Ministry of Health of Ukraine Ukrainian Medical Stomatological Academy

MINISTRY OF HEALTH OF UKRAINE UKRAINIAN MEDICAL STOMATOLOGICAL ACADEMY

"Approved" at a meeting of the department of social medicine, public health organizations health economics with medical and labor expertise Head of Department Protocol No13 from 08.01.2020 Professor______Golovanova I.A.

Methodical recommendations for independent work of studets during preparation of practical (seminar) classes

Educational discipline Social medicine, public health

Module № 1 Topic Social medicine and public health as a science. Evidence-based medicine, its importance for health care practice Study level III Faculty Foreign Students Training Department

1. Relevance of the topic: The nature of the health care system in each country is determined by the position and development of public health as a scientific discipline. The specific content of any course on public health varies depending on national circumstances and needs, as well as the differentiation achieved by various medical sciences.

1 Methodological basis of public health as a science is to study and correct interpretation of the causes, connections and interdependence between health and social relations, ie, the correct solution of the problem of social and biological relationships in society. Discipline "social medicine" refers to the number of specialized in the preparation of social work on the basis of university education, general professional disciplines studied in the unit.

2. Specific objectives:  To interpret theoretical bases, modern principles and legal health framework;  Identify and analyze key indicators of public health in relationship with the factors that affect it;  Develop measures to improve the health of the population and the individual his troops;  Assess the organization, quality and efficiency of different types of therapeutic and preventive care for the urban and rural population in terms of health care reform.

3. Basic knowledge, abilities, skills, necessary for studying the topic (interdisciplinary integration):

Names of disciplines These skills • History of Stages of development of medical knowledge medicine Conduct analysis of sociological research. • Sociology Identify basic concepts, methods and research tools • Medical biology that are used to determine the factors affecting the body • Biophysics and and health. biochemistry Identify and analyze the relationship between natural • Health phenomena. • Normal physiology Know Classification of Diseases ICD-10. • Pathology • Microbiology Knowing the structure of hospitals and health care volume which is therein • Internal medicine

4. Tasks for independent training to employment

2 4.1. A list of the main terms of parameters, characteristics which the student need to learn

Terminology Definition Social medicine Science of public health, the social problems of medicine. It studies the laws of the influence of social factors on human health teams and determines the ways of its preservation and strengthening. Clinical medicine A system of scientific knowledge and practical activities aimed at strengthening and preservation of health, prolongation of human life, the prevention and treatment of human diseases. Health management A system of management of the state and public activities aimed at improving and preserving public Methods of social medicine A universal method is an integral part of 1. Statistical the methodology of social medicine - analysis of the mistakes of the past makes it possible to prevent their 2. History recurrence - methodology of the organization of the 3. Experimental experiment 4. Economic - analysis of economic indicators 5. Expert evaluation - analysis of the consistency of expert opinion 6. System analysis - methodology of a comprehensive study of the health system Health A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity (who). Public (population) health The main feature, the basic property of the human community, its natural state, reflecting the individual adaptive reactions of each fellow member community of people and of the entire community under specific conditions more effectively carry out its social and biological function. Healthy lifestyle The image of a person's life, aimed at

3 disease prevention and health promotion. You can also say that a healthy lifestyle - this is the daily action designed to promote health. Standard of living It is the degree of satisfaction of the material, cultural and spiritual needs (mainly economic category) The quality of life Characterized comfort to satisfy human needs (this is primarily a sociological category).

4.2 Theoretical questions: 1. What is studying social medicine? 2. What is the obektov social medicine? 3. Methods of Social Medicine 4. What are the methods used in social medicine? 5. What role does the medicine in health? 6. What is health? 7. What indicators characterize health 8. What are the genetic determinants of health? 9. What is heredity and environment? What is their role in the pathogenesis of diseases? 10. What is the relationship with the environment? What are the natural and the social determinants of health. 11. What role does the medicine in health? 12. What is a healthy lifestyle? 13. How to create a healthy lifestyle? What are the main factors in its structure?

5. CONTENT OF THE TOPIC: The main tasks of social medicine is the study of patterns the impact of socio- economic conditions, factors and lifestyles on health, as well as its individual groups and the theoretical foundation of an effective system of state and public measures, ways and means to address the impact of harmful environmental factors, ensuring a high level of health for all members of society , increase in the period of their active creative longevity. Public health and health care as a medical science that studies the laws of formation of health of the population in order to develop health strategies and tactics, its definition and content. Functions of social medicine 1. Learning health status.

4 2. Develop measures to eliminate and prevent the harmful effects of the environment on human health. 3. Participates in the development of government measures aimed at promoting human health in order to improve public health. 4. In cooperation with psychologists, sociologists, educators exploring a wide range of medical, social, economic and legal issues, the real conditions of livelihood. 5. Analyzes the impact on human health of the specific measures that are developing themselves doctors and social workers. The object of study of social medicine - healthy people. Social Medicine examines the health status in the modern society. Health status is determined by the following factors: 1. The impact on the public, the aggregate and individual health of social institutions: government, politics, ideology, religion, morality, culture, ethnic traditions, the economy (market). 2. Impact on health (public, combined, individual) scientific, technical, environmental, natural and geographical factors. 3. The degree of dependence (direct or indirect), health (public, aggregate or individual) from the above-mentioned factors. 4. The degree of protection of health (public, aggregate or individual) from the above- mentioned factors. 5.Stepeni mobility and sustainability of basic social structures (institutions) society (the state) and their impact on changes in health status (public, aggregate, individual). 6.Vzaimosvyaz health (public, aggregate or individual) with health status in the community and with the doctor's position in society. 7. Is health a priority value in society (the state). 8. The relationship of demographic and reproductive health indicators of the company with the status (public, aggregate, individual). 9. The proportion of psychiatric patients, "genetic mutant", the degree of aging society. 10. The ratio of employed and unemployed able-bodied persons in the society by age. 11. The proportion of violent deaths in the community. 12. The ratio of birth and abortion in society. 13. The proportion of infertile young women in the same age with children. 14. The proportion of sudden deaths (from "acute cardiovascular insufficiency") for men and women. 15. The share of non-viable babies. 16. The share of vagrants in the society. 17. Statistics, demography, geography and characteristics of crime in society.

Indicators that determine the health of the population: 1. Demographics (fertility, mortality) 2. Incidence 3. Disability 5 4. Indicators of physical development of the population

Experts of the World Health Organization (WHO) in the 80-ies. XX century. We determined the approximate ratio of various health maintenance of modern human factors, highlighting as the main four groups of factors.

Methods of Social Medicine: The statistical method is the main method of the social sciences is widely used in the field of public health. It allows you to establish and objectively evaluate the changes in health status and to determine the effectiveness of the authorities and healthcare institutions. Furthermore, it is widely used in medical research (hygiene, physiological, biochemical, clinical, and others.). The method of expert estimations is in addition to the statistical, whose main task is to define an indirect way of various correction factors. Public Health uses quantitative measurements using statistics and epidemiological methods. This allows predictions based on previously formulated laws, for example, it is possible to predict future fertility, population size, mortality, mortality from cancer, etc. The historical method is based on the study and analysis of public health and health care processes at different stages of human history. The historical method - is descriptive, descriptive method. The method of economic research makes it possible to establish the impact of the economy on health care and, on the contrary, the health on the economy of society. Health economics is an integral part of the economy. Health care in any country has certain material and technical base, which includes hospitals, clinics, institutes, clinics, and others. We study and analyze health financing sources, concerning the most efficient use of these funds. This methods are used to study the effect of socio-economic factors on the health of the people employed in economic sciences. These methods find direct application in the study and development of health issues, such as accounting, planning, finance, health care management, rational use of material resources, scientific organization of labor in the organs and health-care facilities. The experimental method - a method of finding new, more efficient forms and methods of work, the creation of models of care, implementation of best practices, testing projects, hypotheses, the establishment of experimental bases, medical centers, etc. The experiment can be carried out not only in the natural but also the social sciences. In the public health experiment can not be used frequently because of related administrative and legal difficulties. Modeling method developed in the field of health care organization, which is to create a model organization for experimental verification. In connection with the experimental method is more reliable assigned to the experimental areas and health centers, as well as pilot programs on specific issues. Experimental areas and centers can be called "field laboratories" for scientific health research. Depending on the objectives 6 and issues for which they are created, these models vary considerably in size and organization, are temporary or permanent. The method of observation and survey. To replenish and deepen, these data, special studies can be undertaken. For example, to obtain a deeper data, the incidence of certain professions use the results obtained from the medical examination of the contingent. To identify the nature and extent of the influence of socio - hygienic conditions on morbidity, mortality and physical development can be used survey methods (interview, questionnaire method) individuals, families or groups of people in a special program. Survey method (interview), you can obtain valuable information on a variety of issues: economic, social, demographic, and others. Epidemiological method. Prominent among epidemiological research methods covers epidemiological analysis. Epidemiological analysis is a set of methods for studying the characteristics of the epidemic process in order to clarify the reasons that contribute to the spread of this phenomenon in a given territory, and develop practical recommendations for optimization. From the point of view of public health methods, epidemiology is the application health statistics, which in this case It serves as the primary, substantially specific method. Health In modern literature there are many different interpretations of the "health" concepts, which are classified as follows: 1) health as the absence of disease; 2) health and rate as identical concepts; 3) health as a unity of morphological, psycho-emotional, social and economic terms. Indicators that determine the health of the population: 1. Demographics (fertility, mortality) 2. Incidence 3. Disability 4. Indicators of physical development of the population Experts of the World Health Organization (WHO) in the 80-ies. XX century. We determined the approximate ratio of various health maintenance of modern human factors, highlighting as the main four groups of factors: • genetic factors - 15-20%; • the environment - 20-25%; • medical support - 10-15%; • conditions and way of life of people - 50-55%.

Factors influencing health The sphere of Factors influence of factors Promote health Deteriorating health Genetic Healthy heredity. The Hereditary diseases and

7 absence of morphological and disorders. Hereditary functional prerequisites for the predisposition to disease. emergence of the disease. State of the Good household and Harmful conditions of life environment industrial conditions, and production, adverse favorable climatic and natural climatic and natural conditions, environmentally conditions, a violation of the favorable habitat. environment. Medical Medical screening, a high The lack of permanent maintenance level of prevention, timely and medical supervision of the comprehensive medical care. health dynamics, the low level of primary prevention, poor health care. Terms and lifestyle The rational organization of The absence of a rational life: sedentary, adequate mode of life, migration physical activity, social lifestyle.

LITERATURE: Training: Summary: Public Health // Ed. A.F.Serenko, V.V.Ermakova.- M: Medicine, 1984. Additional: • Guide to practical training in social hygiene and public health organization // Ed. Yu.P.Lisitsina, N.Ya.Kopyta. M .: Medicine, 1984. • Health Statistics. Methodology of statistical research. Ed. prof. IS Sluchanko.- Moscow, 1979. • Guidance on social hygiene and public health organization. In 2 vols. Ed. Yu.P.Lisitsina. - M.: Medicine 1987. • AN Varaksin (2006) Statistical analysis of biological and medical information: problems and solutions. Intern. Zh. honey. Pract., 2, 35-38. Methodological: Lecture chair of the course Internet resources: - Natsionalna medichna bіblіoteka US http://www.nlm.nih.gov/

8 - Scientific Pedagogical Library. KD Ushinskogo Russian Academy of Education http://www.gnpbu.ru/ - Natsionalna bіblіoteka Ukraine IM. V.І. Vernadskogo http://www.nbuv.gov.ua/ - Natsionalna Naukova medichna bіblіoteka Ukraine http://www.library.gov.ua/ - Central Scientific Medical Library of the First Moscow State Medical University. THEM. Sechenov http://elibrary.ru/defaultx.asp - ftp://ftp.dsma.dp.ua/302/Russian/Multimediya/soc%20med.pdf

II. HEALTH OF A POPULATION. FACTORS THAT DETERMINE PUBLIC HEALTH. STUDY METHODS

1. Relevance of the topic The problem of preserving and strengthening the health of the population has always been one of the key issues in society. The health of a nation is an indicator of the state’s civilization, reflecting the level of its socio-economic development, the main criterion of expediency and effectiveness of all spheres of human activity. Now in Ukraine, the trend of deterioration in the health of the population has become an alarming level. This is due to the impoverishment of a significant part of the population, environmental degradation, the spread of health, destructive behavioral stereotypes, a decrease in the availability of high-quality medical services, and the health of the costs of the modern education system. Of particular concern is the state of health of children, school and student youth. 2. Specific goals: Know • essential characteristics of health; • individual health assessment criteria and public health indicators; • disease risk factors; • basics of modern health theory; Be able: • to calculate medical and demographic indicators, morbidity and disability indicators; • assess the state, patterns and dynamics of public health; • evaluate key indicators of public health; • assess the impact of socio-economic and biological determinants on health, their trends across different populations, and identify risk; • identify health inequalities caused by social determinants and develop appropriate measures to reduce them. Own: • systematic approach to solving health problems; • skills in researching medical and social problems in modern society.

3. Basic knowledge necessary for studying the topic (interdisciplinary integration) Disciplines Acquired knowledge

9 1 Medical biology Conduct an analysis of sociological research Biological physics and chemistry. Identify the basic concepts, methods and means Normal physiology of research that are used to study environmental Morphology factors and their effects on the body and human Propedeutics of internal diseases health. Conduct a statistical study. Identify links between natural phenomena. Analyze the activities of clinical departments

2 Hygiene and ecology Information communication in the system "Public Health - Environment" to identify the relationship between natural phenomena 3 Social medicine and health care Organization of dental care to the public. Communication of public health risk factors with observed actual characteristics of individual and public health. Evaluate the organization of health care and its performance Assess the relationship of the clinical and organizational aspects of public health services in health care facilities.

4. Tasks for independent work of preparation for the occupation. 4.1. The list of key terms, parameters, characteristics which the student needs to learn while preparing for the class: Term Definition 1. Health a state of complete social, mental and biological well-being, and not only the absence of disease and physical defects. 2. Risk factors These are potentially hazardous factors of behavioral, biological, genetic, ecological, social, environmental and occupational factors that increase the likelihood of developing diseases, their progression and adverse outcome. 3. Types of risk factors endogenous, controlled, exogenous, uncontrollable 4. Medical factors vaccinations against infections, medical examinations, quality of treatment 5. Socio-economic working conditions, level of qualification, income, its size, level of education, recreation, etc. 6. Human Development integral indicator calculated annually for cross-country Index comparison and measurement of the standard of living, literacy, education and longevity as the main characteristics of the human potential of the study area

4.2. Theoretical questions to the lesson: 1. . Define the concept of "health" of a person 2. Individual approach in terms of the health of the individual. 3. An integrated approach to the definition of the concept of "health" of the population. 4. The complex of medical indicators characterizing the health of the population 5. Risk factors floating on human health. 4.3. Practical tasks that are performed in the lesson: A task Make a chart of the following. Typical diseases of students in grades 6-9 (%): 10 Caries - 20.4-22.4 Violation of posture - 11.4-1.2 Injuries, burns - 4.6-5.7 Diseases of the nervous system - 1.8-3 Visual impairment - 18 ORVI -30 Overweight – 38 Сontent: Human health in the WHO charter is treated as a state of complete social, mental and biological well-being, and not only the absence of diseases and physical defects. Human health is determined by a complex of biological (hereditary and acquired) and social factors. The latter are so important in maintaining the state of health or in the emergence and development of the disease, in the preamble of the statute of the World Health Organization it is written: "Health is a state of complete physical, spiritual and social well-being, and not just the absence of diseases and physical disabilities." This definition of the concept of "health" is the most clear, understandable, complete and contains, above all, the biological, social and psychological aspects of this problem. The definition of health is broad and cannot be covered by one indicator. On the positive side, public health can be estimated in terms of life expectancy at birth (or upon reaching any age) —the number of years a child will live if the level of mortality in age groups does not change. The average life expectancy depends on the gender of the person - the biological discrepancy between men and women is 4-5 years. The problem of preserving human health has been given great attention by scientists throughout the history of mankind. In ancient times this work was devoted to the works of Hippocrates, Democritus, Aristotle, Galen and other scientists. The origins of the concept of health lie in the depths of the centuries. Even in ancient times, our ancestors, distinguishing the state of health and disease, in every way sought to preserve health and avoid disease. Hippocrates (the founder of scientific medicine), in addition to physical exercises, widely used massage, water procedures, diet food in its activities. The priority principles in the activities of Hippocrates was the use of recreational means of nature. Another ancient Greek scientist, Aristotle, taught that human health depends on the placement of the dense and indivisible parts that make up the body. Based on his considerations, Aristotle created a solidary theory of health. Reflecting on health, Socrates concluded that health is not everything, but everything without health is nothing. It should be noted that in the history of the development of knowledge about health and methods for improving it, two directions can be traced, which differ significantly in both the theoretical basis and the methodology. One of them is characteristic of the western, the second - for the eastern civilization. From the point of view of individual health, that is, an individual approach, there can be two options. The first is a theoretical one, if one defines health as a theoretically possible ideal to which one should strive, but in fact it is difficult to achieve. In this regard, the definition given by the World Health Organization (WHO) is the most appropriate: “Health is a state of complete social, biological and psychological well-being, when the functions of all organs and systems are balanced with the environment, there are no diseases, illnesses and physical defects. " The second option is practical when it is necessary to give an answer, a healthy or sick one or another person. The main thing is the ability of the body to fully perform its biological and social functions. " When it comes to population health I, that is, the health of the population and its individual groups, we must bear in mind that there is no single criterion by which to determine the health status of the population, for example, region, country, city, district, region. In this case, in world statistics it is customary to use an integrated approach to the definition of the concept of "health"

11 of the population. By this they understand a conditional statistical concept, it is quite fully characterized by a set of indicato demographic (fertility, mortality, average life expectancy); • physical development; • morbidity; • disability; • frequencies of prenosological conditions.

The risk factors for public health occurring in the environment of Ukraine are diverse. The health effects of many pollutants can be linked to other factors (smoking, alcohol, economic problems). This negative impact on health is not always sufficiently studied, but today there is no doubt that environmental pollutants can increase the number of diseases of the respiratory system organs, tumors of various localization, some congenital anomalies, etc., and also worsen state of health. It is known that in order to assess the effects of the adverse effects of environmental factors on health, the following are taken into account: - the biological effect of the harmful factor; - the degree of distribution; - factor stability in the time space; - The size of the population groups, which in varying degrees, are under negative influence. For a comprehensive assessment of the health status of the population, as a rule, generalized health indices are used, which integrate a number of indicators. The use of indices makes it possible to quantitatively describe the state of public health, taking into account various aspects and factors influencing its formation. The essence of the comprehensive health index is that the numerous isolated indicators characterizing the health of the population are replaced by one. Ideally, a comprehensive population health index should include information on all aspects of health and factors influencing its formation. As a rule, a number of the following requirements are included in the calculation of complex population health indicators: 1) data availability (the more complex and informative the indicator, the more problematic is the formation of the required database); 2) quality, which must be guaranteed by the reliability and completeness of the data used to calculate the index; 3) reproducibility by different specialists; 4) specificity (display of changes only in those phenomena, the reproduction of which) 5) sensitivity to changes (with time, the importance of the influence of various factors changes) 6) hierarchy (a single principle for all hierarchical levels).

To characterize health use three main groups of health indicators: The first group is medical records. The second group - indicators of social well-being. The third group - indicators of mental well-being. The first group, that is, the group of medical indicators include the following: 1) incidence; 2) mortality (total and infants) 3) physical development; 4) disability. The second group - indicators of social well-being includes: 1) the demographic situation; 2) the state of the environment; 3) lifestyle; 4) the level of medical care; 5) social and hygienic indicators. The third group - indicators of mental well-being include: 1) the incidence of mental illness; 2) the frequency of neurotic states and psychopathy; 3) psychological microclimate. It should also be noted that the World Health Organization (WHO) has developed a list of criteria for social well-being. This list includes: 1) the percentage of gross national product that is spent on the needs of health care; 12 According to WHO, the average global expenditure on health care is 8% of global GDP. 2) the availability of primary health care; 3) coverage of the population with safe water supply; 4) the percentage of people who were immunized against six infectious diseases that are particularly common among the population: diphtheria, whooping cough, tetanus, measles, polio, and tuberculosis. 5) the percentage of women serving qualified personnel during pregnancy and childbirth; 6) the percentage of children born with low birth weight (less than 2500 g); 7) average life expectancy; 8) the level of health literacy of the population.

