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The mortality is a major component of damage caused by COVID-19. The comparative analysis of changes in mortality was carried out on the basis of the ROSSTAT data over 2012-2020 to determine differences in losses of male and female population caused by pandemic in Moscow. It is demonstrated that at close trends in mortality of males and females before pandemic, in 2020 their mortality changed differently. At equal increase of male and female mortality, main contribution into excess mortality (excluding contribution of COVID-19) was made approximately equally by diseases of nervous system and circulatory system in males and diseases of nervous system in females. The male mortality from COVID-19 is 1.9 times higher than female mortality. As a result of younger average age of death the amount of economic losses in terms of years of potential life lost (PYLL) due to premature death of males because of COVID-19 exceeds economic losses due to premature death of females up to 2 times. Although the average age of death of females from all causes decreased by smaller amount, their values of PYLL increased more, mainly due to higher rate of female mortality from disease of nervous system and from mortality related to drug addiction. In Moscow, the highest increase of PYLL is conditioned by dearth related to drug addiction and alcohol consumption. In the structure of this indicator in males they are ranked fourth and fifth. In females, alcohol-related deaths are ranked as sixth and drug-related deaths as eighth. The pandemic, contributing into increase in economic losses, didn't change their leading causes: diseases of circulatory system, external causes and neoplasms in males; neoplasms, diseases of circulatory system and external causes in females. The value of PYLL due to death from COVID-19 takes sixth place in males and fourth place in females.

Background: Despite implemented measures and general favourable trend, number of patients with myocardial infarction remains high, younger people are increasingly becoming ill and dying. The study purpose: to estimate age-sex mortality dynamics from acute and recurrent myocardial infarction in adults in Moscow compared to Russia's average in 2007-2021 to reveal patterns of mortality change within the implementation period of state prevention programs., Material and Methods: Standardized adult mortality rates for Moscow and Russia, mean expected age at death within interval 20-85 years and gain in life expectancy when eliminating this cause calculated and analyzed., Results: Moscow morbidity rates for acute and recurrent myocardial infarction are twice lower than Russia's, there are higher reduction rates for both diseases - by 16% and 58% respectively. During study period, mortality from myocardial infarction in men was by 45% higher than in women. In 2007 Moscow male-female difference estimated 3% and in 15 years it became 32% due to faster female mortality reduction. Whereas Russia's average age of death from myocardial infarction in 2021 returned to 2010-2011 levels, then in Moscow during 2020-2021 female rates returned to 2008's and male rates fall out the study period., Conclusions: Since implementation of the first programs on reducing mortality from chronic non-infectious diseases during the 15 years period morbidity and mortality rates from myocardial infarction reduced in Russia and Moscow in all ages. Acute and recurrent myocardial infarction have rejuvenated both in men and women as a negative effect of the pandemic.

Purpose of the Study: to determine the main threats to the health of the population of Moscow based on the analysis of the medical and demographic situation in Moscow and the Russian Federation in the context of the COVID-19 pandemic, in order to develop management decisions at the regional level., Material and Methods: Materials of the Federal State Statistics Service (Rosstat), as well as statistical collections of the Russian Research Institute of Health of the Ministry of Health of Russia for 2013-2022 were used., Results: Coronavirus infection has changed the morbidity and mortality rates of the population of the Russian Federation and its constituent entities. In the Russian Federation mortality in 2019-2021 increased from 12.3 to 13.6‰, while in Moscow the increase in the indicator is significant - from 9.5 to 16.7‰. The incidence of COVID-19 in Moscow in 2020-2021 (over the two COVID years) increased from 6191.0 to 8976.0‰oo. The noted decrease in incidence rates across almost all classes of diseases during the COVID period (2019-2020) was associated with the lower medical check-ups and preventive activities, while during 2019-2021 there was an increase in disease incidence of the following classes: mental disorders, behavior disorders; diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism, etc., indicating the need for rehabilitation of this group of patients., Conclusions: The need to counter the threats to the health of the population of Moscow caused by the coronavirus infection requires the development of management decisions aimed at strengthening preventive activities and rehabilitation of patients in the post-COVID period.

The article presents analysis of the program of preventive examinations of Moscow residents in the "Healthy Moscow" pavilions and the routing of patients with established atherosclerosis of brachiocephalic arteries. In 2022, within the framework of preventive examinations (check-ups) of Moscow residents in the "Healthy Moscow" pavilions, the pilot project of organization of surgical treatment of patients with established pathology of pre-cerebral arteries. The project included additional ultrasound examination of brachiocephalic arteries of males aged 45-72 years and females aged 54-72 years. the brachiocephalic artery stenosis was detected in 14 688 out of 370 416 people (4.0% of those passed the check-up). The stenosis was diagnosed in more than 50% - 1 369 people, 9.3% of all stenoses or 0.4% of those passed the check-up). At diagnosis of stenosis, more that 70% of patients were offered to undergo screening ultrasound examination at the "N. V. Sklifosovsky Research Institute of Emergency Care of the Moscow Health Department". The consultation was received by 117 patients out of 254 people. Out of them 22 patients were referred for additional examination, 70 patients for outpatient treatment, 25 patients for surgical treatment. The preventive examination of population organized in the "Healthy Moscow" pavilions permitted to identify sufficient number of patients requiring additional examination with following outpatient and/or surgical treatment of brachiocephalic artery stenosis who timely received necessary care. This result was facilitated by a number of organizational methodological measures implemented jointly with the Moscow Health Department".

Economic and social losses due to epidemics of non-communicable diseases have put prevention and control of them on the first line in the field of sustainable development of the United Nations. The tasks of combating NCDs and risk factors within the framework of the Sustainable Development Goals require targeted actions on the part of States in the field of policy and legislation and provision of health systems with appropriate resources. In the Russian Federation, such work is being implemented within the framework of the national project "Healthcare", federal programs to combat oncological and cardiovascular diseases. Each subject takes into account the peculiarities of economic development, staffing, implementation of informatization processes, etc. The rapid pace of transformation of Moscow healthcare, its unique institutional structure allowed to form the basis for the effective development of a system of proactive dispensary monitoring of patients suffering from chronic diseases. The authors describe the process of formation of preventive work and organization of dynamic dispensary observation in Moscow. The paper presents in detail the organizational, administrative and technological resources used to create a unique system of dynamic dispensary observation. In addition, the article illustrates the personalized subsystem of dynamic dispensary observation in EMIAS and the institute of "physician assistant". The introduction of a proactive dispensary monitoring system will reduce premature mortality and disability among residents of the city. Moscow through an individual monitoring program and motivation for the responsible attitude of metropolitan patients to their health.

