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New coronavirus infection and elderly patients in primary care 新型冠状病毒感染与初级保健老年患者
Pub Date : 2023-07-20 DOI: 10.17816/rfd366923
K. V. Ovakimyan, O. Kuznetsova, E. Frolova, Ruzanna V. Ambartsumyan, V.S. Dranets, A. Litvinova
BACKGROUND: The high incidence of COVID-19 has been a major challenge to health systems in virtually every country in the world during the pandemic. Under these conditions, the elderly were especially vulnerable and were at risk for an unfavorable course of the disease. The elderly were not only at higher risk of contracting COVID-19 and had a worse outcome, but they could also experience reduced access to care for existing chronic noncommunicable diseases and be lost to follow-up. АIM: The aim of the study was to identify risk factors for the development of a severe course of COVID-19 in patients aged 60 years and older who applied for outpatient care during various periods of increased incidence of COVID-19: from March 2020 to February 2022. MATERIALS AND METHODS: The study was performed on the basis of the Center for Family Medicine of the North-Western State Medical University named after I.I. Mechnikov. A retrospective cohort study is based on an analysis of outpatient records of patients enrolled in the framework of compulsory health insurance, who applied for medical care at Center for Family Medicine and underwent COVID-19 during various periods of increased incidence, namely: from 19.03.2020 to 30.06.2020 (1st period), from 01.10.2021 to 30.11.2021 (2nd period) and from 18.01.2022 to 28.02.2022 (3rd period). Elderly patients were defined as study participants aged 60 years or older. RESULTS: The study included 343 patients: 137 men (39.9%) and 206 women (60.1%). The number of participants aged 60 and over was 85 (24.8%). It was found that in elderly patients such non-specific symptoms of acute respiratory viral infection as nasal congestion, rhinorrhea, sore throat, increased body temperature up to 38 ℃ (р 0.05) began to occur significantly more often. The severity of COVID-19 in elderly patients is influenced by the SARS-CoV-2 variant: the incidence of pneumonia and the number of hospitalizations were significantly less during the 3rd period of increase in the incidence (р 0.05), and the likelihood of developing a severe course of the disease was increased in 33.4 times and 23.8 times in waves 1 and 2, respectively, in comparison with wave 3. CONCLUSIONS: Over time, nasal congestion, rhinorrhea, sore throat, and an increase in body temperature up to 38 ℃ became significantly more common (p 0.05). Polymerase chain reaction testing for COVID-19 should be performed in all patients with symptoms of acute respiratory disease, regardless of severity. Pneumonia and hospitalization were significantly less common during the 3rd period of increased incidence (p 0.05), and the probability of developing a severe course of the disease was increased by 33.4 and 23.8 times in the 1st and 2nd waves, respectively, in compared to the 3rd wave. The data obtained should be taken into account when predicting severe outcomes in outpatients, developing tactics for monitoring and managing such patients.
