Morbidity Indicators Research Articles

Влияние заболеваемости женщин в период беременности, родов и послеродовой период на показатели использования коечного фонда отделений патологии беременности.

P u r p o s e : assessment of the impact of morbidity in women during pregnancy, childbirth and the postpartum period on the utilization of bed capacity in pregnancy pathology departments. Materials and methods. Based on official statistics, a comparative statistical analysis of the incidence rates of women of fertile age with the XV class of diseases ICD‑10 «Pregnancy, childbirth and the postpartum period» and indicators of the use of bed capacity in pregnancy pathology departments of St. Petersburg with indicators for the Russian Federation and the Northwestern Federal District in dynamics for 2017 was carried out. 2022. To assess the relationship between indicators, the nonparametric Spearman rank correlation method was used. Statistical data processing was carried out using the MS Office‑2016 and StatSoft-Statistica 10.0 software packages. Results. In 2017–2022, there were significant differences in the level and dynamics of the incidence of class XV diseases in women of fertile age in the metropolis and from the indicators for the Russian Federation and the Northwestern Federal District. With multidirectional dynamics of these indicators, almost the entire study period, the incidence rate of women in St. Petersburg was lower than the national and district averages, and over six years the incidence rate decreased by 30.8%. The work of pregnancy pathology beds, the average length of stay of patients on them in the metropolis were higher than the Russian and regional averages, and the turnover of beds was higher. It was revealed that in Russia and the Northwestern Federal District, the morbidity of pregnant women, women in labor and postpartum had virtually no effect on the average occupancy of a pregnancy pathology bed per year and its average downtime, and in the metropolis, with a decrease in morbidity rates, bed occupancy moderately decreased and its downtime increased. At the same time, the impact of the incidence of class XV diseases in women on the average length of stay of patients in pregnancy pathology beds in the country as a whole and in the Northwestern Federal District was more significant than in the metropolis. At the same time, the impact of morbidity among pregnant women, women in labor and postpartum in the city on the turnover of beds in this profile was less significant than on the indicators in the federal district. It was found that the decrease in morbidity had a moderately pronounced effect on reducing the length of stay of women in the city’s pregnancy pathology departments and increasing the turnover of beds. Conclusion. There are differences in the level and dynamics of morbidity indicators for pregnant women, parturients and postpartum women and indicators of the use of obstetric beds for the pathology of pregnancy in the metropolis from these indicators in Russia and the Northwestern Federal District. The incidence of women during this period has a moderate impact on the average bed occupancy per year, the average length of stay on a bed, bed turnover and the average bed idle time. The impact of a decrease in morbidity on the use of pregnancy pathology beds in the metropolis differed from Russia and the Northwestern Federal District, which was expressed in the strength and significance of the connection.

Профілактика ускладнень перебігу вагітності та пологів у жінок із лейоміомою матки

Purpose - to evaluate the clinical effectiveness of the proposed preventive and therapeutic complex using modern drugs and organ-preserving methods of surgical treatment in pregnant women with uterine leiomyoma FIGO (International Federation of Gynecology and Obstetrics) type 3-6. Materials and methods. This prospective study was conducted with a comprehensive examination, selection of optimal tactics for pregnancy management and delivery in 70 pregnant women with uterine leiomyoma using the complex developed by us (main group), 41 pregnant women with uterine leiomyoma with standard pregnancy management (comparison group) and 50 pregnant women without uterine leiomyomas in the II-III trimesters of pregnancy and after childbirth at 4 clinical bases of the Department of Obstetrics and Gynecology No. 1 of the Shupyk National Healthcare University of Ukraine for 3 years - 2020-2023. Results. 70 pregnant women of the main group, who used the treatment and prevention complex developed by us, had significantly lower rates of iron deficiency anemia, the frequency of the threat of premature birth, fetal distress, and hypotonic labor compared to the comparison group and approached the rates of the control group (p<0.05). A 1.8-fold decrease in the risk of premature birth among women in the main group was also noted, as well as a 1.3-fold decrease in the cesarean section rate. PPH volume during vaginal delivery and cesarean section in the main group was significantly lower compared to the comparison group (p<0.01) and had no statistical difference with the control group (p>0.05). Conclusions. Pregnant women with uterine leiomyoma have an increased risk of iron-deficiency anemia, the threat of premature birth, weakness in labor, fetal distress, cesarean section, and PPH development. The treatment and prevention complex proposed by us and the optimal technique for performing cesarean sections allowed not only to reduce the frequency of complications during pregnancy and childbirth, but also to reduce the rate of PPH and reduce the indicators of maternal morbidity. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

