ISSUES OF MANAGEMENT AND SOCIAL HYGIENE
Background: Today, cataract is one of the main causes of reversible blindness and visual disability. In health care, monitoring of cataract surgery rates is fundamental to achieving universal health coverage.
Objective: To assess the prevalence of visual impairment and blindness, cataract surgical coverage and prevalence, and the factors preventing timely surgical intervention for this disease.
Materials and methods: The cross-sectional clinical population Ural Eye and Medical Study conducted on the basis of the Ufa Eye Research Institute in 2015–2017, involved 5,899 people, including 3,400 rural (57.6 %) and 2,499 urban residents (42.4 %), of which 2,580 (43.7 %) and 3,319 (56.3 %) were men and women, respectively (mean age: 59.0 ± 10.7 years (range: 40–94 years). Data analysis was carried out using IBM SPSS Statistics (USA).
Results: We established that the prevalence of bilateral visual impairment in the population was 6.4 % (95 % CI: 6.85–7.07 %). The main causes of visual impairment were cataract (53.72 %), age-related macular degeneration (11.96 %), myopic degenerative maculopathy (3.46 %), diabetic retinopathy (3.46 %), and glaucomatous optic neuropathy (2.66 %). The prevalence of cataract surgery was 6.1 % (95 % CI: 4.0–9.3 %). Poor visual outcomes after cataract surgery were observed in 11.5 % of cases. The main reasons for low postoperative visual acuity included the refractive error (39.6 %), macular degeneration (19.0 %), glaucoma (15.5 %), posterior capsule opacification (13.8 %), and diabetic retinopathy (12.1 %). The cataract surgical coverage of patients with a decrease in visual acuity of the better-seeing eye to < 0.05; < 0.1 and ≤ 0.3 amounted to 77.5 %, 65.3 %, and 39.8 %, respectively. The factors preventing timely cataract surgery were poor awareness of patients about the need for surgical treatment (36.1 %), being very busy at work or at home (25.3 %), fear of the upcoming treatment (16.8 %), and concomitant somatic diseases (10.3 %).
Conclusion: The results of analyzing the prevalence of blindness and low vision caused by impaired transparency of the crystalline lens, outcomes of cataract surgery, and factors that impede timely surgical treatment in the study area, contribute to improvement of ophthalmology services and planning of surgical care programs to patients with these conditions.
Background: The incidence of endocrine diseases, eating and metabolic disorders has been increasing recently. The prevalence and structure of pediatric and adolescent endocrine disorders are significantly different from those in adults and have specific regional features.
Objective: To study the frequency, structure, and long-term changes in the rates of hospitalization of the child population for diseases of the endocrine system in the Orenburg Region and to assess local features of disease incidence and prevalence.
Materials and methods: We analyzed data on all pediatric cases (aged 0–18) of hospital care for endocrine disorders provided by the regional office of the Federal Compulsory Medical Insurance Fund for 2016–2020. We also applied the Ward’s hierarchical clustering method to establish local peculiarities and to group municipalities by the rates and dynamics of endocrine diseases in children.
Results: The average rate of hospitalization for endocrine disorders was 3.8 cases per 1,000 children and accounted for almost 3.9 % of all types of hospital care. The proportion of inpatients among children aged 0 to 14 years was higher than that among adolescents. Metabolic disorders (34.0 %), insulin-dependent diabetes mellitus (22.3 %), hypofunction and other pituitary disorders (12.6 %), obesity and other types of overnutrition (7.1 %), and undernutrition (5.7 %) prevailed in all hospitalized children. The patterns of pediatric and adolescent inpatients differed significantly. The analysis of the prevalence of endocrine disorders in children and its long-term changes enabled clustering of the territories of the Orenburg Region.
Conclusions: Three distinct clusters of territories were established in the analysis of local rates of endocrine diseases in children. The first cluster was characterized by moderate disease rates, while the second and the third clusters demonstrated high and low incidence and prevalence rates of pediatric and adolescent endocrine disorders.
Introduction: Hospital employees have become one of the main risk groups for the novel coronavirus disease (COVID-19). In extreme conditions of the pandemic and over a short period of time, healthcare professionals were forced to repurpose their work, learn a significant amount of new information, and acquire novel professional competencies. Yet, the importance of supra-professional skills and competencies (so-called “soft skills”) for their job should not be underestimated, especially in crisis situations.
