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The author examines the evolution of Cuban medical diplomacy under the governments of Raul Castro and Miguel Diaz-Canel. The author shows that the essence of the Cuban national health system, which developed after the 1959 Revolution, is its accessibility. At the time of collapse of the socialist bloc, the Cuban government managed to maintain and surpass the achieved level of development of medicine. The presence of a large number of medical specialists allows the socialist government of Cuba to organize cooperation with dozens of states around the world. Under the leadership of Castro, the export of medical goods and services has become the main source of foreign exchange earnings and a driver of economic growth, and medical diplomacy has become an important tool of soft power, which is used to form an attractive image of the state among the world community. In doing so, the government combines pragmatism, increasing the cost-effectiveness of the programs, and altruism, providing gratuitous aid to the countries most in need. The main difficulty in developing this direction in Cuba’s foreign policy is associated with the North American embargo. In 2018, the US government launched a large-scale campaign to discredit Cuban medical internationalism. This policy aims to further restrict already limited access to essential resources. The country was also negatively affected by the ‘right turn’ in the region: the neoliberal governments of several countries refused to continue medical cooperation with Cuba. At the same time, the trends of recent years indicate an imminent repetition of the shift to the left, which in the future can significantly strengthen the Cuban positions in the region. In addition, the coronavirus pandemic showed that the world community needs a rapid medical response force with Cuban missions serving as a basis thereof.

The article describes the experience of improving the methodology for identifying diversity and homogeneity in the behaviour of complex social objects. The subject area of the study in it is, on the one hand, methods of obtaining sociological knowledge of them adequate to the semantics of social processes, and on the other, specific areas of the process of forming stable types of attitudes towards immigrants among the population of various European countries. To obtain pictures of what is happening, the authors use a toolkit that has been tested in a wide range of studies, the basis of which is the identification of areas (hereinafter referred to as applications, equally semantic fields) of mass consciousness on the basis of the application of the Tay-b-Kendall correlation coefficients. A feature of the approach is the complete alignment of all indicators in relation to each of the studied countries and to all countries together. The initial alignment of parameters at the level of primary data, standardization of two-dimensional matrices of combinatorial statistical contingency tables of a number of features made it possible to build a comparative portrait of the unity and diversity of stereotypes of the mass consciousness in relation to some aspects of immigration in European countries. The total volume of the analyzed array for 2016 for 23 countries is 44487 respondents. The results, some of which are presented in the article, make it possible to optimize the tool for differentiating countries in relation to immigrants.

Recently, minimally invasive treatment modalities based on the application of various physical factors have been widely used in anticancer therapy. Electrochemical lysis is a method in which tumor cells are destroyed by local exposure to a constant low voltage electric current.Purpose:to present the current results of using electrochemical lysis in the treatment of various tumors, to describe the mechanism of tumor destruction and methods of delivering electric current to the tumor, as well as to evaluate the electrical parameters and positioning of the electrodes.Material and Methods.aliterature search included the Medical literatureanalysis and Retrieval system Online (Medline), the excerpta Medica data Base (embase), Web of science, scopus, Russian citation index. All articles were published before december 2019. The review included studies on the investigation electrochemical lysisin vitro, in vivo, as well as clinical observations and clinical studies in which electrochemical lysis has been used as an independent treatment, or in combination with other methods of anticancer treatment since 1984.Results.This review provides information regarding the electrochemical mechanisms of tumor destruction, anti-tumoral effects of electrochemical therapy, methodology for planning and distributing the dose of electrical lysis and positioning of electrodes. We have evaluated complications and oncological results. Electrochemical lysis is a safe, simple, effective, and relatively non-invasive method of antitumor treatment.Conclusion. The electrochemical lysis is a promising minimally invasive method which can be used for the treatment of tumors. However, long-term data are needed to validate this treatment before it can be included into clinical recommendation for the treatment of cancer patients.