COVID-19 surveillance in fragile health systems, armed conflict and humanitarian crisis, the case of Yemen

ABSTRACT Background Yemen is a poor country facing armed conflict which significantly disrupted the Health System. Yemen reported fewer COVID-19 cases than neighbouring countries, yet the case fatality rate (19.6%) remained five times the global average. Conflict typically hinders surveillance, however obtaining representative mortality and morbidity indicators remains essential to efficacious epidemic planning. We aimed to explore challenges hindering COVID-19 surveillance in Yemen and opportunities for addressing them, to increase surveillance effectiveness in such conflict and resource-constraint settings. Methods Qualitative study question guide was used for in-depth interviewswith 30 healthcare workers who worked in Yemen’s surveillance system during the pandemic. Participants were recruited through in-country gatekeepers using a ‘snowball’ sampling technique. Thematic framework analysiswas used. Findings A basic level of preparedness existed following responses to previous epidemics, including activating Rapid Response Teams (RRTs), and electronic disease surveillance. Key challenges included the ongoing conflict, an unstable health system, minimal infrastructure restorations, misinformation, community incompliance, and inadequate laboratory diagnostics or transportation capabilities. Participants recommended addressing these barriers through strengthening RRTs, transportation and laboratory testing capacities, implementing community awareness campaigns, alongside improving primary health care services and inter-governorate governance. Conclusion Active community surveillance by RRTs supplemented with community volunteers is imperative and necessary nationwide. National community awareness campaigns on case detection, reporting, and addressing misinformation are essential to implementing such community surveillance. Increased utilization of mobile laboratories could enhance laboratory testing capacity in underserved areas. For each recommendation to be effectively implemented, the international community must provide sufficient resources and financial aid.

The clinical significance of hypoalbuminaemia

Albumin is a relatively small molecule with a radius of 7.5nm and a molecular weight of 65kDa. It is the most abundant protein in plasma, accounting for 60-75% of its oncotic pressure. Its concentration in plasma is merely one static measurement reflecting a dynamic and complex system of albumin physiology, and is the net result of several different processes, one or more of which may become deranged by disease or its treatment. It is also unsurprising that hypoalbuminaemia has proved to be an indicator of morbidity and mortality risk since the underlying conditions which cause it, including protein energy malnutrition, crystalloid overload, inflammation, and liver dysfunction are themselves risk factors. In some cases, its underlying cause may require treatment but mostly it is just a parameter to be monitored and used as one measure of clinical progress or deterioration. While malnutrition, associated with a low protein intake, may be a contributory cause of hypoalbuminaemia, in the absence of inflammation and/or dilution with crystalloid its development in response to malnutrition alone is slow compared with the rapid change caused by inflammatory redistribution or dilution with crystalloids. Other significant causes include liver dysfunction and serous losses. These causal factors may occur singly or in combination in any particular case. Treatment is that of the underlying causes and associated conditions such as a low plasma volume, not of hypoalbuminaemia per se.

Maternal vaccination against COVID-19 and neonatal outcomes during Omicron: INTERCOVID-2022 study

