Relevance. About 800 thousand citizens of the Russian Federation were affected as a result of the Chernobyl disaster, almost a quarter of them were liquidators of the consequences of the disaster at the Chernobyl nuclear power plant (LCDs). LCDs are among the most affected categories of Russian citizens. They usually have up to 12-15 somatic diseases and receive specialized inpatient treatment. Data on their morbidity structure and characteristics need to be generalized and are the basis for improving the organization of specialized medical care.

Intention. To identify the characteristics of morbidity and the main classes of diseases in those suffered from the Chernobyl disaster in the remote period when providing specialized medical care in a round-the-clock hospital, from 2016 to 2018.

 Methodology. There were analyzed 4195 medical records of the LCDs who underwent inpatient treatment in multidisciplinary clinics of the Nikiforov Russian Center of Emergency and Radiation Medicine, EMERCOM of Russia, in the framework of the activities of the Union State in 2016–2018.

Results and Discussion. The features of the morbidity of those affected by the Chernobyl disaster (LCDs and residents of radiation-contaminated territories) are shown. The main classes of diseases are presented in the distant period when providing specialized medical care in the round-the-clock hospital. The features of the organization of specialized medical care have been identified, in particular, the need has been substantiated for the provision of not only specialized therapeutic, but also specialized, including high-tech, surgical care, as well as medical rehabilitation in the preoperative and postoperative periods, after severe injuries and somatic diseases. The need for the creation and use of unified standards for the provision of special- ized therapeutic treatment to those affected by the Chernobyl disaster was confirmed. The necessity of providing specialized medical assistance to those affected by the Chernobyl disaster as part of the Union State target programs (Russia - Belarus) in addition to the State Guarantees Program for providing Russian citizens with free medical care using targeted methods of prevention, diagnosis, treatment and rehabilitation is substantiated. The implementation of the proposals presented in this article will undoubtedly improve the availability and quality of specialized medical care for this cohort.

Conclusion. The features of the morbidity rates and the main classes of diseases revealed and presented in the article for those affected by the Chernobyl disaster in the long-term period when providing specialized medical care in a round-the- clock hospital are the basis for planning the types of specialized medical care for this cohort within the framework of targeted programs and activities of the Union State.

Relevance. Currently, the solution to the problem of medical support for troops (forces) and the population during the liquidation of the health consequences of emergencies by forces and means of the medical service of the Armed Forces of the Russian Federation does not lose its relevance.

Intention. The system-morphological method to create a multidimensional morphological matrix with the corresponding morphological features and develop solutions to the problem of medical support in responding to the health consequences of emergencies.

Methodology. The methodology of system-morphological analysis is presented, which allows creating alternative solutions. Variants of medical support for troops (forces) and the population were developed during the liquidation of the health consequences of emergency situations of a natural, technogenic and social nature: “Departmental”, “Interdepartmental”, “International”. In relation to each option, 9 indicators (criteria) are proposed: normative legal regulation; system controllability; complexity of organizing the system; resource (material) cost; staffing; the adequacy of medical care; efficiency; experience and innovation; autonomy of action. To achieve the goal of the study, the original MPRIORITY 1.0 dialog system (MY PRIORITY) was used which implements a method for analyzing hierarchies through repetitions (iterations).

Results and Discussion. The results characterize each of the considered alternative options with an appropriate weight priority, and their preference is determined. During the first iteration, priorities were identified for a system of indicators and criteria that are characteristic for achieving a result with an emphasis on normative legal regulation of activities with its organizational structure and management system. In the second one, the priorities for the system of indicators and criteria were changed with a focus on the organization of medical care with the existing system of material and technical support, medical supply, as well as the proper level of training of medical personnel.

Conclusion Proposals have been developed for the medical service of the Armed Forces of the Russian Federation, in particular for the Service for Disaster Medicine of the Ministry of Defense of Russia, on the organization of a medical support system for troops (forces) and the population during mitigation of the health consequences of emergencies.

Relevance. Activities in extreme conditions likely involve stress on functional reserves and impaired health. Intention. Calculate the medical and statistical indicators of cases of morbidity with work days lost among employees of the EMERCOM of Russia and compare the above indicators with the working population in Russia in 2010–2015.

Methodology. We analyzed cases of morbidity with temporary disability in employees of the EMERCOM of Russia units according to the automated database of the All-Russian Order of the Badge of Honor Research Institute for Fire Protection, EMERCOM of Russia, over 2010–2015 in about 80% of all employees who had special military ranks: senior commanding officers (officers, warrant officers), junior commanding officers (sergeants) and rank and file. The indicators are calculated per 1000 employees or in ‰. Cases of morbidity correlated with the International Classification of Diseases and Behavioral Disorders of the 10th Revision (ICD-10). Cases of temporary disability of workers in Russia was obtained from the database of the Unified Interdepartmental Information and Statistical System of Russia.

