First Time In Life Research Articles

Trends in the mental health in children and adolescents in Russia

Introduction. Mental health disorders in the world and the Russian Federation pose a serious problem, and their increase in childhood and adolescence is a determining factor in the development of diseases in later life. The purpose of the study is to analyze the follow up data of official sources on the specifics of the incidence of mental disorders in Russia of a children 0–17 year contingent with a differentiation of 0–14 and 15–17 years. Materials and methods. Materials from official statistics of the Ministry of Health of Russia and Rosstat were used in dynamics for various sections of the study as a whole for the 7-year period over 2015–2021, highlighting the years 2019–2021 to potentially identify the impact of COVID-19 on mental health. The analysis was carried out using statistical, analytical, and other methods. Results. The terminology on the problem was discussed. According to the analysis materials, among the reasons for taking in the Russian Federation under observation with a diagnosis for the first time in life (per 100 thousand population) in the “Mental and behavioural disorders” class. The leading reason for the entire population was “psychosis and dementia” — 55.1%; in children (0–14 years old) and in children, especially adolescents — “non-psychotic mental disorders” — 38.5% and 50.2%, respectively. An increase in childhood disability was revealed, both in general and for the studied reasons. Recommendations substantiated. Research limitations. The research materials are limited to the results of the analysis of official statistical information (indicators of morbidity, disability of the population) for the period of 2015–2021. Conclusion. Based on the research materials, we can conclude that the presented characteristics of the incidence of mental disorders and behavioural disorders in the population of Russia, certain negative trends cannot but cause concern, indicating the need for adequate decisions to be made by all levels of the organization and management to provide effective medical care with preventive measures for the adult and child population in Russia.

Characteristics of Primary Morbidity in the Population of the Far Eastern Federal District (Retrospective Analysis)

Background. The peculiarities of the economic and geographical position of the Far Eastern Federal District determine climatic, socio-biological and medical and organizational characteristics that affect the leading criteria for population health. A relevant and priority direction for the development of the macro-region is the study of the main indicators of population health, reflecting the organizational and economic potential of the region, as well as the preservation and promotion of public health based on the formation of a healthy lifestyle and increasing the availability and quality of medical care. Aims — study and analyse the primary morbidity of the adult population in the Far Eastern Federal District. Methods. A retrospective analytical study was carried out. An analysis of the dynamics of primary morbidity by rate of increase (decrease) and a comparative analysis of average annual primary morbidity, including major classes of diseases diagnosed for the first time in life, in the adult population in the macro-region as a whole and in its 11 constituent entities is given. I–IV, VI–XIV, XVII, XIX classes of diseases were taken into account according to the International Classification of Diseases of the 10th revision. Results. The Far Eastern Federal District ranked 5th in descending order by primary morbidity among other Russian macroregions throughout the study period. There was variability in the primary morbidity ranking among the constituent entities of the district. The dynamics of primary morbidity showed a moderate upward trend in 2017, followed by two years of stable trend, and in 2020 there was a moderate downward trend. The prevalence of disease in patients diagnosed for the first time in the population of the other federal districts of the country was characterised by individual variability. At the same time, in most macro-regions a moderate to pronounced decrease in primary morbidity was found in 2020 (rate of increase (decrease) morbidity: from –2.3 to –7.2%), except for the Central Federal District (rate of increase (decrease) morbidity: –0.1%) and the Urals Federal District (rate of increase (decrease) morbidity: –0.2%), where this indicator remained stable. Conclusions. In the Far Eastern Federal District, characteristic variability in the level, dynamics and structure of primary morbidity among the population has been identified. A general pattern with all-Russian indicators was revealed, consisting in a decrease in incidence in most classes of diseases in 2020, except for X Respiratory disease, in which stability remained. The revealed features of the rank distribution of primary morbidity by classes of diseases in the subjects of the district will make it possible to be based on the principle of targeted distribution of funds when planning the volume of medical care to the population.

