РАЗДЕЛ I. Обеспечение инвалидов техническими средствам реабилитации
• Новое в законодательстве по обеспечению инвалидов техническими средствами реабилитации. Дымочка М.А., Андреева О.С. ФГБУ ФБ МСЭ, г. Москва
Ключевые слова: технические средства реабилитации, Федеральные нормативные акты, инвалид, индивидуальная программа реабилитации инвалида.
Резюме. Статья посвящена основным правовым актам Федерального уровня, регулирующим вопросы обеспечения инвалидов техническими средствами реабилитации.
• Анализ практики обеспечения инвалидов техническими средствами реабилитации. Андреева О.С. ФГБУ ФБ МСЭ, г. Москва
Ключевые слова: технические средства реабилитации; кресла-коляски; ортопедическая обувь; кохлеарная имплантация.
Резюме. Статья посвящена вопросам формирования индивидуальной программы реабилитации инвалида по разделу «Технические средства реабилитации и услуги», которые вызывают сложности у специалистов бюро медико-социальной экспертизы.
• Применение эндопротезов клапанов сердца и эндопротезов сосудов в качестве технических средств реабилитации и услуг, предоставляемых инвалиду. Кузьмишин Л.Е., Баньковская М.П. ФГБУ ФБ МСЭ, г. Москва
Ключевые слова: эндопротезы клапанов сердца (искусственные клапаны сердца) и эндопротезы сосудов, виды эндопротезов клапанов сердца и сосудов, принципы выбора вида эндопротеза клапана сердца и сосуда.
Резюме. Представлены сведения о видах эндопротезов клапанов сердца (искусственных клапанов сердца) и эндопротезов сосудов. Изложены особенности выбора эндопротезов клапанов сердца и эндопротезов сосудов.
• Особенности нарушения социально-психологической адаптации у больных с выраженным ограничением передвижения вследствие травмы спинного мозга или ампутации нижних конечностей. Морозова Е.В., Суроегина А.Ю. ФГБУ ФБ МСЭ, г. Москва
Ключевые слова: последствия травм спинного мозга, ампутации нижних конечностей, социально-психологическая адаптация, дезадаптация, приверженность реабилитации, активность и участие.
Резюме. В статье изложен литературный обзор зарубежных исследований по специфике социально-психологической адаптации инвалидов вследствие травм спинного мозга, ампутаций нижних конечностей, имеющих выраженные ограничения передвижения.
РАЗДЕЛ II. АНАЛИТИЧЕСКИЕ ОБЗОРЫ
• Психологическая категория деятельности в практике медико-социальной экспертизы (МСЭ). Шабалина Н.Б., Герсамия А.Г. ФГБУ ФБ МСЭ, г. Москва
Ключевые слова: деятельность, действие, цель, операция, мотив, структура деятельности, предмет деятельности, виды деятельности, психологический диагноз.
Резюме. Для оценки ограничений жизнедеятельности индивидуума в МСЭ важно рассмотреть и проанализировать категорию деятельности, которая, являясь важнейшей базовой психологической категорией, может послужить мостом, соединяющим данные о функциональном состоянии человека с анализом особенностей его жизнедеятельности.
• Применение и использование мультимедийных презентаций в практике специалистов, работающих с детьми, имеющих особенности в развитии, в условиях стационарных учреждений. Сидоренко О.К., Турусова Н.А., Владимирова О.В., Великолуг Т.И. Детский дом-интернат для умственно отсталых детей № 28, г. Москва
Ключевые слова: дети с ограниченными возможностями, обучение с помощью компьютерных технологий, реабилитация, социализация.
Резюме. Активные формы обучения с помощью использования компьютерных технологий имеют чрезвычайно важное значение в процессе реабилитации и социализации детей с ограниченными возможностями. В отличие от обычных технических средств обучения мультимедийные средства активнее способствуют развитию эмоционально-волевой сферы, интеллектуальных и творческих способностей, формированию коммуникативных навыков детей со сложной структурой дефекта.
• Исследование развития функций мышления и интеллектуальной деятельности у детей из социально незащищенных семей. Железнова А.К. Центр социального обслуживания «Зеленоградский», г. Москва
Ключевые слова: речевое развитие ребенка, социальная ситуация развития, социально незащищенные семьи, задержка психоречевого развития.
Резюме. Проведено сравнительное исследование развития функций мышления и интеллектуальной деятельности по уровневым и динамическим характеристикам у детей из социально незащищенных и обычных семей в младшем дошкольном, старшем дошкольном и младшем школьном возрастах.
