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Tobacco Treatment Counselor (Per diem)

• 1 Boston Medical Center Place, Boston, Massachusetts

POSITION SUMMARY:

The Tobacco Research and Treatment Center at Boston Medical Center seeks a tobacco counselor to provide behavioral counseling to help smokers stop smoking.  Working under the direction of the Medical Director of the Tobacco Treatment Program and Tobacco Education and Treatment Coordinator, the counselor will be responsible for assessing and counseling outpatients and inpatients who use tobacco. 

Position: Tobacco Treatment Counselor     

Department: Pulmonary Clinic Med Spec

Schedule: Part Time (Per diem)

ESSENTIAL RESPONSIBILITIES / DUTIES:

• Conduct new and follow up patient assessment sessions via telehealth or in person. Assists patients in moving through the stages of change by providing supportive counseling in a series of one-on-one coaching sessions or group sessions. Manage relapse prevention, follow up and after care services.
• Complete inpatient tobacco consults via in person or telehealth.
• Provides support for vaping counseling as needed
• Provide resource information and motivational coaching based on patient’s completed assessment and stage of change for smoking cessation
• Conduct carbon monoxide and spirometry testing as needed.
• Develops individualized treatment plans, including appropriate medications for patients in collaboration with the patient’s medical team. Documents the counseling sessions along with the plan of care for each patient.
• Schedules inpatient and outpatient counseling and follow up sessions.
• Assists the Tobacco Coordinator to maintain patient database on smoking cessation for inpatient and outpatients
• Assists the Tobacco Coordinator to track smoking quit rates for outpatients
• Assists the Tobacco Coordinator to  run reports on the patient volume and documentation compliance

Must adhere to all of BMC’s RESPECT behavioral standards.

(The above statements in this job description are intended to depict the general nature and level of work assigned to the employee(s) in this job.  The above is not intended to represent an exhaustive list of accountable duties and responsibilities required).

JOB REQUIREMENTS

A Bachelor’s Degree in health education, psychology, social work or related field is required; a master’s degree is preferred. 

CERTIFICATES, LICENSES, REGISTRATIONS REQUIRED :

Tobacco Treatment Specialist certification is required within 6 months of employment. 

EXPERIENCE:

Experience in counseling and group facilitation is required; 6 months experience in tobacco treatment is highly desirable. 3-5 years of direct patient care experience with respiratory diseases and consequences of smoking (i.e. Registered respiratory therapist RRT).

KNOWLEDGE AND SKILLS:

• Applicants should have good clinical and patient counseling skills as well as interest and ability to facilitate group programs.
• Proficiency in word processing and database management skills is necessary. 
• Familiarity with Microsoft Access, Excel and Word preferred. 
• Must demonstrate strong organizational and communication skills and ability to work independently but also work well as part of a team.

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Suburbanization Problems in the USSR : the Case of Moscow

• Référence bibliographique

Gornostayeva Galina A. Suburbanization Problems in the USSR : the Case of Moscow . In: Espace, populations, sociétés , 1991-2. Les franges périurbaines Peri-urban fringes. pp. 349-357.

DOI : https://doi.org/10.3406/espos.1991.1474

www.persee.fr/doc/espos_0755-7809_1991_num_9_2_1474

• RIS (ProCite, Endnote, ...)

Résumé (fre)

La suburbanisation n'existe pas en URSS au sens des phénomènes décrits dans les villes occidentales. Cependant on observe certains transferts limités d'activités industrielles exigeantes en espace ou polluantes, voire même de centres de recherches, vers les zones suburbaines ou des villes-satellites. Mais ces déconcentrations répondent à une logique de planification administrative. En outre, les Moscovites hésitent à aller habiter dans ces centres d'emploi, de crainte de perdre les privilèges liés à l'autorisation d'habiter Moscou (la propiska) et du fait des communications insuffisantes avec la capitale. Le taux de croissance de la population moscovite reste supérieur à celui du reste de l'oblast. Par contre le développement de datchas de seconde résidence est très important dans l'oblast de Moscou, en particulier aux alentours des stations de chemin de fer. L'abolition du système de propiska pourrait transformer les datchas les plus proches de Moscou en résidences principales.

