Search

In modern medicine, studies devoted to the assessment of the parameters of residential infrastructure and the population's attitude towards them have become quite large-scale. Objectives: The aim of the study was to establish associations between individually perceived parameters of residential infrastructure and the main modifiable cardiovascular risk factors (hypertension, obesity, lipid and carbohydrate metabolism disorders) in one of the subjects of the Russian Federation. Methods : The epidemiological study "Study of the influence of social factors on chronic non-communicable diseases" started in 2015 and ended in 2023. The sample was formed by using the stratification method based on the assignment to a medical organization. The study included 1598 respondents aged 35 to 70 years (491 rural residents). The study of infrastructure parameters was conducted based on the subjective opinions of respondents using the neighborhood environment walkability scale (NEWS) questionnaire, divided into eight scales. Logistic regression analysis was used to identify associations between infrastructure parameters and cardiovascular risk factors; the odds ratio (OR) and 95% confidence interval were evaluated. Results : Individually perceived infrastructure parameters of the scale B, reflecting the accessibility of infrastructure facilities, were associated with hypertension [OR = 1.33], obesity [OR = 1.40], and abdominal obesity [OR = 1.59]. Elements of the social infrastructure of the scale C, describing the streets in the residential area, increased the likelihood of developing obesity [OR = 1.42] and visceral obesity [OR = 1.43]. The characteristics of the residential area, represented by the scale D that evaluates pedestrian infrastructure, were associated with all major cardiovascular risk factors (hypertension [OR = 1.65], obesity [OR = 1.62] and abdominal obesity [OR = 1.82], and disorders of lipid [OR = 1.41] and carbohydrate metabolism [OR = 1.44]). Conclusion : Social factors represented by various aspects of infrastructure have become important criteria for determining cardiovascular health. Environmental conditions affect cardiovascular risk factors through behavioral patterns that shape the respondent's lifestyle. Interventions in urban planning-increasing accessibility to infrastructure facilities for the population, developing a pedestrian-friendly urban environment, improving physical activity resources in areas, planning recreation areas, and landscaping-can become the most important concept for the prevention of cardiovascular diseases.

The personnel plays important role in process of maintaining internal quality control and safety of medical care. The employee satisfaction with working conditions is main factor affecting professional development and competence enhancement and consequently quality of medical care. The purpose of the study is to analyze particular personnel policies of the institution and to investigate effectiveness of quality management system regarding health care services. Results. The institution implemented the model of quality management system (ISO 9001-2015) assigning significant role to proper personnel management. The sociological survey was carried out to analyze achieved results and to receive feedback from employees to improve quality management system. The results of sociological survey indicate that the most important targets of personnel policies for 65% of respondents are planning, forecasting skill, competency requirements; for 58% - organization of conditions improving effectiveness of employees; and for 51,7% - maintaining favorable team moral and psychological climate. The employees consider as preferable following ways of professional development: additional training, specialized training programs (78.5%), exchange of experience and communication between Russian and foreign colleagues (51.0%). The analysis established that 61.8% of employees of the institution assume mentoring programs would improve efficiency of new employees. Conclusions. The results of the study revealed that personnel policy of the institution can be improved through implementing particular policies regarding development of employee personal additional competency; of mentoring programs and motivation systems for employees; evaluation of employee individual contribution into achieving the goals of the institution and forming personnel reserve.

The aim of this study was to evaluate Cardio-Ankle Vascular Index (CAVI) and increased arterial stiffness predictors in patients with carbohydrate metabolism disorders (CMD) in the population sample of Russian Federation., Methods: 1617 patients (age 25-64 years) were enrolled in an observational cross-sectional study Epidemiology of Cardiovascular Diseases and Their Risk Factors in the Regions of the Russian Federation (ESSE-RF). The standard ESSE-RF protocol has been extended to measure the cardio-ankle vascular index (CAVI), a marker of arterial stiffness. Patients were divided into three groups: patients with type 2 diabetes mellitus ( n = 272), patients with prediabetes ( n = 44), and persons without CMD ( n = 1301)., Results: Median CAVI was higher in diabetes and prediabetes groups compared with group without CMD ( p = 0.009 and p < 0.001, respectively). Elevated CAVI (≥9.0) was detected in 16.8% of diabetes patients, in 15.9% of those with prediabetes, and in 9.0% of those without CMD ( p < 0.001). The factors affecting on CAVI did not differ in CVD groups. In logistic regression the visceral obesity, increasing systolic blood pressure (SBP) and decreasing glomerular filtration rate (GFR) were associated with a pathological CAVI in CMD patients, and age, diastolic blood pressure (DBP), and cholesterol in persons without CMD., Conclusions: the CAVI index values in the prediabetes and diabetes patients were higher than in normoglycemic persons in a population sample of the Russian Federation. Since the identified disorders of arterial stiffness in prediabetes are similar to those in diabetes, their identification is important to prevent further cardiovascular complications.

