Diseases Of The Circulatory System Research Articles

Place of living at end-of-life according to cause of death: a comparative analysis of all decedents 70 years or older in 2009-2013 in Finland and Norway.

Time at home at end-of-life is perceived as valuable to individuals. Increasing home care is therefore often a political goal. Yet, little is known about where individuals live towards their end-of-life. Our aim was to describe where individuals reside their last 6 months of life in Finland and Norway, and how this differed by cause of death, sex, age, marital status, and income. We used individual-leveled national registry data on all decedents aged >70 years in 2009-2013 to describe the number of days individuals spent at home, in hospital, in long-term care (LTC) and shortterm care (STC) facilities. We described the place of residence for all and by causes of death: cancer, diseases of the circulatory system, disease in the respiratory system, and mental and behavioral disorders (primarily dementia). We analyzed how age, marital status (indicating informal care), and income associated with place of residence. Analyses were stratified by sex and country. During the last 6 months of life, decedents in Finland (n=186,017) and Norway (n=159,756) spent similar amounts of days in hospital (8 and 11 days) and in STC facilities (15 and 13 days). Finnish decedents spent more days at home (96 vs. 84 days) and fewer days in LTC facilities (64 vs. 80 days). Living arrangement differed similarly by cause of death in the two countries, e.g., decedents from cancer and mental and behavioral disorders spent 123 [113] vs. 29 [21] days at home in Finland (Norway). In both countries, for all causes of death, lower age and marital status were associated with more days at home, for both males and females. While those with higher income spent more days at home in Norway, the opposite was found in Finland. Older individual's living arrangements in the last 6 months of life were similar in Finland and Norway but differed by cause of death. Younger individuals and those with access to informal care spent more days at home, compared to their counterparts. With aging populations, more individuals will likely need LTC at their end of life. Policies should align with these needs when developing future health care services.

Analysis of the cause of death among the adult population in the provision of poor-quality medical services in public health institutions of the Republic of Tajikistan

Introduction. The trend of increasing cases of harm to health/life of patients in the provision of poor-quality medical services is of particular importance in the field of public health. The purpose of the study. Analysis of the cause of death among the adult population in the provision of poor-quality medical services in public health institutions of the Republic of Tajikistan. Materials and methods. The study was conducted on the basis of data on deaths among the adult population (over 18 years) of the Republic in the structure of hospital institutions of the Republic of Tajikistan 0ver period of 2019–2021 and 6 months of 2022. Results. Over period of 2019–2022 there were registered 1881, 4119, and 2567 deceased patients older 18 years, respectively, the hospital mortality rate was 0.2; 0.6, and 0.3%. The frequency of respiratory diseases during 2020 compared to the previous year (n = 70; 0.2%) due to complications of COVID-19 increased by more than 15 times (n = 1577; 3.1%), and in 2021 decreased to 2.2 times (n = 541; 1.4%). In the structure of causes of death there were dominated complications of diseases of the circulatory system (39.5%), the consequences of surgical interventions (12.7%), followed by injuries (10.7%), tumors (3.8%) and the endocrine system (3.3%). The duration of the period before hospitalization of patients who died from surgical diseases was 8.5% — up to 1 day, 68.5% — up to 5 days and 22.8% — from 5 to 15 days. Research limitation. Pathological anatomical examination of the corpses of deceased patients, which is of key importance in establishing the causes of deaths in healthcare institutions, is carried out in the republic at an extremely low number for religious reasons. Conclusion. In state healthcare institutions of the Republic, the registration of deaths due to the provision of poor-quality medical services in the period before and after hospitalization does not correspond to reality, which requires the improvement of the reporting system in accordance with international standards.

Occupational risk factors for the development of circulatory system diseases in bearing production workers

