Sanitary-epidemiological Welfare Research Articles

Analyzing and assessing risks for accredited inspection bodies

The legislation of the Russian Federation stipulates the necessity for accreditation within the national system that en-compasses organizations engaged by control (surveillance) bodies to accomplish inspections. Activities performed by inspection bodies have strategic importance and provide necessary support for surveillance over implementation of national development projects. It is especially relevant to provide uninterrupted functioning of accredited inspection bodies. Contemporary conditions require improvement of the existing legal and organizational approaches used by federal budgetary institutions in their activities as well as developing and implementing new ones. Statistical data on the research object of the present study and relevant mathematical models are non-existent; given that, we applied an expert approach to risk identification using the Delphi method and expert judgment. The aim of this study was to analyze and assess risks in activities performed by an accredited inspection body and suggest ways to minimize them. Two groups took part in the study. The first one included experts (18 technical directors of three inspection bodies); the second group was made of analysts. The most competent specialists in the analyzed field of activity where risks would be identified were selected as experts. Their functional duties covered responsibility for risks associated with activities of an inspection body as well as for responses to them. To obtain ideas of analyzed risks, we used a questionnaire to collect experts’ answers and to distribute them into specific categorize for further analysis. A risk level was identified by using the risk analysis diagram. Any response measures were taken relying on this level. We created a register of risk levels and responses to them. A high risk was identified in activities performed by an inspection body as regards external influence of new changes in the legislation. Reformation of the accreditation system for organizations operating in the sphere of providing sanitary-epidemiological welfare may be a potential solution to the existing problem.

Анализ и оценка рисков для аккредитованных органов инспекции

The legislation of the Russian Federation stipulates the necessity for accreditation within the national system that en-compasses organizations engaged by control (surveillance) bodies to accomplish inspections. Activities performed by inspection bodies have strategic importance and provide necessary support for surveillance over implementation of national development projects. It is especially relevant to provide uninterrupted functioning of accredited inspection bodies. Contemporary conditions require improvement of the existing legal and organizational approaches used by federal budgetary institutions in their activities as well as developing and implementing new ones. Statistical data on the research object of the present study and relevant mathematical models are non-existent; given that, we applied an expert approach to risk identification using the Delphi method and expert judgment. The aim of this study was to analyze and assess risks in activities performed by an accredited inspection body and suggest ways to minimize them. Two groups took part in the study. The first one included experts (18 technical directors of three inspection bodies); the second group was made of analysts. The most competent specialists in the analyzed field of activity where risks would be identified were selected as experts. Their functional duties covered responsibility for risks associated with activities of an inspection body as well as for responses to them. To obtain ideas of analyzed risks, we used a questionnaire to collect experts’ answers and to distribute them into specific categorize for further analysis. A risk level was identified by using the risk analysis diagram. Any response measures were taken relying on this level. We created a register of risk levels and responses to them. A high risk was identified in activities performed by an inspection body as regards external influence of new changes in the legislation. Reformation of the accreditation system for organizations operating in the sphere of providing sanitary-epidemiological welfare may be a potential solution to the existing problem.

Determining priority socio-hygienic determinants of life expectancy at birth for the Russian Federation population

Introduction. The study focuses on examining socio-hygienic determinants of life expectancy at birth as an integral health indicator at the federal level. Purpose of study. To determine propriety socio-hygienic determinants of life expectancy at birth (LEB) for the population of the Russian Federation. Materials and methods. Our initial data were taken from the statistical reports issued by Rosstat and Rospotrebnadzor in 2010-2018 in all 85 RF regions - 148 indicators of habitat and lifestyle factors were analyzed. The indicators were structured as a data matrix. Effects produced by them on LEB were calculated by using factor analysis and an artificial neural network based on a four-layer perceptron. Results. We determined fory priority socio-hygienic determinants with the greatest influence on the existing level of life expectancy at birth. Seventy-seven point five percent of them were lifestyle indicators and socio-demographic ones; 12.5% described sanitary-epidemiological welfare of the population. The most significant effects on a LEB growth were produced by 1% increase in the following indicators: “Working hours per one employed person per week”, 7.32 days; “A share of population who have physical activity or do sports”, 4.52 days; “Equipment of housing with centralized water supply”, 3.71 days. Limitations. This study has certain limitations including a limited set of the analyzed factors that modify LEB - 148 indicators over 2010-2018 as per region of the Russian Federation; an area within which initial statistical indicators were determined and limited scenarios of changes in them, properties of the employed artificial neural network. Conclusion. Planning activities aimed at improving the existing medical and demographic situation requires developing adequate approaches to determining priority socio-hygienic determinants given the effects produced on LEB by multiple environmental and lifestyle factors that are variable and heterogeneous as per their types and intensity of their influence.

