Medico-Biological and Socio-Psychological Issues of Safety in Emergency Situations

Relevance . Studying the dynamics of injury rates, injury types and severity, as well as the treatment quality across various country regions, in particular the Arctic, is a prerequisite for managerial, healthcare, and strategic efficiency prior to and during hospital stay, taking into account the climate, geography, social and economic characteristics of every Russian Federation constituent. The objective is to analyse shock-related injuries in the Arctic zone of the Arkhangelsk region to understand season-related injury dynamics. Methods . Retrospective case series description parameters were used to study 140 patients with traumatic shock admitted to the Arkhangelsk Regional Clinical Hospital (ARCH) - a tier 1 trauma center. The analysed medical registration records included patient ambulance record and token (form 114/u), inpatient medical record (form 003/u), surgery logbook (form 008/u), patient radiographs, CT and nuclear MRI reports, as well as laboratory results. The study was conducted in accordance with ethical standards of the Declaration of Helsinki and European Community Directives (8/906 EC) and was approved by the local ethics committee of the Northern State Medical University of the Russian Ministry of Healthcare, Arkhangelsk (protocol no. 02/4-15 dated 04/08/2015). Statistical application package STATA ver.12 was used for statistical data processing. Results and discussion . The research demonstrated that the incidence of shock trauma is 4 times higher in men than in women. The vast majority of the injured are of working age. Seasonal distribution analysis per type of injuries and shock severity, including due to alcohol abuse, was carried out. The number of shock injuries is highest in winter, mainly due to road accidents which constitute 75.6 % of all injuries in winter. Throughout the year, over 50 % of shock injuries are combined injuries, that outperform isolated and multiple injuries in number. In particular, numerous combined injuries occur in winter with a responsible for almost 60 % among all other injuries. The majority the injured with shock-related trauma presented with stage 2 shock (49.3 %), whereas stage 1 and stage 3 shock was diagnosed in 27.9 % and in 21.4 % respectively. In winter, one in four patients with a shock-related injury presented with stage 3 shock. Alcohol-associated shock injuries are more numerous in summer (35.3 %), showing almost the same incidence as road traffic, domestic, and street injuries. Conclusion . The analysis of various types of injuries and season-related incidence of shock injuries in the Arctic territory of the Arkhangelsk region provides evidence to justify preventive measures to reduce the injury rates. Intensified efforts are required to minimise road traffic accidents in winter and combat alcohol abuse responsible for most injuries in summer. Since the vast majority of shock injuries occur in winter, in cold months ambulances must be equipped with local heating facilities, such as evacuation thermal bags with autonomous electric heating, thermal blankets, infusion warmers for blood transfusion and infusion sets.

S. A. Gudrov

Yu. E. Barachevsky

O. N. Popova

S. V. Bragina

Medico-Biological and Socio-Psychological Problems of Safety in Emergency Situations

Season-dependent characteristics of shock-related injuries in the Arctic zone of the Arkhangelsk region