Integral assessment of the health status of the population involves conducting research in several stages. At the first stage, we obtain information on indicators characterizing the state of health of the population (for example, on the level of morbidity, mortality, disability, or physical development) from various sources of information. These sources of information can be: 1. official reports of medical, sanitary and preventive institutions, health authorities, social welfare, state statistics, civil status registration office (ZAGS) 2. the results of retrospective and prospective studies in medical institutions; 2. data of medical examinations of the population; 3. data of clinical, laboratory and instrumental studies; 4. results of medical and sociological research - surveys, population surveys; 5. the results of mathematical modeling and forecasting.

At the second stage - it is necessary to give an integral assessment of the level of health, summarizing all the indicators. To do this, conduct a conceptual (qualitative) analysis and mathematical-statistical (quantitative) analysis. A consequence of the conceptual analysis is the distribution of the population into health groups. The criteria for dividing into health groups are as follows: 1. the presence or absence of a chronic disease; 2. body resistance; 3. level of physical development; 4. compliance with morpho-functional parameters.

For example, the distribution of the population according to its state of health, which was developed at the Institute of Social Hygiene and Public Health Organization named after MA Semashko, associated with the registration of the presence or absence of chronic diseases during the inspection, the following: The first group is healthy people. The second group is healthy people with functional and some morphological abnormalities. The third group - patients with a long course of chronic disease while maintaining the functional capabilities of the body (compensated state). The fourth group - patients with a long course of a chronic disease or a person with physical disabilities, developmental defects, a consequence of injuries, with reduced functional capabilities of the body (subcompensated state). The fifth group - seriously ill (decompensated state). Assessment of the health status and trends of the population is a prerequisite for effective scientifically based health system activities, serves as a basis for planning treatment and preventive measures, developing organizational forms and methods of work of health authorities and institutions, as well as for monitoring the effectiveness of their activities in maintaining and promoting health. population. All this leads to the inextricable link of health indicators with the 13 volume and nature of health care to the population and ultimately making adequate management decisions. So-called risk factors play an important role in shaping the level of public health. The risk factor for illness or death is an endogenous or exogenous adverse effect on the body, increasing the likelihood of a disease or death. These factors are quite numerous, conditionally they can be divided into endo and exogenous. Factors affecting health can be divided into 4 large groups: - Lifestyle; - biological; - state of the environment; - volume and quality of medical The intensity of the impact of these groups of factors varies considerably 1. Lifestyle - smoking, unhealthy diet, alcohol abuse, harmful work, stress, physical inactivity, poor life, drugs, incomplete or large families, hyper-urbanization - the percentage of influence on human health in percent is 51-52% 2. Environment - polluted air, water, food, soil, radiation level, electromagnetic fields - the percentage of influence on human health is 20-21% 3. Biological factors of heredity, constitution, gender, age - the percentage of influence on human health in percentage is 19-20% 4. Medical factors of vaccination against infections, medical examinations, quality of treatment - the percentage of influence on human health in percentage is 8-9% The first place on the impact on the health of the population in modern conditions is played by lifestyle factors, they account for more than 50 percent. Such ways as the standard of living (structure, level of material security per person), quality of life (measured parameters characterizing a person’s material security), lifestyle (psychological, individual behavioral characteristics), lifestyle (national, social order, life, culture). Among the leading factors of lifestyle that adversely affect health, the following should be mentioned: smoking, unhealthy diet, alcohol abuse, harmful working conditions, stress, physical inactivity, poor material and living conditions, drug use; fragile, incomplete or large families; excessive levels of urbanization and the like. Biological factors (gender, age, heredity, constitution) are in second place in terms of their impact on health. They account for about 20 percent. The third place is occupied by environmental factors (air, water, food, soil, radiation level). The impact of these factors is about 20 percent. Finally, purely medical factors - treatment-and-prophylactic and sanitary-anti- epidemic measures (vaccinations against infectious diseases, quality of treatment and examination of patients, etc.) - determine the state of health by 10 percent

Materials for self-monitoring: A. Materials for self-monitoring: 1. Of the following categories of lifestyle to a greater extent affects individual health: A. Living conditions; B. Quality of life; C. Lifestyle; D. Purpose of life; E. Longevity. 2. Which of the following groups are related to physical factors affecting the state of human health: A. Air pollution, water, soil, food, noise, electromagnetic fields, radiation; B. Labor, family, personal, cultural relations, psycho-emotional effects; C. Political change, unemployment, lack of time; D. Burdened heredity, malformations; E. Social and family relationships. 14 3. Which of the following groups are related to social factors affecting the state of human health: A. Air pollution, water, soil, food, noise, electromagnetic fields, radiation; B. Labor, family, personal, cultural relations, psycho-emotional effects; C. Political change, unemployment, lack of time; D. Burdened heredity, malformations; E. Family Relations. 4. Social health is: A. The state of the organism, which determines the ability of a person to contact with society; B. The state of the body, providing adequate intellectual, emotional and conscious-volitional interaction of the organism with the environment; C. The state of the organism, in which the indicators of the basic physiological systems lie within the physiological norm; D. The state of the organism, in which the indices of the main physiological systems change adequately when a person interacts with the external environment; E. no right answer. 5. The general definition of "individual" health (according to WHO) corresponds to the following definition: A. The state of complete physical, mental and social well-being, not only the absence of disease, B. A condition characterized by the absence of disease, physical defects and premorbid conditions, C. State of well-being, due to the absence of diseases and pathological conditions, D. A condition characterized by the absence of disease E. Lack of pathological conditions of the body while maintaining well-being

B. Tasks for self-control:

One cigarette destroys 25 mg of vitamin C. It is known that if a person has been in a smoky room for 1 hour, then this is equivalent to 4 smoked cigarettes. How many people lost vitamin C if he stayed in a smoke-filled room for 2 hours? Answer: 200 mg

Literature: Basic (basic) 1. Public health: a textbook for students. higher honey. teach. institutions. - Kind. 3 - Vinnytsia: New Book, 2013. - 560 p. 2. Oxford Textbook of Global Public Health, 6 edition. Edited by Roges Detels, Martin Gulliford, Quarraisha Abdool Karim and Chorh Chuan Tan. - Oxford University Press, 2017. - 1728 p. 3. Medical Statistics at a Glance Text and Workbook. Aviva Petria, Caroline Sabin. - Wiley- Blackwell, 2013. - 288 p. Auxiliary: 1. Board Review in Preventive Medicine and Public Health. Gregory Schwaid. - ELSEVIER., 2017. - 450 p. 2. Donaldson`s Essential Public Health, Fourth Edition. Liam J. Donaldson, Paul Rutter - CRC Press, Taylor & Francis Group, 2017 - 374 p. 3. Jekel`s epidemiology, biostatistics, preventive medicine and public health. Fourth edition. David L. Katz, Joann G. Elmore, Dorothea M.G. Wild, Sean C. Lucan. - ELSEVIER., 2014. - 405 p. 4. Oxford Handbook of Public Health Practice, Fourth Edition. Charles Guest, Walter Ricciardi, Ichiro Kawachi, Iain Lang. - Oxford University Press, 2012. - 656 p. 5. Example of Biostatistics, Seventh Edition. Stanton A. Glantz - McGraw-HillEducation, 2012. - 320 p. 15 6. Health economics: textbook. - Vinnytsia: Nova Knyga, 2010. - 112 p. 7. Album A., Norrell S. Introduction to modern epidemiology. - Tallinn, 1996. - 122 p. 8. Biostatistics. - K .: Book plus; 2009. - 184 p. 9. Vlasov VV Introduction to evidence-based medicine. - M .: Media Sphere, 2001. - 392 p. 10. Garkavenko SS Marketing: textbook. - K .: Libra, 2002. - 712 p. 11. Glantz S. Biomedical statistics. - M .: Practice, 1999. - 459 p. 12. Greenhalch T. Fundamentals of evidence-based medicine: trans. with English. - M .: GEOTAR-MED, 2004. - 240 p. 13. Health Report in Europe 2012. Wellbeing Course. - WHO, 2013. - 190 p. 14. World Health Report 2013 - WHO, 2013. - 206 p. (access mode: www.who.int/en/2013/report/en). 15. Epidemiological methods of studying noncommunicable diseases / V.M. Lehan, Yu.V. Voronenko, OP Maksimenko and others. - D.: ART-PRESS, 2004. - 184 p. 16. Collection of test tasks for state tests on hygiene, social medicine, organization and economy of health care. Educ. manual. - Vinnitsa: New Book, 2012 - 200 p. 17. Health 2020 is the cornerstone of European policy and strategy for the 21st century. - WHO, 2013 - 232s. 18. Campbell R. McConnell, Stanley L. Bru. Economics: principles, problems and policy. Trans. with eng. 11th ed. - K., Hagar-Demos, 1998. - 785 p. 19. Methods of social medicine / ed. OHM. Ocheredko, OG The process. - Vinnitsa: Thesis, 2007. - 410 p. 20. Mochernyi SV, Nekrasova VV Fundamentals of business organization: a textbook for universities. - M .: Prior Prior, 2004 - 544 p. 21. The population of Ukraine. Demographic Yearbook. - K .: Goskomstat of Ukraine. (access mode: www.ukrstat.gov.ua). 22. Popchenko TP Health care reform in Ukraine: organizational, regulatory and financial- economic support. - K .: NISD, 2012. - 96 p. 23. Guide to Social Medicine and Health Organization. - K .: Health, 2002. - 359 p. 24. Programmatic test questions on social medicine and health care organization. - Ternopil: Ukrmedkniga, 2001. - 316 p. 25. Social medicine and organization of health care (for students of dental faculties of higher medical educational establishments of Ukraine of IV level of accreditation. - K .: Book plus, 2010. - 328 p.). 26. Fletcher R., Fletcher S., Wagner E. Clinical epidemiology. Fundamentals of evidence-based medicine. - M .: Media Sphere, 1998. - 352 p.

Information resources - World Health Organization www.who.int - European Health for All Database www.euro.who.int/en/home - Cochrane Center for Evidence-Based Medicine www.cebm.net - Cochrane Library www.cochrane.org - US National Library of Medicine - MEDLINE www.ncbi.nlm.nih.gov/PubMed - Canadian Center for Health Evidence www.cche.net - Center for Disease Control and Prevention www.cdc.gov - Public Health Center of the Ministry of Health of Ukraine www.phc.org.ua - Ukrainian Health-for-All Database for Health Statistics: http://medstat.gov.ua/eng/news.html?id=203 - British Medical Journal www.bmj.com - Evidence-Based Medicine Magazine www.evidence-basedmedicine.com

16 III. ORGANIZATION OF STATISTICAL RESEARCH

1. Relevance of the topic Modern medical training is aimed at the formation of a professional who knows how to organically connect theoretical knowledge and practical skills in the field of clinical and preventive medicine. Medical education, regardless of its nature, level and direction must necessarily contribute to the formation of the young specialist sociohygienic thinking, understanding of the role of environmental factors, social and living conditions of life in the event of various deviations in health status, the ability to adequately identify and apply different methods prevention. 2. Specific objectives: 1. Master the knowledge of statistics as a scientific discipline, its goals, objectives, components, medical statistics value for doctors in different fields. 2. Get acquainted with the methodology of statistical research and order execution. 3. Be able to make table layouts.

3. Basic knowledge, abilities, skills, necessary for studying the topic (interdisciplinary integration):

Names of disciplines These skills • History of medicine Stages of development of medical knowledge • Sociology Conduct analysis of sociological research. • Medical biology Identify basic concepts, methods and research tools • Biophysics and that are used to determine the factors affecting the body biochemistry and health. • Health Identify and analyze the relationship between natural phenomena. • Normal physiology Know Classification of Diseases ICD-10. • Pathology

• Microbiology Knowing the structure of hospitals and health care • Internal medicine volume which is therein

4. Tasks for independent training to employment 4.1. A list of the main terms of parameters, characteristics which the student need to learn Terminology Definition

17 Statistics Social science that studies the quantitative aspect of mass public events in close connection with their qualitative features. Statistical investigation Scientific organizational process in which the same program is conducted observation of certain phenomena and processes, data collection and registration, processing and analysis.

The object of observation Relatively homogeneous group of (statistical population) elements (observation units) under specific conditions of time and space.

Surveillance unit Is the primary element of statistical population, shows evidence of the similarities and differences. Statistical table Form a systematic, rational and intuitive presenting digital material, which characterizes the phenomena and processes.

4.2. Theoretical questions to the lesson: 1. What is statistics? 2. Categories of medical statistics. 3. Stages of statistical research. 4. The content of the first stage of statistical research. 5. What can be taken as a unit of observation? 6. What can be taken as an object of research? 7. Types of statistical observation. 8. Types of statistical tables. 9. Requirements to the statistical tables. 10. The choice of the form of statistical tables. 4.3. Practical tasks: To be able to make a plan and a program of statistical research and table layouts. 5. CONTENT OF THE TOPIC: Statistics - a social science that studies the quantitative aspect of mass public events in close connection with their qualitative features. This diversity is explained by the qualitative features that for a quantitative description of phenomena using a large number of a variety of statistical values. Statistics establishes a correspondence between the ideal world and the representation of the real world. 18 Statistics, studies issues related to medicine, hygiene and health, called medical or health. Categories for Health Statistics: 1) Statistics of public health; 2) Health statistics; 3) Statistics of research, theoretical or medical statistics. Statistical research - scientific organizational process in which the same program is conducted observation of certain phenomena and processes, data collection and registration, processing and analysis. The aim of the study is to reveal the essence of mass phenomena, processes, laws. No matter what tasks are put in the sanitary-statistical research, it should be carried out in sequence in accordance with the historically established stages, which consist of individual operations. There are 4 stages of statistical research: 1) making a plan and research program (preparations); 2) statistical observation (collection material); 3) the development of statistical material; 4) analysis, conclusions, recommendations, implementation in practice.

Stage 1. Drawing up the plan and research program: 1) the formulation of goals and objectives of the study in accordance with the working hypothesis; 2) identification and selection of statistical population; 3) the definition of the unit of observation; 4) choose the type of statistical analysis (one-time, current, continuous, selective (mechanical, typological, female, casual, parnosopryazhenny et al.); 5) definition of the object of observation, observation time and observation of the subject; 6) definition of data collection program (Mapping of statistical research with a list of registration signs); 7) determining the development of the program data (drawing layouts, tables with related symptoms); 8) determination of the method of observation - a questionnaire, anamnestic studies, copying. In preparing the study, except for the goal, it is necessary to know what should be the study - to determine the object of study. The object of observation (statistical population) - a group of relatively homogeneous items (observation units) under specific conditions of time and space. For example, a set of individuals (patients who died), functional units (beds in hospitals), a group of people who have certain effects (able-bodied and disabled people, organized groups, etc.). Depending on the coverage of observation units (the purpose of the study) statistical population may be general and selective.

19 The unit of observation - is the primary element of statistical population, shows evidence of the similarities and differences. Signs of differences to be studied and are therefore called accounting features. Accounts signs in nature are quantitative and qualitative (attributive), for playing together - factorial and productive. Statistical table - form a systematic, rational and intuitive presenting digital material, which characterizes the phenomena and processes. In drawing up the tables, you must comply with certain requirements: - The table must have a clear, concise title; - The table must have a single, numbered sequentially; - Registration table ends with the results in columns and rows; - In the table should not be empty cells (no sign - put a dash). Types of tables: Simple table - a table that shows a summary of the final data for one feature. Table one the subject (phenomenon) is represented by a predicate (attribute).

Distribution of children's health groups (Table №1) Health group Number of children I II III IV V in total - Group table - a table that is one to be characterized by several predicates, but the symptoms are not related to each other.

Distribution of children's health groups, sex and age (Table №2) Health Gender Age (years) in group М F 0-3 4-6 7-10 11-14 total I II III IV V in total - Combination table - features that characterize the subject are interrelated.

Distribution of children's health groups, sex and age (Table №3) Hea Возраст (лет) lth 0-3 4-6 7-10 11-14 in total group М F total М F total М F total М F total М F total 20 I II III IV V in total

Stage 2. Statistical observation: 1) Instructing the performers; 2) To the copy information; 3) Quality control registration - logical and analytical. Stage 3. Statistical development: 1) Data group (encryption material in accordance with the grouping variable); 2) a summary of the data (layout maps in accordance with the models developed by the table); 3) Data processing (filling tables and calculation of results). Stage 4. Analysis. Conclusions. Recommendation. Introduction in practice. Analysis of statistical research carried out by comparing the data with the control group, the existing regulations, the regional average, with data from other institutions, and to assess the dynamics of the process (phenomenon). Any analytical work ends with a literary design, formulation research findings and develop recommendations for implementing them in practice. Materials for self-control: 1. Tests (presented in Appendix). 2. Control questions. 3. Situational puzzles (presented in Appendix).

ANNEX 1. PROCEDURE FOR DRAWING LESSONS PROTOCOLS 1. When preparing to engage the student in a protocol notebook writes:

Date ______Protocol № ______

Topic of lesson: ______The purpose of lessons: ______Solution of tasks (tasks) for self. 2. On a practical lesson: In the lab the student writes the answers to theoretical questions that are considered. In addition, the student must write: -metodiki statistical studies; -Results research; 21 -Need calculations; Conclusions and recommendations, graphs and tables. LITERATURE: Training: Summary: 1. Social Medicine and Health Care Organization: Textbook / Ed Over. Voronenkov Y. Moskalenko VF - Ternopil: Ukrmedkniga 2000. Additional: 2. Public Health // Ed. A.F.Serenko, V.V.Ermakova - M .: Medicine, 1984. 3. Social Medicine, Organization and Health Economics - Golyachenko OM, Serdyuk AM, Prihodsky OO - Kiev 1997. scientific 4. Guidance on social hygiene and public health organization. Ed. Grape NA .. - M .: Medicine, 1974 (in 2 volumes). 5. Guide to practical training in social hygiene and public health organization // Ed. YP Lisitsyn, hooves NY - M .: Medicine, 1984.

Methodological: 1. Workshop on Sanitary and demographic statistics. Ed. prof. Sluchanko IS - Moscow 1979 2. Training tasks on medical statistics. Ed. prof. A. A.Grando. - Kiev 1984 3. Preparation for practical classes in social hygiene and public health organization - M. I MMI them. Sechenov 1986 4. Medical Statistics in the district general practitioner. Guidelines for practical training. - M. I MMI them. Pirogov 1901 5. Methods of Demographic Studies. Under. Ed. L.E.Darskogo - M.Statistika. 1969 6. Allowance for conducting basic medical documentation in the clinic and hospital // Ed. Ts.V.Yasinskogo. - Chernivtsi 1997 7. Biostatistics / IV Belikov, Kostrikov AV, Rudenko LA A teaching aid for international students. Poltava, 2012 -112s.

Informational resources: https://www.youtube.com/watch?v=x5QqBjerFdg https://www.youtube.com/watch?v=KYHVvXzR72Q http://medstatistic.ru/theory/statistics.html http://medstat.gov.ua/ukr/main.html http://www.uiph.kiev.ua/

22 IV. RELATIVE VALUES. GRAPHIC REPRESENTATION OF STATISTICAL DATA 1. Relevance of the topic: Modern medical training is aimed at the formation of a professional who knows how to organically connect theoretical knowledge and practical skills in the field of clinical and preventive medicine. The need for statistical research in the health care system is not in doubt. Knowledge of calculation and analysis of relative values required in practice physician to characterize health indicators (demographic, morbidity, disability, dental grafting pathologists, etc.), for the performance of the hospitals and the dentist in particular.

2. Specific objectives: 1. To have an idea of relative values, their applications in medicine as well as methods for their image. 2. Learn the methodology for calculating the relative values. 3. To be able to graphically depict the statistics.

3. Basic knowledge, abilities, skills, necessary for studying the topic (interdisciplinary integration):

Names of disciplines These skills • History of medicine Stages of development of medical knowledge • Sociology Conduct analysis of sociological research. Identify basic concepts, methods and research tools • Medical biology that are used to determine the factors affecting the body • Biophysics and and health. biochemistry Identify and analyze the relationship between natural phenomena. • Health

• Normal physiology Know Classification of Diseases ICD-10. • Pathology • Microbiology Knowing the structure of hospitals and health care volume which is therein • Internal medicine

4. Tasks for independent training to employment

4.1 A list of key terms, parameters, characteristics which the student needs to know when preparing for the class:

23 Terminology Definition Extensive coefficients Characterized by the ratio of parts to the whole, that is, determine the proportion of (specific gravity), the percentage parts of a whole as 100%. Intensity factor Reflect the frequency (prevalence) phenomena in their environment Odds ratio Characterized by the ratio of two independent sets. Visibility factor It determines the percentage or how many times there was an increase or decrease of any sign compared to the taken as the basis (1, or 100%). Schedule Visual representation of statistical values with the help of geometric lines and shapes (figures), or geographic map-chart (cartogram).

