[MR morphometry in epileptology: progress and perspectives]. / Primenenie MR-morfometrii v epileptologii: dostizheniya i perspektivy.

Morphometric MRI analysis improves neuroimaging of structural changes in epilepsy. OBJECTIVE: To investigate diagnostic potential of MR brain morphometry in neurosurgical epileptology. MATERIAL AND METHODS: An interdisciplinary working group reviewed the studies devoted to MR morphometry in epileptology as a part of state assignment No. 056-00119-22-00. Study subject was trials of MR-morphometry in epilepsy. Searching for literature data was conducted in international and national databases between 2017 and 2022 using certain keywords. Final analysis included 36 publications. RESULTS: Currently, MR brain morphometry allows measurement of cortical volume and thickness, surface area and depth of furrows, as well as analysis of cortical tortuosity and fractal changes. In neurosurgical epileptology, MR-morphometry has the greatest diagnostic value in MR-negative epilepsy. This method simplifies preoperative diagnosis and reduces costs. CONCLUSION: Morphometry in neurosurgical epileptology is an additional method for verifying the epileptogenic zone. Automated programs simplify application of this method.

[Gender differences in the volume of brain structures in the aspect of physiological aging.]

The aim of the work was to clarify the gender, age and variable differences in the structure of brain structures in healthy volunteers in connection with the task of distinguishing between physiological aging and pathological processes of the brain. The study methods included performing structural MRI of the brain in 131 conditionally healthy volunteers aged 20 to 70 years (72 of them were women and 59 men). Using the method of MR voxel-based morphometry, the total volume of the brain as a whole, as well as its segmented parts, was measured, followed by a comparison of the data obtained in age subgroups and between the sexes. The data obtained in the course of the study indicate that the right and left thalamuses, the left caudate nucleus, the right shell, the left pale ball, and both hippocampus undergo the greatest reduction in size after 60 years. The greatest changes in the hippocampus are the volumes of CA3 Brodman fields. It is established that the process of «physiological aging¼ of the brain.

[Prostate cancer and dogs sense of smell: opportunities of noninvasive diagnostics].

INTRODUCTION: A screening of prostate cancer is an important problem of healthcare system worldwide. AIM: To evaluate a possibility and efficiency of Belgian Malinois dogs sense of smell in diagnosis of prostate cancer. MATERIALS AND METHODS: Urine samples from 176 men were assessed. Of these, 112 samples were taken from patients with biopsy-proven prostate cancer, and 64 from healthy young men. The study with two Belgian Malinois dogs consisted of two stages. The first stage was to train the dogs to distinguish the urine of patients with prostate cancer. A total of 66 urine samples were used at this stage (from 42 patients with prostate cancer and 24 healthy people). At the second detection stage, urine samples of patients with prostate cancer was identified. A total of 110 urine samples were evaluated (70 patients with prostate cancer and 40 healthy people). RESULTS: The first dog correctly identified 68 samples from patients with prostate cancer, and in 37 cases it indicated the absence of disease (sensitivity 97.1%, specificity 92.5%, accuracy 95.4%). The second animal correctly identified 69 and 39 samples, respectively (sensitivity 98.6%, specificity 97.5%, accuracy 98.2%). CONCLUSION: A possibility of training dogs to identify patients with prostate cancer has been demonstrated. Further studies dedicated to the detection of volatile organic compounds in the urine using specialized analyzers of "electronic nose" type, as well as gas chromatography in combination with mass spectrometry, are of both scientific and practical interest.

Neurological disorders in vitamin B12 deficiency.