ASSESSING INFLUENCE EXERTED BY AMBIENT AIR POLLUTION ON PUBLIC HEALTH IN THE RUSSIAN FEDERATION

Background. One of the factors influencing the health of the population, which is the object of one of the federal projects, is atmospheric air. Many studies have established that atmospheric air pollution with chemical impurities can cause the onset of a new or exacerbation of an existing pathology in humans.
 Purpose. Assess the impact of atmospheric air pollution on the health indicators of the population of the Russian Federation.
 Materials and methods. The hygienic assessment of atmospheric air quality was carried out using the data from Rospotrebnadzor form 18 for 2012-2021, data from the federal information fund for social and hygienic monitoring. The analysis of the primary morbidity of the population was carried out using statistical collections "The incidence of the entire population of Russia with a diagnosis established for the first time in life" for 2012-2021. The calculation of additional cases of population diseases associated with atmospheric air quality was performed in accordance with Methodological recommendations 5.1.0095-14.
 Results. For the period 2012-2021 on the territory of the Russian Federation, the share of atmospheric air samples that do not meet hygienic requirements decreased by 1.69 times. Priority substances for which excesses of standards are registered are: benz(a)pyrene, xylene, hydrogen chloride, nickel oxide, ozone, ethenylbenzene, hydrochloride, methanethiol, particulate matter, formaldehyde, etc. Improvement in atmospheric air quality has reduced the number of additional cases of disease from all causes associated with air pollution. The structure of additional morbidity associated with atmospheric air quality is dominated by diseases of the respiratory, digestive, circulatory, and nervous systems. Additional cases of diseases of the population associated with air quality are registered, depending on the class of diseases, in the territories of 22-42 subjects of the Russian Federation.
 Conclusion. The results obtained can be used in the formation of monitoring programs aimed at reducing priority chemical impurities in the atmospheric air and developing programs for the primary prevention of the population from diseases associated with atmospheric air quality.

Обращаемость детей в медицинские организации, как критерий медицинской активности родителей.

An important component of the lifestyle of the population is medical activity, which plays a significant role in maintaining and strengthening the health of not only the adult population, but also children. Purpose of the study: evaluation of the influence of the social characteristics of families in the Chechen Republic on the appeal of children to medical organizations. Materials and methods. The collections “The incidence of the Russian child population (0–14 years old) with a diagnosis established for the first time in life” of the Federal State Budgetary Educational Institution of Central Research Institute of Health and Human Health for 2017–2021 were analyzed. A subjective assessment of children’s referral to medical organizations was carried out on the basis of the results of a survey of 536 parents, which was carried out using the «Questionnaire of the parents of a child under the age of 7 years» in 2021 in 9 districts of the Chechen Republic. Mathematical data processing was carried out using spreadsheets of the MS Office‑2016 software package (Word, Excel) and the StatSoft-Statistica 10.0 statistical software package. Results. Primary morbidity, according to the data on the appealability of the children’s population of the Chechen Republic, is 3.7 times lower than the national average. The number of children in the family, the education of the parents and the financial situation of the family influence the number of children in the family. In families with 5 or more children, parents are less medically active in terms of seeking medical care than in families with 1–2 children and 3–4 children (p<0.05). Families where the mother or father have an incomplete secondary education compared to families where the father or mother has a complete secondary or higher education, including incomplete higher education, parents are significantly more likely to show less medical activity (p<0.01). Families where the funds for the normal material support of the child are not fully enough or not enough at all, more often do not seek medical help or seek medical help only in case of a serious illness of the child, compared with financially secure families (p <0.01). The medical activity of parents is not affected by the age of the parents, family residence in the city or countryside, whether the child is organized or not, and he is also brought up in a family where mothers work or are housewives (p> 0.05). Conclusion. One of the most significant subjective reasons for low attendance to medical organizations in the event of a child’s illness is the low medical activity of parents, which largely depends on the social characteristics of the family. Families with 5 children or more, families where one of the parents has an incomplete secondary education, and families with a low financial situation are more likely to show poor medical care. Scope of the results. Development of organizational measures aimed at improving the quality and availability of medical care in organizations of the children’s healthcare system.

