Problems of Social Hygiene,
Public Health and History of Medicine

The standardized mortality coefficients for different causes have significant variability between regions and depend on many factors. The purpose of study was to investigate interregional variation coefficients of standardized mortality of oncologic diseases as compared with other causes having no explicit diagnosis criteria. The 49 death causes were selected out of 295 causes of the Short nomenclature of the Rosstat. These causes were distributed by 2 groups: neoplasms and causes without explicit diagnostic criteria. The standard mortality indicator was calculated on the basis of the European standard. The significance of differentiations between the groups was estimated using one-factor dispersion analysis by pair comparison and Bonferroni amendment. The level of interregional variation coefficient of the standard mortality indicator from cancer was lower than from other causes with no explicit diagnostic criteria. Even the reasons of death from oncologic diseases which has no explicit criteria have the significantly less marked variation coefficient as compared to other two groups. There were reliable differences of the variation coefficients between the subgroup of oncologic diseases with precise location of tumor and the subgroup of oncologic diseases of other and non-explicit locations. The death causes due to “other diseases” and the death causes due to diseases with no-explicit diagnostic criteria had similarly high level of variation coefficient. The difference of the regional standard mortality indicator of concrete reasons is affected by uncoordinated criteria of diseases diagnostic and the main reason of death determination. The letter of the Minzdrav of Russia concerning the rules of application of notion “senility” as cause of death played certain role also. The different level of morbidity in regions had the influence as well. The harmonization of verification of all the cases of diagnosis, its “depth” and applied criteria is needed for proper analysis of data of death from separate causes is needed.

The article considers the results of continuous retrospective documentary study of regional characteristics of road traffic injuries with medical consequences on the Federal highway M-8 “Kholmogory” in the Arkhangelsk oblast in 2012 - 2018. The analysis was applied to 906 medical records of patients older than 18years hospitalized with urgent indications after road traffic accident and received in-patient treatment in medical organizations of the Arkhangelsk Oblast located in area of the Federal highway M-8 “Kholmogory”. The significant decreasing of number of accidents with medical consequences recorded in the covered area as well as significant decreasing number of victims and perished with minimal rate in 2018 was established. It is revealed that the largest number of victims of road traffic accidents was recorded in summer - 300 (31.1%) and autumn - 270 (29.8%) of this year. The Saturday and Sunday occurred to be the most dangerous days of the week in this respect. In day periodicity, maximal number of victims was recorded in the evening time (18-24 PM, 35.1%) and the smallest number in the night time (1-6 AM, 14.6%). Among injured individuals, significantly dominated males (p<0,001) and in total sampling young people under the age of 40.

The article presents the results of analysis of primary and secondary disability due to malignant neoplasms among young people in Moscow in 2016-2018. The study established that in the structure of young patients recognized as disabled for the first time made up the smallest percentage with tendency of increasing the level of primary disability. The study established the predominance of people with disabilities of group II with high level of primary disability. The second position is taken by patients with disabilities of group III with tendency of increasing their specific severity. The number of patients repeatedly recognized as disabled is much higher than patients recognized as disabled for with the first time. The study established prevalence of disabled patients of group III with tendency of increasing level of repeated disability.

The article devoted to consideration of ethnic feature of primary choice of subjects of health preservation by residents of the Republic of Khakassia. It is established that at equal consumption of medical care in out-patient and polyclinic organizations, among the ethnic population of there is higher demand of services of traditional healers, especially representatives of shaman practices. The primary effecting on decision making in choosing health care institutions is provided by folk customs and family traditions received from senior relatives that is especially expressed among the Khakass ethnos.

The spinal osteochondrosis takes leading role among diseases of the peripheral nervous system, being a serious social problem in many countries. The significant prevalence of this disease among individuals of able-bodied age, high disability rates, large economic losses condition the urgency of this problem, its epidemiological and socio-economic significance. The purpose of study is to analyze the socio-hygienic and clinical features of patients with osteochondrosis in the Kursk Regional Clinical Hospital. The statistical analysis of 250 medical records with diagnosis of osteochondrosis was carried out in the neurological department. The gender and age-specific features of the disease, the frequency of manifestation of osteochondrosis in various parts of the spine, leading syndromes and the nature of patients' labor activity were considered. There are gender differences in patients of the Kursk Regional Hospital with diagnosis of spinal osteochondrosis: females 62.0% and males 38,0%. The most common neurological manifestations of osteochondrosis were found among middle-aged patients (45-54 years). The patients with manifestations of osteochondrosis in the lumbar (65.2%) and cervical (50.8%) parts of the spine are predominated. Among all the syndromes, the pain syndrome was the leading one and was detected in 96.4% of patients. The frequency of disorders of various parts of the spinal column depended on working conditions. Thus, intellectual workers suffered more often from osteochondrosis of the cervical spine, and manual workers - from the lumbar spine. It is necessary to optimize primary and secondary prevention of osteochondrosis, taking into account the age and nature of the patients' labor activity as well as to improve medical care and the rational employment of people suffering from this disease.

