[The review of the book "The general practitioner (the family doctor)" in three volumes by R. S. Gadzhiev].

The review analyzes formulated and proposed by prof. R. S. Gadzhiev genuine original comprehension of ways of enhancement and perspectives of development of primary health care by leading role of general practitioner in its development. The author fundamental postulate about priority of complex implementation of all aspects of activity of general practitioner to enhance quality and efficiency of primary health care in Russia is discussed.

Levamisole-associated multifocal inflammatory encephalopathy: clinical and MRI characteristics, and diagnostic algorithm.

Levamisole-associated multifocal inflammatory encephalopathy (LAMIE) is a devastating adverse effect of levamisole (LEV) treatment. In Russia, people often use LEV without a doctor's prescription for anthelmintic prophylaxis. LAMIE often misdiagnosed as the first episode of MS or acute disseminated encephalomyelitis (ADEM). The aim of our study was to describe clinical, laboratory and morphological characteristics of LAMIE, magnetic resonance imaging (MRI) patterns and create an algorithm for the differential diagnosis. This study was a prospective observational study with retrospective analysis of cases. It was performed at two hospitals with ambulatory service for MS. We included 43 patients with LAMIE with follow-up was from 1 year to 5 years. Age was 19-68 y.o. with female predominance. The most typical manifestations of LAMIE were cerebellar, pyramidal and cognitive symptoms, and majority of patients had biphasic course of the disease. Three main types of MRI patterns were described: ADEM-like, MS-like, atypical demyelination. About 40% of patients had CSF specific oligoclonal bands synthesis, but only 20 % of them converted to MS during the period from 1 month until 2 years. The CSF albumin levels and immunoglobulin G index were elevated in LAMIE patients compared to reference values. We described results of brain biopsy in two cases. Therefore LAMIE should be considered in patients with demyelinating or inflammatory conditions with biphasic onset of the disease and variable MRI presentation.

[S. A. Tomilin on the issue of placement of human personality and its health in social hygiene].

The article discusses the placement of personality and its health in early Soviet social hygiene. It is demonstrated that central position was assigned to analysis of integrated arrays of health statistical data of total population and its large groups. The individual health of personality as research object was shifted to periphery of interests of social hygienic science. On the example of works of S. A. Tomilin, the potential areas of enhancement of social hygienic comprehension of human health problematic are established.

[On the Methodology of Studying Organizational Technologies of Health Preservation].

The article considers methodological studying of problematics of health preservation and its organizational technologies. The health preservation is considered in the context of public health policy. The necessity of complex interdisciplinary and longitudinal approach to studying this problematic is substantiated. The results of analysis of semantics of key concepts of health preservation are presented. The patient-centralized principles of activities and communication as applied to health preservation are substantiated. The differentiation between concepts of "value" and "utility" of organizational technologies of health preservation for health are discussed. The possible areas of studying positioning of health preservation in the system of personality values, including health culture, are proposed. The possible structuration of factors determining health condition and healthy life-style are proved. The scope of principles and approaches for subsequent elaboration of methods, standards, instruments and regulations of complex methodology of studying issues of health preservation and its organizational technologies are established.

[The organization of medical nurse support of patients of elderly age in geriatric practice].

In recent years, the concept of nursing process has been actively introduced. It is especially important in geriatric practice, where the issues of nursing support prevail over those in the young and middle age. There are forms of organization of care, where it is the average medical staff is leading in the provision of medical care (hospices, nursing care hospitals, homes for the elderly, etc.). In these conditions, the responsibility of nurses in making and implementing medical decisions in the event of emergency conditions increases.

[The characteristics of application of computer registry in organization of ambulatory polyclinic care of patients with iron-deficiency anemia].