阿尔汉格尔斯克地区北极地带冲击相关损伤的季节性特征

Relevance . Cardiovascular diseases (CVDs) are the most significant contributor to the global disease burden. CVDs are still the top leader in the nosology of death causes among the population of most countries and globally. Specific climate and geographical conditions in the Russian Arctic are responsible for high CVD risks; poor transport accessibility of some northern territories lead to restricted availability of sophisticated medical care to patients. The objective of the study is to characterize the epidemiology and dynamics of cardiovascular morbidity and mortality among the population of the Komi Republic (KR) throughout 2009 to 2022. Methods . For 2009 through 2022, an epidemiological analytical study (ecological study) was carried out regarding cardiovascular morbidity and mortality among the KR population (in the North-West Russia) using federal statistical observation formats; statistical data were recruited from the Federal State Statistics Service (Rosstat) and the Unified Interdepartmental Information Statistical System (EMISS). Statistical analysis included calculation of mortality-to-incidence ratio (MIR) and incidence-to-prevalence ratio. Results and discussion . For 2009 through 2022, the average annual CVD incidence rate among the KR population stood at (23.1 ± 0.5) ‰, with (277.3 ± 5.9) ‰ prevalence rate. A significant increase (from 21.0 to 29.3 %) in the proportion of coronary heart diseases (CHDs) in the nosology of primary morbidities was noted. The incidence-to-prevalence ratio showed multidirectional dynamics, with positive (growth rate in 2009–2022: +64.5 %) values for arterial hypertension (AH) vs. negative (growth rates: +31.8 and +23.7 %) values for CHDs and cerebrovascular diseases (CCVDs). The cardiovascular mortality rate in 2003–2017 decreased by 29.1 %showing an upward trend since 2018. MIR for CHDs, AH and CCVDs decreased by 33.4, 52.9 and 23.7 % respectively. Conclusion . CVDs remain the main cause of the disease burden in the KR population. The registered trends in morbidity and mortality rates due to major CVDs shows efficient performance of regional cardiology care.

D. A. Korotkov

I. A. Solovyov

E. A. Mordovsky

A. V. Baranov

O. N. Kurochkina

Cardiovascular morbidity and mortality among the population of the Arctic region of Russia

俄罗斯北极地区人口的心血管疾病发病率和死亡率

Relevance . Extreme military service conditions can reduce functional reserves of the military, provoking early development of occupational disorders. The objective is to study morbidity rates dynamics for the last decade (2012–2021) and evaluate the epidemiological significance of different disease chapters among military women to improve their health status. Methods . The study focused on women serving in the Russian military forces with the aim to analyze their morbidity rates over a decade (2012–2021), as presented in the medical report database (3/MED form) and available publications. Medical and statistical codes for main disease chapters are indicated according to the International Statistical Classification of Diseases and Health Related Problems, 10th revision (ICD-10). Morbidity was calculated per 1,000 military women or in ppm (‰), while mortality was calculated per 100,000 persons or 10–5. The average annual indicators calculated based on absolute data, arithmetic averages, errors (M ± m) are provided in study as well. Trends were assessed using dynamic time serie analysis and a second-order polynomial trend. Results and discussion . The long-term average incidence (total morbidity) was 1653.1 ‰, with primary morbidity – 770.6 ‰, regular follow-up – 186.3 ‰, hospitalization – 347.2 ‰, cases requiring a sick leave due to disability – 898.9 ‰, days of disability-related absence from work – 6964 ‰, dismissal rate – 5.11 ‰, mortality rate – 59.2 ∙ 10–5. Polynomial trends in morbidity tracking indicated decreasing trends, with varying significance of determination coefficients. In terms of their social and epidemiological significance, 8 disease chapters (listed in order of severity according to ICD-10) were the major contributors to the military women morbidity: diseases of the respiratory systems (Chapter X), neoplasms (Chapter II), diseases of the circulatory system (Chapter IX), diseases of the musculoskeletal system and connective tissue (Chapter XIII), diseases of the genitourinary system (Chapter XIV), endocrine, nutritional and metabolic diseases (Chapter IV), injury, poisoning and certain other consequences of external causes (Chapter XIX), diseases of the digestive system (Chapter XI). Conclusion . The diseases presented in the above 8 chapters of the ICD-10 were responsible for 87.8 % of socially and epidemiologically significant morbidities. Thus, timely diagnosis, treatment, rehabilitation, and prevention are required to remarkably improve the health status in military women.