Assessing potential of the gain in the life expectancy of population using artificial neural networks

Introduction. At present it is especially vital to search for and test new analytical systems that can give a possibility to predict a medical and demographic situational lowing for multifactorial influence exerted by the environment. Our research goal was to establish regional peculiarities and predictive estimates of potential gain in such an important indicator as life expectancy at birth (LEB) depending on changes in socio-hygienic determinants potent of modifying it. To do that, we took data collected in a RF region where the current demographic situation was rather tense against the backdrop of stable economic conditions. Materials and methods. A potential of the gain in LEB was estimated by modelling cause-effects relations between environmental indicators and life-style related ones, or determinants that determined population health. Models were created by using artificial neural networks. Results. Our methodology was proven to be optimal and precise (differences are equal to 0.98%). It can be applied quite successfully to predict a potential gain in LEB at a regional level together with identifying what modifying factors should be considered priority ones. LEB on the analyzed territory (the Perm region) was established to likely grow by 661.6 days by 2024 and reach 73.12 years; by 855.7 days by 2030 and reach 73.65 years if the current trends related to changes in the analyzed determinants persisted and the achievement of target indicators of national projects and regional development programs. In case the relevant targets set within national projects and regional development programs were achieved, this indicator would grow by 661.6 days and reach 73.12 years. The most significant groups of factors that determine LEB on the analyzed territory against the backdrop of stable economic situation include sanitary-epidemiological welfare (working conditions et al.), public healthcare indicators (population provided with sufficient number of doctors), sociodemographic indicators (expenses on social policies), lifestyle factors (the proportion of the population involved in physical culture and sports; consumption of vegetables and fruits; retail sales of alcoholic beverages, etc.). Their contribution to the gain in LEB varies from 51.2 to 228.6 days. Limitations. Limitations of the study include the model being “stationary” due to its training relying on data collected in 2010-2019; use of a specific set of indicators; failure to consider the influence exerted by the current epidemiological processes (the COVID-19 pandemics). Conclusion. We analyzed data collected in an RF region with a rather tense demographic situation and established that by 2024 an adjusted target LEB value would be achieved there if the trend in changes in socio-hygienic determinants recovered to its pre-pandemic levels. Achievement of target LEB values by 2030 requires additional project activities that consider specific regional features and focus on managing priority determinants and reducing mortality among working age population.

Modifying impact of environmental factors on the course of an epidemic process

Introduction. It is necessary to establish peculiarities and regularities of COVID-19 infection; this task requires further research on how to formalize and build spatial-temporal models of the infection spread. This article focuses on determining non-infectious factors that can modify the epidemic process caused by the COVID-19 coronavirus for further substantiation of integrated solutions that are necessary to ensure sanitary-epidemiological welfare of the RF population. Materials and methods. Our study involved analyzing regularities of regional differentiation in parameters introduced into mathematical models. These models described how the epidemic process developed in RF regions depending on modifying non-infectious factors identified by modelling the dynamics of spread of SARS-CoV-2 delta strain. These modifying factors included anti-epidemic activities; sanitary-epidemiological, sociodemographic, and economic conditions in a region; weather and climate; public healthcare systems and people’s lifestyles in RF regions over 2020-2021. The dynamics of the epidemic process was modelled by using the conventional SIR-model. Relationships between parameters introduced into the model of the epidemic process and modifying regional conditions were examined by using correlation-regression analysis. Results. The modelling made it possible to identify priority risk factors that modified COVID-19 spread authentically (p<0.05) and explained regional differences in intensity of contagion, recovery and lethality. We established that population coverage with vaccination, especially among people aged 31-40 years, had the greatest authentic positive influence on the decline of reproduction index (R0) of the virus (r=-0.37). An increase in monthly average temperatures in autumn and winter as well as over a year made for people moving faster from the susceptible to infected category (r=0.21-0.22). Growing sun insolation over a year, especially in summer, resulted in slower movement of susceptible people into the infected category (r=-0.02-(-0.23)). Next, several sanitary-epidemiological indicators authentically made the infection spread faster; they were improper working conditions (not conforming to the safety standards as per physical indicators) and ambient air quality in settlement not corresponding to the hygienic standards as per chemical indicators and noise (r=0.29-0.24). Recovery took longer in regions where alcohol consumption was comparatively higher (r=-0.32). Limitations. The limitations of the study include modelling the epidemic process using the standard SIR model; limited set of indicators and period of analysis. Conclusions. The existing regional differentiation in development of specific stages in the epidemic process related to the COVID-19 delta strain occurs due to complex interactions and influence exerted by modifying factors that create a certain multi-level and multi-component system. This system is able to transform the epidemic process either potentiating it or slowing it down.