This article is devoted to such an issue as the changing socio-economic inequalities in health that come with age. According to one theoretical explanation, these inequalities increase when people get older: in the lower strata, the negative effects of life’s hardships on health accumulate, and in the well-off ones, conversely, an accumulated positive effect occurs. This explanation is opposed by theories that predict a reduction in inequality. In older cohorts, as one of them notes, inequalities decrease as the physiological mechanisms of aging begin to play an increasingly important role, reducing the importance of social factors. Selective mortality can also help equalize structural distinction — reducing the number of low-status individuals with poor health leads to social differences smoothening out. Proponents of another theory emphasize the importance of social policy — state support and protection, including special social security programs for the elderly, in helping to maintain the health of vulnerable groups. The empirical results contradict the hypotheses and do not provide convincing evidence for any of the assumptions. Two-level modeling with survey data from the European Social Survey (ESS 2012) for 27 countries and statistical data on these countries, as well as regression analysis carried out on arrays of two groups of countries — with low and high government expenditure on health – showed that, as the transition to older age cohorts occurs, there is a gradual expansion of status inequalities, especially noticeable in countries with low budget spending on health. In the most developed social democracies, this trend did not persist — a slight increase in inequality continues until pre-retirement age, and then — in the category of older people — they smoothen out. The findings support arguments about the positive role of the social state in improving national health and reducing health inequalities after retirement.

Studies have shown positive associations between levels of physical activity and alcohol use at both between-persons and within-person levels. This relationship has been of interest to researchers developing physical activity-based treatments for alcohol use disorders, which have had mixed results, one reason perhaps being because they have not controlled for individual differences. The current study investigated whether differences in Five-Factor Model personality traits moderated the physical activity-alcohol use relationship in an undergraduate sample (N = 263). Results showed lifestyle physical activity, extraversion, and neuroticism were each predictive of alcohol use, but there were no interaction effects among these variables, indicating that personality traits do not impact the strength of this relationship. Therefore, individuals high in traits of extraversion or neuroticism are not specifically at risk for increased alcohol use when participating in physical activity. If exercise-based interventions for alcohol use disorders are implemented, individuals high in extraversion and neuroticism continue to possess independent risk factors for alcohol use.

Aim of the study. To describe the results of using mobile health intervention for improving the compliance of patients with tuberculosis and HIV (TB/HIV). Materials and methods. Piloted clinic-affiliated mobile intervention was carried out in 54 patients with TB/HIV and with a history of psychoactive substances abuse in Irkutsk Regional Clinical Tuberculosis Hospital. The mobile intervention included a smartphone application that connected the participants to the staff of Irkutsk Regional TB Hospital and provided daily queries on stress, mood and medication adherence; appointment reminders; virtual support group and consultation resources; weekly quizzes. We assessed longitudinal impact on retention in medical care, visit constancy, viral loads and CD4 counts, TB outcomes. Results. In 6 months, we registered the increase (in comparison with baseline) in mean CD4 counts (F = 6.61; р = 0.04) and in the number of cases of suppressed viral loads – from 20.5 % (9/44) to 55.3 % (21/38) (p < 0.01) in TB/HIV users of e-health app. We found a lower level of TB treatment interruption in patients who used the application in comparison with the patients who refused to use it (4/44 vs 5/10; χ2 = 7.09; р = 0.008). App users completed the course of TB treatment in 63.6 % of cases (28/44), and 61.4 % of patients (27/44) were cured which was higher than the level in the control group (20 % (2/10)) (χ2 = 7.54; p = 0.03). Conclusion. This study has demonstrated that a mobile health intervention can have a positive impact on improving the medical and social care and clinical outcomes for TB/HIV patients with history of psychoactive substances abuse.

The article introduces data from the study of the severity of social anxiety caused by the expectation of retirement and subsequent retirement; highlights signs of retirement stress: acceleration of biological aging, the discrepancy of psychological and biological age. It also regards individual-personal factors of biopsychological aging. The article presents the results of an empirical study of the biopsychological age of people – Russians by origin – pursuing intel-lectual professions and living in the European Union and in Russia. All the participants were continuing their research activity and were aged from 32 to 70 years, both living in Russia (n=101, women, 62), and having migrated to the European Union countries (n=101, women 56). Methods of assessing biological age with regard on health indicators, subjective psychological age, as well as the questionnaire of life path were applied. The results showed that in Russian sample the signs of retirement stress are more pronounced: the subjects have an acceleration of biological aging at the age of 51–65 years. The personal strategies for preventing retirement stress and maintaining relative juvenility, typical for the intellectual occupation professionals, were singled out: for men — democratic working conditions, positive attitude, collaborative non-ambitious non-aggressive behaviour; and for women — wellbeing, respectful partnership in the couple, friendly working conditions; multiple changes of place of residence. However, the difference in relative juvenility strategy for residents in Russian and EU was also observed.

