Demographic Situation Research Articles

Medical and Demographic Processes in the Republic of Karelia in 2011–2021: Trends and Risks

Introduction: The Republic of Karelia is a part of the Northwestern Federal District and, being a sparsely populated constituent entity of the Russian Federation, is characterized by a difficult medical and demographic situation. Objective: To assess trends in medical and demographic processes in the Republic of Karelia in 2011–2021. Materials and methods: We analyzed official statistical data provided by the Territorial Body of the Federal State Statistics Service in the Republic of Karelia for the years 2011 to 2021. Both absolute and relative values and time series indicators were used to characterize the processes under study. Results: A long-term depopulation process has been taking place in the region: since 2011, the size of population has decreased by 39.5 thousand people, which was mainly attributed to the rural population decline and a shrinking number of women. In 2011–2021, the natural population growth rate was negative (–2.8 and –12.1 per 1,000 population in 2011 and 2021, respectively), began to worsen in 2015 due to a decrease in the birth rate, and even aggravated during the COVID-19 pandemic of 2020–2021 owing to increased mortality rates. Diseases of the circulatory system and neoplasms were found to be the leading causes of death during the study period. In 2011–2020, the infant mortality rate ranged from 44.2 to 76.3 per 10 thousand births. We observed a regressive population age structure in the republic characterized by a decrease in the young-age to old-age population ratio from 0.70 in 2011 to 0.67 in 2021. The proportion of residents aged 60 years and older rose from 18.3 % in 2011 to 24.5 % in 2021. The share of working adults, on the opposite, decreased from 61.1 % in 2011 to 54.6 % in the year 2021. In 2020, a gradual increase in life expectancy traced in 2011–2019 turned into a decrease caused by the COVID-19 pandemic. Conclusions: The unfavorable medical and demographic situation in the Republic of Karelia requires special attention of the scientific community and governmental structures. Applying the principle of a systematic approach to solving the problem will help improve the current situation.

Demographic Security in the Context of International Migration

The demographic situation in Russia today remains extremely tense. The period of implementation of the Concept of the demographic policy of the Russian Federation is coming to an end and it is necessary to sum up the results, as well as to identify the remaining problems and determine possible prospects for the country’s demographic security. The article considers the issue of ensuring the demographic security of Russia in the framework of modern realities, when demographic problems are solved by attracting migrants from Eastern European and Asian states. The purpose of the study was to determine the prospects and possible consequences of attracting international migrants to the country, since the flows of international migration are not stable and depend on the socio-economic and political situation both in migrant-sending countries and migrant-receiving countries. An analysis of the dynamics of migration flows to Russia from abroad is carried out. It is revealed that in the future we can talk about the stability of migration flows only from the countries of Central Asia (Uzbekistan and Tajikistan) considering the demographic situation in these donor countries. It is determined that the quality of human capital and the standard of living of the population in the most promising donor countries are significantly lower than in Russia. An assumption was made about the growing problem of not only maintaining the population, but also maintaining the necessary quality of human resources to ensure the implementation of strategic programs and projects in the field of socio-economic development, as well as addressing issues of social support for migrants to prevent the threat of increasing poverty in the country. It is concluded that there is a need for a new approach to the management of migration flows aimed at ensuring the quality of the labor resources. It is proposed to provide conditions for training or retraining of labor migrants, as well as to solve the issue of financial affordability of such training, since most of the migrants are representatives of the poorest segments of the population.

Migration Processes in the Kharkiv Region in the Conditions of Russian Aggression and Their Impact on the Demographic Situation