背景:在大流行期间,COVID-19的高发病率一直是世界上几乎所有国家卫生系统面临的重大挑战。在这种情况下,老年人尤其容易受到伤害,并面临不利病程的风险。老年人不仅感染COVID-19的风险更高,结果更差,而且他们获得现有慢性非传染性疾病护理的机会也可能减少,无法进行随访。АIM:该研究的目的是确定在2020年3月至2022年2月COVID-19发病率增加的各个时期(即2020年3月至2022年2月)申请门诊治疗的60岁及以上患者发生COVID-19严重病程的危险因素。材料与方法:本研究在以I.I. Mechnikov命名的西北州立医科大学家庭医学中心进行。回顾性队列研究分析纳入强制医疗保险框架,在家庭医学中心申请医疗并在发病率增加的不同时期(2020年3月19日至2020年3月6日(第一期),2021年10月1日至2021年11月30日(第二期),2022年1月18日至2022年2月28日(第三期))就诊的患者的门诊记录。老年患者被定义为60岁或以上的研究参与者。结果:共纳入343例患者,其中男性137例(39.9%),女性206例(60.1%)。60岁以上的参与者有85人(24.8%)。发现老年患者急性呼吸道病毒感染的非特异性症状如鼻塞、鼻溢、咽喉痛、体温升高至38℃(0.05)开始明显增多。老年患者的COVID-19严重程度受SARS-CoV-2变异的影响:在发病率增加的第3个阶段,肺炎的发病率和住院次数明显减少(p < 0.05),与第3个阶段相比,第1和第2个阶段发生重症病程的可能性分别增加了33.4倍和23.8倍。结论:随着时间的推移,鼻塞、鼻溢、喉咙痛和体温升高至38℃变得更加常见(p < 0.05)。所有有急性呼吸道疾病症状的患者,无论其严重程度如何,都应进行COVID-19聚合酶链反应检测。在发病率增加的第3期,肺炎和住院的发生率明显降低(p < 0.05),发生严重病程的概率在第1波和第2波分别比第3波增加33.4倍和23.8倍。在预测门诊患者的严重后果、制定监测和管理此类患者的策略时,应考虑到所获得的数据。
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引用次数: 0
Study of the problems of ageism and assessment of attitudes towards age in the medical environment 医学环境中年龄歧视问题的研究和对年龄态度的评估
Pub Date : 2023-04-10 DOI: 10.17816/rfd321218
M. Grigorovich, Elena Y. Vychugzhanina, Elizaveta M. Limonova, Karine D. Guloyan, Anastasia A. Podushkina, Irina A. Gvozdeva
BACKGROUND: Ageism pervades all areas of life, including the areas of medical and social care. Gerontological ageism has a significant negative impact on indicators of physical, mental health, functional status and well-being of older people. In the conditions of an aging society, the study of the scale and characteristics of this problem in various spheres of life is very relevant. AIM: To assess the prevalence of stereotypes of attitudes towards older age among primary health care physicians, senior students of a medical university and directly elderly people. MATERIALS AND METHODS: In the period from 2018 to 2022, 538 people aged 20 to 75 were interviewed in 3 subgroups: 1) senior students of a medical university of medical specialties, 2) young and middle-aged primary health care doctors, 3) elderly people. RESULTS: It was revealed that the opinions about the problems in this age period in the elderly and the beliefs of doctors and medical students often do not coincide. CONCLUSIONS: When training medical personnel, it is necessary to form the correct attitude to age and skills of communicative competence with different age groups of patients.
背景:年龄歧视普遍存在于生活的各个领域,包括医疗和社会保健领域。老年歧视对老年人的身体、心理健康、功能状况和福祉等指标产生了重大的负面影响。在老龄化社会的条件下,研究这一问题在生活各个领域的规模和特征是非常相关的。目的:评估初级卫生保健医师、医科大学高年级学生和直接老年人对老年观念定型的普遍程度。材料与方法:2018 - 2022年,对538名年龄在20 ~ 75岁之间的人进行访谈,分为3个亚组:1)某医科大学医学专业高年级学生,2)中青年初级卫生保健医生,3)老年人。结果:老年人对这一年龄段问题的看法与医生和医学生的看法往往不一致。结论:在对医务人员进行培训时,应形成正确的年龄观和与不同年龄段患者沟通能力的技巧。
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引用次数: 0
The concept of pre-COPD: development and feasibility in primary health care copd前期概念:初级卫生保健的发展和可行性
Pub Date : 2023-04-10 DOI: 10.17816/rfd283633
E. Andreeva, M. Pokhaznikova, A. Turusheva, V. Popov, O. Kuznetsova
BACKGROUND: Chronic obstructive pulmonary disease is often not diagnosed as a preventable disease. The primary physician needs a diagnostic tool to detect chronic obstructive pulmonary disease at an early stage. AIM: To develop the concept of early detection of chronic obstructive pulmonary disease through a diagnostic tool that stratifies patients according to the risk of disease development. MATERIALS AND METHODS: Random sample of persons 3570 years from the lists provided by 15 polyclinics of Saint Petersburg and Arkhangelsk (cross-sectional study, n = 2388). Cohort prospective study (respondents with fixed or variable obstruction, n = 167). All respondents were asked about demographic data, smoking history, risk factors, and the presence of symptoms. Spirometry with a bronchodilator was performed for all participants. RESULTS: Fixed obstruction was found in 6.8% of the participants in the first phase; obstruction was associated with male sex, smoking status over 10 packs/years, age over 55 years, chronic cough and shortness of breath. Of the 65 members of the cohort with variable obstruction, 23.1% had a fixed obstruction after a year, the risk factors of which were a smoking status of more than 10 packs/years, a night cough and forced expiratory volume in 1 second less than lower limit of normal. CONCLUSIONS: Based on the results of the two phases of the study, a diagnostic tool was developed for the early detection of chronic obstructive pulmonary disease in the general population by identifying a group of people with preserved lung function and high-risk chronic obstructive pulmonary disease factors.
