Social, economic, medical and biological aspects of health. Contents of medical and social rehabilitation, its task, types.


Health - a state of complete physical, mental and social well-being and not merely absence of disease or physical defects (WHO, 1946). Health (with medical terms) - a holistic dynamic state of the body, which is determined by energy reserves, and plastic re hulation of functions, characterized by stability to patogene factors and the ability to compensation for the pathological process and is the basis for biological and social functions. Health (from the social aspect ) - a physical, social, psychological, spiritual harmony of man, friendly, peaceful relations with others, with nature, with ourselves. Health protection problem - a problem not only health, but the entire state (G. Apanasenko, L. Popova, 1998)

The health of any human population (public health) EID are detrmined by four basic processes: reproduction health, its formation, consumption and recovery. They are caused by biological, social and economic, social and psychological factors are the foundation on which to build health system management: creating, saving and strengthing it (Fig. 1).

Estimation of population health. Public Health estimated population for health statistics: birth, physical deveopment , life expectancy, morbidity and mortality.

Quantitative estimation of health. Homeostasis of complex organism is expressed in maintaining the stability of the basic parameters of internal environment. Reserves of homeostasis are measured the time within the indicators of internal environment maintained within the physiological norm in the conditios of negative factors internal and external environments action . They depend on the reserve capacity of working organs and the regulatory systems and are expressed in special programs of regulation to be included in the excessive stimuli that signal the threat to their identity.

So, not in the ratio of pathology and regulations need to find these criteria of health but in ability of invalids to perfome their individual biological and social functions.

Perfection of these functions in humans can be described - including quantitative estimation - by the reserves of energy, plastic and regulatory functionsf (G. Apanasenko, L. Popova, 1998).

Formation of health: lifestyle (level of production and labour productivity, satisfaction of material and cultural needs and general cultural level, food features ,moving activity, interpersonal relationships, harmful habits, etc, etc); environment state .





Somatic health (municipal enterprise of biological systems)

The main condition of health is a high energy reserves powers (municipal enterprise). To evaluate the level of health of the individual academician N. Amosov invited to enter the concept of "quantitative estimation of the health level as an indicator of body resistance to negative influence of pathological factors. At the level of the whole organism it can be estimated after physical capacity . It was the most physical working capacity is characterized the "quantity " of health.

Health regimen . In maintaining of health high-level the health regimmen is impotant : health: a certain lifestyle, which promotes restoration, maintenance and development of reserves of the body. Reserves of individual health depends on its physical condition and lifestyle. Physical condition of human ability to perform the physical work. Lifestyle the social category, which includes quality, style and way of life. According to WHO, lifestyle - a way of existence, based on the interaction between conditions in your life and specific of behaviors and personality.

The main factor in the formation of reserves and maintain of a high functional state of the humanns body physiological systems is muscles work. Exercise train almost all working sys tem - the heart, vessels, lungs, liver, kidneys and once-regulatory systems as any muscular tension is the physiological stress. Regular physical exercises are the bright example of extraordinary of human adaptation possibilities. Long-term adaptation is manifested thus in the body restructuring on the central , intersystem , system, organ, tissue, cellular, molecules and molecular levels is a manifestation of biological norm.

Physical distraining is associated with the mechanization of life and work, coupled with excessive and unbalanced eating, hypodynamia against the background of neuro-psychological overload contributes to reserves of homeostasis . Therefore, in modern terms ,the attitude of relevant people to their health has a big importance , because today it takes a passive position. Make each person implicated in the control system to its own health is responsible duty of every health care worker, because "the gift of youth health is and only it is given the gift of youth." "Health should earn. He can not buy. No one will sell it to you" (Paul Bragg, 1991).

Valeology. Science that studies the laws of manifestation, mechanisms and methods of maintenance and health promotion is valueology. Valeologys subject is an individual's health and its mechanisms. The valeology practice involves a formation, preservation and promotion of health of individuals. Valeologiya teaches prevent development of disease and interfere with him on the stage of decline of specific person health. Impacts that are used in this predominantly natural, nonmedicine (cleansing, nutrition improving , hardening, and movement of hypoxic training, psyhorelaxation , manual influences , etc.).

