ISSUES OF MANAGEMENT AND SOCIAL HYGIENE
Introduction: Problems of prevention, diagnosis and treatment of diseases of the circulatory system remain highly relevant. One of the effective preventive measures is early identification of risk factors, including coronary calcium. Recent achievements in the field of computer vision have made it possible to conduct opportunistic coronary calcium screening.
Objective: To study the prevalence of coronary artery calcification as a risk factor for cardiovascular diseases in the population of Moscow based on the results of an automated analysis of radiology findings.
Materials and methods: In July 2021 – December 2022, we conducted a retrospective descriptive epidemiological study, within which we analyzed chest CT images of 165,234 patients (71,635 males and 93,599 females) for coronary artery calcification and calcium scoring using AI services in an automated mode.
Results: Coronary calcium was detected in 61.4 % of the examined. The proportion of men was 68.9 %, women – 55.7 % (р < 0.001). The calcium score ranged from 1 to 60,306 units (mean = 558.2). The average growth rate of the calcium score for the whole population was 170.75, the average growth rate was 168.13, and the average increase rate was 68.13 units during study period. In 47.6 % of men and 36.5 % of women with coronary calcium, the calcium score was clinically significant, i.e. ≥ 300 (p < 0.001). Most people with coronary calcium at a clinically significant level belonged to elderly and senile age groups (42.0 % each).
Conclusions: The prevalence of coronary calcium in the population of Moscow was 8.03 per 1,000 people. In men, coronary calcium (including that at a clinically significant level) was statistically more frequent while the average calcium score in them was significantly higher than in women of most age groups. The mean calcium score demonstrated a constant increase with age.
Introduction: The problem of diseases of the digestive system has a pronounced social and economic impact, as it often leads to long-term sick leave, disability, and mortality. The study of the structure of gastrointestinal disease incidence and the analysis of its rates facilitate improvement of preventive measures aimed at reducing the incidence both at the regional and national levels.
Objective: To make a short-term forecast of the incidence of gastrointestinal diseases in the Russian Federation.
Materials and methods: The time series of data was retrieved from statistics of the Federal State Statistics Service of the Russian Federation (Rosstat) for the years 1990–2021 and studied using the Foster–Stuart, Dickey–Fuller, and Kwiatkowski–Phillips–Schmidt–Shin tests. Forecasting was carried out using the Holt-Winters and Box-Jenkins models. The mean absolute error and root mean square error were estimated to evaluate the forecast accuracy.
Results: The time series study of the incidence of digestive diseases has helped build a predictive model. Its findings show an increase in the incidence of gastrointestinal disorders in the country since 2021, which complies with Rosstat data.
Conclusion: The forecasts made using the developed predictive model confirm the rising incidence of diseases of the digestive system in the population of the Russian Federation.
MEDICAL SOCIOLOGY
Introduction: HIV infection is a complex chronic disease, the incidence of which remains quite high. The total number of Russians, both men and women, living with HIV continues to increase. The registered number of people infected with the human immunodeficiency virus in the Russian Federation reached 851.8 thousand people at the end of 2021. The analysis of high-risk behavior of vulnerable groups of the population will help update the problem of self-preservation and develop a set of preventive measures for the groups at risk of acquiring the HIV infection.
Objective: To study characteristics of self-preservation of men who have sex with men as one of the key populations at increased risk of HIV.
Methods: We used a 2021 database of men who have sex with men, all clients of a non-profit HIV service organization. A total of 3,455 men who had had sex with men in the past twelve months or those who considered themselves homosexual were interviewed. The survey was conducted in Moscow and the Moscow Region by the Charitable Foundation for Support of Social Initiatives and Public Health. The data analysis was carried out in Microsoft Excel and IBM SPSS Statistics 21.0.
Results: The study has revealed the main determinants of behavior and the components of self-preservation in the study subjects.
Conclusion: The clients of the non-profit HIV service organization included in the survey have high-risk behavior and various social diseases, including the combined ones, such as HIV infection, which must be considered when developing preventive measures for this group of population.
PEDIATRIC HYGIENE
Background: A systematic study of the lifestyle of student youth making up the future economic and reproductive potential of the country is necessary to assess health risk factors and to develop appropriate measures of health promotion and disease prevention.
Objective: To establish the prevalence of lifestyle risk factors among students of vocational high schools.
Materials and methods: The prevalence of lifestyle risk factors was studied based on the results of anonymous surveys of vocational school students conducted in the city of Krasnodar in the years 2012 (n = 200) and 2022 (n = 224).
