[The possibilities and advantages of conducting multicenter clinical trials on the basis of outpatient clinics in Moscow].

The article presents the special role of the outpatient unit (urban polyclinics) in the system of urban medical organizations, which has significant development potential in the field of clinical research. This activity became possible due to the systematic work on equipping outpatient clinics with the most modern diagnostic equipment, the availability of specialists trained in the organization and conduct of clinical trials according to the international rules of good clinical practice. A special value lies in the fact that the polyclinic network has an extensive database that includes millions of patients and provides the opportunity to perform the highest level of medical expertise and research.

[Detection rates and high concentration of herpesvirus (Orthoherpesviridae) DNA in autopsy materials from patients with COVID-19 fatal outcome].

INTRODUCTION: SARS-CoV-2 infection causes immune disorders that create conditions for the reactivation of human herpesviruses (HHVs). However, the estimates of the HHVs effect on the course and outcome of COVID-19 are ambiguous. Аim - to study the possible relationship between the HHV reactivation and the adverse outcome of COVID-19. MATERIALS AND METHODS: Postmortem samples from the brain, liver, spleen, lymph nodes and lungs were obtained from 59 patients treated at the Moscow Infectious Diseases Hospital No.1 in 2021-2023. The group 1 comprised 39 patients with fatal COVID-19; group 2 (comparison group) included 20 patients not infected with SARS-CoV-2 who died from various somatic diseases. HHV DNA and SARS-CoV-2 RNA were determined by PCR. RESULTS: HHV DNA was found in autopsy samples from all patients. In group 1, EBV was most often detected in lymph nodes (94%), HHV-6 in liver (68%), CMV in lymph nodes (18%), HSV in brain (16%), VZV in lung and spleen (3% each). The detection rates of HHVs in both groups was similar. Important differences were found in viral load. In patients with COVID-19, the number of samples containing more than 1,000 copies of HHV DNA per 100,000 cells was 52.4%, in the comparison group - 16.6% (p < 0.002). An association has been established between the reactivation of HSV and HHV-6 and the severity of lung damage. Reactivation of EBV correlated with increased levels of liver enzymes. CONCLUSION: Reactivation of HHVs in patients with fatal COVID-19 was associated with severe lung and liver damages, which indicates a link between HHV reactivation and COVID-19 deaths.

Causes of Death in Patients Asking for Polyclinic Care for Coronary Heart Disease.

AIM: Retrospective analysis of the underlying causes for death of patients who did and did not seek outpatient medical care (OPMC) for ischemic heart disease (IHD), and discussion of a possibility for using administrative anonymized but individualized databases for analysis. MATERIAL AND METHODS: The electronic database of the Central Administration of the Civil Registry Office of the Moscow Region (Unified State Register of the Civil Registry Office of the Moscow Region), including medical death certificates (MDC) for 2021, was used to select all cases of fatal outcomes with the disease codes of the International Classification of Diseases, Tenth Revision (ICD-10) (codes of external causes, injuries, poisonings excluded) that were indicated as the primary cause of death (PCD). Personalized data of the deceased were combined with data from electronic medical records of patients who sought OPMC at institutions of the Moscow Region within up to 2 years before death. In addition to IHD, the following PCD codes were taken into account: malignant tumors, COVID-19, diabetes mellitus, cerebrovascular diseases, hypertension, chronic obstructive pulmonary disease, alcohol-associated diseases, and, as examples of unspecified PCD, old age and unspecified encephalopathy.Results In total, among those who died from diseases, the proportion of those who died from IHD was 18.9%; for another 8.4%, IHD was indicated as a comorbid disease in Part II of the MDC. Among those who sought OPMC for IHD, the IHD proportion indicated as PCD was 27.5%, and among those who did not seek OPMC 17.4% (p <0.0001). Those who died from IHD and who had sought OPMC were older (mean age, 75.59 ± 10.94 years) than those who died from IHD and had not sought OMPM (mean age, 73.96 ± 10.94 years; p < 0.0001). The frequency of myocardial infarction as PCD among those who had and had not sought OPMC was the same (12%), chronic forms of IHD were 83.9% and 79.7%, the frequencies of "unspecified" acute forms of IHD (codes I24.8-9) were 4.1% and 8.3%, respectively. The proportion of deaths from COVID-19 was the highest (21.7% and 24.3%, respectively), from malignant neoplasms 11.6% and 12.7%, respectively, and from unspecified encephalopathy 10.6% and 10.7%, respectively. CONCLUSION: Only 25% of patients who had sought OPMC for IHD died from IHD, otherwise the causes of death were the same as for patients who had not sought OPMC for IHD. Analysis of administrative databases allows identifying disparities in the PCD structure and to direct the efforts of specialists to reconciling the criteria for death from various forms of IHD.

