PREVENTION PRIMARY — system of the social, medical, hygienic and educational measures directed to prevention of diseases by elimination of the reasons and conditions of their emergence and development and also on increase in resistance of an organism to influence of adverse factors of the surrounding natural, production and household environment. Unlike the secondary prevention aimed at early detection of a disease, the prevention of a recurrence, progressing of disease process and its possible complications, primary prevention it is designed to keep undisturbed health, not to allow influence of the factors of the natural and social environment capable to cause pathological changes.
Experience of our country visually demonstrates that the system of primary preventive actions is most effective in the medical, social and economic relation and therefore in modern conditions it is considered as the leading direction in the field of protection and strengthening of public health. Further increase in level of health, increase in life expectancy and active working ability of the Soviet people, decrease in incidence and reduction of losses from temporary and permanent disability in many respects depend on widespread and systematic introduction of measures of Pct concerning all population. The modern business strategy of the CPSU and Soviet state for social development, the new tasks of health protection of the Soviet people corresponding to grandiose social and economic transformations are defined by decisions of the XXVI congress, May, November (1982) and ^ June (1983) Plenums of the Central Committee of the CPSU, and also the resolution of the Central Committee of the CPSU and Council of ministers of the USSR «About additional measures for improvement of public health care» (1982). Leaning on opportunities mature socialist about-va, and also on achievements of domestic medical science and powerful capacity of socialist system of health protection, the Central Committee of the CPSU and Council of ministers of the USSR planned the large-scale program of measures for further increase in level of public health of the population of the USSR, first of all by improvement of all forms of scheduled maintenance. The resolution provided implementation till 1990 of the comprehensive program of Pct of diseases, in implementations a cut, except bodies of health care, active part will be taken by party and Soviet bodies, mines-va and department of the USSR and federal republics, labor unions, Komsomol, wide circles of the Soviet public. It once again demonstrates that care about health of the Soviet people of the CPSU and the Soviet state is considered as the major social task as public business of paramount importance. Development of the ideas and practical implementation of measures of Pct are, thus, in a uniform bed of social and economic progress, reflecting interrelation and interdependence of social and economic aspects of social development in the conditions of mature socialism, specific care of the specific person, his needs and requirements and solving along with it such important public problems as increase in level of health of the population, increase on this basis of a manpower, their rabototrudosposobnost, increase in labor productivity and efficiency of social production.
Emergence and development of ideas of Pct is inseparably linked with searches of etiological approach to the prevention of the most widespread. noninfectious diseases, with implementation of the basic epidemiological, social and hygienic, theoretical, pilot and kliniko-social researches conducted for the purpose of establishment of true scales of prevalence of noninfectious diseases, identification of primary deviations from the normal course of processes of life activity and releasers of development of the pathological processes leading to emergence of various forms of noninfectious pathology, and also establishment of their communication with influence of various factors of the environment, internal and external in relation to an organism.
From the second third of 20 century in the majority of economically developed countries change of a nosological profile of pathology — a so-called not epidemic profile of incidence (Yu. P. Lisitsyn) accurately was defined. In 50 — the 60th cardiovascular and oncological diseases, chronic nonspecific diseases of a respiratory organs and other forms of noninfectious pathology strongly took the leading place among the reasons of mortality, disability and temporary disability of the population. At the same time the tendency to «rejuvenation» not of infectious diseases, especially cardiovascular is noted that caused and causes the most notable damage to health of the population and a manpower of society. So, M. P. Roytman and L. L. Lunskaya (1982) report that by the available calculations of competent specialists among persons up to 65 years economic losses only owing to cardiovascular pathology made 42% in cheloveko-years, and in value terms — 56% of the total amount of losses from get sick vayemost of the population of industrialized countries.
Growth of incidence and absence enough effective remedies of treatment of noninfectious diseases were an incentive incentive for searches of ways of their prevention. At the initial stage of these searches (till 60th) the leading place belonged to the empirical approach based on clinical observations which allowed to reveal the separate factors and conditions aggravating a current and promoting further progressing of already arisen pathological process and on this basis to improve to lay down. - professional, the help to patients with the most widespread not infectious diseases.
In our country in the 50th the original tactics of fight against noninfectious diseases including was proved: orientation to the earliest identification of patients with initial forms of pathology and their timely active treatment; establishment of dispensary observation (see Medical examination) behind sick most widespread not infectious diseases (rheumatism, a hypertension, etc.); periodic treatment of these patients for the purpose of the prevention of a recurrence and aggravations. This approach combined optimum therapeutic tactics with elements of a preventive orientation, creating the known conditions for the prevention of emergence heavy nekurabelny or predictively adverse forms not of infectious diseases. In process of expansion and strengthening of potential of health care, growth of availability of different types of medical aid, implementation of the diagnostic methods allowing to find initial changes of functions at stages when the expressed clinical displays of a disease still are absent, developments and deployments of methods of rehabilitation (see) and recovery treatment this direction got more and more expressed preventive orientation and was transformed to secondary prevention of noninfectious diseases.
Though secondary prevention is an integral part of fight against not infectious pathology, its measures cannot suspend growth of incidence not of infectious diseases and, therefore, not fully solve problems of their prevention. In 60 — the 70th in our country the single-step and prospective epidemiological and population and preventive researches aimed at searches of ways of the prevention of the most common forms of noninfectious pathology were executed. At the same time for development of scientific bases and forms of mass implementation of measures of Pct basic researches of the academician E. I. Chazov and his employees had basic value (I. K. Shkhvatsabai, V. N. Smirnov, I. S. Glazunov, M. A. Akhmeteli, R. G. Oganov, V. I. Blizzards, etc.) on urgent problems of theoretical, clinical and preventive cardiology (see) on the basis of which are developed and comprehensive programs of one-factor and multifactorial prevention of cardiovascular diseases are carried out, new methods of mass inspection of the population for detection of the latent forms of cardiological pathology, diagnosis, prevention, treatment and rehabilitation of patients with coronary heart disease (see), are implemented by arterial hypertension (see. arterial hypertension ), a myocardial infarction (see). Pct of cardiovascular diseases, important for the purposes, data were obtained as a result of the epidemiological, theoretical and clinical trials conducted by group of scientists Ying-that physiology and pathologies of cardiovascular system at Kaunas medical in-those led by 3. I. Yanushkevichus.
The large contribution to the solution of scientific and practical problems of prevention of oncological diseases was brought by basic researches on epidemiology of malignant new growths (see. Tumours ), executed under the direction of and with direct participation of the academician N. N. Blochin.
By the beginning of the 80th in our country the first scientific development stage of bases of primary and secondary prevention of cardiovascular diseases was generally complete, and the created scientific doctrine of prevention of diseases of bodies of blood circulation can serve at the same time as methodology of Pct of other forms of noninfectious pathology. On this basis S. P. Burenkov formulated the provision on need of integral approach to rendering to lay down. - professional, the help to the population as leading condition of widespread introduction died Pct in scales of the state in general. At the same time integration of medical aid shall be shown first of all in development of primary link of health care at the level of which holding the main actions for primary and secondary prevention of noninfectious diseases shall be carried out.
In recent years WHO gives more and more attention to methods of mass inspection of the population, assessment of the epidemiological and population and preventive researches conducted in a number of harvest seasons of the world.
