Bulletin of Semashko National Research Institute of Public Health

In the presented work, the issues of insurance medical literacy of patients are considered — a functional subsection of the concept of literacy in health issues. Many citizens who have compulsory and/or voluntary health insurance policies do not have the knowledge to understand and effectively use their insurance programs. The article presents a review of foreign sociological studies of a high degree of representativeness, reflecting the level of insurance medical literacy of patients and the need for its systematic formation.

Drug provision of patients with oncological diseases is in the focus of attention of federal and regional health authorities. The provision of patients with drugs depends not only on financial constraints, but also on its legal regulation and organization of the process. The article analyzes preferential drug provision for patients with malignant neoplasms, as well as the problems of its legal regulation.

Introduction: The attempts to improve the treatment efficacy of diabetes mellitus have led to the development of continuous subcutaneous insulin infusion systems (CSII). Nevertheless, the data on the duration as well as on the discontinuation rate of CSII is limited. Aim: to evaluate the outcomes of insulin pump therapy including the effects on diabetes management and discontinuation rates. Materials and methods: Adults with diabetes mellitus who were switched on insulin pump therapy in Moscow Region in 2015—2019 years. The data about the carbohydrate state and pump therapy discontinuation was received by personal visits, by phone calls or from medical records. The follow-up period was 36 months. Results: Data from 455 patients were received. About 275 (60,4%) patients continued CSII therapy during the first 6 months, but in 36 months only 171 (37,6%) continued the treatment. The main reasons reported were the high cost of monthly consumables (57,6% of patients) and not feeling comfortable wearing the device (29,7%). There was a correlation between monthly consumables supply, diabetic proliferative retinopathy (DPR), and insulin pump discontinuation. Thus, the duration of pump use in patients who were supplied with monthly consumables within state guarantee was 30 ± 1,1 months, in those without supplementation — 16,4 ± 0,9 months (p<0,01). The mean duration of pump use in patients with DPR was 14 months, in those without DPR — 18 months (р=0,031). The level of glycated hemoglobin decreased on almost 0,6% in insulin pump users during 36 months follow-up (p<0,01). Conclusion: Despite the increasing accessibility of insulin pumps the current regulatory documents don’t match in several essential aspects, that may lead to the decrease in the effectiveness of therapeutic interventions.

Significance. Reproductive health is one of the most important indicators of public health, an integral indicator of the health of the nation and the most important indicator of public health. The purpose of study is to provide up-to-date and generalized information about the concept of reproductive losses of the population of the region and related risk factors. Material and Methods. The study is based on official data of the International Health Organization, clinical recommendations and data from systematic reviews published in the databases PubMed, Google Scholar, Elibrary.ru and the libraries of the N. A. Semashko National Research Institute of Public Health. The analysis was carried out using the keywords «the concept of reproductive losses», «reproductive losses of the population» to identify contradictions in existing approaches. In addition, for a systematic review, the study selected papers in English and Russian that contain a description of the risks of reproductive losses. Results. As a result of the study, 3 international medical documents and protocols and 19 articles were analyzed, to which the concept of reproductive losses and their classification were defined. In addition, these studies included medical, social and psychological risk factors for reproductive losses of the population in a total of 6919 women. In the course of individual studies, a total of 12 associated risk factors were identified. Conclusion. It is proposed to expand the concept of reproductive losses of the population taking into account infant mortality and medical abortions, as well as to include medical (including genetic factor), social and psychological factors at the stage of pregnancy planning in the system of risk control of reproductive losses. Scope of application. Family planning centers, maternity hospitals, family planning centers.

Inequality in access to medical services directly affects the health of the population and is one of the most significant social problems. The sources of its formation are not only a significant gap in the amount of monetary incomes of the population, but also significant territorial inequalities in the provision of the population of cities and rural settlements with medical organizations and their services. Paid medicine remains virtually inaccessible to low-income groups of the population, which further exacerbates inequality in access to medical services, especially in rural areas. This work is aimed at identifying the features of the socio-demographic portrait of users of paid medical services and their behavioral strategies regarding their health. On the example of the Vologda region, based on the data of a representative regional sociological survey, it is shown that the main proportion among users of private clinic services are urban residents aged 30—60 years with an average income level and only 8% are residents of rural settlements. At the same time, the behavior regarding their health among respondents using paid and free medical services has a number of features. This suggests that the behavior of the selected groups of respondents, along with socio-economic factors, contribute to the formation of inequality in their health.

The article is devoted to the anniversary of the prominent Soviet physiologist, one of the pioneers of the creation of the national scientific school of labor physiology and psychophysiology of feelings K. Kh. Kekcheev. On the basis of a few archival materials, rare literary publications, his biography was clarified, as well as the scope of his scientific and social activities was supplemented, important personal qualities of the scientist were revealed. The high organizational abilities of K. Kh. Kekcheev, his creative potential were noted, which allowed him to be repeatedly involved in the implementation of scientific projects into practice, the creation of new research organizations. Special attention is paid to K. Kh. Kekcheev's research during the Great Patriotic War of 1941—1945, his contribution to the development of topical problems of military medicine and recognition of his scientific achievements abroad. It is also noted that K. Kh. Kekcheev had an original quality of popularizing new scientific knowledge and achievements.

Since the second half of the 20th century, research on the ion-regulating function of the kidneys, in particular the mechanisms of regulation of such ions as sodium, potassium and magnesium, has become widespread throughout the world. This review is devoted to the history of studying the mechanisms of regulation of potassium homeostasis in the second half of the previous century. When preparing the review, publications of foreign and domestic researchers included in the PubMed and eLIBRARY databases were studied. The existence of tubular secretion of potassium has been proven. Later, the hypothesis of direct exchange of cations in the distal tubules was put forward and experimentally proved. In the 1970s the renal and extrarenal mechanisms of tubular potassium transport have been described in detail. At the same time, domestic researchers proposed and experimentally confirmed the hypothesis of the existence of a reflex system for the regulation of potassium homeostasis; the reflex and hormonal mechanisms of regulation, as well as ontogenetic features of potassium transport, were studied. Thus, by the end of the 20th century, a clear picture of the regulation of potassium homeostasis was formed both at the level of the whole organism and its individual structures.

