Bulletin of Semashko National Research Institute of Public Health

The Ministry of Health of the Russian Federation has published the Order of the Ministry of Health of the Russian Federation dated 03.19.2020 No. 198n "On the temporary procedure for organizing the work of medical organizations in order to implement measures to prevent and reduce risks the spread of the new coronavirus infection COVID-19", that contains strict requirements. The pandemic is characterized by a shortage of resources, which leads to a large number of defects in health care delivery. Many violations committed by medical organizations have been identified. At the same time, despite the identification of hundreds of violations, only a few of them entailed administrative and criminal liability. A similar situation has arisen due to the absence of subjective guilt of both the person directly providing medical care and the officials responsible for organizing it. The article provides several examples of typical situations that entailed responsibility.

The analysis of regulatory legal documents concerning the planning of the main indicators of the volume of medical care in outpatient and inpatient conditions, for various specialties and profiles of beds for 2020 and 2021. identified changes in individual profiles and innovations in the normative-planned indicators of the volume of medical care. Including for the first time, the volume of a number of diagnostic studies was established, which actualizes the issues of staffing the auxiliary treatment and diagnostic service. The erroneous provisions in the territorial program and provisions that contradict the approved departmental order on labor standards are highlighted. Calculations were made of the planned number of beds for the profiles of medical care of "obstetrics", "geriatrics" and "medical rehabilitation" in the Russian Federation and a comparison of their planned and actual number. It is shown that the planned indicators are characterized by sharp annual drops, and the dynamics of the actual provision of bed capacity develops smoothly with the preservation of the general trend in all years of observation. Thus, there is no coordination of planned and normative labor indicators, and health care practice develops independently of them, which indicates a deep crisis in the system of planning the scope of medical care.

The theoretical foundation of the system of motivating and stimulating citizens to health-preserving behavior is presented, this system is a set of measures to reduce the prevalence of known behavioral risk factors for non-communicable diseases, in order to reduce the incidence of such diseases, to preserve human, and, therefore, labor, and the economic potential of the country. In order to clarify and form a unified view of the described topic definitions from the standpoint of public health and health care are given for such terms as motive, motivation, motivation process, incentive, which are actively used at the present time. A need-oriented approach to motivation was formulated. It consists in satisfying the objective need for improving the health of the population through indirect satisfaction of the needs of individuals. The definition of the system of motivating and stimulating citizens to maintain a healthy lifestyle is given, the stages of actions for the successful creation of a system are defined, which purpose is to strengthen the effect of health-enhancing factors, and weaken the effect of negative factors by restructuring the dynamic stereotype of citizens.

Most of the time a modern person spends in closed rooms and is exposed to the adverse factors of living quarters, both at work and while in the premises of residential buildings. In this regard, human health largely depends on how environmentally safe the internal living environment of the premises is. Children are especially sensitive to external factors. Living quarters are becoming a place where children can spend up to 24 hours a day. At home, the upbringing, educational process is implemented, the child's leisure and nutrition takes place. The development of standards and recommendations for the disinfection of living quarters is necessary in order to reduce the risks to the health of children - which is an absolute priority of the state policy of the Russian Federation. The purpose of this work is an analytical review of data on minimization of infectious risks of residential areas for children's health. The article deals with the areas of infectious risk of residential premises; classification of modern disinfectants; the safety of disinfectants for children's health; analysis of regulatory approaches in the Russian Federation to ensuring hygiene in residential premises, including during the COVID-19 epidemic; justification of educational activities on hygiene of housing at the family level.

The redundancy of the proposed indicators for assessing the same fact, as well as the heterogeneity of the proposed indicators (quantitative and qualitative, referring to different objects, etc.) require minimizing their number by developing some generalized (composite, integral) indicators. In addition, these indicators are required at various levels of management to identify problems in the managed system. This publication provides an overview of the methodological approaches found in scientific sources for defining complex assessments (“universal”, which can be used for all types and conditions of health care and “special”, considered for a specific profile of health care, level of management, etc.). Many authors propose integrated methods that take into account not only a set of indicators formed in a certain way, but also the importance of each of the indicators; in addition, it is proposed to take account all components of medical care (general, medical, social and economic efficiency).

The purpose of the study: to study the influence of the level of education as a social determinant of health on the prevalence of health-saving behaviors in women of reproductive age. The data were obtained through an anonymous questionnaire based on the questionnaire "Research of Social Determinants of Health", which was finalized by the authors. A total of 566 non-pregnant women aged 18-49 years were included in the study group. The lower age limit was deliberately limited to 18 years, since female adolescents aged 15-17 years did not reach adulthood, despite the fact that this age range is included in the concept of "reproductive age". The first comparison group included 306 women with higher or incomplete higher education. The second comparison group included 260 women with secondary or specialized secondary education. Each of the groups described above was divided into four more subgroups based on age. The majority of women, regardless of their level of education, had a positive attitude to the principles of a healthy lifestyle. Women with a high level of education were significantly more likely to follow the principles of a healthy lifestyle on a permanent basis. With increasing age, the frequency of following the principles of a healthy lifestyle increases in the group of women with a high level of education, and in the group of women with a lower level of education, it decreases. The study of certain elements of a healthy lifestyle showed that the frequency of irregular alcohol consumption and smoking in the group of women of reproductive age is quite high, more than half of the women surveyed admitted this. Women with a lower level of education were more likely to admit that they were overweight. The level of education did not significantly affect the level of physical activity. A high level of physical activity was noted by about a third of women in both groups compared. With increasing age, the proportion of women with high and very high physical activity in the group of women with a high level of education increased, while in the group of women with a low level of education, on the contrary, decreased. The data obtained allow us to consider education as a social determinant of health, which affects the prevalence of health-saving behaviors in women of reproductive age.

The author presented a review for the dissertation Vitaly Postoev "Improvement of population prevention of congenital malformations in newborns using the regional birth register" for the academic PhD in Medicine by specialty 14.02.03 - "Public Health and Healthcare".