The purpose of the study: to analyze the pharmacotherapy of patients with cardiovascularpathology in the Republic of Tatarstan, referred for medical and social examination. Materials and methods. The object of the study was primary medical documentation. The study included 194 patients with arterial hypertension, first examined at the Bureau of Medical and Social Examination of the Republic of Tatarstan in 2019 and recognized as disabled. Quantitative assessments were carried out on the basis of the developed quality indicators. The study used pharmacoepidemiological methods.

Профилактика психического здоровья населения является одной из важных задач современной системы здравоохранения Российской Федерации. ЦЕЛЬ ИССЛЕДОВАНИЯ Оценка распространенности тревожных и депрессивных расстройств на этапе первичной медико-санитарной помощи в рамках диспансеризации, оценка возрастных, социальных детерминант, влияющих на психическое здоровье. МАТЕРИАЛ И МЕТОДЫ Оценка психического здоровья проводилась с использованием русскоязычной версии опросника The Hospital Anxiety and Depression scale (HADS), который включает шкалы тревоги и депрессии. На первом этапе было проведено поперечное обсервационное исследование среди пользователей интернета. На втором этапе — поперечное обсервационное исследование с участием 600 пациентов, пришедших на очередную диспансеризацию на базе 6 центров Республики Татарстан. Полученные данные обрабатывали статистически с использованием параметрических и непараметрических критериев. РЕЗУЛЬТАТЫ По данным этапа интернет-исследования выявлено, что доля респондентов, имевших нормальные показатели по шкале тревожности и депрессии, составила среди женщин 56 и 87%, среди мужчин — 42 и 68%. На втором этапе исследования по шкале тревожности показатели нормы были зарегистрированы у 66% пациентов, тогда как 20% имели субклинические, а 13% — клинические признаки тревожных расстройств. По шкале депрессии показатели нормы отмечены у 58% пациентов, субклинические показатели — у 27%, а клинические — у 14%. Уровни тревожности и депрессии не были связаны с полом и образованием пациента, тогда как возраст и место проживания (городская, сельская местность) имели значимое влияние. Показано, что риск тревожных и депрессивных расстройств повышается с возрастом пациента. Сельское население по сравнению с городским имело меньший риск развития тревожности (в 2,6 раза) и депрессии (в 2,4 раза). ЗАКЛЮЧЕНИЕ Полученные факты обосновывают необходимость проведения скрининга депрессивных и тревожных расстройств на этапе первичной медико-санитарной помощи.

The purpose of this study is to conduct a medical and statistical analysis of disability indicators for the period 2009-2019 in the territory of the Republic of Tatarstan (RT) and to substantiate the main directions for improving rehabilitation measures.Material and methods. The object of the study was the medico-statistical indicators of «Main Bureau of Medical and Social Assessment in the Republic of Tatarstan (Tatarstan)» of the Ministry of Labor of Russia for 20092019. The study was conducted using a retrospective design. On the basis of the obtained indicators, the absolute and relative values of indicators per capita were calculated. Also, the calculation of the intensive and extensive indicators was carried out. Time series were constructed and trends were evaluated using Mann-Kendall test.Results and discussion. According to the results of the study, a reliable trend was revealed to increase the share of first-time disabled persons of the first group by 2.6 times in 2009-2019, which is consistent with similar indicators for the Russian Federation. Analysis of the structure of the causes of primary disability for 10 years showed that one of the main causes, along with cancer, was diseases of the cardiovascular system. It was revealed that during the study period, the indicator of the level of primary disability among citizens with circulatory system diseases (CSD) decreased by 2.5 times, but the share of disabled people of the first group in 2019, significantly increased compared to 2009 - by 3.7 times. It was found that the main causes of primary disability in the adult population with CSD in the Republic of Tatarstan were coronary heart disease and cerebrovascular diseases. On the basis of the obtained data, the necessity of improving the measures of state control over the implementation of rehabilitation programs, in particular medical rehabilitation, by expanding the functionality of the «Federal Register of Disabled People» is justified.Conclusion. Given that the most important element of secondary prevention in persons recognized as disabled is pharmacotherapy, improving the tools for its rationality and quality is one of the priorities for improving the system of rehabilitation of persons suffering from CSD.

