Indigenous women's reproductive health in the Arctic zone of Western Siberia: challenges and solutions.

In the Russian Arctic, alarming trends (shortage of nomadic Indigenous women, high reproductive loss, child mortality rates) indicate long-term changes towards demographic decline. This study aimed at comparing some indicators of the reproductive health (childbirth rates, number of pregnancies, pregnancy loss) of Indigenous and non-Indigenous women in the exploration of cultural and social factors influencing reproductive behaviour. A multidisciplinary approach draws on methods of medicine, sociology and health economics. It includes data of the women's reproductive health collected from surveys of 879 women (of whom 627 were Indigenous) during expeditions to the settlements and the tundra of the Yamal-Nenets Autonomous Okrug in 2013-2019. In the tundra, 66.7% of registered Indigenous women's pregnancies resulted in childbirth, 7.8% in induced abortions, 25.5% in spontaneous miscarriage. More than three children were delivered by 59.1% of Indigenous women. Most Indigenous families suffered from high pregnancy loss. Marriage between close relatives was 27.0%. Child mortality equalled 24.4%, three times higher than in the population of the settlements and eight times higher than in families immigrating from other regions. The survival of Indigenous peoples significantly depends on women's reproductive health and sufficient medical service that requires targeted policy.

Potentially toxic elements in urban topsoils and health risk assessment for the mining W-Mo center in the Baikal region.

The main threats to health are associated with the entry of potentially toxic elements (PTEs) into human bodies. The aim of this study is to assess the impact of the Zakamensk W-Mo deposit development on soil surface horizons and the health of the local population. The results of the geochemical survey of 2012 revealed the spatial distribution patterns and abundances of 15 PTEs. The elements bulk contents were determined by ICP-MS and ICP-AES. The impact of geochemical situation on the health of the population of Zakamensk was also assessed using the mortality rates from diseases of the digestive and respiratory organs, neoplasms, including malignant tumors of the digestive and respiratory organs in 2008-2012. The tailing dumps have increased concentrations of W, Cd, Pb, Sb, Mo, Cu, Zn, Sn, As, and Co due to petrochemical characteristics of the ore. The soils of the industrial zone accumulate W, Cd, Mo, Pb, Sb, Zn, Cu, and Sn due to the waste storage sites deterioration and the thermal power plant and the foundry emissions. The multi-story residential zone soils accumulate W, Cd, Pb, Zn, and Mo. Tungsten, Pb, Sb, Co, V, and Cr cause the greatest harm to adults and children and together account for 92-96% of the hazard index. Cadmium and Cr are the most dangerous carcinogenic elements in Zakamensk. Despite the closure of DTMP more than 15 years ago, the level of the total risk of developing malignant diseases indicates a catastrophic environmental situation.

[Assessment of the level of consumption of calcium and vitamin D with food in the adult population of Tyumen Region].

Calcium and vitamin D are essential micronutrients, whose deficiency adversely affects not only bone health, but also the functioning of the whole organism. The aim of this study was to explore the level of calcium and vitamin D intake in the adult population of the Tyumen region, in order to optimize the nutritional program. Material and methods. The study included 440 people living in Tyumen and Tyumen region. Inclusion in the study was conducted on the principle of random sampling using a random number program. The questionnaire was used to estimate the consumption of calcium and vitamin D with food. Serum level of 25(OH)D was determined in all participants of the study, the analysis was carried out by ELISA using Sunrise Euroimmin 25-OH Vitamin D ELISA test systems. Results and discussion. The results of our own data led to the conclusion that there were a lack of consumption of foods rich in vitamin D among all ages and inadequate intake of calcium, especially in the older age groups. Approximately half of the respondents rarely ate sea fish, which was interrelated with plasma levels of 25(OH)D - vitamin D deficiency was detected in 70.7%, and its insufficiency was recorded in 22.0% of those examined. Only 45.5% of respondents consumed dairy products daily, while in general there was deficit of calcium intake in all age groups compared with the average age norm. Conclusion. Adequate compensation of chronic calcium and vitamin D deficiency, which is widespread in both the Russian Federation and the Tyumen region, is an extremely important preventive direction of modern medicine.

Brown adipose tissue, energy expenditure, and biomarkers of cardio-metabolic health among the Yakut (Sakha) of northeastern Siberia.

