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Aim. To study the effects of diet optimization and weight loss on the dynamics of metabolic syndrome and cardiovascular risk factors in women with overweight and obesity in six-month dietary counseling and remote monitoring.Material and Methods. A balanced caloric restriction by 240–250 kcal a day on average was recommended to 119 women with overweight and obesity. Actual nutrition was evaluated using special computer software “1C Nutrition Evaluation”.Results. The study showed a significant nutritional imbalance with a relatively high consumption of fats (40.4%) and low consumption of carbohydrates (39.6%), mainly due to the low consumption of starch. On the contrary, the consumption level of monoand disaccharides (20.9%) was twice as high as recommended (10%) by the World Health Organization (WHO). Dietary restriction and nutritional optimization led to a significant decrease in the values of body weight, body mass index, waist circumference, blood pressure, and lipid metabolism. As a result, the risks and probability of metabolic syndrome and cardiovascular diseases decreased.Conclusion. Correction of eating habits allowed to establish a rational and balanced approach to dietary energy restriction and nutritional structure optimization. Achieved weight loss was associated with normalization of parameters of abdominal obesity, blood pressure, and lipid metabolism. Six-month dietary intervention in women promoted control of risk factors for metabolic syndrome and cardiovascular diseases. The results of the study may be used to improve the personalized technology of distant preventive counseling in primary health care aimed at weight loss to achieve both primary and secondary prophylactics of metabolic syndrome and chronic non-infectious diseases.

Introduction: Protecting and promoting health of employees through the implementation of measures to correct risk factors in the workplace is an important mechanism for achieving the strategic goal of increasing healthy life expectancy. Aim: To develop and pilot a package of tools for planning and implementing workplace well-being programs. Methods: In 2019, the federal project "Strengthening Public Health" was launched, within the framework of which model corporate programs were developed and published, including measures aimed at correcting smoking, poor nutrition, insufficient physical activity, psycho-emotional overstrain and excessive alcohol consumption. A set of tools has been developed to facilitate the development and implementation of workplace well-being programs, maximally focused on the needs of a particular enterprise. The set of tools include a questionnaire for the employer and a questionnaire for employees. Results: The set of tools has been tested by mailing to the chief freelance specialists in medical prevention of 28 regions of the Russian Federation, who responsible for the implementation of workplace well-being programs in the regions. Five hundred and eighty-eight completed questionnaires were received (among them 35 from employers, and 553 from employees). The analysis of the piloting results allowed us to make a number of adjustments to the questionnaires and confirm the importance of studying workers' presentiment in planning workplace well-being programs. The improved questionnaires are available online at https://atriya.gnicpm.ru/ . Conclusion: We developed the set of instruments which must be useful for implementation of the workplace well-being programs. Surveys of employers contribute to obtaining a snapshot of the attitudes and priorities of employers in the region to plan targeted measures to stimulate the implementation of workplace well-being programs at the regional level. Questionnaires for employees can be used for an indepth assessment of the priorities on the concrete workplace and development of a targeted program to the needs of a particular enterprise.

To date, few data on how the COVID-19 pandemic and restrictions affected children’s physical activity in Europe have been published. This study examined the prevalence and correlates of physical activity and screen time from a large sample of European children during the COVID-19 pandemic to inform strategies and provide adequate mitigation measures. An online survey was conducted using convenience sampling from 15 May to 22 June, 2020. Parents were eligible if they resided in one of the survey countries and their children aged 6–18 years. 8395 children were included (median age [IQR], 13 [10–15] years; 47% boys; 57.6% urban residents; 15.5% in self-isolation). Approximately two-thirds followed structured routines (66.4% [95%CI, 65.4–67.4]), and more than half were active during online P.E. (56.6% [95%CI, 55.5–57.6]). 19.0% (95%CI, 18.2–19.9) met the WHO Global physical activity recommendation. Total screen time in excess of 2 h/day was highly prevalent (weekdays: 69.5% [95%CI, 68.5–70.5]; weekend: 63.8% [95%CI, 62.7–64.8]). Playing outdoors more than 2 h/day, following a daily routine and being active in online P.E. increased the odds of healthy levels of physical activity and screen time, particularly in mildly affected countries. In severely affected countries, online P.E. contributed most to meet screen time recommendation, whereas outdoor play was most important for adequate physical activity. Promoting safe and responsible outdoor activities, safeguarding P.E. lessons during distance learning and setting pre-planned, consistent daily routines are important in helping children maintain healthy active lifestyle in pandemic situation. These factors should be prioritised by policymakers, schools and parents. HIGHLIGHTS: To our knowledge, our data provide the first multi-national estimates on physical activity and total screen time in European children roughly two months after COVID-19 was declared a global pandemic. Only 1 in 5 children met the WHO Global physical activity recommendations. Under pandemic conditions, parents should set pre-planned, consistent daily routines and integrate at least 2-hours outdoor activities into the daily schedule, preferable on each day. Schools should make P.E. lessons a priority. Decision makers should mandate online P.E. be delivered by schools during distance learning. Closing outdoor facilities for PA should be considered only as the last resort during lockdowns.

Introduction: Excessive salt intake (ESI) is a well-established risk factor of chronic non-communicable diseases (NCDs). Russia is among the countries with the high salt consumption. Population-based strategies to reduce salt intake have a potential for significant contribution to reduce the burden of NCDs. Modeling studies to justify the need and quantify the potential of these measures have been performed in several countries, but the evidence from Russia is still scarce. Aim: To forecast the efficiency of selected population-based prevention strategies to reduce salt intake in Russia. Methods: Potential efficiency of two population-based strategies was assessed. Introduction of the national excise tax on sodium used for industrial food production was the first strategy. The second strategy was a long term health literacy mass-media campaign aimed to reduce salt intake combined with a voluntary reduction in salt content in processed foods by manufacturers. Russia-specific impact of ESI on NCDs and population attributive risk (PAR) were calculated using previously assessed economic burden (EB) of ESI. The prediction period was 15 years. The changes in PAR after the introduction of population-based prevention strategies and changes in the EB of selected NCDs were calculated. Results: The first and the second programmed had a potential to reduce ESI prevalence by 2.99 % and 7.49 %, respectively. The corresponding numbers of prevented cases of NCDs were 23 352 and 57 874. Avoided direct medical costs exceeded 390 million rubles for the first strategy and over 969 million rubles for the second. The cumulative economic effect over 15 years was 4.10 billion rubles for the introduction of the new tax while the predicted cumulative economic effect of the second programme was 9.9 billion rubles. Conclusions: Although the population-based prevention strategies selected for this study have not yet been implemented in Russia, both have a significant potential to reduce the burden of NCDs and have substantial economic efficiency.

High salt intake is an important risk factor for cardiovascular diseases (CVD), closely related to the level of blood pressure in the population. The purpose of the review: to study population-based interventions for CVD prevention, aimed at reducing salt intake; to assess the potential for their implementation in the Russian Federation. We presented population-based strategies for dietary salt intake reduction used in different countries. The main components of strategies aimed to correct this risk factor in the Russian Federation were identified. The main components of the population-based approach to reducing salt intake are: determining population salt consumption, identifying sources of salt in the diet, monitoring of salt content in products, engaging with the food industry, consumer awareness campaigns, changes in product labeling, tax measures. An integrated approach to the problem is the most successful. Measures which were highly effective have not yet been fully implemented in the Russian Federation. At the moment, taxation of high-salt foods and tax subsidies for healthy food are not applied. Food manufacturers are not sufficiently involved - there are no legislatively introduced measures to reduce salt through food reformulation. Firstly it has to be applied to diet-forming products that are consumed daily, such as bakery and dairy products, and meat products.

