To date, there are no specific scales in the Russian Federation for the comprehensive assessment of patient satisfaction and experience of outpatient medical care.Objective. To validate the previously translated Norwegian "Patient Experience Questionnaire" (PEQ), a validated patientreported experience measure (PREM) for outpatients.Materials and methods. Patients aged over 18 years were invited to complete the questionnaire within 24 h after visiting a physician by clicking on a link in the QR [quick response] code printed on the medical report. The construct, discriminant validity, and reliability of individual questions, domains, and the entire questionnaire were analyzed.Results. A total of 452 patients (47.3% male, median age 55 [38–68] years) completed the questionnaire. Less than 18% of the responses were missing. These responses were considered "missing at random". Most patients in this cohort had higher education (67.7%), were married (58%), and were seen by a female physician (91.4%). In confirmatory factor analysis, the factor loadings of the questions were all above 0.6 units, and the reliability of each question, individual scales, and the entire questionnaire was above 0.8 units. The overall questionnaire model met all the goodness-of-fit criteria.Conclusions. The construct and discriminant validity of the previously translated into Russian language Patient Experience Questionnaire, has been confirmed. This PREM is proposed to be used in routine clinical practice and scientific studies under the name "RuPEQ".

The article presents a review of studies on the psychological reactions of children to a situation of surgical treatment. Surgical treatment is considered as a situation with a high potential for stress, which is due to the variety and high intensity of stress effects which are experienced by the child as new and uncontrolled. Negative psychological responses are observed in children both at the preoperative and postoperative stages. At the preoperative stage, preoperative anxiety is highly prevalent. The risk of its development depends on a complex of factors related to the child themself, his/her environment, as well as the disease, hospital environment, the treatment and the circumstances of hospitalization. Preoperative anxiety is a risk factor for more severe pain symptoms, emotional and behavioral changes in the postoperative period. The article discusses the modern methods for the prevention and correction of preoperative anxiety and postoperative emotional and behavioral changes in children: the presence of parents during the induction of anesthesia, providing information using modern technologies and principles of social learning, distraction and other cognitive and behavioral methods for the correction of the mental state, multimodal methods for harmonizing the emotional state and behavior of children (art therapy, play therapy, clown therapy). The authors come to the conclusion that further research is needed in order to develop algorithms for the psychological support of children in a situation of surgical treatment, taking into account their age, clinical characteristics, the psychological features of the child and his/her parents.

The article analyses current understanding of clinical psychology as a field of professional activity of psychologists in medicine and public health. It reveals the main traditional and new areas of activity of a medical psychologist in clinical and preventive medicine. Main directions and forms of clinical psychologist’ work in healthcare system is reviewed. The role of clinical psychologist as part of a multidisciplinary team is outlined and the main models of multidisciplinary teams in the field of medical rehabilitation are analyzed. We identified the main problems and the goals in this area, which solution is necessary to create an effective system for the provision of medical, psychological and social assistance to the population. The article shows that clinical psychology plays a key role within the multidisciplinary approach to assistance of patients and their relatives in specialized psychiatric or addiction treatment, psychotherapy, as well as in general medical practice. One of the main tasks of clinical psychology is considered humanization and personalization of the entire process of medical care, protection from inconvenient impact of technization of medicine on patient and doctor, narrow specialization of health services. Some of the organizational and legal barriers hindering full integration of medical psychologist into the healthcare system and effective realization of the goals of medical and psychological activities were highlighted. The prospects for the development of clinical psychology in healthcare in the theoretical, methodological, substantive and organizational-legal aspects are determined. It is emphasized that in order to realize the potential of clinical psychology, constant improvement of theory and methodology, the development of effective medical and psychological technologies for diagnosis, correction, and rehabilitation are necessary. And at the same time, it is important to create organizational and legal conditions for the full cooperation of clinical psychologist with specialists in other areas.

