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Palliative care for neurological patients is an approach to patient care and assistance to their families facing chronic, progressive, life-limiting and disabling conditions. The peculiarity of palliative care in neurology is due to the signifi cant duration of the late stages of many neurological diseases and the distinctive features of some diseases (cognitive disorders, mental disorders, speech disorders, pelvic organ dysfunction, paresis, convulsions, contracture development, etc.), as well as the presence of concomitant common symptoms (eating disorders, pain, bedsores, respiratory failure, etc.). The symptoms developing in the advanced stages of neurological diseases requiring palliative care are described. Drug and non-drug methods of treatment are described, measures aimed at improving the quality of life and preventing complications are considered. The features of pharmacotherapy, taking into account their interaction with drugs for the treatment of concomitant pathology, are considered.

Introduction. The problem of forming a healthy lifestyle among the adult population - working citizens of our country remains relevant and has not yet been resolved. The purpose of the study is to identify psychological attitudes towards a healthy lifestyle among workers of an industrial enterprise. Methods. The empirical study was carried out on the basis of a large Russian industrial enterprise. 300 production workers were interviewed: 150 representatives of working professions (production personnel) and 150 specialists working in offices (office personnel). The diagnostic tools included a specially designed questionnaire to identify the level of formation of a healthy lifestyle, as well as valid and reliable methods: 1) Health Attitude Index (S. D. Deryabo, V. A. Yasvina); 2) Scale of psychological stress psm-25 Lemur-Tessier-Fillion. Statistical methods included percentage and frequency distribution, comparative analysis with the calculation of Student's t-test. Results. An insufficient level of formation of a psychological attitude towards a healthy lifestyle was revealed among both production and office personnel. It has been established that, despite the high value of health, only 10% of workers and 12% of specialists adhere to the principles of a healthy lifestyle. Among the factors influencing health, passive factors independent of the respondent (ecology, heredity, healthcare system) are more often noted. Among corporate practices, preference is given only to those that are associated with full or partial material compensation for actions. Conclusions. Due to the low level of formation of a psychological attitude towards a healthy lifestyle of workers in industrial enterprises, it is advisable to diversify and expand the corporate practices of improving the health of the personnel of organizations with the practices of their psychological support, focused on increasing the level of motivation to comply with the rules of a healthy lifestyle and developing the need for it.

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.Проблемы лицензирования и лицензионного контроля медицинской деятельности в Российской Федерации связаны с фундаментальной обязанностью здравоохранения - соответствовать федеральным нормам безопасности, качества и доступности. Внедрение в деятельность учреждений медико-социальной экспертизы Российской Федерации специального диагностического оборудования и обязательность его использования с 2022 г. для экспертных нужд стало временем ответа на вопросы: каковы требования безопасности и качества при проведении работ с использованием специального диагностического оборудования; должны ли измениться организационная и управленческая схемы деятельности учреждений медико-социальной экспертизы; новый ли это уровень развития медико-социальной экспертизы или расширение компетенций функциональной диагностики; стоим ли мы у истоков нового вида медицинской деятельности и много ли в этом нового? Ответы на эти вопросы не следует ожидать от будущего, подвергая риску в период неопределённости и поиска путей решения жизнь и здоровье пациентов, а целесообразно искать в истории отечественной медицины и науки, их лучших практиках, адаптируя их под строгое соответствие правового поля нашей страны дня сегодняшнего.

Introduction. The specifics of the professional activity of medical workers in the context of the COVID-19 pandemic, in the presence of stressful factors of production situations, negatively affects the professional profile of specialists and leads to the opportunity of a professional crisis. Purpose. To identify the features of the profile of the professional crisis of medical workers with professional deformities in the context of the COVID-19 pandemic. Materials and methods. The study conducted on 816 medical workers with occupational deformities included questionnaires on the personality profile of the crisis by A.E. Taras and on burnout by C. Maslach & S. Jackson, K. Pearson’s correlation criterion, descriptive statistics and Chaddock’s table to reveal the tightness of correlation processes. Results. The main features of the profile of the professional crisis of medical workers with deformities in the professional field include a high level of functional disorders of cardiac activity and the activity of the gastrointestinal tract; functional disorders of breathing, autonomic system, thinking, sleep; symptoms of anxiety and increased emotionality; attempts to escape from problems, and depressive mood coloring. Limitations. When studying the characteristics of the profile of the professional crisis, a psychodiagnostic study was conducted using the author’s methods on a sample of 816 voluntarily participating medical workers with professional deformities in the context of the COVID-19 pandemic, which is a sufficient reference sample. Conclusion. In the context of the COVID-19 pandemic, the grading of deformations in the professional field of medical workers will contribute to: normalization of the activity of the autonomic, respiratory and cardiovascular systems, and the gastrointestinal tract; harmonization of the sleep-wake cycle; reduction of depression, attempts to escape from problems, tension, complications of thinking, anxiety.

