Translating and adapting the Alcohol Use Disorders Identification Test (AUDIT) for use in the Russian Federation: A multicentre pilot study to inform validation procedures

Aims: The Alcohol Use Disorders Identification Test (AUDIT) is one of the most widely used screening instruments worldwide. Although it was translated into many languages, not many country-specific adaptations exist, and a formal validation procedure of the Russian version has been carried out only recently. The present contribution documents the different steps taken to formally translate and adapt a Russian-specific version of the AUDIT (RUS-AUDIT). Methods: The AUDIT was translated into Russian following an established protocol, revised and adapted to the country context using an expert panel, and field-tested in an iterative approach, in line with WHO rules on instrument translation and adaptation A total of three pilot phases were carried out on 134 patients from primary healthcare (PHC) and 33 patients from specialised alcohol treatment facilities (narcology), guided by a specially established advisory board. Changes in each version were informed by the findings of the previous pilot phase and a thorough panel discussion. Results: Based on the findings of three different pilot phases, the RUS-AUDIT was developed as a paper-and-pencil interview for PHC professionals. Since various issues with representation and counting of standard drinks for the second test item arose, a special show card was developed to support the assessment. Preliminary AUDIT-C scores indicated that more than one-third of the screened women (34.2%) and about half of the screened men (50.9%) from PHC facilities have exceeded risk thresholds. Conclusions: The RUS-AUDIT was constructed as a feasible assessment tool for interviewers and patients. The large number of PHC patients who exceed the risk threshold has corroborated the need for formal validation and Russia-specific cut-off scores, considering the specific drinking patterns.

Impact of National Tobacco Control Policy on Rates of Hospital Admission for Pneumonia: When Compliance Matters

A number of studies claim that tobacco control (TC) regulations are associated with reductions in smoking-related hospitalisation rates, but very few have estimated the impact of TC laws (TCL) at both countrywide and regional levels, and none of them have studied the impact of TCL in relation to compliance with TC regulations. This study evaluates the effects of Russian TCL on hospital admission (HA) rates for pneumonia countrywide and in 10 Russian regions and the extent of these effects in connection with the compliance with TCL. Methods: HA rates for pneumonia from 2005-2019 were analysed to compare the periods before and after the adoption of TCL in 2013. An interrupted time series design and a Poisson regression model were used to estimate the immediate and long-term effects of TCL on pneumonia annual hospitalisation rates after the TCL adoption, compared with the pre-law period. The 10 Russian regions were compared using the TCL implementation scale (TCIS) developed on the basis of the results of the Russian TC policy evaluation survey; Spearman's rank correlation and linear regression models were employed. Results showed a 14.3% reduction in HA rates for pneumonia (RR 0.88; p = 0.01) after the adoption of TCL in Russia with significant long-term effect after 2013 (RR 0.86; p = 0.006). Regions with better enforcement of TCL exhibited greater reductions in pneumonia HA rates (rsp = -0.55; p = 0.04); (β = -4.21; p = 0.02). Conclusions: TCL resulted in a sustained reduction in pneumonia hospitalisation rates, but these effects, varying by region, may depend on the scale of the TCL enforcement.

Missing data and other challenges in assessing inappropriate marketing of baby foods in the Russian Federation: a cross-sectional study

OBJECTIVES

We used the WHO draft nutrient profile model (NPM) to evaluate baby foods targeted at infants and young children (IYC) aged 6-36 months in the Russian Federation to assess their suitability for marketing.

DESIGN

A cross-sectional study in Moscow (Russian Federation).

SETTING

Nutrition information of baby food was primarily collected from retailer websites, with some complementary data from physical stores. Both specialist stores for IYC and general supermarkets were included.

PARTICIPANTS

Two hundred and thirty baby food products targeted to IYC were selected. Breastmilk substitutes and products targeted at children over 3 years old were excluded.

MAIN OUTCOME MEASURES

Per cent of missing nutrition data, per cent of products with added sugar or sweetener and exceeded sodium or salts, per cent of products marketed as suitable for IYC under 6 months.

RESULTS

Most products were 'ready-to-eat', including fruit (n=42, 18.5%) and vegetable (n=29, 12.8%) purees, meat, fish or cheese purees (n =26, 11.5%); 'dry or instant cereal/starchy foods' (n=27, 11.9%), including predominantly dry cereals, 'juices and other drinks' (n=26, 11.5%). 95% (n=219/230) of products were missing total sugar information, 78% (n=180/230) were missing either sodium or salt, and 25% (n=57/230) were missing total fat. Among products with sugar and sodium information, 41% (n=94/230) included added sugar or sweeteners, and 48% (n=24/50) exceeded the NPM sodium threshold. 40% of products (n=92/230) were marketed as suitable for IYC aged under 6 months.

CONCLUSION

Baby foods marketed for IYC showed a high per cent of missing nutrition information and disparity with WHO's guidelines for complementary feeding, age of introduction, sugar and salt content. Stronger regulation is needed in this area to minimise higher risk of non-communicable diseases (NCDs) in later life.

Colchicine and the combination of rivaroxaban and aspirin in patients hospitalised with COVID-19 (ACT): an open-label, factorial, randomised, controlled trial

BACKGROUND

COVID-19 disease is accompanied by a dysregulated immune response and hypercoagulability. The Anti-Coronavirus Therapies (ACT) inpatient trial aimed to evaluate anti-inflammatory therapy with colchicine and antithrombotic therapy with the combination of rivaroxaban and aspirin for prevention of disease progression in patients hospitalised with COVID-19.

