[Mechanical asphyxia in the structure of violent death in the Russian Federation from 2013 to 2022 years]. / Mekhanicheskaya asfiksiya v strukture nasil'stvennoi smerti v Rossiiskoi Federatsii s 2013 po 2022 g.

The objective of the study is to examine the death incidence from mechanical asphyxia in the Russian Federation in the period from 2013 to 2022 yr., to determine the dynamics of changes in indicators of its main types and to reveal territorial specificity. The results obtained with the use of medical statistics methods can be applied to implement measures for health protection, prevent risk factors of fatal outcome among population, to improve the training of forensic medical experts.

[Substantive approach to ensuring infectious safety in forensic medical expert practice]. / Predmetnyi podkhod k obespecheniyu infektsionnoi bezopasnosti v sudebno-meditsinskoi ekspertnoi deyatel'nosti.

The objective of the study is to analyze existing measures and identify problematic aspects of ensuring the organization of infectious safety activity in forensic medical expert institutions, to develop ways of their solution. Documents regulating the functional principles of forensic medical expert institutions in cases of detection or suspicion of infectious pathology have been examined. Specific proposals for the development of a system to ensure infectious safety in the organization of work in the bureau of forensic medical expertise have been formulated.

[Features of methodology for the formation of standard operational procedure in the practice of bureau of forensic medical expertise]. / Osobennosti metodologii formirovaniya standartnykh operatsionnykh protsedur v prakticheskoi deyatel'nosti byuro sudebno-meditsinskoi ekspertizy.

OBJECTIVE: To analyze and summarize data on formation and implementation in practice of standard operational procedures for developing algorithm to improve the quality management system of bureau of forensic medical expertise. MATERIAL AND METHODS: Normative legal documents regulating principles of standardization in healthcare were studied. Literature was analyzed in PubMed, Google Scholar, eLIBRARY search engines in English and Russian languages on the issues of development and implementation of standard operational procedures in practice. RESULTS: Data on using standard operational procedures as a standardization element in medical practice have been analyzed and generalized. Specific proposals for developing system of standard operational procedures, based on general principles for the creation of such documents, in forensic medical expert institutions have been proposed. CONCLUSION: Suggested recommendations can be used in practice to develop new common standard operational procedures.

[Forensic medical examination of the age of living persons in Russia: problematic aspects and solutions]. / Sudebno-meditsinskaya ekspertiza po ustanovleniyu vozrasta zhivykh lits v Rossii: problemnye aspekty i puti resheniya.

The article presents the results of the study of quantitative indicators and analytical compilation of forensic medical expert practice data in terms of the age of living persons in Russia examination as a whole and in individual federal districts and subjects of Russia in the period from 2003 to 2021. It has been established that against the background of the rather low number of expert examinations, performed to determine the living persons age, there has been an increase in this indicator since 2018, mainly due to the Central Federal District. Regional differences in the studied indicators were identified. A systematic survey study of literature (electronic search of publications in PubMed, Science Direct Scopus and eLIBRARY databases) was conducted on the issue of forensic medical assessment of living persons' age, including the methodical support of this examination type, to form an idea of existing scientific clusters. Search modes allowed to form an array of 184 publications indexed in the database Scopus, PubMed, and 8 publications presented in Russian Science Citation Index. The study results were used as a predictor of the efficacy of the package of measures to modernize this type of expert study. The proposed set of measures to improve the scientific and methodical support of forensic medical examination for age establishment will optimize practical activities and increase the evidential efficacy of expert opinions.

[Improvement of legal and regulatory framework of epidemic control measures in bureau of forensic medicine]. / Sovershenstvovanie normativno-pravovogo regulirovaniya protivoepidemicheskikh meropriyatii v byuro sudebno-meditsinskoi ekspertizy.

The study objective is to improve epidemic control measures in the bureau of forensic medicine by reviewing current local regulatory documents, formulating proposals for their modification, and updating issues related to infectious safety and diagnostic accuracy of infectious diseases. Specific proposals have been provided for modifications of statistical forms for infectious disease recording, regulatory documents, and internal instructions.

[Increased quality and accessibility of all types of forensic examinations as a result of the implementation of the 'Modern model of organization and performance of forensic examinations in the Russian Federation']. / Povyshenie kachestva i dostupnosti vsekh vidov sudebno-meditsinskikh ekspertiz kak rezul'tat realizatsii «Sovremennoi modeli organizatsii i proizvodstva sudebno-meditsinskikh ekspertiz v Rossiiskoi Federatsii¼.

To date, there is a clear need to improve the physical resources and staffing of bureaus of forensic medicine (BFM), which do not fully correspond to the volume of forensic studies performed and current requirements for their quality and completeness. The objective of the study is to analyze the main performance indicators of BFM for the development of the main provisions of the 'Modern model of organization and performance of forensic examinations in the Russian Federation'. The detailed analysis made it possible to determine goals, objectives and targets for a set of measures to improve the forensic medical examination service of the Russian Federation.

[Improvement of measures to ensure safe working conditions for staff of the bureau of forensic medicine]. / Sovershenstvovanie meropriyatii po obespecheniyu bezopasnykh uslovii truda sotrudnikov byuro sudebno-meditsinskoi ekspertizy.

