They are classified as socially determined diseases. Socially significant diseases. Mental and behavioral disorders

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From time immemorial, venereal diseases have been attributed to the number of socially caused infections, or, as they are now called, sexually transmitted diseases (STDs).

Since perestroika and the beginning of the sexual revolution, the incidence of syphilis has increased tenfold in our country.

In 1998, the incidence of syphilis for the first time exceeded the incidence of gonorrhea by more than 2 times (119.9 cases in 1998), although earlier gonorrhea significantly prevailed over syphilis.

The incidence of other forms of STDs also increased several times. From 1985 to 1999 - trichomoniasis by 2.5 times, chlamydia by 2 times, ureplasmosis by 3 times, urogenital candidiasis by 10 times. Such a high prevalence of these diseases indicates drastic negative changes in the lifestyle and living conditions, especially of the younger generation. Promiscuous sex, violations of the hygienic regime, non-compliance with healthy lifestyles, drug addiction, alcoholism are fertile ground for their spread.

Venereal diseases (from lat. Veneris - Venus, the ancient Romans had the goddess of love) - diseases united according to the principle of transmission through sexual contact. A more correct term is: diseases (or infections, diseases) sexually transmitted (STDs, STIs, STDs). Some experts classify STDs into "old" and "new".

The old ones include venereal diseases known since ancient times, and the new ones include urogenital infections detected using modern methods of examination. The "old" STIs include gonorrhea, syphilis, chancre, venereal lymphogranulomatosis, donovanosis. The last three are practically not found in Russia, so only gonorrhea and syphilis are considered “classic” sexually transmitted diseases.

The "new" STIs include HIV infection, viral hepatitis B, C and D, chlamydia, mycoplasmosis, ureaplasmosis, trichomoniasis, gardnerellosis, genital herpes, genital warts, cytomegalovirus and vaginal dysbacteriosis, as well as sexually transmitted skin diseases (scabies, pubic lice, molluscum contagiosum).

Venereology- a section of clinical medicine that studies the causes (including social), development mechanisms, manifestations, methods of diagnosis, treatment and prevention of sexually transmitted diseases. Despite the significant achievements of venereology and the fight against venereal diseases carried out in all countries, they are still widespread and continue to be a serious social and moral problem.

The social significance of venereal diseases is determined by their prevalence, danger and severity of consequences for the health of the sick, as well as the impact on the reproduction of healthy offspring.

Many gynecological diseases, infertility of men and women are often the result of venereal diseases, their complications.

STIs are transmitted through homo- and heterosexual contact: vaginal, anal and oral. The more sexual partners a person has, the higher the risk of infection.

A serious rise in venereal diseases was observed in Buryatia at the turn of the century. For example, during 2000, 2660 patients with syphilis and 1922 with gonorrhea were registered in Buryatia.

Syphilis is an infectious disease caused by a spirochete, a curl-shaped bacterium called Treponema pallidum (Treponemapallidum), which is transmitted primarily through sexual contact and is characterized by a periodic course. In 1905, F. Shaudin and E. Hoffmann discovered treponema pallidum.

Opinions about the origin of syphilis are controversial. An epidemic of syphilis devastated Europe in the last decade of the 15th century, when it was called the "great smallpox" as opposed to the "smallpox". Since the epidemic coincided with the return of Columbus from America (1493), many authorities believe that syphilis was introduced from the West Indies. It is noteworthy that, apparently, Columbus himself died of syphilitic aortitis.

According to another theory, syphilis already existed in the Old World, but it spread more widely during the wars that began shortly after Columbus returned to Europe. When soldiers of the French army wintered in Naples in 1495, they developed syphilitic ulcers in the genital area, and then their bodies began to become covered with a rash. The Italians called it a "French disease", and the French blamed the Italians for everything.

The incidence of syphilis in Buryatia is almost twice as high as in the Russian Federation as a whole, and is 121.7 per 100,000 population.

Infection with syphilis occurs from a sick person sexually or by contact. It can also be transmitted in utero from a mother with syphilis to her child.

After infection, an incubation period lasting an average of 3-4 weeks follows. In the "classical" course of a syphilitic infection, 3 clinical periods are distinguished - primary, secondary and tertiary, which successively replace each other after the incubation period.

The primary period of syphilis is characterized by the appearance of erosive and ulcerative lesions in the genital area and an increase in inguinal lymph nodes. Its duration is 6-7 weeks.

Further, 2-3 months after infection or 6-7 weeks after the appearance of the primary affect (sores), a secondary period of syphilis sets in, in which various rashes on the skin and mucous membranes, hair loss, and sometimes hoarseness of voice are observed; the duration of this period without treatment (or if it is not enough) is on average 3-5 years.

Then the tertiary period of syphilis develops, in which a few nodes and ulcers appear on the body, healing with the formation of scars. With a long duration of the disease and the lack of proper treatment, damage to the internal organs and the central nervous system can be observed, which can lead to death.

Syphilis is an acutely contagious disease that poses a danger to others and damages health, and therefore requires immediate examination and treatment in a specialized institution.

Gonorrhea

Gonorrhea(from the Greek gonos + rhoia - seed + expiration) or gonorrhea (from the German tripper - drip) - a common infectious disease with pronounced manifestations in the genitourinary tract, caused by gonococcus. This is a sexually transmitted disease of a person, the causative agent of which is gonococcus (from the Greek gonos + kokkos - seed + grain), resembling a coffee bean under a microscope. It was discovered in 1879 by the German scientist Albert Neiser.

Gonorrhea is one of the most common sexually transmitted infections. It accounts for a quarter of all STIs.

Manifestations of gonococcal infection can be very different - from an asymptomatic course to pelvic inflammatory disease, general blood poisoning, and even meningitis - inflammation of the meninges caused by this microbe.

However, most often gonorrhea occurs in the form of inflammation of the mucous membranes of the genitourinary organs and is accompanied by purulent discharge from the urethra in men and the cervix in women.

Diseases with a similar clinical picture have been known since ancient times. The modern name of the disease "gonorrhea" was first used by Galen, who in the 2nd century AD. erroneously interpreted discharge from the urethra of men as semen.

In men, the incidence of gonorrhea is 2 times higher than in women. This is because gonorrheal urethritis causes severe burning and pain when urinating, and men are forced to see a doctor. Women usually do not experience discomfort, and only those of them who treat themselves carefully find an increase and purulent nature of the discharge from the vagina.

Gonorrhea can be contracted through any type of sexual contact (vaginal, oral, anal sex).

Young children can become infected during the passage of the birth canal of a mother with gonorrhea. To prevent this, in the first minutes after birth, all babies are instilled into the eyes, and for girls also into the genital slit, 1% silver nitrate solution or 30% albucid solution.

Chlamydial infection

Chlamydial infection has always existed, but they learned to identify it only two decades ago. In 1990, data were published that chlamydia was found in 2/3 of couples undergoing treatment for infertility.

It can live in the urethra, as well as in women in the vagina, and in men - in the prostate gland and seminal vesicles.

It has been established that trichomonads are able to absorb other pathogenic microorganisms that retain their vital functions inside their body. Therefore, with superinfection - simultaneous infection with gonorrhea and trichomoniasis, it is impossible to cure the first without getting rid of the second.

Men, having become infected, usually do not feel any changes and do not go to the doctor. But in women, trichomoniasis is usually manifested by abundant grayish-yellow frothy discharge from the vagina, severe itching and a burning sensation in the vulva, which makes them turn to a gynecologist.