Background: Currently, obesity is considered one of the most significant health problems, representing a common chronic disease leading to the development of severe comorbidities, accompanied by the loss of disability-adjusted life years and high mortality. Due to the fact that obesity is one of the leading risk factors for a number of non-communicable diseases, such as diseases of the circulatory system, diseases of the endocrine system and malignant neoplasms., Aims: assessment of adult mortality dynamics from obesity-associated causes in Moscow compared to the Russian Federation in 2011-2020., Materials and Methods: data from the analytic package FAISS (internal use program): standardized mortality rates for population of Moscow and the Russian Federation as a whole., Results: Over the 10-year period under study, mortality in the class of diseases of the circulatory system and malignant neoplasms was decreasing, while mortality from diseases of the endocrine system was increasing. Adult mortality from the diseases of the circulatory system in Moscow reduced by 12%, in the Russian Federation - by 25%. It should be noted, that mortality rate in Moscow (302.5 per 100,000) is significantly (by 34%) lower than in Russia (460.3), at the same time, the rate of mortality reduction over a 10-year period is equal and amounts to 23-25%. Myocardial infarction is the most serious obesity-associated disease characterized by high mortality in the class of the diseases of the circulatory system, it has a declining trend in Moscow and in the Russian Federation as a whole. Adult mortality from the diseases of the endocrine system in Moscow increased by 3 times, and in the Russian Federation - by almost 5 times, while the annual increase during the first year of the pandemic was 88% in Moscow and 24% in Russia. In Moscow, more than a half (66%) of deaths from endocrine causes belongs to non-insulin-dependent diabetes mellitus, in the Russian Federation - about 80%. Compared to the Russia's average, in Moscow mortality rates from neoplasms are lower by 8%, but at the same time, the decline happens at a similar rate (11-12%)., Conclusions: Despite the impact of the COVID-19 pandemic, Moscow demonstrates slowdown of growth of mortality rates from obesity-associated diseases compared to the Russian Federation, which could have been positively affected by prevention programs of noncommunicable diseases and promotion of healthy lifestyles.

The article presents information on trends in hospital morbidity of child population in Moscow, as well as morbidity of children in the first year of life. Authors used population data and information from Form No. 14 of the Federal statistical observational study "Information on the activities of the medical organization departments providing inpatient medical care" between 2014 and 2021.In addition to the general indexes, the article presents categories of diseases that were significantly affected by changes in the lifestyle of children during the COVID-19 pandemic. Significant fluctuations in the incidence of infectious diseases are worth noting as they are certainly related to both fragmentations in groups of children during the pandemic, and proper nutrition, which led to positive changes in hospital morbidity due to gastrointestinal disorders. Changes in education, social isolation, better control over hygiene by the government, society and parents has led to unprecedented positive dynamics in morbidity rates of certain diseases. It is worth noting that the COVID-19 infection during pregnancy didn't lead to expected high increases in morbidity rates associated with diseases in the perinatal period.In addition to hospital morbidity, the article presents data on mortality in 24-hour inpatient facilities, as well as changes in the proportion of emergency admissions of patients under 18 to Moscow state hospitals.

An important goal of COVID-19 surveillance is to detect outbreaks using modern molecular epidemiology techniques based on methods to decode the full genome of the virus, since rapidly evolving RNA viruses, which include SARS-CoV-2, are constantly accumulating changes in their genomes. In addition to using these changes to identify the different virus lines spreading in the population, the availability of sequence information is very important. It will allow the identification of altered variants that may be more transmissible, cause more severe forms of disease, or be undetectable by existing diagnostic test systems. The global scientific community is particularly interested in changes in the spike protein (S-protein, Spike) because they are responsible for binding and penetration into the host cell, lead to false-negative results in diagnostic tests, and affect transmission rates, health outcomes, therapeutic interventions, and vaccine efficacy.Genomic surveillance uses next-generation sequencing (NGS) applications and makes data on the full genome of the virus available. These methods offer new means to detect variants that differ phenotypically or antigenically. This approach promotes earlier prediction as well as effective strategies to mitigate and contain outbreaks of SARS-CoV-2 and other new viruses long before they spread worldwide.Today, molecular typing of strains is playing an increasingly important role in this process, as it makes it possible to identify samples that share a common molecular «fingerprint».

The article is a comparative analysis of the quality of life indicators of patients with rheumatoid arthritis with similar indicators in the Moscow population. We conducted a survey of patients in the register of rheumatoid patients in Moscow using the EQ-5D-5L questionnaire and the EQ-VAS visual analog scale. The population of patients with rheumatoid arthritis, in accordance with the recommendations of EuroQoL, was divided into 6 age and sex groups. The responses of patients from each age and sex group were compared with similar groups of respondents in the Moscow population. Key differences in the quality of life of rheumatoid patients were identified in comparison with both the population norm in Moscow and similar foreign registries.

The article presents the results of analysis of repeated disability because of thyroid cancer in adult population of Moscow in 2015-2019. The study established negative dynamics of increasing of the number of individuals with repeated disability because of thyroid cancer in all essential age contingents (young, middle and elderly age) of adult population. The similar trend was revealed in gender contingents of individuals with repeated disability because of thyroid cancer (in males, increase was made up to 112.5% and in females up to 196.3%). In the gender and age structure of repeated disability because of thyroid cancer, predominated females and the elderly. The study established dynamics of decreasing of percentage of individuals with repeated disability because of thyroid cancer of the disability groups I and III and corresponding increasing in disability group II. The percentage of individuals with repeated disability because of thyroid cancer in disability groups I and II was higher in males as compared with females. Most individuals with disabilities because of thyroid cancer don't work. The study results make available spectrum of disorders of main functions of organism, their degree and types and intensity of limitations in vital activity of individuals with repeated disability because of thyroid cancer. The organized database of characteristics of repeated disability because of thyroid cancer in adult population can be used in implementation of personalized approach to medical social rehabilitation of increasing number of disabled individuals with malignant damage of the most important organ of endocrine system.

The analysis of level and structure of general and primary morbidity according to medical care appealability of Moscow population during implementation of the State program "The Development of the City of Moscow Health Care (Metropolitan Health Care) in 2012-2020" was carried out according to the data from collections of main indices of functioning of medical organizations subordinated to the Moscow Health Care Department and health indices of Moscow population. The decreasing of both primary and general morbidity indices is established. At that, increasing of the life expectancy indices was marked. At the same time, population morbidity indices according to medical care appealability are not sufficiently reliable in assessing degree of achievement of results of any measures of improving population health due to their dependence on multitude of factors.

