Краткие отчеты о совещаниях 1981 г.

Kpanme oNeThI o conern:aH11Jix fl 1981 ,,- EnporreiicKoe pernoHarrhHoe 610po B03 KPATKHE OTlIEThI 0 COBEIUAHI15IX 1981 BCEMHPHAR 0PfAHM3AI.U1R 3DPABOOXPAHEHMR EBponeHCKOe perHOHarihHOe 6~po KOITEHfAfEH 1982 BceMHpHaR opraHH3a!J,HR 3APaBooxpaHeHHR, 1982 Ha ny6nHKaUHH BceMHpHOH opraHH3aIOIH 3ApaBooxpaHeHHR pacnpocTpaHRIOTCR nono~ehHR npOTOKOna ~ 2 BceMHPHOH KOHBeH- IJ,HH 06 oxpaHe aBTOPCKHX npaB. 3aRBneHHR Ha nepeneqaTKY HJIB nepeBOA ny6nHKa!J,HH EBponeHcKoro perHoHanbHoro 610po B03 qaCTHqHO H.r!H i n toto cneAyeT HanpaBnRTb B 3TY OpraHH3a!J,HID no aApecy: Scher!igsvej 8, DK-2100 Copenhagen 0, Denmark . PerHOHanbHOe 6iopo OXOTHO YAOBneTBOpReT TaKHe npocb6bl. 0603HaqeHHR, HCnOnb3yeM1>1e B HaCTORllleM H3AaHHH, If npHBO- AHMbie B HeM MaTepHanbI HH B KOeM cnyqae He Bbij)=alOT MHeHHe CeKpeTapHaTa BceMHPHOH opraHH3a!J,HH 3ApaBooxpaHeHHR O !OpH,D,H- qecKOM CTaTyce KaKoH-nH60 CTpaHbI, TeppHTOPHH, ropOAa H.r!H paHOHa, lfX npaBHTenbCTB H.r!H AP YrOM opraHe snacTH HnH 06 lfX rocyAapcTBeHHb~ rpaHHuax . YnOMHHaHHe HeKOTOpbJX KOMilaHHH HnH npo,a;yKIJ,HH OTAenbHb~ H3rOTOBHTeneH He 03HaqaeT, qTo BceMHpHaR opraHH3a!J,HR 3ApaBo- oxpaHeHHR OTAaeT HM npeAnOqTeHHe no cpaBHeHHIO C APYrHMH, He ynoMRHYTblMH sTeKcTe, HnH peKoMelfAyeT lfX K Hcnonb30BaHHIO. KaK npaBH.rIO' naTeHTOBaHHbJe HaHMeHOBaHHR Bbl,!l;enRIOTCR HaqanbHblMH nponHCHblMH 6yKBaMH . )TOT AOKnaA OTp=aeT KonneKTHBHbie B3rnR,D;bl, Bbij)=eHHbie B 3THX OTqeTax, He o6R3aTenbHO npeACTaBnReT peweHHR HnH O~H- IJ,HanbHYIO nonHTHKY BceMHpHOH opraHH3a!J,HH 3ApaBooxpaHeHHR . 113/lAH O B JJ,AH!lli ISBN 978 92 890 7373 8 © llaHHhlA c6opHHK KpBTKHX OTQeTOB O COBe.aHHRX, opraHH30BBHHbm EaporreACKHM perHOHaJlbHb!M 6JOpo a 1981 rOAY, rrpeAHB3HBQeH AJIR pyKo- BOAHTeneA H rrpocpeccHOHaJlbHblX pa60THHKOB cnYJl(6 3APBBooxpaHeHHR, KOTOpbJe HaAAyT B HeM rrone3HYJO AJIR ce61t 1-iHqJOPMBI.IHIO O pe3ynbTBTBX 3THX coae.aHHA . KpoMe pyccKoro, 3TOT c6opHI-iK 1-i3ABeTCR Ha aHrnHACKOM, cppaH- l\Y3CKOM 1-i HeMe[.\KOM R3bIKBX. Perl-iOHaJibHOe 6JOpO roTOBO o6ecrreqHTb 3BHHTepecoaaHHbm nHU AOITOnHl-iTenbHOA HHqJOpMaUHeA no nJ060MY I-i3 MeporrpI-iRTHA, OITHCBHHe KOTOpbIX rrpHBOAHTCR a c6opHHKe. 6E300ACHOCTb ffilWEBblX ITPOllYKTOB 60flbHHUbl n1rnEHA OKPYJKAIOWEfl CPE/lhl l1H<l>EKU110 HHblE 60flE3HH COllEP)l{A HME KOHTPOfl b 3A TOKC11'1 Hb!Ml1 XMM11'!ECKlfMH BEWECTBAM11 nA60PATOP11M MAJUIPHR MEllJ,\KO-CAHHTAPHOE 3AKOHOllATEflhCTBO HEC"IACTHblE cnY"IAH OCHOBHhIE CAHHTAPHblE MEPbl O<l>TAnbMOnorHR 06WECTBEHHOro 3llPABOOXPAHEHHR OXPAHA 3llOPOBb!I ITPECTAPEJlhIX OXPAHA ITCHXH"IECKOro 3llOPOBb!I ITnAHHPOBAHHE CEMbl1 ITnAIDIPOBAHH!I 3llPABOOXP AHEIDl!I 11 OUEHKA Ero PAEOTbl ITPO<l>ECCHOHAn bHA!I rnrHEHA PA3BHTHE KAllPOB 3llPABOOXPAHEHH!I PAK CECTPHHCKOE llEflO CTHXHf!HblE 6EllCTBH!I <l>APMAUEBTH'IECKl1E rJPEOAPATbl 3KOHOMHKA 3llPABOOXPAHEHH!I CTp . 5 11 17 29 47 53 57 65 73 85 91 101 107 113 119 129 139 147 153 159 167 - 1 - 6E30IIACHOCTb IIl1IUEBblX TTPO)lYKTOB Pa6oqaR rpynna no MeAHKo-caHHTapHblM acneKTaM OCTaToqHhlX aHa6onHKOB B MRCe EHnTXOBeH, 10-13 HORDPR 1981 roAa - 3 - ICP/FSP 002(l)(S) 24 HOROPR 1981 roAa 0 Plffl1H AIi : AH r Jllif!C KHfl CosemaHHe pa6oqett rpynTTb1 6bU10 C03BaHo EBponettCKHM perHoHanbHblM 6IDpo B03 B coTPYAHHqecTBe c npa- BHTenbCTBOM HHAepnaHAOB. B pa6oTe COBemaHHR npHHRnH yqaCTHe 24 3KCnepTa H3 10 CTpaH EsponeHCKoro perHOHa H npeACTaBHTenH KoMHCCHH eBponeHCKHX coo6mecTB, EBponeHCKOH accouHaUHH cneuHanHCTOB no son- pocaM 3aKOHOAaTenbCTBa B o6nacTH nHmeBblX npOAYKTOB H BceMHpHOH accouHaUHH seTepHHapoB-rHrHeHHCTOB B o6nacTH nHmeBblX npOAYKTOB. naH HOe COBemaHHe HMeno CBOeH uenbID OOCYJl(AeHHe MeAHKo-caHHTapHhlX acneKTOB HCnonb30BaHHR aHa6onH- qecKHX areHTOB B npoH3BOACTBe MRCa, np0Bege1rne oueHKH 6e3onaCHOCTH HMeIDWHXCR B HanHqHH coeAHHeHHH H pa3pa60TKY peKOMeHAaUHH no acneKTaM KOHTponR H 6e3onacHoro HCnonb30BaHHR, AnR Toro qTOObl H3BneKaR MaKCHManbHYID nonb3Y OT npHMeHeHHR TaKHX areHTOB B npOH3BO,IlCTBe MRCa, He nogBepraTb onacHOCTH 3go- POBbe noTpe6HTenett MRca . rnasHb!MH sonpocaMH AflR AHCKYCCHH, KaK Ha nneHapHOM 3acegaHHH TaK H B pa6oqHx rpynnax Obll1H crre- .IlYIDWHe: COBpeMeHHOe HCnOITb30BaHHe aHa6orrHqecKHX areHTOB B HeKOTOPblX eBponeHCKHX CTpaHax; HCTOqHHKH H BHAbl OCTaToqHbnc aHa6orrHqecKHX areHTOB a MR Ce; BITHRHHe Ha 3.IlOPOBbe qerroBeKa OCTaToqHbJX HaTypanbHblX H KCeHOOHOTHqecKHX aHa6orrHqecKHX areHTOB B M.R:Ce; 300TeXHHqeCKHe acneKTbl npHMeHeHHR aHaDOITHKOB; acneKTbl KOHTPOITR H cosepweHCTBOBaHHe npaBHn npHMeHeHHR; aHan HTHqec KHe acneKTbl H npHrO,IlHOCTb HCnOITb3yeMbIX MeTO,IlOB; HanpaBrreHHe HH~OpMaUHH HayqHo-HccrregosaTeITbCKHM opraHH3aUHRM, a TaK~e OTAeITbHblM ITHUaM, OTBeTC TBeHHblM 3a npHHRTHe pemeHHH H ClOTpe6HTeITRM. YqacTHHKH rpynnbI cgerranH crre,IlYIDWHe BbIBO,Ilbl H peKOMeH,IlaUHH: 1. AHa6orrHqecK He areHTbl cnoco6cTBYIDT ClpHpOCTY =Boro seca, seca TYWH, 3~eKTHBHOCTH KOPMOB H YBe- n=eHHID npoueHTHoro BblXO,Ila MRCa Ha Tyme Y HeKOTOpblX BHAOB =soTHblX npH HCnOITb30BaHHH onpe,IlerreHHblX CHCTeM =soTHOBO,IlCTBa . IT03TOMY, ClpH YCITOBHH, ecrrH OHH He nOABepraIDT ClOTpe6HTeITR onaCHOCTH , 3TH areHTbl MoryT CbJrpaTb B~HYID POITb B =BOTHOBOACTBe. 2 . ITpO H3BOAHTerrH MRCa nonyqaIDT RBHble H 3HaqHTeITbHbJe BblrOAbl OT HCnOITb30BaHHR TaKHX areHTOB. 'lTOObl H36e~aTb onaCHOCTH H He AOTTYCTHTb 3anpemeHHOro KOMeH,IlyeTCR, npH COOTBeTCTBYIDmeM KOHTpone, pa3pewHTb HCnOITb30BaHHe naTeHTOBaHHblX H 6e3onaCHblX aHa - 6orrHqecKHX areHTOB . 3. IT paBHnbHOe npHMeHeHHe H AOOaBrreHHe B KOPM CKOTY 3KcoreHHhlX HaTypanbHblX CTepOHAHblX aHa6onHqec - KHX rapMOHOB He C03,IlaeT, KaK H3BeCTHO, Me,IlHKo- caHHTapHblX npo6rreM AITR ClOTpe6HTenett. 4 . C APYrOH CTOPOHbl He crreAyeT npHMeHRTb a =BOTHOBO,IlCTBe s KaqecTBe aHa6orrHqecKHX areHTOB , CTHrr- 6eKOBble 3CTporeHbl nOCKOITbKY OHH opanbHO aKTHBHbl, coxpaHRIDTCR B ClHmeBblX npogyKTax AflHTeITbHOe speMR H MOryT o6rraAaTb XHMHqecKOH KaHueporeHHOH aKTHBHOCTbID. 5. no Toro' KaK OHH DYAYT pa3pe1DeHb1 K npHMeHeHHID' KCeHOOHOTHqecKHe aHa6oITH"!eCKHe areHTbl AO~Hbl OblTb nOABep rHyTbl COOTBeTCTBYIDmett HayqHOH oueHKe . ITpH HCnOITb30BaHHH TpeHDOITOH aueTaTa H uepaHorra COOTBeTCTBYIDWHe Me~yHapO,IlHble opraHH3aUHH, HanpHMep, Ofrbe,IlHHeHHblH KOMHTeT 3KCnepTOB C!>AO/B03 no nH- meBblM AOOaBKaM (OK3nn) H Codex Alirnentarius , AO~Hbl ,KaK MO~HO CKopee ,rrposeCTH oueHKy HMeIDWHXCR gaHHblX. 6. ITepBooqepe,IlHOe BHHMaHHe o6mecTBeHHOe 3,IlpaBooxpaHeHHe AOIT~HO ygerrHTb npegynpe~eHHID He3aKOHHOro npHMeHeHHR 3anpe,ueHHblX TTPOAYKTOB nyTeM YCTaHOBITeHHR COOTBeTCTBYIDmero HaOITIDAeHHR 3a ct,epMaMH H/HrrH MRCOOOHHRMH . - 4 - 7. TTpH HCnOnb30B8HHH naTeHTOB8HHblX npOAYKTOB peKOMeHAyeTCR CTporo co6n~A8Tb Bee nonoJKeHHR O MeTo- AHKe H MeCTe npHeMa, a T8KJKe nepHOAe ynaneHHR 3THX BemecTB H3 opraHH3Ma, KaK OHH H3nOJKeHbl B ycnoBH- RHX npHMeHeHHR, <!T06bl npeAOTBpaTHTb npeBbimeHHe A03BoneHHblX ypOBHeM OCT8TO<!HhlX aHa6onHKOB, npOHHKa~- IIIHX B nHmeBble npOAYKTbl. 8. Y<!HTbIBaR 6onbmoe 3Ha<leHHe MeJKAYH8POAHOM ToproBnH B EBpone, JKenaTenbHO npHBeCTH B COOTBeTCTBHe Bee npaBHna no HCnonb30B8HH~ aHa6onH<1eCKHX areHTOB C yqeTOM COBpeMeHHbl)( H B03MOJICHblX H3MeHeHlrn B o6nacTH 3aKOHOAaTenbCTBa B CTpaHax CoBeTa 3KOHOMH'leCKOM B3aHMonoMomH (C3B) H EBponeiicKoro 3KOHOMH - qecKoro Coo6mecTBa (E3C), a TaKlKe H B APYrHx cTpattax. 9. rnaBHOM uenb~ 38KOHOAaTenbCTBa no aHa6onH'leCKHM areHTaM AOnJKHa 6b!Tb 38IIIHT8 n o Tpe6HTenR. 3aKOHOA8TenbCTBO He0 6XOAHMO COBepmeHCTBOB8Tb, a 3TO Tpe6yeT COOTBeTCTBY~IDHM o6pa30M nonroTOBneHHblX K8APOB, onbITa H MaTepHaribHOJ:i 6a3bl . 10. B uenR X oueHKH atta6onH<1eCKHX areHTOB H COBepmeHCTBOB8HHR 3aKOHOA8TenbCTBa Heo6XOAHMO paspa6a- TbIBaTb, HCnblTblB8T b , CTaHA8PTH3HPOBaTb H npHMeHRTb COOTBeTCTB~IDHe <IYBCTBHTenbHhle aHanHTH<!eCKHe MeTOAbl. 11. HaH6onee nOAXOARIDHMH MeTOAaMH, HCnOnb3yeMbIMH B H8CTORmee BpeMR, RBnR~TCR ¢H3HKO-XHMH<!eCKHe HnH HMMYHOXHMH<!eCKHe MeTOAbl. B npHMeHeHHH 6HonorH<!eCKHX MeTOAOB, T8KHX K8K 6HonorH<1eCKHe HCnhlT8HHR HnH rHCTonorH<!eCKHe MeTOAbl cymeCTBY~T cepbe3Hble HeAOCT8TKH. 1 2. Ha nepBOM 3Tane KOHTpOnR oco6e HHO none3Hb!MH RBnR~TCR MeTOAbl P8AHOHMMYHOnorH'leCKHX HCnbITaHHJ:i H, rne 3TO nOAXOAHT, AnR nOATBepJKAeHHR pe3ynbT8TOB MoryT 6b1Tb Hcnonb30B8Hbl ¢H3HKO-XHMH<!eCKHe MeT OAbl . 13 . Heo6XOAHM8R <IYBCTBHTenbHOCTb H TO<!HOCTb MeTOAa 3aBHCHT OT BbI6opa 06pa3ua, T8K K8K H8HBblCIDHJ:i YPOBeHb OCTaTO<!HblX areHTOB Ha6n~naeTCR B HcnpaJKHeHHRX, a C8Mb!M HH3KHM - B MbllllU8X . 06p83Ubl Hcnpal!<- HeHHM MoryT 6b!Tb HCnonb30B8Hbl B uenR X KOHTponR. 14 . n.nR Toro, <!T06bl MOJICHO 6blJ10 cpaBHHB8Tb nonyqeHHble pe3ynbT8Tbl, peKOMeHAyeTCR nepHOAH<!eCKH CBe- PRTb MeJKAyH8POAHhle CT8HA8PTbl MeTOAOB HccnenoBaHHR. 15. B03 peKOMeHAOB8HO yqpeAHTb, n o B03MOJICHOCTH CKopee, EBponeMCKHM COTPYAHH<!a~IDHJ:i ueHTP no MeAHKO - caHHT8PHblM acneKTaM aHa6onHTH<!eCKHX areHTOB, 'IT06b] OH Mor BblTIOnHRTb ponb ueHTp a AnR npoBeAe HHR Aanb- Hel<IDHX HccnenoBaHHM B o 6nacTH atta6onHKOB, BKn~<!aR paCCMOTpeHHe attanHTH<!eCKHX MeT OAOB, BbJBePKY CTaH - A8P THblX MeTOAOB Ha Me)l(AyHapOAHOM YPOBHe, o6ecne'leHHe cnpaBO'IHblX MaTepHanOB H o6MeH HH¢OpMauIDI. 16. CneAyeT ynyqIDHTb o6MeH HH¢opMauHeM MeJKAY HayqHhlMH HHCTHTYTaMH, o6mecTBeHHOCTb~ H nHUaMH, OTBeT- CT BeHHblMH 38 TIPHHRTHe pemeHHM . BaJKHblM BOTIPOCOM RBnReTCR CBOeBpeMeHHb!M H nonHhlH 06MeH HH¢QpMauHeH 0 AeRTenbHOCTH, npoBOAHMO J:i B H8CTORmee BpeMR B o6nacTH H8)7'1Hbl)( HccneAOB8HHA. B HH¢OPM8UHH, HanpaB - nReMOM nHuaM, OTBeTCTBeHHblM 38 npHHRTHe pemeHHJ:i, AOnJKHbl 6b1Tb o603Ha<!eHbl B03MOJICHble BapHaHTbl AeRTenb- HOCTH H OTpaJKeHbJ B03MOJKHble nocneACTBHR ocymeCTBneHHR KaJKAOro H3 HHX. Htt¢opMaUHR, HanpaBnReMaR o6mecTBeHHOCTH, AOnJKHa 6b!Tb <leTKOH, npaBAHBOH , TIOHRTHOJ:i H JlHllleHHOJ:i K8KHX-nH60 cettcauHii. B03 AOnJK- Ha 06ecne<1HTb CB060AHOe o6cYJK,QeHHe 3Toro HenpepblBHoro TIOTOKa HH¢0PM8UHH. - 5 - 60flbHl!!Ubl - 7 - Pa6o qaR rpynna no MeAHKO-COUHa.JlbHblM a cne KTaM o 6cnYJl(HsaHHR s 6onbHHuax I CP/ SPM 03 l ( S) 22 OKTR6pH 1981 rona Xen bC HHKH, 1-4 ceHTR6pH 1981 ron a 0 Plffl1HAJJ: AHfJI11f\CKHf\ Bsen eHHe B 3aceaaHHRX Pa6oqeif rpynnbl npHHRnH yqacTHe 19 speMeHHblX coseTHHKOB H3 16 CTpaH, npeacTaBHTenb Mell!;zyHapOAHoro coseTa MeAHUHHCKHX cecTep, KOHCynbTaHT H mTaTHblH COTPYAHHK B03 . 3To 6bIJIO nepsoe cosemaHHe Ha AaHHYJO TeMY, C03BaHHOe EsponeHCKHM perHOHa.JlbHb!M 6wpo B COOTBeTCTBHH C nporpaMMOH ITon- pa3a eneHHR cecTpHHCKoro nena. 1 Ero uenb cocToRna a cnenyiomeM : 1) H3yqHTb cymeCTBYJ(lmHe B 6onbHHUaX MeAHKO- COUHa.JlbHbie CnYJI(6bl, npeaocTaBnReMbie ISonbHblM H qne- HaM HX ceMeH ; 2) o6cyaHTb B03MOJKHbie sapHaHTbl ycTaHOBneHHR KOHTaKTOB MeJKay pa60THHKaMH MeAHKO-COUHa.JlbHOH 06- nacTH a 6onbHHUaX H pa60THHKaMH apyrHX AHCQHnnHH B cnYJI(6e snpasooxpaHeHHR ; 3) o npenenHTb DYAYWHe HanpasneHHR aeRTenbHOCTH MeAHKQ-COUHa.JlbHblX CnYJK6; 4) onpeaenHTb noTpe6HOCTH CHCTeMbI o6yqeHHR COTPYAHHKOB MeAHKQ-COUHa.JlbHOH o6naCTH; 5) BHe CTH npeAnOJKeHHR no pa3BHTHW MeAHKO-COUHa.JlbHhJX cnYJI(6 H o6yqeH= pa60THHKOB MeAHKo- co- UHa.JlbHbIX cnYJI(6 H o6yqeH= pa6oTHHKOB MeAHKO-COQHa.JlbHOH o6naCTH ; 6) paCCMOTpeTb cospeMeHHOe nonoJKeHHe Aen C yqeTOM HYJKA H B03MOJKHOCTeH MeAHUHHCKOH cnYJI(6bI H BHeCTH npe,IJ,JlOJKeHHR no pemeH= nepaooqepeAHhIX npo6neM. n HC KYCCHR B XOAe AHCKYCCHH 6bIJia npeAnPHHRTa n o nbITKa onpeAenHTb HeKOTOPbie H9 06mHX sonpocos, OTHOCRWHXCR K p a 3BHT= MeAHKo-couHanbHbIX cnYJI(6 . C CaMoro Haqana cosemaHHR BbIBCHHnOCb, qTQ uenH H 3aAaqH Pa- 6oqeif rpynnbI , BbITeK-mHe H3 ee HasaaHHR, aeCbMa orpaHHqeHbI H qneHhI rpynnbl 6bICTPO nepecTpOHnHCb H nepe illJlH K o6cy)l(AeHHW 3aAaq o6mecTBa no olSecneqeHHW MeAHUHHCKHX H MeAHKO - COUHa.JlbHbIX noTpe6HOCTeH Ha- cen eHHR . Bee yqacTHHKH coaemaHHR cornacHnHCb c TeM , qTQ ,IJ,JlR qeTKoro o npeAeneHHR 3THX noTpe6HOCTeH B 6 onb WHHCTBe CTpaH He06XOAHMO npoaecTH cpasHeHHe nonyqeHHbIX C MeCT OCHOBHblX aaHHbIX OTHOCHTenbHO 06- pas a JKH3HH . nnR 3TOH uenH He06XOAHMO npoaeCTH KaK KaqecTBeHHbie, TaK H KOnHqecTseHHbie HCcnenosa - HHR: a npolllJIOM yqeHbie a 6onbllIHHCTBe rocyAapcTs -qneHOB OCHOBHOe BHHMaHHe yaenHnH nposeneHHW KOnH- qecTBeHHblX HCCneAOBaHHH . BaJKHO TaKJKe pacnonaraTb HH¢opMauHeH O B3aHM03aBHCHMOCTH MeJKay HeHcnonb- 30B a HHeM CnYJK6, HX CTPYKTYPOH H opraHH3aUHeH H OTHOmeHHeM K pa6oTe n Hu , 3aHRTblX B 3THX cnyJK6ax . ITOCKOnbKY 6 bIJIO npH3HaHo, qTo no OTHomeH= K 6onbHbIM / KnHeHTaM B HeKOTOPblX cnyqaRX aaJKHO HCnOnb - 30B a Tb HHAHBHAYa.JlbHbIH nOAXOA , yqacTHHKH rpynnbI, KPOMe Toro, cornacHnHCb, qTo ace pa60THHKH 3Apaso - oxp a HeHHR H COUHanbHbIX cnYJ!(6 HecyT OTBeTCTBeHHOCTb 3a BHeceHHe H3MeHeHIDi , rne 3TO Heo6XOAHMO, KaK B COUHanbHbie CTPYKTYPbI, TaK H B ycnOBHR, Bbl3blB=mHe 6one3Hb HnH HHBaJ!HAHOCTb . B 3TOH CBR3H OHH 0A00 pHnH onpeneneHHe noHRTHR 3AOPOBbR, AaHHOe B03 , a TaKJKe nonoJKeHHR AnMa - ATHHCKOH AeKnapauHH . Yqac THHKH cosemaHHR eAHHOAYWHO noA,D;epJKanH npe,IJ,JlOJKeHHe o TOM, qTQ yqe6HaR H npaKTHqecKaR AeRTenb - HOC T b n Hu, o6ecneqHBaWmHX MeAHKO-COUHanbHbie CnYJI(6bI , BO acex CTpaHax AOJDKHa OblTb HanpasneHa Ha c o - a e licTBHe BbinonHeHHW OCHOBHOH COUHa.JlbHOH 3 aAaqH - AOCTHJKeHHe 3AOPOBbR ,IJ,JlR acex K 2000 rOAY- 1 B Ea poneHCKOM perHOHa.JlbHOM 15wpo B03 OTBeTCTBeHHOCTb 3a MeAHKQ - COUHa.JlbHYJO pa60 TY aosnoJKeH a Ha ITonpasneneHHe c ecTpHHCKoro Aena . - 8 - 06cYJ!(.O,aH aonpOCbl HHnHBH.D;YaJlbHOro H 6pHranHoro MenHUHHCKoro o6CTIYJIG{BaHHH, rpynna npHllllla K BhlBO- nY, qTo 6pHrauHhlH MeTon cymeCTBeHHO BTIHHeT Ha pa3BHTHe H coaepmeHCTBOBaHHe HHnHBH.D;YaJlbHOro o6cnYJIG{- BaHHH. B TeqeHHe nocnenHHX neT apaqH H pa60THHKH COUHaJlbHOH c¢epbl oco6oe BHHMaHHe ynenHnH onpene- nemoo HHnHBHnyanbHblX ¢YHKUHH, HO 3TO He npHBMO K ynyqmeHHJO nonol!<eHHH 60TibHbIX/ KnHeHTOB. Heo6xonH- MO ycTaHOBHTb noTpe6HOCTb B CTIYJ1<6ax: onpeuenHTb rpy nnhl HaceneHHll, HaxonHtnHeCll B He6naronpHl!THblX ycnoB Hll X , a TeM KaTeropHHM TIHU, KOTOpble He B COCTOllHHH ynoaneTBOPHTb CBOH noTpe6HOCTH, OKa3aTb He- o6xonHMYJO noMOWb B BOCCTaHOBneHHH HX CTaTyca H ¢H3HqecKo ro 3nopOBbll. Bo MHOrHX cnyqa11 x 3TO noTpe- 6yeT nepepacnpeneneHHll cpencTB. qaCTb H3 HHX, pacxonyeMaH Ha OKa3aHHe cpoqHOH MenHUHHCKOH noMOmH a 6onbHHuax, nonl!<Ha 6bITb HanpaaneHa Ha o6ecneqeHHe nonrocpoqHoro MenHUHHCKoro o6CTIYJ!GiBaHHH n o Mee- TY JKHTenbCTB a . 06yqeHHe MeTonaM 6pHrauHOH pa6oTbl HBTilleTCll, n o o6meMy npH3HaHHID, onHHM H3 HanpaaneHHH ueHTenb- HOCTH H Tpe6yeT no:3TOMY nanbHeH!llero H3yqeHHll . fpynna OTMeTHna, qTo HMeIDTCll cymecTBeHHble pa3TiffqHll B opraHH3aUHH neHTenbHOCTH MenHKO-COUHaJib- HblX CTIYJ1<6 H pa3pa60TKe nporpaMM o6yqeHHll TIHU, 3aHHMaIDmttXCll HX o6ecneqeHHeM B PerHOHe. TaKoe nono- l!<eHHe HeH36el!<HO H n=e ll<enaTeTibHO, noCKOTibKY yCTIOBHll B P erHOHe HeonHoponHb1. Ho B CHTIY 3Toro pa3- H006pa3Hll, no MHeHHJO yqacTHHKOB rpynTihl, 6hlTIO fihl aeCbMa none3HO npoaeCTH cpaBHHTeTibHhle HCcnenoaaHHll Ha Mell<ny HaponHOM ypoaHe H He TOTibK O UTill y qaCTBYJOmHX CTpaH, HO TaKJl<e H UTIH PerHOHaJlbHOro 6IDpo, qTo nacT B03MOll<HOCTb 6onee ToqHo onpenenHTb ero 3anaqy a oKa3aHHH noMomtt rocynapcTBaM-qneHaM. BblBOnhl 1. Bh1BOnh1 H peKoMeHnauHH, cnenaHHhJe a xone naHHoro coaemaHHll - nepaoro, noca11meHHoro paccMaTpHaae- MOMY aonpocy, cnenyeT cqHTaTb npenaapHTMbHhlMH 3aMeqaHHllMH o6mero xapaKTepa; OHH llBTillIDTCll nepBO H nonb!TKOH H3TIOll<HTb H onpenem1Tb rnaBHble npo6neMbJ, npencTaBnllIDWHe HHTepec . 2 . IlOHl!THe "MenHKO- COUHaJlbHal! pafioTa" B CTpaHax PerHOHa HMeeT pa3Hble 3HaqeHHll' H no:3TOMY cy- mecTayeT HaCTOHTenbHal! Heo6xonHMOCTb a 6onee qeTKOH ¢OPMYTIHPOBKe TepMHHa . Heo6xonHMo npennpHHHTb COOTBeTCTBYJOmtte marH UTill OKa3aHHll noMOmH pa6oTHHKaM MenHKO - COUHaJlbHhlX CTIYJl<6 B onpeneneHHH HX ¢YHKUHH . 3TO nacT B03MOll<HOCTb c¢OPMYTIHpoaaTb 6onee KOHKpeTHhle npennoll<e HHll , KacaIDtnHeCll opraHH3aUHH H y npaaneHHll MenHKO-COUHaJlbHhlMH CTIYJ1<6aMH, BKnIDqa11 nnaHHPOBaHHe pecypCOB H o6yqeHHe pa60THHKOB MenHKO - COUHaJlbHOH o6naCTH. PerHOHaJlbHOMY 6IDpo, KOTOpoe YJ!<e ceHqac npennpHHH- MaeT nepBble marH B pa3BHTHH cecTpHHCKOro nena, MOll<eT 6hlTb npennol!<eHO OKa3aTb aHanorHqHyio nOMOWb ro- cynapCTBaM-qneHaM B MenHKO - COUHaJlbHOH o6naCTH . 3 . J1Hua' o6ecneqHaaIDtnHe MenHKO - COUHaJlbHhle CTIYJ1<6b]' noTill<Hbl BHOCHTb 60TibIDHH BKnan B pa3BHTHe HauHo- HaJlbHblX nporpaMM nepBttqHOH MenHKo-caHHTapHOH nOMOmff . 3To, B03M0ll<HO, Bhl:30BeT Heo6xonHMOCTb B 6onee aKTHBHOM HCnOTib30BaHHH nonxona, npH KOTOPOM yqHTb!BaIDTCll COUHaJlbHall CTPYKTypa, nonHTHKa B o6naCTH 3npaaooxpaHeHHll, IDHPOKHH cneKTP COUHaJlbH0-3KOHOMHqecKHX aonpocoa H npaKTHKa npHHllTHll pemeHHH B coa- peMeHHOM o6mecTae, no cpaaHeHHID C HCnOTib30BaHHeM HHnHBH.D;YaJlbHOro nonxona, B OCHOBe KOTOporo neJKHT onpeneneHHa11 MenHUHHcKa11 Monenh . 4 . AoKyMeHTaUHll O 6onbHhlX/KnHeHTax He acerna npenocTaBnlleTCll pa60THHKaM MenHKO - COUHaJlbHOH o6naCTH . 3TO onHH H3 HeraTHBHblX acneKTOB 6pHranHoro MeTona pa60Tbl. IlonroTOBKa noKyMeHTaUHH, KOTOPYJO MOJl<HO 6hlno 6b1 npenocTaBHTb a pacnop11J1<eHHe qneHoB 6pHrans1, Tpe6yeT oco6oro nonxona BBHAY Heo6xonHMOCTH cofinIDnaTb KOH¢H.D;eHUHaJlbHOCTb B p11ne cnyqaea . s. y qpell<neHHe PerHOHaJlbHhlM 6IDpo He6onbIDOH cneuHanbHOH rpynTibl MOrno 6hl o6nerqHTb H yCKOPHTb npoae- neHHe TaKHX MeponpHHTHH, a TaKJl<e coneACTBOBaTb pa3pa60TKe MeTonoa UTill C03UaHHH pa60THHKaMH MenHK o - COUHaJlbHOH o6naCTH co6CTBeHHOH CHCTeMbl oueHKH, nnaHHPOBaHHll H OKa3aHHH noMOtnH C HCnOTib30BaHHeM no- KyMeHTaUHH, aHanOrttqHOH TOH , KOTOpall a HaCToHmee apeMH npHMeHl!eTCll a o6naCTH ceCTPHHCKOro nena. PeKOMeHnaUHH HaUHOHaJlbHblH ypoaeHb 1. Ml! Toro, qTo6bl co3naTb c6anaHCHPOBaHHYJO CHCTeMY COUHaJlbHhlX H MenHUHHCKHX CTIYJ1<6 no o6ecneqeHHID HenpepbJBHOH COOTBeTCTBYIDmeA nOMOtnH, nocTynHOH UTill 6oTibHblX H KTIHeHTOB BO acex ceKTopax H Ha acex YPOBHHX, rocynapcTaa- qneHhl npH coneHCTBHH FerHOHaJlbHOro 6IDpo nonl!<Hbl npHHl!Tb Heo6xonHMb1e Mepbl nmi:: c6opa HH¢OpMaUHH O coapeMeHHblX noTpe6HOCTHX HaceneHHll B nonyqeHHH MenHKO-COUHaJlbHOH noMomH; 0 MeTonax ynoaneTBopeHHH 3 THX noTpe6HOCTeA; O npo¢ecCHOHaJlbHOM COCTaBe pa60THHKOB , BblnOTIHll IDWHX 3TH ¢YHKUHH; 0 CHCTeMax B3aHMoneHCTBHll H B3aHMOCBll3H Mell<ny pafiOTHHK a MH; 06 YPOB He H BH,D;e HX nonroTOBKH; o pa3BHTHH noTpe6HOCTeH B MeUHKo - couHanbHblX CTIYJ!<Dax B 6ynymeM H 06 HX B03MOJl<HOCTllX C yqeTOM pa3BHTHll TeXHOTIOrHH, H3MeHeHHH B neMorpa¢HqecKOH H 3nHneMHonorHqeCKOH ODC TaHOB Ke, co - UHanbH0-3KOHOMHqecKoro pa3BHTHll, a TaKl!<e pecypCOB. l - 9 - onpeAeJl€HHR cymecTBYWIDHX B HaCToRmee apeMJI KaTeropHH pa60THHKOB, HeCYIDHX OTBeTCTBeHHOC T b 3a MeponpHRTHR B MeAHKO - COUHanbHOH o6naCTH; o npeAeneHHR <PYHKllHH H o6R3aHHOCTeH JlHll, o6ecne<rnBaIDmHX MeAHKO - COllHanbHble CJIYJK6bl' C y'!eTOM Tex H9MeHeHHH, KOTOPble npOHCXOART B MeAHllHHe, ceCTPHHCKOM Aene H APYrHX OTpaCJlRX , OTHOCRIDHXCR K 3ApaaooxpaHeHHKJ ; BKJlW'!eHHR JlHll, o6ecne'!HBaWmHX MeAHKO - COllHanbHble CJIYJK6bl, BO acex 6pHraAbl MeAHKo - caHHTapHOH JlOMOIDH ; coaepmeHCTBOBaHHR KOOPAHHallHH AeRTellbHOCTH acex '!JleHOB 6pHraAbI MeAHKo - caHHTapHOH CTOMOIDH; pa3BHTHR KOHTaKTOB H OOMeHa HHct,OpMa1..1HeH, B TOM '!HCJle o6MeHa COOTBeTCTByIDIDeH AOKyMeHTa1..1HeH MeJK,ny paOOTHHKaMH MeAHKO - COllHanbHb!X CJIYJK6 B 60JlbHHllaX H APYrHX yt!peJK,neHHRX Taxoro THna, C OA HOH CTOPOHbl, H npeACTaBHTeJlRMH CMeJtCHblX npocpeccHH, C APYrOH CTOPOHbl ; o npeAeJieHHR AanbHeHmero pa9BHTHR noJlOJIQIT€nbHblX TeHAeHI..IHH H ycnemHbIX Ha'!HHaHHH B 3 TOH o6naCTH , 2. rocyAapCTBaM-'!JleHaM HaAJiellQIT onpeAeJlHTb 3aAa'!H B oonaCTH CHCTeMbl noArOTOBKH JlHll, o6ecne'!HBaw- IDHX MeAHKo - co1..1HaJlbHbl€ CllYJKCbl ; Heo6XOAHMO pa3pa60TaTb H opraHH30BaTb ocymecTBJleHHe nporpaMM, CTaaR- IDHX ll€nbW o6y'!HTb OpHraAHOMY MeTOAY pa60Tbl Hee o praHH3aUHH , a TaKJtCe YAeJIHTb BHHMaHHe ncHXOCOllHanb - Hb!M acneKTaM nOMOmH, 3. Ha noCTAHJlJlOMHOM YPOBHe 06pa3oaaTenbHble nporpaMMb! AOJlJtCHbl BKJlW'!aTb npoBeAeHHe 3aHRTHH no coape - MeHHblM AHCLU-!JlJlHHaM , TaKHM, xax C'!eTHO - Bbl'!HCJlHTeJlbHaR HayKa, npOMbllll!leHHaR TeXHOJlOrHR H ynpaaneHHe (BHHMa HHe npH 3TOM CJleAyeT YAeJIRTb KaK TeopHH, TaK H npaKTH'!eCKOMY OilblTY B ycTaHOBJleHHH KOHTaKTOB, JlOMHMO IlOBblmeHHR YPOBHR noArOTOBKH a o6nacTH ryMaHHTapHb!X H COllHan b Hb!X Hayx). 4. 06y'!eHH€ a YHHBepCHTeTe H AanbHeHmee nOBblmeHHe KBanHct,HKallHH AOJlJtCHbl 6b!Tb AOCTYJlHblM H a nepayw Ot!epeAb AJIR Tex, KTO Ha3Ha'laeTCR Ha PYKOBOARIDHe noCTbl HJlH AOJlJtCHOCTH B o6naCTH npocaemeHHR, aAMHHHCT- paTHBHOH AeRTeJlbHOCTH HJlH Hay'!HblX HCCJleAOBaHHH. s. Heo6XOAHMO HCJlOJlb30BaTb ace HMeIDIDHeCR B03MOJtCHOCTH AllR o6MeHa 3HaHHRMH MeJK,ny '!Jl€HaMH 6pHraAbl no OKa3aHHW MeAHUHHCKOH JlOMOIDH , l1eJK,nyH apOAHb!H YPOB e Hb Heo6XOAHMO ycTaHaam,raaTb H noaaepJIQIBaTb JlOCTORHHble KOHTaKTbl MeJK,Ay B03 H APYrHMH POACTB€HHblMH opraHH3allHRMH, B '!aCTHOCTH MeJK,nyHaPOAHOH acco1..1Ha1..1HeH pa60THHKOB COllHanbH OH JlOMOIDH, MeJK,nyHaPOAHOH ct,eAepa1..1HeH pa60THHKOB COllHaJlbHOH JlOMOIDH H MeJK,nyHapOAHOH acco1..1Ha1..1HeH IDKOJl COUHaJlbHOH noMOIDH, B 1..1enRX npoBeAeHHR AHCKYCCHH, YTO'!HeHHR CT03HllHH H COAeHC TBHR pa3BHTHW B TaKHX o6naC TRX B3aHMHblX HHTepecoa, KaK MeAHKO - COllHanbHaR pa6oTa, Bblpa6oTKa TepMHHOJlOrHH H BKJlaA pa6oTHHKOB MeAHKO - COllHallbHOH o6naCTH a AOCTHl!<eHHe o6mHx 1..1eneH . YpoaeHb B03 I. PerHOHaJlbHOMY 6wp o HaAJl€JtCHT OKa3blBaTb COA€HCTBHe rocyAaPCTBaM- '!JleHaM B nnaHHPOBaHHH H ocymecT - BJleHHH HaUHOHanbHblX HCCJl€AOBaHHH , oco6eHHO a COCTaaneHHH oomero npOTOKOJla, '!TO CTOMOJtC€T npoBeAeHHW cpaBHHTeJlbHOro HCCJl€AOBaHHR, o6MeHy HHct,opMallHeH H OJlblTOM . 2. Pe rHoHanbHOMY 6wpo cneAyeT YA €nHTb BHHMaHHe AaJibHe 11meMY pa3BHTHKl MeAHKo - co1..1HanbHOH pa60Tbl BO acex CTpaHaX PerHO Ha, HMeR B BHAY, '!TO 3Ta A€RT€nbHOCTb MOJtCeT BHeCTH cymeCTBeHHb!H BKJlaA B AOCTHJKeHHe COllHanbHOH 1..1enH o6ecne'!eHHR 3AOPOBbR AJIR acex K 2000 roay . - 11 - rnrHEHA OKPYJKAJOIUEfl CPEW,I Pa6oqee cosewaHHe no npo6neMaM I'HrJ.leHbl OKpYJKaIOweA cpe,o;bJ s apKTHqecKHX H cy6apKTHqecKHX pal!ottax Konettrarett , 3-7 asrycTa 1981 ro,o;a - 13 - ICP/ BSM 003(6)(S) 28 ,o;exa6pR 1981 ro,o;a 0PHfHHAJl: AHrJJl1flcKHf! B ,o;aHHOM pa6oqeM cosemaHHH npHHRnH yqacTHe 23 pa3HOnpo¢HnbHbDC cneIJ,HanHCTa o6mecTBeHHOI'O 3,o;pa- sooxpaHeHHR H3 5 pacnonoJKeHHbDC Ha cesepe Esponb1 H s A3HH rocy,o;apcTs - qneHos, a TaKJKe H3 Coe,o;HHeHHboc illTaTos AMepHKH, Katta,o;bI H ABcTpanHH . Uenb cosewaHHR COCTORna s TOM, qT06bI, co6pas SMecTe cneIJ,HanHCTOS s o6naCTH o6wecTSeHHOI'O 3,o;pa- sooxpaHeHHR H I'HI'HeHbl OKpY)KaIOmeA cpe,o;bJ H3 apKTHqecKHX H cy6apKTHqecKHX paHOHOS MHpa , nposeCTH 06- MeH OilbITOM H o6cy,o;HTb S03MOlKHbJe nyTH peweHHR TaKHX OCHOSHbDC npo6neM I'HI'HeHbl OKpY)KalO!lleH cpe,[J;bl, xax SOAOCHa6JKeHHe , y,o;aneHHe OTXOAOS, nnaHHposaHHe noceneHHH H lKHnH!UHOe CTpOHTenbCTBO s pattoHax xono,o; - HOI'O KnHMaTa H SbIHeCTH COOTBeTCTSYIOWHe pexoMeH,IJ;aIJ,HH. Ha cne,o;yIOweM pa6oqeM cosemaHHH HaMeqeHO 06- CYAHTb APYI'He , CTOflb lKe Sa)J(HbJe npo6neMbJ: 3arpR3HeHHe oxpyiKaIOmeA cpe,o;bJ npOMbllll1leHHbIMH H ropHblMH npe,o;npHRTHRMH,KOHTPOfl b 3a TOKCHqHbIMH XHMHqecKHMH semeCTBaMH, TRJKenbJMH MeTannaMH , 6opb6a c nepeHoc- qHKaMH HH¢eKIJ,HH H HaceKOMbIMH, 300H03aMH, renaTHTOM H T.,o;. KpoMe Toro, paCCMOTpeHHIO no,o;seprHyTCR sonpOCbl opraHH3aIJ,HH cnyiK6 I'HI'HeHbl OKPYJKaIO!UeH cpe,o;bI s pal!oHax xono,o;HOI'O KflHMaTa . C03 bIB cosemaHHR MOlKHO cqHTaTb seCbMa csoespeMeHHbIM, yqHTbJSaR, qTo OpraHH3aIJ,HR 06'be,[J;HHeHHbDC HaUHH nposo3rnacHna 1981-1990 rr. MeJKAyHapO,[J;HblM ,o;eCRTHneTHeM nHTbesoro SOAOCHa6JKeHHR H caHHTapHH . Uenb npose,o;eHHR aecRTHneTHR - o6ecneqHTb see HaceneHHe 3eMHOI' O wapa K 1990 ro,o;y nHTbeS OH SOAOH H COOTBeTCTBYJOWHMH caHHTapHblMH ycnoSHRMH . Ilocne,o;HHM MeponpHRTHeM B03 s 3TOH o6naCTH 6bl!la KoH¢epeHIJ,HR B03 no MeAHUHHe H o6meCTBeHHOMY 3,o;pasooxpaHeHHIO s ApKTHKe H AHTapKTHKe (~eHesa , 1962 r . ) . ~CKYCCHR 6bl!l0 OTMeqeHO, qTo see 6onee lllHPOKOe ocsoeHHe apKTHqecKHX H cy6apxTHqeCKHX paHOHOB B CBR3H C noHCKaMH H ,o;o6bNeH PYA H He¢TH C03,o;aeT ,o;nR xopeHHOI'O H npHwnoro HaceneHHR HOBbJe , CBR3aHHbJe C OKpy- ;KaJOmeH cpe,o;o11 npo6neMb1. CneuHanHCTbl H3 npHHHMaIOlllHX yqacTHe B cosewaHHH CTpaH no,o;rOTOBHnH MaTepHanbI no cywecTBYIOWHM cero,o;H R OCHOBHblM caHHTapHblM npo6neMaM. Oco6oe BHHMaHHe 6bl!lO y,o;enetto npo6neMaM pa110H0B c xono,o;- HbIM KnHMaTOM H HX peweHHIO , npH 3TOM pacCMOTpeHHIO peweHHH attanorHqHbDC npo6neM B paHOHax 6onee yMe - peHHOI'O KnHMaTa SHHMaHHe y,o;enRnOCb flHWb S Tex cnyqaRX, Kor,o;a 3TH peweHHR MOI'JIH 6bJTb HCilOflb30BaHbl s ycnOBHRX apKTHqeCKHX H cy6apKTHqecKHX paHOHOB . B xo,o;e o 6 CYJI(.I:leHHR npo6neMbJ BOAOCHa6;KeHHR paccMaTpHBanHCb sonpOCbI, CBR3aHHbJe c SOAHblMH pecypca- MH' o6pa6oTKOH SO,[J;bl H KOHTponeM ee KaqeCTBa. Ebl!l o6cy)K,[J;eH sonpoc o6pa60TKH H y,o;aneHHR ObITOBbDC ;KHAKHX H TBep,o;bDC OTXOAOB, npH 3TOM HeKOTOpoe BHHMaHHe Obl!lO y,o;ene HO npo6neMe npOMbllll1leHHbDC OTXOAOB . Bonpoc lKHnH!UHOI'O H KOMMYHanbHOI'O nnaHHPOBaHHR BKnJOqan acneKTbl npoeKTHpOBaHHR 3,o;aHHH H SbJ6opa nno - ma,o;KH Aflff 3aCTPOHKH. Sbl!lH TaJOJ(e 3aTpOHYTbl npo6neMbI KflHMaTa SHYTPH ITOMetUeHHH, noJKapHOI'l 6e3onac- HOCTH , ycnOSHH AnR OTAbDCa H T.n . - B npe,o;cTaBneHHbIX AOKna,o;ax H nocne,o;yIO!UHX A HCKYCCHRX Obl!lH paCCMOTpeHbl npo6neMbI coopyiKeHHR KOM- MYHanbHblX y,o;o6CTB H lKHnbR s He6onbWHX nocenxax xopeHHblX JKHTenef1 , a TaKJKe s HaceneHHbDC nyHKTax npH KPYilHbJX npOMbllll1leHHbIX KOMnneKcax. Sbl!lH npe,o;cTasneHbl MaTepHanbJ H paccxa3aHO o MeTo,o;ax o6ecneqeHHR - 14 - eOOTBeTeTBY!OlllHMH eaHHTapHb!MM eoopYJl(eHHf!MH Haee.neHHbIX nyHKTOB pasnHqHoH Be.JIBqHHW, BKnIOqaf! BpeMeH=e narepf! AJIH eTpOHTeJlbHblX pa6oqHx H npoMbD1111eHHb!e KOMilJleKeW B apKT=eeKHX H ey6apKTHqeeKHX paHOHax . 6blJlH TaKJKe onpene.neHbI o5naeTH nanhHeihlrnx HeenenoBaHHH . 1. CpenH HeKOTOpbIX 5onesHeil, o5yenoBneHHblX eaHHTapHo-rHrHeHHqeeKHM eoeTOf!HHeM OKpYJl(aIOmeil epenb1, TaKHX, KaK Ty6epKyne3, renaTHT, 5aUHnnf!pHaf! AH3eHTepHR, HepeHHH03, HMneTHro, anneprHH H peenHpaTop - Hble sa5oneBaHHf! Ha6n~aeTef! 3HaqHTeJlbHOe eHHJKeHJ-1e B 6onb!IlHHeTBe eeBepHblX paHOHOB, npe)l(J:le Beer e sa eqeT 03AOPOBneHHf! OKpYJl(aIOmeH epenbI. OnHaK O noKa3aTeJ1H 3a6oneBaeMOeTH HeKOTOpbIMH H3 3THX 6one9HeH Bee eme OeTaIOTef! 3HaqHTeJlbHO 5onee BbieOKHMH, qeM epenH Haee.neHHf! MHOrHX 6onee IOJKH= pailOHOB; KPO- Me Toro, 5=o OTMeqeHO yBe.n=eHHe enyqaeB 9a5oneBaeMoeTH HeK OTOpb!MH npyrHMH 6one3Hf!MH, B qaeTHOeTH , B pesynbTaTe eTpenTOKOKKOB= HH~eKUHH, 2. Ha6n~aeMble epenH KOpeHHOro Haee.neHHf! eTpeeebI, o6ycnoBneHHble ObieTpblM H3MeHeHHeM B o5pase lKHS- HH, nocnYJl(HJIH 3HaqHTeJlbHblM TonqKQM K anKoronHSMY, HeeqaeTHblM cnyqaf!M, y6HHeTBaM, ne=eeKHM 5o- neSHf!M H eaMoy5HHeTBaM . 3. YcnoBHf! AJlf! OTAbIXa npeneTaBnf!IOT eo6oil oqeHb BaJKHblH aeneKT KOMMYHanhHOro H npOMbllllneHHOro nnaHH- POBaHHf! B eeBepHblX paHOHax, noeKOflbKY HX HanHqHe eoneHeTByeT eHHJKeHHIO BbleOKoro ypOBHf! sa6oneBaeMoe- TH neH~eeKHMH 6oneSHf!MH, a TaKJKe YMeHbWeHHIO qHena TaKHX eouHanbHblX npo6neM, KaK anKoronHSM H pas- BOAbl, o5yenoBneHHblX KnHMaTHqeeKHMH yenOBHf!MH, BbIHY)l(J:laIOmHMH n~eil Bee TH HSOflHPOBaHHblH o6pas lKHSHH. 4. !1naHHPOBaHHe MeponpHf!THH oomeeTBeHHOro 3npaBooxpaHeHHf! H npoeKTHPOBaHHf! eaHHTapHo-TexH=eeKHX eoopYJKeHHH nonJKHo ocymeeTBnf!Tbef! c y qeToM cnenYIODIHX ueneil (B nopRnKe oqepenHocTH): a ) oxpaHa 3AOPOBhf! HaeeneHHR; 5) oxpaHa OKpYJKaIOmeH epenb1; B) noeTHJKeHJ-ie nepB= ABYX ue.neil npH MaKeHManbHOH 3KOHOMHH epeneTB. s . rnaBHblMH TPYAHOeTf!MH, KOTOpble npHXO,!IHTef! npeononeBaTb B xone nnaHHPOBaHHf! H npoeKTHPOBaHHH ea- HHTapHo- TexH=eeKHX eoopYJl(eHHH Mf! paHOHOB ceBepa H xononHoro KnHMaTa, f!Bnf!IOTef! cnenyIOD1He: a) HeoCixonHMOeTb ananTHPOBaTh saKoHonaTe.nbHble HOpMbl H npoeKTbl TaKHM o6pa30M, qTODbl HX MOJKHO DblJlO Obi Henonb30BaTb B ycnOBHRX eeBepa; 5) HH3KHe TeMnepaTypbi H Cie,!IHble noqBblj B) BbleOKaf! CTOHMOeTb 3HeprHH j r) OTeyTCTBHe BO MHOrHX enyqaf!X eoOTBeTeTByIOmeil 3KOHQMHqeeKoil Ciasw, Heo6xonHMOH AJlf! oCieeneqe- HHf! HaeeneHHf! eOOTBeTCTBYIODIHMH eaHHTapHo- rHrHeHJ-iqeCKHMH COOpYJl(eHHf!MH. 6. IlpH nnaHHpOBaHHH H npoeKTHPOBaHHH oeHoB= eaHHTapHo-TexHHqeeKHX eoOpYJl(eHJ-iH AJlf! paHOHOB xonon- HOro KJJHMaTa cnenyeT ytIHTWBaTb Pf!A ~aKTOpOB, B qHeno KOTOpblX BXOAf!T, B qaeTHOeTH, cneny=e: a ) 3KOCHeTeMbl apKT=eeKHX H ey5apKTHqecKHX pailoHOB HMeIOT HH3KHe pereHepaTHB=e enoeoCiHOeTH; 5) BpenHbte MHKpoopraHH3Mbl l>jOryT o5nanaTb 3HaqHTeJlbHO 5onbmeH lKH3Heenoco6HOCTb!Oj B) B eeTeeTBeHHblX HCTOqHHKax BO,!lbl, KaK npaBHnO, omymaeTCf! HexBaTKa MHOrHx BaJICHblX 3neMeHTOB , 7. CymeeTByeT 3HaqttTeJ1bHaf! pa3HHUa B o6eeneqeHHOCTH eaHHTapHo- TexH=eeKHMH eoopYJl(eHHf!MH Me)l(J:IY He6onblllHMH noee.nKaMH KopeHH= JICHTe.neA H KPYilHb!MH npOMbmlJleHHb!MH KOMilJleKeaMH B apKTHqeeKHX H ey5apKTH- qeeKHX pailoHax . 8. B ue.noM JKHTeJlH eeBepHbIX paAoHOB npoBOAf!T 3HaqHTeJlbHO 5onbme BpeMeHH B noMemeHl-iH, H nosTOMY B apKT=eCKHX H ey6apKT=eeKHX pailoHax ropasno BaJKHee o5eeneqHTb llCHTeJlf!M B03MOJKHOeTb yenHHHTbef!, HMeTb 60nbWYIO JKHnYIO nnomanh H lKHTb B 5onee ynoOH= noMax . 9 . lKHTe.nH He6onb!IlHX noee.nKOB apKTHqeeKHX H eyOapKTHqeeKHX paHOHOB B ettny 3KOHO~eeKHX rrpHqHH He MOryT pe!IlHTb npo5neMbI eaHHTapHH C HenonbSOBaHHeM enoJKHOH TexHonorHH. TIOSTOMY oqeHb BaJKHO, qTo5w eaHHTapHo-Tex=eeKHe coopy;,ceHHf! 5=H,no B03MOJKHOCTH, npoeTbIMH, HaAeJKHb!MH H MaKeHManbHO SKOHo= - HbIMH. 10 . 