Kicha Practice-based approach - RUDN · 2020. 3. 18. · 8 Practice-based approach to public health and training • readiness for application of the medical products provided by

РОССИЙСКИЙ УНИВЕРСИТЕТ ДРУЖБЫ НАРОДОВ (РУДН)МЕДИЦИНСКИЙ ИНСТИТУТ

Департамент общественного здоровья, здравоохранения и гигиеныФакультет повышения квалификации медицинских работников

Кафедра организации здравоохранения, лекарственного обеспечения, медицинских технологий и гигиены

НАЗВАНИЕ

УЧЕБНОЕ ПОСОБИЕ

2-е издание

PRACTICE-BASED APPROACHTO PUBLIC HEALTH AND TRAINING

TEXTBOOK

Second edition

МоскваРоссийский университет дружбы народов

2017

Julia

Выделение

УДК 614.1 (075)ББК 51.1(2)я7Р85

И

У т в е р ж д е н о РИС Ученого совета

Российского университета дружбы народов

Р е ц е н з е н т ы :

Коллектив авторов :Д.И. Кича, А.В. Фомина, А.Ю. Абрамов,

А.С. Макарян, О.В. Рукодайный

И00 Название работы (на английском языке) = Practice-based approach to public health and training : учебное пособие / Д. И. Кича, А. В. Фомина, А. Ю. Абрамов, А. С. Макарян, О. В. Рукодайный. – Москва : РУДН, 2017. – 84 с.

ISBN 978-5-209-07690-2

With consideration of the integrated approach of teaching public health, public health system. For the 3–4 year medical students on “General Medicine”, “Pharmacy”, “Dentistry” specialties. Completed in the Department of Public Health, Public Health System and Hygiene of Medical Institute and Department of Public Health Organization, Medical and Pharmaceutical Technology & Hygiene of Medical Staff’s Advanced Graduate Training of Medical Institute of Russian Peoples’ Friendship University (RUDN University).

УДК 614.1 (075)ББК 51.1(2)я7Р85

ISBN 978-5-209-07690-2 © Коллектив авторов, 2017© Российский университет дружбы народов, 2017

Julia

Выделение

CONTENTS

Introduction: Russian Federation education regulation ........................................4

Chapter I. Problem-based approach to public health practice and training practice ...........................................................................5

Chapter II. Public Health and Health Care System ..........................................14Part I. Public (Populations) Health Assessment ........................14Part II. Health Care System Assessment .......................................28

Chapter III. Glossary of Terms and Public Health Terminology with equivalents in Russian, English, French and German languages .....................................................................51

References ....................................................................................................................82

Julia

Выделение

INTRODUCTION

Dear students and doctors!By carrying out the given learning paper, we will help you in addition

to the curriculum to get acquainted with life conditions of the population, healthсare system, medico-social problems, to identify ways of solving the problems of health and public health system by modeling of the task.

We wish you health and success on the activity of your country and your people!

Th e manual is intended for preparing of independent themes, simulation tasks on population’s health and public health organization, for training to the program of study, the fi nal test and the recommended modules base.

Best regards,Edited group D.I. Kicha, A.V. Fomina, A.U. Abramov, A.S. Makaryan,

O.V. Rukodayny, 2017, Moscow, RF.

Chapter I

PROBLEM-BASED APPROACH TO PUBLIC HEALTH PRACTICE AND TRAINING PRACTICE

Russian Federation education regulation: Th e Federal State Educational Standard 3+ — FGOS 3+.

1. Methodical recommendations about the organization of studying of discipline «Public health and health care, health care economy» in Peoples’ Friendship University and Department of Public health and Health care system, 2016, Russia

Th e discipline «Public health and health care, health care economy» is medical and prophylactic scientifi c, educational and applied discipline, re-fl ects regularities of formation of public health, the factors it defi ning; var-ious aspects of health care, including questions of economy and manage-ment of branch. Th e discipline is studied at University in volume of 6 test units (216 hours) with carrying out laboratory researches (110 hours) and independent occupations (106 hours). Th e modular structure of discipline turns on 6 modules: the Module 1 — «Th eoretical and methodical bases of discipline “Public health and health care”, a state policy in the fi eld of public health care»; the Module 2 — «Public health, concept, studying, an assess-ment of the indicators and factors defi ning health of the population»; the Module 3 — «Th e Base of medical statistics and the organization of medi-cal-social research. Statistical analysis»; the Module 4 — «Th e organization of the preventive care to the population and functioning of the main sub-

6 Practice-based approach to public health and training

systems of health care» and medical organization; the Module 5 — «Modern problems of preservation of health, prevention of diseases, health of a fami-ly and medical ethics»; the module 6 — «Th e bases of the economy of health care and medical insurance. Management of health care and medical shots». Statistical researches with students and experts doctors of the organization of health care and public health are carried out in audiences of chair by all categories of the faculty, occupations are provided with necessary evident material and educational and methodical grants. During educational oc-cupation students and listeners pass entrance test, interview, is independ-ent and with the assistance of the teacher solve the educational tasks and situational tasks set for them of mastering knowledge and acquisition of necessary skills and competences, report for the study done on occupation. For increase of comprehensibility of training material the new forms of ed-ucation and control of students and listeners knowledge include simulation tasks, course and theses, presentations and remote forms. Teachers apply el-ements of business game, create production situations, use role imitation of a production activity, give classes on clinical bases and in the organizations of practical health care.

Working of students and listeners on occupations and independent work is estimated within the mark and rating system of an assessment of educa-tional and scientifi c activity of students introduced on chair. On each student the rating card is fi lled, and the examiner has opportunity to make more ex-act idea of progress everyone trained on chair, to calculate the score earned by the student and to give an objective mark.

For the solution of tasks.Working of students and listeners on occupations and independent work

is estimated within the mark and rating system of an assessment of educa-tional and scientifi c activity of students introduced on chair. Th e rating card is fi lled on each student, and the examiner has opportunity to make more exact idea of progress of everyone trained on chair, to calculate the score earned by the student and to give an objective mark.

Th e educational and professional (methodical) complex including a number of elements is developed for the solution of problems of education-al process on chair: the federal state educational standard of the higher ed-ucation, the approximate training program, the working training program, the educational and thematic plan, methodical development for students and teachers of each occupation, the list of practical skills, examination materials, texts and presentations of lectures, the list of information and material secu-rity of educational process.

Chapter I. Problem-based approach to public health practice and training practice 7

2. A discipline place in structure of the Main Educational Process: The discipline belongs to a professional cycle of disciplines (base unit).

Teaching discipline «Public health and health care, health care economy» is based on the knowledge gained on the previous theoretical and clinical disciplines and provides continuity and integration of its teaching not only with hygienic and medical clinical disciplines, but also with humanitarian, social and economic disciplines (bioethics, medicine history, jurisprudence, physics, medical informatics, economy, philosophy, sociology, etc.).

Training purposes: on the basis of studying of the basic concepts of dis-cipline to train the expert having knowledge and abilities for an assessment and decision-making in the fi eld of public health and factors, it defi ning; the systems providing preservation, strengthening and recovery of population health in general and separate uniform groups of the population; organi-zational and medical technologies and administrative processes, including economic, administrative and organizational; tendencies of development of health care in foreign countries.

For the solution of tasks Problems of training is studying and the analy-sis of the indicators characterizing a state of health of various age and sexual, social, professional and other groups of the population, families, actions for preservation, strengthening and recovery of health, theoretical fundamentals of health care, introduction of new economic and medico-social technologies in activity of treatment-and-prophylactic establishments, methods and means of improvement of functioning of establishments (organizations) of health care.

3. Requirements to results of development of discipline.

Process of studying of discipline is directed on formation of the follow-ing general competences (FGOS 3+): OK-1, OK-5, OPK-3, OPK-11, PK-4, PK-18, PK-22.

As a result of studying of discipline the student has to possess the follow-ing common cultural competences (CCC):

• ability to abstract thinking, analysis, synthesis (OK-1);• readiness for self-development, self-realization, self-education, use

of the creative potential (OK-5).As a result of studying of discipline the student has to possess the follow-

ing all-professional competences (OPK):• ability to use bases of economic and legal knowledge in professional

activity (OPK-3);


• readiness for application of the medical products provided by ordersof delivery of hecare (OPK-11).

As a result of studying of discipline the student has to possess the follow-ing professional competences (PC):

• ability and readiness for application of social and hygienic tech-niques of collecting and medico-statistical analysis of informationon indicators of health of the population (PK-4);

• readiness for participation in an assessment of quality of delivery ofhealth care with use of the main medical-statistics (PK-18);

• readiness for participation in introduction of the new methods andtechniques directed on protection of public health (PK-22).

Standard of knowledge and skills of the students in framework of PUBLIC HEALTH AND PUBLIC HEALTH SYSTEM CURRICULUMdeveloped in educational spiral: Way of development of the curriculum: 1) Curriculum evaluation, 2) Qualifying requirements, 3) Professional functions.

Chapter I. Problem-based approach to public health practice and training practice.

Educational OBJECTIVS OF THE PUBLIC HEALTH AND PUBLIC HEALTH SYSTEM CURRICULUM : qualifying requirements.

Section 1. Theory and methodology of “Public Health and Health Care System”

Th e student must have the following mandatory knowledge:• Defi nition of Public Health and Health Care System as a branches of

social economy, science and as an educational topic.• Basic historical events and renowned personnel in the development

of Public Health Public Health System.• Basic patterns of the development of Public Health.• Means of protection and improvement of Public Health & Public

Health Services.• Basic aims of the subject and science of “Public Health and Pub-

lic Health System” – to study impact mechanisms of diff erent socialconditions, factors and life styles on the population health, to studysocial aspects of disease prevention and treatment, diagnosis andrehabilitation in countries with diff erent climatic / geographic andsocio-economic conditions.


• Basic principals of organization and administration of Public Health.• Diff erent systems and forms of Public Health services in diff erent

countries of the world. • International problems of Public Health services and role of World

Health Organization.• Foundations of low for health and biomedical ethics.Th e student should be able :• To defi ne the place and role of community health and public health

organization in the national socio-economic system.• To evaluate the role of diff erent conditions and factors in the devel-

opment of community health.• To propose means of protection and improvement of community

health & public health services depending upon the specifi city of diff erent local conditions and systems of public health services.

• To propose and carry out research to study impact mechanisms of diff erent social conditions and factors, diff erent life styles on pop-ulation health, — to study social aspects of disease prevention and treatment, diagnosis and rehabilitation in countries with diff erent climatic / geographic and socio-economic conditions.

• To evaluate the basic principals of organization and forms of public health services in diff erent countries of the world.

• To evaluate the international problems of Public health and role of World Health Organization.

Section 2. Methods of investigations in Public Health and Public Health Services

Th e student must have the following mandatory knowledge:• Investigation methods / research methods in community health and

public health services: (historical, statistical, economical, expert and system analysis).

• Aims and steps to be taken to organize and to carry out medico-so-cial research in Community and Public Health.

Th e student should be able :• To use methods of investigation in research in community health

and public health services. • To make plans and programs to conduct medico-social research in

community and public health. • To defi ne aims, tasks and object of research, types of statistical meth-

ods to be used, unit of observation types of statistical observations, data groups, statistical tables.


• To organize medico-social research, to process and analyze data with the help of computers, to make (result) reports, to prepare recom-mendations and proposals.

Section 3. Use of statistical Methods in health evaluation and data processing in medical-statistical and social-hygienic investigations

Th e student must have the following mandatory knowledge:• Defi ne the tasks of medical (sanitary) statistics.• Methods of health assessment, evaluation procedures in public

health and methods of assessment of research results received by calculating encompassing indices and coeffi cients.

• Methods to compare diff erent statistical indices.• Methods to evaluate factor correlations - correlation coeffi cient.• Methods to analyses phenomena health condition• Use of graphics in statistics, their diff erent forms.Th e student should be able :• To use methods of health assessment, evaluation procedures in pub-

lic health and methods assessment of research results. • To calculate statistical indices and coeffi cients. • To evaluate indices of health and public health services; -to con-

clude; - formulate proposals and to give recommendations.

Section 4. Community (public) Health, concept, evaluation

Th e student must have the following mandatory knowledge:• Defi nition of community health, concept, criteria, comprehensive

valuation. • Defi nition of disease, criteria • Conception, principals and history of creation of International sta-

tistical classifi cation of diseases and problems related to health (10th revision).

• Defi nition of community health, program and scheme of investiga-tion, criteria and indices of community health, governing factors of community health, information sources of population health, prog-nosis and administration of community health in countries with dif-ferent levels of development of public health systems.

• Medico-social problems of community health in the world (morbi-dity, traumatism, disablement, physical development, demographi-cal processes).


• Programs and comprehensive methods of investigation of popula-tion health status and factors aff ecting it in the world (morbidity, traumatism, disablement, physical development, demographical processes).

• Defi nition of concept and methods of investigations of morbidity/sickness rate in the countries of the world, information sources of morbidity rates, state and medical statistics of morbidity.

• Indices, levels and types of morbidity rates. General morbidity, pri-mary morbidity, morbidity by prevalence. Morbidity with temporal disability. Hospital morbidity. Morbidity by acute infectious diseas-es. Major diseases and morbidity in diff erent regions of the world. Population morbidity based upon medical examinations. Population morbidity based upon causes of death. Specifi city and epidemiology of morbidity in individual population groups and countries of the world.

• Defi nition of concept of disablement, information sources, methods of investigations. Disability groups, causes of disablement. Indices of disablement, calculating and evaluating methods of these indices. Factors aff ecting these indices. Role of disablement indices in the evaluation of community health.

• Defi nition, subject, topics and contents of demography.• Basic demographic data in the countries of the world.• Th e concept of population statistics: population (number), structure

and density of population.• Principals, methods and organization of census.• Th e concept and defi nition of population dynamics, types of popu-

lation dynamics/demographic movements: mechanical and natural demographic changes and their role in Public Health.

• Defi nition of birth rate and death rate, method of calculation, analy-sis and evaluation.

• Factors determining level of general and special birth rates and death rates in the countries of the world.

• General and special birth rates and death rates, methods of calcula-tion, evaluating role in health. Fertility.

• Characteristics, causes, structure and level of death rates in the world. Age-wise death rates. Infant mortality, neonatal mortality, early neonatal mortality, perinatal mortality, maternal death rates.

• Defi nition, role and methods of calculation of average expected life expectancy, life expectancy.


Th e student should be able • To use criteria of community health and make comprehensive eval-

uation.• To use international statistical classifi cation of diseases and problems

related to health (10th revision) for evaluating community health.• To work out program and trial designs to study community health

and its branches in relation to its determining factors. • To work out proposals to administer community health in countries

with diff erent levels of public health development.• To analyses and evaluate medico-social problems of community

health in the world (morbidity, traumatism, disablement, physical development, demographical processes).

