[The personnel policy in health care institutions in the light of tasks of provision of medical care quality and medical activity safety].

The personnel plays important role in process of maintaining internal quality control and safety of medical care. The employee satisfaction with working conditions is main factor affecting professional development and competence enhancement and consequently quality of medical care. The purpose of the study is to analyze particular personnel policies of the institution and to investigate effectiveness of quality management system regarding health care services. Results. The institution implemented the model of quality management system (ISO 9001-2015) assigning significant role to proper personnel management. The sociological survey was carried out to analyze achieved results and to receive feedback from employees to improve quality management system. The results of sociological survey indicate that the most important targets of personnel policies for 65% of respondents are planning, forecasting skill, competency requirements; for 58% - organization of conditions improving effectiveness of employees; and for 51,7% - maintaining favorable team moral and psychological climate. The employees consider as preferable following ways of professional development: additional training, specialized training programs (78.5%), exchange of experience and communication between Russian and foreign colleagues (51.0%). The analysis established that 61.8% of employees of the institution assume mentoring programs would improve efficiency of new employees. Conclusions. The results of the study revealed that personnel policy of the institution can be improved through implementing particular policies regarding development of employee personal additional competency; of mentoring programs and motivation systems for employees; evaluation of employee individual contribution into achieving the goals of the institution and forming personnel reserve.

[The experience of development of partnership between science and health care institutions in resolving issues of circulatory system diseases].

In Russia, the process of clustering institutions at the regional level is evolved. The analysis of scientific publications revealed only several examples of efficiently functioning medical clusters. As a rule, the publications present problems or projects and perspectives of development of medical clusters. At that, no information is available concerning organizational mechanisms integration of institutions. Purpose of the study is to evaluate the results of partnership between institutions of science and practice in resolving strategic health problems related to diseases of blood circulatory system. Materials and methods. The study applied such methods as monographic approach, data derivation, statistical technique, logical and system analysis. Results. The partnership between scientific and educational institutions and practical health care organizations was analyzed on the example of the system of medical care of circulatory system diseases organized in the Kemerovo region. The effective functioning of such a partnership is based on seven integration principles. Thus, the number of treated patients increased by 7.1% from 2011 to 2018. At the same time, the number of beds decreased by 9.2%. As a result, bed turnover increased by 18.1% over this period. The work of X-ray surgery service almost doubled the rate of percutaneous coronary interventions in case of acute coronary syndrome (from 22.0% in 2011 to 42.7% in 2018). The main organizational basics of successful cooperation of institutions are succession and interdependency in work of physians and departments, joint environments of quality management, knowledge management and personnel training, shared management of research and medical activity, common production and information environment, corporate culture and traditions.

[The Social Economic Factors and Models of Forecasting Mortality Because of Cardiovascular Diseases].

The purpose of the study is modeling and analysis of effect of social economic characteristics of regions on population mortality of cardiovascular diseases. The official data of the Federal service of state statistics of the Russian Federation were used concerning social economic indices and mortality of cardiovascular diseases in the regions of Russia in 2012. The selection of social economic indices included percentage of males in population structure, percentage of individuals of retirement age, percentage of urban population, percentage of individuals with income lower that living wage, percentage of the unemployed individuals, Gini coefficient, percentage of individuals with university education, atmosphere air pollution with emissions of permanent sources, average per capita consumption of vodka and liqueurs, criminality, percentage of regional budget for social cultural expenses, percentage of workers involved in unhealthy labor conditions from total number of population of region. The selection of indices of mortality of cardiovascular diseases included class of diseases of blood circulation system in general, ischemic heart disease and class of cerebrovascular diseases. The mortality was evaluated in overall by population and separately on able-bodied age. The modeling of dependence of mortality from social economic indices was implemented using regression analysis. The calculated ?-coefficients and coefficients of determination were applied to determine approximate input of each predictor into alteration of levels of mortality. The statistically significant mathematical models of dependence of mortality on number of social economic indices were derived. The values explain on 40-75% spreading of regional indices of mortality. The percentage of input of age factor into regional differences of mortality reaches 13-35% in various classes of cardiovascular mortality. Besides, in able-bodied age the average per capita consumption of hard alcoholic beverages (vodka and liqueurs) can be considered as a stable predictor of cardiovascular mortality with corresponding input of 5-7% in the regional differences. The other social economic indices demonstrate a statistically significant relationship only in certain indices of mortality that permits to surmise about only supposed cause-and-effect relationships.

