Mortality In Russia Research Articles

Comparative Results of Standard Coronary Artery Bypass Grafting, Staged Hybrid Myocardial Revascularization and Purely Endovascular Correction in Patients with Coronary Artery Disease in Long-Term Period after Surgery

INTRODUCTION: Coronary artery disease (CAD) currently remains the leading cause of morbidity and mortality in Russia and in the world. In 2022, the overall morbidity with CAD among the adult population of Russia was 6517.9 per 100 thousand populations. The main surgical methods of treatment for CAD are coronary artery bypass grafting (CABG) and stenting of the coronary arteries. In some cases, a single-step complete revascularization is not possible, and one of solutions is a hybrid approach. AIM: To compare 5-year results of CABG, staged hybrid myocardial revascularization and isolated endovascular intervention in patients with CAD and multi-vessel lesion of the coronary arteries. MATERIALS AND METHODS: The prospective study included 330 patients with CAD and multi-vessel atherosclerotic lesion of the coronary arteries, who underwent planned myocardial revascularization in 2010–2018. Group 1 included 110 patients who underwent CABG, group 2 — 110 patients who underwent staged hybrid myocardial revascularization, group 3 included 110 patients after percutaneous coronary intervention. In 5-year follow-up period, clinical and instrumental data were evaluated, complications, lethal outcomes and re-interventions were considered. RESULTS: In the immediate period after the surgical intervention, frequency of cardiovascular complications and residual myocardial ischemia was expectedly low in all the groups (р 0.05). At 1 year of follow-up, cardiovascular complications were less common in group 2 (17.3%) compared to group 1 (29.1%, p = 0.038), while in group 3, adverse events were also noted in 27.3% of cases, however, the differences were not significant (p = 0.075). At 5 years, the frequency of cardiovascular complications prevailed in patients of group 1 (80.0%) compared to group 2 (57.3%) and group 3 (67.3%, p = 0.001–0.032). At the end of follow-up, the frequency of repeat revascularization was significantly higher in group 1 (41.8%) compared to group 2 (29.1%, p = 0.049). The number of such cases in group 3 (33.6%) was less than in group 1, however, the differences were not statistically significant (p = 0.125). CONCLUSION: Isolated CABG demonstrates a higher frequency of repeat endovascular interventions at 5 years after surgery compared to hybrid revascularization that also provides better results in terms of preventing cardiovascular complications.

Epidemiological Features of the COVID-19 and Characteristics of Patients during the Spread of the Omicron SARS-COV-2 in Russia

Aim. To analyze dynamic of incidence and mortality of COVID-19 and clinical and epidemiological characteristics of adult patients with a new coronavirus infection during the early period of the Omicron SARS-COV-2 distribution in Russia. Materials and Methods. We conducted a retrospective analysis of the dynamics of COVID-19 incidence and mortality in Russia until 2023. Study included patients aged ≥18 years with a laboratory-confirmed diagnosis of COVID-19, detected in the period from 01/02/2022 to 14/03/2022 (n = 3 582 688) in 85 regions of Russia. Participants were included regardless their COVID-19 vaccination history. Results. We identified 6 periods of rise and decline in the COVID-19 incidence until 2023 in Russia. The 5th (January–July 2022) and the 6th (August-November 2022) periods were associated with the spread of the Omicron SARS-CoV-2. The median age of patients in the early period of Omicron spreading was 49 (36–62) years, 62.7% were women. The largest proportion of patients were represented by the age groups 30–39 and 40–49 years (19.2% each), the lowest – 18–29 years (12.3%). Proportion of patients with mild disease was 90.0%, moderate – 8.5%, severe – 0.9%, extremely severe – 0.6%. Hospitalization rate, proportion of patients treated in the intensive care unit and rate of invasive mechanical ventilation were 7.6%, 9.5% and 6.7% respectively. The median period from the onset of symptoms to the diagnosis was 2 (1–3) days, median of duration of the disease was 8 (6-10) days and median duration of hospitalization was 10 (7–14) days. The median age of the deceased patients was 77 (69–84) years, of which 50.8% were women, 72.6% were persons ≥70 years old. One or more concomitant diseases were detected among 8.7% of patients who became ill and 75.8% of those who died. The probability of hospitalization, admission to the ICU, IMV and death in patients with one or more concomitant diseases were 24.5, 3.2, 3.5 and 35.8 times higher, respectively, compared with patients without concomitant diseases. Conclusion. In the early period of the spread of the Omicron variant in Russia, among adult patients with COVID-19, excluding their vaccine history, the frequency of severe and extremely severe forms of infection was 1.5%. The elderly age and the presence of concomitant diseases remained key risk factors for the development of adverse outcomes of the COVID-19

