Current issues of disability and rehabilitation of elderly and senile patients with lower limb loss due to vascular pathology

Большинство пациентов с ампутационным дефектом нижних конечностей являются гражданами пожилого возраста с высокой ко- и полиморбидностью, наличием нескольких гериатрических синдромов, что неблагоприятно влияет на прогноз, снижает реабилитационный потенциал, в ряде случаев приводит к развитию сердечно-сосудистых осложнений, ампутации второй конечности, тяжелой инвалидизации и высокой послеоперационной летальности. Ключевым звеном процесса реабилитации инвалидов с культей нижней конечности является обеспечение их функциональным протезом. В статье приведен анализ заболеваемости, первичной инвалидности в период 2015-2019 гг., гендерных, возрастных и клинических характеристик пациентов, проживающих в Санкт-Петербурге, которым выполнена ампутация нижней конечности вследствие сосудистой патологии. Установлено, что отсутствует информация о выживаемости пациентов после проведения ампутации в различные сроки постгоспитального периода в Санкт-Петербурге. Выявлен выраженный дисбаланс между количеством выполняемых ампутаций нижних конечностей ежегодно и количеством обращений инвалидов в бюро медико-социальной экспертизы для обеспечения техническими средствами реабилитации и направлением на первичное протезирование, реабилитацию. The majority of patients with amputation defect of the lower extremities are elderly citizens with high co- and polymorbidity, the presence of several geriatric syndromes, which adversely affects the prognosis, reduces the rehabilitation potential, in some cases leads to the development of cardiovascular complications, amputation of the second limb, severe disability and high postoperative mortality. The key link in the rehabilitation process of disabled people with a lower limb stump is to provide them with a functional prosthesis. The article provides an analysis of morbidity, primary disability in the period from 2015 to 2019, gender, age and clinical characteristics of patients living in St. Petersburg who underwent amputation of the lower limb due to obliterating artery diseases is presented. It was found that there is no information on the survival rate of patients after amputation at various times of the post-hospital period in St. Petersburg. We have identified a pronounced imbalance between the number of lower limb amputations performed and the number of applications of disabled people to the bureau of medical and social expertise for providing technical means of rehabilitation and referral to primary prosthetics.

Role of zoledronic acid in treatment of osteoporosis and prevention of fractures

Introduction. One of the causes of primary disability and high mortality, among patients with osteoporosis, are fractures that occur with minimal trauma, as a rule, it is a fall from the height of one’s own height. The final link in the chain of preventive measures to reduce the frequency of osteoporosis and fractures on its background is the introduction of pharmacological correction of bone deficiency into the practical activity of an orthopedic traumatologist. Currently, there are several drugs that can change the disturbed metabolism. For example, the use of zoledronic acid significantly reduces the risk of fractures.Aim: to study the effect of zoledronic acid on bone mineral density in patients with osteoporosis complicated by a fracture of proximal end of the femur.Materials and methods. In a prospective cohort study, 14 patients received zoledronic acid for 2 years.Results. When comparing BMD L2-L4, it was revealed that a year after the start of treatment, its increase relative to the baseline value was 4.6%, but was statistically insignificant (0.86 ± 0.078 g/cm2 versus 0.90 ± 0.08 g/cm2, p > 0.05). After 2 years of treatment, the BMD of this segment increased, relative to the baseline values, by 12% and the differences became statistically significant (0.86 ± 0.078 g/cm2 compared to 0.97 ± 0.076 g/cm2, p < 0.05). The increase in BMD for the second year of treatment by 6% was statistically significantly different from the increase for the first year of treatment (0.90 ± 0.08 g/cm2 compared to 0.97 ± 0.076 g/cm2, p < 0.05).A comparative analysis of the basic units of the IPC hip after 1 and 2 years of treatment did not reveal significant differences: 0.7075 ± 0.046 g/cm2 compared to 0.7079 ± 0.034 g/cm2 and 0.70751 ± 0.046 g/cm2 compared to 0.6630 ± 0.97 g/cm2, p > 0.05. In any case, for 2 years not marked new vertebral body fractures. Only one patient had a fracture of the radius in the distal third. The quality of life, after 2 years, significantly improved on the scale of “habitual daily activities” (p = 0.007), decreased indicators on the scale of “anxiety” and “depression” (p > 0.05).Discussion. The study confirmed that even in the presence of pronounced bone loss, pharmacological correction of impaired remodeling reduces the risk of new fractures and improves the quality of life.Conclusion. Pharmacotherapy with zoledronic acid, in our study, confirmed its effectiveness in the treatment of osteoporosis.

