Children In Moscow Research Articles

Epidemiological Trends in the Incidence of Gastritis and Duodenitis among Children in Moscow

Introduction. The article analyzes the incidence of gastritis and duodenitis among children based on the data provided by medical organizations subordinate to the Moscow Healthcare Department. The disease incidence is presented by age groups. Materials and methods. The data was obtained from the Federal Statistical Observation Form No. 12 “Information on the number of diseases registered in patients living in the service area of a medical organization”, Form of Federal Statistical Monitoring No. 30 “Information about a medical organization” for the period from 2019 to 2023, as well as data on child population in Moscow published on the official website of the Federal State Statistics Service. Results and conclusions. The analysis of the incidence of gastritis and duodenitis in the observed period showed that the most vulnerable age groups are children aged 10-14 years and adolescents (39.9% and 37.0% out of the total number over the past five years, respectively). Among all age groups, there is a negative dynamic in the overall and primary incidence of gastroduodenitis. Based on the results obtained, it can be concluded that there is a moderate incidence of gastritis and duodenitis among the child population in Moscow. Special attention should be paid to preventive measures and health-improving programs in order to reduce the incidence rate and ensure the health of the rising generation.

Clinical and epidemiological features of cutaneous mastocytosis among the pediatric population of Moscow

BACKGROUND: Cutaneous mastocytosis is a rare disease that primarily develops in childhood.
 AIM: This study aimed to determine the clinical and epidemiological characteristics and frequency of detection of cutaneous mastocytosis among children in Moscow.
 MATERIALS AND METHODS: A single-center epidemiological retrospective study was conducted. Data from Form № 12 of the federal statistical observation "Information on the number of diseases registered in patients living in the service area of a medical organization" were used as a statistical source of information. To calculate the incidence rate in intensive indicators per 100 thousand population, data on the population of Moscow for the period 2019–2022 were used.
 RESULTS: Over the period 2019–2022, a gradual trend towards an increase in the number of newly identified cases of cutaneous mastocytosis in children and adolescents in Moscow was revealed. Number of initial applications from children and adolescents (0–17 years old) for this period increased by 4.8 times. The share of cutaneous mastocytosis in the structure of skin diseases and congenital anomalies (malformations) of the skin increases every year. In 2019, for every 1,834 pediatric visits (age category 0–17 years) regarding skin diseases, there was 1 case of mastocytosis; in 2020 the ratio was 1,863:1; in 2021 ― 491:1; in 2022 ― 376:1. Since 2019, there has been an increase in the primary incidence of cutaneous mastocytosis from 3.63 cases per 100,000 child population to 16.61 cases per 100,000 child population in 2022.
 CONCLUSION: The increase in incidence in the pediatric population and the share of cutaneous mastocytosis in the structure of skin diseases in recent years demonstrates the need to generate interest and attention of the medical community to this pathology.

Characteristics of Streptococcus pneumoniae strains serotype 19A isolated from children in Moscow during the post-vaccination period (2015–2022)

Introduction. Community-acquired pneumonia (CAP) is a leading cause of children mortality and morbidity worldwide. The introduction of the 13-valent pneumococcal conjugate vaccine (PCV13) had a very good effect on the CAP prevalence. However, serotype 19A remains the leading cause of severe pneumococcal disease in both vaccinated and unvaccinated children. 
 The purpose of the work. To analyze the clonal epidemiology and sensitivity to antibacterial drugs of pneumococcus serotype 19A strains in the post-vaccination period for monitoring and control of vaccination.
 Materials and methods. The study included twenty six isolates of pneumococci serotype 19A isolated in children in Moscow between 2015 and 2022. Serotyping was carried out using the Neufeld capsule swelling test. Sensitivity was determined using the microdilution method. Resistance genes and multilocus sequence typing was performed using the PCR method.
 Results. By 2019–2022 the detection rate of serotype 19A decreased from 61.5% to 38.5%. A total of 12 different sequence types were identified. Most isolates belonged to 2 clonal complexes: CC230 (n = 15), CC320 (n = 6). Sixteen isolates exhibited a multidrug resistance phenotype (MDR). The dominant phenotype was extremely drug-resistant in the combination of β/Eri/Cli/TMP/Tet (43.8%). The most of MDR isolates belonged to clonal complexes: CC230 (8/16), CC320 (6/16) and Singleton 16988 (12.5%).
 Conclusion. After the introduction of PCV13, the prevalence of serotype 19A decreased, but MDR isolates of this serotype continued to increase. These results highlight the need for continued monitoring of the pneumococcal population exhibiting high resistance to reduce the risk of severe disease caused by this organism.

