METHODS OF PROFESSIONAL ORIENTATION ACTIVITY IN PROFESSIONAL EDUCATION

Статья посвящена проблеме профессионального самоопределения обучающихся. На определённом этапе жизни каждому человеку приходится принимать одно из наиболее важных решений: определиться со сферой образования и выбрать профессию, как показывает практика, многие люди испытывают затруднения в выборе карьерного пути по самым разнообразным причинамArticle is devoted to a problem of professional self-determination of students. At a certain stage of life each person should accept one of the most important decisions: to decide on education and to choose a profession as practice shows, many people experience difficulties in the choice of a career way for the most various reason

RISK ASSESSMENT MODEL FOR CORONARY ATHEROSCLEROSIS IN PATIENTS WITH VISCERAL OBESITY

Aim. To invent a model for coronary atherosclerosis risk prediction in patients with visceral obesity and to conduct comparison research for this model with the other known Framingham and PROCAM.Material and methods. Totally 67 men included, of the age 40-65 (50,95±6,54 y.o.) without angina pectoris and clinical signs of another localization atherosclerosis. Patients had general obesity of I-III grade with BMI 35,16±3,32 kg/m , and visceral obesity by the thickness of epicaridal fat >7 mm. After coronary arteriography or multidetector computed tomography of coronary arteries we selected 2 comparison groups: group I (n=25) — patients with coronary atherosclerosis, group II (n=42) — without. For the invention of the prognostic score we used regression model with regression and optimal scaling.Results. Potential predictors of coronary atherosclerosis riskas a result of two groups comparison were: arterial hypertension, carbohydrate metabolism disorders, triglycerides, leptin, adiponectin and C-rective protein. As the result of regression analysis each predictor got its own significance mark. The rate of correctclassifications reached 79,1% that shows good prognostic value of this regression model. While using Framingham and PROCAM model the prognostic value of subclinical coronary atherosclerosis was 24,6% and 21,6% lower, resp., than the new risk assessment. Conclusion. The model invented of the risk assessment in visceral obesity patients makes it possible to take into account the main pathogenetic mechanisms that connect obesity and coronary atherosclerosis

Comparative analysis of anxiety assessment methods in athletes

Objective: to identify the most effective method for anxiety assessment in athletes. Materials and methods: the selective criteria were formulated and comparative analysis of 9 most commonly used methods of assessing the level of anxiety was made. 79 athletes of combat sports were tested (34 men, 45 women) in the preparative period of training with Lusher's color test and the integrative anxiety test by A.P. Bizyuk, L.I. Wasserman, B.V. Iovlev. Results: among nine methods most frequently mentioned in the literature, Lusher's color test with the calculation of diagnostic coefficients and the integrative anxiety test by A.P. Bizyuk, L.I. Wasserman, B.V. Iovlev were most consistent with the stated criteria. There were significant correlations between the calculated indices of Luscher's color test, which have physiological explanation: the correlation between the vegetative coefficient and the total deviation from the autogenic norm, mental working capacity, situational anxiety, and between total deviation from the autogenic norm and mental performance, sex (increase in the deviation from the autologous norm corresponds to a decrease in mental performance, an increase in the level of anxiety, parasympathetic tone, and need for rest and energy accumulation). The athletes have the low level of situational anxiety and an average level of personal anxiety if compared with average population values. Conclusions: the findings complement the results of other researchers who also confirmed the validity of use of color test and integrative anxiety test in professional sports to identify the threatening breakdown of mental adaptation and psycho-correction work among athletes

Organizational-administrative Features of the Implementation of Educational Services in the Two-level System of Training of Highly Qualified Personnel

It is education - the system of formation of the nation's intellectual capital and as one of the main areas of production innovation - creating the basic conditions for intensive growth of the markets on the basis of rapid updating of technologies and products. Education acts as the first link "education - research - innovation development of mass" of the innovation cycle. This educational sphere acts not only as a necessary element of reproduction of intellectual capital, but also as a dominant element of economic growth, which determines the stability of the external and internal competitive advantages of national economic systems. From the power of the national economy play an individual and a public intellectual capital, which implements the level of economic thinking of the nation, it is largely determined by economic strength, well-being, and the choice of its strategy and the subsequent trajectory of development in a global world order. In this connection, the Russian education there are urgent tasks related to the need to comply with the transformation of the education sector changes. Keywords: economic growth, educational service, training, educational organization JEL Classifications: G20, L00, O4