[Genetic determinants of hypertension in two national cohorts of Mountain Shoria]. / Geneticheskie determinanty arterial'noi gipertonii v dvukh natsional'nykh kogortakh Gornoi Shorii.

AIM: To estimate the prevalence of the genotypes of the candidate genes ACE (I/D, rs4646994), ADRB1 (Ser49Gly, A/G, rs1801252) ADRA2B (I/D), MTHFR (C677T, Ala222Val, rs1801133), and eNOS (4b/4a) and their association with hypertension in two ethnic groups of Mountain Shoria. SUBJECTS AND METHODS: A clinical and epidemiological study was conducted in a population compactly living in the hard-to-reach areas of Mountain Shoria (the settlements of Orton, Ust-Kabyrza, and Sheregesh of the Kemerovo Region). A continuous method was used to survey 1178 residents from the above settlements; the sample consisted of adults (aged 18 years and older), 565 people were genotyped. RESULTS: The prevalence of hypertension among the population of Mountain Shoria was 42.3%. The incidence of this disease among the Shorians was lower (39.9%) than that among the representatives of non-indigenous people (46.1%). The ethnically justified peculiarities of the association of ADRA2B and ACE I/D polymorphisms with hypertension were established. There were fewer patients with hypertension among ACE ID and ADRA2B DD genotype carriers in the cohort of the Shorians than in that of the non-indigenous population: 40.6% versus 58.6% and 38.3% versus 64%, respectively. Conversely, there were more hypertensive patients among the carriers of the homozygous ACE DD genotype in the native ethnic group (60%) than in the non-indigenous one (37.1%). CONCLUSION: Adverse prognostic ACE DD, ADRB1 AA, MTHFR TT, and eNOS 4a/4a genotypes were more frequently observed in the non-indigenous ethnic groups; the ADRA2B DD genotype was more common in the native population. Hypertension was associated with the ACE DD, МTHFR CT, and ADRB1 AA genotypes in the native ethnic group and with the ACE ID genotype in the non-indigenous population.

[IDENTIFICATION OF OCCUPATIONAL RISK FOR ARTERIAL HYPERTENSION. REPORT II: ELIMINATION OF THE MODIFYNG INFLUENCE OF FACTORS OF CARDIOVASCULAR RISK].

This study is a continuation of (Report I) identification of the occupational risk of arterial hypertension (AH) in 13 occupational groups (3842 workers, men). In previous work there was eliminated the influence of traditional factors of the cardiovascular risk, in this study there was implemented the identification of the components of a healthy worker effect (HWE) and the elimination of their influence on the occupational risks of hypertension. Identification and removal of components HWE--the effect of a healthy recruitment (EHR) and the effect of the healthy worker persisting to work (EHWPW--was carried out by the analytic rearranging of the standardized for age and obesity prevalence rate of arterial hypertension with the use of own methodological approaches. For the determination of the presence and severity of EHR there was performed an analysis of the initial prevalence rate of arterial hypertension in the youngest age groups (under 31 years). To overcome HER standardized for age and obesity indices of the arterial hypertension prevalence rate were adjusted by the ratio of the frequency of arterial hypertension in the most young occupational and reference comparable groups. Identification of HWPW was executed by comparing the frequency of AH among workers retiring within 3 years from the occupational groups when compared to the whole sample. Then on the additional risk value there was adjusted the overall prevalence rate of AH in the occupation profession to overcome EHWPW. As a result of the consistent correction and elimination of the influence of HWE components on the prevalence rate of AH, there were obtained risks values, primarily reflecting the impact of occupational factors which can be considered as true occupational risks. Factors of the cardiovascular risk and HWE significantly modified true occupational risks for AH in a number of occupational groups up to inversion. At the same time, the pronouncement of EHR has a paramount importance in the modifying effect.

