[The trends of dynamics and characteristics of structure of population ovary cancer disability in the Chechen Republic].

The article presents the results of analysis of issue of disability because of ovarian cancer in female population of the Chechen Republic. The object of study was total number of women, for the first time and repeatedly recognized as disabled ones. The analysis was applied to three age groups (the young, the middle aged and the elderly) in 2014-2020. It is established that dynamics of disability was characterized by negative trends of increasing of number of the disabled. The clear-cut age differentiation was revealed:the elderly disabled predominated. The study established that the disabled suffer of persistent malfunction of blood circulation system and of immune system that resulted in such life activity limitations as moving, self-service and work functions. The characteristics of structure of ovarian cancer disability according its severity were established. The disabled with second group of disability prevailed in all age groups. At that, percentage of women with first group of disability was higher in the middle-aged disabled. The results of the study testify actuality of optimization of onco-gynecological screening of female population for the purpose of early detection of risk factors and diagnosis of malignant process at initial stages of development. This is rational way to organ-preserving treatment and medical and social prevention of primary ovarian cancer disability. The results of the study can consider as scientific practical base for both targeted routing of preventive and therapeutic and rehabilitation measures.

[The comprehensive rehabilitation and abilitation of the disabled: the examples of evaluation of regional system].

In the Russian Federation, comprehensive rehabilitation and abilitation of the disabled is actively developing effected by the UN Convention on the Rights of the Disabled. In 2018-2019, the quantitative indicators of comprehensive rehabilitation and abilitation were studied in 85 regions of Russia. In 36 regions (42/4%) formation of system of comprehensive rehabilitation and abilitation was necessary. The remaining 49 regions required improving their systems of comprehensive rehabilitation and abilitation (57.6%, respectively). The study results demonstrated that significant increase in rehabilitation organizations (from 12.0% in 2018 to 100.0% in 2021) to be included in regional system of comprehensive rehabilitation and abilitation is expected. In the Republic of Dagestan, the final rating of comprehensive rehabilitation and abilitation system was from 6.5 to 7.6 points that indicates the need to organize and to improve comprehensive rehabilitation and abilitation system in the region. The experience of the Sverdlovsk Oblast and the Perm Krai where pilot project on comprehensive rehabilitation and abilitation system was carried out proved that one of the effective mechanisms of organizing comprehensive rehabilitation and abilitation system is development of state regional program by the authorities with involvement of all interested players and public organizations.

The development of organization of population medical care in conditions of digitization of public health.

The article discusses two main problems of organizing medical care in national health care of Russia: medical and social monitoring of morbidity and mortality; key performance indices of public health in the Russian Federation. Methodologically, the article is based on interdisciplinary scientific approach that allows to study medical, social and economic components of public health, considering observed trends: digitalization of health care and epidemic of new coronavirus infection. Based on statistical analysis of open data on morbidity and mortality of population in the Russian Federation over past few years, results were obtained indicating that collection of medical statistics is not built consistently that medical care in health care is not organized sequentially as cycle or process, but is presented in fragments. This leads to the fact that rural population has very limited access to multidisciplinary and high-tech medical services, and in structure of mortality there is high gender bias (males die more often than females in same classes of causes). Based on identified problems, two organizing solutions are proposed. The first solution is to create, on the basis of the Ministry of Health Care of Russia, special portal for complete, reliable and up-to-date medical statistics, which will be generated and processed using Big Data technologies. The second solution consists in transition from fragmentation to systematic organization of medical care in the "education and prevention-treatment-rehabilitation" continuum, while for each stage special set of key performance indices is established that allows to solve the tasks of improving public health, but also to develop harmonized social and economic public policy.

The characteristics of impaired functions and life limitations of disabled people due to coronary heart disease.

The article presents the characteristics of the impaired functions and life limitations of disabled individuals due to coronary heart disease, considering the clinical data, the disease stages, and the disability severity. It was revealed that the largest share in the structure of impaired functions was made up by the impaired functions of the cardiovascular neuromuscular, movement-related (statodynamic), endocrine systems and metabolism and life limitations of I, II and III degrees related to self-care, movement and labor activity.

[The application of the David back concept mechanotherapy in patients survived after myocardium infarction].

The medical rehabilitation in all areas of medicine is developing actively and rapidly. In cardiology, medical rehabilitation contributes to prevention of recurrent myocardial infarction and other complications in patients with myocardial infarction. The study evaluated impact of anaerobic exercise and strength rehabilitation program on hemodynamics in patients with myocardial infarction using the David back concept mechanotherapy method.

[Regional aspects of disability due to malignant neoplasms in the Russian Federation.]