• To work out programs and trial designs to study diff erent types of mor-bidities in individual countries by using diff erent information sources such as governmental and medical statistics of morbidity, morbidity with temporal disability, hospital morbidity, morbidity by acute infec-tious diseases, other major diseases and morbidity in diff erent regions of the world, population morbidity based upon medical examinations and population morbidity based upon causes of deaths and disablement).

• To receive and analyses basic demographic data of diff erent coun-tries of the world.

• To work out the program and organization strategy of conducting census.

• To calculate, analyses and evaluate birth rate and death rate depending along with the factors aff ecting these rates (general and special birth rates and death rates, natality, infant mortality, neonatal mortality, ear-ly neonatal mortality, perinatal mortality, maternal death rates).

• To use methods of calculation average expected life expectancy, life expectancy.

Section 5. Family as a study subject for medical-social investigations and medical care

Th e student must have the following mandatory knowledge:• Defi nition and basic characteristics of family, types of family.• Role of family in formation of life style and population health.• Need of family in medico-social help, work organization of general

practitioner (family doctor/physician).• Concept, problems and types of primary medico-social help in the

countries of the world (Alma-Ata conference, 1978).


Th e student should be able :• To perform analysis of basic characteristics, structure, functions and

types of family.• To study and determine the role of family in formation of life style

and population health depending upon its characteristics, structure, functions and types.

• To work out program, to study and evaluate the needs of family in medico-social help, to work out proposals for their fulfi llment.

• To evaluate and give proposals for up grading/improving the work organization of general practitioner (family doctor/physician).

• To carry out analysis and evaluate the forms of primary medico-so-cial help in a particular country of the world.

Chapter II

PUBLIC HEALTH AND HEALTH CARE SYSTEM

Individual work for students1. Th e presentation of every topic2. Th e abstract according to topic3. Th e case analysis of medical care organization4. Th e preparing a staff character in medical fi eld (business game)

Part I. Public (Populations) Health Assessment

THEME 1. Methods and objects of public health research: plan and program of the public (population) health research

Public health and health care system— is the science studying public health, its forming factors and con-

ditions, and creating the treatment-prophylactic methods aimed at public health improvement.

In contrast to clinical disciplines, public health studies the health of col-lectives, social groups and the entire society but not the health of separate individuals.

Population’s health (Public health)— is the state of the population’s health, depending on complex social

and biologic factors of the environment, which is measured by demographic indices, physical development, morbidity and disability characteristics.

Chapter II. Public health and health care system 15

Health — is a state of complete physical, mental and social well-being and not merely the absence of disease or infi rmity (WHO).

Basic parameters of public health are:1. Physical development (status)2. Demographic parameters (mortality and birth rate)3. Morbidity4. Physical disability (handicap)Methods of study of public health and public health system :1. Statistical2. Experimental3. Economical4. Historical 5. SociologicalSpecial sociological methods of the research:1. Medical surveys2. Supervision3. Interrogation, interview, questionnaireTypes of the research:1) by volume — entire and selective2) by time — current and occasional 3) by source of information:

– extracting information from medical documents– medical examinations – special social-hygienic and statistical research

Stages of Public Health’s research:I. COMPOSITION OF THE PLAN AND PROGRAM OF THE RE-

SEARCH II. COLLECTING OF STATISTICAL MATERIAL (DATA COLLEC-

TION) III. ELABORATION OF THE STATISTICAL MATERIAL IV. ANALYSIS, CONCLUSIONS, PROPOSITIONS AND PUTTING

IN PRACTICE

I. COMPOSITION OF THE PLAN AND PROGRAM OF THE RESEARCH

Plan of the research includes:1. Th eme of the research2. Aim and Tasks of the research3. Objects of the research


5. Methods of observation. 6. Volume of research’s object.7. Place and Time period of work.8. Personnel (staff )9. Management and fi nancingObjects of the complex social-hygiene research:1. Age-sex and social groups.2. Small social groups (collective of industrial enterprise, collective of

agricultural enterprise, collective of educational institution, etc.) 3. Territorial and communal groups.4. Families.5. Health status groups.6. Handicappers etcAll number of persons possessing the research attribute forms a general

set.Th e part of these persons is named a sample set.For the creation of the sample special methods of selection can be

applied:1. Mechanical. 2. Typological.3. Multistage selection. 4. Monographic. Program of the research includes1. Unit of observation2. Statistical documents (offi cial and unoffi cial)3. Questionnaire and information from offi cial documents (lists, cards,

coupons etc.)4. Types of groups (qualitative and quantitative)5. Construction of statistical tables (model)Th e unit of observation is primary element of the research’s object. Th e

observation unit is a carrier of all attributes of the research taken into ac-count.

Th ere are 2 groups of statistical medical documents:— offi cial (statistical coupons, hospital cards, patient’s record, birth

and death certifi cates);— unoffi cial (questionnaires, sample cards). Th e sample card is one of unoffi cial documents, which a scientist makes

from a patient’s medical documents (medical patient cart)


THEME 2. III Stages of Public Health’s research: Elaboration of The Statistical Material. Statistical data.

Elements of this stage:1. Control of quality the statistical material;2. Grouping of the statistical material;3. Calculation of statistical parameters;4. Report — fi lling of the statistical tables;5. Make Graphs.Control of material means the mechanical control for the correction of

fi lled documents.Grouping:is the bringing together of materials with separate attributes. Aft er grouping of the material it can be placed into tables. In the tables it

is possible to refl ect all the data of the research.Types of groups:Qualities’ groups — based upon symptoms which may be expressed

orally or in written form (sex, type of disease, profession);Quantity various — groups based upon signs consisting of numerical

expression (height, blood pressure, etc)Th ree types of the statistical tables:Th e simple table: Th e fi nal report of the data only to one attribute is sub-

mitted. Th e group table: Is submitted the data of same attributes.Th e combined table: Is the combination of three and more interconnect-

ed attributesIt is necessary to refl ect the table’s results as graphs. Th ere are 4 kinds of graphical images:1. Linear2. Plane (sectoral, column, intra-column, polar)3. Figured 4. Cartogram and card — map diagram4 types of relative statistical indices:1. Extensive index2. Intensive index3. Diff erential index4. Visual indexExtensive index — index of structure (portion from the whole) - is ex-

pressed in percentage %.For the calculation of extensive index it is necessary to fi nd percentage % proportion. Graphical image – pectoral or intra-col-umn diagrams


Intensive index — it shows the rate (frequency) amount of the studying event — is expressed in promill ‰ (for example, birth coeffi cient, death co-effi cient). Graphical image — linear, polar or column diagrams.

Diff erential Index — it is relation of 2 diff erent values (for example, pro-vision of beds to the patients, a doctor amount 10 000 people). Graphical image — column or fi gured diagrams.

Visual Index — it is calculated by comparing few numbers of changing values, when one of these number is estimated to be 100 %. (continue on dynamic rank) Graphical image — column or fi gured diagrams.

THEME 3. Average Values. Reliability (accuracy) of the Average Values

AVERAGES valuesAssessing the public health and results of activity a public health system

uses a lot of averages.Averages are widely used in medical fi eld : Such indicators characterizing

the limits of norm and pathology are the means.Variational series (variable column) – is the line of the option located in

the certain sequence in the ascending or descending orderEach value of variable column names varianta (V)Variable column :Th e frequency, which there are identical values is designated by the letter p. Variable column into grouped one.Th e range between two extreme values in each group is named an in-

terval — i.For each Variable column there must be calculate Average values:Mod is the most oft en repeated value.Median is an average value which divides variable column in two equal

parts. Average arithmetical simple and by method of moment Average3 kinds of Average arithmetical:1. Ordinary average (middle) arithmetical:

М = Σ V / Number of cases NMiddle arithmetical value (is evaluated, if in an variable column one

or several options repeat):М = Σ V P / Number of cases N

Middle, defi ned by the way of moments (Is evaluated at large number of observations):

М = М1 + Σd P / Number of cases N (conditional variants (M1)


Parameters of the variable column :d — standard deviation (mean square deviation),m — error of the average value,t — confi dential factor. σ — gives the most full characteristic of variety of the sign in totalityIt shows the level of deviation from the mean value M and is necessary

for evaluation of the average error of the average arithmetical value.m — (average error) shows how much the outcomes of our selective re-

search diff er from the general set data, Th e less error the outcomes are more authentic.

Confi dential factor (t) it is the number showing, in how many times it is necessary to increase a mistake of average value, that at the given number of supervision of with a desirable degree of probability (P) to approve, that the average value will not leave received thus limits.

Mgen = Msample ± tmP — is a desirable degree of probability : P = 0,68 (68 %) t = 1, M ± tm = M ± 1m.P = 0,95 (95 %) t = 2, M ± tm = M ± 2m.P = 0,99 (99 %) t = 3, M ± tm = M ± 3m.Calculation the Average arithmetical: by the method of moments:

A = i Σd P / N — formula of the fi rst moment average arithmetical;M = M1 + A = M1 + i Σd P / N — formula of the average arithmetical,

calculated by method of moments.M — Middle arithmetical; М1 — conditional average (variant with the

greatest frequency — Mod or median); i — Interval; N — Number of cases (supervision)

σ =√С–AІ — formula of standard deviationC= i Σd Ip — formula of the second

n – moment average arithmeticalm = ±σ formula of the average error

√n

THEME 4. Comparing of average values or statistical indices of healthSmall sample. Comparing of average values or statistical indices

Aft er comparing of two average values (or two statistical indices), calcu-lated during the various periods of time or in a little bit distinguished condi-tions, the importance of distinctions between them is defi ned.


Th us, the following rule is applied: the diff erence between averages (or statistical indices) is considered essential in the event that the arithmetical diff erence between compared averages (or statistical indices) will be more, than two square roots from the sum of squares of mistakes these averages (or statistical indices)

Small sample is a sample consisting from 10 to 30 units of observation. Th e small sample diff ers from the usual research by small quantity of

units of observation and in this case only the simple average arithmetical is calculated instead of mean arithmetical founded by the way of moments. For the evaluation of the error we take (n-1) in the denominator, because we have a very small quantity of observations. And for better accuracy in evaluations we artifi cially reduce number of observations.

Th e confi dential factor at small quantity of observations we take from the table of Student.

THEME 5. Defi nition of necessary quantity of units of observation. Correlation indices

Correlation indicesTh e correlative connection by its direction can be direct and inverse, and

by its force — strong, middle and weak. Th e character and force of the connection is determined by the correla-

tion index. If the correlation index has the sign +, then this connection is direct, and

if (-) — inverse. Th e force of the connection is determined according to the tableReliability of the correlation IndicesIt is necessary also to determine reliability of the correlation –3m). If the correlation index exceeds the error in 3 and more times, then the

correlation is considered authentic (t=3).

THEME 5. Demography

Demography is a science about the population in its social (public) de-velopment.

Demography includes 2 large Parts: a static and dynamic.Demography — Part staticTh us, the static as a science studies quantity, age and sexual structure,

culture, educational level, density of the population and etc. First of all, on the basis of census data the requirements for doctors of this or that specialty


in cities and regions come to light. For a government the data of census helps at planning of construction of specialized medical-preventive establishments (polyclinics, hospitals), for correct distribution of money resources and for preparation of the experts

Each 10 years almost every country there passes census of the popula-tion.

Census has the following rules:Generality (universality) — the special team goes round the house and

records information about all people living in this house. Obligatory requirement is the presentation of the passport or any other

identifi cation document. Information about children, and about presence of the pregnant women on 7 month of pregnancy is also important (registered).

Unifi ed program. Each country has its own the conditions of life. Th ere-fore programs of census of the various countries will diff er from each other.

Simultaneity (synchronism) — the census is carried out on the whole territory of the country simultaneously. Usually for realization of census Sunday days of early spring or late autumn are selected, as at this time major-ity of the people is at home.

Centralization — all gathered documentation is processing in specially created temporary statistical Center, which aft er processing of the obtained data, issues the bulletin (information collection)

Demography — Part DynamicMechanical movement:Th e second part of the demography is dynamics, which divides into me-

chanical movement and natural movementMechanical movement: migration, emigration and immigration.Migration — is any movement inside the country and beyond its bor-

ders.Emigration — is a departure into the other country for constant resi-

dence.Immigration – is an entrance into the country for constant residenceTh e Types of migrations are:1. Scheduled, when the people go in business trip or in holiday accord-

ing to a plan2. Spontaneous, when during war or nature disaster people have to ur-

gently leave their home3. Seasonal are all kinds of trips in the summer, on Christmas, in days

off .Th ere are also intercontinental and in-countries migration.


Dynamic Demography — Natural movement:Th e second kind of movement is a natural movement: birth rate, mortal-

ity and natural increase belongs hereTh e parameters (factors) of natural movement calculated usually on

1000 of population are:Factor of birth rate — the relation of number born for one year to an

aggregate number of the population;Mortality rate coeffi cient — the relation of number died for one year to

an aggregate number of the population;Factor of natural increase - the relation of diff erence between the num-

ber of born and died for one year to an aggregate number of the population (or diff erence between the factor of birth rate and the mortality rate coeffi -cient)

Th e Specials parameters (factors) of natural movement: Factor of early death rate – the relation of children died in the age be-

fore 1 month to the number of born alive for one year;Factor of infantile death rate – the relation of children died in the age

before 1 year to the number of born alive for one year;Factor of perinatal death rates – the attitude (relation) of number of

born dead and children died during the fi rst week of life to the general (com-mon) number of born for one year (alive and dead). Perinatal mortality con-sists of antenatal, intra-natal and neonatal mortality. In each period there are reasons, which result with death.

Th ere are 3 demographic types of the aged structure of the popula-tion:

1) the progressive type (predominates the population under 14 years); 2) the regressive type (predominates the population older then 50 years); 3) the fi xed type (the partition of the population under 14 years equally to the partition of the population older then 50 years).

Th e indices of mortality:For the evaluation of indices of mortality they select: infantile mortality

(death of children on the fi rst month of life); the perinatal mortality (still-birth and children died during the fi rst week).

THEME 6. Health and Requirements of a Family in Medical-social Care

Family is a group of persons (individuals), united not only by kinship bonds or wedlock but also by common budget, living place and mutual aid within the family.


Parameters of a families characteristics:• Structure of a family • Stages of the development of a family • Function of a family Structurally, a family includes 3 principal elements:1. size2. composition3. number of generationsFamilies are divided into “big” and “small”“Small family” is the family which consists of the married couple and

siblings. A small family can otherwise be named nuclear (from the word “nu-cleus”). A minor family can be “incomplete”.

“Big family” is the family which is composed of several generations of relatives or of several married couples interconnected by kinship.

