卷 61, 编号 1 (2017)

The article considers economic menaces of demographic crisis of human resources in Russia induced by annual reduction of able-bodied population by 1 million. It is demonstrated that one of causes of crisis are cascade reactions due to decreasing fertility by 1 million of children from the early nineties. The inadequacy of common solutions for normalizing of established situation is stated. The possibility of annual increasing of numbers of able-bodied population up to 700-800 thousand is substantiated the expense of decreasing of disability and mortality. The innovative strategy of prevention of non-infectious and occupational diseases is developed based on management of health reserves in individuals with high risk. To implement this strategy a four-stage system ofpersonalized prevention is proposed that is implemented by doctors in polyclinics and by medical social workers in health offices on-the-job places. The important role of trade unions in supporting collective and individual health-improving activities at enterprises.

The shortcomings of functioning of ambulatory polyclinic service and overrated volume of provided emergency medical care became actual propblemin primary medical care support of population in small towns due to age structure of population.
Purpose of study. To investigate dynamics of age structure of out-patient visits and calls of emergency care by population of small town in 2011—2015.
The analysis of out-patient visits and calls emergency care in 2011—2015 demonstrated that during five years number of visits to polyclinic decreased up to 5.3% mainly (14%) at the expense of residents of able-bodied age while number of patients of junior and senior able-bodied age increased on 1.5% and 5.1% correspondingly.
The analysis of calls of emergency medical care revealed shortcomings in organization of ambulatory polyclinic care: more than a half (70.4%) of all calls because of instant diseases and conditions falls on the period of working hours of polyclinic (from 8 to 20 h.)
The occasion of call by population of junior able-bodied age in 68.7% became acute diseases of respiratory organs (acute respiratory viral infection — in 93.6%) and by patients of senior ablebodied age in 72.6% — exacerbation of chronic pathology (ischemic heart disease, hypertension disease). The correction of these calls could be implemented by ambulatory polyclinic service itself. The acquired data corresponds to publication data and indicates to existing problems of primary medical care support of rural population in various regions of the Russian Federation.
The investigation of age structure of out-patient visits, calls of emergency medical care of data of sociological survey of respondents revealed shortcomings in organization of functioning of municipal polyclinic related to population of senior able-bodied age that result in increasing of volume of work implemented by teams of emergency care.

In places of imprisonment of Russia the system of registration and monitoring ofpatients is the same as in civil health care. This system includes data on detection, diagnostic, treatment and dispensary observation of socially significant diseases. The obtained information is summarized with data concerning civil population and then is passed to Ministry of Health of the Russian Federation and profile research institutes within the framework of common federal and sectoral report forms. The systematic medical examinations, intensification of activities of infection control, support of effective treatment and coordination of measures between Ministry of Justice of Russia and Ministry of Health of the Russian Federation, international partners favored dramatic decreasing of indicator of morbidity of contingents ofpenitentiary system (up to 2.7 times during 1999-2015). Nowadays, the epidemic situation on tuberculosis in institutions of the penal executive system can be characterized as stable and controlled and having tendency to amelioration. Overall, as compared with Russian national average indices (2015), in places of imprisonment morbidity is higher: with tuberculosis 19,4 times, HIV-infection - in 26,9 times, syphilis - in 8.9 times. Among primarily registered patients of Federal penitentiary service of Russia in investigative isolation ward s in 2015 were detected 46% with tuberculosis, 84.6% with HIV-infection, 96.6% with syphilis. The number of patients infected with HIV-infection in contrast with tuberculosis has no tendency to decreasing in places of imprisonment. In 2015 percentage of infected individuals in institutions of the Federal penitentiary service of Russia began to increase in the structure of morbidity of HIV-infection in Russia in general. The cause of death of deceased with combined pathology (tuberculosis + HIV-infection) is HIV-infection mainly because almost in 90% HIV-infection has late stages. This indirectly testifies presence ofproblems related to detection of infection socially significant diseases among socially deadapted persons in civil health care.