The purpose of this study is to conduct a medical and statistical analysis of disability indicators for the period 2009-2019 in the territory of the Republic of Tatarstan (RT) and to substantiate the main directions for improving rehabilitation measures. Material and methods . The object of the study was the medico-statistical indicators of «Main Bureau of Medical and Social Assessment in the Republic of Tatarstan (Tatarstan)» of the Ministry of Labor of Russia for 20092019. The study was conducted using a retrospective design. On the basis of the obtained indicators, the absolute and relative values of indicators per capita were calculated. Also, the calculation of the intensive and extensive indicators was carried out. Time series were constructed and trends were evaluated using Mann-Kendall test. Results and discussion . According to the results of the study, a reliable trend was revealed to increase the share of first-time disabled persons of the first group by 2.6 times in 2009-2019, which is consistent with similar indicators for the Russian Federation. Analysis of the structure of the causes of primary disability for 10 years showed that one of the main causes, along with cancer, was diseases of the cardiovascular system. It was revealed that during the study period, the indicator of the level of primary disability among citizens with circulatory system diseases (CSD) decreased by 2.5 times, but the share of disabled people of the first group in 2019, significantly increased compared to 2009 - by 3.7 times. It was found that the main causes of primary disability in the adult population with CSD in the Republic of Tatarstan were coronary heart disease and cerebrovascular diseases. On the basis of the obtained data, the necessity of improving the measures of state control over the implementation of rehabilitation programs, in particular medical rehabilitation, by expanding the functionality of the «Federal Register of Disabled People» is justified. Conclusion. Given that the most important element of secondary prevention in persons recognized as disabled is pharmacotherapy, improving the tools for its rationality and quality is one of the priorities for improving the system of rehabilitation of persons suffering from CSD.

The article provides information about the organizational activities and role of S.V. Kurashov in establishing and developing of national medicine and health care in the USSR and his contribution to the organization of health resorts, medical industry, pharmacy. The data on the improvement of outpatient specialized medical care for the population, the dynamics of health care in the USSR in 19501965, and the implementation of national programs to eliminate especially dangerous infections in the country are detailed. The paper shows the role of S.V. Kurashov in the training of medical personnel, the construction of multi-specialty hospitals in rural areas, allowing to provide specialized outpatient and inpatient medical care, in the country's accession to the World Health Organization in Geneva, which increased the importance of the USSR health care in the international arena.

Aim. To assess the possibility of using indicators of potentially preventable hospitalizations of cardiovascular diseases to assess the quality of medical care. Methods. Indicators of quality of cardiovascular disease treatment were formed based on the analysis of literature, current clinical recommendations and the structure of potentially preventable hospitalizations in the districts and cities of the Republic of Tatarstan. The proposed indicators were studied in the districts of the Republic of Tatarstan in 20112015. Results. It is revealed that the distribution of indicator values in the regions of the Republic of Tatarstan differs from normal and is characterized by high variation. Median, minimum and maximum of hospitalization levels for hypertension in 2015 were 8.4, 1.3 and 26.8 respectively; unstable angina, myocardial infarction 2.2, 0.02 and 8.6. Indicators for hospitalization due to stable angina, chronic ischemic heart disease also had a high level of variation (6.3, 0.2 and 17.4). As criteria for quality and optimal use of resources, it is proposed to use nonparametric estimates, one of which is the upper quartile. According to this study, in 2015, upper quartile for hypertension was 11.2; for unstable stenocardia, myocardial infarction 3.4; for stable angina, chronic ischemic heart disease 8.6. Conclusion. The results of this study prove that indicators of potentially preventable hospitalizations may be part of a comprehensive assessment of the quality of care.

The aim of the study was to study the capabilities and perspectives of using big data analysis method to assess rationality and quality of pharrnacotherapy in patients with arterial hypertension. Materials and Methods. Analysis of data on supply of medicinal products (MP) to benefit-entitled categories of citizens (federal and regional) was carried out using the software written in Python 3.6 and OLAP-system. Pharmacoepidemiological methods were based on the defined daily dose (DDD) methodology. Results. Rational pharmacotherapy and high adherence to treatment of arterial hypertension were not recorded in all cases. It was revealed that in the investigated areas of the Republic of Tatarstan, the average of 86 days passed from the initial to the subsequent visit and 25% of patients had the next appointment in 90 days or more in 2013. In addition to MPs for the cardiovascular system pertaining to category C of ATC classification (anatomic therapeutic chemical classification of drugs (the international system)), in 10% of cases, drugs of other categories were administered (acetylsalicylic acid, Piracetam, Cerebrolysin, etc). Inhibitors of renin-angiotensin system were the most widely used MPs (196 DDD/person/year), while calcium channel antagonists came second in the volume of consumption (50.4 DDD/person/year). There were recorded significant differences in total consumption of antihypertensive MPs between areas (up to 3.5 times). Conclusion. Big data analysis method is a promising tool to assess rationality and quality of pharmacotherapy providing the possibility to evaluate qualitative and quantitative indicators of pharmacotherapy at the general population level.