Trichomonas infection can cause infertility. Bank (1966) suggested that infertility due to Trichomonas infection is due to infection of the man (sexual partner) and is not associated with the presence of Trichomonas in women. He drew attention to the fact that successful treatment of a woman does not lead to pregnancy, while after treatment of a man, his partner becomes pregnant. It is believed that these protozoa simply eat sperm.

Recently, some viral diseases of the whole body, one of the ways of transmission of which is sexual contact, have been classified as STDs. This is a herpes infection, papillomatosis, viral hepatitis B, C and D, as well as AIDS

Herpetic infection of the genital tract

Herpetic infection of the genital tract- a viral disease that tends to spread widely. For example, in the United States, this disease is epidemic in nature (there are up to half a million primary cases per year).

The causative agent of herpetic infection of the genital tract is the herpes simplex virus (HerpessimplexvirusHSV). Herpetic lesions were identified already in the 1st century AD by Roman doctors who observed herpetic eruptions on the lips.

The first case of herpetic lesions of the genital tract was registered in 1700. The herpes simplex virus was first described in 1912, and was first isolated from the female genital tract in 1946. The herpes simplex virus develops intracellularly. According to various studies, 65-90% of the world's population is infected with the herpes virus.

Anogenital herpes infection (genital herpes) is a chronic relapsing viral disease, predominantly sexually transmitted, characterized by exacerbation of lesions of the skin and mucous membranes of the genital organs and the genitourinary tract.

Factors contributing to the exacerbation or manifestation of genital herpes include:

• decrease in immunological reactivity;
• hypothermia or overheating of the body;
• accompanying illnesses;
• some mental and physiological conditions (sexual contacts, menstruation);
• medical manipulations (abortion, the introduction of an intrauterine device).

Condylomas, hepatitis and other diseases

warts- anogenital warts are benign warts with localization on the genitals and in the perianal (from the Greek peri + anus - located around + anus) area - the anus.

The disease is characterized by a long latent course and the possibility of the appearance of clinically significant lesions after a long period of time after infection. The causative agent of the disease in more than 90% of cases is the human papillomavirus.

Anogenital warts occur in places that are traumatized during sexual intercourse, and can be either single or multiple.

Some types of papillomaviruses have a very pronounced oncogenic effect. They cause cervical cancer in women and penile cancer in men.

Viral hepatitis B also called serum hepatitis. This name is due to the fact that infection with the hepatitis B virus can occur through the blood, and through an extremely small dose. The hepatitis B virus can be transmitted sexually, by injection with non-sterile syringes from drug addicts, from mother to fetus.

This disease, by all signs of infection and the course of the infectious process in the body, is very similar to AIDS, only liver cells - hepatocytes - are affected in it.

Viral hepatitis C has a more malignant course and can also be transmitted from a carrier of the infection to a healthy person through sexual contact. A complete cure for hepatitis B and C does not always occur, and if the virus remains in the body, then there is a very high probability of developing cirrhosis and liver cancer.

The European Association for the Study of the Liver, which includes Russia, has developed basic principles for the treatment and monitoring of patients with hepatitis C. The basis of all treatment regimens is interferon-alpha. The mechanism of action of this drug is to prevent infection of new liver cells.

The use of interferon cannot guarantee a complete recovery, however, treatment with it prevents the development of cirrhosis or liver cancer. The effectiveness of treatment is significantly increased if interferon is used in combination with ribavirin. A positive effect is achieved in 40-60% of cases.

Another group of conditions - vaginal dysbiosis is also identified with STIs, although their development occurs when local immunity is weakened.

Bacterial vaginosis develops due to the replacement of the normal microflora of the vagina, in particular H 2 0-producing lactobacilli, with a large number of obligate and facultative anaerobic conditionally pathogenic microorganisms (Bacteroides, Prevotella, Peptococcus, Mobiluncus, Gardnerellavaginalis, Mycoplasmahominis, etc.), i.e. those microbes that are normally present in small amounts.

Bacterial vaginosis is a common clinical syndrome in women of reproductive age, the incidence of which in a group of sexually active women reaches 60%.

The causes of the development of the disease remain unclear, however, there are a number of factors that affect the composition of the vaginal microflora, these are:

• therapy with antibiotics, cytostatics,
• radiation therapy;
• frequent washing of the vagina;
• malformations or anatomical defects after ruptures in childbirth, surgical interventions;
• foreign bodies in the vagina, uterus (presence for a long time of vaginal tampons or diaphragms, intrauterine devices, etc.);
• use of spermicides;
• hormonal changes during puberty, pregnancy, after childbirth and abortion;
• entry of pathogenic microorganisms gastrointestinal tracta (GIT).

Under the influence of adverse factors, the composition of the vaginal microflora is disturbed. A decrease in the number of lactobacilli leads to a decrease in the concentration of lactic acid and an increase in pH. Anaerobic microorganisms produce amino acids, which are broken down into volatile amines. Their formation causes the appearance of an unpleasant odor of secretions.

The main symptoms of vaginosis are a homogeneous discharge from the genital tract, often with an unpleasant odor, especially after intercourse or during and after menstruation. With the progressive course of the disease, the discharge may acquire a yellowish-greenish color, become thicker and evenly distributed along the walls of the vagina.

In 20-30% of cases, itching and burning in the vulva, dysuria are noted. According to studies, 24-32% of women have an asymptomatic course of bacterial vaginosis.

Bacterial vaginosis can cause poor pregnancy outcomes.

Gardnerellosis is one of the varieties of bacterial vaginosis, in which microbes, gardnerella, receive the greatest reproduction. Currently, such a diagnosis does not exist, but it is still found in almost all booklets on STIs.

Gardnerellosis by definition is a dysbacteriosis of the vagina. Therefore, it is wrong to make such a diagnosis for men. Sometimes pathogens of gardnerellosis cause urethritis in men, which is manifested by burning and pain during urination. In this case, treatment is necessary. In other cases (when Gardnerellavaginalis is detected by accurate methods or gardnerellosis in a sexual partner), there is no need to treat men.

genital candidiasis is an infectious disease of the genitourinary system caused by yeast-like fungi of the genus Candida. A feature of this disease is a long course and a tendency to recurrence - repetition of exacerbations.

The most common forms of genital candidiasis in women include vulvovaginitis (from Latin vulvovaginitis - inflammation of the vulva and vagina), in men - balanoposthitis (from Greek balanoposthitis - inflammation of the glans penis and foreskin). It is caused by yeast-like fungi of the genus Candida.

This fungus is detected in healthy women, however, with a change in the microbiocenosis of the vagina and a violation of the barrier mechanisms of local immunity, it can acquire pathogenic properties.

Risk factors for the development of genital candidiasis include long-term antibiotic therapy, hormones, the use of immunosuppressants, radiation therapy, severe infectious diseases, pregnancy, diseases of the gastrointestinal tract and the endocrine system, in particular diabetes mellitus.

Symptoms of genital candidiasis in women: thick, white, cheesy, sometimes liquid, creamy vaginal discharge; itching in the vulva and vagina; hyperemia, swelling and dryness of the mucous membrane of the vulva and vagina, sometimes small bubbles, erosion and cracks; some patients have dysuria.

Symptoms of candidiasis of the genitals in men: moderate itching and burning in the vulva; puffiness, hyperemia, superficial peeling, whitish plaque on the glans penis and on the inner leaf of the foreskin.