[A role of cerebrovascular diseases in the progression of multiple sclerosis]. / Rol' tserebrovaskulyarnykh zabolevanii v progressirovanii rasseyannogo skleroza.

OBJECTIVE: To identify the association between cerebrovascular diseases (CVD) and multiple sclerosis (MS) among patients over 50 years old in two independent populations of Moscow and Tyumen. MATERIAL AND METHODS: The study included 94 patients with MS in combination with CVD (main group) and 90 age-and sex-matched patients with MS without a vascular history (comparison group). An analysis of parameters such as disease duration, EDSS at different time points, disease progression index, duration of first remission in each population separately and in both populations together was carried out. RESULTS: The presence of CVD in patients with MS was associated with the presence of other diseases that are associated with an increased risk of developing cerebrovascular pathology. In the main group, there was a statistically significant decrease in the duration of the first remission and an increase in the disease progression index. In addition, other diseases and syndromes were identified in the main group that, in combination with CVD in patients with MS, could lead to a worsening of the course of MS. These included arterial hypertension, diabetes mellitus, obesity, dyslipidemia, chronic venous insufficiency, and regular use of proton pump inhibitors. CONCLUSION: Comorbid vascular pathology can affect the severity of MS from the very beginning of the disease. It can lead to a shorter duration of the first remission and a higher disease progression index, increasing the degree of disability. The combination of autoimmune-inflammatory, demyelinating, and vascular processes can worsen the prognosis for MS.

[Dependence of medical rehabilitation effectiveness of patients with somatic diseases and meteopathology on features of weather-forming factors of the Moscow region]. / Zavisimost' effektivnosti meditsinskoi reabilitatsii patsientov s somaticheskimi zabolevaniyami i meteopatologiei ot osobennostei pogodoobrazuyushchikh faktorov Moskovskogo regiona.

Climate change and formation of regional weather features increase both direct (immediate effects of extremal temperature and other weather and climatic anomalies) and indirect (environmental deterioration, etc.) consequences of global climate change. The development of investigations of medical weather assessment, medical and meteorological forecasting system, the use of treatment and preventive measures give the opportunity to prepare for weather biotropic conditions and reduce weather-conditioned exacerbations. OBJECTIVE: To assess the clinical effectiveness of non-drug comprehensive methods, including balneotherapy and physiotherapy, in patients with somatic diseases, complicated by increased meteosensitivity, depending on the features of weather conditions in the Moscow region. MATERIAL AND METHODS: The study included 120 patients diagnosed with «osteoarthrosis/osteoarthritis¼ with predominant hip and knee joint damage. The majority of patients had comorbidities, namely hypertensive disease (67.2%), ischemic heart disease (32.8%), chronic obstructive pulmonary disease and bronchial asthma (10.8%), grade II-III obesity (10%) and compensated diabetes mellitus (9.2%). The severity and main symptoms of the meteopathic reactions' manifestation were assessed by questionnaires consisting of three blocks, HAM, SF-36 tests and psychological stress scale. Medical and meteorological assessment of weather conditions in Moscow included analysis of the main weather-forming factors for 4 main synoptic observations in 10-minute mode for current and predictive 2 days, as well as daily characteristics of solar activity. Treatment methods included alternating magnetic field (AMF) procedures, general sodium chloride baths, massage and rehabilitation exercises (RE) (1st group); AMF, «dry¼ carbon dioxide baths, applications with brine on the affected joints and RE (2nd group); AMF, «dry¼ radon baths, applications with brine and RE (3rd group). RESULTS: The conducted studies have revealed the trigger role of most biotropic combinations of weather-forming factors that provoke exacerbation in patients with joint diseases. Sodium chloride, «dry¼ carbon dioxide and radon baths combined with AMF, applications with brine on the affected joints and RE are pathogenetically justified and contribute to increase of adaptive potential, functional reserves of the body and provide significantly high (p<0.05) meteocorrective action. CONCLUSION: The obtained results can be used for rehabilitation of patients with joint diseases complicated by increased meteosensitivity.

