ISSN (print): 2072-1668, ISSN (online): 2713-2331 Founders: North-Western State Medical University named after I.I. Mechnikov, «Eco-Vector» LLC Editor-in-Chief: Kuznetsova O.Yu., Doctor of Sc., Full Professor Frequency / Access: 4 issues per year / Subscription Included in: RISC
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READ the details online (tap to see in details) Author’s license agreement (public offer) on the publication of an article in a scholarly journal “Russian Family Doctor” Eco-Vector, represented by its CEO Evgeniy Schepin and acting on the basis of the Charter (hereinafter referred to as the Publisher), on the one hand, offers an indefinite circle of persons (hereinafter referred to as the Author), and on the other hand, hereinafter jointly referred to as the Parties, to execute this agreement (hereinafter referred to as the Agreement) on the publication of scientific article (hereinafter referred to as the Article) in a scholarly journal “Russian Family Doctor” (further-the Journal) in accordance with the conditions stated below. I. 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Preconception Counseling in Primary Care Setting
Preconception counseling is an important step in planning a pregnancy. It improves women’s reproductive health and increases the likelihood of a successful pregnancy. This article provides a detailed overview of the key issues to discuss with a primary care physician before trying to conceive, including plans to have children, current physical health status (such as chronic diseases and medication use), mental health status, and genetic status. Preconception counseling should include a timely medical examination to identify and address potential risks for future children. Special attention should be given to the preconception management of chronic diseases, such as diabetes mellitus and epilepsy. The article emphasized the important roles of psychological support and genetic counseling to minimize risks and prevent possible complications. In addition, the article discusses preventive measures such as infection screening, vaccinations, and lifestyle changes, including efforts to combat obesity and bad habits. These efforts should create optimal conditions for conception and healthy pregnancy. Therefore, preconception counseling is crucial to maintain women’s reproductive health and ensure the safety of expectant mothers and their children.
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Twenty Years Since Discovery of Akkermansia muciniphila: Research and Prospects for Treating Metabolic Disorders in Children
First described in 2004, Akkermansia muciniphila remains a focus for scientists and healthcare professionals due to its potential impact on human health. The World Health Organization reports that 890 million adults are living with obesity in 2024, and this number continues to grow. Russia also demonstrates a steady increase in childhood obesity. From 2010 to 2020, the percentage of children with obesity increased from 6.7% to 9.1%. The intestinal microbiota and its waste products actively regulate metabolic activity in the gastrointestinal tract. Akkermansia muciniphila is known to secrete the P9 protein, which increases glucagon-like peptide-1 secretion by interacting with intercellular adhesion molecule 2. In mice, this improves glucose homeostasis and slows the progression of metabolic disorders, including type 2 diabetes mellitus. In humans, lower intestinal levels of Akkermansia muciniphila are associated with higher blood glucose and lipid levels, as well as greater body weight. In rats with induced diabetes mellitus, the oral administration of Akkermansia muciniphila significantly decreased serum levels of proinflammatory cytokines, such as lipopolysaccharide-binding protein and interleukin-1β, and increased serum levels of the anti-inflammatory cytokine interleukin-10. These results suggest that Akkermansia muciniphila has an anti-inflammatory effect. In recent years, research on Akkermansia muciniphila has demonstrated its high therapeutic and preventive potential. It is important to understand the relationship between dietary fiber, gut microbiota, bioavailability, and potential health benefits in order to develop healthy foods, improve eating habits, and prevent diseases. Akkermansia muciniphila has been identified as a potential probiotic candidate that plays a critical role in maintaining intestinal homeostasis, even in children under five years of age. Even non-viable Akkermansia muciniphila have beneficial effects, confirming the effectiveness of using this species of bacteria as a postbiotic or synbiotic.
