Mortality in Cases of Acute Alcohol Intoxication in Children: A 10-Year Retrospective Study of the Moscow Region, Russia.

BACKGROUND: Russia suffers from high alcohol-related mortality. Most forensic autopsies in Russia include blood alcohol tests, but a systematic analysis of these data has never been conducted for children's deaths. METHODS: We performed an analysis of juvenile mortality using autopsy reports from the Moscow Region Bureau of Forensic Medical Examination from January 1, 2009, to December 31, 2018. RESULTS: Despite a decrease in incidence ( Rs = -0.661), the number of cases of alcohol intoxication in minors was still high. The mean age of children in our study was 14.77 years (95% confidence interval [CI], 14.31-15.23). Death was predominantly among boys (72%) and those with higher blood alcohol concentrations (mean difference [MD], 0.295; 95% CI MD , 0.012-0.58). The number of cases of unnatural death increased with age ( Rs = 0.746, P = 0.001). Accidents were the most predominant cause of death, followed by suicide, homicide, and natural causes. Fatal alcohol intoxication was observed at an average blood alcohol concentration of 3.58 g/L (95% CI, 1.46-5.7), without any specific signs on autopsy. Even a strong smell of alcohol is an unreliable sign in the clinic. CONCLUSION: A systematic study of alcohol in forensic autopsy shows that the number of children who die with alcohol intoxication is high. Teenagers are the predominant age group experiencing alcohol intoxication. In our opinion, an alcohol blood test should be performed in all suspicious cases, especially in teenagers.

The global burden of viral hepatitis from 1990 to 2013: findings from the Global Burden of Disease Study 2013.

BACKGROUND: With recent improvements in vaccines and treatments against viral hepatitis, an improved understanding of the burden of viral hepatitis is needed to inform global intervention strategies. We used data from the Global Burden of Disease (GBD) Study to estimate morbidity and mortality for acute viral hepatitis, and for cirrhosis and liver cancer caused by viral hepatitis, by age, sex, and country from 1990 to 2013. METHODS: We estimated mortality using natural history models for acute hepatitis infections and GBD's cause-of-death ensemble model for cirrhosis and liver cancer. We used meta-regression to estimate total cirrhosis and total liver cancer prevalence, as well as the proportion of cirrhosis and liver cancer attributable to each cause. We then estimated cause-specific prevalence as the product of the total prevalence and the proportion attributable to a specific cause. Disability-adjusted life-years (DALYs) were calculated as the sum of years of life lost (YLLs) and years lived with disability (YLDs). FINDINGS: Between 1990 and 2013, global viral hepatitis deaths increased from 0·89 million (95% uncertainty interval [UI] 0·86-0·94) to 1·45 million (1·38-1·54); YLLs from 31·0 million (29·6-32·6) to 41·6 million (39·1-44·7); YLDs from 0·65 million (0·45-0·89) to 0·87 million (0·61-1·18); and DALYs from 31·7 million (30·2-33·3) to 42·5 million (39·9-45·6). In 2013, viral hepatitis was the seventh (95% UI seventh to eighth) leading cause of death worldwide, compared with tenth (tenth to 12th) in 1990. INTERPRETATION: Viral hepatitis is a leading cause of death and disability worldwide. Unlike most communicable diseases, the absolute burden and relative rank of viral hepatitis increased between 1990 and 2013. The enormous health loss attributable to viral hepatitis, and the availability of effective vaccines and treatments, suggests an important opportunity to improve public health. FUNDING: Bill & Melinda Gates Foundation.

May the Cleaning of Prescriptive Documents Using Best Evidence Reduce the Cost of Prescribed Healthcare?

OBJECTIVES: Clinical practice is developing under influence of the evidence-based clinical practice guidelines (EBCPG). In Russia development of the documents prescribing the content of care is connected with the idea that they may be used as well for estimation of the cost of care. The outcome is the national healthcare legislation of 2011. It dictates that care should be planned, funded, provided, and evaluated in agreement with standards of healthcare (SHC)-documents prescribing the content of care. The objective of this study was to evaluate how the correction of the SHC with the relevant EBCPG may change the cost of the prescribed care. METHODS: We selected the random sample of the SHC from the approved by the Ministry of Health for primary healthcare (SPHC) and specialized healthcare (SSHC). We analyzed interventions comparing SHC to the relevant EBCPG. Not recommended interventions were considered unnecessary. If the recommended by EBCPG intervention was missed in the SHC, then it increased the cost. We take the drug costs and the costs of interventions from the relevant ministerial registries. We calculated the total cost of the SHC by summing up the cost of each medical intervention/medications specified in the SHC. RESULTS: SPHC and SSHC both contain medical interventions and drugs that should not be provided. The total cost of all SHC included became lower: SPHC cost decreased by 66%, SSHC by 19%. The smaller change of the cost of SSHC is explained by the fact that the major part of the total cost of SSHC is the stay in a hospital. CONCLUSION: Correction of the SHC using EBCPG may reduce the cost of care.

