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Vol 21, No 1-2 (2018)

Articles

DISABILITY IN THE XXI CENTURY. THE STATE OF THE PROBLEM OF MEDICAL-SOCIAL REHABILITATION AND HABILITATION OF DISABLED PEOPLE IN CONTEMPORARY RUSSIA

Puzin S.N., Shurgaya M.A., Memetov S.S., Achkasov E.E., Pogosyan G.E., Lyalina I.V., Omarov S.A., Puzin S.S., Gigineishvili D.N.

Abstract

The disability among the population is one of the most important medical and social problems of the global significance. The article presents data on the epidemiology of the disability in the countries of the world. 110-190 million adults have significant difficulties in functioning - a significant degree of restriction in various spheres of life. The child’s disability accounts for 95 million children, out of which 13 million children have a “severe” form of the disability. In countries where the life expectancy exceeds 70 years, an average of about 8 years, representing 11.5 percent of total life expectancy, falls on years associated with the disability. In most countries, the demographic situation of aging of the population causes an increase in the disability among the elderly - two-thirds of the disabled belong to this age group of the population. In the total population of Russia, the share of disabled people is 9.3% - 12.3 million people, including disabled people of the working age accounting for 3 million 801 thousand people (less than a third - 30%), disabled elderly - 8 million 2,665 thousand people. (two-thirds of the total number of disabled people - 65.2%), children with disabilities include 636 thousand people (4.8%). There is noted a tendency to the decline in the primary and secondary disability of an adult (in 2000-2016) and children (2000-2014) population, but in 2015-2016 there was emerging a tendency to the gain in basic indices of the primary and repeated disability in children (the absolute number of disabled people, the level of disability). The analysis of individual programs for rehabilitation and habilitation (IPRH) of disabled people shows the greatest number of recommendations to be given about the needs of disabled people in technologies for medical and social rehabilitation and habilitation. According to the results of the reassessment of disabled persons in 2016, positive results of the implementation of the IPRH for disabled people were achieved in 48.4% of the disabled cases (among the victims of occupational accidents and occupational diseases - 63.8% of the disabled). There were noted low indices of the complete compensation and full recovery of lost functions (4-7% and 2.8-1%, respectively) and extremely low indices - for implementation recommendations for the acquisition of a profession, including new, advanced training, education and creation of a special workplace for the employment (0.2-0.8%).The solution of the problem of increasing the effectiveness of rehabilitation and habilitation activities requires a consistent integrated approach to the determination goals of the rehabilitation process in each case, depending on the cause of disability and close interagency cooperation in the implementation of IPRH for disabled persons. It is advisable to take into account the regional differentiation of the subjects of the Russian Federation in terms of the prevalence of the disability, as well as the age and gender features of the contingents of the disabled persons.
Medical and Social Expert Evaluation and Rehabilitation. 2018;21(1-2):10-17
pages 10-17 views

MEDICAL AND SOCIAL ASPECTS OF THE PHYSICAL REHABILITATION OF THE RECIPIENTS OF THE DONOR KIDNEY

Achkasov E.E., Shelekhova Т.Y., Runenko S.D., Sultanova O.A., Minenko I.A.

Abstract

Aim of the study. To assess the effectiveness of the physical rehabilitation in the first year in recipients with donor kidney. Material and Methods. The article presents an assessment of the functional state and adaptive body reserves using hardware-software complex (HSC) “Sources of Health” for patients before and after the kidney transplantation. The results of the examination and treatment of 57 recipients (of the mean age - 35±9.65) donor kidney at different times of the postoperative period. Depending on the physical rehabilitation program there were selected 2 groups of patients: in Group I the physical rehabilitation was carried out during the year, in Group II - only in the first week after surgery for the prevention of early postoperative complications. Group III combined 30 relatively healthy people (15 women, 15 men) without the need for an organ transplant and of a mean age of 33.7 ± 8.7 years, keeping a normal lifestyle, not engaged in the regular recreational physical exercises. The functional state and adaptive body reserves were evaluated with HSC “Sources of Health” at 1, 3, 6 and 12 months after surgery. Results. The physical rehabilitation with a personalized approach for one year after the kidney transplantation can significantly improve functional and adaptive body reserves in donor kidney recipients. Conclusion. Patients are shown to need for the physical rehabilitation at least for a year after the kidney transplantation in order to improve the functional state and adaptive body reserves.
Medical and Social Expert Evaluation and Rehabilitation. 2018;21(1-2):18-21
pages 18-21 views

REHABILITATION OF PATIENTS IN CHRONIC CRITICAL STATES DUE TO BRAIN DAMAGE IN CONDITIONS OF RESUSCITATION AND INTENSIVE CARE UNITS: THE EXPERIENCE OF THE FEDERAL RESEARCH AND CLINICAL CENTER

Grechko A.V., Molchanov I.V., Petrova M.V., Pryanikov I.V.