A “big” family is sometimes regarded as “complete”. In some foreign countries a family with many children is termed as “big”

Several stages in the development of the family are diff erentiated:1. Preparatory stage (the period of acquaintance, courting, thinking of

the future family)2. Evolution of the family. Th is stage is divided into two steps:

a) Creation of the family (marriage)b) Formation of the family (from marriage till the birth of the fi rst

child)3. Maturation of the family. Th is stage comprises the period from the

birth of the fi rst child till that of the last child.4. Th e stage of narrowing of the family. Th is stage comprises the peri-

od of leaving of all the children from the family for independent life.5. Disappearance of the family. At fi rst, death of one of the couple and

then of the second.Th e main functions of the family:1. Social. 2. Biological (reproductive)3. Economical. 4. Cultural5. Educational (informational)6. Upbringing 7. Function of socializing of children8. Psychological.


9. Epidemiological10. Medical. 11. Prophylactic

Medical function of the family includes the following major ele-ments

1. Formation of necessary diff erentiated conditions for the family members depending on their age-physiological requirements and diff erent health status (for instance elderly, pregnant, children, chronically diseased).

2. Readiness of the family to fulfi l the role of medical staff assistant, participation of the family members in dispenserization (prophylac-tic medical examination), in prevention of hereditary diseases, meet-ing the requirements to vaccination, timely аttendance for medical help in case of diseases.

4. Observation of hygienic and medical requirements to birth, bring-ing up and socialization of children. 5. Carrying out medical recom-mendations and prescriptions on the treatment and rehabilitation of the sick members of the family.

6. Observation of healthy way of life by all members of the family.7. Realization of psychological requirements of mutual assistance, mu-

tual care among adults and children, creation of healthy psychologi-cal atmosphere in the family.

8. Training of members of the family to provide assistance.“Priority families” are those, which require special attention of med-

ical, social and other services:1. A family with a congenitally disabled members (family members

with defects in development, with hereditary disease etc.).2. Families where one or both parents suff er from serious chronic dis-

eases, families with members suff ering from psychic diseases.3. Families where there are cases of miscarriages, premature births

and still births; cases of child’s death in early neonatal period; where there are children with low or high body weight.

4. Families where there are episodes of frequent abortions, complica-tions during pregnancy.

5. Families where there are children with peri-natal pathology.6. Families with frequently ill members.7. Non-complete families.8. Families with many children.9. Young mother and her baby.


Family planning: — a complex of the medical, social and legal events held for the purpose

of the help to families or individuals for the birth of desired children, regula-tion of intervals between pregnancies, control of time of a child-bearing, the prevention of undesirable pregnancy (WHO redaction).

Family planning RF concept:Russian program of family planning is directed to the increase of the

birth rate. Important stimuli is economical part (maternal capital). At birth of a child the essential sum is paid to a young mother. If the pregnancy is registered before 12 weeks, aft er the birth of a child the sum of the benefi t is increased. Th e sanitary education is also very important.

THEME 7. Morbidity

3 concepts characterizing morbidity: Primary morbidity (incidences) has a concern with all diseases revealed

for the fi rst time in the given year.Prevalence (Sickness) – is a set of all diseases registered for the fi rst time

in the given year, and also those diseases, which were registered last year, but which the patients only address in a given year.

Pathological morbidity (prevalence) — is all the pathological cases of the diseases on population that is established during medical surveys (check up).

Th e information about morbidity in the country for various groups can be collected through several ways:

• by carrying out interrogation of the population, that is through questionnaire or population surveys;

• by extracting information from fi les of diseases history, from the sta-tistical coupons;

• using the data’s from health certifi cates, as well as death certifi ca-tes etc.;

• state social statistical data.Structure of morbidity : Th e structure of morbidity in the various countries of the world is very

diff erent.In the developing countries, the infectious and parasitic diseases are in

the fi rst place.On the second place are illnesses connected with malnutrition.On the third place —trauma.


Structure of morbidity in the developed countries:Th e fi rst place – is cardiovascular diseases.Th e second one is neoplasm.On the third place are trauma and accidents.Index of health:Th e health index is the (%) percent of healthy peopleFor children this parameter is about less then 20 % or below.For the adult population it makes near by 20 %.Th e concept and defi nition of quality of life in medicine: QOL associated with health – integral characteristic physical, psycho-

logical, emotional and social functioning of the patient, based on its subjec-tive perception

Non Communicable DiseasesNCDs are the biggest cause of death worldwide.More than 36 million people died from NCDs in 2008:48 % — cardiovascular diseases21 % — cancers12 % — chronic respiratory diseases3 % — diabetes More than 9 million of these deaths occurred before the age of 60 and

could have largely been preventedRISK FACTORS:Common, preventable risk factors underlie most NCDs. Th ese risk fac-

tors are a leading cause of the death and disability burden in nearly all coun-tries, regardless of economic development:

raised blood pressure (responsible for 13% of deaths globally);followed by tobacco use (9 %);raised blood glucose (6 %);physical inactivity (6 %);overweight and obesity (5 %);raised cholesterol.Causes of death:56,5 % – cardiovascular diseases, 13,1 % – neoplasms, 12,5 % – external causes of death, 4,1 % – diseases of the digestive system, 3,8 % – respiratory diseases,1,6 % – infectious diseases


THEME 8. Morbidity with temporary disability

Morbidity with temporary disability is calculated for the working popu-lation. It is calculated on 100 workers and is characterized by 4 parameters:

• Number of cases of disability;• Number of days of temporary disability;• Duration of one case of temporary disability;• Structure of morbidity.THE MEDICAL CERTIFICATE Sick-list in RFTh e basic medical document, given to workers in cases of disease, is the

sick-list of temporary disability.Th e sick-list has 4 functions:1. Medical;2. Legal;3. Financial or economics;4. Statistical.Classifi cation of disability is based on the basic concepts:— the degree of disability (3 groups of disability). Type of Temporary Disability: 1. In case of any disease in cease infection;2. In case of a trauma;3. In case of contact with infectious patient;4. Th ey care of a sick child and elderly at home and hospital;5. During pregnancy or delivery (aft er birth);6. In case of an abortion.7. Treatment of sanatoriaIndicators of rehabilitation: 1. Indicators of medical and vocational rehabilitation of disabled per-

sons: 1) full rehabilitation; 2) partial rehabilitation;2. Indicators stability disability groups: group I disability stability (II

and III disability groups);3. Indicators weighting disability groups;4. Weighting disability group — III.

THEME 8. Medical ethics and medical deontology

Th e term “ethics” comes from the Greek (ethos) or Latin (ethica) — cus-tom, teaching, the science of morals and standards of ethical conduct indi-vidual or group of people (doctors) in the course of life and career.


Medical ethics: — a section of the science and practice of the role of moral principles

in the work of the doctor (medical doctors ), his humane treatment of the patient as a necessary condition for successful treatment and strengthening human health.

Objects-category of Medical Ethics: Doctor — Doctor. Doctor — Nurse Doctor — Patient. Doctor — Family

Doctor — Administration Doctor — Society Doctor — Community.

Part II. Public Health System Assessment

THEME I. Organization of the health care for the urban population

Organization of the Health care system (HCS)1. Principle of organization HCS2. Type of Organization HCS. WHO.3. Structure and Activity of medical organization4. Health care for the urban population (A) Out patient (B) Hospital5. MCH7. Economic & fi nancial.8. Medical insurance.Main principles of organization of national public health services: ac-

cepted on 23 sessions of the World Health Organization Assembly May, 22, 1970

1. Qualifi ed, accessible and free-of-charge medical care.2. Th e state character of national public health services.3. Rational preparation of the national medical staff .4. Preventive supervision in all parts of medical service.5. Health education of the population.6. Use of achievements of a world medical science in medical practicePublic health is a system of stat measures treatment-preventive, an-

ti-epidemic, rehabilitation, economic which includes the following direc-tions:

1. Treatment-preventive activity (ambulatory, polyclinic, hospital, dis-pensary etc.);

2. system of the maternal and child health protection;3. sanitary – anti-epidemic service;4. pharmaceutical provision;5. Medical education and medical science;

Julia

Выделение


6. Sanatorium (resort) activities;7. Medical insurance Th e main problems in the development of primary health care are:• the material maintenance (resource provision) of establishments, • levels of quality of the medical personnel, • quality of medical care. • health education of populationTh e primary stage of rendering medical care to the urban population

are (PHC):• medical (auxillary) ambulatory,• polyclinics (out-patient establishments),• female medical centre (consultation) and maternity homes,• establishments of urgent assistance (ambulance). • health service for industrial workerReforms in the public health services of RF have lead to new techno-

logical services• day-time hospitals,• hospital at homes,• surgical ambulatory services, • family doctor (GP) etc. • health care according to demandTh e polyclinic is:— a highly developed general and specialized health care establishment,

off ered medical assistance on the site at home; it carries out complex meas-ures on treatment and prevention of diseases and their complications.

Th e polyclinics are divided: • by the organization of work on incorporation with stationers and

independent (not incorporated);• by territorial principle;• by the profi le of their services: children’s, adult, dental, physiothera-

py etcTh e main directions of activity of the sector therapist are:• treatment,• preventive measures,• diagnostic, • anti-epidemic,• sanitary – educational,• statistical (fi lling the registration documentation),• medical-social expertise.


Principles of medical examination include three obligatory elements:1. Active revealing of diseases at the early stages.2. Regular supervision over the revealed patients and maintenance of

them with qualifi ed medical care.3. Public preventive maintenance, sanitary educationActivity indices of a polyclinic:1. Maintenance of the population is defi ned by the polyclinic help is

defi ned as the relation:Number of visits to a polyclinic for the estimated period;Number of the inhabitants served by the given polyclinic (average

8–10 visits per one year for 1 person)2. Average visits for one doctor per one year (actual loading on the

doctor):Number of occupied medical posts3. Planning annual normative loading on the doctor:

F = B ×C ×Y, whereF — function of a medical post (annual loading on the doctor); В — loading of the doctor of the given specialist on 1 hour work in a po-

lyclinic (5 persons — for the therapist) and in-home (2 persons); С — number work hours in a polyclinic (4 hours) and in-home (2 hours)

per 1 day; Y — number of working days in one year (280-283 days).4. Th e parameter of scope by medical examination is calculated as

the relation of (%):Number of persons, past medical examinationNumber of the persons suspect to pass medical examination (the sched-

uled specifi cation – 100%)

Theme 2. Organization of hospital care for the urban population. Hospital care date of RF

Th e average duration of stay for patients in the hospitals is about 14 days, while the average number of days for beds usage is about 330 days.

Th e parameter of hospitalization – how many people from 100 are hos-pitalized in the given year –average is 20 %.

Th e reforming of public health services in RF is directed to the:• reduction (about 20 % and more) of the number of unused beds,• reduction of the periods of hospitalization,• intensifi cation of stationary medical care,


• transferring of the part of stationary care to the out-patient — poli-clinic establishments, hospitals to homes and other establishments of non-stationary character

Municipal (urban) hospital— is a treatment-prophylactic establishment ensuring the qualifi ed ser-

vice for the population on the basis of achieved modern medical science and technology.

From the type, volume and character of rendered medical care and the system of work organization, the urban hospital can be:

by profi le — multi-profi le or specialized;by the system of organization — incorporated or not incorporated with

a polyclinic; by volume of activities — of various categories (beds capacity)Th e basic tasks for the urban hospital are• rendering of highly skilled treatment-diagnostic preventive care to

the population; • supply of high medical services to the workers of industrial enter-

prises and to vocational training;• rendering of modern methods of prevention, diagnosis and treat-

ment to the population on the basis of achieved science and tech-nology;

• developing and perfecting of the organizational forms and methods of medical services to the population, caring for the patients and increasing the quality and services work;

• studying the causes of general diseases inside the population, sick-ness with temporary loss of work, developing and realizing of im-provement measures directed to the decreasing and liquidating the most widespread diseases;

• sanitary-hygienic education of the population;• attracting the public to the development and realization of treat-

ment-preventive activities for the population.Th e important section of activity – mutual continuity of the inspection

and treatment of patients between the polyclinics and hospitals, which is achieved by the ways of:

• mutual exchange of information between the doctors of the poly-clinic and hospitals about the condition of patients, directed to the hospitalization and discharge of patients from the hospitals;

• invitation of stationary doctors to participate in dispensary activities (medical check ups) and in the analysis of its effi ciency;


• hospital’s experts should carry out activities aimed at the improving of the professional skills of polyclinic doctors (joint clinical confer-ences, analysis of mistakes, carrying out consultation etc.).

Th e hospital establishments by profi le are:• multi-profi le or general;• specialized (cardiological, infectious, gastro-enterological, dermato-

logical, maternity homes) are usually located in big cities.Functions of the head doctor:• organize and supervise the regulations and timely inspection and

treatment of patients, • to carry out preventive and anti-epidemic activities, • to improve the professional skills of medical personnel,• to supervise the correctness in conducting the medical cards of di-

seases,• to secure the hospital with medical and economic equipment,• to analyze the parameters of the hospital’s activity,• to approve the plans of work and the hospital’s for e casts, • to supervise the usage of materials and medicines,• to responsible for the sanitary conditions of the hospital.Th e functions of the head doctor`s assistant for medical work are:• to response for the organization and quality of all medical activities

in the hospital;• to supervise directly for the treatment-preventive and sanitary —

anti-epidemic work of the hospital; • to check the effi ciency of treatment-preventive activities;• to analyze the case of death in the hospital;• to provide the organization of medical feeding (nutrition) and med-

ical physical activities; • to organize the consultative assistance to a patient.Th e analysis of parameters activity is made by comparing with the

similar data of the given hospital for the last year; with the data from oth-er hospitals; with the standards data of hospital.

On the basis of the data registered in the medical and statistical docu-ments of a hospital the annual report of the hospital is made.

Indices of Activity of a hospital :1. Th e parameter of presence of doctors in a hospital is defi ned as the

relation of %.2. Mid-annual employment of bed (actual number of days of work of

bed during one year).


3. Average duration of stay of the patient in the bed.4. Hospital lethality rate (as a whole for a hospital and its branches) %.5. Parameter of the divergence between the clinical and pathologi-

cal-anatomical diagnoses, %.

Theme 3. Maternity and Childhood Health Care — MCH

Maternal and child health care— is a system of the state, medical and public actions directed to the

strengthening of the health of mothers (women) and children.Th e social-hygienic value of maternal and child health care:1. reduction of death rate among women and children;2. prevention, control and reduction of diseases among women and

children;3. maintenance and improvement of education among the younger

generation, beginning with the early childhoodTh e typical establishments rendering the treatment-prophylactic care

to women and children:1. Maternity hospital (in patient). 2. Female consultation (out patient).3. Houses of resort -sanatoria for the pregnant women and childs.4. Children’s polyclinic.5. Children’s hospital.6. Kindergarten. Nursery — garden, specialized nursery — gardens

(logopaedic and others).8. Schools.9. Children’s homes.

10. Children’s sanatoria, children’s summer establishmentsMain principles of the organization of women and children treatment /

prophylactic assistance:1. Treatment-/-prophylactic service according to the age and physio-

logical features of women and children.2. Mutual continuity between all establishments and systems of the

maternity and childhood health care: a precise system of supervision over motherhood and childhood.