Aim. To analyze hospital admission and ambulatory care of the patients with arterial hypertension (AH) in federal districts and regions from the perspective of the WHO concept of diseases, which can be treated in ambulatory settings (ambulatory care sensitive conditions, ACSC).Material and methods. For analysis we used data from annual forms of federal statistical monitoring (12 and 14), which includes data on hospital admissions with hypertension in federal districts and separate regions in 2017. Hypertension included diseases characterized by raised blood pressure, ICD10: I10-I13.Results. We performed the analysis of 12 and 14 forms per districts and regions of the Russian Federation. Regions with increased hospitalization rates and an increased ratio of the hospitalizations to number to outpatients visits were identified. High variability of these indicators was observed both among both between regions and federal districts. The values of the ratio indicator vary from 0.0131 in the Nizhny Novgorod Region to 0.0234 in the Chechen Republic. The average value of the ratio in the federal district varies from 0.032 in the Volga Federal District to 0.119 in the North Caucasus Federal District. In the North Caucasus and Far East Federal District the value of the indicator is significantly higher than in other districts.Conclusion. Assessing diseases which can be treated in ambulatory setting scan be one of the tools for evaluating the quality of medical care in primary care facilities. However, before including ACSC as an indicator of the quality of health care delivery, a deeper understanding of the reasons that can impact its rates is required.

Background: The prevalence of obesity in Russia has increased sharply since the mid-1990s. Interestingly, the prevalence of obesity in Japan is lower than in many Western countries. Japan has implemented different types of weight control programs using a smart device to monitor patients remotely. New health promotion methods from Japan are now being used in Russia. The Russian-Japanese “Tackle Obesity and Metabolic Syndrome Outcome by Diet, Activities and Checking Body Weight Intervention” (RJ-TOMODACHI) study aims to evaluate a preventive intervention using Japanese health monitoring technology in reducing excess body weight, compared with standard care, in Russia. Methods and Results: The trial is a single-center, 3-armed, parallel group randomized controlled trial conducted among overweight/obese adults. It has been designed to compare the effectiveness of 2 newly developed interventions against standard care for 6 months. Participants in the low- and high-intensity intervention groups will have 3 and 6 consultations over the study period, respectively. In all, 260 adults were screened at baseline; 65 did not participate in the trial for various reasons. The remaining 195 people were randomized into 3 groups (high-intensity intervention, n=73, low-intensity, n=73; standard care group, n=49). Conclusions: The trial protocol has been designed so that the methodology can be adapted for use in Russia.

Russia belongs to countries with a high prevalence of arterial hypertension (AH), which is the main cause of premature death in the Russian population. The level of blood pressure (BP) is controlled in less than a third of patients, which may be due to poor adherence to medical recommendations and irregular medication. The manuscript provides a review of studies evaluating the effectiveness of measures to improve adherence to antihypertensive therapy (AHT).Aim. To prepare a systematic review of Russian studies to assess the effectiveness of measures to increase adherence to AHT, to determine/describe the main directions of the intervention and the methodological level.Material and methods. The search for full-text articles on adherence to AHT published in Russian in the period from 2000 to 2019 was carried out in the main Russian and international electronic databases eLIBRARY.ru, Embase, Russian Medicine, MEDLINE. Of the 563 publications found, 20 were included in the review.Results. In 14 studies, adherence was assessed using the 4-item Morisky Medication Adherence Scale (MMAS-4), other studies used bespoke questionnaires or pill counts. Two studies examined factors associated with adherence. The observation period was up 6 weeks to 12 months, the number of participants is 30-2435 people. A higher adherence was noted in women, people over 50 years old, with higher education, working, with concomitant diabetes mellitus and a history of myocardial infarction. Patient education was effective interventions to improve adherence (in particular, in studies, improvement on the MMAS-4 from 1.8 to 3.9 points, p=0.0002 or from 2.80 to 3.79 points, pConclusion. The most effective ways to improve adherence are patient education and the use of drugs fixed combinations. In most studies, subjective methods of adherence assessing were used.

Unhealthy diet is associated with high morbidity and mortality from chronic non-communicable diseases (NCDs) which in turn are associated with high economic costs. A significant proportion of these costs is attributed to insufficient fresh fruits and vegetables in the diet worldwide with large country-to-country variation warranting research in various settings including Russia. The aim: to assess the economic burden of insufficient consumption of fruits and vegetables in Russia in 2016 due to their contribution to the development of major NCDs. Methods: The calculation was made using population attributive risk for the development of cardiovascular diseases, type 2 diabetes and cancer from meta-analyses and the data on the prevalence of fruits and vegetables consumption and the abovementioned diseases in the Russian population. The economic costs from the main NCDs were calculated using the human capital method. The share of health care system costs and economic losses due to morbidity and mortality from NCDs associated with fruits and vegetables underconsumption was assessed. Results: The contribution of insufficient consumption of fruits and vegetables to the morbidity and mortality from cardiovascular diseases, coronary heart disease and stroke were 5 % each (95 % CI: 3.0-6.2), 5% (95 % CI: 3.7-6.2) and 10 % (95 % CI: 4.9-15.9), respectively. Corresponding proportions for lung cancer was 8.9 % (95 % CI: 3.7-14.4). The economic burden associated with this risk factor, amounted more than 134 billion rubles (95 % CI: 78.8-173.3 billion rubles), 0.16 % of GDP of the Russian Federation in 2016. Indirect losses due to premature mortality (86 %) prevailed in the structure of the economic burden. Conclusions: The high prevalence of fruits and vegetables underconsumption in Russia and its significant contribution to the morbidity and mortality from NCDs are associated with significant economic costs from this risk factor.

The prevalence of hypertension in the Russian Federation (RF) has been growing in recent years, which causes significant socio-economic burden. Aim . To evaluate economic burden of hypertension in the RF in 2016 including direct costs and economic losses caused by decreased labor efficiency. Material and methods . The calculation included the prevalence of hypertension in the RF and the relative risk of hypertension for cardiovascular diseases (CVD) (including stroke and coronary heart disease), chronic obstructive pulmonary disease (COPD), type 2 diabetes mellitus (DM2), cancer of the trachea, bronchi and lungs, breast and prostate. The calculation included Russian statistics on noncommunicable diseases (NCD) for 2016. Statistical analysis – calculations were performed by Microsoft Excel 10.0 Results . Population attributable risk (PAR) of hypertension in mortality from all CVDs was 34%, in morbidity – 30%, including PAR in mortality from coronary heart disease and stroke 38% and 60%, respectively; the same in morbidity – 28% and 14%, respectively. For DM2 PAR in mortality was 1%, in morbidity – 18%. For COPD PAR in morbidity was ≈24%. PARs in morbidity and mortality for lung, bronchi and trachea cancer were ≈12%, for prostate cancer ≈3%, and for breast cancer 6%. Direct medical costs associated with the analyzed NCDs exceeded 84 billion rubles, direct non-medical costs – over 1.5 billion rubles. In the structure of economic burden, the main part was associated with gross domestic product (GDP) losses due to premature mortality due to hypertension. Conclusion . The total economic burden associated with hypertension in 2016 amounted to 869936 million rubles that corresponded to 1% of Russian GDP.

