PREVENTIVE MEDICINE

ARGUMENTATION OF PROGRAM PRINCIPLES FORMATION FOR ACOUSTIC CONDITION AT A RESIDENTIAL AREA NEAR HIGHWAY

A. V. Mel‘tser¹, N. M. Kordyukov¹, E. B. Kuznetsova², I. Sh. Yakubova¹
1Federal state budget institution of higher education «North-Western State Medical University named after I.I. Mechnikov» under the Ministry of Public Health of the Russian Federation 2Federalbudget institution of science «North-Western scientific of hygiene andpublic health» Rospotrebnadzor, Russia

Abstract
Introduction. The construction and operation of highways near residential areas often causes anxiety of the population,as a result appeals to Federal Executive authorities occur. The adverse effect of noise from highways has its own characteristics related to the nature of the noise, the season, time of the day, weather characteristics, traffic vehicles etc. Normative documents do not define criteria for selection of assessment points in the apartments of residential houses located near the highways, there are no defined clear procedures for assessment.
Purpose. To develop a method of noise assessment in the apartments of residential houses for objective assessment of acousticconditions for designing a complex of measures to defend residential area from possible adverse effect from the highway
Materials and methods. In the course of this research the following materials were analyzed: site plan (Scale: 1:500–1:2000) of the Western highway, the protocols of noise assessment results in the apartments of residents, conducted by Federal budget institution of public health « of hygiene and epidemiology in Saint-Petersburg», the normative and methodical documents defining the requirements for noise assessment methods in the residential areas, its control taking into account the nature of noise, time of day, assessment instruments; the contents of citizens appeals.

Results and discussion. A comparative analysis of methods for determining key parameters which are necessary fornoise assessment was carried. The algorithm of noise assessment and noise monitoring program in the apartments of residential houses located near one of the sections of the Western highway — the example of a 10‑storeyed residential building that allows us to give a reasonable conclusion about the adverse impact of noise from the highway.
Conclusions. The assessment of acoustic conditions in residential buildings due to the adverse impact of the motorway canonly be done with a help of dynamic tracking of the noise level on the territory adjacent to the building and on different floors, throughout the year in different seasons and time of day. The minimum number of assessment points must be determined if taking into account the current urban situation, size, shape of a building.
Key words: noise, residential areas, residents appeals for traffic noise, acoustic conditions, methods of noise assessment, noise protection, noise monitoring in residential buildings.

A LONG-TERM EFFECT OF SUMMER HEAT ON THE POPULATION HEALTH IN 2010 IN MOSCOW

V.A. Gordin 1,2, E.A. Sakharova1,2

1Federal State Autonomous Educational Institution of Higher Education “National Research University” Higher School of Economics” (HSE), 101000, Moscow, Myasnitskaya St., 20
2 Federal State Budget Institution “Hydrometeorological Research of the Russian Federation” (FGBI “Hydrometeorological Centre of Russia”), 123242, Russia, Moscow, Large Predtechensky lane, 11-13

Abstract
Introduction. The heat in July-August of 2010 in Moscow with an escort of noticeable air pollution (including smokefrom peat fires) greatly affected the lives and health of the metropolis’ residents. It can be confirmed by mortality da and by information about daily Ambulance trips. In this period a strong peak was observed as for General graphs based on time and individual groups of diagnoses. In addition, the trend of the number of daily trips (as a function of time) changed significantly. The estimates of the moments of change in the trends were stable to the noise in the original data. These moments are close in time to the 2010 Moscow heat.
Purpose. Using the data of Moscow Ambulance trips’ statistics for 5 years, we identified the diagnoses which have asubstantial change in the total number of Ambulance trips.
Materials and methods. We used the archive of non-personally identifiable data of Moscow ambulance trips. Weconsidered the period from 1st January 2009 to 31st December 2013, i. e. 1826 days. The data can be divided into semidiurnal shifts. The total number of diagnoses is equal to 368. All calculations were realized in MATLAB.
Results. We found several diagnoses with significant change in the daily number of Ambulance trips.
Conclusion. In addition to the dramatic increase in the number of Ambulance trips, as for other diagnoses during thesummer heat in 2010, in Moscow, there has been a significant trend change in the daily number of Ambulance trips. Was found a method to find the moment of trend change that is tested for resistance to small changes in the source statistics. It turned out that the moments of fracture of the chart (trend change) quite accurately coincide with the period of abnormal heat of 2010.
Key words: heat wave, effects of heat, trend, the least squares method, white noise.