The review discusses thesteps of vitamin B12 metabolism and its role in maintaining of neurological functions. The term "vitamin B12 (cobalamin)" refers to several substances (cobalamins) of a very similar structure. Cobalamin enters the body with animal products. On the peripherу cobalamin circulates only in binding with proteins transcobalamin I and II (complex cobalamin-transcobalamin II is designated as "holotranscobalamin"). Holotranscobalamin is absorbed by different cells, whereas transcobalamin I-binded vitamin B12 - only by liver and kidneys. Two forms of cobalamin were identified as coenzymes of cellular reactions which are methylcobalamin (in cytoplasm) and hydroxyadenosylcobalamin (in mitochondria). The main causes of cobalamin deficiency are related to inadequate intake of animal products, autoimmune gastritis, pancreatic insufficiency, terminal ileum disease, syndrome of intestinal bacterial overgrowth. Relative deficiency may be seen in excessive binding of vitamin B12 to transcobalamin I. Cobalamin deficiency most significantly affects functions of blood, nervous system and inflammatory response. Anemia occurs in 13-15% of cases; macrocytosis is an early sign. The average size of neutrophils and monocytes is the most sensitive marker of megaloblastic hematopoiesis. The demands in vitamin B12 are particularly high in nervous tissue. Hypovitaminosis is accompanied by pathological lesions both in white and gray brain matter. Several types of neurological manifestations are described: subacute combined degeneration of spinal cord (funicular myelinosis), sensomotor polyneuropathy, optic nerve neuropathy, cognitive disorders. The whole range of neuropsychiatric disorders with vitamin B12 deficiency has not been studied well enough. Due to certain diagnostic difficulties they are often regarded as "cryptogenic", "reactive", "vascular¼ origin. Normal or decreased total plasma cobalamin level could not a reliable marker of vitamin deficiency. In difficult cases the content of holotranscobalamin, methylmalonic acid / homocysteine, and folate in the blood serum should be investigated besides carefully analysis of clinical manifestations.

[Trends in stroke mortality rates in Russia and the USA over a 15-year period]. / Dinamika pokazatelei smertnosti naseleniia ot ostrogo narusheniia mozgovogo krovoobrashcheniia v Rossii i SShA za 15-letnii period.

AIM: to comparatively analyze standardized mortality ratios (SMR) from stroke in the populations aged over 30 years in the Russian Federation and in the USA over a 15-year period. MATERIAL AND METHODS: The analysis included nontraumatic subarachnoid hemorrhage (NTSH) (a group of ICD-10 codes I60), nontraumatic intracerebral hemorrhage (NTIH) (I61), cerebral infarction (CI) (I63), and stroke, not specified as hemorrhage or infarction (SNSHI) (I64). The new European standard (European Standard Population.2013) was used for standardization. The data of the Federal State Statistics Service of the Russian Federation, those of the World Health Organization Mortality Database (WHO MD) and Human Mortality Database (HMD) for the USA were applied. RESULTS: During the considered period, 30-49-year-old Russian men showed a reduction in SMRs from NTSH (I61) by 9.0% (from 18.9 to 17.2 per 100,000 population), from SNSHI (I64) by 10 times (from 12.5 to 1.3); SMRs from CI (I63) increased by 4.3% (from 6.9 to 7.2). In men aged 50 years and older, SMRs from NTIH and SNSHI decreased by 32.3% (from 143.2 to 97.0) and by 10 times (from 580.8 to 60.6), respectively; those from CI increased by 13.8% (from 229.8 to 261.4). In the USA, 30-49-year-old men displayed 26.1% and 2-fold decreases in SMRs from NTIH (from 2.5 per 100,000 population in 1999 to 1.7 in 2013) and CI (from 1.8 to 0.9), respectively; those from SNSHI remained unchanged (1.3). In men aged 50 years and older, SMRs from NTIH, CI, and SNSHI reduced by 39.7% (from 29.0 to 17.5), by 2 times (from 1.8 to 0.9), and by 2 times (143.0 to 72.5), respectively. 30-49-year-old Russian women exhibited a 22.2% reduction in SMRs from NTIH (from 9.0 to 7.0), a 4.3% increase in those from CI (from 2.7 to 2.8), and an 11-fold decrease in those from SNSHI (from 5.5 to 0.5). Women aged 50 years and older showed changes in SMRs from the codes in the same sequence from 105.6 to 60.5, from 172.8 to 189.6, and from 466.5 to 43.7, respectively. In the USA, 30-49-year-old women displayed reductions in SMRs from NTIH by 10.0% (from 1.5 to 0.9), from CI by 33.3% (from 0.3 to 0.2), and from SNSHI by 10% (from 1.0 to 0.9). Women aged 50 years and older exhibited changes in SMRs from the codes in the same sequence from 24.0 to 14.8), n those from CI (from 20.6 to 6.7) and from SNSHI (from 6.5 to 10.3). CONCLUSION: In Russia, the reduction in mortality rates from the above causes (which is most significant from that in NTSH may be associated with both medical and socioeconomic factors, including with the improved prevention and organization of medical care. The differences in SMRs between the two countries may be related to the principles in the organization and control of coding of the causes of death.