3. Preventive orientation, unity of preventive and medical activitiesTh e system of maternal and child health care includes 2 basic units:1. Th e gynecological care unit;2. Th e treatment-and-prophylactic assistance to children.3 Assistance to pregnant women.


Female consultation unit— is the treatment-/-prophylactic establishment providing assistance to

pregnant women and gynecological patients and also conducting actions for the improvement of living and working conditions for women, as well as the increasing of their sanitary-/-hygienic culture (conditions).

Primary goals of female consultation unit:1. treatment-/-prophylactic assistance to the women during the preg-

nancy and aft er delivery;2. reduction of parents’ death rate, early childhood death rate (infant

mortality), gynecological diseases;3. realization of psychological preparations of pregnant women before

delivery;4. rendering of general and specialized assistance to women with gyne-

cological diseases;5. studying and improving the living and working conditions of work-

ing women;6. increasing of the sanitary-/-hygienic culture of women;7. organization of actions against abortions through the use of contra-

ceptive means;8. rendering of social — legal assistance to women;9. organization and realization of statistical workPrinciples of female consultation unit work organization:• work activity according to sector principle; • pregnant women supervision (patronage); • included in the site which are able to control about 2000–2500 wom-

en of all ages.Active supervising care aft er birth (newborn):• is the visiting of the child at home with the purpose of supervising

over the conditions of its health and development;• during the fi rst month the doctor visits a healthy child 3 times, and

the nurse medical visits 4 times.Exchange card supervision:— is a document providing mutual continuity in the work of the female

consultation unit, the maternity hospital and the children’s polyclinic. It is given out to the woman at the female consultation from the 30th week

of her pregnancy.Th e Exchange card consists of 3 parts:Th e 1st part — is fi lled in the female consultation unit, it contains data

which were received during history taking, examination and investigation of the pregnant woman. Th is part remains at the maternity home.


Th e 2nd part — is fi lled at the maternity home, it contains the information about the delivery process and the newborn. It is handed out to the woman for transfer to the female consultation.

Th e 3rd part — is fi lled at the maternity home, it contains the information about the delivery process and newborn. It is handed out to the woman for transfer to the children’s polyclinic.

A. Quantity indicators of female consultation unit activity:1. Th e average number of visits to the gynecologist for one year (actual

loading of the gynecologist):2. Number of visits to the female consultation unit to gynecologists 3. Th e parameter of the average quantity of women in reproductive age

in the locality of a gynecologist:B. Parameters of medical and diagnostic work:1. Timeliness of receipt of the pregnant women under supervision of

the consultation (%).2. Th e average quantity of visits of pregnant women to the female con-

sultative unit.3. Frequency of mistakes of gynecologists in defi ning of the time of de-

livery (delivery dates), character of outcomes of pregnancy (urgent, premature birth, abortions), the level and structure of diseases of pregnant women, densities and frequency of separate gynecological diseases and others.

Th e basic parameters of activities of a maternity hospital (home) (MH):A. Parameters of usage of beds are calculating as in MH.B. Parameters for medical and diagnostic work :1. Frequency of complications at delivery (on 1000 births):Number of complicated deliveries within the estimated period.2. Frequency of the complicated deliveries with diseases (on 1000

deliveries):Frequency of complicated deliveries with extra-genital diseases within

the estimated period. 3. Frequency of operations during deliveries:Number of deliveries through operations. Number of the carried out deliveries in a maternity home for this period.4. Frequency of mother’s death rate:Number of deaths during deliveries within an estimated period. 5. Parameters of the state of health for the newborn, including the

parameter for children born dead:Number of children, born dead for the estimated period.Number of children, born alive and dead for this period


6. Estimated the parameters of the: level and structure of diseases hos-pital acquired of women in a maternity hospital, the reasons of the maternal death, parameters of the activity of the gynecological branch.

Th e basic parameters of activity of a children’s polyclinic:1. Number of visits per year to one pediatric:

a) general. b) In a polyclinic: Th e general number of visits to a polyclinic divided on Number

of sectors pediatric visitsc) At-home: Th e general number of home visits divided on Number of sector

podiatric visits.2. Early scope of newborn children by supervision of %: Number of newborns that were visited at home within the fi rst 3 days

aft er discharge from maternity hospitals.4. Frequency of breast feeding (%): Number of children about 4 months old who are on breast feed-

ing.5. Th e Index of health for children of about one year (%): Number of children about one year old who have never been sick /

healthy 6. Calculated the others parameters of diseases of children from dif-

ferent age groups, the structure of the morbidity diseases, the condi-tions of realization of inoculations among children.

THEME 4. Economy and planning of the public health services

Th e economy of public health studies: Th e action of economic laws in public health services, gives a concrete economic substantiation (explana-tion) to medical-social measures and activity of public health establishments.

Th e economy of public health develops and explains the rational tenden-cies in the eff ective utilization of material, fi nancial and manpower resources of the public health system.

Th e economy of public health has the tasks :• to increase the effi ciency of public health; • to search and use the internal resources to improve public health;• the rational use of material and manpower resources;• to prove economically plans of public health development.


Th e basic questions in which the economy of public health services is engaged are:

• questions of fi nancing public health services;• development of approaches and methods of pricing for various kinds

of medical services;• research in the role of public health services in the general economy

(proves social, medical and economic effi ciency of public health ser-vices);

• development of rational methods and an eff ective utilization of ma-terial, fi nancial and manpower resources for public health services.

Th e main methods research of public health economy:• economical analysis;• fi nancial analysis;• study specifi cations;• economic-mathematical methods;• costs — effi ciency;• economic experiment.Th ere are 2 parts of economy: macroeconomic and microeconomic.Macroeconomic is the effi ciency in the activities of all branches of public

health as a parts of national economy. Microeconomic is the effi ciency in the activities of one doctor or one

medical establishment.Kinds of effi ciency in public health services:Medical effi ciency — consists of the changes of a level and character of

the disease and its tendencies.Social effi ciency — consists of optimization in the levels of birth rate,

reduction of the death rate and the increase in life expectancy.Economic effi ciency — the positive contribution which brings the public

health services by improvement of health of the population in the growth of the national income of the state.

Th e factors that make up the needs of the population in the treat-ment-/-prophylactic care:

• social and economic (working conditions, life, rest, food);• morbidity And fatality of the population;• organizational — medical (system of the organization of medical

care, the level of development of public health services, the level of development of medical science);

• social-economical welfare;• climatic and geographical;


• level of the health education;• development of the internal infrastructure of the country;• development of national public health, medicine.Planning • is one of the major functions of management• represents the process of program organization and formation for

the development and ways of achieving set purposes and projects.Principles of planning:1. Planning on regions, local and national levels.2. Scientifi c character (validity of parameters of the plan which should

be the base for the parameters of the disease and the needs of the population for medical care).

3. Reality of plans, their feasibility as well as its realization.4. Proportion and balance; current and forward planning.5. Optimum combination of the territorial and sectoral planning.Methods of the public health planning :1. Analytical2. Comparative3. Balance4. Normative5. Economic-mathematical.Th ere are various kinds of planning by time:• current planning;• short-term planning;• strategic planning.Th e plan of the public health services includes the following sections:• development of a network of establishments of the public health ser-

vices;• medical staff ;• capital investments (construction and the equipment of the estab-

lishments);• logistic plans;• fi nancial planRequirement of the population on health care as the base of planning:At the formation of programs for the development of the public health

services, it is necessary to take into account the needs of the population in treatment-/-prophylactic care. In practice, these needs act as references of the population in medical institutions behind the treatment-/-prophylactic care, and it is expressed by the number of visits by one inhabitant within one year both to separate experts, and to all specialists put together.


Any planning takes into account 3 major managements factors — 3 М (money, material and manpower).

Planning of the outpatient — polyclinic care:Th e outpatient – polyclinic care is planned by assessments of the number

of visits to the outpatient - polyclinic establishments, one inhabitant per year.Th e absolute need for a medical post for the outpatient — polyclinic net-

work is calculated with the help of the following formula:M = (V × P) : F , where

M — Need for a medical post;V — the norm of the outpatient - polyclinic visits by one inhabitant per

year;P — Population;F — Scheduled function of a medical staff post.Planning of the hospital care (inpatients)Th e instrument for the planning of the stationary care is the measuring

(the number) of medical beds. Th e needs of the population for medical beds can be calculated under

the formula:B = (A × I × R) : D × 100, where :

B — Need in beds on 1000 population;А — the level of morbidity on 1000 population;I — index of hospitalization (20–25 %);R — Average duration of stay of the patient in bed (in days);D — Mid-annual usage of a bed (in days)

Theme 5. Financing of the public health services

Th e system of public health is determined by the form of fi nancing. Th ere are 4 types of public health systems in the countries of the world :

• State system (the basic source of fi nancing is the state budget)• Private (individual) system (all medical services are paid by the pa-

tients)• Insurance system ( an insurance payment by state budget, govern-

ment and non government organizations taxes from salary funds and citizens)

• MixedTh e base Characteristics public health systems:• Many states today carry out the mixed systems of public health

which runs together with various organizational forms


• Th e mixed system entitles a combination of two or more of the above systems / forms .

• ‘Public health services in Italy, Norway, Belgium, Sweden, Finland and Canada can also be possible attributed to the mainly state system.

• In these countries the most part of funds for public health services comes from the state budget (formed mainly from obligatory taxes of the population and businessmen)

• Th e Russian Federation also belongs to these groups of the countries as, despite the reform of public health services with the introduction of obligatory medical insurance; the most part of fi nancial of public health services comes from the state budget and insurance taxes and resources of region of the RF.

• Th e mainly insurance system is observed in the majority of Europe-an countries, some states of Latin America, Japan and Korea others.

Bases of the insurance medicine.Medical insurance is carried out in two kinds:• Obligatory (individual)• Voluntary (collective-corporative or individual)For the realization of the state policy in the fi eld of obligatory medical

insurance federal and territorial funds are created.Advantages of the insurance medicine:• Occurrence of additional sources of fi nancing for the public health

services;• Improvement of quality for rendered medical services;• Th e base of social (fi nancial) maintenance is guaranteed for all

groups of the population;• Rational use of resources;• Expansion of economic independence for treatment-and-prophy-

lactic establishmentsAny type of medical insurance has its basic program:• outpatient ( polyclinic) care;• in patient (hospital) care • emergency care, including;• traumatological care;• pharmaceutical supply.Financing of the treatment–and–prophylactic establishments is carried

out on the basis of the budgeting. Th e treatment-prophylactic budget (T. P. E budget) of medical facility is

a fi nancial plan for the forthcoming expected charges for the maintenance of the establishment-estimate by article.


Basic articles of the T.P.E budget areARTICLE 1. Salary. Th e basic place in the budget of medical facility –

takes up to 50–60 %. hospital’s budge; ARTICLE 3. Economic charges. Densities of charges under the given ar-

ticle are up to 10 %;ARTICLE 8. Research work and purchase of books for a library;ARTICLE 9. Charges on feeding. Th e total sum from the budget for this

given article is up to 15–20 % of the hospital’s budget;ARTICLE 10. Purchase of the pharmaceutical products;ARTICLE 12. Purchase of the equipment and stock;ARTICLE 16. Major overhaul of some buildings.Reserves for the decreasing expenses in treatment-preventive estab-

lishments:Increase of professionalism of doctors and nurse ;Reduction of the number of duplicated inspections;Expansion in the volume of services should be carried out on the poly-

clinic and outpatient level.Expanding the network of social stations (hospices, nursing homes);Increasing of the number of home stations;Introducing of the advanced medical achievements into practice;Reducing of the periods of hospitalization together with the improve-

ment of the continuity in the work of polyclinics and hospitals;Rational organization of the reception and discharge of patients.Specifi cities in public health:1. Specifi city in the organization of medical territorial and industrial

sites;2. Specifi city in the requirement of beds, both generally and in special-

ized hospitals.3. Personnel specifi city in the medical and other attending staff s of the

treatment-preventive and sanitary – epidermal establishments.4. Specifi city of medical and special equipment (instruments, tools, de-

vices).5. Specifi city of soft stocks, furniture, economic equipment, transport.6. Building specifi cations, specifi city in the rooms’ areas in hospital es-

tablishments.7. Financial specifi cations in the content of public health establish-

ments by estimated clausesRequirement norms in public health care of RF:1. Number of the ambulatory – polyclinic visits for 1 inhabitant per

one year.


2. Percentage of patients needing hospitalization.3. Number of laboratory analyses for 1 patient4. Number of X-ray analysis for 1000 inhabitants.5. Number of necessary preventive inoculations6. Coeffi cient of repeated visits7. Norm for the average stay of a patient in bed for the general and

special forms diseases

Theme 6. Organization of Rural Health Care

Medical care for the rural population is organized on the same bases and principles as that of the towns and cities, however there are still some diff er-ences which are related to the following facts and factors:

1. In the villages unlike in the cities the population density is smaller. 2. Th e character of movement for the village inhabitants is diff erent

from that in the cities;3. Th e radius of services and the distances in the countryside are more

than in the cities;4. Th e roads in the countryside are worse than in the cities.5. Specifi city of work and life.6. Th ere is the seasonal character of work.Th e basic feature in the organization of medical care for the village pop-

ulation is the “stages” and the presence of special medical establishments in the villages

Stages of rendering medical assistance:1 stage = Rural local hospital (RLH) and Medical Assistant and Obste-

trician Posts (MAOP) 2 stage = District hospital (DH)3 stage = Central regional hospital (CRH)Besides the above, in case of the necessity the village inhabitants can

receive medical care at the urban establishments of public health and clinics of medical institutes

Functions of Medical Assistant and Obstetrician Posts (MAOPProvision of fi rst aid assistanceProvision of epidemiological-preventive measuresProvision of obstetric assistance on physiological delivery Provides dispensary careUndertaking of current sanitary supervisionProvision of the emergency assistance (ER)


Observation of pregnancyProvision of medical and prophylactic care to the children Direction and in case of emergency or seriousness accompanying pa-

tients to the RLHRadius of population’s service for the MAOP = 4–5 km., Quantity of

population served by the MAOP = from 1000 to 3000 peopleFunctions of a rural hospital:1. Rendering of the outpatient help in a polyclinic branch2. Organization of treatment-and-prophylactic activity in the area.3. Organization of sanitary – anti-epidemiological work in the area.4. Treatment-and-prophylactic care to women, children 5. Rendering of fast and urgent help.6. Analysis of the disease and drawing up of the report about the results

of work.7. Organizational and methodical work on a site.8. Preparation of patients for the consultations of regional experts on

a placeAll medical establishments which are included in the structure of the

medical site, are incorporated and work within one plan under the direction of the chief medical offi cer of the rural hospital.

Th e character and volume of medical aid in the rural hospital is basically determined by its capacity, equipment and the presence of medical specia lists.

Th e capacity of the rural hospital depends on the radius of service, num-ber and density of the population, the distance to the regional hospital, the presence of industrial enterprises, and also the features or peculiarity of local conditions.

