Relevance. Metabolic disorders in non-alcoholic fatty liver disease play a significant role in the development and progression of cardiovascular diseases, accelerating their occurrence, aggravating their course and outcomes. The occurrence and maintenance of a chronic staged course (from fatty hepatosis and non-alcoholic steatohepatitis to progressive liver fibrosis) of the disease is associated with quantitative and qualitative changes in the composition of the intestinal microflora. At the same time, outpatients may consider themselves healthy, which makes it difficult to implement a comprehensive treatment program. The peculiarities of the combination of clinical, laboratory and microbiological characteristics of patients with hepatic steatosis require detailed study for the earliest identification of therapeutic targets, diagnostic and prognostic tools and their effective correction. Purpose of the study: to determine the clinical, laboratory and microbiological characteristics of patients with non-alcoholic fatty liver disease. Material and methods: clinical, laboratory and microbiological data of outpatients were collected, anthropometric indicators were calculated. Statistical analysis: Microsoft Excel 2010 and StatTech v.3.1.8 (Russia) with assessment for normality of distribution and chi-square test. Differences were assessed by nonparametric analysis at a significance level of p<0.05. Results. Patients were assigned to the observation group if they had NAFLD or to the comparison group in it absence. Many patients in the observation group were found to have metabolic syndrome and/or abdominal obesity, accompanied by asthenic syndrome, functional disorders of the biliary tract, and disorders of lipid and carbohydrate metabolism. In the luminal microflora of the intestines of patients in the observation group, the presence of representatives of Pseudomonas spp. was significantly more often detected. Correction of microbiological disorders by adding dietary fiber to the diet provided clinical improvement. Conclusion. In addition to clinical and laboratory data, microbiological characteristics of patients can be used for the earliest diagnosis and effective correction of disorders that occur during the development of NAFLD.

The functional responsibilities of general practitioners (family doctors) (GPs) have changed significantly over the past decade. The number of GP functions has expanded. Despite the increasingly complex professional activities of GPs, there is no scientific evidence for the qualification characteristics of GPs expressed in knowledge, skills, abilities, and competencies in the theory and practice in training. In this regard, a study was conducted to determine the priority of GP competencies that make up the qualification characteristics of a specialist. Aim. To analyze, generalize and rationale the research results, as well as to develop preliminary guidelines for GP training. Material and methods. The information base for the study was the results of ranking competencies according to their importance in the professional activities of GPs in Russia. It was obtained during the ascertaining experiment, implemented using the Delphi method as a method of expert assessment and strategic planning of training specialists. Conclusion. The analysis of competencies developed and agreed upon by experts showed its compliance with the job functions of GPs, the requirements of the Federal State Educational Standard for the General Medical Practice (Family Medicine) and the WONCA guidelines. A summary of the study results to determine the priority of competence in GP activities showed the following: — all competencies (25) were defined as necessary and constitutive of GP qualification; — 21 competencies were considered significant and highly significant for GPs; — 4 competencies were considered as of moderate significance and below moderate significance. The analysis of the priority of competences revealed insufficient methodological support for GP training in accordance with the social order. The results obtained showed the need to continue the study within the project "Quality Management of Training of General Practitioners (Family Doctors)".

The article presents an analytical review of the published data on the features of protein glycosylation in multiple sclerosis (MS). The search in the PubMed database with the keywords "multiple sclerosis, glycosylation", for the period of 2012-2022, resulted in 12 sources presenting the studies on N-glycosylated plasma proteins and immunoglobulins G in multiple sclerosis, clinically isolated syndrome, neuromyelitis optica spectrum disorders and meningitis of viral etiology in patients' cerebrospinal fluid and blood serum. The studies revealed specific changes in glycoproteins in multiple sclerosis. Glycome changes correlated with the age and sex of patients, with the clinical form of the disease, as well as with the degree of disability on the EDSS scale. These findings can contribute to the early diagnosis of MS, the definition of the form of the disease and its course prediction. Given the diversity of the glycome expression, the differences in its modifications in different environments (serum and blood plasma, cerebrospinal fluid), as well as the variety of approaches to its study (many quantitative and qualitative biochemical methods), there is a prospect of further search for markers and predictors of the course of multiple sclerosis.

