Search

Aim. To evaluate the clinical course and inhospital outcomes of myocardial infarction (MI) in patients receiving continuous direct oral anticoagulant (DOAC) therapy.Material and methods. Data from 390 patients treated for MI were included in the analysis. The mean age was 64.1±12.8 years. The majority were men (61,5%; n=240). All patients underwent standard diagnostic and therapeutic procedures according to clinical guidelines, including coronary angiography and percutaneous coronary intervention when indicated. Clinical, anamnestic and laboratory data (including C-reactive protein level, troponin I, coagulation test) were analysed. The inhospital course of MI, mortality and incidence of complications were evaluated.Results. Patients were divided into two groups according to DOAC therapy received. The main group included 41 patients with constant DOAC intake, while the control group consisted of 349 patients not receiving DOAC. Patients aged 65 years and older accounted for 68,3% (n=28) of the main group (p=0,0033), with a high proportion of cerebral circulation disorders and venous thrombosis (p0,05). Prior DOAC administration had no significant effect on the incidence of gastrointestinal bleeding (odds ratio (OR), 3,96 (95% Confidence Interval (CI) 0,76–20,66)) and mortality (OR 1,47 (95% CI 0,37-5,85)) during hospitalization.Conclusion. Patients with MI who received continuous DOAC therapy had significantly more frequent ST-segment resolution at hospital admission compared with patients who did not receive DOAC. DOAC administration had no significant effect on mortality and incidence of inhospital complications of MI.

Aim. To study the relationship between breast arterial calcification (BAC) and the presence and severity of carotid atherosclerosis.Material and methods. We analyzed 4274 digital mammograms of women who underwent diagnostic mammography. In addition to the standard diagnosis of breast diseases, BAC was assessed in all mammograms. The study included 198 women aged 40-74 years, who made up 2 groups with and without BAC, each consisting of 99 people, formed on a case-control basis. The severity of BAC was assessed by a 12-point score. Duplex ultrasound of extracranial arteries determined plaque presence, the severity of CA stenosis (in percent) and intima-media thickness (IMT). All women underwent physical and laboratory examinations, electrocardiography, and were interviewed using a questionnaire assessing socio-demographic data, menopausal status, risk factors, and diseases.Results. The groups did not differ in lipid levels, blood glucose, body mass index, incidence of hypertension, diabetes, or smoking. Women with BAC had a higher incidence of menopause (94,9% vs 84,8%, p=0,033), coronary artery disease (13,1% vs 4,2%, p=0,039) and osteoporosis (18,2% vs 6,1%, p=0,016) in history. In women with BAC, at least one carotid plaque was observed significantly more often than in those without BAC — in 79,8% and 60,6% of cases, respectively (p=0,005). Women with BAC compared with women without BAC had a greater plaque number (1,0 [1,0; 3,0] vs, 1,0 [1,0; 2,0], p

Nowadays, the pyramid of evidence is the main model of decision-making for healthcare professionals. According to this concept, data from randomized clinical trials (RCTs) are considered lower in hierarchy than data obtained from systematic reviews (SRs) and meta-analyses (MAs). However, it заменить на:is not established whether it is appropriate to rate large RCTs with hard endpoints lower than SRs and MAs that combine data from smaller RCTs of questionable quality, or even from prospective or retrospective observational studies. It is also important to consider that in addition to assessing the quality of the studies included in the SRs and MAs, it is necessary to assess the accuracy of the SRs and MAs themselves. If not rigorously conducted, they can also contain systematic errors, leading to increased risks of data manipulation. The publication covers the main stages and principles of preparing SRs and MAs, common types of systematic errors that can arise at each stage, and methods to minimize them. We believe that the tools, knowledge, and skills we offer will help practicing doctors and healthcare professionals critically assess the results obtained from SRs and MAs in terms of methodology and the mitigation of potential data manipulation risks.

Aim. To analyze the indicators of hospitalization and outpatient visits of patients aged 18 years and older with hypertension (HЕТ) in federal districts (FD) and subjects of the Russian Federation from the perspective of the World Health Organization concept of ambulatory care sensitive conditions.Material and methods. The analysis included data from the annual forms of federal statistics (forms № 12 and № 14), on the number of hospitalizations and the outpatient visits of patients aged 18 years and older diagnosed of HTN (ICD10: I10-I12) in 2022. Results. We analyzed the data of the federal statistics (forms № 12 and № 14) of the FDs and subjects of the Russian Federation in 2022. It was found that the Siberian FD has one of the highest rates of adult outpatient visits with HЕТ aged 18 years and older, where, at the same time, one of the lowest rates of hospitalizations is recorded. In FDs with adult outpatient visits higher than the Russian average, there were higher adult hospitalization than the Russian average (Ural, Central and Volga FDs). In FDs with adult outpatient visits lower than the Russian average, there were higher adult hospitalization than the Russian average (South, North Caucasus and Far East FDs). In the Northwestern FD, adult outpatient visits and adult hospitalization were lower than the Russian average. When analyzing the HTN ratio among the adult population aged 18 years and older, the highest indicator was recorded in the North Caucasus FD, while the heterogeneity of the indicator within the FD was one of the highest among the other FDs. The lowest HTN ratio indicator among the adult population aged 18 years and older was recorded in the Ural FD, while the heterogeneity of the indicator within the FD was the lowest among the other FDs. There was a high variability of the ratio both for all subjects of the Russian Federation and FDs. The ratio values ranged from 1,2 in the Nizhny Novgorod region to 12,26 in the Republic of Dagestan.Conclusion. Accounting for diseases that can be treated on an outpatient basis can help to assess the quality of care to the adult population in primary health care facilities. However, before including this indicator as a quality criterion, a deeper understanding of the reasons influencing its change is required.

Аim: the clinical practice guidelines intended for gastroenterologists, internal medicine specialists, infectious disease specialists, general practitioners (family doctors), coloproctologists, surgeons and endoscopists present modern methods of diagnosis, prevention and treatment of C. difficile-associated disease.Key points. C. difficile-associated disease is a disease that develops when the diversity of the intestinal microbiota decreases and C. difficile excessively colonizes the colon, the toxins of which damage the intestinal muco-epithelial barrier, followed by the development of inflammation in the colon wall, with diarrhea being a characteristic clinical manifestation. The clinical presentation of the disease can vary from asymptomatic carriage, mild to moderate diarrhea that resolves on its own, to profuse watery diarrhea and pseudomembranous colitis with development of life-threatening complications. The diagnosis of C. difficile-associated disease is based on an assessment of the clinical presentation, medical history, an objective examination of the patient and laboratory stool tests. The disease severity is determined by clinical symptoms and laboratory findings. Additional diagnostic methods that are used according to indications and contribute to the assessment of severity include endoscopy of the colon and abdominal cavity imaging methods. Treatment should be initiated in cases of characteristic clinical presentation of C. difficile-associated disease and positive laboratory stool testing. The choice of drug and treatment regimen depends on the severity of the episode, the presence of complications, and whether the episode is initial, recurrent, or reinfection.Conclusion. Determination of target groups of patients for the diagnosis of clostridial infection is important in preventing overdiagnosis and subsequent unnecessary treatment. Timely diagnosis and treatment of C. difficile-associated disease help avoiding the development of life-threatening complications and improve the prognosis and quality of life of patients.

