Problemy sotsial''noi gigieny i istoriia meditsiny / NII sotsial''noi gigieny, ekonomiki i upravleniia zdravookhraneniem im. N.A. Semashko RAMN, AO ''Assotsiatsiia ''Meditsinskaia literatura''最新文献

The departmental medical organizations (university clinics, Federal research clinical centers) are important for medical care of population, but their spatial and profile distribution is poorly examined. To integrate them into regional health care systems comprehensive analysis is required. Materials and methods. The frequency and robust statistical analysis of distribution of head offices of the Minobrnauka of Russia providing medical care according Federal Okrugs, organizational legal forms and profile categories was carried out on the basis of data from the Federal forms of statistical observation and the register of licenses. The analysis revealed significant territorial and profile disparity in the departmental network. The typical Federal Okrug had median of ≈5.5 organizations at median of licensed objects of ≈27 (≈3 per organization) that corresponds to scenario of "spot" principal players. The budgetary institutions (≈84.8%) with median of ≈4 prevailed as against ≈1 for autonomous ones. The medians by levels of care were: I≈2, II≈1, III≈1 with wide IQR for level III that confirmed concentration of high-tech medical care. The therapeutic, surgical and laboratory diagnostic profiles dominated. The network of medical organizations of the Minobrnauka of Russia consists of "spot" centers with concentration of high-tech medical care in particular Federal Okrugs. Their integration with Regions, load monitoring and development of primary medical care is needed.

Among challenges and menaces related to losses of human potential in rural areas, it is necessary to note decreasing of population and its aging, higher percentage of migration of residents from rural areas, higher mortality of rural population than urban one, decreasing of natality in rural areas. The life expectancy of rural population is lower than of urban population. The lower indicators are noted in rural males who live no longer than 67 years. The lower rates of new-onset and general morbidity were established in rural population that is related to poor exposure of diseases, inadequate dispensarization and preventive activities in rural areas. These predicaments are conditioned by limited medical care accessibility in rural settlements and remoteness from medical organizations. The comparison of general morbidity of rural population in the Russian Federation before the COVID-19 and during the pandemic determined increasing of general morbidity in 2023 up to 3.3% for certain classes of diseases that require patient rehabilitation, increasing of dispensary work and activation of prevention activities. The challenges to health care system and losses of human potential are be taken into account under elaboration of Federal and municipal programs in rural health care programs in conditions of counteracting risks of menaces to rural population health, as well as for development and making management decisions at the Federal, regional and municipal levels.

The article considers studies of health of elderly population as major element of global stability in conditions of impetuous demographic aging covering countries of the Global North and developing countries. It is noted that by 2050, the share of the elderly will exceed 20% of world population that requires reconsideration both national and international strategies in health care, social care, economics and political sustainability. The health of the elderly is considered both in medical terms and in broad social political context as resource maintaining fiscal resilience, decreasing epidemiological risks, strengthening solidarity of generations and forming inclusive societies. The article analyzes leading international initiatives, including the WHO program "The Decade of Healthy Aging", the UNDP and the UNFPA projects, regional strategies of the EU, ASEAN and other organizations. The key structural barriers are identified preventing implementation of such programs i.e. global inequality in access to medical services, poor inter-sectoral coordination, institutional gaps and insufficient digital inclusion of the elderly. The necessity of institutional development towards global age governance, including establishment of specialized UN body, development of international legal statements on the rights of the elderly and formation of global monitoring system. it is emphasizes that health of the elderly is to be considered as central axis of political and humanitarian agenda of the XXI century, shaping trajectory of sustainable development of global society.

In 1995-2024, development of health people-ware as the most important resource of health care systems, actively discussed by world community under the WHO leadership. Since 2004, global health people-ware situation is characterized as being in crisis. The significant shortage of personnel is intensifying, first of all in countries with mean and low income. The situation is worsening because of uneven staff distribution, losses due to internal and international migration, shortcomings in staff training and management. About 70% of workers in health care and social care are women who badly need step-up of professional status. Since 2010, movement towards universal health care services coverage started. Since 2011, under leadership of the Russian Federation, struggle with noncommunicable diseases is advanced. The UN "Agenda for Sustainable Development for the period up to 2030" became main guiding document since 2015. The COVID-19 pandemic confirmed key role of health care workers in ensuring population needs in health, as well as global, regional and national security. Since 2023, it is proposed to adapt health people-ware to the post-pandemic situation.

