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The objective of this study is to substantiate the system of indicators for assessing behavioral risk factors (tobacco use, alcohol consumption, detrimental diet patterns, lack of physical activity) and their impact on public health in the Russian Federation based on the authors’ methodology for assessing the impact of behavioral risk factors on the health of the adult population using the materials of the statistical survey of the health status of the population (conducted by Rosstat in 2021). For each risk factor, two main indicators were calculated: the prevalence of the risk factor and its impact on public health according to demographic characteristics. The scale of such a risk factor as smoking was assessed in terms of consumption of various types of tobacco and nicotine-containing products and the prevalence of nicotine addiction of varying severity. Alcohol consumption as a behavioral risk factor was assessed in the context of the relationship between the amount of consumption of various alcoholic products and the degree of health risk. The impact of a detrimental diet was estimated by the body mass index for overweight and obesity, with the account to the physical activity of Russian citizens. According to the authors, the proposed set of indicators and specific calculation results can be used to organize continuous monitoring of the prevalence of behavioral risk factors and their impact on the health of the population of the Russian Federation. As a result, a more effective response of the healthcare system and strengthening of interagency cooperation to reduce non-communicable diseases is possible.

In the context of rapid technological progress, the outlines of the prospects for the development of telemedicine technologies are becoming more and more clear At the same time, changes in the organizational, legal and economic spheres often do not keep up with technological changes This was especially evident in the conditions of the spread of the COVID-19 coronavirus The article contains an analysis of the features of telemedicine technologies application in modern conditions, prospects and obstacles that arise in this area В условиях быстрого технологического прогресса очертания перспектив развития телемедицинских технологий становятся все более явственными При этом изменения в организационной, правовой и экономической сфере зачастую не поспевают за технологическими изменениями Особенно наглядно это проявилось в условиях распространения коронавирусом COVID-19 В статье содержится анализ особенностей применения телемедицинских технологий в современных условиях, перспективы и возникающие в этой сфере препятствия

The article considers economic menaces of demographic crisis of human resources in Russia induced by annual reduction of able-bodied population by 1 million. It is demonstrated that one of causes of crisis are cascade reactions due to decreasing fertility by 1 million of children from the early nineties. The inadequacy of common solutions for normalizing of established situation is stated. The possibility of annual increasing of numbers of able-bodied population up to 700-800 thousand is substantiated the expense of decreasing of disability and mortality. The innovative strategy of prevention of non-infectious and occupational diseases is developed based on management of health reserves in individuals with high risk. To implement this strategy a four-stage system ofpersonalized prevention is proposed that is implemented by doctors in polyclinics and by medical social workers in health offices on-the-job places. The important role of trade unions in supporting collective and individual health-improving activities at enterprises.

In the Strategic Academic Leadership Program, the number of publications included in the 1% of the most cited ones in the Web of Science Core Collection database over previous 10 full years is used as an indicator of research potential of universities and scientific centers. The purpose of this study was to analyze the segment of Highly Cited Papers and Hot Papers on surgery using the Essential Science Indicators (ESI) analytical application. According to ESI data, relevant for March 2020, highly cited publications on medicine have formed 2.425 research fronts including 211 ones in surgery. We have analyzed the directions of researches in surgery characterized by the greatest number of citations.В Программе стратегического академического лидерства в качестве показателя научно-исследовательского потенциала вузов и научных центров использован индикатор «количество публикаций, входящих в 1% самых цитируемых за предыдущие 10 полных лет, в научных изданиях, индексируемых в Web of Science Core Collection».Анализ сегмента высокоцитируемых публикаций (Highly Cited Papers) и публикаций горячего цитирования (Hot Papers) по хирургии с использованием аналитического приложения Essential Science Indicators (ESI). Согласно данным ESI, актуальным на март 2020 г., в области клинической медицины высокоцитируемые публикации сформировали 2425 фронтов исследований, из которых 211 фронтов приходятся на хирургию. Выполнен анализ направлений исследований в области хирургии, публикации в рамках которых наиболее часто попадают в кластер высокоцитируемых.