GASTRITIS AND PEPTIC ULCER MORBIDITY AMONG ADULT POPULATION OF THE RUSSIAN FEDERATION, TENDENCY OF THE LAST 20 YEARS

A. P. Shcherbo ¹, N. V. Shirinskaya ²
¹ Medical Corporation PMI, 191186, St. Petersburg, Gorokhovaya Str., 6
² Budget healthcare institution of Omsk region «Medical informational and analytical », 644021, Omsk, 8 Line str., 219а

Abstract
Purpose. A comparative analysis of adult population morbidity with gastric ulcer and duodenal ulcer, gastritis andduodenitis has been done on the territory of the Russian Federation, Siberian Federal District and Omsk region during 1997–2014. Statistical analysis processing is carried out with use of a Statistica 6.0 package.
Results. The observed period was characterized by a considerable growth of the gastritis and duodenitis incidenceamong adult population against a decrease of stomach and duodenum peptic ulcer incidence. Siberian Federal District is a territory with the highest indicators of the gastritis and duodenitis incidence and morbidity as well as the stomach and a duodenum ulcer incidence.
Conclusion. A comparative analysis of the studied statistical indicators on the territories has shown their similar features.
Keywords: incidence, morbidity, stomach and duodenum peptic ulcer, gastritis, duodenitis, adult population.

REVISITING AVAILABILITY IMPROVEMENT OF MEDICAL PREVENTIVE SERVICES FOR PATIENTS OF OPHTHALMOLOGIST

Vishnyakov N. I. ¹, Kochorova L. V. ¹, Nikitina O. G. 2
1State Budget Educational Institution of Higher Education «Pavlov First Saint Petersburg State Medical University» under the Ministry of Public Health of the Russian Federation, Saint-Petersburg, Russia, 197022, St. Petersburg, Leo Tolstoy St., 6–8
2Federal State Budget Educational Institution of Higher Education «Peoples’ friendship university of Russia», Moscow, Russia, 117198, Moscow, Mikluho-Maklaya St., 6

Abstract
Introduction. The problem of availability and quality of an ophthalmic medical care is one of the most critical problemsof the national healthcare.
Purpose. To analyze the patients’ opinion concerning the availability and quality of the ophthalmic primary health carein medical organizations representing different forms of ownership.
Materials and methods. Using a formalized interview method the survey of the patients of city policlinics (248 patients)and commercial optics salons (120 patients) was conducted. The survey data was statistically processed. The calculation of averages and extensive and intensive indicators of reliability assessment of their difference was executed.
Results. All surveyed of the commercial optics salons were satisfied with the quality of the provided ophthalmic services(98,7 %). Among city policlinics patients the percentage of the persons which were satisfied with provided ophthalmic services was 89,4 % (t=3,9; p<0,05). The scores of medical care availability in commercial optics salons were high enough (88,4 %), for city clinics this rate was lower and amounted to 76,0 % (t=5,0; p<0,05). Almost every third policlinic respondent (30,9 %) was compelled to apply to commercial optics salons for sight test. The main reasons were convenient location of commercial optics salons (84,5 per 100 surveyed patients) and absence of lines (80,7 per surveyed patients).
Conclusion. In this way this survey demonstrated that patients of the national clinics have difficulties to get requiredpreventive health care on time. And the ophthalmic patients prefer to visit actively commercial optics salons. The rating of provided service availability in these salons was high enough.
Key words: commercial optics salons, primary health care, ophthalmologist.