The purpose of the study is to analyze issues of prevention of smoking among college students and to reveal influence of social environment including influence of healthy lifestyle to development addiction. The study was based on value social model of health. The study covered student survey (n = 495, proportional selection by gender, age, year of study) and standardized interview with youth professionals (n = 21) to analyze in the youth the main motives for smoking, attitudes to healthy lifestyle and preventive social work methods that are implemented in colleges. The comparative analysis of data was carried out in subgroups of smoking and non-smoking students and experts. The results of study demonstrated the unformed negative attitudes to smoking. Among 25% of smoking students and 39% of non-smoking students smoking itself is considered as mean of communication and integration in youth community. Among 45.6% of respondents the exposure to and conformal behavior as reasons for starting smoking were declared. The analysis of results of the study concerning assessing attitude to smoking from the perspective of fashion and social recognition occurred to be unexpected: the number of non-smoking students who assume smoking is fashionable is 17 times higher than the number of smokers who share these beliefs. The comparison of the data permitted to establish possible causes of such a distribution of answers: in everyday life, smokers are faced with various legislative restrictions and social censure, while their non-smoking peers focus on social communicative and recreational effects of this habit.There are particular contradictions in the interpretation by students and youth professionals of causes of smoking. This testifies certain unawareness of professionals about age-related psychological characteristics and emotional conditions of students.

The article presents the results of study targeted to assessing the level of awareness of students about HIV-infection. On the basis of analysis of publications data, it was established that students of the Russian universities are generally informed about ways of transmission HIV-infection and means and measures of its prevention. It was demonstrated that Russian students are not sufficiently aware of the clinical manifestations of HIV-infection, they do not fully understand the danger of HIV infection as a fatal disease, and often experience phobias against persons living with HIV-infection.The article presented the results of empirical survey of students of the Cherepovets State University (n = 103). The methods of research included statistical analysis, questionnaire, Spirman's rank correlation coefficient. It was established that majority of respondents underestimate the risk of HIV-infection and lack reliable information about prevalence of HIV-infection in the territory of residence. The correlation analysis demonstrated that information about HIV-infection is more significant for students who believe that HIV-infection can concern them. In addition, such students tend to be more tolerant to virus carriers.Along informing students about HIV-infection, it is necessary to train them for responsible behavior in different life situations.

The article considers the role of interdepartmental cooperation in modernization of health sector at the regional level exemplified by Mari El Republic. Based on data of study monitoring, the dynamics of medical and demographic indicators are determined. Over the past five years, life expectancy increased, patient satisfaction with medical care increased. Its accessibility increased in rural areas. The primary health care is provided in 49 outpatient clinics and in 207 paramedic and midwifery centers, that meets the established standards. Against this background, the birth continues decreasing of birth rate and increasing of mortality because of diseases of blood circulation system and neoplasms.In order to more thoroughly study the state of health care and and taking into account requirements of the National Health Care Project, the sociological survey of two categories of respondents (patients and medical staff of the district hospital) was carried out.The indicators of demographic development are restrained by negative alterations in demographic structure of population, its aging and regressivity, decreasing of percentage of women of most active reproductive age and high mortality of men of able-bodied age.The social partnership of interested bodies and organizations involved in the reform and improvement of health care system can reduce severity of the above-mentioned problems. Statistical monitoring of implementation of requirements to accessibility and quality of medical care was carried out. The article presents original scheme of interaction between twelve ministries and departments of the Republic. The proposals of to improve quality and accessibility of medical care, the prestige of medical profession and implementation of healthy lifestyles are proposed.

The program of state guarantees of free medical care of citizens for 2019 and up to 2020-2021 plans to reduce volume of inpatient medical care through development of hospital-replacing technologies. The economic feasibility of hospital-replacing technologies is in significantly lower cost of medical services in a day hospital as compared with twenty-four hours hospital (UPC). However, the existing legislative framework and the lack of proactive financial mechanisms do not stimulate development of hospital-replacing technologies.The purpose of study is to analyze reporting data and results of SWOT analysis of rating of factors affecting introduction of day hospitals, On the basis of analysis the strategic objectives of development of hospital-replacing technologies are formed.The study applied statistical analysis, direct observation, sociological survey, SWOT analysis. The analysis was applied to data from forms of Federal statistical observation No. 14 and industrial statistical monitoring No. 14 for 2009-2018. Based on results of SWOT analysis, experts were interviewed by the heads of health care authorities and medical organizations regarding development of strategy of medical care of children with disabilities. The expert survey was carried out with health care managers in Moscow, the Moscow oblast, Orenburg, Chelyabinsk, Samara, Ivanovo, Ryazan oblasts and the Republic of North Ossetia-Alania.The analysis established that in 2018 the number of medical care organizations increased up to 6495, including medical institutions providing outpatient medical care (41.4%) and in-patient medical care (58.6 %).The analysis demonstrated that percentage of treated patients in day hospitals out of the total number of hospitalized patients (in hospitals was 29,1% in 2018, while in 2009 this percentage was significantly lower - 15,6%, which indicates the intensification of the use of the bed fund of the UPC, which to some extent is associated with increased development of hospital-replacing technologies.The results of SWOT analysis demonstrated that the strategic objectives of development of hospital-replacing technologies should be targeted to develop financial stability of health care, active position of the heads managers of health care institutions and medical organizations and introduction of innovations if needed.It is necessary to develop modern management methods, rational application of health care resources, implementation of economic incentives in all components of health care system, ensure functioning of the system, including effective contract.