• Информационно-статистическое обеспечение деятельности «Главного бюро медико-социальной экспертизы». Силантьев Д.В. ФКУ «ГБ МСЭ по Ульяновской области»
Ключевые слова: медико-социальная экспертиза (МСЭ), портал, госуслуга, документооборот, взаимодействие, интернет.
Резюме. Отдел информационно-статистического обеспечения «ГБ МСЭ по Ульяновской области» создан в целях формирования единого информационного пространства для повышения качества и оперативности экспертной помощи населению, организации электронного документооборота, внедрения стандартов единой информационной системы МСЭ и формирования централизованной базы данных.
• Вопросы медико-социальной экспертизы при лимфомах. Захарченко Н.А., Манкиров В.А. ФГБУ ФБ МСЭ, г. Москва
Ключевые слова: лимфомы; клиническая картина; классификация; стадии развития лимфом; диагностика; течение; прогноз заболевания; инвалидность; международный прогностический индекс; реабилитация больных и инвалидов.
Резюме. В статье дана характеристика гетерогенной группы заболеваний — лимфом; представлена распространенность данной группы заболеваний, описаны этиологические факторы развития лимфом, морфологические варианты неходжкинских лимфом. Дана общая клиническая картина данной группы заболеваний с учетом локальных проявлений и возможной генерализации процесса.
• Некоторые возрастные особенности общей инвалидности вследствие психических расстройств, вызванных употреблением алкоголя в динамике за 2006 – 2010 годы. Красновская Е.С., Аникин М.В. ФГБУ ФБ МСЭ, ФКУ «ГБ МСЭ по г.Москве», г. Москва
Ключевые слова: алкогольная зависимость, инвалидность, психические нарушения, вторая стадия алкоголизма, трудоспособный возраст.
Резюме. Контингент инвалидов вследствие психических расстройств, вызванных употреблением алкоголя (общая инвалидность), представлен, в основном, лицами мужского пола. Очень велика среди данного контингента доля инвалидов трудоспособного возраста.
• Реализация индивидуально-ориентированного подхода к экспертно-реабилитационной психологической диагностике. Жилюк М.А., Павлова С.В., Василенко Е.В., Стрелец Ю.Г. ФКУ «ГБ МСЭ по Мурманской области», г. Мурманск
Ключевые слова: психологическая экспертно-реабилитационная диагностика, индивидуально-ориентированный подход, критерии.
Резюме. Индивидуальный подход к больному предполагает учет всех психологических особенностей индивида и оценку его ресурсных возможностей. В практике МСЭ и реабилитации детей крайне важно определять нозологический функциональный диагноз и качественный анализ причин социальной недостаточности ребенка. Оценка способности к обучению, профдиагностика и профориентация являются актуальными для граждан трудоспособного возраста.
• Оценка различных методов хирургического лечения и оптимальная модель хирургической реабилитации больных и инвалидов с синдромом диабетической стопы. Бегма А.Н., Бегма И.В. ФГБУ ФБ МСЭ, г. Москва
Ключевые слова: Инвалиды вследствие сахарного диабета, синдром диабетической стопы, малые ампутации.
Резюме. 40 – 70 % всех нетравматических ампутаций в мире производится больным с синдромом диабетической стопы. Изучена социально-гигиеническая и клиническая характеристика 103 больных и инвалидов с синдромом диабетической стопы, перенесшие хирургическое вмешательство на стопе или ампутацию нижней конечности на любом уровне.
РАЗДЕЛ III. ЗАМЕТКИ ИЗ ПРАКТИКИ
• Многофакторный подход к анализу первичной инвалидности взрослого населения Тульской области. Китанина К.Ю., Хромушин В.А., Литвяк О.И., Овсянникова Е.Н. ФКУ «ГБ МСЭ по Тульской области», г. Тула
Ключевые слова: первичная инвалидность взрослого населения, ФКУ «ГБ МСЭ по Тульской области», основные показатели инвалидности, обобщенная оценка, алгоритм, многофакторный анализ, алгебраическая модель.
Резюме. С использованием комплексной многофакторной авторской методики, основанной на алгоритме обобщенной оценки показателей (ООП) здравоохранения и алгебраической модели конструктивной логики (АМКЛ) проведен анализ первичной инвалидности взрослого населения Тульской области.
• Медико-социальная экспертиза при болезнях и пороках культей конечностей. Шувалов А.Ю., Паршутин С.А. ФКУ «ГБ МСЭ по Алтайскому краю», г. Барнаул
Ключевые слова: инвалидность, порок культи, болезнь культи, реабилитация.
Резюме. В структуре первичной инвалидности вследствие заболеваний и травм костно-мышечной системы удельный вес ампутаций конечностей составляет около 10%, причем процент лиц трудоспособного возраста среди этого контингента достаточно велик. Основной метод реабилитации данной категории инвалидов — протезирование ампутированной конечности.