OBJECTIVES: This study provides the first investigation of non-shivering thermogenesis (NST) and brown adipose tissue (BAT) activity among an indigenous circumpolar population, the Yakut of northeastern Siberia. The study also examines the health significance of BAT activity in this population by testing the relationships between BAT thermogenesis and biomarkers of cardio-metabolic disease risk, such as percent body fat and blood glucose and cholesterol levels. METHODS: Data were collected in the Sakha Republic (Yakutia) for 31 men and 43 women. Change in energy expenditure and BAT thermogenesis were quantified after a 30-minute mild cooling condition. Anthropometric dimensions, blood glucose, and lipid levels were also collected. RESULTS: On average, the skin temperature of the supraclavicular area was constant after cooling while the skin temperature of a point on the sternum dropped significantly (P < .001), thus suggesting the presence of active supraclavicular BAT among Yakut adults. Participants with evidence of greater BAT thermogenesis exhibited a larger percent change in energy expenditure (% ΔEE) and an increase in respiratory quotient (RQ) after cooling (P ≤ .05). While there was no relationship between BAT activity and blood lipid levels, BAT thermogenesis was positively associated with blood glucose levels (P < .01). CONCLUSIONS: Yakut adults exhibit evidence of active BAT deposits. Given that there is a significant relationship between BAT activity and % ΔEE, it is possible that BAT plays a role in NST among Yakut adults. While the relationship between BAT and body composition is inconclusive, participants with greater BAT seemed to preferentially utilize glucose during cold stress exposure.

[Hygienic environmental assessment in the oil-and-gas bearing area on the base of cytogenetical and molecular-genetic methods].

The study have been conducted in settlements located near oilfields of the Nizhnevartovsk area, the Khanty-Mansi autonomous district (Russian Federation). There were examined 802 persons aged of from 18 to 56 years not proximately employed in processes of the oil extraction. Control group was consisted of329 residents of the north of Tomsk Region living in the area without any polluting environment industry. By using such methods of analysis as micronucleus test in human buccal cells, the xenobiotic biotransformation of both GSTM1 and GSTT1 gene polymorphism, as well as the assessment of oil contamination of local drinking water there was executed the hygienic assessment of ecology in the settlements located near oil fields. The elevated rate of cytogenetic disorders was established to be observed most of all in the residents of this region, as well as in persons recently moved to this area. Most significant deviations from the control according to the micronucleus test were detected in individuals with the GSTM1 (0) /GSTT1(0) genotype. In the control group no such consistent pattern was seen.

Burden of Childhood Rotavirus Disease in the Outpatient Setting of the Russian Federation.

BACKGROUND: This is a prospective, multicentered study conducted in 9 large urban areas in Russia, in order to determine the burden of rotavirus gastroenteritis in children <5 years of age and the genotypes circulating during 1 rotavirus season. METHODS: From November 2012 to May 2013, surveillance was conducted in Moscow, Saint-Petersburg, Vologda, Krasnodar, Krasnoyarsk, Novosibirsk, Yaroslavl, Khanty-Mansiysk and Vladivostok. Children <5 years of age presenting at outpatient clinics with acute gastroenteritis (AGE) of less than 72 hours duration were enrolled in the study. Stool samples were tested for rotavirus and positive samples were P- and G-typed. Clinical symptoms were captured by physicians and parents on Day 1. Symptom severity was analyzed by Vesikari scoring system. The direct expenses of parents caused by AGE were obtained from questionnaires provided to parents by phone. RESULTS: A total of 501 were children enrolled. Stool samples were analyzed for 487 (97%) children, and 151 (31%) of those were rotavirus positive. Rotavirus gastroenteritis was associated with more severe clinical course (Vesikari score 11.4 ± 2.2) versus non-rotavirus gastroenteritis (Vesikari score 9 ± 3). The identified serotypes were G4P[8] 38.9%, G1P[8] 34.2%, G3P[8] 6%, G9P[8] 6%, G2P[4] 2% and G4P[4] 0.7%. The mean overall expenses of parents caused by rotavirus and non-rotavirus gastroenteritis were 143.7 USD and 128.8 USD, respectively. CONCLUSIONS: Rotavirus accounted for 31% of all AGE-related outpatient visits. The major rotavirus genotypes were G1P[8] and G4P[8]. Rotavirus gastroenteritis was associated with significantly more severe clinical symptoms than non-rotavirus gastroenteritis. The average costs of rotavirus cases for parents of children were elevated against the same indications for non-rotavirus. These findings underscore the need for a safe and effective rotavirus vaccine in Russia.