E. A. Belova

S. G. Grigoriev

A. V. Shuba

Morbidity rates dynamics among the military women of the Russian Ministry of Defense (2012 to 2021)

俄罗斯国防部女性军人发病率动态（2012年至2021年）

Relevance . As an epidemiologically proven consequence of the Chernobyl NPP accident, circulatory diseases are among the leading morbidities in liquidators. To predict the development of adverse cardiovascular events in patients with metabolic syndrome, there is the ongoing search for informative laboratory markers. The objective is to show how osteopontin, osteoprotegerin, fetuin-A, and risk factors for genetic circulatory disorders are associated with traditional risk factors for circulatory disorders in Chernobyl nuclear power plant accident liquidators suffering metabolic syndrome. Another objective is to explore the perspectives to use these indicators to forecast coronary atherosclerosis progression. Methods . The study group included 50 male liquidators of the Chernobyl nuclear power plant accident who suffered metabolic syndrome. The patients were split in two groups depending on osteopontin concentration in blood serum, i.e. above or under the upper reference limit. Medical history data, biochemical parameters, including inflammatory proteins, osteoprotegerin, fetuin-A, and genotyping of polymorphic variants of genes associated with the risk of circulatory diseases were analyzed. A control group of 30 conditionally healthy men was formed to determine the normal osteopontin, osteoprotegerin and fetuin-A values in blood serum. Results and discussion . With osteopontin value exceeding 21.4 ng/mL, the liquidators’ medical history showed 1.5 times higher frequency of myocardial infarction, 2.5 times higher frequent history of acute cerebral circulation disorder; ischemic heart disease was associated with type 2 diabetes mellitus. It was shown that the group of liquidators (osteopontin over 21.4 ng/ml) was characterized by a reliable increase in atherogenicity coefficient and osteoprotegerin level. Meanwhile, when compared to the control group, the same group of patients showed lower fetuin-A values and elevated high-sensitivity C-reactive protein, homocysteine, leptin and ghrelin. It was found that in liquidators, the presence of the A allele in the vitamin B12-dependent methionine synthase (MTR) gene (2756 A&gt;G) is associated with more pronounced biochemical markers of atherosclerosis progression compared to GG genotype carriers. Conclusion . Osteopontin performs a protective role in tissue damage, being is practically undetectable in normal conditions. However, in case of pathology its value increases dramatically. In patients with metabolic syndrome, decreased fetuin-A and osteopontin values exceeding 21.4 ng/mL require additional examination with a focus on cardiovascular pathology (coronary artery calcinosis), as well as a dual-energy X-ray absorptiometry to ensure early detection of diminished bone mineral density and body mass. It was found that in liquidators, the presence of A-allele (genotypes AA and AG) in the MTR 2756 A&gt;G gene is characterized by deeper atherogenic changes in the lipid spectrum, increased atherogenicity coefficient and decreased adiponectin content. This justifies the need for genotyping to build individual forecast for atherosclerosis progression in this category of patients.

S. S. Aleksanin

E. G. Neronova

L. B. Drygina

N. V. Makarova

New atherosclerosis progression markers in patients with post-Chernobyl metabolic syndrome

切尔诺贝利后代谢综合征患者中新发现的动脉粥样硬化进展标志物

Relevance . Large-scale military conflicts involving a technically well-equipped peer enemy are associated with a higher risk of delayed evacuation of the wounded which therefore requires extended medical care at advanced medical evacuation stages, especially amid absence or shortage of skillful medical professionals. Telehealth can offer solutions to overcome the difficulties in medical care provision amid combat settings. The objective is to study the prospects and efficiency of telemedicine technologies in enhancing availability of medical care during modern military operations. Methods . The PubMed database and the Scientific Electronic Library (eLIBRARY.ru) were used to collect research papers published from 2014 to 2024 studying the development and implementation of telemedicine technologies to backup combat operations. Results and discussion . Consultations by phone together with transfer of photos and text messaging remain the most common technology to provide telehealth assistance in combat settings. Teleconference connection allowing for two-way audio and video communication involving real-time data transfer is a most promising telecommunication format. Telehealth capacities can be expanded by augmented and mixed reality technologies, AI, drones, or robotic surgery. In combat environments, however, using telemedicine is limited by cybersecurity concerns and the signal bandwidth of modern communications systems. An efficient military telemedicine requires an integral centralized system involving multidisciplinary teams of experienced medical consultants providing round-the-clock emergency and routine telemedicine care to military units, including those engaged in combat operations. Conclusion . In combat settings telemedicine technologies have great untapped potential and can contribute largely in terms of evidence-based decision-making in process of medical triage and evacuation, thus optimizing the distribution of medical capacities and resources and improving the results of injury treatment. Although unfit to replace advanced combat medicine training, telemedicine can reinforce existing capacities by providing specialized medical advice to combat medics.

