The mortality rate of the working-age population is an important indicator of the state of national security of the country, which requires a more detailed study, respectively, the development of measures to reduce the mortality rate of the working-age population. The purpose of the study: to analyze the mortality of the working-age population in the Chelyabinsk region, Russia and the Urals Federal District. Material and methods. The level, dynamics, structure, gender characteristics of mortality in the working-age population have been studied. Results and conclusions. It was revealed that in all the studied populations during the period of the study there is a steady increase in the mortality rate of the working-age population, the mortality of men significantly prevails over the mortality of women of working age. At the same time, the rate of increase in the mortality rate for women of working age exceeds that for men in all studied populations. The data obtained indicate the need to improve medical care for the working-age population, to restore the health care system for the working population. Key words: mortality of the working-age population, level, dynamics, structure of causes of death.

Elderly people are an integral part of society that deserves not only attention, but also the creation of high-quality conditions for their decent lifestyle, including active longevity. For Russia, issues related to the aging of the population are extremely relevant, since this process is taking place against the backdrop of relatively low life expectancy, as well as the continuing high mortality of the working-age part of the population, especially now that the retirement age threshold has been raised. The purpose of the study was to study the opinions of veterans (pensioners) to determine the level of their satisfaction with the medical care and drug provision. Research method - questioning on a standardized questionnaire. The study used a questionnaire approved by the All-Russian Public Organization of Veterans (Pensioners) of War, Labor, the Armed Forces and Law Enforcement Agencies. An analysis of the results of a sociological study was carried out, the purpose of which was to study the opinions of veterans (pensioners) on determining the level of their satisfaction with the medical care and drug provision. significant for veterans (pensioners) problems of access to medical care and drug provision, as well as low satisfaction with the quality of medical and drug provision of veterans (pensioners). The data obtained can be used to develop a set of measures to improve the availability and quality of medical care for veterans (pensioners) and, as a result, increase their satisfaction with the medical care provided and drug provision.

The aim of the study is to investigate the risk factors of radiation and non-radiation nature influencing the mortality among patients examined using PET-CT. Material and methods. The data for the period from 2010 to 2019 were analyzed. In a multivariate model using logistic regression, the significance of the impact of risk - the ionizing radiation due to radiation therapy, computed tomography, occupational exposure of workers, as well as non-radiation risk factors such as gender, age, stage of malignancy and chemotherapy has been analyzed. Results and conclusions. The study showed a significant increase in the mortality depending on stage of malignancy, as well as amount of previous computed tomography examinations. There was no significant relationship with age at first examination, gender of the patient, the number of PET studies performed, and radiation therapy for overall mortality among patients examined using PET-CT.

The aim of the study is to identify and systematize the coping strategy of patients diagnosed with colon cancer. Material and methods: 47 people aged 29 to 79 years (mean age 61 years) took part in the detection, the incidence of malignant neoplasms emanating from the intestinal epithelium (colon cancer), of various stages with a pronounced differentiated tumor. All respondents found at least 3 months from the oncologist from the moment of diagnosis, which was observed in the territory of the Chelyabinsk region and the Chelyabinsk region, they are on inpatient treatment at the Chelyabinsk Regional Cancer Center of Oncological and Nuclear Medicine. To collect empirical material, we used the psychodiagnostic survey method “Methods of Coping Behavior” by R. Lazarus (adapted by T. L. Kryukova). The results of the study of coping behavior in patients with colon cancer, that the predominant coping strategy is "self-control", and fever is pronounced "acceptance". The coping strategies "escape-avoidance", "problem solving planning" and "positive reassessment" are at a fairly high level of expression, while the level of expression of the coping strategies "confrontational coping", "distancing" and "search for social support" is below average. Conclusions: The analyzed coping strategies make it possible to predict the patient's behavior during treatment. Data on this basis have been obtained for the development of a program for the development of coping behavior in patients with a type of oncology.

