[The medical care of seamen of civil shipping: the role of non-commercial organizations].

According to the International Labor Organization, health protection and access to medical treatment are to be guaranteed to seamen in the same way as to people working ashore. However, in practice, formal measures and mechanisms do not always make it possible to provide medical care to crew members of civil vessels due to peculiarities of legal systems of the States in whose territorial waters the vessel is located, remoteness of the vessel from coastline and objective situation that permits to receiving medical care from the shore. As far as possible these problems are resolved by non-profit organizations of seamen. The overview of their activities is presented in this article.

[Sacral magnetic stimulation in overactive bladder syndrome: comparative analysis of protocols with a frequency of 1 and 5 Hz]. / Sakral'naya magnitnaya stimulyatsiya pri sindrome giperaktivnogo mochevogo puzyrya: sravnitel'nyi analiz protokolov s chastotoi 1 i 5 Gts.

Peripheral magnetic stimulation (pMS) has shown its effectiveness in the treatment of lower urinary tract symptoms, such as symptoms of an overactive bladder (OAB). The perineal region (pelvic floor) and the sacral roots area (projection S3 of the root) are used as the locus of stimulation. The published literature presents protocols with different parameters of stimulation, while each of them reliably demonstrates clinical efficacy, however, no comparative studies have been found to select priority stimulation modes when analyzing available sources. OBJECTIVE: To compare the efficacy and safety of different frequency - 1 and 5 Hz - modes of sacral MS in patients with symptoms of OAB. MATERIAL AND METHODS: A single blind prospective randomized comparative clinical study included 59 patients with OAB symptoms. The patients were divided by simple randomization into the group 1 (n=30), which received MS 3 times a week for 5 weeks with a frequency of 1 Hz per sacral root area (S2-S4), and the group 2 (n=29), in which stimulation was performed at a frequency of 5 Hz, while the remaining parameters and duration of therapy were identical to group 1. RESULTS: Sacral pMS with different frequency modes (1 and 5 Hz) is reliably equally effective against the clinical symptoms of OAB, which is confirmed by the absence of significant intergroup differences. In patients receiving MS with a frequency of 5 Hz, there was a more pronounced increase in maximum cystometric capacity, normalization of the maximum and average urine flow velocity and regression of the residual urine volume (p<0.001, p=0.007, p=0.011 and p=0.012 compared with group 1). The greatest difference in indicators was observed in the increase in the maximum cystometric capacity - +31±25 ml at MS with a frequency of 1 Hz and +109±96 ml at MS with a frequency of 5 Hz (p<0.001). MS is a safe procedure and is well tolerated by patients. CONCLUSION: pMS when exposed to the area of S2-S4 roots for 20 minutes 3 times a week with a course for 5 weeks is reliably effective against the clinical symptoms of OAB at different frequency modes (1 and 5 Hz). At the same time, MS with a frequency of 5 Hz may have an advantage over stimulation of 1 Hz in terms of its effect on urodynamic parameters (maximum cystometric capacity, peak and average urine flow velocity and residual urine volume), which may be associated with a large inhibitory effect on detrusor.

[The pharmaceutical insurance as a mean to overcome to overcome inequality in access to health care of population in Kazakhstan].

This article investigates readiness of Kazakhstan's population for implementation of pharmaceutical insurance system to overcome inequalities in health care accessibility. The primary data was obtained using questionnaire survey of 5 819 respondents in 17 regions of Kazakhstan in August-October 2022. The data was analyzed by software SPSS 25.0 applied for processing statistical and typology analysis, classification and comparative analysis. The results demonstrated that subjective readiness, per capita family income, urban/rural residence, education, field of employment, gender and health status are factors affecting population's readiness for implementation of new pharmaceutical insurance system. The study identified average degree of readiness of population to new pharmaceutical insurance system. However, 30% of respondents had no clearly formed opinion. The study concluded that implementing pharmaceutical insurance system with 50% of state co-financing in Kazakhstan is feasible to reduce inequalities in accessing essential medications. The Ministry of Health Care of Kazakhstan is advised to organize regular health education activities in population related to compulsory and voluntary health insurance to ensure successful implementation of the new system.