05eeneqeHHe JKHTeneA 5esonaeHoil BonoA B noeTaToqHoM Kon=ecTBe - BaJKHoe yenoBHe o5eeneqeHHf! nepBHqHoil MenHKo-caHHTapHoil noMODIH - RBnf!eTcR nepBooqepenHoA sanaqeH B xone pa3BHTHR nI06oro Haee.neH- Hor o nyHKTa HnH npOMbIIDneHHOro npennpHf!THf! B apKTHqeeKHX H cy5apKTHqeeKHX paHOHax. KpoMe Toro, ueneeoo6pa3HO Co9naBaTb ueHTpanbHble eHeTeMbl KOMMYHanbHOro BOnoeHa6lKeHHf!, OTnaBaf! HM npennoqTeHHe nepen HH):IHBHnYanbHb!MH npH Beex npyrHX paBHblX yenoBHf!X. - 15 - 11. CneAyeT YAenRTb nepaooqepeAHOe BHHMaHHe Bonpocy YAaneHHR OTXOAOB c npHneraIDll\eH HenocpeACTBeH- HO K JKHJlbID TeppHTOPHH, nOCKOnbKY o6~eM OTXOAOB 06bl'IHO HeBenHK , c yqeTOM aCCHMHnRTHBHOH cnoco6HOCTH OKp}'ll\'.aIDll\eH cpeAbl He6onblllHX ceaepHbD{ nocenKOB. PeKoMeHAaUHH 1. B03 cneAyeT npOAOJIJKHTb npaKTHKY opraHH3aUHH nOA06Hb!X COBell\aHHH AnR paCCMOTpeHHR APYrHX npo6- neM rl-lrHeHbl OKPYJ!<aIDll\eH cpeAbl B apKTHqeCKHX H cy6apKTHtreCKHX paHOHax, TaKHX, KaK: 6opb6a c nepe- HocqHKaMH, KOHTponb 3a TOKCHqHb!MH XHMHtreCKHMH Bell\eCTBaMH H TRl!CenbJMH MeTannaMH, BnHRHHe npOMbllW1eHHOH AeRTenbHOCTH H A06bl'IH HCKonaeMblX, oxpaHa 3AOPOBbR pa6oTaIDII\HX H opraHH3aUHR MeAHKo-caHHTapHb!X Cn}'lll'.6. 2. B03 peKOMeHAyeTCR COAeHCTBOBaTb npoaeAeHHID AanbHeHIIIHX HCCneAOBaHHH no onTHMH3al\HH KnHMaTa BHYTPH noMemeHHH B uenRx COKPall\eHHR 3a6oneaaeMOCTH, o6ycnoaneHHOH caHHTapHO-rHrHeHHqecKHM COCTORHHeM OKpYJKaIDmeH cpeAbl H HeaAeKBaTHb!MH ycnOBHRMH =3HH . ITpH npoBeAeHHH TaKHX HCcneAOBaHHH cneAyeT H3yt;HTb acneKTbI, CBR3aHHbie C noTpe6HOCTRMH B JKHJIOH nnomaAH, C ocaemeHHeM, UHPKYflRUHeH l-1 06MeHOM B03AYXa, KaqecTBOM B03Ayxa BHYTPH noMell\eHHH, OnTH:MH3aUHeH TeMnepaTypHoro pe=Ma H P=Ma anal!CHOCTl-1 B AOMaX AnR OTAenbHblX ceMeH l-1 B KpynHbD{ JKHJlblX KOMnneKcax . 3. PeKOMeHAyeTc~ pa3pa60TaTb noco6ae no KOMMYHanbHOMY nnaHH:POBaHH:ID l-1 CTaffAapTaM npoeKTH:poaaHHR 3AaHHH, nOAXOARII\HM KaK AnR nocenKOB KopeHHblX =TeneH, TaK l-1 AnR npOMbIIWieHHblX KOMnneKCOB B paHOHax xonOAHOro KnH:MaTa. TaKoe noco6ae MOl!CeT 6b!Tb H:3AaHO B COTPYAHHqecTBe C 3aHHTepecoaaHHhlMH npaaa- TenbC TBaMH npH PYKOBOACTBe co CTOpOHbl B03. 4. Paspa6oTaHHOe B CUIA l-1 KaHaAe PyKOBOACTBO no npoeKTH:POBaHH:ID KOMMYHanbH0 - 6b!TOBbD{ COOpYJKeHHH B paHOHax xonOAHOro KflH:MaTaa peKOMeHAyeTCR pacnpocTpaHHTb H H:CilOflb30BaTb COAepl!Call\HeCR B HeM npl-lHUHnbI npa C03AaHHH: acex caHHTapHO- TexHHqeCKHX coopyiKeHH:H B apKTH:qeCKH:X l-1 cy6apKTH:treCKH:X paHOHax. ITocne COOTBeTCTBYIDll\eH AOpa6oTKH: 3TO PyKOBOACTBO MOl!CHO nepeH:3AaTb npa ¢aHaHCOBOH nOAAepl!CKe B03 . S. B03 peKoMeHAYeTCR COAeHCTBOBaTb c6opy AaHHbDC o B3aH:Mo3aaacaMOCTH: Mell(Ay CHl-ll!CeHH:eM MeAH:Ko - caHH- TapHbJX pacXOAOB H CTOH:MOCTbID npoBeAeHH:R Mep no 03AOPOBneHH:ID OKpyl!CaromeH cpeAbl C yqeTOM YPOBHR npeAOCTaBnReMb!X Cn}'lll'.6 . 6 . l{pe3BbI'laHHO Bal!CHO' qTo6bJ qneHbl Mell(AH:CUHnnH:HapHOH 6paraAbl, COCTORl!leH H3 npeACTaBH:Tenei'i acex cnyiK6 0611\eCTBeHHOro 3ApaaooxpaHeHH:R, npH:HH:ManH 6b! yqacTH:e B =nHII\HOM H KOMMyHanbHOM nnaHHPOBaHHH. Bo H: 36el!CaHHe noBTOpeHHR OIIIH60K B03 peKOMeHAyeTCR aKTHBHO COAeHCTBOBaTb o6MeHy onb!TOM Mell(AY CTpaHa- MH. 7. Bo MHOrl-lX apKTH:qecKH:X H cy6apKTH:qecKH:X paHOHax BOAa HBnReTCR 60nblllHM Ae¢H:UHTOM, Aal!Ce npa BHAH:- MOM ee H:306HnH:H. PeKOMeHAyeTCR CTH:MYfll-lpOBaTb KaK OTAen bHblX =TeneH, TaK l-1 npoMbllW1eHHble npeAilPH:R- Tl-lR K CTporoi'i ee 3KOHOMHH. 8. <l>H:3H:qecKHe ' XH:MHqecKH:e l-1 MHKpo6aonoraqeCKH:e CTaHAaPTbl nHTbeBOH BOAbl B apKTH:qecKH:X l-1 cy6apKTH:- qeCKHX paHOHax He AOfll!CHbl 6b!Tb Hl-ll!Ce CTaHAapTOB, AeHCTBYIDII\HX B paHOHax 6onee yMepeHHOro KnH:MaTa . 9. ITpa o6ecneqeHHH 6esonacHoH BOAOH =TeneH acex apKTHqecKax nocenKOB a KOMnneKcoa oco6oe BHHMa - HHe cneAyeT YAenRTb KOHTponw KaqecTBa nH:TbeBOH BOAbl . 10. CneAyeT roTOBH:Tb MeCTHbJe KaAPbl BO acex CBR3aHHblX C oxpaHOH 3AOPOBbR o6naCTRX' BKnIDqaR noAro- TOBKY KaAPOB AflR 3KCnnyaTaUHH H peMOHTa yc TaHOBOK, 06cnYJ1CHBaIDII\HX nocenKH KOpeHHb!X =TeneH. K co- UHanbHOMY H npoMbllWleHHOMY pa3Bl-lTHID apKTl{qecKHX l-1 cy6apKTH:qecKHX paHOHOB Heo6XOAH:MO TaKl!Ce npHBne- KaTb KOpeHHblX =TeneH . 11 . Bee KOpeHHbJe =TenH AOfll!CHbl yqaCTBOBaTb a npHHRTH:H peweHH:H, KaCaIDlllHXCR Tana caHHTapH0-6bJTOBbD{ COOpYJKeHHH, KOTOPble npeAHa3HaqaIDTCR AnR o6CnYl!CHBaHH:R HX nocenKOB. ITpa 3TOM OHH: AOJIJKHbl noAqepKHBaTb caoe l!CenaHHe =Tb B rapMOHHH c npapOAOH, a He npoTHBOnOCTaBnRTb ce6R eH . 12 . CTpOH:TenbHbJe MaTepH:anbJ AflR apKTHqecKHX H cy6apKTH:qecKH:X paHOHOB cneAyeT Tll\aTenbHO npoaepRTb H OT6apaTb c yqeTOM Toro, qTO a npouecce CTa peHHR OHH MOryT Bbl,[lenRTb onpeAeneHHble BPeAHbJe aemecTBa. ITocKOnbKY =TenH npOBOART MHOro apeMeHH: BHYTPl-1 noMemeHHH,a BeHTHnRUHR HX B 30 Hax xonOAHOro KnH:MaTa qaC TO HeAOCTaToqHa, 3TH npOAYKTbl MOryT OKa3b!BaTb nary6Hoe B03AeHCTBH:e Ha 3AOPOBbe flIDAeH. a Cold c limates utilities delivery design manual. Corvallis, Oregon, US Environmental Protection Agency, Environmental Research Laboratory, 1979. - 16 - 13 . MepbJ noJKapHOH 6e3onacHOCTH' 11cnonb3yeMbJe B TennoM KJIHMaTe' AOnJKHbl 6bJTh aAanTHPOBaHbl K ycnoBJ-, - HM xonOAHOro KnHMaTa. Heo6XOAHMO C03AaTh TaK11e CHCTeMbJ 6opb6bJ c noJKapoM, KOTOPbJe He Tpe6 ylOT 6onh- woro Kon11qecTBa BOAbJ; cneAyeT CTHMYnHpOBaTb Hcnonh30BaHHe orHeynopHbIX CTpOHTMhHbIX 11 OTAenoqHbIX B pa110Hax xonOAHO r o KJIHMaTa onaCHOCTh B03HHKHOBeHH.R noJKapa Bbl3bIBaeT oco6yl0 osa6oqeH- HOCTh B CBH311 C npeo6naAatt11eM KapKaCHbIX CTpOeHHH 11 npOAOnJKHTMhHOCThlO OTOilHTMhHOro cesoHa. - 17 - HH<l>EKID!OHHblE 60ITE3HH 19 - Pa6 o q aH rpynna no nepopBAbHWK KBllleqHwH Bn1tgHHBH ICP/ BVM 008($ ) Cor. I 21 geKa6p R 198 1 r oga 0PHDIHAJI : AHrJIHHCKHH 1. 8ee4eHHe AaH HBH H8KAHCUHnAHHBpHBH Pa6oqaA rpynna, B COCTBB ICOTOpoff, KBPAAY C TpeHH QA8HBHH nepCOHBAB 803 BOmAH 17 HMHYHOAOrOB, HHKpo6ROAOroB H 3UHA8HHOAOrOB, npeACTBBAABllDOC HayqHO-KCCA8AOBBT8AbCICH8 HIICTHTYTW, 3BHHTWe, ICBK H8AHllHHCKHHH, TBIC R BeTepRHapHWMlll npo6AeHBHH B A8CHTH CTpBHBX, npoBeAB co- B8!11BHH8 B HHCTHTyTe noAH 3pAHXB BO ~paK·xci,ypTe. 3TO COB8!11BHHe, npoBeAeHHOe UOA npeAC8ABT8AbCTBOH AnpeKTOpa HHCTHTyTa , HBBAOCb COBH8CTIIWH HeponpHHTH8H npBBRT8AbCTBB ~8A8pBTHBHOH Pecuy6JraKH repHBBHH H EBpoueffcxoro peraoHBA&Horo 6Mpo 803. UeA b Pa6oqeff rpynuw COCTOAAB B TOH, QT06W npoBeCTH COBpeHeHHyM Oll8HKy COCTOHHRH n3yqeHRA R HByQHWX HCCAeAOBBHHi opB.JJbHWX ICHlll8QHWX BBKURH H HX RCUOAb30BBHHA B npBICTRKe 06111ecTB8HHOro 3Apaaooxpa- H8HHA B UOArOTOBBTb AOICABA O XOAe pa6oTW B 3TOH 06.!BCTH. AaHHBA fpynna cTaAa oqepeAHOH B cepHH HayqHwx coBemaHBH, opraHH30BBHHWX paHee mTa6-KBBpTupott 8 0 3 a KOHT8KCTe r .. o6BAbHOH nporpalOOI 803 no 6op&6e c ARBpeHHWJra 60A83HJD(H. 2. .llHcxyc CHA Yq ncTHHICH COA8!11BHHH !CpBTICO paCCHOTpeAH OTQ8TW npeAWAYIIIHX HByQHWX rpyuu H UOAp06Ho paccHOTpeAB H8CIC0Ab!CO p~60QHX AOKyHeHTOB, OTHOCJIIIIHXCH IC rABBHOHY uyBKTY noeeCTKH AHA, 0 CA8AYJ(llll8H nopAAKe: H8XBHH3HW ICBJB8QHOro RXHYHRT8TB y qeAOBeKB H KHBOTHWX; OIDITW C KHID8QHWHH BBKllHHBIOI 8 BeTepHHBpHH; 8onpocw paCCHBTPHBBAHCb H8T OAOAOrHH reHOHHKeHeµHH, HCTIOAb3Y8HBH B pa3pB60TICe HOBMX BBICUBHHWX mTBHHOB H B qacTHOCTH nepcneKTHBW 3TOro HOBoro UOAXOAB, ICOTOpwe 3BICJmQBMTCH 8 TOH, QTO ru6pHAJ,1 poTaBupyc HOKHO CHB6AHTb K8AB8HWHR xapaxTepRCTHKBHR C T8H, QT06W o6ecneqHTb ll8HHWH HCToqHHK "KBHAJUBTB" KHBWX BBKllBHHWX MTBHHOB! BO3 HOKHW8 H86AaronpHHTHW8 B03A8HCTBHH o pB./JbHWX BBKUHH, KBK CRAB OT6opa .UH UOHBA8HHH KOBWX noeepxHOCTHWX BHTHreHoe; HBR60Aee TIOAHBH xapBKTCPHCTHKa B03HOKHWX TBUOB mTBHHOB BBICUHH, BKAMQBH HHOrHe qepTW, upacyue clleHOTRUY ( cepOTHn ' 6 HO THU' TRn BH8MH8H llew6pBHW B T . . ~ . ) ; COBPCll8HHOe COCTOHHHe HM8MIIIHXCA B HBABQHR opB./JbHWX BBJCURB, T.e. Tex, ICOTOpwe npRHeBJDDTCA npo- THB TB<!IB H mnreAA~3a; COBP8H8HHOe COCTOAHRe nayquwx RCCA8AOBBHHH R B03HOKHWX UOAXOAOB IC pa3- pa60TK8 3<M>eKTHBHWX opB./JbHWX BBICilRH npOTRll v . c holerae, E. coli, a TBKKe pOTBBRpyCOB! npoBepxa Ha 6e3onaCHOCTb B Aeecnoco6HOCTb o pB./JbHWX KRID8QHWX BBKUKB , o co6euuo KRBWX BBKUHH, BBRAY B03HOKHOH pesepCHH OCAB6AeHHWX mTBHHOB R H8AOCTBTKB H8,U8KBIIHX nposepOIC HB 3<l>4>eKTRBHOCTb H A8ecnoco6HOCTb, 3. BwBO,/!W a pexoH&HAaUHH - 2/J - 3.1 HcnOAb3OBaHHe o6mecTBeHHWH 3ApaaooxpaHeHRea1 HJlelDIIUIXCR a Ha.aaqaa aaxgaH .'.!:!t· YqaCTHRICR rpynmi, Ha OCHOBe BHelDl!IHXCR B HaAHQBB AOICa3aT&AbCTB, noJyQ&HHIIX B pe3y.abTaTe Ja6opaTOpBIIX a llOAeBIIX HCIIWTaHHij, npHILIIH x BWBOAY, QTO aRB&R OPIUbHaR aaxnHHa Ty 21.A npoTRB TR�a. npaHHXaeaaR TpeaR AO3&HH, osa3a,1ac& 6e3onacaol a 3�KTHBHol a xoAe nepaol KOHTpOAHpyeaoA no.aeao� npoaepxa, npoB8A8HHOA B ErnnTe, trpR 3TOH llPOJIBBB 3�1CTHBHOCTb 60.aee 95� cpoEOH Ha TpB ro,,1&. B HaCTOJllll&8 Bp&HR npOBOARTCR BCCJ8AOB&HRR, aanpaBA8HHW8 Ha TO, QTO6w y.ay'IIIIBTb CT&6RAbBOCTb . tgpay- JRpoaaBRe BU:llBH (no BO3HOBHOCTB CHH3HTb A03W). noAar&JO'I', QTO no OEOHQaHBH 3TRX HCCJ8JOB&HBI A&HHym B&EllBHY HOBHO 6yJeT BH8APBTb B 06.ecTBeHROe 3ApaaooxpaH8HHe. mare,1,1�3. npoaeJeHRWe B IIIIIJ>OEOH Hac■Ta6e no.aeawe BCUWTAHRR, noxa3aAR 6e30U&CHOCTb R 3�E­ TRBHOCTb noARB&A8HTHIIX BaXURH 111111)!. Saiplla, paBHO IC&E B BX BeAOCT&TICR B Cll.ly KX TllllOBOI cne11J1t■q­ HOCTR B H&06XOABKOCTB B HHOroxpaTHIIX AO3&X, 3TB nepawe OnMTW C npHXeHeHBeH mTIUQIOB Smo c.ayaaT CT�• HYJ&HR JAR HOBIIX yca.aal, Hanpaa.aeHHWX Ha pa3pa60TEY nyTeH reHORHJl8B8PRB HOBWX oc.aa6.aeHHIIX mTIUOIOB HyTaHT-ra6pBJOB Sb1gella (oco6eHHO s. dysenteriae 1 cepOTRn), EOTOpwe aoryT osa3&TbCR 6e30ll&CHWHH H 3<IJll!e1CTBBJDDIR noc.ae npRHRTRR OAHOI AO3W. !CoHBT&Ty 3EcnepTOB BOO no 6ao.aorll'lecxol cTaBAaPTH3&UBR HaAJ&BRT ycTaHOBBTb 06.Re Tpe60B&KRR AAR BRBIIX nepopaAbHWX aaxgRH C Tea, qTo6w cnoco6CTBOB&Tb HCUO.lb3OB&HHID 3TRX BaKUHH B trpaKTBEe 06- mecTBeHHoro 3ApaaooxpaHeHHR B KX AIUbHeA.meay ycoaepmeHCTBOB&Hln!.'. 3.2 .l!aAbHelbme BCC.18AOB&HBR no nepopa.lbHWH KR■8QHWH BAKHBIIAH Escherichia coli. lt.reHW rpynmi awpa3ll.lR HBeHae OTHOCBT8.lbHO Toro, qTO ycnexa, AOCTBrByTH8 B BCCA8AOB&RRBX KHllleQHIIX B&XllRH, 8 qaCTHOCTH, B TOH QTO xacaeTCR 3UTepOTOKCUOreHHIIX E. coli B eTepg Hapaa, eme He AIUOT OCHOB&HIII JAR npBHeReHHJI BX X qeJoaexy, liHJH IIWH8C81111 pexoHeHA&UJIH O"l'IIOCR ··.u,,­ HO y,1y11meRRJI ae&ARCURUARH&pHoro COTPYAJIRQ8CTBa Hayqawx pa6oTHHEOB B 06.l&CTR xameqHwx B&XUHH. 3ac,1yaaaaeT BHBH&HRJI RCC,18AOll&HR8 llOT8HIUl&AbHOro RCUO.lb3OB&HRR T&XRX B&KllRH A,IIJl AHEBRA&URH llclq)y.ae•KT HWX n.1&3HBA R 6.1oxapoB&HKR nepeA&QR �&XTOPOB R (sax llOX&31U& HOA8.lb nopoeeaxa). K.aoaapoB&HR8 HeycToitqaaoro JC BWCOKRH T&IGlepaTypaH 3HTepOTOECHH& cy6 .. eA]IHJUUI a E. coli A8.1&8T BO3HO&HWH OllTRHR3RpOB&Tb oplUbHWe oc.aa6.aeHHW8 B&EUBHW. YcToitqaawe K BWCO.ICRH T8HUepaTypaH 3HT8POTOECHHRWe reHw i, coli mT&HHOB xax qe,1oaexa, TAK H CBRRbB H8A&BHO 6HJB X.IOHBPOB&HW, • 3HT8POTOECBH, YCTOhHBWI X BHCOEH.H Te:imepaTypaa, no,1yq11.1 IDi!C)'HO� reHHW8 CBOitCTBa nyTeH COeARH8HBR ero C ao.aexy.aaHR HOCRT8.IH. TaxRH o6pa30H, BOBKO 6yA&T CH&6ARTb BAXUBRH p&3,1BQHWHH BupyAeHTHWHR �&ETOPAHB Cao.aesyJRPHWe cuen.aeHHR, npOH38OAHW8 H cy6 .. eAHHIIIDI TQXCH­ HOB) ARa.aOrBQIIWK o6pa30H E.IOHBp08&HR8 aHTBreHa KBB E. coli H APYrHlC noaepXHOCTHIIX aHTHreHOB A&8T HOllyJD BO3HOBHOCTb A.IR pa3pa60TICR BaXUKH �ixax 8 B&TepRH&pau, TAK H 8 H8AHURR8 q9,1oaexa. ByAeT BUO.IHe onp&BA&HIUDI npoBeJ&HRe B 6.aaaail:mea 6yAynl8H BCCA8AOB&HBR BO3J8itCTBBR Ha q9,1oaexa H8CICOJb!CBX nepopa.abHWX HJO(YHR3BP� areHTOB npOTRB 3HTepOTOECBHOreHHWX E. coli BX.U,Q&Rl a) OQQ8BHWit pilus aHTareH, COAep&allJlit "�axTopw ICO.IOHR3aUBH" (CFA I R II), 6) OQHlll8HHWB CFA a cy6HAltHBil& B, a) HeTOXCBHOreHHWe mTaHHW 06; K15; H16, COA8PBIIIIUl8 CFA II a r) BllllleynoHRHyTWI oc.1a6,1eHHllit mTaHH, COAepaa.at TaJtBe cy6r.eABRRJty a . .!, ra.aaXT03a-HeraTJIBHWit rpy6wl HyTaHT 8, typhi, B JCOTOpOH OTCYTCTJIY&T 3H3HH YPRAHII :5-AK!l:,oc,g,p11·, r.ooxo3a-4-3nRHepa3a .! C·rnDDTflX¥---.,qH-3981'CB¥if9 Q r,t;i,Q,..,Cf·Cl1!eU'fOlil \19"AZf"I!' Shi g•l, 1&, - 2 1 HoBaJI reReTH'1ec1taJ1 K8TOAO.lOrHJI (1t.110HHpOB8HHe V, cholerae, c·y6-.,0Dl]IIIl;a l!l)- OTKpWB88T HOBWe nepcneKTRBW A.lJI npOB3BOACTBa HOBWX oc.ra6.reRRWX mTallKOB C onpe,.11e.reHHW)(ll KOK6HR8DHJDOI ae.raeKOH BHpy.11eHTHOCTH H 38JIU!THWIH aHTHreHSKH ..UJI nepopa.lbHOI IDOl'.YHH38UHH npOTHB HH~KUHOHHOI H Jt.raHHqecKOH xo.1epw. C.reAylOIIIHe IUO(YHH3Hpyxlllllle areHTW , DpOXOAJIIIUl8 B HaCTO.ltlllee speMJI CTaJJ;HIO HCC.leAOB8HHJI , 3ac.ryaHBIU>T Aa.lbHebero H3y'leHHJI, 1) Cy6~8AIIHIID88 TOKCHHa xo.11epw, OAHU u.m B CO'18T8HHH C COKRTH'l8CKHK aHTHreHOK (aHTHreurum) noc.1e RHT8HCHBHWX .11 a6opaTOPHWX HCC.118AOBaHHI B H8CTOJIDl88 Bp8MJI DpOXOAHT CTB,lODD oueHKH RS qe.ro- sex e B Ka'leCTB8 opa.!bHOI BaXUHHW R noxa AaeT ,!llllll, B8CbKa o6H&AeBHB8Dlr;Jle pe3y.!bTaTw; 2) "3883,D;a Texaca" BR (pe3HCT8HTHWI K CTpenTOIOIIUIHY oc.1a6.1euuwl mTallK DPOAYUHPYllllllrli TOKCHH cy6~e~ B, ne.ryqelUDII B pe3yAbTaTe ABYX-CT8D8HHOH reHeTH'l8CKOI KYTBUHH) 6w.r nposepeH Ha A0 6 poBO.!bUax R oduapyaH.I 38-HTHOe ABICTBHe; 3) Ilpoxo.1epareHORA, 6e.!OK C BWCOKIUI KOAe1ty.11J1pHWI B8COK, npHrOT08A8HHWH nyTeK Tep11006pa60TKH TOKCHHa XO.!epw, B HCC.l8AOB&BB.llX Ha BllllOTHWX OKa3a.lCJI BWCOXOJDOlyRoreH!Ulll , npH nepopa.a:bHOK BAH nap&HTepa.a:bHOK BB8A8HJIII. ~py rue DOT8HUHa.lbHW8 nepopa.o,Hwe IIJOIYHH3HpytDIIIH8 areRTW KoryT 6WTb npOH3B8,.118HW OT oc.ra6.1eHHWX mTallKOB v . cholerae, npurOTOBA8RIDIX nyTeK pa3.!H'IHWX KOK6RRaUHI KAH C HCDOAb3OBaHHeK APYrOH reHeTH- qecxol TexRo.ror1m. Bnpycuwe 3HTepHTW. PoT&BHpycw JIB.lJIIDTCJI HaH6o.ree cepb83HWJm BupyCHW)(ll naToreurum , BW3WB8l0Jll]D(II AHapem y ROBOPOB,D;8HHWX H B R8XOTOPWX palouax npeBOCXOA.RIIUDOI no 3uaq1U1OCTH naToreHHW8 mTalOOI E. coli. Ycnemuaa XY.ilbTBB8UHJI '18AOB8'18CKHX poTasupycos OTKPWB88T nepcneKTHBW A.IIJI no.ryqeR1IJI BSKUHRW H B R8- CTOJIDl88 Bp8KJI pa3pa6aTWB8JOTCJI mTaJO(W 11 K&BABA&Ta 11 Ba!CIUIHW, Oc.ra6.reHHOCTb BHpyca KOB8T 6WTb onpe,.11;e- .11eua .IIBmb OIDITHWK nyTeK Ha XO3JIHHe - qe.rosexe. Heo6xOABll0 npoBeCTB HCCA8AOB&RBH A.lJI Toro, 'IT06W onpeA8AHTb 'IBC./1O cepOTHIIOB, KOTopwe H8JJ;A8BHT BB8CTH B BSKDHHy. IlO CKO.ilbXY npoae,.11;euue Taxux pHCKO- saHHWX 3KCnepHK8HTOB Ha 11.1a,.11;euuax He npH8K.l8KO C 3TB'l8CKOH TOqKH 3p8HHR, TO .no6aJ1 oueuxa 3¢4>eXTBB- HOCTH BaKUHHW pOT8BHpyca ,.11;O.llllHa 6yA8T OCROBWB&TbCR Ha ee B03AelcTBHH Ha 3a60.resaeKOCTb B 8CT8CTBeR- RWX yc.roBH.llX 60.11e3HH, HaJJ;A8BHT CTHKYAHPOBaTb HCIDITaHHJI BaKUBHW B yc.rOBB.llX TmaTe.!bHO opraHB3OBaHHOro KOHTpOAR. HaA- ./18BHT npOBOAHTb H B ,.ll;aAbHellmeK npoaepxy ,.ll;HarHOCTH'l8CKBX H cepOTHDHWX KeTOAOB , a Taxae R,D;8HTH$BK8DD> xapKepoB BaKUHHW. CooTB8TCTB8HHOe 3Ha'l8HH8 areHTOB HopBO.!K&, a,.11;eHOBHpycos H ,.11;pyrux HHTepoBHpyCOB B TpODH'l8CKHX CTpauax Tpe6yeT ,.11;aAbHeltmero HCC./18,D;OBSHHJI, C T8K 'IT06w onpe,D;e./lHTb oqepe,.ll;HOCTb B pa3pa- 60TK8 BSKUHH. Hay'IHWI pa60THHKaK 6w.ro 6w DOA83HO Hll8Tb KPHTepHH AAJI reH8TH'l8CKOH xapaxTepHCTHKH mT BIIKOB BaKUHHW H ,.11;.IIJI HCCA8,.ll;OBaHHI pa3.ruquwx peKOK6HHaHTOB. Bsu y Toro, 'ITO 3HTepBTW npe,.11;cTaBA.RlOT co6oi ea.Hy~ npo6.11e.y KaK A,KH 3,.ll;pasooxpaReHHH, Tait H ..UJI 3KOHOKHXH, TO C./18,.11;O811./1O 6w HanpaBHTb YCH.!HJI Ha ,.ll;a.!bHeit.mym pa3pa60TKy IDOl'.yHOAOrH'l8CKBX HHCTpyKeRTOB ,.11;.ilJI 6opb 6W RC 3THKB 60.1183HJDIH, a c.11e,.11;OBaT8.ilbHO Heo6xoABJ(O pa3BHBaTb uay'IHW8 HCC.!8AOBaHHR B 3TOH 06.raCTH . Pa6oqaa rpynna EPB no KHmeqttovy iiepc11HH03Y llapHll 1 1-3 HJOHH I 981 r oAa - 22 - ICP / BVM 005(1)(5) 17 HIOJ!n 1981 roAa 0PHDIHAJI: IPAHUY3CIDIH IlpHllff)(BJI BO nHHIISHHe UOCTO.ft:HHO pac Tyotee BO ece11 W:Hpe t{HCJ[O c Jryqaee 3apaxeHH..R qe.i1oeeKa Yersinia, He CQHTSH CJlyqaeo 3a60J1eoeHHH qyvoit, H y<iHTWBSH cospeveHHWH ypoeeHb p83BHTHH HayqHWX HCCJ18AO BSHHH B cesepHOH noJ1ymapHH, EeponeiicKoe perBOHaJlbHOe 6,opo B03 pemHJIO C03A3Tb Pa6oqy,o rpynny AJIH paCCHOT- peHHH 3TOH npo6J1evw. CoaemaHue 3TOH rpynnw cocTonAOCh 1-3 HIOHH 1981 roAa a MeIAyHapOAHOH COT P YA- HH'41U011l8H aeHTpe B03 no itepCHHH033H B HHCTHTyTe IlacTepa a IlapHJ<e. CJleAyiomev: UeJ1b coaemauan 3axJ110qaJ1acb a npHiTH K eAHHOHy MHeHHJO OTHOCHTeAbHO onpeAeAeHHH 6asTepHOAOrHQ8CKHX H SHTHreHHWX CBOHCTB HH- ~KIUIOHHWX areHTOB, BW3WBaJOmHX iiepCHHH03W; npoB8CTH c paaHeHHe 3nHAeHHOAOrHQ8CKOH CHTYBUHH no CTpauav; onpeAeAHTb paiioH pacnpocTpaneHHH p83JIHqHW,C xeHOTHllOB H cepOTHllOB AJIH opr8HH38UHH HS6Jl10AeHHH 38 Ten.4.eHI{HJUIH p a 3BHTBJI KQJl.4oro K:J KHX; ycTBHOHHTb CBff:J b wellA Y p8 3 .IIH'{llWKH THOBlllK Yers i nia H p83.AH\IHWIIR 8HA8KH HH«J)HD;HpOB&HHWX & HBOTHWX; BW~BRTh CD ff3H we•AY KJIHIIHt{8CKHIIH acneKT8.MH H pa3AffqHbll(H THfiBKH Ye r s inia ; onpeA8JIHTb H yToqHHTb H030J10r11qec xy,o xapTHHY P83JIHQBWX THllOB itepCIIHH030B , nop8ll8JOlllllX qeJIOBexa; cpaBHHTb H CT8IIABPTH3Hp088Tb AHBrHOCTHqecxae npoaeAypw. 1. HcnoJlb3 yevwe a HBCTOJ11D,ee speve TSKCOHOlll!Qecxae onpeAeAeHHH Y. pseudotuberculosis, Y. e nteroco l itica a TPH Hoewx BHAS Y. i ntermedia, Y. f redariksenii a Y. kristensenii nocJ1yllHAH oc- Honoit AAR ABCKYCCBH. 2. BWJ10 np11:1HaHo AOBOAbHO paauovepuoe pacnpeAeAeHae 3a60J1eaaevocTH Y. pseudotuberculosis a Eapo- ne . B nacTonmee apevn co eceit o npeAeAeHHOCThJO ycTaHoaAeHa ero naTOAoraqecxaa pOAh. 3. PacnpocTpaHeHHOCTh Y. e nt e r ocolitica a <iHCJIO cJ1yqaea 3a60J1eaaHBH, ew:1waaevwx 3THH v11xpoopra- 1111:1vov, npavo 38 BHCHT OT reorpa~aqecKoro TI OJl0ll8HHH H B03pacTaeT nocTeneHHO B HanpaaAeHHH OT iora K ceeepy Eaponw. 4 . CepoTHn 0:3 Y. e nterocoli t ica npeo6AaAaeT eo ecex CTpauax; BTopwv no pacnpocTpa11eHHOCTB eaAa- e Tca c epOTBll 0:9. 3TH ABB cepOTHna Y. e nt e rocol itica - eABHCTaeHHWe cepOTHllW, naTOJIOraqecsBH xa- paKTep KOTOpwx yCTSHOBJleH. :>HAeVH'4HWX paitoHax . CyAH no ecevy, cepOTHll 0:9 llOCTeneHHO CTSHOBHTCH AOKHHBPYDIIBK a awcoxo 5. B CTpaHax, rAe B Te<ie 1111e nocJleAHHX 15 H 60J1e e JleT npOBOABJISCh pa6oTa no JIHSTIIOCTBKe B VOHHTO- pH11ry itepCHHH030 B, 3TIHAevaqecxaa CHT YBUHH CTS6HJIH3HpyeTCH. 0.)IHSKO a J!pyrax CTpaHax Ha6J110J188TCH ace eme 111Hpoxoe pacnpoc TpaHeHHe 3Toit 1111~exaHB . 6 . IlOCKOJlhK y (3a pe.)IKHV HCKJIJOqeHHev) CJlyqaa 3a60J1eaaHHH itepCHHH038KH He llOAJlellaT 06a:1aTeJ1bHOH perHCTPSUHH, CBeAeHHH O KOJIHqecTae TBKHX CJ!yqaea qepnaJOTCH 113 HH~OpvauHH, noJ1yqaevoit 113 J1a6opaTOPHH. 7. JHAeHHqec KHH xapaKTep itepCHHH030B y. enterocoli t ica CTSBBT WC . cor.taC HO noJ1yqeHHWH B J1a6opaTO- pHHX Eeponw ABHHWH, HS BTOpoe HJIH TpeTbe veCTO c peJIH KHll!eqHwc 6aKTepB8JlhHWX 60J1e3H8H. Hx VOllHO c paBUHTb C paaJIH1.(HhfKH BHABMH C8.AhMOHe., Ae3a, KawnH.116aKTepaa..11bHOH 6o.n:e3HbJO, mHre.11Ae30M H ,.a;eTCltHlf 3II TCpHTOV, BW3WBaevwv 3HTepOTOKCHre HHWV E. coli . - 23 - 8. .llHreCTHBHBJI naTOAOrHJI ( KH111e'{H8JI naTOAOrHJI) BO ecex CTpauax 3liHHllaeT AOMHHHpyRHl\ee OOAO&eHHe cpe- AH ApyrHX 6oAe3HeA; pacnpe,leAeHHe 3TOro 3860AeBBHHJI - pasH011epHoe. 0AHaKO AAJI c eeepHWX CTpaH, qame no-BHAH»o11y, 6oAee xapaKTepeH noiuapTpHT. ,ll.;111 >tpaHUHH 6oAee THIJH'{lla c eHTHUellHJI. 9. Ilpu 3apaieHHH Y. enterocolitica Ha6n>AaeTc11 eJaH»OAeiicTeHe 11e•AY opraHH311011, c peAoii H $eHOTH- no11: qeAOBeK ,lep&HT llOHOllOAHJO B OTHOmeHHH naTOAOrff'{eCKHX CHHAPOMOB, BW3BBHHWX cepoTBllaMH 0:3 H 0:9, OAHBKO MTBIIMW 0:3 6wAH BWAeAeHw TalUl:e OT CBHHeii H HeKOTopwx APYrHX KHBOTHWX, KOTopwe 3KOAOrH- qecxu CBJ13aHW C qeAOBeKOll. Bee APYrHe ceporpynnw Yersinia BCTpeqalOTCJI y ecex ,lpyrHX KHBOTHWX, 11AexonuTa10mmc, nT~ u pw6. E HOTIIIl 1, BWA;eAeHHWH KaK OT 4eAOBexa, T8K HOT IHBOTHWX, no eceH eepOHTHOCTH, He HBAHeTCH naTO- reHHW)( opraHH3MOM, BCTpeqalOIIUIMCJI AHlllb y qeAOBeKa, ITOCKOAbKY OH B paBHOH CTeneHH npHCYTCTByeT B rpylllIBX C Hecnenn$H'{H0H CHMIITOIIBTOAOrHeH H B ICOHTPOAbllWX rpynnax. 10. n o»HMO npOHHKHOBeHHJI Y. entercolitica qepe3 llHlll8B8PHT8AbHYIO CHCTe11y 118Ab3JI HCKAIO'{aTb H031l0&- HOCTH napeHTepBAbHOro npOHHKHOBeHHJI 3THX IIHKpoopraHH3MOB. 11. CorAaCHO ,laHHWll ecex Ha6AIO,leHHii, aeAy,lO'{HO-KHm8'{HWe 3a60AeBaHHJI BW3WB8JOT eceo6mee OCAa6AeHHe opraHH3»a . 12. CeaOHHwe H3MeHeHHJI noro,lW, conpOBOKABmmBeCJI XOAOAOll H CW~OCTbIO, BAH.fDOT HQ npoTeKaHHe 6oAe3HH, '{TO npB3HB·HO BO ecex CTpaHax • 13. B pe3yAbTaTe nepe,laqu Y. enterocolitica OT qeAOBeKa IC qeAOBeKy B03HHKBIOT AOKBAH30B8HHWe 3nHAe- 1111H B c e»bJIX HAH 0TA8AbHWX o6mHHBX, a Taxae 3apaiaJOTCJI HOBOpO&,leHHWe A8TH. 14. H3 scex B03MO&HWX npaqaH 3apaaeHHJI CBHHbH qame ecero BWCTynaJOT B KaqeCTBe OCHOBHOro nepeHOC'{H- Ka 3a6 0AeBBHBH, nepe,laI011lHXCJI qeAOBeKy (cxoaeCTb mTBMMOB, BWAeAJ181lWX OT qe.,,oeexa H CBHHbH; nponeHT 3apaaeHHOCTH CBHHeii 60A83H8TBOpHl,lllH 6aKTepHJIIIH). RblCOKHH 15. mTallllW Yersinia, KOTopwe ace qame BWAeAJIIOTCJI H3 paCTHTeAbHOH ITHID,H, IIOAOKa H BOAW, ne OTHOCJITCJI K $eHOTHna11, BW3WBaIOlllHII naTOAOrHqecKHe JIBAeHHJI y qeAoeexa. 16. B OCHOBe 6aKT8pHOAOrHqecKoro AHBrH03a Ae&HT o6cAeAOBBHHe npo6 BW,leA8HHA. CpeACTHli, KOTOpblKH HBH60Aee qacTO Il0Ab3}'10TCJI npH BW,l8A8HHB H onpeAeAeHHH KHID8'{11WX 6aKTepHii, IIO&HO HCIT0Ab30rt8Tb AAJI 3THX ae ueAeii H B CAyqae CY. enterocolitica. BwAa OA06peHa 11eTOAOAOrHJ1 o60r8JlleHHJI npH npODCACHHH 30H.1(0MROAOrHqecxwc HCCA0A0B8HHH. 17. 3HaqeHHe cepOAHBrHOCTHqecKHX npoueAYP He CAe,lyeT H8,lOOUeHHB8Tb, OAHBKO, OHH HrpaJOT AHIDb ecno- 11ora T8AbHYIO POAb npH npoBe,leHHB 6aKTepaoAornqecKHX ,lHarH030B. K HCIT0Ab30B8HHIO 3THX npoueAyp, KBK r ABBHOIIY 11eTOAY . rrpH6eraIOT B CAyqaJIX' xor ,la APYrHM c noco6ow HeAb3JI BWA8AHTb IIHKpoopram,a 11w. BWAO AOCTBrHyTo c orAacae B OTHOmeHHH He06XOAHIIOCTH CTBH,lapTH38QHH HCil0Ab3Y8MWX aHTHreHHblX cyc neH3HH, '{TO ll03BOAHT cpaBHHBBTb pe3yAbTBTW THTpOBBHHJI, n0Ayqae11we B pa3HWX CTpBHBX, 8 Taxae pn3AH'{Hble CHHAPOIIW. 18. Kax B C8Ab110H8AA83, iiepCHHH03 npe,lCTBBAJl8T c o6oii 60Abmy10 npo6Ae11y AAJI o6mecTB8HHOro 3,lpaeooxpa- H8HBJI, IlpH iiepCHHH03e paCXOAW Ha AeqeHae BTOPH'{HbOC OCAOKH8HHH (apTpHTOB) , paBHO KBK H qaCTOTa CAyqaee KHlll8'{HWX 3860A888HHii, BW3WB8IOMBX weo6xOAHIIOCTb xapypraqecxoro e11emaTeAbCTB8, 11ory T 6WTb AB- ae 81,11118 , qe11 B CAy'{BJIX 3a60AeeaHHJI C8AbllOHeAA83O11. B 6opb6e C iiepCHHH03011 CA8AY0T HCIIOAb30BBTb TY ae 11eTOAHKY, KOTOpaJI npHll8HJl8TCJI B 6opb6e C C8Ab11OHCAAC3O11. Pexo11eH,a;agHa Pa6oqaJI rpynna BWHCCAa CACAYIOmH8 peKOIICHABUHH: 1. Yc oeepmeHCTBOBBHHe Aa6opa~ - 2HWX 118TOAOB a ) CTaHABPTH38UHJI cpe,lCTB H IICTOAOB BWA8ACHHJI H onpe.11eAeHHJI IIHKpoopra]IH3IIOB; 6 ) CTBHABPTH38UHJI c pe,lCTB H 118TOAOB o6ora meHHJI npH npoee,leHHH 30HA811HOAOrHqec KHX HCCAe,lOBBHHii; CTRHAaOTH~RUH~ RHTHreHOB H K0TO~OB THTOOBSHHff llDK nooee~eHHH c eooAoruqecKHX aHaAH3OB; 6) r) - 24 - r) AaAbHeK111ee ycoeepme»cTeoea»ue Y . enterocolitica BHTHreHHOK cxeww H YHHOpOK. paapa6oTBHHOH BoTepcow CTBHABPTH3BUHH weTOAOB HCCAeAOBBHHK npn H3yqeHHH HCToqHHKOB HHtexQHH H KeTOAOB o6HapyxeHHH Yersinia y CBHHeH B IBBOTHhlX, 3KOAoruqecxu CBH3BHHWX C qeAOBexow; HCCAeAOBBHHe qeAoeexa, KBK HOCHTeAH Y, enterocolitica; BeAeHHe CBCTeKBTHqecKHX HB6AIOAeHBH e ueAJIX RWHBAeHHH 3THOAOrHl! H qacTOTW onpeAeAeHHWX CBMOTOKOB, qTo Heo6xOAHKO AAH onpeAeAeHBH npOAOAXHTeAbHOCTH BHKy6auuonHoro ncpHOAB H HH(fleKUHOHHoro HHAexca; HCCAeAOB8HHH no BWHBAeHHJO Yersinia, OCHOBBHHWe H8 o6cAeAOBBHHH HCllpS.-HeHHH, CAeAyeT pacmxpHTh, BKAmqHe R HHX BHBAB3 KB3KB H3 TTOAOCTH IIOCOrAOTKH , a Taxxe CHCTeKBTHqecxoe o6 cAeAOBBHHe xellllOIH B 0TA8AeHHJOC BKymepCTBB H rHHeKOAOrHH HB npeAKeT o6eapyxeHBH 3TOrO HBKpooprBHH3KB. Hayquwe HCCAeAOBBHBH B o6ABCTH naToreueaa H ~H3HOTTBTOAOrHH a3yqesHe naTore»soro wexa»H3Ka ceporpynn 0:3 H 0:9 H cnoco6oe HX nepeABqH OT 60AhHWX .DlAea x 3Aopoeww; u3yqeHHe B03KOXHhlX naToreHHWX wexBHH3KOB 6HOTHDB 1, Y. enterocoliti~~. Y, interme9~~. Y. frederik5en11 H Y. kr1steosen1i; IDDIYHOllBTOAOrBqecxoe u3yqeHH8 BpTBKYAHUHOHHWX CBlOJTOKOB, Y3AOBBTOH 3pBTeMW H APYrHX npH3HBKOB, YKB3WBBJOmHX KB IDOIYHOAOrHqecx~ tH3HOllBTOAOrHJD, H3yqe9ne H Ha6AIOAeBHe 38 B03KOXHOK pe3HCTeHTHOCTbm Y. enterocolitica K BHTB6HOTBKBK oueuxa pB3AHqffWX ueTOAOB AeqeHHH B CBH3H C CBMOTOKBTOAOruea ((fleHOKeH HOCHTeAR), B03HHXBOBeHHe pe3HCT8HTHOCTH, llOHBA8KHe H.llH OTCyTCTBBe BTOpuqawx OCAOXHeHBH (apTpBT - Y3AOBBTBH 3pBTeua) geAecoo6pa3HOCTh C03ABHHH KBBHOKaAbHOro BeHTpa no HepcHHB03y B KBXAOH CTpaue H pa3BBTHe CBH3eH wex~y HBBHOKBAhHhlliB ueHTpBKH H wexAyHapoAHWH ueuTpow. - 25 - Pal3oqa.R rpynna no oonesHH nerHoHepoe ICP/BVM 015(S) 6aaett, 19-21 oKT.Rl3p.R 1981 roaa 21 .Rtteap.R 1982 roaa OPlffHHAJ1; AHrJlliflCl(j,~ BeeaettHe B eoeemaHHH, npoeeaeHHOM PerHOHanhHblM 13wpo e TeeHOM eOTPY/lHHqeeTBe e npaBHTeflbeTBOM ABeTpHH, npHHRnH yqaeTHe 3nH)leMHOnorH, MHKpOl3HonorH , HHlKettepbI H pal3oTHHKH ol3meeT BeHHOro 3)lpasooxpaHeHH.R H3 12 eTpaH. MHOrHe H3 KOTOPblX 3aH.RTbl HayQHblMH HeeneaoeaHH.RMH 0/lHOro HnH HeeKOTib KHX aeneKTOB paeeMaT- PHBaeMoro eonpoea. IlOBTOP.RWmttee.R B eeponeiieKHX eTpaHax BeTiblllDCH 6one3HH nerHOHepoe Bbl3BanH HeOOXO/lHMOeTb oopaTHTb BHHMaHHe Ha 3TO HOBOe 3al3oneBaHHe , enepBbie 3aperHeTpHpoe aHHOe B 1976 roay . Y'iHTbIBa.R ' QTO 3TIH)le - MHOnOrH.R nerHOHenenne3a llO eHx nop oeTaeTe.R He.ReHoii, a TaKlKe 6onbwyW s=HoeT b 3TOro eonpoea a= eTpaH e pa3BHTOH HH)lyeTpHeii TYPH3Ma ,H B eB.R3H e i3bieTpblM yeenH'ieHHeM Ol3'beMa HOBblX 3HaHHii OblilO pewe- HO eo3eaTb Pal3oqyw rpynny no 3TOMY eonpoey Hee 1982 roay , KaK 3TO nepeotta'ianb HO nnaHHpoeanoeb, a HeeKOTib KO paHee. Cny',aH 3al3oneeaHH.R nerHoHenne30M OblilH 3aperHeTpHpOBaHW B oeHameHHblX KOH/lHUHOHepaMH roeTHHHQax, 13onbHHUaX H 3)laHH.RX , ooopyaoeaHHblX eHeTeMaMH xpaHeHH.R OMbWHX 3anaeoe B0/lbl . TaKHM ol3pa30M, 3Ta npo l3neMa TaKlKe eB.R3aHa e rHrHeHOH epe)lbl OOHTaHH.R. Ben&IIIIKH 13one3HH eoenaaantt no epeMeHH e npoee- aettHeM eoopaHHii, Kottrpeeeoe H apyrHx MeponpH.RTHii e Y'<aeTHeM 13onbworo 'iHena nwaeii, 'iTO Hamno OTpa- lKeHHe e ne qaTH H ewseano ooeenoKoeHHoe~b HaeeneHH.R . Ilo3TOMY opraHaM 3JlpasooxpaHeHH.R oqeHb ealKHO HMeTb no B03MOlKHOeTH HaH6onee qeTKOe npeaeTaeneHHe O eoepeMeHHOM eoeTO.RHHH 3 HaHHH B 3TOH oonaeTH, e TeM 'iTOi3bI e 13onbweii yeepeHHOeTbW H 3cpcpeKTHBHOeTbW pearHpoeaTb Ha npoebObl H 3anpoebI a)lMHHHeTpaUHii roeTH HHU H oomeeTBeHHOeTH . .[!HeKyeeH.R 3THOnorH.R 6aKTepH.R Legionella pneumophi la, e&1ssasma.R s 19 76 roay 3TIH/leMHw ntteBMOHHH s ¢HnaaenbcpHH, ClllA, noenYlKttna enoeneaeTBHH npH'iHHOli aHanOrH'iHblX 3nH)leMHii H OT)lenbHblX HHcpeKUHH BO MHOr'HX eTpaHax EsponbI . CnyqaH 3a6onesaHH.R OblilH TaKlKe 3aperHeTpHposaHbl B 10,1rnoii AMepHKe, A<l>PHKe, A3HH H ABeTpanHH . B HaeTo.Rmee s peM.R HMeWTe.R ontteaHH.R wee TH npeaeTaBHTeneii poaa Legionella . Bee OHH, 3a HeKJIID'ieHHeM TOTibKO (L. gormanii), Bbl3bIBaWT nerO'iHbie HHcpeKUHH y qenoseKa; L • pneumophila, L . bozemanni, L. miedadei , L. dumo!!ii, L . gormanii and L. longbeaehae . Cs.R3b BH/lOB aaHHoro poaa no ilHK .RBn.ReTe.R enaooii - Oi3bl'lHO 25% HnH MeHbWe, XOT.R no cpeHOTHilY BH/lhl HMeWT oonbmoe exoaeTBO. 6&11tH Bbl,lleneHo weeTb eepor pynn L . pneumophila H ase eeporpynn&I L. longbeaehae. qeeKHe pa3nH'iH.R Me)K/ly llPYr'HMH BH)laMH eme He Bbl.RBJieHbI. CeponorH- Oe HOBbIBa.Reb npeHMYmeeTBeHHO Ha roMonorH'iHOeTH ilHK H cpnwpeeueHUHH KOTIOHHH Ha 3al3ycpepeHHOM y ronbHo- apo)K)KeBoM arape, rpynna eneuHantteTOB 3aKnwqttna, 'iTO e eeMbe Legionellaeeae eymeeTeyeT , no Kpaii Heii Mepe , TPH poaa: Legionella, Tatlockia, Fluoribacter . IloKa WHpOKoro ~PH3HaHH.R MHeHHe 3THX eneUHanHeTOB He nonyqHno. Jle rHOHennbI l!BJI.RWTe.R r pBMOTPHl.laTenbHblMH 6aKTepH.RMH, pa3Mepbl KOTOPblX OObl'IHO eoeTaBn.RWT 0 .3-0.9 MHKPOHa Ha 2- 20 MHKpOH . OHH nO)l BHlKHbI, HMeWT non.RpHwe lKrYTHKH H He o6pa3yWT enop . HH O)lHH H3 BH/lOB Legione ll a He aaeT xopomero poeTa Ha KPO B.RHOM arape HnH Ha llPYr'HX OObl'lHO HenonbsyeMboc 6aKTepHonorHqeeKHX epeaax. OaHaKo see BH/lbI npoHspaeTawT Ha yron bHd -ap o)K)KeBoM arape; ~ol3aane HHe ACES 6ycpepa yeKop~eT poeT HeKO~O~blX · BH/lOB . JlerHOHennbI OTTIH'iaWTe.R OT llPYr'HX . , P1'MOTPHUaTenbHbIX 6aKTepHH TeM , 'iTO oonbWa.R aon.R t;;, 60%) HX l!CHPHbIX KHenOT HMeeT BeTB.Rmttee.R uenO'iKH; OblilH onHea Hbl HX xapaKTepHbJe MO)lenH. CneaoeaTeflbHO' /ln.R HlleHTHWHKallHH MHKPOOoraHH3Ma MOlKHO TIPHMeH.RTb MeTO/l ra30BOH aaeopl3QHOHHOH xpOMaTOrpacpHH. - 26 - Eone3Hb H MeTO,llbl ee ,llHarHOCTHKH IlHeBMOHHH - OCHOBHOH pe3ynbTaT HH~Hll;HPOBaHHH opraHH3Ma L. pneumophila. IlHeBMOHHH MOI'YT conpOBO)!(,,llaTbCH nopaJKeHH eM cerMeHTOB HnH ,lloneH nerKHX H MOI'YT npO,[!OJIJl(aTbCH MHOrHe He,[lenH. 11MeeTCH PH,ll KnHHH'!eCKHX npOHBneHHH, KOTOpb!e CKOpee THllH'!Hbl ,llnH nHeBMOHHH, Bbl3BaHHOH L. pneumophi l a , '!eM ,llnH nHeBMOHHH, Bbl3bIBaeMOH APYI'HMH areHTaMH . Cpe,[IH HHX - CHMnTOMbl H npH9HaKH nopa*eHHH ueHTpanbHOH HepBHOH CHCTeMb1; oco6eHHO qacTO O!DH6Ka npOHCXO,llHT B CBH3H C nOHBneHHeM TaKHX CHMnTOMOB, KaK nHxopa,[IO'!HOe COCTOHHHe H HapyweHHe o6MeHa BewecTB, a TaK~e ,llHapeH, HapymeHHe geHTenbHOCTH neqeHH, rHnOHaTpHeMHH H reMaTYPHH. Ewno OITHCaHO He06bl'!HOe H HeTHnH'!HOe ,[lnH ITHeBMOHHH ~e6pHnbHOe COCTOHHHe, Bbl3b!BaeMoe L. pneumophila H H3BeCTHOe nog Ha3BaHHeM nHxopa,[IKH IloHTHaKa. EblJIH ,[IOKyMeHTanbHO 3a~HKCHpOBaHbl ,[IBe BCnblDD<H, H B 06011x cnyqaHX cpe,[IH KJIHHH'!eCKHX npOHBneHHH OTMe'!anHCb ITOBb!WeHHe TeMnepaTypbl, 03H06, MHanrHH H ronOBHaH 6onb . CpoK Te'!eHHH 6one9HH orpaHH'!HnCH ABYMH-nHTbW ,[IHHMH, H HH 0,[IHOI'O CMepTHOro HCXO,[la 9aperHCTPHPOBaHO He 6blJ10. MoKpOTa B cnyqae 9a6oneBaHHH nHeBMOHHeH, Bbl3b!BaeMOH L. pneumophi la, 06bNHO He HOCHT rHOAHoro xapaKTepa, H 6aKTepHH nH6 0 He OKpaWHBaWTCH COBCeM, nH60 HMeJOT BeCbMa cna6yw OKpaCKY no f'paMY. 06wee '!Hcno nei\KOll;HTOB 06bNHO HeCKOnbKO nOBblllla eTCH, MO*eT Ha6nW,llaTbCH nHMjloneHHH. )lHarH03 3apa*eHHH Legionella MO*HO HaH6onee TO'!HO nocTaBHTb rryTeM BblHBneHHH MHKpoopraHH9MOB B cy6cTpaTax opraHH3Ma' KOTOpb!e CTepHnbHbl B HOpMe' TaKHX' KaK' HanpHMep' TKaHb nerKoro, acn11paT H3 TpaxeH, KpOBb HnH nneBpanbHaH =,llKOCTb . IlonblTKH Bbl,[lenHTb 6aKTepHH H3 MOKpOTbl 'laCTO OKa3b!BaWTCH HeygaqHb]MH, HO 6naro,1JapH He,[laBH O pa3- pa60TaHHblM ceMHCeneKTHBHblM cpe,[!aM ITOBblCHnHCb noKa3aTenH BbJCeBa 6aKTepH>! . Mo*HO ITOCTaBHTb ,[IHarH03 3apaJKeHHH Legionella, ecnH ,[IOKa3aTb HanH'!He cneIJ;H~H'!eCKOI'O aHTHreHa B CMbJBe H3 HocornOTKH' TKaHH HnH MO'le. 3Ha'!HTenbHO 6onbWHH Ollb!T HaKonneH B o6naCTH npHMeHeHHH MeTO,lla npHMOH HMMYH~moopecueHUHH . IlpH 3TOM MeToge MO*HO nony'!HTb 6onee BblCOKHe pe3ynbTaTbl npH ycnOBHH 6e3yrrpe'!HOH ero nocTaHOBKH, XOTH CTeneHb BanH,[IHOCTH 3TOro TeCTa ewe He,[IOCTaTO'!HO onpegeneHa . AHTHI'eHbl L. pneumophi la 6blJIH 06HapY*eHbJ B MO'!e 60nbHblX nHeBMOHHeH npH noMOWH pa,corn- HMMYHOnOrH'!eCKOI'O aHanH9a H np06bl C ~epMeHTOM, KOH'.bWI'HpOBaHHblM Ha HMMYHOCOp6eHTe . .