Employees of the Bureau of Forensic Medicine (BFM) are exposed to various harmful and dangerous workplace factors during their work. The objective of the study is to improve measures to maintain a safe epidemiological situation in the experience of the BFM of the Republic of Tatarstan based on the results of an online questionnaire survey of employees, which included parts on the assessment of health, working conditions, and morbidity, including tuberculosis. The detailed analysis of the responses made it possible to determine a set of measures to improve the BFM workflow and health status of employees.

[Epidemiological analysis of violent death and cases of not established death cases in Russian Federation (2009-2018)]. / Epidemiologicheskii analiz pokazatelei nasil'stvennoi smerti i sluchaev neustanovleniya prichiny smerti po Rossiiskoi Federatsii (po materialam 2009­2018 gg.).

The paper presents the results of an epidemiological analysis of statistical data on the number of deaths from violent deaths, which cause has not been established; unidentified and unclaimed corpses in forensic medical expertise in Russia as a whole and in individual federal districts for the period from 2009 to 2018. Percentage indicators and share values of the circumstances due to which the death cause was not established are given. It was found that on the basis of a steady decreasing trend in number of violent deaths, the number of corpses with an unknown death cause is growing, mainly due to putrefactive changes in corpses of adults and due to the burning of children corpses. The presence of a strong correlation between the number of unclaimed and unidentified corpses with the number of forensic medical expertise, when the cause of death was not established, was shown. Based on the analysis results at the macro level (federal districts), some interregional differences in the structure of the analyzed indicators were revealed. The results obtained make it possible to confirm the relevance of existing clusters of scientific research and to form new ones, to place accents in the directions of the postgraduate education of specialists.

[Possibilities of improvement of anti-epidemic events at forensic medical institution on the basis of quality management approaches]. / Vozmozhnosti sovershenstvovaniya protivoepidemicheskikh meropriyatii v byuro sudebno-meditsinskoi ekspertizy na osnove podkhodov menedzhmenta kachestva.

The article shows the experience of the Republican Bureau of Forensic Medical Expertise of the Ministry of Health of Tatarstan Republic in organizing and ensuring anti-epidemic measures using a quality management system. The comprehensive implementation of anti-epidemic measures in the expert institution dictates the need for regulation of the main provisions by internal documents (standard operative procedures), built on the basis of existing regulatory legal acts. The method of quality management system based on the Shekhard-Deming cycle was applied in practical activities, a process-based approach was used to organize work in organization. The proposed standard operative procedures, together with a model for managing the activities of an epidemiologist, showed high efficiency and allow improving the process of managing epidemiological risks.

[Overdose deaths from narcotic drugs and psychotropic substances in Russia (an analysis of materials for the period 2003 to 2018)]. / Smertel'nye otravleniia narkoticheskimi sredstvami i psikhotropnymi veshchestvami v Rossii (po materialam 2003-2018 gg.).

The purpose of the work is to study the prevalence of overdose deaths from narcotic drugs and psychotropic substances in Russia, as determined by forensic autopsies, for the period 2003 to 2018. For the study, medical statistics were processed, the percentages for each indication were calculated, and the changes in the percentages for different types of overdose deaths were noted. It was established in forensic autopsies for the period under study, that the percentage of narcotic overdose deaths ranged from 4.2% to 16.6% of the total number of poisonings, while the percentage of overdose deaths from psychotropic substances ranged from 0.7% to 1.3%.

[The conditions and the character of the work of the mortuary personnel in the Great Britain: the problems of health protection, anti-infectious prophylaxis, and reduction of the risk of contamination]. / Usloviia i kharakter raboty meditsinskogo personala morgov Velikobritanii: voprosy okhrany zdorov'ia, obespecheniia infektsionnoi bezopasnosti i snizheniia riskov zarazheniia.

The objective of the present work was to study the specific approaches to the organization of the work of the foreign specialists performing post-mortem autopsies of the subjects who died from infectious pathology and consider the proposals of the representatives of the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) concerning accreditation of mortuaries in the Great Britain. It is shown that the algorithm for the evaluation of the possible risks of contamination of the medical personnel suggests the solution of five problems that envisages obtaining the answers to the following questions: (1) what biological agents can be present in a particular case? (2) what is their virulence factor? (3) what are the transmission routes (mechanisms)? (4) what are the manner of their realization? (5) what is the amount of the pathogen(s) needed to cause a given infectious disease? The anti-infectious prophylactic measures and the prevention of the contamination risks for the medical personnel of the British mortuaries are designed to safeguard the people against the infection with the causative agents of tuberculosis, viral hepatitis B and C, HIV, and Kreutsfield- Jacob's disease. All the employees engaged in the pathological studies must wear specialized clothing in a mandatory manner and make use of the equipment for the personal and collective protection. An indispensable condition for the safe work in a mortuary is the efficient ventilation system, the special viewing equipment, and separate premises. The NCEPOD experts maintain that the general approach to the investigations of the cases of infectious diseases presently adopted in the country needs to be radically re-considered and standardized. Diagnostics of contamination and morbidity of the medical personnel from the corpses has not yet become a routine practice. The principal recommendation to be implemented at the national level consists of the strict observance of the safety precautions as opposed to the total pre-mortem testing of the suspicious cases.

