MINISTRY OF HEALTH

AND SOCIAL DEVELOPMENT OF THE RUSSIAN FEDERATION

Central Research Institute

organization and informatization of healthcare

MEDICAL AND SOCIAL

PROBLEMS

SOCIAL

CONDITIONED

DISEASES

Scientific works

MOSCOW

2004

1 ID No. 01267 dated March 20, 2000

RIO TsNIIOIZ MH and SR RF

MEDICAL AND SOCIAL PROBLEMS

OF CONDITIONED DISEASES: scientific works of the Russian scientific-practical conference.

ISBN 5-94116-011- Under the general editorship of Academician of the Russian Academy of Medical Sciences V.I. Starodubov.

EDITORIAL TEAM:

Mikhailova Yu.V. - Doctor of Medical Sciences, Professor, Artyukhov A.S. - Doctor of Medical Sciences, Professor, Eremicheva T.I. - Candidate of Medical Sciences, Kupina N.N. - st.n. employee, Lastovetsky A.G. - Doctor of Medical Sciences, Magnitsky V.A. - Candidate of Medical Sciences, Soboleva N.P. - Candidate of Medical Sciences, Son I.M. – d.m.s.

Design and art direction: Yurkevich A.I.

Layout: Akhmatgareev V.S.

Corrector: Kanaeva E.V.

Printing and stitching: Pleskov R.A.

Printed in RIO TsNIIOIZ MZ and SZ RF Moscow, st. Dobrolyubova, Order 4c- ISBN 5-94116-011- © RIO TsNIIOIZ Ministry of Health and SZ RF, 2004

THE ROLE OF SOCIALLY CONDITIONED DISEASES

IN THE FORMATION OF PUBLIC HEALTH

Problems of integration of socially conditioned diseases. Starodubov V.I., Mikhailova Yu.V., Son I.M. New trends in the prevalence of socially significant diseases. Voitsekhovich B.A., Kleshchenko E.I. Socially significant diseases in society and the role of the special contingent of the main department for the execution of punishments in their spread. Tsybulskaya I.S., Tsybulsky V.B. Municipal level in the monitoring of socially significant diseases (on the example of the Krasnodar Territory). Kondrakova E.V. HIV infection and tuberculosis in the Sverdlovsk region. Nechaeva O.B., Eismont N.V. Features of the course of pulmonary tuberculosis in drug addicted patients. Zadremailova T. A., Kulikova O. V., Novikova T. I. Pulmonary tuberculosis among patients with mental illness. Novikova T. I., Porosnaya S. I., Chepurin V. V., Moiseeva N. V. The prevalence of socially conditioned diseases among students and measures for their prevention. Kruglyakova I.P. Contemporary Issues and prospects for the development of the TB service in Russian Federation. Shumov A.V. The reservoir of tuberculosis infection in Russia in modern conditions. Khruleva T. S. Peculiarities of detection and spread of tuberculosis among various social groups of the population. Son I.M., Ten M.B., Pronina T.V. Social and professional characteristics of newly diagnosed patients with respiratory tuberculosis in Moscow. Gorbunov A.V., Son I.M., Rostovtsev S.A. Medical and social characteristics of newly diagnosed patients with tuberculosis Social characteristics of children with various manifestations of tuberculosis Tuberculosis as a cause of childhood disability (regional aspects). Tsybulskaya IS, The structure of disorders in the reproductive system of adolescent girls with respiratory tuberculosis. Ankina O.A., Stakhanov V.A., Ovsyankina E.S., Mortality from tuberculosis in newly diagnosed patients. Popovich V.K., Mikhailova Yu.V., Causes of death from tuberculosis. Nechaeva O.B., Skachkova E.I., Popovich V.K. Sexually transmitted diseases, one of the indicators of public health Organizational measures in the institutions of the penitentiary system in cooperation with public health authorities to improve the diagnosis and prevention of syphilis. Yusufov R.Sh., Gadzhimuradov M.N., Medical and social characteristics of patients of the hepatitis center and the center Experience of state insurance of medical workers in case of socially caused diseases (viral hepatitis and HIV infection).

Merzlyakov V.A., Kuzmin E.G., Muravieva M.M., Kuzmin A.E. On the issue of the relevance of the problem of drug use by adolescents.

To assess the role of the information environment and virtual communications in the formation of public health and the development of socially conditioned pathology.

The growth of non-epidemic and non-infectious pathology as a result of the impact of the artificial habitat on social development. Savelyev V.N., The structure of mental disorders and methods of their prevention in the Chuvash

ASSESSMENT OF POPULATION HEALTH LOSS FROM SOCIAL

CONDITIONED DISEASES

Cohort analysis of mortality of the Russian population from socially conditioned diseases. Ermakov S.P., Antonyuk V.V., Tsarkov A.O., Popovich V.K. Age, gender and regional characteristics of mortality from tuberculosis in Socially dangerous diseases (congenital syphilis, hepatitis C) in the home Epidemiology of tuberculosis and its social foundations. Shilova M.V. Analysis of the detection and results of observation of advanced forms of tuberculosis.

Determination of the degree of reliability of the mortality rate from tuberculosis in Moscow.