Summary. The current biopsychosocial paradigm in medicine and medical psychology ensures the development of the theory and methodology of medical psychodiagnostics as a comprehensive study of psychological and psychosocial factors underlying mental adaptation. The diagnostic of prenosological and initial manifestations of borderline spectrum disorders designated as adjustment disorders in ICD-10 (F43.2), requires the criteria qualification of real or potential stressogenic social functioning conditions, thus, an arsenal of adequate methods of clinical and medical-psychosocial psychodiagnostics is required. The questionnaire «Social Frustration Level» represents one of such methods. The study of social frustration phenomenon as a predictor of emotional tension and stress resistance allows to characterize personality traits in relation to environmental influence and assess the specificity and pathogenic significance of socially frustrating factors. The article substantiates theoretical and methodological foundations of the questionnaire, its attributive characteristics — the phenomena of external and internal social frustration identified in medical psychodiagnostics for the first time. Socio-diagnostic criteria are illustrated by examples of the practical use in medical psychodiagnostics of social frustration in teachers of mass schools, the military and in patients with focal epilepsy. The specified research contingent is united by the problem of stress resistance in crisis situations (including a disease situation and the attitude to the disease). The questionnaire «Social Frustration Level» can be considered as a necessary form of psychosocial diagnostics of stress genesis, a source of information in screening psychoprophylactic studies, as well as in the forming of indications for psycho- and sociotherapy.

Recent studies indicate that COVID-19 pandemic has significant negative consequences for the public mental health. These consequences should be assessed and analyzed in the future, but it is already clear, that mass surveys with the use of standard psychological instruments are not adequate for this purpose. The authors emphasize that all stress factors associated with the pandemic (virtual threat and informational stress, deprivation, socioeconomic stress) should be taken into account and qualitatively studied and expect an increase in the prevalence of stress-related mental disorders and physical diseases.

Aim. Health-related quality of life in patients with arterial hypertension (HTN) is still determined by only generic patient-reported outcome measures (PROMs), although disease-specific ones are more reliable and highly valid. Previously, we reported the results of development and item-selection process of the new Russian HTN-specific PROM. The purpose of this last stage was to confirm validity, reliability, responsiveness and sensitivity of the scale and to present its final version.Material and methods. Analysis was done using data from a mass survey of patients with Grades 1-3 HTN (n=359, aged 25 to 91 y. o.) and healthy volunteers (n=48, aged 23 to 65 y.o), 407 returned questionnaires. We conducted two exploratory factor analyses (EFA) with the intermediate version of the PROM (80 questions, 20 of them HTN-specific). The Cattel’s scree test was used to select the optimal number of factors. After removing the items with a low factor loadings, a confirmatory factor analysis (CFA) was performed to assess the model’s fitindexes adequacy. The core indexes to be measured were SRMR, RMSEA, CFI. Finally, the PROM’s reliability (Cronbach’s α and McDonald’s ω) and criterion validity (responsiveness) were evaluated.Results. Both EFA with oblique and varimax rotation showed 35 questions have factor loadings ≥0,5 and assigned to one of 5 factors. The basic structure of the PROM was retained for further CFA. Most of indices of fit measured met the requirements: SRMR was 0,08, RMSEA was 0,07 (90% CI (0,07-0,08)) and CFI was 0,08, which confirms the construct validity. Both Cronbach’s α and MacDonald’s ω of each of the domains were ≥0,80 and the whole scale was 0,89 confirming satisfactory reliability. Scores of the questionnaire were positively correlated with the severity of HTN (p<0,001 for Grades 1-3 HTN) and between HTN and non-HTN patients (p=0,01 and 0,04 in psychologic and social domains respectively).Conclusion. Sequentially addressing of exploratory and confirmatory factor analyses and assessment of reliability and responsiveness allowed to form the final version of the patient-reported outcome measure for arterial hypertension. The new Russian-language questionnaire is a useful and feasible tool for routine practice and clinical trials.

The 2018 ESC/ESH European guidelines for the management of arterial hypertension (HTN) include new statements concerning the role of psychosocial factors in the course and the control of HTN. The importance of adherence to treatment is emphasized and efficient interventions that may improve drug adherence in HTN are presented. However, the Guidelines do not reflect the contemporary knowledge on psychosocial aspects of HTN and their meaning is not presented. It is necessary to integrate psychological concepts into the clinical guidelines, and clinical psychologists should take part in the development of such important documents.