Valeology object - a healthy person and a person that is in the "third state". "Third state" - the transition between health and disease. Status, limited on the one hand, the degree (level) reduction in reserves and the possibility of health as a result of the pathological process at constant conditions of life, on the other - the initial signs of functions - a manifestation of the pathological process. These limits can be characterized by inadequate care. Task of Valeology : to identify the individuals with low health level and using of render healthy methods to withdraw them from the "third state" (G. Apanasenko, L.Popova, 1998).

Especially important in health strengthening and diseasespreventing in our time belong to employees of family medicine. This family physician ,together with the nurse, spend long observation of family members have an opportunity to determine their level of health, prognosing it, correct way of life and thus prevent the development of diseases.

Medical and social rehabilitation, its definition, formation, types, tasks, principles

The definition "rehabilitation" means rehabilitation fitness, ability, capability. It used in all spheres of human activity - political, legal, intellectual , sports and others. In medicine it is defined as the health and labour restoration of patients and disabled patients.

Expert WHO (Committee on Rehabilitation -1963) emphasized that rehabilitation is a process "aimed at preventing disability during treatment and patient care to achieve maximum physical, mental , professional, social and economic completeness to which he will be able within the existing disease.

Rehabilitation is a system of government, social and economic,mental , medical, professional, educational measures aimed at restoring health, disability and her social status based on biological, social and economic, psychological, moral and ethical, scientific and medical traditions.

Biological basis - ability to adapt to certain conditions as a result of operation and recovery of compensatory processes .

Psychological - the ability of the person to feel the prestige and the desire to feel the usefulness and value of their work.

Social and economic fundamentals - value to society of work disabilities, which are usually deep professional knowledge and great experience.

Economic effect of rehabilitation covers costs of public funds spent on their implementation.

Moral and ethical - the principle of a high humanism inherent in our society .

Scientific and methodological basis - modern medicine achievements are closely knit with the achievements of related sciences, the development of techniques that provide a comprehensive solution hearing and significant progress in the restoration and replacement therapy, for example, modern reconstruction, plastic surgery, prosthetic organs, low-invasive surgery, computer survey of patients and others.

Patients in rehabilitation priorities include medical rehabilitation. By of medical staff actively involved experts, educators, psychologists, sociologists, lawyers and representatives of social ensuring, trade unions, enterprises. Large role in this difficult process take place the junior doctors to help professionals in conducting of rehabilitation activities and must possess the scientific basisand and practical skills of rehabilitation treatment.

Formation of rehabilitation. Rehabilitation has become the first use for the treatment of disabled veterans at the beginning of XIX century. Patients had to restore the capacity or ability to self-service , rotate them in society for which they gave to health. Established in 1922 in the U.S. International Society for the care of crippled children-first in the world has taken on the development of the most important issues of rehabilitation . In 1958 at a meeting of WHO's Expert Committee on Medical Rehabilitation was highlighted on the need to use rehabilitation to reduce the negative physical, mental, social consequences of diseases and drawn attention to the feasibility of rehabilitation services.

Rehabilitation began to teach in higher education. Warsaws Medical Academy, one of the world's first opened in 1961, the Department and Clinic of Rehabilitation. Rehabilitation specialists of the secondary link are prepared in England, Denmark and other countries.

In Ukraine, the organization made a lot of rehabilitation and assistance to disabled and infirm: in Kiev an unique , the most authoritative institution in the world to study aging and treatment of elderly and senile age - Institute of Gerontology, the Dnipropetrovrk Research Institute of Medical and social problems of disability were opened . In each region was established for disabled veterans hospitals, schools for children maimed, boarding schools, specialized health centers, Prosthetic plants, organized training for work in these establishments . The state trains and provides possible assistance to the blind, deaf, ben-ment of hostilities, the disabled Chernobyl disaster. The specialized centers for the rehabilitation of patients with first-traumatologic, orthopedic, neuro-surgical, neurological, cardiovascular diseases are opened.

