Purpose. To study the use of digital technology for preventing cardiovascular diseases. Materials and methods. A survey was conducted among 477 respondents who used the digital technology–a pre-hospital preventive care tool for self-assessment of cardiovascular risks. Biological, behavioral, and organizational risk factors affecting health as well as active patient participation in own care were assessed. Results. The authors identified the individuals who had not visited a polyclinic for more than 12 months (17.4%) and more than 24 months (7.1%), thus not examined by healthcare professionals, including those who work at preventive health units (departments). Self-surveys at the pre-hospital stage revealed a high or very high absolute total cardiovascular risk in 31.1% of respondents. According to the survey, healthcare professionals provided preventive health recommendations to 59.7% of the sample, while using the digital technology, 100% of respondents received personalized lifestyle recommendations. A satisfactory level of participation was determined. The greatest interest in using the digital technology was observed among individuals aged 18-39 years (58.9%). Conclusion. The digital instrument Cardiovascular Prevention in Your Pocket (Kardioprofilaktika v karmane) enables the implementation of the 4P medicine at the pre-hospital level of care. The technology generates preventive health recommendations and identifies cardiovascular risk (predictive and preventive), creates tailored preventive health recommendations (personalized), and promotes the involvement of respondents in their own care without support of healthcare professional (participatory).

Aim: To assess the relationship between serum ceramides and the main cardiovascular (CVD) risk factors in coal mining industry workers. Material and methods: The single-center study included 209 Kuzbass mining industry workers aged 39.0 (34.0; 45.0) years. The median length of service in underground mining was 14.0 (10.0; 16.0) years. The traditional cardiovascular risk factors were evaluated and the ceramide content Cer (d18:1) with a fatty acid residue with a different length of the hydrocarbon chain was analyzed. Results: The results revealed high rates of smoking (73.2 %), arterial hypertension (AH) (63.3 %), alcohol consumption (54.1 %), dyslipidemia (64.6 %) and obesity (24.9 %) in coal industry workers. Hypercholesterolemia (60.3 %) and elevated levels of lowdensity lipoproteins (LDL-С) (34.5 %) were the most common variant of dyslipidemia. Moreover, we detected low levels of high-density lipoproteins (HDL-С) (23.9 %) and hypertriglyceridemia (23 %) in coal industry workers with the same frequency. Respondents over 40 years of age showed worse clinical profile compared to younger participants due to a higher number of cases with hypertension, higher systolic (SBP) and diastolic (DBP) blood pressure, plasma cholesterol (TC). In addition, older respondents presented with hyperglycemia 2 times more often and with hypercholesterolemia 1.4 times more often compared to younger respondents. Taking into account the age of participants, comparative analysis of ceramides did not reveal any statistically significant differences. The length of service in the industry was characterized by a higher age of the respondents, a higher frequency of hypertension, as well as higher values of DBP and concentration of TC. There were no differences in the frequency of dyslipidemia and its variants. The content of Cer (d18:1/21:0) increased with length of service, and the content of Cer(d18:1/24:0) had an inverse relationship and decreased with increasing length of service in underground mining. Thus, the levels of Cer(d18:1/12:0) and Cer(d18:1/22:0) were associated with a high risk of obesity, hypertension, dyslipidemia, hypercholesterolemia, low HDL, high LDL, and hypertriglyceridemia. The maximum number of ceramides studied was associated with the risk of developing high LDL levels. Conclusions. Findings showed high frequency of traditional CVD risk factors such as AH, smoking, alcohol consumption, dyslipidemia and obesity in coal industry workers. The concentration of the studied ceramides did not depend on the age of workers. Longer length of service in the coal industry was associated with an increase in plasma concentrations of ceramides such as Cer(d18:1/14:0), Cer(d18:1/18:0), Cer(d18:1/20:0), Cer d18:1/21:0, and a decrease in Cer(d18:1/24:0). Cer (d18:1/24:0) was not associated with any of the parameters characterizing lipid metabolism disorders. Cer(d18:1/12:0) and Cer(d18:1/22:0) levels were associated with a high risk of obesity, hypertension, dyslipidemia, hypercholesterolemia, low HDL-С, high LDL-С and hypertriglyceridemia.