Abstract. Objective: to evaluate the effect of folic acid (FA) supplementation on the efficacy and tolerability of tablet and injectable forms of methotrexate (MT) in patients with rheumatoid arthritis (RA).
Materials and methods: the case histories of 170 patients with a reliable diagnosis of RA were retrospectively analyzed. The age of the patients was 53.7±10.9 years.All patients received MT therapy for 6 to 144 months (87.4±6.9) at a dose of 7.5 to 20 mg/week (14±3.8). Patients were divided into two groups: those who received and those who did not receive standard FC supplements at a dose of 5 mg/week. The efficacy and tolerability of different forms of MTs depending on the prescriptions with FC were evaluated. The efficacy of therapy was determined by the dynamics of the DAS28 index. Tolerability was determined by the frequency of adverse events (AEs): stomatitis, cytopenia, dyspepsia, elevated transaminases.
Results: First, a statistically significant predominance of the efficacy of MT without FC supplementation was found: p=0.02 and OR=0.46; 95%CI 0.23 to 0.91, and specifically its injectable form: pБ 0.001, OR=16.3; 95%CI 5.08 to 51.3. Second, synthetic FC may increase the frequency of side effects: p=0.004, OR=2.52; 95%CI 1.35 - 4.95. Administration of the subcutaneous form of MT without FC supplementation was not associated with an increased incidence of adverse reactions compared to the tablet form: p< 0.001, OR=25; 95%CI 7.7 - 80.7 and compared to patients who received MT injections with FC: p=0.002, OR=0.2; 95%CI 0.1 - 0.6. Additional intake of FC does not affect the correction of side effects when using MT injections and in some cases is able to level them when using the tablet form.
Conclusion: The results of the observation suggest that the subcutaneous form of MT has a greater therapeutic effect compared to the tablet form. The maximum therapeutic potential can be achieved with the injectable form of MTs without the addition of FC. The feasibility of routine use of PC in MT therapy with RA is questionable. Synthetic PC can both increase the frequency of adverse events of oral MTs and neutralize them. It is possible that the multidirectional effects are related to folate levels in the body. The development of side effects in some cases is corrected by supplementation with synthetic FA.

Comorbid pathology aggravates the underlying disease, leads to a change in the clinical picture and becomes a complication leading to death. To assess the prediction of the quality of life and the risk of an adverse outcome in patients with comorbidities, various scales and indices for measuring comorbidity were considered. А comparative analysis of methods for measuring comorbidity frequently encountered in Russian studies is presented, presented by a modern scientific work describing methods for studying comparable diseases. The Charlson index is the most common and convenient method for predicting cases of comorbid pathology.

The aim of the study is to study the features of anamnesis, outcomes of pregnancy and childbirth from woman with placenta previa. Materials and methods. Retrospective cohort study by continuous sampling method: Group 1 - 64 patients with placenta previa, group 2 – 30 women with normal childbirth. The anamnesis of women and pregnancy outcomes were studied. Statistical calculations: Mann-Whitney criteria, χ2 Pearson. Results and сonclusions. Risk factors for placenta previa turned out to be burdened obstetric and gynecological history (abortions, premature birth, cesarean section), low socio-economic status, somatic pathology (overweight / obesity, anemia, varicose veins, gastrointestinal tract diseases). Placenta previa is associated with a high frequency of genital infection, the threat of miscarriage, placental disorders, premature birth, cesarean section, bleeding, decreased morphofunctional indicators of newborns, perinatal morbidity and mortality.

The aim is to describe a rare clinical case of surgical intervention for PJA of the abdominal aorta complicated by rupture. Materials and methods: the results of instrumental research methods were analyzed: multislice computed tomography-angiography (MSCTangiography) of the thoracic, abdominal aorta and iliac arteries, echocardioscopy, ultrasound duplex scanning of the brachiocephalic arteries, magnetic resonance imaging (MRI) of the lumbar spine and head brain, ultrasound examination (ultrasound) of the abdominal organs. Results. The patient underwent an aneurysmectomy of the abdominal aorta from the renal arteries to the bifurcation of the iliac arteries with aortobiiliocal prosthesis with a synthetic INTERGARD prosthesis 18/9/9 mm of the end-to-end type. There were no intraoperative complications. The patient spent 7 days in resuscitation, after 12 days from surgery he was discharged for the outpatient stage of treatment in a satisfactory condition. Conclusion. A penetrating atherosclerotic ulcer is a life-threatening condition that requires aggressive surgical treatment when detected.

