[The gender aspects of changes in mortality during COVID-19 pandemic as exemplified by Moscow].

The mortality is a major component of damage caused by COVID-19. The comparative analysis of changes in mortality was carried out on the basis of the ROSSTAT data over 2012-2020 to determine differences in losses of male and female population caused by pandemic in Moscow. It is demonstrated that at close trends in mortality of males and females before pandemic, in 2020 their mortality changed differently. At equal increase of male and female mortality, main contribution into excess mortality (excluding contribution of COVID-19) was made approximately equally by diseases of nervous system and circulatory system in males and diseases of nervous system in females. The male mortality from COVID-19 is 1.9 times higher than female mortality. As a result of younger average age of death the amount of economic losses in terms of years of potential life lost (PYLL) due to premature death of males because of COVID-19 exceeds economic losses due to premature death of females up to 2 times. Although the average age of death of females from all causes decreased by smaller amount, their values of PYLL increased more, mainly due to higher rate of female mortality from disease of nervous system and from mortality related to drug addiction. In Moscow, the highest increase of PYLL is conditioned by dearth related to drug addiction and alcohol consumption. In the structure of this indicator in males they are ranked fourth and fifth. In females, alcohol-related deaths are ranked as sixth and drug-related deaths as eighth. The pandemic, contributing into increase in economic losses, didn't change their leading causes: diseases of circulatory system, external causes and neoplasms in males; neoplasms, diseases of circulatory system and external causes in females. The value of PYLL due to death from COVID-19 takes sixth place in males and fourth place in females.

Reserves for Reducing Mortality in Russia Due to the Efficiency of Health Care.

Approaches to assessing the role of health care in reducing mortality in Russia from the standpoint of controlling manageable causes are discussed. Based on the concept of avoidable mortality, trends in regional variability of mortality, the nosological and gender characteristics for the years 2000-2019 have been analyzed. The patterns revealed indicate the following: a significant contribution of medicine and health care to the decrease in the premature reduction in the life expectancy of the population, the expediency of developing a regional classification of the list of avoidable causes of mortality, and the decisive role of prevention and the improvement of the lifestyle of the population of young and middle ages in the past two decades against the background of a slow increase in the capacity of clinical medicine in the diagnostics and treatment of diseases.

[Social deprivation of persons older than working age in terms of death causes which require forensic medical examination.]

The article analyzes structure of forensic medical research of persons older than working age and its change during period of improving social and economic situation in the country. Persons whose causes of death are determined by forensic medical examination are considered as a deviant group of people who did not adapt to changing socio-cultural conditions and to age changes. That was manifested in causes and circumstances of death (external causes, death at home without witnesses, death on street or in hospital without examination). The information on 72 324 forensic examinations of elderly residents in Nizhny Novgorod region for 2003-2017 was analyzed. It was done in terms of sex, living or not in the regional center and age groups (advanced: 60-74 years for men and 55-74 years for women, senile: 75-84 years, age of longevity: 85 years and older). It is shown that the size of the deviant group of retirees is increasing, and this increase is not a consequence only of the population aging. The contribution of loneliness to formation of the deviant group exceeds the contribution of socioeconomic disadvantages: no correlation was found between the frequency of forensic examinations and the mortality from causes related to alcohol; from 2003 to 2017, the share of external death causes and the proportion of corpses taken for examination from street are decreasing. The structure of external and somatic death causes of persons older than working age established during forensic medical research is determined by age, place of residence as well as social and economic situations in the region, changing for the period studied in direction of reducing differences.

[Cardinal problems of the regional bacteriological laboratories of tuberculosis facilities].

Restructuring the health care system and the epidemiological situation associated with tuberculosis result in an increased burden on the bacteriological laboratories (BLs) of tuberculosis facilities. At present, there are no statistical data that enable one to estimate the capacity of a laboratory service to assure the adequate quality and efficiency of bacteriological diagnosis. To assess the state of the headquarters BLs of tuberculosis facilities, the authors have worked out a questionnaire to glean necessary information on the activity of the laboratories to such an extent that suffices to reveal cardinal problems in the work of individual laboratories and the laboratory network as a whole. Out of the 48 questionnaires sent from the regional BLs, the data available from 22 laboratories that had fully answered all the questions were analyzed. The data obtained are referred to as of 2004, i.e. when the current antituberculous care projects were launched, which is of significance in organizing the monitoring of a laboratory service and in assessing the progress of the projects. The authors have identified the following cardinal problems: inadequate readiness of most laboratories to fully perform their incumbent functions; no coordination in providing data at the regional and federal levels; inefficient laboratory diagnosis that is associated with the disintegration of the curatorial institution, with neither reference relations no united external or internal quality control programs, with the lack of expertise and the undermanning of the laboratories, with the obsolete list of staff members and the obsolete standards for calculation of their loads, with the deterioration of a material and technical base, and with the unconformity of equipment to the state-of-the-art technologies. In order to solve the above problems, the authors offer a laboratory service monitoring system based on the proposed questionnaire, followed by the computerization of data collection and the compulsory supervision of regional laboratories by the officials of district and federal BLs.