Son I.M., Seltsovsky P.P., Andryukhina G.Ya., Rostovtsev S.A. Causes of death of patients in the therapeutic department of the city tuberculosis hospital. Borisova M.I., Kuular D.E., Samsonov A.N., Dynamics and prognosis of primary disability of the working-age population due to tuberculosis at the regional level. Mavlikaeva Yu.A., Podluzhnaya M.Ya. Medico-social expertise and rehabilitation of disabled people with tuberculosis. Kalyuk AN, Increasing the economic efficiency in the organization of the anti-tuberculosis service. Valiev R.Sh., Khusnutdinova V.R., Valiev N.R., Evaluation of the prevalence of HIV infection, syphilis and risk factors for their transmission in Dynamics of population health depending on income (1990-2002). Kiselev A.S. Morbidity, disability, medical and social expertise and rehabilitation of disabled people with respiratory diseases in the Udmurt Republic. Mukhametgaleeva ED, Social and hygienic features of the contingent of disabled people due to respiratory diseases at the regional level. Pustynkina M.O., Soldatchenko S.Z., The role of drinking water pollutants in the development of morbidity and disability in children in the Republic of Mordovia and Russia. Tsybulskaya I.S., Sulkina F.A.,

FEATURES OF THE ORGANIZATION OF THE TREATMENT AND PROPHYLAXIS

WORKS IN SOCIALLY CONDITIONED DISEASES

Modern approaches to the curation of anti-tuberculosis institutions. Krasnov V.A., Kalachev I.V., Pogozheva L.M., Murashkina G.S., Stepanov D.V., Svistelnik A.V., Revyakina O.V., Novikova N.M., Alekseeva T. V., Silaykina S.T. Organization of the fight against tuberculosis in children in Russia. Aksenova V.A., Klevno N.I. Optimization of hospital-replacing forms of organization of treatment of patients with pulmonary tuberculosis. Starostenko E.V., Tarantseva V.G., Belukhina A.V., Chebotareva T.S. To the question of the tactics of examination of children with sexually transmitted infections Study of educational aspects and the level of awareness of adolescents about measures to prevent sexually transmitted diseases. Khismatullina ZR, Efficiency analysis of the use of dermatovenerological beds Fund Organization of anti-tuberculosis care for people with mental disorders entering or living in neuropsychiatric boarding schools in Moscow.

Organization of anti-tuberculosis activities in stationary institutions of the Ministry of Social Protection of the Sverdlovsk Region. Eismont N.V. Psychological aspects in the treatment of pulmonary tuberculosis in women. Trifonova N.Yu., Identification of risk groups for alcoholization of the population (on the example of the Kirov region).

Performance indicators of dermatovenerological beds in the Russian Federation.

Some aspects and ways of solving the problems of drug addicts in the Middle Volga region. Saprykina A.G., Koryakin S.A., Bogatyreva G.P., Barinova Zh.V. The incidence of HIV infection among citizens of the Moscow region. Galanova G.I., Experience of field work on the prevention of HIV infection. Kuzmin E.G., Kurina N.V., Organizational and functional model of medical and preventive care for HIV-infected people at the prehospital stage in the Perm region.

Chemoprophylaxis of tuberculosis infection in children of early and preschool age.

Medical-biological and socio-hygienic characteristics of patients with tuberculosis in the area of ​​a large city. Saenko G.I. Some aspects of organizing the detection of patients with tuberculosis in conditions. Features of the organization of medical and preventive care for patients with tuberculosis of the respiratory organs during pregnancy, childbirth and the postpartum period.

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From time immemorial, venereal diseases have been attributed to the number of socially caused infections, or, as they are now called, sexually transmitted diseases (STDs).

Since perestroika and the beginning of the sexual revolution, the incidence of syphilis has increased tenfold in our country.

In 1998, the incidence of syphilis for the first time exceeded the incidence of gonorrhea by more than 2 times (119.9 cases in 1998), although earlier gonorrhea significantly prevailed over syphilis.

The incidence of other forms of STDs also increased several times. From 1985 to 1999 - trichomoniasis by 2.5 times, chlamydia by 2 times, ureplasmosis by 3 times, urogenital candidiasis by 10 times. Such a high prevalence of these diseases indicates drastic negative changes in the lifestyle and living conditions, especially of the younger generation. Promiscuous sex, violations of the hygienic regime, non-compliance with healthy lifestyles, drug addiction, alcoholism are fertile ground for their spread.

Venereal diseases (from lat. Veneris - Venus, the ancient Romans had the goddess of love) - diseases united according to the principle of transmission through sexual contact. A more correct term is: diseases (or infections, diseases) sexually transmitted (STDs, STIs, STDs). Some experts classify STDs into "old" and "new".

The old ones include venereal diseases known since ancient times, and the new ones include urogenital infections detected using modern methods of examination. The "old" STIs include gonorrhea, syphilis, chancre, venereal lymphogranulomatosis, donovanosis. The last three are practically not found in Russia, so only gonorrhea and syphilis are considered “classic” sexually transmitted diseases.

The "new" STIs include HIV infection, viral hepatitis B, C and D, chlamydia, mycoplasmosis, ureaplasmosis, trichomoniasis, gardnerellosis, genital herpes, genital warts, cytomegalovirus and vaginal dysbacteriosis, as well as sexually transmitted skin diseases (scabies, pubic lice, molluscum contagiosum).

