Problems of Social Hygiene,
Public Health and History of Medicine

The purpose of the study was to analyze functioning of the Department of telemedicine department over three-year period with assessment of main trends and regional characteristics, as well as the most significant results of telemedicine consultations. The step-wise analysis of applications for telemedicine consultation in 2019–2021 was carried out. They were conventionally classified by “in-coming” and “out-coming” information. At the first stage, number of applications received in 2019–2021 (n=10,145) was analyzed. The regional features of applications were established. At the second stage, extended analysis of all applications received in 2021 (n=4518) was carried out considering type of request, profile of request, fact of video communication, structure of directional diagnoses according the ICD-10 classes with identification of regional characteristics. At the third stage, sampling analysis of applications in 2021 (n=1000) was carried out with in-depth assessment of “in-coming” and “out-coming” information. The study established trend of annual increase of number of requests for telemedicine care (2,380 in 2019; 3,237 in 2020; 4,518 in 2021). The Privolzhsky Federal Okrug is leading in number of applications. The neurologists, rheumatologists and gastroenterologists are the most called-for specialists of somatic profile. The thoracic, neonatal and abdominal surgeons are the most-called specialists of surgical profile. This structure corresponded in whole to the structure of the ICD-10 classes that the region requested. The analysis of consultations testified high need in hospitals to transfer children to the Federal Center for treatment (57.6% of applications), that was not always justified. Therefore, positive decision about hospitalization was made less often (35% of cases). The recommendations of specialists of the National Medical Research Center for Children Health concerning treatment tactics (46% of applications) and additional examinations (44% of applications) were provided more often than it was indicated in application. The conclusion was made about increasing demand for and importance of telemedicine consultations in format “physician–physician” in pediatric practice and necessity of further research study with purpose to improve and optimize this type of medical care.

The article considers issues of attitude of modern man to one's own health, both physical and mental in conditions of instability. The results of sociological studies implemented in 2021–2022 among the population of the Kursk Oblast are presented. The results reflect personal characteristics and attitudes to health, in particular in conditions of complex epidemiological situation and changes in population behavior in area of health saving in conditions of complicated geopolitical situation.

The article presents comparative results of studying opinion of citizens and officials making decisions on modernization of urban environment, about cities conditions. It is established that valuations of citizens and decision makers about urban infrastructure, its quantity and quality, process of cooperation in this area as well as consideration of interests in healthy urban planning differ significantly. The majority of surveyed decision-makers are more satisfied with conditions of their city infrastructure than citizens. The same trend persists in assessing quantity and quality of sport and physical education institutions. On the contrary, environmental situation in municipalities is more likely to suit citizens as compared to decision makers. The decision-makers are more optimistic about intersectorial cooperation in issues of healthy urban planning. The respondents note that issues and interests of health are not sufficiently considered in development and adoption of urban planning decisions in their municipalities. To correct the situation, it is necessary to implement appropriate strategies of healthy urban planning, to determine organizational mechanisms for their implementation in national conditions and to confirm their effectiveness in organizational experiment.

Economic and social losses due to epidemics of non-communicable diseases have put prevention and control of them on the first line in the field of sustainable development of the United Nations. The tasks of combating NCDs and risk factors within the framework of the Sustainable Development Goals require targeted actions on the part of States in the field of policy and legislation and provision of health systems with appropriate resources. In the Russian Federation, such work is being implemented within the framework of the national project "Healthcare", federal programs to combat oncological and cardiovascular diseases. Each subject takes into account the peculiarities of economic development, staffing, implementation of informatization processes, etc. The rapid pace of transformation of Moscow healthcare, its unique institutional structure allowed to form the basis for the effective development of a system of proactive dispensary monitoring of patients suffering from chronic diseases. The authors describe the process of formation of preventive work and organization of dynamic dispensary observation in Moscow. The paper presents in detail the organizational, administrative and technological resources used to create a unique system of dynamic dispensary observation. In addition, the article illustrates the personalized subsystem of dynamic dispensary observation in EMIAS and the institute of "physician assistant". The introduction of a proactive dispensary monitoring system will reduce premature mortality and disability among residents of the city. Moscow through an individual monitoring program and motivation for the responsible attitude of metropolitan patients to their health.