As a result of researches 60 — the 70th it was established that prevalence of separate forms not of infectious pathology, in particular coronary heart disease, a myocardial infarction, a stroke, a diabetes mellitus, etc., is much higher, than it was supposed on a basis a wedge, observations and data of negotiability behind medical aid. Factors which impact on an organism authentically increases probability of emergence and development of noninfectious diseases are revealed — so-called risk factors. It is established that the phenomena of various nature can act as risk factors: unfavorable conditions of life (e.g., production factors, pollution of objects of the environment), the hereditary or acquired deviations of exchange processes from a normal current and separate disturbances of regulation of functions (e.g., features of lipidic exchange, the excess weight, endogenous fluctuations of sugar, imperfection of regulation of a vascular tone and the first symptoms of arterial hypertension arising in this regard). Essentially important result complex sots. - a gigabyte. and the kliniko-social researches executed by groups of owls. scientists led by Yu. P. Lisitsyn, E. I. Chazov, 3. Establishment of communication of adverse factors of a way of life (the irrational mode and food, restriction of a physical activity, addictions) with emergence of various forms of noninfectious pathology, and also a formulation of provision on a role of a healthy lifestyle for preservation of health and Pct of noninfectious diseases was I. Yanushkevichus, etc. (see. Socialist way of life). Epidemiological, population and preventive and social and hygienic researches 60 — confirmed the 70th prophetical words of owls. the pathologist I. V. Davydovsky (1961) that in the activity of the person, his way of life, living conditions, ecology and human physiology the foundation directly related to atherosclerosis, a hypertension, cancer etc. are laid explained why positive change of level of public health is not proportional to improvement of living conditions, showed dependence of the state of health of each person and the whole populations on how the material and cultural benefits provided to the population by the developing society and scientific and technical progress are used. There was obvious an important role of formation at the population of an active position concerning a healthy lifestyle, failure from addictions, first of all from smoking (see Tobacco), irrational forms of behavior for providing a high level of health, increase in terms of life expectancy and creative activity.
Studying of risk factors showed that many of them increase probability of a disease of various forms of noninfectious pathology (e.g., smoking — one of major factors of risk of emergence hron, noninfectious diseases of the bronchopulmonary device, coronary heart disease, malignant tumors of respiratory tracts and some other localizations; irrational food, excess body weight — obesity, a diabetes mellitus, cardiovascular diseases) that the role of separate risk factors in emergence and development of specific diseases is not identical. So, according to the vast majority of researchers, from known today more than 20 risk factors of developing of cardiovascular diseases the greatest for their prevention matter so-called major factors of risk — boundary forms of arterial hypertension, smoking, a hypercholesterolemia, excess body weight, insufficient physical activity.
Among risk factors there is emergence hron, nonspecific diseases of a respiratory organs at adults the main are smoking, pollution of the air basin, production air pollution in workplaces, respiratory viral diseases. At the same time smoking is considerable more aggressive agent, than pollution of the air environment, and plays the leading role in genesis of development hron, nonspecific diseases of the bronchopulmonary device: e.g., according to Ferree with coauthors (V. Ferris et al., 1973), smoking causes 9,3 — 16,5% of incidence hron, bronchitis, and environmental pollution — only 1,4%. It turned out that the importance of separate risk factors varies depending on degree of manifestation and terms of duration of action of each of them, and also from the corresponding conditions. E.g., according to B. V. Ilyinsky and S. K. Klyueva (1981), at the burdened heredity concerning cardiovascular pathology and disturbances of lipidic exchange especially adverse background on which stratification of other risk factors sharply increases threat of development of coronary heart disease is created. Substantial increase of probability of developing of noninfectious diseases at the combined influence of risk factors was established. So, A. M. Markov (1981), referring to data of fr. researchers, reports that if smoking increases probability of an oncological disease by 1,5 times, an alcohol abuse — by 1,2 times, then the combined action of these factors — by 5,7 times. Also regional inadequacy of influence of various risk factors concerning the same forms of noninfectious pathology is found. According to 3. I. Yanushkevichusa and And. V. Baubinen (1980), results of the international KRIS program (Kaunas — Rotterdam Intervention Study) on the issue of development of methodology of carrying out a research of primary prevention of coronary heart disease among the representative contingents of male population at the age of 45 — 59 years of Kaunas and Rotterdam showed that if in Kaunas risk factor of coronary heart disease, the first on the importance, is smoking, then in Rotterdam the importance of this factor is not so big. Thus, for the correct orientation on development of measures of Pct it is necessary to reveal risk factors of the first importance inherent in the population of the specific territory. Standard approach can reduce efficiency of preventive measures as even in rather close territories in the geographical relation the importance of separate risk factors can be unequal.
Indirectly point out regional inadequacy of risk factors also some data of foreign researchers. So, e.g., Gyuberon (E. Guberan, 1979) reports that decrease in Switzerland from 1951 for 1976 of not rheumatic heart diseases mortality happened against the background of increase in consumption of fats by 20% and numbers of the smoking men. Richard with coauthors (J. Richard et al., 1981) specify that though France treats the countries with low level of mortality from coronary heart disease, it is high on the list on consumption of fats. At the same time these, as well as another similar to them data, do not disprove at all the fact that smoking and excess consumption of animal fats increase probability of emergence and development of various forms of cardiovascular pathology, and first of all coronary heart disease though in the conditions of the specific region they can not be the risk factors conducting on the importance. R. G. Oganov and V. I. Blizzard (1982), referring to materials of the 11th conference National in-that hearts, lungs and blood of the USA, report that rates of mortality of men at the age of 35 — 74 years from coronary heart disease increased from 1969 to 1977 in Switzerland for 7,7%, in France — for 6% though coronary heart disease mortality rate in these countries continues to remain one of the lowest in Europe. Besides, at interpretation of dependence of prevalence of coronary heart disease on excess consumption of fats it must be kept in mind that a high level of cholesterol in blood serum in population and at the same time high frequency of clinically expressed coronary heart disease meet only when usual food of the population includes the high-calorific food rich with lipoproteids of low density and cholesterol. By the researches conducted in the All-Union scientific cardiological center and Institute of experimental medicine of the USSR Academy of Medical Sciences together with a number of scientific institutions of the USA it is established that the increased level of cholesterol in lipoproteids of high density reduces probability of developing of coronary heart disease and can be considered as «anti-risk factor» of coronary heart disease.
The provision proved by numerous epidemiological, population and preventive and population and genetic researches that many risk factors begin to work and be shown already in the childhood and, therefore, sources of emergence of the majority of forms of noninfectious pathology, including cardiovascular diseases is essentially important for the organization of effective fight against widespread noninfectious diseases, it is necessary to look for at children's age. So, as a result of the research of prevalence of risk factors of coronary heart disease conducted in the Netherlands among children of 9 — 12 years the increased arterial pressure was revealed at 5% of boys and 10% of girls, the level of cholesterol in blood of 220 mg of % and above — at 14% of boys and 16% of girls; obesity and reduced physical activity were revealed at 5% inspected, 2% of children smoked. R. V. Petkyavichus with coauthors (1980) on the basis of preliminary results of the epidemiological research conducted in Kaunas report about considerable prevalence among school students of 10 — 15 years of so-called harbingers of atherosclerosis (see). According to this research, only 47,4% of the inspected boys and 42,2% of girls had no predvestna of k of atherosclerosis. From four considered harbingers (risk factors) of atherosclerosis and other cardiovascular diseases (arterial hypertension, smoking, decrease in physical activity, existence or tendency to obesity) under the influence of two risk factors there were 14% of the inspected children, three — 4,5%. At the same time the increased arterial pressure was revealed at 18,5% of boys and 17,6% of girls, strong indications of obesity — at 6,8% of boys and 6,4% of girls, tendency to obesity — at 19% of boys and 18,8% of girls; decrease in physical activity was revealed at 18,7% of boys, 7,7% of the inspected children smoked. According to Byyuli (V. of Bewley, 1977), in the countries of Western Europe up to 10 years begin to smoke apprx. 40% of children. Pearson and Richardson (R. Pearson, To. Richardson, 1978) report that they among school students of Great Britain smoke 37%. Though the researches quoted above were devoted to problems of Pct of diseases of bodies of blood circulation, their results indicate also considerable prevalence among children and teenagers of risk factors hron, nonspecific diseases of a respiratory organs and oncological diseases (smoking), a diabetes mellitus (obesity, excess body weight) and other forms of noninfectious pathology. In a number of researches rather high prevalence of genetic predisposition to internal causes of risk of developing of noninfectious diseases is shown (disturbances of lipidic and carbohydrate metabolism, imperfection of regulation of a vascular tone, etc.). So, e.g., according to E. Ya. Magracheva (1980), in Leningrad the hereditary hypercholesterolemia is observed at 0,6% of newborns. Yu. I. Bubnov, M. A. Akhmeteli and V. I. Zamorin (1982) on the basis of the population and genetic research conducted in Moscow consider that prevalence of a family hypercholesterolemia (see) makes 1,18%. In this regard for further development of methodology of Pct the conducted population and genetic researches directed to receiving quantitative assessment of the importance of genetic predisposition and environmental influences on prevalence of internal causes of risk in populations, identification of genotypes of risk, genotypes of predisposition to separate forms of noninfectious pathology that will allow to create groups of persons, measures of primary prevention needing first-priority carrying out concerning them have basic value.
