing the load on the spine, since this factor plays a key role in the formation of the health of the whole organism. The movement, correct posture, comfortable clothes and shoes, rationally selected chairs and beds allow you to maintain health of the spine, and the overload, in particular heavy school backpacks have a negative effect on its development and functioning. The issue of the load on the spine of schoolchildren attracts attention of the government, physicians, parents and teachers. The problem really exists and it is not solved yet, despite significant efforts in this direction. The numerous Russian and foreign studies carried out by medical experts, students and teachers confirm the facts of violation of SanPiNs, supporting actuality of research topic. The electronic textbooks can be a key point in solving this problem.

The statistics of causes of death is the informational basis for identifying public health problems. That is why the accurately accounting for mortality from diabetes mellitus, which is a global medical and social problem for society, is important.The study was carried out to analyze the correctness of coding death causes of diabetes mellitus and the frequency of alleged death.Materials and methods. The Moscow deceased population database of July 2018 - July 2019 was analyzed. Using the decision tables on codes linkages from ICD-10, incorrect codes for underline cause were established for 342 death cases from diabetes mellitus. Among 43044 cases of cardiovascular death the cases of presumed death from diabetes were detected. The analysis was carried out in the Microsoft Access 2007 software.The results. In 18.4% of cases, the cause of death from diabetes was encoded incorrectly. If a modification of the underline death cause is assumed due to the mention of certain diseases in any line of the Death Certificate, cases of coding for death from diabetes with wrong fourth character are more often detected when mentioning kidney diseases. If modification of the underline cause is provided for cases when information in the Death Certificate indicates that diabetes has caused the development of some diseases then the largest number of cases with incorrect coding was detected when mentioning circulatory diseases. Only in one medical organization the frequency of incorrect coding is 3.4%, in the rest it varies from 15.4% to 52.2%.Among all death causes, diabetes was only 0.41%. If to add cases of presumptive death from diabetes mellitus, then the proportion of diabetes in the structure of death causes will almost triple and reach up to 1.2%.Conclusions. The quality of diagnosis and coding of death causes from diabetes has not improved in recent years. To increase it, it is advisable to organize and establish the institution of coders. It is advisable to indicate the presence of diabetes mellitus in the Death Certificate without fail and use the information from the diabetes register. It is proposed to encode the death cause from diabetes mellitus with multiple complications use line D in the Death Certificate to indicate damage to various organs and systems if it is necessary.

The main causes of aging of the population are decreasing of birth rate, increasing of life expectancy, increasing of mortality rate of population of able-bodied age. The continuing aging of population results in increasing of number of elderly people requiring social and medical care. The role of social service institutions is increasing. The purpose of study is to assess activities of the division’s centers of social services to elderly age and disabled citizen in the Russia for 2007-2017.The article presents analysis of the indices of functioning of the centers of social support of elderly population and disabled persons in the Russian Federation. In 2007-2017 in the conditions of aging of population most of the indices of divisions of the centers of social support of elderly population and disabled persons decreased except social rehabilitation divisions and divisions of social service at home.The methods. The normative documents regulating activity of the centers of social services and their structural divisions are investigated.The indices of functioning of divisions centers of the social support of elderly population and disabled persons such as day care, temporary residence, social and rehabilitation services, social services at home, specialized social and medical services at home, urgent social services in Russia, were analyzed according to the Federal State Statistics Service (Rosstat) for period of 11 years. The analytical and statistical methods were used.Conclusion. In the Russian Federation, the last decade has been characterized by significant increase in the total proportion number of persons over working age (from 20,8 to 25,0%). At the same time, decreasing of indices of functioning of divisions of temporary residences, day care, specialized divisions of social and medical services at home, urgent social services divisions, reduction in the number of social workers centers of social services to elderly age and disabled citizens was established.

The purpose of the study is to design and to prove rehabilitation process management for musculoskeletal system disorders with the use of on line communication technology between patients and medical institution.Material and methods. Medical and sociological study used sampling of 381 patients involved in hip-and-knee joint replacement program before the surgery and in rehabilitation period with the use of specially designed and implemented at the base of the V. I. Razumovsky Research Institute of Traumatology, Orthopedics and Neurosurgery of Saratov State Medical University interactive system of monitoring and feedback (SMF). The results. The implementation of developed criteria of SMF performance confirmed its demand among the patients. It was revealed that more than 91% of them are ready for active rehabilitation after surgery and all the participants of the study consider as acceptable the distant communication with medical specialists. The performed trial test established that for the period of interaction with SMF patients have changed their attitude to the ways of communication preferring those which suppose on line communication.Conclusion. The developed organizational technology being patient-focused provided acceptable quality of informational interaction for health services access at the base of active feedback, interactivity and customization. It is shown that aged but able-bodied patients are impressionable for such practice, so using of on line communication influencing labor and social activity prolongation being both factor and instrument of health services accessibility.