НЕЙРОКОГНИТИВНЫЕ НАРУШЕНИЯ У ПАЦИЕНТОВ С ВИСЦЕРАЛЬНЫМ ОЖИРЕНИЕМ В ПЕРИОПЕРАЦИОННОМ ПЕРИОДЕ КОРОНАРНОГО ШУНТИРОВАНИЯ

Visceral obesity (VO) is a predictor of complications after coronary artery bypass grafting (CABG), and a risk factor for cognitive and psychological disorders.Purpose. Of our study was to investigate features of neurocognitive disorders and their interactions in patients with VO in a perioperative period of CABG.Materials and methods. 90 patients with a body mass index from 25 to 35 kg/m2 were included in the study, they had indications for CABG. VO was assessed in terms of «waist circumference/hip circumference» (WC/HC). Group 1 included patients with VO (WC/HC >0.9 for men and WC/HC >0.85 for women), Group 2 – patients without VO (WC/HC ≤0,9 for men and WC/HC ≤0,85 for women). Cognitive functions were evaluated with the use of the automated complex software Status PF (Kemerovo,Russia). The Spielberger State-Trait Anxiety Inventory (STAI-T, STAI-S) was used for an estimation of anxiety.Results. Group 1 showed statistically lower rates of attention and neurodynamics and higher levels of depression and anxiety in the perioperative period of CABG. Group 1 demonstrated the decrease in memory and neurodynamics scores as STAI-T levels were higher in the perioperative period of CABG; the growth of STAI-T levels in Group 2 did not always lead to the derangements of attention and neurodynamics scores. Moreover, in Group 2 higher attention and neurodynamics scores were at higher STAI-T levels in 6 months after CABG. High STAI-S levels in both groups negatively affected the performance of attention and neurodynamics in the perioperative period of CABG.Conclusion. Patients with VO have a higher risk of developing neurocognitive disorders in the perioperative period of CABG. Висцеральное ожирение (ВО) является предиктором осложнений после коронарного шунтирования (КШ) и фактором риска когнитивных и психологических нарушений.Цель. Изучение особенности нейрокогнитивных нарушений и их взаимосвязей у пациентов с ВО в периоперационном периоде КШ.Материалы и методы. В исследование включено 90 пациентов с индексом массы тела от 25 до 35 кг/м2 и определенными показаниями к КШ. Наличие ВО оценивалось по показателю «окружность талии/окружность бедер» (ОТ/ОБ). Группу 1 составили пациенты с ВО при ОТ/ОБ >0,9 для мужчин и ОТ/ОБ >0,85 для женщин, группу 2 – пациенты без ВО при ОТ/ОБ ≤0,9 для мужчин и ОТ/ОБ ≤0,85 для женщин. Для оценки когнитивных функций использована программа Status PF (Кемерово, Россия), тревога оценивалась по шкале реактивной тревожности (РТ) и личностной тревожности (ЛТ) Спилбергера – Ханина.Результаты. В группе 1 отмечались статистически значимо более низкие показатели внимания и нейродинамики и более высокие уровни депрессии и тревоги в периоперационном периоде КШ. В группе 1 при более высоких уровнях ЛТ отмечалось снижение памяти и нейродинамики в периоперацонном периоде КШ; а в группе 2 повышение уровня ЛТ не всегда приводило к нарушению внимания и нейродинамики. Более того, в группе 2 при высоких уровнях ЛТ через 6 месяцев после КШ наблюдались более высокие показатели внимания и нейродинамики. Высокий уровень РТ в обеих группах негативно отражался на показателях нейродинамических процессов и внимания в периоперационном периоде КШ.Выводы. Пациенты с ВО имеют высокий риск развития психокогнитивных нарушений в периоперационном периоде КШ.