[VII All-Russian Scientific and Practical Conference «Clinical Somnology¼]. / VII Vserossiiskaya nauchno-prakticheskaya konferentsiya «Klinicheskaya somnologiya¼.

On November 17-18, 2023, the VII Scientific and Practical Conference "Clinical Somnology" was held in Moscow. The conference was organized by the all-Russian public organization "Russian Society of Somnologists" (ROS). The forum discussed the issues of diagnostics and treatment of sleep disorders, also presented the topics of fundamental research, discussed new ways of studying sleep and the prospects of development of somnology as a science. The conference was attended by more than 250 participants from 38 regions. Broadcasting of the sessions of the first day of the event was watched by more than 270 listeners. Within 2 days of the conference 14 symposiums were held and 52 reports were presented.

[Prevalence of cognitive impairment in older adults in the Russian Federation]. / Rasprostranennost' kognitivnykh rasstroistv u patsientov starshego vozrasta v Rossiiskoi Federatsii.

Dementia is one of the main challenges to modern society. According to estimated data, as of 2019, there were 1.949.811 people living In Russia with dementia of various etiology. At the same time, there have been no large epidemiological studies of dementia in the Russian Federation. The article provides an overview of the available data on the epidemiology of cognitive impairment (CI) In Russia given from various sources. Not only estimated, but also available clinical data were analyzed. In general, the obtained prevalence values for CI are comparable to global values. Thus, in an epidemiological study of people over 60 years of age in a separate district of Moscow, the prevalence of dementia was 10.4%, Alzheimer's disease 4.5%. A study of outpatients aged 60 years and older showed a high prevalence of both dementia and non-dementia CI at general medical appointments (incidence of dementia 7.8%, MCI 49.6%). It has been shown that the problem of non-dementia CI is already relevant in people of pre-retirement age (the prevalence of non-dementia CI in patients 55-64 years old is 36.8-44.8%). Unique data obtained in a population of institutionalized centenarians (prevalence of dementia 69%), as well as data on the relationship of CI with both somatic and demographic factors are presented.

[From the history of domestic dentistry: Moscow Dental School of the Privat-docent of Moscow University, MD Gilyariy Ivanovich Vilga]. / Iz istorii otechestvennoi stomatologii: Moskovskaya zubovrachebnaya shkola privat-dotsenta Moskovskogo universiteta doktora meditsiny Gilyariya Ivanovicha Vil'ga.

Based on archival data, the authors describe the Moscow School of Dentistry with dental courses for doctors, dentists, and dentists of the Moscow University, Privat-docent Dr. Gilyari Ivanovich Vilga, examine the background to its formation, provide unique archival data on the location of the school, as well as its internal organization and equipment. The authors review in detail the program of courses, as well as their duration, cost, and form of student accountability. During its existence (1909-1918), more than two thousand dentists were educated at G.I. Vilg's school, among them Alexander Ivanovich Evdokimov, a future corresponding member of the USSR Academy of Medical Sciences, director of the State Institute of Dentistry (GIZ) and the State Institute of Dentistry and Odontology (GIZO). The authors of the article also focus on analyzing the differences in the approaches to the organization of several dental schools, viz: The First Moscow I.M. Kovarsky School of Dentistry and the Second G.I. Vilga School of Dentistry. In his efforts, I.M. Kovarskij's aspirations to establish the best dental school in Russia were crowned with success: a specially constructed and equipped building meeting the state-of-the-art requirements (the building even boasted an X-ray machine), and the best professors and instructors of the University of Moscow of that time were hired. In contrast, G.I. Vilga rented premises for his school, the equipment was in short supply, and he himself was the only eminent professor. Nevertheless, his fierce desire to unite the entire dental community and organize the best dental care for the entire population of Russia allowed his brainchild to enter the top five schools of the time.

