(HERALD
OF THE MECHNIKOV
SAINT-PETERSBURGSTATEMEDICALACADEMY)
№ 1(34) 2010
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SCIENTIFICJOURNAL
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ISSN 2074-9120
Preventive and clinical medicine (Herald of the Mechnikov Saint-Petersburg state medical academy).
2010 № 1 (34), 241 pp.
Subscription index: 42363-полугод, 42364-год / Editor-in-chief
Academician of RAMS, Honoured scientist of RF, M.D., Professor A.V.Shabrov
EDITORIAL BOARD
Academician of RAMS, Honoured Scientist of RF, M.D., Professor V.G.ARTAMONOVA (Saint-Petersburg), M.D., Professor A.M.BOLSHAKOV (Moscow), A.A.BORISOV (Saint-Petersburg), Honoured Scientist of RF, M.D., Professor V.A.DOTSENKO (Saint-Petersburg), M.D., Professor L.P.ZUEVA (Saint-Petersburg), M.D., Professor S.I.IVANOV (Moscow), M.D., Professor A.V.ISTOMIN (Moscow), M.D., Professor V.R.KUCHMA (Moscow), M.D., Professor B.V.LIMIN (Vologda), Honoured Scientist of RF, M.D., Professor V.S.LUCHKEVICH (Saint-Petersburg), Honoured Scientist of RF, M.D., Professor V.G.MAIMULOV (vice-editor-in-chief, Saint-Petersburg), Academician of RAMS, Honoured Scientist of RF, M.D., Professor G.G.ONISCHENKO (Moscow), Academician of RAMS, Honoured Scientist of RF, M.D., Professor Yu.Р.PIVOVAROV (Moscow), Academician of RAMS, Honoured Scientist of RF, M.D., Professor S.N.PUZIN (Moscow), Academician of RAMS, Honoured Scientist of RF, M.D., Professor, Yu.A.RAKHMANIN (Moscow), M.D., Professor P.G.ROMASHOV (Saint-Petersburg), Academician of RAMS, Honoured Scientist of RF, M.D., Professor P.I.SIDOROV (Arkhangelsk), Academician of RAMS, Honoured Scientist of RF, M.D., Professor G.A.SOFRONOV (Saint-Petersburg), Academician of RAMS, Honoured Scientist of RF, M.D., Professor V.I.STARODUBOV (Moscow), M.D., Professor E.I.TKACHENKO (Saint-Petersburg), Academician of RAMS, Honoured Scientist of RF, Professor V.A.TUTELIYAN (Moscow), Honoured Scientist of RF, M.D., Professor V.P.CHASCHIN (Saint-Petersburg), M.D., Professor T.S.CHERNYAKINA (executive secretary, Saint-Petersburg)
EDITORIAL COUNCIL
Corresponding member of RAMS, M.D., Professor N.M.ANICHKOV (Saint-Petersburg), Candidate of Medicine A.I.VERESCHAGIN (Moscow), M.D., Professor L.I.GLUSHKOVA (Syktyvkar), M.D., Professor S.A.GORBANEV (Saint-Petersburg), M.D., Professor V.A.DADALI (Saint-Petersburg), M.D., Professor G.I.DIYACHUK (Saint-Petersburg), Corresponding member of RAMS, M.D., Professor N.V.Zaitseva (Perm), M.D., Professor A.L.ZELDIN (Saint-Petersburg), Doctor of Biology, Professor A.L.KOVALENKO (Saint-Petersburg), Corresponding member of RAMS, Professor B.A.KURLYANDSKY (Moscow), M.D., Professor S.A.LINNIK (Saint-Petersburg), M.D., Professor A.V.MELTSER (Saint-Petersburg), M.D., Professor S.V.NAGORNY (Saint-Petersburg), M.D., Professor V.I.NIKOLAEV (Saint-Petersburg), M.D., Professor V.M.PETRENKO (Saint-Petersburg), M.D., Professor L.G.PODUNOVA (Moscow), Honoured Scientist of RF, M.D., Professor I.V.POLYAKOV (Saint-Petersburg), Candidate of Medicine I.A.RAKITIN (Saint-Petersburg), M.D., Professor V.G.RADCHENKO (Saint-Petersburg), M.D., Professor A.V.Skalny (Moskow), M.D., Professor E.G.TOPUZOV (Saint-Petersburg), M.D., Professor S.A.KHOTIMCHENKO (Moscow), M.D., Professor A.G. SHIMAN (Saint-Petersburg), Corresponding Member of RAMS, M.D., Professor A.P.SCHERBO (Saint-Petersburg), M.D., Professor I.Sh.YAKUBOVA (Saint-Petersburg)