[Long-term survival in working-age patients after cerebrovascular accident]. / Otdalennaya vyzhivaemost' patsientov trudosposobnogo vozrasta posle tserebral'nogo insul'ta.

AIM: To assess the long-term survival in working-age patients after cerebrovascular accident (CVA) and to define basic medical and social factors determining the survival rates. MATERIAL AND METHODS: A continuous retrospective study included 756 working-age patients (<60 years) after CVA. The life-table method and Kaplan-Meier analysis were used to calculate a survival rate. RESULTS: The highest risk of death was observed in the first year of CVA. One-year survival after CVA was 81.7%, falling to 74.7% at 3 years and to 57.9% at 7 years. The five-year survival was lower among men (60%) compared to women (74.5%). The figures were higher in working population compared to non-working population (78% vs. 56%, respectively). Long-term survival rate depends on the type of CVA: the five-year survival rate after unspecified stroke was 83.0%, after ischemic stroke - 69.0%, after hemorrhagic stroke - 43.0%. The direct dependence between long-term survival and patient age has been identified: older patients have worse long-term prognosis. CONCLUSION: The seven-year survival rate in working-age patients after cerebrovascular accident was 58%. The health and social factors affecting the long-term survival rates in working-age patients are as follows: hemorrhagic stroke, unemployment, male gender and advanced age.

[IDENTIFICATION OF OCCUPATIONAL RISK FOR ARTERIAL HYPERTENSION. 1: ELIMINATION OF THE MODIFYNG INFLUENCE OF FACTORS OF CARDIOVASCULAR RISK].

On results of research in 13 occupational groups (3842 workers, men) there were performed an analysis of a contribution of non-occupational factors of cardiovascular risk (FCVRs) and the elimination of their modifying influence on risks for the development of the arterial hypertension (AH). In the capacity of non-occupational FCVRs there were considered 16 predictors of AH. There were calculated the relative risk of AH and 95% the confidential interval (CI) in occupational groups on benchmark data of the prevalence rate of AH and after the elimination of the modifying influence of FCVRs. Reference group was the general sample, that is, all the occupations. Modifying influence of FCVR was eliminated by means of direct standardization. With the aid of trees of classifcation from the number of FCVRs in occupational groups the presence of obesity and age of the worker (respectively, 100 and 78 conditional points) was shown to have the maximum impact on the development of AH. Elimination of the influence of data of FCVRs led to the change of benchmark values of occupational risks of AH in the average for 10%, in four occupations level of the statistical importance of risks of AH changed. In top-managers, and also in operating personnel and technical workers the risk for AH from the high decreased to not significant, respectively to 1,00 at 95%, CI: 0.74-1.36 and 1.20 at 95%, CI: 0.97-1.49. On the contrary, the risk for AH increased from low to statistically not significant in underground equipment operators (0.85 at 95%, CI: 0.71-1.01) and labourers (0.89 at 95%, CI: 0.69-1.14).

[A rank-order method for the integrated assessment of trends in all-cause and cardiovascular mortality rates in the subjects of the Russian Federation in 2006-2012].