Abstract

The article presents the experience of the Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology for the organization of medical care for patients in long-term (chronic) critical conditions due to the craniocerebral trauma, stroke, and surgical treatment of brain tumors who needs to be provided the functioning of vital organs against the background of prolonged impairment of consciousness, including methods of excommunication from the apparatus of artificial ventilation, medical correction of the level of consciousness, adequate general symptomatic treatment, nutritional-metabolic therapy and early rehabilitation by multidisciplinary medical teams.
Medical and Social Expert Evaluation and Rehabilitation. 2018;21(1-2):22-29
pages 22-29 views

MAIN PROBLEMS OF THE ORGANIZATION OF THE REHABILITATION OF CHILDREN WITH CONSEQUENCES OF NEUROINFECTION AND ORGANIC PATHOLOGY OF THE NERVOUS SYSTEM IN VARIOUS REGIONS OF THE RUSSIAN FEDERATION

Vishnyakov N.I., Kochorova L.V., Samojlova I.G.

Abstract

The article reviews the results of a survey of healthcare professionals from different regions working with the children’s population. The survey included specialists working in the field of rehabilitation of children who underwent neuroinfections and other disorders of the nervous system, as well as specialists providing other types of medical care to the children. The survey was mainly attended by experienced specialists. Almost half of the respondents have a seniority of more than 20 years (47.0%). According to the results of the study, it was established that practically every fifth doctor (19.8%) does not know where the rehabilitation help to the children who underwent neuroinfections is provided. The weighty shares of experts point to the extreme urgency of such problems as the waiting time for the commencement of rehabilitation, the transportation of children to the rehabilitation site, the lack of modern medical equipment, the lack of doctors and nurses and other problems. 60.3% of the respondents indicated a significant shortage of specialists able to provide rehabilitation assistance to children who had undergone neuroinfections. One out of every five respondent (18.2%) pointed to the lack of growth in the quality of rehabilitation measures in their region. And 22.4% of specialists noted the lack of the gain in high-tech methods of rehabilitation of children in their region. An analysis of the responses of specialists made it possible to identify two main groups of problems to which management decisions should be directed. These groups include organizational and financial problems. All specialists point to the need to expand the network of medical institutions that provide rehabilitation to children who have undergone neuroinfections, as well as the need to introduce new rehabilitation techniques into practice.
Medical and Social Expert Evaluation and Rehabilitation. 2018;21(1-2):30-33
pages 30-33 views

A NEW MODEL OF MEDICAL REHABILITATION OF PATIENTS FOLLOWING ENDOPROSTHETIC HIP REPLACEMENT IN THE CLINICS OF THE SAMARA STATE MEDICAL UNIVERSITY

Kotelnikov G.P., Yashkov A.V., Borinskiy S.Y.

Abstract

The study is devoted to the evaluation of the effectiveness of the new organizational model of medical rehabilitation in patients after the endoprosthetic hip replacement in conditions of the Samara State Medical University clinics.There were observed 348 patients underwent total endoprosthesis of the hip joint due to degenerative-dystrophic processes. In the comparison group consisted of 179 patients, the traditional approaches to re-rehabilitation remained. In the main group of 169 patients, a problem-oriented multidisciplinary approach was implemented, using the International Classification of Functioning (ICF) clinical scales to execute timely examination and route patients to medical organizations. Within the framework of the Pilot Project, for the patients of the main group there were worked out the stage-by-stage approach, continuity, consistency of received medical measures in specialized licensed medical rehabilitation clinics of the Ministry of Health of the Samara Region. There was executed the evaluation of immediate, remote results of clinical and functional parameters of patients after hip joint prosthetics within the framework of the Pilot Project. To evaluate the rehabilitation potential and prognosis, a clinical, laboratory, functional and biomechanical assessment of the patients’ condition was carried out based on radiography, rheovasography, electromyography, podography, thermography, psycho-logical testing, and scale analysis. The analysis of the effectiveness of the new organizational model of medical rehabilitation in patients after hip arthroplasty in conditions of Clinics of the Samara State Medical University is presented.
Medical and Social Expert Evaluation and Rehabilitation. 2018;21(1-2):34-38
pages 34-38 views

