Since January 1, 2019, the Federal project “Development of export of medical services” is being implemented, which is aimed at improving the quality of medical services in the Russian Federation and their promotion on the international market. Despite this, the problems and opportunities of medical tourism remain one of the urgent health problems not only in Russia, but also in the Chelyabinsk region. Through the conducted research, among political, economic, social and technological factors, problems and opportunities affecting the development of the export of medical services in the region were identified. The experts also named the necessary measures for the development and promotion of medical services on the international market Aim: analysis of existing problems in the field of medical tourism and import of medical services offered on the territory of the Russian Federation, and identification of possible prospects for the development of this area of medical activity. Materials and methods. The materials of this study were analytical materials and official statistical data of the FSBI “TSNIIOIZ” of the Ministry of Health of the Russian Federation. When processing the results, the information and analytical method, the statistical method, the method of questioning and expert evaluation, the method of processing and summarizing information were used. Results. The study involved 50 medical workers holding senior positions in medical organizations of the Chelyabinsk region (heads of structural divisions, chief physicians and deputy chief physicians). The study of the opinion of the study participants on the problems and prospects of the development of medical tourism led to the following results: • Shortage of personnel and material and technical resources is the main constraining factor of development in the provision of medical services to foreign citizens • It is necessary to equip medical organizations with a sufficient amount of medical equipment to increase the level of medical services provided to foreign citizens. The analysis of the external environment revealed political, economic, social and technological factors that hinder and contribute to the development of medical tourism in the country. Thus, the leading political factor contributing to the development of the export of medical services, experts called the support of medical tourism from the state. And the respondents consider the sanctions imposed by the European Union and the United States to be the main negative political factor. Respondents consider the relatively low cost of providing paid medical services as the main economic opportunity for the development of medical tourism. Whereas the main negative economic factor is the increase in the cost of medical devices and medical equipment due to restrictions on the import of imported equipment directly and the emergence of parallel imports. The most important for attracting foreign patients among social factors is the level of qualification of medical personnel, as well as high performance indicators in certain medical areas. Significant social threats, from the point of view of the respondents, is the lack of a unified system of voluntary medical insurance and international accreditation for most medical organizations of the Russian Federation. In order to develop medical tourism and increase the demand for Russian medical organizations among foreign tourists, the participants of the experiment consider it necessary to use the latest treatment technologies and achieve an international level of service, as well as create conditions that will help foreign patients to facilitate obtaining a medical visa. Conclusion. The results of the study made it possible to assess the problems of medical tourism and assess the prospects for development from the point of view of the heads of medical organizations of the Chelyabinsk region, as well as to develop a set of measures for the development of medical tourism in the Chelyabinsk region. The scope of the results. The data obtained will allow us to develop a set of measures aimed at the development of medical tourism in Russia, the adoption of which will help to increase the volume of exports of medical services and the number of treated foreign citizens.

Significance. Increasing involvement of patients in quality improvement of health care is a global trend. Appeals of the citizens to the state authorities are the easiest way to protect the rights of the citizens in the field of health care. The increased social activity of the citizens and transparency of the state authorities have determined the increase in the number of complaints and appeals of the citizens to the state authorities and medical organizations regarding provision of medical care. Handling appeals and complaints is a systemic problem of the Russian healthcare. Organization of monitoring over incoming information will make it possible to organize systematic work to protect the rights of the citizens in the field of health care, to improve health care quality and accessibility. The purpose of the study is to analyze organization of activities for handling appeals in public health protection at the regional level in order to develop proposals aimed at improving efficiency of appeals’ handling. Material and Methods. Material: official data of the Ministry of Health of the Chelyabinsk region. Research methods: mathematical and statistical; analytical (quantitative, structural, comparative). Results. A growth trend in the number of public appeals to the health executive authorities both at the federal and regional levels has been identified, including dynamics in the increase in the number of appeals related to the provision of medical care, financing and staff remuneration in medical organizations. Regional features of the structure of public appeals submitted to the Ministry of Health of the Chelyabinsk region have been determined. Results of the analysis of the appeal handling in medical chats in the Telegram messenger in 2022, as part of the “ZdravControl” project implementation have been presented. Conclusion. Results of the analysis of the public appeal handling in the field of public health protection at the regional level substantiate the need for developing a set of organizational measures to improve organization of care delivery in the region, and raising public awareness about their rights in the field of public health protection. Implementation of the “ZdravControl” project will make it possible to reduce the number of appeals submitted by the residents directly to the health executive authorities, as well as distribute the appeals by source and method of receipt.