In early 2023, when Omicron was the variant of concern, we showed that vaccinating pregnant women decreased the risk for severe COVID-19-related complications and maternal morbidity and mortality. This study aimed to analyze the impact of COVID-19 during pregnancy on newborns and the effects of maternal COVID-19 vaccination on neonatal outcomes when Omicron was the variant of concern. INTERCOVID-2022 was a large, prospective, observational study, conducted in 40 hospitals across 18 countries, from November 27, 2021 (the day after the World Health Organization declared Omicron the variant of concern) to June 30, 2022, to assess the effect of COVID-19 in pregnancy on maternal and neonatal outcomes and to assess vaccine effectiveness. Women diagnosed with laboratory-confirmed COVID-19 during pregnancy were compared with 2 nondiagnosed, unmatched women recruited concomitantly and consecutively during pregnancy or at delivery. Mother-newborn dyads were followed until hospital discharge. The primary outcomes were a neonatal positive test for COVID-19, severe neonatal morbidity index, severe perinatal morbidity and mortality index, preterm birth, neonatal death, referral to neonatal intensive care unit, and diseases during the neonatal period. Vaccine effectiveness was estimated with adjustment for maternal risk profile. We enrolled 4707 neonates born to 1577 (33.5%) mothers diagnosed with COVID-19 and 3130 (66.5%) nondiagnosed mothers. Among the diagnosed mothers, 642 (40.7%) were not vaccinated, 147 (9.3%) were partially vaccinated, 551 (34.9%) were completely vaccinated, and 237 (15.0%) also had a booster vaccine. Neonates of booster-vaccinated mothers had less than half (relative risk, 0.46; 95% confidence interval, 0.23-0.91) the risk of being diagnosed with COVID-19 when compared with those of unvaccinated mothers; they also had the lowest rates of preterm birth, medically indicated preterm birth, respiratory distress syndrome, and number of days in the neonatal intensive care unit. Newborns of unvaccinated mothers had double the risk for neonatal death (relative risk, 2.06; 95% confidence interval, 1.06-4.00) when compared with those of nondiagnosed mothers. Vaccination was not associated with any congenital malformations. Although all vaccines provided protection against neonatal test positivity, newborns of booster-vaccinated mothers had the highest vaccine effectiveness (64%; 95% confidence interval, 10%-86%). Vaccine effectiveness was not as high for messenger RNA vaccines only. Vaccine effectiveness against moderate or severe neonatal outcomes was much lower, namely 13% in the booster-vaccinated group (all vaccines) and 25% and 28% in the completely and booster-vaccinated groups, respectively (messenger RNA vaccines only). Vaccines were fairly effective in protecting neonates when given to pregnant women ≤100 days (14 weeks) before birth; thereafter, the risk increased and was much higher after 200 days (29 weeks). Finally, none of the neonatal practices studied, including skin-to-skin contact and direct breastfeeding, increased the risk for infecting newborns. When Omicron was the variant of concern, newborns of unvaccinated mothers had an increased risk for neonatal death. Neonates of vaccinated mothers had a decreased risk for preterm birth and adverse neonatal outcomes. Because the protective effect of COVID-19 vaccination decreases with time, to ensure that newborns are maximally protected against COVID-19, mothers should receive a vaccine or booster dose no more than 14 weeks before the expected date of delivery.

Blood pressure fragmentation as a new measure of blood pressure variability: association with predictors of cardiac surgery outcomes.

Background: Fluctuations in beat-to-beat blood pressure variability (BPV) encode untapped information of clinical utility. A need exists for developing new methods to quantify the dynamical properties of these fluctuations beyond their mean and variance. Objectives: Introduction of a new beat-to-beat BPV measure, termed blood pressure fragmentation (BPF), and testing of whether increased preoperative BPF is associated with (i) older age; (ii) higher cardiac surgical risk, assessed using the Society of Thoracic Surgeons' (STS) Risk of Morbidity and Mortality index and the European System for Cardiac Operative Risk Evaluation Score (EuroSCORE II); and (iii) longer ICU length of stay (LOS) following cardiac surgery. The secondary objective was to use standard BPV measures, specifically, mean, SD, coefficient of variation (CV), average real variability (ARV), as well a short-term scaling index, the detrended fluctuation analysis (DFA) ⍺1 exponent, in the same type of analyses to compare the results with those obtained using BPF. Methods: Consecutive sample of 497 adult patients (72% male; age, median [inter-quartile range]: 67 [59-75] years) undergoing cardiac surgery with cardiopulmonary bypass. Fragmentation, standard BPV and DFA ⍺1 measures were derived from preoperative systolic blood pressure (SBP) time series obtained from radial artery recordings. Results: Increased preoperative systolic BPF was associated with older age, higher STS Risk of Morbidity and Mortality and EuroSCORE II values, and longer ICU LOS in all models. Specifically, a one-SD increase in systolic BPF (9%) was associated with a 26% (13%-40%) higher likelihood of longer ICU LOS (>2 days). Among the other measures, only ARV and DFA ⍺1 tended to be associated with longer ICU LOS. However, the associations did not reach significance in the most adjusted models. Conclusion: Preoperative BPF was significantly associated with preoperative predictors of cardiac surgical outcomes as well as with ICU LOS. Our findings encourage future studies of preoperative BPF for assessment of health status and risk stratification of surgical and non-surgical patients.