The increase in the number of older people (elderly and senile) among the population around the world is associated with a significant impact on the increase in the incidence of malignant neoplasms (MN). The federal project «Fight against oncological diseases for 2018-2024¼ has been launched in Russia within the framework of the national project «Healthcare¼. The article presents the results of a study of the general disability (primary and repeated) of the adult population due to MN in the Chechen Republic (2010-2020). The main trends in the dynamics of general disability (age differentiation, severity, level) in the Chechen Republic and in the North Caucasus Federal District as a whole are compared. Older people with disabilities prevail in the structure of both primary and repeated disability due to MN in the Chechen Republic. This corresponds to the indicators for the North Caucasus Federal District and correspond to the data for the Russian Federation as a whole. The level of disability in the Chechen Republic is lower compared to the indicators for the North Caucasus Federal District. The proportion of disabled people with severe group II and group I disabilities is higher in the republic compared to extensive indicators for the district. The formed structure of disability and the identified trends in its dynamics are a scientific and practical basis that is advisable to use when developing an integrated approach to the medical and social rehabilitation of disabled people and the prevention of health disorders due to MN, taking into account the identified features of disability of the population in the territorial subject of the Russian Federation.

[The repeated disability because of thyroid cancer in adult population].

The article presents the results of analysis of repeated disability because of thyroid cancer in adult population of Moscow in 2015-2019. The study established negative dynamics of increasing of the number of individuals with repeated disability because of thyroid cancer in all essential age contingents (young, middle and elderly age) of adult population. The similar trend was revealed in gender contingents of individuals with repeated disability because of thyroid cancer (in males, increase was made up to 112.5% and in females up to 196.3%). In the gender and age structure of repeated disability because of thyroid cancer, predominated females and the elderly. The study established dynamics of decreasing of percentage of individuals with repeated disability because of thyroid cancer of the disability groups I and III and corresponding increasing in disability group II. The percentage of individuals with repeated disability because of thyroid cancer in disability groups I and II was higher in males as compared with females. Most individuals with disabilities because of thyroid cancer don't work. The study results make available spectrum of disorders of main functions of organism, their degree and types and intensity of limitations in vital activity of individuals with repeated disability because of thyroid cancer. The organized database of characteristics of repeated disability because of thyroid cancer in adult population can be used in implementation of personalized approach to medical social rehabilitation of increasing number of disabled individuals with malignant damage of the most important organ of endocrine system.

[The rehabilitation, health path, mechanotherapy in recuperation of functional reserves of organism].

The article presents historical essays concerning each method of rehabilitation, period of its revision depending on time and pathological etiology of each disease, application of rehabilitation (health path, mechanotherapy), different modes of choosing each method of rehabilitation. The term "rehabilitation" became widespread after adoption of the Federal Law No. 181 of November 24, 1995 "On social protection of disabled people in the Russian Federation". This is the set of measures targeted to recuperation of functional reserves of organism, improving quality of life, maintaining working capacity of patient, one's integration into society, reducing incapacitating states impact to support people with impaired functions to adapt to new conditions of life in society. The rehabilitation and habilitation are processes targeting to ensure that the disabled could be able to achieve and maintain optimal levels of physical, sensory, intellectual, psychological and/or social functioning. The rehabilitation covers wide range of activities, including rehabilitative medical care, physiotherapy, psychotherapy, logopedics and ergotherapy and supportive services too. The disabled are to have access to both general medical services and appropriate rehabilitation services.

[The characteristics of repeated medical social expertise of adult population of the Russian Federation in 2018-2020].

The medical social expertise is considered as recognition of a person as the disabled and specification, in accordance with established procedure, of needs of examined person in social protection measures, including rehabilitation, based on evaluation of disabilities caused by persistent dysfunction of organism. The main normative legal acts governing activities of institutions of medical social expertise are the Federal Law of November 24, 1995 "On social protection of disabled people in the Russian Federation", the Decree of the Government of the Russian Federation of February 20, 2006 № 95 "On the procedure and conditions for recognition disabled person". Because of COVID-19 pandemic conditions, the normative legal base has undergone a number of changes. In particular, on 09.04. 2020, the Resolution of the Government of the Russian Federation № 467 "On the temporary procedure for recognizing a person as disabled" came into force. The actual article considers the features of this temporarily order related to the repeated medical and social examination and its results as of 2020. The qualitative analysis of permitted to get patterns of increasing and decreasing (improvement or deterioration) of particular statistical indices.

[Effectiveness of medical rehabilitation of elderly patients who have suffered a myocardial infarction.]