4.2. Theoretical questions to the lesson:

1. Types of relative values. 2. The intensity factor, calculation method 3. Types of intensive factors, application in medicine. 4. Extensive coefficients, method of calculation. 5. Scope of extensive indicators in medicine. 6. The ratio, calculation method, application in medicine. 7. The display clarity, calculation methods, application in medicine. 8. Types of graphic images. 9. Selecting graphic image depending on the type of indicator. 4.3. Practical tasks: 5. Content of the topic: Absolute values are used in the characterization of the total population (the population, the total number of doctors in the country, and others). As well as in the assessment of rare events (number of especially dangerous infections, the number of people with developmental abnormalities). Derived values are divided into relative and secondary. Relative values are used in the analysis of alternative characters (if there is the phenomenon or not). Types of relative values: 1) extensive coefficients; 2) intensity factor; 1) The ratio; 24 4) the visibility factors.

Extensive factors characterize the attitude of part to whole, that is, determine the proportion of (specific gravity), the percentage parts of a whole as 100%.

Part of the phenomenon х 100 Extensive index = All phenomenon

They are used to characterize the structure of the statistical population. For example: the proportion (share) of flu among all diseases as a percentage; the proportion of work-related injuries of all injuries among workers (the number of work- related injuries to the total number of injuries, multiplied by 100%). Intensive coefficients represent the frequency (prevalence) phenomena in their environment. Intensive factors are general and specific. General: birth rate, the overall incidence rate, etc .; special (characterized by a narrow base): the number of women of childbearing age (fertility), the number of women who developed hypertension, etc. . Phenomenon х 1000 (10 000, 100 000) Intensive indicator = Environment

In practice, the intensity factor used to assess the health, medical and demographic processes. For example: the number of cases with temporary disability illnesses per 100 employees; the number of cases of hypertensive disease per 100 inhabitants; the number of births per 1,000 people (defined as the ratio of the number of births per year to the average population of the administrative area, multiplied by 1000). Odds ratios characterize the ratio of two independent sets. Methods of calculating the coefficient of correlation is the same as when calculating the intensity factor. Used to describe the security (level and quality) health care: the number of beds per 10,000 people; the number of doctors per 10,000 inhabitants; the number of immunizations per 1000 inhabitants (the ratio of the number of persons covered by the vaccine, to the population of the administrative area, multiplied by 1000). Visibility factor determines the percentage or how many times there was an increase or decrease of any sign compared to the taken as the basis (1, or 100%). This ratio characterizes the change of a phenomenon (indicator) in time or space. For example, the number of physicians in 2005, compared with the number of doctors in 1994, taken as 100% (the ratio of the number of professionals in a given year to the number of experts in the preceding year, multiplied by 100%). Graphical representation of statistical data is widely used in any statistical study, it makes the studied parameters more visible, accessible to understanding, allow deeper analysis of them. The graph is called a visual representation of statistical values with the help of geometric lines and shapes (figures), or geographic map-chart (cartogram). In the same 25 manner charts Graphic images are divided into linear, planar (A bar, vnutristolbikovaya, pie), volume (cartogram, kartodiagramma), curly. Line Chart - is used for visualizing the processes that show the development of the phenomenon in time (dynamics) for uninterrupted monitoring. The phenomenon of such a diagram is represented as a line, which may be straight, broken line curve (the temperature of the patient list, the incidence of patients depending on age).

One type is a linear chart radial diagram - it is used for visualizing the effects of a vicious cycle (period) of time (day, year).

A bar chart - is used for visualizing the processes in the dynamics, characteristics of phenomena in space (mortality, mortality, fertility, morbidity data, areas, etc.).

Intrabar diagram - is used for the structure characteristics of a phenomenon (the age structure of the population, the structure of causes of death, etc.).

26 Pie Chart - is used to characterize the composition (structure) of certain events (morbidity structure of the population, etc.).

Map-diagram - used to visualize the spatial distribution of the image of this or that phenomenon, in absolute or relative terms, which are distributed on geographical maps. Selection of the chart due to the fact some indicators need to be represented graphically. So intense indicators may show the bar and line charts, cartogram and kartodiagrammoy. Extensive performance graphically represented using vnutristolbikovoy and pie charts. For clarity, the indicator used a bar graph, while the aspect ratio - curly, bar. Materials for self-control: 1. Tests (presented in Appendix). 2. Control questions. 3. Situational puzzles (presented in Appendix). An example of the solution of situational tasks TASK: The population of the city is 300000 Births - 850 Number of deaths - 895 (including the cardiovascular system - 465, from diseases of the nervous system - 245, from injuries and accidents - 120 from other causes - 65). Number of deaths of children under 1 year - 5 Number of registered diseases for the year - 62,000 (including respiratory diseases - 150000: SARS - 85,000, pneumonia - 8200, neoplasm - 850) The total number of general practitioners of family medicine - 150 Calculate: - Fertility - Mortality - Child mortality - The structure of causes of death - General morbidity (prevalence) - Morbidity structure - Provision of population with general practitioners

Calculation: Phenomenon 27 Intensive indicator = ------х 1000 (‰) Environment

The number of births per year alive 850 Childbirth = ------х 1000 = ------х 1000 = 2,83 ‰ Average annual population 300000

Number of deaths per year 895 Mortality = ------х1000 = ------х 1000 = 2,98 ‰ Average annual population 300000

Number of deaths of children under 1 year 5 child mortality = ------х 1000 = ------х 1000 = 8,5‰ The number of live births 850

Index of the number of births - the number of deaths 850 - 895 natural = ------х 1000 =------= 0,15‰ population growth Average annual population 300000

Part of the phenomenon extensive index = ------х 100 (%) All phenomenon

The structure of causes of death:

The proportion of 465 deaths from = ------х 100 = 52% cardiovascular diseases 895

The proportion of 245 deaths from = ------х 100 = 27,4% diseases of the nervous system 895

The proportion of 120 deaths from = ------х 100 = 13,4% accidents 895

28 The proportion of 65 deaths from = ------х 100 = 7,2% other causes 895

Graphic image.

visibility ratio shows how many times (how many%) or that phenomenon more (or less) of another. The unit (or 100%) take the lowest value (in this case - the number of reported cases of tumors).

85000 ------= 100 SARS occurs 100 times more often than tumors 850 8200 ------= 9,6 Pneumonia occur 9.6 times more frequently than tumors. 850

The ratio characterizes the numerical ratio of two unrelated sets, matched only logically. 150 The number of doctors per 1,000 population = ------х 1000 = 0,5 300000

(At the rate - 1 GP 1300-1500 urban population, rural population 1100-1200).

LITERATURE: Training: Summary: 1. Social Medicine and Health Care Organization: Textbook / Ed Over. Voronenkov Y. Moskalenko VF - Ternopil: Ukrmedkniga 2000. Additional: 2. Public Health // Ed. A.F.Serenko, V.V.Ermakova - M .: Medicine, 1984. 3. Social Medicine, Organization and Health Economics - Golyachenko OM, Serdyuk AM, Prihodsky OO - Kiev 1997. scientific 4. Guidance on social hygiene and public health organization. Ed. Grape NA .. - M .: Medicine, 1974 (in 2 volumes). 5. Guide to practical training in social hygiene and public health organization // Ed. YP Lisitsyn, hooves NY - M .: Medicine, 1984. Methodological:

29 1. Workshop on Sanitary and demographic statistics. Ed. prof. Sluchanko IS - Moscow 1979 2. Teaching jobs in medical statistics. Ed. prof. A. A.Grando. - Kiev 1984 3. Preparation for practical classes in social hygiene and public health organization - M. I MMI them. Sechenov 1986 4. Medical Statistics in the district general practitioner. Guidelines for practical training. - M. I MMI them. Pirogov 1901 5. Methods of Demographic Studies. Under. Ed. L.E.Darskogo - M.Statistika. 1969 6. Allowance for conducting basic medical documentation in the clinic and hospital // Ed. Ts.V.Yasinskogo. - Chernivtsi 1997 7. Biostatistics / IV Belikov, Kostrikov AV, Rudenko LA A teaching aid for international students. Poltava, 2012 -112s.

Internet resources: https://www.youtube.com/watch?v=x5QqBjerFdg https://www.youtube.com/watch?v=KYHVvXzR72Q http://medstatistic.ru/theory/statistics.html http://medstat.gov.ua/ukr/main.html http://www.uiph.kiev.ua/

V. VARIATION ROWS. AVERAGE VALUES

1. Relevance of the topic The need for statistical research in the health care system is not in doubt. Scientific substantiation of health management, the development of medical science and practice requires the timely information and reliable data on the state of activities of medical institutions, the factors that affect the health of the population. In a measure of social and economic information required shall be subject to statistical analysis and in-depth statistical analysis. In his professional activities the doctor makes extensive use averages to assess the state of health of the population, evaluation of medical institutions. Average values are used to assess the physical development of different groups of the population, during the sanitary - hygienic studies to assess some indicators medical institutions work.

2. Specific objectives: To have an idea of the average values and variation series, their applications in medicine. Learn the method of calculating the averages. To be able to analyze the average values.

3. Basic knowledge, abilities, skills, necessary for studying the topic (interdisciplinary integration): 30

• Microbiology Knowing the structure of hospitals and health care • Internal medicine volume which is therein

4. TASKS FOR INDEPENDENT TRAINING TO EMPLOYMENT 4.1. A list of the main terms of parameters, characteristics which the student need to learn Terminology Definition Mean values A quantitative general characteristic of a homogeneous aggregate varying with the changing sign.

Variation number Series in which the ordered compared variants and corresponding frequency.

Variant (V) Quantitative trait expression.

Моdа (Мо) Option, which meets the highest number of visits in a number of variations.

Mediana (Ме) The value of dividing the variation number two. Amplitude The difference between the extremes.

Standard deviation (σ), Shows how different versions of the calculated average value. The average error of the arithmetic mean It shows variation in average.

31 (m).

Criterion Student (t). It indicates significant difference between the average and relative values. 4.2. Theoretical questions to the lesson: 1. Identify types of averages. 2. Define the number of variations. 3. Types of variational series. 4. The main properties of the mean. 5. Types of arithmetic mean 6. Methods of calculating the arithmetic mean 7. Evaluation criteria mean. 8. What does the expression "to evaluate the reliability of the results of research"? 9. What is the amplitude? 10. Define the standard deviation. 11. The method of calculating the standard deviation. 12. Define average arithmetic mean error. 13. The method of calculating the average error of the arithmetic average. 14. The method of calculating t-test. 4.3. Practical tasks: 5. CONTENT OF THE TOPIC: Average values are used in the evaluation of physiological parameters (average heart rate, breathing, blood pressure), parameters of physical development (the average height of boys 18 years old, average body weight), with sanitary characteristics (the average living space per person, the average number of bacteria in 1 ml), in a quantitative description of medical services (the average number of visits per hour, the average occupancy rate for the year). To calculate the average values it necessary to build a variation number. Variational series - a series in which the ordered options are compared and the corresponding frequency. Variant (V) - a quantitative expression of the trait. Variation ranks are: 1. - Simple - the frequency of each option is equal to 1, ie, each variant occurs once; - Complex (grouped) - Each option is represented by its definition-divided frequency. 2 - Rank - options are organized by ascending or descending order; - No-ranking - options are not systematized and are located in a free manner. 3. - Interval - the interval between the options of variations in the number of same- headed; - Noninterval - the interval between the options in a number of variations of neodymium-Nakov. 4. - Increte - options presented whole and (or) fractional numbers; 32 - Discrete - options presented only integers. 5. - Closed - version has an upper and lower limits; - Open - version has only the top or only the bottom border. Types of averages: - A simple arithmetic mean (the sum of all values divided by the number of observations) V М   , where n M - arithmetic mean V - the value of an ordered series n - total number of observations

- Arithmetic average weighted by the process of the work (the sum of all values multiplied by the number of its occurrence, and divided by the number of observation- tions - objects) VР М   , where n М – arithmetic mean V - the value of an ordered series P - frequency options n - the sum of frequencies This kind of arithmetic mean is used in case of ovarian cancer in the study do one or more of the repeat option (complex variation number). - Arithmetic average weighted by the method of moments. The method of moments is used in interval variation series. If the interval between the variants is 1 - applied the method of moments in the deviation: dp М  Mo   , where n M - arithmetic mean Mo - moda d - a deviation from the conventional medium P - frequency options n - the sum of frequencies If the interval between the options is greater than or less than 1 method is applied on equidistance points: dp М  Mo  i  , где n M - arithmetic mean Mo - moda i - the interval between versions d - a deviation from the conventional medium

33 P - frequency options n - the sum of frequencies - Moda (Mo) variant, option, which meets the highest number of visits in a number of variations; - The median (Me) - the value of dividing the variation number in half; The main properties of the mean value: 1) has the abstract, as it is generalizing value: erased random fluctuations therein; 2) occupies a central position in the series (in a strictly symmetrical row); 3) the sum of all deviations from the average value of an option is equal to zero. This property is the average value is used to verify the calculation of the average. It is estimated by the level of fluctuations in a number of variations. The criteria for such an assessment can be: - the amplitude (the difference between the extremes); - Standard deviation (σ), showing how the different variants-you from the calculated average value d 2 P σ = ±  , n - Mean error of the arithmetic mean (m).  m = n Species distribution The normal (Gaussian, symmetric, bell-shaped) distribution (normal, Gaussian distribution) - describes the combined effect on the phenomenon under study a small number of randomly combined factors (compared to the total amount of factors), the number of which is unlimited large. It occurs in nature most often, for which he has been called "normal". Character, forms a distribution of continuous random variables.

34 allows a comparison between only do the two sampled values. If you want to compare with each other as non-homogeneous sample quantities, they are compared in turn. Student's t-test reliability is defined as the difference between the average values or relative indicators, divided by the square root extracted from the sum of squared errors of arithmetic or ments concerning indicators. М  М P  P t = 1 2 t = 1 2 2 2 2 2 m1  m2 m1  m2 The difference between the compared values is significant and selective hundred- statistically significant when the probability of faultless prognosis of 95%, ie lead-rank t- test must be equal to or greater than 2 (for n> 30). Only under these conditions, the forecast is considered infallible, testifying to the reliability of the new method used (drug, hygienic-cal characteristics).

Materials for self-control: 1. Tests (presented in Appendix). 2. Control questions. 3. Situational tasks (presented in Appendix). An example of the solution of situational tasks A task: Determination of the period of stay of patients in the surgical ward Number of days Number of VP d d2 d2P (V) patients (P) 16 1 16 -4 16 16 17 7 119 -3 9 63 18 8 144 -2 4 32 19 16 304 -1 1 16 20 29 580 0 0 0 21 20 420 1 1 20 22 7 154 2 4 28 23 5 115 3 9 45 24 2 48 4 16 32 n=95 ∑ = ∑ = 252 1900

The arithmetic mean is simple: V М   , где n M - arithmetic mean V - the value of an ordered series 35 n - total number of observations If in the test series, one or more embodiments are repeated, the calculated weighted arithmetic mean. VР М   , n where is ‘n’ - the sum of frequencies 1900 М   20 days 95 The degree of variation of the number of variations is determined by calculating the standard deviation (σ) d 2 P 252 σ = ±  = ± = ±1,63 days n 95 LITERATURE: Training: Summary: 1. Social Medicine and Health Care Organization: Textbook / Ed Over. For ronenka Y. Moskalenko VF - Ternopil: Ukrmedkniga 2000. Additional: 2. Public Health // Ed. A.F.Serenko, V.V.Ermakova - M .: Medicine, 1984. 3. Social Medicine, Organization and Health Economics - Golyachenko OM, Serdyuk AM, Prihodsky OO - Kiev 1997. Scientific 4. Guidance on social hygiene and public health organization. Ed. Grape NA .. - M .: Medicine, 1974 (in 2 volumes). 5. Guide to practical training in social hygiene and public health organization // Ed. YP Lisitsyn, hooves NY - M .: Medicine, 1984. Articles 1. Workshop on Sanitary and demographic statistics. Ed. prof. Slu Chanko-IS - Moscow 1979 2. Training tasks on medical statistics. Ed. prof. A. A.Grando. - Kiev 1984 3. Preparation for practical classes in social hygiene and public health organization - M. I MMI them. Sechenov 1986 4. Medical Statistics in the district general practitioner. Guidelines for practical training. - M. I MMI them. Pirogov 1901 5. Methods of Demographic Studies. Under. Ed. L.E.Darskogo - M.Statistika. 1969 6. Allowance for conducting basic medical documentation in the clinic and hospital // Ed. Ts.V.Yasinskogo. - Chernivtsi 1997 7. Biostatistics / IV Belikov, Kostrikov AV, Rudenko LA A teaching aid for international students. Poltava, 2012 -112s. Informational resources: https://www.youtube.com/watch?v=x5QqBjerFdg 36 https://www.youtube.com/watch?v=KYHVvXzR72Q http://medstatistic.ru/theory/statistics.html http://medstat.gov.ua/ukr/main.html http://www.uiph.kiev.ua/

VI. EVALUATION OF THE RELIABILITY OF THE RESEARCH RESULTS. PARAMETRIC CRITERIA FOR ASSESSING THE RELIABILITY OF THE RESULTS

3. Basic knowledge, abilities, skills, necessary for studying the topic (interdisciplinary integration):

37 • Microbiology • Internal medicine Knowing the structure of hospitals and health care volume which is therein

4. Tasks for independent training to employment 4.1. A list of the main terms of parameters, characteristics which the student need to learn Terminology Definition Mean values A quantitative general characteristic of a homogeneous aggregate varying with the changing sign.

Variation number Series in which the ordered compared variants and corresponding frequency.

Variant (V) Quantitative trait expression.

Моdа (Мо) Option, which meets the highest number of visits in a number of variations.

Mediana (Ме) The value of dividing the variation number two. Amplitude The difference between the extremes.

Standard deviation (σ), Shows how different versions of the calculated average value. The average error of the arithmetic mean It shows variation in average. (m).

Criterion Student (t). It indicates significant difference between the average and relative values. 4.2. Theoretical questions to the lesson: 1. Identify types of averages. 2. Define the number of variations. 3. Types of variational series. 4. The main properties of the mean. 5. Types of arithmetic mean 6. Methods of calculating the arithmetic mean 7. Evaluation criteria mean. 8. What does the expression "to evaluate the reliability of the results of research"? 38 9. What is the amplitude? 10. Define the standard deviation. 11. The method of calculating the standard deviation. 12. Define average arithmetic mean error. 13. The method of calculating the average error of the arithmetic average. 14. The method of calculating t-test. 4.3. Practical tasks: 5. CONTENT OF THE TOPIC: Average values are used in the evaluation of physiological parameters (average heart rate, breathing, blood pressure), parameters of physical development (the average height of boys 18 years old, average body weight), with sanitary characteristics (the average living space per person, the average number of bacteria in 1 ml), in a quantitative description of medical services (the average number of visits per hour, the average occupancy rate for the year). To calculate the average values it necessary to build a variation number. Variational series - a series in which the ordered options are compared and the corresponding frequency. Variant (V) - a quantitative expression of the trait. Variation ranks are: 1. - Simple - the frequency of each option is equal to 1, ie, each variant occurs once; - Complex (grouped) - Each option is represented by its definition-divided frequency. 2 - Rank - options are organized by ascending or descending order; - No-ranking - options are not systematized and are located in a free manner. 3. - Interval - the interval between the options of variations in the number of same- headed; - Noninterval - the interval between the options in a number of variations of neodymium-Nakov. 4. - Increte - options presented whole and (or) fractional numbers; - Discrete - options presented only integers. 5. - Closed - version has an upper and lower limits; - Open - version has only the top or only the bottom border. Types of averages: - A simple arithmetic mean (the sum of all values divided by the number of observations) V М   , where n M - arithmetic mean V - the value of an ordered series n - total number of observations

39 - Arithmetic average weighted by the process of the work (the sum of all values multiplied by the number of its occurrence, and divided by the number of observation- tions - objects) VР М   , where n М – arithmetic mean V - the value of an ordered series P - frequency options n - the sum of frequencies This kind of arithmetic mean is used in case of ovarian cancer in the study do one or more of the repeat option (complex variation number). - Arithmetic average weighted by the method of moments. The method of moments is used in interval variation series. If the interval between the variants is 1 - applied the method of moments in the deviation: dp М  Mo   , where n M - arithmetic mean Mo - moda d - a deviation from the conventional medium P - frequency options n - the sum of frequencies If the interval between the options is greater than or less than 1 method is applied on equidistance points: dp М  Mo  i  , где n M - arithmetic mean Mo - moda i - the interval between versions d - a deviation from the conventional medium P - frequency options n - the sum of frequencies - Moda (Mo) variant, option, which meets the highest number of visits in a number of variations; - The median (Me) - the value of dividing the variation number in half; The main properties of the mean value: 1) has the abstract, as it is generalizing value: erased random fluctuations therein; 2) occupies a central position in the series (in a strictly symmetrical row); 3) the sum of all deviations from the average value of an option is equal to zero. This property is the average value is used to verify the calculation of the average. It is estimated by the level of fluctuations in a number of variations. The criteria for such an assessment can be:

40 - the amplitude (the difference between the extremes); - Standard deviation (σ), showing how the different variants-you from the calculated average value d 2 P σ = ±  , n - Mean error of the arithmetic mean (m).  m = n Species distribution The normal (Gaussian, symmetric, bell-shaped) distribution (normal, Gaussian distribution) - describes the combined effect on the phenomenon under study a small number of randomly combined factors (compared to the total amount of factors), the number of which is unlimited large. It occurs in nature most often, for which he has been called "normal". Character, forms a distribution of continuous random variables.

