Vol 61, No 6 (2017)

During the period of health care reforming, study of a true picture of population health and medical social needs in particular age-gender groups, including elderly age, is a necessary condition for planning development of health care, social support and scientific substantiation of prevention programs. The article presents the results of comparative analysis of indices of disability of main age groups of adult population of the Russian Federation during 2005-2016. The methods of study: documentary, data sampling, statistical and graphic techniques. The volume of study made up to 34,840,933 individuals aged from 18 years and older, recognized as disabled, including disabled persons of elderly age - 12,971,062 individuals. The established characteristics of primary and repeated disability of citizen of elderly age in the Russian Federation (gender characteristics, nosological structure, regional differentiation) are covered that reflect demographic tendencies of aging of population. The dynamics of disability of citizen of elderly age during long term period (2005-2016) testifies alteration of ratio between primary and repeated established cases of disability. In 2005 overwhelming exceeding of primary recognized as disabled persons over repeatedly recognized was marked: 81.2% against 18.9%. In 2016 in total contingent of the examined the disabled persons with repeatedly established disability prevailed: 62.7% against 37.3%. During the period of observation, the level of repeatedly established disability among citizen of elderly age increased up to 74,5% (R2 = 0,546), whereas in contingents of young and middle age is marked a stable tendency to decreasing of value of indicator (R2 = 0,934, R2 = 0,5873 correspondingly). The citizen of elderly age prevails in the structure of disability due to malignant neoplasms, diseases of blood circulation system, diseases of musculoskeletal system and connective tissue, diseases of eye, ear and mastoid bone, diseases of endocrine, nervous and urogenital system. In connection with high invalidation, the elderly category of population is in need of significant medical social support. The development of activities targeted to medical social rehabilitation of citizen of elderly age it is appropriate considering regional differentiation of the subjects in the Russian Federation related to prevalence of disability and also gender characteristics of disability.

Introduction. During implementation of medical activity an uncertainty and increased risk are present. to manage these two conditions a single system of management is needed capable preventing negative risks even during period of planning. The article presents experience of medical organization of transition to risk-oriented model of quality management system in concordance to ISO 9001:2015. Material and methods. The study was carried out in quarter IV 2016-quarter I 2017 in the research institute of complex problems of cardio-vascular diseases (hereinafter referred to as the organization). In the capacity of study techniques audit, SWOT analysis and logical analysis were applied. Results. According to step-by-step transition to risk-oriented model of quality management system training of administrators and owners of processes was organized. The genuine methodology of risk evaluation was developed. The implemented audit established 11 risks through 14 processes and directions of activity of medical organization. Among causes of risks internal causes were mentioned in 90%, including human factor (half of cases) i.e. the personnel of organization. With purpose of management, all established risks were separated to critical and non-critical ones in functioning of institution. The percentage of risks of critical character made up to 26%. The application of SWOT analysis permitted to establish 80 factors of internal and external environment of the organization. The results of implemented activities concerning transition to the new risk-oriented model of quality management system permitted to revise the strategic map of achievement of targets of the management system of the organization subject to evaluation of risks and factors of internal and external environment of the organization. The outcome of implemented activity became a positive assessment of quality management system of the institution during external certification audit according requirements of standard ISO 9001:2015. Conclusion. The application of methodology of step-by-step transition to risk-oriented model of quality management system of medical organization made it possible to implement an in-depth analysis of strong and weak aspects, to identify risks, threats and possibilities oriented to achievement of strategic targets of organization.

The article presents results of the examination of workers of phthalic anhydride manufacture with work experience more than 10 years underwent impact of complex of harmful factors of production including chemical substances, noise, difficulty and intensity of working process. The group of comparison consisted of employees of administration department. The study established exceeding of both maximum permissible concentration (MPC) of phthalic anhydride (2.2-6.3 mg/m3 at MPC 1.0 mg/m3) and level of total and local vibration and thermal load at work places that corresponds to class 3.2-3.3 of work conditions on indicator of harmfulness and danger of industrial environment. The equivalent levels of noise with maximal values at work places of machinery operators of oxidation (84.6 dBA) are identified. The study established decreasing of phagocytic activity (relative phagocytosis, phagocytic number and phagocytic index in 1.13, 1.39 and 1.26 times correspondingly) relative to group of comparison and also decreasing of level of serum immunoglobulin G in relation of standard. On the basis of flow cytometry, the reliable decreasing of expression of CD95 T-cell receptors is established. The results of allergen-sorbent testing demonstrated increasing of the level of specific sensitization to phthalic anhydride by its metabolite of phthalic acid in 79.2% of workers. The indices of immune regulation CD95, phagocytic activity, specific to anhydride IgE, reflecting characteristics of immune regulation in workers of phthalic anhydride manufacture are recommended to be applied as markers of effect during assessment of health risk in people working in conditions of combined impact of physical and chemical factors.