Acute lethal poisonings in children: a 10-year retrospective study of the Moscow Region, Russia.

BACKGROUND: Poisoning is a critical public health problem. Toxic substances differ across time, region and age. Little is known about poisoning in Russia, and even less is known about lethal poisoning in children in Russia. We aimed to describe the characteristics of cases of lethal poisoning in children and adolescents. DESIGN AND METHODS: Our retrospective study was based on autopsy reports from archives of the Moscow Region Bureau of Forensic Medical Examination for the period of 2009 to 2018. RESULTS: A total of 438 lethal poisoning cases were recorded. The average age of the poisoned children was 11.3 years. Deaths predominantly occurred in boys, mostly due to the higher frequency of poisoning with household and technical chemicals (p<0.01). Accidental deaths were also higher in males (p < 0.01). Therapeutic drug poisoning (p<0.01) and suicide (p < 0.01) were more frequent in females. The leading cause of lethal poisoning in children was exposure to carbon monoxide, especially in children aged 5 to 9 years (p<0.01) and 1 to 4 years (p<0.01). Carbon monoxide poisoning occurred more often in winter (p<0.01). Regarding the structure of poisoning with household and technical chemicals, the most frequent was poisoning by a mixture of utility gases. CONCLUSION: Our study shows that carbon monoxide poisoning is a serious problem in the region. This may be associated with the ongoing use of individual heating systems. A significant increase in the frequency of fatal poisoning by chemicals, especially by propane-butane gas mixtures while sniffing, has become a disturbing trend.

Quality improvement in hospitals in the Russian Federation, 2000-2016: a systematic review.

We reviewed published evidence on quality improvement in hospitals in the Russian Federation since 2000. We used three data sources: MEDLINE, 'Rossiiskaia Meditsina' (Central Scientific Medical Library), and elibrary.ru using specific search terms. No language or study design restrictions were imposed. In total, 1717 articles were identified; 51 met the inclusion criteria and were thematically analysed. Russian legislation, government acts and grey literature were sourced to contextualise identified themes. Since 2010, the Federal Ministry of Health has increasingly sought to improve quality of care, providing additional resources and new initiatives across the health system. These include clinical practice guidelines, pay for performance schemes, electronic medical records, more specialist care, paraclinical care, and quality control systems. Quality of care, increasingly a concern of the Russian government, is said to be improving. Yet most initiatives have rarely been evaluated. This reflects the limited capacity for health services research in Russia. It seems likely that the full potential for improvements in quality of care in Russia is still to be realised.

The effectiveness and safety of proton radiation therapy for indications of the eye : a systematic review.

BACKGROUND AND PURPOSE: : Proton radiation has been used for the treatment of uveal melanoma since 1975, but few studies have been conducted to assess its efficacy and safety. This paper aims to systematically review the effects and side effects of proton therapy for any indication of the eye. MATERIAL AND METHODS: : A range of databases were searched from inception to 2007. All studies that included at least ten patients and that assessed the efficacy or safety of proton therapy for any indication of the eye were included. RESULTS: : The search generated 2,385 references, of which 37 met the inclusion criteria. Five controlled trials, two comparative studies and 30 case series were found, most often reporting on uveal melanoma, choroidal melanoma and age-related macular degeneration (AMD). Methodological quality of these studies was poor. Studies were characterized by large differences in radiation techniques applied within the studies, and by variation in patient characteristics within and between studies. Results for uveal melanoma and choroidal melanoma suggest favorable survival, with, however, significant rates of side effects. Results for choroidal hemangioma and AMD did not reveal beneficial effects from proton radiation. CONCLUSION: : There is limited evidence on the effectiveness and safety of proton radiation due to the lack of well-designed and well-reported studies. There is a need to lift evidence on proton therapy to a higher level by performing dose-finding randomized controlled trials (RCTs), comparative studies of proton radiation versus standard given alternatives and prospective case studies enrolling only patients treated with up-to-date techniques, allowing extrapolation of results to similar patient groups.

Biomedical journals and databases in Russia and Russian language in the former Soviet Union and beyond.