Assessment of GCS and FOUR Score as Prognostic Indicators for Hospital Stay and Morbidity in Traumatic Brain Injury Patients: An Observational Study

ABSTRACT Aim: The objective of the present research was to evaluate variations in hospital stay as well as morbidity based on the Glasgow Coma Scale (GCS) and Full Outline of Un-Responsive (FOUR) scores for patients who had traumatic brain injury (TBI). Materials and Methods: A total of 107 patients with TBI patients who attended the emergency department of MES Medical College, Perinthalmanna, were enrolled into the study. FOUR and GCS scoring systems were used to assess the patients within 24 hours of the presentation to the emergency department. Both FOUR and GCS scoring systems were assessed at the same time. The outcome was measured in terms of length of hospital stay and morbidity, which was assessed using modified Rankin score. Chi-square test was used to calculate sensitivity, specificity, positive predictive value, and negative predictive value. The area under the curve (AUC) was calculated using receiver operating characteristic curve analysis. A P value <0.05 was considered significant. Results: We found a strong positive correlation between GCS and FOUR score with a Spearman coefficient of 0.9. Comparison of AUC between GCS score and FOUR score showed a statistically significant difference (P = 0.0044), predicting that FOUR score was a better predictor of hospital stay (>15 days) than GCS score. Comparison of AUC between GCS score and FOUR score showed a significant statistical difference (P = 0.0002), showing that FOUR score was a better predictor of morbidity than GCS. Conclusion: FOUR score was a better predictor of hospital stay and morbidity as compared to GCS score.

IDENTIFICATION OF FACTORS INFLUENCING BIRTH WEIGHT, LENGTH, AND HEAD CIRCUMFERENCE

Newborn size at birth is an important indicator of fetal health, neonatal health, infant survival and childhood morbidity. The aim of our study was to assess and identify factors that significantly influence birth weight, length, and head circumference by performing a post hoc analysis of the data collected during the retrospective-prospective observational cohort study which was conducted at the Clinic for Gynecology and Obstetrics at the University Clinical Centre Kragujevac, Serbia. The influence of potential factors on birth weight, length, and head circumference was evaluated by multiple linear regression analysis. The study included 320 pregnant women and 332 newborns. Four factors had a significant negative effect on birth weight: smoking, twin pregnancy, use of methyldopa and corticosteroids during pregnancy. Smoking, twin pregnancy and corticosteroid use also had a significant negative effect on birth length. Negative effect on fetal head circumference at birth had smoking, use of corticosteroids and antibiotics during pregnancy. Maternal height and gestational age at birth showed a positive influence on fetal anthropometric measurements. Clinicians should pay attention to pregnant women with lower body height, twin pregnancy, who smoke and use corticosteroids, methyldopa and antibiotics.

Trends and Disparities in Severe Maternal Morbidity Indicator Categories during Childbirth Hospitalization in California from 1997 to 2017.

Severe maternal morbidity (SMM) is increasing and characterized by substantial racial and ethnic disparities. Analyzing trends and disparities across time by etiologic or organ system groups instead of an aggregated index may inform specific, actionable pathways to equitable care. We explored trends and racial and ethnic disparities in seven SMM categories at childbirth hospitalization. We analyzed California birth cohort data on all live and stillbirths ≥ 20 weeks' gestation from 1997 to 2017 (n = 10,580,096) using the Centers for Disease Control and Prevention's SMM index. Cases were categorized into seven nonmutually exclusive indicator categories (cardiac, renal, respiratory, hemorrhage, sepsis, other obstetric, and other medical SMM). We compared prevalence and trends in SMM indicator categories overall and by racial and ethnic group using logistic and linear regression. SMM occurred in 1.16% of births and nontransfusion SMM in 0.54%. Hemorrhage SMM occurred most frequently (27 per 10,000 births), followed by other obstetric (11), respiratory (7), and sepsis, cardiac, and renal SMM (5). Hemorrhage, renal, respiratory, and sepsis SMM increased over time for all racial and ethnic groups. The largest disparities were for Black individuals, including over 3-fold increased odds of other medical SMM. Renal and sepsis morbidity had the largest relative increases over time (717 and 544%). Sepsis and hemorrhage SMM had the largest absolute changes over time (17 per 10,000 increase). Disparities increased over time for respiratory SMM among Black, U.S.-born Hispanic, and non-U.S.-born Hispanic individuals and for sepsis SMM among Asian or Pacific Islander individuals. Disparities decreased over time for sepsis SMM among Black individuals yet remained substantial. Our research further supports the critical need to address SMM and disparities as a significant public health priority in the United States and suggests that examining SMM subgroups may reveal helpful nuance for understanding trends, disparities, and potential needs for intervention. · By SMM subgroup, trends and racial and ethnic disparities varied yet Black individuals consistently had highest rates.. · Hemorrhage, renal, respiratory, and sepsis SMM significantly increased over time.. · Disparities increased for respiratory SMM among Black, U.S.-born Hispanic and non-U.S.-born Hispanic individuals and for sepsis SMM among Asian or Pacific Islander individuals..

