Background In contrast with the setting of acute myocardial infarction, there are limited data regarding the impact of diabetes mellitus on clinical outcomes in contemporary cohorts of patients with chronic coronary syndromes. We aimed to investigate the prevalence and prognostic impact of diabetes according to geographical regions and ethnicity. Methods and results CLARIFY is an observational registry of patients with chronic coronary syndromes, enrolled across 45 countries in Europe, Asia, America, Middle East, Australia, and Africa in 2009–2010, and followed up yearly for 5 years. Chronic coronary syndromes were defined by ≥1 of the following criteria: prior myocardial infarction, evidence of coronary stenosis >50%, proven symptomatic myocardial ischaemia, or prior revascularization procedure. Among 32 694 patients, 9502 (29%) had diabetes, with a regional prevalence ranging from below 20% in Northern Europe to ∼60% in the Gulf countries. In a multivariable-adjusted Cox proportional hazards model, diabetes was associated with increased risks for the primary outcome (cardiovascular death, myocardial infarction, or stroke) with an adjusted hazard ratio of 1.28 (95% confidence interval 1.18, 1.39) and for all secondary outcomes (all-cause and cardiovascular mortality, myocardial infarction, stroke, heart failure, and coronary revascularization). Differences on outcomes according to geography and ethnicity were modest. Conclusion In patients with chronic coronary syndromes, diabetes is independently associated with mortality and cardiovascular events, including heart failure, which is not accounted by demographics, prior medical history, left ventricular ejection fraction, or use of secondary prevention medication. This is observed across multiple geographic regions and ethnicities, despite marked disparities in the prevalence of diabetes. ClinicalTrials identifier ISRCTN43070564

BackgroundA significant prevalence of osteoarthritis (OA), the most disability joint disease in the world, which is important in the search for the new treatment. Analysis of modern therapy of OA was the reason for research efficacy of NSAIDs and SYSADOA on biochemical, inflammatory and immunological signs in the treatment of OA.ObjectivesDifferentiated approach to the treatment of OA depending of presence of hyperuricemia.Methods176 patients (144 women, 32 men) was exanimated, aged (59,71±0,86) years with confirmed radiographic OA according to Kellgren and Lawrence scale. Division into groups was performed depending on treatment. For 14 days group 1 (n=30) received nimesulide 100 mg twice daily, and group 2 (n=30) - meloxicam 15 mg 1 per day. For 6 months 3rd group (n=54) received diacerein 50 mg twice a day and the 4th group (n=32) - chondroitine sulfate (CS) 500 mg twice daily. 5th group (n=30) received glucosamine sulfate (GS) 400 mg 3 times per week for 1.5 months. It was estimated dynamics of VAS, WOMAC, Lequesne, uric acid (UA), CRP, IL-1β, IGF-1, NO, ESR, biochemical indicators. Statistical analysis - SPSS Statistics.ResultsNimesulide compared to meloxicam found more effective for WOMAC index, the reduction of pain, stiffness and functional failure 53.93% vs 37.3%, 29.7% vs 13.5%, 41.6% vs 26.6% respectively. Only nimesulide decreased NO by 40.2%, and showed a decrease trend of UA from 375,33±24,6 to 321,57±19,6 mkmol/l while meloxicam had no effect on their levels. In 60% of patients with OA was found hyperuricemia with nephrolithiasis. Was showed the relation between the severity of OA and the presence of hyperuricemia by VAS, Lequesne, WOMAC, lesions more number joints, higher stage of X-ray progress. Diacerein, CS and GS showed clinical effect on pain reduction by VAS, Lequesne, WOMAC (p<0.05), respectively. Was showed lower levels of CRP, IL-1, NO during treatment by diacerein (CRP from 5,6 (IQR: 3,6–8,0) to 3,0 (IQR: 1,95–4,3) mg/l, IL-1 from 19,47 (IQR: 15,22–23,81) to 12,0 (IQR: 9,0–16,2) pg/ml, NO of 4,09 (IQR: 3,0–4,19) to 2,2 (IQR: 1,0–3,44) mmol/l), CS (CRP from 6,0 (IQR: 3,25–9,0) to 3,10 (IQR: 1,81–6,0) mg/l, IL-1 20,0 (IQR: 11,5–26,52) pg/ml to 16,7 (IQR: 9,80–18,62) pg/ml, NO of 3,0 (IQR: 2,05–4,00) to 2,0 (IQR: 2,0–3,0) mmol/l) and GS (CRP from 6,0 (IQR: 4,0–8,45) to 4,0 (IQR: 4,0–6,0) mg/l, IL-1 from 4,69 (IQR: 2,5–7,59) to 2,52 (IQR: 1,75–3,94) pg/ml, NO 3,28 (IQR: 2,02–4,79) to 2,37 (IQR: 1,59–3,03) mmol/l) (p<0,05). Diacerein reduced UA from 415,5 (IQR: 347,0–452,5) to 374,0 (IQR: 318,75–423,5) mkmol/l (p=0.001) and glucose from 5,1 (IQR: 4,8–5,8) mmol/l to 4,88 (IQR: 4,00–5,40) mmol/l (p=0.0001). CS in patients with hyperuricemia (p=0.001) increased the level of UA, which reduced the efficacy of CS, but without hyperuricemia didn't influence the level of UA and efficacy of CS.ConclusionsWas showed that nimesulide is more effective than meloxicam during first 14 days, and reduces NO, an important proinflammatory factor. The presence of hyperuricemia in 60% patients with OA, resulted in...

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Civil society organizations (CSOs) aim to influence public policy. One way of influencing policy is through communication. In authoritarian contexts, CSOs face restrictions that make criticism of governmental actors less likely. However, to achieve change, CSOs need to highlight public problems that are often created by the inaction of governmental actors. This research examines the communicative strategies of CSOs involved in waste management in Russia. By drawing on the Narrative Policy Framework, it examines narratives used by CSOs on social media. Interviews with these CSO provide explanations of why CSOs select specific narrative strategies. We argue that the narrative strategies of CSOs are determined by their objectives of communication related to the activities they are involved in but are also influenced by their working relationship with the government. Results show that CSOs that are involved in educational activities and service provision mostly pursue an angel‐shift‐strategy, highlighting policy solutions. Only larger CSOs communicate critically and continue to attempt working with governmental actors to influence policy through awareness‐raising and policy advocacy.

The purpose of the study is to determine the effective structure of the professional consciousness of a future doctor. The objectives of the study are the following: 1. To determine the most complete and corresponding to the professional activity, structure of professional consciousness of a future doctor on the basis of a theoretical analysis of literary sources. 2. To extrapolate the structure of professional consciousness to the professional activity of future doctors, taking into account current social trends in health care. Research Questions. To reveal the psychological content of the structure of the professional consciousness of a future doctor, to extrapolate this structure to innovations in the health care system. Research Methods: Theoretical methods were the main methods in the study: extrapolation, abstraction and concretization, induction and deduction, comparison, generalization, systematization and interpretation of facts. Findings. The development of the professional consciousness of a doctor is the successful implementation of his professional activity and can be considered as a steady psychological resource impeding and preventing professional stress and emotional burnout in a time perspective.Conclusion. In terms of changes in the content of professional activity the need for the internal resources development of the individual for the professional activity qualitative performance will increase among future doctors. The formed structure of professional consciousness can serve as a basic resource, demanded in a certain time perspective.