Features in the organization of the outpatient and stationary services in a rural hospital are:

• Th ere is no precise restriction of time for the outpatient reception;• Th e hours for receiving patients should be assigned at the time, that

is the most convenient for the population, in view of seasonal preva-lence of agricultural works;

• Th e possibilities for a medical assistant to receive a patient in the absence of doctors for various reasons;

• Th e calls for doctors at homes is only possible in the village, where the village local hospital is located, the calls from homes in the other villages are carried out by the medical assistant;

• Allocation of one preventive day per one week by the doctor for a tour along the site and performing of functions assigned to him;


• Watching in at the station, with the right to go home and obligatory informing other personnel about his location, in case of the necessi-ty to render urgent help.

Functions of a district hospital areProvision of the qualifi ed medical care at the district level.Provision of the Emergency Service (ER)Consultative and practical assistance to the rural staff Administrative control of the rural hospitals workFunctions of a regional hospital:1. Highly qualifi ed medical care is provided.2. Coordination of medical care in the Medical and Prophylactic Es-

tablishment (MPE)3. Provision of the Emergency Service (ER)4. Statistical control 5. Consultative and diagnostic assistance 6. Provision of both the polyclinic and hospital care7. Provision of sanitary and anti-epidemiological assistance8. Scheduled departures of experts of an area 9. Organization of the clinical-diagnostic conferences for doctors of an

area10. Th e analysis of contingents of patients and volume of the help, de-

fects of the help of doctors, diagnostic and clinical mistakesTh e functions of the head doctor• Directly carries out the management of activities of the CRH, an-

swers for all preventive, medical (treatment), diagnostic, administra-tive and fi nancial activities of the hospital;

• Supervises the work of all public health establishments of the area;• Is responsible for the organization and the level of public health ser-

vices in the areaTh e head doctor has the following assistants:For organizational-methodical work;For childhood and delivery assisting; For the medical partFor the purpose of improvement of the doctors’ professional skills, clin-

ical-anatomic conferences, seminars, meetings, lectures and reports where the doctors are acquainted with new methods of work are organized at the base of the central regional hospital.

Th e specialization and improvement of professional skill for the average medical workers, medical assistance-obstetrician as a rule, are also carried out on the base of the CRH.


Th ere are 5 categories of regional hospitalsTh e number of beds or the capacity of the regional hospital depends on

the population of the area. Th e most expedient regional hospitals have 1000 beds with all specia-

lized branches. In a regional hospital irrespective of its capacity there should be the fol-

lowing structural divisions: a hospital; the advisory (consultative) polyclinic; treatment-diagnostic branches; laboratories; a room for medical statistics; a branch for emergency and consultative services

Th e consultative polyclinictogether with the branch for emergency consultative service organizes

and carries out the sending out of the consultants (experts).In case of the necessity the patient through the reception is directed to

the hospitalization to the appropriate branch of the regional hospital.Th e consultative polyclinic regularly analyzes cases of divergence from

the diagnoses, mistakes made by the doctors of the treatment-preventive es-tablishments of the areas during their inspection and treatment of patients

Theme 7. Disability and Medical Sanitary Establishments

DisabilityTh e state of an individual when he/she is not able to work due to medical

reasons.Types of Disability:• Temporary.• Permanent.If a patient is sick continuously during 4 months with the same disease or

within 1 year with breaks during 5 months, he is direct to the social-medical examination.

Th e purpose of this examination is to determine the working capacity of the man.

Disability can be divided into 3 group:I group II group >> II-a group II-b group III groupHospital’s certifi cates of disability can be issued/obtain:1. Th rough illness.2 On pregnancy and births.3. On a short leave to care for a sick child.


4. On a short leave to take care for aged parents.5. During quarantine.6. During traumas7. In case of an accidents.8. Aft er a medical abortionsTh e commission of medical-social-experts is made up of:1. Th e head of the department, 2. Th e deputy main doctor for treatment, 3. Th e deputy main doctor for the medical-social examination4. Th e main doctor.Some independent experts - advisers from other treatment-preventive

establishments, representatives of trade-union organizations and social workers are also invited

Functions of the Commission of clinical experts:1) Prolongation of a hospital sheet (certifi cate of disability) till recovery.2) Th e resolution of complex (diffi cult) and disputed questions of ex-

amination3) Issuing of a hospital sheet(certifi cate) for sanatorium treatment4) Employment of patients without attributes of physical disability5) Th e Direction to the Socio-medical expert Commission “SMEC”Composition of the Socio-medical expert Commission “SMEC”Th e Assistant head physician for disability examination (determination)Th e Assistant head physician for medical workTh e head Physician (General)Doctors — specialistsFunctions of the Socio-medical expert Commission “SMEC”Prolongation of temporal disability period for over 4 monthsTh e determination of physical disability groups and re-examinationDefi ning the reasons for physical disabilityLabor recommendations to the disable, employment and conversion

trainingFunctions of a disability certifi cate:• Medical • Statistical• Legal• EconomicTh e scheme (extend) for issuing a medical certifi cate of disabilityTh e attending physician can off er a certifi cate for 5 days + 5 days exten-

sion.


Head of department. Th e attending physician from 10 days} up to 1 monthCEC from 1month up to 4 months.SMEC from 4 months and above.Th e kinds of rehabilitation are:Medical rehabilitation. Th e prescription of medicines, medical physical

activities, physiotherapy procedures are directed to the improvement of the conditions of health.

Social rehabilitation. Th e whole complex of measures is directed to the giving a person the understanding, that he is necessary to other people, the state, friends, relatives. Societal organizations for the disable are formed, for example, an organization for the blinds.

Labor rehabilitation. An opportunity to work among the healthy people and to feel like a member of the large society, carrying out industrial norms or special tasks is refl ected very well in the emotional conditions of the in-valids.

Psychological rehabilitation. Highly skilled psychologists, psychoana-lysts, psychotherapists work in the societies of disable people, always ready to give possible help or advice.

Medical Sanitary Establishment (MSE) for industrials workers— is a hospital-polyclinic complex in which a polyclinic, a hospital,

a health centers and shops are located and function directly within the enter-prise, as well as other health-improving establishments (curative-diagnostic branches, studies), preventive branches (studies), night and day time dispen-saries — sanatoria, dietary dining rooms etc

Types of Medical Sanitary Establishments1. Closed (when it’s used by members of the establishment only) 2. Open (when other members of the public can use it’s facilities)MSE are created by large enterprises or group of enterprises with a work

force of 4000 or more workers, and at the chemical, coal, mining and petro-leum-refi ning industrial enterprises - 2000 and more.

Primary goals of the MSE:1. Provision of treatment-and-prophylactic assistance.2. Development and realization jointly with administration of the en-

terprise, trade-union and the public, CSES the preventive actions directed at strengthening and health care of members.

3. Decrease (reduction) of disease.* Th e locality sectional doctor in MSE — 2000 persons, and at the chemical,

coal, mining and a petroleum-refi ning industrial enterprises — 1500 workers.


* At the formation of the complex sites both the industrial (homogene-ous working conditions and the set of trades), and territorial (affi nity/close-ness of the location) a principle are taken into consideration.

Th e role of the medical complex’s therapist:1. Rendering of the therapeutic assistance.2. Realization of prophylactic activities (studying of working condi-

tions of workers, the analysis of disease, realization of prophylactic medical examination, sanitary — improving and anti-epidemiologi-cal activities)

Theme 8. Organization of the Sanitary Epidemiological Supervision

Th e Federal service on consumer protection and wellbeing of the person.Th e and Centre for Sanitary and Epidemiological Supervision.Sanitary-and-epidemiological well-being :— is a state of health of the population, the inhabitancy of persons, i.e,

the state of their surroundings in which there are no harmful factors aff ect-ing the lives of the persons or their surroundings thus providing favorable living conditions

Factors of the inhabitancy1. Biological (virus, bacterial, parasitic, etc)2. Chemical 3. Physical (noise, vibration, ultrasound etc.) 4. Social (food, conditions of life, working, resting etc)By “harmful factors aff ecting the lives of persons” we mean factors of

their living surroundings, that create the treat to either the lives of the people or their future generations.

By “favourable living conditions”, we mean, a living condition, in which harmful factors aff ecting the lives of persons are absent (a harmless condi-tion), these are conditions which have the ability to restore the destroyed functions in a human organism.

Sanitary-Epidemiological state (condition)is the state of health of the population and their living surroundings

within a defi ne territory at the particularly specifi ed time.Social-hygienic monitoring— is the state system of monitoring or supervising the state of health

of the population and the living surroundings, it’s the analysis, estimation and forecasting and also the defi nition of the ‘cause-eff ect’ — relationship between the state of health of the population and the infl uence of factors of inhabitancy.


Th e state sanitary-and-epidemiologic supervision— this is an organ which activities include the prevention (warning),

detection and the supression of infringements of the legislation in the fi eld of maintaining the sanitary and epidemiological well-being of the population, with the purpose of the public’s health care and care of the living surround-ings.

Th e sanitary-and-epidemiologic conclusion— is a document certifying the conformity or discrepancy of factors of

inhabitancy, various kinds of activity, production, work and services, pro-jects and documentation as well as the construction projects and exploita-tion documents, to sanitary rules.

Sanitary-epidemiological actions are the organizational, administrative, veterinary and other measures directed to the elimination or decrease (re-duction) of harmful infl uence.

Among the characteristics of areas of CSES service they are responsible for the sanitary supervision, housing of area (locations), water supply, water drainage etc.); Th ere is a communication between the CSES with public or-ganizations and the administration of the area, sanitary — educational work.

Th e concept of «CSES» include in its components in detail:1. State sanitary — improving measures;2. Sanitary legislation;3. Practical activity of bodies and the establishments of sanitary —

epidemiological services;4. Research work in the fi eld of hygiene, epidemiology, microbiology

and infectious pathology;5. State system of preparation of the sanitary staff , and also preparation

of the workers of a network of hygiene and epidemiology.6. Mass improvements in the participation of the population in the or-

ganization and realization of preventive measures;7. Th e system of measures on the distribution of medical and hygienic

knowledge among the population.Division of the Centre of Sanitary and Epidemiological Observation

(CSES) Operative managementDepartment of hygienic control of the nutritionDepartment of municipal hygieneDepartment of hygienic control of the laborDepartment of sanitary-hygienic supervision under MPEDepartment of hygienic control of children and teenagersDepartment of hygienic control of the environment


Department of radiological medicineDepartment of supervision under sources of non-ionized radiationDepartment of disinfecting controlDepartment of epidemiological controlKinds of sanitary supervision1) Precautionary sanitary supervision.2) Current sanitary supervision.

1. Maintenance of the sanitary — hygienic requirements for the development of rules of the internal schedule.

2. Periodic visits of the object by sanitary doctors and their assis-tants.

3. Supervision over conditions of health of the population (organ-ization of routine medical check-ups)

4. Realization and control of laboratory research.5. Development of the tasks and off ers on the elimination of sani-

tary lacks and improvement of sanitary condition of objects.6. Mass Organization of sanitary — educational work with the

public and population, sanitary — technical training with the application of the sanctions (disciplinary collection, penalties, withdrawal of products , suspension of work of an object or shop, discharge from work etc.)

Th e Federal Agency of supervision in sphere of protection of the rights of consumers and well-being of the person is formed according to the decree of the president of the Russian federation from March, 9th 2004.

Th e part of functions of Ministry of Health of the Russian federation, the Ministry of economic development and trade, the ministry of an antimonop-oly policy is transferred Federal Agency.

Federal Agency is the authorized federal enforcement authority which is carrying out functions:

under the control and supervision in sphere of maintenance of sani-tary-and-epidemiologic well-being of the population of the Russian federa-tion, protection of the rights of consumers in the consumer market.

In federal Agency of supervision in sphere of protection of the rights of consumers and well-being of the person 89 territorial administrations and 90 centres of hygiene and epidemiology in subjects of the Russian federation are formed.

Chapter III

GLOSSARY OF TERMS AND PUBLIC HEALTH TERMINOLOGY WITH EQUIVALENTS

IN RUSSIAN, ENGLISH, FRENCH AND GERMAN LANGUAGES

Абсолютная нищетаСостояние, когда у людей недостаточно ресурсов для удовлетво-

рения своих жизненных потребностей, нет достаточного питания, одежды и крыши над головой.

Th e state where people have insuffi cient resources to meet their basic needs to maintain life, lacking essential requirements such as adequate food, clothing, and shelter.

E Absolute povertyF la pauvreté absolueG absolute ArmutАккредитация организаций здравоохранения Официальное признание компетентности (способности) организа-

ции здравоохранения выполнить определённые медицинские услуги.Th e offi cial recognition of competence (ability) of healthcare organiza-

tion to perform certain medical services.E Accreditation of healthcare organizationsF l’accréditation des organisations de santéH die Akkreditierung von Organisationen im GesundheitswesenАктивность медицинская Деятельность индивидуума и групп населения, направленная на

сохранение и укрепление собственного здоровья и здоровья окружаю-щих и являющаяся необходимой предпосылкой формирования здоро-вого образа жизни.


Th e activity of individuals and groups, aimed to preserve and to strength-en own health and health of others and which is the prerequisite of a healthy lifestyle.

E Medical activityF L’activité médicaleG Aktivität medizinischeАнализ эффективности затратФорма экономической оценки в области здравоохранения, где за-

траты выражены в денежном эквиваленте, но некоторые значения вы-ражаются в физических единицах (например, приобретенные годы, обнаруженные случаи и т.п.).

In the health fi eld, a form of economic evaluation where the costs are expressed in money terms but where some of the consequences are expressed in physical units (e.g. life-years gained, cases detected).

E cost/eff ectiveness analysis F analyse cout/effi cicatéG Kosteneff ektivitätsanalyseАудитПроцесс независимой проверки счетов и других записей аудитора-

ми, профессионально обученными и аккредитованными для этой цели.Th e process of independently checking accounts and other records by

auditors professionally trained and accredited for the purpose.E auditF auditG auditАудиторЭто профессиональный бухгалтер, назначаемый для проверки

правильности счетов компании, который готовит акционерам компа-нии независимый отчёт, в котором дано достоверное и объективное представление о делах компании или учреждения. Для работы в госу-дарственной или частной аудиторской компании, специалист должен пройти специальную профессиональную подготовку и сдать соответ-ствующий экзамен.

A professional accountant appointed to check the accuracy of company or institutional accounts and to present an independent report to sharehold-ers on whether the accounts present a true and fair view of the aff airs of the company or institution.

E auditorF auditeurG auditor

Chapter III. Glossary of Terms and Public Health Terminology 53

Баланс здоровьяВыраженное состояние равновесия между потенциалом здоровья

и действующими на него факторами.Th e expressed condition of equilibrium between the health potential and

acting on it factors.E Th e balance of healthF Bilan de santéG Balance GesundheitБиологически активные добавки к пищеПродукты, содержащие пищевые и (или) биологически активные

вещества (их концентраты) природного происхождения или идентич-ные им вещества искусственного происхождения, предназначенные для употребления внутрь или введения в состав пищевых продуктов с целью обогащения рациона питания человека и не являющиеся един-ственным источником пищи или диетическим питанием.

