[The medical nurses: the factors of professional burning-out].

Nowadays, the professional burnout of paramedical personnel becomes a serious health care problem, resulting in productivity loss and medical care costs increase. The most effective mean to prevent the mentioned burnout is elimination of risk factors. The study purpose is to identify such factors (both positive or negative ones) and to quantify their contribution into development of professional burnout as exemplified by paramedical personnel in the Tomsk Oblast of Russia. The study sampling included 2,486 paramedicals as respondents. The sociological survey was carried out using questionnaire that included the Maslach Burnout Inventory tool and questions to assess corresponding factors of social, professional, economic and physical spheres of life. The study established high prevalence of high degree (29.57%) and extremely high degree (37.01%) of professional burnout in respondents. The following factors were associated with decrease in likelihood of burnout: advanced age (r = -0.089), married status (OR = 0.7; 95% CI 0.6-0, 9), higher number of children in family (r = -0.088), adequate sleep (r = -0.046), amount of time spent on sports per day (r = -0.167). The following factors were associated with increase in the likelihood of burnout: self-reported lack of sleep (OR = 2.1; 95% CI 1.8-2.5), frequent night shift work (r=0.082). The multiple linear regression analysis was applied with selection of model using the Akaike criterion: two mathematical models were formed for the integral value of professional burnout and its "Emotional exhaustion" sub-scale. The models described 15% and 20% of dispersion, respectively. The models allow both to quantify particular contributing factors to development of this syndrome and to develop programs of strengthening positive factors and mitigate negative ones. This will prevent development of professional burnout in paramedical personnel in the Tomsk Oblast.

[The factors associated with development of professional burning-out in physicians].

The professional burnout of physicians is a common world problem that has significant negative impact on quality of medical care and decreases effectiveness of human resources policy in health care. The first step in solving the burnout problem is to identify the most common provoking and protective factors (predictors) of this phenomenon. The study was targeted to determine and categorize the key factors associated with burnout of physicians and to provide prevention and treatment of the condition in the future. The participants of the study completed a questionnaire targeted to evaluating professional burnout levels and establishing key factors of its development and prevention. The sampling of 1668 physicians from the Tomsk Oblast participated in the study. The moderate or high levels of professional burnout were found in more than half of respondents and only 1% of them had no predictors of this syndrome. The correlation and multiple regression analysis were applied to classify various factors impacting on professional burnout as negative (resulting in professional burnout) or protective (preventing development of professional burnout). The results of the study demonstrated the importance of integrated approach in effective solving of the problem of professional burnout in Russia. The study will assist in finding practical applications of its results in preventing and reducing the risk of development of professional burnout.

[Clinical and Functional Phenotypes of Chronic Obstructive Pulmonary Disease, the Effect on the Severity of the Disease and Prognostic Value in Assessing the Risk of Disease Progression].

Background: Chronic obstructive pulmonary disease (COPD) is characterized by progressive limitation of airflow rate, hyperergic inflammatory response of the respiratory tract, and systemic manifestations. Prognosis of the disease depends on the severity of these pathogenetic components. FEV1 which characterizes the speed limit airflow do not allow predicting the rate of COPD progression. Aims: Comparison of the prognostic significance of such clinical parameters as frequency of exacerbations and the development of comorbid diseases to assess the nature of COPD progression by using different classification approaches. Materials and Methods: The prospective comparative study included 98 patients with COPD. In the framework of the study protocol, 2 visits were required when a practitioner recruited patients who met inclusion/exclusion criteria, obtained the signed informed consent, collected the anamnestic data, and performed basic procedures of the study: spirometry, 6-minute stepper test, assessment of dyspnea on questionnaire mMRC, body plethysmography, lung diffusion capacity study, dopplerechocardiography, tomography of the chest. Visit 2 was conducted in 12 months after the first one to assess the dynamics of the disease. The dynamics of the disease was considered negative if, upon repeated examination, the patient was referred to the group with more severe COPD. Results: Our study demonstrates that comprehensive assessment of such factors as the frequency of COPD exacerbations in the preceding 12 months and the presence of comorbid diseases in a patient is reasonable for assessment of disease severity and determination of disease prognosis. At the same time the frequency of COPD exacerbations as one of the evaluated factors is most strongly associated with disease progression. Conclusions: Thus, a practitioner is recommended to use the proposed additional clinical criteria to assess the severity and degree of progression of COPD.