The purpose of the study is to to identify key social and medical problems of childhood psychiatry by analysis of statistical and clinical data of Moscow health care institutions. It is established that actual problems are related to increasing of incidence of morbidity of mental disorders in children, their late detection, absence or unavailability of diagnostic techniques with high evidentiary effect, inability to use modern achievements of psychopharmacotherapy, close relationship of mental disorders with social factors, as well as with high stigmatization of mental health sphere. It is necessary to intensify research in studying etiopathogenetic factors, elaborating strategies of mental disorders prevention in childhood, clinical trials targeted to expand age range of application of medications and to icrease activities on destigmatization and psychoeducation in society.

Introduction: Liver cirrhosis is a major but preventable cause of health loss worldwide. The era of «big data» allows us to evaluate this nosology in a new format., Purpose: Evaluation of the registered population of patients with cirrhosis of the liver of cirrhosis of various etiology in Moscow. Moscow., Materials and Methods: Based on the data of the Moscow Department of Healthcare for the drug provision for the period from 2017 to 2019. Тhe population of patients with an established diagnosis of liver (other etiology) was characterized according to ICD-10 code K.74 (K74.0-74.6) according to the International Statistical Classification of Diseases and Related Health Problems of the 10th revision., Results: Over a 4-year period, more than 2 thousand patients with established diagnosis of liver cirrhosis received preferential drug provision in Moscow. The largest part of the population of patients with liver cirrhosis receiving preferential drug provision in Moscow is represented by the patients of age groups 40-59 years old and 60-79 years old, the groups 30-39 years old and 80-99 years old were comparable annually. There was a decrease in the number of patients with liver cirrhosis in the age groups of 30-39 and 18-19 years compared with the base year (2017) by 37% and 57%, respectively. At the same time, in pediatric patients (from the neonatal period to 17 years), there was an intensive increase in patients from 52 to 550% compared to the baseline year (2017).

Ensuring effective epidemiological surveillance of tuberculosis is essential and one of the paramount tasks for any national tuberculosis control program. The article analyzes the organization of the tuberculosis epidemiological monitoring system at the level of the subject, based on the experience of implementing such a system in the city of Moscow in 1996-2020, defines its tasks and principles of its construction. The systems of epidemiological monitoring of tuberculosis, implemented taking into account the developed principles, provide an analysis of the epidemiological situation in the territory, the results of which can be successfully used for making managerial decisions, program-target planning and evaluating the effectiveness of the measures taken.

The article presents the experience of the city children's polyclinic No. 133 of the Moscow Department of Health in a difficult epidemiological situation associated with a new infection COVID-19. A description of the stages of the organizational work of a polyclinic in a pandemic is given, including such areas as: a) conducting lectures and webinars for doctors and nurses of a medical organization, introducing recommended methods for diagnosing and treating COVID-19, creating and observing conditions for the personal safety of employees; b) the formation of tools and a database for analytical work; creation of registers of patients and employees of the polyclinic in order to monitor and evaluate the effectiveness of work; characteristics of the structures of age-specific morbidity in children who have undergone a new coronavirus infection and community-acquired pneumonia with substantiated confirmation for them of compulsory dispensary observation and rehabilitation measures; description of the development of routing of healthy and sick children, operational identification and continuous analysis of difficulties in the work of the polyclinic during this period; c) the formation of distance technologies in treatment and prophylactic work with patients, organized group and individual exercise therapy classes, including respiratory rehabilitation gymnastics for children who have undergone a new coronavirus infection; development of an organizational algorithm for the formation of medical and nursing teams for visiting patients with COVID-19 at home and individual teams for visiting patients for patronage. The organization of this treatment and prophylactic work was approved and a confirmation was received from the Ministry of Health of the Russian Federation of the right to replicate the experience gained from the work of the polyclinic in the conditions of COVID-19.

It is known that the oral cavity is an epidemiological hazard due to the high level of viral and bacterial contamination. Despite the narrow specialization and distant connection with the problem of viral pneumonia, dentists, nevertheless, are at risk of contracting the new coronavirus infection COVID-19. To reduce the epidemiological activity the provision of routine dental care was suspended in the vast majority of regions of the Russian Federation including the Moscow region, from the end of March 2020 to June 20, 2020. During the entire period of routine medical care suspended, the Moscow region chief dentist's team was daily monitoring information about applied patients. The suspension of routine medical care has reduced the number of cases of COVID-19 infection contact transmission in medical organizations during the period of the most active increase in the morbidity. In addition, the decrease in the number of patients enabled medical organizations to reduce the number of medical personnel, which contributed to a decrease in the percentage of morbidity among doctors.

About 30% of male infertility is associated with genetic abnormalities. Genetic polymorphisms increase the level of individual susceptibility to adverse environmental factors and affect human reproductive function., Aim: To study associations of glutathione S-transferase GSTP1(Ile/Val) gene polymorphisms (A313G; rs1695) with the risk of pathospermia in men of the Moscow region., Materials and Methods: We examined 138 men in the Moscow region (n=70 - proven pathospermia, n=68 - fertile men). We obtained genomic DNA from blood leukocytes and studied the gene polymorphisms of glutathione-S-transferase GSTP1 (Ile/Val) (A313G; rs1695) in real time., Results: In the analysis of the distribution frequencies of polymorphisms GSTP1 (Ile/Val) (A>G rs1695), we revealed the predominance of the AA genotype in fertile men and the predominance of the GG genotype (homozygous minor allele) in men with pathospermia. However, we found no significant difference in these parameters between the compared groups of patients (p=0.344). For GSTP1 (Ile/Val) polymorphism (A313G, rs1695), significant differences in the distribution of genotype frequencies in the subgroup of men with teratospermia (2=7.00; p=0.03) were revealed. The frequency of allele G in the subgroup of men with teratospermia is statistically significantly different from the frequencies of alleles in the control group: 52% versus 30% (2=10,004; p=0.0015). In subgroups of men with azoospermia and asthenospermia, we did not find significant differences in the distribution of genotypes of GSTP1 polymorphism (rs1695) (p>0.05)., Discussion: Glutathione-S-transferase (GSTP1) is a multifunctional protein that protects sperm cells from the damaging effects of reactive oxygen species and xenobiotics. The Association of GSTP1 polymorphism (Ile/Val) (A313G, rs1695) with teratospermia explains the main stages of the pathogenesis of male infertility in this category of patients., Conclusion: Gene polymorphism GSTP1 (A313G, rs1695) can be considered a genetic marker of susceptibility to pathospermia in men.

