[The readiness of Kazakhstan to implementation of medicinal insurance: the sociological substantiation and education activities of public organizations].

Until recently, in Kazakhstan, both health care services and medication support of population were financed from National budget and compulsory social health insurance foundation. But actual system meet needs of Kazakhstanis in medications not in full measure. The purpose of the study is to identify readiness of citizens to implementation of new medicinal insurance program with state co-financing. The study was carried out in 2022 in 17 regions of Kazakhstan. The readiness of Kazakhstanis to participate in medicinal insurance program with state co-financing was studied through sociological survey of 5 819 Kazakhstanis. The sociological survey revealed that respondents express average degree of readiness to implementation of new medicinal insurance program with state co-financing and to purchasing of insurance policy. The correlation between social demographic characteristics (objective indicators) and readiness indicator (subjective indicator) was revealed. The younger males with higher education, residing in urban areas, with average and high income and officially married are more inclined to purchase insurance policy. At that, according to results of sociological survey, one third of respondents have no relevant information about health insurance in general and medicinal insurance in particular. They found it difficult to express their personal position about this issues. It is supposed that Kazakhstanis in the result of educational measures will take part in medicinal insurance program with state co-financing. The education projects can be implemented through public organizations operating locally and communicating with population at the micro level. It is determined that it is especially important to apply educational measures to rural residents, middle-aged and elderly people, females and persons with low average income per family member.

[The medical care of seamen of civil shipping: the role of non-commercial organizations].

According to the International Labor Organization, health protection and access to medical treatment are to be guaranteed to seamen in the same way as to people working ashore. However, in practice, formal measures and mechanisms do not always make it possible to provide medical care to crew members of civil vessels due to peculiarities of legal systems of the States in whose territorial waters the vessel is located, remoteness of the vessel from coastline and objective situation that permits to receiving medical care from the shore. As far as possible these problems are resolved by non-profit organizations of seamen. The overview of their activities is presented in this article.

[The pharmaceutical insurance as a mean to overcome to overcome inequality in access to health care of population in Kazakhstan].

This article investigates readiness of Kazakhstan's population for implementation of pharmaceutical insurance system to overcome inequalities in health care accessibility. The primary data was obtained using questionnaire survey of 5 819 respondents in 17 regions of Kazakhstan in August-October 2022. The data was analyzed by software SPSS 25.0 applied for processing statistical and typology analysis, classification and comparative analysis. The results demonstrated that subjective readiness, per capita family income, urban/rural residence, education, field of employment, gender and health status are factors affecting population's readiness for implementation of new pharmaceutical insurance system. The study identified average degree of readiness of population to new pharmaceutical insurance system. However, 30% of respondents had no clearly formed opinion. The study concluded that implementing pharmaceutical insurance system with 50% of state co-financing in Kazakhstan is feasible to reduce inequalities in accessing essential medications. The Ministry of Health Care of Kazakhstan is advised to organize regular health education activities in population related to compulsory and voluntary health insurance to ensure successful implementation of the new system.

[Modern features of fertility in lowand middle-income countries, including in the context of the COVID-19 pandemic].

The main issues in the problem of fertility in countries with low and middle incomes of the population are the high prevalence of complications and maternal deaths during childbirth, as well as the high incidence of such indicators of the birth of an infant with low growth and weight indicators for their gestational age, malnutrition of pregnant women and mothers, frequent abortions, short intervals between births due to the educational status of the mother and the financial wealth of households, high prevalence of teenage motherhood, low availability of cesarean section, high cost of educating children as a factor in fertility. The impact of the COVID-19 pandemic on fertility in low- and middle-income countries has been most pronounced due to disruptions in the health care system, a surge in domestic violence, teenage pregnancy and female genital mutilation.

[ADULTS NEUROGENESIS AS A RESERVE FOR HEALTH PRESERVATION].