[Comparison Study of Oropharyngeal Microbiota in Case of Bronchial Asthma and Chronic Obstructive Pulmonary Disease in Different Severity Levels].

BACKGRAUND: The result of comparative study of oropharyngeal microbiota taxonomic composition in patients with different severity level of bronchial asthma (BA) and chronic obstructive pulmonary disease (COPD) is presented in this paper. AIMS: To compare oropharyngeal microbiota composition in case of bronchial asthma and chronic obstructive pulmonary disease in different severity levels. METODS: 138 patients, 50 with BA and 88 with COPD were studied. For each patient was collected anamnesis vitae, swab from the back of the throat and performed physical examination. High-throughput 16S ribosomal RNA gene sequencing and bioinformatic analysis was employed to characterize the microbial communities. RESULTS: As a result of the study wasfound a number of differences on various taxonomic levels in microbiota's composition within group of patients with different severity level of BA and group of patients with different severity level of COPD and between those groups. COPD patients with GOLD 1-2 in comparison with GOLD 3-4 patiens are marked by prevalence of species Brevibacterium aureum, genus Scardovia, Coprococcus, Haemophilus, Moryella, Dialister, Paludibacter and decrease of Prevotella melaninogenica species. BA patients with severe uncontrolled asthma in comparison with patients which have mild persistent asthma are marked by decrease of Prevotella and increase of species Bifidobacterium longum, Prevotella nanceiensis, Neisseria cinerea, Aggregatibacter segnis and genus Odoribacter, Alloiococcus, Lactobacillus, Megasphaera, Parvimonas, Sneathia. Patient's microbiota in BA group in comparison with COPD group is characterized by the prevalence of Prevotella melaninogenica and genus Selenomonas, Granulicatella u Gemella, and decrease of Prevotella nigrescens, Haemophilus influenza and genus Aggregatibacter, Alloiococcus, Catonella, Mycoplasma, Peptoniphilus u Sediminibacterium. There are no differences between microbiota composition in case of severe uncontrolled BA and very severe COPD. CONCLUSION: Lack of differences in oropharyngeal microbiota taxonomic composition between patients with severe uncontrolled BA and very severe COPD allow us to suggest a similarity of bronchopulmonary system condition in case of diseases' severe stages.

[Genetic determinants of antibiotic resistance in oropharyngeal streptococci in patients with chronic obstructive pulmonary disease and in those with asthma]. / Geneticheskie determinanty ustoichivosti orofaringeal'nykh streptokokkov k antibakterial'nym sredstvam u patsientov s khronicheskoi obstruktivnoi bolezn'yu legkikh i bol'nykh bronkhial'noi astmoi.

AIM: To identify oropharyngeal Streptococcus species and to analyze the genetic determinants of antibiotic resistance in patients with asthma and in those with chronic obstructive pulmonary disease (COPD). MATERIAL AND METHODS: An experimental diagnostic Streptopol+ (Lytech Co. LTD) panel based on a multiplex real-time PCR was applied to investigate the representation of antimicrobial resistance genes (mef and ermB) and the species composition of streptococci isolated from oropharyngeal swab samples from 89 patients with stable COPD and from 51 patients with asthma. RESULTS: In the stable disease period, the oropharyngeal swabs were found to contain Streptococcus pneumoniae in 7.8% of the patients with asthma and in 6.74% of those with COPD; the common feature of these groups was a tendency towards a severe disease course and recurrent exacerbations requiring antibiotics. S. pyogenus was detected in 42.9% of the oropharyngeal swabs from COPD and asthma patients without exacerbations. The oropharyngeal swabs showed the mef gene in 100% of the patients with asthma and in 100% of those with COPD; the ermB gene was encountered in 91% of the patients with COPD and in 82.4% of those with asthma. The COPD patients displayed a direct correlation between the representation of the ermB gene and sputum production and smoking index. The mef and ermB genes were directly correlated with the frequency of exacerbations in patients with COPD. CONCLUSION: The identified streptococci are a reservoir of antimicrobial resistance genetic determinants - the mef and ermB genes encoding the mechanisms of streptococcal macrolide resistance. The representation of the above genes directly correlates with the frequency of exacerbations and the number of antimicrobial drug uses.