METHODS

The ACT inpatient, open-label, 2 × 2 factorial, randomised, controlled trial was done at 62 clinical centres in 11 countries. Patients aged at least 18 years with symptomatic, laboratory confirmed COVID-19 who were within 72 h of hospitalisation or worsening clinically if already hospitalised were randomly assigned (1:1) to receive colchicine 1·2 mg followed by 0·6 mg 2 h later and then 0·6 mg twice daily for 28 days versus usual care; and in a second (1:1) randomisation, to the combination of rivaroxaban 2·5 mg twice daily plus aspirin 100 mg once daily for 28 days versus usual care. Investigators and patients were not masked to treatment allocation. The primary outcome, assessed at 45 days in the intention-to-treat population, for the colchicine randomisation was the composite of the need for high-flow oxygen, mechanical ventilation, or death; and for the rivaroxaban plus aspirin randomisation was the composite of major thrombosis (myocardial infarction, stroke, acute limb ischaemia, or pulmonary embolism), the need for high-flow oxygen, mechanical ventilation, or death. The trial is registered at www.

CLINICALTRIALS

gov, NCT04324463 and is ongoing.

FINDINGS

Between Oct 2, 2020, and Feb 10, 2022, at 62 sites in 11 countries, 2749 patients were randomly assigned to colchicine or control and the combination of rivaroxaban and aspirin or to the control. 2611 patients were included in the analysis of colchicine (n=1304) versus control (n=1307); 2119 patients were included in the analysis of rivaroxaban and aspirin (n=1063) versus control (n=1056). Follow-up was more than 98% complete. Overall, 368 (28·2%) of 1304 patients allocated to colchicine and 356 (27·2%) of 1307 allocated to control had a primary outcome (hazard ratio [HR] 1·04, 95% CI 0·90-1·21, p=0·58); and 281 (26·4%) of 1063 patients allocated to the combination of rivaroxaban and aspirin and 300 (28·4%) of 1056 allocated to control had a primary outcome (HR 0·92, 95% CI 0·78-1·09, p=0·32). Results were consistent in subgroups defined by vaccination status, disease severity at baseline, and timing of randomisation in relation to onset of symptoms. There was no increase in the number of patients who had at least one serious adverse event for colchicine versus control groups (87 [6·7%] of 1304 vs 90 [6·9%] of 1307) or with rivaroxaban and aspirin versus control groups (85 [8·0%] vs 91 [8·6%]). Among patients assigned to colchicine, 8 (0·61%) had adverse events that led to discontinuation of study drug, mostly gastrointestinal in nature. 17 (1·6%) patients assigned to the combination of rivaroxaban and aspirin had bleeding compared with seven (0·66%) of those allocated to control (p=0·042); the number of serious bleeding events was two (0·19%) versus six (0·57%), respectively (p=0·18). No patients assigned to rivaroxaban and aspirin had serious adverse events that led to discontinuation of study drug.

INTERPRETATION

Among patients hospitalised with COVID-19, neither colchicine nor the combination of rivaroxaban and aspirin prevent disease progression or death.

FUNDING

Canadian Institutes for Health Research, Bayer, Population Health Research Institute, Hamilton Health Sciences Research Institute, Thistledown Foundation.

TRANSLATIONS

For the Portuguese, Russian and Spanish translations of the abstract see Supplementary Materials section.

Adaptation of the Health Literacy Survey Questionnaire (HLS19-Q) for Russian-Speaking Populations-International Collaboration across Germany, Israel, Kazakhstan, Russia, and the USA

The Russian language is the eighth most spoken language in the world. Russian speakers reside in Russia, across the former Soviet Union republics, and comprise one of the largest populations of international migrants. However, little is known about their health literacy (HL) and there is limited research on HL instruments in the Russian language. The purpose of this study was to adapt the Health Literacy Questionnaire (HLS₁₉-Q) developed within the Health Literacy Survey 2019–2021 (HLS₁₉) to the Russian language to study HL in Russian-speaking populations in Germany, Israel, Kazakhstan, Russia, and the USA. The HLS₁₉-Q was translated either from English or from a national language to Russian in four countries first and then critically reviewed by three Russian-speaking experts for consensus. The HLS₁₉ protocol and “team approach” method were used for linguistic and cultural adaptation. The most challenging was the adaptation of HLS₁₉-Q questions to each country’s healthcare system while general HL questions were flexible and adaptable to specific contexts across all countries. This study provides recommendations for the linguistic and cultural adaptation of HLS₁₉-Q into different languages and can serve as an example of international collaboration towards this end.

Seroprevalence of SARS-Cov-2 Antibodies in Adults, Arkhangelsk, Russia

Population-based data on coronavirus disease in Russia and on the immunogenicity of the Sputnik V vaccine are sparse. In a survey of 1,080 residents of Arkhangelsk 40–75 years of age, 65% were seropositive for IgG. Fifteen percent of participants had been vaccinated; of those, 97% were seropositive.

