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 .
RESTORATION OF HEALTH:
recreation;
treatment;
rehabilitation
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 humann’s 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. Valeology’s 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 diseases’preventing 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
Rehabilitation began to teach in higher education.
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, ¹ 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 Labor”of 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-
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 body’s 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
communication);
- Retraining and employment of patients in specialized
establishments
, at home (if it’s 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 person’s 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.