GOALAcute myocardial infarction is one of the causal factors of society and economic losses of companionship. Success in the treatment of acute myocardial infarction raises questions on the effective rehabilitation of the first places. New methods, clinical guidelines and standards have been introduced into clinical practice. However, the effectiveness of rehabilitation in the Russian Federation lower than developed countries. The present study was aimed to improve rehabilitation care to patients after acute myocardial infarction. Analysis of the effectiveness of rehabilitation and pharmacoepidemiological studies was conducted on the basis of a medical spa facility in 2006 and 2009.MATERIAL AND METHODSExperts form and database were developed to achieve the objectives. Quantitative assessments were carried out on the basis of the developed quality indicators. We used pharmacoepidemiological and statistical methods in the study.RESULTSMyocardial infarction was often combined with hypertension (73.8% and 61.9%) and chronic heart failure (87.6% and 85.8%). Patients had a high prevalence of risk factors: smoking (46.1% and 42.3%), overweight (53.8% and 67.2%), dyslipidemia (44.6% and 66.1%) in 2006 and 2009, respectively. Rehabilitation includes physical exercise, mineral baths, swimming pool. The average number of drugs of rehabilitation stage was 4,46±0,12 and 4,11±0,11. Beta-blockers are indicated for all patients after acute myocardial infarction, and they were prescribed in 86.1% and 90.1% of cases. Drugs affecting renin-angiotensin system were in second place frequency of prescribing. These drugs are prescribed in 67.6% and 41.7% patients. The frequency of prescribing of statins increased by 5.8 times from 2006 to 2009 and reached 81.32%.CONCLUSIONRehabilitation and pharmacotherapy in patients after acute myocardial infarction corresponds to the principle evidence-based medicine. However, the list of use drugs was narrow, and the doses were lower than recommended by current clinical guidelines. These facts may indicate a deficiency of awareness of doctors around the characteristics of drug usage. Standards of health - resort treatment and rehabilitation of patients after myocardial infarction is limited and their revision is required based on existing clinical guidelines and evidence-based medicine.

Работа посвящена оценке нового отечественного препарата димефосфона (диметилоксобутилфосфонилдиметилата) для лечения женщин с климактерическим синдромом. Проведено рандомизированное клиническое исследование димефосфона в дозе 50 мг/кг при трехкратном ежедневном введении в течение шести месяцев у женщин в возрасте от 46 до 55 лет с продолжительностью менопаузы один год с умеренной степенью тяжести климактерического синдрома. Выявлено, что пациенты уже после начала приема димефосфона отмечали улучшение состояния здоровья. Было установлено, что шестимесячный курс терапии димефосфоном достоверно снижал показатели индекса Куппермана у женщин с климактерическим синдромом: нейровегетативные проявления на 69,3 %, психоэмоциональные и эндокринно-метаболические 68,1 и 61,7 % соответственно по сравнению с исходным этапом (до начала лечения). Модифицированный менопаузальный индекс был значимо снижен на 67,4 %. Димефосфон оказывал нормализующее действие на гормональные нарушения при климаксе. Было установлено, что трехмесячный курс терапии значимо повышал сниженный уровень эстрадиола на 108,5 % и к концу шестимесячного курса на 163,3 %. На этих сроках регистрации уровни фолликулостимулирующего и лютеинизирующего гормонов были достоверно снижены на 39; 28,8; 60,3 и 45,9 % соответственно. Препарат приводил к значимому снижению массы тела у пациенток, повышенной на всех сроках исследования. При шестимесячном приеме димефосфон не вызывал изменений биохимических параметров сыворотки крови: глюкозы, холестерина, билирубина, общего белка и активности аланин- и аспартатаминотрасферазы. Сравнительная оценка качества жизни женщин с климактерическим синдромом после шестимесячного курса терапии димефосфоном достоверно была повышена, и по ряду параметров SF-36 было даже выше, чем у женщин контрольной группы. Результаты проведенных исследований свидетельствуют о высокой терапевтической эффективности димефосфона и перспективности дальнейших исследований монотерапии димефосфоном женщин с тяжелыми проявлениями климактерического синдрома в постменопаузе и изучения терапевтической эффективности димефосфона в комбинации препаратами заместительной гормональной терапии.