Dietary Calcium Intake in Schoolchildren: a Two-Center Observational Study
BACKGROUND: Dairy products are a key source of calcium for children and adolescents. Calcium is essential for achieving peak bone mass, which largely determines bone health in old age. In recent years, there have been no large studies conducted in Russia that have evaluated dietary calcium intake. AIM: The study aimed to evaluate dietary calcium intake in schoolchildren aged 7–17 years. METHODS: A questionnaire was developed to evaluate dairy product consumption as part of a comprehensive survey of 1,361 students in grades 2–11 in two secondary schools in Yaroslavl and Kostroma (Russia). RESULTS: The mean calcium intake was 1,271.91 ± 779.7 mg/day, which decreased significantly with age. Physiological calcium intake was compared with reference values established in Russia. The percentage of children receiving an adequate amount of calcium decreased with age, ranging from 57.7% of students in grades 2–4, to 40.3% of students in grades 5–9, and 35.0% of students in grades 10–11. The percentage of children receiving 50%–99% of the daily calcium requirement increased from 33.1% of students in grades 2–4 to 44.4% and 48.0% of students in grades 5–9 and 10–11, respectively. The percentage of children receiving less than 50% of the daily calcium requirement also increased, from 9.2% to 15.3% and 17.0%, respectively. CONCLUSION: The obtained data demonstrate high prevalence of inadequate dietary calcium intake, especially in adolescents.
Comparison of Different Indications for Bone Densitometry in Male Patients
BACKGROUND: The national clinical guidelines include referral criteria for bone densitometry in cases of osteoporosis. These criteria are based on the 10-year risk of major fragility fractures, as calculated by the Fracture Risk Assessment Tool (FRAX). The effectiveness of the current diagnostic threshold for male patients has not yet been evaluated in Russia. AIM: The study aimed to evaluate the current and alternative thresholds for assessing 10-year fracture risk using the FRAX tool and the International Society of Clinical Densitometry (ISCD) guidelines for bone densitometry referrals in male patients aged 50 years and older. METHODS: A cross-sectional study was conducted in a random population of male patients aged 50 years and older who were referred for dual-energy X-ray absorptiometry. Diagnostic criteria such as sensitivity, specificity, and accuracy of various approaches to identifying patients at high risk for fractures were evaluated. These criteria are based on ISCD guidelines, with diagnostic thresholds based on 10-year fracture risk (FRAX) charts. The cost of diagnosing each case of high fracture risk was also estimated. RESULTS: Implementation of the ISCD guidelines increased diagnostic costs due to the large number of unnecessary densitometries performed. The current diagnostic threshold developed for female patients was associated with the lowest patient coverage by densitometry (14.4%) and identified the smallest percentage of men at high risk for fractures (7.7%). The use of male diagnostic thresholds provided optimal densitometry coverage and sufficient identification of patients at high risk for fractures at minimal cost. CONCLUSION: The alternative diagnostic thresholds for identifying men at high fracture risk proposed in the study were more effective and less costly than the current approach according to ISCD guidelines.
Copyright (c) 2025 Eco-Vector https://creativecommons.org/licenses/by-nc-nd/4.0/
Quality of Outpatient Care for Patients with Chronic Non-Communicable Diseases
BACKGROUND: The pressing task of the healthcare system is to provide high-quality medical care, including outpatient care, to patients with chronic non-communicable diseases. The progression of these diseases depends on the quality of medical care. Defects can complicate diagnosis, treatment, and prognosis. AIM: The study aimed to evaluate the quality of primary healthcare for patients with chronic, non-communicable diseases. METHODS: This was a cross-sectional study that included an analysis of a random sample of 288 outpatient medical records (n = 288). The study used quality criteria specified in the clinical guidelines on hypertension, type 2 diabetes mellitus, asthma, chronic obstructive pulmonary disease, and stable ischemic heart disease. The study also used parameters regulated by Order of the Ministry of Health of the Russian Federation dated March 15, 2022 No. 168н (168n) On Approval of the Procedure for Outpatient Follow-Up of Adults. This order regulates parameters such as the availability of data on complaints, smoking status, examinations, laboratory testing, investigations, diagnoses, and data on influenza and pneumococcal infection vaccinations. RESULTS: Complaints were obtained in 6.6%–11.7% of patients. The smoking status was reported in 75.5%–90.2% of cases. A complete physical examination was performed on all patients with stable ischemic heart disease (100%) and none of the patients with type 2 diabetes mellitus (0%). Patients with hypertension had the fewest referrals for laboratory tests (4.9%), whereas patients with asthma had the most referrals (88.7%). Only 54.7% and 56.7% of patients with asthma or chronic obstructive pulmonary disease, respectively, were referred for complete investigations. The diagnoses corresponded to clinical guidelines in 75.9% of patients with diabetes mellitus and only in 10.0% of patients with chronic obstructive pulmonary disease. Vaccinations against influenza and pneumococcal infection were recommended for 21.5% and 14.9% of patients, respectively. An analysis of the quality of medical care for patients with chronic non-communicable diseases during outpatient follow-up revealed issues that could affect disease progression, as well as the identification of complications and suitable treatments. CONCLUSION: The patient management did not fully comply with the clinical guidelines and Order of the Ministry of Health of the Russian Federation dated March 15, 2022 No. 168н (168n). Further research is needed to understand why outpatient follow-up is inadequate and how to improve it.