Special importance of widespread introduction died Pct concerning children and teenagers is defined not only considerable prevalence of risk factors among them. The conducted population and preventive researches show that at children's and youthful age of a measure of Pct are most effective. So, at transfer into a special diet to 7-year age it is possible to achieve normalization of level of lipoproteids in blood of the children who were born with a giperlipoproteidemiya from the parents suffering from disturbances of lipidic exchange. Timely measures possible to eliminate also in some cases the nursery and juvenile arterial hypertension of secondary genesis or caused hereditarily by the transferred imperfection of a vascular tone. E.g., by data I. S. Glazunova (1981), systematic carrying out within a year concerning group of school students at the age of 12 — 13 years having arterial hypertension, non-drug preventive actions (restriction of reception of salt and carbohydrates, increase in physical activity, streamlining of a work-rest schedule) led to reliable decrease at them systolic and diastolic arterial pressure.
Need of carrying out wide preventive measures concerning the children's population and youth, including first of all measures of educational and sanitary and educational character, increases and because at this age the main behavioural installations, views, skills, habits, tastes, etc. — the word what defines further a way of life of the person form. During this period it is possible to prevent emergence of addictions, emotional intemperance, installation on passive rest and irrational food which can become further risk factors of noninfectious diseases and with great difficulty, and at times are painfully got rid at mature age, to create a habit to a physical activity, exercises and sport, to various and moderate food, keenness and attention to people around, the rational mode. These habits will promote counteraction to influences of the factors causing emergence and development of various forms of noninfectious pathology, correction, and it is possible, and elimination of the available internal causes of risk.
Identification and studying of risk factors was productive as well for secondary prevention not of infectious diseases.
Clinical and epidemiological trials showed that many risk factors of emergence of various forms of noninfectious pathology at a stage of the developed disease make heavier its current, increasing probability of development of severe nekurabelny forms and lethal outcomes. So, according to M. A. Akhmeteli (1982), with one risk factor (smoking) increase in mortality from coronary heart disease by 3,5 times is noted. Approximately in the same limits increase of rates of mortality in group of patients with an ischemic disease with disturbances of lipidic exchange or with arterial hypertension is noted. In group of patients with coronary heart disease who had a dislipoproteidemiya in combination with arterial hypertension and smoking, coronary heart disease mortality in 10 times more, than in a group of persons, having coronary heart disease, but not having eit is silent risk factors.
3. I. Yanushkevichus and A. V. Baubinen (1980) report that coronary heart disease mortality of men with the increased systolic arterial pressure (160 mm of mercury. and more) was 3 times higher, than among patients with standard arterial atmosphere pressure; mortality from coronary heart disease left off smoking by 3,5 times, and regularly smoking by 6 times exceeds mortality of patients, never smoking. Mitchell and Mayzel (R. Mitchell, J. Maisei, 1971) report that among the smokers having emphysema of lungs, mortality is 25 times higher, and hron, bronchitis — by 21 times, than at patients with the same diseases, but not smokers of tobacco. Thus, effective secondary prevention not of infectious diseases includes measures of Pct. This situation confirms unity of preventive activity in the field of health protection once again, and in this regard, despite distinction of the initial purposes, primary and secondary prevention can be considered as two stages of the uniform preventive process designed to provide a high level of public and individual health and also performance of the main economic function of health care — preservation and enhancement of a manpower of society on the basis of the prevention of incidence and disability. This staging is rather accurately expressed for and orientations of each of the mentioned forms of preventive activity on preservation of a manpower: measures of primary prevention are intended for the prevention of incidence, the edge of secondary prevention is directed against disability, development of severe forms of a disease at which working capacity either is lost, or is significantly limited.
Preventive orientation — a basis of socialist system of health protection.
In our country are carried out and the large economic, social and cultural transformations which played and playing a crucial role in prevention and eradication of origins and development of various forms of pathology are carried out. Thanks to systematic implementation of social policy of the CPSU welfare and culture of the population constantly grows, improve a working condition and life, the medical science and the Soviet national health care develop (see the Communist Party of the Soviet Union, Health care , Prevention , Union of Soviet Socialist Republics). Though in connection with the received hardest heritage, at the first stages of development of the Soviet health care at most of attention also providing the dignity addressed on fight against infectious diseases (see). - epid, wellbeing, already in 20 — the 30th the measures which laid the social, legislative and organizational foundation of Pct of noninfectious pathology in our country were carried out. The systems of labor protection which are equitable to interests of workers (see), social security (see), the state social insurance (see) and the accident prevention were created (see). In the world maximum allowable concentrations (see) harmful in-in in air of a production zone of workrooms which along with professional selection (see), preliminary and periodic medical examinations of workers, implementation of safe technologies, establishment of the shortened working hours, treatment-and-prophylactic food and additional issue for working at a factory with professional vrednost (see), a close check and industrial sanitary inspection provided low level of incidence of occupational diseases (see) are introduced for the first time. Necessary conditions for good rest (see) workers are created. The right to rest is guaranteed by the Constitution of the USSR, duration of working week with two days off is established no more than 41 hour, the worker is granted the paid leave, the network of sanatoria, rest houses, boarding houses, dispensaries and other institutions for organized rest of workers constantly extends. Broad development was gained physical culture and sport.
The USSR — the first country where the uniform sanitary and epidemiologic service (see) invested large with authority was created is established the state sanitary inspection (see). In improvement of living conditions of the population, including the prevention of various forms of noninfectious pathology, an important role the organization of sanitary protection of objects of the environment and dwelling, sanitary inspection behind quality of drinking water and subjects to water supply, purity of the air basin, a design, improvement and a sanitary condition of the inhabited places played development of sanitary education (see). Radical measures for improvement of food were carried out (see) population. In particular, evidence-based physiological standards of need of adult able-bodied population for the main feedstuffs depending on intensity of work were for the first time developed and implemented. Much attention was paid to questions of clinical and treatment-and-prophylactic nutrition (see clinical nutrition, Food treatment-and-prophylactic), and also baby food. In the country production of dietary products and products of baby food was arranged, it is created and constantly the network of milk kitchens and dietetic dining halls extended.
