Седация и неинвазивная масочная вентиляция у пациентов с послеоперационным делирием и острой дыхательной недостаточностью

Aim: To compare the safety and efficacy of dexmedetomidine and haloperidol in patients with delirium and acute respiratory failure in non-invasive mask lung ventilation.Materials and methods. We carried out a retrospective analysis of data on patients with somatogenic delirium and acute respiratory failure (57 men, 4 women) experienced noninvasive ventilation (NIV) in the intensive care unit of the Botkin State Clinical Hospital in 2017–2018. Depending on the type of sedation the patients were divided into two groups: those on dexmedetomidine (n=31) and those receiving haloperidol (n=30). Dexmedetomidine was administered as a continuous infusion at a rate of 0.2–1.4 µg/kg/h while controlling the level of consciousness; haloperidol was administered by intravenous bolus injections until a sufficient level of sedation was reached in a dose of 2.5 mg 2–3 times a day.Results. The efficiency of sedation to achieve the required level of cooperation and possibility of NIV was 87.1% (27 patients) and 66.6% (20 patients) in dexmedetomidine and haloperidol groups. When estimating sedation in patients of both groups according to the RASS scale the scores did not differ significantly and were equal on the average to 1.7±0.3 (eye contact to voice). In haloperidol group in 10 out of 30 (33.3%) patients a sufficient level of sedation was not achieved, which required immediate tracheal intubation and invasive lung ventilation. Mortality in this group was 20% (6 patients), while in dexmedetomidine group it was 6.4% (2 patients).Conclusion. The use of dexmedetomidine, despite greater variability of hemodynamic parameters, allows to perform NIV with sufficient cooperation with the patient, reduces the frequency of tracheal intubation, risk of complications and mortality.Цель работы: сравнить безопасность и эффективность дексмедетомидина и галоперидола у пациентов с делирием и острой дыхательной недостаточностью при применении неинвазивной масочной вентиляции легких.Материалы и методы. Провели ретроспективный анализ данных 61 пациента (57 мужчин, 4 женщины) с соматогенным делирием и острой дыхательной недостаточностью при проведении неинвазивной масочной вентиляции легких (НИМВЛ) в отделении реанимации и интенсивной терапии ГКБ им. С. П. Боткина в 2017–2018 гг. В зависимости от вида препарата седации пациентов разделили на две группы: дексмедетомидина (n=31) и галоперидола (n=30). Дексмедетомидин назначали в виде продленной инфузии со скоростью 0,2–1,4 мкг/кг/ч под контролем уровня сознания; галоперидол больные получали в виде внутривенных фракционных введений до достижения достаточного уровня седации в дозе 2,5 мг 2–3 раза в день.Результаты. Эффективность седации для достижения необходимого уровня кооперации и проведения НИМВЛ составила в группах дексмедетомидина 87,1% (27 пациентов) и галоперидола 66,6% (20 пациентов). При оценке седации у больных обеих групп по шкале RASS показатели достоверно не различались и соответствовали в среднем 1,7±0,3 (открывает глаза на оклик). В группе галоперидола у 10 из 30 (33,3%) пациентов не удалось достичь достаточного уровня седации, что потребовало немедленной интубации трахеи и проведения инвазивной ИВЛ. Летальность в этой группе составила 20% (6 пациентов), тогда как в группе дексмедетомидина — 6,4% (2 пациента).Заключение. Применение дексмедетомидина, несмотря на более выраженную лабильность гемодинамических параметров, позволяет проводить НИМВЛ при достаточной кооперации с пациентом, уменьшает частоту интубации трахеи, риск развития осложнений и летальность

The impact of changes in stakeholder salience on CSR activities in Russian energy firms: a contribution to the divergence / convergence debate

This empirical paper examines the drivers underpinning changes to socially-responsible behaviours in the Russian energy sector. Responding to recent requests to contextualise CSR research, we focus on the changing set of stakeholders and developments in their saliency as reflected in corporations’ CSR activities. Based on interviews with more than thirty industry professionals, our findings suggest that Russian energy companies’ CSR is strongly stakeholder driven, and organisations adapt their activities according to their dependence on the resources that these salient stakeholders possess. We challenge the proposition that CSR in Russia arises from purely endogenous, historical, paternalism or neo-paternalism. We identify stakeholders that now shape CSR in the Russian energy sector, both endogenous (institutional and contextual forces relevant to the national business system) and exogenous (relating to the organisational field of the energy industry - international by nature). We thereby contribute to the convergence / divergence debate within CSR theory by demonstrating that both national business systems and the organisational field must be taken into account when analysing the forces that shape CSR strategies in any one country