Venereology- a section of clinical medicine that studies the causes (including social), development mechanisms, manifestations, methods of diagnosis, treatment and prevention of sexually transmitted diseases. Despite the significant achievements of venereology and the fight against venereal diseases carried out in all countries, they are still widespread and continue to be a serious social and moral problem.

The social significance of venereal diseases is determined by their prevalence, danger and severity of consequences for the health of the sick, as well as the impact on the reproduction of healthy offspring.

Many gynecological diseases, infertility of men and women are often the result of venereal diseases, their complications.

STIs are transmitted through homo- and heterosexual contact: vaginal, anal and oral. The more sexual partners a person has, the higher the risk of infection.

A serious rise in venereal diseases was observed in Buryatia at the turn of the century. For example, during 2000, 2660 patients with syphilis and 1922 with gonorrhea were registered in Buryatia.

Syphilis is an infectious disease caused by a spirochete, a curl-shaped bacterium called Treponema pallidum (Treponemapallidum), which is transmitted primarily through sexual contact and is characterized by a periodic course. In 1905, F. Shaudin and E. Hoffmann discovered treponema pallidum.

Opinions about the origin of syphilis are controversial. An epidemic of syphilis devastated Europe in the last decade of the 15th century, when it was called the "great smallpox" as opposed to the "smallpox". Since the epidemic coincided with the return of Columbus from America (1493), many authorities believe that syphilis was introduced from the West Indies. It is noteworthy that, apparently, Columbus himself died of syphilitic aortitis.

According to another theory, syphilis already existed in the Old World, but it spread more widely during the wars that began shortly after Columbus returned to Europe. When soldiers of the French army wintered in Naples in 1495, they developed syphilitic ulcers in the genital area, and then their bodies began to become covered with a rash. The Italians called it a "French disease", and the French blamed the Italians for everything.

The incidence of syphilis in Buryatia is almost twice as high as in the Russian Federation as a whole, and is 121.7 per 100,000 population.

Infection with syphilis occurs from a sick person sexually or by contact. It can also be transmitted in utero from a mother with syphilis to her child.

After infection, an incubation period lasting an average of 3-4 weeks follows. In the "classic" course of a syphilitic infection, 3 clinical periods are distinguished - primary, secondary and tertiary, which successively replace each other after the incubation period.

The primary period of syphilis is characterized by the appearance of erosive and ulcerative lesions in the genital area and an increase in inguinal lymph nodes. Its duration is 6-7 weeks.

Further, 2-3 months after infection or 6-7 weeks after the appearance of the primary affect (sores), a secondary period of syphilis sets in, in which various rashes on the skin and mucous membranes, hair loss, and sometimes hoarseness of voice are observed; the duration of this period without treatment (or if it is not enough) is on average 3-5 years.

Then the tertiary period of syphilis develops, in which a few nodes and ulcers appear on the body, healing with the formation of scars. With a long duration of the disease and the absence of a full-fledged treatment, lesions can be observed internal organs and central nervous system, which can lead to death.

Syphilis is an acutely contagious disease that poses a danger to others and damages health, and therefore requires immediate examination and treatment in a specialized institution.

Gonorrhea

Gonorrhea(from the Greek gonos + rhoia - seed + expiration) or gonorrhea (from the German tripper - drip) - a common infectious disease with pronounced manifestations in the genitourinary tract, caused by gonococcus. This is a sexually transmitted disease of a person, the causative agent of which is gonococcus (from the Greek gonos + kokkos - seed + grain), resembling a coffee bean under a microscope. It was discovered in 1879 by the German scientist Albert Neiser.

Gonorrhea is one of the most common sexually transmitted infections. It accounts for a quarter of all STIs.

Manifestations of gonococcal infection can be very different - from an asymptomatic course to pelvic inflammatory disease, general blood poisoning, and even meningitis - inflammation of the meninges caused by this microbe.

However, most often gonorrhea occurs in the form of inflammation of the mucous membranes of the genitourinary organs and is accompanied by purulent discharge from the urethra in men and the cervix in women.

Diseases with a similar clinical picture have been known since ancient times. The modern name of the disease "gonorrhea" was first used by Galen, who in the 2nd century AD. erroneously interpreted discharge from the urethra of men as semen.

In men, the incidence of gonorrhea is 2 times higher than in women. This is because gonorrheal urethritis causes severe burning and pain when urinating, and men are forced to see a doctor. Women usually do not experience discomfort, and only those of them who treat themselves carefully find an increase and purulent nature of the discharge from the vagina.

Gonorrhea can be contracted through any type of sexual contact (vaginal, oral, anal sex).

Young children can become infected during the passage of the birth canal of a mother with gonorrhea. To prevent this, in the first minutes after birth, all babies are instilled into the eyes, and for girls also into the genital slit, 1% silver nitrate solution or 30% albucid solution.

Chlamydial infection

Chlamydial infection has always existed, but they learned to identify it only two decades ago. In 1990, data were published that chlamydia was found in 2/3 of couples undergoing treatment for infertility.

It can live in the urethra, as well as in women in the vagina, and in men - in the prostate gland and seminal vesicles.

It has been established that trichomonads are able to absorb other pathogenic microorganisms that retain their vital functions inside their body. Therefore, with superinfection - simultaneous infection with gonorrhea and trichomoniasis, it is impossible to cure the first without getting rid of the second.

