[The personnel maintenance of primary health care physicians in condition of challenges from menaces to population health].

In condition of challenges from menaces to health due to COVID-19 the role of primary health care physicians increases that requires development of management decisions at the regional level. The purpose of the study. On the basis of analysis of medical demographic indicators and data concerning provision of primary health care personnel in the Russian Federation, proposals were made related to reforming of primary health care system in conditions of implementation of general medical practice with purpose to counteract menaces to population health. The analytical and statistical methods were applied. The official statistics data from the Minzdrav of the Russian Federation and Rosstat, results of original researches with content analysis and interpretation were used. The COVID-19 pandemic negatively impacted population health. The indicator of newly detected morbidity in the Russian Federation in 2020 decreased as compared to 2019 from 78024.3 to 75989.7‰oo (by 2.6%). This is the result of decreasing of dispensary and preventive activities among population. In next COVID-19 year (2021), as compared to 2020, indicator of primary morbidity increased to 85531.6‰oo that 12.6% higher than in 2020. The increase occurred in all classes of diseases that caused necessity of rehabilitation of these patients. The COVID-19 morbidity increased up to 2.4 times i.e. from 3391.1 in 2020 to 8085.7‰oo in 2021. The provision of physicians in the Russian Federation was 37.7‰o in 2021. Across the Federal Okrugs differences in indicators made up to 1.3 times and in subjects of the Russian Federation - up to 2.7 times. In conditions of COVID-19 significance of menaces to population health worsened. The situation requires both enhancement of primary health care and implementation of physicians of new formation - general practitioners responsible for patient health. The general practice (GP) widely developed in Russia in the 1990s during last ten years loses its significance in most subjects of the Russian Federation. In 2021, provision of general practitioners in the Russian Federation made up to 0.67‰o. In the Federal Okrugs, difference between indicators made up to 5.6 times. In the subjects of the Russian Federation the difference is enormous - 141.5 times. The article presents and scientifically substantiates prospective functional organizational models of general practice. The established situation with COVID-19 infection requires development of management decisions and measures at the regional level concerning improvement of organization of primary health care and implementation of general practice in conditions of counteracting risks of menaces to population health and health preservation.

[Public health risk threats associated with coronavirus infection in Moscow and the need to counteract].

PURPOSE OF THE STUDY: to determine the main threats to the health of the population of Moscow based on the analysis of the medical and demographic situation in Moscow and the Russian Federation in the context of the COVID-19 pandemic, in order to develop management decisions at the regional level. MATERIAL AND METHODS: Materials of the Federal State Statistics Service (Rosstat), as well as statistical collections of the Russian Research Institute of Health of the Ministry of Health of Russia for 2013-2022 were used. RESULTS: Coronavirus infection has changed the morbidity and mortality rates of the population of the Russian Federation and its constituent entities. In the Russian Federation mortality in 2019-2021 increased from 12.3 to 13.6‰, while in Moscow the increase in the indicator is significant - from 9.5 to 16.7‰. The incidence of COVID-19 in Moscow in 2020-2021 (over the two COVID years) increased from 6191.0 to 8976.0‰oo. The noted decrease in incidence rates across almost all classes of diseases during the COVID period (2019-2020) was associated with the lower medical check-ups and preventive activities, while during 2019-2021 there was an increase in disease incidence of the following classes: mental disorders, behavior disorders; diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism, etc., indicating the need for rehabilitation of this group of patients. CONCLUSIONS: The need to counter the threats to the health of the population of Moscow caused by the coronavirus infection requires the development of management decisions aimed at strengthening preventive activities and rehabilitation of patients in the post-COVID period.

[The problems of rural health care and prospects of development].