The aim of this work was a comprehensive analysis of a two-stage treatment strategy - isolated endovenous laser ablation (EVLA) of the main superficial vein, followed by assessment of the left suprafascial tributaries and their elimination, if necessary. Material: in a prospective study we analyzed the results of treatment of 374 patients who had 420 EVLA of the truncal superficial veins. Results: at the second month, in 83 (19.8%) limbs was complete regression of tributaries. In 276 (65.7%) cases, a significant decrease in the number of tributaries or their diameter was noted. There was no clinical improvement in 61 (14.5%) limbs. At the sixth month 98 (23.3%) limbs were assigned to the first group, 265 (63.1%) to the second, and in 57 (13.6%) cases the tributaries remained unchanged. In 271 cases with chronic venous disorders symptoms, they regressed on 220 (81.2%) limbs at the second, and on 226 (83.4%) at the sixth month. Thrombophlebitis of the left suprafascial veins developed in 46 (10.9%) limbs. Conclusions: 1) Complete regression of tributaries was observed in 19.8% of the limbs at the second, and in 23.3% at the sixth month. In 63.1–65.7% of cases, there was a significant decrease of the number of tributaries or their diameter. 2) Symptoms of chronic venous disorders regressed in 83.4% of the extremities by the sixth month. 3) The incidence of thrombophlebitis of the tributaries was in 10.9% of cases.

The aim of the study was to evaluate the current range of para-implant complications after metal osteosynthesis and joint prosthetics and to study the features of the course of the wound process with various methods of their treatment. Material and methods. The materials of a comparative analysis of 64 clinical cases of paraprosthetic and paraimplant complications are presented, in the treatment of which various modern approaches were used to influence the inflammation focus. The results of cytomorphological studies revealed two types of inflammatory reaction of paraimplant tissues, one of which is dominated by the processes of purulent inflammation, and in the other there are manifestations of the granulomatous nature of the tissue response. Analysis of local immune reactions revealed a direct correlation between the level of phagocytosis activity and the proportion of wound macrophages, lymphocytes, or polynuclear cells, depending on the local management of the wound process. A higher activity of cellular immunity during treatment under vacuum therapy determined a 1.4-2.9-fold reduction in the elimination of pathogens and the transition of the wound process to the stage of regeneration, and was also accompanied by a decrease in the proportion of multinucleated cells and lymphocytes in the granulomatous type of inflammatory reaction. Conclusions. The revealed effects of locally controlled negative pressure exposure open up possibilities for cytoregulation and control of reactions of purulent and granulomatous inflammation and improvement of the results of treatment of paraimplant complications in purulent surgery and traumatology.

Surgical treatment of hiatal hernia and GERD with the use of fundoplications and cruroraphy is accompanied by relapses in 18-50% of cases. The highest risk of recurrence in patients suffering from hiatal hernias of types III and IV, recurrent hiatal hernias, obesity, diabetes mellitus, hiatal hernia and GERD after sleeve gastrectomy. Since 2017, in the above nosological groups, we have been using laparoscopic Collis surgery with Roux-en-Y gastric bypass to correct hiatal hernia and GERD. 187 operations were performed. Recurrence of hiatal hernia and GERD in the follow-up period of up to five years have not been registered. In the long–term postoperative period, one complication was found - peptic ulcer of gastrojunoanastomosis. The cause of the complication is the length of the gastric tube more than 5 cm. A gastrojunoanastomosis resection was performed with a shortening of the gastric tube to 5 cm and the formation of a new gastrojunoanastomosis with a good long-term result. Conclusion: Collis surgery with Roux-en-Y gastric bypass is an effective and safe procedure for the correction of hiatal hernia and GERD.