Modelling the impact of compliance fruit and vegetable intake recommendations on mortality in Russia

Background

Low fruit and vegetable intake is among the top ten selected risk factors for global mortality. The World Health Organization recommended daily fruit and vegetable intake is known to be 400 g/day. Despite strong evidence indicating that low fruit and vegetable intake relates to chronic diseases and mortality, most adults do not comply with dietary recommendations. According to the ESSE-RF epidemiological study, the prevalence of low fruit and vegetable consumption was 41.9%. The purpose of this study is to model the impact of following the national fruit and vegetables intake recommendations in decreasing N of death attributable to low fruit and vegetable intake.

Methods

A validated and transparent macrosimulation model, the PRIME (Preventable Risk Integrated ModEl) was used to estimate the cardiovascular and diet-related cancer death toll that could be prevented or delayed for the populations of Russia in a year. Data included in the model are a baseline scenario (actual F&V intake), a counterfactual scenario (recommended intake), and age-and sex-specific mortality for cardiovascular and diet-related cancer diseases, together with the total population risk of a specific year. Monte Carlo analyses with 5000 iterations were performed to produce the 95% uncertainty intervals.

Results

In 2018, an estimated 52 725 deaths (95% CI: 33 474, 69 837) could be averted or delayed if Russians adhered to dietary recommendations on fruit and vegetable intake. Cardiovascular disease accounted for 97.8% of these deaths. The modelled reduction in deaths for coronary heart disease was 43 530 (95%CI: 24 782, 60 168), for stroke 8 063 (95%CI: 5 252, 10 715). The modelled reduction in deaths for lung cancer was 1132 (95%CI: 484, 1731).

Conclusions

The modelling illustrates the potentially large social benefits of compliance with national fruit and vegetable intake recommendations.

Key messages

Despite strong evidence indicating that low fruit and vegetable intake relates to chronic diseases and mortality, most adults do not comply with dietary recommendations. The modelling illustrates the potentially large social benefits of compliance with national fruit and vegetable intake recommendations.

Policy recommendations for improving health literacy: based on European Health Literacy Survey 2019

The European network on Measuring Population and Organizational Health Literacy (M-POHL) was founded in 2018 under the umbrella of the European Health Information Initiative (EHII) of the World Health Organization - Regional Office for Europe. Health literacy (HL) is increasingly recognized as a critical determinant, mediator or moderator of health, and large parts of populations have been shown to have limited HL. Therefore, it is one of the aims of M-POHL to install international comparative population HL surveys at regular intervals. These can provide a valuable and valid basis for developing evidence-informed recommendations for policy, research and practice in the field of HL. To meet this purpose, M-POHL brings together experts from research and policy. Following up on the first European HL survey (HLS-EU), the first project of M-POHL was the international HLS19 survey, with 17 participating countries from the WHO European region. In addition to general population HL, the survey also covered specific HL's such as digital, communication, navigation, and vaccination HL. Despite the obstacles posed by the Corona pandemic, the survey could be administered, and an international comparative report was prepared by the HLS19 project consortium. On this basis, M-POHL will hold two workshops in June and August 2021 to develop resulting recommendations for policy and research in Europe. It is expected that these recommendations will a. o. focus on: population groups in most need of support in their HL; how to improve different dimensions of HL (such as finding, understanding, assessing, and applying relevant health information); HL as applied to health care, disease prevention, and health promotion; and aspects relating to the specific HL's measured. The presentation will describe the process of development, and give an overview of the M-POHL recommendations.

Changes in sleep quality during COVID-19: Results of the Russian online survey on spring 2020

Introduction

The Russian Federation reported one of the largest number of COVID-19 infections. Major restrictions (social distancing, travel bans, event cancellation, changes to work practices) were introduced on the 28th March 2020 with the level of restrictions varied depending on the epidemiology of the virus from region to region. Purpose is to estimate the impact of COVID-19 on sleep among adults in Russia.

Methods

The NMRC TPM conducted a national online-survey ‘Study of the impact of restrictions on physical activity of the population in self-isolation due to COVID-19'. Data were collected during the period of tightest restriction through the country between 26 April 2020 and 6 June 2020. A link on the online survey was distributed through the regional center of public health. Sleep quality was assessed by comparing the period before the COVID-19 and the last 7 days.

Results

In spring 2020, 2432 completed questionnaires from 62 regions of Russia were received. There was a predominance of female respondents (86.6%), the average age was 33.6±14.9 years and 38.2±13.1 years for men and women, respectively. The majority of completed questionnaires were received from the Republic of Tatarstan (n = 804), Irkutsk (n = 474), Sakhalin (n = 225) and Tver regions (n = 152). Compare pre-COVID to during COVID there was a significant decline in the number of days per week participants reported not getting enough sleep (3.21±2.44 to 2.86±2.57; p < 0.001) and participants also reported an increase in the number of days per week they had trouble falling asleep (1.70±2.24 to 2.13±2.48; P < 0.001). The number of days participants waking up earlier than wanted before and during the pandemic has not changed (2,6 Đ, 2,59 (p < 0,5)).

Conclusions

Effective health promotion strategies directed at adopting or maintain positive health related behaviors such as targeted social media messaging and balanced media reporting, should be used to maintain healthy sleep during these unprecedented times.

Key messages

Changes in sleep quality during COVID-19 identified as a result of the online-survey ‘Study of the impact of restrictions on physical activity of the population in self-isolation due to COVID-19'.

Effective health promotion strategies directed at adopting or maintain positive health related behaviors should be used to maintain healthy sleep during COVID-19 pandemic.