Objective: To evaluate the association of the type D personality and the level of coronary arteries calcification in population-based sample., Methods: 1595 residents aged 25 to 64 years were recruited in a observational cross-sectional study in the period from 2012 to 2013. In addition to the ESSE-RF study protocol, we assessed the presence of a Type D personality and quantified coronary artery calcium (CAC) using multispiral computed tomography. The obtained data was analyzed by the Agatston method. The patients were divided into two groups: patients with type D personality (n = 231) and without type D (n = 1379)., Results: CAC score differed significantly between the groups: 689.3 ± 53.7 in patients with type D and 546.5 ± 47 without type D (p = 0.04). The greatest differences of calcium score were found in the left coronary artery system, namely left anterior descending artery (p = 0.01) and circumflex artery (p = 0.03). Patients with type D had higher levels of clinically significant anxiety (p = 0.04) and depression (p = 0.02). Type D personality is associated with high levels of CAC score independently from age, sex, diabetes mellitus status, smoking, alcohol consumption, body mass index, arterial hypertension status, cholesterol level, history of brain stroke, myocardial infarction, coronary artery disease, HADS-A and HADS-D scores., Conclusions: Type D personality is associated with higher average values of the CAC score, and type D may represent a potentially modifiable risk factor CAD. But it is unclear whether type D can affect the progression of CAC score., (Copyright © 2020 Elsevier Inc. All rights reserved.)

In Russia, the process of clustering institutions at the regional level is evolved. The analysis of scientific publications revealed only several examples of efficiently functioning medical clusters. As a rule, the publications present problems or projects and perspectives of development of medical clusters. At that, no information is available concerning organizational mechanisms integration of institutions. Purpose of the study is to evaluate the results of partnership between institutions of science and practice in resolving strategic health problems related to diseases of blood circulatory system. Materials and methods. The study applied such methods as monographic approach, data derivation, statistical technique, logical and system analysis. Results. The partnership between scientific and educational institutions and practical health care organizations was analyzed on the example of the system of medical care of circulatory system diseases organized in the Kemerovo region. The effective functioning of such a partnership is based on seven integration principles. Thus, the number of treated patients increased by 7.1% from 2011 to 2018. At the same time, the number of beds decreased by 9.2%. As a result, bed turnover increased by 18.1% over this period. The work of X-ray surgery service almost doubled the rate of percutaneous coronary interventions in case of acute coronary syndrome (from 22.0% in 2011 to 42.7% in 2018). The main organizational basics of successful cooperation of institutions are succession and interdependency in work of physians and departments, joint environments of quality management, knowledge management and personnel training, shared management of research and medical activity, common production and information environment, corporate culture and traditions.

The purpose of the study is modeling and analysis of effect of social economic characteristics of regions on population mortality of cardiovascular diseases. The official data of the Federal service of state statistics of the Russian Federation were used concerning social economic indices and mortality of cardiovascular diseases in the regions of Russia in 2012. The selection of social economic indices included percentage of males in population structure, percentage of individuals of retirement age, percentage of urban population, percentage of individuals with income lower that living wage, percentage of the unemployed individuals, Gini coefficient, percentage of individuals with university education, atmosphere air pollution with emissions of permanent sources, average per capita consumption of vodka and liqueurs, criminality, percentage of regional budget for social cultural expenses, percentage of workers involved in unhealthy labor conditions from total number of population of region. The selection of indices of mortality of cardiovascular diseases included class of diseases of blood circulation system in general, ischemic heart disease and class of cerebrovascular diseases. The mortality was evaluated in overall by population and separately on able-bodied age. The modeling of dependence of mortality from social economic indices was implemented using regression analysis. The calculated ?-coefficients and coefficients of determination were applied to determine approximate input of each predictor into alteration of levels of mortality. The statistically significant mathematical models of dependence of mortality on number of social economic indices were derived. The values explain on 40-75% spreading of regional indices of mortality. The percentage of input of age factor into regional differences of mortality reaches 13-35% in various classes of cardiovascular mortality. Besides, in able-bodied age the average per capita consumption of hard alcoholic beverages (vodka and liqueurs) can be considered as a stable predictor of cardiovascular mortality with corresponding input of 5-7% in the regional differences. The other social economic indices demonstrate a statistically significant relationship only in certain indices of mortality that permits to surmise about only supposed cause-and-effect relationships.