Men, having become infected, usually do not feel any changes and do not go to the doctor. But in women, trichomoniasis is usually manifested by abundant grayish-yellow foamy discharge from the vagina, severe itching and a burning sensation in the vulva, which makes them turn to a gynecologist.

Trichomonas infection can cause infertility. Bank (1966) suggested that infertility due to Trichomonas infection is due to infection of the man (sexual partner) and is not associated with the presence of Trichomonas in women. He drew attention to the fact that successful treatment of a woman does not lead to pregnancy, while after treatment of a man, his partner becomes pregnant. It is believed that these protozoa simply eat sperm.

Recently, some viral diseases of the whole body, one of the ways of transmission of which is sexual contact, have been classified as STDs. This is a herpes infection, papillomatosis, viral hepatitis B, C and D, as well as AIDS

Herpetic infection of the genital tract

Herpetic infection of the genital tract- a viral disease that tends to spread widely. For example, in the United States, this disease is epidemic in nature (there are up to half a million primary cases per year).

The causative agent of herpetic infection of the genital tract is the herpes simplex virus (HerpessimplexvirusHSV). Herpetic lesions were identified already in the 1st century AD by Roman doctors who observed herpetic eruptions on the lips.

The first case of herpetic lesions of the genital tract was registered in 1700. The herpes simplex virus was first described in 1912, and was first isolated from the female genital tract in 1946. The herpes simplex virus develops intracellularly. According to various studies, 65-90% of the world's population is infected with the herpes virus.

Anogenital herpes infection (genital herpes) is a chronic relapsing viral disease, predominantly sexually transmitted, characterized by exacerbation of lesions of the skin and mucous membranes of the genital organs and the genitourinary tract.

Factors contributing to the exacerbation or manifestation of genital herpes include:

• decrease in immunological reactivity;
• hypothermia or overheating of the body;
• accompanying illnesses;
• some mental and physiological conditions (sexual contacts, menstruation);
• medical manipulations (abortion, the introduction of an intrauterine device).

Condylomas, hepatitis and other diseases

warts- anogenital warts are benign warts with localization on the genitals and in the perianal (from the Greek peri + anus - located around + anus) area - the anus.

The disease is characterized by a long latent course and the possibility of the appearance of clinically significant lesions after a long period of time after infection. The causative agent of the disease in more than 90% of cases is the human papillomavirus.

Anogenital warts occur in places that are traumatized during sexual intercourse, and can be either single or multiple.

Some types of papillomaviruses have a very pronounced oncogenic effect. They cause cervical cancer in women and penile cancer in men.

Viral hepatitis B also called serum hepatitis. This name is due to the fact that infection with the hepatitis B virus can occur through the blood, and through an extremely small dose. The hepatitis B virus can be transmitted sexually, by injection with non-sterile syringes from drug addicts, from mother to fetus.

This disease, by all signs of infection and the course of the infectious process in the body, is very similar to AIDS, only liver cells - hepatocytes - are affected in it.

Viral hepatitis C has a more malignant course and can also be transmitted from a carrier of the infection to a healthy person through sexual contact. A complete cure for hepatitis B and C does not always occur, and if the virus remains in the body, then there is a very high probability of developing cirrhosis and liver cancer.

The European Association for the Study of the Liver, which includes Russia, has developed basic principles for the treatment and monitoring of patients with hepatitis C. The basis of all treatment regimens is interferon-alpha. The mechanism of action of this drug is to prevent infection of new liver cells.

The use of interferon cannot guarantee a complete recovery, however, treatment with it prevents the development of cirrhosis or liver cancer. The effectiveness of treatment is significantly increased if interferon is used in combination with ribavirin. A positive effect is achieved in 40-60% of cases.

Another group of conditions - vaginal dysbiosis is also identified with STIs, although their development occurs when local immunity is weakened.

Bacterial vaginosis develops due to the replacement of the normal microflora of the vagina, in particular H 2 0-producing lactobacilli, with a large number of obligate and facultative anaerobic conditionally pathogenic microorganisms (Bacteroides, Prevotella, Peptococcus, Mobiluncus, Gardnerellavaginalis, Mycoplasmahominis, etc.), i.e. those microbes that are normally present in small amounts.

Bacterial vaginosis is a common clinical syndrome in women of reproductive age, the incidence of which in a group of sexually active women reaches 60%.

The causes of the development of the disease remain unclear, however, there are a number of factors that affect the composition of the vaginal microflora, these are:

• therapy with antibiotics, cytostatics,
• radiation therapy;
• frequent washing of the vagina;
• malformations or anatomical defects after ruptures in childbirth, surgical interventions;
• foreign bodies in the vagina, uterus (presence for a long time of vaginal tampons or diaphragms, intrauterine devices, etc.);
• use of spermicides;
• hormonal changes during puberty, pregnancy, after childbirth and abortion;
• entry of pathogenic microorganisms gastrointestinal tracta (GIT).

Under the influence of adverse factors, the composition of the vaginal microflora is disturbed. A decrease in the number of lactobacilli leads to a decrease in the concentration of lactic acid and an increase in pH. Anaerobic microorganisms produce amino acids, which are broken down into volatile amines. Their formation causes the appearance of an unpleasant odor of secretions.

The main symptoms of vaginosis are a homogeneous discharge from the genital tract, often with an unpleasant odor, especially after intercourse or during and after menstruation. With the progressive course of the disease, the discharge may acquire a yellowish-greenish color, become thicker and evenly distributed along the walls of the vagina.

