Special indicators of morbidity. Essays on medicine Morbidity of the population. Types and methods of study

Morbidity - a set of diseases detected in the population.

The most accessible and widely used indicator. It is important for planning the health care system, they give a real social picture of the life of the population. The study of morbidity is based on international classification diseases. Now we use the classification adopted by WHO in 1989, and since 1998 it has been used in the Russian Federation, it includes 21 classes of diseases (in each class there are certain diseases that are called nosological forms and have a code), for reasons or by mechanisms, by localization: disease respiratory system, digestion, circulation, etc. Now we use 10 revised classification. Separately, a class is distinguished, which is called "features of individual conditions", this class includes diseases associated with complications of pregnancy, childbirth and the postpartum period.

There are 3 types of disease detection:

newly diagnosed - include acute and chronic diseases that are first detected when contacting medical institutions;

general morbidity - the totality of all diseases among the population that were detected both for the first time this year and in previous years, but about which the patient applied again this year;

cumulative incidence or prevalence is characterized by all cases of diseases identified both in this year and in the past, about which the sick person applied to the institution both this year and did not apply.

The source of these data is the reporting information of medical institutions.

Morbidity study methods:

solid - the entire population;

selective involves the study of the incidence of a certain group of the population.

To study the morbidity, they use the appealability (to the clinic): they study the appeal and visit, with the disease - the appeal, the visit - for help. The appeal is analyzed by a statistical coupon, the appeal is the first visit to the doctor about this disease.

Average visit per inhabitant per year = 9. This helps to plan honey. help.

Morbidity is studied on the results of honey. examinations and more information about the dead. The most complete source of data on diseases is the appeal for honey. help. The following types of diseases are evaluated according to the appealability:

general morbidity, which includes all cases of visits to primary outpatient clinics, then a statistical coupon of inverted diagnoses is issued;

acute infectious disease - a statistical form is drawn up as an emergency notification of an infectious disease. When non-communicable diseases, but carrying social significance: tuberculosis, oncology, then a special notice is issued;

hospitalized morbidity, when the patient enters the hospital, then a card is issued for the person who left the hospital;

morbidity with temporary disability, then the sick leave is the accounting form.

If a person does not go to honey. establishment with a disease, these diseases come to light at honey. inspection. Honey. examinations are divided into:

targeted when oncologists come out and check all or the most common honey. examinations of those who work with food products, once every 3 months.

preliminary honey. pre-employment screening educational institution, before the competition, are regulated by the relevant order.

periodic honey. inspections; their goal timely detection deterioration in health or the appearance of a disease - this, as a rule, in prof. groups that work in harmful conditions labor or with hazards, for these groups periodic honey. examinations in order to identify them in a timely manner, remove them from this environment and carry out treatment-and-prophylactic, prophylactic, health-improving and even rehabilitation measures.

In the analysis of morbidity, as a rule, quantitative indicators are used, among them intensive ones characterize the level of morbidity, and extensive ones characterize the proportion of individual nosological forms (tonsillitis, pneumonia) in the structure of general morbidity and refer to indicators that are characterized as morbidity. –>

and indicators of group and individual, i.e. indicators of the incidence of incidence and structure of incidence for specific population groups, i.e. the same quantitative and qualitative indicators, but for specific population groups. It is possible to estimate the frequency of diseases transferred during the year - how many times a year 1 patient has been ill with a disease or how many times this disease occurs in a group.

Relative indicators include intensive and extensive, calculated per 1000, but diseases with loss of temporary ability to work are calculated per 100.

Indicators with temporary disability - the state of the body when functional disorders caused by illness and interfering with labor activity, which are reversible or transitory. AT overall structure the incidence of the disease with temporary disability is 60-80% of the total incidence, most often these indicators are taken into account in the analysis of the incidence of prof. groups or socio-professional groups. The level of this incidence is influenced by working conditions, as well as living conditions and the quality of honey. service. These indicators are used for preventive measures directed at this population group. When considering temporary disability, quantitative indicators are analyzed - the number of cases of disability per 100 employees, the second indicator ->

the number of days of incapacity for work - the severity of the course of the disease (the longer, the more difficult) and -\u003e

the average duration of one case - the number of days is taken and divided by the number of cases on average.

The second type is qualitative indicators, extensive, which characterize the structure of morbidity -> extensive qualitative indicators characterize the structure of morbidity, are usually analyzed in days of disability and thus determine the place of one or another nosological form in the structure of morbidity. With an in-depth analysis of temporary disability, various age and sex groups are taken, various prof. groups, etc. Attention!!! These are indicators that are used for comparison, and for comparing everything: fertility, mortality, and morbidity, and in connection with temporary disability, that is, any indicators - this indicator is called a normalized intensive indicator - an indicator that is used for comparison homogeneous groups of territories, etc., and to compare the same indicators in different regions, for example, you need to look at the birth rate in our republic compared to the indicators for the country. For this, a normalized intensive indicator is used - this is the ratio of the intensive indicator of our republic in relation to the indicator in the country as a whole, i.e. comparable indicators. In the numerator is the indicator that we are comparing, in the denominator is the indicator that is, as it were, a relatively standard (with whom we want to compare). If the indicator is close to 1, but less than 1, then we have less than the country as a whole, if the indicator is greater than 1, then more than the country as a whole. But if we consider the incidence, then the indicators in our region may be higher, this indicator allows you to sound the alarm, if we have 2 times more, then we will get a normal. intens. exponent = 2; that is, how many times our indicators differ from the standard ones. You can compare our and neighboring city, here we can operate with any similar indicators. If we consider infant or maternal mortality, then here the indicators exceed 1.2 - this should be alarming, this is a significant excess if we compare the country as a whole.

Data on the incidence of the population are collected, processed and analyzed using the methods of medical statistics. The incidence of the population is studied by three methods:

A) according to the population's accessibility for medical care - the foundation was laid by zemstvo doctors who offered cards; allows you to identify clinically expressed diseases and for medical care. awn

B) according to the data medical examinations- the initial forms of the disease, as well as latent, latent forms are revealed.

C) according to the data on the causes of death - latent diseases are detected that are not diagnosed during life, masked diseases (in case of discrepancy between clinical and post-mortem diagnoses).

The completeness of the detection of diseases is affected by:

1) the completeness of the population's appeal to medical institutions - determined by remoteness, the presence of transport links, the need for sick leave, the presence of self-treatment, the fashion for diagnoses

2) completeness of accounting for the detection of diseases

3) equipment of the medical institution with diagnostic equipment and qualified personnel

4) the possibility of patients applying to non-state institutions

5) qualification and conscientiousness of the doctor

6) organization of professional examinations

AT foreign countries to study the incidence, data from disease registries, the results of special selective studies, sociological methods (surveys, questionnaires, interviews) are used.

Statistical study of incidence population can be carried out:

BUT) continuous method- allows you to get exhaustive materials about the incidence of the population; is based on a summary of reported data on the incidence of the population for all medical institutions.

B) Selective method- allows you to obtain data on the incidence of various population groups Influenced various factors, conditions and lifestyle of people; research is carried out according to special programs in certain periods of time in specific territories.

Each method has its own source of information, statistical accounting document, analysis algorithm. For statistical analysis can be used as a) officially established documents medical records, and b) specially designed forms.

An important methodological point in the characterization, description and analysis of morbidity is correct application terms and their common understanding.

The study of the incidence of the population By negotiability for medical care in health care facilities - the leading method that usually detects acute diseases and chronic diseases in the acute stage.

It consists of the study of general and primary morbidity, as well as 4 types of special morbidity records:

1) acute infectious diseases

2) important non-epidemic diseases

3) hospitalized diseases

4) diseases with temporary disability - they are distinguished, because they have medical, social and economic significance.

