Том 67, № 3 (2023)

In the 21^st century, more and more attention is paid to long-term forecasts for the development of countries, regions and the world as a whole; the scope of their application is expanding, including the coverage of social sectors, and, above all, healthcare. Acquaintance with the existing foreign and domestic practice of developing long-term forecasts can be useful not only for those involved in their development, but also for decision makers in the healthcare sector.

The purpose is generalization and systematization of published long-term forecasts in healthcare. Systematic search for publications according to the developed protocol. The protocol included databases of peer-reviewed publications, search terms, and search restrictions. The search for publications was carried out in the databases including Embase, Medline, Scopus, RSCI, etc. The search query was carried out using a combination of terms “free text” and “medical subject headings” related to the definition of long-term forecasts in healthcare. The main search restrictions were the language of publications, the date of publication and the forecast period covered. Conducting a comprehensive analysis, generalization and systematization of the information received on published foreign and domestic long-term forecasts in the field of healthcare, covering forecasts for the world as a whole, its regions and the Russian Federation. The long-term forecasts are most widespread in certain areas of healthcare development. Comprehensive forecasts covering several aspects of system development are less common. Quantitative forecasting methods are used more often, qualitative methods are mainly used in forecasting the technological development of the sector.

Conclusion. Studying international experience, strengthening the Russian institutional base for conducting comprehensive long-term forecasts in healthcare will contribute to a better understanding of possible scenarios for the sector development and increase the state ability to respond in a timely manner to the economic, environmental and social changes taking place in the country.

Acknowledgment. The study was carried out as part of a study by the Center for Fundamental Research of the National Research University “Higher School of Economics”.

Conflict of interest. The authors declare no conflict of interest. 

Received: September 07, 2022
Accepted: February 07, 2023
Published: July 06, 2023

Introduction. In the Vologda region healthcare there are complex management and economic (acute shortage of doctors) and spatial (large territory, complex settlement system) restrictions on the availability of medical care. The private health sector is an alternative to the public sector, but it expands the burden of public spending. This actualizes research aimed at assessing the availability of medical care in both sectors of the industry.

Purpose of the study. Assessment of the availability of medical care for the population of the Vologda region  in the public and private sectors.

Materials and methods. The toolkit is a questionnaire survey of the population (sample consisted of 1,500 people) conducted in the region in 2018 and 2020. The analysis is carried out by means of the distribution of respondents’ estimates, expressed in specific weights of the total amount of responses, in the comparative context of demographic and territorial groups, the public and commercial sectors of the industry. The integral index of accessibility of medical care is proposed and tested.

Results. Respondents estimate the availability of medical care/services in private medical institutions higher than in public ones (the accessibility index (AI), in 2020 was 179.6 and 163.4, respectively). During the study period, the index increased, but the gap between sectors remained. The lowest subjective estimates of accessibility were received by medical care in rural areas (AI for the public sector — 167.8, private — 179.5) and in Cherepovets (AI accounted of, respectively, 148.1 and 151.4). The highest level of accessibility was found in small towns (AI was 177.6 and 194.8).

Limitations. When studying the availability of medical care in the region, 1,500 questionnaires were evaluated, which represents a sufficient reference sample to solve the tasks set.

Conclusion. The study allowed obtaining valuable results, which, along with the developed tools (in particular, the index of accessibility of medical care), are recommended to the authorities for monitoring the situation in the healthcare of the region.

Compliance with ethical standards. The sociological survey underlying the study was voluntary. A positive conclusion was received from the Expert Commission of the Vologda Scientific Center of the Russian Academy of Sciences (dated August 12, 2022), established to conduct an examination of materials for open publication.

Acknowledgment. The reported study was funded by the RFBR (project number 20-010-00852 А).

Conflict of interest. The authors declare no conflict of interest.

