Emergence of international integration processes raises new issues of the development of the legislative and regulatory framework at the supranational level for public health benefit. The paper explains the need to actively protect the interests of public health at the supranational level based on the analysis of relevant aspects of the policy, structure, functioning and experience of the largest regional integration structures – the Eurasian Economic Union and the European Union. The review of the basic principles, approaches and measures is carried out, using the example of ensuring food safety, which is directly related to solving the problem of prevention and control of infectious and non-communicable diseases. The relevant regulatory framework of the World Trade Organization (WTO), as well as the development of technical regulation, are discussed. The relevance of cooperation between supranational structures and the World Health Organization and other relevant UN organizations in the field of public health is emphasized. Specialists in this field are called upon to participate in the regulation of international integration processes, including the activities of the WTO, trade and investment agreements, and tariff policy.

Formation of safety culture is a basic requirement of international standards and Roszdravnadzor’s Proposals (Practical Recommendations) for quality and safety of medical activities in Russian Federation. A developed safety culture influences the reduction of undesirable events in medical organization.

 Aim. To assess the level of safety culture of the Clinical Center of Sechenov University with the subsequent development of a strategy for its improvement.

 Materials and methods. The study was conducted using the Hospital Survey on Patient Safety questionnaire adapted by the authors according to the methodology of the Agency of Healthcare Research and Quality. A total of 1049 medical workers of the Clinical Center of Sechenov University participated in the survey. Statistics To assess the reliability and consistency of the obtained results, the Cronbach’s Alpha coefficient was calculated in IBM SPSS program, statistical analysis was performed, and comparative analysis with international databases was carried out.

Results. Middle medical personnel 45.2 % (n = 474), physicians 40.6 % (n = 426), junior medical personnel 11.7 % (n = 123), residents 2.5 % (n = 26) participated in the survey. Representatives of the most high-risk specialties participated more actively: anesthesiology and resuscitation 12.3 % (n = 129), surgery 9.6 % (n = 101), cardiology 8.3 % (n = 87). The strongest component of safety culture was teamwork within departments 83.1 % (n = 872). Nine components were found to be neutral. Two components were the weakest requiring improvement: staffing 44,5 % (n = 467) and non-punitive response to adverse events 47.1 % (n = 495). The overall safety culture level of the Clinical Center was 64 %. Comparative analysis with foreign data showed that the level of safety culture of the Clinical Center is higher than the average of the Organization for Economic Cooperation and Development countries and Saudi Arabia (52 %), and is on par with the indicators of medical organizations in the United States of America (65 %). The strategy for improving the safety culture of the Clinical Center has been to develop a culture of reporting: anonymous collection of reports of adverse events electronically, role-playing training of employees in a game format on how to report and deal with adverse events, and launching a competition, “Sechenovtsy for Safety. Incidents”.

In recent years, researchers have noted an increase in mortality from neurodegenerative diseases and a decrease in mortality from strokes. There have been no studies comparing mortality from these causes in the regions of the Russian Federation.

Aim: comparative analysis of regional (age-) standardized death rate (SDR) among men and women from cerebrovascular diseases (CVD) and nervous system diseases (NSD) in 2013 and 2022 and discussion of factors influencing SDR.

Materials and methods. Rosstat data obtained upon request were used. SDR was calculated using software (state registration number of computer program 216661114) using the European Standard Population using the direct standardization method per 100 thousand population; The average regional SDR values were calculated for the class of NSD and individual groups from this class, CVB (codes I60–69).

Results. A decrease in the regional average SDR from CVD was revealed among men (218.09 ± 60.81 in 2013 and 159.41 ± 51.20 per 100 thousand people in 2022) and women (144.30 ± 39.33 and 103.51 ± 32.63 respectively) and the increase in SDR from LBP (19.77 ± 17.70 and 65.99 ± 56.67 for men, 10.99 ± 11.32 and 52.81 ± 46.13 for women). Only in 4 regions was there a decrease in SDR from both NSD and CVD in both men and women. The dispersion of regional SDRs from NSD and CVB in 2022 compared to 2013 increased by more than 10 times, which indicates a significant and growing regional variability of indicators. In the stroke group, the most significant decrease occurred from “Stroke not specified as hemorrhage or infarction” (code I64). The regional average contribution of acute stroke (codes I60–64) to the SCS from NSD and CVB (in total) decreased (in 2013 among women 51.57 ± 16.26 %, in 2022 33.96 ± 14.95 %; among men 54.0 ± 15.01 and 39.82 ± 14.26 respectively). Alzheimer’s disease makes a negligible contribution to mortality; In men in certain regions, alcohol-associated LBP is significant.

