Introduction: The study continues our previous research into biological challenges to public health. At present, biological threats associated with long-term socially determined infections are becoming particularly relevant.

   Objective: To analyze and evaluate national strategies to address the spread of HIV, tuberculosis, and viral hepatitis as severe public health challenges.

   Materials and methods: Our sources of information were reporting forms of the Federal State Statistics Service (Rosstat) on HIV, tuberculosis and viral hepatitis for 2009–2023, WHO and UNAIDS global reports for the years 2021
and 2022, scientific publications issued in 2008–2023, and regulations adopted in 2004–2022. We used epidemiological, analytical, and statistical methods in the study.

   Results: Despite the improved tuberculosis situation, Russia is still among the countries with a high burden of HIV and viral hepatitis B and C. Meanwhile, the long-term strategy to end socially significant infectious diseases has been developed only for HIV infection. The Target Tuberculosis Program until 2024 has been already fulfilled in terms of main indicators. The plan to combat chronic viral hepatitis C by 2030, without defining target indicators, was approved only in 2022. Despite high rates of HIV/tuberculosis/hepatitis co-infections and their adverse effects on public health quality, target programs do not contain consolidated indicators for comorbidity, loss of human resources and related economic costs, staffing and materiel of specialized health facilities. Structural disconnection of the healthcare system for patients with socially significant infections complicates implementation of targeted programs to tackle their spread.

   Conclusions: To prevent the spread of HIV infection, tuberculosis, and viral hepatitis, the optimal solution is to organize Centers for Socially Significant Infections with a single strategy and established consolidated target indicators of co-infection, economic expenses, human losses, staffing and materiel of specialized health facilities.

   Introduction: Global disasters and challenges have a significant impact on the functioning of national health systems. Heterogeneous and often differing approaches to assessing the readiness of the latter for a timely and effective response to these events necessitate the development of an integrated and unified model of its functioning given the resource potential.

   Objective: Based on international approaches, to develop a theoretical model of resource provision of a regional healthcare system for a sustainable response to global challenges.

   Materials and methods: We conducted a six-stage analytical review of international scientific publications using PRISMA method. The first and third stages included creation of primary databases (initial sample size: 470 articles, additional sample size: 549 articles) of publications found in the National Medical Library of the National Institute of Health (NLM and NCBI) and the PubMed databases for the period of January 1, 2000 to May 2024. The second and fourth stages included peer review and selection of eligible publications. At the fifth stage, an expert analysis of the final sample (30 articles) consisting of the most informative publications was carried out. At the sixth stage, we developed a BPMN (Business Process Management Notation) model of resource provision of the healthcare system that allows it to maintain stability in the face of global challenges.

   Results: We developed the theoretical model of the regional healthcare system resource provision for its sustainable response to global challenges, represented by five levels of interaction that take into account medical care types and conditions, different stages of resource reserve formation, as well as hierarchical links between health facilities.

   Conclusion: The developed model has been formalized and algorithmized in terms of description of the main processes taking place in the health system structural elements under different scenarios of their functioning and can be used to elaborate plans and programs to improve the regional healthcare system emergency response to global challenges.

   Introduction: Currently, environmental risks are one of the most important human health threats. Air, water and soil pollution; climate change and loss biodiversity; food contamination, household conditions, and other environmental factors have a significant impact on public health.

   Objective: To develop methodological foundations of the strategy to counter environmental risks to public health.

   Materials and methods: Based on systematization of provisions of regulatory documents (3 federal laws, 3 presidential decrees, and 3 state reports) and guidelines for risk assessment, a methodological approach to creating the strategy for countering environmental risks to public health is disclosed. The use of these documents is justified by the fact that environmental risks actually entail the risks of failure to achieve strategic benchmarks for maintaining and strengthening public health. We summarized the results of 23 scientific publications issued in 2001–2022. The articles were selected using search engines (PubMed, CyberLeninka, and eLibrary.ru) by the keywords: environmental risks to health, public health, environment, health risk management. Based on the reviewed documents, methodological foundations for developing the strategy for countering environmental risks are described.

   Results: We outline the leading current environmental risks, present their classification and the developed methodology for risk response strategy. The methodology contains a number of sequential stages: identification of environmental risks; assessment of their human health effects; risk stratification; development of specific measures aimed at protecting population health by eliminating or reducing the impact of environmental risks; assessment of effectiveness of measures and adjustment.

   Conclusion: The methodology presents a comprehensive approach to addressing environmental risks, which is an important step towards improving public health and the quality of human life.

   Background: Considering the integrative impact of social determinants on public health is essential in the methodological development and implementation of strategies to counter the risks of public health deterioration.

   Objective: To develop proposals for the contents of individual components of the draft Strategy for counteracting the risks of public health quality decline associated with social determinants of health.