• Состояние первичной инвалидности трудоспособного населения Оренбургской области вследствие хронической обструктивной болезни легких в 2008-2010 годы. Данькова Л.Р., Смагина Т.Н., Громов В.В. ФКУ «ГБ МСЭ по Оренбургской области», г. Оренбург
Ключевые слова: экология, трудоспособное население, хроническая обструктивная болезнь легких, первичная инвалидность.
Резюме. На основе показателей первичной инвалидности вследствие хронической обструктивной болезни легких (ХОБЛ) проведен анализ влияния неблагополучной экологической обстановки в регионе на инвалидизацию трудоспособного населения Оренбургской области.
• К вопросу о соблюдении порядка направления на медико-социальную экспертизу на современном этапе. Ушакова О.В. ФКУ «ГБ МСЭ по Волгоградской области», г. Волгоград
Ключевые слова: порядок направления на медико–социальную экспертизу, административный регламент, государственная услуга.
Резюме. В условиях регламентированных административных процедур для качественного предоставления государственной услуги по проведению медико–социальной экспертизы существенно повышается значимость вопросов конструктивного взаимодействия органов медико–социальной экспертизы и органов здравоохранения.
• Инвалидность вследствие болезней органов кровообращения взрослого и детского населения. Лаврова Д.И., Петросян К.М. ФГБУ ФБ МСЭ, г. Москва
Ключевые слова: болезни органов кровообращения, первичная и повторная инвалидность, взрослое и детское население, Российская Федерация, Москва.
Резюме. Число впервые признанных инвалидами вследствие болезней органов кровообращения среди взрослого населения в РФ в 2010г. составило 39,2%, а по Москве — 47,2% от общего числа инвалидов при уровнях инвалидности 29,9 и 32,4 на 10 тыс. взрослого населения соответственно.
• Динамика формирования инвалидности у детей в Челябинской области за 2007-2011 годы. Клейменова Н.В., Варасина Л.М., Мельник Е.В. ФКУ «ГБ МСЭ по Челябинской области», г. Челябинск
Ключевые слова: инвалидность у детей, первичная инвалидность, динамика, ранговые места.
Резюме. Изучена динамика инвалидности у детей, распределение контингента детей-инвалидов по возрасту, полу, месту проживания, ведущему ограничению жизнедеятельности, обусловившим инвалидность заболеваниям за период 2007-2011 гг. Интенсивный показатель первичной инвалидности, общее число лиц, которым впервые определена категория «ребенок-инвалид» среди детского населения Челябинской области имели тенденцию к увеличению на протяжении всего исследуемого периода. В контингенте детей — инвалидов за 2007-2011 гг. преобладали лица мужского пола, дети возрастной категории 8-14 лет. Инвалидность чаще всего определялась вследствие психических расстройств и расстройств поведения, врожденных аномалий, болезней нервной системы.
• Анализ показателей заболеваемости злокачественными новообразованиями и комплексные меры по её профилактике. Домашенко А.А., Дарымова Н.В. ФКУ «ГБ МСЭ по Ростовской области», г. Ростов-на-Дону
Ключевые слова: заболеваемость, смертность, злокачественные новообразования, профилактика заболеваемости.
Резюме. Показатели первичной заболеваемости онкологическими заболеваниями в Ростовской области за последние годы увеличились на 4,5%, на 12,8% увеличилась распространенность злокачественных новообразований, однако имеются устойчивые тенденции к снижению показателей смертности от онкологических заболеваний.
• Анализ основных социально-экономических показателей в Республике Ингушетия и меры социальной поддержки населения. Алисханов М.А. ФКУ «ГБ МСЭ по Республике Ингушетия», г. Назрань
Ключевые слова: макроэкономические показатели, социальная сфера, безработица, денежные доходы населения.
Резюме. Республика Ингушетия значительно отстает от среднероссийского уровня по основным макроэкономическим показателям
• Рекомендации по эффективной интеграции инвалидов боевых действий и военной службы России в общество посредством внедрения инновационных технологий. Захарова Е.А. ФГБУ ФБ МСЭ, г. Москва
Ключевые слова: инвалид, социальная и профессиональная реабилитация, инновационные технологии, трудоустройство и социализация.
Резюме. Социальная и профессиональная реабилитация инвалидов боевых действий и военной службы осуществляется при помощи инновационных решений, на примере продукта ACCS (AlternativeComputerControlSystem), который эффективно применяется уже сейчас у людей, перенесших травму спинного мозга с последующей утратой функций конечностей.