Cardiovascular diseases are the leading cause of death worldwide. It is possible to influence the development of these diseases by influencing their main pathogenetic link — dyslipidemia.Aim: to evaluate, using the example of alirocumab, the potential effect of drugs affecting the activity of PCSK9 on the achievement of goals for the prevention of the development of cardiovascular diseases and cardiovascular complications in patients of working age who had an acute myocardial infarction (MI) less than a year ago, with uncontrolled dyslipidemia.Materials and methods. The target group was created based on the Russian clinical guidelines; its number was calculated using Russian registry data. Based on the published results of the clinical trial of alirocumab ODYSSEY OUTCOMES in a group of patients with LDL cholesterol levels of more than 2.6 mmol/l (100 mg/dl), a model was built to estimate the number of fatal and non-fatal outcomes in the target group with standard therapy and with alirocumab.Results. The effect of alirocumab administration was modeled in patients of working age who had a myocardial infarction less than 12 months ago with an LDL cholesterol level of more than 5.0 mmol/l, the number of this group in the Russian Federation was estimated to be 3,029 people. It has been shown that with therapy in this group, mortality can be reduced by 29%, and the number of non-fatal cardiovascular events — by 22%, i. e. alirocumab therapy in this group for 2 years can prevent 29 deaths and 185 non-fatal events, with an increase in the duration of therapy to 5 years, the number of lives saved will be 117 and 401 non-fatal cardiovascular events will be prevented.Conclusion. Modeling has shown that alirocumab therapy in patients with recent myocardial infarction and LDL cholesterol levels above 5.0 mmol/L will significantly reduce mortality in this group and prevent the development of serious nonfatal cardiovascular complications, which will also reduce the burden on specialized hospitals, as well as prevent patients from becoming disabled. At the same time, decision making requires a balanced consideration of all ethical, clinical and economic aspects, including the assessment of costs and potential effects from the position of the of a willingness to pay and the formation of the budget of the health system.

The review is devoted to a modern problem of polypharmacy. A universal definition and clear criteria for this concept have not yet been formed, but it is believed that this is the prescribing of at least 5 medications (M). The article discusses the frequency and main causes of polypharmacy, demonstrates its clear relationship with the age. The presence of overweight and obesity, multimorbidity, low physical activity, fragility are clearly associated with polypharmacy. Cognitive impairment, disability, long-term pain syndrome and malignant diseases also predispose to polypharmacy. The absence of a permanent attending physician, living in a nursing home, consulting with several specialists, poor management of medical records are associated with polypharmacy. It is believed that polypharmacy leads to a following number of adverse consequences: it increases the risk of falls, side effects of M, hospitalizations and even death. The main reason for this is the occurrence of various adverse interactions between M, including unpredictable ones, but the causal relationship of these phenomena with polypharmacy is not always proven. To study of adherence to prescribed therapy with polypharmacy is not an easy task, to date, there is no clear answer to the question whether polypharmacy affects adherence to drug therapy. The article presents in detail the problems of potentially irrational prescriptions, discusses the main methods of preventing and combating polypharmacy. Obviously, the most acceptable methods are the cancellation of drugs that are not indicated or contraindicated to the patient, and the prescribing of those drugs for which there are direct indications, but which the patient does not receive. The patient’s therapy should be individualized as much as possible, taking into account numerous factors related to the peculiarities of the disease course, the prognosis, the patient’s lifestyle, his physical and mental status.

Aim. To study the relationship between the structural and functional left ventricular (LV) parameters and N-terminal pro-brain natriuretic peptide (NT-proBNP) and inflammatory markers in patients with type 2 diabetes (T2D) without clinical manifestations of cardiovascular diseases, as well as to evaluate the possibility of their use for early diagnosis of subclinical LV dysfunction.Material and methods. Data from 120 patients of both sexes aged 45-75 years (57,11±7,9 years) were analyzed. They were divided into three following groups: 1st — with T2D (n=47), 2nd — with prediabetes (n=20), 3rd — control (n=53). All participants underwent transthoracic echocardiography with assessment of the linear and volumetric heart dimensions, systolic and diastolic LV function. Speckle tracking echocardiography was analyzed with calculation of LV global longitudinal strain (GLS). The blood levels of NT-proBNP and inflammatory markers were determined (high-sensitivity C-reactive protein (hsCRP), fibrinogen, interleukin-6).Results. According to echocardiography, patients with carbohydrate metabolism disorders revealed significantly higher LV mass values, LV posterior wall thickness, and relative wall thickness in comparison with the control group. Transmitral flow parameters, as well as tissue Doppler sonography, in the T2D and prediabetes groups were significantly different from those in the control group. GLS in the groups of patients with carbohydrate metabolism disorders was lower than in the control group (p=0,001). The level of NT-proBNP was significantly higher in the T2D and prediabetes groups compared to the control group, while in all three groups it did not exceed normal values (p

Aim. To study the problem of obesity at the national level.Material and methods. The ESSE-RF3 study examined a representative sample of the population of 15 Russian regions aged 35-74 years with a response >70% (n=28731). Modular design questionnaire was used. The study received approval from the Independent Ethics Committee of the National Medical Research Center for Therapy and Preventive Medicine. Signed informed consent was obtained from each participant. Body mass (BM) was measured once with an accuracy of 100 g. The height was measured with an accuracy of 0,5 cm once in a standing position without shoes. Waist circumference was measured with a standard measuring tape with an accuracy of 0,5 cm. There were following BM categories: insufficient (BM index (BMI) 40). Abdominal obesity (AO) was assessed using the following criteria: waist circumference ≥102 cm and ≥88 cm for men and women, respectively. The changes of obesity were studied with the inclusion of materials from the ESSE-RF (2012-14) and ESSE-RF2 (2017) studies, carried out using the same methodology with ESSE-RF3 in the same age range of 35-64 years. Statistical analysis was carried out using the open-source R 3.6.1 environment. Analysis of associations between factors and a binary variable was carried out using the logistic regression method. The significance level for all tested hypotheses was 0,05.Results. Mean BMI values is 28,2±4,6 kg/m2 among men and 28,9±5,9 kg/m2 among women. The prevalence of overweight is 44,0 and 33,7%, obesity — 30,0 and 39,5%, AO — 30,9 and 55,1% among men and women, respectively. In addition, 30,3% have a combination of obesity and AO; obesity and/or AO — 49,1%. Obesity statistics did not significantly change, but in each section the rates are higher among women. The closest associations were found between obesity and hypertension (men: odds ratio (OR) (95% confidence interval) 2,88 (2,66-3,12), women: OR 3,03 (2,81-3,27) (p

The outcomes of competency-based medical education (CBME), is becoming increasingly important, especially for general practitioners (GPs). The research team of the National Medical Research Center for Therapy and Preventive Medicine, with the support of the Russian Society for the Prevention of Noncommunicable Diseases, initiated a study "Management of the quality of training of general practitioners (family doctors)", the aim of which is to determine the priority competencies of GPs (family doctors) of the Russian Federation. As the main research approach in the ascertaining experiment, the Delphi method is proposed to use. The respondents are GPs with experience in practical healthcare, general practice residents, teachers of departments of general practice.Conclusion. The planned research is of high significance for the theory and practice of professional education, in particular the training of GPs. Scientific rationale of GP qualification characteristics, which are the target component of the educational system for training GPs, will make it possible to determine the patterns of the educational process and the principles for selecting the content of educational programs, as well as methodological systems and conditions for training GPs. Ranking competencies according to their importance in professional activities by GPs (family doctors) of the Russian Federation will help determine key competencies and will make it possible to see the position of doctors in the priority of GP activities, which is directly related to assessing the healthcare quality