Further reforming of the rural health care should be proceeded with special attention to availability of medical care in countryside.The purpose of the study is to develop on the basis of analysis of accounting data and research results recommendations for improving organizational forms of medical care to country dwellers. The exploration of peopleware and main performance indicators of medical organizations in rural areas was implemented.The statistical, analytical and sociological methods were applied. The reporting forms 47, 30, 12 of Federal statistical monitoring are analyzed.Results. The provision of population with medical personnel in rural municipalities in 2010-2018 increased from 12.5 to 14.5 per 10 thousand of rural population. The provision with paramedical personnel made up to 52.3%oo and during the same years indicator decreased from 55.4 to 52.3%oo. During the analysis period, 4241 feldsher obstetric posts were reduced and in 2018 their number made up to 33,350. The number of feldshers in rural areas decreased on 18.5%. In 2005-2018 number of central district hospitals and district hospitals decreased in 2.5 times. At that, provision of beds in municipalities of rural areas decreased from 49.6 to 38.8%oo. There significant winding up of district hospitals and their restructuring into branches of central district hospitals occurred. In 2018, remained only 47 out of them equipped with 1549 beds. Unfortunately, the reporting forms of the Ministry of Health of the Russian Federation do not account branches of central district hospitals. This information is to be included in accountability of the Ministry of Health.It is necessary to expand scope of authority of local government bodies in resolving medical and social problems in rural territories.

[The suicidal activity and comorbid mental pathology in persons with gender dystrophia].

According to foreign publications, 58% of patients with gender disorders had additional psychiatric diagnosis, 39.3% had at least one suicide attempt. The data of suicidal activity and mental comorbidity in Russian population of transgenders are absent.Purpose of the study is to assess suicidal activity and mental comorbidity in persons with gender disorders.The retrospective analysis of records of patients applied with complains on gender disorders from January 2014 to April 2021 was applied. The demographic characteristics, life anamnesis, comorbid mental pathology at time of appliance, frequency of suicidal attempts, suicidal thoughts and auto-aggressive behavior were examined. The data of 926 patients with gender disorders were included: FtM 515 (55.7%), MtF 411 (44.3%). The median age of patients applied for care appliance was 24 years (13-65 years). In group of transgender patients 75.2% had no mental illness, except gender disorders. At that, there was high prevalence of comorbid mental pathology (24.8% on average). Usually, it was background mental illnesses and reversible mental disorders, which were not causes of gender disorders. The suicide rate in transgender group was 12.5%. For 1 patient with suicidal experience, there were 1.3 suicidal attempts (from 1 to 5). The significant dependence of increased suicidal activity, depression, auto-aggressive behavior and rate of comorbid mental pathology on age of debut of gender disorders was established. The transgender patients with debut of gender dysphoria in puberty age are most vulnerable to development of any mental pathology. The suicidal activity of patients with gender disorders depends on both social causes and presence of comorbid mental pathology. A number of modifiable risk factors for suicidal behavior were identified: support of relatives, external correspondence to associated gender, early steps to "change gender", earlier apply for medical care, background compensated mental illnesses.

[THE AGE-RELATED FEATURES OF THE MORBIDITY OF THE POPULATION IN THE CONTEXT OF THE COVID-19 PANDEMIC].

The COVID-19 pandemic has led to changes in all medical and demographic indicators, including changes in the incidence of the population. The article provides an analysis of the age characteristics of the primary morbidity of the population in the conditions of the COVID-19 pandemic. A pattern has been determined: the highest rates of primary morbidity in the conditions of the COVID-19 pandemic (for 2020) were determined in the age group older than working age. It was in this group that the highest incidence rates of COVID-19 were established. On the contrary, a comparative analysis of the primary morbidity of children (0-14 years old) in Russia as a whole in the «pre-pandemic¼ year (2019) and in the conditions of the COVID-19 pandemic (2020) showed a decrease in the level of this indicator by 13.9% (from 172455.1 to 148537.7 per 100 thousand population, р < 0.05). Among the child population, 1208.3‱ cases of COVID-19 were registered. Thus, in the Central Federal District, the indicators of primary morbidity of children were lower than the general.

[The results and perspectives of primary health care reforming in Moscow].