Digital technologies in the tasks of managing the sanitary-epidemiological situation at the level of the subject of the Federation

The relation of tasks of managing the sanitary and epidemiological situation at the regional level to the storage, transmission and analysis of large data arrays determines the relevance of their digitization for data transformation and computational operations. Purpose: to use digital technologies for processing dynamic spatially distributed information to optimize management decisions regarding the provision of sanitary-epidemiological welfare of the population. Methods: system and mathematical analysis, geoinformation analysis, forecasting, online consulting, computing technologies. Results. Using the example of the Krasnoyarsk Territory, digital technologies were used to assess, analyze and optimize the sanitary-epidemiological situation at the regional and municipal levels (55 municipalities, 2.9 million people, 40 thousand production facilities, 19 classes of diseases and causes of death, about 10 years of observations, 50.0 thousand health studies, etc, a total of 1.5 billion units of information). The territorial distribution of the total risk of causing potential harm to the health of the population has been quantified with geoinformation binding, and a shift in priorities towards the location of the activities of economic entities has been revealed. The zones of aerotechnogenic impacts on the population were digitized, the maxima of the spread of diseases associated with the risk of harm to the health of the exposed population were estimated. There are obtained digital parameters of models of dependence of morbidity of the population on the total risk of harm to the health of the population formed by subjects of various types of aactivity. With the use of digital technologies, at the regional level there is substantiated an effective model of the system of socio-hygienic monitoring, based on the combination with risk-oriented control and supervisory activities. Their optimal interaction in relation to the sanitary-epidemiological situation is ensured by a cyclical interconnected planning process that eliminates zones of excessively high or unacceptably low intensity of observations. Limitations. The results of the conducted research on the use of digital technologies for processing dynamic spatially distributed information for the assessment, analysis and optimization of the sanitary-epidemiological situation are applicable only in the territories of federal districts, regional and municipal levels of the Russian Federation. Conclusion. The potential for optimizing the sanitary-epidemiological situation at the regional and municipal levels is quite high. Digitalization provides efficiency, high accuracy, and selection of scenario management decisions to minimize risks to public health.

Прогноз ожидаемой продолжительности жизни населения России на основе модели влияния комплекса социально-гигиенических детерминант на коэффициенты повозрастной смертности на примере болезней системы кровообращения

The article dwells on cause-effect relations between certain socio-hygienic factors and age-specific mortality rates due to cardiovascular diseases. New research trends in hygiene, a multidisciplinary approach to studies in the field and the current state policy make the present work topical. Our methodical approach to predicting probable age-specific mortality rates due to cardiovascular diseases relied on applying artificial neural networks. We analyzed a set of indicators that described the public healthcare system, sanitary-epidemiological welfare on a given territory, lifestyle, economic conditions, sociodemographic conditions, and primary incidence. Overall, we obtained 18 models (as per 5-year age-specific periods) of a relationship between socio-hygienic determinants and mortality rates due to cardiovascular diseases. The determination coefficients fell within 0.01–0.75 range and the greatest explanatory power occurred when the age period “30 years and older” was analyzed. We detected comparability of variational series obtained for mortality due to cardiovascular diseases among the whole population and the determination coefficients of the created models. We established predictive estimates of life expectancy at birth (LEB) in case there were changes in the analyzed socio-hygienic determinants by 2024 set within a certain scenario. Thus, changes in the whole set of determinants would result in 514 days added to LEB; lifestyle-related indicators, 205 days; indicators describing sanitary-epidemiological welfare, 126 days; economic indicators, 102 days; sociodemographic indicators, 101 days; primary incidence rates, 40 days; indicators describing the public healthcare system, 19 days. Several determinants were shown to be the most significant for reducing mortality due to cardiovascular diseases among working age population and older age groups. They are indicators describing people’s physical and motor activity, income levels, consumption of vegetables, education, and working conditions. Our research results are consistent with those obtained by other studies with their focus on establishing cause-effect relations between environmental factors and public health.