Aim: To estimate the prevalence of the genotypes of the candidate genes ACE (I/D, rs4646994), ADRB1 (Ser49Gly, A/G, rs1801252) ADRA2B (I/D), MTHFR (C677T, Ala222Val, rs1801133), and eNOS (4b/4a) and their association with hypertension in two ethnic groups of Mountain Shoria., Subjects and Methods: A clinical and epidemiological study was conducted in a population compactly living in the hard-to-reach areas of Mountain Shoria (the settlements of Orton, Ust-Kabyrza, and Sheregesh of the Kemerovo Region). A continuous method was used to survey 1178 residents from the above settlements; the sample consisted of adults (aged 18 years and older), 565 people were genotyped., Results: The prevalence of hypertension among the population of Mountain Shoria was 42.3%. The incidence of this disease among the Shorians was lower (39.9%) than that among the representatives of non-indigenous people (46.1%). The ethnically justified peculiarities of the association of ADRA2B and ACE I/D polymorphisms with hypertension were established. There were fewer patients with hypertension among ACE ID and ADRA2B DD genotype carriers in the cohort of the Shorians than in that of the non-indigenous population: 40.6% versus 58.6% and 38.3% versus 64%, respectively. Conversely, there were more hypertensive patients among the carriers of the homozygous ACE DD genotype in the native ethnic group (60%) than in the non-indigenous one (37.1%)., Conclusion: Adverse prognostic ACE DD, ADRB1 AA, MTHFR TT, and eNOS 4a/4a genotypes were more frequently observed in the non-indigenous ethnic groups; the ADRA2B DD genotype was more common in the native population. Hypertension was associated with the ACE DD, МTHFR CT, and ADRB1 AA genotypes in the native ethnic group and with the ACE ID genotype in the non-indigenous population.

The purpose of this study was to explore the long-term survival of patients after myocardial infarction (MI) and to elucidate main medical and social factors affecting survival., Material and Methods: In 2006 we included into this study 791 consecutive patients with MI. Duration of follow-up was 8.5 years. Survival was analyzed by construction of life tables and calculation of Kaplan-Meier estimates., Results: During follow-up 446 patients died. Leading was cardiovascular death (88.2%). Other causes were cancer (7.1%), internal diseases (4.1%), and external causes (0.6%). Risk of death was the highest during first year. One, three, and five-year survival was 74.9, 62.2 and 53.8%, respectively. Main medical and social factors that reduced long-term survival were: old age, lack of work, no percutaneous coronary intervention during initial hospitalization, recurrent myocardial infarction, and male sex among working age patients.

On results of research in 13 occupational groups (3842 workers, men) there were performed an analysis of a contribution of non-occupational factors of cardiovascular risk (FCVRs) and the elimination of their modifying influence on risks for the development of the arterial hypertension (AH). In the capacity of non-occupational FCVRs there were considered 16 predictors of AH. There were calculated the relative risk of AH and 95% the confidential interval (CI) in occupational groups on benchmark data of the prevalence rate of AH and after the elimination of the modifying influence of FCVRs. Reference group was the general sample, that is, all the occupations. Modifying influence of FCVR was eliminated by means of direct standardization. With the aid of trees of classifcation from the number of FCVRs in occupational groups the presence of obesity and age of the worker (respectively, 100 and 78 conditional points) was shown to have the maximum impact on the development of AH. Elimination of the influence of data of FCVRs led to the change of benchmark values of occupational risks of AH in the average for 10%, in four occupations level of the statistical importance of risks of AH changed. In top-managers, and also in operating personnel and technical workers the risk for AH from the high decreased to not significant, respectively to 1,00 at 95%, CI: 0.74-1.36 and 1.20 at 95%, CI: 0.97-1.49. On the contrary, the risk for AH increased from low to statistically not significant in underground equipment operators (0.85 at 95%, CI: 0.71-1.01) and labourers (0.89 at 95%, CI: 0.69-1.14).