History of creation and development of emergency medical care in City of Moscow

The article is devoted to the history of the creation and development of emergency medical care for the population of Moscow. The stages of the activity of the home care centers, the night emergency room at the Ambulance Station and their subsequent organization in the district emergency centers are considered. The main regulatory and legal documentation is indicated, in the development of which the heads of the Station n. a. A. S. Puchkov and A. M. Nechaev took part. The work on the creation of a system of emergency and emergency medical care for adults and children in Moscow, the rules of action of the doctor of the emergency room upon receipt of appeals is shown. The article describes the search for effective ways to solve organizational and material problems in the field of emergency and emergency medical care at different stages of the development of the emergency service. The role of the Moscow Ambulance and Emergency Medical Care Station in the development and implementation of organizational and methodological measures to improve the work of emergency departments in the capital is shown. A description of a major project is given, the purpose of which was the full integration of emergency medical care for adults and children into the structure of the Ambulance and emergency Medical Care Station in Moscow at the present stage, the organization of a Single city dispatch center for emergency and emergency medical care with the formation of a single information space, the previous preparatory work for receiving calls on a single federal number 103 on the base of the Station. During its history, the Moscow emergency medical Service has passed a difficult path. Thanks to the efforts made, the service is now an integral part of the Ambulance n. a. A. S. Puchkov and Emergency Medical Care Station in Moscow.

The economic evaluation of a vaccination against pertussis infection in children in Moscow

Actuality. Previously, we calculated the economic consequences of the booster vaccination against pertussis infection (CI) with the tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine, combined, adsorbed (INN) in some regions of the Russian Federation, which showed that the public benefit within 7 years after immunization could potentially exceed the cost of vaccination 1.23 times. At the same time, it is important to provide an economic justification for vaccination for a megalopolis, such as Moscow, with an underestimation of the diagnosis of the disease in conditions of high population density, contributing to the spread of infection. Materials and methods. The assessment of the economic benefits of obtaining an epidemiological gain during revaccination was carried out within the framework of a market economy using an assessment of the cost of the disease. The calculations were based on data on the cost of CI treatment in Moscow, considering cases of complicated and mild course and on the basis of current tariffs of the OMI system. Modeling was performed based on morbidity rates, taking into account the underestimation of detectability in a cohort of 14-year-olds numbering 100 thousand people. Two scenarios were compared, providing for the preservation of the existing procedure of revaccination only at 6 years (95% coverage) and the scenario in which the second revaccination of all adolescents was carried out at 14 years. Using the model, epidemiological indicators of changes in the incidence of CI were determined, and direct and indirect costs were calculated on their basis. When testing the sensitivity of the model, other levels of vaccination of 14-year-old children were also used in the calculations. Results. Booster revaccination of a conditional cohort of 100,000 children aged 14 years with the mentioned vaccine will reduce the incidence of pertussis during the period of saving immune protection (7 years) by 53.7% (from 1702.5 to 788.4 cases per 100 thousand of the population of these ages). This epidemiological gain will be accompanied by an economic benefit calculated in the metric of the total cost of prevented cases of the disease, which will amount to 155.4 million rubles. For a cohort of 100 thousand revaccinated adolescents of 14 years. The economic benefits accompanying a potential reduction in the incidence of infants can range from 254.4 to 470.5 million rubles, depending on the nature and intensity of contacts between adolescents and younger children. Conclusion. With the given parameters of underestimating the diagnosis and cost of the vaccine in the population over 14 years of age in Moscow, revaccination of adolescents is an economically justified measure.