Changes in Mental and Physical Status and Potential Treatment for Patients with Post-COVID-19 Chronic Heart Failure
BACKGROUND: Coronavirus infection can negatively impact the mental and physical status of patients with chronic heart failure, exacerbating anxiety and depressive symptoms. These changes should be recognized and addressed promptly. AIM: The study aimed to evaluate the impact of COVID-19 on the mental and physical status of patients with chronic heart failure who were eligible for treatment in primary care settings. METHODS: The study included patients with chronic heart failure of various origins with or without a history of COVID-19. The physical and mental health of all patients was evaluated using three scales: the Sheehan Patient-Rated Anxiety Scale, the Beck Depression Inventory, and the Social Adaptation Self-Evaluation Scale. Eligible patients with COVID-19 were prescribed sertraline, a selective serotonin reuptake inhibitor antidepressant, based on results of a psychometric evaluation. RESULTS: Sertraline is shown to significantly improve anxiety disorder, particularly severe cases, in patients with chronic heart failure who have recovered from COVID-19. Sertraline was found to be even more clinically effective in the treatment of depression; it improved depressive symptoms in all study groups. Sertraline was found to affect cardiovascular parameters in patients with chronic heart failure after COVID-19. Sertraline decreased heart rate, thereby improving the course of chronic heart failure. In addition, the ejection fraction remained virtually unchanged in the short term, which indicates the efficacy and safety of sertraline. This supports the recommendation to add sertraline to the combined therapy for this patient group. CONCLUSION: The study confirms the significant impact of COVID-19 on the physical and mental status of patients with chronic heart failure. However, the agents used to treat these conditions may affect the cardiovascular system. Patients require a comprehensive treatment strategy that includes support for mental and physical health.
Asymptomatic Hyperphosphatemia in Healthy Young Men and Women: Potential Association with Electronic Nicotine Delivery Systems and Heated Tobacco Products
BACKGROUND: Hyperphosphatemia is defined as fasting phosphorus levels higher than 1.45 mmol/L. Although it is often asymptomatic, it can cause adverse effects, including hypocalcemia, decreased calcitriol levels, secondary hyperparathyroidism, ectopic calcification, hemodynamic disorders, and increased morbidity and mortality. Therefore, it is crucial to promptly identify and treat the underlying causes of hyperphosphatemia. Hyperphosphatemia is typically associated with renal failure. Less common causes include hypoparathyroidism; burn injury; metabolic and respiratory acidosis; rhabdomyolysis; tumor lysis syndrome; acromegaly; and excessive intake of phosphorus from food or medication. AIM: The study aimed to identify the possible causes of an asymptomatic increase in blood phosphorus levels in young healthy adults. METHODS: Laboratory tests were performed in young healthy men and women aged 18 to 35 years. RESULTS: Despite preserved renal function, asymptomatic hyperphosphatemia was diagnosed in 12 (9.9%) participants. A significant association was found between hyperphosphatemia and the use of electronic nicotine delivery systems and heated tobacco products (p = 0.0002). CONCLUSION: More research is needed on the effects of electronic nicotine delivery systems and heated tobacco products on human health, especially calcium and phosphorus metabolism.