SAINT-PETERSBURG – 2010
CONTENTS
PUBLIC HEALTH AND PUBLIC HEALTH SERVICES
Orel V.I., Tsiteladze A.A.Problemsof physical examination of teenagers entering military educational institutions of the general secondary education
Sayed Kamruzzaman, Krasnenkov V. L., Vinogradov A.F.Analysis of infantile death rate and factors influencing its decrease at realization of target programs in the Tver region
Petrova N.N.Characteristicsof pathological ear, nose and throat diseases of the Saint-Petersburg industrial enterprise workers
Eliovich I.G., Gorbanev S.A., Nekhoroshev А.С. On regional information databases of social-hygienic monitoring improvement
Scherbuk A.Yu., Bashkov L.L., Donskov V.V. Experience of regenerative treatment organization in a megacity in patients surviving hi-tech operations (St.-Petersburg as an example)
Morozko P. N. Assessment of health and the academic progress of sports high school students
SURROUNDING AND WORKING ENVIRONMENT
Israilova G.M, Eshmuradova S.T., Turaev I.E.Hygienic evaluationof risk factors of contamination of dairy and meat products manufactured under watershortage conditions
Khamrakulova M.A. Carbohydrate-energy metabolism disorders in the liver under the influence of decys pesticide and their correction by introduction of biologically active substances
Chernushevich N.I.Upper extremities functionalstate inpersons working in trades with various kinds of physical activity
Figurovsky A.P., Mozzhukhina N.N., Alikbaeva L.A., Khomulo D.P., Yermolaev-Makovsky M. A. Hygienic characteristic of working conditions at manufacturing chipboard
NEW TECHNOLOGIES, METHODS OF DIAGNOSTICS, TREATMENT, PREVENTION
Nikolaev V.I., Denisenko M.D. Special characteristics of emotional tension and hemodynamic change inman during psychoemotional stress
Minko B.A., Prokhorov D.G., Semeonova A.A., Shevtsov I.V.Ultrasonic examination of patients with renal cancer at small-invasive surgical interventions
Kasumov V.R.Method of subpial transectionsin a system of surgical treatment of multifocal epilepsy
CLINICAL AND EXPERIMENTAL STUDIES
ReznikovaT.N.,Semivolos V.I., Ilves A.G., Seliverstova N.A.Characteristicsof intrinsic pattern of illness atdemyelination foci localization in the brain of patients with multiple sclerosis
ZborovskyA.B., ZavodovskyB.V., NikitinaN.V., YashinaYu.V., BudkovaE.V.,Doronina I.V., Pavlova A.B., Zborovskaya I.A. Clinical-pathogeneticvalue of metabolic syndrome markers determination in patients with osteoarthritis
Komyakov B. K., Akimov A.N., Tagirov N.S., Lazarenko I.B., Gadzhiev N.K.Combined coral calculi treatment
Kosinets V.A.Efficacy of metabolic drug "Cytoflavin" use in experimental widespread purulent peritonitis
Sayganov S.A., Khurtsilava O.G.Acute cardiac insufficiency treatment in myocardium infarction of the right ventricle
Shuster P.I., Tselebrovskaya O.N., Sagidullin F.A. Hypogonadism androgen therapy efficacy and safety in patients with hyperuricemy and radically eliminated urolithiasis
Ishinova V.A. Dynamics of tactile sensitivity in patients with psychogenic pain in the course of mental relaxation
Galeev Sh.I., Topuzov M. E., Rubtsov M.A.Prognosis of severe acute pancreatitis: whether consensus “Atlanta1992” criteria enough?