Highlights The theoretical novelty of the work consists in using the regional target indicator of the mortality rate from diseases of the circulatory system as an indicator for assessing the effectiveness of management decisions at the level of municipalities in the constituent entity of the Russian Federation. To counteract the growing burden of cardiovascular diseases (CVD), the project solution “Long and active life” is being implemented in all constituent entities of the Russian Federation, indicating regional target indicators (RTI). A regional program is also in effect in the Kemerovo Region. In the absence of unified approaches to assessing the effectiveness of health care management technologies within the framework of the regional program, extrapolation of the RTI in municipalities seems promising for solving such a problem. Aim. To assess the characteristics of the population’s appeal to medical organizations and the prevalence of individual risk factors for CVD in connection with the effectiveness of health care management in the municipalities of the Kemerovo Region-Kuzbass for 2019–2023. Methods. Data from the Federal State Statistics Service for the period 2019–2023 were used. regarding mortality due to CVD, disease codes: I00–I99, and federal statistical observation forms No. 30 and No. 131/o. Statistical processing was performed using descriptive statistics methods. Results. The average effectiveness of the regional program in the municipalities was in the range from 111.8 to 176.4%. In four municipalities, it is observed that the number of visits due to diseases exceeds the regional values. In these municipalities, the following dominate in the structure of the studied factors: poor nutrition in a share from 32 to 40.3%; hypercholesterolemia – from 3.8 to 16%; smoking – from 5.3 and 8.9%. Low physical activity and alcohol consumption do not act as a leading risk factor in the region. Conclusion. A relationship was established between the effectiveness of health care management technologies and the number of requests for help. In particular, low efficiency is associated with a higher proportion of visits for treatment purposes compared to preventive and outpatient observation; a higher prevalence of controllable risk factors for CVD (poor nutrition, hypercholesterolemia, and tobacco smoking).

Highlights The article presents the results of the analysis of age and gender characteristics of patients, epidemiological and clinical features of the course of the new coronavirus infection, and appropriate patient care strategies in the Kemerovo region – Kuzbass in 2020–2022 according to the Federal Registry of COVID-19 patients. Annotation Aim . To analyze age and gender characteristics of patients, epidemiological and clinical features of the course of the new coronavirus infection (NCI, COVID-19), and the aspects of patient care strategies for this cohort of patients in the Kemerovo region – Kuzbass in 2020–2022 using the data from the Federal Registry of COVID-19 patients. Methods . The object of the study was the Federal Registry of COVID-19 patients (for the Kemerovo region – Kuzbass). The data was presented in the format of data as of January 10, 2023 and in dynamics – from June 14, 2020 to December 31, 2022. The subject of the retrospective study included: age and gender of patients, prevalence and morbidity associated with COVID-19, mortality from NCI, type of medical care/treatment and its absence (outpatient, inpatient, including treatment in the intensive care unit (ICU)), severity of NCI (mild, moderate, severe, extremely severe), etc. The unit of analysis was the adult population (18 years and older) permanently residing in the Kemerovo region – Kuzbass and included in the Federal Registry of COVID-19 patients with U07.1 and U07.2 ICD-10-CM codes. Results . The authors analyzed the data of 345,588 patients diagnosed with NCI. The median age was 53.2 (38.7; 66.0) years. The majority of participants were female (61%), the number of males was much lower (39%). The prevalence of the disease in 2020 was 2,593.1 cases per 100 thousand population of Kuzbass, in 2021 it was 6,764.5 cases, in 2022 it was 7,468.8 cases in the analyzed age group. The majority cases were people with mild (78.3%) and less often moderate severity (16.8%) of the disease. The authors noted that the cases with severe (2.9%) and extremely severe (2.0%) course were detected with the same frequency. The majority of patients were undergoing outpatient treatment (75.9%), a quarter of patients (23.7%) were undergoing inpatient treatment, 0.4% of patients refused treatment. The median duration of outpatient treatment was 11 (7.0; 15.0) days, inpatient treatment lasted 10.0 (7.0; 14.0) bed-days. The inpatients were 16.7 years older than the outpatients. In the ICU, 7,025 patients received treatment during the analyzed period, which accounted for 2% of all patients aged≥ 18 years and 8.6% of those who were hospitalized. 75.1% of patients treated in the ICU needed mechanical ventilation. During the analyzed period, 3.9% of the patients with NCI included in the analysis died. Mortality from NCI in 2020 amounted to 124.6 cases per 100 thousand population, in 2021 – 392.5 cases, in 2022 – 136 cases. The median age of the deceased persons was 72 (64.4; 81.8) years, the deceased women were 3.6 years older than men. Conclusion . The study made it possible to systematize data on gender and age characteristics of patients, epidemiological and clinical features of the course of NCI, as well as aspects of medical care for this cohort of patients in the Kemerovo region – Kuzbass in 2020-2022 according to the Federal Registry of COVID-19 patients. The results obtained can be used for rational allocation of healthcare resources.

The study focuses on the problem of increasing labour productivity in the health care sector. Its relevance is conditioned by the general trend of development and increasing the efficiency of all sectors of the economy and social sphere in the context of modern internal and external challenges. The paper considers the flow of patients, the speed of which is largely determined by the level of their satisfaction and loyalty to the medical organisation, as a resource for increasing the productivity of medical personnel. The aim of the study is to examine the factors affecting the indicators of public satisfaction with the process of medical care in primary health care in the Russian Federation (on the example of polyclinics) and to determine on this basis the possible directions for increasing the productivity of medical staff through increasing the flow of patients. The study used general scientific methods of theoretical analysis and synthesis, the unity of history and logic. The main hypothesis is that the dynamics of factors influencing the evaluation of the level of satisfaction with the process of medical care plays an important role in improving labor productivity and requires the adoption of organiza-tional decisions aimed at improving the quality of services provided. The study is based on the results of the sampling observation of the quality and availability of services in the spheres of education, health care and so-cial services, employment promotion, conducted by Rosstat in 2015–2023 and the socio-cultural approach, which assumes the orientation of medical organisations on patients as full participants in the treatment and di-agnostic process. On this basis, consumer satisfaction with the medical care received is considered as a signifi-cant predictor of improving the performance of a medical institution. The organisational solutions proposed by the authors of this study are based both on the results of subjective assessments of respondents and objective data of official statistics. The findings and semantic conclusions made may be in demand by management bod-ies at different levels of health care management.