ПРИЛОЖЕНИЕ
• Информационно-аналитические материалы о первичной инвалидности взрослого населения в Российской Федерации, Федеральных округах и субъектах в 2010-2011 годы. Гришина Л.П., Талалаева Н.Д., Веригина Н.Б., Войтехова И.В., Бунина А.М., Петросян К.М. ФГБУ ФБ МСЭ, г. Москва
Ключевые слова: инвалидность, взрослое население, округа, субъекты, уровень, ранговые места.
Резюме. Представлен большой информационно-аналитический материал о первичной инвалидности взрослого населения в Российской Федерации, по всем федеральным округам и субъектам за 2010-2011 гг. Определены ранговые места субъектов по уровню первичной инвалидности в 2010 и 2011 гг. Даны показатели всей первичной инвалидности, а также инвалидности вследствие двух ведущих классов болезней: при болезнях системы кровообращения и при злокачественных новообразованиях. Всегопредставлено 36 таблици 11 диаграмм.
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SECTION I. Provision of disable people with technical MTANS of rehabilitation
• The new in the legislation on the provision of the invalids with technical means of rehabilitation. Dymochka M.A., Andreeva O.S. Federal Bureau for Medical and Social Expertise, Moscow
Key Words: technical means of rehabilitation; Federal normative acts; a disabled person; an individual program of rehabilitation of the disabled.
Resume: The article is devoted to the main legal acts of a Federal level, regulating the questions of provision of the invalids with technical means of rehabilitation. In the article an analysis of the statements of the Federal law “About a social protection of the invalids in the Russian Federation” has been given, concerning the questions, as well as resolutions and decisions of the Government of the RF and the Orders of the Ministry of Health and Social development.
• An analysis of practice of provision of technical means of rehabilitation for the disabled. Andreeva O.S. Federal Bureau for Medical and Social Expertise, Moscow
Key words: technical means of rehabilitation; wheel-chairs; orthopedic foot-wear; cochlear implantation
Resume: The article is devoted to the questions of the formation of an individual program of rehabilitation (IPR) of an invalid by the unit “Technical means of rehabilitation and the services” that make difficulties to the specialists of the bureaus of medical and social expertise. Such questions are: determination of medical indications and contraindications for provision of the invalids with the wheel-chairs with an electric drive, including children-disabled; definition of medical indications for provision of the disabled with room or excursion-type wheel-chairs with a manual acting drive from the wheel rim, as well as the list of absolute and relative medical contraindications; the legal regulation of questions of provision the invalids with a wheel-chair “a step-on the go”, (“a step without a pause”, “a step straight off”), with orthopedic foot-wear. There have been given explanations on the formation of an IPR for the disabled undergone a cochlear implantation.
• The application of endoprosthetic heart valves and endoprosthetic vessels as the technical means of rehabilitation and the services provided for a disabled person. Kuzmishin L.E., Bankovskaya M.N. Federal Bureau for Medical and Social Expertise, Moscow
Key Words: endoprosthetic heart valves (artificial valves of heart) and endoprosthetic vessels; types of endoprosthetic heart valves and endoprosthetic vessels; the principles of selection of a heart endoprosthetic valve and a vessel.
Resume: The information has been presented about the types of endoprosthetic heart valves (artificial heart valves) and endoprosthetic vessels. There have been described the particulars of selection of endoprosthetic heart valves and endoprosthetic vessels in dependence on the age of a patient, the severity of the leading disease, anatomotopographic and morphologic characteristics, the amount of the damaged heart valves or the vessels, the presence of concomitant diseases, the possibility of a patient to receive anticoagulants systematically and to control the blood coagulation.
• Peculiarities of disorder of social-psychological adaptation in the patients with markedly expressed limitation of locomotion in consequence of a spinal cord trauma or lower limb amputation. Morosova E.V., Suroegina A.Yu. Federal Bureau for Medical and Social Expertise, Moscow
Key Words: Sequelae of the spinal cord traumas; lower limb amputations; social-psychological adaptation; disadaptation; adherence to rehabilitation; activity and participation.
Resume: In the article there has been presented a literature survey of the foreign studies on the specificity of social-psychological adaptation of the disabled in consequence of the spinal cord traumas, lower limb amputations, having markedly expressed limitations of locomotion, the results of empiric investigation of the patients on the base of FSBI FBMSE Clinic have been described, where psychological peculiarities of adaptation mechanisms have been considered, the main adaptation strategies, social-psychological, social-environmental and social-everyday factors, influencing on the rise of disadaption emotional states.
SECTION II. ANALYTICAL SURVEYS
• Psychological category of activity in the practice of medical-social expertise (MSE). Shabalina N.B., Gersamiya A.G. Federal Bureau for Medical and Social Expertise, Moscow
Key Words: activity; action; aim; operation; motive; structure of activity; object of activity; types of activity; psychological diagnosis.