Continuity of Radiologists Between Diagnostic Breast Imaging and Image-Guided Breast Biopsy: Impact on Patient-Reported Biopsy Morbidity Experiences.

To determine whether continuity of care between diagnostic breast imaging and subsequent image-guided breast biopsy could reduce patient-reported biopsy-related morbidity. This was a prospective, pragmatically randomized, 2-arm health utilities analysis of 200 women undergoing diagnostic breast imaging followed by US- or stereotactic-guided breast biopsy at a single quaternary care center from September 3, 2019, to April 10, 2023. Breast biopsy-naive women with a BI-RADS 4 or 5 finding at diagnostic imaging were randomly scheduled for the typically first available biopsy appointment. One day after biopsy, enrolled patients were administered the Testing Morbidities Index (TMI). The primary outcome was the difference in TMI summary utility scores in patients who did vs did not have the same radiologist perform diagnostic imaging and biopsy. Response rates were 63% (100/159) for the different radiologist cohort and 71% (100/140) for the same radiologist cohort; all respondents answered all questions in both arms. Mean time to biopsy was 7 ± 6 days and 10 ± 9 days, and the number of participating radiologists was 11 and 18, respectively. There was no difference in individual measured domains (pain, fear, or anxiety before procedure; pain, embarrassment, fear, or anxiety during procedure; mental or physical impact after procedure; all P >.00625) or in overall patient morbidity (0.83 [95% CI, 0.81-0.85] vs 0.82 [95% CI: 0.80-0.84], P = .66). Continuity of care between diagnostic breast imaging and image-guided breast biopsy did not affect morbidity associated with breast biopsy, suggesting that patients should be scheduled for the soonest available biopsy appointment rather than waiting for the same radiologist.

Registry-derived stage (RD-Stage) for capturing stage at diagnosis for pancreatic carcinoma in Australia.

Stage of pancreatic carcinoma at diagnosis is a strong prognostic indicator of morbidity and mortality, yet is poorly notified to population-based cancer registries ("cancer registries"). Registry-derived stage (RD-Stage) provides a method for cancer registries to use available data sources to compile and record stage in a consistent way. This project describes the development and validation of rules to capture RD-Stage (pancreatic carcinoma) and applies the rules to data currently captured in each Australian cancer registry. Rules for deriving RD-stage (pancreatic carcinoma) were developed using the American Joint Commission on Cancer (AJCC) Staging Manual 8th edition and endorsed by an Expert Working Group comprising specialists responsible for delivering care to patients diagnosed with pancreatic carcinoma, cancer registry epidemiologists and medical coders. Completeness of data fields required to calculate RD-Stage (pancreatic carcinoma) and an overall proportion of cases for whom RD stage could be assigned was assessed using data collected by each Australian cancer registry, for period 2018-2019. A validation study compared RD-Stage (pancreatic carcinoma) calculated by the Victorian Cancer Registry with clinical stage captured by the Upper Gastro-intestinal Cancer Registry (UGICR). RD-Stage (pancreatic carcinoma) could not be calculated in 4/8 (50%) of cancer registries; one did not collect the required data elements while three used a staging system not compatible with RD-Stage requirements. Of the four cancer registries able to calculate RD-Stage, baseline completeness ranged from 9% to 76%. Validation of RD-Stage (pancreatic carcinoma) with UGICR data indicated that there was insufficient data available in VCR to stage 174/457 (38%) cases and that stage was unknown in 189/457 (41%) cases in the UGICR. Yet, where it could be derived, there was very good concordance at stage level (I, II, III, IV) between the two datasets. (95.2% concordance], Kendall's coefficient = 0.92). There is a lack of standardisation of data elements and data sources available to cancer registries at a national level, resulting in poor capacity to currently capture RD-Stage (pancreatic carcinoma). RD-Stage provides an excellent tool to cancer registries to capture stage when data elements required to calculate it are available to cancer registries.