The objective of this study is to assess the associative relationship between the main parameters of the infrastructure with arterial hypertension (AH) in a large industrial region (Kuzbass).Materials and methods. The study involved 1598 people (from 35 to 70 years old) living in Kemerovo region. Blood pressure was measured according to the recommendations of the Russian Society of Cardiology / the Russian Medical Society on Arterial Hypertension (2010). The assessment of the territory of the residence zone was carried out according to the subjective opinion of the respondents about the parameters of the infrastructure (questionnaire Neighborhood Environmental Walkability Scale). The format of this structure was highlighted, which was considered unfavourable according to the respondent's answer to the questionnaire.Results. In the course of this study, negative associations with a high risk of developing hypertension were identified for the following infrastructure parameters: inaccessibility of public transport (OR=1,84), remoteness of the workplace (OR=1,60), the lack of sidewalks on the streets (OR=1,66), the remoteness of the pharmacy (OR=1,64), the lack of pedestrian crossings that ensure safety when crossing streets (OR=1,48) and the absence of shadows falling on the sidewalk from the trees (OR=1,31).Conclusion. This study demonstrated the importance of studying the parameters of infrastructure and planning urban space in order to provide a healthoriented space for the population of a particular constituent entity of the Russian Federation.

The aim of the study is to identify social and economic factors associated with the development of coronary and cerebral ischemic events in urban residents based on the results of a three-year follow-up. Material and methods. The prospective non-interventional observational study included 431 patients. Data on the coronary and cerebral ischemic events in history, and social, economic and demographic data were collected at the baseline. Follow-up appointments were scheduled 3 years later to assess new cases of coronary and cerebral ischemic events. Taking into account the presence or absence of the adverse events in history at the baseline and follow-up visit, four groups of patients were formed. There were 350 (81.2 %) people without a coronary history (group 1), and 81 (18.8 %) with it (group 2). Respondents without a coronary history were divided into a subgroup with the absence of new ischemic (coronary and cerebral) events at the repeat stage, numbering 246 (57.1 %) people (1a), as well as a subgroup with their development – 104 (24.1 %) (1b). Similarly, respondents with a coronary history were divided into a subgroup with the absence of adverse events at the second stage, which included 35 (8.1 %) people (2a), as well as a subgroup with their occurrence – 46 (10.7 %) (2b). Results. At the baseline, only 18.8 % out of 431 patients had coronary events in history. At the follow-up visit, 150 (34.8 %) patients presented with new coronary or cerebral ischemic events: 10.7 % of those cases were fatal, 1.9 % – new cases of myocardial infarction, 3.5 % – cases of stroke, 13.5 % – new cases of angina pectoris, and 5.3 % – other diseases associated with coronary artery disease. One third out of 350 patients without coronary events in history and half of patients with coronary events in history presented with newly developed adverse events. Young respondents (35–49 years old) with no coronary history were 3 times more likely to have coronary and cerebral ischemic events over 3 years than people of the same age, but with previous diseases of the cardiovascular system. During the 3-year followup period, the risk of coronary and cerebral ischemic events in patients with coronary events in history was associated unemployment odds ratio (OR) 2.74 (95 % confidence interval (CI) 1.33; 5.66, p = 0.006), widowhood OR 2.98 (95 % CI 1.32; 6.74, p = 0.008), living in a rural area OR 2.30 (95 % CI 1.16; 4.55, p = 0.017) and female gender OR 2.63 (95 % CI 1.28; 5.43, p = 0.008). Conclusions. The risk of coronary and cerebral ischemic events during the 3-year follow-up period in the population of urban residents is associated with social and economic determinants such as female gender, unemployment, living in a rural area, and widowhood in the presence of a coronary history. 35–49-year-old men without a coronary history should also be considered as a group of special attention for the prevention of adverse events.