In healthcare, a new digital branch of medicine has emerged – telemedicine, which is especially relevant for primary healthcare. To ensure the quality functioning of telemedicine centers, it is important to provide timely and high-quality training of medical personnel in the relevant field of knowledge. The solution of this problem is entrusted to the leading medical universities of the country. The article is devoted to the generalization of the experience of teaching telemedicine technologies at the Department of Family Medicine with the course of telemedicine technologies of the Samara State Medical University at the levels of specialist, residency, advanced training of doctors and primary retraining of doctors in the specialty "General Medical Practice (Family Medicine)" and «Therapy». A successful combination of presenting theoretical material and developing practical skills for conducting telemedicine consultations in practical classes in the form of training simulation telemedicine consultations in real conditions of outpatient practices, including using the capabilities of the Center for Remote Medicine Clinics of the Samara State Medical University, made it possible to train more than 300 specialists who have the skills to conduct telemedicine consultations, who use telemedicine consultations in real medical practice in medical institutions of the Samara region.

BACKGROUND: Arterial hypertension is a common cardiovascular disease that requires constant monitoring by a doctor of drug therapy to achieve the target blood pressure level. AIM: To analyze pharmacotherapy of essential hypertension in patients, who have achieved a controlled course of the disease. MATERIALS AND METHODS: In this study 274 patients with controlled course of stage 2 arterial hypertension and no comorbidities were recruited. Blood pressure indicators, anthropometric data, results of laboratory and instrumental studies, the volume of drug therapy for hypertension were analyzed. RESULTS: We analyzed 543 drug prescriptions for 274 patients with stage II hypertension. In 97 (35.3%) patients only one drug was prescribed, in 112 (40.7%) two drugs, in 46 (16.7%) three drugs from various pharmacological groups, among which monodrugs were in the lead: angiotensin-converting-enzyme inhibitors 31.86%, cardioselective -blockers 23%, angiotensin 2 receptor blockers 9.3%. Combined drugs were present in 18.4% of general doctors prescriptions. Fixed forms of combined antihypertensive drugs were taken by only 50 (18.4%) patients. To prevent cardiovascular complications of arterial hypertension, 75 (26%) patients were prescribed statins (atorvastatin or rosuvastatin) and 56 (19.5%) antiplatelet monotherapy with Cardiomagnyl, Thrombo ACC or clopidogrel. CONCLUSIONS: To achieve the target blood pressure level and control arterial hypertension in patients with stage II hypertension, general practitioners used all main

Bronchial asthma is a widespread disease that is becoming increasingly costly to the medical and financial systems of many countries with each passing year. The rising prevalence of bronchial asthma necessitates a search for the most efficient diagnostic and treatment strategies for various asthma phenotypes, including some that are relatively uncommon. From this point of view, glycomics appears to be one of the most interesting and perspective branches of medicine. This research area studies various carbohydrate complexes and their roles in the development of various diseases. Researchers are interested in the study of the receptors for advanced glycation end products and their soluble variants with regard to bronchial asthma. Furthermore, sialic acid-binding immunoglobulin-type lectins (Siglecs) may play a vital role in the principal novel strategies of the treatment. By affecting Siglecs, a decrease in the proinflammatory activity of immunocompetent cells results, and the bronchial walls are protected. Finally, N- and O-glycans remain almost unresearched. These molecules, on the other hand, have the potential to play a significant role not only in the diagnosis and confirmation of asthma but also in the allergenicity of various molecules. Scientists are interested in N-glycans, not only in the diagnostic context but also in their role as a molecule that can reduce allergenicity, for example, egg white vaccines. Glycomics and glycoproteomics are cutting-edge disciplines of medical science that are opening up new perspectives in the management of patients with diseases of various organs and systems, including diseases of the respiratory tract in general and bronchial asthma in particular. Despite the fast-paced nature of the development of glycoscience, theories about the role of the molecules investigated in the pathophysiology of respiratory disorders are only beginning to emerge.