Бронхіальна астма як професійне та екологічно-обумовлене захворювання: сучасні погляди на проблему згідно рекомендацій міжнародної організації праці 2022 року

Abstract. According to the International Labour Organization (ILO), the annual incidence of occupational bronchial asthma (OBA) ranges from 12 to 300 cases per million workers. Unlike in European countries, bronchial asthma in Ukraine remains an «under-recognised» occupational disease, accounting for less than 0.2 % of occupational pathology. The aim of the study: to analyse the algorithm for diagnosing and recognising bronchial asthma as an occupational disease according to the ILO 2022 recommendations, to compare its main provisions with the current one in Ukraine in order to adapt the system of registration of OBA to the requirements of the European Union because of the European integration process. Materials and methods. An analytical review of scientific publications using the abstract databases of scientific libraries PubMed, Medline and text databases of scientific publishers PubMed, Central, BMJ group and other VIP databases. The main legislative documents of Ukraine and the ILO regulating the process of recognising occupational diseases were analysed. The methods of system and content analysis were used. The results. Population risk assessments show that the development of 9–15 % of asthma cases in working population is directly related to exposure to harmful factors in the workplace. The risk of disease development is significantly increased due to air pollution with chemical and toxic substances as a result of hostilities in Ukraine. A comparative analysis of the international principles of diagnosis and recognition of bronchial asthma as an occupational disease with a similar system in Ukraine revealed significant differences: Ukrainian documents do not contain important information on the properties of various forms of chemical compounds, their toxicological profile, the minimum duration of exposure that causes an occupational disease, and the latency period. The lack of reference to these legally defined indicators affects the objectivity of diagnosis, the unification of diagnoses, which leads to a distortion of statistical indicators of occupational morbidity in Ukraine. Conclusions. The system of diagnosis and recording of occupational diseases, including OBA, should be improved according to the current ILO 2022 recommendations because of the reintegration processes of Ukraine’s accession to the European Union. Key words: occupational bronchial asthma, sensitizers, irritants.

Mother, child and adolescent health outcomes in two long-term refugee camp settings at the Thai-Myanmar border 2000-2018: a retrospective analysis.

The study assessed mothers, children and adolescents' health (MCAH) outcomes in the context of a Primary Health Care (PHC) project and associated costs in two protracted long-term refugee camps, along the Thai-Myanmar border. Myanmar refugees settled in Thailand nearly 40 years ago, in a string of camps along the border, where they fully depend on external support for health and social services. Between 2000 and 2018, a single international NGO has been implementing an integrated PHC project. This retrospective study looked at the trends of MCAH indicators of mortality and morbidity and compared them to the sustainable development goals (SDGs) indicators. A review of programme documents explored and triangulated the evolution and changing context of the PHC services, and associated project costs were analysed. To verify changes over time, interviews with 12 key informants were conducted. While maternal mortality (SDG3.1) remained high at 126.5/100,000 live births, child mortality (SDG 3.2) and infectious diseases in children under 5 (SDG 3.3) fell by 69% and by up to 92%, respectively. Maternal anaemia decreased by 30%; and more than 90% of pregnant women attended four or more antenatal care visits, whereas 80% delivered by a skilled birth attendant; caesarean section rates rose but remained low at an average of 3.7%; the adolescent (15-19 years) birth rate peaked at 188 per 1000 in 2015 but declined to 89/1000 in 2018 (SDG 3.7). Comprehensive PHC delivery, with improved health provider competence in MCAH care, together with secured funding is an appropriate strategy to bring MCAH indicators to acceptable levels. However, inequities due to confinement in camps, fragmentation of specific health services, prevent fulfilment of the 2030 SDG Agenda to 'Leave no one behind'. Costs per birth was 115 EURO in 2018; however, MCAH expenditure requires further exploration over a longer period.

