[Management solutions using digital technologies in the Healthy Moscow pavilions].

The digital transformation of healthcare is an integral part of the priorities in modern healthcare. A striking example of the practical implementation of compliance with the basic principles of digital healthcare is the Healthy Moscow project, which has been implemented since 2021, which has become a real breakthrough in Russia in ensuring accessibility and convenience in providing medical care to the population. The aim of the project is the early prevention of chronic non-communicable diseases, the formation of a healthy lifestyle and the improvement of the well-being of Moscow residents, as well as the development of a conscious attitude to taking care of their health. Pavilions in the park areas of Moscow are an integral part of the modern medical infrastructure, providing convenient conditions for obtaining medical advice and information. The article provides information on the types of digital technologies and basic equipment that the pavilions (large and small) are equipped with as part of the Healthy Moscow project, it is shown that the introduction of digital healthcare technologies is one of the key tasks of the national strategy of Russia, which contributes significantly contribution to the successful implementation of the Healthy Moscow project.

[THE EVOLUTION OF PROACTIVE DISPENSARY MONITORING IN THE MOSCOW HEALTHCARE SYSTEM].

Economic and social losses due to epidemics of non-communicable diseases have put prevention and control of them on the first line in the field of sustainable development of the United Nations. The tasks of combating NCDs and risk factors within the framework of the Sustainable Development Goals require targeted actions on the part of States in the field of policy and legislation and provision of health systems with appropriate resources. In the Russian Federation, such work is being implemented within the framework of the national project "Healthcare", federal programs to combat oncological and cardiovascular diseases. Each subject takes into account the peculiarities of economic development, staffing, implementation of informatization processes, etc. The rapid pace of transformation of Moscow healthcare, its unique institutional structure allowed to form the basis for the effective development of a system of proactive dispensary monitoring of patients suffering from chronic diseases. The authors describe the process of formation of preventive work and organization of dynamic dispensary observation in Moscow. The paper presents in detail the organizational, administrative and technological resources used to create a unique system of dynamic dispensary observation. In addition, the article illustrates the personalized subsystem of dynamic dispensary observation in EMIAS and the institute of "physician assistant". The introduction of a proactive dispensary monitoring system will reduce premature mortality and disability among residents of the city. Moscow through an individual monitoring program and motivation for the responsible attitude of metropolitan patients to their health.

Assessment of sources, environmental, ecological, and health risks of potentially toxic elements in urban dust of Moscow megacity, Russia.

Potentially toxic elements (PTEs) in urban dust of Moscow megacity and related risks have been studied. 78 samples were collected in the Moscow downtown in sites with different anthropogenic load, namely, major highways, residential area, and recreation zones. The concentrations of PTEs in urban dust were determined by ICP-MS and ICP-AES. Then, environmental, ecological and health risks of PTEs in urban dust were assessed. In addition, potential sources of PTEs in dust were identified. It is shown that Moscow dust is mainly contaminated by Sb, Zn, Pb, Cd, Cu, Sn, and Mo, which according to the data of principal component and correlation analyses can be attributed to anthropogenic sources (non-exhaust vehicle emissions). Potential ecological risk factor demonstrates that Cu, Mo, and Cd have moderate potential ecological risks in 13% of studied area, while Sb has this risk in 62% of area. Potential ecological risk indices indicate that 41% of studied territory is of moderate ecological risk. Concerning the human risks through ingestion, dermal contact, and inhalation pathways, PTEs in Moscow dust have no significant non-carcinogenic risks for adults. However, the value of total hazard index for children is 1.8 showing that non-carcinogenic risks may occur. Moreover, possible carcinogenic risks caused by Cr are evaluated. The finding of the present study can be used for ecological management in the megacity to reduce both ecological and human risks. A special attention should be given to periods of hot and dry weather and to traffic-related emissions.

[LITERATURE REVIEW OF GUIDELINES FOR MEDICAL DEVICES ASSESSMENT].

