Problems of Social Hygiene,
Public Health and History of Medicine

The trend towards empowering nurses with broader functions and responsibility is global and is driven by the development of medical technology and demographic trends. Therefore, raising the question of changing the role of a nurse in Russian health care is legitimate. However, when implementing innovations in such a sensitive area as health care, it is necessary to take into account the context of the reform. The article presents the results of comprehensive sociological researchers conducted in 2019 and 2020, and concerning: the first - working conditions and the quality of professional training of the Moscow nurses and physicians; the second - their attitude to the idea of expanding the functions of nurses; ideas about the presence of the necessary conditions for this, the response from patients and doctors, the impact on the availability and quality of medical care. The data indicate the ambiguity of the attitude towards the planned innovation. On the one hand, there is an understanding of the need for a certain redistribution of functions and responsibilities between doctors and nurses with an increased role for the latter. On the other hand, the experience of recent years has formed among nurses and physicians negative expectations from innovations of an organizational nature. First of all, a further increase in the load is expected, despite the fact that the current one is perceived by many as excessive, and also that the increase in load and responsibility will not receive adequate material compensation. Other concerns are associated with stereotypes that have formed among doctors and patients, who are used to seeing nurses exclusively in secondary roles, as well as with the inadequacy of their current professional training. The elimination of negative expectations can be facilitated by a system of measures to improve the regulation, organization and remuneration of nurses, improve the quality of professional training of nurses, taking into account their new role, as well as the social prestige of this professional group.

The spread of the new coronavirus infection (COVID-19) required dramatic changes in the healthcare system, the work of medical workers under extreme stress and an increased threat of infection. In order to formulate general recommendations for preventive work with employees in emergency conditions, a study was carried out of the current nature of work, the emotional state of medical workers and staff loyalty.In a multidisciplinary hospital in Moscow (City Clinical Hospital N 52) in the fall of 2020, a survey of hospital employees (595 people) was carried out according to the author's questionnaire with the additional use of the methodology for measuring the burnout syndrome index (MBI) and loyalty index (eNPS).A number of changes in the nature of work of medical workers were revealed, which had a significant impact on their emotional state, such as changes in the usual functionality, place and mode of work. Despite the negative aspects of working conditions, during the pandemic, the employee loyalty index remained quite high (eNPS = 24), doctors were the most loyal, and junior and middle staff were the least loyal. The assessment of the organizational aspects of the work as a whole was also quite high. The close connection between psychoemotional factors and the loyalty of the organization's employees was confirmed. The study made it possible to offer general recommendations for the development of preventive algorithms for working with employees in case of emergency.

Ensuring effective epidemiological surveillance of tuberculosis is essential and one of the paramount tasks for any national tuberculosis control program. The article analyzes the organization of the tuberculosis epidemiological monitoring system at the level of the subject, based on the experience of implementing such a system in the city of Moscow in 1996-2020, defines its tasks and principles of its construction. The systems of epidemiological monitoring of tuberculosis, implemented taking into account the developed principles, provide an analysis of the epidemiological situation in the territory, the results of which can be successfully used for making managerial decisions, program-target planning and evaluating the effectiveness of the measures taken.

Introduction. Liver cirrhosis is a major but preventable cause of health loss worldwide. The era of «big data» allows us to evaluate this nosology in a new format.Purpose. Evaluation of the registered population of patients with cirrhosis of the liver of cirrhosis of various etiology in Moscow. Moscow.Materials and methods. Based on the data of the Moscow Department of Healthcare for the drug provision for the period from 2017 to 2019. Тhe population of patients with an established diagnosis of liver (other etiology) was characterized according to ICD-10 code K.74 (K74.0-74.6) according to the International Statistical Classification of Diseases and Related Health Problems of the 10th revision.Results. Over a 4-year period, more than 2 thousand patients with established diagnosis of liver cirrhosis received preferential drug provision in Moscow. The largest part of the population of patients with liver cirrhosis receiving preferential drug provision in Moscow is represented by the patients of age groups 40-59 years old and 60-79 years old, the groups 30-39 years old and 80-99 years old were comparable annually. There was a decrease in the number of patients with liver cirrhosis in the age groups of 30-39 and 18-19 years compared with the base year (2017) by 37% and 57%, respectively. At the same time, in pediatric patients (from the neonatal period to 17 years), there was an intensive increase in patients from 52 to 550% compared to the baseline year (2017).

