Vol 62, No 5 (2018)

The article considers the incidence, mortality and in-hospital mortality rates from community-acquired pneumonia in St. Petersburg, 2009-2016. Epidemiological characteristics were studied in comparison with values in Russian Federation, as well as levels in Moscow and the Northwestern Federal District. The relationship between incidence and mortality rates from community-acquired pneumonia and epidemics of influenza was demonstrated. After the analysis of the medical records of patients who died of community-acquired pneumonia, defects in the organization of medical care, which had a negative prognostic impact, were indicated. A series of measures was proposed to improve the situation with community-acquired pneumonia in St. Petersburg.

Introduction. Infection caused by virus hepatitis B is a serious medical and social problem worldwide because of high morbidity, mortality and high costs of treatment. After introduction of mass vaccination for HBV in Russia the main issue related to HBV is high incidence and prevalence of chronic forms. Methods. Forms No. 2 and No. 6 of the state statistical reporting in 1986-2016 were analyzed. A population-based cross-sectional study of Arkhangelsk population aged 18-39 years was carried out to assess the prevalence of HBV markers (HBs Ag, anti-HBc) and antibodies to HBs Ag as well as factors associated with HBV infection. Results. During the study period, the pattern of incidence of acute- and chronic HBV infection in the Arkhangelsk region is similar to the pattern of incidence in Russia, but the magnitude of regional indicators of the incidence of acute HBV was lower while the incidence of chronic HBV infection was higher than nationwide. According to laboratory data, among 1243 participants the prevalence of serological markers (HBs Ag and/or anti-HBc) in the sample was 11.8% among men and 10.2% among women. Altogether, 1.1% of the men and 1.3% of the women had positive results for HBs Ag. In total, 46.4% of the men and 38.9% of the women had all three tests negative. 46.9% of the participants were positive only for antibodies to HBs Ag. Discussion. In the Arkhangelsk region the vaccination has had the greatest influence on intensity of epidemic process of acute HBV infection. The incidence of chronic HBV infection decreased in the region in 3 times after initiation of large-scale vaccination. Conclusion. The percentage of vaccinated persons in Arkhangelsk region is high. Still there are sources of infection in the population.

The higher prevalence and variety of clinical manifestation of disorders of falling asleep and sleep maintenance (insomnia) in persons of able-bodied age condition necessity of development of personified prevention programs subject to main pathophysiologic mechanisms conditioning risks of development of sleep disorders and related to them somatic diseases. Purpose of study. To analyze functional state of brain and cerebral blood flow in brain workers with higher level of professional stress and sleep disorders and to determine risk factors of development of established disorders for scientific substantiation of preventive activities. Material and methods. The examination was applied to two groups of brain workers with higher level of work intensity (class 3.3) and professional stress. The main group included 77 individuals stated availability of insomnia (index of insomnia severity 20.4±3.1 points). The control group included 88 individuals without significant sleep disorders. The clinical instrumental examination was implemented including questionnaire survey, night polysome graphic analysis, electroencephalography (EEG) and rheography analysis. Results. The high level of professional stress in workers with sleep disorders was statistically related to decreasing of efficiency of total time of sleep, decreasing of slow-wave sleep шт its structure, increased sleep fragmentation due to increasing of reactions of EEG-activation (r=0.35). The study of cerebral blood flow established that in 50% of individuals with sleep disorders and 32% of individuals without sleep disorders the instability of vascular tone was registered. According data of prospective observation, the signs of sleep disorders continued in 92% of patients with non-specific alterations of EEG with predominance of low-amplitude high-frequency activity and in 65% of patients with absence of similar alterations. The detected alterations can be considered as markers of condition of increased reactivity of central and vegetative nervous system being predisposing factor of changing from acute or transitory insomnia to chronic form.

The article presents data concerning economic and medial social losses related to temporarily disability of workers of petrochemical enterprise. The analysis of data of morbidity of temporarily disability during 2013-2015 was implemented on the basis of the Private Institution "The Medical Sanitary Unit № 36" serving a large petrochemical enterprise. The economical public losses were calculated in rubles considering treatment expenses from budgets of all levels and foundations of mandatory medical insurance, payments of sick list, based on rate and duration of temporarily disability, unproduced gross regional product. The comparison of intensive indices according gender signs were implemented using Student criterion and extensive indices using χ2-criterion. It is established that in 2013-2015 the level of morbidity according number of cases of temporarily disability per 100 working persons was equal to 57.33±4.37 and according number of days of temporarily disability - 672.19±45.76. In 2015, intensive indices of morbidity as compared with 2013, decreased in cases on 14,1% and in days on 5.4%. The average annual losses made up to 216 347.4 thousand of rubles. At that, quantity of losses related to temporarily disability in males was 1.3 times higher than temporarily disability in females. The greatest input into economical losses was conditioned by unproduced gross regional product (53.9%). The benefits payments due to temporarily disability comprised 25.4%, hospital treatment expenses - 12,7%, out-patient care - 5.5%, day hospital treatment - 2.1%, emergence medical care support - 0.9% from total amount of economic losses. The analysis demonstrated significance of losses both for workers and business and public society in general. It can be useful for development of strategies of allocation of resources and establishment of priorities in health care.

The article considers legal and regulatory of the Russian Federation framework issues of first aid treatment in an emergency. The authors provide insight into the basic normative documents that determine the powers of personnel admitted to the emergency zone including military and State Fire-Fighting Service personnel, members of accident rescue units and services. As a result of the analysis of regulatory documents, the authors come to the conclusion that it is necessary to bring the existing regulatory framework in line with a single standard, legislatively expand the range of authority of the relevant personnel in providing emergency care, and to prepare training programs for personnel in emergency situations.