Students attending educational institutions can be considered as a distinct population group with a number of characteristic features related to the age peculiarities, type of activity, living conditions, and other parameters of their everyday life.

The declining trend of this social group general health associated with the negative impact of a number of adverse factors can be noted [1–3].

Today, a significant increase in the drive to get higher education is noted among young people. While in 1991 the number of students was about 2,824,500 people, in 2019 it reached 4,068,327 people [4].

Thus, due to rapidly increasing size of the group and the number of indications for the dynamic monitoring of the group members’ health status and maintaining its high level, it is necessary to organize preventive measures and the measures focused on the early diagnosis and timely treatment of disorders.

The scheduled preventive health screening has been going on in recent years in Russia. Of course, all the citizens are covered by this scheme. A number of the higher education institutions arrange examination of students and employees in the outpatient clinics and medical centers with which a treaty on healthcare provision exists. Such a model is implemented in the Peoples' Friendship University of Russia (RUDN). Students can take the examination they need for free (under the Compulsory Health Insurance) and use a number of healthcare services in the Clinical Diagnostic Center of the RUDN University.

Along with health screening, recently the check-ups often conducted at the Departments by the specialist doctors have become widely available. These allow one to conduct primary examination, detect some conditions and prevent certain complications, such as early stage of hypertension. Such check-ups are conducted in the Pirogov Russian National Research Medical University.

The complex of examinations conducted during triennial health screening in the age group of 18–30 years is as follows:
1) questionnaire: the doctor finds out the complaints, the family history of the disease and the symptoms typical for the most prevalent and dangerous diseases: cardiovascular, bronchopulmonary, gastrointestinal tract disorders. In addition, he/she fills the items about harmful habits, diet, and physical activity;
2) anthropometric measurements: stature, body weight and waist circumference are measured. The doctor uses these data to determine the body mass index;
3) blood pressure measurement;
4) estimation of total cholesterol levels in blood;
5) estimation of fasting blood glucose levels;
6) chest fluoroscopy (every two years);
7) electrocardiography (during the first preventive health screening, then, at the age of 35 years and older, every year);
8) intraocular pressure measurement (during the first preventive health screening, then, at the age of 40 years and older, every year);
9) gynecological examination (every year for women aged 18–39).

The primary aim of the study was to examine the processes of organizing the healthcare provision and preventive measures for health preservation in students at different times. In accordance with the aim, the study objectives were to determine the current features of the spread of chronic and acute disorders among students of medical higher educational institutions; to study the features of healthcare provision and preventive measures for preservation of students’ health at different times; to develop proposals for the implementation of the above measures that are relevant at the moment.

METHODS

The empirical study conducted in the Pirogov Russian National Research Medical University in the fall semester of the 2022/2023 academic year involved students of grades 1–3 (151 students, among them 107 females and 44 males). The subjects’ age was 18–25 years. The questionnaire survey was conducted to obtain information about the students’ health status. The questionnaire included questions about the students’ age, gender, chronic diseases and the history of acute disorders in the last calendar year, as well as about their physical fitness, features of diet and daily routine, presence or absence of harmful habits.
To provide full and comprehensive analysis of the research problem we conducted the review of literature on medical care provision to students in Russia at different historical stages. Statistical analysis of the data obtained was performed by standard methods using the Excel spreadsheet (Microsoft; USA).

RESULTS

The analysis of the surveyed sample health state showed the following:
1) a total of 30 respondents (19.9%) had chronic disorders affecting various organs and systems (chronic gastritis, chronic pancreatitis, bronchial asthma, congenital heart defect, etc.);
2) a total of 144 respondents (95.4%) had a history of acute respiratory virus disease in the last calendar year, among them 94 people (62.2%) got ill three times and more;
3) a total of 121 respondents (81.1%) exercised regularly;
4) a total of 69 respondents (46.7%) believed that their diet was full and balanced;
5) a total of 12 respondents (7.9%) used nicotine (cigarettes, e-cigarettes and tobacco heating systems) on a regular basis;
6) a total of 146 respondents (96.7%) slept less than 8 h per day, among them 52 people slept less than 4 h per day.