Objective: To establish the role of soft skills in the adaptation of medical workers to severe conditions of the COVID-19 pandemic.
Materials and methods: We conducted an anonymous questionnaire-based survey of 638 hospital workers on the basis of the Google platform. The form containing two built-in scales was specially developed by the authors to assess the level of emotional intelligence (EQ) and adaptability of hospital employees under crisis conditions.
Results: We found that most employees (78.7 %) had a moderate EQ level, while 13.0 % and 8.3 % had high and low EQ levels, respectively. We established that 100 % of the respondents with low EQ and 76.5 % of the respondents with moderate EQ had low adaptability; in the rest 23.5 % of the employees with moderate EQ, the level of adaptability was assessed as medium. Individuals with high EQ demonstrated medium (53.0 %) and high (44.6 %) levels of adaptability to the situation and only 2.4 % found it difficult to adapt to rapid changes. The estimated Spearman’s correlation coefficient of 0.43 (p < 0.001) showed a moderate strength of correlation between the EQ level and adaptability.
Conclusions: Highly developed soft skills contribute to better adaptation of employees to the new reality. Under current conditions, HR managers shall concentrate on introducing soft skills development training for healthcare professionals.
Introduction: Malignant neoplasms remain a serious sociomedical problem that requires solutions to health care optimization. In the overall structure of cancer incidence in the female population in 2018, uterine and cervical cancer ranked third (8.0 %) and fifth (5.2 %), respectively.
Objective: To determine the main trends in the incidence of gynecologic cancers in Saint Petersburg, Russian Federation, and to monitor achievement of the targets of the Fight against Cancer Program.
Materials and methods: To assess the prevalence and the structure of the incidence of malignant neoplasms of the female reproductive system, a comprehensive methodology was developed, which included the analysis of statistical reporting forms officially approved by the Ministry of Health of the Russian Federation for 2010–2020.
Results: The prevalence of gynecologic cancers showed a steady rise. In 2011–2019, the incidence rates of cervical, uterine and ovarian cancer in St. Petersburg increased by 6.9 %, 18.2 %, and 18.5 %, respectively. The proportion of cases of the uterine body cancer was the largest (43.6 %), followed by ovarian (28.7 %) and cervical cancer (22.5 %). The shares of malignant neoplasms of other sites, including vulva, vagina and placenta, were much lower and equaled 3.9 %, 1.2 %, and 0.1 %, respectively. At the same time, the percentage of followed-up patients with stages I and II uterine cancer had grown from 74.4 % in 2011 to 79.4 % in 2020 (t = 4.9, p < 0.05) and of those with stages I and II ovarian cancer – from 32.2 % to 35.5 % (t = 3.7, p < 0.05). The one-year gynecologic cancer mortality rate in St. Petersburg decreased significantly, from 25.8 % to 20.1 % (t = 4.0, p < 0.05), while the five-year survival in 2011–2020, on the contrary, increased from 52.3 % to 57.9 %.
Conclusions: Malignant tumors of the female reproductive system rank first in the structure of the annual cancer incidence. Every sixth (15.1 %) incident cancer is a gynecologic neoplasm. In 2011–2019, rising incidence rates were observed for the most common female genital tract tumors, including cervical, uterine, and ovarian cancer. It is of great concern that not all monitored indicators approved by the Fight against Cancer Program are being properly implemented in St. Petersburg.
COMMUNAL HYGIENE
Introduction: Petroleum industry is a fundamental part of the economy of the Russian Federation. One of the approaches to up-to-date assessment of human health effects of subthreshold concentrations of pollutants is to determine changes in the immune and hormonal status in people with non-occupational or occupational exposure to industrial contaminants.
Objective: To establish body mass indices, hormonal and immune status in workers of an oil producing enterprise and the population environmentally exposed to low concentrations of airborne pollutants emitted by oil production facilities.
Materials and methods: The survey covered the population living in the area affected by oil production facilities and 131 oil extraction workers. We estimated the body mass index (BMI) of the subjects and tested their blood serum for the four main classes of antibodies (immunoglobulins IgA, IgM, IgG, and IgE), circulating immune complexes (CICs), and the levels of thyroid-stimulating hormone (TSH), thyroxine (free T4), and cortisol.