Analysis of Morbidity and Mortality Rates from Malignant Neoplasms of Trachea, Bronchi, Lungs of Professional Genesis in Men aged 40 to 65 Years Old in the Russian Federation

Relevance. MN (malignant neoplasms) of the lungs ranked first in the world in the structure of mortality from all MN among both sexes in 2020. Despite the significant contribution to the development of MN (including MN of the trachea, bronchi, lungs (ICD-10 – C33, С34)) of production factors, their influence is underestimated.Aim. To analyze the morbidity and mortality rates from the trachea, bronchi, lungs MN in men in the age range from 40 to 65 years in 2010–2020.Materials and methods. Data on the number of tracheal, bronchial, and lung MN detected for the first time in life among men in the age range from 40 to 65 years, as well as the number of deaths, were obtained from the Cancer Registry of the P. A. Herzen medical Institutebranch of the Federal state budgetary institution «NMIC of radiology» of the Ministry of health of Russia. The method of descriptive cross-sectional epidemiological study was used. A division was carried out by quartiles of standardized (world standard) indicators of the incidence of tracheal, bronchial, lung MN per 100 thousand male population in the subjects of the Russian Federation in 2020. Statistical processing – MS Office Excel 2019, Statistica 10.Results. Irkutsk, Orenburg, Rostov region, Moscow,federal districts of the Russian Federation were selected for the study (based on the quartile division). Long-term analysis (10-year period) of morbidity and mortality from MN of the trachea, bronchi, lungs in men aged 40 to 65 years in the Federal District, selected subjects and the Russian Federation as a whole, showed a moderately pronounced downward trend. Despite this, the indicators remain at a high level.Conclusion. The influence of harmful production factors on the development of MN is recognized in the Russian Federation in a very small number of cases, and therefore the true incidence rate is higher than the registered one. It is necessary to significantly improve the quality of detection of occupational diseases, as well as to optimize preventive measures aimed at preventing the harmful effects of production factors on the health of workers. Further detailed study of the role of individual factors of harmful industries on the development of tracheal, bronchial and lung diseases is required.

NATIONAL TRENDS IN THE PREVALENCE OF DISEASES AMONG RESIDENTS OF UKRAINE AND KHARKIV REGION

Introduction: the relevance of determining national trends in prevalence of diseases among the adult population in Ukraine is high, as it solves several important medical, social and economic problems of society.
 The aim: to determine national trends in prevalence of diseases among the adult population in Ukraine and Kharkiv region.
 Materials and methods: data from official sources of statistical information of Ukraine (State Institution "Center for Medical Statistics of the Ministry of Health of Ukraine") were used to determine national trends in prevalence of diseases among the adult population in Ukraine and Kharkiv region. A systematic analysis and generalization of the obtained data was performed and trends in prevalence of diseases among the adult population in Ukraine and Kharkiv region.
 Results: a decrease in the prevalence of diseases among the adult population of Ukraine over the 2010-2017 years with trends of -18.3% (general morbidity) and -25.9% (diseases detected for the first time in life) has been determined. Over the 2010-2019 years, the dynamics of reducing the prevalence of diseases and morbidity of adult residents of the Kharkiv region with trends of -12.6% and -23.0% has been established. For 2018-2019, progressive trends in reducing the prevalence of most diseases were noted, except for eating disorders and metabolic disorders (trends of increase, respectively, + 2.2% and + 2.9%) and symptoms, signs and deviations from the norm, which were found in clinical and laboratory studies (trends + 2.8% and + 3.5%) and neoplasms (only in terms of 100 thousand people) — + 0.1%.
 Discussion: the obtained results of the general dynamics of trends in the prevalence of diseases of the population in Ukraine completely coincide with the data of other world studies.
 Conclusions: there was a significant decrease in the spread of prevalence of diseases and morbidity among the mature population of Ukraine and the Kharkiv region.

Clinical features of mental disorders during the pandemic of a new coronavirus infection

Despite progress in the development of treatments and prevention for the new coronavirus infection COVID-19, there is still insufficient data on the impact of the global pandemic on people's mental health, in particular on the nature of mental disorders resulting from both the impact of SARS-CoV-2 on the central nervous system, and the impact of stress factors associated with the pandemic on the mental state, which indicates the relevance of the problem and the need for further research. The article presents data on mental disorders that occur for the first time in life under the influence of restrictive measures, quarantine and other factors caused by the epidemic in the general population. The specificity of the influence of these factors on persons diagnosed with mental illness is also shown. The papers that present the results of studies of mental disorders in patients in the acute period of infection and after recovery are analyzed. The possible consequences of COVID-19 for the mental health of people are considered.