Methodology for studying general and primary morbidity

The general morbidity of the population is being studied Based on a complete accounting of all primary applications for medical care in medical institutions. Unit of account- first visit to the doctor this disease in the current year. Main accounting document in outpatient clinics - "Statistical coupon for registration of final (refined) diagnoses" (f. 025-2 / y), which is filled in for all cases of acute diseases and the first visits in this calendar year for chronic diseases. For each acute disease, a statistical coupon is filled out and a plus sign (+) is put in the column “diagnosis established for the first time in life”. For chronic diseases, the statistical coupon is filled out only once a year at the first application. The sign "+" is put in the event that a chronic disease is detected in a patient for the first time in his life. At the first visit of a patient in a given year regarding an exacerbation of a chronic disease identified in previous years, a minus sign (-) is put. With repeated appeals in a given year for exacerbations of chronic diseases, the diagnosis is not recorded. All specified diagnoses are recorded by the doctor in "Sheet for recording the final (clarified) diagnoses" in the "Medical card of an outpatient" (f. 025 / y), which allows you to see the dynamics of diseases.

All coupons with registered diagnoses of diseases at the end of the reception are transferred to the medical statistics office, encrypted and used for statistical summaries, reporting and calculation of morbidity rates. Information about cases of diseases among the population is contained in “Report on the number of diseases registered in patients living in the service area of ​​a medical institution for ... a year” (f. 12).

Some outpatient clinics use new system accounting for diseases by completed service case with automated processing of primary medical records. To do this, use the "Coupon of the outpatient". This record is completed for each completed case of outpatient care (POS) for a patient at an outpatient facility (i.e. a case of recovery, remission, hospitalization, or death of the patient). All visits made due to the disease are entered into it, this document is stored in the doctor's office until the SPO is completed, after which it is signed by the doctor and transferred to the medical statistics office. Information about return visits is used to characterize the volume medical care.

Indicators of general and primary morbidity.

1) the frequency of primary morbidity

Average annual population = (number of inhabitants on January 1 + number of inhabitants on December 31) / 2

2) the frequency of general morbidity

3) special intensive indicators - calculated by age, gender groups, by nosological forms of diseases, by professional, social, territorial and other characteristics:

4) incidence structure

Modern levels of general and primary morbidity and their structure in the Republic of Belarus.

Primary morbidity: 74,000 per 100,000 population, increased by 40% since 1990, there is an increase in all classes, except for infectious and endocrine diseases

1st place: respiratory diseases (49%)

2nd place: injuries and poisoning (10%)

3rd place: diseases musculoskeletal system (5%)

4th place: diseases of the skin and subcutaneous fat (5%)

5th place: infectious diseases

6th place: diseases genitourinary system

General morbidity: 130,000 per 100,000 population, increased by 18% in 10 years

– the accumulation index is calculated (general morbidity / primary morbidity)

- in children, the incidence is 3 times, in adolescents 2 times more than in adults

– in women, the incidence is higher, because more often they turn to

- Citizens have a higher incidence of morbidity than rural population, because the accessibility of medical institutions is higher

1st place: respiratory diseases

2nd place: diseases of the circulatory system

3rd place: diseases of the digestive system

4th place: diseases of the musculoskeletal system

The most common diseases in the world are:

2nd place: anemia (2 billion cases annually)

3rd place: external diseases - injuries, poisoning, occupational diseases

4th place: mental disorders.

Ministry of Health of the Russian Federation

State budgetary educational institution higher professional education

"North-Western State medical University named after I.I. Mechnikov"

Ministry of Health of the Russian Federation

Department of Public Health and Health

ANALYSIS OF POPULATION MORBIDITY

ed. z.d.s. RF, prof. V.S. Luchkevich

Teaching aid

St. Petersburg

UDC 312.6001.8 BBK 51.18

Population morbidity analysis: teaching aid / ed. V.S. Luchkevich. - St. Petersburg: SZGMU im. I.I. Mechnikova, 2015. - 47 p.

Team of authors: V.S. Luchkevich, P.N. Morozko, G.M. Pivovarova, N.I. Pustotin, V.P. Panov, I.L. Samodova, A.Yu. Lomtev, E.V. Mironchenko, E.A. Abumuslimova, G.N. Marinicheva, T.V. Samsonova, A.Sh. Kalichava.

Reviewer: head. Department of Social Hygiene, Management and Health Economics, SBEI VPO North-Western State Medical University named after A.I. I.I. Mechnikova, Doctor of Medical Sciences, Professor Filatov Vladimir Nikolaevich

The educational and methodical manual is devoted to the methodological aspects of the study, calculation and analysis of indicators of various types of morbidity, necessary for a comprehensive assessment of health individual groups and contingents of the population of the administrative territory, to determine the effectiveness of therapeutic, preventive, hygienic and anti-epidemic measures.

The teaching aid contains the basics of the incidence of the population as the most important indicator of public health, a criterion for assessing the quality and effectiveness of health-improving work, an objective and sensitive indicator of medical and social well-being. The teaching aid reflects the causes and risk factors for morbidity, determines the consequences of the influence of the disease on health.

The teaching aid is intended for students in the direction of training (specialty) 060101 "Medicine" and 060105 "Medical and preventive care".

Approved as a teaching aid

TOPIC: Analysis of the incidence of the population.

STUDENT STUDENTS- students in the direction of training (specialty) 060101 "General Medicine" and 060105 "Medical Preventive Business".

DURATION OF PRACTICAL LESSON - 4 hours (in

academic hours)

PURPOSE OF THE LESSON: to study the basics of medical, social and clinical statistical analysis of the incidence of various population groups and learn how to use health data to assess the effectiveness of medical and recreational activities, as well as to substantiate the organizational forms of preventive measures.

As a result of studying the topic, the student should know:

1. The concept of public health. health criteria. Comprehensive assessment of public health.

2. Definition of the concept of morbidity, pain, pathological affection.

3. Types of morbidity. Methods and sources for studying morbidity.

4. Morbidity according to referral data.

5. Morbidity according to medical examinations.

6. Morbidity, studied on the basis of registration data of causes of death.

7. Status, trends and forecast of changes in health indicators of various population groups, taking into account the impact socio-economic conditions.

8. Morbidity according to the study of the causes of disability.

9. Basic concepts of the International Statistical Classification of Diseases (ICD).

As a result of studying the topic, the student should be able to:

1. To be able to correctly register individual types of morbidity with the definition of observation units for each type of morbidity.

2. Be able to analyze the data of summary statistical forms (reports), assess the level and structure of registered morbidity.

3. To be able to assess the incidence according to the hospitalization of inpatients.

4. Be able to analyze data on newly diagnosed pathology and accumulated chronic forms diseases according to the results of complex medical examinations.

5. To be able to calculate and analyze morbidity indicators (structure, level, dynamics), with the construction of graphic images, identifying the relationship between morbidity and risk factors.

HEALTH

According to the definition of the World Health Organization (WHO): “Healthy

Vie is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

AT in accordance with Federal Law No. 21.11.2011 323-FZ) Zdo-

health is a state of physical, mental and social well-being of a person, in which there are no diseases, as well as disorders of the functions of organs and systems of the body.

AT medical and social studies in the assessment of health is advisable

identify four levels:

1. Health individual person- individual health.

2. The health of social and ethnic groups is group health.

3. Health of the population of administrative territories - regional health

4. Population health is public health.

1. Deduction of the gross national product for health care.

2. Availability of primary medical and social assistance.

3. Coverage of the population with medical care.

4. Level of immunization of the population.

5. The degree of examination of pregnant women by qualified specialists.

6. Nutritional status of children.

7. Child mortality rate.

8. Average life expectancy.

9. Hygienic literacy of the population.

Based on WHO materials, the Ministry of Health of the Russian Federation proposes the following definitions of health.