Conclusions. Significant regional variability of SDR from individual groups of causes and a general trend towards a decrease in SDR from CVD and an increase in SDR from NSD were revealed, which is due to many factors. To eliminate the influence of different approaches to determining the cause of death, a unified protocol of criteria for their establishment is necessary.

Medical staff shortage and outflow due to occupational burnout is a global challenge for the health care system.

Aim. To assess the burnout prevalence and its factors among medical workers of the health care system of Nizhny Novgorod region in order to develop an evidence-based burnout prevention program.

 Materials and methods. The study involved 25,070 unique respondents, health care personnel of 148 state medical facilities in Nizhny Novgorod region, which accounted for 70.9 % of the total number of medical workers in the public health sector of the region. The Maslach Burnout Inventory (MBI) questionnaire in versions for medical workers and management personnel, adapted into russian by N.E. Vodopyanova and E.С. Starchenkova, was used as a burnout diagnostic technique. Statistical analysis was performed using SPSS Statistics v. 26 (Chicago, IL), StatTech v. 3.1.6 (StatTech LLC, Russia).

 Results. High and extremely high degree of occupational burnout syndrome was diagnosed in 46.7 % of medical workers. Among management personnel burnout was revealed in 49.8 % of respondents, among physicians – in 53.5 %, among nurses – in 44.4 %. Factors associated with burnout among medical workers were female gender, living and working in the city, financial status, bad habits and chronic diseases; working conditions: overtime work, inability to take a break and lack of rest lounges for workers; and wage rate. For the management personnel the occupational difficulties that showed the most pronounced associations with burnout were the lack of satisfying work results (OR = 6.7, p < 0.001) and problems with team management (OR = 6.1, p < 0.001); for physicians: being worried about their own health (OR = 5.8, p < 0.001) and monotonous work tasks (OR = 6.3, p < 0.001); for nursing staff: being worried about their own health (OR = 4.5, p < 0.001) and inadequate organization of work (OR = 4.4, p < 0.001).

Conclusion. Our study revealed the high prevalence of burnout among medical workers in the public health care system of Nizhny Novgorod region. This regional study presents the data necessary to develop a burnout prevention program for health care workers, including the management personnel.

Rehabilitation in the prosthetics process can significantly enhance patients’ functional abilities and their skill in managing prostheses. Nevertheless, most international rehabilitation recommendations for prosthetic users are aimed at adults. Prior to this research, Russian scientific studies had not proposed a comprehensive model that would integrate current scientific knowledge on the rehabilitation of children needing upper limb prosthetics due to congenital diseases.

The aim of the study to develop an organizational-functional model of phased interdisciplinary medical rehabilitation for children requiring upper limb prosthetics due to congenital diseases.

Materials and methods. Organizational-functional modeling based on the analysis of regulatory legal acts, scientific research, and guidelines for the medical rehabilitation of children with upper limb peculiarities.

Results. The organizational-functional model of rehabilitation includes 3 stages: preparation for prosthetics, rehabilitation upon receiving the prosthetics, and family support during the use of the prosthetics. The main goals of each stage are developed, specialists responsible for solving specific tasks at each stage are identified, and organizations (divisions) responsible for the implementation of each stage are determined. Methodological materials for the parents of children from the target group have been created. Materials aim at optimizing interaction with families and their psychological support. A scheme for remote family support throughout the entire period of prosthetic use has been developed.

Conclusion. The developed organizational-functional model of phased interdisciplinary medical rehabilitation for children needing upper limb prosthetics due to congenital diseases is designed to ensure adherence to the fundamental principles of rehabilitation – early start, phased approach, continuity, interdisciplinarity, individualized approach, as well as active family involvement in the rehabilitation process.