In the conditions of reforming psychiatric service in the Russian Federation, the procedure of organizing psychiatric care of patients in hospital, the effectiveness of treatment of patients in psychiatric hospital during 2015-2017 were analyzed. The article presents the results of study of organization of psychiatric care of patients in specialized hospital on the basis of Psychiatric clinical hospital № 13. The analysis covered number of patients treated in hospital by nosological forms; number of patients by gender. The age categories of mental patients and the format of professional status of patients were considered. The main indicators of psychiatric hospital activity were investigated: average duration of stay of patient in hospital, annual bed using, bed turnover, number of bed days. The attention was paid to primary output of patients with disabilities, number of re-hospitalizations and compulsory hospitalization. The analysis of financing of inpatient psychiatric care of treated patients for the study period of time was implemented. The vector of providing psychiatric care to patients at the stage of out-patient and hospital-replacing cases.

The article presents definition of concepts of exporting medical services in foreign and Russian practice. It includes overview of the elements of strategy of developing export of medical services (within the framework of the National project “Health Care”). The article considers the need to develop marketing strategy, information exchange system and conditions ensuring compliance of medical services with high standards of quality and safety of medical activities at the national level. The perspective direction development of the quality and safety system in Russia during implementation of the Federal project “Development of export of medical services” through improving the efficiency of medical organizations and their accreditation is determined.

In order to study the change in the morphometric parameters of projection triangles of the facial skull during tooth loss in adult patient, 185 categorized skulls were studied from the craniological collection of the Museum of the Department of Normal Anatomy of the Military Medical Academy. The skulls belonged to adults aged from 22 to 75 years and were separated into two groups - with complete set of teeth and complete absence of teeth on the upper jaw (100 and 85 skulls respectively). Based on standard points, the following projection triangles were developed: lateral front triangle, anterior maxillary triangle, lateral maxillary triangle, lateral infratemporal triangle. It was established that the morphometric characteristics of the proposed projection triangles of the facial skull and infratemporal fossa reliably change with tooth loss. In this case, only those sides that pass through the points located on the alveolar process of the upper jaw change. It is proved that the sides drawn through the alveolar point and the most lateral and posterior points on the alveolar process are most affected. The selection of the proposed projection triangles and the study of their features depending on the degree of preservation of the upper dentition is important for planning and anatomical justification of surgical access on the structures of the middle zone of the face.

The article considers the relevance of marketing research in the field of paid medical services. Due to the fact that the market of paid services in Russia has increased significantly, medical management took neighboring position to medical marketing. The article emphasizes that in Russia annually the number of private medical institutions increases. This trend is directly related to to the fact that free medical care is not always able to provide necessary services vital for the patient. In turn, the existing increased competition pushes private medical institutions to actively fight for the client. The statistical data demonstrates that the loss of five customers per day results in losing of up to two million rubles monthly. It id established that due to increasing numbers of private medical institutions an urgent need for new logistics and marketing research of all medical production arises to have more comprehensive picture of the provision of a paid medical care.It is concluded that reaching these marketing and marketing research tasks determine the new special place of marketing technologies. The marketing in the health care system acts as basic system of principles targeted to creating and studying the demand and supply of medical services. In the health care market, the role of the consumer is played by patients whose needs must be met by medical clinics. The marketing in the health care system is the process of developing and providing medical services. The corresponding data and main conclusions related to provision of paid medical services in the Krasnodar region is presented.

The article reveals the conditions for creation of concept of “the Soviet medicine” and traces the evolution of its principles i.e. the understanding of its key features. The source base was created on extracted their formulations from the program texts of Bolsheviks, journal publications of medical administrators, minutes of meetings of historians of medicine and textbooks on the organization of health care. The study demonstrated how during the hundred years (1918-2018) the semantics of formulations changed quite radically. The explanation is proposed concerning how and why the former meanings were lost and the form of statements sacralized.