Public Health - medical and social resource and the potential of society, contributing to national security.

Public health - medical-demographic and social category, reflecting the physical, mental, social well-being of people who carry out their livelihoods within certain social communities.

More complete is the definition of public health, developed at the seminar of heads of organizational profile departments:

Public Health - this is the most important economic and social potential of the country, due to the influence of various factors environment and way of life of the population, allowing to provide optimal level quality and safety of human life.

Health is a state that ensures the optimal relationship of the organism with the environment and contributes to the activation of all types of human activity (labor, economic, household, recreational, family planning, medical and social, etc.).

health criteria.

The main criteria characterizing public health are:

1. Medical and demographic(fertility, mortality, natural increase, infant mortality, premature birth rate, life expectancy.

2. Morbidity (general, infectious, with temporary disability, major non-epidemic diseases, hospitalized, according to medical examinations).

3. primary disability.

4. Indicators of physical development.

5. Mental health indicators.

All criteria are evaluated in dynamics.

Comprehensive assessment of public health.

In a comprehensive assessment of the health status of adults, the distribution into health groups is as follows.

The first group is healthy individuals (who have not been ill for a year or rarely go to the doctor without losing their ability to work).

The second group is practically healthy individuals, with functional and some morphological changes or rarely sick during the year (isolated cases of acute diseases).

The third group - patients with long-term chronic diseases (more than four cases and 40 days of disability per year).

The fourth group - patients with long-term chronic diseases (compensated condition).

The fifth group - patients with frequent exacerbations of long-term diseases.

However, the division of both adults and children into health groups is rather arbitrary.

For rate individual health a number of very conditional indicators are used: health resources, health potential and health balance.

BASIC CONCEPTS OF INCIDENCE

Definition of the concept of morbidity, primary morbidity, morbidity, pathological affection.

The incidence of the population is the most important indicator of public health, a criterion for assessing the quality and effectiveness of health-improving work, the most objective and sensitive indicator of medical and social well-being. Reducing the incidence of the population is of great social and economic importance, is one of the key social and hygienic problems and requires the active participation of legislative and executive power in the preparation and implementation of special programs for the promotion of health and social protection population. Studying the causes and risk factors of morbidity, determining the consequences of the influence of diseases on health status and developing ways to prevent diseases are priority professional tasks for employees of medical institutions. Thus, incidence data is a tool for the operational management and management of health care. Moreover, morbidity rates reflect the real picture of the life of the population and make it possible to identify problem situations to develop specific measures to protect public health and improve it on a nationwide scale.

According to the WHO A disease is any subjective or objective deviation from the normal physiological state of an organism.

Thus, the concept of "disease" is broader than the concept of "disease".

An important direction in the study of morbidity is the assessment of the influence of risk factors of conditions and lifestyle, the analysis of the relationship of medical and social, hygienic, genetic, organizational, clinical and other factors that contribute to the formation of the most common forms of diseases. The use of modern statistical techniques has made it possible to establish that a higher level of morbidity in the population depends not only on adverse impact environmental factors, but also from a number of biological, socio-economic, social and living conditions and lifestyle.

One of the principles of modern health care is the preservation of the health of the healthy, which makes it possible to give priority to state and public activities in the field of disease prevention. The disease is generally available for registration when the patient seeks medical help. Morbidity is one of the criteria for assessing the state of health of the population and shows the level, frequency of spread of all diseases.

taken together and each separately among the population as a whole and its individual age, sex, social, professional and other groups.

Morbidity is an indicator that characterizes the level, prevalence, structure and dynamics of registered diseases among the population as a whole or in its individual groups and serves as one of the criteria for evaluating the work of a doctor, medical institution, health authority in the territory.

In the incidence statistics, there are the following indicators:

1. Actually morbidity (primary morbidity).

2. Prevalence (morbidity).

3. pathological lesion.

4. true morbidity.

Primary morbidity (actual morbidity) is a combination of

the frequency of newly emerged diseases that were not recorded anywhere in previous years and were detected among the population for the first time in a given calendar year (relapses of chronic pathology that occur during the year are not taken into account). It is calculated as the ratio of the number of newly emerging diseases to the average population, multiplied by 1000, expressed in ppm.

It is registered according to statistical coupons (account form 025-2 / y) of specified diagnoses with a sign (+).

Cases of acute diseases are registered at each occurrence, cases of chronic diseases - only once a year.

Morbidity (prevalence of diseases) - this is a set of all diseases among the population, both first detected in this calendar year and registered in previous years, but about which the patient applied again this year (registered according to all statistical coupons for updated diagnoses, accounting f. 025-2/y), expressed in ppm. Statistically expressed as the ratio of the number of all diseases of the population per year to the average population, multiplied by 1000.

There is a significant difference between the concepts of actual morbidity and morbidity. Soreness is always higher than the level primary disease

bridges.

Incidence rate itself in contrast to the pain of

indicates the dynamic processes occurring in the health of the population and is more preferable for identifying causal relationships.

Soreness index gives an idea of ​​both new cases of diseases and previously diagnosed cases, but with an exacerbation of which the population applied in a given calendar year. The indicator of morbidity is more stable in relation to various environmental influences, and its increase does not always mean the presence of negative shifts in the state of health of the population. This increase can take place as a result of the achievements of medical science and practice in the diagnosis, treatment of patients and prolongation of their lives, which leads to the "accumulation" of contingents registered with dispensaries.

Primary incidence- this is an indicator that is more sensitive to changes in environmental conditions in the year under study; when analyzing this indicator for a number of years, you can get the most correct idea of ​​the incidence and dynamics of morbidity, as well as the effectiveness of a complex of social, hygienic and therapeutic measures aimed at its decline.

In the specialized literature, the term “ accumulated morbidity" - it is the totality of all cases of primary diseases registered during a number of years when seeking medical help.

The cumulative incidence rate per 1000 population of the corresponding age is calculated. This incidence rate most reliably reflects the health of the population studied by the method of seeking medical attention.

Pathological affection - a set of diseases pathological conditions identified by doctors through active medical examinations of the population. Statistically expressed as the ratio of the number of cases of diseases present in the this moment, to the average population, multiplied by 1000, expressed in ppm.

These are mainly chronic diseases, but acute diseases that are present at the moment can also be taken into account.

Periodic and mass medical examinations make it possible to identify previously unknown chronic diseases, for which the population does not actively apply to medical institutions. Cases of initial (hidden) manifestations of certain diseases are subject to registration. The advantage of the method of active medical examinations is also the clarification of the diagnosis of certain chronic diseases and pathological abnormalities.

Reliable information about the size and nature of morbidity for various groups of the population (age-sex, social, professional, etc.) is necessary to assess trends in the state of public health, the effectiveness of medical and social measures, and planning various types of specialized care, rational use material and human resources of health care.

The true morbidity it is negotiability plus morbidity on medical examinations and minus unconfirmed diagnoses on medical examinations.

In the analysis of morbidity, a number of indicators of the frequency of cases of diseases are calculated for certain age and sex groups.

Depending on the purpose of the study, various statistical materials and accounting documents are used (medical records, emergency notices, disability certificates, hospital leave cards, medical death certificates, other special forms and questionnaires). When choosing the main diagnosis, one should be guided by the "International Classification of Diseases and Related Health Problems" (10th revision, 1993, WHO). When diagnosing and coding morbidity, preference should be given to: 1) the underlying disease, rather than a complication; 2) more severe and deadly disease; 3) infectious, not noncommunicable diseases; 4) acute form disease, not chronic; 5) specific disease associated with certain conditions work and life.

TYPES OF INCIDENCE.

