Bulletin of Semashko National Research Institute of Public Health

Modern medicine is experiencing an influx of a younger generation, often referred to as “Generation Z” — people born between 1997 and 2010. This is the first generation to grow up in the era of the Internet, smartphones and mobile applications, which has shaped their unique perception of the world. Representatives of this generation are characterized by different views on privacy, trust and interaction in the digital space. They attach great importance to personal well-being, including financial stability, healthy eating, physical activity, quality sleep and stress management methods. Modern conditions of the healthcare system are associated with an increased risk of developing burnout syndrome among medical workers, including at the beginning of their professional activity, among residents of various specializations. It is estimated that up to 60% of residents face this condition, which causes justified concern about the well-being of young specialists and the stability of the healthcare system itself.

The aim of the study was to study the joint activities of anti-tuberculosis organizations and medical organizations providing primary health care in organizing and conducting periodic examinations aimed at the early detection of tuberculosis among the population. Materials and methods. An anonymous voluntary survey was conducted among 160 district general practitioners (respondents) working in 17 state budgetary medical organizations of the Kaluga Region. A special questionnaire containing 19 open and closed questions (containing a list of answer options) was developed to collect data. Results. The survey results showed that almost half of the respondents did not know about the procedure and frequency of examinations aimed at the early detection of TB among the assigned population and about the high-risk groups for TB living in the territory of medical service, and only less than 30% of them kept a permanent record of the assigned population covered by examinations. The supervisory work of district TB doctors aimed at early detection of TB was assessed negatively by 66.3% of respondents, who noted that this activity was presented either in the form of lectures (50.6% of respondents) or was devoted to assessing the coverage of examinations of the assigned population (36.3% of respondents). The analysis of newly diagnosed cases of TB, relapses of TB and cases of death from TB was noted by only 29.3% of respondents, and regular verification of lists of patients with active TB and those removed from the dispensary register due to recovery — by 25.6% of respondents. Conclusion. The results of the study allowed us to identify gaps in the joint work of the anti-tuberculosis service and organizations providing primary health care, dedicated to the organization and conduct of periodic examinations aimed at early detection of TB among the population.

The organization of medical and social services in Russia is associated with difficulties due to differences in the nature of medical and social work in social protection institutions and healthcare institutions, which requires its adaptation taking into account the specifics of the contingent with mental disorders and their need for social assistance. The purpose of the study is to analyze the current regulatory framework and organizational technologies for providing social assistance to patients with mental disorders with the development of recommendations for their improvement. The analysis of the professional standard of a social worker and organizational technologies for providing medical care to patients with mental disorders, taking into account the needs of patients in receiving medical and social services, made it possible to revise and adapt the labor functions of a social worker working in a psychiatrist's office. As a result, methodological approaches to the formation of job descriptions for a social worker and a social worker were developed by adapting professional standards to the Procedure for Providing Medical Care for Mental Disorders and Behavioral Disorders. This work algorithm helps to increase the effectiveness of dispensary observation, accessibility and quality of social and medical rehabilitation care for patients with mental disorders.

For further theoretical development of the methodology of public health as a medical and social resource of society, it is extremely important to identify the existing foreign and domestic science conceptual approaches to the interpretation of the theoretical concepts of «society», «community», «population», «population» and their relationship. The aim of the study: to define the theoretical concept «society», its relationship with the concepts of «community», «population», «population» taking into account the existing foreign and domestic science conceptual approaches to the interpretation of these theoretical concepts in order to further take them into account in the development of more effective strategies to improve public health as a medical and social resource of society, ensuring national security. Material and methods. Desk study: the WHO recommendations «Closing the gap in a generation: health equity through action on the social determinants of health» and GOST R ISO 31000—2019 standard were used as a methodological approach. The authors analysed scientific articles on the subject of the study published in scientific databases: PUBMED and eLIBRARY. The search was carried out using the keywords «society», «community», «population», «population» in the keywords of the publication. Subsequent analysis of the obtained list of papers was performed using manual sorting. The total number of analysed scientific articles on the subject of the study was 61, with 31 articles in PUBMED and 29 in eLIBRARY. Results. There are many different interpretations of the concepts of «society» and «community», «population», «population». The main problem in defining these terms is the lack of unity of terminology, unity of interpretation of concepts, correlation with the concept of public health as a medical and social resource of society. The authors from the point of view of system analysis give their definition of the concept of «society» and its main structural elements and links and show its relationship with the concept of «community», explaining that the concepts of «society» and «community» have both common features and specific differences. They are interrelated and complement each other, creating a multi-level structure of social interactions. Conclusion. The main problem in defining the theoretical terms «society», «community» is the lack of unity of terminology, unity of interpretation of concepts. The system approach allows us to study society as a complex, multi-layered structure consisting of various elements that interact with each other. The authors have defined the concept of «society» and «community» and developed a scheme showing the main parts of society as a system.

