PATRONAGE (fr. patronage protection) — the form of organized scheduled maintenance which is carried out in house conditions by nek-ry treatment and prevention facilities (clinics for women, policlinics, clinics, out-patient clinics, medical and obstetrical centers, etc.).
P. is most widespread in institutions protection of motherhood and childhood (see). Its purpose is health protection of pregnant women, mothers and children. The item of a certain category of mentally sick provides an aftercare them in the conditions of a family, production labor collective (collective farm) under constant control to lay down. institutions, and P. inf. patients and convalescents — the prevention of a recurrence, complications and distribution inf. diseases.
The item in specialized clinics (oncological, tubercular, narcological, etc.) aims to control observance by patients of the recommended mode.
A special form P. is rendering the medico-social help to lonely and aged patients, disabled veterans and work; it is carried out about - you the Red Cross and Red Crescent (see. Union of societies of the Red Cross and Red Crescent of the USSR ).
In pre-revolutionary Russia P. of children was for the first time organized at children's consultations in Moscow, St. Petersburg, Kiev and nek-ry other large cities, but it could not have significant effect on improvement of health of children since the network of children's consultations was insignificant (see. Consultation ). The item of pregnant women in limited sizes for the first time began to be carried out to the USSR in the 20th. After the edition the Narkomzdravy USSR in 1933. «Instructions about work of consultations for women» it became an obligatory element of work of clinics for women.
Overseeing inf. by sick and contacting it was carried out still far back in the past. It had character of superficial medical examination and was a part of primitive anti-epidemic actions. Deeper contents in this concept was enclosed in the period of broad carrying out nation-wide measures for fight with inf. diseases in the USSR in 1917 — 1935. Since 50th, overseeing by convalescents after postponed inf became obligatory. diseases. However P.'s role inf. patients it was gradually reduced also by the beginning of the 70th, it was replaced with dispensary observation for inf. patients and convalescents which is carried out offices of infectious diseases (see) policlinics. At the beginning of the 20th in the USSR together with creation of network of antitubercular clinics (see. Clinic ) the system P. of tubercular patients was developed.
The item mentally sick for the first time arose in 16 century in of Geele (Belgium) and in the second half of 19 century in the form of colonies of posemeyny contempt extended almost in all countries of Western Europe. In Russia P. mentally sick was for the first time organized H. N. Bazhenov in 1886 in Ryazan psychiatric-tse («at gate of hospital»); it would consist in resettlement of patients in nearby to psychiatric areas that provided rendering regular medical aid to them and a possibility in case of need of the timely room back in-tsu. However it existed not for long and under pressure of conservative members of a territorial justice it was soon closed. In 1892 H. N. Bazhenov recreates P. in the village of Semenovskom near Moscow. In 1893 P. mentally sick was organized in Ekaterinoslavskaya, in 1898 — in Nizhnegorodskaya (in Balakhna — at the initiative of P. P. Kashchenko) and in Voronezh provinces and was generally recognized not only as means of unloading of psychiatric BCs, but also as the measure having a certain therapeutic value for patients, long stay to-rykh in psychiatric would lead to development of so-called hospital weak-mindedness.
In the years of World War I, and then civil war of P. mentally sick almost everywhere stopped the existence. Later in a number of places it was recovered. In 1954 the main organizational forms P. and duties of mental health (psychoneurological) facilities and families or collective farms concerning the patronized patients were regulated, the amount of remuneration for patronizing of mentally sick is determined.
In process of development of the Soviet health care, creation of powerful base to lay down. - the prof. of institutions especially broad development got P. of pregnant women, mothers and children. In the cities, working settlements of P. of pregnant women, mothers, children it is carried out by nurseries, clinics for women and policlinics, and in rural areas — central regional, regional and local-tsami, out-patient clinics, medical and obstetrical centers. It doctors, the paramedic, the nurse, the midwife (on medical and obstetrical centers, as a rule, one person — the paramedic or the midwife) carry out hl. obr. by the local principle.
More perfect organizational forms are developed also for P. mentally sick, to-ry is carried out by psychoneurological clinics (P.'s extra pain-nichny) and psikhiatricheoky (psychoneurological)-tsami (hospital P.). The item of lonely and aged patients, disabled veterans and work is assigned to patronage nurses about-in Red the Cross and Red Polumeeyats.