Introduction. The purpose of the study is to determine the leading and least represented on the website of the Federal project "Development of exports of medical services" (Federal project) profiles of medical services for the formation of proposals for the development of medical tourism in the Chelyabinsk region.Materials and methods The study is based on empirical and theoretical methods of studying the website of the Federal Project and the information of the Coordinating Center for Medical Tourism Development placed on the websites of the Ministry of Health of Russia and Central Research Institute of Health Organization and Informatization. Statistical method and questionnaire survey method were used.Results and Discussion Factors influencing the choice of medical organization are: availability of information about the medical organization in free access, transport accessibility, staffing of hospitals with equipment, level of professional training of doctors, quality of service and patient safety in medical organizations, the cost of medical services. Leading areas of medical tourism for adult patients: obstetrics and gynecology, neurology and neurosurgery, traumatology and orthopedics. Rating of medical services profiles for children's age category of foreign tourists: pediatrics, rehabilitation, ophthalmology, neurology, otorhinolaryngology and dentistry. The main factors motivating managers of medical organizations to participate in the Federal project: attracting additional funds, development of quality system management and obtaining a JSI certificate, improving the image of the medical organization in the framework of medical tourism. Reasons that hinder participation in the project: lack of targeted funding, problems of interaction with the project organizers, maintenance and processing of permits for medical tourism, pandemic conditions.Conclusion The condition for effective implementation of the Federal project in the Chelyabinsk region is to create a Regional Coordinating Center, which will organize and carry out activities aimed at the development of medical tourism in the region and the promotion of medical organizations in the Chelyabinsk region.

Introduction. The main goal of the state policy in the field of healthcare is to form a system that ensures the availability of medical care and increases the efficiency of medical services. The volume, type and quality of medical care must correspond to the level of morbidity, the needs of the population and the advanced achievements of medical science. Primary health care is the backbone of the health care delivery system. The problem of it improvement, including in rural areas, is a priority and has national significance. The development of measures to increase the availability of primary health care according to the territorial principle is an urgent scientific and practical problem.The purpose of the study — based on the analysis, methodologically substantiate and develop measures to increase the availability and improve the system of organizing the provision of primary health re to the rural population on a territorial basis.Materials and methods. Mathematical-statistical and analytical (quantitative, structural, comparative) research methods were used.Results and Discussion. In the Chelyabinsk Region, there are disproportions in the provision of the population with medical personnel: the provision of the urban population with doctors and l personnel is significantly higher than that of the rural population. The indicator of staffing with paramedical personnel in full-time positions of feldsher-obstetric stations is 20.1% lower than in the Russian Federation. The index of "combination rate" among doctors working in outpatient departments is 1.2 times higher than the target indicator of the National Health Project, and in rural areas it is 1.1 times. In order to unify the organizational and methodological approaches, the authors proposed a classification of medical stations and their organizational and functional structure.Conclusions. The organization of the provision of primary health care to the rural population according to the territorial-district principle with the formation of an organizational model of the rural medical district will increase the availability of primary medical health care to the rural population.

Objective: to determine the prevalence and severity of clinical and cytological manifestations of papillomavirus infection in HIV-infected women of childbearing age in relation to immunological and virological parameters.Materials and methods. Statistical data were obtained through direct randomised inclusion of 182 HIV-infected women of fertile age who were being followed up at the AIDS Centre during their initial gynaecological examinations. Statistical processing of the findings was carried out using IBM SPSS Statistics software.Results and discussion. The results of the study showed a high detection rate of chronic papillomavirus infection of high carcinogenic risk (HPV HRS) among HIV-infected women, which is a prognostically unfavorable factor for the development of pathological changes in the cervix and was confirmed in a study by extended colposcopy. It was found that the concentration of HPV VKR increases against the background of a decrease in the immune status, and there is an indirect relationship between the level of HIV viral load and the concentration of HPV VKR.Conclusion. The feasibility of HPV vaccination among HIV-infected girls and women aged 9–45 has been demonstrated.