Prevention of circulatory system diseases (CSDs), preservation of the health of the working population is a priority task of the Russian Federation healthcare, in the solution of which it is of interest to study the causal relationships of the influence of production factors on the development of CSDs in workers of various professional groups. The purpose of this study was to assess the prevalence and occupational causality of diseases of the circulatory system in the main professional groups of bearing production workers. Material and methods. The occupational risk of developing CSDs in workers of the main professional groups in the bearing production was assessed based on the hygienic classification of production factors and chronic non-infectious morbidity according to medical examinations using the methodology for assessing occupational health risk. Results and discussion. It has been established that bearing production workers in the course of labor activity are exposed to the complex effects of harmful (class 3.1–3.4) factors of the working environment of various nature, which determine the a priori occupational health risk in categories from low to very high. The level of CSD prevalence was 446.4‰, while arterial hypertension was the most frequently established nosologic form (80.66 %). A high degree of causal relationships of arterial hypertension with the work was established for adjusters and machine operators (RR = 2.44; etiologic fraction (EF) 58.98 %; CI = 1.335–4.450), turners (RR = 2.32; EF = 56.93 %; CI = 1.184–4.451), grinders (RR = 2.31; EF = 56.63 %; CI = 1.189–4.469), hot-spot workers (RR = 2.16; EF = 53.64 %; CI = 1.193–3.901), which indicates professional conditioning. Conclusions. The complex impact of production factors contributes to the development of CSDs among workers in the production of bearings, which is confirmed by a high degree of causal relationship between arterial hypertension and work.

Comorbidities, mortality and metabolic profile in individuals with primary biliary cholangitis-A Phenome-Wide-Association-Study.

Primary biliary cholangitis (PBC) is a chronic, immune-mediated liver disease that can lead to fibrosis and cirrhosis. In this cohort study, we aimed to investigate morbidity and mortality in conjunction with metabolomic changes of PBC in a UK population-based cohort. 454 participants with PBC and 908 propensity score (age, sex, BMI, ethnicity) matched controls without liver disease were included in the study. A subset of participants with PBC and controls were analysed for their metabolomic profile. Further, PBC-associated comorbidities were investigated by PheWAS analysis. Lastly, we assessed causes of death in individuals with PBC using a Fine and Grey competing-risks regression model. Compared to the control group, various pathways associated with the metabolism of amino acids, lipids, and liver biochemistry were significantly enriched in individuals with PBC. We found reduced levels of S-HDL-cholesterol and Glycoprotein Acetyls in individuals with PBC as well as an association with diseases of the circulatory system. Notably, PBC individuals had a higher prevalence of digestive diseases, autoimmune diseases, cardiovascular diseases, anaemias, mental disorders, and urinary tract infections compared to the control group. Strikingly, the overall mortality was almost three times higher in the PBC group compared to the control group, with diseases of the digestive system accounting for a significant elevation of the death rate. A subsequent analysis, enhanced by propensity score matching that included the APRI score, demonstrated that the observed morbidity could not be exclusively attributed to advanced hepatic disease. Our study provides a detailed perspective on the morbidity of individuals with PBC. The exploration of potential effects of disease state on morbidity suggest that early detection and early treatment of PBC could enhance patient prognosis and prevent the onset of comorbid diseases. Finally, the metabolomic alterations could represent a link between the pathophysiological processes underlying PBC development, progression, and associated morbidity.

Occupational health risk for women employed in industries with harmful working conditions

The preservation and strengthening of the health of the able-bodied population is the most important indicator of the socio-economic potential of the country.
 A modern working woman experiences the complex impact of adverse factors of the production environment and the labor process, which are potentially dangerous to health, contribute to the formation of production-related and occupational diseases.
 The study aims to analyze the occupational health risk of women employed in jobs with harmful working conditions at the processing plant of the mining and processing plant and the petrochemical complex of the Republic of Bashkortostan.
 Materials and methods. The authors studied the state of health by analyzing the occupational risk of female workers in contact with harmful production factors of a processing enterprise (407 people) and a petrochemical complex (473 people). The experts used clinical, functional, clinical and statistical research methods in their work and analyzed the levels and structure of chronic non-communicable diseases to determine the degree of industrial conditionality. The calculations were performed using the Microsoft Excel program.
 The combined effect of a complex of harmful production factors of the mining and processing plant (dust of polymetallic ores, chemicals, noise and severity of labor — class of working conditions 3.1) contributes to the development of chronic non-communicable diseases in female workers in 80.3±2.0% of cases, versus 54.6±4.4% of cases in the control group. A number of identified diseases have the character of production-related, while a very high degree of its conditionality is characteristic of diseases of the musculoskeletal system and connective tissue (RR — relative risk = 4.3, EF — etiological proportion = 75%), a high degree was inherent in respiratory diseases (RR=3.1; EF=67.7%). Diseases of the circulatory system (RR=1.6, EF=37.5%) and diseases of the nervous system (RR=1.58, EF=36.7%) had an average degree of occupational 
 conditionality.
 In the workers of the main group of the petrochemical complex, chronic non–communicable diseases were diagnosed significantly more often than in the control, respectively — 84.0±1.7 and 67.0±3.5% of cases, p<0.01. The combined effect on the workers of the complex of chemicals in combination with the intensity of the labor process associated with the 3-shift nature of work (class of working conditions 3.1), was the cause of the industrial conditionality of diseases of the nervous system, circulatory system, blood, digestive organs of moderate degree.
 Female employees of the enterprises of the concentrating plant of the mining and processing plant and the petrochemical complex, engaged in work with harmful working conditions, represent a "risk group" for the occurrence of changes from various organs and systems, depending on the current etiological production factors. Based on the indicators of the degree of occupational conditionality of a number of diseases in female workers, mining and petrochemical complexes belong to industries with a high and medium occupational risk of health disorders.
 Ethics. The survey of female employees was conducted with their informed consent, approved by the bioethical committee of the Institute. The fundamental documents are: "Ethical principles of conducting scientific medical research with human participation" (amendments 2008) of the Helsinki Declaration, as well as "Rules of Clinical Practice in the Russian Federation" (approved by Order of the Ministry of Health dated 06/19/2003 No. 266).

