Prevention - a term meaning a complex of various kinds of measures aimed at preventing a phenomenon and / or eliminating risk factors.

The specific content of the concept of prevention has many meanings used to denote different areas of politics, social, collective and individual activities and several types of medical activities. Nevertheless, the specific objective content of this concept is always an action - the ability to promote or hinder the implementation of one or another trend of public health that interests us.

Thus, the general content of the concept of "prevention" can be reduced to activities through which it is possible to achieve the preservation and improvement of individual, group or public health. We can say that this is a set of measures aimed at preventing people from developing diseases, their exacerbations, socio-psychological and personal maladaptation.

Prevention of diseases - a system of measures of a medical and non-medical nature, aimed at preventing, reducing the risk of developing deviations in the state of health and diseases, preventing or slowing down their progression, and reducing their adverse effects.

Medical prevention is a system of preventive measures implemented through the healthcare system.

Prevention is a system of state, social, hygienic and medical measures aimed at ensuring high level health and disease prevention.

Preventive measures will only be effective if they are carried out AT ALL LEVELS: state, labor collective, family, individual.

The state level of prevention is provided by measures to improve the material and cultural standard of living of the population, legislative measures regulating the protection of public health, the participation of all ministries and departments, public organizations in creating optimal living conditions from the standpoint of health based on the comprehensive use of the achievements of scientific and technological progress.

Preventive measures at the level of the labor collective include measures to ensure sanitary and hygienic control of production conditions, hygiene of the home, trade and public catering, to create a rational regime of work, rest, favorable psychological climate and relationships in the team, sanitary and hygienic education.

Prevention in the family is inextricably linked with individual prevention and is a determining condition for the formation healthy lifestyle life, it is designed to provide a high hygienic level of housing, balanced diet, complete rest, activities physical education and sports, creating conditions that exclude the emergence of bad habits.

Medical prevention in relation to the population is defined as:

●individual - preventive measures carried out with individual individuals. Individual medical prevention - personal hygiene - scientific and practical medical activities for the study, development and implementation of hygienic knowledge, requirements and principles of maintaining and strengthening health in everyday individual life. This concept is also used to determine the compliance of human life with medical and hygienic standards and medical recommendations - conscious active hygienic behavior;

● group - preventive measures carried out with groups of people with similar symptoms and risk factors (target groups);

●population (mass) - preventive measures covering large groups population (population) or the entire population as a whole. The population level of prevention is generally not limited to medical interventions, but rather local prevention programs or grassroots campaigns aimed at promoting health and preventing diseases.

However, the medical-ecological consistency emphasizes the conventionality of dividing prevention into socio-economic and medical measures, and into social and individual ones. All of its many components are interconnected. social relations and are revealed in the public health policy.

Public medical prevention, preventive (preventive, social, public) medicine - scientific and practical medical activities to study the prevalence of diseases, disabilities, causes of death in society in order to substantiate socio-economic, legal, administrative, hygienic and other directions and preventive measures, therapeutic events.

Reasons for strengthening prevention at the present stage:

1) the type of pathology changes: from epidemic (infection) to non-epidemic;

2) there is an unfavorable course of viral pathology;

3) unfavorable trends in the dynamics of demographic processes;

4) the physical and neuropsychic health of the population (especially children) is deteriorating;

5) the aggressiveness of the environment increases

In preventive medicine, the concept of the stages of prevention has been introduced, which is based on modern epidemiological views on the causality of human diseases. The subjects of the application of preventive measures and influences are different stages of the development of the disease, including various preclinical conditions, and the objects are individuals, groups of individuals, individual populations and the population as a whole.

In cases where preventive measures are aimed at eliminating the cause (root cause, etiological factor, etiology of the disease) and / or weakening the action of pathogenetic risk factors for the development of morbidity that has not yet occurred (chains of epidemiological causes of the disease), we are talking about primary prevention. In modern epidemiology, primary prevention is divided into primordial prevention and primary specific.

Primordial prevention is a set of measures aimed at preventing risk factors for the occurrence of diseases associated with adverse living conditions, the environment and work environment, and lifestyle.

Primary prevention - a set of medical and non-medical measures aimed at preventing the development of deviations in the state of health and diseases, eliminating their causes common to the entire population, its individual groups and individuals.

The purpose of primary prevention is to reduce the frequency of new cases (incident) of any disease by controlling its causes, epidemiological conditions, risk factors.

Primary prevention includes:

●Conducting environmental and sanitary-hygienic screening and taking measures to reduce the impact of harmful factors on the human body (improving the quality of atmospheric air, drinking water, the structure and quality of nutrition, working conditions, living and resting, the level of psychosocial stress and other factors affecting the quality life).

●Formation of a healthy lifestyle, including:

Creation of a permanent information and propaganda system aimed at increasing the level of knowledge of all categories of the population about the impact of negative factors and the possibilities of reducing it;

Hygienic education;

Reducing the prevalence of smoking and consumption of tobacco products, reducing alcohol consumption, preventing the use of drugs and narcotic drugs;

Attracting the population to physical culture, tourism and sports, increasing the availability of these types of health improvement.

●Measures to prevent the development of somatic and mental illnesses and injuries, including professionally caused, accidents, disability and death from unnatural causes, road traffic injuries, etc.

●Implementation of medical screening to reduce the impact of risk factors and early detection and prevention of diseases of various target population groups through preventive medical examinations:

Preliminary - when applying for a job or entering an educational institution;

When registering and calling for military service;

Periodic - for examination of admission to a profession associated with exposure to harmful and dangerous production factors, or with increased danger to others;

Examinations of decreed contingents (workers in public catering, trade, children's institutions, etc.) in order to prevent the spread of a number of diseases.

●Immunoprophylaxis of various population groups.

●Prophylactic medical examination of the population in order to identify the risks of developing chronic somatic diseases and improve the health of persons and contingents of the population under the influence of adverse factors, using medical and non-medical measures.

