Search

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 article is devoted to the study of the process of transformation of the activities of Russian children's public organizations in the face of the threat of the spread of coronavirus infection COVID-19 and the opening of new opportunities for non-profit organizations to work in this situation. The paper uses the results of a survey conducted from March 18 to 23, 2020 by experts of the Charitable Foundation for the Development of Philanthropy, which covered 232 organizations operating in the non-profit sector. The results of the study allowed us to conclude that the period of self-isolation contributed to the stimulation of children's public organizations to actively implement information technologies in their activities, find new opportunities for remote interaction in their work, and develop online projects.

Based on the results of sociological research, the article considers the consequences of the pandemic on the social health of citizens of the Eurasian Economic Union (EAEU) states. A comparative analysis is carried out between groups of labor migrants from the EAEU states in Moscow and Russian citizens of the same age. The paper discusses the measures taken by the EАEU, for the maintenance of social health in terms of the COVID-19 pandemic crisis.

The article notes that the number of citizens who apply for paid medical services is growing all over the world. The main reasons for this growth are: an increase in the level of well-being of the population; an increase in the areas of care for their own health; the inability to get the necessary assistance in state (free) structures that provide medical care; the complete absence of a number of medical services in free polyclinics, etc. The paper also presents data on the conduct of the study, which determines that on the basis of surveys and statistical data, as well as when studying reviews, it can be noted that in their significant part, consumers of medical services note that, first of all, the poor quality of public medical services prompted them to turn to paid services, but a number of respondents note that public free services in the field of medicine, especially recently, have significantly increased the level of quality. It is also concluded that from the point of view of consumers, one of the main advantages of purchasing services in commercial medical institutions is the ability to visit a doctor without waiting lists and guaranteed on the day of the appointment. Among the general trends in the paid medical services market, we can mention measures to consolidate the format and expand the areas of multi-specialty in private clinics, as well as to create conditions and factors, especially in the situation of a pandemic crisis, to provide high-quality medical services, including overcoming the consequences of the coronavirus epidemic and preventing its spread in the network of medical institutions. Statistical data and conclusions on the main areas of multidisciplinary research in the current state of paid medical services in the context of the pandemic crisis are presented. The review of new directions of providing medical services on a daily basis under the influence of the current state of the pandemic is made.

The efficiency of health care and the quality of medical care can be improved by implementing modern management methods and technologies. It requires modern and high-quality training of medical management personnel. Qualified personnel are the key factor in the organization and transformation of the health system. Human resources ultimately ensure the efficiency and effectiveness of the entire health sector. Requirements to economic management methods are changing and increasing, and specialists with skills in managing medical organizations at different levels of the healthcare system are becoming in demand. At the level of the constituent entities of the Russian Federation, the role of medical personnel who possess strategic methods of healthcare management is increasing. Available training programs in leading higher educational institutions of medical profile do not fully fulfill these tasks due to limited time, a large volume of lecture material, and frequent changes in the conditions and tasks of health care. These problems can be solved by optimizing training programs for retraining and advanced training of health care organizers, introducing active training methods such as business games, case methods, and project activities into the curriculum. The paper describes the system of training students for training courses in the field of healthcare and public health through planning and implementation, project management in the context of military educational organizations of the Ministry of Defense of the Russian Federation, the statistical analysis of the training effectiveness, the factors that influence the success of development programs.

The current state of demand for medical information in the media has a high practical significance for the mass audience. Medicine is a science-intensive, rapidly developing field. In this regard, it is necessary to systematically inform the public about the achievements of medicine - in science, technology and industry, explaining the essence and possible consequences of a scientific discovery, popularizing methods of treatment of a particular disease, introducing society to innovative technological processes in the medical field, achievements and developments of the medical and pharmaceutical industry. The paper reviews the experience of media coverage of medical issues in the aspect of familiarity with innovations and technologies in the context of historical development both in our country and abroad. It also describes the presentation of medical topics in modern media - in periodicals, on radio, on television - in popular science programs or TV movies, in electronic sources. In addition, the article analyzes the genre diversity of the presentation of medical topics. The paper provides information about the media coverage of the main directions of the national project "Health" and its innovative directions.