Aim: To investigate factors associated with pathological cardio-ankle vascular and ankle-brachial indices (CAVI and ABI) in patients with carbohydrate metabolic disorders (CMD)., Subjects and Methods: A cross-sectional study was conducted in the framework of the multicenter epidemiological study "Epidemiology of Cardiovascular Diseases and Their Risk Factors in the Russian Federation" (ESSE-RF) in March to October 2013. The standard ESSE-RF protocol was extended by an additional study of peripheral arterial stiffness, by estimating CAVI and ABI automatically. A sample of 1619 people was formed in several stages, in which 311 patients with type 2 diabetes mellitus and prediabetes were identified and divided into 3 groups: 1) 41 patients with pathological CAVI values (≥9.0); 2) 241 with normal CAVI (<9.0); 3) 29 with pathological ABI (<0.9)., Results: In the population-based sample of patients with CMD, the pathological CAVI values (≥9.0) were detected in 14.5%, and the pathological ABI was in 9.3% of the examinees. Regression analysis showed that the pathological vascular indices (both CAVI and ABI) were significantly associated with increases in blood pressure (BP) and heart rate (HR), and a decrease in glomerular filtration rate. At the same time, only the pathological CAVI was associated with advancing age (odds ratio (OR), 1.111; 95% confidence interval (CI), 1.050-1.176; p < 0.001), visceral obesity (OR, 3.088; 95% CI, 1.001-10.495; p=0.038), smoking duration (OR, 1.093; 95% CI, 1.008-1.185; p=0.009), prior stroke (OR, 4.695; 95% CI, 1.408-15.658; p=0.018), and a need for insulin therapy (OR, 18.947; 95% CI, 1.902- 87.783; p=0.006). The pathological ABI was associated with male sex (OR, 2.227; 95% CI, 1.040-4.765; p=0.039), prior myocardial infarction (OR, 8.646; 95% CI, 2.174-34.378; p=0.005), obesity (OR, 2.439; 95% CI, 1.010-5.889; p=0.034); hyperglycemia (OR, 2.439; 95% CI, 1.010-5.889; p=0.034), hyperuricemia (OR, 4.009; 95% CI, 1.850-8.684; p=0.033), and increases in triglyceride levels (OR, 2.984; 95% CI, 1.376-6.470; p=0.004) and CAVI (OR, 1.193; 95% CI, 1.034-1.377; p=0.005)., Conclusion: The pathological vascular indices CAVI and ABI are associated with different risk factors for cardiovascular events in a cohort of patients with CMD. The common factors associated with both CAVI and ABI are increases in blood pressure and HR and a reduction in glomerular filtration rate. The common factors associated with both CAVI and ABI are increases in blood pressure and HR and a reduction in glomerular filtration rate.

Aim: To rank the subjects of the Russian Federation by the trend direction in all-cause and cardiovascular mortality (including mortality from coronary heart disease and cerebrovascular diseases) as a whole and at able-bodied age., Subjects and Methods: The investigation used mortality rates from to the 2006 and 2012 data available in the Federal State Statistics Service on 81 subjects of the Russian Federation. According to mortality rates, each region was assigned a rank in 2006 and 2012. Trends in rank changes in the Russian Federation's regions were analyzed. A cluster analysis was used to group the subjects of the Russian Federation by trends in rank changes., Results: The cluster analysis of rank changes from 2006 to 2012 could combine the Russian Federation's regions into 10 groups showing the similar trends in all-cause and circulatory disease mortality rates. Overall, the results of the ranking and further clusterization of the regions of the Russian Federation correspond to the trends in all-cause and cardiovascular mortality rates according to the data of other Russian investigations, by qualitatively complementing them., Conclusion: The trend rank-order method permits a comprehensive comparative analysis of changes in all-cause and cardiovascular mortality in the subjects of the Russian Federation both as a whole and at able-bodied age, which provides qualitatively new information complementing the universally accepted approaches to studying the population's mortality.

This study is a continuation of (Report I) identification of the occupational risk of arterial hypertension (AH) in 13 occupational groups (3842 workers, men). In previous work there was eliminated the influence of traditional factors of the cardiovascular risk, in this study there was implemented the identification of the components of a healthy worker effect (HWE) and the elimination of their influence on the occupational risks of hypertension. Identification and removal of components HWE--the effect of a healthy recruitment (EHR) and the effect of the healthy worker persisting to work (EHWPW--was carried out by the analytic rearranging of the standardized for age and obesity prevalence rate of arterial hypertension with the use of own methodological approaches. For the determination of the presence and severity of EHR there was performed an analysis of the initial prevalence rate of arterial hypertension in the youngest age groups (under 31 years). To overcome HER standardized for age and obesity indices of the arterial hypertension prevalence rate were adjusted by the ratio of the frequency of arterial hypertension in the most young occupational and reference comparable groups. Identification of HWPW was executed by comparing the frequency of AH among workers retiring within 3 years from the occupational groups when compared to the whole sample. Then on the additional risk value there was adjusted the overall prevalence rate of AH in the occupation profession to overcome EHWPW. As a result of the consistent correction and elimination of the influence of HWE components on the prevalence rate of AH, there were obtained risks values, primarily reflecting the impact of occupational factors which can be considered as true occupational risks. Factors of the cardiovascular risk and HWE significantly modified true occupational risks for AH in a number of occupational groups up to inversion. At the same time, the pronouncement of EHR has a paramount importance in the modifying effect.

