Репозиторий Университета

© 2019 Elsevier B.V. Human populations are chronically exposed to mixtures of toxic chemicals. Predicting the health effects of these mixtures require a large amount of information on the mode of action of their components. Xenobiotic metabolism by bacteria inhabiting the gastrointestinal tract has a major influence on human health. Our review aims to explore the literature for studies looking to characterize the different modes of action and outcomes of major chemical pollutants, and some components of cosmetics and food additives, on gut microbial communities in order to facilitate an estimation of their potential mixture effects. We identified good evidence that exposure to heavy metals, pesticides, nanoparticles, polycyclic aromatic hydrocarbons, dioxins, furans, polychlorinated biphenyls, and non-caloric artificial sweeteners affect the gut microbiome and which is associated with the development of metabolic, malignant, inflammatory, or immune diseases. Answering the question ‘Who is there?’ is not sufficient to define the mode of action of a toxicant in predictive modeling of mixture effects. Therefore, we recommend that new studies focus to simulate real-life exposure to diverse chemicals (toxicants, cosmetic/food additives), including as mixtures, and which combine metagenomics, metatranscriptomics and metabolomic analytical methods achieving in that way a comprehensive evaluation of effects on human health.

© 2019, Pediatria Ltd. All rights reserved. Urinary tract infection (UTI) is one of the most common diseases of the urinary system faced by pediatricians. Objective of the research: To study and analyze outpatient records of patients in their first year of life, sent to a nephrologist for a consultation due to microbial inflammatory changes in urine general analysis. Materials and methods: Outpatient records of 160 children aged from 1 month to 1 year, who were sent in 2017 for a consultation with a nephrologist in consultative diagnostic clinic of G.N. Speransky City Children's Hospital № 9 with directing diagnosis UTI. Results: Authors performed an assessment of guiding diagnoses, age and gender composition of patients, an assessment of life anamnesis and disease clinical symptoms dynamics before referring patients for consultation with a nephrologist. The article discusses mistakes and issues of diagnosing UTI in young children. Conclusion: Authors substantiates pediatrician’s tactics for timely UTI diagnosis in young children and correct tactics of managing these patients.

© 2019, Pediatria Ltd. All rights reserved. The question of the methodology for assessing the physical development (PD) of the child population remains debatable. An analytical, prospective, cohort study (8300 children) was performed. A comparative evaluation of 4 methods of PD assessment based on informativity criterion is presented. The ratio of methods and content of regulatory documents of the Ministry of Health of the Russian Federation is shown. Advantages of the complex technique were revealed, which is important for pediatricians, since the stated deviation in child's PD allows to determine the amount of diagnostic, preventive, and health-improving measures and recommendations for a healthy lifestyle. Within the confines of Decade of Childhood, it is necessary to eliminate the existing contradictions in normative base of the Ministry of Health of the Russian Federation, medical statistics, and medical personnel training.

© 2019 by the authors. Licensee MDPI, Basel, Switzerland. This study examined the differences in health spending within the World Health Organization (WHO) Europe region by comparing the EU15, the EU post-2004, CIS, EU Candidate and CARINFONET countries. The WHO European Region (53 countries) has been divided into the following sub-groups: EU15, EU post-2004, CIS, EU Candidate countries and CARINFONET countries. The study period, based on the availability of WHO Global Health expenditure data, was 1995 to 2014. EU15 countries have exhibited the strongest growth in total health spending both in nominal and purchasing power parity terms. The dynamics of CIS members’ private sector expenditure growth as a percentage of GDP change has exceeded that of other groups. Private sector expenditure on health as a percentage of total government expenditure, has steadily the highest percentage point share among CARINFONET countries. Furthermore, private households’ out-of-pocket payments on health as a percentage of total health expenditure, has been dominated by Central Asian republics for most of the period, although, for the period 2010 to 2014, the latter have tended to converge with those of CIS countries. Western EU15 nations have shown a serious growth of health expenditure far exceeding their pace of real economic growth in the long run. There is concerning growth of private health spending among the CIS and CARINFONET nations. It reflects growing citizen vulnerability in terms of questionable affordability of healthcare. Health care investment capability has grown most substantially in the Russian Federation, Turkey and Poland being the classical examples of emerging markets.