Sex differences in lung cancer incidence and mortality in Russia in the light of computed tomography usage expansion: breakpoint and age-period-cohort analyses

BackgroundRussia has one of the highest lung cancer burdens globally, particularly in men. Mortality started to decline in the 1990s after the reduction in smoking prevalence. However, Russia’s recent experience is largely unknown. This study aims to describe recent trends in the incidence and mortality of lung cancer in Russia along with the use of computed tomography (CT). MethodsWe obtained incidence data from national cancer reports covering 1993–2021 and mortality and population data from the Russian Fertility and Mortality Database covering 1965–2021. The number of CT scanners was obtained from the OECD. Changes in age-standardized rates (Segi-Doll, per 100,000) were assessed using segmented regression and temporal effects using age-period-cohort analysis. ResultsLung cancer rates in men have been substantially higher than in women and have declined sharply since their peak in the 1990s. The latest breakpoints in incidence in women were in 2012 (95 % CI: 2000; 2014) from stagnation with an annual change of 0.7 % (−0.2; 1.5) to 3.4 % (1.6; 5.2) increase. In men, the decrease in incidence stopped in 2013 (2011; 2014) from −1.8 % (−2.1; −1.4) to 0.3 % (−0.7; 1.3). The growing number of CT scans accompanied the recent changes in incidence rates. Incidence declined sharply in 2020 in men and women. There were no substantial changes in declining mortality trends. Period effects were visible after 2012 when incidence rates increased and deviated from mortality. After accounting for the period effect, generations born after the 1950s had lower risks. ConclusionIncreasing lung cancer incidence rates in Russia in the late 2010s, especially in women, and the stable mortality trends could be a possible sign of diagnostic or treatment period effect. The increased use of CT should be monitored for possible benefits and harms.

Modeling the impact of using trastuzumab deruxtecan in patients with breast cancer on reducing cancer mortality in Russia

Background. Reducing malignant mortality to 185 cases per 100,000 by 2030 is one of goals of the state program “Healthcare development” in Russia.Aim. To assess potential impact of using trastuzumab deruxtecan in patients with breast cancer on reducing cancer mortality.Materials and methods. Three indications of trastuzumab deruxtecan were considered: adult patients with HER2-positive unresectable or metastatic breast cancer that were previously treated with trastuzumab and a taxane in the advanced or metastatic setting (referred as “Second line”); adult patients with HER2-positive unresectable or metastatic breast cancer who previously received at least two lines of therapy in the metastatic setting including trastuzumab emtansine (referred as “Third line”); adult patients with HER2-low metastatic breast cancer who had received one or two previous lines of chemotherapy (referred as “HER2-low metastatic breast cancer”). The set of comparators for each clinical situation was formed based on the clinical guidelines and clinical trials of trastuzumab deruxtecan. Overall survival and treatment duration were modelled on the clinical trials basis. The model was used to estimate number of lives saved in case of transitioning all eligible patients to trastuzumab deruxtecan within a three-year horizon.Results. Up to 3,609 patients p. a. in the “Second line” situation, 1,300 patients p. a. in the “Third line” situation and 2,260 patients p. a. in the “HER2-low breast cancer” situation can initiate trastuzumab deruxtecan treatment. In that case mortality from neoplasms could be reduced by 1,461 deaths in case of “Second line”, by 427 deaths in case of “Third line” and by 801 deaths in case of “HER2-low metastatic breast cancer” over three years. Reduction in mortality will contribute to achieving the target mortality rate from neoplasms of 21.61–24.81 %, 4.31–12.57 % and 5.91–20.89 %, respectively.Conclusion. Using trastuzumab deruxtecan for breast cancer treatment in different clinical situations leads to quantitate reduction in cancer mortality in Russia.

