Vol. 5 No. 5 (2016): VESTNIK of KSMA

The article gives estimations of prof. Aidaralievs A.A. work as a scientist, health organizer and education.

The article presents the current state and prospects for the development of public health in the example of training at the IHSM. At the source of science was a founder of the national social hygienist and health care organizations, medical historian, a prominent scientist, Professor Akmatbek Aidaraliev.

This article provides a brief analysis of the current situation in the country's health system, the direction for the development of public health strategies. The characteristics of the world's health care model, which is the most effective: the market, the state or social insurance? It proved widely used method of economic analysis in the health system.

This article reflects the results o f specific indicators and structural reforms that have been achieved through the implementation o f the healthcare development program "Salamatty Kazakhstan" for 2011-2015. These are: the increase in life expectancy, decrease maternal and infant mortality, reduced growth rates o f tuberculosis, implementation o f modern instruments o f management and financing, etc. In connection with the successful completion
o f the program "Salamatty Kazakhstan" for 2011-2015 was developed and adopted a new program o f healthcare development o f the Republic of Kazakhstan "Densaulyk" for 2016-2020. The program "Densaulyk" will be directed to consolidate and develop the achievements and challenges in the protection o f health in accordance with new challenges and will be the basis for the systematic development o f the sector until 2050.

The article describes the basic model o f modern health care system development occurring in the world. The characteristics and challenges faced by the compulsory medical health system existing in Russia. We give modern Russian health problems and their solutions.

The science o f medical errors is today one o f the priorities o f modern medical science to build the system evaluation o f quality health care. The most important aspect is to determine the adverse outcomes o f medical care and the formation o f the list. All cases o f medical assistance to the poor outcome should be subject to expertise. Medical errors are a common cause o f adverse outcomes. Origin all medical errors can be divided into medical errors, system errors and medical errors associated with system.

The modern stage o f development o f the Russian society affected zero the whole health system. On the one hand, there is a lot o f new requirements to quality o f care, on the other, the financial situation in health care is deteriorating. State medical institutions are in a difficult position, the reality confronts them with the task o f seeking ways o f improvement. Objective components o f activities o f medical institutions (economic, social, political) is difficult to change, can affect the subjective component (the team, his potential, leadership effectiveness). This raises the problem o fmanagerial improvement.

One of the conceptual challenges for realization ofpersonnel policy ofpublic health is "the reform of the personnel health service in accordance with the principles and requirements of the modern theory of scientific management of human resources".
The concept States that the problems of personnel management must be addressed by modern technologies of recruitment and diagnostic staff, competent placement of personnel subject to the requirements of the workplace and potential worker, providing professional growth of the employee.
One important task is the study of the professional characteristics of various groups of healthcare professionals and development of proposals on optimization of the human resources management, public health and health care.

This article discusses the issues of continuing medical education with using distance technologies on example of Institute of upgrading qualification of FMBA. It point out the availability of distant education, its benefits and the necessity for its widespread introduction. Observed that the necessity for rehabilitation and expansion of interstate relations in the sphere of medical postgraduate education is important.

Establishment and development of Ophthalmology in the Kyrgyz Republic fall within the period of pre­revolutionary Russia and the USSR. The Board of Trusteeship of blind of Saint - Petersburg and People’s Commissariat of Public Health of the Russian Soviet Federated Socialist Republic played an important role in it. Training of own Ophthalmological Personnel started from 1939, when there was organized the eye clinic. The founder of the Ophthalmological Service of the Republic was professor O.A. Dudinov.