Resume: To estimate the limitations of vital activity of an individual in MSE it is important to consider and analyze the category of activity that being the most important basic psychological category may serve as the bridge connecting the data about the functional state of a man with the analysis of particular characteristics of his vital activity. Despite the multiplicity of the types of vital activity classification accepted in the practice of MSE, all of them may be analyzed and united from the position of a total psychological theory of activity, from the position of its psychological structure, subject-content and dynamic component. Psychic disorders make a destructive influence on all elements of activity but to different extents and in different combinations. It is important and necessary for a psychologist in MSE to estimate a capacity for the activity in all its aspects being based on the psychological diagnosis.
• The application and the use of multimedia presentations in practice of specialists working with the children having peculiarities in the development under conditions of stationary establishments. Sidorenko O.K., Turusova N.A., Vladimirova O.V., Velikolug T.I. Children’s Boarding-House for Mentally Retarded Children No.28, Moscow
Key Words: children with limited possibilities; education with a help of computer technologies; rehabilitation; socialization.
Resume: Active forms of education with a help of computer technologies have extremely important meaning in process of rehabilitation and socialization of children with limited possibilities. Unlike ordinary technical means of education multimedia means more actively promote the development of an emotional-will sphere, intellectual and creative capabilities, the formation of communicative habits of the children with a complex structure of the defect. Pedagogical practice has confirmed that the use of the multimedia presentations is a powerful stimulus in the training of children with a complex structure of the defect. In such situation the teacher-specialist possesses a possibility at his disposal to realize a creative approach to the development and the carrying out of a full-blooded interesting lesson with the use of an up-to-date methodical and didactical aid for all stages of its implementation. Informative-communicative technologies are the most important mechanism for stimulation and development of imagination, latent abilities, emotions of children with limited possibilities, including the most infantile or cancelled ones. The screen attracts an attention of a pupil that can’t be achieved even in an individual work with him, for example, in case of a child suffering from early children’s autism.
• The study of development of the thought functions and intellectual activity in children from socially unprotected families. Zheleznova A.K. Centre of social service «Zelenogradskiy», Zelenograd, Moscow
Key Words: speech child’s development; social situation of development; socially unprotected families; retardation of psychic and speech development
Resume: We have carried out a comparative study of the thought functions and intellectual activity by the characteristics of levels and dynamics in children from socially unprotected families and ordinary families at the junior preschool, senior preschool and junior school age. We have used neuropsychological tests, WISC subtests, classic methods of pathopsychology. We have revealed the number of statistically significant differences by levels at the different ages in comparable groups by the different indicators, stability of these indicators, significant negative and positive dynamics of the aged deviations. As a result of the study there was made a conclusion about retardation by the rate and by the level in the development of intellectual functions of the children’s group from socially unprotected families.
• Information-statistical provision of activity of “The Chief Bureau for Medical and Social Expertise”. Silantiev D.V. Chief Bureau for Medical and Social Expertise on the Ulyanovsk area
Key Words: medical-social expertise (MSE); portal; the state service; rotation of documents; interaction; internet
Resume: The department of information-statistical provision for “CB MSE on the Ulyanovsk area” has been created for the purpose of the formation of an integrated information space for the increase of the quality and operational speed of the expert aid to the population, organization of electronic form of document rotation, introduction of standards of integrated information system of MSE and the formation of a centralized data base. The department has created a local net in the administration and expert groups with an access to the Internet net, there has been developed an electronic journal of a record during examination, the information from which is going on to the united data base in the Chief Bureau server, there has been developed an official site of the institution with information for the citizens with poor vision. The department provides works on the organization of the state service supply on the carrying out of medical and social expertise in the electronic form with realization of interdepartmental interaction. In the framework of this work the department proposes a model of the building of the two-leveled departmental segment SMEV based on automatized information system “The portal of medical-social expertise”. The problems existing for today consist in the necessity of financial contributions to information provision of MSE and the organization of the efficient turnover of the documents.