The article on basis of materials from state archives for the first time reconstructs circumstances of obtaining in the All Union Research Institute for Penicillin and Other Antibiotics or the All Union Research Institute for Penicillin VNIIP first producers for industrial production of penicillin at national enterprises The factors affecting course of breeding work and achieved results are considered.

The article considers organizational, pedagogical and substantive characteristics of training of medical personnel for rural health care system considering demographic, infrastructural and personnel imbalances. It is demonstrated, on the basis of international and Russian statistics, that shortage of medical personnel in rural areas is determined not only by general level of provision of physicians and paramedical personnel, but also by spatial inequality, labor conditions and limited accessibility of educational and professional trajectories. The evidence-based approaches to rural health care practice are summarized: targeted recruitment and distributed clinical training, simulation training, telementoring, inter-professional models and retention practices. The necessity of integrated ecosystem "education-clinic-community" based on regional requests and telemedicine infrastructure is grounded.

In order to characterize motor activity of Belarusian adolescents considering duration of individual components of the daily regime, to reveal nature of influence of social economic characteristics of families in which adolescents are brought up on parameters of their physical activity, material was analyzed taken from original database compiled on the basis of survey of 1254 adolescents aged 15-18 years (the sampling quoting Republican). It is established that motor activity of Belarusian adolescents has no gender differences and no differences conditioned by place of residence and is characterized as insufficient one. The every tenth teenager is outdoors for less than one hour per day, and 56.05% of girls and 50.31% of boys (p=0.042) are outdoors for less than two hours per day. Almost 2/3 of respondents spend three or more hours daily at the computer, telephone, regardless of gender and place of residence. The level of physical activity of adolescents is associated with duration of their interaction with gadgets. The higher risk of insufficient motor activity in combination with prolonged use of digital devices, regardless of gender and place of residence, is demonstrated by adolescents who spend less time for homework preparation. The relationship between adolescent lifestyle and family characteristics is confirmed. The risk related to avoiding health-preserving modes of spending free time is higher in case of lower self-assessment of financial situation of their family, and by some components in adolescents from incomplete families. The education of parents is significant factor. For commitment to healthy motor activity of modern Belarusian teenager it is necessary to form self-organization skills, and motivation against the background of positive emotional psychological reinforcement from the family.

This report is the second part of article devoted to history of development of pharmaceutical law. The second stage of development of regulatory norms in the field of pharmaceutical circulation is described. In XX century in conditions of developing pharmaceutical industry and expanding medication market the center of creation of regulatory acts shifted from European countries to North America. The European lawmakers when developing normative base for sphere of circulation of medications took into account experience and approaches of legal regulation in the USA. In the European states and the USA by the end of XX century harmonized complexes of legal norms in sphere of circulation of medications formed on the basis of national special laws on medicinal remedies.

The article is devoted to consideration of changes in conceptions about physiological mechanism of effect of donor blood as medication in the XIX century. The relationship between changes of physiological knowledge about properties and functions of blood and modification of whole and defibrinated blood preparations applied for transfusion is demonstrated. The temporary transition from using blood to salt blood substitutes at the end of the XIX century is justified. The studies of liquid tissue - blood - in the XIX century became scientific base for fundamental discoveries in the early XX century. The relationship between evolution of conceptions about mechanism of action, modes of preparation and methods of administration of donor blood throughout the XIX century was established.

The purpose of the study is to develop matrix organizational technology to implement new methods of diagnostic treatment and rehabilitation in multi-field hospital. The study involved sampling of 47 experts. In total matrices were filled in for 44 methods of diagnostic treatment rehabilitation and prevention. At that one method could belong to two types. For example it could be applied both as prevention and as treatment method (endovascular surgical correction of cardiac arrhythmia with implantation of frequency-adapted three-chamber pacemaker). The matrix begins with passport section. The initial step of filling procedure is identification of type of medical care to belongs considered method. The types of method (preventive diagnostic therapeutic) are arranged horizontally in matrix. If method is comprehensive one integrating for example elements of diagnostic and treatment then its positioning is to be reflected in two corresponding columns of matrix. The proposed matrix organizational technology of implementing new methods of diagnostics treatment and rehabilitation in multi-field hospital permits to neatly arrange priorities of implementation of necessary management decisions and organizational activities both at the stage of implementation planning and at the stage of implementation proper of innovative technology in multi-field hospital.