背景:慢性阻塞性肺疾病通常不被诊断为可预防的疾病。初级医师需要一种诊断工具在早期发现慢性阻塞性肺疾病。目的:通过一种根据疾病发展风险对患者进行分层的诊断工具,建立早期发现慢性阻塞性肺疾病的概念。材料和方法:从圣彼得堡和阿尔汉格尔斯克15家综合医院提供的名单中随机抽取3570岁的人(横断面研究,n = 2388)。队列前瞻性研究(有固定或可变阻塞的应答者,n = 167)。所有受访者都被问及人口统计数据、吸烟史、危险因素和症状的存在。所有参与者均使用支气管扩张剂进行肺活量测定。结果:第一阶段有6.8%的受试者出现固定梗阻;梗阻与男性、吸烟超过10包/年、年龄超过55岁、慢性咳嗽和呼吸短促有关。65例可变梗阻队列中,23.1%在1年后出现固定梗阻,其危险因素为吸烟超过10包/年、夜间咳嗽、1秒用力呼气量低于正常下限值。结论:基于两个阶段的研究结果,通过识别一组肺功能保留且慢性阻塞性肺疾病高危因素的人群,开发出一种诊断工具,用于在普通人群中早期发现慢性阻塞性肺疾病。
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引用次数: 0
The case of arrhythmic equivalent of myocardial ischemia in the practice of family doctor 心律失常等同于心肌缺血在家庭医生实践中的应用
Pub Date : 2023-04-10 DOI: 10.17816/rfd303084
I. V. Yubrina, I. Moiseeva, L. Degtyareva
In the practice of the family physician (general practitioner) there are patients with recurrent cardiac arrhythmia (most commonly ventricular extrasystoles) accompanying angina pectoris attacks associated with local myocardial ischemia and manifested by ST-segment depression or elevation on the electrocardiogram. At the same time, there are patients with ischemic heart disease who may have palpable or insensible episodes of cardiac arrhythmia without ST-segment displacement and typical retrosternal pain during exercise. This clinic requires a detailed approach to diagnosing the equivalent of myocardial ischemia, including, exercise tests and coronarography, especially if a diagnosis of ischemic heart disease has been confirmed before. The case of cardiac arrhythmia as an equivalent of angina pectoris in a 67-year-old male patient with a history of myocardial infarction with postinfarction angina pectoris is presented in the article. Stenting of the right coronary artery was performed twice during ischemic heart disease treatment. Knowledge of the signs of myocardial ischemia equivalents determined the tactics of patient management by a general practitioner already at the stage of interview of ischemic heart disease history. Examination and referral of the patient for coronarography contributed to timely angioplasty with stenting of the affected left circumflex coronary artery, which caused local myocardial ischemia and arrhythmia.