The article presents the dynamics of disability due to cerebrovascular diseases in 2014-2018 in Moscow. The age gender analysis of the disabled in this category was carried out. It was established that 30% of total population of the disabled due to cerebrovascular diseases accounted for the share of those who were recognized as disabled for the first time in the structure of total population. The most frequently disabled persons are those who are older than able-bodied age. In total structure of the disabled due to cerebrovascular diseases, women predominate.

To preserve the country's population is among one of the most vital tasks over the period of existence of the new Russia and constitutes the subject of national security. The article presents the results of analysis of population mortality rate of the Russian Federation, the Central Federal Okrug and City of Moscow during the first eight months of 2020 towards to concurrent period of 2019. In January-March 2020, the population total mortality rate, retaining prevalent trends of number of preceding years, decreased in the Russian Federation by 3.8%, in the Central Federal Okrug by 3.0% and in City of Moscow by 3.9%. However, since April-May the situation has changed dramatically and, according to the results of January-August, mortality by this time has increased, and its growth made up to 6.5% in the Russian Federation, 7.8% in the Central Federal Okrug and 15.6% in the City of Moscow. In May 2020, the gain of absolute number of the deceased in the Russian Federation by months (towards to concurrent month of 2019) made up to 11.9%, in June to 18.6%, in July to 19.7% and in August to 9.6%. In Moscow, the peak values of this increase were noted in May - 57.2% and in June - 41.6% In the conditions of new coronavirus infection pandemic, the share of COVID-19, as main cause of death (ICD-10 codes U07.1 and U07.2), in the structure of total mortality in April-August consisted 3.2% and in the structure of excess deaths in May-August - 28.6%. The increase of mortality and continued decrease of birth rate resulted in increasing of natural population loss by 1.5 times and more and reached such values as -3.6 in the Russian Federation, -4.9 in the Central Federal Okrug and -1.6 in the City of Moscow (per 1000 of population). The process of depopulation of the Russian nation not only retained, but significantly has become significantly aggravated.

The spinal muscular atrophy is neuromuscular disease caused by mutations in SMN1 gene. The clinical picture of disease is characterized by progressive muscular weakness and atrophy associated with degeneration of spine, and in severe cases by affection of motor neurons of lower bulbar cells. The spinal muscular atrophy progressing course resulting in disability and infant mortality. Actually, specific treatment is at the stage of clinical trials. However, patients are needed in permanent symptomatic arresting of manifestations and pathogenetic treatment preventing development of disease. The article presents calculations of direct medical costs for treatment in pediatric patients (0-17 years old) in Moscow with the main types of spinal muscular atrophy. It is established that the cost of specialized medical care of children with spinal muscular atrophy per single under age patient in Moscow consisted 7,131,185.84 rubles annually, including primary diagnostic, treatment and rehabilitation and medicinal treatment. In total, according to data for 2020 in Moscow, where number of children patients is 144, the cost of specialized medical care of children with spinal muscular atrophy is estimated as 1,024,580,269.16 rubles. At that, data takes into account only direct medical costs for out-patient and in-patient care of children with spinal muscular atrophy, excluding number of exacerbations of disease. Taking into account average numbers of hospitalizations per year because of illness, the cost of in-patient care of single child amounts to 7,844,304.42 rubles annually and 1,127,018,732.08 rubles for all children with spinal muscular atrophy in Moscow (according data of 2020).

The article discusses results of complex cross-sectional and anthropometric medical check up in the M. V. Lomonosov Moscow State University in 2002-2003 and 2013. The sampling covered 494 students aged 18-23 years. The check up included basic anthropometric measurements and cardiovascular parameters. The pulse pressure and Bayevsky adaptation potential were calculated. Results. The secular trend in body mass increasing was established. So, decade variations was +3.3 kg in young men (p=0.021) and +1.8 kg in girls (p=0.098). The cardiovascular system parameters degraded over ten years: occurrence of bradycardia and tachycardia increased significantly for both genders. In most observed participants in 2002-2003 the sufficient adaptation according Bayevsky was established (75.1% in young men and 71.6% in girls). Over ten years, this proportion decreased to 44.1% in young men (p=0.0000) and to 51.7% in girls (p=0.034). The percentage of adaptation failure cases increased. Conclusions. The analysis of decade dynamics demonstrated deterioration of physical development and somatic health parameters of modern youth. The established trends should be considered in planning health improving programs targeted to early prevention of cardiovascular diseases and development of adaptive capabilities of modern youth.

Accuracy of statistical registration of mortality in Russia, especially in times of crisis, is a pressing and relevant issue; this problem was challenging Moscow in the 2000s: until recently, the capital was a complete outsider in terms of accuracy of statistical registration of mortality. The purpose of the study was to identify peculiar features of evolution and the structure of mortality from an event of undetermined intent among Moscow working-age population in the 2000s against the background of the processes taking place in Russia. The article analyzes mortality from an event of undetermined intent among Moscow population of young and old working age in the 2000s, as well as its nosological aspects in 2011-2018, when certain events of undetermined intent were separated as individual nosological units. A sharp decline in indicators in 1999-2000 and their growth in 2015-2017 have been identified. It is shown that these shifts were due to all leading events of undetermined intent (falls/jumps from a high place, hanging/strangulation/suffocation, medicament, alcohol and drug poisoning as well as specified and unspecified events). As a result, the structure of mortality after 2015 has significantly changed due to a sharp increase in the significance of alcohol, medicament and especially drug poisoning. It should be emphasized that in the 2010s the significance of latent suicide in all age and gender groups of Moscow working-age population is significantly higher than in Russia.

Prevention of strokes and the fight against their consequences require not only the work of the healthcare system, but also the self-preserving behavior of the population, which is largely motivated by competence in this sphere. The study of public awareness on this issue and the development of recommendations on information policy were the main objectives of the study. In October-December 2019 two surveys were conducted in Moscow, the sample of each was 800 people. The study found an increase between the waves in the number of those who think they know the signs of a stroke (up to 65%). Despite the mainly correct answers, this self-evaluation is not always backed-up by real knowledge: e.g. a stroke was sometimes confused with an ischemic heart disease, a heart attack and epilepsy. Less competency is demonstrated by men and people with primary/secondary education, younger respondents. 94% of the respondents will call an ambulance when they see signs of a stroke, 16% will begin to provide assistance on their own, and in general their actions will be correct, although there are a number of misconceptions. Among the main risk factors of a stroke the respondents consider bad habits. The population receives information about signs of a stroke mainly from relatives/friends (25%) and on the Internet (22%). The study found necessity for the right information about strokes. There is a need for some greater presentation of peer-reviewed information materials in the information field.