Received: August 15, 2022
Accepted: December 15, 2022 
Published: July 06, 2023

The level of motivation in the Health care system is an important indicator. All participants in the therapeutic and diagnostic process must have a high level of motivation to achieve the maximum level of effective interaction deserving specific attention. In this aspect, it is necessary to study the factors that influence on the motivation in workers in the Healthcare system.

The aim of the work: based on the data of Russian and foreign literature on motivation in the Healthcare system to evaluate this indicator as the index for increasing the effectiveness of interaction between participants in the therapeutic and diagnostic process.

The presented article includes the sources of literature (Russian and foreign) presented in the Scopus, Web of Science, MedLine, The Cochrane Library, EMBASE, Global Health, CyberLeninka, RSCI, etc. databases, which demonstrate the main issues concerning motivation in the healthcare system.

There are considered issues in the healthcare system, related to the motivation and some ways of solving them are proposed.

Conclusion. To elevate the effectiveness and the quality of the providing of the health care it is worth to develop the motivation of all participants in the therapeutic and diagnostic process.

Contributions of authors:
Timurzieva A.B. — concept, main idea, text writing, selection of literature and it`s translation from English to Russian, compiling a reference list or bibliography;
Abramov Yu.E. — writing the text, compiling a reference list or bibliography;
Lindenbraten A.L. — checking the compliance of the main idea with the selected literature sources, editing.
All authors are responsible for the integrity of all parts of the manuscript and approval of its final version.

Acknowledgment. The study had no sponsorship.

Conflict of interest. The authors declare no conflict of interest. 

Received: November 29, 2022
Accepted: December 18, 2022
Published: July 06, 2023

Introduction. The introduction of restrictive measures during the COVID-19 pandemic led to a reduction in the timing of screening aimed at early detection of tuberculosis among the population. As a result, there has been increased the proportion of patients with common forms of tuberculosis, the treatment of which is of considerable complexity and creates a high risk of death.

Objective of research: study of premature mortality from tuberculosis and HIV infection in Russia before and during the Covid-19 pandemic.

Material and methods. Rosstat data on deaths due to tuberculosis and HIV infection over 2000–2020. The age of 70 years has been adopted as the standard age for calculating the indicator of has increased potential years of life lost (PYLL). Pearson and Spearman correlation coefficients were used for the analysis.

Results: In Russia, before the Covid-19 pandemic in 2000–2019, the decrease in the total number of patients who died from tuberculosis and HIV infection, and the total PYLL, occurred due to a decrease in the proportion of patients who died from tuberculosis — from 99.3% to 25.4%. Pandemics in 2020 in addition, total PYLL decreased to 45.3% or by 9%, PYLL from TB to 8.9% or by 10.1%, PYLL from HIV infections to 36.4% or by 8.9% compared to 2019.

Limitations of the study. The analysis of PYLL from tuberculosis and HIV infection was carried out for the entire population and for individual age groups in 2000–2020, which was sufficient to achieve the goal.

Conclusion. In Russia, during the pandemic, the main reason for the decrease in the total PYLL and PYLL from tuberculosis and HIV infection were changes in the definition of the main cause of death in the combination of tuberculosis and HIV infection with Covid-19, when Covid-19 began to be indicated as such, and tuberculosis and HIV infection moved into the category of secondary causes and ceased to take part in the formation of mortality rates from these diseases.

Compliance with ethical standards. This study did not require the submission of the conclusion of the Biomedical ethics committee or other documents.

Contribution of the authors:
Tsybikova E.B. — concept and design of the study;
Vladimirov A.V. — processing of the material.
All co-authors are collecting material, writing and editing text.

Acknowledgment. The study had no sponsorship.

Conflict of interest. The authors declare no conflict of interest. 

Received: July 07, 2022
Accepted: September 08, 2022
Published: July 06, 2023 

The purpose of the study was to identify the presence of deterministic rates of childhood disability due to mental disorders in the context of its registered (recorded) and calculated levels.