[l.nH ,[IHarHOCTHKH nerHOHenne3a MO~eT 6b!Tb npHMeHeH ceponOI'H'!eCKHH aHanH3. B HaCTOHwee BpeMH HaH6onee pacnpOCTpaHeHHblM aHanH30M HBnHeTCH MeTO,ll HenpHMOH HMMYHO~wopecueHUHH (!FA) C HCnOnb30- BaHHeM B Ka'!eCTBe aHTHreHa y6HTblX HarpeBaHHeM HnH o6pa6oTaHHblX ~OpManHHOM 6aKTepHA . HapacTaHHe THTpa HMMYHHO>I CblBOpOTKH 06bNHO Ha6nwgae TCH cnycTH 2-6 He,llenb nocne ITOHBneHHH CHMnTOMOB 3a6oneBa- HHH, npH'!eM aHTH6HOTHKOTepaITHH He OKa3b!BaeT no-BH,[IHMOMY CBOero B03,[leAcTBHH. 3<),~eKTHBHOCTb HenpHMOH HMMYH~nwopecTeHIJ;HH (!FA) npH ,[IHarHOCTHKe Legionella ewe He ycTaHoB- neHa gnR Bcex rpynn HaceneHHH. BBHAY 6blcTporo yBernqeHHH '!Herra BHAOB Legionella H ceporpynn uenecoo6pa9HO C03,[laTb cnpaBO'!Hble na6opaTOPHH no Legionella . 3TH na6opaTopHH ,[IOJIJl(Hbl HMeTb 6 aHKH o6pa31.IOB CblBOPOTKH, nonyqeHHblX B xoge HccnegoBaHHH, nono=TenbHO ITO,[ITBepll(,[leHHblX Bbl,[leneHH eM KYnbTypbl, 'ITO n03BOITHT o6ecne'!HTb onpegeneHHYW CTeneHb BanH,[IHOCTH !FA H APYI'HX ceponorH'leCKHX aHanH30B. Heo6XO,llHMO paspa6oTaTb 6onee npOCTble H 3KOHOMH'!Hble no cpaBHeHHW C !FA ceponorH'!eCKHe MeTO,[lbl. HecKOITbKO ueHTpOB 3aHHMaJOTCH paspa60TKOH MeTO,lla MHKpoarrnJOTHHaIJ;HH, H nepBble nonyqeHHble B xoge HX anp06HpOBaHHH pe3ynbTaTbl HBnHJOTCH BnonHe 06Hage~HB8=HMH . HccnegoBaHHH in vitro H in vivo noKa9b!BaWT, 'ITO 9PHTpOMHUHH, PH~MHUHH H HeKOTOpble ,[!py- rHe aHTH6HOTHKH TeTpaUHKnHHOBOro PHAa HBnHWTC H 9~eKTHBHblM cpe,[ICTBOM 60pb6bl c pa3Hb1MH BH,[laMH Legionella. XoTH COOTBeTCTBywwero KOHTpOnHpyeMoro HCnblTaHHH npoBegeHo He 6blJ10' aHanH3 OT,[lenb- HblX cnyqaeB noKa3b!BaeT, 'ITO npegnO'!THTenbHee Hcnonb30BaTb ne'!eHHe 3PHTPOMHUHHOM (g03HPOBKa: 2-4 rpaMMa e~egHeBHO, BHaqane BHYTPHBeHHO, 3aTeM - nepopanbHO). TeopeTH'!eCKH KOM6HHHpOBaHHaH TepaITHH C npHMeHeHHeM 3PHTPOMHUHHa H PH~aMnHll;HHa HMeeT npeHMY- mecTBO YCHneHHOI'O geHCTBHH, Hee uenecoo6pa3HO npHMeHHTb npH neqeHHH 6onbHb]X C HMMYHHblMH Hapyme- HHHMH. - 27 - 3rtHaeMHOJIO!'HJ1 H cj,aKTOpb! PHCKa HeT TO'-!HblX aaHHblX O qacTOTe HHcj,HI-IJ,!POBaHHJl Legionella, O,l::IHaKO pe3yJibTaTbl H3y'-!eHHJ1 pacnpocTpa- HeHHOCTH 3TOJ:i 15oJie9HH B HeKOTOPblX eaponeACKHX CTpaHax noKa9aJIH, '-!TO Ha ,l::IOJIID L. pneumophila npHXO):IHTCJl 1-3% Bcex CJIY'-!aeB 3a60JieBaHHJ1 pa3JIH'-!Hb!MH BH,l::laMH nHeBMOHHH B 60JibHHUax. Ha6nwaaWTCJ1 KaK OT,l::leJibHble CJiy'-!aH , TaK H BCnblll!KH 3a6oneaaeMOCTH Jie!'HOHeJIJie30M, npH'-!eM npeo6na- aawT e,l::IHHH'-!Hble CJiy'-!aH. 60JiblIIHHCTBO CTpaH, OT KOTOPblX nocTynaeT HHcj,OpMaUHJl O TaKHX CJIY'-!allX, OTMe '-!aWT Bb~a.JICeHHYJO Ce30HHOCTb 3a60JieBaHHJ1 nHeBMOHHeA L. pneumophila: He6oJihmoe '-IHCJIO CJIY'-!aeB Ha6nroaaeTCJ1 B nepBble MeCJlUbl l'O):la, OCHOBHOe JKe '-IHCJIO 3al5oneaaHHA npHXO,l::IHTCJl Ha KOHeu neTa H oceHb. ITpH aHaJIH3e 3aperHCTPHPOBaHHblX CJIY'-!aeB 6b!JIO caenaHo 3aKJIW'-!eHHe, '-!TO HHcj,HUHPOBaHHe CJIY'-!aeTCJl B aaa pa3a qame cpeaH ~HH, '-!eM cpe):IH JKeHfilHH. Bo3paCTHOJ:i cj,aKTOP TaKllte Hl'paeT 3aMeTHYID pOJib : onacHOCTb 3al5oneBaHHJ1 Legionella B09pacTaeT no Mepe CTapeHHJl qeJIOBeKa BnJIOTb J:10 AOCTHJKeHHJl HM 60-neTHe!'o B03pacTa. AHaJIH3 OT aeJibHblX CJIY'-!aeB no3B0JIHT Bb!JlBHTb uem,IA pllJ:1 cj,aKTOpOB' cnoco6c TBYIOO-IJ,!X 3a6oneBaHHID nHeBMOHHeJ:i L. pneu mophila cpeJ:IH HaceneHHJl. B '-!aCTHOCTH, TaKHMH cj,aKTOpaMH J1B JIJ1IDTCJ1 KypeHHe CHl'a- peT, He):laBHHe noe3):IKH (a '-!aCTHOCTH, 3a !'paHHey), noTpe6neHHe aJIKOl'OJIJl H npo~BaHHe no6JIH90CTH OT CTPOHTenbHOJ:i nJIOfila):IKH HJIH pal5oTa Ha HeH. B o MHOl'HX 6onbHHUax 3apaJKeHHe Legionella HMeeT 3HAeMH'-!ecKHA xapaKTep . PocT pHcKa 3a6one- BaHHJ1 nHeBMOHHei1, Bbl 3BaHHO>I L . pneumophi la B YCJIOBHJlX 60JibHHUbl aCCOUHHpyeTCJl C no'-!e'-!Hb!M ,l::IHaJIH30M, TpaHcnJiaHTaUHei1 no'-!KH, npHMeHeHHeM noaaBJIJll<IIU-IX HMMYHHTeT MeMKaMeHTOB , paKOM, xpOHH'-!eCKHM 15pOHXH.- TOM, 3 Mcj,H3eMoi1, KypeHHeM CHrapeT H caxapHb!M Mal5eTOM . HeT cpaKTOB, CBHAeTeJibCTBYIOOO-IX o nepeaa'-!e nHeBMOHHH Le g ionella OT qenoaeKa K qenoBeKy, oaHaKO MHO!'He HCCJieaoBaHHJl yKa3b!BaIDT Ha TO , '-!TO HCTO'-!HHKOM HHcj,eKUHH CJI=T cp e aa ol5HTaHHJ1. ITpH aHaJIH3e Tpex BCnh!WeK L • pneumophila OblllO ycTaHOBJieHO, '-!TO HHcj,eKUHJl nepeHOCHTCJl TOKaMH B09):IYXa qepe3 CHCTeMb! KOH/:IHUHOHHpOBaHHJl, a TaKJKe B pe3yJibTaTe palSOTbl HcnapHTenbHblX KOH,l::le HCaTOPOB, noaal<ll!Uix B cpeay 3arpJ13HeHHb1e a3po30JIH BOAhl. KaK nonal'aIDT , B qeTb!pex CJiy'-lallX npH'-IHHOH BCnbIWeK ISblllH CHCTeMb! nHTbeBOH B0):lbl . XoTJl MexaHH9M nepeaa'-IH HHcj,eKUHH qepe3 cHcTeMb1 nHTbeBoJ:i BOAbI eme He onpeaeneH, ecTb npeanonoJKe HHe, '-!TO 3Ta nepe- aaqa n poHcxoaHT qepe3 a3po30JIH, o6pa3yK11U1ecJ1 a aoaonpoaoae HJIH aymax. 3KOJIO l'HJ1 15oJie3 HH H Me pbl 15opb 6bl C Hei1 lbyqeHHe ITPHPOAHblX cj,aKTOpoa n03B0JIHJIO YC TaHOBHTb , '-!TO HCTO'-!HHKOM 3apaJKeHHJ1 L. pneumophila MOl'YT l5b!Tb B0,l::IOTOKH, peKH, 03epa H APY!'He ecTeCTBeHHble pe3ypayapbl B0):lbl . qaCTO 15aKTepHID MOJKHO TaKJKe OIS HapyJKHTb B CHCTeMax nHTbeaoA B0/:lbl H TennooO MeHHHKax CH CTeM OXJiaJKJle HHJl BO,l::lbl . UpyrHe BH/:lbl -Legionella 6blllH BbiaeneHb1 H3 oKpYJKawme i'i cpeabl . 6o pbl5a co BCnh!Dll(aMH L . pneumophi l a o c y mecTBJIJlJiaCb c nOMOfilbID XJIOPHPOBaHHJl CHCTeM BOAOCHa6JKeHHJ1 . KaK noKa9b!BaIDT 3nHaeMHOJIOl'H'-!eCKHe HCCJieaoaaHHll, 3 TH CHCTeMb! qame acepo CJIYJKaT HCTO'-!HHKOM pacnpo- CTpaHe HHJl HHcj,eKUHH. OaHaKO XJIOPHPOBaHHe He JlBJIJleTCJl H):leaJJbHb!M MeTOJ:IOM o6pa6oTKH B0/:lbl OXJia,l::IHTenb- Hb!X CHC TeM. CneayeT no3TOMY npoaeCTH npaKTH'-!eCKHe HCnbITaHHJl H APYl'HX MeTO,l::10 B . SblllH BblC Ka3 aHbI npeanoJIOJKeHHJl (noKa OHH eme He ,l::IOKa3aHbI) , '-!TO pepynHpOBaHHe TeMnepaTypbl B0/:lbl MOJKeT OKa3aTbCJ1 nOJie9HOH Mepoi1, ecnH ycTaHOBJieHO, '-! TO H CTO'-IHHKOM BCnhlWKH 6one3HH CJIYJKaT CHCTeMb! nHTbeBOH B0):lbl . 0T,l::l enhHble CJIY'-!aH Ol5 HapyJKe HHJ1 pa3HOBH,l::IHOCTei1 L e gi onell a a aoaonpoaoae He cnYJKaT ocHoa aHHeM AJIJl npoaeaeHHJl palSOTbl no YHH'-ITOJKeHHID Op!' aHH3MOB , ecJIH HeT APYl'HX AOKa3aT e Ji bCTB B03MOJKHOCTH BCilblWKH HHcj,eKUHH. OaHaKO Heo6XOAHMO CJie,l::IHTb 3a TeM , '-I T Ol5bl OXJi a):IHTeJibHble CHCTeMbl 3KCn.nyaTHPOBaJIHC b Haane- JKamHM o6pa30M . BOAY H3 CHCTeM OXJia)l(J:leH HJl cneayeT nepHO):IH'-!eCKH c nycKaTb , 0 '-IH!JlaTb H, ecJIH Heo6- XO,l::IHMO, CHCTeMb! cneayeT o6pa6aTb!BaTb COO TBeTCTBYIDmHMH 6 HOJIOl'H'-!eCKHMH COC TaBaMH AJlll npeaynpe)l(J:leHHJl o6pa30BaHHJ1 CJIH 3 H H BO,l::lopocnei1 . l.lHcTepHbl AJIJl xpaHeHHJl nHTbe BOH B0,l::lbl ,l::IOJIJKHbl HMeTb K PblWKH. 1. BH,l::lbl L e gi o nella HMeIDT noaceMeCTHOe pacnpOCTpaHeHHe B MHpe, H B0 9 MOJKHOCTb 3apaJKeHHJ1 3THMH He,l::laBHO 06HapyJKeHHb!Mli naTO!'eHHblMH Opl'a HH3MaMH AOJIJKHa Y'-IHTb!BaTbCJl npH npoaeaeHHH amW,epeHUHaJibHOl'O AHa!'Hosa nw6oro cnyqaJ1 3a6one aaHHJ1 nHeBMOHHeJ:i . TaKoA A HarH03 MOJKeT 6bITh nonyqeH Ha ocHoae noap o6 - HbIX aaHHhlX 3nHaeMHOJIOl'H'-!eCKOl'O' KJIHHH'-!eCKOl'O H 6HOXHMH'-!eCKOl'O xap aKTepa . - 28 - 2. TepMHH '"Legionella pneumonia" cnegyeT npHMeH.RTb a Ha y'I HOH nHTepaType ,l:\nll OnHCaHHll nHeBMOHHli, Bb13bIBaeMOH Bli,l:\aMH Legionell a . TepMHH "6one9Hb nerHoHepoa" cnegyeT npHMeH.RTb K HH<!>eKUHOHHOMY 3a6oneaaHHW, HMewmeMY Te *e KJ1HHH'leCKHe H 3nHneMJ,fOnOrH'leCKHe 3aKOHOMepHOCTH, '!TOH acnbllllKa 6onesHH, 11Meamall MeCTO B <l>l1Hn.RH,!ll1H B 1976 rogy H Bbl3BaHHall L. pneumophila. 3. IlOMl1MO nHeBMOliliH B11,1:\bl Legionella MoryT Bbl9bIBaTb gpyryw conpoao)!(JlaKlll\YOCll 03H060M 6one3Hb (HanpHMep, n11xopauKa TIOHTHaKa), B CB.R3H C 'leM peKOMeHgyeTCll npO,l:\OJDKHTb HccnegoaaHHll ,l:\nll nony'leHHll nonHOH KapTHHbl 3a6oneaamrn, Bbl3b!BaeMoro 3Tl1MH naToreHHblMH M11KpoopraHH9MaMH. 4 . nnll nocTaHOBKl1 TO'!Horo paHHero n11arHosa L. pneumoni a KJil!HliU11CTY peKOMeH,!lyeTCll B3l!Tb y 6onbHOro Ml! aHan113a CMblB 11 3 HOCOrnOTKH (H, ecnH B03MO~HO, KYCO'leK nerO'IHOH TKaH11) gnll KynbTHBH- poaaHHl! 6aKTepHH. B HaCTO.Rmee apeM.R pa3pa60TaHa cpega gm! 11cnonb30BaHH.R np11 PYTHHHhlX 11CnbJTaHH.RX a nHarHOCTH'leCKOH na6opaTOPHl1. 5. IlpH pa6oTe C Legionella B na6opaTOPHb!X ycnOBl1.RX cnegyeT TIOMHHTb, '!TO, KaK H MHor11e ,1:1pyr11e 6onbHH'IHhle naToreHHb!e MHKpoopraHH3Mbl' 3TH 6aKTep11H OTHeceHbl B03 B rpynny Pl1CKa 2; 0,1:\HaKO ecJIH B 3KCnepHMeHTe nonyqaWT HaCbll!leHHble a3p030nbHble COCTaBbl, Heo6xonHMO cne,1:10BaTb npaa11naM pa60Tbl C opraHl13MaMH rpynnbl PHCKa 3. 6. Heo6xonHM O pa3pa6oTaTb HegoporoH HMM)'HOnorH'leCKHH TeCT, KOTOPb!H MO*HO CTaBHTb B ycnOBH.RX B ycnOBl1.RX 06bNHOH ,[:\HarHOCTH'leCKOH na6opaTop1111 ,l:\nll 6b!CTPOH nocTaHOBKl1 AHarHoSa (HanpHMep, ,l:ln.R o6Ha- p~eHHl! 6aKTep11H HnH 11X aHTHreHOB B CMblBe 113 HocornoTKH HnH MO'le). 9TOT TeCT gon*eH 6bITb nocTaTO'IHO TO'IHhIM, cneu11<!>H'IHhlM H Hecno*Hb!M B HCnOnHeHHH. 7. Heo6xo,1:1HMO pa3pa60TaTb cTaH,!lapTbl Ha npoae,1:1eHHe ceponorH'lecK11x aHan113oa H onpegeneHHe aan11,1:1- HOCT H pe3ynbTaTOB. Oco6eHHO cnegyeT oueH11BaTb noTeHUHanbHOe 3Ha'!eHHe OCHOBHblX TeCTOB Ml! Ka,l(JJ,OH nonyn.RUHH . 8. B EaponeJ'.icKOM perHOHe, npeno'ITHTenbHee no,1:1 srHAOH B03, cne,1:1yeT opraHHsoaaTb 06yqeH11e na6opaH- TOB MeTO,l:\aM ,l:\HarHOCTHKH Legionell a . 9 . Cne,1:1yeT CTHMyn11poaaTb pa3pa60TKY HaUHOHanbHblX nporpaMM Ha,l:\30pa 3a pacnpocTpaHeHHeM HHq,eKUHH Legionella; KpoMe Toro, Heo6XOAHMO co3,1:1aTb COTPYAHH'lawmHM ueaTp B03 B Eapone. 10. ner110Henna pacnpocTpaHeHa goaonbHo mHpoK o . ~ame acero ee BHAbl o6HapY*HBa= a cHcTeMax nHTbeBOH B0,1:\bl H Tennoo6MeHHHKax CHCTeM oxna*AeHH.R. IlpH 3KCnnyaTaUHH H o6~BaHHH BO,l:\Ono,1:1roTo- BHTenbHblX CTaHUHH He06XO,l:\HMO co6nwnaTb COOTBeTCTBYWIDHe TeXHH'leCKHe npaa11na. IlpH OTCYTCTBHH KOMnneKca npl13HaKOB 3ap=eHHll Legionel la npoaeneHHe Mep no YHH'ITO*eHHW opraH113MOB MO*HO C'IHTaTb HeonpaagaHHhlM. - 29 - KOHTPOflb 3A TOKCW!HbIM11 Xl1MWIECKHMH BElliECTBAMH Pa6oqaR rpynna no nAattnpoaattl1lO YeponpHRTHfi B HenpeABHAeHHbIX o6CTOHTeAhCTB8X H npH HeC- qacTHldX c~yqaHx, CBH38HHhlX C yTeqxoH IlOTeH- ~HSAhHO 0Il8CHblX Xl:WHqecKHX aem;eCTB - 31 - ICP/ RCE 903 ( 7 ) (S) 31 YapTa 1981 roAa OPfilHHAJI : AHr .llllliCK!lli B 3aceAaHHIDC Pa6oqefi rpynIIl>I, co3aaaaofi EaponeficKm< peraoaaAbHblld 6ropo B03 npa noA,11epxxe H yqa - CTHH npaBHTeAbCTBa l!HAepAaHAOB, npHHID<a.llH yqacTHe 25 cnenHaAHCTOa H3 17 CTpaH, a TaKXe npeACTaaH- TeAH B03, MOT a KlHEIT/MPITTXB. Pa6oTa rpynnw 6wAa oprattH3oaaaa a paMKax Eaponeficxofi perHottaAbHOH nporpaMMhl B03 no 6e30ilaCHOCTH XHMHqeCKHX aemecTB, oc~eCTBAReMOH EaponeHCKHM perHOHaAbHbIM 6ropo B03, a TaKXe a paMKax perHOHSAbHOro COTPYAHHqe cTBa a o6AaCTH rHrHeHhl OKpyxa10111eH c peAhl a KOHTPOAR XHMH- qecxHX aemecTa. BwcTynaR tta coaemattHH OT HMean npaaHTeAbCTBa HHAepAaHAoa, A-P JI . lCHHAJl(aap, MHHHCTP 3Apaaooxpa- tteHHR H oxpaHhl oxpyxalOllleH cpeAhl, OTMeTHA aaxHOCTb o6cyXAaeMoro aonpoca KaK AAR pa3aHThlX, TaK H A,lJI pa3BHBaromHXCR CTpaH . ~aKTHqecKH ace rpynnw HaCeAeHHR IlOABepxeHhl B03AeHCTBHID IlOTeHilHaAbHO OilBCHhlX xm,aqecKHX aemecTB, BK.moqaR npOMhIIDAeHHhlX H CeAhCKOX03JiliCTBeHHhlX pa604HX, JIIOAeH, exeAHeBHO HCil0Ab3ytOmHX XKM.HQeCKHe npo- AYKTW, H Tex ~HTeAeH HaCeAeHHhlX nyHKTOB, KOTOphle IlOABepraIDTCJI B03AeHCTBHIO XHMHqecxux aem;eCTB, HBXO- ARmHXCR B a03Ayxe HAH a IlHTbeBOH aOAe. IlpH cymecTay1om;eM B H8CTOJLIIJ;e e epe?dJI orpOMHOM ypoa H e ,.a;06bttlH ' IIPOH3B0,ll;CTB8, TpaHCIIOPTliPOBKB t xpa - HeHHJI XHMHtleCKHX aemeCTB, KOTOphle HCilOAb3YJOTCJI HAH AHKBH.LtHpyroTCJI KSK OTXOAW, HeAb3JI H36ex&Tb Hecqa- CTHhlX CAyqaea, KOTOphle ace 4ame npOHCXOART a MHpe. IlpH paCCYOTpeHHH a03MOXHoro apeAHOrO B03AeHCT- BHR, KBK KpaTKOCp04HOro TaK H AOAr ocpoq ttoro xapaKTepa, KOTOpoe MOXeT OK838Tb HB 3AOPOBbe qeAoBeKa H Ha OKpyxaromyro cpeAy c~yqaHHa.fl y TeqKa XID(HqecKHX aemeCTB, npeACTaBAHeTC.fl Ba•HbTM, 4T06bl a K8~Aoll CTpaHe 6bJA pa3pa60TaH COOTBeTCTBylOIIIHIT Yexattlil3Y IIO 6opb6e C no1106Hb!MH HecqBCTHblMH c.yyqaRMH. rAaBHB.fl ueAh 3TOro coaemaHHH 38KJTI048eTCH B TOM, 4T06bI COAeHCTBOBBTb C03A8 HHIO H8 p83AHqffbIX ypOBHJlX MOAeAH acecTOpO Httero IlABHa 3cj)¢eKTIIBHhlX YeponpHRTIIH B ttenpeABHAeHHblX o6CTOHTeAbCTaax, CB.fl38H - HMX C yTe4KOH TIOTeHUHBAhHO OIIBCHhlX XHMHqe cKHX aemeCTB. MOAeAb Taxoro IIAaHa 6yAeT BKJDOqeHa 38TeM B MeT0,4H4eCKHH AOKyMe HT' KOTOphlH MOJKeT 6b1Tb HCII0Ab30B8H npaBHTeAhCTB8MH AA.fl TIOArOTOBKH liJlH ,ll0 pa60TKH CBOHX CHCTeM OK838 HHH Cp04HOH IIOMOmH. IlpH IlOArOTOBKe K co aemaHl1lO PerHOHaAbHOe 6ropo 11aAO YKB38 HHe npoaecTH ABS OCHOBHhlX HCCAeAOBaHHR: a ) KOHnenTyBAbHBR MOAeAb CHCTeMhl OKB3aHHR B MaCmTa6ax BCefi CTPBHhl cpoqHOK IlOMOmH nplil ttecqacT- HblX C.,ty48JIX I CB.fl38 HHhlX C yTe4KOli XHMHtteCKHX aemecTB j B 3TOii MOAeJlll onpe,.a.eAeHhl KOMIIOHeHTbI CllCTeMhl, TBKHe K8Kpacnpe11eAettaeo6R3aHHOCTeH Ha pa3AHqHhlX ypOBHIDC, KaHSJll,I CBR3H , AOCTyn K HH- <l>OPMSilH.li, 06opy11oaaHHe, JllO.llCKHe pecypchl H T ·A .; 6 ) a3yqeHHe KOMilOHeHTOB CHCTeMhl, c~eCTByKlllleH B eaponeHCKHX CTpattax; 3TO IICCAe11oaattHe, KO- Topoe npoBOAHA UeHTP nccAe11oaaaHH H KOHTpoAR a AoHAotte npa coAeficTaHH KHEIT/MPITTXB, cTaaHAO CBOeH ueAbro IlOAyqeaHe HH~OpMSUHH O cymecTayromnx B eaponeHCKHX CTpaaax CHCTeMax OKB3a HHR cpoqHOH IlOMOfilH nptt yTe4Ke onaCHhlX XKMH4eCKHX BemecTB. KpoMe Toro, Ha coaemaHHH 6hlAH npe11CTBBAeHhl AOKAa Ahl O ABYX crre uaaAbHhlX HCCAeAOBaHHRx; OAHO 6hlAO nocaJlllleHO CAy4aK HOH yTeqxe 2 , 3,7,8 - TeTpaxAopo-P-AHOKCl!Ha ( TX.ll.ll) Ha npOMbllll.lleHHOM npe11npHRTHH B Ceae3o, MTaAHR, B ApyroM pe4b mAa O xe11e3HOAOPOXHOM npottcmeCTBHH B MHCCHCayra, OttTapao, KattaAa, B pe3yAbTBTe KOTOporo npOH30mAa yTeqKa XAOPHHa. - 32 - CneuHaAbHble HCCAeAOBaHHJI Aa.lllf BO3ldOJt(HOCTb npoaHaJllf3HpOBaTb, HaCKOAbKO a c eo6oeMJIIOllteH B aAeKBaT- HO H JlBAJleTCB KOHUellTYSAhHan MOAeA h CH CTeMhJ OK838HHR Cp04HOH OOMO~n. 3TO ASJIO B03MOXHOCTb YCTBHO- BBTb BO3MOJt(HO A>J 6oAee ::>(Jxl>eKTHBHOe H 6blCTpoe OKa3aHBe noMomH BO apeMJI aaapBM npH c yme c TBOBBHBB Ta- KOH CliCTeMhl. B peayAbTaTe npoBeAeHHOH AllCKyC CHH Ha coaemaHBB 6bJAO pemeHO BHeCTH OTAeAbHble H3MeHeHJrn B npeA- AOJt(eHHYJ0 ldOAeAb CBCTeMbl. PeKOMeH.llBUH1! 0C HOBHble peKOMeHABUHH, Bblpa6oTaHHWe Pa6oqej;i rpynDOH, BKJDOqaAB CAeAy,o,ne e . 1. Heo6xOAIDIO IlO,11,,lleplt(BBBTb npaBBTeAbCTBa B paapa60TKe BCeCTOpOHHero B MaCmTa6ax BCe H CTPBHbl IL/18- Ha MeponpHJITBH B HenpeABHAeHHblX o6 CTOJITeAbCTBBX no OKa3aHHIO cpoqHOH noMomH DPH yTe qKe IlOTeHUHa.llbHO onaCHb~ XHMuqecKBX aemeCTB. OKaaaHBe cpoqHOH noMomH Ha paaJllfqffblX ypOBHHX - ynpaBAeHqeCKOM ( npo- ldhlmAeHHble npeAnpBJITBJI, TpaHcnopT, o6opy AOBBHBe AAJI xpaHeHHJI XBMBqecKHX aemeCTB) n npaBHTeAhCTBeHHOld ( MeCTHble, perBOHa.llbHble B HaUHOHB.llbHble y qpelt(,lleHBJI ) - AO.lllt(HO BXOAHTb B TaKOH DAaH, TaKHe KJDOqeabJe BOilpOCbl KaK pacnpeAeAeHBe o6naaHHOCTeH, AHHHH CBJl3H, AOCTyn K HH(J>opMaUBH , o6opy,llOB8HHe , JDOACKBe pecypCbl H T . A . TaKJt(e AO.lllt(Hbl 6b1Tb BKJDOqeHbl B DABH. OH TBIO(e AO.lllt(eH 6b1Tb COBMeCTBld C D.llaHOld wepo- DPHJITHM B Apy rBX HenpeABHAeHHb~ o6CTOJIT e .llbCTBax' BO3ldOJJ(HblX B MHpHOe apeMJI ' BKJDOqaJI DPHPOAHble 6eACTBBR, 2 . ,11.JrJI OKa3aHHJI DOMOmB npaBHT e .llbCTB8ld B 3TOM Ae Ae E aponeHCKOM Y perBOHB.llbHOM Y 6 wpo B03 He o6xOAIDI O pa a pa 6 oTa Tb B ony6AHKOBaTb P YKOBOAJJmHe AOKyweHTbl O DAaHHpOBaHH>J Me ponpHJITBH B He npeABH,lle HHblX 06 - CTOJITeAbCTBSX H npe HecqacTHhl.X CAyqanx, CBJl38HHLle C yTeQKOH DOTeHllH8AbHO onaCHhlX XHMH4eCKHX ee~e CTB. MoAeAb DAaHa, npe,llAOJJ(eHHBJI Pa6oqei, rpynnoH , DOC.lie H3MeHeHHH H AOpa6oTKH ldOJJ(eT C.llYJJ(BTb B KaqeCTBe OCHOBbl npH IlOArOTOBKe ::>Toro pyKOBOAJlfilero AOKyMeHTa. ~ - PerHOHa.llbHOe 6wpo ,llO.lllt(HO IlO.llOJt(HTb HaqaAo Ae»Te.llbHOCTH, HanpaBAeHHOH Ha npo~HABKTHKY HecqaCTHblX CAyqaee, CBJl38HHhIX C yTe4KOH XHllHQeCKRX ee~eCTB . H3yqeaee yxe lllfeBmHX M0CTO HeC 48 CTHhIX CAyqaee , BX npHqHH H o6CTOJITe.llbCTB, B KOTOpblX OHH npOH3OmAB, AO.lllt(HO C.llylt(HTb B KaqecTBe OCHOBbl npH onpeAeAeHHH TeX o6 CTOJITe.llbCTB, KOTOpble MoryT npHBeCTH K HecqacTHOM Y CAyqaw, o6AerqaJI TaKHM o6pa30M aw6op H HC- DO.ll b3OBaHBe npo~HAaKTBqecxBX Mep. 4 . IloCKO.llbKy HecqacTHWe CAyqan, CBJl3aHHble C yTeqxoH XIDIBqecKBX aemeCTB, CKOpee acero 6yAyT npOBC- XOABTb H B 6yAymeM, HeCMOTPJI Ha ace npo~BAaKTBqecKBe Mepw , KOTOpble MoryT 6b1Tb DPBHJ!Tbl, PerBOHB.ll bHOM Y 6wp o Heo6XOAIDIO no,llrOTOBBTb PYKOBOAJlfilBe AOKyldeHTbl no BOCCTBHOBAeHHIO aapall(eHHblX paHOHOB, BKJDOqaJI aapall(eHHble rpyHTOBble BOAbl B noqay. 5. 3<!i<l>eKTBBHOCTb OK83aHHJI cpoqHQH IlOMOmB B aaaqBTeAbHOH CTeneHH 38BBCBT OT HaABqHff IlO,llrOTOB.lleHHOro aepcoHaAa . 06yqeHBe oxaaaHHIO cpoqHQH noMOmB B npo~AaKTHKe HecqacTHblX CAyqa ea AO.llll(HO 6b1Tb BKJDOqeHO 8 p aaAeA O pa3BHTBB KaApOB Melt(,llyHapO,llHOl! nporpaMMbl no 6eaonacHOCTH XBMHqecxBX aemecTB, OTBeTCTBeHHOCTb aa KOTOpyw a ldelt(,llyHapO,llHOM DAaHe HeCeT EaponeHCKOe perBOHBAbHOe 6wpo B03. 6. HauHOHB.llbHble B Melt(,llYHBpO,llHble HH(J>opMaUHOHHble CHCTeMbl, COAeplt(amue ,llBHHble O XBMBqecxBX aemecTBBX e: RX TOKCH\IHOCTH' ,D.OJl)l(Hhl CT8Tb 6oJiee M.06HJlbHbllUI H B3BHl40CBJl38HHWMH, QT.06hJ 6hJTb B COCTOJIHHlf cua6xaTb Heo6xOAHldOH BHcJ>OpMaUBeH acex, KTO OTBeqaeT 38 npHHJITBe Mep B HenpeABB,lleHHblX o6CTOJITe.llbCTBBX B npB Hec qaCTHbJX cAyqaJ1x. 7 . qT06bl OKB38Tb noMomb BAaCTJIM npB npBHJITBB C.llOJt(HOro, HO Hepe,llKO npBHUBDBB.llhHOro pemeHHJI 06 3BB- Kyauun, B03 ,llO.llll(H8 DO,llrOTOBHTb AOKyMeHT O 11,llODyCTBMblX ypOBHJIX npB aaapBHHblX CBTyauBJIX 11 ,llAJI pa3ABqHblX XID<BqecKBX aemecTB. - 33 - P86oq8ff rpynn8 no p83p86oTKe MeTOAHqeCKHX yxa38HHii B OTHOmeHHH KOHTpo..1111 3a TOKCH'-IHblliH H ..apyrmrn orraCHblMH OTxo,n;aMH ICP/ RCE 402 (1) 27 anpeAR 1981 roAa OPIIT'l1HAJI : AfIT .JJIDICKIIB Pa6oqaff rpynna 6L1Aa C03B8H8 EeponeiiCKHM perHOH8AhHblM 6ropo B03 H Mell<AYH8POAHblM perHCTpOM TIOTeH- JIH8AbHO-TOKCHqHblX XHMHqecKHX eemecTB IDHEI1 AAR coeMeCTHoro o6cyll<AeHHR CeoAa np8KTHqeCKHX np8BHA H MeTOAHqeCKHX YK838HHH no KOHTpOAIO 3a TOKCHqHblMH H ApyrHMH on8CHblMH OTXOA8MH . B P86oqeii rpynne npH- HHllla.JIH yqaCTHe 35 ytreHhlX - cneuHSJIHCTbl B 06 ... taCTH oxpaHbl OKPYlK.810JlleH cpe.n;bl, XHMHKH' HHXeHepbl-XHMHKH' 0:H.M.eHephI I"paJK,a;aHCKOI'O CTpOHTe.JlbCTBa, TOKCHKOJIOI"H, epaqn, 3KOHOMHCTbl, a.n;BOK8Tbl H a.zv,t:HHHCTpaTHBHble p860THHKH H3 20 CTp8H Eeponb1, CeeepHOH AMepHKH H A3HH. Pa3pa6oTxa MeTOAHtfeCKHX yKa3attnH H Cao..aa rrpaKTHt1ecxnx npaau..11 A.Jiff rrpHHHT HJI pemettHH H KO HT po..1111 38 TOKCHqH blMH H ApyrHMH on8CHblMH OTXOA8MH RBAReTCR Ball<HOH COCT8BHOH qaCThlO npOBOAHMOro IDHEI1 H3yqe- HHR 3KCnOpT8 H YA8Ae H HR TOKCHqHLJX H ApyrHX on8CHLIX OTXOAOB, a TaKll<e q8CTblO nporp8MMbl no 6e30TI8CHOC- TH XHMHqecKHX eemecTB H H3yqeHHIO OTI8CHbl X ¢8KTOpOB OKPYll<810meii cpeAbl , KOTopaR npoBOAHTCR Eepon eiiCKHM peruOH8AhH blM 6ropo B03 npH noAAepll<Ke IIPOOH B p8MK8X Mell<AYH8pOAHOH nporpaMMbl no 6e30n8CHOCTH XHMH- t.teCJCHX eem;eCTB. B nOCAeAHee BpeMR CT8A o6menpH3HaHHblM TOT ¢aKT. qTO OTAeAbHble MeTOAbl ycTp8HeHHR npOMLJmAeHHbl X OTXOAOB, KOTOp ble HCTIOAb30BaAHCh p8H hme ( H8np>ruep, Be,.!l;y:mHe IC 38p8ll<eHHIO qepe3 3eMAIO rpyHTOBblX BOA), RBAJllOTCR OTI8CHblM HCToqHHKOM 3ap8ll<eHHR, npeACT8BAJllOmHM yrpo3y AAR 3AOpOBbR AIOAeii . 8 3TOH CB.R3H H8CTOJITe.JlbHO Heo6XOAHMO paapa6oTaTb C BOA rrpaKTHtfe CKHX rrpaBHJI, COI'J18CHO KOTOpOMY B roCyAapcTBaX-4.Jle- HaX 6 b!AH 6 bl npHHRTbl COOTBeTCTByromHe Mepbl no npeAOTBp8meHHIO onaCHOCTH 38pallCeHHR. B noc.teAHee BpeMR oco6oe 6ecnOICOHCTBO Bb13b!B alOT nepeB03KH OII8CHblX OTXOAOB 3a rp8HHilY' 8 TaKJl(e B03MOXHOCTH HX 3KCTIOpTa B pa3BHBaIODlHeCH C TpaHbl. TaKID! o6pa30M , BTOpoH rAaBttoH 3a,.llaqeff Pa6oqeff rpynnbl 6b!AO p8CCMOTpeTb He06XOAffMble Mepbl ICOHTPOAR 38 T81CHMH nepeB031C8MH. ,l!HCICyCCHR fpynrr8 AeT8AbHO paccMOTpeA8 068 3TH BonpOCbl. ITpoelCT CBOAa 1Ip81CTHqec1CHX npaBHA, p8cnpocTpaHeH- Hbl H 3a6A8roepeMeHHO cpeAH yq8CTHHICOB BCTpeqH. 6b!A TI0Ap06HO H3yqeH . KpoMe Toro. y q8CTHHKaM 6bIAO npeAAOJICeH o Bbl CICa38ThCR no APYrHM Ball<Hb!M BOnpoC8M' ICOTOpbte 6btAH BKAIOqeHhl B o6myro MeTOAHqeCKYJO p83p8- 60TKY , IC8CalOmyrocR inter alia Mell<AYH8p0AHblX rrepeB0301C H BbUlleAmyw no OICOHq8HHH BCTpeqH . 0CHOBH8R p860T8 BeA8Ch B qeTb!pex n0Arpy nn8X . B nepeoii H3 HHX p8CCM8TpHBaAHCh BonpOCbl oxpaHbl 3AOPOB b R pa6oqHX H H8CeAeHHR . ,Zl.iin p83~RCHeHHR 38A8q BCTpequ 6blA c¢opMyAHp0B8H PRA nOAOJICeHHH np8r- MaTHqec1Co r o X8p81CTep8 . Bbuo OTMeqeHO' qTO 6oAee AeT8AbHble 381COHOA8TeAbHble 81CTLI peAICO MoryT 6LITh npID!eHeHbl 38 npeAeAaMH CTp8H bl , C yqeTOM yc.IOBHH ICOTOPOM OHH 6•1AH BbmymeHbl. B LJAO Bb!p8ll<eHO o6mee MHeHHe' QTO TepMHH " onaCHbte OTX0.1lbl 11 Heo6xo,.a;HMO TO.AKOBaTb CKOpee nyTeM pa3'LJICHeH HH B03MOJKHOro B03- ..4eHCTBHH ooaCHblX OTXO.llOB, HeJKe.AH ayTeM OIIJICaHHH HX <t>opMbl H COCTaBa. Bpe.11aoe B03,.lleH'CTBHe o naCHbtX OTXO,.llO B Ha 3,D;OpOBbe tteJJ:oBeKa MOJ«.eT 6b1Tb CKOpOTeQHbIM' HO MOJKeT IIPOAOJUK.aTbCJI H .llARTeJJ:bHOe BpeMH' KaK' H8IIpHMep, npOHCXOAHT npH MeAAeHHOM 3apall<eHHH rpyHTOBb!X BOA B pe3yAhT8Te 38rpR3HeHHR 3eMAH OTXOA8>1H . Y q8CTBHICH BCTpeqn npHmAH IC o6me><y corA8CHIO B TOM, qTO npo6AeM8 oqHCTICH MycopHblX CB8AO IC , ICOTOp8R He pemaAaCb B rrpomAOM H He ffBAReTCR npeAMeTOM o6cyll<AeHHR Pa6oqeii rpynTILI, Tpe6yeT paCCMOTpeHHR c ueAblO npHHHTHH Mep no .ilHKBH.ztaUHH HaH60.11ee ooaCHbtX CKOIIAeHHH OTXO,.llOB C TeM' ttT06 bt H36eJK.aTb B03HHKHOBeHH.R cepbe3 HbIX npo6Ae>< B 6yAyme>< . - 34 - Bo BTOpOH noArpynne paCCM8TpHB8Jn!Cb TeXHOAOrHqeCKHe 8CDeKThl KOHTPOAR 38 onaCHhll,IH OTXOA8MR, BK~ttaJI eonpocbl COKpam,eHHJI OTXOAOB' HX YTHJJlI3aUHH H BTOpHtlHOro HCil0Jlb30BaHH.fl' o6pa6oTKH I xpaHeHUJI H JrHKBUA8UHH. Oco6oe BHIDl8HHe 6hlAO YAeAeHO CTeDeHH OCT8TOqHoro pUCK8 AAR H8CeAeHHR H OKpyx0ro~efl cpeAhl npn HCDOAb30B8HHll A8HHOTI TeXHOAOrHH' oco6eHHO' np:e JmKBBA8DBB coxxeHHhlX OTXOAOB. Eh!Jm p0c- CMOTpeHbl TaJCJte TaKHe BOilpOCbl K8K Il04XOA K KOHTpOJDO 38 Bb[JJleJIOtteHHhJM OC8AKOM (T . e. 11 KOHUeHTpHp0B8Tb .tt HaK8IlJIMB8Tb I! HJU1 11 paa6aBJUJTb H JIHKBH.ll;Hp0B8Tb") B eonpoChl KOHTPOJIJI B neplilOA D OCJl e o6pa60TKH. B0xH yro pOAb B Bh!6ope p8UHOH8AbHhlX cpeACTB KOHTPOAR 38 OTI8CHbll,IH OTXOABllH HrpBA8 T8KXe CTOIDIOCTb Tex- HOJIOI'Htlecxoro nponecca. B TpeTbeH DOArpynne p8CCM8Tp:0B8AHCb BODPOCbl Tp8HCDOpTHpOBKH OD8CHhlX OTXOAOB' BKAffiq8R ee opr8- HB38UHIO, KOHTPOJlb 38 nepeB03Ka.MH K8K Ha H80H OH8JlbHOM, T8K H Ha MelK..ll;yHapOAHOM ypOBHe. Oco6oe BHll- M8HHe 6hlAO yAeAeHO upo6AeM8M Me~AYH8POAHhlX nepeB030K H B03MOXHOro Bh1B038 38 rp8HHUY H3 p83BHThJX B p83BHB~HeCR CTp8Hbl orraCHhJX OTXOAOB. 4eTBepTaR DOArpynn8 38HIDl8A8Cb B0Dp0C8MH DA8HHp0B8HUR H yrrp8BAeHHR npn opr8HH38UHll KOHTPOAR 38 Oil8 CHhlMB OTXOAIDm, CpeAH paCCMOTpeHHblX TeM 6blJIH: 06ma11 DOJIHTHKa, IlJl8HHp0B8HHe, 38KOHOA8TeJlbCTBO, MeX8HH3M peryAHp0B8HHR H KOHTpOAR, upHHYAHTeAbHh!e Mephl, $HH8HCOB8R OTBeTCTBeHHO CTh, CTp8XO B8HHe, o6yqeHHe KMPOB H y q acTHe o6~eCTBeHHOCTH. 1. 0AHHM H3 BBXHeiimHX Tpe60B8HHH p83BHTHR COOTBeTCTByroDleH CHCTeMhl KOHTPOAR 38 OD8CHh!MH OTXOABMH RBAReTCR AOCTynHOCTb Heo6XOAHMOH HH$OpM8DHH O KOAHqeCTB8X H BHAe OTXOAOB, 06 HCDOAh3yeMOH B H8CTOR- ~ee BpeMR IIp8KTHKH KOHTPOAR 38 HIDlH. 2 . IlpH paccMOTpeHHH npo6AeM KOHTPOAR 38 OD8CHhlMH OTXOAaMH Heo6XOAIDIO YAeAHTb BHHM8HHe BAHRHIDO H8 3AOPOBbe qeAOBeK8 H OKPYXaIO!JlyID cpeAy o6onx BHAOB B03AeHCTBHR - KP8TKOCpoqHoro, OCTporo H DPOAOAXH- TeJlbHOro , IlOCTeneHHoro, K8K H8IJpHMep, IlPH 38paxeHHB rpyHTOBMX BO,Il.. 3. Heo6XOAHMO T8KXe p8CCMOTpeTh COUH8AbH0-3KOHOMHqecKne H DOAHTHqeCKHe 8CDeKThl, CBR38HHhle C npo6- JleMoH KoHTpOJ1.R 30 onacabll4e o Txo,n;ave. 4. B H8CTOJllllee BpeMR c~eCTByeT MHOXeCTBO TeXHOAOrHqeCKHX npoueccoB no nepep060TKe OD8CHhJX OTXO- AOB. 0AHH H3 T8KHX rrponeccoB, o6hlqHo, He MOXeT 6h!Tb uplDleHeH AAR nepep060TKB APYrHX BH,ll.OB OTXOAOB, B TOM CAyq0e, eCAH OTXOAhl MOryT 6h1Tb nepep060T8Hhl p83JmllHhll[B cnoco6aMH, KBK rrp8BHAO, Bhl6Bp8eTCR HaH- 60J1ee 11MOJJtHMH" T eXHOJIOrHQeCKH:i:i nponecc. lleM MeHbme OCT8TOtJHhrit pHCK, TeM 60J1bme CTOHMOCTb TeXHOJIO- rnqecKoro nponecca . MeTOAhl nepep060TKH OTXOAOB DO CTOHHHO p83BHBBIDTCR, H MOryT MeHRTb CR C p83BHTH- eM TeXHOAOrHH n c pOCTOM DOTpe6HOCTeH o6~eCTB8. CAeAyeT CTHMYAHp0B8Tb HCCAeAOB8HHR n Dp8KTHqec- xyro AeHTeAbHOCTb Heo6XOAHMyro BO MHOrHX o6A8CTHX. 5 , 4TO KacaeTCR 0Xp8Hhl 3AOPOBbR pa6oqnx, He06XOAHMO co Bcefi RCHOCTh~ yCT8HOBHTb, K8KHe H3 BpeA- HMX OTXOAOB DpeACT8BAJDOT MRHHM8AbHyro, H K8KHe c~eCTBeHHyro OD8CHOCTb AAR 3AOPOBbR pa6oqHX B TOM CAy- qae, eCAH He npHHIDIBroTCR cneUH8AbHhle Mephl upeAOCTOpOXHOCTH, B 60Ab-HCTBe CAyq0e B 3 TH Meph! AO~XHW 6hITb 0.l{HHBKOBO C TpO rHlllt: KBK rrpH KOHTpOJJe 38 Q"HCThD(B XHVBQeCKHl,fH eeine cTBBMH I TBK M 3 8 BX OTXO,Il.8Mli' 38 HCKAIDqeHHeM TeX CAyq0eB, KOrA8 OTXOAhl npeACT8BAJDOT 3H8qHTeAbHO MeHbmyro OD8CHOCTb AAR 3AOPOBbR qeJ10BeKa. 6 . H8HAY-HH KOHTPOAb 38 TpBHCnOpTRpOBKOH OD8CHhJX OTXOAOB MOXeT 6h!Tb H8ABXeH B p8MK8X 06-x np0- BHA nepeB030K OD8CHhJX rpy30B, 0AH8KO, OD8CHhle OTXOAhl MoryT C03A8B8Tb AOTIOAHHTeAhHh!e npo6AeMhl, no- CKOAbKY B HX Tp8HCDOPTRpOBKe M8TepH8AbHO He 38HHTepecOB8H HH HX npOH3BOAHTeAb, HH nepeB03qHK, Kpo- M e Toro, COCTBB OTXO,Il.OB MOXeT 6bJTh He YKB3BH' H B pe3yJibTBTe CMemeeaHH.R HeCOBM.eCTHM.hIX OTX0,11;0B ,ll,JIJI 6oAee 3KOHOMHqHQH HX Tp8HCDOPTHpOBKH MOXeT 6b!Tb C03A8H8 onacH8R CHTY8UHR. 7 . IlpH npoBeAeHHl! B CTp8H8X TIOAHTHKH KOHTPOAR 38 on8CHhll,IH OTXOABllH Heo6XOAHMO 38KOHOA8TeAbHO o6ecneqHTb COOT BeT CTByro~yro BX nepep060TKY HAH AHKBHA8DIDO . EcJm 3TO He AeA8eTCR, T8K8R DOAHTHKB Be- AeT K Heup8BHAbHOH np8KTHKe ycTp8HeHHR OTXOAOB . 8. 3BKOHOA8TeAbCTBO B o6A8CTH KOHTPOAR 38 OTI8CHh!MH OTXOA8MH MOXeT HMeTh p83AHqHhJe $opMhl B 38BHCH- :t.t 0CTH OT 3BKOHO,l[BT€JlbHOM Cl1CT€Mbl M ,apyrnx oco6eHHOCTe11 KB.Ji..ll,OJ! CTpBHhl. 3aKOHO.lI,BTeJlbCTBO JdOJC.eT o c - HOBblBBTbCJJ Ha o npe,Il.e JleHH bIX rHrHeHHQeCKllX C TBH,Il.BpTBX, MOJKeT M CXO,llHTb R3 3a..11a1.1 oxpBHhl OKpyxaJOm,eH cpe- ~w, MOJKeT 3BBHCeTb OT 3KOHOYHQeCKOH 3BHHTe pec oBaHHOCTH HJIH He3BHHTepecoBBHHOCTH, paBHO KBK HOT c o- coqeT8HHR Aro6h!X H3 3THX $8KTOpOB. - 35 - 9. ITpH KOHTPOAe 3a onaCHblMH OTXOAaMH He06XOAHMO HCXOAHTh H3 TOro, qTo HX npOH3BOAHTeAb HeceT OT- BeTCTBeHHOCTb 3a ITOA60p KBaAHcjll{UHpOBaHHblX IlOAP.f!AqHKOB' KOTOpble MOryT op raHH30BaTb 6e3onacHy!O TpaH- cnopTHpOBKY HAH nepepa6oTKy / AHKBHAaUH!O OTXOAOB. 8 HeKOTOpblX CAyqa.f!X, npH pemeHHH aonpocoa, Haxo- A.fl'DlHXCH BHe ero KOMIIeTeH~HH, npOH3BOAHTeJlh OTXOAOB AOJl~eH o6pamaT b CH 3a KOHCyJlbTauHeR AJIH Toro, 4'T06LI BbIIlO.ilHHTb CBOH o6.H3aHHOCTH. 10. TaM, r Ae 3TO npeAYCMOTpeHO 3aKO HOM , 3a nocAeACTBH.fl KaJ<AOro nOATBeplK,.ll;eHHOro cjlaKTaMH CAyqa.f! He- aepHoro HCnOAb30BaHH.fl OTXOAOB npH npeHe6pexeHH.fl CBOHMH o6.R3aHHOCT.flMH B o6AaCTH KOHTpOA.fl 3a onaCHblMH OTXOAaMH Ha Jll06oH CTa,.n;HH UHKJla HX nepepa60TKH, OTBeTCTBeHHOCTb HecyT KaK OTAeJlhHble ~Hua, TaK H yq- peJK,.ll;eHH.fl, a KOTOphlX OHH COCTO.f!T Ha CAyx6e. 11, CTpaxoaaHH e HecqacTHhlX CAyqaeB npH ycTpaHeHHH onaCHblX OTXOAOB mHpOKO npaKTHKyeTC.fl. ,lleHCTByro- ma.fl nporpaMMa KOHTpOA.fl 3a onaCHhlMH OTXOAaMH Tpe6yeT BeAeHHe TaKoro CTpaxoBaHH.fl, CTpaxoBaHHe Ha cAyqaij 3apru<eHH.fl OKpyxaromeH cpeAbl .RBA.fleTca aaxHoH, Ho AOCTaToqHo cneuaaAbHO H MepoH. CooTBeTCTByIO- mee (HAU orpaHuqeHHOe) CTpaxoaaHHe TaKoro POAa B03MOXHO AHmb B CAyqae cymecT BOBaHH.fl COOTBeTCTByromeH rocyAapCTBe HHOH CHCTeMbl CTpaxoaaHHJI . 1. MexAyHapOAHOMy perHCTpy IlOTeHUHaAbHO TOKCHqHblX xHMHqeCKHX aemecTB IDHEII H EaponeHCKOMy peruo- Ha-lbHOMY 6ropo 8 03 Heo6XOAHMO COBMeCT HO noArOTOBHTb AOKyMeHTaQH!O, KOTOpa.R BK.uoqaAa 6s1 KaK MeTOAH- qeCKHe yKa3aHH.fl TaK H CBOA npaKTHqeCKHX npaBHA, KOTOphle CAYXHAH 6 s1 B KaqecTBe pyKOBOACTBa npH npH- HJITHH pemeH H H ,,nni;aMH, OTBeTCTBeHHbIMH 3a KOHTpO..ilb o naCHbIX OTXO,.n;OB ( MHOr11e 60J1ee ,n;eTaJlbHhie peKOMeH,n;a- UifH B OT HOmeHHH cjlopMbl H COAepxaHHJI 3THX AOKyMeHTOB 6b!AH CAeAaHbl Ha 3aCeAaHHH Pa6oqeH rpynns,). 2. ITo 3aBepmeHHH pa60Tbl rpynnbl 8 03 Heo6XOAH1110 ITOAr OTO BHTb 6oAee AeTaAbHblH c npaaoqHblH MaTepHaA H AOKyMeHTaUH!O no HeKOTOphllll ( rAa BHhlM o6pa3oM , TeXHHqeCKHM) o6mHM aonpocaM HCITOAb30BaHH.fl OTXOAO B. 3. CoOTBeTCTByromee ropH,.n;HqecKoe TOAKOBaHHe TepMHHOB , TaKHX xax "onaCHLie OTXO.IJ;bl 11 , He c.,te,llyeT ceH- qa c BK.,not.f a T b B TeKCT MeTO,n;HqeCKHX yxaoaHHH. B&IJIO 6LI .11yqme oo.n;rOTOBHTb rrpaKTHl.