A screening study of latent tuberculosis infection in children in a metropolis city

Objective. To carry out a screening study among children and adolescents for tuberculosis infection in the city of Moscow using modern immunodiagnostic methods.Materials and methods. The results of a mass screening study for tuberculosis prevalence in the pediatric population of a metropolis city were analyzed. The study was conducted during 2019–2021 in Moscow using the Mantoux skin test with 2 TE PPD-L and a skin test with a recombinant tuberculosis allergen (RTA), as well as the indicators of tuberculosis incidence in children.Results. The introduction of mass screening for tuberculosis based on RTA among the pediatric population and subsequent work with the identified risk groups contributed to a decrease in the number of newly-diagnosed cases. In 2019–2021, the incidence of tuberculosis among children in Moscow did not exceed 3.8 per 100 thousand children aged 0–17 years, with this number varying from 1.2 to 2.1 among permanent residents. The risk indicators of primary infection among children aged 1–7 according to the Mantoux test (0.37% in 2019, 0.47%, in 2020, and 0.35% in 2021) and the prevalence of latent tuberculosis according to the results of screening based on RTA among children aged 8–17 in 2019–2021 (no more than 0.3%) indicate a stable epidemiological situation as regards tuberculosis infection in the city.Conclusions. The development of an effective monitoring system for preventive tuberculosis screening among urban pediatric populations contributed to the detection of latent tuberculosis cases prior to the development of its local forms. The subsequent implementation of preventive measures in risk groups allowed the incidence of tuberculosis among children to be reduced.

Популяционное исследование распространенности целиакии среди школьников г. Москвы

Objective. Examination of schoolchildren in Moscow using a specially designed questionnaire to identify children at risk of developing celiac disease. Patients and methods. The study enrolled 3070 Moscow schoolchildren aged 7–18 years old. Serological and genetic examinations were performed in 42 children at risk for celiac disease, including determination of IgA and IgE to wheat, IgA and IgG to tissue transglutaminase, and IgA to endomysium. Molecular HLA testing for alleles that predispose to celiac disease was conducted. Endoscopic and morphological diagnostics were performed when indicated. Results. The risk group for celiac disease amounted to 10.2% of all schoolchildren surveyed. According to the results of the questionnaire, children in the risk group significantly more often had abdominal pain, excess gas, bloating, flatulence, dyspeptic complaints (diarrhea, constipation, vomiting), asthma attacks or other forms of allergies, headache, joint or body pain, fatigue and weakness, mood swings, depression, anxiety, or episodes of emotional arousal. Changes in height, weight, delayed physical or sexual development, dental enamel defects, and skin rashes were also noted. Of the 42 children in the risk group, the DQ2 heterodimer was detected in 13 (31%) children, the DQ8 heterodimer – in 2 (4.8%), and a combination of DQ2 and DQ8 heterodimers – in 1 (2.4%). Thus, characteristic HLA haplotypes were identified in 38% of the examined children. Three children had IgA antibodies to tissue transglutaminase (at >10 norm) and IgA anti-endomysium antibody titers. Conclusion. The method of questioning by means of a specially designed questionnaire for school-age children allows to identify individuals at risk of developing celiac disease. According to serological, genetic, endoscopic, and morphological investigations, the incidence of celiac disease among children at risk was 7.1%. The prevalence of celiac disease among school-age children in Moscow corresponds to global trends, amounting to 0.7%. Key words: questionnaire, gluten-free diet, cereals, gluten intolerance, celiac disease, children

Clinical and Epidemiological Features of COVID-19 in Children in Moscow in 2020–2022