P. A. Seliverstov

Y. G. Shapkin

Telemedicine technologies in combat settings: efficiency and prospects (literature review)

战斗环境中的远程医疗技术：效率与前景（文献综述）

Relevance . Amid international unrest, Russia’s top priority is to augment its defense capacities. The President of Russia decided to increase the army and navy corps by 30 %. To fulfill this task, physically strong and healthy conscripts are required to man the military units. The objective is to analyze medical examination data of drafted young men aged 17 to assess the health profile of conscripts from the Orenburg region. Methods . The study relied on Rosstat statistics for the Orenburg region, as well as reports and records of the Military Medical Expertise Center at the Federal Budgetary Institution “Military Commissariat of the Orenburg Region” collected over a decade’s timespan from 2014 to 2023. Conscripts were split into the following categories labelled by letters of the Russian alphabet: ‘A’ for fit for military service, ‘B’ for fit for military service with minor restrictions, ‘V’ for fit for military service with limitations, ‘G’ for temporarily unfit for military service, ‘D’ for unfit for military service. In addition, conjoined analysis of A &amp; B categories of conscripts fit for military service vs V &amp; D ‘unfit or fit for military service with limitations’ was performed for peace-time settings. The incidence of diseases in conscripts was correlated with relevant chapters of the International Classification of Diseases and Behavioral Disorders (ICD-10); calculations per 1000 conscripts (‰) were carried out. The obtained dynamics across different indicators was studied using dynamic series analysis and second-order polynomial trend; the determination coefficient was calculated as well. Results and discussion. Within the last decade, the number of conscripts in the Orenburg region has not shown any sig nificant dynamics and is likely to remain unchanged in the coming years. The results showed that every 1,000 of examined conscripts included 761 those who were fit for military service, 98 needed treatment or rehabilitation, and 141 were unfit or fit with limitations. The annual disease incidence rate among B &amp; D category conscripts was (141.6 ± 2.6) ‰, standing for 14.1% of all the examined conscripts. In terms of significance, rank 1 was assigned to musculoskeletal and connective tissue (ICD-10, Chapter XIII), rank 2 to mental and behavioral disorders (Chapter V), rank 3 to circulatory diseases (Chapter IX), rank 4 to diseases of the eye and adnexa (Chapter VII), rank 5 to nervous system disorders (Chapter VI). Among all military service exemption causes in conscripts, cumulative specific contribution of these diseases was 61.9%. In 2014-2023, the average of 8.3% of conscripts needed conservative treatment, with treatment provided to 87.1% of those in need of treatment; 1.5% needed surgical treatment (treatment received by 79.4%) and 48.3% needed oral cavity sanitation (79.4% treated accordingly). Conscripts with eye-sight disorders underwent vision correction. Conclusion . Follow-up observation, medical and healthcare initiatives, and extensive promotion of healthy lifestyles allowed to improve the conscripts’ health status. The undertaken measures increased in the overall fitness for military service, allowing to sustainably deliver on Russia’s conscription demands.

S. A. Kuzmin

L. K. Grigorieva

Health profiling of conscripts from the Orenburg region drafted to serve in the Armed Forces of Russia