Aim: to study the impact of anti-smoking measures within the Federal Law N 15-FL on the number of hospitalization of patients with acute cardiovascular conditions in the Samara and Arkhangelsk Regions and the Chuvash Republic. Methods: Monthly hospitalization rates for acute myocardial infarction and unstable angina were analyzed usinginterrupted time series by means of the STATA 15.0 software package, which includes the ITS module in three regions of the Russian Federation from 01.01.2012 to 31.12.2017, and by gender (men and women) and age (0-59 years and 60 years and older). Results. Reduction in hospital incidence after each stage of the anti-tobacco policy was obwerved in two of the three regions. In the Samara Region we observed a reductionby 16.3 % in 2013 and by 18.4 % in 2014 for unstable angina and by 10.6 % in 2013 and by 10.5 % in 2014 for acute myocardial infarction, respectively. In the Arkhangelsk Region the number of hospitalizations decreased by 14.3 % in 2013 and by 14.4 % in 2014 for unstable angina, and by 7.5 % in 2013 and by 7.7 % in 2014 for acute myocardial infarction. No significant decrease was observed in the Chuvash Republic. Gender stratification revealed a decrease in the hospital incidence of acute myocardial infarction and unstable angina in women in the Samara and Arkhangelsk Regions, and in men - only in the Samara region. The percentage of reduction in unstable angina was higher than in the acute myocardial infarction. An analysis of age groups in the Samara Region showed a decrease in the number of hospitalizations for acute myocardial infarction and unstable angina in both age groups, and in the Arkhangelsk Region only in people over 60 years of age. Conclusions: anti-tobacco legislation introduced in Russia in 2013 and 2014 is likely to have contributed to a decrease in the number of hospitalizations for acute cardiovascular diseases, but the effect varied across genders and age-groups.

Aim. To analyze the associations of health care system resources utilization and temporary disability (TD) with the main cardiovascular risk factors (RF) at the population and individual level in working age population based on ESSE-RF study data.Material and methods. The analysis was based on ESSE-RF study data. Standard epidemiological survey methods and evaluation criteria were used. Analysis of probability and number of outpatient visits, hospitalizations, ambulance calls and TD was conducted by using hurdle model. Hypertension, obesity, hypercholesterolemia, hyperglycemia and tobacco consumption were independent variables.Results. A total of 21923 individuals aged 25-64 years were included: men – 8373 (38%) and women – 13550 (62%). The probability of outpatient visits significantly determined in group with tobacco consumption and with hypercholesterolemia for men, and for women – in the smoking group, with obesity and with hyperglycemia. Numbers of outpatient visits has doubled for patient with hyperglycemia. The numbers of outpatient visits were higher among women smokers compared to non-smokers. Chance to be hospitalized significantly associate with smoking, obesity, hypercholesterolemia for men and with obesity, hyperglycemia – for women. Hypercholesterolemia was associated with a smaller number of inpatient treatment cases among men. The probability of ambulance calls increased for smoking men, for male group with hypertension, hypercholesterolemia, obesity and with hyperglycemia, at the same time, the likelihood increased in female group with hypertension, hyperglycemia, smoking and with obesity. In addition, numbers of ambulance calls were higher in 1.55 times for women with obesity (pConclusion. So, there is a significant association of probability of using and consumption level of healthcare recourse with the RF depending on the type of medical care, sex and RF.

Aim. To evaluate the structure of multimorbidity, outcomes and the potential effect of dapagliflozin in patients with a combination of cardiovascular disease (CVD) and type 2 diabetes in Russian clinical practice.Material and methods. The data of 10 registries with the inclusion of 22957 people, including 4370 with type 2 diabetes in 6 regions of the Russian Federation, were analyzed. Scenarios for reducing mortality from all and cardiovascular causes and hospitalizations for CVD were simulated among groups of patients with diabetes combined with myocardial infarction (MI) and diabetes combined with heart failure with reduced ejection fraction (HFrEF) based on data from the Federal Registry of diabetes, the RECVASA and REGION registries, relative risks associated with analyzed adverse events from the DECLARE study.Results. When analyzing the data of all 22957 patients with CVD included in the registries, it was found that the proportion of patients with comorbid diabetes was on average 19.0%. Of the various diagnoses of CVD, the combination with diabetes was most often recorded in patients that had MI – 2.0%, stroke – 22.5% and heart failure – 24.0%. In the RECVASA registry (Ryazan) for 4 years of follow-up of 699 patients with a combination of CVD and diabetes mortality from all causes was 20.9%, and from cardiovascular causes – 15.6%. The simulated number of potentially prevented cardiovascular deaths with dapagliflozin taking in patients with diabetes combined with MI for 4 years in Russia will be 39124, and 37440 cardiovascular hospitalizations. The number of potentially preventable deaths from all causes among patients with diabetes combined with HFrEF will be 4543, cardiovascular deaths in 1995, and the number of prevented cardiovascular hospitalizations will be 7072.Conclusion. According to data from the registries of CVD patients in 6 regions of the Russian Federation, it was revealed that in real clinical practice the proportion of people with comorbid diabetes averaged 19% both at the outpatient and hospital stages. These subgroups of multimorbid patients have both the highest risk of developing fatal and non-fatal cardiovascular complications, and the largest number of indications for prescribing drugs that affect the prognosis due to effects on both CVD and diabetes.

As per data provided by the WHO, about one third of death cases due to cancer are caused by risk factors that can be modified. Also, according to data provided by several authors, 4 modifiable risk factors cause 70% of malignant neoplasm cases that could have been prevented. Malignant neoplasms occupy the 2nd rank place in mortality structure in the Russian Federation. A significant share of analyzed malignant neoplasms can potentially be prevented provided that risk factors are corrected; therefore, investments into prevention should be a core in any activity aimed at public health improvement. Our goal was to evaluate economic losses that occurred due to most common oncologic diseases related to behavioral risk factors among population in Russia in 2016 (including costs borne by the public healthcare and losses in the economy). Our analysis comprised direct expenses borne by the public healthcare or, in other words, money spent on oncologic diseases treatment, direct funds allocated to pay disability allowances and temporary disability payments as well as indirect losses in the economy associated with untimely deaths and disability among employable population. Aggregated economic losses that occurred due to 10 most common malignant neoplasms included into our analysis amounted to 241.3 billion rubles or 0.3% of the country GDP in 2016. Direct expenses accounted for 71.7% of the total losses while GDP losses caused by untimely deaths and disability amounted to 28.3%. The highest direct expenses borne by the public healthcare were due to colorectal cancer (52 billion rubles) and cancer in the trachea, bronchial tubes, and lungs (50 billion rubles). Our data indicate it is necessary to invest into oncologic diseases prevention and treatment. These investments can produce a significant economic effect in long-term period thus making for economic growth.