Significance criteria of Student's (t - test) The most common method for assessing the reliability of the difference between the compared selected results is the Student's criterion, the proposal by V. Gosset. T test allows a comparison between only do the two sampled values. If you want to compare with each other as non-homogeneous sample quantities, they are compared in turn. Student's t-test reliability is defined as the difference between the average values or relative indicators, divided by the square root extracted from the sum of squared errors of arithmetic or ments concerning indicators. М  М P  P t = 1 2 t = 1 2 2 2 2 2 m1  m2 m1  m2 The difference between the compared values is significant and selective hundred- statistically significant when the probability of faultless prognosis of 95%, ie lead-rank t- test must be equal to or greater than 2 (for n> 30). Only under these conditions, the forecast is considered infallible, testifying to the reliability of the new method used (drug, hygienic-cal characteristics).

41 Materials for self-control: 1. Tests (presented in Appendix). 2. Control questions. 3. Situational tasks (presented in Appendix). An example of the solution of situational tasks A task: Determination of the period of stay of patients in the surgical ward Number of days Number of VP d d2 d2P (V) patients (P) 16 1 16 -4 16 16 17 7 119 -3 9 63 18 8 144 -2 4 32 19 16 304 -1 1 16 20 29 580 0 0 0 21 20 420 1 1 20 22 7 154 2 4 28 23 5 115 3 9 45 24 2 48 4 16 32 n=95 ∑ = ∑ = 252 1900

The arithmetic mean is simple: V М   , где n M - arithmetic mean V - the value of an ordered series n - total number of observations If in the test series, one or more embodiments are repeated, the calculated weighted arithmetic mean. VР М   , n where is ‘n’ - the sum of frequencies 1900 М   20 days 95 The degree of variation of the number of variations is determined by calculating the standard deviation (σ) d 2 P 252 σ = ±  = ± = ±1,63 days n 95 LITERATURE: 42 Training: Summary: 1. Social Medicine and Health Care Organization: Textbook / Ed Over. For ronenka Y. Moskalenko VF - Ternopil: Ukrmedkniga 2000. Additional: 2. Public Health // Ed. A.F.Serenko, V.V.Ermakova - M .: Medicine, 1984. 3. Social Medicine, Organization and Health Economics - Golyachenko OM, Serdyuk AM, Prihodsky OO - Kiev 1997. Scientific 4. Guidance on social hygiene and public health organization. Ed. Grape NA .. - M .: Medicine, 1974 (in 2 volumes). 5. Guide to practical training in social hygiene and public health organization // Ed. YP Lisitsyn, hooves NY - M .: Medicine, 1984. Articles 1. Workshop on Sanitary and demographic statistics. Ed. prof. Slu Chanko-IS - Moscow 1979 2. Training tasks on medical statistics. Ed. prof. A. A.Grando. - Kiev 1984 3. Preparation for practical classes in social hygiene and public health organization - M. I MMI them. Sechenov 1986 4. Medical Statistics in the district general practitioner. Guidelines for practical training. - M. I MMI them. Pirogov 1901 5. Methods of Demographic Studies. Under. Ed. L.E.Darskogo - M.Statistika. 1969 6. Allowance for conducting basic medical documentation in the clinic and hospital // Ed. Ts.V.Yasinskogo. - Chernivtsi 1997 7. Biostatistics / IV Belikov, Kostrikov AV, Rudenko LA A teaching aid for international students. Poltava, 2012 -112s.

VII. STANDARDIZATION METHOD. CORRELATION-REGRESSION ANALYSIS

1. Relevance of the topic The correlation between the observed phenomena at the medical and biological studies. In this relationship is influenced by different circumstances and conditions. In correlation measures include: the dependence of the incidence of typhoid fever on the degree of immunization coverage against this disease. However, slaughtering-levaemost 43 typhoid fever depends not only on vaccination, but also on the health benefit of the devices, water supply, sanitary culture of the population, and so on. The correlation depend-ence is between postoperative complications, legality and timing of production operations in acute diseases of the abdominal cavity. Dependency bridges the child's body weight is also a correlation of growth.

2. Specific objectives:  Have an understanding of the existing links between the phenomena  Have an idea about the correlation between phenomena  To be able to apply the rank correlation method

3. Basic knowledge, abilities, skills, necessary for studying the topic (interdisciplinary integration):

• Microbiology Knowing the structure of hospitals and health care • Internal medicine volume which is therein

4. TASKS FOR INDEPENDENT TRAINING TO EMPLOYMENT

4.1 A list of key terms, parameters, characteristics that share-wives know the student in preparation for the class: Terminology Definition Functional relationship This type of correlation between the two characteristics, when the value of each one of them corresponds to a different specific value strictly Correlation Such a relationship in which each determined lennomu-value corresponds to a 44 feature few other values interconnected with it characteristic (relationship between height and weight of the human body, the connection between the body temperature and heart rate, etc.). Correlation characteristic of the medical and biological processes The practical significance of establishing Identification of causal between the a correlation factor and efficient feature-mi (when assessing physical development, to determine the relationship between working conditions, welfare and health, under-definition of the dependence the incidence of the disease by age, length of service, the availability of industrial hazards, etc.) Correlation coefficient The dimension of the direction and strength of the link between the signs. 4.2 THEORETICAL QUESTIONS: 1. What kinds of links exist between the phenomena or symptoms? 2. Is the functional connection is characteristic of medical and biological phenomena? 3. What is the correlation? 4. Can we assume that the correlation value of one characteristic respectively, are a few other values interconnected to sign him? 5. Is it possible to argue that the correlation is manifested in mass observations, ie, In total? 6. What is the criterion for assessing the nature and correlation of forces? 7. Is it possible to argue that the correlation coefficient gives an indication of the presence and direction of correlation? 8. With the rise in body temperature increases heart rate in most patients. Can we say that this relationship refers to the direct correlation? 9. Can we say that the range of values of the correlation coefficient ranges from -1 to +1? 10. What are the methods for determining the correlation coefficient? 11. Can it be said that the method of squares (Pearson) gives more accurate results than by rank (Spearman)? 12. What is the procedure for determining the correlation coefficient method ranks? 13. How is the character and the power connection on the coefficient of correlation? 14. How is the accuracy of the correlation coefficient? 15. Is it possible to argue that if the correlation coefficient is more than three times exceeding a-is a mistake, then it is valid? 5. CONTENT OF TOPIC: 45 There are three methods of calculating standardized indicators: direct, indirect and reverse. Standardized indices are provisional and are used exclusively for the purpose of comparing them with each other. The list of necessary data for the calculation of standardized long-exponent different methods. Met Environment Phenomenon Standart hod Straigh Distributed on the Distributed on the The distribution of t studied traits studied traits phenomenon on the basis of the studied Indirec Distributed on the 1). Do not distributed Group indicators t studied traits on the basis of the studied phenomenon studied (morbidity, mortality) 2). The phenomenon izuchaemo on th basis expressed by small numbers Back Do not spread on Distributed on the Group indicators the studied trait, there studied traits studied phenomenon is only a total number (morbidity, mortality) of

There are two types of connections between phenomena (signs):

- Functional;

- Correlation.

The functional relationship reflects the strict dependence of processes or phenomena, and change-of any one phenomenon necessarily associated with a change in the numerical values of the other events at a well-defined value. The functional relationship is usually manifested in the physical and chemical phenomena, where it can be presented in the form of the equation, the formula (for example, an increase in volume of a sphere in strict dependence on increasing its radіusa).

When the correlation relationships characteristic of medical and biological phenomena, the value of one attribute correspond to different values of other attributes.

The correlation is:

- Positive - direct (the other increases as one feature);

- Negative - feedback (decreases with an increase in the other one indicator).

46 The correlation coefficient shows not only the direction of communication, but also on the level of this connection.

A strong relationship is expressed by a factor of 0.7 to 0.99,

Medium - from 0.3 to 0.69,

Weak - to 0.29.

At zero coupling coefficient no.

Rank correlation (Spearman's method):

You need:

• create two rows of paired matched signs denoting the first and second row respectively, x and y. In this first series of feature present in descending or ascending order and numeric values of the second series positioned opposite the first row of values to which they correspond • feature quantity in each of the compared rows replace a sequence number (rank). Rank or numbers indicate the place of indicators (value) of the first and second rows. At the same numerical value of the second attribute grades should be assigned in the same order, which was adopted in the distribution of the values of the first symptom. At the same feature quantity among the ranks should be determined as the average of the sum of the serial numbers of these quantities • determine the difference between the ranks х и у (d): d = х — у • to build the ranks of the resulting difference in the square (d2) • receive the amount of the difference of squares (Σ d2) and substitute the values into the formula:

6 d 2  1  , n(n2 1)

where  - rank correlation coefficient, d - the difference between the ranks, n is the number of matched pairs at-signs.

Squares method (Pearson method)

You need:

Build a variational series for each of the compared signs, marking the first and second series of numbers x and y, respectively;

47 To determine for each of a number of variations mean values (M1 and M2);

Find deviations (dx and dy) of each numerical value of the average value of its all- variational series;

Obtained by multiplying the deviation (dx X dy)

Each deviation squared and summed across each row (Σ dx2 and dy2)

Substitute the values into the formula for calculating the correlation coefficient:

If computing calculation based on a formula:

Formula of error of rank correlation coefficient: 1  2  m = , t = n  2 m According to the method of Pearson's correlation coefficient error is calculated by the formula:

2 1 rxy  mr = , t = . n  2 mr

T values measured at the table of critical values of t test (for n <30).

LITERATURE: Training: Summary: 1. Social Medicine and Health Care Organization: Textbook / Ed Over. Voronenkov Y. Moskalenko VF - Ternopil: Ukrmedkniga 2000. Additional 2. Public Health // Ed. A.F.Serenko, V.V.Ermakova - M .: Medicine, 1984. 3. Social Medicine, Organization and Health Economics - Golyachenko OM, Sør- Duke AM Prihodsky OO - Kiev 1997. Scientific 4. Guidance on social hygiene and public health organization. Ed. Grapes Nye NA .. - M .: Medicine, 1974 (in 2 volumes). 5. Guide to practical training in social hygiene and organization Aids-tion // Ed. YP Lisitsyn, hooves NY - M .: Medicine, 1984. 48 Articles 1. Workshop on Sanitary and demographic statistics. Ed. prof. Sluchanko IS - Moscow 1979 2. Teaching jobs in medical statistics. Ed. prof. A. A.Grando. - Kiev 1984 3. Preparation for practical classes in social hygiene and organization Aids-tion - M. I MMI them. Sechenov 1986 4. Medical Statistics in the district general practitioner. Methodical recommendations- tion for practical training. - M. I MMI them. Pirogov 1901 5. Methods of Demographic Studies. Under. Ed. L.E.Darskogo - M.Statistika. 1969 6. Allowance for conducting basic medical documentation in the clinic and hospital // Ed. Ts.V.Yasinskogo. - Chernivtsi 1997 7. Biostatistics / IV Belikov, Kostrikov AV, Rudenko LA A teaching in Training Manual for foreign students. Poltava, 2012 -112s.

VIII. METHODS OF CALCULATION AND EVALUATION OF DEMOGRAPHIC INDICATORS

1. Relevance of the topic Medical demography - examines the relationship of reproduction of the population with social and hygienic factors and develop on this basis, medical and social measures aimed at ensuring the most favorable development of demographic processes and improve public health. Population (population) - a set of people united by a common living within a given territory. The statistical study of population conducted in two main directions: 1) the population at some point in time, ie, its static (structure of the population being studied on such basic characteristics as gender, age, occupation, marital status, nationality, language, education, etc.) 2) changes in the number of the population, ie its dynamics, movement. 2. Specific objectives: Mastering the methods of calculation of demographic indicators, the analysis of the demographic situation and the development of measures for its improvement 3. Basic knowledge, abilities, skills, necessary for studying the topic (interdisciplinary integration):

49 Names of disciplines These skills • History of medicine Stages of development of medical knowledge • Sociology Conduct analysis of sociological research.

• Medical biology Identify basic concepts, methods and research tools • Biophysics and that are used to determine the factors affecting the body biochemistry and health.

• Health Identify and analyze the relationship between natural • Normal physiology phenomena. • Pathology Know Classification of Diseases ICD-10. • Microbiology

• Internal medicine Knowing the structure of hospitals and health care

volume which is therein 4. TASKS FOR INDEPENDENT TRAINING TO EMPLOYMENT 4.1 A list of key terms, parameters, characteristics that share-wives know the student in preparation for the class: Terminology Definition Statics population The population at some point in time Present population Persons in time of the census in the territory. Resident population Persons permanently residing in the territory. Population dynamics Changing the number of population

(movement) Demographic burden It determines the number of different ratios of aggregated age groups: children (0-14 years old), the elderly and old (60 years and older), able-bodied (conventionally 15-59). Migration MOVEMENT OF PEOPLE ASSOCIATED WITH THE LOCATION CHANGE. The annual birth rate The ratio of the number of live births per year to the total population; The annual mortality rate The ratio of the number of deaths for the year to the total population. Rate of natural increase The ratio of the difference between the number of births and deaths for the year to the total population (or the difference between the birth rate and mortality rate);

50 Gross ratio The number of girls born per woman on average, for the entire fertile period of life. Net factor – net reproduction rate of the female population, showing the average number of girls born per woman during her lifetime, have survived to the age of the mother at the time of their birth while maintaining at each age level fertility and mortality rates of the period. Live-born A fruit weighing 500 grams or more at birth (which corresponds to approximately 20 weeks of pregnancy) with any of the following signs of life: respiration, heartbeat, pulsation of the umbilical cord, muscle contraction of voluntary movements. Antenatal period With 22 weeks (154 hours) of fetal development before birth. Intrapartum period Delivery period.

Postnatal The first 168 hours of life (Week)

Perinatal period With 22 weeks of fetal development up to seven days of life 4.2. Theoretical questions to the lesson: 1. What studies demography 2. What indicators characterize static population 3. What indicators characterize the natural movement of the population? 4. birth statistics (indicators). 5. Mortality statistics (indicators and benchmarks). 6. Infant mortality. 7. Types of migration. 8. The method for calculating the coefficients of the natural movement of the population. 9. Types of population 10. The types of infant mortality 4.3. Practical tasks are performed in class: A task. According to the situational problem to analyze demographics. 5. CONTENT OF THE TOPIC: Among public health parameters of the most important place is occupied by medical and demographic indicators that best represent the range of affect population health factors, socio-economic, political, behavioral, natural-climatic and environmental origin, and therefore are the most adequate measuring instruments of national well-being and public health . Analysis of the dynamics of demographic processes suggests a negative and tense situation in the beginning of the new century in the country and the Stavropol

51 region. Under these conditions, physicians need to be able to analyze the root causes of the current demographic situation and develop measures to improve it. Demographics - the science of population. Population (population) - a set of people united by a common living within a given territory. The statistical study of population conducted in two main directions: 1) population at some point in time, ie, its static (structure of the population being studied on such basic characteristics as gender, age, occupation, marital status, nationality, language, education, etc.) 2) changes in the number of the population, ie its dynamics, movement. There are: - mechanical movement of the population (under the influence of changes in migration processes), and the natural movement of population (changes in the population of the territory as a result of interaction between the main demographic phenomena. By birth and death rates are vital as marriage and divorce).

Statics population.

The main source of information on the size of the population census are (complete count of the population). In the period between the censuses conducted random socio- demographic research.

The age structure of the population, corresponding to the three types Type of the age The proportion of the age group in the general population (%) structure to 14 years 14-49 50 and older Progressive 30 50 20 Station 25 50 25 Regressive 20 50 30 Demographic burden There are the following demographic load indicators: the ratio of the number of children or the elderly (or the total number of children and the elderly) to the number of people of working age; the ratio of the number of old people and children. Classification societies depending on the degree of population aging Group the proportion of persons group characteristics aged 60 years and older 1 To 8 demographic youth 2 8-10 threshold of aging 3 10-12 proper aging 4 12 and larger demographic aging Population dynamics. Mechanical movement of the population is a result of migration. Migration - a movement of people associated with the change of residence. Migration is divided into irrevocable (with the constant change of permanent residence), temporary (resettlement 52 for a limited time), seasonal (move in certain periods), the pendulum (commuting to work, school). Also isolated - internal migration or emigration and immigration - external migration. External migration is associated with crossing the state border.

Medical value: - Urbanization alters the structure of morbidity and mortality, impact on the epidemic situation leads to illegitimate births; - Commuting increases the number of contacts that contribute to the spread of infectious diseases, leading to increased stress diseases, injuries; - Seasonal migration leads to uneven seasonal load of health care institutions; - Indicators of the health of migrants differ from indicators of health of the indigenous population. Natural movement of population. Indicators of the "natural" movement, usually expressed per 1000 population, are: Fertility rate Among the factors that have an impact on fertility, are: social status of women, their employment in production, the level of material well-being, cultural level, housing, pensions, national characteristics, psychological and religious factors, the demographic policy of the state. the number of live births per year Birth Rate = ------* 1000 average annual population

For in-depth you need to know the characteristics of the birth rates of overall and age- specific fecundity (fertility). fertility rate is the ratio of live births to the number of women of childbearing age (15-49 years), multiplied by 1000.

the number of live births per year Fertility Rate = ------* 1000 the number of women aged 15 to 49 years

The mortality rate - the ratio of the number of deaths for the year to the total population;

the number of dying per year Mortality = ------* 1000 average annual population Mortality among the most important demographic indicators characterizing the health status of the population. Medical causes of death registration is the responsible doctor's function. In our country, in the cities introduced compulsory registration of causes of death. Medical death certificate is a legal and medical document certifying the fact and cause of death. 53 In recent years, the overall mortality rate tends to increase. Noteworthy is the sharp increase in the death rate of men of working age. In the analysis of mortality rates, along with the general, special factors are calculated taking into account age, gender, profession, and so on. D.

Rate of natural increase - the ratio of the difference between the number of births and deaths for the year to the total population (or the difference between the birth rate and mortality rate); RATE OF NATURAL INCREASE = BIRTH RATE - MORTALITY

Maternal mortality - mortality is caused by pregnancy, irrespective of the duration and location of death occurring within 42 days of pregnancy and after her graduation from any cause related to pregnancy or aggravated by its management.