For any suspicious symptoms, you should always consult a doctor, because only he can make the correct diagnosis and prescribe treatment under the control of tests among a wide variety of STIs.

The main principles of STI treatment are:

• simultaneous treatment of sexual partners,
• exclusion of unprotected sexual contacts during treatment,
• strict adherence to all medical recommendations.

To avoid contracting STIs, as well as the physical suffering and mental stress associated with them, it is necessary to lead a healthy lifestyle.

It must be remembered that:

• the best sexual partner - beloved, constant and only;
• for casual sex, a condom is always used;
• having sex under the influence of alcohol or drugs reduces self-control.

Shurygina Yu.Yu.

To date, there are three main groups of diseases that are uncharacteristic for humans as a biological species:

1) Diseases of civilization- these are diseases common in economically developed countries, the origin of which is associated with the achievements of scientific and technological progress. These include coronary heart disease, atherosclerosis, hypertension, heart attacks, strokes, malignant neoplasms, allergies, spinal osteochondrosis, etc., which will be discussed later.

2) Socially significant diseases- diseases caused mainly by socio-economic conditions that are detrimental to society and require social protection of a person. They are the main cause of morbidity, disability and mortality, especially among the working-age population of developed countries. These include diseases of the circulatory system, malignant neoplasms, diabetes mellitus, tuberculosis.

3) Socially conditioned diseases are formed under the influence of the immediate environment of a person and are associated with the socio-economic state of the country of residence. This group includes narcological diseases, venereal diseases, tuberculosis, viral hepatitis B, etc.

9. Definition of the concept of "pathogenesis". The role of the etiological factor in pathogenesis. Pathogenetic factors and their characteristics. Causal relationships in the development of the disease. The concept of "vicious circle" and its significance in pathogenesis. The essence of the concepts of "functional" and "organic" diseases.

Pathogenesis- this is the doctrine of the mechanisms of development, course and outcome of the disease; a section of pathophysiology that studies the role of the causative factor in the development of the disease, the ratio of pathogenetic mechanisms and mechanisms of recovery throughout the disease.

The role of the etiological factor in pathogenesis is different and depends on the strength, nature and duration of its action.

1) The etiological factor plays the role of a “push”, a trigger factor. Its action is short-term, quickly stops, and the further development of the disease occurs under the influence of the changes caused by it.

2) The etiological factor plays a decisive role in the development and course of the disease throughout its entire length, and with its elimination, recovery occurs.

3) The etiological factor acts throughout the disease, but its role at different stages of the disease is not the same. The disease-causing factor penetrates the body and at first does not cause disease. Then there is a gradual change in the reactivity of the body, leading to the development of the disease. In the future, recovery may occur even if the pathogen remains in the body.

4) The etiological factor, changing the protective properties of the body, opens the way, the "gate" for the action of other disease-causing agents, i.e. plays a provoking role in relation to the action of another factor.

As a result of the action of the etiological factor, disturbances occur in the body, on which the further development of the disease and its manifestations depend. Functional and structural disorders that occur in the body as a result of the action of an etiological factor and affect the further development and manifestation of the disease are called pathogenetic factors.

It is customary to single out the main link and leading factors of pathogenesis.

Properties of the main link of pathogenesis: 1) occurs under the influence of an etiological factor, i.e. is the primary injury; 2) precedes the other links of pathogenesis and is necessary for their deployment; 3) specific to this particular disease.

Properties of the leading factors of pathogenesis: 1) occur in the dynamics of the disease after the primary damage; 2) non-specific for a particular disease (found in many diseases).

Changes that occur during the development of the pathological process and are interconnected by cause-and-effect relationships form a pathogenetic chain that can be closed in the so-called "vicious circle"; it always enhances pathological changes in organs and tissues and worsens the course of the disease. But the "vicious" circle that has arisen at the level of peripheral organs and tissues can be broken and eliminated by the normalizing influence of higher nervous and hormonal mechanisms of regulation. If vital organs are involved in a “vicious” circle during a pathological process (for example, in shock - the nervous, cardiovascular and respiratory systems), then the patient himself, as a rule, cannot get out of this state without emergency and vigorous medical interventions.

Under functional diseases one should understand such diseases of certain organs and systems, when the disorder of the main functions occurs not as a result of an organic lesion, but as a result of a violation of the nervous and humoral regulation of their activity.

Under organic diseases refers to diseases that are caused by violations of the structure of an organ. They are based on structural disturbances, i.e. organic anatomical substrate as the cause of the disease.

10. General pathogenetic mechanisms of the development of diseases and their essence. The value of connective tissue in pathology.

Common mechanisms of disease pathogenesis are nervous, hormonal, humoral, immune, genetic.

Meaning nervous mechanisms in the pathogenesis of diseases is determined by the fact that the nervous system ensures the integrity of the body, interaction with the environment (fast, reflex), rapid mobilization of the body's protective and adaptive forces. Structural and functional changes in the nervous system lead to a violation of the triple nervous control over the state of organs and tissues, that is, there are violations of the function of organs and systems, blood supply to organs and tissues and the regulation of trophic processes.

Violation of the state of the nervous system can be the initial link of cortico-visceral (psychosomatic) diseases: hypertensive, ulcerative and resulting from psychogenic effects. The cortico-visceral theory of the pathogenesis of diseases is based on the reflex theory of I.M. Sechenov and I.P. Pavlov and is confirmed by the possibility of reproducing pathological reactions according to the mechanism of a conditioned reflex and the occurrence of functional disorders of internal organs in neurotic disorders.

The main pathogenetic factors that determine the development of cortico-visceral diseases are the following:

1) violation of the dynamics of nervous processes in the higher parts of the brain
(in particular, in the cerebral cortex);

2) changes in cortical-subcortical relationships;

3) the formation of dominant foci of excitation in the subcortical centers;

4) blocking of impulses in the reticular formation and increased disturbance of cortical-subcortical relationships;

5) functional denervation of organs and tissues;

6) trophic disorders in the nervous tissue and on the periphery;

7) violation of afferent impulses from organs that have undergone structural and functional changes;

8) disorder of neuro-humoral and neuro-endocrine relations.

The shortcomings of the cortico-visceral theory can be attributed to the facts that specific causes and conditions that cause the development of various forms of cortico-visceral pathology have not been identified, and the provisions on the violation of cortico-subcortical relations are too general and do not allow explaining the different nature of pathological changes in internal organs in neurotic disorders.

Meaning hormonal mechanisms in the pathogenesis of diseases is determined by the fact that the endocrine system is a powerful factor in the overall regulation of the vital activity of the organism and its adaptation to changing environmental conditions. In pathological processes, the endocrine system provides long-term maintenance of functional activity and metabolic processes at a new level. The restructuring of hormonal regulation ensures the development of protective and adaptive reactions of the body.

To humoral The mechanisms of the development of diseases include the formation in the focus of primary damage of various humoral biologically active substances (histamine, bradykinin, serotonin, etc.), which cause changes in blood circulation, blood condition, vascular permeability and the functions of many organs and systems in the process of development through hematogenous and lymphogenous pathways and course of pathological processes.

Immune mechanisms are associated with the function of the immune system, which ensures the constancy of the protein composition of the body. Therefore, in all pathological conditions accompanied by a change in the structure of one's own proteins or the penetration of foreign proteins into the body, the immune system is activated, the altered and foreign proteins are neutralized and excreted from the body. This is its protective role. But in some cases, a violation of the function of the immune system can lead to the development of allergic and autoimmune diseases.

