[Urban stress of a megalopolis resident: stress factors and correctioN].

Residents of a megalopolis are constantly exposed to urban stress - the combined effects of a number of different extreme factors and living conditions of the urban environment. Urban stress of a megalopolis resident has an extreme complex multifactorial effect on his body and psyche. The features of the existing subspecies of urban stress (ecological, psychological, social, informational, professional, related to the pandemic), as well as the main stress factors causing them, are considered. The medical and social features of urban stress are described. The consequences of exposure to urban stress, directly related to human health disorders, include the so-called «urban stress diseases¼ or «diseases of civilization¼, primarily psychosomatic diseases. It is determined that urban stress is a multifactorial complex of stress factors affecting the physical and mental health of megalopolis residents. Due to the fact that an increasing number of megalopolis residents are experiencing the negative impact of an aggressive urban environment, it is necessary both to formalize stress factors in order to possibly correct them to improve the quality of life of citizens, and to develop appropriate optimizing medical and social recommendations. Modern organizational and medical and social measures aimed at reducing the negative impact of urban stress on the health of megalopolis residents are considered. It is proposed to minimize the negative impact of extreme urban stress factors on the physical and mental health of megalopolis residents by using therapeutic and preventive strategies to increase their stress resistance. There are a number of different organizations and departments in Moscow that provide psychological and psychotherapeutic support. Also, in order to determine the level of the body's reserves and stress resistance, it is possible to undergo a comprehensive examination both in the nearest polyclinic and in the nearest park within the framework of the Healthy Moscow program.

[Risk factors, treatment organization and quality indicators for chronic obstructive pulmonary disease in primary care settings: Dutch experience].

INTRODUCTION: Chronic obstructive pulmonary disease (COPD), usually in advanced stages, is associated with high mortality, being the third leading cause of death worldwide. In the Netherlands, care delivery to patients with COPD has become a focus of the regional medical community, since the COPD death rates in this country are higher than the European Union average. However, between 2011 and 2021, the number of people with COPD (under follow-u by general practitioners) decreased. The experience of this country is interesting, as a large set of measures to improve the situation has been developed and implemented in this region. The purpose of the study was to analyze the experience of the Netherlands in organizing medical care for COPD in primary care settings. MATERIAL AND METHODS: The search for scientific literature sources was carried out using the PubMed database and Google system. The search time horizon equaled to 5 years. RESULTS: In the Netherlands, in the system of care delivery to patients with COPD, primary care settings are heavily burdened. The article summarizes approaches to identify COPD risk factors, summarizes current clinical recommendations as of December 2022, and highlights findings of the study on medical digital platforms with the potential to organize continuous monitoring of patients. The paper exemplifies criteria for assessing the treatment quality in specialized care settings, including primary care. DISCUSSION: It is assumed that the most effective measure to further improve efficacy of COPD treatment is the introduction of remote digital medical devices. A possible integration of the updated standards and quality indicators into digital services will further strengthen the concept of continuous automated remote monitoring of COPD patients. Evidence-based selection and introduction of effective digital solutions into current practice will improve quality of care delivery to patients.

[MODERN TRENDS IN IMMUNOPROPHYLAXIS (ANALYSIS OF FOREIGN EXPERIENCE)].

Currently, immunoporphylaxis reaches the population through information support, mass vaccination sites and the system of monitoring warning. The capabilities of information technologies have made it possible to monitor the patient's health at all stages of life, regardless of the place of medical care delivery (including vaccination). The use of mathematical modeling technologies coupled with the queueing theory made it possible to develop an optimum location scheme of vaccination sites. Organization of the work of vaccination centers considered the need to optimize travel arrangements of the recipients and operating costs. The integration with geographic information systems contributes to the adequate distribution of vaccination centers in densely populated areas. The availability of information support made it possible to create the following innovative vaccination solutions: "get a vaccine without ever leaving your car" (with prior registration on the website), vaccination at pharmacies (with the subsequent data transfer to the cloud storage), deployment of vaccination sites at sports and religious facilities. Compact mobile vaccination sites have proven their effectiveness in both sparsely populated areas and in places with a high throughput. Effective performance of mass vaccination centers is impossible without the use of effective information and communication technologies. The systems ensure interaction between the patient, medical professionals and software that allows you to write, read or update in real time the database located in the data storage center. The information technologies of vaccination have made it possible to create a system for continuous support of immunoprophylaxis.

