Bulletin of Semashko National Research Institute of Public Health

Since 2018, Chapter 37 of Federal Law No. 323-FZ «On the Fundamentals of Citizens' Health Protection» and Article 40 of the Federal Law «On Compulsory Medical Insurance in the Russian Federation» have referred to clinical recommendations and the fact that medical care must be provided in accordance with clinical recommendations and taking into account the standards of medical care. At the same time, the deadline for medical organisations to switch to the provision of care based on clinical recommendations has been extended to 1 January 2025. At the moment there are no officially approved clinical recommendations for dentistry. Purpose: To study the opinion of dentists about the development and significance of clinical recommendations for dental care. Materials and methods of the study: qualitative survey of practicing doctors in different subjects of Russia. Results: Opinions of dentists about clinical recommendations differ depending on the level of knowledge, implementation and use. Conclusion: The development and implementation of modern clinical guidelines based on evidence-based best practice that practitioners will be able to refer to in simple and understandable cases is relevant in the Russian Federation.

Inpatient palliative care is primarily needed by adult patients over the age of 60 who have chronic diseases and a polymorbid background. Realizing the needs of patients and solving their urgent problems in inpatient settings is the main task of nurses. The study conducted in 2021—2022 confirmed the importance of the professional activities of nurses in solving problems and needs of palliative patients. The special conditions of professional activity for nurses are the severity of the patients' condition, since most often in their practice they encounter patients with various forms of cancer (85.0%, CI 81.4—88.6), severe irreversible consequences of cerebrovascular accidents (58.6%, CI 53.8—63.4), degenerative diseases of the nervous system in the late stages of the disease (40.2%, CI 35.4—45.0). Nurses in the professional field often face such groups of problems of palliative patients in inpatient settings, as pain syndrome (85.5%), manifestations of digestive disorders (60.3%), respiratory disorders (55.4%), slightly less — with mental and neurological (48.2%), as well as urological problems of patients (40.4%). The frequency of occurrence of problems and symptoms in palliative patients in the professional activities of nurses is presented. The leading problems in palliative patients requiring nursing care are constipation (86.5%), nausea and vomiting (80.0%), dry mouth (70.1%), shortness of breath (79.4%), urinary incontinence (75.9%), difficulty urinating (64.5%), insomnia (77.9%), manifestations of dementia (70.4%) and depression (61.6%).

Effectiveness of gender-affirming medical and legal interventions in improving psychosocial indicators in individuals with gender incongruence has been shown in a large number of international studies. However, they suffer from a number methodological problems such as the failure to indicate the type of intervention and take into consideration the possible effects of other interventions and social factors. Materials and methods. We conducted a cross-sectional study on a Russian sample of individuals with gender incongruence using an online survey featuring the following sections: demographic and social factors, medical and legal gender-affirming interventions, and the Gender Congruence and Life Satisfaction Scale (GCLS). Means and correlation with GCLS found for continuous variables. Compared GCLS means for respondents who had and had not (but wanted to) undergone interventions. Built linear regression models with GCLS as a dependent variable and all others as independent. Results. Age, social support, and differences between baseline and current and between current and ideal appearance correlated with GCLS in a statistically significant manner. Legal gender recognition and vaginoplasty were effective in improving GCLS outcomes among the respondents assigned male at birth; legal gender recognition, hormone-replacement therapy, hysterectomy, and mastectomy — among those assigned female at birth. Linear regression models reaffirmed the importance of social support and the difference between current and ideal appearance in the whole sample; vaginoplasty — among the respondents assigned female at birth; legal gender recognition — among the respondents assigned female at birth; other results were mixed. Discussion. The chosen design helped to demonstrate the synergetic effect of combining gender-affirming interventions, which can be different from their effectivenesses when considered alone. Conclusions. Recommend inclusion in clinical practice guidelines of vaginoplasty — for individuals assigned male at birth; hormone-replacement therapy, mastectomy, and hysterectomy — for individuals assigned female at birth; legal gender recognition — for all.

The article presents the results of the implementation of the project of the Perm State Pharmaceutical Academy Museum to
study the problems of dispensing alcohol and alcohol-containing drugs from pharmacies within the framework of the Prohibition during the First World War.