Features of Primary Ocular Disability in the Krasnodar Region in 2016–2018

Purpose: to study the state and dynamics of changes in primary ocular disability in the period 2016–2018 by nosological forms. A complete retrospective study was made based on the data of the MSE (medical and social expertise) Bureau’s reporting documents. The following indicators of primary disability (per 10 thousand population) were registered from 2016 till 2018: among the adult population (18 years and older) 69,0–70,7–68,6 respectively; among the able-bodied population 42,8–44,1–41,1 respectively; among the population of retirement age — 125,1–126,4–124,6 accordingly. In the structure of primary disability of the adult population by severity for the period 2016–2018, the dynamics recorded an increase in the proportion of 1 group and 3 group with a decrease in the share of disability of 2 group. In the nosological structure of primary disability of the adult population in 2016–2017–2018, eye diseases account for 3 %, 3 % and 3.2 %, respectively, of all first recognized as disabled. There has been an increase in first-time applicants to the MSE Bureau. In the nosological structure of primary disability, the percentage of glaucoma patients over the past period is 47–33–32.5 % of the total number of primary disability for eye diseases, which determines the 1st rank. There is a progressive increase in the number of people with disabilities due to glaucoma of group 1 and group 2 throughout the study period. In the nosological structure of primary disability for 2016–2018 the percentage of patients with retinal diseases is 25–23–23.8 % of the total number of primary disability for eye diseases, which corresponds to the 2nd rank. There is a progressive increase in the number of disabled people in group 2. A low proportion of persons of working age in the structure of primary ocular disability was noted. A consistently high share of primary disability and a progressive increase in severe disability combined with an increase in persons of retirement age in the Krasnodar region forms an unfavorable forecast for an increase in the number of blind and visually impaired residents of the region.

Analysis Disability Indicators Due to Malignant Neoplasms in Kyrgyzstan

In the structure of the first recognized by persons with disabilities, persons with disabilities take a leading position due to malignancies. In the implementation of measures for the prevention and rehabilitation of persons with disabilities, it is necessary to carry out a disability analysis with a view to taking measures to reduce it. In the Kyrgyz Republic as a whole, there is a downward trend in dynamics by year, with the exception of 2015 and 2018. The most dysfunctional situation has developed in the Issyk-Kul region, where the largest frequency of primary recognized persons with disabilities is annually noted, and in 2018 and 2020 in the Talas region. In the Issyk-Kul region, despite highly intensive indicators, in comparison with other regions, the dynamics showed a decrease in the frequency of primary recognized persons with disabilities in 2015 by −11.7%, in 2016 by −3.3%, in 2019 by −9.6%, in 2020 by −17.8% with zero growth in 2014 and 2017. The increase was only in 2018 by +6.8%. In the frequency of persons with disabilities due to neoplasms under medical supervision in health organizations, a multi-directional trend was revealed, which is characterized by an increase in all years, with the exception of 2017 and 2020. The highest level of persons with disabilities in all years by region of the republic was observed in the Issyk-Kul region. By year, there was an upward trend in the level of the indicator, with the exception of 2020. The analysis made it possible to identify regions with an unfavorable situation. These include Issyk-Kul, Talas, Osh, Chui, Naryn regions. The precarious situation dictates the need for effective prevention of primary disability due to socially significant pathology leading to disability.

Indicators of the need of disabled people for vocational rehabilitation activities

BACKGROUND: In the system of medical and social expertise and rehabilitation of disabled people, the solution of issues of employment, socialization, improvement of the level and quality of their life becomes obviously relevant. AIMS: To study and analyze the needs of disabled people in vocational rehabilitation, including employment and the creation of special jobs, in a comparative aspect - in St. Petersburg and the Russian Federation. MATERIAL AND METHODS. The materials of the study were data from Rosstat of Russia, official state statistical reporting: Forms 7-sobes "Information on medical and social expertise of persons aged 18 and older" for 20152019. RESULTS: The article analyzes the indicators of primary disability and the needs of disabled people in vocational rehabilitation activities based on the study of the individual rehabilitation or habilitation program (IPRA) for disabled people in Saint Petersburg and the Russian Federation in dynamics over five years (20152019). An analysis of the needs for vocational rehabilitation measures, taking into account its structure in IPRA (vocational guidance and employment) and the disability group, was carried out. Since the greatest difficulties arise in the selection and organization of jobs for people with disabilities of groups I and II, the needs of people with disabilities in creating a special workplace have been studied. The necessity of solving organizational, methodological, and financial issues when creating special jobs for the disabled is emphasized. CONCLUSION: The implementation of the state program "Accessible environment" and its subprograms aimed at creating models of employment of disabled people in the regions of the Russian Federation requires taking into account the territorial characteristics of the prevalence of primary disability and the specifics of the regional labor market in the employment of disabled people.

AGE-RELATED ASPECTS AND GENDER DIFFERENTIATION OF PRIMARY DISABILITY DUE TO THYROID CANCER IN THE ADULTS POPULATION OF MOSCOW