Résumé (eng)

The suburbanisation does not exist as such in the USSR with the meaning one has of the phenomena in Western cities. Though one may notice some limited transfers of industrial activities demanding a lot of space or polluting ones, even research centres, towards the suburban areas or satellite-towns. But these déconcentrations correspond to an administrative planification logics. Moreover the Muscovites hesitate before going and living in these employment centres, because they are afraid of loosing the privileges linked with the authorisation to live in Moscow (the propiska) and because of insufficient communications with the capital. The growth rate of the Muscovite population remains higher than this of the remainder of the oblast. To the contrary developing of datchas for second residences is very high in the Moscow oblast, especially in the vicinity of a railway station. The abolishment of the «propiska» system might transform the datchas nearer to Moscow into main residences.

• Economic structure [link]
• Suburbanization of activities [link]
• Suburbanization of population [link]
• Conclusions [link]
• Literature [link]

Liste des illustrations

• Table 1. Employment structure, % [link]
• Table 2. Annual rate of population increase, % [link]
• Fig. 1. Spatial distribution of country-cottages and gardening associations in the Moscow region [link]

Texte intégral

Galina A. GORNOSTAYEVA

Moscow University

Suburbanization Problems

in the USSR :

the Case of Moscow

Suburbanization processes typical to cities in Western Europe, the USA and other countries are not observed in the USSR or they are distorted to such an extent that they may not be compared with existing standards. This states the question how Soviet cities-succeeded in escaping this stage of urban development. In order to answer this question, we should first summarize the main aspects of Western suburbanization.

Firstly, it is well known that the urbanization processes are linked to structural changes in the economy. Thus the transition from the stage of concentration to this of suburbanization is associated with industrialization, and the transition to the third stage - déconcentration - is related with the rapid growth of employment in the non-industrial sphere. Secondly, a suburbanization of economic activities can be distinguished. It applies in the first place to the building and iron- working industry, transports, engineering and chemical works. These are polluting and requiring extensive areas. This suburbanization of industry is caused by the following factors: rising demand for land from firms ; worsening of transport

tions in the inner cities ; demand for lower land costs and taxation levels in suburbs ; rapid growth of road transports; state policies regulating the growth of large cities ; migration of the labour force to the suburban zones. Scientific and educational activities are also transferred from the centre to the suburbs.

The third important aspect of suburbanization applies to the population. In the suburbs two opposite flows of population meet ; one is centripetal, coming from non- metropolitan regions, the other is centrifugal, coming from the central city. The reasons for the migration to the suburbs are as follows : declining living standards in large cities (overcrowding, slow housing renewal, environmental problems, etc.); growth of motorization of the population, development of communications (telephone, telex, fax, computer) ; intensifying decentralization of working places ; lower land prices in the suburbs ; state support for the intensification of real estate development in the suburbs. The above-mentioned factors and reasons for suburbanization are altered in the Soviet cities. Let us explore them, by taking for example the largest one - Moscow.

Economic structure

The employment structure in the USSR reveals sharp differences from those in developed urbanized countries. The USSR is characterized by a high share of employment in agriculture, industry, construction and a low share in the non-industrial sphere (tab. 1).

A correlation analysis of the percentage of urban population and employment in the different spheres of economic activity reveals that the share of urban population in the USSR is higher than in countries with the same percentage of persons employed in agriculture.

TABLE 1. EMPLOYMENT STRUCTURE,

Source: personal calculations.

The urbanization processes in the Moscow Capital Region (MCR) are more intensive than in other regions of the USSR. Structural changes are more obvious here : the share of employment in the non-industrial sphere increases more substantially and the percentage of persons employed in industry and agriculture is lower than in the whole country. However the MCR cannot therefore be compared with a metropolitan region in a Western country. Although Moscow is the most advanced agglomeration in the USSR, it lags is far behind the major world cities in terms of development and it is at the very start of the post- industrial stage of its structural and urban transformation.

The structural «anomaly» of the USSR as a whole and of the MCR in particular is explained by the enforced process of industrialization (starting from the thirties) at the expense of the peasantry (thus, there is not only a booming industrial employment in cities, but also worsening living and working conditions in villages and forced collectivization having triggered off the massive rural emigration). As a result, the share of urban population in the USSR is higher than expected, based on changes in the economic structure. While urbanization in the developed countries was due, among

other causes, to an increasing labour efficiency in agriculture, this remained quite low in the USSR. Therefore the employment share in agriculture is overstated in comparison with countries with a similar percentage of urban population, and even this considerable part of the labour force is unable to feed the whole population of the country.