• The questions of medical-social expertise in lymphomas. Zakharchenko N.A. Federal Bureau for Medical and Social Expertise, Moscow; Chief Bureau for Medical and Social Expertise on the city of Moscow
Key Words: lymphomas; clinical picture; classification; stages of lymphomas’ development; diagnostics; the course of a disease; prognosis of a disease; disability; international prognostic index; rehabilitation of patients and of disabled persons
Resume: In the article there has been given a characteristic of heterogenous group of diseases – lymphomas; the prevalence of this group of diseases has been presented, there have been described etiological factors of lymphomas’ development, morphologic versions of non-Hodgkin’s lymphomas. There has been given a total clinical picture of the given group of diseases considering local manifestations and a possible generalization of the process with the bone marrow affection (leukemization of the process) and of the central nervous system (CNS) affection (capsules of the brain and of the spinal cord), there have been characterized B-symptoms of the disease. The stages of the disease have been presented, the grade of the lymphomas’ malignancy. In the work there has been described a necessary list of diagnostic studies, including laboratory and instrumental methods of the study. The course of the disease and a prognosis of the disease considering the grades of lymphomas’ malignancy have been characterized. Statistical risk factors in lymphomas and the survival’s indicators in dependence on them have been presented. The criteria of a temporal loss of a capacity for work in lymphomas have been given, recommendations on assignment to medical-social expertise (MSE), the disability’s criteria have been presented, rehabilitation means have been described.
• Some aged peculiarities of general disability in consequence of psychical disturbances caused by the use of alcohol in dynamics for 2006-2010 years. Krasnovskaya E.S., Anikin M.V. Federal Bureau for Medical and Social Expertise, Moscow
Key Words: alcohol dependence; disability; psychical disorders; the second stage of alcoholism; able-bodied age
Resume: The contingent of the disabled in consequence of psychical disturbances caused by the use of alcohol (general disability) is mainly presented by the persons of a male sex. Among this contingent there is a very high proportion of invalids of an able-bodied age – 86.9% (676 men from 778 men), in different periods of observation from 83.0% up to 89.7%. The specific weight of the disabled in consequence of psychical disturbances caused by the use of alcohol, with the second stage of alcohol dependence being formed in them up to 30 years of age (incnclusively), comprised 80.6% (627 men.) There has been observed a tendency to reduction of the number of invalids the second study of alcoholic dependence in whom was formed at age of 20-30 years: from 78.6% (in 2006 year) up to 66.3% (in 2010 year). In such a way alcoholism is not only a direct threat the health but and the capacity for work of our country population, that is why an accent in prophylactic measures must be put on the decrease of an interest in the use of alcohol beverages by children, teenagers and the persons of a young age.
• Realization of an individually-oriented approach to the expert-rehabilitation psychological diagnostics. Zhilyuk M.A., Pavlova S.V., Vasilenko E.V., Strelets Yu.G. The Chief Bureau for Medical and Social Expertise on the Murmansk area, Murmansk
Key Words: psychological expert-rehabilitation diagnostics; individually-oriented approach; criteria
Resume: An individual approach to a patient supposes taking into consideration all psychological peculiarities of an individual and estimation of his resource’s capabilities. Nevertheless the specificity of the psychologists’ work in MSE of a combined profile consists in examination of the persons of different ages, of a wide nosologic variability, one-time reception of the patient, impossibility to carry out complete experimental-psychological examination of every person. In connection with it is purposeful to select the main objects of examination which are put by the psychologist together with the doctors-experts, and to refer to the examination first of all the patients which have in their anamnesis the diseases caused by the damage of a central nervous system of different etiology. In practice of MSE and rehabilitation of children it is extremely important to define a nosologic functional diagnosis and a qualitative analysis of the child’s social insufficiency causes. The assessment of the ability to education, professional diagnostics and professional orientation are very urgent for the citizens of the able-bodied age.
• Estimation of different methods of surgical treatment and an optimum model of surgical rehabilitation of the patients and of the disabled with a diabetic foot syndrome. Begma A.N., Begma I.V. Federal Bureau for Medical and Social Expertise, Moscow
Key Words: the disabled in consequence of diabetes mellitus; a diabetic foot syndrome; partial amputations.
Resume: About 40-70% of all non-traumatic amputations throughout the world are performed to the patients with a diabetic foot syndrome. There have been studied a social-hygienic and clinical characteristics of 103 patients and invalids with a diabetic foot syndrome undergone the surgical invasion on the foot or a lower limb amputation on any level. On our opinion, the amputation by Lisfranc, in connection with its long duration, healing, the complexity of prosthetics and the great number of recidivating stump ulcers in a follow-up period, must be recognized by the operation of desperation when an infectious process being spread on the proximal foot sections. For the salvation of a weight-bearing limb function the partial amputations and the amputations by Chopart have been recognized as the optimum ones.
SECTION III. NOTES FROM PRACTICE
• Multinomial approach to the analysis of the primary disability of the adult population of the Tula area. KitaninaK.Yu., KhromushinV.A., LitvyakO.I., OvsyannikovaE.N. Medical Institute at the Tula State University, Tula, Chief Bureau for Medical and Social Expertise on the Tula Area, Tula
Key Words: primary disability of adult population; “Chief Bureau for Medical and Social Expertise on the Tula Area”; the main indicators of disability; generalized estimation; algorithm; multinomial analysis; algebraic model.