Health System in Iraq Post 2003 War

Background: War represents a major human crisis; it destroys communities and results in ingrained consequences for public health and well-being Objective: We set this study to shed light on the public health status in Iraq after the successive wars, sanctions, sectarian conflicts, and terrorism, in light of certain health indicators. Design: The primary source of data for this analysis comes from the Iraqi Ministry of Health, and The World Health Organization disease surveillance. Results: Most of the morbidity indicators are high, even those that are relatively declining recently, are still higher than those reported in the region. Common communicable diseases such as schistosomiasis, mumps, and measles continue to be a problem. Mumps showed two recent epidemics; in 2015, and in 2020. The same with respect to Measles. More than 40·% of the surveyed population showed both systolic and diastolic hypertension. Fasting glucose of 10·4% of the participants showed hyperglycaemia, only 6·5% of whom reported being diagnosed and treated as diabetic. The leading cancer in males is Bronchus and Lung cancer, followed by Colorectal, Urinary bladder, and Prostatic cancers while in females; Breast cancer is in the top of the list, followed by Thyroid, Colorectal, Brain, and Bronchogenic cancers. Rates for childhood cancers are obviously higher even than those in high-income countries. Conclusions: The struggling public health services in Iraq have been severely impacted by humanitarian and political crises and brutal armed conflict that resulted in restricted population access to food, clean water and basic services including healthcare and medicines.

Assessment of the relationship of the morbidity rate of the adult population in the Sverdlovsk region with the staffing of medical staff

Analysis of indicators of primary and general morbidity of the population plays a decisive role in the management strategy in the healthcare system. It is necessary for developing management decisions at all levels of government. Evaluation of the results of this study allows optimal planning and forecasting of the development of various health care indicators, including the staffing level of medical personnel.
 The purpose of the study is to assess the relationship between morbidity among the adult population of the Sverdlovsk region and the level of medical staffing.
 Materials and methods. statistical materials from the annual collection “Health of the population of the Sverdlovsk region and the activities of medical organizations” were used: statistical reporting data on the morbidity of the population, staffing with medical personnel.
 Results. In the Sverdlovsk region, over 2017–2021 a gain in primary morbidity among the adult population accounted for 33.1% and an increase in overall incidence — 9.4%. The medical staffing level for 2021 (61%) was by 6.1% lower than during 2017 (65%). When assessing the impact of medical staffing on the morbidity rate using correlation analysis, a strong inverse relationship between these indicators was revealed.
 Limitations. When studying the morbidity rate of the adult population of the Sverdlovsk region, an analysis of data from FFSN No. 12 and No. 30 for 2017–2021 was carried out.
 Conclusions. The identified problems can negatively affect the availability and quality of medical care provided to the population, lead to an increase in primary and general morbidity rates, as well as a decrease in their labour potential. The results we obtained require appropriate attention and subsequent management decisions in matters of training and attracting medical personnel, which should be based on systemic measures aimed at eliminating personnel shortages.

The pathology of type 2 diabetes mellitus and relevant treatments

The prevalence rates of Type 2 Diabetes Mellitus (T2DM) continue to rise globally making it an urgent health concern warranting comprehensive examination closely scrutinizing pathophysiology causes symptoms management techniques as well as anticipated methods addressing how best to prevent or cure resulting complications. We know that T2DM is characterized by defective insulin secretion and tissues not responding adequately to treatment- a condition exclusively termed Insulin Resistance - which could influence both genetic predisposition or environmental factors like obesity or sedentary lifestyles. Increased morbidity indicators ranging from myocardial infarction peripheral vascular disease and stroke alike make timely diagnosis imperative. Lifestyle modifications offer optimal intervention possibilities for both preventing onset or long-standing concerns. A concentration on bolstering insulin sensitivity while halting progressive pancreatic cell failure that common among T2DM patients is to enhance comprehensive and effective treatment plans. From the diversity of T2DM established in terms of its symptoms points to the need for targeted preventive procedures designed towards reducing cases in the future.

The regional provision of population with specialized medical care according to profile of cardiovascular surgery

The diseases of circulatory system take leading position in structure of mortality. The efficiency of development of scientifically-proved and modern models of medical care support is to be based on data of monitoring of level, dynamics and structure of corresponding pathology. The accessibility and timeliness of high-tech medical care support directly depends on degree of influence of relevant regional characteristics.The purpose of study was to estimate demand and accessibility of specialized high-tech medical care to residents of the Astrakhan Oblast related to leading nosological forms of diseases of circulatory system.The monographic, statistical, logical and system analysis methods were applied. The research was carried out applying continuous methodology and included data from reporting forms № 12 and № 14 in the Astrakhan Oblast in 2010-2019. The Absolute and average values, extensive indicators that model structure as well as methods of dynamic numbers derivation were applied. The mathematical methods based on specialized statistical software STATISTICA 10 were implemented too.The indicator of circulatory system general morbidity decreased up to 8,5% in 2010-2019. The leading positions are taken by cerebrovascular diseases (29,2%), ischemic heart diseases (23,8%) and diseases characterized by increasing of blood pressure (17,8%). The indicator of general morbidity of these nosological forms increased up to 16,9% and primary morbidity up to 43,9%. The average long-term level of prevalence comprised 55,3±1,23%0. At that, specialized medical care within the mentioned direction decreased from 44,9% to 30,0% and implementation of high-tech medical care increased from 2,2% to 4,0%.