Aim. Improvement of the health-related quality of life (HRQoL) is one of the basic principles of value-based medicine. HRQoL could be assessed by the patient-reported outcome measures (PROMs) also in case of arterial hypertension (HTN). However for HTN patients only generic PROMs are still used. Previously the group of experts had created the primary version of HTN-specific PROM. The purpose of the second part was to conduct a validation survey and to select the items in a statistically-based manner.Material and methods. Validation survey was conducted in a large multidisciplinary center among patients with HTN stages 1-3 and healthy volunteers. Inclusion criteria were age >18 years old, ability to understand or complete the scale themselves, absence of significant illness requiring hospitalization. The items were selected according to the principles of classical test theory (CTT) and item response theory (IRT). The criteria for CTT were sensitivity (standard deviation and coefficient of variation with corresponding confidence intervals), representativeness (item-total Pearson’s correlation coefficient), internal consistency (Cronbach’s a coefficient). In IRT analysis two methods were adopted — value of four degrees of difficulty and the discrimination estimate. Each question was evaluated according to 8 criteria. An item was considered for selection when it was retained by ≥4 criteria. The expert panel considered practical significance of each item.Results. A total of 430 questionnaires were distributed and 407 (94,7%) of them were returned completed (from 359 hypertensive patients, mean age 62,3±11,7 y.o.; 48 healthy volunteers, mean age 38,8±10,5 y.o.). The average time for PROM filling was 24±4,2 minutes. Of 163 questions, 27 met all 8 criteria and 3 questions did not match any. Of the 36 HTN-specific questions, 11 matched ≥5 criteria and in the generic part there were 87 questions (33 in the PHY domain, 35 for PSY, 8 for SOC, 11 for THER). The symmetric distribution of criteria was seen in 25 questions, of which 11 were evaluated by experts and then retained. For 40 questions, <4 eligibility criteria were recorded, of which 9 were retained after expert review. The PROM draft contained 80 questions (19 questions in the physiology domain, 22 in psychology, 6 in social, 13 in therapy, 20 items are HTN-specific).Conclusion. The methods of CTT and IRT allowed to reduce the PROM volume without losing the semantic richness and the need to reorganize the conceptual structure. The next step is the validation of the scale.

Aim. While essential hypertension (HT) is highly prevalent and health-care is on its way to be value-based, there still no Russian-language tools to assess health-related quality of life (HRQoL) exclusively in hypertensive patients. The aim of this first part of the study was to develop and primarily evaluate a new core HT-specific patient-reported outcome measure (PROM).Material and methods. HT-specific PROM was established in several steps. As a first step conceptual framework was developed and quantity of domains and subdomains was determined. Psychometrics were also instituted for the whole scale. Next, the primary item pool was built via selection from open-access Russian-language generic and English-language specific PROMs (the latter proceeded with double-translation). Moreover some newly developed HT-specific items were introduced into scale. Finally the item pool was revised according to small pilot survey with subsequent experts’ scrutiny. Results. Four experts, three in HT, one in clinical psychology constituted the expert panel. After an iterative process of literature searches 14 relevant questionnaires were selected to build 264-item pool with five-point Likert response scales (poor to better HRQoL) with a global score. Based on conceptual framework 4 key domains (physiology, psychology, social, treatment) and 24 subdomains were drafted. On the basis of onsite and extra-mural interviews with 30 hypertensive patients (18 females, mean age 62,1±10,5 years old, 1-3 severity grades) extra questions on symptoms, psychological and social burden were developed and incorporated into corresponding domains. PROM draft underwent small pilot survey (n=50, 32 females, mean age 58,3±9,6 years old, 1-3 severity grades) and then was further revised, simplified by expert panelists. The initial PROM consisted of 163 items of which 36 were HT-specific.Conclusion. The forming HT-specific PROM is intended to measure basic HRQoL, elicit the differences between hypertensives with any stage and assess HRQoL dynamics in response to treatment. Further work will be focused on conducting a large-scale survey with PROM’ primary version.