[Vitamin D--A New Vector of Cancer Prevention?].

Currently, a great number of research projects are focused on finding new treatment methods for cancer and carcinogenesis predictors, as well as the ways to dicrease cancer development risks. This article provides an overview of research on vitamin D as cancer prevention factor. The results of independent experiments and in vitro tests explaining the mechanisms of protective effect of vitamin D and its derivatives on cancer are illustrated. The review of epidemiological survey results obtained from different countries and various populations that were focused on the association of vitamin D use with various cancer pathologies incidence was performed.

[The airways microbial community composition in healthy individuals and bronchial asthma patients].

This review summarizes the results of studies on the composition of microbial communities in the airways of healthy individuals and patients with asthma. Modern molecular genetic technology of the microbial identification, which are based on a sequence determination of encoding proteins genes conserved regions. These regions form the 16s-subunit ribosomal RNA in microorganisms of different species. These genes are detected by sequencing markers characteristic of individual microorganisms and their phylogenetic groups, and allow to perform a deep analysis of the microbiota in healthy volunteers and patients with chronic bronchoobstructive diseases. So, apparently healthy human bronchial tree is characterized by low bacterial contamination (most typical representatives here are the genera Pseudomonas, Streptococcus, Prevotella, Fusobacteria and Veilonella, much less potentially pathogenic Haemophilus and Neisseria are represented). In bronchial asthma patients the lower respiratory tract microbiota undergoes a qualitative transformation: as compared to healthy individuals the number of Proteobacteria increases and the number of Bacteroidetes decreases. Severe asthma in children is associated with significant respiratory tract Staphylococcus spp. insemination. Association between the asthma developing higher risk in young children and organisms such as Haemophilus, Moraxella and Neisseria spp. It is of considerable interest to determine the role of the microbiome in the development of human diseases of the bronchopulmonary system, and to understand the impact of the microbes communities as a course of disease and the important factor for the development of resistance to therapy.

[Composition of microorganism community in the airways of patients with chronic obstructive pulmonary disease].

This review summarizes results of research on the composition of microorganism community in the airways of patients with chronic obstructive pulmonary disease. Modern technologies for molecular genetic identification of microorganisms provide a deep insight into the microbiota of patients with chronic broncho-obstructive diseases for the better understanding of bronchopulmonary pathology in man and effect of microbiotic communities on the clinical course of diseases and formation of resistance to antibiotics.

[Molecular and pharmacogenetic mechanisms of severe asthma].

This review summarizes the results of studies to identify the dominant mechanisms of development and persistence of inflammation in severe asthma and results of pharmacogenetic studies of determination response to drugs. These mechanisms could potentially be used for diagnostic purposes and become the new targets of asthma therapy. Pharmacogenetic information will enable the use of a personalized approach to the asthma management which will adjust the therapy technology and increase the possibility of achieving disease control.

[The number of life years lost (DALYs) due to premature mortality in the population of Tomsk region in 2012].

AIM: To calculate the index of years of life lost population due to premature death in the Tomsk region in 2012, and the contribution of various groups of diseases in the total indicator DALY among males and females. MATERIALS AND METHODS: In the calculation of DALY used the number and the gender and age structure of the population of Tomsk region by 01.01.2012, according to Rosstat. To conduct the calculation of DALY used the methodology presented by the world Bank in the report "Investing in health" in 1993 According to the methodology, the DALY is the number of years of life of the population, lived with disability or other health problems, and lost due to premature death. RESULTS: The total loss of DALYs in the Tomsk region by the end of 2012 amounted 112,3, per 1000 population (11.6 +/- 8.9). In the structure of DALYs by cause of death 1st place is occupied by diseases of the circulatory system, 2nd injury and poisoning, 3rd neoplasms. CONCLUSIONS: The indicator DALY in the Tomsk region are significantly lower than the Russian Federation as a whole (according to S.A. Leonov--1.25 times, according to G. Yang--2 times). The relatively low level of DALYs in the Tomsk region is associated with favourable compared with other regions of the age structure (younger populations). It should also be noted that more than 70% of population live in urban areas, where, as is known, the availability of medical care are higher than in rural.