The share of agricultural employment in the mcr increased from 7,4 % to 7,6 °7o between 1980 and 1985 (as a result of Moscow attractiveness and the better living standards in its surrounding villages), whereas it continued to decline in other parts of the Central region. The population growth in villages adjacent to Moscow is especially intensive, though labour efficiency in localities near Moscow is higher than in the other oblasts. In spite of this, Moscow oblast provides only 61 % of milk, 34 °/o of potatoes, 45 % of vegetables and 23 % of meat needed by the population in Moscow city and oblast (Argumen- ty i facty, 1988, N50, p. 3). The structural anomaly is not only related to processes in agricultural sphere but also in industrial sector. As a result of the low economic mobility of socialist firms and of the absence of market relations, the industrial development was extensive,

without significant increases of the labour

productivity.

Thus the employment transfer from the

agricultural to the industrial sector, their

extensive development and their low labour

productivity are intrinsically related with the political definition of productiorfrela- tions and course of structural economic transformation.

Suburbanization of activities

Moscow and Moscow oblast show divergent economic structures and changes (tab. 1). In Moscow the employment share in the non-industrial sphere in Moscow is growing more rapidly, whereas the share of industrial employment is decreasing. In Moscow oblast the part of transport and communication infrastructure, retail trade, administration, housing (presently less developed than in Moscow) is increasing. Some stages in the transformation of activities in the mcr's settlements may be pointed out here. The stage of industrialization and reconstruction after World War II is characterized by the swift industrial development and the active restructuration of the Moscow and Moscow oblast economy. New industries have been built (motor-car and aircraft assembly, machine-tool industry, organic synthesis, etc.), around Moscow research and production potential. Nevertheless, this restructuration is extensive, since traditional industries don't curtail production. It favours the heavy concentration of modern functions in Moscow. There is no transfer of firms outside Moscow. Suburbanization of industrial activities did not occur because of the state owning the means of production and of thé socialist form of production relations. When research and technological progress are slowing down, these firms become inefficient and spatially immobile. The period 1956-1970 is marked by an intensive development of the region scientific sphere and by the rise of « satellite » urban policy. The new centres were specialized in modern branches of machinery and research-engineering activities and were undoubtedly very attractive for the population. Therefore towns like Dubna were growing rapidly. While the aim was to redirect part of Moscow population

growth, they display a quite specific relation with the capital. For instance, Muscovites working in Pushchino cannot reach their job every day because they lack transport facilities. Nevertheless, they don't wish to move and register their passports in the city in which they actually work, since they would have to give up their Moscow registration and then lose all Moscow privileges (see further). These new centres are isolated from information sources in Moscow. Poor telephone communications, lack of computers and telex systems hamper contacts and teamwork with colleagues in the city. It seems that material resources for experimental work in research centres are not sufficient to compensate for lack of information and communications. At the same time, poor transport links with Moscow and the other towns of Moscow oblast isolate the scientists from the higher standard of culture in the centre and from a well developed social infrastructure. An original home-work relation can be observed in Dubna: the Muscovites get the second registration of passports and live there in hostel apartments during 4 or 5 working days, during the weekends they go back to Moscow, where their families are living. The change of functions in Moscow oblast towns is still going on. Inside the towns of the first circle adjacent to Moscow, the share of employment in the non-industrial sectors and transport is growing. Inside the towns of the second circle (suburban zone) these changes lead to an increasing potential of non-industrial, industrial and construction functions. Finally, in the outlying parts of the region the further grovth of construction and industrial functions is observed and the organization potential is intensifying in some towns. The mcr towns display a crawling concen-

tration of the regional most important functions and their extension outside the boundaries of Moscow to the towns of the suburban zone. But the déconcentration of functions in the mcr is not only of natural- economic character. It also results from the state urban policy. Déconcentration is not related to the search for more advantageous sites for firms and institutions as regards to economic or social relations (the availability of cheaper labour force or more comfortable living conditions, etc.), nor is it sustained by the expansion of transport and communication facilities. Thus, this déconcentration is independent from curtailment of any function in central Moscow, whose potential is still growing, and it is also completely inadequate regarding the continuing concentration of population (see below). All this, together with the slow economic and territorial mobility of firms, is an obstacle to the economic restructuration of the region, and to the reorientation of Moscow and its suburbs to non-industrial activities and to progressive scientific and informational work. The mass labour-consuming functions still remain in Moscow and its suburbs, but they are inevitably cut off from modern types of activities.