Significance. Today, the issue of preserving health, especially in older ages, is considered both in the context of care delivery and development of enabling conditions for remaining socially active. In order to increase the period of active longevity and healthy life expectancy, the national project “Demography”, federal and regional projects "Development and implementation of the program of systemic support and improvement of quality of life of older citizens “Older Generation”, which are of an interdepartmental nature, include measures for rural dwellers aged over 65, to ensure transportation of this contingent to health care facilities for additional screenings by vehicles of the social service. For the first time ever, this organizational technology was implemented in the Chelyabinsk Region in 2019 as a pilot. The purpose of the study is to analyze results of the project on improving availability of primary health care to rural dwellers aged over 65. Material and methods Material: materials of the pilot project “Transportation of people aged over 65 to health care facilities”. Methods include mathematical-statistical, analytical, and organizational experiment. Results. During the implementation of the pilot project, 1,892 people were transported to health care facilities, 75.6% of them completed their clinical examination. 80.97% of people of older working age with detected diseases and pathological conditions were taken under medical follow-up, this indicator is 24.4% higher than the regional one. Conclusion. Results evaluation of the project implementation proves effectiveness of the developed measures aimed at improving availability of primary health care to rural dwellers aged over 65. Scope of application. The presented results of the analysis can be used by heads of health care facilities and regional public health authorities for developing measures aimed at improving availability of primary health care for rural dwellers in the region and effectiveness of preventive measures.

The strategy for the development of healthcare in the Russian Federation improves the staffing of the healthcare system, identified as a priority. The state programs set target indicators for the provision of the population with medical personnel, measures to equip medical organizations with medical workers, and measures of social support for medical workers. The aim of the work was to study the factors relevant for graduates that determine the choice of place of work and the development, based on the data obtained, of measures aimed at improving the availability of qualified medical personnel for medical organizations. The results of a sociological study of graduates of a medical university on the problems of employment in medical organizations are studied. Analyzed: indicators of the population of the region with doctors; the need for medical organizations of the region in medical personnel; events implemented in the region in order to provide medical organizations with qualified personnel. The measures, the implementation of which is aimed at increasing the availability of medical organizations with qualified personnel and achieving the effectiveness of employment of graduates of the university, are determined.

Objective: to study the medical and social aspects, behavioral risks, the level of awareness of HIV infection and pre-contact HIV prevention among men who have sex with men. Materials and methods. The sources of information were official statistics and the results of rapid testing for HIV infection among 2,295 individuals classified as MSM. The study of the level of awareness and attitudes towards pre-contact prophylaxis of HIV infection among MSM was carried out through voluntary anonymous questionnaires. The questionnaires included 12 open and closed type questions developed by the authors. Results and its discussion. The obtained data demonstrated a high level of HIV infection detection rate among the MSM group, which, according to rapid testing, averaged 2.8% for 2016–2018, which is 7 times higher than the detection rate among the general population. Anonymous questionnaire data revealed a high level of MSM awareness regarding HIV infection. Conclusion The result of the study showed that MSM use barrier contraceptives to a greater extent and are not ready to use pre-exposure prophylaxis. But the results of rapid testing indicate high risks of HIV infection in this group and, therefore, the need to find approaches to solving these issues, including using pre-contact prophylaxis.

Prevention and control of HIV infection in the Russian Federation are recognized as a nation-wide one and are one of the priorities for Russia's healthcare. The main principle of implementation of the State Strategy for the Prevention of the Spread of HIV Infection in the Russian Federation until 2010 and beyond is interdepartmental interaction and increase of the availability and quality of medical care and social support for patients with this pathology. The study of the regulatory and legal framework that determines the organization and provision of medical care to HIV-infected persons has been conducted. A number of legislative contradictions, which require the improvement of legislation regarding HIV-infected persons, were established.