The personnel plays important role in process of maintaining internal quality control and safety of medical care. The employee satisfaction with working conditions is main factor affecting professional development and competence enhancement and consequently quality of medical care. The purpose of the study is to analyze particular personnel policies of the institution and to investigate effectiveness of quality management system regarding health care services. Results. The institution implemented the model of quality management system (ISO 9001-2015) assigning significant role to proper personnel management. The sociological survey was carried out to analyze achieved results and to receive feedback from employees to improve quality management system. The results of sociological survey indicate that the most important targets of personnel policies for 65% of respondents are planning, forecasting skill, competency requirements; for 58% — organization of conditions improving effectiveness of employees; and for 51,7% — maintaining favorable team moral and psychological climate. The employees consider as preferable following ways of professional development: additional training, specialized training programs (78.5%), exchange of experience and communication between Russian and foreign colleagues (51.0%). The analysis established that 61.8% of employees of the institution assume mentoring programs would improve efficiency of new employees. Conclusions. The results of the study revealed that personnel policy of the institution can be improved through implementing particular policies regarding development of employee personal additional competency; of mentoring programs and motivation systems for employees; evaluation of employee individual contribution into achieving the goals of the institution and forming personnel reserve.

The epidemiological data of suicide rate, protective and risk factors is required to evaluate suicide losses, to develop appropriate interventions and to determine their effectiveness. Despite stable decreasing trend in suicide rates over the past three decades, the burden of suicides is determined by loss of young working-age population. In the post-Soviet Russia, fluctuations in suicide mortality indicators are associated with complicated periods of social economic transformations and radical changes of public policy. The risk factors also include economically depressive territories of residence, unemployment, psychoactive substance abuse, childhood and adolescence, family ill-being, incarceration, particular professional groups, physical illnesses, etc. The review established researchers’ aspirations for topics improving understanding of suicide risk factors in population of Russia and needs of vulnerable groups. Such works are to result in better strategies of suicide prevention and development of new crisis care technologies. They identify problems in program implementation and provide important stimulus for determining global priorities in research and development areas.

The article (the third one in author’s series of historical studies of drug supply and pharmaceutical business) examines the period of economic renaissance of the Russian pharmaceutical market in the first years of the third millennium. The analysis of state of the market based on data from Russian analytical agencies, medical periodicals and recollections of participants is presented. The article consists of three reports. The first one considered “field players” of the pharmaceutical market (owners of different types of pharmaceutical business). The second one dealt with all the personnel serving the market game (Russian employees of pharmaceutical companies) and their reflection of the new, post-Soviet experience of living in private business. The third report covers issue of “spectators and judges” i.e. consumers in broad sense of word: from state to buyers of pharmacy medications. The conflicting interests of state structures and officials who played double role (bulk buyers and regulators) as well as needs and problems of retail consumers of pharmaceutical production are demonstrated.

The article, on the basis of archival documents introduced into scientific circulation, considers personality of prominent Russian physician Vyacheslav Avksentievich Manassein (1841–1901), who held the position of professor of the therapeutic Chairs of the Medical Surgical Academy in 1875–1892. The Manassein's public activity had special character, reaching All-Russian scale owing to the weekly “The Physician” published by him in 1880–1901. The article considers various aspects related to the scientific school of S. P. Botkin. For the first time, it is reported about the facts shedding light on complicated relationship of S. P. Botkin with his student V. A. Manassein.

The analysis of various social, economic, and demographic factors demonstrates different degrees and directions of their impact on human body systems and human health in general. The examination of residents of several cities of Russia and neighboring countries provides an opportunity to assess strength and direction of relationship between socioeconomic factors and morphofunctional health. The comprehensive morphofunctional examination was applied to 722 young females aged 18.8±0.05 years from six cities: Moscow, Samara, Saransk, Arkhangelsk (the Russian Federation), Tiraspol (the Transdniestria Moldavian Republic), and Baku (the Republic of Azerbaijan). The economic, demographic, social and ecological indicators of the city and relevant region were considered as factors of urban environment. The Spearman's rank correlation coefficient (RS). was used as measure of relation between attributes. The variability of morphophysiological characteristics is hardly related to the population density (RS −0.18–0.15). At the same time the greatest contribution was demonstrated by complex of economic factors and environmental pollution (RS up to −0.29 for both). The relationships between functional indicators of cardiovascular system and economic status of the region, associated demographic factors, and indicators of air pollution were established in the surveyed cities. In overall, the results suggest that cardiovascular system is the most susceptible area to influence of city-level social economic factors and demonstrates deterioration of functional indicators under economic decline at the regional level. In other morphophysiological systems, adaptive changes were established only as tendencies. The deterioration conditions of human body systems under impact of urban environment factors is evident in some cities. The observed deterioration potentially can adversely affect health during growth and will further be aggravated by ongoing negative environmental influences. In this regard, it is necessary to enhance knowledge about impact of external influences on human health and body systems to develop directed preventive measures improving quality of life.