The study of migration processes, caused by the Russian invasion of Ukraine on February 24, 2022, is a rather relevant scientific problem. The main territorial directions of migration processes in Kharkiv region and their impact on the demographic situation in the oblast are defined in the article. Attention is focused on the essence of the terms war fugitives – forced migrants (internally displaced persons) in Ukraine and Ukrainian refugees abroad. At the end of February 2022 yet, the offensive of the Russian invaders on Kharkiv has been stopped thanks to the heroic resistance of the Armed Forces of Ukraine and the Territorial Defense troops. Therefore, Kharkiv has been included in the list of the first cities of Ukraine to receive the title of Hero City (March 21, 2022). Temporal differences in migration flows are determined and the peculiarities of the territorial placement of internally displaced persons (IDPs) in the Kharkiv region and other oblasts of Ukraine are defined on the base of the analysis of statistical data provided by the Kharkiv Regional Military-Civil Administration. The scale of these forced migrations is described, primarily in the city of Kharkiv. Its population has been decreased from 1,400,000 people on the eve of the Russian invasion to 300,000 people in April, 2022. According to the estimations of the Kharkiv city authorities, 600,000 people have been evacuated from Kharkiv by railway alone in the spring of 2022. It has been impossible to evacuate from the northern and eastern areas of Kharkiv region in the first months of the war. A significant part of the region territory (territories of 5 out of 7 districts) is under occupation. Attention is focused on the wave of return (re-evacuation) of the population to Kharkiv, which has started in May, 2022 after the liberation of the city’s nearest surroundings from the Russian occupiers and lasted until the spring of 2023, when the population of Kharkiv reaches 1.1 million people. Almost the whole territory of the Kharkiv region has been liberated in September-October, 2022. The ethnic structure of the population of Kharkiv region at the early 21st century is also revealed. It is indicated that a significant part of the forced migrants who have adapted to the new areas will remain there. This applies not only to Ukrainian migrants abroad, but also to Kharkiv residents who live currently in the other regions of Ukraine, especially among those who have lost their homes and jobs in the Kharkiv region. This will objectively negatively affect the already difficult demographic situation in Kharkiv region in the near future.

Demographic Development and Trends in Population Migration in Uzbekistan

The article reveals the features of population reproduction mode in Uzbekistan and its new trends that have developed over the past years and will ensure a large-scale increase in the country’s labor resources in the future. The research outlines changes in the sex and age structure of the population which predetermines the size of the workforce. The scale of labor migration in Uzbekistan and the factors that determine it are estimated. The object of the study is population, trends in its reproduction and mobility. The goal of the study is to reveal the features of the demographic situation that determine many important directions of the socio-economic development of the republic and the formation of labor migration flows. The research found that in many regions of Uzbekistan, the rate of job creation lags the growth rate of labor resources resulting in unemployment, especially among young people. According to survey results, the imbalance in the labor market, as well as the low labor cost were the main reasons for seeking work outside the country. Also, the results of the survey substantiate the positive and negative consequences of current external labor migration, changes in the qualitative characteristics of labor migrants and their priorities. Given the demographic situation in Uzbekistan today, in the coming years there will be a significant outflow of labor migrants to foreign countries, where Russia will prevail. Labor migration will continue to provide relative stability in the labor market of the republic and the inflow of remittances, which will contribute to improving the living standards of the country’s population. Changes in the migration policy of Uzbekistan aimed at streamlining migration processes in the republic that have been made in recent years will play a significant role.

Demographic Development and Social-Demographic Policy in Zambia

The purpose of the study was to identify trends in demographic development and features of the socio-demographic policy of the Republic of Zambia in the context of the demographic transition. The main research method is the statistical analysis of the demographic data of the current registration and population censuses of the Republic. The sources of information are demographic statistics and demographic surveys presented in the materials of national agencies and international organizations of the UN system. Zambia is on the path of the demographic transition, but so far remains one of the youngest countries in the world in terms of the average age of the population. The annual population growth rate remains significant at the level of 2.5-3%. The country maintains a high birth rate. As a large cohort of young people enter their reproductive years, the population of the Republic is expected to double in the next 25 years. The demographic situation may exacerbate some socio-economic problems, including an increase in demand for jobs, a shortage of medical care and social services. In this situation, the state socio-demographic policy of Zambia, although focused on the UN Sustainable Development Goals until 2030, has not yet fully responded to demographic changes. By 2030, the authorities of the Republic of Zambia have set the achievement of a prosperous nation with an average income as the goal of the country’s development by 2030. In this context, the health of the workforce remains an important component. It is considered that a healthy workforce will allow the country to increase productivity and gain a significant demographic dividend.