A combination of organic and inorganic cations in the synthesis of transition metal nitrates: preparation and characterization of canted rectangular Ising antiferromagnet (PyH)CsCo2(NO3)6.

Pyridinium cesium cobalt nitrate, (PyH)CsCo2(NO3)6, obtained from a nitric acid solution crystallizes in the orthorhombic space group Pnma with unit cell parameters a = 8.6905(14) Å, b = 11.9599(18) Å, c = 18.386(3) Å, V = 1911.0(5) Å3, and Z = 4. It consists of [Co(NO3)3]- layers, in which each Co2+ ion is connected with four monodentate bridging NO3-groups and one bidentate terminal NO3-group, forming a corrugated rectangular net. Magnetization and specific heat measurements show that (PyH)CsCo2(NO3)6 undergoes a long-range canted antiferromagnetic ordering in two steps at TC1 = 5.0 K and TC2 = 2.6 K. The temperature dependence of the magnetic susceptibility and the field dependence of the magnetization measured for (PyH)CsCo2(NO3)6 show that it is an Ising antiferromagnet. In support of these observations, our DFT + U + SOC calculations show that the Co2+ ions of (PyH)CsCo2(NO3)6 have an easy-axis magnetic anisotropy with preferred spin orientation along the b-axis. To a first approximation, the spin lattice of (PyH)CsCo2(NO3)6 is a weakly alternating Ising antiferromagnetic chain (J1/J2 ∼ 0.85), and these chains interact weakly (J3/J2 ∼ 0.07) to form a rectangular Ising antiferromagnetic lattice. In agreement with the prediction for a rectangular Ising antiferromagnet by Onsager, (PyH)CsCo2(NO3)6 undergoes a long-range antiferromagnetic ordering.

A cascade of magnetic phase transitions and a 1/3-magnetization plateau in selenite-selenate Co3(SeO3)(SeO4)(OH)2 with kagomé-like Co2+ ion layer arrangements: the importance of identifying a correct spin lattice.

We prepared a new compound, Co3(SeO3)(SeO4)(OH)2, having layers in a kagomé-like arrangement of Co2+ (spin S = 3/2) ions. This phase crystallizes in the orthorhombic space group Pnma (62) with unit cell parameters a = 11.225(9) Å, b = 6.466(7) Å and c = 11.530(20) Å. Its layers, parallel to the ab-plane, are made up of Co1O5 square pyramids and Co2O6 and Co3O6 octahedra. As the temperature is lowered, Co3(SeO3)(SeO4)(OH)2 undergoes three successive magnetic transitions at 27.5, 19.4 and 8.1 K, and the magnetization of Co3(SeO3)(SeO4)(OH)2 measured at 2.4 K exhibits a 1/3-magnetization plateau between 7.8 and 19.9 T. The H-T magnetic phase diagram constructed for Co3(SeO3)(SeO4)(OH)2 from ac and dc magnetic susceptibility, specific heat and magnetization measurements contains three magnetic phases I, II and III. Phase I is antiferromagnetic, while phases II and III are ferrimagnetic and responsible for the 1/3-magnetization plateau. To interpret these complex magnetic properties, we identified the correct spin lattice for Co3(SeO3)(SeO4)(OH)2 by evaluating its intralayer and interlayer spin exchanges based on spin-polarized DFT+U calculations.

Radiation dose reconstruction for higher aquatic plants and fish in Glyboke Lake during the early phase of the Chernobyl accident.

