Teacher’s Aggression: Modern Approaches to Studying and Prevention

The results of analysis of modern scientific approaches to the study and prevention of pedagogical aggression are presented. The relevance of the work is caused by a wide spread of aggressive forms of behaviour in society, including the educational environment. After reviewing the theoretical and empirical psychological and pedagogical works of Russian scientists, the authors found that most researchers see the reasons for pedagogical aggression in professional deformation of teacher’s personality. It is noted that it may occur at different stages of development of a specialist, affect the structure of personality, is detrimental to its activity and behaviour. It is shown that at the same time, other researchers focus on the destructive manifestations of pedagogical discourse, considering the aggression of the teacher an integral part thereof and is evident in the evaluation of actions aimed at changing the subjectivity of a student. The authors propose the idea of complex psychological support of teacher’s action as ways of prevention and correction of pedagogical aggression, the purpose of which should be assistance in overcoming various kinds of difficulties of personal and professional character. It is indicated that the work on forming the culture of behavior and speech etiquette of teachers and students of pedagogical universities, learning the techniques of public communication and effective response in conflict situations have serious importance

Cognitive status in older patients with limited mobility as a predictor of negative outcome

Background. Cognitive impairment (CI) is one of the important disability factors in the elderly. The role of CI in prognosis of the frailest patients with limited mobility is uncertain.The aim. To determine the influence of the initial cognitive status in the group of patronage patients aged 60 years and older on the risk of mortality within one year.Materials and methods. Study group consisted of 450 patients from patronage group with one-year period of observation (from July 2019 till July 2020). Initial physical, functional, neuropsychiatriac and social statuses were evaluated by comprehensive geriatric assessment. Cognitive impairment was screened by Mini-Mental State Examination (MMSE), with dividing patients into dementia group (MMSE ≤ 24) and no-dementia group (MMSE > 24). The mortality rate after one year was assessed.Results. Of the 450 patients included in the study, dementia was present in 44.2 %. Patients with dementia were more prone to greater severity of chronic pain, sleep disturbances, depression, malnutrition and anemia. After one year of observation 34 out of 196 patients (17.3 %) in the group of patients with dementia and 18 out of 248 patients (7.3 %; p = 0.002) in the no-dementia group died. According to multivariate analysis, independent risk factors for death in patients with dementia were anemia, hearing impairment and a history of bone fractures.Conclusion. Thus, the assessment of the cognitive status of frail patients with limited mobility is important for the purpose of identifying the most vulnerable individuals with a high risk of adverse outcomes

Prevalence of geriatric syndromes in frail patients and mortality risks

The prevalence of older people in Russian population increases rapidly. Therefore, the concept of healthy aging is becoming crucial in Russia and all over the world, and thus disability prevention is one aspect of this issue.AimTo assess a possible association between geriatric syndromes, comorbidities, and mortality rate among frail patients who receive home medical care in Moscow.Materials and methodsThe study included 450 patients with home medical care provided by the State Budgetary Healthcare Institution “Diagnostic Center No. 3 of the Moscow Health Department” from June 2019 to April 2021. Physical health, functional, cognitive, social and emotional statuses were evaluated by comprehensive geriatric assessment (CGA). The mortality rate after 1 year was assessed.ResultsThe all-cause case mortality rate in patients during the observation period was 22.4%. There was no difference in age and comorbidities in survivors and deceased patients, but the latter group had more geriatric syndromes. The association between risks of mortality and anemia and some geriatric syndromes, such as malnutrition and hearing impairment, total dependence (Barthel index less than 60) was observed

Influence of socioeconomic factors on pregnancy outcome in women with structural heart disease

OBJECTIVE: Cardiac disease is the leading cause of indirect maternal mortality. The aim of this study was to analyse to what extent socioeconomic factors influence the outcome of pregnancy in women with heart disease.  METHODS: The Registry of Pregnancy and Cardiac disease is a global prospective registry. For this analysis, countries that enrolled ≥10 patients were included. A combined cardiac endpoint included maternal cardiac death, arrhythmia requiring treatment, heart failure, thromboembolic event, aortic dissection, endocarditis, acute coronary syndrome, hospitalisation for cardiac reason or intervention. Associations between patient characteristics, country characteristics (income inequality expressed as Gini coefficient, health expenditure, schooling, gross domestic product, birth rate and hospital beds) and cardiac endpoints were checked in a three-level model (patient-centre-country).  RESULTS: A total of 30 countries enrolled 2924 patients from 89 centres. At least one endpoint occurred in 645 women (22.1%). Maternal age, New York Heart Association classification and modified WHO risk classification were associated with the combined endpoint and explained 37% of variance in outcome. Gini coefficient and country-specific birth rate explained an additional 4%. There were large differences between the individual countries, but the need for multilevel modelling to account for these differences disappeared after adjustment for patient characteristics, Gini and country-specific birth rate.  CONCLUSION: While there are definite interregional differences in pregnancy outcome in women with cardiac disease, these differences seem to be mainly driven by individual patient characteristics. Adjustment for country characteristics refined the results to a limited extent, but maternal condition seems to be the main determinant of outcome

Dependence in instrumental activities of daily living and its associations with other geriatric syndromes in people over 65 years of age: data from the Russian epidemiological study EUCALYPT