Partnering Universities and Companies in Russia: Effects of New Government Initiative

The paper presents the results of 2-year survey conducted in 2011-2012 among Russian universities and companies who jointly implement R&D projects aimed at development of high-tech manufacturing. The joint projects represent a new government instrument to stimulate the development of linkages between universities and companies by giving matching grants for R&D to companies with obligation to order R&D to a university-partner. The objectives of the survey included analysis of motivation for cooperation both from side of universities and companies; primary effects and side-effects of such initiative; changes that may be introduced to the government regulations concerning matching grants. Total 38 teams were surveyed. Our findings show that major motivations from side of universities were access to new practical research tasks from companies, selection of most competitive teams of researchers capable to work with companies, and strengthening reputation in business environment. Companies were interested in getting government funding in order to solve their technological problems; to strengthen, due cooperation with universities, their research capacity, and to use modern research infrastructure located at universities. The analysis allowed identification of the major effects of the matching grants mechanism. They included: strengthening of university orientation towards solving practical tasks which are of interest to business; institutionalization of relations between universities and business in the sphere of innovation activity; broadening of research cooperation and the formation of research consortiums; harmonization of research and educational tasks in universities, and orientation of the parties towards continuing cooperation in the innovation sphere

Cooperation between Russian research organizations and industrial companies: factors and problems

The study is focused on the cooperation of Russian companies with research organizations in implementing R&D projects during technological innovation. Taking into account behavioral changes, authors carry out a micro-level analysis based on empirical data of executive survey of over 600 Russian industrial firms (2011—2012) and about 350 research organizations and universities (2012). The authors emphasize the key factors of firms’ demand for outsourcing R&D reveal the main barriers to the development of university-industry cooperation and their particularities for different cooperation actors. The analysis shows that there is a positive relation between the size of a company and R&D outsourcing. As for the factor of age, the highest cooperation activity of Russian firms is observed among enterprises founded over 20 years ago. As far as concernes cooperation activity of research organizations, large ones are significantly more likely to cooperate with business. A common prerequisite for research organizations' R&D cooperation with business is sufficient academic ranking. Business and science evaluate differently various obstacles to effective cooperation. For firms, the main problems are the inflated costs of national R&Ds, insufficient research organizations’ orientation at company needs, and low quality of developments. As for representatives of research organizations, they mention as barriers primarily the lack of companies' receptivity to innovation and inadequate information about promising developments. Businesses are more optimistic about cooperation with science if they already have a relevant experience of interaction. In the case of research organizations we observe a different pattern: most problems seem more significant to organizations conducting R&D in business interests

Reforming voluntary drug insurance in Russian healthcare: does social solidarity matter?

With low take-up of both private health insurance and the existing public drug reimbursement scheme, it is thought that less than 5% of the Russian population have access to free outpatient drug treatment. This represents a major policy challenge for a country grappling with reforms of its healthcare system and experiencing low or no economic growth and significant associated reductions in spending on social services. In this paper, we draw on data from a 2011 Levada-Center survey to examine the attitudes and social solidarity of the Russian population towards drug policies in general and towards the introduction of a proposed voluntary drug insurance system in particular. In addition to being among the first to explore these important questions in the post-Communist setting, we make three important contributions to the emerging policy debates. First, we find that, if introduced immediately and without careful planning and preparation, Russia’s voluntary drug insurance scheme is likely to collapse financially due to the over-representation of high-risk unhealthy individuals opting in to the scheme. Second, the negative attitude of higher income groups towards the redistribution of wealth to the poor may further impede government efforts to introduce voluntary drug insurance. Finally, we argue that Russia currently lacks the breadth and depth of social solidarity necessary for implementing this form of health financing

Стимулирование занятий спортом работников предприятий: статистико-социологическое исследование

