Bulletin of Semashko National Research Institute of Public Health

Introduction. This review article discusses the place and role of environmental determinants in public health from different perspectives. Purpose of the study. To study the role of environmental determinants in public health. Material and methods. In preparing the review, a reporting method was used for systematic reviews and meta-analysis. The search was carried out in the bibliographic databases Elibrary, PubMed, MEDLINE, Google Scholar for the keywords «environmental determinants, public health, environment, health risk factors». Results. The article deals with the categories and factors that determine the environmental determinant from the standpoint of public health. Various methods for assessing the impact of environmental determinants on public health are presented. Their strengths and weaknesses are considered. Based on the results of the analysis of methods for assessing the impact of the environmental environment on health, it was proposed to take into account the combined and combined impact of environmental factors, as well as the time factor, the characteristics of gender and age influence. Conclusion. The concept of the term “environmental determinant” and the categories of parameters that determine it differ significantly in studies. From the standpoint of a deep understanding of ecology as a science and public health, an environmental determinant is the environment surrounding a person in all its manifestations, covering all spheres of life and affecting his health. There is no single methodological approach to assessing the impact of environmental determinants on public health. Many methods have certain disadvantages and are of limited use. To assess the impact of environmental determinants on public health, it is necessary to make a purposeful choice of indicators that fully meet the goals and objectives of the study. With monitoring of environmental determinants by government in all subjects of the Russian Federation, both operational and planned impact on public health is possible, taking into account newly emerging and chronic environmental factors.

The state of health of scrub nurses is influenced by professional activity. The article presents an analysis of the effects of surgical smoke on the health of operating nurses, the frequency of development of chronic oropharyngeal pathology and symptoms during work in the operating unit, the load on the scrub nurse per shift is presented. The study proved the direct and strong influence of surgical smoke on the occupational morbidity of scrub nurses, at the same time, directions for a preventive solution to the problem of exposure to surgical smoke were identified and presented.

According to the World Report on Disability provided by the World Health Organization, there are more than one billion people living with some form of disability in the world, which is about 15 per cent of the world's population. In Dagestan, according to the Ministry of Health of the Russian Federation, there is a high proportion of disabled people among the adult contingent and children with disabilities from the total number of disabled people. The analysis of disability and its structure makes it possible to make management decisions on the prevention of disability, consisting in improving the quality and accessibility of rehabilitation measures. In addition, it requires measures to increase social programs and medical and social activities that promote the integration of people with disabilities into social processes. The trend of growth of primary disability in the Republic of Dagestan, the need for medical and social services of the republic to obtain scientifically based information regarding the disability of the adult population of the republic and the need to develop scientifically based measures to reduce morbidity and disability determine the relevance of this article.

The article provides a comparative analysis of information on specialized medical care provided at the expense of mandatory medical insurance. Using the example of the Belgorod region, objective parameters of medical organizations have been identified, leading to a reasonable increase in the average amount of expenses of compulsory medical insurance funds per case of treatment.

The article contains an analysis of the regulatory and legal framework and materials of scientific publications of domestic authors on the issues of modern peculiarities of the organization of medical care for patients with type 1 and type 2 diabetes mellitus in the Russian Federation. Objective: to systematize theoretical and practical aspects of improving the system of organization of medical care for adult patients with diabetes mellitus. Some problems in the field of organization of medical care, for example, problems of provision and staffing of specialists and insufficiently effective application of financial management methods by medical organizations are among the risks of worsening the quality and availability of medical care.

The article examines step by step the introduction of information technologies into the obstetrics system of the Tver region. A comprehensive analysis is provided of the connection between the digitalization of care provided and the reduction of mortality rates, improving the quality of care provided and increasing public awareness. The problems arising when introducing information technologies at the regional level are analyzed.