Asymptomatic COVID-19 Infection Induced First Episode Psychosis: A Case Series

Aims: We presented 3 similar cases of 1st episode psychosis that occurred after Corona Virus Disease -2019 (COVID-19) infection which we treated at our institute’s on going post-COVID-19 mental health clinic, to provide more evidence to the existing literature and to describe whether an asymptomatic COVID-19 infection can also induce psychosis in previously healthy individuals and tried to elaborate the probable etiology and nature of the psychotic symptoms.
 Presentation of the Cases: All the 3 cases had COVID-19 infection, few days before their psychotic symptoms started for the 1st time. They didn’t have any history of regular substance or medication use that are known to induce psychosis or any previous history of psychiatric disease or family history of psychiatric disease, without any abnormality in physical examinations and laboratory investigations. All the cases had history of stress which were not overwhelming (except the 3rd case) and were mostly related to COVID-19 infection and pandemic associated social and financial stress. 1st case (54 years, married male) developed delusion of persecution, delusion of reference, 2nd and 3rd person auditory hallucinations, 2nd case (61 years, widower male) developed delusion of persecution, 2nd person auditory hallucination (commanding type), disinhibited behaviour (disrobing in public) and the 3rd case (32 years, unmarried male) developed delusion of persecution and delusional misidentification (Intermetamorphosis). All of them responded well to commonly used antipsychotics within 4 weeks that prompted a diagnosis of Acute and Transient Psychotic disorder according to ICD-10 criteria.
 Discussion: This study points out that even an asymptomatic COVID-19 can induce psychosis for the first time in life, where the etiology most probably is the direct effect of the virus itself on brain or the COVID-19 and pandemic related stress which is supported by the fact that factors like family history of psychiatric disease, substance use or medication use or any comorbidity that can induce psychosis were also absent. The psychopathological findings were persecutory delusion and auditory hallucinations with one case having Intermetamorphosis phenomenon which is a rare finding and perhaps a novel finding in post-COVID-19 Psychosis.
 Conclusion: All COVID-19 infected individuals should be screened early for appearance of any symptom that raises the suspicion of psychosis. Large studies are needed to ascertain the etiology of post-COVID-19 psychosis.

The dynamics of alterations and prognostic models of levels of morbidity of urban and rural population of the subject of the Russian Federation

The article presents data of analytical study of morbidity indices of urban and rural population of the Republic of Tatarstan. The dynamics of population morbidity rate in the Republic of Tatarstan is characterized by steady trend of decreasing of indicator and is described by polynomial trend in both absolute and relative indices. The highest rates of increase in population morbidity were mainly observed until 2010. The maximal periods of decreasing or slowdown of rate increasing were characteristic in 2011-2019. In the structure of population morbidity, the highest percentage fell on diseases of respiratory and circulatory systems, injuries, poisoning and some other consequences of external causes impact that was typical both for the Republic of Tatarstan in whole and its rural territories. In general, morbidity rate of urban population was higher than that of rural population. This difference was statistically significant, but growth rate of number of cases in rural territories outstripped growth rate of number of cases in urban territories and was higher than in the Republic of Tatarstan in whole, but was not statistically significant. The medium-term prognosis of dynamics of population morbidity rate in the Republic of Tatarstan in whole demonstrated that, all other things being equal and taking into account current trends, decrease in number of registered patients with diagnosis established for the first time in life can be expected to 2874.2 thousand of population by 2024 (that is less as compared with 2019 level by 242.4 thousand of population, or by 7.8%) and number of registered patients with diagnosis established for the first time in life to 70217.8 per 100 thousand of population (which is less as compared with 2019 level by 9680.8 per 100 thousand of population, or by 12.1%).