Aim: To assess the long-term survival in working-age patients after cerebrovascular accident (CVA) and to define basic medical and social factors determining the survival rates., Material and Methods: A continuous retrospective study included 756 working-age patients (<60 years) after CVA. The life-table method and Kaplan-Meier analysis were used to calculate a survival rate., Results: The highest risk of death was observed in the first year of CVA. One-year survival after CVA was 81.7%, falling to 74.7% at 3 years and to 57.9% at 7 years. The five-year survival was lower among men (60%) compared to women (74.5%). The figures were higher in working population compared to non-working population (78% vs. 56%, respectively). Long-term survival rate depends on the type of CVA: the five-year survival rate after unspecified stroke was 83.0%, after ischemic stroke - 69.0%, after hemorrhagic stroke - 43.0%. The direct dependence between long-term survival and patient age has been identified: older patients have worse long-term prognosis., Conclusion: The seven-year survival rate in working-age patients after cerebrovascular accident was 58%. The health and social factors affecting the long-term survival rates in working-age patients are as follows: hemorrhagic stroke, unemployment, male gender and advanced age.

The article considers means of development ofsystem of specialized medical care under acute coronary syndrome. The new organizational approaches provide optimization of structure of specialized hospital, development of mechanisms of multi-stage and multi-level interaction of medical organizations of the subject of the Russian Federation as exemplifed by the Kemerovskaia oblast and integration of resources of institutions of health care, science and education.

Losses of health from myocardial infarction in the city of Kemerovo were estimated accordingly to the disability-adjusted life year (DALY) index, as well as its compartments: YLL (years lost due to premature death) and YLD (years lost disability). When ranking districts of the city of Kemerovo both in terms of chemicals exposure and the value of the DALY index there was revealed the opposite direction of these indices. The performance of the correlation analysis of health losses with concentrations of chemical contaminants allowed to reveal a feedback between them among the elderly patients (60 years and older) and direct--in young (up to 45 years old) cases. This fact probably may attest to the significant contribution of the environmental pollution in the process of development and progression of atherosclerotic changes in the young population.

The authors describe their first experience of a new approach in dispensary follow up of patients presenting with atherosclerosis obliterans of lower-extremities vessels. The work was based on the municipal system of rendering outpatient medical care in the city of Kemerovo. The patients were subdivided into two groups: one group remained under supervision of the surgeon, the other one was referred to the cardiologist. The mean duration of follow up amounted to 12 ± 1.5 months. The scope of carried out diagnostic, therapeutic and preventive procedures was assessed. The new approach to outpatient follow up, i. e., participation of the cardiologist in the therapeutic process made it possible to improve quality of medical care, also revealing positive alterations in diagnosis, treatment, and prevention of atherosclerosis obliterans of lower-limb vessels.

Despite undoubted achievements of modern cardiology in prevention and treatment of atherosclerosis, cardiologists, neurologists, and vascular surgeons are still facing severe stenotic atherosclerotic lesions in different vascular regions, both symptomatic and asymptomatic. As a rule hemodynamically significant stenoses of different locations are found after development of acute vascular events. In this regard, active detection of arterial stenoses localized in different areas just at primary contact of patients presenting with symptoms of ischemia of various locations with care providers appears to be crucial. Further monitoring of these stenoses is also important. The article is dedicated to innovative organizational approaches to provision of healthcare to patients suffering from circulatory system diseases that have contributed to improvement of demographic situation in Kuzbass.

Increasing prevalence of cardiovascular diseases induces an urgent need to identify and clear delineation of the most important risk factors for the development and progression of atherosclerosis. Unlike the second part of XXth century, today the World Health Organization considers particulate matter ambient pollution one of the most important predictors of cardiovascular events. However, results of similar studies conducted in the last decades, is highly fragmented. The authors' objective was to try to understand and organize this massive of accumulated information and analyze it to draw conclusions about the impact of particulate matter on the functioning of human cardiovascular system.