AIM: To rank the subjects of the Russian Federation by the trend direction in all-cause and cardiovascular mortality (including mortality from coronary heart disease and cerebrovascular diseases) as a whole and at able-bodied age. SUBJECTS AND METHODS: The investigation used mortality rates from to the 2006 and 2012 data available in the Federal State Statistics Service on 81 subjects of the Russian Federation. According to mortality rates, each region was assigned a rank in 2006 and 2012. Trends in rank changes in the Russian Federation's regions were analyzed. A cluster analysis was used to group the subjects of the Russian Federation by trends in rank changes. RESULTS: The cluster analysis of rank changes from 2006 to 2012 could combine the Russian Federation's regions into 10 groups showing the similar trends in all-cause and circulatory disease mortality rates. Overall, the results of the ranking and further clusterization of the regions of the Russian Federation correspond to the trends in all-cause and cardiovascular mortality rates according to the data of other Russian investigations, by qualitatively complementing them. CONCLUSION: The trend rank-order method permits a comprehensive comparative analysis of changes in all-cause and cardiovascular mortality in the subjects of the Russian Federation both as a whole and at able-bodied age, which provides qualitatively new information complementing the universally accepted approaches to studying the population's mortality.

[Long-Term Survival After Myocardial Infarction].

The purpose of this study was to explore the long-term survival of patients after myocardial infarction (MI) and to elucidate main medical and social factors affecting survival. MATERIAL AND METHODS: In 2006 we included into this study 791 consecutive patients with MI. Duration of follow-up was 8.5 years. Survival was analyzed by construction of life tables and calculation of Kaplan-Meier estimates. RESULTS: During follow-up 446 patients died. Leading was cardiovascular death (88.2%). Other causes were cancer (7.1%), internal diseases (4.1%), and external causes (0.6%). Risk of death was the highest during first year. One, three, and five-year survival was 74.9, 62.2 and 53.8%, respectively. Main medical and social factors that reduced long-term survival were: old age, lack of work, no percutaneous coronary intervention during initial hospitalization, recurrent myocardial infarction, and male sex among working age patients.

[The values of cardio-ankle vascular and ankle-brachial indices in patients with carbohydrate metabolic disorders: The ESSE-RF study in the Kemerovo Region]. / Znacheniya serdechno-lodyzhechnogo sosudistogo i lodyzhechno-plechevogo indeksov u patsientov s narusheniyami uglevodnogo obmena (issledovanie ESSE-RF v Kemerovskoi oblasti).

AIM: To investigate factors associated with pathological cardio-ankle vascular and ankle-brachial indices (CAVI and ABI) in patients with carbohydrate metabolic disorders (CMD). SUBJECTS AND METHODS: A cross-sectional study was conducted in the framework of the multicenter epidemiological study "Epidemiology of Cardiovascular Diseases and Their Risk Factors in the Russian Federation" (ESSE-RF) in March to October 2013. The standard ESSE-RF protocol was extended by an additional study of peripheral arterial stiffness, by estimating CAVI and ABI automatically. A sample of 1619 people was formed in several stages, in which 311 patients with type 2 diabetes mellitus and prediabetes were identified and divided into 3 groups: 1) 41 patients with pathological CAVI values (≥9.0); 2) 241 with normal CAVI (<9.0); 3) 29 with pathological ABI (<0.9). RESULTS: In the population-based sample of patients with CMD, the pathological CAVI values (≥9.0) were detected in 14.5%, and the pathological ABI was in 9.3% of the examinees. Regression analysis showed that the pathological vascular indices (both CAVI and ABI) were significantly associated with increases in blood pressure (BP) and heart rate (HR), and a decrease in glomerular filtration rate. At the same time, only the pathological CAVI was associated with advancing age (odds ratio (OR), 1.111; 95% confidence interval (CI), 1.050-1.176; p < 0.001), visceral obesity (OR, 3.088; 95% CI, 1.001-10.495; p=0.038), smoking duration (OR, 1.093; 95% CI, 1.008-1.185; p=0.009), prior stroke (OR, 4.695; 95% CI, 1.408-15.658; p=0.018), and a need for insulin therapy (OR, 18.947; 95% CI, 1.902- 87.783; p=0.006). The pathological ABI was associated with male sex (OR, 2.227; 95% CI, 1.040-4.765; p=0.039), prior myocardial infarction (OR, 8.646; 95% CI, 2.174-34.378; p=0.005), obesity (OR, 2.439; 95% CI, 1.010-5.889; p=0.034); hyperglycemia (OR, 2.439; 95% CI, 1.010-5.889; p=0.034), hyperuricemia (OR, 4.009; 95% CI, 1.850-8.684; p=0.033), and increases in triglyceride levels (OR, 2.984; 95% CI, 1.376-6.470; p=0.004) and CAVI (OR, 1.193; 95% CI, 1.034-1.377; p=0.005). CONCLUSION: The pathological vascular indices CAVI and ABI are associated with different risk factors for cardiovascular events in a cohort of patients with CMD. The common factors associated with both CAVI and ABI are increases in blood pressure and HR and a reduction in glomerular filtration rate. The common factors associated with both CAVI and ABI are increases in blood pressure and HR and a reduction in glomerular filtration rate.

