Unfavorable maternal outcomes: age structure and territorial distribution

Modern society is a society formed as a result of numerous changes that occurred in the world at both global and national levels. It includes many ethnic entities organized into a complex ethnic and social structure. This article analyzes the practice of management of cross-national relations in Perm Krai with the aim of strengthening the interethnic harmony. Perm Krai, just like the whole Russian Federation, is characterized by polyethnicity. While some ethnic groups have been living and developing for a long time within Perm Krai, others regard the region as a temporary place of refuge. Constant complication of the national structure and interethnic relations requires an appropriate policy that can ensure the inter-ethnic harmony. The aim of the article is to study administrative practices for achieving the interethnic harmony at the regional level, since it is at the regional level that unique administrative decisions are being developed and implemented to resolve interethnic problems and prevent conflicts on national grounds. The Perm region has accumulated a wealth of experience in the area of development and harmonization of cross-national relations, which was highly appreciated at the all-Russian level. Management practices for implementing the tasks set out in the Strategy of the State National Policy in the Russian Federation for the period up to 2025, Perm Krai has developed six targeted programs for the development and harmonization of interethnic relations. This experience is of interest for specialists in the management of social and interethnic interaction, achievement of the inter-ethnic harmony in society.

Objective. To conduct epidemiological studies of the long-term dynamics of maternal mortality (MM) and failed maternal mortality, development of trends and territorial distribution.
 Materials and methods. The data of official statistics on maternal mortality calculated for
 100 000 live births and a long-term dynamics of unrealized maternal mortality according to the data of the Ministry of Healthcare of PK "Unified Information System of Healthcare of Perm Krai" are presented. The number of cases of complicated pregnancy, childbirth and the postpartum period with the formation of multiple organ dysfunction or insufficiency requiring intensive therapy, blood transfusion and emergency surgical interventions was calculated. The epidemiological descriptive and evaluative method was used when performing the studies. The long-term dynamics of MM was calculated, the rectilinear epidemic trend for the function of the parabola y1 = a + bx and the curvilinear tendency for the function of the parabola y2 = a + bx + c2, its upper and lower confidence bounds (Me 0.95) were determined. The rate of growth and increment were investigated and the research cyclical fluctuations were determined.
 Results. The maximum level of maternal losses (ML) in Perm Krai established in 2003 was 44.2 per 100 thousand live births. The minimum figure in 2015 was 5.2 per 100 thousand live births. The average long-term indicator of MM is 19.3. A feature of the long-term dynamics of the studied period was a steady decline in MM with an average annual rate of 5.7 %. Cyclical fluctuations were initially regular in nature, and subsequently had a lengthened rhythm of 13 years. Failed maternal mortality in Perm Krai had a pronounced downward trend; the decrease rate was 518.9 %. The annual loss rate was 69.8 %.
 Conclusions. The long-term dynamics of MM in Perm Krai was characterized by an average degree of intensity, an epidemic tendency to decrease, the presence of cyclical fluctuations, the formation of internal causes testifying to the possible activation of maternal losses. The long-term dynamics of failed maternal mortality had a pronounced downward trend.

Clinical features and outcomes of patients with preeclampsia and eclampsia at Gondar University hospital, Amhara, Ethiopia 2021