English

Wilson’s disease (WD) is a genetic disorder characterised by mutations in copper metabolism. Adenosine triphosphate (ATPase) ATP7B gene is responsible for disturbance in copper metabolism that leads to accumulation of copper mainly in liver and also in extra hepatic organs (like brain, cornea, heart and kidney).1 Heavy metal accumulation in brain (mainly in basal ganglia) leads to neuropsychiatric manifestations.2 Kayser Fleischer (KF) ring is golden brown ring distributed along the periphery of cornea. It is due to abnormal deposition of copper in the Descemet’s membrane of cornea. Kayser Fleischer (KF) ring is a pathognomonic sign of Wilson’s disease. Fulminant hepatic failure can be the first presentation of WD. Patients presenting with fulminant Wilson’s disease (FWD) clinically present as acute liver failure with encephalopathy and coagulopathy. The mortality of patients is high and orthotropic liver transplantation is the only option, which has been shown effective in patients with Fulminant Wilson’s disease.3 We are report a case of a young male who presented as acute liver failure first time in life and later was diagnosed as FWD.

Доказательная политика как научное обоснование экологических программ в России

The article discusses the socio-economic effects of Russia’s state programs in the sphere of natural resources management, in particular those effects that, in our view, are not given enough attention within the framework of the national project ‘Ecology’. This shortcoming of the state programs can be overcome if policy-makers adopt an evidence-based approach. To this end, we propose an adjustable and flexible set of indicators of state programs. The analysis relies on the model of panel data that uses Rosstat data for Russian regions between 2017 and 2018. According to the modeling results, environmental factors have a significant influence on morbidity. An increase in emissions of pollutants into the atmosphere from stationary sources per unit (ton per capita) causes an increase in morbidity per 1,000 people (registered diseases in patients with a diagnosis established for the first time in life). Similarly, a 1 % increase in the share of industrial production in GRP causes an increase in morbidity by 3 units. Significant differences between regions of Russia were also detected. For example, in the Central Federal District, other things being equal, the incidence rate is lower by 52 units than other regions of Russia; in the North Caucasian Federal District, by 135 units, and in the Southern Federal District, by 109 units. In the North-Western Federal District, on the contrary, the incidence rate is higher by 113 units.

Analysis of cardiovascular morbidity in the pediatric population of the city of Voronezh

Aim: To perform a territorial comparison of the incidence rates of certain cardiovascular diseases (CVD) in the pediatric population of the city ofVoronezh.Material and Methods. The morbidity rates in the pediatric population over certain inner-city zones were assessed using a differentiated approach. This tactic was chosen taking into account historical background as a high percentage of the population (75.8% of the total population in the city district of Voronezh) was registered at particular clinics based on a territorial logic. Of these, 11 pediatric clinics in Voronezh provided care for over 160,000 children under the age of 14 years (about 79% of children residing in the city district of Voronezh) on a territorial basis. The ranking of indicators was performed using a specially designed software developed at the Voronezh State Medical University named after N.N. Burdenko. The territories at risk were identified based on the results of this analysis by the level and dynamics of morbidity in the pediatric population. Results. Cardiovascular diseases were below the top five leading disease classes and were ranked 8–9 in children in the context of overall morbidity structure in the city ofVoronezh. The study showed that the incidence of cardiovascular diseases increased in the adult population of Voronezh relative to the value for the same period analyzed last year: the growth rate in the number of medical care encounters was 14.65% with 14.05% of diagnoses established for the first time in life. The average long-term level of cardiovascular mortality in theVoronezh city district was 24.79 ± 1.40 cases per 1,000 children under 14 years of age.Conclusion. The differences, found in the morbidity rates from the individual intra-city territories provided with pediatric polyclinics, can be explained by the various factors such as the age structure of the population residing in a particular region and human resources of a medical organization including the availability of a pediatric cardiologist. Knowledge of information regarding pediatric disease incidence in certain inner-city territories allowed us to rationally optimize the resources of the urban health system to improve the availability and quality of medical care to the population, particularly the young segments, suffering from cardiovascular diseases at the pre-hospital stage.