Life expectancy at birth for the rf population: prediction based on modeling influence exerted by a set of socio-hygienic determinants on age-specific mortality rates exemplified by diseases of the circulatory system

The article dwells on cause-effect relations between certain socio-hygienic factors and age-specific mortality rates due to cardiovascular diseases. New research trends in hygiene, a multidisciplinary approach to studies in the field and the current state policy make the present work topical. Our methodical approach to predicting probable age-specific mortality rates due to cardiovascular diseases relied on applying artificial neural networks. We analyzed a set of indicators that described the public healthcare system, sanitary-epidemiological welfare on a given territory, lifestyle, economic conditions, sociodemographic conditions, and primary incidence. Overall, we obtained 18 models (as per 5-year age-specific periods) of a relationship between socio-hygienic determinants and mortality rates due to cardiovascular diseases. The determination coefficients fell within 0.01–0.75 range and the greatest explanatory power occurred when the age period “30 years and older” was analyzed. We detected comparability of variational series obtained for mortality due to cardiovascular diseases among the whole population and the determination coefficients of the created models. We established predictive estimates of life expectancy at birth (LEB) in case there were changes in the analyzed socio-hygienic determinants by 2024 set within a certain scenario. Thus, changes in the whole set of determinants would result in 514 days added to LEB; lifestyle-related indicators, 205 days; indicators describing sanitary-epidemiological welfare, 126 days; economic indicators, 102 days; sociodemographic indicators, 101 days; primary incidence rates, 40 days; indicators describing the public healthcare system, 19 days. Several determinants were shown to be the most significant for reducing mortality due to cardiovascular diseases among working age population and older age groups. They are indicators describing people’s physical and motor activity, income levels, consumption of vegetables, education, and working conditions. Our research results are consistent with those obtained by other studies with their focus on establishing cause-effect relations between environmental factors and public health.

Developing the methodology for health risk assessment within public management of sanitary-epidemiological welfare of the population

The article focuses on generalizing Russian scientific and methodical developments aimed at updating and supplementing the health risk assessment methodology. This methodology is a key component in tackling tasks related to providing sanitary-epidemiological welfare of the population. Russian approaches to risk assessment are shown to have a significant peculiarity, which is a wide use of methods of multidimensional statistical analysis, mathematical modeling, fuzzy logic, and their combinations. The most significant Russian scientific innovations include development of qualitative risk assessment, non-carcinogenic health risks included; severity of health disorders taken into account in risk assessment; methodical support for assessing integral risks under exposure to heterogeneous environmental factors. Russian experts suggested and developed an idea that it was possible to model evolution of risks and their growth under changing exposures. Approaches to assessing risks evolution under long-term exposure to variable factors made it possible to solve a whole set of applied hygienic tasks. In addition to establishing qualitative characteristics of non-carcinogenic risks under exposure to chemicals, methods for assessing risks under exposure to environmental noise, certain lifestyle factors and factors related to work process have also been substantiated and implemented. Progressive development of the health risk assessment methodology ensured operative, smooth and effective transitions of control and surveillance activities performed by Rospotrebnadzor onto a fundamentally new control platform that relies on the risk-based model. Obviously, analytical opportunities offered by the health risk assessment methodology are extensive. Development of methodical grounds in hygiene and epidemiology as well as design of applied algorithms and approaches to risk assessment and management based on the fundamental methodology should involve several trends. We should extend our knowledge on mechanisms of health disorders under exposure to heterogeneous environmental factors and work-related ones; hygienic standardization needs improvement; we should apply situational modeling and prediction of sanitary-epidemiological welfare under changing or preset conditions; we should provide substantiation for the strategic and tactical regulatory actions aimed at managing threats and risks. The experience accumulated in developing the health risk assessment methodology in variable spheres should be considered a starting point for creating new risk assessment and risk management technologies. They should give an opportunity to solve any tasks related to providing sanitary-epidemiological welfare of the population in the Russian Federation.

Развитие методологии анализа риска здоровью в задачах государственного управления санитарно-эпидемиологическим благополучием населения