Basic principles of primary prevention:

1) continuity preventive measures(throughout life, starting in the antenatal period);

2) the differentiated nature of preventive measures;

3) mass prevention;

4) scientific nature of prevention;

5) the complexity of preventive measures (participation in the prevention of medical institutions, authorities, public organizations, the population).

Primary prevention, depending on the nature of the object, also provides for two strategies: population and individual (for high-risk groups), which often complement each other.

With a population strategy, the goal of prevention is achieved by solving the problem of reducing the average risk of developing a disease (hypercholesterolemia or blood pressure, etc.) by carrying out activities covering the entire population or a large part.

An individual strategy solves another problem - reducing high risk in individuals classified as "risk groups" according to certain epidemiological characteristics (gender, age, exposure to a specific factor, etc.).

Secondary prevention - a set of medical, social, sanitary-hygienic, psychological and other measures aimed at early detection and prevention of exacerbations, complications and chronicity of diseases, life restrictions that cause maladaptation of patients in society, reduced working capacity, including disability and premature death.

Secondary prevention is applicable only to those diseases that can be identified and treated in the early period of development, which helps to prevent the transition of the disease to a more dangerous stage. By early detection of patients on the basis of screening tests (mammography, electrocardiogram, Pap smear, etc.) and their treatment, the main goal of secondary prevention is achieved - the prevention of undesirable outcomes of diseases (death, disability, chronicity, transition of cancer to the invasive stage).

Secondary prevention includes:

●Targeted health education, including individual and group counseling, teaching patients and their families the knowledge and skills associated with a particular disease or group of diseases.

●Conducting dispensary medical examinations in order to assess the dynamics of the state of health, the development of diseases in order to determine and carry out appropriate health and therapeutic measures.

●Providing courses of preventive treatment and targeted health improvement, including therapeutic nutrition, exercise therapy, medical massage and other therapeutic and preventive methods of health improvement, sanatorium treatment.

●Conducting medical and psychological adaptation to changes in the situation in the state of health, the formation of the correct perception and attitude to the changed capabilities and needs of the body.

●Conducting events of the state, economic, medical - social character aimed at reducing the level of influence of modifiable risk factors, maintaining residual working capacity and the ability to adapt in the social environment, creating conditions for optimal support of the life of patients.

The effectiveness of secondary prevention is determined by a number of circumstances:

1. How often the disease in the preclinical stage occurs in the population.

2. Whether the duration of the period between the appearance of the first signs and the development of a pronounced disease is known.

3. Whether the diagnostic test has high sensitivity and specificity for this disease and whether it is simple, inexpensive, safe and acceptable.

4. Does clinical medicine have adequate medical means for diagnosing this disease, effective, safe and affordable methods of treatment.

5. Is there the necessary medical equipment.

Tertiary prevention - rehabilitation (synonymous with restoring health) - a set of medical, psychological, pedagogical, social measures aimed at eliminating or compensating for limitations in life, lost functions in order to restore social and professional status as fully as possible, prevent relapses and chronic disease.

Goal-tertiary prevention - slowing down the development of complications in an already existing disease.

Its task is to prevent physical insufficiency and disability, to minimize the suffering caused by the loss of full health, and to help patients adapt to incurable conditions. In clinical medicine, it is often difficult to distinguish between tertiary prevention, treatment, and rehabilitation.

Tertiary prevention includes:

●education of patients and their families in knowledge and skills related to a specific disease or group of diseases;

●dispensary examination of patients with chronic diseases and the disabled, including dispensary medical examinations to assess the dynamics of the state of health and the course of diseases, the implementation of permanent monitoring of them and the implementation of adequate therapeutic and rehabilitation measures;

●conducting medical and psychological adaptation to changes in the situation in the state of health, the formation of the correct perception and attitude to the changed capabilities and needs of the body;

●carrying out measures of a state, economic, medical and social nature aimed at reducing the level of influence of modifiable risk factors;

●preservation of residual working capacity and opportunities for adaptation in the social environment;

●Creation of conditions for the optimal support of the life of the sick and disabled (for example, the production of medical nutrition, the implementation of architectural and planning solutions, the creation of appropriate conditions for persons with disabilities, etc.).

Main directions of preventive activity

Medical preventive measure - an event or a set of measures that have an independent complete value and a certain cost and are aimed at the prevention of diseases, their timely diagnosis and improvement.

Types of medical preventive measures:

●preventive counseling of individuals - health education;

●preventive counseling of population groups - health education;

●preventive medical examinations to identify early forms diseases and risk factors and carrying out recreational activities;

●immunization; vaccination;

●dispanserization - dispensary observation and rehabilitation;

●preventive health-improving measures - various types of physical culture, sanatorium-and-spa rehabilitation, physiotherapeutic medical measures, massage, etc.

One of the most important problems facing practical healthcare in strengthening preventive activities, improving its quality, efficiency and effectiveness is the development of new and adaptation to modern requirements and working conditions of modern organizational, information and preventive technologies.

Modern organizational, informational, educational and other preventive technologies used or recommended for use:

1. Identification of risk factors(FR) development of chronic non-communicable diseases. One of the most relevant modern preventive directions is the identification of basic and additional risk factors, informing patients about the identified deviations and the possibility of their correction using modern preventive, health and treatment technologies.

Forms and methods of work (screening technologies from English screening - “selection, sorting”) - a strategy in healthcare, a survey of the population aimed at identifying diseases in clinically asymptomatic individuals in the population, as well as the risk of diseases.

The purpose of screening is the early detection of diseases, which allows to ensure early start treatment and reduce mortality. There are mass (universal) screening, which involves all persons from a certain category (for example, all children of the same age) and selective screening, used in risk groups (for example, screening of family members in case of a hereditary disease). Assessment and forecast for the total risk of CVD development. An assessment of the total risk is necessary to determine the likelihood of developing cardiovascular events in the next 5-10 years.

2.Consultative and health-improving assistance- view medical care, which includes the provision of medical, informational and educational services, the issuance of recommendations aimed at preventing diseases and promoting health, as well as consulting specialists involved in the management and treatment of the patient.

The purpose of consultative and health-improving care is to provide the maximum possible assistance to patients in reducing the impact of modulated risk factors, preventing diseases and their consequences through individual preventive counseling.