Difficulties in primary diagnosis of HIV infection at the stages of health care settings

Aim: to demonstrate the difficulties and timeliness of HIV diagnosis by primary care physicians, to carry out a clinical and epidemiological analysis of newly diagnosed cases of HIV infection.
 Materials and methods: The study evaluated the routing of diagnosis and analyzed the epidemiological and clinical and laboratory data of 85 patients with a newly diagnosed HIV infection hospitalized in the St. Petersburg Clinical Infectious Diseases Hospital named after S. P. Botkin during the period from November 2018 to October 2019. To confirm positive results, ELISA and western blot were used.
 Results: Among the observed patients, 71.3% were women and 28.7% were men. The average age was 39.3 2 years. Upon admission to the infectious diseases hospital with an established diagnosis of HIV infection, 49.5% were hospitalized in specialized departments (n = 42). Of them, nine (9) were referred by the polyclinic with an established diagnosis, in 20 patients the diagnosis was established in somatic hospitals, and emergency room doctors newly diagnosed HIV infection in 13 more patients. The remaining 50.5% (n = 43) were hospitalized in various departments with other diagnoses. Clinical and laboratory analysis of these patients showed that for the first time in life, an established diagnosis of HIV infection corresponded to both early (15.3%) and late (84.7%) stages of the disease with dominance of sexual transmission of the virus (43.6%).
 Conclusion: HIV infection at both early and late stages can manifest under the guise of various other diseases, which makes it necessary to expand testing of patients for HIV infection, including using rapid tests.

Prefrontal Neural Ensembles Develop Selective Code for Stimulus Associations within Minutes of Novel Experiences.

Prevailing theories posit that the hippocampus rapidly learns stimulus conjunctions during novel experiences, whereas the neocortex learns slowly through subsequent, off-line interaction with the hippocampus. Parallel evidence, however, shows that the medial prefrontal cortex (mPFC; a critical node of the neocortical network supporting long-term memory storage) undergoes rapid modifications of gene expression, synaptic structure, and physiology at the time of encoding. These observations, along with impaired learning with disrupted mPFC, suggest that mPFC neurons may exhibit rapid neural plasticity during novel experiences; however, direct empirical evidence is lacking. We extracellularly recorded action potentials of cells in the prelimbic region of the mPFC, while male rats received a sequence of stimulus presentations for the first time in life. Moment-to-moment tracking of neural ensemble firing patterns revealed that the prelimbic network activity exhibited an abrupt transition within 1 min after the first encounter of an aversive but not neutral stimulus. This network-level change was driven by ∼15% of neurons that immediately elevated their spontaneous firing rates (FRs) and developed firing responses to a neutral stimulus preceding the aversive stimulus within a few instances of their pairings. When a new sensory stimulus was paired with the same aversive stimulus, about half of these neurons generalized firing responses to the new stimulus association. Thus, prelimbic neurons are capable of rapidly forming ensemble codes for novel stimulus associations within minutes. This circuit property may enable the mPFC to rapidly detect and selectively encode the central content of novel experiences.SIGNIFICANCE STATEMENT During a new experience, a region of the brain, called the hippocampus, rapidly forms its memory and later instructs another region, called the neocortex, that stores its content. Consistent with this dominant view, cells in the neocortex gradually strengthen the selectivity for the memory content over weeks after novel experiences. However, we still do not know precisely when these cells begin to develop the selectivity. We found that neocortical cells were capable of forming the selectivity for ongoing events within a few minutes of new experiences. This finding provides support for an alternative view that the neocortex works with, but not follows, the hippocampus to form new memories.

POSSIBILITIES OF DETECTION OF ATRIAL FIBRILLATION BY REMOTE ELECTROCARDIOGRAPHIC METHODS IN CONDITIONS OF PRELIMINARY HEALTH CARE

Atrial Fibrillation is a complex and dangerous disease. Methods of remote electrocardiography for examination of patients were used in outpatient units with different territorial remoteness of two medical institutions. ECG records on the Internet were sent to the cloud storage, where it was sent to the personal office of the doctor of functional diagnostics to control the automatic conclusion of the devices. Medical ECG reports were returned to the device to the doctor/paramedic for future work with the patient. Atrial Fibrillation was detected in 137 patients: in 40 cases (29,1 %) for the first time in life. A high risk of brain complications (2 or more points) was installed in 114 people (83,2 %) according to the CHA2DS2-VASc. The standard of treatment was not met by all patients. Electrocardiography with remote transmission revealed arrhythmia at the level of the doctor «first contact». Electrocardiography with remote transmission showed arrhythmia at the level of the doctor «first contact».