Resume: There has been carried out an analysis of the primary disability of the adult population of the Tula area with the use of a complex multinomial author’s method, based on the algorithm of the generalized estimation of the indicators (GEI) of health care and an algebraic model of the constructive logic (AMCL). The study is continuous, it was carried out for two stages with the use of a method of copying out the data, a method of expert assessments, documental, monographic, analytical, graphic, statistical methods as well as the methods of prognosis and modeling. There have been studied the structure and dynamics of the primary disability of the adult population of the Tula area for 2000-2009 years. The factors the most brightly reflecting the problems of the primary disability have been underlined. There has been studied the contribution of each of the factors to the result and the summarized influence of the factors decreasing the level of achievement of the GEI result. The results of the study show the noticeable territorial differences of the districts in the Tula area by the indicators of the primary disability and the leading factors worsening the situation on every territory. The received mathematical models make possible: to evaluate the sensitivity of the GEI of the primary disability to the change of separate factors, to perform prognosis of the situation development. The given studies may serve as an information base for the development of the programs on prophylaxis of the primary disability.
• Medical-social expertise in diseases and defects of the limb stumps. Shuvalov A.Yu., Parshutin S.A. Bureau for Medical and Social Expertise on the Altaiskiy Kray, Barnaul
Key Words: disability; defect of a stump; disease of a stump; rehabilitation
Resume: In the structure of the primary disability in consequence of diseases and traumas of a skeletal-muscular system the specific weight of the limb amputations comprises about 10%, with it a per cent of able-bodied age persons among this contingent is rather high. The main method of rehabilitation of this category of invalids — prosthetic fitting of the amputated limb. The possibility of a real-value prosthetics depends on the amputation method (guillotine, circular, patched one, etc.) and on the defects and diseases of the stump as well which make prosthetics more difficult or impede it. The defects of the stump comprise: defects of the soft stump tissues, defects of a bone stump that in most cases need surgical treatment. In the diseases of the stump in front of prosthetics the patients need both a special conservative treatment and, in some cases, a surgical treatment.
• The state of primary disability of the able-bodied population of the Orenburg area in consequence of a chronic obstructive pulmonary disease in 2008-2010 years. Dankova L.R., Smaginа T.N., Gromov V.V. Chief Bureau for medical and social expertise on the Orenburg area, Orenburg
Key Words: ecology, able-bodied population, chronic obstructive pulmonary disease, primary disability
Resume: Based on the indicators of primary disability due to chronic obstructive pulmonary disease (COPD), an analysis of the influence of unfavorable environmental conditions in the region was carried out on the growing indicators of disability of the able-bodied population in the Orenburg region. In connection with the most polluted atmosphere in urban settlements the analysis was carried out by the settlements. To determine the timeliness of diagnosis, the effectiveness of prophylactic medical examination of the patients with COPD there was implemented an analysis of the persons for the first time acquired the disability, by groups. As a result of the analysis of a direct correlation has been established between air pollution and the primary disability of able-bodied population due to COPD. It was marked that the late diagnosis of the disease causes an increase in the primary disability of able-bodied population with specific weight of the I and II groups, to a greater extent in urban areas.
• About the question of keeping the order of referral to medical-social examination at the contemporary stage. Ushakova O.V. Chief Bureau for Medical and Social Expertise on the Volgograd Area, Volgograd
Key Words: the order of referral to the medical and social expertise; administrative regulations; the state service
Resume: Under conditions of administrative regulating procedures for qualitative rendering the state service on the carrying out of medical and social expertise the significance of the constructive interaction of the medical and social expertise organs and the health care organs increases markedly as well as the significance of improvement of the system of control of the order of referral of the citizens to the medical and social expertise by the organizations rendering therapeutic-prophylactic help.
• Disability in consequence of diseases of the blood circulation organs in the adult and children’s population. Lavrova J.I., Petrosyan K.M. Federal Bureau for Medical and Social Expertise, Moscow
Key Words: diseases of the blood circulation organs; primary and repeated disability; adult and children’s population; Russian Federation; Moscow.
Resume: The number of people for the first time recognized as the disabled in consequence of diseases of the blood circulation organs among the adult population in the RF in 2010 year comprised 39.2%, and on Moscow – 47.2% from a total number of invalids, with the levels of disability – 29.9 and 32.4 for 10 thousand of adult population, relatively. The greatest proportion of people in the structure of the primary and repeated disability of the adult population both in the RF and in Moscow are the invalids in consequence of ischemic disease and cerebral vascular diseases, the persons of a pensionable age with severe disability. The proportion of the disabled in consequence of the blood circulation organ diseases in the structure of the primary (1.4% in the RF and 1.5% in Moscow) and the repeated disability (1.8% in the RF and 2.3% in Moscow) of the children’s population is not high. Among the children’s population both in the RF and in Moscow there has been marked a rather high proportion of the disabled in consequence of the anomalies of a blood circulation system established mainly at the early age.