During pregnancy, a woman's health undergoes major physical and psychological changes. Even in uncomplicated pregnancies, these changes can affect the physical component of the pregnant woman's quality of life, as well as the health of the mother and fetus. Earlier attempts have been made to study the quality of life c physiologic pregnancy and assessed the associated socio-demographic, physical and psychological factors in developed countries, in addition, a systematic review was published in 2018. The diagnosis of gestational diabetes mellitus is associated with the risk of adverse pregnancy outcomes for both mother and fetus, which may negatively affect quality of life. The objectives of the present study were to investigate the characteristics of quality of life in pregnant women with of gestational diabetes mellitus in comparison with women with physiologically normal pregnancy. This work is part of further planned research to analyze the risks of reduced public health quality in the management of pregnant women with gestational diabetes mellitus.
Materials and Methods. From Maya 2023 to January 2024, a sociological survey of 553 pregnant women referred for consultation with an endocrinologist at the consultative and diagnostic department of the perinatal center of the S.S.Yudin State Clinical Hospital in Moscow was conducted using online questionnaires. The SF-36 questionnaire (The Short Form-36) is an international questionnaire used to study the quality of life, validated in Russia. The socio-demographic characteristics block of the questionnaire was adapted by the authors of the study to interview pregnant women. The aim of the present study was to further contribute to the knowledge of the clinical relationship between of gestational diabetes mellitus and physical and psychological components of the quality of life of pregnant women.
Compliance with ethical standards: the study was approved by the Interuniversity Ethics Committee, Protocol No. 4 of 13.04.2023. Respondents signed informed consent to participate in the study, and gave consent to publish the results of sociological surveys.
Results. The study revealed that the physical component of quality of life was statistically significantly reduced in pregnant women with of gestational diabetes mellitus. The leading factors determining the physical functioning of the mother are pregnancy term and age. The decrease of the physical component of pregnant women with of gestational diabetes mellitus quality of life deserves serious attention for the development of unified programs for pregnant women with of gestational diabetes mellitus as part of a strategy to counter the risks of deterioration in the quality of public health of pregnant women associated with medical and social determinants of public health. Such unified programs for pregnant women with of gestational diabetes mellitus must include dosed physical activity, training in the principles of diet therapy and psychological self-regulation to form pregnant women’s with of gestational diabetes mellitus commitment to a healthy lifestyle. In the development and implementation of such programs for pregnant women with of gestational diabetes mellitus, endocrinologists, medical psychologists, and exercise therapy doctors should take an active part, along with obstetricians and gynecologists.
The decrease in the physical component of quality of life in pregnant women with GDM certainly deserves attention for the development of individual/universal programs of dosed physical activity, teaching the principles of nutritional therapy in the direction of the formation of commitment to a healthy lifestyle in pregnant women. Detection of a pathological condition in a future mother is always a stressful factor, in this regard, psychological counseling/work with a psychologist seems reasonable to improve the care and quality of life of pregnant women with of gestational diabetes mellitus.

The article discusses the most common errors at different stages of laboratory diagnostics of male fertility, and also provides
examples where special attention of urologists-andrologists to the existing problem is required. By paying due attention to this problem
at all diagnostic stages and taking into account all additional factors that contribute to the occurrence of errors, it is possible to avoid or
significantly reduce negative consequences for patients, thereby improving the quality and safety of medical activities, in particular urological care for men at risk of infertility.

The article presents the main results of a sociological study of the problems of formation of the social health of student youth
in Belgorod. It is established that the social health of modern students is determined primarily by social factors and characterizes the internal state of an individual. The structural components of social health are presented and the reasons preventing the formation of social
health of students are identified. The factors contributing to the formation of the social health of students are identified and the importance of forming socially significant personality qualities and increasing the social activity of young people is substantiated. Recommendations on the formation of the social health of the student youth of Belgorod are proposed.

The objective of the study was to analyze of developed innovative technologies within the framework of clinical testing in
medical care profiles. To conduct this analysis the clinical testing protocols for 2023 and 2024 from the website of the Ministry of Health
of the Russian Federation were used (https://minzdrav.gov.ru/poleznye-resursy/protokoly-klinicheskoy-aprobatsii/klinicheskoy-aprobatsii). Based on the analysis of the application of the developed innovative technologies within the framework of clinical testing by medical
care profiles for 2023, it was found that the largest number of methods (protocols) were for cardiovascular surgery (38.61%). Based on the
analysis of the distribution of developed innovative technologies within the framework of clinical testing by types (stages of the treatment and diagnostic process) for 2023, it was found that the largest number of methods (protocols) were for treatment methods —
84.16%, which corresponds to 85 methods out of 101 clinical testing methods included in the analysis for 2023. Based on the analysis of
the use of developed innovative technologies within the framework of clinical testing by medical care profiles for 2024, it was found that
the largest number of methods (protocols) were in obstetrics and gynecology — 42.03%, which corresponds to 29 implemented clinical
testing protocols. In 2024, medical care using innovative medical technologies within the framework of clinical testing was mainly provided within the framework of treatment methods in the profiles of obstetrics and gynecology, pediatrics and neonatology in those federal
medical organizations that provide medical care within the framework of clinical testing. Compared to 2023, in 2024 there is a clear emphasis on innovative methods of providing medical care aimed at protecting motherhood and childhood, which is one of the main priorities of the healthcare system of the Russian Federation for the period from 2025 to 2030.

Minister of Health of the USSR G. A. Miterev in 1946 should have felt quite confident: for 7 years of work in a leading position
he had accumulated considerable experience as a health care organiser, the actions of the People's Commissariat of Health headed by
him during the Great Patriotic War were extremely successful, the post-war development of Soviet health care was going on confidently.
However, at the end of the year he was suddenly deprived of his post for attempted scientific cooperation with recent allies in the war —
the Americans: academician-secretary of the Academy of Medical Sciences of the USSR V. V. Parin during a business trip transferred to the
Soviet Union. During a business trip, Parin gave them samples of the anti-cancer drug ‘KR’ (krutsina) developed by N. G. Klyueva and
G. I. Roskin and the manuscript of a book on cancer biotherapy. The scientists were accused of anti-patriotic and anti-state actions, and
the minister was branded as an apolitical swindler. In June 1947, a trial of honour was held against N. G. Klyueva and G. I. Roskin, and in
August of the same year — against G. A. Miterev. All charges brought against them during these trials were dropped at a meeting of the
Presidium of the CPSU Central Committee in October 1959.