An important area of medical media is the preservation of health and a healthy lifestyle, the preservation and maintenance of adaptive properties of the body - the basis of content strategies of a large number of modern Russian media. To a greater or lesser extent and by virtue of their professional duties, it is the publications of doctors or interviews with them, as well as official research published in public and non-professional media, that popularize medical knowledge. The article focuses on the fact that the functions of popularizing health and a healthy lifestyle are inherent in the media, both special and for a wide range of the population. In addition to mass media that publish articles on preventive medicine and medicine of innovations and introduction of medical technologies, there are a number of mass media that cover medical knowledge for the population, in order to familiarize society with the achievements of medicine in the direction of maintaining health, maintaining a healthy lifestyle. This paper also concludes that all publications, all materials of Internet portals and messages, both in non-specialized and specialized media, most of the medical topics have a message of interpretation of the popularization of medical topics related to the preservation, maintenance of health and maintaining a healthy lifestyle. Popularization of medical knowledge in the media is an important direction for medical professionals and the public.

The paper provides the results of the sociological survey to ascertain the opinions of physicians and paramedical personnel on the introduction of the new pay system for labor in a federal budget institution. The findings indicate that health personnel positively responded to the introduction of the new pay system for labor, their personal interest in achieving the quality indicators of their work has increased.

The paper is devoted to organizational issues of health care quality control in Russia as at II quarter of 2008. The analysis is made of the organization of this kind of control in the context of the RF subjects with due regard for the system approach on the basis of territorial normative acts. The peculiarities of the legal provision and the organization of health care quality control in the RF subjects permit to divide them into 4 main groups according to the complete coverage of health care quality issues in the documents, and also to assess the influence of the legal provision of these issues on health care quality and the population's opinion.

The materials of publications on the realization of the national priority project "Health" concerning, in particular, the classification of citizens by groups of health in the course of additional dispensarization, indicate quite diverse results. The paper provides a comparative analysis of the correlation between groups of health established according to the results of the additional dispensarization of working citizens in the Russian Federation at large and in municipal formation for the period of 2000-2008. To ascertain the reasons for the divergence of the indicators it is necessary to conduct a thorough study of the problem at the primary level of separate municipal health institutions.

Diseases of the respiratory system are in the lead of general mortality of population, they tend to increase, particularly with regard to pneumonias, chronic obstructive pulmonary diseases, bronchial asthma and others. The paper surveys the structure and levels of mortality from diseases of the respiratory system, sex and age indices with special reference to the working age, the mortality dynamics since 2000, levels of mortality by regions with special reference to subjects with the minimum and maximum levels both for the total and by the main nosologies (pneumonia, diseases of the lower respiratory tract, bronchial asthma); an attempt is made to carry out the correlation analysis of the level of mortality from diseases by the main nosologies.

Analyzed in the paper are volumes and structure of surgery in 1993-2002. It is shown that the fluctuating and mismatching nature of surgical up trend observed both in hospitals and outpatient clinics contradicts the redistribution of scope of medical care in favor of its primary stage, which is not supported up to now by an appropriate personnel policy.

The timely restructuring of healthcare at water transport is an issue of special importance under the social-and-economic conditions of today. The paper mirrors positive and negative aspects of the present state medical care provided to those occupied at water transport system of the North-West Okrug of the Russian Federation. The virtually identical standard of medical care rendered to the discussed category of employees is observed in other Okrugs of Russia. A model of medical care for seamen for the at-sea and on-shore conditions is put forward. In order to preserve and to promote the discussed sphere of healthcare it is necessary to preserve the positive traditions of the past and, jointly with the interested branches, departments and public and other organizations, to apply the modern methods healthcare organization, i.e. to reorganize some of the sectors, to introduce a strict Register of institutions and organizations preoccupied with medical are at water transport and to develop and to introduce new technologies in all spheres of medical care within the branch.

Described in the paper is the activity of the Russian national children's recreation facility "Orlenok", where up to 16 000 children (mainly teenagers) come annually for recreation and recovery. Information on history, evolution as well on the structure of health-improving, preventive and educational measures is presented. The major provisions and stages of the Concept of development of "Orlenok"--a recreational, methodological, medical and cultural facility--are defined. The recreational facility is regarded as an experimental center, where pilot projects targeted at health improvement and prevention of diseases among the growing generation are tested.

Presented in the paper are data on the health of population in Arkhangelsk Region. Specific features of morbidity are defined. Parameters of morbidity are described; its structure is evaluated and retrospectively analyzed. The key trends are displayed for the recent 5 years, they are: an increasing number of acute diseases, many of which become chronic; and growing primary disability. The regional specificity of morbidity must be taken account of in structuring of medical care.

