BACKGROUND: The second decade of this century is characterised by the fact that the number of pregnant women who intend to give up their children has considerably decreased. However, despite this, the proportion between the number of abandoned children and all newborns increased from 2009 to 2014.AIM: The goal of this work is to scientifically substantiate changes in Russian legislation based on a comprehensive analysis of the main trends in the development of early social orphanhood and changes in the medical and social characteristics of mothers who give up their children.MATERIAL AND METHODS: The general aggregate of mothers who gave up their children in the Chelyabinsk Region has been studied. In total, 1,438 mothers were observed in 2009-2017. The information has been copied from the reports and records for 2009-2017 found in 51 maternity homes of the Chelyabinsk Region: reporting form No. 32 “Information on Medical Care for Pregnant Women, New Mothers and Women in Labor” and registered form No. 96 “Labor and Delivery Medical Record”.RESULTS: During the period under study, on average, 158 newborns per year were abandoned in maternity homes of the region: 51 children were abandoned by residents of the regional centre, 74 and 33 were abandoned by the women who lived in urban districts and rural municipalities, respectively. Today, mothers who give up their children tend to be marginalised. Two-thirds of them give birth to children out of marriage. Seven out of ten do not have a regular income, and six out of ten have socially significant diseases caused by their lifestyle.CONCLUSIONS: The decline in attention to the prevention of early social orphanhood is caused by the inevitable increase in the number of newborns left without parental care. Every year, the number of well adapted in society women who give up their children when they find themselves in a difficult life situation is decreasing. The number of marginalised pregnant women is growing. Reducing the rate of abandonment of newborns among the marginalised contingent of pregnant women requires changes in the medical legislation of the Russian Federation.

(1) Background: The use of face masks and gloves in public places directly shows the commitment of the population to the established regulations. Public transport is one of the most-at-risk places of contamination. The aim of the study was to analyze the face mask use by public transport passengers and workers during the COVID-19 pandemic. (2) Methods: Public transport passengers and workers were surveyed. Periodic intermittent selective observation was used to gauge the level of adherence to the established regulations among public transport passengers. Factor analysis was used to identify factors determining the face-mask-wearing comfort. (3) Results: The majority of passengers (87.5%) and all transport workers (100%) used face masks and gloves. Most of the users wore only face masks. Only 41.6% of passengers and 74.7% of transport workers wore face masks correctly. Motivational attitudes at the implementation of preventive measures were determined: established regulations in the public place (55.8%) and the protection of one’s own health and the health of family members (44.2%). Only 22.5% of those wearing face masks believed that doing so will have any effect on the spread of an infectious disease, and 10.8% wore masks to maintain the health of people around themselves. A low level of social responsibility was demonstrated. For 53.4% of workers, face mask wearing was uncomfortable. The majority of workers had adverse reactions to mask wearing: feeling short of breath (52.8%), hyperemia of face skin (33.8%), and facial hyperhidrosis (67.4%). (4) Conclusions: The comfort of wearing a mask is determined by adverse reactions occurrence, the properties of the mask, working conditions, and the duration of wearing the face mask. It is necessary to develop recommendations to reduce wearing discomfort. These recommendations, along with methods of raising the social responsibility of the population, can contribute to a greater commitment of the population to non-specific prevention measures.

Any system, including the health care system, maintains stability, integrity and adapts to the requirements of evolution due to the changes introduced into it at the stages of development. None of the health systems are flawless and all are improving in various ways. The article provides an overview of the stages of development of healthcare in the Russian Federation based on an analysis of the regulatory legal framework over the past thirty years. As an illustration, an analysis of the organization of medical care for children with cancer was carried out.