Aim. To analyze the prevalence of anxiety and depression in Russians using the Hospital Anxiety and Depression Scale (HADS) during the Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation (ESSE-RF) study. To study the associations of increased levels of anxiety and depression (HADS-A/ HADS-D ≥8+) with demographic and socio-economic characteristics according to the ESSE-RF3 study.Material and methods. In the ESSE-RF3 study, a representative sample of the population of 15 Russian regions aged 35-74 years was examined with a response >70%. After removing respondents with missing data from the analysis, the final sample was 28716 people. The level of anxiety/depression was assessed by the sum of points

Aim. To study the relationship of gut microbiota (GM) composition with clinical and paraclinical characteristics of patients with coronary artery disease (CAD) and heart failure with reduced ejection fraction (HFrEF).Material and methods. The study included 64 patients (men, 71,9%) with CAD, 33 (men, 87,9%) with HFrEF and 38 (men, 63,2%) with various cardiovascular risk factors (control group). GM composition was assessed using real-time polymerase chain reaction and next- generation sequencing. To identify correlations of GM composition with clinical and paraclinical characteristics, the Spearman rank correlation coefficient (ρ) was calculated. Generalized linear models (QuasiPoisson, overdispersion) with covariates (age, body mass index) were used to compare groups by phylotype.Results. The relative abundance of Bacillota phylotypes is significantly higher in patients with CAD and HFrEF compared to controls (p

Aim. To analyze the prevalence of smoking according to the Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation-3 (ESSE-RF3) study, and compare these data with the previous two stages.Material and methods. Data from following three cross sections of the ESSE-RF study were used: 2013-2014, 2017, 2020-2022. At the first stage, the prevalence and probability of smoking was assessed according to ESSE-RF3 data in 2020-2022 (n=28628, 35-74 years). At the second stage, an analysis was carried out over time using data from all three ESSE-RF sections (n=43804, 35-64 years).Results. In the overall ESSE-RF3 sample, the prevalence of smoking was 17,0% (men — 27,7%, women — 7,6%). Smoking probability varies significantly by sex, age, education level and income. Over time, the standardized prevalence of smoking increases from 25,0% in 20132014 to 26,2% in 2017, and then decreases to 21,5% in 2020-2022. Women are characterized by the same direction of trends, while men had consistent decrease in prevalence from 41,3 to 37,0 and 34,3%, respectively. The probability of smoking in 2017, relative to 20132014, decreases only in some socio-demographic categories of the population. In 2020-2022, a decrease in the probability of smoking is typical for both the general sample and all subgroups of the population.Conclusion. The results obtained characterize the current situation and time trends of the last decade and contain important information on smoking epidemiology in Russia.

At the present time, there is a growing trend of vegetarian diets, even in countries with a traditional Nordic diet.Aim. To study the prevalence and characteristics of vegetarian diets in the Russian population at the present stage.Material and methods. The analysis included data from representative samples of the adult population 25-74 years old, examined within three sections of the Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation (ESSE-RF) study in 20132014, 2017 and 2020-2022. A total of 57351 participants (24862 men and 32489 women) were analyzed. Nutrition assessment was carried out using the frequency method. Restrictive diets include semi-vegetarian, vegetarian and vegan diets. Data are presented as frequencies and odds ratios (OR) with 95% confidence intervals (CI).Results. The prevalence of restrictive diets in the Russian population according to three sections of the ESSE-RF study was 3,1%. There is an increase in the prevalence of these diets from 2,7% in 2013, to 3,6% in 2017 and 3,3% in 2020-2022. Men are less likely than women to exclude red meat from their diet (OR 0,55 [0,49-0,61], p

One technology that helps overcome the problem of low research reproducibility is biobanking, which involves maintaining strict quality standards at all stages. In addition to data on the biosample (detailed documentation on sampling, transportation, preparation and subsequent storage), one of the key points is the availability of information about the donor (patient). The aim of this article was to analyze creating clinical abstract of biospecimens, combining data from various biobanks and assessing the possibilities of electronic medical records and other modern technologies for this. The search for publications was carried out in the PUBMED, eLIBRARY.RU, RSCI databases. One approach to creating a clinical description is the targeted collection of information by a specially trained employee. Primary information is most often taken from the individual records of the study participant, which are developed and approved when planning work. An alternative method is the use of electronic medical records and other documents that collect information during the assessment and treatment of patients. There are also mixed types of clinical data collection, a prime example of which is the UK Biobank. Completeness, structure, and standardization are essential characteristics of clinical description associated with biospecimens. Various standards are currently being developed to unify clinical description, making biobanks and collections more available to external researchers and organizations, which is necessary for collaboration and more efficient use of stored biospecimens. Harmonization of clinical description methodology between different biobanks open up broad boundaries for large- scale research within personalized and translational medicine.

On October 5, 2023, on the initiative of the National Medical Research Center for Therapy and Preventive Medicine and with the support of the Russian Society for the Prevention of Noncommunicable Diseases, the III International Research and Practice Forum "Scientific and Pedagogical Schools of Therapy and Preventive Medicine" was held. The Forum included two areas: symposiums dedicated to the best practices of higher education institutions; round tables dedicated to problems of education and practice integration. Scientific and pedagogical schools of the Far Eastern State Medical University, Siberian State Medical University, Samara State Medical University, Northern State Medical University, Smolensk State Medical University, S. I. Georgievsky Medical Institute of the V. I. Vernadsky Crimean Federal University were represented. Scientists and practicing doctors representing the following educational organizations took part in the discussion of integration of medical education and practical healthcare: Belgorod National Research University, Kemerovo State Medical University, Medical Institute of the Derzhavin Tambov State University, V. F. Voino-Yasenetsky Krasnoyarsk State Medical University, Academy of Postgraduate Education of the Federal Scientific and Clinical Center, Research Medical Center "Gerontology", Multifunctional Medical Center (Tashkent, Republic of Uzbekistan), Ulaanbaatar Songo Hospital (Ulaanbaatar, Mongolia), First Pavlov State Medical University of St. Petersburg, Yaroslavl State Medical University, Volgograd State Medical University, Volgograd Regional Clinical Hospital № 3, National Medical Research Center for Therapy and Preventive Medicine of the Russian Ministry of Health. The Forum showed that many medical higher educational institutions of the country have formed both independent scientific and pedagogical schools of fundamental biomedical sciences, therapy, preventive medicine, which have national and international recognition, and those that are intensively developing in accordance with Russian and international principles and demands of practical healthcare. The presence in medical education of authoritative scientific and pedagogical schools of therapy and preventive medicine is one of the indicators of the effectiveness of universities and academies in training internists and general practitioners.

Aim. To validate and evaluate the accuracy of 14 genetic risk scores (GRSs) for type 2 diabetes (T2D), created earlier in other countries, using a Russian population sample from the biobank of the National Medical Research Center for Therapy and Preventive Medicine.Material and methods. For genetic analysis, next generation sequencing data was used on a sample from the Russian population (n=1165) based on the biobank collection. The study included 14 GRSs associated with T2D.Results. The study demonstrated that the predictive power of 12 out of 14 GRSs for T2D was replicated in the Russian population. As quality metrics, we used the area under the ROC curve, which for models including only GRS varied from 54,49 to 59,46%, and for models including GRS, sex and age — from 77,56 to 78,75%.Conclusion. For the first time in Russia, a study of 14 T2D GRSs developed on other populations was conducted. Twelve GRSs have been validated and can be used in the future to improve risk prediction and prevention of T2D in Russia.