俄罗斯奥伦堡地区应征入伍者健康状况分析

Relevance . Currently, in the south-west of the Bryansk region, the settlements most affected by the Chernobyl NPP accident show the radiation exposure of about 30 % of the natural level without causing any negative impact on health. However, the settlements are still facing severe social challenges. Throughout the timespan after the Chernobyl accident, significant population decline has been observed in these settlements. Over the past 20 years, the number of residential settlements in the south-west districts of the Bryansk region has decreased by 22 % and the number of residents by 16%. Considering the long-lasting consequences of the Chernobyl disaster, social protection of the accident affected population and the development of radioactively contaminated areas remains relevant so far. The objective is to assess the current demographic situation in the Bryansk region southwestern settlements, most affected by the Chernobyl NPP accident, as well as to justify the shortage of social infrastructure required to ensure the settlements return back to normal conditions. Methods . The study analyses current social problems, including demographics and infrastructure in the five southwestern districts of the Bryansk region, most affected by the Chernobyl NPP accident. Results and discussion. In 2023, the southwestern districts of the Bryansk region included 72 residential settlements (71 rural and the town of Novozybkov) with an average annual effective radiation dose of population exposure above 1 mSv. The total registered population of the settlements is 63,869 people. The share of rural and urban population is 39 and 61 %, respectively. A difficult demographic situation was noted in the populated areas of the Chernobyl accident zone. Thus, the share of persons under working age (0–15 years) does not exceed 17 % of the total population. Social infrastructure demands were assessed to ensure wellbeing of the population in the Bryansk region districts, most affected by the Chernobyl NPP accident. Conclusion . In the rural settlements where the population is exposed to an average annual effective radiation dose above 1 mS, assessment and audit of the existing social infrastructure is required with follow-up efforts to eliminate the shortages, if any, to comply with modern norms and standards.

A. V. Panov

R. A. Mikailova

V. V. Krechetnikov

Social aspects of rehabilitation of the Bryansk region settlements affected by the Chernobyl NPP accident

切尔诺贝利核电站事故影响下布良斯克地区定居点重建的社会方面

Relevance . Few studies have identified changes in the social wellbeing of the youth throughout the COVID-19 pandemic. The objective is to assess the emotional status of young medical workers involved in medical care during COVID-19. Methods . The study was carried out in spring 2024 in the format of an online survey. The responses were assessed using a scale specifically developed for the survey to assess respondent’s emotional state as ‘favorable’, ‘unfavorable’, or ‘average’. 135 male and 164 female medical workers were interviewed. The respondents’ age ranged from 20 to 35 years, allowing to consider them representing the youth as a social group. Their work experience in providing medical care to COVID-19 patients ranged from 6 to 24 months or more. Statistica 10.0 software package was used for statistical data processing. Results and discussion. Among the interviewed young medical workers, 20.0 % (95 % CI 15.5–24.8) assessed their emotional state as ‘unfavorable’ and 18.4 % (95 % CI 14.1–22.7) as ‘favorable’. Medical workers with 12 to 24 or more months of experience in providing medical care to COVID-19 patients were significantly less likely (p ≤ 0.05) to refer to their emotional state as ‘favorable’ and significantly more likely (p ≤ 0.05) to report anxiety, the need for non-stop motion, and inability to stand still or stay seated in one place. The group of medical workers reporting ‘unfavorable’ emotional state included 54.7 % (95 % CI 49.1–60.3) contested that before starting the job in COVID-19 departments, they had only been instructed, interviewed by the management, and trained right on the job. Meanwhile, ‘favorable’ emotional state was associated with prior training throughout CME cycles. This group of young medical workers also reported practicing one of two preventive strategies, i.e either a combination of sports, adequate physical activity, and “healthy eating” or sport, adequate physical activity, and sleep schedule, thus showing the respondents’ commitment to healthy lifestyles. Conclusion . In in young medical workers, providing medical care to COVID-19 patients is accompanied by deteriorated emotional state. This process can intensify with increasing work experience. Lack of training throughout CME cycles prior to work is an unfavorable factor. Adherence to healthy lifestyles is the most common strategy among young healthcare workers to prevent adverse emotional states.

