Relevance. Road traffic injuries, having the nature of a global epidemic, pose an urgent medical and social problem. Among victims of road traffic accidents, mortality is many times higher than that of victims who were injured under other circumstances. The survival of victims in road accidents depends on the timeliness, quality and capacity of emergency medical care, on the competence of care providers and on the effectiveness of the organization of this type of medical care at the prehospital stage.

Intention – to estimate the time of providing emergency medical care for victims on the federal highway M-8 “Kholmogory” on the territory of the Arkhangelsk region.

Methodology. The material of the study was a sample of 906 medical records (form 003/y) for victims of the road accidents, who were admitted to hospitals of Arkhangelsk region in the period from 01.01.2012 to 31.12.2018. Registered forms were selected according to the criteria of retrospective full-design documentary observation. Differences between the observation groups were considered statistically significant at level of p < 0.05 as adjusted for multiple comparisons (Bonferroni correction).

Results and Discussion. Time factor of emergency medical care on the federal highway M-8 “Kholmogory” in 3 medical districts of the Arkhangelsk region was characterized. The ambulance teams arrived at the place of accident within 20 minutes in 30 (3.3 %) cases, from 21 to 40 minutes – in 345 (38.1 %) cases, from 41 to 60 minutes – in 299 (33 %) cases and over a period of more than 1 hour – in 232 (25.6 %) cases. There was no statistically significant difference in time of providing emergency medical care for victims with isolated, multiple and concomitant traumas.

Conclusion. It was shown that in 74.4 % of cases (p < 0.001) ambulance arrived at the site of a road accident earlier than 60 minutes. The largest number of cases of providing emergency medical care exceeding 60 minutes was noted in the Arkhangelsk Medical District – 28.4 % (p < 0.013), and the lowest –in the Severodvinsk Medical District – 18.3 %. In more than a quarter (26 %) of cases the emergency medical care was provided for victims with polytrauma beyond the 60 minutes period, with most of them in the Arkhangelsk Medical District (p = 0.004).

Intention. To conduct a comparative analysis of the dynamics of the consolidation of intraarticular fractures of the posterolateral parts of the lateral tibial condyle, the anatomical and functional outcomes of surgical treatment of these patients after plate osteosynthesis with traditional anterolateral and posterolateral transfibular surgical approaches as well.

Methodology. A comparative prospective study of the effectiveness of osteosynthesis in patients with fractures of the posterolateral part of lateral tibial condyle in two compatible clinical groups was performed in dynamics for periods of 7–10 days, 1, 3, 6 and 9 months after surgery. In the first group (25 patients), bone osteosynthesis was performed from traditional anterolateral approach (TALA), and in the second group (20 patients), from the posterolateral transfibular approach (PLTFA). The average duration of osteosynthesis operations was compared. The displacements of fragments of the articular surface of the lateral tibial condyle, the indices of the KSS and Lysholm scales, the results of measurements of the angle of flexion and valgus stress test of the knee joint were evaluated. Data processing was performed using the Data Analysis and Chart Master modules (Excel), the Basic Statistics / Tables module (Statistic for Windows) as well.

Results and Discussion. In the PLTFA group, the average operation time was (81.0 ± 8.5) minutes (from 67 to 96 minutes), in the TALA group, the duration of operations was 35.8 % longer and averaged (110 ± 5.2) minutes (from 82 to 125 minutes) (p < 0.05). The values of the KSS and Lysholm scales in dynamics showed a steady and statistically significant (p < 0.01) increase with increasing time after surgery without significant differences between the groups. The angle of flexion of the knee joint increased more rapidly during the first three months, then the rate decreased from 6 to 9 months (p < 0.05) without significant differences between the groups. The frequency of displacements of fragments of the articular surface in the first group was statistically significantly (p < 0.05) higher than in the second group. Differences in the valgus-stress test indices in both groups reached a maximum after 9 months – 52 and 30 %, respectively.