Chronic widespread pain and cause of death: a 25-year follow-up study.

Chronic widespread pain (CWP) has been suggested as a risk factor for mortality in cardiovascular diseases and malignancies. Different definition of CWP makes it difficult to compare previous studies. The aim was to study whether mortality and certain causes of death were increased among people with CWP and whether the definition of CWP influenced outcome. This 25-year follow-up study included 2425 people from the general population, at baseline divided into 3 pain groups: CWP, chronic regional pain, and no chronic pain (NCP). Chronic widespread pain was defined according to the ACR1990 (CWPACR1990) and the more stringent WP2019 (CWPWP2019) criteria. Causes of death were derived from official national register. Mortality, adjusted for age, sex, socioeconomic status, and smoking habits were analyzed with Cox regression. Overall mortality was not higher in people with CWPACR1990 (hazard ratio [HR] 1.08, P = 0.484) compared with NCP but significantly higher when using CWPWP2019 (HR 1.32, P = 0.033). People with CWPWP2019 had a higher mortality in diseases of the circulatory system (HR 1.32, P = 0.033) but not for neoplastic diseases. CWPACR1990 showed an increased mortality in malignancies of digestive organs. An increased mortality in influenza, pneumonia, acute kidney failure, and chronic kidney disease was observed for the CWPWP2019 definition. The more stringent WP2019 definition of CWP showed an excess risk for death, especially within diseases of the circulatory system. The results suggest that WP2019 defines a more vulnerable group in the population. Chronic widespread pain should be acknowledged in the clinic as a risk factor for increased mortality.

Дозовая зависимость смертности от болезней системы кровообращения у работников ядерной индустрии (систематический обзор и pooled-анализ): отсутствие эффекта малых доз и подтверждение порога, установленного НКДАР и МКРЗ при 0,5 Гр

Based on the maintained database (source database) on effects in nuclear workers (NW), a selection of major studies of the relationship between mortality from diseases of the circulatory system (CVD; codes 390–459 according to ICD-9 and I00–I99 according to ICD-10) and external radiation dose. The sample included 30 papers and covered cohorts from 6 countries plus an NW cohort from 15 countries. For the sample, in most cases based on published standardized mortality rates (SMR), the relative risks (RR) of mortality from CVD were calculated for the selected dose groups with subsequent processing of the material for outliers. Initial: n = 207; final sample: n = 199; covers very low (0–10 mSv; 15.8 % of the sample), low (>10–100 mSv; 45.8 %) and moderate (>100–1000 mSv; 36.4 %) doses; data for high doses (>1000 mSv; n = 4; 2 % of the sample), due to dubiousness, were excluded. A systematic review and pooled analysis of the RR for mortality from CVD depending on the dose on an ordinal scale was performed on the final sample. For the entire dose range (0–1000 mSv) and for moderate doses, statistically significant trends in increasing RR were found when expressed in five types of regressions (except for the logarithmic one for the entire range). Although the r values were small (0.230–0.293), the effect was clear. The ERR per 1 Gy (Sv) calculated for moderate doses using linear regression was 0.54. This value is higher than those obtained previously in meta-analyses, but should be considered as the most adequate. No dose relationship was found for the very low + low dose range (0–100 mGy); the r coefficients for the regressions were either negligible or negative at statistical insignificance. For the subthreshold dose range for CVD mortality after exposure (according to UNSCEAR and ICRP: 500 mSv), only a weak trend towards an increase in RR was found, statistically insignificant, despite the large sample size (n = 191), while for the dose range 500–1000 mSv, the highest tendency among the pooled analyzes was revealed to increase the risk depending on the level of exposure (r = 0.297–0.423; statistically insignificant due to the small sample size: n = 8). It is concluded that for mortality from CVD after irradiation, the threshold value of 0.5 Gy established by UNSCEAR and ICRP and confirmed in the present pooled analysis should be strictly adhered to. Due to the lack of effects of low doses, it is inappropriate to raise the issue of low dose effects in the context of these pathologies.