In connection with the development of genetic and other types of research in translational medicine, collections containing a significant number of biospecimens and large data sets are required. Since in-depth examination of patients is most often carried out during hospitalization, the creation of collections based on electronic medical records (EMR) data is promising. In this regard, the project "Total biobanking in the hospital of the National Medical Research Center for Therapy and Preventive Medicine" was initiated, aimed at total biobanking of blood and related products from patients in inpatient departments and the creation of a unified system that combines information on biosamples, clinical and other types of data.Aim. To describe the collection of biospecimens collected within the project "Total biobanking in the hospital of the National Medical Research Center for Therapy and Preventive Medicine" for August 2023, and to analyze the process of biospecimen description.Material and methods. Recruitment of patients is carried out on the basis of inpatient departments of the National Medical Research Center for Therapy and Preventive Medicine, only if the patient signs informed consent. After blood is taken, the biomaterial enters the biobank, where sample preparation and storage is carried out, as well as data about each biosample is entered into a special FreezerPRO system. At the same time, clinical data about the patient is collected using EMR, which are combined in the Medialog medical information system.Results. A special software for data exchange between the medical information system and the biobank has been developed, which combines information about patients entering the Medialog medical information system and the FreezerPro biospecimen management system, which contains detailed information about biospecimens. As of August 25, 2023, biomaterial from 3996 patients was collected, which was accompanied by a detailed clinical summary. In particular, data is available on diagnoses (for 100% of patients), laboratory test data (100%), paraclinical data, in particular, electrocardiography (100%), echocardiography (76,8%), 24-hour Holter monitoring (59,8%), esophagogastroduodenoscopy (27,3%), etc. The most common diseases were hypertension (76,0%), atherosclerosis (69,9%), coronary artery disease (52,9%), arrhythmias (50,6%), diabetes (19,2%). In addition, 25,0% of patients had prior stenting.Conclusion. Total biobanking within the hospital of a multidisciplinary research medical center allows for the rapid and high-quality collection of biomaterial and related data. A collection of biospecimens with comprehensive and detailed clinical annotations has been collected. A primary analysis of the collection was carried, which showed that it can be used for a wide range of studies.

Aim. To develop an algorithm and manage total biobanking of samples of whole blood, serum and plasma of patients in the hospital of the National Medical Research Center for Therapy and Preventive Medicine in order to create a detailed biosample collection through the integration of electronic medical records and a biobank database.Material and methods. The study includes all patients admitted to the hospital of the National Medical Research Center for Therapy and Preventive Medicine in various departments who signed informed consent for biobanking. Clinical information is collected as part of patient examination and stored in electronic medical records in the Medialog medical information system. Biobanking of blood and related products is carried out in accordance with standard operating procedures. From each patient, 12 aliquots of serum and blood plasma are stored, as well as 1 tube of whole blood with ethylenediaminetetraacetic acid potassium salt. Information about biospecimens, patient identification numbers and storage location coordinates are contained in the biobank database.Results. An algorithm for total biobanking of biomaterial and data from inpatients has been developed and put into practice. This collection is associated with large biomedical data stored in a medical information system, laboratory information system and biobank. The combined databases make it possible to search for samples in the collection according to specified criteria.Conclusion. The collection developed can be used for a wide range of studies by forming patient samples according to the necessary criteria. The developed algorithm for total biobanking in a hospital can be used in various medical centers equipped with biobanks.

Aim. To study the proportion of coronavirus disease 2019 (COVID-19) survivors and hospitalization cases of the Russian population for the period 2020-2022, depending on socio-demographic characteristics.Material and methods. The work was performed on random samples of the population aged 35-74 years from 15 regions participating in the Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation-3 (ESSE-RF3) study. The examination was carried out from February 2020 to March-April 2022 (n=28718, 47% men).Results. According to a survey of sample participants, the proportion of respondents who had COVID-19 by the spring of 2022 among all surveyed was 26,0%. Among 45-54-year-old respondents, this parameter was maximum (28,0%), while among those aged 65-74-year-old — minimal (22,3%). The following categories of people were more likely to have COVID-19: women (27,9 vs 23,9% of men, p

Aim. To establish reference values of handgrip test for a middle-aged and elderly population (35-74 years), as well as study the association of health characteristics and muscle strength.Material and methods. For the analysis, we used data from the Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation-3 (ESSE-RF3) study, conducted in 2020-2022. The sample was selected similarly to the previous ESSE-RF stages. The sample included 27689 men and women aged 35-74 years from 14 Russian regions. Of the individual variables, the characteristics with the highest evidence level of influence on muscle strength were taken as covariates. Muscle strength was assessed by a handgrip test using a MEGEON 34090 device with an accuracy of 0,1 kg. Three measurements were taken for each arm in a standing position, and the maximum value was used in the analysis. Normative sex-specific handgrip test values were established regardless of age: a participant's handgrip value was considered reduced if it was 2 standard deviations below the average value of participants at the age with the best/highest scores.Results. The average handgrip test values for the entire male sample were 43,4±11,1 kg, while for the female sample — 27,6±6,1 kg. In men under 53 years of age, muscle strength decreases at a rate of 0,12 kg/year, then the decline accelerates to 0,48 kg/year. In women under 45,5 years of age, a slight and insignificant increase in muscle strength was detected by 0,02 kg/year, and after 45,5 years, handgrip value falls at a rate of 0,2 kg/year. Therefore, both men and women lose 1,3% of muscle strength per year to year and the decline rate do not differ. The peak age can be considered 35 years old, since at this age, the average muscle strength in men and women is 47,6±11,5 and 29,2±5,7 kg, respectively, and the calculated norm (M–2SD) for men was 47,6–2´11,5≈24 kg using rounding down, and for women it was 29,2– 2´5,7≈17 kg. With age, as expected, the proportion of people of both sexes with a metabolic syndrome level below the threshold increases, reaching 7,5% after 65 years. Multivariate regression analysis showed that, taking into account adjustments for covariates, for every 10 years, muscle strength decreases by an average of 3,1 kg in men and by 1,7 kg in women. Negative associations of metabolic syndrome with inflammation markers (fibrinogen and C-reactive protein) and noncommunicable diseases are also significant, but only men have significantly lower rates of metabolic syndrome in the presence of anxiety and depression, low income and urban residence.Conclusion. The use of handgrip test in any age range during medical examinations or preventive examinations of the adult population and informing primary care specialists about the results obtained can help improve the general health of the population.

Aim. To assess the associations of social and behavioral risk factors with cognitive impairment in the Russian population aged 55-74 years.Material and methods. This study was conducted as part of the Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation-3 (ESSE-RF3) study. A total of 13736 participants living in 14 Russian regions were examined. Cognition was assessed using the Mini-Mental State Examination (MMSE) score as follows: cognitive impairment was recorded in the total score

Aim. To analyze alcohol consumption according to the Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation-3 (ESSE-RF3) study and compare these data with the previous two ESSE-RF sections.Material and methods. Data from following cross-sectional sections of the ESSE-RF study were used: 2013-2014, 2017, 2020-2022. At the first stage, alcohol consumption was assessed according to ESSE-RF3 data in 2020-2022, conducted during the coronavirus disease 2019 (COVID-19) pandemic (n=28685, 35-74 years). At the second stage, a comparison of all three sections of the ESSE-RF study was carried out (n=42043, 35-64 years). Alcohol consumption was divided into those not drinking alcohol, those drinking alcohol little or moderately (