Population Projections for Russia

The subject of the work is population forecasting against the background of changes in the demographic situation in Russia. The topic is an overview of the country’s population projections. Special attention is paid to the forecasts of the size and composition of the population of the Russian Federation in the period from 1991 to 2022. The source data are statistical collections and databases of Rosstat and the Population Division of the UN Department of Economic and Social Affairs. The purpose and objectives of the work are to overcome the attitude to previously developed forecasts as to the material that “does not matter” in comparison with current forecasts. The retrospective of forecasts not only provides grounds for reasoning about the demographic losses of the country in certain historical periods, but also allows us to anticipate possible prospects for the development of the population and to improve the conceptual basis of its forecasting. Verification of officially published forecasts, comparison of prognostic developments from different sources, allows us to develop their methodology and clarify the requirements for them on the part of users– government agencies, science, the expert community, the education system. The paper describes the process of compiling a “library” of predictive sources, suggests tabular and graphical methods of its formalization and subsequent analysis. The article provides conclusions that may be useful for developers and users of demographic forecasts.

Potential rural tourism resources of the Mangistau region of Kazakhstan

The development of agro-tourism in the Mangistau region is taking place in the economic and socio-cultural areas, becoming important in preservation of natural and cultural heritage. Purpose – the authors consider the current state and prospects of rural tourism in the region. Methods – the information base of the study is statistical data from the Bureau of National Statistics of the Agency for Strategic Planning and Reforms of the Republic of Kazakhstan, information from domestic periodicals and international literature sources. Results – analysis of the available tourism resources in rural areas of the region based on the 4E model of Joseph Pine and James Gilmore was carried out, a comparison of the demographic situation in the countryside and in the city, seasonality of tourism activities was determined, the resources of tourism industry were analyzed, and best foreign practices were shown. Shortcomings of objects of tourist agribusiness were revealed in the region. The authors point out that this type of tourist services is still underdeveloped due to numerous problems that hinder their spread, among which are the backwardness of social and engineering infrastructure of rural areas, poor quality of the road network and transport links. All this reduces the attractiveness, does not contribute to the preservation of the ecology of rural areas, makes it difficult to arrange and create the necessary conditions for accommodation of tourists. Conclusions – agro-tourism helps to strengthen the economy of rural settlements, creates additional jobs, reduces the outflow of villagers to cities, increases their cultural and intellectual level, stimulates production of environmentally friendly food, income generation due to the development of local trade. Expanding the scope of its distribution requires a systematic approach, taking into account the specifics of the region.

Medical and sanitary service of northern part of Bukovyna after the First World War (1918-1928)

The article deals with the main trends in the restoration and development of the medical and sanitary service in the territory of Northern Bukovyna in 1918-1928, during which martial law continued here, after which the territory became part of the Kingdom of Romania.In the first post-war period the population of the region found itself almost entirely without healthcare. Collapsed health system could not fight the spread of epidemic diseases through the region that also led to a complicated demographic situation in the post-war Bukovyna. The enduring spread of diseases among the population and, to a certain extent, the wish of Romanian authorities to use medicine for propaganda purposes forced the start of a comprehensive work to improve health and sanitary conditions in the region. The primary task that had to be urgently solved by the health service in the early post-war years has become the overcoming of the epidemics of infectious diseases that at the end of World War I led to great mortality among the population. Quite common among the residents of the region were dysentery, typhoid, typhus, relapsing fever, tuberculosis, and a number of pediatric respiratory infections – scarlet fever, measles, whooping cough, diphtheria, contagious parotitis, varicella and others. Some years there was an urgent need for the establishment of health centres, dispensaries. According to the law of 1923, the Health Service was divided into two parts: sanitary and hospital. The Sanitary Service was engaged in supervision, control and study of the health status of the settlements, the use of general and special preventive measures and prevention of epidemics, to provide medical care outside hospitals, educate the population about prevention and treatment of social diseases etc. The Hospital Service was responsible for hospital treatment and medical supervision of patients in hospitals. Bukovyna along with Khotyn district and the northern part of Moldova was included in the VIII sanitary region under the guidance of General Sanitary Inspectorate. For the operation of health service, Bukovyna was divided into five health areas, each headed by a Chief Physician. Areas were divided into sanitary districts. At the head of each one was the district doctor who had assistants, district midwives, and health agents. The duty of medical personnel was to countercheck social diseases. In this regard, 9 infirmaries and 27 dispensaries were founded in Bukovyna within 10 years (1918-1928).To avoid the spread of infectious diseases from abroad – an official centre «Grigore Ghica Vodӑ» was created to examine travellers at the border at the railway station in Nepolokivtsi.Also, in the first post-war decade for health services of the land the Sanitary Inspectorate has founded in Chernivtsi: Regional warehouse of medical instruments and devices; Regional warehouse of drugs, serums, vaccines and bandages, and the Institute of Hygiene.Compulsory preventive vaccination against smallpox and other infectious diseases was introduced. Doctors held free consultations in towns and villages both at home and in hospitals. At the same time, in the first post-war decade a decrease of doctors and paramedical staff is observed.Taking into consideration the shortage of a sufficient number of hospitals, clinics, doctors, nurses, lack of medicines, vaccines, therapeutic sera in Bukovyna, it should be ascertained that the state of epidemic diseases in the region in the early post-war years remained extremely hard. Only in the mid-20s such diseases as smallpox, typhus, and dysentery had been largely overcome thanks to vaccination, organizational and educational measures taken by the authorities. However, there remained high death rate from heart diseases, pneumonia, tuberculosis, due to difficult living conditions and inaccessibility of health care to the most.