Formed connective tissue performs a supporting function and protects the body from mechanical damage, while unformed connective tissue performs the function of metabolism, synthesis of plastic substances and biological protection of the body. Connective tissue also performs the function of regulating the homeostasis of liquid media, protein composition, acid-base balance, barrier and phagocytic function, participates in the production, storage and release of biologically active substances. Violation or perversion of these functions leads to the development of pathological processes.

11. The relationship between destructive and protective-adaptive processes in pathogenesis. The concept of "sanogenesis" and its mechanisms.

Each disease is manifested by destructive and protective-adaptive changes. The former arise as a result of the action of etiological factors, and the latter as a result of the mobilization of neuro-reflex and hormonal adaptation mechanisms. However, protective and adaptive changes that exceed the parameters of the biological functions of the body become destructive and increase the severity of pathological changes. In addition, the same changes in different diseases and in different people can be of a different nature.

The transition of a protective-adaptive reaction into a destructive one is observed when it goes beyond the limits of physiological parameters, when the living conditions of the organism change, when new pathogenetic phenomena arise that increase the disorder of the recovery function.

sanogenesis- a complex of complex reactions that arise from the moment of action of a damaging factor and are aimed at eliminating it, normalizing functions, compensating for violations and restoring the disturbed interaction of the organism with the external environment. Thus, sanogenesis is the mechanisms of recovery, while a very important component of this process is the compensation of impaired functions.

By development, sanogenetic mechanisms are divided into primary and secondary.

Primary mechanisms are considered as physiological processes (phenomena) that exist in a healthy body and turn into sanogenetic ones when a disease process occurs. They are divided into the following groups:

1) Adaptive mechanisms that adapt the body to functioning under conditions of pathogenic action and prevent the development of the disease (blood release from blood depots and increased erythropoiesis to hypoxia, etc.).

2) Protective mechanisms that prevent the entry of a pathogenic agent into the body and contribute to its rapid elimination (bactericidal substances of biological fluids, protective reflexes - cough, vomiting, etc.).

3) Compensatory mechanisms.

Due to the primary sanogenetic mechanisms, the response to an emergency impact can be limited to a state of pre-illness.

Secondary sanogenetic mechanisms are formed during the development of the pathological process. They are also divided into 3 groups:

1) Protective, providing localization, neutralization, elimination of a pathogenic agent.

2) Compensatory mechanisms that compensate for dysfunction during the development of pathology.

3) Extreme mechanisms. Occur with deep violations of the structure and functions of organs and tissues, i.e. at the final, critical stage of the disease.

12. The concept of the general adaptation syndrome and stress, the causes of their occurrence and development mechanisms. The concept of adaptation diseases, their types and essence.

The doctrine of stress was formulated by the outstanding Canadian scientist Hans Selye, who formulated the general concept of the development of stress and revealed the mechanisms, primarily hormonal, of this process.

Stress or General Adaptation Syndrome is a set of general physiological, psychological and biochemical reactions of the body in response to the action of extreme stimuli of any nature - stressors.

In his works, Selye used the concepts of "stress" and "general adaptation syndrome" as synonyms. By this term, he understood the totality of nonspecific reactions of the body that occur under the action of a stressor, along with specific responses, the nature of which depends on the nature of the stimulus.

In response to the action of stimuli of moderate strength, a state develops in the body, which is denoted by the term eustress - physiological state of tension of the adaptive reserves of the body, caused by a stimulus of moderate strength. This condition is common for a person, since environmental factors constantly act on the body. Moreover, eustress has an adaptive value, since it helps to train the body's defense reactions.

On the contrary, the action on the body of stimuli of extreme strength and duration causes the development of a condition that is currently denoted by the term distress. With the development of distress, nonspecific protective-adaptive reactions lose their positive significance and cause the formation of damage in the body. The severity of such changes depends both on the properties of the extreme stimulus (strength, duration) and on the resistance of the organism, determined by genetic and acquired characteristics.

There are the following types of stress depending on the duration of the process: 1) acute; 2) subacute; 3) chronic.

In addition to revealing the mechanism of stress, Selye's merit is also a description of the complex of pathological changes in the body that occur during stress. They are currently referred to as Selye's triad. It includes: 1) hypertrophy of the adrenal cortex and involution (reverse development) of the thymic-lymphatic apparatus; 2) the formation of ulcers in the gastrointestinal tract; 3) changes in the peripheral blood: the development of neutrophilic leukocytosis and a decrease in the content of lymphocytes and eosinophils.

There are 3 stages in the development of stress:

1)Anxiety stage. Duration 6-48 hours. It includes 2 types of reactions. First associated with the development of primary damage: hypotension, slowing of the pulse and respiratory movements, hypoglycemia, decrease in body temperature and muscle tone, increased vascular permeability and blood clotting, increased protein breakdown.

Second group reactions is aimed at counteracting these changes and is due to an increase in the secretion of ACTH, glucocorticoids, adrenaline and a number of other hormones: an increase in blood pressure and body temperature, an increase in heart rate, respiration, an increase in the level of glucose and fatty acids in the blood and their entry into tissues. In this stage, the development of the “Selye triad” takes place. These changes lead to a temporary decrease in the body's resistance to the damaging factor.

2)The stage of resistance. It develops approximately 48 hours after the start of the stress reaction. At this stage, hypertrophy of the adrenal cortex develops, a steady increase in the secretion of glucocorticoids, catecholamines, thyroid hyperplasia, and slight atrophy of the gonads. These hormonal changes lead to an increase in the body's resistance to the action of extreme stimuli.

With moderate strength or short duration of the action of the stimulus, the resulting structural disturbances in the organs and their functional activity are gradually normalized. If an excessively strong stimulus acts, the depletion of the function of the adrenal cortex gradually develops, catabolism processes intensify and the body's resistance to the action of the stimulus decreases.

3)stage of exhaustion. It is characterized by a decrease in the production of pituitary and adrenal hormones. In this stage, there is a decrease in the body's resistance to the action of extreme stimuli.

© MUZHANOVA V.K.

SOCIALLY CONDITIONED DISEASES IN THE REPUBLIC

VK. Muzhanova Ministry of Health of the Republic of Buryatia, Minister - MD V.V. Kozhevnikov;

Republican Medical Information and Analytical Center, head. - Director, Ph.D. B.S. Budaev.

Summary. The problem of socially conditioned diseases in the Republic of Buryatia is determined by the high incidence of tuberculosis, HIV infection and venereal diseases. In this regard, there is a problem of timely detection of socially conditioned diseases in the primary health care of the republic. The financing of primary health care includes the provision of care for socially determined diseases, the implementation of preventive measures and the early detection of socially determined diseases, which are one of the important tasks of municipal health care.

Key words: socially conditioned diseases, primary health care, primary health care, early detection.

Socio-economic changes in society cause the growth and spread of socially conditioned diseases, which include a number of infectious diseases (tuberculosis, sexually transmitted infections, HIV infection, hepatitis) and other diseases (alcoholism, drug addiction, substance abuse). The social component of the latter poses a danger to society as a whole. Since the beginning of the 90s of the XX century, the process of the spread of socially determined infectious diseases has been observed in Russia (1). The economic instability of the society, chronic stress, alcoholism of the population led to a rapid

spread of HIV, tuberculosis, sexually transmitted infections.