Economically developed countries face an increasing healthcare burden due to the growing number of diagnostic procedures. Compounding this issue, personnel shortages persist. Centralizing radiological care and transitioning to automation allow radiologists to focus on the analysis and interpretation of imaging findings. Assessing radiologist productivity within a centralized system, such as the Moscow Reference Center for Radiology, is necessary. Goal: to evaluate radiologist productivity within a centralized radiological care system. Materials and Methods: data from August 2020 to July 2024 were analyzed. The data were extracted from the Unified Radiological Information Service of the Unified Medical Information and Analytical System of Moscow. The database included anonymized radiologist identifiers, dates of employment, contractual working hours, hours worked, completed radiological reports (broken down by imaging modality), total completed reports, planned versus executed workload (in standardized units and percentages), and audit results. Labor effort, labor hours per unit, output, and productivity metrics were calculated. Results: the Moscow Reference Center demonstrated a consistent and stable increase in labor productivity. From 2020 to 2024, this rate nearly doubled, increasing from 782.02 to 1325.20. In 2020, the average labor hours per unit per radiologist was 12.57, decreasing to 8.77 by 2024. The average labor effort was 92.34 in 2022 and increased to 196.07 in 2024. In 2020, it was 8.57, increasing to 11.07 in 2021. The output indicator was calculated. In 2020, it was 8.57, increasing to 11.07 in 2021. A plateau was observed in subsequent periods. Conclusion: modifying working conditions and activities enhances radiologist productivity while reducing labor hours per unit. A centralized approach to radiological care proved more effective compared to distributing resources across primary care facilities.

Introduction: According to data from the V. A. Nasonova Research Institute of Rheumatology, 75% of patients suffering from rheumatic diseases become disabled before retirement age [1]. Early diagnosis of rheumatic diseases is often challenging for many specialists [2]. Frequently, the reasons for late diagnosis include a lack of awareness among doctors about the symptoms of the diseases, the variety of their clinical manifestations, as well as patients' delayed requests for medical assistance. This study analyzed questionnaires from 100 patients over 18 years old with confirmed rheumatic diseases. Objective of the study: To identify subjective reasons affecting the timing of diagnosis in patients with rheumatic diseases in outpatient settings, according to the patients themselves, using the examples of spondyloarthritis and rheumatoid arthritis. Materials and methods: The study included 100 patients aged 18 to 91 years who were under the care of a rheumatologist with a confirmed rheumatic diagnosis and who voluntarily agreed to participate in this study. The average duration of the disease from the onset of the first symptoms to the visit to the rheumatologist and the establishment of the rheumatological diagnosis was calculated, along with the percentage of referrals to related specialists and the reasons for the delayed detection of rheumatic diseases and late visits to the rheumatologist, according to the patients themselves. Results: The average duration of the disease from the onset of the first symptoms to the visit to the rheumatologist and the establishment of the rheumatological diagnosis was 6.88 ± 1.8 years. According to patients, the reasons for the late detection of rheumatic diseases are: personal oversight 39%, oversight by physicians 80%, lack of opportunity to visit a rheumatologist 1% (multiple responses were allowed).

Chronic critical limb ischemia (CCLI) is an unfavorable process in patients with obliterating diseases of the arteries of the lower extremities and is accompanied by a high risk of fatal outcomes, limb amputation and disability. Objective. To analyze the prevalence of risk factors in patients with CCLI and comorbidity of ischemic cardiovascular diseases (CVD) with indications for multivessel revascularization, to evaluate their prognostic significance and information content. Materials and methods. A retrospective multicenter research (2018—2024) was performed, big data on medical services in patients (n=782): the group А (n = 657) — patients with CCLI 3—4 st., average age — 74±3.1 years, men 72.8%. The group В (n=125) — patients without CVD and risk factors CVD, average age 44±1.05 years, men — 65.6%. The anamnestic (≥12 months before the development of CCLI) prevalence, information content and prognostic significance of smoking, alcohol consumption, intermittent claudication, hypertension, diabetes, hypercholesterolemia, hyperhomocysteinemia, chronic heart failure, history of myocardial infarction, level of daily physical activity, compliance to medication, self-monitoring of hemodynamic parameters, primary care of cardiologist or cardiovascular surgeon were studied. In patients of group B, the risks of developing CCLI within 12 months in the absence of intermittent claudication were research. The analytical period is 12 months. The following methods: content analysis, statistical, systematization, comparative analysis, mathematical. Results. In patients of group А established a high prevalence and significant prognostic significance and informativeness of Kullback for most of the risk factors of CLLI. In patients of group B, there was no risk of developing CCILI. Conclusion. The results of the research determine the need for personalized multifactorial analysis of the CVD at the primary health care level in all patients over 50 years old for correct the risk factors of CCLI.