The main problem of the elderly in Tajikistan is health, which restricts or eliminates their active life. Purpose of the study was assess the socio-hygienic aspects of the main indicators of the health of elderly in Tajikistan. We used report forms of health facilities, State Service of Medical and Social Expertise and the statistical agency for 600 elderly for the period 2010-2014. In the structure of morbidity first place among classes of diseases were 34.2% of cases of diseases of the circulatory system. In second place were diseases of bodies of digestion (15.1%), followed by diseases of the musculoskeletal system and connective tissue (13.2%), diseases of the endocrine, nutritional and metabolic disorders (11.3%), respiratory diseases (10.5%). The proportion of listed types of pathology in general morbidity structure amounted to 73.8%. In conclusions, in old age, the structure of morbidity changes by reducing the number of acute diseases and an increase in the number of diseases associated with progression of chronic pathological processes.
 

Training of health care managers is relevant in Russia. It increases the level of validity in decision-making management while ruling medical institutions of all forms of ownership and raises the efficiency of their work.

The paper presents the results of the analysis of incidence and materials a questionnaire survey of General practitioners (family medicine) outpatient institutions of Almaty. During 2013-2015. marked increase in morbidity with temporary disability of General practitioners from 62.4 to 91.6 cases of disability, days of disability from 399,4 to 769,4; the average duration of one case of incapacity for work - from 6.4 days to 8.4 days. It was found that among the reasons of temporary disability from General practitioners proportion of "disease" is significantly higher than the control group, as well as in the number of cases in the primary group exceeds 1.5 times higher than in the control group. The results of the study indicate the need to adopt comprehensive measures
to overcome the reasons for the low level of medical activity, especially in the stage o fforming of chronic pathology in young specialists after graduation from medical school.

At watch workers and military personnel at short-term and prolonged activity in high mountain (3600 m above see level) have been researched adaptive alterations of the external breathing parameters including correlation o f duration and speed of inspiratory and expiratory capacities. It is shown that on the stage of the prolonged (1,5 - 2 years) work on high altitude adaptation changes in the system of the external breathing of military personnel takes place due to the frequency components of respiratory act, and at watch workers in the increase o f volume characteristics o f respiratory pattern. As a result o f it the military personnel have been significantly less respiratory reserve than the watch workers at the same stage.

The red marrow at 17 adult people (corpses) was studied. A red bone marrow is the central hemopoesis organs body, where self-supported populations o f stem stromal cells and haemo poetic stem cells stay. Quantitative analysis o f o f stem stromal cells was done on myelograms received from dabs. In our research myelograms showed increased segmented and young lymphocytes and decreased number o f number o f erythroblasts and granulocytes at inhabitants o f Karabalta. These changes can be explained by the influence o f exogenous, endogenic and demographic factors.

The article presents the results of investigations of immune status and natural resistance in experimental animals after administration of tactivin in different periods of adaptation to the conditions of the highlands. Introduction of tactivin into the animals especially on the 5th day of adaptation prevents the development of hypoxia-induced immunodeficiency.

Case-control study was conducted in rural regions of Armenia with the most intensive arable land cultivation. Patients with malignant tumors of different localization as case group and residents matching by sex, age, place of residence, etc. as control group were selected. Nested study was implemented with analysis of phytotoxic activity of environmental objects. Strong correlation between assortments of pesticides, their amounts and cancer morbidity wasn’t revealed, as well as differences in mutagenic burden of environmental objects in case and control groups were not proved. Meanwhile, certain phytotoxic activity was registered in both groups. However, application methods, storage of pesticides, reentering or harvesting periods are considered as factors contributing to development of malignant tumors.

This article provides an overview of the results of studies published in recent years on the hygienic assessment of the working o f environment of health professionals working with cytostatics. The data demonstrated the risk of contamination of workplace air and surfaces by cytostatics. The necessity of hygienic assessment of working conditions in oncology clinics in Kyrgyzstan is given.

The article presents the hygienic assessment of the prevalence of parasitic infections and the acute bacterial intestinal infections among residents of Kyzylorda and Karaganda regions. The data of a retrospective analysis of bacterial and parasitic pollution of objects in the Kyzylorda and Karaganda regions for the years 2004-2013 and the results of their own research of contamination of the environment by parasites.