Conclusion. With PLTFA, surgery duration decreases, articular surface fragments are better reduced, and their subsequent displacement at the stages of treatment is less likely; therefore, this approach is preferable for osteosynthesis of fractures of the posterolateral parts of the lateral tibial condyle.

Relevance. Diffuse-type tenosynovial giant cell tumor (D-TGCT) is a relatively rare tumor of tendon sheaths and synovial membranes, but its appearance significantly impairs organ function. Currently, the pathogenesis of this disease is associated with overexpression of colony stimulating factor-1.

Intention: To show the possibilities and advantages of radical resection of D-TGCT of the knee joint with arthroscopic access before traditional open surgery.

Methodology. In hospital # 2 of the All-Russian Center for Emergency and Radiation Medicine named after A.M. Nikiforov, EMERCOM of Russia (St. Petersburg), two female military personnel aged 31 and 38 years underwent arthroscopic surgeries on the knee joint for radical resection of D-TGCT in 2018. Dynamic magnetic resonance imaging (MRI) and histological examination of puncture biopsy specimens were conducted preoperatively. Functionality of the knee joints was assessed before surgery and in the long term using Knee injury and osteoarthritis outcome score (KOOS), Lysholm Knee Scoring Scale (Lysholm) and visual analogue scale (VAS) and MRI control.

Results and Discussion. D-TGCTs of the knee joints were removed simultaneously and radically using arthroscopic access. Histological examination of the obtained samples revealed the giant-cell diffuse-type tumors in both cases. A stable remission of the disease was obtained in the long-term period of postoperative observation. Good cosmetic surgery results have been achieved. The average KOOS, Lysholm, and VAS scores for knee function in patients were consistent with excellent and good results.

Conclusion. The long-term results of surgical treatment of D-TGCT of the knee via arthroscopic access showed that the procedure can be reliable, safe and beneficial for functionality.

Relevance. Patients with prolonged impaired consciousness due to traumatic brain injury are the most difficult category of patients in inpatient medical rehabilitation units. Despite the experience gained in managing this complex category of patients, the problem of nutrition status and trophological insufficiency, as well as practical issues regarding the organization of optimal nutrition at this stage of medical rehabilitation remain unresolved.

Intention. To study the role of nutritional support for patients with long-term impaired consciousness on the basis of a clinical and epidemiological analysis of severe traumatic brain injury.

Methodology. The data of an epidemiological analysis of traumatic brain injuries and features of ongoing nutritional support in patients with long-term impaired consciousness are presented, based on a study of domestic and foreign publications from 2005 to 2019.

Results and Discussion. Timely and adequate nutritional support optimizes the structural-functional and metabolic systems of the body, adaptive reserves interfere with rapidly progressive depletion and chronic catabolic processes, contribute to positive changes in the functional state of the brain, reduce infectious complications, and increase the effectiveness of rehabilitation measures and the rate of recovery of consciousness.

Conclusion. The analysis revealed the ambiguity of the interpreted data on clinical recommendations and approaches to the use of nutritional support in patients with long-term impaired consciousness due to traumatic brain injury. Considering the fact that in most cases such patients need continuous long-term comprehensive rehabilitation measures, accompanied by significant energy costs of the body, an essential component of the rehabilitation process, in our opinion, is the inclusion of adequate nutritional support that prevents fast-progressing exhaustion and chronic catabolic processes. In this regard, such an urgent task is to optimize the algorithms of nutritional support in patients with long-term impaired consciousness after a traumatic brain injury, the solution of which will improve the functional state of the brain and, therefore, the rehabilitation prognosis and quality of their life.

Relevance. The mental health status of military personnel is an important factor in the combat readiness and combativity of the armies of the countries of the world. Intention. Analysis of the mental disorders among army conscripts and 18–19 year old men in Republic of Belarus in 2003–2015.