The earliest correction of behavioral risk factors for chronic non-communicable diseases will reduce the rates of premature mortality of the population. Currently, the relationship between the altered spectrum of intestinal microflora in various indicators of suboptimal health status and body mass index is not sufficiently studied. When they are in a state of suboptimal health status, patients consider themselves healthy and do not go to the doctor for a long time, which makes it difficult to implement early preventive measures in this group of patients. Goal. To determine the qualitative and quantitative composition of the intestinal microflora before and 1 month after taking a metaprebiotic complex containing dietary fiber (inulin) and oligosaccharides (oligofructose) in outpatient patients who consider themselves healthy, have behavioral risk factors for chronic non-communicable diseases or chronic non-communicable diseases in remission, and/or do not consult a doctor within the last 3 months. Materials and methods. Outpatient patients were examined (114 people: 36 men, 78 women aged 18 to 72 years). A survey was conducted, including a detailed active collection of complaints (including using the international SHSQ-25 questionnaire) and anamnesis, as well as a thorough physical examination with an anthropometric study. Using the MALDI-ToF mass spectrometry method, the degree of microbiotic disorders, the structure of the intestinal microflora were determined with the identification of microorganisms isolated from feces before and after taking the course of the metaprebiotic complex with various indicators of suboptimal status and body mass index. Results. New data were obtained on the intestinal biocenosis of patients who consider themselves healthy at different levels of suboptimal status. When using a metaprebiotic complex containing inulin and oligofructose, an improvement in the composition of the intestinal microflora was found due to a decrease in the frequency of release of conditionally pathogenic enterobacteria and other gram-negative microorganisms (median degree of contamination: from 0.45 (0.3-0.98) to 0.3(0.21-0.7) at low suboptimal status and from 0.5(0.7-1.7) to 0.31 (0.2-1.3) at high) and increase the frequency of enterococcal excretion (median degree of contamination: from 5,58 (4,16-7,0) tо 6,3 (4,8-7,8) at low suboptimal status and from от 4,5 (2,8-6,3) tо 5,1 (3,8-6,4) at high). Conclusion. The importance of studying the microbiotic complex of the intestine in increasing the indicators of suboptimal health status and body mass index in patients who consider themselves healthy is proved, which will allow for the earliest detection and rational individual prevention of chronic non-communicable diseases.

Цель – определить качественный и количественный состав микрофлоры кишечника амбулаторных пациентов, считающих себя здоровыми и/или не обращающихся к врачу в течение последних 3 месяцев, до и через 1 месяц после приема метапребиотического комплекса, содержащего пищевые волокна (инулин) и олигосахариды (олигофруктоза). Материал и методы. Проведено обследование амбулаторных пациентов, считающих себя здоровыми и/или не обращавшихся к врачу в течение последних 3 месяцев. Собраны клинические данные с целью активного выявления наличия диспепсических жалоб. После проведения клинического обследования у 114 чел. определена степень микробиотических нарушений структуры микрофлоры кишечника до приема метапребиотического комплекса и у 78 чел. из них – через 1 мес. после приема курса метапребиотического комплекса при различных показателях субоптимального статуса и неспецифических диспепсических жалобах. Результаты. Получены новые, значимые для практической медицины данные о биоценозе кишечника при различных уровнях субоптимального статуса пациентов, считающих себя здоровыми: обнаружено недостаточное суммарное количество микрофлоры. При применении метапребиотического комплекса, содержащего инулин и олигофруктозу, обнаружено улучшение состава микрофлоры кишечника за счет снижения частоты выделения условно-патогенных энтеробактерий и других грамотрицательных микроорганизмов. Заключение. Доказана значимость изучения микробиотического комплекса кишечника при повышении показателей субоптимального статуса здоровья у пациентов, что позволит проводить более ранний индивидуальный активный скрининг в данной категории пациентов.