The internationalized segment of manuscripts on surgery published in top-rated journals indexed in the Web of Science Core Collection (WoS CC) was analyzed. Presence of national publications in surgical journals of different quartiles was estimated. It was shown that 59.6% of surgical articles of Russian authors, indexed in the WoS CC, were published in high-ranking journals (Q1 and Q2). The number of such articles has been increased by more than 3 times (from 23 in 2010 to 86 in 2018) on the background of no growth in the fourth quartile. We formed a rating of national educational and academic organizations, which have made the greatest contribution to a portfolio of publications on surgery, indexed in Q1-Q2 quartiles of WoS CC, as well as in the segment of highly cited publications.Выполнен анализ интернационализированного сегмента публикаций по хирургии, размещенных в высокорейтинговых журналах, индексируемых в Web of Science Core Collection (WoS CC). Оценена степень присутствия публикаций российских авторов в изданиях, относящихся к различным квартилям в научной области Surgery. Показано, что 59,6% статей отечественных авторов в области хирургии, проиндексированных в WoS CC, опубликованы в высокорейтинговых журналах (Q1 и Q2) WoS CC. Число таких статей увеличилось более чем в 3 раза — с 23 в 2010 г. до 86 в 2018 г. на фоне отсутствия динамики роста числа публикаций в 4-м квартиле. Составлен рейтинг образовательных и академических отечественных организаций, внесших наибольший вклад в формирование портфеля публикаций по хирургии, проиндексированных в журналах 1—2-го квартилей WoS CC., а также в сегменте высокоцитируемых публикаций.

The photo time-keeping monitoring of working of 50 physicians of ultrasound diagnostic was carried out in 20 pilot territories with consideration for modern technical possibilities. The substantiation of the study was based on point 3 of the regulations of development and authorization of type labor standards, approved by enactment of the Government of the Russian Federation of November 11 2002 № 804 (legislation corpus of the Russian Federation, 2002, № 46, article 4583) and point 19 of the plan of actions («road map») «The alterations in sectors of social sphere directed to increasing of efficiency of health care», approved by the enactment of the government of the Russian Federation of December 28 2012 № 2599-p (legislation corpus of the Russian Federation, 2013, № 2, article 130; № 45, article 5863; 2014, № 19, article 2468). The results of study testify the necessity of development of normative documentation related to establishment of standards of load of endoscopy physicians concerning increasing of time spend to implementation of curative diagnostic examinations.

The purpose of the present research was to analyze the validity of the choice for biomedical disciplines fixed by the passport of the national project 'Science' for the following priority of the Strategy for the scientific and technological development of the Russian Federation: 'the transition to personalized medicine, high-tech medical care and health saving technologies ...'. We assessed the degree of relevance of this choice to great challenges facing the Russian Federation, as well as trends in the development of global biomedicine. The hypothesis of this study was the assumption that when determining priority areas it is necessary to proceed from the analysis and comparison of two arrays: the list of nosologies which account for the maximum morbidity, mortality, disability level of, primarily, the able-bodied population of Russia, and scientometric data identifying trends in the development of global biomedicine.Цель исследования - анализ обоснованности выбора биомедицинских дисциплин, закрепленных паспортом Национального проекта 'Наука' за приоритетом Стратегии научно-технологического развития Российской Федерации 'переход к персонализированной медицине, высокотехнологичному здравоохранению и технологиям здоровьесбережения, в том числе за счет рационального применения лекарственных препаратов (прежде всего антибактериальных)'. Дана оценка степени релевантности этого выбора большим вызовам, стоящим перед Российской Федерацией, а также тенденциям развития глобальной биомедицины. Гипотезой исследования явилось предположение о том, что при определении приоритетных направлений необходимо исходить из анализа и сопоставления двух массивов данных: перечня нозологий, на которые приходятся максимальная заболеваемость, смертность, уровень инвалидности прежде всего трудоспособного населения России, и данных наукометрического анализа, выявляющего тенденции развития глобальной биомедицины.