Aim. To study the prevalence of familial hypercholesterolemia (FH), the characteristics of the clinical features and treatment of the disease in selected regions of the Russian Federation, this article describes the design and initial characteristics of patients included in the study.Material and methods. The study participants were selected among those included in the study “Epidemiology of cardiovascular risk factors and diseases in the regions of the Russian Federation” (ESSE-RF) in different regions of the Russian Federation. The study included individuals with lowdensity lipoprotein cholesterol (LDL-C) levels >4.9 mmol/l or LDL-C levels >1.8 mmol/l, but ≤4.9 mmol/l during statin therapy, according to the data obtained in the ESSE-RF study. These persons are invited for examination and questioning by experts in the field of FH diagnostics. On the basis of the survey data and provided medical documentation, the following information is collected: age, sex, smoking status, presence of hypertension, history of coronary artery disease, stroke, atherosclerosis of cerebral and peripheral arteries, LDL-C level, type, volume and duration of lipid-lowering therapy throughout life, presence and dates of secondary causes of hyperlipidemia, information about the family history of development of early cardiovascular diseases and atherosclerotic diseases, increased levels of LDL-C in relatives of the 1st and 2nd degree of kinship. All patients are examined for the presence of tendon xanthomas (Achilles, metacarpal, elbow, knee tendons) and Corneal arcus. During the visit, blood is taken for subsequent biobanking, measurement of current blood lipid levels, elimination of secondary forms of hypercholesterolemia (for subsequent determination of liver enzymes, thyroid stimulating hormone) and genetic testing. The diagnosis of FH is based on Dutch Lipid Clinical Network Criteria (DLCN). Besides, all participants in the study are tested for compliance with the diagnosis of FH according to Simon Broome criteria. All patients with a definite or probable diagnosis of FH according to DLCN or Simon Broome criteria are subjected to ultrasound examination of carotid, femoral arteries and heart and molecular genetic testing for LDLR, APOB and PCSK9 gene variants.Results. Out of 16 360 participants of the ESSE-RF study in 10 regions, 1787 people (10,9%) met the criteria for inclusion in this study. Among them, men accounted for 35.4%, of which 1150 (7%) patients had a LDL-C level >4.9 mmol/l and 637 (3,9%) had a LDL-C level from 1,81 mmol/l to 4.9 mmol/l during lipid-lowering therapy. When compared to the original cohorts of participants from the 10 regions as compared to 3 previously surveyed regions and selected sub-groups within these cohorts we observed significant differences in several parameters such as age, total cholesterol level, triglycerides, LDL-C, the frequency of cardiovascular diseases, that may indicate regional differences in FH prevalence.Conclusion. The analysis of clinical data of the participants of the ESSE-RF study shows that more than 10% of individuals require an additional examination to verify the FH diagnosis, and regional differences in the FH prevalence are possible.

Intensive investigation of cardiovascular disease (CVD) risk factors (RFs), both traditional (smoking, dyslipidemia, diabetes, etc.) and non-traditional, which are a component of the so-called exposome, as well as their non-drug and drug correction provide wide prospects for effective cardiovascular prevention. Prevention becomes the dominant trend in cardiology and in medicine in general. The aim of the article was to describe cardiovascular prevention in young, middle, elderly and senile age. Due to the multifaceted nature of cardiovascular RFs, an integrated biopsychosocial approach, individual and population-based prevention, cumulative risk assessment of all CVDs, intersectoral collaboration and the involvement of decision-makers, are key to the success and effectiveness of prevention measures. It is important to note that, on the one hand, preventive measures should be started as early as possible due to cumulative effect of RFs, on the other hand, most of the preventive interventions for CVD are extremely relevant at all life stages.

Introduction 24-hour movement behaviours (physical activity, sedentary behaviour and sleep) during the early years are associated with health and developmental outcomes, prompting the WHO to develop Global guidelines for physical activity, sedentary behaviour and sleep for children under 5 years of age. Prevalence data on 24-hour movement behaviours is lacking, particularly in low-income and middle-income countries (LMICs). This paper describes the development of the SUNRISE International Study of Movement Behaviours in the Early Years protocol, designed to address this gap. Methods and analysis SUNRISE is the first international cross-sectional study that aims to determine the proportion of 3- and 4-year-old children who meet the WHO Global guidelines. The study will assess if proportions differ by gender, urban/rural location and/or socioeconomic status. Executive function, motor skills and adiposity will be assessed and potential correlates of 24-hour movement behaviours examined. Pilot research from 24 countries (14 LMICs) informed the study design and protocol. Data are collected locally by research staff from partnering institutions who are trained throughout the research process. Piloting of all measures to determine protocol acceptability and feasibility was interrupted by COVID-19 but is nearing completion. At the time of publication 41 countries are participating in the SUNRISE study. Ethics and dissemination The SUNRISE protocol has received ethics approved from the University of Wollongong, Australia, and in each country by the applicable ethics committees. Approval is also sought from any relevant government departments or organisations. The results will inform global efforts to prevent childhood obesity and ensure young children reach their health and developmental potential. Findings on the correlates of movement behaviours can guide future interventions to improve the movement behaviours in culturally specific ways. Study findings will be disseminated via publications, conference presentations and may contribute to the development of local guidelines and public health interventions. Funding Agencies|American Council on Exercise, USA; Beijing Health System High Level Talents Training Project, China [2015-3-88]; Biomedical Research Foundation, Dhaka, Bangladesh [BRF-19-01]; Canadian Institutes of Health Research Frederick Banting and Charles Best Canada Graduate Scholarship (CGS-M)Canadian Institutes of Health Research (CIHR); Canadian Institutes of Health Research Planning and Dissemination GrantCanadian Institutes of Health Research (CIHR) [155265]; Civilian Research Development Foundation (CRDF) Global [OISE-20-66864-1]; Department of National Planning and Monitoring, PNG Government [02704]; Early Start, University of Wollongong, Australia; Faculty of Health Sciences at the University of the Witwatersrand, Johannesburg, South Africa; Fogarty International Center (FIC) of the National Institutes of Health [D43 TW010137]; Geran Universiti Penyelidikan (GUP), Universiti Kebangsaan Malaysia [GUP-2018-142]; Global Challenges Program, University of Wollongong, Australia [888/006/497]; Harry Crossley Foundation, South Africa; National Institute of Education-Ministry of Education, Singapore [OER 04/19 TWP]; Pham Ngoc Thach University of Medicine, Vietnam [1319/QD-TDHYKPNT]; Sasakawa Sports Research Grant, Sasakawa Sports Foundation, Japan [190A2-004]; Stella de Silva Research grant from Sri Lanka College of Paediatricians, Sri Lanka; The DST-NRF Centre for Excellence in Human Development at the University of Witwatersrand, Johannesburg, South Africa; International Society of Behavioral Nutrition and Physical Activity, Pioneers Program (ISBNPA-2021); The University Research Coordination Office of the De La Salle University, Philippines [29 IR S 3TAY192021]; Universidad de La Frontera Research Directorate, Chile [DI20-0093, DFP19-0012, DI20-1002]; WHO European Office for Prevention and Control of Noncommunicable Diseases