The earliest correction of behavioral risk factors for chronic non-communicable diseases will reduce the rates of premature mortality of the population. Currently, the relationship between the altered spectrum of intestinal microflora in various indicators of suboptimal health status and body mass index is not sufficiently studied. When they are in a state of suboptimal health status, patients consider themselves healthy and do not go to the doctor for a long time, which makes it difficult to implement early preventive measures in this group of patients. Goal. To determine the qualitative and quantitative composition of the intestinal microflora before and 1 month after taking a metaprebiotic complex containing dietary fiber (inulin) and oligosaccharides (oligofructose) in outpatient patients who consider themselves healthy, have behavioral risk factors for chronic non-communicable diseases or chronic non-communicable diseases in remission, and/or do not consult a doctor within the last 3 months. Materials and methods. Outpatient patients were examined (114 people: 36 men, 78 women aged 18 to 72 years). A survey was conducted, including a detailed active collection of complaints (including using the international SHSQ-25 questionnaire) and anamnesis, as well as a thorough physical examination with an anthropometric study. Using the MALDI-ToF mass spectrometry method, the degree of microbiotic disorders, the structure of the intestinal microflora were determined with the identification of microorganisms isolated from feces before and after taking the course of the metaprebiotic complex with various indicators of suboptimal status and body mass index. Results. New data were obtained on the intestinal biocenosis of patients who consider themselves healthy at different levels of suboptimal status. When using a metaprebiotic complex containing inulin and oligofructose, an improvement in the composition of the intestinal microflora was found due to a decrease in the frequency of release of conditionally pathogenic enterobacteria and other gram-negative microorganisms (median degree of contamination: from 0.45 (0.3-0.98) to 0.3(0.21-0.7) at low suboptimal status and from 0.5(0.7-1.7) to 0.31 (0.2-1.3) at high) and increase the frequency of enterococcal excretion (median degree of contamination: from 5,58 (4,16-7,0) tо 6,3 (4,8-7,8) at low suboptimal status and from от 4,5 (2,8-6,3) tо 5,1 (3,8-6,4) at high). Conclusion. The importance of studying the microbiotic complex of the intestine in increasing the indicators of suboptimal health status and body mass index in patients who consider themselves healthy is proved, which will allow for the earliest detection and rational individual prevention of chronic non-communicable diseases.

From 30 to 43% of smoking patients with chronic obstructive pulmonary disease (COPD) cannot give up nicotine despite the diagnosis and deterioration of health. Most of the publications related to the treatment of COPD do not distinguish smoking patients into a separate group. The aim of this study is a comparative analysis of the effectiveness of long-acting muscarinic antagonists (LAMA), LAMA/long-acting β2 -agonists (LABA) in smoking patients.Methods. The study involved 121 patients with a high degree of nicotine addiction and irreversible bronchial obstruction. All the patients continued to receive bronchodilator therapy. The respondents were divided into two groups: patients who quit smoking and patients who continued to smoke. In turn, each group was divided into two subgroups depending on the treatment – LAMA (Tiotropium 5 μg and Glycopyrronium 50 μg) and LAMA/LABA (tiotropium/olodaterol 5/5 μg and glycopyrronium/idacaterol 50/110 μg). We used the changes of FEV1 and the dynamics of CAT (COPD Assessment Test) as the comparison criteria.Results. The results of the CAT and spirometry showed a tendency to improve in both groups, regardless of the treatment regimen. However, the improvement in symptoms and spirometry parameters were more pronounced in the group of patients who quit smoking: –1 and –11 points, respectively (p < 0.05) and 12 and 23%, respectively (p < 0.05). Comparison of the efficacy of various treatment regimens in the group of smoking patients showed there was no statistically significant difference between LAMA and LAMA/LABA neither in spirometry parameters (11.45 and 13.1%; p < 0.05), nor in the CAT scores (–1.5 and –1.67; p < 0.05). However, combination therapy (LAMA/LABA) was more effective than monotherapy (LAMA) in the group of patients who quit smoking both according to spirometry (25.5 and 13%, respectively; p < 0.05) and CAT (–12.3 and –5.9, respectively; p < 0.05). There was no statistically significant difference between the active substances both in the monotherapy group (tiotropium/glycopyrronium) and in the combination group (tiotropium/olodaterol and glycopyrronium/indacaterol).Conclusion. According to CAT and spirometry, there was no difference between tiotropium and glycopyrronium, nor was there a difference between fixed-dose combinations of tiotropium/olodaterol and glycopyrronium/ indacaterol (both in the group of smokers and in the group of non-smokers). Smoking cessation is key to improving both spirometry and CAT results.