The article presents the results of analysis of indices of total morbidity of population of the Central Federal Okrug (CFD) of the Russian Federation in 2010-2017. The significant differences in indices of total morbidity between the CFD subjects in certain ICD-10 classes were established. The indices of total morbidity of population during study period (8 years) in the Central Federal District factually didn't altered, while dynamics of indices in other subjects was characterized by multidirectionality. The gap in levels of total morbidity of population in the subjects was significant: from 115,123.6 per 100,000 of population in the Kursk Oblast to 194,404.1 per 100,000 of population in the Orel Oblast. The significant difference in rates of increase/ decrease of indices is noted. Thus, in Moscow decrease rate made up to 10%, while in the Orel Oblast morbidity increased up to 13.1%. Besides, in 2017, the Orel Region took a leadership in rate of increasing of total morbidity in such classes of diseases as infectious and parasitic diseases (39.3%), diseases of blood and blood-forming organs (49.1%), diseases of endocrine system (59,1%), diseases of nervous system (26.8%), diseases of respiratory system (28.2%), diseases of musculoskeletal system (16%), malformations (56%). It is very likely that this trend developed under influence of demographic situation in the subject due to significant increasing of percentage of people older than able-bodied age. The city of Moscow occupies leading position in decreasing of rate of prevalence of diseases and last but one place in level of total morbidity being inferior only to the Kursk Oblast. Thus, in Moscow was noted the most significant decreasing of morbidity in classes of infectious and parasitic diseases (26%) and diseases of digestive system (20.6%). The diseases of blood and blood-forming organs (235.2 per 100,000 population) and mental disorders (2353.5 per 100,000 population) were registered the less. The main contribution into trends of increasing or decreasing of indices is made by persons aged 18 years and older (74.1%).

The feasibility of the key theses of the Draft Strategy for Scientific and Technological Development of the Russian Federation until 2035 is analyzed. These theses, related to the scope of R&D financing in the Russian Federation, investments from the national business sector, inventive activity in the knowledge generation sector, and R&D personnel productivity, are compared to the respective indicators in other countries. Attention is drawn to the fact that the resources to increase in the medium term the scope of state financing of the Russian scientific and technological sphere are exhausted and, hence, the only way to accomplish an increase in domestic R&D expenditure up to 1.77% of the GDP, planned by Presidential Decree no. 599, implies a sharp growth in extrabudgetary funds. Special focus is placed on the budget’s imbalance relative to the staff size, owing to which Russia has one of the lowest “domestic R&D expenditures per researcher” indicators among developed countries. It is concluded that the draft strategy erroneously considers as the main subject of the country’s scientific and technological development the scientist and research organization instead of the national business sector.

