Результаты проведения диспансеризации населения старше трудоспособного возраста в Российской Федерации

Introduction. In the Russian Federation, diseases of the circulatory system are leading in the structure of the common incidence and mortality in the adult population, and since 2008, they have also been the leading causes of death among the employable age population. Reducing mortality among the employable age population and mortality from diseases of the circulatory system are the most important target indices of the national project “Healthcare”. Materials and methods. Life expectancy was calculated using an indirect (demographic) method, the contribution of mortality from diseases of the circulatory system by age groups to the differences in life expectancy of men in Kuzbass and subjects of the Russian Federation, and elimination reserves of life expectancy were calculated based on the component method. The age-related mortality rates of the Russian Fertility and Mortality Database were used. To identify the incidence of atherosclerosis of the main arteries, 610 patients aged 47.003±4.875 years were examined. Results. Mortality in Kuzbass men from diseases of the circulatory system is higher in all age groups compared to the Russian Federation, except for 20–29 years. In 2022, the difference in life expectancy with the Russian Federation is 3.30 years, of which 0.79 years is the contribution of diseases of the circulatory system (0.23 years – ischemic heart disease, 0.32 years – cerebrovascular diseases). The elimination reserve associated with the exclusion of mortality from diseases of the circulatory system is 5.78 years. In a random sample, we found a high occurrence of asymptomatic atherosclerosis in men of employable age (61.35%). Arterial hypertension as one of the leading risk factors for the development of atherosclerosis was revealed in almost half of the examined individuals (43.2%). Limitations of the study are related to the duration of the preventive medical examination. Conclusion. Regional features of the life expectancy of Kuzbass men and the impact of mortality from circulatory system diseases, a significant proportion of which is associated with atherosclerosis, have been identified. The elimination of mortality from diseases of the circulatory system promotes an increase in the life expectancy of Kuzbass men by 5.78 years.

The problem of incidence rate among workers of the main professions of the coal mining industry is traditionally considered from the perspective of occupational pathologies. At the same time, the issues of the spread of production-related somatic diseases among this category of the employable population are undeservedly left without due attention. The objective of the study was assessing the frequency of somatic pathology occurrence in workers of coal pits in the South of Kuzbass. 489 workers of the main professions of coal pits in the South of the Kemerovo region were examined (men aged 22 to 55 years, who were randomized into 2 groups according to the level of exposure to a complex of unfavorable factors of the production environment). The first group with a higher level of exposure to harmful and hazardous production factors of class 3.3 and 3.4 included 196 people: machinists of mining and technological equipment, machinists of drilling rigs, explosives; the second group with the level of danger and harmfulness of class 3.1 and 3.2 consisted of 293 workers, namely, drivers of technological motor vehicles. The study of the frequency of somatic pathology was carried out depending on the length of work experience and the age of the subjects. Each group was divided into subgroups: by the age and work experience. In group 1, somatic pathologies were detected in 52.0% of the cases, in group 2 - in 44.4% (χ2=2.772, p=0.096). In the structure of somatic diseases in the group with a higher class of danger and harmfulness, diseases of the circulatory system (38.24%), diseases of the musculoskeletal system and connective tissue (12.75%) and diseases of the nervous system (8.82%) prevailed; in the group with a lower hazard class there were also diseases of the circulatory system (33.85%), diseases of the musculoskeletal system and connective tissue (14.62%), diseases of the nervous system (12.31%). The frequency of somatic diseases is recorded in a direct linear relationship with the work experience and age of coal pit workers. Limitations. This study is limited to a sample of workers in the main professions of coal pits undergoing periodic medical examinations at the Research Institute for Complex Problems of Hygiene and Occupational Diseases. Conclusion. In the structure of somatic diseases of workers of the main professions of coal pits in the South of Kuzbass, three nosological forms occupy a leading position: diseases of the circulatory system, diseases of the musculoskeletal system and connective tissue, and the nervous system. Among the surveyed workers employed in coal pits with a higher level of exposure to harmful and hazardous production factors, a 100% incidence of somatic diseases was revealed among the respondents aged more than 41 years and with work experience over 21 years. These data should be taken into account when carrying out periodic medical examinations, preventive medical examinations, for the development and implementation of therapeutic and prophylactic measures and post-shift rehabilitation programs. Ethics. The study was conducted in compliance with the standards of the Bioethical Committee of the Research Institute for Complex Problems of Hygiene and Occupational Diseases, established in accordance with the Helsinki Declaration of the World Association "Ethical Principles for Conducting Human Scientific Medical Research" as amended in 2013 and the "Rules of Clinical Practice in the Russian Federation", approved by the Order of the Ministry of Health of the Russian Federation No. 266 of 19.06.2003. All subjects signed an informed consent to participate in the study.