What regional living conditions affect hypertension in Russia?

Background

The area of residence and its characteristics affect cardiovascular disease indicators at different spatial scales. Our study evaluated the impact of a wide range of characteristics of large administrative regions (socio-economic, etc.) on individual probability of the prevalence, awareness, treatment, and control of hypertension among the Russian adult population.

Methods

We used data from the cross-sectional phase of the epidemiological study “Epidemiology of Cardiovascular Diseases in the Regions of the Russian Federation” (ESSE-RF) conducted in 2013-2014. A total of 19,791 individuals aged 25-64 years were examined. To calculate regional indices, 64 indicators were obtained from the official website of the Federal State Statistics Service of Russia.

Results

There were no associations between the territorial characteristics and the prevalence of hypertension in the general population. However, the Socio-Geographical Index has a direct impact on men (OR = 1.18; 95% CI: 1.05-1.32), people with low education (OR = 1.14; 95% CI: 1.02-1.27) and older people (OR = 1.16; 95% CI: 1.02-1.32). Hypertension awareness is directly associated with the Demographic (OR = 1.13; 95% CI: 1.02-1.25) and Industrial Territory Index (OR = 1.15; 95% CI: 1.01-1.33). The deterioration of the social situation (Socio-Geographic Index) related to poor adherence to treatment (OR = 0.76; 95% CI: 0.64-0.90) and poor control of hypertension (OR = 0.79; 95% CI: 0.69-0.90). The influence of territorial characteristics on the awareness, treatment, and control of hypertension is less pronounced than the individual characteristics of the population and differs when stratified by gender, age and educational level.

Conclusions

The analysis made it possible to assess the influence of the characteristics of the population living in large areas on the prevalence, awareness, treatment, and control of hypertension. These patterns reflect an empirical approach to the territorial characteristics.

Key messages

The first attempt to understand why there are such significant differences in the prevalence, awareness, treatment and control of hypertension in the Russian regions. New knowledge about the impact of living conditions on the health status.

Classification of original deprivation indices used in public health

Background

Many studies around the world have been carried out to establish the association between deprivation and health outcomes. Both separate deprivation indicators (income, education) and indices that include several ones are used. Deprivation indices have been actively used in public health since the mid-80s of the last century. Nowadays, there is no clear classification of deprivation indices.

Methods

In order to create a taxonomy of deprivation indices, scientific publications related to the development and application of indices have been combined, analyzed, and systematized. The search was carried out in two bibliographic databases (PubMed and Google Sholar). After conducting a full-text review and searching and adding relevant papers from the bibliography, and adding papers that were already known to the authors, 61 documents were included in the study. These documents referred to 61 original deprivation indices. Original index is defined as “an index that includes a combination of deprivation indicators that is unique and not repeated in other indices”.

Results

Four key characteristics of the indices included in the classification were determined: type of deprivation, spatial scale, data source and weighting method. To create the taxonomy, an integrative approach was used that allows you to add new classes and subclasses when new information appears. In accordance with the type of deprivation 72% (44 \ 61) socio-economic, 7% (4 \ 61) material deprivation, 5% (3 \ 61) environmental deprivation and 16% (10 \ 61) multidimensional indices were identified.

Conclusions

The terms and definitions introduced during the review are aimed at ensuring uniformity in the taxonomy and finding a common language among researchers and specialists who develop and use indices. We also hope that the data from the study will stimulate the use of a competent approach and will help in resolving conflicts or inconsistencies that arise during the construction and use of indices.

Key messages

Development of the first classification of deprivation indices. Stimulation of the use of competent approach and thus help researchers and public health professionals resolve conflicts or inconsistencies in the construction and use of indices.

Adaptation of and Protocol for the Validation of the Alcohol Use Disorders Identification Test (AUDIT) in the Russian Federation for Use in Primary Healthcare

Aims

To adapt and validate the Alcohol Use Disorders Identification Test (AUDIT) for use in the Russian Federation and countries with Russian-speaking populations by:

Methods

Systematic review of past use and validation of the Russian-language AUDIT. Interviews to be conducted with experts to identify problems encountered in the use of existing Russian-language AUDIT versions. A pilot study using a revised translation of the Russian-language AUDIT that incorporates country-specific drinking patterns in the Russian Federation.

Results and Conclusions

The systematic review identified over 60 different Russian-language AUDIT versions without systematic validation studies. The main difficulties encountered with the use of the AUDIT in the Russian Federation were related to the lack of:

A revised version of the Russian-language AUDIT was created based on the pilot studies, and was validated in primary healthcare facilities in all regions in 2019/2020.

The Double Mutation DSG2-p.S363X and TBX20-p.D278X Is Associated with Left Ventricular Non-Compaction Cardiomyopathy: Case Report

Left ventricular non-compaction cardiomyopathy (LVNC) is a rare heart disease, with or without left ventricular dysfunction, which is characterized by a two-layer structure of the myocardium and an increased number of trabeculae. The study of familial forms of LVNC is helpful for risk prediction and genetic counseling of relatives. Here, we present a family consisting of three members with LVNC. Using a next-generation sequencing approach a combination of two (likely) pathogenic nonsense mutations DSG2-p.S363X and TBX20-p.D278X was identified in all three patients. TBX20 encodes the cardiac T-box transcription factor 20. DSG2 encodes desmoglein–2, which is part of the cardiac desmosomes and belongs to the cadherin family. Since the identified nonsense variant (DSG2-p.S363X) is localized in the extracellular domain of DSG2, we performed in vitro cell transfection experiments. These experiments revealed the absence of truncated DSG2 at the plasma membrane, supporting the pathogenic relevance of DSG2-p.S363X. In conclusion, we suggest that in the future, these findings might be helpful for genetic screening and counseling of patients with LVNC.

