The article analyzes the evolution of views on the concept of epidemiology in various phrases, provides a critical rationale and assessment of individual groups of definitions of epidemiology, presents a substantiated description of new scientific directions in epidemiology. Additions and changes to the existing structure of epidemiology have been developed and proposed, taking into account modern scientific data on infectious and somatic pathology. The formation of new directions in epidemiology has significantly enriched it not only in scientific but also in applied terms. The section epidemiology of infectious diseases forms the fundamentality of the science of epidemiology, which is constantly developing, which cannot be said about non-infectious epidemiology. Taking into account current trends, the author proposes his own vision of the modern structure of epidemiology as a science. The epidemiology of noncommunicable diseases is still at a lower stage of development than the epidemiology of infectious diseases. It lacks a full-fledged theoretical basis, both in general and in individual sections. There is no epidemiological terminology generally accepted in world medical science.

This review presents critical insights into the clinical and epidemiological aspects of participation of various causative agents of opportunistic infections in the formation of complex comorbidity in humans. Clinical and epidemiological aspects are important components of complex comorbidity due to wide occurrence, causing negative impact on human health and population reproduction. The data on the relative incidence of mono- and concurrent-infections are heterogeneous. The causative agents of opportunistic infections can persist in the human body, cause latent endogenous infections, and engage in intracellular parasitism. A high level of circulation of opportunistic infections pathogens creates the conditions for atypical forms of multisystemic pathology. Broad clinical polymorphism and low specificity cause untimely diagnosis. Low tension of anti-infection immunity is associated with the low protective activity of pathogens and mosaicism of antigens. Examples of complex comorbidity with the involvement of herpes viruses can be a combination of EpsteinBarr virus and Corynebacterium diphtheriae, cytomegalovirus and infectious mononucleosis and a combination with Streptococcus pneumoniae, Haemophilus influenzae type b. The combination of cytomegalovirus infection can occur with either one infectious disease or multiple ones (for example, metapneumovirus infection, S. pneumoniae, Bordetella pertussis, and H. influenzae). Mycoplasmosis can have a course of specific polyetiological infections in combination with viruses, bacteria, fungi, and protozoa. The authors also paid attention to the manifestation forms of pneumocystosis in the impairment of the immune status of the body (combination with toxoplasmosis, blastocystosis, etc.). The possibility of association of blastocysts with Staphylococcus spp., Klebsiella pneumoniae, and Lamblia intestinalis has been shown, and the roles of anisacidosis and chlamydial infection in the formation of complex comorbidity are also discussed. Complex comorbidity requires increased attention to diagnosis, assessment of epidemiological determinants, and the organization of epidemiological studies for its analysis.

The aim of the investigation was to assess the potential of cluster analysis as an additional method of data analysis for 24-hour blood pressure monitoring (BPM) in patients with both normal geometry and with various types and extents of remodeling of the left ventricle (LV). Materials and Methods. The investigation included 71 patients, ranging in age from 23 to 71. The inclusion criterion was significant arterial hypertension (AH), while exclusion criteria were symptomatic AH and severe co-morbidity. Body mass, height, waist measurement, body mass index, lipid profile, and glycemic level were determined for each subject in addition to carrying out echocardiography and conventional and cluster analysis of 24-hour BPM data of each. Results. In patient groups with different types of left ventricular hypertrophy (LVH), the conventional analysis demonstrated differences in the standard 24-hour BPM parameters. Development of concentric LVH is associated with the highest average day-time and average night-time blood pressure, pressure-induced loads and blood pressure variability. Eccentric LVH has a pathogenetic link to other factors and is formed under conditions of relatively low blood pressure. The use of cluster analysis allowed to reveal the increased occurrence of systolic-diastolic AH in concentric LVH, and isolated systolic AH and isolated diastolic AH in eccentric LVH. Conclusion. Such an integrated approach to the interpretation of 24-hour BPM results, comprising both conventional and cluster analysis, allows for objectification of the study results and reveals the significant features of AH in patients with different types of LV remodeling.

The article is devoted to the review existing in the world practice of perceptions of safety of medical care, especially biosafety. The authors defined and outlined the general epidemiological safety of medical care. Definition and general provisions of epidemiological safety of medical care was given by authors. The most actual tasks which are required for development and deployment in practice of health care of epi-demiological safety as making system of ensuring quality and safety of medical care are defined.

