INFLUENCE OF ENVIRONMENTAL FACTORS ON HYGIENE PREVALENCE OF CIRCULATORY DISEASES OF POPULATION OF THE PRIMORSKY KRAY BIOCLIMATIC ZONES

The article presents the results of the environmental and hygienic assessment of the prevalence of diseases of the circulatory system in the adult population in the Primorsky Kray. The analysis was conducted on the incidence of Form 12 for the period of 1991-2011. To characterize the habitat 8 sanitation (according to the Form 18 provided by Center of Hygiene and Epidemiology in the Primorsky Kray) and 7 climatic factors of the modular that were formalized in a 5-point scale based on the developed normalized rating scale were taken. Each module consisted of a factor of 3 to 10 parameters of the environment. To establish the connection between environmental factors and the level of circulatory diseases we used regression analysis of the statistical package SSP. It was revealed that for the last 6 years for the first time the disease circulatory system in the adult population began to occupy first place in the structure of the entire morbidity and reached 43-49 %. Ranging of the administrative territories of Primorsky Kray as habitat and morbidity. With the use of Pearson (χ2) and regression analysis the patterns of environmental factors impacting on the level of cardiovascular diseases were determined. The prevalence of cardiovascular diseases in the adult population of the region depends on the bioclimatic zones, the degree of environmental stress of the situation and factors of the environment. The prevalence of cardiovascular diseases in adults as the organism's response to the impact of the environment influenced primarily hygienic parameters: the level of pollution of the atmospheric air, characterization of chemical pollution and adverse physical factors in urban and rural areas, transport load as well as the level of diseases of the circulatory system has a strong connection with climatic parameters: the number of days with BASR, latitude, speed of air movement

The effect of environmental factors on the immune-metabolic status of people living in industrial areas of Primorsky region

The estimation of the total effect of the environment on immune-metabolic parameters of people living in industrial areas of Primorsky region was conducted. The study involved 1128 healthy people living in the Primorsky region for at least 10 years. Integrated exposure index (HE) that takes into account the gradient of "response of the body" to the combined effects of multiple environmental factors (climatic, technological, socioeconomic, etc.) was developed. With use of gradient approach in Primorye 4 categories of areas were identified: the relatively favorable (IIE > 0,4), moderate (IIE = 0,3-0,4), relatively unfavorable (IIE = 0,2-0,3) and unfavorable environment (IIE 0,4). With the use of cluster analysis the classification of objects method К-means was performed, which revealed three immune-metabolic phenotypes. Compensated phenotype corresponds to the first phase of the adaptation of the organism - the activation parameters. Increased exposure leads to the formation of subcompensated phenotype, and the destruction of the body of the adaptation fund - to the formation of decompensated phenotype. The distribution of the proportion of healthy individuals with selected phenotypes in the population living in the areas with different environmental pressure shows the following dependencies: compensated and subcompensated phenotypes prevalent in areas with better living conditions, the percentage of decompensated phenotype increased environmental degradation. In areas where environmental load exceeds the capability to adapt the body subcompensated and decompensated phenotypes prevail. Violations identified unfavorable combination of endogenous and exogenous risk factors may be the basis for the formation of disease