Aim of the study. Analysis of medical tourism’s organizational features based on the example of the large medical organizations in the United Kingdom, South Korea, Italy and China. Materials and methods. The data were collected by the authors by interviewing the heads of medical organizations and their deputies in the United Kingdom, South Korea, Italy and China (3–4 respondents per medical organization) using the developed questionnaire to identify the main mechanisms and tools for organizing the export of medical services. SWOT-analysis (Strengths; Weaknesses; Opportunities; Threats) was performed in order to comprehensively evaluate the received information. Results. Along with weaknesses and threats that slow down the development of medical services exports, strengths (internal factors) and opportunities ( external factors) that contribute to the development of medical tourism were also identified: the widespread popularity of the brand of medical organizations abroad which is associated with the provision of premium medical services; versatility and ability to conduct high-tech surgical operations; the presence of a separate premium class building and an international department for working with foreign patients and promoting a medical organization in the world market; well-established business relationships with assistance companies; foreign medical personnel who speak foreign languages and possess necessary skills to treat foreign patients; developed electronic medical care system; developed system of quality control of medical care; the presence of branches in other countries; the presence of a medical visa in the system of legislation; established cooperation with many countries at the embassy level; state licensing and accreditation for the provision of medical services to foreign citzens; the availability of a state website on the provision of medical assistance to foreign citizens; the possibility of the age of value added tax. Conclusion. We identified main patterns in the organization of export of medical services that can be applied to develop this direction in medical organizations of the Russian Federation during the analysis the strengths and weaknesses of four large medical organizations abroad, as well as external factors that affect the work of these medical organizations.

.Objective. To study the opinion of parents (legal representatives) on the problems of medical care for children with oncological diseases.Methods. The study was based on the Questionnaire for parents (legal representatives) on medical care children with cancer. The questionnaire consisted of 27 questions, the respondents were asked to choose one or several answers or to enter their own option.Results. This medical and social study demonstrated that 81.1±1.9% of respondents are not satisfied with the attitude of doctors and nurses towards them and their children, 15.9±1.8% of respondents are partially satisfied and only 3±0.8% of respondents are fully satisfied. The reasons for dissatisfaction were as follows: rude communication (35.8±2.4%), inadequate attention of medical personnel (21.3±2.0%) and lack of interest in the treatment success (19.7±2.0%). The combination of these options was noted by 23.2±2.0% of the respondents. 63.7±2.4% of respondents would prefer to treat their children at a medical organization of federal subordination, 33.9±2.4% – at medical organization outside the territory of the Russian Federation, of which 57.4±2.4% would like to receive a patient-oriented service and simplified routing between medical organizations during treatment. 12.7±1.6% mistrust in the qualifications of medical personnel in the Russian Federation, 11.8±1.6% of respondents indicated the lack of comfortable conditions for examination and treatment, 5.3±1.1% of respondents indicated the lack of necessary diagnostic and treatment methods and 12.8 1.6% of respondents indicated a combination of the above options.Conclusion. The results obtained indicate the need to implement patient-oriented approaches and to improve the routing of children with cancer.

Malignant neoplasms prevail in the structure of mortality in children all over the world, while most patients are diagnosed at the common stages; the second place is taken by external causes. It determines a particular relevance of developing new approaches to strengthen the role of district pediatricians in the early diagnosis of malignant neoplasms in children.Material and methods. The Algorithm for determining the appropriateness of referring a patient to a pediatric oncologist was introduced in the medical organizations of the Arkhangelsk region in 2016. To evalute the effectiveness of the Algorithm, we compared two groups of patients with histologically verified solid malignant neoplasms: Group 1: 49 patients who received medical care in the Arkhangelsk region in 2011–2015 (prior to the experiment); Group 2: 51 patients who received medical care in the Department of Pediatric Oncology of the Arkhangelsk region in 2016–2018. Results. The average survival time was significantly increased in Group 2016–2018 (30.3 ± 1.57 months) as compared with the survival time of patients receiving treatment in 2011–2015 (25.04 ± 2.05 months) (p=0.045). The following time parameters were reduced: from the moment of contacting the pediatric oncologist to the verification of the diagnosis – from 9.0 to 7.0 days; from verification of the diagnosis to the start of specialized treatment – from 12.0 to 8.0 days; from the moment of contacting the local pediatrician to the referral to the pediatric oncologist – from 11.0 to 2.0 days; from the moment of contacting the local pediatrician to the start of specialized treatment – from 23.0 to 9.0 days. Conclusion: The organizational experiment confirmed the effectiveness of the Algorithm and the expediency of its implementation in the medical organizations.