Development of health behavior in patients is an important task of psychological rehabilitation. The models of behavior change and their application in psychological rehabilitation are analyzed. We discuss applications of the PROCEED–PROCEED model to the evaluation of rehabilitation. The value of the model is in the possibility to operationalize and formalize assessment of the effectiveness of the organization of rehabilitation. Based on interdependence theory the importance of achieving consistency of rehabilitation goals and the gradual transformation of expectations is discussed. The effectiveness of rehabilitation and the possibility of patient's behavior change at early stage are associated with the formation of interpersonal relationships that are consistent with the expectations of the patient and his family. The lifestyle changes and active participation of the patient in rehabilitation can only be provided by the transformation of one’s relations with specialists. Subsequently, this interaction has to be reconstructed in the direction of greater participation and responsibility of the patient.

Objective:A comprehensive study of the prevalence and structure of risk factors (RF) of cardiovascular diseases (CVD), the daily dynamics of central aortic pressure and arterial stiffness in healthy women of different age groups.Materials and methods:the study involved 161 women aged 18 to 65 years with one or more CVD RF. All volunteers underwent a survey, 24-hour blood pressure monitoring with determination of arterial stiffness and daily dynamics of central aortic pressure, determination of carotid-femoral pulse wave velocity (cfPWV) and vascular stiffness by volume sphygmography.Results:the examined were divided into 3 groups: 1 group of 52 women of young age from 18 to 30 years (23.8 Ѓ} 5.3 years); 2 group of 54 women from 31 years before the onset of menopause (41 Ѓ} 5.9 years); group 3 — 54 women in the postmenopausal period (55.4 Ѓ} 5.8 years). High prevalence of modifiable CVD RF among women of various ages was revealed: smoking, non-compliance with dietary recommendations, lack of physical activity. Obstetric and gynecological pathologies prevail in younger age groups. In group 1 the studied parameters correspond to normal in most parameters. Significant differences in central and peripheral pressure, arterial stiffness indicators, with the exception of cfPWV, were identified in group 2 in comparison with young women. A comparative analysis of groups 2 and 3 showed a significant difference and worsening of indicators characterizing the degree of development of arterial stiffness, the contribution of the reflected wave and the associated dysfunction of the left ventricle.Conclusion:a comprehensive study of arterial stiffness allows you to identify subclinical changes in the vascular wall and evaluate their progression in women of different age groups.

Regulatory approaches to assessing the safety of homeopathic medicines in the Russian Federation and abroad are formed in accordance with regulatory acts, national and international rules and guidelines. Scientific literature is particularly important for justification of safety of homeopathic medicines. The purpose of this study was to determine the requirements and procedure for presenting justification of homeopathic medicines safety in the registration dossier in accordance with the documents of the Eurasian Economic Union and the European Union. According to the current Russian and foreign regulatory approaches the safety may be justified by scientific literature data on homeopathic use and by substantiation of the dosage in the case of medicines that have long experience of safe use and those that are authorized under a simplified procedure based on a dossier with a product instruction that does not establish indications for use. In both cases, there is no need to provide the results of preclinical or clinical studies of the drug. This approach reflects specific features of homeopathic medicines. An objective criterion of the safety of homeopathic medicines is the assessment of the dosage of active substances, taking into account the «first safe dilution» of homeopathic substances. A formal safety justification using registration data for similar drugs or additional information on the use of these pharmaceutical substances in homeopathy is also possible, but may be insufficient. The completeness and proper documentation of bibliographic data are the main criteria for an appropriate rationale for the safety of homeopathic products.