BACKGROUND: Research on the development and implementation of new principles and methods applicable in the evaluation of medical devices (MD) will allow to accumulate new, as well as the most effective long-used and proven approaches to the clinical and economic evaluation of such an important and extensive class of medical technologies. AIMS: The aim of the study is to identify and analyze developed, approved recommendations for the assessment of MD in the world and domestic practice of assessing health technologies, as well as to find and summarize the current principles, optimal proven and innovative methods for assessing MD for the draft modern recommendations for MD assessment in Moscow. MATERIALS AND METHODS: The sources of the study were scientific articles on the topic of MD assessment and recommendations published over the past five years. RESULTS: A review of publications revealed disunity in the approaches to assessing MD according to international sources, as well as the lack of unified agreed recommendations in Russia. A number of problems and aspects that need to be taken into account when formulating uniform recommendations are clearly defined. CONCLUSION: It is obvious that there is a need to formulate and adopt clear recommendations on the assessment of medical technologies (HTA) of MD, taking into account positive international experience.

[ASSESSMENT OF THE QUALITY OF LIFE OF PATIENTS WITH RHEUMATOID ARTHRITIS IN COMPARISON WITH POPULATION NORMS IN MOSCOW].

The article is a comparative analysis of the quality of life indicators of patients with rheumatoid arthritis with similar indicators in the Moscow population. We conducted a survey of patients in the register of rheumatoid patients in Moscow using the EQ-5D-5L questionnaire and the EQ-VAS visual analog scale. The population of patients with rheumatoid arthritis, in accordance with the recommendations of EuroQoL, was divided into 6 age and sex groups. The responses of patients from each age and sex group were compared with similar groups of respondents in the Moscow population. Key differences in the quality of life of rheumatoid patients were identified in comparison with both the population norm in Moscow and similar foreign registries.

[THE INFRASTRUCTURAL POTENTIAL OF THE MOSCOW HEALTHCARE SYSTEM IN THE CONTEXT OF FINANCING THE STATE PROGRAM "DEVELOPMENT OF HEALTHCARE IN MOSCOW"].

INTRODUCTION: The resource provision of the capital's healthcare system in general and each medical organization in particular is the leading structural component that increases the availability and quality of medical care Reproduction and maintenance of citizens' health can be viewed from the perspective of combining the fundamental triad of resources - human, logistical and financial - in order to achieve the final product - the implementation of medical care to the population. One of the independent types of resource provision in most socio-economic systems, including healthcare, includes financial resources - a form that forms the infrastructure of medical organizations (medical equipment, equipment, devices, etc.) that can be used not only to carry out medical activities directly related to treatment and prevention, but also to conduct scientific research in various subject areas of medical science. MATERIALS AND METHODS: Information from the Moscow Government Portal «Open Budget of the City of Moscow¼ and the official website of the Mayor of Moscow were used to conduct the study. After data collection and aggregation, statistical, comparative and graphical analysis methods were used for their processing in order to construct dynamic time series. RESULTS AND DISCUSSION: In the course of the study, the study of the main regulatory documents regulating the healthcare sector at the federal level and at the level of the city of Moscow was carried out. The study describes the current state of the capital's healthcare sector in terms of the regulatory framework and funding allocated for the development, expansion and modernization of the capital's healthcare infrastructure, as well as the features and main results of the purchase of medical equipment and equipment under life cycle contracts. CONCLUSION: Information on financing, on purchased medical equipment, devices and equipment, on the number and parameters of the functioning of the capital's healthcare infrastructure will allow analyzing and improving the work of medical organizations, implementing operational and predictive management in order to improve the quality, effectiveness and efficiency of the healthcare sector of the city of Moscow.

[EVALUATION OF THE MEDICAL AND ECONOMIC EFFICIENCY OF NON-INVASIVE PRENATAL TESTING IN MOSCOW].

AIM: to evaluate the medical and economic efficiency of prenatal diagnostics of fetal chromosomal abnormalities (CA) in pregnant women in Moscow using a non-invasive prenatal test (NIPT) as a second-line model. A comparative analysis of the medical and economic efficiency of standard prenatal screening and prenatal screening with NIPT in groups of pregnant women, registered in Moscow, with high and medium fetal CA risk was carried out. Analysis was based on the number of children born with CA and the costs of medical care (direct costs) and social payments (indirect costs), calculated for both scenarios. Following standard prenatal screening 111 children with CA would be born, following prenatal screening with NIPT - only 26. Including NIPT in prenatal diagnostics increases direct costs by 299.97 million rubles and reduces annual indirect costs from 61.19 to 28.95 million rubles. Starting from the 13th year of using NIPT the estimated effect of reducing indirect costs would exceed direct costs. NIPT in prenatal diagnostics can increase the detection of fetal CA and reduce indirect costs. Assessing the indirect costs in economic efficiency enhances the accuracy of the estimate.

