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The authors formulated concept on development of occupational medical service of JSC Medical Society "Salvation" for its accomplishment on enterprises of JSC "Kamaz" Group. The concept is based on united technologic line of diagnosis and treatment, including primary care, establishments for specialized medical care and rehabilitation. Within the concept, medical departments, occupational safety protection, staff management and trade union organizing health centers on industrial enterprizes are organized for cooperation, and partnerships between medical professionals and the enterprise staffers are established.

The characteristics of the structure and procedural components of the quality of functioning of the regional laboratory services are presented. The major directions of the modernization of the laboratory services are proposed. The need of leasing implementation is proved as one the promising methods of renovating the material and technical basis of the laboratory services.

The reforms that have affected the Russian health care system since the breakup of the Soviet Union, principally those in the general administration of the Russian Federation, have suffered from inconsistency and the absence of a strategy. The various reforms have caused a shift from a national health system characterized by highly centralized management and control, typical of the totalitarian uniform state, to a highly decentralized but fragmented multitude of state systems. Each of these systems is relatively centralized at the local level and run by local administrations with limited government infrastructure and experience. The role of government in the emerging system, and in particular the role of the federal government, remains ill defined. As a result, there is a grave risk that the Russian health care system may disintegrate as a national system. This undermines (a) the prevailing universal and fairly equitable access to care, (b) stabilization of the system following a long period of transition, and (c) the long-term reform that is required to bring the Russian health care system up to par with the health care systems in other developed countries. A rapid transition to a genuine federal health system with well-articulated roles for different levels of government, in tandem with implementation of the 1993 Compulsory Health Insurance System, is essential for the stabilization and reform of the Russian health care system.

In improvement of the management of the medical service the reserves are available, enabling considerably to improve system and organization of medical maintenance as a whole. They are differentiation of administrative and operative management, creation of authorities of territorial management of the medical service at three levels (in the garrison, in the zone of responsibility, in the district), endowed with the appropriate rights and powers, introduction in the daily practice of the modern means of automation and communication.

The transition of military health service to territorial principle of work, perhaps, could originate some quantitative and qualitative changes in the existing structure of medical establishments which are occupied with outpatient or polyclinic care. A number of new conditions will provide for this matter: quantitative and structural changes in attended contingency: vector changes in admission of patients to medical establishments; the necessity to introduce new methods of specialized medical care in polyclinics; the necessity to enhance the quality of diagnostics in the zone of responsibility. The main goals of polyclinics in territorial system of medical support could be the following: organization of the system of diagnosis and consultation; estimation of working capacities of each polyclinic in order to disclose what categories of patients must be conducted to the base polyclinic for diagnosis or consultation; organization of cooperation between polyclinic and hospital in order to share diagnostical functions, and thus, eliminate the duplication in diagnostical work.

The transition to a territorial system of medical support needs to solve a problem of control over the work of all military medical establishments in the zone of responsibility of the base military hospital independently of their subordination to different fighting services. To meet these requirements it is necessary to create a coordination centre (group) in the base military hospital. Its basic task is to coordinate all medico-diagnostical, sanitary-hygienic and counter-epidemic measures in the zone of responsibility and also to supervise the special training of medical personnel. Another important task is to coordinate combat and mobilization readiness of medical units and establishments in the zone of responsibility.

The author of this article, Surgeon General of the Russian Armed Forces, colonel-general, MD, describes the basic principles of territorial system of medical support (TSMS) of the Army and Navy. The essence of TSMS is to realize a structural unification of medical assets, and, thus, obtain a decentralized, but autonomous command in the zones of responsibility in order to assure the most effective medical support of troops (forces) within a certain territory in peaceful time, as well as during mobilization deployment, and in the initial period of war. Medical and diagnostical procedures in the zone of responsibility will be performed by a base (zonal) military hospital (BMH) as a largest medical establishment on the given territory (capacity 400 beds and more). BMH will provide not only secondary (qualified) medical care, but also some (basic) types of tertiary (specialized) medical care. In case of disaster relief the emergency medical care will be provided at the level of a military district using the assets of a special medical detachment formed by a district military hospital. In case of disaster BMH (zone of responsibility) will form the emergency medical care teams, the other military hospitals or polyclinics will form medico-nursing teams. The system of sanitary-epidemiologic supervision, as well as sanitary-hygienic and counter-epidemic measures is formed on the basis of rational distribution of zones of responsibility between sanitary-epidemiological establishments independently of their different ministerial subordination. The basic scheme of direction over medical supply in TSMS can remain unchanged (planning and centralization), but a part of supply functions must be given to BMH in the zone of responsibility.(ABSTRACT TRUNCATED AT 250 WORDS)

The introduction of economic incentives, the utilization of a fund for social development of institutions considerably increased the intensification of labour, improved health care indicators and the accessibility of health care for the population. The expedient form of work appeared to be collective bargaining which considerably expanded the rights of the leader and collective. ++ Interdepartmental cost-accountable relations with the future introduction of ++intra-structural cost-accountable relations is a prospective form of health services administration and management.

The increasing prevalence of overweight and obesity, the classification of the population whose age is the most favourable for working activities as patients, considerable prevalence of the disease among children and young people, the disease progress and severe complications make obesity one of the most important problems today. The development of obesity and complications is mainly caused by energy imbalance which gets aggravated in subjects manifesting lipid metabolism pathology. Disorders in the character and rhythm of nutrition are most remarkable in cases of obesity complicated by cardiovascular pathology, diseases of the hepatobiliary system, diabetes mellitus, and so forth. Taking into consideration the significance of the problem of obesity the Institute of Nutrition, Academy of Medical Sciences of the USSR, developed a program of measures whose realization will favour the solution of the Food Program.

The paper is concerned with the clinical problems of endemic goiter control. The stabilization of prevalence of thyroid hyperplasia has been shown as a result of underestimation of other than iodine deficiency giterogenic factors. Functional essence of the disease, a tendency to hypothyrosis, have been unraveled. Organizational problems and prospects of research in this area are considered.