On the example of 5437 employees of enterprises and institutions of the Kemerovo region, compiled into 14 occupational groups, an analysis of the relationship between age structure and the frequency of arterial hypertension due to the working conditions has been performed At high levels of hardness of employment and the impact of physical factors, a shift in the age structure toward younger age is seen, which is considered as a demographic consequence of professional ageing. In turn, expressed professional ageing causes the reduction in the prevalence of hypertension, which is, probably is implemented by the effect of "healthy worker".

Aim: To study the medical and social aspects of in-hospital mortality after myocardial infarction (MI) in the cardiology center of a major industrial city in Western Siberia., Patients and Methods: The material of the study was the database of patients with acute coronary syndrome (19 283 patients), formed by a continuous method retrospectively. The volume of the study were 6463 patients with MI for 2006-2011., Results: In-hospital mortality of patients with MI was 11.8%, with MI complicated by cardiogenic shock--87.4%, in the primary MI--7.4%, during the second MI--22.1%. In-hospital mortality in MI depends on the age of the patients: in group of patients of working age mortality was 4.7%, the retirement age--12.4%, old age--22.7%. In the working-age group mortality in men is almost three times higher than in women. The mortality of patients with MI without reperfusion was 13.4%, in the case of reperfusion therapy--9.2%., Conclusions: Hospital mortality depends on the patient's age, type of MI (primary or repeated), the severity of the condition, applied treatments.

The importance of occupational selection in prevalence of arterial hypertension in researches of professional cohorts is considered in the article. Because arterial hypertension represents not only the independent disease, but also one of the most important indexes of the functional status of a human body, prevalence of arterial hypertension in professional groups can be substantially caused by occupational selection. As an epidemiological phenomenon of occupational selection "healthy worker effect", known of scientific literature from the middle of last century is considered. Besides, it is offered to consider the regularities of professional selection opposite to "healthy worker effects", as "unhealthy worker effect". The professional conditionality of arterial hypertension considered from epidemiological line items can be distorted by occupational selection. Thus existence of "healthy worker effect" makes impression of absence of direct link between level of occupational influence and frequency of arterial hypertension. At the same time, the increase in prevalence of arterial hypertension not always testifies to its professional conditionality, and can be connected to "unhealthy worker effects". Possible solutions of problems associated with identification of relationships between occupational factors and prevalence of hypertension in the presence of "effects of the healthy" and "unhealthy worker" are discussed. The challenge of considered problem in occupational medicine despite the numerous offered methodological approaches of elimination or decrease in influence of occupational selection is noted.

The authors presented dependence of arterial hypertension on work intensity, exemplified by two occupational groups--teachers and electricians, and demonstrated modifying influence of occupation on prevalence of traditional cardiovascular risk factors.

Tendency to growth of prevalence of ischemic heart disease (IHD) occurring in Russian Federation despite application of preventive measures designates necessity of search for novel nontraditional factors of risk. Among other studied factors of genesis of cardiovascular diseases in general and of IHD in particular is the role of xenobiotics - chemical pollutants, substances foreign to the body. In this paper we present results of a number of epidemiological studies on the problem of xenobiotics and IHD. Special attention is given to the difficulty of isolation of the leading chemical pollutant and as a consequence of pathogenetic link what leads to underestimation of pathological states caused by ecological factors especially in such urbanized region with developed chemical industry as Kusbass.

Risk analysis of development of arterial hypertension in 14 occupational groups of Western Siberia (4472 workers) is carried out. As a reference group the all-Russian data on prevalence of arterial hypertension by results of the second stage of monitoring of an epidemiological situation on arterial hypertension in the Russian Federation (2005-2007) were used. Paid off the odds ratio and 95% a confidential interval. The obtained data allowed to characterize occupational distinctions of risk of development of arterial hypertension and to allocate occupational groups of Western Siberia with high level of arterial hypertension. Results of research testifies to need of consideration of healthy worker effect as the factor of formation of frequency of arterial hypertension connected with a profession in occupational groups.

The analysis of age features of prevalence of an arterial hypertensia in the basic professional groups of the coal-mining enterprises was carried out. In total 1575 workers of collieries and cuts of Kuzbas united in 9 professional groups participated in the research. The results of research demonstrated the distinctions of age structure in the professional groups, testifying about expressed professional senescence among workers of mines, which reveals itself in the decrease in relative density of persons of 50+ years. In these groups with the expressed professional senescence the decrease in relative density of persons with an arterial hypertensia--so-called effect of the "healthy worker", in turn, is observed.