Objectives to analyze the quality and quantity of the intestinal microflora of relatively healthy people and/or of those who did not visit a doctor in the last 3 months, before and 1 month after taking a meta-prebiotic complex containing dietary fiber (inulin) and oligosaccharides (oligofructose). Material and methods. We examined the individuals who considered themselves healthy and/or did not consult a doctor during the past 3 months. To detect the presence of dyspeptic complaints, the clinical data were collected. 114 people with different suboptimal status and non-specific dyspeptic complaints were chosen for the study and underwent the clinical examination for the degree of gut microbiota imbalance before taking the meta-prebiotic complex. 78 people followed the course of the meta-prebiotic and were examined after 1 month after the start. Results. We have obtained new data on intestinal biocenosis at various suboptimal status in relatively healthy people: the total number of bacteria is insufficient. When using a meta-prebiotic complex containing inulin and oligofructose, the composition of the intestinal microflora was improved due to the decreased cases of detection of opportunistic enterobacteria and other gram-negative microorganisms. Conclusion. The significance of studying the intestinal microbiotic complex in patients with the increased suboptimal health status is proved, and the earlier active screening of this category of patients is recommended.

Introduction: According to the WHO, 30.9% of the adult population of the Russian Federation are active smokers. From 30% to 43% of smoking patients with COPD are not able to give up nicotine despite the diagnosis and deterioration of health. Most of the publications related to the treatment of COPD do not distinguish smoking patients into a separate group. The purpose of this study is a comparative analysis of the effectiveness of LAMA (Tiotropium bromide and Glycopyrronium bromide) and LABA / LAMA (Olodaterol + tiotropium and Indacaterol + Glycopyrronium bromide). Materials and methods: The study involved 102 patients with a high degree of nicotine addiction and irreversible bronchial obstruction. All the patients were submitted to the treatment of nicotine addiction syndrome on the basis of Otkrytie Medical Center LLC. All the patients continue to receive bronchodilatory therapy. Respondents were divided into two groups: patients who quit smoking and patients who continued to smoke. In turn, each group was divided into two subgroups depending on the drugs being taken - LAMA and LAMA / LABA. As comparison criteria, we selected the dynamics of FEV1 and the dynamics of CAT. Results: As a result of the analysis of the obtained data FEV1 increase was detected in both study groups, regardless of the treatment regimen. FEV1 increase within the group of smoking patients was lower than of those who quit smoking - 11% and 22% respectively (p < .05). CAT dynamics showed a downward trend in both groups. However, the patients who quit smoking demon-strated greater reduction of symptoms during therapy than the smoking patients — -10 and − 1 points respectively (p < .05). No statis-tically significant difference was found either on CAT (p = .31) or spirometry - FEV1 (p = .22) for the LAMA and LAMA / LABA subgroups. Combined therapy (LAMA / LABA) applied to the group of patients who quit smoking found to be more effective than monotherapy (LAMA) both in terms of spirometry (an increase in FEV1 came to 26% and 13% respectively (p < .05)), and the de-gree of reduction of the symptoms (CAT) - -11 and − 5 respectively (p < .05). Conclusion: While maintaining nicotine status, long-acting anticholinergic (LAMA) and combined long-acting bronchodila-tors produce a moderate and comparable effect. Therefore, when choosing the tactics of COPD treatment, it is necessary to take into consideration the current nicotine status of the patient as well as the nicotine addiction degree.

