ORIGINAL RESEARCHES
The article analyzes changes in fertility and marriage rates in the Moscow agglomeration in 2020–2022. The choice of the Moscow agglomeration as an object is due to the significant influence of the share of nonresident births in Moscow on birth rates in Moscow and the Moscow region, which should be, to some extent, eliminated in order to correctly assess the impact of other factors. In 2020, due to the COVID-19 pandemic, marriage rates dropped significantly, especially for first marriages. A likely consequence of this was that the increase in the total fertility rate for first births in 2021 was very small, but for second and third and subsequent births was substantial. It can be assumed that the negative impact of the decline in marriage rates in 2020 on first births in 2021 was partially offset by the positive impact of the start of the maternity (family) capital for the first child. Combined with the effect of this factor, the increase in marriage rates in 2021 may have contributed to higher fertility rates for first births in the first half of 2022, while they declined for second and third and subsequent births. In addition to its effect on the decline in the number of marriages in 2020 and its indirect effect on first births, the initial period of the pandemic probably had an effect on the significant decline in the number of births in the Moscow agglomeration in January and February 2021.
Introduction. "Health and well-being of people" is the first national development goal of the Russian Federation until 2030. The Sustainable Development Goals (SDGs), also known as the Global Goals adopted by the United Nations (UN) in 2015, are comprehensive and indivisible and are being implemented everywhere [1]. At the 2016 Shanghai Conference on Healthy Cities, people's health and well-being were placed at the center of the UN's 2030 Agenda for Sustainable Development (“Agenda 2030”). A preliminary assessment of the current state and current trends using the example of Moscow can be a “starting point” for making decisions in the field of public health management in large cities.
Goal. To assess the progress of the city of Moscow towards achieving the third sustainable development goal (SDG 3).
Materials and methods. For the analysis, data from open sources of the Federal State Statistics Service of Russia, the Rospotrebnadzor department for the city of Moscow were used.
Results. Despite the pandemic, Moscow has maintained positive trends on a number of SDG targets and is advancing ahead (the proportion of births attended by skilled health workers; reducing infant and child mortality and tuberculosis incidence). There is also a decrease in mortality from traffic accidents, diseases of the circulatory system and neoplasms, primary incidence of malaria and hepatitis B. The assessment of public health indicators at the Moscow level is a new step in regional and territorial management through the use of the SDG 3 operational tool.
Intoduction. The construction of mathematical models of changes in the total and daily amounts of the coronavirus of the population of St. Petersburg in various segments and the period from 2020 to 2022. The need for research is dictated by the presence of a dysfunctional situation in the city, as well as the need to develop a methodological apparatus for short-term operational assessment of changes and forecasting of key indicators of the spread of coronavirus.
Purpose. To assess the change in the total and daily indicators of coronavirus disease in the population of St. Petersburg in the periods May-August 2020 and 2021 and to carry out a short-term forecast.
Methods. The solution of the problem was carried out by modeling and performing short-term prediction of the folding situation of coronavirus in St. Petersburg by the total (integral) and daily (differential) number of diseases in the region. Modelling is based on statistics that are generated through monitoring by coordinating councils to combat the spread of COVID-19 in regions and in the country.
Results. An approach and mathematical apparatus for modeling and forecasting the dynamics of regional key indicators of the spread of the pandemic in the regions of Russia are proposed.
Practical relevance. The proposed solution to the problem will enable the administration and health authorities to receive scientific information for evaluating and adjusting their work to create normal economic and social living conditions for residents of Russian regions.
Background. During past three decades Russia is characterized by natural population decrease. And low fertility along with high mortality is the reason for this. A small natural increase in population has been observed in Moscow since 2011, but the COVID-19 pandemic interrupted the achieved positive dynamics due to sharp mortality growth. According to a number of studies, fertility decline is caused, among other things, by high prevalence of infertility, both female and male. As a result, infertility prevalence in the capital’s population is one of the main sources of reproductive losses. The study purpose is to estimate potential births losses due to female and male infertility in Moscow compared to Russia’s indicators.
Materials and methods. Data from reporting statistical form №12 on disease prevalence (Ministry of Health of Russia) for 2011–2021 were used for analysis. Estimation of potential births loss was made using the method developed by Zemlyanova E.V. (2003).
Results. Prevalence of female infertility in Moscow increased 3 times in 2011–2021, male infertility – 2 times, in Russia prevalence of infertility in females increase by one third, in males – nearly twice. In Moscow infertility prevalence indicators are substantially lower than Russia’s average. In 2021 prevalence of infertility in women equaled 735.9 per 100,000, in men – 11.4 per 100,000, in Russia as a whole – 789.1 and 67.1 respectively. Thus, there is multiple difference between female’s and male’s indicators: 64:1 in Moscow and 12:1 in Russia respectively.
The scales of summary potential births loss due to female infertility in Moscow estimated 16 %, due to male infertility – less than 1 %; in Russia – 18 % and 3 % respectively.
Conclusion. Thus, potential births loss due to infertility both in women and men are present both in Moscow and Russia and summary figures equal about 17–21 %. There is a significant underestimation of cases of male infertility in primary health care. True data on infertility prevalence especially in men is possible to obtain only as a result of creation of a specialized andrological service in the healthcare system. Development and implementation of a state program on protection of male reproductive health can contribute to fertility increase.
Introduction. The high prevalence of dental diseases and their complications, congenital anomalies, traumatic injuries and various neoplasms of the maxillofacial region among children and adults necessitates the improvement of the medical care system.
