Sociology of Medicine

Ophthalmic care in the United States is among the most technologically advanced and innovation-driven areas of modern medicine. The country's high level of clinical equipment and infrastructure, rapid adoption of surgical, pharmacological, and digital technologies, development of specialized centers, and implementation of large-scale clinical registries give US ophthalmology substantial scientific and practical potential. At the same time, this system has marked internal contradictions: high healthcare expenditures and rapid technological progress do not necessarily translate into equitable access to medical care across different population groups.

This review aimed to analyze the organizational structure, financing mechanisms, and key barriers affecting access to ophthalmic care in the United States. We analyzed data from the Organisation for Economic Co-operation and Development, the Centers for Medicare & Medicaid Services, the American Academy of Ophthalmology, the National Eye Institute, the IRIS® Registry, and scientific publications addressing workforce capacity, insurance limitations, geographic disparities, and social indicators for assessing eye health.

The review demonstrates that the main barriers to access are associated with the high cost of medical services, limitations of insurance coverage, uneven distribution of specialists, logistical difficulties, low health literacy, and communication barriers. The most vulnerable groups include low-income patients, individuals without comprehensive insurance coverage, residents of rural and remote areas, older adults, and racial and ethnic minorities. Potential directions for reform include expanding insurance coverage, developing telemedicine and mobile ophthalmic services, improving price transparency, training healthcare professionals for underserved regions, implementing culturally adapted educational programs, and using clinical registries to monitor quality of care and identify disparities.

These findings may be useful for developing strategies aimed at improving access to ophthalmic care and preventing systemic imbalances in healthcare.

BACKGROUND: The rural paramedic performs today a wide range of tasks: from conducting preventive examinations and medical check-ups to providing specialized care for patients with chronic diseases, including chronic heart failure (CHF). This multifaceted nature of their work necessitates the use of a specialized medical-sociological instrument for assessing paramedics’ self-evaluation of professional effectiveness.

AIM: To develop and test a medical-sociological instrument for assessing self-evaluation of professional effectiveness among rural paramedics, considering their specific role in the management of patients with CHF.

METHODS: The total study sample consisted of 373 paramedics from district hospitals in the Saratov region; all respondents were female. The average age of the respondents was 47 ± 4 years. To conduct a correlation analysis for the purpose of testing convergent validity, a subsample of 77 respondents was formed, with the gender and age structure of the group maintained. Statistical data processing was performed using the Jamovi 2.6.44 software package. The following analyses were conducted: reliability analysis of the instrument (McDonald’s ω), confirmatory factor analysis using the Robust Maximum Likelihood method, and Spearman rank correlation analysis.

RESULTS: The developed medical-sociological instrument “Self-Assessment of Professional Effectiveness of Paramedics” has undergone comprehensive psychometric testing on a sample of 373 individuals. Confirmatory factor analysis using robust procedures (Robust Maximum Likelihood) showed that the scaled model demonstrates optimal goodness-of-fit indices with the empirical data [standardized root mean square residual (SRMR) = 0.059; root mean square error of approximation (RMSEA) = 0.059; goodness-of-fit index (GFI) = 0.995; adjusted goodness-of-fit index (AGFI) = 0.991; comparative fit index (CFI) = 0.908], and all scale items possess statistically significant factor loadings. The reliability of the instrument is confirmed by a high level of internal consistency (McDonald’s ω = 0.838). Convergent validity was established based on identified positive correlations with traditional self-effectiveness scales. Standardization of the questionnaire was conducted, and normative values for interpreting individual results were developed.

CONCLUSION: The obtained psychometric results confirm the reliability and validity of the developed instrument, which allows it to be recommended for practical use in scientific research in sociology of healthcare. The use of this scale enables a more accurate identification of paramedics’ needs for additional support and professional development, and also contributes to the formation of targeted programs for continuing education and strengthening the human resource capacity of the primary healthcare level.