[On the issue of Moscow health care reforms: a review of publications].

The article presents review of scientific publications from databases of CyberLeninka and RSCI related to Moscow health care reforms within the framework of the Moscow State program "The Development of Moscow health care (Metropolitan health care) for 2012-2020". The analysis established that during reforms positive shifts in Moscow health care system occurred, expressed by significant improvement in material and technical base of institutions, implementation of new diagnostic and treatment technologies, increasing of salary of medical workers, implementation of information technologies. However, the Moscow health care system continues to encounter challenges from problems related to staffing (especially the district service), high workload of medical personnel, insufficient level of motivation and low level of qualifications of medical workers. The implemented system of general medical practice did not contribute into strengthening the role of district physician as coordinator of patient flows. The fragmentation and lack of continuity in functioning of health care institutions remains too. The hospital-replacing technologies, designed to compensate reduction in beds, have not received development in primary health care. because of lacking of economic incentives for institutions and low tariffs. The serious problems associated with shortcomings in organization of functioning of medical institutions are established that requires further improvement of methods of analyzing functioning of medical institutions and organizational activities at all levels, considering effectiveness of activities implemented.

Evolution characteristics of temporal and spatial pattern of Russian economic differences since the 21st century.

Under the background of "the Belt and Road" and "the economic corridor of China, Mongolia and Russia" initiatives, it is of great significance to study the temporal and spatial economic pattern in the Russian Federation. Based on the economic development difference index, regional economic grade index, global trend analysis tool and spatial autocorrelation model, this paper analyzes the temporal and spatial pattern evolution characteristics of Russian economic differences from 2002 to 2020. The results are as following. First, although the economic imbalance among various federal subjects has been decreasing, the economic polarization has been still severe between the prosperous developed regions and the stagnant backward regions during 2002-2020. Russia's economy shows a trend of changing from significant positive correlation in strong agglomeration space to positive correlation in weak agglomeration space, and then to random distribution. Second, there has been great differences of the economic development among various federal subjects. The economic grade of the Russian federal subjects presents a significant spatial differentiation pattern. The Russian Federation's economic resources are concentrated in the first-class federal subject (Moscow City), second-class federal subjects (Tumen Region, Moscow Region and Saint-Petersburg city) and a few third-class federal subjects (Yamalo-Nenetsky Autonomous Area, Khanty-Mansiysky Autonomous Area, Republic of Tatarstan, Krasnodar Territory, Sverdlovsk Region, etc). Third, the Russian Federation's economy presents "High Core, Low Periphery", "High West, Low East" and "High south, Low north" spatial differentiation pattern. The economic hot regions coincide with the high-class economic regions, which are mainly distributed in the contiguous areas of Ural Federal District and Volga Federal District, as well as the Moscow City, Moscow Region, Saint-Petersburg city, Krasnodar Territory and Rostov Region. The economic cold regions coincide with the low-class economic regions, which are mainly located in the Far East Federal District, the east of Siberian Federal District, the north of North West Federal District and the south of North-Caucasian Federal District. Finally, we suggest the recommendation for policy makers in Russia. And we propose the future research ideas.

[The development of diagnosis coding model by means of implementing automated system of coding support: The results of functional and cost analysis].

Actually, in many medical organizations there is an inexpedient structure of labor costs of medical workers, in many respects associated with large time spent on making up medical documentation. The very important aspect is proper formulation of clinical diagnosis and its coding according to the International Classification of Diseases of the 10th revision that in most cases is performed in tradition mode (so called manual coding). The article presents results of functional and cost analysis of application of automated system of coding support in various departments of the Medical Sanitary Unit of of the Ministry of Internal Affairs of Russia at the Moscow Oblast. The study established significant difference in time spent and cost of coding process before and after implementation of automated system. The automated coding of diagnosis permits to reduce six-fold time and cost of coding process, as well as up to 12.6% reduce number of coding errors. The results of functional and cost analysis serve as an objective justification of economic expediency of implementing automated system of diagnosis coding support in multidisciplinary hospital.

[The morbidity of population during implementation of Moscow health care reform].

