Medical and Social Expert Evaluation and Rehabilitation

Peer-review quarterly medical journal.

Editor-in-chief

Journal founders

  • Izdatelstvo "Meditsyna"
  • Eco-Vector Publishing Group

Publisher

About

The journal is intended for practitioners and specialists involved in disability issues.

It covers the following topics:

  • theoretical and practical aspects of prevention and prevalence of disability;
  • medical and social evaluation;
  • medical, vocational, and social rehabilitation of people with disabilities;
  • legal, regulatory, and economic issues relating to disability;
  • the training of, and refresher courses for, specialists from institutions for medical and social evaluation;
  • and rehabilitation of people with disabilities.

The journal disseminates information on the current state and future of Russia’s social policy for people with disabilities, the practices of Russian regional and territorial agencies working in the field of social protection, and modern approaches to solving the problems of disabled people in other countries. Special attention is devoted to original research focused on new promising methods of diagnosis and treatment of disabling conditions.


Types of accepted articles

  • reviews
  • systematic reviews and metaanalyses
  • original research
  • clinical case reports and series
  • letters to the editor
  • short communications
  • clinical practice guidelines

Publications

  • in English and Russian
  • quarterly, 4 issues per year
  • continuously in Online First
  • with Article Submission Charge (ASC)
  • distribution in hybrid mode - by subscription and/or Open Access
    (OA articles with the Creative Commons Attribution 4.0 International License (CC BY-NC-ND 4.0))

Indexation

  • Russian Science Citation Index (Web of Science)
  • Russian Science Electronic Library (eLibrary.ru)
  • Google Scholar
  • Ulrich's Periodicals directory
  • WorldCat
  • Crossref

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Current Issue

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Vol 25, No 1 (2022)

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Expertise and rehabilitation

Malignant neoplasms as a nosological cause of primary disability in the Russian Federation during the COVID-19 pandemic
Puzin S.N., Shurgaya M.A., Idrisova L.S., Pogosyan G.E., Suleymanov E.A.
Abstract

BACKGROUND: In cases of health disorders secondary to malignant neoplasms that lead to social restrictions and the need for social protection measures, including rehabilitation, disability is established. This is the most important health indicator of the population. Coronavirus disease 2019 (COVID-19) has significantly affected the management of patients with malignant diseases, and a more severe course of COVID-19 commonly occurs in older age groups.

AIM: This study aimed to analyze the dynamics and structure of primary disability caused by malignant neoplasms in the adult population in the Russian Federation.

MATERIALS AND METHODS: The study object was a cohort with newly recognized disability caused by malignant neoplasms in the Russian Federation (by applying to the Bureau of Medical and Social Expertise). The main outcome was the occurrence of primary disability during the study period. Three age groups of the adult population (young, middle, and old) were analyzed. The study was conducted in 2010–2020. Research methods included documentary, data copying, and statistical and graphics analysis.

RESULTS: The dynamics of cancer-related primary disability in the Russian Federation was characterized by an annual increase in the number of people with disability from 180.2 thousand in 2010 to 214.6–222.2 thousand in 2017–2019; however, this number decreased to 196.5 thousand in 2020. The number of older people with primary disability was the highest, followed by middle-aged people with primary disability, and no significant change was found in the number of young people with primary disability. The proportion of people with secondary disability decreased, and those with tertiary disability increased, with a negative trend in the growth of the proportion of people with primary disability in 2020.

CONCLUSIONS: The incidence of disability caused by malignant neoplasms may not reflect the proportion of populations with persistent health disorders because residents were unable to present for medical consultations due to the restrictions caused by the spread of a new coronavirus infection. The scale and structure of primary disabilities caused by cancer become the scientific and practical basis for determining directions for developing healthcare and social protection services.

Medical and Social Expert Evaluation and Rehabilitation. 2022;25(1):5-12
pages 5-12 views
Medical and social characteristics of people with disability and neuromuscular, skeletal, and movement-related disorders
Povorinskii A.A., Vladimirova O.N., Shoshmin A.V., Riabokon A.G.
Abstract

BACKGROUND: Measures of growth are important for creating a construction and expansion system of opportunities for the constituents of the Russian Federation. The need for complex rehabilitation in people with impaired neuromuscular, skeletal, and movement-related functions is still not fully understood.