HEALTH STATUS ANALYSIS BASED ON MEDICAL EXAMINATION RESULTS AMONG CERTAIN GROUPS OF ADULT POPULATION IN 2013–2014

V. I. Orel, S. I. Bezhenar, N. A. Guryeva, V. T. Danilov
State Budget Educational Institution of Higher Professional Eduсational «Saint- Petersburg State Pediatric Medical University» under the Ministry of Public Health of the Russian Federation, 194100, Saint-Petersburg, Litovskaya str., 2.

Abstract
Introduction. Demographic and health characteristics of the population of our country today are characterized by lowlife expectancy, especially among males, high mortality rates, the growth of primary and total morbidity, in particular with socially significant diseases, some of which occupy the leading places in the structure of morbidity and mortality in adult population, and are also major causes of disability and premature death.
Purpose. To analyze the structure of diseases and the distribution of the assigned population group on health basing onthe results of the clinical examination.
Materials and methods. The research is based on the official reports of medical examination of certain adult groupsf. 131 / о (Addendum No. 4 to the order of MH of the Russian Federation dated 18.06.2013 No. 382n «Details about the clinical examination of certain groups of the adult population»).
Results. In 48,2 % of those examined were identified chronic non-communicable diseases (NCDS) — III health group,27,1 per cent — do not have the chronic diseases but had risk factors for diseases with high or very high total cardiovascular risk — II health group, the rest (24,7 per cent) have not been established chronic diseases and no risk factors or had low or moderate total cardiovascular risk — group health.
Conclusions. The prevalence of chronic non-communicable diseases and risk factors of diseases with high and veryhigh cardiovascular risk in adult population should be considered when planning health and rehabilitation activities in outpatient care.
Keywords: clinical examination, adult population.

WORK ANALYSIS OF SPECIALIZED WORK PLACES FOR «SEVERE» DISABLED PEOPLE IN RUSSIA AND ABROAD (REVIEW)

E. O. Gordievskaya, A. T. Davydov, E. M. Starobina
Federal State Budget Institution «Saint Petersburg Scientific and Practical of Medical and Social Expertise, Prosthetics and Rehabilitation of the Disabled» named after G. A. Albrecht of Federal Medical and Biological Agency». 195067, Russia, Saint-Petersburg, Bestuzhevskaya str., 50

Abstract
The problem of employment of disabled people with severe disabilities is particularly acute in our country and abroad. The article shows the analysis of domestic and foreign experience of specialized work places for «severe» people with disabilities, their main tasks and directions of activity. The consideration is given to the positive aspects of work of people with disabilities in such work places. The article gives comments of specialized work places if take into account modern international documents, including the UN Convention on the rights of persons with disabilities. The conclusion is that such work places are necessary to prepare «severe» disabled people for work, inclusion in the protected employment and a gradual transition to the open labour market.
Key words: specific work places, «protected work places», «closed work places», medical-production work places, «severe» disabled people, social-labor adaptation of disabled people, employment of disabled people.

THE BASIC PRINCIPLES AND MEASURES WHEN DEVELOPING A SOCIAL COMPONENT OF THE REHABILITATION AND HABILITATION INDIVIDUAL PROGRAM

E. N. Demina
Federal State Institution Saint Petersburg Scientific and Practical Centre of Medical and Social Expertise, Prosthetics and Rehabilitation named after G. A. Albrecht of the Ministry of Labour and Social Protection of the Russian Federation, 195067, Russia, Saint Petersburg, Bestuzhevskaya str., 50

Abstract
Purpose. To design the basic principles and measures when developing a social component of the rehabilitation andhabilitation individual program. Methodological basis of research is general scientific and special methods of literary analysis.
Results and discussion. The scope and content of measures of a social rehabilitation for disabled people depend on theprinciples that state follows, when organizing and implementing relevant social programs.
Conclusions. Using basic principles, the scope and content of measures taking into account the social status level ofthe disabled people, as well as considering the possibilities of regional interdepartmental rehabilitation system of disabled people when developing the section «social rehabilitation» in YPRES increases the effectiveness of rehabilitation and social adaptation of people with disabilities.
Keywords: scope of social rehabilitation measures, social status of a disabled person, social-environmental rehabilitation, social-pedagogical rehabilitation, social and psychological rehabilitation, social and cultural rehabilitation, social adaptation.