THE MODEL OF THE EFFECTIVE QUALITY MANAGEMENT OF COMPLEX REHABILITATION SERVICES FOR INDIVIDUALS WITH DISABILITIES IN NON-STATIONARY FORMS IN A MULTIFUNCTIONAL INSTITUTION FOR DISABLED INDIVIDUALS (OCCUPATIONAL ADAPTATION). PROJECT “PLAN-DO-CHECK-ACT”

Syrnikova B.A., Semenova T.N., Kobzar I.Z., Achkasov E.E., Pogosyan G.E.

Abstract

The article discloses the experience of the institution of social services in creating a complex rehabilitation model in the combination of three types of services: rehabilitation therapy, social and labor adaptation, occupational adaptation. The article reviews such matters as Human Resources Management, organization of the interaction with disabled people and monitoring their satisfaction through the creation of a Quality Management System in accordance with international standards ISO 9001.
Medical and Social Expert Evaluation and Rehabilitation. 2018;21(1-2):39-43
pages 39-43 views

EXPERT VALUE OF VERTEBROGENIC FACTORS IN DISCIRCULATORY ENCEPHALOPATHY PATIENTS (ACCORDING RESULTS OF THE FACTORIAL ANALYSIS)

Starovoytova I.M., Potekhin N.P., Sarkisov K.A., Shumeyko T.V.

Abstract

287 patients with the verified diagnosis “discirculatory encephalopathy” (DE) are analyzed. The military-medical commissions have examined 139 people (1st group of comparison), Bureau of medico-social examination - 148 people (the 2nd group of comparison). Middle age in the first group of comparison was - 47.1±7.6 years, in the second one - 56.67±5.11 years. The factorial analysis of the signs characterizing results of laboratory and tool examinations taped the most significant symptom-complexes determining an internal picture of the illness. The greatest contribution to the formation of an internal picture of the illness is made by disturbances of a cerebral hemodynamics, especially in the bed of vertebral arteries. Results of a research have shown the importance of a vertebrogenic factor in the formation of DE. It is recommended to include an examination of the cervical part of a backbone in an algorithm of inspection of DE patients. By results of the factorial analysis arterial hypertensions fails to be the main and determining factor in the formation of DE, and only strengthens the influence of other factors.
Medical and Social Expert Evaluation and Rehabilitation. 2018;21(1-2):44-49
pages 44-49 views

THE EPIDEMIOLOGICAL PICTURE OF THE DISABILITY IN VARIOUS DEMOGRAPHIC CONTINGENTS OF THE POPULATION IN THE RUSSIAN FEDERATION IN THE ASPECT OF THE SOCIAL POLICY OF THE STATE

Puzin S.N., Dymochka M.A., Boitsov S.A., Shurgaya M.A., Govorushkina N.S., Krivoruchko Y.D., Chandirli S.A., Malichenko V.S.

Abstract

In 2012 Russia ratified the UN Convention on the Rights of Persons with Disabilities, which provides for the creation of an accessible environment for disabled people, ensuring their rights to work, medical care, education and full participation in public life. This is the fundamental basis on which the social policy of the state in relation to the disabled persons is currently being built. The strategic direction of the social policy of the state is the rehabilitation and habilitation of disabled people, the effectiveness of which depends on the completeness of the study of the epidemiological picture of the spread of disability and the need for various methods of rehabilitation and habilitation in citizens with limited life activity due to violations of the body’s functions. The article presents information characterizing the epidemiological picture of the disability of the population in the Russian Federation, taking into account the main age categories. Data on the total number of disabled people receiving various types of rehabilitation and habilitation services in the Russian Federation are also presented. There are highlighted problematic issues, the solution of which is necessary for the implementation of the social policy of the state.
Medical and Social Expert Evaluation and Rehabilitation. 2018;21(1-2):50-54
pages 50-54 views

COMPREHENSIVE STUDY OF DISABILITY DUE TO DIABETES MELLITUS IN THE RUSSIAN FEDERATION

Chikinova L.N., Begma I.V., Zapariy N.S., Boltenko Z.V.