One of the most pressing problems at present is the high incidence of tuberculosis and mortality from it. According to WHO forecasts, tuberculosis will remain one of the leading causes of morbidity and mortality in the world in the next 10 years. At the end of the 80s. tuberculosis incidence began to rise in most regions of Russia, the incidence rate in the Russian Federation increased 2.6 times from 34.0 per 100 thousand population in 1991 to 86.3 in 2003. proportion of women among the sick. The increase in the incidence rate was accompanied by severe changes in the structure of patients. Among newly diagnosed patients with pulmonary tuberculosis, the number of patients with acutely progressive and widespread forms has increased. Among newly diagnosed extrapulmonary tuberculosis, the proportion of lesions of peripheral lymph nodes has increased, and the number of cases of tuberculosis of rare localizations has increased. In the structure of mortality of the population of the Russian Federation, tuberculosis among infectious diseases is 85%, and the problem of mortality from tuberculosis in working age is especially acute (1).

In the Republic of Buryatia, the epidemiological situation of tuberculosis remains extremely tense. The incidence rate in different years exceeds the federal average by 1.7-2.8 times and does not tend to decrease. Every year 1200-1400 patients are registered in the republic with the diagnosis of tuberculosis established for the first time in their lives. Since 1995 to 2006 the incidence changed in waves and amounted to 2006 in 2006. - 173.6 (RF 2005 - 82.8). It also exceeds the average federal level of mortality from tuberculosis in different years by 17-26%, which in 1999-2005. remained at the level of 21.0-25.2 (RF - 21.8). A particularly unfavorable situation in the republic has developed in terms of the incidence of tuberculosis among children. Morbidity rate in children diagnosed for the first time in their lives

active tuberculosis exceeds the average federal level by 2-3 times. The highest incidence rate was observed in 1999 - 75.2 (RF - 17.9), the figure in 2005 was 41.2 per 100 thousand population (RF - 17.0).

Another urgent problem of socially conditioned diseases is the spread of HIV infection. Prior to 1996, relatively few cases of HIV infection were registered in Russia. However, since 1996, the incidence of AIDS began to grow exponentially: by January 1, 2000, 25,470 cases of HIV infection were registered in Russia, and by December 1, 2007, there were already 407,508. and teenagers. The epidemiological situation of HIV infection in the Republic of Buryatia has worsened since 1999. of the last century, several cases of HIV infection were registered in the republic - the incidence in 1998 was 0.76 per 100 thousand of us. By 2006, there was a 31-fold increase in the incidence - the figure was 23.9 per 100,000 population. The prevalence of HIV infection over the same period increased by 321 times, which in 2006 amounted to 276.5, exceeding the figure for the Russian Federation by 6.9% (228.8), and for the Siberian Federal District - by 9.0% (224.3). There is a trend of rejuvenation of the disease. Nearly 50% of HIV patients in Russia are young people under the age of 25 (1). In the Republic of Buryatia, 80% of HIV-infected people are aged 15 to 30 years. The tension of the epidemiological situation with HIV infection in the Republic of Buryatia is supported by the extremely unfavorable situation in the neighboring Irkutsk region, where the frequency of HIV infection in 2005 exceeded the figure for the Siberian Federal District by 3.6 times (Irkutsk Region - 805.8, Siberian Federal District -224, 3) and in 3.5 - in the Russian Federation (228.8).

HIV-infected pregnant women are a particular problem. Over the past 3 years, the number of children born to HIV-infected women has increased dramatically in Russia (1). In the Republic of Buryatia, the number of HIV-infected pregnant women increased by 2 over 5 years (51 and 105)

times, and they accounted for 55.7% of the total number of all identified HIV-infected women. Only 44.5% of registered HIV-infected women in 2005 terminated their pregnancy, and only 25% of HIV-infected women underwent complete chemoprophylaxis of the vertical route of HIV infection in a timely manner.

According to the forecasts of the Russian Academy of Medical Sciences, in the coming years, the annual increase in the number of newly infected with HIV by 30% is expected in Russia. Basically, the sexual route of transmission of the infection remains by way of spread. In Russia, sexual transmission of HIV infection was 49.5% in 2003 (1), in Buryatia - 65.1% in 2005. years has increased by 37.5%. In the early 1990s, the Republic of Buryatia had the lowest incidence of syphilis and recorded only a few cases per year. The peak incidence was observed in 1996 - 4779 (454.8 per 100 thousand population) patients were registered, which exceeded the federal average by 78.6% (RF - 254.6). In the next 10 years, the incidence decreased by 3.7 times - the figure in 2006 was 107.6 per 100 thousand people (RF - 72.0). But even the achieved results show that the indicators are high and the incidence of syphilis in the republic exceeds the average federal level by 50-70%.

Socially conditioned diseases are common in the same population groups, they often come into contact with each other, thereby aggravating the course and their treatment. According to WHO, more than 3 million people in the world are simultaneously infected with TB and HIV pathogens

(one). The HIV epidemic is considered to be the leading cause of the resurgence of tuberculosis in industrialized countries and its marked increase in third world countries. Tuberculosis is one of the most virulent of all opportunistic infections in HIV-infected people and develops earlier than others. Usually more than 50% of cases develop tuberculosis within a few months after primary HIV infection.

infections. On the other hand, tuberculosis contributes to the progression of latent HIV infection and the development of AIDS (4). In the Republic of Buryatia, over the past 3 years, the incidence of tuberculosis among HIV-infected people has increased by 1.4 times. The incidence rate of tuberculosis among HIV-infected people in 2005 was 3,333.3 per 100,000 people, which is 19 times higher than the incidence rate of the entire population.

In 1991, in Russia, out of 531.0 thousand patients with sexually transmitted infections (STIs), 12 were identified as HIV-infected (2.3 per 100 thousand), and in 1999 out of 1739.9 thousand - 822 ( 47.2 per 100 thousand) (1). In the Republic of Buryatia during 2000-2004. 52 times increased the number of cases of HIV infection among patients diagnosed with STIs for the first time in their lives. The prevalence of socially conditioned diseases among the population is approximately the same and was in 2002 in the Russian Federation: tuberculosis - 388.6, syphilis and gonorrhea - 306.3, HIV infection - 258.1 per 100 thousand population (1).

Early detection of socially conditioned diseases in primary health care is one of the most important health problems. About 17-25% of the population of the Russian Federation, i.e. every 4-6th inhabitant of Russia can be classified as a risk group for tuberculosis (3). All these people seek medical help, first of all, in polyclinics of the general medical network, and among them 70-75% of all newly diagnosed TB patients are registered. It is among them that it is necessary to sharply improve diagnostics. Thus, among people with concomitant diseases who are under dispensary observation, tuberculosis is detected late, mainly when they return to polyclinics with complaints or in general somatic hospitals. Among certain social groups (unemployed, pensioners, the disabled), only 1/3 of TB patients are detected during preventive examinations. Despite the decrease in the volume of preventive programs, fluorographic examination remains the most accessible to the population.

Since it is impossible to quickly increase the coverage of the population with fluorographic examinations, in order to establish the maximum number of patients, it is necessary to optimally form contingents for fluorographic examinations.

