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 problem of timely final diagnosis, early initiation of treatment and optimal management of patients with malignant neoplasms is very actual. The purpose of the study is to analyze experience of managing patients with malignant neoplasms in the largest private medical organization. The sociological survey of 412 oncologists, surgeons, including coloproctologists and obstetrician-gynecologists working in clinics of Medsi Group of Companies in Moscow and Moscow Oblast was carried out. In 2023, in all clinics of Medsi Group of Companies functioning in Russia, after establishment of diagnosis of malignant neoplasm, 45.7% of these patients continued examination and treatment within the framework of this medical organization. In Moscow, Medsi Group of Companies JSC organized specialized competence center for patients of oncological profile where specialists determine further tactics of patient management. In each clinic of Medsi Group of Companies, position of senior oncologist is allocated, ensuring control of timely clinical diagnosis and routing of patients to the next stage of treatment. The patient transition to each of subsequent stages of treatment or refusal of patient to continue treatment is recorded on oncological desktop in the medical information system "Medialog". Thus, is minimized probability of losing control over patient management in medical organization.

The in-patient forms of medical rehabilitation of children with nervous system diseases continue to be recovery leading option. They ensure personal doctor-patient contact and make rehabilitation process at most personalized and qualified. Nevertheless, in-patient forms of rehabilitation are very expensive, always involve epidemic risks and entail some social dis-adaptation in children and adolescents with behavioral and mental disorders. The study demonstrated that telemedicine has great positive qualities and is able in many cases to replace full-time form of rehabilitation. The initial caution of medics participated in rehabilitation group during study was replaced by confidence in efficiency of rehabilitation applied using telemedicine technologies. The research material permits to suggest telemedicine has great potential to implement in pediatrics.

The network form of implementation of educational programs in health care or network form of education, is an innovative approach to educational process that is actively applied in medical and adjacent universities to improve quality of future specialists training. This approach implies cooperation of various educational and scientific institutions, such as universities, research institutes, medical organizations, as well as application of electronic resources and remote technologies. The article considers legislative regulation of implementation of online form of educational programs and application of online form of education in the field of health care in the Russian Federation. The results of study carried out in scientific and educational laboratory of Educational Development of the Siberian State Medical University that allows to evaluate implementation of individual educational programs in medical schools in Russia are considered. The Russian projects of online forms of interaction in health care that significantly contribute into development of health care are considered in terms of training professional personnel.

The general medical practice in modernized primary health care units of Moscow medical organizations by its generalized statistical indicators takes the leading place in rating of health care organizations of the Subjects of the Russian Federation. The research study revealed problems in achieving target indicator - level of patient satisfaction with quality of medical care provided by general practitioners/family doctors made up to 54.3%. One of the causes was higher degree of physician burnout (34.1%). To elaborate efficient prevention program,a set of organizational technologies to prevent burnout was developed and tested. The purpose of the study was approbation of developed organizational technologies preventing burnout of general practitioners in the pilot project. The methodology of pairwise survey permitting to simultaneously obtain answers of respondents - patients and general practitioners - to objectify results of the study, characterizing factors under study at fixed period of time - the last 12 months. The sociological survey was applied on the basis of two international questionnaires - EUROPEP (to study patient satisfaction) and COSPOQ III to evaluate psycho-social state of general practitioners). The developed organizational technologies of burnout prevention permitted to increase index of patients' satisfaction with medical care up to 30.33%, and cumulative efficiency on blocks of questionnaire up to 26.97%. Conclusion. The efficiency of preventive measures reached 27.28%.

The population morbidity is one of leading indicators of public health. On the basis of morbidity, not only population needs in various types of medical care are determined, but also development of medical organizations network is prognosticated and effectiveness of health care system is assessed. This approach permits to adjust functioning of population medical care services in each Subject of the Russian Federation. Hence, studying dynamics of adult population morbidity by disease classes and considering regional characteristics continues to be actual. The purpose of the study is to analyze dynamics of general and newly registered (primary) morbidity of adult population in the Russian Federation, Federal Okrugs and Subjects of the Russian Federation in 2016-2022. The research materials and methods included calculation of dynamic series indicators (visibility indicators, growth rates, growth/loss rates), direct ranking method. The indicators of total and newly registered (primary) morbidity per 100,000 of adult population (aged 18 years and older) in dynamics in 2016-2022 were calculated. The research materials are the statistics collections of the Ministry of Health of the Russian Federation and the Federal State Budget Institution "The Central Research Institute for Health Organization and Informatics" of Minzdrav of Russia of adult population morbidity of the Russian Federation. The software Microsoft Excel was applied to process statistical data. The results. The analysis of total morbidity of adult population in the Russian Federation in 2016-2022 demonstrated that in 2022 value of this indicator made up to 159,545.4 per 100 thousand of population that is 9.0% more than in 2016. The increase of total morbidity is observed in 66 Subjects of the Russian Federation that consists 77.65% of total number of the Subjects. The level of primary morbidity in the Russian Federation increased by 21.9% (from 55227.3 per 100 thousand adults in 2016 to 67326.6 in 2022). The increase of primary morbidity is observed in 81 Subjects of the Russian Federation that consist 95.3% of total number of the Subjects. The analysis of morbidity demonstrated that in 2016-2019 its indicators had no significant changes. In 2020-2022, sanitary and epidemiological well-being of population in the Russian Federation was determined by epidemic situation and global challenge associated with the new corona-virus infection. As a result, in 2020, occurred decreasing of morbidity registration for all classes of diseases, except respiratory diseases. In 2021, began to show increasing of registration of morbidity that proceeded in 2022 in most classes of the ICD-10.

