In recent years, the problem of functional diseases of the gastrointestinal tract (GIT) has become increasingly relevant, due to the widespread prevalence of this pathology and the numerous problems associated with it. Every second inhabitant of our planet suffers from gastrointestinal diseases, which significantly worsen the quality of life of citizens, limit their social and work activities. Gastrointestinal diseases are a group of diseases associated with damage to the esophagus, stomach, intestines, liver and pancreas. As a rule, they are chronic They often have a recurrent course, reduce the quality of life and can lead to disability. A significant argument determining the medical and social significance of diseases of the digestive system is that all age groups of the population suffer from this pathology [1-3]. Goal / Strive Assessment of the morbidity and disability status of the adult population of the Krasnoyarsk Territory with liver pathology for the period 2021-2023. Materials and methods / Materials and methods The research is continuous. The object of the study: a contingent of people aged 18 years and older with diseases of the gastrointestinal tract, including cirrhosis of the liver. Information sources: state report on the health status of the population of the Krasnoyarsk Territory for 2021-2023 of the Ministry of Health of the Krasnoyarsk Territory [1-3], Federal State statistical Observation Form No. 7-sobes, approved by Rosstat Order No. 742 dated 05.12.2019, for 2021-2023. [4], the Federal State Information System "Unified automated vertically integrated information and analytical system for conducting medical and social expertise". Ratings / Results Citizens with a progressive course of the disease, persistent disorders of body functions, which cause disability and lead to the establishment of the first, second, and third disability groups, are referred for medical and social examination (ITU) [5]. The structure of primary disability among the adult population by class of digestive diseases for 2021-2023 is shown in Table 1. Table 1 The structure of primary disability among the adult population by class of digestive diseases for 2021-2023 Name of the disease / Name of the disease2021 2022 2023 abs.ct./ abs.ct.s.ct./ abs.ct.s.ct./ abs.ct.% Diseases of the digestive system, of which: / Diseases of the digestive system, including: 250 100,0 236 100,0 365 100,0 Cirrhosis of the liver 204 81.6 181 76.7 287 78.6 Crohn's disease 15 6.0 7 3.0 18 4.9 Name colitis / Ulcerative colitis 6 2.4 16 6.8 9 2.5 Friends / Others 25 10.0 32 13.5 51 14.0 Cirrhosis of the liver is the most relevant for medical and social expertise, as it ranks first in disability among gastrointestinal diseases. Cirrhosis of the liver is a chronic progressive liver disease that develops after a prolonged period of inflammatory or toxic effects, as a result of which healthy liver parenchyma is replaced by fibrous tissue and regenerative nodules, leading to portal hypertension (PH) and hepatic cell insufficiency (hepatic insufficiency). The disease develops from an asymptomatic phase (compensated cirrhosis) to a symptomatic phase (decompensated cirrhosis), the complications of which lead to high mortality [5]. Cirrhosis of the liver remains a serious public health problem in Russia and abroad. Currently, it occupies one of the main places among the causes of disability of the population and is one of the ten most common causes of death. At the same time, in the age group of 20-40 years, mortality from cirrhosis of the liver exceeds that from coronary heart disease. Despite modern advances in intensive care and transplantation, the mortality rate in the development of liver failure remains high and WHO predicts that over the next 10-20 years, mortality from liver diseases will increase by 2 times [6]. This disease leads to disability in almost 100% of cases and the establishment of a disability group. Cirrhosis of the liver in 75% leads to severe disability groups (second and first) (Table. 2) and the establishment of permanent disability during the initial examination in 16% (Table 3). Table 2 The structure of primary disability of the adult population by disability groups due to cirrhosis of the liver for 2021-2023 (abs. hours) Cirrhosis disability groups 2021 2022 2023 Doctors / Liver disease disability groups I II III I II III I II III cirrhosis of the liver 39 116 49 34 103 44 43 156 88 Table 3 Establishment of an indefinite disability group during the initial examination due to cirrhosis of the liver in 2021-2023 (abs. hours) Indicator name / Indicator name 2021 2022 2023 Indefinite, of which: / Indefinite, of which: 34 24 16 Further / According to the list 16 11 11 Cirrhosis of the liver is a serious disease requiring comprehensive treatment and rehabilitation. Discussion / Discussion Medical rehabilitation of patients with cirrhosis in the compensation stage implies early detection of signs of incipient decompensation of cirrhosis of the liver, the addition of new complications, and consists in the following: 1. A gentle lifestyle with limited physical activity, with the exception of alcohol and hepatotoxic substances. 