(2). There is an insufficient volume and low quality of examination of children in the general medical network if they are suspected of having tuberculosis. Thus, sputum examination for Mycobacterium tuberculosis is not carried out, contacts with patients with tuberculosis were not performed. Among children with a tuberculin test bend, only in 16.3% of cases a laboratory examination is performed (5).

In organizing the timely diagnosis of STIs, there are many related problems in laboratory screening, the work of the obstetric and gynecological service and outpatient specialists. In Buryatia, despite the high proportion of patients with syphilis actively diagnosed in 2005 (66.8%), the detection of this infection in the outpatient network decreased by 1.4 times over 5 years: in 2000 -12, 3%, in 2004 - 8.9%. Latent and late forms of the disease have become more frequent. The proportion of latent syphilis has increased over 10 years in

4.2 times and amounted to 57.2% in 2005. The presence of patients with syphilis with a long period of infection indicates the emergence of diagnostically difficult cases occurring among somatic pathology. The unfavorable epidemiological situation of the last decade requires a more thorough study of errors in the detection of infectious forms of syphilis.

In order to stabilize the epidemiological situation associated with social diseases in the Republic of Buryatia, reduce premature mortality, morbidity, disability of the population and increase life expectancy, the Government of the Republic of Buryatia dated September 16, 2003 No. 293 approved the republican target program "Prevention and control of diseases social character” for 2004-2007. However, limitations in the financing of the program did not allow to fully implement the planned activities and receive

effective effect of their implementation. Out of a total need of the program of 196.4 million rubles, in 2005, 26.9 million rubles were allocated, which amounted to 13.7%. At the same time, the allocated funds are used for the development of specialized services at the regional level. There is a practice of developing their own municipal programs, for the implementation of which financial resources are also allocated insufficiently. Significant financial support in 2005 was provided at the expense of the federal budget to obtain vaccines, drugs, test systems, laboratory equipment, reagent kits in the amount of 28.7 million rubles. rubles.

President of the Russian Federation V.V. Putin in his Address to the Federal Assembly on May 26, 2004 and on April 25, 2005, the task was set to improve the quality of medical care for the population of the country, which began its implementation as part of the implementation of the priority national project "Health" in 2006-2007. The main objective of the project is the priority of primary health care. The key figure in providing it to the population should be the district doctor, a general (family) practice doctor responsible for the health of the patient as a whole. As part of the implementation of the priority national project "Health" in 2006. outpatient clinics of the Russian Federation received modern diagnostic equipment in the amount of 22,652 units in the amount of 14,296.9 million rubles. To the Republic of Buryatia for 2006-2007 received 606 units totaling

256.2 million rubles, incl. 73 ultrasound machines, 84 sets of laboratory equipment, 63 units. X-ray equipment, etc. As a result, the availability of modern diagnostic equipment in municipal polyclinics has increased, instrumental examinations have become more accessible for the population.

The problem of the effectiveness of the primary network for the early detection of diseases is becoming more important in connection with the division of powers of the executive branch and the revision of the profiles and volumes of medical care provided at the municipal level.

This problem is especially relevant for the constituent entities of the Russian Federation in the light of the entry into force on 01.01.2005 of the Federal Law of 08.22.2004 No. 122-FZ. In accordance with this law, the delimitation of powers between federal state authorities, state authorities of the constituent entities of the Russian Federation and local governments has changed the system of health care financing at the regional and municipal levels. But in this law, the organization and financing of specialized medical care, including anti-tuberculosis, dermatovenerological, in municipal healthcare organizations did not fall within the powers of local governments (6). Also, in accordance with the order of the Ministry of Health and Social Development of the Russian Federation of October 13, 2005 No. 633 “On the organization of medical care”, the provision of medical care for socially conditioned diseases is not reflected in the primary health care section. But the Decree of the Government of the Russian Federation of December 30, 2006 No. 885 approved

funding from local budgets for primary health care for sexually transmitted diseases and tuberculosis.

Thus, the implementation of preventive measures for socially conditioned diseases, their early detection remains one of the important tasks of municipal health care. The significance of this problem for the Republic of Buryatia is determined by the high incidence of socially conditioned diseases. In 2007, the Government of the Republic of Buryatia adopted the "Program for the socio-economic development of the Republic of Buryatia for 2008-2010 and for the period up to 2017". In the Health Development section, one of the objectives of the program is the prevention and control of socially conditioned diseases, the indicator of the effectiveness of which is the reduction of their level.

SOCIAL DISEASES IN REPUBLIC OF BURYATIA

Medical information-analytical center of the Republic of Buryatia

The problem of social diseases in Buryatia Republic is determined by high levels of tuberculosis morbidity, AIDS, venereal diseases. In this connection the problem of timely revelation of social diseases in primary link of public health of republic takes place. Financing of primary medical-sanitary help includes giving the first aid in social diseases, prophylactic measures and early discovery of these diseases.

Literature

1. Starodubov V.I., Mikhailova Yu.V., Son I.M. Problems of integration of socially conditioned diseases // Medico-social problems of socially conditioned diseases: tr. Ross. scientific-practical. conf. - Moscow: RIO TsNIIOIZ, 2004. - P.4-11.

2. Son I.M., Litvinov V.I., Starodubov V.I. and other Epidemiology of tuberculosis. - Moscow, 2003. - 283 p.

3. Shilova M.V. Identification and diagnosis of tuberculosis in institutions of the general medical network // Ch. doctor. - 2005. - No. 3. - S. 6-16.

4. Kopylova I.F. Tuberculosis and HIV infection // Clinical issues, diagnosis, treatment and prevention of HIV infection and opportunistic diseases: Mat. scientific-practical. conferences. - Kemerovo, 2003. - S.31-39.

5. Tinarskaya N.I. Prevention of tuberculosis in newly infected children // Tuberculosis - a problem of public health: tr. scientific-pract. conferences - Kemerovo, 2002. - S.97-98.

6. Gerasimenko N.F., Aleksandrova O.Yu. New in the Russian legislation in the field of health care // Ch. doctor. - 2005. - No. 6. - P.5-17.

Diseases are a pathology that is characterized by a fairly high prevalence among the population and serious treatment costs. At the same time, it can lead to a significant deterioration in the condition of patients and limit their physical capabilities.

On the list of socially significant diseases

It was approved by Decree of the Government of the Russian Federation No. 715 of December 1, 2004, as amended by Decree of the Government of the Russian Federation No. 710 of July 13, 2012. This regulatory document regulates the list of socially significant diseases. Among them:

1. Sexually transmitted infections.
2. Tuberculosis.
3. Viral hepatitis B and C.
4. Malignant neoplasms.
5. Diseases characterized by high blood pressure.
6. Behavioral and mental disorders.

All these diseases bring a huge number of problems, both social and financial. Successful fight against them is one of the factors of health and development of society.

Sexually transmitted infections

Such diseases represent a serious danger to the whole society, as they affect the population of young and middle age. That is, that part of it, which forms the main budget of the state. It is for this reason that health care institutions, the sanitary service, as well as many state and non-state organizations are actively preventing socially significant diseases of this type. The most effective forms of such work are the following:

• social advertising on billboards, as well as in the media;
• distribution of leaflets and booklets among the population;
• campaigns with free distribution of protective equipment against sexually transmitted infections (condoms);
• systematic educational work with the dissemination of information to the population about such diseases, means of protection against them (directly in educational institutions, as well as in the workplace);
• conducting screening examinations of people of the most susceptible age.

