COSTS OF THE HEALTH CARE IN RUSSIA ASSOCIATED WITH SMOKING

Aim. To analyze costs of health care in Russia associated with smoking in 2009. Material and methods. Cardiovascular diseases, cancers and chronic obstructive pulmonary diseases (COPD) were included in the analysis. Calculation was performed on the basis of the relative risks of diseases associated with smoking, and obtained from foreign surveys, official statistics on morbidity and health system resources expenditure, and costs of health-seeking in line with state program of guaranteed free medical care.  Results. In 2009 total costs of the health care system associated with smoking exceeded RUR 35.8 bln. It corresponded to 0.1% of gross domestic product in Russia in 2009. The costs structure was the following: hospitalization – RUR 26.2 bln, emergency calls – RUR 1.4 bln, and outpatient health-seeking – RUR 8.2 bln. Costs of outpatient pharmacotherapy were not included into analysis because of lack of baseline data needed for calculations. Cardiovascular diseases caused 62% of the health care costs associated with smoking, cancers – 20.2%, and COPD – 17.8%. Conclusion. The smoking in Russia is associated with significant health care costs. It makes needed resources investment in preventive programs to reduce smoking prevalence

Drugs influencing on PCSK9 activity: modelling of efficacy in patients who had myocardial infarction with uncontrolled dyslipidemia

Cardiovascular diseases are the leading cause of death worldwide. It is possible to influence the development of these diseases by influencing their main pathogenetic link — dyslipidemia.Aim: to evaluate, using the example of alirocumab, the potential effect of drugs affecting the activity of PCSK9 on the achievement of goals for the prevention of the development of cardiovascular diseases and cardiovascular complications in patients of working age who had an acute myocardial infarction (MI) less than a year ago, with uncontrolled dyslipidemia.Materials and methods. The target group was created based on the Russian clinical guidelines; its number was calculated using Russian registry data. Based on the published results of the clinical trial of alirocumab ODYSSEY OUTCOMES in a group of patients with LDL cholesterol levels of more than 2.6 mmol/l (100 mg/dl), a model was built to estimate the number of fatal and non-fatal outcomes in the target group with standard therapy and with alirocumab.Results. The effect of alirocumab administration was modeled in patients of working age who had a myocardial infarction less than 12 months ago with an LDL cholesterol level of more than 5.0 mmol/l, the number of this group in the Russian Federation was estimated to be 3,029 people. It has been shown that with therapy in this group, mortality can be reduced by 29%, and the number of non-fatal cardiovascular events — by 22%, i. e. alirocumab therapy in this group for 2 years can prevent 29 deaths and 185 non-fatal events, with an increase in the duration of therapy to 5 years, the number of lives saved will be 117 and 401 non-fatal cardiovascular events will be prevented.Conclusion. Modeling has shown that alirocumab therapy in patients with recent myocardial infarction and LDL cholesterol levels above 5.0 mmol/L will significantly reduce mortality in this group and prevent the development of serious nonfatal cardiovascular complications, which will also reduce the burden on specialized hospitals, as well as prevent patients from becoming disabled. At the same time, decision making requires a balanced consideration of all ethical, clinical and economic aspects, including the assessment of costs and potential effects from the position of the of a willingness to pay and the formation of the budget of the health system

Effects of female sexual chemosignals on mucosal immunity in BALB/c and C57BL/6 male mice

The immune response to immunogenic stimuli depends on various factors like cytokine context, way of entry, and immune status of the organism. In mice, female chemosignal entry into the male organism via the respiratory system causes activation of the mucosal immune response, which leads to the development of enhanced resistance to infections and is of adaptive value. However, the activation of mucosal immunity depends on the genetic predispositions of the immune response. BALB/c and C57BL/6 are prototypically Th2- and Th1-type mouse strains, respectively, therefore, they can serve as perfect model organisms for studying mechanism of lung mucosal immune activation in response to female chemosignals. Respiratory tract mucosal immune response to intranasal application of LPS, urea solution, saline and female urine used as a chemosignal was investigated in BALB/c and C57BL/6 male mice. Application of both female urine and LPS increased total white blood cell count and protein concentration in bronchoalveolar lavage fluid in BALB/c, but not in C57BL/6 male mice, suggesting an important role of Th2 pathway in lung mucosal immune response. At the same time, urine application provoked a significantly lower plasma corticosterone elevation than LPS. Thus, sexual signals associated with infection risks provide genotype-dependent mobilization of innate immunity without significant activation of physiological stress mechanisms