METHODS AND SOURCES FOR STUDYING INCIDENCE

Classification of types of morbidity.

1. According to the referral data:

a) general morbidity; b) infectious disease;

c) hospital morbidity; d) morbidity with temporary disability;

e) the most important non-epidemic diseases (tuberculosis, syphilis, sexually transmitted diseases, etc.).

2. According to the data of medical examinations and dispensary observation: children,

conscripts, working teenagers and other decreed categories of the population.

3. According to cause of death.

4. According to the study of the causes of disability.

Of these, two types are subject to general continuous current registration, including data on the causes of death and data from preventive medical examinations, and three types are subject to additional special registration and statistical accounting, due to their special medical and social significance and signal and operational significance for the organization of preventive measures.

can be studied separately detection rate - the number of cases

left per 1000 examined according to preventive examinations and dispensary observation, as well as according to data on the causes of death. Sources of information and types of morbidity are presented in Scheme 1.

Each type of morbidity has an accounting and reporting form. The study of only one of the listed species is only part of the general morbidity data. When studying morbidity, especially within a short period of time, for example, a year, it is not always possible to take into account all cases of illness according to the data on negotiability. This is especially true for the initial forms of diseases.

WHO points out that whatever indicator of incidence is calculated, it must meet a number of requirements: be reliable, objective, sensitive and accurate.

Each of the methods for studying morbidity has its own characteristics regarding the quality and value of the data collected on their basis.

The reasons for the separate study of each type of morbidity:

1. Infectious morbidity - requires rapid anti-epidemic measures.

2. Hospital morbidity - information about it is used to plan the bed fund.

3. Morbidity with temporary disability - determines the economic costs.

4. Major non-epidemic morbidity - provides information on the prevalence socially determined diseases.

The health of the population as a set of quantitative indicators of public health is characterized by morbidity, demographic indicators and indicators of physical development.
Morbidity is an indicator that characterizes the level, frequency of the spread of diseases among the population. The possibility of using information about the incidence of the population, its appeal for diseases in different types institutions helps academic nurses and doctors to control individual sections of activities, manage institutions, make plans medical care population and recreational activities.
To characterize the morbidity of the population, three concepts are distinguished: the incidence itself, the prevalence of yawning (morbidity), and pathological susceptibility.
Under the actual incidence (according to the term recommended by WHO - incidente) is understood the totality of diseases not previously recorded anywhere, for the first time in a given year, identified diseases. Morbidity is therefore also called the frequency of newly diagnosed diseases, primary morbidity.
Under prevalence (prevalence) or morbidity
is understood as the totality of all diseases registered in a given year, first detected in a given year and registered in previous years, for which patients reapplied in a given year. Both incidence and prevalence are most often calculated per 1000 population.
Pathological prevalence (pointprevalence) is understood as the frequency of diseases detected in the population on a certain date (moment), most often at the time of a medical examination. This takes into account not only diseases, but also premorbid conditions, morphological or functional abnormalities that may cause disease in the future. The attack rate is calculated as a rate per 100 examined.
There are three main methods for studying morbidity: according to the data of appealability, according to the data of medical examinations and data on the causes of death (Table 6).
The study of morbidity according to the data of attendance is carried out by continuous accounting, based on the data of the current accounting of all appeals to all medical institutions in Russia. Often these data are not enough for reliable conclusions about the actual dynamics and prevalence of diseases. Therefore, selective in-depth studies of morbidity are periodically carried out according to special programs that take into account gender, age, professions, work experience of individual contingents, the impact of environmental pollution, risk factors, etc.

Basic statistical
accounting document
Morbidity according to the data of appeals to outpatient clinics institutions is studied in the order of current registration on the basis of a complete record of all diseases. The unit of observation is the first treatment for this disease in the current year. An important operational document is the “List of final (refined) diagnoses” in the outpatient medical record (f. 025 / y), where all diseases are entered.

Diagnosed in the patient in the order of observation of him. On the basis of this document, a statistical coupon is filled out (f. 025-2 / y) and a consolidated morbidity record sheet is compiled (f. 071 / y).
Chronic diseases (diseases of the circulatory system of the digestive system and other long-term illnesses) are taken into account only once a year. Chronic diseases diagnosed for the first time in life are registered in the statistical coupon with a “+” sign. With repeated appeals for exacerbation of these diseases, the diagnosis is not recorded. All acute diseases are considered to be primary, the diagnoses of acute diseases are recorded in each new case of their occurrence in the statistical coupon with a “+” sign.
Statistical coupons with a "+" sign provide the initial data for obtaining the incidence rate. The total number of statistical coupons gives the initial figures for obtaining an indicator of the prevalence (morbidity) of diseases. The completed statistical coupons are encrypted and, at the end of the medical appointment, are transferred to the medical statistics office, where they are stored according to the sections, and within the site - according to the classes of diseases of the international classification of diseases, injuries and causes of death. This system for storing and accounting for statistical coupons allows you to obtain summary data on the general morbidity of the population, allows you to select medical records of outpatients according to statistical coupons to control the quality of medical and diagnostic work of doctors, etc.
When studying infectious disease the unit of observation is each case of the disease, for which an “Emergency notification of an infectious disease, food, acute occupational poisoning” (form 058 / y) is drawn up.
Quarantine diseases are subject to mandatory registration and accounting; diseases, information about which is collected by specialized medical institutions with simultaneous information from the sanitary and epidemiological service about some of them (tuberculosis, syphilis, leprosy, fungal diseases and etc.); diseases about each case of which are notified to the centers of state sanitary and epidemiological surveillance - TsGSEN ( typhoid fever, typhus, dysentery, measles, scarlet fever, diphtheria, etc.); and diseases about which only summary information(influenza, acute respiratory viral infections etc.), according to form 85 - influenza.
"Emergency notification" is filled in by the doctor of the clinic or any other medical institution who identified the patient. Where there are no doctors (remote rural areas, etc.), employees of feldsher-midwife stations are required to report the detection of cases of infectious diseases. Information is sent to the district, city TsGSEN directly by the staff of medical institutions. To account for receipts emergency notices in medical institutions and sanitary and epidemiological supervision centers there are identical special journals (form 060 / y) in which a record of sent and received notices is kept.
In the analysis of infectious morbidity, the frequency of detection of diseases per 100,000 population, seasonality, hospitalization coverage, group morbidity rates (by sex, age, profession, place of residence, etc.) necessary for planning and evaluating anti-epidemic measures are determined.
When studying the incidence of the most important non-epidemic diseases (tuberculosis, venereal diseases, mental illness, cancer and other malignant neoplasms) the unit of observation is a patient with a diagnosis of one of these diseases for the first time in his life. The accounting documents for the study of non-epidemic morbidity are "Notifications about the patient ..." - forms No. 089 / y and f. 090/y (table 7).
Doctors who have identified the listed most important non-epidemic diseases in any medical institutions are required to in due course report this to specialized dispensaries (tuberculosis, oncology, dermatological and venereological), filling out notices for this. In dispensaries, the diagnosis is specified; from the confirmed notices of the patient, an alphabetical file is compiled, which is also used to compile reports on newly identified patients. Based on the reports, a number of indicators are determined that characterize the structure and frequency of detected diseases by nosological forms per 100,000 population.
The system for recording hospitalized morbidity is based on the registration of each case of hospitalization of a patient in a hospital. At discharge, the “Statistical card of the person who left the hospital” (form 066 / y) is filled out. The report of the medical institution (form 1) has a table on the distribution of patients in the hospital. Indicators of hospitalized morbidity are: the frequency of hospitalized per 1000 population for certain disease; indicators of hospitalized by gender, age, place of residence, profession; structure of hospitalized by diseases.
Data on hospitalized morbidity make it possible to judge timely hospitalization, the nature and volume of hospital medical care, the duration of treatment, and mortality. Hospitalized morbidity rates give an idea of ​​the most severe pathology, determine the selection for hospitalization and reflect the organization and continuity of hospital and community care.
The unit of observation in the study of morbidity with temporary disability is each case of temporary disability due to a disease that occurred in a worker in a given year. An exacerbation of one chronic disease can result in several cases of disability during the year. The accounting document is a certificate of incapacity for work (sick leave), which is not only a legal document certifying temporary release from work, but also financial, since on the basis of it, benefits are paid from social insurance funds.
Examination of temporary disability is carried out in accordance with the “Instruction on the procedure for issuing documents certifying temporary disability of citizens”, approved by the Decree of the Social Insurance Fund of the Russian Federation of 10/19/94 and Orders of the Ministry of Health and Medical Industry of the Russian Federation - No. 21 of 10/19/94. and N° 5 dated 13.01.95. According to specified documents the analysis of morbidity with temporary disability is carried out according to the accounting and reporting form 036 / y "Book of registration of disability sheets". The main indicators of morbidity with temporary disability are: the number of cases and days of disability per 100 employees (total and for certain reasons of disability), the average duration of one case of disability, indicators of the structure of morbidity.
An analysis of these general indicators makes it possible to judge the dynamics of morbidity, to single out those causes of disability that occupy the main place in the morbidity of workers. However, these indicators do not allow to establish other important factors affecting morbidity. Therefore, there are many methodological approaches and a large number of methods for studying morbidity with temporary disability.
For example, the method of studying morbidity according to personal (police) records has become widespread in the activities of medical institutions serving industrial enterprises. For each employee of the enterprise, a special accounting document “Personal employee card” is filled out, which indicates the profession, gender, age, total work experience, work experience in this profession, etc. Information about all cases of loss of ability to work, indicating the appropriate type of disability (disease, accident at work, accident at home, etc.) and the duration of release from work. This accounting system allows you to determine, in addition to the indicated indicators, special coefficients calculated for otaamp;
chewing groups; determine the percentage of sick people as the ratio of the number of employees who had at least one case of disability during the year (sick people) to the total number of so-called “year-round” people who worked at this enterprise all year; to single out a group of long-term and frequently ill patients who had at least 4 cases or 40 days of disability during the year for homogeneous reasons for disability. The analysis of these indicators makes it possible to purposefully plan the implementation of the necessary medical, health-improving and sanitary-hygienic measures and evaluate their effectiveness.