Significance. Studying prevalence of behavioral risk factors, especially at the population level, is extremely relevant for public health and disease prevention. However, it is clear that prevention programs require different approaches for different age groups. The purpose of the study is to analyze age-specifics of behavioral risk factors in the population of Kuzbass. Material and methods. The study sample was formed based on the results of two epidemiological studies conducted in the Kemerovo region. Primary monitoring was carried out in 2015-2017 among 1270 men and women aged 35-70 (random sample). The sample of young people was formed based on the study of individual and contextual conditions for developing behavioral risk factors among students at the Institute of Food Science and Technologies of the Kemerovo State University. The study was conducted in 2022 among 626 students; a non-random sampling method was used to form the sample. Data on smoking, alcohol consumption and physical activity were collected through interviews. The level of physical activity in the adult sample was assessed using the International Physical Activity Questionnaire (IPAQ), and in the sample of people aged 18-29 - using the Global Physical Activity Questionnaire (GPAQ). Statistical calculations were performed in SPSS version 22 (IBM Corp. USA). The critical level of statistical significance was taken to be 0.05. Results. The proportion of young people who smoked equaled to 35.1% and was 2.4 time higher than the proportion of smokers aged 60 and older, and 1.4 time higher than those aged 40-59 (p <0.001). Respondents aged 40-59 most often gave up smoking (23.2%, p<0.001). People in the middle and older age groups smoked exclusively traditional cigarettes (99.1% and 100.0%, respectively); while among young people, this figure was only 37.8%. The majority of young people preferred to use electronic cigarettes (68.4%), while people aged 40-59 only mentioned them as an option in 6.5% of cases. Persons aged 18-29 were 1.2 times more likely to consume alcohol on a regular basis than respondents aged 40-59 and 2.1 times more likely than people aged 60 and older. Episodic alcohol consumption, as well as complete abstinence was typical of persons aged 60 and older. In the age group of 18-29 years, 75.9% of those surveyed drank beer; in the group of 40-59 years, this figure decreased 1.2 times, while in the group of 60+ it decreased 1.9 times (p<0.001). Wine consumption had a similar trend: with age there was a decrease of 1.4 times and 1.6 times, respectively. The average MET/week was higher in the age group of 40-59 years and exceeded that in people aged 60 and older 1.4 times, and in people 18-29 years - 1.7 times (p<0.001). The share of working physical activity is also higher in people of the middle and older age groups. Transport and recreational physical activity is more typical of respondents aged 18-29. Conclusion. Behavioral risk factors (tobacco and alcohol consumption, physical activity patterns) have a number of age and gender characteristics that should be taken into account to ensure successful disease prevention. Scope of application. Preventive medicine.

Background. Overweight and obesity significantly increase the risk of premature death and the development of chronic diseases. Many anthropometric indices have been developed to verify obesity, although the best among them still remains undetermined.The aim. To determine the sex and age specificities of the dynamics of anthropometric indicators characterizing obesity.Materials and methods. The program was implemented in the period from 2015 to 2020. It provided for the implementation of a sample research. The baseline research included 1,124 women and 476 men. The average age was 54.9 ± 9.75 years and 52.6 ± 10.0 years, respectively. To identify gender specificities, all participants were divided into three age groups: 35–49 years old, 50–59 years old, and 60–70 years old. The observation period was 3 years. To determine the level of visceral fat, the VS-532 fat mass analyzer (Tanita Health Equipment HK Ltd., Hong Kong) was used. Body mass index (BMI), waist-hip index (WV/HV), visceral obesity index (VOI) were also calculated. Statistical processing of the results was carried out using the program Statistica 6.0 (StatSoft Inc., USA).Results. New cases of obesity developed in 30.6 % of the surveyed. There was an increase in the prevalence of obesity according to the criteria of WV (by 8.9 %) and VFL (by 5.4 %) and a decrease in the number of people who are obese according to WV/HV – by 4.2 %. Of all the indicators, only VOI showed a statistically significant decrease in the mean values over the observed period, while BMI, WV and VFL showed an increase.Conclusions. It is necessary to apply various criteria for the diagnosis of obesity, since individual indices are not able to fully reflect the gender and age specificities of the distribution of fat in the body

Dietary habits affect the risk of all-cause mortality (ACM) in the adult population according to prospective studies.Aim. To assess the effect of dietary habits on the ACM risk in the Rus­sian population.Material and methods. The prospective cohort included represen­ta­tive samples of 10 Russian regions (n=17175, 6767 men and 10408 wo­men aged 25-64 years), examined in 2012-2014 as part of the ESSE-RF study. Dietary habits were studied based on the consumption rate of the main food groups. The vital status of the cohort was updated every 2 years. The follow-up period was 6 years. Kaplan-Meier curves were used to analyze overall survival (OS). Cox proportional hazards model was used to assess the ACM risk.Results. In the Russian population, an increase in OS is associated with daily consumption of vegetables/fruits, dairy products (milk, kefir, yogurt, cottage cheese, and cheese), and the presence of the Heal­thy Eating Model (HEM) in the diet. A decrease in OS is associated with excess salt intake (ESI) in the diet, the habit of adding salt to pre­pared foods, and daily consumption of pickles (p<0,05). Among men, an increase in OS is observed with daily consumption of fruits/ve­ge­tables, cheese, and HEM, while a decrease is observed with daily consumption of pickles, general ESI, and the habit of adding salt to foods (p<0,05). In women, daily consumption of red meat, liquid dairy products, cheese, and sweets is associated with an increase in OS (p<0,05). The risk of ACM in the general population and among men increases with ESI — relative risk (RR)=1,31 [1,06-1,61] (p=0,012) and 1,41 [1,06-1,87] (p=0,017), respectively, adding salt to food — RR=1,34 [1,09-1,65] (p=0,006) and 1,5 [1,13-1,98] (p=0,005) and daily consumption of pickles — RR=1,48 [1,02-2,14] (p=0,039) and 1,5 [1,01-2,54] (p=0,045). In women, regular consumption of red meat — RR=0,7 [0,49-0,99] (p=0,043), liquid dairy products — RR=0,68 [0,5-0,93] (p=0,015) and cheese — RR=0,64 [0,46-0,9] (p=0,011) were associated with an ACM decrease.Conclusion. An ACM risk increase in the general population and among men is associated with excess salt intake, and a decrease in ACM risk in women is associated with the regular inclusion of red meat and dairy products in the diet.