Background: A Hypertensive disorder of pregnancy (HDP) is one of the most common obstetric complications that occur during pregnancy. It occurs generally in about 5 – 10 % of pregnancy and it accounts for 10 – 15 % of maternal death worldwide. It also accounts for perinatal mortality particularly from prematurity and associated complications. Even though there are few studies exploring HDP in Ethiopia, there was no study done on maternal and perinatal outcome of hypertensive disorders of pregnancy and associated factors in the study area. Hence, the aim of this study was to assess maternal and perinatal outcome of hypertensive disorders of pregnancy and associated factors in Jimma University Medical Center. Method: Hospital based prospective cross sectional study was conducted among 202 mothers admitted to Jimma University Medical center from January 01/2019 to June 30/ 2019. Consecutive sampling technique was employed using interviwer administed quetionnaires. The data were entered using Epidata 3.1 version and exported to SPSS version 21. Bivariate and multi-variable binary logistic regression was used at 95% CI and AOR to identify predictors at P-value of <0.05. Result: From 1980 total admission to labor ward and maternity ward, 202(10.2%) mothers were diagnosed with HDP. Preeclampsia with severity feature was the most common presentation (60 %) followed by eclampsia (10.4%). About one third (32 %) of the mother developed at least one maternal complication which could be considered as unfavorable maternal outcome. HELLP syndrome was the most common complications (38.5%) followed by aspiration pneumonia (20 %). Five mothers (2.4 %) of HDP died during the study period, three of them were due to eclampsia complicated by pulmonary edema and two were due to preeclampsia with severity feature complicated by acute kidney injury (AKI) with encephalopathy. There was statistically significant association between place of residency being rural area (AOR = 0.142, 95 % CI: 0.025, 0.801) and having eclampsia (AOR = 9.852, 95% CI: 2.963, 133) and unfavorable maternal outcome. Fifty percent of the fetuses developed unfavorable perinatal outcome with at least one complication. Prematurity and associated neonatal complications particularly hyaline membrane disease was the most common complication. There were 14.4 % still birth and 5.5 % ENND. Gestational age at delivery of 28 – 33 weeks (AOR = 10.11, 95 % CI : 1.635, 62.6), having eclampsia (AOR = 2.761, 95 % CI : 0.898, 8.487) and antepartum onset of HDP (AOR = 6.6 , 95% CI : 3.4,12.75) of the mother had statistically significant association with unfavorable perinatal outcome. Conclusion and recommendation: The presence of preeclampsia with severity features and eclampsia has been associated with poor maternal and perinatal outcomes which were manifested by increased maternal ICU admissions, maternal death, preterm delivery rate still birth and ENND. JUMC should give due emphasis for early recognition and management of mothers with HDP. Keywords: Hypertensive disorder of pregnancy, maternal outcome, perinatal outcome, associated factors, Jimma university medical center

The structural analysis of gross regional product (GRP) of Perm Krai has been conducted. The GRP has been calculated using income and expenditure approaches to determine the influence of each of its components on the growth rate of generalized indicator. The significant statistical discrepancy of GRP values, calculated with different methods, has been revealed. The GRP calculated using the expenditures approach is characterized by the greater range of fluctuation than the gross added value and the GRP calculated using the income approach. The reason of the discrepancy has been determined. It is the incomplete disclosure of interregional relations at the regional level. The authors have highlighted the challenges that arose when calculating the values, including the resulting simplification of the methods of calculation of macroeconomic indicators at regional level that are quite substantial to regions, including Perm Krai. Based on the sensitivity analysis and the results of the correlation analysis the authors have identified factors that have the significant effect on the rate of economic growth in the region. Correlation analysis has shown the high dependence of the GRP on consumer spending both in Perm Krai and in Russia. Empirical analysis has allowed to substantiate the main directions of regional economic policy and to identify the instruments of public administration. The use of these instruments together with the methods affecting the salary range, stimulating consumer demand, investment and government spending will allow the government of Perm Krai to influence economic growth in the region.

Aim. The project National Register of Patients with Mucoviscidosis (MV), introduced in Russia, opened the widest perspectives for comparative analysis and summarizing of clinico-epidemiological data all over Russia, federal districts, regions and separate territories. The register data permit to generalize the experience of observation and management of MV patients in centers.
 Comparative analysis of the clinico-epidemiological characteristics of MV and volume of therapy in patients living in Perm Krai (PK) with the other regions of Privolzhsky Federal District (PFD) and Central Federal District (CFD) of Russia was carried out.
 Materials and methods. According to the Register of MV Patients in the Russian Federation for 2017, the data of 1576 patients with MV were analyzed: 930 (59.0 %) patients were observed in CFD, 600 (38.1 %) in PFD, 46 (2.9) in PK.
 Results. Among MV patients in PFD and PK, there was noted a great variety of variants of the gene CFTR, associated with both the presence of autochthonic and relatively closed ethnic groups and migration of the population. A high allele frequency of the variant E92K was revealed in patients of Chuvash Republic (55.3 %). A group of patients from PK, registered in 2017, had a low mean age, the lowest age of making a diagnosis.
 Conclusions. Clinico-epidemiological studies, according to the data of MV patients register, permitted to detect some peculiar features that can be significant for practical healthcare. Further studies on MV patients register should be continued.

