[Readiness for intersectoral cooperation to preserve health of megalopolis population].

INTRODUCTION: For a better understanding of issues related to health-preserving activities for the benefit of city population, theoretical knowledge about the attitude and readiness of all interested parties for intersectoral cooperation is needed. The purpose of the study is to analyze readiness of the participants of health-preserving activities for intersectoral cooperation in Moscow. MATERIAL AND METHODS: In 2023, a one-time, one-time study of intersectoral responsibility, commitment and awareness, as well as satisfaction with individual health care (original test cards) was conducted among different participants in the health care of the population of the city of Moscow (n = 1007). From among them, participants were identified -workers of «medical¼ infrastructure facilities of urban space, participants-workers of other facilities (sports, culture, industry, waste disposal, transport, food, trade, education and others) and the population as a participant in intersectoral health saving. RESULTS: The research based on the original integrated assessment methodology shows insufficient readiness for intersectoral cooperation to implement health-saving activities for the benefit of Moscow population. Immature intersectoral responsibility, literacy, motivation for teamwork noted among the participants of the unified health-preserving city space determines the lack of internal conviction that it is necessary to deal with both own health, and health of other members of the urban community. CONCLUSION: The data obtained can form basis for new methodological approaches to prioritize control measures to improve intersectoral cooperation between the participants of health-preserving activities in the metropolis.

[The results and perspectives of primary health care reforming in Moscow].

The primary health care is characterized by its directivity to population health, while general practitioner is key figure in its organization and is responsible for assigned population health. The Russian Federation continues to suffer from overspecialization of medical care in outpatient health care. At that, the number of unreasonable visits to medical specialists is too high. The general practitioner, with appropriate training, can appoint patients by 11 specialties and in conditions of municipal polyclinic can undertake up to 81% of visits to medical specialists. The purpose of the study is to evaluate primary health care functioning in Moscow and to formulate proposals for reforming health care, considering development of general medical practices in a metropolis. The study was focused on analysis of morbidity of population of Moscow, on support of out-patient health care with physicians before and after implementation of three-level system of ambulatory polyclinic care, on evaluation of preventive activities of general practitioners and on development of proposals for improving organizational forms of activities with emphasis on health preservation. In the study were applied such methods as statistical, direct observation, sociological. The analysis was applied to forms of federal statistical observation i.e. form № 30 in Moscow and the Russian Federation for 2010-2019. The population sociological surveys concerning satisfaction with medical care were carried out. The research base was Moscow. The analysis demonstrated that results of Moscow health care system reformation is economically effective because of shortage of medical personnel primarily of administrative staff and its rational employment. The reformation results were positively assessed by patients, whose satisfaction with medical care made up to 95.6%. The general practitioner is to be responsible for health status of attached population and is called upon not only to carry out treatment and preventive activities, but also to coordinate organization of medical care of attached population at all stages of its provision. The implementation of general medical practice in conditions of municipality is to calculate complete transition of medical organizations providing out-patient medical care to general medical practice, that will result to certain extent, in reduction of staff positions of medical specialists. It is necessary to expand duties of medical nurse in general practice. The optimal model of joint work of general practitioner with feldsher and medical nurse of general practice. The complex general practice team can include medical registrar. The proposed perspective models permit to implement integrating role of general practitioner and to increase accessibility and efficiency of primary health care.

[The problems of implementing strategies of prevention in The Russian Federation: The new considerations of old truths (publications review)].

Over the last decades, with purpose of increasing efficiency of medical and preventive activities, the search, development, implementation and improvement of new methods and models of health care system functioning and management of medical organizations is carried out. Purpose of the study - to analyze mechanisms of implementing strategies of medical prevention in the Russian Federation. The publications on implementation of strategies of medical prevention in the Russian Federation were analyzed. The data analysis testifies that improvement of preventive activities at the level of ambulatory polyclinic care is initiated in many subjects of the Russian Federation. However, efficiency of these innovations remains relatively low. The conclusion is made that high morbidity and mortality of non-communicable diseases testify the most urgent need in optimizing prevention system.

[The development of health preservation technologies: from individual to family approach].