The idea of alleviating Moscow's development appeared from the very beginning of its rapid growth, since the excessive concentration of population and employment led (as in the other major world cities) to environmental discomfort, worsening of transport, strip-holding of land and other congestion signs. In market economies, the firms react to alterations of economic or social conditions by their mobility: some

of them close, other relocate in more convenient places. In the USSR, the problem of firm transfer (unhealthy or unprofitable firms) becomes unsolvable because of the special type of production relations. Economic and territorial passivity of firms is apparent in the difficulties of erecting industrial buildings and dismantling machinery and equipment, in the low turnover of the means of production. The same problem exist regarding the labour force. Firms transferred to the suburban towns of Moscow oblast are encountering great difficulties in recruiting staff in sufficient numbers and of required skill. The local labour force is rather weak, while the Moscow workers wouldn't leave the capital to follow their firm, because they are afraid of being deprived of passport registration in Moscow. From the social point of view, giving up a Moscow registration is more significant to people than losing their job. The processes going on in the mcr are therefore not quite comparable with those in the Western world. The market economy is more «lively» and replacement of functions has the character of territorial waves. Some functions disappear while new ones emerge. In the mcr, the waves are replaced by stratification. New functions do not replace the old ones, but joining them. At the same time, this process of relative déconcentration of functions overpass the process of stable concentration of population. In the mcr, the modern branches are gravitated closely to Moscow, where skilled workers are retained by their registration advantages. Suburban towns have to be satisfied with commuters or specialists from the outlying regions of the USSR.

Suburbanization of population

The urbanization structure of the region is characterized by the predominance of its main centre - Moscow. The share of the capital in the total Moscow oblast population was as follows: in 1929 - 44,3 Vo, in 1939 - 51,6 %, in 1959 - 54,9 %, in 1979 -54,5 Vo, in 1985 - 57,3 % (Moscow Capital Region, p. 137.). Within the agglomeration, the share of Moscow is still higher, in 1959 it was 75,5 % and in 1985

- 67,3 % (ibid., p. 141), whereas in the highly developed capital regions of the world the agglomeration counts one half or less of the total population and of the economic potential, the second half being concentrated in the suburbs (Gritsay, p. 71). Moreover, the growth rate of Moscow population is higher than that of Moscow oblast (tab . 2).

TABLE 2. ANNUAL RATE OF POPULATION INCREASE,

Migrations are of great importance to the mcr. The internal migration of rural population to the cities is rather substantial, and the immigration flow from the rest of the USSR is not compensated by the decrease of rural population in the mcr. The nearer a town to Moscow, the larger the migration share in its total population increase.

The dynamics of population in the mcr has a specific character. In agglomerations of the developed countries the principle of the «broken glass» summarizes the suburbanization process. When, for some reasons, the centre loses its attractiveness the urban population moves to suburbs in search of higher living standard. In Moscow agglomeration the principle of the «overfilled glass» is operating. People wanting to live in Moscow cannot enter the city and are forced to settle near it. In Moscow immigration undoubtedly prevails over emigration, confirming the extreme territorial differentiation in conditions, level and way of life. As a rule, commuting is oriented from suburbs to Moscow (600 thousand persons come to Moscow and only 200 thousand leave it), but it accounts only for 12-15 % cf the total employment in Moscow's economy. Moreover, these commuters are not Muscovites but potential new inhabitants of the capital (striving for passport registration and domicile in Moscow).