The oil and gas industry of Perm Krai is one of the core industries that determines the actual status and prospects for the social and economic development of the region. This article assesses the impact of the oil and gas industry on the social and economic development of Perm Krai. The author comes to the conclusion that the industrial production, and in particular the oil and gas complex, remains the basic economy sector of Perm Krai, which plays a leading role in income generation of the territorial budget. On the basis of the oil and gas industry it is possible to develop the accompanying sectors in the economy. In other words, it can become a locomotive for developing other economy branches. Trends in the oil industry development in the Perm Krai coincide with those typical for the Russian Federation as a whole. Therefore, the sanction measures could not fail to have an impact on the economy of Perm Krai in general and the activities of the oil industry enterprises in particular. The action of economic sanctions led to a reduction in oil extraction, accompanied by a price drop; volumes of export; the limitation of supplies of specialized equipment and technologies for the developing oil deposits and oil production. To overcome this situation in the Perm Krai, the following measures can be proposed: creation of the new competitive capacities (which requires the additional investment sources) and creation of a petrochemical cluster.

The article is devoted to reflections on the modern development of federalism models in the Russian Federation using the example of the Komi-Permyak Okrug of Perm Krai. The authors are convinced that the Russian model of federalism in the post-Soviet space is more resistant to political challenges than in a number of newly formed states. The article examines the modern history of the Komi-Permyak Okrug of Perm Krai from the early 1990s to 2005. The article examines the discussions about the status of the okrug in the early 1990s and assesses the role of the Komi-Permyak Autonomous Okrug in the system of Russian federalism in the 1990s. It presents an analysis of the situation in the Komi-Permyak Autonomous Okrug in the early 2000s and the beginning of public discussions about merging the okrug with Perm Oblast into a new constituent entity of the Russian Federation. The article examines the main stages of decision-making and subsequent reform, and discussions about possible options for autonomy for the okrug as part of the newly created Perm Krai. The article assesses the activities of political and public opinion leaders who participated in the unification process in 2003–2005. It is noted that the unification of the Komi-Permyak Autonomous Okrug and Perm Oblast in 2005 marked the beginning of the process of subsequent merger of five more constituent entities of the Russian Federation. The final part provides an assessment of the consequences of the reform. The authors conclude that the Komi-Permyak Okrug managed to most effectively implement the goals of the administrative reform, since the authorities of the Perm Krai were able to improve the level of socio-economic well-being of the population of the okrug and ensure the preservation of the language and ethnic culture of the Komi-Permyak people.

Objective. To analyze the effectiveness of etiotropic antiviral therapy with direct antiviral drugs against chronic viral hepatitis C in the adult population of the Perm Krai.
 Materials and methods. In the regional register of Perm Krai, 20095 patients with chronic viral hepatitis C were registered. In 2019–2021, antiviral therapy with direct antiviral drugs, registered in the Russian Federation, and included in the list of vital and essential medicines for medical use was prescribed to 282 patients with chronic hepatitis C. There were 137 men (48.6 %), 145 (51.4 %) – women. The age of the patients ranged from 26 to 82 years, the duration of the disease – from 3 to 25 years.
 Results. All the therapy regimes we used showed 100 % effectiveness in the population of patients suffering from chronic hepatitis C associated with mild liver fibrosis regardless of genotype, whereas in the population of patients with grade 3 fibrosis or liver cirrhosis, 100 % effectiveness was achieved only after the use of sofosbuvir-containing schemes. The pangenotypic schemes resulted in 100 % achievement of a stable virological response among patients with genotype 1 regardless of the stage of liver fibrosis and previous therapy experience. In the treatment of patients infected with genotype 3 of hepatitis C virus with severe fibrosis, the effectiveness of 100 % was noted after the use of sofosbuvir-containing regimes.
 Conclusions. Among the adult population of Perm Krai, the overall effectiveness of therapy in patients with chronic hepatitis C, who used direct antiviral drugs, was 97.8 %.