Results and analysis.  The average annual level of morbidity cases with work days lost among the personnel of the EMERCOM of Russia was (374.2 ± 9.6) ‰, including (345.2 ± 9.1) among the employees of the Federal Fire Service, (361.4 ± 28.3) ‰ in the Main Inspectorate for Small Boats, (339.3 ± 20.5) ‰ in the Search and Rescue Units, and (867.6 ± 97.6) ‰ in the Rescue Military Units. In the structure of cases of work days lost in the EMERCOM of Russia, the shares of employees of the divisions were distributed as follows: 81.5, 2.8, 2.1 and 13.6 %, respectively. The leading classes of diseases among the personnel of the EMERCOM of Russia were: respiratory diseases (Chapter X) with morbidity rate (167.7 ± 8.2) ‰ and 44.7% in the structure; injuries, poisoning and some other consequences of external causes (Chapter XIX) (41.8 ± 1.4) ‰ and 11.2 %; diseases of the musculoskeletal system and connective tissue (Chapter XIII) – (34.7 ± 1.2) ‰ and 9.3%; circulatory system diseases (Chapter IX) – (25.2 ± 1.6) ‰ and 6.7%; and some infectious and parasitic diseases (Chapter I) – (21.9 ± 2.9) ‰ and 5.9 %. For workers in Russia, the average annual level of morbidity cases with work days lost 1.4 times as high: (522.5 ± 28.1) ‰ (p < 0.01). The consistency of the indicators is high, negative, and approaches statistical significance (r = –0.75; p < 0.1), which may indicate the influence of multidirectional factors in the formation of cases of work days lost among the EMERCOM of Russia employees and working population in Russia. Trends over time, structure and morbidity rates for cases with work days lost among employees of the EMERCOM of Russia divisions are presented.

Conclusion. Accounting for morbidity indicators with work days lost can contribute to a more rational allocation of resources during the operational activities of the EMERCOM of Russia.

Relevance. The realities of modern life demonstrate the likelihood of occurrence of man-made emergencies and terrorist acts. In 2000–2017 In Russia, 120 major terrorist acts and 118 emergency situations related to explosions in buildings, communications, and technological equipment of industrial and agricultural facilities were taken into account. In these terrorist acts, 1570 people were killed and 5118 people were injured; during explosions at industrial facilities 725 and 1919 people, respectively, were killed and injured.

Intention. The analysis of explosions in mines and explosive trauma during the terrorist act in the subway of St. Petersburg in 2017 was carried out. Common signs and problems of medical care to victims were determined.

Methodology. The general signs of explosive injury are identified, the nosological forms are compared in the victims. The volume of medical care at the prehospital stage and the nature of the treatment and diagnostic measures at hospital admission were assessed. The significance of first aid in the golden hour interval has been determined.

Results and discussion. According to the results of the study, the feasibility of treating victims of industrial accidents and terrorist acts in multidisciplinary medical institutions with the mandatory inclusion of rehabilitation measures in the treatment algorithm is substantiated. The analyzed data revealed a problem in determining the severity of the condition of patients with combined thermomechanical injury, the feasibility of further developing an integrated index for determining the severity of injury for victims of this category, the development of which is carried out at the I.I. Dzhanelidze Research Institute of Emergency Care.

Conclusion. It is shown that the planning and creation of reserves, their nomenclature and volumes should be coordinated with dedicated medical professionals and undergo regular adjustments.

Relevance. Humeral shaft fractures in middistal third are more common for young patients; they can be open and be included in polytrauma cases. Operative treatment is preferable via minimally invasive or conventional plate osteosynthesis.

Intention. To compare outcomes in two similar clinical groups of patients with fractures of the humeral diaphysis in its distal and middle thirds after using a minimally invasive plate osteosynthesis (MIPO) and open reduction internal fixation (ORIF), trough posterior approach.

Methodology. Two comparable groups of patients with the above fractures were studied (20 MIPO and 22 ORIF surgeries). Intervention time, restoration of humeral anatomy, functional results and complications were assessed 1, 6, 12, 18 and 24 weeks after surgery. Clinical, radiographic and statistical methods were used.

Results and discussion. Mean surgery duration was similar in the groups. Restoration of humeral anatomy in MIPO group was achieved by close reduction in all cases. The majority of MIPO patients showed good functional results by 12th week after surgery. In ORIF group restoration of function was insignificantly delayed (p > 0.05). Complications were observed in 2 (10 %) MIPO patients and 6 (27 %) ORIF patients; in the latter group, postoperative radial nerve palsy predominated.

Relevance. The level of suicides, according to several authors, is one of the most significant indicators of mental health in society, including in the armies of the world.

Intention. To analyze suicides and their existing prevention system in the Russian Federation population and Armed Forces in 2007–2018.