Teplov A.Yu., Grishin S.N., Farkhutdinov A.M.Possible mechanisms of contractile function changein isolated murine striated muscles at allergic body change
Ermolov S.Yu., Ermolova T.V., Dobkes A.L. Role of hemodynamic factorsin evaluation of plasmaphoresis efficacy in patients with chronic liver diseases
Grinevich V.B., Lapteva E.N., Egorov D.V., Kravchuk Y.A.Estimation of the index of body´s mass by the method of two-frequency bioelectrical impedance analisis at the patients with discompensative cirrhosis of the liver
Chuprov I.N. The updatedcomplex descriptionof the skin basal cell carcinoma
EPIDEMIOLOGY, MICROBIOLOGY, INFECTIOUS AND PARASITIC DISEASES
Akhmedova M.D., Imamova I.A.Earlyrisk prognosis of acute renal insufficiency development in acute enteric infections in children
Gulyamov N.G., Dalimov T.K.,Mirzajanova D.B.Adrenal gland cortex functional insufficiency intyphoid fever infection: hormonal and immunological aspects of pathogenicity
Shoumarov S.B., Gulyamov N.G., Smagin A.A. Causes and ways of seronegativity formation overcoming in vaccinal prevention of typhoid fever
Shvedova N.M., Mikhailova E.V., Khmilevskaya S.A.Epstein-Barr virus mononucleosis in children. Pharmacoeconomical substantiation of immunotropic therapy
Khalikova S.A., Daminova M.N. Amino acid spectrum and nitrogen oxide state in blood serumof children with chronic virus hepatitis C
Khayitov R.Kh., Akhmedova H.Yu. On causes and possibility of frequency rate decrease ofhuman HBV, HCV and HIV infection through donor blood
Aleksandrova E.A., Kazimirova N.E., Lepilin A.V., Shuldyakov A.A. Clinical-pathogenetic aspects of periodontitis development in patients with pulmonary tuberculosis
Zarubaev V.V., Kovalenko A.L., Sologub T.V., Romantsov M. G, Petrov A.Yu. Comparative efficacy of antiviral drugs in experimental influenza infection caused by viruses А/Swine (Н1N1), Puerto (Н1N1), Мallard|PennsyLvania (H5 N2)
SCIENTIFIC REVIEWS
Romantsov M.G, Isakov V.A., Rybalkin S.B., Krasnov V.V., Kovalenko A.L.Modern approaches to the treatment of herpetic infection (clinical review)
Romantsov M.G., Goryacheva L.G., Kovalenko A.L. Cycloferon for treatment and prevention of children diseases (clinical review)
PERSONNEL TRAINING
Gaykovaya L.B., Kukharchik G.A., Burbello A.T., Vavilova T.V.Laboratory studies in efficacy and safety evaluation of medicinal therapy of ischemic heart disease
Romantsov M.G., Grebenyuk T.B., Sologub T.V., Danilenkova G.G. Principles of constructive pedagogics in educational process of higher medical schools
PUBLICHEALTHANDPUBLICHEALTHSERVICES
1320 Орел
©V.I.Oryol, A.A.Tsiteladze, 2010
UDC 613.956:616-071.2:378
Orel V.I., Tsiteladze A.A. Problemsof physical examination of teenagers entering military educational institutions of the general secondary education // Preventive and clinical medicine. – 2010. - №1 (34). – Р.7-11.
¹State educational institution for high professional education «Saint-Petersburg State Pediatric Medical Academy by Federal agency for health services and social development»; 194100, Saint-Petersburg, Litovskaya str., 2; tel./fax: (8-812) 554-05-83; e-mail: .
²Stategeneral secondary educationschool «Saint-PetersburgMilitarySuvorovSchool»;194011, Saint-Petersburg, Sadovaya str., 26;tel./fax: 310-18-00,e-mail: spb-svu.nm.ru.
Summary:The study conducted the analysis of the medical examination of adolescents to enroll in military schools, a comprehensive assessment of their health status. In reforming the military education system interagency integration is necessary in carrying out the basic stages of a medical examination of young people entering the military school in child health clinics of the Ministry of Health.
Key words:military school of general secondary education (college); assessmentof adolescent health status;medical examination;interdepartmental integration.
References
1. Баранов А.А.Профилактические основы развития приоритетного национального проекта в сфере здравоохранения в интересах детей. / Баранов А.А., Кучма В.Р. // Здравоохранение Российской Федерации.– 2008. – №1. – С. 10-11.
2. Рапопорт И.К. Состояние здоровья школьников и проблемы выбора профессии. /Рапопорт И.К. // Гигиена и санитария. – 2009. – №2. – С. 36-38
3. Varni JW, et al. The Peds QL: Measurement Model for the Pediatric Quality of Life Inventory. MedicalCare, 1999; 37(2):126-139
4. Куликов А.А.Оптимизация учебно-воспитательного процесса на основе мониторинга здоровья школьников. /Куликов А.А., Лебедев СБ., Шевченко В.Н. // Регион: Политика. Экономика. Социология. – 2000. – №4. С. 132-135.
5. Пажеский Его Императорского Величества корпус за сто лет: в 2 т. /авт.-сост. Д.М. Левшин. – СПб.; «Т-во Художественной печати», 1902. – с Т.1 – С. 204-216.