Methodological aspects of the development of the strategy for the improvement of efficiency of sanatorium-resort services in the regional healthcare system based on the experience of "Prokopievsky" sanatorium, Kemerovo region. Different stages in the history of the sanatorium are described with special reference to its role in continuous medico-social rehabilitation of the patients and in the maintenance of continuity of medical care provided by municipal outpatient, inpatient, and sanatorium settings. Transition to new forms of organization and work of sanatorium-resort facilities required in-depth analysis of their day-by-day activities as well as problems and obstacles hindering their further development. After having overcome the crisis of 2001-2006, sanatorium "Prokopievsky" strengthened its position at the market of sanatorium-resort services not only by continuing basic activity but also by developing new lines of medical aid and attracting new categories of patients. In 2007, the share of proceeds from medical and commercial services reached 93.3% and 1.2% respectively compared with 0.12% and 1.32% in 2002.

Pertussis toxin (PT), a secreted virulence factor of Bordetella pertussis, ADP ribosylates mammalian G(i) proteins and plays an important early role in respiratory tract infection by this pathogen in a mouse intranasal infection model. To test the hypothesis that PT targets resident airway macrophages (AM) to promote this infection, we depleted AM by intranasal administration of liposome-encapsulated clodronate prior to bacterial inoculation. This treatment enhanced respiratory tract infection by B. pertussis, even though it also induced a rapid influx of neutrophils to the airways. Strikingly, AM depletion also enhanced infection by mutant strains deficient in PT production or activity to the same level as the wild-type infection, indicating that AM may be the primary target cells for PT in promoting infection. The enhancing effect of clodronate-liposome treatment on infection (i) was shown to be due to macrophage depletion rather than neutrophil influx; (ii) was observed for both tracheal infection and lung infection; (iii) was observed during the early and peak phases of the infection but was lost by day 14 postinoculation, during clearance of the infection; (iv) persisted for at least 1 week (prior to bacterial inoculation); and (v) was equivalent in magnitude to the effect of PT pretreatment and the effects were not additive, consistent with the idea that PT targets AM. We found that PT efficiently ADP ribosylated AM G proteins both in vitro and after intranasal administration of PT in mice and that the duration of G protein modification in vivo was equivalent to the duration of the enhancing effect of PT treatment on the bacterial infection. Collectively, these observations indicate that PT targets AM to promote early infection of the respiratory tract by B. pertussis.

Previously we found that pertussis toxin (PT), an exotoxin virulence factor produced by Bordetella pertussis, plays an important early role in colonization of the respiratory tract by this pathogen, using a mouse intranasal infection model. In this study, we examined the early role played by another exotoxin produced by this pathogen, adenylate cyclase toxin (ACT). By comparing a wild-type strain to a mutant strain (DeltaCYA) with an in-frame deletion of the cyaA gene encoding ACT, we found that the lack of ACT confers a significant peak (day 7) colonization defect (1 to 2 log(10)). In mixed-infection experiments, the DeltaCYA strain was significantly outcompeted by the wild-type strain, and intranasal administration of purified ACT did not increase colonization by DeltaCYA. These data suggest that ACT benefits the bacterial cells that produce it and, unlike PT, does not act as a soluble factor benefiting the entire infecting bacterial population. Comparison of lower respiratory tract infections over the first 4 days after inoculation revealed that the colonization defect of the PT deletion strain was apparent earlier than that of DeltaCYA, suggesting that PT plays an earlier role than ACT in the establishment of B. pertussis infection. Examination of cells in the bronchoalveolar lavage fluid of infected mice revealed that, unlike PT, ACT does not appear to inhibit neutrophil influx to the respiratory tract early after infection but may combat neutrophil activity once influx has occurred.