Abstract

When analyzing the indices and the structure of the disability due to diabetes mellitus over the period of 2012-2016, a decrease in the number of diabetes mellitus patients both recognized as disabled for the first time (RDFT) and recognized as disabled repeatedly (RDR), reduction in the level of the primary and secondary disability due to diabetes mellitus, a predominance of group III invalids in the structure of the contingent of RDFT and RDR, but more than a third were invalids of the I and II disability groups, which determines the need for the development of comprehensive programs for the prevention of diabetes mellitus, rehabilitation of patients and people with disabilities with this pathology.
Medical and Social Expert Evaluation and Rehabilitation. 2018;21(1-2):55-59
pages 55-59 views

MEDICO-SOCIAL ASPECTS OF THE GENERAL AND PRIMARY DISABILITY IN CHILDREN POPULATION LIVING IN THE URBANIZED AREA

Myachina O.V., Esaulenko I.E., Puzin S.N., Zuikova A.A., Pashkov A.N., Shurgaya M.A., Davydov M.A.

Abstract

The aim of the investigation was to make an analysis of the primary and general disability in children population living in the industrial Levoberezhniy district of the city of Voronezh under the exposure to the constant anthropogenic load. The analysis was made according to the statistical form №19 «Information about children with disabilities». The duration of the period of the investigation amounted of 9 years (2009-2017). The general disability level in the industrial Levoberezhniy district was determined to be 11.24±0.33 / 1000 of the children population, and primary disability level accounted for - 1.36±0.18 / 1000 of children population. The most number of children with disabilities is in the group of 5-9 years. The majority of disabled children were shown to be boys (60.48±0.86%). Diseases of the nervous system held the 1st position in rank-abundance distribution in the general invalidity structure of children - 24.7%, (cerebral palsy and other paralytic disorders were the most frequently occurred), 2nd was occupied by congenital anomalies - 23.59% (out of them, anomalies of the nervous system), 3rd - diseases of the ear and mammillary tubercle - 17.68%, 4th - endocrine - 11.32% (of them diabetes), 5th - diseases of the bone-muscular system and connective tissue - 5.26% (of them juvenile arthritis). Structure of reasons for the primary disability in different age groups and general age structure have the important practical value for planning of the medico-social inspection and rehabilitation of children with disabilities.
Medical and Social Expert Evaluation and Rehabilitation. 2018;21(1-2):60-64
pages 60-64 views

MORBIDITY IN THE REPUBLIC OF SOUTH OSSETIA FOR THE PERIOD FROM 2012 TO 2016 (GENERAL ASPECTS)

Puzin S.N., Gal I.G., Totchiev G.F., Amerkhanov E.N., Dmitrieva N.V.

Abstract

The article presents the main indices of the morbidity - the general prevalence and incidence in the Republic of South Ossetia over the period from 2012 to 2016 for the main classes, groups and specific types of diseases, as well as for individual socio-demographic groups: the population over 18 years and children aged up to 18 years. Statistical data of the total incidence for 2012-2015 in The Republic of South Ossetia is considered in comparison with similar indices of the Russian Federation. The material reflecting the ranking of incidence rates per 100 thousand of the population is presented. The analysis of the morbidity, the study of statistical indices of the morbidity, both general prevalence, and incidence, as well as the dynamics over the period of 2012-2016, are the key reference points for the development of a corresponding resource for the emerging national health system of the Republic of South Ossetia. This is of particular interest in the implementation of the integration in cooperation between the Republic of South Ossetia and the Russian Federation.
Medical and Social Expert Evaluation and Rehabilitation. 2018;21(1-2):65-69
pages 65-69 views

ANALYSIS OF LETHAL OUTCOMES AMONG CHILDREN WITH ETHANOL IN BLOOD SAMPLES

Klevno V.А., Maksimov A.V.