Presented in the paper is the level and dynamic figures (for a period of 15 years) of infant mortality, i.e. one of the most important indices of population health and of quality of medical care, including all its components, as well as of perinatal mortality as observed in Leningrad Region. The main causes of infant mortality are described.; the key measures on its prevention are defined.

The results of monitoring of bad habits (smoking) among senior schoolchildren in 23 towns of Moscow Region are dynamically described in the paper for 2000-2003. Smoking-related specific features are analyzed with respect to the age and sex differences of teenagers. A database, comprising above 25,000 entries, was created on the prevalence of smokers among city schoolchildren.

Presented in the paper are the results of monitoring of congenital defects (CD) among newborns in Nizhniy Novgorod Region in 1999-2003. All CD were subject to routine registration at maternity homes, pediatric clinics and dissection rooms of hospitals. The mean CD prevalence made, during the mentioned period, 15 cases per 1000 newborns, which is in keeping with the CD figures registered in other regions of Russia. The share of some nosological CD forms is in line with the results of the International Registry.

Described in the paper is a concept of an alternative educational facility (City center for medical, psychological and social follow-up, diagnosis and consultation of schoolchildren in Yaroslavl) popularizing the healthy mode of life among pupils of general schools. The center's experts developed and tested comprehensive approaches to teaching the motivation and skills of the healthy mode of life through the comprehensive training of pupils, teachers and parents.

The health protection of population is a subsystem of a macrosystem, i.e. of social sphere. The social sphere, in its turn, is a logistic macrosystem, therefore, the logistical principles can be applied to its subsystems. The system of population health protection is regarded from such standpoint in the paper; the dynamics of human resources are described in detail including an independent author's classification of it. A scheme is presented of how to manage the human resources evolution; effects exerted by the subsystem through the infrastructure on human resources are elucidated.

Discussed in the paper are the peculiarities related with the morbidity observed in a number of Russia's northern regions; a conclusion is made on that it is necessary to take account of the above specific features while rendering the medical care.

Issues related with training of pre-graduate and postgraduate general physicians (family doctors) and of nurses with higher education in the field of family medicine at the chair of polyclinic therapy are under discussion in the paper. The authors believe that the quality of training of experts in the field of family medicine is to a great extent predetermined by the efficiency of rendering the primary medical-and-social care to population.

Psychological- medical- and pedagogical commissions (PMPC) are most often established at educational institutions. However, children cannot be thoroughly examined in educational settings in certain cases; therefore, the physicians fail to diagnose mental deficiency in children due to insufficiently careful examinations. Correspondingly, PMDCs, when established at patient-care and preventive facilities, ensure a more accurate diagnosis and determination of an intellectual-deficiency degree in children or teenager; they also provide for elaborating a set of psychological- medical- and pedagogical measures. The experience of establishing PMPC at a regional patient-care and preventive facility, as well as of its cooperation with educational institutions and with social assistance organizations and its functional peculiarities within the structure of the patient-care facility are analyzed in the paper. Recommendations are defined on cooperation between psychiatrists, psychologists, social activists, pedagogues and of other experts working for such commissions.

The development of family medicine and promotion of genetic approaches to maintaining the health of population are under discussion in the paper. The necessity of training a new generation of physicians by using special programs is substantiated. The system approach to the training of family doctors must comprise, apart from clinical disciplines, the knowledge of human genetics as of a leading medical-and-biological branch of science. The significance of family-related research and analysis of pedigree (for the sake of accurate diagnosis and prevention of diseases) are demonstrated.

Estimates of the vital potential of population in the Astrakhan Region during the 1990-2000 market reforms, which were obtained on the basis of the continuous statistic observations of the total number of births and deaths during the mentioned period as well as on the basis of demography tables and potential demography, are described in the paper. An evaluation of man's "weight", expressed in man-years, is defined with respect to age and sex. The below phenomena are typical of the reform time: prevalence of the share of female vital potential; functionality of the life potential of citizens aged 0 to 19 and 20 to 59; a decreased role of the life potential of citizens aged 0 to 19 due to a low fertility; a diminished share of the life potential among able-bodied men; a decreased correlation index of the life potential of men versus women; a growing life potential in children aged above 1 year due to the paradox of the mean life expectancy; an increasing life potential within the age range of 10 years due to a dropped birth rate in the 90-ies and to the aging process because of the low birth rate and, correspondingly, low children's mortality rate; and compensation of losses in the life potential of men and women primarily due to the aging process.

