Problems of Social Hygiene,
Public Health and History of Medicine

The article analyzes the main aspects of the development of various approaches and methods in the provision of medical care to patients with closed abdominal trauma with damage to the liver and spleen. The most important stages of improving approaches, the impact of scientific and technological progress on the introduction of modern technologies in this area of surgery are described. The modern views of various authors on the existing problem are considered.

The self-preserving behavior of young people is of particular interest, since the prospects for the reproduction of the population and the development of the economy depend on it. The article presents the results of a sociological study of the self-preservation behavior of young residents of Moscow, many of whom came from Russian regions. There were studied the ideas of young people about the role of lifestyle in ensuring health and longevity, the meaning and obligatory nature of take care of health, the influence of primary socialization and the current social environment, as well as models of behavior in terms of combining work and rest, eating habits, physical activity, seeking medical help. It is shown that the majority of young people living in the capital are aware of the value of health, consider taking care of it the norm and duty of every person, and see the lifestyle as the key factor in health and longevity. The parental families of the majority of respondents do not have pronounced self-preservation practices, while the current social environment treats health care with understanding. Basically, the respondents deny bad habits, have a good psycho-emotional status. However, not everyone can afford quality food and regular meals. Young people often sleep much less than they should, do not often go in for sports and are in the fresh air. The medical activity of young people is controversial. The majority of respondents express their willingness to undergo regular medical examinations and screening examinations. At the same time, almost half of young people carry disease on the legs, explaining this by their unwillingness to miss classes, lose wages and annoy the employer. Due to the unsatisfactory according to young people accessibility and quality of free medical care, they have to self-medicate or go to private clinics, the cost of which services two-thirds of the respondents considered very tangible. Thus, the self-preserving attitudes that young residents of Moscow have in many respects run into problems of a material nature.

Introduction. In the last decade, there has been a «breakthrough» development of scientific approaches to the assay of genomic and immune factors underlying anti-cancer treatment efficiency. The choice of antitumor therapy in practice is increasingly determined by molecular signatures, and not only by the specificity of organ tumor originated from (or by the histological properties of the tumor). An urgent and important scientific and practical task is to study the successful experience of organizing Centers for Personalized Cancer Treatment (CPCT).Aim: analysis of the 10-year experience of the Clinical Center for Personalized Cancer Treatment in the Netherlands.Materials and methods. Data were extracted from the internet databases using keywords: personalized cancer therapy / treatment, cancer, targeted therapy etc.Results. The Center's research project collects data on patients with metastatic cancer who are eligible for anticancer treatment as part of standard practice. The system accumulates various information about tumor DNA, mutations and abnormalities in DNA, treatment results (outcomes), as well as other important clinical characteristics, including individual tumor process. Registered parameters are stored in a digital database and are available for scientific research.Discussion and Conclusions. CPCT consider the possibilities for the more in-depth genomic analysis of patient DNA (including non-tumor DNA) in the future in order to improve the medical decision making regarding early diagnosis and personalized choice of anticancer therapies. Rapid progress will lead to the emergence of more advanced methods for re-evaluating biological samples accumulated in biobanks, that will facilitate the understanding the pillars of personalized anti-cancer treatment approaches as well as create an additional bases for the new drug development.

The article discusses the development of telemedicine technologies. It is noted that throughout history, technological revolutions have destroyed the workforce, creating new forms and models of work, making others obsolete and leading to broader changes in society, and digital technologies have developed faster than any innovation in recent history. By the method of content analysis of thematic publications, a review of the country practice of implementing telemedicine technologies in national health systems was carried out. It is concluded that telemedicine is an excellent tool for use in the health sector, reducing inequality and providing access to medical services. Where the construction of hospital facilities can take months, telemedicine uses improvised technologies to provide and maintain remotely