The object of this study was the outbreak of cholera that occurred in the Saratov region in August-September 1942. The article
describes the social and epidemiological situation that had developed in Saratov by 1942. The development and course of the epidemic
outbreak of cholera are considered, the scope and nature of the measures taken to prevent and eliminate it are shown. The contribution
of the teams of medical, scientific and educational healthcare institutions of the city of Saratov to the fight against the epidemic and the
nature of work in wartime conditions was noted. The article is dedicated to the feat of medical workers of the rear in honor of the 80th anniversary of Victory in the Great Patriotic War.

The article is devoted to an outstanding figure in the organization of healthcare and postgraduate medical education of the
Soviet period, a wonderful man and just a beautiful, charming woman Maria Dmitrievna Kovrigina. She went through a difficult, but very
bright, fruitful life path, made a fantastic career rise, made a huge contribution to the development of Soviet healthcare, higher postgraduate medical education, maternity and childhood care. July 6, 2025, will mark the 115th anniversary of the birth of this extraordinary
woman, and March 12, 2025 It has been 30 years since her death. Maria Dmitrievna was a graduate of the Sverdlovsk State Medical Institute (SSMI, now UGMU), where they cherish her bright memory. In 1950—1953, Maria Dmitrievna Kovrigina was Minister of Health of the
RSFSR, and in 1954—1959, Minister of Health of the USSR. Many initiatives introduced under her leadership, especially in the field of maternal and child health, have been part of the country's life for a long time. These are orphanages, the transfer of nurseries to industrial
enterprises, an increase in state aid to pregnant women, single and large mothers, the establishment of the honorary title «Mother Heroine» and the Order of Maternal Glory. Through her efforts, millions of children's lives were saved, and not only in our country — it was not
for nothing that in the post-war years M. D. Kovrigina became the recipient of high awards from Poland and Bulgaria. Since 1959 For 27
years, Maria Dmitrievna has been the director of the Central Institute for Advanced Medical Education (CIUW, now the Russian Medical
Academy of Continuing Professional Education of the Ministry of Health of the Russian Federation — RMANPO of the Ministry of Health
of the Russian Federation). The article reflects the main stages of M. D. Kovrigina's life and work, her main achievements in the field of
medicine and education, and focuses on the international recognition of her achievements. The professional and personal qualities of
M. D. Kovrigina, which contributed to her outstanding successes and achievements, are shown.

Medical and health tourism has developed significantly in recent years, driven by a variety of factors, including globalization, increased health awareness, and all kinds of innovations in medical technology and services. The article emphasizes that modern medical tourism includes not only receiving medical services, but also the opportunity to improve health in unique natural and cultural conditions. It is mentioned that the main factors contributing to this phenomenon include globalization, the development of technology, as well as the increasing awareness of the population about available treatments. The analysis of current trends in the field of medical
tourism, including outbound, inbound and domestic tourism, is presented. It also mentions a noticeable reduction in outbound medical tourism in Russia in 2023, caused by the geopolitical situation and changing preferences of citizens, which led to an increase in interest in domestic resorts and sanatoriums. The article summarizes that despite the existing challenges, Russia continues to develop its medical services, and the interest of foreign patients is growing, especially in areas such as ophthalmology, which opens up new horizons for medical tourism in the country.

The article examines the anatomical and physiological aspects of workplace design in order to preserve health, increase labor productivity and improve the quality of life of employees. The key anatomical and physiological features of a person, such as the structure of the spine, joints, organs of vision, nervous and respiratory systems, which must be taken into account when organizing the
workplace, are analyzed. Special attention is paid to the ergonomic approach aimed at creating a comfortable and safe working environment. The study substantiates the importance of using adaptive solutions, such as adjustable work surfaces, ergonomic chairs, correct lighting and regular breaks, to prevent occupational diseases and reduce the physical and psychological burden on employees. The presented conclusions and recommendations are based on an analysis of current data, statistics and international experience.

Since 2017, telemedicine has occupied a significant place in the healthcare system of the Russian Federation, which was facilitated by the legislative recognition and regulation of telemedicine technologies, enshrined in Federal Law No. 242-FZ of July 29, 2017.
This article presents the results of a sociological survey conducted among 375 medical workers in the Moscow region, aimed at studying
their attitude to the introduction of telemedicine technologies in the dispensary supervision of the adult population. The survey showed
a generally positive assessment of the impact of telemedicine on the quality of medical services. However, significant problems have also
been identified, including technical difficulties, lack of training, and patient awareness of telemedicine services. The results of the study
emphasize the need to develop an integrated approach to the implementation of telemedicine technologies with an emphasis on data
security, training of medical personnel and patient education.

The article presents the anniversary and memorable dates of the history of medicine in 2025.