ХХ ғасырдың ІІ жартысындағы Шығыс Қазақстан облысының этникалық құрамының динамикасы

The article analyzes the dynamics of changes in the ethnic composition of the East Kazakhstan region. The study used statistical data of current statistics and the results of the 1959 and 1989 population censuses. A detailed description is given of the two dominant nationalities of the region: Kazakh and Russian nationalities (share, urban and rural population, proportion of men and women). In the middle of the 20th century, Russian nationality prevailed, then by the end of the 20th century, the number of Russian nationality decreased and the number of Kazakh nationality increased. Migration had a strong influence on the ethnic structure of the population of the region, since the mass migration of Russians, Germans, the arrival of the Kazakhs led to the formation of a new proportion, so the Kazakh population began to return to the first place, and the Russians took second place. The relevance of the article lies in the study of the influence of the dynamics of ethnic composition on the demographic situation of the region in the 1950s-1980s. The foundations of demographic processes in modern Kazakhstan were formed in this thirtieth anniversary. Summing up the study of the settlement of the population of East Kazakhstan based on the censuses of 1959, 1970, 1979 and 1989, the most pronounced main positive and negative demographic processes had a great impact on the national composition of the region. And this, in turn, is a vivid manifestation of the demographic development of the East Kazakhstan region

Этнодемографические трансформации начала 1940-х годов в Акмолинской области (по архивным документам)

The article discusses the features of the ethno-demographic development of the Akmola region in the early 1940s. Based on the study of archival material, an attempt was made to analyze the planned resettlement in the Akmola region of residents of land-poor areas of the former USSR (mainly from the European part of Russia and Ukraine) to land-rich regions of the country, including the north-eastern regions of Kazakhstan. The scientific novelty of the article lies in the fact that for the first time it outlines the features and results of the policy of planned resettlement of peasants - volunteers from Ukraine and Russia to the Akmola region in 1940-1941; evacuation routes, their locations are shown; a specific analysis of the ethno-demographic indicators of the region and their changes were carried out. The authors note that due to the extremely difficult demographic situation in Kazakhstan over the previous decade of 1928-1938, there was a sharp and significant decrease in the number of the Kazakh population, caused by collectivization, famine, mass migration from Kazakhstan accompanying these processes. The government of the republic saw a way out of the situation in the resettlement of representatives of other peoples of the Soviet Union to Kazakhstan, they submitted this initiative for consideration to the top leadership of the USSR. The authorities of the USSR decided to satisfy this initiative. However, the settlers had numerous difficulties associated with the poor organization of resettlement, the unwillingness of local collective farms and party - Soviet bodies to accept labor migrants. Thus, the “first virgin lands” – the beginning of the 1940s, did not achieve their goals. Volunteer migrants who came to Kazakhstan from the European part of Russia and Ukraine of those years often found themselves in distress. Nevertheless, voluntary migrants influenced the change in the ethno-demographic appearance of the Akmola region

