卷 25, 编号 2 (2021)

The author revises the latest evidence in the literature regarding of organizing medical care for patients with osteoporosis in primary medical care. In the world, there is an increase in the group of older people (60 years and older), therefore, the problem of osteoporosis and osteoporotic fractures becomes very urgent. In Russia, the number of hip fractures will increase by 70% by 2050 compared to 2015. The article provides an overview of studies demonstrating the clinical and cost-effectiveness of population-based screening programs for the identification and subsequent treatment of patients at high risk of fractures, and discusses the issues of secondary prevention of fractures. With the active identification of patients at high risk of fractures and the initiation of antiosteoporotic therapy, a decrease in the incidence of osteoporotic fractures, including hip fractures, is expected.

在老年人中发生的最常见的老年综合征之一是认知障碍（CR）。 痴呆症是一种严重的CR，导致违反专业，家庭和社会活动并逐渐减少独立性。 然而，在大多数情况下，痴呆症的阶段之前是长时间的非痴呆症CR。 在这方面，公共卫生的优先事项之一是在早期阶段确定可能可逆的痴呆和认知障碍（CF）形式。
目的：研究老年人的临床和人口特征，评估其对认知状态的影响，并确定老年人CR的频率。
材料和方法：从24.10.2019到15.12.2019在圣彼得堡申请老年科的65岁及以上患者连续样本的单阶段研究。 检查方法：蒙特利尔认知状态评估量表（MCA），老年抑郁症量表，血压测量（BP），门诊记录数据，药物治疗评估，实验室测试（临床血液测试，脂谱，激素测试，葡萄糖，转氨酶
结果：研究参与者中度认知障碍（MCI）的频率为62.9％（95％CI56-70），重度认知障碍（CRD）-8.2％。 动脉高血压（AH），急性脑血管意外（ONMC），睡眠质量差的投诉，认知投诉和抑郁症状与CF的减少正相关，即使在调整协变量后。 高血压和抑郁症状与CR的存在有关（p<0.05）。 抑郁症与总CF和注意力功能指标下降相关（p<0.05），糖尿病（DM）-思维功能下降（p=0.02），血红蛋白水平低-总CF和记忆功能下降（p<0.01）。 服用β受体阻滞剂（β受体阻滞剂）与总CP减少和记忆功能恶化有关（p<0.01）。
结论：在老年和老年患者中，CR的频率很高。 已经证明动脉高血压（AH），贫血，糖尿病（DM），抑郁症状和使用β受体阻滞剂与老年人和老年认知状态恶化的关联。

该文章介绍了梅奇尼科夫西北国立医科大学家庭医学教研室的建立历史，指出了国际项目在其建立和发展主要活动方向中的作用。文章举了一些成功的长期合作的例子，特别是与爱荷华大学（美国） 的合作。描述了在卫生及临床医学研究科初级环节医师的专业再培训框架内的教学“全科医学（家庭医学）”专业形成的主要阶段。强调了在学习过程中使用各种交互技术的重要性，包括在模拟条件下技能培训，这些技术早在专家认证过程中开始使用之前就已被该部门引入。注意到为医疗系六年级学生教授“门诊内科学”学科的特点，并介绍了由学生科学协会参与者进行的科学研究的指导经验。考虑了该部门近年来实施的主要研究方向，旨在全科医疗实践中全面研究圣彼得堡和阿尔汉格尔斯克的老年患者的管理特点和慢性阻塞性肺疾病的发病率。强调了国际互动在实施大型科学项目中的作用，特别是与天主教鲁汶大学（比利时）的互动。指出了家庭医学科近期的发展前景。

International cooperation contributed to the development of family medicine in the North of Russia, it was characterized by a system approach and interdisciplinary interaction. The article presents the results of Russian-Norwegian projects that were developed with the active participation of the Department of Family Medicine of NSMU (Arkhangelsk), as well as the main aspects of the projects: significance for practical health care, research, and educational components.

Several complementary projects aimed at the development of primary health care, such as “Reform of Arkhangelsk Region Health Care System with a special emphasis on primary care”, “System approach to NCD prevention” and “Suicide prevention in the Arkhangelsk region” were implemented together with the Norwegian Directorate of Health. “The POMOR Program – specialist training in general practice in Northern Russia” project (together with the University of Tromsø – The Arctic University of Norway, Norwegian Medical Association, and Norwegian Centre for Rural Medicine) facilitated the development of tutorship in family medicine in the Arkhangelsk and Murmansk regions. Better interaction between psychiatrists and general practitioners in the mental health sphere became an essential area of international collaboration (“Integrating mental health into primary care in the Arkhangelsk County, Russia: the Pomor model in psychiatry” project together with the University of Tromsø – The Arctic University of Norway and University Hospital of North Norway, Tromsø). The education component of the projects got a sequel in the continued medical education system of NSMU while the scientific one was continued in the form of publications in international and Russian journals, and master’s thesis defense of public health degrees. The project's results were consistently presented at the international and Russian forums. General practitioner’s education is a cross-cutting theme for the cooperation on the path from a beginner to an expert and plays a special role in support of GPs during the COVID-19 pandemic.