[Dynamics of functional parameters in different schemes for bronchial asthma therapy: results of the STRELA-ACT multicentre study].

Different strategies for disease control in real clinical practice are compared in terms of dynamics of functional parameters in patients with persistent bronchial asthma. This prospective multicentre surveillance study was carried out in 19 Russian clinics using the common protocol. The patients were divided in 3 groups in accordance with the changes of basal antiinflammatory therapy during the study period. Group A--stepwise increase in the extent of combined salmoterol/fluticason therapy, group B--long-term stable-dose salmoterol/fluticason therapy, group C--salmoterol/fluticason therapy with gradual decrease of the dose and/or transition to an alternative variant. Statistical analysis using Statistica 6.0 program included data from 543 patients. The results suggest that the two first modalities increased the level of control (ACT test) and improved characteristics of external respiration throughout the study period. Strategy 3 was associated with a decrease in the external respiration function and the level of control.

[Genome-wide association study of allergic diseases in Russians of Western Siberia].

Genome-wide association studies are currently considered as one of the most powerful tools to establishing the genetic basis of complex diseases. A number of such studies were carried out for allergic diseases; however, in Russian population this analysis has not been performed so far. For the first time, we performed genome-wide association study of allergic diseases in Russian inhabitants of Western Siberia. Two new loci associated with childhood bronchial asthma were identified (20q13.12, rs2425656, P = 1.99 x 10(-7); 1q32.1, rs3817222, rs12734001, P = 2.18 x 10(-7) and 2.79 x 10(-7), respectively) as well as one locus, associated with allergic rhinitis (2q36.1, rs1597167, P = 3.69 x 10(-7)). Genes located in the loci, YWHAB and PPP1R12B for asthma and KCNE4 for allergic rhinitis, are new genes for these diseases. It was found that BAT1 (6p21.33), MAGI2 (7q21.11) and ACPL2 (3q23) genes are, likely, common (syntropic) genes of allergic disease and a topic sensitisation. It was shown that RIT2 (18q12.3) and (5q31.1) genes can be involved in the control of lung function. The results of the study enlarge the body of data on genetic factors of allergy and expand the list of genes underlying these diseases.

Toxicity of monazite particulates and its attenuation with a complex of bio-protectors.

BACKGROUND: Workers employed on mining, processing and storage of monazite are at risk of exposure to dust with expected adverse health effects. OBJECTIVES: To study the adverse health effects of monazite particles in experiments on rats and to test the possibility of attenuating these effects. METHODS: Outbred white rats were injected intratracheally with a suspension of ground monazite concentrate (MC) in order to investigate the cellular response of the lower airways 24 hours later and the organism's status 6 months after the injection. The bio-protective complex (BPC) tested in these experiments consisted of glutamate, an iodine preparation, methionine, a polyvitamin-polymineral composition, and/or "Eicosavitol" (fish oil preparation rich in PUFA, predominantly of the omega 3-group). Bio-protectors were administered together with the rat food and drink daily for one month before the MC injection in the short-term experiment, or over 6 months after such injection in the long-term experiment. RESULTS: MC induced manifestations of its cytotoxicity, fibrogenicity and systemic toxicity as well as genotoxicity. The tested BPC attenuated virtually all these effects. Although a similar protective potential of "Eicosavitol" against almost all of them was lower compared with that of BPC, combining BPC with "Eicosavitol" provided, as a rule, the greatest protective effect. CONCLUSION: It may be assumed that the many-sided adverse effects of MC on the organism is due, at least partially, to the presence in its composition of not only rare earth elements but also of natural radioisotopes of the thorium and uranium families. The combination of the bio-protectors tested was highly effective and may be recommended for administering in periodic preventive programmes to exposed workers.