СОСТОЯНИЕ ЗДОРОВЬЯ МЕДИЦИНСКИХ СЕСТЁР В ОРЕНБУРГСКОЙ ОБЛАСТИ

Middle-level medical personnel have the most unfavorable health indicators, their incidence is higher than that of doctors and workers in other sectors of the national economy. In this regard, the issues of strengthening and preserving the health of this contingent are becoming especially relevant. The purpose of the study is to study the morbidity of nurses according to medical examinations. To investigate the level of anxiety and depression among them. Materials and methods. A sample study of the "Medical records of a patient receiving outpatient medical care" of nurses working in medical organizations of the Orenburg region who underwent a medical examination in 2022 was conducted. The nurses were also surveyed using the questionnaire "Hospital scale of anxiety and depression". The material was developed on a personal computer using Statistica 10.0 and MS Excel programs. The results obtained. The incidence of nurses was 147.8%. The leading classes of diseases are diseases of the eye and its accessory apparatus, diseases of the circulatory system, diseases of the genitourinary system, diseases of the musculoskeletal system and connective tissue, mental disorders and behavioral disorders. The association of morbidity with age, length of service, and qualification category has been established. More than a third of the nurses experienced a state of anxiety. The presence of significant symptoms of depression was determined in 11.7 ± 2.4%. The causes of anxiety and depression in nurses were more personal than organizational in nature. An average positive relationship has been determined between the increase in symptoms of anxiety and depression with an increase in morbidity. In their presence, the risk of disease for related classes of diseases increases by 2.6 – 6.6 times in the presence of anxiety, and by 4 – 9 times in the presence of depression. In general, the incidence of all classes of diseases among nurses due to anxiety was 10.8%, which is 7.3% of the total incidence, and the incidence due to depression was 3%, which is 2% of the total incidence. Conclusion. An evidence-based approach based on a comprehensive assessment is needed to make informed decisions on improving the health of nurses. The present study revealed a fairly high incidence of nurses, as well as a high level of anxiety and depression. Although no cases of occupational disease have been identified, a link has been found between morbidity and age, experience, and qualifications. About half of the nurses need follow-up dynamic monitoring, more than half need further follow-up and treatment in a polyclinic.

DEVELOPMENT OF AN INTEGRATED ASSESSMENT FRAMEWORK FOR ASSESSING REGIONAL QUALITY OF LIFE FOR MONITORING THE HEALTH STATUS OF THE POPULATION OF THE SUBJECTS OF THE RUSSIAN FEDERATION

HighlightsWe have developed an integrated assessment framework for assessing regional quality of life of the population residing in the subjects of the Russian Federation in 2017-2021 that includes four indices: Social-geographical, Demographic, Economic and Industrial-environmental. The study results have confirmed the importance of the influence of regional quality of life on the health of the Russian population residing in the regions. Further assessment of the validity of the indices is needed to analyze the impact on individual health indicators and to study subjects in more depth, including within the framework of a specific nosology or nosology groups. AbstractAim. To develop an integrated assessment framework for assessing regional quality of life of the population residing in the regions of Russia, followed by an analysis of its association with mortality rates in 2017–2021.Methods. The publication “Regions of Russia. Socio-economic indicators” published by the Federal State Statistics Service for 85 subjects for the period from 2017 to 2021 was used as the source data material. Factor analysis, the principal component method, was used to identify hidden variables or factors, reduce the number of variables based on classification and determine the structure of relationships. To assess the validity of the developed indices, an analysis of their associations with mortality rates for 2017–2021 was carried out. A linear regression analysis of the effect of indices on mortality rates was carried out.Results. The analysis revealed 4 distinct indices, which included 25 indicators. With an increase in the Social-geographical Index, there is an increase in total mortality by 3.8%, mortality from infectious and parasitic diseases by 36%, neoplasms by 8.8%, diseases of the circulatory system by 5%, respiratory organs by 10.6%, digestive organs by 12.3%, external causes by 23.3%. With an increase in the Demographic Index, there is a decrease in mortality from infectious and parasitic diseases by 12.9%, an increase in total mortality by 19%, mortality from neoplasms by 16.3%, diseases of the circulatory system by 21.4%, respiratory organs by 13%, digestive organs by 19.2%. With an increase in the Economic Index, total mortality decreases by 7.8%, mortality from neoplasms by 5.6%, diseases of the circulatory system by 10%, respiratory organs by 7.8%. With an increase in the Industrial-environmental Index, there is an increase in total mortality by 3.1%, mortality from infectious and parasitic diseases by 27.2%, and neoplasms by 3.3%.Conclusion. We have identified the regional indices reflecting the current quality of life of the Russian population, the validity of which is confirmed by significant association with mortality in the regions. Further use of indices is possible for a detailed assessment of individual subjects, focusing on a specific index showing the most significant relationship with the health of the population.