Material and methods. We examined associations between registered, counted and uncounted disability and integral measures of children with mental disorders in 0–14, 15–17 and 0–17years groups. In addition, health resource and activity measures, mental disorder morbidity rates, demographic indicators and their association with child disability rates were examined. Period of analysis was from 2010 to 2020. The study is analytic, non-personalized, retrospective, not randomised.

Results. In the Arkhangelsk region, in the 0–14 years group the rate of calculated total disability was on average 55.9% higher than the rate of registered disability. The underreporting of total disability was higher than in the 15–17 years group. We found no significant links between demographic, socio-economic, health resource indicators and the level of official childhood disability.

Limitations of the study. To avoid errors of extrapolation, caution should be exercised when attempting to scale the results obtained in the study to the population of other regions or the country as a whole, other types of disability, separate age and gender groups, and individual cases of disability.

Conclusions. In the Arkhangelsk region there is underreporting of childhood disability caused by mental disorders. The levels of children’s disability due to mental disorders recorded by official statistics have no significant relationship with indicators reflecting the demographic, socio-economic situation, resources and health care activities. The estimated and unrecorded levels of disability are found to be significantly associated with indicators of socioeconomic status, health care resources, and the overall incidence of mental disorders.

Compliance with ethical standards: the study does not require submission of the opinion of the biomedical ethics committee or other documents.

Contribution of the authors:
Volova T.L. — statistical data processing, writing the text;
Shelygin K.V. — statistical data processing, writing the text;
Menshikova L.I. — research concept and design, editing.
All authors are responsible for the integrity of all parts of the manuscript and approval of the manuscript final version. 

Acknowledgment. The study had no sponsorship. 

Conflict of interest. The authors declare no conflict of interest.

Received: August 23, 2022
Accepted: December 15, 2022
Published: July 06, 2023

While the assisted reproductive technologies have been available for several decades, there still exists a great divergence in legal frameworks regulating reproductive donation.

The article discusses legal regulations on embryo and gamete (sperm and oocytes) donation in Europe, Americas, Canada and Australia. The search for publications was carried out in all available bibliographic and abstract databases (RSCI, Scopus, Web of Science, CyberLeninka, eLibrary, PubMed) containing reports on the subject of the article. The main search restrictions were the language of publications (English and Russian) and the date of reports (not earlier than 2000). We seek to chart global trends and identify major legislative “gaps”; the latter emerge because each type of reproductive donation causes specific conflicts and calls for specific regulations. There is a visible trend towards open gamete donation across the globe as more and more governments insist on deanonymization of donors. Legislators intend to protect children’s interests and to secure their right to identify their biological parents. Financial remuneration is perceived differently, and regulations diverge across the globe. Many governments permit reimbursements, but do not allow any commercial payoffs. Yet, issues of parenthood and donor-recipient obligations remain quite controversial, which results in divergent legal frameworks. Sperm donation is the least controversial and safest procedure; therefore, it is legal in all countries and is allowed in non-medical setting. On the other hand, informal sperm donation requires targeted legal regulations. Parenthood and anonymity in sperm donation also cause concern and require specific legislation. In some countries, oocyte donation is illegal while in others it is under severe limitations. Currently medical treatment and observation of oocyte donors after ART cycles is not yet legally regulated, which leaves women unprotected from post-donation health issues. Embryo donation hinges on the status of the embryo. Specific definition will determine the consequences including from adoption to research use. There remains a problem of authority over embryo’s future in cases of a spouse’s death or divorce.

Contribution of the authors:
Bashmakova N.V. — research concept and design, editing;
Polyakova I.G. — collection and processing of material, writing the text;
Symaniuk Е.Е. — research concept and design, editing;
Khramtsova A.Yu. — collection and processing of material, compilation of the list of literature.
All authors are responsible for the integrity of all parts of the manuscript and approval of the manuscript final version.

Acknowledgment. The study had no sponsorship.

Conflict of interest. The authors declare no conflict of interest.