Mortality and economic burden of Krasnoyarsk region, Russia, caused by regular tobacco usage.

BACKGROUND: This study assesses mortality and economic burden due to the regular tobacco usage among the population of the Krasnoyarsk region of the Russian Federation. This territory was chosen for the analysis because of two factors: high smoking prevalence in the Krasnoyarsk region (46% among the adult population) and premature mortality of the working-age population, which leads to a significant burden to the federal budget of the Russian Federation. DATA SOURCES: In our work, three main causes of smoking-related deaths were considered: cardiovascular disease, lung cancer, and COPD. The working-age population was investigated (20-72 years old). The databases of mortality and population size of the territorial body of state statistics of the Krasnoyarsk region (data for 2013) were used as the information sources. METHODS: Joint application of population-attributable risk and disability-adjusted life years method allowed us to estimate medico-demographic and economic burden due to the tobacco-attributable premature mortality in the investigated population. RESULTS: We found that tobacco use-related economic burden is at least equal to 2% of the gross regional product of the Krasnoyarsk region in 2013. CONCLUSION: An assessment of economic tobacco use-related burden is important for determining the volume of necessary funding for development of smoking prevention programs, proper estimation of tobacco companies' taxation, and other measures for controlling tobacco use. Smoking cessation is a priority for prevention of the tobacco-related diseases and reduction of their burden on local economy.

LEVEL OF THE GUALITY OF LIFE OF THE PATIENTS AFTER ESOPHAGOPLASTY ON THE BASIS OF GASTROINTESTINAL INDEX ASSESSMENT.

The article presents the interview results of 55 patients after esophagoplasty (30 cases - after esophagogastroplasty, 25 cases - after esophagoplasty) using questionnaire GIQLI. The authors came to conclusions about advantages of extirpation of esophagus with esopagogastroplasty compared with subtotal shunt esophagocoloplasty because of high rate of gastrointestinal index of the quality of life and their components in patients after esophagogastroplasty compared with results of patients after esophagoplasty. There was noted an expessed growth in the scales and rise of gastrointestinal index in patients who underwent esophagogastroplasty after 3 years of follow-up.

[An assessment of the immune status of the children population as a marker of technogenic pollution of the environment].

This article describes results of the immunological study of school-aged children residing in cities with different levels of the technogenic air pollution. Children from cities with the highest level of the technogenic pollution had a high number of immature neutrophils (band cells) and eosinophils. The children living in these ecologically unfavorable areas have presented a reduction of T-cell antigen receptor CD3, CD4, CD8, CD20, CD16, CD95. This indicates to that both T-cell and B-cell immunity is suppressed. The decline of the phagocytic function in neutrophils indicates to the suppression of the nonspecific host defense mechanisms also.

[Formation of working conditions and the problems of hygienic assessment of industrial environmental factors in railway tunnels].

Tunnels are an integral part of the ways and artificial constructions of the railway. Objective assessment of working conditions is important, because current regulations fail to allow to give a definite hygienic assessment of some factors of the production environment of the tunnels. Objective: to reveal the peculiarities of the formation of working conditions in railway tunnels with the subsequent hygienic assessment for the development of preventive measures. Measurement of the factors of working process and working environment is carried out with the use of the certified equipment for the approved the hygienic and sanitary-chemical methods in workplaces in tunnels of the East-Siberian railway. Specific conditions were shown to be formed due to constructive solutions, climate and geographical location, the length of railway tunnels, the composition of the rocks through which the tunnel, the nature of the maintenance tunnels, ventilation system, repetition rate and type of passing rolling stock. All employees from occupational groups from examined tunnels were established to be exposed to high concentrations of aerosols with predominantly fibrogenic action, noise levels, adverse climate (low positive and negative temperatures, high relative humidity and mobility of air), the lack of natural lighting, low levels of artificial light, hard exertion of labor (dynamic physical load, working position, the slopes of the body, movement in space). Additionally, high levels of the vibration, nonionizing and ionizing radiation were typical for jobs of the Baikal and the North-Muya tunnel. There is proposed the algorithm of hygienic assessment of the microclimate, light environment at the working places depending on the time of the works in the underground conditions and constructional features of tunnels, methods of accounting personnel dose rates from natural sources.

