Primary Morbidity Research Articles

Lost years of life due to the mortality from diseases of the urinary system in the industrial region of Kazakhstan with air pollution

Introduction. The relevance of the epidemiological problems of loss of years due to diseases of the kidney and urinary tract is due to the progressive gain in the number of patients in many regions and countries of the World. 
 Purpose. Estimation of years of life lost due to the mortality from diseases of the urinary system (DUS) in the Pavlodar region, which is one of the industrial regions of Kazakhstan. 
 Materials and methods. Medical-demographic (mortality rates) and medical-statistical (primary morbidity rates) data was obtained from the Department of Statistics of the Republican Center for Electronic Health Care of the Republic of Kazakhstan (RCEHC RK). The study period was eight years (from 2015 to 2022). The Years of Life Lost (YLL) indicator was calculated according to methodological recommendations. An assessment of the relationships between population health indicators for pathologies of the urinary system (US) with social factors (gross domestic product per capita – GDP), and environmental indicators (ecological and meteorological) as possible causes of adverse events in human health was carried out using correlation and time series analysis.
 Results. In the structure of years of life lost due to the mortality from US organs, chronic renal failure (CRF, 55.96–65.85%) led. In the regional center of Pavlodar, there was a peak in years lost in mortality from DUS over 2021 (3.3‰ YLLs), during the COVID-19 pandemic. According to the average annual losses by age groups, in the Pavlodar region, the maximum losses were detected in the elderly (10.5‰ YLLs) and senile (15.8‰ YLLs) age. An excess of the maximum one-time concentrations of pollutants in the atmospheric air above the MPC level with the highest pollution level in 2018 was registered. Correlation analysis showed a high level of correlation between the loss of years of life because of the mortality due to US diseases with atmospheric air pollution in Ekibastuz (r = 0.80), weak – 
 in Pavlodar region (r = 0.28) and low – in Pavlodar (r = 0.13).
 Limitations. Of the environmental pollution factors, only atmospheric air pollution factors were studied, which does not reflect all the possible effects of environmental pollution on population health. In the group of reasons with code R, the conclusion “old age” prevailed, which may have led to an inaccurate analysis of the causes of death.
 Conclusion. Regional connections between the loss of years of life due to mortality due to US diseases with atmospheric air pollution and temperature in the winter season, as well as newly identified morbidity with atmospheric air pollution, have been identified.

The appealability of patients with glaucoma in the Kyrgyz Republic

According to world forecasting, the number of patients with glaucoma all over the world will reach 111.8 million up to 2040 . The percentage of primary open-angle glaucoma is 2.34% and primary closed-angle glaucoma is 0.73%. According to mathematical forecast, further increasing of common and primary morbidity is expected. The retrospective analysis of patient records of the Department of Eye Microsurgery № 2 of the National Hospital of the Ministry of Health of the Kyrgyz Republic was carried out. It is established that among total number of treated patients with glaucoma, no significant difference in rate of cases of closed-angle (53,7±1,7) and open-angle forms (46,3±1,7) was established. In most cases, open-angle glaucoma was diagnosed in age group of 60-79 years and closed-angle glaucoma in age group of 50-79 years. The women are reliably more often suffer of glaucoma. The majority of patients had stage III (42,3±2,5), stage II (31,8±2,4) and stage I (22,2±2,1). At all stages, women more often had glaucoma with the exception of stage III and IV that were diagnosed with same rate were diagnosed in patients of both sexes. Unfortunately, there were isolated cases of open-angle glaucoma at young age. The results of the study dictate importance of prevention, early diagnostic, treatment and rehabilitation of ophthalmologic patients.

The personnel maintenance of primary health care physicians in condition of challenges from menaces to population health

