Analysis of intra annual spatial dynamics of community-aсquired pneumonia incidence in the urban environment

Background. The spread of community-acquired pneumonia (CAP) in children and adults is interconnected and conditioned by natural, climatic and social factors.The aim. To assess the relationship between the incidences of CAP in different seasons of the year with the location of educational institutions in the urban settlement.Materials and methods. A cross-sectional study of the spatial distribution and seasonal dynamics of CAP cases in 2015 in a Siberian city with a population of more than 600 thousand people was carried out. Using GIS, 787 cases of CAP were analyzed among children of preschool and school age and adults. For statistical processing, 111 analyzed territorial units (ATUs) with an area of 250 m2 each were allocated on the maps. The dynamics of morbidity was assessed by weeks and seasons of the year among different age groups.Results. There was a direct moderate correlation between the number of CAP cases registered during the year with the number of schools and preschool educational institutions in ATU (r = 0.59; p < 0.001). ATUs with the presence and absence of educational institutions differed in the number of epidemic foci of CAP among the total population in winter and spring. The maximum number of cases of CAP among children and adults was registered in the second half of winter (weeks 3–13), the minimum – in the summer months (weeks 25–34).Conclusions. GIS analysis confirms the more frequent registration of CAP diseases among the total population in urban areas with educational institutions. There was established a direct moderate correlation between the incidence of CAP in children and adults by weeks of the year. Statistically significant differences in the number of cases in areas with and without educational institutions were noted in seasons with a higher incidence (autumn and winter)

Epidemiological assessment of the prevalence of coxarthrosis according to reports from medical organizations

Background. Coxarthrosis prevalence rates are necessary to assess the socio-economic significance of this pathology and to calculate the need for endoprosthetics. Information about the provision of medical care to patients with coxarthrosis is presented in the reports of various medical organizations, but in state statistical reports at the regional level this nosological form is not taken into account as a separate line.The aim. To estimate the prevalence of coxarthrosis based on the combined use of medical records from various sources in a region with a specialized clinic for prosthetics of large joints.Materials and methods. A retrospective descriptive epidemiological study based on materials from the Irkutsk region for 10 years (2008–2017) was carried out. Three main sources of data on patients with coxarthrosis were used: continuous and randomized samples based on population visits to polyclinics (n = 24 029), information from the bureau of medical and social expertise on disability (n = 19 081) and information from a specialized clinic on total hip arthroplasty (THAP) (n = 6227). The dynamics of indicators by years, the distribution of patients by sex, age and groups of disabilities have been analyzed. Regional indicators of incidence and prevalence of coxarthrosis were calculated based on extrapolation of sample data.Results. The following average annual regional indicators for patients with coxarthrosis were calculated: primary visits to polyclinics (incidence) – 73.8 (71.9–75.7) with a frequency of visits 1.9 times a year, the frequency of THAP operations – 3,3 (3,0÷3,6), disability – 10.1 (10.0÷10.3). The median age of patients at the initial visit was 61 years (Q1 = 46; Q3 = 76). The proportion of men among different groups of patients ranged from 41 to 44%, the proportion of disabled people among patients of the polyclinic and surgical hospital – from 45.2 to 47.1%. The estimated prevalence of coxarthrosis among the adult population was 413.5 (410,6÷416,4) / 10000.Conclusions. The epidemiological analysis algorithm described in the article is proposed as the first stage in assessing the social and economic significance of coxarthrosis and the regional need for arthroplasty of large joints

PREVALENCE AND STRUCTURAL CHARACTERISTIC OF COXARTHROSIS IN THE UST-ORDYNSK BURYAT DISTRICT

The prevalence of coxarthrosis in Ust-Ordynsk Buryat Region was defined as 19,8 ‰0 This article gives complex characteristics of coxarthrosis in the named region

Assessing socio-economic damage caused by coxarthrosis in the population

Background. About 40 % of patients diagnosed with coxarthrosis annually seek medical help and receive social support due to this disease. Increased use of an expensive surgery for treatment of coxarthrosis and projected growth of its prevalence in the population determine the relevance of socio-economic analysis. The aim of the study. To assess the value and structure of economic damage caused by the delivering health and social care to patients with coxarthrosis at the state level of the Russian Federation. Methods. To assess economic damage, we used the average annual number of various categories of patients and disabled people with coxarthrosis in the Irkutsk region for 2008–2017. Three main categories were identified: patients who visited the outpatients’ clinic; patients with total hip replacement; disabled people due to coxarthrosis. For each category, we calculated weighted average damage per  1  conventional patient, taking into account direct and indirect costs and subsequent multiplication by the average annual number of individual categories of patients. Calculations were performed in 2017 prices. Results. The average annual socio-economic damage from coxarthrosis amounted to 1.39 (1.34÷1.43) billion rubles or 0.1 % of the gross regional product. The most of the damage (64.4 %) were indirect costs associated with disability due to coxarthrosis, 22.2  % of the total amount were the costs of hip replacement surgery, 13.4 % were the costs of outpatient visits. Indirect economic losses due to disability in patients of working age were 4.2 times higher than losses due to disability of oldage pensioners. Conclusion. The results of the study confirm the economic feasibility of surgical treatment of coxarthrosis, especially in patients of working age