Introduction. Workplace stress is a considerable risk factor for the development of chronic non-communicable diseases (NCDs), such as cardiovascular diseases, diabetes, and obesity. Annual global economic losses due to workplace stress exceed 8 trillion dollars. This study aimed to assess the stress levels among employees in the energy sector of the Ural Federal District, working under acceptable and harmful labour conditions, and to analyse their satisfaction with personal and professional life. Materials and methods. In 2022—2023, 4653 employees from the energy sector were surveyed. The questionnaire included questions about stressful situations, personal and professional life satisfaction. Data were analyzed using statistical methods, including Student's t-test and Pearson's χ²-test. Results. Significant differences in stress levels and life satisfaction were found between groups working under acceptable and harmful conditions. Employees in harmful conditions more often reported complete satisfaction with personal and professional life (73.85% and 63.53% respectively in 2023), but also experienced more difficulties in coping with stress. In acceptable conditions, satisfaction levels decreased, while the frequency of stress remained high. Among different types of activities, the highest satisfaction was observed among operational staff, although a negative trend was noted in their assessments in 2023. Conclusion. Working conditions and type of activity significantly affect stress levels and life satisfaction. To reduce stress and improve employee well-being, it is recommended to implement stress management programs, improve working conditions, and regularly monitor stress and satisfaction levels. Limitations. The study is limited by geographical and sectoral factors, as it covers only employees in the energy sector of the Ural Federal District. Ethics. The study was carried out in compliance with the principles of the Declaration of Helsinki of the World Medical Assembly, adopted in 1964.

The issues of planning and financing medical care are inextricably linked to its accessibility and quality at all levels of the healthcare system. The availability of reliable and sufficient information on resource provision and its utilization directly affects the quality of managerial decisions, including those concerning the efficiency of medical organizations. Objective: To conduct an analytical review of the legal and regulatory framework regarding the planning and financing of medical care, as well as the formation of statistical and financial reporting by public medical organizations. Materials and Methods: Content analysis of regulatory legal acts and other documents concerning the regulation of planning and financing medical care at the federal level and the level of the constituent entities of the Russian Federation, as well as federal requirements for maintaining statistical and financial reporting at the level of medical organizations. Results: The conducted content analysis revealed that the planning and financing of medical care, as well as the principles and requirements for reporting in public medical organizations, are governed by a large number of regulatory documents of various statuses and levels. This complicates the process of monitoring and assessing the effectiveness of financial activities of medical organizations and hinders the search for ways to enhance their financial sustainability, including at the federal level where the basic planning and allocation of healthcare system resources take place. Conclusion: There is a need to develop new approaches for creating clear and comprehensible evaluation indicators and a methodology for federal level monitoring of the financial condition and performance efficiency of public medical organizations.

Improving the quality of life of people with disabilities is directly related to the introduction of a multiprofessional approach, which determines the participation of specialists of various profiles, including specialists in social work, in health protection, including the provision of various types of medical and social assistance. The development of professional social work in Russia over the past thirty years has allowed them to expand the scope of their professional activities, one of which is the field of health protection. Professional social work in healthcare, in particular, in medical organizations, can be considered as a separate specific area of its activity — medical and social work. To date, theoretical, methodological, legal and organizational foundations of medical and social work have been developed, and personnel are being trained in the system of higher and secondary vocational education. At the same time, the country has only local experience of their participation in providing medical and social assistance to people with mental disorders, addicted to psychoactive substances, in need of palliative care, since issues remain unresolved related to both the «narrow» understanding of the essence of medical and social work by the medical community, awareness by doctors of the needs for such specialists, the introduction, for example, of a team method of work in medical organizations of specialists of various profiles, as well as issues of interdepartmental interaction between organizations and specialists of health and social protection systems, patients and recipients of social services in organizations that need an integrated approach to providing them with various types of medical, social and other assistance.