Creation and development of systems of protection of motherhood and the childhood (see) and health protection of children and teenagers (see), rational and evidence-based population policy (see. Demography ) provide in general more favorable course of demographic processes, than in the majority of economically developed capitalist countries, and also conditions for education physically and it is moral healthy generations. The wide network of the obstetric and gynecologic and pediatric institutions staffed by qualified personnel guards health of mother and the child, carrying out the large volume of scheduled maintenance (see. Pregnancy , Baby, Children's policlinic, Clinic for women, Newborn, Patronage ).
Implementation of the social and preventive direction of the Soviet health care demanded development and deployment of new forms of work of the medical institutions providing unity of medical and preventive activity in implementation of measures for public health care. Medical examination is among such forms (see), edges consists in active overseeing by health of certain contingents of the population, in studying of working conditions and life, ensuring their correct physical development and preservation of health, and also in the prevention of diseases (or their progressing) by carrying out corresponding to lay down. - the prof., a dignity. - a gigabyte. and social actions. In 20 — the 30th medical examination was applied to fight against social diseases (tuberculosis, venereal diseases, trachoma), and also in the field of protection of motherhood and an infancy and health protection of the working leading industries of industrial production. Thus, social policy of the socialist state and a sotsialnoprofilaktichesky orientation of the Soviet health care already in 20 — provided the 30th implementation of effective recreational actions, many of which from modern positions can be estimated as measures of Pct of noninfectious diseases. Certainly, the maintenance of these measures was limited to extent of development of problems of an etiology, a pathogeny and prevention of noninfectious diseases.
Due to the increase in a role of neinfektsioiny diseases in structure of incidence and mortality of the population in 50 — the 60th fight against them, and first of all with oncological and cardiovascular diseases, was considerably strengthened and included carrying out, separate measures of secondary and primary prevention. Along with orientation to lay down. - prof. of institutions on the earliest detection and timely treatment of initial forms of noninfectious diseases were expanded scales and quality of medical examination is increased, and also systematic development of services of specialized medical aid began that was promoted in many respects by performance of the tasks provided by resolutions of the Central Committee of the CPSU and Council of ministers of the USSR «About measures for further improvement of medical care and public health care of the USSR» (1960) and «About measures for further improvement of health care and development of medical science in the country» (1968). In 50 — the 60th under dispensary observation patients nek-ry extended hron, were taken by diseases (a hypertension, rheumatism, etc.), medical examination of country people is organized; specialists doctors of policlinics (see) and medical and sanitary parts were involved in dispensary work, except local therapists, pediatricians and obstetricians-gynecologists, (see). In the third Party program as perspective of development of socialist health care the task of transition from medical examination of the separate contingents to medical examination of all population was set. During this period the organization of oncological service was almost complete (see), the cut was the basis the dispensary principle. Since 1948 mass routine maintenances are without fail performed (see. Medical examination) for the purpose of detection of tumoral and pretumor diseases with broad use of large picture frame fluorography (see), and also cytologic, endoscopic and other methods. Fight against cardiovascular diseases was conducted by hl. obr. in the direction of early detection and active treatment of atherosclerosis, an idiopathic hypertensia and rheumatism. In ambulatornopoliklinichesky institutions cardiorheumatological offices were organized. In the late fifties and in the 60th were created cardiorheumatological institutions, and also the specialized help is organized by a sick myocardial infarction, to-ruyu the academician E. I. Chazov (1980) considers the initial stage of creation of cardiological service. The important role in further development of preventive activity, strengthening of responsibility of the public and public institutions and organizations, an operating controls by the industry and agriculture, and also certain citizens for implementation of measures for health protection was played by acceptance of Bases of the legislation of USSR and federal republics about health care (see the Legislation on health care).
Along with expansion of preventive measures and improvement of medical aid by the patient with noninfectious diseases the important decisions which defined the main directions of a scientific medical research in the long term were made. Studying of origins of the most widespread noninfectious diseases and development of effective methods of their prevention and treatment became one of priorities of medical science. The party program recommended to concentrate efforts of medical science to opening of warning facilities and overcoming malignant new growths, cardiovascular and other diseases. This change in a perspective of a scientific medical research matched the general orientation of research activity to the advancing development of fundamental, and in particular biological, sciences.
Active implementation of this orientation is connected with decisions October (1964) Plenums of the Central Committee of the CPSU which provided radical reorganization of situation in the Soviet biological science and gained further development in decisions XXIII, XXIV, XXV of congresses of the CPSU, resolutions of the Central Committee of the CPSU and Council of ministers of the USSR «About measures for further improvement of health care and development of medical science in the country» (1968), «About measures for acceleration of development of molecular biology and molecular genetics and use of their achievements in the national economy» (1974), «About measures for further improvement of national health care» (1977).
At the same time and in close interaction with fundamental were carried out sots. - a gigabyte., epidemiological researches on the basis of which data on prevalence of various forms of noninfectious pathology in various regions of the country were obtained among various social and age groups there are population, the specific importance of these or those living conditions, natural and social factors in emergence and development of certain forms of pathology in separate groups of the population was established.
Systems approach to assessment of the state of health of the population gave necessary material for objective judgment of the importance and a measure of pathogenic impact on a human body of separate conditions and factors in a specific situation of combined effect of all variety, all set of conditions and a way of life.
In the 70th on the basis of achievements of medical science and constantly developing personnel and material potential of the Soviet health care a number of large-scale programs of population and preventive researches was carried out. So, in 1972 with active participation of owls. specialists, in particular scientists Ying-that physiology and pathologies of cardiovascular system at Kaunas medical in-those, was executed the international program on the issue of development of methodology of researches of primary prevention of coronary heart disease among the representative contingents of male population of 45 — 59 years of Kaunas and Rotterdam.
Especially widely complex cardiological researches began to be conducted after creation of the All-Union scientific cardiological center USSR Academy of Medical Sciences (VKNTs USSR Academy of Medical Sciences) which is the main scientific and methodical base, the main organizational link on development and deployment of measures of primary and secondary prevention of cardiovascular diseases and improvement of medical aid by the cardiological patient and the establishment conducting in the country on studying of the most urgent problems of cardiology. In VKNTs long-term programs of cardiological researches in scales of the country are developed, implemented and coordinated. So, since 1976 at the initiative of the All-Union scientific cardiological center USSR Academy of Medical Sciences the program of multifactorial prevention of an ischemic disease among male population at the age of 40 — 59 years is carried out, scientists of Kaunas, Minsk, Tashkent, Frunze, Kharkiv take part in performance a cut. The purposes of the program are studying of a possibility of decrease in incidence and coronary heart disease mortality among the population as a result of carrying out primary (elimination of risk factors) and secondary prevention, and also model building of performing multifactorial prevention of coronary heart disease for the existing health service. Distinctive feature of this program is the active impact on all inspected group of the population differentiated taking into account social factors: generally non-drug preventive actions concerning smoking, a hypercholesterolemia, the excess body weight, low physical activity (individual and group conversations, lectures, delivery of instructions and other materials, at a part of persons — with participation of psychologists). In group of patients, in addition, also medicamentous therapy, character is carried out the cut is defined by weight of a condition of the patient, portability of these or those drugs. Carrying out within 2 years of the preventive actions directed against risk factors in groups of both primary, and secondary prevention showed a possibility of decrease in prevalence in population of such factors as smoking, a hypercholesterolemia. At the same time it is possible to reduce the average level of systolic and diastolic arterial pressure at patients with existence of coronary heart disease, and also without it. The events for fight against smoking held within 2 years were quite feasible in the conditions of district clinic and were characterized by considerable percent of successful results.
Main objective of other research program is the fight against arterial hypertension which is carried out in 22 centers of the Soviet Union under the direction of the All-Union scientific cardiological center. This problem is solved in a complex, and is directed by a combination of measures of primary and secondary prevention preferential to the prevention of further development of an idiopathic hypertensia that in turn will lead to considerable decrease in frequency of a myocardial infarction and disturbances of cerebral circulation.