[Hygienic assessment of toxic dust factor at the aluminium smelter in Eastern Siberia].

There is presented the assessment of priority toxic matters in the air of working zone for basic occupations of aluminum smelting by electrolysis. There are presented results of different production technologies. There are presented the results of the physical-chemical analysis of the morphology and composition of produced toxic-dust complexes.

[Assessment of carcinogenic risks to workers of the main enterprises of the Irkutsk region].

The purpose of research is the assessment of the individual cancer risk (ICR) for workers of the basic occupations in key branches of industry of the Irkutsk region. There was executed the calculation of ICR levels for workers of the basic occupations of the aircraft industry, aluminum smelters and vinyl chloride production plants. The estimation of the exposure for workers was carried out according to long-term time-weighted average concentrations in the air of the working area, for the population - on annual average concentrations in the ambient air. To assess the risk that is not associated with the profession, the dose was calculated for the period of life (70 years). When calculating the toxicant doses in the working area there were used the "standard" indices ofpulmonary ventilation for adults, body weight, the work experience in the contact with carcinogens of 30 years, the number of days in the contact of 240, the duration of the working time 8 or 12 hours (in accordance with the working hours) duration. ICR for the Irkutsk population amounted of 3.08E-04, in Shelekhov - 4.8E-05, Sayansk - 1.1E-05. The amount of risk depends on the content offormaldehyde in all territories and chromium VI in cities of Irkutsk and Shelekhov. ICR for workers of basic occupations of studied plants in dozens of times are higher than for the urban population. Priority carcinogens are: chromium VI, nickel, formaldehyde, silicon dioxide -for the aircraft plant employees; 1,2-dichloretan, vinyl chloride - for the workers of vinyl chloride production plant; benzopyrene - for the aluminum smelter workers.

[Thyroid gland pathology in children population exposed to the combination of iodine deficiency and fluoride pollution of environment].

The article presents results of study of the impact of iodine deficiency and technogenic fluoride on the state of the thyroid gland in children. On the example of two districts of the city of Bratsk there were executed dynamic investigations (2002 and 2012), including the estimation of the pollution of ambient air and soil by fluorine compounds, levels of iodine intake by the body, the clinical examination of children aged from 5 to 7 years d and interviewing of their parents. In the course of the medical examination there were executed: physical examination by the pediatrician, endocrinologist, ultrasound examination of the thyroid gland, the determination both of serum hormone content by radioimmunoassay and urinary excretion offluorine and iodine. Concentrations of hydrogen fluoride and a solidfluorides in ambient air led to the accumulation offluoride ion in the soil. The iodine entering with drinking water and food, was established to provide only 37.5-50% of the daily requirement of iodine. Increased fluoride ion content in urine and milk teeth in children is associated with the concentrations of the fluorine-containing pollutants in the ambient air and soil. The fluoride pollution against the background of the natural iodine deficiency was established to increase the frequency of functional and morphological disorders of the thyroid gland in children.

[Determination of priority unfavorable environmental factors].

In the Irkutsk region there are recorded high indices of rates of morbidity, disability, mortality rate of the working-age population and low levels of life expectancy of the population, that is confirmed by ranking position levels among the all subjects of the Russian Federation. According to all mentioned indices of health the region is inside the top ten unfavorable regions of Russia. In relation to the problem in the state of health of the adult population the estimation of the causal relationships between environmental factors and certain health indices is actual. The list of studiedfactors included health indices that characterize the harmful working conditions of the working population and basic socioeconomic indices in the region. Estimation of causal-relationship relationships was performed with the use of methods of multivariate analysis - correlation and multiple linear regression. In the selection offactors for the construction of mathematical models of multiple regression there were used methods of the analysis of variables variability, pair correlation coefficients matrix and sequential switching covariates to eliminate the problems of multicollinearity, pre-standardization of indices for the elevation of the numerical stability of regression analysis algorithm. As a result of the execution of the analysis there were constructed statistical models for the dependence in the system variables "environment - public health", which allowed to identify the most informative regression models for the adult population health according to indices of primary disability of the population, the mortality rate and life expectancy of the working age population. According to results of the analysis there were identified priority factors affecting on the health of the adult population of the Irkutsk region. To these factors there are referred the proportion of workplaces failing to meet sanitary standards for vibration and 8 socio-economic indices of living standards of the population.