Anemia is a clinical hematological syndrome and also a risk factor for the adverse outcome of many chronic somatic diseases. To assess effectiveness of out-patient polyclinic care for patients with anemia, the computer program "Patient Monitoring System with Anemic Syndrome" was used. The study included 1498 patients (males - 491; females - 1007) aged from 18 to 80 years old, who were under medical observation by general practitioners. The prevalence of anemic syndrome in different age and gender groups varied from 11 to 58%. Statistically significant differences between subgroups of men and women were found in the categories 18-30 years, 31-40 years and 41-50 years. In adult patients of working age, anemic syndrome during routine examination was detected in 37% of cases of seeking outpatient medical care (anemic syndrome in women was three times more common than in men). In patients older than working age, the prevalence of anemic syndrome was lower and averaged 25.7%. In the structure of anemia, 48.4% are hypochromic, 5.4% are hyperchromic, 46.2% are normochromic. The study for serum iron was prescribed in 33.9% of cases of hypochromic anemia, in 22.5% of cases of normochromic anemia and in 11.1% of cases of hyperchromic anemia. Serum iron was detected in every second patient with diseases of the urogenital system, every third patient with neoplasm. Therapy with iron preparations was prescribed in 30.6%, and the administration of vitamin B12 - in 1.4% of cases.

[Chronic right ventricular failure in a patient with diffuse toxic goiter and alcoholic cirrhosis of the liver: case description].

We present a case of a patient with pronounced edematous­ascitic syndrome. Initially, its causes were considered to be alcoholic cardiomyopathy (right ventricular failure) with heart rhythm disturbances and liver cirrhosis. Targeted treatment had a low clinical effect, which served as a basis for revising the diagnostic concept. Subsequent follow­up revealed a diffuse toxic goiter with the predominant right ventricular lesion. Achieving euthyroidism has led to a significant improvement in the patient's condition.

[The methodology of complex social hygienic investigation of various groups of population and families (In memoriam of professor O. V. Grinina)].

The article expounds main principal positions of professor O. V. Grinina scientific educational methodological school of social hygienic investigations of health of population and family. The methodological analysis of scientific works of professor O. V. Grinina and her disciples was implemented to demonstrate key positions and results of studies constituting scientific school of program methodological basics of complex social hygienic studies of population health, health care and conditions of life of families. The purpose of publication is to characterize indications of the school of complex social hygienic investigations of priority population groups and families. These issues are covered by thematic fundamental works substantiating patterns of formation and estimation of health of families, program methodological issues of complex medical social studies of family and its individual members, availability of large group за disciples developing priority issues of investigation of population health at the level of family and organization of medical care based on the principles of per family observations, general (family) medical practice. The results are demonstrated and patterns are established containing in implemented complex social hygienic per family studies of various population groups, women, children and families in 1970s-1990s. The methodological significance of valid family-focused technologies in new social economic conditions of development of society and health care and principles of curative preventive activities in conditions of mandatory medical insurance are demonstrated. The professor O. V. Grinina substantiated and developed program of medical social characteristic of family. its sections and methodology of long-term continuous monitoring of family. She also determined characteristics of health of family as a group patient, principles of work of out-patient physicians with families directly at the polyclinic district.

[The medical ethical aspects of organization of medical rehabilitation].

The article considers such aspects of organization of medical rehabilitation care of population as accessibility, quality, social efficiency from perspective of medical ethics. The quality of diagnostic, prevention and treatment of diseases is affected by qualification of medical personnel that is applied both to areas of clinical medicine and health care management. The specialists are to apply common principles and standards of health care. Among them are support of valuable quality of medical care under optimal application of available resources and observance of medical ethics standards. The Republic of Dagestan is anagrarian region where 55% of population resides in rural area and most of health care resources are cumulated in urban area. The indices of health of population residing in rural area are in many parameters worse than in urban population and provision of medical institutions with medical personnel is low. The specialized medical care support including medical rehabilitation, of rural population, is provided without additional managerial decisions and is much more difficult as compared with patients residing in urban area. Hence in conditions of necessity of optimization of resource support of health care system functioning no extensive development of possibilities of medical rehabilitation is possible in rural residents of Dagestan.

[On the Issue of Labor Conflicts Control in Medical Stuff].

The article presents the results of study of inter-personal conflicts in medical staff. The awareness of psychological causes of development of conflicts, their dynamics and methods of counteracting, psychological characteristics of conflicting personalities permits to implement their prevention and outcoming. The particular attention is paid to types of reaction of personalities and their behavior in conflict situation and acquiring of full information about conflict to find out the most rational modes of their regulation.

