Medical and Social Expert Evaluation and Rehabilitation

BACKGROUND: The relevance of the topic stems from the high comorbidity of metabolic syndrome and obstructive sleep apnea (OSA) in the older population, which increases the risk of cardiovascular complications and leads to the formation of a vicious circle.

AIM: To study the interrelationship between the components of metabolic syndrome and moderate obstructive sleep apnea in older patients.

METHODS: The study included 132 older patients (67.1 ± 2.9 years). Depending on the presence of abdominal obesity (AO) and OSA, four groups were formed: group 1, AO−/OSA− (32 participants); group 2, AO−/OSA+ (30 participants); group 3, AO+/OSA− (34 participants); and group 4, AO+/OSA+ (36 participants).

RESULTS: The most pronounced worsening of the metabolic profile was observed in older patients with comorbidity of AO and OSA: progression of insulin resistance (by HOMA-IR), deterioration of integral metabolic status (pronounced increase in TyG), and enhancement of the atherogenic dyslipidemic profile (increased triglycerides / low-density lipoprotein cholesterol). The highest blood pressure values and the greatest prevalence of circadian rhythm disturbances were found in AO+/OSA+ patients, indicating a more severe course of hypertension in this group compared with the others. Correlation analysis confirmed the high diagnostic efficacy of the TyG index as a marker of metabolic disorders in elderly patients (ρ = 0.847, p < 0.001).

CONCLUSION: The presented data suggest that the highest risk of metabolic disorders and the most severe course of arterial hypertension were observed in patients with comorbidity of abdominal obesity and moderate obstructive sleep apnea. The TyG index has high diagnostic accuracy for metabolic disorders in older patients.

BACKGROUND: Vocational guidance for persons with disabilities requires comparable and reproducible criteria that allow correlating persistent impairments of body functions with the requirements of specific types of work activity and factors of the working environment.

AIM: To form and validate a database of assessment indicators for types of work activity as a tool for their ranking within the framework of vocational guidance.

METHODS: A total of 435 types of work activity from the initial groups of the All-Russian Classifier of Occupations were analyzed. For each of them, a profile was formed based on 21 medico-social indicators, grouped into blocks of safety, ability to perform work functions, and working conditions. Primary assessments were obtained using several large language models on a unified ten-point scale; post-processing was performed for unified interpretation (“the higher, the more suitable”) and calculation of integral values by averaging inter-model assessments. External validation was conducted on independent expert survey data (87 questionnaires): in each question, five professions were compared on a 0–100 scale; a total of 9,135 assessments were processed. Comparisons were made after intra-question min-max normalization; the consistency of ranking (Spearman coefficient, Kendall coefficient), the proportion of concordant pairs, and the normalized rank difference were assessed.

RESULTS: The proportion of informative comparison blocks was 92.3%, and constant expert assessments were identified in 7.6% of cases. The consistency of the model ranking with experts was moderate: average Spearman coefficient ρ = 0.416, average Kendall coefficient τ-b = 0.363, proportion of concordant pairs 0.653, average normalized rank difference 0.278. The highest validity was demonstrated by indicators related to impairments of neuromuscular, skeletal, and movement-related (statodynamic) functions (necessity of using a wheelchair), while the indicator of emotional tension showed minimal consistency.

CONCLUSION: The formed assessment database is applicable for profiling and preliminary selection of types of work activity in the vocational guidance of persons with disabilities. For contextual factors of working conditions, clarification of operational definitions and expert calibration are required.

This work presents a qualitative and quantitative analysis and synthesis of data on the effectiveness of components of organizational models of comprehensive cardiac rehabilitation with the goal of their further integration into the stage of medical and social expert evaluation in patients who have undergone cardiac surgery. The systematic review and meta-analysis were conducted in accordance with the PRISMA-2020 recommendations. Prior to conducting the review, a structured clinical question (PICOS) was formulated. The search for relevant sources was conducted in electronic bibliographic databases [PubMed, EMBASE (via Wiley Online Library), Science Direct, Google Scholar, eLIBRARY] covering the period 2015–2025. The review included randomized (RCT) and non-randomized controlled studies, as well as observational studies (retrospective and prospective cohort studies). After a multi-step screening process, 20 studies were included in the review, some of which were included in the meta-analysis using a random-effects model. Risk of bias assessment was conducted using the Cochrane Risk of Bias 2 (RoB 2) tool and the Newcastle Ottawa Scale (NOS). Meta-analysis of 7 RCTs (n = 547) demonstrated a significant increase in 6-minute walk test (6MWT) distance in groups undergoing comprehensive rehabilitation: the mean difference (MD) was 35.4 m [95% CI 22.1–48.7; p < 0.001], and statistical heterogeneity was assessed as moderate (I² = 42%). Analysis of 3 RCTs (n = 324) revealed a trend toward reduced risk of rehospitalizations: the pooled odds ratio was 0.65 (95% CI 0.42–1.01; p = 0.054). Based on the analysis of 3 RCTs (n = 417), no significant improvement in quality of life (according to SF-36/SF-12 questionnaires) was noted: standardized mean difference was −0.17 (95% CI −0.39–0.05; p = 0.13). The results confirm the clinical relevance of structured cardiac rehabilitation programs with organizational, personnel, and technological components for improving functional outcomes. To optimize the medical and social expert process, multidisciplinary assessment, standardized instruments (6MWT), and telehealth technologies should be integrated, as this will help overcome the fragmentation of care and increase the objectivity of expert decisions. Limitations include study variability and a lack of data on long-term outcomes.