Abstract

Cases of consumption of alcoholic beverages by children and adolescents are rare. Children’s bodies are considered to be much less resistant to toxic effects of alcohol. However, there are described cases of the non-lethal ethanol poisoning in children when its blood concentration exceeded 5 g/L. The aim of the study. The forensic medical evaluation of the toxic action of ethanol in children depending on age, blood concentration of alcohol taking into account causes of death. Material. Data from statistical reporting, the Bureau of forensic medical examination for the Moscow region over the period of 2003-2017. Results. In lethal outcomes of children the prevalence rate of a positive result of the forensic chemical test of blood for the presence of ethyl alcohol was 1:6. Detected ethanol concentration in corpse blood would correspond to clinical manifestations of intoxication, from mild to severe. Conclusion. Children, whose blood alcohol content formally met the criterion of severe intoxication or alcohol poisoning, can take actions.
Medical and Social Expert Evaluation and Rehabilitation. 2018;21(1-2):70-72
pages 70-72 views

COMPARATIVE ANALYSIS OF AGE AND CLINICAL CHARACTERISTICS OF ALCOHOL DEPENDENT PATIENTS IN NARCOLOGICAL HOSPITALS OF THE TWO REGIONS OF THE REPUBLIC OF TAJIKISTAN

Sharopova N.M., Krivoruchko Y.D., Malikov N.V., Martiushov A.N.

Abstract

According to the preliminary analysis of the epidemiological data in various regions of Tajikistan, there were established differences in the dynamics of epidemiological indices. Based on this, a hypothesis about differences in the impact of biological and social factors on the increase of the risk of the developing alcohol dependence was proposed. The article analyzes age and related characteristics of patients enrolled in a drug treatment medical institutions of Dushanbe (100 observations) and Kurgan-Tyube (50 observations). Obtained results of the analysis showing the differences of the examined groups of patients can help not only to optimize the volume and nature of the specialized narcological help but also to form an idea of targeted preventive measures for different population groups.
Medical and Social Expert Evaluation and Rehabilitation. 2018;21(1-2):73-78
pages 73-78 views

ORGANIZATIONAL AND LEGAL PECULIARITIES OF MEDICINAL PROVISION OF DISABLED PEOPLE IN THE RUSSIAN FEDERATION

Puzin S.N., Grechko A.V., Pryanikov I.V., Malichenko V.S.

Abstract

Current demographic situation, characterized by a change in the structure of the morbidity rate and rapid aging of the population, has led to an increase in the number of disabled people in the world. Existing international legal norms, activities of international organizations and non-governmental organizations (NGOs), as well as the implemented state policy are not fully able to overcome restrictions on the realization of the rights of disable persons, especially with regard to access to essential medicines. The article analyzes the system of the drug provision organization for disabled people in the Russian Federation, formulates recommendations on the systematization of approaches to the organization of this process with a view to improving the effectiveness of medical and social rehabilitation of disabled people
Medical and Social Expert Evaluation and Rehabilitation. 2018;21(1-2):79-83
pages 79-83 views

IMPLEMENTATION MEASURES ON THE DEVELOPMENT OF APPROACHES FOR APPROVAL OF NEW CLASSIFICATIONS AND CRITERIA USED IN THE REALIZATION OF THE MEDICAL AND SOCIAL EXPERTISE OF CHILDREN ON THE BASIS OF THE “MAIN BUREAU OF THE MEDICAL SOCIAL EXPERTIZE IN THE VORONEZH REGION” MINISTRY OF LABOR OF RUSSIA

Esaulenko I.E., Sergeeva O.V., Dmitrenko L.B., Rushanian A.A.

Abstract

This article reflects the course and questions of the Pilot project on the approbation of new classifications and criteria used for the implementation of medico-social examination in children. Stages and results of a research described have allowed giving suggestions on the improvement of classifications and criteria according to received results on the basis of institutions of medico-social examination.
Medical and Social Expert Evaluation and Rehabilitation. 2018;21(1-2):84-88
pages 84-88 views

THE ROLE OF ANTICHOLINERGIC PROPERTIES OF DRUGS IN THE DEVELOPMENT OF FALLS IN PATIENTS OF SENILE AGE

Ilina E.S., Bordovsky S.P., Polshina N.I., Nikulin V.E., Gorbotenkova S.V., Bogova O.T., Ivanova T.A., Lyalina I.V., Sychev D.A.