Accounting for children with cancer is characterized by low reliability of statistics. In addition, the available data do not have significant scientific value., Since they represent only an approximate number of patients identified annually and some general information (incidence, prevalence, etc.). Moreover, subsequent analysis of the accumulated information is of particular importance. An electronic database of children with cancer has been developed that meets these requirements and has been introduced into the clinical practice of pilot medical organizations.Purpose of the study. Our aim was to study the opinions of pediatric oncologists on the issues of registration of children with oncological diseases.Materials and methods. In order to assess the results of the implementation of the electronic database, a "Questionnaire for a survey of a pediatric oncologist to assess the effectiveness of the implementation of an electronic database" was developed, which contained 15 questions. For objectivity, the questionnaires were filled in anonymously by the respondents.Results. The medico- social study involved 187 pediatric oncologists. The majority of respondents (71.3 ± 3.3%) noted that currently there is no register of children with cancer in the Russian Federation, 15.4 ± 2.6% noted the regional register, 9.1 ± 2.1% – independent in individual medical organizations, 1.7 ± 0.9% is a single register for the Russian Federation and 2.5 ± 1.1% are not aware of this. Among respondents, 81.9 ± 2.8% noted that the electronic database is an effective tool for recording children with cancer, while as an advantage, 15.1 ± 2.6% noted an increase in the reliability of statistical data, 9.2 ± 2.1% – reduction of time for searching patient information, 4.4 ± 1.5% – optimization of working time, 71.3 ± 3.3% – a combination of the above options.Conclusion. A medical and social study showed the feasibility of introducing an electronic database of children with cancer into the clinical practice of pediatric oncologists.

Background. Over the past decades, there has been a steady increase in the incidence of childhood cancer. The most childhood cancers are detected at advanced stages. The incidence of childhood cancer increased by 12.8 % (from 11.7 per 100,000 in 2007 to 13.2 per 100,000 in 2017) and the prevalence increased by 37.9 % (from 63.9 in 2007 to 88.1 in 2017 per 100,000). The purpose of the study was to develop algorithms for early cancer detection in children.Material and Methods. In the Arkhangelsk region, the algorithm for referring a patient to a consultation with a pediatric oncologist was introduced into pediatric clinical practice in 2016. To evaluate the effectiveness of the algorithm, we compared two groups of patients with histologically verified solid malignant neoplasms. Group I included 49 patients, who received treatment in 2011–15 (before performing the experiment), and group II consisted of 51 patients, who received treatment in the Department of Pediatric Oncology in 2016–18 (the control group).Results. The use of the algorithm for referring a patient to a consultation with a pediatric oncologist led to the increase in the 3-year survival time from 25.04 ± 2.05 months to 30.3 ± 1.57 months (р=0,045). The time parameters of various stages preceding the start of specialized treatment were statistically significantly reduced: the time from the visit of a pediatric oncologist to verification of the diagnosis decreased from 9.0 (7.0; 14.0) to 7.0 (5.0; 9, 0) days (p˂0.001); the time from diagnosis verification to the beginning of specialized treatment – from 12.0 (8.0; 16.0) to 8.0 (6.0; 10.0) days (p˂0.001); the time from the visit of a pediatrician to referral to a pediatric oncologist – from 11.0 (6.0; 17.0) to 2.0 (1.0; 3.0) days (p˂0.001); the time from the visit of a pediatrician until the beginning of specialized treatment – from 23.0 (17.0; 32.0) to 9.0 (8.0; 12.0) days (p˂0.001).Conclusion. The introduction of a structural and functional model for organizing medical care for children with cancer was shown to be effective.