[The Modern Approaches to Development of the System of Working Population Health Protection].

The article presents the results of expert appraisal of corporation approaches to protection of health of workers, role of social partnership and measures of incentives to implementation of programs of development of healthy life-style at enterprises. The results of study of modern approaches of Russian companies to protection of health of workers permits to establish availability among employers of significant potential for amelioration of health of working population. It is most expressed among large companies and is expressed in development on the following main directions: evaluation of health of workers, evaluation of industrial risks, organization of medical care, organization of sanitary anti-epidemiological activities, formation of healthy life-style. To stimulate employers to implementing corporation programs combining priorities of business and state, development of national standard or model intersectoral program considering best practices of companies-leaders. The experts emphasized importance of development of standard of medical specialist of management of health protection of workers. Their competences are to bypass the framework of occupational safety and include skills in personnel management, economic efficiency calculation, development of complex programs of protection and promotion of health of workers, including healthy life-style.

[The Medical Rehabilitation: History and Definitions].

The article considers the positioning of medical rehabilitation in the health care system. The position of world Health Organization related to significance of rehabilitation for health is demonstrated. The main concepts and definitions of medical rehabilitation are analyzed in details.

[THE MEDICAL EDUCATION AND GLOBALIZATION CHALLENGES].

The article considers actual issues of medical education initiated by globalization. The impact of globalization on medical education has multi-vector, multi-factor, multi-directional, parallel and cumulative character. This singularity merges all factors, effects, changes and processes adding by globalization to medical education into heterarchy system formed by crossing, manifold, and simultaneously coexisting structures. The alterations of systemic conditions of functioning of medical education as priority of economic principle, substitution of notion "medical care" by "medical service", diseases of rich and diseases of poor, uncertainty factor, chaotization, priority of applied medical knowledge, individualistic paradigm of medical training are considered. The role and value of the World directory of medical schools in international medical organization is demonstrated.

[The primary medical sanitary care and characteristics of drinking water supply of population].

The article considers characteristics of organization ofprimary medical sanitary care on territory with carcinogenic risks related to drinking water supply as exemplified by the Orlovskaia oblast. The importance of registration by local health authorities the sources of permanent chemical pollution of drinking water. The analysis of the State program of the Orlovskaia oblast "The development of health care in the Orlovskaia oblast in 2013-2020". The necessity of additional inclusion of issue related to healthy drinking water supply of population to prevent development of malignant neoplasms and prevalence of oncologic morbidity on oblast territory.

[THE CERTAIN TENDENCIES OF MODERN MEDICAL ETHICS].

The article analyses such tendency in modern foreign medical ethics as paying particular attention to relationship physician-society. The modern tendency to entrust physicians with main responsibility for expenses control and economical expenditure of health care resources is considered The analysis is founded on publications of World medical association and codes of medical ethics of the USA and Canada.

[The development of strategic management of high-tech surgical medical care].

The high-tech surgical medical care is one of the most effective types of medical care in Russia. However high-tech surgical treatment very often is inaccessible for patients. The development of basics of strategic management of high-tech surgical care makes it possible to enhance availability of this type of care and to shorten the gap between volumes of rendered care and population needs. This approach can be resulted in decrease of disability and mortality of the most prevalent diseases of cardio-vascular diseases, malignant neoplasms, etc. The prerequisites can be developed to enhance life quality and increase longevity of population.

[The health policy as a problem of comprehension].

The article deals with the issues of health policy elaboration in the framework of scientific philosophic concept of comprehension. The validity of application of criterion of mode and criterion of compliance in assessment of health policy effectiveness is justified The key role of managerial blocks of commitments assumption and responsibilities performance in health policy strategic management is demonstrated. The importance of incorporation of component of moral appropriateness of health activities into health policy design is emphasized.

[Ergoferon and oseltamivir in treatment of influenza: results of multicentre randomized comparative clinical trial].

