Introduction The article is devoted to the current state of continuing medical education for general practitioners in the city of Moscow. Materials and methods During the study, sociological, analytical and statistical research methods were applied. Domestic and foreign literary sources, as well as regulatory documents relevant to the research problem, were analysed. A questionnaire was developed to survey general practitioners working in Moscow. Results of the study The results of the study demonstrated a lack of satisfaction with the organisation and content of training in the previous format, the absence of significant changes in the learning objectives following the education reform and an ambiguous attitude towards this reform. The minimum continuing education requirements for general practitioners working in the city of Moscow were shown to consist of day release, short-term training, theoretical and practical orientation and the application of contemporary educational technologies. Discussion and conclusion Conceptual approaches to the development of continuing medical education in the field of general medical practice in Moscow were formulated. These comprised organisation of training, setting of learning objectives, selection of forms and methods of training, determination of interactive training content, application of a competency-based approach and individualisation of the educational path.

Background. Obesity is a component of metabolic syndrome, a separate disease, and a predictor of most chronic diseases. In recent decades, increasing attention has been paid to the effect of obesity on chronic localized pain. Aim. To determine the clinical characteristics of chronic localized pain depending on the body mass index and sociodemographic factors. Materials and methods. The study enrolled 112 eligible patients, 37 (33%) males and 75 (67%) females aged 19 to 65 years, with a mean age of 40 [32; 40] years. Patients were divided into three groups depending on the body mass index. All patients underwent a comprehensive general clinical examination, including an assessment of the pain prevalence and duration, the number of exacerbations in the current year, the pain severity using the Numeric Pain Rating Scale (NPRS), and the number of pain descriptors. Results. Obese patients experience more severe pain (p=0.004), are prone to prolonged (p=0.010) and frequent exacerbations (p=0.004), and use more lexical units to describe the pain (p=0.001). The main pain sites associated with obesity are the upper (p=0.023) and lower extremities (p=0.002). The overweight group falls between obese subjects and those with normal body weight and, by many parameters, is similar to the normal body weight group. It was noted that age worsens the pain; thus, with age, the number of exacerbations per year (p=0.006) and the duration of exacerbations (p=0.016) increase, and a direct correlation of age with the pain prevalence and the number of descriptors was revealed (r=0.271; p=0.004 and r=0.267; p=0.004, respectively). The most severe pain occurs in females. In contrast, physical activity reduces the number and duration of exacerbations and the prevalence of pain (p=0.004; p=0.048; p=0.015, respectively). Conclusion. Obesity, older age, and female gender are associated with more severe chronic pain. Body weight loss in obese patients with pain, as well as lifestyle modification with increased physical activity, is an essential aspect of overall rehabilitation, although additional studies are needed to establish strategies for maintaining long-term effects.

Одним из распространенных заболеваний, которое все чаще ассоциируют с хронической болью, является ожирение. Многофакторная связь между болью и ожирением включает как изменения в центральном восприятии боли, так и потенциальное развитие системных воспалительных механизмов. Целью данной работы было изучение клинических характеристик хронического болевого синдрома у пациентов с избыточной массой тела и ожирением и сопоставление с уровнем маркеров воспаления. В исследование включили 112 пациентов – 37 мужчин и 75 женщин от 18 до 65 лет (в среднем – 40 [32; 49] лет), с хроническим болевым синдромом – скелетно-мышечной болью различной локализации, первичными головными болями. В зависимости от индекса массы тела участников разделили на три группы. Методы исследования включали общеклиническую оценку характеристик болевого синдрома – длительности и количества обострений в текущем году, интенсивности боли с помощью числовой рейтинговой шкалы оценки боли, количества дескрипторов при описании боли, лабораторное обследование в момент обострения – скорость оседания эритроцитов, С-реактивный белок, интерлейкин 6, фибриноген. Статистический анализ проводился с помощью программы StatTech v. 2.6.1. Пациенты с ожирением испытывают более длительные, интенсивные и частые обострения хронической боли (р = 0,010, p = 0,004, p = 0,004), чаще боль затрагивает конечности (p = 0,018 для локализации в верхних конечностях и p = 0,002 – для нижних). Выявлена взаимосвязь интенсивности боли со скоростью оседания эритроцитов (ρ = 0,337, р < 0,001) и уровнем фибриногена (ρ = 0,224, р < 0,037), статистически значимые различия между уровнем С-реактивного белка и количеством обострений в году (p < 0,001). Ожирение негативно влияет на течение хронической боли, провоцируя более частые, интенсивные, пролонгированные эпизоды, затрагивающие верхние и нижние конечности. Учитывая зависимость уровня воспалительных маркеров от индекса массы тела и выявленной взаимосвязи с интенсивностью боли, можно полагать, что постепенный набор веса может усугублять течение хронических болевых синдромов. Показанная в исследовании специфика взаимосвязи между маркерами воспаления и тяжестью боли говорит о том, что ассоциация между ожирением и хронической болью не является прямой, а, вероятно, опосредована различными факторами. One of the common diseases that is increasingly associated with chronic pain is obesity. The association between pain and obesity is multifactorial and includes both changes in central pain perception and the potential development of systemic inflammatory mechanisms. Our purpose was to study the clinical characteristics of chronic pain syndrome in overweight and obese patients and compare it with the level of inflammatory markers. The study included 112 patients – 37 men and 75 women aged 18 to 65 years (mean age 40 [32; 49] years) with chronic pain syndrome – musculoskeletal pain of various localization, primary headaches. Participants were divided into three groups based on body mass index. The research methods included a general clinical assessment of the characteristics of the pain syndrome – the duration and number of exacerbations in the current year, the intensity of pain using a numerical pain rating scale (NPRS), the number of descriptors, laboratory examination at the time of exacerbation – ESR, C-reactive protein, IL-6, fibrinogen. Statistical analysis was carried out using the StatTech v. 2.6.1. Patients with obesity experience longer, more intense and more frequent exacerbations of chronic pain ((p = 0.010, p = 0.004, p = 0.004), more often pain affects the limbs (p = 0.018 for localization in the upper limbs and p = 0.002 for the lower, respectively). We found the correlation of pain intensity with ESR (ρ= 0.337, p < 0.001) and fibrinogen (ρ= 0.224, p < 0.037), statistically significant differences between the level of C-reactive protein and the number of exacerbations per year (p < 0.001) were revealed. The obesity negatively affects the course of chronic pain, provoking more frequent, intense, prolonged episodes, affecting the upper and lower extremities. Due to the dependence of the level of inflammatory markers on the body mass index and the identified relationship with the intensity of pain, it can be assumed that gradual weight gain may exacerbate the course of chronic pain syndrome. The specificity of the relationship between inflammatory markers and pain severity shown in the study suggests that the relationship between obesity and chronic pain is not direct but is likely mediated by various factors.