Methodology. Mental disorders and behavioral disorders (F00–F99 by Chapter V, the International Classification of Diseases of the 10th revision) were analyzed according to 3/MED Form in the military units, where ≥ 80 % of the military personnel served. The longterm trends of the main statistical indicators of suicides and mental disorders among military personnel compared to the Russian population have been established.

Results and Discussion. In 2007–2018, the level of suicides in the Russian Armed Forces was (12.00 ± 1.35) per 100 thousand military personnel and was 1.7 times lower than in the population of Russia (20.12 ± 1.56) per 100 thousand (p < 0.001). The level of suicides seems to decrease among the military personnel of the Russian Armed Forces. When analyzing the longterm incidence of mental disorders and the level of suicides in the personnel of the Armed Forces of Russia, no significant correlation was found. At the same time, in a cohort of officers and ensigns, a statistically significant correlation was established between the level of suicides and the general incidence of the Chapter V diseases (r = 0.87; p < 0.01), including stressrelated neurotic and somatoform disorders (F40–F48; r = 0.72; p < 0.01), mental and behavioral disorders associated with the use of psychoactive substances (F10–F19; r = 0.89; p < 0.001). In the military conscripts, there was a correlation between the level of suicides and general morbidity related to Chapter V diseases (r = 0.72; p < 0.05), including personality and behavior disorders in adulthood (F60–F69; r = 0.81; p < 0.01) and organic, including symptomatic, mental disorders (F00– F09; r = 0.76; p < 0.05). It was revealed that among the officers and military personnel under the contract, family and domestic causes of suicide prevailed in contrast to the draft servicemen. Meanwhile somatic and mental diseases as a predominant cause of suicide accounted for a relatively small proportion.

Conclusion. Psychoprophylactic measures should be aimed at early detection of servicemen prone to suicidal behavior, effective assistance in resolving militaryprofessional difficulties and domestic problems, as well as at improving their adaptation to military service. Special attention should be paid to the early detection of people with addictive disorders, especially alcohol abusers.

Relevance. Liquidators of consequences of the radiation accidents demonstrate increased rates of psychoneurological diseases after radiation exposure. However, the functional reorganization of brain neurons versus radiation exposure is insufficiently studied, thus precluding assessment of the pathogenesis of these diseases.

Intention. To study neuromorphological correlates of low-dose radiation effects on brain neurons in radiobiological experiments.

Methodology. In this GLP study, white outbred male rats (150 animals) at the age of 4 months were exposed to 0,5 Gy 60Co γ-rays at 0.5, 1.0, 2.5, 6.6 Gy/h. Age control group included animals with false exposure. Brain samples were taken 1 day, 6, 12, 18, 24 months after exposure. After conventional histologic processing, tinctorial properties, morphometric parameters, total protein and nucleic acids were assessed in neurons with subsequent mathematical modeling.

Results and analysis. Normochromic neurons decreased linearly and their destructive forms increased over the observation period with increase in the irradiation dose. Among reversible changes, neurons in a state of inhibition and decreased functional activity predominated. The nerve cell index decreased over time, therefore some neurons died. Neuronal morphometry fluctuated, as well as their main structures, protein, cytoplasm and nucleolus RNA, nucleus DNA. With increasing dose rate, the changes became more expressed, and differed from the control group. These changes could be a basis for pathological processes in the brain.

Conclusion. The ionizing radiation of studied range doesn’t cause significant organic changes of the brain neurons. However, under increasing radiation exposure the number of dysfunctional neurons linearly increases, as well as altered neurons. Almost all the neuromorphological parameters change, thus resulting in instability of structural – functional organization of neurons, with potential CNS disorders.

Relevance. There is a need to evaluate doses retrospectively in Chernobyl nuclear power plant accident recovery workers without established external doses.

Intention: To assess the ability of cytogenetic analysis to estimate external radiation doses retrospectively in Chernobyl nuclear power plant accident recovery workers exposed to low-dose radiation in the remote period.

Methodology. Cytogenetic biological indication and biological dosimetry were performed in Chernobyl nuclear power plant accident recovery workers 27–30 years after their participation in recovery works. Stable and unstable chromosome aberrations were assessed in peripheral blood lymphocytes.

Results and Discussion. The analysis of unstable chromosome aberrations showed that 45.1 % of Chernobyl nuclear power plant accident recovery workers had radiation markers more frequently than in the comparison group. Biological doses were retrospectively evaluated in 18 % of Chernobyl nuclear power plant accident recovery workers and ranged within 14–48 cGy. Specific anamnestic factors should be assessed while evaluating doses retrospectively.

Conclusion. Analysis of stable chromosome aberrations allows retrospective dosimetry after low-dose exp sure if external dose is unavailable. Based on this, adverse health effects of low-dose exposure can be assessed and reimbursed in Chernobyl nuclear power plant accident recovery workers.