AIM: This pilot study aimed to determine the need for comprehensive rehabilitation of adults with neuromuscular, skeletal, and movement-related functions according to the main indicators of primary disability.

MATERIALS AND METHODS: The comparative analysis of the dynamics of newly detected (primary) disabilities in the Russian Federation due to all causes and disorders of neuromuscular, skeletal, and movement-related functions (categories b710–b799 according to the International Classification of Functioning, Disabilities and Health) was conducted. Indicators in the Leningrad region were analyzed from 2016 to 2020.

RESULTS: The need for rehabilitation in the Leningrad region is lower than that in the whole country. Individuals with neuromuscular, skeletal, and movement-related disorders aged 18–44 years need the most intensive rehabilitation.

CONCLUSIONS: The results of this study revealed that the decrease in overall primary disability is faster than the decrease in primary disability in the target group. The prevention and rehabilitation of neuromuscular and statodynamic disorders were slower, whereas the need for rehabilitation was higher in the specific-cause group than in the all-cause group

Medical and Social Expert Evaluation and Rehabilitation. 2022;25(1):13-22
pages 13-22 views
Disability indicators for the social protection and rehabilitation measures in the population of the Russian Federation
Goryainova M.V., Karasaeva L.A., Nurova A.A., Pavlova S.V., Azovtsev D.Y., Goryainov I.V.
Abstract

BACKGROUND: To improve social policy and to study the mechanisms of public administration, it is important to analyze the trends in the development of the social phenomenon –population disability. The need for a systematic analysis in the planning and regulation of social protection measures for people with disability and rehabilitation to minimize the risks of negative socioeconomic consequences leads to a long-term comprehensive study and analysis of disability indicators in the population of the Russian Federation.

AIM: To identify the medical and social characteristics of the state and trends of disability in the Russian Federation and St. Petersburg for 2015–2019.

MATERIALS AND METHODS: The study analyzed people with primary disability living in St. Petersburg and the Russian Federation. Data were obtained from the State Statistical Reporting 7 Social Security. Analytical, expert assessment methods, and statistical analysis were performed.

RESULTS: During the study period (2014–2019), the level of primary disability in the adult population of the Russian Federation tended to decrease: in 2015, it was 58.9 per 10 thousand adult populations, and in 2019, it was 53.1 per 10 thousand people. The dynamics showed an uneven rate of decrease in the level of primary disability, with a peak decline in 2016. In the analysis of the indicators of people with primary disability by age, for over 5 years, the proportion of people of working age and with disabilities decreased from 46.8% in 2015 to 42.3% in 2019. A study of the need for vocational rehabilitation measures for people with disability, specifically the need to create special jobs for the employment of people with primary and secondary disabilities, showed that medical and social specialists identified the need to create special jobs for 27.7% of the analyzed population (n=15,977), and the largest share of recommendations on the need to create a special workplace was issued to people with secondary disability, i.e., 89.8% (n=14,341). The share of the recommendations on the creation of special jobs for people with secondary disability was 2.6 times higher than for those with primary disability, with an average of 72.3% (n=41,769), and recommendations were drawn up mainly for people with secondary disability, with 88.4% (n=36,937).

CONCLUSIONS: At present, it is relevant to plan the socioeconomic costs for the implementation of social and vocational rehabilitation programs of people with disability and the creation of conditions for their employment in special jobs. This enables the delivery of organized and optimal rehabilitation for the constituents of the Russian Federation.

Medical and Social Expert Evaluation and Rehabilitation. 2022;25(1):23-30
pages 23-30 views
Identification of clinical and rehabilitation groups among patients with cervical tetraplegia
Bushkov F.A., Razumov A.N., Sichinava N.V.
Abstract

BACKGROUND: Spinal cord injury at the cervical level often leads to a severe neurological deficit, such as tetraplegia (International Standards for Neurological Classification of Spinal Cord Injury) and gross functional disorders. Currently, methods of differentiated rehabilitation strategy are developed, taking into account the needs of the patients.