The actuality of considered problem is in the fact that many medical social problems of preserving and improving population health can be resolved by the family and with its support. The purpose of the study is to substantiate scientifically priority of family approach in development of National health preservation system in actual conditions. MATERIALS AND METHODS: The national and foreign electronic databases were investigated to find publications concerning transformation of matrimonial relations, effect of family on health and need in health preservation technologies at each stage of its development. RESULTS: It is demonstrated that implementation of family-oriented technologies of health preservation based on knowledge of trends in family health, matrimonial relations and demographic shifts in its structure is one of the priority directions of preserving and strengthening population health. Moreover, in modern socioeconomic conditions, the categories of families that are in special need of medical social protection and health preservation such as socially problematic families, families where violence is practiced, families of the unemployed and migrants are shown up. Hence, one of the priority scientific tasks is to substantiate conceptual model of health preservation technologies for various types of families. CONCLUSION: The family and its health should become priority object of medical observation and research studies from the standpoint of public health and health care.

[The priority directions of forming and supporting healthy life-style in megalopolis conditions].

The activities related to formation and maintenance of healthy life-style of population are to be carried out in accordance with the Strategy of prevention of chronic non-communicable diseases. The purpose of the study is to analyze current trends in the formation of healthy life-style of Moscow residents and to determine priority areas of its maintenance. Materials and methods. The analysis of the lifestyle of the Moscow population in conditions of actual infrastructure of urban environment was carried out as exemplified by two administrative Okrugs. According to dispenasarization data the prevalence risk factors of chronic non-communicable diseases. in Moscow residents was investigated. The Results. It is demonstrated that in actual conditions, the population is be provided with recommendations concerning development of stress resistance, proper diet and physical activity enhancement using really existing integrated prevention space. The specialists involved into issues of citizens following healthy life-style in their professional activities are to rely on the results of both study of characteristics of self-preservation behavior of population and analysis of the state of prevention infrastructure in particular municipality.

[Comorbidity of somatic diseases in psychiatric patients]. / Komorbidnye somaticheskie rasstroistva u patsientov s psikhicheskimi zabolevaniyami.

OBJECTIVE: To study the prevalence of somatic diseases in patients with mental disorders based on the results of medical examination in Moscow mental health clinics in 2018. MATERIAL AND METHODS: A retrospective analysis of the results of the clinical examinations of 6492 outpatients, which accounted for 79.5% of patients who underwent medical examination in this time period. RESULTS: Comorbid somatic diseases were found in 4883 (75%) patients. Hypertension and non-insulin-dependent diabetes mellitus were most frequent with the prevalence higher than in the general population of the Russian Federation. Patients with diagnosed schizophrenia, along with hypertension and diabetes mellitus, have found to be at increased risk of diseases of the endocrine system and metabolic disorders. The incidence of the mentioned diseases is not higher than that reported in literature. CONCLUSION: The higher prevalence of socially relevant diseases (hypertension, diabetes mellitus) among patients with mental disorders demands the development of strategies for prevention, early detection and treatment of these diseases in psychiatric patients.

[The Mental Health and Chronic Infectious Diseases].

Actually, the problem of decreasing growing burden of NCD is especially acute both worldwide and in the Russian Federation. According to the results of scientific research in recent decades, mental disorders are increasingly considered as the new main group of CNCDs. The article presents data from scientific publications concerning issues of relationship between mental and somatic health, corresponding key research approaches, prevention and treatment of mental diseases, including associated with the main groups of CNCDs, effect of borderline mental disorders on body systems functioning.

[The effectiveness of preventive counseling with the use of remote technologies on medical awareness of cardiovascular risk factors in patients with high and very high cardiovascular risk].

Purpos. To assess the effectiveness of preventive counseling with focus on diet modification followed by remote support via telephone on awareness of cardiovascular (CV) risk factors (RFs) in patients (pts) with high/very high CV risk. Material and methods. This is a prospective randomized controlled study of 100 pts with high/very high CV risk (5-9% and ≥10% according to the SCORE scale) and any 2 criteria for metabolic syndrome.  Pts were randomized into 2 groups in 1:1 ratio - the intervention group (n=50) and the control group (n=50). The intervention group received comprehensive preventive counseling with focus on diet modification followed by remote preventive counseling by phone every two weeks for the first 3 months after enrollment (a total of 6 sessions). The control group received usual care in Health centers which also included basic preventive counseling. A specially designed questionnaire was used to evaluate the awareness of the basic CV RFs, including open questions. The awareness was assessed at baseline, 6 and 12 months. Results. The groups were well balanced according to demographic and clinical features. The results of the study revealed an extremely low awareness of major CV RFs of pts in both groups at baseline: practically none of them indicated as RFs for cardiovascular disease elevated cholesterol (8,0% and 4,0%, respectively) and blood pressure (14.0% and 4.0%). At 6 month the level of awareness of CV RFs has increased significantly. Moreover, pts of the intervention group were more informed about elevated cholesterol (58,0% vs. 28,0%; p<0,01) and unhealthy diet (76,0% vs. 52,0%; p<0,05). At 12 month the level of awareness of CV RFs was significantly higher in both groups  to compare from baseline. Conclusion. Preventive counseling with focus on diet modification followed by 3 months  remote support via phone provided a significant improvement of awareness of CV RFs in pts with high/very high CV risk.