In condition of challenges from menaces to health due to COVID-19 the role of primary health care physicians increases that requires development of management decisions at the regional level. The purpose of the study. On the basis of analysis of medical demographic indicators and data concerning provision of primary health care personnel in the Russian Federation, proposals were made related to reforming of primary health care system in conditions of implementation of general medical practice with purpose to counteract menaces to population health. The analytical and statistical methods were applied. The official statistics data from the Minzdrav of the Russian Federation and Rosstat, results of original researches with content analysis and interpretation were used. The COVID-19 pandemic negatively impacted population health. The indicator of newly detected morbidity in the Russian Federation in 2020 decreased as compared to 2019 from 78024.3 to 75989.7‰oo (by 2.6%). This is the result of decreasing of dispensary and preventive activities among population. In next COVID-19 year (2021), as compared to 2020, indicator of primary morbidity increased to 85531.6‰oo that 12.6% higher than in 2020. The increase occurred in all classes of diseases that caused necessity of rehabilitation of these patients. The COVID-19 morbidity increased up to 2.4 times i.e. from 3391.1 in 2020 to 8085.7‰oo in 2021. The provision of physicians in the Russian Federation was 37.7‰o in 2021. Across the Federal Okrugs differences in indicators made up to 1.3 times and in subjects of the Russian Federation - up to 2.7 times. In conditions of COVID-19 significance of menaces to population health worsened. The situation requires both enhancement of primary health care and implementation of physicians of new formation - general practitioners responsible for patient health. The general practice (GP) widely developed in Russia in the 1990s during last ten years loses its significance in most subjects of the Russian Federation. In 2021, provision of general practitioners in the Russian Federation made up to 0.67‰o. In the Federal Okrugs, difference between indicators made up to 5.6 times. In the subjects of the Russian Federation the difference is enormous - 141.5 times. The article presents and scientifically substantiates prospective functional organizational models of general practice. The established situation with COVID-19 infection requires development of management decisions and measures at the regional level concerning improvement of organization of primary health care and implementation of general practice in conditions of counteracting risks of menaces to population health and health preservation.

Актуальные проблемы эпидемиологии офтальмологической заболеваемости среди молодежи России и Центрального федерального округа.

Indicators of primary morbidity of the eyes and their appendages in adolescents aged 15–17 years and young people, in particular among students of higher educational institutions, increase annually due to increased visual stress as risk factors. The purpose of the work is to identify current problems in the epidemiology of ophthalmological morbidity among young people in the Russian Federation and the Central Federal District. Materials and methods. A theoretical analysis of the literature on the epidemiology of ophthalmic diseases in young people and a search for statistical data on the epidemiology of ophthalmic diseases was carried out. To assess the dynamics of epidemiological indicators, an increase calculation was carried out. Results. The increase in the incidence of visual organs in adolescents per 100 thousand children aged 15–17 years from 2000 to 2021 was +47.9%, and from 2018 to 2019 the increase in the incidence of myopia was +9.2%. In the structure of diseases for adolescents, it is pathologies of the visual organs that lead, and 40% of students have visual impairments, the detection of which increases by 3–7% annually, while the severity of myopia grows every year by 5–7%. The increase in morbidity of the eyes and adnexa in the Central Federal District for 2019–2021 was +57.5%, however, morbidity statistics do not consider the age distribution of diseases and their structure. The largest (+296.0 +110.1%) increase per 100 thousand population is observed for the Vladimir, Voronezh, Lipetsk, Ivanovo and Kaluga regions. It was revealed that in 2017, the incidence rate of eyes and their appendages in the Voronezh region over 10 years increased from 64.8 to 94.8 per 1000 students, 45.6% of students had impaired visual acuity. In the region, there is a staff shortage of ophthalmologists, insufficient coverage of preventive examinations and a low level of detection of patients at an early stage of disease. Conclusion. The epidemiology of eye diseases on the territory of the Russian Federation and its constituent entities in the young population has not been sufficiently studied. Improving regional analysis tools will help identify factors of variability in the epidemiology of eye diseases across the country’s regions. In regions with a high increase in ophthalmic morbidity, it is necessary to study in more detail the epidemiology of vision diseases in young people.

Использование высокотехнологичных методов лечения – путь повышения эффективности и качества оказания специализированной медицинской помощи пациентам с урологической патологией.