The article focuses on generalizing Russian scientific and methodical developments aimed at updating and supplementing the health risk assessment methodology. This methodology is a key component in tackling tasks related to providing sanitary-epidemiological welfare of the population. Russian approaches to risk assessment are shown to have a significant peculiarity, which is a wide use of methods of multidimensional statistical analysis, mathematical modeling, fuzzy logic, and their combinations. The most significant Russian scientific innovations include development of qualitative risk assessment, non-carcinogenic health risks included; severity of health disorders taken into account in risk assessment; methodical support for assessing integral risks under exposure to heterogeneous environmental factors. Russian experts suggested and developed an idea that it was possible to model evolution of risks and their growth under changing exposures. Approaches to assessing risks evolution under long-term exposure to variable factors made it possible to solve a whole set of applied hygienic tasks. In addition to establishing qualitative characteristics of non-carcinogenic risks under exposure to chemicals, methods for assessing risks under exposure to environmental noise, certain lifestyle factors and factors related to work process have also been substantiated and implemented. Progressive development of the health risk assessment methodology ensured operative, smooth and effective transitions of control and surveillance activities performed by Rospotrebnadzor onto a fundamentally new control platform that relies on the risk-based model. Obviously, analytical opportunities offered by the health risk assessment methodology are extensive. Development of methodical grounds in hygiene and epidemiology as well as design of applied algorithms and approaches to risk assessment and management based on the fundamental methodology should involve several trends. We should extend our knowledge on mechanisms of health disorders under exposure to heterogeneous environmental factors and work-related ones; hygienic standardization needs improvement; we should apply situational modeling and prediction of sanitary-epidemiological welfare under changing or preset conditions; we should provide substantiation for the strategic and tactical regulatory actions aimed at managing threats and risks. The experience accumulated in developing the health risk assessment methodology in variable spheres should be considered a starting point for creating new risk assessment and risk management technologies. They should give an opportunity to solve any tasks related to providing sanitary-epidemiological welfare of the population in the Russian Federation.

Predicting growth potential in life expectancy at birth of the population in the Russian Federation based on scenario changes in socio-hygienic determinants using an artificial neural network

The article presents the result produced by predicting growth potential in life expectancy at birth (LEB) of the RF Population. The predictions are based on scenario changes in social and hygienic determinants (SHD) identified by using an artificial neural network (ANN). This research is vital given the existing social strategies aimed at improving the medical and demographic situation in the Russian Federation. These strategies stipulate achieving targets set within the major national and federal projects. We identified an optimal ANN structure based on a four-layer perceptron with two inner layers containing eight and three neurons accordingly. This structure is able to produce results at the highest determination coefficient (R2= 0.78). Differences between actual LEB levels and predicted ones obtained by using the suggested model did not exceed 1.1 % (or 0.8 years). We established that average LEB in the RF would reach 75.06 years (by 2024) provided that the demographic situation in the country recovers in the nearest future, LEB level reaches its values detected in 2018–2019, and SHD values grow to their preset levels according to the target scenario. Therefore, the detected growth potential amounts to 3.0 years (1095 days) against 2018. “Lifestyle-related determinants” produce the greatest effects on the growth potential in LEB by 2024 (461 days). We also identified effects produced by such SHD groups as “Sanitary-epidemiological welfare on a given territory” (212 days), “Social and demographic indicators” (196 days), “Economic indicators” (131 days), “Indicators related to public healthcare” (70 days). An indicator that shows “A share of population doing physical exercises or sports” is the most significant determinant producing the greatest effects on potential changes in LEB. If it grows up to 55.0 %, a potential growth in LEB amounts to 243.5 days. If we do not consider COVID-related processes and rely only on the trends that are being observed now when predicting changes in the demographic situation by 2030, we can expect a possible additional growth in LEB that equals 286 days. The developed algorithm for determining growth potential in population LEB can be used as an instrument for determining and ranking priority health risk factors.

Прогноз потенциала роста ожидаемой продолжительности жизни населения Российской Федерации на основе сценарного изменения социально-гигиенических детерминант с использованием искусственной нейронной сети

The article presents the result produced by predicting growth potential in life expectancy at birth (LEB) of the RF Population. The predictions are based on scenario changes in social and hygienic determinants (SHD) identified by using an artificial neural network (ANN). This research is vital given the existing social strategies aimed at improving the medical and demographic situation in the Russian Federation. These strategies stipulate achieving targets set within the major national and federal projects. We identified an optimal ANN structure based on a four-layer perceptron with two inner layers containing eight and three neurons accordingly. This structure is able to produce results at the highest determination coefficient (R2= 0.78). Differences between actual LEB levels and predicted ones obtained by using the suggested model did not exceed 1.1 % (or 0.8 years). We established that average LEB in the RF would reach 75.06 years (by 2024) provided that the demographic situation in the country recovers in the nearest future, LEB level reaches its values detected in 2018–2019, and SHD values grow to their preset levels according to the target scenario. Therefore, the detected growth potential amounts to 3.0 years (1095 days) against 2018. “Lifestyle-related determinants” produce the greatest effects on the growth potential in LEB by 2024 (461 days). We also identified effects produced by such SHD groups as “Sanitary-epidemiological welfare on a given territory” (212 days), “Social and demographic indicators” (196 days), “Economic indicators” (131 days), “Indicators related to public healthcare” (70 days). An indicator that shows “A share of population doing physical exercises or sports” is the most significant determinant producing the greatest effects on potential changes in LEB. If it grows up to 55.0 %, a potential growth in LEB amounts to 243.5 days. If we do not consider COVID-related processes and rely only on the trends that are being observed now when predicting changes in the demographic situation by 2030, we can expect a possible additional growth in LEB that equals 286 days. The developed algorithm for determining growth potential in population LEB can be used as an instrument for determining and ranking priority health risk factors.