Regional Differences in Life Expectancy in Russia Through the Lens of Epidemiological Transition

An immense territory of Russia with several climatic zones and, accordingly, a fundamentally different styles of life, inevitably results in pronounced varieties in the levels and structure of mortality across the regions of the country. Since the scale and sustainability of differences in mortality in Russia can be considered an entire epidemiological epoch, the evaluation of them through the lens of epidemiological transition seems methodologically appropriate. Regional differences are regarded as a kind of projection of evolution in time, though taking into account modern realities. The analysis of regional differences in mortality is based on such indicators as life expectancy, structure of mortality, i.e., predominantly endogenous to exogenous causes of death ratio, as well as the average age of death from predominantly endogenous causes calculated on the basis of life tables by cause of death. The study showed that according to the periodization of epidemiological transition only Moscow and St. Petersburg are at the final phase of the 3rd stage and are moving to the 4th stage of epidemiological development. Meanwhile, the burden of exogenous and preventable pathologies precludes the completion of the 3rd stage in the regions with high life expectancy according to Russian criteria. The stadial nature of epidemiologic development of Russian regions is currently conditioned by socio-economic and medical determinants, with more pressing medical determinants in regions with high and medium levels of life expectancy and socio-economic factors prevailing in regions with low life expectancy.

Cardiovascular toxicity of chemotherapy and thyroid status of patients with gastric and colon cancer: Current state of the problem. A review

Cardiovascular and oncological diseases are the main causes of disability and mortality in Russia, sharing common risk factors and exacerbating each other. The specific toxicological effects of fluoropyrimidines, platinum drugs, and taxanes commonly used in the treatment of gastric and colorectal malignancies have been noted to potentially contribute to the onset of cardiovascular pathologies in some cases. However, the manifestation and prevalence of cardiovascular toxicity due to cancer treatment regimens are influenced by various factors beyond just the chemotherapy protocols employed. Gender, age, overall health status (including cardiac and thyroid functions), and other risk factors play significant roles in the development and progression of heart and vascular diseases in these patients. Thyroid dysfunction, even in the absence of severe clinical symptoms, can significantly impact the course of cardiovascular pathologies, complicating the management of toxic effects associated with polychemotherapy on both the cardiac muscle and vascular system. This paper analyzes modern ideas about pathogenetic relationship between cardiovascular diseases and gastric and colon cancer. The profile and mechanism of cardiovascular toxicity of chemotherapy in patients with gastric and colon cancer, pathogenetic relationship of thyroid status and cardiovascular diseases are presented. Organizational management issues of chemotherapy toxicity are briefly highlighted.

Modern methods for assessing blood loss in childbirth and diagnosing postpartum hemorrhage: A review