The item in the socialist countries will be organized by the similar principle. In the capitalist countries of P. it is carried out in limited sizes, has preferential a dignity. - the gleam, character, is carried out by the public medical service or the charitable and private-capitalist organizations (insurance companies).
Patronage of pregnant women
Patronage of pregnant women aims to provide the favorable course of pregnancy, childbirth and the birth of the healthy child. It promotes observance of rules of personal hygiene by the pregnant woman, improvement a dignity. - a gigabyte. conditions in life, to holding recreational and preventive actions in a family. The item is a part of a dispensary method of observation (see. Medical examination ), it is carried out according to plan, and in case of complications during pregnancy it is carried out as well over and above the plan. Patronage work is performed by local midwifes of clinics for women, out-patient clinics, rural medical sites, medical and obstetrical centers, nurses of children's policlinics under the direction of and control of the doctor.
At home the midwife carries out the first visit of the pregnant woman at the beginning of pregnancy, at the same time she finds out working conditions and lives of the pregnant woman, gives advice on improvement a gigabyte. situations of the house, proceeding from specific conditions, are found out by the state of health of people around and relationship in a family, leads discussions about personal hygiene, a work-rest schedule, a balanced diet, explains the Soviet legislation on protection of the rights and health of women (in case of need the midwife addresses the lawyer of clinic for women, to-ry gives practical help in the solution of the questions concerning the woman). The midwife makes all councils and recommendations in a notebook of work at home of the patronage nurse (a patronage leaf) for the subsequent check of their performance. At repeated visits the midwife measures the ABP at the pregnant woman, listens to heartbeat of a fruit, defines its situation, gives advice about carrying a bandage, about preparation of mammary glands for feeding of the child, etc. In case of complaints, identification of complications or at suspicion on a complication of pregnancy (hypostases, increase in the ABP, the wrong provision of a fruit, etc.) she invites the pregnant woman in clinic for women or reports about it to the doctor, to-ry resolves an issue of a possibility of treatment of the pregnant woman at home or need of its hospitalization. In the latter case the midwife controls timeliness of arrival of the woman in a hospital and continues active observation after an extract it home. Success of patronage work in many respects depends on ability to establish and support optimum psychological, ethical and business contact with the pregnant woman.
Patronage visits are carried out and when the pregnant woman for any reasons does not visit consultation with the purpose of check of a condition of the health (the pregnant woman shall visit consultation in the first half of pregnancy once a month, from 21 weeks — once in 3 weeks; from the 32nd week — 1 time in 2 weeks, from the 37th week until the end of pregnancy — every week) and also if the woman skips classes in physiopsycho-preventive preparation for childbirth in consultation. The midwife finds out the reason of the admission and appoints other day of occupations. In nek-ry cases (range of distance to clinic for women, a possession of many children) the midwife gives individual classes at home, paying special attention to need of education at the pregnant woman of positive emotions and confidence in favorable completion of childbirth for it and the child. It is desirable to invite to classes in preparation for childbirth husbands where they can get acquainted with physiology of pregnancy and childbirth and value of the physiopsychopro of l of aktichesky preparation for the favorable course of pregnancy and childbirth. Special value P. has in rural areas where the midwife not only visits pregnant women, but also actively reveals them.
In the course of P. the local midwife carries out a dignity. - the gleam, conversations also recommends or gives in temporary use to women the corresponding popular literature (brochures, leaflets, instructions). The local nurse of children's policlinic visits future mother on receipt of data on pregnancy from clinic for women and at the end of pregnancy at home. The pediatrician will see off prenatal P, only among pregnant women with an adverse current there are pregnancies or with the burdened obstetric anamnesis. The woman in childbirth who did not visit consultation in 2 — 3 weeks after the delivery is also subject to P.
Patronage of children
Patronage of children — systematic, continuous, active overseeing by development of children of early age (up to 3 years) and for the weakened children, irrespective of age. It will be seen off by pediatricians and local nurses, starting with the prenatal Item. The patronage nurse of the pediatric site of children's policlinic shall carry out prenatal P. within 10 days after obtaining information about the pregnant woman from clinic for women. The second time the nurse visits future mother at home on the 32nd week of pregnancy. She checks how the family is prepared for appearance of the child whether there is all necessary for leaving and education of the baby, leads a discussion about features of behavior and development of the newborn. After an extract from a maternity home the pediatrician and the nurse of children's policlinic visit the newborn in the first 2 — 3 days. If in a family the first child was born, it is desirable to make it in the first day. Further the local nurse visits the child in 1 — 2 day within the first week and weekly at home within the first month after the birth. The local pediatrician on the first month of life of the child visits him 3 — 4 times at home. Special attention at the same time is paid on activity of suction, a condition of an umbilical wound, integuments, mucous membranes, etc. Big help to the local vra-chu-pediatrician at the first visit of the child is given by detailed history of development of the child (see), made in a maternity home.
