Vol 18, No 1 (2014)

Articles
PSYCHOSOMATIC RISK FACTORS OF STROKE
Kandyba D.V.

Abstract

The article presents a literature review on the increasing role of psychoemotional disorders in the genesis and decompensation cardiovascular disease and stroke. The modern paradigm of stroke prevention needs substantial addition, based on an integrated approach in the form of correction of traditional and psychosomatic risk factors. The most significant mental health problems, defining psychosomatic variant pathogenesis of cardiovascular and cerebrovascular complications are depression and anxiety
Russian Family Doctor. 2014;18(1):4-11
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THE STRUCTURED APPROACH TO THE DETERMINING OF THE OLD AND ELDERLY PATIENTS' NEEDS IN MEDICAL CARE
Degryse J.-., Frolova E.V., Tour E.Y.

Abstract

The web-based program is described in the article. The program aimed on the assessment of health conditions of the elderly and old adults. It based on the method of comprehensive geriatric assessment. The structured approach allows using it even by preoccupied general practitioners, revealing the unmet needs of the old patients. The evidence based recommendations for the diagnosing and screening of unmet needs and for rehabilitations and treatment, plans are described.
Russian Family Doctor. 2014;18(1):12-19
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MODELING LONG-TERM EFFECTIVENESS OF PREVENTION OF HARMFUL AND HAZARDOUS ALCOHOL CONSUMPTION BASED ON SCREENING AND BRIEF INTERVENTION
Barinova A.N., Boyarski S.G., Plavinski S.L., Kuznetsova O.Y., Degtyareva L.N., Chicherina S.L.

Abstract

Based on the results of the screening of the 3442 persons Marcov-cohort model was used to estimate results of the preventive program based on the methodology of screening and brief intervention (SBI) to prevent harmful and hazardous alcohol consumption. It is found, that in case of pessimistic scenario introduction of SBI in Russian Federation will be associated with avoidance of 18 716 disability-adjusted life-years (DALY) (95% CI = 17 61119 819), in case of more optimistic scenario effectiveness of SBI increase to 564 618 DALY (95% CI = 539 910589 327). This means that economical effect will be from 5,92 rubles per each ruble invested in the SBI (95% CI = 5,57-6,27 rubles) to 179 rubles (95% CI = 171-186 rubles). Comparison to other preventive programs show, that SBI is a cost-effective intervention independent of the pessimistic or optimistic scenario used.
Russian Family Doctor. 2014;18(1):20-26
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CLINICAL CHARACTERISTICS IN THE ELDERLY PATIENTS WITH BRONCHO-OBSTRUCTIVE SYNDROME
Zelenukha D.N., Frolova E.V., Tadjibaev P.J.

Abstract

The analysis of clinical features (age, sex, dyspnoe, smoking status, symptoms of heart failure, etc) was done in the elderly with broncho-obstructive syndrome identified with spirometry. Bronchial obstruction revealed if a fixed ratio of forced expiratory volume in 1 second (FEV1) to forced vital capacity (FVC) was less than 0,70 (70%). Spirometry was performed in 605 people. Frequency of airflow limitation (FEV1/FVC < 0,70) in the sample was 20% (95% CI = 17%-24%), and increased with age. Patients with broncho-obstructive syndrome showed no clinical features which could physician to rely on in diagnosing broncho-obstructive syndrome without spirometry.
Russian Family Doctor. 2014;18(1):27-32
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METABOLIC PROFILE OF YOUNG WOMEN IN EARLY PREGNANCY AND AFTER INDUCED ABORTION
Panova O.V., Kulikov A.M.

Abstract

The metabolic profile was estimated in young pregnant women 15-19 years old as the level of substances of low and middle molecular mass in blood serum, red blood cells and urine. The assessment was provided in the early period before the 12th week of gestation and after the medical abortion. Metabolic changes were indicated in 59,5% of patients. The endogenous intoxication was found in one third of patients (30,5%). The activation of metabolic processes during the fetal growth, the presence of toxicosis and acute inflammation diseases can be considered as possible reasons of the endogenous intoxication. Pregnancy interruption didn't lead to disappearance of endogenous intoxication and metabolic damages. On the contrary in a week after induced abortion the metabolic profile in a half of patients worsened due to accumulation of substances of catabolic origin in the biological environment. Postponed adverse metabolic changes were also found. The level of substances of low and middle molecular mass approached to normal in a month after abortion. There is an evidence that interruption of pregnancy by the means of surgical abortion turned out to be a high-powered factor for the metabolic disorders of different degree of manifestation.
Russian Family Doctor. 2014;18(1):33-36
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QUALITY ASSESMENT OF SPIROMETRY PERFORMED BY TRAINED GENERAL PRACTITIONERS IN FRAME OF THE RESPECT STUDY IN SAINT PETERSBURG. PART I
Pokhaznikova M.A., Andreeva E.A., Kuznetsova O.Y., Lebedev A.K., Degryse J.-.