The paper carries data on the morbidity of greenhouse female workers in Kuzbass. Influence of the medical, social and occupational factors exerted on the occupational morbidity is evaluated; methodological approaches to prognosticating the morbidity with temporary disablement are defined.

A need to amend the ideology of the psychiatric-care promotion in Russia is preconditioned by the medical-and-demographic, economic, legal, pharmacological as well as information-and-technological prerequisites. Main issues and tasks, arising in the reform before the bodies of state power, the psychiatric service and population were defined in the paper. Some priority trends of improving the psychiatric-care management in the Russian Federation were formulated within the context of a "new understanding" of the psychiatric-care protection by WHO, including staffing the system with high-skill ambulatory personnel; development of the chain of rehabilitation and of medical-and-social prevention; and a more comprehensive use of technologies substituting for inpatient facilities.

The paper deals with a high suicide rate in the European North. Data for the rural and urban population categories are compared. Specific features of suicide attempts and of completed suicides are accentuated for the gender and sex aspects. A set of system-making factors, which are responsible for shaping the suicidal behavior in Russia's European North, is defined; social-and-hygienic portraits of self-murders are compiled. The main trends are outlined in the field of suicidal prevention.

The research results of complex medical examinations among machine-operators (age: 18-60, labor record: 1 to 20 years) are described in the paper for 12 district of the Kurgan Region.

A standard of diagnostics, namely, of divergence or coincidence (in %) between the clinical and the postmortem diagnoses as well as a category of such divergence (diagnostic error) is of primary importance within the system of final criteria-based evaluations of the medical care. City Morbid Anatomy Bureau (CMAB) was set up, 1989, in Saint Petersburg in order to coordinate the clinical and pathologoanatomic functions as well as to shape the unified approaches and to ensure equal opportunities of obtaining the unified information from all city patient-care facilities. A unified and formalized card, i.e. "card of the diseased", is filled in for all dead who were examined by the pathologist. The data, when processed by a special program, can be used to derive statistics on the mortality structure (in hospitals, at home, and in separate patient-care facilities), on complications (immediate death causes), as well as on a presence and nature of diagnostic errors (in different patient-care facilities, in cases of various nosological forms, and for certain age-and-sex categories etc.). This, in its turn, can be used to draw the annual reports for the city and, if necessary (e.g. upon a request from a medical institution), to compose the analytic reports. Finally, the paper contains the nosological structure of those who died in and outside the urban hospitals; there is also a dynamic analysis of the nature and reasons of diagnostic errors.

The epidemiological as well as medical-and-social aspects related with diseases of the musculoskeletal system as observed in the Saratov Region over the recent 7 years are presented in the paper. A set of measures was worked out to optimize the medical-and-social aid rendered to patients with defects in the musculoskeletal system; the mentioned measures can be also used to advance the prevention system.

An experience of reforming the healthcare system in the Saratov Region is outlined in the paper. The reforms are based primarily on the following: a system of stimulating payments; a contract-based structure of labor management and of remuneration; quality monitoring of medical services; and resource-sparing technologies.

A model of hospital management, i.e. a state regional ophthalmologic clinic, was designed on the basis of the Republican Clinical Hospital for Ophthalmology of the Udmurt Ministry of Health. Apart from the basic typical elements, its structure comprises the research-and-production units (as finances sources) and investment technologies. Described in the paper are related components and an analysis of the medical-and-economic efficiency of using the above model.

The medical-and-demographic processes as a starting point for the planning of means and resources for the short- and average-term future are forecasted in the paper on the basis of long-term peculiarities of the natural-science data and with respect for the social-and-economic crisis now underway in the country.

The research topic, presented in the paper, is dedicated to the possibilities of managing the district healthcare element, i.e. central district hospital (CDH), focusing on the methods of setting up an information-and-analytical department at the CDH. An algorithm is designed for collecting and condensing the data meant for the CDM management needs; approaches to defining the managerial parameters and to creating a district data base are described. The topicality of the paper and of the algorithms outlined in it are highly favorable for recovering the managerial structure and for ensuring a high-quality medical care provided by rural patient-care facilities. The paper's concepts are also aimed at advancing the accessibility and quality of specialized medical care at the CDH and at ensuring the up-to-date standards of communications and management with the resources being shared rationally and with the cost-saving medical-care mode being maintained within district limits.