BACKGROUND:Adequate and rational pharmacotherapy is an important element of rehabilitation of patients with myocardial infarction. Orders of the Ministry of Health of the Russian Federation, domestic and international guidelines, and scientific publications - all contain a complete algorithm for rational pharmacotherapy [1, 2]. These documents are based on the principles of evidence-based medicine (EBM) and help practicing physicians to carry out individualized and rational pharmacotherapy. However, clinical studies have shown low adherence of physicians to clinical guidelines. In the Russian Federation the death rate from cardiovascular diseases is higher than in developed countries. Thus, studies of the causes of high cardiovascular mortality are needed.OBJECTIVE:To assess adherence of practicing physicians to principles of evidence-based medicine in treating patients after myocardial infarction at the stage of rehabilitation.METHODS:A retrospective analysis of 157 cases of patients in rehabilitation after myocardial infarction for the years 2006 and 2009 was undertaken.We analyzed the list of drugs, prescribed to patients during the period of rehabilitation, drug combinations, regimens and pharmacoepidemiological parameters. We used the following rehabilitation criteria: blood pressure control, smoking cessation, and weight control. Recommendations of controlled physical activities have also been studied. Patient care was compared with the guideline recommendations. Statistical analysis was performed using the OLAP system.RESULTS:65 patients with myocardial infarction received rehabilitation therapy in 2006, and 92 - in 2009. It was found, that in 2006 physicians prescribed an average of 4.5 drugs per patient, and in 2009 - 4.6 drugs per patient. The average number of cardiovascular drugs (category C of ATC classification) per patient was 2.9 in 2006, and 2.6 - in 2009. Polypharmacy was found in half of the patients.In terms of evidence-based medicine, an important element in the rehabilitation of patients is smoking cessation and normalization of body weight. Nicotine replacement therapy and prescriptions of drugs for weight loss is one of the strategies to achieve goals. According to our study, drugs for smoking cessation and overweight were not prescribed at all. In terms of evidence-based medicine, the use of beta-blockers and ACE inhibitors for a long time by all patients is an important element of secondary prevention.The frequency of prescribing of beta-blockers was 86.1% and 91.1 %% in 2006 and 2009 respectively. The frequency of prescribing of subgroup C09 "Agents acting on the renin-angiotensin system (RAAS)" was 67.7% and 44.4% in 2006 and 2009 respectively. Beta-blockers had the highest frequency of use, while the subgroup RAAS drugs were second to them.We found that the following recommendations of clinical guidelines, based on the principles of evidence-based medicine, were not followed. We found low rates of ACE inhibitors prescribing. The structure of prescribed ACE inhibitors varied in 2006 and 2009. In 2006, 58.4% of all prescriptions were for enalapril. In 2009 enalapril use decreased to 30%, while prescribing of lisinopril increased from 0 in 2006 to 13.3%. Among angiotensin II antagonists (C09C) only losartan was used in 3.1% and 1.1% of cases in 2006 and 2009, respectively. Fixed drug combinations were not used at all.The proportion of patients who had hypertension was 73.9% and 61.9 %% in 2006 and 2009, respectively. The rate of Antihypertensive use (C02), namely Guanfacine and Moxonidine was less than 2% in both 2006 and 2009.In accordance with evidence-based principles the strategy for prevention of recurrent myocardial infarction with prescription of lipid-lowering drugs was used. Lipid-lowering drugs were prescribed to 13.8% of patients in 2006 and to 82.2% of patients in 2009. Doctors used atorvastatin and simvastatin only from the list of drugs of this group. We found that in clinical practice physicians used drugs, not supported by evidence, in particular trimetazidine was frequently used. Antiarrhythmic drugs were not prescribed at all, while part of the patients had arrhythmias. Standards of rehabilitation of patients with myocardial infarction do not contain a section on pharmacotherapy and could not be used for quality assessment.CONCLUSIONS:Pharmacotherapy of patients aimed at secondary prevention of myocardial infarction did not fully conform to the principles of evidence-based medicine. Standards for rehabilitation after myocardial infarction require revision based on existing clinical guidelines and evidence-based medicine.