The narrow range of choice and virus resistance to the most common drugs require search and introduction of new drugs with proven efficacy and safety for the treatment of influenza. Ergoferon is a new combined medicine containing release active antibodies to interferon-gamma (anti-IFNgamma), CD4-coreceptor and histamine. The formulation influences various links of antiviral defense and provides antiinflammatory effect. The efficacy of the drug is related to its production process during which multiple reduction of the initial concentration of every component leads to release of special release activity. Previous experimental studies showed that anti-IFNgamma had antiviral activity against pandemic influenza virus A (H1N1) 2009 comparable to that ofoseltamivir (suppression of virus replication in the lung tissue, increase of the lifespan and reduction of the laboratory animals mortality). The aim of the multicentre randomized clinical trial was to compare (versus oseltamivir) the efficacy and safety of ergoferon in the treatment of influenza in adults. 213 patients with flu-like symptoms were examined in 8 medical centres of Russia during two epidemiological seasons (2010-11 and 2011-12). The inclusion criteria were: the first 48 hours after the onset; fever > or =37.8 degrees C, at least one common symptom and at least one respiratory symptom. Influenza was confirmed in 52 patients by QuickVue rapid diagnosis. 23 patients received ergoferon according to the treatment scheme and 29 received oseltamivir (daily dose 150 mg). Duration of the treatment was 5 days. The patients were followed up for 7 days. The primary endpoint was the percentage of the patients with the body temperature normalization for 2-5 days of the treatment. The maximum efficacy of ergoferon was observed on the second day of the treatment: almost half (48%) of the initially febrile patients had normal body temperature (versus 28% in the patients treated with oseltamivir). The comparison of the two groups of the patients by the morning and evening measurements of the body temperature every five days of the treatment by Cochran-Mantel-Haenszel revealed a significant difference between the two groups (chi2 = 7.1; p = 0.008). The average duration of the fever in the group of ergoferon was 2.3 +/- 1.2 days, in the group of oseltamivir--2.6 +/- 1.3 days (the efficacy of oseltamivir in the present study was comparable with the previously published data). The percentage of the patients treated with antipyretics because of hyperthermia on the second day of the treatment lowered 3 times and amounted to 17% (versus 41% in the oseltamivir group). The severity of common and respiratory symptoms (nose/throat/chest) significantly decreased on the third day of the treatment in both groups, the majority of the patients had either minimum severity or no signs of influenza. The clinical improvement was associated with positive changes in the life quality. No cases of the disease aggravation were recorded. Complications requiring antibiotic treatment or hospitalization were not observed during the followup. There were no adverse events recorded due to the drug use. No deviations in the laboratory indices were stated. Ergoferon is a new safe drug for the treatment of influenza. Its clinical efficacy was comparable to that of oseltamivir. The therapeutic effects of the drug were evident from: significant reduction of the disease severity, duration of febricity and general toxicity and respiratory flu symptoms, lower percentage of the patients with fever for 2 days. The febrile period in most of the patients did not exceed 2 days.

[On the role of the state-private partnership in public health].

The article deals with the issues of study of state-private partnership in the framework of development of strategic measures of regulation of this area in public health. It is demonstrated that the regulation of state-private partnership has to combine the dynamism inherent in entrepreneurship and the public stability needed for normal public health functioning. The control functions of state authorities in the area of public health policy developed into concept of "supervision" which obligates the state to manage the health system guided by norms of ethics and financial expediency. The regulation as a main tool of "supervision" in the state-private partnership has to meet the same two requirements. The activation of entrepreneur activity in public health by no means is caused by increase of privatization in this sector. Under these conditions, the implementation of market mechanisms in public health system make is more effective and efficient.

[The theoretical characteristics of the organization of the system of consultative medical care].

In the Russian Federation, nowadays, there is no normative legal definition of the concept of medical care and subsequent definition of its structural types, including "the consultative medical care". The definition of this concept and its legal consolidation provide the normative legal base for structural development of comprehensive system of medical consultative care which will embrace both previous forms of medical and paramedical activities and new forms conditioned by scientific and technical progress and social evolution of society.