One of the main conditions for the successful implementation of the adopted Spatial Development Strategy in the Russian Federation is the sustainable development of its regions. The study was conducted in order to study the level of sustainable development of the regions of Volga Federal District, which occupies 6.1% of the territory of Russia, based on the model developed by the authors. The indicators of sustainable development proposed for assessment (economic, social, scientific and innovative, environmental) make it possible to make an objective and comprehensive assessment of the regional policy pursued in the region, show the level of sustainable development and give appropriate guidelines in further management decisions for its management. As a result of the study, following the results of 2020, the regions were ranked according to the level of their sustainable development of the year into five groups. The Republic of Tatarstan has taken a leading stable position. The group close to sustainable development includes Bashkiria, Samara and Nizhny Novgorod regions, as well as Perm Krai. Saratov region has signs of unstable socio-economic development. The Orenburg, Penza, Kirov, Ulyanovsk regions and the Udmurt Republic were included in the group with an unstable pre-crisis economic state. According to the level of sustainable development, Chuvashia, Mordovia and Mari El are classified as a group with signs of socio-economic crisis. The regions of Volga Federal District, regardless of the rank obtained, are invited to annually assess the level of sustainable development and form a development strategy based on the experience of the leading regions. The results of the study can be the basis for making a forecast of the socio-economic development of the regions of the Volga Federal District and indicators of their sustainability for the future.

Objective. To study individual dental and general health parameters in patients with temporomandibular joint dysfunctions to improve the effectiveness of diagnosis and comprehensive treatment of patients with degenerative diseases of the craniomandibular complex. Materials and methods. The research was conducted at 2 clinical sites: the Dental Polyclinic of Ye.A. Vagner Perm State Medical University (Perm, Perm Krai, Russia) and the Department of Maxillofacial Trauma and Orthognathic Surgery of Dental Hospital of Zunyi Medical University (Zunyi, Guizhou Province, China). A health questionnaire was developed for the project, 2 observation groups of young and middle-aged patients (according to the WHO classification) were formed: group A comprised patients from Russia, and group B comprised patients from China. Results. Significant differences were identified in the structure of concomitant somatic conditions among patients with TMJ dysfunction between the Russian Federation and the People`s Republic of China. A number of modifying factors that influence the development and clinical course of the primary dental disorder were determined. The study also demonstrates that implementation of a unified health questionnaire for patients with TMJ dysfunction combined with somatic pathology enables deeper analysis of individual etiopathogenetic processes, which, consequently, will improve the effectiveness of treatment and lead to stable clinical outcomes, regardless of the patient's country of residence.

This study focuses on the infiltration of saturated brine from liquid-waste storage facilities into the surrounding groundwater and surface-water bodies. The storage facilities are situated at the Verkhnekamsk Potassium and Magnesium Salt Deposit (Perm krai, Russian Federation); they store highly mineralized brine of potassium, sodium, and magnesium chlorides. An analytical solution of a one-dimensional equation of contaminant transport by a homogeneous steady-state groundwater flow is used to estimate the time it takes the contaminant to travel from the storage facilities to the nearest surface water body, as well as to evaluate the formation time of a stationary concentration profile, with contaminant adsorption in the porous matrix either neglected or taken into account. The contaminant concentration at the point of brine entry into the surface water body is calculated. The ANSYS Fluent software package is used for direct 3D simulation of brine infiltration into the surrounding medium. The simulation results revealed different stages of contaminant propagation in the porous medium. The contaminant was found to spread over a wide area with an almost uniform high brine concentration close to the saturation value. The contaminant reaches the nearest riverbed approximately 20 days after the start of infiltration. The estimates of the time required for the contaminant front to reach the surface water body obtained by three-dimensional simulation agree with the analytical estimates derived from a one-dimensional model. The proposed system of physical models adequately describes the hydrodynamic processes accompanying the operation of large storage facilities and can be used to predict contaminant-front propagation in the groundwater near storage facilities.