The article presents scientific evidence that new neurons from progenitor cells throughout life in almost all animals with a nervous system are an integral component of neuronal ontogenesis and plasticity.It has been shown that there are neural stem cells in the brain that give rise to adult neurogenesis, occurring primarily in the dentate gyrus, a subregion of the hippocampus important for learning, memory, and emotion. With age, there is a decrease in adult neurogenesis, which is associated with a decrease in cognitive functions. Newly formed neurons and «immature¼ neurons together constitute a potential reservoir of young cells («brain reserve¼) that can be used to prevent aging and/or delay the onset/reduce the impact of neurological disorders.The possibility of using neurogenic processes for therapeutic purposes to reduce pain and improve the quality of life of patients is implied.

[ISSUES ON EDUCATION OF CHILDREN IN LONG-TERM MEDICAL NEEDS IN HEALTHCARE ORGANIZATIONS].

The article presents a theoretical analysis of domestic and foreign experience in teaching children undergoing long-term treatment or rehabilitation in the context of medical care. The specification of educational process, its differences from the traditional classroom-lesson system, the main role of stakeholders such as administration and medical organization, teachers, children and parents and different educational technologies, as well as the basic functions of the education of children in a hospital school are analyzed.

The activity of noncommercial organizations providing medical social care to migrants in conditions of COVID-19.

The article considers actual topic concerning acquisition by migrant associations of certain importance in the public sphere of different countries. The analysis demonstrated that these public structures begin to act as actors of intersectorial cooperation within the framework of state policy in the fields of migration and health care. It is substantiated that various institutions of civil society remained in shadow of state and commercial structures for a long time. Only recently, Russian socially oriented noncommercial organizations acquired status of suppliers of social services, including medical social care of population. At that, they became a subject of cooperation in order to provide medical social care to population, which is provided not only to Russian citizens within the framework of mandatory medical insurance, but also to migrants. It is proved that during the pandemic, many noncommercial organizations expanded scope of cooperation with government, business and public structures of medical and social profile. Some noncommercial organizations that were originally organized as associations of migrants and had character of diasporas are now legitimate NGOs. Such organizational and functional changes can be interpreted as a result of development in the field of care of migrants and their integration into the Russian noncommercial sector. As a consequence of transnational commitment of migrants themselves and their interest in development of their native countries. Also, as a result of institutional integration, and consequence of spreading of COVID-19 and intensification of need in medical and social care to countrymen and their families. It is concluded that institutional changes allow NGOs to establish more open relations with associations of migrants of various origins, as well as to attract additional resources for planning, financing and implementing projects that are strategically important both for survival of organizations themselves and for helping migrants in pandemic conditions.

[REASONS FOR CITIZENS TO APPLY FOR PAID MEDICAL SERVICES ACCORDING TO SOCIOLOGICAL SURVEYS OF THE POPULATION].

An actual characteristic of the processes taking place in the Russian healthcare, especially during the ongoing transformation of the state healthcare system aimed at building a patient-oriented healthcare model, is the analysis of the reasons why citizens prefer medical care provided for a fee. The purpose of the study is to study the main reasons for the treatment of the population of the city of Moscow for medical services provided for a fee and their comparison with the reasons for applying for paid medical services (PMU) in other regions of the Russian Federation.The main materials of the study were the data of a sociological survey of visitors to the capital's medical organizations about the reasons for the population's application for obtaining PMU, as well as the results of sociological surveys on this topic in other regions of the Russian Federation. As a result, not only the main reasons for applying for medical services on a paid basis were identified, but also regional peculiarities of the prevalence of PMU.

[HEALTHY LIFESTYLE OF THE POPULATION IN THE CONTEXT OF A PANDEMIC: EXPERT OPINIONS OF RESEARCHERS AND EMPLOEES OF NON-PROFIT ORGANIZATIONS].