[The development of territorial program of mandatory medical insurance: calculation of standards of out-patient care volume].

The article presents technique of calculation of the planned volume of outpatient care consumed by population of the subject of the Russian Federation considering demographic structure and level of morbidity. The formulas are presented developed for calculating financial costs of outpatient care and treatment in day hospital to be included into of mandatory health insurance program.

[The evaluation of prevalence risk factors of emotional burning-out syndrome in health care managers].

Professional activities of health care managers is connected with the impact of many stress factors as a result of which the burnout syndrome may develop. The aim of the study was to evaluate the incidence of this syndrome among the health care managers and risk factors responsible for its development. In the case group of managers (170 persons) burnout syndrome was detected in 24,7% and 44,7% displayed the initial (I-II) stages of it. With the help of methods of multivariate analysis (pattern recognition method) a complex of factors responsible for burnout syndrome development, and their grading due to the power of their influence. With the help of mathematical model, the potential efficiency of managerial scenarios developed for correction of some risk factors was determined.

[Preventive Counselling With the Use of Remote Technologies Provides Effective Control of Metabolic Risk Factors in Patients With High and Very High Cardiovascular Risk].

PURPOSE: to assess the impact of preventive counseling with focus on diet modification on lipid and metabolic parameters in patients with high / very high cardiovascular (CV) risk who visited Health centers. MATERIALS AND METHODS: This was a prospective randomized controlled study of patients aged 40 to 65 years with high/very high CV risk (≥5% according to the Systematic Coronary Risk Evaluation scale [SCORE]) and any 2 criteria for metabolic syndrome. Patients were 1:1 randomized into 2 groups. The intervention group (n=50) received comprehensive preventive counseling with focus on diet modification followed by remote preventive counseling by phone every two weeks for the first 3 months after enrollment (a total of 6 sessions). The control group (n=50) received usual care in Health centers which also included basic preventive counseling. RESULTS: A total of 100 patients (women 82%, age 59.74±4.66 years) were randomized. At baseline 81% of patients had high and 19% - very high CV risk. The groups were well balanced according to demographic and clinical features. At 1 year of follow-up patients from the intervention group experienced significant improvement of metabolic parameters compared with controls: their diastolic blood pressure (BP) decreased by 5.62±7.7 mm Hg, total and low-density lipoprotein cholesterol (TC and LDL-C) - by 0.5±0.83 and 0.46±0.62 mmol/l, respectively. Both groups experienced statistically and clinically significant decreases in systolic BP (intervention, - 17.76±16.2 mm Hg, control, - 13.44±15.6 mm Hg; both groups p.

[Efficacy of primary prevention for atherosclerosis-induced diseases in patients with high cardiovascular risk in Russia and other European countries (Part 1)].

RELEVANCE: Evaluation of the effectiveness of risk management in persons with high cardiovascular risk is an important element in reducing the death rate of the population from cardiovascular diseases (CVD). AIM: Analysis of the prevalence and level of risk factors control in patients with high CV risk CVD from the Russian centers of the primary care unit of the EUROASPIRE IV study in comparison with the general population of the study. MATERIALS AND METHODS: In this cross-sectional study, 14 European countries, including the Russian Federation, participated. Patients aged 18 to 79 years were included in the study, without clinical manifestations of atherosclerosis, who were prescribed antihypertensive therapy and/or lipid lowering therapy and/or treatment for diabetes between the ages of ≥6 months and.

[Efficiency of primary prevention for diseases caused by atherosclerosis in patients at high cardiovascular risk in Russia and other European countries (Part 2)].

BACKGROUND: The picture of primary prevention obtained from real-life practice makes possible scheduling measures for prevention improvement. AIM: To analyze features of drug and non-drug therapy aimed at decreasing cardiovascular risk in Russian patients with a high risk (HR) of CVD compared with the study general population. MATERIALS AND METHODS: 14 European countries, including the Russian Federation, participated in this cross-sectional study. The study included patients aged 18-80 without clinical signs of atherosclerosis who have received antihypertensive and/or lipid-lowering therapy and/or therapy for diabetes mellitus (DM) within >6 to.