AIMS: This study aimed to examine the clinical heterogeneity of patients with a cervical injury and to form appropriate clinical and rehabilitation groups based on common relevant rehabilitation goals.

MATERIALS AND METHODS: We examined 190 patients with severe cervical myelopathy C4–D1 level aged 18–60 years in whom changes in clinical and functional status were monitored for 5–7 years. The rehabilitation program was standardized and based on existing national clinical guidelines for physical rehabilitation in patients with spinal cord injuries.

RESULTS: The greatest changes were in patients with motor levels C6 and C7. Patients with cervical tetraplegia, according to the criterion of functional and motor homogeneity, can be divided into four clinical and rehabilitation groups: patients with a high level of damage to C4–C6 (functionally dependent), patients with a low level of damage to C7–D1 (functionally independent), patients with complete motor damage (types A and B), and patients with incomplete motor damage (types C and D).

CONCLUSIONS: The allocation of clinical and rehabilitation groups allows the prediction of the results and outcomes of rehabilitation. A timely rehabilitation prognosis can improve the quality of life of patients with cervical tetraplegia and their families and contribute to their timely adaptation to society.

Medical and Social Expert Evaluation and Rehabilitation. 2022;25(1):31-40
pages 31-40 views
Psychological defense mechanisms and coping strategies in people with disability and traumatic spinal cord injury with different levels of neuropsychiatric adaptation
Khokhlova O.I., Vasilchenko E.M.
Abstract

BACKGROUND: Despite the multitude of publications on the mechanisms of psychological adaptation in people with spinal and spinal cord injuries, there is a shortage of complex studies that explore the features of these mechanisms depending on the level of neuropsychic adaptation.

AIM: This study aimed to explore the relationships between the mechanisms of psychological adaptation and the level of neuropsychic adaptation in patients with traumatic spinal cord injury.

MATERIAL AND METHODS: Altogether, 80 patients with <3 years of traumatic spinal cord injury were examined: 65 (81.2%) were men, and 15 (18.8%) were women. The mean age was 37.5±11.61 years, and 46 (57.5%) patients had paraplegia and 34 (42.5%) had tetraplegia. The level of neuropsychic adaptation was determined using the I.N. Gurvich test: a person is considered psychologically adapted if the sum score ranges from 0 to 20, and a person is considered maladapted if the sum score is >20. Psychological defense mechanisms were assessed using the “Lifestyle Index” of Plutchik–Kellerman. To determine strategies for coping with stress, we used the “Ways of Coping Questionnaire” of Folkman and Lazarus.

RESULTS: According to the findings, 64.6% of the participants had manifestations of neuropsychiatric maladaptation due to aspects of personality development and personal background. Psychologically maladapted individuals had a higher intensity of defense mechanisms (regression, compensation/identification, substitution, and projection) and coping strategies (escape–avoidance, search for social support, and confrontation). Positive correlations were found between the total index of defense intensity and levels of maladaptive coping (escape–avoidance, confrontation, distancing, acceptance of responsibility, and self-control).

CONCLUSION: People with traumatic spinal cord disease and symptoms of neuropsychiatric maladaptation tend to have a combination of an increased level of tension of psychological defenses with the actualization of regression, substitution, compensation/identification, and projection. People with traumatic spinal cord disease were also found to have a preference for coping strategies aimed primarily at avoiding the problem and reducing emotional discomfort.

Medical and Social Expert Evaluation and Rehabilitation. 2022;25(1):41-54
pages 41-54 views
Development of a system providing early assistance to children and their families in the Russian Federation
Vladimirova O.N., Afonina K.P., Starobina E.M., Lorer V.V., Ishutina I.S., Kogan Z.V.
Abstract

BACKGROUND: The concept of developing a system of comprehensive rehabilitation and habilitation of people with disability in the Russian Federation, including children with disabilities, for the period up to 2025, includes providing early assistance to children and their families initially, contributing to the early identification of impaired functions in children, subsequent routing of children with disabilities, and prevention of disability in children.