The article presents research data monitoring health and demographic indicators in the region of nuclear test field "Azgyr", located in the Republic of Kazakhstan. Thus, health and demographic situation in the study area is characterized as unfavorable. The dynamics observed decrease in the proportion of the child population and reproductive age of women. The percentage of these categories of the population in 2015 was lower than in the country, region, district, and control. Although in 2006 there was a different picture. However, there is a decrease of natural population growth in the period, mainly due to lower birth rates. The general level of natural population growth is significantly lower than in the country, region, district and the control rural district.

Summary. Providing the population with quality drinking water is currently one of the most pressing problems.
Purpose of the study. To assess the state of drinking water supply in Tajikistan and existing strategies to improve it.
Materials and methods. Use the results of surveys of 346 water supply facilities and laboratory studies of drinking water CGSEN republic for 2005-2015.
Results and discussion. On average in the country providing the population with drinking water from centralized water supply systems is 58.1%. In 2006 approved by the National Programmer for the Advancement of providing the population with clean drinking water RT for 2008 - 2020g.g.
Conclusions. In the whole country, the provision of safe drinking water is low, especially in rural areas. Positive changes in the provision of drinking water will create a satisfactory social and household and sanitary-epidemiological conditions and quality of life.

Mutagenic hazard of xenobiotics circulating and contaminating the environmental media is proven by numerous researches. Nowadays the issues relevant to the environment quality, safety for human health are of keen interest. Considering the significance of mentioned topic the assessment of existing pollution levels of the environmental objects (soil, sludge) was done for premountain region of Armenia (marz Lori), based on monitoring data of organochlorine pesticides (DDT, DDE, DDD, Y-HCH), surfactants, as well as monitoring of possible mutagenic components.
It was shown that relatively high levels and determination frequency of pollutants were registered in the environment samples of Spitak region. At the same time it should be mentioned that existing levels of organochlorine pesticides do not exceed the hygienic standards.
On the basis of complex assessment of research results, namely study of phytotoxic activity, levels of both organochlorine pesticides and surfactants, as well as frequency of their determination, relatively low indices were obtained for Stepanavan region that makes it more attractive for expansion and development of remedial and health-improving programs.

Resume. It has been developed and put into practice 55 health organizations (HO) Bishkek effective and safe medical waste management system (WMS), focused on the hazardous medical waste (MW). For disinfection of infected MO under the effective regime, WMS has been developed system of autoclaving in the VC-75 gravity autoclave. Designed WMS system contributes to a decrease of 36,4% in the consumption of disinfectants used for the disinfection of HO MW, and a decrease in infected MO volume by 8%, resulting in lower costs for their remediation. Also part of the handing over plastic syringes recycled within the framework developed by the WMS system, HO Bishkek receive additional funds to maintain the system WMS system.

The toxic effects of exposure to antimony examined in 100 workers. Disorders of nervous, cardiovascular, respiratory and digestive systems and skin lesions were revealed. 35 of them diagnosed occupational chronic antimony poisoning. Preventive measures are recommended. 

The mechanism of formation of pathological violations depends on influence of harmful production factors and adaptation opportunities of various functional systems of an organism. The assessment of professional risk taking into account an exposition of adverse factors of production and indicators of a state of health of workers is directed on forecasting of risk of development of occupational diseases and development of a complex of administrative decisions on optimization of work and preservation of labor longevity of workers of harmful productions.

Due to annual medical examination determined proportion of occupational and work-related diseases, selected groups for annual clinical check-up, substantiated of justifying the rehabilitation measures of workers in harmful industry.

The article presents results of peculiarities of bone metabolism in patients with chronic occupational intoxication by phosphorus compounds according to radiological and biochemical investigations. The results of the study showed that not all patients were found changes in the bone density, the severity of them was different, were two groups of patients: 1 - persons with normal bone density; 2 - individuals with reduced indicators of bone density. Depending on bone density was studied the characteristics of biochemical markers of bone metabolism, the results of which should be considered when carrying out medico-social examination this group of patients with occupational intoxication.