The problem of an adequate choice of a treatment method in multiple sclerosis (MS) remains one of the most urgent in modern neurology. The number of patients and the cost of drugs are increasing, leading to an increased MS societal burden. However, treatment costs can be reduced due to the introduction of generic drugs, including domestic ones, which price is significantly lower. Objective: to assess the attitude of Russian patients to the reproduced disease modifying therapies (DMTs) and features influencing an attitude to the replacement from the original to the reproduced drug. Patients and methods. We interviewed 300 patients from six regions of the Russian Federation, receiving interferon beta-1a 44 μ g, interferon beta-1b, glatiramer acetate, and teriflunomide, who had an experience of switching from an original drug to a domestic biosimilar drug or generic not earlier than 2009. Results and discussion. The majority of patients (63%) do not notice any changes due to drug replacement from the original to the generic one, some (28%) experience a deterioration in their well-being, and others (7%) experience an improvement in their condition. Young patients (up to 30 years) are relatively less likely to notice a deterioration in well-being after drug replacement. The clinical deterioration after drug replacement is much more often experienced by the patients whose drug was replaced in a pharmacy (74% of cases) and not by the attending clinician (only 54% of cases of deterioration). The majority (87%) of patients with relapsing-remitting MS (RRMS) did not interrupt the treatment after replacement; 13% of respondents reported that they had stopped taking the drug. Among them, there were much more patients whose drug was replaced in a pharmacy, and not due to clinician recommendation (more than 80% of such cases). Adverse reactions to a new drug are another reason for drug withdrawal (20% of all withdrawals). Patients receiving interferon beta-1b have a higher negative attitude towards domestic DMTs: 52% of the respondents gave negative feedback (compared to 20–35% in other groups). Relatively higher loyalty to Russian DMTs was observed in patients receiving interferon beta-1a (20% of negative feedback, which is notice-ably lower than in other groups) and teriflunomide (a relatively higher proportion of positive feedback to Russian drugs – 25% compared to 11–16% in other groups). The majority (76%) of the respondents noted that they are interested in learning more about the development and registration of new Russian drugs. Conclusion. The majority of RRMS patients do not tend to have a negative attitude towards Russian DMTs. Consequently, the proportion of ratings in favor of Russian DMTs exceeds the weight of ratings against them. The key priority in the formation of loyalty to Russian DMTs should be changing the perception of adverse reactions. This will significantly increase the adherence to therapy and the quality of the provided treatment.

The study was aimed at analysing strategies of prevention of puncture-related complications in patients with myocardial infarction undergoing subjected to emergency coronary interventions by means of a femoral arterial access. We carried out a retrospective comparative analysis of two strategies aimed at preventing false aneurysms of femoral arteries: Group One (232 cases) - elective use of special devices for closure of puncture defects in patients with high risk of haemorrhage (previously performed thrombolytic therapy; exogenous obesity of the second-third degree, 2-3 degree arterial hypertension, use of 2b/3a blood platelet receptors inhibitors); Group Two (525) cases - conventional routine use of these technologies. Puncture defects were closed using by means of devices Cordis Exoseal and St.Jude Angio-Seal. The obtained results suggested advantage of the conventional approach: demonstrating a statistically significant (p < 0.05) decrease in the total incidence of false aneurysms of femoral arteries (from 5.2 to 1.9%) and the frequency of cases requiring surgical suturing of the defect in the femoral artery (from 1.7 to 0.2%). In the conditions of an intensive flow of emergency patients presenting with acute coronary pathology and requiring coronary interventions, devices for closing defects in the femoral arterial access make it possible to level puncture complications. Over the examined period of 2013-2014 there were performed more than 600 closures of defects of the femoral artery by means of the Cordis ExoSeal. These devices proved to be efficient, reliable, and very simple to use. A decrease in the incidence rate of puncture-related complications was also associated with rational prescription administration of drugs influencing positively various links of haemostasis.