Modelling the impact of compliance with WHO salt recommendations on cardiovascular mortality in Russia

Funding Acknowledgements

Type of funding sources: None.

Introduction

High salt intake is considered the primary diet-related risk factor (being responsible for 3 million deaths and 70 million DALYs), because of its association with NCDs, such as cardiovascular diseases (ischemic heart disease, stroke, and hypertension). The World Health Organization (WHO) recommended daily salt intake is known to be &lt;5 g / day (2 g sodium per day). Despite strong evidence indicating that high salt intake relates to chronic diseases and mortality, most adults do not comply with dietary recommendations. The average amount of salt consumed per day is significantly higher and amounts to 11.35 g/day among Russian adults (2018).

The purpose of this study is to model the impact of following the national salt consumption recommendations in decreasing N of death  attributable to excessive salt consumption.

Methods

This study provides a health impact evaluation, which models the effect of sodium reduction on mortality associated with blood pressure and CVD in 2018 in Russia. Cardiovascular disease included coronary heart disease, stroke, hypertensive disease, heart failure, aortic aneurysm, pulmonary embolism and rheumatic heart disease. The observed salt intake from the Russian National Health Survey of 2018 was used to determine the reference (baseline) scenario and the counterfactual scenario considered that average salt consumption was reduced to 5g/day. A comparative risk assessment model, the Preventable Risk Integrated ModEl (PRIME) was used to estimate the deaths from cardiovascular diseases that could be averted or postponed based on the sodium recommendation scenario compared to the baseline scenario. The sensitivity of the model to the results from the meta-analyses was assessed with Monte Carlo simulations.

Results

In 2018, an estimated 104 602 (95%: 46 832, 154 233) deaths from CVDs could have been prevented if the average salt consumption had been reduced to 5 g/day in Russia. Coronary heart disease (CHD), stroke and hypertensive disease accounted for 97% of these deaths. The modelled reduction in deaths for coronary heart disease was 59 454, for stroke 37 306 and for hypertensive disease 4 833.

Conclusion

A considerable number of lives could be saved if Russians adhered to the national salt intake recommendations.

Effects of COVID-19 pandemic on physical activity: Results of the Russian online survey on spring 2020

Funding Acknowledgements

Type of funding sources: None.

Introduction

The Russian Federation reported one of the largest number of COVID-19 infections. In spring 2020 social distancing, travel bans, the cancellation of sporting and other mass participation events, and changes to work practices have dramatically affected daily life throughout the country. Major restrictions were introduced on the 28th March 2020 with the level of restrictions varied depending on the epidemiology of the virus from region to region. Cities with a large number of cases had the most strict restrictions such as limitations on any outdoor activities. In cities with a smaller number of cases limitations were less strict, especially with outdoor activities. Indoor sport activities were limited across the country and outdoor sports were restricted – depending on the situation in the region.

The aim of this study is to estimate the impact of COVID-19 on the levels of physical activity among adults in Russia.

Methods

Cross-sectional data were collected during the period of tightest restrictions between 26 April 2020 and 6 June 2020. The link on the on-line survey was distributed through the regional centers of public health. Eligible participants included all Russian adults aged 18 years and over. Participants reported frequency and duration of walking, moderate- and vigorous-intensity physical activity, and muscle strengthening activities before COVID-19 and during the past seven days.

Results

A convenience sample of 2432 adults from 62 regions of Russia completed a 15-min self-report questionnaire. Participants were primarily female (83%). Compared with before COVID-19, physical activity was adversely affected during COVID-19. The average time spent in MPA and VPA each declined by around 12 minutes per day (42.43 ± 37.57 to 30.44 ± 35.35 and 37.79 ± 37.80 to 26.56 ± 34.69, respectively [all P < 0.001]). The number of minutes per day spent walking decreased by around 20 minutes from 60.5 ± 38.66 to 40.83 ± 38.6 (P < 0.001). The proportion of participants who met the WHO Guidelines for physical activity declined from 68% to 49% (P < 0.001). The proportion who participated in muscle strengthening activities for 2 or more days per week declined from 53% to 45% (P < 0.001). Compared with those who did not use online PA resources, those who did were 1.4 (95%CI 1.3, 1.5) and 1.9 (95%CI 1.8, 2.1) times more likely to meet the recommendations for PA and for muscle-strengthening activities, respectively.

Conclusion

Effective health promotion strategies directed at adopting or maintain positive health-related behaviors such as targeted social media messaging and balanced media reporting, should be used to increase the physical activity during these unprecedented times.

Cystic Fibrosis Polymorphic Variants in a Russian Population

Purpose

Cystic fibrosis (CF) is one of the most common monogenic diseases with an autosomal recessive inheritance. Carrier screening leads to a reduction in the number of children born with CF disease. The aim of this study was to develop the custom panel for the diagnosis of heterozygous carriage of polymorphic variants in the CFTR gene and to establish their allelic frequencies (AF) in one of the Russian regions where ethnic Russians predominate.