[Hygienic assessment of intraschool environment in rural and urban secondary school institutions].

The purpose of the research is to assess the intra-environment indices in urban and rural secondary schools. In the course of special studies there was given the hygienic assessment of the climate, illumination and air quality of classrooms. In classrooms in rural schools microclimate indices were established to fail to meet hygienic requirements mainly on the temperature and humidity parameters. In rural schools, the temperature was decreased to 16-17 °C in 19.0 ± 8.6% of classrooms, humidity was elevated to 63.1% in 25.7 ± 7.4% of classrooms. Among urban schools the humidity in 49.6 ± 4.4% of classrooms reduced to 23.3 ± 0.3%, in 20.8 ± 5.4% of offices it was increased to 71.9 ± 0.9%. The coefficient of the natural illumination in rural schools has been reduced to 0.86-1.4% in 33.9 ± 14.2% of classrooms. In 25.1 ± 2.3% of classrooms in urban schools the level of natural light ratio was below the normative values and varied in the range of 0.32-1.3%. It is noted that in the offices of informatics natural light indices are significantly lower than in the classrooms for core subjects. The artificial lighting in urban schools was found to be lower than hygienic standards on the desks by 1.9 times, 2.2 times - at the board. There were obtained statistically significant handshaking health problems of urban schoolchildren due to intraenvironmental factors. The c dimate in surveyed gyms in rural schools is different in the low temperature and high humidity. The hygienic assessment of the air pollution classrooms' medium was executed for a range of chemicals: formaldehyde, carbon monoxide, nitrogen dioxide, sulfur dioxide, particulate matter. Concentrations of formaldehyde; nitrogen dioxide, suspended solids in the air in classrooms in urban schools appeared to be higher than in rural schools. Carbon monoxide concentrations in classrooms in rural schools was found to exceed their values in urban schools. The air in classrooms of the one of the cities was found to be differed by a specific atmosphere for its chemical - hydrogen fluoride, in concentrations exceeding the maximum allowed concentration by 3-3.5 times.

[Assessment of nutrition of students of educational institutions of the various type].

Among the risk factors that have priority in shaping the health of the population, a leading place is held by a rational nutrition. Presented results indicate to the absence of a stable group eating regularly, with the rational regularity and having all the necessary meals and the recommended food set. In the population of the adult people of the city of Irkutsk there is revealed the role of the nutritional factor in the formation of morbidity rate level of the adult population. It was found that the risk of diseases of the circulatory system accounted of 2.5 (95% CI: 2.1-3.6), for infectious and parasitic diseases - 2.4 (95% CI: 1.7-3.5), for the endocrine system - 2.2 (95% CI: 1.4-3.4), andfor the urinary system - 2.3 (95% CI: 1,7-3,0).

[Assessment of the efficiency of prevention of iodine deficiency among the children's population of the city of Mezhdurechensk of the Kemerovo region].

In the article there are presented results of a study of indices of ioduria in preschool kids and school children of the city of Mezhdurechensk (south of the Kemerovo region). 411 children aged of 3-17 years participated in the study. The median of ioduria on preschooler kids was 97,0 pg/l, and the proportion of urine samples with iodine levels less than 50 pg/l - 1,0%. The median of ioduria in school children is 98,0 pg/l, the percentage of urine samples with iodine levels less than 50 pg/l accounts for 1,3%. On average, on the population of children there was established that the percentage of urine samples with iodine levels from 50-100 pg/l (mild deficiency) was detected in 53,5% of children. Comparative analysis of indices of the level of ioduria according to data obtained in 2008 and 2014 in a group of school children showed that the measures taken to prevent diseases caused by iodine deficiency (the use of iodized salt in the diet of children and adolescents from organized groups on a regular basis) have given positive results.

[Methodical complex for the assessment of mass noninfectious prevalence rate and the medico-ecological situation in the territory].