This study deals with an assessment of radiation dose dynamics to fish and higher aquatic plants (helophytes) in Glyboke Lake (10-km exclusion zone) during the early phase of the Chernobyl accident. Models of radioactive contamination of water and sediment and models of radioactive contamination and radiation dose to fish and aquatic plants were developed. It was found that, in 1986, the total dose rate to fish reached 0.25 Gy d-1. Within 6 months after the accident, the dose rate due to 90Sr, 134Cs and 137Cs had increased. The absorbed dose to prey fish of Glyboke Lake for this period was estimated as being 27-81 Gy of which 4-40 Gy was formed by 131I exposure. The radiation dose rate due to 90Sr, 106Ru, 134+137Cs and 144Ce to aquatic plants reached its quasi-equilibrium values approximately 50 days after the accident and remained virtually unchanged until the end of the 1986 growing season. The highest levels of 89Sr, 91Y, 95Zr, 103Ru, 141Ce exposure were observed between 30 and 50 days with a decrease by 2-3 times at the end of the growing season. Radiation exposure of the short-lived 131I, 140Ba, 140La, 239Np reached its maximum within 5-15 days after the accident. The absorbed dose rate to aquatic plants reached 0.69 Gy d-1, while the contribution of cerium radionuclides to the total dose rate formed 50% in the initial period and reached 90% at the end of the growing season. The magnitude of the radiation dose rate to plant roots was 2.4 times higher than aboveground organs, and that of rhizomes was 1.6 times higher. During the growing season of 1986 the total dose of exposure of plants in Glyboke Lake was about 78 Gy. The results of this study emphasise the necessity to consider the history of exposure of past generation of living organisms as part of the assessment of current radiation effects.

[Encephalopathy GNAO1]. / Entsefalopatiya GNAO1.

OBJECTIVE: To study the clinical picture of all patients with GNAO1 encephalopathy detected in the Russian Federation. This publication is a multicenter study combining data from epileptological centers in Moscow, Novosibirsk, St. Petersburg, Nizhny Novgorod, Tyumen. MATERIAL AND METHODS: Nine patients were included, aged 2 to 19 years, with 4 mutations. Male to female sex ratio = 5:4. RESULTS: 8 patients (5 with mutation c.607G>A (p.Gly203Arg), 1 - c.155A>G (Gln52Arg), 1 - c.485G>A (p.Arg162Gln)) had a variant of epileptic encephalopathy, developmental encephalopathy, 1 patient had torsion dystonia without epilepsy (mutation c.713A>G (p.Asp238Gly)). Epileptic seizures in 8 children with epileptic encephalopathy GNAO1 in 100% debuted at 1 month of life, becoming the earliest symptom of the disease. Motor development delayed in 100% of cases. Mental development was not affected only in the case of the dystonic variant. Hyperkinesis (dystonia, choreoathetosis, ballism) followed later, from 2 to 8 months. They were more severe than epilepsy. 4 patients with the c.607G>A (p.Gly203Arg) mutation developed repeated dystonic storms that were resistant to most drugs. CONCLUSION: Epilepsy in GNAO1 is difficult to treat, but temporary or complete remission is possible. Effective drug strategies for the treatment of hyperkinesis have not yet been developed. Expansion of indications for surgical therapy (DBS) of hyperkinesis in this syndrome is desirable.

Metastable CrMnNi steels processed by laser powder bed fusion: experimental assessment of elementary mechanisms contributing to microstructure, properties and residual stress.

The complex thermal history imposed by the laser-based powder bed fusion of metals (PBF-LB/M) process is known to promote the evolution of unique microstructures. In the present study, metastable CrMnNi steels with different nickel contents and, thus, different phase stabilities are manufactured by PBF-LB/M. Results clearly reveal that an adequate choice of materials will allow to tailor mechanical properties as well as residual stress states in the as-built material to eventually redundantize any thermal post-treatment. The chemical differences lead to different phase constitutions in as-built conditions and, thus, affect microstructure evolution and elementary deformation mechanisms upon deformation, i.e., twinning and martensitic transformation. Such alloys designed for additive manufacturing (AM) highlight the possibility to tackle well-known challenges in AM such as limited damage tolerance, porosity and detrimental residual stress states without conducting any post treatments, e.g., stress relieve and hot isostatic pressing. From the perspective of robust design of AM components, indeed it seems to be a very effective approach to adapt the material to the process characteristics of AM.

