Methodological guidelines "Psychoemotional risk factors in outpatient practice" were developed as a practical document for primary care physicians in order to expand and improve knowledge, as well as provide care to the adult population within the studied theme. The methodological guidelines include an information and content part for medical specialists and a practical part for patients, presented in the format of memos. The guidelines include the main sections: definition, structure and epidemiology of psychoemotional risk factors, psychoemotional risk factors in the clinics of internal diseases, screening of psychoemotional risk factors, prevention and correction of psychoemotional risk factors for noncommunicable diseases, non-drug care for patients, pharmacotherapy of psychoemotional disorders. The guidelines are intended for primary care physicians, for specialists who develop and implement educational programs for patients, as well as for therapeutic residents.

The growing weight of noncommunicable diseases, primarily cardiovascular diseases (CVDs), is a great threat to the health of population worldwide, worsening the quality of life and reducing life expectancy. Realization of this threat led to initiation of epidemiological study by the Russian Ministry of Health to investigate the prevalence of CVDs and their risk factors, since it is CVDs that specify the high allcause mortality in Russia. In the modern history of epidemiology of non-infectious disease, the Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation (ESSE-RF) study occupies a special place. This is the largest epidemiological study, which is considered as a continuation of preventive activity in order to obtain unbiased information on epidemiological characteristics of population in Russian regions. To conduct the study, the Research Organizing Committee of ESSE-RF study was created and a protocol was developed. All interested scientists and experts from following three centers took part in the work: National Medical Research Center for Therapy and Preventive Medicine, Almazov National Medical Research Center, National Medical Research Center of Cardiology. The Russian regions were justified and selected for participation. In 2012-2014 ESSE-RF study, 13 following Russian regions took part: Volgograd, Vologda, Voronezh, Ivanovo, Kemerovo, Tyumen Oblasts; Krasnoyarsk and Primorsky Krai; the Republic of North Ossetia (Alania); cities of Orenburg, Samara, St. Petersburg and Tomsk. All participated regions used a single study protocol, while biochemical parameters were determined in Federal centers using the same equipment and reagent kits. The paper presents some of the most interesting results that indicate a change in Russian epidemiological situation over the past few years. After the end of cross-sectional study, a field of priority research areas was formed in each center.Conclusion. Epidemiological studies are the most important scientific tool for assessing the prevalence of diseases, their risk factors, as well as predicting adverse events. Based on the results obtained, healthcare system and medical community determine priorities and develop related strategies (population-based and high-risk strategies). For their implementation, a regulatory and legal framework is being created.

Due to continuous aging of population and increase in the number of elderly people, osteoporosis became socially significant disease leading to disability, increasing mortality and thereby putting an additional burden on the public healthcare system.Screening to identify groups with a high probability of fracture is recommended using the FRAX^®Tool for all postmenopausal women and men over 50 years old (А1). In the presense of major pathological fractures (hip, spine, multiple fractures) it is recommended to diagnose osteoporosis and prescribe treatment regardless of the results of spine and hip double X-ray absorptiometry (DXA) or FRAX^®(B2).It is recommended to evaluate C-terminal telopeptide when prescribing antiresorptive therapy and procollagen type 1 N-terminal propeptide (P1NP) when prescribing anabolic therapy to patients receiving osteoporosis treatment at baseline and 3 months after the start of therapy in order to assess the effectiveness of treatment early and adherence to the therapy (А2). It is recommended to diagnose osteoporosis and prescribe treatment to patients with high individual 10-year probability of major pathological fractures (FRAX^®) regardless of the results of spine and hip DXA (В3).It is recommended to diagnose osteoporosis and prescribe treatment with a decrease in BMD, measured by DXA, by 2.5 or more T-score standard deviations in femoral neck, and/or in total hip, and/or in lumbar vertebrae, in postmenopausal women and men over 50 years old (А2).It is recommended to prescribe bisphosphonates, denosumab or teriparatide to prevent pathological fractures and increase BMD in patients with postmenopausal osteoporosis, osteoporosis in men, glucocorticoid-induced osteoporosis (А2). When the clinical effect of therapy in osteoporotic patients without pathological fractures is achieved (BMD T-score > -2.0 SD in femoral neck and absence of new fractures), it is recommended to interrupt bisphosphonates therapy for 1-2 years with subsequent follow-up (B2). In patients with vertebral fractures, hip fractures or multiple fractures, it is recommended to continue ceaseless long-term treatment of osteoporosis (В3).All drugs for the treatment of osteoporosis are recommended to be prescribed in combination with calcium and cholecalciferol (А2). In order to reduce the risk of recurrent fractures by prescribing osteoporosis therapy timely and maintaining long-term follow-up of patients over 50 years old with pathological fractures, it is recommended to create Fracture Liaison Services (В2).