Examination of persistent disability (disability) is a function of the social security authorities. Disability is a permanent loss of ability to work or its significant limitation. The medical and social expert commission (MSEC) determines the exit to disability and its severity. MSEC establishes the following causes of disability: common disease, disability since childhood, Occupational Illness, labor injury, disability in former military personnel, disability before the start of employment. severity disability MSEC classifies into three groups: the first ~ persons with total loss disability in need of outside care; the second - persons with significant disability, but not in need of outside care; the third - persons with limited labor function.
The main statistical accounting MSEC documents
are the “Inspection certificate in MSEC” and “Statistical coupon for the certificate of inspection in MSEC”. As a result of their development, appropriate indicators of the frequency or structure of disability by sex, age, etc. are obtained. The most important indicator is the frequency of primary disability (primary disability - the totality of persons recognized as disabled for the first time per 1,000 or 10,000 of the total working population), analyzed in dynamics by years, by disability groups, by occupational age.
The level of disability depends on social and hygiene factors, industrial and living conditions, legal status, as well as from the treatment, diagnostic and preventive activities of medical institutions, therefore, when referring patients to medical and social expertise it is important to characterize in detail the volume and quality of medical care, clinical examination, duration of illness, etc. The results of such an assessment will help identify defects in the organization of medical care and find a way to reduce disability.
The method of studying morbidity according to the data of medical examinations is based on conducting in-depth comprehensive preventive examinations (preliminary, periodic, targeted) performed by groups of specialized doctors.

pianists. The primary accounting documents for medical examinations are the “Prophylactic Examination Card”, Form No. 046 / y, “Medical Card of an Outpatient”, Form No. 025 / y, “Medical Clinical Record Card”, Form No. 131 / y.
According to the results of preventive examinations, the indicator of "pathological damage" is determined, calculated for 100 examined. At the same time, newly diagnosed patients are divided into "practically healthy" and patients in need of medical care, and the reasons for not applying to medical institutions are studied and analyzed. Data from medical examinations are diagnostic value, accuracy and reliability. Using this method, mainly cases of chronic diseases that were previously unknown or with which the population does not actively apply to medical institutions, morphological and functional abnormalities, initial manifestations certain diseases.
Morbidity according to the causes of death is studied according to the reporting document "Medical death certificate", form No. 106 / y. In this document, the point concerning the cause of death is especially important. In this case, it is necessary to correctly name and put in the first place the immediate cause of death, then indicate the disease that caused or caused the immediate cause of death (the underlying disease), list others important diseases that contributed to the death, but not associated with the disease or its complication, which served as the direct cause of death
Undoubtedly, this method study of morbidity is ancillary. However, it significantly complements the data on general morbidity, especially in relation to the most severe diseases that ended lethal outcome helps to develop measures to reduce mortality and mortality.
All of these methods of studying morbidity have their own characteristics, advantages and disadvantages. Thus, in the study of morbidity, according to the data of the appeal to medical institutions, acute diseases are predominantly detected, and chronic diseases are mainly in the acute stage. In the study of morbidity, according to medical examinations, chronic

cal diseases that occur in patients without obvious symptoms, especially on initial stages or in compensation. Morbidity with temporary disability covers far from all diseases, but only those that were the cause of temporary disability of the working population.
Thus, each of the described methods only within its capabilities gives an idea of ​​the prevalence of diseases. Therefore, in order to have complete and reliable data on the incidence of the population, it is necessary to use all the presented methods in a complex manner.
Recommended literature

1. M erko in A. M., Polyakov L. E. Sanitary statistics. - L.: Medicine, 1974. - 384 p.
2. Cases Ko IS, Tserkovny G, F. Statistical information in the management of health care institutions. - M.: Medicine, 1976. - 224 p.
3. Bushtueva K. A., Cases to I. S. Methods and criteria for assessing the health status of the population in connection with environmental pollution. - M.: Medicine, 1979. - 160 p.
4. Zhuravleva K.I. Statistics in health care. - M.: Medicine, 1981. - 176 p.
5. Social hygiene and healthcare organization (under the editorship of A. F. Serenko and V. V. Ermakov). - M.: Medicine, 1984. - 640 p.
6. Guide to social hygiene and healthcare organization (under the editorship of Yu. P. Lisitsin). T. 1, M.: Medicine, 1987. - 432 p.

It is known that public health depends on the impact of various factors: social and biological, material and spiritual, internal and external. Among them, the social, industrial and geographical environments are decisive. In recent years, the state of health has been aggravated by the growing environmental stress of the environment and the low level of adaptation of the population to market forms of socio-economic relations. The study of the health status of the population should now be based on a combination, integral expression of social and natural factors that form and determine the level of population health.

Therefore, population health indicators should be seen as the end result of an interrelated interdepartmental system its protection at the level of the state, large region, region, district.

It is well known that one of the main criteria for the state of health of the population is morbidity. In the current changed socio-economic conditions, establishing the level and structure of general morbidity presents a certain difficulty, which is explained by a number of reasons: first of all, the rise in the cost of medical services and drug provision, the deterioration of the social population, paid services during some laboratory tests, as well as limited medical care in rural areas.