The purpose of the study is to determine the relationship between risk factors for the development of chronic non-communicable diseases and first-time preliminary diagnoses during the medical examination of the adult population of Eastern and South - Eastern administrative districts of Moscow. Determine the risk factors that cause the most significant effect for the development of diseases of the endocrine system and eating disorders and metabolic disorders. The analysis of the medical examination data with a comprehensive assessment of the data from industry statistical reports, including the report form N 131, approved by the order of the Ministry of Health of the Russian Federation. It was found out that the risk factors identified during the medical examinations cause the development of chronic non-communicable diseases and the dynamics of indicators for the identified risk factors for obesity and established preliminary diagnoses of obesity from endocrine system diseases, eating disorders and metabolic disorders are equally directed. These percentages of preliminary diagnoses established during the medical examinations can be used for rapid assessment of the quality of the medical examinations and the adoption of cross-sectoral connections and measures aimed at preventing the development of this pathology at the regional level, with a broader implementation of preventive measures to improve public health, including monitoring and measures to reduce the impact of risk factors associated with insufficient physical activity, poor nutrition through the involvement of agencies, responsible for maintaining urban planning and transport policies and requirements for the urban environment, as well as the availability of medical care.

The serum of 1006 children aged 0-18 years and elderly people aged 60 to 90 years and older for the presence of specific class G immunoglobulins to the Epstein-Barr virus was studied using enzyme immunoassay. The dependence of seropositivity of children on their age and seropositivity of more than 98% of all surveyed elderly people is shown., Competing Interests: The authors declare no conflict of interest.

The article presents the results of analysis of indices of total morbidity of population of the Central Federal Okrug (CFD) of the Russian Federation in 2010-2017. The significant differences in indices of total morbidity between the CFD subjects in certain ICD-10 classes were established. The indices of total morbidity of population during study period (8 years) in the Central Federal District factually didn't altered, while dynamics of indices in other subjects was characterized by multidirectionality. The gap in levels of total morbidity of population in the subjects was significant: from 115,123.6 per 100,000 of population in the Kursk Oblast to 194,404.1 per 100,000 of population in the Orel Oblast. The significant difference in rates of increase/ decrease of indices is noted. Thus, in Moscow decrease rate made up to 10%, while in the Orel Oblast morbidity increased up to 13.1%. Besides, in 2017, the Orel Region took a leadership in rate of increasing of total morbidity in such classes of diseases as infectious and parasitic diseases (39.3%), diseases of blood and blood-forming organs (49.1%), diseases of endocrine system (59,1%), diseases of nervous system (26.8%), diseases of respiratory system (28.2%), diseases of musculoskeletal system (16%), malformations (56%). It is very likely that this trend developed under influence of demographic situation in the subject due to significant increasing of percentage of people older than able-bodied age. The city of Moscow occupies leading position in decreasing of rate of prevalence of diseases and last but one place in level of total morbidity being inferior only to the Kursk Oblast. Thus, in Moscow was noted the most significant decreasing of morbidity in classes of infectious and parasitic diseases (26%) and diseases of digestive system (20.6%). The diseases of blood and blood-forming organs (235.2 per 100,000 population) and mental disorders (2353.5 per 100,000 population) were registered the less. The main contribution into trends of increasing or decreasing of indices is made by persons aged 18 years and older (74.1%).

The statistics of causes of death is the informational basis for identifying public health problems. That is why the accurately accounting for mortality from diabetes mellitus, which is a global medical and social problem for society, is important. The study was carried out to analyze the correctness of coding death causes of diabetes mellitus and the frequency of alleged death., Materials and Methods: The Moscow deceased population database of July 2018 - July 2019 was analyzed. Using the decision tables on codes linkages from ICD-10, incorrect codes for underline cause were established for 342 death cases from diabetes mellitus. Among 43044 cases of cardiovascular death the cases of presumed death from diabetes were detected. The analysis was carried out in the Microsoft Access 2007 software., The Results: In 18.4% of cases, the cause of death from diabetes was encoded incorrectly. If a modification of the underline death cause is assumed due to the mention of certain diseases in any line of the Death Certificate, cases of coding for death from diabetes with wrong fourth character are more often detected when mentioning kidney diseases. If modification of the underline cause is provided for cases when information in the Death Certificate indicates that diabetes has caused the development of some diseases then the largest number of cases with incorrect coding was detected when mentioning circulatory diseases. Only in one medical organization the frequency of incorrect coding is 3.4%, in the rest it varies from 15.4% to 52.2%. Among all death causes, diabetes was only 0.41%. If to add cases of presumptive death from diabetes mellitus, then the proportion of diabetes in the structure of death causes will almost triple and reach up to 1.2%., Conclusions: The quality of diagnosis and coding of death causes from diabetes has not improved in recent years. To increase it, it is advisable to organize and establish the institution of coders. It is advisable to indicate the presence of diabetes mellitus in the Death Certificate without fail and use the information from the diabetes register. It is proposed to encode the death cause from diabetes mellitus with multiple complications use line D in the Death Certificate to indicate damage to various organs and systems if it is necessary.

Introduction: Voiding disorders in men are manifested by various symptoms associated with impairment of the urinary flow along the urinary tract and worsening of the urinary bladder storage function. There is a considerable lack of data on the prevalence of LUTS, their severity, and correlation with data from objective studies in men in the Russian Federation in general and in the Moscow region in particular., Materials and Methods: A prospective multicenter epidemiological study "Specific Features of Lower Urinary Tract Symptoms in Men Living in the Moscow Region" was conducted based on data acquired from April 1 to May 31, 2017 by an anonymous survey of 525 men (mean age 64.2+/-9.93 years old), residing in Moscow and presenting with complaints of urination disorders. The respondents answered questions of a specially developed 140-item questionnaire. All demographic and medical information was taken into account, including concomitant diseases and ongoing therapy. The patients filled out the IIEF, I-PSS, QoL, and AMS (Aging Male Screening) questionnaires., Results: Analysis the I-PSS scores showed that symptoms of the emptying phase predominated over the symptoms of the filling phase in all age groups. The most frequent complaints were "frequent urination" and "weak urine stream". Forty and 30% of respondents had moderate and severe LUTS, respectively. The remaining 30% of men had mild LUTS. Prostate volume was significantly greater than that reported in similar studies conducted in Asia, Europe and North America (mean 55.27 cm3). The level of total prostate-specific antigen (PSA) was known in 98.8% of patients over the age of 50 and averaged 3.87+/-4.41 ng/ml. The mean age at the first testing for total PSA in Moscow is 56.7+/-9.0 years., Conclusion: This study is the first epidemiological study of this scale and focus. Its findings can be used to compose a "portrait" of a standard patient and identify patterns that limit the extrapolation of international epidemiological studies to the population of Russian patients. It seems necessary to develop an updated LUTS management strategy, taking into account the identified national characteristics.