3. Diagnosis and prevention of emotional and behavioral disorders.

A fairly significant amount of chronic non-communicable diseases, their course and progression is associated with the presence of psychosomatic disorders. In this regard, many involve in the work of medical psychologists, working in close contact with the attending physicians.

4. Information support.

Informatization is the basis that underlies the development, implementation and monitoring at all levels of theory and practice of disease prevention and health promotion activities for various population groups, taking into account existing health risks. The current situation indicates the need to systematize and streamline the system information support preventive activities, identifying ways to unify data banks for disease prevention and health promotion, priority areas in solving information support problems, as well as expanding access to the formed information base and increasing the efficiency of its use. Information support is a systematized complex form of information in a certain area of ​​activity, adapted to the domestic and international information network.

Information resources are individual documents and arrays of documents in information systems: libraries, archives, funds, data banks, and other types of information systems.

Information technology - a set of methods, production and software and technological means, combined in a technological chain that provides the collection, storage, processing, output and dissemination of information.

Information technologies are designed to reduce the complexity of the processes of using information resources.

The goal of information provision is to create an information system that can more effectively facilitate the acquisition, use and dissemination of data in support of health for all. Considering that preventive activity is defined as an unconditional priority of the policy and practice of protecting and promoting the health of the population, the formation of information support for preventive activities should be a priority in the formation of state and sectoral information policy, and at the level of healthcare facilities - the basis for creating a single information space for specialists and the population provided for .

5. Hygienic education and upbringing.

The tasks of sanitary education, hygienic education and education of the population (both individuals and various groups and categories of citizens) should be implemented in one form or another by all departments and specialists of healthcare facilities and prevention departments.

The main goal of hygienic education and upbringing is to inform categories of the population about the impact of negative factors on health and the possibilities of reducing it, to form motivation for strengthening and maintaining health, to increase personal and group responsibility for health, to gain knowledge and skills that contribute to maintaining a healthy lifestyle,

6. Coordination of activities for medical preventive examinations and medical examinations of the population.

The main purpose of the activity of the office of professional examinations is to optimize the organizational forms of medical examinations and clinical examination of the population in medical facilities. Coordination of activities in this direction of all interested departments and specialists of the polyclinic and the use of economically and clinically feasible methods to improve the efficiency and quality of this work.

7. Coordination of the activities of departments and specialists of healthcare facilities for the implementation of targeted programs in terms of health promotion and disease prevention.

Preventive program (or preventive fragment general program) - a systematic presentation of the main goals, objectives, activities for the prevention of morbidity, the preservation and promotion of health. Preventive programs (or preventive fragments of the general program) include a justification and a list of measures to implement the tasks set, terms and conditions for implementation, performers, resource needs, expected results, as well as systems for managing, monitoring and evaluating efficiency.

8.Monitoring of health and preventive activities.

It is proposed to include a cabinet for monitoring health and preventive activities in the structure of the prevention department. Monitoring is a purposeful activity that includes permanent observation, analysis, assessment and forecast of the state of an object (process, phenomenon, system) or, in other words, an analytical tracking system.

Health monitoring involves the observation and analysis of the health status of the attached population and its individual target groups according to the information provided by the statistics department (morbidity by referral, including for certain classes and groups of diseases, gender, age, etc., morbidity based on the results of medical examinations, disability, mortality, etc.).

Monitoring of the preventive activities of the units of the prevention department and health care facilities includes analytical monitoring of the volume, quality and effectiveness of the provision of preventive and health-improving medical services both in the structure of the prevention department and as a whole in health care facilities, hygiene education and upbringing of the population.

9. Sociological research in the field of preventive activities. When solving specific problems of health promotion and disease prevention, the formation of a healthy lifestyle, the study of the processes taking place in this direction in society is becoming increasingly important, which can be achieved by conducting simple sociological studies. Planning and conducting effective preventive interventions involves studying the degree of readiness of certain groups of the population and individuals to learn and perceive hygiene knowledge and healthy lifestyle skills.

Sociological research in the healthcare system is a way to gain knowledge about the processes taking place in society related to attitudes towards one's own and public health, the use of preventive, health-improving, therapeutic and rehabilitation interventions, assessing their accessibility, effectiveness and quality, based on obtaining information and identifying patterns based on theories, methods and procedures adopted in sociology

10. Intersectoral interaction or social partnership. When forming an integrated approach to solving the problems of health promotion and disease prevention, health authorities and institutions should take a leading position, initiate cooperation with all interested organizations and individuals. Such cooperation is currently interpreted as "social partnership".

Epidemiological research should be an integral part of the health system when planning and implementing preventive intervention programs.

Tasks of the epidemiology of chronic noncommunicable diseases:

1. Systematic monitoring of the levels of morbidity and mortality of the population.

2. Identification of trends, global patterns of the spread of diseases.

3. Identification of territories, individual groups of the population with high and low incidence.

4. Establishing the relationship between morbidity and specific factors of the external and internal environment.

5. Quantitative assessment of the role of individual factors and their complexes in the occurrence of diseases.

6. Forecasting morbidity and mortality, risk of disease.

7. Evaluation of the results and effectiveness of disease prevention measures.

8. Development of specific recommendations for improving prevention, early diagnosis, medical examination of the population and carrying out recreational activities to transform the working and living conditions of people, change habits, customs, lifestyles.

9. Preparation of the necessary data for health planning and financing.

According to modern ideas, the epidemiological analysis is carried out in four stages:

First stage- Analysis of the current situation, including needs assessment and prioritization of NCD prevention. Only descriptive epidemiological studies can provide a true picture of the health system's need for certain interventions. For example, how to determine the true need for interventions aimed at the treatment of hypertension? According to official statistics, the incidence of hypertension is about 10% of the adult population of Russia, while according to epidemiological monitoring, the true prevalence of hypertension is a fairly stable indicator and is about 40% of the adult population. Accordingly, when carrying out any activities aimed at detecting hypertension, it is possible to predict an increase in the burden on healthcare in relation to the treatment of patients with hypertension. Need assessment allows you to prioritize - i.e. the most significant on this moment public health problems for which it is advisable to allocate resources. Priorities are determined on the basis of a set of parameters assessed in the framework of epidemiological studies: the prevalence of events, their social significance, the risk of complications, economic damage associated with this disease and risk factor, etc.