The article presents the results of a study aimed at identifying the problems of maintaining a healthy lifestyle in the context of the COVID-19 pandemic. The results of the study showed that not only people of older age groups are infected, but also young people with chronic diseases. Forced isolation, uncertainty of the future and stress have significantly worsened the physical, social and mental health of the population of all age groups. Therefore, people began to strengthen their own physical, social and psychological health, to carry out preventive health measures. The problems of maintaining a healthy lifestyle in the context of the COVID-19 pandemic can be effectively solved by using an integrated approach to public health, jointly provided by state and public organizations.

[The effect of digital mass media on mental health of children and youth].

The article considers the impact of digital media on mental health of children and the youth based on the analysis of studies of national and foreign researchers. On the one hand, the application of information technologies by children and the youth is related to requirements of actual reality that allows them to be active and independent in virtual space and contributes to development of special skills and abilities, exchange of knowledge and experience, broadens scope of interests. On the other hand, the information media establish conditions of high risk for health. The article presents the results of an empirical study, carried out in 2019 at the Balashov Institute of the Saratov State University. The questionnaire survey was applied to sampling of 386 respondents to identify the relationship between the amount of time spent online by young people and the feeling of loneliness. The study discovered that the higher is the user Internet activity that is not accompanied by sense of satisfaction, the higher is the level of frustration and loneliness. The problem areas are identified that make it difficult to ensure the effective safety of users and the timely identification of threats to their mental health: the shortage and fragmentation of scientific research; the ambiguity of opinions of expert community regarding the impact of digital technologies on the development of children and adolescents; the complexity of social control of online users due to their social demographic and sociocultural heterogeneity; the conflict of interests between providers, business structures, advertisers and other subjects of virtual reality and underage users; low level of internet literacy of parents and teachers. All these factors hinder the development of adequate technologies of early detection, prevention and support of victims of cyberaggression or cybercrimes.

[The attitude of the youth to vaccine prevention of influenza in conditions of COVID-19 pandemic].

The article considers the problem of attitude of the youth to vaccine prevention of influenza. The study was organized on the basis of qualitative research methods (focus groups) of students of two universities in the Central and Volga Federal Okrugs. The data about attitudes towards vaccination and refusal motivation was obtained. The need in increasing awareness of the youth about vaccine prevention as an actual health-preserving technology was substantiated.

[The COVID-19 pandemic as transformation factor of domestic violence].

The article presents the results of project targeted to identify specifics of transformation of domestic violence while anti-pandemic measures are in force. The sociological survey was organized on the basis of the Crisis center for women in difficult life situations (Belgorod region, Russia). The sampling consisted of 46 women aged from 20 to 45 years endured domestic violence. The primary information was collected using semi-structured interview technique. Also, semi-structured interviews of experts from among sociologists and crisis center personnel were carried out. It is established that COVID-19 pandemic significantly impacted on family relationships. The conditions of forced isolation and anti-pandemic measures observance significantly increase risk of domestic violence.

[Analysis of the course and outcomes of pregnancy in patients with advanced stages chronic kidney disease].

BACKGROUND: Pregnancy in patients with advanced chronic kidney disease (CKD) is associated with a high risk of adverse outcomes for the mother and the fetus, but data on the characteristics of the course of pregnancy in these women is limited. AIM: To analyse of the course and outcomes of pregnancy in patients with CKD stages 3a4. MATERIALS AND METHODS: Thirty five pregnant women with CKD stages 34 were included: 3a 12 (34.3%) patients, stage 3b 10 (28.6%), stage 4 13 (37.1%). RESULTS: Proteinuria, serum creatinine, blood pressure in dynamics, the presence of a physiological response were investigated. Pregnancy management included blood pressure correction, antianemic, antiplatelet, anticoagulant therapy, prevention and treatment of urinary infection, correction of metabolic disorders. All pregnant women had proteinuria of varying severity, which increased towards the end of pregnancy. Seventeen (51.5%) patients had hypertension, successfully corrected with antihypertensive drugs. The average delivery term was 34.6 weeks. Preeclampsia developed in 14 (42.4%) cases, an inverse relationship was found between the presence of a physiological response and preeclampsia (p=0.009; rs=-0.463). All children were born alive and viable. After delivery in patients with CKD 3a creatinine values returned to the pre-gestational level, in patients with grade 3b and 4 progression of CKD was noted. CONCLUSION: A favorable pregnancy outcome in women with late stages of CKD is possible with constant monitoring by a multidisciplinary team of doctors with mandatory monitoring of renal function, proteinuria, blood pressure, coagulation, markers of preeclampsia and indicators of fetal health. It was proposed to consider the physiological response of the kidneys to pregnancy as a predictor of a favorable outcome.