In 20-30% of cases, itching and burning in the vulva, dysuria are noted. According to studies, 24-32% of women have an asymptomatic course of bacterial vaginosis.

Bacterial vaginosis can cause poor pregnancy outcomes.

Gardnerellosis is one of the varieties of bacterial vaginosis, in which microbes, gardnerella, receive the greatest reproduction. Currently, such a diagnosis does not exist, but it is still found in almost all booklets on STIs.

Gardnerellosis by definition is a dysbacteriosis of the vagina. Therefore, it is wrong to make such a diagnosis for men. Sometimes pathogens of gardnerellosis cause urethritis in men, which is manifested by burning and pain during urination. In this case, treatment is necessary. In other cases (when Gardnerellavaginalis is detected by accurate methods or gardnerellosis in a sexual partner), there is no need to treat men.

genital candidiasis is an infectious disease of the genitourinary system caused by yeast-like fungi of the genus Candida. A feature of this disease is a long course and a tendency to recurrence - repetition of exacerbations.

The most common forms of genital candidiasis in women include vulvovaginitis (from Latin vulvovaginitis - inflammation of the vulva and vagina), in men - balanoposthitis (from Greek balanoposthitis - inflammation of the glans penis and foreskin). It is caused by yeast-like fungi of the genus Candida.

This fungus is detected in healthy women, however, with a change in the microbiocenosis of the vagina and a violation of the barrier mechanisms of local immunity, it can acquire pathogenic properties.

Risk factors for the development of genital candidiasis include long-term antibiotic therapy, hormones, the use of immunosuppressants, radiation therapy, severe infectious diseases, pregnancy, diseases of the gastrointestinal tract and the endocrine system, in particular diabetes mellitus.

Symptoms of genital candidiasis in women: thick, white, cheesy, sometimes liquid, creamy vaginal discharge; itching in the vulva and vagina; hyperemia, swelling and dryness of the mucous membrane of the vulva and vagina, sometimes small bubbles, erosion and cracks; some patients have dysuria.

Symptoms of candidiasis of the genitals in men: moderate itching and burning in the vulva; puffiness, hyperemia, superficial peeling, whitish plaque on the glans penis and on the inner leaf of the foreskin.

For any suspicious symptoms, you should always consult a doctor, because only he can make the correct diagnosis and prescribe treatment under the control of tests among a wide variety of STIs.

The main principles of STI treatment are:

• simultaneous treatment of sexual partners,
• exclusion of unprotected sexual contacts during treatment,
• strict adherence to all medical recommendations.

To avoid contracting STIs, as well as the physical suffering and mental stress associated with them, it is necessary to healthy lifestyle life.

It must be remembered that:

• the best sexual partner - beloved, constant and only;
• for casual sex, a condom is always used;
• having sex under the influence of alcohol or drugs reduces self-control.

Shurygina Yu.Yu.
1 The data of official statistics, the results of many years and numerous studies in various regions of Russia confirm the fact of a critical deterioration in the health of the child and adult population: its numbers are decreasing, the birth rate is decreasing, and life expectancy is decreasing. These negative trends also have specific social consequences - a decrease in a full-fledged human resource, an increase in the number of chronic diseases, problems of conscription into the army. Recently, in Russia, the use of alcohol, narcotic and other psychoactive substances (PSA) by young people has become a problem that poses a threat to the health of the younger generation and the population as a whole. The number of cases of the use of narcotic substances is increasing, there is an increase in the volume of medical and social consequences of drug addiction. One of the leading factors in the use of psychoactive substances in adolescence is psychological, which manifests itself in a decrease in psychological defense skills, an inability to cope with life's difficulties, and a lack of constructive value orientations, which does not allow one to effectively resist negative factors from outside. Our goal was to study new aspects of preventing the medical and social consequences of substance abuse. The main objectives of the psychological and pedagogical approach in the field of prevention of drug and alcohol addiction are: 1) the formation of adequate self-esteem in adolescents and young people; 2) development of communication skills and confident behavior, including opposition to peer pressure; 3) adaptation to changing conditions and development of social flexibility. These tasks can be implemented through the volunteer movement among adolescent volunteers. The organization of volunteer activities is one of the effective forms of positively oriented prevention within the framework of the psychosocial model. This form works in several directions at once. Firstly, it solves the problems of anti-drug content not only in relation to the volunteers themselves, but also to their peers. Secondly, a teenager not only acquires the amount of certain knowledge and learns the appropriate behavioral skills, but he also develops an active life position that allows him to reproduce this knowledge and skills among his peers. Thirdly, the transfer of psychological culture is carried out within the teenage subculture, which removes the moment of age-related resistance to the opinion of adults. The effectiveness of activities carried out by teenage volunteers often turns out to be very high, and this is no coincidence. After all, the fact that the children who conduct classes with peers belong to the same generation, their success and attractive image, their competence and accessibility of the presentation of the material - all this increases the positive effect of such classes. Evidence of the spread of ideas of a healthy lifestyle and responsible behavior, the result of which is the abstinence from drinking alcohol and avoiding drugs, is that the number of children who want to do volunteer work is constantly increasing. Lectures, talks, distribution of leaflets, film lectures, parent conferences - this is not a complete list of events held with teenagers. There was a need to change the approach to the improvement of all adolescents, including young men of military age. The state of health of adolescents and young people in the context of the economic and demographic crisis acquires the character of the primary tasks of national policy, determines the main trends in the formation of the health of the entire population of the country and its labor potential in the short term. Thus, among the various primary prevention strategies associated with the prevention of substance use, the priority is a positively oriented psychosocial model. Further development of the problem presents us in the systematization and creation of a register of social technologies, the identification of evaluation criteria for their effectiveness, the introduction of the most advanced technologies into the practice of medical and social institutions.