[THE STATUS OF THE SERVICE OF MEDICAL STATISTICS ACCORDING TO THE STAFF SURVEY RESULTS].

INRODUCTION: The Medical Statistics Service plays an important role in providing a medical organization with timely, high-quality statistical information. Therefore, it is important to study the opinions of specialists on the organization of this work. PURPOSE: To analyze the opinions of the staff of departments (offices) of medical statistics on the current work organization. MATERIAL AND METHODS: A survey was conducted among employees of the departments (offices) of medical statistics of the Moscow inpatient facilities. The survey results are presented as a frequency (in percent) of the choice of the answer options with a 95% confidence interval. Frequency confidence intervals were calculated using the EpiInfo 7 program. RESULTS: A total of 103 employees of the departments of medical statistics of the Moscow inpatient facilities took part in the survey. The majority of the respondents has a 20-year experience or more (29.1%). 61.3% of the heads of the departments of medical statistics, 70.4% of the doctors-statisticians and 74.2% of the medical statisticians stated a lack of a qualification category. The majority of the respondents were positive in their evaluation of the work organization of the medical statistics service (79.6%). The significance (importance) of the medical statistics service is unconditionally understood by 86.4% of the respondents. The respondents demonstrated a high degree of job satisfaction and work environment (10 scores out of 10). CONCLUSION: The study has identified a fairly positive attitude of the respondents towards their work, and the medical statistics service in general. However, the results obtained have also raised new questions, in particular, why specialists in this area do not have qualification categories, why they are not satisfied with the possibility of career growth, etc.

[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.

[CENTER FOR PUBLIC HEALTH AND MEDICAL PREVENTION IN MOSCOW: ISSUES OF FORMATION AND DEVELOPMENT PROSPECTS].

The authors have identified the priorities of the CPHMC based on the results of the Center's work in 2021 and the trends in the development of public health in Moscow. Along with this, the preferred directions for the development of the public health system in the city of Moscow are highlighted. Scientific research in the areas of work of the Center for Medical Health Care allows using reliable and up-to-date scientific information in the work of health care in Moscow, which makes it possible to improve not only the quality, but also the volume of work performed, projects of management decisions in the field of public health. As part of the activities of the CPHMC, it is planned to expand the range of activities related to the formation of the health of labor collectives and to draw the attention of employers to corporate public health programs to the maximum.

[MEDICAL AND SOCIAL SUPPORT OF CHRONIC PATIENTS: OLD PROBLEMS, NEW SOLUTIONS].

The purpose of the article is to study approaches to medical and social support of patients with chronic diseases in Russia and abroad in order to identify possible ways to solve emerging problems in this area of modern healthcare development. The reasons of comorbidity (polymorbidity), disadvantages of algorithms for accompanying patients with two or more chronic diseases, models of management of patients with chronic diseases and priorities of their use are considered. Based on the analysis of Russian and foreign publications, as well as the systematization of the opinions of experts interviewed during the scientific and practical expert session conducted by the authors (April 2022), conclusions are drawn about existing problems and possible ways to solve them. A proposal has been put forward to organize an information and coordination center for the support of patients with two or more chronic diseases. The purpose, tasks (and the order of their solution), the structure of the center, the need for the work of a curator leading patients (and who can perform the duties of a curator), the possibilities of integrating types of care (medical, social, psychological) to patients who need to be accompanied by specialists-representatives of organizations of very different orientation: medical, rehabilitation, social and preventive. It is shown that the increase in the number of polymorbid patients is a serious burden for modern healthcare systems around the world, and requires the search for effective approaches to solving the problem. The importance of self-preserving behavior of patients and the responsibility of the person himself for adherence to the treatment and prevention of diseases, as well as maintaining a healthy lifestyle is emphasized.

[DIGITAL THERAPY TECHNOLOGIES (LITERATURE REVIEW)].

This article presents an analysis of international experience in the implementation of digital therapeutics technologies in health care. The features of digital therapeutics products: their distinction from digital health products and digital medicine are highlighted. An analysis of the global market for digital therapeutics is presented. The aspects of regulation of digital therapeutics and the barriers to its implementation are presented. The importance of digital therapeutics for the transition of health systems to a value-based management model is discussed.