Methodology. We studied the indicators of the general and primary morbidity of the personnel of the Armed Forces of the Republic of Belarus based on 3/MED reports from military units, where about 80% of the total number of conscripts served. The indicators of mental disorders in the population of Belarus are obtained from «1-psychiatry» and «1-narcology» state statistical forms (Ministry of Health). The incidence rate was determined per 1000 people.

The indicators of mental health disorders were classified according to the groups (blocks) of Class V «Mental and behavioral disorders» of the International Classification of Diseases and Behavioral Disorders, 10th revision (ICD-10).

Results and Discussion. The conducted medical and statistical studies showed that average annual levels of the general and primary morbidity among the conscripts with mental disorders in the Armed Forces in 2003–2015 were statistically significantly lower compared to 18–19 year old civilians in the Republic of Belarus. The overall incidence rates of mental disorders were (34.05 ± 1.05) and (111.98 ± 4.58)‰ (p < 0.001), the primary incidence rates were (17.26 ± 1.02) and (28.51 ± 1.26)‰, respectively (p < 0.001). Polynomial trends in the general and primary morbidity among military conscripts with mental disorders with different determination coefficients showed a decrease and among 18–19 year old men – an increase. In the structure of the studied medical and statistical types of mental morbidity among military conscripts from the Armed Forces of the Republic of Belarus, neurotic, stress-related, and somatoform disorders (group 5, F40–F48 according to ICD-10) and personality and behavior disorders in adulthood (7th group, F60–F69) were most common. Their total contributions were 85.4 and 78.5%, respectively, for the structure of the general incidence rate and the primary incidence rate. In military conscripts in 2003–2015, there was a decrease in the level and percentage of neurotic, associated with stress, and somatoform disorders in the overall structure of incidence of mental disorders. In the structure of the analyzed medical and statistical types of mental disorders among 18–19 year old men in the Republic of Belarus, mental and behavior disorders associated with the use of psychoactive substances (2nd group, F10–F19) and mental retardation (8th group, F70–F79) were most common. Their total contributions to the structure of the overall and primary incidence were 69.7 and 74.9%, respectively. Unfortunately, these mental disorders among 18–19 year old men in the Republic of Belarus in 2003–2015 tended to increase.

Conclusion. The existing system of military medical examination of draftees, professional selection, along with distribution of personnel according to military registration specialties based on personal characteristics, professional preparedness and functional reserves of the organism, as well as medical support in the Armed Forces of the Republic of Belarus help to optimize the military professional adaptation of military conscripts and psycho-prevention of mental disorders.

Relevance. Occupational activities of firefighters are considered extreme. Toxic combustion products are the most dangerous. Among these products, dioxins and dioxin-like compounds are particularly dangerous due to their ability to accumulate in the body.

Intention is to analyze the content of toxic combustion products in atmospheric air during and after fires of various locations, as well as to evaluate dioxin concentrations in the blood plasma of employees of the Federal Firefighting Service of the Emercom of Russia, depending on the polymorphic variants of xenobiotic detoxification genes and professional experience.

Methodology. To assess accumulation of dioxins in the body of firefighters with different polymorphic variants of xenobiotic detoxification genes, atmospheric air at different locations of fires was assessed for toxic combustion products. Accumulation of dioxins in the body of firefighters was analyzed depending on the polymorphisms of xenobiotic detoxification genes and work experience. 350 employees of the Federal Firefighting Service of the Emercom of Russia were examined, of them there were 234 firefighters and 116 supervisory staff involved in the investigations at the fire sites. The control group consisted of 82 rescue workers who were not directly involved in fire fighting. The examined individuals aged (32.2 ± 9.5) years.