PROTECT-2 Study: Association Between the Prevalence of Medical Conditions in Students of the North-Western State Medical University named after I.I. Mechnikov and Smoking Status
BACKGROUND: Products containing tobacco and nicotine are harmful to the human body. A previous PROTECT study revealed an unfavorable trend toward combined use of traditional and electronic cigarettes. The study also revealed that respondents are not aware enough of the negative effects of new nicotine products. AIM: The study aimed to evaluate the association between smoking status and prevalence and patterns of tobacco and nicotine product consumption and morbidity rates in medical university students. METHODS: A cross-sectional study of a continuous population of first-year students of the medical department of the North-Western State Medical University named after I.I. Mechnikov was conducted. An online questionnaire was used to collect data on smoking status, and outpatient records and the results of annual physical examinations from the university clinic were evaluated. RESULTS: The analysis included 466 first-year students, 26.0% of whom were male. The response rate was 91%. The mean age was 19.1 ± 2.5 years. Over two-thirds of respondents (79.6%) had never used traditional or electronic cigarettes. Prevalence of cigarette smoking was 2.4%. The use of any nicotine product was reported by 5.2% of respondents. The combined use of traditional and electronic cigarettes was found to be 12.9%. The study found no differences in smoking status by sex. Outpatient records showed that 10.1% of students had hypercholesterolemia, 2.4% had hyperglycemia, and 6.2% were overweight or obese. Atopic diseases, such as hay fever, allergic rhinoconjunctivitis and allergic dermatitis, were found in 3.2% of respondents. Upper and lower respiratory disorders, such as chronic sinusitis, tonsillitis, bronchitis, and asthma, were diagnosed in 6.4% of students. Acute respiratory viral infections more than three times per year were reported by 1.9% of first-year students. Cardiovascular disease was found in 6.9% of the respondents. The most common conditions included spinal diseases (15.5%), visual impairments (37.8%), gastrointestinal diseases (9%), and neurological diseases (4.3%). The prevalence of diseases affecting nearly all body systems ranges from 0.2% to 2.8%. The study found no difference in the prevalence of these diseases according to smoking status. CONCLUSION: Respondents who smoked preferred the combined use of traditional and electronic cigarettes. Annual physical examinations of first-year students reveal that some have risk factors for chronic non-communicable diseases. The trend of increased combined smoking in the presence of risk factors and medical conditions shows that smoking products are increasingly harmful to the health of young people, so further research is required.
Comparison of Frailty Rates in Aged Patients Using Updated Clinical Guidelines
BACKGROUND: Frailty is associated with the dysfunction of various organs and systems. According to Russian publications, it is often identified through outpatient screening. However, the clinical guidelines for frailty were revised in 2024. The diagnosis algorithm was significantly simplified, eliminating the need for pre-frailty identification and assessment of functional, mental, and emotional disorders prior to a comprehensive geriatric assessment. Therefore, it is necessary to determine whether the updated diagnostic algorithm changed the rates of frailty and associated geriatric syndromes. AIM: The study aimed to evaluate frailty rates in patients aged 60 years and older using the 2020 and 2024 diagnostic criteria, as well as determine the association between the rates of frailty and geriatric syndrome. METHODS: This cross-sectional, single-center study included aged male and female patients. Frailty was diagnosed using the 2020 and 2024 criteria. A comprehensive geriatric assessment was then conducted using questionnaires and scales. The DK-50 digital hand dynamometer (Russia) was used to assess muscle strength. RESULTS: The study included 462 patients (77 male and 385 female). The median age was 76 (62–83) years. No significant differences in frailty rates based on the 2020 and 2024 criteria, were found in the general aged population (25.7% and 29.9%, respectively; p = 0.164), nor in different age groups of men and women (p > 0.05). In addition, pre-frailty that was not identified using the 2024 criteria was present in 60.4% of patients. Of these, the Short Physical Performance Battery showed decreased mobility in 36.9% of patients, and the Mini-Cog test suspected cognitive impairment in 10.7% of patients. Among patients with frailty, muscle strength (p < 0.0027) and physical performance (p < 0.0015) were 3.9 and 8.9 times lower, respectively, using the 2020 criteria. Skeletal muscle function less than 2 times lower, using the 2024 criteria. CONCLUSION: The frailty rates showed no difference by sex or age, using the 2020 and 2024 criteria. Screening for frailty using the 2024 criteria, revealed that 36.9% of patients previously identified as pre-frail were underdiagnosed for functional disorders related to decreased mobility, which significantly increased the risk of frailty.
Body Composition Estimation: Bioelectrical Impedance Analysis, Skinfold Thickness Measurement or Anthropometry?