Th e products, containing food and (or) biologically active substances (their concentrates) of natural origin or identical to them substances of ar-tifi cial origin, intended for internal administration or introduction into the food composition for the purpose of enriching the human diet, being not the only source of food and dietary food.

E Biologically active food supplementsF Des additifs biologiquement actifs à la nourritureG NahrungsergänzungsmittelБиостатистика Совокупность математических методов и приемов, используемых

в биологии и медицине.Th e aggregate of mathematical methods and techniques used in biology

and medicine.E BiostatisticsF la biostatistiqueG BiostatistikБиоэтикаНаука о законах, принципах и правилах регулирования профессио-

нальной деятельности при решении проблем, связанных с охраной здоровья, медициной и медицинской наукой.

A science about laws, principles and rules of professional activity regula-tion in solving health, medicine and medical science problems.

E Bioethics F la bioéthiqueG Bioethik


БлагосостояниеСостояние физического здоровья, эмоционального комфорта и эко-

номической безопасности, а также усилия общества по оказанию помо-щи своим гражданам в достижении этого состояния.

Th e physical health, emotional comfort and economic security as well as the eff orts of society to assist its citizens in achieving this state.

E WelfareF le bien-êtreG Wohlbefi ndenБолезньОбщее или частичное ограничение жизнедеятельности организма,

обусловленное срывом адаптогенных механизмов под воздействием эндогенных и экзогенных факторов и характеризующееся стеснением свободы деятельности (ВОЗ).

Total or partial body disability due to breakdown of adaptive mecha-nisms under the infl uence of endogenous and exogenous factors and is char-acterized by oppression of activity freedom (WHO).

E DiseaseF la maladieG KrankheitБольницаМедицинская организация, предназначенная для оказания меди-

цинской помощи в условиях стационара.Th e medical institution, which provide medical care in a hospital envi-

ronmentE HospitalF l’hôpitalG KrankenhausБольнойФизическое лицо, у которого установлено наличие заболеванияA person that has the presence of the diseaseE PatientF le MaladeG KrankeВалеологияНаука о здоровье, рассматривающая предупреждение заболеваемо-

сти и инвалидности в качестве основы повышения потенциала здоро-вья популяции.

Th e science about health, dealing with the disease and disability preven-tion as a basis for improving of health potential of the population


E ValeologyF la ValeologyG ValeologiВещество лекарственноеВещество природного, синтетического или биотехнологического

происхождения, обладающее специфической фармакологической ак-тивностью и в определенной лекарственной форме применяемое для профилактики, диагностики и лечения заболеваний людей, предотвра-щения беременности, реабилитации больных или для изменения со-стояния и функций организма путем внутреннего или внешнего при-менения.

Th e substance of natural, synthetic or biotechnological origin, having specifi c pharmacological activity and in a specifi c dosage form used for pre-vention, diagnosis and treatment of human disease, prevention of pregnancy, rehabilitation of patients, or to modify the status and functions of the body by internal or external application.

E Medicinal substanceF la substance médicaleG medizinische SubstanzВмешательство медицинскоеВоздействие (физическое, химическое, биологическое, психологиче-

ское) на организм пациента, осуществляемое врачами и средним ме-дицинским персоналом с помощью методов и средств профилактики, диагностики, лечения, медицинской реабилитации, протезирования, целью которого является оказание медицинской помощи.

Th e impact (physical, biological, physiological) on patient body by medical and nursing staff by methods and means of prevention, diagnostics, treatment, medical rehabilitation, prosthetics, whose goal is providing of medical care.

E Medical interventionF une intervention médicaleG medizinische InterventionВрачСпециалист, имеющий высшее медицинское образование и право

заниматься врачебной деятельностью.A specialist with higher medical education and the right to engage in

medical practiceE PhysicianF le médecinG Mediziner


Гарантия прав пациентаСистема нормативных правовых актов, обеспечивающая реализа-

цию прав пациента.Th e system of normative legal acts, ensuring realization of the patient

rightsE Th e guarantee of the patient rightsF La garantie des droits du patientG Gewährleistung der Rechte des PatientenГенетически модифицированные продовольственное сырье

и пищевые продуктыПродовольственное сырье и пищевые продукты, полученные мето-

дами генетической инженерии из генно-инженерных организмов или с их использованием.

Th e raw and processed food products obtained through genetic engi-neering from genetically engineering organisms or with their usage

E Genetically modifi ed food raw materials and food productsF Des matières alimentaire et des produits alimentaires Génétique-

ment modifi és G Gentechnisch veränderte lebensmittelrohstoff und LebensmittelГигиена личнаяСовокупность гигиенических знаний и навыков, выполнение кото-

рых способствует сохранению и укреплению здоровья человекаA set of hygienic knowledge and skills, the implementation of which

contributes to the preservation and enhancement of human health.E Personal hygieneF L’hygiène personnelleG Persönliche HygieneГигиена трудаЗдоровье индивидуума или группы, связанное с работой и профес-

сиональной средой. Th e health of individual or group in relation to work and the occupation-

al environment. E ccupational healthF La santé au travailG Gesundheit am ArbeitsplatsГод жизни с поправкой на качество жизни (QUALY) Единица измерения, применяемая для количественной оценки ро-

ста продолжительности жизни (с поправкой на её качество) в результа-те осуществления здравоохранительных программ (ВОЗ).


Th e unit of measurement used to quantify the increase in life expectancy (adjusted for quality) as a result of the implementation of health programs (WHO).

E Year of life adjusted for quality of life (QUALY)F L’Année de vie ajustée sur la qualité de vie (QALY)G Lebensjahr mit der änderung auf die Lebensqualität (QUALI)Год жизни с поправкой на нетрудоспособность (DALY) Единица измерения, используемая для характеристики глобаль-

ного бремени болезней и эффективности медицинских вмешательств. Рассчитывается по количеству лет жизни без нетрудоспособности и функциональных нарушений, которые будут потеряны в результате преждевременной смерти, наступления нетрудоспособности, инва-лидности в данном году (ВОЗ).

Th e unit of measurement used to characterize the global burden of dis-ease and the eff ectiveness of medical interventions. It is calculated by the number of years of life without disability and functional abnormalities that are lost due to premature death, disability, disability in a given year (WHO).

E Year of life adjusted for disability (DALY)F L’Année de vie ajustées sur l’incapacité (DALY)G Lebensjahr mit Anpassung an die Behinderung (DALY)ГоспитализацияОтбор, поступление и пребывание пациентов в стационарах орга-

низаций здравоохранения.Selection, admission and stay of patients in hospitals health care organ-

izations.E HospitalizationF L’hospitalisation G KrankenhausaufenthaltГосударственные гарантии по предоставлению населению бес-

платной медицинской и лекарственной помощи Установленные законодательством объемы и условия предоставле-

ния населению медицинской и лекарственной помощи за счет средств бюджета.

Th e volumes and conditions of medical and pharmaceutical care provid-ing, established by legislation at the expense of the budget.

E State guarantees on providing the population with free medical and medicinal help

F Les garanties d’état de fournir à la population des soins pharmaceu-tiques et médicale


G Die staatlichen Garantien für die Erbringung der Bevölkerung Kos-tenlose medizinische und medikamentöse Hilfe

Государственные минимальные социальные стандарты в обла-сти здравоохранения

Установленные органами государственной власти социальные нор-мативы и нормы, регламентирующие определенный уровень удовлет-ворения потребностей граждан в общедоступных и бесплатных видах медицинской и лекарственной помощи.

Th e social norms and norms regulating a certain level of satisfaction of citizens in public and free medical and pharmaceutical care, established by public authorities.

E Th e state minimum social standards in health careF L’Etat minimum de norms socials au domain de la santéG Die staatlichen minimale soziale Standards im GesundheitswesenГруппа рискаЧасть населения с наличием различных факторов, повышающих

вероятность возникновения заболеваний и других проблем, связан-ных со здоровьем.

Th e proportion of the population with the presence of various factors that increase the likelihood of illness and other problems connected with health.

E Risk groupF Le groupe de risqueG RisikogruppeГруппы здоровьяЧасть населения, выделенная в зависимости от наличия (или от-

сутствия) и степени тяжести заболеваний, физических дефектов.Th e group of population, allocated according to presence (or absence)

and severity of illness and physical handicaps.E Health groupF Le groupe de santéG Gruppe GesundheitДемографияНаука, изучающая закономерности явлений и процессов в струк-

туре, размещении и динамике населения с учётом политических, соци-альных, экономических, биологических и других факторов.

Th e science that studies the regularities of phenomena and processes in structure, placing and dynamics of the population taking into account polit-ical, social, economic, biological and other factors.


E Demography F La DémographieG DemographieДемография медицинскаяНаука, изучающая взаимосвязь воспроизводства населения с меди-

ко-социальными факторами и разрабатывающая на этой основе меры медицинского, социального, организационного характера, направлен-ные на обеспечение наиболее благоприятного развития демографиче-ских процессов и улучшение здоровья населения.

Th e science that studies the relationship of reproduction of population with medical and social factors and also medical, social and organizational measures, that develops on this bases and aims on ensuring of most favourable advancing of demographic processes and the improvement of public health.

E Medical demographyF La démographie médicaleG Demographie medizinischeДеонтология медицинскаяСовокупность соответствующих профессиональных, морально-

этических и правовых принципов и правил, которыми должны руко-водствоваться медицинские работники в своей деятельности.

A set of appropriate professional, ethical and legal principles and rules that should guide health care workers in their activities.

E Medical deontologyF La Déontologie médicaleG Deontologie medizinischeДеятельность медицинскаяПрофессиональная деятельность юридических лиц и индивидуаль-

ных предпринимателей по организации и оказанию медицинской помо-щи, обеспечению санитарно-эпидемического благополучия населения.

Professional activities of legal entities and self-employed individuals in the organization and delivery of health care, provision of sanitary and epi-demic welfare of the population.

E Medical activityF L’activité médicaleG medizinische TätigkeitДеятельность фармацевтическаяПрофессиональная деятельность юридических лиц и индивиду-

альных предпринимателей в сфере обращения лекарственных средств.Professional activities of legal entities and self-employed individuals in

the fi eld of medicine Circulation.


E Pharmaceutical activitiesF Les activités pharmaceutique G pharmazeutische TätigkeitДиагнозМедицинское заключение о состоянии здоровья пациентаMedical report on the patient healthE DiagnosisF Le diagnoseG DiagnoseДиагностикаСоставная часть медицинской помощи, направленная на выявле-

ние заболевания путем проведения обследования человека.Th e integral part of medical care aimed to detect disease by conducting

medical examination.E DiagnosticsF Le diagnosticG DiagnoseДиспансерСпециализированная лечебно-профилактическая организация,

предназначенная для выявления заболеваний, осуществления динами-ческого наблюдения и оказания медицинской помощи.

Th e specialized treatment-and-prophylactic organization, designed to identify diseases, the implementation of dynamic monitoring and medical care.

Е DispensaryF Le dispensaireG DispensaireДокументация медицинскаяСистема документов установленной формы, в которой фиксируют-

ся данные, необходимые для правильной организации медицинского обслуживания населения, изучения состояния его здоровья и деятель-ности медицинских организаций.

Th e system of documents of the established form, containing the data, necessary for the proper organization of medical care, study health and med-ical organizations.

E Medical documentationF La documentation médicaleG medizinische Dokumentation


ДолгожителиЛюди в возрасте 90 лет и старше.People aged 90 years and older.E CentenariansF Serait multiplié parG HundertjährigeДонор органов и тканей человекаЛицо, добровольно отдающее свои анатомические образования

для пересадки больным людям.A person who voluntarily lay down their anatomical structures for trans-

plant to patients.E Th e donor of human organs and tissuesF Le donor d’organes et de tissues humainsG Spender von Organen und Geweben menschlichenДоноры крови и ее компонентовЛица, добровольно сдающие свою кровь и её компоненты для меди-

цинских нужд.Persons who voluntarily surrendered their blood and its components for

medical purposes.E Donors of blood and blood componentsF Les donneurs de sang et de ses corposantsG Spender von Blut und BlutbestandteilenДоступность медицинского обслуживанияМера доли населения, достигшего надлежащего уровня медицин-

ского обслуживания. Это понятие используется, чтобы выявить нера-венство в использовании медицинских услуг различными группами населения по географическому, социальному признаку и качеству ока-зания помощи в клинических условиях.

A measure of the proportion of a population that reach appropriate health services. Th is concept is used to detect inequity in the use of services between diff erent populations defi ned geographically, socially or in terms of their clinical condition.

E Availability of Health ServicesF L’accès aux services de santéG Zugang zur GesundheitsversorgungЗаболеваемостьПоказатель, характеризующий распространённость (частоту) бо-

лезней среди населения или его отдельных групп.A measure of the prevalence (frequency) of disease among the popula-

tion or its separate groups.


E Incidence (Morbidity) F L’incidence (Morbidite)G MorbiditätЗаболеваемость общаяПоказатель, соответствующий отношению суммы заболеваний, за-

регистрированных впервые и накопленных в предыдущие годы, к сред-ней численности населения.

An indicator corresponding to a ratio of the sum of diseases registered for the fi rst time and accumulated in previous years, to the average popula-tion.

E Prevalence (morbidity) generalF L’incidence (Morbidite) generale G Allgemeine MorbiditätЗаболеваемость первичнаяПоказатель, соответствующий отношению числа случаев заболева-

ний, зарегистрированных впервые за данный период, к средней чис-ленности населения.

An indicator corresponding to a ratio of the number of cases of diseases registered for the fi rst time during the given period to the average popula-tion.

E primary morbidityF L’incidence (Morbidite) primaire G Primäre InzidenzЗаболевания социально значимыеЗаболевания, обусловленные преимущественно социально-эконо-

мическими условиями, приносящие ущерб обществу и требующие со-циальной защиты человека.

Diseases caused predominantly by socio-economic conditions that bring harm to society and requiring social protection.

E Socially signifi cant diseasesF Les maladies socio-signifi cativesG Krankheiten gesellschaft lich wichtigeЗаболевания ятрогенныеРасстройства (нередко психогенные), возникающие как следствие

деонтологических ошибок медицинских работников (неправильных, неосторожных высказываний, действий и др.).

Th e disorders (oft en psychogenic) arising as a consequence of the de-ontologic mistakes of medical professionals (incorrect, careless statements, actions, etc.).


E Iatrogenic diseasesF Des maladies iatrogènes G Iatrogene KrankheitЗдоровьеСостояние полного физического, душевного и социального благо-

получия, а не только отсутствие болезней или физических дефектов (ВОЗ).