{eCKH IIOJle3Hble pa6oqne onpe11e.J1eHH.R' B KOTOpblX 6111 r ., :aBHliW o6pa30M pacKp&1BaJ1:C..fl o n aCHbtH xapaKTep OTXO,ll;OB' a He Ha HX COCTaB H cjlopMa. 4 . KoMnJleKCHbTe aHSJIHTH l.teCKHe A8HHble O CTPYKType p83J[H't{HbIX BH,llOB OTXO.ll;OB 61i1BaeT O tteH b c .,,:QJKHO rro..ty- qffTb. ITo3TOMy HaCTO.f!TeAbHO Heo6XOAH1110 ><MeTh TaKoro POAa HHcjlopMauH!O npH onpeAeAeHHH COOTBeTCTBy!O- mHx MeTOAO B KOHTPOJl.fl 3a onaCHbl'MH OTXOA8MH H AJl:.R o ~ e HKH HX B03MOJKHOH onaCHOCTH . HHcjJOpMarmH Heo6XOAHMO HCil0Ab30BaTb pa3AffqHb1e cjlopMbl H MeTOAbl. 5. ITpH nepeB03Ke onaCHhlX OTXOAOB qepe3 rpaHHUY Heo6XOAHMO 3a6AaroapeMeHHO onoaemaTb O HeH COOTBeT- CTByH)IIU,Ie ICOMn eTeHTHbi e op r a H bl K8K rocyAapcTB8-0TrrpaBHT0JI.R, T8K H rocy,aapcTBa-no.11y1.taTeJ1.R . BO-IIOAyttaTeJlb HeCeT OTBe TCTBeHHOCTb 3a nepeB03Ky, nepepa6oTK Y H ~HKBH,.llallmo O TXOAOB B COOTBeT C TBHH C npHH.f!TblMH CTaHAapTaMH . 0co6oe BHHMaHHe Heo6XOAHMO YAeAHTb npo6AeMrur pa3BHBaR>mHX CJI CTpaH, ITOArOTOB- Ke AAJI HHX MeTOAHqecKHX pa3pa60TOK no pemeHH!O 3THX npo6AeM. A0B8HHR H rrpaKTHQ0CKyIO Ae.RTe.JlbHOCTb. Heo6XOAHMO TaKxe CT HMYAHpoBaTb HC CAe - 6 . MHoroe y xe H3BeCTHO O TeXHOAOrHH KOHTPOA.fl 3a o n acHhlll!H OTXOAaMH B pa3BHThlX CTpa,rax. 3 HaquTeAb- HO MeHbme H3BeCTHO O nOA06HOH npaKTHKe B pa3BHBa!OmHXC.fl rocyAapcTBax. 8 CB.fl3H C 3THM He06XOAH1110 B Ae.f!TeAbHOC TH, npoBOAHMOH IDHEII/ 8 03, OCHOBHOe BHHMaHHe YAeAHTb o npeAeAeHH!O c neuucjluqeCKHX npo6AeM, CTO.fllllHX nepeA pa3BHBaromHMH C.fl CT paHaMH, H pa3pa6oTaTb MeTOAHKy HX pemeHH.fl . .mpoBaTb HCCAeAOBaTeAbCKY!O AeRTeAbHOCTb " npaKTHqecKyro pa6oTy. Heo6XOAHMO TaKxe CTHMy- 7. Becnop .f!AoqHa.fl pa3rpy3Ka Mycopa - 3TO HenpHeMAeMblH cnoco6 yc TpaHeHH.fl BpeAHHX OTXOAOB' OT KOTopo - c TeM' ttT06bt H36exaTb B 6y.4ymeM B03HHKHOBeHH..fl rrpo6J1:eM' C B.fl3 a HHbIX C KOHTpo - _,JeM 3 a onaCHblMH OTXo.n;aMH J He06XO,llHMO no.11roTOBHTb c nenHa.JlbHyIO pa3 pa6oTKY ,.il;..t.fl pa3 BHBaIOD(HX C..fl CTpaH ITO npoueAype ycTpaHeHHJI ioreromuxca cBaAOK My copa H no a.thTep HaTHBHbIM n y T RM pemeHH.fl 3Toro aonpoca. 8 . rioc.,,:e.4yI0111H fr yXO.ll 3a 3eMe.JlbH bJMH y qaCT KaMH ' Ha KO TOpblX 6bJJIH pacno .. toJKeHbl CB8JIKH o naCHblX OTXOAOB ( H83eMHbie, no,aoeMHbie H A P YrHe) , ,ll0.1tJKeH rrpe.n;ycMaTpHB8Tb He06X0,4HMb!H KOHT pO..tb B03MOJKHOro 3apaxeH H.fl, a T8KJKe np HH.flTH.fl Mep no rrpeAOTBpameHHlO HeBepHoro HCTIOJ1b30B8HH.fl 3 THX 3eM eJlbHblX y 1.taCTKOB B 6yAym;eM. 8 aKTe Ha 30MJleBJ18A0H H e Heo6xo.1tHMO YK838Tb, ttTO A8H HblH yttaCTOK 30MJIH HCilOJlb30B8JIC.fl ITOA pa3rpy3Ky Mycopa. - 36 - 9. PeKOMeH.D,yeT CJJ npe.D,yCMOTpe Tb B .D,eHCTBy,omeM 3aKOHO.D,aTeAbCTBe HAH B roTOBOM K YTBepJK.D,e HHlO 3aKoHe n o oxpane oKpyJKaromeH cpe.D,hl Toro HAH Hnoro rocy.D,apCTBa npoBe.D,eHH e cooTBeT CTB~Hx Yep no ycTpa.HeHHro onaCHb[X OTXO,ll;OB. 10. rocy;tapCTBO o6JJ3ano BBeCTH COO TB eTCTBy,omee 3aKOHO;taTeAbCTBO' R.JIMHHHCTpaTHBHhle Me pbl H CHCTeMy KOHTPOAJJ 33 yc TpanenHeM o naCHblX OTXO.D,Oll . .ll,pyrne BffAhl KOHTpOAJJ co CTOpOHbl rocy.D,apCTB 3a onaCHb!MH OTXO.D,aMH Mor y T 6hlTb pa3AHQHbl " 3aBHCeT b OT .D,eikTBYlODIHX KOH CTHTYDHOHHblX HOpM H npaKTHQeCKOH .D,eJJTeAb - HOCT H B 3TOH o6AaCTH B OT.D,eAhHhlX CTpanax. TeM He Me nee' .D,OAJKH O 6LITb rapaHTHJ)OBaHO npaeo H8 a nne- JIJIIJ;HlO B CBR3H C TeM HJIH HHhW pemeHHeM KOMIIeTeHTHhlX BJl8CTeM. 11 . OpraHH3aUHR KOHTpOAR 38 onaCHhJYH OTXOAaMH ,ll;OJIXH a ocymecTBARTb CR, T8K CKa38Tb, 11 0T po~,.n;eHHR B .llO CMepTH 11 ' T . e. OT IlOJIBJleHH R AO JIHKBHA8UHH OTX0,11.0B . Heo6xo,zu1M o Y t:JHTbIB8Tb Bee H CTO'llHHKM (u Bcex npOH3BO.ll,HTeAeH) onaCHblX OTXO.ll,OB, 3HaTb MecT a xpan eHHJJ , nyTH nepeB030K, MeCTa nepepa60TKH H cpe.D,C TBa XHKBH.D,aOHH OTXO.D,OB . Heo6XO.ll,HMO HCnOAb30BaTb nyTeBhle XHCThl HAH TpancnopTHhle .D,eKAapanHH npH n epeB0 3 - Ke onaCHbIX OTX0,11;0B, 'llT06 hJ o6ecne'llHTb HX ,11;0CT8BKY K n y HKT Y H83H8'lleHHJI . 12 . .Jho6oe pa3pemeHHe Ha nepepa6oTKY OT XO.ll,OB HAH HX XHKBHAanHro .ll,OAXHO 3aKOHO.D,aTeAbHO npe.D,ycMaTpH - BaTb rrpaao BMemaTeJlbCTB a co CTOpOHbl KOJ.IDeTeHTHhJX BJlaCTeM B CJryqae neo6XO,ltKMO CTH ycTpaH e HHR 38 C 'lle T a..11a,.n;eJ1blla noc..11e,.n;CTBHM HenpaBHJlbHOH o6pa6oTKH onaCHbIX OTX0,11;0B, eCJIB c aM OH He MOXe T HJm He XO'lleT 3TJDd 38HHM8TbC..fl . 13 . IlepCOHaA ' 3aHJJThlH opraHH3auHe H yc Tpan e HHJJ o n aCHbIX OTXO.D,OB' .D,OAJKeH 6 LITb COOT BeT CTB~HM o6pa- 30M o6yqen Ha Bcex ypoBHJJX - pyKOBO.D,JJIDeM, ynp aBAenqeCKOM H 3 KCnAy aTaUHOHHOM, Heo6 XO.ll,HMO pa3pa60- TaTb nporpaMMbl o6yq e HHJJ, B qa cTHOC TH, B CTpanax , r.D,e TOAbKO npHCT y nalOT K pemeHHlO npo6AeM n epepa6oT- KII o naCHLJX OTXO.l(OB. 14. Bee .ll,OKA8.llbl H .ll,OKyMe HTbl 3TOH BCTpeqH' a TaKJKe npe.D,CTOJJmHX COBelllaHHH .ll,OAXHbl 6L!Tb nanpaBAeHbl B nanHOHaAbHble MHHH CTepcTBa, 3anHMaromHeCJJ Bonpoc aMH ToproBAH H nepeB030K . YqpeX.D,eHHJJ n o oxpane OKpyJKaromeH cpe.D,hl H 3.D,paBooxpaHeHHlO B CTpanax 06bIQH O noAy'lalOT MaTepHaAbl JOHEil H B03. 1 5 . Heo6x O.D, HMO CTHMy AHpOBaTb y qacTHe 061lleCTBeHHOCTH B .D,eJJTeAbHOCTH n o o6ecneqeHHlO ycTpaneHHJJ onaCHblX OTXO~OB. Heo6xo.D,HM O TaKJ<e opr aHH30B a Tb o6yqenne naceAeHHJJ n o 3 TOMY Bonpocy . 16 . JOHEil/ B03 neo6xo~HMO pa3pa60TaTb, oco6eHHO .D,AH pa3BHBaIDmHXCJJ CTpaH MeTO.ll,OAOrHlO ycTaHOBAeHHJJ H o6 napyJKeHHJJ MeCT pacnOAOXeHHJJ 3a6pomeHHhlX yqacTKOB pa3rpy 3KH onacHbl X OTXO.D,OB, a TaKJ<e MeTO.D,OAO rHlO BOCC TaHOBAeHHR 3 THX 3eMeAb. - 3 7 - Co ee111aHHe no n.11aHupoeaHmo MOHHTOpHHra ICP/ RC E 903( 9) ( S) 27 1ao.11a 1 981 ro.ita Il 3IlHAeMHOAoraqe CKHX HCCJleAO BaHHli 8 o 6AaCTH KOHTPOJIH 3a TOKCllQHbWH xnMnqec KHMII aeme c TeaMH KoneHrareH, 5-8 MaH 1981 roAa OPl1I'11HAJI: AHr.JIHHCKHi1 1. CoeemaHue 6hl.llO opraHH30eaHo EeponeHCKml perHOHa.llhHblll 6ropo B03 e pru,xax EeponeHCKOH peruoHa.llbHOH nporpaMl,lbl B03 no 6e3onaCHOCTH XHMHqeCKHX eemeCTB. B HeM npHHH.IIH yqaCTHe 14 cnenHa.llHCTOB no MOHHTO- paar y H 3ITH,lleMHO.IIOraqeCKHM HCC.lle,llOBaHHHM H3 11 CTpaa . 3aAaqa coeemaHHH cocToa.11a a pa3pa60TKe .Jl.llH Eaponeilcxoro peruoHa c xoop.itaaapoaaaaoH Mex,llyHapO.JlHOH nporpa.MMLI IIO MOHHTOpHHry H 3rm:;:r;eM1IOJ10ruqeCKHM HCCJJ.e,n;oeaHHJI.M, ne.Jr.b KOTOpblX - BbIJIBHTb HCTQqffHKH, IIYTH H y pOBHH B03,lleHCTBHH Ha 3.JlOPOBbe qe.11oaexa noTeHrma.11bHO onaCHhlX x HMHqe CKHX ee111eCTB . 8 3TOH CBH3H nepe,ll yqaCTHHKaMH coae111aHHH CTOH.lla 3a,llaqa H3yqaTh 06111He aonpOCbl opraHH3anKH MOHHTOpHHra H npOXOHCY.llb- THpoaaTb PeraoHa.llbHOe 6ropo e OTHomeHHH npoBe,lleHHH KOHKpeTHblX acc.11e,llOBaHHH. 2. ,!lacxyccua YqaCTHHXH c oae111aHHH rrpe,ll.llOXH.IIH ,lleBHTb KOHxpeTHhlX TeM, no KOTOpblll ne.11ecoo6pa3HO npoeeCTH eayqahle a cc.11e ,lloaauaa: 2) 0 T,lla.lleHHhle noc.11e,llCTBHH B03,lleHCTBHH xpoMa a HHXe.llH Ha 3.llOPOBbe pa6oqux, 3aaHCH111He OT ¢axTo- poe, CBHOBHHhlX C rrpo~eccamr IlpOH3B0ACTBa. 3) B.IIHHHHe CO,llepxaJIIID{CH B BO,lle opraHHqeCXHX XHMHqeCKHX ae111eCTB ea 3,llOpOBbe qe.11oaexa . 4) B03,lleHCTBHe HCKyCCTBeHHblX llHHepa.llbHhlX B0.IIOKOH Ha 3,llOpOBhe. 5) HcUO.llb30BaHHe MeTO,llHKH H3MepeHHH y poaHeH npoTonop¢HPHHOBOro n;HHKa, a Taxxe ,llpyrHX ,llHarHOCTH- q eC KHX Te CTOB AJIH y cTaHOBJleHHH CTeneHH aoo,n;eliCTBHH CBHHUa Ha 3AOPOBbe ,n;eTeH . 7 ) Pe3y.llbTaThl x poHaqecxoro B03,lleHCTBHH apoMaTaqeCKHX aMHHOB Ha 3,llOpOBbe. 8 ) Bo3AeHcTBHe Ha 3AOPOBhe AeTeH KaAMHH a pTyTa, c o.itepxa111Hxca e MeAHOH aMa.11braMe, Hcrro.11h3yeMoH npH n.110M6HpoaaHHH MOJIOqHblX 3y6oe . 9) B03,lleHCTBHe ¢oc¢aToopraHaqeCKHX COe,llaHeHHH Ha 3AOPOBbe HaCe.11eHHH B ne.110M a Ha npe,llCTaBHTe- .11eH npo¢eCCHOHa.llbHblX rpynn, B qaCTHOCTH. YqaCTHHXH c oaemaHHH IlpHJIIJIH K c or.11runeHmo e OTHOmeHHH BRAa aH¢OpManKH, KOTOpaH He06XO,llHMa llpH no,llrOTOBKe npOTOX0.110B A.IIH npoBe,lleHHH MOHHTOpaHra a 3UHAeMHO.IIOraqeCKHX HCC.lle,llOBaHHH, a Taxxe ¢opMbl ITT< npe,llCTaa.11eHHH. ITpOTOKO.llhl no npoae,lleHmo HCC.lle,llOBSHHH no BblllleHa3BaHHblll TeMSM ( 1 ) H (2 ) 6bLIIH COCTaB- .11e Hhl B COOTBeTCTBHH C 3 TOH c or.11acoaaHHOH ¢opMOH npe,llCTaa.11eHHH B xaqeCTBe 06pa3noa ,lleTa.llH3HpoaaHHhlX llpOTOK0.110B. ITpe,ll.llOXeHHH COCTae.11eHhl TaXmf o6pa30M, qTo6hl H3 HID( 6 bLIIO HCHO, xaKHe Tpe6oeaHHH npe,ll~HB.IIHroTCH npH p a 3pa6oTxe 3XCnepm<eHTa.llbHblX HC C.lle,llOBSHHH . ITpH 3TOM B xaqeCTBe npHMepoa paCCMaTpHBS.IIHCb npo6.11e- Mbl' KOTOpb1e He acer AS Tpe6 yroT nepaooqepe,llHOro BHHMSHHH npH npoBe,lleHHH CXOOp.JlHHHpoaaHHblX Mex,llyHapo,ll- HblX HCC.lle,llOBaHHH. - 38 - CoBemaHHe TalOl(e Bblpa6oTaAo pexoveH,21annn B OTHomeHnn o6mHx nyTeB opraHH3annn MOHHTOPHHra n npo- Be,lleHHJ! 3Irn,ll,ellBOAOrHlleCKIDC HCCAe)IOBaHirii B o6AaCTH KOHTPOAJ! 3a TOKCH'IHhll<H XHMHlleCKHMH BemeCTBa:im B EBponeucxoM pernoHe. B xo,21.e o6meii ,l!BCKyCCHR y qa CTHHKH COBemaHJrn paCCMOTpeAH TaKne acneKTbl ,lleJ!TeAbHOCTH, KaK HHTerpa- UHJ! HCCAe)IOBaHHB B o6AaCTR R3ylleHRJ! ¢aKTOpOB, B03,lleBCTBYJ()IJU{X Ha 3,l!OpOBbe pa6o4Bx H BCero HaCeAeHnJ!; pa3pa60Txa MeTO,l!OB oneHKR 3TOro B03,lleBCTBHJ!; pOAb anll)leMHOAOrHR B KORTpoAe aa XHMRlleCKH:im BemeCTBa- :im; H npo6AeMbl HaAH'IHJ! H ,llOCTynHOCTH He06XO,llHMOB HH¢opvannn. 3 . B3aHMOCBJ!3b Mel!t)lj v MOHHTopnHrOM H anll)le:imoAorneB 1. CAe,llyeT npHAOlltHTb Heo6xO,l!BlO,Je ycBAHJ! ,l!AJ! Toro' 'IT06b! o6ecne'Il<Tb conocTaBHMOCTb ,llaHHb!X MOHHT O- pnHra H ,llaHHbIX, noAyqaeMbIX BAH ncnOAb3yeMbIX CHCTeva:im ve,llHKo-CaHHTapHOB HH¢opvannn, a TalOl(e ,llaHHblX qT06bl oxa38Tb co,21eBCTBHe pa6oTe B 3TOM HanpaBAeHHil, CAe,21yeT: pa3pa60T8Tb ,lleT8AH3HpOBaHHble npOTOKOAbl )!AR npoBe,lleHHR HCCAe,llOB8HHB, BK.7I!OllaIDmBX B KalleCTBe KOM- DOHeHTOB npoBeAeHHe MOHHTOpHHra H 3TIB.ll,eMROAOrHqecKHX HCC~eAOBaHuH; - C03,ll8Th CHCTeMbl, o6ecnellHBaIDmHe CBJ!3b Mell,llY nporpaMMaMB Me,llHKO-C8HHTapHOB HH¢opvannn H MOHHTO- pHHra OKpyJKaIDmeB cpe,llbl; - CO,lleB CTBOB8Tb pa3BHTHID peryARpHblX KOHTaKTOB, opr8HH38UHH o6mnx nporpaMM no,llrOTOBKH , o cymecT- BAeHBIO COBMeCTHblX npoeKTOB ,llAJ! 3nHAeMHOAOrOB H AHU, yqaCTBYIDmHX B peaAH3aUHH nporpaMM n o MOHH- TOpHHr y . 2. EHOAOrHlleCKHB MOHHTOPHHr - BeCbMa neHHldB HHCTpyveHT ,l!AJ! oneHKH B03,lleBCTBHJ! XllllHlleCKHX BemeCTB Ha 3,l!OpOBbe. CAe,llyeT aKTHBH3HPOB8Tb npe,llllpHHBM8eMJ,Je B EBponeBCKOM pernoHe H8UHOH8AbHble R ve1t,llyHa- po,21Hble yCHAHJ!, 'IT06bl B pe3yAbT8Te peaAH3aUHH nporpalll! no 6HOAOrHlleCKOMy MOHHTOPHHr y noAyllHTb cono- CTaBHMb!e ,l!SHHble ' a TalOl(e co,21eBCTBOBaTb npoBe,lleHHID Taxoro MOHHTOPHHra. Pa6oTy B 3TOM HanpaiueHHil CAe)lyeT npOBO,l!HTb c yqeTOM OCHOBHblX neAeB nporpaillll,l RHEII/B03 no 6HOAOrHqecxov y MOHHTOpHHry, o6ec n e - ·qnBaJ! npn 3TOM TeCHOe COTpy,l!HHqecTBO C 3TOB nporpaMMOB. 3 . B OT,lleAbHb!X CAyqaRX, xor,21a HCnOAb30BaHHe 6noAornqecxoro MOHHTOPHHra ,l!AJ! Henocpe,llCTBeHHOro onpe- ,21eAeHHJ! ypOBHJ! B03,lleBCTBHJ! Ha 3,l!OpOBbe He onpaB,ll8HO, ,ll8HHble B OTHomeHHH npncyTCTBHJ! xmmqeCKHX Be- meCTB B BO,lle, B03,llyxe, 1IH111e BAH npo,21yKT8X CAe,llyeT COOTHOCHTb C ,ll8HHb!MB B OTHOmeHHH ¢aKTnqecxoro B03- ,21eBCTBHJ! 3TID< BemecTB Ha 3,l!OPOBbe OT,lleAbHblX rpynn HaCeAeHHJ! . Heo6xO,llHMO TalOl(e pa3pa6oTaTb 3KCne- PHMeHT8AbHble npoeKTbl )!AR ycTaHOBAeHHJ! TaKHX CBH3eB. Ilpn 3TOM CAe,llyeT npHHHM8Tb B pacqeT ocymeCT- BAHe1rne B H8CTOHroee npeMJ! Mellt,llyHapO,l!Hble nporp8100,J no MOHHTOPHHry, B ll8CTHOCTH, 3KCnepHMeHTaAbHi.rli npoexT DHEII/B03 no oneHKe B03,lleBCTBHJ! Ha 3,llOpOBbe co,21ep1tamHXCJ! B B03,llyxe 3arpH3HHIDmID< BemecTB H uporpaMM y ~AO/B03 no MOHHTOPHHry 3arpH3HeHHH IlHIDH H KOPMOB ,llAH llHBOTHbIX. 4. CAe,21yeT pery AHpHO oneHnBaTb B03MOlltHOCTb ncnOAb30BaHHJ! aAbTepHaTHBHbIX MeTO,llOB H3MepeHHH ypOBHeB B03,lleBCTBHJ! Kallt,lloro xmmqecxoro BemeCTBa, BbI6paHHOro )!AH n3yqeHHH. IlpH npoBe,21eHHH oneHKH CAe,llyeT 8H8AH3HPOBaTb nee nveromnecJ! ,21aHHMe, BhlJ!BAHTb rpyrmM HaCeAeHHH, 3,llOPOBbe KOTOpb!X MOllteT 6MTb IlO,llBepr- HyTo pncxy, H onpe,lleAHTb nyTH HCnOAb30BaHHJ! cymeCTByromHX MeTO,llOB oneHKH. Pa3J111qH•1e nyTH H BB.l!M B03c!!eBcTBHB 5 . B Tex CAyqaRX, KOr,lla Ha,210 yCT8HOBHTb, KaKHM o6pa30M BAHJ!eT HAH MOllteT DOBJraHTb B 6y,llymeM Ha 3,210- pOBbe TO HJ111 HHOe xmmqecxoe BemeCTBO, npncyTCTByromee B pa3JraQHLIX cpe,llax,cAe,21y eT opr8HH30BLIB8Tb npo- Be,lleHHe 3KCne pm1eHT8AbHblX npoeKTOB no MOHHTOpHHry C TeM, qTo6LJ onpe,lleAHTb B3aKMOCBJ!3b MeJK.lly CTeneHbID B03,lleBCTBHJ! H HCTOqHHKaMH 3Toro B03,lleBCTBHH . 3TO D0 3 BOAHT BblJ!BHTb OCHOBHL!e HCTO'IHHKH B03,lleBCTBHH H nOAY4BTb HH¢QpxanBIO B 0TROmennn KPHTnqecxnx nyTeB. 6 . Kpoxe npoBe,lleRHH oneHKH CTeneHH pncxa ,llAJ! 3,l!OpOBbH OT,lleAbHblX xmmqeCKHX BemeCTB, Heo6xo,llHMO npoBe CTH HC CAe,l!OB8HHH, HMeromne neAbID onpe,21eAHTb xapaKTep B03,lleHCTBHH pa3Jral1Hb!X xm,mqeCKHX BemeCTB H Bb!HBHTb ¢aKTOPbl pncxa, KOTOpL!e HBAJ!IDT CJ! pe3yAbT8TOM 3Toro B03,lleBCTBHH. - 39 - 7. CAeAyeT pa3BHBaTb HCCAeAOBaHHR no H3yqeHmo OKpyxaromeH qeAOBeKa c peAbl, HCnOAb3yR AAR 3Toro KO - JmqeCTB 0 HHble, 3KCnepaMeHTa.JibHhie H KB83H3KCDepHM0HTa.JlbHble MeTOAbI. npH npoBeA0HHH rro,.n;o6HblX H CC.11e,11;0- BaHHH CAeAyeT H3yqaTb TaKHe acneKTbl, KaK B3alD!OCBR3b MeXAY A030H H noAyqaeMhlld 3~<!JeKTOM, 3KCTpanOAR- D;HH OT BblCOKilX X 60.1tee Ma.JII,IM ,ll;03aM, aHa.JIH3 MHO>KeC TBeHHOI"O B03,LJ;e:itcTBHH, on;eHKa B03MOXHOI'O pRCKa, pa:J- AHqHoro POAa B3aHMOAeHCTBHR, MHOXeCTBeHHble 3~eKTbl, nOABepxeHHOCTb HHAHBHAYYMa B03AeHCTBmo, a TaKllte o ueaxa AeHCTBeHHOCTH H 3~eKTHBHOCTH pa3AHqHbJX i,ep no oxpaae OKpyxalOll\eH cpeAbl. 8 . CAeAyeT 6oAee TmaTeAbHO nOAXOAHTb K Bonpocy aAa nT aD;HH 31Il!AellmOAOrHqecxoro HHCTPYMeHTapHR K c ne- D;H~>NeCKIDI rrpo6AeMaM, CBR3aHHhlld C oxpyxalOOleH cpeAOH . B pe3yAbTaTe pa3BHTHR AeRTeAbHOCTH B 3TOM Ha- npaa.xemm nORBHT CR B03MOXHOCTb yc TaHOBHTb HaH60Aee aAeKBaTHbre napaMeTpbl' KOTOpbre CAeAyeT HCnOAb 30- BaTb IIpH o praHH3BnHH oxpaHbl 3AOPOBbR. ITpa npoBeAeHHH MOHHTOPHHr a a npa o6cAeAOBHHHH HaCeAeHHR CAe- AYeT THKllte HCilOAb30BHTb 3TIH.JI;eMHOAOrHqeCKH8 MeTOAbl (HanplD!ep, KAHH>NeCKHe, aHHAHTHqecxue, 3KOAoruq ec- KHe), OTBeqaromne KOHKpeTHhlld yCAOBHml. 81,,16opx.a 7 a HaJIH3 1 o6ecrreqeHHe Kaqe CTaa 9 . B EB poneHCKOM per HO He BblRBAeHhl Te XHMHqe cKHe BemeCTBH, KOTOpb!e Tpe6 ytOT nepBooqepeAHOro BHID!a- HHR. MeTOAhl npOB8A8HHR MOHHTOpuara H 3TIH,!l;eMHOAOrHqeCKHX nponeAYP no Bbr6opxe, aaaAH3Y, o6pa60TKe H IlP8AC TaBAeHmo AaHHblX B OTHOmeHHH 3THX aemeCTB CAeAyeT CTaffAapTH3HpoaaTb C yqeTOM npaKTuqe CKOH ne7 Ae coo6pH 3HOCTH. 1 0 . CAeAyeT HCil0Ab30BaTb nponeAYPhl no o 6ecneqeamo xaqeCTBa, KOTOpble IlpHMeHJnOTCR IlpH ocymeCTBAeHHH IIpOBOAHYJ>IX B KOHTeKCTe r A06 a.Jib HOH CHC TeMbl l<OHHTOPHHra oxpyxaromei< cpeAhl npoeKTOB l!lHEII/803. ITpH HC- IlOAb30BaHHH 3THX nponeAYP HaAO TIPHHHMHTb BO BHID!aHae cneD;H~HqeCKHe yCAOBHR EaponeHCKoro peraoaa. 11. 8 OTA8AbHblX CAy qaRX B pe3yAbT a Te npoaeA8HHR M8XAYHapOAffbJX 3KCnepHMeHT aAbHbJX 3 UH.JI;el<HOAOrHqe c KHX HCCAeAOBHHHH H MOHHTOPHHra MOXeT B03HHKHYTb Heo6XOA1D!OCTb B npoBeAeHHH KpynaoMaCmTa6HhlX npoeKTOB HAH opraHH3allHH o6bNHhlX HaD;HOHaAbHhlX nporpa"" no MOHHTOpHHr y H 3 UH.JI;eMHOAOraqeCKHM HCCAeAOBaHHRM. B Tex CAyqaRx , KOrAa B paMKHX 3THX n porpa l,lll a3yqruoTCR x HMHqeCKHe aemecTaa H HCCAeAylOTCR npo6A8Mbl , npeACTaBAJnOIDHe HHTepec AAR neAoro PRAa CTpaH EaponeHCKoro perHOHa, npoaeAeHHe OTAeAbHbJX HanHOHaAb HbJX nporpaMM CA8AY8T opraHH30Bb!BaTb H KOOPAffHHpoaaTb Ha i,exAyHapOAHOM ypoaHe C HCil0Ab30BHHHeM cymeCTByro- mrx a PerHoHe soaMoxttoc TeH. CoTpYAHHq ec Tao c MexAyHapoAHhlYH o pra HH 3aUHRIDI a Koop Aff HaUHR AeRT8AbHOCTH c o praHH3aUHm<H Apyrax pernOHOB 1 2. ITp a peaAH3anmi nporpaMM n o MOHHTOpHHr y H 3IIBAeMHOAOrnqeCKHM HCC AeAOBaHHm<, npOBOAHMblM B COTP YA- HHq eCTBe c EaponeHCKHM perHOHaAbHhlM 6 ropo 8 03 , CAeAyeT llpHHHMaTb BO BHID!aHHe COOTBeTCTBytOIDHe y xe cy- meCTByromne HAR nAa HHp yeIDre Ha 6yAymee nporpal,lllbl, KOTOphre opraHH3yroTCR DOA 3rHAOH APYrHX MeXA y HapoA- HblX opraHH3aUHH, B qaCTHOCTH IDHEIT, KEC, C3B a 03CP. Heo6xoAID,10 noMepxHBaTb aKTHBHOe COT PYAHHqe c T- BO C AJ)yrHMR opraHH3allHRMH, ocymeCTBARlOIDHMil COO TB e TCTBYIOJI\He nporpaMMbr B AaHHOH o6Aa CTH. 13 . CT paHbl APY rHX perHO HOB, KOTOphle MOryT CTOAKHYTbCR a 6yAymeM c BHBAOrHqHhlMil npo6AeMBMH, CAeAyeT HH~OpMHPOBBTb B OTHOmeHHH ABHHbCX H Ollh!Ta, noAyqeHHbCX B pe3yAbTBTe npoBeAeHHR B EBponeHCKOM perHOHe rrporpaKM no MOHHTOpHHr y H 3IlH,2J;0M1IOJIOI"HqecICHM RC C.Jl0,.IJ;OB8HHHM. 14. CAeAyeT COAeHCTBOBBTb TOMY, qT06bI KBK MOXHO 60Abme CTpBH IlpHHHMB.JIH y qaCTHe B nporpaMMe no MOHH- TOPHHry npHCYT CTBHR OC TBTKa neCTHllHAOB B rpyAHOM MOAOKe, npOBOAHMOH B KOHT eKCTe rAo6B.JlbHOH CHCTeMbl MOHHTOPHHra COCTOR HHR OKp yxarome i< c peAhl - CTpBHhl, yxe yqac Ta yromHe B 3 TOH nporpaMMe , AOAXHbl npeACTa- BHTb ABHHbre AAR npOBeAeHHR oneHKH ~BKTOpOB pHCKa. KpoMe Toro, y qHTblBBR BBXHOCTb ABHHOH npo6AeMhr A AR Eaponei<cxoro perHOHa, CAeAyeT rrpeATIPHHRTb CKOOPAffHHPOBBHHble B ><eXAYHBPOAHOM Mac mTa6e A8HCTBHR B 3TOH 06ABC TH. r pynn8 n.118HHpOB8HHR no pa3p3 60Txe nporpa.MMJ,J n oArO TOBKH K8~poa a 06.118CTH KOHTpo .11 n 3 8 T OKCH\.IHhllrn XHli!Hl.leCKHlOf BemeCTBavn Bprocce.11b, 1 5 -1 9 moHR 198 1 r OA8 - 40 - I C P/ RCE 903 < 1 0 ) \ S ) 23 c eHTR 6 pR 1 98 1 r OA8 0 Pfil'l1HA.JJ: AHr JlllliCKID! B A8HHOM coaem8HHH, opraHH30B8HHOM B COTPYAHBQe CTBe C KoimccueB eBponeBCKBX coo6meCTB, npHHRJIB YQ8 CTHe 15 BpeMeHHblX COBeTHHKOB B3 11 CTp8H EapOID,I , A3HH B !OJ<HOB A»epBKB, npeACT8BHTeJib KOMHCCBH a 4 COTPYAHBK8 mTa6-xaapTup•1 B03 . B XOAe coaemaHHR P86oqeB rpynnw n o npocJ>eCCBOH8JlbHb!M np0<)>8BJI8M npH KOHTpo.11e 38 TOKCHQHbllm XHlm- q eC KHMB aemeCTB8MH, KOTopoe npOXOAff.110 B AeK86pe 1980 rOA8 B BpffiCCe.11e, 6b!JIH onpe AeJieHbl 38A8QB , KOTO- P••e CJieAyeT pemHTb AJIR o6ecneqeHHR KOHTPOJIR 38 TOKCBQHbllm XHMBQeCKHlm aeme CTB8MH, H yCT8HOBJieH Kpy r 3H8HHB H H8BbZKOB , He06XOAffMWX AJIR npeTBOpeHBR 3 THX 38A8Q B XB3Hb. Ilpa p83p86 0TKe npocJ>eCCHOH8JlbHblX npo(j)8BJIOB 6b!JIH npHHRTbl BO BHHM8HHe OTAeJibHble r p y nn•• 38A8 q' KOTOpwe AOAIHbZ BWil OJIHRTb p860 THHKH' 38HH- M8.IOZIUl eCR npo6.11 e M8MH o6ecneqe HHR 6e 3on8C HO CTH npn HCDOJib 3 0B8HRH TOKCHQRblX XHMHQeCKHX aemeC TB , H BOn- p oC BMH oxp8HW oxpy x8romeB q e .11oae K8 c peAW H oxp8HW 3AOPOBbR .JDOAeB, DOABepraromHxc n AeB CTBHID XHlmQeCKHX Be meC TB. B ODHC8HHH npo(j)aBAOB nepeQHCJIJIIOTCS! 06.11a CTH 3H8HHB ' KOTOpb!e Reo6XOAHMbZ cneUHa.JIH CTBM n o COO TBeT CTB)'IO!ltID! AffCUHnJIHHaM. IlpH 3TOM oco6oe BHHM8HBe YAeJISieTCS! TeM 06.118CTffi! 3H8Hlrn, npHMeHeHHe KOTOpb!X Tpe6yeT 60JibIDOro onb!T8. CeBlI8C H8 noBeCTKe AHR CTOHT BOnpoc pa3pa60TKH yqe6Hb!X nporpaMM AJIS! COOTBeTCTBYJ(llleH noArOTOBKH cnen;H8JIHCTOB pa3JIHQHOro npo(j)BJIS! H Bwpa6oTKH y HHX Heo6xOAffMWX npax- THQe CKBX H8BhlKO B pa6o TW B A8HHOH 0 6 .118CTH . Ue Jib A8HHOr o coaemaHHS! COCTOS!.118 B TOM, lIT06bl onpeAeJIBTb OCHOBHble IlOJIOXe HHS!, KOTOpblX CJieAyeT llPRAepxHB8TbCS! npH pa3p860TKe nporpBMMl,I noArOTOBKB B o6 JI8CTB KOHTPOJIS! 38 TOKCBQHWMH xmmqecKHlm Be - meCTB8MB H, B Q8CTHOCTB, KOHTPOJibHOB nporp810tbl noArOTOBKH , KOTOpyro MOXHO 6yAeT HCnOJib30B8Tb B xaqe- CTBe y qe6HOB MOAeJlll. IlepeA yqaCTHHK81lH coaem8HBS! CTOS!.118 T8X.e 3a,.!1;8Q8 paCCMOTpeTb npeAJIOXeHHe n o o praHH38IlBH Kp8TKOCpOQHblX x y pCOB no TOKCHKOJIOrHH AJIS! BblllyCKHBKOB yqe6Hwx 38BeAeHBB, KOTOpblM no POAY p a 6 oTbl IlOTpe6yroTCS! onpeAeJieHHble 3H8HBS! B o6JI8 CTH TOKCBKOJIOrHB . .llHc xyc cuSI YqaCTByroIDHe B COB8ID8HBB BpeMeHHhle COBeTHBKH p8CCK838Jlll O no.11oxeHBH A8JI B o6JI8CTH noArOTOBJtB no ,'OKCHKOJIOrBH B CBOHX CTp8H8X. Bc .11eA 38 3THM 6WJI8 npOB8A8H8 o6maR ,.!IBCKyCCBS! no 3TOMY aonpocy. BbZ- .118 npH3H8H8 H8CymH8S! Heo6xOAHMOCTb p83p860TKB y qe6Hb!X nporpaMM B 3TOB 06.118CTB. rpynn8 npH111JI8 K cor.11ameHHID B OTROmeHHB CTp8TerBB, KOTOpyro CJieAyeT HCnOJib30B8Tb npn p83p86 0TKe y qe6 Hb!X nporpBMll. Ilpli! 3TOM 6b!JIO YK838HO H8 Heo6XOAUMOCTb HCnOJib30B8HHS! p83p860T8HHWX H8 npoIDJIOM c oaemaHHH npocJ>eCCHOHa.JlbHblX npo(j)aBAOB B neJIS!X onpeAeJieHBS! xpyr8 3H8HBB, He06XOAHMblX AJIS! cnenna..mCTOB B KBXAOH 06.11acTn. KoHTpOJibH8S! nporp810t8 AOJIIH8 BK.JDOQ8Tb ace Heo6XOAHMble AJIS! DOArOTOBKB no TOKCBKO- JIOrHB KOMnOReHTbl 3H8HBB, p8cno.11oxeHHble B COOTBeTCTBRH C noTpe6HOCTS!MB B JIOrBKOB nponecc8 o6 y qeHBS! . KO BTPOJibH8S! nporp8MM8 cp8BHBB8eTCS! C nporpSMMOH, no KOTOPOB npOXOABJI o6yqeHBe cnenuaJIBCT, co6uparo- DtBB CS! pa60T8Tb B o6JI8CTB KOHTpOJIS! 38 TOKCBQHbllm XBlmQ8CKBlm aemeCTB8lm, B pe3yJibT8Te qero BbZS!BJIJIIOT- CS! npo6eJibl B ero 3H8HBS!X B 3TOB 06.11aCTB . B 3TOM c .11yq8e T8KOMY cnenHaJmCT y MoxeT 6WTb npeAOC T8BJie- Ha B03MOXHOCTb no c em8Tb Kypc w C ne.11bro no.11yqeHHS! aeo6XOAHMWX 3 R8HHH . Kpo»e Toro, KOHTpOJibH YID npor- p 8MM Y MOXHO BCDOJ!b30B8Tb npn n.11aaupOB8HBH o6yqeHHS! C OTpbZBOM OT pa60Tbl AJIS! cneUHa.JIB CTOB , xeJISIDIDHX pa6oT8Tb B 3TOH o6JI8CTH, HO He HM8IDDtBX TpeTHQHOro o6pa30B8HHS!. rpynna pa3pa60Ta.11a KOHTPOJibHYfil nporpa10ty noArOTOBKH TOKCHKOJIOrOB Ii! o6 CYAli!JI8 BOnpocw, CBS!38HRble - 41 - fp y nna npe,n;JIOXHJia HCnOJib30BaTb MO,ll;yJIBpHblH nO,llXO,ll; npn onpe,n;eJieH Hll co,n;epxaHnB Ky p coa no pa3.11nqHblM KOM- IlOHeHTaM rrporpaMM&I. TaKoH MOAYJI.Rp Hhrii rro,n;x:VA MOJCHO HCilOJib3068Tb IIPH opraa11 3arun:1 K 8K AJIHTe.JibHhlX, Tax n He,n;eJihHblX HHTeHCllBHblX Kypcoa B neJIJIX AHKBH,D;annn npo6eJIOB B no,n;rOTOBKe c nennaAHCTOB, 06.11a,n;aromnx ,n;o- C TaTOQHblll o6'beMOM OCHOBHLIX 3H8HHii. KOHTPOJibHaB nporpaMMa no,n;rOTOBKn TOKCHKOJioroa B 3HaqHTeJibHOH CTeneHn cxo,n;na co MHornMH nporpaM- MaMH n o H3yqeHH10 ,ll;OKAHHHqecKnX ,n;ncnnnJinH ,ll;JIB CTy,n;eHTOB-MeAHKOB II CTy,n;eHTOB-BeTepnnapoa. r.11aBHblli He,D;O CT aTOK nporpaMM no AOKAHHllqecKOMY o6yqeHmo COC TOHT a TOM , qTo OHR coaepmeHHO He npe,n;yc MaTpHBaIOT opraHH3anHH Kypc oa no o6meil TOKCHK0.11ornn. B xo,n;e coaemaHn11 6hl.11n onpe,n;e.11eH,1 3a,n;aqn Kypcoa no o6meil TOKCHXOJIOrnH. BeTepnHapHbIM n Me,D;llllHHCXHM mKOJiaM 6bIJIO peKoMeH,n;oaaHO BBeCTH a caMOM cpoqHOM nop-",ll;Ke npeno,n;aaaane no TOKCllXOJIOrnH. 3a,n;aqa mxo.11 COCTOHT He TO.ilbKO B TOM, qTo6hl rOTOBllTb xa,n;pbl TOKCnK0.110- roa' B XOTOPblX omymaeTCJI aexaaTxa' HO H B TOM' qTo6bl AllKBH,1l;HpOBaTb BBHble npo6eAbl B o6meM MeAHOHHCKOM o6pa30BBHHH. f pynna Ta=e paccM0Tpe.11a H o,n;o6pn.11a c yqeToM c,n;e.11aHHb1X 3ayeqaHHH npe,n;.11oxeHHB 06 o praHn3ailHH KpaTKOCpoqHblX (npo,n;OJIXHTeJlbHOCTbID B 2-3 Mecana) Kypcoa no TOKCHKOJIOrllH 0 ,ll;JIB pa60THHKOB, KOTOpb!M Heo6- XO,ll;llMbl 3HaHHJI B 3TOH 06.11aCTll AJIR BblilOJIHeHHB CBOllX noace,n;HeBHblX o6a3aHHOCTeH. BbIJIO npe,n;.11oxeHO npo- BO,ll;llT b o6yqeHHe Ha Kypcax B Tpn 3 Tana, Klll,ll;blli 3Tan npo,n;OAXHTeJibHOCTbID He 60.11ee nJITH ne,n;eJib. 3To Bbl3BBHO Heo6xo,n;nMO CTbIO ,ii:aTb B03MOXHOCTb 3aHJITblM Ha pa6oTe AIO,ll;JIM nocemaTb KypCbl II HCKAIOqHTb aepORT- HOC Tb HX OTCYTCTBHJI Ha pa6oqey MeCTe a TeqeHHe ,ll;JIHTeJibHOro nepHO,n;a apeMeHn. 1. Ily TeM c paaHeHHJI KOHTpOJibHOH yqe6HOH nporpaMMbl no,n;rOTOBKH TOKCHKO.l!Oroa c c ymeCTByrom;HMH nporpaM- MaMH no,n; rOTOBKll c nen11aAHCTOB, BXOABDlllX B TOKCllKOJiornqecxyro 6pHra,n;y, MOXHO BblJIBHTb npo6e.11bl B o6yqeHnn 3THX c neOHaAHCTOB. JlnKBll,n;HpOBBTb 3 TH npo6eAbl MOXHO nyTeM opraHH3ailHH ,n;onOJIHHTeJlbHblX 3aHBTllH. 2 . AHaJIH3 ncno.ilb3yeMblX yqe6HblX nporpaMM noKaa,rnaeT' qTQ KOHTpOJibHBJI yqe6HaJI nporpaMMa no,n;roTOBKII TOKCllXOJIOrOB BO MHOrOM cxo,n;na C 06,1qHQH qe6HOH nporpaMMOH no ,il;OKAHHHqecKOH no,n;rOTOBKe BbffiYCKHHKOB 0CHOB HOH He,D;O CTaTOK llCilOJlb3yeMblX B HaCTOJIQlee epe- M.R nporpaMM no ,ll;O KJIHHHqecxoH rro,11;rOTOBKe 3 THX BhlllYCKHHKOB - OTCyT CTBHe MHHHM8.JlbHOli llO,ll;rOTOBKH B o6Jia- CTH o6~eH TOKCHKOJIOrHH. qTO xa c aeTC.R BbIIlYCKHHKOB no ApyrHM Me,ll;HIJ;HHCKHM c neQH8JibHO CT.RM, TO HM, KaK c.11e,ii:yeT H3 KOHTpO.ilbHOH nporpaYM1>1' tteo6xo,n;nm1 60.11ee nmpoKne 3HaHHB' KOTOpb1e OHH MOryT no.11y=Tb' noce- maa COOTBeTCTByroOIHe xypcbl. 3. IlpH npeno,n;aeaHnn o6meH TOKCllKOJIOrnH 6blJIO npe,n;.11oxeno HCnOJlb30BaTb qeTb!pe MOAYJIJI, ·.COOTBeTCTByromllX neJIJIM o6yqeHHJI, npe,n;yCMOTpeHHblM KOHTPOJibHOH y qe6HOH nporpaMMOH AJ!J'I TOKCHKOJIOroa. 4. BbLIIO npH3HaHo, _qTo B KOHTpOJibHOH nporpaMMe ,ll;OCTaToqno rro,n;po6Ho onpe,n;eJieHbl Te 3HaHHB, KOTOpb1e He o6xo,ii:nMbl TOKCHKOJIOry B TaKHX 06.11aCTJIX, xaK XHMHB, 6 HOXHMHJI, ~H3HOJIOrHB H naTOJIOrHJI . TaKHM o6pa- 30M ' yqe6Hble 3aae,n;eHHJI Mor y T p·yKO BO,ll;CTBOBaTbCJI 3THMR c ae,ii:eHHBMH npH onpe,n;eJieHnn MHHHMaJibHOro o6'beMa 3 H8HHH no 3 THM AHCllHilJIHHaM, KOTOphle aeo6xo,11;HMM ,ll;JI.R rrpaBHJibHOro IlOHIDd'.8HHH TOKCHKOJIOrHH. 5. rro MHeHmo f pynllbl, 0,ll;HOBpeMeHHO C pa3pa60TKOH y qe6HblX nporpa>Ol ,D;JIJI TOKCHKO.l!Oroa c.11e,n;ye T pa3pa60- TaTb CTpyKT YPY nx rrpo,n;aHXeHHB no c.11yx6e . IlpH 3TOM 6bLIIO OTMeqeHo, qT o npn paapa6oTKe 3 TOH CTPYKT Y- pbl ne.11ecoo6pa3HO HCilOJib30BaTb pa6oqHH ,ll;OKyYeHT " Ilpo~CCHOHaJibHble rrpo~aHJlbl rrpn KOHTpo.11e 3a TOKCnqHbl- MH xmmqecxmm eemecTBaMH", rAe IlpHBOAHTCH OllHC3HHe Kpyra o6H3aHHOCTeH TOKCHKOAOroe. 6 . Heo6xo,n;HMO yHn¢nnHpOBaTb pa3JIHqHoro po,n;a TOK CHKO.l!OrnqecKne ,n;aHHble' B CBJl3ll C qey CJie,n;yeT IlpH- ,n;epx11aaTbCJI IlpHHilHilOB npoaepeHHOK .11a6opaTOPHOH rrpaKTHKH H o6ecneqnaaTb KOHTPO.ilb KaqeCTBa . 7 . BaxHOH COCTaBHOH qa CTbID no,n;roTOBKll xa,n;poa MOXHO c qnTaTb HaAHqne npn3HaHHblX B Mex,n;ynapo,n;HOM MaC- mTa6e KBaJIH~HKailHOHHblX xapaKTepHCTHK TOKCHKOJIOroa. 8 . B,1.110 npe,n;.11oxeHO npeno,n;aaaHHe Ha yTaepx,n;eHHblX xpaTKOCpoqHbJX ( npOAOAXHTe.llbHOCTbID B 2 - 3 Me CJ!Ila ) xypcax no TOKCHKOJIOrnn' ne.11b KOTOpblX ,n;aTb caMble Heo6xo,n;llMble 3 HaHnB c neITHaJill CT aM ,n;pyroro npo~llJIB' pa36HTb Ha Tpn 3 Tana, qTo rroMoxeT penmTh rrpo6.11eMy noce~eHn11 xyp coa pa6oTaromnMR c nennaAHCTaMn, a TaK- xe 06Aerq11T ycaoeHHe MaTepna.11a. 9 . Bbl.Ila IlpH3HaHa ne.11ecoo6pa3HO CTb o praHH3anm, KpaTKOCpOqHblX x y pcoe ,ll;JIB AHKBH,n;annH npo6e.110B B 3Ha- HHRX, Heo6 XOAHMblX npH ocymeCTB~eHHH KOHTpOAR 3a TOKCHQHbIYH XHlfHQeCKHMH semeCTBaMH, B CBH3H C qeM 6bIAH TaKxe o npe,n;e.11em1 3a,n;aqH, no,n;.11examne e ,mo.11ne nmo a nepayro o qepe,ii:h . B pa3BHaaronmxca CTpanax, B03- MOXHO' c.11e,n; yeT opraHH30B1,IBaTb no,ii:06 Hble KypCbl 60JibmeH IlpOAOJIJl(llTeJlbHOCTn. - 4 2 - 10. Yqa CTHHKl! coeemaHHR OTMeTHJOI, QTO B HeKOTOpLlX pa3BHB8IDIIJ,HXCJJ CTpaHax eCTb B HSJllfQHH TeXHHQ0CJCHli nepCoHaA, KO TOphlH MOXH O npHBAeKaTb K n OAPO TOBKe KaApO B TOKCHKOAOPOB. BMAO npeAAOXeHO H3yqHTb 3TY B03lf0)1(HOCTb. 11. BhWIO OTMeqeHo, qTo OAHIDI H3 rAaBHhIX npenHT CTBHH Ha nyTH OCYJlleCTBAeHHJl aAeKBaTHOr o KOHTpOAJl 3a TOKCHqffbD,{l! XHMHqec Kmm aemecTBaMH B pa3BHBaJOJIU{XCJl CTpaHax JlBAJleTCJl HexaaTKa TeXHHQeCKOH JtHTepaTyphl Ha MeCTHbJX JJ3hlK8X . 1 2. BoAbIDYTO DOMOIDb MOXHO OKa3aTb pa3BJrnaIOfilID,!CJl CTpaHaM' o6ecneqHB HX HH<)>op>iaDHe fi B OTHOmeHHH DpHH.RTH.R aAeKBaTHhlX npo¢HAaKTnqeCKHX Mep DpH KOHTpOAe 3a TOKCH q ffbD,{l! xmmqeCKHMH aemeCTBaMH. 0 T CYT CTBHe CH C- TeMhl KOHTpOAR 3a 6HOAOPHqecKmm ~KTOpaMH H ¢aKTopaMH OKPyxaiomefi cpeAhl, pa3pa60TaHHOH c neID! aAbHO AAR pa3BHBaIOIDHXCJl CTpaH, CKa3LmaeT CJl OTpHD;aTeAbHO Ha npo¢HAaKTHqeCKOH p a6oTe . 1 3. Yqa c THHJCH coaemaHH.R DOAqe pKH YAH BaxHOCTb HHTerpan;mi nporpaMM n o TOKCHKOAOPHH B ncnOAb3yellble B HBCTOHmee speMJl aKaAeMHqeCKHe nporpal,ll,lhl. Hyio npor palQ! y nOAPOTOBKH, TO y qa CTHHKH coaemaHHJl OTMeTHAH HaAHqne neAoro PRAB nyTeH, n c nOAb3 YJl KO- Topwe ,3Toro MOXH O A06HTb CJl B paMKax HhlHemHeH BKBAeMuqeCKOH CHCTeMhl. 14. IlpH n OAPO TOBKe KaAPOB B o6AaCTH KOHTPOAR 38 TOKCHqffbD,{l! xmmqecxmm aemeCTBaMH CAeAyeT npeAy- CMOTpeTb B03MOXHOCTb HenpephlBHOro o6y q e HHJl c n ennaAHCTOB C TeM , qTo6hl TOKCHKOAOrn acex ypOBHeH 6hlAH B xypce nocAeAHHX AOCTHXeHHH. PeKOMeH)laDHH 1. IlpH onpeAeAeHHH nOTpe6HO CTefi a KBApax ODblTHhlX TOK CH KOAOPOB, KOTOpble roTOBJlTCJl c yqeTOM coo6pa- xeHHH 3 nnAellHOAoruqecxoro xapaKTepa H HYXA CHCTeM 3ApaaooxpaHe HHR, a TaKxe B COO TBeTCTBHH C 3BXOHO- AB TeAbHhDm HOpMBMH, CAeAyeT o6ecneqHTb TaKoe nOAOXeHne , npn KOTOPOM nOAPOTOBKa cnenuaAHCTOB B 3 TOH o6 Aa CTH nAaHnposaABCb 6hl B ToqsoM COOTBeTCTBHH C HMelOIDHlmCJl AAH 3TOH neAH pecypcaxn. 2 . YHHBepCHTeTaM, npo¢eCCHOHBAbHhlM opraHH3BDHHM H npaBHTeAbC TBBM CAeAyeT nOAXOAHTb K Bonpocy 0 apH 3HB HHH TOKCHKOAOrOB B xaqeCTBe CBMOCTOJlTeAbHOH xaTeropHH pa6oTHHKOB KBK K npo6AeMe, 3BCAY1HBBIO- ~eB CaMoro npBC Ta...tbHOr o BHRMSHHJJ. 3 T O 03HaqaeT , QTO nocAe OKOHQSHHff KypCOB DOBblJDeHHOro THDa TOX - CHKOAOPBM CAeAye T npHCBBHBST b COO TBeTCTByiomue CTeneHH H XBSAH¢HKSDHH. 3 . YqaCTHHKH coaemaHHJl HS CTO.RTeAbHO pexoxeHAyIOT SKBAeMHqeCKHM yqpexAeHHJlM B caxoe 6.JtHxaii:mee BpeMR DpHHJlTb s eo6XOAHMhle Mephl no YAOBAeTBOpesmo noTpe6HO CTeH B KBAPBX AAR ocymeCTBAeHHJl KOHTPOAR 3a TOK- CHQHJ,ll!J,f XHMH'l0CKHllE ee~eCTB8KH . 4. B03 B COTPYAHnq eCTBe C npeACTSBHTeAHMH yqe6HhlX 3SBeAeHHH,npoll1dDLlleHHOCTH n npaBHTevlb CTB CAeAy- eT C03B8 Tb cosemaHHe C TeM, qT06hl CTHMyniposaTb M06HAH38DHIO Heo6xOAfflWX AA.R 3TOH neAH pecyp COB H paccvoTpeTb BOnpoc O BHeApeHJill CTPYKTYPhl npOABHJCeHHJl n o CAy16e AAR TOKCHKOAOPOB. 5 . YqnThlBaR TOT ¢aKT, qTo KOHTPOAbHaJl y qe6Ha.R npor pal,ll,la AAR TOKCHKOAOrOB BKAJOqaeT KOMDOHeHThl, KO- TOphle HYXAaIOTCJl B AOpa60TKe, rpynna peKOMeHAYeT B03 DpOAOAXHTb pa6oTy B 3 TOM HanpaaAeHnn. 6 . 