The register of patients with diabetes mellitus is appropriate to implement for specification of diagnoses of death of persons registered in this registry. The new version of "The record chart of registration and monitoring of patient with diabetes mellitus" increased information value of register for verifying causes of death at the expense of adding indices of organization of observation of diabetes mellitus and concretization of complications of diabetes mellitus. The information concerning development of complications of diabetes mellitus including the forms the most dangerous for life is very important for rectifying chain ofpathological conditions resulted in death and as a consequence proper determination of initial cause. However, a number of informational and organizational problems are to be resolved to implement information about patients with diabetes mellitus (and other chronic diseases) with purpose of verifying causes of death. First, it is reasonable to make information of specialized registers available to medical specialists providing medical care related to other diseases. The easiest way of searching patient in various registers and data bases is on the basis of one’s personal number of insurance certificate and individual taxation number. The application of two authenticators increases validity of the system of medical information interchange. Second, corrections are to be made in register ofpatients with diabetes mellitus. To correct the record chart of striking individuals with diabetes mellitus off the register can be implemented by two ways. One, to leave empty fields in column "immediate cause of death" and to add subsection "initial cause of death" transferring points of subsection 3.5 to the new subsection. Two, to substitute name of subsection 3.5 with "initial cause of death". Hence, the column "diseases that favored coming of death" is unnecessary in the register of patients with diabetes mellitus.

The research institute of medical problems of the North, Krasnoyarsk, 660005, Russian Federation The absence of information concerning features of health and social characteristics of members of families in the nidus of respiratory clamidiosis became the reason of carrying out present research study. The article presents characteristic of medical social condition of members of families of patients with diseases of upper section of respiratory tract associated with chlamydia contamination. The sampling consisted of 87 families, 44 out of them with patients with verified clamidiosis (main group) and 43 families of ENT patients with unconfirmed respiratory clamidiosis (control group). The total number of families membership made up to 245 individuals. The diagnostic of clamidiosis was implemented using complex of laboratory techniques (direct immunofluorescent and enzymelinked immunosorbent assays, polymerase chain reaction). The evaluation of medical social condition of members of family was implemented using questionnaire technique. The genuinely developed questionnaire included sections concerning health condition, health risk factors and social characteristic of members of families of ENT patients. The study resulted in establishing high degree of contagiousness of chlamydia infection in the nidus of respiratory clamidiosis. It is demonstrated that in the family nidi of respiratory clamidiosis the members of family frequently and long-time ill with acute diseases and suffering from chronic pathology of various organs and systems prevailed. In these families, also chronic pathology of ENT-organs was diagnosed more frequently due to more \number of members of families with diseases of throat. In the nidus of respiratory clamidiosis number of families with "good nutrition" was significantly less and number of families considering degree of their social well-being were significantly more. Thus, the study results demonstrated that medical and social condition of families with nidus of respiratory clamidiosis is significantly worse s compared with families without such a nidus.

The migration situation in Russia is characterized by presence of significant number of foreign citizens, including those who are working without official registration and evidence of examination for tuberculosis and other infections. In connection with that, attention is to be paid to propositions concerning organization of preventive examination for tuberculosis in the departure country i.e. medical examination of potential migrants according Russian standards on the basis of local medical institutions. The article presents review of data of official statistics concerning migration and prevalence of tuberculosis including scientific publications about analysis of international experience of organization and implementation of preventive examinations in the departure countries. The experience of implementation of medical examinations of migrants in number of departure countries demonstrates that these programs permit focusing efforts on diagnostic of tuberculosis in one of risk groups hence achieving comparatively high degree of reliability of results and providing economic significance. In the context of conditions in Russia and accounting international experience two scenarios are proposed of implementing preventive examinations for tuberculosis in departure countries: with and without introduction of requirement of preliminary medical inspection of working migrants.