Scientific approaches to optimizing the hospital medical care with respect to 3 healthcare levels (regional, municipal and departmental) are presented in the paper. An appropriate model of patient-care facilities aimed at solving the issues of intersectoral involvement of such regional, municipal and departmental institutions in implementing the Territorial Program of State Guarantees in Rendering the Free-Of-Charge Medical Care To Population is suggested.

The results of a sociological inquiry held at 7 Moscow inpatient facilities on the basis of "a questionnaire designed for studying the social-and-hygienic life conditions of artificial-kidney patients" are described in the paper. They are indicative of that a majority of patients have a sufficiently high assessment of their life quality although they experience a constant need in hemodialysis and their vital activity is significantly limited in view of such severe pathology as chronic renal insufficiency. This can be regarded as a positive factor within a system of measures undertaken in the treatment of the above disease.

The paper considers the topical aspects of the health status and sociomedical needs of children and adolescents; it shows it necessary to transform the activity of primary pediatric service facilities at the stage of reforming the country's public health system. The results of one of the largest sociological studies conducted among district pediatricians as to the organization of therapeutical-and-prophylactic and sociomedical and to children are discussed.

The paper deals with a complex sociohygienic study of the basic indices of resource provision of the public health system in the Tver Region and with an analysis of the scope of inpatient care to the population of the Torzhok District, Tver Region. Based on an in-depth examination, the efficiency of the use of the bed fund of the central district hospital (CDH) was evaluated and economic losses from inadequate use of beds and economic effects of work of daily CDH-based hospitals were calculated.

The paper considers topical problems of medical examination of young men to define the category of their fitness for military service and organizational aspects of three-stage implementation in this area under the present conditions. Appropriate methods for evaluating economic efficiency have been developed and tested. They make it possible to deduce in situ an integral to assess activities in medical providing the preparation of young men for military service in the context of years, some nosological entities, and medical facilities.

The paper gives the results of the work and state of matters with diagnostic resources at medical institutions of the Krasnodar Territory. Statistical data for 5 years served as the basis for a cost-effectiveness analysis of use of the diagnostic equipment in different medical institutions. The results of effectiveness of the equipment use were proved to be higher in diagnostic centers than in other types of treatment-and-prophylactic institutions.

How to achieve a higher efficiency in managing the activities of the subjects of the compulsory health insurance (CHI) system is considered in the paper. In the authors' opinion, they are, to a considerable extent, caused by the existing economic levers aimed at optimizing the activities of its main subjects such as medical service producers and purchasers. The results of introduction of economic stimulation mechanisms into practice of the CHI system are given. These mechanisms used on a specific territory may enhance the total level of efficiency of the activities of therapeutical-and-prophylactic institutions and insurers.

The paper presents the results of a study into the impact of migration, including rotational one on the formation of medicodemographic processes, such as composition and natural movement of the population, general and age-standardized causes of death.

This paper sums up the effect of socio-economic crisis developing in the country in the nineties on the population health. Based on analysis of the status and time course of medico-demographic processes, morbidity, and physical development, the author demonstrates the staged pattern in the formation of these values: each new exacerbation of the socio-economic situation augmented the negative changes in comparison with the previous high level.

Medical personnel of ships has been liquidated during the period of public health reforms, and in accordance with International Regulations of Floating Safety, sailors now have to be trained to render first medical care and care of victims on board the ship. This paper discusses the problems essential for such training of sailors and presents the experience gained by the first worldwide department of marine medical training of sailors at S. O. Makarov State Navy Academy. Basic characteristics of navy legislation are presented. Special attention is paid to general laws and laws essential for this sphere.

Medical aspects of driving safety are discussed. Legal problems in first care of victims of accidents and evaluation of fitness to driving are analyzed. The paper is addressed to specialists in public health management.

The author emphasizes that the mortality phenomenon is heterogeneous, integrating many components with different impact, with different methodological approaches to their evaluation. This paper presents an integrative approach to analysis of mortality. The following components are analyzed: total and age-associated mortality, violent deaths, perinatal mortality, hospital mortality, and deaths at home.

This paper presents a model of a new type of outpatient medical care: specialized course of therapy on an outpatient basis. Indications for rendering such care mainly to patients with chronic diseases are formulated. Treatment of such patients in an outpatient setting by intermittent courses with possible short-term hospitalization and temporary invalidity conforms to the standards of hospital care. Data on social and medical efficiency of such treatment organization are presented.