0 TxeqaJl , qTO npo6AeMa , CBJl3BHHBJl C MeXAYHBPOAHhlM npH3HSHHeM KBaJtH¢HKBDHH TOKCHKOAOPOB, B03HH- KBeT c pa3y DO CAe Toro , KSK y qe6Hhle nporpaMMhl_ AAR TOKCHKOAOPOB HaliAYT npaKTHqecKoe DpHMeHeHue, r pyn- na peKOMeHAyeT B03 B3JlTb HS ce6R HHHD;HBTHBY B 3TOH o6AaC TH. 7 . qAeHhl rpynnhl HBCTO.RTeAbHO pexoxe,vr;yioT yHnBepCHTeTaM u MeAHD;BHCKID! IDKOASM npBHJlTb cpoqHwe vephl no opraHH3~HH KypCOB no TOKCHKOAOrnn AAR scex CTYAeHTOB-MeAHKOB B CTYAeHTOB-BeTepBHapoB B CBJ13B C paCTyIDID! B03AeHCTBBeM xHMHqeCKHX aemeCTB Ha 3AOPOBb e qeAOBeKa B Heo6XOAHMOCTblO C03ABHBJl 6a3bl AAR nOAPOTOBKB B 6YAYJlleM c nenuaABCTOB 3 Toro npo¢HAJl . 8 . B03 CAeAyeT YAeABTb o co6oe BHHMBHHe npo 6AeMe o6ecneqeHB.R pa3BHBaIOIDHXCJl CTpSH yqe6HhlM MBTepHa - AOM Ha COO TBeTCTBYJ(ll!BX Jl3hllt8X . 9 . Yqn TwBaR, qTo B HeKOTOPhlX p83BHBaIOIDHXCJl CTpaHaX, B0 3 MOXHO, yxe C03ASH HeKO TOpblH pe3epB TeXHH- q eCKHX KBAPOB, CAeAyeT o6paTHTb BHID!BHHe H8 pa3pa60TKY AAR BbillY CKHHKO B yqe6HblX 3SBeAeHHH p83ABqsoro npo¢HAJl TBKHX nporpaMM n OAPO TOB KH , KOTOpble n 03B0AJlT HM y qa CTBOBaTb B peaAH 3BDHH nporpaMM B o6AaCTH KOHTPOJJJJ 38 TOKCHqHhW:Jf XHMHtfeCKRMH ee~eCTB8}(H. - 43 - 10 . TTpH paCCMOTpeHHH KOHKpeTHL!X npo6AeM opraHH3aI1HH o6yqeHHH B pa3BHBaromHXCH CTpattax CAeAyeT npHHll.MaTb BO BHHMaHHe MeCT Hble yC.ilOBH.fl . 11. KottTpOAbHbie nporpaMMbl MH cnet1HaJIHCTOB pa3AHqHblX AHCI1HilAHH, y qacTay,omnx a ocymeCTBAeHHH KOHT- pOAR 3a TOKCHQHblM1l XHMHQeCKHMH aemeCTBaMH, AO.JlXHhl pa3pa6aTWB8TbCH TaKHM xe nyTeM, QTO H nporpaJlllLl AAH TOKCHKOAoroa. TTpn llOArOTOBKe oco6oe BHHM8HHe CAeAyeT YAeAHTb cne11naAHCTaM B o6AaCTH YA8AeHHH H o6pa60TKH OTXOAOB, a TBKJKe cneI1H8AHCTBM, npHBAeKaeMblM llPH OK838HHH cpoqaoil llOMOl!lH. 12. CAeAyeT opraHH30BBTb B 6JIHJKailmee apeMH KpBTKOCpOqHbie KypCbl AAH AHI1' KOTOpb!M tteo6xOAH1lbl 3HBHHH B o6AaCTH TOKCHKOAOrHH, HO KOTOpble He o6ABABIDT AOCTBTOqHoB llOArOTOBKOH B 3TOH o6AaCTH. Pa6ot1an rpynna n o CBCTewaM p erAaweHTB- poeaHBR COAe pxaHHR XHMBtleCKID< eemec TB a IlOTpe6BTeAb CKID< TOBapax - 44 - I CP / RCE 903 ( 12) (S) 2 OKTn6pn 19 8 1 rOAa OPMI'HHAJJ: Alff JlllliCKIDI B XOAe KOH CYAbTaTHBHoro coeemaHHR DO nepeoot1epeAHYM 38A3QaM KOHTpOAR 38 TOKCBQHhlMli XHlfeqe CKllllH eemecTBa:,,m B Eepone (BaAeH, 3-6 Hon6pn 1980 roAa ) 6MA onpeAeAeH neAhlH pnA npo6Ae M, Tpe6 yromnx cpot1 - aoro p aCCMOTpeHBR co CTOpOHhl npaBBTeAbCTB, HanBOHaAbHhlX HH CTHTYTOB B MeIAYHBPOAHhlX opraHH38IlBH. Yt1aCTHBKB KoH CYAbTaTHBHOro COBemaHHR peKOMeHAOBaAB inter alia pa3pa60THTb PYKOBOAffiIJ,Be YK838HBH n o C03A8HBID CBC TeM perAaMeHTBPOB8HBR B KOHTpOAR COAepI 8HBR XB>mtleCKID< eemeCT B B IlOTpe6nTe Ab CKRX TO- Bapax . Bo HCilOA HeHBe ABHHOH peKOMeHABnB B B 6hlA8 C03 B8H8 AaHHan Pa6ot1an rpynna. 0Ha 6hlA8 opraHB30- BaHa B COTPYAHlltleCTBe C HHCTHTYTOM rnrBeHhl n npo(J>e cCBOHHAbHhlX 6oAe3Hen (Co<l>Bn ) B pa>0eax AeHTeAb- HOCTB no p eaAB38IlHB IlporpaMMhl pa3BllTllR OpraHll38IlHB 06aeAnHeHHhlX HanHn; B Pa6ot1eil rpynne npHHHAB y t1aCT Be np eAC TBBBTeAB 11 eeponeuCKID< CTpaH , npeAC T8BHTeAB KoMDCClrn eeponeuCKID< coo6meCTB (KEC ) B MeIAyHapOAHOro coro3 a TeopeTnt1ecKou n npHKABAHO H xn..-un (MCTIIX ), a TaKie ABB Ha6AIDABTeAn OT yKa3aH- Ho r o BhlDie MH CTBT y T a rurneHhl. B OC HOBY ABCKyCCBB 6hlAB nOAOieHhl OTtl e Thl 06 BCCAeAOB8HBHX 8AMBHBCTp8TBBHhlX nponeAYP KOHTpOAR 38 TOKCBQHLIMH xm.mqeCKHKH eemeCTBaMn B cneneaAbHO OTo6paHHblX eeponeHCKHX CTpattax . 3TH HCC AeAOBa- HHR 6hlAB npoBeAeHhl CHA8¥B HHCTBTyTa rnrHeHhl B npo<J>eccuoHaAbHhlX 6oAe3Heil (Co<!>HH) B Hayt1HO-BCCAeAO- BaTeAbCKOro neHTpa no MOHHTOPBHry B oneHKe npn ~OHAOHCKOM YHBBepcnTe T e . B XOA e ABCKy CCBB 6hlA T8K- x e o6 c yIAeH npoeKT pyKOBOACTBa no pa3pa60TKe 38KOHOA8TeAbHhlX vep B OTHOmeHHH XHMntleCKID< BemeCT B , COAepx amHxcn a IlOTpe 6HTeAbCKID< TOBapax, BhlnymeBHOro cnennaAbHO AAR yt1aCTHBKOB rpy nIIhl a BHAe pa6o- q ero AOKyMeHTa. Yt1aCTHBKH rpy nIIhl npHIDAB K eABHOMY MHeHBID OTHO CBTeJihHO Heo6XOAHMOCTB C03A8HBR K8KOr O-AB6o YHB- <l>nnBpOB8HHOr o 38KOHOA8TeAbCTB8 B pacc vaTpBBaevon o6ABCTB. HO BHan KOHOennun yt1peIAeHBR 38KOHOA8TeAbCTB8 B TOM BBAe, KaK OHa npeACT8BAeHa B npoeKT e pyKOBOA- CTBa, BepOHTHO , RBAReTc n HaB.lfytlIDBM nOAXOAOM , IlOCKOAbK Y npeACT8BAHeT co6on npaKTHtleCKBH nyTb K pe- meHBID apo6AeMhl OTHOCBTeAbHO 38KOHOA8TeAbHhlX nponeAYP, He06XOAH1WX B CAOIHO H B v eHnromeucn CBTyanuu . Yt1aCTHBKB COBemaHBR paCCK838AB O AeHCTByromax B H8CTonmee Bpevn B RX CTpaHax vepax KOHTpOAR 38 6e30il8CHOCTbID noTpe6BTeAbCKRX TOBapoB. BMAB TaKie KpaTKO B3AOXeHhl CTOffiIJ,Be 38Aat1B B A8H 063op MeponpnnTBH, apOBOABMhlX KoMUCCueii eBponenCKID< coo6mecTB, a TaKie 6MAB 38TpOH YThl npo6AeMhl , IlpeA- CT8BAHIDmBe BHTepec AAR Me XAyHapOAHOro COID3a (1 Jl8CTHtleCKHX MaTepH8JlOB. TeopeTUtleCKOH B npBKA8AHOH XBMBB, oco6eHHO B o6AaCTB B CBe Te 3TBX BhlCTynAeHBH B OTtleTOB O npoBeAeHHhlX BCCAeAOB8HHHX y t1a CTHBKB Pa6ot1en rpy nnhl OTMe- TBAB , tlTO npoeKT 3aKOHa O 38IDBTe OT XBMBtleCKRX BpeAHOCTen (3aKOH O 6e3onaCHOCTB noTpe6nTeAbCKRX TOBapoB)B TOM BBAe , xaK OH npeACT8BAeH B PYKOBOACTBe, BilOAHe COrAacyeT CR C MH eHnev 3KCnepTOB , 3Ha- KOMhlX C 38KOHOA8TeAbHhllm nponeAypavB B 3TOH o6A8CTB . B XOAe AUCKyCCBB 3aKoHonpoeKT 6hlA t18CTHtlHO OTpeAaKTBPOBaH B 38TeM npHHHT , npu 3TOM 6hlAO peme- HO nonCHBTeAbHl,IH TeKCT K pyKOBOACTBY u c nOAb30B8Tb B KatleCTBe BBeAeHBR K AaHHOMY 3aKOH On poeKTy. Yt1aCTHHKB rpynilhl IlOAt1epKHYJ1B Heo6xOAHMOCTb BH<l>OPMBPOB8HBH o6meCTBeHHOCTB B C8HBT8pHoro npo- caemeHBR IDKOAbHBKOB B OTHomeHBB BOnpocoB oxpaHhl HaCeAeHBH B oxpyxaromen c peAhl OT TOKCHtleCKID< B03- AenCTBBH XBMHtleCKBX eemecTB , COAe pxamID< CH a noTpe6HTeAbCKID< TOBapax. BHBM8HB e yt1BCT HBKO B coaemaHBH 6 hlA O o6pameHO Ha p OCT o6aev a veXAYH8pOAHOH TOprOBAB noTpe6u- TeAb CKBMB TOBapaMn B 3KCn OpT noTeHOB8AbHO BpeAHhlX npOAYKTOB , OTCIDA8 - He06XOABMO CTb B c npaBeAAB- BOCTb Tpe6oaaHBH HMnopTHpyromux CTpaH 38npamBB8Tb BCt1epnhlBBromyro BH<l>opMBilBID 06 3TllX npOAYKTax . - 45 - ,lL,tR BHeCeHHR B CTIHCOK Tpe6yromIDC nepaooqepeAHOro BHHMBHHR npH pa3pa6 0 TKe PYKOBOARmHx yKa3BHllH n o o xpatte 3AOPOBbR nOTpe6nTe.11eii TOBBpOB 6blJI npeAJIOJleH 11eJ1blH PRA noTpe6,ITeJibCKIDC npo,ilyKTOB . 1 . YqaCTHHKH rpynm, cor.11aCHJIHCb C Tew, QTO npoeKT 3BKOHa C03,JlBeT COOTBeTCTByromyro 3BKOHO,ilBTeJibHyro ll BAJlHHHCTpBTHBHyro OCHO By ,JlJIR pemeHllR npo6JieVI,1 o6ecneqeHHR 6e30IIBC HO CTll IIOTpe6nTeJibCKIDC TOBapoB, B KOTOphlX npncyTCTBYIDT Bpe,ilHWe AJIR 3,ilOpOBbR XH>mQeCKHe BemeCTBa. IlpoeKT 3axotta o 3amnT e OT ape,il- HhlX XH>mQeCKIDC aemeCTB, CO,JlepxamIDCCR B IIOTpe6nTeJibCKIDC TOBapax (3aKOH O 6e30IIBCHOCTH IIOTpe6nTeJib- CKHX TOBapoa) MOXeT CJIYXHTb B KBQeCTBe PYKOBO,JlCTBB ,JlJIR rocy,!lapCTB - QJie HOB, 3BHHTepecoaaHHWC B yqpex- ,JleHHH 3BKOHO,JlBTeJibHblX ll llHCTHTYl1HOHHhlX npoQe,ilyp B 3TOH 06.11aCTH. Il03TOMY yqacTHHKH rpynnw peKOMeH - ,JlOBBJIH, QT06hl npoeKT 3axoaa C IIOHCHHTeJibHWM BBe,JleHHeM 6WJI p acnpocTpaHeH 803 c pe,ilH r ocy,!lapCTB-QJieHOB ,JlJIR IIOCAe,Jlyromero paCC MOTpeHHR ll BHeCeHHR nonpaaoK . 2. YqaCTHHKH rpynm, COQJIH Heo6xO,JlHYblll, QT06hl mHpOKBR o6mecTBeHHOCTb ocoaaa.11a B03MOXHble ape,ilHble B03,JleliCTBHR XHMHQe CKHX aemecTB, npncyTCTByromnx B IIOTpe6HTeJibCKHX TOBapax, ll HMeJia 6w IIOHRTHe 06 HX npaBHJlbHOM HCIIOJlb30BBHllll , B CBR3H C 3THM rpynna peKOMeH,JlOBaJia 803 pa3 pa60TBTb MeponpHHTHH , HMeroJlllle 11e.11bro llH¢Op>mpOBBHHe o6mecTBeHHOCTH B OTHOmeHHH IIOTeHQHBJ!bHWX onaCHOCTen. 0co6oe BHHMBHHe CJie,Jly e T npn 3TOM YAeJIHTb CBHHTBpHOMy npocBemeHmo ,JleTeii. 3. 3KCIIepTW npHm.llll K BhlBOAY, QTO 3 amHTB IIOTpe6nTe.11eli OT Bpe,ilHWX B03,JleHCTBHH TOKCHQHWX XH>mQe CKHX aemeC TB , npHCYTCTByromnx B IIOTpe6HT8JlbCKHX TOBapax, Tpe6ye T T8XHHQ8CKoro OIIhlTB, oco6eaao npe npoBe- Ilo wepe BhlRBJieHHll ROBWX ape,ilHOCTee c.11e- ,J1yeT Ha wex,JlyaapO,ilHO M y poBHe paapa6aThlBBTb ll cor.11aCO BhlB8Tb HOBble BHBJIHTllQeCKHe ll TO KCHKOJIO rHqecKlle MeTO,ilW, T aKHM o6pa30M, aeo6xO,JlllMO nOCTOHHHO co aepmeH CTBOBaTb IIO,JlrOTOBKY .11a6o paHTOB B 06.11ac TH a tta- JI BTBqecxoH veTOAOAO rHH H TOKCHKOJIOrHu . HaAAeIHT TaK.Ie YAeAHTb BHB»aHHe apeAHOMY B03AeliCTBHIO Ha OKpyxaromyro cpe,ily XHMHQ8 CKHX aemecTB, HBXO,Jlmu;IDCCll B IIOTpe6eTeJibCKHX TOBapax ll npoBe,JleHmo HCCJie,JlOBa- HHli B 3TOH 06 .rnc TH . Ilo3TOMY peKOMeH,JlyeTCll' QT06bl ,JlJlll JIBl1, ocymecTBJIRromex BCe KaTeropHH aaaJIHTH- qec KHX, 3BKOHO,JlBT8JlbHhlX H B,JlMHHHCTpa THBHhlX npo11e,J1yp B03 pa3pa60TBJ1a nporpa!Gly yqe6ttwx ceMHHapoa H ,JlpyrHX BHBJIOrHQHWX MeponpHHTHli no KOHTPOJIID 38 TOKCllQHWMH XHMHQeCKHMH BemeCTBBMH, npncyTCTBYIDJllll>m B IIOTpe6 eTeJib CKHX TOBapax. 4 . B caeTe pac mnpeHHll wex,Jlyttapo,ilHOH ToprOBJIH nOTpe6nTeJibCKHMH TOBapawn ll, CJie,JlO BaTeJibHO, B03MOX- HOCTH Henpe,ilH BMepeHHOro pacnpocTpaaeHHll XHMHQeCKOH onaCHOCTH qepe3 nocpe,ilCTBO 3THX TOBapoa y qaCTHH- Kll rpyIIIIhl CO QJIH Heo6xo,JlHMbIM, QT06hl llH¢opwa11nn OTHOCHTeJibHO OTKphlTHR HOBhlX XHMHQeCKHX ape,JlHOCTeli 6bl- CTHMYJillpOBaTb ll a KTHBH3HpOB BTb yCHJlll ll B 11e.11nx pa3pa60TKH Me x ,JlyHapO,ilHOro perHCTpa IDHEil no noTeHUll- aJibHO TOK CHQHblM XHMllQ8CKHM aemecTBBM (MPIITXB). XOTll B npoeKTe 3aKOHa roaopHTCll O IIOTpe6eTeJibCKHX TOBapax, nOHBJlllIDJllHXCll Ha BHyTpeHHHX phlHKax, rpynua oco6o no,JlqepKHy.11a, QTO COO TBeTCTBYIDJllllH KOHTpOJib ,ilOJIXeH ocyme cTBJIRTbCll TBM , r,Jle 3TO aeo6xO,Jlll- vo , B OTHomeHHl:I IlOTpe6RTeJibCKHX TOBapoe, npeAHa3 HaqeHHLIX AJIH 3KCilOpTa. T aKHM o6pa30M, y q a cTHHKH rpyUIIhl peKOMeH,JlOBBJIH 803 ll Me x ,JlyttapO,ilHOMY perHCTPY noTeHUHBJlbHO TOK- CHQHWC XH>mQe CKHX aemec TB paCCMOTpeTb Bonpoc O TOM, KBK 6 MCTpee ,JlOBeC TH AO CBe,JleHHR rocy,JlapCTB- qJeHOB ea¢opwaumo OTHO CHT eJibHO B03MOXHWX XHMHQeCKHX ape,ilHOCTeli aemec TB, npncyTCTBYIDJllllX B IIOTpe6H- TeJibCKHX TOBapax . B03 TaKXe HB,JlJieXHT OKB3 BTb no MOJllb CTpaHBM B y nopRAOQeHHH HeKOTOPWX npo11e,J1yp C TeM, QT06hl HCKJIID- qHTb B03MOIHOCTb 3KCilOpTa noTpe6HTeJibCKHX TOBapoe, COAepxam.wc IlOTeHnuaJib HO onac Hhle XHlfflqecKue ae- mecT Ba, 6e3 COO T BeT CTayromeli HH¢0pMBUHH, npe,!lOCTBBJIHeMoli KOMIIeTeHTHOMY pyKOBO,JlllJlle My o praay HMUOpTH- p y lOl!leli CTpBHhl , 5. Ilo MHeHHID rpyIIIIhl , I1eJ1ecoo6pa3HO npoaeCTH BHBJIH3 B,ilMHHHCTPBTHBHhlX npoue,ilyp, HCTIOJlb3YeMWx npH KOHTpOJie 38 TOKCHqffL[MH XHMHqeCKHMH aemecTB8MH B ne.JIJIX OK838HHH ITOMOJJI;H rocyAapCTBaM-4.JieHaM, pa3pa- 6aThlBaIDDIHM 3BKO HO,JlBT 8Jlb Hble wepb! B 3 TOH 06.11aCTH ' TIOCKOJlbKY 3 TO ,JlBCT UM B03MOXHOCTb yqecT b OTihlT AP Y- rHX rocy,!lapCTB-QJieaoa; rpynna peKOMeH,JlOBBJIB nepeCMOTpeTb MeTO,JlHKy g3yqeaHH B,JlMHHH CTpaTHBHblX npoue- AYP KOH TpOJIH 38 TOKCHqffbIMH XHMHqecKHMH aemecTBRMH H BKJIIOQHTb B KaQeCTBe ee COC TaBHOli qaCTH c ne- QHaJibHblH PB3,JleJI no IIOTpe6eTeJib CKHM TOBapaM. - 46 - 6. YqHThlBaR TY 60Ahmyro pOAb, KOTopyro IlOTpe6uTeAbCKHe TOBaphl urparoT B o6meM B03AeHCTBHH Ha qeAOBe- K8 xrumqecKHX aemecTB, yqacTHHKn rpynnhl cquTaroT aeo6xo.,,.mu,w yAeAHTh nepaooqepe,ll.aoe BHH¥aHHe H3yqe- HHID BO3MOXHOCTH TOKCHqHoro B03AeHCTBHR Ha qeAOBeKa OT06paHHhlX BH,ll.OB Il0Tpe6HTeAbCKHX TOBapoB H pe- KOMeHAYIDT B03 paccMOTpeTb aonpoc O pa3pa60TKe PYKOBO,ll.CTB8 no CO3,ll.aHHID cnenuaAbHhlX perAaveHTHpyroow:x IlOAOXeHHH , o6ecnequaaromax 6e30ilaCHOCTb onpe,ll.eAeHHhlX BH.J1OB TOBapoB . 7. B 38KAIDqeHHe yqaCTHHKH rpyllllhl peKoveHAOBa.>m B03 opraHH3OBaTb npoeKThl no onpe,ll.eAeHmo npHOpH- TeTHOCTH HayqHhlX HCCAeAOBaHHH npH u3yqeHHH Bpe,ll.HhlX CBOBCTB noTpe6HTeAbCKHX TOBapoa, CO,ll.epxamID< TOKCHqHble XIDIHqeCKHe aemecTBa. CAe,ll.yeT CTIDIYAHpOB8Tb COTPYAHHqeCTBO C T8KIDIH opraHH38IlHfillH, KaK Me•AYH8pO,ll.HhlH perHCTp IlOTeHDH8AbHO TOKCffqHhlX XHVHqeCKHX aemecTB. - 4 7 - ITAEOPATOPIDI Pa(Soqan rpynna no npo�HJiaKTHKe oTpaene� H ponH ueHTPOB no OopbOe C OTpaeneHHRMH B CHCTeMaX Me.[IHKo-caHHTSPHOA nOMODUi PHM p 10-13 HOR0PR 1981 ro.11a Bee,c;eHHe _ 49 _ ICP/ATH Ol4(S) 14 .11eKaOpn 1981 ro.11a 0 PHrHHAJI : AH r JJHnc KHfi B coeemaHHH, C03BaHHOM B COTPYJ:IHHqeCTBe C KaTOnHqeCKHM YHHBepCHTeTOM CenmeHHoro cep.11ua B PHMe, npHHffnH yqaCTHe BpeMeHHble COBeTHHKH H3 .[leBRTH CTpaH EeponeAcKoro perHoHa, npe.[ICTaBHTenH Me:1t,11yHapo.11- HoA aKa.[leMHH cy.11eOHoA H COUHanbHOA Me.[IHUHHbl, BceMHpHoA �e.11epauHH accoUHaUHA paOoTHHKOB KnHHHKO-ToK­ CHKOnorHqecKHX ueHTPOB H UeHTPOB no Oopb5e c OTpaeneHHRMH, a TaK�e COTPYAHHKH CeKpeTapHaTa B03. B 1974 ro.11y e 11HoHe npomno C03BSHHoe PerHoHanbHblM O�po coee111aHHe PaOoqeA rpynlll>I, no.11roToBHBmeA oTqeT O COCTOffHHH .11en B HaUHOHanbHblX TOKCHKonorHqeCKHX cn}'Jlt5ax. B npo.11oruiteHHe 3TOH paOoTbl 0blllo pemeHo opraHH30BaTb coeemaHHe .11aHHoA PaOoqeA rpynnhl .11nn npoee.11eHHR o03opa HMe�merocn B onpe.11eneHllblX CTP&Hax PerHOHa oOopy.[IOBSHHff, B qaCTHOCTH Ha nepH�epHHHOM ypoeHe. /lHCXYCCHff YqaCTHHKH fpynllbl npoaHanH3HPOBanH CTaTHCTffqeCKHe H 3nH.[lei,ornnorHqecKHe .[laHHbie O cnyqanx OTpae- neIOdl e rocy.11apcTeax - qneHax PerHoHa. EbllIH o0c}':1(,[lellb1 KOHKpeTHble npo5neMbl, CTORm;He nepe.11 cTpaHa- MH - yqaCTHHUaMH coeemaHHff H OTMeqeHbl onpe.11eneHHble pa3nffqHff B cnOll<HBDIHXCff B 3THX CTpaH�X CHTyaUHRX. fpynna pacCMOTpena eonpoCbl np�HJlaKTHKH OTpaeneHHH Ha YPOBHe nepBffqHOA Me.[IHKo-caHHTapHOH noMo­ DUi H onpe.[lenHJla no.[IXOJ:lhl K YAOBneTBOpe= paCTYDUiX noTpeOHOCTeA C yqeTOH npeeanHpYJ(lllero OTHomeHHR K npoOneMe, Hcnonb3yeMb1X MeTO.[IHK oOyqeHHR, 3KOHOMHqecKHX �aKTOPOB H HanHqHff pecypcoe. E= paccMoT- peHW nyTH npHeneqeHHR HaceneHHR K yqacT= B pemeHHH npoOneMbl. DbllIH TaK�e npoaHanH3HPOBaHbl qeTwpe ypoBHff opraHH3aUHH naOopaTOPllblX cn}'lltO, oOcY:1tJ:1ellbI uenH H MH­ HHMaJlbHble noTpeOHOCTH, eepoRTHbie npoOneMbl H nyTH HX pemeHHff, BblffBneHbl nonollCHTen&Hble H OTPHUaTen&- Hbie CTOPOHbl B3aHMO.[leHCTBHff cn}'lltO pa3nHqHoro YPOBHff. KpoMe Toro, 0bllla o5CY:ltJ:leHa OTHOCHTenbHaff ea�- HOCTb cn,'J!tO Ka:1t,11oro YPOBHff B KOHKpeTllblX ycnOBHffX. Ebllla npoaHanH3HPOBaHa opraHH3aUHR CHCTeMbl HanpaeneHHff 5onbHblX Ha neqeHHe H HH�OPMaUHR O cnyqa­ ffX OTpaeneHHH c yqeTOM reorpa�=ecKoro nono�eHHR, IIJIOTHOCTH HaceneHHff, noTpeOHOCTH o0mHHbl, HanHqHff Ka.QPOB (Henpo�eCCHOHaJlbHblX H cneUHanbHO no.[lrOTOBneHHhlX) H cpe.[ICTB TpaHcnopTa. Dblll paCCHOTpeH eon­ poc O 3HaqeHHH HCnon&3oBaHHff cqeTHO-B-HCnHTenbHOH TeXHHKH Ha HeCTHOM, perHoHanbHOM, HaUHOHanbHOM H MeJSD;yHapO.[IHOM YPOBHRX. Ilpe.11cTaBHTenH YHHBepCHTeTa - opraHH3aTOPbl coeemaHHff - npo.[leMOHCTPHPOBanH HMe�meecn B HX pacnopn•eHHH oOopy.110BaHHe H paccKa3anH o5 opraHH3aUHH CBff3H C TePMHHanaMH .[lpyrHx KOMl!b�TepoB B HTanHH. DblllH paCCMOTpellbl npoOneMbl TepanHH H peaOHJIHTaUHH; ponb .[IHarHOCTHqecKoro oOopy.11oeaHHff H nyHK­ TOB OKa3aHHff HHTeHCHBHOA noMoDUi; 5pHra.[IHaff paOoTa, B KOTOPOH npHHHMa�T yqacTHe pa50THHKH cneUHanH- 3HPOBaHHoA, o6meA H ecnoMoraTen&HoA Me.[IHUHHCKHX cn}'llt6; a TaK�e eonpOChl npo�HJlaKTHKH noBTOPHblX H XPOHffqeCKHX OTpaeneHHA. B XO.[le paOoTbl coee111aHHff 5blllH oOc}':1(,[leHbI eonpochl, CBR3aHHble C opraHH3aUHell HHTeHCHBHblX KpaTxo­ cpoqHhlX KYPCOB, nepHO.[IHqecKHX 3aHRTHA B CHCTeMe o5mero oOpa3oeaHHR H no.11rOTOBKH no npaKTHqeCKHM H TeopeT=ecKHM acneKTaM TOKCHKonorHH .11nn MeJ:IHUHHCKoro H ecnoMoraTen&Horo nepcoHana ecex KaTeropKA; All� npoeKTHPOBIItHKOB npe.11npHRTHA, npOH3B0.[lffDUiX H HCnonb3YIOll1;HX TOKCHqecKHe eemecTBa; MR YR3BHMblX rpynn HaceneHHR, B qacTHOCTH OepeMeHllblX •eHIItHH; MR rpynn noehlmeHHoro PKCKa, B qaCTHOCTH paOoTHH- KOB rrpoMbIIIIJleHHOCTH H cen&cKoro X03RACTea; H .11nn ecero HaceneHHR e uenoM. Ilonoll<HTen&HY� oueHKY noJiyqHJlH MeTO.[lhl opraHH3aUHH CTPYKTYPllblX CHCTeM OCHOBHoro oOyqeHHR H nOBbDDeHHR KBanH�HKaUHH, B paM­ KaX KOTOPblX .11a�TCff 3HaHHff no pa3nffqHbJM acnexTaM TOKCHKonorHH; cneUH�HqeCKHe MeTOJ:lhl oOyqeHHff nepco­ Hana 3.[lpaeooxpaHeHHff, paOOTHHKOB npOMbIIIllleHHOCTH H cen&CKOro X03ffHCTBa, O�HUHanbffhlX H .1100poeonbllblX COTPYJ:IHHKOB cn}'lltO oxpallbl 3.!IOPOBbff H HeTO.[lbl HCnOnb30BaHHff cpe.[ICTB MaCCOBOH HH�opMaUHH .[lnff pacnpocT­ paReHHff cpe.[IH HaceneHHff COOTBeTCTB�mHX CBe.[leHHA, a Ta�e nonynnpHOH HJlH cneUHanbHOH HayqHoA nHTe- paT)'phl. DbllIH swpa6oTaHbI npe.11no�eHHff no cee.11eHH� .[10 MHHHMYMa He.[IOCTaTKOB, npHCYDUiX Ka�OMY MeTO.[ly. - 50 - bbLJlO OTMe4eHO, 4TO BO MHOrHX cny4aflx HCnonb30BaHHe noBTOpfleMOH B ne4aTH HJlH n o panHo KPaTKOH, npoc- TOH H HarnflAHOH HH¢OpMaUHH MOJKeT cn~Tb ¢aKTOPOM, cnoco6cTBYffilllHM npenynpeJK,AeHHffi OTpaBneHHH, oco6eH- HO, ecnH TaKyffi HH¢OpMaUHffi naBaTb BO BpeMfl nepena4H OCHOBHblX COOhlTHH AHfl. 1 . HaneJKHbJe CTaTHCTH4eCKHe H 3nttneMHonorH4eCKHe naHHbJe noMoryT BhlflBHTb rpynnhl nOBhlllleHHOro PHCKa' onpenenHTb BpenHhle BemecTBa, npencKa3aTb B03MOJKHOCTb KPHTH4eCKHX CHTyauHH, nOM04b B nnaHHPOBaHHH npo¢HJlaKTH4eCKHX H npyrHX Mep 6opb0hl c OTPaBneHHflMH B CTpaHax. 2. IlpHMeHeHHe C4eTHO-Bbl'IHCnHTenbHOH TeXHHKH 3Ha4HTenbHO nOMOJKeT HaKonneHHffi, HCnOn b30BaHHffi, o6pa- OOTKe H pacnpocTpaHeHHffi naHHb1x; o6ner4HT o6MeH HH¢opMauHeH , oco6eHHO, ecnH HanaJKeHa CBR3b co cnyJK- 6aMH oxpaHw 3AOPOBbR pa604HX H cyne6HOH MeAHUHHbl HOT HHX nocTynaeT COOTBeTCTBYffimaR HH¢opMaUHfl; a TaKJKe o6ner4HT nocTaHOBKY AHarH03a H npoBepKy HaneJKHOCTH COBpeMeHHblX MeTOAOB ne4eHHR H nocnenyffi- mero Ha6nffineHHfl. 3. 'lTOObl CTaTHCTH4eCKHe naHHbJe ObLJlH 6onee nonHbJMH' HX cnenyeT COCTaBnflTb Ha OCHOBe OOlllHPHOH HH¢op- MaUHH, nonyqeHHOH B pe3ynbTaTe Tene¢oHHblX onpocoB, perHCTpauHH cny4aeB o6pameHHR B nyHKThl nepBOH noMOlllH H rocnHTanH3aUHH H naTonoroaHaTOMH4eCKHX HccnenoBaHHH . CTaTHCTH4eCKHe naHHble, nocTynaffil!lHe H3 ueHTPOB oxpaHbJ 3AOPOBbR pa6o4HX, MoryT TaKJKe OKa3aTbCR none3Hb!MH. 4 . CnenyeT npHnOJKHTb 6onbllle ycHnHH K TOMY, 4TOObl KOMMep4eCKHe opraHH3aUHH npenocTaBnflnH nonpo6HbJe naHHbJe O XHMH4eCKOM COCTaBe npenapaTOB, nocTynaffiJnHX Ha PblHOK . JKaTbCfl MHHHManbHblM Ha6opoM COOTBeTCTBYffilllHX naHHbJX. ToKCH4eCKHe nponyKTbl AOnJKHbl CHa6- 5. PyKOBOAHTenb ueHTpa no 6opb6e C OTpaBneHHflMH nonJKeH o6nanaTb MeAHUHHCKHMH 3HaHHflMH, 4TOObl OhlTb B COCTOflHHH pewaTb BOnpOCbl, KaCaffill\HeCfl o6ecne4eHHfl T04HOCTH HH¢OpMaUHH, ne4eHHR H nOMOII\H, o6paTHOH CBfl3H H T.n., C KOTOPbIMH CTanKHBaeTCR HaUHOHanbHOe 3APaBooxpaHeHHe . 6 . HHTerpaUHfl pa3BHBaBllJHXCR no CHX nop B OTphlBe npyr OT npyra ceKTOPOB B KOMnneKCHYffi HaUHOHanbHYffi TOKCHKOnOrH4eCKYffi cnYJ)(6y, n03BOnHT cornaCOBhlBaTb OCYJneCTBnfleMbJe MeponpHflTHR H nOBhlCHT b HX 3¢¢eKTHB- HOCTb, npH ycnoBHH o6ecne4eHHfl 3TOH CflYJ)(Obl HanneJKaJllHMH PYKOBOARJUHMH KanpaMH H C03AaHHR COOTBeTCTByffi- mero opraHH3Yffimero ueHTpa. 7. ~enaTenbHO YCTaHOBHTb KOHTaKThl H OCYmeCTBflflTb 06MeH HH¢opMaUHeH MeJK,Ay MeAHUHHCKHM H npyrHM nepcoHanoM, pa6oTaffill\HM B TOKCHKOnorH4eCKHX ueHTpax, C OAHOH CTOPOHbl , H lllHPOKOH o6meCTBeHHOCTbffi, C n pyroH, B uennx nOBhlllleHHR 9Ha4eHHR naHHOH CnYJ)(Ohl . 8 . TOKCHKOnorH4eCKHe ueHTPbl He AOnJKHbl ynenflTb cnHWKOM MHOro BHHMaHHfl npenynpeJK,AeHHffi no6pOBOflbHOro 3noynoTpe6neHHfl nexapCTBeHHblMH cpencTBaMH, nocxonbKY 3TY npo6neMY ner4e peWHTb cHnaMH npyrHX ueHT- POB. CnenyeT ynY4JJIHTb COTPYAHH4eCTBO C 3THMH ueHTpaMH, a TaKJKe cnYJ)(6aMH, o6ecne4HBaffilUHMH nocne- AYffi!llee ne4eHHe 6onbHhJX . 9. IlpenynpenHTb H npenoTBpaTHTb nonhlTKH CaMoy6HHCTBa - sana4a, Tpe6ylOIJlafl oco6oro BHHMaHHfl MenH- UHHCKOro H napaMenHUHHCKoro nepcoHana, 4neHOB ceMbH H lllHPOKOH o6mecTBeHHOCTH. CnenyeT HMeTb npencTaBneHHe O COUHanbH0-3KOHOMH4eCKHX ¢aKTOpax, KOTOphle MoryT OhlTb npH4HHOH nononHHTenbHblX nCHXH- 4eCKHX CTpeccoB. 10 . MeTOA 06Y4eHHR nonJKeH OCHOBbJBaTbCfl He Ha npenocTepeJKeHHflX 06 onaCHOCTH, a Ha Heo6XOAHMOCTH n oomPeHHfl H pa3BHTHfl y4aCTHfl H MOTHBHPOBaHHOCTH neHCTBHH . "MeTOA nHpaMHAbl" (HHHUHaTOPOM o6yqe- HHfl BhlCTynaeT ueHTP no 6opb6e c OTpaBneHHflMH, HaXOAflll\HHCfl Ha BeplllHHe nHpaMHAbl, a opraHH9yeTCfl OHa Ha KaJKAOM ypOBHe MeAHKo- caHHTapHOH nOMOII\H H Ha YPOBHe OOJnHHhl, HaxonnmeHCR KaK 6w B OCHOBaHHH 3TOH rHnOTeTH4eCKOH nHpaMHAbJ) MOJKeT Ob!Tb none3HWM MeTOAOM MOOHJ1H3aUHH HaceneHHfl Ha Y4aCTHe B nepBH'lHOH npo¢HnaKTHKe, HO npH 3TOM cnenyeT H96eraTb nepeHaCb!Il\eHHOCTH HH¢OpMauHeH. 11. naoopaTOPHhle HCnbJTaHHfl AOnJKHbl no B03MOJKHOCTH OCYmeCTBnflTbCfl Ha Bcex YPOBHflX, OAHaKo, ecnH HC- nhJTaHHe He MOJKeT Ob!Tb AOnJKHbJM o6pa30M OCYJneCTBneHO Ha KaKOM-TO H3 YPOBHeH, ero He cnenyeT npOBOAHTb iaoo6me, a o6pa3Ubl nnR HCnbJTaHHR AOnJKHhl Ob!Tb HanpaBneHbJ B na6opaTOPHH cneny)()[Qero YPOBHfl. 12 . CnaJKeHHOCTb pa60Thl Bcex 3BeHbeB TOKCHKonorH4eCKOH cnYJ)(Obl no3BOnHT o6ecne4HTb 3¢¢eKTHBHOCTb npOBOAHMblX effi MeponpHHTm! H HeOOXOAHMblH o6MeH HH¢opMaUHeH, npH 3TOM, onHaKo, cnenyeT 4eTKO onpene- nHTb 06fl3aHHOCTH KaJK,Aoro YPOB Hfl. 13 . Pea6HnHTaUHOHHOe o6cnYJ)(HBaHHe nonJKeH npOBOAHTb ueHTP no ne4eHHffi OCTpblX OTpaBneHHH H, KaK npa- BHJ1 0 , B Te4eHH e Bc ero nepHona npe6bJBaHHR 6onbHOro B OTneneHHH HHTeHCHBHOH noMOJllH. llnR ne4eHHfl 6onbHOro MOJKeT n o Tpe6oBaTbCR 6pHrana , COC TaBn eHHafl H3 npencTaBHTeneH pa3nH4HhlX AHCUHnnHH: ncHXHaT- PHH, OpTonenHH, o6meH H cneuHanbHOH XHpyprHH, ¢H3H4eCKOH MeAHUHHbl H T . n. , B 3aBHCHMOCTH OT KOHKpeT- - 51 - 14. Balt<HaH POJ!b TOKCHKOJ!OrHt1ecKoro ueHTpa 3aKJIIO'laeTCH B TOM' 'IT06bi HaHTH aJibTepHaTHBHhle nyTH 6opb- 6bi C 6btTytoll(HMH B HaCTOfllUee ape MR npHBbl'IKaMH. HeT CMblCJia HanaraTb 3anpeTbl ' KOTOpb!e TPYnHo aHenpHTb B n paKTHKY , 15. ,llrrn acex KaTerop11A Men11UHHCKoro 11 npyroro nepcoHana nomKHbl nnaHHpoaaTbCH HaUHOHaJibHhJe nporpaM- Mbl OCHOBHOH npen,nHnJIOMHOH H nocTnHnJIOMHOH nonroTOBKH a o6JiaCTH TOKCHKOJ!O!'HH H 6opb6b! c oTpaaneHHH- MH, Y'IHTb!Batoll(He perHOHaJibHb!e 11 HaUHOHaJibHble oco6eHHOCTH . 16. CnenyeT pa3pa60TaTb MOnYJIH o6yqeHHH nnH TOKCHKOJ!O!'OB pa3HblX cneuHaJibHOCTeH, HanpHMep cneu11a- J!HCTOB a o6JiaCTH KJ!HHH'leCKOH TOKCHKOJ!O!'HH H 3KCnepHMeHTaJibHOH TOKCHKOJ!O!'HH. 17. HauHOHaJibHb!H ueHTP no 6opb6e C OTpaaneHHHMH nomKeH B3HTb Ha ce6H HHHUHaTHBY B nene opraHH3aUHH H npoaeneHHH IIJlaHHpyeMbJX Ha HaUHOHaJibHOM ypoaHe nep11on11t1eCKHX KaMIIaHHA H nocTOHHHhlX MeponpHHTHH, uenb KOTOpb!X - 06ecnet1HTb pacnpocTpaHeHHe c6anaHCHPOBaHHOH HHcj,opMaUHH H opraHH3aUHIO aneKBaTHO!'O o6yqe HHH. 5!noaHTbJe aemecTaa 1 . Bo acex CTpaHaX ueHTpb! no 6opb6e c OTpaaneHHl!MH noJIJKHbl HMeTb cao6onHblH nocTyn K HHcj,opMaUHH , conepJKameA noJIHb!e naHHble O XHMH'leCKOM COCTaBe TOKCH'IHblX H noTeHUHaJibHO TOKCH'IHblX aemecTB. 2 . TTpH ueHTpe no 6opb6e C OTpaaneHHl!MH cnenyeT co3naTb ueHTpaJibHOe xpaHHJIH111e XHMH'leCKHX cl>OPMYJ!, B Tex cTpaHax, rne nono6Hoe xpaHHJIH!lle HaxonHTCH aHe ueHTpa, cnenyeT npenycMoTpeTb B03MOJKHOCTb npe- n ocTaaneHHH ueHTPY no 6opb6e c OTpaaneHHHMH Heo6xonHMOH HHcj,OpMaUHH no nepBOMY Tpe6oaaHHIO . 3 . XHMH'leCKHe ¢0PMYJibl nonJKHbl conepJKaTb caeneHHH 06 aKTHBHblX HH!'PenHeHTax ' a TaKJKe acex no6aaKaX, paCTBOPHTeJll!X H npyrHX aemecTaax, conepllCa!IIHXCH B nponyKTe . B HHX TaKJKe nomKHbl yKa3 b!BaTbCH 11cnonb- 3yeMb1e Ha MellC,r.yHaponHOM ypoaHe HaY4Hb1e , TOpl'OBble H o6menpHHHTble Ha3BaHHH , paBHO KaK H TO'IHOe KOJIH- '! eCTBO KallC,r.Oro aemecTaa. 0 nto6hlX H3MeHeHHHX B COCTaae cl>OPMYJ! cnenyeT HaMenneHHO coo6maTb B ueHTP no 6opb6e c oTpaaneHHHMH. 4 . CnenyeT rapaHTHPOBaTb KOHcl>HneHUHaJibHOCTb HHcj,OpMaUHH, npenocTaBJIHeMOH npoMbnuneHHOCTb!O , 5. TTpH pa3pa60TKe 3aKOHonaTeJlbC'rBa nnH HCnOJib30BaHHH npH paCKPblTHH cl>OPMYJI cnenyeT HCnOJib30BaTb B Ka"!eCTBe MonenH aHaJio rH'IHOe 3aKOHonaTeJ!bCTBO , npHHHTOe B OTHomeHHH neKapCTBeHHb!X cpencTB. Jla6opaTOPHH 6 . KJIHHHKo- cj,apMaKOJ!OrH'!eCKHe H TOKCHKOJ!OI'H'leCKHe aHaJIH3bl aeCbMa CXOJICH Me)l(,r.y co6oA . H,r.eHTH'I HYIO MeTonHKY npoaeneHHH a HaJIH30B H cj,aKT HCnOJlb30BaHHH aHanorH'I HOI'O o6opynoaaHHH, rrpencTaa - Jll!eTCH uenecoo6pa3HblM o6benHHHTb 3TY pa6oTy. 7. B HaUHOHaJibHOM MaCmTa6e cneu11aJIHC TaM acex YPOBHeA MenHKo - caHHTapHOH IIOMOll(H cnenyeT COTPYnHH- 'laTb a nene orrpeneneHHH Tex na6opaTOpHblX HCCJienoaaHHH, rrpoaeneHHe KOTOPblX Ha116onee IIOJ!HO COOTBeT- CTByeT IIOTpe6HOCTHM H pecypcaM TOH HJ!H HHOH CTpaHbl. 8 . HaUHOHaJibHble yqpe)l(,r.eHHH' BblCTynatoll(He B Ka'leCTBe crrpaBO'IHblX ueHTPOB' nomKHbl rrpoaonHTb crreu11an11- 3HPOBaHHble aHaJIH3bl, KOTOPble He MOryT 6b!Tb rrpoaeneHbJ Ha nPYI'HX YPOBHHX' a TaKllCe nomKHhl pacnonaraTb o6opynoaaHHeM nnH HayqHh1x 11ccnenoaaHHH. 3JieKTPOHHaH o6pa6oTKa naHHblX 9 . CnenyeT paCmHPHTb 6aHKH naHHblX . Ee Tb orrpeneneHHb!e rrpeHMYffieCTBa a HaJIH'I HH OTneJibHOro KOMIIbto- Tepa (HJ!H aneKBaT HOI'O 06beMa 3ape3epa11poaaHHOI' O rrpocTpaHCTBa), rrpenHa3Ha'leHHOro HCKJ!IO'IHTeJibHO nnH TOKCHKOJIOrH'leCKHX CJ!YllC6 , KO TOPb!H conepllCaJI Obi naHHble O CJiy'laHX OTpaaneHHH HapHny C naHHblMH O XHMH- '!eCKOM COCTaae nponyKTOB, MeTonax net1eHHH , 6116n11orpacj,HH H T.n. HHcj,OpMaUHto KOHcl>HneHUHaJibHO ro xa- paKTepa MOJICHO 6yneT IIOJIY'IHTb J!Hillb c IIOMO!llb!O crreUHaJibHOro Kona . 10. TTocKOJlbKY 60J!bmal! 'laCTb HHcj,OpMaUHH O cnyt1al!X OTp aaneHHH He HOCHT KOHcl>HneHUHaJibHOI'O xapaKTepa, cnenyeT CTHMYJIHpOBaTb Me)l(,r.yHaponHoe COTPYnHH'leCTBO rryTeM ycTaHoaneHHl! CBH3eH MellC;.y 3JleKTPOHHO- Bbl- t{HCJ!HTeJibHb!MH ueHTpaMH c yt1eTOM Heo6xonHMOCTH 06ecrret1eHHH KOHcj,HneHUHaJibHOH HHcj,OpMaUHH . 11. CnenyeT pa3pa60TaTb crreuHaJibHYIO KOMIIb!OTOPHYIO nporpaMM)' nnH MellC;.yHaponHoro 6aHKa naHHblX, ynenHB IIpH 3TOM HannellCamee BHHMaHHe H3blKOBO H rrpo6neMe H aonpocy CTaHnapTH3aUHH TepMHHOJ!OI'HH nnH rrpenyrrpellC- neHHll OUIHDOK , MOrymHX B03HHKHYTb 113 - 3a HaJIH'IHH CJ!HIDKOM DOJlblliOI'O 'IHCJ!a CHHOHHMOB, - 52 - 12. Cne,a;yeT pa3BHBaTb COTPYAHH'¾eCTBO' KOHTaKTbl H o6MeH HH(j>OpMal.\HeH Me)l(,Il;y OTBeTCTBeH HblMH flHl.\aMH' 3aHHMaWIIIHMHCH npo6neMaMH OCTPblX OTpaBneHHH H npo6neMaMH XPOHH'leCKHX OTpaBneHHH (HanpHMep , pa6oTHH- KaMH TOKCHKOnorH'¾eCKHX ueHTPOB no 6opb6e c OTpaBneHHHMH H cn)IJIC6 oxpaHhl 3,IJ;OPOBbH pa60'¾HX). 3aKOHO,IJ;aTenbCTBO 13. HauHoHanbHblH ueHTP n o 6opb6e C OTpaBneHHHMH, KOTOPblH pacnonaraeT KOHKpeTHOH HH(j>OpMauHeH 0 Bcex cny'laHX OTpaBneHHH H conyTCTBYWIIIHX HM 06CTOHTenbCTBax, ,IJ;OJD!CeH OKa3blBaTb npaBHTenbCTBaM KOH- cynbTaTHBHYW noMOWb npH paspa60TKe 3aKOHO,IJ;aTenbCTB B o6naCTH TOKCHKonorHH. 06yqeHHe H no,a;roTOBKa 14 . Heo6XO,Il;HMO Bbl,Il;enHTb COOTBeTCTBYKX!lHe (j>HHaHCOBble cpe,IJ;CTBa H npe,a;ocTaBnHTb ,a;pyrHe nbrOTbl B uenHX co,a;eHCTBHH noBb!IlleHHW 3HaHHH Bpa'leH ooweH npaKTHKH H ,a;pyrHX pa60THHKOB s,a;paBooxpaHe HHH, oco6eHHO Ha YPOBHe nepBH'¾HOH Me,IJ;HKo- caHHTapHOH nOMOlllH, B o6naCTH TOKCHKOnorHH H npHBne'¾eHHH 60nbwero '¾Hen~ cny - waTeneH Ha KYPCbl nOBblilleHHH KBanH(j>HKal.\HH H opHeHTal.\HH . 15. B uenHX o6ecne'¾eHHH 3q,q,eKTHBHOCTH nnaHHpoBaHHH H ocywecTBneHHH nporpaMM o6yqeHHH ,IJ;nH nepCOHana s,a;paBooxpaHeHHH, ,a;o6pOBOflbHblX pa60THHKOB H HaceneHHH cne,a;yeT BblHCHHTb, B KaKOH KOHKPeTHOH HH(j>OpMal.\HH HCnblTblBaWT n o Tpe6 HOC Tb ueneBble rpynnbl . 3q,q,eKTHBHOCTb saBepweHHOH nporpaMMbl ,a;omicHa oueHHBaTbCH n y - TeM npoBe,a;eHHH nepHO,Il;H'¾eCKHX oueHOK . 16 . HaceneHHe H npe,a;cTaBHTenH cpe,IJ;CTB MaCCOBOH HH(j>OpMal.\HH ,Il;OJDICHbl HMeTb B03MO~HOCTb CBH3aTbCH no Tene(j>oHy c ueHTPOM no 60pb6e c OTpaBneHHHMH H nonyqHT b OTBeTbl Ha HHTepecywl!lHe HX BOnpOCbl; B OT,a;enb- Hb!X cnyqaHX nonpoCHTb ,a;aTb OTBeTbl Ha no,a;OOHbie BonpOCbl MO~HO BpaqeH o6weH npaKTHKH, '¾TO nocn~T CTH - MYflOM K nOBb!IlleHHW KBanH(j>HKal.\HH H npoBe,IJ;eHHW npOCBeTHTenbCKOH pa60Tbl cpe,a;H flHI.\, 3aHHTepeCOBaHHbIX B nonyqe HHH OTBeTa Ha CBOH sanpOCbl . 17. ITpH pacnpocTpaHeHHH HH(j>OpMal.\HH qepe3 o(j>HI.\HanbHhle KaHanbl HnH C nOMOWbW cpe,IJ;CTB MaCCOBOH HH(j>op- Mal.\HH cne,a;yeT noMHHTb o Heo6XO,IJ;HMOCTH npe,a;oCTaBneHHH c6anaHCHPOBaHHOH HH(j>OpMal.\HH, '¾TO HCKflW'lHT Bos- MO~HOCTb nOHBneHHH naHH'¾eCKHX HaCTpoeHHH cpe,a;H HaceneHHH. 18 . UeHTPbl no 6opb6e c OTpaBneHHHMH B npOMbimneHHO pasBHTblX CTpaHax ,IJ;OJDl(Hb] no,a;enHTbCH BCeM HaKon- neHHblM OTiblTOM C ,a;pyrHMH rocy,a;apCTBaMH' KOTOPbie opraHH3YWT HnH nnaHHPYWT MeponpHHTHH no 60pb6e C oT- paBneHHHMH. 19. ITOMOWb B opraHH3al.\HH TaKoro COTPYAHH'¾eCTBa MoryT OKa3aTb B03 H HenpaBHTenbCTBeHHble opraHHsa- 1.\HH, TaKHe, KaK BceMHpHaH q,e,a;epal.\HH acCOI.\Hal.\HH pa60THHKOB KflHHHKO-TOKCHK onorH'¾eCKHX ueHTpOB H UeHTPOB no 6opb6e c oTpaBneHHHMH. 20. Cne,a;yeT pasBHBaTb COTPYAHH'¾eCTBO, a TaK~e o6MeH HH(j>OpMauHeH H onbJTOM Ha ABYCTOPOHHeH OCHOBe. - 53 - CeMHHap no npo6neMe HenocTaToqHoCTH rnroKo3o- 6- ¢oc¢aTHO r o ne rHnporeHe3a AAaHa , TYPUHR, 20- 22 OKTR6pR 198 1 rona - 55 - ICP/ MPD 0 12(S) 1 neKa6 pR 198 1 rona 0 PH rn HAJJ : AH r JJHfl C Kl1fl CeMHHap 6 blII opraHH30BaH Eapon eHCKHM perHOHanbHh!M 6ropo B03 B COTPYAHHqeCTBe C MHHHCTepCTBOM 3npaaooxpaHeHHR H COUHanbHOH nOMOWH B AHKape, C MeAHUHHCKHM ¢aKynbTeTOM YHHBepCHTe Ta UyKypoaa, C npencTaBHTenRMH pa3ITttqHblX rocynapCTB, HeCKOITbKHX YHHBepCHTeTOB TYPUHH, C HaUHOHanbHO H nporpaMMOH TYPUHH no 6 opb6e c ManRpHeH, a Ta!OKe a COTPYAHHqecTae c B03 . B KaqecTae Ha6nronaTeneH Ha ceMHHape np HCYTCTBOBanH MHOrHe yqeHble-MeAHKH H CTYAeHTbl H3 YHHBepCHTeTa UyKypoaa , Uenb coae111aHHR 3aKnroqanacb B nonroTOBKe PYKOBOARIIIHX yKa3aHHH AITR HHAHBHnyanbHblX H 06111ecTBeHHblX MeponpHRTHH a o6nacTH 3npaaooxpaHeHHR no 6opb6e c ManRpHeH H n p yrHMH 3a6oneaaHHRMH a cTpaHax, r ne HenocTaToqHoCTb rnroK03o-6-¢oc¢aTHoro nerHJJ;poreHe3a ( r6$[1) npencTaanReT npo6neMY, HMeR npH 3 TOM a BHJJ;Y, B qac THOC TH, qTo TaKaR Henoc TaToqHQCTb 3aTPYAHReT H nenaeT He6e3onacHOH neKapCTBeHHYW npo¢H- naKTHKY H neqeHHe ManRpHH (KaK B HayqHOM, TaK H B 3THqeCKOM nnaHe), a TaK~e TO, qTo 3 Ta HenocTaToq- HOCTb, KaK 6b1Jl0 ycTaHoaneHo, WHPOKO pacnpocTpaHeHa cpenH oTnenbHblX rpynn HaceneHHR , TaKHX KaK 3 THH- qecKHe rpynnb1, npo~Haaro111He B npOBHHUHH KYKYPOBa B TypUHH, 0CH OBHblMH TeMaMH AHCKYCCHH 6blIIH: " Oo111He acneKTbl HenocTaToqHQCTH r6$[1", "EHOXHMHqec KHe acneK - Tbl HenocTaToqHQCTH r6$[1", "ManRpHR H Mepbl no npo¢HnaKTHKe HenocTaToqHQCTH r6$[1 , neqeHHe ManRpHH a cnyqaRx HenocTaToqHocTH r6$[1" H "llpo6neMb1 HenocTaToqHocTH r6$[1 H peKoMeHnauHH" . EblIIO npencTaane- Ho TPHHanuaTb CaMOCTORTenbHblX AOKnanoa no naHHOH TeMe . Ha coae111aHHH OblIIH npenno~eHbl cnenyro111He OCHOBHble peKOMeHnaUHH: 1 . B TypeuKOH npOBHHUHH UyKypoaa HMeroTCR ' no Kpai:lHei:l Mepe' TPH pa3nHqHb1e HCcnenoaaTenbCKHe rpynnbl' 3aHHMaro111HeCR npo¢HnaKTHKOH HenocTa ToqHQCTH r6$[1, ace OHH 3aHRTbl pa3pa6oTKOH onH3KHX no conep~a HHW TeM. Heo6XOAHMO o6ecneqHTb KOO PAHHaUHJO nei:l cTBHH 3THX rpynn B npoaeneHHH npencTORIIIHX Hccnenoa aHHH HeAOCT a ToqHQCTH r6$[I . 