The paper reviews the main tasks of the psychological intervention in patients with arterial hypertension (HTN) and prehypertension. It presents an analysis of the studies, involving the assessment of psychological intervention efficiency in HTN prevention, lowering blood pressure (BP) and promoting adherence to treatment in HTN patients as well as prevention and correction of psychopathological complications of HTN. According to the results of well-planned studies, the psychological methods, used in the HTN prevention and treatment, do not achieve a satisfactory level of evidence-based efficiency. The findings in favor of the psychological intervention for HTN prevention are the weakest. At the same time, there is evidence of the efficiency of some psychological methods in reducing BP and promoting adherence to treatment. The efficiency of psychological intervention in preventing and slowing progression of vascular cognitive dysfunction is well documented, although the BP is not taken into account in most relevant studies. The authors suggest possible explanations of the limited efficiency of psychological interventions in HTN prevention and treatment according to up-to-date meta-analytic studies and outline future directions of research.

AIM:To assess stress level and coping strategies in chronic insomnia as its potential psychological factors.MATERIAL AND METHODS:The study group included 29 patients (19 women), aged 18-55 years old (mean age 33.1±2.1 years), with chronic insomnia diagnosed in accordance with the International Classification of Sleep Disorders III. The control group was formed by 32 subjects (11 men), aged 18-55 years old (mean age 31.5±2.0 years), without sleep disorders. Insomnia Severity Index and polysomnography were used to evaluate sleep quality. Stress level and coping strategies were assessed via an interview (stressfull life events during last year, their duration, their controllability, unexpectedness, and outcome), and by 'Level of subjective control' and 'Ways of coping questionnaires'.RESULTS:Both groups were comparable by the mean number of significant events during last year (4.97±0.34 vs 4.72±0.23, p=0.54). Patients with insomnia more often reported the loss of a relative (p=0.04), while controls more frequently reported positive events, such as pregnancy (p=0.007) or wedding (p=0.02) among close ones. Insomniacs more often described the stressful events as uncontrolled (p<0.001) and prolonged (p<0.001). They demonstrated lower indices of all the scales of the 'Level of subjective control', questionnaire except the scale of interpersonal attitudes. They rarely implemented confrontive coping (p=0.001), seeking social support (p<0.001), accepting responsibility (p<0.001) and positive reappraisal (p<0.001).CONCLUSIONS:The interpretation of stressful events and personal response in insomnia patients might be considered as psychological risk factors for insomnia development.

Background. Overweight and obesity in children are accompanied by a wide range of comorbidities. The role of overweight in the formation of cardiovascular diseases is unquestionable, however, the impact of overweight on cognitive functioning is less obvious. Obstructive sleep apnea is a potential factor which affects neurocognitive impairment in overweight children. objective. To assess the relationship between obstructive sleep apnea syndrome (OSA) and cognitive functions in obese and overweight adolescents. Methods. We examined 39 adolescents (26 boys) aged 12–18 years old. Among them 17 persons were overweight, and 22 children were obese. We assessed anthropometric parameters, cognitive functions, respiratory status (cardiorespiratory monitoring) and the main indices of carbohydrate and lipid metabolism. C-reactive protein level as a cardiovascular risk marker was evaluated. Results. More than half patients were found to have sleep-disordered breathing. The adolescents with OSA had higher levels of serum cholesterol, triglycerides and glucose. Abnormalities in main respiratory indices correlated with decreased volume of short-term auditory memory and slower reasoning process. At the same time the difference in neurocognitive characteristics between adolescents with and without OSA was more prominent in the younger age group (12–14 years old). conclusions. Thus, our study has shown that obstructive sleep-disordered breathing in overweight/obese adolescents is a risk factor for some neurocognitive problems.