Second phase- development of programs includes: formulating goals and objectives, creating a model for the functioning of the program with predicting outcomes and developing a plan for evaluating the program. The goals and objectives of any health program should be the result of a needs assessment and prioritization based on the results of epidemiological studies. Comparison of data from epidemiological studies of the current situation and prospective studies performed earlier makes it possible to create a model for the functioning of the program with clear time characteristics, distribution of resources, and a forecast of program effectiveness. Based on the program functioning model, a program evaluation plan is built, the best option, which is epidemiological monitoring, which allows assessing the impact of interventions on the population as a whole, timely identifying the compliance of real changes with the planned ones and making adjustments to the program. The evaluation of any program should include economic parameters ranging from exact definition resources spent and before evaluating the cost-effectiveness of the program / interventions according to the currently recommended methods of "cost-utility", "analysis of the impact on the budget", etc.

Third stage- implementation, includes quality assessment, and here epidemiological monitoring with the inclusion of certain parameters (coverage of new intervention target audience etc.) is an optimal tool for quality control of implemented public health programs.

The final stage- includes analysis of processes and outcomes.

Monitoring plays a significant role in the implementation of preventive programs. Monitoring (from Latin word"monitor" - warning) - a specially organized, systematic observation of the state of objects, phenomena or processes with the aim of their assessment, control or development forecast. In other words, it is the systematic collection and processing of information that can and should be used to improve the decision-making process, as well as indirectly to inform the public or directly as a tool. feedback for the purposes of project implementation, program evaluation or policy development. The results of epidemiological monitoring of risk factors for NCDs, being combined into a single database, should help to correctly determine the priority of the national healthcare system as a whole.

Epidemiological monitoring allows you to evaluate short-term outcomes in real time and predict long-term outcomes based on short-term outcomes (for example, predict a possible decrease in mortality in the long-term period in middle-aged and young people based on the dynamics of risk factors). If always available operating system epidemiological monitoring makes it possible to track both the medium and long-term results of preventive public health programs.

Russia created the concept of a unified preventive environment, which was approved by the entire international medical community and became the main achievement of the first global conference on healthy lifestyles and the prevention of non-communicable diseases. The Russian concept was reflected in the resolutions of the WHO and the political declaration of the UN General Assembly. The preventive environment implies, on the one hand, the creation of infrastructure, information and educational, regulatory, tax and other conditions that allow the population to lead a healthy lifestyle, on the other hand, motivating the population to maintain health and longevity

All services, ministries and departments should take part in the formation of a unified preventive environment, each of which should partly become a health care one. The competence of the Ministry of Education is the creation of education and upbringing programs for the formation of a healthy lifestyle, which must be psychologically verified for different ages. The tasks of the Ministry of Communications, press, television and radio include the development of psychologically adjusted programs for various social groups of the population, informational and motivational videos, reality shows, interactive sessions, computer "viruses" on popular sites - everything that forms the fashion for physical and spiritual health. Ministry Agriculture ensures the safety and environmental friendliness of food. Ministry of Natural Resources - clean water and healthy environment. The Ministry of Regional Development is developing new approaches to urban planning and communications planning. Ministry of Labor - provides healthy working conditions, safe workplace. Do not do without sanitary and epidemiological well-being. The competencies of the ministries of economy and finance are the formation of priorities for financial support for all these programs. Along with state structures, all civil society, non-governmental organizations, representatives of business and private sectors, the family as the primary cell of society, should be involved in the formation of a preventive environment.

In order to implement the provisions, documents on the formation of a healthy lifestyle and the prevention of chronic NCDs among the population in the health care of our country, an active creation of a system of preventive institutions and departments (infrastructure for the prevention of chronic NCDs) is being actively created, which provides for the involvement of all medical organizations in preventive work, the specification of their functions and interaction (primary health care institutions, sanatorium-resort, stationary medical institutions).

The NCD prevention infrastructure being created includes:

Republican (regional, regional) centers of medical prevention, which are independent legal entities (Order of the Ministry of Health of Russia dated September 23, 2003 No. 455). The scientific and methodological management of the activities of the Centers for Medical Prevention (MCP) is carried out by the Federal State Budgetary Institution “State Research Center for Preventive Medicine” of the Ministry of Health of Russia;

City (district, interdistrict) centers of medical prevention. The organizational and methodological management of the activities of city (district) CMPs and the examination of the quality of the preventive services they provide are carried out by the subjective (republican, regional, regional) CMP;

Health centers for adults, including those formed on the basis of central district hospitals serving the rural population. The scientific and methodological guidance of the CZ is carried out by the Federal Coordinating and Methodological CZ on the basis of the Federal State Budgetary Institution "State Research Center for Preventive Medicine" of the Ministry of Health of Russia. The direct organizational and methodological management of the activities of the HC and the examination of the quality of the preventive services provided by them is carried out by the city (district) CMP.

The health center is based on public institutions healthcare subjects Russian Federation and municipal health care facilities, including children's health facilities.

Offices of doctors who have undergone thematic improvement in the formation of a healthy lifestyle and medical prevention;

Cabinet of medical prevention;

Testing room on the hardware-software complex;

Cabinets for instrumental and laboratory examinations, an office (hall) for physiotherapy exercises;

Health schools.

All patients are screened for:

Opportunistic - initially there are no risk factors, weak or unknown, for example, the patient applied himself. It is expected that opportunistic screening will also be carried out in relation to persons who have applied for medical help for the first time within the last five years,

Selective - initially there are strong risk factors.

The health center should assess the potential impact of risk factors on the patient's condition:

●low- a preventive consultation is carried out, if desired, the patient is sent to a school of health corresponding to the general profile;

●medium- additional screening is carried out, the patient is necessarily sent to a health school of the appropriate profile;

●high- the patient is sent for an in-depth examination, treatment or rehabilitation to a specialized medical organization.