Results and Discussion. The data obtained indicate that high concentrations of dioxins in surface air at the fire site persist for more than 2 weeks, while the maximum permissible concentration is increased 4.5-10-fold. The highest concentration of dioxins is observed during fires in industrial enterprises and in residential buildings. According to the analysis of the dioxins in the blood of the Federal Firefighting Service employees and the control group, concentrations of individual chemical compounds among the employees of the Federal Firefighting Service were 2–7 times higher and 15 times higher in terms of the dioxin equivalent compared to the control group (p <0.05). High concentrations of dioxins were also revealed in the blood of supervisory staff. Analysis of the dioxins in the blood of the staff of the Federal Firefighting Service, EMERCOM of Russia showed that increased length of service correlated with dioxin concentrations in the blood: variations in chemical compounds reached 2.3–6.8 times (p <0.05) between those with 0–1 year vs 6 years or more experience and 1.3–1.7 times (p <0.05) between those with 2–5 years vs 6 years and more experience. Concentrations of dioxins in the blood plasma of employees of the Federal Firefighting Service of the Emercom of Russia were assessed depending on the polymorphic variants of xenobiotic detoxification genes and professional experience. A group of individuals carrying the combination of the EPHX1 Tyr / Tyr, CYP1A1 A / A, GSTT1 I / I, GSTM1 I / I, GSTP1 A / A, GSTP1 C / C genotypes was revealed: their dioxin concentrations in the blood were as low as 25% of that among other groups despite length of service.

Conclusion Genotyping of firefighters will help arrange timely measures to detoxify dioxins, especially in carriers of minor alleles of xenobiotic biotransformation genes, in order to reduce morbidity and increase professional longevity.

Intention. To conduct an analysis of HIV infections spread among drug users and subsequently show how HIV spreads in the society under interaction of drug addicts with other people.

Methodology. An analysis of studies related to the area of research made by leading scientists in the field of epidemiology, infectology, narcology, psychiatry for a long-term period has been performed.

Results and Discussion. Long-term study and thorough analysis demonstrate a persisting role of drug use and drug users in the spread of HIV infection and viral hepatitis through sexual contact and injection equipment and show main mechanisms of involvement all social groups in infection process.

Conclusion. Injecting drug users represent a large number of people living with HIV, the least adherent to antiretroviral therapy and setting the stage for HIV transmitting in healthy population and maintaining the epidemic process at a high level.

Relevance. Anti-epidemic support of the rear in the wartime is an important component of the health of civilians and military personnel, as well as a guarantee of the implementation of defense measures, since the risk of emergence and rapid spread of infectious diseases in such circumstances increases.

Intention – to analyze the efforts of the authorities and medical community regarding the anti-epidemic prevention (based on a concrete example of the Arkhangelsk province during the First World War).

Methodology. The article is based on original archival sources kept in the State Archive of the Arkhangelsk region, in the funds of the medical department of the Arkhangelsk provincial board of the Arkhangelsk province and the health department of the Arkhangelsk town executive committee, which are correspondence on issues of sanitary and medical nature, reports of medical inspectors, reports on the epidemic situation in the province in 1914–1917.

Results and Discussion. A system of interaction between central and regional authorities is presented. Specific practical measures aimed at preventing the spread of epidemics are analyzed. This work was carried out in several directions. A strict sanitary and epidemiological control was carried out regarding vulnerable groups of the population (first of all, numerous workers engaged in construction of defense facilities). Outbreak response measures were developed. For the same purposes, preventive measures were taken in Arkhangelsk and in all counties of the province, preparatory work was carried out to deploy quarantine barracks, if necessary.

Conclusion. The material presented in the article shows that during the First World War the efforts of the state apparatus, local authorities, public and community initiative managed to keep under control the sanitary and medical situation and prevent its negative scenario. The epidemiological disadvantage of the following years is explained by the destruction of the state apparatus and aggravation of social problems due to the Revolution and the Civil War.

Relevance. The need to improve medical and psychological support for cadets of higher military educational institutions in order to reduce disease incidence and subsequent dismissal of military professionals for health reasons. Intention. To identify personality-associated predictors of stress-induced somatic diseases in cadets.