The number of deaths of pregnant women, pregnant women who gave birth within 42 days after delivery Maternal mortality = ------* 100000 the number of live births

Exemplary levels of fertility, general and infant mortality rate (per 1,000 population) Indicator` level Birthrate Coefficient The infant mortality rate of total per 1,000 live births mortality Very low To 10 - Low 11-15 До 10 До 14 Below the average 16-20 - - Average 21-25 10-15 15-50 Above average 26-30 - - High 31-40 16-20 51-75 Very high 41 and more 21 and more 76-100 Extremely high - - 101 and more

Child mortality: Mortality period of life Infant mortality early neonatal 168 hours (The most sensitive indicator of the late neonatal 2,3,4 week demographic) neonatal to 28 days

54 postneonatal 29 day – 1 year Perinatal mortality perinatal period: antenatal (with 154 hours of intrauterine life before birth), intrapartum (childbirth), postpartum (the first 168 hours of life) Dead birth antenatal +intrapartum

1. Clinical formula for calculating the infant mortality rate = The number of children who died in the first year of life * 1000 The number of live births 2.Mladenets mortality WHO formula = The number of children died at the number of children who died in the first year of the first year of life generation of current year + generation last year * 1000 The number of live births Number of live births this year last year EXAMPLES OF CALCULATION OF INDICATORS: Task №1. In the city and in 2005 population of 60,000 people. born 1200 people. 360 people died. The fertility rate = (1200 * 1000) / 60 000 = 20‰ Mortality rate = (360 * 1000) / 60 000 = 6‰ Rate of natural increase = (1200-360) * 1000/60000 = 14‰ (20% 0 - 6‰) MATERIALS FOR SELF-CONTROL: 1. Tests (presented in Appendix). 2. Control questions. 3. Case studies (presented in Appendix). LITERATURE: Training: Summary: Public Health // Ed. A.F.Serenko, V.V.Ermakova.- M: Medicine, 1984. Additional: • Guide to practical training in social hygiene and public health organization // Ed. Yu.P.Lisitsina, N.Ya.Kopyta. M .: Medicine, 1984. 55 • Health Statistics. Methodology of statistical research. Ed. prof. IS Sluchanko.- Moscow, 1979. • Guidance on social hygiene and public health organization. In 2 vols. Ed. Yu.P.Lisitsina. - M.: Medicine 1987. • AN Varaksin (2006) Statistical analysis of biological and medical information: problems and solutions. Intern. Zh. honey. Pract., 2, 35-38. Methodological: Lecture chair of the course Internet resources: - Natsionalna medichna bіblіoteka US http://www.nlm.nih.gov/ - Scientific Pedagogical Library. KD Ushinskogo Russian Academy of Education http://www.gnpbu.ru/ - Natsionalna bіblіoteka Ukraine IM. V.І. Vernadskogo http://www.nbuv.gov.ua/ - Natsionalna Naukova medichna bіblіoteka Ukraine http://www.library.gov.ua/ - Central Scientific Medical Library of the First Moscow State Medical University. THEM. Sechenov http://elibrary.ru/defaultx.asp. - ftp://ftp.dsma.dp.ua/302/Russian/Multimediya/soc%20med.pdf

IX. METHODS OF STUDYING THE INCIDENCE (MORBIDITY) OF THE POPULATION. CALCULATION AND EVALUATION OF INCIDENCE RATES

1. Relevance of the topic Incidence is a complex system of interrelated concepts and indicators. It shows the level of the frequency distribution of all diseases combined, and each separately in the general population and specific age, sex, social, professional and other groups. Data on the incidence and burden of disease, and disease prevalence are important for: • inform management decisions at both the federal and municipal levels of government health care system • a comprehensive assessment of the state of health of the population • organization and carrying out of social and hygienic monitoring of diseases • evaluation of the LPU (volume analysis, quality and efficiency), including: economic • the development of regional programs of compulsory health insurance and public health care guarantees, the formation of the municipal orders for medical care • the calculation of insurance premiums and fees for certain groups of the population, the distribution of funds among the participants of the MMI system • Planning and forecasting the development of the network of health care institutions • preparation and proper placement • rational organization of various types of medical and social care • preventive and curative measures • assess the quality of the medical staff, the institution of the health system as a whole.

56 2. Specific objectives: Have an idea of the kinds of morbidity - An understanding of the methods of studying disease - To capture the method of calculation of certain types of disease 3. BASIC KNOWLEDGE, ABILITIES, SKILLS, NECESSARY FOR STUDYING THE TOPIC (INTERDISCIPLINARY INTEGRATION):

Names of disciplines These skills • History of medicine Stages of development of medical knowledge • Sociology Conduct analysis of sociological research.

• Medical biology Identify basic concepts, methods and research tools • Biophysics and that are used to determine the factors affecting the body biochemistry and health. Identify and analyze the relationship between natural • Health phenomena. • Normal physiology • Pathology Know Classification of Diseases ICD-10.

• Microbiology Knowing the structure of hospitals and health care • Internal medicine volume which is therein

4. TASKS FOR INDEPENDENT TRAINING TO EMPLOYMENT 4.1. A list of the main terms of parameters, characteristics which the student need to learn

Terminology Definition Primary morbidity the number for the first time diagnosed disease for 1 year. This includes all acute diseases and for the first time installed on chronic diseases the first treatment in a medical institution (chronic relapses pathology arising during the year are not counted). Soreness or prevalence of diseases it is the totality of all acute and chronic diseases of all registered non-stock in a given calendar year. Soreness is always higher than the actual disease. The incidence rate in contrast to the painful shows dynamic processes occurring in

57 public health and is preferred to identify causal relationships. Pathological prevalence collection of all diseases and pathological- logical conditions identified in the complex physical. This figure gives an idea of the contingent of patients registered at a certain date. chronic pathology and in most cases the disease to which people are not paid to medical institutions is allocated mainly. Uptake of medical care it is the absolute number of patients for the first time in a calendar year applied to medical institutions about the disease. All primary and repeated applications characterizes attendance. 4.2 Theoretical questions: 1. What is called the total incidence? 2. What is called the primary morbidity? 3. What is called hospital morbidity 4. What is called the incidence of temporary disability? 5. What is the unit of observation when evaluating morbidity 6. Basic methods of studying morbidity 7. Sources of study of morbidity

5. Content of the topic:

Incidence - one of the indicators of population health. The study is conducted on the incidence of the common scheme of statistical studies and strict sequence of steps. Stages: 1. collection of information 2. The grouping and summary materials of encryption 3. The counting process 4. The analysis of the materials and their design (recommendations conclusions). In the study of disease in connection with the state of the environment must be sent- ing study of environmental factors and the incidence of in-depth analysis. Sources of information about the disease: 1. Medical data on health-seeking behavior 2. Data honey. inspections 3. The material according to the cause of death Incidence rates: There are: 1. Primary or actual incidence 1. prevalence or morbidity 2. The frequency of diseases revealed by medical examinations or pathological lesions. 58 Primary disease - is the number of first time diagnosed disease for 1 year. This includes all acute diseases and for the first time set of chronic diseases-tions of the first treatment in a medical institution (recurrent chronic pathology arising pas are not considered during the year).

Primary incidence = Number of newly emerged diseases x 1000

The average population

Soreness or disease prevalence - a set of all acute and chronic diseases registered in a given calendar year. Soreness is always higher than the actual disease. The incidence rate in contrast to the painful evidence of the dynamic processes taking place in the health of the population and is more preferable to identify causal relationships.

The indicator gives an idea of pain as new cases diagnosed and about earlier cases, but with the aggravation that the population asked in a given calendar year.

Prevalence = Number of available diseases among the population for the year x 1000 /

The average population

Pathological losses - (frequency of illnesses identified during inspection) - the frequency of disease in the population that is installed during the one-time medical examinations, as a result of taking into account all of the disease, as well as forms and premorbid state (based on 100 surveyed)

Methods of studying morbidity.

1. Incidence according to initial uptake which includes common-morbidity for infectious disease hospital morbidity with temporary disability in the morning-that is not the most important epidemic diseases (tuberculosis, syphilis).

2. Incidence according to medical examinations and clinical supervision.

3. Morbidity according to the cause of death (the data is taken in the registry office documents - death certificate).

Causes of illness:

1. The incidence of infectious diseases - requires fast of anti-epidemic measures

2. The incidence of hospital - information about it are used for planning the number of beds the first fund

3. Morbidity with temporary disability - determines the economic over-spending 59 4. The most important non-epidemic disease - gives information about the prevalence of co-socially conditioned diseases.

Statistical methods for the study of disease.

1. Solid

2. Selective

Solid - acceptable for operational purposes.

Selective - used to identify the relationship between illness and environmental factors. Sampling method was used during the census. An example of it can serve as a study on the incidence of separate territories. The choice of method of studying morbidity in an area or its individual groups is determined by the purpose and objectives of the study. Indicative information on the levels, structure and dynamics of morbidity can be obtained from reports of health care institutions and central management reporting using a continuous method.

Identifying patterns of morbidity, relations is only possible if the sampling method through to the copy of passport and medical data of primary accounting documents statistical card.

The unit of observation in the study of general morbidity of the patient is the primary treatment for the current calendar year on the disease.

Key records to study the overall incidence of this honey card and become a ticket to clarify the diagnosis.

The incidence of infectious diseases is studied by taking into account in each case of an infectious disease or suspected infectious disease, which is issued on the registration document - an emergency notification of infectious disease. Emergency notification is sent within 12 hours to the center gosudarstvennog sanitary and epidemiological surveillance and logged infectious diseases. Based on the entries in this magazine compiled a report on the movement of infectious diseases for each month, quarter, six months, a year.

The unit of observation in the study of infectious diseases is a case of infection-tional disease. Calculated per 10,000, 100,000. The study of infectious morbidity, including the identification of the source of contamination, seasonality analysis, effectiveness of anti- events.

The most important non-epidemic diseases: tuberculosis, sexually transmitted diseases, psychic-cal diseases, fungal infections, cancer, cardiovascular diseases. 60 RECORDS - notification of major non-epidemic diseases.

The unit of observation - in these diseases is a sick man. Accounting morbidity-sti conducted in dispensaries.

Morbidity with temporary disability.

The unit of observation is every case of temporary disability.

RECORDS - piece of disability (not only has the medical-statistical, legal and financial implications).

Recalculation of 100 employees.

Main factors:

1. The structure of morbidity in the case.

2. The structure of morbidity in calendar days.

3. The number of cases per 100 employees.

4. The number of days per 100 employees.

5. The average duration of one case of the disease. The incidence of infectious diseases is studied by considering each case of infection- tional disease or suspected infectious disease, which is issued on the roster to-Document - emergency notification of infectious disease. Emergency notification is sent within 12 hours to the center of state sanitary and epidemiological, and is registered in the log- infection tional diseases. Based on the entries in this magazine compiled a report on the movement of infectious diseases-tion for each month, quarter, six months, a year. The unit of observation in the study of infectious diseases is a case of infection-tional disease. Calculated per 10,000, 100,000. The study of infectious morbidity, including the identification of the source of contamination, seasonality analysis, effectiveness of anti- events. The most important non-epidemic diseases: tuberculosis, sexually transmitted diseases, psychic-cal diseases, fungal infections, cancer, cardiovascular Zabolev-tion. RECORDS - notification of major non-epidemic diseases. The unit of observation - in these diseases is a sick man. Accounting morbidity-sti conducted in dispensaries. Morbidity with temporary disability. The unit of observation is every case of temporary disability. RECORDS - piece of disability (not only has the medical-statistical, legal and financial implications). 61 Recalculation of 100 employees. Main factors: 1. The structure of morbidity in the case. 2. The structure of morbidity in calendar days. 3. The number of cases per 100 employees. 4. The number of days per 100 employees. 5. The average duration of one case of the disease. Indicators of hospital morbidity Incidence of hospitalized patients - a record of the persons treated in hospital for a year. Data on hospital morbidity allow us to judge the timeliness of hospitalization, duration, and treatment outcome, coincidence or divergence of diagnosis, the amount of medical care and others. Data on hospital morbidity are taken into account in the planning of hospital beds, the determination of the need for various types of hospital care. The unit of observation in the study of hospital morbidity is every case of hospitalization. Accounting is a form of statistical card left a hospital. The total hospitalization rate is 150 deaths per 1,000 people. In the structure of hospitalized patients constitute the bulk of patients with diseases of the circulatory system, digestive system, chronic respiratory diseases, patients with injuries. MATERIALS FOR SELF-CONTROL: 1. Tests (presented in Appendix). 2. Control questions. 3. Case studies (presented in Appendix). LITERATURE: Training: Summary: Public Health // Ed. A.F.Serenko, V.V.Ermakova.- M: Medicine, 1984. Additional: • Guide to practical training in social hygiene and public health organization // Ed. Yu.P.Lisitsina, N.Ya.Kopyta. M .: Medicine, 1984. • Health Statistics. Methodology of statistical research. Ed. prof. IS Sluchanko.- Moscow, 1979. • Guidance on social hygiene and public health organization. In 2 vols. Ed. Yu.P.Lisitsina. - M.: Medicine 1987. • AN Varaksin (2006) Statistical analysis of biological and medical information: problems and solutions. Intern. Zh. honey. Pract., 2, 35-38. Methodological: Lecture chair of the course Internet resources: - Natsionalna medichna bіblіoteka US http://www.nlm.nih.gov/ - Scientific Pedagogical Library. KD Ushinskogo Russian Academy of Education http://www.gnpbu.ru/ 62 - Natsionalna bіblіoteka Ukraine IM. V.І. Vernadskogo http://www.nbuv.gov.ua/ - Natsionalna Naukova medichna bіblіoteka Ukraine http://www.library.gov.ua/ - Central Scientific Medical Library of the First Moscow State Medical University. THEM. Sechenov http://elibrary.ru/defaultx.asp - ftp://ftp.dsma.dp.ua/302/Russian/Multimediya/soc%20med.pdf

X. PRIMARY MEDICAL CARE ON THE PRINCIPLES OF FAMILY MEDICINE.

1. Relevance of the topic Health care is an area of activity of the state to ensure that citizens' rights to life and health, which is regarded as one of the priorities in the political, economic and social life of the state and society. Hospital has always held among medical institutions and continues to occupy a special place. This is due to several factors, among which are the main ones. In hospitals, people get highly skilled specialized inpatient care. Inpatient care is provided mainly in the most serious diseases, requiring a comprehensive approach to diagnosis and treatment, the use of the most sophisticated methods of examination and treatment using the latest medical technology, sometimes very expensive, in some cases - surgery. Knowledge of hospital care organization people will help future doctors to recognize the importance of the help and learn to calculate basic indicators of hospital.

2. Specific objectives: - To have an idea of the health care provision of the urban population - To have an idea of secondary health care; - To know the basic functions of outpatient, clinics and hospitals; - To have an idea of hospital care; - Have an idea for the provision of health care to the rural population

3. Basic knowledge, abilities, skills, necessary for studying the topic (interdisciplinary integration):

Names of disciplines These skills • History of medicine Stages of development of medical knowledge • Sociology Conduct analysis of sociological research.

• Medical biology Identify basic concepts, methods and research tools that are • Biophysics and biochemistry used to determine the factors affecting the body and health.

• Health Identify and analyze the relationship between natural • Normal physiology phenomena. • Pathology Know Classification of Diseases ICD-10. • Microbiology Knowing the structure of hospitals and health care volume

63 • Internal medicine which is therein

4. TASKS FOR INDEPENDENT TRAINING TO EMPLOYMENT

4.1. A list of the main terms of parameters, characteristics which the student need to learn

Terminology Definition Outpatient care Outpatient medical care provided to persons coming to the doctor, and at home. Ambulatory (лат. health care setting designed to provide medical-hospital Ambulatorius -mobile, medical care. walking) Polyclinic Health care setting designed to provide outpatient medical care and carrying out a set of preventive measures aimed at reducing of the incidence. Hospital Health care setting, providing public inpatient care, and in the case of association with the clinic and outpatient care. Rural medical district Complex medical institutions that constitute the first link in the system of medical provision of rural population. Paramedics-obstetric point Health care setting, part of the rural medical district and is (ФАП) led by the local hospital (ambulance) complex medical and sanitary and anti-epidemic measures in a particular area. It is the primary (pre-hospital) health care in rural areas. Dispensary (fr. Dispensaire, Specialized health care facility designed for the early from Lat. Dispensare - detection of patients, their treatment and medical follow-up, distribute) as well as for organizing and conducting active preventive measures aimed at preventing and reducing morbidity. Clinical examination Active dynamic monitoring of the health of the (dispanserisation) population, which includes a set of preventive, diagnostic and therapeutic measures Medical Card outpatient Basic medical document which is put on each were registered in the outpatient setting. The clinic (ambulatory- Torii, consultations) in the patient's card entered summary information about each visit (for the purpose of treatment, preventive examination etc.). She filled in all urban and rural settings, leading outpatient care, and has established a single form. Medical card of the inpatient Medical document drawn up in the stationary-bunk on each applicant irrespective of the purpose of receipt and date of stay in the hospital. Medical card of the inpatient, formerly called the medical history Primary treatment. It considered the first treatment the patient's medical care

64 to the doctor about the disease Continuing claims Considered a reference to the doctor for acute illness (with the extension of treatment), or of the same chronic disease. Primary morbidity Is the sum of new and have not been previously registered and newly diagnosed diseases. Under the overall incidence It refers to the sum of all (primary and recurrent) applications for medical help. Family doctor (WHO) A qualified physician who has received special training. He observes the patient on Proto throughout life, so that can detect serious diseases at an early stage and promptly prescribe treatment or refer you to a specialist. To the family doctor can contact Liu bym medical issues each family member, regardless of gender and age. Family doctor It is a versatile specialist that can provide expert medical and diagnostic assistance in all cases of diseases in children and adults. Protection of public health Is a set of political, economic, legal, social, cultural, scientific, medical, sanitary, hygienic and anti-epidemic measures aimed at preserving and strengthening the physical and mental health of every person, maintaining its long and active life, providing him medical assistance in case of loss of health Specialized (secondary) Provided by doctors who have the appropriate treatment and preventive care specialization and can provide more qualified-ing counseling, diagnosis, prevention and treatment than general practitioners. Specialized medical and preventive care is provided-tsya in specialized hospital wards urban central district and partly in regional hospitals. Highly specialized (tertiary) It is a physician or group of physicians who have been treatment and preventive care trained in the complex for the diagnosis and treatment of diseases, in the case of the treatment of diseases requiring special diagnosis and treatment methods, as well as the purpose of the installed-diagnosis and treatment of diseases, are rare. Highly specialized medical and preventive care is provided in specialized national hospitals, republican dispensaries, specialized-governmental health centers, clinics with research institutes subordinated to the Academy of Medical Sciences of Ukraine and Ministry of Ukraine of clinical health care settings (urban, regional hospitals), on the basis of which work corresponding departments medical academies, institutes and universities, institutes of Advanced medical Uptake of medical care It is the absolute number of patients for the first time in a calendar year applied to medical institutions about the disease. All primary and repeated applications characterizes 65 attendance. Hospital Hospital with permanent places (beds) to patients Bed turnover (bed function) Utilization of hospital beds: the average number of patients coming to the one beds actually available for the year. The utilization of hospital The number of patients actually held koykodney x 100 / beds (Execution on planned number of bed-days. koykodnyam plan) The mean duration of The number of patients held koykodney for the year / hospital stay (Average bed / number of emigrants (prescription + dead). day) Provision of hospital beds Total number of beds x 10,000 / population served. (per 10 000 population): Urgent care A system of emergency medical care provided to patients with sudden and acute exacerbation of chronic diseases in the places of residence (at home, in hostels, hotels and so on.) Emergency Type of care provided to citizens for diseases, accidents, injuries, poisoning, and other conditions requiring urgent medical intervention. Dispensary Special therapeutic and preventive medical institution- provider medical in the power of certain groups of the population, and carrying out systematic observation-denie for their health 4.2. Theoretical questions: 1. What is referred to secondary care? 2. referring to the tertiary care? 3. What is called inpatient care? 4. The main types of hospital care 5. Indications for inpatient care 6. Functions of the hospital therapeutic profile 7. Functions surgical hospitals 8. Specific indicators surgical hospital 9. Key indicators of hospital performance CONTENT OF THE TOPIC: Inpatient care is provided to citizens for diseases (including acute and chronic diseases), poisoning, trauma; in the pathology of pregnancy, childbirth, during the postpartum period, abortions and births, but children. This type of care provided to citizens at a planned or emergency hospitalization, when the patient requires intensive use of diagnostic methods-ki, the treatment and the use of sophisticated medical technology, laundry vracheb-ing observation. The fundamental principles of primary health care as the main type of medical care:  Availability.  Free.  Service in the community. Obligation to provide complex medical events: 66  treatment of the most common diseases and injuries, poisonings and other urgent states.;  medical prevention of major diseases;  sanitation and hygiene education;  other activities related to the provision of health care to citizens. The main objective is the preservation of family medicine and health promotion. For its implementation are put before the health problems are: - Develop and implement, providing health care system in which the family doctor will be the integrator and the main organizer of health care for every citizen, all the members of his family and the public fixed territory as a whole; - Maternal and child health; - Dynamic monitoring of the health status of family members holding a particular area with qs-sary preventive measures; - Hygienic training and promotion of healthy lifestyles in families; - Providing outpatient care and the organization of inpatient care in hospitals, neko-toryh hospitals clinics, pet hospitals; - Planning families; - Provision of emergency medical assistance; - Providing a certain amount of specialized types of medical care; - Conducting disability examination.

Modern territorial Polyclinic is a major diversified, specialized medical institution designed eye-binding aid to the population and to implement a set of preventive measures to improve the health of patients and the prevention of diseases. Its functions include: • first aid for acute and sudden illness, injuries; • treatment of patients at the health center or at home; • organization and conduct of the clinical examination; • examination of temporary disability; • the release of patients from the work; direction on MSEK persons with signs of persistent disability; • referrals to a spa treatment; • timely hospitalization in need of hospital treatment.