PREVALENCE OF HEXADECANOIC ACID IN FATTY ACID SPECTRUM IS A GENERIC FEATURE OF PATHOGENIC BACTERIA OF THE GENUS YERSINIA

B.G. Andryukov 1, N.F. Timchenko 1, E.P. Nedashkovskaya1,
 L.I. Sokolova2
1Federal State Scientific Institution "Scientific research institute here, Epidemiology and Microbiology named G.P. Somov ", Vladivostok, Russia;
2Dalnevostochny State Federal University, Vladivostok, Russia.

Abstract
Purpose: determining the fatty acid composition patterns in strains of Y. pseudotuberculosis and Y. enterocolitica toidentify opportunities for their clinical and epidemiological differential diagnosis.
Materials and methods. Bacterial strains used in the study: strains of Y. pseudotuberculosis and Y. enterocolitica fromthe collection of SRI EM SB RAMS. Conditions for cultivation: beef extract agar at 28°C for 24 hours. Preparation of the FA was conducted according to the European Committee for Standardization and recommendations of Sherlock MIS-protocol. Analysis of FA methyl esters was carried out by gas chromatography (ISO 5508:1990) in combination with mass spectrometry at the Department of Analytical Chemistry of the Far Eastern Federal University. Chromatography graphic-sample separation was performed on a capillary column with methyl silicone phase Ultra-1 Hewlett-Packard length of 25m and internal diameter of 0.2mm. Analysis Mode: 120°C – 2 min. Mass spectrometer: quadruple, with electrons ionization (70 eV) in selective ion mode. To assess the reproducibility of the results three-time analysis of samples under identical conditions was carried out. Analysis of quantitative data was carried out by Statistic 6.1 (Stat soft Inc., USA) using descriptive and nonparametric statistics (multiple measures ANOVA)
Results. Evaluation of reproducibility analysis of FA Yersinia strains showed that the obtained results are homogeneousand stable. To test the uniformity of data sets of individual fractions FA and stability phenomenon we used assessment of the degree of variation. The coefficients of variation of the content of these fractions ranged from 0,303 to 5,994% for strains of Y. pseudotuberculosis and from 0,74 to 7,25% for Y. enterocolitica strains. Analysis of FA spectra identified in the examined Yersunia strains revealed predominant content of hexadecanoic (palmitic) acid (C16:0). The relative amount of the acid ranged from 28,09% to 36,49% for Y. pseudotuberculosis (32,16±3,98%) and 32,18% to 41,54% for Y. enterocolitica (36,73±5,03%; p>0,05). The ratio of saturated to unsaturated FA in the strains of Y. pseudotuberculosis was (44,54:55,46), while Y. enterocolitica  – (48,23:51,77). Total content of hexadecanoic and octadecanoic (C18:0) based on the total content of saturated FA in Y. pseudotuberculosis was up to 89,73%. The comparable figure in the strains of Y. enterocolitica was 92,35%.
Conclusion. The analysis of the fatty acid spectra of Y. pseudotuberculosis and Y. enterocolitica, grown at 28°C, showedno significant differences in their composition. In view of similar studies conducted earlier, generic feature of Yersinia is the prevalence of hexadecanoic acid in the spectrum of FA.
Key words: fatty acids (FA), Y. pseudotuberculosis, Y. enterocolitica, Yersinia, generic indication.