AIM: This study aimed to analyze the development of a system providing early assistance to children and their families in the Russian Federation.

MATERIALS AND METHODS: Metadata of target programs were analyzed for the development of comprehensive rehabilitation and habilitation of people with disability. This system provides early assistance to the population of the Russian Federation. Data obtained from the monitoring of the early assistance system, including 83 indicators, in four directions, were analyzed: organizations providing early assistance services, children in need of early assistance and who received it, specialists providing early assistance services (form 1-RP), and during the period of implementation of the “concept of development of early assistance in the Russian Federation until 2020.”

RESULTS: The relevance of forming an early assistance system is considered from a demographic, neurobiological, biopsychosocial, organizational, social, and socioeconomic point of views. The number of children in need of early assistance increased from 296.2 thousand in 2017 to 407.0 thousand in 2019, accounting for 3.9% of all children aged 0–3 years. The number of children who received early assistance services increased from 223.4 thousand in 2017 to 340.5 thousand in 2019, and the coverage rate of the target group of children with early assistance among the total population of the Russian Federation was 83.7% in 2019. Factors that hindered the development of the early assistance system in the Russian Federation were regulatory and legal, informational, organizational and content, personnel, conceptual, and categorical.

CONCLUSIONS: In the Russian Federation, conditions have been created for the development of early assistance to children and their families at a new level. In the drafted federal law, early assistance is allocated as a separate direction of state policy, and the need for a synergy of administration bodies and departments (health care, social protection, and education) on unified technologies was noted. Several issues remain unresolved, namely, staffing policy, interagency cooperation, financial and economic issues, and others.

Medical and Social Expert Evaluation and Rehabilitation. 2022;25(1):55-64
pages 55-64 views
Cervical cancer in a comparative aspect of its incidence and mortality in the female population in the Republic of Chechnya, North Caucasian Federal District, and Russia
Idrisova L.S., Suleymanov E.A., Puzin S.N., Shurgaya M.A.
Abstract

BACKGROUND: Investigating women with malignant neoplasms is a primary task, taking into account the damage to the reproductive system.

AIM: The study aimed to analyze the incidence of cervical cancer and mortality in the female population of the Republic of Chechnya in a comparative aspect with the indicators for the North Caucasian Federal District, which includes the republic, and Russia as a whole.

MATERIAL AND METHODS: The study analyzed data of the State Statistical Reporting 7 (sobes) “Information on malignant neoplasms for 2020” (Tables 2000 and 2010, approved by Rosstat of Russia) and data on oncology of the Moscow Research Oncological Institute named after P.A. Herzen.

RESULTS: The rate of in situ detection in the Republic (30.1 per 100 cases detected) exceeds the indicator for the North Caucasian Federal District (15.0 per 100 cases detected) and differs slightly from the indicator in the country (30.8 per 100 cases detected). A possible explanation for the increase in the incidence of cervical cancer in 2010–2019 is the increase in the prevalence of human papillomavirus infection and the use of modern highly sensitive technologies for screening and early diagnosis. In 2020, the incidence of cervical cancer in the female population decreased. The dynamics of the incidence rates in the female population with cervical cancer in the Republic of Chechnya corresponds to the indicators in the North Caucasian Federal District and Russia. Owing to the spread of coronavirus disease 2019 among the population in 2020, the oncological services in Russia worked under challenging conditions. Clinical examinations for certain groups of the adult population were suspended, cancer screening opportunities were significantly limited, and the burden on the oncological care system was increased in general, which led to a decrease in the detection rates and affected the registration of cancer incidence rates.

CONCLUSION: Generally, the North Caucasian Federal District, which includes the Republic of Chechnya, had the lowest mortality rates in comparison with other federal districts of the country. Compared with Russia, the Republic of Chechnya is among the territories with significantly lower mortality rates from cervical cancer.