The article compares the prevalence of pathological changes in different organs and systems among city and rural residents of the next ages: elderly (60-74 years for men and 55-74 years for women), senile (75-84 years) and advanced (85 years and older) ages. The results of the continuous survey of all persons of the retirement age of one urban (7 809 people) and two rural areas (14 749) of the Nizhny Novgorod region were analyzed. The region is comparatively homogeneous in terms of the national composition of the population. In the city, the number of chronic pathologies of different organs and systems per one person of elderly age are: 2,83 for man and 2,76 for woman of elderly ages, 3,06 and 3,07 respectively for senile ages, 2,71 and 2,75 of advanced ages. In rural areas, the analyzed indicators for men and women are respectively 1,64 and 1,58 for elderly ages, 1,84 and 1,78 for senile ages, 1,86 and 1,84 for advanced ages. Demonstrating the difference in the phenotypic manifestations of the genes of predisposition to chronic diseases in old age between the city and village, the results make it possible to produce the following assumptions. First, better access to medical care does not guarantee the better health status of the elderly, while it contributes to an increase in the life expectancy of men. Second, in spite of better access to health care, urban lifestyle contributes to the accumulation of chronic diseases in population of a region. Third, if chronic pathology of three different classes of diseases presented, then the probability of a long life is fundamentally determined by the access to health care. Fourth, the probability of longevity is significantly reduced in result of illness by neoplasms, cardiovascular, respiratory, endocrine or genitourinary diseases in ages of working or beginning of retirement period.В статье проведено сравнение распространенности патологических изменений в разных органах и системах у жителей города и села пожилого (60–74 года для мужчин и 55–74 года для женщин), старческого (75–84 года) и преклонного (85 лет и старше) возраста. Проанализированы результаты сплошного обследования всех лиц пенсионного возраста одного городского (7 809 человек) и двух сельских районов (14 749) Нижегородской области, сравнительно однородной по национальному составу населения. В городе число хронических патологий разных органов и систем, приходящихся на одного пенсионера пожилого возраста, составляет 2,83 на одного мужчину и 2,76 на одну женщину, старческого возраста — 3,06 и 3,07 соответственно, преклонного возраста — 2,71 и 2,75. В сельских районах анализируемый показатель для мужчин и женщин пожилого возраста составляет 1,64 и 1,58 соответственно, старческого возраста — 1,84 и 1,78, преклонного возраста — 1,86 и 1,84. Демонстрируя различие фенотипических проявлений генов предрасположенности к хроническим заболеваниям в старости в городе и селе, полученные результаты позволяют сделать следующие предположения. Во-первых, лучший доступ к медицинской помощи не гарантирует лучшее состояние здоровья пожилых, однако способствует увеличению продолжительности жизни мужчин. Во-вторых, несмотря на лучшую доступность медицинской помощи, городской образ жизни способствует накоплению у населения региона хронических заболеваний. В-третьих, при наличии хронических заболеваний трех разных классов болезней вероятность долгой жизни принципиальным образом определяется доступностью медицинской помощи. В-четвертых, вероятность дожития до преклонного возраста существенно снижается в результате заболевания в трудоспособном или раннем пенсионном возрасте сердечно-сосудистыми патологиями, новообразованиями, болезнями органов дыхания, эндокринной и мочеполовой систем.

Aim. To analyze the statistical indicators of a local therapist's performance in the Russian Federation and its districts in the 2008-2012 period. Materials and methods. The authors analyzed staffing and understaffing in the federal districts with respect to the Russian Federation, a doctor's actual function and its deviation ratio, staffing of local therapists, secondary employment coefficient, and the total number of physician visits with the ratio of the number of home/polyclinic ones. Results. The staffing of local therapists was steady-state in the country as a whole in the period analyzed. At the same time, there was a decline in staffing. The performance of doctors everywhere is greater than the recommended one since 2009. There was a reduction in the number of visits to local therapists in both the country as a whole and its regions, with more visits being made by rural dwellers. Conclusion. The current approach to the standards for the load and number of physicians should determine needs for specialists of this profile and become a major part to solve the problem of delivering available and high-quality primary outpatient care to the population of Russia.

Background No data exist on obesity or the accuracy of body mass index (BMI) in Russian Federation firefighters. Aims To determine the prevalence of obesity and rates of misclassification of BMI-based obesity status. Methods Career firefighters in the Moscow region completed anthropometric assessments including height, weight, BMI, body fat per cent (BF%) and waist circumference (WC). Using these three methods, we defined obesity as BMI ≥30, BF% >25 and WC >102, respectively. Results The study group consisted of 167 male firefighters. Obesity prevalence was 22% for BMI [95% confidence interval (CI) 16.9-28.5], 60% for BF% (95% CI 52.5-67.3) and 28% for WC (95% CI 21.3-34.9). False positive rates for BMI-based obesity status were low, with 3% (95% CI -1.1 to 7.1) and 6% (95% CI 1.6-9.9) of non-obese participants defined by BF% and WC standards misidentified as obese using BMI. However, 65% (95% CI 55.7-77.4) of BF%-defined obese participants and 36% (95% CI 22.5-49.9) of WC-defined obese participants were misclassified as non-obese using BMI (i.e. false negatives). Conclusions Rates of BMI-based obesity in Russian male firefighters were similar to that of males in the general Russian adult male population. Compared with BF% or WC standards, BMI-based obesity classi- fication produced low rates of false positives but demonstrated high rates of false negatives.