2. A diet with a restriction of proteins and table salt. Complex therapy: multivitamins, hepatoprotective agents, blood products and blood substitutes, means of detoxification. 3. Treatment of complications of cirrhosis of the liver: correction of nutritional status, prevention and treatment of varicose veins, treatment of hepatic encephalopathy, treatment of hepatorenal syndrome, treatment of ascites. With timely and proper treatment, it is possible to slow down the progression of cirrhosis of the liver at least and achieve the reverse development as much as possible. Close interaction between the patient and the doctor, regular monitoring and strict compliance with the recommendations and prescriptions of the attending physician are of no small importance. 4. Liver transplantation. Liver transplantation is a last resort when all possible methods have been exhausted. treatment. It is the only effective treatment for irreversible liver damage complicated by progressive liver failure. The indication for liver transplantation is irreversible acute or terminal stage of chronic liver failure of various etiologies. The need for liver transplantation is 20 people per 1,000,000 population per year. This method of treatment is also in demand in the Krasnoyarsk Territory. So, in 2021, 8 transplants were performed, in 2022 -9 transplants, in 2023 - 10 transplants. The development of the liver transplantation program at the Krasnoyarsk Regional Hospital has made this type of high-tech medical care more accessible to residents of the region. A special feature of the Krasnoyarsk Territory is the high prevalence of parasitic liver damage, and, accordingly, a large number of patients with unresectable forms of alveococcosis are on the waiting list. The survival rates of patients after liver transplantation surgery are comparable with the results of the leading transplant centers in Russia. Currently, a shortage of donor organs, as well as a limited human resource, is a constraining factor in the development of transplantology in the Krasnoyarsk Territory [5]. After liver transplantation, one-year survival is 85-90%, five-year survival is 70-75%, ten-year survival is 60%, and twenty-year survival is 40% [1-3]. During the initial examination after liver transplantation, disability group I is established during the first 2 years (Table 4). Table 4 The structure of primary disability of the adult population by groups after liver transplantation for 2021-2023 (abs. hours) Disability groups / Disability groups 2021 2022 2023 Group I / 1st group 3 4 6 Group II / 2nd group 0 0 0 Group III / 3rd group 0 0 0 Table 5 Distribution of newly recognized persons with disabilities by groups after liver transplantation in 2021-2023 (abs. hours) Disability groups / Disability groups 2021 2022 2023 I 1 1 1 II 2 2 2 III 2 3 4 Upon repeated examination after two years after liver transplantation, in the presence of complications with moderate or severe impairment of body functions, disability group III or II is established (Table 5). The stability index of the first disability group over the years was 23%. The partial rehabilitation rate for disability groups II and III was 37% and 40%, respectively. Partial restoration of the disabled's abilities for household, social, professional and other activities is determined by the result of surgical treatment: the degree of functional viability of the transplanted organ and the presence (absence) of postoperative and/or post-transplant complications [7]. Professional rehabilitation. When considering the issue of vocational rehabilitation, it is necessary to take into account the emotional and volitional attitudes of a disabled person to continue working, the nature of work and working conditions. Contraindicated types and working conditions are work associated with severe physical exertion, high set pace, forced body position, vibration, driving vehicles, exposure to toxic agents (salts of heavy metals, chlorinated hydrocarbons and naphthalenes, benzene and its homologues), high or low temperatures. This takes into account the stage of the disease, the nature of the course, the degree of liver dysfunction, the stage of portal hypertension, and systemic manifestations. Citizens are recognized as able-bodied in accessible types and conditions of light physical labor, as well as mental labor with moderate neuropsychiatric stress, functionally compensated or with mild liver dysfunction, without systemic manifestations, in the absence of signs of process activity, and chronic hepatitis IV (Child-Pugh stage A liver cirrhosis) of stable course. with the same frequency and duration of exacerbations and the state of liver functions, with portal hypertension of the first stage without manifestations of hypersplenism. Social rehabilitation helps to compensate for the impaired vitality of people with disabilities, including those with disabilities. This type of rehabilitation