Postpartum hemorrhage (PPH) is one of the leading causes of maternal mortality in Russia and worldwide. Accurate calculation of circulating blood volume (CBV) and personalized estimation of the extent of blood loss (EBL) play vital roles in the early diagnosis of PPH. Visual assessment of BL in childbirth is an available diagnostic method, but it has a high error rate compared to the gravimetric method. A dynamic assessment of the shock index (SI) as an indicator that reflects hemodynamic disorders early enough can be used as an additional diagnostic method for PPH and a test that allows predicting the need for transfusion of blood products. Aim. To review current literature on the assessment of BL in childbirth and the diagnosis of PPH. Materials and methods. The search for publications by Russian and foreign authors was carried out in the information electronic databases PubMed, PubMed Central, Scopus, MEDLINE, ScienceDirect, Cochrane Library, and eLibrary from 2016 to January 2024 using the keywords "obstetric blood loss," "PPH," and "SI." Results. When assessing the CBV, its correlation with the body mass index was revealed. Subjective methods for the PPH assessment have a large margin of error, which does not depend on the experience and seniority of the healthcare provider. The gravimetric method is more accurate, but it can underestimate the clinical situation when physiological blood loss is exceeded. Dynamic assessment of SI is an early marker of hemodynamic disorders and makes it possible to identify patients with a high risk of adverse outcomes more reliably than other parameters. Conclusion. In order to provide timely and adequate emergency medical care for excessive obstetric blood loss, a personalized approach should be used to calculate the EBL, taking into account the woman's body mass index, as well as a systematic assessment of the BL, including at least the extent of blood loss and monitoring of the SI.

ДЕМОГРАФИЧЕСКИЙ КРИЗИС В СОВРЕМЕННОЙ РОССИИ

The demographic situation in Russia requires close attention and analysis due to the relevance and significance of the socio–economic consequences. The article examines the problem of the demographic crisis in modern Russia. The current causes of the demographic crisis and the decline in the birth rate are considered. The socio–economic consequences of a decrease in the population and a decrease in the birth rate are revealed. The data on the dynamics of the population, fertility, and mortality in Russia are presented. The forecast of the birth rate in Russia is given, the dynamics of the total birth rate in the period from 1960 to 2023 is studied. The necessity and directions of developing additional measures aimed at overcoming the demographic crisis are substantiated. The goals, objectives, and directions of the national project "Demography" are presented. In addition, measures of state support for young families aimed at increasing the birth rate were considered.

The state of cancer care in Russia: liver cancer - (From 22). Age-related features of the observed and relative one-year and five-year survival of patients. (clinical and population-based study). Part 2.

Survival rate calculations for liver cancer patients at the federal level in the Russian Federation are only conducted in the North-Western Federal District and a few other individual administrative territories. In the first part of our study, we presented a detailed analysis of the prevalence of liver cancer, noting that the levels of standardized incidence and mortality rates in Russia and the North-Western Federal District are virtually identical, allowing us to consider the results of our study as nationally representative. The conducted research confirmed the seriousness of the issue of liver cancer among the population. However, certain advancements in patient treatment were recorded, with a significant increase in survival rates, primarily for one-year survival. For example, in the North-Western Federal District, one-year survival increased from 13.6% in 2000 to 23.1% in 2022, representing a 69.8% increase. At the same time, five-year survival rates remained largely unchanged. Increases in survival rates were observed in most age groups. A significant deficiency in the initial patient record-keeping was identified - insufficiently accurate determination of the stage of liver cancer. One-year survival rates for male and female liver cancer patients (22.7% and 22.1%) were nearly equal, as were the survival rates for liver cancer patients residing in urban and rural areas. Therefore, further improvement in the outcomes of treatment for this complex patient group can only be achieved through the implementation of regional and federal screening and epidemiological surveillance programs among populations at high and extremely high risk of developing hepatocellular carcinoma.

The mortality of children population

The article presents comprehensive medical statistical analysis of indicators and causes of mortality of children population of the Russian Federation in 2017-2021. It is emphasized that in Russia, in conditions of extremely unfavorable demographic situation, the hyper actual task is to preserve life of every child. It is demonstrated that crucial role in mortality of children population is played by not only infant mortality and mortality of children aged 1-4 years, but also by mortality of children of older ages. The children population mortality still keeps gender and residence differences. The problem of reliable registration of infant mortality is to be revisited since part of newborns born alive are classified after birth as stillborn. Beginning from 2018, the first place was taken by the class "Injuries, poisonings and some other consequences of external causes" driving back the class "Individual conditions occurring in perinatal period". Thus, measures of preventing negative impact of social factors on children health continue to be an important component of modern system of health care of children population. The directions of measures reducing children mortality in Russia are proposed.