It is known that iron deficiency is a negative factor for the onset of pregnancy. It aggravates its course, increasing the risk of preeclampsia, placental insufficiency, uterine inertia, premature birth, bleeding and hypogalactia. This condition increases the risk of unfavorable outcomes, iron deficiency anemia and cognitive delay in a child. Raising the awareness of women of reproductive age and the clinical suspicion of physicians regarding the iron deficiency anemia and latent iron deficiency can facilitate timely visit a doctor. At the expert council “Relevant issues of iron deficiency in the Russian Federation” held in June 2020, aspects of the epidemiology, diagnosis and treatment of this condition were discussed, and promising directions for improving the situation were proposed.

Sedentary lifestyle, being a behavioral risk factor for chronic non-communicable diseases, is relevant for preventive medicine. A key role in the correction of behavioral risk factors for chronic non-communicable diseases is occupied by general medical practice, where the patient is continuously observed for many years. Increased physical activity reduces the risk of atherosclerosis, diseases of the musculoskeletal system, malignant tumors, has a positive effect on the psychological state of patients and reduces the overall morbidity and mortality. Increasing the reserves of the cardiorespiratory system of the body, physical activity improves the quality of life of patients and reduces the cost of medical care.To effectively combat sedentary lifestyle, it is necessary to adequately motivate patients that can be achieved through routine counseling to enhance physical activity. The method of such consultation should take into account limited time of outpatient admission and all personal characteristics of patients (starting level of physical activity, health group and risk of disease).The article presents a summary of modern scientific views in the field of increasing physical activity of patients, discusses current issues of counseling. The groups of patients with or without chronic diseases and the high risk of cardiovascular complications were discussed. The variant of rational outpatient counseling with the help of the algorithm of organization of physical activity mode, providing stratification of patients, planning, optimization and control of personal motor activity was presented. The proposed method of optimization of counseling successfully solves the problems of motivation, increase of physical activity and individual approach in outpatient practice.

Patients who have cardiovascular risk factors (CVD) consider themselves healthy. They have no active complaints, and they will not go to the doctor. In this regard, the risk factors in outpatients who will be considering themselves healthy sill not sufficiently studied.For early detection of cardiovascular risk factors, the SCORE scale is used. The researchers also offered IPAQ and SHSQ-25 questionnaires. Aim. To study the severity of cardiovascular risk in outpatients depending on their physical activity and the presence of suboptimal health status. Material and methods. 358 people (155 men and 203 women aged 18 to 60 years) who considered themselves healthy or did not seek medical care during the last 3 months were examined. The main risk factors of CVD were studied and individual cardiovascular risk was determined on the SCORE scale. Physical activity was assessed using the IPAQ questionnaire. The presence of suboptimal health status was determined by the SHSQ-25 questionnaire. Statistical processing was carried out using Microsoft Excel 2010, Statistica 10.0 with estimation of normality of distribution and using criteria х2, Kraskel-Wallis, Mann-Whitney test. Results. We identified statistically significant differences in the suboptimal status depending on the severity of cardiovascular risk (х2=11,752, d.f.=1, p=0,003), total cholesterol (х2=7,139, d.f.=1, p=0,008) and blood pressure (х2=25,636, d.f =1, p=0,001); significant differences in the groups of physical activity and risk factors for CVD (х2=18,859, p<0,001; х2=18,965, p=0,001; х2=8,745, p=0,004, respectively); with normal and elevated body mass index (х2=22,06, p=0,001; х2=16,742, p=0,001, respectively). Significant differences were found in the severity of suboptimal status in different risk categories on the SCORE scale (х2=22,556; p=0,001); and in patients with low cardiovascular risk, the SCORE scale for suboptimal status depending on the level of physical activity (х2=8,273 p=0,016). Conclusion. For primary screening of the outpatients considering themselves healthy, and not seeing a doctor we offer IPAQ and SHSQ-25 questionnaires for inclusion them in programs of annual observations of patients with low cardiovascular risk (on SCORE scale).

