[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 development of health preservation technologies: from individual to family approach].

The actuality of considered problem is in the fact that many medical social problems of preserving and improving population health can be resolved by the family and with its support. The purpose of the study is to substantiate scientifically priority of family approach in development of National health preservation system in actual conditions. MATERIALS AND METHODS: The national and foreign electronic databases were investigated to find publications concerning transformation of matrimonial relations, effect of family on health and need in health preservation technologies at each stage of its development. RESULTS: It is demonstrated that implementation of family-oriented technologies of health preservation based on knowledge of trends in family health, matrimonial relations and demographic shifts in its structure is one of the priority directions of preserving and strengthening population health. Moreover, in modern socioeconomic conditions, the categories of families that are in special need of medical social protection and health preservation such as socially problematic families, families where violence is practiced, families of the unemployed and migrants are shown up. Hence, one of the priority scientific tasks is to substantiate conceptual model of health preservation technologies for various types of families. CONCLUSION: The family and its health should become priority object of medical observation and research studies from the standpoint of public health and health care.

[The normative legal regulation of medical care support of rare (orphan) diseases in adult population of The Russian Federation].

The article considers the results of legal regulation analysis of medical care support including medication maintenance of adult patients suffering from rare diseases exemplified by life-threatened and chronic progressed rare (orphan) diseases resulting in life expectancy decrease and or disability ("List-24"). MATERIALS AND METHODS: Law database was analyzed in terms of current orders of medical care provision, standards of medical care, and clinical guidelines for rare diseases from "List-24" regarding to adult patients. RESULTS: It is concluded that there are no determined rules of medical care provision to adult population in case of rare diseases from "List-24". There are standards of medical care on 6 rare diseases (25% of total diseases amount) from this list for adult patients. However, based on content analysis data of approved standards it was established that there are only 3 from 11 standards (27.28%) for primary medical care support, 4 standards (33.34%) for medical care provision in planned condition, and only 1 standard (9.09%) had appropriate legal basis for its development (clinical guidelines availability). Nevertheless, there is negative prognosis for this the only standard due to legal necessity of all clinical guidelines revision till the end of 2021. CONCLUSION: Revision and creation of clinical guidelines and standards of medical care afterwards are needed for adult patients treatment with rare diseases from "List-24". The conclusion was made in terms of medical care standardization improvement for adult patients suffering from rare diseases from "List-24" based on its alignment with current legal regulation.

[The medical social technology of health preservation of elderly population in conditions of self-isolation].

In Moscow (as of January 1, 2020), the number of population made up to 12,678,079, and out of them the elderly population made up to 2.8 million. Up to the end of 2020, the number of the elderly will reach 3.3 million requiring implementation of corresponding preventive measures due to mass prevalence of coronavirus infection. The COVID-19 pandemic demonstrated that despite restructuring of functioning of industry, social security and health care, quarantine and self-isolation occurred to be exactly the effective measures. The self-isolation regimen also revealed aggravation of harmful effects of stress factors, hypodynamia, hypooxygenation and decreasing of immunological resistance. It is especially important to organize leisure activities and to create the most comfortable conditions for isolated living of the elderly as most susceptible to infection. The experience demonstrated that properly chosen set of activities during self-isolation regimen both disciplines and permits to apply surplus of free time to intensify health potential and to consolidate family relationships.

[The cost of specialized medical care of children under spinal muscular atrophy in Moscow].

The spinal muscular atrophy is neuromuscular disease caused by mutations in SMN1 gene. The clinical picture of disease is characterized by progressive muscular weakness and atrophy associated with degeneration of spine, and in severe cases by affection of motor neurons of lower bulbar cells. The spinal muscular atrophy progressing course resulting in disability and infant mortality. Actually, specific treatment is at the stage of clinical trials. However, patients are needed in permanent symptomatic arresting of manifestations and pathogenetic treatment preventing development of disease. The article presents calculations of direct medical costs for treatment in pediatric patients (0-17 years old) in Moscow with the main types of spinal muscular atrophy. It is established that the cost of specialized medical care of children with spinal muscular atrophy per single under age patient in Moscow consisted 7,131,185.84 rubles annually, including primary diagnostic, treatment and rehabilitation and medicinal treatment. In total, according to data for 2020 in Moscow, where number of children patients is 144, the cost of specialized medical care of children with spinal muscular atrophy is estimated as 1,024,580,269.16 rubles. At that, data takes into account only direct medical costs for out-patient and in-patient care of children with spinal muscular atrophy, excluding number of exacerbations of disease. Taking into account average numbers of hospitalizations per year because of illness, the cost of in-patient care of single child amounts to 7,844,304.42 rubles annually and 1,127,018,732.08 rubles for all children with spinal muscular atrophy in Moscow (according data of 2020).

[The dynamics of primary and common morbidity of population older than able-bodied age].