Already in 1991 the question of rehabilitation of invalids in Ukraine began to decide at the legislative level the law "On Principles of Social defend of disabilities and regulations. "The situation of health-social-developed branch review", approved at the state level by the Cabinet of Ministers of Ukraine from 22.02.1992 year. In the situation noted that "medical and social comission of experts reveals compensatory-adaptive capacities of individuals, implementation of which will contribute to the functional, social and psychological rehabilitation of the disabled. Regulations imposed by the position of specialist from medical and social rehabilitation of the municipal , inter-district, district medical and social expert commissions (MSEC), and Republican, Crimea, central comissions of Kyiv and Sevastopol.

An important document, which acquired the further development of Rehabilitation cocept is the Provision about rehabilitation and adaptation individual program for disabled persons, approved by the Cabinet of Ministers of Ukraine from 02.22.1992, 83.

In accordance with the provisions rehabilitation and adaptation of disabled persons is - a comp- lex measures aimed at restoring health and abilities of the disabled and create necessary conditions for him and equal opportunities in all areas. The document that defines the types, forms,volums of rehabilitation, optimal timing of their implementation and specific executors is individual Rehabilitation program being developed by MSEK with accaunting to local opportunities, social and economic, geographic and national peculiarities. The situation defines the main types of reabilitation aid : medical, professional, social and every day life .

In Article 12 of the Law of Ukraine "On Protection of Laborof 21.XI.2002 year is pointed on the need of rational employment for the disabled, under which understand the work, adequate disease and profession ,that promotes the restoration of broken functions and is the most important point of prophylaxes for disability patients.

World Health Organization (WHO) in general concept for National Health Services Health for all in the XXI Century " has determined that the concept is built on three fundamental values : health, a crucial right rights; justice for health and solidarity in action both between countries and within societies of each country; the responsibility of individuals, groups and organizations for further development of health and their participation in this process.

According to WHO concepts the program "Nation Healthy for 2002-2011 is developed in Ukraine. The main purpose of the program defines preserving the health of Ukraine's population, increasing fertility, reducing mortality, longevity and continued an active life, improving health care, social supporting a fair and civil rights to health.

Further orderly development of medical and social rehabilitation to return to profit to the normal life in society many people who have suffered illness and injures, will measure the real prophylaxes and reduce disability.

The task of rehabilitation. -The maximal possible recovery;

- Functional recovery (full or insufficient compensation ,when

There is no possibility to recovery);

- Return to everyday life;

- Involvement to the labor process.

The purpose of rehabilitation. The main purpose of rehabilitation returning of the maximum number of sick and disabled people to society, socially useful work as a prerequisite for healthy and full of value life . Kinds of rehabilitation. Rehabilitation is based on using of biological and social mechanisms of adaptation, compensation and conventionally combined into three interrelated types: medical, social and professional .

Medical rehabilitation is the main type of the rehabilitation process.

Leading methods of medical rehabilitation is the restorating therapy and reconstructive surgery following (as necessary) prosthesis.

Replacement therapy is carried out primarily by medicine treatment, physical activation (therapeutic exercise, massage, physiotherapy, resettlement ), psychological methods (group and individual psychotherapy).

Tasks for Medical Rehabilitation:

- The health restoration ;

- Elimination of the pathological process;

- Prevention of complications and relapses;

- Recovery, partial or full compensation of lost functions;

- Preparation for domestic and industrial loads;

- Prevention of disability .

Physical activation (rehabilitation) includes a set of actions aimed at the restoring of physical capacity of patients with physical disability and temporary disability. Is main features are: therapeutic exercise, massage, physiotherapy, Mechanical labour therapy .

The task of physical rehabilitation:

- Mobilization of bodys reserve forces ;

- Activation of protective and adaptive mechanisms;

- Prevention of complications and relapses;

- Accelerating the recovery of various functions and systems;

- Reduction in terms of clinical and functional recovery;

- Training and body hardening;

- Recovery of capacity.

Psychological Methods (psychologycal and social rehabilitation) provides the correcting of psychological condition, the patient psycho-hygienic learning skills, orientation according to to active life return at the level adequacy to his skills and abilities. This is especially important period after discharge from hospital to the process of adaptation to the changes in the family, society, sphere of professional activity.