Introduction. It is now recognized that stress plays an important role in the occurrence and exacerbation of chronic pain syndromes. Stress has a modulatory effect on the structures of the nervous system depending on the nature, duration and intensity of the stressor which is reflected in the clinical characteristics of pain.Aim. To study the features of the clinical characteristics of chronic localized pain syndromes depending on the presence of psychosocial stressors at the onset of pain.Materials and methods. The study included 118 patients with chronic localized pain syndromes 38 men (32.2%) and 80 women (67.8%) aged 19 to 66 years (mean age 41 ± 11 years). Depending on the presence of premorbid psychosocial stressors at the onset of pain patients were divided into two groups group I (main), group II (control). The research methods included a general clinical assessment of the pain syndrome characteristics, an assessment of the emotional state, psychosocial indicators and quality of life using special scales and tests. Statistical analysis was carried out using the StatTech v. 2.6.1.Results. Patients of group I experience more than 4-6 episodes of exacerbations per year, the duration of pain is from 8 to 28 days, affecting an average of 4 (3; 6) localizations, using more descriptors (p < 0.001, p = 0.013, p = 0.014, p=0.017, p=0.002 resp.), more likely to suffer from headaches and cervicalgia (p = 0.004 and p < 0.001 resp.), use on average 4 (2; 5) drug group for pain relief (p = 0.004). Among patients with premorbid psychosocial stressors the proportion of women is 6.5 times higher (p < 0.001). A significantly greater number of patients with sleep disorders and anxiety were identified in group I (p < 0.001, p = 0.009 respectively), the total score in assessing fatigue was 24 (19; 39) points which corresponds to moderate fatigue (p = 0.009). The average stress score on the Holmes-Rahe scale was 80 (53; 102) (p < 0.001), the main stressful events are work-related problems. Direct statistically significant relationships between the level of stress and the characteristics of the pain syndrome were established the number of pain localizations, the intensity of pain, the number of descriptors (p < 0.001, p < 0.001, p < 0.001). The life quality index was 2 (2; 4) scores according to the EQ-5D-3L questionnaire which indicates   a decrease in the quality of life (p < 0.001) in group I. It was noted that the chances of stress onset of pain in an active lifestyle are 3.4 times lower (p = 0.012).Conclusion. Premorbid psychosocial stressors are markers of the severity of chronic pain and affective distress. At the same time premorbid psychosocial stressors can be considered a modifiable factor. If it is assessed and recognized in time, the development of chronic pain and associated affective distress can be eliminated and potentially prevented.

The feminization and middle age decreasing in general practitioner profession is a worldwide trend.Purpose of the study is to explore gender and age structure, professional characteristics of general practitioners in Moscow.The retrospective analysis of personal records of students of the Chair of General Medical Practice of the Institute of Professional Education of the The I. M. Sechenov First Moscow State Medical University trained from 2016 to 2020 (n = 400).It is established that women made 80.5% out of them. The average age was 50.7 ± 0.7 years; average general professional experience - 28.8 ± 0.8 years, in general medical practice - 9.7 ± 0.3 years. The internship/residency in therapy was graduated by 84.2% of students. Up to 96.3% worked in state medical organizations. The majority (97.0%) had no academic degree. Indicators with positive dynamics: share of women, physicians with internship/residency in therapy, employees of state medical organizations, without an academic degree. Indicators with negative dynamics: age, professional experience. Differences between men and women were established for residency and professional experience in general medical practice.The average social and professional portrait of general practitioner in Moscow: woman 50 years old graduated internship/residency in therapy, professional experience of more than 20 years, with professional retraining about 10 years ago, working in state medical organization, no academic degree.The activities were proposed considering gender and age specifics, professional characteristics of general practitioners, directed to increasing efficiency and comfort of training.