Journal «MEDICINA» 4/2016

Trend analysis of tobacco consumption rates is essential for efficiency evaluation of national tobacco control measures in Russian Federation. Global Youth Tobacco Survey (ages 13-15) was conducted twice in Russian Federation during the last 10 years. The first round of the survey was taken in 2004 as baseline, and the current situation was evaluated in the second round in 2015. Both rounds were conducted in 5 regions of Russian Federation: Khabarovsk, Novosibirsk, Cheboksary, Moscow and Pskov regions. At the conclusion of two rounds in 2004 and 2015 a common pattern was identified in all regions. In general, collected data gives evidence of success of tobacco control measures and of positive dynamics in tobacco consumption among teenagers of ages 13-15, expressed in sharp decline of various consumption rates. However, some of the changes are meager and some are negative. Moreover, some new challenges that require corrections of the tobacco control policies were discovered. The following trends may be counted as positive. Smoking rates went sharply down, by more than twofold, and number of potential future smokers decreased by 3.5 times. Also the exposure to secondhand smoking reduced remarkably by twofold at home and by 2.5 times at public places. The availability of tobacco products lowered by twofold in average. The support of ban of smoking in closed public places increased among teenagers, as well as the impact of health warnings on the cigarette packs and awareness of hazardous effects of tobacco on health.

As for negative trends, the most pronounced were the following: the proportion of teenagers showing markers of nicotine dependence have increased multifold (by 6 times) and at the same time the proportion of teenagers who tried to quit in the last 12 months have decreased, as well as those who would like to quit in future. A deterioration of healthcare services in smoking cessation and treating tobacco dependence was identified. A considerable new challenge is presented in prominent increase of e-cigarettes usage by teenagers. It is possible that wide availability of the devices and the option of using cartridges with any amount of nicotine have led to the development of more severe nicotine dependence in teenagers mentioned above.

The survey shows that the tobacco control policies adopted in Russian Federation have succeeded to get the slowdown rates of tobacco consumption almost to the numbers set up in the Framework on Implementing National Tobacco Control Policies for 2010-2015 years, as well as lowering the percentage of people exposed to secondhand smoking, and increasing the awareness of health hazards of smoking in general public in the last few years. However, the areas where the efforts have to be strengthened even further were also identified. There is a need in the development of a healthcare service for smoking cessation support, treating tobacco dependence and tobacco-related health issues, and reinforcing the compliance with the ban of smoking in public places, the ban of tobacco advertising in media and the ban of tobacco sales to minors (under 18 years of age). A prompt adoption and implementation of measures aimed to protecting the teenagers’ health from the hazards of using electronic nicotine delivery devices and to preventing introduction of teenagers to other new forms of tobacco products is needed.

Key words: prevalence of tobacco use, tobacco smoking, risk factors, epidemiology, electronic cigarettes, electronic nicotine delivery, fight against tobacco, nicotine dependence

Implementation of a preventive programs directed at the HIV infection spread demands evaluation of its effectiveness judged by the number of HIV cases averted taking into account cost incurred. To simplify comparison of interventions in HIV filed and other medical fields a simplified cost-effectiveness analysis was proposed which is based on cost of HIV case completed with estimation of quality-adjusted life years (QALY) lost due to infection. Using model of HIV progression it was showed that cost of one HIV case is 1720 thousand rubles for males and 2195 thousand rubles for females (annual discount rate is 3.5%) taking present cost of antiretroviral therapy. One HIV case even if HIV treatment is optimal is associated with loss of 6,4 QALY in males and 4,4 QALY in females. Use of simplified cost-effectiveness analysis for comprehensive HIV prevention programs for intravenous drug users demonstrated that those programs incurred costs off by cutting down future treatment costs.

Key words: HIV-infection, cost-effectiveness, QALY, injecting drug users, prevention, public health

The article considers effects of the regional development characteristics on working-age population dropouts from the production process. Indicators applied are working-age mortality and duration of a single case of temporary disability. The study revealed positive effect of increasing the capacity of medical institutions and their consolidation in provision of high-quality and high-tech medical care.

Key words: mortality, working age mortality, the average duration of a single case of temporary incapacity, the restructuring of regional health systems, regression analysis

The article presents the results of studies on the development of composition and technology of complex eye drops with taurine and carnosine. The data on the selection of excipients is represented. Approved the selection of the active ingredients. The release of drugs from the dosage form was studied. The technology of production of eye drops was represented.