Relevance. There is a continuing growth of infection with the human immunodeficiency virus (HIV) and the need for effective design of preventive measures.

Intention. To explore features of risky sexual behavior in people living with HIV with and without substance abuse and in healthy respondents.

Methodology. The study involved 136 individuals in the groups as follows: 1st (n = 50) – drug users with blood-borne HIV infection, 2nd (n = 50) – heterosexual HIV infection, 3rd (n = 36) – without HIV infection. A specially developed clinical map was used, as well as an original questionnaire recording the characteristics of risky behavior and the main characteristics of the life situation of the disease (“Infection risk and the disease situation”). Statistical data processing included the Fisher criterion (ϕ-criterion).

Results and Discussion. The characteristics of respondents’ sexual behavior related to gender, the presence/absence of HIV and the transmission route were revealed in the study. It has been established that HIV-infected and healthy respondents do not differ in the frequency of barrier protection methods (condoms) use. Various variants of risky sexual behavior were noted in all groups, in particular, unjustified rejection of condoms. The results are partially confirmed in the published data. In the Russian sample, non-use of condoms and the prevalence of “trust in a partner” were studied for the first time.

Conclusion. Important components of prevention programs include increasing sexual literacy and working with people who use psychostimulants and other drugs.

Relevance. Necessity for enhancement of therapeutic approaches to post-traumatic stress disorder (PTSD) using a modern high-tech biofeedback.

Intention. Scientific foundation for using biofeedback training in complex therapy of PTSD in combatants.

Methodology. Military men, 40 healthy and 36 PTSD, aged 33.2 and 34.8 years, respectively (p > 0.05) were examined. Neurology signs were estimated with “Neurotic disorders-questionnaire-symptomatic”, quality of life – with “Quality of life questionnaire-12”, PTSD signs – with “Mississippi scale”. Stress-testing and biofeedback training were carried out using “Reacor” biofeedback psychophysiological hardware.

Results and Discussion. Inverse correlations were revealed between PTSD signs and systolic wave amplitudes (SWA) from digital photoplethysmogram during stress-testing with biofeedback psychophysiological hardware. Heart rate variability and breathing recursion used in foreign studies as biofeedback training parameters for this disorder treatment didn’t correlate with signs of post-traumatic stress disorder. The effectiveness of SWA biofeedback training for PTSD complex treatment in combatants was proved. Everyday trainings during 8–10 days statistically significantly reduced neurotic manifestations and improved self-rating of life quality regarding “mental health”.

Conclusion. SWA is a prognostic marker within health – illness continuum and can be used as a sensitive physiological parameter in the biofeedback trainings for overcoming PTSD. Conscious involvement of combatants into a treatment process via inclusion of SWA biofeedback trainings in PTSD complex treatment improves the results and self-ratings of life quality.

Relevance. Physical and psychological stressors of professional activity of military doctors can negatively affect both their personal well-being and professional reliability.

Intention. To analyze the frequency of psychological signs of professional burnout and related deformations of professionally important personality traits in medical officers engaged in clinical and managerial activities.

Methodology. The study was conducted in 2018-2019 at the research center of the Kirov Military Medical Academy (St. Petersburg). The object were the medical service officers (n = 203) engaged in clinical and managerial activitiesy, who arrived from the troops to apply for residency. The complex of psychodiagnostic methods included 50-point IPIP-version of “Markers of the big five” questionnaire by L. Goldberg; psychodiagnostic questionnaire “Deviance”, developed by the staff of the S. M. Kirov Military Medical Academy; “Professional burnout” questionnaire by M.A. Dmitrieva and V.M. Snetkov; “Individual typological questionnaire” by L.N. Sobchik. To identify professionally important person qualities and their subsequent assessment, the officers underwent a survey. It was found out what personal qualities of managers, subordinates and colleagues are valuable (important), or, conversely, interfere with the professional activity. The results were systematized using content analysis.

Results and Discussion. The conducted psychodiagnostic examination of medical officers showed that both managerial and clinical activities in the troops can contribute to emotional fatigue, increasing indifference, deformation of contacts with the military, a negative assessment of oneself and one’s professional capabilities. Professional burnout signs were found in 9.4 and 9.3 % of clinical specialists and medical platoon commanders (chiefs of unit medical service), respectively. Statistically significant interrelations are established between professional burnout indicators and such relatively steady traits as excessive propensity to risk, search of thrills, autoand hetero-aggression, inadequate self-assessment, isolation, internal conflicts. The higher need for external control and motivation in officers with more pronounced signs of professional burnout were established.

Conclusion. The relevance of professional burnout screening of military doctors and medical units commanders is substantiated. Timely detection of adverse personality deformities caused by professional burnout and the development of measures to eliminate the negative states can play a positive role in maintaining the health and professional longevity of medical professionals.