Patients and Methods

The diagnostic panel was designed on the basis of data from the register of CF patients in Russia for 2017 and validated on 22 blood samples of patients with previously genetically established CF. The study participants (n=642) for CF variants estimation were randomly selected from the population-based cohort study ESSE-Vologda. Genotypes were determined by real-time PCR on the QuantStudio 12K Flex Real-Time PCR System. Data processing was performed using the TaqMan Genotyper Software.

Results

The proposed diagnostic panel allowed simultaneous analysis of 60 variants of the CFTR gene. A total of 23 carriers of the following variants were identified among 642 participants: F508del (rs113993960) with a frequency of 2.02%, L138ins (rs397508686) and 394delTT (rs121908769) – 0.47%, CFTRdele2.3 (c.54–5940_273+10250del21080; p.S18Rfs*16) – 0.31%, R117H (rs78655421), and G542X (rs113993959) – 0.16%. The frequency of heterozygotes in the Russian population was 3.58% or 1:28 (CI95%: 2.28–5.33% by Clopper–Pearson exact method).

Conclusion

High frequency of heterozygous CFTR variants carriers and availability of highly productive diagnostic panel for detection of CFTR variants suggest the prospect of carrier screening for some common CF variants among Russian population.

The LDLR, APOB, and PCSK9 Variants of Index Patients with Familial Hypercholesterolemia in Russia

Familial hypercholesterolemia (FH) is a common autosomal codominant disorder, characterized by elevated low-density lipoprotein cholesterol levels causing premature atherosclerotic cardiovascular disease. About 2900 variants of LDLR, APOB, and PCSK9 genes potentially associated with FH have been described earlier. Nevertheless, the genetics of FH in a Russian population is poorly understood. The aim of this study is to present data on the spectrum of LDLR, APOB, and PCSK9 gene variants in a cohort of 595 index Russian patients with FH, as well as an additional systematic analysis of the literature for the period of 1995-2020 on LDLR, APOB and PCSK9 gene variants described in Russian patients with FH. We used targeted and whole genome sequencing to search for variants. Accordingly, when combining our novel data and the data of a systematic literature review, we described 224 variants: 187 variants in LDLR, 14 variants in APOB, and 23 variants in PCSK9. A significant proportion of variants, 81 of 224 (36.1%), were not described earlier in FH patients in other populations and may be specific for Russia. Thus, this study significantly supplements knowledge about the spectrum of variants causing FH in Russia and may contribute to a wider implementation of genetic diagnostics in FH patients in Russia.

Protocol and Rationale for the Russian-Japanese "Tackle Obesity and Metabolic Syndrome Outcome by Diet, Activities and Checking Body Weight Intervention" (RJ-TOMODACHI) Randomized Controlled Trial

Background: The prevalence of obesity in Russia has increased sharply since the mid-1990s. Interestingly, the prevalence of obesity in Japan is lower than in many Western countries. Japan has implemented different types of weight control programs using a smart device to monitor patients remotely. New health promotion methods from Japan are now being used in Russia. The Russian-Japanese "Tackle Obesity and Metabolic Syndrome Outcome by Diet, Activities and Checking Body Weight Intervention" (RJ-TOMODACHI) study aims to evaluate a preventive intervention using Japanese health monitoring technology in reducing excess body weight, compared with standard care, in Russia. Methods and Results: The trial is a single-center, 3-armed, parallel group randomized controlled trial conducted among overweight/obese adults. It has been designed to compare the effectiveness of 2 newly developed interventions against standard care for 6 months. Participants in the low- and high-intensity intervention groups will have 3 and 6 consultations over the study period, respectively. In all, 260 adults were screened at baseline; 65 did not participate in the trial for various reasons. The remaining 195 people were randomized into 3 groups (high-intensity intervention, n=73, low-intensity, n=73; standard care group, n=49). Conclusions: The trial protocol has been designed so that the methodology can be adapted for use in Russia.

Subsidies for improving diet and population health in Russian Federation

Background

The insufficient consumption of fruit and vegetable (F&V) is important contributors to main non-communicable diseases (NCDs). Russia lags behind many countries in the world in per capita consumption of F&V. A growing number of countries have implemented subsidies to address the growing burden of dietary-related diseases. The purpose of the study is to assess the potential social and economic impact on mortality and morbidity due to main NCDs of policy to subsidies F&V in Russia.

Methods

Using a population model of dietary-related diseases and health care costs, we simulated the effect of 10% subsidy on F&V, over the 15 years of the Russian population. We estimated cardiovascular diseases (CVD), diabetes and cancers cases prevented, health-related costs, and incremental cost-effectiveness ratios. Baseline prevalence of the risk factor was derived from the Russian epidemiology survey.

Results

Subsidies aimed at reducing the price of F&V by 10% can lead to an increase in the consumption of F&V by about 14%, and thereby prevent 37 064 deaths, the projected economic effect due to the prevented deaths will amount to 10.7 billion rubles over 15 years. The number of prevented cases of CVD will be 28 881, type 2 diabetes - 580 cases, cancer - 4025 cases. When calculating the economic effect for the analyzed period, the prevented medical costs for CVD will amount to 147.9 million rubles, for cancer - 86.6 million rubles, for type 2 diabetes - 3 million rubles. The implementation of this measure in the Russian population will allow to “save” 221.6 million rubles related to the payment of disability benefits from the main NCDs and 1.2 billion rubles due to the prevented loss of GDP from disability over 15 years. Thus, the cumulative forecasted effect of this measure in the Russia over 15 years will amount to 11.2 billion rubles.