In the 20th century, Russian biomedical science experienced a decline from the blossom of the early years to a drastic state. Through the first decades of the USSR, it was transformed to suit the ideological requirements of a totalitarian state and biased directives of communist leaders. Later, depressing economic conditions and isolation from the international research community further impeded its development. Contemporary Russia has inherited a system of medical education quite different from the west as well as counterproductive regulations for the allocation of research funding. The methodology of medical and epidemiological research in Russia is largely outdated. Epidemiology continues to focus on infectious disease and results of the best studies tend to be published in international periodicals. MEDLINE continues to be the best database to search for Russian biomedical publications, despite only a small proportion being indexed. The database of the Moscow Central Medical Library is the largest national database of medical periodicals, but does not provide abstracts and full subject heading codes, and it does not cover even the entire collection of the Library. New databases and catalogs (e.g. Panteleimon) that have appeared recently are incomplete and do not enable effective searching.

Is content of medical journals related to advertisements? Case-control study.

AIM: To assess the relatedness of journal content to paid advertisements published in the journal. METHODS: The case-control study was performed on a convenience sample of 7 journals subscribed by Central Medical Library in Moscow--4 international (American Journal of Hypertension, British Journal of General Practice, The Lancet, and New England Journal of Medicine) and 3 Russian peer reviewed journals (Terapevticheskii Arkhiv, Khirurgiia, and Voeno-Meditsinskii Zhurnal). In each issue containing a paid advertisement, classifieds excluded, we searched for articles related to the advertised product and compared this issue with a control issue - the next or a later issue without this advertisement. RESULTS: In American Journal of Hypertension (33 issues from 2002-2004) 94 placements of advertisements were found, 7 of which were closely related to the article topic in the same issue (7/94) vs 2/66 in the control issue. The odds ratio (OR) and 95% confidence interval (CI) for advertisements to be accompanied by related articles was OR, 2.6; 95%CI, 0.5-13). In British Journal of General Practice (27 issues from 2003-2005) there were 7/63 advertisements related to the article topic vs 0/28 in the control issue (OR, 7.2; 95% CI, 1.3 to 44). In The Lancet (49 issues from 2004) there were 8/162 advertisements related to the article topic vs 8/104 in the control issue (OR, 0.6; 95% CI, 0.3-1.5). In New England Journal of Medicine (37 issues from 2004) there were 12/81 advertisements related to the article topic vs 8/75 in the control issue (OR, 1.5; 95% CI, 0.56-3.79). In Terapevticheskii Arkhiv (10 issues from 2004) there were 38/93 advertisements related to the article topic vs 1/83 in the control issue (OR, 56.66; 95% CI, 4.4-253). In Khirurgiia (25 issues from 2003-2005) there were 3/83 advertisements related to the article topic vs 0/70 in the control issue (OR, 2.7; 95% CI, 0.3-26). In Voeno-Meditsinskii Zhurnal (33 issues from 2003-2005) there were 17/31 advertisements related to the article topic vs 2/31 in the control issue (OR,17.6; 95% CI, 3.6-87). CONCLUSIONS: The strong relatedness between the content of the articles and advertisements placed in 3 of 7 journals and explicit placement of the advertisements face to face or overleaf the related research articles support the hypothesis that journal content is manipulated to place more emphasis on the advertisements.

Population health and status of epidemiology: WHO European Region I.

BACKGROUND: This article of the International Epidemiological Association commissioned paper series stocktakes the population health and status of epidemiology in 21 of the 53 countries of the WHO European Region. By United Nations geographical classification, these countries belong to Eastern Europe, Western Asia and South-Central Asia. METHODS: Published data were used to describe population health indicators and risk factors. Epidemiological training and research was assessed based on author knowledge, information searches and E-mail survey of experts. Bibliometric analyses determined epidemiological publication outputs. RESULTS: Between-country differences in life expectancy, amount and profile of disease burden and prevalence of risk factors are marked. Epidemiological training is affected by ongoing structural reforms of educational systems. Training is advanced in Israel and several Eastern European countries. Epidemiological research is mainly university-based in most countries, but predominantly conducted by governmental research institutes in several countries of the former Soviet Union. Funding is generally external and limited, partially due to competition from and prioritization of biomedical research. Multiple relevant professional societies exist, especially in Poland, the Czech Republic and Hungary. Few of the region's 39 epidemiological academic journals have international currency. The number of epidemiological publications per population is highest for Israel and lowest for South-Central Asian countries. CONCLUSIONS: Epidemiological capacity will continue to be heterogeneous across the region and depend more on countries' individual historical, social, political and economic conditions and contexts than their epidemiologists' successive efforts. National and international research funding, and within- and between-country collaborations should be enhanced, especially for South-Central Asian countries.