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.В статье описано представление о здоровье и болезнях в различные исторические эпохи. В зависимости от исторического периода имеет место различный объём информации о медицине, включая болезни и концепцию здоровья, что обусловлено количеством археологических и документальных свидетельств. Длительное время представления о здоровье были тесно связаны с религией. Гиппократ и другие учёные Древнего мира как основу здоровья определяли состояние равновесия четырёх основных жидкостей. По мере развития анатомии, физиологии и медицины развитие болезней рассматривалось как повреждение анатомических структур и нарушение их функций. В XIV-XV вв. появилось направление, рассматривающее влияние общественных и социальных факторов на здоровье человека. В XIX в. идеи здоровья и болезни, основанные на физиологических и анатомических исследованиях, получили дальнейшее развитие. Немецкая анатомическая школа сопоставила концепцию здоровья и патологию человека, связала развитие заболеваний с изменениями в клетках. В течение XX в., с одной стороны, медицина становилась всё более молекулярной и субмикроскопической; с другой стороны, возобновилось глобальное внимание к людям - как здоровым, так и больным, что породило синергетические, многогранные определения здоровья. Всемирная организация здравоохранения в 1946 г. сформулировала определение здоровья как «состояние полного физического, психического и социального благополучия, а не просто отсутствие болезней или физических дефектов». В дальнейшем эта концепция неоднократно подвергалась критике, т. к. рассматривала здоровье в качестве идеала и приближала к понятию счастья. На сегодняшний день очевидно, что здоровье является многофакторным понятием и, помимо медицинской составляющей, тесно связано с другими сферами жизни человека: социальной, экологической, культурной, экономической, политической.

Progressive increase in the proportion of elderly patients in the population of many countries actualizes the issues of preserving physical and mental health, working capacity and quality of life of retirees. As a part of preventive geriatric rehabilitation, ‘the Active Longevity’ program has been operating in many cities of Russia over the past three years, one of the aspects of the program is the involvement of elderly patients in active life, including an increase in physical activity. This study included 744 patients who attended face‑to‑face physical training sessions. According to the results of the survey, 41% of pensioners noted an increase of daily physical activity, 94% reported an improvement in health and mood, the level of total blood cholesterol decreased. Almost all patients, both with and without clinical and subclinical manifestations of anxiety and depression, reported a good and very good mood immediately after exercise. Increasing physical activity in elderly patients improves the quality of life and prolongs its duration, and is also an effective method of non‑drug treatment of anxiety‑depressive disorders.

Introduction The COVID-19 pandemic is associated with the spread of conspiracy theories, which are heterogeneous in terms of the structure of their views The hypothesis is that the substrate for the spread of conspiracy trend is an increased level of anxiety, reduced due to the paralogical (conspiracy) interpretation of events The purpose of this research was to study the prevalence of conspiracy trends during the preparation for the COVID-19 pandemic in Moscow (before the introduction of strict restrictive measures) Methods: 320 people, randomly selected from the general population, were asked if they agree or disagree with 9 statements regarding the conspiracy interpretation of events, compared with the level of anxiety/depression (using the HADS scale) There are 3 trends (COVID-conspiracy, COVID-skepticism, COVID-obscurantism) Results: 45 7% of respondents were ready to agree with one or the other conspiracy idea I The level of anxiety in all adherents of conspiracy theory was found to be higher than in the rest of the sample Differences in sociodemographic characteristics of adherents of different conspiracy tendencies are revealed Among COVID skeptics, there are significantly fewer students and pensioners, and among COVID conspiracy theorists, the level of education received is lower, with unstable labor and family status Discussion Conspiracy trends were universal for all social groups in the background of increased anxiety among the population of Moscow in preparation for the COVID-19 pandemic It is suggested that the mechanism for the development of conspiracy tendencies may be the process of rationalization of an increased level of anxiety as a protective response during a crisis © 2020 Izdatel'stvo Meditsina All rights reserved

At the end of 2019, a new coronavirus (SARS-CoV-2) was discovered in China, causing the coronavirus infection COVID-19.The ongoing COVID-19 pandemic poses a major challenge tohealth systems around the world. There is still little informationon how infection affects liver function and the significanceof pre-existing liver disease as a risk factor for infection andsevere COVID-19. In addition, some drugs used to treat thenew coronavirus infection are hepatotoxic. In this article, weanalyze data on the impact of COVID-19 on liver function, aswell as on the course and outcome of COVID-19 in patients withliver disease, including hepatocellular carcinoma, or those onimmunosuppressive therapy after liver transplantation.