Aim – to assess the frequency of disability in instrumental activities of daily living (IADLs) and to analyze its associations with other geriatric syndromes in persons aged ≥65 years. Material and methods. The study involved 4,308 people (30% male) living in 11 regions of the Russian Federation, aged 65 to 107 years (average age 78 ± 8 years). The majority (60%) of participants were examined in a polyclinic, every fifth – in a hospital (20%) or at home (19%), 1% – in nursing homes. All patients underwent a comprehensive geriatric assessment, including an assessment of instrumental activities of daily living on the Lawton scale. Results. Among the elderly, a high (54%) prevalence of dependence in IADLs was revealed, and with increasing age, this indicator increased significantly, reaching 82% in people over 85 years old. In patients with disability in IADLs, the frequency of all geriatric syndromes, except orthostatic hypotension, was higher, of which the most common were chronic pain syndrome (90%), frailty (80%), dependence in basic activities of daily living (ADLs) (78%), cognitive impairment (75%), probable depression (63%) and urinary incontinence (54%). One-factor regression analysis showed that the presence of disability in IADLs increases the chances of detecting other geriatric syndromes by 1.6–5.9 times. Conclusion. The results of the EUCALYPT epidemiological study demonstrate a high prevalence of dependence in IADLs among the Russian population. The study also gives an idea of the relationship of dependence in IADLs with various geriatric syndromes

Diagnosis and Treatment of Elderly and Senile Chronic Constipation: an Expert Consensus

Aim. An appraisal of practitioners with chronic constipation management details in older and senile adults.Key points. Chronic constipation is a common issue in geriatrics. Aside to age-related physiological bowel disfunction, a higher constipation incidence is conditioned by declined physical activity and frailty, polypharmacy and a series of secondary constipation-developing chronic states and diseases. Chronic constipation is associated with a higher risk of cardiovascular disease and complications, impaired general perception of health and pain, growing alarm and depression, and reduced quality of life. The treatment tactics in chronic constipation is cause-conditioned and should account for the patient’s history and therapy line, overall clinical condition, cognitive status and functional activity level. An essential baseline aspect of constipation management is apprising the patient and his family of the underlying factors and methods for non-drug and drug correction. An higher-fibre diet is recommended as first measure, with osmotic laxatives added and titrated to clinical response if none observed towards the non-drug and high-fibre regimens. Stimulant laxatives and prokinetics should be recommended in patients reluctant to fibre supplements and osmotic laxatives. Subsidiary correction includes biofeedback, transanal irrigation, acupuncture, foot reflexology and percutaneous tibial nerve stimulation.Conclusion. Elderly and senile chronic constipation is a prevalent multifactorial state requiring an efficient management via assessment and correction of total risk factors and consistent use of non-medication and drug therapies

Preventive technologies in geriatrics: focus on falls

Falls predict functional status declines in old age and institutionalization. Among the causes of the falls are sensory deficits, cognitive impairment, chronic diseases such as cardiovascular, endocrine diseases, musculoskeletal system pathology, the use of sedatives, antihypertensive drugs, neuroleptics and diuretics, as well as external causes, including inappropriate aids. The optimal diagnostic method in this case is a comprehensive geriatric assessment, which allows for focused history taking, detailing the circumstances of the fall, identification of risk factors and assessment of consequences, the gait and balance testing, determination of the lower limbs and joints functions are hold in the course of CGA along with orthostatic test that detects sensory deficits. Additional measures of mandatory recommendations should be a discussion of rational nutrition, with an emphasis on adequate intake of protein with food and fluids as prevention.</jats:p

Nursing geriatric protocol: set of measures to prevent the development of delirium in hospitalized elderly and senile patients

In this article, the authors consider the problem of delirium in the elderly and senile age, which is an actual geriatric syndrome in the world clinical practice. The paper focuses on the management of an elderly patient with delirium by secondary medical personnel. For this purpose, the geriatric nursing protocol «Set of measures to prevent the development of delirium in hospitalized elderly and senile patients» is provided, which is used in the clinical practice of the Russian Clinical and Research Center of Gerontology. The protocol provides an idea of the prevalence and relevance of delirium. The parameters for evaluating a patient with delirium, the nursing strategy, and the expected results from implementing the protocol are described. The necessary diagnostics for the scale are given, an important place is given to the prevention of delirium. The need to train nurses in diagnosis, prevention, and patient care is discussed.</jats:p

Torasemide: additional benefits for postmenopausal women with arterial hypertension

Effective and safe diuretic torasemide has additional effects of renin-angiotensin-aldosterone system blockage. Torasemide can be used as monotherapy or combined with other antihypertensives. In low doses torasemide produces pronounced antihypertensive effect without augmentation of excretion of potassium and water with urine. Long-term administration of torasemide was not associated with significant effects on lipid, purine, carbohydrate, or electrolyte metabolism parameters. Torasemide particularly effective in postmenopausal women, as these women are more likely formed low-renin hypertension. Therefore, torasemide can be used more widely in modern clinical practice.</jats:p

Nurse protocol: nutrition and malnutrition assessment

Hospitalized older adults are at risk of malnutrition. Nurses should carefully assess and monitor the nutritional status of the older hospitalized patient so that appropriate nutrition-related interventions can be implemented in timely fashions.Elderly patients are at risk of malnutrition due to dietary, economic, psychological and physiological factors. Older people are at risk of developing malnutrition. This condition or the risk of its development is observed in 39–47% of hospitalized elderly patients. The use of the Mini-Nutritional Assessment (MNA) is recommended to identify malnutrition or the risks of its development. The MNA scale takes into account the diet, patient mobility, BMI, the dynamics of weight loss, psychological stress, acute diseases, dementia and other mental features of the patient.Management plan of a patient with malnutrition: monitoring the implementation of the recommendations of a dietitian, clinical pharmacologist, and other specialists who determine the patient’s nutrition, ensuring adequate supply of nutrients, clinical nutrition (artificial nutrition, special nutritional support, parenteral, enteral nutrition, or a combination thereof), oral administration dietary supplements.</jats:p