Неалкогольная жировая болезнь печени у взрослых: клиника, диагностика, лечение. Рекомендации для терапевтов, третья версия

Aim. To study the epidemiological characteristics and changes of hypertension (HTN), as well as factors associated with HTN in the Russian population aged 35-74 years.Material and methods. The Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation-3 (ESSE-RF3) study examined a representative sample of the population aged 35-74 years of 15 Russian regions with a response >70% (n=28611). Modular design questionnaire was used. Blood pressure (BP) was measured twice after a 5-minute rest in a sitting position on the right arm with an Omron blood pressure monitor. There were following criteria for hypertension: systolic blood pressure (SBP) ≥140 mm Hg and/or diastolic blood pressure (DBP) ≥90 mm Hg, and/or antihypertensive therapy. The effectiveness of treatment was considered the proportion (%) of people who achieved target blood pressure values among those being treated, while the control was considered the proportion (%) of patients with a BP <140/90 mm Hg of the total number of hypertensive patients. HTN changes were studied in a single age range of 35-64 years with the inclusion of materials from the ESSE-RF (2012-14) and ESSE-RF2 (2017) studies, carried out using the same methodology as ESSE-RF3. Statistical analysis was carried out using the open-source R 3.6.1 environment. Analysis of the association between factors and a binary variable was performed using logistic regression. The significance level for all tested hypotheses was 0,05.Results. According to ESSE-RF3, the average levels of SBP and DBP in the population were 131,9±18,7 and 84,4±10,9 mm Hg, respectively, while the proportion of those with BP ≥140/90 mm Hg — 38,8% (men: 44,8%, women: 33,9%). Prevalence of hypertension was 53,9% (men: 56,0%, women: 52,1%), awareness — 77,7% (men: 71,5%, women: 82,3%), while the treatment received 63,4%, significantly higher among women than among men: 72,3 vs 53,3%. The effectiveness of treatment was 44,0%, higher among women compared to men (48,2 vs 37,4%). In addition, 27,9% of patients have controlled HTN.Conclusion. The problem of controlled HTN in Russia remains unresolved in the 21st century. The following significant sex differences remain: the prevalence of HTN is higher among men, but awareness of the disease, treatment rate and its effectiveness are lower compared to women.

Background: Non-alcoholic fatty liver disease (NAFLD) is a very serious medical and social problem that can lead to the progression of liver cirrhosis and eventually hepatic failure. There is a paucity of data regarding the prevalence and risk factors for NAFLD in the Russian Federation. Methods: The open multicenter prospective screening study, DIREG 1, involved patients aged 18-80 years who were admitted to various polyclinics for ambulatory therapeutic care (with or without apparent signs of hepatic diseases) at 208 centers in the Russian Federation from March 25th to November 26th, 2007. NAFLD was diagnosed by ultrasonography; a range of clinical and laboratory findings were also recorded for each participant. Results: A total of 30,754 outpatients were included in the screening study analysis. The prevalence of NAFLD was 27.0% (8,315/30,754), of which 80.3% had steatosis, 16.8% had steatohepatitis and 2.9% had disease at the cirrhotic stage. Most cases of NAFLD were observed in those aged 50-59 years (31.1%), 40-49 years (23.6%), and 60-69 years (18.1%). The most common risk factors associated with the NAFLD cohort vs the general screening population were dyslipidemia (75.9% vs 37.6%), arterial hypertension (69.9% vs 41.8%), and hypercholesterolemia (68.8% vs 33.5%) (all P<0.001). Conclusion: There is an urgent need to address the high prevalence of NAFLD in the Russian Federation (27%) and the large proportion of individuals with associated risk factors.