Typologization of russian regions as per environmental factors, factors related to educational process and schoolchildren’s health

The structure of children population determined as per health groups is an integral characteristic of population health in this age group; it can be used as a criterion in creating medical and preventive programs aimed at managing demographic processes and assessing their efficiency. Health disorders among children occur due to many reasons including influence by socioeconomic and sanitary-epidemiological factors, peculiarities of the educational process, eating habits, lifestyle, etc. Our research aim was to determine types of regions in Russia as per environmental factors, the educational process and schoolchildren’s health. Determining different types of regions was considered to be an information basis for developing common strategies and mechanisms for improving schoolchildren’s health. Typologization of regions as per health groups revealed that the most favorable situation was in 31 regions; the last favorable, only in 2. The most favorable situation as per the educational process was in 55 regions where schools operated in one shift; the least favorable situation was observed in two RF regions where schools had to operate in two or even three shifts. Relative sanitary-epidemiological welfare was found in 20 regions and the situation in 21 regions was the least favorable as per several markers that characterized quality of drinking water, ambient air, and soils. Socioeconomic situations in the regions were analyzed to reveal that only 3 regions could be considered the most favorable and 28 regions were the least favorable; the latter were combined into one cluster with the lower values of the relevant markers including gross regional products per capita, living standard, provision with qualified medical personnel and in-patient hospital beds. A situation in each particular region is a reflection of regularities related to influence exerted by a set of aforementioned factors on children’s health; this proves the necessity to create a road map for each region in the RF with feasible mechanisms aimed at improving the existing situation as per specific aspects.

Типологизация российских регионов по комплексу факторов среды обитания, учебно-воспитательного процесса и здоровья школьников

The structure of children population determined as per health groups is an integral characteristic of population health in this age group; it can be used as a criterion in creating medical and preventive programs aimed at managing demographic processes and assessing their efficiency. Health disorders among children occur due to many reasons including influence by socioeconomic and sanitary-epidemiological factors, peculiarities of the educational process, eating habits, lifestyle, etc. Our research aim was to determine types of regions in Russia as per environmental factors, the educational process and schoolchildren’s health. Determining different types of regions was considered to be an information basis for developing common strategies and mechanisms for improving schoolchildren’s health. Typologization of regions as per health groups revealed that the most favorable situation was in 31 regions; the last favorable, only in 2. The most favorable situation as per the educational process was in 55 regions where schools operated in one shift; the least favorable situation was observed in two RF regions where schools had to operate in two or even three shifts. Relative sanitary-epidemiological welfare was found in 20 regions and the situation in 21 regions was the least favorable as per several markers that characterized quality of drinking water, ambient air, and soils. Socioeconomic situations in the regions were analyzed to reveal that only 3 regions could be considered the most favorable and 28 regions were the least favorable; the latter were combined into one cluster with the lower values of the relevant markers including gross regional products per capita, living standard, provision with qualified medical personnel and in-patient hospital beds. A situation in each particular region is a reflection of regularities related to influence exerted by a set of aforementioned factors on children’s health; this proves the necessity to create a road map for each region in the RF with feasible mechanisms aimed at improving the existing situation as per specific aspects.