Aim. To study the epidemiological characteristics and changes of hypertension (HTN), as well as factors associated with HTN in the Russian population aged 35-74 years.Material and methods. The Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation-3 (ESSE-RF3) study examined a representative sample of the population aged 35-74 years of 15 Russian regions with a response >70% (n=28611). Modular design questionnaire was used. Blood pressure (BP) was measured twice after a 5-minute rest in a sitting position on the right arm with an Omron blood pressure monitor. There were following criteria for hypertension: systolic blood pressure (SBP) ≥140 mm Hg and/or diastolic blood pressure (DBP) ≥90 mm Hg, and/or antihypertensive therapy. The effectiveness of treatment was considered the proportion (%) of people who achieved target blood pressure values among those being treated, while the control was considered the proportion (%) of patients with a BP

Aim. To study levels and types of physical activity, as well as its individual socio-demographic and seasonal determinants in the Russian population according to the Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation (ESSE-RF) study.Material and methods. Data from the ESSE-RF2 (2017) and ESSERF3 (2020-2022) was used. The sample included 28731 men and women aged 35-74 from 15 regions. The level of physical activity was assessed using the Global physical activity questionnaire (GPAQ). The following socio-economic and demographic characteristics were taken as covariates: sex, age, place of residence (urban and rural), level of education, marital status, work characteristics, income level, season of the year. Statistical analysis was performed using SPSS version 22 (IBM Corp. USA).Results. The study showed that 27,4% of the sample have insufficient physical activity. Among the low physical activity category, there are more women than men (28,12 vs 26,7%, p

Aim. To study the prevalence of dyslipidemias and their association with various risk factors in the Russian population of men and women aged 35-74 years in 2020-2022.Material and methods. This work was carried out as part of the Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation-3 (ESSE-RF3) study. The sample included 28731 men and women aged 35-74 years living in 15 Russian regions. Hypercholesterolemia (HC) was diagnosed with total cholesterol (TC) ≥5,0 mmol/l, while elevated low-density lipoprotein cholesterol (LDL-C) was considered ≥3,0 mmol/l, hypertriglyceridemia — with triglyceride levels ≥1,7 mmol/l, reduced high-density lipoprotein cholesterol (HDL-C)

Aim. To assess the prevalence of psychological stress (PS) using the Perceived Stress Scale-10 (PSS-10) in various Russian regions and to analyze PS associations with socio-demographic characteristics and behavioral risk factors and some non-communicable diseases (NCDs).Material and methods. We studied representative samples of the population aged 35-74 years in the Russian regions, examined as part of the Epidemiology of Cardiovascular Diseases in Regions of Russian Federation-3 (ESSE-RF3) study. The subjects were interviewed using a questionnaire containing a section on the psychological stress — PSS-10. For men, PS levels are ranked as follows: "Low" — 0-11, "Medium" — 12-17, "High" — 18-40. For women, PS levels are ranked as follows: "Low" — 0-13, "Medium" — 14-19, "High" — 20-40. Statistical analysis was carried out using the open-source R 3.6.1 environment.Results. The average PS level was 12,0±7,3 (men: 10,7±7,0; women: 13,1±7,4). Every fifth person (20,3%) in the Russian population has a high PS level, with higher PS rates among women compared to men (high PS level — 21,6 vs 18,9%, respectively). A high PS level was associated with the income level (average or low), no marriage, unemployment, low level of physical activity, depression, anxiety, NCDs (type 2 diabetes, myocardial infarction, stroke), additionally for women — hypertension.Conclusion. The Russian population is characterized by a high PS prevalence, while PS rates are higher among women, which must be taken into account when predicting the NCD risks.

Aim. To study genetic causes of decreased low-density lipoprotein cholesterol (LDL-C) in Russian patients.Material and methods. The study included the following Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation (ESSE-RF) participants: individuals with LDL-C

The article discusses the effectiveness and safety of homologous and heterologous revaccination for Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in people of different age groups.Aim. The study the severity and duration of immune response in people of different age groups after SARS-CoV-2 revaccination.Material and methods. The study was carried out as part of the prospective registry Saturn, which included persons who received various SARS-CoV-2 revaccination regimens (homoand heterologous) based on the combination of two vaccines: Gam-COVID-Vac and Covivac. Group I (n=106) included persons who received a homologous revaccination with Gam-COVID-Vac, while group II (n=54) — heterologous revaccination with Gam-COVID-Vac and Covivac, group III (n=40) — homologous Covivac revaccination. In addition, all participants in the study were divided into two age categories: ≥60 years (n=33) and

An important condition for providing quality and safe care is to understand the differences between men and women in epidemiology, pathophysiology, risk factors, clinical performance of diseases, response to treatment and use of medical care. The first part of the review was devoted to the evolutionary mechanisms of differences in life expectancy and potential strategies for increasing life expectancy in men. The second part of the review examines sex and gender differences using the example of 3 groups of diseases, which, according to the World Health Organization, are the main causes of death in the European Region, in the programming of health and disease, as well as the reasons for the male-female health-survival paradox.

The distribution of publications posted in the Elibrary for the period from January 1, 2012 to December 31, 2022, in the structure of a cognitive matrix of taxonomic characteristics for the analysis and assessment of primary health care in the Russian Federation made it possible to establish areas of scientific interest and identify gaps in specific areas and indicators characterizing its current and future development.Aim. To distribute scientific publications according to the relevant segments of the cognitive matrix of taxonomic characteristics for the analysis and assessment of primary health care in the Russian Federation.Material and methods. A database of 41824 publications was used, for which a triple review was carried out with the involvement of 9 experts selected according to appropriate criteria for level of education, work experience in the healthcare system, and academic credentials. At the first two stages, publications not related to primary health care, as well as duplicate publications, were excluded. At the final stage of reviewing, a selective analysis of publications was carried out, assessing the correctness of their distribution into the corresponding taxa of the cognitive matrix, followed by adjustment (if necessary).Results. A cognitive matrix of taxonomic characteristics has been generated for the analysis and assessment of primary health care in the Russian Federation, containing 30339 publications distributed across relevant domains, subdomains and primary health care indicators. The matrix is also presented in a heat map format, allowing an assessment of the most studied taxa of primary health care, as well as highlighting those areas in primary health care in which more research should be carried out to provide a basis and methodology for making informed decisions on its development.Conclusion. Systematized and ordered publications can serve as a basis for a wide range of users in the preparation of systematic reviews and other publications on specific domains, subdomains, primary health care indicators and universal health coverage principles. This study has shown the high efficiency of the cognitive matrix of taxonomic characteristics as a unified tool for aggregation or decomposition of features characterizing the development of primary health care in the Russian Federation.

Aim. To search associations for lipid profile parameters (lowand highdensity lipoprotein cholesterol levels, triglycerides and total cholesterol) in population samples from two Russian regions and make a replication analysis of a previously published genome-wide association study (GWA study, GWAS) for residents of three other Russian regions.Material and methods. The study included representative samples from the Vologda (n=689) and Ivanovo (n=1675) regions collected for the Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation (ESSE-RF) study. We assessed lipid profile parameters and performed a targeted sequencing. A linear regression model adjusted for sex, age, and statin use was used to assess the associations of genomic variants with lipid profiles. The work replicated the results of a study by Usoltsev D, et al., 2023, carried out on population samples of individuals from St.Petersburg, Orenburg and Samara regions.Results. We identified variants for which associations with lipid parameters had previously been identified in a Russian sample. The proportion of replicated variants was 89% and 92% for the samples from the Vologda and Ivanovo regions, respectively. The directions of effects of all replicated variants in the previously published study (samples from the Orenburg and Samara regions and St. Petersburg) and in both studied samples (samples from the Ivanovo and Vologda regions) coincide.Conclusion. The results of the search for associations with lipid parameters in different Russian samples are consistent with each other.