In socio-hygienic studies, as an overview characteristic of the state of health of the population, as a rule, indicators of general morbidity are used, differentiated by its main structural components (classes, nosological forms and groups of diseases). Considering the ethnopathogenetic mechanisms of the formation of various types of pathology, the statistical description of morbidity, as a socio-biological phenomenon, was carried out for the largest statistical groups - 19 classes of diseases, injuries and causes of death. WHO, 1995

Analysis of the results of studies in the regions of the Kyzylorda region for the period 2006-2010 (Tables 19-23) shows that the incidence rate in the region according to the population's accessibility to medical institutions varies within different limits from 64,799.9 ± 62 in 2006 to up to 32539.2±59.6 - in 2010 per 100 thousand population. A similar pattern is observed in the context of the analyzed districts of the region. At the same time, a very interesting feature was revealed: the negotiability for medical assistance residents of settlements where there are no medical posts, amounted to 54182.9 ± 190 per 100 thousand population in 2006 in the Aral region, a higher incidence rate was detected in settlements, where the central district hospitals are located - 91355.3±107 (Kazalinsky district).

An analysis of the literature published over the past twenty years also confirms different level accessibility of the population for medical care. In particular, V.A. Medic, 1991 gives an indicator of the general incidence of the rural population of the Novgorod region, equal to 731.6 appeals per 1000 population.

Moreover, a high level of morbidity was found in the settlements where the central district hospitals are located (840.5%). The low level of this indicator was established by the author in the settlements where district or medical outpatient clinics are deployed (652.5%).

A.P. Ayriyana with co-authors, 1990 it was found that the frequency of outpatient visits of the rural population of the Ararat region of Armenia was 748 per 1000 population, and for men this figure was higher (801.0%) than for women (699.0%).

In the conditions of Kazakhstan, an in-depth study of the general morbidity of the rural population according to the data of a three-year visit to health care facilities in 11 rural areas was carried out by T.K. Kalzhekov (1990). According to him, the incidence rate was 872.1 cases per 1000 population (diseases of the oral cavity and teeth were excluded), including 832.7 in men, 821.9 in women. Along with this, when calculating the incidence rate according to the data of the appealability, the author used the materials of medical assistant registration of diseases, carried out in settlements

(Aral, Kazalinsky districts).

The research results obtained by us in this work are identical and closer to the data of S.Kh. Dushmanov (1984), who conducted similar studies in the Taipak district of the West Kazakhstan region, located in the same climatic and geographical zone with the base territory of our observation. According to his data, the morbidity rate according to his data was equal to 668.7 per 1000 population. At the same time, the incidence rate in men was 597.5%, in women - 734.9% per 1000 population.

The morbidity data obtained by us in terms of negotiability coincide with the results of the studies of the above-mentioned authors and they confirm the dependence of the level of negotiability on the availability of medical care to the population. In other words, the level of negotiability is inversely proportional to the distance to the medical institution. In addition, this indicator also depends on the level of staffing by doctors of narrow specialties.

In the structure of morbidity according to the appeals of rural residents for 2010, living in the Aral Sea area, leading place ranks pathology of the respiratory system, the share of which was 28.7% of all diseases of the total number of applications - 19625.6 per 100 thousand people. In second place is the number of visits for diseases of the digestive system (12.4% or 8505.5 per 100 thousand of the population) with the same frequency of visits, both in men and women. However, if we do not exclude diseases of the hard tissues of the teeth from the class of the digestive system, then the diseases of this system come out on top in almost all ecologically disadvantaged areas. In third place are blood diseases and hematopoietic organs, which account for 10% of the total number of applications or 6789.3 per 1000 population (Table 13, 14,15,16).

Table 13 Incidence by referrals in the context of the main classes of diseases in the regions of the Kyzylorda region for 2006-2007 (indicators per 100 thousand population)

Table 14 Incidence by referrals in the context of the main classes of diseases in the regions of the Kyzylorda region for 2008-2009 (indicators per 100 thousand population)

Table 15 - Morbidity by referrals in the context of the main classes of diseases in the regions of the Kyzylorda region for 2010 (indicators per 100 thousand population)

Table 16 - Morbidity according to medical examinations in some districts of the Kyzylorda region in the context of the main classes of diseases. Average data for 2006-2010 (indicators per 1000 population)

Observations recent years in the region under study convince us that chemical composition water is not only an indicator of its quality, adversely affecting sanitary conditions life of the population, but negative factor that adversely affect human health. This is evidenced by diseases of the genitourinary system, which occupy the fourth place in the structure of morbidity in terms of appeals in the Kyzylorda region: 8.6% of the total number of appeals (5837.9 for the same population). The fifth and sixth places are respectively occupied by diseases of the skin and eyes, its appendages, and the seventh, eighth and ninth places are occupied by diseases of the nervous system and circulatory organs, injuries and poisoning. The listed 9 classes of diseases make up 83.5% of all diseases, for which in 2010 there were registered applications to medical institutions (MPI) of the region.

In the structure of the incidence of the population of individual regions, the above-mentioned classes of diseases are found in most cases, but the rank arrangement of different classes of diseases may not be the same.

At the same time, it should also be noted that the morbidity of children in terms of negotiability in almost all analyzed districts of the region is higher than that of the adult population. This difference is especially pronounced in such regions as Aral and Kazalinsky.

Thus, the analysis of morbidity materials according to the data of outpatient visits made it possible to identify a certain regularity and regional features of the nature of the pathology of the rural population in the Aral Sea region. The data obtained clearly indicate sharp fluctuations levels of negotiability in different territories, which, in our opinion, is due varying degrees completeness of accounting, level of accessibility and specialization of medical care, especially in rural areas. In other words, this indicator largely depends on a number of factors, both objective and subjective. In particular, P.P. Petrov, T.K. Kalzhekov, (1990) on a large factual material convincingly showed that some patients who need medical care do not go to doctors even with a three-year period of observation of the population's accessibility to health facilities. To a certain extent, the listed shortcomings make it difficult to objectively assess the incidence rates according to the data on the use of medical facilities and dictate the expediency of supplementing it with in-depth comprehensive medical examinations of rural residents.

Therefore, in order to establish the true level of morbidity and determine the number of patients who do not seek medical help for a long time, an in-depth comprehensive medical examination (CMO) of the rural population living in the Aral Sea zone and at control observation sites was carried out.

From the standpoint of protecting public health and preventing morbidity, in our opinion, living conditions, determined by the increased mineralization of natural water sources, have the greatest hygienic significance. It is well known that natural waters increased mineralization have a vast area of ​​distribution, and in a number of districts of the Kyzylorda region are the only source water supply.

According to the results hygiene assessment water quality, the population of the studied districts of the region were divided into two groups: the population of the first group: Aral, Kazalinsky districts used water of increased mineralization, the second group (control - Zhambyl) used water of optimal salt composition, corresponding to SanPiN 3.01.067.97. Of those examined in the Aral region, 99.4% were women (35401), 99.5% were men (35770). In other areas, these ratios were as follows: Kazalinsky - women 35828 or 99.3%, men - 36344 people (99.4%). The study was conducted in the period 2006-2010.

At the same time, the data on morbidity according to attendance were significantly supplemented mainly due to diseases of the digestive system, diseases of the nervous system and sensory organs, diseases of the circulatory system, respiratory organs, diseases of the genitourinary system, birth defects development and chromosomal abnormalities.

The analysis of the incidence according to the data of medical examinations in the study region indicates its similarity with that according to the materials of outpatient visits, and also allows us to identify some of its features. Attention is drawn to the very high level of morbidity according to medical examinations in almost all areas in environmentally disadvantaged areas. It is enough to note that the incidence rates per 1000 population in the Aral, Kazalinsky districts exceed the control level of the Zhambyl district, in the group both sexes, respectively, by 40, 35, 32.5% (2800±8.4; 2700±8.0; 2650±9 .4; control - 2000±5.3) (Table 17).