Methodology. 433 male cadets aged 21-24 years in their 5-6th year of training were examined. We used the D. Keirsey personality questionnaire and the Giessen personality inventory. Somatic morbidity was analyzed based on the results of annual medical examinations and correlated with the International classification of diseases, injuries and behavioral disorders, 10th revision (ICD-10).

Results and Discussion. The growth of somatic morbidity of cadets in the course of training was established. Diseases of the digestive system (K00–K93 according to ICD-10) were most common, their percentage increased from 0 % in the first year to 7.3 % in the 5-6th years of training. Diseases of the circulatory system (I00–I99) and diseases of the skin and subcutaneous tissue (L00–L99) increased up to 2.7 %. Personality characteristics of cadets have been studied. Typological and psychosocial personality characteristics associated with the risk of health disorders in the learning process were identified.

Conclusion. Typological and psychosocial personality traits can be predictors of stress-induced somatic diseases in cadets in the course of training. Vulnerability to cardiovascular diseases is closer associated with typological personality traits, to skin diseases – with psychosocial traits, and diseases of the digestive system correlated with both typological and psychosocial personality traits.

Relevance. There is no element that reflects the safety of environmental actors in modern concepts of environmental consciousness. This circumstance negatively affects the practice of environmental actions, for example, during cleaning household waste or taking part as volunteers in mitigating aftermath of natural emergencies.

Intention. To identify aspects of environmental actions that may pose a risk to the health of students due to lack of awareness.

Methodology. In 2019, 60 first-year students of Yelets State Ivan Bunin University aged 17–18 were surveyed. Their awareness of the safety of environmental activities at school age was revealed.

Results and Discussion. The survey showed that the problem of safety of environmental actors is especially relevant for schoolchildren. Due to insufficient knowledge in the field of hygiene or health effects of household waste and, in general, the danger of natural emergencies, they are unprotected both in environmental and legal aspects. At the same time, due to increased suggestibility, young people readily respond to environmental calls about protecting nature. Gaps in the environmental consciousness in terms of ensuring their own safety can lead to negative consequences for students in more complex environmental circumstances, for example, emergency situations requiring the involvement of population.

Conclusion. The necessity of developing regulatory documents on the safe behavior of the population involved in some environmental activities is substantiated.

Relevance. To improve the quality of publications while maintaining their growth rate, employees of the Ministry of Science and Higher Education of Russia have approved a methodology for assessing the integrated score of publication performance of organizations.

Intention. Analysis of the integrated score of publication performance of the leading educational and scientific organizations of the Russian Emergencies Ministry for 10 years (2010–2019).

Methodology. The object of the study was the annual indicators of the integrated score of publication performance of the Russian Emercom as calculated by the staff of the Scientific Electronic Library [https://www.elibrary.ru/].

Results and Discussion. A low average annual integrated score of publication performance was revealed in the Emercom of Russia. For an educational organization in the Russian Emercom, it amounted to (55.67 ±5.8) points, for a research organization – (29.0 ± 1.5) points (p < 0.01). The average annual integrated score of publication performance for the same period at Omsk State Technical University turned out to be 6 times higher (306.4 ± 19.0) than the average for educational institutions of the Russian EMERCOM (p < 0.001). It turned out that the EMERCOM of Russia had few highly rated publications on computer and information sciences, physical and chemical branches of knowledge, and quite a lot of publications on social sciences. Most likely, the latter are not a priority in the state assignment for research and development of the EMERCOM of Russia. Shown are the ways to increase the integrated score of publication performance of the EMERCOM of Russia organizations.

Conclusion. The slogan of researchers “print or die” in modern conditions is becoming less and less relevant. Russian and world science were flooded with insignificant and sometimes false publications. The fractional calculation of the integrated score of publication performance will make the authors think before including anyone in gift co-authorship or creating “fake” affiliations. This methodology will help improve the quality of domestic publications, and printing weak articles will become irrelevant.