The article presents the results of analysis of trends in morbidity and dispensary observation of Moscow adult population with diseases of musculoskeletal system and connective tissue. The analysis was applied to data from statistical report forms # 12 of the Moscow Health Care Department in 2012-2016. The stability of percentage of diseases of musculoskeletal system in the structure of total and primary morbidity during last 5 years was established. The significant dynamics of indices of total morbidity is absent. The statistically significant descending trend if primary morbidity at the expense of deforming dorsopathies in the age group older than 55 years was established. The deforming dorsopathies hold first place in the structure of diseases of musculoskeletal system. The dynamics of decreasing of indices of total morbidity of the given pathology in the age group of 18-55 years and older than 55 years is statistically non-significant. The statistically significant ascending tendency of indices of total morbidity of arthroses of adult population and primary morbidity of synovial membranes and tendons in the age group of 18-55 years is established. The established in adult population and individuals aged 18-55 years both decreasing of number of being dispensary registered on the subject of pathology of musculoskeletal system and its increasing among individuals older than 55 years are statistically non-significant. The trend of dropping of indicator of being on dispensary registration of individuals with primarily diagnosed pathology is also insignificant. The correlation between rate of dispensary registration and primary morbidity, including particular pathologies, is absent.

Unlabelled: Postoperative intracranial infectious complications are one of the most topical problems of neurosurgical intensive care due to theirs significant capability to impair outcomes of the main disease., Purpose of the Study: To define the risk factors of postoperative meningitis in patients with chiasm-sellar tumors., Research Objectives: 1. to define the effect of somatic and intracranial risk factors on occurrence of postoperative meningitis in patients after transsphenoidal and transcranial approaches to the tumor. 2. To define the effect of postoperative meningitis on outcomes of treatment in patients after transsphenoidal and transcranial approaches to the tumor., Materials and Methods: Somatic and intracranial risk factors of occurrence of postoperative meningitis (pneumonia, urinary tract infection, sepsis, intra-abdominal hypertension, the presence of external ventricular and lumbar drainage, monitoring of intracranial pressure, cerebrospinal fluid, and reoperation) were fixed every day. The study was conducted in the ICU of the Burdenko from October, 2010 to July, 2012. The 34 patients (19 males, 15 females) were included in the study (average age 47.5 years). The patients were divided into two groups; 17 patients each group. The group-1 included patients after transcranial approach to the tumor and the group-2 included patients after transsphenoidal approach., Results: In the group-1 a meningitis occurred in 3 patients (17.6% +/- 9.2%, DI [-0.4 - 35.6]). In the group-2 a meningitis occurred in 7 patients (41.2% +/- 11.9) DI 95% [17.8 - 64.4]. Accumulation of cerebrospinal fluid under the skin flap authentically increased a risk of a meningitis occurrence in patients after transcranial approach to the tumor (p = 0.031). There was no defined statistical significance of other risk factors. But there was defined a trend of the increasing of meningitis occurrence in patients after transsphenoidal approach in case of lumbar drainage or reoperation. Duration of mechanical ventilation and ICU stay in patients with meningitis was authentically longer than in patients without meningitis in both groups. In the group-2 the duration of mechanical ventilation and ICU stay was significantly shorter than in the group-1., Conclusions: Meningitis is not a typical complication of postoperative period in patients with transcranial approach to the tumor. After transsphenoidal approach a meningitis occurrence is likely in case of postoperative liquorrhea, lumbar drainage or reoperation. Subcutaneous accumulation of cerebrospinal fluid is a single defined statistically significant risk factor of meningitis. Postoperative meningitis impairs a condition of patients with chiasm-sellar tumors, increases the duration of mechanical ventilation and impairs treatment outcomes.

The detection of season deficiency was carried out among children and adolescents residing in Moscow. It is established that vitamin D3 deficiency, in all children and adolescents comprises 89% in spring and 62% in autumn. Independently of season, the vitamin D3 deficiency is least expressed in children of early age and its most propagation takes place in adolescents. The higher propagation of vitamin D3 deficiency demands the development and implementation of guidelines concerning compensation of need in vitamin D depending of age, season and region of residence of child.

This article is devoted to topical problem in obstetrics critical states therapy and reflects long-term experience of resuscitation mobile center of S.P. Botkin hospital. Epidemiology of critical state in obstetrics and modern approaches to treatment of these conditions are considered on a voluminous clinical data. Mobile telemedical complexes and multidisciplinary consultations are used for decision-making optimization in difficult clinical situations. The modern concept of anaesthesiology safety level increase is presented. This organizational approach, mobile forms of anaesthesiology and resuscitation care are utterly effective and economically reasonable in Moscow obstetric care system.

The evaluation of prevalence and intensity of vitamin D3 deficiency in preschoolers and schoolchildren residing in Moscow and St. Petersburg was implemented. It is established that 63.6% of all Moscow children and adolescents of and 43% of St. Petersburg minors live in conditions of vitamin D3 deficiency. Regardless of the residence region, the vitamin D3 deficiency prevalence is more typical for schoolchildren as compared with preschoolers. The higher prevalence of vitamin D3 deficiency demands to change the policy of vitamin D3 supply among minors.

Thirty-five autopsy cases of influenza A/HIN1 in Moscow were analyzed. Primary pathological changes were found in the trachea and lung. The lung showed a pattern of the exudative and proliferative stages of diffuse alveolar damage. In addition, there were signs of infectious-toxic shock associated with viremia, as suggested by pronounced changes in the brain, kidneys, liver, spleen, adrenals, and lymph nodes. Bacterial bronchopneumonia was detected in only 20% of cases.