New trends and clinical patterns of human trichinellosis in Russia at the beginning of the XXI century.

Official national statistics show a gradual decline in the incidence of trichinellosis in Russia from 971 cases in 1996 to 527 cases in 2002. Of the total 864 cases involved in 47 trichinellosis outbreaks during 1998--2002, only 35.8% were due to infected pork compared to 80% in 1995--1996. Other important sources were wild animals, such as bear (Ursus arctos) (39.5%), badger (Meles meles) (10.6%), and dog meat (11.9%). Children composed 15.9% of all cases. Overall, 81.0% of pork-cases occurred in the European part of the country, and 89.4% of bear-meat cases were from the Asian region where most of the badger and dog-meat cases also originated. The percent of clinically severe cases of disease derived from pork and from bear meat was 7.7% and 7.9%, respectively; the frequency of moderate cases from pork was significantly higher than from bear meat. Clinically severe cases from badger and dog meat were 1.1% and 1.9%, respectively, where the number of clinically moderate cases from badger meat was significantly larger than that from dog meat. A disturbing trend is the 52.3% of trichinellosis cases during 1998--2002 in Russia that were derived from wild animal meat, especially the clinically severe cases occurring among the aboriginal Siberian population. The contributing factors to the slow decline in trichinellosis incidence in Russia and to the increase in percentage of cases originating from wild animal meat are the distribution and consumption of veterinary-uncontrolled pork, poaching and distribution of wild animal meat, and the neglect of medical and civil regulations. These trends should be seriously evaluated by the institutions of health, education, and by the veterinary service.

[Imported cases of malaria and HIV infection in Russia]. / Rasprostranenie zavoznykh sluchaev malarii i VICH-infektsii v Rossii.

Malaria does not belong to a group of diseases that are markers of HIV infection; a combined transmission of malaria and HIV infection does not occur (except for cases of vertical and syringe-associated transmission of causative organisms), but HIV infection is more common in the malaria-endemic areas since both diseases are socially related. Expansion of both infections is associated with the same social processes in society. This paper analyzes the relationship of the spread of HIV-infection to the routes of migration of narcotic agents in case of Russia, by comparing the spread of HIV infection with the regional distribution of cases of malaria imported by Tadjikistan inhabitants. Importation of malaria from other CIS countries was compared as a control. The authors estimated the coefficients of correlation between the affliction of Russia's population with HIV infection and the rate of malaria importation from Tadjikistan (0.733) and other CIS countries (0.496), as well as between the importation of malaria to Russia and the total volume of a migratory flow from Tadjikistan in the period of 1992 to 2001 (-0.931). The findings indirectly support the assumption that there is a relationship of malaria importation from Tadjikistan to illegal migration, which suggests that the intensive importation of malaria from Tadjikistan may serve as a marker of importation of injectable narcotic drugs and hence that the spread of HIV infection in Russia may be intensified. The authors again emphasize that prevention of the spread of socially related infections requires that the whole society should combine efforts since public health care should not be a hostage of social problems.

[Human dirofilariasis in the Moscow region]. / Difiliarioz cheloveka v Moskovskom regione.

Dirofilaria repens Railliet et Henry, 1911 was for the first time studied in the Moscow Region where 11 patients (6 males and 5 females) aged 4-72 years were recorded in 2000-2002. The geographical distribution (the southern and south-eastern parts of the region) of local cases of dirofiliriasis, was observed. There was a relatively high rate of D. repens in the male genitalia of the infected patients as compared with that reported by other authors. In accordance with the current terminology, D. repens in the Moscow Region is proposed to be regarded as emerging infection. The authors show it necessary to obligatorily record all autochtonous cases of D. repens infection, to make epidemiological surveillance and analysis in order to early detect and prevent dirofilariasis-associated complications.

[The modulation of Plasmodium falciparum virulence as a factor in the self-regulation of the malarial parasitic system]. / Moduliatsiia virulentnosti Plasmodium falciparum kak faktor samoreguliatsii parazitarnoi sistemy maliarii.

Higher Plasmodium falciparum virulence is one of the major factors that contributes to the development of severe malaria and leads to death. However, the nature of virulence and its time course are not so far fully understood. The authors have made a published data-based hypothesis that the virulence of P. falciparum strains circulating in the malaria endemic areas of tropical Africa is not strictly genetically determined. The virulence of P. falciparum increases with its passage through the non-immune organisms of the infected persons. This mechanism of virulence modulation ensures the survival of the parasite in the human population with a considerable communal immunity. To test the validity of the hypothesis, the authors have used a mathematical analytical method to assess the published data on malaria mortality in some areas of tropical Africa. The results of the analysis have shown close values of actual and expected data.

[Phenotypic variability in P. vivax with short- and long-term incubation period]. / Fenotipicheskaia izmenchivost' P. vivax s korotkoi i dlitel'noi inkubatsiiei.