Профілактика захворювань аліментарного та аліментарно залежного генезу

The most important direction in the fight against noncommunicable diseases is pre-ventive referral. Measures aimed at preventing morbid and premorbid conditions make it possible to achieve an important goal – to reduce economic costs and improve the demographic situation in the country. Balanced nutrition is the main factor in a healthy lifestyle. Nutrition should ensure the normal growth of the body, determines mental and physical development, the functioning of all organs and systems, the formation of immunity, as well as the adaptation of the body's reserves depending on living conditions. The health of the population of a particular region depends on the ecological state of the envi-ronment and reflects the dynamic balance between the organism and the habitat of the individual species. In the human body, a dynamic stereotype is created with the preservation of homeostasis, which is supported by metabolic processes and neurohumoral and endocrine regulation. The deterioration of the environment is reflected in the health of the population. Hygiene is a branch of preventive medicine that studies the influence of various environmental factors on human health, performance and longevity. The purpose of this science is to develop measures aimed at improving a person and preventing the occurrence of diseases of both an indi-vidual and society as a whole. Hygiene focuses on the development of criteria for assessing envi-ronmental quality and scientific substantiation of optimal environmental parameters for human habi-tation. An important task of food hygiene is to study the physiological needs for food ingredients, on the basis of which quantitative and qualitative nutritional standards for different groups of the population are developed, depending on working conditions, life, age, gender, climate; substantia-tion of nutrition ratios of certain population groups; finding out the reasons for the development and spread of alimentary diseases and working out measures for their prevention, as well as the formation of food sets for therapeutic and therapeutic and prophylactic purposes; establishing the nutritional and biological value of new food products; ensuring the proper quality of food raw ma-terials and food, the introduction of sanitary food protection from the effects of harmful factors of physical, chemical and biological nature. Today in Ukraine, according to statistics, diseases, in the pathogenesis of which lies the food factor, have increased significantly. The peculiarity of alimentary pathology is that it can only be treated by correcting nutrition. The main priorities for the prevention of alimentary and alimentary-dependent seizures should be: ensuring physiological needs for essential ingredients with regard to ecological and endemic human living conditions; raising the level of knowledge among the population in the problems of healthy eating; ensuring high quality of domestic and imported food products. Keywords: prevention, alimentary diseases, population of ecologically non-safe regions, accident at the Chernobyl nuclear power plant.

Демографическая ситуация в Архангельской области: анализ, пути решения

The issue of differentiation of socio-economic development indicators is relevant for the regions of the Russian Federation. An important condition for the effective and stable development of territories is a favorable demographic situation. This requires a competent and thoughtful demographic policy that will ensure population reproduction and economic development of the constituent entities of the Russian Federation. The study area is the Arkhangelsk Oblast, partly included in the Arctic zone of the Russian Federation, which is of strategic interest to Russia due to its geopolitical, geo-economic position in the modern world. The aim of the work is to analyze the changes in the qualitative and quantitative composition of the population of the Arkhangelsk Oblast, determined by the processes of fertility, mortality, migration, as well as the socio-economic situation and state policy. To analyze the demographic situation, the paper uses traditional methods of analysis (comparison, relative and average values, graphic method). The paper presents the territorial differentiation of the demographic situation in the regions of the Northwestern Federal Okrug. The information base is national and regional statistical information for the last 10 years. The article discusses the interim results of the implementation of the national project “Demography” in the Arkhangelsk Oblast. The results of the study can be useful for state authorities and local governments that manage the regional development of territories within the framework of the national project “Demography”.

CLINICAL AND PROGNOSTIC FEATURES OF ELDERLY PATIENTS WITH UNSTABLE ANGINA PECTORIS UNDERGOING CONSERVATIVE TREATMENT DEPENDING ON LEFT VENTRICULAR EJECTION FRACTION