Relevance. COVID-19 pandemic predetermines the relevance of the analysis of clinical and epidemiological peculiarities in different periods of morbidity growth in the pediatric population.Aim. To identify clinical and epidemiological features of the course of COVID19 in Moscow among children (2020–2022).Materials and Methods. The retrospective clinical and epidemiological analysis of the incidence of COVID-19 among children in Moscow over a two-year period (March 9, 2020 to March 30, 2022) was performed. We used data from case histories of 3092 children diagnosed with U07.1, hospitalized in infectious diseases departments for children with COVID-19 at Bashlyaeva Children's Clinical Hospital of Moscow and materials from Rospotrebnadzor report No 970 «Information about cases of infectious diseases in persons with suspected new coronavirus infection», information portal Stopcoronavirus.rf and others. The presence of SARS-CoV-2 RNA was confirmed by real-time reverse transcription polymerase chain reaction.Results. Five upsurges of morbidity differing by clinical and epidemiological manifestations of the course of COVID-19 were distinguished. In the first period of morbidity rise (March–June, 2020) the age groups 7–14 and 14–17 years prevailed, in the fifth period (January 2022–March 2022) infants and young children prevailed. The most frequent severe and critical forms of COVID-19 were registered in the genovariate delta due to lung lesions, less frequently in the omicron strain. Comorbid pathology in children during all periods of the pandemic was a risk factor for severe course and unfavorable outcome of the disease. In general, the number of children hospitalized in intensive care unit (ICU) decreased: 3.7%. 4,7%, 4,7%, 3,3%, 3,2%. Administration of viral neutralizing monoclonal antibodies to SARS-CoV-2 to children at risk for severe disease during the fourth and fifth waves of COVID-19 reduced the number of children hospitalized in the ICU, despite the high morbidity rise than in the previous waves of COVID-19.Conclusion. Each of the five identified COVID-19 morbidity bursts among children had its own features. The proportion of severe infection among hospitalized children was 3.7%, 4.7%, 4.7%, 4.7%, 3.3%, 3.3% according to the waves of morbidity rise. During the first two waves of COVID-19, the disease occurred as acute respiratory infections (80%). In the second wave, the proportion of children hospitalized in the ICU with a multisystem inflammatory syndrome reached 57.6%. In the third wave of COVID-19 there was an increase in the number of cases of bilateral viral pneumonia (34.8%), severe forms of pneumonia (CT-3-4) in children with comorbid diseases. In the fourth period the structure of hospitalized children in the ORIT was 72.3% of children from the risk group. During the fifth wave of COVID19, the number of infants and young children hospitalized increased (49%) in the early period of admission from the onset of the disease (44%).

Improving the organizational structure of the population prevention in the megapolis

Highlights. A comparative analysis of the morbidity rate in the population in Moscow, the Central Federal District and the Russian Federation for the period from 2012 to 2019 depending on the age groups was carried out; performance of the Center for Prevention and Health Centers in Moscow and in its administrative districts was assessed; suggestions for improving the organizational structure of the population prevention in the megapolis were made.Aim. To analyze and assess the organizational structure of population prevention in Moscow, and to suggest proposals for its improvement.Methods. The data of the Ministry of Health of Russian Federation on the morbidity rate in the (general) population in Moscow, the Central Federal District and the Russian Federation, by age groups of the population was analyzed. The analysis and assessment of the performance was done for the following entities carrying out preventive programs in Moscow: the Center for Prevention (CP), 58 departments and 224 offices for prevention, 62 Health Centers (HC) and the performance of youth-friendly clinics in the Russian Federation. We used statistical, sociological, analytical research methods for the analysis.Results. Total morbidity rate in the population of Moscow (2019) was lower than in the Central Federal District and in the Russian Federation, it amounted to 140,743.0 per 100 thousand of the population, in the Central Federal District it was 149701.0‰оо, and in the Russian Federation it was 164899.4‰оо.At the same time, total morbidity rate in children aged 14 years old in Moscow was higher than in the Russian Federation and in the Central Federal District; it amounted to 222946.1 per 100 thousand of the corresponding population, in the Russian Federation it was 219845.6‰оо, and the Central Federal District it was 211643.2‰оо. The analysis of total morbidity in children in Moscow by classes of diseases is given. The article analyzes the performance of CP and HC in Moscow and output of youth-friendly clinics in Russia. Suggestions for improving the organizational structure of the population prevention in the megapolis were made.Conclusion. Total morbidity rate in the population in Moscow is lower than in the Central Federal District and the Russian Federation, however, the rates in children are higher than in the Russian Federation for a number of diseases. The results obtained should be taken into account in the development of the population-based prevention strategies for children. Based on the results of the study, it can be concluded that the Center and departments for prevention in Moscow are subject to reorganization; additional duties and responsibilities should be introduced and existing ones should be adjusted. It is necessary to organize the continuity and coordination in care provided by the CP, HC and primary health care physicians. It is recommended to create more youth-friendly clinics in the Russian Federation, in particular, in Moscow.