The relevance of studying the ideas of students majoring in medicine and biology in the Central Black Earth Region of Russia about the problem of drug addiction and its prevention is associated with the significant prevalence of illegal drug use among young people in general, including those with medical education. In recent years, the incidence of drug-related morbidity has been declining, but episodic drug use is often not diagnosed and is not included in official data, but requires special attention. Even students of medical and biological specialties who have specialized knowledge but demonstrate insufficient preventive awareness are at risk. The aim of the study was to conduct a comparative analysis of knowledge and attitudes about drug addiction and its prevention among students of medical and biological specialties in the Central Black Earth Region of Russia, with an emphasis on the level of education (higher and secondary) and place of residence (city / village). The research program included a survey of 1 140 students from the Kursk, Voronezh, Belgorod, Lipetsk and Tambov regions. An original questionnaire implemented through the Yandex Forms platform was used. The data were processed using descriptive statistics methods with confidence intervals, χ²-criterion and Student's t-criterion with a significance level of p≤0.05. The selection of respondents met the representativeness criteria according to the methodology of the Central Research Institute of Health Organization and Informatization of the Ministry of Health of the Russian Federation. The results showed that 81.8% of students have an objective understanding of the harm of non-medical use of psychoactive substances, but significant differences were recorded by place of residence: in rural areas, underestimation of the danger and a tendency to "controlled drug use" prevail. Objective attitudes are more common among university students (66.5%) compared to college students (59.3%). Readiness for drug diagnostic screening is higher among urban students, while in rural areas an increased tendency to conceal drug status and a predisposition to drug addiction was recorded (21.6% versus 3.3% in the city). The final conclusion showed that medical and biological education does not guarantee the automatic formation of attitudes that exclude drug use. Living in rural areas is a pronounced risk factor for the prevalence of delusions and drug addiction. It is necessary to intensify extracurricular preventive work, especially in colleges located outside the cities, and systematically train specialists responsible for preventive activities in educational institutions.

The full-scale military invasion of Ukraine by the russian federation has brought to the forefront the urgent issue of effectively utilizing the countryʼs labor resources amid a sharp increase in the number of internally displaced persons (IDPs), many of whom are women with children fleeing the horrors of war. This situation necessitates the development and implementation of a well-balanced state policy regarding IDPs. An additional factor contri­buting to the urgency of this issue is the prolonged hostilities and the complete destruct­tion of a significant number of settle­ments in the combat zones, which has effectively ruled out the possibility of many IDPs returning to their homes as they existed before 2022. Two hypotheses are tested: first, that a significant number of IDPs are satisfied with state pay­ments, refusing to look for a job or retraining in anticipation of the end of active hostilities in order to return to their places of permanent residence or as close to them as possible; second, that there is a relationship between the employment of IDPs on a permanent basis and the distance of forced migration. The research employed methods of scientific abstraction, analysis, synthesis, comparative analysis, and systematization. It has been established that as a result of russiaʼs full-scale military aggression against Ukraine, a significant portion of IDPs were not only forced to seek refuge in new places of residence but also had to accept the reality of not being able to return to their native homes, instead having to rebuild their lives from that point onward. Findings indicate that, due to the implementation of state policy toward IDPs, only a relatively small proportion opted to return to territories temporarily occupied by Russia. The majority of displaced persons found employment in their new locations; however, a significant number were forced to accept low-paying jobs. It was determined that government assistance was generally sufficient to cover housing rental costs. At the same time, the spread of various forms of abuse related to the receipt of state aid by IDPs led to a gradual narrowing of the pool of individuals eligible for such payments. It was also found that the employment of internally displaced persons largely depends on the efforts of local authorities aimed at creating new jobs. Nonetheless, the widespread employment of IDPs in low-wage positions highlights the untapped potential to improve the effectiveness of their labor utilization by ensuring their skills, knowledge, and expertise are more fully and appropriately applied.

A residential location approach to traffic safety: Two case studies from Germany