Modern concepts about the pathogenesis of thrombosis of various etiologies

Thrombosis becomes the cause and complication of many cardiovascular diseases, and their prevalence remains a leader in the structure of morbidity and mortality in Russia and throughout the world. Modern fundamental and clinical research has significantly supplemented traditional ideas about the mechanisms of thrombus formation. First of all, Virchow's triad has been rethought, in which, according to new data, the leading role is assigned to vascular damage, and slowing down blood flow plays a primary role in the formation of only venous, but not arterial, blood clots. In recent years, the mechanisms of endothelial dysfunction underlying thrombosis associated with inflammatory (immunothrombosis) and atherosclerotic (atherothrombosis) damage to the vascular wall have been studied in detail. The cellular and molecular mechanisms of acquired hypercoagulability and hereditary thrombophilia have been deciphered. The traditional concept of dividing blood clots into “red” (venous, consisting of fibrin and red blood cells) and “white” (arterial, platelet) is being revised. It has been shown that red blood cells can occupy most of the volume of not only venous, but also arterial thrombi, and play an important role in thrombus formation reactions. The process of compression (contraction, retraction) of blood clots, caused by contraction of activated platelets, changing the structure of the blood clot and affecting the course and outcome of thrombosis, is being actively studied. A deep understanding of the pathogenesis of thrombosis, taking into account modern concepts, is necessary for effective prevention, early diagnosis and treatment of thrombotic conditions.

The anatomy of COVID mortality in Russia’s regions, 2020–22

ABSTRACT Counterfactual estimates of excess deaths in Russian regions in the period 2020–21 are compared with officially reported COVID deaths to analyse underreporting. COVID mortality levels at the end of years 2020 and 2021 as well as annual growth during 2021 and the first half of 2022 reveal that COVID is a real threat to high labour productivity regions and those with relatively bigger defence and civilian sectors. Corruption lowers COVID mortality growth, suggesting a public health system where better care is obtained informally. Improved access to a doctor just before the pandemic lowered the level of mortality during the worst year (2021) but did not impact the mortality growth or the mortality level in 2020. Better prevention of any virus including COVID in the future would include more regionally decentralised vaccine and testing initiatives to boost compliance plus a fundamentally reformed health system that includes access to foreign-made vaccines and higher quality mortality data.

Современные подходы к психотерапевтической реабилитации пациентов с хроническими сердечно-сосудистыми заболеваниями

The review is devoted to the topical problem of rehabilitation of patients with cardiovascular diseases, which remain the leading cause of morbidity, disability and mortality in Russia and worldwide. A number of works demonstrating a close relationship between the course and prognosis of cardiovascular diseases and the psycho-emotional sphere of patients were analyzed. International and Russian experts emphasized the importance of timely identification and correction of psychosocial risk factors, in particular, depression, anxiety disorders, psychosocial stressors and others. The question of the need for a multidisciplinary approach to the patient in cardiac rehabilitation programs is raised. Emphasis is placed on the expediency of combining psychocorrection, psychotherapy and psychopharmacotherapy to increase the effectiveness of rehabilitation measures. The leading goals of these interventions are to change the internal picture of the disease, to achieve psychosocial adaptation and to improve the quality of life of patients with chronic cardiac diseases. This approach contributes to the prevention of exacerbations, complications and chronicization of somatic pathology, which improves labor prognosis, reduces the risk of disability and early mortality. Thus, the conducted analysis allows forming a holistic view of the importance of specialized psychological and psychotherapeutic care, the existing methods of correction and pharmacotherapy within the framework of rehabilitation measures in patients with cardiac diseases.