Aim. To analyze socio-demographic characteristics and the prevalence of behavioral risk factors in the adult population of the Vladimir region, taking into account sex characteristics.Material and methods. This cross-sectional population-based study was organized in 5 cities of the Vladimir region (Vladimir, Kovrov, Murom, Yuryev-Polsky and Vyazniki) from May 2018 to March 2020. The study included 1350 men and women aged 30-69 years. The response rate was 87%. A total of 1174 people completed the study, of whom 424 (36.1%) were men and 750 (63.9%) were women. A total of 1174 people completed the study. Of these, 424 (36,1%) were men and 750 (63,9%) women. Respondents were surveyed using a standard questionnaire prepared by the National Medical Research Center for Therapy and Preventive Medicine, which included socio-demographic characteristics, behavioral risk factors, data on somatic diseases and medications taken.Results. Smoking prevalence among men was 38,4%, which was 4 times higher than in women (p=0,001). Walking

Aim. To study the prevalence of hyperuricemia (HU) and gout depending on hypertension (HTN), as well as to evaluate their associations with mortality in the Russian population.Material and methods. The analysis included data obtained in two cross-sectional studies — ESSE-RF and ESSE-RF2. All study participants were surveyed using a modular designed questionnaire. Serum uric acid (UA) was determined using the uricase method. HU corresponded to a UA >420 µmol/l in men and >360 µmol/l in women. HU without gout was considered asymptomatic HU in the present study. Associations with endpoints were assessed using Cox proportional hazards models with associated hazard ratios.Results. The average prevalence of HU was 18,2%. HU, as expected, predominates among the male cohort — 22,6% vs 15,7%, respectively. The prevalence of asymptomatic HU was 4,4% higher among men compared to women. The prevalence of gout increased with age and averaged 2,6% in the entire population. A high content of UA was revealed in men in the absence of hypertension. The prevalence of HU in women with HTN was 3 times higher than in participants without hypertension. In the male cohort, in the group of hypertension without HU, all-cause and cardiovascular mortality significantly increases, and in the group with hypertension and HU, only all-cause mortality increases. In women, the cardiovascular death risk increased in HTN — hazard ratio 3,98 (95% confidence interval 1,86-8,52). At the same time, in women with HTN and HU, all-cause and cardiovascular death risk increased by 66% and 6,7 times, respectively.Conclusion. Every fifth study participant was diagnosed with HU. The prevalence of HU in hypertensive men was approximately 1,5 times higher than without hypertension. In women with HTN, HU was detected three times more often than without HTN, which may indicate a more pronounced relationship between HTN and HU in women. HU can worsen the HTN prognosis. Thus, monitoring and timely correction of UA levels in hypertensive patients become necessary to improve the prognosis.

High salt intake is a risk factor for the development of hypertension, most cardiovascular diseases and their complications.Aim. To study the characteristics of high salt intake in Russian and Moscow populations according to epidemiological studies.Material and methods. Data from representative samples of adult population aged 25-64 years (n=21922, 8372 men and 13550 women) from Russian 13 regions and persons aged >18 years (n=4063, 1662 men and 2401 women) from Moscow were used. A combination of 2 out of 3 items was taken as excess salt intake: daily consumption of meat and sausage products and pickles and/or adding salt to the finished dish. The results are presented as frequencies and odds ratios (OR).Results. The prevalence of high salt intake in the Russian population was 49,3% (53% among men and 47% among women); in the Moscow sample — 49,6% (60,3% for men and 41,9% for women). The habit of adding salt to a finished dish is widespread in the Russian Federation — 40,5% (47% among men and 34,7% among women); among Muscovites it is less pronounced — 25,8% (31,6% among men and 21,7% among women). Positive associations of high salt intake were noted with male sex (OR=1,1), education level (OR=1,5 and OR=1,3 for primary and secondary education, respectively), smoking (OR=1,74), alcohol consumption (OR=1,3, OR=1,4 and OR=1,5 — for moderate, high and very high alcohol consumption, respectively), rural place of residence (OR=1,34), anxiety (OR=1,27), depression (OR=1,36) and abdominal obesity (OR=1,1), and negative — with thyroid disease (OR=0,9), previous cerebral stroke (OR=0,8) and type 2 diabetes (OR=0,87). The prevalence of high salt intake in the all-Russian sample is not associated with income level and age, but was noted among Muscovites.Conclusion. In the Russian population, a high prevalence of high salt intake was revealed, which is more pronounced among smokers, alcohol drinkers, those with primary and secondary education levels, rural residents, as well as those with anxiety and depression.

Vaccination is an effective tool to control infectious diseases at the population level. There is an increase in the proportion of the adult population vulnerable to controlled infections, which is confirmed by the emergence of disease outbreaks involving population aged >18 years. Qualitative research methods are used to explore factors influencing vaccination behavior.Aim. To develop and present a qualitative study design to study barriers and drivers for vaccination in adults.Material and methods. The World Health Organization (WHO) approach of Tailoring Immunization Programs (TIP), Capability-Opportunity-Motivation-Behavior (COM-B) tool, developed by the WHO and adapted in several countries to study vaccination issues, and the Rapid Assessment Process method were chosen and adapted for conducting a study in three Russian regions. The qualitative methods selected are focus groups and in-depth personal interviews in two target groups of adults and medical workers. A purposive sampling method will be used to select population participants aged ≥18 years.Results. A qualitative research design was developed, including the following steps: selecting target populations, developing a discussion plan, training the analytical group, testing the methodology and questions in the target groups, collecting and analyzing data, developing recommendations and interventions.Conclusion. Qualitative research methods are preferable for identifying vaccination barriers and drivers. Based on the results obtained, an educational program for health workers will be developed, including communicating approaches to be used with patients when discussing vaccination matters.The qualitative research design developed and presented can be used by researchers, public health professionals, and decision-makers to study vaccination behavior among adults.

Aim. To evaluate the information content of genetic risk scores (GRSs) for coronary artery disease (CAD), previously developed on European populations, in representatives of the Russian population.Material and methods. The work involved 1685 people from the ESSE-Ivanovo epidemiological study. CAD was verified in 3,1% of individuals. The coronary composite endpoint was assessed annually during 8-year follow-up. Next generation sequencing was performed using a targeted panel. Logistic regression analysis and area under the ROC curve (AUC) were used. Age, sex, and smoking status were taken into account in the multivariate model.Results. Of the 16 GRSs included in the analysis, only 2 GRSs demonstrated significance in the univariate analysis of association with CAD (highest AUC — 0,577). In a multivariate model, with an increase by 1 standard deviation (SD) for the 6 studied GRSs, a significant association with CAD was obtained — the odds ratio varied in the range of 1,31-1,47. The two GRSs demonstrated significant differences in the incidence of CAD between the groups corresponding to the upper and lower quintiles. Forty-five endpoints were registered. The risk ratio for the end point with an increase in GRS by 1 SD, taking into account cofactors, exceeded statistical significance for the 9 analyzed GRS and was in the range of 1,36-1,54.Conclusion. For the first time in Russia, 16 CAD GRSs, previously developed on European samples, was validated. The results were reproduced only for a few of the studied CAD SGRs.