The aim of the study was to study the factorial conditionality of the state of health and the features of medical activity (MA) of patients with COVID-19 who were treated on an outpatient basis using telemedicine technologies.Material and methods. The study of lifestyle factors (LS) and MA was conducted by an anonymous survey of 7,743 patients with COVID-19. The patients' health was assessed based on the study of the course of the underlying disease and the presence of concomitant diseases, which were detected in 24.3% of COVID-19 patients according to the data of copying information from medical records.Results. It was revealed that the prevalence of tobacco smoking was 33.25 cases per 100 respondents, 45.4% of respondents were overweight, 75.6% of patients had a low level of physical activity, 68.2% and 53.8% of patients had low medical literacy and MA, respectively. It is established that the greatest impact on the health status of the patients interviewed was provided by the bio-social activity (Smoking) (h = 0.702; m = 0.0063; p = 0.0022), physical activity (h = 0.624; m = 0.0026; p < 0.001, health behavior (h = 0.527; m = 0.0030; p < 0.001) and health literacy (h = 0.532; m = 0.0028; p < 0.001).Conclusion. The studied risk factors affecting the health status of COVID-19 patients, most of which are manageable, should be taken into account when forming therapeutic and preventive measures.

The article is devoted to the study of the issue of changing the functionality of nurses, analyzing the opinions of nurses and doctors themselves on the implementation of such an innovation, assessing the benefits and consequences associated with expanding the functions and increasing the role of nurses in the medical community. The research is based on CHAID-analysis of data from a questionnaire survey conducted in 2020, which revealed the respondents' attitude to the idea of improving the status of nurses and expanding their functions, expectations of the possible reaction of the medical community and patients to this innovation, and the development of so-called «trees» of classifications for various variables.The collected and systematized data on changes in the functionality of nurses can serve as a starting point for the possible expansion of the functions and powers of nurses in the metropolitan health care, as well as increasing the role and status of nurses in the professional environment. The results of the Moscow study presented in the article confirm the conclusions of other scientists and practitioners from the Russian regions, in which a pilot project has already been implemented to change the functionality of nurses.

Quality of life (QoL) is an important health outcome and represents the primary aim of all medical interventions. The term QoL has been is frequently used in medical and philosophical literature in recent decades and has become an important concept and goal of public health research.Traditionally, biomedical results rather than QoL were the basic endpoints in clinical and public health research.However, recent research is increasingly focusing on the study of QoL in patients and the making use of QoL assessment has increased considerably. The concept of QoL has led to extensive research and has been used by the professional medical community in the treatment of a broad array of diseases.Literature search methods included database searches Scopus, Web of Science, MedLine, the Cochrane Library.Historical trends in the concept of QoL are discussed in this article and issues related to the conceptual and methodological aspects of constructing QoL in the context of health care.

Introduction. Thanks to advances in science and medicine, the threshold age of a patient who can undergo open surgery on the valves of the heart or coronary arteries is increasing every year. Elderly patients constitute a special group in this regard.Aim. Determine how elderly cardiac patients assess their health status and highlight the factors influencing it.Materials and methods. The results of a survey of 107 patients who are in the Department of cardiac rehabilitation of the A. N. Bakulev National Medical Research Center for Cardiovascular Surgery in 2020-2021 after surgical or endovascular treatment of cardiac pathology. The survey is carried out by a cardiologist using a questionnaire that allows you to characterize the patient's health status on the basis of self-esteem. Statistical data processing was carried out in Microsoft Office Excel 2003 and Statistica v. 6.0 programs.Results. The majority of respondents (63.6%) assessed their state of health as satisfactory. No correlation was found between the state of health and the level of education. On average, the patients had 3.7 ± 1.8 chronic diseases. Obesity was observed in 29.4% of men and 68.8% of women. The body mass index did not correlate with the self-reported health status of the respondents, but it did correlate with the number of accumulated diseases (r = 0.42, t-statistic = 2.58).Conclusions. Recovery of elderly patients after cardiac surgery is progressing rapidly. In women, the recovery process is slower due to the greater number of associated pathologies. Old age is not a direct contraindication for cardiac surgery. When self-assessing their health status, elderly patients do not associate it with risk factors.

Purpose: determination of the risk factors increasing the probability of development of non-communicable diseases at employees of the railway industry and also value of a condition of conditions for maintaining the healthy lifestyle by employees.Materials and methods. 13,595 people were interviewed (1.5% of the staff). The questionnaire contained 49 questions on the main components of healthy lifestyle, compiled on the basis of the STEPS toolkit.Results. More than 93% of respondents agree that the person himself is responsible for his health, while only 11% of respondents correspond to the full extent of healthy lifestyle. The price factor when choosing products is decisive for 54% of respondents. 80% of the company's employees feed on what they brought from home. Less than half of the company's employees are engaged in physical education, sports, recreational gymnastics; would like to do, but now 40% do not do it. The proportion of persons involved in physical activity is slightly higher among young employees (54% versus 44% among workers aged 36 years and over). More than 2/3 of the survey participants do not smoke (while 30% smoked earlier, but were able to quit). Among women, the proportion of non-smokers is higher (86%) compared to men (64%).Conclusion. Based on the data obtained, it is possible to conclude that the company employees responsible attitude towards their health prevails. At the same time, a number of negative practices are quite widespread. These results point to the need to advance the values and practices of healthy lifestyle.