© 2018; Pediatria Ltd. All rights reserved. An expert analysis of lectures and reports at the XIX Congress of the European Union of School and University Medicine and Health (Belgium, Leuven, 2017) presents issues of school and university medicine: modern approaches to assessment of children’s health; ensuring equal access of all children, adolescents and youth to medical care during the period of education in accordance with the Convention on the Rights of the Child, regardless of socioeconomic status, ethnicity and cultural level; the effectiveness of health services, friendly to students, assessment of medical care for students quality; the role of parents in organizing medical care for students; the role of the media in shaping the identity of children in the process of growth and development. The concept of «positive health» focuses on positive and healthy aspects, and not only on medical treatment. The main elements of «positive health» include: physical functioning, daily routine, mental health, social activity, intentions, quality of life. In Europe prevails a program approach to prevention based on targeted work with relevant groups of children and adolescents. There is a need for assessing the impact of environmental factors, access to care and education for children with special needs, providing preventive care for vulnerable children, infants and their families, promoting healthy behavior among students, special approaches to providing mental health to students through available health services and various programs, incl. based on the welfare of children and interventions in the early stages of emotional problems considering risk factors that can be identified in educational institutions. Modern main directions of research in the field of health protection and promotion of students in educational organizations are due to large-scale changes in the environment (pronounced urbanization), the new way of life and quality of life for children and adolescents, their life conditions in a rapidly changing world combined with unfavorable trends in health and development indicators of the growing up generation of Russians.

© 2018 International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Objectives: To describe characteristics of the drug policy in Russia in terms of health technology assessment (HTA), registries of patients, pricing of drugs, cost-containment methods, and reimbursement of drugs. Methods: The legal and regulatory frameworks and the literature were reviewed to analyze several aspects of Russian healthcare: the scheme of cooperation between its structures, its levels, drug provision, issues related to HTA, the reimbursement system, pricing of medicines, and cost-containment methods. Results: The Russian drug policy has improved over the last few years: HTA has been developed, rules for the pricing of drugs and cost-containment methods have been established, and registries of patients have been created. The reimbursement system in Russia is different from the ones in Western Europe and consists of a few programs: reimbursement for specific categories of citizens, vital and essential drug list, list of 24 orphan diseases, list of 7 nosologies, and other programs, depending on region. Financing for drug provision in Russia is divided into 2 levels: federal and regional. There is still a lack of transparency and equality in healthcare as well as huge differences in access to healthcare, depending on region. Conclusions: The healthcare system in Russia is complicated and needs improvement. Nowadays, changes are being made; for example, there are attempts to implement HTA at federal and regional levels.

The article presents the results of medical sociological study carried out with the purpose of analyzing concepts and motivation attitudes of students of medical universities concerning healthy life-style and its components. The results of study demonstrate that students admitting importance of preservation of one's own health, are committed to unhealthy life-style and more often renounce sport involvement and are inactive in the area of diseases prevention and health promotion. It is emphasized that healthy life-style of students of medical universities is rather exception than prevalent practice.

© 2018 IEEE. In accordance with the results of the analysis of the current status of the medical industry in Russia, the methodical approach to the assessment of the feasibility of medical device creation project has been developed based on the calculation of the potential socio-economic impact of the implementation of medical devices by the cost of illness method, which includes the model and evaluation methodology and allows to make formalized quantitative assessment of the positive effect of the implementation of medical devices, to compare the potential impacts of the implementation of different medical devices being developed with the costs of the creation of medical device, as well as to prioritize medical device creation projects in the portfolio.

© 2018, The Author(s). Introduction: Heart rate (HR) reduction is an integral part of antianginal therapy, but many patients do not reach the guideline-recommended target of less than 60 bpm despite high use of beta-blockers (BB). Failure to uptitrate BB doses may be partly to blame. To explore other options for lowering HR and improving angina control, CONTROL-2 was initiated to compare the efficacy and tolerability of the combination of BBs with ivabradine versus uptitration of BBs to maximal tolerated dose, in patients with stable angina. Methods: This multicenter, open, randomized study included 1104 patients with Canadian Cardiovascular Society (CCS) class II or III stable angina, in sinus rhythm, and on background stable treatment with non-maximal recommended doses of BBs. Consecutive patients were allocated to ivabradine + BB or BB uptitration in a 4:1 ratio. Results: At the end of the study (week 16), addition of ivabradine to BB treatment and BB uptitration resulted in reduction in HR (61 ± 6 vs. 63 ± 8 bpm; p = 0.001). At week 16, significantly more patients on ivabradine + BB were in CCS class I than with BB uptitration (37.1% vs. 28%; p = 0.017) and significantly more patients were angina-free (50.6% vs. 34.2%; p < 0.001). Patient health status based on the visual analogue scale (VAS) was also better in the ivabradine + BB group. Adverse events (AEs) were significantly more common with BB uptitration than with the ivabradine + BB combination (18.4% vs. 9.4%, p < 0.001). Conclusion: In patients with stable angina, combination therapy with ivabradine + BB demonstrated good tolerability, safety, and more pronounced clinical improvement, compared to BB uptitration. Trial Registration: ISRCTN30654443. Funding: Servier.