[Organizational aspects of managing patients with atherosclerosis obliterans of lower-limb vessels at an ambulatory stage].

The authors describe their first experience of a new approach in dispensary follow up of patients presenting with atherosclerosis obliterans of lower-extremities vessels. The work was based on the municipal system of rendering outpatient medical care in the city of Kemerovo. The patients were subdivided into two groups: one group remained under supervision of the surgeon, the other one was referred to the cardiologist. The mean duration of follow up amounted to 12 ± 1.5 months. The scope of carried out diagnostic, therapeutic and preventive procedures was assessed. The new approach to outpatient follow up, i. e., participation of the cardiologist in the therapeutic process made it possible to improve quality of medical care, also revealing positive alterations in diagnosis, treatment, and prevention of atherosclerosis obliterans of lower-limb vessels.

[HEALTH LOSSES FROM MYOCARDIAL INFARCTION CAUSED BY AIR CHEMICAL POLLUTION OF THE INDUSTRIAL CENTRE].

Losses of health from myocardial infarction in the city of Kemerovo were estimated accordingly to the disability-adjusted life year (DALY) index, as well as its compartments: YLL (years lost due to premature death) and YLD (years lost disability). When ranking districts of the city of Kemerovo both in terms of chemicals exposure and the value of the DALY index there was revealed the opposite direction of these indices. The performance of the correlation analysis of health losses with concentrations of chemical contaminants allowed to reveal a feedback between them among the elderly patients (60 years and older) and direct--in young (up to 45 years old) cases. This fact probably may attest to the significant contribution of the environmental pollution in the process of development and progression of atherosclerotic changes in the young population.

[THE ORGANIZATIONAL TECHNOLOGIES OF INCREASING QUALITY OF SPECIALIZED MEDICAL CARE UNDER ACUTE CORONARY SYNDROME AS EXEMPLIFIED BY THE KEMEROVSKAIA OBLAST].

The article considers means of development ofsystem of specialized medical care under acute coronary syndrome. The new organizational approaches provide optimization of structure of specialized hospital, development of mechanisms of multi-stage and multi-level interaction of medical organizations of the subject of the Russian Federation as exemplifed by the Kemerovskaia oblast and integration of resources of institutions of health care, science and education.

[Particulate matter air pollution effects on the incidence of heart diseases among the urban population].

Increasing prevalence of cardiovascular diseases induces an urgent need to identify and clear delineation of the most important risk factors for the development and progression of atherosclerosis. Unlike the second part of XXth century, today the World Health Organization considers particulate matter ambient pollution one of the most important predictors of cardiovascular events. However, results of similar studies conducted in the last decades, is highly fragmented. The authors' objective was to try to understand and organize this massive of accumulated information and analyze it to draw conclusions about the impact of particulate matter on the functioning of human cardiovascular system.

[Optimization of organizational approaches to management of patients with atherosclerosis].