The clinic conducts preventive work, control measures, health education among the population of the service area and studying health attached segment of the population, identify early disease, organizes the statistical recording and analysis of health indicators population-tion, studying the incidence of temporary disability in the attached factories. We must recognize that in spite of the inefficiency of the Soviet economic model and extremely low resource provision, the organizational structure of the industry and the control circuit as a whole allowed to perform all the basic functions of an integrated health system. According to the nomenclature clinics divide: • the organization of work - combined with a hospital and not united (self parking-tional); • on a territorial basis - both urban and rural;

67 • the profile - for general maintenance of the adult or the child population, dentists-ronmental and consultation and diagnosis. The main structural units of the clinic are: • desk with a table of certificates; • Department of prevention; • Medical prophylactic departments: department (therapeutic hirurgich-mechanical and others.), Offices (cardiology, rheumatology, endocrinology, etc.), A treatment room; • Diagnostic units: laboratory, radiology department (office), branch (office) of functional diagnostics, medical office accounting and statistics, administrative and economic part, and others. Emergency care - a system of urgent medical care provided to patients with sudden and acute exacerbation of chronic diseases in the places of residence. It should be provided by special teams, working in the emergency department (clinic, Territorial Medical Association). Emergency tasks: • Provision of emergency medical aid (including resuscitation); • call on the testimony of an ambulance; • hospitalization, which is carried out through the dispatch ambulance service; • ensuring continuity with the clinic (usually the head of the emergency department at the morning meeting, reports on incidents of non-emergency care, or directly inform the head of the therapy department); • emergency care patients go directly to the clinic. Hospital replacement technology For inpatient technologies include: • Day care at outpatient clinics; • Hospitals day stay in the hospital; • Hospitals at home. The purpose of a day hospital (DS) - carrying out diagnostic, therapeutic, rehabilitate- habilitation, preventive measures to patients not requiring round the clock medical supervision, using modern technologies of treatment and examinations in accordance with the standards and protocols of the patients. The function of a day hospital include: • conduct a comprehensive course of treatment, including, as a rule, intensive therapy (intravenous injections and drip infusion of drugs), as well as therapeutic and diagnostic procedures; • conducting complex and comprehensive diagnostic tests and therapeutic proce-dures associated with the need of special training of patients and short-term medical follow-up after the specified therapeutic and diagnostic activities; • post-operative medical monitoring of patients operated on in a hospital or outpatient clinics on the simple surgical procedures; • selection of appropriate therapy for patients with newly diagnosed disease or with chronic diseases when changing the degree of severity of the disease; • preventive examinations and rehabilitation of persons from groups of increased risk of disease, including professional, as well as long-term and frequently ill; • Conduct rehabilitation and wellness complex course of treatment of patients, the disabled, pregnant women;

68 • examination of health, degree of disability and the decision on the direction of the medical and social expertise; • follow-up care of patients discharged from the hospital at an earlier date for the completion of treatment. Medical effect of day hospital activities is determined by: • achieving the end result, according to the protocol of examination and treatment of patients in out-patient (stationary) conditions: Recovery, improvement, stabilization performance, reducing phenomena of decompensation, reduced the number of complaints, etc. The main objective of the research is to produce authentic-tion evidence achievements intended effect; • Reducing the length of stay of patients in treatment; • the absence or reduction of hospital mortality rates for specific diseases; • reduce the number of postoperative complications. Rural health services Medical care of the rural population has a specificity of forms and methods of the Organization of care. The main and distinctive feature of the system Organization's rural health services is its phasing, with koto-plenty treatment and prevention assistance to residents of the village is a complex of medical institutions (from FAP to the regional hospital). The essence of the principle of phasing-lies in the fact that the medical assistance that could be provided at an early stage in each of the subsequent stages. Accordingly, each stage is composed of medical institutions, whose functions are different. The main tasks and functions of the rural medical district: 1) outpatient and inpatient medical care to the population; 2) nursing pregnant; 3) measures for the health of children and adolescents; 4) sanitary and anti-epidemic measures; 5) study of incidence on the site; 6) health education and organization of the health of the asset; 7) monitor the sanitary condition of settlements and other objects; 8) to ensure the health of field work; 9) Preparation of sanitary asset and health education. FAPs (FAP) is organized where the rural population is 700 - 3000, and the distance to the nearest health facility - 2 - 4 km. In FAP carried out medical and preventive work: 1) to provide emergency first aid outpatient and at home; 2) the identification and isolation of patients with highly contagious diseases; 3) prevention and reduction of disease, including infectious and parasitogenic tion; 4) The current FDA for preschool-school institutions, utilities, food, industrial facilities, water supply; 5) concerning medical examination of the population, the selection of patients on clinical examination, recruitment of patients; 6) monitoring the state of health of patients, accounting; 7) on the preparation and conduct of accounting and reporting documentation of its activities. According to the instructions of the doctor conducting a paramedic treatments and prevention at the population-grafting site. Ongoing preventive examinations of pregnant women, nursing babies and postpartum women.

69 District hospitals - medical institution, which is the first medical aid. Its capacity is determined by the number of beds and it depends on the radius Servicing-tion, population size and density, the presence of industrial plants. The nature and volume of hospital care provided to district hospitals, over-hang of its equipment and the availability of medical specialists. The district hospitals are deployed bed general and the main specialties (surgery, paediatrics, infectious diseases). The outpatient department (outpatient) district hospital doctors are receiving adults and children, providing emergency assistance at home and, if necessary Gospa-catalyzes the patient to the hospital. Doctors with paramedics carried dispanseriza-tion of the population area, carry out the examination of ability to work, provide pre-emstvennost in the examination and treatment of patients at the hospital, "ambulance", specialized medical institutions, organize and carry out preventive examinations of the population, the active patronage of women and children, are engaged increasing health awareness of the population. The main objectives of CDH: 1) providing the population with the district and the district center of highly skilled, special reshape the company inpatient and outpatient medical care; 2) operational and organizational-methodological guidance and control over the activities of Stu all health care institutions of the district; 3) planning, financing and organization of the logistics of medical institutions of the district; 4) Development and implementation of measures aimed at improving the quality of health services for the rural population; 5) the introduction into the practice of health facilities district of modern methods and means of prevention, diagnosis and treatment; 6) carrying out activities on the alignment, management and professional development of personnel. Regional hospitals (WMD) - the third phase of the provision of highly skilled (including highly specialized) medical care for the rural population - include the following institutions: 1) regional hospital with advice clinic; 2) regional specialized centers; 3) regional hospitals and specialized hospitals; 4) regional center sanepidnadzora; 5) Hospital medical schools, research institutes and other medical institutions of the regional center. Receiving hospital care • A common indication for hospitalization is a need for around the clock supervision of a physician, hospital treatment and active treatment. • For planned hospitalization You need to get a referral. Referrals made medical commission of the medical organization in the compliance of dance with clinical indications requiring intensive care, and the clock-th observation of medical personnel. • For planned hospitalization of patients, with the exception of pregnant women and children, may be the sequence, which depends on the severity of the patient's condition, expression, strength of clinical symptoms requiring hospital mode, and is determined by the medical commission. • If there are indications provided emergency hospitalization in the duty or the nearest hospitals, where, if necessary, the patient is sent to medical transportation.

When the amount of health care diagnostic and therapeutic measures is determined by the attending physician depending upon the particular disease, its severity and the presence of clinical indications. • If you have a medical indication determined by the attending physician, the patient may be provided surgical care with the use of minimally invasive techniques (for example, the minimum section of the skin), including endoscopic (by PRIMA-ru, in acute appendicitis, cholecystitis). About hospitals applying dan-technologies, you should inform the doctor. • During routine operation allowed the order. • When a planned hospitalization placement in accordance with the sanitary standards is carried out in the wards. On admission to the hospital for emergency indications pre-chamber starts placement is for a period of not more than a day. • Patients in the treatment hospital are provided therapeutic feeding and taking into account the severity of the disease state. • Patients are provided with medicines and medical-th destination in accordance with the standards as part of the form. In the case of vital indications, patients are provided with drugs and medical devices over the Formulary by the decision of the medical commission. • When hospitalization of the child, if necessary, care for them, from birth to one-lei or another family member is given the opportunity to stay in a hospital. Re-shenie the presence of indications to provide such an opportunity taken by the attending physician in conjunction with the head of the department. , Stays with a child family member is given a sheet of temporary disability. Nursing mothers are provided with meals.

General characteristics of the hospital. By type, the volume and nature-provided medical assistance and the organization of the hospital system can be: • The profile - diversified and specialized; • The system of organization - whether or not combined with a polyclinic; • The volume of activity - different bed capacity. The main problem the hospital: 1. Delivery of high quality preventive and curative care. 2. The introduction of services to the population of modern methods of prevention, diagnosis and treatment of diseases. 3. Development and improvement of organizational forms and methods of health of the population, servicing and care, improving the quality and work culture. 4. Sanitary and hygienic education of the population. 5. Involve the community in the design and implementation of measures for treatment and preventive maintenance. At the head of the hospital costs of administrative and managerial staff in the face of the main Vera-cha, head nurse, deputy chief physician at the medical unit at polyclinics-exchanger, to work with the nursing staff, for administrative parts and OE In operating mode hospitals Urban hospitals are divided into hospitals with kruglosutoch nym stay patients, day hospitals and hospitals mixed mode Rabo you.

71 The power and structure of individual types of inpatient facilities linked to laziness Num- served population provided that: the value of separation should be optimal (40 - 60 beds), but not less than 30 one-profile. The main structural units of the hospital are receiving otde-tion, profiled medical department, department of special treatments, certain diagnostic services and others. Organization of therapeutic and preventive care in a therapeutic department, the Research Institute Hospital Therapeutic department of the hospital is receiving patients with any form of nozologiche-tion of internal medicine. The main tasks carried out by the therapy department: • provide the population of highly specialized care; • Provide first aid and emergency care to patients; • systematic development and introduction of new effective methods and means of prevention, diagnosis and treatment; • widely used in the treatment of clinical nutrition, physical treatments and physical therapy and other methods of restorative treatment.; • accounting and analysis of morbidity; analysis of the efficiency of the staff and the quality of medical care; learning outcomes and long-term results of treatment; • professional development of doctors, nurses; • implementation of measures for the dissemination of health knowledge. Therapeutic department of the hospital is composed of chambers to accommodate patients, studies department head and senior nurse, staffroom, Sesto maternal office, treatment room, an office of functional diagnostics, dining room, household room, etc. Organization of therapeutic and preventive care in the surgical department of a hospital Inpatient surgical care is provided in the surgical wards of the three V-rows: general, specialized and highly specialized (centers). General surgery department organized as a part of the district and city hospitals. They provide the main types of skilled inpatient surgery in the power of the majority of the population. The organization of specialized on-divisions are the same principles that contribute to the concentration of patients on a specific feature: • disease of one organ system - separation of Vascular Surgery, Surgery of the lungs, proctology, urology, etc .; • The nosology forms, taking into account the localization - burn units, surgery, urinary and osteo-articular tuberculosis, etc .; • The sections of surgical pathology - oncology departments, emergency-hee rurgii, purulent surgery, etc.;. • The characteristics of methods of operations - Plastic Surgery; • The age peculiarities - pediatric surgery. Tasks surgical department: • provide the population of highly specialized inpatient medical care; • screening and treatment of surgical patients; • systematic development and introduction of new effective methods of dia-gnostics and treatment; • widely used in the treatment of clinical nutrition; • activities to enhance the quality of service, maintenance and care of surgical department; • studying disease outcomes and long-term results of treatment;

72 • periodic professional development of health-la persona; • targeted health education to the entire population through the media. In the surgical department of the Chamber are usually organized to accommodate the patients, dressing, treatment room, operating unit. Specific performance indicators surgical department stationary are: 1. Surgical activity. 2. The rate of postoperative complications. 3. Postoperative mortality. 4. The structure of surgical interventions. 5. The duration of stay in the hospital operated. Following the most important indicators are calculated to evaluate the use of hospital beds: 1) provision of hospital beds; 2) the average annual employment of hospital beds; 3) the degree of utilization of hospital beds; 4) the turnover of hospital beds; 5) the average length of hospital stay. Provision of hospital beds (Per 10 000 population): total number of beds x 10,000 / number-Servicing emogo population. The average annual employment (work) hospital bed: number koykodney actually spent by patients in the hospital / average annual Num lo beds. The average number of hospital beds It is defined as follows: the number of beds actually employed each month of the year in the hospital / 12 months. This rate can be calculated as in the whole hospital, and in offices. His assessment is carried out by comparing with the calculated standards for offices in various fields. By analyzing this figure, it should be borne in mind that the number actually held koykodney includes days spent by patients in the so-called Extra beds, to-torye among average beds are not counted; Therefore, the average occupancy rate may be higher than the number of days in a year (over 365 days). Work less or more beds standard indicates respectively on underload and overload-ke hospital. Tentatively, the figure is 320 for urban hospitals - 340 days a year. The utilization of hospital beds (Implementation of the plan for koykodnyam): the number of patients actually held koykodney x 100 / number of planned koykodney. Planned number koykodney for the year is determined by multiplying the average number of beds in the standard of bed occupancy in the year, The average number of days of use (employment) beds per year Profile berth Number of days of bed Number of days of bed occupancy rate for urban occupancy rate for rural hospitals hospitals Therapy 330-340 320-330 Pediatrics 330-340 320-330 Neurology 330-340 320-330

73 Infectious 320-330 290-300 Ophthalmology 330-340 - Otorinolyaringology 330-340 - Dermatology 330-340 - Surgery 330-340 320-330 Obstetrics 300-310 280-290 Gynecology 300-310 280-290 This index is calculated for the whole hospital and offices. If srednegodo-wai bed occupancy within the norm, it is close to 30%; in case of overload or underload hospital rate will be correspondingly higher or lower than 100%. Turnover hospital bed: The number of patients withdrawn (deceased discharged +) / average number of beds. This figure shows that a number of patients, "serviced" one bed for a year. Fast turnover of beds depends on the duration of hospitalization, which in turn is determined by the nature and course of the disease. At the same time, decrease shenie timing hospital stay and, consequently, increased bed turnover is largely dependent on the quality of diagnosis, timely hospitalization, care and treatment in the hospital. Calculation of indicators and analysis should be carried out in whole-stationary violated, and in offices, profiles beds, nosology forms. In accordance with the planned regulations for generic urban hospital bed turnover is considered optimal in the range of 25 - 30, and to dispensaries - 8 - 10 patients per year. The mean duration of hospital stay (Average bed / day): the number of patients held koykodney for the year / number of emigrants (prescription + dead). Like the previous indicators, calculated as at the hospital as a whole and the department- ments, profiles beds, a separate disease. Roughly standard for general hospitals is 14 - 17 days, taking into account the profile of beds - significantly higher (up to 180 days) The average number of days of hospital stay Profile berth The average Profile berth The average number of hospital number of stay hospital stay Therapy 17.2 Dermatology 21.4 Surgery 13.3 Ophthalmology 14.5 Obstetrics 10.0 Otorinolyaringology 9.2 Gynecology 5.1 Phthisiatry 180.0 Neurology 30.0 Psychiatry 80.8 Pediatrics 16.4 Stomatology 17.6 Infectious adult 13.5 Logopaedics 60.6 Infectious child 15.5 Oncology 26.6 Ambulance station can function as an independent institution under the calls of more than 25 thousand. Per year. fewer calls to the station are the structures of the Ambulance -governmental entities other health facilities (hospitals, clinics), especially in rural areas. There are five categories Ambulance stations (depending on the number of calls per year): v - 5-10 thousand calls 1-75-100 thousand calls...

74 With a large number of challenges and created a considerable distance substations (in the area of fifteen minutes-term availability). The head of the Ambulance station - the chief doctor (a substation - their heads), each headed by a senior doctor replaced. Along with the housekeeping part of the plant consists of: - Operations Division (which manages call reception and transmission); - Hospitalization department (which keeps records availability in hospitals); - Transport department (... Providing a road station of calculation - one car for 10 thousand and 15 thousand urban villagers when the number of calls to more than 75 thousand added machine control visits per year); -department statistics. The basic structural unit of a visiting team. Are distinguished team of emergency medical assistance (including doctor, paramedic, medic) and the Transport Brigade (including paramedic or Feld Fischer-obstetrician). Moreover, the brigade divided into linear and specialized. Recently appeared in the 50s, and include a physician. Types of specialized teams: Pediatric (created with a population over 100 thousand people...); anesthetic and resuscitation (with the number of over 500 thousand.), neurologic, cardiac, psychiatric, trauma, neyroreanimatsionnaya, pulmo- technologically, hematological and other. A doctor working in a specialized team must have experience of Rabo you on specialty not less than three years. Basic first aid tasks 1. The provision of emergency medical aid victims and patients as quickly as possible on the site and during transport. 2. The maximum fast transportation of the sick and injured, pregnant women, premature infants (including at the request of health care facilities). 3. The study of the causes of the need for emergency medical care, and the development of measures to address them. Tasks specialized teams be increased by: 4. Implementation of the methodological guidance outreach outpatient health facilities in the relevant areas. 5. Provide advice. 6. Improving the working methods of rapid diagnosis and emergency care in the prehospital phase. Indications to call Ambulance - Sudden illness, life-threatening, that evolved in the street, public places, establishments, s, acute disorders of the cardiovascular, respiratory, central nervous system and other organs and systems; - Births that occurred outside the hospital; - Immediate patient treatment at the station; - Advice and practical help emergency physicians (and, if necessary, and other health care facilities). A call for "O3" takes Manager (since the call all conversations are recorded on magnetic tape- term), he sends it to the appropriate substation directly or team (by phone or ra-tion). This is fixed when receiving a call, it is transferred, the brigade soon. Call the specialist team through the doctor on duty (in the central control room). At the same time there is a list of indications for each of the teams call. For example, neyroreanimatsionnaya team travels to the following cases:

75 - Coma of unknown etiology; - Rapidly progressive neurological disease (with impaired vital functions); - Suspected intracranial hemorrhage; - Status epilepticus; - Acute cerebrovascular accident (if required resuscitation); - Acutely flowing neuroinfections. Responsibilities ambulance doctor: -rendering emergency; -Current interior disinfection; -with an unconscious patient's condition - an inventory of documents and valuables with an indication in the accompanying sheet; - The timely completion of medical bags, consumed oxygen, nitrous oxide. Doctor NSR on the first request of the patient (or his relatives) must give his last name; number you-call. He must know the whereabouts of medical institutions, service area. The competence of the doctor is accompanied by the issue of the patient's relatives. The main indicators for the emergency operation are: - The number of teams (daily) - the number of calls made (including health care) - The number of calls on the sudden illness (including different nosological entities) and accidents is the number of calls transferred to acute care (and vice versa) - The number of directions for hospitalization, - Average load - Departure time teams from receipt of the call, - The number of deaths prior to arrival and in the presence of teams and the number of repeat calls and their outcomes, - The percentage of discrepancies diagnoses direction and admissions. Emergency care - a system of urgent medical care provided to patients with sudden and acute exacerbation of chronic diseases in the places of residence (at home, in the dormitories, hotels, and so on). It is special teams working in the emergency department (clinic, territorial medical association). There are separate system of emergency care to adults and children. Emergency tasks: - The provision of emergency medical aid (including resuscitation..) - Calling on the testimony of an ambulance, - Hospitalization, which is carried out through the dispatch ambulance service, transportation of patients can be carried out directly with a team of emergency care, first aid, sanitary transport, - Ensuring continuity with the clinic (usually the head of the emergency department at the morning meeting, reports of cases of emergency care, or directly inform over-veduyuschego therapy department) -providing relationship with the center of sanitary-epidemiological, - Issuance of sick leave (no more than three days), recipes, - Emergency care patients go directly to the clinic, -providing work at home hospital (if any).