Bibliographic link

Tsyganok S.S., Parakhonsky A.P. EFFECTIVE FORM OF PREVENTION OF SOCIALLY CONDITIONED DISEASES // Modern problems of science and education. - 2004. - No. 2.;
URL: http://science-education.ru/ru/article/view?id=3090 (date of access: 01.02.2020). We bring to your attention the journals published by the publishing house "Academy of Natural History"

As a result of studying the chapter, the student must:

know

• general characteristics major socially significant non-communicable diseases (diabetes mellitus, hypertension, cancer, mental disorders);
• a general description of the main socially significant infectious diseases (hepatitis, HIV infection, tuberculosis, sexually transmitted diseases);

be able to

To identify medical and social problems that arise in clients with socially significant non-communicable and infectious diseases;

own

Fundamentals of the culture of modern social thinking, methods of medical and social analysis of socially significant diseases.

General characteristics of socially significant diseases

The concept of “socially significant diseases” appeared in the 19th century. in an era of rapid industrial development. At that time, the high incidence of this form of pathology (primarily tuberculosis) was associated with difficult working conditions, unsatisfactory living conditions and the inaccessibility of qualified medical care.

As the course of the historical process has shown, social transformations aimed at improving working conditions and creating safety measures, improving the quality of life of workers, and the development of medicine have led to a decrease in the incidence of certain types of diseases from this group. It should be noted that different authors attributed different diseases to socially significant diseases at that time. Tuberculosis and sexually transmitted diseases originally belonged to this group.

Sometimes socially significant diseases included vitamin deficiency (hypovitaminosis), neurosis, starvation, and a number of occupational diseases.

In the 1980s the first reports appeared that in some countries of the world (USA, Spain, Brazil, Tanzania) a previously unknown form of immunity disorder was found, clinically occurring in the form of a tumor disease. It turned out that the cause of the disease is the human immunodeficiency virus - HIV. This disease is called "acquired immune deficiency syndrome" - AIDS. It has been found that a large number of people are carriers of HIV, but they do not have clinical manifestations of the disease. This group of patients is called "HIV-infected".

Quite quickly, HIV infection acquired the character of an epidemic. This was facilitated exclusively by social factors: almost 100% of patients are male homosexuals and drug addicts (both men and women). At this time, ICD-10 (1995) excluded homosexuality as a disease.

By the beginning of the 1990s. In Russia, the situation with sexually transmitted diseases has sharply worsened. The multiple increase in the incidence of syphilis and gonorrhea has been associated with the emergence of effective antimicrobials that can be used to treat these diseases at home.

A significant contribution to the spread of sexually transmitted diseases is the lack of awareness of the general population about the causes and epidemiology, clinical manifestations, principles of therapy, and most importantly, about prevention. The apparent ease of eliminating a number of external signs of these diseases with the help of antibiotics is the basis for a "frivolous attitude" to them. a large number citizens, especially young people. Self-medication, which has become widespread, contributes to the transition of acute types of diseases into a chronic form, which is difficult to respond to subsequent therapy and often leads to infertility.

The increase in the incidence of tuberculosis is mainly due to the deterioration of the sanitary and epidemiological situation in Russia at the end of the last century. The increase in the incidence of active forms (for the first time detected) is about 2%, and the increase in the incidence of respiratory tuberculosis for the first time is about 3%.

The increase in the incidence of major non-communicable diseases, such as hypertension, mental illness, diabetes mellitus and tumor diseases, is due to a number of reasons. Among them is the acceleration of the pace of life (most relevant for hypertension and mental illness).

Technological progress, the use of new synthetic materials in industry, construction, everyday life, the deterioration of environmental conditions of human life, as well as changes in the quality of nutrition have contributed to an increase in the incidence of diabetes and cancer.

Age is an important factor in the development of cancer. Many malignant tumors, including cancer of the prostate, stomach, and colon, are most common in people over the age of 60. More than 60% of oncological diseases are detected after 65 years. In general, the likelihood of developing such diseases after a person reaches the age of 25 doubles every five years. The rise in cancer appears to be the result of a combination of stronger and longer exposure to carcinogens and a weakening immune system organism. Both of these factors are associated with an increase in life expectancy.

In order to specify the work on solving the medical and social problems of those suffering from socially significant diseases, the Decree of the Government of the Russian Federation of December 1, 2004 No. 715 approved a list of socially significant diseases and a list of diseases that pose a danger to others. It states that socially significant diseases include: tuberculosis; infections transmitted predominantly sexually; hepatitis B and C; disease caused by the human immunodeficiency virus (HIV); malignant neoplasms; diabetes; mental and behavioral disorders; diseases characterized by high blood pressure.