6. Постановление Правительства РФ от 25 февраля 2003 г. № 123 «Об утверждении Положения о военно-врачебной экспертизе». / Собрание законодательства РФ. – 2003. – №10. ст. 902.
Information about the authors:
Oryol V.I. Doctor of Medicine, Professor, Honoured Scientist of FR, head of State educational institution for high professional education «Saint-Petersburg State Pediatric Medical Academy by Federal agency for health services and social development»; 194100, Saint-Petersburg, Litovskaya str. 2; work tel. (812) 554-05-83, mobile phone 8-921-949-41-47; e-mail: .
Tsiteladze A.A. Chief Physician of Saint-PetersburgMilitarySuvorovSchool; work tel. (812) 310-18-00, mobile phone 8-921-791-20-66; e-mail: .
Accepted 14.10.2009 г.
1242 Сайед
UDC 614.1: 312.2: 616-053.3 (471.331)
© К. Sayed, A.G. Ivanov, 2010
The Analysis of Infant Mortality and Factors Lowering its Rate
while Implementing Strategic Programs in Tver Region
K. Sayed, A.G. Ivanov
State Educational Institution of the Higher Professional Education
“TverStateMedicalAcademy of the Federal Agency for Public Health and
Social Development” Tver, Russia
Sayed K., Ivanov A.G.Analysis of infantile death rate and factors influencing // Preventive and clinical medicine. – 2010. - №1 (34). – Р.11-14.
State Educational Institution of the Higher Professional Education «TverStateMedicalAcademy of the Federal Agency for Public Health and Social Development». Russia, 170100, Tver, Sovetskay str., 4. Tel. 8 (4822) 32-17-79, fax: 8 (4822) 34-43-09. E-mail:
Summary:The research represents the analysis of infant mortality and factors determining its rate in Tver Region for the period of 1996-2007. It reveals a positive dynamics in the indexes of infant mortality for the last 11 years which is to large extent can be attributed to the implementation of the «Complex Program on Women and Child Care and Child Mortality Reduction» in Tver Region, carried out in 1989-2010. It also proves the effectiveness of developing and launching strategic programs on fighting both the rate and the definite causes of death among the population.
Kеywords:infant mortality; manageable, partially manageable and unmanageable factors; strategic regional programs.
Infant mortality belongs to the leading index of not only the effectiveness of the StateHealth Service but the national well-being on the whole. For several decades Tver Region has been among the regions with the highest infant mortality rates both in The Central Federal District and in Russian Federation on the whole.
The aim of research was to substantiate the necessity of developing and implementing strategic programs to lower the rate of mortality among the population especially occurring due to definite causes.
Material and Methods of Research:The research represents the analysis of statistic data provided by the Local Committee of Federal Statistic Data Service of Tver Region on infant mortality, perinatal mortality including early neonatal one and mortinatality.
Multi-factor analysis applied determined quantitatively the importance and share of different factors influencing the rate of infant mortality.
Results of the research and their discussion. The rates of infant mortality in Tver Region in 1997-2007 fluctuated between 19.3‰in 1998 and 9.8‰in 2007. Since 1999 the positive dynamics of this index might be observed – there has been a gradual decrease in infant mortality. On the whole the index fell down by 46.2% (from 18.2‰ in 1996 to 9.8‰ in 2007). But at the same time it continued exceeding the average rates of child mortality in Russia. By 2007 this difference has amounted 4.3% (9.4‰ throughout Russia and 25.6% throughout the Central Federal District (7.8‰).
Similar trend could be observed in urban areas of the Region since 1999 but in the rural area this process started a bit later – in 2002. The comparison of mortality rates among urban and rural infants aged less than 1 year old displayed the exceeding of deaths the latter above the former (except in the years of 1998, 2000 and 2006 when the mortality among rural children was lower than among the urban ones.) At the same time infant mortality in urban settlements fluctuated between 8.3‰ in 2007 and 19.9‰ in 1998, as for the rural ones the figures were 10.2‰ in 2006 and 24.1‰ in 1996. Thus positive dynamics in the rates of infant mortality could be equally observed both in urban and in rural areas. The indexes of 1996 dropped (by 47.8% and 42.7% correspondingly) and the most rapid changes could be observed in rural settlements since 1996 to 2006.