CLINICAL MEDICINE

NON-DEVELOPING PREGNANCY AS A MEDICAL AND SOCIAL PROBLEM

E. A. Zakharova, M. S. Selikhova
State Budget Educational Institution of Higher Professional Education «Volgograd State Medical University» of the Ministry of Health of the Russian Federation, 1, Pavshikh Bortsov Sq., Volgograd, 400131, Russian Federation

Abstract
Purpose. Assessment of the non-developing pregnancy problem according to obstetricians and gynecologists at present, aswell as the impact of various factors on the degree of patient compliance with non-developing pregnancy in their medical history.
Materials and methods. A sociological method was used including the anonymous survey of obstetricians andgynecologists of Volgograd gynecology departments and patients hospitalized for non-developing pregnancy. The questionnaire for each of the respondent group contained 25 questions. On the basis of the statistical analysis of one-dimensional and two-dimensional distributions there were defined the level of patients’ awareness of non-developing pregnancy, the evaluation of medical care quality at all stages of the treatment process as well as the obstetricians’ and gynecologists’ opinions about the reasons of patients’ compliance reduction in case of studied disease and the ways to prevent missed abortion exacerbations.
Results. The results of the sociological survey allow to identify a clear split between the doctors’ and patients’ opinionson the issue of trust building, which is vital for the treatment effectiveness. There was no agreement between the doctors and the outpatient and inpatient units in matters of the preconception care training schemes after previous missed abortion. According to the results there were identified the main difficulties in the management of patients with this pathology, which are the occurrence of non-developing pregnancy in healthy primigravidae women without defined risk factors, the growing «pseudocompetence» of the population due to the lack of medical information availability.
Conclusion. Measures of reducing missed abortion frequency should not be limited only to medical problems solving,considering the equal dualism of its causes. Obstetricians and gynecologists should contribute to the patient compliance. In order to build a relationship based on trust, obstetricians and gynecologists should be more active in mass media for the problem clarification and for helping the society to form the right attitude towards its solving. Preconception care is a strict requirement for all women based on individual pregnancy forecasting and identified risk factors.
Keywords: missed abortion, compliance, survey, treatment adherence.

PREDICTION OF SURGICAL SITE INFECTIONS IN TOTAL KNEE ARTHROPLASTY

1. N. Tkachenko, E. M. Fadeev, M. Yu. Bakhtin, A. V. Alkaz

Federal state budget institution of higher education «North-Western State Medical University named after I.I. Mechnikov» under the Ministry of Public Health of the Russian Federation

Abstract
The purpose of research. To improve the results of total knee replacement (TKA) through the development of coefficientsfor the prediction of surgical site infection.
Materials and methods. 814 total knee replacements had been retrospectively analyzed for the research. All patients’data (non-complicated post-total knee replacement (1st group — 771 patients) and post-total knee replacement with complications in 12 month (2nd group — 43 patients)) had been used as an educational matrix for a mathematic forecast and as a construction of a prevention algorithm for septic complications in primary TKA.
Results. The study had shown 20 significant criteria which can influence the occurrence of surgical site infection in TKA.
Conclusions. 12‑month testing period of the software in prospective research (211 cases) had shown a significantdecrease rate of septic site complications in comparison to retrospective research (decrease of 5,3 % in the prospective cases and 2,3 % — in retrospective).
Key words: total knee replacement, surgical site infection, forecast.

PHARMACOLOGY OF SUBSTRATE ANTIHYPOXANTS
UNDER THE JOINT INFLUENCE OF COLD AND OTHER ADVERSE FACTORS IN EXPERIMENT

V. V. Vorobieva1, S. N. Proshin2, P. D. Shabanov3
1Federal state budget institution of higher education «North-Western State Medical University named after I.I. Mechnikov» under the Ministry of Public Health of the Russian Federation
2State budget institution of higher professional education «Saint-Petersburg State Pediatric Medical University» under Ministry of Health of the Russian Federation
3The Federal state military educational institution of higher professional education «Military medical Academy named after S. M. Kirov» under Ministry of Defense of the Russian Federation