ДИНАМИКА ЗАБОЛЕВАЕМОСТИ И ЕЁ ХРОНИЗАЦИИ У ДЕВУШЕК В РОССИЙСКОЙ ФЕДЕРАЦИИ

The health condition of the Russian Federation children, including adolescents, has been characterized by negative trends in the past thirty years. The aim of the study is to identify the main trends in the total and for the first time in the life registered incidence in girls 15-17 years old in the Russian Federation, as well as to track the quantity and dynamics of the indicator of chronicity of diseases. The data of form N12 of the federal statistical observation for the period 2000-2017 are analyzed, using the method of descriptive statistics. A significant increase was revealed both in the total incidence of girls (by 56.9%) and for the first time in the life registered incidence (by 63.0%). The maximum increase in total incidence is observed for the most classes of diseases, for example: neoplasms (2.4 times), injuries, poisoning and some other consequences of external causes (2.4 times), congenital anomalies (malformations) (2.3 times), cardiovascular system diseases (2 times), diseases of the musculoskeletal system and connective tissue (2 times). The growth for the first time in life registered incidence was revealed for the overwhelming majority of classes of diseases, for example: injuries, poisoning and some other consequences of exposure to external causes (2.5 times), diseases of the nervous system (2.2 times), cardiovascular system diseases (2 times), neoplasms (2 times), diseases of the ear and mastoid process (2 times), diseases of the musculoskeletal system and connective tissue (1.9 times). High figures of the chronicity index aggregative for all classes of diseases reflect the initially high level of chronic pathology in girls 15-17 years old, what is an unfavorable characteristic of their health condition. An analysis of the chronization index of the diseases among girls aged 15–17 years over the study period revealed its maximum growth for classes of congenital anomalies (malformations) (by 31.1%) and tumors (for 23.0%), and for certain nosologies: menstrual disorders (5.8 times) and renal failure (4.2 times). The health of children, and especially adolescents, determines the health of the nation in the nearest future; therefore, the issues of its preservation and improvement require thorough attention.

Об отражении в уголовном законе факта совершения преступления впервые в юридическом значении в отношении отдельных категорий преступлений

According to the results of a comprehensive study of the problem, it was found that domestic criminal legislation reflects the fact of committing a crime for the first time, traditionally in a legal, and not factual (committing a crime for the first time in life) understanding: such legislative practice always has a preferential criminal law value and is carried out in various ways: in relation to specific crimes or their separate elements, in relation to certain categories of crimes. When assessing the legislative practice of using the concept of a person who first committed a crime in the legal (criminal-legal) sense for the prospect of its improvement and further development, it is noted that the “cross-cutting” meaning of this concept for the entire Criminal Code of the Russian Federation in 1996 was not defined in any norm of this Criminal Code. It has been suggested that for this reason the Plenum of the Supreme Court of the Russian Federation did not give an interpretation of this concept “for all occasions”: to date, no explanation has been given of the criminal-legal meaning of the concept of a person who first committed a crime in the cases provided for in Part 1 Article 531, part 1 of Article 56, paragraph “a”, Part 1 of Article 61 of the Criminal Code of the Russian Federation. It was revealed that such clarifications are expected by the law enforcement officer because the existing interpretations in relation to other norms are of a “thematic” nature and differ in their content. The advantages and disadvantages of the last form of reflecting this circumstance in the Criminal Code of the Russian Federation of 1996 are named. Based on the analysis of the practice of applying criminal legislation, attention is drawn to the need for its improvement in this direction with specific proposals.

Spread of socially significant diseases and control of them in Russia

On the data from Rosstat the article presents dynamics in the incidence of socially significant diseases, the list of which is specified in the RF Government Decree No. 715 of I December 2004. The List includes the following diseases: disease caused by HIV, tuberculosis, viral hepatitis B and C, sexually transmitted diseases, diabetes mellitus, malignant neoplasms, mental and behavioral disorders, hypertensive disease — 9 diseases in total. In 2007 there was adopted Federal targeted program “Prevention and control of socially significant diseases (2007–2012)”. In subsequent years similar programs were adopted and implemented by regional authorities. As a result, primary incidence in Russia declined in 2018 as compared to 2005: in active tuberculosis by 1.9 times, in syphilis — by 4 times. The number of patients taken under observation with diagnosis established for the first time in life, also declined: in mental disorders by 1.4 times, in alcoholism by 2.8 times, and in drug addiction by 1.7 times. And within these 13 years was registered an increase of primary incidence in non-communicable diseases: in hypertension by 1.9 times, diabetes mellitus by 1.4 times, malignant neoplasms by 1.2 times, and in infectious disease caused by HIV by 2.5 times. There were identified the causes of these differently directed dynamics. Regional differences in the incidence of socially significant diseases were examined by the number of patients being on the books in medical establishments. There were identified 10 RF subjects with the highest and 10 subjects with the lowest number of patients in 2018.