76 LITERATURE Training Basic 1. Social Medicine and Health Care Organization: Textbook / Ed Over. For ronenka Y. Moskalenko VF - Ternopil: Ukrmedkniga 2000. More 2. Public Health // Ed. A.F.Serenko, V.V.Ermakova - M .: Medicine, 1984. 3. Social Medicine, Organization and Health Economics - Golyachen-to OM, Serdyuk AM, Prihodsky OO - Kiev 1997. Scientific 4. Guidance on social hygiene and public health organization. Ed. Grape NA .. - M .: Medicine, 1974 (in 2 volumes). 5. Guide to practical training in social hygiene and public health organization // Ed. YP Lisitsyn, hooves NY - M .: Medicine, 1984. Articles 1. Workshop on Sanitary and demographic statistics. Ed. prof. Slu Chanko-IS - Moscow 1979 2. Teaching jobs in medical statistics. Ed. prof. A. A.Grando. - Kiev 1984 3. Preparation for practical classes in social hygiene and public health organization - M. I MMI them. Sechenov 1986 4. Medical Statistics in the district general practitioner. Guidelines for practical training. - M. I MMI them. Pirogov 1901 5. Allowance for conducting basic medical documentation in the clinic and hospital // Ed. Ts.V.Yasinskogo. - Chernivtsi 1997 6. Biostatistics / IV Belikov, Kostrikov AV, Rudenko LA A teaching aid for international students. Poltava, 2012 -112s. 7. Flip the department course Informational resources: http://medstatistic.ru/theory/statistics.html http://medstat.gov.ua/ukr/main.html http://www.uiph.kiev.ua/ http://www.moz.gov.ua/ua/portal/

XI. SECONDARY AND TERTIARY MEDICAL CARE TO THE POPULATION. EMERGENCY MEDICAL CARE TO THE POPULATION 1. Relevance of the topic: Hygienic healthy development aims to preserve and strengthen their health. Health and hygiene information program for them involves the promotion of a healthy lifestyle: advice on labor hygiene, rest, nutrition, physical education and sport, the fight against addictions. In modern conditions the preventive work of special importance hygienic education of groups of people with an increased risk of disease. Among the premorbid state of the most prognostically

77 dangerous, such as a tendency to be overweight, prehypertension, high cholesterol, pre-diabetes, etc. At the heart of many of them are violations of sanitary norms of behavior: Lack of exercise, smoking, alcohol abuse, poor nutrition, wrong mode. 2. Specific objectives: Master the technique of individual conversations Capture the method of writing health byuletney To capture the method npisaniya lecture for the public

3. Basic knowledge, abilities, skills, necessary for studying the topic (interdisciplinary integration):

Names of disciplines These skills • History of medicine Stages of development of medical knowledge • Sociology Conduct analysis of sociological research.

• Medical biology Identify basic concepts, methods and research • Biophysics and tools that are used to determine the factors affecting biochemistry the body and health.

• Health Identify and analyze the relationship between • Normal physiology natural phenomena. • Pathology Know Classification of Diseases ICD-10. • Microbiology • Internal medicine Knowing the structure of hospitals and health care volume which is therein

4. Tasks for independent training to employment 4.1. A list of the main terms of parameters, characteristics which the student need to learn

Terminology Definition Prevention (ancient greek set of different kinds of events, aimed at prophylaktikos -. safety) preventing any phenomena and / or elimination of risk factors. Primary prevention system of government measures to prevent the occurrence and impact of risk factors for disease (vaccination,

78 rational mode of work and recreation, quality nutrition, physical activity, environmental protection and so on.). Secondary prevention a set of measures aimed at addressing the significant risk factors, which under certain conditions (stress, weakened immunity, excessive load on any other functional systems of the body) can cause, aggravation and relapse. The most effective method of secondary prophylaxis is a medical examination of a complex method of early detection, dynamic monitoring, targeted treatment, rational sequential improvement. Tertiary prevention a set of measures for the rehabilitation of patients who have lost the ability to full life. Tertiary prevention is aimed at social (creation of confidence in their own social fitness), labor (the ability to restore labor skills), psychological (behavioral recovery of activity) and health (recovery of the functions of organs and body systems) rehabilitation. Health education section of preventive activity of bodies and health institutions, aimed at hygienic training and education of the population with a view to engaging in active participation in health. Sanitary and educational work in the It is a set of differentiated, targeted health care setting health education activities, providing hygiene education of different population groups and organically related to the activities of medical institutions. Sanitary and educational work is carried out in accordance with local conditions and challenges faced by various types of health care institutions. Hygienic general information promoting a healthy lifestyle, the

79 importance of preventive check-ups, seasonal information (prevention of influenza, acute gastro-intestinal diseases, etc...); Target information prevention of chronic diseases (located under the cabinet of experts) 4.2 Theoretical questions: 1. The main objective of the sanitary education of the population 2. What is called prophylaxis? 3. What is called primary, secondary, tertiary prevention 4. The main objectives of health education in health centers and dispensaries 5. The main objectives of health education in hospitals 6. Means and methods of hygienic education of the population. 7. What does the sanitary general information? 8. What does the target sanitary information? 5. CONTENT OF THE TOPIC: Health education in the outpatient clinics

In modern conditions of release 2 main aspects of health education in outpatient clinics:

- Health education to attract the population to medical preventive work;

- Health education dispanserizuemyh contingents under dynamic observation of them (Lisitsyn, 1987).

checkups success largely depends on the attitudes of the population and the willingness to participate in them. In order to attract people for medical checkups apply lump-sum health education exposure, t. E. Shock, short-term, massive information on the goals, objectives and practical significance of the clinical examination. This is ensured by:

-agitatsionno information-sanitary and educational influence;

- Visual aids (posters, slogans, etc...), Exhibited at the place of residence of the population and directly in the out-patient department;

- Explanation and persuasion by means of printed information (leaflets, invitations, themed memo);

- Lectures, explaining the essence of the method of dispensary services; 80 - Demonstration of thematic sanitary and educational films.

Health education of people with chronic diseases is carried out by the method of the course full-time-distance learning. This course includes:

- Individual interview, during which the patient receives the necessary hygiene recommendations;

- A group discussion with the participation of medical specialists, during which the patient receives additional medical and sanitary information, making it possible to better understand the doctor's advice, to recognize the need to follow them. Group Chat is best done in the form of a discussion in which the process of increased cognitive activity recipients. This contributes to the consolidation of the knowledge gained, the development of the necessary belief;

- The issuance of "Books dispanserizuemogo", which is a key element of distance learning and where the note to appear on the timeline another prophylactic. Ill get it together with the corresponding disease-liner memo.

"Book dispanserizuemogo" enables the patient to record the individual parameters of his health behavior that perpetuates in his mind received hygienic recommendations the doctor - patient monitor their implementation.

In the context of the clinical examination, this form of health education is also used in hygienic education of persons with an increased risk of diseases

Health education in the hospital

The aim of health education in the hospital - to increase the efficiency of therapeutic and preventive measures necessary inculcation patient hygiene practices.

Health education in the hospital gives information:

- On the right hygiene behavior during their stay in the hospital, especially after discharge to prevent the progression of the disease, ie, it serves the purpose of secondary prevention. It is important to take into account the need for the patient to get the most

information about the disease and the state;

81 - Additional medical and hygienic for obschegigienicheskih issues due to the fact that the sick person there is increased interest in health issues, and in the hospital, there are all the conditions and time to obtain the necessary information.

In accordance with the objectives of informative health education carried out at all stages of hospital stay:

- At the front desk - an individual conversation with the award of a memo containing information about nosocomial regulations about hygienic requirements to the behavior of the patients;

- In the room - individual or group discussion;

- In the halls of the hospital department - group discussions with patients, the discussion in accordance with the nosological form of the disease with the use of thematic visual aids -. Lecture slides, folders, etc. lecturing successfully used slaydoskop with a set of large-format slides illustrating the basic health information and hygiene recommendations reported by patients;

- Discharge - individual interview with the award of a memo containing hygiene recommendations which are strictly necessary for the successful rehabilitation and to prevent relapse.

Health education in the service area

Precinct-territorial principle of health allows for a broad health education at sites served by the clinic area, primarily in the medical district.

This work is made up of health education:

- Patients and their relatives during home visits, forms and means of health education are similar to health education of patients with acute diseases);

- Total population catchment area (population information on preventive and curative activities carried out by the clinic, and hygienic education of the population, aimed at fostering the skills of a healthy way of life).

For the purpose of methodical preparation of medical workers outpatient clinics for hygienic education of the population and providing them with organizational assistance in its implementation in clinics prevention departments created office promoting a healthy lifestyle. The main tasks of the office are:

82 - Organization and carrying out a set of measures aimed at hygiene education and promotion of healthy lifestyles;

- Providing organizational assistance clinic doctors to conduct health education activities;

- Acquisition of the materials for the promotion and teaching;

- Methodological assistance to nursing staff and sanitation asset in conducting health education with the public. LITERATURE Training Basic 1. Social Medicine and Health Care Organization: Textbook / Ed Over. For ronenka Y. Moskalenko VF - Ternopil: Ukrmedkniga 2000. More 2. Public Health // Ed. A.F.Serenko, V.V.Ermakova - M .: Medicine, 1984. 3. Social Medicine, Organization and Health Economics - Golyachen-to OM, Serdyuk AM, Prihodsky OO - Kiev 1997. Scientific 4. Guidance on social hygiene and public health organization. Ed. Grape NA .. - M .: Medicine, 1974 (in 2 volumes). 5. Guide to practical training in social hygiene and public health organization // Ed. YP Lisitsyn, hooves NY - M .: Medicine, 1984. Articles 1. Workshop on Sanitary and demographic statistics. Ed. prof. Slu Chanko-IS - Moscow 1979 2. Teaching jobs in medical statistics. Ed. prof. A. A.Grando. - Kiev 1984 3. Preparation for practical classes in social hygiene and public health organization - M. I MMI them. Sechenov 1986 4. Medical Statistics in the district general practitioner. Guidelines for practical training. - M. I MMI them. Pirogov 1901 5. Allowance for conducting basic medical documentation in the clinic and hospital // Ed. Ts.V.Yasinskogo. - Chernivtsi 1997 6. Biostatistics / IV Belikov, Kostrikov AV, Rudenko LA A teaching aid for international students. Poltava, 2012 -112s. 7. Flip the department course Informational resources: http://medstatistic.ru/theory/statistics.html http://medstat.gov.ua/ukr/main.html http://www.uiph.kiev.ua/ http://www.moz.gov.ua/ua/portal/

83 XII. ORGANIZATION OF MEDICAL EXAMINATION OF DISABILITY. 1. Specific objectives: Interpret: - Basic principles of temporary disability examination - The ratings of the primary condition, general morbidity and morbidity with temporary disability of different regions of Ukraine Develop creativity - Develop management decisions aimed at improving the health of the population - Independently analyze literature to speak at meetings of student scientific societies.

2. Basic knowledge, abilities, skills, necessary for studying the topic (interdisciplinary integration):

Names of disciplines These skills Medical physics The basis of mathematical-statistical research. General hygiene Identify risk factors that affect health. Identify relationships between natural phenomena. History of medicine To analyze the development of medical science in historical perspective Clinical course To analyze the activity of clinical departments

3. Content of the topic:

The main objective of the examination is to determine the possible disability of the person to carry out their professional duties, depending on the health and social criteria. In addition, the medical expertise disability tasks include: * Definition and treatment regime required for the restoration and improvement of human health; * Determination of the degree and duration of disability was due to illness, accident, or other causes; * Recommendation of the most rational and full use of the labor of persons with disabilities, without prejudice to their health; * The identification of long-term or permanent disability and direction of patients on medical and social expert commission.

Types of temporary disability: 1) diseases and injuries; 2) spa treatment and medical rehabilitation; 84 3) care for a sick family member, a healthy child and a disabled child; 4) the quarantine; 5) maternity leave; 6) prosthesis. The right to the examination of temporary disability and the issuance of documents confirming the temporary disability are: - Physicians of state and municipal systems zdravoohrag tion; - Private practitioners on the basis of a license to conduct TD (to obtain said license physicians in private practice, must have a certificate (certificate) on okon¬chanii refresher course for TD); - Health workers with secondary medical education (in some cases by the decision of local governments health care). They do not have the right to issue documents certifying temporary disability health professionals: - Stations (offices) of emergency medical assistance; - Blood transfusion stations; - Institutions of forensic examination; - Balneogryazelechebnits and urban balneary resort; - Holiday homes, tourist facilities; - Sanitary-epidemiological institutions. Leaf disability is issued only from the day when the disability was personally installed a doctor, including holidays and weekends. Issuance of a leaf of invalidity for the last 1-3 days (but no more) is possible only in special cases on the basis of: - Help-direction of the health center in case of confirmation of TD since the appeal to the health center; - Reference (signal list) issued by the ambulance doctors or the emergency department of hospitals. Workers who have temporary disability occurred is a permanent place of residence or work (business trip, during annual leave, etc.), disability certificate is issued in place of his temporary stay physician netrudosposobno¬sti establish the facts, but only with the approval of head physician medical institution. Monitoring compliance with the instructions of the PCP in the state, municipal and private health care facilities, as well as private practitioners performed the appropriate health management body level, professional medical associations, the executive body of the Social Insurance Fund. The monitoring committee may participate for accreditation and licensing of medical and pharmaceutical activity and units of territorial compulsory health insurance funds. Levels examination of temporary disability: The first - the attending physician; The second - the commission for the examination of therapeutic and prophylactic institutions; The third - the commission for the examination of health management authority area; Fourth - the commission for the examination of body health management;

85 Fifth - the main expert on examination of temporary disability. The organization and procedure of the examination of temporary disability are constructed on the basis of the functions of each of these levels.

ORDER OF DOCUMENTS CERTIFYING TEMPORARY DISABILITY Leaf disability is polyfunctional document serving as a basis for: 1) leave from work in the case of TD; 2) The calculation of TD for benefits. The front side of the form sheet filled with disability attending physician, the reverse side - administration of the enterprise, working on koto¬rom patient. When making a leaf of invalidity column "diagnosis" and "final diagnosis" is not filled. Under "cause of disability" highlights and below are recorded: the appropriate type of disability (illness, accident at work or at home, quarantine, child care, spa treatment, prenatal or postnatal leave) and additional information provided on the form in brackets form of the disease, in accordance with accepted nomenclature. In the column "Mode" noted the prescribed form of medical protective regime: inpatient, outpatient, home, bed, sanatorium. In the column "abuse stamp mode" put the date of the violation and its type (non-compliance with prescribed medical protective mode, delayed appearance to the doctor, alcohol intoxication, access to the work without the discharge physician, unauthorized departure from the medical facility, departure for medical treatment in another administrative area without the permission of the attending physician). If the next time you visit a patient is recognized as disabled, extension leaf of invalidity (certificate) is carried out from the day of his appearance to the doctor; if it recognized as able-bodied - in the "get to work" notes "appear (date) able- bodied." In the "off work" written in Arabic tsif¬rami from which the day, month, year, and words - for a number of months inclusive and shall be exempt from the work the patient.

Legibly indicate the position of the doctor, his name and signature is placed. At the collegiate extension shall contain the names of members of the medical advisory committee (at least three) and put their signature. In the column "get to work" marked the date of restoration of true- dosposobnosti next day after inspection and acceptance of the patient's true- dosposobnym. In the case of persistent disability in the leaflet are not disability- emphasized "continued", recorded date, and the new sheet number. The new leaflet highlights the "continuation sheet N" and indicate the number of the primary sheet. On letterhead documents BH in cases where the doctor made corrections, it must be certified by the record that is corrected, the doctor's signature, date and seal of a medical institution.

86 Allowance issued sick leave certificates and conducted in accordance log (f 036u). In issuing these documents at home doctors accountable for them, handing roots forms signed by the recipient. Blown forms of documents certifying TD, are stored in a separate folder with a list, in which the surname, name and patronymic of the physician, date of delivery, number and series of corrupt forms. The destruction of spoiled forms produced by an act of the Commission, established by order of the head of the institution at the end of the calendar year, damaged roots and used the forms are kept for 3 years, after which eliminated. To obtain a duplicate in case of loss of the document certifying TD, is lost in the hospital a certificate from the employer not to pay him the allowance for the lost sick leave. The procedure for issuing certificate of incapacity for diseases and injuries In diseases and injuries of the attending physician issues a sheet capacity alone is not hard-and at the same time for up to 10 calendar days and the pro- dlevaet it alone for up to 30 days, taking into account the approved Health Care of Russian indicative deadlines TD in various diseases and injuries. Doctors engaged in private medical practice outside the health facility, have the right to issue documents udosto veryayuschie temporary disability for a period not exceeding 30 days. In special circumstances (remote areas of the countryside), to address local health administration issuing sick leave may be allowed the doctor to complete rehabilitation or referrals to medical and social examination. Nursing worker has the right to issue sick leave, alone and at the same time it provides for up to 5 days and extended to 10 days in exceptional cases, after consultation with the doctor nearest health facility, - up to 30 days. In terms of HV 30 days decision on further treatment and prolong leaf of invalidity made by medical advisory committee, appointed by the head of the medical institution. By decision of medical advisory committee, with a favorable clinical and labor forecasting piece of disability can be extended to a full rehabilitation, but for no longer than 10 months, in some cases (injuries, conditions after reconstructive surgery, tuberculosis) - no more than 12 months, with the frequency extension Commission not less than 30 days. Citizens in need of treatment in specialized health facilities, physicians give piece of disability followed in the direction of establishing an appropriate profile for the continuation of treatment. Disabled citizens, aimed at consultation (examination, treatment) beyond the administrative area, disability certificate is issued for a number of days required for the journey, and extended at the place of examination or treatment in the manner prescribed by the instruction. At discharge from the hospital, including the hospital Pathology Center, disability certificate is issued for the entire period of hospital treatment for non-

87 resident - given the days of travel to the place of residence; while maintaining a sheet of disability disability at discharge may be extended to 10 days. When illness or injury resulted from alcohol or drugs, sick leave is issued with the corresponding mark on the fact of intoxication in the history of the disease (medical card) and certificate of incapacity. In TD, in the period of the next annual leave, sick leave is issued in due course. When TD women who are on leave for child care, or caregiver of a child working on part-time work or at home, sick leave is issued on a common basis in the prescribed manner. In the outpatient treatment of patients at the time of the invasive methods of examination and treatment (endoscopy with biopsy, chemotherapy intermittent method, hemodialysis, etc.) sick leave by decision of medical advisory committeecan be given intermittently on the turnout days in hospital. In these cases, the days of the procedures specified in the certificate of incapacity, and release from work only on these days. Citizens who seek medical care at the end of the working day, sick leave, with their consent, shall be issued from the next calendar day. When the TD in the period of leave without pay, maternity leave, partially paid leave for child care disability certificate is issued after the end of these holidays in the case of continuing disability. In the case of diseases of students and students of secondary and higher educational institutions for their release from school issued certificate of the required form.