[Modern features of fertility in lowand middle-income countries, including in the context of the COVID-19 pandemic].

The main issues in the problem of fertility in countries with low and middle incomes of the population are the high prevalence of complications and maternal deaths during childbirth, as well as the high incidence of such indicators of the birth of an infant with low growth and weight indicators for their gestational age, malnutrition of pregnant women and mothers, frequent abortions, short intervals between births due to the educational status of the mother and the financial wealth of households, high prevalence of teenage motherhood, low availability of cesarean section, high cost of educating children as a factor in fertility. The impact of the COVID-19 pandemic on fertility in low- and middle-income countries has been most pronounced due to disruptions in the health care system, a surge in domestic violence, teenage pregnancy and female genital mutilation.

[ADULTS NEUROGENESIS AS A RESERVE FOR HEALTH PRESERVATION].

The article presents scientific evidence that new neurons from progenitor cells throughout life in almost all animals with a nervous system are an integral component of neuronal ontogenesis and plasticity.It has been shown that there are neural stem cells in the brain that give rise to adult neurogenesis, occurring primarily in the dentate gyrus, a subregion of the hippocampus important for learning, memory, and emotion. With age, there is a decrease in adult neurogenesis, which is associated with a decrease in cognitive functions. Newly formed neurons and «immature¼ neurons together constitute a potential reservoir of young cells («brain reserve¼) that can be used to prevent aging and/or delay the onset/reduce the impact of neurological disorders.The possibility of using neurogenic processes for therapeutic purposes to reduce pain and improve the quality of life of patients is implied.

[ISSUES ON EDUCATION OF CHILDREN IN LONG-TERM MEDICAL NEEDS IN HEALTHCARE ORGANIZATIONS].

The article presents a theoretical analysis of domestic and foreign experience in teaching children undergoing long-term treatment or rehabilitation in the context of medical care. The specification of educational process, its differences from the traditional classroom-lesson system, the main role of stakeholders such as administration and medical organization, teachers, children and parents and different educational technologies, as well as the basic functions of the education of children in a hospital school are analyzed.

The activity of noncommercial organizations providing medical social care to migrants in conditions of COVID-19.

The article considers actual topic concerning acquisition by migrant associations of certain importance in the public sphere of different countries. The analysis demonstrated that these public structures begin to act as actors of intersectorial cooperation within the framework of state policy in the fields of migration and health care. It is substantiated that various institutions of civil society remained in shadow of state and commercial structures for a long time. Only recently, Russian socially oriented noncommercial organizations acquired status of suppliers of social services, including medical social care of population. At that, they became a subject of cooperation in order to provide medical social care to population, which is provided not only to Russian citizens within the framework of mandatory medical insurance, but also to migrants. It is proved that during the pandemic, many noncommercial organizations expanded scope of cooperation with government, business and public structures of medical and social profile. Some noncommercial organizations that were originally organized as associations of migrants and had character of diasporas are now legitimate NGOs. Such organizational and functional changes can be interpreted as a result of development in the field of care of migrants and their integration into the Russian noncommercial sector. As a consequence of transnational commitment of migrants themselves and their interest in development of their native countries. Also, as a result of institutional integration, and consequence of spreading of COVID-19 and intensification of need in medical and social care to countrymen and their families. It is concluded that institutional changes allow NGOs to establish more open relations with associations of migrants of various origins, as well as to attract additional resources for planning, financing and implementing projects that are strategically important both for survival of organizations themselves and for helping migrants in pandemic conditions.

[Study of Multiple Enzymatic Incorporation of Modified Nucleotides of Purine and Pyrimidine Nature in the Growing DNA Chain].

