[The digital health care and digital twins as its components: the systematic review].

The article presents systematic review of National and foreign publications concerning strategy of digital society development, definitions and concepts of digital twins in health care. The analysis of development of digital twins of patients and application of digital twins of human organs in medicine is presented. The experience of digital twins functioning in health care management system in Russia and abroad is presented.

[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 medical demographic indicators and health preservation of rural population of the Russian Federation].

For the last 20 years of analysis, mortality rate of rural population was higher than that one of entire population; in 2020, increasing of mortality due to COVID-19 was noted.The indicators were 15.4 per 1000 population for rural population, and 14.3‰ for urban population. In 2021, the indicators increased up to 17.5 and 16.5‰, respectively. The birth rate of rural population over last 20 years tended to increasing. In 2013, mortality and birth rates became equal (14.5‰). In subsequent years, birth rate decreased and in 2021 amounted to 9.6‰ and in 2022 to 9.5‰. In 2021, the indicator of general morbidity of rural population of the Russian Federation was 124941.0‰oo For entire population the indicator was higher - 167713.8‰oo. In 2021, the highest rates of general morbidity of rural population were in the classes of diseases of the respiratory system - 34470.2‰oo and the circulatory system - 21588.2‰oo. In 2021, the ranking of general incidence of rural population in the Federal districts of the Russian Federation demonstrated difference in indicators by 1.5 times and in the subjects of the Russian Federation it reached 5.3 times. The highest indicator was noted in the Nenets Autonomous District - 278926.7‰oo, the lowest one in the Magadan Oblast - 52441.5‰oo. In 2021, the incidence of COVID-19 in rural population amounted to 2151.9‰oo. In 2021, the indicator increased by 2.8 times up to 6056.8‰oo. There is 2.4-fold increase in incidence of COVID-19 in rural population from 3391.1‰oo (2020) to 8085.7‰oo (2021). The ranking of incidence rates of rural population of COVID-19 in the subjects of the Russian Federation demonstrated difference in 15.6 times. The highest indicators were noted in the Republic of Khakassia - 14104.1 per 100 thousand population and the lowest in the Magadan region - 902.9‰oo. Conclusions. The unfavorable medical and demographic situation in the countryside indicates the low availability of medical care, the need for financial support of rural areas at the municipal, regional and Federal levels.

[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.

[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 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 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.

[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%.

[Results and prospects of scientific research on sensory conflict under exposure to noise and vibration at work].

The article presents results of longstanding research concerning influence of physical occupational hazards on workers' health. The authors justify a concept of sensory conflict developing under exposure to physical hazards and being a key chain in occupational diseases formation. New approaches are suggested to prevent occupational diseases caused by physical factors.

[Changes of spiroergometric parameters in males under 30 years of age with a hypertensive reaction of arterial pressure to graduated exercise].

UNLABELLED: AIM. To study changes in blood pressure (BP) and spiroergometric parameters in 18-30-year-old males with normal BP at rest having different reactions of BP to graduated exercise. MATERIAL AND METHODS: Forty two male examinees performed treadmill-test according to R. Bruce protocol with measurements of BP, ECG parameters and gas composition of exhaled air. RESULTS: The treadmill test has shown that 20 (47.6%) males had a normotensive reaction of BP to exercise, 22 (52.4%)--a hypertensive reaction. The latter had higher systolic and/or diastolic BP levels than those normal for performance of treadmill test. Significantly higher were also parameters of pulmonary ventilation, oxygen pulse in combination with large consumption of O2 and expiration of CO2. CONCLUSION: The presence of significant differences by spiroergometric indices in males with normotensive and hypertensive reactions of BP to exercise but normal BP at rest reflects metabolic shifts at early stages of hypertension in the latter.

Cholera toxin and its B subunit do not change cytosolic free calcium concentration.

Using the fluorescent Ca2+ probe Quin-2 it has been reported that cholera toxin (CT) and its B subunit (B-CT) increase cytosolic free Ca2+ concentration ([Ca2+]i) in entherocytes, thymocytes and fibroblasts. In this work we show, however, that the fluorescence increases of Quin-2-loaded cells (rat thymocytes, mouse splenocytes, P-388 macrophages and 3T3 fibroblasts) observed upon addition of CT or B-CT are not caused by an increase in [Ca2+]i. The observed effect appears to be accounted for by EDTA-2Na admixtures (present as conservation agent in all CT and B-CT preparations) which 'unquenches' the fluorescence of Quin-2 acid leaked out from the cells into the extracellular medium and produces influorescent complexes with contaminating heavy metal ions. Thus the mitogenic effect of B-CT is not obviously connected with the cytosolic free Ca2+ increase but is probably due to ganglioside-mediated protein phosphorylation.