Coronavirus disease 2019 (COVID-19) pandemic was not only a serious challenge for the healthcare system around the world, but also an incentive for intensive research and development for the introduction of innovative technologies and drugs, in particular vaccines against the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-COV-2). The first vaccination campaigns provided significant protection against severe disease course and hospitalization. However, new SARS-COV-2 variants require further comprehensive research and the introduction of booster vaccination. Booster vaccination is the most important tool for immunostimulation and increase of protection duration against the severe disease course. The study of booster vaccines, including BioNTech/Pfizer, Moderna, Oxford AstraZeneca, Sputnik V, Sinopharm и Covaxin vaccines, sheds light on their unique action mechanisms and contribution to long-term immunity. The analysis of clinical data demonstrates their effectiveness and safety. The review summarizes modern knowledge about booster vaccinations against the COVID-19 with focus on action mechanisms and efficiency. In addition, the immune system function in response to COVID-19 is considered, while the role of memory cells, antibody and cellular immunity reactions are emphasized.

Aim. To analyze hospitalizations and outpatient visits to primary health care facilities of patients aged 18 years and older with chronic coronary artery disease (CAD) by federal districts and the constituent entities of the Russian Federation from the perspective of the World Health Organization concept for diseases treating mainly on an outpatient basis.Material and methods. We used data from Federal Statistical Monitoring for 2022 on the number of diseases, hospitalizations and the number of outpatient visits of patients aged 18 years and older with an established diagnosis of CAD (ICD 10:I25).Results. In the Central, Southern and Northwestern Federal Districts, the hospitalizations and outpatient visits of the adult population with chronic CAD were higher, and in the North Caucasus, Far Eastern and Ural Federal Districts — below the Russian average level. In the Volga Federal District, the outpatient visits with chronic CAD were higher than the Russian average, and the hospitalizations were below the Russian average. In the Siberian Federal District, the outpatient visits were lower, and the hospitalizations were higher than the Russian average level. When analyzing the ratio of hospitalization rate to the number of outpatient visits of the adult population with an established chronic CAD in the primary health care unit, characterizing the availability, quality and efficiency of outpatient care, the highest indicator was recorded in the Siberian Federal District, while its heterogeneity within the federal district was the highest in comparison with other federal districts. Its lowest was recorded in the Southern Federal District, while heterogeneity within the federal district was the lowest in comparison with other federal districts. The values of this parameter varied from 3,67 in the Kurgan Oblast to 38,33 in the Republic of Tuva.Conclusion. Accounting for diseases treating primarily on an outpatient basis can become one of the tools for assessing the quality of adult primary health care. However, before including this indicator in the criteria for assessing the quality of medical services, a deeper understanding of the reasons influencing its change is required.

Aim. To validate and evaluate the accuracy of 4 genetic risk scores (GRSs) for hypertension (HTN), previously created on European samples, on a population sample of the Ivanovo Oblast.Material and methods. For genetic analysis, targeted next-generation sequencing was used on a sample of the Central Russia (n=1682) based on the biobank collection. Four GRSs associated with HTN, previously developed for the European population, were selected for validation. The coefficient of determination and the area under the ROC curve were used as quality metrics for regression models. Additional validation was carried out to include all nucleotide sequence variants, regardless of linkage disequilibrium level. A combined GRS was compiled based on coefficients from individual GRSs using the clumping + thresholding (C+T) method.Results. The study demonstrated that the predictive value of previously developed GRSs when used for Central Russian population is lower than in the original studies. The proportion of explained variance was 0,5-0,8%. The best predictive ability (proportion of explained variance — 2,5%) was demonstrated using previously developed GRSs (Evangelou E, et al., 2018), which includes the largest number of nucleotide sequence variants (n=852).Conclusion. GRSs for HTN, developed on European samples, is not recommended for Russian population without preliminary validation. To create original GRSs, combining statistical parameters (β-coefficients and p-value) from different GRS is not recommended.

Aim. To analyze availability and affordability of alcoholic beverages in Russian cities.Material and methods. We assessed the actual state of urban infrastructure in the Arkhangelsk, Tver and Sverdlovsk regions. Data were collected in three districts of Arkhangelsk, three districts of Tver, three districts of Yekaterinburg and Revda, where participants of the Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation-3 (ESSE-RF3) study (2021) lived. The study objects were elements of the city infrastructure where alcoholic beverages were sold. To assess the infrastructure, special software was developed to collect and analyze the necessary data using Open Street Maps. Data were collected from January to March 2022.Results. In total, 1180 alcohol-selling outlets were identified in the study areas: in Arkhangelsk — 450, in Yekaterinburg and Revda — 444, and in Tver — 286. Mainly alcoholic beverages in Sverdlovsk and Tver regions can be purchased in the alcohol section of a grocery store (n=260, 58,6% and n=185, 41,4%, respectively), and in the Arkhangelsk region — in a specialized liquor stores (n=263, 58,4%). The median number of alcohol stores located within a radius of 1000 m from the place of residence of the ESSE-RF3 participant was 33, and within a radius of 400 meters — 8. In Arkhangelsk, the alcohol was sold in a grocery store located in the same building as the college branch. In the Sverdlovsk region, the nearest alcohol store was located at a distance of 50 m from the kindergarten, in the Tver region — 44 m from the college. A 0,5 liter bottle of vodka was sold below the price floor in 55,1% of specialized liquor stores in the Sverdlovsk region and in 66,8% of such liquor stores in the Tver region.Conclusion. As a result of the study, availability and affordability of alcoholic beverages in Arkhangelsk, Tver, Yekaterinburg and Revda was assessed. The findings reflect the high availability of alcohol and indicate the need for interventions at both the national and local government levels. The used method of collecting and analyzing data demonstrated sufficient research effectiveness and can be recommended for wider use.

Hypertrophic cardiomyopathy (HCM) at the cellular level is characterized by hypertrophy, cardiomyocyte disorganization and myocardial fibrosis areas. The leading death cause in HCM remains sudden cardiac death (SCD). Despite the existing risk scores for SCD in HCM, there are still patients with uncertain SCD risk. In addition, SCD cases are also recorded among low-risk patients. From the above, search for novel markers for a more accurate risk assessment should be continued. Fibrosis is currently suspected to be a substrate of potentially life-threatening ventricular arrhythmias. Despite the increasingly widespread use of cardiac magnetic resonance imaging in the diagnosis of myocardial fibrosis and stratification of patients at high SCD risk, the determination of myocardial fibrosis biomarkers remains a relevant and promising area. The article presents the results of studies proving the diagnostic significance and relationship with the risk of life-threatening cardiac arrhythmias of the following markers: C-propeptide of type I procollagen, matrix metalloproteinase proteins, tissue inhibitor of metalloproteinases 1, microRNA family, soluble suppression of tumorigenicity 2, galectin-3, apelin. Evaluation of these biomarkers can be used to improve risk stratification of patients with HCM.

Aim. To study the relevance of motivation measures based on the survey of medical staff.Material and methods. Medical staff of adult primary health care facilities was surveyed using an original questionnaire regarding the organization of work, the importance of financial and non-financial incentives. The survey was strictly voluntary and anonymous, and conducted electronically and on paper. In total, 35191 questionnaires were accepted for processing. Processing was carried out using the method of descriptive statistics.Results. The organization of work environment is of the greatest importance to respondents (>80%), while in second place is the presence of clear criteria for work efficiency assessment, and in third place — a clear incentive and penal scheme. Respondents rated the opportunity for contact with the administration more highly than "communicating work assessment criteria to employees". The undisputed top in financial incentives is payments for high performance criteria in all categories of personnel. Of the non-financial measures, the most popular were a letter of gratitude from the manager and permission to independently plan working hours (maximum among medical specialists (51%)).Conclusion. The results obtained make it possible to highlight the main directions for motivation system of medical staff as follows: clear evaluation criteria for all personnel categories, provision of conditions for fulfilling the developed criteria, active outreach on evaluation criteria, incentive payments and other measures of material incentives, development of targeted incentive technologies, feedback with employees on issues related to their performance, working conditions, etc., developing a system of non-financial incentives and corporate culture.