The results of study of medical social risk factors of developing the iron-deficiency anemia in pregnant women are presented. The medical case history data, the characteristics of pregnancy, delivery and puerperal period course, the indicators of laboratory and instrumental findings are discussed in their dynamics. The analysis of significance of risk factors is carried out, the results of comparing of parameters of basic and control groups according Student's test were used. The most significant risk factors were revealed. They are to be taking into account in forecasting anemia and in choosing the corresponding preventive and curative measures at the first visit of pregnant woman to the maternity clinic.

Unlabelled: OBJECTIVES; Methicillin-resistant Staphylococcus aureus (MRSA) is a common pathogen of nosocomial infection. The goal of this work was to evaluate the clonality of hospital-acquired MRSA (HA-MRSA) circulating in Russian Federation and to compare different multiplex PCR techniques with SNP-based approach for MRSA typing., Methods: Epidemiologically unrelated MRSA isolates (n = 62) from Moscow hospitals were selected for typing. Genomic DNA from clinical isolates was purified using the DNA express kit (Lytech Ltd, Russia). Staphylococcus chromosomal cassette mec (SCCmec) typing was performed by PCR using the previously described methods. Seven loci from five housekeeping genes (arcC162, arcC210, aroE132, gmk123, tpi241, tpi243 and yqiL333) were used for SNP-typing. Detection of particular nucleotides in selected loci was carried out in the thermocyclic primer extension reaction, followed by mass spectrometry of the products. Standard MLST procedure was performed as reference method., Results: The majority of the MRSA isolates (93.6%) belong to world-wide disseminated clonal complex (CC) 8. Three isolates (4.8%) belong to CC 1. All ST 239 isolates were found to carry SCCmec type III; ST 8 isolates, SCCmec type IV., Conclusion: Among Russian MRSA CC 8 isolates carrying SCCmec IV type are predominant. SNP-typing is powerful toll for studies of molecular epidemiology of MRSA.

One of the aims in the strategy of Moscow health service is perfection of early diagnosis of urological diseases. Examination of about 1.500000 males over 50 years was conducted in 2002-2007. The number of PSA tests rose 5-fold for 5 years. The number of ultrasonographies and transrectal ultrasonic investigations of the prostate rose from 21650 (2002) to 128890 (2007), the number of polyfocal biopsies--from 2165 (2002) to 12219 (2007). The rate of detection of prostatic diseases increased from 1146 cases per 100000 adult male population (1999) to 2097 (2007). Chronic prostatitis was registered in 17.8%, prostatic adenoma in 29.6% examinees, new cases of prostatic cancer were detected in 0.86% examinees. Standard prostatic cancer morbidity rose from 30.4 to 47.0 per 100000 male population. Percentage of early detected prostatic cancer increased from 42.9% in 2000 to 62% in 2007, detection of prostatic cancer stage III-IV reduced from 27.3% in 2000 to 16.6% in 2007. Thus, new prophylactic measures improved efficacy of outpatient urological service, raised rate of detection of chronic prostatitis, prostatic adenoma, prostatic cancer

The study reveals that traffic traumatism continues to be a serious problem for all international community. The causes of traffic traumatism and ways of its prevention are analyzed. The results of sociological analysis of opinions of injured persons about activities and modes of preventing traffic traumatism are discussed. The system of social medical, legal and educative impacts on all participants of traffic accidents is proposed.

The paper describes some experience in organizing and delivering specialized emergency health care to children who have suffered during traffic accidents in the Moscow Region, by attracting the forces and means of a disaster medicine service. In May 2004 to October 2008, examinations were made among 615 children, 552 of whom were evacuated to Moscow by intensive care cars (n = 469) and medical helicopters (n = 83). The paper shows that the two-stage medical victim medical evacuation provision system is effective and provides evidence for prospects for putting the developed model into practice of rendering a medical aid to traffic accident victims on out-of-town highways.

Retrospective analysis of the data available in the reporting form 0-89/y-[cyrillic letter: see text] and information analytical tables for Moscow tuberculosis monitoring) over 7 years on all notified new cases of tuberculosis among 15-17-year-old children has indicated that it is necessary to change the procedure for detecting tuberculosis for this age group of children in order to improve the early diagnosis of the disease. The Mantoux test is likely to be rather effective in examining adolescent schoolchildren and students from secondary specialized establishments and ineffective among unorganized young people and in migrants' families. Planned fluorography is of rather informative value in all the groups under study if there is a timely referral for examination. The authors consider whether it is worth making a tuberculosis 2 TE PPD-L in organized collective bodies (schools, colleges, etc.). Other groups of children may undergo only digital small-dose fluorography. Unorganized children above 10 years of age who lack annual Mantoux test results must be referred for digital small-dose fluorography. Refusal to undergo fluorography is justifiable only if there is no tuberculin sensitivity or evident symptoms of intoxication. In the megapolis, due to uncontrolled migration, a lawmaker must consolidate the statute on that mandatory control should be exercised over 15-17-year-old adolescents who must undergo fluorography during their each visit to a health care facility, on entering an educational establishment, or on employment. On consulting a physician, the adolescent who has undergone fluorography 6 months before must have it again.

As of now, exit intensive care teams (EICT) are a mobile service of the S. P. Botkin City Clinical Hospital. The main area of their activity is to deliver intensive care to 35 Moscow obstetric hospitals. In 2003-2006, the EICT mates performed 1159 calls, delivered care to 783 puerperas and parturiants, and transferred patients to the specialized intensive care units and research centers of Moscow. Throughout the existence of the exit intensive care center and EICT, none patient died during interhospital transportation. The concentration of these patients at 4 specialized Moscow hospitals could improve a therapeutic process, gain uniqe clinical experience, and reduce mortality by 3-fold (from 45.2 to 14.6%).