At all stages of recovery after myocardial infarction (MI), the expansion of physical activity of elderly patients is one of the most important components. Of course, certain restrictions can reduce the load on the myocardium, reduce its oxygen needs and create conditions for early healing. Subsequently, depending on the dynamics and indicators of the cardiovascular system, the elderly patient is transferred from one stage of activity to another, the level of blood pressure, the number of heartbeats, the presence of arrhythmia, electrocardiogram data, EchoCG data, as well as individual load tolerance are evaluated. To date, there is a huge selection of optimal options for selecting methods of medical rehabilitation for elderly patients who have suffered a MI, and one of them is mechanotherapy. The mechanical therapy program of the David Back Concept complex - strength training is a set of simulators for working on the back muscles. The medical and diagnostic complex is designed for the diagnosis, treatment and prevention of pathologies of the musculoskeletal system, as well as for the rehabilitation of patients after surgical interventions and spinal injuries. Medical rehabilitation of elderly patients with coronary heart disease and after a MI through mechanotherapy, the program of the David Back Concept complex, provides for the restoration of their physical and social status to an optimally achievable level, determined by the capabilities of adaptive mechanisms.

[The particular medical social problems of individuals of elderly and senile age as exemplified by the Rostov Oblast].

The article analyzes dynamics of main indices of disability in population older than able-bodied age in the Rostov Oblast. The trend of decreasing of scope of examinations of individuals of the mentioned age group, including decreasing the number of first and iteratively recognized as the disabled, against the background of increasing in the population structure of percentage of individuals older than able-bodied age. At the same time, increasing of accumulated disability was established in the studied category of population.

[The age gender structure of the disabled due to cerebral vascular diseases in Moscow in 2014-2018].

The article presents the dynamics of disability due to cerebrovascular diseases in 2014-2018 in Moscow. The age gender analysis of the disabled in this category was carried out. It was established that 30% of total population of the disabled due to cerebrovascular diseases accounted for the share of those who were recognized as disabled for the first time in the structure of total population. The most frequently disabled persons are those who are older than able-bodied age. In total structure of the disabled due to cerebrovascular diseases, women predominate.

[Age-related aspects and gender differentiation of primary disability due to thyroid cancer in the adults population of Moscow.]

The results of the analysis of primary disability due to thyroid cancer of the adult population of Moscow in the period 2015-2019 are presented. An increase in the number of peaple newly recognized as disabled (PNRD) due to this pathology was revealed. In the age structure of primary disability elderly people was dominated. The predominant gender contingent of the PNRD were women. It was found that the predominant number of PNRD had a moderate impairment (II degree) of the basic functions of the body. At the same time, gender differentiation in the severity of persistent impairment of the body functions among disabled was revealed. In the contingent of disabled men the proportion of persons with severe (III degree) and complete (IV degree) impairment of the function of the blood system and the immune system and with a severe impairment of the function of the endocrine system and metabolism was higher compared to the contingent of disabled women. It was determined that the main types of capacity limitations were self-care, work, moving and communicate limitations (the first degree of difficulties in life areas prevailed (p<0,05). Thyroid cancer, due to the rapid growth of morbidity and disability, is an important public health concern. The study of disability indicators of the population is necessary for the development of rational measures of medical and social rehabilitation of patients suffering from thyroid cancer, and for the implementation of medical and social prevention of disability.

[The Psychological Status of the Disabled due to ischemic heart disease].

The article analyzes psychological state of the disabled due to ischemic heart disease. It is established that depressive mood prevailing among the disabled decreases their quality of life and impedes effective medical and social rehabilitation that requires implementation of measures restoring psychological status of the disabled through rehabilitation program.

[Drug therapy of atrial fibrillation in elderly patients.]

Currently, studies of the causes of atrial fibrillation are actively conducted. However, molecular and cellular mechanisms of atrial fibrillation have not been precisely established so far. Great success in the treatment of atrial fibrillation was achieved thanks to the development of surgical methods. However, these approaches, unfortunately, are not always applicable to elderly and senile patients. Antiarrhythmic drugs used in atrial fibrillation, exhibit a large number of side effects. Much attention of researchers is now attracted by fundamentally new directions in the drug treatment of atrial fibrillation. These include predserdno-selective antifibrillatory funds. Drugs, the action of which is aimed at at atrial remodeling, inflammation and fibrosis, so is of interest. Effective suppression of atrial remodeling, inflammation and fibrosis prevents the formation of a permanent form of atrial fibrillation. A new approach to the treatment of atrial fibrillation, taking into account the vegetative status of the patient, will undoubtedly increase its effectiveness.

[The gender and age characteristics of morbidity of thyroid cancer].