Key words: eye drops, carnosine, taurine, prolongated dosage forms

Connective tissue dysplasia of the heart is the frequent manifestation of connective tissue disturbance. To clarify the etiopathogenic features of the heart connective tissue dysplasia in sportsmen investigation of endothelial markers (d-dimer, C-protein, von Willebrand’s factor and antithrombine III) and damage factors (low density lipoprotein, very low density lipoproteins, homocystein, cytokines IL-4, TNF-α, IL-8) the study in 16 female athletes with mitral prolapse I and II degrees was undertaken. It was detected that endothelial dysfunction in athletes with prolapse of the mitral valve was associated with high levels of D-dimer, reduction of von Willebrand’s factor activity and low antitrombine III. Also high activity of antiendothelial factors such as low and high density lipoproteins, homocysteine, IL-8 compared with the athletes without mitral valve prolapse was determined.

Key words: mitral valve prolapse, sportsmen, еndothelial dysfunction

This article provides an analysis of the literature concerning research on the use of the proximal femoral nail antirotation (PFNA) with and without augmentation in treatment of patients with fractures of the osteoporotic femur. The authors used the descriptive and analytical methods. The search for relevant publications was carried out in the following databases: Google Scholar, e-Library Medline, and the Cochrane Consort library. Existing evidence base for the benefits of using PFNA with augmentation in osteosynthesis of hip fractures accompanied by osteoporosis shows the need for randomized controlled trials, despite the obvious theoretical and experimental advantages of the method.

Key words: proximal femoral nail antirotation, PFNA, augmentation, fracture of the femur, osteoporosis

The article presents results of literature analysis on the possible applications of neuroprotective drugs and results of modern pharmacoepidemiological studies of those drugs. Conclusions are made about the feasibility of an in-depth pharmacoepidemiological analysis of polyvalent neuroprotective drugs, including antioxidant melatonin (from the group of antioxidants), to extend their application in clinical practice.

Key words: pharmacoepidemiological analysis, neuroprotective drugs, melatonin

The article is devoted to the possibilities of modern intellectual support systems for medical decision-making in surgical practice. Review article describes general problems with the analysis of existing systems, analysis of their structure and mechanisms underlying the design of decision support systems for medical decisions (SPWR). Examples of different models SPUR intended for use in clinical practice of a surgeon are presented. The principles of SPUR at the different types of intraabdominal procedures are discussed. The article also describes the principles of operation of the existing systems of decision support for the most common types of surgery.

Key words: intra-abdominal surgical intervention, infectious complications, information system, decision support system for medical decisions, algorithms of diagnostics and treatment, disease model

The article presents the results of monitoring of the quality of iodized salt use for food purposes among different population groups living in conditions of natural iodine deficiency. Commitment among pregnant women, health workers and pensioners to mass and group iodine prophylaxis is estimated. The highest motivation for prevention is revealed among healthcare professionals. Among pregnant women as a risk group for iodine deficiency disorders, awareness and motivation for prevention is low. The examination of children born to women taking and not taking 200 mg / day of potassium iodide during pregnancy was undertaken (definition of neonatal TSH level, assessment the state of newborns according to Apgar scale, ultrasonic examination of the thyroid gland of children, assessment of intellectual and psychological status of children). Low-quality mass prevention of iodine deficiency with the use of iodized salt among the population of Ufa was revealed. The use of individual and group iodine prophylaxis with 200 mg/day of potassium iodide among risk groups (pregnant women throughout the gestational stage) significantly reduce the manifestations of iodine deficiency, but does not completely eliminate them.

Key words: iodine, iodine deficiency, thyroid gland, pregnancy, children

We conducted closure of the burn defects using plastics with the stem on the feed leg. It has been established that thermal imaging picture of the stem helps to determine possibility of cutting of feed leg when leveling the luminescence intensity between its peripheral end and surrounding tissues is leveled and the temperature gradient is stabilized and does not exceed 0,5^оС.

Key words: skin grafting, Filatov stem, infrared imaging

Article describes the studies of the resulting indicators of the Drug Treatment Service modernization in 2015. The study resulted in the development of a technique for calculation of integral quality assessment. Integral assessment made it possible to rate drug treatment services in federal districts and regions of Russia and compare them.

Key words: modernization, drug treatment service, rating, ranking, integral estimate, Russia