The issuance of a leaf of invalidity for a period of sanatorium treatment and rehabilitation Leaf incapacity for spa treatment is given on the number of days missing to the next and additional holidays, and travel time. In the case of regular and additional leave before his departure to the resort and in the provision of leave without pay in advance the number of days equal to the regular and additional holidays, sick leave granted for a period of treatment and travel, minus the days of basic and additional leave. At the direction of the spa treatment in the sanatorium "Mother and Child," a disabled child under the age of 18 years old with a medical opinion on the need of individual care for him disability certificate issued by one of the parents (guardian) for the entire period of sanatorium treatment of a child with taking into account the travel time. The participants of liquidation of consequences of Chernobyl disaster in 1986-1987. and the disabled, who have established a causal relationship with disease consequences of radiation exposure, disability certificate for spa treatment shall be issued for the entire period of the permit and travel days. At the direction of the sanatorium patients from hospitals after acute myocardial infarction, coronary artery bypass surgery for heart aneurysm, gastric

88 ulcer, duodenal ulcer, gallbladder removal sick leave is extended by the attending physician of the sanatorium for the whole period of follow-up care. At the direction of the centers of rehabilitation of patients directly from hospitals sick leave is extended by the attending physician at the center of the whole period of follow-up care and rehabilitation. Working to soldiers-internationalists, invalids of the Great Patriotic War, as well as people with disabilities from the army towards medical-selection committee to the centers of rehabilitation therapy soldiers-internationalists under the order Mizdrava and social security fund, disability leaflet issued for the entire duration of the tour and travel days. Citizens are aimed at the rehabilitation clinic research institutes of balneology and physiotherapy, disability certificate issued by the attending physician medical facility on the basis of the decision of KAC at the time of treatment and travel and, when indicated, extended physician clinics institutions. The procedure for issuing certificate of incapacity to care for a sick family member, a healthy child and a disabled child Leaf disability for patient care doctor issued by a family member (trustee), directly to a caregiver. Leaf disability issued for the care of an adult member of the family and adolescent patients over 15 years receiving treatment in outpatient for up to 3 days, the decision of medical advisory committee- up to 7 days. For a child up to 7 years in outpatient treatment - for the duration of acute illness or to remission during exacerbation of chronic disease; child older than 7 years - for up to 15 days if the medical conclusion does not require much time. For a child up to 7 years with hospitalization - for the entire duration of treatment, older than 7 years - after the conclusion of medical advisory committeeon the need for care. For children up to 15 years, infected with HIV, suffering from serious blood diseases, malignant tumors, burns - for the entire period of stay in the hospital. In cases of illness mother on leave to care for a child up to 3 years or a disabled child under 18 years old, disability certificate issued to a person effectively acting as a child care institution, which treated the mother, for the entire period during which it is not can provide care. At the same time the disease two or more children to care for them are given one piece of disability. At different times the disease two children on sick leave for another child is issued after the close of the first document without offsetting days coincided with days of leave from work on the first sick leave. Sick leave shall not be granted for care: a) for chronic patients in remission; b) during the period of annual leave and leave without a mother detention; c) in the period of leave and maternity leave; d) during the period of partially paid leave for child care,

89 The procedure for issuing certificate of incapacity for pregnancy and childbirth Maternity disability certificate issued by a doctor - an obstetrician- gynecologist, and in his absence - the doctor leading the overall reception. Issuance of a leaf of invalidity is made from 30 weeks of pregnancy at the same time duration of 140 calendar days (70 calendar days before childbirth and 70 calendar days after delivery). When multiple pregnancy sick leave and maternity leave is given at 28 weeks of pregnancy, while the total duration of prenatal and postnatal leave is 180 days. In complicated childbirth for women, including nonresident, disability certificate issued by an additional 16 calendar days health facility where births occurred. In these cases, the total duration of prenatal and postnatal leave is 156 calendar days. At birth, occurring before 30 weeks of pregnancy and the birth of a living child, sick leave and maternity leave is issued LTD where delivery occurred at 156 days, and in the case of stillbirth or death within the first 7 days after birth - only 86 calendar days. Leaf disability on antenatal leave of 90 days is given to women who live in areas with a reduced socio-economic status (residing or staying in the evacuation zone, as well as in the settlements subjected to radioactive contamination). The total duration of leave be¬remennosti leave of such persons 160 days. If pregnancy occurs in a woman find the time to partially paid leave without pay is issued on a common basis for childcare sick leave. Women who have adopted a newborn baby, the hospital issues a disability certificate at the place of his birth to 70 calendar days from the day of birth. In step "embryo grafting" disability certificate issued by the operating doctor for the period from the date of admission to determine whether the pregnancy, then the sick-leave certificate is issued on a common basis. When the operation of abortion disability certificate issued in accordance with the procedure provided for the issuance of certificate of incapacity for diseases and injuries. The procedure for issuing certificate of incapacity under quarantine When temporary suspension from work of persons exposed to infectious patients or as a result of bacteria, sick leave granted in the health care setting, an infectious diseases physician or health care provider to report physician- epidemiologist. The duration is determined by the approved quarantine isolation periods. "Home" mode is indicated in the certificate of incapacity. Manual HV with dismissal from work due to contact with sick contagious diseases issued to workers and employees: a) baking, pasta, confectionery, vegetable, fruit, sausage and milk production; b) trade enterprises and storing products of the above productions; c) catering. For infectious diseases include: a) open tubercular ulcers and fistulas, lupus on the exposed parts of the body;

90 b) pulmonary tuberculosis with the release of sputum containing bacilli; c) Syphilis infectious manifestations of the disease; g) actinomycosis with ulcerations and fistulas on exposed parts of the body; d) acute inflammatory processes of infectious origin of the eye; e) cutaneous infectious diseases. Employees of public nutrition, water, child care if they have a disability helminthiasis leaflet issued for the entire period of de-worming. When quarantine the child care center is not hard-sheet capacity for child up to 7 years of care given health facility, observe it, one of the working members of the family for the duration of the quarantine on the basis of reference epidemiologist. The procedure for issuing certificate of incapacity in prosthetics When hospitalization Orthopaedic Enterprise disability certificate is issued for the duration of hospital stay and time of travel to the place of treatment. Citizens prosthetic in outpatient orthopedic prosthetic companies, disability certificate is issued. Soldiers-internationalists aimed at prosthetics in the prescribed manner, disability certificate is issued for the entire period of prosthetics given days required for travel to the place of treatment.

DIRECTIONS TO THE ORDER OF THE CITIZENS TO MEDICAL AND SOCIAL EXPERTISE

On medical and social expertise forwarded citizens who have persistent signs of life and limit disability and in need of social protection: - With the obvious adverse clinical prognosis and labor regardless of the timing of BH, but not more than 4 months; - With a favorable prognosis of labor in the case of continuing disability to 10 months (and in some cases - injuries, conditions after reconstructive surgery, tuberculosis - to 12 months) for a decision on the continuation of treatment or the establishment of disability; - Working disabled to change the employment recommendations in the case of clinical deterioration and employment forecast. The right to direct citizens to the medical and social expertise are physicians and outpatient medical institutions of different levels and forms of ownership with the approval of direction on medical- social expert commissionmedical advisory committeefacilities. In establishing the disability period ends HV date regi-stration direction on medical-social expert commission (f 088u) medical advisory committeeoffices and hospital closes piece of disability. This date is specified in the "Getting Started". Persons who are not recognized as disabled, sick leave is extended to the health facility rehabilitation or re-direction to the medical-social expert commission. In case of refusal by the patient referral to medical-social expert commissionor late appearance on his expertise for unexcused sick leave shall not

91 be extended from the date of refusal or the date of registration of documents medical-social expert commission. Refusal or failure to appear fixed in the certificate of incapacity. 5. METHOD OF THE EDUCATIONAL PROCESS AT PRACTICAL LESSON 5.1. Preparatory stage. Stress (series) classes mentioned topics for further study discipline and doctor's practice in order to create incentives for targeted training activities. To acquaint students with specific goals and plan lessons. Conduct a standardized control entry-level training of students. 5.2. The main stage - should be structured and include students of educational activity depending on the types of classes (practical seminar); provide student learning activities with objects or models that replace them in order to create new knowledge, practical skills for specific purposes session. It is important for the assimilation of new knowledge and skills at this stage is to solve situational problems, graphic images, drawings, diagrams. It is advisable to task for students at this stage are accurate and structured, executed and inspected writing teacher during a class, discuss the results. 5.3. Final stage. We estimate the current activities of each student during class, standardized control terminal, an analysis of student achievement, announced evaluation of each student and set in the Log of visits and student achievement. Group leader simultaneously captures evaluations of the roll of the success and attendance of students, teacher assured them his signature. It is advisable to briefly inform students about the topic of the next classes and instructional techniques to prepare for it. LITERATURE Training Basic 1. Social Medicine and Health Care Organization: Textbook / Ed Over. For ronenka Y. Moskalenko VF - Ternopil: Ukrmedkniga 2000. More 2. Public Health // Ed. A.F.Serenko, V.V.Ermakova - M .: Medicine, 1984. 3. Social Medicine, Organization and Health Economics - Golyachen-to OM, Serdyuk AM, Prihodsky OO - Kiev 1997. Scientific 4. Guidance on social hygiene and public health organization. Ed. Grape NA .. - M .: Medicine, 1974 (in 2 volumes). 5. Guide to practical training in social hygiene and public health organization // Ed. YP Lisitsyn, hooves NY - M .: Medicine, 1984. Articles 1. Workshop on Sanitary and demographic statistics. Ed. prof. Slu Chanko-IS - Moscow 1979 2. Teaching jobs in medical statistics. Ed. prof. A. A.Grando. - Kiev 1984

92 3. Preparation for practical classes in social hygiene and public health organization - M. I MMI them. Sechenov 1986 4. Medical Statistics in the district general practitioner. Guidelines for practical training. - M. I MMI them. Pirogov 1901 5. Allowance for conducting basic medical documentation in the clinic and hospital // Ed. Ts.V.Yasinskogo. - Chernivtsi 1997 6. Biostatistics / IV Belikov, Kostrikov AV, Rudenko LA A teaching aid for international students. Poltava, 2012 -112s. 7. Flip the department course Informational resources: http://medstatistic.ru/theory/statistics.html http://medstat.gov.ua/ukr/main.html http://www.uiph.kiev.ua/ http://www.moz.gov.ua/ua/portal/

XIII. ORGANIZATION OF DENTAL CARE TO THE POPULATION. PROMOTION OF DENTAL HEALTH AMONG THE POPULATION.

1. Relevance of the topic: Dental care refers to one of the most popular types of health care. In general morbidity structure of the population of our country oral cavity diseases rank third. At the same time 99% of the patients served by outpatient institutions. In the structure of diseases that require hospitalization (about 1%), one of the first places occupy odontogenic inflammatory diseases and injuries of the maxillofacial unit.

2. Specific objectives: 2.1. Know the job, the structure and organization of dental care. 2.2. To be able to calculate and analyze the performance of the dental clinic.

3. BASIC KNOWLEDGE, ABILITIES, SKILLS, NECESSARY FOR STUDYING THE TOPIC (INTERDISCIPLINARY INTEGRATION):

Names of disciplines These skills • History of medicine Stages of development of medical knowledge • Sociology Conduct analysis of sociological research.

93 • Pathology • Microbiology Knowing the structure of hospitals and health care • Internal medicine volume which is therein

4. Tasks for independent training to employment 4.1. A list of the main terms of parameters, characteristics which the student need to learn 4.2. Theoretical questions to the lesson: Institutions providing dental care to the urban population Types of dental clinics Categorization of the dental institutions Features dental clinic (offices) The structure of the dental clinic Dentist functions Types of medical records in the practice of a dentist Performance clinic (department) Performance of a dentist (general practitioner, surgeon, orthopedist) Organization of the decentralized dental surgeries Hospital care organization Hospitals performance indicators 5. CONTENT OF THE TOPIC: Organization of the dental clinic. Among all health care providers in the dental strength, Dental Clinic is a leader. Dental clinics are:

The level of service:  republican  regional  city  district

In subordination:  territorial  departmental

By source of funds:  budgetary  private

By category (number of doctors' rates) Without category (40 posts) 94 Category I (30-40 posts) Category II (25-30 posts) Category III (20-25 posts) Category IV (15-20 posts) Category V (10-15 posts) The calculation of medical positions is conducted according to the number of the population:. 10 thousand of the adult population is 4 medical office, dental therapists and dental surgeon in total and one orthopedic dentist. Position the head of the dental office is administered by 12 positions dentists (but no more than 3 positions at the clinic). The main functions of the dental clinic: organization and holding of specialized dental care to different groups of the population; the introduction of dispensary method in the activities of dentists for the prevention of diseases of the oral cavity; organization of rehabilitation of the oral cavity in a planned manner and with the population of dental treatment in the institution; providing narrow-profile types of dental care; improving diagnostic and treatment methods (physiotherapy, radiological, biochemical, cytological, functional diagnostic and other.); promotion of drugs and hygiene practices in the field of dentistry to the public; examination of temporary disability; management accounting and reporting statistical documentation.

The structure of the dental clinic:  registry;  specialized dental offices (offices);  therapeutic dentistry  surgery  prosthetic dentistry  pediatric dentistry (no children's dental clinic)  office emergency dental care;  physiotherapy;  x-ray study  periodontal office;  functional diagnostics  dental laboratory;  clinical laboratory;  organizational and methodical cabinet;  administrative and economic part.

95 The most important condition for improving the quality of the dental clinic is a clear medical management accounting and reporting documents, the ability to analyze statistical data and based on them to develop to improve health care measures. Medical accounts of the dental clinic: Medical card dental patient. (F.043 / o). To be completed in the first call of the patient in the clinic (passport fills part of the registrar, the diagnosis and subsequent sections are filled with your doctor). Check list of follow-up. Card filled in all the patients taken under medical observation, about the disease. The diagnosis and the date of the establishment indicated in the upper right corner of the map. outpatient operations log entries. The log records all performed in the clinic surgery, briefly describes the course of the operation, type of anesthesia, the surgeon and the name of the operating sisters. Sheet Daily accounting work of a dentist (f.№037 / o). It is the primary health document, which serves to fill the graph diary (a form designed to take account of the work of doctors of dental profiles) Blog accounting robots dentist (f.№039-2 / 0). Designed to accommodate medical and preventive work of a dentist for 1 day and in total for the month. (Form is designed to take account of the work of doctors of all dental profiles) Direction for consultation and support offices Summary of accounting dentist dental clinic, department, office. Consolidated statement of dentist fills each doctor individually, and a consolidated statement for the clinic (department) is made of medical statistics or employee appointed by the head of the institution. Journal of Accounting preventive work dentist (f.№049 / o). Literature Training Basic 1. Social Medicine and Health Care Organization: Textbook / Ed Over. Voronenkov Y. Moskalenko VF - Ternopil: Ukrmedkniga 2000. Advanced 2. Public Health // Ed. A.F.Serenko, V.V.Ermakova - M .: Medicine, 1984. 3. Social Medicine, Organization and Health Economics - Golyachenko OM, Serdyuk AM, Prihodsky OO - Kiev 1997. Scientific 4. Guidance on social hygiene and public health organization. Ed. Grape NA .. - M .: Medicine, 1974 (in 2 volumes). 5. Guide to practical training in social hygiene and public health organization // Ed. YP Lisitsyn, hooves NY - M .: Medicine, 1984. Articles 1. Workshop on Sanitary and demographic statistics. Ed. prof. Sluchanko IS - Moscow 1979 96 2. Teaching jobs in medical statistics. Ed. prof. A. A.Grando. - Kiev 1984 3. Preparation for practical classes in social hygiene and public health organization - M. I MMI them. Sechenov 1986 4. Medical Statistics in the district general practitioner. Guidelines for practical training. - M. I MMI them. Pirogov 1901 5. Methods of Demographic Studies. Under. Ed. L.E.Darskogo - M.Statistika. 1969 6. Allowance for conducting basic medical documentation in the clinic and hospital // Ed. Ts.V.Yasinskogo. - Chernivtsi 1997 7. Biostatistics / IV Belikov, Kostrikov AV, Rudenko LA A teaching aid for international students. Poltava, 2012 -112s. 8. The course of lectures of the department Informational resources: http://medstatistic.ru/theory/statistics.html http://medstat.gov.ua/ukr/main.html http://www.uiph.kiev.ua/

XIV. ANALYSIS OF THE ACTIVITIES OF THE DENTIST AND DENTAL CLINIC 1. Relevance of the topic: Dental care refers to one of the most popular types of health care. In general morbidity structure of the population of our country oral cavity diseases rank third. At the same time 99% of the patients served by outpatient institutions. In the structure of diseases that require hospitalization (about 1%), one of the first places occupy odontogenic inflammatory diseases and injuries of the maxillofacial unit. 2. Specific objectives: 2.1. Know the job, the structure and organization of dental care. 2.2. To be able to calculate and analyze the performance of the dental clinic. 3. Basic knowledge, abilities, skills, necessary for studying the topic (interdisciplinary integration):

Names of disciplines These skills • History of medicine Stages of development of medical knowledge • Sociology Conduct analysis of sociological research. • Medical biology Identify basic concepts, methods and research • Biophysics and tools that are used to determine the factors affecting biochemistry the body and health. • Health • Normal physiology Identify and analyze the relationship between • Pathology natural phenomena.

97 • Microbiology Know Classification of Diseases ICD-10. • Internal medicine Knowing the structure of hospitals and health care volume which is therein 4. Tasks for independent training to employment 4.1. A list of the main terms of parameters, characteristics which the student need to learn

4.2. Theoretical questions to the lesson: 1. Institutions providing dental care to the urban population 2. Types of dental clinics 3. Categorization of dental institutions 4. The functions of the dental clinics (branches) 5. The structure of the dental clinic 6. Functions of the dentist 7. Types of medical records in the practice of a dentist 8. Performance clinic (department) 9. Performance of a dentist (general practitioner, surgeon, orthopedist) 10. Organization of the decentralized dental surgeries 11. The organization of hospital care 12. Performance hospitals 4.3. Practical tasks: 5. CONTENT OF THE TOPIC: Performance dental clinic: the following indicators are used to analyze the dental service activities: General (primary) indicators: The percentage of patients identified in the planned reorganization The number in need of rehabilitation x 100 Number examined in the manner planned reorganization Completeness of follow-maintenance patients The number of patients taken under medical observation x 100 The number of registered patients Completeness of dental health The number of sanitized number needing remediation x 100 The number in need of rehabilitation (Normal level of at least 50%) Renovated considered a patient who are sealed all decayed teeth removed teeth and roots, which are not subject to treat and cure inflammatory diseases of the periodontal, oral mucosa.

98 Specific weight of primary dental patients rehabilitated in total Number sanitized in the total number of primary dental patients х 100 The total number of primary dental patients (Normal level of at least 50%) The ratio of the number of disinfected and deleted teeth The number of cured teeth The number of extracted teeth (Normal figure 4: 1) The number of visits per day per dentist. The number of visits at the dentist in the past month (for the year) The number of working days per month (year) Physician specialty Receiving norm (h) 1 Dental therapist 3 . (Baseline medical 9 examination) 2 Surgeon 5 . 3 Orthopedist 2 .

The average number of rescues day per doctor (in a month) The number of sanitized The number of working days (1 rate index reorganization on the day) The prevalence of dental caries The number of persons with carious teeth x 100 The number of examinees The intensity of caries (defined CPU index) - the average number of teeth affected by caries in one of the surveyed The number of carious, sealed and extracted teeth The number of examinees Increase the intensity of caries KPU this year - KPU previous year x 100 KPU of the previous year

99 Employment of dentists is carried out in two shifts on a rolling basis. In the organization of the reception of patients in the dental clinic a great role belongs to the dentist on duty. He has, if necessary, emergency dental care, examines the patient and determines the amount needed him further assistance, directs patients to the narrow profile specialists for further treatment, providing a uniform load of doctors. Repeated visits by patients clinics are appointed and regulated by the attending physicians. With proper organization of the patients had one doctor to complete rehabilitation. The main functions of a dentist working in the clinic is: - The provision of preventive and curative, surgical or orthopedic assistance to the population (for uptake); - Consultations for other physicians; - Dispensary observation of certain dental patients groups; - Carrying out the planned rehabilitation of the oral cavity in certain population groups - Health education. Routine sanitation of the following subject groups: - The child population; - Invalids of the Great Patriotic War and persons equated to them; - pregnant women; - Youth of premilitary age; - Vocational school students, colleges, universities; - Patients are followed up by a physician. Dental clinic provides, if necessary, help at home, on-call doctors territorial polyclinics. In order to provide dental care at home, the clinic has a portable instrument. Accounting work of a dentist. To account for dentists working system is used based on the measurement of the volume of work in units of labor input (UET) (see Appendix) In one conventional unit labor dentist traditionally done 20 minutes of working time, ie, labor expended doctor to stage fillings with an average caries. The load in the conventional unit labor dentist at 6-day working week is 21 per day standard unit of labor, and at 5-day work week - 25 standard unit of labor. Measuring the volume of work of dentists in a common unit of work has led to the ordered system of labor accounting, labor orientation of the final result and reducing unproductive time spent in connection with the second visit. Performance therapist dentist 1. The number of the seals imposed per day (rate of 10) 2. The number of UET performed per day (rate of 25 standard unit of labor) 100 3. The ratio of the number of fillings imposed in uncomplicated caries among the seals imposed in complicated caries (rate of 6: 1) 4. The average number of visits per seal Performance dental surgeon 1. The number of notional unit of labor per day 2. The number of surgical procedures performed in the month 3. The percentage of postoperative complications 4. The number of extracted teeth per day Performance orthopedic dentist 1. The number of notional unit of labor per day 2. The average number of patients received a doctor for a day 3. The average number of visits per patient received prostheses 4. The number of repeat visits to primary 1 visit 5. The average time the prosthesis manufacturing 6. Number peredelennyh dentures made from among Materials for self-control: 1. Tests (presented in Appendix). 2. Control questions. 3. Case studies (presented in Appendix). Literature Training: Basic: 1. Social medicine and health care organization /Golychenko O.M., Ternopil, 2009. 2. Health economics /V.Moskalenko. Nova knyha, 2010 Additional: 1. Fundamentals of biostatistics / V.Kardash, M Grytsiuk, I.Navchuk the ath. Chernivtsi. -2012. -120p. 2. Statistical methods to study population health condition and activity of medical institution /Agarkov V.I., Buteva L.V.Grishenko S.V. the ath/ - Donetsk:DNMU, 2010, -63p. Scientific: 1. VM Lekhan The development strategy of the health system: Ukrainian dimension /V.M. Lekhan, GA Weak, MV Shevchenko / Ukraine. Health of the Nation. - 2010. - № 1. - P. 5-23. 2. The annual report on public health, sanitary and epidemiological situation and results of the healthcare system of Ukraine. 2015. Kyiv, -2016. 3. Annual report on public health, sanitary and epidemiological situation and results of the healthcare system of Ukraine. 2014. Kyiv, -2015.

101 4. The annual report on public health, sanitary and epidemiological situation and results of the healthcare system of Ukraine. year 2013. Kyiv, -2014. 5. The concept of public health. Kyiv, 2016. Internet resources: 1. http://www.who.int/topics/ru/ 2. https://www.ncbi.nlm.nih.gov/pubmed 3. scholar.google.com.ua 4. www.uiph.kiev.ua/dawnload/Vidavnictvo/.../Щорічна%20доповідь.2015.p df 5. http://www.umsa.edu.ua/kafhome/socmed/kaf_socmed.html 6. medstat.gov.ua 7. www.coursera.org 8. www.extension.harvard.edu/academics/courses/fundamentals- biostatistics/24540

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