DEVELOPMENT AND SUBSTANTIATION OF PROMISING MODELS OF MEDICAL CARE FOR DISEASES OF CIRCULATORY SYSTEM IN INDUSTRIAL REGION. 2010–2023 RESULTS

HighlightsWe have identified regional peculiarities of traditional and non-traditional cardiovascular risk factors.We have defined and characterized clinical and organizational characteristics of the specialized care, prevention, and treatment of diseases of the circulatory system in the Kemerovo region - Kuzbass.Moreover, we have described the principles of innovative organizational models for improving care for patients with diseases of the circulatory system, focused on the needs of outpatient organizations. AbstractThe review presents the main research findings obtained at the Department of Optimization of Medical Care for Cardiovascular Diseases of the Research Institute for Complex Issues of Cardiovascular Diseases over the past 13 years of work. The uniqueness of the obtained data lies in the fact that we have identified regional peculiarities of cardiovascular risk factors in residents of an industrial region (using the Kemerovo region data). Data on monitoring of health and risk factors served as the basis for the development of innovative organizational models for improving care for patients with diseases of the circulatory system from the stage of primary care to tertiary care using a systematic and integrated approach, and situational analysis. Management decisions within models are based on international quality standards that reaffirm that risk-based management, the role of personnel and the work environment are the integral to the improvement of performance and the achievement of the main goals of medical organization. Using the project approach, we have implemented management tools for internal quality control and safety of patients and personnel.

Trends and Disparities in Cardiovascular Death in Sarcoidosis: A Population-Based Retrospective Study in the United States From 1999 to 2020.

Despite significant cardiac involvement in sarcoidosis, real-world data on death due to cardiovascular disease among patients with sarcoidosis is not well established. We queried the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research database for data on patients with sarcoidosis aged ≥25 years from 1999 to 2020. Diseases of the circulatory system except ischemic heart disease were listed as the underlying cause of death, and sarcoidosis was stated as a contributing cause of death. We calculated age-adjusted mortality rate (AAMR) per 1 million individuals and determined the trends over time by estimating the annual percentage change using the Joinpoint Regression Program. Subgroup analyses were performed on the basis of demographic and geographic factors. In the 22-year study period, 3301 cardiovascular deaths with comorbid sarcoidosis were identified. The AAMR from cardiovascular deaths with comorbid sarcoidosis increased from 0.53 (95% CI, 0.43-0.65) per 1 million individuals in 1999 to 0.87 (95% CI, 0.75-0.98) per 1 million individuals in 2020. Overall, women recorded a higher AAMR compared with men (0.77 [95% CI, 0.74-0.81] versus 0.58 [95% CI, 0.55-0.62]). People with Black ancestry had higher AAMR than people with White ancestry (3.23 [95% CI, 3.07-3.39] versus 0.39 [95% CI, 0.37-0.41]). A higher percentage of death was seen in the age groups of 55 to 64 years in men (23.11%) and women (21.81%), respectively. In terms of US census regions, the South region has the highest AAMR from cardiovascular deaths with comorbid sarcoidosis compared with other regions (0.78 [95% CI, 0.74-0.82]). The increase of AAMR from cardiovascular deaths with comorbid sarcoidosis and higher cardiovascular mortality rates among adults aged 55 to 64 years highlight the importance of early screening for cardiovascular diseases among patients with sarcoidosis.