It is carried out by wide use of all opportunities of medical medical units of the industrial enterprises or territorial policlinics. The program provides that each center carries out both preventive measures, and active treatment of persons with rather stable increase in arterial pressure, i.e. such at which at two skriniruyushchy inspections arterial pressure was equal or exceeded 160/95 mm of mercury.
Tentative data of drug treatment in some centers which were considered at implementation of the program within several years, demonstrate that the share of effectively treated patients increased by 4 — 10 times. The research, besides, allowed to plan ways of fuller coverage medical care of patients. Also the research of economic aspects of fight against arterial hypertension among the population is provided in the program. Though the research still continues, the accumulated experience is already implemented into practice of fight against arterial hypertension in two fundamental units of health care — territorial policlinics and medical medical units.
On the basis of the mentioned scientific and practical program the state all-union program of fight against arterial hypertension is developed, edges it will be carried out within the 80th. According to R. G. Oganov and V. I. Blizzards (1982), implementation of this program can lead to decline in mortality from cardiovascular diseases, at least, for 10 — 15% among the population at the age of 35 — 74 years, to increase in average life expectancy, decrease in incidence and reduction of losses from temporary and permanent disability in connection with a brain stroke, a myocardial infarction, heart failure, progressing of coronary insufficiency.
Along with development of scientific bases of primary and secondary prevention of noninfectious diseases in the 70th large measures for public health care were carried out. Performance of the measures provided by resolutions of the Central Committee of the CPSU and Council of ministers of the USSR «About strengthening of nature protection and' improvement of use of natural resources» (1972) «About additional measures for strengthening of nature protection and improvement of use of natural resources» (1978) and some other directive acts, inclusion of questions of environmental control in the Constitution of the USSR, acceptance of Bases of the water legislation, the law «About Protection of Free Air» promoted considerable improvement of the surrounding environment, elimination of many factors connected with risk of causing damage to health of the person, including and with probability of emergence of various forms of noninfectious pathology.
For Pct of noninfectious pathology the important role was played by the measures for further development of specialized medical care which are carried out in the 70th (see). On the basis of large to lay down. institutions, including regional (regional, republican) the BC, created the specialized centers (pulmonary, endocrinological, etc.) which task entered not only rendering highly skilled to lay down. and the advisory help, but also organizational and methodical work on places, including and concerning prevention of the corresponding forms of pathology. In city policlinics the specialized offices which are carrying out work on treatment and medical examination of patients hron, nonspecific diseases of a respiratory organs and digestion, diabetes, etc. were organized. For the 70th almost the coverage dispensary observation of patients increased by 75%, scales of medical examination of healthy faces and routine maintenances, hl extended. obr. children, teenagers, women, working leading industries of the national economy, including agricultural workers. Considerably security with doctors, all types of the out-patient and polyclinic and stationary help increased. Large measures for protection of motherhood and the childhood are carried out.
The concept about risk factors formed a basis for development and implementation in a number of foreign countries under the auspices of WHO of programs on one - and multifactorial prevention of hl. obr. cardiovascular diseases, in particular coronary heart disease, at first on the narrow organized and unorganized contingents of middle-aged persons, and then and in wider scales. During implementation of these programs methods of mass inspection, identification and screening of the persons which were under the influence of risk factors, pharmacological and not pharmacological measures of elimination or correction of risk factors, forms of dynamic overseeing by patients and estimates of efficiency of the taken measures were approved. The main directions of Pct of cardiovascular diseases according to these programs were: 1) structural change of food for the purpose of prevention or decrease in a lipidemia, reduction of excess body weight, and also normalization of arterial pressure; 2) fight against smoking; 3) fight against arterial hypertension; 4) fight against small physical activity. For identification of the contingents of risk in a number of the countries the automated systems of mass inspection of the population having high capacity and based on rather simple unified techniques were designed and implemented. Inspected if necessary recommendations about change of food and the mode of a physical activity were made, pharmacological drugs for correction of disturbances of lipidic exchange and arterial pressure, and also the means facilitating disaccustoming from smoking were appointed. In system of the preventive measures provided by programs, the leading place was taken by the sanitary education aiming at rationalization of a way of life, food, failure from addictions and behavioural installations. It should be noted that in the capitalist countries of the program of Pct of cardiovascular diseases were carried out with the minimum participation of the state and were not correlated with any state measures for improvement of living conditions, work and satisfaction of other social needs of the population that reduced their effectiveness and reduced scales of coverage of the population preventive measures, being limited to hl. obr. more secure social groups. However despite the known social limitation, these programsy played a positive role in improvement of a way of life that affected in decline in mortality from cardiovascular diseases in 10 countries of the world among male and female population at the age of 35 — 74 years.
Though during implementation of many programs of the Pct based on identification and elimination of separate risk factors the encouraging results are received, a number of researchers consider that the concept about risk factors cannot explain completely an etiology of the majority of noninfectious diseases and, therefore, does not solve a problem of their etiological prevention.
Various importance of separate risk factors depending hl. obr. from specific social and klimato-geographical conditions, ethnic and other features of various groups of the population, points to a role of living conditions both in an origin, and in opportunities of the prevention of many noninfectious diseases. Barch is not accidental (R. Barch, 1980), based on materials of the mathematical analysis of mortality from coronary heart disease in the different countries, came to a conclusion that for decline in mortality from this disease, except elimination of action of major factors of risk, also other measures shall have essential value. At the same time the concept about risk factors allows medicine and health care to develop the measures preventing their impact on an organism. These measures already today, on condition of broad and their vigorous implementation, allow to keep life and health to the considerable contingents of the population.
However it is necessary to recognize that the majority of the carried-out foreign programs of fight against noninfectious diseases are rather pragmatic, oriented by hl. obr. on a conscientious attitude of the elected groups of the population to the health, voluntary failure from addictions and the wrong behavioural installations (failure from smoking, the usual mode of a physical activity and structure of food etc.) also were not correlated with measures for improvement of living conditions and work, improvement of system of medical and sanitary providing, etc. The purpose of these programs, thus, came down to the prevention of incidence of noninfectious diseases at separate groups of the population while Pct it is designed to prevent, first, development of risk factors among all population, secondly — to provide the living conditions and production activity minimizing influence of adverse factors of the natural and social environment including by means of the system of the public health care including effective sanitary inspection and dynamic overseeing by the state of health of the population and having opportunities for systematic holding recreational actions, and also timely rendering a necessary medical and disease-prevention service to each citizen. Limitation of the 70th spent in the second half admits the capitalist countries of programs of fight against noninfectious diseases many specialists. Since 1982 under the auspices of WHO the international program of researches on control of the tendencies and decisive factors determining the frequency of cases of cardiovascular diseases begins to be carried out. Within 10 years estimates of tendencies of mortality from cardiovascular diseases and incidence of a coronary disease and diseases of vessels of a brain, and also assessment of to what degree these tendencies in certain settlements are connected with changes of the known risk factors, systems medical - a dignity will be carried out. service, and also main socio-economic indexes. Thus, the specified program is designed to estimate the importance of risk factors, social and economic conditions and extent of development of health services both in emergence, and in prevention of noninfectious pathology. Therefore, at the present stage of development of ideas of Pct the concept of comprehensive prevention as systems of the social, hygienic and medical measures aimed at providing a high level of health and the prevention of diseases, developed by founders of the Soviet health care on the basis of the Marxist-Leninist doctrine about social conditionality of health and a disease gains universal recognition.
