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 article considers main problems related to implementation of social protection of persons involved in medical care support during COVID-19 pandemic. The purpose of the study is to identify organizational legal problems in implementing social protection of persons involved in medical care support during COVID-19. The normative legal acts of the Russian Federation, the WHO documents, official data of Minzdrav of Russia, information from portals of "Stopcoronavirus.rf", Constitutional Court of Russia, Inquiry Committee of Russia, office of Public Prosecutor of Russia and Trade Union of medical workers of Russia were analyzed. The study used as its methodology the dialectical method of cognition of social legal phenomena. The logical analysis, system analysis and comparative jurisprudence analysis were applied too. The analysis of national legislation, court decisions, information from official websites of the President of the Russian Federation, executive authorities (state reports on sanitary epidemiological well-being of population of the Russian Federation in 2020-2023) demonstrated that in 2020-2023 additional social guarantees were provided for workers of medical organizations, including additional social payments. Unfortunately, complicacy of establishing diagnosis, misinterpretation of clinical norms, lacking of explanations at instant of novels occurrence resulted in emergence of complaints of workers of medical organizations.

The article considers role of high-tech medical care in export of medical services from the Russian Federation. In conditions of globalization and increasing international competition, it acquires special significance since it includes advanced methods of diagnostic and treatment of complex diseases that attract patients from abroad. The economic and social aspects of high-tech medical care export are considered. The statistical data and trends of development of this sector are analyzed. The particular attention is paid to state support and implementation of technological innovations contributing to increasing of competitiveness of Russian medical services at global medical market.

The accessibility of medical care plays important role in ensuring basic human needs and means unimpeded access to all services in national health care system. It is conditioned by: balance of necessary volumes of medical care of population, national medical and financial resources, availability and qualification of medical personnel, rendering of necessary types of medical care in territories, possibility of patient free choice of physician in charge and medical organization, available transport possibilities, level of public education on health promotion and diseases prevention. The availability of radiotherapy, as an integral part of oncological care, is determined by possibility of its timely delivery to all patients and is conditioned by total number of oncological centers equipped with radiotherapy equipment and qualified specialists. In this regard, availability of radiotherapy treatment is gradually introduced into priority state programs of health care modernization. The timely delivery of radiotherapy associated with increasing of numbers of oncology centers, improvement of their equipment and medical personnel staffing is crucial part of development strategy of state oncological care programs.

This study considers characteristics of attitude of medical workers to the disabled and persons with limited health capacities.The prerequisites of emergence of inclusive health care emergence were analyzed. The significance of documents of the UNO and the WHO considering both protection and conditions of granting human rights and freedoms to the disabled and reserving inclusive health care in society. The role of physicians in practical implementation of this phenomenon in the Russian Federation is determined from medical psychological positions. It is demonstrated that personality characteristics of the disabled are non-specific regarding their nosology since even the mentally ill disabled can be psychologically healthy. On basis of this assumption the role of physician in inclusive health care is revealed that comes to awareness of one's contribution to medical social psychological support of the disabled and persons with limited health capacities. The physician is to come out as activator of mobilization of medical psychological resources of persons with physical or mental defects. The study considers positions and activities of physician in the process of minimization of aftermaths of health disorder by means of medical psychological recommendations containing determination of "challenge" of one's own inferiority and resulting in leading to its compensation. The physicians are proposed to be guided by targeting this category of patients to lacking of sparing regimen in their life-style. This proposal means to resolve problem of integration of this category of patients into society (inclusion in fact) by setting tasks that are on verge of their resource capabilities. The concept of inclusive health care is formulated. Its core is actualization by physicians humanistic professional and civic position towards the disabled and persons with limited health capacities with disabilities and handicapped persons.

The purpose of the study is to assess dynamics of level of common and primary morbidity in class of diseases of ear and mastoid in adult population of the Russian Federation in 2018-2022. The analysis of morbidity indicators was carried out on the basis of data from statistical collections of Minzdrav of Russia and the Federal State Budget Institution "The Central Research Institute for Health Organization and Informatics of Minzdrav of Russia". It is established that in the Russian Federation, level of common and primary morbidity in class of diseases of ear and mastoid in adult population in 2018-2022 was decreasing and reached its lowest values in 2022 (2875.3 and 1760.8 cases per 100,000 of population respectively). The similar trend is observed in all Federal Okrugs of the Russian Federation. The increasing of level of common morbidity is established in 18 Subjects of the Russian Federation, with maximal increase in the Ivanovo Oblast (+17.0%). The increase of level of primary morbidity was noted in 21 Subjects of the Russian Federation, with maximal increase in the Penza Oblast (+35.0%). The most of Subjects of the Russian Federation are characterized by decreasing of both level of common morbidity with maximal decreasing the Republic of Adygei (-48.0%) and primary morbidity of adult population in class of diseases of ear and mastoid with maximal decreasing in the Republic of Tuva (-54.0%). The presented trends of indicators of morbidity in class of diseases of ear and mastoid are results of complex and multi-factorial processes. heir identification will permit to develop measures improving otorhinolaryngological care of population.