BACKGROUND: Among 13 thousand doctors interviewed in 2021, 42% displayed signs of professional burnout. This phenomenon negatively affects the frequency of repeated hospitalizations, the number of adverse events, and increased employee turnover. However, studies concerning burnout in doctors are rare and do not focus on specialists who provide medical care for patients with circulatory system diseases (CSD). AIM: was to assess the level of burnout in medical workers involved in the provision of medical care for patients with CSD and to explore staff perceptions of its prevention. MATERIALS AND METHODS: A sociological survey (based on the standardized Maslach Burnout Inventory questionnaire) was conducted among medical personnel (women represented the majority of the sample — 76%, men — 24%). The sample is represented by doctors (n=89), nursing staff and auxillary nurses (NSAN) (n=128). The mean age for the whole group of respondents was 40.7±0.7, professional experience lasted 12.0±0.6 years. Standard methods of descriptive statistics were used for the data analysis. The age characteristics of the group had no significant differences by professional categories. Doctors had 39.0±1.2 years (min — 24, max — 63), NSAN had 41.0±0.6 years (min — 19, max — 67). Professional experience lasted differed doctors 39.0±1.2 years, in NSAN — 12.3±0.8. Men were characterized by a mean age of 36.7±1.6 years and professional experience lasted 10.0±1.2 years and women 42.0±0.7 years and 12.6±0.7 years, respectively. The character of distribution of quantitative data in the presented study was analyzed using the Kolmogorov–Smirnov and Shapiro–Wilk criterion. RESULTS: 80.2% of respondents presented with a high level of reduced professional accomplishments (RPA), 53.4% — a moderate average level of depersonalization. The emotional exhaustion was similar in all respondents, although average level of emotional exhaustion was the most prevalent (39.6%). 43.8% of doctors had an average level of emotional exhaustion, which is higher compared with NSAN — 37.5%. Clinical and paraclinical units are associated with a medium level of emotional exhaustion and a high RPA. At the same time, paraclinical units are characterized by a medium level of depersonalization, in contrast to clinical units, which are found to have a high level of this factor. According to the respondents, possible measures to prevent emotional burnout should include a set of measures including, rational distribution of responsibilities within departments, workload among the staff, as well as the formation of special skills to overcome stressful situations and optimization of activities with the help of digital solutions (support system for medical decisions, etc.). CONCLUSION: Working as medical staff and providing medical care for patients with CSD is strongly associated with a high level of reduced professional accomplishments (80.2% of respondents). Proper measures for the prevention of emotional burnout should primarily include organizational solutions focused on optimizing internal processes in medical staff’ work. According to the respondents, among the measures aimed at the prevention of emotional burnout, the most demanded may be: rational distribution of responsibilities within departments, workload among staff, as well as the formation of special skills to overcome stressful situations and optimization of activities with the help of digital solutions (medical decision support system, etc.).