Reserves for Reducing Mortality in Russia in the Context of Its Age and Nosological Characteristics

The unattainability of increasing the life expectancy of the Russian population to 78 years within the announced time frame due to the epidemiological (COVID-19 pandemic) and subsequent geopolitical crisis has actualized the task of finding reserves for reducing mortality and concentrating efforts on priority areas. Based on official statistics, we analyzed the dynamics of mortality in the main (15-year, with age up to 1 year) age groups of the population from leading causes of death (causing 3/4 of mortality in the male population and 2/3 in the female population in each age group) for period 2000–2021. We calculated standardized mortality rates (European age structure standard). Mortality caused by alcohol and drugs was assessed collectively, taking into account external causes (poisoning with psychoactive substances, accidental and with uncertain intentions) and psychosomatic pathologies. When analyzing mortality from diseases of the circulatory system we distinguish acute and chronic forms of pathologies, since they are determined by various risk factors. There are reserves for increasing life expectancy at all ages due to a decrease in mortality from socially determined and preventable causes, but the main risk group is the most demographically and economically significant age stratum of 30–44-year-olds, the mortality rate in which (due to losses due to alcoholism and its consequences, HIV/AIDS, injuries of uncertain intent and ill-defined conditions) indicate persistent marginalization. In turn, this once again emphasizes that without the policy to reduce mortality going beyond healthcare, its effectiveness will be extremely low. A necessary condition for developing effective policies is the reliability and quality of information. Meanwhile, the general problem of accounting for the mortality of the Russian population, regardless of age, is the problem of diagnostic quality, as evidenced by the abnormally high level and contribution of losses from vague, uncertain and unidentified causes. The scope of application of the results obtained is their use to adjust the goals, priorities and system of measures in national projects aimed at increasing life expectancy. Directions for future research are related to the analysis of differentiation of mortality from the main causes from the social status of the deceased.

Russian Short-Term Mortality Fluctuations Data Series

The COVID-19 pandemic has revealed significant gaps in the coverage and quality of the existing international and national statistical surveillance systems. The most reliable approach to estimating mortality associated with short-term risk factors or factors fluctuating within calendar years is based on estimating weekly excess mortality. Although this approach is obvious, its application turned out to be problematic due to the lack of reliable data. In response to this challenge, a new Short-Term Mortality Fluctuations (STMF) data series was created in 2020. The Russian Short-Term Mortality Fluctuations Data Series (RuSTMF) is a further development of the STMF idea at the regional level. It contains weekly crude and standardized death rates for the Russian regions and Russia as a whole. The main source for calculating death rates is depersonalized individual data on the deceased provided by the Rosstat. This database provides for the analysis of short- and medium-term changes in mortality in males, females and total population in Russia as a whole and its regions, as well as the estimation of «excess» deaths during short-term sharp increases in mortality due to, for example, heat or cold waves, seasonal influenza epidemics, the Covid-19 pandemic or technogenic catastrophes.

Impact of using novel antitumor drugs in adult patients with locally advanced or metastatic urothelial carcinoma on reducing cancer mortality in Russia

Background. Standard first-line therapy options for patients with locally advanced or metastatic urothelial carcinoma (UC) is platinum-based chemotherapy. Currently, patients also have access to immune checkpoint inhibitors (ICIs) such as pembrolizumab, nivolumab, and atezolizumab, along with avelumab, which, unlike other drugs in this class, can be used as maintenance therapy after first-line platinum-based chemotherapy.Aim. To evaluate the effects of using ICIs in treating adult patients with locally advanced or metastatic UC on reducing overall and one-year cancer mortality in Russia.Materials and methods. A mathematical model based on overall survival and progression-free survival data from clinical trials has been proposed. This model describes duration of therapy and treatment outcomes for cases of treatment without ICIs (routine clinical practice); with pembrolizumab, nivolumab, and atezolizumab in first and second-line therapy according to real-life clinical practice (current practice); and with avelumab as maintenance therapy after platinum-based chemotherapy (proposed practice) over a 3-year period. The model was used to estimate the number of lives saved and healthcare system costs when transitioning from historical to current practice, and from current to proposed practice over a three-year horizon, considering the number of locally advanced or metastatic UC patients who may start platinum-based therapy annually in Russia.Results. Annually, up to 4,182 patients with locally advanced or metastatic UC in Russia can start platinum-based chemotherapy. Compared to historical practice, the use of pembrolizumab, nivolumab, and atezolizumab in the first and second lines of therapy in accordance with the routine clinical practice allows to reduce mortality from malignant neoplasms by 553 cases over a 3-year horizon. Over the same period, avelumab-based treatment would additionally save 2,506 lives. Moreover, the cost of saving one life with the use of avelumab amounts to 6.0 million rubles, which is 9 % lower than the cost of saving one life with the use of other ICIs (6.6 million rubles).Conclusion. The use of avelumab as maintenance therapy after platinum-based chemotherapy in the 1st line in patients with locally advanced or metastatic UC has a significant and quantifiable impact on reducing cancer-related mortality in Russia.