Results: We established that all the subjects (in both observation groups (workers (group I) and residents (group II), and the comparison group) were overweight but BMI of the industrial workers was within the normal range. We also found that the hormonal parameters did not differ significantly between the groups but the level of the stress hormone cortisol was lower among the workers. IgA and IgE levels were significantly higher in the exposed residents. A high level of circulating immune complexes in both population groups indicates high prevalence of chronic disorders.
Conclusions: The study proves the need for an in-depth study of indices of the endocrine and immune systems and a clinical examination of both the exposed population and industrial workers. It is especially important to study the markers of exposure to oil production emissions in the biological media of the general population.
Background: Water is a key source of life on Earth; it is involved in the transfer of nutrients, macro- and microelements between soil, plants, animals and humans, as well as in the concentration and dispersion of chemical elements and the formation of minerals. The elemental status of the population is largely determined by the chemical composition of the natural waters on the territory of residence.
Objective: To perform a comparative analysis of the concentrations of iron, manganese, calcium and magnesium in natural waters of the Khanty-Mansiysk and Yamalo-Nenets Autonomous Districts (Okrugs).
Materials and methods: We established concentrations of iron, manganese, calcium and magnesium in 100 samples of natural waters taken from rivers, lakes, backwaters, channels, etc. of the Khanty-Mansiysk and Yamalo-Nenets Autonomous Districts, 50 samples each, using spectrophotometry, capillary electrophoresis and atomic absorption spectrometry. The results obtained were compared with the reference values provided in Russian sanitary rules and regulations SanPiN 1.2.3685–21.
Results: We established elevated levels of iron in most surface water samples from both districts and of manganese in the Khanty-Mansi Autonomous Okrug accompanied by extremely low concentrations of Ca and Mg in the vast majority of all samples. At the same time, we registered significantly lower concentrations of Ca (p = 0.012) and Mg (p = 0.021) in the water samples from the Yamalo-Nenets Autonomous Okrug compared to those from the other district.
Conclusion: In the population of the Tyumen North, the constant use of such water for drinking purposes can lead to the early development and rapid progression of cardiovascular and osteoarticular diseases, type 2 diabetes, neoplasms, etc.; at the same time, people are at risk of generalization of immunosuppressive conditions, diseases of the central nervous system, gastrointestinal tract, oxidative metabolism disorders, etc.
PEDIATRIC HYGIENE
IIntroduction: An important health indicator of a newborn available for measurement immediately after birth is the extent of physical development, which reflects individual sex and physique characteristics, various climatic, geographical, and socio-economic living conditions.
Objective: To assess physical development of newborns in a large agro-industrial center using international standards that take into account gestational age by months of the year.
Materials and methods: We examined archived medical records of women who gave birth in 2014 in the city of Barnaul to analyze anthropometric parameters of 2,019 newborns (788 girls and 1,231 boys), their gestational age, and medical histories of the mothers. All pregnancies were singleton; no congenital malformations were registered in the sample. The analysis of the correspondence of anthropometric parameters of the child at birth to the gestational age and assessment of physical development were carried out using sex-specific INTERGROWTH-21st charts by the seasons of the year.
Results: We established some seasonal variations in the body weight of newborns requiring a more detailed monitoring assessment.
Conclusion: The use of international standards for assessing physical development of newborns will allow an in-depth consideration of the problem of children’s health maintenance since they take into account gestational age, thus enabling early diagnosis of developmental abnormalities.
OCCUPATIONAL HEALTH
Background: Forensic medical examiners are known to be exposed to a combined effect of occupational risk factors potentially leading to adverse health outcomes. In the current epidemiologic situation largely influenced by the ongoing COVID-19 pandemic, postmortem examination of the bodies having signs of deadly communicable diseases, including the novel coronavirus disease, poses a high infection risk, thus making the development and implementation of appropriate preventive measures an urgent and important task.
Objective: To summarize and systematize the results of scientific research and requirements of legal and regulatory documents in the field of ensuring workplace safety of forensic medical examiners
Materials and methods: We searched for literary sources published in Russian and English in 2000–2021 in the PubMed, eLibrary, and Cyberleninka databases using such keywords as “healthcare workers”, “safety”, “forensic medical examiner”, “prosector”, and “deadly infections”. We conducted an analytical review of legal documents regulating safety in the conduct of forensic medical examination. Based on the relevance of search results, we selected 30 articles and five legal and regulatory documents for this review and carried out their content analysis using descriptive and analytical methods.