在家庭医生(全科医生)的实践中,有反复发作的心律失常(最常见的室性心动过速)伴有心绞痛发作,并伴有局部心肌缺血,表现为心电图上st段下降或升高。同时,缺血性心脏病患者在运动时可出现可触及或不明显的心律失常发作,但无st段移位和典型的胸骨后疼痛。该诊所需要一种详细的方法来诊断心肌缺血,包括运动试验和冠状造影,特别是如果之前已经确诊为缺血性心脏病。心律失常作为心绞痛的等效在一个67岁的男性患者心肌梗死史与梗死后心绞痛是在文章中提出的。在缺血性心脏病治疗期间,右冠状动脉支架置入两次。对心肌缺血等效症状的了解决定了全科医生在缺血性心脏病病史访谈阶段对患者的管理策略。检查并转诊患者进行冠状动脉造影,及时对受影响的左旋冠状动脉进行血管成形术支架植入,导致局部心肌缺血和心律失常。
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引用次数: 0
Analysis of the clinical course, complications and causes of mortality at the onset of the primary necrotizing systemic vasculitis 原发性坏死性全身性血管炎的临床病程、并发症及死亡原因分析
Pub Date : 2023-04-10 DOI: 10.17816/rfd115270
BACKGROUND: Primary necrotizing systemic vasculitis is a significant problem of practical healthcare due to a severe progressive clinical course and a high risk of complications, including life-threatening damage. AIM: To evaluate the features of the clinical course of primary necrotizing systemic vasculitis during the first 3 years of the disease. MATERIALS AND METHODS: The study included 232 patients with primary necrotizing systemic vasculitis, who were hospitalized in Saint Petersburg clinics from 2010 to 2018. The features of the clinical course, complications, causes of mortality during the first 3 years of the disease were assessed. RESULTS: The cohort of patients with рrimary necrotizing systemic vasculitis consisted of patients with granulomatosis with polyangiitis (n = 94), microscopic polyangiitis (n = 46), eosinophilic granulomatosis with polyangiitis (n = 69), polyarteritis nodosa (n = 23). The highest values of the Birmingham Vasculitis Activity Score index were noted among patients with granulomatosis with polyangiitis and microscopic polyangiitis (21.4 and 21.5 points, respectively). Patients with microscopic polyangiitis were significantly more likely to develop chronic kidney disease (C3aC5 stages) compared to other primary necrotizing systemic vasculitis (p 0.001). We established that the average value of the Vasculitis Damage Index after 36 months of the disease was highest in the group of patients with granulomatosis with polyangiitis (4.7 points) and significantly exceeded the corresponding indicator at the same period of the disease in the group of patients with microscopic polyangiitis, eosinophilic granulomatosis with polyangiitis, polyarteritis nodosa (3.8, 2.7 and 3.1 points, respectively). CONCLUSIONS: The most unfavorable prognosis among primary necrotizing systemic vasculitis during the first 3 years of the disease was noted in patients with granulomatosis with polyangiitis, which is reflected in the high level of the Vasculitis Damage Index that shows the number of irreversible organ lesions.
背景:原发性坏死性全身性血管炎是实际医疗保健中的一个重要问题,因为它具有严重的进行性临床病程和高风险的并发症,包括危及生命的损害。目的:探讨原发性坏死性全身性血管炎发病前3年的临床特点。材料与方法:该研究纳入了2010年至2018年在圣彼得堡诊所住院的232例原发性坏死性全身性血管炎患者。评估了该疾病前3年的临床病程、并发症和死亡原因的特点。结果:包括肉芽肿合并多血管炎(94例)、镜下多血管炎(46例)、嗜酸性肉芽肿合并多血管炎(69例)、结节性多动脉炎(23例)。伯明翰血管炎活动评分指数在肉芽肿合并多血管炎和显微镜下多血管炎患者中最高,分别为21.4分和21.5分。与其他原发性坏死性全身性血管炎相比,显微镜下多血管炎患者更有可能发展为慢性肾脏疾病(C3aC5期)(p < 0.001)。我们发现,病变36个月后血管炎损伤指数的平均值以肉芽肿合并多血管炎组最高(4.7分),明显超过了显微性多血管炎、嗜酸性肉芽肿合并多血管炎、结节性多动脉炎组同期相应指标(分别为3.8、2.7和3.1分)。结论:原发性坏死性全身性血管炎发病前3年预后最差的是肉芽肿病合并多血管炎患者,反映器官不可逆病变数量的血管炎损伤指数较高。
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引用次数: 0
The problem of toxoplasmosis in outpatient practice. Part I. Toxoplasmosis in immunocompromised patients 门诊治疗中弓形虫病的问题。第一部分免疫功能低下患者的弓形虫病
Pub Date : 2023-04-10 DOI: 10.17816/rfd296574
Toxoplasmosis remains one of the most common opportunistic infections in immunocompromised patients, primarily in people living with HIV. An increase in the number of requests for medical care by patients with HIV infection as the disease progresses determines the need for knowledge of outpatient therapists and general practitioners of decision-making algorithms for suspected toxoplasmosis in such patients. The main clinical manifestations of toxoplasmosis in patients with immunodeficiency states, the formulation of a preliminary diagnosis, and the routing algorithm are given.