© EV Arsentyev,. The article deals with the main turning points in the life and work of N.A. Semashko, the first People’s Commissar of Health of the RSFSR, from 1920 to 1925. The authors of the article proceed from the fact that the historical and biographical data available about Semashko are interpreted according to ideologically tinted stereotypes that were formed in the Soviet historiographic school. Based on various sources (mainly documents from the State Archives of the Russian Federation and Semashko’s family archive), as well as critical analysis of data from literature, an attempt was made to give an ideologically neutral assessment of the participation of Semashko in the organization of the sanatorium and resort sector in the RSFSR and the assistance provided to Soviet Russia from foreign public organizations. New facts were discovered about Semashko’s life, which in particular made it possible to clarify his role in helping medical personnel in Crimea during political repressions there (after the Bolsheviks established power on the peninsula). The authors of the article point out that despite the difficulties that existed at that time, in many respects, it was only due to Semashko’s authority and organizational abilities that the famous Soviet All-Russia health resort was established in Crimea. While work was carried out on the archives, data were found on the supply of humanitarian aid to the People’s Commissar of Health by US public organizations, sympathizing with Soviet Russia in the first half of the 1920s. It is concluded that the formation of Semashko’s scientific biography, which assumes an objective assessment, in particular, concerning his contribution to the organization of medical care, will make it possible in general to move on to an objective analysis of the features of the Soviet health care system and the transformation of the Soviet model (the Semashko model) into the modern Russian model of health care.

© SD Batoev. The current continuing outflow of valuable production forces and intellectual resources from Transbaikal has a negative impact on the socio-economic development of this border area. A retrospective analysis of the health care system provided to the Russian population living in remote areas demonstrates that not all formative stages of the health care system in Transbaikal were completed without problems. The Russian Empire implemented a state policy on the demographic and socio-cultural integration of Transbaikal for the purpose of rational economic development, effective consolidation of the territory and provision of border security. The pre-revolutionary government, facing significant financial shortages and an unfavorable socio-economic and political situation from the mid 18th century, carried out continuous work to create the foundations for the Transbaikal public health system. However, social issues were not a priority with regard to all population groups living on the outskirts of the Russian Empire, therefore many projects and decisions were implemented with significant delays or in a reduced format. In addition, it is necessary to take into account an objective point restraining the introduction of the central authorities’ solution: a new type of medical care was being promoted, to which the indigenous and newly arrived people of Transbaikal had to grow accustomed. At the same time, by the beginning of the 20th century, the heterogeneous population of Transbaikal, which traditionally used folk methods as well as Tibetan medicine, gradually began to understand the advantages of official medicine and science-based hygiene for improving and preserving human potential, which is the basis of the physical and intellectual development of any nation, and to master their leading principles. From the beginning of November 1920, under the conditions found in the Far Eastern Republic, measures were taken for the first time to organize free and preventive medicine for all population groups on the territory of Transbaikal, which marked the beginning of positive changes in the sphere of health care in terms of ensuring the real availability of medical care. Thus, the long process if creating a treatment and prevention system in pre-revolutionary Transbaikal took place within the framework of the all-Russian model of state medical care. It was continuous in nature and had a number of significant differences from the health care system established in European Russia.

For the purpose of studying the possibility of labor functions development for public health and healthcare during training in the educational organizations the comparative analysis of provisions of the professional standard with the materials stated in textbooks and national manuals of the corresponding profile was carried out. It was found that in the development of Federal state educational standards of higher education in dentistry (specialization level), updating educational methodological publications on dentistry and public health, the formation of a unified database of evaluation tools for accreditation of specialists and obtaining or confirming qualification categories, it is necessary to take into account the content of labor functions of the professional standard in each discipline.