Conclusions

The modelling illustrates the potentially large social and economic benefits of subsidies on F&V for improving population health.

Key messages

The insufficient consumption of fruit and vegetable (F&V) is important contributors to main non-communicable diseases (NCDs). The modelling illustrates the potentially large social and economic benefits of subsidies on F&V for improving population health.

Economic burden of noncommunicable diseases attributable to risk factors in the Russian Federation

Aim

to estimate the economic burden of major chronic noncommunicable diseases (NCDs) attributable to risk factors in the Russian Federation in 2016

Material and Methods

The following risk factors were included in the analysis: smoking, high alcohol intake, high salt intake, low intake of fresh vegetables and fruits, consumption of processed red meat, low physical activity, obesity, hypertension, which reliably have a causal relationship with major NCDs: cardiovascular diseases(CVD),type 2 diabetes, chronic obstructive pulmonary disease(COPD), cancer of 10 localizations. The relative risks (RR)of morbidity and mortality from major NCDs associated with risk factors are identified through a literature search. Based on the data on the prevalence of risk factors in the Russian population and RR, the population attributable risk (PAR)was calculated for each analyzed disease. Statistical analysis calculations using descriptive statistics methods were performed in the MSExcel 10.0 program.

Results

The largest burden from the four main NCDs is associated with hypertension - 10.9 billion€, which is equivalent to 1.01% of GDP. The next largest contribution to the burden from NCDs was the burden from obesity 7.6 billion€ 0.7% of GDP, smoking over 5.2 billion €, 0.49% of GDP and the low physical activity 3.4 billion€, 0.32% of GDP. Of all the analyzed risk factors, the least contribution to total costs in connection with NCDs was determined by the burden from high alcohol intake 1.1 billion€, 0.1% of GDP, due to the low prevalence of high alcohol intake in the Russian population.

Conclusions

In this study, for the first time, the assessment of the economic burden of risk factors by the share (contribution) to the morbidity and mortality of main NCDs (CVD, T2DM, COPD and 10 cancer localizations) in the Russian Federation for 2016 was performed. Such the significant economic burden is a strong argument for increasing investments in the prevention and treatment of risk factors of NCDs.

Key messages

In Russia the largest burden from the four main NCDs is associated with hypertension. Such the significant economic burden is a strong argument for increasing investments in the prevention and treatment of risk factors of NCDs.

Economic arguments for population interventions to reduce alcohol consumption in Russian population

Aim

To get economic arguments for population-based interventions to reducing the consumption of alcohol in the Russian Federation.

Material and Methods

Studies of international practice on the implementation of population-based preventive measures to reducing alcohol consumption was carried out in order to identify interventions with proven effectiveness. We used the official statistics data collected by Ministry of health on the number of patients, health care resources utilization. Directs nonmedical costs included disability payments. Indirect costs included decreased productivity due to premature mortality and disability.

Results

Russian Federation has on the moment rather strong legislation in the area of alcohol regulation, but still there is a potential for further improvement. Increase in the price for alcoholic beverages by 10% in the Russian Federation can potentially prevent 7 477 potential years of life lost, the prognosed economic effect due to premature deaths reduction will be 42 002 523€ for 5 years. Increase in the minimum age for alcohol sales from 18years to 21years can save 48 920 potential years of life lost in Russian population, and the economic effect will be 279 912 075€ for 3 years. Reducing the permissible limit of blood alcohol concentration in vehicle drivers to 0.03mg/ml will allow to gain 8 834 673€ of economic effect for 3years.The deprivation of driving license for longer period after drinking and driving will give economic 916 809€ for 1 year due to prevent 217fatal accidents in alcohol intoxicated condition. And the effect of a complete ban on advertising alcoholic beverages in all media will give potential impact of 678 437 773€ for 10years

Conclusions

There are still potential for improvement the legislation in the area of alcohol control in Russian Federation. Described interventions demonstrate substantial potential economic effect. These data can be used as an argument for policy makers to justify the investments in these interventions

Key messages

The main results obtained in the simulation demonstrated the possibility of improving the prognosis of mortality and morbidity from NCDs associated with alcohol consumption. These data can be used as an argument for policy makers to justify the investments in these interventions.

Transcriptome of Extracellular Vesicles: State-of-the-Art

Exosomes and microvesicles are two major categories of extracellular vesicles (EVs) released by almost all cell types and are highly abundant in biological fluids. Both the molecular composition of EVs and their release are thought to be strictly regulated by external stimuli. Multiple studies have consistently demonstrated that EVs transfer proteins, lipids and RNA between various cell types, thus mediating intercellular communication, and signaling. Importantly, small non-coding RNAs within EVs are thought to be major contributors to the molecular events occurring in the recipient cell. Furthermore, RNA cargo in exosomes and microvesicles could hold tremendous potential as non-invasive biomarkers for multiple disorders, including pathologies of the immune system. This mini-review is aimed to provide the state-of-the-art in the EVs-associated RNA transcriptome field, as well as the comprehensive analysis of previous studies characterizing RNA content within EVs released by various cells using next-generation sequencing. Finally, we highlight the technical challenges associated with obtaining pure EVs and deep sequencing of the EV-associated RNAs.