Abstract
Purpose. Experimental study of protective properties of themitochondrialantihypoxants  in acute exposure to cold,vibration and immobilization of rats.
Methods. The rats were subjected to the combined effects of the cold (-150С at 60 min.) and immobilization after treatment with overall vibration with amplitude of 0,5 mm and frequency of 44 Hz during 90 min. The rectal temperature and succinate dehydrogenase activity (SDG) of blood lymphocytes were estimated using quantitative cytochemical test based on reduction reaction of para-nitropurple tetrazolium to formazan. The substances as succinic (18 mg / kg) and glutamic (135 mg / kg) acids and mixture of succinic and glutamic acids in equimolar doses of 50 and 80 mg / kg as sodium salts were used to study pharmacological protection from action of adverse factors.
Results. Initial average rectal temperature in intact rats was 35,1±0,70С. Acute cooling of rats in condition of deprivation of mobility induced significant (р<0,001) decreasing rectal temperature down to 23,4±1,4 (∆Тrect.=-11,70С). The combination of acute cooling with one treatment of overall vibration before cooling in combination with immobilization resulted in decreasing rectal temperature down to 21,4±1,5 (∆Тrect.=-14,20С). The most protective effects against cold and vibration were shown for amber acid which held rectal temperature on the level of 31,3±2,40С. Gomeostatic action of succinic acid was confirmed by dynamic of SDG of blood lymphocytes. SDG activity of lymphocytes on quantity of granules of formazan in intact group was 13,7±2,4. SDG activity of lymphocytes after combined action of adverse factors decreased down to 5,7±1,5. SDG activity of lymphocytes approached to physiological level as of 11,9±2,1 after using of succinic acid.
Conclusion. Succinic and glutamic acids showedexpressed protection against cold, vibration, stress and hypoxia afteracute combined action of cold, immobilization and vibration supporting rectal temperature and energetic status of blood lymphocytes in range of physiology.
Key words: cooling, vibration, immobilization, rectal temperature, succinate dehydrogenase activity of blood lymphocytes, rats, mitochondrial antihypoxant.

THE EFFECT OF SMOKING ON THE LIFE QUALITY OF PATIENTS SUFFERING FROM GASTROESOPHAGEAL REFLUX DISEASE, THE ASSESSMENT OF CHANGES OF PATIENTS’ LIFE QUALITY USING TRIMEBUTINE IN A COMPLEX THERAPY

V.P. Pidzhimyan, N.L. Shaporova, V.N. Yablonskaya
State Budget Educational Institution of Higher Professional Education «Pavlov First Saint-Petersburg State Medical University» under the Ministry of Public Health of the Russian Federation, 197022, Saint Petersburg, L’va Tolstogo str., 6/8

Abstract
Purpose. To investigate the effect of smoking on the life quality of patients suffering from gastroesophageal refluxdisease, the assessment of changes of patients’ life quality using trimebutine in a complex therapy.
Materials and methods. Using a validated SF-36 124 patients suffering from GERD were interviewed, 84 of them aresmokers and 40 are non-smokers. Smokers and non-smokers, patients were divided into 2 groups – receiving a complex therapy (proton pump inhibitor) trimebutine and monotherapy - receiving a proton pump inhibitor.
Results. Analysis of the results of the study showed that indicators of life quality of smoking patients suffering fromGERD were significantly worse than that of non-smoking patients, except of mental health indicator. After the treatment all groups showed a statistically significant improvement in quality of life, but the results of groups receiving a complex therapy, were significantly better. Changes of life quality indicators among smoking patients receiving trimebutine in a complex therapy, were 20-30% higher than that of non-smoking patients receiving a complex therapy.
Conclusions. Tobacco smoking impairs the life quality of patients suffering from GERD. Indicators of life quality among patients suffering from GERD with a complex therapy including proton pump inhibitor and trimebutine are determined significantly better than with monotherapy, especially in smokers.
Keywords: gastroesophageal reflux disease, tobacco smoking, quality of life, trimebutin.