Moscow became the most attractive place for living and an intensive flow of ruined rural residents as well as residents from other regions of the country were rushing -to Moscow. These processes were generated not only by the inception of the country structural economic transformation,

but also by the policy of special privileges for Moscow. These privileges came into being after the establishment of a centralized distribution system. Such a system involves the assignment of a priority level of foodstuffs and manufactured goods to each territory. Moscow was awarded the highest priority level. From the very beginning, better living standards and higher income for certain population categories were established there. In the thirties the artificial differentiation in living standards was confirmed by imposing restrictions to passport registration in the capital, and also by the division of administrative bodies into Moscow and Moscow oblast authorities. In the period 1925-30 dozens of new large firms were located in Moscow, but housing was insufficient at that time. Therefore, a great number of migrants from every corner of the country came to get a job in Moscow and settled in cottages in the nearby countryside. Soon, these settlements in the nearby countryside. Soon, these settlements turned into urban ones. For example, towns like Mytishchi and Luberstsy developed rapidly, and even Muscovites moved there when the railways were electrified. This was clearly the outset of a suburbanization process, but it stopped as soon as the restrictions on passport registration in Moscow were imposed and the social barrier between Moscow and Moscow oblast was established. In the period 1930-40, new industrial developments were banned from Moscow and firms drawn towards the city were located on the outskirts thus causing a rapid growth of the old and new towns. Although the development of cottages as second residence near Moscow started even before the revolution, since the en-

vironmental degradation of Moscow was practically completed at that time, they became the main resorts of those years. They had flourished in the districts with privileged natural conditions and convenient transport services (not further than 2 km from a railway station). In the period 1930-40, this sprawl of leisure housing carried on - cottage settlements expanded into an entire belt of scattered one- storeyed buildings. But at the same time, urban multi-storeyed housing also increased and after World War II these multi- storeyed buildings were found in the cottage settlements of the leisure zone. In the period 1950-60 a network of gardening associations was established. In those

years the most convenient land near Moscow had already been built on. The gardening plots allotted to the Muscovites were located in the remote parts of the mcr, outside the suburban zone, and very frequently they were on improper territories. Because of their remoteness, the difficulties in cultivation and building, the lack of infrastructure, these plots cannot become effective leisure resorts. More frequently Muscovites use them for fruit and vegetable growing.

The desire of the Muscovites for having a second residence in the suburbs can be interpreted as an unfulfilled suburbanization tendency. This desire has the same, mainly environmental, causes as suburbaniza-

tion in Western countries. The cottages within the reach of Moscow's traffic and having access to appropriate infrastructure and amenities, might become the principal residence of Muscovites if passport registration is abolished. The restrictions of passport registration in Moscow fixed in the thirties were devised as an administrative solution against the effects of Moscow's unique attractiveness and not as a means of eliminating the attractiveness itself. For this reason, Moscow became even more attractive, like a forbidden fruit. The consequences were both the concentration of the upper strata of society in the city and the extensive development of industry, resulting in a growing shortage of unskilled labour.

The shortage of regular workers in Moscow is sometimes explained by the increasing number of working places. An adequate planning of the «limiters» (1) system is then put forward as the solution for controlling the growth of Moscow is found in (Glushkova, 1988, p. 43). To be frank, about twenty industrial units and more than one hundred scientific institutions were already created in the seventies alone, in spite of the industrial building ban in Moscow, only a few firms moved outside the city in return. New industrial units easily find staff, since they offer new machinery, relatively good working conditions and higher wages. New scientific and administrative institutions are in a similar position. But the situation is totally different in the old industrial units, with rundown equipment and a high level of manual tasks. Those units suffer from a staff shortage. Moreover, as in any other city, there is a social mobility in Moscow, in most cases improving - from manual up to mental, from unskilled up to highly skilled work. Furthermore, the prestige of a higher education (university) is overestimated in Moscow, whereas the prestige of the manual professions has declined as a result of the stagnation of reinvestments in industry, the high share of manual labour (40 %), and also favouritism and

crowding in the administrative staffs. The attractiveness of an upper class position is therefore overestimated, and social mobility activated. Since Moscow cannot admit free «immigrants» the lower strata of the social structure are vacant and there appears a shortage of unskilled labour force. The lower strata of the social structure were filled in with « limiters ». Available employment in Moscow was not the cause of an organized immigration flow, but represented the only possible way to register the passport there. Roughly half of these people drawn into Moscow's economy left their jobs. «Limiters» get the right to register their passports in Moscow and take up their residence in new houses when their contract expires. They usually quit their job as soon as possible in search of better working conditions (Glushkova, 1988, p. 42). The nature of unskilled work in Moscow and the associated working conditions are so unattractive that it is nearly impossible to find Muscovites willing to perform them.