Results: As a solution to the problem of epidemiological surveillance, a series of modular buildings for postmortem examination of patients with suspected or confirmed deadly infectious diseases, including COVID-19, was developed and introduced.
Conclusions: Our findings indicate that in the context of the current pandemic, it is critical to update the requirements for biological safety of forensic experts stipulated in sanitary rules and norms. Construction of modular special purpose buildings in the city of Kazan contributed to improvement of biological safety during autopsy of COVID-19 victims.
EPIDEMIOLOGY
Introduction: Acute respiratory infections are one of the most common human diseases and are caused by many pathogens, while helminths receive undeservedly little attention in the structure of respiratory disorders. Meanwhile, the course of helminthiases of the respiratory system is disguised as a disease of nonparasitic etiology, with such manifestations as low-grade fever, dyspnea, cough, pleurisy, bronchitis, being therefore misdiagnosed and inadequate treated with serious consequences. In this review, we point out similar symptoms of bronchopulmonary pathologies associated with respiratory infections and parasitic diseases.
Objective: To give a comparative characteristic of the clinical picture of pulmonary helminthiases and acute respiratory infections.
Materials and methods: We analyzed literary sources on medical parasitology and helminth biology published in 1900–2021, found in the Web of Science, PubMed, Scopus, Elsevier, Springer and Google Scholar databases. In addition, were reviewed fifteen published case reports of pulmonary parasitoses.
Results: We considered the life cycles of flatworms and roundworms belonging to 10 genera including Paragonimus, Taenia, Echinococcus, Ascaris, Toxocara, Ancylostoma, Necator, Strongyloides, Metastrongylus, and Dirofilaria, and summarized data on the respiratory symptoms of parasitic diseases, pathogenesis in the organism of the definitive host, and routes of entry.
Conclusion: This review presents a comparative description of helminthiasis with mixed pathogenesis, mimicking the clinical picture of respiratory infections. To avoid inadequate treatment, we recommend supplementing a carefully collected medical history with a differential diagnosis of parasitic diseases for diseases of nonparasitic etiology (allergic and chronic systemic diseases, viral, bacterial infections). It is the early diagnosis of helminthiasis that prevents a life-threatening health condition, severe operations, and further long-term rehabilitation of patients.
Introduction: This overview provides information on epidemiological aspects of solid waste management during the COVID-19 pandemic. It describes the contribution of health care to the increase in the global waste generation and its impact on environmental pollution. It also highlights up-to-date methods of countering the biological threat of pollution with solid household and medical wastes contaminated by SARS-CoV-2.
Objective: To analyze publications on changes in the structure and amount of waste during the pandemic with account for the specifics of work of municipal services.
Methods: We searched for scientific papers published in 2020–2021 in electronic databases (Web of Science, Scopus, PubMed, eLIBRARY and ResearchGate) using the following keywords: COVID-19, medical wastes, environment, and plastic pollution. Out of 97 sources found, we selected 55 papers taking into account the keywords and then reviewed 40 publications for this work.
Results: We established that the production of medicinal and other disposable products increased sharply during the coronavirus pandemic. Apart from the additional burden on the environment due to improper disposal of contaminated items, the latter increased the risk of the disease spread. Numerous studies have confirmed the three-day viability of SARS-CoV-2 on plastics, which suggests the persistence of the virus on waste and is important for epidemiological assessment of the situation. This overview describes solid household and medical waste management solutions developed in Russia and abroad.
Conclusions: The review confirms the global problem of environmental pollution with solid household wastes. In addition to the increased burden on the environment, inappropriate biologically hazardous waste management and treatment pose the risk of COVID-19 spread in the general population. Effective measures for the disposal of medical waste are being developed around the world now. New standards of solid waste transportation and municipal personnel safety during the pandemic are being elaborated. The overview discusses the existing systems of municipal waste management in different countries and the specifics of work of municipal services related to the novel coronavirus disease.
IN MEMORY OF A COLLEAGUE
ISSN 2619-0788 (Online)