An analysis was made of the structure and number of medical workers (doctors and paramedical personnel) of the Moscow healthcare system for the period 2017-2021. The analysis showed that the number of medical full-time positions over the same period increased by 13.6%, and regular positions of nursing staff by 8.9%. The provision of the population (per 10 thousand population) with doctors increased by 13.0% from 35.6 in 2017 to 40.2 in 2021. The provision of the population with nurses decreased by 2.4% from 58.4 in 2017 to 57.0 in 2021. Among medical workers, the number of individual doctors, over the same period, increased by 15.5%, and the number of individuals of paramedical personnel decreased by 3.4%. The staffing of medical rates (by positions), in general, decreased by 2.4% from 82.5 in 2017 to 80.5 in 2021, and the rates of nursing staff decreased by 9.7% from 87.4% in 2017 to 79.0% in 2021. The part-time ratio was 1.1 for medical positions and for positions of paramedical personnel. Issues related to low staffing and the coefficient of part-time employment for individual medical positions and positions of paramedical personnel require further resolution.

The article provides a brief overview of the history of gene therapy from its inception to the present. It describes the main events that characterize the periods of history of the formation of this therapeutic direction in medicine; the basis achievements and problems of each periods. It lists the main gene therapy drugs that licensed at different times listed; innovative gene therapy technologies, which are now use in clinical practice or are still at the stage of approbation. The article is a review of publications from the Scopus and PubMed and official information from public Internet sources.

The article is a comparative analysis of the quality of life indicators of patients with rheumatoid arthritis with similar indicators in the Moscow population. We conducted a survey of patients in the register of rheumatoid patients in Moscow using the EQ-5D-5L questionnaire and the EQ-VAS visual analog scale. The population of patients with rheumatoid arthritis, in accordance with the recommendations of EuroQoL, was divided into 6 age and sex groups. The responses of patients from each age and sex group were compared with similar groups of respondents in the Moscow population. Key differences in the quality of life of rheumatoid patients were identified in comparison with both the population norm in Moscow and similar foreign registries.

The purpose of the article is to study approaches to medical and social support of patients with chronic diseases in Russia and abroad in order to identify possible ways to solve emerging problems in this area of modern healthcare development. The reasons of comorbidity (polymorbidity), disadvantages of algorithms for accompanying patients with two or more chronic diseases, models of management of patients with chronic diseases and priorities of their use are considered. Based on the analysis of Russian and foreign publications, as well as the systematization of the opinions of experts interviewed during the scientific and practical expert session conducted by the authors (April 2022), conclusions are drawn about existing problems and possible ways to solve them. A proposal has been put forward to organize an information and coordination center for the support of patients with two or more chronic diseases. The purpose, tasks (and the order of their solution), the structure of the center, the need for the work of a curator leading patients (and who can perform the duties of a curator), the possibilities of integrating types of care (medical, social, psychological) to patients who need to be accompanied by specialists-representatives of organizations of very different orientation: medical, rehabilitation, social and preventive. It is shown that the increase in the number of polymorbid patients is a serious burden for modern healthcare systems around the world, and requires the search for effective approaches to solving the problem. The importance of self-preserving behavior of patients and the responsibility of the person himself for adherence to the treatment and prevention of diseases, as well as maintaining a healthy lifestyle is emphasized.

Violation of the interconnected system of institutions for assessing the qualifications of medical specialists can be associated with two main circumstances. The first circumstance is the emergence of new institutions with duplicate tasks and organizational forms, and the second is the withdrawal from the system of an institution that performs the necessary system function. Two relatively new institutions, namely the independent assessment of qualifications (IAQ) and certification for the title of «Moscow Doctor», are considered from the point of view of these circumstances. The paper reveals that there is a convergence of the rules of the Institute of accreditation with the Institution of IAQ of qualifications, which can result in significant duplication of their activities. Therefore, it is necessary to resolve the issue of its possible unification with the Institution of accreditation while the IAQ is at the experimental stage and has not been put into practice. A certain similarity of the principles of activity can be traced in such institutions as certification for the qualification category and certification for the title of «Moscow doctor». Both of these institutions identify and rank the qualifications of specialists exceeding the basic level. The fundamental innovation of certification for the status of «Moscow Doctor» is that this institution actually introduces a qualification category that is higher than the current highest category. At the same time, this institution shows the importance of the institution of certification for a category whose existence is being questioned.