   Materials and methods: We conducted a desk research using “The urban health index: A handbook for its calculation and use” by the World Health Organization and GOST R ISO 31000-2019, Risk management. Principles and guidelines, as the methodological approach since challenges to public health entail risks of reducing the quality of public health associated with its social determinants. We examined 28 scientific articles on the topic under study published over the past 12 years (from January 1, 2012 to January 1, 2024) and found in the Russian eLibrary and the international PubMed databases. The articles containing “social determinants of health” in the title were selected. The method of expert assessment was used to decide on the main objectives and directions of the draft Strategy and its target implementation indicators. Experts were chosen from among public health professionals immersed in this topic.

   Results: Social determinants of health have both positive and negative direct and indirect effects on population health. Based on the results of analyzing foreign and Russian scientific works on the impact of social determinants on public health quality, as well as certain foreign attempts to consider social determinants in health care for public health improvement, we substantiated the importance of creation and developed proposals for the structure and contents of the Strategy.

   Conclusion: The authors proved the necessity to implement the strategy for countering risks of public health quality decline given social determinants of health and recommended the contents of individual components of the strategy.

   Introduction: Despite the importance of physical activity and its substantial impact on public health indicators, there are practically no studies on this issue in relation to older age groups, and no studies have been conducted on the influence of health determinants on physical activity indicators.

   Objective: To analyze the influence of social determinants on the indicators of physical activity of the population of preretirement and retirement age.

   Materials and methods: A questionnaire-based survey of 1,489 respondents of three age groups (45–59 years (preretirement age), 60–74 years, and 75 years and older (retirement age)) was conducted in December 2023 to January 2024. Age, sex, and educational level (high and low) were considered as social determinants. The statistical significance of differences was analyzed using the χ² test. The strength and direction of the correlation were evaluated using the coefficient of association (Ca), a nonparametric analogue of the correlation coefficient.

   Results: The self-assessed level of physical activity in men and women was approximately the same until the age of 74, and then decreased significantly regardless of the level of education. Yet, among people with a higher level of education, it remained high for a longer time (the proportion of the low level increased from 22 % to 48 %). The proportion of men with a very low level of physical activity was higher among men with a low educational status. When comparing subjective and objective assessments, we revealed a significant overestimation of self-rated high level of physical activity and underestimation of the prevalence of low physical activity (χ² = 4.02). The conclusions reached for men were also true for women, but the differences were less pronounced.

   Conclusion: Men and women with a higher level of education have higher self-assessed physical activity, which is also confirmed by objective characteristics.

   Introduction: Population morbidity and coverage with follow-up and preventive medical examinations are the criteria for assessing preventive measures.

   Objective: To analyze the dynamics of morbidity and the coverage with preventive medical examinations and health screening of the population of the Udmurt Republic in 2002–2022.

   Material and methods: Over the period 2002–2022 we studied incidence and prevalence rates in the adult population (per 1,000 population) and the coverage with follow-up (per 1,000 patients) and preventive medical examinations (%) using such research methods as literature review, statistical, time series, mathematical, and comparative analysis.

   Results: Both the incidence and prevalence rose in the Udmurt Republic with the growth rates of 12.6 % and 22.3 %, respectively. The negative growth of incidence was established in the town of Glazov (–4 %) and the Alnashsky (–10.96 %), Vavozhsky (–23.1 %), Votkinsky (–24.6 %), Kiyasovsky (–35.4 %), and Mozhginsky (–9 %) districts; that of prevalence – in Glazov (–0.15 %) and the Vavozhsky (–27.9 %), Votkinsky (–3.2 %), and Uvinsky (–18.3 %) districts. The coverage with preventive examinations in the region did not change significantly (from 84.1 % to 84.5 %) while that with follow-up examinations grew by 140.55 %. In Glazov and the Alnashsky, Vavozhsky, Votkinsky and Kiyasovsky districts with decreasing incidence rates, the coverage with reventive medical examinations dropped on average to 68.64 % (from 87.82 % in the year 2002) whereas the coverage with follow-up examinations increased by 133.1 %. The decrease in incidence in the Mozhginsky district from 643.5 to 585.6 per 1,000 population was observed against the background of an increase in the coverage of the population with preventive examinations from 91.1 % to 94.7 % and follow-up examinations by 147.5 %.

   Conclusions: In 2002–2022, both incidence and prevalence rates and the coverage of population with follow-up examinations increased in the Udmurt Republic. The coverage with preventive medical examinations did not change significantly. Incidence rates decreased in the town of Glazov and the Alnashsky, Vavozhsky, Votkinsky, Kiyasovsky, and Mozhginsky districts, which allows us to predict an improvement in epidemic processes in other administrative territories.