The article presents the analysis of the existing services for prevention of occupational diseases in Kazakhstan.
Analyzed legal documentation for the organization of occupational therapeutic service, and the health of the working population in the country. The analysis of possibilities of creating new forms of medical provision and maintenance of services for the protection of workers ' health in the primary stage of health. Consider the training of highly qualified medical staff on occupational diseases in the framework of continuous professional education: at undergraduate and postgraduate levels. Given appropriate recommendations to improve the occupational medicine services in the Republic within the framework of the recommendations of WHO and ILO and for the revision of the state educational standards RK on educational programs: undergraduate, internship, residency, master's and doctoral programs.

The article presents new information on the use of an inhibitor of leukotriene receptor - Montelukast (Singlon) in the treatment of atopic dermatitis in children.

Familial Mediterranean fever (FMF), known as well as periodic disease, is autosome-recessive hereditary disease clinically expressed in acute episodes of fever associated with serositis and amiloidoses. FMF rate is highest in Armenians and Jewish but spread widely across the world. FMF pose the serious social-medical problem for Armenian public health due its prevalence, medical, social and economic consequences. In view of hereditary nature of disease and absence of means of specific prevention genetic testing and consulting of young families are recommended.

A retrospective analysis of case histories for the period from 2011 to 2015, identified 461 patients with glaucoma. The ratio of patients with open and closed-angle glaucoma is 78.7% (363 patients) and 21.3% (98 patients), which is different from the other Central Asian data. Glaucoma is diagnosed mainly in advanced stage, by patients in high age; intraocular pressure compensation in the outpatient service does not often achieved. This problem in the Kyrgyz Republic requires further study and improvement of management system.

The paper shows the efficiency of the method of ultrasound imaging to reduce the number of complications of percutaneous transhepatic endobiliary interventions in obstructive jaundice. The authors performed a puncture of intrahepatic bile ducts under the control of ultrasound imaging in a different modes with subsequent X-ray control. The use of ultrasound imaging for percutaneous transhepatic endobiliary interventions in patients with obstructive jaundice is an effective and safe method for the selection of the bile duct of the target and perform the puncture.

Investigations aimed at the study of certain organochlorine pesticides (OChP) levels in rural female population, as well as their possible unfavorable impact on pregnancy, delivery course and indices of physical development of newborns and infants were done in Aragatsotn marz (province) of Armenia (2005-2008). Face-to-face interviews by a specially developed questionnaire were conducted and chemical determination of OChP (y-HCH, DDT, DDE, DDD) in breast milk was done by gas-liquid chromatography method (n=120).
Significant differences in levels of both certain OChP and their sum in subject to delivery order were not recorded. Total amount of OChP in primipara in comparison with secundipara was slightly higher (11%). Indices of physical development of newborns by sex (boys, girls) and delivery order, as well as infants in subject to OChP levels in mother’s breast milk did not differ significantly.
Comparative analysis of OChP content in the breast milk samples of rural female population (Aragatsotn marz) versus results of the same research conducted in urban area (Yerevan) showed significantly high concentration of certain OChP (DDT, DDD) in rural area.

The present paper is a segment of research on the problem of child disability in Republic of Armenia dedicated to medical and statistical analysis of some aspects of the mentioned phenomenon. As a research data RA Ministry of Labor and Social Affairs Medical and Social Expertise Agency data about disabled children in age group 0-17 years old registered in the Republic were used.The results of the study revealed high variability of as crude as well as cause-specific disability rate in some regions (marzes) of the Republic. According to the results diseases of nervous system tоок the first place among all causes of child disability in all age strata.The second place in age group 0-4 Шок congenital abnormalities. In older age groups as a second and third leading causes of disability mental and behavioral disorders and congenital abnormalities were detected.
The obtained data will be very useful for the development of the set of science-based measures directed to the reduction of children’s disability in the Republic and improvement of the system of medical and social assistance for disabled children.