Aim. To analyze digital technologies in the primary health care system, as well as studying the impact of digital health literacy on patient satisfaction with the services provided.Material and methods. A study assessing patients' opinions on the digitalization of primary care in Russia was conducted from June to September 2023 among 1004 participants from 42 regions. A questionnaire with 33 questions was used, of which the 8 most relevant ones were selected for the article, aimed at assessing the satisfaction and personal experience of patients in using digital technologies. Data was collected through Yandex Forms. Data analysis included synthesis of results, classification and content analysis of literature.Results. The study examined the impact of digitalization on primary care patient satisfaction. Analysis of digital technologies in the primary health care system made it possible to establish that the target audience has a positive attitude towards the introduction of innovations. The patients also aimed at using them and are ready to seek new digital medical services. At the same time, it is important for patients to increase the effectiveness of personal interaction with the physicians. In order to improve digital innovation, development of practical guidelines for the updating and further implementation of digital tools is needed.Conclusion. The study confirmed that digital health literacy plays an important role in improving primary care patient satisfaction. Based on the data obtained, it is necessary to develop and implement educational programs for patients and medical professionals aimed at increasing the level of digital literacy and optimizing the use of digital tools in me dicine.

Aim. In patients with acute thrombophlebitis of the great saphenous vein and/or large tributaries, compare the effectiveness and safety of 1,5-month fondaparinux sodium therapy and endovenous laser ablation in the area of the saphenofemoral junction in combination with shortterm anticoagulation or without anticoagulant therapy.Material and methods. This prospective, single-center, randomized, open-label clinical trial included 105 patients with acute great saphenous vein thrombophlebitis at a distance of at least 5 cm from the saphenofemoral junction. Thirty-four patients were randomized into the group of endovenous laser ablation in the area of the saphenofemoral junction without the anticoagulant therapy. The group of endovenous laser ablation in combination with 7-day fondaparinux sodium included 35 patients, while the group of 1,5-month treatment with fondaparinux sodium — 36. In all cases, class 2 compression stockings were used for 1,5 months. Clinical manifestations of venous thrombosis and its prevalence according to compression ultrasonography were assessed in the first 45±2 days from the start of treatment.Results. The mean age of patients was 49,1±13,7 years. There were more women (73,3%). The prevalence of risk factors for the occurrence and progression of venous thrombosis was low. Previous episodes of thrombophlebitis were observed in 3 (2,9%) patients. External factors that could provoke venous thrombosis were identified in 21 (20,0%) patients. Thrombosis was located in the great saphenous vein in 97,1% of patients, while large tributaries were involved in 25,7% of cases. The median distance from the proximal thrombus to the saphenofemoral junction was 45,2 cm. Patients randomized to the pharmacotherapy group were significantly older (mean age 49,1±13,7, 45,9±13,3 and 53,8±13,2 years, respectively; p=0,032), had slightly less pain and swelling. In all patients, after endovascular laser obliteration, a stable flow cessation at the intervention site was achieved. There were no cases of progression of venous thrombosis. After 7±2 days, in all groups there was a significant decrease in the proportion of patients with clinical manifestations of venous thrombosis, as well as the severity of persistent clinical manifestations. After 45±2 days, clinical manifestations were observed in a few patients and their severity was minimal. However, in the drug treatment group, a more frequent persistence of edema was noted both after 7±2 days (26,5, 20,0 and 47,7%, respectively; p=0,036) and after 45±2 days, (0, 2,9 and 16,7%, respectively; p=0,01). Hematomas and bruises were exclusive hemorrhagic complications. Hematomas were revealed in groups with endovenous laser ablation only. All hemorrhagic complication were minor according to World Society of Thrombosis and Hemostasis (ISTH) and type 1 according to Academic Research Consortium (BARC) classifications.Conclusion. In outpatients with low risk of recurrence and mainly distal localization of acute thrombophlebitis of the great saphenous vein and/ or large inflows, endovenous laser ablation close to saphenous vein junction without anticoagulation or with 7 days of anticoagulation and medical treatment with 1,5-month anticoagulation had comparable efficacy and invasive treatment was sufficiently safe.

Liver transplantation (LT) requires not only a carefully organized system for monitoring the condition of patients in the early postoperative period, but also reliable coordination of the actions of doctors of different specialties in the long-term period. This is due to improved survival of liver transplant recipients and a shift in the mortality structure towards cardiovascular diseases and the need to correct metabolic complications that often occur in recipients, in particular hyperlipidemia. Treatment of lipid metabolism disorders after LT includes lifestyle changes, immunosuppressive and lipid-lowering therapy (LLT), which reduces cardiovascular risk. The use of LLT in patients after LT is limited by potential side effects caused by drug interactions, in particular myopathy up to rhabdomyolysis. According to current clinical guidelines, the safest treatment for patients after LT is pravastatin and fluvastatin, the use of which is limited by low availability and low efficacy. It seems promisingto improve LLT in patients after LT through the use of ezetimibe, which has a potentially favorable tolerability profile when combined with immunosuppressants, as well as pitavastatin, which is metabolized through cytochrome P-450 isoenzymes not involved in the metabolism of immunosuppressants, and metabolically neutral PCSK9 inhibitors.

Aim. To study the relationship of the density and proximity of tobacco products (TPs) and electronic nicotine delivery systems (ENDS) with increased levels of depression, anxiety and stress among the population in 3 constituent entities of the Russian Federation.Material and methods. The work used data from the Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation-3 (ESSE-RF3) study in 3 Russian regions (Arkhangelsk, Sverdlovsk and Tver regions) among the population aged 35-64 years (n=1674), who signed a consent to participate in the study. We analyzed data on the status of smoking and consumption of ENDS, passive smoking, attempts to quit smoking, as well as the presence of depression, anxiety (Hospital Anxiety and Depression Scale (HADS) score ≥8) and stress (Perceived Stress Scale (PSS) >21). Elements of urban infrastructure (data collection: January-March 2022) selling TPs and ENDS were assessed using aт OpenStreetMap-based program. Associations were established using logistic regression analysis.Results. With a twofold increase in the distance of TP and ENDS outlets from the place of residence, the depression probability was reduced by 13% (odds ratio (OR) 0,87; 95% confidence interval (CI): 0,79-0,96) and by 12% (OR 0,88; 95% CI: 0,78-0,99), respectively. With increase in distance from of TP outlets, the anxiety decreased probability by 12% (OR 0,88; 95% CI: 0,81-0,97). With an increase in the number of TP outlets within a radius of 1000 m from the place of residence, there were an increase in the probability of depression (OR 1,18; 95% CI: 1,031,36), anxiety (OR 1,12; 95% CI: 1-1,26) and stress (OR 1,24; 95% CI: 1,05-1,46). A greater number of ENDS outlets within a radius of 1000 m and 400 m was associated with a high likelihood of depression (OR 1,17; 95% CI: 1,02-1,34 and OR 1,25; 95% CI: 1,04-1,47, respectively). An increased depression probability was found in those exposed to tobacco smoke at home (OR 1,88; 95% CI: 1,27-2,73) and at work (OR 1,67; 95% CI: 1,14-2,41). An increase in the number of attempts to quit smoking doubles the odds of depression (OR 2,40; 95% CI: 1,35-4,23) and anxiety (OR 2,00; 95% CI: 1,18-3,38).Conclusion. Unfavorable environmental factors, including the proximity and density of TP and ENDS outlets, can increase the probability of depression, anxiety and stress among the population living in these areas.