Diseases of the genitourinary system due to their high prevalence in the population and the frequent development of complications are an urgent medical and social problem and require timely, effective and high-quality medical care. In the Russian Federation, urolithiasis, prostate adenoma, obstructive (reflux) uropathies occupy the leading positions in the structure of hospitalized morbidity in urological departments of hospitals, which account for more than 3/4 of all hospitalizations. Improving the efficiency and quality of medical activities in providing specialized medical care to patients with diseases of the genitourinary system in hospital settings requires the use of high-tech diagnostic and treatment methods. The purpose of the study is to study the dynamics of morbidity of the adult population of the Orenburg region with diseases of the genitourinary system, and to assess the effectiveness and quality of specialized medical care for patients in the urological department of the Orenburg Regional Clinical Hospital. Materials and methods. The study analyzes information copied from information statistical collections of the Ministry of Health of the Orenburg Region and the Federal State Statistics Service. The indicators of general and primary morbidity of diseases of the genitourinary system among the adult population of the Orenburg region are analyzed. The dynamics of changes in morbidity rates was studied for the period from 2017 to 2021 by constructing dynamic series and calculating special indicators: absolute increase/decrease, growth/decrease rate, growth/decrease indicator, visibility indicator. To assess the effectiveness and quality of specialized medical care for patients with diseases of the genitourinary system, the urological department of the Orenburg Regional Clinical Hospital named after V. I. Voynov was selected as the base of the study. During the study, the bed performance indicators and special indicators of the effectiveness and quality of medical activities were analyzed. Study period: 2019–6 months of 2023. In addition, a comparative analysis of the department’s performance in 2007 and 2022 was carried out. The following research methods were used: statistical and analytical. Statistical processing of the materials included the calculation of absolute, relative and average values. Results. In the Orenburg region, from 2017 to 2021, the level of general morbidity of the adult population with diseases of the genitourinary system decreased by 14,4%. At the same time, in the studied region over the past period, the indicator of primary morbidity of the adult population with diseases of the genitourinary system had a more pronounced decrease, which amounted to 37,4% over five years. It has been established that over the past 5 years, when high-tech operations using endoscopic and laser technologies were widely performed in the urological department of the hospital, the overall performance of the department has improved. The exception was in 2020, when a tense epidemiological situation was recorded for the new coronavirus infection Covid‑19. In the last 3 years, there has been a decrease in the average length of patient stay in bed, which allowed an increase by 19,3% in the number of treated patients, as well as to perform more operations – in 2022, 1 019 surgical interventions were performed compared to 905 in 2019. The urology department of the hospital has a low mortality rate, which was minimal (0,3%) in 2019 and 2023. As a result of a comparative analysis of the performance of the urological department in 2022 and in 2007, it was found that in recent years, the average length of stay in a bed has decreased in 2,5 times. If in 2007 the number of operations amounted to 385, then in 2022 their number increased to 1019. At the same time, the turnover of the bed increased 2,6 times. There was also a 27,5% increase in surgical activity. Conclusions. Thus, in the Orenburg region over the past five years, there has been a decrease in the level of general morbidity of the adult population with diseases of the genitourinary system by 14,4%, and the level of primary morbidity of the adult population with diseases of the genitourinary system by 37,4%. The introduction of high-tech methods of surgical treatment, including endoscopic and laser technologies, in the urological department of the V. I. Voynov State Medical University has significantly improved the efficiency and quality of specialized medical care for patients with diseases of the genitourinary system.

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.

Estimation of the morbidity of persons of an organized collective in the Subarctic belt

Introduction. Weather, climatic conditions, and technogenic pollution of the habitat can determine the characteristics of the response of the organism of various groups of the population. 
 Purpose — assessment of the morbidity of persons of an organized team in conditions of ecological trouble in the Subarctic climatic zone. 
 Materials and methods. The object of observation is the prevalence (including primary incidence) according to ICD-10 for 2016–2021 among military personnel serving under contract in Norilsk (n = 200). The observed male cohort was a newcomer population, engaged in mental work; the share of persons with work experience in the specialty in this climatic zone of 3–10 years was 80.0%. We compared the incidence rates of the observed group and the adult population of Norilsk. Assessed working conditions according to the intensity of the labour process. 
 Results. The working conditions are harmful, the class of working conditions is 3.3. In the subarctic zone, under anthropogenic load, the prevalence of diseases and primary morbidity in people of mental labour are 1.7 times and 24.0% higher than in the adult population of Norilsk; in the 6 leading classes (with the exception of injuries), the primary incidence exceeded that in the adult population of the Krasnoyarsk Territory by 1.9–10.8 times. In the long-term trend, the prevalence and incidence increased with absolute values, respectively, by 63.8‰ and 57.5‰, deviations from the base value of 1.7% and 6.1% per year. 
 Research limitation. Male persons from among the alien population engaged in mental work in an organized team in a dysfunctional environment.
 Conclusion. To prevent the morbidity of the population in adverse living conditions, it is necessary not only to assess the weather and environmental troubles to develop preventive measures to reduce the anthropogenic load, prevent cold risk, but also to analyze the incidence in the management of labor in a particular production.