The article is devoted to the review existing in the world practice of perceptions of safety of medical care, especially biosafety. The authors defined and outlined the general epidemiological safety of medical care. Definition and general provisions of epidemiological safety of medical care was given by authors. The most actual tasks which are required for development and deployment in practice of health care of epidemiological safety as making system of ensuring quality and safety of medical care are defined.

The article gives the characteristics of the current state of the problem legionellosis, features of pathogen ecology and features of the epidemiology of legionellosis. There is insufficient knowledge about the epidemiological features of infection in health care and implementation of epidemiological surveillance. Shows the results of epidemiological studies on the legionellosis in the Nizhny Novgorod region: there is a representation of Legionella pneumophila in the etiology of community-acquired and nosocomial pneumonia, the level of contamination and colonization of various departments in medical institutions. Studied the sensitivity of the Legionella pneumophila to disinfectants. High risk objects of colonization and the most likely reservoirs for L.pneumophila in medical institutions are detected. Identified three types of hospital departments, depending on the probability of infection in patients and the possibility of admission of patients with Legionella infection. Proposed parameters of epidemiological and microbiological surveillance system for monitoring and control with a differentiated approach depending on the type of departments. Developed approaches to improve epidemiological surveillance and control of Legionella infection in the Nizhny Novgorod region.

This article shows the modern views of the resistance of microorganisms to disinfectants and mechanisms of its formation. Different versions of the impact of subbactericidal concentrations of disinfectants, which can be replicated in laboratory conditions. The results of experiments on the formation of induced acquired resistance by the test strain of E.coli to disinfectants from the group of quaternary ammonium compounds (QAC) in the laboratory. The estimation of changes in the microbiological properties, sensitivity to antibiotics and disinfectants, performed electronic microscopy of bacteria in the process of resistance appearance. Any evidence of the possibility of microbial resistance to QAC-containing disinfectants under the influence of repeated impacts of subbactercidal concentrations in laboratory conditions, the time frame of its appearance.

The article presents the technique to evaluate the sensitivity of microorganisms-causative agents of infections isolated from patients, carriers and environment to the disinfectants. The proposed technique gives a possibility to detect the condition of microorganism resistance to disinfectant and to evaluate the degree of its sensitivity. The evaluation of sensitivity, specificity, accuracy, positive and negative prognostic value, reproducibility of developed technique was made.

In the article analyzes the results of a pilot project on monitoring of microbial resistance to disinfectants, implemented in the Nizhny Novgorod region for 3 years. The data obtained by the Monitoring Centre for Preventive Medicine Research Institute of Nizhny Novgorod State Medical Academy in cooperation with medical facilities in the Nizhny Novgorod city and the Nizhny Novgorod region in 2009-2011 in the dynamics. Analyzed some of the performance indicators for monitoring of microbial resistance to disinfectants, number of cultures of microorganisms and their species composition, state of the sensitivity of the microflora in health care to different groups of chemical compounds and certain disinfectants, the tendencies of their change, resistance profiles of different species of bacteria, identified groups of disinfectants based on the frequency of detection of resistant strains. Established the prevalence of resistance to disinfectants microflora in medical facilities in the Nizhny Novgorod region in according whith regional monitoring.

Modern problems of the laboratory diagnostics of healthcare-associated infections (HAIs) at the present stage developments of a science existing and public health services and a way of their decision are discussed. The opinion of authors of the national concept of prophylaxis of HAIs (edition 2010) about priority directions of activity on perfection of laboratory diagnostics of the HAIs caused by conditional-pathogenic microorganisms as a basis of system of HAIs surveillance is presented.

The presence of favorable conditions for circulation of L. pneumophila in medical institutions in Nizhny Novgorod region; the high contamination (average, 12.9%) of the various environmental objects physiotherapy, surgery, intensive care, maternity wards. Detected objects at high risk of contamination, reservoirs for L. pneumophila in health care settings. L. pneumophila demonstrated sensitivity to disinfectants of different groups of chemical compounds. The evaluation of microbial landscape in patients with pneumonia. The data on insignificant role of L. pneumophila in the etiology of pneumonia in patients admitted to medical facilities in Nizhny Novgorod region.