[The gender aspects of changes in mortality during COVID-19 pandemic as exemplified by Moscow].

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.

[On becoming of nephrology in the USSR: The role of Moscow therapists M. I. Vihert and E. M. Tareev].

The article considers stages of becoming of Soviet nephrology as independent scientific educational clinical discipline. The role of M. I. Vikhert in becoming of nephrology as independent clinical direction within the framework of the clinic of internal diseases is demonstrated. Also the role of E. M. Tareev as the founder of nephrology in the USSR as institutionalized clinical discipline is revealed.

[The outstanding Russian ophthalmologist Alexey Nikolaevich Maklakov]. / Vydayushchiisya russkii oftal'molog Aleksei Nikolaevich Maklakov.

The conducted archival research and analysis of literary publications allowed us to supplement the biography and creative path in science, clinical and social activities of the outstanding Russian ophthalmologist A.N. Maklakov. This article emphasizes the urgency of the problem of teaching in medical universities, and gives special attention to the thoughts of the scientist about providing clarity in the process of teaching students. The article notes his role in the arrangement and equipment of the new eye clinic of the Moscow University, and presents fragments of memoirs of his student and mentee, another famous Russian ophthalmologist S.S. Golovin. A remark is made about the need to clarify the terms traditionally accepted in the history of medicine in relation to surgery and ophthalmology. An assessment is given on the contribution of A.N. Maklakov to the establishment of the Moscow Ophthalmological Circle, his efforts to unite doctors, and the development of the statutory documents of the All-Russian Society of Eye Doctors.

Metagenomic insights into the wastewater resistome before and after purification at large­scale wastewater treatment plants in the Moscow city.

Wastewater treatment plants (WWTPs) are considered to be hotspots for the spread of antibiotic resistance genes (ARGs). We performed a metagenomic analysis of the raw wastewater, activated sludge and treated wastewater from two large WWTPs responsible for the treatment of urban wastewater in Moscow, Russia. In untreated wastewater, several hundred ARGs that could confer resistance to most commonly used classes of antibiotics were found. WWTPs employed a nitrification/denitrification or an anaerobic/anoxic/oxic process and enabled efficient removal of organic matter, nitrogen and phosphorus, as well as fecal microbiota. The resistome constituted about 0.05% of the whole metagenome, and after water treatment its share decreased by 3-4 times. The resistomes were dominated by ARGs encoding resistance to beta-lactams, macrolides, aminoglycosides, tetracyclines, quaternary ammonium compounds, and sulfonamides. ARGs for macrolides and tetracyclines were removed more efficiently than beta-lactamases, especially ampC, the most abundant ARG in the treated effluent. The removal efficiency of particular ARGs was impacted by the treatment technology. Metagenome-assembled genomes of multidrug-resistant strains were assembled both for the influent and the treated effluent. Ccomparison of resistomes from WWTPs in Moscow and around the world suggested that the abundance and content of ARGs depend on social, economic, medical, and environmental factors.

Event rates and incidence of post-COVID-19 condition in hospitalised SARS-CoV-2 positive children and young people and controls across different pandemic waves: exposure-stratified prospective cohort study in Moscow (StopCOVID).