Antibiotic therapy in pediatric outpatient ENT infections

Inflammatory diseases of the ENT organs are currently the most common pathology in children. Diseases of the nasal cavity and paranasal sinuses occupy the leading place in the structure of primary morbidity, averaging 55.5%. In the paediatric population, ENT pathology develops more often as a secondary bacterial complication of a previous viral infection of the upper respiratory tract. Bacterial otorhinolaryngological complications often require the prescription of antibacterial drugs. In outpatient practice, the choice of rational and safe therapy is of utmost importance. The article presents clinical cases of ENT diseases in children and algorithms for the choice of initial antibacterial therapy. Recommended drugs for the treatment of ENT diseases and the main indications for their administration are presented. Most national and international guidelines recommend amoxicillin as a first-line drug for the treatment of major respiratory pathogens (S. pneumoniae, H. influenzae, S. pyogenes) and bacterial complications of ENT diseases in children, taking into account its low toxicity, cost and convenient form of administration. In case of ineffective therapy or in the presence of risk factors for drug resistance of pathogens, semi-synthetic penicillins in combination with β-lactamase inhibitors are recommended.

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

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

Особенности заболеваемости детей болезнями костно-мышечной системы и соединительной ткани в Чеченской республике.

Pathology of the musculoskeletal system is of great medical and social importance and is one of the ten most common diseases. The high prevalence of diseases is due to a variety of risk factors. Polyethics, Cultural, Territorial and Demographic Features of the Chechen Republic (high birth rate, high proportion of the child population, predominance of rural residents, shortage of medical personnel), are reflected in the specifics of the provision of medical care to the population, and the analysis of the incidence of diseases of the musculoskeletal system and connective tissue in children is of interest and the need for detailed consideration. The purpose of the study: to determine the peculiarities of primary and general morbidity of diseases of the musculoskeletal system and connective tissue in children in the Chechen Republic. Materials and methods. Primary and general morbidity rates of children with musculoskeletal and connective tissue diseases were assessed and analyzed according to official statistical reports and publications of the Federal State Statistics Service and the Ministry of Health of Russia for the Chechen Republic in dynamics for 2016–2022. Statistical processing was performed in MS Office‑2016 program (Word, Excel). Results. The study showed a low incidence of musculoskeletal and connective tissue diseases in children in the Chechen Republic. The incidence of children in the groups of 0–14 and 15–17 years for the last 7 years has generally had a decreasing dynamics, with a change of trend: a decrease in 2016–2019 and an increase in cases of most nosologies in 2020–2022. Against the background of the COVID‑19 pandemic, there was a significant increase in deforming dorsopathies and arthropathies in general, including reactive arthropathies and juvenile arthritis. At the same time, no such correlation was found in rheumatoid arthritis: against the background of the pandemic, the downward trend in the registration of cases was continued. Conclusions. When organizing medical care for children with diseases of the musculoskeletal system and connective tissue, the prevalence of pathology, the level of medical staffing and the age composition of the child population should be taken into account. During 2016–2022, a decrease in primary morbidity prevailed in children 0–14 years of age, and in adolescents – in total morbidity. The COVID‑19 pandemic (the virus itself, decreased physical activity, and conditions limiting the availability of ambulatory care) contributed to the increase in most arthropathies and deforming dorsopathies. On the contrary, the incidence of rheumatoid arthritis in children has been steadily decreasing for 7 years.

Incidence of sudden cardiac death among diseases of the circulatory system during the COVID-19 pandemic in the Penza region

To study the incidence of sudden cardiac death (SCD) among overall and primary morbidity of diseases of the circulatory system (DCS) during the COVID-19 pandemic, as well as several years before it in urban and rural populations of the Penza region. Statistical analysis of data using correlation (Pearson's coefficient), regression methods, t-test was performed to determine the significance of results. The higher incidence of DCS among men in urban areas has been found. COVID-19 morbidity did not cause an increase in the incidence of SCD in the rural population in comparison with primary DCS morbidity, which was strongly correlated with the prevalence of novel coronavirus infection.