[Comparative analysis of mortality from acute forms of ischemic heart disease during a 15-year period in the Russian Federation and the United States and the factors influencing its formation]. / Sravnitel'nyi analiz smertnosti naseleniia ot ostrykh form ishemicheskoi bolezni serdtsa za piatnadtsatiletnii period v RF i SShA i faktorov, vliiaiushchikh na ee formirovanie.

AIM: To comparatively analyze the registered mortality rates from coronary heart disease (CHD) as a whole, as well as myocardial infarction (MI) and other acute forms of CHD during a 15-year period in the Russian Federation (RF, 2000-2014) and the United States of America (USA, 1999-2013). MATERIAL AND METHODS: Primary data were obtained from the database of the RF State Statistics Service, the World Health Organization Mortality Database, Human Mortality Database, then converted into standardized mortality rates and are presented in three age groups (30+, 30-49, and 50+ years old) in men and women separately. RESULTS: The analysis revealed a substantial excess of the registered mortality rates from CHD in the RF versus in the USA, as well as a lower incidence of MI and a higher incidence of other acute CHD forms registered as the cause of death. It also showed considerable differences in the structure of registered types of MI as the cause of mortality. CONCLUSION: The differences found in the mortality rates from CHD, MI, and other acute forms of CHD in the RF and the USA can be explained by objective (the higher prevalence of cardiovascular risk factors, the higher and earlier incidence of CHD in the RF, as well as differences in the organization of medical care and, as a result, actually higher mortality rates from CHD in Russia) and subjective (differences in approaches to statistically developing a population-based mortality rate, as well as defects in filling out the medical documents and coding the causes of death) factors.

[Assessment of the Possibility of Comparing Mortality Rates from Diseases of the Circulatory System in the United States and Russia].

OBJECTIVE: to compare and discuss causes of differences between standardized mortality rates (SMR) from diseases of the circulatory system (DCS) among men and women older than 50 years in Russia and USA. MATERIAL AND METHODS: Data on mortality rate in the USA were taken from WHO mortality database (WHO MD), those on the USA population by 5-years age bands from Human Mortality Database (HMD). Information on mortality rates in Russia was obtained from Rosstat. In analysis we used age-adjusted death rates and SMR for DCS or ages more or equal 50 years. For standardization of mortality rates we used data of the European Standard Population 2013. RESULTS: By 23 3-digit codes mortality rates among men in USA were higher than in Russia (in the structure of mortality among women there were 28 such codes). Portion of such deaths in Russia in total number of DCS deaths was 6.5% both for men and women, while figures for USA were 36.8 and 40%, respectively. About 99% of differences in SMR from DCS between countries were determined by 8 and 6 groups of causes in men and women, respectively. Analysis of 4-digit ICD codes showed that almost 40% of DSC class deaths both in Russia and USA had the forth digit of ICD-10 code 8 or 9 and were accompanied by wording "other" or "unspecified" or formulation of diseases which were not used in clinical practice and were absent in both guidelines issued by Russian or American professional societies. Despite existence of ICD rules the conducted analysis allows to state that those rules could be interpreted differently in various countries. This resulted in obtaining noncomparable data. CONCLUSION: Comparison of mortality rates in USA and Russia based on existing ICD coding rules cannot be correctly performed. Therefore, this comparison does not allow to assess contribution of financing and organization of medical service in differences in mortality rates between two countries.

