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Vol 25, No 2 (2021)

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Reviews

Organization of primary medical care for patients with osteoporosis

Gladkova E.N.

Abstract

The author revises the latest evidence in the literature regarding of organizing medical care for patients with osteoporosis in primary medical care. In the world, there is an increase in the group of older people (60 years and older), therefore, the problem of osteoporosis and osteoporotic fractures becomes very urgent. In Russia, the number of hip fractures will increase by 70% by 2050 compared to 2015. The article provides an overview of studies demonstrating the clinical and cost-effectiveness of population-based screening programs for the identification and subsequent treatment of patients at high risk of fractures, and discusses the issues of secondary prevention of fractures. With the active identification of patients at high risk of fractures and the initiation of antiosteoporotic therapy, a decrease in the incidence of osteoporotic fractures, including hip fractures, is expected.

Russian Family Doctor. 2021;25(2):7-17
pages 7-17 views

Original studies

Elderly patients with cognitive impairments on an ambulance care

Bogdanova T.A., Turusheva A.V., Frolova E.V., Logunov D.L.

Abstract

BACKGROUND: Cognitive impairment is one of the most common geriatric syndromes that occur in the elderly. Dementia is a severe cognitive disorder that results in the professional, social, and functional impairment and gradual loss of independence. However, in most cases, the stage of dementia is preceded by a long period of non-dementia cognitive impairment. In this regard, one of the priorities of public health is to identify potentially reversible forms of dementia and cognitive impairment in the early stages.

AIM: To assess demographic characteristics, co-morbidities and factors that are associated with cognitive impairment in adults aged 65 years and over and to determine the prevalence of cognitive disorders in aging population.

MATERIALS AND METHODS: cross-sectional study included all patients aged 65 years and older who attended the ambulance care from 24.10.2019 to 15.12.2019 in Saint Petersburg. Measurements: the Montreal cognitive assessment test, the 15-item Geriatric Depression Scale. Data collection included a full medical history, blood pressure measurement, a medication review and blood tests (complete blood count, lipids, hormones, glucose, ALT, AST and creatinine).

RESULTS: The prevalence of mild cognitive impairment was 62.9 % (95 % CI 56-70), severe cognitive impairment — 8.2 %. We detected that hypertension, stroke, sleep disorders, subjective memory complaints and symptoms of depression were identified as factors associated with CI after adjustment for covariates. Hypertension and depression were related with cognitive impairment (p < 0.05). Also patients with depression scored worse in global cognition and attention function (p < 0.05). Patients with diabetes had association with a decrease in abstraction function (p = 0.02). Low hemoglobin levels were related with poor global cognition and memory impairment (p < 0.01). Beta-blocker use was significantly associated with poor global cognition and memory impairment (p < 0.01).

CONCLUSIONS: We found that elders have a high prevalence of cognitive disorders. We also demonstrated association between co-morbidities and factors as hypertension, anemia, diabetes, depression and administration of beta-blockers with poor cognitive performance in the elderly.

Russian Family Doctor. 2021;25(2):19-27
pages 19-27 views

The prevalence of urinary incontinence and its relationship with physical and cognitive status in older adults: Results of the Crystal and the Eucalyptus studies

Turusheva A.V.

Abstract

BACKGROUND: Urinary incontinence worsens the psychological state of older adults, increases the risk of developing anxiety, depression, falls-related injuries, leads to a decrease in the quality of life, and a decrease in the level of physical activity in old age.

AIM: To assess the prevalence of urinary incontinence according to the data of the Crystal and Eucalyptus studies, to identify factors associated with the development of urinary incontinence, as well as factors that reduce the risk of urinary incontinence in old age.

MATERIALS AND METHODS: A random sample of 1007 people aged 65 and older. The main parameters: urinary incontinence, frailty, nutritional status, anemia, CRP, functional status, depression, dementia, chronic diseases, grip strength, level of physical functioning, falls. The observation time is 2.5 years.

RESULTS: According to the Eucalyptus study, urinary incontinence syndrome was detected in 48.0%, in the Crystal study — in 41.2%. In 62.4% cases urinary incontinence was diagnosed for the first time. Urinary incontinence was associated with a higher prevalence of COPD, history of stroke, sensory deficits, frailty and other geriatric syndromes. Improved nutrition and increased protein intake led to the disappearance of urinary incontinence complaints in 47.7% of cases. The disappearance of complaints of urinary incontinence was associated with an improvement in the emotional status. A decline in cognitive function has been associated with an increased risk of urinary incontinence in old age.