[The coroner's autopsies in the Great Britain: the problems related to the quality of the studies, standardization, auditing, financial support and the approaches to their solution]. / Koronerskaia autopsiia v Velikobritanii: problemy kachestva issledovanii, standartizatsii, audita, finansirovaniia i puti ikh resheniia.

This article continues the series of previous publications of the authors based on the analysis of the detailed report of the experts of the National Confidential Enquiry into Patient Outcome and Death program (NCEPOD) designed to evaluate the quality of autopsies carried out by the coroners in the Great Britain. It was shown that only in 13 to 55% of the 1,691 case the operators had an opportunity to refer the necropsy materials for the pathological study. The problems encountered in association with histological and toxicological analysis arose from the misunderstanding between the coroners and the pathologists as regard the organizational aspects of autopsy studies as swell as the financial and economic considerations. The Coroner Rules that had been adopted in 1984 and remained in force in the country until 2005 needed to be radically revised, corrected, and amended to facilitate the solution of a number of problems and eliminate the formal organizational and technical contradictions that hampered the further improvement of the quality of autopsies that must be performed by the corners at the national rather than the local level. The maximum number of the unacceptable results were revealed in the protocols of autopsires carried out by the forensic medical experts. All pathologists in the Great Britain are recommended to pay special attention to all cases of sudden death of the adult subjects and the deceased epileptic patients. The detailed investigations are mandatory in all cases of death following medical manipulations, such as surgical interventions, and complications.

[Forensic medical assessment of the cases of HIV infection and hemocontact viral hepatitis B and C during the period from 2011 till 2015 in different subjects of the Russian Federation]. / Sudebno-meditsinskaya otsenka sluchaev VICh-infektsii i gemokontaktnykh gepatitov V i S v period s 2011 po 2015 g. v sub''ektakh Rossiiskoi Federatsii.

The annually increasing number of the patients presenting with HIV infection and hemocontact viral hepatitis is naturally accompanied by the growing number of deaths from these infectious pathologies. The objective of the present study was to analyze the results of forensic medical expertises of the cases of HIV infection and hemocontact viral hepatitis B and C during the period from 2011 till 2015 in different subjects of the Russian Federation. The data obtained confirm the tendency toward the further rise in the frequency of such cases in the practical work of forensic medical experts. Moreover, they indicate the necessity of registration of such cases in state forensic medical expertise organizations and open up the prospects for the development of the common approaches to the solution of the existing problems including the evaluation of the degree of the harm to human health.

[The peculiarities of the evaluation of the severity of the harm to health in the case of development of psychic problems associated with the concomitant HIV infection and the accompanying infectious pathology].

The objective of the present study was to elaborate the qualifying criteria for the evaluation of the severity of the harm to health in the case of development of a psychic disease associated with the concomitant HIV infection and the accompanying infectious pathology, in the first place tuberculosis, venereal diseases, parenteral hepatitis B and C. The scientifically substantiated qualifying criteria are proposed to be used for the expert assessment of the harm to health in the case of development a psychic disease associated with the concomitant HIV infection and the accompanying infectious pathology.

[Monitoring HIV infection morbidity in Moscow based on the data of forensic medical expertise].

The objective of the present study was the retrospective analysis of the cases of rapid diagnostics of the HIV status of the corpses referred to the pathologo-anatomical departments of Moscow. The standard statistical methods were used for this purpose. The structure of H IV infections is described in terms of age and sex of the affected subjects as well as stages of the disease. It was shown that cooperation of forensic medical services with AIDS control and prevention centres is of primary importance for the substantiation of the diagnosis, improvement of the quality of the relevant statistical information about the causes of death, enhancement of the objective value of epldemiological data on the occurrence of HIV infection and HIV-associated diseases in the city of Moscow.

[The role of the biological damaging factor in the explosive injury].

This article describes the specific features of the action of the biological damaging factors on the human organism associated with the explosive injury. Both the direct action of the damaging agents contained in the biological weapons and their secondary effects in the form of systemic and local infectious complications of the inflicted wounds are considered. The criteria for the evaluation of the degree of harm to the health of the victims of explosion attributable to the action of the biological damaging factor are proposed.

[The current state of the organizational component of the personality identification procedures for the unrecognized casualties of emergency situations].

This paper reports the results of analysis of organizational problems related to personality identification of unrecognized casualties in a variety of emergency situations. The necessity of purpose-oriented introduction of high-technology methods into the practical work of forensic medical experts is emphasized. The priority of the organizational component in the interdepartmental interactions during joint expertise actions at the sites of emergency situations is substantiated. The specific features of injuries in unrecognized subjects who died or suffered in emergency situations are considered with reference to the latter's peculiar conditions. The authors discuss prospects for the further development of organizational and legal basis of research for the purpose of personality identification with the use of the database of human medico-biological characteristics as envisaged by the current legislation.