Abstract

Spirometry is the main diagnostic method of the chronic obstructive pulmonary disease in primary care level. Quality spirometry is a key role in the study of the prevalence of airway obstruction. Aim: to assess the quality of spirogram according to the American Thoracic Society (ATS)/European Respiratory Society (ERS) criteria, performed by GPs in frame of the RESPECT study (RESearch on the PrEvalence and the diagnosis of COPD and its Tobacco-related aetiology). Methods: Spirogram quality assessment was performed according to ATS/ERS criteria for reproducibility and acceptability. Results: Altogether 2093 spirograms before and 1533 spirograms after reversibility test were evaluated. Mean Evol less than 150 ml was obtained for the majority of spirograms (for 1817 spirograms without reversibility test, 90,9%; and for 1343 spirograms with reversibility test, 89,6%). In other cases mean Evol was less than 5% forced vital capacity (FVC). The mean forced expiratory time (FET) more than 6 sec was carried out for 970 spirograms without bronchodilator (48,6%) and for 584 spirograms with bronchodilator test (39%). In remain cases with FET less than 6 sec the plateau on the curve «volume-time» was achieved. The reproducibility, based on FVC and forced expiratory volume for the 1 sec (FEV1), was obtained for 92,1% spirograms without reversibility test (n = 1839) and for 89,8% spirograms with reversibility test (n = 1346). In total, 12,3% (n = 260) spirograms without bronchodilator and 12,2% (n = 187) with bronchodilator were assumed as unreproducible and unacceptable. Conclusion: The RESPECT investigators are able to perform spirometry with acceptable quality according to ATS/ERS criteria. The spirometry educational course makes it possible to implement spirometry in the daily work in the primary care, likewise early detection of airway obstruction.
Russian Family Doctor. 2014;18(1):37-43
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DYNAMICS OF TOTAL CHOLESTEROL LEVELS AND ITS EFFECT ON MORTALITY IN PEOPLE OVER AGE 65 NOT RECEIVING LIPID-LOWERING THERAPY
Turusheva A.V., Frolova E.V.

Abstract

Cardiovascular diseases is the leading cause of death and disability in the old people. High total cholesterol level is a proven risk factor for cardiovascular diseases and mortality in the middle-aged persons. Importance of lipid-modifying therapy in the elderly remains controversial. Many foreign researchers have noted a decrease in total cholesterol in old people, which was not associated with lipid-lowering drugs or hypolipidemic diet. Objective: describe the total cholesterol level dynamic in persons over 65 years of old throughout the 4 years of observation; evaluate the impact of level of total cholesterol on mortality of these persons. Methods. The participants were selected randomly into two age groups, 65-74 years and 75 years and older from a database of policlinic № 95 of Kolpino district of St. Petersburg (149 and 115 patients). Examination of each participant included a twofold determination of total cholesterol during the first screening in 2009, and during the second screening in 2012. Results. The decrease of total cholesterol level was not associated with the change of nutrition, taking lipid-lowering medications, changes in body weight or level of physical activity. Changes of total cholesterol level were dependent on its level at the beginning of the study. In individuals with an optimal level of total cholesterol in the beginning of the study, we found significant increase in total cholesterol levels. In the group with borderline high cholesterol level we did not identified the change of total cholesterol levels. In the group of high total cholesterol level, we detected a statistically significant reduction in total cholesterol levels. The results show that the level of total cholesterol had no effect on mortality rate.
Russian Family Doctor. 2014;18(1):44-49
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DRY EYE SYNDROME IN GENERAL PRACTICE
Zakhlevnaya G.N.

Abstract

To help family physicians who frequently treat patients with ophthalmological complaints, an overview of the etiology, pathogenesis, clinical manifestations and treatment of dry eye syndrome provides in this article.
Russian Family Doctor. 2014;18(1):50-53
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