Proceeding from this concept of an action of Pct shall carry as all-recreational character, promoting improvement of living conditions and strengthening of health of the population in general, and the purpose on prevention of specific forms of pathology, in particular elimination of action of risk factors is strict. At the same time the best results can be received at complex implementation of the preventive measures providing at the same time improvement of working conditions and life, protection of an organism against external pathogenic influences with elimination of risk of developing of a disease and increasing resistance of an organism to these factors on the basis of mobilization of biological adaptive and compensatory mechanisms. Such approach defines need of regulation with the preventive purpose of a set of factors of life and the professional activity creating conditions and a way of life of the person and relating to an ecological and production situation, living conditions, food, to spiritual, physical culture, etc. Only the state in general can carry out function of such regulation. Therefore, comprehensive implementation of measures of Pct is possible only in socialist society where protection of public health is the most important social function of the state, a cut legislatively, organizationally and financially provides its performance, imposes the corresponding obligations on authorities, managements of the national economy and certain citizens, and also creates the special industry of the state activity — the health care based on a preventive orientation, free of charge and general availability of a medical and disease-prevention service, use of all achievements of science for the benefit of preservation and promotion of health of the people.
The present stage of development of social and preventive activity in our country is inseparably linked with performance of tasks of the XXVI congress, May, November (1982) and June (1983) Plenums of the Central Committee of the CPSU, the resolution of the Central Committee of the CPSU and Council of ministers of the USSR «About additional measures for improvement of public health care» (1982). In the speech on a June (1983) Plenum of the Central Committee of the CPSU the Secretary general of the Central Committee of the CPSU, the Chairman of Presidium of the Supreme Council of the USSR comrade Yu. V. Andropov pointed to the escalating importance of health care in the conditions of the developed socialist society, defined the main directions of further improvement of health protection — increase in qualitative level of medical care and every possible development of the preventive direction. «The increasing place in social policy of party, undoubtedly, will be taken by questions of health care — comrade Yu. V. Andropov told on the Plenum. — The democratic nature of our first-ever system of free health care is well-known. However its qualitative level still not always conforms to requirements of the developed socialism. It was noted in recent years in solutions of party more than once. But, that to execute them, considerable efforts are necessary. The special attention is deserved the prevention of diseases and as one of ways to it — introduction of annual medical examination of all population. It is about human health, that is about business paramount both in social, and in the economic plan» («Truth» of June 16, 1983).
In the 80th it is necessary to provide substantial increase of level of public health, life expectancy and active working capacity by widespread introduction of primary and secondary prevention of noninfectious pathology in scales of the state in general on the basis of implementation effective social, kommunalnobytovy, a dignity. - a gigabyte. 7 medical, organizational, educational and propaganda actions. They are directed to further improvement of living conditions, decrease in prevalence of risk factors among the population, improvement of a socialist way of life, strengthening of sanitary inspection, strengthening and further development of primary link and specialized health services, expansion of scales of medical examination of the healthy faces especially subject to action of risk factors of developing of noninfectious diseases, and also patients with these forms of pathology, radical reorganization and increases in effectiveness of sanitary education. At the same time primary prevention becomes the leading direction in activities for health protection.
The CPSU and the Soviet government planned effective measures for implementation of this direction. So, the main objective of economic strategy of party formulated by the XXVI congress the CPSU in the 80th assumes considerable expansion of scales of social and preventive activity of the state. In system of measures for increase in life expectancy and labor activity of people, to strengthening of their health the leading place will be taken by the wide program of increase in national well-being planned by party: further growth of the material income of the population, increase in funds of consumption and direction of these funds for satisfaction of social needs of the Soviet people, growth of housing construction, fuller satisfaction of needs of citizens for high-quality and various food stuffs, improvement of working conditions, life, rest, satisfaction of cultural requirements, etc.
Along with the program of increase in national well-being «The main directions of economic and social development of the USSR for 1981 — 1985 years and for the period till 1990» provided implementation of complex measures for providing effective population policy, to protection and improvement of the environment, providing optimal conditions for development of modern production, to formation of a healthy lifestyle — i.e. positive impacts on the conditions which are directly influencing the level and the nature of incidence of the population on formation, preservation and strengthening of public health. The resolution of the Central Committee of the CPSU and Council of ministers of the USSR «About measures for strengthening of the state help to the families having children» (1981), accepted in development of decisions of the XXVI congress provided measures for improvement of financial position and living conditions of the families having children, and newlyweds for creation to women of more favorable conditions allowing to combine work in social production with education of children. In particular, practice of work of women on the mode of part-time or part-time working week and work at home will be widely adopted. Since 1981 the working women having two and more children were granted the additional three-day paid leave and the right to use another summer holiday or in time, convenient for them. In the 11th five-years period duration of the paid period on a nosotrophy will be increased by the child up to 14 days. It is paid to labor protection and health of workers especially much attention at the industrial enterprises where female labor is widely applied. Also a number of measures for increase in material security of large families, lonely mothers, introduction of side benefits at purpose of pensions to the women who brought up five and more children is provided in the resolution. All these measures are directed as it is told in the resolution, on strengthening of a family as one of the supreme moral values of socialist society.
The graphic evidence of what huge gain of socialist society is the state social security system allowing to exercise constitutional rights of the Soviet citizens on material security in old age in case of a disease, full or partial disability, and also loss of the supporter, the resolution of the Central Committee of the CPSU and Council of ministers of the USSR «About measures for further improvement of social security of the population» is (1981). In the 80th this important institute of society of mature socialism will gain further development. The resolution provides increase in the minimum size of various type of pensions, rapprochement of the size of pensions of the workers and employees who left work more than ten years ago and the workers of similar qualification retiring today. Funds for improvement of living conditions in houses nursing homes for aged and disabled people will be allocated.
The largest social and economic transformations aiming to provide steady and uninterrupted supply of the population of the USSR with all types of food and further improvement of social living conditions of country people are planned by decisions May (1982) Plenums of the Central Committee of the CPSU, the Food programme of the USSR adopted by it and the resolution of the Central Committee of the CPSU and Council of ministers of the USSR «About measures for further improvement of housing, household and welfare living conditions of country people». During implementation of decisions May (1982) Plenums will be carried out effective measures for improvement of living conditions of country people, sanitary improvement of the village, development of rural health care (see. Food programme).
Fight against risk factors is carried out in the state scale. So, for implementation of Pct not of infectious pathology the measures provided by the resolution of the Central Committee of the CPSU and Council of ministers of the USSR «About measures for strengthening of fight against smoking» (1980) are designed to play an important role. In fight against a hypodynamia the crucial role belongs to physical culture and sport, ensuring their mass character, expansion of material and technical resources of institutions of physical culture and sport. To expand scales of the sports movement, to make occupation physical culture (see) and sport (see) property of all population, a powerful tool of increase in level of public health — a main objective of the resolution of the Central Committee of the CPSU and Council of ministers of the USSR «About further rise in mass character of physical culture and sport» (1981). The Central Committee of the CPSU and Council of ministers of the USSR obliged the Central Committee of the Communist Parties of federal republics, regional committees, regional committees, district committees, city town committees and district committees of party to strengthen the party leadership in the sports movement. According to the resolution the main task of the sports movement — in every possible way to promote strengthening of health of the Soviet people, increase in their working capacity and labor productivity, formation of high moral qualities, courage, force and endurance, to education of healthy and cheerful younger generation. It is offered to m3 of the USSR, ministries and departments of the USSR, councils of ministers of federal republics to improve medical control (see) behind health of athletes and athletes; to take measures to expansion of network of medical and sports clinics, providing them with the modern equipment, the equipment and medicamentous means; to provide in comprehensive plans of sanitary and recreational actions for the corresponding industries of the national economy more intensive implementation of sports and recreational work for strengthening of prevention of a number of diseases. So social policy of the CPSU provides further improvement of health protection, including widespread introduction of measures of primary prevention.