Dynamic praxis was tested in three groups of elderly subjects, including control respondents with mild cognitive impairment, respondents with moderate cognitive impairment, and patients with vascular dementia. The groups were compared with one another. This comparison was methodologically based on Luria’s theory of systemic and dynamic localization of higher mental functions. The elderly subjects manifested disorders in praxis. Locomotor actions become slow in elderly subjects with mild cognitive impairment. These subjects compensated for difficulties in mastering a dynamic program by verbalizing this program and delaying the orientation phase of the action. Respondents with moderate cognitive impairment and clear manifestations of cerebrovascular pathology had stereotypies in the motor sphere and a speed slowdown in motor actions, which were more expressed in patients with vascular dementia. These subjects could only in part compensate for these disorders. But some of them could master a motor program after a cue or education.

Self-consciousness was compared in 17 elderly (aged 65-89 years old) persons with cognitive impairment without dementia and 17 patients with vascular dementia. Neurocognitive functions and mental health complaints were evaluated. Neuropsychological assessment included evaluation of higher psychological functions, such as attention, memory, conceptualization, gnosis (optic, acoustic), manual skill, speech. Older persons with cognitive impairment assessed their neurocognitive functions adequately. Patients with vascular dementia usually denied cognitive deficit or explained it as a result of aging. Regardless of physical health, older persons with cognitive impairment have active attitude to aging. They could find ways of compensation of cognitive deficits without assistance. Patients with vascular dementia could not compensate their cognitive deficit even with support.

OBJECTIVE:The study was aimed at determining the dynamics of the emotional state and factors influencing thereupon in patients presenting with atherosclerosis of lower limb arteries and undergoing surgical treatment.MATERIAL AND METHODS:The study included a total of sixty-five 36-to-90-year-old patients (53 men and 12 women) subjected to examination twice - prior to surgery and before discharge by means of semi-structured interview, self-assessment scale of feeling and mood, methods "Integrative test of anxiety" and "Type of attitude towards the disease" (TOBOL), questionnaire for assessing health-related quality of life SF-36 and Krantz questionnaire in order to determine the position in the therapeutic process.RESULTS:After surgery (on postoperative day 7-10 of hospital stay) the patients demonstrated a decrease in the degree of anxiety and somatic complaints. Women (p=0.037), patients with the duration of the disease from 1 to 8 years (p=0.033), with signs of personality anxiety (p≤0.045), disadaptive variants of attitude to disease and treatment (p≤0.05), as well as clearly manifesting mistrust for medical recommendations (p=0.014) belong to a group of risk of emotional stress at the postoperative stage.CONCLUSION:Clinical and socio-demographic determinants are comparatively less important in formation of pronounced anxiety of postoperative period than the patient's personality.

Aim. To assess the relation of obstructive sleep apnea syndrome (OSAS) by the data of Berlin questionnaire and risk of fatal cardiovascular events. Material and methods. Totally, 275 persons studied (115 males, 160 females) age 25-64 y.o., with unknown cardiovascular complications, underwent structured interview. The risk of sleep-disordered breathing was assessed by Berlin questionnaire, cardiovascular risk — by SCORE. Anthropometric parameters were studied, as lipid profile, fasting glucose, uric acid, creatinine, C-reactive protein, adiponectin, leptin. Results. The increased OSAS risk according to Berlin questionnaire was found in 7,3% of the studies. Most (90,0%) common was concomitance of the components of OSAS such as snoring/stops of respiration and cardiometabolic disorders. Males more frequently complained on snoring/ stops of breathing — 21,7% vs 6,3% (p=0,001), that determined higher general risk of OSAS among them comparing to women — 11,3% vs 4,4% (p=0,03). For males (1,7%) and females (3,1%) the complaints on daytime sleepiness were less common. Among those 40 y.o. and older the increased risk of OSAS was found in 9,8%, comparing to 1,2% younger than 40 y.o. (p=0,01). In higher OSAS risk there was higher total cholesterol — 6,10±0,18 vs 5,53±0,09 mM/L (p=0,05) and low density lipoproteides — 4,17±0,19 vs 3,59±0,08 mM/L (p=0,02); they were more often overweight — body mass index 31,73±1,19 vs 27,71±0,38 kg/m2 (p=0,001), and had higher systolic pressure — 134,89±4,96 vs 126,72±1,18 mmHg. (p=0,04) and diastolic pressure — 84,26±2,69 vs 78,55±0,80 mmHg (p=0,03). Respondents with higher risk of OSAS regardless the gender, did not differ by SCORE. While determine the specific combinations of OSAS components, there was no independent significance of snoring/respiration pauses and daytime sleepiness in the total cardiovascular risk by SCORE.Conclusion. In the Russian population, higher OSAS risk is associated with the signs of metabolic syndrome. Berlin questionnaire does not reveal the subgroups of those who have OSAS risk together with cardiovascular risk.