Results: In 2022, lifestyle risk factors were found in 88.4 % of the respondents, which was 8.6 % less than in 2012 (p = 0.002). The most common factors among the students were imbalanced diet (80.4 %), low physical activity (45.5 %), and smoking (37.0 %). Over the ten years, the proportion of smokers decreased by 15.0 % (p < 0.001) while that of students with high physical activity and a healthy diet increased by 11.5 % (p = 0.02) and 7.1 % (p = 0.05), respectively. The specialty-specific analysis showed that alcohol consumption prevailed among woodworking machine operators (57.5 %), gas and electric welders (50.0 %), and assistant secretaries (41.2 %); imbalanced nutrition was a frequent finding in gas and electric welders, cutters (93.3 % each), and tailors (90.0 %); low physical activity was reported by 80 % of tailors, 53.3 % of pastry chefs, and 50 % of assistant secretaries; poor sleep duration was common among auto mechanics (63.3 %), assistant secretaries (44.1 %), and electric and gas welders (20.0 %). The prevalence of tobacco smoking was found to decrease by 40.2 % among assistant secretaries (p = 0.003), by 29.3 % among cutters (p = 0.028), and by 20.0 % among pastry chefs (p = 0.05).
Conclusion: The high prevalence of lifestyle risk factors observed requires both comprehensive and systematic health promotion among adolescents and creation of conditions aimed at improving the culture of a healthy lifestyle, developing sustainable motivation for maintaining health and skills of healthy living.
COMMUNAL HYGIENE
Introduction: The government system of public health monitoring was created in order to eliminate adverse health effects of environmental factors in humans. The use of human biological specimens as markers of effect of environmental pollution makes it possible to assess the dynamics of concentrations and levels of exposure to priority metals, to identify territories with the highest and lowest levels of priority metals, and to predict both negative and positive changes in response of critical organs and systems based on trend analysis.
Objective: To develop a biomonitoring algorithm to improve objectivity of assessing human health damage caused by environmental pollution with metals.
Materials and methods: Concentrations of metals in human biological specimens were measured by atomic absorption spectrometry in 2000-2020. Cause-and-effect relationships were established by mathematical modeling of the relationship between the dose of exposure at its various pathways and metal concentrations in human blood, urine, hair and nail specimens.
Results: We propose a biological monitoring program, which includes determination of territories of the highest potential risk of health damage causes by priority metals, of exposure zones and monitoring points spatially linked to economic entities classified as those posing extremely high and high potential human health risks, of the size of population at risk and particular risk groups, as well as substantiation of priority metals of natural and man-made origin, media and pathways of exposure based on the results of proven causal relationships in the system “exposure – marker of exposure – marker of effect”, the study and dynamic assessment priority metal concentrations in biological specimens of individuals at risk. The detection of increased levels of metals in biological specimens may indicate that the environmental pollution is dangerous to human health and requires managerial decision making as a means of managing health risks and eliminating health damage manifested by diseases associated with metal exposure.
Conclusion: The suggested algorithm of biological monitoring, aimed at establishing and eliminating adverse effects of environmental factors in humans will contribute to the development of the public health monitoring system in terms of determining and specifying priority territories, zones, control points, and relevant indicators for inclusion in monitoring programs. The results of biological monitoring of metals can be included in the substantiating materials of expert opinions, used in justifying the prosecution of persons guilty of pollution of the environment with metals due to proven violations of mandatory sanitary and epidemiological requirements by economic entities that caused harm to public health, in justifying and evaluating the effectiveness of sanitary, hygienic, and preventive measures.
Introduction: There is an urgent need for reclamation of abandoned coal mine lands in Kuzbass to reduce their adverse effects on the environment.
Objective: To assess risks to public health posed by air pollution associated with coal mine liquidation and land reclamation.
Materials and methods: We used data on the volume of maximum permissible emissions of the abandoned coal mine area for 2019 to assess the spread and exposure to pollutants at 40 points selected on the map of the city of Prokopyevsk, Kemerovo Region, and to estimate the maximum and mean concentrations of the contaminants. The values of carcinogenic risk and risks of non-carcinogenic effects were calculated in compliance with the Russian Guidelines R 2.1.10.1920–04, Human Health Risk Assessment from Environmental Chemicals, while risks of chronic toxicity were assessed using methods by Shcherbo et al. The calculated risk values were then compared with their acceptable levels. Risks were also assessed with account for the contribution of background concentrations of chemicals.