Despite undoubted achievements of modern cardiology in prevention and treatment of atherosclerosis, cardiologists, neurologists, and vascular surgeons are still facing severe stenotic atherosclerotic lesions in different vascular regions, both symptomatic and asymptomatic. As a rule hemodynamically significant stenoses of different locations are found after development of acute vascular events. In this regard, active detection of arterial stenoses localized in different areas just at primary contact of patients presenting with symptoms of ischemia of various locations with care providers appears to be crucial. Further monitoring of these stenoses is also important. The article is dedicated to innovative organizational approaches to provision of healthcare to patients suffering from circulatory system diseases that have contributed to improvement of demographic situation in Kuzbass.

[The dependence of the prevalence of hypertension on the severity of the professional aging].

On the example of 5437 employees of enterprises and institutions of the Kemerovo region, compiled into 14 occupational groups, an analysis of the relationship between age structure and the frequency of arterial hypertension due to the working conditions has been performed At high levels of hardness of employment and the impact of physical factors, a shift in the age structure toward younger age is seen, which is considered as a demographic consequence of professional ageing. In turn, expressed professional ageing causes the reduction in the prevalence of hypertension, which is, probably is implemented by the effect of "healthy worker".

[Several medical and social factors which may influence in-hospital mortality in patients with myocardial infarction].

AIM: To study the medical and social aspects of in-hospital mortality after myocardial infarction (MI) in the cardiology center of a major industrial city in Western Siberia. PATIENTS AND METHODS: The material of the study was the database of patients with acute coronary syndrome (19 283 patients), formed by a continuous method retrospectively. The volume of the study were 6463 patients with MI for 2006-2011. RESULTS: In-hospital mortality of patients with MI was 11.8%, with MI complicated by cardiogenic shock--87.4%, in the primary MI--7.4%, during the second MI--22.1%. In-hospital mortality in MI depends on the age of the patients: in group of patients of working age mortality was 4.7%, the retirement age--12.4%, old age--22.7%. In the working-age group mortality in men is almost three times higher than in women. The mortality of patients with MI without reperfusion was 13.4%, in the case of reperfusion therapy--9.2%. CONCLUSIONS: Hospital mortality depends on the patient's age, type of MI (primary or repeated), the severity of the condition, applied treatments.

[Importance of occupational selection in prevalence of hypertension: effects of healthy and unhealthy worker].

The importance of occupational selection in prevalence of arterial hypertension in researches of professional cohorts is considered in the article. Because arterial hypertension represents not only the independent disease, but also one of the most important indexes of the functional status of a human body, prevalence of arterial hypertension in professional groups can be substantially caused by occupational selection. As an epidemiological phenomenon of occupational selection "healthy worker effect", known of scientific literature from the middle of last century is considered. Besides, it is offered to consider the regularities of professional selection opposite to "healthy worker effects", as "unhealthy worker effect". The professional conditionality of arterial hypertension considered from epidemiological line items can be distorted by occupational selection. Thus existence of "healthy worker effect" makes impression of absence of direct link between level of occupational influence and frequency of arterial hypertension. At the same time, the increase in prevalence of arterial hypertension not always testifies to its professional conditionality, and can be connected to "unhealthy worker effects". Possible solutions of problems associated with identification of relationships between occupational factors and prevalence of hypertension in the presence of "effects of the healthy" and "unhealthy worker" are discussed. The challenge of considered problem in occupational medicine despite the numerous offered methodological approaches of elimination or decrease in influence of occupational selection is noted.

[The environment as a risk factor of coronary heart disease in urbanized region with developed chemical industry].

Tendency to growth of prevalence of ischemic heart disease (IHD) occurring in Russian Federation despite application of preventive measures designates necessity of search for novel nontraditional factors of risk. Among other studied factors of genesis of cardiovascular diseases in general and of IHD in particular is the role of xenobiotics - chemical pollutants, substances foreign to the body. In this paper we present results of a number of epidemiological studies on the problem of xenobiotics and IHD. Special attention is given to the difficulty of isolation of the leading chemical pollutant and as a consequence of pathogenetic link what leads to underestimation of pathological states caused by ecological factors especially in such urbanized region with developed chemical industry as Kusbass.