CONCLUSIONS: Despite the high prevalence of urinary incontinence, it often remains undiagnosed. The correct wording of the question in the conversation with the patient allows to identify 30% more cases of urinary incontinence. Given the high prevalence of urinary incontinence among patients with COPD, stroke, sensory deficits, frailty and other geriatric syndromes, all patients in these groups should be purposefully asked about the presence of symptoms of urinary incontinence. Improved nutrition and increased protein intake are associated with the disappearance of urinary incontinence complaints.

Russian Family Doctor. 2021;25(2):29-37
pages 29-37 views

Medical Education

Family medicine and international cooperation in the North: A step ahead

Andreeva E.A., Rezvy G.G., Sørlie T.

Abstract

International cooperation contributed to the development of family medicine in the North of Russia, it was characterized by a system approach and interdisciplinary interaction. The article presents the results of Russian-Norwegian projects that were developed with the active participation of the Department of Family Medicine of NSMU (Arkhangelsk), as well as the main aspects of the projects: significance for practical health care, research, and educational components.

Several complementary projects aimed at the development of primary health care, such as “Reform of Arkhangelsk Region Health Care System with a special emphasis on primary care”, “System approach to NCD prevention” and “Suicide prevention in the Arkhangelsk region” were implemented together with the Norwegian Directorate of Health. “The POMOR Program – specialist training in general practice in Northern Russia” project (together with the University of Tromsø – The Arctic University of Norway, Norwegian Medical Association, and Norwegian Centre for Rural Medicine) facilitated the development of tutorship in family medicine in the Arkhangelsk and Murmansk regions. Better interaction between psychiatrists and general practitioners in the mental health sphere became an essential area of international collaboration (“Integrating mental health into primary care in the Arkhangelsk County, Russia: the Pomor model in psychiatry” project together with the University of Tromsø – The Arctic University of Norway and University Hospital of North Norway, Tromsø). The education component of the projects got a sequel in the continued medical education system of NSMU while the scientific one was continued in the form of publications in international and Russian journals, and master’s thesis defense of public health degrees. The project's results were consistently presented at the international and Russian forums. General practitioner’s education is a cross-cutting theme for the cooperation on the path from a beginner to an expert and plays a special role in support of GPs during the COVID-19 pandemic.

Russian Family Doctor. 2021;25(2):39-46
pages 39-46 views

Chronicle

Department of Family Medicine NWGMU named after I.I. Mechnikov. First 25 years

Kuznetsova O.Y.

Abstract

The article describes the history of the creation of the Department of Family Medicine of the NWSMU named after I.I. Mechnikov, notes the role of international projects in its establishment and development of the main areas of activity. Examples of successful long-term cooperation are given, in particular, with the University of Iowa (USA). The main stages of the formation of teaching the specialty “General Practice (Family Medicine)” within the framework of professional retraining of primary health care doctors and residency are described. The importance of using various interactive technologies in the learning process is emphasized, including the development of skills in simulation conditions, which were introduced at the department long before their use in the process of accreditation of specialists. The features of teaching the discipline “Polyclinic Therapy” for the 6th year students of the medical faculty, as well as the experience of leading scientific research that was carried out by participants of the student scientific society are noted. The main directions of scientific research carried out at the department in recent years are described, aimed at a comprehensive study of the features of the management of elderly patients in general medical practice and the prevalence of chronic obstructive pulmonary disease (COPD) in St. Petersburg and Arkhangelsk. The role of international cooperation in the implementation of large-scale scientific projects, in particular with the Catholic University of Leuven (Belgium), is emphasized. The perspectives for the development of the Department of Family Medicine in the near future are outlined.

Russian Family Doctor. 2021;25(2):47-53
pages 47-53 views

Congratulations to the Department of Family Medicine of NWSMU named after I.I. Mechnikov for 25 years anniversary. Letter to the editorial board

Toon P.D.

Abstract

The letter briefly describes cooperation of the St. Petersburg Medical Academy of Postgraduate Studies and Royal college of general practitioners (Great Britain) with active participation of the author, aimed at improving the training of general practitioners in Russia and the contribution of the Department of Family Medicine of St. Petersburg Medical Academy of Postgraduate Studies (now – North-Western State Medical University named after I.I. Mechnikov) in the implementation of joint international projects.

Russian Family Doctor. 2021;25(2):55-58
pages 55-58 views

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