Endometriosis is one of the most common chronic disorders affecting women's reproductive health, yet its significance extends far beyond a purely clinical problem. The relevance of this study stems from the fact that the disease is associated with prolonged diagnostic delay, a marked decline in quality of life, economic losses, and disruptions to reproductive plans, while its social and demographic effects remain insufficiently conceptualized from an interdisciplinary perspective. The scientific novelty of the study lies in examining endometriosis as a socially significant problem. The article presents the results of a scoping and analytical review based on a review of international and Russian publications, materials from international organizations, clinical guidelines, and studies devoted to patients' diagnostic pathways, quality of life, economic burden, work-related losses, and the impact of endometriosis on fertility. The findings show that diagnostic delay across countries is measured in years and is caused by a combination of behavioral, professional, and institutional barriers. The study systematizes the social consequences of the disease, including chronic pain, psycho-emotional burden, reduced work productivity, rising direct and indirect costs, as well as changes in family and reproductive strategies. Particular attention is given to the demographic effects of endometriosis through infertility, delayed motherhood, and the growing demand for assisted reproductive technologies. In the Russian context, institutional constraints related to the uneven availability of specialists, diagnostic services, and long-term hormonal therapy are outlined. The article reveals the mechanisms through which a medical problem is transformed into a socioeconomic and demographic risk and substantiates the need for comprehensive measures in healthcare and social policy.

In the national development programs of modern states, the terms health preservation and healthy lifestyle frequently appear. Health preservation concepts are widespread in fields such as psychology, sociology, and economics. Self-care has expanded beyond basic care. Consumers no longer view spending on health as a luxury or an optional expense but rather as a necessity for increasing life expectancy and improving mental resilience.

The wellness economy is adapting to new models of consumer behavior, creating new business formats in the field of public health. All activities that generate income for the wellness economy contribute to increasing people's responsibility for their health and promoting a healthy lifestyle. The economic efficiency of production and service provision should be complemented by a social component aimed at preserving citizens' health.

The review presents the opinions of domestic and foreign experts—doctors, economists, managers, sociologists, and psychologists—on the development of new approaches in public health, the reorientation of consumers toward a healthy lifestyle, as well as stimulating new business ideas, the introduction of innovations, and health-preserving technologies. New areas of activity focused on health improvement can expand the scope of scientific and clinical research dedicated to health preservation.

Despite a half-century history of studying the city as a living environment, the majority of research remains focused on the pathogenic factors of urbanization—pollution, stress-inducing factors, and the spread of infections. However, this approach leaves a key question unanswered: why, under identical urban conditions, do some individuals maintain a high level of health and well-being while others lose it? Paradoxically, the positive resources of the urban environment itself and the resilience mechanisms of its inhabitants have long remained on the periphery of scientific analysis. This article offers a systematic analysis of Aaron Antonovsky’s salutogenic approach as an alternative lens for investigating the city–health relationship. As a result of a scoping and analytical review encompassing a corpus of 70 key publications in international databases, we identified three principal directions for applying salutogenesis to urban themes: first, the reconceptualization of urban stressors as potentially salutogenic challenges; second, the operationalization of the “sense of coherence” (SOC) in relation to the urban lifeworld; and, third, the formation of principles for the salutogenic design of public spaces. Special attention is given to the transformation of these ideas in the era of digitalization, where the digital urban environment becomes simultaneously a generalized resistance resource and a source of new entropy. The findings show that the COVID-19 pandemic paradoxically actualized the salutogenic agenda, shifting the focus from mere survival to the search for community resilience resources. The article presents a historical and theoretical overview of the evolution of the salutogenic model, as well as a holistic conceptual framework for its application in urban studies, taking into account the potential and limitations of this approach within the Russian context of urban environment design and digital healthcare.

The article is devoted to the Union Health of the Healthy that appeared in 2024 as the successor to the Concept of Health Protection for Healthy People in the Russian Federation published more than 20 years ago. Over the past years, the concept has not received adequate practical implementation.

This article aimed to consider the features of the new union, its goals and objectives in the context of today's problems in the field of health, and, using the example of the union's project Health of Schoolchildren, to assess the feasibility of the assigned tasks.

The significance of the Health of Schoolchildren project is determined by the fact that the health of today's adolescents is an indicator of tomorrow's social and economic development of the country.

This paper reviews the leading health problems of schoolchildren and outlines ways to improve their health. The author presents her understanding of the relevance of increasing health literacy among both adolescents and their parents, drawing on empirical data from the study Digital Transformation in the Life of Students (2023). The paper focuses on the problem of digital infrastructure in Russian schools, the consequences of this process, and a non-trivial solution to this problem abroad.

The activities of the Health of the Healthy Union have a progressive orientation and generate positive expectations. The success of the Health of Schoolchildren project and the entire union depends on the effective interaction of the main participants in this process—the Ministry of Health, the Ministry of Sports, the Ministry of Education, and the Ministry of Science and Higher Education—oriented toward improving the health of the Russian population.