High performance morbidity according to the data of comprehensive medical examinations in comparison with the same level of referrals convincingly indicate the low availability of specialized medical care at the level of rural medical districts for patients with chronic diseases with a high prevalence various pathologies. On the other hand, it must also be remembered that many diseases occur before certain time secretive asymptomatically, without causing much concern to the patient, which to a certain extent disorientates the latter. In addition, the explanation for the high proportion of pathology additionally identified during medical examinations should obviously be sought in the inattentive attitude of the population to their health and preventive examinations. It is interesting to note the studies of V.A. Medic, (1991) among rural residents of the Novgorod region of the Russian Federation, she received following results: 27.9% of the respondents rated their health as good, 59.8% considered it satisfactory, and only 12% rated their health as poor or very poor. Moreover, 62.4% of the respondents were convinced that they did not have any chronic diseases.

Table 17 - Comparative incidence rates of the study areas according to medical examinations. Average data for 2006-2010 (indicators per 1000 population)

As a result of the work carried out, a high level of morbidity of the rural population in the study area was established not only in the “both sexes” group, but also in each study group. Moreover, the detected levels of diseases in these areas are close to each other. For example, the incidence rate per 1000 population among men in the Aral region was 2747.6 ± 11.6, in Kazalinsky - 2670.7 ± 11. A similar pattern is also observed in women (respectively - 2853±12.2, 2729.7±2749±14.1). At the same time, this indicates the homogeneity of the selected group for studying the health of the population, taking into account socio-economic, natural-climatic, sanitary-hygienic, environmental and demographic risk factors for the development of pathology in the population.

In the structure of this incidence, the first ranking place in the main observation group belongs to diseases of the digestive system, the share of which in the Aral region was 16.3% of all registered diseases or 455.1 cases per 1000 population, in Kazalinsky - 15.7% (425.2 per 1000). 1000 people) for the same population.

The most common pathologies in this class of disease are: gastric and duodenal ulcers, gastritis and duodenitis, cholelithiasis, cholecystitis, cholangitis, pancreatic diseases, etc.

The second place in the structure of morbidity according to the materials of medical examinations is occupied by diseases of the respiratory organs (the share is 15.5%, 15.5%, 15%, respectively, and the rates per 1000 population are 434.2±1.8, 418.5±1.8, 397.5±2.2). In third place are diseases of the circulatory system: respectively 15.3%, 15.2%, 14.7% of the total number of applications or 427.1, 411.7, 403.9 per 1000 inhabitants. Then, successively, diseases of the nervous system with a specific gravity: 8-7.3-8%, diseases of the eye and its appendages - (6.5-6.3-7.3%). These five classes of diseases account for 61.6-60-61.5% of all diseases in the main regions, respectively.

Incidence rates in women are generally higher than in men, which is consistent with literature data. At the same time, the incidence rates of the musculoskeletal system and connective tissue in men, as well as injuries and poisonings, significantly exceed those of women.

Summarizing these data, we are convinced by a specific example that the problem of establishing the true level and structure of morbidity can only be solved by conducting in-depth comprehensive medical examinations. A careful analysis of Table 24 draws attention to almost all analyzed classes of diseases with very high incidence rates in the main group, which are much higher than similar levels in the control area. In the vast majority of cases, the differences between the compared pathologies are statistically significant (P<0,001).

Table 18 shows the comparative indicators of the leading classes of diseases in three ecologically unfavorable districts of the Kyzylorda region, depending on the nature of the salt composition of the water consumed.

For control, the Zhambyl district of the Almaty region was taken, where the average level of water mineralization over the past five years was 900±95 mg/l. From the data presented in the above table, it can be seen that the data of the leading classes of diseases in the main group of districts do not differ much from each other. However, when compared with the control group (Zhambyl district), this difference is significant with a very high degree of certainty (P<0,001). В контрольном районе анализируемые классы болезней по своим показателям примерно в 1,5 раза ниже аналогичных уровней основной группы наблюдения.

Table 18 - Comparative incidence rates of the population of the study areas, depending on the nature of the salt composition of the water consumed (indicators per 1000 population)

At present, it is considered proven that water with a high degree of mineralization causes a number of disturbances in water-salt metabolism, the functional activity of the cardiovascular and digestive systems, and contributes to the development of atherosclerosis, arterial hypertension and cholelithiasis. This is convincingly confirmed by the materials of medical examinations of our studies, which is shown in Table 26.

A comparative assessment of morbidity rates indicates that the residents of the first group had the highest level. In this group, the level of individual analyzed nosological forms of diseases was from 1.4 to 2 times higher than in the second group.

We have established a high functional relationship between the above-mentioned nosological forms of diseases and the level of water mineralization. This is convincingly shown in Table 19 on the example of the Aral region. As can be seen from the data in this table, hypertensive disease, coronary heart disease, cholelithiasis, urolithiasis and bronchial asthma have a high close relationship with the level of mineralization.

Table 19 - The influence of the level of mineralization on some indicators of the incidence of the population (per 1000 inhabitants)

The above values ​​of the correlation coefficients indicate the presence of a stable relationship between the compared phenomena. Unfortunately, such dependences have so far been assessed visually without determining qualitative parameters, which significantly reduced the objectivity of the analyzed material. In our opinion, it is the parameters of the qualitative dependence of changes in population health indicators on the impact of various risk factors that make it possible to select a certain range of significant evaluation indicators, which can greatly simplify the system for monitoring the state of public health.

The results of assessing the health status of the population living in the Aral Sea region indicate the great importance of the salt composition of water in the ethnopathogenesis of many diseases. The endemicity of the spread of the disease in those settlements of the region, the water supply of which is carried out from the river. Syr Darya, as well as the originality of the physicochemical composition of urinary stones, confirms the role of the water factor in the pathogenesis of many diseases of the digestive system. In this regard, it was considered appropriate to analyze diseases of the digestive system in the Kyzylorda region for a long period of observation, to determine the prognosis of this pathology for the near and long term.

An analysis of the incidence data given in Table 20 indicates a steady increase in the studied pathology over the past 17 years in the Kyzylorda region. Already by 2008, the incidence of digestive organs increased by 1.6 times compared to 2006. This, to a certain extent, coincides with the intensity of environmental degradation of the human environment in the Aral Sea area. In the future, the trend of a further increase in the incidence of the digestive system persists until 2008.

For forecasting, we used the extrapolation method, which is based on the assumption that previous trends will continue in the future and its logical basis is the assumption that the influencing factors remain unchanged. Forecasting using this method is carried out in several successive stages, when, based on the available data on the incidence for the study period of 2006-2010, using the calculated coefficients, the expected theoretical indicators were calculated.

The applied extrapolation method showed that the incidence of the digestive organs in the observed region will remain stable in the near future with a trend of further growth and will amount to 16419 cases in 2012, and in 2015 it will probably increase by 1.3 times compared to 2006 and will amount to 16841 cases. (table 20).

Table 20 - Calculations of the forecast of the incidence of the digestive system in the Kyzylorda region for the near and long term

In total (I fact.xX): sum XxX

Theor.=Iav.+VxH

I fact.-I theory.

moving average

Forecast: I average + VxX

Thus, the validity of the statement about the existence of a relationship with the prevalence of diseases of the digestive system with the level of mineralization of drinking water is beyond doubt. Here we can talk about the quantitative parameters of this connection, which can be different in different regions.