In the urban districts of Tver Region the rates of infant mortality in 2007 remained within the boundaries of 5.0‰ and 16.2‰. In comparison to 1996 the indexes decreased by 8.5% that is they became 3.6 times lower. Among the municipal districts the range of infant mortality indexes varied considerably between 2.8‰ and 43‰. At the same time the changes in indexes for the studied period proved diverse in different districts of the region: the increase in infant mortality was reported in 12 districts with the decrease in 14 ones; it remained practically the same in 4 districts and in 6 ones the cases of infant mortality were not registered at all.
The biggest drop in the mortality rate of infants aged less than 1 year old was registered among girls (for them it became 2.1 times lower (1.5 lower for the boys)) in comparison to 1996. Thus the share of male infants in the structure of those who died in early child age has increased. So if in 1996 this share slightly exceeded the half of the total number of children who died under 1 year old (54.6%) in 2007 it amounted 62.1%.
For the studied period the index of perinatal mortality in Tver Region exceeded the average rates throughout the country (with the exception of 2000) and in 2007 the difference made up 15.4% (10.4‰ against 8.8‰). In 2007 Tver Regin was placed the forth among the regions of the Central Federal District in perinatal mortality following Ryazanskaya (12.8‰), Kostromskaya (11.2‰) and Kaluzskaya (10.6‰) Region, exceeding by 1.3‰ the average rate of the Central Federal District.
The coefficient of perinatal mortality in Tver Region was within the limits of 10.4‰ and 19.3‰ (in 2007 and 1998 correspondingly). For 11 years it has fallen by 42.8%. The dynamics of early neonatal mortality and mortinatality, determining the rate of perinatal mortality has remained unstable for the studied period but there has been some progress in it. By 2007 the rate of mortinatality became 3 times smaller and the index of early neonatal mortality dropped by 15.3%.
The causes of death among children under 1 year old proved to be different in urban and rural areas. In the former ones perinatal death has been found out to be responsible for 53% of deaths among newborns, in the latter ones this is the cause of 33% of deaths. The second major cause of urban newborn deaths (24% of deaths) is congenital anomalies (22% for the rural newborns). At present the diseases of respiratory system are considered to be a leading cause of newborn deaths in the rural area (25%, while for the urban area it is 13%).
For the last 11 years the coefficient of infant mortality that could happen due to definite causes has decreased; namely, the number of deaths due to the congenital anomalies became 2.4 times smaller, mortality due to some causes of perinatal death decreased by 31%, due to accidents, poisoning and traumas – by 40%, due to the diseases of respiratory tract – by 38%.
The research has revealed the social character of factors contributing to the presence of a considerable level of infant mortality in cities as well as in the rural area. It was found out that these factors are eliminable and can be eliminated by the collaboration of medical workers and social organizations involved. It is known that a number of these factors fully depends on the level of health service provided for children aged less than 1 year old, pregnant women and women in labour. The problem of medical services available for women in labour is especially critical for the rural settlements of the region.
The integrated evaluation of medical and social factors determining the frequency of deaths among infants under 1 year old has revealed the following factors being the most considerable: bad habits of a father, financial well-being of a family, mother’s social status, mother’s marital status, parents’ heredity, living conditions, mother’s bad habits and frequency of prenatal nursing.
In the rural areas 8 leading factors of medico-social character determining the rate of infant mortality are as follows: father’s bad habits, mother’s social status, full-term of a newborn by the time of labour, financial well-being of a family, father’s educational background, complications in labor, frequency of prenatal nursing and mother’s marital status.
Most of these factors are of social character and refer to the category of eliminable ones.
There has also been studied the degree of influence of social, biological and medical factors on the infant mortality rate in the region on the whole, in the district centers and in the rural settlements of the region.
As an instrument for measuring the influence of factors on the result a multy-factor analysis has been applied. It provided quantitative estimates of the influence of different factors on the result that is on the rate of infant mortality.
On the whole 27 of the manageable factors determining the mortality rate of infants under 1 year old have been studied. They have been grouped into 3 main types: manageable, partially manageable and unmanageable ones. Moreover within each group factors of medical and not medical character have been distinguished. These groups of factors are rather conventional and still they help to determine those ones which are possible to manage in order to bring down the rate of infant mortality and those of them which depend mostly on the quality of medical service. Obviously, manageable factors determined are much of a practical value.
The estimates have revealed that irrespective of the type of settlement these are manageable factors that play the major role in building the rate of infant mortality, with factors of medical character (that is depending on the level of health service) predominating. Among manageable factors of medical character the biggest ratio belongs to the complications in labour (7.1% in the rural area and 12.4% in the regional centre) as well as full-term of a newborn at birth (more than 5%).