Conducting a comprehensive examination, includes:

Measurement of height and weight;

Ophthalmological examination;

Testing on a hardware-software complex for screening assessment of the level of psychophysiological and somatic health, functional and adaptive reserves of the body;

Computerized heart screening (rapid assessment of the state of the heart by ECG - signals from the extremities);

Angiological screening with automatic measurement of systolic blood pressure and calculation of the shoulder-ankle index;

Express analysis for determining total cholesterol and glucose in the blood;

A comprehensive detailed assessment of the functions of the respiratory system (computerized spirometer).

For residents of rural areas who wish to apply to the Executive Health Center municipality in the field of healthcare, at the established hours and days of the week, travel can be organized from the health facility to the territorial health center located in the area of ​​responsibility. The health center for residents of rural areas living in the area of ​​responsibility of the health center can, in a planned manner, conduct outreach campaigns aimed at promoting actions to promote a healthy lifestyle.

For a citizen, including a child, who applied (sent) to the Health Center, a paramedical worker starts an accounting form No. 025-TsZ / y “Health Center Card”, tests on a hardware and software complex, and is examined on installed equipment.

Movement of the contingent of the Health Center

The results of the examinations are entered into the Card, after which the citizen, including the child, is sent to the doctor. To identify additional risk factors, it is recommended to conduct studies that are not included in the list of a comprehensive examination.

The doctor, based on the results of testing on the hardware-software complex and examination on the installed equipment, conducts a citizen, including a child (child's parents or other legal representatives), assessment of the most likely risk factors, functional and adaptive reserves of the body, taking into account age-related characteristics, health forecast, conducts a conversation on a healthy lifestyle, draws up an individual program for a healthy lifestyle.

If necessary, the doctor recommends dynamic monitoring at the Health Center with repeated examinations in accordance with the identified risk factors or observation in the offices of medical prevention and a healthy child of health care facilities, attendance at classes in the relevant health schools, medical and physical education rooms and medical and physical education dispensaries according to programs developed at the Health Center.

If during the examination at the Health Center a suspicion of any disease is detected, the doctor of the Center recommends that the citizen, including the child, contact the appropriate specialist doctor at the health facility to determine further tactics for his observation and treatment.

Information about citizens who are suspected of having a disease and who need to be monitored in the medical prevention office (in the office of a healthy child), with their consent, are transferred to the medical prevention office (in the office of a healthy child), the district general practitioner (district pediatrician) according to the place of residence of the citizen, respectively.

At the end of the case of the initial appeal to the health center, which includes a comprehensive examination, for each citizen, the registration form No. 002-TsZ / y “Healthy Lifestyle Card” is filled out, approved by order of the Ministry of Health and Social Development of Russia dated August 19, 2009 No. 597n, which, at the request of the citizen, is issued to him in his hands .

For each person who applied to the health center, the registration form No. 025-12 / y “Coupon of an outpatient patient” is filled out. Upon completion of the examination and examination by the doctor, the completed Coupons are transferred to the appropriate unit of the health facility for further formation of registers of accounts for payment under the compulsory medical insurance program in accordance with the territorial programs of state guarantees for the provision of free medical care to citizens of the Russian Federation.

At the end of the reporting period (month, year), the Health Center draws up a reporting form No. 68 “Information on the activities of the health center” (monthly, annual).

The regions are responsible for the organizational component, selection and repair of premises. The network of Health Centers is being created with a calculation of 1:200,000 of the population. In total, 502 centers for adults and 211 health centers for children have been opened throughout the country.

Regarding the implementation of the proposed measures, the Health Center interacts with the medical prevention offices, the healthy child's offices of the healthcare facility at the citizen's place of residence.

Departments of medical prevention as part of polyclinics and general centers medical practice(family medicine), as well as in a number of health centers. Organizational and methodological management of the activities of the MPO and examination of the quality of the preventive services provided by them is carried out by the city (district) CMP;

Rules for organizing the activities of the department (office) of medical prevention

1. These rules establish the procedure for organizing the activities of the department (cabinet) of prevention (hereinafter - the Department).

2. The department is organized in a medical organization (its structural subdivision) providing primary health care.

3. The department of prevention includes the following structural units:

anamnestic office;

Cabinet of functional (instrumental) studies;

Healthy Lifestyle Promotion Office;

Cabinet of centralized accounting of annual medical examination;

Smoking cessation clinic.

4. When organizing the activities of the Department, it is recommended to provide for the possibility of conducting the necessary diagnostic tests directly in the Department.

5. The department is headed by a head who reports directly to the chief physician of a medical organization (the head of its structural unit) that provides primary health care.

6. The main functions of the Department are:

Participation in the organization and conduct of medical examinations;

Participation in the organization and conduct of preventive medical examinations;

Early detection of diseases and persons with risk factors for the development of diseases;

Control and accounting of the annual medical examination of the population;

Preparation and transfer to doctors of medical documentation for patients and persons with an increased risk of diseases for additional medical examination, dispensary observation and medical and recreational activities;

Sanitary and hygienic education and promotion of a healthy lifestyle (combating smoking, alcoholism, overnutrition, physical inactivity, and others).

In addition to the listed structures, psychological (psychotherapeutic) care offices are involved in the implementation of preventive measures, including those for individual and group correction of behavioral risk factors for chronic NCDs. The organizational and methodological management of this area of ​​activity of the offices of psychological (psychotherapeutic) assistance and the examination of the quality of the preventive services they provide are carried out by the city (district) CMP.

The highest collective body for the development of strategies and tactics, the construction and functioning of preventive structures, the formation of a healthy lifestyle among the population and the prevention of NCDs is the specialized commission of the Expert Council of the Ministry of Health of Russia on preventive medicine, acting on voluntary. The profile commission includes the main freelance specialists in preventive medicine from the health authorities of all constituent entities of the Russian Federation, heads of the subject (republican, regional, regional) Centers for Medical Care, leading scientists and specialists, representatives of professional medical societies and associations in the field of preventive medicine.