Th e state of complete physical, mental and social wellbeing and merely the absence of disease or infi rmity (WHO).

E HealthF La santéG GesundheitЗдоровье для всехНаправление политики ВОЗ по достижению всеми людьми мира

такого уровня здоровья, который позволил бы им вести активную про-изводственную, социальную и личную жизнь.

Th e direction of WHO policy on attainment by all people of the world of so level of health that would permit them to lead an active professional, social and personal life.

E Health for everybodyF La santé pour tousG Gesundheit für alle MenschenЗдоровье населенияМедико-демографическая и социальная категория, отражающая

физическое, душевное, социальное благополучие людей, осуществля-ющих свою жизнедеятельность в рамках определенных социальных общностей.

Th e medical and demographic and also social category refl ecting the physical, mental and social well-being of people that carry out their activity within certain social communities.

E Health of populationF La santé de la populationG Die Gesundheit der BevölkerungЗдоровье общественное Интегрированный уровень общественного прогресса, характери-

зующий общество в целом с позиций здоровья населения, социально-го, культурного и экономического благополучия.

Th e integrated level of social progress that characterizes society as a whole from the standpoint of health, social, cultural and economic well-being.


E Public healthF La santé publiqueG die öff entliche GesundheitЗдоровье психическоеСостояние, характеризующееся динамическим процессом психи-

ческой деятельности, которому свойственны детерминированность психических явлений, гармоническая взаимосвязь между отражени-ем обстоятельств действительности и отношением индивида к ней, адекватность реакций организма на социальные, психологические и физические (включая биологические) условия жизнедеятельности бла-годаря способности личности контролировать свое поведение, плани-ровать и осуществлять свой жизненный путь в микро- и макросоци-альной среде.

A condition characterized by a dynamic process of mental activity, which is characterized by the determinism of psychic phenomena, the harmonic relationship between the refl ection of the reality of the circumstances and the individual’s attitude to it, adequacy of reactions to social, psychological and physical (including biological) conditions of life due to the ability of the individual to control his behavior, plan and implement their way of life in the micro- and macrosocial environment.

E Mental healthF la santé mentaleG psychische GesundheitЗдоровье физическоеСостояние, характеризующееся уровнем физического развития,

физических возможностей и адаптационных способностей отдельных индивидов, групп людей и общества в целом, обеспечивающее дости-жение качества жизни, благополучия общества и сохранение и укре-пление общественного здоровья.

A condition characterized by physical development level, physical ca-pacity and adaptive abilities of individuals, groups and society as a whole, ensuring achievement of quality of life, prosperity of society and the preser-vation and promotion of public health.

E Physical healthF La santé physiqueG körperliche GesundheitЗдоровый образ жизниКатегория общего понятия «образ жизни», включающая благо-

приятные условия жизнедеятельности человека, уровень его культуры


и гигиенических навыков, которые позволяют сохранять и укреплять здоровье, предупреждать развитие его нарушений и поддерживать оп-тимальное качество жизни.

Th e General concept of «lifestyle», including favorable conditions of human life, the level of its culture and hygiene practices that maintain and improve health, prevent the development of disorders and to maintain an optimal quality of life.

E Healthy lifestyleF Un mode de vie sain G Eine gesunde LebensweiseЗдравоохранениеСистема государственных, общественных и медицинских меро-

приятий, направленных на сохранение и укрепление здоровья людей, профилактику и лечение заболеваний.

Th e system of state, public and medical measures aimed at preserving and strengthening the health of people, prevention and treatment of diseases.

E HealthcareF La santé publique G GesundheitswesenЗдравоохранение общественное1. Проведение профилактических, лечебных и оздоровительных

мероприятий усилиями общества, первичных структур массо-вого медицинского обслуживания и органов власти на местах с целью укрепления здоровья, предотвращения заболеваний и продления жизни людей.

2. Наука и искусство предотвращения болезней, продления жиз-ни и укрепления психического, физического здоровья через эффективный и организованный вклад отдельных групп насе-ления и общества (ВОЗ).

1. Th e preventive, curative, and health promotion eff orts of the com-pany, primary structures of mass health services and authorities on the ground for the purpose of promoting health, preventing diseases and prolonging human life.

2. Th e science and art of preventing disease, prolonging life and pro-moting mental and physical health through eff ective and organized contribution of individual groups and society (WHO).

E Public healthcareF La Santé publiqueG Öff entliches Gesundheitswesen


ИнвалидностьСоциальная недостаточность вследствие нарушения здоровья со

стойким расстройством функции организма, приводящего к ограниче-нию жизнедеятельности и требующего социальной защиты.

Th e social failure due to violation of health with persistent disorder of body functions, leading to restriction of life and requiring the social protec-tion.

E DisabilityF le handicapG BehinderungИндекс здоровьяУдельный вес не болевших (не обращавшихся за медицинской по-

мощью) в течение определённого календарного срока среди населения данного возраста.

Th e relative density of population of this age, keeping well during certain period of time.

E Health indexF L’indice de santéG index GesundheitИндекс уровня жизниСоотношение среднедушевого дохода и прожиточного минимума,

выраженное в процентах.Th e ratio of income per capita and subsistence minimum, expressed as

a percentage.E Th e index of standard of livingF L’indice de niveau de vieG Der index des LebensstandardsИнструкция по применению лекарственного средстваОфициальный документ, содержащий основную характеристику

лекарственного средства, одобренный Министерством здравоохра-нения при регистрации лекарственного средства и предназначенный для врача и (или) пациента и использования в справочной литера-туре.

Th e offi cial document containing the basic characteristics of a medicine approved by the Ministry of health at the registration of medicines and de-signed for the doctor and (or) the patient and use in the open literature.

E Instruction for use of medical productF Mode d’emploi d’un médicament pour leG Gebrauchsanweisung des Arzneimittels


Исследование доклиническое Биомедицинское исследование, не включающее в себя эксперимен-

тов на людях.Biomedical research, not including experiments on humans.E A preclinical study (survey)F l’étude préclinique (examen)G Präklinischen studienИсход медицинский / результат медицинскийПоследствия медицинской помощи или программ здравоохране-

ния для клинического благополучия пациентов или населения (улуч-шение, стабилизация, ухудшение и т.д.).

Th e consequences of medical care or health program clinical well being of patients or population (improvement, stabilization, deterioration, etc.).

E Th e medical outcome/ resultF l’ issue médical / résultat médicalG das medizinische ErgebnisИсходы заболеванийМедицинские и биологические последствия заболевания.Medical and biological consequences of the disease.E Th e disease outcomes F les résultats (l’ issue) des maladiesG Ergebnisse ErkrankungenКарта амбулаторного больного, медицинскаяМедицинский документ, в котором отражается диагностическая,

лечебная и другая медицинская помощь, оказываемая амбулаторно.Th e medical document, which refl ects diagnostic, treatment and other

medical care provided on an outpatient basis.E Medical card of the outpatientF La carte médicale ambulatoire le patientG Die Patientenakte von einem ambulantenКарта стационарного больногоМедицинская — медицинский документ, в котором отражается ди-

агностическая, лечебная и другая медицинская помощь, оказываемая в условиях стационара.

Th e medical document, which refl ects diagnostic, treatment and other medical care rendered in the hospital.

E Medical card of the hospital patientF Carte de patient hospitaliseG Karte Krankenhauspatient


Качество жизниКатегория, включающая сочетание условий жизнеобеспечения

и состояния здоровья, позволяющее достичь физического, психиче-ского и социального благополучия и самореализации.

Th e category, comprising the combination of living conditions and health status that allows you to achieve physical, mental and social well-be-ing and fulfi llment.

E Th e quality of lifeF La qualité de vieG LebensqualitätКачество медицинской помощиСовокупность характеристик медицинской помощи, отражающих

ее способность удовлетворять потребности пациентов с учетом стан-дартов здравоохранения, соответствующих современному уровню ме-дицинской науки.

Th e set of characteristics of medical care, refl ecting its ability to meet the needs of patients with the standards of health, corresponding to the modern level of medical science.

E Quality of medical careF La qualité de l’aide médicaleG Qualität der medizinischen HilfeКачество профилактической медицинской помощиСовокупность характеристик, подтверждающих соответствие ока-

зания профилактической медицинской помощи имеющимся потреб-ностям, ожиданиям пациента и общества, современному уровню ме-дицинской науки и медико-профилактических технологий.

Th e set of characteristics confi rming the compliance of the assistance of preventive health care available to the needs, expectations of patient and society, the modern level of medical science and medico-preventive techno-logies.

E Preventive care qualityF La qualité des soins preventives (prophilaktique) G die Qualität der vorsorgeКойка больничнаяМесто, обеспеченное персоналом, приспособленное для размеще-

ния больных, оказания им круглосуточной стационарной помощи со дня госпитализации до дня выписки, и расположенное в тех отделени-ях больницы, где пациенты находятся постоянно (ВОЗ).

A place, staff ed with personnel fi t for the accommodation of patients, providing them with round-the-clock inpatient care from day of admission


to day of discharge, and located in those areas of hospitals where patients are constantly (WHO).

E Hospital bedF Le lit d’hôpitalG KrankenbettКойко-деньЕдиница учёта: одни сутки, проведенные пациентом в больничном

стационаре.Th e unit of account: one day spent by the patient in a hospital.E bed-dayF Le lit de jourG TagesbettКоммунальная помощьСостояние системы здравоохранения и медицинского обслужи-

вания при котором пациенты могут получить необходимую медицин-скую помощь в непосредственной близости от своего места жительства.

A provision of health and care services such that individuals have no need to move either out of their home, or their immediate neighbourhood to receive most of the care they need.

E community careF Les soins de proximité (communaute)G gameindenahe VersorgungКомпетентность в вопросах здоровьяИндивидуальная компетенция по вопросам влияния факторов,

определяющих здоровье, т. е. знаний о здоровом образе жизни и уме-нии справляться с проблемами со здоровьем.

Individual competence to infl uence factors determining health, i.e. the knowledge gained to lead a healthier life or to cope with health problems.

E Health competenceF La competence en matiére de santéG gesudheitliche KompetenzКомплекс исследованийПроизводимая по определенному плану совокупность действий

медицинского персонала, представляющих собой сложную или ком-плексную медицинскую услугу, выполняемая или для установления диагноза, или для окончания проведения определенного этапа лече-ния, или для проведения профилактики.

Th e medical staff set of actions, which is diffi cult or complex medical services performed for the diagnosis, for the completion of the certain stage of treatment, or for prophylaxis, produced according to a certain plan.


E Th e complex investigationF Les services complex d’exanan G Der Komplex der ForschungКомплексная система медико-санитарной помощиСистема здравоохранения, включающаяся в себя все элементы,

необходимые для удовлетворения потребностей населения в области здравоохранения.

A health system that includes all the elements required to meet all the health needs of the population.

E comprehensive health systemF le systéme de santé completG umfassendes GesundheitssystemКонкуренцияСостязание между экономическими субъектами: борьба за рынки

сбыта товаров с целью получения более высоких доходов, прибыли, других выгод.

Th e competition between economic subjects: the struggle for the mar-kets of goods with the aim of obtaining higher profi ts, profi ts, profi ts.

E Th e competitionF La concurrenceG WettbewerbКонсалтингПрофессиональная консультативная помощь руководителям орга-

низаций (предприятий), предпринимаемая в решении проблем, возни-кающих в процессе осуществления их деятельности.

Th e professional advice to managers of organizations (enterprises) un-dertaken in the solution of problems arising in the implementation of their activities.

E consultingF Le conseilG BeratungКонсенсусОбщее согласие, характеризующееся отсутствием серьезных возра-

жений по существенным вопросам у большинства заинтересованных сторон и достигаемое в результате процедуры, стремящейся учесть мнения всех сторон и сблизить несовпадающие точки зрения.

Th e general agreement, characterized by the absence of serious objection to the substantive issues the majority of stakeholders and the resulting proce-dure seeking to consider the views of all parties and to reconcile confl icting points of view.


E consensusF le consensusG KonsensКонсилиумОсмотр пациента двумя и более специалистами одного или разных

профилей более высокой квалификации, чем лечащий врач.Th e examination of the patient by two or more professionals from the

same or diff erent profi les more skill than the attending physician.E conciliumF Le conseil medical (concilium) G ConsiliumКонтингенты медицинскиеСовокупность лиц, находящихся на учете в организациях здраво-

охранения по медико-социальным показаниям.Th e totality of the persons registered in the health institutions for me-

dico-social reasons.E medical contributorsF Les troupes (contingents) médicalesG Kontingente medizinischeКонтингенты декретированныеОпределённые граждане, требующие к себе особого внимания го-

сударства и общества (женщины детородного возраста, беременные, дети, подростки, инвалиды Великой Отечественной войны и др.) через установление определенных льгот и условий.

Some nationals requiring special attention of the state and society (wo-men of childbearing age, pregnant women, children, teenagers, invalids of the great Patriotic war, etc.) by establishing certain benefi ts and conditions.

E Th e decreed contingentsF Les contingents de décretG Kontingente dekretirovannieКонцепцияСовокупность обоснованных взглядов (мыслей, положений), на-

правленных на футурологическое представление объекта (процесса, явления, системы).

Th e set of justifi ed beliefs (ideas, positions), directed on futurist perfor-mance of object (process, phenomena, systems).

E the conceptF le conceptG Konzept


Критерии общественного здоровьяУнифицированные количественные измерители, применяемые для

оценки уровня общественного здоровья и изменений его во времени (медико-демографические показатели, показатели заболеваемости, фи-зического развития и инвалидности).

Th e standardized quantitative measure used to assess the level of public health and its changes over time (medical demographic indicators, morbidi-ty, physical development and disability).

E public health criteriaF Les critères de santé publiqueG Die Kriterien für die öff entliche GesundheitЛетальностьОтношение умерших к числу больных. Th e ratio of deaths to number of patients.E MortalityF mortalitéG MortalitätЛечение Совокупность мероприятий, имеющих целью восстановление здо-

ровья и устранение или облегчение страданий больного человека.A set of measures aimed to restore health and eliminating or alleviating

the suff ering of the sick person.E TreatmentF traitementG BehandlungЛечение санаторно-курортное Часть медицинской помощи, оказываемой гражданам на основе

природных лечебных ресурсов в комплексе профилактических и ле-чебно-оздоровительных мероприятий в целях медицинской реаби-литации граждан после перенесенных ими заболеваний и иных рас-стройств здоровья.

Th e part of the medical care provided to citizens on the basis of natural medicinal resources in a complex of preventive and therapeutic measures for medical rehabilitation aft er suff ering their diseases and other health dis-orders.

E spa-treatmentF le traitement de sanatoriumG Spa-Kur


Лечение бесплатноеКомплекс медицинских услуг, гарантированных государством и осу-

ществляемых государственными организациями здравоохранения за счет средств республиканского и местных бюджетов.

Th e range of medical services guaranteed by the state and run by government health organizations at the expense of means Republican and local budgets.