The substrate properties of nitrogen-base modified derivatives of purine and pyrimidine deoxynucleoside triphosphates during their simultaneous pairwise insertion into the growing DNA strand have been studied. Modified nucleotides were introduced using real-time PCR and the primer extension reaction; in one reaction, derivatives with both different and similar functional substituents were used. Genomic bacterial DNA, specially constructed synthetic DNA fragments, and SELEX libraries were used as templates. The reactions were performed using DNA polymerases with no 3'-5' correcting exonuclease activity: Taq, Vent (exo-), DeepVent (exo-), and KOD XL. It was shown that the substrate efficiency is affected by both the size of the substituent group and the chemical nature of deoxynucleoside triphosphate. The effectiveness varies significantly depending on the polymerase used. The most effective of the studied substrates are pyrimidine deoxynucleoside triphosphates in combination with Vent (exo-) DNA polymerase. DNAs modified by pairs of dissimilar nucleotides (dU + dC, dU + dA, dC + dA) with similar and different functional substituents were obtained.

[REASONS FOR CITIZENS TO APPLY FOR PAID MEDICAL SERVICES ACCORDING TO SOCIOLOGICAL SURVEYS OF THE POPULATION].

An actual characteristic of the processes taking place in the Russian healthcare, especially during the ongoing transformation of the state healthcare system aimed at building a patient-oriented healthcare model, is the analysis of the reasons why citizens prefer medical care provided for a fee. The purpose of the study is to study the main reasons for the treatment of the population of the city of Moscow for medical services provided for a fee and their comparison with the reasons for applying for paid medical services (PMU) in other regions of the Russian Federation.The main materials of the study were the data of a sociological survey of visitors to the capital's medical organizations about the reasons for the population's application for obtaining PMU, as well as the results of sociological surveys on this topic in other regions of the Russian Federation. As a result, not only the main reasons for applying for medical services on a paid basis were identified, but also regional peculiarities of the prevalence of PMU.

[HEALTHY LIFESTYLE OF THE POPULATION IN THE CONTEXT OF A PANDEMIC: EXPERT OPINIONS OF RESEARCHERS AND EMPLOEES OF NON-PROFIT ORGANIZATIONS].

The article presents the results of a study aimed at identifying the problems of maintaining a healthy lifestyle in the context of the COVID-19 pandemic. The results of the study showed that not only people of older age groups are infected, but also young people with chronic diseases. Forced isolation, uncertainty of the future and stress have significantly worsened the physical, social and mental health of the population of all age groups. Therefore, people began to strengthen their own physical, social and psychological health, to carry out preventive health measures. The problems of maintaining a healthy lifestyle in the context of the COVID-19 pandemic can be effectively solved by using an integrated approach to public health, jointly provided by state and public organizations.

[The effect of digital mass media on mental health of children and youth].

The article considers the impact of digital media on mental health of children and the youth based on the analysis of studies of national and foreign researchers. On the one hand, the application of information technologies by children and the youth is related to requirements of actual reality that allows them to be active and independent in virtual space and contributes to development of special skills and abilities, exchange of knowledge and experience, broadens scope of interests. On the other hand, the information media establish conditions of high risk for health. The article presents the results of an empirical study, carried out in 2019 at the Balashov Institute of the Saratov State University. The questionnaire survey was applied to sampling of 386 respondents to identify the relationship between the amount of time spent online by young people and the feeling of loneliness. The study discovered that the higher is the user Internet activity that is not accompanied by sense of satisfaction, the higher is the level of frustration and loneliness. The problem areas are identified that make it difficult to ensure the effective safety of users and the timely identification of threats to their mental health: the shortage and fragmentation of scientific research; the ambiguity of opinions of expert community regarding the impact of digital technologies on the development of children and adolescents; the complexity of social control of online users due to their social demographic and sociocultural heterogeneity; the conflict of interests between providers, business structures, advertisers and other subjects of virtual reality and underage users; low level of internet literacy of parents and teachers. All these factors hinder the development of adequate technologies of early detection, prevention and support of victims of cyberaggression or cybercrimes.

[The attitude of the youth to vaccine prevention of influenza in conditions of COVID-19 pandemic].