During 2012-2018 in the Russian Federation, pursuant to Presidential Decree No. 599 of 05.07.2012, a set of state support measures was implemented aimed at increasing the specific gravity of Russian publications indexed in international databases. The national project 'Science' (NPS) designed to realize the goals set by Presidential Decree No.204 of 05.07.2018 'On the National Goals and Strategic Tasks for Development of the Russian Federation until 2024' continues and develops the theme of increasing the publication activity of the Russian Federation in the internationalized space. One of the six NPS targets is 'The place of the Russian Federation in terms of specific gravity in the total number of articles in areas defined by the priorities of scientific and technological development in publications indexed in international databases'. The purpose of this study was to evaluate the basic value of this indicator for biomedical disciplines related to the priority direction (paragraph 20c) of the Strategy for Scientific and Technological Development of the Russian Federation. We compared volumes of publication flows of the Russian Federation in 20 biomedical disciplines with a similar indicator of countries ranked fifth in the number of publications on the subject area under consideration, indexed in the Web of Science Core Collection (WoS CC). A 5-10 fold lag of the Russian Federation was recorded for the most part of the priority areas in the field of biomedicine identified by the NTS passport. The impact of public policy measures aimed at increasing the national biomedical publication stream for the period of 2012-2018 was estimated as insufficient to meet the considered NTS target.В течение 2012-2018 гг. в Российской Федерации во исполнение Указа Президента #599 от 07.05.12 был реализован комплекс мер государственной поддержки, направленных на увеличение удельного веса российских публикаций, индексируемых в международных базах данных. Национальный проект 'Наука' (НПН), призванный реализовать цели, обозначенные Указом Президента #204 от 07.05.18 'О национальных целях и стратегических задачах развития Российской Федерации на период до 2024 года', продолжает и развивает тему увеличения публикационной активности РФ в интернационализированном пространстве. Одним из шести целевых показателей НПН является 'место Российской Федерации по удельному весу в общем числе статей в областях, определяемых приоритетами научно-технологического развития в изданиях, индексируемых в международных базах данных'. Цель исследования - оценка базового значения этого показателя для биомедицинских дисциплин, отнесенных к приоритетному направлению 20-в Стратегии научно-технологического развития РФ. Сопоставлены объемы публикационных потоков Российской Федерации по 20 биомедицинским дисциплинам с аналогичным показателем стран, занимающих 5-е место по числу публикаций в рассматриваемой предметной области, индексируемых в Web of Science Core Collection (WoS CC). Зафиксировано 5-10-кратное отставание Российской Федерации по большей части выделенных паспортом НТН приоритетных направлений в области биомедицины. Результативность мер государственной политики, направленных на увеличение отечественного публикационного потока по биомедицине за период 2012-2018 гг., оценена как недостаточная для выполнения рассматриваемого целевого показателя НПН.

Socio-political changes over the past 30 years have led to important changes in the mortality of the Russian population. The largest variations were observed in death rates due to preventable causes, which depend on the conditions and way of life of the population as well as on the quality of health care. We show that now that mortality rates are declining, government measures to protect public health are more important for improving the demographic situation than efforts to increase the income of the population. Expenditure on the protection of public health is greatest in regions with a high level of economic development, but they do not necessarily lead to the reduction of mortality from preventable causes. Avoidable mortality depends not only on the level of poverty in a region, but also on other factors: climate, the economic way of life, the level of property stratification of the population and the intensity of regional economic development. The analysis of the heterogeneity of avoidable mortality in Russia is of interest not only for Russian researchers. Data on mortality in Russia may be used as a testing ground for studying the various factors that influence mortality. The wide range of changes in mortality on different scales permits us to analyze trends which are weaker and less noticeable in countries with a smaller population.