E free treatmentF le traitement gratuityG Kostenlose BehandlungЛисток нетрудоспособностиДокумент, удостоверяющий временную нетрудоспособность, бе-

ременность и роды и подтверждающий временное освобождение граждан от работы, учебы, службы и другой трудовой деятельности, обусловленное медицинскими причинами и социальными факторами, предусмотренными действующим законодательством.

A document certifying the temporary incapacity, pregnancy and child-birth and supporting temporary exemption of the citizens from work, study, service and other work activities due to medical causes and social factors, provided by the current legislation.

E medical certifi cate sic list F Le feuillet de l’invaliditéG KrankgeschriebenЛицензияСпециальное разрешение на осуществление вида деятельности при

обязательном соблюдении лицензионных требований и условий, вы-данное лицензирующим органом соискателю лицензии или лицензиату.

Th e special permission for implementation of activity at obligatory ob-servance of license requirements and conditions issued by the licensing au-thority to the license applicant or licensee.

E LicenseF LicenceG LizenzМедицина доказательнаяМедицина, основанная на использовании медицинских технологий

с научно доказанной эффективностью.Medicine based on the use of medical technologies with scientifi cally

proven effi cacy.E Evidence-based medicineF Médecine fondée sur les preuvesG Evidenz-basierte Medizin


Менеджмент (управление)Вид деятельности по эффективному использованию материаль-

но-технических, финансовых, кадровых и других ресурсов в решении поставленных задач.

An activity on the effi cient use of logistical, fi nancial, personnel and oth-er resources in the solution of tasks.

E managementF La gestionG managementМедицинское страхованиеФорма социальной защиты интересов населения в охране здоро-

вья, цель которого — гарантировать гражданам при возникновении страхового случая получение медицинской помощи за счет накоплен-ных средств и финансировать профилактические мероприятия.

Th e form of social protection of population health interests, the purpose of which is to guarantee to citizens at occurrence of the insured event to receive medical care due accumulated funds and Fund preventive measures.

E health insuranceF l’assurance médicaleG KrankenversicherungМаркетинг медицинскийКомплекс мероприятий, направленный на изучение спроса, орга-

низацию, производство и создание условий для удовлетворения по-требности населения в различных видах медицинских товаров и услуг.

A complex of measures, directed on studying of demand, organization of production and the creation of conditions to meet the needs of the popu-lation in various types of medical goods and services.

E medical marketingF Le marketing medicalG Marketing MedicalМедицинское страхование, обязательноеВид государственного социального страхования, обеспечивающий

гражданам равные возможности в получении медицинской и лекар-ственной помощи за счет обязательных страховых взносов.

Th e state social insurance, providing citizens by equal opportunities to receive medical and medicinal aid at the expense of compulsory insurance contributions.

E compulsory health insuranceF l’assurance medicale obligatoireG die obligatorische Krankenversicherung


МониторингРегулярное наблюдение за изменениями в состоянии (например,

в состоянии здоровья) или ситуации (например, уровня загрязнения) или за изменениями в деятельности, гарантирующей выполнение за-планированного.

E MonitoringF La Surveillance (monitoring) G ÜberwachungНадзор санитарно-эпидемиологический, государственныйДеятельность по предупреждению, обнаружению, пресечению

нарушений законодательства в области обеспечения санитарно-эпи-демиологического благополучия населения в целях охраны здоровья и среды обитания.

Th e prevention, detection, suppression of violations of legislation in the fi eld of ensuring of sanitary and epidemiological welfare of the population in order to protect health and the environment.

E State Sanitary and epidemiological supervision, F La surveillance épidémiologique et Sanitaire d’étatG Sanitär-epidemiologischen überwachung, Staat Надлежащая технологияНаучно обоснованный метод, соответствующий локальным ресур-

сам, возможностям и обстоятельствам. A method of working that is scientifi cally valid and fi ts the local resourc-

es, capacities and circumstances. E appropriate technologyF Des technologies appropriéesG die richtige TechnologieНетрудоспособность1. Временное или длительное лишение индивидуальной активно-

сти в результате острой или хронической болезни, часто измеряемое числом дней, в течение которых человек лишен обычного уровня ак-тивности (в терминах шкалы ежедневных возможностей) (ВОЗ). 2. Не-возможность вследствие медицинских или социальных противопока-заний продолжать привычную профессиональную деятельность.

1. Th e temporary or prolonged deprivation of individual activity as a re-sult of acute or chronic disease, oft en measured by the number of days dur-ing which a person is deprived of normal activity level (in terms of the scale of daily capacity) (who). 2. Th e inability due to medical or social contraindi-cations to continue the usual professional activities.


E disabilityF Le handicapG ArbeitsunfähigkeitНорматив в здравоохраненииРеальный показатель обеспечения населения медицинскими услугами,

который намечено достигнуть в плановом порядке, и который обеспечен медицинскими кадрами, финансовыми средствами и капиталовложениями.

Th e real indicator of population provision by health services, which is scheduled to reach in a planned manner, and provided with medical person-nel, fi nancial resources and capital investments.

E the norm in healthcareF La norme en matière de santéG Die Norm im GesundheitswesenНорматив гигиеническийУстановленное исследованиями допустимое максимальное или ми-

нимальное количественное и/или качественное значение показателя, характеризующего тот или иной фактор среды обитания с позиций его безопасности и/или безвредности для человека.

Th e set research admissible maximum or minimum quantitative and/or qualitative value of an indicator characterizing this or that factor of habitat from the standpoint of safety and/or harmlessness for a human being.

E Hygienic standardF La norme d’hygièneG HygienestandardНормативы объемов медицинской помощи Необходимые объемы медицинских и организационных меропри-

ятий, в результате которых можно предупредить возникновение забо-леваний, обеспечить выздоровление при острых заболеваниях и до-биться ремиссии при хронических заболеваниях.

Th e necessary volumes of medical and organizational activities, which can prevent the occurrence of diseases, promote recovery from acute diseas-es and to achieve remission in chronic diseases.

E Standards of medical care capacitiesF La réglementation des volumes de soinsG Vorschrift en Volumen der medizinischen VersorgungНормативы бюджетного финансирования расходов на здраво-

охранение в расчёте на одного жителя Показатель, отражающий размеры средств, необходимых для ком-

пенсации затрат государственных организаций здравоохранения на предоставление бесплатной медицинской помощи.


Th e indicator refl ecting the amount of funds necessary to cover the costs of public health organizations for the provision of free medical care.

E the standards of budget funding expenditure on health per one in-habitant

F La réglementation du fi nancement budgétaire des dépenses de santé par habitant

G Vorschrift en der Haushalts-Finanzierung der Gesundheitskosten pro Einwohner

Обеспечение лекарственноеСовокупность материальных, финансовых и организационных

мероприятий, направленных на обеспечение населения доступными, безопасными, эффективными и качественными лекарственными сред-ствами.

Th e provision of medicinalTh e set of material, fi nancial and organizational measures aimed for pro-

vision of available, safe, eff ective and quality medicines.E drug provisionF la provision des medicaments G ArzneimittelversorgungОбеспечение справедливости в вопросах охраны здоровьяКаждый должен иметь возможность достижения его или ее полно-

го потенциала здоровья, и соответственно никто не должен быть ли-шен права реализации этого потенциала.

Everyone should have a fair opportunity to attain his or her full health potential and pragmatically, that no one should be disadvantaged from achieving this potential.

E «equity in health» F «L’egalite des chances en matiere de sante»G «Chalncengleichheit im Gesundheitsbereich»Образ жизниЖизненный уклад, основанный на взаимодействии условий жизни

в широком смысле и индивидуальных моделей поведения, определяю-щихся социокультурными факторами и личными характеристиками.

A general way of living based on the interplay between living condi-tions in the wide sense and individual patterns of behavior as determined by socio cultural factors and personal characteristics.

E lifestyleF Le mode de vieG lifestyle


Основные службы здравоохраненияУслуги, направленные на обеспечение основных потребностей на-

селения в услугах здравоохранения.Services designed to provide for the essential health needs of a popula-

tion.E Basic health servicesF Les services de santé de baseG gesundheitliche GrundversorgingОценка политики здравоохраненияПроцесс анализа политики в области здравоохранения, разработки,

осуществления, мониторинга и оценки.A process for analyzing health police formulation, implementation, moni-

toring and evaluation.E health policy reviewF L;examen (evaluation) de la politique de santéG health policy reviewПолитика, способствующая укреплению здоровьяAn explicit concern for the promotion of health police formulation, im-

plementation, monitoring and evaluation. E health public policy F La politique de la santé publique G Gesundheit public policyПомощьПроцесс оказания технической или финансовой поддержки. П. мо-

жет быть в виде грантов или кредитов, которые не должны быть погашены. Также П. может быть в виде технических консультаций с использованием, как человеческих ресурсов, так и оборудования и поставок.

Th e process of providing technical or fi nancial support. assistance may come in the form of fi nancial grants which do not have to be repaid or loans which do. Assistance may also come in the form of technical advice and sup-port in kind including human resources, equipment or supplies.

E Assistance (care)F L’Assistance (aide)G AssistanceПотребность населения в медицинской помощиОбъективно существующая необходимость в оказании медицин-

ских услуг.Th e current need for medical services.


E Th e demand for medical care F le besoin de soins médicauxG die Notwendigkeit der medizinischen VersorgungПраво граждан на информацию о состоянии здоровьяПраво на получение гражданином в доступной форме имеющейся

информации о состоянии здоровья, включая сведения о результатах обследования, наличии заболевания, его диагнозе и прогнозе, методах лечения, связанном с ними риске, возможных вариантах медицинского вмешательства, последствиях и результатах проведенного лечения.

Th e right of providing the citizen by the available information on health status, including information on survey results, the presence of the disease, the diagnosis and forecast, methods of treatment, the related risk, possible options for medical intervention, consequences and results of the treatment.

E Th e right of citizens to information about healthF Le droit des citoyens à l’information sur la santéG Das Recht der Bürger auf Informationen über GesundheitПраво граждан на охрану здоровьяГарантированное Конституцией право граждан Российской Фе-

дерации (включая бесплатное лечение в государственных организа-циях здравоохранения), которое обеспечивается созданием условий доступного для всех граждан медицинского обслуживания, а также развитием физической культуры и спорта, мерами по оздоровлению окружающей среды, возможностью пользования оздоровительными учреждениями, совершенствованием охраны.

Th e constitutionally guaranteed right of citizens of the Russian Federa-tion (including free treatment in public health institutions) provided by the creation of conditions available to all citizens health, maintenance, and de-velopment of physical culture and sports, measures to improve the environ-ment, the use of health facilities, improvement of security.

E Th e right of citizens to health protectionF Le droit des citoyens à la protection de la santéG Das Recht der Bürger auf Schutz der GesundheitПрактика клиническая, надлежащаяСовокупность правил по планированию, выполнению, контролю,

оценке и документированию результатов клинических испытаний ле-карственных средств.

A set of rules for the planning, implementation, monitoring, evaluation and documentation of results of clinical trials of medical products.


E Appropriate clinical practiceF les bonnes pratiques cliniquesG richtige klinische PraxisПриемлемостьПоддержка в решении задачи основными партнёрами. Основными

партнёрами в здравоохранении являются партнеры в сфере политики (представители правительства и министры здравоохранения), профес-сионалы (врачи, медсёстры, юристы, бухгалтеры, экономисты, менед-жеры и т. д.), представители различных учреждений (больницы, аптеки, покупатели и поставщики медицинских препаратов и оборудования, работники министерства и учреждения в других отраслях, работода-тели, профсоюзные организации, компании, СМИ и т.д.), потребители (производители лекарственных средств и медицинского оборудования, пациенты, сообщества и группы специальных интересов).

How far the solutions to a problem are supported by the main partners. In health development the main partners are: political: (parliaments and ministers of health); professional: (doctors, nurses, lawyers, accountants and economists, managers etc); institutional: (Health Funds, purchasers, pro-viders, ministers and institutions in other sectors, employers trade unions, companies, media etc), consumer: (contributors, patients, community and special interests groups).

E AcceptabilityF l’acceptabilitéG AkzeptanzСамопомощьВсе медицинские мероприятия, осуществляемые физическими ли-

цами для себя и своей семьи, в том числе поддержание здоровья, про-филактика заболеваний, самодиагностика и самолечение.

All the healthcare activities carried out by individuals for themselves and their families, including the maintenance of health, preventing of disease, self-diagnosis and self-treatment.

E self-careF auto-prise en charge G SelbstbetreungСанитарное просвещениеРазработанные возможности для обучения, призванные содей-

ствовать изменениям в поведении по отношению заранее поставлен-ной цели здравоохранения.

Consciously constructed opportunities for learning which are designed to facilitate changes in behavior towards a pre-determined health goal.


E health educationF L’education sanitaireG GesundheitserziehungСистема контрактовСистема медицинских услуг, включающая договор между тремя

отдельными сторонами: а) льготных категорий граждан или больных; б) фондом держателей и покупателей, действующих от имени льготни-ков, и в) поставщиками услуг.

E contract systemF Le system contractualG KontraktsystemУкрепление здоровьяПроцесс, позволяющий отдельным лицам и обществам усилить

контроль над факторами, определяющими здоровье и таким образом улучшить свое здоровье.

Th e process of enabling individuals and communities to increase control over the determinants of health and thereby improve their health.

E health promotionF la promotion de la santéG GesundheitsförderungУлучшение здоровьяРезультат процесса систематического улучшения здоровья для

конкретной группы населения, и комплекс мер, основанных на увели-чение продолжительности жизни и улучшение качества жизни, а затем обеспечение и планирование ресурсов здравоохранения, направлен-ных на увеличение средней продолжительности жизни.

Th e result of a systematic process of approving, for a specifi c population, a range of measures that are based on the length of life and the quality of life, and then providing and planning health resources that increase the average length of improved life enjoined by that population.

E Health gain streytening F L’amelioration de la sante, ranforsmant (gain en matiere de santeG gesumdheitliche Vebesserung, Mehr an GesundheitУчётОрганизация записей о доходах и расходах, а также баланс между

доходами и расходами в течение определенного периода времени.Th e organized recording of income and expenditure and the balance be-

tween them over a period of time.E AccountingF la comptabilitéG Buchhaltung

REFERENCES

1. Glossary of Terms in the «Health for All» Series No 1–8. Geneva, World Health Organization, 1984 (Health for All Series, No. 9).

2. WHO Regional Offi ce for Europe, staff in Translation and Editorial unit, 1994 (personal communication).

3. Terminology for the European Health Policy Conference. A glossary with equivalents in French, German and Russian.

4. WHO Conference on European Health Care Reforms, Ljubljana, Slo-venia, 17–20 June, 1996. — Terminology, WHO Regional Offi ce For Europe, Copenhagen, 1996.

5. Терминология по общественному здоровью и организации здраво-охранения. — Новости экспертизы и регистрации, 2007. — № 9. — С. 11–42.

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