The article reflects results of empirical analysis of sport incentives for working adults in Russia. The study uses data from a small, but according to the authors, representative sample (2208 employees) of Russian adults’ attitudes towards their health and quality of medical care in Russian Federation. The survey was initiated by the National Research University Higher School of Economics in 2017, before the start of COVID-19 pandemic, which for a certain period disrupted the employees’ measures promoting sports for their workers. However, the relevance of the study has been fully preserved. The authors not just give a snapshot of sport-promoting measures adopted by Russian enterprises, but also justify the methodology for statistical analysis of a healthy lifestyle policies provided by employers to their employees.The paper reports the main parameters and the content of the population survey used in the study; describes main sport participation indicators and its’ determinants; presents estimates of factors attributed to sport participation among working adults. More specifically, the authors study the stimulating effect of two popular measures to encourage sport participation in Russian enterprises: providing access to sport infrastructure at the worksites and subsidies for practicing sport in sport centers.Using descriptive and econometric analyzes, the authors investigate the association between sport-encouraging measures and working adults sporting activity, estimate statistical significance of this relationship. In order to concretize and deepen the empirical analysis of sport participation among working adults, the authors adjust their analyses by adding such respondents’ characteristics as gender, age, health status, smoking status, education, type of work and place of residency.The study shows that probability of sport participation is much higher for those who has access to sport infrastructure at their worksites (for both men and women). However, employers’ subsidies for sport activity outside working places is not associated with any increase in the probability of doing sports.Статья отражает результаты эмпирического анализа проблемы стимулирования занятий спортом работающего населения России. Исследование проведено по данным опроса небольшой, но, по мнению авторов, достаточно репрезентативной выборки (2208 работников) об отношении к собственному здоровью и качестве медицинской помощи в Российской Федерации. Несмотря на то, что опрос осуществлялся по заказу НИУ ВШЭ в 2017 г., то есть до начала пандемии, вызванной распространением коронавирусной инфекции, которая на определенный период нарушила тренд складывавшейся ситуации по стимулированию занятий спортом работающего населения, актуальность исследования в полной мере сохранилась. Оно позволило авторам не только получить реальную картину стимулирования занятий спортом на российских предприятиях, но и предложить методику статистического анализа создаваемых работодателем условий для здорового образа жизни персонала.В статье раскрыты особенности и содержание программы социологического обследования занятий спортом сотрудников организаций, характеризуются применяемые в эмпирическом анализе результативные и факторные показатели, представлены результаты расчетов. Основное внимание уделено оценке эффекта двух популярных в России мер поддержки занятий спортом сотрудников предприятий – предоставления им доступа к спортивной инфраструктуре на самих предприятиях и компенсации расходов на занятия физической культурой и спортом в спортивных центрах.При помощи дескриптивного и эконометрического анализа авторы исследуют наличие взаимосвязи между указанными мерами поддержки и масштабами вовлеченности персонала в занятия спортом, оценивают тесноту связи между этими параметрами. В целях конкретизации и углубления эмпирического анализа исследуемой проблемы рассматриваются такие характеристики респондентов, как пол, возраст, состояние здоровья, вовлеченность в курение, образование, тип работы и место проживания.Проведенный статистический анализ позволил заключить, что доступ к спортивной инфраструктуре на предприятии ассоциируется с более высокой вероятностью занятий спортом как работающих мужчин, так и женщин. В то же время статистическая связь между компенсацией работникам расходов на занятия спортом за пределами организации и их регулярностью не прослеживается