[The Actual Aspects of Medical Social Monitoring of patients of elderly age].

The article presents the results of research carried out jointly by the Krasnoyarsk state medical institute and the regional gerontological center. The data concerning health condition of gerontological patients was collected in 2019. The most sensitive problems of medical and social support of elderly patients were established. The results demonstrated that the elderly patients apply self-medication in terms of independent (without medical appointment) use of medications on daily basis that is potentially dangerous for their health. The particular place is occupied by non-steroid anti-inflammatory medications to stop painful syndrome of various etiologies. The low patient compliance is associated with inadequate communicative activity of physicians. The lacking of insomnia therapy in elderly patients with was established too. The identified problems require timely identification and necessitate special approaches to medical and social support of elderly patients, including intensive education of medical literacy and knowledge concerning methods of prevention, treatment and healthy lifestyle.

[IMPROVEMENT OF ORGANIZATIONAL APPROACHES TO REGULAR MEDICAL CHECKUP SERVICE IN THE METROPOLITAN HEALTHCARE SYSTEM].

An adequate response to the challenges people face in the context of continuing urbanization, increasing life expectancy and, at the same time, falling birth rates, is to maximize the containment of chronic non-communicable diseases (NCDs) by high level of healthcare organization and medical services provided to the patients with such pathologies. Global economic losses caused by NCDs result in disability and early mortality among working population as well as in significant treatment costs increasing with the advancement of the disease. That is why outpatient care for NCD patients which includes behaviour factors monitoring is an urgent task for the world and Russian healthcare. In this regard, the goal of this study is to find organizational solutions to improve regular medical checkup service for NCD patients in the metropolitan healthcare system, relying on the data provided by medical organizations in the form of statistical observations. Thus, the results of correlation analysis have revealed a connection between the increased number of individuals in the second and third health groups and individuals scheduled for a regular medical checkup at the end of the year and its absence between the clinical examination results and the number of firstly diagnosed patients. It is also reported that the number of diseases registered for a regular medical checkup at the end of the reporting period (year) has increased, so patients with polymorbid conditions are supposed to prevail among the others on these days and require a special approach to their management. Taking into account the results obtained, possible ways for optimizing the organizational model of a regular medical checkup are the following: special hours (days) for such patients admission, permanent cooperation of a doctor (local general practitioner, GP, family doctor) and a health worker with a secondary medical education (to deal with organizational issues), etc.

[The role on medical education in implementation of program "Zemstvo doctor"].

The article presents the results of study concerning improving medical care quality in rural areas. The purpose was to investigate the characteristics of medical personnel training in the framework of the "Zemstvo Doctor" program. The activities of the University were analyzed concerning implementation of professional training of medical personnel and including continuing medical education. To achieve this goal, efficiency of educational programs development considering contribution of the "Zemstvo doctor" program implementation was evaluated. The study was carried out in 2013-2019 on the basis of the Medical Institute of Belgorod State National Research University. The structured interview was applied as methodology of collecting primary data. The fact of decreasing of medical profession prestige that occurs against the background of implementation of the state program "Zemstvo Doctor" was established. The overcoming of this situation is necessary to improve medical care quality in rural areas. The focusing on existing regional features of medical care support and taking into account characteristics of health of population are required. In this respect the key factor is the training of rural physicians to employ high-tech technologies, including digital simulation and telecommunications equipment. The relevance of the state program "Zemstvo Doctor" is obvious, but the medical education system has no official instructions concerning the need of correcting educational programs. The efficiency of changes applied to educational programs was determined by subjective assessment of the need and the clinical experience of physicians-lecturers who are involved in resolving scientific and practical problems of health care in rural areas.