Diseases that pose a danger to others include: a disease caused by the human immunodeficiency virus (HIV); viral fevers transmitted by arthropods and viral hemorrhagic fevers; helminthiases; hepatitis B and C; diphtheria; infections transmitted predominantly sexually; leprosy; malaria; pediculosis and other infestations; glanders and melioidosis; anthrax; tuberculosis; cholera; plague.

Mental disorders and behavioral disorders.

An illness caused by the human immunodeficiency virus (HIV).

Diabetes.

Malignant neoplasms.

Tuberculosis.

Hepatitis.

Infections transmitted primarily through sexual contact.

Diseases caused by high blood pressure.

The concept of "socially significant diseases".

An elementary analysis of the phrase “socially significant” shows that the diseases of this group are of great importance for society and pose a threat to a large number of people. The concept of socially significant diseases includes a number of diseases that carry the greatest threat to the well-being of the country's population. The main features included in the concept of a socially significant disease are:

The mass nature of the disease, that is, a high percentage of the spread of the disease among the population, including the presence of a significant percentage of "hidden" patients in society,

High rates of annual increase in the number of patients, diseases of this group tend to spread quite quickly,

limiting the full functioning of the patient in society in the presence of such a disease,

risk of illness to others

infectious and non-infectious.

In addition, diseases belonging to this category not only destroy the health and body of a person, but also have negative social consequences: the loss of family, friends, work, livelihood, etc. A characteristic feature of such diseases is that they take away in the bulk of the life of young people, people of working age. An important feature of socially significant diseases is that if you know how not to get sick and follow certain rules, then the disease can be prevented or stopped at an early stage of the disease.

The situation with the spread of diseases of this group has become so acute that it causes concern at the level of the government of the Russian Federation. Epidemiological observations served as the basis for compiling list of socially significant diseases. In accordance with Article No. 41 of the Fundamentals of the Legislation of the Russian Federation on the protection of the health of citizens, the Government of the Russian Federation approved a list of diseases that are classified as socially significant. (Decree of December 1, 2004 N 715 "On approval of the list of socially significant diseases and the list of diseases that pose a danger to others"). This list includes: a disease caused by the human immunodeficiency virus (HIV), tuberculosis, hepatitis, sexually transmitted infections, diabetes mellitus, malignant neoplasms, mental and behavioral disorders, diseases characterized by high blood pressure.

Order of the Ministry of Health and Social Development dated October 7, 2011 No. 1154n approved the distribution of subsidies provided in 2011 from the federal budget to the budgets of the constituent entities of the Russian Federation for co-financing the activities of regional programs implemented at the expense of the budget of the constituent entity of the Russian Federation, within the framework of the federal target program "Prevention and control of socially significant diseases (2007-2012)”, in order to financially cover the costs of improving the provision of specialized medical care:

With diabetes mellitus;

With tuberculosis diseases;

With oncological diseases;

In case of diseases with sexually transmitted infections;

With diseases of mental disorders;

In diseases of arterial hypertension;

In case of HIV-infection;

In cases of viral hepatitis.

The inclusion of a certain nosology in the list of socially significant diseases depends on a number of national, cultural and economic factors. For example, in Japan, diabetes is a common but not socially significant disease. Drug provision and education of patients is organized in such a way that their average life expectancy is not lower than that of a person who does not have diabetes. Tuberculosis is a serious problem for Russia, many countries in Africa and Asia, and in countries North America the prevalence of the disease is low.

35% is currently the proportion of complications in diabetes mellitus. Amputation of limbs was subjected to 1% of patients. In total, for the first time during the year, 38.6 thousand people were recognized as disabled due to diabetes.

The incidence of cerebrovascular disorders (cerebrovascular diseases, including stroke) due to arterial hypertension is 5776 cases per 100,000 thousand of the population, mortality is 325 cases per 100 thousand of the population.

The number of newly registered cases of HIV infection has reached 37.7 thousand, in correctional institutions of the Federal Penitentiary Service - 2 thousand cases. The proportion of HIV-infected pregnant women included in the program for the prevention of HIV infection in newborns was 75%.

The incidence of acute viral hepatitis B and C reached 8.6 and 4.5 cases per 100 thousand of the population, respectively, chronic viral hepatitis B and C - 51.4 cases per 100 thousand of the population.

Socially significant diseases, and even more so diseases that pose a danger to others, affect public interests. Here, a conflict is possible between private interests, the realization of the will of individuals (to be treated or not) and the interests of society. Finally, the state interests are the interests, the bearer of which is the state. The representatives of these interests are the competent state and other authorized bodies.

Today, the incidence rate is so high that, according to many epidemiologists, sociologists, hygienists, and others, in order to reduce the social significance of diseases in this group, in addition to all of the above, it is necessary to ensure:

The full functioning of the individual in society in the presence of a disease.

Reducing the number of "hidden" patients and guaranteeing the absence of a significant number of such patients in society (by improving the quality of diagnosis in the first years, the number of officially registered patients will certainly increase, however, in the end, the social significance of the disease will be reduced due to a decrease in the number of fatal and seriously traumatic outcomes of the treatment of the disease, due to the start of treatment at an early stage, for example, cancer patients).

So, socially significant diseases are a group of diseases that pose a threat modern society. Today, the situation with the spread of socially significant diseases is very serious, requiring the consolidation of many structures, not only state, medical, pedagogical, but also voluntary. Volunteering has great potential in organizing primary prevention, the essence of which is to expand hygiene knowledge among young people, the formation of health-saving behavior strategies in situations associated with the risk of infection or the onset of the development of the disease.