Questionnaire-based survey to determine an at-risk group for coeliac disease among school children in Moscow, Russia.

Coeliac disease (CD) is a chronic digestive disorder which presents indiverse ways and is under-diagnosed. The purpose of this study was to provide insights into suspected CD among Russian schoolchildren, through defining the percentage of participants in an 'at-risk' group for CD in a paediatric cohort, by means of a questionnaire as a primary screening tool. Russian school children of both sexes age 7-18 years were enrolled in a population-based study to identify individuals affected by CD. Each participant was presented with a structured questionnaire based on criteria that can be used to reveal symptomatic signs of CD. Following on, we developed a case-finding strategy for the 'at-risk' group, based on serological and genetic testing and, where possible, endoscopic examination of participants. 10.2% of questionnaire respondents (312/3070) were classified as an at-risk group. Pathobiological CD analysis of this group returned positive test results for 13.5% of participants (42/312), and 0.6% of them (2/312) had CD confirmed by biopsy sample analysis. Our findings suggest that at-risk groups among children with symptomatic or some oligosymptomatic CD presentations can be identified through adopting a questionnaire as part of a population-based screening survey, if generally accepted screening programs are inaccessible.

Features of the formation of specific Igg4 antibodies to milk proteins in healthy young children living in different megalopolises of the Russian Federation

Objective: Study specific Igg4 antibodies to milk proteins indexes in healthy babies living in different Russian megalopolises.Methods: The complex research of the specific Igg4 antibodies to milk proteins during cohort study of 259 healthy babies of the first year of life. Children lived in five Russian cities: 60 children in Moscow, 50 newborns – in Saint Petersburg, 55 children came from Kazan, 43 children lived in Khabarovsk and 51 – in Vladivostok. Non-competitive enzyme-linked immunosorbent assay was used to quantify specific Igg4 antibodies to cow milk proteins (CMP), beta-lactoglobulin (β-LG), alpha-lactalbumin (α-LA), casein and goat's milk protein (GM) in coprofiltratesResults: The highest frequency of the high Igg4 was discovered to CMP and goats’ milk was observed among children from Saint Petersburg during comparative assessment of the frequency of defining Igg4 to milk proteins in healthy newborns aged 2.5 months living in Moscow and Saint-Petersburg. The highest frequency of Igg4 increased rates to milk proteins among newborns from Kazan, Khabarovsk and Vladivostok was diagnosed during first three months of life on breastfeeding without any clinical symptoms of food intolerance. With age decrease of the frequency of specific Igg4 to milk proteins were observed among all babies from above-mentioned cities. By 8 month of life it made isolated cases.Conclusions: High frequency of increased Igg4 to milk proteins among 2 months old babies on breastfeeding was observed in the cities of Central and Far Eastern districts of Russian Federation. In this regard it can be supposed that Igg4s were got from mothers in the prenatal period and after birth through breastfeed. The presence of high frequency of the increased indexes of specific Igg4 to milk proteins probably was related to mothers’ nutrition habits during pregnancy and lactation periods.