The controllability (the grade of management decision implementation) is one of the integral indices of management efficiency for each company or organization. The purpose of the study is to investigate controllability of medical organizations and to stipulate the directions for its optimization.Material and methods. The anonymous questionnaire survey was carried on involving 92 medical managers selected by such criteria as professional experience, competence and agreement dimensions.The results. The controllability in medical organization management was assessed including differential estimation by medical areas with the following outcomes. Most regularly, the decisions are taken by management staff are associated with treatment and diagnostic process, economic and financial areas. The role of the structure of non-effected decisions (44.3±5.2% - unexpected adverse events, 31.8±4.9 - low-levelled executive discipline, 23.9±4.5 - decision-making defects) was emphasized and such corresponding optimization directions as executive discipline enforcement; professional retraining of decision-makers; retrieval of timely, and complete information for decision-making; reinforced control of decision quality and implementation; improved motivation system for executives; inclusion of executes into decision-making process; increased innovative decision segment; maximally avoided double organizing measures and exclusion for decision documentation of purely mobilizing appeals; the combination of various management styles in the implementation process; the improvement of coordination of organizing mechanisms as well.Discussion. The obtained results significantly contribute to the notion of medical institution controllability, directions and prospects of its optimization.Conclusion. The results of study can be implemented in everyday practice of medical institutions as well as in professional training of health care managers.

The Hepatitis E (HE) is a viral liver disease that is common on all continents at different rates and very frequently is not symptomatically distinguishable from other viral hepatitis, such as hepatitis A, B and C, as well as from other infectious diseases referred to as “acute jaundice syndrome”. The GE-anthroponosis (in the case of infection caused by genotypes 1 or 2 of hepatitis E virus) or anthropozoonosis (in the case of infection caused by 3 or 4 viruses) is predominantly propagated through fecal-oral transmission. The article presents the general characteristics of VGE, human risk factors and means of prevention. The particular attention is paid to the development of complex of anti-epidemic, hygienic and veterinary sanitary measures in the Belgorod Oblast.

The access barriers to asthma basic treatment and medical care in many countries are an urgent problem and emphasize the need for population studies to examine the associated risk factors for barriers to health care, causes of severe exacerbations, disruption of life quality, and the development of preventive measures. The purpose of study was to evaluate the association of quality of life, access to medical care and emergency of severe exacerbation in persons with bronchial asthma in the Republic of Kazakhstan. The cross-sectional study was applied. The sample included 3,572 patients of both genders aged 18-59 years with bronchial asthma, registered in out-patient clinics of the Republic of Kazakhstan. The assessment of frequency of severe exacerbation in patients with asthma, depending on availability of medical care, demonstrated significant differences in groups of minimal, average and maximum decrease (χ2 = 160.66, 2057.06, 166.19, p <0.001). The most of patients in group with severe asthma exacerbations more than 3 times per year had signs of a maximum decrease in access to medical care - 53.5% and 42.11% were classified as a medium-level barrier of access. The indicator of quality of life was significantly lower in group of patients with severe exacerbation of disease more than 3 times per year in groups with severe access barriers as compared to group with similar number of exacerbations where the number of barriers was less than two - 10.85 vs. 15, 28 (t = 3.985, D.f. = 1, p = 0.003). The study permitted to conclude that improving quality and increasing availability of medical care of asthmatic patient is the key to managing course of asthma at stage of diagnosis and during treatment as well.

The article is devoted to the history of the organization in Russia of the Main Department of public health management in Russia - the world's first Ministry of Health that was organized resulting the activities of the Commission headed by the academician G. E. Rein. The article considers aspects of opposing to its organization by the democratic medical community which was concerned about bureaucratization of medical and sanitary activities and which disappeared with liquidation of this institution on the eve of the February Revolution. The role of academician G. E. Rein in the organization of the Main Department, as well as the fate of the activities of his Commission in preparing reforms in the field of health is demonstrated.