This article presents an analysis of international experience in the implementation of digital therapeutics technologies in health care. The features of digital therapeutics products: their distinction from digital health products and digital medicine are highlighted. An analysis of the global market for digital therapeutics is presented. The aspects of regulation of digital therapeutics and the barriers to its implementation are presented. The importance of digital therapeutics for the transition of health systems to a value-based management model is discussed.

The purpose of the work is to identify the most optimal ways to solve the problem of home parenteral nutrition for patients with short bowel syndrome.Basics. Discussion of the current situation will help optimize the work of the Orphan Diseases Center, lead to a greater introduction of online technology, and aim at the search and implementation of new methods of treating patients in this category.Conclusion. The most optimal strategy has been proposed to improve the interaction between various specialists and patients in need of long-term parenteral nutrition.

An important goal of COVID-19 surveillance is to detect outbreaks using modern molecular epidemiology techniques based on methods to decode the full genome of the virus, since rapidly evolving RNA viruses, which include SARS-CoV-2, are constantly accumulating changes in their genomes. In addition to using these changes to identify the different virus lines spreading in the population, the availability of sequence information is very important. It will allow the identification of altered variants that may be more transmissible, cause more severe forms of disease, or be undetectable by existing diagnostic test systems. The global scientific community is particularly interested in changes in the spike protein (S-protein, Spike) because they are responsible for binding and penetration into the host cell, lead to false-negative results in diagnostic tests, and affect transmission rates, health outcomes, therapeutic interventions, and vaccine efficacy.Genomic surveillance uses next-generation sequencing (NGS) applications and makes data on the full genome of the virus available. These methods offer new means to detect variants that differ phenotypically or antigenically. This approach promotes earlier prediction as well as effective strategies to mitigate and contain outbreaks of SARS-CoV-2 and other new viruses long before they spread worldwide.Today, molecular typing of strains is playing an increasingly important role in this process, as it makes it possible to identify samples that share a common molecular «fingerprint».

The problems of licensing and licensing control of medical activities in the Russian Federation are related to the fundamental responsibility of healthcare - to comply with federal standards of safety, quality and accessibility. The introduction of special diagnostic equipment into the activities of the institutions of medical and social expertise of the Russian Federation and the obligation to use it for expert needs from 2022 has become the time to answer the questions: what are the safety and quality requirements when carrying out work using special diagnostic equipment; whether the organizational and managerial schemes of the activities of institutions of medical and social expertise should change; whether this is a new level of development of medical and social expertise or an expansion of the competencies of functional diagnostics; Are we standing at the origins of a new type of medical activity, and is there much new in this? Answers to these questions should not be expected from the future, putting at risk, in a period of uncertainty and searching for solutions, the life and health of patients, but it is advisable to look in the history of domestic medicine and science, their best practices, adapting them to the strict compliance with the legal field of our country today today.

The article presents data on sports, active forms of leisure, travel among elderly Russians. An important conclusion is made that health promotion by means of active recreation and sports among senior citizens in Russia is one of the directions of active longevity policy. An overview of charitable foundations for senior citizens of the Russian Federation and their activities in promoting an active lifestyle among elderly citizens is presented.