DISCUSSION

The state government had been seeking for the mechanisms to control large population since 1920s. This was accomplished through leveling the significance of such concepts, as personal freedom, private space. The group cult, creation of new social relationship forms, active promotion of collectivism had a marked impact on the daily life of all categories of citizens, including students [5].

Thus, in 1920s the first students' communes were established that allowed a certain number of students of higher education institutions to maintain a common household [6]. Thanks to the establishment of the students' communes, their members could substantially improve their material condition and establish some kind of domestic interaction [7].

The communard students shared financial and material resources that were common for all members of the commune. The communards even had common underwear [9, 10]. This aspect of their everyday life could lead to the active spread of infectious diseases, thereby significantly reducing people’s general health, the same as the fact of accommodation of a sufficiently large number of students in one fairly small room.

Moreover, low income of the communard students contributed to a rather poor quality diet being a key factor of the development of gastrointestinal disorders, vitamin deficiencies, etc. [5].

During the World War II and the postwar period all the efforts of healthcare workers were focused on providing qualified, full medical care to victims of military operations. That is why no full medical check-ups or preventive healthcare measures for students were organized.

The heyday of preventive activities to protect the health of students falls on the end of the last century. The state policy contributed to realization of these on an ongoing basis by providing the following:
1) More than 30,000 specialized inpatient and outpatient clinics.
2) About 50,000 outpatient clinics and departments belonging to higher education institutions.
3) Medical and feldsher health centers, as well as dental clinics.
4) 175 student sanatoriums.

All the above organizations executed the common task: realization of preventive, therapeutic and diagnostic activities aimed at preservation, maintenance, and restoration of the students’ health. During the Soviet era the main documents regulating preventive measures in the late 20th century were the Order of the Ministry of Healthcare of the USSR dated May 30, 1986 № 770 “On the Procedure for Conducting a General Medical Examination of the Population” and the “Statute of the Procedure for Conducting a General Medical Examination of the Population” issued on May 30, 1986 [8].

The fundamental unit that executed this task consisted of the student outpatient clinic and specialized student departments of urban outpatient clinics. Their key functions were as follows:
1) providing full-fledged qualified outpatient medical care to students of higher educational institutions;
2) organizing and conducting various activities aimed at prevention and reduction of morbidity among students of higher educational institutions;
3) comprehensive control of the students’ admission to training in accordance with the current requirements of the lists of medical indications and contraindications to getting higher education;
4) organizing and conducting annual preventive examinations for students of higher education institutions of all grades with further support of individuals who needed additional diagnosis when they were through subsequent diagnostic tests during the examination;
5) organizing and implementing anti-epidemic measures.

However, by the end of the last century one could see that student outpatient clinics were not enough, and the development of this area was rather slow. As time passed, this problem grew exponentially: many pre-existing student outpatient clinics were liquidated, while organizations that continued to function, had no organized system for purchase of new equipment and medicines, as well as for employment of new staff members and encouraging the work of employees.

It is assumed that students can get medical care in the basic urban and municipal outpatient clinics, however, this approach has a number of disadvantages:
1) it is often noted that physicians working in urban and municipal outpatient clinics have no specific experience of working with the discussed social group;
2) regular preventive examinations and routine outpatient monitoring of the students’ health are impossible. Thus, there is a fixed age that is preferable for health screening: the check-ups conducted at the age of 18 and 21 years fall on the period of studentship;
3) preventive measures aimed at preserving the health of this social group cannot be implemented.

To provide a thorough discussion of the problem, we studied whether it was possible for students to get the above medical care in medical universities of Moscow.

Thus, the Pirogov Russian National Research Medical University provides the possibilities of attaching to the “university-controlled” urban outpatient clinic № 203 and passing the annual medical examination in this clinic. A discount on paid medical services, provided by specialists, who work in the educational institution, specifically on the consultations provided by opticians-optometrists, obstetrician-gynecologist and dentist, is provided to students of the University.