Abstract

The article presents own results of the effect of anticholinergic properties of drugs on the development of falls in senile cardiovascular disease (CVD) patients under conditions of polypharmacy. The total anticholinergic load was calculated according to the ACBS scale (Anticholinergic Cognitive Burden Scale). Our study showed the ACB scale to be convenient and allows us to identify designations of dangerous drugs that can disrupt cognitive abilities in CVD patients of older age groups, leading to a fall.
Medical and Social Expert Evaluation and Rehabilitation. 2018;21(1-2):89-93
pages 89-93 views

“DIFFICULT” ISSUES OF THE MANAGEMENT OF INFLAMMATORY BOWEL DISEASES PATIENTS

Bakulin I.G., Skalinskaya M.I., Skazyvaeva E.V.

Abstract

The article presents “difficult” questions found by physicians in the management of inflammatory bowel diseases (IBD) patients, and also discusses and analyzes data of the Register, established by the North-West Center of the IBD (within the framework of the Federal Register of IBD patients). To date, there are many complex and unresolved issues regarding the management of IBD patients. The situation becomes especially relevant when bearing in mind these diseases start at a young and working age and pose a significant social problem. Data on the IBD prevalence rate and their separate forms vary considerably, but almost all available sources report its gain in recent years. The information displays the prevalence rate of IBD, the forms of the disease, the timing of the diagnosis, both the essence and frequency of complications. The obtained data are compared with the results of other registers. To the actual moment, despite the obvious breakthrough in the development of drugs for the treatment of IBD, not all patients can achieve an optimal response, complete relief of the inflammatory process. The discussion touches upon issues related to the immunogenicity of various genetic engineering biological products and its effect on the efficacy and safety of therapy, as well as the efficacy and safety of biosimilars in the treatment of IBD and the problems associated with predicting the effectiveness and safety of the treatment.
Medical and Social Expert Evaluation and Rehabilitation. 2018;21(1-2):94-100
pages 94-100 views

INFLUENCE OF ANTIARRHYTHMIC DRUGS ON THE SPECTRAL ANALYSIS OF HEART RATE VARIABILITY IN PATIENTS WITH ATRIAL FIBRILLATION

Popova E.P., Bogova O.T., Puzin S.N., Matsokin I.S., Gadzhimagomedova A.A., Sychev D.A., Fisenko V.P.

Abstract

The use of the spectral analysis of the heart rate variability to assess the effectiveness of therapy is of great attention of researchers and doctors. This method allows you to get knowledge of the influence of the autonomic nervous system on the heart activity, which is an important factor for the manifestation of the effects of antiarrhythmic drugs. In this study, we studied the effect of antiarrhythmic drugs of class III amiodarone and sotalol on spectral indices of the heart rate variability in patients with atrial fibrillation. The power of slow frequencies prevailed in the structure of the spectrum with the introduction of amiodarone and sotalol. This suggests that the sympathetic nervous system have a predominant influence on the heart.
Medical and Social Expert Evaluation and Rehabilitation. 2018;21(1-2):101-104
pages 101-104 views

EXPERIENCE IN IMPROVING TRAINING OF ENGINEERING MEDICAL STAFF ON THE BASIS OF INTRODUCTION OF SCIENTIFIC AND PRACTICAL INTERDISCIPLINARY RESEARCH IN THE EDUCATIONAL PROCESS

Puzin S.N., Fetisov G.P.

Abstract

There is presented the example of the basic department of the Moscow Aviation Institute (National Research University) as the experience of the training engineering personnel for medicine. Measures are proposed to improve the quality of master’s training.
Medical and Social Expert Evaluation and Rehabilitation. 2018;21(1-2):105-107
pages 105-107 views

ISSUES OF MEDICAL AND SOCIAL EXPERTISE AND REHABILITATION OF DISABLED PEOPLE IN THE PREPARATION OF BACHELORS OF SOCIAL WORK

Martynenko A.V., Vorobtsova E.S., Ovchinnikova S.V.

Abstract

We analyzed stages of the establishment and development of medical and social workers training, the system of medical and social education in the Russian Federation. We presented the experience of the A.I. Yevdokimov Moscow State University of Medicine and Dentistry in the training the Bachelors of Social Work for the professional engagement in the institutions of the medical and social expertise and rehabilitation area. We examined the purpose, objectives and subject matter of the educational subjects as well as educational technologies used for this purpose.
Medical and Social Expert Evaluation and Rehabilitation. 2018;21(1-2):108-111
pages 108-111 views

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