It is desirable that primary P. was carried out by the pediatrician together with the nurse, edges processes an umbilical wound of the newborn (if it is necessary), carries out other appointments of the doctor, receives instructions on overseeing by the child further. Explain to mothers rules of feeding of the child with a breast, a toilet of the newborn, swaddling, bathing, make the recommendations concerning the mode, care of the newborn, the beginning of walks, etc. The pediatrician on the basis of survey of the child estimates funkts, the condition of its bodies and systems, especially nervous system, reveals the available anomalies of development. All obtained data are fixed in the history of development of the child. The local nurse fixes the work in a notebook of work at home — a patronage leaf. At the subsequent visits the nurse notes performance of councils by mother in a patronage leaf and makes new offers and recommendations. The local pediatrician periodically checks records of the nurse and implementation of recommendations by mother.
Twins, premature, the children who were born with big body weight, with an intracranial injury and also at mothers who had pathology of pregnancy and childbirth treat risk group and shall be under special observation of the doctor.
Children of the first and second year of life are observed on system of the active Item. At the age of 1 month the child shall be examined in children's policlinic in day, specially allotted for reception of children of early age. Further healthy children are observed by the local pediatrician and the patronage nurse once a month till 1 year of life. During these visits watch dynamics of body weight, growth, a circle of a breast, head, formation of psychological development of the child. Taking into account the obtained data and a condition of the child the pediatrician makes recommendations about feeding, the organization of a day regimen, a hardening, physical training, prevention of rickets, etc. In the history of development of the child entries about the carried-out preventive inoculations, about the postponed infectious and other diseases are made.
Aged up to 3 months of children the surgeon for the purpose of detection of inborn diseases shall examine, hl. obr. dysplasia of a hip joint.
At the end of the first year of life the pediatrician makes an epicrisis, in Krom gives an assessment of the state of health of the child, his physical and psychological development, reflects the nature of feeding, data on the postponed diseases, the svede-deniya about specific prevention of rickets, performing massage and gymnastics, draws up the plan of observation and if it is necessary, and improvements on the second year of life.
The local pediatrician and the patronage nurse observe the child of the second year of life 1 with carrying out anthropometrical measurements quarterly. Once a year examines the child with the preventive purpose zhgomatolog. Once a year do to the child blood test, urine, a calla on eggs of worms. The pediatrician draws the detailed conclusion about the state of health of the child at the age of two years, estimates his physical and psychological development.
On the third year of life of the child the pediatrician examines it with the preventive purpose of 1 times in 6 months, anthropometrical measurements are at the same time taken. The patronage nurse observes the child 1 quarterly. Once a year the child is examined the ophthalmologist and the stomatologist, besides, do it blood tests, urine, a calla. The main attention on the second and third year of life of the child is given to the organization of the mode, holding the tempering actions, gymnastics according to age, to a balanced diet.
At the end of the third year of life of the child the doctor sums up the results: estimates the state of health, dynamics of its physical and psychological development for this period, makes the rehabilitation plan and treatments (according to indications).
Further children of preschool age are observed by the local pediatrician once a year. See also Protection of motherhood and childhood .
Patronage of TB patients
P.'s Feature of TB patients is carrying out scheduled, medical and educational maintenance in the centers of a tuberculosis infection not only at home, but also on productions, in institutions and children's collectives. The item is carried out by paramedical staff of an antitubercular clinic regularly for a long time because the TB patient is considered infectious for 2 years after the termination of elimination of bacilli by it. Work in the center is carried out according to the plan, made by the doctor depending on degree of danger of the center, entered in the map of the local sister (the patronage card). The main objective of P. — improvement of the center — is reached as implementation of the general a gigabyte. actions (washing and disinfecting of the objects surrounding the patient, solutions of chloroamine and lime chloride, the maintenance of rooms in purity, their regular airing), and instilling in the patient of rules of personal hygiene, correct behavior of the house, na1 to work, on the street. The importance of P. consists in control of implementation of appointments of the doctor concerning the mode and treatment and performance of the ordered medical actions, and also in training of members of the family of the patient in rules of precaution and prevention, especially the persons who are looking after the heavy bacillar patient. A lot of work as P. is carried out on observation and systematic inspection of the family members who are constantly contacting to the patient, especially children. At once after identification at the patient of an open form of tuberculosis family members are registered an antitubercular clinic, their these inspections, data on the antitubercular vaccination done to children are entered in the patronage map. An important element P. is carrying out a dignity. - a gleam, works with the patient and members of his family.