CHEMICAL STUDY OF SNOW OF VLADIVOSTOK CITY AND RUSSKY ISLAND

In the paper thefirst results of mass and spectrometer research of snow cover of the largest city in the Far East - Vladivostok (mainland and Island Russky), dropped-out on the November 19 2012, are presented. To exclude secondary pollution by anthropogenous aerosols we used the top layer (5-10 cm) of just dropped-out snow placed in the 3-liter sterile containers. In a couple of hours, when snow in containers thawed, 10 ml of liquid were gained from each sample and were analyzed on a mass spectrometer of high resolution with inductive-connected plasma (MS-ICP) Element XR (Thermo Scientific). Measurements were carried out with use of a technique of TsV3.18.05-2005 Fr.1.31.2005.01714. Tests were selected in 20 points: 16 points - Vladivostok, 3 points - Island Russky (DVFU campus, the bridge, the settlement) and a comparison point - the bay Hero in the southwest of Peter the Great Bay. For the first time application of the most highly sensitive chemical method for an applied ecological task is shown today. Distribution of Pb, Cr, Mn, Fe, Co, Ni, Cu and Zn in areas of Vladivostok different by anthropogenous loading and on Russian Island is revealed. In districts of Vladivostok with high transport loading high contents of metals (Mn, Cu, Zn) which source is motor transport (exhaustgases, autopaint, catalysts) are fixed also. Tests from districts of the Academic Town have traces of influence of the sea coast (halite and potassium-containing minerals) and railroad tracks (a microparticle of iron and its oxides) that strongly pollutes environment iron because of continuous movement of trains. In the tests taken on the Eagle hill, the highest point of Vladivostok, high concentrations of Mn (the highest concentration from all tests) and Cu (the third concentration from all tests) are recorded. This point of selection is in the downtown and, apparently, isn't ecologically clear. It should be noted that height above sea level in an urban environment isn't in sufficient condition for ecological safety. Russian Island is a pure zone with low background contents of heavy metals. The raised maintenance of Cu, Ni and Zn in snow cover of the bay Hero is shown

МОДЕЛЬ ОРГАНИЗАЦИИ РАННЕЙ ДИАГНОСТИКИ РАКА ПОЧКИ

 Challenges of early kidney cancer detection and screening significantly increase morbidity and mortality rates, thus dictating the need to improve prevention, early diagnosis and organization of medical care for the population of primorsky Krai. The aim of the study was to create a model for improving early diagnosis of kidney cancer in the primorsky Krai using the program for assessing the risk of kidney cancer (ARKC). The model included a population questionnaire to identify risk factors and algorithm of patient routing («roadmap») with suspected kidney cancer for in-depth examination and treatment. Material and Methods. 2982 residents of the primorsky Krai (women – 1950, men – 1032) in the age range 29–75 took part in the questionnaire survey using the ARKC program. Results. No risk factors were identified in 1879 (63.0 %) individuals. All patients at high risk for kidney cancer (656 – 22.0 %) and patients of the uncertainty group (447 – 15.0 %) were referred for physical and ultrasound examination to exclude kidney tumors. Non-tumor pathology of the kidneys was revealed in 156 (14.0 %) patients. Renal mass suspicious for renal cell carcinoma was revealed in 21 (1.9 %) patients (later confirmed in 17 patients with stage I–II cancer, in 3 patients with stage III, in 1 patient with stage IV). According to the results of the factor analysis, two main groups of factors had a predominant effect on the rise in the overall kidney cancer incidencer. The first group of factors (65.0 %) is caused by smoking, excessive alcohol consumption, overweight, unbalanced nutrition, and the influence of carcinogens. The second group of factors (35.0 %) is caused by problems of a medical and social nature: the low material and technical base of primary care medical organizations, the insufficient professional training of medical workers on the issues of cancer prevention and treatment, including kidney cancer.Conclusion. To improve the early detection of kidney cancer, a prognostic model with computer program for assessing the individual risk of developing kidney cancer was developed. population survey using the ARKC computer program allowed us to narrow the diagnostic search, form risk groups and effectively route patients with suspected kidney cancer for in-depth examination in accordance with the «road map».  Проблема ранней диагностики и скрининга рака почки существенным образом влияет на запущенность и смертность от данной патологии, что диктует необходимость решения проблем профилактики, улучшения ранней диагностики и организации медицинской помощи населению Приморского края при злокачественных новообразованиях (ЗНО) почки. Целью исследования явилось создание модели совершенствования ранней диагностики ЗНО почки в Приморском крае на основе разработки и внедрения в практику компьютерной программы оценки риска рака почки – «ОРРП». Эта модель включает в себя анкетирование (опрос) населения на выявление факторов риска и алгоритм маршрутизации пациентов («дорожная карта») с  подозрением на рак почки для углубленного обследования и лечения.Материал и методы. Объектом исследования было население Приморского края. Проведено анкетирование по программе «ОРРП», в котором приняли участие 2982 жителя в возрасте от 29 до 75 лет (женщин – 1950, мужчин – 1032). С целью поиска научных решений по снижению уровнясмертности от новообразований проведен анализ причин  роста онкологической заболеваемости и смертности населения Приморского края с использованием  медицинских карт пациентов, результатов ведомственных экспертиз медицинских организаций, противораковых комиссий, коллегий, аппаратных совещаний, мониторинга показателей государственной программы «Развитие здравоохранения Приморского края», «Плана мероприятий по снижению смертности населения от новообразований, втом числе злокачественных». Результаты. По результатам опроса у 1879 (63,0 %) лиц не выявлено факторов риска, им рекомендовано пройти контрольное анкетирование через 3 года. Пациенты группы высокого риска (656 – 22,0 %) были направлены к урологу для углубленного обследования. Пациенты группы неопределенности (447 – 15,0 %) были направлены на осмотр участкового терапевта. Всем пациентам групп неопределенности и высокого риска назначалось ультразвуковое исследование для исключения новообразования почек. У 156 (14,0 %) пациентов выявлена неопухолевая патология почек, у 21 (1,9 %) пациента – подозрение на ЗНО почек, которое позже подтвердилось (у 17 пациентов I–II стадии, у 3 пациентов – III стадии, у 1 пациента – IV стадии). По результатам анализа анкет на рост показателей заболеваемости раком почек оказали преимущественное влияние две основные группы факторов. Первая группа факторов (65,0 %) обусловлена курением,  чрезмерным употреблением алкоголя, избыточной массой  тела, несбалансированным питанием, влиянием  канцерогенов. Вторая группа факторов (35,0 %) обусловлена проблемами медико-социального характера: низкая материально-техническая база медицинских организаций  первичного звена, недостаточная профессиональная  подготовка медицинских работников по вопросам  профилактики, своевременной диагностики и лечения онкологических заболеваний, в том числе рака почки. Заключение. Для осуществления мероприятий по улучшению ранней диагностики ЗНО почек разработана прогностическая модель на основе компьютерной программы для оценки индивидуального риска развития ЗНО почек у населения  Приморского края. Анкетирование населения с использованием компьютерной программы «ОРРП» как первого этапа популяционного скрининга позволило сузить диагностический поиск, сформироватьгруппы риска и осуществить эффективную маршрутизацию пациентов с подозрением на ЗНО почки для углубленного обследования.