The article gives an idea of health and diseases in various historical epochs. Depending on the historical period, there is a different amount of information about medicine, including diseases and the concept of «Health». This is due to the amount of archaeological and documentary evidence. For a long time, ideas about health have been closely linked with religion. Hippocrates and other scientists of the ancient world at the heart of health determined the state of equilibrium of the four main fluids. With the development of anatomy, physiology and medicine, the development of diseases was considered as damage to anatomical structures and disruption of their functions. In the XIV-XV centuries, a direction appeared that considers the influence of social and social factors on human health. In the XIX century, the ideas of health and disease are further developed based on physiological and anatomical studies. The German Anatomical School compared the concepts of human health and pathology, linked the development of diseases with changes in cells. During the 20th century, on the one hand, medicine became more and more molecular and submicroscopic; on the other hand, global attention to people, both healthy and sick, resumed, which gave rise to synergetic, multifaceted definitions of health. The World Health Organization in 1946 formulated the definition of health as «a state of complete physical, mental and social well-being, and not just the absence of diseases or physical defects.» In the future, this concept was repeatedly criticized, as it considered health as an ideal and brought it closer to the concept of happiness. Today it is obvious that the concept of health is a multifactorial concept and, in addition to the medical component, is closely related to other areas of human life: sociology, ecology, cultural studies, economics, etc.

Despite the fact that the coronavirus pandemic has almost disappeared, its consequences will be a problem for national health systems, medical institutions and individual citizens for a long time to come. During the period of quarantine measures, which were the main form of social distancing and a measure to counteract the spread of the disease, many people practicing a healthy lifestyle, sports and just moderate physical activity were forced to significantly reduce their physical education practice. As a result, many of them faced the problem of weight gain.The article examines the quantitative and qualitative aspects of this problem through the prism of sociological research by international analytical agencies.

Introduction. In recent years, the role of women in medicine, particularly in surgical practice, has increasingly become a subject for discussion. Traditionally, male doctors have dominated in surgical specialties, especially in urology. Slow rhythm of changes in the structure of the specialty remains the problem relevant, despite the optimistic perspectives of the world urological community gender heterogeneity.Materials and methods. We have conducted an anonymous survey. Respondents were asked to complete a survey, which included questions from the survey of the European Association of Urology. The sample included 63 women, who were divided into two groups.Results. Despite the opinion of both groups about the lack of a separation into «female» and «male» specialties, there are concerns about a conflict with stereotypes and ideas about the impossibility of women working in a surgical specialty. Respondents of both groups had more than 70% assurance that in order to achieve professional success, a female surgeon needs more efforts than a male surgeon. In the question of the future status after 10 years, the student population in more than 60% noted the option «operating urologist» and less than 10% of respondents chose the «researcher». At the same time, the ratio among female-doctors has 41 and 33%, respectively. Among female students, in most cases, indicated the lack of such a dilemma (family/career). Female doctors have a ratio of 50:50, respectively. In the question about pay, more than 75% of respondents were confident about receiving equal pay, similar to male doctors.Conclusion. The increasing number of female urologists across the world is a nowadays reality. Rejection of existing stereotypes, elements of gender discrimination from colleagues and patients, mentoring, awareness-building - will help attract young female doctors to the urological specialty. These aspects will be the first step in changing of the current urology.

Introduction. The resource provision of the capital's healthcare system in general and each medical organization in particular is the leading structural component that increases the availability and quality of medical care Reproduction and maintenance of citizens' health can be viewed from the perspective of combining the fundamental triad of resources - human, logistical and financial - in order to achieve the final product - the implementation of medical care to the population. One of the independent types of resource provision in most socio-economic systems, including healthcare, includes financial resources - a form that forms the infrastructure of medical organizations (medical equipment, equipment, devices, etc.) that can be used not only to carry out medical activities directly related to treatment and prevention, but also to conduct scientific research in various subject areas of medical science.Materials and methods. Information from the Moscow Government Portal «Open Budget of the City of Moscow» and the official website of the Mayor of Moscow were used to conduct the study. After data collection and aggregation, statistical, comparative and graphical analysis methods were used for their processing in order to construct dynamic time series.Results and discussion. In the course of the study, the study of the main regulatory documents regulating the healthcare sector at the federal level and at the level of the city of Moscow was carried out. The study describes the current state of the capital's healthcare sector in terms of the regulatory framework and funding allocated for the development, expansion and modernization of the capital's healthcare infrastructure, as well as the features and main results of the purchase of medical equipment and equipment under life cycle contracts.Conclusion. Information on financing, on purchased medical equipment, devices and equipment, on the number and parameters of the functioning of the capital's healthcare infrastructure will allow analyzing and improving the work of medical organizations, implementing operational and predictive management in order to improve the quality, effectiveness and efficiency of the healthcare sector of the city of Moscow.