The article considers the problem of attitude of the youth to vaccine prevention of influenza. The study was organized on the basis of qualitative research methods (focus groups) of students of two universities in the Central and Volga Federal Okrugs. The data about attitudes towards vaccination and refusal motivation was obtained. The need in increasing awareness of the youth about vaccine prevention as an actual health-preserving technology was substantiated.

Socio-economic assessment of patient blood management practical implementation in surgical treatment of coronary heart disease (I20-I25).

Aim    To evaluate possible social and economic benefits of correcting preoperative iron deficiency /iron deficiency anemia as a comorbidity in a model population in the process of transition from the routine practice to the optimized preparation of patients to elective surgery (as exemplified by several circulatory diseases: I20 - I25, class IX ICD 10).Material and methods    By building imitation models depending on the patient blood management (PBM) practice, changes in years of life lost/saved adjusted for disability were evaluated, including in monetary terms, in relation to the annual number of operations performed for ischemic heart disease (IHD) (I20 - I25) in the age group of 17 years and older, as well as a potential effect of PBM on the applied health economics.Results    With implementation of the PBM systemic measures in cardiac surgery, the potentially prevented annual social and economic damage will amount to more than 38 thousand years of life saved and more than 20.2 billion rubles in monetary terms. Furthermore, it will be possible to exclude 9435 hemotransfusion from the cardiosurgical practice, which will annually save more than 2.3 thousand liters of blood with a total cost of 77.7 million rubles in favor of clinical situations that have no alternative.Conclusion    The implementation of PBM in cardiac surgery, the discipline with the highest levels of preoperative iron deficiency/anemia and the use of blood components, will not only improve the clinical outcomes and cost-effectiveness of surgical interventions, but will also prevent social and economic damage to the country.

[Experience in the management of patients with genetic epilepsies and epileptic encephalopathies in the outpatient practice]. / Opyt vedeniya patsientov s geneticheskimi epilepsiyami i epilepticheskimi entsefalopatiyami v ambulatornoi praktike.

OBJECTIVE: To describe the spectrum of being detected gene mutations in patients with epilepsy in clinical practice of neurologists specializing in epilepsy with an analysis of diagnosed epileptic syndromes, the characteristics of seizures, the timing of a genetic diagnosis, options and treatment effectiveness. PATIENTS AND METHODS: The study included 100 patients (40 boys, 60 girls) with epilepsy and/or epileptic encephalopathy and a gene mutation identified. The average age was 6.9±5.1 years. Through remote access, epilepsy specialists filled out a specially designed unified table containing information from outpatient case history. RESULTS AND DISCUSSION: There are patients with a wide range of gene mutations, the leading of which is a mutation in the SCN1A gene (15%). The main method (85%) of detection remains the sequencing of the last generation in the «Hereditary Epilepsy¼ panel. Years pass from the onset of the disease to the genetic diagnosis (Me - 3 years). In most cases, patients with severe (52% have epileptic encephalopathy, 88% have developmental disorders) and pharmacoresistant (mean amount of anti-epileptic drugs - 3.8±2.2, multitherapy - 70%) syndromes have undergone genetic testing. In the treatment of these patients epileptologists are increasingly (52%) use alternative methods: steroids, ketogenic diet and others. The absence of seizures was observed only in 46% of patients. CONCLUSION: Thus, in the outpatient practice of epileptologists, patients with a wide range of gene mutations are found. As a rule, these are patients with severe, therapy-resistant epileptic syndromes.

[The COVID-19 pandemic as transformation factor of domestic violence].

The article presents the results of project targeted to identify specifics of transformation of domestic violence while anti-pandemic measures are in force. The sociological survey was organized on the basis of the Crisis center for women in difficult life situations (Belgorod region, Russia). The sampling consisted of 46 women aged from 20 to 45 years endured domestic violence. The primary information was collected using semi-structured interview technique. Also, semi-structured interviews of experts from among sociologists and crisis center personnel were carried out. It is established that COVID-19 pandemic significantly impacted on family relationships. The conditions of forced isolation and anti-pandemic measures observance significantly increase risk of domestic violence.