Despite a slight decrease in the incidence rate of malignant neoplasms (from 266.5 in 2007 to 261.3 in 2008), the proportion of advanced forms was 20.9% (2007-19.1%), and mortality from malignant neoplasms is third position (12.8%) in the structure of causes of general mortality. Among the measures to improve the functioning of screening programs for the detection of malignant neoplasms, it is necessary to adequately equip the oncological service and PHC organizations with the necessary equipment and tools for taking material (SVA, PHC centers), train obstetrician-gynecologists and midwives, additional training of cytologists and radiologists. In order to bring preventive examinations as close as possible to the female population, it is necessary to install a sufficient number of mammographs in cities and districts of the region where there are X-ray rooms. Since 2006, one of the modern methods of diagnosing and treating breast cancer has been actively used in the Aral region - an immunohistochemical study for the Hercept test and targeted therapy with the Herceptin drug in case of HER-2 / neu overexpression. 2011 additional about 45 million tenge for two dispensaries.

Over the past 5 years, the region has seen a decrease in the incidence rate from tuberculosis ( from 153.2 to 128.8 per 100,000 population), however, the epidemiological situation remains tense. In comparison with the average republican indicator (RK for 2008 - 125.6), the incidence rate of tuberculosis is higher by 2.5%.

Despite the trend towards stabilization of epidemiological indicators, there is a further rejuvenation of the incidence of tuberculosis (76.4% - persons from 18 to 55 years old), an increase in the proportion of cases from among non-working and socially maladjusted groups, and an increase in the incidence of drug resistance. In the Aral region, the mortality rate from tuberculosis increased from 23.9 to 25.7, which is 1.5 times higher than the indicator in Kazakhstan - 17.2 per 100,000 population. In 2008, the incidence rate for children was 27.3 per 100,000 population, adolescents - 106.3 (children's incidence in the Republic of Kazakhstan - 26.4, among adolescents - 122.7). Isolation of children from foci of tuberculosis infection is carried out only in a quarter of cases, as a result of which children with an advanced form of tuberculosis are detected annually, while there is an increase in tuberculosis among contacts from 23.7% (2007) to 27.5% (2008). The region lacks pre-school sanatorium groups, while more than 50% of cases of children from foci of infection need isolation and rehabilitation, more than 90% of children from "risk" groups. The epidemiological situation in the Aral region is complicated by the presence of a large number of correctional institutions, a significant number of tuberculosis patients in them. The incidence of active tuberculosis among this contingent is more than 6.3 times higher than among the civilian population of the region. The mortality rate in these institutions remains high and amounts to 126.8 per 100,000. prison population. In addition, in 2008, 108 convicts suffering from tuberculosis were released to the Kyzylorda region (99 in 2007).

For the timely detection of the disease, the institutions of the general medical network of the region are not sufficiently provided with binocular microscopes of high resolution, 11 institutions of the region need to purchase microscopes. To ensure the treatment of tuberculosis patients at the outpatient stage, 16.5 rates of chemizers were introduced to the staff of family medical outpatient clinics, independent city and village clinics by the beginning of 2008, which is clearly not enough for today (23.0 rates in 2007).

The Aral region is in the concentrated stage of the HIV / AIDS epidemic (0.17% of the population with an average global indicator of 1.1%). As of January 1, 2009, 1,059 HIV-infected people were registered. An analysis of the dynamics of the incidence of HIV infection indicates a pronounced upward trend in the incidence, the average annual growth rate is 33.3%. In order to stabilize the spread of HIV infection at the concentrated stage of the epidemic, the implementation of the Program to combat the AIDS epidemic in the Kyzylorda region until 2010 will continue, which provides for the expansion of preventive measures, as well as the provision of full antiretroviral therapy to AIDS patients who need it.

Since August 2007, a method of rapid testing has been introduced in obstetrical institutions of the region to diagnose HIV infection in pregnant women who were not registered with the dispensary. In 2008, the need for express tests for pregnant women was recalculated, and all obstetric facilities were provided with tests in the required volume. 2165 pregnant women were examined by the express method for HIV/AIDS, two women were identified with HIV positive results (37 in 2007).

The situation in the Kyzylorda region on drug use remains tense. The number of people under the supervision of narcologists with drug addiction is increasing. In 2006 - 4499, in 2007 - 4809, in 2008 - 4881. Due to the growth of drug addiction, the number of patients treated inpatients is increasing. According to the analytical report on "Monitoring of the drug situation in the Republic of Kazakhstan for 2007", the Kyzylorda region ranks fourth in terms of the number of people treated for drug addiction, which amounted to 1012 people. There is one Center for the treatment and rehabilitation of drug addicts in the region, in which, due to the unsuitability of the premises, it is not possible to separate the stages of treatment and rehabilitation, which affects the quality of assistance provided. The narcological service of the region is insufficiently equipped with computer and multimedia equipment, regional medical associations of the region with tests for the determination of drugs. In addition, it is necessary to purchase a separate building with a territory for the Center for Medical and Social Rehabilitation of Drug Addicts.

Analyzing the indicators for the psychiatric service for 2008, it can be noted that according to the nosologies taken for dispensary registration, a greater number are accounted for by organic disorders, mental retardation and neurotic disorders. It is these nosological groups that determine a large percentage of morbidity among the population, which is caused by a high level of injuries and the prevalence of diseases of the cardiovascular system, leading to vascular encephalopathies. The causes of mental retardation are unfavorable environmental conditions, congenital and hereditary pathology. An increase in the number of neurotic disorders is a worldwide trend, which is associated with many non-medical factors of a socio-economic nature that lead to stress in everyday life, in the family and at work.

Further stabilization of the sanitary and epidemiological situation and improvement of public health remain an urgent task. In the Aral region, there is a high incidence of hepatitis B (more than 10 cases per 100,000 population), which is one of the highest in the country. In the coming years, a high infectogenic potential of the causative agent of viral hepatitis "A" is predicted, which, along with the presence of a large number of persons susceptible to infection, will maintain unfavorable conditions for this disease. There is still a risk of complication of the epidemiological situation associated with the threat of importation of especially dangerous and other infectious diseases, although no outbreaks have been registered in the border areas (SARS, avian influenza, type 71 enterovirus infection, etc.).

The development of most chronic non-communicable and socially significant diseases (diseases of the cardiovascular system, diabetes mellitus, etc.) is associated with a person's lifestyle. In this regard, it becomes important to form a healthy lifestyle of Kazakhstanis living in the zone of ecological disaster, the development of physical culture. The implementation of measures in the field of promoting a healthy lifestyle would contribute to strengthening intersectoral interaction, especially in such matters as limiting the sale of alcohol and tobacco products, and road safety.

The low level of quality of medical services, insufficient availability and quality of medicines cause an insufficient level of quality of medical care.

To improve the quality of medical services, it is necessary to constantly train qualified personnel, standardize medical care, accreditation of healthcare organizations, to solve this issue, periodic protocols for the diagnosis and treatment of diseases have been introduced in all health care facilities of the region, which is confirmed in 56 verified medical organizations in the region.

At the same time, the number of complaints from the population about the poor quality of medical care in health care facilities in the Kyzylorda region is increasing. Every year, about 63% of complaints are recognized as justified.

The shortage of personnel at the beginning of 2009 amounted to: 564 doctors, 98 paramedical workers, including 197 doctors and 24 paramedical workers in rural areas. Despite the increase in the provision of the population with medical personnel of all specialties with other departments (from 37.7 in 2004 to 40.5 per 10,000 population in 2008), the provision with practical doctors has been declining for a number of years. The staffing of medical organizations with doctors is decreasing from 78.1% in 2004 to 70.2% in 2008. In rural areas, these figures are even lower.

There is a trend of "aging" of medical personnel: people over the age of 50 account for 36.4%, under 30 only 11.6%. The proportion of specialists with more than 25 years of experience is increasing, which indicates a decrease in the influx of young personnel. The situation is aggravated by the lack of a concept for the development of human resources.