Sovetskoe zdravookhranenie最新文献

The paper considers the conceptual approaches to medical provision of emergency relief operations. The author doubts the rightfulness of some theses in special publications and states his views on issues related to the organization of medical care in the zone of catastrophes, its amount and the training of personnel. It is suggested to conduct an open discussion on the problem of medical provision during liquidation of consequences of accidents, natural disasters, catastrophes and other emergency situations.

The article entitled "Clinico-organizational aspects of preventing mortality among urban and rural population" provides results of the comprehensive socio-hygienic survey of the health status of urban and rural population residing in Leningrad region in the light of influence by modern urban environmental factors. With the help of information-retrieval system more than 44 thousand of survey items were processed. A comprehensive review of mortality rates is provided, serious shortcomings in the prevention of mortality are revealed.

Suggestions are made of organizational and methodological restructuring of diagnostic polyclinic service which make it possible to substantially increase its diagnostic and economic effectiveness. The major elements of such restructuring should include: 1. introduction of special programmes on risk group selection according to separate diseases; 2. The application of standardized complex ++fluoro-roentgenographic techniques while using apparatus available in the majority of regular polyclinics. The programmes elaborated permitted to detect a great number of different diseases (tumors and chronic non-specific lung diseases, tumors and gastric ulcer, tumors of the colon, breast tumors, etc) the proportion of which in the general pattern of diseases in great. According to the authors' opinion the introduction of the proposed diagnostic programmes into the work of polyclinics would sharply increase the effectiveness of this service.

A discussion is provided of issues related to the determination of priorities in the field of rehabilitation . It is indicated that under present conditions the disability due to occupational diseases is a major socio-hygienic problem causing great socio-economic losses to the national economy. While analysing the impact of regional features in the development of public health and its specialized services on the level of medico-social rehabilitation of disabled persons it was found that there is no correlation between the phenomena studied. This situation can be explained by the absence of specialized rehabilitation service. It is suggested to create a network of cost-accounting medicosocial rehabilitation centres based on insurance medicine, their cost-effectiveness is demonstrated.

The paper deals with the problem of rehabilitation of reconvalescents working at industrial enterprises. The most complicated and inadequately elaborated issues of this problem are those of rational employment and labour prognosis for reconvalescents. The so-called workshops of health established at industrial enterprises promoted the reduction in disease relapses, the decrease of disability and improvement of workers' health, however, with the transition to new economic methods of management many enterprises ceased to function. The well-grounded research findings are provided which are confirmed by the data of surveys on the problem of necessity to preserve or reconstruct the workshops of health on the new economic basis taking into account the interests of all workers.

The paper is devoted to the changes in the technology of health documentation keeping at Moscow city polyclinic No. 98 by using a special form of ambulatory case history and leaving it in the possession of patients while carrying over-all information on the patient to professional computers. The proposed system would be cost-effective.

The paper outlines the issues related to expert evaluation of medical consultation quality provided at out-patient departments of central regional hospitals (CRH). The algorithm and programme of expertise were included into the special "Expert Assessment Schedule for Ambulatory Consultations" containing an assessment of eight major items. An expert assessment was carried out of 447 patients who made ambulatory visits to CRH, with a view of studying the reasons for failures, searching for the possibilities to overcome them and for the reserves of raising the quality of medical care for rural population. The findings of assessing the quality of ambulatory consultations at the CRH level showed that the physician's performance is in need of improvement taking into account the information acquired and shortcomings at each stage of medical consultation delivery.