Aim. To evaluate medical and social status, life quality, prevalence of modifiable risk factors (RF) of atherosclerosis in patients after acute myocardial infarction (MI), and to evaluate the risk of cardiovascular diseases in this category of patients. Material and methods. Totally, 200 patients with MI diagnosis were questioned. Age 32-65 y.o. (mean age 50,4±1,4). Responders were Chelyabinsk and suburbs inhabitants. Responders were invited to reply on social status, life quality before MI, prevalence of modifiable RF of atherosclerosis. Results. Average evaluation of social wellbeing and life quality before MI was at a satisfactory level. An exclusion was income by 1 family member (below average). Prevalence of RF of atherosclerosis: chronic stress — 72,0%, arterial hypertension — 67,5%, overweight — 55,0%, smoking — 49,0%, high cholesterol — 42,5%, hypodynamia — 20,5%, hyperglycemia — 18,5%, non-rational food habits — 16,5%. Only 26,0% of responders linked the development of MI with their lifestyle. Conclusion. At an example of MI patients, predominantly of economically active age, living in large industrial city, the risks for cardiovascular pathology were estimated: low family income (53,5%), insufficient information on negative influences of modifiable RF of atherosclerosis and their high prevalence.

Aim. To do comparative research on the structure, level and dynamics of morbidity by presentation rate and mortality from cardiovascular causes (CVD) of Chelyabinskaya Region inhabitants during ten years period — 2005-2014yy.Material and methods. The area of the study was Chelyabinskaya region — one of the economically largest regions in Russia. Data sources were official data of Federal Statistics service of RF, reports and accountability sheets from medical institutions during 2005- 2014yy.Results. In mortality from CVD structure from CVD the leading causes are ischemic heart disease (IHD) and cerebrovascular diseases (CeVD). During the period of study there was found a growth of general and primary morbidity by admittance for CVD. In the structure of general morbidity by admittance for CVD during last 10 years IHD is the leading, in the structure of general morbidity by admittance — CeVD. For the period studied, there was decrease of mortality from CVD by 22,7%, incl. 6,3% for IHD, and 1,7 times for CeVD.Conclusion. Regardless positive tendencies of last years, Chelyabinskaya region continues to be the region with high level of mortality from CVD. The revealed patterns of dynamics and structure of morbidity and mortality from CVD dictate the necessity of elaboration of the interventions for improvement of medical care for the patients with cardiovascular diseases at the level of regions.

For the purpose of improvement of quality of delivery of health care to women with infertility at Ministry of Health of Chelyabinsk region the Commission on selection and the direction of patients in the medical organizations for carrying out treatment works with use of auxiliary reproductive technologies at the expense of means of regional and federal budgets. In the work the Commission considers indications, contraindications and restrictions to application of extracorporal fertilization, exercises control of sequence of receiving medical care and efficiency of treatment.

Improved accessibility for the population of the Russian Federation (RF) high-tech medical care (HMC) is one of the main tasks of public health policy. We analyzed the accessibility by providing MEP profile Cardiovascular Surgery with rankings from 4 local groups. To achieve this goal, we used the method of sampling and statistical processing of data on information and analytical monitoring system of high-tech medical care of the Ministry of Health of the Russian Federation. The study included 6598 patients with different clinical manifestations of coronary artery disease requiring surgical correction. In accordance with the data obtained, we have developed measures to improve access to health care at the regional level.

Because of the significance of cardiovascular pathology at the morbidity rate and death rate in adults, we analyzed incidence of cardiovascular diseases and its dynamics in urban and rural population in Chelyabinsk region. We used data from general and primary morbidity level, the results of additional clinical examinations and targeted prophylactic examinations conducted by visiting teams. The study data shows a higher level of latent cardiovascular diseases lead to the accumulation of chronic diseases due to late diagnosis and lack of secondary and tertiary prevention. A comparative analysis of the morbidity level on negotiability and the results of medical prophylactic examinations using an index of the reversibility can help not only to predict the true incidence and evaluate the effectiveness of medical care, but also to plan preventive measures at the population level on a scientific basis.

An effect of 3-oxypiridine and succinic acid derivates--emoxipine, reamberin and mexidole--on severity of clinical symptoms of distal sensomotor polyneuropathy, anxiety and depression was studied in 120 patients with diabetes mellitus with syndrome of diabetic foot. These medications were used in addition to basic antidiabetic therapy. After 14 days of the treatment an equally pronounced decrease of integral index of "negative" neurological symptoms and reduction of anxiety-depressive disorders were detected.