Bacterial vaginosis (BV) is the most prevalent lower genital tract disease in women of reproductive age (both pregnant and non-pregnant) and the most common cause of vaginal discharge and foul odor from the genital tract. To date, there is a lot of literature describing many different approaches to the diagnosis and treatment of BV during pregnancy. BV is common, and its precise prevalence varies widely depending on the patient population. Studies confirm that the prevalence of BV among pregnant women is the same as in the population of non-pregnant women, and ranges from 6 to 32%. The link between BV and a patient’s ethnicity, smoking, sexual behavior and douching was established. BV is more prevalent among African American women, smokers, sexually active women compared to virgins and those who use douching. Diagnosis of BV is based on clinical symptoms and the results of microbiological examination. Diagnostic criteria are the same for pregnant and non-pregnant women. If BV is confirmed, treat-ment is indicated. In most international guidelines on sexually transmitted infections, the use of either metronidazole 500 mg orally 2 times a day for 7 days, or clindamycin 300 mg orally 2 times a day for 7 days are recommended for the prevention of adverse obstetric outcomes. BV is considered as the risk factor for adverse obstetric outcomes, such as premature birth, premature rupture of membranes, spontaneous abortion, chorioamnionitis and postpartum infections, such as endometritis and infectious compli-cations in the area of the postoperative wound after cesarean section. Pregnant women with symptoms of BV are advised to be screened and treated to eliminate the symptoms. Treatment with oral or local antibiotics is acceptable to achieve recovery (cure) in pregnant women with a symptomatic course of BV and a low risk of adverse obstetric outcomes. Women without symptoms of BV and women without identified risk factors for preterm birth should not be routinely screened and treated for BV, while patients with an increased risk for premature birth may benefit from routine screening and treatment for BV.

Lack of physical activity (PA) is considered as one of the risk factors for a number of chronic non-communicable diseases. The sedentary lifestyle of a significant part of developed countries population, along with the insufficient effectiveness of traditional tools to stimulate the PA of the population, determine the interest of healthcare in optimizing urban space for increasing PA. In Russia, the number of studies in this area is extremely small, which determines the purpose of this review: presentation of the foreign results of the implementation of practical concepts and programs for optimizing urban space, as well as prospective studies that demonstrate the most evidence-based causal relationships of PA changes. Focus in prevention of diseases in Russia over the past decade, determines the scientific interest in risk factors, the features of its formation, and possible ways of implementation. In this regard, the results of such topics will be in demand by Russian health care, which will require the conduct of own Russian studies, taking into account foreign experience.

Introduction.. The main purpose of pre-university educational institutions of the Ministry of Defence ofRussia, e.g. Suvorov Military Schools, Nakhimov Naval Schools, presidential schools and cadet corps, is to educate graduates, who are highly motivated and sufficiently prepared for military vocational activities, including graduates’ general physical fitness. Successful performance of the task is complicated by the fact that educational process in such organisations has a general educational orientation, which is common for the entire system of school education. However, it is obvious that the specifics of the mission of preuniversity educational institutions of the Ministry of Defence of the Russian Federation requires more intensive physical activities, which improve health and increase physical endurance of students, taking into account their age-specific physiological characteristics. In this regard, it is necessary to develop a variable methodological block as a supplement to an invariant part of the main programme of physical culture, which will be aimed at stimulating the development of motor and power capabilities, skills and professionally significant qualities of future military personnel.The aim of the research was to select and scientifically justify the introduction of appropriate and effective means for high-school students’ physical education in pre-university educational institutions of the Ministry of Defence ofRussia.Methodology and research methods. To identify the appropriate ways of solution of the problems of profile physical education of potential officers at the stage pre-professional development, the methodological framework was based on the theory of physical culture and sport, individually-modular approach to the development of the system of professional and applied physical training, its principles and regularities, conceptual provisions of health preservation in adolescence and youth. In the course of the research, the authors thoroughly studied the scientific and methodological sources, regulatory and legal base of the organisation of educational process, questions of its planning and control of all forms and activities of students’ physical training in military schools. The following methods were applied: interview, pedagogical observation, questionnaire survey, technique of entrance and final testing of selection of the research participants, formative experi ment, monitoring, comparative analysis and systematisation of indicators (resultant scores) of sports achievements of examinees. Experimental data were processed by the methods of mathematical statistics.Results and scientific novelty. The selection of means of physical training in pre-university all-service military and naval educational institutions was made on the basis of theoretical and statistical material of analytical review and collected empirical data and pedagogical experience in 17 pre-university educational institutions of the Ministry of Defence of Russia (n = 607). The list of the most productive means is made. The quantitative ratio of military-applied methods, which positively influence the system of physical training in the 10th-11th grades, is established. The pilot testing showed that systematic use of special training exercises of military-applied orientation significantly improves the indicators of physical training of students. The analysis of students’ questionnaires before and after the experiment revealed strengthening of students’ moral stability, growing interest in military science and motivation to studying of an applied training material, as well as significant increase in the number of applicants seeking to continue their training in higher educational institutions of the Ministry of Defence of the Russian Federation and to dedicate their lives to military service. The proposals and practical recommendations on purposeful introduction of complexes of specialised physical exercises and elements of disciplines of military-applied sports to educational process are formulated.Practical significance. The results of the research can be employed to plan and organise physical training of high-school students of pre-university educational institutions of the Ministry of Defence ofRussia as additional programme and methodological support at the initial stage of military-applied physical training of future military specialists.