Highlights High cardiovascular morbidity and mortality in the Russian Federation and in Kuzbass is mainly due to high number of elderly and senile patients; it simply reflects the current demographic situation in the country. Elderly and senile patients with acute coronary syndrome (ACS) account for 50% of hospitalized patients. In real clinical practice, a significant number of elderly patients with ACS receive conservative treatment, whereas the prognosis in this cohort is determined by the development of recurrent coronary events and the progression of heart failure. Due to small number of patients older than 75-80 years included in randomized clinical trials, there are certain gaps in the management of elderly patients with ACS and heart failure. Obviously, elderly patients require a special approach to patient management, taking into account the complexity of clinical and anamnestic factors affecting the prognosis. AbstractAim. To study clinical and prognostic features of elderly patients with unstable angina pectoris undergoing conservative treatment depending on left ventricular ejection fraction (LVEF).Methods. 130 elderly patients, with mean age of 82 (77; 89) years, hospitalized for unstable angina with a GRACE score of less than 140 to a vascular center in Kemerovo were included in the study. During hospitalization, standard laboratory and instrumental studies were performed, except coronary angiography. The quality of life was assessed using the EQ-5D 3L questionnaire. After 12 months, patient compliance with treatment recommendations, primary and secondary endpoints, and quality of life were analyzed.Results. All patients were diagnosed with heart failure, 50 (38.5%) patients presented with LV EF less than 40% (the group I), 80 (61.5%) patients presented with LV EF more than 40% (the group II). The groups were comparable in gender, age, presence of multifocal of atherosclerotic disease, prevalence of aortic stenosis, arrhythmias and comorbidities. Women predominated in both groups, and arterial hypertension was noted in all patients. In the group I, a history of myocardial infarction, coronary revascularization, and NYHA FC III were more common (p<0.05). The level of quality of life at discharge was low in both groups: 34.8 (29; 42) and 39.4 (34; 46) points, respectively (p>0.05). Almost all patients were on triple neurohumoral blockade (beta-blockers, renin-angiotensin-aldosterone system inhibitors and mineralocorticoid receptor antagonists) for heart failure and dual antiplatelet therapy. One year later, 85.2% of patients in the group I and 90% of patients in the group II were taking all prescribed medication at low or medium therapeutic doses (without the need for drug titration). The overall mortality in the groups was 46% and 37.5%; cardiovascular deaths accounted for 32% and 30%, respectively (p>0.05). There were no differences in the frequency of endpoints (hospitalization, stroke, acute coronary syndrome, coronary revascularization) between the groups. The level of quality of life remained low in both groups.Conclusion. In patients over 75 years hospitalized for unstable angina, main clinical and anamnestic characteristics, annual prognosis and quality of life do not depend on LV EF, whereas the need for coronary revascularization during the 1 year remains high.

Single-industry towns: Grouping and identification of factors influencing the demographic situation

Subject. This article considers single-industry towns of the Russian Federation as specific settlements. Objectives. The article aims to analyze the distribution of single-industry towns by category for 2014–2022, and model the rate of population change in single-industry towns. Methods. For the study, we used statistical, regression, and comparative analyses. Results. The article finds that social and economic factors, as well as the distance from a single-industry town to the capital of the region, affect the population growth of single-industry towns. Conclusions. The results of the study can be taken into account by government agencies when designing a strategy for the development of single-industry towns.

Научное обоснование предложений по совершенствованию медицинской помощи жителям села

P u r p o s e o f t h e s t u d y : based on the analysis of the medical and demographic situation and the staffing of the rural population, develop proposals for improving medical care for the villagers. M a t e r i a l s a n d m e t h o d s : statistical, analytical, direct observation. The article used the forms of state statistical observation of the Ministry of Health of the Russian Federation. The results of the actual research. Materials and methods: statistical, analytical, direct observation, the forms of state statistical observation of the Ministry of Health of the Russian Federation were used. R e s u l t s . The rural population in the Russian Federation (2021) is 36,9 million people (25,2% of the country’s population). The proportion of the rural population of working age was 53,8%, which is lower than in Russia as a whole – 56%. A 21-year analysis showed that the birth rate of the rural population increased until 2012, while mortality rates decreased, in 2013 the mortality and birth rates became equal and amounted to 14,5‰ each, in 2020 the death rate increased to 15,4‰ due to the COVID‑19 pandemic. The average (expected) life expectancy of the rural population (70,7 years) is lower than that of the urban population (71,8 years); the indicator for rural men is extremely low (66 years). The overall incidence of the rural population is 1,4 times lower than that of the urban population, 117993,2 and 166901,5‰oo respectively. Primary morbidity is also 1,5 times lower (55082,4 and 83002,2‰oo, respectively). The difference in primary morbidity rates of the rural population in the federal districts (2020) was 1,3 times, in the constituent entities – 8,3 times. The incidence of COVID‑19 in the rural adult population (2020) was 1986,0‰oo, which is 2 times lower than in the Russian Federation as a whole (3913.9‰oo). There was a significant difference in these indicators (by 59 times) in the subjects of the Russian Federation, which can be associated with a lower density of the rural population, low availability of medical care in the countryside, as well as the ambiguity of COVID‑19 coding. For 6 years (2016–2021), the provision of doctors in medical organizations in rural areas in the Russian Federation decreased from 14,8 to 13,6‰o, and of nurses – from 54,6 to 49,3‰o. The number of nursing staff individuals working for feldsher-obstetric station decreased by 12,5%, paramedics – by 9,4%. Given the special importance of paramedical assistance in the countryside, the reduction in the number of paramedics should be considered a negative. C o n c l u s i o n . The unfavorable medical and demographic situation in the countryside requires the development of organizational and managerial decisions aimed at increasing the availability of medical care to the villagers. C o n c l u s i o n s . Proposals have been developed to improve the provision of medical care to the population of rural areas.