An Integrated Approach to the High-Quality, Safe and Healthy Nutrition Provision for Schoolchildren

Schoolchildren nutrition is one of the urgent problems and is currently one of the most important aspects for federal executive authorities. The study aims at the integrated approach development to ensure high-quality, safe and healthy nutrition for schoolchildren at the municipal level. The study object is the school nutrition system in Ekaterinburg. Nutrition satisfaction assessments results in 2019–2020 revealed that 81 % of headmasters, 48 % of teachers, and 62% of school medical staff believed that children liked to eat in the school canteen. At the same time, a man determined that 40 % of elementary school students, 31 % of high school students, 31 % of parents of elementary school students and 28 % of parents of high school students were satisfied with the catering at school, generally. The thesis presents the proportion data on the unsatisfactory samples of nutritional value identified in the course of inspections in schools in Ekaterinburg in 2019–2022, as well as the dynamics of satisfaction with catering in the school canteen and menu. The researchers systematized data on the reasons for nutrition refusal and (or) limited nutrition in the school canteen; on the attainment of the macro- and micronutrients consumption norms compared to the actual daily rations of schoolchildren in Ekaterinburg. The proportion of children with diseases of the endocrine system in schools varies from 0 to 37 %, including those with obesity – from 0 to 15 %, with diseases of the circulatory system – from 0 to 10 %, digestive system – from 0 to 72 %, musculoskeletal system – from 0 to 65 %. The researchers interrelate the number of unsatisfactory laboratory test samples of food products in public catering enterprises in schools with the digestive diseases in schoolchildren. Based on the research results, a man developed draft municipal program.

Analysis of newly diagnosed disabilities dynamics among medical workers in the Irkutsk region from 2003 to 2021 period

BACKGROUND: The specificity of the professional activities of medical workers is one of the main reasons for their high morbidity, including due to the influence of unfavorable factors in the working environment. The need to reduce labor losses in the industry necessitates the study and analysis of the disability status of doctors within the framework of long-term observation.
 AIM: A study of the dynamics of primary disability indicators of doctors working in their specialty in the Irkutsk region at the time of examination, in comparison with the primary disability of the adult population of the Irkutsk region for 19 years from 2003 to 2021.
 MATERIALS AND METHODS: An observational retrospective continuous study of primary disability indicators of working doctors in the Irkutsk region for 19 years (2003–2021) was conducted. Analytical, statistical, data copying, and expert assessment methods were used.
 RESULTS: During the study period, 1,703 people working as doctors in the Irkutsk region were recognized as disabled for the first time. The average long-term intensive rate of primary disability of doctors for 19 years averaged 75.4 (±7.55) per 10 thousand working doctors, which is 17% lower than the same indicator for the adult population of the region. The following diseases took the first place among doctors during 2003–2011: diseases of the circulatory system, and over the past ten years since 2012 — malignant neoplasms.
 CONCLUSIONS: The level of primary disability in physicians responds more quickly and sensitively to changes in social legislation, and is less affected by changes in the number of physicians in the region than the corresponding rates in the adult population of the region as a whole. The nosological structure of doctors disabled mainly coincides with the indicators of the adult population.

Seasonally adjusted laboratory reference intervals to improve the performance of machine learning models for classification of cardiovascular diseases

BackgroundVariation in laboratory healthcare data due to seasonal changes is a widely accepted phenomenon. Seasonal variation is generally not systematically accounted for in healthcare settings. This study applies a newly developed adjustment method for seasonal variation to analyze the effect seasonality has on machine learning model classification of diagnoses.MethodsMachine learning methods were trained and tested on ~ 22 million unique records from ~ 575,000 unique patients admitted to Danish hospitals. Four machine learning models (adaBoost, decision tree, neural net, and random forest) classifying 35 diseases of the circulatory system (ICD-10 diagnosis codes, chapter IX) were run before and after seasonal adjustment of 23 laboratory reference intervals (RIs). The effect of the adjustment was benchmarked via its contribution to machine learning models trained using hyperparameter optimization and assessed quantitatively using performance metrics (AUROC and AUPRC).ResultsSeasonally adjusted RIs significantly improved cardiovascular disease classification in 24 of the 35 tested cases when using neural net models. Features with the highest average feature importance (via SHAP explainability) across all disease models were sex, C- reactive protein, and estimated glomerular filtration. Classification of diseases of the vessels, such as thrombotic diseases and other atherosclerotic diseases consistently improved after seasonal adjustment.ConclusionsAs data volumes increase and data-driven methods are becoming more advanced, it is essential to improve data quality at the pre-processing level. This study presents a method that makes it feasible to introduce seasonally adjusted RIs into the clinical research space in any disease domain. Seasonally adjusted RIs generally improve diagnoses classification and thus, ought to be considered and adjusted for in clinical decision support methods.