The effect of applying clinical organizational telemedicine technology management of anti-tuberculous care on dynamics of tuberculosis morbidity and mortality

The tuberculosis is the most important medical and social problem among globally dangerous epidemiological phenomena. the tuberculosis ranks 9th place in the structure of mortality and disability of population and 1st place among causes of death from single infectious agent.The purpose of the study was to analyze dynamics of total morbidity and mortality because of tuberculosis against the background of the implementation of telemedicine clinical organizational technology in phthisiology care 2007-2021.The official Regional and Federal data of Rosstat for 2007-2021 were used. The indicators of total morbidity and mortality of population caused by tuberculosis in the Sverdlovsk Oblast were established. The research methods were content analysis, dynamic series analysis, graphical analysis, statistical differences analysis.In the Sverdlovsk Oblast, the morbidity and mortality of tuberculosis exceeded national average indicators by 1.2-1.5 times. In 2007-2021, as a result of implementation of clinical organizational telemedicine technology in managing phthisiology care, total morbidity and mortality of population caused by tuberculosis decreased up to 2.275 and 2.97 times respectively. The rate of decrease of analyzed epidemiological indicators generally correlated with national average data with statistical validity of difference t≥2.In regions with unfavorable epidemiological indicators of tuberculosis, application of innovative technologies in management of clinical organizational processes is required. The development and implementation of clinical organizational telemedicine technology for managing regional phthisiology care contributes to significant reduction of morbidity and mortality of tuberculosis and optimizes sanitary and epidemiological well-being.

Основные показатели заболеваемости населения, в том числе прогностические, в оценке репродуктивного потенциала региона.

The article presents the results of a study conducted to study the main indicators of population morbidity from the perspective of assessing the reproductive potential of the region. Statistical, analytical, and graphological methods were used in the work. A key factor in the reproductive potential of a region is the level of health of its population, including morbidity rates. When developing measures to stimulate the birth rate, which is especially necessary for territories with the lowest rates of population reproduction, such as the Central Federal District and, in particular, the Kostroma Region, a detailed study of the regional characteristics of the health status of the population is necessary. It was determined that, according to predictive models, the incidence rate in the Kostroma region will increase from 701.1 per 1000 population in 2020 to 768.8 per 1000 population in 2025. To identify the relationship between indicators of the birth rate and morbidity in the Kostroma region for period 2010–2020 A cross-correlation analysis was carried out to reveal not only the degree and direction of the relationship between the analyzed indicators, but also the time lag. For the Kostroma region, according to the time series under consideration, no statistically significant relationship was found between the level of fertility and morbidity. There is a slight correlation (–0.3) between the analyzed indicators for the Kostroma region with a time lag of 6 periods, but it is not statistically significant and does not allow us to draw clear conclusions.

Analysis of morbidity in hospitals

The article presents an analysis of morbidity in hospitals and the average length of stay by disease classes and individual nosology in Russia for the period from 2016 to 2021. The aim of the work was to analyze the indicators of morbidity in hospitals among the adult population of Russia for the period 2016-2021. Statistical and analytical research methods were used in the work. The data on the number of discharged adult patients (18 years and older) from medical organizations providing inpatient care as well as on the number of bed-days discharged were used from the federal statistical observation form № 14 'Information about the activities of units of medical organizations providing care in inpatient settings' for 2016-2021. The morbidity in hospitals rate decreased from 205.5 to 196.0 per 1000 people of the corresponding age, the average duration of stay in a hospital bed decreased from 11.7 to 10.6 days. The downward trend in morbidity in hospital is traceable for almost all classes of diseases. Since 2020, due to the pandemic of the new coronavirus infection COVID-19 and the reprofiling of most hospitals to infectious diseases hospitals, there has been a change in the structure of morbidity in hospital in adult patients by disease class.