The institution of passport registration raised many problems. Thus the « limiters » are recruited in social groups not needing most of the advantages of a large city, their psychology and value system differ sharply from native Muscovites. The direct environment of the hostels where «limiters » live, has a pronounced criminal character. Fictitious marriage in order to register the passport in Moscow has become a widespread practice.

Moscow's environmental problems can hardly be solved as long as passport registration exists. The population is literally locked up within the city boundaries. Notwithstanding the environmental stresses, the Moscow privileges prevent the Muscovites from leaving the city. The urban districts not saturated with harmful industrial units are the most prestigious. The social and economic causes of Moscow's extensive growth reveal that its problems are a reflection of the ones facing the USSR. The concentration of economic, social and management functions in Mos-

cow in Soviet times materializes the strong centralism of the particraty and weighs down on the city's development. Low labour efficiency in agriculture and sheer desolation of villages on the one hand, rapid but extensive industrialisation together with forced increasing social attraction of Moscow, confirmed by the restrictions on passport registration, on the other hand, were the key factors of the mcr's polarization during decades. Together with objective factors found in other large cities of the world, subjective factors related to the Soviet political and economic system influence Moscow's growth.

The objective factors are as follows: the diversity of employment in the capital, the emergence of new types of occupations, the concentration of high-skilled and creative labour, the higher living standards, the large educational and cultural opportunities.

The subjective factors are the higher supply level of foodstuff and manufactured goods different than in other regions (the existence of meat-rationing system in many regions of the country and its absence in Moscow establishes a significant threshold not only in terms of supply but also in the outlook of the population); the lack of communications and individual motorized transport (in the rsfsr one counts 47 cars per 1000 urban inhabitants against 560 in the USA) (Argumenty i facty, 1988, N47, p. 2); the craving for joining the upper social classes and for accessing neighbourhoods with a high quality of life; unjustified promotion of upward social mobility releasing «the ground floors» of Moscow's economy; continued growth of employment due to the extensive economic development and the low economic and territorial mobility of firms. Today, the hierarchy of priorities for selecting a residence within the mcr and the whole country is as follows. Food supply comes first. The supply of manufactured

goods, the opportunities to obtain better and larger living quarters and to accede to a prestigious employment with a wage increase, social promotion, well developed consumer services come next. And only at the end of the scale appears the opportunity to fulfil cultural needs and education. Thus, there is a process of «pseudo- urbanization» characteristic of the Soviet economic and social system, superimposed on the process of «natural» urbanization. By natural urbanization we mean the process related to economic development and to the natural difference between rural and urban ways of life. The specificity, the structural changes and the hierarchy of city functions shape the migration flows conditioned by natural urbanization. «Pseudo-urbanization» points to «the scum» of the process, that may complete the economic and socially conditioned urbanization. The «pseudo-urbanization» is generated by a disproportionate development of the country's economic structure (hypertrophie share of industry; economic and political reforms have triggered off a massive flow of the peasantry towards the cities, related not with the rising but with the lowering of labour efficiency in agriculture, with impoverishment of the countryside and hence with the urge towards the centres of relative well-being), and by the territorial inequalities in standards of living, artificially created and maintained by the institution of passports and registration.

The suburbanization of population cannot be observed in the MCR. The centripetal tendencies mentioned above resulted in rapid growth of Moscow and its suburbs, as well as in some stagnation of its periphery. Thus Moscow agglomeration is now in the first stage of development, the stage of «crawling» concentration where centrifugal forces are very weak. This situation will last as long as the barrier in terms of standards of living exists between Moscow and Moscow oblast.

Conclusions

This study has reaffirmed the general lack of suburbanization in the Soviet cities. Some signs of suburbanization like the

transfer of some activities from Moscow to the suburbs, the concentration of population in towns and villages near the central

city and commuting, differ significantly pie and firms will emancipate, only if the from the Western cities. The process of ur- existing political and economic system in banization will take its normal course, peo- the USSR is dismantled.

Argumenty i facty, 1988, N47, p. 2 Argumenty i facty, 1988, N50, p. 3

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(1) Limiters are unskilled workers, hired in an organised way by Moscow firms; after working there for several years of working they get the right to register

their passports and to take up their residence in Moscow.