Introduction. Dyslipidemia is one of the most common risk factors for cardiovascular disease (RFCVD). In coal industry workers, working conditions are considered as an additional risk factor to the well-known RFCVD. The study aims to analyze the prevalence of RFCVD in coal industry workers in comparison with the general population of the Kemerovo region. Materials and methods. The study included 2,356 male respondents, 1,656 (70.3%) coal industry workers (the main group) and 700 (29.7%) people from the population sample of participants in the multicenter epidemiological study of ESSE-RF included in the territory of Kuzbass (control group). The traditional FSSR was evaluated, including the parameters of lipid metabolism (total cholesterol (TCH), triglycerides (TC), low-density lipoproteins (LDL) and high-density lipoproteins (HDL)). Results. A comparative analysis of the FSSRP of coal industry workers and the control group showed their high prevalence in the control group: the prevalence of diabetes mellitus by 12.3 times, previous stroke by 4.8 times, myocardial infarction by 4 times, arterial hypertension by 3.8 times, obesity by 1.8 times, dyslipidemia by 1.2 times. The average values of systolic (SBP) and diastolic (DBP) blood pressure and plasma glucose levels were within the normal range in both groups, but statistically significantly higher in the control group. There were 1.3 times more smokers among coal industry workers (60.4% compared to the control group). 45.7%, p<0.001). The median of TCH and its fractions, TC were within the limits of the normative values for workers in the coal industry, whereas in the control group the LDL level was statistically significantly higher. The incidence of hypertriglyceridemia (34.2% vs. 22.4%) and low HDL (15.8% vs. 2.0%) was statistically significantly higher in miners. The researchers observed hypercholesterolemia and high LDL levels in more than half of the patients (50.6% and 65.3%, respectively) of the control group. A correlation analysis of work experience in the coal industry and the FSSR demonstrated an association with age (r=0.83, p≤0.001), body mass index (BMI) (r=0.37, p≤0.001), SBP level (r=0.33, p≤0.001) and DBP (r=0.36, p≤0.001), concentration of TCH (r=0.65, p≤0.001), LDL (r=0.51, p≤0.001) and TC (r=0.84, p≤0.001). The authors found that coal miners had an 11.5-fold increased risk of HDL reduction, 2.3-fold increased hypertriglyceridemia, and 2-fold increased risk of smoking compared to the population of the region. The proportion of people with hypertriglyceridemia and low HDL prevailed in all age groups of coal industry workers. Taking into account the work experience of more trained individuals, the risk of hypercholesterolemia and high LDL levels increases by 2 times, the risk of hypertriglyceridemia and low HDL levels is slightly lower. Limitation. The design of the study did not allow to determine the causal relationship between the profession and the RFCVD. The analysis of the nature of nutrition, intake/abuse of alcoholic beverages was not carried out and metabolic syndrome was not diagnosed as possible causes of dyslipidemia. Inclusion in the main and control groups was carried out for different periods of time. Conclusion. Smoking and dyslipidemia are among the most common RFCVD among workers in the Kuzbass coal industry. The largest proportion is hypercholesterolemia, one third has hypertriglyceridemia and elevated LDL, half as often as low HDL. The duration of work in underground conditions is associated with age, BMI, SBP, DBP, concentrations of TCH, LDL, TC. The proportion of people with hypertriglyceridemia and low HDL prevails in all age groups of coal miners. In more trained workers, the risk of hypercholesterolemia and high LDL increases by 2 times, the risk of hypertriglyceridemia and low HDL is slightly lower. Ethics. The study was performed in accordance with the standards of good clinical practice and the principles of the Helsinki Declaration. Prior to inclusion, all respondents signed an informed consent form.

Highlights Scientific novelty and practical significance of the presented work is seen in the relationship between the development of medical equipment management system and quality management in health care institutions and medical science. The application of the principles of international ISO 9001:2015 to the system of medical equipment management, which has its own special features in this industry makes the author’s approach unique. The role of the process approach in ensuring the sustainable functioning of medical equipment is shown in the study. The performance of the medical equipment management system based on the principles of international standard ISO 9001:2015 has been analyzed. The positive dynamics in terms of achieving the target performance indicators of this process in 2013–2021 is revealed. Aim . To analyze the experience of applying the process approach in the management of medical equipment based on the principles of the international standard ISO 9001:2015. Methods. The basis of the study was “Research Institute for Complex Issues of Cardiovascular Diseases” (NII KPSSZ). The object of the study is the quality management system of the Research Institute for Complex Issues of Cardiovascular Diseases. The subject of the study is the process of equipment and measuring instruments management. The main methods of this study were: system analysis, unity of historical and logical. The period of the study was 2013–2021. Results. The process approach in medical device management is considered within the framework of the quality management system of NII KPSSZ. During the study period there was an increase in equipment units by 2.58 times (from 976 to 2520 units, respectively, 2013–2021), which led to an increase in scheduled maintenance (SM) by 4.25 times (due to the introduction of pre-checking maintenance). The relative number of repairs to the total amount of equipment in different years amounted to 33.4–54.3% or on average 40.3%, the increase in current repairs of medical equipment relative to 2013 in 2021 amounted to 2.68 times. There is a positive dynamic in terms of decrease in the number of comments and increase in the number of proposals to improve the process during 2013–2021. Conclusion. The analysis of performance indicators in the period under the study indicates the determining role of the quality management system in ensuring the sustainability and stability of the medical equipment management system. The implementation of research tasks allowed the authors to form a holistic vision of the role of the process approach in solving the problem of finding effective organizational solutions that ensure the quality and safety of medical care. The presented experience can be replicated for any medical organization.