Consider some of the most common and dangerous diseases from the above list, included in the 1st and 2nd group.

2. Mental and behavioral disorders.Psychic disorders pose a serious threat to the social well-being of people. More than 450 million people in the world suffer from mental or neurological disorders. About a quarter of the population, both in developed and developing countries, suffer from some form of mental disorder at some time in their lives.

There are currently 120 million people in the world with depression, 37 million with Alzheimer's disease. About 50 million suffer from epilepsy and 24 from schizophrenia. At the same time, according to WHO, 41 percent of countries do not have a developed policy on mental illness, and 25 percent of countries have no legislation on this issue. Two-thirds of governments allocate no more than one per cent of the health budget to psychiatry.

Today, the World Health Organization notes the trend of an increase in the number of mental illnesses in society. Some experts attribute this phenomenon to the unstable socio-economic situation in the country. According to official data, in Russia today there are 6 million people with mental problems. According to medical statistics, since the 1990s, Russia has been among the top five countries with the highest number of suicides. The current epidemiological situation has led to the inclusion of mental disorders in the list of the most significant social diseases. The highest level of primary incidence of mental disorders, especially borderline pathology, is observed in adolescence. This is due to the fact that at this age each individual experiences the action of two natural, but not unambiguous processes: intensive socialization of the personality and active physiological restructuring of the body. So, in particular, a serious problem adolescence is insufficient social adaptation, manifested primarily in a high frequency of behavioral disorders - from increased conflict and lack of discipline to behavior, an obligatory and determining component of which is the commission of illegal actions.

To prevent the aggravation of the epidemiological situation, society needs to realize its seriousness. To do this, people must have reliable information about these diseases.

Depression(lat. deprimo "pressure", "suppress") is a mental disorder, a disease that is characterized by a decrease in mood, loss of the ability to experience joy, impaired performance.

Symptoms of depression very extensive and vary depending on the severity of the disease. It's safe to say that depression is a disease of the whole organism. The most common symptom of depression is low mood. Very often, a person suffering from this disease experiences sadness, a sense of hopelessness, anxiety and fear, guilt and anxiety. He becomes irritable, withdraws into himself, minimizes or does not communicate at all with friends and loved ones. A person ceases to enjoy previously pleasant activities. He has reduced self-esteem, lost interest in life, in hobbies, in favorite hobbies. Life becomes as if colorless and flat. From the physiological side of the manifestation of a depressive state - feeling of constant fatigue. A person quickly gets tired even after those things that he previously coped with easily. Often he experiences constant fatigue, i.e. as if he did not rest at all, and a short rest does not give the desired effect, sexual desire decreases. There may be such bodily disorders as: headaches, malfunctions in digestion, heart function, and other pains are possible. A depressed person often suffers from sleep disturbances. He cannot fall asleep for a long time in the evening, or vice versa, he finally wakes up too early in the morning. Decreased appetite or vice versa, there is overeating.

neuroses- the most common type of painful conditions caused by the influence of psychotraumatic factors; they are characterized by obsessive states, hysterical manifestations, etc., a critical attitude towards them, the preservation of consciousness of the disease, the presence of somatic and autonomic disorders.

Neurosis(or as it is also called a neurotic disorder) is the general name for a group of certain functional psychogenic reversible disorders. Neurosis has a direct tendency to a protracted course. To date, neurosis is characterized by a decrease in mental and physical performance. Most often it manifests itself in the form of hysteria or variants of obsessive behavior and is an asthenic condition of a person. Neurosis is directly related to the state of the nervous system, and if a person has experienced any strong feelings, stresses, or had some other effect on the nervous system, then the likelihood of a nervous system increases. As practice shows, neurosis, most often, occurs due to strong stressful situations. It is stress that causes the exhaustion of the nervous system, as a result of which the heart rhythm is disturbed, as well as the work of the stomach and other organs.

The main causes of neurosis:

Strong physical or mental stress, expressed in constant work, without the possibility of rest for a long time. The emergence of a permanent, i.e. chronic stress, as well as a strong emotional experience associated with problems in his personal life. The combination of these factors gives a double effect of the development of neurosis.

Severe exhaustion of the nervous system due to the inability to perform a certain task, or solve a problem that has arisen.

· Busy work schedule, without the possibility of rest, or inability to rest.

· Congenital tendency to rapid fatigue, and then overwork.

Abuse of alcohol or drugs.

The presence of concomitant neurosis diseases that greatly deplete the body, and in particular the immune system.

The main symptoms of neurosis. Symptoms of neurosis are divided into mental and somatic. Mental symptoms include:

· Emotional stress, often manifested in the form of obsessive thoughts and obsessive actions that appear for no apparent reason.

· Acute reaction and unpreparedness for stressful situations. If some people react to this with tearfulness or aggression, then with neurosis, a person develops obsession and isolation. Constant worries and anxieties for no apparent reason. Perhaps the development of phobias.

· Rapid fatigue, chronic fatigue.

High sensitivity to sudden changes in temperature, as well as to bright light and very loud sound.

The appearance of complexes about their communication, low or too high self-esteem.

Changeable mood, depending on trifles. Strong irritability.