Introduction The Russian Federation reported one of the largest number of COVID-19 infections. Major restrictions (social distancing, travel bans, event cancellation, changes to work practices) were introduced on the 28th March 2020 with the level of restrictions varied depending on the epidemiology of the virus from region to region. Purpose is to estimate the impact of COVID-19 on sleep among adults in Russia. Methods The NMRC TPM conducted a national online-survey ‘Study of the impact of restrictions on physical activity of the population in self-isolation due to COVID-19'. Data were collected during the period of tightest restriction through the country between 26 April 2020 and 6 June 2020. A link on the online survey was distributed through the regional center of public health. Sleep quality was assessed by comparing the period before the COVID-19 and the last 7 days. Results In spring 2020, 2432 completed questionnaires from 62 regions of Russia were received. There was a predominance of female respondents (86.6%), the average age was 33.6±14.9 years and 38.2±13.1 years for men and women, respectively. The majority of completed questionnaires were received from the Republic of Tatarstan (n = 804), Irkutsk (n = 474), Sakhalin (n = 225) and Tver regions (n = 152). Compare pre-COVID to during COVID there was a significant decline in the number of days per week participants reported not getting enough sleep (3.21±2.44 to 2.86±2.57; p < 0.001) and participants also reported an increase in the number of days per week they had trouble falling asleep (1.70±2.24 to 2.13±2.48; P < 0.001). The number of days participants waking up earlier than wanted before and during the pandemic has not changed (2,6 Đ, 2,59 (p < 0,5)). Conclusions Effective health promotion strategies directed at adopting or maintain positive health related behaviors such as targeted social media messaging and balanced media reporting, should be used to maintain healthy sleep during these unprecedented times. Key messages Changes in sleep quality during COVID-19 identified as a result of the online-survey ‘Study of the impact of restrictions on physical activity of the population in self-isolation due to COVID-19'. Effective health promotion strategies directed at adopting or maintain positive health related behaviors should be used to maintain healthy sleep during COVID-19 pandemic.

Despite treatment advances, the prognosis of patients with both primary and secondary pulmonary hypertension (PH) remains unfavorable. The increased activity of the sympathetic nervous system is one of the universal mechanisms involved in the PH pathogenesis. Pulmonary artery denervation is a novel minimally invasive pathogenetic method of PH treatment. The denervation procedure is mainly implemented by using radiofrequency ablation of the pulmonary trunk, where most sympathetic nerve fibers are located. In this article we present an overview and analysis of the present state, results of various experimental and clinical studies, as well as clinical experience. The results of studies demonstrated the safety of endovascular surgery and its beneficial effect on both hemodynamic and clinical parameters.

Aim. To assess the dynamics of blood pressure (BP) and determine the predictors of the hypotensive effect after carotid artery stenting (CAS).Material and methods. The analysis included 99 patients who underwent CAS in a period of March 2014 and May 2016. Inclusion criteria: (1) the presence of 50% symptomatic or 70% asymptomatic stenosis of the carotid artery (according to NASCET criteria), (2) follow-up for at least 1 year, (3) measurement and recording of BP at four points: 24 hours before surgery, 1 hour, 24 hours and 12 months after surgery. Results. According to office measurement of BP, the average systolic/diastolic pressure was 117,11/60,75, 119,73/60,75, 134,75/70,48 mm Hg after 1 hour, one day and 12 months after the intervention, respectively. In comparison with the average numbers of BP before the intervention, 148,13/89,52 mm Hg there was a significantly significant decrease in BP levels after CAS (pConclusion. The obtained results indicated the need for more thorough conservative postoperative management, especially for patients with a dissociated circle of Willis. It is also necessary to achieve the target blood pressure values by individualized correction of antihypertensive therapy.

This article examines the role of physicians within the managerial structure of Russian hospitals. A comparative qualitative methodology with a structured assessment framework is used to conduct case studies that allow for international comparison. The research is exploratory in nature and comprises 63 individual interviews and 49 focus groups with key informants in 15 hospitals, complemented by document analysis. The material was collected between February and April 2017 in five different regions of the Russian Federation. The results reveal three major problems of hospital management in the Russian Federation. First, hospitals exhibit a leaky system of coordination with a lack of structures for horizontal exchange of information within the hospitals (meso-level). Second, at the macro-level, the governance system includes implementation gaps, lacking mechanisms for coordination between hospitals that may reinforce existing inequalities in service provision. Third, there is little evidence of a learning culture, and consequently, a risk that the same mistakes could be made repeatedly. We argue for a new approach to governing hospitals that can guide implementation of structures and processes that allow systematic and coherent coordination within and among Russian hospitals, based on modern approaches to accountability and organisational learning.

Objective: To evaluate the prevalence and geographic distribution of overweight and obesity in Russian adults aged 25–64 years as well as the association between chronic risk factors and obesity. Methods: Data were obtained from the survey “Epidemiology of Cardiovascular Diseases and Its Risk Factors in Some Regions of the Russian Federation” (ESSE-RF). This is a large cross-sectional multicenter population-based study that included interviews and medical examination (anthropometry, blood pressure [BP] measurement, and laboratory analysis) applied in 2012–2014. Results: The sample included 20,190 adults (response rate 79.4%) aged 25–64 years. Approximately one third of participants (30.3%) had obesity and another third (34.3%) were classified as overweight. BMI increased with age in both sexes. The prevalence of obesity between regions ranged from 24.4 to 35.5%. Overweight and obesity levels decreased with higher education (men only). Overall obesity rates were higher in rural than urban populations, but rates of overweight were similar in rural and urban populations. Participants with obesity were more likely to have BP > 160/100 mm Hg (odds ratio > 2.0) and also > 140/90 mm Hg, raised blood glucose, and high triglycerides. Conclusion: The prevalence of overweight and obesity in Russian adults aged 25–64 years is not evenly distributed geographically, but it is comparable to that of other European countries. Individuals with obesity were also more likely to have indicators of poor cardiovascular and metabolic health.

Background The aim of this study was to evaluate the impact of COVID-19 on the levels of physical activity (PA) and sleep and to examine specific COVID-19 factors that may be associated with changes in PA and sleep among adults in Russia. Methods Cross-sectional data were collected during the period of tightest restrictions between 26 April 2020 and 6 June 2020. Eligible participants included all Russian adults aged 18 years and over. Participants reported their sleep patterns and problems, frequency and duration of walking, moderate- and vigorous-intensity PA, and muscle strengthening activities before COVID-19 and during the past 7 days. Access to an outdoor green space and fitness centres, use of online resources, adherence to self-isolation recommendations and other preventive measures from Ministry of Health were self-reported. Results The sample included 2432 participants from 62 regions, 83% of who were female. There was a significant decline in the number of days per week participants reported not getting enough sleep (3.21 ± 2.44 to 2.86 ± 2.57; P P P P Conclusion Compared with before COVID-19, PA and sleep hygiene were adversely affected during COVID-19. Awareness of factors associated with these declines will assit policymakers in developing strategies to mitigate the negative lifestyle behaviours that have manifested during the COVID-19 confinement.

Introduction In Russia, mortality rates from CVD are one of the highest in the world. In recent decades, it has been demonstrated that the contribution of a modifying risk factors to cardiovascular mortality in different populations can vary significantly. Aim To evaluate the 7-year survival and association of risk factors with cardiovascular mortality among rural residents of Russia. Materials and methods This study was carried out as part of the international project InterEpid, which included a one-stage epidemiological study of the prevalence of major chronic noncommunicable diseases and their risk factors (n=1050), and a prospective stage among residents of rural areas of Russia. The analysis includes the results of a survey of representative samples of the rural population of the Samara Region of Russian Federation (n=919) aged 20–64, response rate 87,5%.The following endpoints are included in the analysis: 1. Cases of death from all causes; 2. Deaths from CVD. Results In Samara region 7-year survival was 92.7%. Cardiovascular diseases were most frequent cause of deaths (42%). Cardiovascular mortality was significantly associated with hypertension RR 2.11 (1.32; 2.94), p=0.004, low physical activity RR 1.82 (1.02; 2.41), p=0.009, high salt intake RR 1.28 (0.84; 2.21), p=0.03 and high processed meat intake RR 1.37 (0.91; 1.93), p=0.03. Smoking had a significant effect on cardiovascular mortality only among men RR 2.11 (1.14; 2.84), p=0.005. Conclusion 7-year follow up demonstrated significant unfavorable effect of smoking on men's cardiovascular mortality; hypertension, low physical activity, high salt and processed meat intake on the risk of cardiovascular mortality in both sexes in rural areas of Russia. All this underlines the need to develop differentiated preventive and treatment and preventive programs adjusted to country specific of risk factors prevalence and its impact on the prognosis. 7-year survival (Samara region) Funding Acknowledgement Type of funding source: None