ДИНАМИКА ЗАБОЛЕВАЕМОСТИ И ХРОНИЗАЦИИ ПАТОЛОГИИ У ДЕТЕЙ В РОССИЙСКОЙ ФЕДЕРАЦИИ

The health condition of the Russian Federation children has been characterized by negative trends in the past thirty years. The aim of the study is to identify the main trends in the total and for the first time in the life registered incidence in children 0–14 years old in the Russian Federation, as well as to monitor the quantity and dynamics of the indicator of chronicity of diseases. The data of form N12 of the federal statistical observation for the period 2000–2018 are analyzed, using the method of descriptive statistics. A significant increase was revealed both in the total incidence of girls (by 19.0%) and for the first time in the life registered incidence (by 19.3%). The maximum increase in total incidence is observed for the following classes of diseases: neoplasms (2.3 times), congenital anomalies (malformations) (1.8 times), diseases of nervous system (1.5 times), diseases of the musculoskeletal system and connective tissue (1.4 times). The growth for the first time in life registered incidence was revealed for the following classes: neoplasms (2 times), congenital anomalies (malformations) (1.6 times), diseases of the respiratory system (1.3 times). High figures of the chronicity index aggregative for all classes of diseases (1.262 in 2000 year and 1.259 in 2018 year) reflect the high level of chronic pathology in children 0–14 years old, what is an unfavorable characteristic of their health condition. An analysis of the chronization index of the diseases revealed its maximum growth for: asthma, asthmatic status (71.1%), allergic rhinitis 
 (hay fever) (43.0%), diseases characterized by high blood pressure (41.9%), urolithiasis (30.9%). The greatest decrease in the chronicity index was revealed by the following nosologies: cerebral palsy (19.8%), chronic and unspecified bronchitis, emphysema (18.7%), gallbladder and biliary tract disease (16.2%), and blood coagulation disorders (12.6%). The health of children determines the health of the nation in the nearest future; therefore, the issues of its preservation and 
 improvement require thorough attention.

STATE AND IMPROVEMENT OF SANITARY AND EPIDEMIOLOGICAL WELFARE MANAGEMENT IN THE RUSSIAN ARCTIC

High morbidity, premature mortality and environmental pollution in the Arctic Zone of the Russian Federation (AZRF) require improved management of sanitary and epidemiological wellfare. The aim of the study is to conduct a review of the state of the environment and public health, as well as propose solutions on the management improvement of sanitary and epidemiological welfare on the territory of the Russian Arctic. Methods. The materials of socio-hygienic monitoring form No. 2 "Information on infectious and parasitic diseases" and summary databases of records of occupational diseases (poisoning) for 2007-2018 were analyzed in the context of municipalities of the Russian Arctic. The risk of health disorders caused by contamination of drinking water and atmospheric air was assessed in accordance with R 2.1.10.1920-04 (Guidelines for assessing public health risk from exposure to chemicals polluting the environment). Results. In some Arctic regions, there are problems associated with a migration outflow (Vorkuta) and high mortality of the working population, high infant mortality and low life expectancy (Chukotka Autonomous Region). The population of the Russian Arctic in the main classes of diagnosed diseases for the first time in life is higher than at the average for Russia, the Nenets Autonomous Okrug is the territory of "risk" morbidity. In contrast to Russia as a whole, an increase in the incidence of occupational diseases is reported on the territory of the Russian Arctic. Conclusions. In a number of regions of the Russian Arctic, the population is exposed to unacceptable risks of health problems associated with air pollution and drinking water. According to the results of the study, we propose some priority measures to improve the management of sanitary and epidemiological well-being in the Russian Arctic.