Background: Pertussis toxin (PT) is an exotoxin virulence factor produced by Bordetella pertussis, the causative agent of whooping cough. PT consists of an active subunit (S1) that ADP-ribosylates the alpha subunit of several mammalian G proteins, and a B oligomer (S2-S5) that binds glycoconjugate receptors on cells. PT appears to enter cells by endocytosis, and retrograde transport through the Golgi apparatus may be important for its cytotoxicity. A previous study demonstrated that proteolytic processing of S1 occurs after PT enters mammalian cells. We sought to determine whether this proteolytic processing of S1 is necessary for PT cytotoxicity., Results: Protease inhibitor studies suggested that S1 processing may involve a metalloprotease, and processing does not involve furin, a mammalian cell protease that cleaves several other bacterial toxins. However, inhibitor studies showed a general lack of correlation of S1 processing with PT cellular activity. A combination of replacement, insertion and deletion mutations in the C-terminal region of S1, as well as mass spectrometry data, suggested that the cleavage site is located around residue 203-204, but that cleavage is not strongly sequence-dependent. Processing of S1 was abolished by each of 3 overlapping 8 residue deletions just downstream of the putative cleavage site, but not by smaller deletions in the same region. Processing of the various mutant forms of PT did not correlate with cellular activity of the toxin, nor with the ability of the bacteria producing them to infect the mouse respiratory tract. In addition, S1 processing was not detected in transfected cells expressing S1, even though S1 was fully active in these cells., Conclusions: S1 processing is not essential for the cellular activity of PT. This distinguishes it from the processing of various other bacterial toxins, which has been shown to be important for their cytotoxicity. S1 processing may be mediated primarily by a metalloprotease, but the cleavage site on S1 is not sequence-dependent and processing appears to depend on the general topology of the protein in that region, indicating that multiple proteases may contribute to this cleavage.

Pertussis toxin (PT), a virulence factor secreted by Bordetella pertussis, contributes to respiratory tract infection and disease caused by this pathogen. By comparing a wild-type (WT) B. pertussis strain to a mutant strain with an in-frame deletion of the ptx genes encoding PT (DeltaPT), we recently found that the lack of PT confers a significant defect in respiratory tract colonization in mice after intranasal inoculation. In this study, we analyzed serum antibody responses in mice infected with the WT or DeltaPT strain and found that infection with the DeltaPT strain elicited greater responses to several B. pertussis antigens than did infection with the WT, despite the lower colonization level achieved by the DeltaPT strain. The same enhanced antibody response was observed after infection with a strain expressing an enzymatically inactive PT; but this response was not observed after infection with B. pertussis mutant strains lacking filamentous hemagglutinin or adenylate cyclase toxin, nor when purified PT was administered with the DeltaPT inoculum, indicating a specific role for PT activity in this immunosuppressive effect. In particular, there were consistent strong serum antibody responses to one or more low-molecular-weight antigens after infection with the DeltaPT strain. These antigens were Bvg independent, membrane localized, and also expressed by the closely related pathogens Bordetella parapertussis and Bordetella bronchiseptica. Two-dimensional gel electrophoresis and mass spectrometry were used to identify one of the immunodominant low-molecular-weight antigens as a protein with significant sequence homology to peptidoglycan-associated lipoprotein in several other gram-negative bacterial species. However, a serum antibody response to this protein alone did not protect mice against respiratory tract infection by B. pertussis.

In this study, we sought to determine whether pertussis toxin (PT), an exotoxin virulence factor produced exclusively by Bordetella pertussis, is important for colonization of the respiratory tract by this pathogen by using a mouse intranasal infection model. By comparing a wild-type Tohama I strain to a mutant strain with an in-frame deletion of the ptx genes encoding PT (deltaPT), we found that the lack of PT confers a significant peak (day 7) colonization defect (1 to 2 log(10) units) over a range of bacterial inoculum doses and that this defect was apparent within 1 to 2 days postinoculation. In mixed-strain infection experiments, the deltaPT strain showed no competitive disadvantage versus the wild-type strain and colonized at higher levels than in the single-strain infection experiments. To test the hypothesis that soluble PT produced by the wild-type strain in mixed infections enhanced respiratory tract colonization by deltaPT, we coadministered purified PT with the deltaPT inoculum and found that colonization was increased to wild-type levels. This effect was not observed when PT was coadministered via a systemic route. Intranasal administration of purified PT up to 14 days prior to inoculation with deltaPT significantly increased bacterial colonization, but PT administration 1 day after bacterial inoculation did not enhance colonization versus a phosphate-buffered saline control. Analysis of bronchoalveolar lavage fluid samples from mice infected with either wild-type or deltaPT strains at early times after infection revealed that neutrophil influx to the lungs 48 h postinfection was significantly greater in response to deltaPT infection, implicating neutrophil chemotaxis as a possible target of PT activity promoting B. pertussis colonization of the respiratory tract.

The workers engaged in modern chemical nitrogen production before their retirement on the privileged basis because of noxious working conditions experienced the state of stress and overstress of the regulatory mechanisms, decrease of muscular and mental working capacity both at the initial stage and during the work shift, increase of chronic morbidity and temporary disability rates. These indicators were not identical in groups with different working conditions and sex structure. Among machine operators the major part of males before retirement compared to females maintained a more satisfactory level of work capacity. Disease rates and the degree of decrease of functional body capacities were higher in male metal workers in comparison with machine operators.