The analysis of level and structure of general and primary morbidity according to medical care appealability of Moscow population during implementation of the State program "The Development of the City of Moscow Health Care (Metropolitan Health Care) in 2012-2020" was carried out according to the data from collections of main indices of functioning of medical organizations subordinated to the Moscow Health Care Department and health indices of Moscow population. The decreasing of both primary and general morbidity indices is established. At that, increasing of the life expectancy indices was marked. At the same time, population morbidity indices according to medical care appealability are not sufficiently reliable in assessing degree of achievement of results of any measures of improving population health due to their dependence on multitude of factors.

Diode Laser Spectrometer for Diagnostic Assessment of Exhaled Air Components.

The main requirements for a screening test are simplicity, non-invasiveness, safety of testing procedures, high processing speed, and ability to detect diseases at an early stage. A multichannel gas analyzer for assessment of exhaled air composition (diode laser spectrometer), non-invasive screening, and biomedical testing was developed on the basis of near-infrared diode lasers with fiber output. The device measures the following exhaled air components: 12CO2, 13CO2, CH4, NH3, H2O, and H2S. The concentration of molecules was measured in a multi-pass Herriot cell with a reference length of 40 cm, 1.8 L volume, and a total optical path length of 26 m. Three diode lasers manufactured by NTT Electronics (Japan) were used in the work. Detection of CH4 was carried out in the 1.65 µm wavelength range, 12CO2, 13CO2, and H2S levels were measured in the 1.60 µm range, NH3 and H2O in the 1.51 µm range. All measurements were taken in real time. Clinical testing of the spectrometer was carried out at V.M. Buyanov City Clinical Hospital of Moscow Department of Health. More than 150 patients were examined. The tests included analysis and measurement of these molecular components in the exhaled air of patients with various diseases. The content of these components was studied in conditions of various changes in the human physiological state (dosed physical activity, relaxation, psychoemotional stress, etc.). The studies have demonstrated efficacy of using the developed hardware system for assessment of exhaled air components in order to reveal functional disorders in various diseases of the digestive system, cardiorespiratory system, diseases caused by impaired nitrogen-excreting function of the kidneys, etc.

[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.

[THE ASSESSMENT OF THE RESEARCH POTENTIAL OF THE AMBULATORY-POLYCLINICAL INSTITUTIONS OF THE MOSCOW HEALTHCARE SYSTEM].

Scientific research and their inclusion in the health care system is an important part of modern medical science. To study the readiness of primary care physicians as well as administration staff to introduce a research component into the national health care system, "The Research Institute for Healthcare Organization and Medical Management of Moscow Healthcare Department" conducted an online survey of two groups of respondents - physicians of primary care settings (n = 593) and heads of outpatient clinics in Moscow (n = 168) in 2021. The results of the study show the insufficient involvement of primary care doctors in research activities in their working places: more than half do not consider scientific activities as a priority, motivating it by the lack of conditions, practical skills, age and health status as well as high level of employment, although they do not reject it in the future. Heads of Moscow primary health care settings demonstrate similar answers. According to their opinion, research activities are poorly represented in organizations of this type, and most likely the situation will not be changed in the near future; about half do not have sufficient information about the number of employees engaged in scientific work and are rarely familiar with their topics (often extensive, represented by various fields of medicine); about one third of managers reported participating in research projects of Moscow City Department of Health. The study made it possible to identify barriers that prevent the introduction of research components into the activities of Moscow primary health care organizations, which should be taken into account when making managerial decisions.

[The social health of citizen of the Eurasian Economic Union in conditions of COVID-19 pandemic].

The article considers, on the basis of results of sociological research, consequences of pandemic impact on social health of citizens of the Eurasian Economic Union states. The comparative analysis was applied to two groups of labor migrants from the EAEU states in Moscow and Russian citizens of the same age. The measures taken by the EАEU to maintain population social health in conditions of COVID-19 pandemic are considered.

[Social health of the citizens of the States of the Eurasian Economic Union in the context of the COVID-19 pandemic].

Based on the results of sociological research, the article considers the consequences of the pandemic on the social health of citizens of the Eurasian Economic Union (EAEU) states. A comparative analysis is carried out between groups of labor migrants from the EAEU states in Moscow and Russian citizens of the same age. The paper discusses the measures taken by the EАEU, for the maintenance of social health in terms of the COVID-19 pandemic crisis.

[IMPLICATIONS OF THE FIRST WAVE OF COVID-19 FOR SMALL BUSINESSES: SOCIOLOGICAL ASSESSMENT].