HEALTH AND DEMOGRAPHIC INDICATORS IN POPULATION OVER WORKING AGE

Highlights An analysis of the medical and demographic situation in the Russian Federation during the covid years (2020–2021) showed that the mortality rate in the studied population increased by 39.1%, the primary morbidity rate – by 26.3%, the incidence of COVID-19 increased by 135.6% and amounted to 10,304.1. The results of the study should be taken into account in the development of management decisions on the health of the elderly population at the federal, regional and municipal levels, as well as for planning dispensary work and preventive care for this population. Aim. To conduct an analysis of medical and demographic indicators and mortality rate in the population older than working age to develop management solutions regarding the health of older adults in the context of pension reforms.Methods. The study analyzed statistical data from the Federal State Statistics Service and the Central Scientific Research Institute of Public Health of the Russian Ministry of Health for period from 2012 to 2021.Results. The mortality rate in the population older than working age in the Russian Federation in 2021 amounted to 5 102.3‰oo. In the federal districts, the fluctuations in indicators were 1.3-fold: from 4 091.6‰oo in the North Caucasian Federal District to 5 374.6 in the Siberian Federal District. In the constituent entities of the Russian Federation, the difference between indicators was significant (2.9-fold): from 2 066.6‰oo in the Republic of Ingushetia to 5 974.6 in the Novgorod region. In 2021, the primary morbidity rate in the population older than working age in the Russian Federation was 66 183.5, in the Federal District the difference between indicators was 1.25-fold, the highest values ​​were noted in the Siberian Federal District – 73 257.0‰oo, the lowest in the Central Federal District – 58 462.2. In other constituent entities of the Russian Federation, the difference was significant as well (2.3-fold): the Oryol region showed 91 162.7‰oo, in the Kursk region - 39 282.9. In 2021, the following diseases had high morbidity rate in the Russian Federation: respiratory diseases – 21 391.3‰oo (32.3%), COVID-19 – 10 304.1 (15.6%), injury, poisoning and certain other consequences of external causes – 6 528.1‰oo (9.9%), and diseases of the circulatory system amounted to 6 191.7‰oo (9.4%). Regarding this class of diseases, the highest morbidity rates were associated with high blood pressure – 29.9%, cerebrovascular diseases – 28.4%, and hypertension– 25.4%. In federal subjects of the Russian Federation, the difference in the incidence of COVID-19 in the studied population was almost 6-fold in 2021: from 3463.4‰oo in the Chechen Republic to 20 481.6‰oo in the Altai Republic, indicating the ambiguity of COVID-19. During the year of the analysis (2020–2021), the mortality rates in the studied population increased from 4 408.1 to 5 102.9‰oo (by 39.1%), the primary incidence increased from 57 041.4 to 60 183.5‰oo (by 26. 3%), the incidence of COVID-19 increased from 4 373.9 to 10 304.1 COVID-19 (by 135.6%).Conclusion. The results of the study should be taken into account at the federal, regional and municipal levels during planning dispensary and preventive work for the health protection of the older generation.

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.

Morbidity rates of the children population under conditions of aerogenic chemical exposure: risk factors and associations

Introduction. In the the industrialized regions of the Russian Federation one of the hygienic problems is the formation of additional morbidity among the population associated with intense air pollution.
 The purpose of the work is to study the health disorders in children under conditions of aerogenic chemical exposure in terms of primary morbidity.
 Materials and methods. Analysis of the primary morbidity of the children population (data from state statistical reporting and actual seeking medical care in 2017–2021); the content of the main chemical pollutants in the atmospheric air in residential buildings (data from social and hygienic monitoring and the regular observation network of Roshydromet for 2016–2020 according to the content of twenty two impurities); chronic non-carcinogenic risk; connection of diseases with aerogenic chemical exposure according to epidemiological indicators; economic assessment of predicted losses.
 Results. Comparing to the reference area, the level of primary morbidity in children with diseases of the respiratory system, digestion, kidneys, nervous system, osteoarticular apparatus, associated with aerogenic exposure to chemical pollutants, was established to be an increased by up to 3.4 times. In the atmospheric air of residential buildings, the content of a number of chemicals (metals, aromatic and fluorine-containing inorganic compounds) was found to be increased by 6.9 times and 4.0 times relative to the average daily and maximum one-time maximum permissible concentrations, respectively, and within the hygienic standards. The formed exposure causes an unacceptable risk of developing non-carcinogenic effects (HI up to 18.7 times) in relation to target organs. Additional morbidity in the children population (about 1.5 thousand cases per year) has been identified in the event of which the projected economic losses will amount to about 10 million rubles over year.
 Limitations. The study includes the children population under the age of 14 years.
 Conclusion. The primary morbidity of children in regions with developed industrial infrastructure is characterized by special random events associated with aerogenic exposure to risk factors. Projected additional losses require priority regulatory action.