Purpose. Improvement of specialized medical care by optimizing the routing system for patients with maxillofacial pathology in a metropolis on the example of Moscow.
Materials and methods. The study was conducted on the basis of the GBUZ “Maxillofacial Hospital for War Veterans of the DZM”. A search was made for regulatory documents regulating the routing of patients with maxillofacial pathology. The statistical data of the specialized medical care provided to patients with maxillofacial pathology in institutions subordinate to the Moscow City Health Department for the period from January 2021 to December 2021 were analyzed.
Results and discussion. The article presents a list of regulatory documents governing the routing of patients. The structure of diseases of the maxillofacial region among the children and adults of the city of Moscow was determined. Routing schemes for patients with planned and emergency maxillofacial pathology are given. Problems are identified and solutions are proposed, as well as the continuity of the provision of specialized care in organizations in the field of “maxillofacial surgery”.
Conclusions. A well-functioning routing system will improve the timeliness, availability and quality of specialized medical care. In addition, an optimized routing system will contribute to proper planning and resource allocation in healthcare.
REVIEWS
Introduction. Public health experts recognize that an environment that supports a culture of health best serves health goals. Therefore, some companies are creating a culture that supports health and builds healthy lifestyles for employees.
Objective. A description of the key elements for creating a workplace health culture and the international experience of employers in applying corporate health practices to change employee behavior.
Materials and methods. A content analysis of corporate health publications from the Scopus and PubMed bibliographic databases and public Internet sources.
Discussion. Behavioral change programs aim to encourage workers to quit unhealthy habits, change-eating habits, increase physical activity, and manage stress and depression. Usually these programs implemented using a comprehensive approach. These interventions can be personal or mass-based. The former include individual counseling, food stamps or discounted fitness club memberships, systems of contracts that encourage behavioral changes in employees, rewards for quitting tobacco, free provision of anti-nicotine products, closure of company parking lots for those who live near the workplace, etc. The latter involve the introduction of a ban on smoking on the territory of the organization, reducing the cost of a healthy meal in the corporate canteen, etc.
Conclusion. There is an ongoing discussion in the scientific community about the effectiveness of workplace wellness programs. Many experts agree that a comprehensive strategic approach that includes measures to create a culture of health and a supportive work environment, along with regularly updated programs to promote health and change employee behavior is beneficial to both workers and businesses.
Introduction. Monitoring of the health status of the population as a whole, assessment and analysis of the leading determinants of health, including genetic, behavioral, anthropogenic, biophysiological factors, represent one of the global functions of public health, focused on health protection and provision of medical services. To date, health disorders are primarily related to lifestyle and are always a collection of individual personalized health data. Unhealthy diet and low physical activity are risk factors for the development of a number of chronic non-communicable diseases, primarily cardiovascular, metabolic, in particular type 2 diabetes mellitus and some types of cancer. These risk factors lead to early disability, a decrease in the quality and life expectancy of people, disability, as well as the health budget and the economy. So, if on average only 3 % of the health budget is spent on disease prevention programs, then about 7 % of the budget in the EU countries is spent on the treatment of obesity and turns into 2.8 % of world GDP. In this regard, the implementation of early preventive measures is characterized by favorable and positive results.
Purpose. Analyzes the role of unhealthy diet and low physical activity as key risk factors for cardiovascular and metabolic diseases, especially in the population of patients with type 2 diabetes mellitus.
Methods and materials. The characteristics of the presented studies included in the article cover international experience and analysis of the pilot study conducted on a population sample of patients with type 2 diabetes mellitus. To assess the economic costs associated with unhealthy diet and low physical activity, a general approach was used based on the analysis of individual diseases, in particular, type 2 diabetes mellitus, using population attributive fractions, regression method.
Results. Based on the data obtained, it follows that patients with an unhealthy diet and low physical activity, burdened with overweight or obesity, have a high five-year risk of developing new cases of type 2 diabetes and cardiovascular complications. This includes early disability and the economic costs of providing medical care. Using the example of a number of European countries and its own results, this study is focused on assessing the economic damage that is associated with unhealthy diet and low physical activity among the population, regardless of the region of residence and the metropolis.
Introduction. Malignant neoplasms of the upper gastrointestinal tract occupy the 6th position in terms of the frequency of detection of new cases of cancer. Within the framework of the Federal project “Fight against oncological diseases”, state tasks have been set that provide for a significant reduction in mortality from neoplasms, including malignant ones, to 185 cases per 100,000 people. The development, standardization and algorithmization of medical methodologies for drug treatment of cancer aimed at improving the quality of oncological care is underway. In early June 2022, the results of the latest clinical developments, including targeted and immune therapy for upper gastrointestinal tumors, were presented at the Annual Congress of the American Society of Clinical Oncology (ASCO). Popularization of innovative approaches to the treatment of cancerous tumors of the gastrointestinal tract fully meets the objectives of the Federal project.
Materials and methods. This material was the result of a study of innovative clinical developments in drug therapy for tumors of the upper gastrointestinal tract, presented at the ASCO Annual Congress - June 2022 and the digital platform MEDTalks.nl: the Korean clinical trial K-Umbrella; the German-Swiss Phase 2b DANTE clinical trial; French national randomized trial GERCOR.
Discussion and Conclusions. The results of the presented clinical developments demonstrate positive effects and an acceptable drug safety profile, which opens up prospects for their implementation in practice as part of innovative medical methodologies for the treatment of patients with malignant neoplasms of the upper gastrointestinal tract.