The primary health care is characterized by its directivity to population health, while general practitioner is key figure in its organization and is responsible for assigned population health. The Russian Federation continues to suffer from overspecialization of medical care in outpatient health care. At that, the number of unreasonable visits to medical specialists is too high. The general practitioner, with appropriate training, can appoint patients by 11 specialties and in conditions of municipal polyclinic can undertake up to 81% of visits to medical specialists. The purpose of the study is to evaluate primary health care functioning in Moscow and to formulate proposals for reforming health care, considering development of general medical practices in a metropolis. The study was focused on analysis of morbidity of population of Moscow, on support of out-patient health care with physicians before and after implementation of three-level system of ambulatory polyclinic care, on evaluation of preventive activities of general practitioners and on development of proposals for improving organizational forms of activities with emphasis on health preservation. In the study were applied such methods as statistical, direct observation, sociological. The analysis was applied to forms of federal statistical observation i.e. form № 30 in Moscow and the Russian Federation for 2010-2019. The population sociological surveys concerning satisfaction with medical care were carried out. The research base was Moscow. The analysis demonstrated that results of Moscow health care system reformation is economically effective because of shortage of medical personnel primarily of administrative staff and its rational employment. The reformation results were positively assessed by patients, whose satisfaction with medical care made up to 95.6%. The general practitioner is to be responsible for health status of attached population and is called upon not only to carry out treatment and preventive activities, but also to coordinate organization of medical care of attached population at all stages of its provision. The implementation of general medical practice in conditions of municipality is to calculate complete transition of medical organizations providing out-patient medical care to general medical practice, that will result to certain extent, in reduction of staff positions of medical specialists. It is necessary to expand duties of medical nurse in general practice. The optimal model of joint work of general practitioner with feldsher and medical nurse of general practice. The complex general practice team can include medical registrar. The proposed perspective models permit to implement integrating role of general practitioner and to increase accessibility and efficiency of primary health care.

[Personalization of Nordic walking programs in a sanatorium-type medical center]. / Personifikatsiya programm skandinavskoi khod'by v usloviyakh meditsinskogo tsentra sanatornogo tipa.

Nordic walking is a wellness technology available to people of all ages with varying fitness levels and health conditions. The greatest health strengthening effect when using it is achieved in those cases when the program is personified depending on a specific disease taking into account the current functional state of the body and system-forming parameters of activity including the initial vegetative tone. OBJECTIVE: To assess the effectiveness of Nordic walking in adolescent 15-17 years old depending on type of initial vegetative tone and the time of the lessons. MATERIAL AND METHODS: It was examined 60 adolescents aged 15-17 years of the II health group including 30 persons with vagotonic and 30 persons with sympathicotonic type of initial vegetative tone. In each groups the subgroups were identified who were engaged in Nordic walking from 8:00 to 9:00 (morning subgroups, 15 teenagers) and from 18:00 to 19:00 (evening subgroups, 15 teenagers). The course included 21 sessions of 45 minutes daily. Heart rate variability, the level of self-esteem according to D. Keirsey, well-being, activity and mood according to the SAN method, subjective load tolerance according to the Borg scale and general physical endurance according to the results of a test with a 6-minute run were assessed. RESULTS: A significant positive effect was observed with the differentiated use of Nordic walking taking into account the type of the initial vegetative tone and the daily rhythm of physical activity. In adolescent vagotonics training in the evening according to the analysis of heart rate variability, the functional reserve and activity of regulatory systems increased with a tendency to normalize the sympathetic-parasympathetic balance, the indicators of the psychological sphere improved, physical endurance increased, as well as the motivation for training and their subjective tolerance. In sympathicotonic adolescents, a similar positive effect of Nordic walking took place when exercising in the morning. A different distribution of training time (morning hours for vagotonics and evening hours for sympathicotonics) was accompanied by tension in the work of the autonomic nervous system apparatus caused disharmony in the emotional state, did not lead to an increase in physical endurance and worsened subjective load tolerance. CONCLUSION: When planning a course of Nordic walking in adolescents it is necessary to take into account the type of initial vegetative tone and choose the right time for classes: with vagotonia they should be carried out in the evening, with sympathicotonia - in the morning.

[The medical social characteristics and evaluation of life quality of patients with diseases of blood circulation system].