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%.

Заболеваемость острым коронарным синдромом в Российской Федера- ции и в Республике Башкортостан.

Purpose of the study. Based on an analysis of the medical and demographic situation and the incidence of acute coronary syndrome in the Russian Federation, in the federal districts and constituent entities of the Russian Federation, as well as in the pilot territory of the Republic of Bashkortostan, proposals are given for the development of management decisions at the regional and federal levels. Materials and methods: statistical, analytical. We used statistical materials of the Federal State Statistics Service (2014–2021), statistical materials: M., TsNIIOIZ of the Ministry of Health of the Russian Federation (2023) and the Republic of Bashkortostan MIAC, Ufa (2022). Results. The leading cause of mortality in the Republic of Belarus, as well as in the Russian Federation as a whole, is diseases of the circulatory system (CVD). In 2022, the mortality rate of the population from CVD in the Republic of Belarus was 459,5 per 100 thousand population, in the Russian Federation the figure was higher – 560,8‰oo. Fluctuations in indicators in the constituent entities of the Russian Federation are 7,6 times. The primary morbidity rate of the adult population in the Republic of Bashkortostan was BSK (2022) 4948,6‰oo. Acute coronary syndrome (ACS) is a group of clinical symptoms or signs suggestive of acute myocardial infarction (MI) or unstable angina (UA). The primary incidence rate of the adult population of the Republic of Belarus with unstable angina pectoris was (2022) 113,8‰oo, acute myocardial infarction – 97,7‰oo, in the Russian Federation the figures are higher – 106,7 and 140,8‰oo, respectively. The difference in the incidence of myocardial infarction among the adult population in the constituent entities of the Russian Federation is 9,3 times; the difference in unstable angina is huge – 54 times, which to a certain extent indicates the ambiguity of the coding of unstable angina. The study indicates the need for an in-depth analysis of the incidence of acute coronary syndrome in the constituent entities of the Russian Federation. Conclusions. It is necessary to develop management decisions, including improving the accessibility and quality of cardiac care to thepopulation, including patients with acute coronary syndrome, at the regional and federal levels.

STUDY OF THE PROBLEM OF CHILDREN’S EPILEPSY IN THE REPUBLIC OF SAKHA (YAKUTIA)

Epilepsy is one of the most common diseases of the nervous system in children. According to WHO, more than 50 million people worldwide suffer from epilepsy. It is estimated that the proportion of the general population with its active form (that is, with recurrent seizures and the need for treatment) currently ranges from 4 to 10 per 1,000 people. Globally, 2.4 million people are diagnosed with this disease every year. In Russia, epilepsy affects more than 1 million people. The analysis of statistical data on the prevalence and incidence of epilepsy in children in the Republic of Sakha (Yakutia) was carried out. In Yakutia, the first epidemiological study of epilepsy in the pediatric population was conducted in 1985 by E.A. Krivogornitsyna. As a result of the survey, data were obtained on 322 children who were registered at the dispensary with neurologists and psychiatrists in 32 districts of the republic and the city of Yakutsk. According to the study of the epidemiology of epilepsy in children in 2004 (Baisheva G.M., 2004), the prevalence of epilepsy was 5.2 per 1,000 children of the Republic of Sakha (Yakutia), and the primary incidence was 114 per 100,000 children. Prevalence of epilepsy in children under 14 years of age in 2020 was 5.4 per 1,000 population, the primary incidence was 50 per 100,000 population. On average, from 2010 to 2020, the primary incidence of epilepsy in children is 80 per 100,000 population. The prevalence of epilepsy in adolescents aged 15 – 17 years averaged 10.4 %. The average value of primary morbidity in this group of children was 140 per 100,000 population. The organization of comprehensive medical care will make it possible to form a strategy for the management of epilepsy patients at the municipal and republic levels.