Interest in chloroquine, and its analog with a more favorable safety profile - hydroxychloroquine, in 2020 is certainly associated with the outbreak of a new coronavirus infection, SARS-CoV-2. The high pathogenicity and lack of specific immunity in the population caused the rapid spread of infection with an extraordinary increase in the burden on the health systems of many countries. In such conditions, it was necessary to quickly find and implement effective methods of treatment and prevention. One of the most promising candidates for this role was hydroxychloroquine, as a multi-purpose drug with a well-studied safety profile and a rich history of use. The article describes some historical stages of the study of chloroquine and its derivatives starting from the 19th century and ending in 2020. The experience of its use for the treatment of diseases such as malaria, rheumatoid arthritis, diabetes, bronchial asthma, photosensitivity and skin porphyria was reviewed. Separately, some historical aspects of its use for the treatment of viral and oncological diseases were considered. The bibliometric method used in this scientific work clearly demonstrates the dynamics of the changing interest of the scientific community in chloroquine and its derivatives. Chloroquine and its derivatives can definitely be attributed to «pharmaceutical centenarians» with an intense life that continues.

The characteristics of development of vascular lines are important for development and improvement of of surgical treatment, decreasing risk of complications and development of personalized approach to treatment of patients. The purpose of the study is to reveal prevalence of different variants of development of common carotid artery bifurcation and to assess their significance for clinical medicine. The sample included 70 volunteers of average age 43.4 ± 10.7 years. The 3D reconstructions of MRI data 1.5 T Brivo 355 were evaluated. The observation data was grouped and processed using software Microsoft Excel 2007 and IBM SPSS Statistics 20. To summarize the data, 5 main variants of location of great vessels were identified. The most rare types of development and course of carotid arteries in bifurcation area were variants "II" and "III" (8.2% of all observations). The most common development options were "I" (51.4%) and "IV" (31.4%). The variants "I" and "IV" were determined relatively evenly.The variants "II" and "III" were found on the right in 60% and 66.7% correspondingly and "V" option was found on the left in 61.5%. The typical options of location of carotid arteries near the bifurcation (variants "I" and "IV"), 82.8% in total. The cases of ventral position of external carotid artery (variants "II" and "V") were established in 12.9%. The variant III was found in 4.3% of all cases. The distribution of vascular development options depending on the gender of patients was investigated. The study did not reveal significantly pronounced deviations in distribution of variants of vascular development, taking into account the age factor. The mentioned data permits to judge with confidence about necessity of developing personalized treatment of diseases of carotid arteries, considering their anatomical features of development in bifurcation area.

The problems of professional advancement of medical personnel, their professional formation and professional career have enduring importance in connection with development and improvement of medical care system in any society. The purpose of the study is to investigate characteristics of influence of type of organizational culture of medical organizations on career orientations of medical personnel. The study covered sampling of 7 364 employees of medical organizations. The complex of psycho-diagnostic techniques was applied that permitted to examine prevailing type of organizational culture of medical organizations (The R. Harrison questionnaire adapted by S. A. Lipatov), preferences of medical personnel in building up their professional career (E. Schein questionnaire "Carrier Anchors"), and their concepts about competitive medical worker (semantic differential - 16 opposite personality characteristics). The statistical methods included standard procedures of primary mathematical processing of empirical data (frequency and percentage distribution, calculation of mean group indices, standard deviation and dispersions), comparative analysis using Student's test (correctness of criterion application was checked by the Libya test), Spearman correlation analysis. It is established that under developed organizational culture of medical organization, its orientations towards task and personality, with team cohesion and high level of value-orientated unity of their members, medical workers have consistency of concepts concerning career and a unity of career orientations targeted to professional competence and service to other people that determines quality of medical care.

The COVID-19 pandemic poses new challenges for the health sector, related to the organization of medical rehabilitation of patients with COVID-19. Special attention is required for patients after artificial ventilation, who have a high risk of developing physical, mental and cognitive disorders. There are acute post-ovoid syndrome lasting more than 3 weeks and chronic-lasting more than 12 weeks after discharge from the hospital. The most common symptoms are: shortness of breath, fatigue, anosmia, ageusia, myalgia, feeling of fever, tightness in the chest, tachycardia, headaches, anxiety, memory loss, sleep disorders, difficulty concentrating. The article presents the stages of rehabilitation of patients with COVID-19. Dynamic monitoring, measures for the prevention of complications, organization and methods of rehabilitation, including physiotherapy procedures and physical therapy, are considered.