The results of the study on post-traumatic stress rates and individual indicators arising in response to the diagnosis of a life-threatening disease are being analyzed. The participants of the study are the patients of Burdenko National Medical Research Center of Neurosurgery, Ministry of Health of the Russian Federation (n = 25) diagnosed with meningioma. It has been shown that one of the psychological consequences of the diagnosis of “meningioma” is post-traumatic stress of different intensity rates. Increased depression, shyness and emotional lability are associated with high post-traumatic stress rates. The comparison of the triad of emotional-personal characteristics, social support indicators (according to the Psychological Safety Questionnaire) and basic assumptions (according to the World Assumptions Scale) made it possible to verify the research hypothesis. It has been revealed that high rates on depression and shyness scales (according to the Freiburg Personality Inventory) do not reflect the tendency to avoid social contact, but indirectly indicate the presence of auto-aggression or introverted orientation directed to oneself in people diagnosed with this disease.

This study is devoted to psychologically mediating the social structuring of health. According to theoretical views, which have not yet received a convincing justification, the decline in the social status of an individual is accompanied by the loss of the psychological resources necessary to overcome the difficulties of life and the stresses caused by them, which leads to deteriorating health in the lower social strata. The verification of this assumption was carried out using data from the European Social Survey — representative surveys of the population of 27 countries conducted in 2012–2013. Studying indirect psychological effects has demonstrated that in many of these countries such a psychological characteristic as self-efficacy is indeed a mediator of the social structuring of health, especially prominent in many post-communist societies, but not in the most developed western countries where mediating effects turned out to be weak or completely absent. A two-level analysis of psychological mediation, depending on the factors of the economic well-being of countries, the development of a social state and cultural identity, does not support the assumption of the importance of an individualistic culture for the manifestation of mediation, and convincingly demonstrates that indirect effects are related to the social and economic context. In countries with a strong economy and social state, the distribution of psychological resources is barely related to the social structure — the relative well-being of the lower social strata, due to the developed system of state social guarantees, allows for many of them to maintain self-respect and optimism. Psychological resources, the distribution of which does not reflect social stratification, lose the role of a mediator. In the less developed part of Europe, where the lower strata cannot rely on comprehensive government assistance, the hardships of life and the stresses they generate lead to a loss of faith in themselves and in the possibility of changes for the better among people with low status, resulting in psychological resources acting as a mediator of health social structuring.