BACKGROUND: The relevance of this ensues from the fact that despite the numerous currently available health promotion training programs for the reduction of body weight, there is still the need for the development of the new forms of the efficacious physical training programs and the methods of motivation for compliance with them among the people of different age, sex and social status. AIM: The objective of the present study was to determine the role of motivational factors, including the assessment of the biological age, in the improvement of the effectiveness of the health promotion training programs for the reduction of the excess body weight. MATERIAL AND METHODS: A total of 82 students with overweight and first-degree obesity at the age from 17 to 21 years (average age 18.5±1.4 years) were examined. 42 girls included in the first (main) group spent 9 months performing health promotion training programs on an individual basis developed taking into consideration the motivational factors. The physical training programs included the aerobic exercise in the form of dance classes. 40 students in the control group were engaged in physical training envisaged by the academic curriculum of the university. The third group (the group of comparison) was comprised of 36 practically healthy girls having the normal body weight. We studied the components of the body composition with the use of bioimpedanceometry, evaluated the physical working capacity (the PWC-170 test) and the adaptive reserves of the body (heart rate variability test as proposed by R.M. Baevskyi, Garkavi test). In addition, the psycho-emotional status of the participants was estimated making use of the Lusher test and SAN. The biological age was determined by the original method based on the combination of the morphological and functional indices. RESULTS: The excess body weight in the students comprising group 1 was reduced by 10% on the average; simultaneously the physical working capacity among these students increased by an average of 24.5% while the level of emotional stability and self-esteem increased by 20% and 24%, respectively. We also documented a decrease in the initially increased biological age by 5 years on the average. The students included in group II did not experience any significant changes in the parameters of interest. CONCLUSION: The consideration of the motivational factors for the development of the training programs designed to promote the reduction of the excessive body weight significantly increases their effectiveness, as evidenced by the improvement of the morpho-functional and psychological characteristics in the students of the first group and its absence in their counterparts included in group II.

© VV Romanova, YA Shulatov. During the Korean War (1950–1953), China and North Korea accused the US of waging bacteriological warfare, including the use of biological weapons developed Japanese war criminals from Unit 731, who had been convicted during the Khabarovsk Trials in 1949. The Soviet Union did not immediately join in the allegation campaign against the Allies, with the Soviet Foreign Ministry initially taking a restrained stance. However, with Moscow’s backing and active involvement in international orga-nisations and the media, a powerful propaganda campaign was unleashed against American-led UN troops in Korea, as well as the political leadership of the US. The campaign was markedly political in nature and it involved many prominent individuals, including public figures from Western countries. An extensive action plan was developed, although its implementation was incoherent, which was a reflection of both the lack of evidence and a rapidly changing international environment. The article demonstrates how the Soviet stance on the use of biological warfare during the Korean War changed and reveals how the extensive campaign was launched amid the Cold War.

© SD Batoev. The formation of the health care system in Transbaikal after the revolution of 1917–1918 had a number of essential features that will be covered in this paper. In 1919, the organization of medical care in Transbaikal retained its pre-revolutionary structure. In connection with the tense political situation in eastern Russia and the serious danger of a military conflict with Japan, in the spring of 1920, a buffer state was created – the Far Eastern Republic (FER). The FER Ministry of Health was established within the framework of the administrative territorial unit. During this period, the Ministry of Health had to fight epidemics, organize medical and sanitary assistance for the population and provide medical support for the People’s Revolutionary Army. Throughout the FER’s territory, free access to all types of medical care (outpatient, inpatient, sanatorium and dental) was introduced for all working groups of the population. From that point on, the state medical authorities consolidated and directed all the FER’s medical and sanitary and veterinary affairs. The Ministry of Health consisted of a civilian and military administrative unit, a medical and veterinary council and local health institutions for the indigenous population. The institutions were involved in the organization of health care and conducted medical and preventive activities and statistical studies. Despite Soviet Russia’s comprehensive assistance, the FER’s economic situation remained dire and unstable. The deficit of skilled health workers and medical institutions prevented the improvement of the health care situation. Radical changes in the public health system became possible only after the accession of Transbaikal to the RSFSR. In the territory of Transbaikal during the existence of the FER (from the spring of 1920 to the end of 1922), the formation of a health care system aimed at providing all segments of the region’s population with access to qualified medical care was an ongoing process.

© 2018, Media Sfera. All rights reserved. Modern public healthcare practices are constantly being improved by the medical community, which involves approval and implementation of professional standards such as including public health activities in the responsibilities of medical specialists. To understand how well such skills can be mastered by the specialists, we have conducted a comparative analysis of ophthalmologist qualifications found in the most often used guidelines and textbooks. With logical, analytical and hypothetical analysis, books and guides published before 2018 were found to have insufficient coverage of the public health responsibilities. Improvement of the public healthcare in terms of professional standards is an important course of development for the medical field. The continued work on Russian Federal State Educational Standard (Higher Education) for Ophthalmology - index number 31.08.59 - should include actualization of educational materials with modern public health notions, development of a universal learning evaluation database for specialist accreditation, as well as evaluation tools for the obtainment and confirmation of their qualification. The professional standards for ophthalmologists should fully account for the job responsibilities they acquire. Training of ophthalmologists in the public healthcare should utilize the following textbooks published in 2018: «Organization of medical aid in the Russian Federation» under the editorship of V.A. Reshetnikova, «Healthcare and public health» under the editorship of G.N. Tsarik, and «Public health and healthcare» by V.A. Medic.