The article presents the results of a psychological study of patients with principal disabling pathologies that form the main structure of disability in the Russian Federation due to malignant neoplasms: diseases of the circulatory system; diseases of the musculoskeletal system and connective tissue; diseases of the endocrine system and metabolic disorders (diabetes mellitus of the first and second types). The article presents the results of studying a sample of patients by various psychological parameters, provides statistical comparisons of psychological characteristics of patients depending on the specifics of their social situation, in which patients either claim to be disabled and are under conditions of medical and social expertise, implying the possibility of changing social status, or patients of the same nosological categories, who do not claim to be disabled and who are rehabilitating on the basis of their own personal and socio-environmental resources outside of the "disabled" status. Psychological techniques are presented, the specificity of emotional and personal parameters is analyzed and characterized, including personality frustration and experience of the significance of the disease in the spheres of life, self-esteem indicators, identification characteristics, strategies that provide rehabilitation adherence, which characterize the activity of patients in the compared groups in many ways. The conceptual position that defines the activity of patients as «rehabilitative» has been substantiated. The results of the study revealed statistically significant differences in psychological indicators in the compared groups of patients rehabilitating outside the "disabled" status and patients claiming to be disabled. The indicators obtained in the study indicate that the personal self-regulation of patients rehabilitating outside the «disabled» status qualitatively differs from the self-regulation of patients claiming disability, in terms of stable self-esteem and belief in the ability to realize life in significant areas of social functioning, in the ability of perspective planning of the future, in active self-realization of social roles, active participation in interpersonal, leisure, professional, household and other spheres, high responsibility for one's health, against the background of stable emotional perception of the current social situation of the disease.

One of the main duties of the Russian Federation is to respect and protect the rights and freedoms of its citizens. In addition, the Russian Federation as a social state the activities of which are designed to provide a decent life and a high level of social protection for all categories of the citizens, without exception, by regulating social, economic and other spheres of society provides social support to all segments of the population, paying special attention to certain categories of citizens which, due to life circumstances or health conditions, need social assistance and special support from the state. The main massif in the category of socially unprotected layers of the population are people with physical disabilities. Comprehensive support for the above category of citizens is carried out, among other things, based on the decision of the medical and social examination. However, the current situation has greatly complicated the on-site examination of disabled people and predetermined the correspondence order as the only possible mechanism for medical and social examination during the coronavirus pandemic. Thus, in fact, conditions close to emergency sent medical and social expertise to the path of telemedicine.

The aim of the study was to study excessive daytime sleepiness (EDS) among the residents of Chuvashia. 2161 residents of the republic were interviewed (men - 1007, women - 1154) aged 18 to 70 (average - 36.5 ± 13.8 years old). The Epworth Sleepiness Scale and NoSAS test were used to assess the risk of obstructive sleep apnea syndrome (OSAS). Mathematical and statistical processing included descriptive statistics, one-way analysis of variance and calculation χ2-distribution. EDS was detected in 846 people (39.2%), without any gender difference and their place of residence. The respondents with EDS were older and had a larger body mass index. With age, the number of individuals with EDS rate increased, reaching the maximum in the age group of 61-70 years. EDS was more often observed in respondents with diseases, sleep disturbances, regular alcohol consumption, smokers, as well as snoring, respiratory arrest in sleep, increased blood pressure and/or treatment for it, and tiredness during the day. The probability of OSAS by NoSAS was determined in 295 people (13.7%), in 21.4% of men and 6.9% of women; EDS was present in 45.4% of the respondents with OSAS. The spread of EDS in the population makes it possible to recommend doctors of various specialties to pay attention to this act as well as to the described risk factors in patients as highly probable grounds for qualifying OSAS, its targeted diagnosis and treatment, as well as comorbid pathology.

The article deals with the problem of professional self-determination of persons with disabilities in the context of the transformational processes of the education system in Russia. The work consists of two semantic blocks. The first one provides a social analysis of the trial monitoring of accessibility and quality of inclusive higher education in Moscow, as well as in Belgorod, Lipetsk, Tambov and Tver regions. In addition, the educational needs of university applicants with disabilities in these regions are analyzed. The second part of the article reveals the main conceptual approaches to the organization of a system of professional and career guidance for students with disabilities in an inclusive university. The article also presents results of empirical psychological studies proving the importance of professional self-determination of students of the inclusive university as an integral goal of career guidance activities based on the coherent-synergetic approach developed by the authors.