弓形虫病仍然是免疫功能低下患者(主要是艾滋病毒感染者)中最常见的机会性感染之一。随着疾病的发展,艾滋病毒感染患者要求医疗服务的数量增加,这决定了门诊治疗师和全科医生需要了解此类患者疑似弓形虫病的决策算法。给出了免疫缺陷状态下弓形虫病患者的主要临床表现、初步诊断的制定及路径算法。
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引用次数: 0
Healthy aging and oral health 健康老龄化和口腔健康
Pub Date : 2023-04-10 DOI: 10.17816/rfd312945
E. Frolova, A. Turusheva, V. Trezubov, R. Rozov, M. Kabanov, R. Gvetadze, S. Arutyunov
Currently, much attention is paid to healthy aging and aspects affecting it, such as, for example, oral health. Oral health determines the social, physical and mental well-being of an elderly person. A large proportion of the dentists patients are elderly people with numerous concomitant chronic somatic diseases who regularly take numerous medications. Along with this, this category of people is characterized by specific dental symptoms and syndromes. The review analyzes geriatric syndromes associated with oral health problems. It is proposed to include questionnaires to identify dental problems in a comprehensive geriatric assessment.
目前,人们对健康老龄化及其影响因素,如口腔健康,关注较多。口腔健康决定着老年人的社会、身体和心理健康。牙医的病人中有很大一部分是患有许多伴随慢性躯体疾病的老年人,他们经常服用许多药物。与此同时,这一类人的特点是有特定的牙齿症状和综合症。这篇综述分析了与口腔健康问题相关的老年综合征。建议在全面的老年评估中包括问卷调查,以确定牙齿问题。
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引用次数: 0
The memory to S.L. Plavinsky 给s。l。普拉文斯基的回忆
Pub Date : 2023-04-10 DOI: 10.17816/rfd321184
Olga Y. Kuznetsova
The obituary is dedicated to the member of the editorial board of the Russian Family Doctor Journal Professor S.L. Plavinsky.
这则讣告是献给《俄罗斯家庭医生杂志》编委会成员S.L. Plavinsky教授的。
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引用次数: 0
Modification of the course of post-COVID syndrome associated with reactivation of chronic persistent Epstein−Barr virus infection and chronic nasopharyngotonsillitis of mixed etiology 慢性持续性eb病毒感染和混合病因慢性鼻咽扁桃体炎再激活与covid - 19后综合征病程的改变
Pub Date : 2023-04-10 DOI: 10.17816/rfd217717
V. Neverov
A wide range of symptoms that occur in patients with post-COVID syndrome can include both manifestations of the clinical consequences of COVID-19 and symptoms of an exacerbation of a chronic pathology that they had before the development of coronavirus infection. Correct assessment of clinical data can help determine the origin of the existing manifestations of the disease and build a plan for adequate diagnostic and therapeutic measures. In the article, on the example of a clinical case, a variant of the modified (exacerbation of chronic pathology) course of the post-COVID syndrome was analyzed. An example of modern laboratory diagnostics of reactivation of chronic persistent EpsteinBarr virus infection and exacerbation of chronic nasopharyngotonsillitis of mixed viral-bacterial-mycotic etiology, developed against the background of post-COVID syndrome, is given. The principles of therapy for this comorbid condition are presented and explained.