Research data indicate an increase in the risk of cardiovascular events (CVEs) with unhealthy diet.Aim. To assess the impact of diet on the development of cardiovascular events in the Russian population.Material and methods. The prospective cohort included representative samples of 10 Russian regions (n=17175, 6767 men and 10408 women aged 25-64 years), examined in 2012-2014 as part of the ESSE-RF study. The diet was studied by the frequency of consumption of the main food groups. The vital status of the cohort was clarified every 2 years. The follow-up period was 6 years. Kaplan-Meier survival curves were used to analyze survival, and the Cox proportional hazards model was used to assess the risk of CVEs.Results. Analysis of Kaplan-Meier curves showed better survival before the CVEs in the general population with daily consumption of cottage cheese (p=0,0029), cheese (p=0,00017), red meat (p=0,036) and the presence of the healthy eating model in the diet (p=0,013). A decrease in survival before the CVE onset was noted with excess salt intake (ESI) in the diet (p=0,0038) and the habit of adding salt to food (p=0,0032).Among men, a decrease in survival before the CVE onset was noted with ESI (p=0,018) and the habit of adding salt to food (p=0,047), and an increase — with regular consumption of red meat (p=0,00027). Among women, daily consumption of red meat (p=0,038), cheese (p=0,026), cottage cheese (p=0,019), as well as rare consumption of fatty dairy products (sour cream/cream) (p=0,04) delay the CVE onset. In the general population, in a univariate Cox proportional hazards analysis, daily cheese consumption and healthy eating model significantly reduce the risk of CVEs — 0,74 (0,61-0,89) and 0,78 (0,65-0,94), respectively, and excess salt and adding salt to food increase the CVE risk — 1,33 (1,12-1,59) and 1,33 (1,111,58), respectively. However, after introducing correction for socio-demographic indicators and risk factors, the significance is lost. In men, adding salt to food significantly increases the risk of cardiovascular events as follows: odds ratio 1,34 (1,04-1,73). Other eating habits are significant only in univariate analysis and lose their significance after introducing corrections.Conclusion. Adding salt to food significantly increases the risk of cardiovascular events among men of active working age.

Construction of prognostic models is a promising direction for preventive medicine. The search for new factors affecting cardiovascular health is an important addition to conventional risk scores. The aim of the study was to search for significant cardiovascular risk factors and develop a prognostic model using machine learning in healthy individuals. The analysis was based on an dataset of anamnestic, clinical, paraclinical, socio-economic and other parameters of two stages of the epidemiological study (Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo), which included 1 217 participants aged 35–70 years. There were 70.9 % (n = 863) and 29.1 % (n = 35) healthy respondents and cardiovascular patients, respectively. A total of 1, 915 features were analyzed using artificial intelligence. We identified 28 significant predictors of the following unfavorable cardiovascular outcomes: angina, myocardial infarction, heart failure, stroke, arrhythmias (atrial fibrillation and/or flutter), etc. Based on these, a prognostic model was developed. It should be noted that the most significant parameters included the forced expiratory volume in one second, internal fat proportion, no alcohol consumption, a change in salt intake after a doctor's recommendation, and no job. The paper determined the significant features that had not previously been recognized as cardiovascular risk factors affecting cardiovascular health. This undoubtedly provides an information gain for conventional prognostic models.

Significance. Development of integrated quality management systems is a key direction in the development of management activity, ensuring achievement of the organization goals. For the first time ever, analysis of the experience of a federal medical research institution and a state clinical cardiology dispensary in the integration of quality management systems using project management approach has been undertaken. The results show practicability of the integration approach and synergy effect in achieving common goals. The limitations of the project approach can be eliminated along with accumulation of experts' experience and monitoring over effectiveness of activities. The purpose of the study was to present the experience of integrating quality management systems of two institutions providing medical care to patients with cardiovascular diseases. Material and methods. The base of the present study was the Research Institute for Complex Issues of Cardiovascular Diseases and Kuzbass Clinical Cardiology Dispensary named after Academician L.S. Barbarash. The objects of the study were the quality management systems of the two institutions. In order to achieve the intended goal, the project and system approaches were applied. Results. Cooperation between the two institutions made it possible to attain the target indicator of the regional program “Control over Cardiovascular Diseases” in terms of the number of coronary artery X-ray endovascular interventions (5,335 interventions in 2022 against the planed 5,721). An organizational and functional model has been developed to provide care to the most difficult category of patients requiring heart transplantation. Joint comprehensive audits have been organized in accordance with the requirements of international standards for quality management systems and internal quality and safety control of medical activities. The corporate culture of the institutions develops on the basis of common professional, social and cultural values through joint events (e.g. “Gifts of Nature” contest, courage insights, New Year, sports days, etc.). A unified procedure for personnel actions in various conditions of both peacetime and high readiness has been determined. Conclusion. The project made it possible for the first time ever to receive evidence of practicability of the integration approach to improve performance of several institutions complying with the requirements of the international standard series 9001:2015 “Quality Management Systems”. Administration of the two quality management systems provides a synergy effect in achieving common goals. They become interrelated elements of the system of medical care for circulatory diseases. Scope of application. The obtained results can be used by medical organizations, organizationally and functionally united by common goals and objectives.