consists in carrying out measures to normalize the lost functions of the body.: - physical education and physical therapy; - social and psychological assistance, trainings; - provision of technical rehabilitation devices; - social and household services for the disabled (medical procedures and household services at home). Conclusion / Conclusion In general, rehabilitation for cirrhosis of the liver should be individualized and multi-modal, taking into account all aspects of the disease and the needs of the patient. Despite the fact that cirrhosis of the liver is a very dangerous disease that can lead a patient to death, it can and should be combated. At the same time, success depends both on a timely diagnosis and on the right treatment tactics. Ethics of publication. The submitted article has not been previously published, and all borrowings are correct. Conflict of interests. There is no information about a conflict of interest. The source of financing. The study had no sponsorship....
According to various sources, today, about 2.4 billion people in the world suffer from diseases in which any type of rehabilitation measures are indicated. [1-3] According to forecasts, these figures will steadily increase due to the growth of chronic diseases, often associated with an increase in life expectancy of populations, an increase in disability rates and changes in other socio-demographic characteristics [46]. In 2017, WHO launched the Rehabilitation 2030 program, emphasizing the exceptional importance and prospects for the development of this area [7-10]. Rehabilitation sets as its main goal the maximum independence, independence and integration of a disabled person into society. Among the many aspects facing a multidisciplinary team of specialists, one of the most important is to improve the patient's quality of life [11-13]. According to the definition of the World Health Organization (WHO), this term It covers the physical, psychological, emotional and social health of a person based on his perception of his place in society [14-17]. Goal/ Aim To assess the quality of life of people with disabilities due to malignant neoplasms of the brain in Moscow. Materials and methods / Materials and methods As a result of a voluntary informed consent survey of 286 disabled respondents over the age of 18, data were obtained that made it possible to assess the quality of life of people with disabilities due to malignant neoplasms of the brain. The assessment of the quality of life of people with disabilities due to malignant neoplasms of the brain was carried out on the basis of the EQ-5D quality of life questionnaire, taking into account disability groups. The assessment was carried out according to 5 components: D1 — mobility or the ability to move; D2 — self—care; D3 — daily activities; D4 — pain / discomfort; D5 - anxiety/ depression, as well as on the EQ-VAS scale, where it is considered to be up to 75% minor disorders, up to 50% moderate disorders, up to 25% are significant violations and less than 25% are pronounced violations. Results / Results Assessment of mobility in movement: 25.1% of respondents (72 people) had no problems, 68.2% of respondents experienced some difficulties, and 6.7% of respondents "I am completely bedridden." In 100.0% of the disabled of group III, there were no problems. 111 disabled people (38.9%) did not have difficulties with self-care, of which 100.0% were disabled in group III and 63.4% were disabled in group II of the total number of inva the leads of these groups. 154 disabled people (53.9%) experienced some difficulties in self-care, of which 84.3% (113 people) were disabled in group I and 41 people (36.6%) were disabled in group II. 7.2% of respondents (21 people) are not capable of self-care, all disabled people of group I. 93 of the respondents (32.5%) had no problems with performing their daily duties, of which 49.1% (55 people) of the disabled of group II and 95% of the disabled of group III. 150 disabled people (52.6%) noted some difficulties with performing daily duties, 47.3% of them in group II disabled people, 70.9% in group I disabled people (Table 1). 14.8% of disabled respondents are unable to perform daily duties, 29.1% of them in group I disabled people and 3.6% of cases among disabled people of the II group. Table 1 Comparative characteristics of the answers to the problems of movement, self-service, and performing daily duties (abs. number, %) Categories / CategoriesVariants of respondents' (disabled) responses / Respondents’ (disabled) response options / Total Disability groups / Disability groups IIIIII abs. ch. / abs. numberabs. ch. / abs. numberabs. ch. / abs. numberabs. ch. / abs. number Total / Total286100,0134100,0112100,040100,0 Movement I don't have any problems with movement 72 25,1 — — 32 28,6 40 100,0 I have some difficulty moving 19568,211585,88071,4—— I am completely bedridden196,71914,2———— Self-service I don't have any problems with self-service 111 38,9 — — 71 63,4 40 100,0 I have some problems washing or dressing.15453,911384,34136,6—— I am completely unable to wash or dress on my own217,22115,7———— Doing my daily chores I have no problems doing my daily chores. 