The technique of studying of processes of stigmatization of victims in emergency is insufficiently developed now and is based on results of practical observations of certain experts and methodical adaptations. Surveying features of internal and external stigmatization which is traumatic for victims and leads to weighting of experiences, negative development of the cognitive scheme "I-in-the-event", its dynamics, the authors define them as the adverse prognostic moments in a psychotherapy of the studied category of persons. In the article there is made an attempt of survey systematization of a series of social and demographic and environmental factors which have to be known to the expert working with the victim in emergency that in due time and precisely to diagnose character of consequences of a psychological trauma, to prognosticate the course of post-stressful disorders and to plan psychocorrectional influence. There are selected the characteristics of victims in emergency (an invalidism and traumatization, age, gender factors, education level) having significant effect on stigmatization development. The author analyses some of the problems arising during a psychotherapy of patients with stigma, defines the factors increasing probability of a delay with the request for the specialized help or refusal of therapy.

In this article the authors consider the phenomenon of stigmatization as one of the unfavorable socio-psychological results of emergency situations raising the level of personality vulnerability though not studied enough so far. A study was made to reveal stigmatization with relation to persons who had suffered from emergency situations, among the inhabitants of the two regions exposed to terroristic attacks: that of North Ossetiya (the town of Beslan and the city of Vladikavkaz) and the Central Region (the city of Moscow). Analysis of the obtained data permitted one to make a conclusion of the presence of signs of stigmatization in both groups of respondents, of insufficient awareness in society of the specificities of individual forms of response to stress, of manifestations of post-stress mental disorders, as well as a transfer of social stereotypes related to persons with mental disorders to the victims. Socio-demographic factors causing outward stigmatization have been defined. A degree of expression of stigmatization tendencies depends on a respondent’s social status as well as on the past traumatic experience.

The article presents a study of the impact of social capital on the mental health of the region’s population. The author considers social capital through indicators of interpersonal interaction and entry into social networks. The empirical base was the data of a sociological survey of the population of the Vologda Oblast. The methods of comparison, generalization, factorial and cluster analysis were used. The study revealed two options for the structure of social networks. In the first version, residents of the region communicate closely with their relatives and friends - almost every day. The second option corresponds to the structure of social networks, characterized by low communication activity – once a month or less. The method of factor analysis identified 5 latent variables characterizing the inclusion in the social networks of the region’s population. This is the "far circle of social support", "the inner circle of support", the psychological basis for entering social networks; activation of social networks; exclusion. Based on the latent variables identified, residents of the region were divided into three groups. These groups also differ in subjective assessments of health. It was determined that interpersonal alienation in the form of inactive communication and the lack of social support are associated with more frequent manifestations of negative mental states in the form of anxiety, depression, neurosis., В статье представлены результаты исследования влияния социального капитала на состояние психического здоровья населения региона. Социальный капитал рассматривается через показатели межличностного взаимодействия и вхождения в социальные сети. Эмпирическое исследование проводилось с помощью социологического опроса населения Вологодской области с использованием модели многоступенчатой районированной выборки с квотным отбором единиц наблюдения. При помощи факторного анализа выявлено 5 латентных переменных, характеризующих включенность в социальные сети населения региона, выявлены варианты структуры социальных сетей. С помощью кластерного анализа на основе выделенных латентных переменных жители области разделились на три группы, которые различаются и по субъективным оценкам здоровья. Определено, что межличностное отчуждение в виде малоактивного общения и отсутствие социальной поддержки связано с более частными проявлениями негативных психических состояний в виде тревоги, депрессии, невроза.

The article presents the results of a personality characteristics study of orphans and children left without parental care growing up in an orphanage. It is assumed that examined personality characteristics have an effect on the socialization and integration processes after graduating from the orphanage. The paper gives a comparative analysis of personality characteristics in 18 boys and 14 girls aged from 12 to 17 years in orphanages, as well as finds out the personality characteristics undermining the developing of child’s proactive attitude. The study used a children's version of "Individual typological questionnaire" by L.N. Sobchik and Cattell 14 PF method of multivariate personality study. Statistical significance of the results is due to Mann–Whitney U test and Student t-test for nonrandom access. Cattell 14PF study shows that boys and girls in the test groups have personality differences (p≤0.05). A pattern of the results may indicate a general trend of personal characteristics negatively affecting the success of adaptation after graduating from the orphanage.