ТЕМПЫ ПРИРОСТА И ПРОГНОЗИРОВАНИЕ ОБЩЕЙ ЗАБОЛЕВАЕМОСТИ ЖИТЕЛЕЙ СЕЛЬСКИХ РАЙОНОВ

Introduction. It is necessary to forecast the development of population morbidity, based on the processing and analysis of accumulated reliable information to provide timely high-quality medical service, and to develop a set of targeted therapeutic and preventive measures. Aim. The aim of the study was to assess the features of the growth rate and to forecast general morbidity of the adult population in rural areas focused on different branches of agriculture. Material and methods. The processing and analysis of data from annual statistical reports of the Sanitary-Epidemiological Welfare and Public Health Service of Tashkent region on morbidity of adult population (18 years and older) living in Bostanlyk (fruit and vegetable) and Chinaz (cotton growing) districts were performed. Indicators of general morbidity of rural population in dynamics were studied for the period 2007–2018 by classes of diseases according to ICD-10. Comparative analysis of general morbidity was performed for two 5-year periods (2007–2011 and 2014–2018). Statistical analysis was performed using Microsoft Excel 2016 and Statistica 10.0 software packages. Student’s t-test was used to determine the significance of differences in mean values. Differences of arithmetic mean values were considered reliable at p < 0,05. Results and discussion. In the period from 2007 to 2018, the dynamic changes in the general morbidity of ВЕСТНИК СОВРЕМЕННОЙ КЛИНИЧЕСКОЙ МЕДИЦИНЫ 2021 Том 14, вып. 6 39ОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯ the adult population in the cotton-growing and, to a greater extent, in the fruit-and-vegetable districts of Tashkent province were characterized by a negative average growth rate (-6,8 vs. -66,5%). As a result of analysis of statistical data for 2014–2018, in comparison with 2007–2011, decrease of general morbidity of population in fruit and vegetable growing district by 39,5%, and on the contrary, in cotton-growing district there was increase by 9,6%. Forecasting indicates a further decrease in the general morbidity of population in rural areas of Tashkent region in the coming years. At the same time, the tendency to further increase of respiratory diseases - in the fruit and vegetable growing district and respiratory, digestive and circulatory diseases – in the cotton-growing district is outlined. Conclusion. The observed decrease in the general morbidity of the rural population, apparently, is associated with the implementation in Uzbekistan of crop diversification policy since 2010, based on reducing the use of pesticides and mineral fertilizers. Significant prevalence of general morbidity of six leading classes of diseases, characteristics of growth rate and medium-term forecast create the need for monitoring and contribute to establishment of a set of measures for prevention, early detection of diseases and pathological conditions, taking into account the contributing risk factors.

РОЗВИТОК І СТАНОВЛЕННЯ СИСТЕМИ КОНТРОЛЮ ІНФЕКЦІЙНИХ ЗАХВОРЮВАНЬ ДО ХХ СТОЛІТТЯ

У цій роботі ми розглянули створення та розвиток національних та місцевих органів влади, завданням яких було забезпечення та реалізація національної політики щодо запобігання виникненню та поширенню інфекційних захворювань. Вивчалися повноваження органів державного та місцевого самоврядування в структурі системи контролю за поширенням інфекційних хвороб у російській імперії до початку ХХ століття. Показано відносний вплив розвитку медичної науки, міжнародної торгівлі на прийняття міжнародних санітарних конвенцій та розроблення нових правових документів у галузі профілактичної медицини та їх впровадження у структуру законодавства Російської імперії. Значення сільських та місь- ких реформ (1864) для розвитку профілактичної медицини. Створення умов для формування у структурі професійних установ місцевого самоврядування, відповідальних за санітарну та протиепідемічну роботу на територіальному рівні. Показано, що зі створенням нових форм самоврядування шляхи розвитку боротьби з інфекціями в сільській та міській медицині відносно відрізняються, насамперед, від специфічних умов життя та праці сільського та міського населення, до тяжкості дій тих факторів ризику, які вплинули на санітарно-епідеміологічний добробут населення.

Epidemiological Zoning of the Volga Federal District Territory by the Level of Potential Epidemic Hazard of Hemorrhagic Fever with Renal Syndrome Natural Foci

HFRS is a relevant threat to the sanitary-epidemiological welfare of the population of the Russian Federation. It takes a leading position in the structure of natural-focal ifections of viral etiology incidence around the country. The most unfavorable situation on HFRS morbidity rates (more than 80% of the overall incidence) is observed in the constituent entities of the Volga Federal District (VFD). The purpose of the work is to differentiate the territory of the Volga Federal District in terms of the potential epidemic hazard (PEH) of HFRS infection. Materials and methods. We used information on the HFRS incidence contained in the statistical reporting form No. 1 “Information on infectious and parasitic diseases” and the data on epizootic activity of natural HFRS foci from the established forms of surveys and forecasts of the state of population and the numbers of small mammals over the period of 2014-2018. The assessment of the PEH level of HFRS infection was carried out according to the original method developed with the participation of the authors. The software used was the analytical platform Deductor Professional and the geo-information system Arc GIS. Results and discussion. Among the constituent entities of the Volga Federal District an extremely high level of risk of HFRS infection (6 points), the first type of territories, was established for the Udmurt Republic, the Republics of Bashkortostan, Tatarstan, Mordovia, and Chuvash Republic. The second type of territories characterized by high level of risk, where the PEH was 5 points – Samara, Ulyanovsk, Nizhny Novgorod, Kirov, Saratov, Orenburg regions and the Republic of Mari El. The territories in which there is an increased risk of HFRS infection cover the territory of the Penza Region (PEH – 4 points). The average risk of infection was noted only in the Perm Region (PEH – 3 points). Prompt implementation of a complex of nonspecific preventive measures at sites with a pronounced increase in the potential epidemic hazard of HFRS infection will significantly reduce the incidence rate in the VFD and the Russian Federation as a whole.