[High life expectancy of Muscovites at old ages: reality or statistical artifact?]

Since the mid-2000s, after a few decades of negative trends and fluctuations, Russia has experienced the longest and most stable period of life expectancy increasing for the entire period of observation which was determined not only by a decrease in mortality at the middle ages, but also at the old ages. This period has been marked by a very fast increase in life expectancy of Muscovites. The paper shows that the mortality at old ages in Moscow systematically deviates from the patterns observed in economically developed countries with reliable mortality statistics. We assume that experience of these countries is applicable to regions of Russia. Based on this assumption the adjusted estimates of life expectancy at old ages in Moscow and Russia were calculated, as well as effect of the underestimation of mortality over age 80 on life expectancy at birth and at the age of retirement.

[Neurosurgical aspects of the treatment of neuroblastoma patients]. / Neirokhirurgicheskie aspekty lecheniya bol'nykh s neiroblastomoi.

Neuroblastoma (NB) is the most common extracranial solid tumor in children. The neoplasm grows from progenitor cells of the sympathetic nervous system and can be detected anywhere along the sympathetic neurological circuit: retroperitoneally, mediastinally, cervically, and pelvically. Examination of children with suspected neuroblastoma is comprehensive and performed in strict compliance with a therapeutic protocol. A decision on the treatment regimen is made based on the tumor staging and the risk group of the patient. The diagnosis and treatment of NB patients are comprehensive and can be fully carried out only at the pediatric oncology department. In 10-15% of cases, an hourglass tumor spreads to the intervertebral foramina or spinal canal at one or more levels. A tumor node is always located extradurally with respect to the spinal cord. Symptoms of spinal cord compression of various severity are observed in 5-7% of patients. We present several cases of patients with neuroblastoma with intraspinal extension. Despite apparent benefits of primary surgical decompression of the spinal cord, modern experience of treatment of children with intraspinal tumor extension does not reveal advantages of surgery over chemotherapy. Neurological disorders of various nature and severity persist in the majority of patients in the long-term period, regardless of primary treatment. A higher level of spinal deformities after surgical tumor resection is observed. The issue of spinal cord decompression should be discussed by the neurosurgeon and pediatric oncologist, and the most common method of choice may be chemotherapy. The article discusses the indications and contraindications for neurosurgical interventions in NB patients and addresses the issues of NB metastasis to the brain and cranial bones as well as the opsoclonus-myoclonus syndrome.

[Thoracoscopic operations for neurogenic tumors in children].

AIM: To present an overall experience of endoscopic operations in children with neurogenic tumors in two medical institutions. MATERIAL AND METHODS: Thoracoscopic excision of tumors was performed in 19 children aged 1 month-7.5 years (mean 1.5 years) in two clinics for the period 2010-2014. In 9 children (47.3%) age did not exceed 1 year. In our study ganglioneuroma was diagnosed in 9 cases, ganglioneuroblastoma--in 2 patients, neuroblastoma stage I--in 8 cases. All patients were under observation and treated according to NB2004 protocol. Tumor's diameter ranged from 1 to 6 cm (mean 4.9±1.9 cm). Mean duration of surgery was 62±22 minutes. There were no any intraoperative complications. Early postoperative period in all patients after endoscopic surgery was more favorable than in those after open operations. Any local recurrences were not observed for the follow-up period. RESULTS: Thoracoscopic operations can become more preferable method in treatment of children with neurogenic tumors if great vessels are not involved into neoplastic process and limited volume of tumor is absent.

[Rapid increase in maximal country specific life expectancy across cohorts].