The patient, who has risk factors but considers himself / herself to be healthy, does not consult a doctor, but is in a suboptimal status. The study of the patient’s health at different levels of physical activity is an important issue of preventive medicine. Material and methods . 351 people (133 men and 218 women) aged 18 to 75 years after obtaining voluntary informed consent to the study were examined. Patients were divided into 8 groups according to the international physical activity questionnaire (IPAQ). In addition to the classic clinical and laboratory examination, patients were interviewed using questionnaires: suboptimal health status (SHSQ-25), hospital anxiety and depression scale (HADS), stress susceptibility questionnaire (PSS). Statistical processing was carried out by programs Microsoft Excel 2010 and Statistica 10,0. Research result . When studying the values of discovering the fact of the differences in some indicators: increase of arterial pressure in 3 and 4 group physical activity, age of women, increasing of body mass in the 2, 3, 5 and 8 groups physical activity that proves the relationship of the presence of risk factors and physical activity level of the patient. Significant differences between the actual values of the mean age and the alarm level in groups with high and low suboptimal status were revealed. Significant differences in suboptimal status were revealed, which reflected the presence of risk factors for chronic noncommunicable diseases in groups with different physical activity (age of women over 45 years old, overweight, monthly use of alcohol, the presence of hypercholesterinemia and high level of depression). Significant differences in groups with high and low indicators of suboptimal status in the presence of risk factors for chronic noncommunicable diseases are revealed: age over 45 years, increased systolic and diastolic blood pressure, high levels of anxiety. Significantly differed in the indicators of suboptimal status of the group of physical activity: 2, 3, 6 and 7. Conclusion . In groups of patients who consider themselves healthy and do not see a doctor for 3 months or more, the risk factors of chronic non-communicable diseases, more common in groups of patients who are not engaged in physical activity, were identified. Differences in indicators of suboptimal health status in the presence of risk factors of chronic noncommunicable diseases are revealed. The SHSQ-25 questionnaire objectively reflected the main screening indicators of chronic disease risk factors, it is simple to use in primary health care, it is an economical and effective tool for screening subclinical, reversible stages of chronic diseases.

The article presents the data of a retrospective analysis of the average per capita consumption of food by the population of the Samara region in comparison with the all-Russian indicators and recommended values of consumption in the period from 2010 to 2015, as well as the analysis of the actual nutrition of different groups of the working-age population of the Samara region in 2015 (2154 people aged 18 up to 62 years of age, 1179 of them women, 975 men) using the method of 24-hour reproduction of food and the frequency method with quantitative assessment of consumed products, in comparison with the dynamics of the prevalence of alimentary-dependent diseases. Estimation of parameters of nutritional status was also conducted on blood level of cholesterol and glucose, bioelectrical impedance analysis of body composition (n=514). It was found that 48.2% of the subjects had normal body weight, 38.1% -overweight, 13.7% - obesity. The analysis of actual consumption revealed an unfavorable trend of increasing consumption of fats, as well as sugar from 2010 to 2015, while the consumption of vegetables, fruits and berries was lowed compared to the national indicators and recommended consumption values. The analysis of actual nutrition allowed to make a conclusion about severe violations of the relationships between nutrients in the diet of all surveyed populations, characterized by the excess intake of fat (45% of the energy diet value), including saturated fatty acids, and added sugar (13% calories). In the diet of 82% of the respondents the content of vitamins B1 and B2 did not reach the recommended level, niacin - 37%, vitamin A - 47%, vitamin C - 68%, calcium and iron - 14%. With an increase in BMI, there was an increase in blood level of cholesterol and glucose (r=0.24 and r=0.26, respectively, p<0.05), both in men and women. In individuals with excess fat and added sugar in the diet, increased fat body component (r=0.17, p<0.05) and lowered content of skeletal muscle mass (r=0.25, p<0.05) were observed. The revealed unfavorable trend of nutritional and metabolic disorders, against the background of increased consumption of fats, added sugar, indicates the need for an integrated approach to the correction of diet at both individual and population levels.