Among the most common diseases of this type, syphilis and gonorrhea should be noted. HIV due to its danger is highlighted in a separate column of the list.

Tuberculosis

This socially significant disease is one of the most dangerous. It is special because its causative agent, Mycobacterium tuberculosis, is extremely widespread, especially in the population of large cities.

Despite the fact that tuberculosis has been known since the time of the Egyptian pharaohs, there are still no truly effective means to combat them. Modern medicine uses techniques for the simultaneous use of a large number of special antibiotics that have serious side effects. Patients with pulmonary tuberculosis are treated from several months to 2-3 years.

With these socially significant diseases, the fight is carried out with the help of a whole range of preventive measures. Among them:

1. Sanitary and educational work among the population.
2. Conducting screening studies as part of medical examination (fluorography).
3. Compulsory treatment of patients evading TB care.
4. Provision of food kits to reduce the number of relapses in patients who have already had TB.
5. Limitation of the list of professions available for persons suffering from a socially significant disease of this type.

Thanks to these activities in developed and developing countries, it is gradually possible to contain the increase in the incidence of tuberculosis.

Viral hepatitis B and C

There are several options for the spread of these diseases. Among them:

• during blood transfusion;
• through a syringe;
• from mother to child during pregnancy;
• during sexual contact.

Viral hepatitis C is especially dangerous, since in 70-80% of cases it becomes chronic. Without proper treatment, the pathological process can lead to the development of liver cirrhosis, effective means of combating which do not exist today.

Malignant neoplasms

Such types of pathology are one of the most dangerous types of socially significant diseases. The program for the development of world health in the 21st century assigns a special role to the fight against them. This is largely due to the serious danger of malignant neoplasms, as well as the growing incidence of pathology of this form.

Currently, there are a huge number of programs and funds that provide assistance to patients with cancer. In order to timely detect such a pathology, every resident of the Russian Federation must undergo preventive examinations in a timely manner as part of a medical examination. If such diseases are detected in the early stages of their development, patients have a good chance of recovery.

As for prevention, in the case of this group of pathology, we are talking about:

• sanitary and educational work among the population about the factors contributing to the development of malignant neoplasms;
• work with the population to form their commitment to a healthy lifestyle;
• activities to create workplace conditions that are not conducive to the formation of oncological diseases.

Taking into account the fact that malignant neoplasms develop when the activity of the human body's own cells is disrupted, it is unlikely that it will be possible to prevent the formation of such a pathology in the coming decades. Currently, scientists are focusing on the development of effective drugs that can overcome the tumor process, providing a person with a complete recovery.

HIV

Along with malignant neoplasms, this pathology is one of the most serious. The fight against it is of particular importance for society due to the fact that it affects mainly the young population and middle-aged people. The causative agent of the disease is the human immunodeficiency virus. It can be sent like this:

• sexually;
• when injected with used needles;
• during blood transfusion;
• from mother to child during pregnancy and childbirth.

A few decades ago, this disease was transmitted mainly by injection. To date, the main way of spreading the human immunodeficiency virus is sexual. The highest probability of infection during anal intercourse, as it is more traumatic.

The danger of a socially significant disease of this type has forced the World Health Organization to develop effective measures to prevent its spread. Of these, the following are implemented on the territory of the Russian Federation:

1. Actions in which condoms are distributed free of charge to the population (most often the organizer is the Red Cross).
2. Providing drug addicts with syringes free of charge.
3. Carrying out educational actions in educational institutions.
4. Implementation of systematic work on the prevention of HIV infection in healthcare facilities. We are talking about activities before using donated blood (transfusion is carried out only after testing for major infectious diseases, including HIV).
5. Conducting screening studies.
6. Performing free anonymous HIV diagnostics.
7. Organization of the work of direct and hot lines, anonymous telephone counseling on the ways of infection and the organization of HIV treatment.

Despite the measures taken, today this socially significant infectious disease is spreading more and more widely. At the same time, over time, the age of newly diagnosed patients is getting higher. In many ways, this may be due to more active preventive work with young people.

This socially significant disease is most common in the developed countries of the world. Gradually, the number of patients with this diagnosis is increasing in the Russian Federation. A constant increase in blood glucose levels is gradually capable of destroying the vascular wall. Particularly affected are those of them that have a small caliber. As a result, vision and kidney function can be impaired, which leads to an increase in blood pressure levels. As the disease progresses, the patient begins to lose sensitivity of the skin of the hands and feet. Subsequently, the microcirculation of the lower extremities can be disturbed to such an extent that the "diabetic foot" syndrome develops. It leads to gangrenous changes and the need to remove the affected tissues.

As a result, patients with diabetes mellitus, especially those who avoid therapeutic measures, often become disabled after 10-12 years from the manifestation of the disease. As a result, such a pathology perfectly fits the concept of a socially significant disease.

Diseases characterized by high blood pressure

Today, both in Russia and in the world as a whole, the main cause of death is the pathology of the cardiovascular system. The most important factor leading to the development of serious diseases of this profile is constantly elevated blood pressure. This pathology contributes to the development of the following most dangerous diseases:

• myocardial infarction;
• acute violation of cerebral circulation;
• cardiomyopathy;
• coronary artery disease;
• arrhythmias of various types and others.

Currently, the prevention and treatment of socially significant diseases of this type is the cornerstone in the activities of outpatient health care institutions.

Behavioral and mental disorders

The incidence of this pathology is also constantly increasing. Probably, the reason for this is the increase in diagnostic capabilities, as well as the ever-increasing demands on the person himself from the public. A huge amount of money is spent annually on the treatment of such diseases. A feature of the pathology is the partial or complete loss of a person from public life in the presence of such a socially significant disease, which means additional costs for relatives and / or the state.

Understanding the issue

The forces of state regulation alone, as well as medical workers of budgetary organizations, cannot cope with these diseases. Their selection into a separate list, as well as active educational work, are aimed at creating an understanding among the public of the danger of this pathology, both for each person individually and for society as a whole. As a result, public organizations (both governmental and non-governmental) can take on a certain role in preventing the occurrence of such ailments and partially helping people suffering from them, which brings the solution of problems associated with these diseases closer.

Further tactics

Currently, socially significant diseases are a worldwide problem. As a result, the World Health Organization has already developed a plan for the coming years to combat each type of such pathology. These programs have already shown their effectiveness. Not all of them have made it possible to reverse the situation in the direction of reducing the incidence, however, due to their implementation, the level of disability is gradually decreasing, and the duration of active life in patients with socially significant pathology is increasing.

About the activities of the funds

In order to help patients with certain diseases of public importance, special funds are created. Their sponsors are often wealthy individuals or organizations. Thanks to their funds, every year a large number of patients undergo specialized treatment using the best domestic and foreign techniques.

To generate interest in this type of patronage, the government of most countries of the world, including the Russian Federation, applies preferential taxation schemes to the "donors" of such funds.

In the most general form, socially significant diseases are diseases, the occurrence and (or) distribution of which to a certain extent depends on socio-economic conditions (see Table 1 for a list of socially significant diseases). For example, outbreaks of tuberculosis are facilitated by overcrowding, unfavorable living conditions, improper and poor nutrition, and so on. Lack of the minimum necessary knowledge of hygiene and well-formed skills can lead to outbreaks of hepatitis A, sexually transmitted infections, and so on. The main feature and at the same time the key problem of socially significant diseases is the ability to spread widely (mass character). In patients suffering from diseases of this group, as noted in the Concept of the Federal Target Program "Prevention and Control of Socially Significant Diseases (2007-2011)" (approved by the order of the Government of the Russian Federation of December 11, 2006 No. 1706-r), the need for medical care increases as their condition worsens and complications arise. The treatment of such patients requires the attraction of additional funds and the strengthening of the material and technical base of health care institutions.