ECONOMIC EFFICIENCY OF REDUCTION IN SYPHILIS AND HONORRHEA MORBIDITY

After the epidemic in the middle of 1990-s, incidence of syphilis in Irkutsk region reduced from 432.4 in 1997 to 66.4 in 2013. At the same time incidence of gonorrhea reduced from 375.9 in 1993 to 75.8 in 2013 per 100,000 of population. About 10 000 cases of gonorrhea and 12 000 cases of syphilis are reported annually during the pick of the epidemic. We used cost-benefit analysis to estimate the economic efficiency of regional morbidity reduction. The costs were adjusted to 2013 year prices. Average direct and indirect costs per case were as follows: syphilis 23.2 and gonorrhea 7.1 thousand rubles. Reductions in syphilis and gonorrhea from maximum in the middle of 1990-s to 2013 have saved about 300 million rubles approximately. In 2005-3013 the costs reduction was estimated as 10 million rubles per year. This sum composed about 20 % of total subsidy from federal budget to Irkutsk region for struggle with sexually transmitted infections (STI). Per year correlation between sum of subsidy for struggle with STI and number of syphilis cases composed -0.54 and -0.55 of gonorrhea cases (p > 0.05). Social factors also were discussed among reasons of morbidity reduction. In 2005-2013 regional income and birth-rate in Irkutsk region were increasing in contrast with the middle of 1990-s

SEVERE ACUTE RESPIRATORY SYNDROME (SARS) – A NEW INFECTIOUS DISEASE AND MAIN PROBLEMS OF ITS PROPHYLAXIS IN ASIAN PART OF RUSSIA

Publications, directive and instructionalmethodical papers of WHO, Government and Ministry of Public Health of Russian Federation prepared due to SARS epidemics are reviewed. A brief characteristics of the new disease is represented, the history of the virus discovery, the disease dynamics and SARS dissemination in the world in 2003 are described. Information about SARS suspected cases in Russia and main data on laboratory and clinical epidemiological diagnostics are represented. Measures undertaken for the new disease control are considered in the concluding part of the review. Peculiarities of Siberia and Far East (the region closely connected with the most SARS affected Asian countries) are marked

СОВРЕМЕННЫЕ ПОДХОДЫ К АНАЛИЗУ СМЕРТНОСТИ ОТ ПНЕВМОНИЙ

Mortality from pneumonias in Russia  stays  on high level with  periodical increase. In order  to study this  occurrence is necessary the  complex approach with  obligatory regards for results  of postmortem pathological investigations. In the paper  are analyzed 8 lethal  outcomes coded as pneumonias and  30 due  to influenza with different role of bacterial component. Was demonstrated that death in cases of pneumonia usually occurred in patients with severe  background pathology (alcohol abuse, chronic hepatitis etc) and in combination with  viral lesions as well. Development of bacterial complications of influenza doesn’t  correspond directly neither with the age of the patients, nor the duration of the illness  or hospitalization. In Irkutsk were  investigated 30 cases  with  the use of morphological, bacteriological, and PCR. Was  proved the  high  value  of information due  to PCR which  correlated with  clinical   and  pathological data.   Importance of  pneumococci in etiology of community acquired pneumonia was shown (11 cases versus 1 positive culture). Was assumed that the  course  of pneumonias depends upon  the  properties of their pathogen.Смертность от пневмоний в России  сохраняется на высоком  уровне и периодически повышается. Для изучения причин этого  явления требуется комплексный подход с обязательным учётом посмертных патолого-анатомических исследований.В работе на материале Санкт-Петербурга проведен анализ 8 летальных исходов от пневмонии и 30 летальных  исходов от гриппа с различной ролью  бактериального компонента. Показано, что от пневмоний умирали в основном пациенты с тяжелой  фоновой патологией (алкоголизм, хронические  вирусные  гепатиты  и  др.), а также  в  сочетании с  вирусными  поражениями. Развитие бактериальных осложнений в случаях летальных исходов при гриппе напрямую не связано ни с возрастом пациентов, ни  с длительностью заболевания, ни  с госпитализацией.На материале Иркутска изучено 30 наблюдений с использованием   морфологических,   бактериологических и молекулярно-биологических методов (ПЦР). Показана высокая информативность ПЦР-исследования, коррелировавшая с клиническими и морфологическими данными. Доказано большое значение  в  этиологии внебольничных  пневмоний пневмококков (11 случаев по сравнению с 1 положительным результатом при  посеве). Высказано предположение, что течение пневмонии связано и со свойствами их возбудителя

Rabies re-emergence after long-term disease freedom (Amur Oblast, Russia)

Retrospective descriptive epizootological study was conducted in the Amur Oblast (Russian Far East), where a rabies outbreak was reported in 2018. The aim of the study was to analyze probable routes of rabies introduction and features of its spatial and temporal spread in the territory that remained free from this infection from 1972 to 2018. In 2018–2021, altogether 1,416 animals were examined for the infection with the rabies virus. Forty-seven animal rabies cases were confirmed; the proportion of wild animals (Vulpes vulpes, Nyctereutes procyonoides, Canis lupus) amounted to 66%. The first cases were detected within 30 km from the state border with China. Nucleotide sequences of the nucleoprotein gene of three rabies virus isolates were determined and their belonging to the Arctic-like-2 genetic lineage was established. Genetically closest rabies virus isolates have been found in Heilongjiang Province (China, 2011, 2018) and Jewish Autonomous Oblast (Russia, 1980). GIS and open Earth remote sensing data were used to map the rabies cases. After 2018, the epizootic spread within the forest-steppe landscapes of the Zeya-Bureya Plain, where human and animal rabies cases had been earlier reported (until 1972). The front of the epizootic spread in a north-eastern direction at an average speed of 59 (16–302) km during one epizootic cycle. The introduction of the rabies virus was most likely along the Amur River valley from downstream regions of Russia and China that are rabies infected