Linear increase in the best-practice (maximal among countries) life expectancy, known as the Oeppen-Vaupel line, is the most demonstrative image of longevity progress. This study is devoted to the analysis of trends in best-practice life expectancy across cohorts born in 1870 to 1950. Other than the conventional period life expectancy, cohort life expectancy measures the lifetime of real individuals from the population under consideration. Since mortality is mostly decreasing with time, period life expectancy in a given year is usually lower than cohort life expectancy for people born in the same year. The corresponding gap between period and cohort life expectancies increases with time. Our analysis is based on data for 24 developed countries from the Human Mortality Database for the period 1870 to 2008. To estimate life expectancy for non-extinct cohorts, we apply the Lee-Carter model to extrapolate mortality rates until the year 2050. The annual increase in the best-practice cohort life expectancy across cohorts born in 1870 to 1950 is 0,43 year, while the annual increment in the period life expectancy across the same range of years is equal to 0,28 year. The best-practice cohort life expectancy has increased from 53,7 years in 1870 to 83,8 years in 1950. During this time the gap between period and cohort life expectancies has increased from 1,2 to 10,3 years. Cohorts born in 1920 to 1950 will live longer than one can expect by looking at respective period mortality patterns. For these cohorts, the longest part of their additionally gained lifetime will be spent at ages 65 and older. This substantially changes the distribution of human lifetime among different stages of the life cycle.

[Physico-chemical characteristic of medicinal preparations for intrabladder electrophoresis in patients presenting with bladder diseases (an experimental study)].

The physico-chemical characteristic of medicinal preparations used for the treatment of various bladder diseases is provided including their electrophoretic activity and the ability to penetrate into bladder tissues, e.g. during electrophoresis. The optimal parameters of intracavitary electrophoresis are considered.

Prevalence and socio-economic distribution of hazardous patterns of alcohol drinking: study of alcohol consumption in men aged 25-54 years in Izhevsk, Russia.

AIM: To estimate the prevalence of hazardous drinking and its socio-economic distribution among Russian men. DESIGN: Participants were an age-stratified, population-based random sample of men aged 25-54 years living in Izhevsk, a city in the Urals, Russia. Interviewers administered questionnaires to cohabiting proxy respondents about behavioural indicators of hazardous drinking derived from frequency of hangover, frequency of drinking beverage spirits, episodes in the last year of extended periods of drunkenness during which the participant withdraws from normal life (zapoi), consumption of alcoholic substances not intended to be drunk (surrogates) and socio-economic position. Logistic regression was used to examine associations between socio-economic position and indicators of hazardous drinking in the past year. FINDINGS: Of 1750 men, 79% drank spirits and 8% drank surrogates at least sometimes in the past year; 25% drank spirits and 4% drank surrogates at least weekly and 10% had had an episode of zapoi in the past year. After adjustment for other socio-economic factors, education was strongly associated with indicators of hazardous drinking. Men with the lowest level of education compared to the highest level of education had an odds ratio of surrogate drinking of 7.7 (95% CI 3.2-18.5), of zapoi of 5.2 (2.3-11.8) and of frequent hangover of 3.7 (1.8-7.4). These indicators of hazardous drinking were also independently strongly associated with being unemployed (versus employed) and with levels of household wealth/amenities. Associations of all these variables with daily consumption of beverage spirits were weaker. CONCLUSION: Using a novel range of indicator variables of hazardous drinking, this paper shows that the prevalence of these behaviours is high among working-age men in this Russian city. Moreover, these hazardous behaviours show very clear socio-economic patterns, with particularly high prevalence among those who have had the least education and are not in employment. In contrast, more conventional measures of heavy drinking, based on frequency of consumption of beverage spirits, are less prevalent and show much weaker associations with socio-economic position.

Diagnostic value of the Conventional and Doppler ultrasound in pregnancy complicated with preeclampsia.