Смертність через провідні непухлинні хвороби учасників ліквідації наслідків аварії на ЧАЕС та мешканців радіоактивно забруднених територій у віддаленому періоді після аварії

The purpose of the study: Based on a descriptive analysis, to determine the post-accident changes in the level and structure of mortality of participants in the chornobyl cleanup workers of the accident at the Chornobyl Nuclear Power Plant (ULNA) and residents of RADIATION- contaminated TERRITORIES )residents of the RZT) of Ukraine from the main non-neoplastic diseases depending on age, time since the date of the accident and gender. Materials and methods: Mortality from non-neoplastic pathology in 1986-1987 in ULNA, numbering 64,762, and residents of RZT, numbering 174,860, aged 18-60 on the date of the accident as a result of the accident at the Chornobyl nuclear power plant, was studied based on clinical-epidemiological and dose data of the State Register of Ukraine. Epidemiological, medical-statistical, analytical methods were used during the research. Research results: On the basis of descriptive analysis, a description of the level and structure of mortality from non-neoplastic diseases of the ULNA and the residents of the RZT was provided, both for the entire post-accident period and for five-year periods. In ULNA, mortality increased with each five-year period and in recent years has increased by 15.7 times compared to the initial period. In residents of the radioactively contaminated territory of Ukraine, the mortality rate increased for 25 years after the accident, with the highest rate in the period 2008-2012, regardless of age, with subsequent stabilization of the indicators. The structure of mortality among participants of the ULNA and residents of the RZT throughout the entire observation period remains unchanged and almost does not differ from the general mortality trends of the population of Ukraine. Diseases of the circulatory system, digestive organs, and respiratory organs are stable in terms of the frequency of the causes of death. Age, sex, and temporal differentiation of mortality, differences in nosological causes among defined categories of victims of the consequences of the accident at the Chornobyl nuclear power plant were revealed. Conclusions: During the post-accident observation period (1988-2017), diseases of the circulatory system, digestive organs, and respiratory organs remained the main causes of mortality in ULNA in and among residents of RZT aged 18–60 on the date of the Chornobyl accident. The dynamics of mortality in ULNA was characterized by growth during the entire period of observation, in residents of RZT – growth over 25 years with subsequent stabilization. It is necessary to take into account during dispensation the revealed features of mortality of ULNA and RZT in order to develop comprehensive measures to reduce the mortality of this contingent.

Diabetes mellitus as a cause of premature death in small areas of Spain by socioeconomic level from 2016 to 2020: A multiple-cause approach

ObjectiveThis study aimed to assess premature mortality due to Diabetes in small areas of Spain between 2016 and 2020, and its relationship with socioeconomic level and the immediate cause of death. As a secondary objective, we evaluated the effect of the Covid 19 pandemic. MethodsThis was an ecological study of premature mortality due to Diabetes from 2016 to 2020, with a focus on small areas. All deaths in people under 75 years of age due to Diabetes as the underlying cause were included ResultsThe final sample comprised 7382 premature deaths in 5967 census tracts. Women living in census tracts with an high level of deprivation(RR=2.40) were at a significantly higher risk. Mortality from Diabetes increased with deprivation, especially people aged 0–54(RR=2.40). People with an immediate cause of death related to a circulatory disease, living in census tracts with an high level of deprivation(RR=3.86) was associated with a significantly greater risk of death with underlying Diabetes. When a disease of the circulatory system was recorded as the immediate cause of death, being 65–74 years (RR=71.01) was associated with a significantly higher risk of premature mortality. ConclusionsLiving in geographic areas with higher levels of socioeconomic deprivation is associated with a higher risk of premature death from Diabetes in Spain. This relationship has a greater impact on women, people under 54 years, and people at risk of death caused directly by diseases of the circulatory system. Premature mortality due to diabetes saw a modest increase in 2020.