Level and correlations of soluble suppression of tumorigenicity 2 protein in heart failure and its relationship with clinical and paraclinical characteristics of patients

Aim. To establish the correlations of the soluble suppression of tumorigenicity 2 protein (sST2) and N-terminal pro-brain natriuretic peptide (NT-proBNP) with some clinical and paraclinical characteristics of patients with heart failure (HF).Material and methods. The study included 130 patients with HF (men — 54, women — 76, mean age, 64,3±8,3 years) from the regional registry of HF patients in the Voronezh Oblast. All patients underwent echocardiography and general clinical investigations. In addition, the serum levels of sST2 and NT-proBNP were determined and their correlations with other parameters were studied.Results. The blood level of sST2 in HF patients was 339,8 [266;405] pg/ml. In the study sample of patients with HF, sST2 levels correlated with right atrial (r=0,49) and right ventricular (r=0,32) sizes, left ventricular end-diastolic dimension (r=0,34) and volume (r=0,33), left ventricular early diastolic filling rate (r=-0,35), blood calcium level (r=-0,55) and functional class of exertional angina (r=-0,37).Conclusion. The data obtained may indicate a pathogenetic relationship between sST2 and systolic and diastolic dysfunction of the left ventricle and right heart

SOCIO-ECONOMIC DAMAGE BY ACUTE CORONARY SYNDROME IN RUSSIAN FEDERATION

Aim. To estimate the economic damage by acute coronary syndrome (ACS) in Russia in 2006-2009. Material and Methods. Direct costs and economic losses associated with ACS were estimated. The structure of direct costs includes the costs of hospitalization, medical emergencies, out-patient visits, high-tech medical care, as well as drug therapy in outpatient treatment. Losses in the economy associated with ACS include loss of gross domestic product due to death in working-age, temporary disability and payments of disability benefits. Estimation of economic damage by cardio-vascular diseases was based on analysis of Russian Ministry of Health official statistics. Results. Approximately 520,000 cases of ACS are registered annually (36,4% - myocardial infarction, 63,6% - unstable angina). Trend to increased mortality from myocardial infarction, especially among women, was found during the analyzed period. From 2000 to 2009 this index rose from 34.9 to 41.1 per 100,000 of population among women, and from 52.3 to 55.9 per 100,000 of population among men. Total direct costs of health care for patients with ACS in 2009 amounted to almost 21 billion rubles, and indirect – 53.5 billion rubles. The total economic damage by ACS in Russia in 2008-2009 exceeded 70 billion rubles per year. Conclusion. ACS in Russia is connected with significant social and economic damage. Most part of this damage is indirect losses in economy due to premature mortality of working aged men

Characteristics of a 1-year outpatient management of patients after myocardial infarction: data from a Russian multicenter study

Aim. To evaluate a 1-year outpatient management of patients after myocardial infarction (MI) aged <75 years according to a Russian multicenter study, as well as to assess compliance with recommendations on the frequency of visiting specialists and the performance of diagnostic examinations.Material and methods. This observational study includes a representative sample of MI patients admitted to 16 clinics in 13 Russian regions. Patients with MI who were alive the next day after hospitalization aged <75 years were included in the study according to a special randomization scheme. When writing this article, the data from questionnaires of 6 and 12 months after hospitalization were analyzed: the number of visits to doctors of various specialties, hospitalizations, the number of diagnostic procedures performed (electrocardiography (ECG), echocardiography and surgical interventions (percutaneous coronary intervention, coronary artery bypass grafting (CABG)). The study included a cohort of 723 patients who participated in the survey both 6 and 12 months after hospitalization (67% — patients discharged from the hospital), of which 562 (77,7%) were men and 161 (22,3%) — women. Statistical processing was performed using IBM SPSS Statistics v.25 software for Windows.Results. In the first 6 months after MI, 218 (38,8%) men and 62 (38,5%) women visited the cardiologist the recommended number of times. However, 151 (20,9%) people were not monitored by a cardiologist in the first six months. There was a significant increase in the number of people not observed during the second 6 months up to 209 (28,9%) people (p<0,01). Of the 689 interviewed patients, 210 (30,5%) people visited the therapist the recommended number of times in the first six months, while in the second 6 months — 402 (58,4%) patients. It is also reasonable to single out patients who were not monitored by either a cardiologist or a general practitioner into a separate group. In the first 6 months, the total number of unobserved patients was 68 (7,5%), while in the second six months this number increased to 189 (25,9%). The recommended number of ECGs (4 or more times) was performed in 316 (40,4%) patients, while ECG was not performed in 35 (4,5%) patients. Echocardiography 2 or more times was performed in 194 (25,4%) patients. The procedure was not performed in 167 (21,9%) patients. During the first 6 months, 170 (22%) people were hospitalized, while 156 (20,2%) — during the second half of the year. Angioplasty during the first 12 months after discharge from the hospital was performed in 183 (23,1%) patients, CABG — in 41 (5,2%) patients without age and sex differences.Conclusion. Outpatient management of patients aged <75 years 12 months after MI characterized by low compliance with recommendations on the number of cardiologist consultations and diagnostic procedures, which may adversely affect adherence to the recommended drug treatment and lead to a worse prognosis