Aim to estimate the economic burden of major chronic noncommunicable diseases (NCDs) attributable to risk factors in the Russian Federation in 2016 Material and Methods The following risk factors were included in the analysis: smoking, high alcohol intake, high salt intake, low intake of fresh vegetables and fruits, consumption of processed red meat, low physical activity, obesity, hypertension, which reliably have a causal relationship with major NCDs: cardiovascular diseases(CVD),type 2 diabetes, chronic obstructive pulmonary disease(COPD), cancer of 10 localizations. The relative risks (RR)of morbidity and mortality from major NCDs associated with risk factors are identified through a literature search. Based on the data on the prevalence of risk factors in the Russian population and RR, the population attributable risk (PAR)was calculated for each analyzed disease. Statistical analysis calculations using descriptive statistics methods were performed in the MSExcel 10.0 program. Results The largest burden from the four main NCDs is associated with hypertension - 10.9 billion€, which is equivalent to 1.01% of GDP. The next largest contribution to the burden from NCDs was the burden from obesity 7.6 billion€ 0.7% of GDP, smoking over 5.2 billion €, 0.49% of GDP and the low physical activity 3.4 billion€, 0.32% of GDP. Of all the analyzed risk factors, the least contribution to total costs in connection with NCDs was determined by the burden from high alcohol intake 1.1 billion€, 0.1% of GDP, due to the low prevalence of high alcohol intake in the Russian population. Conclusions In this study, for the first time, the assessment of the economic burden of risk factors by the share (contribution) to the morbidity and mortality of main NCDs (CVD, T2DM, COPD and 10 cancer localizations) in the Russian Federation for 2016 was performed. Such the significant economic burden is a strong argument for increasing investments in the prevention and treatment of risk factors of NCDs. Key messages In Russia the largest burden from the four main NCDs is associated with hypertension. Such the significant economic burden is a strong argument for increasing investments in the prevention and treatment of risk factors of NCDs.

Background - The Russian Federation has among the highest rates of cardiovascular disease (CVD) in the world and a high rate of untreated hypertension remains an important risk factor. Understanding who is at greatest risk is important to inform approaches to primary prevention. Methods - 2,353 hypertensive 35–69 year olds were selected from a population-based study, Know Your Heart, conducted in Arkhangelsk and Novosibirsk, Russian Federation, 2015–2018. The associations between untreated hypertension and a range of co-variates related to socio-demographics, health, and health behaviours were examined. Results - The age-standardised prevalence of untreated hypertension was 51.1% (95% CI 47.8–54.5) in males, 28.8% (25.4–32.5) in females, and 40.0% (37.5–42.5) overall. The factors associated with untreated hypertension relative to treated hypertension were younger ages, self-rated general health as very good-excellent, not being obese, no history of CVD events, no evidence of diabetes or chronic kidney disease, and not seeing a primary care doctor in the past year as well as problem drinking for women and working full time, lower education, and smoking for men. Conclusion - The study found relatively high prevalence of untreated hypertension, especially, in men. Recent initiatives to strengthen primary care provision and implementation of a general health check programme (dispansarisation) are promising, although further studies should evaluate other, potentially more effective strategies tailored to the particular circumstances of this population.

Background Cardiovascular disease (CVD) mortality is substantially higher in Russia than in neighbouring Norway. We aimed to compare blood pressure- and lipid-lowering medication use and proportion meeting treatment targets between general population samples in the two countries in those with CVD and diabetes. Methods The study population was adults aged 40–69 years reporting a diagnosis of myocardial infarction (MI), stroke and/or diabetes participating in cross-sectional population-based studies in Russia (Know Your Heart (KYH) 2015–18 N = 626) and Norway (The Tromsø Study 2015–16 (Tromsø 7) N = 1353). Reported medications were coded according to the 2016 WHO Anatomical Therapeutic Chemical Classification system. Treatment targets were defined using the Joint European Societies guidelines for CVD prevention in clinical practice (2016). Results Age- and sex-standardized prevalence of use of lipid-lowering medications was higher in Tromsø 7 for all three conditions with a disproportionately large difference in those reporting MI (+ 48% (95% CI 39, 57%)). Proportion meeting treatment targets for LDL cholesterol was poor in both studies (age- and sex-standardized prevalence of control KYH vs Tromsø 7: MI 5.1% vs 10.1%; stroke 11.6% vs 5.8%; diabetes 24.9% vs 23.3%). Use of antihypertensive medication was higher in KYH for stroke (+ 40% (95% CI 30, 50%)) and diabetes (+ 27% (95% CI 19, 34%)) groups but approximately equal for the MI group (− 1% (95% CI -1, 1%)). Proportion meeting blood pressure targets was lower in KYH vs Tromsø 7 (MI 51.8% vs 76.3%; stroke 49.5% vs 69.6%; diabetes 51.9% vs 63.9%). Conclusions We identified different patterns of medication use in people with CVD and diabetes. However despite higher use of lipid-lowering medication in the Norwegian study treatment to target for total cholesterol was poor in both Russian and Norwegian studies. In contrast we found higher levels of use of antihypertensive medications in the Russian study but also that less participants met treatment targets for blood pressure. Further work should investigate what factors are responsible for this seeming paradox and how management of modifiable risk factors for secondary prevention could be improved.

Objective To study the prevalence of cardiovascular (CV) risk factors (RFs) in the rural population of the Chui region of Kyrgyzstan (Central Asia). Methods The sample was representative of the population in terms of age and sex and included at least 10% of the population aged 18-65 y. Of the 1,672 people included in the cohort, 1.330 people responded to the invitation (79.5% of the total sample population). All study participants were interviewed using standardized questionnaires and examined by a cardiologist. Blood pressure (BP), weight, height, waist circumference (WC), fasting serum glucose, and fasting lipid level were measured. Results The prevalence of major CV RFs in the examined sample was as follows: arterial hypertension 34.1%, obesity 25.7%, and abdominal obesity 52.3%; the factors were significantly more prevalent in women (68.2%) and increased with age. The frequency of lipid metabolism disorders was 88.4% in the examined subjects, and an increased level of low-density cholesterol (70.5%) was common. Hypodynamia was detected in 15.6% of the subjects, diabetes mellitus in 3.76%, and a family history of cardiovascular disease was present in 34.8% of the examined subjects. The frequency of smoking was 24.6% and was significantly higher in men (46.9%). Conclusion Abdominal obesity, followed by hypercholesterolemia and arterial hypertension were the most common RFs among the rural population of the Chui region of Kyrgyzstan. Smoking was the most common RF among men. The prevalence of traditional CV RFs, except smoking, increased with age.

