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.

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.

Целью открытого сравнительного проспективного исследования с контролем по исходным значениям теста АСТ (The Asthma Control TestTM) была оценка уровня контроля над бронхиальной астмой (БА) у пациентов, наблюдавшихся участковыми терапевтами, врачами общей практики (семейными врачами) и врачамиспециалистами (пульмонологами, аллергологамииммунологами). В ходе исследования пациенты ( n = 190) совершали 3 визита в клинику в течение 168 ± 6 дней. При каждом из визитов оценивались показатели АСТ. Согласно полученным данным, фармакотерапия БА в большинстве случаев проводится с использованием рекомендаций GINA (2006). Назначение комбинированной терапии пациентам ассоциировано с наилучшим контролем болезни. Различия в уровне контроля БА у пациентов, наблюдавшихся различными специалистами, на фоне идентичного режима базисной терапии обусловлены тем, насколько точно врачами соблюдались рекомендации по диагностике и мониторированию симптомов БА (GINA, 2006). Для оптимизации ведения больных БА в реальной клинической практике необходимо более широко использовать современные инстру менты оценки уровня контроля болезни (АСТ) и оснастить лечебные учреждения необходимым диагностическим оборудованием.

The aim of the study was to evaluate life quality (LQ) of patients with severe bronchial asthma (BA) in connection with the degree of the disease control. Seventy two BA outpatients were divided into two groups: 50 patients with uncontrolled BA, and 22 patients who had achieved full BA control thanks to combined therapy with salmeterol plus fluticasone propionate in a dose of 1000 mg per day during 3 months. Clinical symptoms, respiratory parameters, and daily requirement of broncholytics were under study. General and specialized questionnaires (SF-36; AQLQ) were used to evaluate LQ. The study revealed that full BA control lead not only to improvement of clinical symptoms and positive changes in the respiratory function, but to significant increase of LQ as well. Thus, achievement of full BA control as a complex goal of treatment increases patients' LQ, especially in social sphere.

The aim of the study was to compare the clinical characteristics and the inflammatory process activity in the airway of patients with severe therapy-sensitive and therapy-resistant bronchial asthma (TSBA; TRBA). The subjects were 171 patients with severe bronchial asthma (BA) aged 18 to 60; the diagnosis was established prior to the study according to GINA 2002 criteria. There were 50 TSBA patients, 121 TRBA, and 50 controls. According to a range of criteria, BA in TRBA was more severe than that in TSBA. TRBA patients displayed significantly higher indices of inflammatory process activity, such as absolute and relative number of eosinophiles and neutrophiles in induced sputum (IS), and IS level of IL-5. Evaluation of IS inflammatory markers in patients with severe BA allowed substantiation of the central role of persistent inflammation as a risk factor of TRBA development.

Interleukin-5 (IL-5) is an important marker of inflammation in bronchial asthma (BA). The level of IL-5 was investigated by immune-enzyme assay (IEA); the expression degree of IL-5 mRNA was studied, before and after the conducted therapy, by the inhibition reaction-IEA (IR-IEA) in sputum and blood serum of patients. No differences between contents of IL-5 were found in blood plasma of patients with various disease degrees or of patients with different BA etiologies. The IL-5 contents in sputum were reliably different in different groups and depended on a disease severity, exacerbation and remission. An evaluation of an expression degree of the IL-5 RNAm in eosinophiles, derived from patients' blood, provided for clarifying the differences between acute asthma and other disease forms and for defining the therapy influence on the parameter in question. The IL-5 RNAm expression in sputum was reliably different in patients with moderate forms and with acute forms of the disease; it was decreasing due to treatment. Finally, the results of the evaluation of the IL-5 level and the study of mRNA expression of the cytokine mutually supplement one another and make it possible to evaluate the disease degree and therapy efficiency.