Table 1

List of socially significant diseases (approved by Decree of the Government of the Russian Federation of December 1, 2004 N 715)

ICD-10 disease code	Name of diseases
	tuberculosis
At 16; At 18.0; In 18.1	Hepatitis B
At 17.1; At 18.2	hepatitis C
	malignant neoplasms
	diabetes
	mental and behavioral disorders
	diseases characterized by high blood pressure

In the absence of adequate government measures (organizational, technical, financial, medical, preventive, medical, etc.), the level of morbidity, disability and mortality from certain diseases is growing, life expectancy of the population is decreasing, huge funds are spent on stabilizing the situation with morbidity and eliminating negative social and macroeconomic consequences. It is no coincidence that in Part 2 of Art. 43 of the Law "On the Fundamentals of Protecting the Health of Citizens in the Russian Federation" states that the list of socially significant diseases and the list of diseases that pose a danger to others is approved by the Government of the Russian Federation based on the high level of primary disability and mortality of the population, reducing the life expectancy of patients.

The social significance of diseases can decrease with a targeted and effective impact on the main factors that cause and maintain these diseases. In this situation, it would be logical to create legal mechanisms that guarantee the necessary medical and drug provision for patients with certain socially significant diseases. It is assumed that an additional mechanism to the main (we are talking about the provision of medical care on a general basis) mechanism will allow citizens who want and care about their health (benefits for patients) to maintain their ability to work, an acceptable level of quality of life.

At the same time, socially significant diseases in a number of ways can hardly be compared with diseases that pose a danger to others.

In Art. 41 of the Law "Fundamentals of the Legislation of the Russian Federation on the Protection of the Health of Citizens" states that Citizens suffering from socially significant diseases are provided with medical and social assistance and are provided with dispensary observation in the relevant medical institutions free of charge or on preferential terms. Types and scope of medical and social assistance provided to citizens suffering from socially significant diseases are established by the federal executive body that carries out legal regulation in the field of healthcare.

Measures of social support in the provision of medical and social assistance and drug provision to citizens suffering from socially significant diseases are established by the state authorities of the constituent entities of the Russian Federation.

Financial support for measures to provide medical and social assistance to citizens suffering from socially significant diseases (with the exception of assistance provided by federal specialized medical institutions, the list of which is approved by the Government of the Russian Federation), in accordance with these Fundamentals of Legislation, is an expenditure obligation of the constituent entities of the Russian Federation.

Diseases that pose a danger to others

The spread of plague, cholera, anthrax in modern conditions can lead to morbidity and even death in the shortest possible time of thousands of people, jeopardize the security of the region and the state, and cause irreparable damage to the economy. In this situation, it is necessary to take urgent measures to localize and prevent the spread of a disease that is acquiring the character of an epidemic, to treat a large contingent of patients. Disability of the population and the demographic crisis recede into the background.

table 2

List of diseases that pose a danger to others (approved by Decree of the Government of the Russian Federation of December 1, 2004 N 715)

ICD-10 disease code	Name of diseases
	human immunodeficiency virus (HIV) disease
	viral fevers transmitted by arthropods and viral haemorrhagic fevers
	helminthiases
At 16; At 18.0; In 18.1	Hepatitis B
At 17.1; At 18.2	hepatitis C
	diphtheria
	sexually transmitted infections
	pediculosis, acariasis and other infestations
	glanders and melioidosis
	anthrax
	tuberculosis

Under normal conditions (outside of an outbreak, epidemic), the prevalence of diseases that pose a danger to others is usually low, in contrast to diseases classified as socially significant, and much less dependent on ethnic, national, cultural and other characteristics of the region.

In Art. 42 of the Law “Fundamentals of the Legislation of the Russian Federation on the Protection of the Health of Citizens” states that Citizens suffering from diseases that pose a danger to others are provided with medical and social assistance in institutions of the state healthcare system intended for this purpose under the Program of State Guarantees for the Provision of Free Medical Care to Citizens of the Russian Federation . For certain categories of citizens suffering from diseases that pose a danger to others, the place of work is retained for the period of their temporary incapacity for work, measures of social support are established, determined by the state authorities of the constituent entities of the Russian Federation. Financial provision of measures to provide medical and social assistance to citizens suffering from diseases that pose a danger to others (with the exception of assistance provided by federal specialized medical organizations, the list of which is approved by the Government of the Russian Federation), in accordance with these Fundamentals, is an expenditure obligation of the constituent entities of the Russian Federation. Measures of social support in the provision of medical and social assistance to citizens suffering from diseases that pose a danger to others are established by the state authorities of the constituent entities of the Russian Federation.

In the domestic literature there is such a thing as "especially dangerous infections". These are infections that can occur among the population in the form of individual diseases, epidemics and even pandemics, often accompanying natural disasters, wars, mass famine, etc. They are characterized by natural foci, rapid spread and severe course. These most often include plague, tularemia, yellow fever, cholera, generalized forms of anthrax. The list and measures to prevent the spread of especially dangerous infections were first clearly enshrined in the International Health Regulations adopted by the 22nd World Health Assembly (WHO) in 1969. Subsequent changes were made to the Rules. At the national level, in pursuance of the Rules, relevant acts were adopted.

According to Art. 3 of the Federal Constitutional Law of May 30, 2001 No. 3-FKZ "On the state of emergency", the circumstances of the introduction of a state of emergency include, in particular, emergency environmental situations, including epidemics and epizootics resulting from accidents, natural hazards, disasters, natural and other disasters that caused (could cause) human casualties, damage to human health and the natural environment, significant material losses and disruption of the living conditions of the population and requiring large-scale rescue and other urgent work. A state of emergency throughout Russia or in its individual areas is introduced by decree of the President of the Russian Federation. This is a special legal regime for the activities of state authorities, local governments, organizations, regardless of organizational and legal forms and forms of ownership, their officials, public associations, which allows restrictions on the rights and freedoms of Russian citizens, foreign citizens, stateless persons, the rights of organizations established by law. and public associations.

Federal Law No. 52-FZ of March 30, 1999 "On the sanitary and epidemiological well-being of the population" introduces the following concepts:

• - infectious diseases that pose a danger to others,
• - human infectious diseases characterized by severe course, high mortality and disability, rapid spread among the population (epidemic);
• -- restrictive measures (quarantine) -- administrative, medical, sanitary, veterinary and other measures aimed at preventing the spread of infectious diseases and providing for a special regime of economic and other activities, restricting the movement of the population, vehicles, cargo, goods and animals. Restrictive measures (quarantine) are introduced at checkpoints across the state border of the Russian Federation, on the territory of the Federation, its constituent entities, in organizations and at objects of economic and other activities in case of a threat of the emergence and spread of infectious diseases.

In accordance with Art. 6 of the Federal Law of March 30, 1999 No. 52-FZ "On the sanitary and epidemiological well-being of the population", the introduction and cancellation of restrictive measures (quarantine) on the territory of a constituent entity of the Russian Federation is the authority of the constituent entities of the Russian Federation in the field of ensuring the sanitary and epidemiological welfare of the population.