Self medication is a global health problem that is becoming particularly relevant in the context of digitalization and limited access to medical care. In the Russian Federation, this practice is recognized as one of the key threats to the healthcare system, which requires the development of scientifically sound strategies to minimize it. The analysis of international and Russian experience has revealed the main factors of the spread of self medication: organizational barriers (difficulties in making an appointment with a doctor), economic constraints, low medical literacy (denial of the risks of self medication), and the availability of over the counter medications. The development of antimicrobial resistance and complications of diseases is particularly dangerous. Effective measures aimed at preventing and reducing the effects of self medication include: improving regulatory regulation, introducing educational programs, developing telemedicine services, and monitoring the advertising of medicines. The results of the study emphasize the need to move to the concept of responsible self medication, taking into account international experience and Russian specifics.

In the context of the rapid development of medical technologies and increased requirements for the quality of emergency care, the problem of training ultrasound diagnostics specialists to perform urgent examinations is becoming particularly relevant. The article examines the theoretical and applied aspects of the formation of professional competencies in the field of point-of-care ultrasound (FOCUS), including the differences between urgent and routine diagnostics, the specifics of educational strategies and the obstacles faced by practitioners. Recommendations on optimizing the system of continuing medical education, taking into account the tasks of emergency medicine, are presented.

The name of Doctor of Medical Sciences, Professor, corresponding member of the Academy of Medical Sciences of the USSR A. G. Bukrinskaya is among the leading Russian virologists of the 20th century. Based on the study of archival documents, the scientific heritage of the scientist, as well as the involvement of a few publications dedicated to A. G. Bukrinskaya, the article presents new biographical information supplemented by generalized information about her work at the D. I. Ivanovsky Institute of Virology of the Russian Academy of Medical Sciences and public activities.

The article is devoted to L. M. Starokadomsky, a Russian naval physician and polar researcher, a prominent specialist in the field of hygiene of water transport. He participated in the development of the Northern Sea Route in 1910—15, and in 1932—34 in the North-Eastern polar regions. He participated in the North-Eastern polar expeditions of the People's Commissariat of Water Transport. An island he discovered in the Severnaya Zemlya archipelago (1913) was named after him. Author of manuals on hygiene of sea transport.

Today, the actively used method of transfusion of donated blood and its components, during the Great Patriotic War, due to its novelty, was not sufficiently mastered in civilian healthcare. By the beginning of the Great Patriotic War, transfusion had not yet become widespread in the USSR. In fact, the Great Patriotic War was the first serious test for the blood service. To meet the needs of the armed forces, a wide network of blood procurement was deployed with the involvement of a large number of civilians and military personnel of the rear units. In order to save money, various types of scrap blood began to be used in civil healthcare. The activities carried out proved their effectiveness, and due to the opportunities that transfusion specialists opened up, Soviet healthcare received a powerful impetus in a number of areas.

The narrative we inherited from the Soviet history of medicine and healthcare in the USSR is largely distorted or intentionally falsified. In order not to fall into error when researching this material, it is necessary to use three mandatory techniques: referring to primary sources, the method of criticism of the source and the comparative historical method. Another important methodological issue is the study of scientific schools in medicine and the criteria for distinguishing these schools (including moral criteria). The authors conclude that it is necessary to describe the history of medicine of this period anew.

The article is devoted to the activities of health care authorities, malaria and sanitary epidemiological stations and the House of Health Education of the Saratov Region in organizing and conducting comprehensive measures, including active detection of malaria patients, diagnosis, therapy and prevention of the disease, among residents of the region and military personnel who were treated in evacuation hospitals. During the Great Patriotic War, malaria and sanitary control points were additionally organized in endemic areas of the region to carry out large-scale measures to prevent malaria, medical workers of which regularly gave lectures, gave talks, accompanied by exhibitions of posters and the distribution of leaflets and brochures. All materials on sanitary and educational work for doctors and paramedics were prepared by the staff of the House of Health Education. The paper presents an analysis of the incidence of malaria in the region for 1941—1944 and the multifaceted activities of all links of the medical service aimed at stabilizing, reducing and improving the epidemiological situation in the region.