[THE HISTORY OF THE TRANSFORMATION OF THE CONCEPT OF HEALTH].

The article gives an idea of health and diseases in various historical epochs. Depending on the historical period, there is a different amount of information about medicine, including diseases and the concept of «Health¼. This is due to the amount of archaeological and documentary evidence. For a long time, ideas about health have been closely linked with religion. Hippocrates and other scientists of the ancient world at the heart of health determined the state of equilibrium of the four main fluids. With the development of anatomy, physiology and medicine, the development of diseases was considered as damage to anatomical structures and disruption of their functions. In the XIV-XV centuries, a direction appeared that considers the influence of social and social factors on human health. In the XIX century, the ideas of health and disease are further developed based on physiological and anatomical studies. The German Anatomical School compared the concepts of human health and pathology, linked the development of diseases with changes in cells. During the 20th century, on the one hand, medicine became more and more molecular and submicroscopic; on the other hand, global attention to people, both healthy and sick, resumed, which gave rise to synergetic, multifaceted definitions of health. The World Health Organization in 1946 formulated the definition of health as «a state of complete physical, mental and social well-being, and not just the absence of diseases or physical defects.¼ In the future, this concept was repeatedly criticized, as it considered health as an ideal and brought it closer to the concept of happiness. Today it is obvious that the concept of health is a multifactorial concept and, in addition to the medical component, is closely related to other areas of human life: sociology, ecology, cultural studies, economics, etc.

[Lifestyle factors and medical activity of patients with COVID-19 treated on an outpatient basis using telemedicine technologies].

The aim of the study was to study the factorial conditionality of the state of health and the features of medical activity (MA) of patients with COVID-19 who were treated on an outpatient basis using telemedicine technologies. MATERIAL AND METHODS: The study of lifestyle factors (LS) and MA was conducted by an anonymous survey of 7,743 patients with COVID-19. The patients' health was assessed based on the study of the course of the underlying disease and the presence of concomitant diseases, which were detected in 24.3% of COVID-19 patients according to the data of copying information from medical records. RESULTS: It was revealed that the prevalence of tobacco smoking was 33.25 cases per 100 respondents, 45.4% of respondents were overweight, 75.6% of patients had a low level of physical activity, 68.2% and 53.8% of patients had low medical literacy and MA, respectively. It is established that the greatest impact on the health status of the patients interviewed was provided by the bio-social activity (Smoking) (h = 0.702; m = 0.0063; p = 0.0022), physical activity (h = 0.624; m = 0.0026; p < 0.001, health behavior (h = 0.527; m = 0.0030; p < 0.001) and health literacy (h = 0.532; m = 0.0028; p < 0.001). CONCLUSION: The studied risk factors affecting the health status of COVID-19 patients, most of which are manageable, should be taken into account when forming therapeutic and preventive measures.

[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.

[PROBLEMS OF MAINTAINING NURSING STAFF PRODUCTIVITY IN CONNECTION WITH AGGRESSIVE PATIENT BEHAVIOR].

The article is devoted to the results of a study of the problems of nursing staff performance maintenance in connection with aggressive behavior of patients. We studied the opinions of 413 nurses concerning the aggressive behavior of patients in medical organizations of the Central Federal District. The paper reveals the problems of patient aggression and its interaction with nursing staff productivity.

[BIOLOGICAL TREATMENT OF PSORIASIS IN TIME OF NEW CORONAVIRUS INFECTION COVID-19].