The article presents analysis of key aspects of patient-oriented approach to medical care support in conditions of wide prevalence of digital and telecommunication technologies in modern society. The theoretical reconstruction of main models of “doctor–patient” communication presented in scientific publications is made. The analysis of components of existential landscape of medical communication, (the leading ones are trust and autonomy of patient's personality) was carried out. It is established that purpose of physician–patient interaction in conditions of e-health care is defined as diagnosis and issue of medical report but not follow-up recovery. The conclusion was made about antinomy of digital health care which consists in fact that active introduction of digital technologies into modern medicine, on one hand, serves as demonstration of power of man and his superiority over his own nature. On the other hand, individual is becoming more and more objectified and becomes vulnerable to challenges of biomedical and digital technologies. All this results in increasing of existential risks for patients and physicians associated with crisis of trust and human dignity. The study is targeted to developing of scientific discussion about problems and perspectives of communication between doctors and patients in realities of modern digital society.

The epidemiological monitoring of morbidity, mortality and disability is one of the important mechanisms of studying population health. The purpose of the study is to carry out comparative analysis of health status of population of the Russian Federation and the Republic of Uzbekistan. Materials and methods. The demographic indicators as well as indicators of morbidity, mortality and disability of adult population of the Russian Federation and the Republic of Uzbekistan in 2010–2020 were analyzed. The statistical, analytical and mathematical methods were applied. The statistical significance of differences in relative values was calculated using the Student's coefficient and was considered as significant at p<0.05 and t>2. The results. During the study period, an increase in population size of the Russian Federation and the Republic of Uzbekistan was established. The population age structure was of regressive type in the Russian Federation and of progressive type in Uzbekistan. In the Russian Federation, significant decrease of natality up to 12.8% and statistically significant increase of mortality up to 34% occurred. The natural population loss in the Russian Federation raised three-fold. In the Republic of Uzbekistan, there was statistically significant increase both of natality and mortality indicators up to 11% and of positive values of natural population growth by 14% (p<0.03). In the Russian Federation, there is statistically significant (p<0.006) decrease of indicator of primary disability from 7.7 cases per 1000 of population in 2010 to 5.6 cases in 2020. In the Republic of Uzbekistan, significant increase (p<0.009) of indicators of primary disability from 0.1 cases per 1000 of population to 2.2 cases per 1000 of population was established. The conclusion. The different types of population in the Russian Federation (regressive) and in the Republic of Uzbekistan (progressive) predetermine differences in demographic indicators of both countries. The high level of mortality and increasing of morbidity of circulatory system and neoplasms in both countries justify need in improving measures of primary and secondary prevention at the state level.

In pandemic conditions, situation of active and uncontrolled use by population of antimicrobial preparations treating COVID-19 occurs. So, new risks of development of medication resistance among patients with various infectious diseases, tuberculosis included, appear. The purpose of the study is to characterize prevalence of antimicrobial preparations use by population in relationship with development of medication resistance in patients with tuberculosis during COVID-19 pandemic. Material and methods. The analysis of sales of antimicrobial medicines was implemented on the basis of published official data from the joint-stock company DSM Group presenting monthly audit of the Russian pharmaceutical market. The determination of primary antibiotic resistance was carried out in 2018–2020 on 3312 patients with tuberculosis. The modified method of proportions on liquid nutrient medium in system with automated accounting of microorganisms growth, the method of absolute concentrations and the method of polymerase chain reaction with real-time detection were applied. The results of the study. It was established that the most demanding antimicrobial medications among population were ceftriaxone, azithromycin, levofloxacin, moxifloxacin, azithromycin. At the same time, the maximum increase in sales in 2020 up to 150% as compared with of 2019 was determined in medications derived from quinolone moxifloxacin, levofloxacin, which began to be used in treatment of coronavirus infection. At the same time, these medications are traditionally used in tuberculosis treatment. But in 2020, alarming trend was established that limits treatment of tuberculosis patients. The primary resistance of mycobacteria was also established in newly diagnosed tuberculosis patients, also for the same antimicrobial medications of quinolone derivatives, and increasing in proportion of patients with primary medication resistance to levofloxacin, moxifloxacin in 2020 as compared to 2018 was 189–480%. At the same time, increasing of resistance to other antibiotics made up to 60.8% on average. Conclusion. The study results imply alarming scenario of medication resistance shifts towards very virulent and highly medication‐resistant genotypes. This trend can result in conditions of successful transmission of deadly medication-resistant mutants that can seriously undermine effectiveness of implemented programs of struggle with tuberculosis worldwide.