Though implementation of programs of Pct will be provided with all system of social and economic actions of society, demands a comprehensive approach and, therefore, active participation of party and Soviet bodies, labor unions, an operating controls the industry, construction, agriculture, the general public, and also activity of the population, the special guide coordinating and a methodical role in this case belongs to bodies of health care. They shall act as peculiar coordinators of activities in the field of Pct of all industries and public organizations: to prove and formulate specific objectives of scheduled maintenance, to recommend forms and methods of the solution of these tasks, to participate in their implementation and control not only performance, but also efficiency. This function exclusively responsible because implementation of the program of Items of noninfectious diseases it is real only at implementation of uniform policy, at integration of all elements of preventive activity in uniform according to plan and purposefully carried out complex. Performance by bodies of health care of the coordinating and methodical functions in implementation of activities for Pct is provided with the resolution of the Central Committee of the CPSU and Council of ministers of the USSR «About additional measures for an ulto chsheniye of public health care» (1982), the Crimea, in particular, creation at M3 of the USSR of interdepartmental council for coordination of activity of the ministries, departments and public organizations in prevention of diseases and strengthening of health of the population, development and implementation of the relevant activities is provided, generalizations and distribution of the accumulated experience in this area.
Work of bodies and healthcare institutions for implementation of measures of Pct is not limited to coordination of efforts of party, Soviet and economic organizations. The known organizational reorganization of activity of healthcare institutions is carried out, measures for strengthening of effectiveness of sanitary inspection, orientation are carried out to lay down. - professional, institutions and medical staff on Pct of noninfectious diseases, and also on improvement of system of hygienic education and sanitary education which problem will consist in formation at each person, and first of all at youth, vital need in rational use of all conditions provided by socialist society for protection and strengthening of health. Activation of promotion of a healthy lifestyle in many respects depends on that, employees of bodies and institutions of education, culture, the higher and secondary vocational education, mass media will participate how harmoniously in it along with medics. Work on a gigabyte. to education shall begin with the childhood and to be an integral part of an educational system and education in preschool institutions, schools, technical training colleges, technical schools, higher education institutions. At the same time increase in effectiveness and efficiency dignity. educations depends not only on scales of use of mass media (the press, cinema, radio, television). It is also important to provide high scientific character, persuasiveness and clarity a dignity. - a gleam, materials; not to allow promotion sensational insufficiently checked by science and practice and the subjective points of view and recommendations that sometimes takes place in the general and literary and art press; to attract groups of the leading scientists to preparation mass a dignity. - a gleam, editions, widely discussing them before issue with competent specialists as it was made, e.g., by preparation of the Popular medical encyclopedia (see).
It is obvious that in modern conditions the main form of work on Pct of noninfectious diseases is medical examination, and the main device of its implementation — establishments of primary link, and first of all local service, in rural areas, besides, of establishment of a regional link of health care. Therefore the main efforts of bodies of health care on prevention of noninfectious diseases are concentrated on the measures providing further increase in efficiency and expansion of scales of medical examination and mass routine maintenances of the population on strengthening and improvement of activity of primary links of health care, modernization of healthcare institutions today that completely corresponds to the tasks set for the Soviet health care in «The main directions of economic and social development of the USSR accepted by the XXVI congress of the CPSU for 1981 — 1985 and for the period till 1990», decisions May, November (1982) and June (1983) Plenums of the Central Committee of the CPSU. Already in the 11th five-years period it is necessary to carry out real steps for introduction of annual medical examination of all population, first of all children, teenagers, women, the working leading industries of the national economy, and also the persons having risk factors concerning the diseases which are most often leading to disabilities, disability and death especially cardiovascular. The cardiological service which creation was provided by the resolution of the Central Committee of the CPSU and Council of ministers of the USSR «About measures for further improvement of national health care» (1977) is in this respect urged to play an important role. This service, acting as a functional subsystem of the Soviet health care, is under construction on the principle of successive use of all levels and forms of medical service, since out-patient and polyclinic, fast and acute management, priority for it, and completing hospital and sanatorium providing. The main objective of service is implementation of uniform methodical approaches to diagnosis, prevention and treatment of cardiological patients, the organization of fight against cardiovascular diseases, implementation of purposeful scientific research in the field of cardiology. It is presented by system of cardiological institutions, each of which carries out the circle of the specific and interconnected organizational and methodical, medical and diagnostic and preventive tasks. Basic scientific centers of service are 14 research in-t of cardiology and their branches. Till 1985 73 cardiological clinics, 578 cardiological departments in-tsakh, 3648 cardiological offices in policlinics will be developed in the country, 1578 specialized ambulance crews are organized.
Implementation of Pct of various noninfectious diseases is promoted in many respects by performance of measures for development of separate specialized health services, holding actions for further improvement oncological, ophthalmologic, obstetric and gynecologic, psychoneurological and other types of the specialized help to the population; development of network of the specialized centers and offices in pulmonology, neurology, gastroenterologies, endocrinology, etc.; strengthening of sanitary inspection in all spheres of public life (on production, in life) etc.
The major task is activation of work with children's pressed niy, strengthening of activity of nurseries to lay down. - professional, institutions on Pct, including the major sections on sanitary and educational work with a family of the child, active dynamic overseeing as development of the child, the organization of periodic complex medical examinations, etc. Each children's policlinic shall become the original center of active formation of health of children, efficient promotion of a healthy lifestyle in each family, in each preschool institution, at each school.
Are already approved and are implemented into practice to lay down. - professional, institutions some new forms of the organization of scheduled maintenance.
For carrying out mass inspections of the organized contingents of the population the policlinics for routine maintenances equipped by the modern equipment, autoanalyzers mechanized by systems of registration and the accounting of data are created. In a number of the cities of the country as an experiment the automated systems of mass inspection oriented to identification of the hidden initial stages and risk factors of certain forms of noninfectious pathology are implemented. For carrying out mass surveys of country people the mobile teams staffed by doctors and medical staff of regional medical institutions and equipped with laboratory property and the diagnostic equipment began to work.
The organization in the 500 policlinics and more visits per shift of departments of prevention which part are an anamnestic office on detection of risk factors, an office of pre-medical reception, sick female and men's inspection rooms, offices of preventive fluorography and hygienic education proved the efficiency. Such departments are created also in polyclinic departments of the central regional BCs. Their task — carrying out primary inspection and the organization of scheduled maintenance by forces of district doctors and specialists doctors of policlinic. For activation of work on identification of the contingents needing receiving various pharmacological and not pharmacological means of correction of the state of health it is necessary to use all opportunities. It is known that within a year in to lay down. institutions address on average apprx. 80% of the population consisting in it on service. Such addresses can be used for carrying out surveys for the purpose of detection of the latent pathology and risk factors; for these purposes stay in a hospital can be also used. Integration of efforts of all links of health care of the area and area — a considerable reserve for expansion of scales of preventive activity. Important correctly to use it, providing succession in work of various medical institutions with primary link servicing this specific patient.
Also creation of specialized regional and interdistrict laboratory and diagnostic institutions, the remote diagnostic centers where the most modern equipment can rationally be used is repaid. Their work saves time and increases quality of analyses. So, for universal use of electrocardiographical methods at mass inspection of the population the centers of remote transfer of electrocardiograms for the Wave system organized in all federal and autonomous republics, edges and areas are urged to play an important role (from institutions of primary link of medical aid the centers of remote diagnosis of republican, regional and regional BCs). Also the remote centers with transfer of the ECG and their centralized interpretation on the basis of the Soviet managing SM-4 computer system are created. Such systems have capacity to 35 analyses of an ECG an hour.