[Basal phosphorylation of synaptic membrane proteins in the presence of ATP and GTP]. / Bazal'noe fosforilirovanie belkov sinapticheskikh membran v prisutstvii ATP i GTP.

A comparative study of endogenous ATP- and GTP-used basal protein phosphorylation in synaptic membranes from the rat brain cortex was carried out using the method of determination of total protein phosphorylation and autoradiography of proteins separated in PAGE. Under identical conditions 33P incorporation into proteins was shown to be appropriate in the presence of ATP as contrast to that in the case of GTP; in both cases the same proteins were phosphorylated. Inhibition of endogenous basal phosphorylation by alkali cations (K+, Na+, Li+) was more effective in the presence of GTP as compared to that with ATP. The differences between synaptic membrane protein kinases used by ATP and GTP are discussed.

[Insulin regulation of 2 kinetically different types of calcium current]. / Reguliatsiia insulinom dvukh kineticheski razlichnykh tipov kal'tsievogo toka.

At least two kinetically different kinds of calcium current are shown to exist in the frog atrial cells. The current with faster activation kinetics is usually depressed by insulin. Insulin also increases the amplitude of the slower calcium current. Pretreatment of atrial cells with cycloheximide does not change the effect of insulin on the fast calcium current but dramatically facilitates the insulin-induced activation of the slower calcium current.

[Effect of insulin on the calcium current of the frog myocardium]. / Vliianie insulina na kal'tsievyi tok miokarda liagushki.

The experiments on frog atra tuberculae revealed that insulin could induce biphasic changes of calcium currents of different directions. The current is inhibited with hormone due to a decrease both in the conductivity of channel system and reversal potential. In some cases prior to inhibition of calcium current, a short rise of this current occurred (3-6 min) induced by increased reversal potential. Possible mechanisms of insulin electrophysiological effects are discussed.

[Modification by cycloheximide of the effects of insulin on the transport of calcium by sarcolemma of the myocardium]. / Modifikatsiia tsiklogeksimidov éffektov insulina na transport kal'tsiia sarkolemmoi miokarda.

The inhibitory effect of insulin on Ca2+-current was supposed to be due to activation of phosphoproteinphosphotases stimulated by a specific intracellular insulin messenger. The results obtained support the above suggestion. Pretreatment of myocardial preparation with cycloheximide in low concentrations completely blocks the inhibitory insulin effect on Ca2+-current due, probably, to a decrease in peptide formation. Moreover, prolonged effect of the hormone involves a considerable increase of the current as compared to its initial value. Possible mechanisms of modifying effect of cycloheximide on the function of insulin-dependent regulatory system in the myocardium, are discussed.

[GTP--a substrate for 3',5'-AMP-dependent phosphorylation of synaptic membrane proteins]. / GTP--substrat dlia 3':5'-AMP-zavisimogo fosforilirovaniia belkov sinapticheskikh membran.

Using the method of electrophoresis in polyacrylamide gel (PAGE) it is shown that not only ATP, but GTP may play the role of phosphate donor for 3':5'-monophosphate (cAMP)-dependent phosphorylation. GTP is incorporated predominantly in the same "classic" 3':5'AMP-dependent phosphorylated proteins (with Mr 86 000, 82 000, 68 000, 61 000, 54 000) as that from ATP does. EGTA treatment of synaptic membranes enhances 3':5'-monophosphate (cAMP)-dependent phosphorylation with GTP used as a phosphate donor.

[Pathogenetic therapy of motor disorders of the gastrointestinal tract in the postoperative period and in peritonitis]. / Patogeneticheskaia terapiia dvigatel'nykh narushenii zheludochno--kishechnogo trakta v posleoperatsionnom periode i pri peritonite.

The authors have established the relationship between disorders of the motor function of the gastro-intestinal tract and the reduced volume of the mesenterial blood flow under peritonitis and after laparotomy in experiment and clinic. The regional blood flow was studied angiographically, the intestinal motor activity was followed by recording the intestinal potential. Similar changes in the inhibition of motor functions were found after creation of a graded stenosis of the mesenterial artery and reduced volume of the blood flow. The employment of a number of vasoactive drugs is believed to be expedient for the purposeful correction of the impaired regional blood flow as a cause of the inhibition of motor activity of the gastro-intestinal tract.

[Regional microcirculatory disorders in peritonitis]. / Regionarnye mikrotsirkuliatornye narusheniia pri peritonite.

Investigations performed under experimental and clinical conditions have shown that regional microcirculatory alterations in peritonitis consist in the arterial spasm, arteriovenous shunt of blood, hypoperfusion of the intestine, local metabolic disorders. The application of alpha-adrenoblockaders is recommended for directed action on microcirculation with an obligatory correction of deficit of the circulating blood volume.