2 . Heo6xonHMO Ha3HaqHTb MeAHUHHCKHH ¢aKynbTeT UyKypoaa COTPYAHHqaroWHM ueHTPOM B03 AITR HCfiblTaHHR HOBhlX neKapCTBeHHblX cpencTB C uenbro HX 6e3onacHo ro HCfiOITb30BaHHR ITHUaMH C HenocTaToqHQCTbW r6$[1. B 3TOM cnyqae ¢aKynbTeT eiyneT nonyqaTb noMOlllb co CTOPOHbl B03 H 6yneT BbinOIT HRTb ¢YHKUHH ueHTpa no KOOPAHHaUHH naHHOH neRTeIT bH OC TH . 3. Pa3 a TPH rona cnenyeT npoaonHTb noA06Hb1e coae111aHHR a pa3nHqHb1x c TpaHax , rne WHPOKO pacnpocT - paHeHa HenocTaToqHoCTb r6$[1 (MecToM npoaeneHHR cnenyro111ero coae111aHHR Morna obi o blTb HTanHR) . 4. OnacHOCTb npHMaKBHHa Hera B03AeHCTBHe Ha ITHU C HenocTaToqHQCTbW r6$[1 , a TaK~e Bbl6op MeTOAOB neqeHHR 3THX nroneH cnenyeT pa3bRCHRTb HaceneHHW n poBHHUHH UyKypoaa , HCfiOITb3YR npH 3TOM TeneBHAeHHe, panHo H MecTHyro npeccy. anR oonee 3¢¢eKTHBHoro ocY111ecTaneHHR naHHOH nporpaMMhl HeooxonHMO npHaneqb K yqaCTHW B 3 TOH KaMnaHHH npenonaaaTenbCKHH COC Taa H MeCTHble rpynnbl penHrH03HO HaCTpoeHHblX nroneH. llocKonbKY HenocTaToqHoCTb r6$[1 pacnpocTpaHeHa a nepeaHRX 3TH-Tropx, naHHaR xaMnaHHR no=Ha npe~e acero npOBOAHTbCR B 3 THX nepeBHRX. Ocooble YCHnHR cnenyeT npHno=Tb K TOMY, qTQObl nporpaMMa WHpo- KO oxaaTbIBana Te paH0Hb1, rne OTMeqeHo pacnpocTpaHeHHe n aHHOH HenocTaToqHocTH. s. C uenbro npoaeneHHR CKP HHHHr a cne nyeT npHMeHHTb ¢nopHCUeHTHblH TeCT (oH ~ e npHMeHReTCR B npo - BHHUHH Uyxypoaa). NBT-uHTOXHMHqecKHl1 TeC T MO~eT 6b1Tb, TeM He MeHee, Hcnonb30BaH B KaqeCTBe no - nonHHTen bHOro TeCTa . IIocKOITbKY a MeCTHblX na6opaTOPHRX OTCYTCTBYWT cqeTqHKH KoynTepa , KOnHqecT - BeHHOe onpeneneHHe HenocTaToqHQCTH r6$il cnenyeT BbinOITHRTb a COOTBeTCTB HH c ycoaeprueHCTBOBaHHblM Me - TOAOM UH HKaMa, KOTOPbIH TaK~e oblJl peKoMeHnoaaH B03 . B Te x cnyqaRx , onHaKo , Karna naoopaTOPHH pacnonararoT cqeTqHKOM KoynTepa , npennoqTHTeITbHblM 6blIIO Obi HCnOITb30BaHHe npyrHX MeTOAOB H3MepeHHR YPOBHeH 3H3 HMa 3pHTPOUHTOB . - 56 - 6 . nnH OUeHKH B03AeHCTBHH pa3nH4HblX BHAOB IlPHMaKBHHa Ha flHU, CTpa,ua~Jll}iX HeAOCTaT04HOCTb~ f6$n B TYPUHH, He06XOAHMO npoBeCTH KflHHH4eCKOe HccneAOBaHHe C y4eTOM HHJKecneAYIODlero: a) BBeAeHHe OAHOH HeAenbHOH A03bl npHMaKBHHa BMeCTO ellCeAHeBHblX A03; 6) npHMeHeHHe AancoHa B Ka4eCTBe anbTepHaTHBHoro npHMaKBHHY neKapCTBeHHoro npenapaTa AflH n HU, CTpaAa~mHX HeAOCTaT04HOCTb~ f6$n ; B) H3MepeHHe YPOBHH ceneHa y nHu, CTPaAa~mHX HeAOCTaT04HOCTb~ f6$n, a TaKllCe onpeAeneHHe B03- AeHCTBHH BBeAeHHH ceneHa Ha BbDKHBaHHe 3PHTPOUHTOB y nHU C HeAOCTaT04HOCTb~ f6$n npH npoae- AeHHH 3KcnepJ{MeHTa n o nepeJCpeCTHOMY nepenHBaH= KPOBH . 7. BTopoe ne4eHHe C uenb~ npeAOTBpaJ!leHHH peUH,QHBa, o6hl4HO npOBOAHMOe B TYPUHH B 3HMHHe MeCHUbl ( 3HMHee Pa.JlHKanbHOe ne4eHHe ) , He cneAyeT npOBOAHTb TaM, rAe HeAOCTaT04HOCT b r6~n HBnHeTCH npo 6neMOH. 8. Heo6XOAHMO npoBeCTH H3y4eHHe pacnpocTpaHeHHOCTH HeAOCTaT04HOCTH f6$n cpeAH pa3nH4HblX rpynn Ha- ceneHHH TypUHH, BKn~4aH pa604HX MHrpaHTOB. - 57 - MELU1KO- CAHHTAPHOE 3AKOHOLIATEJlbCTBO Ko HC y.llbTaTHBHblH KOMHTeT no Me,a;HKO- CaHHTapHOMy 3aKOHOAaTeJibCTBY - 59 - ICP/ HLE 002 (S) 14 mo.11n 1981 roAa OPIITliHAJI: ~PAHUY3C!Ofil ~aHHaH BCTpeqa HBH.llaCb rrepBblll COBemaHHeM KoHCY.llbTaTHBHOro KOMJITeTa no MeAHKO-CaHHTapHOMy 3aKO-- HOAaTe.llbCTBY, opraHH30BaHHblll B COTPYAHHqe cTBe C npaBHTe.llbCTBOM repMaHCKOH ~eMOKpaTnqec KOH Pecny6- ,ml!CH . Ha COBemaHHH npHCYTCTBOBaJIH 12 3KcnepTOB H3 11 CTpaH PerHOHa: PYKOBOAHTeJIH o6meCTBeHHOro 3ApaBooxpaHeHHH 11 3KCnepTbl B 06.11a CTH 3aKOHOAaTeJibCTBa ( O<!>HnHa.llbHble npeACTaBHTeJIH MJlHHCTepCTB 3Apa- sooxpaHeHHH H yqeHb1e) . C03AaHHe KOHCY.llbTaTHBHOro KOMllTeTa HaAJieXHT paccMaTpHBaTb KaK MeponpHJITHe no yKpen.11eHlilO npor- PW<Mbl 803 no MeAHKO-CaHHTapHOMy 3aKOHOAaTe.llbCTBy, qTo o6cyxAaJIOCb Ha ceCCHHX BceMllpHOH accaM6JieH 3ApasooxpaHeHHH s 1977 rOAY (WHA30 . 44) 11 B 1980 roAy (WHA33 . 28). 803 npH3HaJia, qTO ycTapeBmee MeAHKO-CaHHTapHoe aaKOHOAaTe.llbCTBO MOXeT HBHTbCH npenHTCTBHeM AJIH AOC TruteHHH 3AOPOBbH AJIH scex Ha HanHOHaJibHOM ypOBHe II 6b(Jl0 OTMeqeHO, qTo COOTBeTCTByromee MeAHKO- CaHHTapHoe aaKOHOAaTe.llbCTBO HB- JIHeTCH BaxHblM KOMnOHeHTOM KaK c.11yx6 3ApaBooxpaHeHHH, TaK II r11rneHbl OKPYXaI<llleH cpeAbl. EBponeHCKOe per110Ha.1IbHOe 6ropo nepBblll Ha3HaqHJIO perHOHa.llbHOl'O CO TPYAHHKa no sonpocaM MeAHKO- caHHT a pHOl'O 3aKOHaAaTe.llbCTBa, COCTaBH.110 cpeAHecpoqayro nporpaMMy B 06.11aCTH Me,ll;HKO- CaHIITapaoro 3aKO- HOAaTe.llbCTBa H C~OpMllpOBa.110 KOHCy.llbTaTHBHblH KOMllTeT no 3TOMY sonpocy. r.11aBHaH ne.11b COBemaHHH 3aKJllOqaJiaCb B TOM, qT06bl o6MeHHTbCH MHeHHeM OTHOCHTe.llbHO nporpaMMbl Pe- rHOHa.llbHOro 6ropo rro MeAHKO-CaHHTapHOMY aaKOHOAaTeJibCTBy Ha 1980-1985 rr. ITpexAe scero q.11eHbl KOMHTeTa OCTaHOBHJIHCb Ha o6meM paCCMOTpeHHH MeAHKO-CaHHTapHoro 3aKOHOAa- Te.llbCTBa, 11 nepeA TeM , KaK Bbipa6oTaTb OKOHq aTe.llbHble peKOMeHAamm,o6cyAHJIH cpeAHecpoqayro nporpa1£My. 1. 06mee paCCMOTpeHHe MeAHKO-CaHHTapttoro 3aKOHOAaTe.llb CTBa 1.1 MeAHKO- caHHTapaoe 3aKOHOAaTeJibCTBO 11 "3AopoBbe AJIH Bcex B 2000 rOAY" MeAHKO-CaHHTapHoe aaKOHOAaTeJibCTBO CJIYXHT o qeHb BaxHblll HHCTpyMeHTOM AJIH ocymeCTBJieHHH TaKO H IlOJraTHKH B 06.11aCTH 3ApaBooxpatteHHH, rrpH KOTOPOH BO r.11aey yr.11a CTaBHTCH qe.11oeeK H o6mecTBO. HHe TaKoro 3aKOHOAaTe.JlbCTBa - He CaMOneJib , a JIHmh 0,.!UIH H3 llHCTpyMeHTOB, KOTOphlH MO~eT 6 &ITb HCilOJib - 30BaH AJIH ocymeCTBJieHHH AaHHOH nOJIHTIIKH B 06.11aC TH 3ApaBooxpatteHHH. MeAHKO-CaHHTapaoe 3aKOHOAaTe.llbCTBO MOXeT BHeCTH BaxHblH BKJiaA B perHOHa.llbHYID CTpaTermo AJIH AOC - Trute HHH neJIH "3AOP0Bbe AJIH BCex K 2000 l'OAY", oco6eHHO B c.11eAyromHX 06.11acTHX : 1.1. 1 OxpaHa 3AOpoBbH r JiaBHa.H n;e.Jlb 3aKJllO'tlaeT CJI B TOM' 't{T06bt 381IlHTHTb qeJIOBeKa OT OIIaCHOCTeH t Ha KOTOp1,1e OH C a.M MOJK.eT OKa3aTb .milb orpaHHqeHHOO B03AeHCTBHe (HJIH HHKaKoro soo6me) HJIH C KOTOpblllH OH He B COCTOHHHH CaM 6opOTbCH . B oqeHb o6mnx qepTax 3 TO KacaeTCH y.11yqmeHHH OKpyxarome n c peAbl, B KOTOpOH Mb! ,arneM. 1. 1 . 2 CTHMy.11npoaaane o6 paaa ><H3HH 1 6.11aronpHHTHO aoaAeHCTBylOlllero Ha 3AopoBbe 3TOT MOMe HT n oApaaYMeBaeT C03AaHHe ,no6b!X CTHMY.1108 AJIH OTAe.llbHblX ,mqHOCTeH II rpynrr HaceJieHHH 113MeHHTb npHBblqKH, He c rroco6 c TBY1()111He 3AOPOBbID H seCTH 60.11ee 3AOP0Bb!H o6paa ><H3HH . MeAHIUIBCKHe pa60THHKH H, B CBOID o qepeAb, nO.IIHTHqecKHe AeHTeJIH OC03HaJIH, qTo oco6ettHO B npOMbllilJieHHO-pa3BHTblX CTP BHax , HMeHHO nyTeM H3MetteHHH npHBblqeK, MOXHO 6yAeT AOCTHrHyTb 60.11ee COBepmeHHoro COCTOHHHH 3AO- POBbH HaceJieHHH. - 60 - 1.1.3 PaccMaTpHBaR 3TOT BOnpoc, lJJieHbl KoMHTeTa o6paTHJlliCb K OT'leTy MeJK)lyHapO,llHOH ICOH(!JepeHnHll no nepBH'I- HOH Me,ll;HICO-caHHTapHOH nOMOIIIH (AJwa-ATa, 6-12 ceHTR6pR 1978 ro.11a), B ICOTOPOM oco6o no.11qepICHBaJIOCb 3H8QeHHe 38KOHOASTe~bCTBa. 1.1.4 µocTynHOCTb cJivJK6 MeAHICO-caHHTapHOH noMomH llT06b! COOTBeTCTByIDIIIHe CJ1yJK6~1 M6',l\HltO-CaHHTapHOH nOMOl!IB npHHOCHJIH IIOJ!b3y et! noTpe6HTeJIRM ' IIOCJie,ll- HHM CJ1e.11yeT o6ecnetmTb paBHyto ,ll;OCTynHOCTb BCex 3THX CJiyJK6. IlpH HaJIH'IIDI npaBHJlbHOro 3aICOHO,llaTeJib- CTBa MOJKHO 6y,ll;eT o6ecnelJHTb ,ll;OCTyTIHOCTb 3THX CJiyJK6 JtaK B nJiaHe reorpa(!JH'leCICOM, TaK H B COi.HaJibHOM- H (!JHHaHCOBOM. 1.2. He1t0Tophle npo6J1em1 ceroAHmnHero AHR B Me,llHICo-caHHTapHOM aaICoHOAaTeJibCTBe llJ!eHhl KoMHTeTa TaICJKe o6cy,ll;HJIH xpyr CYIIleCTBymIIIHX B HaCTOmnee BpeMR npo6JieM, OTHOCJ!mHXCR IC Me)IHKO- caHHTapHOMy 3aKOHO,llaTeJibCTBY B pa3JIH'IHbIX CTpaHax . 1. 2 . 1 C O,ll;HOH CTOPOHhl Ha)IJieJKHT npnJIOJKHTb yCHJIHR IC TOMY' 'IT06b! 6b!JI H3,llaH 06111BH 3aKOH O Me,llHICO-CaHHTap- HOM o6cJiyJKHBaHHH, OXBaThlBaIOillHH Bee acneKThl HaD;HOHaJibHOr o 3,llpaBooxpaHeHHR. C ,ll;pyroH CTOpOHhl , noJia- rruoT , qTO no Mepe B03MOXHOCTB, npaBHA8, HMerom.ne HenocpeACTBeHHOe B03AeHCTBBe Ha qeAOBeKa AOJUCHM onpe,ll;eJIRTbCR Ha MeCTHOM YPOBHe. 1. 2 . 2 MaoronJiaHOBaR npHpO,ll;a ICOHnennHl! 3,llpaBooxpaHeHHR Bhl3hlBaeT Heo6xo,llHMOCTb ycoBepmeHCTBOBaTb ICOOp- )1.HHa= MelK,ll;y pa3JIH'IHhlMll MHHHCTepCTBaMH, OTBeTCTBeHHhlMll 3a COCTaBJieHHe 3aICOHO,ll;aTeJibCTBa HJ!li npaBHJI, KaCruomHXCR 3,ll;paBooxpaHeHHR HJIH 6JIH3KHX K HeMy acneICTOB . Bo MHOrHX CTpaHax npH,ll;eTCR no HOBOMy opraHH3OBaTb pyKOBO,ll;Rl!IBe opraHhl 3,ll;pasooxpaHeHHR H Ha,ll;- JieJKHT BHe,ll;pHTb HOBoe 3aKOHO,llaTeJihCTBO C TeM , 'IT06hl yxpenHTb ICOOp,llHHHpy,am;yto pOJib OT,ll;eJIOB 3,ll;paBOOX- paHeHHR H ,ll;pyrHX 3JieMeHTOB HaIIHOHaJihHOH ceTH. t .2 . 3 YllaCTHe o6mecTBeHHOCTH RBJIReTCR Heo6xo,llHMhlM B BH,ll;Y onpe,lleJI~HHOro xapaKTepa npo6JieM 3,ll;paBooxpa- HeHHR, KOTOphle Tpe6ytoT He TOJlbKO noHHMaHHR co CTOPOHhl HaceJieHHR , HOH aeo6XO,l\HMOH ,l\JIR HX pemeHHR no,ll;AepxICH. BO3HHKaeT Bonpoc, ICaKHM o6pa30M, JIHna, npe,llOCTaBJIJDOOIHe Me,ll;HICO-CaHHTapHyto IlOMOillb H Jlliila, el! Il0Tpe6JIJU0111He, MOryT 6hlTb npHBJie'leHM IC yqaCTHIO B onpe,lleJieHHl! IIOJIHTHKH B o6JiaCTB 3,ll;paBooxpaHeHHR HK npHHRTHIO pemeHHH. l . 2 .4 Ilpo6JieMa npas 6oJibHbIX Bo MHOrHX CTPaHax OID,YlllaeTCR IIOTpe6HOCTb HaceJieHHR B lJeTICOM onpe.11eJ1eHID1 npaB 6oJibHbIX: npaBO Ha noJiy'leHHe HH(!JOpMaflHH, npaBo, oxpaHJDC111ee qeJioBeICa OT 'lhero-JIH6o BMemaTeJibCTBa Bero JIH'IHyto JKH3Hb, apaBO CB060,ll;bl Bb16opa. npaBO OTICa3aTbCR OT JielJeHHR H T. )I. 1. 2. 5 Ilpo6JieMa ~HHaHCHpoBaHHR CJlyJK6 Me,ll;HKO-CaHHTapHOH noMOSH BOJibillOH pa3phlB, CYIIleCTBy,am;HH B HaCTomnee BpeMR, Me x,ll;y BO3MOJKHOCT.fD<H CJiyJK6 3,llpaBooxpaHeHHR H BO3HHKillHMH HOBhlMH IIOTpe6HOCTRMll B 60JibillOH CTeneHH ,ll;OJIJKeH 6y,ll;eT CO KpaTHTbCR C yBeJIH'leHHeM 3cp(!JeKTHB- HOCTH CY111eCTByIDIIIHX B HaCTomnee BpeMR CHCTeM H C nepepacnpe)leJieHneM cpe,ll;CTB, 'ITO C,ll;eJiaeT BX 60J1ee 3 cp(!JeICTHBHblMH B IlJiaHe CTOHMOCTH, a TaICJKe nyTeM CHHJKeHHR H3JIHmHeH Harpy3KH, ltOTOphle HecyT CJiyJK6hl 3,ll;paBOOxpaHeHHR B aacTomnee BpeMR , 'ITO RBHJIOCb pe3yJihTaTOM CJia6oro HHTepeca B npomJIOM K npo(!JHJiaICTHJte , 3ICOHOMH'leCICaR CHTyanHR' ICOTOpyto Mb! nepeJKHBaeM B HaCTOJDnee BpeMR ' npH3bIBaeT K COOTBeTCTByKID,e><y nepecMOTpy MHOrHX IlOJIOJKeHHH ,ll;eHCTBy,am;ero B HaCTomnee BpeMR Me,llHKO-CaHHTapaoro 3altOHO,ll;aTeJibCTBa. 1.3. KoMDOHeHTbl Me,ll;HKO-CaHHTapaoro 3aKOHOAaTeJibCTBa llJieHhl KOMHTeTa onpe,ll;eJIHJIH meCTb rJiaBHbIX KOMnOHe HTOB Me,ll;HICO-CaHHTapHoro 3aKOHO)laTeJibCTBa: OICpy- xruomaR cpe.11a; noTpe6HTeJIH; JIHna, npe,llOCTaBJIJllOIIUle Me,ll;HKO-CaHHTapHyto noMomb; yqpex,lleHHR; p e ryJIHpy,am;ne a paBHJia BJlaCTH; (!JHHaHcnpoBaHne (ICannTaJIOBJIOJKeHHR n TeICYIIIHe paCXO,llbl) CJiyJK6 Me)IHKO-CaHHTapHOH DOMomn. - 61 - 1.4. KOHTeKCT MeAHKO-CaHHTapttoro 3aKOHOAaTeAbCTBa 1.4.1 MeAHKo-caHHTapttoe 3aKOHOAaTeAbCTBO H cogttaAbHaH, nOAHTaqecKaH, 3KOHoMHqecKaH, KVAbTVpttatt H HCTopaqecKaH CHCTeKhl MeAHKO-CaHHTapttoe 3aKOHOAaTeAbCTBO B AaHHOH CTpaHe AOJIJl(HO paccMaTpHBaTbCH B CBeTe e~ COUHaAb- HhIX t no..1mTHtteCKHX H 3KOHOMHt.IeCKHX CHCTeM, a T8KJl(e e~ KYJibTypbI H HCTOpHH. HcxO.l(JI H3 3TOro, Mbl MO- xeM OTMeTHTb 3HaqHTeAbHYJO pa3HRllY B CHCTeMIDC MeAHKO-CaHHTapHoro 3aKOHOAaTeAbCTBa B pa3AHqHbJX CTpa- TeM He Mettee, HeCMOTPH Ha HaAHqHe pa3HHlll>Z,MOXHO OTMeTHTb neAblH PHA o6mHX MOMeHTOB B pa3AHqH>eX H8Il,BOH8J[hHbIX CHCTeMax .Me,lUIKO- C 8HHTapHoro 38KOHO,ll;aTeJibCTBa . 1.4.2 Me.DjHKO-CaHHTapttoe 3aKOHOAaTeAbCTBO, HHpopMaD;BH H npocaemeHHe .ll.;IH Toro' qT0.6bJ oc~eCTBHTb BHOBb pa3pa6oTaHHYJO noAHTHKY B o6AaCTH 3ApaaooxpaHeHHH' npaBHTeAb- CTBO MOXeT HCll0Jlb30B8Tb pa3JI.Hl.1Hble K8H8Jrhl H MeTOAhl IIP.R140 HJIH KOCBeHHO, npu6era.n K IIOMOIJJ.H TpeTbeH CTO·- pOHW HAR HHbWH nyTHMH H cpeACTBaMH, CO3AaBaH CTHMYAbl HAR OKa3bZBaH noMOillb, nocpeACTBOM RH~OpManHH o6mecTBeHHOCTH, qeyy MOryT nOCAYXHTb cpeACTBa MaCCOBOH HH~OpMaUHH; o6yqeHHe MeAHUHHCKHM tt APYrHM MeTOAaM, cnoco6cTBYJO=M yAytUIZeH1ilO 3AOPOBbH; o6ecneqeHHe npaBHAbHOro HanpaBAeHHH noArOTOBKll MeAHKOB H , HaKOHen, TOqHO BwpaxaHCb,C IlOMO~ro 3aKOHOAaTeAbHOro R peryAHpyromero MexaHH3MOB, 1.4.3 Me,1UIKO-CaHHTaTHOe 3aKOHOAaTeAbCTBO R 3THKa CyilleCTByeT oqeHb TecHaH CBH3b MeXAY MeAHKO-CaHHTapHbW 3aKOHOAaTeAbCTBOM H 3THKOH, B qaCTHOCTR B TOM' qTo KacaeTCH npo6Ae,n,1 HapymeHHH CB060Abl AffqHOCTH' HHOr Aa Bbl3bIBaeMOH o6H3aTeAbHWMH MeAHKO- caHHTapHbWH MepaMH, nepecaAKOH opraHOB, CTepHAH3anHeH, HCKYCCTBeHH>CM oceMeHeHHeM R HMUAaHTanHeH 3M6pROHa, A~rKOH 6e360Ae3HeHHOH CMepTbID, A06poBOAbHbW npepwBaHHeM 6epeMeHHOCTH, 3KCnepHMeHTaMH Ha qeAOBeKe H onpeAeAeHHeM KPHTepHeB CMepTH , 1.4.4 Cou,raAOrHqecKHH acneKT B Me,.!UIKO-CaHHTapHOM 3aKOHOAaTeAbCTBe lLieHbl KoMHTeTa noAqepKHYAH TPYAHOCTH, KOTOPWMH conpOBOXAaeTCH npHHHTHe 3aKOHa H oneHKa ero BO3- AeHCTBHH Ha TO HJIJI HHOe COCTORHHe Me,n;e:xo-caHHTapaoH IlOMOIIJll. 3ctxbeKTHBHO CTb, npHrOAHOCTb H npaeMJieMOCTb Me,lUIKO-CaHHTapaoro 38KOHOA8TeJlbCTB8 rrpe,a:;cTaBJIJOOT co- 6oH qpe3awqaHHO CAOXHbJe npo6AeMbl' KOTOpble Tpe6yroT ,rnyqeHHH' npeAOOqTHTeAbHO COUHOAOraMH-IDPHCTaMH' a TaICXe cnenHaAHCTaMH a o6AaCTH MeAHUHHCKOH COUHOAOrHH , tL1eHbl KOMHTeTa COttJIH B03MO*HbIM COCT8BHTb npoexT MOAe.JIH Me,4llKO-CaHHTapHoro 38KOHOAaTeAbCTBa, HeCKOTPH Ha c~eCTByromHe B CTpattax pa3AHqHH B COUHaAbHOM, IlOAHTHqecKOM, 3KOHOMHqecKOM, KYAhTypHOM H KCTOpHqecKOM IIAaHax. ITpexAe scero npo6AeMa 3aKJ1JOqaAaCb B pa3pa60TKe KOHnenTVaAbHbZX pru<OK AAH MeAHKO- CaHHTapttoro 3aKOHOAaTeAbCTBa RAH CXeMbJ 3aKOHa B o6AaCTH MeAHKO-CaHHTapHOH nOMO-. 1 . 6 PoAb 803 B cg>epe Me.DjHKO-CaHHTapttoro 3aKOHOAaTeAbCTBa lLieHW KOMHTeTa c oqAH, qTO pOAb B03 ( EaponeHCKOe perHOHaAbHOe 6ropo) a c ~epe MeAHKO- CaHHTapHoro 33KOHO,n;aTeJ[b C TBa JIBJIJleTCJI tteTMpexxpaTHoii:. C OAHOH CTOPOHhl, HH~OpMaUHH OTHOCHTeAbHO npHHHTBH aaxHbZX HOBblX 3aKOHOB AOAXHa nocTaBAHTbC~ KaxAOH cTpaHOH a PerHoHaAbHOe 6ropo . C APyroH CTOpOHbl, HH~pMaUHH AOJIJl(Ha npeAOCTaBAHTbCH PerHOHaAbH>CM 6ropo Aro60H CTpaHe, KOTOpaH o6pamaeTCH C npocb60H npeAOCTaBHTb RH~OpManmo no c~ecTayromeMy B APyroH CTpatte RAH CTpaHIDC Me,D;HKO- c a HBTapHOMY 3aKOHOAaTeAbCTBY , PerROHaAbHOe 6ropo MOXeT, TaKHM o6pa30", BbZCTynaTb B pOAH qettTpa AOKy><eHTalJHH AAH MeAHKO- c aHHTap- HOro 3aKOHOAaTeAbCTBa . 1.6. 2 ITpocaemeHHe a IlOArOTOBKa B HaCTO.RZD;ee speMH c ~eCTByeT qeAblH PM, opraHH3OBaHHblX 803 MeXAyttapOAHblX KYPCOB no nAaHHpoaaHHID 3Apa aooxpaHeHHH, a AMHHHCTpaTHBHblM CAyX6aM 3ApaaooxpaHeHHH , 3KOHOMHKe 3ApaaooxpaHeHHH H T,A , lLieHbl KOMRTeTa BbICKa3aJIH MHeHHe' qTQ 6bLJIO 6bl IlO.Jie3HO opraHH30B3Tb MeJK,n;yHapo,n;Hbie K YJ?Cbl IIO Me.llHICO- C aHHTaOHO- MV 3 a KOHOAaTeAbCTBV_, - 62 - 1. 6.3 HccJ1eAOBaHH.R qJleHhl KOMHTeTa Bb!J)a3HJIH MhlCJlb O TOM, qTo PerHOHaJlbHOe 6ropo AOJlll(HO npe,.!UlpBH.RTb uenocpeACTBeHHO J1H60 KOCBeHHO, cepHro cpaBHHTeJlbHblX HCCJleAOBaHBH B 06J1aCTH MeAHKO-CaHBTapuoro 3aKOHOAaTeJlbCTBa. 1. 6.4 B03 MOXeT Taxxe noArOTOBBTb cnHCOK cnenBaJIBCTOB B 06J1aCTH MeAHKO-CaHBTapuoro 3aKOHOAaTeJrbCTBa, KOTOphle MoryT,B CJ!yqae ueo6XOAHMOCTH , 6hlTb npHBJleqeHhl KaK KOHCYJrbT8HThl, KaK pa3BBTbn.m CTpaururn, TaK H pa3BHBaIOlll,l[MHC.R . 2. CpeAHecpoqua.n nporpaMMa B 06J1aCTH Me,JUIKo-caHHTapuoro 3axoHOAaTeJ1bCTBa IlporpaloOla, npeAJI OXeHH8.R PerHoHaJlbHb!M 6ropo, noJ1yquJ1a no,ll.,ll.epxxy co CTOPOHhl qJleHOB KOMHTeTa B TOM, qTo xacaeTc.R Bbl.lleJ1eHHb1X npo6J1eM, pemeuHil npe,.ll.JioxeuHldX B onpeAeJ1eHHH neJ1eil, a Taxxe MeponpH.RTlrli, nyTeH H cpeACTB HX ocymeCTBJleHH.R. Oua BKJIIDqaJla n.RTb no,mporpaMM, KaCa.IOll\HXC.R COOTBeTCTBeHHO nOJIHTH- KH B 06J1aCTH 3ApaBOOXpaueHH.R, COCTOJIBH.R 3APaBooxpaHeHH.R , CJ1yx6 MeAHKO-CaHBTapuoro 3aKOHOAaTeJlbCTBa, o6MeHa HH~OpManBeH, a TaKXe KaAPOB . 2 .1 IloJIHTHKa B 06J1aCTI! 3ApaaooxpaueHB.R UeJlb 38KJIIDqaeTC.R B TOM , qT06bl OKa3aTb COAeHCTBBe CTpaHaM npBH.RTb 3aKOHOA8TeJ[bCTBO, KOTOpoe 6y- AeT cnoco6cTBOB8Tb yJ1yqmeHHro MexaHB3MOB H AeHCTBeHHOCTH CJ1yx6 3ApaaooxpaueHB.R B ocymecTBJleHmi CTpa - TerHH ' npeAHa3HaqeHHblX AJI.R o6ecneqeHH.R 3AOP0Bb.R AJIH BCex. ,llJl:,r 3TOrO 6b!JIH npe AJIOXeHbl AB a HCCJleAO- BaHH.H. IlepBoe HCCJleAOBaHBe 6yAeT KaC8TbCH TeHAeHUHH B MeAHKO-CaHHTapHOM 3aKOHOAaTeJlbCTBe (3aKOHhl, Ka- CaIOm,Hec,r o6mecTBeHHOro 3AP8BOOXpaHeHHH, 3aKOHhl no nepaHquoil MeAHKO-CaHHTapHOH noMOIDH , a Taxxe 3a- KOHbl, KaCaI<lllHeCH oxpaHbl H yJ1yqmeHHH 3AOPOBbH). Bo BTOpOM HCCJleAOB8HHH 6yAeT npoBeAeH aHaJm:3 Mep, npBH.RTblX pa3J1HqHbD(H npaBHTeJlbCTBBMH ,.ll.JI.R Toro, qTo6 hl o6ecneqHTb J1yqmee pacnpeAeJleHHe (reorp~Hqecxoe, a Taxxe no cneUHaJIH3aUHH H THny) nepcouaJ1 a H8IlHOH8JlbHOro 3ApaaooxpaHeHHH, C TeM qTo6bl npeAOCTaBHTb KBXAOH KaTeropmi uaceJ1eHH.R paBHhle B03MOXHOC- TH AOCTyna K MeAHKO-CaHHTapHOH nOMOlllH. 2 .2. CocTO.RHHe 3Apaaooxpaueuu,r UeJ1b 3aKJ1roqaeTCH B TOM , qTo6bl npe,l(IlpHH.RTb HJIH YJ1YqmffTb oneuxy B03AeHCTBHH ropHAHqecKHX HJm: npa- BOBblX MeponpH.RTHH Ha COCTOHHHe 3AOpoBb.R . IlpeJK,.D;e acero ueo6xOAHMO 6blJIO H3YqHTb MeTOAOJIOrBqecKHe acneKTbl Taxoro HCCJleAOB8HH.R no HX B03AeH- CTBBID, a TBKXe cpaBHBTb llOCTaBJleHHble neJIH B noJ1yqeuHble pe3yJrbTaTbl OT BHeA?eHHH MeAHKO-CaHBTapuoro 3aKOHOAaTeJrbCTBa. 4JleHbl KOMHTeTa noAqepKHYJIH 3HaqeHHe KOMilOHeHT8 "3aKOHHOCTR" B pa3JIH'lHblX ocymecTBJI.Re>O,D( B03 nporpaMMax . 2 .3 CJ1yx6hl Me@!KO - caHBTapuoro 3aKOHOAaTeJlbCTBa UeJ1bro AaHHOH noAnporpaMMbl .RBJ1.ReTC.R CTBMyJ1HpoaaHHe ycoBepmeHCTBOBaHHH CTPYKTYPbl H Ae.RTeJ1bHOCTH CJ1yx6 _MeAffKO-CaHHTapHoro 38KOHOAaTeJlbCTBa B rocyABPCTBax-qJleHax. IlpeAnOJlaraeTCH npoBeCTH CJleA)'IOOIHe MeponpB.RTB.R: (1) H3yqHTb ua6op MeX8HH3MOB, C noMOfilbID KOTOpblX MOXHO AOCTHrHyTb YAOBJleTBOPHTeJlbHOH KOOPAHHa- nHH MeXAY MHHBCTepCTBaMH H OTAeJlaMH, npnqacTHblMB K npoBeAeHBro MeponpB.RTHH B 06J1aCTH MeAHKO-CaHHTap- Horo 3aKOHOAaTeJlbCTBa; (2) o6ecne'lBTb rocyAapCTBa-qJleHbl PYKOBOACTBOM no MeABKO-CaHHTapHOMY 3aKOHOAaTeJ[bCTBy; (3) npH,ll.aTb rJ1aCHOCTH MeponpH.RTH.R, HanpaBJleHHble Ha TO, qT06hl npeAOTBP8THTb C03AaHHe CJIHlllKOM CJIOXHOro 3aKOHOA8TeJlbCTBa; B CBH3H C 3THM QJ!eHhl KoMHTeTa coqJIH, qTO ueo6XOABMO COCT8BHTb KOAH~Ka - llHID HJIH neperpynnHpOB8Tb no HOBOMY cymeCTByI(IIIHe 3aKOHbl AJI.R Toro, QT06bl ynpOCTHTb 3TO 3aKOHOA8TeJ[b- CTBO H OCB060AHTb ero OT JIHIDHHX AeT8JleH. UeJlb 3aKJIIDqaeTCH B TOM , qTo6hl cnoco6cTBOBaTb o6MeHy HH~OpManueil no MeAHKO-CaHHTapHOMy 3aKOHOAa- TeJlbCTBy MeJK,.D;y rocyAapCTBaMH-qJleHaMI< AJIH npoBeAeHH.R cpaaueHmi H BhlHeceHH.R pemeHHH. - 63 - npeAnOJraraeTCR npoBeCTH CJreAyrom,He MeponpHRTHR: (1) CO3AaTb H BHOCHTb COOTBeTCTBy!OIIIHe H3MeHeHHR B ceTb POACTBeHHbOC yqpeJl(AeHHH Ha Ha!lROHaJrbHOM ypoBHe H BbIRBHTb y qpeJl(AeH>!R H QeHTPbl' KOTOpble MOryT CT a Tb noTeHUHaAbHbU,OI yqaCTHHKa•<H AaHHOH pa60Tbl; (2) CO3AaT b CHCTeMy nepHOAH14eCKOH HH¢OpMa!lRH no MeAHKO - CaHHTapHOMy 3aKOHOAaTeJrbCTBy, KOTOpaR 6yAeT nocTynaTb OT CTpaH a P e rnoHaJlbHble 6ropo; (3) pa3pa60TaTb cJryJl(6y HH¢OpMallRH H KOHCyJrbTa!lRH AJlR OTBeTOB Ha npocb6bl, nocTyna.JOIIU{e OT ro - cyAaPCTB-14JreHoB; (4) PerHOHaAbHOMY 6ropo HaMeXHT pacnpocTpaHRTb CTpaHaM nepHOAH14eCKy!O HH¢OpMannro O BaIHbOC HO- BbOC npaBHJrax H 3aKOHax C ncnOAb3OBaHHeM KOlllllb!OTOpHOH CJryx6bl, m,e!OllleHCR B pacnopRiemra P e rHOHaAb- Horo 6ropo; ( 5) H3y'4HTb lllHPOKHH cneKTP CY!lleCT BytOIIIHX MexAyHapoAHbOC cor,tameHHH, coAePJl(WIODC noJrOJl(_eHru1, Ka- CaI01JtBecJ1 3ApaaooxpaHeHH.H, 2. 5. KaAPOBbie pecypc•1 UeJrb AaHHOH noAnporpaMMbl 38KAI0'4aeTC.ll B TOM, 14T06bJ paclllHpHTb tUICJ[O IDleI<l!IHXC.ll B HaJlH'4HH cne!lRa- JlHCTOB' o6JraAaIOIIIHX AOCTaTO'4HblM H He06XOAHMbIM onbITOM' a Taxxe AaTb BO3MOJl(HOCTh CTP8H8M PerHOHa H pa3BHBa.JOIIU{MC.ll CTp8HaM HCnOJrb3OB8Tb 3 TH KaApbI , npeAUoJraraeTC.ll npoaecTn cJreA)'!OlllHe MeponpH.llTH.ll: (1) COCTaBHTb cnpaBO14HHK MaTepH8JlbHOH 6a3bl AJl.ll o6yqeHH.ll H noArOTOBKH B o6JraCTH MeAHKO-CaHHTap- HOr o 38KOHOAaTe..llbCTBa; (2) ycoeepmeHCTBOB8Tb CHC TeMy KOHCyJrbT8nHH no aonpocy H8A,,tell(amero pa3MemeHH.ll cne!lR8AHCTOB B o6Jr8CTH MeAHKO- CaHHTapHoro 38KOHOAaTeJrbCTBa; ( 3) OKa3aTb COAeHC TBHe Kypca.M, Ha nepeOM 3 Tane nyTeM Hanpae..11eH.HJ1 JieKTOpoe K8K B pa3BHTbie, T8K H B pa3BHBaIOlll,HeCR CTpaHhl; (4) COCTaBHTh perHOH8JlhHblH c nHCOK 3KCnepTOB no MeAHKO - C8HHTapHOMY 3aKOHOAaTeJrbCTBy , 3. PeKOMeHA8UIDI 3,1 , liH<J>OpMaUH.ll tf ... te Hbl KOMHTeTa OTMeTHJ[H' '4TO AeHCTB)'!Ollla.ll OilbITHa.ll CHCTeMa C yqaCTHeM AeCRTH CTpaH P e rnoHa npH- HOCHT 6JraronpH.llTHHhie pe3yJlbT8Thl H nopeKoMeHAOBaAH IIOCTeneHHO pacnpocTpaH.llTb e l! Ha see CTpa Hbl PerHOHa , BhL/10 6 bl IIOJre3HhIM rrpoaeCTH c oaemaHHe C yqacTHeM cnenHaAHCTOB H3 pa3HbOC CTpaa. 3,2, CTpocaeseHHe H ITOArOTOBK8 3. 2.1 qJleHbl KOMHTe Ta peKOMeHAOB8JlH Pe rHOH8JlbHOMY 6ropo rrpeAJrOXHTb r ocyAapCTB8M-qJ[eHaM rrpe.m:rpHH.llTb Heo6XOAHMbie marn AJl.ll Toro' '4T06bJ BKAI0'4HTb B Kypc MeAHKO - CaHHTapHoro 3aKOHOA8TeAbCTB8 B xaqecTBe o6.H3aTeAbHOH rrporpaMMhJ: npH H3y'4eHHH IOPHAH14eCKHX, MeAHnHHCKHX H corrpaxacaromHXC.ll C MeAHnHHOH acneKTOB, mxoJr o6mecTBeHHoro 3ApaeooxpaHeHH.ll (xypc hl 6oJree rJry6oKoro H3y'4eHH.ll), 3. 2. 2 ll.n:eHhl KoMHTeTa Taxxe peKoMeHAOB8JlH CO3A8Tb MeJl(AyHapOAHhle KYPChl no MeAHKO-CaHHTapHOMy 38KOHO- A8TeJrbCTBy AJl.ll PYKOBOAJIDIHX pa60THHKOB CHCTeM o6mecTBeHHOro 3ApaaooxpaHeHH.ll , ll.n:e Hbl KOMHTeTa npeMOIHJlH npoeeCTH pa6oqee c oaemaHHe, KOTOpoe MOJl(eT 6 &ITb IIOArOTOBJle HO CO KpameH- HOH KOHCYJrbT8THBHOH rpynnoil AJr.ll Toro, '4T06&1 a&1pa60TaTb nporpaMMY H pa3pa6oTaTh MeTOA o6yqe HH.ll , AJr.ll nocJreA)'!Olllero HX HCITOJ[b3OB8HH.ll, ll.n:eHhl KOMHTeTa rrpeAOCT8BHJ[H rrepaooqepeAHOCTb HCCJreAOB8HlilO CY!lleCTByromHX B H8CTOJ1D1ee apeM.ll TeH- AeHnHll B o6JraCTH MeAHKO- C8HHT apHor o 38KOHOAaTeJlbCTB8 AJ[Jl oneHKH XOAa pa60Tbl B IIOCJreAy!OlllHll nepHOA BilJlOT b AO AOCTHJl(eHH.ll QeJrH "311opOBbe AJl.ll acex K 2000 roAy" . - 64 - 3.4. Pe3e pB c nenHa.llHCTOB lll!eHbl Ko1,1HTeTa peKOl,leH,l[OB=, n o B031,[QJl(HOCTH, CKOpee npHCTYllHTb K COCTaBJieHIDO CllHCKOB 3KCnepTOB B pa3JIHqHJ,D{ cnenHa.llbHOCTJDC! 1,1e)[HIIHHCKOe 3aKOHO,llaTe.llbCTBO, Me,.![HKO-CaHHTapHoe 3BKOHO,llaTe.llbCTBO, 3BKOHO,llaTe.llbCTBO, KaCBlOllleecR 60.llb HHll , OKPYJKIUOllleM cpe,llhl,~apwaneBTHKH, rHrHeHhl npo,llyKTOB llHTaHHR ll T,,ll, lll!eHhl KoWHTeTa BhlCKa3a.llH l,IHeHHe, qTo TeCHOe COTp y,llHHqecTBO HB,ll.lleXHT llO,ll,llepxHBaTb H Bnpe,llb H PB3BHBBTb ero 1,1e)l(,lly PerHOH8.llbHbllol 6ropo H! HaUBOHaJibHbu.m: npaBBTeJlbCTBaMH , mTa6-KBapTHpoM , ,llpyrHWH p e rHOHa.llbHJ,D(H 6ropo, ,llpy rHWH 1,1eJK,llyHapO,l!HbBm opramrnanumm' B qbIO KOl,llleTeHnmo BXO,l[RT H BOllpOCbl we,JWKO-CBHHTapuoro 3aKOHOAaTe~bCTB8, YHHBepcHTeTBMH H neHTPB>l'.ll, cneUHBJIH3HP)'I<IllHWHCR B 06.11aCTH Me,.![HKO-CBHHTBpHor o 3aKOHO,llaTe.llbCTBa, - 65 - HEClfACTHhlE CJIY'!AJ,f CH1UI03HYM no 3IIHAe>OloAornn AOpoxHoro TpaeMaTH3Ma H HHBaAHAHOCTH - 67 - ICP/ ADR OSl(S ) 24 MapTa 1981 roAa OPIITHHAJJ : ~PAHUY3CKJIB Cmmo3Hyv: ao AaHHOH TeMe 6wA opraHH30BaH EepoaeHCKHll peruoHaAbHm, 6wpo B03 B COTPYAHH'leCTBe c apaeuTeAbCTBOM ~paHI(HH B KaqeCTBe OAHOro H3 MepoapHHTHK, rrpeAyCMOTpeHHhlX aporp8.lGIOH B03 no rrpeAy- ape•AeHHID Hec qaCTHblX CAyqaeB Ha AOporax. AKTyaAbHOCTb CHMil03Hyv:a HeCOMH8HHa, IlOCKOAbKY 1981 rOA o6~HBAeH Me~yHapOAHl,IM roAOM HHBaAHAOB, B CHMil03HyYe IlPHHHJm yqaCTHe npeACTaBHTe.m CAyx6 o6meCTBeHHOro 3APRBOOxpaHeHHH, 3IlHAeMHOAOrH, TpaBMOTOAOrH' 3KCrrepTbl no eonpoCaM pea6H.mTarum' crrenHaAHCTbl B o6AaCTH 6HOMexaHHKH H AOPOXHOH 6e30- naCHOCTH, .llHCKYCCHH rpyrrna paCCMOTpeAa CA8AytO!llR8 BOapOCbl: 3IlHA8MHOAOrHH TPRBMaTH3Ma apu AOPO•HO-TpaHCilOpTHhlX apoucmeCTBHHX; Kaxue M8pbl CAeAyeT apeArrpHHmraTb B M8=HCKOM H COUHRAbHOM IlAaHax, qTo6w CHH3HTb T=eCTb OOCAeACTBHli HecqacTHLIX c~yqaes, BeAynmx K HHBa.JraAHOCTH; B03MOXHOCTb pa3pa60TKH KAaCCH¢HKaOHH CTerreHeK IlOTepH TPYAOCnoco6HOCTH B pe3yAbTaTe HecqaCTHb!X CAyqaee Ha AOporax, a Taltll(e B03MO•HOCTb ap0B8A8HHH oneHKH B03A8HCTBHH, KOTopoe OKa3blBaeT Ha CAyx6 bl 3APaBooxpaHeHHH Heo6xOAHMOCTb AeqeHHH CAyqaee TpaBMaTH3Ma . 1. rpyrrna 0A06p HAa BblBOAbl' CAeAaHHble yqaCTHHKaMH coeemaHHH B TyAy3e ( 24- 28 ¢eepa.1H 1979 rOAR) OT - HOCUT8AbHO o praHH3RilHH CA yx6 CKOpoil OOMOmH, a) IlepeaH llOMOMb - 3TOT BRA llOMOmH 0Ka3,maeTCH HeaocpeACTBeHHO Ha MeCTe npoucmeCTBHH; - B 3aBHCIDIOCTH OT COI(HRAbH0-3KOHQMHqecKHX yCAOBHH H reorpa¢nqeCKOro llOAOXeHHH CTpaHbl nepeyw TIOMOlllb MOr YT OICa3bJBBTb: JDOAH, He HMelOJJUie COOTBeTCTBYJOmeH IlOArOTOBKlI, COOTB8TCTB)'l(llllID( o6pa30M llOArOTOBA8HHb!H BCilOMOraTeAbHb!H aepcoHaA' Me,ltHilHHCKHli nepcoHaA; CA8AYeT o6eca eqHTb He 06XOAHMb18 ycAO BHH TpaHCilOpTHpOBKH IlOCTPRARBmero C MeCTR apoucmeCTBHH B 60AbHHITY; CAeAyeT o6ecae4HTb He06XOAHMYID TeAe¢QHHyw CBH3b, Bbl.lleAHB AAH Bbl30BR llOMOmH caenHRAbHblH RO- Mep, a TRKJl(e o6ecaeqHTb CBH3b Me~y nyHKTOM aepeoa llOMOmH, llOAHOHeH H c aenuaAHCTaMH B o6 - A8 CTH AOPOXHbIX llpOHCme CTBHH; MeXAY TpaHCllOpTHOH CAy•6oH aepBOK llOMOmH H apneMHldM OTAeAeHHeM 60AbHHilbl AO~Ha IlOAAep•u- B8TbCH TeCHaH CBH3b. - 68 - - B 38BHCID!OCTH OT COD;ll8Ab H0-3KOHO>mqecKID( H reorpa$HqeCKHX YCAOBHH MOXHO npeAyCMOTpeTb op- raHH38IOIJ() o6cAyxuaaHHil AByx ypoB Hen: - BhICOKOClleIJ;lla.Jrn3HpOBaHHhle TpasMaTOAOrHqecKHe CAyx6hl, KOTOpwe o6wqHo IlBAJDOT Cil COCT8BHOH qaCTbro BblCOKOp83BHTOB CHCTe~w nepBoll DOMODW; - MeHee cneuaa.m3Hp0B8HHhle CAyx6w, BMeID111He B CBOeM pacnopRxeHHB Heo6XO,ltBMOe peaHBM8UHOH- HOe o6opyAOB8HHe. B CAyqae He06XOABMOCTH K yqaCTmo B pa6oTe MOryT 6b!Tb npHBAeqeHhl c neuHa.mCThl (HanpID1ep, HenpoxapyprH ), Ceiiqac t Kor ,Aa em,e He npoee,z,;eH aHaJIH 3 (J>aKTOpOB CTOHl,JOCTlf / BbJT'O,Abl BCDOJlb30BaHH.fl BblCOKOCne~a.JIH3B- poBaHHhlX CAyx6, B 60AbIIIHHCTBe CTpaH MC~YT H8HTH 6oAee lllllpOKoe npID!eHeHHe Me Hee cneuHa.im3HPOBBHmre CAyx6w, B TO Bpe»H, K8K cneIJ;llaAH3ffPOBBHHhle ueHTphl, BMelOl!Ule B CBoeM pacnopJUteHHB COOTBeTCTBYID!Dll e CpeAC TBa, Ayqme npac noco6HTb AAH llpOBeAeHHil aayqawx H3hICKaHHH, B TOM 'IHCA e B o6AaCTH np0$HA8KTHKH, 2. a) OpraHH3aIJ;llH o6CAYXHB8HHH 06ciyxHBBHHe AOAXHO 6h1Tb opraHH30BaHO TBKHM o6pa30M, qTo6hJ OHO MOrAO o6ecneQHTb n o MeHbmeH Mepe : AeqeHHe n OC TP8A8Bme r o CHAa>m MHOrOAH CUHllAHHapHOH 6paraAM, B COCT aB KOTOpOH BXOAHT HaH60Aee OllbJTHhl€ c n e uHaAH CTbl H3 HMe =HXCil B Ha.mqaH; npH cepbe3HblX TpasMax, Kor A8 nopaxaeTCH ueHTpUb- HaH HepBHail CHC TeMa ' K AeqeHmo CAeAyeT npHBA€KaTb c nen;HBAH3HpOB8HHble 6p1>r8Abl, B pa cnopJUteHHH KOTOphlX BM€IDT CH COOTB€TCTB~e CP€ACTaa; Mepw n o M€AHKO-CaHnTapHOB pea6HJIHTaIJ;llH naIJ;lleHTa CAeAyeT npeAllpHHHllaTb n o B03MOXHOCTH cpa3y no- CAe nponcmeCTBHH, BO BCHKOM CAyqae, AO OTllpBBKH IlBIJ;lleHTa a pea6HAHTBUHOHHOe OTAeAeHae ; HCTOpmo 6oAe3HH llBUH€HTa CAeAyeT BeCTH Ha BCeM llpOTJUteHHH AeqeHHH, BKAIDqaH »eAffIJ;llHCKYID pea6n- AHTamno. ieqeHHe CAeAyeT IlpOBOAffTb C yqeTOM pe3yAhT8TOB $ YHKllHOHaAbHOH Aff8rHOCTHKH; B AeqeHl!'H AOAXHa llpHHHM8Tb yqaCTHe MHOrOAHCil;HllAHHapHBil 6para», KOTOPBil npH3BBHa o6ecneQHTb »eAHUHHCKoe , napa- »eAffIJ;llH CKOe H COUH8AbHOe o6CAYXHBBHHe; llpH onpeAeAeHHB cpoxa npe6btBBHHil DOCTPBABBmero B neHTpe CAeAyeT Y'IHTbtBaTb Il0Tpe6HOCTH naIJ;lleHTa B Me AHD;HHCKOM o6CAYXHBBHHB H xapaxTep He06XOAHMMX pea6HAHTaIJ;llOHHhlX wep; CAeAyeT COCT8BHTb IlOAP06HYID HCTOpmo 6oAe3HH nanneHTa, KOTOpaH AOAXHa BKAIDq8Tb ero $YHKUHOHaAb- HblH np0$8RA; 3 Ta HCTOpHH 6oAe3HH 3BTeM HanpBBAHeTCH B 6oAbHHD;Y, rAe nanneHTY 6MAa OKa3aHa nepBaH IlOMO~b, a Taxxe BO see CAyx6w, KOTopwe 3BHIDIUHCb IlOCAeAY111!1HM AeqeHnew (Aeqa~eMy spaqy, cnennaAHCTY no pea6nAHTaIJ;llH , yqpeXAeHHHM COUH8AbHOro o6ecneqeHHH ) . o6CAYXHB8HHe Ha AOMY npOH3BOAffTCH MHOrOAHCD;HilAHHapHOB 6paraAOH, B OTAeAbHhlX CAyqaHX IlBD;lleHT noAyqaeT Heo6XOAID!YID noMO~h B TeqeHae sceH caoea nocieAYID~en xH3Hn; CAeAyeT llp€ AYCMOTpeTb OKa3aHHe llOMOIIIH nanaeHT Y B IlCHXOAoraqe CKOM, COD;H8AbHOM H llp0$eCCHOHUb- HOM DAaHe, a B COOTBeTCTB~ CAyqaHX o6ecneqHTb e»y B03MOXHOCTb no Ayq eHHH 3HaHHB, Heo6XOAH- MhlX AAil noc T y nAeHHH B DIKOAy ; CAeAyeT npeAyCMOTpeTb KPBTKOCpoqHYID DOBTOPH YID roCnHTUH3allHIO naIJ;lleHTa B n eiHX nposepxu ero o6~ero COCTOilHHil AOnOAHHTeAbHOro AeqeanH BAH nepe»eHhl o6cTaHOBKH, s KOTOpOH OH XHBeT, 6) ,Il.;,H npoBeAeHHil KOMnAeKCHOB pa60Tbl DO pea6nAHT8Il;ll>I CAeAyeT npeAyCMOTpeTb : C03A8 Hne rn6KHX MHOrOAHCil;HllAHH8PHhlX 6pnraA C TeM' qTo6ht B 3aBHCHMOCTH OT CHTyannn MOXHO 6hJAO npOH3B0AHTb 3BMeHy OAHHX cnenaunCTOB APYrBMn ; 3 . - 69 - aepecvoTp CTpyKTypw DOAqBHeHBH B pa>Otax 6pnraA B ne.11nx o6ecaeqeHHH CJlaJ<eHHOH 6pnraAHOH pa60TLI B COOTBeTCTBHH C DOTpe6HOCTJn!R .11eqeHHH KaJK,.IIOro 60JibHOro; apn onpeAe.lleHnn pa3Mepa KOMIJeacaann CJleAyeT apHHHJ,(aTb B pacqeT OKoaqaTeJlbHyYO CTeaeHb THlleCTH TpaBMI>t, He3aancm<o OT 3aperHCTpnpoaaHHOH B MOMeHT apOHCmeCTBHH TpaB)D,I Hee 3THOJ!Ornn; n~eHTY CJleAyeT OKa3WBaTb waTepHaAbHyYO DOMOmb Bero CTpeMJleHnn BHOBb npncTyDRTb K pa6oTe C Tex, qTo6w HClt.lll()qBTb BO3MOllHOCTb HaHeCeHHH exy MaTepHaAbHOro ymep6a; o6yqeHHe MeARDBHCKoro nepcoaa.11a AO.JlllBO B1t.JllOqaTb KaK DOArOTOBKy B 06.JiaCTH npeAynpexAeHnH AOPOll- HO-TpaHcnopTHhlX aponcmeCTBBH, TaK H DOArOTOBKY B 06.11aCTH npO<lra.JiaKTRKH H .11eqeHBH Tpaax, no.11y- qeH Bh1X B pe3y.JibTaTe AOPOllHO-TpaHCilOPTHbIX nponcmeCTBHH; C.JieAyeT CTpeMRT b CH K CO3AaHHIO CHCTeMl>I p ery.JIHpHoro o6MeHa ODWTOM Mell,.lly cnenna.mc TaMR, apeACTaB- .JIJl'.IOIIlRMR pa3ARqHwe AHCDBDJIBHW (cneana.mcTawn H 06.11aCTB neARaTpHR, repBaTpBR , KapARO.JIOrBR, .11eroq- HbIX 3a60.11eBaHHH HT . A . ), a TaKJle MellAY cnennaARCTaMB pa3ARqffbJX CTpaH; C.JieAyeT CTpeMRTbCH K TOMY, qTo6w B TOM paHOHe, rAe apOllBBaeT aaaneaT, 6 w.110 B HaABqnB He06XOAR- MOe AAH .11eqeHBH MeARDBHCKOe o6opyAOBaHBe; 06c.11yXBBBHBe aa KOMMyHaJibHOM ypoaHe npeADO.Jiarae T HCDO.Jlb3OBBHBe c ymeCTByromRX B KOMMyHe HeO~BDB- aAbHbIX CBCTeM OKa3aHHH DOMOmff . IlpocaemeHBe IlpocaeTBTe.JibHLie weponpBHTBH C.JieAyeT npeAYCMOTpeTb A.JIB C.JieAytOIIIIDC qeTwpex rpynn aace.11eHHH : aace.11eHae , B qaCTHOCTH Ta ero qaCTb, KOTOpaH DO.Jlb3yeTCH c peACTBaMH AO POllHOro TpaHcnopTa ; opraHB3aTop&1 apocae111eHBH; MeABDRHCKHe pa60THBKH, BK.IIIOqaa CTyAeHTOB; .JlBila, npHHHMaro111Be pemeHBH , B qacTHOCTH , IlOARTBqecKHe AeHTe.JIH (aaxHOCTb npoBeAeHHH pa60TLI C 3 TOH rpynnoH He Bbl3b1BaeT COMHeHHH, ec.JIH y1.1eCTb TO BJilUIHHe, KOTOpoe OKa3htB8IOT 3aKOHO,ll;8TeJibHMe 110.AOJKe- HHH H npaaH.11a Ha aoaeAeHne qe.11oaeKa Hero oKpyxeHBe) . Oco6oe BHID!aHHe C.lleAyeT YAe.llHTb CaHBTBPHOMy apocaemeHmo B 06.11aCTH ap~HJIBKTHKB AOPOllHO - TpaHCDOpT- HblX apOHCmeCTBHH c peAH TaKHX rpynn, KaK: AeTH; DOllBJILie AroAff . YqaCT HHKH CHMD0 3HYMB IlOAqepKHYJIB HHTepec, KOTOpblH npeACTaBJIHWT HCC.lleAOBaHBH, apOBOAHMWe MHOro- ARCDRil.JIBHapHblMB HaUBOHBJlbHWMR HCC.lleAOBaTeJlbCKBMB rpynnaMB DO H';)yqeHHIO aonpocoa, CBH3BHBhlX C yKa3aH- Hb!MB awme ABYMH rp ynnaMB DOB&IIneHHOro PHCKa ( Hanpuwep, 3KCnepHMeHTbl , npOBOAm(hle B IllaenBB H B CoeAH- HeHHOM Kopo.11eacTae). 