EPIDEMIOLOGICAL ASPECTS THE INCIDENCE OF CANCER OF THE KIDNEY AND BLADDER IN PRIMORSKY KRAI

Urinary system cancer is a malignancy caused by environmental exposures, the prevalence of which directly depends on the impact of environmental and anthropogenic factors. The aim of the study was to assess the kidney and bladder cancer incidence in different ecological and bioclimatic zones of Primorsky Krai. Material and methods. The incidence of kidney and bladder cancers in Primorsky Krai for the period between 1994 and 2014 was analyzed. In assessing the risk of kedney and bladder cancers in bioclimatic zones (marine climate, marine to continental transition and continental climate), environmental problems of the territories of Primorsky Krai were classified using the following ranks: critical, stress-like, satisfactory, and relatively favorable. The risk assessment was conducted using the guidance on Human Health Risk Assessment for Environmental Impact Assessment. To calculate the environmental impact on risk of urinary system cancer, the information entropy analysis was used. Results. The territories with low, medium and high incidence of bladder and kidney cancers were identified. The high incidences of kidney and bladder cancers were registered in the territories with environmental problems ranked as critical and stress-like, affected by coal, mining and chemical industries, and in the territories with intensive use of chemical pesticides. The incidence of bladder cancer in men tended to rise from the continental bioclimatic zone to the coast in all ecological zones mainly due to differences in the structure of the bioclimate between the coast and continental areas of Primorsky Krai. The increased risk of urinary system cancer was shown to be associated with parameters, such as the quality of drinking water, total pollution of the environment, chemical composition of groundwater, and the sanitary condition of the soil. Conclusion. The environmental risk assessment and ranking of territories by risk allow the cancer prevention and control programs to be developed and the need for increased cancer screening in certain areas to be identified

ОЦЕНКА МЕТОДА АНКЕТИРОВАНИЯ И ДОБРОВОЛЬНОГО ОБСЛЕДОВАНИЯ НА ВИЧ ДЛЯ ИЗУЧЕНИЯ РИСКОВАННОГО ПОВЕДЕНИЯ ЖИТЕЛЕЙ ПРИМОРСКОГО КРАЯ