The foreign students’ health status is also actively monitored in the University. According to federal laws of the Russian Federation, all foreign students are obliged to have health insurance and pass annual medical examinations. To be admitted to studies at the medical institutions of Moscow, as well as to curricular practical training and clinical practice, foreign students have annual medical examinations. Thanks to close cooperation between the University and the clinics that provide medical care under the Compulsory Health Insurance, foreign students undergo health screening in a timely manner and receive all the necessary medical care. The software to control the expiry dates of health insurance and documents on the University foreign students’ health status allowing one to enter information about all medical documents and analyze its relevance has been developed. Controlling the health insurance availability and the relevance of medical documents on the health status, as well as active cooperation between the University and medical institutions allow foreign students to preserve and improve their health, enable the timely diagnosis of a number of disorders, as well as timely treatment and prevention of complications.

Medical care provision and health screening for students are organized in the other medical university, Sechenov First Moscow State Medical University. However, admission is carried out in the same way, i.e. in a common queue. This significantly increases the duration of health screening, despite the fact that this aspect is often the main factor of the student’s motivation to pass a preventive examination.

When comparing the leading medical universities, mention should also be made of the stage of development of health screening in other countries. Unfortunately, in the countries of Western Europe, there is currently no free health monitoring for students. If students want, they can get a paid check-up in any clinic that provides such services.

During the period of studying at the higher education institution, i.e. at the age of 17–25 years, young men and women experience termination of the increase in body length, stabilization of pubertal development; the energy expenditures per unit of weight become close to that of adults. At the same time they still have a rather high level of lability of the nervous processes and emotions, excitatory processes clearly predominate over inhibition processes, while plasticity and endurance of the central nervous system mechanisms, speed of thinking, learning new information, and switching attention from one activity to another are rather high.

Meanwhile, a rapid increase in the load on students of higher education institutions is reported annually. The test/exam period implies rather high requirements for the student’s level of training, which is associated with the significant overload of his/ her intellectual and emotional sphere. According to statistics, the annual increase in the number of cases of various disorders and morbidity rate among young people aged 17–25 is 4–5%. The analysis of statistical data demonstrates the annual decrease of the health index together with the increase in overall morbidity.

In terms of hygiene, the students’ everyday life also has many flaws: disturbance of the daily routine, low levels of physical activity, unfavorable conditions for organizing the self-study process and generally not very high quality of life when living in the dormitory are often typical for students. Disturbances of the regime and nature of nutrition resulting from a number of factors, including the financial one, are frequently reported. The members of this age group can also have harmful habits (smoking, alcohol consumption) [11, 12].

“Occupational” disorders affecting students include the following:
– disorders of the musculoskeletal system (scoliosis of varying severity, joint diseases of different etiology);
– gastrointestinal tract disorders (gastritis, duodenitis, digestive disorders, stomach and duodenal ulcers);
– vision problems (myopia);
– central nervous system disease (autonomic dysfunction syndrome, cerebrovascular disease);
– mental disorders (such as depression), etc.
– Our findings and the literature analysis have shown that some disorders are definitely peculiar to students. These disorders are associated with the students’ daily routine that cannot always be considered as proper and beneficial for students. The results of the questionnaire survey have shown that the increase in the incidence of acute respiratory disorders is observed in students after entering the higher education institution. Furthermore, the majority of respondents have harmful habits and unbalanced diet.

CONCLUSIONS

The data provided allow us to draw some conclusions. Due to unbalanced diet, undefined working hours and frequent exposure to other stressors, students of higher education institutions are characterized by the presence of a number of chronic disorders, the course of which should be controlled in order to provide the necessary treatment. The students’ health status should be continuously monitored due to the possibility of some disorders in members of this social group. Unfortunately, a negative trend in the development of this area in the Russian Federation relative to the earlier period (late 20th century) is currently observed. The findings allow us to put forward a number of proposals. To organize the full-fledged medical support of students, it is necessary to adopt the well-ordered legislative framework to regulate the process of free medical care provision to this social group by the specialized medical institutions. To provide students the opportunity to get the full-fledged medical support, it is necessary to raise additional funds from the federal budget and the Compulsory Medical Insurance fund. Furthermore, it is necessary to consider the group of “students” as distinct medical and social community at the state level and make this group a priority in the development of programs focused on implementation of measures related to health support and healthcare. It is important to develop the specialized medical programs adapted for this specific social group, focused on health support and healthcare among students, and including the development of the scheme for health screening and treatment (if necessary) together with adoption and implementation of the specialized projects aimed at shaping adequate and caring attitude to health in students.