Vol 21, No 1-2 (2018)

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.