COVID-19后综合征患者出现的各种症状可能包括COVID-19临床后果的表现,也可能包括他们在发生冠状病毒感染之前就有的慢性病理恶化的症状。正确评估临床数据有助于确定疾病现有表现的起源,并制定适当的诊断和治疗措施计划。本文以一例临床病例为例,分析了新冠肺炎后综合征病程改变(慢性病理加重)的一种变体。本文给出了在后covid综合征背景下发展起来的慢性持续性eb病毒感染再激活和慢性病毒性-细菌-真菌混合病因的慢性鼻咽扁桃体炎加重的现代实验室诊断实例。提出并解释了这种合并症的治疗原则。
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引用次数: 0
Prevalence of chronic obstructive pulmonary disease and its risk factors among residents of Saint Petersburg and Arkhangelsk (based on the RESPECT project) 圣彼得堡和阿尔汉格尔斯克居民慢性阻塞性肺病患病率及其危险因素(基于RESPECT项目)
Pub Date : 2023-01-18 DOI: 10.17816/rfd112584
E. Andreeva, M. Pokhaznikova, V. Popov, O. Kuznetsova
BACKGROUND: The study of the true prevalence of chronic obstructive pulmonary disease remains a significant area of research, as there is still a large gap between the official record of detected cases of the disease and epidemiological data. AIM: To study the prevalence of chronic obstructive pulmonary disease and its risk factors in two cities in the North-West region of Russia. MATERIALS AND METHODS: A random sample of respondents (2121 residents of Saint Petersburg, 1012 residents of Arkhangelsk); 2974 received qualitative results of spirometry (including 2388 with a bronchodilator test). The questionnaire included demographic, socioeconomic indicators, and risk factors for chronic obstructive pulmonary disease. RESULTS: The average age (54.9 9.2 and 52.3 9.2 years) and the proportion of respondents with higher education (37.4% and 29.7%) were higher in Saint Petersburg (compared to Arkhangelsk, p 0.0001). The proportion of ever smokers (49.5% and 44.4 %, p = 0.008), as well as the prevalence of chronic obstructive pulmonary disease (7.6% and 5.4%, p = 0.044), were higher in Saint Petersburg. In Arkhangelsk, exposure to biomass fuel and occupational hazards were more often noted. The prevalence of chronic obstructive pulmonary disease was higher in smokers and increased with age; the prevalence of smoking and chronic obstructive pulmonary disease was higher in men. CONCLUSIONS: The analysis of chronic obstructive pulmonary disease risk factors allows us to better understand not only the prevalence but also the structure and significance of each risk factor in different populations, which will improve the early diagnosis of the disease.
背景:慢性阻塞性肺疾病真实患病率的研究仍然是一个重要的研究领域,因为该疾病检测病例的官方记录与流行病学数据之间仍然存在很大差距。目的:研究俄罗斯西北地区两个城市慢性阻塞性肺疾病的患病率及其危险因素。材料和方法:随机抽样调查对象(圣彼得堡居民2121人,阿尔汉格尔斯克居民1012人);2974例肺活量测定获得定性结果(包括支气管扩张剂试验2388例)。调查问卷包括人口统计、社会经济指标和慢性阻塞性肺疾病的危险因素。结果:圣彼得堡的平均年龄(54.9 9.2岁和52.3 9.2岁)和受高等教育的受访者比例(37.4%和29.7%)较高(与阿尔汉格尔斯克相比,p 0.0001)。曾经吸烟者的比例(49.5%和44.4%,p = 0.008)以及慢性阻塞性肺病的患病率(7.6%和5.4%,p = 0.044)在圣彼得堡更高。在阿尔汉格尔斯克,更经常注意到接触生物质燃料和职业危害。慢性阻塞性肺疾病的患病率在吸烟者中较高,且随年龄增长而增加;吸烟和慢性阻塞性肺病的患病率在男性中较高。结论:通过对慢性阻塞性肺疾病危险因素的分析,不仅可以了解不同人群的患病率,还可以了解各危险因素的结构及意义,有助于提高慢性阻塞性肺疾病的早期诊断水平。
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引用次数: 0
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Russian Family Doctor
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