The combined transmission of P. vivax phenotypes was studied. The phenotypes were determined by the duration of a latent parasitic development stage by comparing the intervals from first manifestations of malaria with short- and long-term incubations to its relapse. The study used data on 2493 patients treated with chloroquine (900 mg base for adults) alone at follow-ups in the North-Eastern Delhi (India) in 1988-1992. The combined transmission of P. vivax phenotypes was shown to differ in malaria with short- and long-term incubation. The P. vivax phenotype with manifestations on an average a year following infection in patients with mainly short-term incubation malaria and that with manifestations on an average year and a half after infection in a group of patients with primary long-term incubation malaria were significantly more frequently. Long-term incubation malaria shows simultaneously a larger number of phenotypes than does short-term incubation one. Patients with long-term incubation malaria display a combination of 2 phenotypes (6%) significantly less frequently than that of 3 different phenotypes or more (17%). The similar combinations were observed in the equal number of patients with short-term incubation malaria (7%).

[An evaluation of the spectrum of Plasmodium vivax subpopulations by the results of an experimental study of late relapses in Delhi]. / Otsenka spektra subpopuliatsii Plasmodium vivax po rezul'tatam éksperimental'nogo izucheniia otdalennykh retsidivov v Deli.

The spectrum of Plasmodium vivax subpopulations could be evaluated by analyzing the results of experimental studies of late relapses in P. vivax malaria in north-western Delhi. The spectra of the subpopulations causing late recurrences were different for malaria with short-and longterm incubations. The conclusions previously made by mathematical stimulation as to that malaria with longterm incubation is mainly transmitted at the beginning of the season have been confirmed. Based on the results of the frequency analysis, 6 P. vivax subpopulations with the values of their development duration of 15, 240, 300, 390, 720, and 1020 days, respectively, were identified for formalization of an epidemic process.

[The reaction of taiga ticks to an attractant. II. The rates of removing ticks from a population]. / Reaktsiia taezhnykh kleshchei na attraktant. Soobshchenie II. Tempy iz''iatiia kleshchei iz populiatsii.

Catching ticks on the attractant-moistened napkins and on the flag (control) under field conditions during 5 days has demonstrated that a population of taiga ticks on the treated areas can be killed within 1-2 weeks when attractive-acaricidal granules are applied.

[The mathematical modelling of tropical malaria]. / Matematicheskoe modelirovanie tropicheskoi maliarii.

The new mathematical model of P. falciparum malaria has been created. One means the operational forecast of epidemic process when different control measures are realized. The original modelling methodology for epidemics is used. The proposed methodology is allowed to take into account the natural variety of model's parameters. The malaria model consists of the nonlinear integro-differential in partial derivatives combined equations including individual and population characteristics. The informatics technologies permits to see information about model and its grounds. The model's verification has been done on data of Garki-project.

[A method for stratifying malariogenic territories in order to construct a system of mathematical models of the prevalence of malaria. 1]. / Metodika stratifikatsii maliariogennykh territorii s tsel'iu postroeniia sistemy matematicheskikh modelei rasprostraneniia maliarii. Soobshchenie 1.

The paper describes procedures for stratifying malariogenic areas that are homogeneous in the development pattern for epidemic stratum rises, which will be used to design a set of mathematical malaria spread models. The first stage of the procedures is to stratify P. falciparum and P. vivax malaria on phase planes. The morbidity rate of P. falciparum and P. vivax malaria was analyzed in the north-western areas of India in 1975-1990. Eighty-two observations provided 4 types of phase curves for tropic malaria, which form a polygon, a loop polygon, U-shaped ones and those without any specific signs and 4 groups of phase curves for P. vivax malaria and the U-shaped phase curve with a loop for P. vivax malaria. It is shown that there is a steady-state pattern of phase curve changes in 71%. It is suggested that the pattern of a phase curve can be a diagnostic characterization of the given area.

[Sanitary and helminthic characteristics of soil]. / Sanitarno-gelmintologicheskaia kharakteristika pochvy.

Soil of 20% of economic districts of Russian Federation is slightly polluted by helminths (10 eggs per kg of soil), 64% is moderately polluted (11-100 eggs per kg), 16% much polluted (more 100 eggs per kg). Soil of agricultural fields is polluted 2-3 times more because of use of sewage and their sediments. Recommendations on protection of soil from pollution by helminths are given.

[The malariological zoning of the Guyana portion of the nosogeographical range of malaria based on cluster analysis]. / Maliariologicheskoe raionirovanie gaianskogo uchastka nozoreala maliarii na osnove klasternogo analiza.

Cluster analysis of malaria incidence in Guyana revealed a relationship between population migration intensity and increased rate of P falciparum infection. Such a relationship was not detected for P. vivax malaria. Seasonal differences in malaria incidence are explained by changes in vector ratio. Malariogenic stratification helped clear out the role of three main malaria vectors in different regions of Guyana.