BACKGROUND: Long-term health outcomes in children and young people (CYP) after COVID-19 infection are not well understood and studies with control groups exposed to other infections are lacking. This study aimed to investigate the incidence of post-COVID-19 condition (PCC) and incomplete recovery in CYP after hospital discharge and compare outcomes between different SARS-CoV-2 variants and non-SARS-CoV-2 infections. METHODS: A prospective exposure-stratified cohort study of individuals under 18 years old in Moscow, Russia. Exposed cohorts were paediatric patients admitted with laboratory-confirmed COVID-19 infection between April 2 and December 11, 2020 (Wuhan variant cohort) and between January 12 and February 19, 2022 (Omicron variant cohort). CYP admitted with respiratory and intestinal infections, but negative lateral flow rapid diagnostic test and PCR-test results for SARS-CoV-2, between January 12 and February 19, 2022, served as unexposed reference cohort. Comparison between the 'exposed cohorts' and 'reference cohort' was conducted using 1:1 matching by age and sex. Follow-up data were collected via telephone interviews with parents, utilising the long COVID paediatric protocol and survey developed by the International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC). The WHO case definition was used to categorise PCC. RESULTS: Of 2595 CYP with confirmed COVID-19, 1707 (65.7%) participated in follow-up interviews, with 1183/1707 (69%) included in the final 'matched' analysis. The median follow-up time post-discharge was 6.7 months. The incidence of PCC was significantly higher in the Wuhan variant cohort (89.7 cases per 1000 person-months, 95% CI 64.3-120.3) compared to post-infection sequalae in the reference cohort (12.2 cases per 1000 person-months, 95% CI 4.9-21.9), whereas the difference with the Omicron variant cohort and reference cohort was not significant. The Wuhan cohort had higher incidence rates of dermatological, fatigue, gastrointestinal, sensory, and sleep manifestations, as well as behavioural and emotional problems than the reference cohort. The only significant difference between Omicron variant cohort and reference cohort was decreased school attendance. When comparing the Wuhan and Omicron variant cohorts, higher incidence of PCC and event rates of fatigue, decreased physical activity, and deterioration of relationships was observed. The rate of incomplete recovery was also significantly higher in the Wuhan variant cohort than in both the reference and the Omicron variant cohorts. CONCLUSIONS: Wuhan variant exhibited a propensity for inducing a broad spectrum of physical symptoms and emotional behavioural changes, suggesting a pronounced impact on long-term health outcomes. Conversely, the Omicron variant resulted in fewer post-infection effects no different from common seasonal viral illnesses. This may mean that the Omicron variant and subsequent variants might not lead to the same level of long-term health consequences as earlier variants.

[Touches to the portrait of I.M. Kovarsky]. / Shtrikhi k portretu I.M. Kovarskogo.

Ilya Matveyevich Kovarsky (1856-1933) - the founder and permanent head of the First Moscow Dentistry School, organizer and honorary member of the Moscow Dentistry Society, editor and publisher of one of the first Russian dental journals «Odontological Revue¼ - was deprived of his personal pension and suffrage in 1930 as a former owner of a private capitalist enterprise; his name was actually erased from the national dentistry. The portrait of Ilya Matveyevich Kovarsky - a remarkable doctor, teacher and worthy man - is reconstructed by the documents preserved in the Kovarsky family archive (on the basis of which this article was written) and the memories of his eldest daughter (published for the first time).

HIV knowledge, self-perception of HIV risk, and sexual risk behaviors among male Tajik labor migrants who inject drugs in Moscow.

BACKGROUND: The interplay of human immunodeficiency virus (HIV) knowledge and self-perception of risk for HIV among people who inject drugs is complex and understudied, especially among temporary migrant workers who inject drugs (MWID) while in a host country. In Russia, Tajik migrants make up the largest proportion of Moscow's foreign labor. Yet, HIV knowledge and self-perceived risk in association with sexual risk behavior among male Tajik MWID in Moscow remains unknown. OBJECTIVE: This research examines knowledge about HIV transmission, self-perception of HIV risk, and key psychosocial factors that possibly contribute to sexual risk behaviors among male Tajik labor MWID living in Moscow. METHODS: Structured interviews were conducted with 420 male Tajik labor MWID. Modified Poisson regression models investigated possible associations between major risk factors and HIV sexual risk behavior. RESULTS: Of the 420 MWID, 255 men (61%) reported sexual activity in the last 30 days. Level of HIV knowledge was not associated in either direction with condom use or risky sexual partnering, as measured by sex with multiple partners or female sex workers (FSW). Lower self-perceived HIV risk was associated with a greater likelihood of sex with multiple partners (aPR: 1.79, 95% CI: 1.34, 2.40) and FSW (aPR: 1.28, 95% CI: 1.04, 1.59), but was not associated with condom use. Police-enacted stigma was associated with sex with multiple partners (aPR: 1.22, 95% CI: 1.01, 1.49) and FSW (aPR: 1.32, 95% CI: 1.13, 1.54). While depression and lower levels of loneliness were associated with condomless sex (aPR: 1.14, 95% CI: 1.05, 1.24; aPR: 0.79, 95% CI: 0.68, 0.92, respectively), only depression was associated with condomless sex with FSW (aPR: 1.26, 95% CI: 1.03, 1.54). CONCLUSIONS: HIV prevention programing for male Tajik MWID must go beyond solely educating about factors associated with HIV transmission to include increased awareness of personal risk based on engaging in these behaviors. Additionally, psychological services to counter depression and police-enacted stigma are needed.