BACKGROUND: Preeclampsia (PE) is a pregnancy complication usually of the third trimester. The clinical manifestations are hypertension and proteinuria with or without edema. Its pathogenesis is characterized by generalized vasoconstriction and endothelial dysfunction. The aim of this study was to evaluate the diagnostic value of the Doppler ultrasound examination of the renal interlobar vessels in pregnancy complicated with preeclampsia in the context of the theory about the increased vessel resistance in this pregnancy disorder. METHODS: Fifty two women aged 16-38, (mean age 23+/-9.54) streamed into three groups were examined by abdominal ultrasound in Triplex regime. The first group included 18 pregnant with PE, the second 21 women in the third trimester of normal pregnancy, and the third group 13 non-pregnant women. In all 3 groups the renal volume (RV) and parenchyma volume (PV) were determined by conventional ultrasound (CU). The doppler waveform analysis (DWA) of the interlobar renal arteries (IRA) gave the following indices: resistance index (RI), pulsatility index (PI), peak systolic velocity (Vmax) and end diastolic velocity (Vmin). RESULTS. RV and PV in the PE group were significantly higher then those of the healthy pregnant women: RV: 231.4+/-58 to 187+/-45, p<0.05 and for PV: 200+/-11 to 130+/-6.78, p<0.05. Such a difference was not found out for the healthy pregnant women compared to the non-pregnant ones. No significant differences of the examined doppler indices were found in the three groups. CONCLUSION: Although the arteriolar vasoconstriction and the tissue hypoxia are leading in the PE pathogenesis, the DWA of the IRA in PE pregnancy does not differ from those of the healthy pregnant and nonpregnant women. As one of the most frequently used imaging technique Doppler Ultrasound (DU) of the renal IRA and DWA of these vessels shows no diagnostic advantage as compared to the renal CU in pregnancy complicated with PE.

[Characteristics of indicators of infant mortality in Russia]. / Osobennosti pokazatelei mladencheskoi smertnosti v Rossii.

Since 1993 infant mortality rates have generally decreased in Russia due to the decline in early neonatal mortality. Late fetal mortality rates have also decreased. These facts seem to be unexpected since the health statistics registers a decline in the health status of pregnant women. It is noteworthy that in some of Russia's regions, the average perinatal mortality rate is related to the lowest level of its early neonatal component. Against this background, it is useful to remind that Russia's state statistics mainly registers perinatal death of infants or fetuses weighing 1000 grams or more. This understates the official early neonatal mortality rate by one third and makes possible any manipulations in reports.

A rise in plasma creatinine that is not a sign of renal failure: which drugs can be responsible?

This is a review of the available information about drugs which cause an increase in plasma creatinine concentration without decreasing glomerular filtration rate (GFR). The GFR is the main, but not the single, determinant of the plasma creatinine levels. Several drugs, such as cimetidine, trimethoprim, corticosteroids, pyrimethamine, phenacemide, salicylates and active vitamin D metabolites, have been reported to increase plasma creatinine without influencing its glomerular filtration. Cimetidine, trimethoprim, pyrimethamine and salicylates can inhibit secretion of creatinine by the proximal tubule. Corticosteroids and vitamin D metabolites probably modify the production rate and the release of creatinine. The exact mechanism of phenacemide-creatinine interaction is not fully explained. These drug-induced alterations in plasma creatinine concentration have clinical significance when GFR is estimated by using plasma creatinine.

[Secondary systemic amyloidosis A combined with primary glomerulonephritis and systemic diseases]. / Vtorichna sistemna amiloidoza A v suchetanie s purvichni glomerulonefriti i sistemni zaboliavaniia.

