Bulletin of the Russian Society of Professionals in Medical and Social Expertise, Rehabilitation and Rehabilitational Industry

The study is devoted to the dynamics and structure of primary disability due to ischemic stroke among the adult population of Moscow in 2016–2024. The analysis is based on data from the “7 Sobes” forms, the Unified Automated Information System (EAIS), medical and social expertise acts, and other official sources. It was revealed that the share of such disability in the structure of the central vascular hospital increased from 16.5 % to 32.4 %. Ischemic stroke led to disability 5.4–6.4 times more often than hemorrhagic stroke (the largest gap was in 2016 and 2021, the smallest in 2020 and 2024). The predominant group was the elderly (53.8–69 %), their share increased to 69 % by 2023, and slightly decreased to 68 % in 2024; The proportion of middle-aged people decreased from 41.7 % to 28 % (rising to 29 % by 2024), while the proportion of young people varied between 2.3–4.5 %. Among able-bodied disabled people, men outnumbered women (the ratio increased from 2.5:1 in 2016 to 4.6:1 in 2022, then decreased to 3.7:1 by 2024); among the elderly, women outnumbered men by 1.3–1.5 times. By disability group, the highest prevalence was observed in Group III (41–50.9 %, projected to reach 42.6 % by 2024), followed by Group II (28.4–33.6 %, projected to reach 31.4 % by 2024), and Group I (20.5–26 %, projected to reach 26 % by 2024). The data obtained are important for rehabilitation planning, healthcare resource allocation, and the development of preventive measures.

Introduction. Assessment of the severity of cardiovascular functional impairment in patients with valvular heart disease within disability evaluation is based on standardized clinical and functional criteria. Expert decisions rely on the integrated interpretation of multiple indicators, which supports the need for approaches enabling their quantitative integration. Currently, prognostic model-based approaches are used to a limited extent in this field, highlighting their potential for improving the objectivity of risk assessment for persistent severe impairment and enhancing the reproducibility of expert decisions. Aim. To develop a prognostic model for quantitative risk assessment of persistent severe cardiovascular functional impairment in patients with valvular heart disease, to evaluate its discrimination and calibration using internal validation, and to implement the model as a risk calculator to support expert decision-making. Methods. A cross-sectional retrospective study was conducted on a sample of 557 patients undergoing disability evaluation due to valvular heart disease. The target outcome was the presence of persistent severe cardiovascular functional impairment (binary variable). The model was developed using binary logistic regression. Predictors included clinical and echocardiographic variables (coronary artery disease, NYHA functional class, left ventricular ejection fraction, systolic pulmonary artery pressure, atrial fibrillation, diabetes mellitus, chronic kidney disease ≥ stage 3a, and age). Discrimination was assessed using ROC-AUC, and calibration using the Brier score, calibration slope, and the Hosmer — Lemeshow test. Internal validation was performed on an independent dataset (n = 250) not used for model training. Results. The model demonstrated high discrimination (ROC-AUC = 0.939; 95 % CI 0.919–0.962) and good calibration (Brier score = 0.075). The PRAUC indicated strong performance under moderate class imbalance. At the optimal classification threshold, sensitivity was 0.82 and specificity was 0.93. A higher threshold prioritizing specificity achieved specificity ≥ 0.95 with a decrease in sensitivity. Conclusion. The developed prognostic model provides a quantitative assessment of the risk of persistent severe cardiovascular functional impairment and can be used as a decision-support tool in disability evaluation of patients with valvular heart disease, contributing to improved objectivity and reproducibility of expert decisions.

The aim of the study was to conduct a comparative analysis of the level, structure, and risk factors for the development of emotional burnout syndrome (EBS) among physicians at the Medical and Social Examination (MSE) bureau with and without disabilities. A cross-sectional study was conducted at the Main MSE Bureau for the Irkutsk Region from June to August 2025, involving 87 physicians (15 with disabilities, 72 without disabilities). Diagnosis was performed using the V. V. Boyko questionnaire. The results revealed two qualitatively different models of EBS development. For physicians with disabilities, a model of “critical start and subsequent adaptation” is characteristic: the peak of burnout is observed among novice specialists (work experience 1–5 years, age 25–35 years), after overcoming which the indicators significantly decrease. For physicians without disabilities, a “classical cumulative model” with a peak at the middle stages of their career (work experience 6–20 years) is observed. A pronounced gender disparity was identified: among men without disabilities, the “Exhaustion” phase was formed in 50 % of cases compared to 4.5 % among women. The practical significance of the work lies in substantiating the need for differentiated support programs: for physicians with disabilities — an intensive adaptation program; for colleagues without disabilities — targeted prevention at the middle stages of their career with special attention to men. The study emphasizes the importance of considering disability status as a significant factor when developing measures for the prevention of professional burnout.

Introduction. Patients with colorectal cancer after completion of treatment demonstrate differences in the level of physical functioning and psychological status, which complicates the selection of optimal medical rehabilitation strategies and requires the development of differentiated approaches. Objective. To develop an algorithm for differentiated assignment of medical rehabilitation in patients with colorectal cancer based on clinical and psychosocial assessment. Methodology. Patients (n = 104) were examined after completion of specialized treatment for colorectal cancer at oncology inpatient facilities in Moscow (2018–2023). Patient condition was assessed using the Karnofsky Performance Status (KPS) and the Mental Component Summary (MCS) of the SF-36 questionnaire. Depending on the combination of these indicators, patients were divided into groups reflecting different levels of physical functioning and psychological status. Results. Four patient groups were identified, differing in the combination of functional status and psychological condition. Each group demonstrated a distinct structure of leading impairments determining priority directions of rehabilitation. Scientific novelty. An algorithm for differentiated assignment of medical rehabilitation in patients with colorectal cancer is proposed, based on the integration of clinical and psychosocial parameters with the formation of typological clinical and psychosocial profiles. In contrast to existing approaches, the algorithm enables a transition from universal rehabilitation programs to a stratified model of intervention selection. Practical significance. The developed algorithm can be used in medical rehabilitation to improve the targeting and justification of rehabilitation interventions in patients with colorectal cancer. Its application contributes to the individualization of rehabilitation programs.

Modern sports medicine has achieved significant results in the physical recovery of athletes; however, the issues of psychosocial adaptation and quality of life during the injury period remain insufficiently studied. The aim of the study is to identify the level of satisfaction with the existing set of measures for athletes’ rehabilitation. The research is based on a quantitative survey (questionnaire) with a sample of N = 161 (professional athletes and Olympic reserve) and a qualitative content analysis of respondents’ open-ended answers. A contradiction has been revealed between the high assessment of the medical aspect of rehabilitation (96,9 %) and the deficit of psychosocial support. Athletes demonstrate a high level of psychosocial distress: 80,1 % experience fear of re-injury, 53 % face everyday and legal problems, and 49,1 % report a decline in mood and apathy. An institutional dysfunction has been identified. The main burden of social support falls on the family, while sports organizations are less involved in solving non-medical issues. Using empirical data, the study demonstrates a mismatch between the medical and social components of rehabilitation for injured athletes and justifies the need to introduce the institution of sports social workers. The research findings support the inclusion of such a specialist as a full-time position in the structure of sports clubs and rehabilitation centers.

Secondary prevention of stroke in elderly and senile people is aimed at correcting risk factors, using drug therapy and lifestyle changes, as well as at rehabilitation after stroke. The goal is to prevent a second stroke in the first 24–48 hours after an acute cerebral ischemic attack. The review of literature on secondary prevention of stroke in elderly and senile people includes studies on risk factor correction, drug therapy, recommendations for lifestyle changes and rehabilitation.