Bulletin of Semashko National Research Institute of Public Health

In recent years, for a number of life-threatening and chronic progressive rare (orphan) diseases, leading to a reduction in life expectancy of citizens or their disability, the powers to provide patients with drugs have been transferred from the regional level to the federal one. The most expensive diseases that have consistently formed the main financial burden for regional budgets since the creation of the List of the Government of the Russian Federation include paroxysmal nocturnal hemoglobinuria (Marchiafava-Mikeli), idiopathic thrombocytopenic purpura (Evans syndrome), other sphingolipidoses: Fabry disease (Fabry-Anderson), Niemann-Pick, as well as pulmonary (arterial) hypertension (idiopathic) (primary). In order to assess the impact on the budget of these diseases, an analytical decision-making model was developed that allows real-time calculation of how much federal budget funds will be required depending on the number of patients, the cost of drug therapy and the proportion of the patient population receiving a particular treatment. depending on the course of the disease. In addition, the developed model will make it possible to estimate at the regional level the necessary costs for drug provision for these diseases, if this authority remains at the level of the constituent entities of the Russian Federation.

The article presents a comparative analysis of the standard assurance of medical and genetic consultations according to the current and new orders of the Ministry of Health of Russia. Along with the identified positive changes in the new regulatory document, the authors note a number of controversial positions of the new order that prevent its implementation in healthcare practice. The document provides two possible indicators for establishing the majority of positions: the population and the number of births, and provides recommendations for using only one of these data. Such recommendations do not reflect the full scope of the work of the position and the institution as a whole. The implementation of the new labor standards, presented both at the federal and regional levels of government, will require an increase in the actual number of positions several times, which indicates the economic unreasonableness of the new document.

The article presents the scientific and practical contribution of the Sanitary House and malaria station to the organization of malaria control and prevention in the Saratov region in the 20s of the twentieth century. There are considered forms and methods of sanitary and educational work of employees of the House of Sanitary Education and doctors-lecturers aimed at improving hygienic knowledge and sanitary culture among urban and rural residents of the region.

During the Great Patriotic War of 1941—1945, forensic doctors took an active part in the investigation of fascist atrocities — conducted a survey of mass graves, places of execution, concentration camps, etc. But even after the end of the war, forensic medical experts encountered in their work the identification of the remains of Soviet servicemen. Forensic medical experts of the Stavropol Territory had to face the specifics of the study of the remains, which in most cases were not buried, but buried under ice. Members of the forensic medical examination went to the Marukhsky Pass — the place of discovery of the remains — to inspect them at the place of discovery and conducted an examination in order to establish the number of dead Soviet soldiers and determine the causes of their deaths.

Background. In the middle of the 20th century biotelemetry was intensively developing. It was a separate field of science which ensured a qualitative transition in the biomedical sciences. The formation and large-scale application of biotelemetry is associated with the names of a significant number of scientists. Preliminary studies revealed a significant contribution made by the scientific school of Professor L. I. Fogelson in terms of scientific development of methodologies for electrocardiography telemetry via radio. Objective: to study in detail and systematize the contribution of the scientific school of L. I. Fogelson in the development of biotelemetry in the USSR in the 1960s–1970s. Results. L. I. Fogelson is known as the leader of the scientific school in the field of electrophysiology cardiology medical and labor expertise. The scope of scientific works of the school is quite extensive. In the 1960s-1970s a separate scientific group is being formed within the school focusing on research in the field of biotelemetry. The technique of radioelectrocardiography has been improved and introduced as a method of scientific knowledge. The formal structuring of these researches included among other things the organization and financing of a separate research work the interaction of a scientific and medical center and an industrial enterprise and the training of scientific personnel. The results of many years of research are reflected in a number of articles and four dissertations. The process of generating two generations of disciples is noteworthy. Conclusion. Thanks to scientific research led by L. I. Fogelson it became possible to comparatively study the activity of the heart in a person suffering from certain diseases in the process of stress tests physical labor. The biotelemetric approach has led to qualitative changes in clinical medical science.