BackgroundThe Russian Federation has very high cardiovascular disease (CVD) mortality rates compared with countries of similar economic development. This cross-sectional study compares the characteristics of CVD-free participants with and without recent primary care contact to ascertain their CVD risk and health status.MethodsA total of 2774 participants aged 40–69 years with no self-reported CVD history were selected from a population-based study conducted in Arkhangelsk and Novosibirsk, Russian Federation, 2015–2018. A range of co-variates related to socio-demographics, health and health behaviours were included. Recent primary care contact was defined as seeing primary care doctor in the past year or having attended a general health check under the 2013 Dispansarisation programme.ResultsThe proportion with no recent primary care contact was 32.3% (95% CI 29.7% to 35.0%) in males, 16.3% (95% CI 14.6% to 18.2%) in females, and 23.1% (95% CI 21.6% to 24.7%) overall. In gender-specific age-adjusted analyses, no recent contact was also associated with low education, smoking, very good to excellent self-rated health, no chest pain, CVD 10-year SCORE risk 5+%, absence of hypertension control, absence of hypertension awareness and absence of care-intensive conditions. Among those with no contact: 37% current smokers, 34% with 5+% 10-year CVD risk, 32% untreated hypertension, 20% non-anginal chest pain, 18% problem drinkers, 14% uncontrolled hypertension and 9% Grade 1–2 angina. The proportion without general health check attendance was 54.6%.ConclusionPrimary care and community interventions would be required to proactively reach sections of 40–69 year olds currently not in contact with primary care services to reduce their CVD risk through diagnosis, treatment, lifestyle recommendations and active follow-up.

Aim . To assess the economic burden associated with the absence of lipid-lowering therapy (LLT) in patients with cardiovascular diseases (CVD) and hypercholesterolemia (HCS) in the Russian population in 2016, including direct costs of the health care system and indirect economic losses due to premature death, absenteeism and disability. Material and methods . The calculation includes data from local population-based studies (prevalence of HCS, treatment coverage and efficiency), as well as Russian statistics on CVD for 2016. Population attributive risk (PAR) was determined, which reflected the incidence of excessive morbidity associated with the lack of HCS therapy in developing CVD for the Russian population, based on LDL cholesterol level. Direct and indirect components of economic burden associated with the absence of LLT have been calculated, as well as the number of deaths with the calculation of "lost years of potential life" lacking to reach the age of 72 years, and losses associated with premature mortality in the economically active age. Indirect costs (economic losses) included non-received gross domestic product (GDP) due to premature mortality and disability in economically active age and loss of earnings due to temporary disability (TD). To estimate the indirect costs, the number of people of the working age with permanent disability in each of the disability groups has been calculated. The indirect costs due to temporary disability were calculated as payments of salary including for days of incapacity for work multiplied by the number of days of TD according the Russian statistics data. Results . The absence of LLT in people with HCS increases the risk of CVD related mortality by one third, death due to cerebrovascular diseases, including stroke, by more than a half. PAR was estimated to be 17% for CVD mortality in general, 26% for cerebrovascular diseases. Contribution of HCS and the lack of LLT to morbidity is 29% for ischemic heart disease (IHD), 20% for myocardial infarction. Outpatient calls take the first place among all out-patient care statistics, and those associated with IHD are in the leading position among them. Hospitalization takes the second place. The absence of LLT caused the loss of more than 400,000 years of life in economically active age. The direct costs are determined by expenses for hospitalizations in the presence of IHD. The share of direct costs for hospitalizations is 86%, while in the presence of cerebrovascular diseases it is 76.8%. Payments for disability allowance, which refers to direct non-medical costs, exceed 154 million Russian rubles (RUR) for IHD and 104 million RUR for cerebrovascular diseases. The biggest share of economic burden associated with the lack of LLT in individuals with this risk factor is accounted for indirect economic losses: about 507 billion RUR in IHD, of which more than 90 billion RUR are associated with myocardial infarction. The costs associated with cerebrovascular diseases make up over 305 billion RUR, the vast majority of which is due to stroke: over 248 billion RUR. Due to the low LLT coverage in the Russian Federation, the economic burden associated with its absence is over 80% of the calculated HCS related losses in total. Conclusion . Economic burden of the lack of LLT in HCS patients is calculated as 530 billion RUR, which is about 0.6% of GDP in 2016, and the largest part of expenditures is related to IHD. The increased awareness of HCS and its improved control with increasing treatment coverage will make possible to lower cholesterol values at the population level, which will also reduce the economic burden of this risk factor for CVD.

Aim. To analyze the associations of health care system resources utilization and temporary disability (TD) with the main risk factors (RF) for cardiovascular diseases (CVD) in working age population based on ESSE-RF study data.Material and methods. The analysis was based on ESSE-RF study data (13 regions of the Russian Federation). Standard epidemiological survey methods and evaluation criteria were used. The analysis included results of a survey of the ESSE-RF study participants about the utilization of health services and TD during last 12 months. Average number of outpatient visits, hospitalizations (including duration of in-hospital treatment and number of cases), ambulance calls and TD (a number of days and cases) per one study participant and associations with RF for CVD were estimated. We conducted a comparative analysis of the utilization of health services and TD in association with cardiovascular RF, also logistic regression analysis was performed to predicting the likelihood of outpatient visits, hospitalizations, ambulance calls and TD.Results. A total of 21,923 individuals in the 25-64 age group were included: men – 8,373 (38%) and women – 13,550 (62%). Number of men who was hospitalized significantly increased in group with tobacco consumption (1,41; p

Aim. To assess the impact of lockdown measures during coronavirus disease 2019 (COVID-19) pandemic on physical activity (PA) of the adult population in Russia.Material and methods. The online survey was conducted during the period of strict restrictions in Russia from April 26, 2020 to June 6, 2020. The survey involved respondents aged ≥18 years. Participants reported the frequency and duration of moderate to high-intensity PA, as well as walking and other types of exercise, before the pandemic and during the last seven days during the survey period.Results. In the country as a whole, there was a decrease in all types of PA during the pandemic. The proportion of participants who met the World Health Organization recommendations for any type of PA decreased from 68 to 49% (pConclusion. The results of the study are the evidence base to substantiate the feasibility of measures aimed at correcting the lifestyle of the population in the context of the COVID-19 pandemic.

BackgroundArterial hypertension (HT) is common in the Russian adult population, with half of affected individuals inadequately controlled. Low adherence to medication seems likely to be a factor. We report a scoping review of studies on adherence to antihypertensive therapy (AHT) in Russia to determine the extent of research undertaken, the frequency of adherence among adults diagnosed with HT, methodologies used in the studies, and their ability to describe determinants of adherence.MethodsA scoping review of published studies that have assessed adherence to AHT in Russian HT patients searched the main Russian and international electronic databases eLIBRARY.ru, Russian Medicine, Embase, MEDLINE for full-text reports published in the Russian language between 2000 and 2017. The last search was on November 28, 2017. Among 520 reports identified, 31 were included in the review.ResultsEighteen studies assessed adherence using the 4-item Morisky Medication Adherence Scale (MMAS-4); others used bespoke questionnaires or pill counts. 25 studies assessed levels of adherence, 11 examined its determinants, and 18 examined intervention strategies. The proportion of “adherent” patients varied from 11 to 44% using the MMAS-4, from 23 to 74% when using bespoke questionnaires, and from 5 to 43% when using pill counts. Adherence was associated with sociodemographic factors, access to free drugs provided through the Medicine Assistance Scheme (MAS), use of home blood pressure (BP) monitoring, anxiety, and comorbidity. There was no evidence that adherence was associated with income or physical activity. Evidence of an association between MAS, grade of HT, or experience of hypertensive crisis was inconclusive. Various methods to improve adherence were studied including patient education (improved from 1.8 to 3.9 points,p = 0.0002 or 2.80 to 3.79 points,p p ConclusionsThe main determinants of adherence to AHT are sociodemographic characteristics, the severity of HT, and presence of comorbidity. Patient education and use of fixed-dose combinations of drugs were identified as most important for improving adherence. Most studies assessing adherence use self-reported methods so there is a need for greater use of objective methods.Trial registrationThis scoping review has not been registered.