© 2018, Dynasty Publishing House. All rights reserved. The objective. To study the quality of life of feeding mothers and toe establish whether the adherence to breastfeeding influences physical and mental health of women. Patients and methods. We conducted a questionnaire survey of 151 mothers who had small infants. Their quality of life was studied with the help of the SF-36 questionnaire. Results. As we have found, the higher is the material wellbeing of the family, the less women adhere to breastfeeding (per capita income of the family of breastfeeding mothers are almost 2 times lower than in nonbreastfeeding women – 22500 ± 3.800 and 43958.33 ± 4.240 rubles, respectively, р < 0.05). Subjective perceptions of physical health (functioning), parameters of life activity (Vitality – VT) and subjective assessment of their health (General Health – GH) were similar in both breastfeeding and nonbreastfeeding mothers (VT 56.48 ± 3.77 and 58.33 ± 2.91; GH 68.52 ± 4.13 and 65.83 ± 1.95, р > 0.05). Irrespective of breastfeeding adherence, women after childbirth did not report of worsening of their health (50.93 ± 4.01 and 44.79 ± 2.61, respectively, р > 0.05). But in breastfeeding mothers parameters of the quality of life were demonstrative of a higher endurance (physical functioning 73.89 ± 1.66 and 85.22 ± 3.19, role functioning 52.78 ± 2.16 and 65.63 ± 3.73, р < 0.05). Breastfeeding mothers more rarely had difficulties in routine activities due to their physical condition and pain (bodily pain 73.89 ± 3.77 and131.35 ± 2.16, р < 0.05), physical and emotional condition did not interfere with communication and social activity (social functioning 67.13 ± 1.93 and 139.8 ± 6.92, р < 0.05, mental health 95.11 ± 7.18 and 58.17 ± 8.11, р < 0.05). They are less prone to depression and have higher values of the positive emotions parameter (role emotional functioning 64.08 ± 3.98 and 215.73 ± 12.67, р < 0.01). Conclusion. The results of the study can be used in programmes aimed at expanding breastfeeding.

© 2018 The Author(s). In this article, the requirements for a prospective register of assisted reproductive technologies are considered. The basis of such a register is a specialized data store - the electronic passport of the woman's reproductive health. This register will Serve as a basis to analyse the effectiveness of the use of assisted reproductive technologies and for Supporting the making of medical decisions about the likelihood of pregnancy.

© 2018 Dynasty Publishing House. All rights reserved. The objective. To offer a characteristic of phenotypes of atopic bronchial asthma (BA) in children according to the level physical health (LPH). Patients and methods. Our observation included 359 children aged 4 - 14 years with atopic BA. We performed a questionnaire survey among parents, studied medical histories and took anthropometric parameters. The parameters of respiratory, muscular and cardiovascular systems, and LPH according to the method by G.L.Apanasenko (1992) were determined. Results. Using multiple factor analysis with the principal component method we selected parameters that characterize the level of physical health in BA: values of external respiratory function - ERF (VC, FEV1), hand muscle strength (HMS), body mass index (BMI), vital index (VI), Robinson index (IRob), muscular endurance (ME). In BA with low LPH no patient has full control over disease. Overweight is recorded in 37.9% of them, lower ERF parameters in 33.3%, lower HMS in 87.9%, deviations on the part of the cardiovascular system in 80.3%. In BA with higher LPH, full control over diseases is observed in almost half of children (48.7%), harmonious physical development - in 87.1% of cases. Parameters of ERF, muscular and cardiovascular system corresponded to the norm in 92.3; 61.5 and 100% of patients, respectively. Children with BA with average LPH take the intermediate position between these two groups. Conclusion. Physical health should be regarded as a factor of retaining control over BA. Phenotype determination according to the level of physical health and degree of disease control permits to personify rehabilitation programmes for children with atopic bronchial asthma.

© 2018 Media Sphera Publishing Group. All rights reserved. This article reflects the main stages of outpatient care formation in Moscow. It describes the most significant health care and health education reforms in different periods of Russian history. The article stresses the relevance of outpatient service modernization as a priority of Russian health care reform. The dominance of outpatient care and the introduction of a new three-level primary health care system into healthcare practice have demonstrated the optimal scheme of interaction of all Moscow medical institutions. The article shows the importance of consolidating the efforts of the Government of Moscow and Moscow medical universities, and the I.M. Sechenov First Moscow Medical University in particular, to solve the basic issues of prevention, early diagnosis, and treatment of diseases and to achieve the high quality of life in Muscovites.