Assessment of the Impact of Oil Production Processes on the Health of the Population of Oil-Producing Areas of the Irkutsk Region

Introduction. The state of the population health depends on the ecological and hygienic well-being of the territory. In places with developed oil production, there is a long-term impact of pollutants on the human body and, as a result, corresponding diseases develop. This is evidenced by numerous domestic and foreign studies, but the territory of the Irkutsk region is not covered by such studies. Therefore, the work objective is to assess the impact of oil production processes on the incidence of the population of oil-producing regions of the Irkutsk region.Materials and Methods. The source materials were the statistical indicators of overall and primary disease incidence of the population of the regions of the Irkutsk region for the period from 2016 to 2019, posted on the website of medical statistics of the Irkutsk region. For the calculation of the non-carcinogenic risk, we have used environmental monitoring data from an oil-producing company based on average daily concentrations of pollutants in oil-producing areas.Results. It is shown that oil-producing areas are characterized by extremely high incidence rates for such groups of diseases as respiratory diseases, diseases of the circulatory system, diseases of the musculoskeletal system, diseases of the digestive system, diseases of the genitourinary system, as well as deviations in pregnancy, childbirth and the postpartum period. Infant mortality rates in these territories are up to 4 times higher than the corresponding average indicators for the Irkutsk region as a whole. The calculation of non-carcinogenic risk showed an excess over the permissible values accepted in Russia.Discussion and Conclusions. The results of the analysis testify to the unfavorable medical and demographic situation in the territories under discussion. The pronounced excess of the incidence rate for the presented groups of diseases in the oilfield areas in comparison with the territories taken for comparison reflects the possible impact of environmental pollution on the health of the population. A connection between the growth of infant mortality in the territories under consideration and the beginning of the industrial development of hydrocarbon deposits in these places has been revealed. The contribution of oil companies to the socio-economic development of the regions, including co-financing of medical care for the population, could partially offset the negative impact of industrial processes.

RELEVANCE OF THE USE OF ASSISTED REPRODUCTIVE TECHNOLOGIES IN CURRENT CONDITIONS IN UKRAINE

The aim. To determine the relevance and analyze the problems of using assisted reproductive technologies against the background of assessing the state of reproductive health in modern conditions in Ukraine.
 Materials and methods. The research materials were official statistical data from the reports of the Center for Medical Statistics of the Ministry of Health of Ukraine "Health of the Female Population in Ukraine", "Health of the Male Population of Ukraine", "Information and Statistical Guide on Assisted Reproductive Technologies in Ukraine", "Gender Peculiarities in the provision of medical care in health care institutions" for 2015-2020.
 Results. The dynamics of the demographic situation in Ukraine in recent years, the state of reproductive health of the population, and the use of assisted reproductive technologies (ART) were analyzed. It has been established that the depopulation of the population is a negative manifestation of the modern demographic crisis. Reproduction of the population largely depends on its reproductive potential, in the preservation of which ART plays a certain role. The medical, legal, and economic aspects of the use of ART, which become relevant during hostilities, the serious consequences of which can harm the fertility of the population, are clarified.
 Conclusions. Against the background of the demographic crisis in Ukraine, which is characterized by a decrease in the birth rate and population depopulation, it is important to improve the reproductive health of the population, treat infertility, and help solve the problem of postponing the birth of children in wartime conditions. Improving the quality and accessibility of ART should become one of the priorities of the state's demographic policy.