In modern medicine, studies devoted to the assessment of the parameters of residential infrastructure and the population’s attitude towards them have become quite large-scale. Objectives: The aim of the study was to establish associations between individually perceived parameters of residential infrastructure and the main modifiable cardiovascular risk factors (hypertension, obesity, lipid and carbohydrate metabolism disorders) in one of the subjects of the Russian Federation. Methods: The epidemiological study “Study of the influence of social factors on chronic non-communicable diseases” started in 2015 and ended in 2023. The sample was formed by using the stratification method based on the assignment to a medical organization. The study included 1598 respondents aged 35 to 70 years (491 rural residents). The study of infrastructure parameters was conducted based on the subjective opinions of respondents using the neighborhood environment walkability scale (NEWS) questionnaire, divided into eight scales. Logistic regression analysis was used to identify associations between infrastructure parameters and cardiovascular risk factors; the odds ratio (OR) and 95% confidence interval were evaluated. Results: Individually perceived infrastructure parameters of the scale B, reflecting the accessibility of infrastructure facilities, were associated with hypertension [OR = 1.33], obesity [OR = 1.40], and abdominal obesity [OR = 1.59]. Elements of the social infrastructure of the scale C, describing the streets in the residential area, increased the likelihood of developing obesity [OR = 1.42] and visceral obesity [OR = 1.43]. The characteristics of the residential area, represented by the scale D that evaluates pedestrian infrastructure, were associated with all major cardiovascular risk factors (hypertension [OR = 1.65], obesity [OR = 1.62] and abdominal obesity [OR = 1.82], and disorders of lipid [OR = 1.41] and carbohydrate metabolism [OR = 1.44]). Conclusion: Social factors represented by various aspects of infrastructure have become important criteria for determining cardiovascular health. Environmental conditions affect cardiovascular risk factors through behavioral patterns that shape the respondent’s lifestyle. Interventions in urban planning—increasing accessibility to infrastructure facilities for the population, developing a pedestrian-friendly urban environment, improving physical activity resources in areas, planning recreation areas, and landscaping—can become the most important concept for the prevention of cardiovascular diseases.

HighlightsThe article presents proposals for improving primary health care for the coal industry workers by creating specialist outpatient clinics, integrating medical organizations at all levels, and incorporating an interdepartmental approach for various ministries and departments to preserve the health of the able-bodied population. Aim. To develop a promising model for organizing health services for coal industry employees in the Kuzbass (using the Kemerovo region – Kuzbass data).Methods. The object of the study is the organization of primary health care (PHC) for coal industry employees. The subject of the study are the coal industry employees. The analytical method and content analysis of domestic and foreign literature and regulatory documents regarding the organization of primary health care for employees (federal laws of the Russian Federation, regulatory documents of the Ministry of Healthcare, Ministry of Labor and Social Protection of the Russian Federation and Kemerovo region-Kuzbass) were used in this review.Results. The new model of the organization of PHC for coal industry employees has three levels of interdepartmental interaction. The first level involves new specialized outpatient clinics for the working population that should be created within territorial polyclinics as the main link in the provision of primary health care with the support from enterprises and the occupational pathology service providers of the region. The second level involves the identification of cardiovascular risk factors, diagnosis of cardiovascular diseases, and developing personal preventive measures for patients. The third level of the model is managerial, it aims to develop preventive programs to negate occupational-related adverse factors and implement them at personal, workplace and interdepartmental levels.Conclusion. The interdepartmental approach involving all participants of the process will be able to achieve the target parameters by improving the PHC model for the working population. The developed model will shorten the wait times, simplify document management, ensuring continuity, monitoring of cardiovascular risk factors, outpatient management of patients with premorbid disorders, and interdepartmental responsibility for outcomes.

Aim. To evaluate the contribution of arterial hypertension (AH), high lowdensity lipoprotein cholesterol (LDL-C) level and their combination to the development of (myocardial infarction) MI and stroke.Material and methods. The analysis is based on data from 1 and 2 observations of ESSE-RF study (Epidemiology of cardiovascular diseases in various regions of the Russian Federation)". A multi-s tage cluster random sample was used, formed according to the territorial principle on the basis of medical and preventive institutions (health facilities). Socio-demographic data (gender, age, education, wealth), smoking status and medical history were determined. Blood pressure (BP) was measured twice, on the right arm, in a sitting position with an automatic blood pressure monitor. Blood samples and its derivatives (serum and plasma) were stored at a temperature of -70ºC. LDL-C value was also included into analysis (LDl- C ≥3 mmol/l). Prospective monitoring of new cases was carried out in the initial sample without patients with coronary artery disease, MI, and stroke. The median follow-up time is 7.5 years. The sample size was 19 794. 356 non-fatal cases were identified, including 222 cases of MI and 174 cases of stroke.Results. The average age was 44.7 years, in men — 43.2, and in women — 45.3. The prevalence of isolated forms of hypertension, high LDL-C level and its combination were 12.7%, 30.3% and 32%, respectively. It was revealed that the age was the lowest in healthy and those with an increased LDL-C, whereas those with hypertension and combined conditions were older. The risk of nonfatal cases of MI and stroke in the Cox models, was adjusted for gender, age and region. There was a significantly higher risk of new cases of nonfatal CVD in individuals with isolated hypertension compared with those with isolated LDL-C.Conclusion. The frequency of isolated AH and isolated LDL-C were 13% and 30%, respectively. The combined condition was detected in 30%. The presence of AH, isolated LDL-C and their combinations in the sample doubled the risk of new CVD events.