SARS-CoV-2 infection in children in Moscow in 2020: clinical features and impact on circulation of other respiratory viruses: SARS-CoV-2 infection in children in Moscow in 2020

ObjectivesThis study aimed to estimate the impact of the COVID-19 pandemic on the circulation of non-SARS-CoV-2 respiratory viruses and the clinical characteristics of COVID-19 in hospitalized children. MethodsA total of 226 and 864 children admitted to the Children's City Clinical Hospital with acute respiratory infection in September to November of 2018 and 2020 in Moscow were tested for respiratory viruses using multiplex polymerase chain reaction (PCR) and Mycoplasma pneumoniae/Chlamydia pneumoniae using enzyme-linked immunosorbent assay. ResultsThe detection rate of non-SARS-CoV-2 viruses in 2020 was lower than in 2018, 16.9% versus 37.6%. An increase in the median age of children with respiratory viruses was observed during the pandemic (3 years vs 1 year). There was no significant difference in the frequency of intensive care unit (ICU) admission in children with SARS-CoV-2 and other respiratory virus infections (2.7% vs 2.9%). SARS-CoV-2 and human rhinoviruses, human metapneumoviruses, and human adenoviruses showed significantly lower than expected co-detection rates during co-circulation. An increase in body mass index (BMI) or bacterial coinfection leads to an increased risk of ICU admission and a longer duration of COVID-19 in children. ConclusionsThe COVID-19 pandemic led to significant changes in the epidemiological characteristics of non-SARS-CoV-2 respiratory viruses during the autumn peak of the 2020 pandemic, compared with the same period in 2018.

Traumatic brain injury in children in Moscow

Traumatic brain injury (TBI) is the main cause of unnatural death and disability in the child population, ranking first among all injuries requiring hospitalization. The lack of full and detailed medical and social statistics on the prevalence of TBI and its consequences impedes their reasonable assessment and reduces the possibility of prevention. The aim is to study and assess the current epidemiological situation of TBI in children in Moscow. Materials and methods. Comparative study of main trends in the incidence and mortality of TBI in children in Moscow in 2003–2018 with the average Russian indicators based on state statistical data. Results and conclusions. Megacities are a high risk area for TBI in children, therefore policies require additional prevention strategies. Limitations in the existing forms for state statistics impede an objective assessment and establishment of true levels of morbidity and mortality in children from TBI, as well as identification of its causes. Increased hospitalization rate of children with TBI in Moscow at high morbidity levels contributes to low mortality and lethality rates in children from this type of injury.

Construction of playgrounds and sports facilities for children in Moscow and the Moscow region

Construction of playgrounds and sports facilities for children in Moscow and the Moscow region

Альтруизм и парохиализм у детей и подростков: гендерные и возрастные различия

The article presents the results of an experimental study of altruism and parochialism among school- children in Moscow and the Moscow region. The propensity for prosocial behavior in children was assessed using an experimental technique developed by E. Fehr and adapted earlier in our experiments with children (Tanzania). A sample of the study consists of 379 children and adolescents (192 boys and 187 girls) aged 7 to 17 years. Schoolchildren made decisions in six proposed dilemmas — prosocial behavior, envy and altruism. The aim of the study was to identify the sex and age characteristics of altruistic and parochial behavior of children and adolescents from schools in Moscow and the Moscow region. The results of the research show that girls were more prosocial in making decisions in relation to unfamiliar peers in one of the experimental games. But the age of the schoolchildren was more important predictor than sex in decision of the allocation of resources. With age, students were more altruistic in relation to friends and unfamiliar peers. The most important factor influencing altruistic behavior turned out to be belonging to one’s own group (friend- ship) — a significant parochial effect was observed in all six dilemmas.