4 IlpH o praHH3aUHB MeponpHHTBH no 6opb6e c AOPOllHO-TpaHcnopTHWMB apoHcmeCTBHJn!R H BX noc.11eACTBHHMB Heo6 xOABMO HMeTb a pacnopHlleHHB CJleAYJOIIIYIO HH~pvanHro : OCHOBHLle A8HHhle O IlOTeprreamex; orrn:caHHe rrpoHcmeCTBHff, BKJilOqaff YK838HHe MeCTa rrpoacme CTBHH H npH1.{HHW TpaeM ; npeAnpHHHTLie vep&I no pea6HJIHT!mHB; OKOHqaTeJlbHblH pe3y.llbTaT (Bb13AOPOBJle HHe, cvepTb HJIB HHBaABAHOCTb). - 70 - 5. CAeAveT BHI<MaTeAbHO OTHeCTHCb K Bhlpa6oTxe Ae$RHHIIHH B OTHomeHHE Toro , qTo RBAReTCR TpaB»oil, Ae<!>eKTOH n.llll aHoHa.lllleH 1 noTe p eil TPYAOcnoco6HoCTn H $nanqecKBM HeAOCTBTKOM. ~BanqecKBe aeAoeTaTKE HaKJlaAhlB8JOT OTne qaTOK Ha B CID XH3Hb qeAOBeKa B CKa3hlB8JOTCR B pa3JmqH],IX XB3HeHHbIX CBTYBUHRX . 0HH - npORBAeHBe TOH BAH BHOH CTeneHH BHBB.Jl~HOCTB, CBR38HHOH C o6CTORTeAbCTBaHH B o co6eHHOCTRHli HecqacT- Horo CAyq an, DOAy qeHHbI>rn Tp8BM8Hll H npeAnpBHRThlH KypCOH AeqeHHR. 6 . Enle He AOKa3aHo, 0AH8KO , HOXHO Jlll npBKeHRTb 3TY IIIKB.JI Y npH H3yqeHHH nocAeACTBH H TpaBM , KOTOpb•e He npHBOART K AeTaAbHOMy HCXOAY· 7 . CAeAveT coaAaTb cTaHAapTH3HpoBaHHYJO K.Jiaccu$uKaUHOHHYJO CHCTeHy vep no »eAHKo-comraAbHOH pea6HJm·· TBI{HH H cnoco6cTBOBaTb ee HCDOAb30BaHUID. 8. Heo6XOAHMO npOBO)WT b pa6oTv n o ycoBepmeH CTBOBBHHID CVDleCTBVlOIIIHX CHCTeM oneHKH CTeneHH KHBBJlH.ll.- ~ (BKAIDqan I CDIH ). Kpove Toro, npeACTaBAReT CR BeCbM8 BIU(HhlM oneHHTb B03MOXHOCTb HCDOAb 3 0BaHHR 3THX CHCTeM B paaAHqHhlX CTpaHax H yqpeXAeHHRX, a TBKxe npn 8H8.JIH3e paaAHqBhlX AOPOXHO-TpaHCDOPTBhlX cnTyanuii. 9. CAeAveT TaKXe npoBeCTH oneHKy CHCTe», HCD0Ab3ye»LIX npe onpeAeAeBHH CTeDeHH T.IU<eCTH TeAeCHoro DOBpexAeHHR, DOAyqeHHOro B peayAbTaTe He c qaCTHor o CAyqaR . ITpH 3 TOH oneHKa AOAXHa npOH3BOAflTbCR C y q e TOH KOAHqecTBa ABeE B onpeAeAeHHblli nepHOA BpeMeHH, a He KOAHqeCTBa DOCTPBAaBmHX B TeqeHHe 3TO- ro nepnoAa epeHeHH. Pa6oqaH rpynna no H3vqeHmo poAH MeAHOHHCKHX g,aKTopoB KaK npHqHHbl !!OPOJKHO-TpaHcaopTHbIX npoHcmecTBHH - 71 - ICP/ ADR 044 ( 5) 4 HJ-OHJI 1981 roAa OPIITlIBAJI: AHrJ!lillCfil!H fAaBHaJI ueAb CO3bIBa CoeemBHHJI 3aK.JilOqaAaCb B o6cyJKAeHHH cymecTBylOJlleH HHQ)OpMBUHH, OTHOCHTeAbHO CBH3H AOPOlKHO-TpBHCnopTHOH 6e3onacHOCTH C MeAHUHHCKHMH COCTOHHHJIMH AHU, HBXOAJimHXCH B AOpore. BbIAO pemeHO HCKJllOqffTb H3 o6cyJKAe HHH eoapoCbl, KacaromuecJI apo¢ecCHOHBAbHbIX BOAHTeAeH (fpyana I), MeAHUHH- CKHX CTaHAapTOB, apHHJITbIX AAJI BbIAattH BOAHTeAhCKHX apaB, a TaKJKe npo6AeMy 3AOyaoTpe6AeHHJI aAKOrOAeM H HapKOTHqeCKHMH cpeACTBBMH, fpy n na OTMeTHAa, <!TO B apOMMmAeHHO-pB3B HTbIX CTpaHax , r Ae AOporH TeXHHqecKH OCHBOleHbl, MeAHUHH- CKHe COCTOJIHHJI He CAyJKaT BaJKHOH apHqHHOH yeequft B pe3yAbTaTe AOPOJKHO-TpaHcnopTHblX apoHcmeCTBHH. B MeHee pa3BHTbIX CTpaHaX OOAOJKeHHe pacueHHBBeTCJI HHaqe, OOCKOAbKY o n acHOCTb apoHcmecT BHH 6MAa 6oAee BWCOKOH H HX TIOC.Jle)lCTBHJI 60.Jiee cepbe3Hbn.t:M B TOM, QTO KacaeTC.ff CMepTeJibHOro HCXOA8 HJtH cepbe3HLIX TpaBM, fpyana onpeAeAHAa PJIA COCTOJIHHH, ao KOTOpbllll Tpe6yeTCJI 6oAee DOAHaJI HH¢opMaUHJI, BK.JilOqaJI CBJI3b qucAa H cepbe3HOCTH npHCTynoB KOpoHapHOH HmeMHH C yCAOBHJIMH BO,UeHHJI, a TBKJKe KAHHHqeCKHe OTKpbITHJI. Ba.HO TaKJKe noAyqffTb 60Abme HH¢opMaaHH OTHOCHTeAbHO BO3MOJKHOCTH apHil~KOB c peAH B3HTbIX Ha yqeT 3ITH- .JlellTHKOB BO epeMJI HX H8XO)(AeHB.ff 3a pyJieM. 06mee YHeHHe 6WAO TaKOBO' qTo CHMilTOMbl pa3AffqHbJX 6oAe3- CHMllTOMOB rHnepTOHH.ff He npeACTaBJIHeT co6oH 60.JlbmoH onaCHOCTH. TaKXe c y meCTBeHHWM HBJIReTCJI B03~eH- CTBHe HCilOAh3 yeMbIX npH AeqeHHH AeKapCTBeHHblX cpeACTB, oco6eHHO B CAyttB HX YMCTBeHHbJX paccTpOHCTB, npH KOTOpOH mHpOKO npHMe HJiroTCJI CHAbHO AeHCTByromHe IlCHXO-aKTHBHble MeAHKaMeHTbl. fpynna cqHTaeT, qT o CAeAyeT o6H3aTb npOH3B0AHTeAeH AeKapCTBeHHbIX cpeACTB onpeAeAHTb HaAHqHe KaKOH-AH6o o naCHOC TH H pe- KOMeH,llOBQTb epaqaM ,llO Toro t K8K HO Boe JteKapCTBeHHOe cpe,n;CT B0 llOJIBHTC..R Ha pb1Ke, pa3JIHqHble Mepbl npe- AOCTOPOJKHOCTH, KOTOpble AOAJKHbl 6b1Tb npHHJITbl 60Ab HbIIIIH BO BpeMJI HX HaXOJKAeHHH 3a pyAeM. CymecTByeT He06XOAHMO CT b B 6oAee IlOAHOH HH¢opMallHH OTHOCHTeAbHO nocAeACTBHH AHarHOCTHqeCKHX npoueAYP H npHMeHeHHJI B CBH3H C 3THM aHeCTe3HH HAH CeAB THBHbJX cpeACTB ; ace pacTymett nonyAJIPHOCTH aM6yAaTopHOH AHarHOCTHKH" TepanHH (a HMeHHO: IIPH ;) TOM CJie,llyeT OOMHH.Tb 0 a M6 yAaTOpHaJI XHpyprHJI). CoqAH BaJKHbllll HH¢OpMHpOBBTb BOAHTeAeH O TOM, <!TO HapymeHHJI y rAeBOAHOro o6 MeHa MOr yT CAyqaTb CH y HHX H 6e:i HaAHqHH AHB6eTa, flO 3TOMY nepeA TeM KaK ceCTb 38 PYAh, He CAeAyeT y noTpe6AHTb B 60AbmOM KOAHqecTBe nnmy, HBCblOleHHyro yrAeBOAaAm H He AOnycKaTb ApyrHX 3AOYil0Tpe6AeHHH. He 6blAO npeACTaBAeHO AOCTBTOqHO TOqHOH HH¢OpMBUHH OTHOCHTeAbHO B03AeHCTBHJI HapymeHHH 3peHHJI HB 6e30IIaCHOCTb B0I A0HHH, B qaCTHOCTH OTHOCHT0.JlbHO 3HaQeHHH ,llHHaMHQeCKOH OCTpOTbl 3peHHH, eocnpHHTH.ff npOCTpaHCTBa, aAanTaUHH K TeMHOTe H c noco6HOCTH nepeHOCHTb c~enmu:HH CBeT . CymeCTByeT HaCTOHTeAbHan Heo6XOAHMOCTb B pa3pa60TKe npBKTHqecKHX MeTOAOB AAJI npoeepKH 3THX acneKTOB 3peHHJI, KOTOpble HMeroT qpe3BbJqattttyro BaJKHOCTb AAJI npeAOTBpameHHJI AOPOJKHO-TpattcnopTHbJX npoHcmeCTBHH. rpynna paccMOTpeAa npHqHHbl, yBeAH qHBme HCH o naCHOCTH YAHqHoro ABHXeHHJI, KOTOpOH flOABepraroTCJI Ae- TH, CTapHKH H HHBaAH...llbl. MecTax nepeceqeHHH AOpo r. Ehl~O OTMe4eHO, 4T0 npecTapeAhle BOAHTe~H IlOAB epraroTC.ff oco6oH o rraCHO CTH B fpynna cqHTaeT, qTO APYrHe BOAHTeAH, KaK npaBHAO, 6e3 AOCTBTO '-IHOr o BHH- MaHH.ff OTHOC.HTC.ff K npo6.11eMaM' HCilbITbJBSellhlM IlO)l(H.iTldMli BO)J;HTeAJIMH H nemeXO,.llaMH. - 72 - H, H3 KOHell, rpynna paCCMOTpeAa TPY..!!HOCTH 3THq ecKoro xapaKTepa, C KOTOphlMH BCTpeqaJOTCR Bpatrn, B c~yqanx. , KOrAa B npOTHB OBeC MeAHUHH CKHM COBeTaM, BO,l[,HTeJIH, Hl4elOillH€ K TOMY cepb€3H ~ e npOTHBODOKa- 3aHBJI, H8CTBHBWOT Ha BOX.ll,0HHli TpaHCIIOpTHLlX cpe,zr, : TB . IlOIIblTKH 10pu,1u1qeCKH.M nyTeM o6Jl38Tb epaqefi HH- (jlOpMHpOB3Tb O T3KHX CAyqanx He OK333Ali Cb ycnemHbDm; 60.abmHl! CTBO pacueHJiAH 3TO K3K pe3yAbT3T npe- He6 p elKeHliR 3 THqecKHM npHHUHilaM .l[OBepHTeAhHOCTH Me.lllillHH CKOH HH<l>opwanirn. 06cylK.ll3AHCb Mepbl ' KOTOp hle MOrJIH 6bl 6~Tb llpHHJITW BpaqaMH a TaxoH CH TyaUHH; y qac THHKH opmn.Jrn x TBKOMY MHeHmo , QTO a KpaHHeM CAyqa e 06 3TO>I HMAelKHT coo6maTb COOTBeTCT By lOllleM y aBTOPHTeTHOMy AHIIY Me.llHUHHCKOH n po(j)eccHH H npe..a;- not1TBT€Jlb HO c rJ1aay Ha r.n:aa. - 73 - OCHOBHhlE CAHl1TAPHhlE MEPhl Pa6oqaH rpynna no HayqeHmo Me,ll,l!Ko-caHHTapHsIX acneKTOB c6poca Heo6pa6oTaHHbIX oT6pocoa Ha noaepxHOCTb 3eMJIH: onaCHOCTb MHKpo6Horo aapalleHHH - 75 - lCP/ RCE 401(5) (S) 13 ¢eapaAH 1981 roAa 0PHDIHAJI: AHTJ!JfilCKlfil B Pa6oq)'10 rpynny BXOAHAO 13 3KCnepTOB-KOHC yAbTaHTOB H3 8 EaponeHCKHX CTpaH H CDIA - cneIJ;HaJIHC - Tbl B o6AaCTH 6aKTepHOAOrHH, BHpycOAOrHH, napa3HTOAOrHH, MHKOAOrHH, TepaIIHH H aeTepHHapHOH MeAHilHHhl, 3IIHAeMHOAOrHH , a TaKJ<e TeXHHKH-CaHHTapw, HHJlteHepbl-XHMHKH, npeACTaBHTeAH opraHOB 3ApaaooxpaHeHHH. YqaCTHHKH BCTpe= paCCMOTpeAH pa3AHqHwe acneKTbl onaCHOCTH MHKpo6Horo 3apaioteHHH OT Heo6pa6o- TaHHblX OT6pocoa, oco6oe BHID<aHHe yAeJIHB ca.11MoHeAAe H 6blqbeMy uemno - aa6oAeaaHHJDl, npeACTaBAJIJOIIIHM B HaCTOJll[lee apeMH HaH60Abill)'10 onacHOCTb AAH HaCeAeHHH Eaponw . Ha OCHOBe HMe!OllleHCH HH<!>OpMaUHH Pa6oqaH rpynna npHHHAa pemeHHe OTHOCHTeAbHO CTeneHH pHCKa, CBH3aHHOro C onacHOCTbfil MHKpo6Horo aa- pruteHHH, H awpa6oTaAa COOTBeTCTByJCIIIHe peKO><eHAamm no BeAeHHro HCCAeAOBaTeAbCKOH pa60TW B paHOHax, KOTOPWM, KaK npeACTaBAHeTCH, yrpoJl(aeT cepbil3H_aH onaCHOCTb aapaJl(eHHH. B nocAeAHee AeCHTHAeTHe B npOM1>1111AeHHO-pa3BHTblX CTpaHax B CBH3H C HeB03MOJl(H0CTbID c6poca OTXOAOB B oxeaH, a TaKJ<e B pe3yAbTaTe p o cTa ueH Ha 3Heprmo, KOTOPWH cymecTBeHHO yaeJm=A CTOHMOCTb APYrHX BHAOB ycTpaHeHHR OTXOAOB, TaKHX, H8llp1D,1ep, KaK c.uiraHlle Mycopa, 3HaqHTeAh HO pacmHpHAOCb HCI10Ab30Ba- HHe 3eMAH AAH ycTpaHeHHH Heo6pa6oTaHHblX OTXOAOB . B nocAeAHHe rOAbl yaeAHqHAOCb qHCAO 3a60AeBaHHH ca.llMOHeAAOH B pe3yAbTaTe =eaoro OTpaaAeHHH . 3Ta TeMa 6 wAa npeAMeTOM o6cy]l(AeHHH KOH¢epeHIU<H, npOXO,ll,HBilleH a BHAbAXOBeHe, HHAepAaHAW, c 6 no 10 OKTH6pH 1980 rOAa, H C03BaHHOH BceMMpHOR acCOIIHauHeR aeTepHHapoa-rHrHeHHCTOB nHmeBblX npOAYKTOB H BceMHpHOH opraHH3SUHeH 3ApaaooxpaHeHHH . .ni,:cKyccHH B pa3Hb!X CTpaHax ypoae Hb c6poca ropOACKHX OTXOAOB Ha noaepxHOCTb 3eMJIH KOAe6AeTCH OT 15% AO 74% co cpeAHID< noKa3aTeAeM OKOAO 50% . 8 HaCTOJll[lee apeMH AeHCTByeT AmDb He3HaqHTeAbHaH qacTb MycopOCJl(Hr aTeAbHblX neqe,r H Apyrnx cpeACTB TepMHqecKOH o6pa60TKH Mycopa. B 60AbmHHCTBe Jl(e CAyqaea npaKTHKyeTCH c6poc Heo6pa6oTaHHblX OTXOAOB B OKeaH H 3aKans1aaHHe ax B 3eMJllO . □opHAOK ycTpa HeHHH OTXOAOB MOJl(eT 6b!Tb cymecTBeHHO pa3J1HqHb[I,( B pa3HblX CTpaHax, B PHAe rocyAapCTB OH eme OKOHttaTeAbHO He y TaepJl(AeH. PacceHBaHHe OTXOAOB no noaepxHOCTH 3eMJIH JIHmb ttaCTHttHO MOJl(eT CAy]l(HTb ueAJDl YA06peHHH nottaw . B pHAe CAyttaea OTXOAbl npHBHOCHT B noqay noAe3Hble opraHHttecKHe aemeCTBa H MHKp03AeMeHTW. □po6Ae ­ Ma, CBH38HHaR C npHCYTCTBHeM TOKCH'-1:eCKHX MeTa~AOB B OTXOAax, BblXO,.lUIAa aa paMKH noaeCTKH AH.fl BCTpe- qH. HeCMOTpH Ha mHpOKO pacnpocTpaHeHH)'lO npaKTHKY HCil0Ab30BaHHH ceAb CKOX03HHC TBeHHblX 3eMeAb H nacT6 Hlll AAH c 6poca ropOACKOro Mycopa H Heo6pa6oTaHHblX OTXOAOB, nOKa e me co6paH He3Ha=TeAbHWH OIIHAeMHOAOrHtteCKHH MaTepHaA, KOTOpb!H AOKa3MBaA 6 bl B03MOJl(H0e BAHHHHe nOA06Horo HCilOAb30BaHHH OTXO - AOB Ha 3AOP0Bbe qeAoaeKa . □poaeAeHHWe HCCAeAOBaHHH, 66AbmaH qacTb KOTOpblX He AaAa B8JlHWX CTaTHC - TIItteCKHX peayAbTaTOB, He Bb!HBHJIH KaKHX- JlH6o onacm1x <!>OPM B03AeHCTBHH Ha 3AOPOBbe qeAOBeKa. He 6bLl(O TaKJ<e ycTaHOBAeHO ttenocpeACTBeHHOH B3aHMOCBH3H Me]l(AY B03HHKHOBeHHeM BHpyCmlX 3 IIHAeMHH H c6po- COM Ha noaepXHOCTb 3eMJIH npoAe3HH<!>IIUHpoaaHHblX OTXOAOB . YttHTb!BaH npnpOAY B03HHKHOBeHHH BHpyCHblX HH¢eKUHH H aa6oAeBaHHH, npeACTaBAHeTCH MaAoaepOHTHWM, ttTO onHAeMHOAOrHtteCKHMH MeTOAaMH aoo6me B03- MOXHO apocAe,ll,HTb TaK)'lO B3aHMOCBH3b . 0TAeAbHble H3 aaperHCTpHpOBaHHblX CAyttaea BHpyCHblX 3IIHAeMHH (BKJIIOttaH 3nHAeMHID renaTHTa A), CB H3aHHble C HCnOAb30BaHHeM OTXOAOB, HBHJIHCb pe3yAbTaTOM a6COJllOTHO HeapaBHAbHOH H He6e3onacHOR o6pa60TKH OTXOAOB, qTo MOrAO 6 wTb AOKa3aHO XHMHtteCKHMH H 6HOAOrHttec- KHMH OIlb1T3.MH. _J - 76 - Taenia saginata, 6•1qmi neneHb, npeAeTaBJ1J1eT eo6oii e Me.ll,HUHHeKoil TOqJOJ 3peHHJI HaH60J1ee onaeHyio Bhlemyio ~OPMY napa3HTHqeeKoro opraHH3Ma, CYIJleeTByiomero B paHoHax )'MepeHHoro KAHMaTa. .lJ.pyrHe napa- 3HTbl npeAeTaBJIHIOT eo6oil MeHbIDyJO onaeHOeTb . ,ll./IJI HX ymrqTOJKeHHJI, KaK H AJIJI 6opb6bl e 6bJqbHM nenHeM , 06bJqHO HeDOJlb3)'IOTCJI Ae3HH~KllHH, BoJle3HeTBOpHble rpH6JOJ H enopoo6pa3YJ0111He 6aKTepnH noeTOJIHHO npn- eyTeTByroT B noqBe, D03TOMy e6poe Heo6pa6oTaHHblX OTXOAOB Ha DOBepxHOCTb 3eMJIH , DO Beeil BepOJITHOCTll , He yBeJIHqHT onaeHOeTb, KOTopyio npeAeTaBJIHIOT eo6oii 3TH opraHH3Mhl, B HaeTOJllll,ee BpeMJI AJIJI 6opb6bl C paenpoeTpaHeHHeM B pe3yJlbTaTe e6poca OTXOAOB 6oJle3HeTBOPH~IX MIIKpoopraHH3MO B HeilOJlb3)'IOTCJI pa3JlllqHbJe MeTOAbl - OT eTa6nJIH3aIUrn nyTeM aHa3p06HOH o6pa60TKH AO mnpo- KOii a3po6Hoii o6pa60TKH nyTeM naeTepH3anHH , xHMHqeeKoro B03AeiieTBHJI H HOHH3Hpyiome il pQAHaD;HH, 3a- npemeHHe e6paeblBaTb Myeop H naCTH CKOT JIO JIHKBH.}laUHH naToreHHblX MHKpoopraHH3MOB (npOAOJllKHTeJlbHOeTb 3TOro nepHOJla 3aBHCHT OT MeeTHOH TeMnepaTypbl B03Ayxa ) JIBJIJleTCJI 3~KTHBHblM H HeAOpQrHM epe.}ICTBOM 6opb6bJ BO MHOrID< paiioHax. IlOBTOpHoe 3apaJKeHHe MOJKeT npOH30HTH npn Jlro6oii AaJKe CaMOii HQAeJKHOH eHCTeMe KOHTpOJIJI H yMeHbmaeT 3~KTHBHOeTb nponeeea Ae3HH~Kll;HH. Oco6oe BHHMaHHe Ha BeTpeqe 6hlJIO yAeJleHO paceMOTpeHHro pa3J1HqHblX BH,llOB HH~KnHii, o6ttapyJKeHmJX B KJlllHHqeeKHX yeJIOBHJtX, a TaKJKe yBeJIHqeHHro tmeJla 3AOPOBblX ~aKTOpOB OKPYJKaIOllleil cpeAbl, ~eTaJlbHOe 3llHJleMHOJIOrHqeeKOe HeCJleAOBaHHe nponeeca pa3BHTHJI HH~Kmm AO MOMeHTa llOJIBJleHHJI THllffqHblX emmTOMOB 60J1e3HH IlpeJ1eTaBJ1JleTeJ1 KpailHe TPYAHhlM H AOporoeTO.fllIUD!. lieKJ!roqeHHe coeTaBJIJleT XOJ!epa, KOTOpaJI Bee APYrHe KHmeqHble 3a60J1eBaHHJ1 nepeAaroTCJI camnrn pa3- HhlMH enoeo6aID1, ll3 KOTOpbIX eaMhlH paenpoeTpaHeHHblH n y Tb - 3TO 3aHeeeHHe HH~eKIIHH PYKOH B llOJIOCTb pTa. CaJ1MOHeJ1J1a MOJKeT pacnpocTpaHJITbCJI B pa3J1HqH= yCJIOBHJtX , ll 6blJIO 6bl HepeaJlbHO pacCtmTblBaTb Ha JIHKBH,.lla- IlHfO 3THX 6aKTepHH y eeJlbCKOX03JIHCTBeHHblX lKHBOTHblX B HaCTOJllll,e e BpeMJI, MttorHe naToreHm1e MHKpoopra- HH3Mhl He npeACTaBJIHIOT eo6oil HenocpeAeTBeHHOH y rp03bl AJIJI 3AOPOBbJI qeJIOBeKa , XOTJI MoryT npHqHHHTb BPeA xo3J1ficTBy . Mx paccMoTpeHHe He BXOAHJIO B 3a.}laqy Pa6oqeil rpynnM. Heo6pa6oTaHHble OTXOJ!bl CO.}lepJKaT B ce6e pa3JlllqHble 60J1e3HeTBOpHble MHKpoopraHH3Mhl, BKJllOqaJI 6aKTe- pHH, BHPYCM, napa3HTHqeeKHe opraHH3Mbl H rpH6KH. 3TO roBOPHT O BO3MOJKHOM ID< npOHHJOIOBeHHH B opra- HH3M lKHBOTHblX H J!WAeil npll HCDOJlb30BaHKl! TaKHX OTXOAOB. IlpHMeHeHHe OTXOJIOB Ha ceJlbCKOX03JIHCTBeH- HblX yrO.}lb.flX JIJIJI BblJ)JUJU{BaHHJI ypoxaJI H Bhlllaca CKOTa qaeTO JIBJIJleTCJI HaH60J1ee .}lemeBhlM cnoco6oM ycTpaHe- HHJI 3THX OTXOJ!OB . OTXOJ!bl JlaIDT Cblpbe JIJIJI npOMhlIDJleHHOeTH H MOryT eJ!YlKHTb B KaqecTBe YA06peHHil .}IJIJI 3eMJIH, HO ID< HCDOJlb30BaHHe BeAeT K pacnpocTpaHeHHW B OKPYiaJ<llleil cpe.}le 6oJle3HeTBOpHbIX MHKpoopraHH3- MOB. 0AHaKO, CYIJleCTByIDT ll MHOrHe Apyrne HCTOqHHKH H DYTH pacnpOCTpaHeHHJI 60J1e3HeTBOpm!X MHKpoop- raHH3MOB, npeACTaBJIJIWIDHX onaCHOCTb JIJIJI 3JIOPOBbJI qeJIOBeKa H lKHBOTHblX . Il03TOMy onacHOCTb e6poca OTX0.}10B AOJllKHa eOH3MepJITbCJI C 3THIDI B03MOJKHOCTJIMH, HO onpe.}leJleHHe e~ MHKp06HOJ10rnqeeKHMH cpe.}ICTBaMH H 3llH,lleMHOJIOrHqecKHMH cpeJ!CTBaID! JIBJIJleTCJI J!OporoCTO.fl!IIHM . TeM He MeHee, yMeHbmeHHJI onaCHOCTH npn HCDOJlb30BaHHH Heo6pa6oTaHHblX OTXOJ!OB MOJKHO .}106HTbCJI, ecJIH COOTBeTCTByt<mlHM o6pa30M o6pa6aTblBaTb H HCDOJlb30BaTb 3eMeJlbHbJe yrO.}lbJI. Ho ecJIH npn 3TOM coxpaHJIWTCJI J!pyrHe BaJKHble HCTOqHHKH 6oJle3HeTBOp- . UJ,JX MHKpoopraHH3MOB, paccqeTbl Ha cymeeTBeHHOe H 6blCTpoe COKpameHHe qHcJla 3a60J1eBaHHH TOJlbKO B pe- ~ YJlbTaTe BBe.}leHHJI 6e3onacHOH npaKTHKH ycTpaHeHHJI OTXOAOB 6y.}lyT HepeaJIHCTHqHbl . PHCK 3apaJKeHHJI B Jlro60M HaceJleHHOM nyHKTe 3aBHCHT OT PJ1Aa pa3J1HqHblX ~aKTOpOB. CpeJIH HHX - c oeTOJIHHe 3AOPOBbJI HaeeJleHHJI, oeo6eHHOCTH noqBbl, TewnepaTypa B03Ayxa, BJlaJKHOCTb, KOJIHqeCTBO ocaAKOB H paCDOJIOJKeHHe rpyHTOBblX BOJI; oeo6eHHOCTH 3eMJ1eAeAHJ1 H lKHBOTHOBOJICTBa, a TaKJKe MeTOAbl 6e3onacHoii nepeB03KH H c6poca OTX0.}10B Ha DOBepxHOCTb 3eMJIH. Bee 3TH .}laHHble HeB03MOIHO npnBeCTH B a6eOJIWTHOM Ho AJIJI 6opb6bl C yrp030H 3apaJKeHHJI HaCeJleHHJI MOJKHO HCDOJlb30BaTb COOTBeTCTByt<mllle MeTo.}!Hqec- KHe yKa3aHHJI, coeTaBJIJleMhle e yqeTOM oeo6eHHOCTeil KaJK.}!Oro paBOHa. 3apaJKeHHe CaJIMOHeJIJIOH qepe3 npOAYKTbl llHTaHHJI - 3TO OAHH H3 BHAOB 3apaJKeHHJI, onaeHOCTb KOTOporo MOieT B03paCTH npH c6poee Ha IlOBepXHOCTb 3eMJIH Heo6pa6oTaHHblX OTXOAOB, COAepxamnx 3TH MHKpoopraHH3- MhJ. XOTJI Mhl em~ He pacnoJ1araeM 3IlHAeMHOJIOrHqecKHMH AaHHhlMH, DOATBepJKAafOIIIHMH 3TO, ycTaHOBJleHo, qTO y poraToro CKOTa, IlOABepJKeHHOro B03.}leileTBHro TBKHX OTXOAOB, Bhlme 3a60J1eBaeMoeTb caJIMOHeJIJIOH, qe» y JKHBOTfillX KOHTpOJlbHOH rpyDDbl . Taenia sagina ta qacTO pa3BHBaeTCJI B opraHH3Me qeJIOBeKa H, eeJIH 3apa- JKeHHe DPOH30IDJIO , JIHqKH BhlXOAJIT e qeJIOBeqecKHlm HCilpaJKHeHEJIMH . qepe3 OTXO,lll,J OHH voryT 3apa3HTb poraTbdi CKOT, qTO eOOTBeTeTBeHHO BeAeT K B03HHKHOBeHmo llHCTHllepKa, B CBOW oqepeAb, IlpeACTaBJl.f!f<lll;ero onacHOCTb 3apaJKeHHJI qeJIOBeKa. Pa3JIHqHbJe BH.llbl TeDJIOBOH o6pa60TKli' HOHli3HpyiomaJI paAHau;ru, HJIH AJIH - TeJlbHOe xpaHeHHe MOryT yHHqTQlKHTb HJIH yMeHbmHTb qHCJIO HaXOAJllll,HXCJI B Heo6pa6oTaHHblX OTXOAaX HOCHTe- J1eii caJ1MoHeJ1J1bl H mtqeK Taenia sagina ta . K B03AeilCTBIDO XHMHqeCKOH .}le3HH~KIIHH, B OTJ!Htme OT caJIMOHeJIJlbl' JIHqKH Taenia sagina ta yeTOH'IHBbl - 77 - 4TO KacaeTCR APYrHX 6oAe3HeTBOpHblX HO CHT eAeH , TO HX o naCHOCTb AAR 3AOPOBbR HaCeAeHHR npeAC Ta B- .JIIleT C .fl Y:eHbmeH B 60.JibMIIHCTBe paHoHOB' r ..n:e npoBO.lIH..iUICb Heo6XOJIHMbie HCC.1le,llOBaHIUI. 0,.n;HaKO' ITOTeHUH- aJibHaH onaCHOCTb, HCXOAHmaR OT BHpy coe H napa3H THqe CK HX opraHH3MOB, TaKHX KaK Sarcocvstis, He 6hI- Aa AOAJltHbI>I o6pa30M oueHeHa. HaAHqHe BHpyca renaTHTa AB Heo6pa6oTaHHblX OTXOAaX MOJlteT , K npHMepy, n peACTaBARTb AOITOAHHTeAbHYIO o naCHOCTb B pattoHax, rAe 3Ta HH¢eKUHR AOCTaToqHo pacnpOCTpaHeHa. 1. Heo6xOAHMO llPHHRTb Mepbl (CM . nyHKT 3) AAR 3HaqHTeAbHOro CHHXeHHR KOHileHTpaUHH 6oAe3HeTBOplil>1X 111HKpoopraHH3MOB B Heo6pa6oTaHHblX OTXOAax AO Toro, KaK CTaHeT BO3MOJltHbI>I me KOHTaKT co caexm.m oaoma- MH e <l>PYKTSMH, KOTOpble ynoTpe6AJIIOTCR qeAOBeKOM a lIHJIIY • 2. EcAH B OTXO,n;ax co.n;epxaTCR 6oAe3HeTBOPHbie l,UiKpoopraHH3Mbl, KOTOpble cnoco6Hbl pa3MHOJltaTbCR HAR 3apaJ1taTb MRCHble H MOAOqHble npoAyKTbl' AOMameroro llTHUY' TO TaKHe OTXOAbl HeAb3R c6paCbIBaTb Ha TeppHTO- ·pmo , rAe uacyT AOMamHHH CKOTHAH llTHllY• HcKAroqeHHe COCTaB~JIIOT Te CAyqaH, KOrAa co apeMeHH c6poca OTXOAOB HAO HaqaAa Bblllaca Ha 3TOH TeppHTOpHH AOMamHHX JltHBOTHblX npomAO Heo6xo.n;m,oe BpeMR. 3. ,ll.;I:R OTHOCHTeAbHO HeorpaHHqecHHOro HCllOAb3OBaHHR Heo6pa6oTaHHblX OTXOAOB peKOMe5AyeTCR upOBOAHTb CAeAyromHe BHAbl ,n;e3HH¢eKUHH: a) TeITAOBaR o6pa60TKa B TeqeHHe 30 lllHHYT llPH TeMITepaType 10°c, 3aroTOBKa KOMITOCTa npH BblCO- KOH TeMITepaType, ropRqaR cymxa; 6) HOHH3HpyromaH pa,D;HaUHH c Ham.<eHbmm.< ypOBHeM B 5 kGy (500 kRad); B) npOAOAlltHTeAbHOe xpaHeHHe OTXOAOB, BpeMH xpaHeHHH AOAXHO 6b1Tb o6pa6oTaHO nponOpUHOHaAbHO TeMnepaType; r ) o6pa60TKa xm,HqecKHMH aemecTBaMH, KOTOpb!e yHHqTOJt<aIOT m,eromHeCH B OTXOAax MHKpoopraHH3MbI. 4. B OTAeAbHblX CAyqaHX, Kor Aa HCKAroqeHO 3apaxeHHe CBelltHX llHmeBblX npo,n;yKTOB, KOTOpbie MoryT 6b!Tb HCllOAb3OBaHbl qeAOBeKOM' peKOl4eHAyeTCH aHa3po6HaH o6pa60TKa H .n;pyrHe BHAbl CTa6HAH3 aUHH' ecAH OHH n po- BOAHTCH TaKHM o6pa30M, qTo6bI MaKCm.<aAbHO yMeHbfilHTb BO3MOJltHOCTb llOBTOPHOI'O 3apaxeHHH. 5. He CAeAyeT HCITOAb3OBaTb o6uure MeTOAHqecKHe yKa3aHHH BO acex paHOHax 6ex yqeTa MeCTHblX ycAOBHH. 6 . Heo6xo.iurno CTHMYJ1HpOBaTb tie TKO CITAaHHPOBaHmie 3 ITHAeMHOAOrHqecKHe UCCAeAOBaHHH O B03MOJltHOH B3am.<OCBH3H c6poca OTXOAOB Ha noaepxHOCTb 3eMAH H BO3IDIKaIOmHX onacHOCTeH AAH 3AOPOBbH HaceAeHHH. Pa6oqaJl rpvrrna no npocJ>eCCHOHaAbHbW npowaHAal,I a IlO,llrOTOBKe onepaTopoB CHCTeM BOAOCHa6xeHHJI H KaHaJIH38ll;HH H OllHCTHl,IX coopylK.eHHii ~ eAbWT, 30 MapTa - 3 anpeAJJ 1981 roAa BcTynAeHHe - 78 - ICP/ EHP 005(S ) 3 moHJJ 1981 ro,.n;a OPJ.irnHA.JJ: AHI'JIHMGIDlli B pa6oTe Pa6oqeil rpynnhl npHHJlJIH yqacTHe ceMb BpeMeHHbIX KOHCYAbTaHTOB, ,llBa caHHTapHbIX HHXeHepa B03 H lleTblJ)e Ha6JllO,.n;aTeAJl' 1n1eIOJIU{e Oilb!T pa60Tbl B o6AaCTH BO,llOCHa6xemrn H KaHaAH3a)lllll ' pa3BHTHJl Ka,ll - pos n no,llrOTOBKH cneUHaJIHCTOB no nporpam,e onepaTop/ pyKOBO,llHTeAb . YqacTHHKH Pa6oqeil rpynn•• COCTaBHAH np<><!JeCCHOHaAbHble npo(JJaHAhl ,llAJl onepaTopos n PYKOBO,llHTeAe H CHCTeM BO,llOCHa6xeHHJl H KaHaJIH3aUHH, a TaKXe BO,llOOllHCTHblX coopyxeHHM . OHH TaKXe o6cy,llHJIH Tpe6osaHHJl K n o,.n;rOTOBKe H MeTO,llOAOrHJO ,llAJl 3 THX THilOB nepcoHaAa, BKJDOllaJl Heo6XO,llHMYJO MaTepaaAbHYJO 6aay, TaKy,o KaK coopyxe HHJl , Ha KOTOpblX MOXHO npOBO,llHTb o6yqeHHe. CosemaHI<e cTaAo llaCTbJO nporpa.MML1 EsponeilcKoro peraoHaAbHoro 6ropo B03 no pa3BHTHJO Ka ,.n;pos a,.n;pa- BooxpaHeHHJJ ,llAJl 03,llOpOBAeHHJl OKpyxarom_eil cpe,llhl, a TaKXe nporpaMMLI Eropo no OCHOBHbW caHI<TapHMM :Mepru,i • OHO TaKXe JlBHAOCb BaxHMM BKAa,llOM a Mex,.n;yttapO,llHOe ,lleCJlTHAeTne IlHTbesoro BO,llOCHa6xeHHJl a caHnTapHJI. P a6oqaJl rpyrrrra paCCMOTpeAa cymecTsyiom;y,o rrpaKTHKY a OTHOmeHHH no,.n;rOTOBKH nepcoHaAa a o6AaCTH IlHTbeBoro BO,llOCHa6xeHHJl H KaHaJIH3aITHH BO ~paHUHH , ~ e,.n;epaTHBHOH Pecrry6JIHKe repMaHnn , HTaJIHn , Hli,llep- Aa H,.n;ax H Coe,.n;nHeHHOM KopOAeBCTBe . EMAH TaKXe 06cyx,.n;eHL1 nAaHbl, KacaromnecJJ no,.n;roTOBKH onepaTopos/ PYKOBO,llHTeAeH, COCTaBAeHHhle ,llByMJl CTpaHaMH, pacnoAoxeHHhle Ha IOXHOM no6epexbe Cpe,llH3eMHOro MOPJJ ( A.Joocap, ErnneT). YllaCTHHlCH onpe,.n;eJIHAH OT,lleAbHbZe npo(JJeCCHOHa.JibHble npo(JJaHAM ,llAJl onepaTopos H PYKOBO,llHTeJIE!H, 3aHJl- TblX B 3KCilAYHTaUHH ceTH llliTbeBoro BO,llOCHa6xeHHJl, KaHa.JIH3aUHH , BO,llOOllHCTHblX coopyxeHHH ,llAJl rrpeCHOH BO,llhl , BO~OO'IHCTIWX coopyxeHHH ,llAJl CTOllHbIX BO,ll n HaCOCHbIX CTaHUHH. OHH TaKXe onpe,.n;eAHAH Tpe6oBaHHJl K no,.n;roTOBKe nepcoHaAa no KaX,llOH KaTeropnn OT,lleAbHO. OpraHH3aUHJl, MeTO,llbl H rrpaKTHKa no,.n;roTOBKH 6bIJIH o6cyx,.n;eHhl HapJl,lly C npo6AeMaMH, KaCaromHMHCJl HCilOAb30BaHHJl cymeCTByI<!D,en 6a3hl, a TaKXe ueHTPOB , c neUHaJibHO nocTp0eHHbIX ,llAJl o6ylleHHJl Ha rrpaKTHKe. 1. B CHAY e~ 60Abmoro 3HalleHHJl ,llAJl rrpaBHAbHOH pa60Thl CHCTeM BO,llOCHa6xeHHH n y,.n;aAeHHJl OT6pocoB , a COOTBeTCTBeHHO H ,llAH 3,llOpOBbJl HaceAeHHJl CAe,.n;yeT yCHAHTb H YAYllIDHTb IlO,llrOTOBKy rrepcoHaAa, 3aHJlTOro B 3KCnAyaTaUHH 3THX CHCTeM H BHe,llpHTb e~ Tall , r,.n;e 3 TOH no,.n;rOTOBKH em~ He cymeCTByeT . 2 . CncTeMbl IlO,llrOTOBKH ,llOAXIW JlBHTbCJl peayJibTaTOM npouecca Bceo6'beMA!Om_ero nAaHnpOBaHHH Ka,llpOB, BKJDOllaJJ KAaccn(JJHKaumo pa6oTM, pa3BHTHe npo(JJeccnoHaJibHLIX npo(JJanAoB, oueHKY nepcoHaAa, Heo6xo,llH:Moro ·a KaX,llOH KaTeropaa, a TaKXe opraHH3aumo no,.n;roTOBKH xa,.n;pos. 3 . IlepBooqepe,llHOe BHHMaHHe Ha,llAeXHT y,.n;eJIHTb OT6opy H no,.n;roTOBKe HHCTPYKTOpOB. 0To6paHHble a KalleCTBe HHCTPYKTOPOB Ka,llpbl ,llOAXHbl o6Aa,llaTb nmpoKlll! npaKTHlleCKHM OilhlTOM n COOTBeTCTBYJOmHMH ne,.n;arorH- qecIODm cnoco6HocTRMH . 4. PyKOBO,llHTeJIH CaMH ,llOAXHbl n epHO,llHlleCKH npOXO,llHTb nepeno)lrOTOBKy B Te lle HHe Bcero CTaxa p a60Thl H 0,llHOBpeMeHHO ,llOAXHbl He CTH OTBeTCTBeHHOCTb 3a HenpephlBHYJO IlO)lrOTOBKY CBOHX Ka,llpOB B COOTBeT CTBHe C TeXHHlleCKHMI< HOBOBBe,lle HHHMH. - 79 - 5. He CAeAyeT CTHMYJIHPOBBTb ucnOAb30BBHHe qacTHqHO 3BHJITblX onepaTopoa B nOAb3Y onepaTopa, Hec y - mero OTBeTCTBeHHOCTb 38 6oAee, qeM OAHY yc TaHOBKY OAHOBpeMeHHO, qTo o6ecneqHT ero 38HJITOCTb B Te- qeHHe noAHoro pa6oqero AHII . 6. !IepcoHaA. KOTOpbI:ii 6yAeT o6cAy)l(HBaTb HOBbie ycTaHOBKH, AOAXeH H83HaqaTbCJI KaK !,O)l(HO paHbme H npHBAeKaTbC/1 K pa6oTe, KOrAa ycTaHOBKa HBXOAHTC/1 eme a CTaAHH KOHCTPYKOHH H CTPOHTeAbCTBa. 0AHO- ape MeHHO OHH AOA)l(Hbl noAyqaTb HaBblKH pa60Tbl Ha y)l(e cymecTByJOmHX ycTaHOBKax. 7. CpeACTBa Ha nOArOTOBKY AOAXHbl o6ecneqnaaTbCJI B3HOCBMH OT BOAHOro X03RRCTBB HJIH nocTynaTb OT APYrHX yqpe)l(AeHH:ii KB CTOHMOCTb ¢yHKOKOHHpy,omax CHCTeM H5AAe)l(HT BKJIIOqaTb oneHKY paCXOAOB, CBH3aH- HWX C n o~r OTO BKOli nepcoHaAa. 8. HaAAe)l(KT YAYqfilHTb CTaTyc o6cAy)l(llBIUOmero ycTaHOBKH nepCOHBAa, a TaKJ<e npK3HBTb IIX KCTHHHOe 3uaqeHHe AA/I o6mecTaeHHOCTH c nOMOfilblO TaKHX 1,1exaHH3MOB, KaK CHCTeMa Bb!Aaqn cepTH¢HKaTOB, npH3HaHHe npo¢eCCKOHBAbHhlX npo¢a:iiAOB, a TaKJ<e C03AaHHe npo¢eccHOHBAbHWX acconnaun:ii. 9. Crum opraHl>l, PYKOBOAJ!lllHe CHCTeMaMH BOAOCHa6)1(eHHJI n CTOqHhtx BOA AOAXHJ,1 npKCTynHTb K OOArOTOBKe nepcoHaAa AH6o nyTeM KOOPAHHHPOBaHHOH pa60Tbl y)l(e cymecTBy,omHX yqpeJttAeHHH, AU6o HC00Ab3YII cneunaAbHO AAH 3TOro C03AaHHbie ycTaHOBKH . CHCTeMa, KOTOpaH 6yAeT npHHJITa, AOAXHa COOTBeTCTBOBaTb cymecTBYJO- me li opraHH3aUHOHHOH CTpyKType 3aHHTepecoaaHHOH CTpBHbl. 10. BbtmeCTO.fllIU{e opraHbl BOAOCHa6)1(eHHJI AOAXHl>I C03ABTb CBOH co6CTBeH111>Ie yqpe)l(AeHHH no nOAI'OTOBKe nepcoHaAa, a TaK)l(e pa3pa6oTaTb 06113aTeAhH}'lO nporpa.>[l,(y 06yqeHH11, a TO apeMH KBK HH)l(eCTO.fllIU{e opraH&I AOAXHbl o6~eAHHHTb CBOH ycHAHH B pa3BHTHH HBBbIKOB o6meli nOAI'OTOBKH . 11. !IOAI'OTOBKa AOAXHa o6ecneqnaaTbCJI Ha noAHOMaCmTa6Hbtx ycTaHOBKax a AOAXHa OOAKpenAHTbCH COOT- aeTCTByromeli HOMHHaAb HOH OOAI'OTOBKOH. 0AHaKO, a Tex CAyqaHX, I'Ae OOAHOMacmTa6Hble ycTaHOBKH OTCYT- CTB}'lOT HAH orpaHHqeHbl, nOAI'OTOBKY CAeAyeT ocymecTBAJITb, HCOOAb 3YH cymecTBytOl!tyro 6a3y. 12. KOMilOHeHTbl HOMHHaJibHOH llO,l(rOTOBKH AO.JIJKHhl BKJOOqaTb H3yt-1eHHe Tpy,.n;oablX HHCTPYKUHii, ropH,IUi'-1:eCKHX, a,ll;MHHHCTpaTHBHbIX, rHrHeHHqecKHX acneKTOB, a TaKJKe acrreKTOB 6e3onacHOCTH H T . ,l(. 13. KomroueHT TexHHqecKOH OOAI'OTOBKH AOAXeH 6&ITb AOCTaToquo mnpoKHM H o6ecneqHBaTb 3HBHHe CHCTe- "1,1 B ueAoM, paBHO KaK H yMeHHe ynpaBAJITb OTAeAbHb!MH ee 3BeHbHMH, o6ecnequaaTb ocaoeHHe npoueAyp 3KCnAyaTatnrn K p83BHBaTb KOHKpeTHbie TexHHqecKHe HBBblKH . 14. TaM, I'Ae Heo6xo,LUIMO HCOOAb30BaTb AAH llOAI'OTOBKH Ma,lOMaCmTa6Hble MOAe .m, CAeAye T no3a60- THTbCJI O TOM, qT06&1 IIX ra6apHTbl no3BOAH,m AOCTaToquo 3<!Xl>eKTHBHO aocnpOH3BOAHTb pa6oqu:ii npouecc, a T8KJ(e B03MOlK.Hbte CHTyallHJI, B03JUIKaIOm;He B xo,4e 3KCII.,11ya Ta1un1. 15. HaAAe)l(HT npHHHTb npo¢eccKOHBAbHble npo¢aHAbl K/HAH npacnoco6HTb 1IX Ha HaUHOHBJlbHOM ypOBHe AAH nepcoHaAa, KOHTpo,mpy,omero BOAOCHa6)1(eHHe H YAaAeHHe OTXOAOB, a TaK)l(e nepcoHaAa, 3BHHTOI'O 3KCOAya- TBOHeli qT06bI 6bIAO qeTKOe npeACTaBAeHHe O COAe p)l(aHHH pa60Tbl. CAeAyeT TaK)l(e ycTaHOBHTb npo¢eCCHOHBAb- Hble Tpe6oaaHHH. 3TH npo¢eccHOHaAbHble npo¢aHAbl AOAXHbl HCOOAb30BaTbCH B KaqeCTBe OCHOBbl A,1H COOT- eeTCTByromero nAaHHpoaaHHH pa3BHTHJI KBAPOB. 16. ,ll.n:n Toro. qT06&1 o6ecne=Tb nOAHOe HCOOAb30BaHHe HMe,omelicn B HBAHqHH MaTepaaAbHOH 6a3bl H K36exaTb Ay6AHPOBaHHJI paBHO, KaK H o6ecneqHTb KH¢op1,1auH10 no MeTOAOAOrHH H TeXHOAOI'HH nOAI'OTOBKH nepcoHaAa, HaAAe)l(HT C03ABTb ueHTpaAbHbIU KOOpAHHHpyromHH oprau, C TeM, qT06bl MaKCHMaAbHO HCOOAb30BaTb orpaHHqeHHbie npo¢ecCHOH3.)lbHble KaAPbl · 1 7 . Haa6oAee ;«eAaTeAbHbIM JIBAJleTCH o6pa30BBHHe ueHTPOB no noArOTOBKe nepcoHaAa Ha perHOHa,lbHO>I HAR HaOHOHBAbHOM ypOBHHX no cpaBHeHHIO C C03Aa HHeM ueHTpOB Ha Me)l(AyHapOAHOM ypoaue . KpoMe Toro, AA/I Toro qT06bI o6AerqHTb TeXHHqecKoe COTPYAHHqeCTBO Me)l(AY pa3BHBBIOIIlHMHCJI CTpaHaMH, Te CTPB Hbl, KOTO- pwe rrpHCTyITHAH K C03AUHHIO MaTepHBAbHO-TeXHHqecKOH 6a3bl A,lH nOAI'OTOBKH, AOAXHbl OKB3b1B8Tb COAeHCTBHe COCeAHHM CTpaHaM, y KOTOpbtx TBKBH MaTepHBAbHO-TexHHqeCKBH 6a3a e me OTCyTCTByeT . 18. Heo6XOAHMO rrpH3HBTb 60Abmoe 3uaqeHHe nepcoHaAa, pa60Taromero Ha YCTBHOBKBX H CAeABTb 3TO rryTeM npeAOCTBBAeHHH B03M0)1(H0CTeli H C03AaHHH CTHMYAOB npOABH)l(eHHH no CAyx6e 6AarOABPII o6yqeHmo . Heo6- XOAHMO ycTBHOBHTb CHCTeMy oueHKH AAH KOHTpOAH rrporpaMM nOAI'OTOBKH >I aueceHHH B HHX COOTBeTCTBYJOfilHX H3>IeHeHHH. qTo6bI CAeAaTb HX HaH6oAee ITOAXOAHIIlHMH. BAeKBaTHbIMH H 3<!Xl>eKTHBHbll',m . - 80 _ 19. IloArOTOBKa, 3aHRToro B 3KCilAyaT~HH ycTaHOBOK n epcoH=a,AOJIJKHa npOBOAHTbCR He TOAbKO AHllru<ll , no KOHTpaKTY OTBeTCTBe HHbl>IH 3a CTpOHTeAbCTBO ycTa HOBKH H IlOCTaBAJnOlllm!H COOTBeTCTByJOIIIHee o6opyAOBa- HHe - TaKJl(e AOJIJKHbl 6 b!Tb HCil0Ab30BaHbl CAy><6 bt' npeAAarae Mhle opraHH3auumru' o6ecnemrnruommm rrp($ec- CHOH=hHyro IlOArOTOBKy B AaHHOM ceKTOpe. ·20 . COTPYAHHtleCTBO >re><AY CTpaHrum AOJIJKHO 6 b1Tb HarrpaBAe HO Ha pa3BHTHe ceKTOpa BOAOCHa6><e HHR H cam1- Tapuu B n eAOM H Ha IlOArOTOBKy He o6XOAHMOro nepCOHaAa, 3aHRTOro 3KCilAyaTrumeH, B t1a CTH OCTH . 21 . CTpaHbl, C xopomo pa3BHThWH C H CTeMa.KH D O.ztrOTOBKH , .40JUCHhl CTHMy.mpOBaTbC.fI K OKa3aHHJO IlOMOID.H B pa3pa6oTKe nporp8>04 H opraHH38llUU y t1pe><AeHHfi AAR IlOArOTOBKH nepcoHaAa CTpaHaM , rAe TaKOBble e~e He C03AaHbl, 22 . CAeAyeT MaKCHK8AhHO HCilOAb30BaTb a ce B03MO><HOCTH AAR IlOArOTOBKU HHCTPYKTOPOB , Ha y><e c~ecT- By,ooieH KaTepuaAh HOll 6a3e B Apyrux CTpaHax H AJUI 3TOro Heo6XOAmtO M8KCHM8AhHOe Me><Aytt apOAHOe COTPYA- HBQeCTBO. 