The patient, who has risk factors but considers himself / herself to be healthy, does not consult a doctor, but is in a suboptimal status. The study of the patient’s health at different levels of physical activity is an important issue of preventive medicine.Material and methods. 351 people (133 men and 218 women) aged 18 to 75 years after obtaining voluntary informed consent to the study were examined. Patients were divided into 8 groups according to the international physical activity questionnaire (IPAQ). In addition to the classic clinical and laboratory examination, patients were interviewed using questionnaires: suboptimal health status (SHSQ-25), hospital anxiety and depression scale (HADS), stress susceptibility questionnaire (PSS). Statistical processing was carried out by programs Microsoft Excel 2010 and Statistica 10,0.Research result. When studying the values of discovering the fact of the differences in some indicators: increase of arterial pressure in 3 and 4 group physical activity, age of women, increasing of body mass in the 2, 3, 5 and 8 groups physical activity that proves the relationship of the presence of risk factors and physical activity level of the patient. Significant differences between the actual values of the mean age and the alarm level in groups with high and low suboptimal status were revealed. Significant differences in suboptimal status were revealed, which reflected the presence of risk factors for chronic noncommunicable diseases in groups with different physical activity (age of women over 45 years old, overweight, monthly use of alcohol, the presence of hypercholesterinemia and high level of depression). Significant differences in groups with high and low indicators of suboptimal status in the presence of risk factors for chronic noncommunicable diseases are revealed: age over 45 years, increased systolic and diastolic blood pressure, high levels of anxiety. Significantly differed in the indicators of suboptimal status of the group of physical activity: 2, 3, 6 and 7.Conclusion. In groups of patients who consider themselves healthy and do not see a doctor for 3 months or more, the risk factors of chronic non-communicable diseases, more common in groups of patients who are not engaged in physical activity, were identified. Differences in indicators of suboptimal health status in the presence of risk factors of chronic noncommunicable diseases are revealed. The SHSQ-25 questionnaire objectively reflected the main screening indicators of chronic disease risk factors, it is simple to use in primary health care, it is an economical and effective tool for screening subclinical, reversible stages of chronic diseases.

Aim - to investigate the influence of IL-17, IL-10 on the level of asthma control among obese patients. Materials and methods. 79 patients with asthma aged from 18 to 65 years were enrolled in our study and categorized into three groups according to their body mass index (BMI): group 1 - normal BMI (27 (34,2%) patients, age 50±13,8), group 2 - overweight (28 (35,4%) patients, age 44±16,5) and group 3 - obese (24 patients (30,4%), age 57,3±8,2). These patients underwent spirometry and were compared for clinical characteristics, plasma level of IL-17 and IL-10 using ELISA assay. Results. IL-17 concentrations were higher in the obese and uncontrolled asthmatics. Statistically significant correlation between the level of IL-10 and BMI was not found. Conclusions. Our study shows that cytokines IL-17 play an important role in the immune response of asthma in obese patients, and represent an important therapeutic target for the asthma treatment.