The results of preventive medical care are determined by its quality. The quality of preventive medical care is a set of qualitative and quantitative characteristics that confirm the compliance of the provision of preventive medical care to the population or an individual with the existing needs of the population for this care (medical - based on evidence-based medicine and psychosocial - based on the attitude, understanding and motivation of the population).

Criteria for the quality of preventive care

Availability and accessibility of the required type of preventive medical services. Criterion - the list and completeness of preventive medical services of the institution (subdivision, specialist, etc.).

Adequacy of measures, technologies and resources used to achieve the goals of health promotion and prevention. The criterion is the compliance of preventive measures, services, technologies and resources used with the goals of health promotion and prevention in the activities of a medical institution (half of the division, specialists, etc.).

Continuity and continuity of the process of improving patients in the healthcare system. Criterion - a model of preventive activities of a medical institution that ensures interaction and coordination.

The effectiveness and strength of the impact of the applied preventive medical intervention on improving the health indicators of groups of individuals and the population as a whole based on evidence-based studies. The criterion is the introduction (application) of evidence-based preventive medical methods, approaches, technologies.

The effectiveness of preventive medical intervention in relation to improving the health indicators of individual groups of individuals and the population as a whole in practice. Criterion - the dynamics of health indicators in the application of effective methods of prevention in practical conditions.

The effectiveness of the applied preventive medical intervention in relation to the chosen criterion. Criterion - compliance of the result of medical preventive care with the chosen criterion of medical, social, economic efficiency.

Ability to meet the needs of patients, the population and meet real opportunities implementation. The criterion is the conformity of forms, methods, technologies, accessibility and other characteristics of preventive medical care, needs, attitudes of patients and the population as a whole.

EXAMPLE TESTS

Choose one correct answer

1. The object of primary prevention are:

a) convalescents of acute diseases

b) people with chronic diseases

c) the entire population

2. The subject of preventive medicine is:

a) disease pathogenesis

b) symptoms of diseases

c) the risk of disease

d) disability due to illness

3. The functions of primary medical prevention do not include:

a) ensuring the methodology of health-saving technologies

b) monitoring risk factors for noncommunicable diseases

c) rehabilitation after an illness

SITUATIONAL PROBLEM

A 52-year-old man has no complaints. Work is associated with psychological stress. Smokes up to 17 cigarettes a day. The mother suffers from coronary artery disease diabetes Type 2, the father suffered a myocardial infarction at the age of 52 years.

Objectively: the condition is satisfactory. Height 174cm, body weight 96kg. The skin is clean, normal color. Above lungs breathing vesicular, no wheezing. Heart tones are clear, clean, rhythmic. BP - 120/75mmHg, heart rate - 78bpm. The abdomen is enlarged in volume due to subcutaneous fat, soft, painless on palpation. Liver on the edge of the costal arch. The symptom of tapping is negative on both sides. There are no peripheral edema. Stool and diuresis are normal.

Survey results

Urinalysis: relative density - 1023, leukocytes 0-1, erythrocytes 0-1 in the field of view. Urine protein 100 mg/day.

Biochemical blood test: total cholesterol - 5.4 mmol / l.

EXERCISE

1. Select the risk factors for the development of cardiovascular diseases in a patient.

2. Patient management tactics.

Preventive, rehabilitation and recovery measures during physical exercises

1. Preventive measures to prevent sports injuries.

Prevention of sports injuries. To prevent sports injuries, a set of measures is carried out: correct technique training, ensuring the good condition of places of work, equipment, clothing, shoes, the use of protective devices, regular medical supervision, the implementation of hygiene requirements, daily educational work, etc. The role of a sports doctor in preventing injuries is very significant. Its functions include: ensuring the complete safety of classes, competitions, educational work with athletes (persistent explanation of the inadmissibility of using rough, incorrect techniques that can cause injury, the need for constant use of protective equipment, etc.). The doctor must conduct constant explanatory work not only among athletes, but also among coaches about the conditions that contribute to the occurrence of injuries, the importance of showing doctors and medical workers any injury in an athlete (there are cases when an athlete, having received a minor injury, does not seek medical help, resulting in a complication). Experience shows that where thoughtful explanatory work is carried out (medical advice, conversations, lectures), the likelihood of injury is much less.

The doctor conducts work on injury prevention both independently and together with coaches, teachers and organizers of competitions. Of great importance in the prevention of sports injuries is the regular control by the administration, coaches, teachers and judges of the condition of the places of employment, inventory, equipment, the availability of serviceable sports shoes, clothing and protective equipment for athletes that correspond to the sport and the rules of the competition. The sports doctor must check how this control is carried out.

Injury prevention depends on ensuring that sports facilities meet established government standards and that strict health and maintenance regulations are followed.

After providing first aid, the doctor must find out the cause of the injury. In that great help he is provided by coaches, judges, athletes.

In the prevention of sports injuries, a properly organized record of injuries that occurred during classes and competitions is important.

It is the doctor's duty to keep a systematic record of all cases of injury. Not only serious injuries, but also injuries moderate it is necessary to carefully study, identify the causes of their occurrence and determine the necessary measures to eliminate them. Each such case is discussed in detail at the coaching council, as well as with the athletes.

When practicing sports such as gymnastics, acrobatics, etc., insurance is extremely important in preventing injuries. The usefulness of insurance depends on its timeliness and technical readiness of the insurer (coach or experienced sportsman). During acrobatic exercises on special apparatus, it is necessary to use special belts with a cable passed through the block for insurance. In many sports important role belongs to self-insurance (the ability of an athlete to independently get out of a dangerous position, changing or stopping the exercise to prevent the possibility of injury, mastering the skill of a correct and safe fall, the ability to avoid dangerous movements and body positions). Self-insurance techniques should be especially well mastered by wrestlers, gymnasts, acrobats, jumpers into the water when jumping from a springboard.

It is necessary to persistently educate the athlete in self-insurance skills, but this requires a reasonable measure. If an athlete is accustomed to over-belaying, then he will not have the necessary confidence when performing exercises without insurance (for example, in competitions).