Currently, the ongoing pandemic of the novel coronavirus infection is still a major public health problem worldwide. The questions of immunosuppressive therapy of patients with psoriasis and psoriatic arthritis, the possibility of vaccination against the background of the use of genetically engineered drugs remain open. The article is of an overview nature and includes up-to-date information on the feasibility and safety of the use of genetically engineered biological drugs in patients with psoriasis in a pandemic (COVID-19). According to the international recommendations of the National Psoriasis Foundation COVID-19 Task Force expert group, treatment of psoriasis and/or PsA does not significantly alter the risk of SARS-CoV-2 infection and does not lead to worse prognosis of COVID-19. Therefore, patients not infected with SARS-CoV-2 should continue biological or other systemic therapy for psoriasis and/or PsA. According to a registry from 25 countries, hospitalization with SARS-CoV-2 infection was more common in patients receiving nonbiological systemic therapy than in patients receiving BAs. Thus, genetically engineered biological drugs do not appear to cause an increased risk of coronavirus infection and do not determine a more severe course. With regard to vaccination of patients with psoriasis, many issues require further study. According to international agreements, vaccination is not contraindicated in patients with psoriatic disease. However, there is still insufficient data on how the treatment of psoriatic disease affects vaccination. Avoiding COVID-19 or reducing the severity of infection following SARS-CoV-2 vaccination is thought to far outweigh any risk directly related to vaccination complications.

[On the Need for Psychological Support for Citizens in the Context of the COVID-19 Pandemic].

The article deals with issues related to the psychological support of citizens during the most acute periods of the COVID-19 pandemic. Even before the COVID-19 pandemic, global statistics on mental illness and disorders (including neurological and substance use disorders; suicide risk and related psychosocial and cognitive impairments) were already disappointing. In this connection, the world economy is suffering serious financial losses, and the social sphere is faced with the need to organize socio-psychological support and rehabilitation of citizens experiencing certain psychological problems. The purpose of this work is to present data reflecting the work of psychiatrists and psychologists in providing counseling and rehabilitation psychological assistance to citizens during the COVID-19 pandemic through indicators of the depth of anxiety of citizens who applied for appropriate services.

[The comparative analysis of population attitude to vaccination against COVID-19 infection in foreign countries and in Russia].

The COVID-19 vaccination is considered as decisive factor in termination of pandemic. Hence, the vaccine development and clinical trials are carried on in an accelerated rate. At that, success of any mass immunization program, including its global application, directly depends on population willingness to be vaccinated. The purpose of the study is to investigate opinions about COVID-19 vaccination in various countries and to identify factors contributing to or hindering to increasing commitment to immunization. METHODS AND MATERIALS: The search of relevant data was implemented through such bibliographic databases as eLIBRARY.RU, PubMed, MEDLINE, Scopus and Google Scholar. Moreover, the primary research data concerning opinions of Russians about coronavirus infection vaccination was analyzed. RESULTS: The cross-country study of opinions about COVID-19 vaccination permitted to identify main factors impacting degree of readiness to mass immunization, including fear and personal perceptions of risk of COVID-19 infection, attitudes to influenza vaccination and fear of vaccination, mainly due to disinformation about efficiency, efficacy and safety of the vaccine. CONCLUSION: The conclusion was made that public opinion surveys implemented in various countries are important because they provide priceless information for implementing public policy targeted to improve health care support, in particular to develop effective vaccination campaigns against COVID-19, identifying high-risk groups, socially and economically vulnerable individuals for whom vaccination is to be paramount and free, and also setting vaccination fees for other groups based on their readiness to pay.

[The lean polyclinic: aspects of optimization of medical processes].

The article considers main issues of implementing the lean polyclinic project in practice of Russian polyclinic institutions. The main problems that can be solved by implementing the principles of economical production, optimizing operations and eliminating losses, including financial ones, are identified. It is concluded that saved funds can be distributed to motivate employees in the form of higher salaries and bonuses, as well as to provide training opportunities, to attend conferences by specialists. This approach results in reasonable use of the Federal funds, the mandatory medical insurance Fund, and regional budgets.

[Organization integrated approach in treatment patients with aggravated comorbid background and lung abscess complicated by recurrent pulmonary bleeding].

The purpose of the demonstration of this clinical case was to show the effectiveness of an integrated approach to treating a patient with bacterial pulmonary destruction complicated by recurrent pulmonary bleeding. A patient with a complicated course of abscessed pneumonia of the left lung against a background of severe concomitant pathology, after a long course of antibacterial therapy for the underlying disease. Upon admission to the hospital the patient standard examination was carried out according to national clinical recommendations, non-specific antibiotic therapy was continued, indications for planned surgical intervention were determined. Against the background of the controlled treatment with broad-spectrum antibiotics for 4,5 months, the patient retained the clinical manifestations of the disease and decay cavity in the left lung, which was an indication for surgical treatment. After short-term preoperative preparation, tracheobronchial catheterization of an abscess of the upper lobe of the left lung was performed. When examining the patient 1,5 months after the operation, his absence of complaints and the closure of decay cavities in the lung were recorded, which is a criterion for effective treatment. The clinical example demonstrates the high effectiveness of the personalized approach to treating patients with a burdened comorbid background and complicated pulmonary destruction, which are threatened both by the development of surgical complications and by the occurrence of postoperative complications when using resection methods of treatment.