PSYCHIATRIC ASPECTS OF MURDERS IN CHUVASHIA (2011–2020)

Murders are one of the most important causes of mortality in Russia, and most aggressors suffer from mental disorders. The purpose of the research is to study the structure of mental disorders of murderers and its features in Chuvashia in 2011–2020. Materials and methods. The forensic psychiatric examination examined 507 murderers (409 men and 98 women) aged 15 to 83 years (average age – 40.65±13.82 years). Mental disorders, medical, social and criminal indicators of murderers, as well as 507 victims were taken into account. Results. 474 murders were committed single-handedly, 14 – in a group of 2-4 people; ordinary murders accounted for 96.5%, those with two or more victims – 3.5%. Post-homicidal suicides in aggressors were observed in 2.5%. Mental disorders were qualified in forensic psychiatric examinations in 72.6% of the subjects, most often they were alcohol dependence (20.1%), especially among women (27.6%). Among other mental disorders, personality disorders (13.8%), organic mental disorders (12.8%), schizophrenia (6.3%), mental retardation (2.8%) and comorbid mental disorders (16.8%) were noted. 10.5%, most often patients with schizophrenia and organic mental disorders, are recognized as insane during forensic psychiatric examinations. The instruments (method) of murder in 94% of cases were piercing and cutting objects, "blunt weapons" and strangulation. Women were significantly more likely to use "bladed weapons", and men – to "blunt weapons". More than 40% of the victims were family members, more than 50% were acquaintances, friends, and only 6.3% were strangers. Women were significantly more likely to kill their spouses (unmarried cohabitants etc.) and children, and men – acquaintances. 84.0% of criminals were intoxicated at the time of the murder. Both the aggressor and the victim drank together in 59% of cases. Insane murderers (with pronounced mental disorders) were significantly older, had a lower level of education, family status, hereditary burden of mental disorders, various organic harms, they killed two or more victims more often and committed post-homicidal suicides (7.5%). Conclusions. Almost three–quarters of all murderers had mental disorders, and one in five had mental disorders due to alcohol abuse. The leading cause of the murders was conflicts arising between familiar people and/or family members against the background of alcohol intoxication. A certain role was played by the criminal experience of the participants in the incident, long-term hostile relations, readiness to inflict bodily harm to the victim and murder another person.

Expanding the usage of osimertinib as adjuvant therapy for <i>EGFR</i>-mutated NSCLC: a model-based assessment of its impact on reducing cancer mortality in Russia