The original methodology developed by authors for personalized registration and distribution of workload of pathologists is implemented into a number of departments of pathological-anatomic service of the Irkutsk Oblast, including pathological-anatomic department of the Oblast State Budget Institution "The Irkutsk Municipal Clinical Hospital № 1". In order to evaluate efficiency of new methodology comparative analysis of workload volumes performed by pathologists with calculated standard workload was carried out for two periods i.e before application of new methodology and after its implementation. It is established that in 2017-2019 before implementation of new methodology, discrepancy between workload performed by physicians and its calculated value exceeded 40% in some specialists. The implementation of new methodology resulted in significant, up to 10-fold, decreasing of discrepancy between workload practically performed by physicians and its standard value. As a result, actually this discrepancy on average does not exceed 4% in most specialists. The application of the Student's t-test to compare value of discrepancy between workload performed by pathologists for two compared periods also permitted to establish statistical significance of given differences related to majority of physicians (p<0.05) that serves as justification of efficiency and reasonability of new methodology.

In the history of Russian pharmaceutical market, the year of 1993 became the year of both formation of rules of market relations and alteration of market landscape for changed conditions. The significant segment of state centralized purchases moved under responsibility of regional authorities and their health authorities. At that, authorizations of former three state organizations occupied with import purchases were distributed between new state companies of the Ministry of Health Care and commercial organizations and firms that entered pharmaceutical market. Pretty soon, this diversity gave rise both to competition for budget funds and Government experiments with market regulation. The traces of these clashes and attempts to make market manageable are found in the Ministry of Health Care archives and journal publications.The Report II uses informational potential of medications prices to decode rules of play in Russian pharmaceutical market with purpose to analyze distributions of power at playing table.

The article presents results of analysis of quality of medical care of population in the Kyrgyz Republic. The calculated index of quality of primary health care organizations and structure of defects at primary level of health care by region are considered. The analysis of examination of quality of medical services at in-patient level demonstrated annual increase of unjustified hospitalizations and detected defects in examination and treatment of patients.

Nowadays, such digital devices as laptop, tablet, computer, smartphone are an important component of life in all age categories of population that differently affect their health. The article presents analysis of problems of digital behavior of children and youth as related to health. The materials of sociological survey were used to consider mutual effect of recommendations on safe use of digital devices and behavior indicators of health of students. The purpose of the study is to analyze significance of digital behavior for health based on materials of normative legal documents, results of various studies exemplified by students using digital devices in context of various components of self-preservation behavior. The normative legal documents regarding digital educational environment and research materials (including the study "Digital transformation in the life of students" carried out by Russian Society of Sociologists in 2023 in 29 cities of Russia (N=8,734) were analyzed. The study was focused on importance of formation of communication human culture of communication with various types digital devices and advisability to begin this work from children age. The difficulties existing in this area are noted. Among students, almost half of respondents don't follow basic recommendations concerning working with digital devices important for health prevention. The rest of hygiene recommendations are ignored by up to 87% of respondents. The presence of students' attitudes to healthy lifestyle, physical activity and increased self-estimation of health positively affect those who apply recommendations on communication with digital devices. The role of family and pedagogues as subjects in formation of hygienic culture of using digital devices is currently significant, but yet insufficient. The increasing of culture of communication with digital devices among youth and more active orientation on positive health indicators can input into health amelioration.

For many years, the medications "outside of instruction" (the so-called "off-label" ones) had no single-valued legal status in the Russian Federation and other countries that entailed number of problems. Most of them had to do with schemes and tactics of treatment of patient, impossibility of proper medical care support, legal responsibility of physician for applying medications outside of attached instruction. The important move in resolving mentioned problem became adoption of the Federal Law "On entering changes in the Federal Law "On Fundamentals of Health Care of Citizen in The Russian Federation" that became first step on the path leading to acquisition by "off-label" its legal status. The analysis of relevant normative legal acts, the Criminal code of the Russian Federation was carried out. The basic conclusions related to application of medications in medical institutions in Russia, to physician strategy in cases requiring application of of medications "outside of instruction" were formulated. In case of applying medications "outside of instruction" without informed voluntary agreement of patient, without utmost necessity, single-handed instead of decision of medical commission or in situations which could be managed without this kind of medications i.e. under unfounded risk the physician can be prosecuted since treatment with off-label medications is considered as insecure according to legislative base currently in force.