• Dynamics of formation of disability in children in the Chelyabinsk region for 2007-2011 years. Kleimenova N.V., Varaksina L.M., Melnik E.V. Federal Governmental Institution Chief Bureau for medical and social expertise on the Chelyabinsk area, Chelyabinsk
Key Words: children’s disability, primary disability, dynamics, ranking places.
Resume: In the article there has been studied the dynamics of children’s disability, distribution of the contingent of disabled children by age, sex, the place of residence, leading limitation of vital activity, the diseases conditioned the disability, for 2007-2011 years. The intensive indicator of primary disability, total number of persons to whom the category «disabled child» has been established for the first time, among the children’s population of Chelyabinsk area had a tendency to increase throughout the whole studied period. In the contingent of children-disabled for 2007-2011 years, there prevailed the male persons, the children attained the age of 8-14 years. In most cases the disability was defined owing to psychical disorders and disturbances of behavior, congenital anomalies, diseases of a nervous system.
• An analysis of indicators of morbidity by malignant tumors and complex measures on its prophylaxis. Domashenko A.A., Darymova N.V. Chief Bureau for Medical and Social Expertise on the Rostov Area, Rostov-on-Don
Key Words: morbidity; mortality; malignant tumors; prophylaxis of morbidity.
Resume: The indicators of the primary morbidity by oncologic diseases in the Rostov area has increased by 4.5% for the last years, there has grown the prevalence of malignant tumors by 12.8%, but we may say about stable tendencies of reduction of indicators of mortality because of oncologic diseases. The measures on prophylaxis of oncologic diseases have been directed on the diminushion of morbidity and include the early diagnostics of the given pathology and the timely treatment of diseases promoting the development of malignant tumors.
• An analysis of the main social-economical indicators in the Republic of Ingushetiya and the measures of social support of population. Aliskhanov M.A. Chief Bureau for Medical and Social Expertise on the Republic of Ingushetiya, Nazran
Key Words: macroeconomical indicators; social sphere; unemployment; monetary incomes of population.
Resume: The Republic of Ingushetiya is being significantly behind the average Russian level by the main macroeconomical indicators. Nevertheless the amount of the permanent population for the period of 2004-2009 years has grown up, the average annual amount of people occupied in economics has grown up, the average monthly incomes of population have increased. The volume of expenses necessary for the stable development of the Republic provides the budgetary policy of Ingushetiya. During last years, owing to social goal-directed consolidated budget there has grown up the volume of expenses on the salary for the budgetary sphere workers, there has increased the sum of children’s allowances, the benefits to keep the children-orphans and the children left without their parents’ trusteeship, the children’s summer rest is being organized. There has been carried out social support of the most vulnerable layers of population, the net of the social service institutions is being widened.
• Recommendations on efficient integration of the invalids of the war actions and military service of Russia into the society by means of introduction of innovatory technologies. Zakharova E.A. Federal Bureau for Medical and Social Expertise, Moscow
Key Words: an invalid; social and vocational rehabilitation; innovatory technologies; provision of employment and socialization
Resume: The social and vocational rehabilitation of the invalids of the war actions and military service is realized with a help of innovatory decisions, on the example of ACCS product (Alternative Computer Control System), that is used effectively just now in the people undergone a spinal cord trauma with a subsequent loss the limb functions. Introduction of ACCS into the systems of control of computers, everyday electronics and the means of independent mobility gives a man the single outline of the control. The ACCS is one of the ways of the contemporary technologies usage for the effective provision of employment and socialization of the invalids.
SUPPLEMENT
• Information-analytical materials about primary disability of adult population in the Russian Federation, federal districts and administrative units in 2010-2011 years. Grishina L.P., Talalaeva N.D., Verigina N.B., Voitekhova I.V., Bunina A.M., Petrosyan K.M. Federal Bureau for Medical and Social Expertise, Moscow
Key Words: disability; adult population; districts; administrative units; the level; ranking places
Resume: There has been presented a great information-analytical material about the primary disability of the adult population in the Russian Federation, all over federal districts and administrative units for 2010-2011 years. There have been defined the ranking places of administrative units by the level of the primary disability in 2010 and 2011 years. The indicators of the primary disability in total have been given, as well as the indicators of primary disability in consequence of the two leading classes of diseases: in the diseases of a blood circulation system and in malignant tumors. In total there has been presented 36 tables.
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