ПРЕДИКТОРЫ КОРОНАРНОГО АТЕРОСКЛЕРОЗА У МУЖЧИН С МЕТАБОЛИЧЕСКИМ СИНДРОМОМ

The purpose. Тo study set of the risk factors (RF) which are most significantly connected with risk of coronary atherosclerosis at men with the metabolic syndrome (MS).Material and methods. The research included 82 men from MS by criteria of ВНОК, 2009, at the age of 39 - 73 years (56,42±7,3 years). Group 1 (n=40), patients with MS and a coronary heart disease: angina of pectoralis of IIIII f.cl. and a coronary atherosclerosis according to a coronaroangiography, group 2 (n=42), patients about the MS which don’t have a coronary heart disease: angina of pectoralis and symptoms of coronary atherosclerosis. In groups of comparison the analysis of the main and additional metabolic RF and by means of a method of logistic regression search of the most adverse set of RF bound to a coronary atherosclerosis at patients with MS was carried out.Results. At patients of group 1 (n=40) higher rates of insulin (р<0,001), HOMA-IR index (р<0,001), Apo B (р<0,05), LPa (р<0,05), IL-6 (р<0,05), ФНО-α (р<0,05), CRP (р<0,05) and lower indicators of ApoA1 (р<0,05), apelin (р<0,001), than in group 2 (n=42) were defined. The predictors which are the most significantly connected with coronary atherosclerosis at patients with in steel MS: apelin, ApoB, insulin, IL-6, CRP and waist circumference.Conclusion. The received set of predictors allows to choose more perspective and schemes of prophylaxis of cardiovascular complications at patients with MS are rational. The obtained data, are also valuable material for carrying out further scientific research with studying of a role of neurohormonal and pro-inflammatory activity of visceral adipose tissue in risk of development of a coronary heart disease in patients with MS.Цель. Изучить совокупность факторов риска (ФР), наиболее значимо связанных с риском коронарного атеросклероза у мужчин с метаболическим синдромом (МС).Материалы и методы. В исследование было включено 82 мужчины с МС по критериям ВНОК, 2009 г., в возрасте 39-73 лет (56,42±7,3 лет). Группу 1 (n=40) составили пациенты с МС и ИБС – стенокардией напряжения IIIII ф кл. и коронарным атеросклерозом по данным коронароангиографии; группу 2 (n=42) – пациенты с МС, не имеющие ИБС – стенокардии напряжения и признаков коронарного атеросклероза. В группах сравнения был проведен анализ основных и дополнительных метаболических ФР и с помощью метода логистической регрессии поиск наиболее неблагоприятной совокупности ФР, связанных с коронарным атеросклерозом у пациентов с МС.Результаты. У пациентов группы 1 (n=40) были определены более высокие показатели инсулина (р<0,001), индекса HOMA-IR (р<0,001), Апо В (р<0,05), ЛПа (р<0,05), ИЛ-6 (р<0,05), ФНО-α (р<0,05), вчСРБ (р<0,05) и более низкие показатели Апо А1 (р<0,05), апелина (р<0,001), чем в группе 2 (n=42). Наиболее неблагоприятной совокупностью ФР, связанных с коронарным атеросклерозом у пациентов с МС, стали показатели, характеризующие нейрогуморальную активность висцеральной жировой ткани (ВЖТ) (апелин), показатель липидного спектра крови (АпоВ), показатель углеводного обмена (инсулин), показатели провоспалительной активности плазмы (ИЛ-6, вчСРБ) и показатель абдоминального ожирения (ОТ).Заключение. Полученная совокупность предикторов позволяет выбрать более перспективные и рациональные схемы медикаментозной и немедикаментозной профилактики сердечно-сосудистых осложнений у пациентов с МС. Полученные данные являются также ценным материалом для проведения дальнейших научных исследований с изучением роли нейрогуморальной и провоспалительной активности ВЖТ в риске развития ИБС у пациентов с МС.

Ассоциация острого нарушения мозгового кровообращения с сердечно-сосудистыми факторами риска у больных сахарным диабетом типа 2 в Алтайском крае

Аmong patients DM of type 2 (DM 2) Altay territories the stroke is at the bottom of death in 4,1 times more often, than among the edge population. A research objective: to estimate and compare a role of various risk factors (RF) in occurrence of a stroke at patients DM 2 sick of a diabetes according to register DM 2. Assumed RF in the basic group (patients prevalence was compared to a stroke) and in comparison group (patients without a stroke) with calculation of the odds ratio of development of a stroke. Were compared statistically significant RF developments of a stroke 2005 and 2008. Studying RF of a stroke at patients СД of type 2 and work carrying out on decrease in force of their influence, has allowed to level influence of one of the most significant risk factors of development of a stroke in 2005, late diagnostics blood pressure that has resulted in 2008 in decrease in death rate from a stroke among patients DM 2 on 24,9% more than among the population of Altay territory.Среди больных сахарным диабетом типа 2 (СД-2) Алтайского края острое нарушение мозгового кровообращения (ОНМК) является причиной смерти в 4,1 раза чаще, чем среди населения края. Цель исследования — оценить и сравнить роль различных факторов риска (ФР) в возникновении ОНМК у больных диабетом по данным регистра СД-2. Сравнивалась распространенность предполагаемых ФР в основной группе (пациенты с ОНМК) и в группе сравнения (пациенты без ОНМК) с расчетом отношения шансов развития ОНМК. Сравнивались ФР, статистически значимо ассоциированные с ОНМК в 2005 и 2008 гг. Изучение ФР, ассоциированных с ОНМК, у пациентов с СД-2 и проведение работы по снижению силы их влияния позволили нивелировать влияние одного из самых значимых факторов риска развития ОНМК в 2005 г., — поздней диагностики артериальной гипертензии, что привело в 2008 г. к снижению смертности от ОНМК среди пациентов СД-2 на 24,9% больше, чем среди населения Алтайского края