Introduction. Diseases of cardiovascular system are the leading causes of morbidity and mortality among the able-bodied population. There have been no studies of the impact of the COVID-19 epidemic on cardiovascular mortality in Russian Railways. The study aims to analyze the mortality of Russian Railways employees from diseases of the circulatory system during the COVID-19 pandemic with the working-age population of the Russian Federation. Materials and methods. The study was carried out on the basis of data obtained during the COVID-19 pandemic (2019-2021). Information on the mortality of employees of JSC "Russian Railways" is formed on the basis of the data of the CHUZ of JSC "Russian Railways". Information about the natural movement of the working-age population was formed on the basis of data from the Unified State Register of Civil Status Records. Results. During the pandemic, the mortality rate in JSC "Russian Railways" was 2.2 times lower compared to the working-age population of the country. Excess mortality by road polygons was different. The maximum mortality rate (3.4 per 1000 employees) was among employees of enterprises of central subordination, the minimum (2.1) was on the Northern Railway. 82.5% of deaths occurred in men, while the mortality rate among men is 2 times higher compared to women. The main cause of death of workers were diseases of the circulatory system (BSC) - 28.7%. The mortality rate from BSK in JSC "Russian Railways" was 0.656, which is 2.9 times lower than for the working-age population of Russia. Conclusion. The study showed that under the conditions of a new coronavirus infection, the mortality rate from circulatory system diseases in Russian Railways employees is lower than in working-age population of Russia. Ethics. We have carried out this study in accordance with the rules of good clinical practice and the Helsinki Declaration. The study did not require the conclusion of the Ethics committee.

As a continent with 54 independent states Africa’s diversity is often highlighted but frequently forgotten when fertility is discussed. Fifty and more years ago to consider that all African countries and societies had a single fertility pattern (large numbers of children) and single trend (unchanging over time) was a valid characterization. Since the 1960s however that uniformity has disappeared replaced by substantial inter- and intra-country differences in fertility patterns and trends that render previous perceptions of continent-wide homogeneity obsolete. In this chapter we consider two African countries—Ghana and Kenya—whose fertility patterns and trends and their determinants have been well documented (Bongaarts 2008; Garenne 2008; Machiyama 2010; Shapiro and Gebreselassie 2008; Sneeringer 2009). Both countries have benefited from regularWorld Fertility Surveys (WFS) and Demographic and Health Surveys (DHS) that record trends in fertility family planning (FP) and other relevant indicators. The recently introduced Performance Monitoring and Accountability 2020 (PMA2020) surveys monitor progress since 2012 for the FP2020 initiative and occasional Situation Analysis and Service Provision Assessment surveys have also detailed the readiness of the health system in both countries to make quality FP services available. Ghana and Kenya share some common history: both have relatively strong health system legacies from the period of British colonialization; both were among the earliest countries to achieve independence; they were the first two African countries that developed policies to address population growth in the 1960s; and both have received substantial and sustained resources over several decades from many external donors and technical assistance organizations explicitly intended to increase the availability and quality of family planning services. However they are composed of cultures that are both diverse within each country and markedly different in many ways between the two countries. The two countries demonstrate remarkably different pathways in fertility and family planning patterns and trends from the 1970s to the present. We highlight some of the key differences and similarities explain why they have occurred and identify insights that could inform a wider understanding of fertility transitions and the role of family planning in other African countries. (excerpt)

Although globalization can contribute to increased blood pressure by spreading unhealthy behaviors, it also provides powerful means to tackle hypertension. The dissemination of information about and advice on cardiovascular prevention and facilitated contact with health services are valuable resources. To investigate the effects of urbanization, geographical area, and air temperature on hypertension burden and kidney damage, a survey was performed in 2008 with a door-to-door approach among urban and rural adult dwellers of three geographic areas (capital, inland, coast) of Yemen. Subjects (n=10 242) received two visits several days apart to confirm the diagnosis of hypertension. Proteinuria (dipstick test ⩾+1) was used as a marker of kidney damage. Prevalence rates were weighted to represent the Yemen population aged 15–69 years in 2008. Rates of hypertension and proteinuria progressively increased from the capital (6.4% 95% confidence level (CI) 5.8–7.0 and 5.1% 4.4–5.9, respectively), to inland areas (7.9% 7.0–8.7 and 6.1% 5.1–7.1), to the coastal area (10.1% 8.9–11.4 and 8.9% 7.3–10.4). When compared with urban dwellers, rural dwellers had similar hypertension prevalence (adjusted odds ratios (ORs) 1.03; 95% CI 0.91–1.17) but higher proteinuria rates (adjusted ORs 1.55; 1.31–1.85). Overall, home temperature was associated with a lower hypertension rate (adjusted OR 0.98; 0.96–0.99). This large population study reveals that the highest burden of hypertension and kidney damage is detectable in remote areas of the country.