   Introduction: Malignant neoplasms and tuberculosis make a significant contribution to the global mortality, which makes mass health screening even more critical.

   Objective: To investigate and compare the scope, dynamics, and effectiveness of preventive chest fluorography/X-ray examinations in the context of the pandemic and to argue for enhanced preventive care efforts.

   Materials and methods: We conducted a comparative study of the scope and effectiveness of individual clinical efforts adopted within the first stage of adult health screening in the Russian Federation as a whole and its federal districts in 2019–2022 based on data of Report Form No.131/u (personal checkup records). We applied descriptive statistics methods and analyzed data using Medcalc 18.2.1 software (Medcalc Software Ltd).

   Results: The number of preventive fluorography/X-ray examinations in the country has increased by 10.4 %. Most federal districts demonstrated growing numbers of fluorography/X-ray examinations (except for the Central and Siberian Federal Districts), which positively affected the detection rate (with the exception of the Ural Federal District). The increase in detection of pathological conditions amounted to 36.2 %, with the Southern Federal District being the absolute leader: the detection rate went up by 97.9 %. Other federal districts demonstrated both positive and negative growth. On the
national level, the number of pulmonary tuberculosis cases decreased by 31.9 % (to 2,759 cases) while the number of tracheal, bronchial and pulmonary malignant tumors increased by 19.6 % (to 15,784 cases).

   Conclusion: Uneven changes in the scope and effectiveness of preventive measures were due to the continued stagnation of the screening endeavors. To achieve better quality of disease prevention, it is necessary to develop and adopt new workflows, which would incorporate artificial intelligence technologies to automate detection and reporting of findings of preventive imaging.

   Introduction: The observed high rate of mobilization of the medical community during the COVID-19 pandemic was associated with a high level of psycho-emotional and physical stress of health professionals, which persisted during the transitional and post-pandemic periods.

   Objective: To study the influence of psychosocial factors on the quality of work of general practitioners in the post-pandemic era and their effects on patient satisfaction with medical services.

   Materials and methods: In 2022–2023, a sociological survey was conducted in Moscow health facilities using internationally validated COPSOQ III (long version) and EUROPEP questionnaires and involving 340 general practitioners and 394 patients who visited them at least once over the past 12 months. The statistical analysis of collected data was carried out using the Statistica 10 and SPSS application software packages (p ≤ 0.05).

   Results: The comparison showed that, in terms of home visits, the workload of general practitioners was 2.1 and 1.8 times higher before and during the pandemic in the years 2019 and 2020, respectively, and 1.07 times higher than normal in 2021. Continuation of professional activities without a break for health improvement in the transition period caused fatigue leading to job dissatisfaction and severe burnout in 34.1 % of the general practitioners, which, in their turn, worsened interaction with patients and were the reason for dissatisfaction of 50.3 % of the responding patients with medical care.
Study limitations: The survey was conducted among general practitioners and patients of Moscow.

   Conclusion: Prevention of job dissatisfaction and adverse effects of the latter on the level of satisfaction of the population with health care is related to the necessity to develop corporate programs for promoting health and reducing burnout risk in general practitioners working at Moscow health facilities.

   Introduction: The study of physical growth of children, including adolescents, is one of the important research areas of pediatrics and healthcare management.

   Objective: To establish the features of physical development of adolescents aged 15–17 years over the past 30 years in the Ivanovo Region.

   Materials and methods: 180 and 274 adolescents were examined in the years 1994 and 2023, respectively, in municipal educational establishments of the city of Ivanovo. Their physical growth was assessed based on measurements taken using common methods of anthropometry. Means of body height and weight (M ± m) were calculated. Individual assessment of physical development was carried out using the sigma deviation method based on local age-specific standards. Data processing was conducted using generally accepted methods of variation statistics. The statistical significance of differences between the parameters was established using the Student’s t-test and nonparametric Mann-Whitney U test for normal and non-normal distributions, respectively.

   Results: We observed no growth acceleration processes in adolescents aged 15–17 years living in the Ivanovo Region over the past 30 years. Yet, we noticed an increase in the number of children with disproportionate physical development. By the age of 17 years, the percentage of children with normal physical development decreased (from 73.3 % to 63.8 %) while that of teenagers with deviations in physical growth, mainly underweight, increased (from 10.6 % to 23.6 %), with no statistical increase in height observed in the age range under study. We revealed no significant differences in the mean
height between the boys aged 16 and 17 years, and in both weight and heigth between the girls aged 15, 16, and 17 years.

   Conclusions: We identified features of physical growth of adolescents aged 15–17 years over the past 30 years in the Ivanovo Region, all indicating the need for constant monitoring of anthropometric parameters with revision of regional standards every 10 years and the development of programs for prevention of developmental disorders in the region.