Effects of tobacco control policy on cardiovascular morbidity and mortality in Russia

Background

According to the Global Adult Tobacco Survey carried out in Russia in 2009, the country had one of the highest smoking prevalence rates in Europe. In response to this health and economic burden, Russia implemented a comprehensive Tobacco Control Law (TCL) in 2013, which has been associated with a 21.5% relative decline in adult smoking prevalence in 2016 compared with 2009. This study tests the impact of the TCL on cardiovascular disease (CVD) related health outcomes, including morbidity and mortality.

Method

The study evaluated the TCL as an intervention in a natural experiment during the period 2003-2015. A synthetic control was created as a comparator, using data from countries that did not have a comparable comprehensive tobacco control intervention. Changes in trends in CVD outcomes - hospital discharge rates (HDRs) and standardized death rates (SDRs) - were then compared to test for an impact associated with the TCL.

Results

Pre-intervention trends in CVD-related HDRs were similar between Russia and the synthetic control, but became divergent after the TCL with greater benefit observed in Russia. This implies a beneficial impact of the TCL on CVD related morbidity in the Russian population. Whilst SDRs continued to reduce in both Russia and the control, the impact of TCL is less clear.

Conclusion

This study provides further evidence to support comprehensive tobacco control in line with the WHO Framework Convention for Tobacco Control (WHO FCTC). Alongside a reduction in tobacco consumption, smoking-related CVD morbidity appears to benefit quite soon after implementation, whilst smoking-related deaths might need a longer post-intervention period to be detectable.

In vitro and in silico liver models: Current trends, challenges and opportunities

Most common drug development failures originate from either bioavailability problems, or unexpected toxic effects. The culprit is often the liver, which is responsible for biotransformation of a majority of xenobiotics. Liver may be modeled using "liver on a chip" devices, which may include established cell lines, primary human cells, and stem cell-derived hepatocyte-like cells. The choice of biological material along with its processing and maintenance greatly influence both the device performance and the resultant toxicity predictions. Impediments to the development of "liver on a chip" technology include the problems with standardization of cells, limitations imposed by culturing and the necessity to develop more complicated fluidic contours. Fortunately, recent breakthroughs in the development of cell-based reporters, including ones with fluorescent label, permits monitoring of the behavior of the cells embed into the "liver on a chip" devices. Finally, a set of computational approaches has been developed to model both particular toxic response and the homeostasis of human liver as a whole; these approaches pave a way to enhance the in silico stage of assessment for a potential toxicity.

Characteristics of vessels wall, myocardium and epicardial fat in patients with heart failure with preserved ejection fraction with and without metabolic syndrome

BACKGROUND

The structure of the vessels wall and myocardium is an independent predictor of cardiovascular events among patients with heart failure (HF). There is a data that metabolic syndrome (MS) accelerates the progression of structural and functional disorders of the vessel wall and myocardium. Epicardial fat thickness was shown to correlates with visceral fat thickness and to be an independent predictor of cardiovascular diseases.

OBJECTIVES

To investigate the characteristics of vessels wall, myocardium and epicardial fat in patients with HF with preserved ejection fraction (HF-PEF) with and without MS.

MATERIALS AND METHODS

A total of 59 patients with HF-PEF were included. First group - patients without MS (n = 29), second group - patients with MS (n = 30). Following characteristics were evaluated: Arterial stiffness (stiffness index [SI]), reflection index (RI), augmentation index (Alp). The function of big vessels was evaluated by phase shift (PS), of the small vessels - by the occlusion index (OI). Investigations were performed by the device "angioscan." Sizes of the heart chambers and the thickness of the myocardium wall and epicardial fat thickness were evaluated echocardiographically.

RESULTS

Among the patients from both groups significant changes of the vessels wall and myocardial structure were found. SI at the first group was 8.26 ± 1.72 m/s, at the second group - 9.62 ± 5.61 m/s (non-significant, P = 0.25). RI at the first group was 39.79 ± 18.12%, at the second - 31.43 ± 17.23% (non-significant, P = 0.086). Alp at the first group was 23.47 ± 14.69%, at the second - 11.16 ± 17.14% (significant, P = 0.011). PS at the first group was 8.05 ± 7.72 ms, at the second - 5.34 ± 4.4 ms (non-significant, P = 0.36). OI at the first group was 1.34 ± 0.58%, at the second - 1.46 ± 0.54% (non-significant, P = 0.46). Significant intergroup differences were found in the interventricular septum thickness: 10.3 ± 1.2 mm at the first group and 11.3 ± 1.6 mm at the second (P = 0.01); left ventricle wall thickness: 10.1 ± 1.1 mm at the first group and 11.3 ± 1.6 mm - at the second (P = 0.001); left ventricle myocardium mass: 157.75 ± 46.11 g at the first group and 201.19 ± 58.82 g - at the second (P = 0.005). The epicardial fat thickness was 14.8 ± 1.8 mm at the first group and 36.7 ± 1.7 mm - at the second group (significant, P = 0.001).

CONCLUSION

Among patients with hypertension and HF-PEF with and without MS significant changes in the structure of the vessel wall and myocardium were found. The presence of MS lead to more pronounced myocardial remodeling. The epicardial fat thickness is significantly higher among patients MS.