Влияние питания на продолжительность жизни в российских регионах

The paper studies the impact of nutrition on the life expectancy (LE) of men, as well as women in Russian regions. The empirical analysis is based on data from the Federal State Statistics Service. The panel data includes 1694 observations (77 regions of the Russian Federation in 2000–2021). The authors suggest a summary indicator of regional nutrition patterns based on the nutrition norms developed for 10 food groups by the Ministry of Health of the Russian Federation. The study was run using fixed effect models while controlling for indicators of the socio-economic development of regions.Econometric analysis shows that LE of men and LE of women increases with the decrease in the number of deviations from the regional nutrition norms. Alcohol consumption also reduces the LE of men and women, but the effect on men's life expectancy is more pronounced. As expected, the regional GRP per capita increases life expectancy, while inequality in income distribution leads to the LE decrease. The most important factor that positively affects LE of men, as well as LE of women is the proportion of urban citizens. In addition, LE is also affected by regional healthcare design: the number of doctors per 1000 people increases the LE of women; the number of hospital beds per 10 thousand people is associated with both the LE of men and LE of women. COVID-19 significantly contributed to the decrease in LE of men and especially of women. Its negative impact was already noticeable in 2020 but became particularly pronounced in 2021.The study draws attention to a significant regional variation in the LE of men and LE of women related, among other things, to deviations from the food consumption patterns. The findings may be of interest to regional authorities responsible for developing healthy nutrition policies in Russian regions and increasing the LE of men and women.В статье представлены результаты исследования влияния питания на ожидаемую продолжительность жизни (ОПЖ) как мужчин, так и женщин в регионах России. Эмпирический анализ основан на данных Федеральной службы государственной статистики. Панельные данные включают 1694 наблюдения (77 субъектов Российской Федерации в 2000–2021 гг.). Используется сводный показатель качества питания на основании разработанных Минздравом России норм потребления продуктов питания по 10 продуктовым группам. Исследование проводится с применением моделей с фиксированными эффектами при контроле за показателями социально-экономического развития регионов.В результате эконометрического анализа установлено, что чем меньше в регионе отклонений от норм потребления продуктов питания, тем выше ОПЖ и мужчин, и женщин. Потребление алкоголя снижает ОПЖ мужчин и женщин, причем влияние на ОПЖ мужчин выражено гораздо сильнее. Подтвердилось и предположение о том, что высокий уровень развития региона, оцениваемый с использованием среднедушевого ВРП, коррелирует с увеличением ОПЖ, тогда как неравенство в распределении дохода ведет к ее снижению. Важнейшим фактором, положительно сказывающимся на ОПЖ как мужчин, так и женщин, является проживание в городской местности. Кроме того, на ОПЖ влияют и отдельные характеристики региональных систем здравоохранения: превышение средних по России значений показателей численности врачей на 1000 человек населения (увеличивает ОПЖ женщин) и числа больничных коек на 10 000 человек населения (связь с ОПЖ и мужчин, и женщин). Существенное воздействие на снижение ОПЖ мужчин и особенно женщин оказала пандемия COVID-19. Ее негативные последствия проявились уже в 2020 г., но стали особенно заметными в 2021 г.Результаты проведенного исследования свидетельствуют о существенной региональной дифференциации в ОПЖ как мужчин, так и женщин, связанной в том числе и с различными нормами потребления продуктов питания. Выводы статьи могут представлять интерес для региональных органов власти при разработке мер государственной политики по повышению качества питания в регионах России и увеличению ОПЖ мужчин и женщин

Sedation and Non-Invasive Mask Ventilation in Patients with Delirium and Acute Respiratory Failure

Aim: To compare the safety and efficacy of dexmedetomidine and haloperidol in patients with delirium and acute respiratory failure in non-invasive mask lung ventilation.Materials and methods. We carried out a retrospective analysis of data on patients with somatogenic delirium and acute respiratory failure (57 men, 4 women) experienced noninvasive ventilation (NIV) in the intensive care unit of the Botkin State Clinical Hospital in 2017–2018. Depending on the type of sedation the patients were divided into two groups: those on dexmedetomidine (n=31) and those receiving haloperidol (n=30). Dexmedetomidine was administered as a continuous infusion at a rate of 0.2–1.4 µg/kg/h while controlling the level of consciousness; haloperidol was administered by intravenous bolus injections until a sufficient level of sedation was reached in a dose of 2.5 mg 2–3 times a day.Results. The efficiency of sedation to achieve the required level of cooperation and possibility of NIV was 87.1% (27 patients) and 66.6% (20 patients) in dexmedetomidine and haloperidol groups. When estimating sedation in patients of both groups according to the RASS scale the scores did not differ significantly and were equal on the average to 1.7±0.3 (eye contact to voice). In haloperidol group in 10 out of 30 (33.3%) patients a sufficient level of sedation was not achieved, which required immediate tracheal intubation and invasive lung ventilation. Mortality in this group was 20% (6 patients), while in dexmedetomidine group it was 6.4% (2 patients).Conclusion. The use of dexmedetomidine, despite greater variability of hemodynamic parameters, allows to perform NIV with sufficient cooperation with the patient, reduces the frequency of tracheal intubation, risk of complications and mortality