The article presents models for the functioning of a regional healthcare system under emergency conditions, using the examples of biological threats and man-made disasters. The models take into account the interaction between emergency medical services, hospitals, outpatient clinics, and a coordination center, enabling the identification of problematic areas in the organization of medical care delivery processes. The article provides a set of quantitative metrics that allow for the assessment of throughput capacity, resource availability, and the flexibility of the healthcare system. The obtained results demonstrate the effectiveness of a systems-based approach to the management of medical resources in emergency situations and can serve as a foundation for the development of software products for healthcare monitoring and planning.

The article presents methodological approaches to the development of a qualitative SWOT analysis model for use in the healthcare sector in terms of providing paid medical services in medical organizations of the Russian Federation, taking into account the studied features. The qualitative factors influencing the use of the model are studied and strategic problems in the paid medical services market are classified. A comprehensive analysis was carried out, including regression and dispersion analysis of data, including data from a survey conducted in a Moscow medical organization providing outpatient medical care, which made it possible to build a qualitative SWOT analysis model depending on both the form of ownership and the features of the structural divisions of medical organizations. The results obtained are based on the work of specialists in the field of management in healthcare and represent new opportunities for assessing internal and external factors in healthcare, in particular, in the provision of paid medical services. Thanks to a sociological study, the empirical basis of which was the data of a survey of 343 patients of the State Budgetary Healthcare Institution “GP No. 210 of the Moscow Health Department”, as well as an expert assessment, problem areas in the organization of paid medical services in the Russian Federation were identified.

The article is devoted to one of the founders of Russian, Soviet medical epidemiology, laureate of the USSR State Prize, corresponding member of the USSR Academy of Medical Sciences, Doctor of Medical Sciences, Professor Antonina Konstantinovna Shubladze. Based on the study of archival documents and the study of published materials, her scientific biography has been supplemented, her contribution to the formation and development of domestic epidemiology has been clarified. It is indicated that in the studied literary and archival sources it was not possible to identify information confirming the information that A. K. Shubladze was a representative of the Red Cross of the USSR in England in 1945—1947.

In commemoration of the 150th anniversary of Z. P. Solovyov's birth, which the medical community celebrates in 2026, this study presents an analytical review of archival documents and published scientific literature on the role of Zinovy Petrovich in the creation of the first domestic medical aircraft.

The article is devoted to the history of the spread of smallpox in the Voronezh province of the second half of the 19th century. The chronological scope of the study is defined as 1879 — 1896. Beginning: 1879 — the growth of smallpox epidemics, the assumption of office of the first city sanitary doctor of Voronezh M. Ya. Kapustin, formation of the city sanitary council; end: 1896 — appointment of the first sanitary doctor N.I. to the Voronezh province. Tezyakov and the initiation of centralized preventive events in the region, smallpox vaccination. Particular attention is paid to the topic of the population’s attitude towards vaccination, the need to explain to illiterate sections of society about the benefits of vaccinations and their impact on people’s health. Based on archival documents from the depositories of the Voronezh region, materials on morbidity and mortality of the population are analyzed, data on the number of people vaccinated against smallpox from 1880 to 1896 are provided.

The letters of N. A. Semashko to the local rural doctor E. A. Zakharova and other documents concerning her personality, introduced into scientific circulation for the first time, allowed us to expand our understanding of the range of interests of the outstanding organizer of Soviet health care at the turn of the 1930s and 1940s, to understand what he valued most in a specialist, what kind of help he could provide to a good local doctor. The professional merits of doctor Zakharova, her organizational talent, strong willed and human qualities are noted. The range of assistance provided by N. A. Semashko is shown: from simple advice on how to start work, to a personal visit to the site with an analysis of the main points of what was seen.

В литературе, как правило, большое внимание уделяется изучению отдельных аспектов освоения минеральных источников Северного Кавказа. Большинство авторов концентрирует свое внимание на регионе Кавказских Минеральных Вод, который и сегодня известен своими курортами. При этом обходится вниманием период начального изучения минеральных источников, начало которому было положено еще в XVIII в. при императоре Петре Великом. Кроме того, обойдены вниманием изучение и развитие бальнеологических ресурсов Северо-Восточного Кавказа в первой половине XIX в., когда на этой территории происходили трагические события Кавказской войны. Привлекая данные литературы, а также архивные документов из российских и зарубежных архивов в статье предпринята попытка рассмотреть параллельно развитие и изучение минеральных вод Центрального и Восточного Кавказа.

This article examines measures to combat cholera in the Nalchik District of the Terek Region from 1892 to 1910. It analyzes the role of doctors, state surveillance services, government agencies and the clergy in organizing anti cholera measures among the population of the district.