Background Russia has one of the highest mortality rates from cardiovascular disease (CVD) in the world. For patients with acute myocardial infarction (AMI), longer pre-hospital delays are associated with increased complications and mortality. The aim of this study is to use multivariate analyses to identify risk factors for prolonged pre-hospital delay and its components (patient decision time delay and transport time delay) in the Russian Federation for AMI patients. Methods A total of 1128 hospitalised patients with suspected AMI were recruited in a prospective observational study with a representative sample of suspected AMI patients from 16 hospitals in 13 regions of Russia, of theses 6 cases were excluded as they had an MI while already hospitalised, 243 cases were excluded due to missing date/time data. Data were collected from both patient questionnaires and clinical records. Pre-hospital delays analysed include total pre-hospital delay ≥2 hrs, patient decision time (≥ 1 hr) and transport time (≥1). Logistic regression models were used to identify patient (sociodemographic, socioeconomic, previous medical history), symptom and admission related predictors of increased delays. Results The median total pre-hospital delay was 4.83 hrs (IQR 2.64–10.82), decision time 1.25 hrs (IQR 0.38–4.5), and transport time 2.03 hrs (IQR 1.23–4.5). No age differences were found across total, decision or transport related delay. The odds of admission within 2 hours from symptom onset (total prehospital delay) significantly decreased with poorer wealth status, indirect route to hospital and symptom onset between 12–6am. Additionally, taking aspirin was associated with lower odds of arriving within 2 hrs. Whilst symptom presentation and co-morbidity was not significantly associated with total delay, patients who thought their symptoms were due to a problem with their heart were more likely to reach the hospital within 2 hours (OR1.65, 95% CI 1.03–2.62). Odds of transport delay >1 hr were significantly greater for patients travelling indirectly but significantly lower for male patients. Symptom onset overnight was associated with increased transport time. Odds of decision time >1 hr were significantly greater among patients that did not attribute their symptoms to a heart problem and patients with symptoms stating overnight (12–6am). Sociodemographic, socioeconomic and comorbid status were not significantly associated with decision time. Conclusion Pre-hospital delay in the Russian Federation is protracted, particularly when patients travel indirectly to their definitive health facility. Symptom characteristics (time of onset and attribution to heart) are important for all components of pre-hospital delay in the Russian Federation. The is initial evidence that male patients experience reduced transport times, but further analyses are required to understand why. Tractable areas for improvement exist; reducing patient decision time and increasing use of EMS.

Aim. To study of the prevalence of the metabolic syndrome and its components among residents of the Kyrgyz Republic.Methods. This study was conducted within the framework of the international «INTEREPID» project, in which, in addition to Kyrgyzstan, the Russian Federation and Kazakhstan participated. Study type is cross-sectional epidemiological study. A cohort was formed randomly, consisting of 1672 people, representative of sex and age structure of the population. In addition to completing the questionnaire, we performed the following examinations: estimation of height, body weight and waist size, measurement of blood pressure and heart rate, electrocardiogram, as well as the determination of a number of biochemical parameters: sugar and creatinine levels in blood and lipid profile (low density lipoproteins, high density lipoproteins and triglycerides levels).Results.Among the residents of the Kyrgyz Republic the prevalence of metabolic syndrome was 30.9% with predominance of its occurrence among women (33.3% vs. 27.7% in men, pConclusion. Among the residents of the Kyrgyz Republic the high prevalence of the metabolic syndrome was registered with certain gender and ethnic features of its components occurrence.

Aim. To study clinical and economical rationales for cardiovascular risk evaluation at workplace (on example of the personnel of engineering research institute).Material and methods. Complex preventive screening with evaluation of arterial hypertension (HT) prevalence, cardiovascular risk level and requirement for risk factors correction is performed. Economical rationales for preventive screening (with estimation of the total costs, costs for one studied person and costs for revealing of one person needed in preventive actions) are also estimated.Results. Preventive screening in the organized collective found new HT cases (12,2%), high and very high cardiovascular risk (58,6%). The desire for risk factors correction is found in 13,0-59,0% of workers. The total costs for preventive screening of 468 persons were 174413 rubles in 3,5 months. Costs for examination of one worker were 561,7 rubles. Costs for detecting of one worker requiring preventive actions were from 635,6 to 3077,4 rublesConclusion. There are rationales for preventive screening of cardiovascular risk and desire to correct it at the workplace.

Aim. To estimate the economic damage by acute coronary syndrome (ACS) in Russia in 2006-2009. Material and Methods. Direct costs and economic losses associated with ACS were estimated. The structure of direct costs includes the costs of hospitalization, medical emergencies, out-patient visits, high-tech medical care, as well as drug therapy in outpatient treatment. Losses in the economy associated with ACS include loss of gross domestic product due to death in working-age, temporary disability and payments of disability benefits. Estimation of economic damage by cardio-vascular diseases was based on analysis of Russian Ministry of Health official statistics. Results. Approximately 520,000 cases of ACS are registered annually (36,4% - myocardial infarction, 63,6% - unstable angina). Trend to increased mortality from myocardial infarction, especially among women, was found during the analyzed period. From 2000 to 2009 this index rose from 34.9 to 41.1 per 100,000 of population among women, and from 52.3 to 55.9 per 100,000 of population among men. Total direct costs of health care for patients with ACS in 2009 amounted to almost 21 billion rubles, and indirect – 53.5 billion rubles. The total economic damage by ACS in Russia in 2008-2009 exceeded 70 billion rubles per year. Conclusion. ACS in Russia is connected with significant social and economic damage. Most part of this damage is indirect losses in economy due to premature mortality of working aged men.

Aim. To estimate economic efficiency of a complex of resource-saving activities for cardiovascular diseases prevention at a workplace. Material and methods. The complex of activities including preventive examination and preventive intervention with their efficacy monitoring was performed in 523 people of a technical research institute staff. Preventive examination included evaluation procedures for cardiovascular diseases and their risk factors (89,5% of respondents). Preventive intervention based on risk factors modification was performed in intervention group. Control group included staff not participating in preventive consultation. Costs associated with cardiovascular diseases and risk factors (medical care consumption and temporary disability) and cost- efficiency analysis was performed. Results. High prevalence of arterial hypertension, metabolic and psychoemotional risk factors at workplace was found in preventive examination. Significant reduction in blood pressure (BP) and total cholesterol (TC) plasma level as well as a tendency to cardiovascular risk (CVR) decrease was reached due to preventive intervention. Costs associated with cardiovascular diseases and their risk factors in intervention group were lower than these in control group (168 584 and 489 500 rbl per 100 people yearly, respectively). Cost- efficiency analysis shown that costs of BP, TC plasma level and CVR reduction were moderate in intervention group. Costs were not efficient in control group. Conclusion. Implementation of cardiovascular diseases prevention at workplace is economically efficient both for society and for employer.