O. Y. Milushkina

V. I. Popov

N. A. Skoblina

S. V. Markelova

E. V. Astashkevich

M. K. Karolina

The emotional state of young medical workers involved in medical care for COVID-19 patients

参与新冠肺炎患者医疗护理的年轻医务人员的情绪状态

Relevance . Participants of armed conflicts are exposed to extreme stress amid life-threatening situations, which can lead to mental adaptation disorders exacerbated by combat stress disorders. Combatants facing these conditions require psychological correction and psychotherapy. The objective is to assess the risk of mental adaptation disorders in combatants using traditional diagnostics and fasts screening methods. Methods . A cohort of 163 combatants who participated in the special military operation underwent clinical and psychological examination. The average age of subjects was 34.3 years, and the average time of service in the special military operation was 8.2 months. The combatants’ psychological status was evaluated using the Mississippi Scale (military version), the Beck Depression Inventory, and the Beck Anxiety Inventory. In addition, a set of screening methods, like PC-PTSD-5, PHQ9, and GAD-7, were used to evaluate the risk of mental maladaptation, depressive symptoms, and anxiety. In the course of examination, the reliability of responses was assessed using 10 adapted questions for sincerity evaluation obtained from a standardized personality assessment method. The present study shows the median value, as well as the upper and lower quartiles (Me [Q1; Q3]). The consistency of the studied indicators was evaluated using Spearman’s rank correlation coefficient. Results and analysis. The average sincerity score was 7 [6; 8] points, showing sufficient reliability of the examination results. The psychological test results re concordant with the overall transformation pattern in the functional and mental profile of stress exposed combatants, depending on the duration of exposure to combat conditions. The average Mississippi Scale scores were 71 [63; 84] points, and 2 [1; 3] points on the PC-PTSD-5, associated with absence of mental adaptation disorders and a low probability of PTSD, respectively. PTSD clinical symptoms were identified in 3.7% of the examined combatants (compared to 14.3% in foreign publications), and mental adaptation disorders were observed in 8.6%. All these methods showed moderate, positive, and statistically significant (r = 0.627; p &lt; 0.001) consistency of obtained indicators. The average Beck Depression Inventory score was 7 [3; 12] points, and the PHQ-9 score was 5 [3; 8] points, suggesting absence or mild depression, respectively. The methods demonstrated strong, positive, and statistically significant (r = 0.799; p &lt; 0.001) consistency among the indicators. The average Beck Anxiety Inventory score was 10 [4; 18] points, and the GAD-7 screening method score was 5 [2; 6] points, corresponding to low or moderate anxiety. For both methods, the consistency among indicators was moderate, positive, and statistically significant (r = 0.567; p &lt; 0.001). Conclusion . The study justified the reliability of results obtained by traditional tests and screening methods, showing trustworthy indications for psychological correction (psychotherapy) in the examined combatants.

V. K. Shamrey

V. I. Evdokimov

M. P. Pluzhnik

Indicators of mental adaptation disorders in combatants of the special military operation

特别军事行动参战人员心理适应障碍指标

Publication Information	Publisher: Nikiforov Russian Center of Emergency and Radiation Medicine, EMERCOM of Russia，Publishing cycle: ，Journal Type: journal，Open Access Journals: No
Basic data	Year of publication: 2019，Proportion of original research papers: 0.00%，Self Citation Rate:N.A.， Gold OA Rate: 0.00%

Medico-Biological and Socio-Psychological Issues of Safety in Emergency Situations

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Share Submission Experience

Season-dependent characteristics of shock-related injuries in the Arctic zone of the Arkhangelsk region

Cardiovascular morbidity and mortality among the population of the Arctic region of Russia

Morbidity rates dynamics among the military women of the Russian Ministry of Defense (2012 to 2021)

New atherosclerosis progression markers in patients with post-Chernobyl metabolic syndrome

Telemedicine technologies in combat settings: efficiency and prospects (literature review)

Telemedicine technologies in combat settings: efficiency and prospects (literature review)

Health profiling of conscripts from the Orenburg region drafted to serve in the Armed Forces of Russia

Social aspects of rehabilitation of the Bryansk region settlements affected by the Chernobyl NPP accident

The emotional state of young medical workers involved in medical care for COVID-19 patients

Indicators of mental adaptation disorders in combatants of the special military operation

ISSN	1995-4441, 2541-7487
h-index	5