Most frequently group and individual psychotherapy, autogenous training, behavioral therapy is used . Moreover, psychological rehabilitation includes a set of principles and rules of medical personnel, relatives, employees, similar to patients ,wich depends of psychological reactions to the illness of the patient. Soial and psycho, logical aspects of rehabilitation include issues such as restoration of personal skills and abilities of the patient for its interaction with social environment, and psichological correction facilities patient facilities to duties of a citizen, member of society, group, family.

In psychological rehabilitation is important pedagogical aspects - process of education, professional retraining and employment program for so-called schools of patients and their relatives, intended to formulate the disease, risk factors make patients and their relatives conscious and active participants in the rehabilitation process.

Social (home) rehabilitation. Rehabilitation of patients treated as ecologycal , mental and sosial system, that considers man in communion with nature and social environment. Health or disease in humans depend not only on biological changes in the body, but also of social conditions change. The disease changes the way ordinary human life, it temporarily or permanently loss the opportunities to work, complicated relationship, material situation, disturbed the process of cultural and spiritual communication . The patient suffers from pain, reduced the physical activity, capacity, it concerns the possible consequences of the disease ,sometimes he needs of nursing .

Social (household) Rehabilitation - a state and public actions aimed at :

- Return rights to socially useful work;

- Legal protection;

- Physical protection of its existence;

- Restoring the social status of individuals through: the organizationof active way of life, restoration of lost or weakened social

ties,creation of a moral and psychological comfort in the family, at work, providing with

the cultural needs of man, leisure, sports;

- At necessity - skills development for service (joint work of the rehabilitologist, specialist from labour , psychologist): Preparation of the patient to use standard or specially made devices,

Facilitate the self-service;

- Resolving of material issues (dwelling , transportation, telephone


- Retraining and employment of patients in specialized establishments , at home (if its necessary);

- Providing various kinds of social aid (prosthesis, providing moving means , working adjustment, organization of resort treatment, etc.);

- Legal protection for the patient.

These problems are solved by medical institutions together with the social welfare.

Professional rehabilitation includes: training of person who suffered the disease to employment, return to the previous work, retraining on the same business or learning a new profession at disability, employment.

The main aim is preparing the patient to work. Its implementation depends on: the nature and course of illness, functional status of the patient, his physical ability, occupation, qualifications, work experience, positions, working conditions, willingness to work. Participants: rehabilitologist , experts from labor therapy , psychologists, educators, sociologists and lawyers.

The task of professional rehabilitation: adaptation, reintegration, professional retraining , further employment.

In this way, medical and social rehabilitation, in addition to restoring health of patient, involves the restoration of its ability, social status , that person return to everyday life in the family, in the workplace, restore the persons individuality, as a full member of society.

03.01. Organization and administration of medical and social rehabilitation

The system of rehabilitation of patients with temporary disability and disabled persons is a process of influence on them and their social environment;Its all structure components are social depend to solution of disability prevention problems in patients with temporary disability and reintegration into society of disabled persons (Fig. 2).

Rehabilitation system consists of:

- Institutions wich organize, coordinate the activities of individual establishments,

carrying out the rehabilitation and manage it;

- Institutions (services) of rehabilitation of various organizational forms and types,

realizing a rehabilitation programs;

- Rehabilitation programs;

- Object of rehabilitation: patient (with a temporary disability

or disabled), which is in a system like that to be rehabilitation, and

goes from it as rehabilitated person .

Staged rehabilitation program

The current state system of rehabilitation includes the following stages:

- Rehabilitation expert diagnosis;

- Working out (on its basis ) of rehabilitation programs;

- Further implementation of these programs;

- Development and adaptation of the network of rehabilitation establishments ;

- Dynamic control over the rehabilitation and

their adjustment, if it is necessary;

- Analysis of adaptive rehabilitation at its final stage.

System management of medical and social rehabilitation.

Leadership in organizing and conducting medical and social reabilitation tion in Ukraine belongs to the Ministry of Health and Ministry of Labour and Social Policy.

At the state level, there are rehabilitation centers and offices at research institutes in Ukraine. They are centers of scientific and methodical, scientific and practical institutions. Authority, which includes cooperation of all rehabilitation establishments on the regional level is a Rehabilitation council at the regional Health Care Administration. Rehabilitation councils are performed the organizational, methodological and supervisory functions.