[Resolution of the XV Congress. All-Russian public organization "Russian Society of Surgeons named after Academician V.S. Saveliev" 26 October 2023 Moscow, Russia]. / Rezolyutsiya XV S"ezda. Obshcherossiiskoi obshchestvennoi organizatsii «Rossiiskoe obshchestvo khirurgov im. akademika V.S. Savel'eva¼ 26 oktyabrya 2023 g. g. Moskva.

Resolution of the XV Congress. All-Russian public organization "Russian Society of Surgeons named after Academician V.S. Saveliev" 26 October 2023 Moscow, Russia.

[Questionnaire survey of patients of medical dental organizations in different regions of the Russian Federation on the issues of individual and professional oral hygiene]. / Anketirovanie patsientov meditsinskikh stomatologicheskikh organizatsii razlichnykh regionov RF po voprosam individual'noi i professional'noi gigieny rta.

To analyze the respondents' attitudes to oral hygiene and to assess the need for professional oral hygiene in different regions of the Russian Federation based on the data of questionnaire analysis. OBJECTIVE: To obtain comparative data on the issues of individual and professional oral hygiene of patients of medical dental organizations in a number of Russian cities. MATERIAL AND METHODS: We conducted an anonymous questionnaire survey of 624 patients (18 to 70 years old) who applied to medical dental organizations of different forms of ownership in five regions of the Russian Federation (Moscow, Omsk, Ryazan, Samara, Tambov). Patients were interviewed using a specially designed questionnaire. RESULTS: The study involved patients of medical dental organizations from 5 regions of the Russian Federation, 57.2% of them were women and 42.8% men. In all cities more than 50% of the surveyed patients received care under the MHI program. More than 50% of the surveyed patients said that they tried to brush their teeth twice a day, the rest of the respondents said that they brushed their teeth only twice a day. Up to 27% of patients are not willing to comply with individualized dental care recommendations for various reasons. CONCLUSIONS: Highly motivated patients to high-quality dental hygiene behavior are in minority; according to the results of the study, it can be stated that there is a high need for professional oral hygiene among the surveyed respondents. It is necessary to work with patients to improve hygienic knowledge, skills and motivation for quality oral hygiene.

[Urban stress of a megalopolis resident: stress factors and correctioN].

Residents of a megalopolis are constantly exposed to urban stress - the combined effects of a number of different extreme factors and living conditions of the urban environment. Urban stress of a megalopolis resident has an extreme complex multifactorial effect on his body and psyche. The features of the existing subspecies of urban stress (ecological, psychological, social, informational, professional, related to the pandemic), as well as the main stress factors causing them, are considered. The medical and social features of urban stress are described. The consequences of exposure to urban stress, directly related to human health disorders, include the so-called «urban stress diseases¼ or «diseases of civilization¼, primarily psychosomatic diseases. It is determined that urban stress is a multifactorial complex of stress factors affecting the physical and mental health of megalopolis residents. Due to the fact that an increasing number of megalopolis residents are experiencing the negative impact of an aggressive urban environment, it is necessary both to formalize stress factors in order to possibly correct them to improve the quality of life of citizens, and to develop appropriate optimizing medical and social recommendations. Modern organizational and medical and social measures aimed at reducing the negative impact of urban stress on the health of megalopolis residents are considered. It is proposed to minimize the negative impact of extreme urban stress factors on the physical and mental health of megalopolis residents by using therapeutic and preventive strategies to increase their stress resistance. There are a number of different organizations and departments in Moscow that provide psychological and psychotherapeutic support. Also, in order to determine the level of the body's reserves and stress resistance, it is possible to undergo a comprehensive examination both in the nearest polyclinic and in the nearest park within the framework of the Healthy Moscow program.

[performance evaluation of the programs aimed at myocardial infraction prevention by relevant mortality rates].

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.