The increasing of longevity and quality of life and population health are considered as the most important component of human development index. The diseases of blood circulation system have leading rank in morbidity, disability and mortality of population of Russia representing one of the most actual problems of health care. The diseases of circulatory system negatively effect on physical and mental health, emotional conditions and social components of life activities. All the mentioned results related to cardiovascular diseases can be detected and measured through evaluation of indices of life quality of patients. In Russia, the directive documents and national programs concerning health care modernization were adopted to rectify the unfavorable medical demographic situation on national level through decreasing of mortality, morbidity and disability due to diseases of circulation system. The purpose of the study is to analyze social hygienic characteristic and life quality of patients with diseases of circulation system during 5 years prospective cross-sectional medical statistical study in the Nizhni Novgorod Oblast at the base of the "Specialized Cardio-surgery Clinical Hospital" of Nizhni Novgorod. The study included all patients with certain corresponding criteria of involvement being at hospital treatment in the pilot medical organization. The sampling included 420 patients. The life quality inventory SF-36 and questionnaire were applied to respondents during their first and control (5 years later) visits. The questionnaire covered social and working status, presence of risk factors of cardiovascular diseases. The study demonstrated that among respondents made no control of cholesterol level 40.3%, arterial blood pressure - 16% that determines necessity of amelioration of sanitary education activities of population. The low level of income (less than 6000 rubles per one member of family) was marked by 42% of respondents. At that, 77% had financial problems with medications purchasing that testifies necessity in co-financing with the state. The results of the study testify the positive impact of implementation of target programs of prevention of cardiovascular diseases on the life quality of patients in the pilot subject of The Russian Federation. The original technique of sociological surveys and evaluation of life quality of patients can be applied at the regional level in development of managerial decision making.

[The effectiveness of the spa and resort-based health-promoting treatment of the schoolchildren under conditions of the continuous academic process].

Two groups of schoolchildren were included in the present study; 59 of them were allocated to the experimental group while 66 others comprised the control group. All of them were examined to estimate psychological, psycho-physiological and physiological effects of the health-promoting treatment basedon a local health resort. Mean reaction time and mean root square deviation of this parameter determined with the use of the noise-immunity test improved significantly in both groups, but the number of 'late reaction' errors declined only in the experimental group. The analysis of the heart rate variability at rest demonstrated a significant increase of the total power spectrum as well as its very low-, low-, and high-frequency components in the supine position only in the experimental group but not in the control one. Moreover, the mean duration of cardiointervals also increased. The physical working capacity test showed a significantly enhanced working capacity in the treated children. The orthostatic test revealed an increase in the ratio of low-frequency/high-frequency components and a relative increase of the high-frequency component in the experimental group the amplitude of the transition process in the control group. The results of the study confirm the overall positive effects of the health promotion in schoolchildren presenting with heart rate variability treated at the local health resort on their psycho-physiological and physiological conditions, with the heart rate variability patterns being the most informative objective criteria of the physiological responsiveness.

[The economic culture of medical institution as the factor of innovative development].

The article presents the results of study of economic culture of sanatorium type medical institution based on the analysis of its components sorted out with specially developed procedures. The medical organizational pattern of enhancing the economic culture of sanatorium type medical institution was proposed. It's effectiveness was checked in the medical organizational experiment.

[Efficiency of medical and economic activities of a sanatorium-and-spa facility in the active phase of the public health system reform under macroeconomic instability].

Results of a comprehensive study have demonstrated that the reform of the public health system currently underway in this country provides conditions for the extension of medical care based at sanatorium-and-spa facilities with simultaneous rise in relevant expenses. Bearing in mind the unstable macroeconomic situation, this requires thorough monitoring medical and economic activities of health resorts for the purpose of enhancing cost efficiency. The goal of optimization can be achieved by increasing competitive capacity based on strict control of expenditures and income redistribution for financing the most promising projects.

[Use of physiological reparation regulators in glaucoma surgery: a clinicoimmunological study].

The paper presents the comparative results of clinical and immunological studies dealing with the use of the physiological reparation regulators (the human amniotic membrane and systemic enzyme therapy) and the antimetabolite 5-fluorouracil (5-FU) to prevent excessive ocular tissue scarring. The clinical observations have demonstrated the high efficiency of the proposed methods for the physiological regulation of reparative processes as compared with the use of 5-FU, which manifested as a more marked normalization ofophthalmotonus and fewer numbers of postoperative complications. The investigation of the study of proliferation-activating cytokine (TGF-beta1) and antiprolerative cytokine (IFN-gamma) has demonstrated the immunomodulating properties of the physiological reparation regulators used in the present study.