Implementation of work on Pct in institutions of primary link of health care shall not be followed by additional load of district doctors. Increase in volume of scheduled maintenance of local therapists and pediatricians is compensated by the decrease in population on one established post of the district doctor provided by the resolution of the Central Committee of the CPSU and Council of ministers of the USSR «About measures for further improvement of national health care». Implementation of this provision allowed to increase for years of the 10th five-years period number of established posts of local therapists almost by 25%. Work on disaggregation of medical sites is continued. By 1985 the number of the serviced population on one medical site shall be reduced to 1700 persons. A task of heads of bodies of health care — in the shortest terms to complete local network that will promote more widespread introduction of measures of Pct. It is necessary to involve more widely in scheduled maintenance of average medics, exempting doctors from performance of work unusual for them. In the conditions of rural areas the role of employees of medical and obstetrical centers increases (see) by preparation and carrying out routine maintenances, the organization and carrying out dynamic overseeing by the state of health and planned improvement of the persons which are on the dispensary account.
The strategy of the CPSU and Soviet state in the field of public health care and, in particular, in social and preventive activity for the 80th is fullestly expressed in the resolution of the Central Committee of the CPSU and Council of ministers of the USSR «About additional measures for improvement of health of the population» (1982), planned the large-scale program of further strengthening of potential of the Soviet health care, improvement and development of all types of medical aid, broad implementation of measures of primary and secondary prevention.
Including work on further improvement of public health care of one of the major social tasks set by the XXVI congress, the Central Committee of the CPSU and Council of ministers of the USSR obliged the Central Committee of the Communist Parties of federal republics, regional committees and regional committees of party, councils of ministers of federal and autonomous republics, executive committees of regional and regional councils of People's Deputies, the ministries and departments to concentrate attention on further strengthening of prevention of diseases, injury prevention, improvement of the environment, improvement of working conditions, life and rest, education at the Soviet people of a conscientious attitude to preservation and promotion of health.
For the purpose of increase in overall performance on public health care, including according to the prevention of cardiovascular, oncological, pulmonary, endocrine, nervous and other diseases, treatment and recovery of working ability of patients, M3 of the USSR and councils of ministers of federal republics it is offered to strengthen preventive activity of out-patient and polyclinic institutions, to organize as a part of large policlinics of department of prevention; to increase quality of routine maintenances and medical examination of the population, first of all women and children, to develop network and to improve work of medicogenetic consultations, to strengthen medical and recreational work among children and teenagers. It is recognized also necessary to improve medical service of children in preschool institutions, having paid special attention to ensuring systematic overseeing with the state of health of children and holding recreational actions, to carry out in 1983 — 1987 in republican, regional and regional-tsakh the organization of remote and diagnostic offices (centers) for diagnosis of diseases of bodies of blood circulation, and also to increase effectiveness of the state sanitary inspection, first of all in the field of agricultural and industrial production, to systematically improve a dignity. - a gigabyte. rules and norms.
Together with councils of ministers of federal republics, the ministries and departments, the All-Union Central Council of Trade Unions and the Central Committee of the All-Union Leninist Young Communist League it is entrusted to m3 of the USSR and USSR Academy of Medical Sciences to develop and carry out in 1983 — 1984 till 1990 the comprehensive program of works on strengthening of prevention of diseases and to strengthening of health of the population, having provided at the same time further improvement of conditions and labor protection, holding the sanitary and recreational actions directed to decrease in level of temporary disability, professional incidence, operational injuries and disability, improvement of the environment (see Environmental control); activation of work on hygienic education of the population, strengthening of measures of public impact on the persons abusing alcohol and on fight against other addictions reducing working capacity and worsening the state of health; development of active recreation of the population, implementation of mass physical culture and sport, expansion and increase in efficiency of use of sanatoria dispensaries, tourist and sports centers and other recreational institutions.
With participation of Academy of Sciences of the USSR it is offered to m3 of the USSR and USSR Academy of Medical Sciences to expand in 1983 — 1985 scientific research on studying of origins of cardiovascular, oncological, pulmonary, endocrine, psychological and other diseases in various klimatogeografichesky zones, development of scientific bases of their primary prevention, effective methods of early diagnosis and treatment, strengthening of health of children and teenagers.
For ensuring mass routine maintenances and medical examination of the population, early detection of diseases and treatment of patients with the resolution measures for development and deployment are provided in practice of methods and means of the medical microanalysis, to increase in release of devices and reactants for carrying out modern kliniko-biochemical researches, to development of production of the laboratory equipment, necessary for these purposes. Tasks on providing health care with specialized medical motor transport, the dispatching equipment, medical equipment for equipment of institutions of ambulance and emergency medical service and out-patient and polyclinic institutions are established to the relevant ministries and departments. It is entrusted to ministry of the meat and milk industry of the USSR and Ministry of the Food Industry of the USSR to increase production of dietary products and special products of baby food.
The Central Committee of the CPSU and Council of ministers of the USSR obliged the ministries and departments of the USSR, councils of ministers of federal republics to increase together with the All-Union Central Council of Trade Unions, the central committees and republican councils of labor unions the responsibility of heads of the enterprises, organizations and institutions for strict observance of health regulations and norms, standards, safety of work, holding the recreational actions directed to further improvement of working conditions and rest of workers; to pay special attention to respect for hygienic norms at a design and building of rural settlements; to lift a role of labor collectives in fight against unhealthy habits, especially with alcoholism and smoking, to strengthen fight on sozDenmark of favorable moral and psychological climate at the enterprises, in institutions and the organizations; to provide in plans of social and economic development of the enterprises of an action for improvement of prevention of diseases and strengthening of health of workers, further decrease in level of operational injuries and professional incidence; to provide further expansion of network of country dachas for city preschool institutions, orphanages and summer camps; to create the elementary sports constructions and platforms at schools and preschool institutions, summer camps; to increase production of special furniture for preschool institutions, schools and technical training colleges, and also the small-size equipment, tools, exercise machines and other equipment necessary for industrial practice practice.
It is entrusted to the interested ministries, departments and public organizations to strengthen work on distribution of hygienic knowledge and skills, especially among children and teenagers; to take measures for improvement of preparation of a sanitary asset and broader attraction it to holding preventive actions; to activate participation in hygienic education of the population of television, radio, cinema, cultural and educational institutions.
Implementation of the new complex challenges facing the Soviet health care in connection with basic change of level and scales of preventive activity, broad implementation died Pct, demands from medics of big organization, growth of creative activity. The party learns to use more stoutly and more effectively resources, to open the available reserves more widely. These reserves are put in improvement of planning and organizing work, rational placement and effective use of personnel and material resources, intensive implementation in practice of achievements of science and modernization of healthcare institutions, strengthening of primary links, upgrading of preparation and improvement of medical shots, improvement of work on ideological and moral education of health workers in the spirit of decisions June (1983) Plenums of the Central Committee of the CPSU.
November (1982) and June (1983) Plenums of the Central Committee of the CPSU defined the key directions of economic and social development of the country. In the speech on a November (1982) Plenum of the Central Committee of the CPSU the Secretary general of the Central Committee of the CPSU comrade Yu. V. Andropov especially noted that care of the Soviet person, of conditions of his work and life, of its spiritual development remains the most important program installation of party. Implementation of decisions November (1982) and June (1983) Plenums of the Central Committee of the CPSU will create real social and economic opportunities for transition in the eighties from implementation of separate elements to comprehensive primary prevention on the basis of general medical examination of the population.
Bibliography: Andropov Yu. V. 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S. P. Burenkov, I. P. Leads, A. M. Grindings.