Features of training pedagogues for supporting gifted children

The prerequisites for the study: the informatization and digitalization of modern society have led to the development of informatization in education and digital pedagogy. However, the transformations that have taken place in the national education system have changed the attitude towards students who show outstanding abilities. This has led to the emergence of relevant regulatory documents as well as public funds, social programs, educational organizations, the main purpose of which is to identify, teach and develop gifted children. Nevertheless, in higher educational institutions, the issues of training teachers for psychological and pedagogical support of gifted children are considered narrowly, within the framework of certain disciplines and a single level of education. There is no training for teachers to work with parents of gifted children. The purpose of the study is to determine the features of training teachers for psychological and pedagogical support of gifted children and substantiate the necessary pedagogical conditions. Methods: the study of psychological and pedagogical literature, the analysis of the readiness of teachers for professional activity in the context of the digitalization of education and working to support gifted children in Moscow and the Moscow region, the analysis of the websites of educational organizations. The authors consider the problems of digitalization of education in the context of working with gifted children. The issues of using digital pedagogy, training pedagogical staff to use digital technologies in educational activities, and supporting gifted children are expounded. The authors determine the features of the content of further education courses for teachers and parents and the training of teachers for psychological and pedagogical support of gifted children. The possibility of using digital technologies and the system of additional education to train for supporting gifted children, their parents, and teachers is considered.

Trends of physical development and adaptation to the study load and health-improving sports activities in elementary schoolchildren of Moscow

To determine the trends of the state of regulatory systems (RS), adaptation, and PD in primary school children in Moscow shaped by preventive physical fitness (PF) classes developed within the framework of the federal state educational standard (FSES) to improve adaptation, PD, MS, and muscular core state. A pedagogical experiment was conducted; 120 schoolchildren of both sexes in the 1st-4th forms at two Moscow schools were examined during the initial stage of the experiment. All students were engaged in preventive physical fitness classes, including game-based activities and exercises embedded in the FSES for primary schools. More than 50% of students attended extracurricular sports sections in football (17.5%), ballroom dancing (10.0%), karate (6.6%), swimming (5.8%), gymnastics (including acrobatics) (5.0%), basketball (5.0%) and figure skating (3.3%). Diagnostic methods included: anthropometric methods to measure height, bodyweight using a stadiometer and automatic medical scales; dynamometer method, in standing position, arm with dynamometer extended horizontally at shoulder level; a motor test to determine coordination abilities; diagnostics of heart rhythm variability (HRV) using Varicard-Express hardware-software complex. The calculated HRV parameters were determined: a regulatory systems activity index (RSAI) to determine the adaptive capacity of the body, and stress index (SI) to assess the subject's exposure to stress. It was demonstrated that schoolchildren in the Moscow metropolitan area are characterized by slower growth processes with activation at 8-9 years instead of 6-7 years. The baseline RSAI values in all children were at level 5, which corresponds to the state of RS stress of the body. Preventive PF classes led to improved adaptation in 7-8-year-old children. The condition of 50% of schoolchildren based on SI was optimal; 1/5 (22%) of schoolchildren had the initial stage of psychoemotional stress, 18% (in total) of children had severe and extremely severe RS stress related to the school environment. Monitoring of the RS adaptation and health state allows teaching, preventive, health-improving, and recreational activities in educational institutions with respect to individual and typological features of students, as well as minimizing the negative effects of the education digitalization on the physical and mental development of schoolchildren.

Efficiency of the transillumination method in the diagnosis of caries of permanent teeth in children

The aim of the study was to increase the effectiveness of early diagnosis of dental caries in children. An epidemiological survey of 678 children (351 of them girls and 327 boys) aged 6-12 years was conducted in the cities of Novorossiysk, Krasnodar Territory (582 people) and Moscow (96 people). By the method of randomization, 450 people were selected, who were divided into three age groups: I gr. - 6-7 years; II gr. - 8-9 years old; III gr. - 10-12 years. In each age group, the children were conditionally divided into three subgroups (50 people each) depending on the rate of caries intensity (DMFT=0, DMFT=1-2, DMFT≥3). In children with different indexes of the DMFT, the informativeness of identifying foci of demineralization of the enamel of erupted incisors, molars, canines and premolars was assessed by visual inspection, vital staining and using an apparatus based on the transillumination method. As a result of an epidemiological survey of children in Moscow, caries prevalence levels were low at 6-7 years old and average at 8-9 and 10-12 years, and in Novorossiysk children: low - at 6-7 years and high - at 8- 9 and 10-12 years. Children of 6-12 years old in Moscow have an average level of intensity of caries, and children of Novorossiysk have an average level of 6-7 and 10-12 years, a high level of 8-9 years. During clinical examination of 450 children from 6 to 12 years old, 6.840 permanent teeth were examined. A comparative analysis of the detection of foci of enamel demineralization visually and using the apparatus showed that the apparatus method revealed significantly more teeth with foci of enamel demineralization. This device can be recommended for use in wide clinical practice, given its efficiency and low cost in comparison with other known devices.