[Possibilities of application of modern training methods (project activities) in training health care organizers on the example of a military medical educational organization].

The efficiency of health care and the quality of medical care can be improved by implementing modern management methods and technologies. It requires modern and high-quality training of medical management personnel. Qualified personnel are the key factor in the organization and transformation of the health system. Human resources ultimately ensure the efficiency and effectiveness of the entire health sector. Requirements to economic management methods are changing and increasing, and specialists with skills in managing medical organizations at different levels of the healthcare system are becoming in demand. At the level of the constituent entities of the Russian Federation, the role of medical personnel who possess strategic methods of healthcare management is increasing. Available training programs in leading higher educational institutions of medical profile do not fully fulfill these tasks due to limited time, a large volume of lecture material, and frequent changes in the conditions and tasks of health care. These problems can be solved by optimizing training programs for retraining and advanced training of health care organizers, introducing active training methods such as business games, case methods, and project activities into the curriculum. The paper describes the system of training students for training courses in the field of healthcare and public health through planning and implementation, project management in the context of military educational organizations of the Ministry of Defense of the Russian Federation, the statistical analysis of the training effectiveness, the factors that influence the success of development programs.

[TREATMENT AND DIAGNOSTIC ALGORITHM WITH THE APPLICATION OF MODERN BRONCHOLOGICAL POSSIBILITIES IN THE TREATMENT OF A PATIENT WITH INCREASING RESPIRATORY OBSTRUCTION OF UNKNOWN ETHIOLOGY].

More and more often, medical workers have to provide assistance to patients with HIV infection with acute disorders of vital functions who require intensive care and resuscitation. The main task of clinicians is to quickly stop the symptoms of secondary diseases that have led to the complications (specific and nonspecific) so that the patient can start or continue antiviral therapy. The aim of this work was to present the first experience of successfully treatment of a patient with progressive HIV infection using stenting of the main bronchi with their critical tumor stenosis in complex treatment. Conducting temporary endoscopic recanalization of the lumen of the large airways made it possible to avoid transferring the patient to artificial ventilation of the lungs, to carry out the necessary complex of diagnostic and therapeutic procedures, to restore ventilation and aeration of the lungs, which led to an increase in blood oxygenation and some improvement in the patient's general well-being.

[RISK FACTORS OF CHRONIC NON-INFECTIOUS DISEASES: ANALYTICAL RESEARCH OF DISPENSANIZATION RESULTS IN THE CITY OF MOSCOW].

The purpose of the study is to determine the relationship between risk factors for the development of chronic non-communicable diseases and first-time preliminary diagnoses during the medical examination of the adult population of Eastern and South - Eastern administrative districts of Moscow. Determine the risk factors that cause the most significant effect for the development of diseases of the endocrine system and eating disorders and metabolic disorders. The analysis of the medical examination data with a comprehensive assessment of the data from industry statistical reports, including the report form N 131, approved by the order of the Ministry of Health of the Russian Federation. It was found out that the risk factors identified during the medical examinations cause the development of chronic non-communicable diseases and the dynamics of indicators for the identified risk factors for obesity and established preliminary diagnoses of obesity from endocrine system diseases, eating disorders and metabolic disorders are equally directed. These percentages of preliminary diagnoses established during the medical examinations can be used for rapid assessment of the quality of the medical examinations and the adoption of cross-sectoral connections and measures aimed at preventing the development of this pathology at the regional level, with a broader implementation of preventive measures to improve public health, including monitoring and measures to reduce the impact of risk factors associated with insufficient physical activity, poor nutrition through the involvement of agencies, responsible for maintaining urban planning and transport policies and requirements for the urban environment, as well as the availability of medical care.