BACKGROUND: The body fat percentage is determined using dual-energy X-ray absorptiometry, bioelectrical impedance analysis, skinfold thickness measurement, and anthropometry. Skinfold thickness measurement and anthropometry are the most prevalent, yet less accurate, methods of body composition estimation. Body fat measurements obtained using different formulas based on skinfold thickness and anthropometry have not yet been compared to each other or to those obtained using bioelectrical impedance analysis in the Russian population. AIM: The study aimed to compare body fat percentage measured through bioelectrical impedance analysis and 15 different methods based on skinfold thickness, body mass index, as well as neck, waist, hip, and thigh circumferences. METHODS: This cross-sectional study included participants aged 17 to 30 years who provided informed consent. The main study parameters included sex, age, body weight, height, and skinfold thickness (above the triceps, above the biceps, chest, anterior axillary line, infrascapular region, above iliac crest, abdomen, and anterior thigh), as well as neck, waist, hip, and thigh circumferences. Accuniq BC720 was used to perform a bioelectrical impedance analysis with 15 body fat estimation formulas. RESULTS: The body fat percentage ranged from 17.6% [14.7%; 20.4%] to 41.8% [39.5%; 43.1%] in women and from 7.2% [5.2%; 10.2%] to 29.1% [27.5%; 31.5%] in men, depending on the formulas used. The body fat percentages most comparable to the bioelectrical impedance analysis data were obtained using two formulas: the U.S. Navy body fat estimation formula for women and the Davidson formula for men. Bioelectrical impedance analysis can identify people with excess body fat, even if they have a normal body mass index, body fat percentage, or waist-to-hip ratio. CONCLUSION: The U.S. Navy formula for women and the Davidson formula for men were the most accurate at determining body fat percentage, and they produced results comparable to those of bioelectrical impedance analysis. More research and specific formulas are needed to calculate body fat percentage in the Russian population.
The Effects of Personal History of Weight Gain and Loss on Attitudes Toward Overweight and Obese Individuals
BACKGROUND: A physician’s views on overweight and obesity can affect their attitude toward patients with these conditions, as well as their willingness to recommend weight loss and choice of treatment options they consider effective. AIM: The study aimed to evaluate the effects of a personal history of weight gain and loss on attitudes toward overweight and obese individuals among sixth-year medical students. METHODS: This cross-sectional study included sixth-year medical students who provided written informed consent. The main study parameters included sex, age, personal history of weight loss or gain, family history of being overweight, and scores on the Antifat Attitudes questionnaire and Body Parts Satisfaction Scale. RESULTS: The study showed that people with higher body mass indexes were more dissatisfied with their bodies. Body satisfaction levels were also influenced by factors such as the number of previously used weight-loss strategies and a history of being bullied for being overweight or obese. People with a family history of being overweight, who were bullied because of their weight, and who are currently dissatisfied with their body image are less likely to dislike overweight or obese people and to exercise. Male participants and participants who follow a diet tend to dislike overweight and obese people, blaming them for their conditions. CONCLUSION: A participant’s personal history of weight gain and loss, as well as their own body image, significantly affects their attitude toward overweight and obese individuals.
Case Report on Clinical Presentation of Foodborne Botulism
Botulism is an extremely dangerous infection caused by consuming food containing the botulinum toxin. It is classified as a foodborne toxic infection. Although botulism is relatively rare, it remains a significant health concern because it is difficult to diagnose, often resulting in late diagnoses and frequent fatal outcomes. Paresis and paralysis of smooth and skeletal muscles during botulinum toxin exposure often confuse healthcare professionals, leading to misdiagnosis and incorrect treatment. The article presents a case report of botulism in a female patient who was admitted to the intensive care unit (ICU) at the Botkin Clinical Infectious Diseases Hospital in 2024. The report clearly illustrates the clinical and laboratory challenges of diagnosing and treating this disease. The clinical presentation of botulism is similar to that of various infectious and non-infectious diseases. This underscores the importance of raising awareness and organizing health education initiatives, especially in primary outpatient settings, to encourage medical specialists to remain vigilant about botulism. It is crucial to educate the population systematically about the dangers of consuming improperly produced or stored canned foods in order to significantly reduce rates of botulism.