Medical and Social Expert Evaluation and Rehabilitation. 2022;25(1):65-72
pages 65-72 views

Review

Overview of the verticalization of technology: history of the occurrence and relevance of application
Podolskaya J.А., Borisov I.V., Sukhbaatar O., Sorokina V.S.
Abstract

Verticalization is a mobilization technique that is aimed at preventing and treating impaired gravitational gradient in patients who are on bed rest for >24 h, regardless of their motor and cognitive status, and is conducted actively and passively. Passive verticalization as a rehabilitation technique is recommended for patients who cannot stand up independently and keep themselves in an upright position because of the severity of the general condition.

In the preparation of this review, mainly literature sources from highly rated publications were used. Preference was given to sources published in the last 10 years. Review articles and materials prepared by experts in the field of writing/editing scientific publications, including review articles, were selected for the review.

In the aggregate of the verticalization methods analyzed, the common recommendations for all are the early start of rehabilitation measures, continuity, and careful monitoring of hemodynamic characteristics. The technique itself today has more than 50 years of experience, and the combination of verticalization technologies with a mechanotherapeutic simulator with electric motor support is a modern solution for their application. This equipment can be used in both intensive care in addition to the equipment of continuous respiratory support and rehabilitation and other wards.

The verticalization procedure, if possible, should be applied at the earliest possible time after the traumatic event to improve the rehabilitation potential. The verticalization of patients with chronic impairment of consciousness has physiological features, and hemodynamic adaptation is recommended to reduce the risk of orthostatic cerebral ischemia. For patients with disorders of the central nervous system, preliminary adaptation should be conducted to subsequent verticalization by gradually lifting on a multifunctional bed under hemodynamic control, including the CNAP continuous blood pressure monitoring system (Dräger systems).

Medical and Social Expert Evaluation and Rehabilitation. 2022;25(1):73-84
pages 73-84 views

For the practitioner

A scoring system to reflect persistent blood and immune system dysfunctions in the International Classification of Functioning in people with disabilities and HIV infection
Ugleva E.M., Iamshchikova T.Y., Vladimirova O.N., Karasaeva L.A.
Abstract

The article highlights the issues the International Classification of Functioning, which is being implemented worldwide to describe the functioning and limitations of human activity. The components are distinguished as follows: the functions and structures of the organism, activity, and participation―the performance of an action by an individual and his/her involvement in a life situation, as well as personal and environmental factors. In the Russian Federation, for the first time in a regulatory document (Order of the Ministry of Labor of Russia, dated August 27, 2019, N 585n), the International Classification of Functioning indicators were used to characterize persistent disorders of human functions.

HIV infection is characterized by damage to the immune system with a decrease in the body’s resistance, which results in various diseases, such as secondary (opportunistic) infections and oncological, hematological, autoimmune, and lymphoproliferative diseases. A feature of HIV infection is the multiple organicity of lesions and the variety of clinical symptoms, which explains the diversity of impaired body functions reflected in the Order of the Ministry of Labor of Russia, in particular cardiovascular, respiratory, digestive, immune, endocrine, urinary system, neuromuscular, skeletal and movement-related (statodynamic), mental functions, blood, and metabolism disorders.

The article highlights the issues of using the International Classification of Functioning in people with HIV infection or acquired immunodeficiency syndrome as a score to reflect the severity of persistent body disorders, particularly blood and immune system disorders, and the possibility for its use in people with disability.

The paper presents a clinical example of a patient aged 34 years suffering from HIV infection, severe cellular immunodeficiency, complicated by pneumocystis pneumonia, candidiasis stomatitis, cheilitis, cachexia against the background of chronic viral hepatitis B and C, and poly-drug addiction with a second degree of dependence. The International Classification of Functioning in people with HIV infection or acquired immunodeficiency syndrome as a point assessment reflects the severity of persistent body disorders particularly blood and the immune system disorders and the possibility for its use in people with disabilities.

Medical and Social Expert Evaluation and Rehabilitation. 2022;25(1):85-92
pages 85-92 views


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