Age- and cause-specific contributions to increase in life expectancy at birth in Korea, 2000–2019: a descriptive study

BackgroundKorea’s life expectancy at birth has consistently increased in the 21st century. This study compared the age and cause-specific contribution to the increase in life expectancy at birth in Korea before and after 2010.MethodsThe population and death numbers by year, sex, 5-year age group, and cause of death from 2000 to 2019 were acquired. Life expectancy at birth was calculated using an abridged life table by sex and year. The annual age-standardized and age-specific mortality by cause of death was also estimated. Lastly, the age and cause-specific contribution to the increase in life expectancy at birth in the two periods were compared using a stepwise replacement algorithm.ResultsLife expectancy at birth in Korea increased consistently from 2010 to 2019, though slightly slower than from 2000 to 2009. The cause-specific mortality and life expectancy decomposition analysis showed a significant decrease in mortality in chronic diseases, such as neoplasms and diseases of the circulatory system, in the middle and old-aged groups. External causes, such as transport injuries and suicide, mortality in younger age groups also increased life expectancy. However, mortality from diseases of the respiratory system increased in the very old age group during 2010–2019.ConclusionsLife expectancy at birth in Korea continued to increase mainly due to decreased mortality from chronic diseases and external causes during the study period. However, the aging of the population structure increased vulnerability to respiratory diseases. The factors behind the higher death rate from respiratory disease should be studied in the future.

Hospitalizations for primary care sensitive conditions: an approach to the elderly population in the interior of the brazilian Amazon

The aim of this study is to analyze Hospitalizations for Conditions Sensitive to Primary Health Care (HACSC) in the elderly population in a municipality in the interior of the Brazilian Amazon. This is an ecological, time-series study in which the Hospital Information System (SIH/SUS) was used for data collection, the unit of analysis being the municipality of Santarém from 2011 to 2020. The data was subjected to simple descriptive statistical analysis and presented in the form of tables and graphs. During the period under study, 7,567 HACSC notifications were identified. Diseases of the circulatory system stood out (43.54%), specifically stroke (23.54%), followed by diseases of the respiratory system (23.34%), most notably pneumonia (22.19%). There was a higher incidence among females (53.11%), and there was a worsening and aggravation of the conditions, since 95% of the cases were emergency cases. Therefore, discussions on HACSCs should involve the engagement of various actors in order to re-evaluate actions and strategies and identify possible limiting factors for effective preventive activities for these conditions.

Health dynamics of children and adolescents in the Far Eastern federal district in 2013–2020

Aim. To identify trends in the primary morbidity of children and adolescents in the Far Eastern Federal District.Materials and methods. A retrospective analytical study of the dynamics of primary morbidity in children and adolescents by disease class was conducted.Results. Among the children population, a very high and high stability of the decrease in morbidity rates was established (R = -0.714– (-1.0)) for all classes of diseases. Among the adolescent population, a weak stability in the decrease in morbidity rates was characteristic of VII Diseases of the eye and adnexa (R = -0.262) and X Respiratory diseases (R = -0.262); a moderate stability of IV Diseases of the endocrine system, nutritional disorders, and metabolic disorders (R = -0.333); a moderate stability of IX Diseases of the circulatory system (R = -0.623); and a high stability among all other classes (R= -0.738 – (-0.928)). In the older age group, weak resistance to growth dynamics was determined in classes III Diseases of the blood, hematopoietic organs, and certain disorders involving the immune mechanism (R = 0.024) and VIII Diseases of the ear and mastoid process (R = 0.095).Conclusion. The data obtained forms a basis for further research into regional risk factors that contribute to poor health of the population. The findings can also be used to predict the health status of younger generations.

ИТОГИ 70-й СЕССИИ НАУЧНОГО КОМИТЕТА ПО ДЕЙСТВИЮ АТОМНОЙ РАДИАЦИИ (НКДАР) ООН (Вена, 19–23 июня 2023 г.)

The paper dwells upon the key outcomes of the 70-th Session of the United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR) which took place during 19-23 June 2023. Experts from 30 UNSCEAR Member-states as well as the representatives of international organizations participated in the work of the Session. Within the framework of the meetings of the working group and subgroups the documents on the following projects were discussed: R.757 “Second primary cancer after radiotherapy”, R.758 “Epidemiological studies of radiation and cancer”, R.759 “Evaluation of public exposures to ionizing radiation from natural and other sources”, R.760 “Evaluation of diseases of the circulatory system from radiation exposure” and R.761 “Nervous system effects of ionizing radiation”. The Committee also discussed interim reports: UNSCEAR/70/7 “Implementation of the Strategy to improve collection, analysis and dissemination of data on radiation exposure (including consideration of the Committee’s ad hoc working group on sources and exposure)”, UNSCEAR/70/8 “Implementation of the Committee’s Future Programme of Work and proposals for 2025‒2029 period (including consideration of the Committee’s ad hoc working group on effects and mechanisms)”, working materials for this document “Terms used by the United Nations Scientific Committee on the Effects of Atomic Radiation”, UNSCEAR/70/9 “Implementation of public information and outreach strategy for 2020–2024” and Report to the UN General Assembly.