EPIDEMIOLOGICAL ANALYSIS AND PROGNOSIS OF MISCARRIAGE IN UKRAINE AND LVIV REGION

The aim. Substantiation of the prognostic component in the process of developing the model of prevention of miscarriage among the female population of Ukraine.
 Materials and methods. A retrospective epidemiological analysis of the miscarriage dynamics among the female population of Ukraine and Lviv region for the period of 2014-2021 was performed, and prognosis of the indicators of this pathology until 2026 was established. The work uses the methods of a systemic approach and structural-logical analysis, medical-statistical analysis , prognostic methodology using exponential smoothing according to the two-parameter Holt method.
 Results and discussion. Over the analyzed period from 2014 to 2021, an increase in the index of the ratio of the total rate of miscarriage to the total number of pregnancies (cases of miscarriage per 100 pregnancies) from 5.50 in 2014 to 6.22 in 2021 in Ukraine and from 3.57 to 4.72 in Lviv region, respectively, was noted. In order to predict the ratio of miscarriages to the total number of pregnancies we have chosen the exponential smoothing method according to the two-parameter Holt method. In our opinion, this indicator will be the least dependent on the impact of war and COVID-19 pandemic. 
 All other conditions remaining unchanged, the prognosis results predict that in 2026, the ratio of miscarriage to the total number of pregnancies in Ukraine will amount to 6.37 cases of miscarriage per 100 pregnancies, and 5.38 cases of miscarriage per 100 pregnancies in Lviv region.
 Conclusions.
 Analysis of the dynamic indicators of the ratio of stillbirths to the total number of pregnancies over the analyzed 8-year period both in Ukraine and in Lviv region showed a trend towards annual growth of this index.
 A worsening of the demographic situation according to the results of the study, as well as the likely development of a demographic crisis in connection with the state of war in Ukraine and the mass migration of the female population provoked by the war, requires searching for all possible ways to prevent miscarriage and take into account this prognostic-negative trend in the development of preventive programs.

Youth Citizenship: Connected and Unconnected in Public Issues

This study is about youth citizenship in the management of public issues. The study based on considerations related to the demographic situation of the population in Indonesia, which is actually dominated by young people. Especially for this study, young people will be placed in two important areas. First, the citizenship of young people and secondly the citizenship of young people who grow up in the context of a region (city) that is economically growing in a moderate range (Kupang City) and a small town (Bajawa City). The main issue raised in this article is how are the conditions and citizenship of young people growing and developing in response to the public issues around them? The method used in this study is a qualitative method based on in-depth interviews, case studies and discussions involving young people ranging in age from 15-25 years. The results of research in these two areas show a tendency for the involvement of young people in public affairs. First, young people in both regions have the ability to define public issues that they consider important. Second, the tendency to use digital media as a forum for organizing and social movements. Digital media allows children's movements which tend to be small, limited. Third, autonomous movement. This independence is especially strongly influenced by their desire not to be interfered with by other groups. Fourth, diametric relations with the government. Even though their efforts are often considered important by the government, they tend to keep their distance from the government.

The impact of migration on the socio-economic state of the state

The authors conducted a study of migration as a socio-economic category, taking into account qualitative and quantitative criteria, and also indicated the impact of migration on the development of the state. The authors note that migration is a multidimensional category, which includes different directions, motives of subjects and characteristics, while state regulation of migration flows is an integral part of migration. Also, according to the authors, migration processes do not unequivocally lead to one negative or positive impact on the socio-economic development of the state. This leads to the conclusion that the impact of migration depends on the characteristics of migration flows, their volume and qualitative features. In the case when a country has a negative balance of migration, and the influx of migrants is mainly characterized by inability to work or low qualifications, this leads to an obvious negative effect of migration. However, for countries with low population levels, insufficient natural growth and a small number of skilled workers, migration can significantly affect economic activity and growth in the country. Therefore, states need to determine migration policy based on macroeconomic data, the state of the labor market and the demographic situation in the country. Migration can replenish a dwindling labor force, but it can also put pressure on wages and spur local unemployment. At the same time, according to the authors, first of all, the state needs to fight against illegal migration. According to the material presented in the article, illegal migration has a significant negative effect on the state budget, necessitating investments in the fight against this phenomenon and a decrease in tax revenues. In addition, such migration contributes to an increase in the volume of the shadow economy, which operates outside state control, which poses a threat to the stability of socio-economic development. The authors emphasize that, first of all, it is necessary to take legal and administrative measures to combat illegal migration in order to reduce public spending. As a result, such actions also help to reduce the scale of the shadow sector of the economy by reducing the number of people employed in this area of labor resources.