To prevent injury great importance has a warm-up before training or competition. It is carried out under any meteorological conditions. The meaning of the warm-up should not be considered simply as “warming up the muscles” (this is only one side of the complex process of preparing the motor apparatus of the athlete’s body for the upcoming physical stress). Warm-up contributes to a general increase in the level of activity: excitation in the nerve centers that coordinate the activity of body systems during exercise, the preparation of the motor apparatus, an increase in gas exchange, respiration and blood circulation. It creates, as it were, a general working background against which you can more successfully perform sports exercises.

The warm-up includes a certain set of physical exercises, which usually consists of general and special parts. a common part aims to create optimal excitability of the central nervous system and neuromuscular apparatus, to enhance the activity of the cardiovascular and respiratory systems. The special part is aimed at creating optimal excitability of those parts of the neuromuscular apparatus that will be involved in the implementation of the upcoming physical activity. In order to prevent muscle fatigue during the warm-up, a load is given not only to the muscles that should perform the main work during the competition, but also to those that will not be loaded. The load performed during the warm-up must be strictly individualized.

A rationally constructed warm-up does not cause fatigue of the body and excessive excitement.

One of the measures to prevent injuries is the regular hardening of the body of athletes to the effects of low and high temperatures, solar insolation, etc. In order to prevent sports injuries, special protective equipment is used.

Below are some proven tools and measures to prevent injuries.

In athletics: a rational warm-up, especially in cold weather; warm training suit in cool weather, with strong wind, rain; appropriate shoes (for runners, shoes should have spikes of 12-18 mm, which is especially important when running on slippery ground, with the exception of crosses); jumpers in track and field shoes must have rubber pads to cushion heel strikes and body concussions; marathon runners and stayers have felt or felt insoles.

In football: bandaging the ankle joints with elastic bandages; the imposition of special shields on the anterior region of the lower leg to protect against possible bruises and fractures; putting on a suspensory under the shorts to protect against bruises of the genital organs, and the goalkeepers additionally put on cotton shorts under the usual ones and elbow pads on the area of ​​the elbow joints.

In ice hockey: the use of special gloves for the hands, shields on the shins and on the forearm;

protection of the knee and elbow joints with knee pads and elbow pads, and the head with a helmet; goalkeepers - additionally special protective devices in the form of masks, fur boots, etc.

In gymnastics: proper skin care of the palms; magnesia for the hands (before approaching the shells) in order to prevent damage to the palmar surface; pads on the palms of thin leather to prevent abrasions and abrasions.

In skiing and skating: measures to protect against frostbite - headphones, flannelette triangles on the genital area, as well as the correct fit of shoes, regular drying of clothes (in particular, mittens) and shoes.

In boxing: a set of preventive measures (protective masks and helmets during training, careful bandaging of the hands, the use of a protective shell on the genitals, a mouthpiece to protect the teeth).

In weightlifting: a wide leather belt worn by a weightlifter to prevent injuries to the ligamentous apparatus of the lumbar spine; leather cuffs to prevent injuries of the wrist joints; imposition of a cotton-gauze shock absorber on the area of ​​​​the sternum during training in order to prevent chronic periostitis of the sternum, which is the result of repeated injury to it with a barbell.

In fencing: a number of protective devices (t-shirts, jackets, bibs, high tight collars, gloves; for women, in addition, hard bras, for men - a bandage); a thorough check before training and competitions of the condition of masks, bibs and weapons, in particular, the presence of protective hats on them.

In motorcycling and cycling: protective helmets worn to protect the head during track and road racing.

Work experience shows that when due attention is paid to the prevention of sports injuries when playing sports, the correct implementation of methodological and organizational instructions, good medical supervision and educational work, as a rule, there are no injuries.

2. Rehabilitation measures during physical exercises.

2.1. Tasks and purpose of physical rehabilitation

The main task of physical rehabilitation is the full restoration of the functional capabilities of various body systems and the musculoskeletal system (MDA), as well as the development of compensatory adaptations to the conditions of everyday life and work.

Rehabilitation tasks include:

Restoration of the patient's everyday capabilities, i.e.

ability to move, self-service and perform simple household work;

Rehabilitation, i.e. professional skills lost by a disabled person through the use and development of the functional capabilities of the motor apparatus;

Prevention of the development of pathological processes leading to temporary or permanent disability, i.e. implementation of secondary prevention measures.

The goal of rehabilitation is the most complete restoration of the body's lost capabilities, but if this is unattainable, the task is to partially restore or compensate for the impaired or lost function, and in any case, slow down the progression of the disease. To achieve them, a complex of therapeutic and regenerative means is used, among which the following have the greatest rehabilitative effect: physical exercises, natural factors (both natural and reformed), different kinds massage, training on simulators, as well as orthopedic devices, occupational therapy, psychotherapy and auto-training. Even from this list, it is clear that the leading role in rehabilitation belongs to the methods of physical influence, and the further it moves from stage to stage, the more important they are, eventually forming a branch, or type, called “physical rehabilitation”.

The concept of physical rehabilitation

Physical rehabilitation - component medical, social and professional rehabilitation, a system of measures to restore or compensate for physical capabilities and intellectual abilities, improve the functional state of the body, improve physical qualities, psycho-emotional stability and adaptive reserves of the human body by means and methods of physical culture, elements of sports and sports training, massage, physiotherapy and natural factors (V. G. Dmitriev). Or in short: physical rehabilitation is an integral part of medical and social and labor rehabilitation, using the means and methods of physical culture, massage and physical factors.

Physical rehabilitation should be considered as a medical-pedagogical and educational process, or, more correctly, educational process. The main means of physical rehabilitation are physical exercises and elements of sports, and their application is always a pedagogical, educational process. Its quality depends on how much the methodologist has mastered pedagogical skills and knowledge. Therefore, all the laws and rules of general pedagogy, as well as theories and methods of physical culture are extremely important in the activities of a rehabilitator (rehabilitologist) - a specialist in physical rehabilitation. First of all, he must be a good teacher - a specialist in physical education, physical culture, and at the same time possess profound knowledge essence of pathological processes and diseases with which he has to meet in his patients. He must be able to determine which methods and means will have a general effect on the body, and which - local, local or, better, specific, differentiate the load depending on the type of pathology and the patient's condition. This is not easy even for an experienced specialist, if you do not know and do not use methods for assessing (controlling) the impact of stress on the patient's body and the effectiveness of rehabilitation measures.