The item on production provides the account and treatment of the TB patients working at this enterprise, regular routine maintenances of the persons which are especially in direct contact with TB patients. As P. carry out also protection of interests of the patient on production, resolve an issue of its employment, monitor observance of instructions, according to the Crimea TB patients with active elimination of bacilli do not dopukatsya to work in the food and utility enterprises, child care preschool, school and other facilities.
Patronage mentally sick
Patronage of mentally sick is intended for patients, the Crimea further stay in closed to lay down. institutions it is not shown, but owing to mental insolvency they cannot join completely in usual life. The purpose P. is the aftercare mentally sick in extra hospital conditions.
Due to the emergence of neuroleptics and snowballing of the social and rehabilitation direction in psychiatry (see. Rehabilitation ) Items, especially in rural areas, attach great value as to an organizational form of the extra hospital mental health services giving optimum opportunities of involvement of patients in various labor processes in the conditions of the healthy environment. The item will be organized at psychoneurological and mental health facilities and can be carried out in a family of the patient, in others families by individuals and production labor collectives (collective farms).
The choice of collective farms and families, in to-rye can be placed patients, the direction them on P. and removal from P. is made by the patronage commission consisting of hl. the doctor of psychoneurological or mental health facility, the doctor who is carrying out functions of the manager P., and the attending physician.
Contracting parties sign the patronage agreement (agreement) providing вза^ imny obligations of psychoneurological or mental health facility and the patronizing persons or collective farm concerning the patients placed on P.
Pomeshcheniya on P. the uneasy patients dangerous to themselves and people around, inclined to vagrancy, or weak, slovenly patients, and also suffering heavy somatopathies or infectious diseases (tuberculosis, syphilis etc.) are not subject. Transfer into P. of the patients who are on compulsory treatment is forbidden.
Overseeing by the patients patronized in families their treatment and contents is carried out by regular visit (at least once in 3 months) local psychiatrists and paramedical staff psikhonevrol, clinics, dispensary departments and offices at home. In rural areas where on collective-farm P. considerable groups of patients are located sometimes, for overseeing they, implementation of actions for a social and labor readaptation by mental health facility, as a rule, psychiatric-tsey, allocate special medical staff.
The patient is on P. before change of its mental state; at an aggravation of symptoms it is translated in corresponding stationary to lay down. establishment, and at improvement it can be removed from the Item.
Bibliography: Belovo A. P. Organization of medical care to children in the conditions of the large city, JI., 1978; O. S. Organization of the ambulatornopoliklinichesky help to children Is fighting, M., 1978; Grebesheva I. I. Organization of the treatment-and-prophylactic help to children, M., 1977; Doroshenko K. G., JI e x - those r A. M. and P I am a N y x A. M. Kabinet of infectious diseases and anti-epidemic work on the medical site, Tomsk, 1976; E p e of N to about in V. A. Health worker and patient, page 60, Chisinau, 1976; Methodical instructions on work of the doctor of an office of infectious diseases, sost. A. F. Podlevsky, JI., 1971; G. A. Novgorodians, D e of m-chenkov.a of G. 3. and Polonsky M. JI. Medical examination of the population in the USSR, page 100, etc., M., 1979; Practical obstetrics, under the editorship of. Ya. P. Solsky, page 15, Kiev, 1976; Reformed H. H. Family contempt of the insane in Russia and abroad, SPb., 1907; Serebryakova 3. H. The organization of psychiatric patronage and perspective of its development in the USSR, M., 1965, bibliogr.; The reference book on obstetrics and gynecology, under the editorship of JI. S. Persianinova and I. V. Ilyin, page 8, M., 1978.
I. V. Shatkin; V. P. Bisyarina (ped.), G. S. Klochkova (ftiz.), V. V. Kochemasova (academician), 3. N. Serebryakova (psikhiat.).