To evaluate and compare physical activity patterns of urban and rural dwellers in Cameroon, and study their relationship with obesity, diabetes and hypertension. We studied 2465 subjects aged >or=15 y, recruited on the basis of a random sampling of households, of whom 1183 were urban dwellers from Yaoundé, the capital city of Cameroon and 1282 rural subjects from Bafut, a village of western Cameroon. They all had an interviewer-administered questionnaire for the assessment of their physical activity and anthropometric measurements, blood pressure and fasting blood glucose determination. The procedure was satisfactorily completed in 2325 (94.3%) subjects. Prevalences were age-adjusted and subjects compared according to their region, sex and age group. Obesity was diagnosed in 17.1 and 3.0% urban and rural women, respectively (P<0.001), and in 5.4 vs 1.2% urban and rural men, respectively (P<0.001). The prevalence of hypertension was significantly higher in urban vs rural dwellers (11.4 vs 6.6% and 17.6 vs 9.1% in women and men, respectively; P<0.001). Diabetes was more prevalent in urban compared to rural women (P<0.05), but not men. Urban subjects were characterized by lower physical activity (P<0.001), light occupation, high prevalence of multiple occupations, and reduced walking and cycling time compared to rural subjects. Univariate analysis showed significant associations between both physical inactivity and obesity and high blood pressure. The relationship of physical inactivity with hypertension and obesity were independent in both urban and rural men, but not in women. Body mass index, blood pressure and glycaemia were higher in the first compared with the fourth quartiles of energy expenditure. Obesity, diabetes and hypertension prevalence is higher in urban compared to rural dwellers in the populations studied. Physical activity is significantly lower and differs in pattern in urban subjects compared to rural. Physical inactivity is associated with these diseases, although not always significant in women.

Significance. Analysis of the dynamics in working-age mortality will allow us to take into account the gender and age specificity of mortality from leading causes in order to develop optimal policies to reduce it. The purpose of the study: to assess dynamics in working-age mortality in the Amur region and identify reserves for its reduction. Material and methods. We have analyzed mortality rates among working-age population in 2000-2022, based on official data of the Federal State Statistics Service of the Russian Federation, as well as data from the form “C51” “Distribution of deaths by gender, age group and cause of death” and the form 4ph “Average annual population by gender and age”. In order to ensure comparability of male and female indicators, as well as in dynamics with due regard to changes in the retirement age, the age limits are conditionally adopted as standard15-59 years. Results. From 2017 to 2022, the working-age mortality increased by 15.6%, its level exceeded the average annual values in the Far Eastern Federal District by an average of about 10% over the analyzed period. The contribution of the male working-age mortality exceeds the female contribution to the overall mortality among working-age population. The nosological spectrum of mortality among working-age population is steadily formed due to mortality from external causes, neoplasms and diseases of the circulatory system, together accounting for more than 60% of all causes of death, both among males and females. In the structure of external causes of mortality until 2020, mortality due to poisoning dominates; from 2020-2022, it was injury with undetermined intent among both men and women. Conclusion. Reducing working age mortality requires a differentiated approach, taking into account different mortality trends and causes of death among male and female population, as well as regional specifics of working age mortality. One of the promising directions for reducing mortality is adoption of effective targeted measures to increase the level of self-protective behavior in working age males.

Rural residence may adversely affect cancer outcomes, perhaps because rural cancer patients are managed differently. Current UK guidelines recommend all patients with suspected melanoma be referred urgently for specialist excision biopsy; however, up to 20% of patients receive their biopsy in primary care. This project explored if rural dwellers with melanoma were more likely to have their primary biopsy in primary care. A clinical database of all primary cutaneous melanomas diagnosed in Northern Scotland between January 1991 and July 2007 was analyzed for patient demographics, clinical variables, and intermediate outcomes. Significant findings on univariate analysis were then included in a binary logistic regression model to adjust for confounders. On univariate analysis patients living in rural areas were significantly more likely to have their melanomas excised in primary care compared with those living in the city (26.3% compared with 17.7%, P < .001). There were no significant differences between rural and urban dwellers in Breslow thickness or completeness of excision. Following adjustment for key confounders, those living in suburban areas and remote small towns were significantly more likely to be treated contrary to current UK melanoma guidelines compared to those in cities. In Northern Scotland patients living in suburban areas and remote small towns are significantly more likely to have an initial melanoma excision in primary care, contrary to current UK guidelines. This geographical contrast signposts the way to further in-depth research into the interplay between place of residence and how the cancer journey is experienced.