Legal regulation of compulsory vaccination as a means of ensuring sanitary-epidemiological welfare

Legal regulation of compulsory vaccination as a means of ensuring sanitary-epidemiological welfare

THE EXPERIENCE OF EMPIRICAL RESEARCH ON COMPARATIVE ASSESSMENT OF RADIATION AND CHEMICAL HEALTH RISKS DUE TO EXPOSURE TO ENVIRONMENTAL FACTORS

Introduction. The world practice of solving environmental problems has shown the effectiveness of modern environmental quality management schemes based on the analysis and risk management. Material and Methods. The use of risk assessment and analysis methodology allows obtaining quantitative characteristics of the possible damage, to compare the potential effects of radiation and chemical factors and to determine priority sources of danger. The main directions of the practical use of results of assessment of the risk arising from the impact of chemicals polluting the environment are: ranking of residential areas according to the levels of health risks from the studied factors, planning and evaluation of the results of social and hygienic monitoring (SHM), including the correction of planning and implementation, taking into account the priority sources of environmental pollution, the priority adjustment of sources of risks posING the greatest threat to public health. Results. Approaches to the research on the comparative assessment of carcinogenic risk and damage to public health from ionizing radiation and chemical carcinogens in various environmental objects have been developed. The results of studies in the locations of nuclear facilities in the Sverdlovsk region, the Kola Peninsula, the Voronezh region, the Krasnoyarsk territory, and the Leningrad region indicate to a much greater impact of the chemical risk factor on the population health compared to the radiation one. The primary environment of health risks in multimedia risk assessment is the air, what should be considered when developing regional environmental policies. Conclusion. The conducted studies have shown Contribution of nuclear power facilities to the formation of man-made risk to public health to be negligible and by orders of magnitude smaller than Contribution of risk from facilities emitting harmful chemicals. Atmospheric air is the main environment for the formation of health risks in the multimedia exposure to chemicals. Therefore, measures aimed at improving the quality of air should be regarded as a priority for the implementation of measures to preserve public health. The obtained results allow detecting the priorities of the policy in the field of health protection and sanitary-epidemiological welfare of the population and contribute to the development of a strategy for further environmentally acceptable socio-economic development of the studied regions.

Provision of Biological Safety in the Territory of the Republic of Tatarstan during Preparation and Holding of FIFA World Cup-2018 in Kazan

Objective – assessment of effectiveness of the measures for biological safety provision at potentially hazardous facilities in the territory of the Republic of Tatarstan in the process of preparation and holding of FIFA World Cup-2018 in Kazan. Materials and methods. Regulatory-legal acts covering the requirements to the provision of biological safety during the work with pathogenic biological agents, international guidelines and documents determining inter-agency collaboration between the Rospotrebnadzor Administration in the Republic of Tatarstan and other departments and inter-agency task forces (Office of the Federal Security Bureau of Russia in the Republic of Tatarstan, Counter-Terrorism Commission in the Republic of Tatarstan, etc) were studied. Results and discussion. Considered were managerial-methodological approaches and matters of inter-agency cooperation on biological safety provision during preparation and holding of FIFA World Cup-2018 in Kazan. Biological safety was examined through the prism of its provision while working with pathogenic biological agents at potentially hazardous biological facilities and counterterrorism integrity of the objects. The guiding, directive document in the performance of the complex of measures on biological safety provision and inter-agency collaboration was the Order of the President of the Russian Federation dated May 09, 2017 No 202 “On peculiarities of application of reinforced security measures during holding of FIFA World Cup-2018 and FIFA Confederations Cup-2017 in Russia”. As the result of the measures conducted, biological safety, including counter-terrorism security of potentially hazardous biological objects and sanitary-epidemiological welfare, was fully provided.