The purpose of the study is to analyze dynamic of primary and general morbidity of population older than able-bodied age in Moscow Oblast, including data comparing in the Central Federal Okrug and the Russian Federation. The data of statistical reports of City of Moscow, the Central Federal Okrug and the Russian Federation in 2013-2018 was included in analysis. The common analytical and mathematical statistical methods were applied. It was established that in Moscow Oblast in 2013-2018, against the background of stagnation of primary morbidity of population older than able-bodied age, indices of mental and behavioral disorders, neoplasms and diseases of circulatory system. At the same time, the level of primary morbidity of the region's population older than able-bodied age exceeds that one of the Russian Federation or the Central Federal Okrug in almost all classes of diseases. The structure of primary morbidity has not changed and respiratory diseases, injures and poisoning and diseases of circulatory system continue to rank first places. The level of general morbidity also remained unchanged. However, morbidity of neoplasms, diseases of endocrine system and mental and behavior disorders continues to increase. The structure of general morbidity of population of this age group differs the structure of primary morbidity and diseases of circulatory, respiratory and musculoskeletal systems ranked first places. Monitoring and analysis of primary and general morbidity of population older than able-bodied age is necessary for developing measures of its decreasing on the basis of development of medical social and geriatric care in the regions.

[Organizational reserves saving the population's health from diseases of the circulatory system].

Modern approaches to public health protection in the world are increasingly focused on health conservation, which involves focusing health care efforts on prevention. Timely identification of patients with arterial hypertension (AH) and provision of effective medical care is the main organizational reserve for preventing health losses. Based on the concept of "cardiovascular continuum", analysis of literature sources and the study itself, organizational measures have been developed to preserve health and prevent health losses and reduce mortality from diseases of the circulatory system. From the perspective of the concept of "cardiovascular continuum", the causes of death from BSC are two parallel interrelated processes: arterial hypertension and atherosclerosis, which are the consequences of endothelial dysfunction. Analysis of literature sources and survey results 123 of experts and healthcare professionals in a number of subjects of the Russian Federation show that adequate and timely medical care to the population at BSK, and a reduction in population systolic blood pressure and the reduction of lepidopteron low-density (LDL) are organizational reserves predotvratit loss health and reduce mortality from CVD. We have developed a set of measures to reduce mortality from circulatory diseases in accordance with the concept of the "cardiovascular continuum" include the following: increase population coverage with BSK medical assistance; medical surveillance and treatment of patients with prehypertension; decreased population levels of cholesterol in arterial hypertension (AH); carrying out of thrombolytic therapy; medical emergency cardiovascular conditions in accordance with the concept of "Golden hour"; improving the provision of medicines to the population, increasing the provision of cardiologists to the population. The implementation of a set of measures in the pilot rural district allowed reducing the total mortality of the population for the year of analysis by 12%.

[Making management decisions of oncopathology prevention based on monitoring of disease dynamics and trends].

The article deals with results of comparative analysis of the dynamics and trends of the incidents of malignant neoplasms in the population of the Moscow region. The Central Federal district and the Russian federation as a whole according to Rosstat data for 2009-2018. It was established that in Moscow region in comparison with other territories, the level and growth rates of the incidence of malignant neoplasms were lower. In the structure of the incidence of malignant neoplasms, the first rank places are occupied by breast, skin, lung, colon and prostate cancer. Attention is drawn to the fact that over the entire period of observation, the indicator of the number of people under medical supervision in the Moscow region was consistently higher than in the Russian Federation and the Central Federal district. Over the period of 2012-2018, the share of malignant neoplasms of the first stage of the spread of the tumor process increased by 23.4% in the region, and the share of stages III and IV decreased (by 16.9% and 12.3%, respectively).The increase in the number of newly detected malignancies seems to be due to increased diagnostic capabilities in recent times.

[The management of quality and safety of medical activities as world trend in health care: the review].

Since the publication of the reports of the Institute of medicine "To Err is to Human" and "Crossing the Quality Chasm" considerable attention in medical organizations all over the world is paid to improving quality medical care and safety of patients. The improvement of quality can consolidate health care delivery systems, improve efficiency of health sector and accelerate achievement of health-related goals. Therefore, quality improvement nowadays occupies meaningful position in health care policy programs in countries with different income levels.

[The role of actual demographic trends in improving state health policy].

The decreasing of demographic security level is a global social economic trend in both developed and developing economies. Hence there is an urgent need in improving state social policy, including health care. The key target of this study is to evaluate the role of modern demographic trends in improving state social economic policy in health care. The study characterizes demography role in developing state health care strategy and to assesses world demographic trends that permitted to formulate potential barriers and obstacles in achieving stable level of demographic security. The distinctive features of modern demographic trends in Russia were identified and used as a background in developing prospective ways of improving state health policy in Russia with specific focusing on identified identified predicaments in national demographic development. The interdisciplinary analysis was applied in the field of theory and practice of health demography as a new scientific area as well as systemic and economic analysis. The most important result of the study was the established need in assessing relationship between current national demographic situation and economic efficiency and social economic consequences for whole society that actualized retrieval and elaboration of relevant social economic indices of life quality within the framework of health demography.