Introduction. The COVID-19 pandemic influenced the health status and mortality of population all over the world. The mortality rate in Moscow also increased significantly since the density of Moscow population is high and the city is very attractive for migrant workers. Objective. To determine the contribution of migrants died from the COVID-19 to the mortality in Moscow for 2019–2021. Materials and methods. In study, authors used the data on Moscow population and the real-time data on deceased persons by death causes according to the ICD-10 provided by the Moscow Healthcare Department. Results. The average contribution of migrants to the total mortality in Moscow is 10% among women and 16% among men. As for the age composition, the most significant contribution is from the migrant children and working-age youth aged 20 to 30 in women (an average of 50%) and 35 in men (an average of 60%). These results are especially true for migrant workers. Diseases of the circulatory system, external causes and neoplasms were the leading death causes among migrants before the pandemic. Then, the COVID-19 became the third common cause in 2020 and the first one in 2021. As for the death cause, the migrants contributed most to the perinatal and maternal mortality as well as to the mortality from infectious diseases, mental disorders and external causes. Conclusion. Cardiomyopathy and endocarditis, leading causes from the diseases of the circulatory system, often become the complications of infectious diseases, including imported infections. It is crucial to reimplement a rigorous record-keeping by citizenship and place of birth or residence, particularly within the databases on deceased population, in order to monitor the epidemiological situation and to make timely organizational decisions.

The article presents the results of a study of working conditions and a study of the morbidity of public civil servants in St. Petersburg based on statistical processing of the results of mandatory medical examinations in 2017, 2019 and 2023 for a total of 19797 people. It is determined that the working conditions of public civil servants, regardless of the sectoral sphere of the executive authority, are characterized by an increased level of risk factors for stressful situations that affect the occurrence of diseases and lead to deterioration of health. The structure of the main diseases of civil servants included: diseases of the eye and its accessory apparatus (21.51 %), diseases of the musculoskeletal system and connective tissue (21.15 %), diseases of the genitourinary system (10.98 %), diseases of the circulatory system (10.81 %), diseases of the endocrine system, eating disorders and metabolic disorders (9.19 %). The level of general morbidity of diseases of the circulatory system of civil servants of St. Petersburg statistically significantly exceeded the same indicator among the entire working-age population of the city in 2019 by 4.0 times and in 2023 by 2.8 times. The presented data indicate a significant influence of a complex of specific labor factors on the unfavorable dynamics in the structure and level of individual groups of diseases, which makes it advisable to timely identify and prevent the effects of these factors. Today, there is a need to establish hygienic standards for working conditions (service), and the development of medical prevention among government civil servants requires improvement through the development of programs to promote health and increase motivation to lead a healthy lifestyle, reduce the impact of stress factors.

Despite the success of recent decades in reducing mortality from diseases of the circulatory system (CVD), cardiovascular disease (CVD) remains the most common non-communicable pathology in all countries of the world. CVDs have high rates of morbidity, disability, and mortality. The most common of these are arterial hypertension and coronary heart disease. CVD occurs against the background of the presence of risk factors (RF). The ability to timely detect risk factors and manage their level underlies the prevention of CVD. Monitoring the level of risk factors at the individual level and assessing their prevalence at the group level is not feasible without the use of specialized software. Registration and monitoring of patients in the program allows you to create a data archive for use by medical professionals and the patient himself. In the literature there is information about the prevention and medical examination of the population with cardiovascular diseases. However, to date, the medical and social problems of FR management in CVD have not been sufficiently described. In this regard, the effectiveness of measures carried out within the framework of prevention and medical examination decreases.The fight against diseases of the CVD group has not only social, but also economic significance. High rates of temporary disability and disability of patients lead to serious losses at the state level. This determines the need for further improvement of mechanisms for the prevention and treatment of CVD.