Received: August 11, 2021
Accepted: December 14, 2021
Published: July 06, 2023

“Personalized” medicine is based on the belief that each person has unique molecular, physiological, environmental and behavioral characteristics, and in case of development of the disease, each patient should be treated taking into account these unique characteristics. This belief was to some extent confirmed by the use of the latest technologies, such as DNA sequencing, proteomics, imaging protocols and the use of wireless devices for health monitoring, which revealed large inter-individual differences.

The purpose: to substantiate a personalized approach will be used in the medicine of the future.

Literary sources (scientific articles) were searched, including those published in peer-reviewed journals indexed in Pubmed, WoS, Scopus, Global Health, CyberLeninka, and the Russian Science Citation Index. Seventy two articles devoted to personalized medicine were analyzed, of which 51 are included in this review. The review included articles on personalized medicine, published mainly over the past 10 years on the topics of oncology, genetics, and articles considering the legal, demographic and social aspects of this problem. From the analysis were excluded articles devoted to the philosophical aspects of personalized medicine, the use of computer and wireless technologies for data processing and communication. Historical precedents, some legislative and policy aspects of its implementation in practice, new technologies that make it possible, some new experiences including successes and failures, ways of testing and using individualized drugs, and future directions, including potential ways of treating people with problems concerning fertility and infertility are considered. The existing limitations of “personalized” medicine are presented. Since aspects of “personalized” medicine are rooted in biological realities, individualization of medical practice in certain cases is probably inevitable.

Conclusion. With the development of technology and the accumulation of experience, an individual approach to the patient becomes more effective and cost-effective. In order for the various stakeholders to embrace “personalized” medicine and begin operating in this paradigm, it is necessary to develop and implement more effective strategies for the education and training of health professionals at all stages.

Contribution of the authors:
Dolgopolov I.S. — the concept and design of the study, writing the text, compiling a list of references;
Rykov M.Yu. — the concept and design of the study, writing the text, critical revision of the article with the introduction of valuable intellectual content.
All authors are responsible for the integrity of all parts of the manuscript and approval of its final version.

Acknowledgment. The study had no sponsorship.

Conflict of interest. The authors declare no conflict of interest.

Received: December 08, 2021
Accepted: January 19, 2022
Published: July 06, 2023 

2023 will mark the 200th anniversary of birth of Nikolai Vladimirovich Pleshkov, who made a significant contribution to the development of the medical traditions of Taurida gubernia. There are no report devoted to his life in modern scientific literature. This article is based on the work with archival collections and pre-revolutionary literary sources. A former orphan, Pleshkov was able to receive a decent education due to his outstanding education, learned several foreign languages, and was well versed in local history, science, culture, literature, philosophy and religion; he was the author of many reports on religious and philosophical topics. In addition, he was actively involved in public life of Simferopol. He was one of the co-founders and for many years — chairman of Simferopol Doctors’ Society. During the Crimea war, the doctor worked under N.I. Pirogov. Among other things, Pleshkov is an author of the first Russian translation of Pascal’s work “Pensees”. Nowadays the former hospital building where N.V. Pleshkov worked houses the chair of Human Anatomy of the Institute “Medical Academy named after S.I. Georgievsky”. The facts of his biography, reconstructed in this article, allow not only to take a new look at the history of the development of health care in Taurida gubernia in the XIX century, but also to form the sense of continuity of passion among medical students. 

Contribution of the authors:
Zvereva E.E. — research concept and design, material collection and processing, text writing;
Kutia S.A. — research concept and design, processing, editing;
Zanina E.M. — research concept and design, compiling a list of references.
All authors — approval of the final version of the article.

Gratitude. The authors are grateful to the local historian Tatyana Arkadyevna Bragina. 

Acknowledgment. The study had no sponsorship 

Conflict of interest. The authors declare no conflict of interest.

Received: August 23, 2022 
Accepted: September 29, 2022
Published: July 06, 2023