The article presents scientific evidence that new neurons from progenitor cells throughout life in almost all animals with a nervous system are an integral component of neuronal ontogenesis and plasticity.It has been shown that there are neural stem cells in the brain that give rise to adult neurogenesis, occurring primarily in the dentate gyrus, a subregion of the hippocampus important for learning, memory, and emotion. With age, there is a decrease in adult neurogenesis, which is associated with a decrease in cognitive functions. Newly formed neurons and «immature» neurons together constitute a potential reservoir of young cells («brain reserve») that can be used to prevent aging and/or delay the onset/reduce the impact of neurological disorders.The possibility of using neurogenic processes for therapeutic purposes to reduce pain and improve the quality of life of patients is implied.

The article focuses on the problem of the dignity of doctor and patient, in the Russian Federation, their relationship in the context of the modern realities of medicine. Today there is an acute problem of decreasing patient's trust in the doctor. Despite the development of advanced technologies and the appearance of modern effective methods of treatment, which increase the effectiveness of recovery, the human interaction between the patient and the doctor takes second place. This leads to a problem of distrust of treatment methods and psychological tension, which can be a factor impeding healing. It also leads a person to endlessly change doctors in order to compare specialists' opinions, to search for information about his ailment on the Internet, up to self-diagnosis and cases of self-treatment. At the same time, there has been a significant increase in the number of cases of diminishing the dignity of the doctor. This threatens to reduce public respect for medical professionals, disappointment in their own profession, and an increase in conflict situations. Therefore, along with the use of all the medical technologies available today, it is extremely important for the doctor to observe the principles of his and the patient's dignity and not to lose the purely human connection with the patient.

Introduction. Despite the need for the heads of departments to implement the labor functions of a clinician and manager, the study of personal growth and perceived ability to work in this category of medical workers was not carried out.The purpose of the study: determining the relationship of personal growth and perceived ability to work of heads of departments of medical organizations, as well as the impact on self-esteem of various characteristics of this category of respondents.Methods. A correspondence survey was conducted of 216 heads of clinical departments in the section «personal growth» of the questionnaire «psychological well-being of Riff» and the questionnaire «perceived ability to work» of the Institute of Social Research of the University of Michigan. The personal growth index is the average score according to the statements of the 1st questionnaire. The index of ability to work is the sum of points for each of the statements of the 2nd questionnaire. The average length of service is 23.1 ± 8.60 years, the average age is 47.9 ± 8.08 years. 123 (56.9%) men, 117 (54.2%) worked in a hospital, 114 (52.8%) worked in the «red zone», 111 (51.4%) have a second higher education, 138 (63.89%) have a qualification category, 63 (29.1%) have an academic degree. The Spearman correlation coefficients and the Student's criterion are calculated to assess the relationship and significance of differences between indices and characteristics.Results. The personal growth index is 4.89 ± 0.818, the work ability index is 33.60 ± 4.564 points. Respondents aged 41-50 have significantly (p < 0.001) lower indices. There was no significant difference between the index of personal growth and the index of ability to work in respondents of different sexes (р = 0.864 and р = 0.951), those who worked in inpatient and outpatient settings (р = 0.834 and р = 0.848); those who worked in the «red zone» (р = 0.727 and р = 0.775), respondents with a qualification category (р = 0.543 and р = 0.404), with an academic degree (р = 0.871 and р = 0.898), with the second highest education (р = 0.443 and р = 0.588). There is an average direct correlation of personal growth indices and perceived ability to work (r = 0.6; p < 0.001).Conclusion. The relationship between personal growth indices and perceived ability to work, significantly lower indices in the group of 41-50 years and over 60 years must be taken into account to ensure the professional development of department heads.