[Health charity: the main directions of activities of foreign non-profit organizations].

Health charity is the activity of non-profit organizations in the sphere of providing assistance to citizens in obtaining medical services: raising funds for treatment, rehabilitation, assistance to accompanying persons, psychological support, etc. The article deals with the main types of health charity activities, the content analysis of foreign sources reflecting the issues under study, and the typology of non-profit organizations implementing projects in the field of health charity.

[The ethnic and family characteristics of choice between official, folk and additional (alternative) medicine].

The article devoted to consideration of ethnic feature of primary choice of subjects of health preservation by residents of the Republic of Khakassia. It is established that at equal consumption of medical care in out-patient and polyclinic organizations, among the ethnic population of there is higher demand of services of traditional healers, especially representatives of shaman practices. The primary effecting on decision making in choosing health care institutions is provided by folk customs and family traditions received from senior relatives that is especially expressed among the Khakass ethnos.

[Severe bronchial asthma patient care organization in various regions of the Russian Federation. From endotypes and phenotypes of bronchial asthma to personalized choice of therapy].

The meeting of the Expert board was held in Moscow on June 24, 2019, at which the following issues were considered: the applicability of a new terminology characterizing asthma endotypes and phenotypes in real clinical practice, the effect of phenotypes and biomarkers in patients with bronchial asthma on the choice of biological drug, as well as the optimal clinical profiles of patients for whom dupilumab is most effective, taking into account the data of the III phase clinical trials, regional features of medical care and changes in updated international clinical guidelines for the diagnosis and treatment of asthma. The Expert board included members of leading Russian scientific and educational medical institutions: S.N. Avdeev, corresponding member of the Russian Academy of Sciences, prof., MD; O.A. Volkova, Ph.D.; I.V. Demko, prof., MD; G.L. Ignatova, prof., MD; I.V. Leshchenko, prof., MD; Kanukova N.A.; Kudelya L.M., prof., MD; V.A. Nevzorova, prof., MD; N.G. Nedashkovskaya; O.P. Ukhanova, prof., MD; L.V. Shulzhenko, prof., MD; R.S. Fassakhov, prof., MD.

[The social pedagogic adaption of individuals with mental health disorders].

The article presents the results of research and practical social pedagogical activities carried out jointly by Laboratory of Social Projects of Belgorod State University, Borisovka Psycho-Neurological Boarding School and the non-governmental public organization of social initiatives "Faith". The project was implemented during March - November 2018 in the Belgorod Oblast of the Russian Federation. The study implemented such methods of collecting primary sociological data as monitoring of educational and social activities of individuals with mental health problems residing in psycho-neurological boarding school; half-structured interview of experts - employees of psycho-neurological boarding school and teachers. Actually, social adaptation of individuals with mental health problems is an acute social problem. They belong to the most vulnerable population group wrapped with complex of social stereotypes and various signs of social deadaptation. The social adaptation of such personalities is achieved by involvement into social educational activities. The study results demonstrated that there are a number of psychological and pedagogical difficulties in face-to-face training for individuals with mental health problems. Among them are serious emotional reactions in response to actions of teacher or other students; behavior disorders, decreasing of education motivation, inadequate self-assessment. The remote education permits to avoid these and other difficulties. The individual with mental health problems while in appropriate comfortable conditions can receive effective education, support themselves materially and be useful member of society. The study established such most effective methods of remote education for individuals with mental health problems as information-receptive method; reproductive method; method of cognitive visualization of case studies from practice and research method.