The COVID-19 epidemic is wreaking havoc on the health of the world's population and causing heavy economic losses. At the beginning of the pandemic (spring-summer 2020), the Samara region was in 6th place out of 15 regions with the highest number of cases. Based on the data of the Territorial Compulsory Health Insurance Fund for the Samara Region on the number of insured residents of the region, taking into account five-year age and sex groups and the register of payment for a completed case of treatment of the disease in medical organizations, a demographic and medical and economic analysis of the incidence of COVID-19 in the population of the region was carried out. Based on the results of the first wave of the pandemic, an epidemiological picture was compiled in order to understand the extent of the priority spread of the infection in various age and sex groups, areas of residence (urban/rural) and the cost of treating patients. The maximum number of cases is observed in the age groups from 30 to 74 years, regardless of territorial affiliation. The proportion of cases among the urban population of the Samara region amounted to 83.6% of the total number of cases, the rural population — 16.4%. The proportion of women who fell ill in the Samara region during the first wave of COVID-19 is 1.5 times higher than the proportion of sick men, in older age groups this difference increases by 2—3 times. The highest incidence of COVID-19 is observed in the age group of 55—59 years old both in the region and in the city, in rural areas — at the age of 50—54 years. The highest incidence rate among women in the region was noted in the age group of 50—54 years, among men — in 55—59 year olds. The share of costs for the treatment of patients with COVID-19 in the Samara region of the total cost of compulsory health insurance is on average 5% in the region. During the first wave of the pandemic under compulsory health insurance, the average cost of treating one patient for COVID-19 was 6—8 times higher than the average cost of treating one patient for all other diseases. The results of the study can be used to form evidence-based practical recommendations for planning resources and improving the organization of treatment, prevention and anti-epidemic measures in urban and rural living conditions.

Ensuring sustainability of healthcare system, its adaptation to new challenges and threats during the COVID-19 pandemic and restrictive measures imposed by international community in current political situation, achieving key goals of state programs in public health protection and promotion the health of the population of the Russian Federation require comprehensive interaction of public authorities with expert and civil society in order to exchange knowledge and search for the most effective management and organizational decisions. In this article, the authors consider the activities of a large-scale public movement of the ALL-RUSSIAN NATIONAL FRONT aimed at improving domestic healthcare through civil control over the implementation of the National project «Healthcare», the authors also present the results of a sociological study among patients and medical workers on the accessibility of medical care and staffing of the healthcare system, as well as identify the main problems of personnel shortage and offer expert proposals on how to solve it. This allowed us to draw a conclusion about the important role of social movements in the formation of state social policy in public health and healthcare.

Modern education is undergoing fundamental changes, primarily associated with digital transformation, due to the influence of the «challenge of the era». Features of the formation of the health of modern schoolchildren under the influence of new «digital» factors of the school environment determine the urgent need to improve school health care, designed to provide high-quality primary health care to students; in updating the complex of medical and preventive measures carried out at school, which determines the timeliness of this study. The purpose of this work is to consider the prerequisites for the need to modernize school health care in a digital environment. The paper shows the features of the state of health of modern schoolchildren studying in a hyper-information educational environment and the degree of involvement of school medical personnel in activities to ensure healthy learning conditions. The data obtained allow us to conclude that it is necessary to improve approaches to the prevention of school diseases in modern conditions and the timeliness of increasing the competence of medical staff of school health care on health risk factors for students in the «digital» educational environment.

The article substantiates the relevance of the problem of assessing medical activity and management effectiveness. The results of the conducted research are presented, the purpose of which was to develop and test a system of information support for quality management and efficiency of medical activity in a medical organization. The use of this system and the integrated assessment of medical activity can help to make decisions in the medical organization. In this study the following methods are used: analytical, statistical, comparative analysis, modeling, scientific experiment.

This article supplements the previously available knowledge about the main determinants of infectious diseases immunoprophylaxis in Russia. It is presented the National Calendar of Preventive Vaccinations in the Russian Federation which is updated in 2021. The main historical milestones of the USSR /Russia vaccination calendar changes are given from the moment of introduction to the present. A number of regulatory legal acts aimed at improving immunoprophylaxis in the Russian Federation have been analyzed. The article reviews various problems associated with vaccination refusals.

The article identifies the main types of factors affecting the growth of reproductive losses of the population. Based on the survey data, the main risk factors among respondents that could serve as predictors of the growth of reproductive losses and the occurrence and development of internal fetal malformations were identified and analyzed. An increase in the risks of reproductive losses was found in the presence of genetic disorders in close relatives, due to the age of a pregnant woman of 35 or more years and in the presence of psychoemotional overload. Anatomical abnormalities of the uterine structure and immune-hormonal disorders were identified as key medical factors. The main demographic and socio-behavioral risk factors of socially determined risks of reproductive losses and high levels of their prevalence have been identified. The results obtained were correlated to determine the odds ratio between individual risk factors and were used as the basis for creating a prognostic model of risk factors for reproductive losses of the population of residents of the Magadan region.

The article discusses the risk factors that affect the health and development of children, as well as presents questions on measures to improve the health of the child population. Data on the health status of children in various countries in recent years indicate a deterioration in the health status of the child population, with a trend towards an increase in the number of children with chronic diseases, functional abnormalities and physical development disorders. In this regard, the relevance of studying the patterns of the physical development of the child's body, its regional characteristics in association with socio-economic, demographic, hygienic, climatic and other factors seems undeniable. The physical development of the child's body is assessed using the main morphometric parameters. In recent years, scientific studies have noted negative trends in the increase in the frequency of disharmony of physical development, which in turn increases the risk of developing both major non-communicable chronic diseases and any other pathology.