Physical exercises give a positive effect in rehabilitation when, firstly, they are adequate to the capabilities of the patient or disabled person, and secondly, they have a training effect and increase adaptive capabilities, provided that the methodologist knows and takes into account a number of methodological rules and principles of physical training.

The essence of training is repeated, systematically repeated and gradually increasing physical activity, which causes positive functional and sometimes structural changes in the human body. As a result of training, the regulatory mechanisms are normalized, improved, increasing the adaptive capabilities of the patient's body to dynamically changing environmental conditions. On the one hand, new motor skills are formed and strengthened or existing motor skills are improved, on the other hand, various physical qualities (strength, endurance, speed, flexibility, dexterity, etc.) develop and improve, which determine the physical performance of the body. No other means and methods of rehabilitation are able to replace physical exercises. Only as a result of their influence, we are able to restore and improve the patient's physical performance, which, as a rule, noticeably decreases during pathological processes.

2.2. Means of physical rehabilitation:

Rehabilitation means include psychotherapeutic effects, drug correction, exercise therapy (kinesitherapy), physiotherapy, massage, occupational therapy, spa treatment, music therapy, herbal medicine, aerotherapy, choreotherapy, manual exposure, etc. Leading place among the means of physical rehabilitation, physical exercises are given, since physical activity is the most important condition for the formation of a healthy lifestyle, the basis for the correct construction of medical rehabilitation.

Means of physical rehabilitation can be divided into active, passive and psychoregulatory. Active means include all forms of therapeutic physical culture: a variety of physical exercises, elements of sports and sports training, walking, running and other cyclic exercises and sports, work on simulators, choreotherapy, occupational therapy, etc.; to passive - massage, manual therapy, physiotherapy, natural and reformed natural factors; to psychoregulatory - autogenic training, muscle relaxation, etc.

3. Restorative measures during physical exercises.

3.1. Massage is a system of methods of dosed mechanical impact on the body by the hands of a massage therapist or special devices. Friction, pressure, vibration serve to maintain and restore human performance and health. Today it is a scientifically based system, proven by the practice of specialists. Recall some information about anatomy and physiology. The human nervous system, as you know, is divided into central and peripheral. The central includes the head and spinal cord, to the peripheral - nerve nodes and nerves. The nervous system is divided into somatic, innervating, that is, regulating the work of the motor apparatus, skin, sensory organs, and vegetative, responsible for the internal organs and the vascular system. Massage has a reflex effect on parts of the body, organs far from the place of its application. Yes, back in 1908. A.E. Shcherbak proved that irritation of the collar zone affects the internal organs, the innervation ([from Latin in-in, inside and nerves] the connection of organs and tissues with the central nervous system with the help of nerves) of which depends on the nerve formations located in this areas. IP Pavlov's research proved that the reaction to pain stimulation can be suppressed by a conditioned stimulus. Massage becomes such an irritant when it is applied taking into account the form and stage of the disease. Properly selected massage techniques can soothe or excite nervous system, thereby causing certain changes in various human organs and systems. The effect of massage on the nervous system depends on the techniques, the duration of their exposure, the place of application, that is, the degree of irritation of the receptor devices. Already in the documents of the first international congress on massage, held in Paris in 1937, it was written:<Действовать на кожу - это почти непосредственно воздействовать на нервную систему, ибо кожа снабжает мозг непрерывным током возбуждений, которые мы можем варьировать до бесконечности целой гаммой действий>.Now about the skin itself. It is an excretory organ that regulates heat transfer, protects the body from chemical, mechanical, and thermal influences. It contains blood and lymphatic vessels, nerve endings, sweat and sebaceous glands, hair follicles. Under the influence of massage, obsolete cells of the epidermis (surface layer) are sloughed off and removed from the skin, blood flow to the massaged area increases. The nutrition of the skin improves, it becomes more elastic and smooth. At the same time, the outflow of venous blood and lymph is enhanced, which entails a decrease in edema and congestion in the massed and nearby areas, the activity of the glands and the release of special biologically active substances - histamine, acetylcholine, which contribute to human muscle activity, improve. Good job muscles is important not only for the movement of all parts of the body, but also for respiration, blood circulation, lymph formation, thermoregulation, and metabolism. Massage relieves pain, makes muscles soft, elastic, restores their performance, even if the muscles that were not involved in physical work are massaged. The secret lies in the fact that as a result of massage, the content of lactic acid in the muscles decreases, organic acids are better excreted, which has a life-giving effect on tired muscles. When massaging the ligamentous-articular apparatus, joint mobility and tissue elasticity improve, periarticular edema decreases, due to improved blood supply and lymphatic drainage, the formation of synovial (intra-articular) fluid, which plays the role of lubricant, is accelerated. Special mention should be made of the effect of massage on the circulatory and lymphatic systems. Through the circulatory system, oxygen, nutrients, hormones (substances secreted by the endocrine glands) enter all organs and tissues. Through the circulatory and lymphatic systems, end products of metabolism that are unnecessary to the body are removed. Massage dilates blood vessels, enhances the outflow of venous support and facilitates the work of the heart muscle, improves blood circulation in general, normalizes blood pressure, increases the number of red blood cells and platelets in the blood. Pay attention to how the blood vessels and lymph nodes are located. This is essential: the area of ​​the lymph nodes is not massaged, and the gels of the lymph glands are enlarged, painful, then massage cannot be done. That is why it should be remembered that the lymph nodes are located in the neck, subclavian, axillary,

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MASSAGE AND ITS SIGNIFICANCE FOR THE PHYSICAL IMPROVEMENT OF A HUMAN. PLAN Introduction Basic principles of massage Massage technique and its basic techniques Sports massage