The rise of public health care in Germany was part of a modernization process, the first product of which was the state. As part of the cameralist policy of encouraging population productivity, the dignitaries of Prussia and other German states began to establish special authorities responsible for the health and well-being of the population as early as the late seventeenth century. The 18th century saw a bureaucratization of health management methods, with district doctors (Kreisphysickus) as representatives in the field. They were entrusted with a wide range of administrative responsibilities, but their social status remained low. Some of the district doctors became known as the authors of treatises on medical police, presenting their views on the development of public health. Their theories, however, were far removed from actual practice. The situation began to change only after 1848, when political events in Germany prompted a new generation of physicians to vigorously demand political, social and medical reforms.

The article presents brief biographical data and the main directions of research work of scientists who performed their dissertation research under the guidance of Professor Alexey Ivanovich Doinikov, Head of the Department of Propaedeutics of Orthopaedic Dentistry at the Moscow Medical Dental Institute. According to the authors, representatives of the scientific clinical school of A. M. Doinikov should be considered B. P. Markov (Moscow), E. S. Kalivrajiyan (Voronezh), V. V. Parilov (Krasnoyarsk). Parilov (Krasnoyarsk), S. E. Zholudev (Sverdlovsk), V. M. Zotov (Samara) — these professors, working in different cities of Russia, continued and creatively developed the scientific research in the field of orthopedic dentistry initiated by him.

The paper discusses the impact of I. M. Sechenov's research and teaching efforts on the spread of interest in physiology within the academic world and in society at large during the second half of the 19th century. I. M. Sechenov insisted on the importance of developing experimental methods and laboratory research, and was a consistent popularizer of Charles Darwin's theory. His scientific inquiries were discussed and supplemented by the work of other scientists, contributing to a gradual change in the concept of what is man. The problem of what place a human occupies among living organisms, what causes certain features received answers in natural science discourse, and later in popular medical literature for the people.

Immunization covers a large proportion of the population compared to other health services at the primary health care level, its standard operational use, distribution and safety vary among different populations in different countries, including Nigeria. The results of evaluating the effectiveness of training of health workers and measuring the level of improvement in relation to immunization coverage in Oron Local Government Area of Akwa Ibom State, Nigeria are outlined. This is beneficial for the country and will save lives, protect the health of the population and is a faithful investment in the health of the country's population with epidemiological disadvantage.

The article analyzes the main indicators of disability due to diseases of the visual organ in a specific region — the Arkhangelsk region, where the rate of aging exceeds the average in the Russian Federation (23%). All cases of primary disability due to diseases of the visual organ are analyzed and characteristics are given by gender, age group, nosology, which is the main one when receiving disability. In the structure of general disability, eye diseases occupied the 5th-7th place from 2018—2022. Primary disability of the elderly population is characterized by the prevalence of the age group of 70+ years. The average age of disability in old age is 74 years. Primary disability is mainly represented by group 1, which indicates a high maladaptation of the elderly. Among those who received groups 1 and 2, males predominate. The data can be used for effective planning of therapeutic and preventive measures, improving the effectiveness of early diagnosis of conditions and reducing the number of elderly.

The article discusses the main aspects of the training of scientific and scientific-pedagogical personnel in graduate school. There are presented the main requirements for the new concept of postgraduate studies, as well as the problems are identified and the ways to improve the training of postgraduate students in modern conditions are proposed. The article analyzes the current legal documents governing the admission and training of personnel in graduate school, presents the experience of the Leading Researcher Federal Scientific State Budgetary Institution «N. A. Semashko National Research Institute of Public Health», and concluded that increasing the requirements for the organization of admission to graduate school, the procedure for appointing a supervisors and their interaction with graduate students are the main aspects of increasing the efficiency and effectiveness of scientific graduate school.

Introduction: In the Russian Federation, significant changes have taken place in the legal field of healthcare over the past decades: a large number of regulatory legal acts regulating the activities of medical organizations have been adopted and approved, putting the quality and accessibility of medical care in the fundamental principles, placing emphasis on the satisfaction of the population with the quality of medical care received (satisfying the needs of the population). The aim of the study was to study the legal regulation of the stages of development and formation of a new primary health care system based on the activities of a general practitioner/family doctor and factors affecting the social effectiveness of health care in terms of satisfaction. Materials and methods: The methodological base of the study is represented by regulatory documents; WHO documents; publications of foreign and domestic authors; an analysis of more than 11 Russian regulatory documents of the federal and departmental level from the electronic fund of legal and regulatory and technical documents «Consultant+», valid and amended from 1992 to 2019. The assessment of the social effectiveness of healthcare in terms of «satisfaction» was carried out on the basis of international WHO recommendations (2018). Conclusion. It is shown that the development of PSMP in the country is consistent with international legal acts and is aimed at increasing the importance of general medical practice for the entire population and patient satisfaction with the quality of medical services provided. In the system of assessment and organization of medical care, the satisfaction indicator is a general indicator of the social effectiveness of healthcare, indicating the goals of increasing the healthy life expectancy of the population, life expectancy, reducing the mortality and disability rate of the population and ensuring state guarantees related to these rights. In their research, the authors focused on the selection and analysis of the development of methodology and methods for assessing the satisfaction of GPS and patients, contributing to motivate the professional activity of a general practitioner and the economic efficiency of management decisions.