Amyloidosis is characterized by organic dysfunction as a result of deposition of amyloid substance in the walls of the small blood vessels and extracellularly in different organs. The involvement of the kidneys in systemic amyloidoses AL and AA has irreversible evolution to renal failure. The object of the study was to determine the prevalence of the secondary (reactive) systemic amyloidosis AA in combination with primary glomerulonephritis (PGN) and lupus nephropathy (SLE) and to create diagnostic approach for its early detection. The prevalence of amyloidosis among the renal biopsies in the Department of Nephrology by the Chair of Internal Diseases for the period 1981-1988, retrospectively, is 4% (in 11 out of 268 biopsies). For the period 1989-1996, prospectively, by directed quest, amyloid was found in 35 out of 269 renal biopsies (11%). For differentiation of AA preliminary treatment of the histologic material with KMnO4 was used. In 20 cases amyloidosis appeared as independent finding in the renal tissue, while in 15 it was combined with histologic picture of immune nephropathies: in 11 with primary glomerulonephritis (7% out of 155 PGN) and in 4 with systemic lupus erythematodes (11% out of 31 SLE). The combination of PGN with AA was almost always associated with chronic infections. It was most often observed in diffuse membranous GN or FSGSH. Our studies demonstrate increased prevalence of amyloidosis among the renal biopsies during the last years, which could be due to directed quest, but it could be a real fact, too. We suggest staining for amyloid in all renal biopsies, as well as its directed quest in mucosae of the gastro-intestinal tract and by aspiration of the abdominal subcutaneous fatty tissue in the patients with primary GN or systemic diseases.

Educational level and adult mortality in Russia: an analysis of routine data 1979 to 1994.

The investigation of socio-economic differences in mortality in Russia was effectively prohibited in the Soviet period. The extent and nature of any such differences is of considerable interest given the very different principles upon which Russian society has been organised for most of this century compared to the West where socio-economic differences in health have been extensively documented. Using cross-sectional data on mortality in Russia around the 1979 and 1989 Censuses, we have analysed mortality gradients according to length of education. Our results show that educational differences in mortality are at least as big as seen in Western countries, and are most similar to the recently reported differences observed for other former communist countries such as the Czech Republic, Estonia and Hungary. As observed in many other countries the strength of association of mortality with education declines with age, varies by cause of death and is generally stronger among men than women. Differentials are particularly large for accidents and violence, where for men and women the mortality rate among those with primary or basic secondary education is over twice that of people with higher education. Even larger effects are seen for causes directly related to alcohol (including alcoholic cirrhosis and accidental poisoning by alcohol), and for infectious and parasitic diseases and respiratory diseases. These educational differences may in part be related to educational differences in alcohol consumption. Of particular significance is the fact that there are indications that socio-economic differences in mortality have widened considerably in the 1990s, a period during which there was a huge increase in the national burden of alcohol-related deaths. This widening of socio-economic differences at this time suggest that these increases in consumption were especially acute among those with less education. At a more general level the fact that large educational differences in mortality were seen in Russia in 1979 and 1989, prior to the collapse of the Soviet Union, is very striking and informative. In this period there was a far weaker association between income and education than is seen in the West, suggesting that the education effects are unlikely to be driven by underlying differences in financial resources. The protective effect of education, in the Russian context at least, has been driven by more subtle and mechanisms. The apparent widening of socio-economic mortality differences since the collapse of the Soviet Union suggests that the transformation underway in Russian society requires a strengthening of the public health function.

The reactions of a heterogeneous population to perturbation. An interpretative model of mortality trends in Russia.

PIP: "The rapid increase in mortality in Russia during the past ten years is perplexing.... In this paper, the authors offer a new interpretation of these dynamics.... They suggest that recent developments are the cumulative result of a compensation mechanism which followed the rapid decrease in mortality which occurred around 1985, and of the continuation of a deterioration movement which began in the early 1960s.... To prove this and to explain these rapid fluctuations, the authors have developed a model based on hypotheses which involve heterogeneous populations. In addition to analysing mortality in Russia, they provide new models which relate to the consequences of heterogeneity on the dynamics of mortality." (EXCERPT)^ieng

Life expectancy in the former USSR and mortality dynamics by cause of death: regional aspects.

"The purpose of our paper is to present recent trends of mortality in the former USSR in terms of demographic transition theory.... Analysis of data on mortality dynamics by age and cause of death allows us to consider some features of the progress of the demographic transition.... The principal causes of the discrepancy between the former USSR and Western countries appear to follow first of all from considerably lower living standards.... The second principal cause of unfavourable patterns of mortality was an unhealthy environment in the workplace and at home." The focus is on the 1980s.