Comparative effectiveness and safety of non-vitamin K antagonists for atrial fibrillation in clinical practice: GLORIA-AF Registry

Background and purpose: Prospectively collected data comparing the safety and effectiveness of individual non-vitamin K antagonists (NOACs) are lacking. Our objective was to directly compare the effectiveness and safety of NOACs in patients with newly diagnosed atrial fibrillation (AF). Methods: In GLORIA-AF, a large, prospective, global registry program, consecutive patients with newly diagnosed AF were followed for 3 years. The comparative analyses for (1) dabigatran vs rivaroxaban or apixaban and (2) rivaroxaban vs apixaban were performed on propensity score (PS)-matched patient sets. Proportional hazards regression was used to estimate hazard ratios (HRs) for outcomes of interest. Results: The GLORIA-AF Phase III registry enrolled 21,300 patients between January 2014 and December 2016. Of these, 3839 were prescribed dabigatran, 4015 rivaroxaban and 4505 apixaban, with median ages of 71.0, 71.0, and 73.0 years, respectively. In the PS-matched set, the adjusted HRs and 95% confidence intervals (CIs) for dabigatran vs rivaroxaban were, for stroke: 1.27 (0.79–2.03), major bleeding 0.59 (0.40–0.88), myocardial infarction 0.68 (0.40–1.16), and all-cause death 0.86 (0.67–1.10). For the comparison of dabigatran vs apixaban, in the PS-matched set, the adjusted HRs were, for stroke 1.16 (0.76–1.78), myocardial infarction 0.84 (0.48–1.46), major bleeding 0.98 (0.63–1.52) and all-cause death 1.01 (0.79–1.29). For the comparison of rivaroxaban vs apixaban, in the PS-matched set, the adjusted HRs were, for stroke 0.78 (0.52–1.19), myocardial infarction 0.96 (0.63–1.45), major bleeding 1.54 (1.14–2.08), and all-cause death 0.97 (0.80–1.19). Conclusions: Patients treated with dabigatran had a 41% lower risk of major bleeding compared with rivaroxaban, but similar risks of stroke, MI, and death. Relative to apixaban, patients treated with dabigatran had similar risks of stroke, major bleeding, MI, and death. Rivaroxaban relative to apixaban had increased risk for major bleeding, but similar risks for stroke, MI, and death. Registration: URL: https://www.clinicaltrials.gov. Unique identifiers: NCT01468701, NCT01671007. Date of registration: September 2013

Anticoagulant selection in relation to the SAMe-TT2R2 score in patients with atrial fibrillation. the GLORIA-AF registry

Aim: The SAMe-TT2R2 score helps identify patients with atrial fibrillation (AF) likely to have poor anticoagulation control during anticoagulation with vitamin K antagonists (VKA) and those with scores >2 might be better managed with a target-specific oral anticoagulant (NOAC). We hypothesized that in clinical practice, VKAs may be prescribed less frequently to patients with AF and SAMe-TT2R2 scores >2 than to patients with lower scores. Methods and results: We analyzed the Phase III dataset of the Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation (GLORIA-AF), a large, global, prospective global registry of patients with newly diagnosed AF and ≥1 stroke risk factor. We compared baseline clinical characteristics and antithrombotic prescriptions to determine the probability of the VKA prescription among anticoagulated patients with the baseline SAMe-TT2R2 score >2 and ≤ 2. Among 17,465 anticoagulated patients with AF, 4,828 (27.6%) patients were prescribed VKA and 12,637 (72.4%) patients an NOAC: 11,884 (68.0%) patients had SAMe-TT2R2 scores 0-2 and 5,581 (32.0%) patients had scores >2. The proportion of patients prescribed VKA was 28.0% among patients with SAMe-TT2R2 scores >2 and 27.5% in those with scores ≤2. Conclusions: The lack of a clear association between the SAMe-TT2R2 score and anticoagulant selection may be attributed to the relative efficacy and safety profiles between NOACs and VKAs as well as to the absence of trial evidence that an SAMe-TT2R2-guided strategy for the selection of the type of anticoagulation in NVAF patients has an impact on clinical outcomes of efficacy and safety. The latter hypothesis is currently being tested in a randomized controlled trial. Clinical trial registration: URL: https://www.clinicaltrials.gov//Unique identifier: NCT01937377, NCT01468701, and NCT01671007