Statement of the research problem. In the context of the coronavirus pandemic, small businesses have been exposed to serious risks, since their viability primarily depends on the consumer demand of the population, which in turn has declined sharply in these force majeure circumstances. Small businesses are either waiting for the lifting of restrictive measures, or they are counting on state support, or they are looking for other ways out of the current situation in order to preserve jobs, the level of income of employees, remain on the market and ensure the supply of vital goods and services to the population. Economic and social stability in the region and in the country as a whole largely depends on the ability of small businesses to assume these obligations. Description of the data or materials used. The study was conducted using the method of semi-formal interviews with owners of enterprises with a staff of up to one hundred people (small businesses). The experts surveyed included 17 small business entrepreneurs from seven Russian regions (Moscow, Saint Petersburg, Omsk region (Omsk), Krasnodar territory (Anapa), Volgograd region (Cherepovets), Arkhangelsk region (Arkhangelsk), Kemerovo region (Jurga)) and by population (cities with millions of people, large and medium-sized cities). The surveyed entrepreneurs represented both industrial production and service companies. The interview was conducted using remote means of communication using a specially developed guide. The results of the study showed that the conditions of the pandemic forced small businesses to change the usual format of work, transform traditional business processes, and switch to remote customer service. Despite the current problems, small businesses are looking to the future with a restrained degree of optimism. The crisis outlined the weakest points of their business to the leaders of small firms, allowed them to abandon inefficient business processes. Those enterprises that could not do this are forced to leave the market. In the post-crisis period, small businesses expect the government to change fiscal and regulatory policies aimed at reducing the financial burden on business and reducing control and audit measures. Despite the current problems, small businesses are looking to the future with a restrained degree of optimism. The crisis revealed the weaknesses of the business and showed possible prospects for development.

[The social factors increasing healthy life longevity (according sociological surveys materials)].

The article discusses the main social factors that can positively effect on increasing the longevity of healthy life in the elderly. The main principles are based on the results of applied studies carried out by the authors in Moscow, Kursk, Velikiy Novgorod and Simferopol in 2019-2020. The respondents were both the elderly themselves and the specialists providing them social services support. The emphasis is made on the factors of healthy lifestyle of the elderly and first of all on feasible physical activity and productive creative activity. The considerable attention was paid to internal resources of the elderly person (general condition of physical and mental health and ability to maintain it, capacity for self-care and physical activity, positive frame of mind, personal persuasion in the need to properly use the opportunities available to elderly people). The following external factors are distinguish - constructive relationship with closest relatives, development of infrastructure for leisure activities, physical exercises and sport activities, accessibility for the retired of health care institutions. Among the means of maintaining active and healthy longevity of the elderly are marked informing about possibilities of using their potentials, appropriate consultations, provision of technical means of rehabilitation, involvement into constructive activities, giving positive examples and persuasion. The importance of individual approach to each retired is emphasized, taking into account their physical capabilities, health status and chronic diseases. The types of "activities" are marked useful for physical and spiritual health of elderly person, available to them at home that is especially actual in conditions of self-isolation due to prevention of coronavirus infection.

[Assessment of Risk Factors for Atherosclerosis in Individuals of Different Categories of Cardiovascular Risk Using the Aterostop Calculator].

Aim        To analyze first results of using the Aterostop calculator for a comprehensive evaluation of the risk for cardiovascular diseases (CVD).Material and methods        A cross-sectional study analyzed major and additional risk factors in 460 subjects without apparent disease and in patients with documented CVD of atherosclerotic origin using the application (calculator) Aterostop developed in the National Medical Research Center of Cardiology in Moscow, Russia.Results   45.4% of evaluated persons belonged to the categories of very high and extreme risk. Age and frequencies of smoking, arterial hypertension, and diabetes mellitus (DM) increased with the increase in risk; the growth of DM was exponential. 129 (28%) individuals used lipid-lowering medications at the time of study. Their plasma levels of low-density lipoprotein cholesterol (LDL-C) were significantly lower than in those who did not received this treatment. However, achieving the target level was inversely proportional to the risk: the greatest proportion of individuals who reached the LDL-C target was in the category of low risk and the smallest proportion was in the category of extreme risk (75 % vs. 3.7 %, respectively).Conclusion            The results obtained with the calculator Aterostop were consistent with earlier reports of insufficient effectiveness of primary and secondary prevention of atherosclerotic CVDs, which requires more tight and fruitful cooperation of the physician and the patient.

[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.