Vol 23, No 3 (2020)

The article analyzes the current regulatory and legal framework for the organization of social services for the elderly and disabled in social service institutions on the territory of the Russian Federation. The article reflects the shortcomings of legal documents regarding the organization of work of such institutions to improve the quality and accessibility of social care for patients receiving social services in social service organizations. The assessment of staffing standards is given.

Background. Disability is one of the most important medical and social problems. According to the latest data, more than 1 billion people in the world are disabled according to WHO data in 2016, more than 1.9 billion adults aged 18 and older were overweight, of which more than 650 million were obese (11% of men and 15% of women). According to WHO, it is expected that children with obesity will increase to 70 million by 2025. Obesity in early childhood it is most severe and less treatable, and can also lead to serious complications: hypertension, diabetes, metabolic syndrome, and other diseases. The aim: we believe that the study of the population of disabled people due to various diseases with obesity in various nosologies is important for the development of comprehensive measures for the prevention of morbidity, early diagnosis and rehabilitation of this group of people. Materials and methods. We conducted a comprehensive study of children with the status of “disabled child” and initially examined in the ITU Bureau No. 4 for the Republic of Mordovia. The study group included overweight and obese children with various diseases. Information from the statistical collections of Rosstat and approved forms of state statistics No. 7-Sobes for 2019 were also included. Results. In 2019, 1065 children were examined in 4 bureaus of the ITU RM; of these, 730 children were examined to determine the category of “disabled child”, which was 68.5% (first: 262; 35.9%, second: 468; 64.1%). The largest proportion of children recognized as disabled for the first time is young children from 0 to 3 years (45,2%). In the structure of primary disability of this age category, congenital malformations account for 31% (28 people out of 90). The proportion of disabled people in the age category from 4 to 7 years is 16.5%. The proportion of disabled people in the age group 15 years and older is 9.5%. The first place is occupied by diseases of the endocrine system (42.1%), the second by diseases of the musculoskeletal system (26.3%). The largest number of patients with primary examination are obese with disorders of neuromuscular, skeletal and movement-related (statodynamic) functions ― 10 children (5%); with disorders of the cardiovascular system ― 8 children (4%); and disorders of the endocrine system ― 7 children (3.5%). When re-examining children with various pathologies, the ranking places are occupied by violations of the same functions ― neuromuscular (6.1%), cardiovascular (3.7%), endocrine (2.5%). In other persistent disorders of body functions, there are also obese patients in both groups, but their number is very small. Conclusions. When monitoring for 2018–2019, we see an increase in the number of obese children with various functional disorders. Most often, obese children recognized as disabled are found in groups with impaired statodynamic and cardiovascular functions, most likely this is due to restricted movement. And such patients are recommended to follow the principles of a healthy diet more carefully, no matter what aggravates the existing condition. And thus, in a short time to carry out all the necessary rehabilitation measures and in some cases reduce the period of disability.

Background. The problems of treating recurrent nodular goiter are still relevant. The technical difficulties of the intervention on the neck tissues altered by the scarring process and the comorbid background of patients cause an unacceptably high risk of complications of traditional surgical treatment and, as a result, a long and difficult rehabilitation period and high costs for the treatment of patients who have undergone surgery for recurrent goiter. Alternative methods, such as sclerotherapy, which reduce the risk of complications, have been successfully used in patients with non-operated thyroid, but the possibilities of minimally invasive destruction of recurrent nodules have not been studied enough, and it is not known whether it is as safe and effective as sclerotherapy of non-recurrent nodules. The aim of the study was to compare the efficacy and safety of treatment of recurrent and non-recurrent nodular goiter using sclerotherapy. Materials and methods. The study included 30 previously not operated patients with nodular goiter and 30 patients with recurrent nodular goiter. All of them underwent 4 courses of sclerotherapy, each of which included 5 sessions with a frequency of 1 session per week; polidocanol was used as a sclerosant. Results. The analysis showed that the efficiency of reduction of nodules did not decrease in patients with recurrent goiter, despite severe sclerotic changes in the tissues. The size of the nodules and the volume of thyroid tissue were reduced during sclerotherapy, regardless of the presence of a history of thyroid surgery, as well as the cure of functional autonomy and relief of symptoms of neck compression. The tolerability of sclerotherapy also did not depend on the presence of recurrent goiter, and the rate of complications was the same (0.8%). Complications of sclerotherapy were not serious in any case. Conclusions. Thus, sclerotherapy of recurrent nodules is a good alternative to traditional surgical treatment; it is not inferior in efficiency and safety to sclerotherapy of nodules in a non-operated thyroid. Its use will significantly reduce the rehabilitation period and the cost of treating patients with recurrent nodular goiter.

Chronic disorders of consciousness is a complex medical and social problem. Rehabilitation of these patients is one of the most important tasks from both practical and scientific points of view. The lack of a standardized approach and techniques with a large evidence base in the restoration of consciousness, the need for multidisciplinary teams in the rehabilitation process, difficulties in creating a rehabilitation environment, as well as many other problems are acutely faced by patients’ relatives, doctors, healthcare organizers, scientists. In this article, we will consider approaches to the rehabilitation of patients with chronically impaired consciousness.