Results: The list of priority pollutants included inorganic dust containing 20–70 % SiO2, nitrogen dioxide, nitrogen oxide, sulfur dioxide, carbon (soot), carbon monoxide, and inorganic dust containing < 20 % SiO2. The estimated maximum and mean concentrations of airborne pollutants during mine reclamation activities were not exceeded at any exposure point. Hazard indices for acute exposures to pollutants exceeded the acceptable level at three points located closer to the sources. Carcinogenic risks did not exceed the level of acceptable risk at any point. Total risks of chronic toxicity were 1.2 and 1.75 times higher than acceptable at two points. Hazard indices estimated with account for the backgroundlevels of pollutants were 1.448–2.603 times higher than the acceptable level at all exposure points. The carcinogenic risk assessed taking into account the background levels was found to be acceptable. The most affected (target) critical organs and systems were respiratory organs and blood. Total risks of chronic poisoning assessed with account for background concentrations of ambient air pollutants exceeded the acceptable level by 3.15–5.40 times at all points.
Conclusions: Reclamation activities have no significant effect on ambient air quality and health of the population of Prokopyevsk. Total risks of chronic toxicity and hazard indices exceed acceptable levels in residential areas located close to the reclamation site. High hazard indices and total risks of chronic toxicity established at all exposure points taking into account background concentrations of contaminants, are determined by generally poor environmental conditions in the city with the intensively developing coal industry.
EPIDEMIOLOGY
Introduction: Infectious mononucleosis is a viral disease, the clinical picture of which includes fever, tonsillitis, lymphadenopathy, hepatomegaly, and splenomegaly. A significant proportion of cases of infectious mononucleosis remains unrecognized for various reasons. The presence of hidden sources of infection prevents adequate evaluation of the epidemic situation and promotes the spread of pathogens, including within organized groups of children and adults. Objective: To characterize the causes of errors in diagnosing infectious mononucleosis and their epidemiological consequences on the example of non-infectious disease hospitals.
Materials and methods: We reviewed 60 scientific publications indexed in international (Web of Science, Scopus, PubMed) and domestic (RSCI) databases in 2012–2022 and selected using the following keywords and phrases: infectious mononucleosis, diagnosis of infectious mononucleosis, and errors in the diagnosis of infectious mononucleosis. The limited number of studies devoted to epidemiology of Epstein-Barr virus infection, both in Russia and abroad, did not allow us to select only those papers that were included in the RSCI core collection or published in Q1–Q2 journals.
Results: The main cause of errors in diagnosis of infectious mononucleosis is a great variety of clinical manifestations related to various etiological agents, as well as age and immunological status of the patient. Poor awareness of the clinical picture and laboratory diagnostics of infectious mononucleosis among healthcare professionals can be yet another reason. Wrong assessment of the epidemic situation, unidentified and unaccounted-for sources of infection among the population, introduction and spread of pathogens in noninfectious disease clinics. We have established the possibility of etiological agents of infectious mononucleosis to use almost all known mechanisms of transmission, of which airborne and artificial ones are the most prevalent in hospitals. The absence of preventive measures aimed at the source of infection and susceptible individuals determines actions that can interrupt mechanisms of transmission as the only realistic way of combatting the spread of pathogens of infectious mononucleosis.
Conclusion: Misdiagnosis of infectious mononucleosis can cause serious epidemiological consequences, including the nosocomial spread of pathogens.
Introduction: Current conceptions of the epidemiology of hemorrhagic fever with renal syndrome (HFRS) interpret the necessity of a selective approach to organizing measures of disease prevention from the standpoint of different epidemiological risks of infection in a particular area.
Objective: To develop a differentiated approach to planning and carrying out preventive measures in HFRS endemic areas with different levels of epidemiological risk of infection using the capabilities of geographic information technologies and to test the methodology on an outbreak model in the Republic of Bashkortostan in 2022.
Materials and methods: We have analyzed data on 2,993 HFRS cases registered in the Republic in 2022. The main research method was epidemiological. The Deductor Studio Professional analytical platform and ArcGIS geographic information system were used as software.
Results: We established that the Ufimsky, Blagoveshchensky, Iglinsky, Tuymazinsky, and Chishminsky administrative district, the cities of Oktyabrsky and Ufa were high risk areas for HFRS. The total recommended area of the territory subject to additional pest control treatments was 4,369 hectares.
Conclusions: Identification of local high risk areas for hantavirus infection within the boundaries of individual administrative territories helps improve the efficiency of the infectious disease surveillance on these territories by means of large-scale targeted preventive measures. Prompt implementation of a complex of non-specific preventive measures in areas with a high risk of infection can significantly reduce their potential epidemic danger. Approaches to planning and taking preventive actions using up-to-date geographic information systems and analytical software allows simultaneous visualization and statistical analysis of primary data. Such a combined use of spatial characteristics of the epidemic process and application of analytical methods creates a scientific basis for planning infection control measures.
ISSN 2619-0788 (Online)