The purpose of this article - the narration of main provisions of the algorithm of the system use of techniques and methods for the determination of the epidemiological risk for the morbidity of the population for the identification and assessment of mass noninfectious diseases, local variants ofpopulation health and the degree of stringency of medical and environmental conditions (or ecological trouble), in areas of industrial and non-administrative units of the area (region). Control-flow chartfor the evaluation of mass non-communicable diseases and medical-ecological situation in the territory on the basis of techniques and methods of risk assessment for decision-making control includes the following steps: 1) determination of the conditional regional level of the background prevalence rate as the unit of regional type of population health, shaped by regional climatic and geographic and other features of the environmental conditions; 2) detection of the epidemiological relative risk of the morbidity rate and mass non-infectious diseases; 3) determination of the wave-like character of the dynamics of the riskfor mass non-infectious morbidity rate of the population and the adaptation process shaping it in the territories; 4) separating the leading mass non-communicable diseases, especially shaping peculiarities of local variants of population health in the special industrial and non-industrial areas; 5) determination of the degree of stringency of medical and environmental situation (or ecological trouble) in the studied area, with local variants ofpopulation health; 6) a forecast of the expected trends in the dynamics of the risk for mass non-infectious prevalence rate; 7) justification of the main directions of the development of medical and environmental preventive measures on the reduction of mass non-infectious diseases and the improvement of the quality of health of the population in the studied areas. The given methodical complex will allow to more effectively solve problems ofprevention of mass non-infectious prevalence of the population and improve health and environmental conditions in the study area based on public health monitoring data.

[Monitoring of health of young students of northern territories residing in conditions of ecological trouble].

In recent years, in sanitary science the interest in issues of young people has dramatically increased, that has been actualized by the necessity of a new objective assessment of the role of the youth in modern sanitary-ecological, sociocultural and economic processes. In this regard, a special interest is aroused by young students, the health of whom is determined largely by the condition of the habitat. So far complex assessment ofriskfactors in urbanized areas, prioritization of impacts, the establishment ofpriority impacts, the detection of informative territorial environmentally dependent indices ofpopulation health are presented to be important tasks in the solution of the regional challenges. The aim of this work was the assessment of the state of health of students of the Bratsk State University, residing in conditions of ecological trouble. In the territory of the city of Bratsk the environmental situation is characterized by long term multi-component air pollution with highly toxic vehicular and industrial emissions. In the work throughout the 4 years following-up there was executed an assessment of the physical development of students, there was determined structure and revealed the an increased level of morbidity rate of students of Bratsk state University in terms of educational space, which is characteristic for territories of ecological trouble in the city of Bratsk. Parameters of physical development of students in dynamics of training were established to be not liable to variation. It confirms the stability of the morphological signs as compared to functional ones. In the analysis of dynamics of indices of the harmonicity ofphysical development there was revealed a gain in the proportion of harmoniously developed students by the end of training. Physiometric indices of students to the fourth course of training were characterized by the increase offunctional capabilities of the respiratory system.The indices of the cardiovascular system performance had a tendency to the growth of the hypertensive response in boys and the increase in the number of people with normotensive response to physical stress by the end of training. To the IV course of training there was observed the increase in the number of young boys with stringency of mechanisms of adaptation to stress, whereas in young girls satisfactory adaptation was seen.

[The impact of social deadaptation on rural population health in the Novosibirsk oblast].

The sociological survey was organized for developing of organization of medical care to socially deadapted patients in rural territories. The sampling consisted of 156 district therapists of central district hospitals of the Novosibirskaia oblast providing primary medical care at out-patient stage. The females consisted 83.3%, males 16.7°%, average age of respondents made up to 43 years. The carrier experience made up to 19 years in average. It is established that in 57.1% of cases patients indicated social factors as a cause of development of disease. At that, 82.7°% of physicians are confident that activities concerning social adaptation of socially deadapted patients will ameliorate quality of provided medical care. The most of respondents (64.15) indicate the need in activities concerning social adaptation of such patients. The most of physicians (67.2%) mention that activities of adaptation of socially deadapted patients are to involve clinical psychologists and psychotherapists and 31.7°% consider that it is necessary to involve social workers. The organization of rehabilitation activities of social adaptation for this type of contingent is to be intersectoral with participation of medical and social workers.