The article is devoted to the results of a study of the problems of nursing staff performance maintenance in connection with aggressive behavior of patients. We studied the opinions of 413 nurses concerning the aggressive behavior of patients in medical organizations of the Central Federal District. The paper reveals the problems of patient aggression and its interaction with nursing staff productivity.

Currently, the ongoing pandemic of the novel coronavirus infection is still a major public health problem worldwide. The questions of immunosuppressive therapy of patients with psoriasis and psoriatic arthritis, the possibility of vaccination against the background of the use of genetically engineered drugs remain open. The article is of an overview nature and includes up-to-date information on the feasibility and safety of the use of genetically engineered biological drugs in patients with psoriasis in a pandemic (COVID-19). According to the international recommendations of the National Psoriasis Foundation COVID-19 Task Force expert group, treatment of psoriasis and/or PsA does not significantly alter the risk of SARS-CoV-2 infection and does not lead to worse prognosis of COVID-19. Therefore, patients not infected with SARS-CoV-2 should continue biological or other systemic therapy for psoriasis and/or PsA. According to a registry from 25 countries, hospitalization with SARS-CoV-2 infection was more common in patients receiving nonbiological systemic therapy than in patients receiving BAs. Thus, genetically engineered biological drugs do not appear to cause an increased risk of coronavirus infection and do not determine a more severe course.With regard to vaccination of patients with psoriasis, many issues require further study. According to international agreements, vaccination is not contraindicated in patients with psoriatic disease. However, there is still insufficient data on how the treatment of psoriatic disease affects vaccination. Avoiding COVID-19 or reducing the severity of infection following SARS-CoV-2 vaccination is thought to far outweigh any risk directly related to vaccination complications.

The article discusses an approach to assessing the level of maturity of medical technologies based on the TRL (technology readiness level) methodology. The author presents a tool for planning scientific results and developments in the direction of «medical sciences» with a clear description of the expected results at each level of research and development. The levels of technological maturity of developments in the field of healthcare are described in detail, possible results and reporting forms for each level are presented, their differences are analyzed depending on the planned final product. Also presented are proposals for the distribution of powers between the state and business to finance the process of creating and implementing a new medical technology, depending on its stage of maturity.

The article deals with topical issues of changing the socio-economic state of citizens under the influence of the situation with the spread of a new coronavirus infection that swept the entire world at the beginning of this year. Currently, society is asking whether people's attitudes to each other will change, how the economic situation in general and the financial situation of citizens will develop, in particular, in the conditions of active use of remote technologies, the development of Internet resources and the transition to digitalization, which are gaining popularity in conditions of self-isolation and restrictions on mass events. The article uses the results of a survey of the research project «Self-organization and mutual assistance in countering the spread of coronavirus infection», conducted by the center for research of civil society and the non-profit sector of the Higher School of Economics. The responses of respondents regarding the introduction of digitalization, increasing online opportunities, both in terms of work, training, and entertainment and communication, converge and confirm the prospects for development. However, while volunteers are optimistic about digitalization, representatives of the civilian population are more concerned about strengthening the digital control of the state over the lives of citizens.

Immunoprophylaxis is one of the pressing health problems. The safety of those involved in the provision of medical care acquired particular importance during the period of the introduction of the high alert regime. Regulatory norms determine the need for the prevention of infectious processes, including among this group of workers. However, at the moment there are not fully regulated organizational and legal aspects, including the issue of vaccination against coronavirus infection caused by the SARS-CoV-2 virus.

For the first time in pediatric practice, the psychological state of 100 children (7-17 years old) with COVID-19 in the state of hospitalization was studied on the basis of the Scientific Medical Research Center of Children's Health of the Russian Ministry of Health Care and the directions of psychological and pedagogical assistance were determined. Analysis of medical and psychological-pedagogical documentation, conversation, observation, screening diagnostics were conducted. It was established that according to the totality of physical and psychological factors (the main psychological difficulty) patients can be grouped into the following groups: children in a severe physical state, with unstable manifestations of mental activity (n = 4; 4%); children in a predominantly moderately severe state with significant distress related to the disease (n = 48; 48%); children in a satisfactory physical state, with mild and mostly situational difficulties in adapting to the situation of hospitalization (n = 46; 46%); children in a satisfactory physical state, in a relatively stable positive psychological state (n = 2; 2%). Consideration of the severity of their physical and psychological condition and their basic psychological difficulties allows differentiated psychological aid to be rendered to children and teenagers in special conditions of the «red zone».