Based on profound analysis of medical supplies, morbidity, work conditions and work safety during this period of economic reforms in Russia, the authors justified priority directions, goals and tasks of health care system in protection and improvement of workers' health state.

To analyze the statistical indicators of a local therapist's performance in the Russian Federation and its districts in the 2008- 2012 period.The authors analyzed staffing and understaffing in the federal districts with respect to the Russian Federation, a doctor's actual function and its deviation ratio, staffing of local therapists, secondary employment coefficient, and the total number of physician visits with the ratio of the number of home/polyclinic ones.The staffing of local therapists was steady-state in the country as a whole in the period analyzed. At the same time, there was a decline in staffing. The performance of doctors everywhere is greater than the recommended one since 2009. There was a reduction in the number of visits to local therapists in both the country as a whole and its regions, with more visits being made by rural dwellers.The current approach to the standards for the load and number of physicians should determine needs for specialists of this profile and become a major part to solve the problem of delivering available and high-quality primary outpatient care to the population of Russia.Цель исследования. Анализ статистических показателей работы участкового терапевта в Российской Федерации и федеральных округах за период с 2008 по 2012 г. Материалы и методы. Анализировали обеспеченность и коэффициент отклонения обеспеченности специалистами в федеральных округах по отношению к Российской Федерации, фактическую функцию врачебной должности и ее коэффициент отклонения, укомплектованность участковыми терапевтами, коэффициент совместительства и общее число посещений врача с удельным весом посещений на дому и в поликлинике. Результаты. Показатель обеспеченности участковыми терапевтами в целом по стране за анализируемый период был стабильный. При этом отмечалось снижение укомплектованности специалистами. Функция врачебной должности повсеместно выше рекомендованного начиная с 2009 г. Отмечено снижение посещаемости участковых терапевтов как в целом по стране, так и в регионах на фоне роста посещаемости сельскими жителями. Заключение. Современный подход к нормам нагрузки и нормативам численности определил бы потребность в специалистах данного профиля и стал бы основной частью в решении проблемы оказания доступной и качественной первичной амбулаторной помощи населению России.

The statistics of population health and development of public health system is incomplete. Mortality values can be analyzed for 5-year intervals, while morbidity is represented for the following age groups: children, adolescents, adults aged 20-39 and 40-59 years. The authors suggest revising the structure and volume of statistical data on morbidity with regard for age and sex for 5-year intervals, which will help more reliably and correctly solve modern problems of public health.

The need to reform health care in Russia became evident in the late 1980s when due to socioeconomic crisis, the government could not cover the expenses connected with this field and put the up-to-date expensive technologies into life. The introduction of the compulsory health insurance system (CHIS) is aimed at: 1) obtaining an additional financial source for health care by making the goal-oriented stable rates of deductions from the wage fund; 2) protecting the Russian Federation citizens' rights to have free medical aid of the guaranteed scope; 3) enhancing the quality of medial care delivered to the population by introducing a mechanism of movement of funds paid for a patient; 4) paying for medical care in relation to the volume and quality of the work done by simultaneously controlling the stipulated use of funds. Three-year experience of CHIS in Russia has indicated that there is a real mechanism of reformation and government regulation of health care under the conditions of transition to the market, with the interests of the general population and medical personnel in mind. Obvious legal, organizational, technological, and psychological problems and disadvantages have been found at all management levels, which are an obstacle in the way of the reforms and which whip up social tension and call for prompt decisions.

Morbidity assessed from consultation rate is one of the most important dynamic characteristics of population health. Hence, public health system financing should be directly related to the value of total morbidity parameters. A method for calculation of an insurance payment is presented, based on the existing morbidity. This method permits correction of the sum of an insurance payment with consideration for the scope of a local program of obligatory medical insurance.