The structure and sensitivity of the agents of community-aquired urinary infections (CUI) in Moscow were studied in a prospective clinicomicrobiological trial carried out in 2005 with participation of 8 Moscow outpatient clinics. Minimal inhibitory concentration (MIC) of antimicrobial drugs was estimated using agar dilution test according to NCCLS recommendations (2000-2002). Acute and chronic cystitis, chronic pyelonephritis and acute pyelonephritis were most frequent CUI (49.1, 39.8 and 5.3%, respectively, while among complicating factors most frequently occurred urolithiasis (48.5%), diabetes mellitus (24.2%), renal cysts (7.6%), infravesical obstruction (6,1%). CUI in Moscow were primarily caused by E.coli (72.5%). Compared to complicated CUI, uncomplicated ones were characterized by less frequent E. coli isolation (53 and 80.9%, respectively), but significantly more frequent isolation of P.aeruginosa (4.5 and 0%) and E. faecalis (9.1 and 4.2% isolation. High resistance of E.coli isolated from patients with uncomplicated CUI was seen to cotrimoxasol (28.7%) and ampicillin (39.1%), low resistance--to amoxicilline/ clavulanate (6.3%), fluoroquinolones (6.3%), nitrofurantoin (0%), cefuroxime (6.3%), cefotaxime (0%), phosphomicine (0%). Patients with complicated CUI compared to uncomplicated CUI significantly more often had E.coli strains nonsensitive to amoxicilline/clavulanate (14 and 6.3%), cotrimoxasol (25.6 and 18.8%), nalidixic acid (18.6 and 6.3%, respectively). Polyresistant E. coli strains were significantly more prevalent in complicated CUI than in uncomplicated CUI (45.4 and 25.1%, respectively). Thus, E. coli, a main causing agent of uncomplicated CUI, demonstrates high resistance to ampicilline and cotrimoxasol. High microbiological activity is shown byfluoroquinolones, nitrofurantoin, oral cephalosporines of the second-third generation.

HIV-infection morbidity rates continue to increase in Moscow, the Moscow Region, and in the whole country. The epidemiological situation associated with tuberculosis concurrent with HIV infection remains tense in Moscow and its region, as judged from the data of an analysis of this disease at tuberculosis hospital seven (TH-7) over 9 years. A total of 411 patients with tuberculosis concurrent with HIV infection were treated at TH-7 in 1996 to December 2004. Among them, 49.6% were Moscow residents, 15.1 and 26.5% of the patients lived in the Moscow Region and other regions of the Russian Federation, respectively; 6.8% were homeless persons and 2% foreigners. The number of patients with tuberculosis concurrent with HIV infection has been annually increasing at TH-7. Among the total number of patients, their proportion was 13.4% in 2004. In the structure of patients with comorbidity, the proportion of surgical patients has been on the rise and it was 51.8% in 2004. Among the surgical patients with tuberculosis concurrent with HIV, the proportion of patients with generalized (multiple organ) tuberculosis has increased; it was 50% in 2004. Patients with tuberculosis concurrent with HIV infection need a greater scope of surgical interventions al number of patients for therapeutic and diagnostic purposes.

To compare the effects of urological, neurological and obstetricogynecological risk factors of urine incontinence (UI) in women, we made a questionnaire survey covering a representative sample of 4336 female residents of Moscow aged 25-74 years. We used standard epidemiological methods and unified criteria, descriptive statistics and modeling by means of logical regression in 6.12 version of SAS system. We revealed that chronic cystitis and other inflammatory urinary diseases provoke a 4-fold increase in the relative risk (RR) of UI in women being higher than obstetricogynecological risk factors (RR 1.5-2.8) and neurological risk factors (RR 1.3-2.0). UI in many cases is of stress type, but in urinary inflammation a mixed type occurs 1.8 times more frequently. Thus, chronic cystitis and other urinary inflammatory diseases are essential UI risk factors in women.

Statistics for the last 6 years show a trend to growing number of new cases with tuberculosis of the lungs with drug-resistant pathogen. In recurrent tuberculosis multiple drug resistance (MDR) was three times higher than in new cases. Treatment efficacy depended on MDR and patients' compliance. The results of the basic treatment course were unstable: many patients had exacerbation within 3-4 years after therapy, many patients died, especially those with M. tuberculosis resistant to many drugs.

Despite the fact that the mass immunization of the children population with the DPTs vaccine has been carried out in the Russian Federation since 1959, the pertussis infection persists to be one of the pressing problems for the children population. Although the vaccination coverage of the children population with pertussis vaccines is high in Russia, at present time the pertussis incidence rates are increasing among schoolchildren and remain high among infants younger than 12 months old. Many researchers believe that the variability of the genetic structure of the pertussis causative agent may be one of the causes of increasing pertussis incidence rates. This investigation provides the molecular genetic characteristics of 97 B. pertussis strains isolated in pertussis patients in Moscow in different periods of pertussis epidemic process since the 1950s up to present time. It shows the changes in the structures of genes, which are encoding the main protective antigens of the pertussis microbe that are the pertussis toxin (ptxS1) and the pertactin (pm). The structurre of the ptxS1 and pm gene of the B. pertussis vaccine strains was compared with the structures of these genes in the B. pertussis strains isolated from the pertussis patients at present time and also in past years. All B. pertussis strains isolated in the prevaccination period (1948-1959) and most strains (95%) isolated during the first twenty years of the mass immunization in Russia are characterized by the presence of the so called "vaccine" alleles of the pertussis toxin and pertactin genes that are ptxS1 B or ptxS1 D and pm 1 alleles that corresponds to the genetic structure of the vaccine producing strains. In the early 1970s the B. pertussis strains of another toxin and pertactin genetic structures with so-called "non-vaccinal" alleles ptxS1 A and pm 3 (pm 2 since 1980s) began to appear. The B. pertussis strains with "non-vaccinal" alleles have completely displaced the "old" strains. At present time in Moscow the pertussis disease is caused by the B. pertussis strains bearing ptxS1 A and pm 2 or pm 3 alleles of pertussis toxin and pertactin genes. There was no correlation between the genotype and serotype. Thus, the structure of the B. pertussis toxin and pertactin genes in strains which have been isolated since the 1980s up to now differs from the structure of these genes in strains which are used for producing DPTs vaccine. The data obtained in this investigation suggest that the genetic structure specificity of circulating B. pertussis strains that are producing the disease at present time should be used as one of the criteria for selecting vaccine producing strains.

The social status and the presence of occupational and household hazards were analyzed in 134 patients with torpid chronic and undulating course of sarcoidosis lasting 3 years or more to estimate the significance of the above factors when the course of sarcoidosis was poor. The fact that 162 cases of hazards (metals, building materials, wood, textile, and paper dust, smoking, chemical substances, contact with patients with tuberculosis) occurred in 113 patients and 49 of the 134 patients with chronic forms of the disease were exposed to psychoemotional factors suggests that dust substances and chemical elements of different kinds, frequent stressful situations, and the X-ray signs of fibrosis of sarcoidosis-induced changes due to the absence of timely examinations should be regarded as a risk factors of the torpid chronic course of respiratory sarcoidosis (just at the stage of its primary detection).