Primary morbidity of adolescents in the Vilyui group of districts of the republic of Sakha (Yakutia) in 1996–2021

The analysis of the primary morbidity of the adolescent population of the districts/uluses included in the Vilyui group (Verkhnevilyuisky, Vilyuisky, Mirninsky, Nyurbinsky and Suntarsky) has been carried out. First, we analyzed the morbidity data in the indicated uluses in a comparative aspect with all the administrative-territorial formations of the republic. At the same time, the levels of morbidity for certain classes of diseases were revealed in dynamics for the periods under consideration. It was found that, in terms of the incidence of adolescents, in general, the Suntarsky, Nyurbinsky and Verkhnevilyuisky uluses had a relatively better position, and the Vilyui ulus had a relatively worse position. In the Vilyui ulus, relatively high levels of primary morbidity are noted in 12 classes of diseases out of 17, while in the Nyurbinsky ulus – one each.

Особливості захворюваності дорослого населення Дніпропетровської області на урологічні хвороби

Purpose: to determine the regional features of urological morbidity and its specific weight in the structure of the general morbidity of the adult population of the Dnipropetrovsk region. Materials and methods. Bibliosemantic, analytical, and medical-statistical methods were used, which make it possible to characterize the current state of health of the population and determine trends in the incidence and prevalence of diseases. The results. The average long-term indicator of the primary morbidity of the population of the Dnipropetrovsk region for all classes of diseases was 7,272.23 per 10,000 adult population, total morbidity was 22,250.84 per 10,000 adult population with a tendency to increase, hospital morbidity was 2,167.9 per 10,000 adult population, with a general tendency to decrease the level of hospitalization. Diseases of the genitourinary system rank second, fourth, and sixth in the structure of primary morbidity, prevalence of morbidity, and hospital morbidity of the adult population, respectively. The leading nosological groups of urological diseases registered for the first time in the adult population of the region are cystitis - 64.88 cases per 10 thousand population, kidney infections - 43.23 per 10 thousand population and kidney and ureter stones - 17.92 per 10 thousand population with a tendency to increase indicators during the studied period, with the exception of kidney and ureter stones. Similar trends persist for the prevalence of diseases. The level of hospitalization of the population of the region turned out to be the highest for kidney and ureter stones - 25.28 per 10 thousand population and kidney infections - 20.01 per 10 thousand population, remained relatively stable during 2012-2019, while during 2020- In 2021, a significant decrease was noted for kidney and ureter stones, kidney infections, while the indicator of hospital morbidity for kidney and ureter stones remained relatively stable. Conclusions. Significant levels of morbidity and prevalence of diseases of the genitourinary system, including urological diseases, negative trends towards their increase require improvement of monitoring of the health status of the population, prevention, timely and complete detection of urological pathology, and high-quality treatment.

Estimation of morbidity of military personnel under contract in extreme living conditions

We analyzed the incidence of military personnel in the Arctic, subarctic (Arctic zone) and continental climatic zones for 2015–2020. In terms of the prevalence of diseases, the highest registration was determined in the Subarctic, respectively 3493.2 ± 12.7‰, 3692.6 ± 19.2‰ and 2610.1 ± 72.6‰. However, in the conditions of the Arctic, it is difficult to provide general medical or specialized medical care due to the duration of non-flying weather. The incidence of the class «Diseases of the genitourinary system» in the Arctic exceeded that in other climatic zones, 1.3–1.6 times. In the Subarctic, the most highly recorded pathology of the digestive system. For diseases of the respiratory and digestive organs, genitourinary, musculoskeletal, endocrine systems and blood circulation, the excess in the Arctic zone, compared with the continental climate, reached 1.3–2.0 times. Primary morbidity in different climatic zones did not differ. The first four ranking places were left for diseases of the respiratory, genitourinary, musculoskeletal and endocrine systems. In the conditions of the Arctic zone, traumatism was relevant, and in the conditions of the Subarctic and continental climates, diseases of the ear and its mastoid process. The prevalence of diseases in the Arctic zone proves the influence of weather and climate conditions on the health of servicemen. Differences in the prevalence of diseases in the Arctic and Subarctic regions were determined by the class «Diseases of the genitourinary system»: 2nd and 6th ranking places (excess by 1.3 times, p = 0.01). In the continental climate, indicators for diseases of the genitourinary, musculoskeletal and endocrine systems, the circulatory system and the digestive system did not differ. In the Arctic zone, data on diseases of the endocrine system did not differ and were less significant (by 1.3–1.4 times) than in the continental belt, but the injury rate was 1.5–2.1 times higher. The revealed features in the long-term dynamics of the incidence of military personnel allow us to adjust the directions of preventive activities.