93 32,6 — — 55 49,1 38 95,5 I have some problems with doing my daily chores 15052,69570,95347,32— I am completely unable to perform my daily duties 4314,83929,143,6—— 12.7% of respondents (36 people) did not experience pain and discomfort, 67.2% (192 people) noted moderate pain and discomfort, of which 85 were disabled in group I (63.4%), and 92.0% (103 people) were disabled in group II. Severe pain or discomfort was noted by 58 disabled people (20.1%), of which 49 people were disabled in group I (36.6%), disabled people in group II — 8.0% (9 people). Anxiety or depression was not noted by 17.1% of respondents (49 people), of whom 67.5% were disabled Groups III, 16.1% of the disabled of group II and 33.0% of the disabled of group I. 156 (54.5%) respondents experienced moderate anxiety or depression, of which 77 people (57.5%) with disabilities of group I, 71 people (63.4%) with disabilities of group II and 20.0% with disabilities of group III (Table 2). 81 disabled respondents (28.4%) noted severe anxiety or depression, of which 53 were disabled in group I (39.5%), 23 were disabled in group II (20.5%) and 5 were disabled in group III (12.5%) (Table 2). Table 2 Characteristics of responses of respondents with disabilities of the I-II-III disability groups on problems of pain/discomfort, anxiety and depression (abs. number, %) / Categories / CategoriesVariants of respondents' (disabled) responses / Respondents’ (disabled) response options / Total Disability groups / Disability groups IIIIII abs. ch. / abs. numberabs. ch. / abs. numberabs. ch. / abs. numberabs. ch. / abs. number Total / Total286100,0134100,0112100,040100,0 Pain/Discomfort I don't feel pain or discomfort 36 12,7 — — — — 36 90,0 I am experiencing moderate pain or discomfort19267,28563,410392,0410,0 I am experiencing severe pain or discomfort 5820,14936,698,0—— Anxiety/Depression I do not experience anxiety and depression 49 17.1 4 3.0 18 16.1 27 67.5 I am experiencing moderate anxiety and depression 15654,57757,57163,4820,0 I am experiencing severe anxiety and depression 8128,45339,52320,5512,5 Table 3 shows the structure of the presence/absence of changes in the quality of life of people with disabilities due to cerebral palsy by individual components, taking into account the severity of disability, which implies that among the disabled In group III, there was a slight decrease in the quality of life for all components of the survey, a moderate decrease among the disabled of group II, and a pronounced decrease in all components of the quality of life assessment among the disabled of group I. Table 3 Characteristics of responses of respondents with disabilities of the I-II-III disability groups on problems of pain/discomfort, anxiety and depression (abs. number, %) No. / n Components / componentsevels / Levels 1 — norm / normal2 — moderate violations / moderate violations3 — severe violations / extreme violations total / TOTALIIIIIIIII / TOTALIIIIIIII / TOTALIIIIIIIIIIIIII abs. h. / % / number / s. h./ % / number / s. h. / % / number / s. h. / % / number / s. h. / % / number / s. h./ % / number / s. h./ % / number / s. h./ % / number / s. h. / % / number / s. h./ % / number / s. h. / % / number / s. h./ % / number / s. h./ % / number / % D 1 Mobility and the ability to move 72/ 25,1 — 32/ 28,6 40/ 100,0 195/ 68,2 115/ 85,8 80/ 71,4 — 19/ 6,7 19/ 14,2 — — D 2 The ability to take care of yourself 111/ 38,9 — 71/6 3,4 40/ 100,0 154/ 53,9 113/ 84,3 41/ 33,6 — 21/ 7,2 21/ 15,7 — — D 3 The opportunity to engage in social activities 93/ 32,6 — 55/ 49,1 38/ 95,0 150/ 52,6 95/ 70,9 53/ 47,3 2/ 5,0 43/ 14,8 39/ 29,1 4/ 3,6 — D 4 Feeling of pain and discomfort 36/ 12,7 — — 36/ 90,0 192/ 67,2 85/ 63,4 103/ 92,0 4/ 10,0 58/2 0,1 49/ 36,6 9/ 8,0 — D 5 Alarm or 49/ 4/ 18/ 27/ 156/ 77/ 71/ 8/ 81/ 53/ 23/ 5/ depression 17,13,016,167,554,557,563,420,028,439,520,512,5 Discussion The data obtained can be used in the development of measures to improve rehabilitation programs, taking into account the severity of impaired bodily functions of a disabled person and disability, which will contribute to improving the quality of life of a disabled person. Conclusions / Summary The conducted study on the assessment of the quality of life showed that among the disabled of group III there was a slight decrease in the quality of life, among the disabled of group II there was a moderate decrease and among the disabled of group I there was a marked decrease in the quality of life. The data obtained as a result of the sociological study should be taken into account when planning measures for the comprehensive rehabilitation of people with disabilities due to malignant neoplasms of the brain. It is necessary to take into account both the degree of severity of persistent functional disorders people with disabilities and disabilities, but also pay great attention to such types of rehabilitation as social, psychological and socio-cultural....