Представлены результаты анализа первичной инвалидности вследствие рака щитовидной железы у взрослого населения Москвы в период 2015-2019 гг. Выявлено увеличение численности впервые признанных инвалидами (ВПИ) вследствие данной патологии. В структуре первичной инвалидности по возрасту преобладали инвалиды пожилого возраста. Превалирующим гендерным контингентом ВПИ были женщины. Установлено, что в контингенте ВПИ преобладающее число инвалидов имели умеренную (II) степень выраженности нарушений основных функций организма. В то же время, выявлена гендерная дифференциация по тяжести стойких нарушений функций организма у инвалидов. В контингенте мужчин ВПИ удельный вес лиц с выраженной (III) и значительно выраженной (IV) степенью нарушения функции системы крови и иммунной системы и с выраженной степенью нарушения функции эндокринной системы и метаболизма был выше по сравнению с контингентом женщин ВПИ. Определено, что основными видами ограничений жизнедеятельности были ограничение способности к самообслуживанию, к трудовой деятельности, к передвижению и общению (преобладала I степень ограничений жизнедеятельности, p<0,05). Рак щитовидной железы в связи с быстрыми темпами роста заболеваемости и инвалидности является важной задачей охраны здоровья населения. Изучение показателей инвалидности у населения необходимо для разработки рациональных мер медико-социальной реабилитации больных, страдающих раком щитовидной железы, и для осуществления медико-социальной профилактики инвалидности. The results of the analysis of primary disability due to thyroid cancer of the adult population of Moscow in the period 2015-2019 are presented. An increase in the number of peaple newly recognized as disabled (PNRD) due to this pathology was revealed. In the age structure of primary disability elderly people was dominated. The predominant gender contingent of the PNRD were women. It was found that the predominant number of PNRD had a moderate impairment (II degree) of the basic functions of the body. At the same time, gender differentiation in the severity of persistent impairment of the body functions among disabled was revealed. In the contingent of disabled men the proportion of persons with severe (III degree) and complete (IV degree) impairment of the function of the blood system and the immune system and with a severe impairment of the function of the endocrine system and metabolism was higher compared to the contingent of disabled women. It was determined that the main types of capacity limitations were self-care, work, moving and communicate limitations (the first degree of difficulties in life areas prevailed (p<0,05). Thyroid cancer, due to the rapid growth of morbidity and disability, is an important public health concern. The study of disability indicators of the population is necessary for the development of rational measures of medical and social rehabilitation of patients suffering from thyroid cancer, and for the implementation of medical and social prevention of disability.

Analysis of statistical data on primary disability is the basis for planning measures for its prevention

The current stage of health protection and social protection of the population poses new challenges for the ITU institutions to improve the quality of expertise, address issues of disability prevention, and there is no doubt that statistical analysis still plays an important role in their implementation. Considering the issues of disability, the dynamics of a social phenomenon that has all the rights to public attention is reflected. Materials on disability and the activities of ITU institutions, when adequately analyzed and used, are an effective tool in the work of government bodies to organize and improve measures to prevent and reduce disability, improve expert and rehabilitation services for the population. The purpose of this article is to present one of the organizational forms of the work of the ITU Bureau for the study of the causes and factors that directly led to disability, the prevention of disability, taking into account the task set by the Ministry of Labor and Social Protection of the Russian Federation to the Federal State Institutions of Medical and Social Expertise.

SURVEILLANCE OF DISABILITY DUE TO OCCUPATIONAL DISEASES IN KARAGANDA REGION BETWEEN 2016 AND 2020

The paper presents the results of statistical studies of disability due to occupational diseases in the Karaganda region between 2016 and 2020. The analysis of disability due to occupational diseases was conducted using the automated information system called "Centralized Database of Persons with Disabilities" (CDPD). The structure of primary disability by the severity of groups, age and sex, the place of work of the affected workers has been studied.

Primary disability of the adult population of the Krasnodar Territory due to malignant neoplasms

According to the indicators of primary disability due to malignant neoplasms, the Krasnodar Territory belongs to the regions with an unstable trend, characterized by a pronounced increase in indicators over the past five years. During the twelve years studied in the territory of the region, there was a tendency to increase primary disability due to malignant neoplasms. One of the reasons for the increase in the level of primary disability is the late detection of malignant neoplasms by medical organizations of the region that provide assistance to the population on an outpatient basis. This is due to the lack of effectiveness of preventive examinations of the population, dispensary monitoring of patients with chronic precancerous diseases, insufficient oncological alertness of doctors of the main clinical specialties, as well as the citizens themselves.

Equity in Access: A Mixed Methods Exploration of the National Disability Insurance Scheme Access Program for the Kimberley Region, Western Australia

This study explored the process and early outcomes of work undertaken by a program to increase Aboriginal people’s awareness of, and access to, the National Disability Insurance Scheme (NDIS). This ‘Access Program’ was implemented through the Aboriginal Community Controlled Sector in the remote Kimberley region of Western Australia. Access Program staff were interviewed to explore the strengths, challenges, and future directions of the program. The demographics, primary disability types, and NDIS access outcomes for clients who engaged with the program in the first 12 months of its implementation have been described. The Access Program engaged with 373 clients during the study period and assisted 118 of these to achieve access to the NDIS. The program was reported as successful by staff in its aim of connecting eligible people with the NDIS. Vital to this success was program implementation by the Aboriginal Community Controlled Sector. Staff in these organisations held community trust, provided culturally appropriate services, and utilised strengths-based approaches to overcome barriers that have historically hindered Aboriginal people’s engagement with disability services. Our results demonstrate the Access Program is a successful start in increasing awareness of, and access to, the NDIS for Aboriginal people in the Kimberley region. Much work remains to assist the large number of Aboriginal people in the Kimberley region believed to be eligible for NDIS support who are yet to achieve access.