Antibiotic resistance of Streptococcus pneumoniae isolated from children in Moscow before
 and after the introduction of 13-valent pneumococcal conjugate vaccination

Introduction. The formation and spread of antibiotic-resistant Streptococcus pneumoniae isolates is a concern. After the thirteen-valent pneumococcal conjugate vaccine (PCV13) was added to the children’s immunization program in Russia in 2014, an important task is to monitor the resistance level to antimicrobials and the spectrum of circulating antibiotic-resistant pneumococcal serotypes. Materials and methods. The study included 708 nasopharyngeal pneumococcal isolates from children patients under 5 years who recovered from 2010 to 2018, received inpatient and outpatient care at the National Medical Research Center for Children’s Health (Moscow). The determination of sensitivity to antimicrobials was performed by the disk diffusion method. The MICs of penicillin, amoxicillin, and erythromycin were determined using the E-test method. Evaluation of the results was carried out according to the EUCAST-2019 criteria. Results. In total, 33 different serotypes were identified in the S. pneumoniae collection. Six predominant serotypes accounted for 68.6% of the total distribution and included serotypes: 19F, 6B, 23F, 14, 15B/C, 6A. In general, antimicrobial resistance ranged from 3.5% to chloramphenicol to 54.8% to tetracycline. The level of resistance to oxacillin, erythromycin, and clindamycin increased by 15-20% between 2010 and 2018. However, since 2016, there has established a prevalence level of 40-46%, this process is offset by an increase in the proportion of non-vaccine pneumococcal serotypes. Conclusion. A high level of resistance to penicillin and erythromycin remains. Monitoring the resistance level to antibiotics and the epidemiology of serotypes, clarifying the laws of formation of resistance, and its spread in a dynamically changing pneumococcal population is an important area of microbiology.

Serotype distribution of Streptococcus pneumoniae isolated from children in Moscow before
 and after introduction of 13-valent pneumococcal conjugate vaccination

Introduction. In 2014, a 13-valent conjugated pneumococcal vaccine (PCV13) was introduced into the children’s immunization program in Russia. In this regard, to describe and analyze the epidemiology of pneumococcal infections, it is important to study and evaluate the distribution of serotypes and the effect of PCV13 vaccination on the serotype distribution of the nasopharyngeal Streptococcus pneumoniae isolates isolated in children from 2010 to 2018. Materials and methods. The study included 708 nasopharyngeal pediatric pneumococcal isolates recovered from 2010 to 2018, in patients under 5 years of age, who received inpatient and outpatient care at the National Medical Research Center for Children’s Health (Moscow). Serotyping was performed using antisera and / or molecular typing by PCR Results. In total, 33 different serotypes were identified in the S. pneumoniae collection. Six predominant serotypes were accounted for 68.6% of the total distribution and included serotypes: 19F, 6B, 23F, 14, 15B/C, 6A. The average prevalence of vaccine serotypes was of 77.7% in 2010-2015, with a significant decrease to 52% in 2018, which was accompanied by an increase in the prevalence of serotype 15B/C (16% in 2018) and serotypes 11A and 23A, from 1.1% in 2010 to 9.3% and 8% respectively in 2018. Conclusion. The use of PCV13 vaccination in Russia has led to a significant decrease in the carriage of pneumococcal vaccine serotypes. These results emphasize the need for careful monitoring of an ever-changing pneumococcal population.