To evaluate public HIV awareness and to reveal HIV cases, 3500 subjects who were not obliged by law to pass examinations were interviewed and tested for HIV. This investigation was carried out by mobile groups outside of health care institutions among target population groups and employees of different enterprises in eight municipalities of Primosrkiy Region. Interviews associated with counselling and discussions were conducted before and after HIV tests. On a whole, the subjects showed acceptable awareness of HIV epidemiology and prevention issues; however, a high rate of wrong answers in questionnaires (18,7%) was noticed among people aged 30 to 49 years who in recent years were predominant among newly found HIV cases in Primorskiy Region. This finding should be taken into accounted in the designs of preventive and educational interventions. HIV detection rate among people who are not obliged by law to pass HIV testing has been found to amount to 0,08%. Twenty-nine percent of study subjects believe that preventive voluntary screening for HIV should be more available.В целях определения информированности населения и выявления инфекции вирусом иммунодефицита человека проведено исследование 3500 человек из числа не подлежащих обследованию в обязательном порядке по требованиям нормативных документов. Особенностью исследования стала форма его проведения в рамках мобильной выездной работы, за пределами медицинских организаций, в ключевых группах населения и трудовых коллективах на территории 8 муниципальных образований Приморского края. Материалы и методы. Проводилось до- и послетестовое консультирование по вопросам профилактики инфекции вирусом иммунодефицита человека с использованием методов интервьюирования, опроса, предоставления информации, обсуждения. Результаты исследования. Исследуемые проявили достаточный уровень информированности по основным вопросам эпидемиологии и профилактики инфекции вирусом иммунодефицита человека. Однако наибольшее количество неправильных ответов получено в возрастной группе 30–49 лет (18,7% от числа всех опрошенных данного возраста), преобладающей среди возрастных групп с впервые выявленной инфекцией вирусом иммунодефицита человека на территории Приморского края в последние годы. Этот фактор необходимо учитывать при построении адресных профилактических и информационных мероприятий на популяционном уровне. Выявляемость инфекции вирусом иммунодефицита человека при обследовании лиц, не подлежащих обязательному медицинскому освидетельствованию, составила 0,08%. 29% участников исследования считают необходимым увеличение доступности превентивного скринингового обследования на вирус иммунодефицита человека.</p

ОСОБЕННОСТИ РАЗВИТИЯ ЭПИДЕМИЧЕСКОГО ПРОЦЕССА ВИЧ-ИНФЕКЦИИ В ПРИМОРСКОМ КРАЕ

The official statistical data of HIV Registry filed at Regional Center for Prevention and Control of AIDS and infectious Diseases were used in assessing the time course of HIV epidemic in Primorkiy Region to define the region-specific features of the development of HIV epidemic in 2011–2016. HIV prevalence is increasing in the Region since 2011. Although the importance of the sexual route of HIV transmission  is on the rise, the main route is still injection drug use. Trends in changes in the gender and age structure  of HIV-infected population are defined. The highest  HIV prevalence is found among males aged 25 to 49 years: 1113.4 per 100 000 male population, almost three times higher than the average value.Изучена динамика распространения ВИЧ-инфекции на территории Приморского края за весь период регистрации инфекции для выявления особенностей становления эпидемии на конкретной территории и определения тенденций развития эпидемического процесса в 2011–2016 годах. В работе использованы официальные статистические данные регистрации ВИЧ-инфекции ГБУЗ «Краевая клиническая больница № 2 — Центр по профилактике и борьбе со СПИД и инфекционными заболеваниями».  С 2011  года в Приморском крае регистрируется подъем заболеваемости  ВИЧ-инфекцией. Несмотря на повсеместное увеличение значимости полового пути заражения ВИЧ, в Приморье основным фактором риска остается внутривенное введение наркотиков. Выявлена тенденция изменения гендерного и возрастного состава лиц, живущих с ВИЧ. Наибольший уровень пораженности ВИЧ-инфекцией  регистрируется среди мужчин в возрасте 25–49  лет (1113,4 на 100 тысяч мужского населения), почти в три раза превышая краевые показатели округа (ДФО).</p