Objective. To determine relationship between metabolic syndrome (MS), its components and cognitive dysfunction among older adults. Design and methods. Altogether 196 subjects who did not have a history of cerebrovascular events (53 males, 143 females aged 64–86) — survivors of Leningrad Siege — were examined. IDF и АНА/NHLBI (2009) criteria for MS were used. Cognitive function was assessed applying Mini-Mental State Examination scale (MMSE). Results. MS was identifi ed in 48 % subjects. The prevailing components were hypertension, central obesity, hyperglycemia. According to MMSE results there were no participants with signs of dementia, but in 40 % cognitive dysfunction of different degree was found. Memory and attention were most impaired. Total MMSE score was associated with decreased verbal auditory working memory in women of the age group ≤ 70 years old (p < 0,05). Individual components of MS were associated with cognitive dysfunction, but only in women under or 70 years old. In this group participants with cardiometabolic disorders had the lowest scores at “Repetition” and “Sequence of actions” subscales. Hypertriglyceridemia was the component of MS most tightly associated with cognitive dysfunctions. Conclusions. Women with MS (especially with hyper-triglyceridemia) are a risk group of cognitive dysfunctions.

Aim. To study the relation of emotional status with negative tendencies in food preference style in Russian population, including regional specifics of Saint-Petersburg, Samara and Orenburg. Material and methods. The study is the part of ESSE-RF (Epidemiology of Cardiovascular diseases in different regions of Russian Federation). Totally 1941 men and 2859 women studied at the age 25-64 y.o. — citizens of Saint-Petersburg, Samara and Orenburg. The socio- demographic data assessed, as absence/presence of cardiovascular disorders, diabetes and gastrointestinal disorders (by self-report), some parameters of the food preference style and emotional status using the Hospital Score of depression and anxiety.Results. The preference of animal fats was registered in 4,8%, daily intake of sausages in 22,4%, confectionery — in 48,4%, >6 tea spoons of sugar — in 36,5% respondents. The risk factors for pernicious habits were male gender, younger age, lower income, and tendency to spend most part of the income for food. In 51,3% of participants there were increased values on anxiety score and in 30,3% — increased depression scores. Probability of animal fats preference — odds ratio (OR)=1,89, confidence interval (CI) 95%=1,40-2,57 (p<0,001), and regular intake of sausages and meat plucks — OR=1,67, CI 95%=1,41-1,96 (p<0,01), was higher in persons with depressive states; at the same time the probability of daily intake of confectioneries and sweets was significantly lowered — OR=0,83, CI 95%=0,72-0,96 (p=0,01). Inhabitants of Orenburg and Samara had much more probably prefer sausages and animal fats comparing to Saint-Petersburg citizens, and the risk of depression was significantly variable in regions: being maximum in Orenburg — 43,9% vs 20,6% in Saint-Petersburg and 26,3% in Samara (p<0,001) without significant differences by anxiety levels. Conclusion. There is an interdependence of emotional status and food preference of a person. Emotional state, at the most related to an actualization of "pernicious" eating habits, reflects the depression. Presence of depression signs is linked with more common intake of animal fats and sausages, but less common intake of confectioneries and sweets. Interregional differences in the eating style and risks of the health disorders might probably be defined with the differences in life quality of the people.