Mother-fetus immunogenetic dialogue as a factor of progeny immune system development

Despite the advances in medicine, about 4 million children under the age of 6 months die annually around the world due to infection, which is 450 deaths per hour (UNISEF, 2009). The degree of development of the immune system of children born in time is determined by many factors, including the immunogenetic similarity or difference of mother and fetus organisms, which, in turn, is due to the genotypes of mating pairs, as well as the selection of surrogate mothers during in vitro fertilization. From our review of the literature, it follows that immunogenetic interactions of mother and fetus organisms, which occur at all stages of pre- and postnatal development, have a signifcant effect on the resistance of offspring to infections and allergens. Before implantation, the mother’s immune responses are formed under the influence of semen fluid antigens, leukocytes and cytokines, as well as under the influence of the genes of the major histocompatibility complex, which are expressed in embryos at the stage of two cells. After implantation, transplacental transfer of immunoglobulins and immunocompetent cells becomes of immunomodulating importance. It is important to emphasize that, although substances with a high molecular weight usually do not pass through the placenta, this rule does not apply to immunoglobulin G (IgG), which, with a molecular weight of about 160 kDa, overcomes the transplacental barrier due to binding to the fetal Fc receptor. The level of IgG in newborns usually correlates with the level of maternal antibodies. During the period of natural feeding, the immune protection of newborns is provided by the mechanisms of innate immunity and the factors of humoral immunity of mothers. It has been shown that immunoglobulins from the milk of many animal species are transferred through the neonatal intestinal epithelium to the blood. Since breast milk contains large amounts of various immunoactive components, including proteins, cytokines, hormones, immunoglobulins, exosomes containing micro-RNA, and viable immune cells, the immunomodulating effects of breast milk persist even after elimination of maternal immunoglobulins from the blood of the offspring, up to maturation. Analysis of a large body of experimental data shows that the study of mechanisms of “motherfetus” and “mother-newborn” interactions are the basis of a knowledge base needed to fnd means of life-long directed modulation of the descendants’ immune status

New opportunities for biomarkers in cardiovascular risk stratification. Resolution of Advisory board

Early detection of people with a high-risk of developing cardiovascular diseases is a key point of the prevention strategy. The existing risk scales have a number of limitations: insufficient accuracy for an individual or the appearance of a “residual risk”. Existing approaches to improving the accuracy of risk prediction include the use of biomarkers. Troponin I is promising, which has proven its prognostic value in healthy and asymptomatic individuals at the population level. For example, the BiomarCARE study with the participation of 74 thousand people from 5 countries showed an association of increased troponin I concentration and the frequency of cardiovascular events and overall mortality. Similar results were obtained in other cohorts. The simulation results indicate the potential economic feasibility of using troponin I for the purpose of risk stratification. The first pilot Russian study was conducted, which made it possible to describe the population distribution of troponin levels. It confirmed the prognostic significance of the biomarker in relation to the development of cardiovascular outcomes in men in the Russian population. Further studies on large cohorts are needed to clarify the results of the pilot project

Hospital stage of myocardial infarction treatment in 13 Regions of Russian Federation by results of the international research

Aim: To describe the characteristics of the patient with MI who is admitted to a hospital and to characterize the main diagnostic and treatment interventions in clini

Strategic Environmental Assessment and Monitoring of the Zaslavsky Reservoir

10995/27938В данной статье рассмотрено Заславское водохранилище и его влияние на окружающую среду, а также данные о стратегической экологической оценке и мониторинг данного водного объекта.This article examines the Zaslavskoye reservoir and its impact on the environment, as well as data on the strategic environmental assessment and monitoring of this water body