Introduction. Platinum-based chemo have long been the only option for adjuvant therapy after tumor resection in early-stage NSCLC. Osimertinib is EGFR tyrosine kinase inhibitor which demonstrated efficacy as adjuvant therapy in patients with NSCLC.Aim. To evaluate the effects of expanding the use of osimertinib as adjuvant therapy for EGFR+ NSCLC on reducing cancer mortality in Russia.Materials and methods. According to the ADAURA clinical trial, osimertinib has shown a significant reduction in the risk of recurrence or death, with hazard ratio of 0.17 and a 99% confidence interval of 0.11–0.26, p < 0.001. However, long-term overall survival data is not yet available in the literature. To evaluate the potential benefits of osimertinib as an adjuvant therapy for EGFR+ NSCLC, a model was proposed, which aims to describe the time to recurrence and overall survival of patients over a 10-year horizon, with or without use of osimertinib. We also evaluated the additional costs associated with expanding the use of osimertinib for this particular indication.Results. In Russia, the use of osimertinib as an adjuvant therapy for NSCLC has the potential to benefit approximately 1 280 patients annually. Currently, around 450 patients are already receiving osimertinib as adjuvant therapy, leaving room for an additional 830 patients to be considered for this treatment option. If all eligible patients receive osimertinib, it is estimated that there could be a reduction of 683 cancer-related deaths over a span of 10 years. The long-term effects of osimertinib are particularly noteworthy, as they can positively impact the proportion of patients registered for five or more years by an increase of 0.006 percentage points, and among lung cancer patients by 0.231 percentage points. The additional costs associated with this expansion are estimated at 2.2 billion rubles per year.Conclusions. The use of osimertinib as an adjuvant therapy for EGFR+ NSCLC has a significant and quantifiable impact on reducing cancer-related mortality in Russia.

The design of research project of behavioral strategies of women with breast cancer experience

The breast cancer can be successfully cured after its early diagnosis. Nevertheless, this disease remains one of the main causes of female mortality in Russia and in the world. The effective mode of overcoming this disease is to intensify institutional programs of prevention and treatment in context of the national health care system. The efficacy of such programs depends on social economic inequality and differences between population groups with respect to informational, financial and regional aspects. The study design includes: comprehensive approach to analysis of social economic and infrastructural conditions of organization of prevention and treatment of breast cancer; of characteristics of symbolic filling of the breast cancer phenomenon in the Russian society; of factors determining willingness and ability of women of different social status groups to be involved in prevention and treatment of breast cancer and conditions, including conditions of increasing their subjectness.

Partial Contribution of Socioeconomic Factors to the Mortality Rate of the Working-Age Population in Russia.

This study's relevance lies in the need to assess the role of socioeconomic, medical, and demographic factors on working-age population mortality in Russia. The purpose of this study is to substantiate the methodological tools for the assessment of the partial contribution of the most important factors that determine the dynamics of the mortality of the working-age population. Our hypothesis is that the factors determining the socioeconomic situation in the country affect the level and dynamics of mortality of the working-age population, but to a different extent in each separate period. To analyse the impact of the factors, we used official Rosstat data for the period from 2005 to 2021. We used the data that reflect the dynamics of socioeconomic and demographic indicators, including the dynamics of mortality of the working-age population in Russia as a whole and in its 85 regions. First, we selected 52 indicators of socioeconomic development and then grouped them into four factor blocks (working conditions, health care, life security, living standards). To reduce the level of statistical noise, we carried out a correlation analysis, which allowed us to narrow down the list to 15 key indicators with the strongest association with the mortality rate of the working-age population. The total period of 2005-2021 was divided into five segments of 3-4 years each, characterising the picture of the socioeconomic state of the country during the period under consideration. The socioeconomic approach used in the study made it possible to assess the extent to which the mortality rate was influenced by the indicators adopted for analysis. The results of this study show that over the whole period, life security (48%) and working conditions (29%) contributed most to the level and dynamics of mortality in the working-age population, while factors determining living standards and the state of the healthcare system accounted for much smaller shares (14% and 9%, respectively). The methodological apparatus of this study is based on the application of methods of machine learning and intelligent data analysis, which allowed us to identify the main factors and their share in the total influence on the mortality rate of the working-age population. The results of this study show the need to monitor the impact of socioeconomic factors on the dynamics and mortality rate of the working-age population in order to improve the effectiveness of social programme. When developing and adjusting government programmes to reduce mortality in the working-age population, the degree of influence of these factors should be taken into account.