Evaluating socio-economic inequality in cause-specific mortality among the working population requires large cohort studies. Through this census-based study, we aimed to quantify disparities in mortality across occupation-based social classes in Italy. We conducted a historical cohort study on a sample of more than 16 million workers. We estimated the mortality rate ratios for each social class, considering upper non-manual workers as reference. Non-skilled manual workers showed an increased mortality from upper aero-digestive tract, stomach and liver cancers, and from diseases of the circulatory system, transport accidents and suicides in both sexes, and from infectious diseases, diabetes, lung and bladder cancers only in men. Among women, an excess mortality emerged for cervical cancer, whereas mortality from breast and ovarian cancers was lower. When education was taken into account, the excess mortality decreased in men while was no longer significant in women. There are remarkable disparities across occupation-based social classes in the Italian working population that favour the upper non-manual workers. Our data could be useful in planning policies for a more effective health and social security system.

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.

Introduction.Methanol and its derivatives occupy one of the leading places among the main organic synthesis intermediates in terms of their importance and scale of production. According to experts, by 2027 the global demand for methanol can reach 135 million tons, the annual growth will be about 5.5%. However, there is little information regarding the assessment of working conditions and occupational risks for workers in modern methanol production and its derivatives.The aim of the studyis hygienic assessment of working conditions and the formation of health risks in workers of modern production of methanol and methylamines.Materials and methods.The assessment of the main adverse factors of production is given. When studying the state of health, objective indicators (the results of an in-depth medical examination) and subjective (the results of a quantitative assessment of the risks of the main pathological syndromes associated with health) are considered.Results.According to long-term observations, the concentration of harmful substances in the air of the working area, indicators of labor severity, parameters of physical factors met hygienic requirements, with the exception of industrial noise exceeding the maximum permissible level, as well as labor intensity of 1 degree. The General assessment of working conditions corresponds to the category of harmful 2 degrees (3.2). According to the results of the medical examination and quantitative assessment of the risks of health disorders in workers, the most significant were functional disorders and diseases of the circulatory system. The levels of somatic pathology on the part of the main body systems were significantly higher in apparatchiks compared to the engineering and technical personnel (ETP).Conclusions:In the production of methyl alcohol and methylamines, the main hygienic importance is the impact on workers of the complex of harmful substances of 1-IV hazard classes in low concentrations, increased levels of industrial noise, labor intensity of 1 degree. According to the subjective assessment of health and medical examination, the greatest prevalence of health risks in workers was observed from the circulatory system, and the levels of the revealed somatic pathology were statistically significantly higher in apparatchiks compared with the ETP.

Objective. To estimate the prevalence, awareness, treatment and control of arterial hypertension (HTN) among adult inhabitants of Krasnoyarsky territory based on the data from Russian multicenter epidemiological study ESSE-RF. Design and methods. The study included 1603 subjects 25 to 64 years old selected by the systemic multistage stratified randomization among urban and rural inhabitants of Krasnoyarsky territory. Office blood pressure (BP) was measured twice by the automatic tonometer “Omron” on the right hand in the sitting position. HTN was defined as systolic BP ≥ 140 mm Hg and/or diastolic BP ≥ 90 mm Hg or self-reported previously elevated BP or use of antihypertensive treatment (HTNT). Treatment efficacy was defined as proportion of achieved target BP among individuals who received HTNT, and BP control was assessed as proportion of achieved target BP level among all hypertensives. Results. The gender distribution was 653 males (40,7%) and 951 females (58,3%). The median level of systolic BP was 133,4 ± 0,5 mm Hg, diastolic BP— 82,9 ± 0,3 mm Hg. The median prevalence of HTN was estimated at 49,4% and appeared to be higher as compared with average Russian parameter 44% (based on the date of 10 regions from the ESSE-RF study). The median prevalence of HTN was estimated at 56,3% in men and 43,7% in women. The HTN prevalence in rural community was significantly higher as compared with urban community (63,4 ± 2,4 vs. 44,2 ± 1,5%, p < 0,01). The median rate of HTN awareness in Krasnoyarsky territory was 77,9% (average rate in Russia based on the ESSE-RF study results was 73,1%). The median rates of HTNT, treatment efficacy and BP control in Krasnoyarsky territory was estimated at 59,5%, 31,6% and 18,8%, respectively. Target BP level was achieved significantly more often among female, than male hypertensives, except those aged 25–34 years. Conclusions. Thus, estimated prevalence of HTN in Krasnoyarsky territory is higher than average Russian indices based on the data of ESSE-RF study from 10 regions. The median HTN prevalence among men is higher than in women. The rural inhabitants are more likely to have HTN compared with urban inhabitants. Despite high rates of HTN awareness and HTNT, the treatment efficiency in Krasnoyarsky territory appeared to be lower as compared with average Russian ESSE-RF indices.