The thyroid cancer is the most prevalent oncologic disease of endocrine organs, characterized by multi factorial risk of development. The purpose of the study was to analyze dynamics of indices of thyroid cancer morbidity of population of the Russian Federation, considering gender and age differences in 2008-2018. The increase of "rough" indicator of thyroid cancer morbidity of male population made up to 56.6%, and of female population - 48.3%. The dynamics of standardized indicator in gender contingents was characterized by increasing up to 48.7% in males and up to 43.9% in females. There is an increasing of thyroid cancer morbidity with age and prevalence of the morbidity in females as compared with males in all age categories. The highest morbidity was established in male population aged 65-69 years (8.3 per 100,000 population) and in females aged 55-64 years (27.3 per 100,000 population). In the territories of the Russian Federation, in the gender aspect, variations in thyroid cancer morbidity were established. both in male and female populations, maximal thyroid cancer morbidity was established in the North Western and Siberian Federal Okrugs, and morbidity below national level was registered in the Privolzhskiy and North Caucasian Federal Okrugs. It is necessary to take into account differentiation of the territories of the Russian Federation in terms of the thyroid cancer morbidity in different gender and age groups for development of rational measures of early identification of risk factors, diagnosis and treatment of patients.

[The indices of severity of disability because of malignant neoplasms in individuals of young age in Moscow in 2016-2018].

The article presents the results of analysis of primary and secondary disability due to malignant neoplasms among young people in Moscow in 2016-2018. The study established that in the structure of young patients recognized as disabled for the first time made up the smallest percentage with tendency of increasing the level of primary disability. The study established the predominance of people with disabilities of group II with high level of primary disability. The second position is taken by patients with disabilities of group III with tendency of increasing their specific severity. The number of patients repeatedly recognized as disabled is much higher than patients recognized as disabled for with the first time. The study established prevalence of disabled patients of group III with tendency of increasing level of repeated disability.

[The characteristics of limitations of life activity of the disabled persons older than able-bodied age due to Parkinson's disease].

The article presents characteristics of limitations of life activities of the disabled older than able-bodied age due to Parkinson's disease and considering clinical data, stages of illness, severity of disability and disorders of functions of organism. The highest percentage in the structure of life restrictions was taken by restrictions of first, second and third degree related to self-service, movement, labor activity (12.1%, 9.5% and 10.5% respectively). The lowest percentage of restrictions of first, second and third degree related to education, control and communication.

[Disability due to arterial hypertension and alimentary factors, determining cardiovascular risk].

The problem of disability is associated with the problem of socially significant diseases, the main feature and at the same time the key characteristic of which is mass character. The epidemic nature of the spread and the medical and social burden of arterial hypertension (AH) leads to the assignment of this pathology to the number of socially significant diseases. The aim of the study was to analyze primary disability due to AH in Moscow and clinical and pathogenetic parallels between the level of arterial pressure and alimentary factors determining cardiovascular risk (CVR). Material and methods. The object of study was the data on the primary disability of the population of Moscow during the period 2011-2017 according to the form of state statistical observation #7-sobes and data of the Ministry of Health of Russia. The study was retrospective. The subject of a selective study was an analysis of the nosological spectrum of causes of disability, the nature of functional impairment and the degree of disability of elderly people who underwent inpatient treatment at the hospital for war veterans of the Rostov region in 2018-2019. The analysis of the spectrum of factors that determine the CVR. Results and discussion. The total number of newly recognized disabled (NRD) due to hypertension amounted to 11,069 people. The growth of the share of NRD of young age (6.8-11.7%), a decrease in the proportion of NRD of middle age (45.3-41.7%) and elderly in 2015-2016 (39.1-39.9%), but the growth of this indicator in this contingent in 2017 to 46.6% were noted. The proportion of NRD group III increased (to 69.1%), NRD group II decreased (to 20.3%) with a negative trend of growth in the proportion of VPI of the most severe group I. Selective survey data among people with disabilities undergoing inpatient treatment at the hospital for war veterans of the Rostov Region (2018-2019) indicated that they had a wide range of factors determining the CVR. Conclusion. The persistence of patients with hypertension triggers, supporting its further progression, is the cause of the low effectiveness of therapy and exacerbates the prognosis. It is advisable to have a unified approach to improving the efficiency of dietary use at the stages of complex treatment, prophylactic and rehabilitation programs with the goal of primary and secondary prevention of hypertension and disability due to this socially significant pathology.

[Contemporary approaches to the treatment of age-related macular degeneration in elderly patients.]

The article compares the course of age-related macular degeneration in elderly patients in three groups after complex therapy (intravitreal administration of angiogenesis blockers and photodynamic therapy). 339 case histories of persons with an average age of 75,6±9,7 years were analyzed (p<0,05). A slight decrease in the area of pathological autofluorescence and retinal thickness according to optical coherence tomography was revealed in all three groups of increased visual acuity. The best effect of combination therapy was observed in the first six months, no further positive dynamics was observed. Thus, timely diagnosis and complex therapy slows down and sometimes stops the progression of age-related macular degeneration and vision loss.