The number of permanent average annual rural population in the Russian Federation is declining and over 2013-2022 decreased from 37.2 to 36.9 million people. The mortality rates for rural population x were higher than for urban population over past decades. The natality of rural population that had growing trend began to decline since 2013 and in 2022 indices made up to 8.8‰ in for the rural population and 8.9‰ in urban population. The general and newly registered morbidity of rural population was lower than of urban population. In 2022, general morbidity of rural population consisted 129761.8‰00, of urban population 187593.8‰00, primary morbidity consisted 64755.2 and 96963.8‰00 respectively. The analysis of total morbidity of rural population in dynamics from pre-COVID year (2019) and in subsequent years of pandemic demonstrated its abrupt decline in 2020. In 2021-2022, total morbidity increased slightly up to 124,808.5 and 129761.8‰00 respectively. The increase occurred mainly in classes of respiratory diseases by 11% and of circulatory disease class by 3.2%. The increasing of COVID-19 morbidity was noted and indicators consisted 2151.9 in 2020, 6050.4 in 2021 and 144.2‰00 in 2022. The ranking of indicators of newly detected morbidity in rural population by Subjects of the Russian Federation demonstrated in 2022 difference up to 13.6 times. The provision of rural population with physicians in medical organizations located in rural areas consisted 13.2‰0. In the Subjects of the Russian Federation difference in indicators is great i.e. 54 times. The results of the study testify necessity of monitoring and in-depth analysis of health indicators of rural population and determining factors. The modernization of rural health care has to begin with increasing of accessibility of primary health care of rural residents. The reforms require increasing of potentials of financial, material, technical and human resources at regional and municipal levels.

The article considers actual issues of attraction of medical workers to juridical responsibility according to norms of civil and administrative law in the Russian Federation. The purpose of the study is to consider peculiarities of attraction of medical workers to civil and administrative responsibility in cases of violation of defense of life and health of citizen. The professionalism, ethics and responsibility for health of patients of medical workers are integral elements of efficient health care system. However, cases of improper implementation of professional responsibility, violation of ethical norms and legal acts occur in medical practice quite often. Because of this situation attraction of medical workers to civil and administrative responsibility becomes an actual issue. The conclusion is made that justified attraction of medical workers to responsibility is an integral part of health care system, targeted to support safety and quality of medical care. The combination of efforts to increase legal literacy, to intensify control and defense of rights of patients permits to develop responsible and efficient medical system ensuring safety and well-being of patients.

The article considers formation of academic subject and scientific discipline "Public Health and Organization of Health Care" in Russia during 1963-2023. The role of Yu. P. Lisitsyn, Full Member of the Russian Academy of Medical Sciences, and his disciples in improving educational process, scientific substantiation of medical organizational measures that contributed into improvement of health of various population groups. The results of scientific research performed at the Chair and participation of the Chair in educational methodological support of teaching academic discipline "Public Health and Public Health" at different levels of Higher Education (students, resident doctors, postgraduate students, health care practitioners) are described.

In conditions of sanctions policy and escalation of political conflict of Russia with unfriendly countries occurs constant increase of economic pressure on Russian market through introduction of bans and restrictions of various kind. Currently, countries of the European Union are developing the fourteenth package of sanctions measures that targets even more concentration of implementing measures on identification and suppression of schemes to circumvent existing prohibitions against Russia. Unconditionally, such approach impacts supply of goods of medical purpose that in order to bypass imposed restrictions imposed were imported within the framework of legalization of parallel import. It is worth to note that based on analysis of consumer market by the Ministry of Industry and Trade, limited number of medical supplies were included in list of goods falling under parallel import mechanism. At that, most of components for medical equipment at customs clearance are classified as separate goods without identification of their medical purposes and therefore such goods were imported under similar legalization scheme. The situation with organization of supplies of goods within the framework of medical support began to worsen with introduction of principle of extraterritoriality of sanctions, which implies possibility of imposing prohibitive measures on foreign contractors from friendly countries for Russia that makes actual considered topic. The article examines in detail main trends in development of sanctions policy, considers structure of goods with medical purpose for which parallel import legalization is being implemented and reveals concept of extraterritoriality of sanctions that complicates re-import of prohibited goods. The practical recommendations on their bypassing for Russian counterparts and their foreign partners partners from friendly countries were formulated.

The article presents general analysis of national health care system of the Kirghiz Republic, including particular problems government agencies encounter, role of non-communicable diseases in increasing of total mortality, morbidity and disability of the population. The data is presented concerning economic losses associated with decreasing of labor productivity because of non-communicable diseases morbidity. The priority measures to strengthen primary health care organizations and ways of resolving existing problems in national health care are discussed.