23 . B pa..Kax Me><AyHapOAHOr o AeCRTHAeTHR IlUTbeBoro BOAOCHa6><eHHR u caHUTapuH nporpaKMbt AOJIJKHbl ocy~eCTBARThCR CHCTeMOM OpraHH3aUUH 06beAUHeHHblX Hamru , a ecAH OHH oc~eCTBARIDTCR Ha ABYCTOPOHHefi OCHOBe, TO oco6oe BHmtaHHe AOJIJKHO y AeARTbCR IlOArOTOBKe nepcoHaAa, 3aHRTOro 3KCITAyaTanneil ycTaHOBOK, oco6e HHO B TeX CTpaHax , rAe BOAHOe X03RHCTao oco6eHHO HyJKAaeTCR B pa3BHTUU . 24. OpraHH3aUUR 06beAHHeHHblX Hanttli H areHTCTBa, COTP YAHHtlaJOIIIHe Ha ABYCTOPOHHe fi OCHOBe, AOJIJKHbl ITOA,ll;ep><Ha a Tb H8 UUOH8.,1bHble ycHAHR B nAaH e IlOArOTOBKH HHCTPYKTOPOB AAR ABHHOro ceKTOpa, n y Te M npa- BHAbHOro HCilOAb30BaHI<R CBOI<X nporpa= CTHITeHAHH I< IlOArOTOBKH nepcoHaAa. 25 . B03 HBAAe><HT npHCTyITHTb K npoBeAeHHI-O KOHCYAbTaTHBHOro HCCAeAOB8HHR H/ HAH opraHU38llHH KOHC YAh- TaUUH AAR Toro, t1T06bl paCCMOTpeTb c ~eCTByro~yro opraHH38llHl-O IlOArOTOBKH onepaTopoB, a TaKJl(e o6R3a- TeAb Hbte rrporpa mrhl IlOArOTOBKH , tlTO IlOCAy><HT cnpaBOt!Hblld noco6HeM AAR pa3pa60TKH aH8AOrHt1Hb!X >repo- npHRTHH. 26 . B03 AOJIJKHa OKa3aTb COAeH CTBHe B opraHH3aUHH xpaTKOCpOt!HblX xypcOB HAH c eMHHapoB Ha H8llHOH8Ab- HOM y pOBHe AAR ITOArOTOBKH HHCTp yKTOpOB B 3TOM cexTope . 27. HenpaBHTeAb CTBeHHble opraHH3alllUI, a TaKJl(e Ke.l(.ll;yHapOAHble H H8llHOHaAhHb!e np($eCCHOHaAbHble accouuanuu AOJIJKHbl CTHMYAHPOBaTb C03Aa HHe HfilIHOH=bHb!X npo<),ecCHOHaAbHb!X accouuanuH B PaMKax BOAHOr o X03srliC TBa H OK83hIBaTh mt IlOA,ll;ep><Ky. 28 . B03 AOJIJKHa OKa3b!BaTh ITOMO~ rocyAapc TBaM-t1AeHaM B pa3pa6oTKe KOAyAefi ITOArOTOBKH , COOTBeTCT- BYJOIIIHX ux ITOTpe6HOCTRM, BICJIJO'IBR, , rAe 3TO IlOAXOAHT , BH3 Y8Ab Hble noco6HR AAR Toro , t!T06bl npeOAOAeTb AHHrBHCTHtleCKHe H Apyrue TP YAHOCTH, 2 9. B CHAY Toro, tlTO >re><AY TBepAb!MH OTXOAa,rn H Kat1eCTBOM BOAb! c~eCTByeT CBR3h , HaAAe><HT yAeAHTb BHHMaHBe IlOArOTOBKe npo<),e CCHOH=bHhlX npo~aHAOB AAR nepcoHaAa, 38HRTOro rrpo6AeMOH AHKBHAanuu TBepAb!X OTXOAOB . CeMHHap no cooTBeTcTBywwew TexttonorHH o np e cHeHHR nHTbeBOH BOgbl M JKHp, 14-19 HOR6p;i 1981 raga Ba egeHHe - 81 - A LG / EHP 001( S) 11 RHBap;i 1982 raga OPHIBHAfl: <l>PAHUY3CKHv! Ha gaHHOM MeJKAyHapogHOM ceMHHape' KOTOPblH npoxogHn B Hall,HOHanbHOM arpOHOMH'leCKOM HHCTHTyTe ( r. Am1mp), npHCYTCTBOBanH oxono CT a Bpaqew, y-qeHb!X, HHJKeHepoB, gonJKHOCTHblX nm-1 H npegcTaBHTMeH OcpHll,HanbHblX opraHOB H3 CTpaH CeBepHOH Act,pHKH . ITepeg yqacTHHKaMH ceMHHapa CTOMH gBe uenH : o6cygHTb noTeHuHanbHb!e B03MOJKHOCTH BpegHoro B03gewcTBHR Ha 3gopoabe qenoaexa nHTbeBOH BOgbl, c ogep•mwew 3Ha'IHTMbHb1e KOHUeHTPaUHH conew MHHepanoa; npoaHanH3HpOBaTb Hcnonb3yeMb1e B HaCTo;iwee apeMR MeTOgbl onpecHeHHR BOgb1,npegHa3Ha"'leHHOH gn;i ITHTb.A:. ,/lHC K YCCHR B Ha'lane gHCKyCCHH yqacTHHKaM ceMHHapa coo6=H o TOM, 'ITO npHHRTb!e B 1970-7 1 rr . H geHCTByw- WH e c eH"'laC CTaHgapTbl B03 6ygyT 3aMeHeHbl B 1982 rogy p;igoM peKOMeHAall,HH gn;i npaBHTMbCTB; B HHX 6ygyT yKa3aHbl npegenbHO gonyCTHMble K OHUeHTpall,HH TOKCH'IHblX aewecTB' a TaKJKe 6ygeT gaH nepe"'leHb aewec TB, KOTOPble yxygwawT Ka"'leCTBO BOgbl H CTaHOBRTCR onaCHblMH npH 6onee Bb!COKHX KOHUeHTPaUHRX. ITy 6JlHKaUHR gaeT Hay'{HOe o6oCHOBaHHe npegenbHO gonyCTHMblM KOHUeHTpaUHRM, 'ITO Heo6xog11Mo gn ;i npaaHn b- Horo npHMeHeHHR peKOMefiAall,HH . C TpaHb! 6ygyT caMH pewaTb Bonpoc pa3pa60TKH CBOHX HaUHOHanhHblX C T aHAapTOB, COOTBeTCTBYWWHX KOHKpeTHblM ycnoBHRM KaJKAOH 113 HHX. DbLJIH paCCMOTpeHbl npe11MY111eCTBa H HegocTaTKli pa3nH'IHblX MeTogoa o6ecconHBaHHR BOgbl (o6paTHblH OCMOC , 11cnonh30BaH11e HOH006MeHHOH CMOnb1, XHMH"'lecxoe o ca>KgeHHe, 3nexTpog11anH3, g11cTHnnR11,HR). ITp 11 3TOM 06cyJKAeH11w nogaeprc;i TaKJKe aonpoc 11cnonb30BaHHR c onHe'IHOH 3HeprHH a 3THX u en;i x . B xoge g 11cxycc1111 6bLJIH 3aTpOHYTbl aonpOCbl 6 11onorH'lecxoro o npecHeHHR BOgb! H OTMe'leHO, 'ITO g aHHaR n p o6neMa ewe HaxogHTCR B CTagHH H3y'{eHHR . 0 6cyJKAanc;i aonpoc o TOM, xaxHe ypox11 MOJICHO 113Bne'lb 113 onb1Ta, HaxonneHHoro a pe3 y nbT a Te 3 Kcn nyaTaUHH uenoro p;iga ycTaHoaox s CeaepHoH Act,pHxe. 11, HaKOHeu , oco6oe BHHMaHHe 6bLJIO ygeneHo KOHKpeTHblM npo6neMaM 06eccon11saHHR BOgbl B OAHOH 11 3 CTpaH, rge 3Ha'lliTMbHaR gon;i noTpe6HOCTeH B nHTbeBOH Boge ygoaneTBOBpReTCR 3a C'leT o npecHeHHR MOPC KOH BOgbl. BblBOgbl 1. B HeKOTOpblX pawoHax C eBepHOH Act,pHKli' B qaCTHOCTli ,Ha ceBepe Caxapw, cepbe3HYW npo6neMY nHTbe- s o ro aogoctta6J1CeH11R npegcTaBnReT H36b1TO'IHOe cogepJ1CaHHe B aoge conH 11 oco6eHHO ct,Topa. 2 M JICHP pacnonaraeT 6onbWHM 'IHCUOM ycTa HOBOK, oco6eHHO B npOMbWLJieHHOM ceKTOpe' KOTOpb!e MOJICHO H ~ nonb 3 0BaTb g n;i o6ecconuBaHHR ;:iogbl C np11MeHeH11eM pa3nH'IHblX MeTogoB . CTeneHb liX 3cpcpeKTHBHOCTH 3 a B HCHT OT KOHKpeTHblX ycnOBHH. 3. B03Mo)l(H0 peWHTb B03HHKWYW npo6neMY,11 TOnhKO c oo6paJ1CeHHR B 60nhWHHCTBe cny"'laeB Te X HH'leCKH CT OHMOCTli MoryT npenRTCTBOBaTb 3 TOMY 0 4 . He npegcTaBnReTCR B03MOJICHblM xnac cm!>HUHP OBaTb MeTOgbl B 3 aB11CHMOCTH OT CTOliMOCTli o 6pa6 0TK11 B Ogbl Hnli Ka"'leCTBa Heo6pa6oTaHHOH BOg bl. KaJKAblH c ny-qaw g onJICeH ObITb H3y'{eH B 11HA11Bl1g yanbHO M nop;igxe, - 82 - 05'.k>eKTHBHO, C yqeTOM pesynbTaTOB TIJl<ITeilbHOro KOilH'l'.eCTBeHHOro H Ka'l'.eCTBeHHOro aHanHsa KOHKpeTHOH BOAW, y cnOBHH CTpOHTeilbCTBa H ¢YHKl.1,HOHHpOBaHHR ycTaHOBOK, a TaK*e C yqeTOM HX o=aeMOH s¢¢eKTHB- HOCTH . K npHBOAHMblM B IlHTepaType AaHHblM O paCXOAaX cneAyeT OTHOCHTbCR c 6onbWOH OCTOPO*HOCTbIO, IlOCKOilbKY BO MHOI'HX cnyqaRx CJIHWKOM Mano H3BeCTHO O MeTOAaX pac'l'.eTOB. 5. 11cnonb3yeMb1e B HaCTORD\ee BpeMR MeTOAbl MO*HO TTOApa3Aem1Tb Ha cneAYIOII(He rpynnbI: 051I(He MeTOAbl, HCilOilb30BaHJ-1e KOTOPblX TT03BOilReT YAaTTRTb Bee COilH 'l'.aCTH'l'.HO (o5paTHblli OCMOC H sneKTPOAHailH3) HilH nonHOCTblO (AHCTHililRI.1,HR); ceneKTHBHbie MeTOAbl, HCTTOilb30BaHHe KOTOpbIX TT03B0IlRe T YAaTTRTb IlHWb onpeAeneHHbJe HOHbl (HOHttpOBa- HHe H XHMH4eCKOe OCaJK,Z'.leHHe ) . 6 . B 3aBHCHMOCTH OT saconeHHOCTH TTOAile*aD\eH o5pa50TKe BOAbl MeTOAbl e e o5ecconHBaHHR MO*HO B mH- POKOM nnaHe KnaccH¢HI.1,HPOBaTb cneAYIOlllHM o5pa30M: AilR o5pa50TKH BOAbl C HH3KOH KOHUeHTPaUHeH coneH (o5bJt!HO AO 1 r / n ) , cneAyeT HCTTOilb30BaTb ce- neKTHBHbie MeTOAbI ; TaKHe MeTOAbI, KaK npaBHnO, 5onee 3KOHOMH4HW, nOCKOilbKY 3aAa'l'.a COCTOHT B YAaTTeHHH onacHoro nnR 3AOPOBbR HOHa (HanpHMep, ¢ Top B BOAOHCTO'l'.HHKax -HOH 'l'.aCTH An=pa); nnR o5pa50TKH BOAbl C He3HatrnTenbHbIM COAep*aHHeM COilH npeATTO'l'.THTeilbHee HCilOilb30BaTb B saBH- CHMOCTH OT o5CTORTeilbCTB o5paTHblH OCMOC HilH 3neKTPOAHaTTH3. Me TOA sneKTPOAHaTTH3a, Hcnonb- syeMbrn B OCHOBHOM nnR o5pa50TKH BOAbI, COAep~eH 1 - 2 , 5 r B 1 n., npeAnonaraeT HCilOilb30Ba- HHe KOilH'l'.eCTBa 3HeprHH, nponopl.J,HOHanbHOI' O KOiltt4eCTBY BWAeileHHOH H3 BOAbl COilH . 3 TOT MeTOA, OAHaKo,cnHWKOM 'l'.yBCTBHTeneH K Kone5aHHRM COAep*aHHR COilH B nonne*aD1eH o5pa50TKe BOAe; MeTOA AHCTHililRUHH nyqwe npHMeHRTb AilR o5pa50TKH MOPCKOH HilH O'l'.eHb 3aconeHHOH BOAbI; 3TY TeXHOilOI'HIO TaK*e nyqme HCTTOilb30BaTb npH HaTTH4HH BOCCTaHaBnHBaeMblX HCTO'l'.HHKOB 3HeprHH. 7 . EOilbWHHCTBO MeTOAOB onpecHeHHR BOAbl RBilRIOTCR BeCbMa CilO*HblMH' B CBRSH C 'l'.eM HX Hellb3R OT HeCTH K paspH,[\y COOTBeTCTBYKII\eH TeXHOilOI'HH B TOM CMbicne, KaKOH B Hero BKnaAbIBaeTCR OpraHH3al.1,HeH 0 5 beAHHeHHbIX Hal.1,HH . 8. IlpH HCTTOilb30BaHHH IlI050H TeXHOilOI'HH BCTaeT npo5neMa YAaneHHR KOHUeHTpaUHH Hna H COilH . a onpoc Tpe5yeT oco5oro BHHMaHHR H rny5oKoro HsyqeHHR. 9. IloKa He paspa5oTaHbI MeTOAW HCTTOilb30BaHHR KOHUeHTpa TOB OTXOAOB . 1 0. PacXOAbl' CBR3aHHbie C onpecHeHHeM BOAbl ' O'l'.eHb BblCOKH npH HCTTOilb30BaHHH Ill050H TeXHOilOI'HH. 3TOT 0AHaKO BOAY He05XOAHMO o5ecconHBaTb TaM, rAe c~eCTByeT onaCHOCTb AilR 3AOPOBbR. B TaKHX cnyqaRX onpecHeHHYIO BOAY cneAyeT HCTTOilb30BaTb IlHWb nnR IlHTbR . 11. CoAep~aHHe coneH MHHepanoB H ra30B B AHCTHililHPOBaHHOH BOAe HeAOCTaTO'l'.HO. IlpHPOAHOH nnR ITHTbR ee MO~HO CAenaTb IlYTeM A05aBneHHR B Hee MOPCKOH BOAW HilH BOAbl IlOBWWeHHOH coneHOCTH, 'l'.T O Jl \13 BOilHT YBeilH4HTb KOilH'l'.eCTBO BOAbl H CHH3HTb paCXOAbl . MO*HO TaK*e npH6erHYTb K peMHHepanH3aUHH H a3pa1.1,HH. 12 . 05bJt!Hbie MeTOAbl onpecHeHHR BOAbl MO*HO npHMeHRTb npH HaTTH4HH BOCCTaHaBilHBaeMblX HCTO'l'.HHKOB 3HeprHH (B 'l'.aCTHOCTH, conHe'l'.HOH, BeTpRHOH H reoTepMH'l'.eCKOH ) . TennoByIO 9HeprHIO COnHUa uenecoo5pa3HO HCTTOilb30BaTb B cnyqae o5pa50TKH BOAW MeTOAOM AHCTHililRUHH; APYPHe MeTOAbI, Tpe5YKII\He MexaHH'l'.eCKOH 3HeprHH, npeAnonaraIOT TepMOAHHaMH4eCKOe (npH O'l'.eHb HH3KOH s¢¢eKTHBHOCTH) HilH ¢oTOXHMH'l'.eCKOe npeo5pa30BaHHe COnHe'l'.HOH 3HeprHH . 13. IloKa HeB03MO*HO TO'l'.HO onpeAeilHTb paCXOAbl no o5pa50TKe BOAbl C HCTTOilb30BaHHeM BOCCTaHaBnHBaeMOH 3Hepr,m. XOTR npH 3TOM He pacXOAYeTCR HHKaKHX cpeACTB Ha nonyqem1e 3HeprHH, KanHTaTTbHbie saTpaTbI BbICOKH, a HeAOCTaTOK OilbITa He TT03BOilReT onpeAenHTb ypoBeHb 3KCnnyaTal.1,HOHHblX paCXOAOB. 14. Y'l'.aCTHHKH ceMHHapa cornaCHilHCb c TeM, 'l'.TO 5wno 5bl O'l'.eHb none3HblM nnR CTpaH CeBepHOH Aq,pHKH paspa5oTaTb THTTOBOH npoeKT napHHKa C HCilOilb30BaHHeM AHCTHililRUHH BOAW, B KO TOPOM MO*eT nom:i.ep*HBaTbCR He05XOAHMblli MHKPOKilHMaT BOAa AilR pacTeHHH. CeilbCKOI'O X03RHCTBa conHe'l'.HOH 3HeprHH nnR H npOH3BOAHTbCR npec HaR - 83 - 1 . nocne ony6nHKOBaHH.R B 1982 rOAY peKOMeHAaJ.IIDI B03 eceM CTJ)aHaM npeAnaraeTC.R HCnOnb30BaTb HX nocne npHBeAeHH.R 3THX peKOMeHAaUHH B COOTBeTCTBHH C HaUHOHMbHblMH CTaHAapTaMH, OTBe4aKJllU,IMH KOH- KpeTHblM ycnoBH.RM KaJl(AOH CTpaHbJ. 2. n ocKOnbKY H36biT04HOe COAepJKaHHe qJTopa ocooeHHO nnoxo OTpaJKaeTC.R Ha KOCTl!Ke H 3y6ax AeTeH , peKOMeHAyeTC.R KOHTpOnHpoeaTb ypoeeHb noTpe6neHH.R AeTbMH 3TOro ae~eCTBa ,COAepJKa~eroc.R B nHTbeBOH BOAe, n~eBblX npOAYKTax (ocoeieHHO B qJHHHKax), 3y6HOH nacTe H T . A . 3. TOKCH4eC K Oe B03AeHCTBHe qJTOpa OTHOCHTenbHO xopowo H3BeCTHO,OAHaKO cneAyeT H3Y4HTb noTeHUHanb - HYIO o nacHOCTb, KOTOPYIO npeACTaBn.RIOT H APYI:'He pacTaope!lHble B BOAe conH. 4. 0 COAepJKaHHH qJTOpa B nHTbeBOH BOAe arnpOKO H3BeCTHO . He cneAyeT,OAHaKo,3aOb!BaTb, 4TO HeKo- TOpb!e n~eBble npOAYKTbl, B qacTHOCTH qJHHHKH, TaKJKe COAepJKaT 3TO ae~eCTBO B H36b!T04HOM KOnH4eCTBe, a aKTHBHOCTb qJTOpa CB.R3aHa C HanH4HeM APYI:'HX 3neMeHTOB . CT03TOMY He06XOAHMO npoaeCTH AMbHe»wee HCcneAOBaHHe 3TOJ:'O aonpoca, npH 3TOM cneAyeT TaK)Ke o6paTHTb BHHMaHHe Ha ecTeCTBeHHb!e HnH npoMbllll!leH- Hbie H CT04HHKH qJTOpa. 5. BBHAY OJ:'paHH4eHHOCTH 3nHAeMHOnOI:"H4eCKHX AaHHb!X CTpaHaM peKOMeHAyeTc.R pa3pa60TaTb npoJ:"paMMb! 3nHAeMHOnOI:"H4eCKHX H TOKCHKOnOI:'H'leCKHX HCCneAOBaHHH no npooneMaM OKpYJKaIO~eH cpeAbl H BbJAMHTb CPeACTBa Ha pa3BHTHe TaKHX HCcneAOBaHHH, 4TO nocnyJKHT pa3pa6oTKe CTpaTeJ:"HH AeHCTBHH. 6. 3<1><1ieKTHBHOCTb pa3nH'IHblX MeTOAOB onpecHeHH.R BOAbl qacTO 3aBHCHT OT npaBHnbHOH npeABapHTMbHOH o6pa60TKH, KOTOpal! B CBOIO o qepeAb 3aBHCHT OT HMH'IH.R HeOeiXOAHMb!X CBeAeHHH O noAneJKa~eH o6pa60TKe BOAe. CT03TOMY peKOMeHAyeTC.R AO npHH.RTH.R KaKoro-nHOO peweHH.R O C03AaHHH ycTaHOBKH npoaeCTH Ka4eCTBeHHb!H H KOnH4eCTBeHHb!H aHanH3 HMeIOIIJ;HXC.R B HMH'IHe HCTO'IHHKOB BOAbl H,no B03MOJKHOCTH,OJKHAae- MblX c Te'leHHeM apeMeHH H3MeHeHHH HX COCTaBa BUM.RX oeiecne'leHH.R coxpaHHOCTH o6opyAOBaHH.R. 7 . BBHAY BblCOKOH CTOHMOCTH onpecHeHH.R BOAbl 3TOT MeTOA peKOMeHAyeTC.R Hcnonb30BaTb nHWb B KpafrneM. cn)"{ae; He cneayeT npHHHMaTb HHKaKoro peweHHH B OTHOWeHHH C03AaHH.R HOBblX ycTaHOBOK AO Tex n a p, noKa He OYAYT Hccne,a;oaaHbl ace cy~eCTBYKIIIHe HCT04HHKH nHTbeBOH BOAbl HnH BOAbl C OTHOCHTMbHO He- OonblllHM COAep)KaHHeM conH H He 13YAYT npoaeAeHb! ace HeOOXOAHMb!e I:'HAPOI:'eOnOI:'H'leCKHe H3b!CKaHH.R . 8 . BBHAY Bb!COKOH CTOHMOCTH onpecHeHH.R BOAbl oco6oe BHHMaHHe peKOMeHAyeTC.R YAM.RTb ycTpaHeHHIO B03MOJKHOH yTe4KH BOAbl H3 CHCTeMbl pacnpeAeneHH.R Ha acex CTa,a;H.RX OT npOH3BOACTaa AO noTpe6neHH.R . q aCTO uenecool3pa3Hee KanHTMbHO OTpeMOHTHJ)OBaTb CHCTeMY, qeM CTpOHTb HOBYIO onpeCHHTMbHYIO ycTa - HOBKY . 9 . BBHAY BblCOKOH CTOHMOCTH o npecHeHH.R BOAbl cneAyeT npoaeCTH HCCneAOBaHHe uenecooopa3HOCTH C03AaHH.R AB OH HOH pacnpeAenHTMbl!OH CHCTeMbl C TeM, 4 TOObl oopaooTaHHa.R BOAa HCnMb30Banacb Obi HCKmo- 4HTMbHO An.R nHTb~. 10. ObUlO Obi )KenaTenbHO, 4T06bl CTpaHbl C03AMH rocyAaJ)CTBeHHble TeXHH'leCKHe OTAMbl An.R OKa3aHH.R COAeH CTBH.R e pacnpeAMeHHH on!)eCHeHHO H BOAbl . 3TH OTAenbI MOI:'nH Obi K OHUeHTJ)HJ)OBaTb y c e6.R H pacnpocTpaH.RTb nonyqaeMb1e H3 pa3nH'IHblX HCT04HHKOB AaHHble OTHOCHTMbHO MeTO,a;OB o npecHeHH.R BO,D;bl H KO HCynbTHJ)OBaTb pa3nH4Hb,e o pI:"aHbl H MYHHLIHnMHTeTbl; O HH MOI:'nH Obi OKa3blBaTb COAeHCTBHe B OpJ:"aHH - 3aUHH paoOTbl CnYJKO BOAOCHa6JKeHH.R, J:'OTOBHTb TeXHH4eCKHH nepCOHan H HHqJOPMHPOBaTb HaceneHHe 0 npoeineMax BOAOCHaei)KeHHll. 11. CTpH!ll!THe peweHH.R O CTPOHTenbCTBe onpeCHHTenbHOH ycTaHOBKH AMJKHO HMeTb LIMb!O OnTHMH3aUHIO paeiOTbl eceH CHCTeMbl BO,a;OCHaei)KeHH.R paHOHa, npH 3TOM oco6oe BHHMaHHe cneAyeT YAMl!Tb 3KcnnyaTaUHH, COAePJKaHHIO H 803 >.0JKHOCTl!M HCnonb3yeMOH TeXHOnOf"HH , a TaK)Ke ee B03Ae f 1CTBHIO Ha OKJ)YJKaIOWyIO cpeAY . 12 . MJKHp HaKonHn 3Ha'IHTMbHbllil o nblT B opr-aHH3aUHH pa60Tbl 6onee TPHAUaTH ycTaHOB OK o npecHeHH.R BOAbl, HCnOnb3YIOIIU-!X pa3nH4Hble TeXHH4eCKHe peweHH.R . PeKOMeHAyeTC.R nonHOCTb!O Hcnonb30BaTb eecb HaKo nneHHblH o nblT, a TaKJKe COOTBeTCTBYIOIIJ;He MaTepHanbl An.R no,a;roTOBKH nepcoHana . 13. HeooXOAHMO aKTHBHO pa3BHBaTb AMbHeHlllHe yCHnHll no pa3pa60TKe Anll CTpaH CeaepHOH Aq,pHKH Ha - A e )KHOH TeXHOnOI:"HH ooecconHBaHH.R BOAbl, Hcnonb3YIOWeH BOCCTaHaBnHBaeMbJe HCT04HHKH 3 Hepr-HH. 14 . B LIMl!X npoBeAeHH.R npoq,WiaKTH4eCKO H MeAHKo-caHHTapHOH paoOTbl H oxpaHbl OKJ)YJKaIO~eH cpeAbl Heo 6XOAHMO pa3pa60TaTb KOHKpeT Hble MeJKAyHaPOAHble peKOMeHAaUHH B OTHOWeHHH COCTaea BOAbl An.R l!PP HI:'aUHOHHblX H IlP04HX CMbCKO X03 l! HCTBeHHblX ueneH. - 85 - O<l>TAJlbMOflOrllil OEmECTBEHHOro 3aPABOOXPAHEHIDI Coeem,a HHe [IQ npo6.11e.Mal1 HCIIO.Jlb30B8HHR OCTa- TOqHoro apeHH.fl JUlllBMH c HapymeHH.flMH apeHHR BpmcceAh, 28-30 HHBBP.fl 1981 rOAB 1. - 87 - !CP/ SPM 049(S) 17 <!>eBPBJLJI 1981 rOAB OPIITHHAJI: AfITJil,fHCKllli ilOACqHTBHO, qTo HapymeHH.fl <l>YHKllHH opraHOB qyBCTB H CB.fl3BHHble C HHMH CAyqaH HHBBJUIAHOCTH H pac- CTpOHCTB 3AOP0Bh.fl - 3TO OAHO H3 HBH6oAee pacnpocTpaHeHHW< aa6oAeBBHHH B EaponeiiCKOM perHOHe . Oco- 6oe MeCTO B 3TOH rpynne 3a6oAeBBHHH 3BHHMBIDT paCCTpOHCTBB 3AOP0Bb.fl H HHBBJUIAHOCTh, Bhl3BBHHl,Ie Hapy- meHHRMH apeHHJI. BoAee Toro, qHCAO AIDAeli, CT PBABIDIIl,IDC 3TIDl HeAyroM B EaponeliCKOM perHOHe, oco6eH- HO , c peAH CTapmroc D03PBCTHblX rpynn HBCeAeHHJI HMeeT TeHAeHnmo K pocTy . B CB.fl3H C 3THM 6b!AO C03BBHO HhlHemHee CoaemaHHe . Ha HeM 6hlAH o6cy;<AeHhl pe3yAhTBThl HCCAeAOBB - TeAhC KOH Ae.f!TeAhHOCTH H COCTO.flHHe MeAHUHHCKoro o6cAylKHBBHH.fl AHU C HapymeHH.flMH apeHH.fl. B pa6oTe CoaemaHH.fl npHHHMBAH yqacTHe rpynna cneuHBAHCTOB B pa3AHqHbO( o6AaCT.flX. B Hee BXOAHAH npeACTBBHTeAH HBUHO HBAhHblX HCCAeAOBBTeAhCKli)C yqpelKAeHHH H Aa6opaTOPHH, npocpeccopa OKyAHCTbl, o¢TBAhMOAOrH, npeA- CTBBHTeAH 4BCTHb1X opraHH3BllHH no OKB3BHIDO noMoma AHUBM C HapymettHeM apeHHR, a TBKJ<e nepCOHBA B03. TTpu KABCCH<!>HKBUHH HapymeHHH H paccTpOHCTB apeHH.fl no-npextteMy BCTpeqamTCH TPYAHOCTH KBK opr aHH- 3BUHOHHOro TBK H KOHUenTyBAhHOro xapaxTepa. B CBH3H C 3THM HB Coaema HHH 6hlAH o6cyxAeHhl KPHTepHH KABCCH<!>HKBUHH OCTBT04Horo apeHHJI, 6hlAB ABHB oneHKB pacnpoCTpaHeHHOCTH 3TOro HeAyra, paCCMOTpem1 npo 6AeMb1, C KOTOpbWH nprocOAHTCH CTBAKHBBTbCH AHUOM C uapymeHHHMH apeHH.fl. Oco6oe BHlrnBHHe HB Coae- maHl'OI 6hlAO YAeAeHO oueHKe c ymecTaymmeli TeXHOAOrHH, He06XOAHMOCTH pa3pa60TKH npOCTOH H3<W>eKTHBHOH TeXHOJIOrHH' KOTOpa..fl IIO3BOJIHJI8 6ht ,,1lHU8M C OCTBTOtlID>IM apeHHeM B0CTH H038BHCIDfblii: o6pao JlH3HH . BblJ[H TBKJ<e paCCMOTpeHbl : xapaxTep OKB3blBBeMOH B HBCTOHmee apeM.fl MeAHUHHCKOH noMoma H aonpochl KBAPOBoro o6ecneqeHHR. 3To no3BOAHAO BOCnOAHHTb npo6eAb1 B 3HBHHJIX npocpecCHOHBAhHblX pa60THHKOB o6mecTBeH- HOCTH, B TBKJ<e c¢opMyAHPOBBTb pexoMeHABUHH no a) npoBeAeHmo MeponpHRTHH B CB.fl3H C Me•AYHBPOAHhlM rOAOM HH~BAH.llOB H 6) npoBeAeHHID KOMUAeKCHb!X HCCAeAOBBHHH B HBH60Aee BWlHhlX o6ABCT.FIX. 2. TeMM H peKOMeHABUHH TTpH o6cylKAeHHH HBH60Aee BBlKHblX TeM 6b!AO yCTBHOBAeHO' 4TO HeKOTOpb•e npo6AeMhl .f!BA.f!IDT C.fl 06111HMH AJLJI acex CTpaH: OA HB rpynna yqacTHHKOB CoaemaHHJI npeAAOlKHAB npoaeCTH cepmo MeponpHJITHH KBK Ha MelKAYHB- POAHOM TBK H HBUHOHBAhHOM YPOBHe 6e3 npeABBPHTeAbHOro c6opa AOllOAHHTeAbHOH HH¢QpMBUHH, Apyra.fl rpyn- na yqacTHHKOB o6paTHAB BHHMBHHe HB HeKOTOpb•e npo6eAM B HMelOIIlrocC.fl 3HBHH.flX' KOTOpbie C,leAOBBAO 6hl ycTpa- HHT b npelKAe 4eM npOBOAHTb ABAhHeHmHe MeponpH.FITH.fl . Ha CoaemaHHH 6 blAH eAHHOrABCHO yTeepJKAeHM pexo- MeHAB UHH, KOTOphle npHBeAeHhl HHlKe B PB3AeAax, nOCBHmeHHblX HanpaBAeHH.FIM pa60Tbl H c cpepaM HCCAeAOBBTeAb- CKOH A0RT0.JihHOCTH . 2.1 3 nHAeMHOAOrH.fl: npo6AeMhl o6o3HaqeHHJI nOH.FITHH H COCTBBAeHHe KABCCH$HKBUHH 2.1.1 HanpaaAettuH AeHTeAhHOCTH a) 803 AOAIHB noompHTh ucnOAbaoaattae Me•AYHBPOAHOH KAaccapaxauHH tta pymeHHH ¢u3uqecxax H ( 803, JKeHeaa, 1980), oco6eHno, npu onpeAeAeHHH BHAB u cTeneHH noepexAeHHJI, a TBK- ~e DPH oueHKe rrporHO3a . 0 38M01.18HHHX, BO3HHK8lOIIlKX npH HCllO.Jib3OB8HHli KJI8CCH¢HK8UHOHHOH CHCT0Mhl, CAeAyeT coo6maTh B 803 AJLJI BHeCeH'1.fl B Hee tteo6xOAHMhlX H3MeHeHHH . CaeAyeT ynpa3AHHTb o6mue KBTero- PHH, BBeAeHHhle 803, a UMeHHO: HOpMBAbHOe apeHHe, CAa6oe apeHHe a CAenoTa. AYeT ynoTpe6A.f! Tb AHmh B Tex CAyqaJIX, KOr~a OTCyTCTByeT CBeTOBB.fl peBKUH.fl. TepMHH "cJienoTa 11 c..11e - 6) Heo6xOAlrnO nonbITBTbC.fl ynpOCTHTb <l>YHKUHOHBAbHytO qaCTb KABCCH<!>HKBUHOHHOH CHCTeMbl AJLJI nocAe- Aymmero HCnOAb30BBHHH ee B PB3BHBammHXCH CT paHax . - 88 - B) B03 AOJlJl(Ha noMepxHBaTh npaBHTe.nbCTBa B Ae.ne HCnOAb30B8HWI KOMn.neKCHhlX KA8CCH$HK8IlHOHHhlX CBCTeH AAR onpeAe.neHW! HapymeHHll, ¢yHKnHOHaAbHhlX paccTpOMCTB 3peHBR HAAR nporH03a, H B MeHhmeM Mepe - AAR ycTaHOBAeHHR CTeneHH paCCTPOKCTBa 3PHTeAbHOH ¢YHKUHH, T.e . AAR BhlRBAeHHR lilleeT AH nauHeHT npaBO Ha COUHaAbHOe o6ecneqeHHe H noAyqeHHe noco6HH no HHBaAHAHOCTH. r) B03 A0Jlll(Ha KOOPAHHHPOBTb AeRTeAbHOCTb npaBHTeAbCTB no c6opy AaHHhlX O HapymeHWIX 3peHHR , ncnOAh3YR npH 3TOM MexAyHapoAHYJO KABCCH$HKaumo Hapym eHHH ¢u3aqecxax H APY"Hx Ae¢eKTOB. Ilo Ay- \JeHHble ,llaHHhle .11.0.JIXHbl CJfYXllTb B xaqecTBe OCHOBhl rrpn JI.JraHHpOB8HHH H ocym eCTBJieHIUf IlOJIHTHKH OK83aHHJf Me.11.HOHHCKOM nOMOmH. 2.1 . 2 Heo6xOAHMOCTb HCCAeAOBaHHH a) Heo6xOAIDIO npoBe CTH AeMorpa¢HqeCKHH aHaJIH3, oco6eHHO, CTapmax B03paCTHhlX rpynn, HCXOAR H3 lnlelOIIIHXCR AaHHhlX O HapymeHHRX 3peHW1 y HaCeAeHHR H HCnOAh3yR npH 3TOM Melll,ll,vHapOAHYJO KA8CCH$HK8UHJO HapymeHHH $H3HqeCKHX H ApyrHX Ae¢eKTOB , 6) Heo6xOAJn!O noAyqnTh 60Aee noA=e AaHHhle O npaqn1,ax B03HHKHOBeHllJI c.nenOTbl H HapymeHHH 3peHHR' HCnOAh3YR npH 3TOM aHaAHTHqecKHe cpeACTBa KABHHqecKOn 3nHAeMHOAOrHH, 2 . 2 IlepcneKTHBhl Hcno.nb30BaHHR MeXAHCillinAHHapHoro H MHOrOAHCUITnAHHapHoro nOAXOAB npH Ae q eHHH OCTa- TQqHoro 3pe HHR. a) B03 c.neAyeT yqpeAHTb KOMHCCHlO 3KCnepTOB , B KOTOpyro BOIDAH 6hl cneuHa.nHCThl B pa3JIHqHblX 06AaCTJlX H ueAb!O KOTOpoil 6b!AO 6bl AB.nbHefimee H3yqeHHe npo6AeMhl qacTBqHQll noTepH 3peHW1. CTOR.nH 6hl CAeAyromHe 38A8qH: IlepeA KOMHCCHeil COCT8BARTb peKOMeHABUHH AAR npaBHTeAhCTB no BeAeHmo cor.nacoBaHHhlX HCCAeAOB8HBU H opraHH38llBH MeAHUHHCKOro 06cAyXBB8HHR AH!\ C HapymeHHeM 3peHHR; ¢opMyAHPOB8Tb CTpaTermo ocymeCTB.neHW! 38nA8HHPOB8HHhlX weponpHRTHll B 06.naCTH MeAHUHHCKOro o6cAy- XliB8HHR AH!\ C uapymeuHRMH 3peHHR; pacnpOCTPBHRTb HH$QpM8llHH O n.naHBp ye>Lh!X H ocymecTBARe>Lh!X npoeKT8X B CTpaHax-yqacTHHUBX; pacnpOCTpaHRTb QTqeThl, B KOTOphlX ABeTCR oueHKa npoeKTy u.m pe3yAhT8T8M 38BepmeHHhlX HCCAeAOB8HHll, 6) Heo6xOAIDIO npOAOJU<HTb npoBeAeHHe cneUH8AbHhlX COBemaunn AAR nOAP06Horo o6cylll,ll,eHHR TeM 38- TPOHyThlX Ha =HemHeH BCTpeqe, C ueAb!O BH$Qp1,1BpOB8HWI noCTORHHOH KOILBCCHB, yqpexAeHHe KOTOpoil peKO- MeHAOB8HO B nyHKTe 2.2.1 a). B) Heo6xOAHMO noompRTb npaBBTeAb CT B8 B opraHH38UHH pa6oT, no KOMUAeKCHOMY H3yqeHmo HapymeHHll ·,pe HHR no npo¢HA8KTHKe , AHSrHOCTHKe, AeqeHmo H BOCCT8HOBAeHmo 3peHHR, a TSKXe B opraHH38UHB HCCAe- K 3TOH pa6oTe peKOMeHAyeTCR npHBAe- K8Tb CAeAyromHX c neuHaAHCTOB: O$T8AbMOAOroB, HeBponaTOAOroB, Hefipo¢H3HOAoroB, $H3HOAoroB, cneUH8AH C- TOB no o6yqeHH10 JIHU. co CJIR6bl'M 3peHHeM, rJJa3HhlX OTITHKOB' c n eu,Ha.IMCTOB n o KOHT8KTHbIM JlllH38M, c n eoe:a- JIHCTOB B 06Jf3CTfl Tpy.4.0BO~ TepanHH, a.4.BOK8TOB, cneUHEURCTOB no ymHbIM 60J1e3HRM, TeXHHKOB H c neuHaJm C- TOB B 06J18CTJ-f MbIIDeQHOM .n;eJITeJtbHOCTH. 8 38BHCHMOCTH OT Toro, K8K8R CHCTeMa OK838HHR MeAHUBHCKOll DOMOIDH cymeCTByeT B CTpaHe, 3TH pa- 6oThl AOJU<Hhl JIH6o BORTH COCT8BHOll qacTb!O B CBCTeMy 3AP8BOOxpaHeHHR, JIH6o CT8Tb C8MOCTORTeAbHhlM Ha- npaB.neHHeM, CBR38HHW! co c.nyx6aMH 0Ka38HWI MeAHUHHCKOll noMOIDH, r ) Heo6XOAHMO npOA0JlJl(8Tb o6yqeHHe cneuaa.nHCTOB B pa3.nnqHhlX 06.naCTRX OK838HHR MeAHUHHCKOll no- MOIDH H BeAeHHR HCC.neAOBaTe.nbCKOH pa60Thl, 3TO ABeT o6yqaJOmID!CR B03MOXHOCTb nOHRTb po.nb H 3HaqeHBe KBXAOll H3 AHCDHnJIHH , Heo6xOAHMO Taxxe, qT06•1 o6yqaJOmHeCR MOr.nH npeACT8BHTb ce6e noc.neACTBWI Hapy- meHBil 3peHHR AAR qe.noBeKa. 0HH AOJlJl(Hhl 3H8Tb O cymecTBYJOllUO{ MeAHI\HHCKHX CAYX6ax H cpeACTB8X .neqeHWI AHII, C HapymeHHRMH 3peHHR . PeKOMeH.D;yeTCR TSKXe nepeCMOTpeTb yqe6Hhle nporpalOlhl MeABUHHCKHX yqpelll,ll,e- HHll H BK.nJOqHTb B HID< BOnpoc 06 y qa cTHH 0¢Ta.nbMO.noroB B BOCCTSHOB.neHHH 3PHTe.nhHOll ¢YHKDHH, HMeR B BHAY ero oco6oe 3Ha q e HHe. - 89 - 2.2.2 Heo6xOAHMOCTb BCCJleAOBaHHH a) llpo6JleMhl HCCJleAOBaTeJlb CKO>[ AeRTeJlbHO CTH ,.'.10J1JKHb[ onpeAeJ!RTb Cfl C y<leTOM <!lyHKilHOHaJlbHb[X xapaK- TepHC THK HJ!H MeTOAOB BeAeHHfl HC CJleAOB8HHH . 3 TO MOJ<eT COAellC TBOB a Tb 6oJlee a KTBBHOMy HCil0 Jlb30B a HH10 l!ell.llHCUHilJ!HHapHOC'O IIOAXOAa. Heo6XOAHMO npoaHaJlH3HpoBaTb pO.llb T8KHX <!laKTOpoB KaK KOHTpacT' pa3 Mep' D;B8T , ,llBH)l(eHHe, oc a emeHHe, BpeMJI, - npH p a3.JIHl.(HbfX r.n:a3H blX 3a60.11eBaHHH•X K cf)yHKUHOH8JibHbIX HapymeHH.HX, a TH Klle npH Bb!IlO .. '!HeHHH 60.11nHb[MH ynp~HeHHH AJIR C'.1183. 6) Heo6XOAHMO pa3pa60TaTb cepmo AH8C'HOCTH'leCKHX TeCTOB' KOTOpbte 6bIJIH 6hJ npHMeHHMbl KaK 8 CJly- 'laRX C'Jla3HOH naToJiorHH TaK H npB onpeAeJleHHH 3PHTeJlbHOH <llYHKUHH. a) Heo6xOAKMO B3y'IHTb npouecc BOCCTaHOBJleHHR 3pBTeJlbHOH <llYHKUHH llOCJle TpaaM HJIH IlOTepB 3peHHR y oauaeHTOB C OCTaTO'IHbIM 3peaBeM Hy llOAODhlTHhJX llBBOTHhlX, HCI10Jlb3Yfl IlpH 3TOM DCBXO<!lH3HqecKy,o, HeHpo- <!lB3BOJl0['H'leCKy,o B KOM6HHBPOB8HHy,o TeXHHKy. r) Heo6xoABllO AaTb oueHKY 3paTe.11hHOH <llYHKUHH y MJiaAeH.Uea, AeTefi MJia,IDllero ao3pacTa a y cTapmroc B03paCTHhJX rpyoo HaCeJieHHH C HOpMaJibHbIM 3peHHeM. A) Heo6xOAHMO COAeHCTBOBaTb npoaeAeHHIO BCCJieAOBaHKH Mhlille'IHOH AeRTeJibHOCTH B APYC'HX ¢aKTOpoa llH3HeAeHTeJibHOCTH qeJioBeKa (HCCJieAOBaHHH THDa qeJIOBeK - MamHHa, qeJIOBeK - OKpyJ<aromaH cpeAa) . 8 CBR3H C 3TBll Heo6xOAHM0 opoaeCTH DCHXOJIO('H'leCKHH, COUH8JIOC'B'leCKHH H 3KOHOMH'leCKHH aHaJIH3 B03AeH- CTBllil TeXHH'leCKOC'O oporpecca Ha JIIDAeH C HapymeHBRMH 3peHWI. 2 . 3 .1 HaopaaJieHHfl AeRTeJibHOCTH a) TexHH'leCKHH nporpecc MOJ<eT OKa3hJBaTb KaK D03HTHBHOe TaK H HeraTHBHOe BJIHRHHe Ha pa3JIH'1Hble CJ!OH HaCeJieHHR . 803 AOJlllHa Tpe6oaaTb OT npaBHTeJibCTB C03AaHHR COOTBeTCTBYromHX KOMHTeTOB HJIH a reHTCTB, KOTOphle MOrJIH 6hI upeABHA8Tb B03 MOXHOe B0 3AeHCTBHe pa3BHBaromelicJI T8XHOJIOrHH Ha ~110..a:eli C HapymeHHHMH 3peHHH H yMeHbmHTb HeraTHBHOe BJIHHHHe 3TOro pa3BHTHJI Ha HH¢pa c TpyKTypy ( TpaHcnopTHble CHCTeMbl' npaBHTeJlbCTBeHHble yqpeJ<AeHHfl' apxHTeKT y pa' c peACTBa MaCCOBOH HHct,opMaUHH). 6) KoMHTeTy 3KCDepTOB 803 CJieAyeT IIOAC'OTOBHTb llOCJie COOTBeTCTBY!OllleH oueHKH H corJiacoaaHHH AO - Ky¥eHT' COAepllamHH nepe'leHb BCDOMOraTeJibHhlX c peACTB AJIR JIHU C HapymeHHRMB 3peHHH' KOTOpbre :IIOJICHO 6•1- JIO 6M HCllOJib30BaTb 80 acex CTpaHaX H B KOTOpOM 6hl./lH 6hJ oopeAeJieHM KpHTepHH oueHKH . B) 803 CJieAyeT BeCTH KaTaJior acex TeXHHQeCKHX c peACTB' oueHKa KOTOpmr yll<e 6bIJia AaHa B o6meM oepe'IHe BCilOMOC'aTeJibHhlX cpeJ!CTB .llJIH JlHU C HapymeHHflMH 3peHHfl. ~o 3T0['0 803 He06XO.llHh10 c o6paT& HHct,opMaumo H3 acex CTpaH-yQaCTHHU 06 KMeromHX Cfl B HaCTORmee apeMR KaTaJiorax BCDOMOraTeJI&HhJX cpeJ!CTB H 110.llC'OTOBHTb o6menpHHflTYID KJiaCCH<!lHKaUHOHHy,<J CHC TeMy 3THX cpeJ!CT B, 2 . 3 . 2 Heo6xOAKMOCTb HCCJie.llOBaHHH a) Ha OCHOBe o6cJie.llOBaHHH H Ha6JIIDJleHHH Heo6xOJ!HMO AaTb oueHKy 110Tpe6HOCTH, KOTOpyro HCDbITBaIDT JIHJIB C HapymeHH..RMH 3p8HHJI, BO BCilOMOraTeJihHblX c pe..a:CTBSX . 6) Heo6xOJ!HMO pa3pa6oTaTb CHCTeMy y qa CT HH HaCeJieHHH BO acex 3Taoax H3y'leHHR BCDOMOraTeJihHhJX c peJ!C TB (AH38H H , pa3BHTHe H oueHKa) . B) Heo6xOAHMO Jl8Tb aHaJIH3 ¢aKTOpOB CTOHMOCTH - BhlC'O.llhl pa3pa6aTbIBaeMhJX TeXHH'leCKHX cpeJ!CTB. r) Heo6XOAHM0 66.Jibmee BHHMaHHe y.lleJIHTb BCI10MOraTeJibHbIM cpeJ!CTBaM !IepeJ!BHJ<eHHH, .ll) Heo6xO.llHMO .ll8Tb aHaJIH3 BJIHRHHH ¢aKTOPOB OKpyJ<aromeH c peJlhJ Ha ,IlOJleH C HapymeHHRMH 3 peHHH. 2 . 4 CJi yJ1C6a OK838HHR llOMOillH 2. 4. I HanpaaJiemrn .lleRTeJibHOCTH a) CoeuHaJIHCTaM B pa3HhJX o6JiaCTRX He06XO.llKMO C <llYHKUHOH8JlbHOH " Jie'le6 HOH TOQKH 3 peHHfl .llaTb o ueHKY Il0Tpe6 HOCTRM 8 cJi y J<6 ax OKa3aHHfl IIOMOMH, !lpH 3TOM CJle.llyeT y.lleJIRTb BHHh!aHHe He OT.lleJibHbL\I Hap y meHHRM HJIH paCC TpO HCT BHM 3J!Op0Bbfl, a o6meMy COC TORHHID 3J!Op0 Bbfl nauHeHTH. - 90 - 6 ) JiHua C HapymeHHJU<B 3peHHR AOJlll(Hhl UOAYQBTb KOHCYAbTSUHH H Heo6xOAHMYJO HHcpop»aumo HapaBH e C QJleHal,(l! rp ynlihl c neUBBJlHCTOB , 38HHMBIOmHXCR oueHKOH B BOCCTBHOBAeHHe» ID( 3PHTeJlbHOH ¢YHKUHR. B ) Ta» , rAe 3 TO B03MOXHO , BO CCTB HOBAe HH e 3PHTeJlbHOH ¢YHKU1rn CAeAyeT np OBOAHTb no »ecTy XH - TeJlbCTBB nauneHTB, a He B c neunaJIH3 HpOBBHHblX y qpexAe HHJIX. q epe3 CBC Te»y o6mec TBeHHoro npocaemeHHR H cpeACT Ba MBCCOBOH HH¢0PMBUHH, He06XOAHM 0 HHcpopMBPOB8T b HB CeJieHne O KOHKpeTHLIX IlOCAeACTBHRX DOTepH 3peHHR AAR q eJIOBeKa. r) MeAHUHH CKOe o6cJiyXHBBHHe ABU C Hapym e HHJU<H 3peHHR He AOJlll(HO orpaHHQHBBTbCR JlHIDb OKB 3 BHH eM HHAHBHJIYBJlbHOli no»omn . Heo6xOAHM O TBKXe npHHRTb Mepbl' KOTOphle AB.IUI 6 hl 60Jlb HOM Y B03MOXHOCTb DOJlb - 30B8TbCR B AOCTynHblX npeAeJIBX 6JiaraMH o6mecTBB (XHJlhe ' cpeACTBa CBR3H' ra3eTbl H T . ... ) . A) B03 AOJlll( HB K00p,ll;HHHPOB8T b COBMeCT Hble yCHAHR B IlJlBHHPOBBHHH H pa3BHTHH CAyx6 OKB3BHBR DOMO- mn Jl..Hll8M C HapymeHHHMH apeHHR KSK HB Mex.4yHapO,ZlHOM TBK HB HBUHOHB Jlb HOM, perHOHBJlbHOM B MeCT HOM YP OBHRX. e) Kax.ll;aR CTpaHa A0Jlll(H8 pacnoJiaraTb n epCOHBJlOM DO o6yqeHHIO JlBll co CJia6MM 3peHne». 3TO ,ll;OJlll(Hbl 6 b1Tb npo¢eCCHOHBJlbHO IlOArOTOBJleHHble c ne11HBJlH CThl C He06XO,ll;HMblMH 3HBHBRMH B CMeXHblX o 6JIBCTRX ( 0¢TBJlb- MOJIO rHR , DBTOAOrHR , onTHKB , DCHXOJIOrHR) . x) B03 ,ll;0Jlll(H8 CO.ll;eHCTBOBBTb IlOArOTOBKe »eTO,ll;HQeCKHX noco6Hii B DOMOmb CJ1yx6a1,1 OK83BHHR llOMOmH H ,ll;pyrHM yqpexAeHHRM IlOA06Hor o POAB B CTpana x . 3TH »eTO,ll;HQeC KH e noco6HR CJle,ll;yeT pa c npoCTpaHR Tb KSK cpe,ZlH c neu;HBJ[HCTOB-rJIB3HHKOB, TBK H cpe.zu:1 HB CeJleHHJl. 2 . 4.2 Heo6xo,ll;HMOCTb HCCJle,ll;OBBHHH a) Heo6xOAHMO npoaeCTH CPBBHHTeJlbHhlH BHBJ1H 3 3BKOHO,ll;a TeJlbHblX BKTOB H npBBHJl, AeHCTBYIOUIID( B p83JlHQHblX CTpanax, H HMeI<II\HX OTHOmeHHe K npe,ll;OCTBBJleHHIO Heo6xO,ll;ID!Oll IlOMomn JlHllBM C Ha pymeHHRMH 3peHHR. 6) Heo6xOAHMO H3YQHTb npo6JieMhl ' B03 HHKBIOmHe y Jllil1 C HapymeHiiJIMH 3 p eHHR B pe3yJ1bTBTe AeilCTBHR TSKHX npaBHJl . B) Heo6xO,ll;IDIO npoaeCTH HC CJle,ll;O BBHHR UCHXOJ10 ruqecKor o B0 3,ll;eilcTBHR p 83JlHQHblX BH.110B JieQeHHR H BOC - CTS HOBJleHHR 3PHTeJlbHOH ¢yHKUHH HB JlHll C HBpymeHHJU<H 3peHHR . 2 . 5 Ilo,ll;rOTOBKa a o6yqenne KBApOB 2 . 5. 1 HanpaaJieHHe pa6oTM a ) B03 CJle,ll;yeT llO,ll;rOTOBHTb cepmo y qe6 HblX MBTepHBJlOB ,ll;JlR a cex CTpan- y QaCTHH!l. o 6pa3UB MOXHO HCUOJlb30B8Tb yqe6Hhle MBTepHaJlhl , BhlllymeHHhle B illBeUHH. 6) IlpBBHTeJlbCTBa A0Jll(Hhl yAeJIRTb oco6oe BHIDIBHHe o6yqeHHIO na11HeHTOB BH.JJ,eTb H nepe,ll;BHrSTb CR - 3TO BBXHBR COC TBBHBR QB CTb nporpBM:Mhl BOC CTSHOBJleHHR 3PBTeJlbHOH ¢ y HKUHH. B) Heo6xO,llHMO DODldTBTbCR HCUOJlb 30B8Tb 3 ¢¢eKTHBHble cnoco6bl o6yqeHirn' npH»eHReMlde r!pn BOCCTBHOB- JieHHH ¢YHK11Hll ,ll;pyrHx opraHOB qyBCTB (OCR3BHHR, CAyxa) , B npouecce o6yqeHHR Jllill C napymeHHRMH 3peHHR. 2. 5.2 Heo6xO,ll;Hl<O CTb HCCJle,ll;OBSHHH a) Heo6xO,ll;HMO pacCMOTpeTb 3<!><1>eKTHBHOCTb o6yqeHHR, npH KOTOPOM yaeJIHQeHHe qyBCTBHTeJlbHOCTH AO- CTHraeTCR n yTeM HCUOJlh30B8HHR ceHCH6H.IUl3BUHH H MeTOAB MeHRIOmeHCR ¢HKCBUHH. 6 ) Heo6xO,ll;HMO H3yQHTb MeT O.IU>l o6yqeHHR, HJlH CO,ll;eH CT BHR , nepexo.ii;y OT 0,ll;HO r o opraHa qyaCTB K APY - row y ( OT OCR3BHHR K 3peHH10 ). B ) Heo6xO,ll;HMO onpe,ll;eJIHTb OllTHMBJlbHNe » eTO,ll;bl BOCCTBHOBJleHHR 3 PHTeJlbHOH ¢YHK11HR , BKJDOQSR TSKOH BBXHhIH ero acnexT, KBK o6yqenne nepe,ll;BHXeHHIO. - 91 - OXPAHA 3~0POBbH IlPECTAPEJTh!X Pa6oqafl Ppynna no 6HXeBHOPaJJbHblM HCCJ!eAO BaHHflM B o6nacTH oxpaHbl 3AOPOBbfl npecTapeJiblX J!Jo6eK, 10-12 HIOJlfl 1981 POAa 1. BBeAeHHe - 93 - ICP/ ADR 054(8) 26 HOR6pfl 1981 POAa OPlffHHAJI: AHfJllitl:CKHfr CoBemaHHe 6b!Jl0 C03BaHo EBponeHCKHM pePHOHaJlbHblM 610po B03 B COTPYAHHqecTBe C npaBHTe!lbCTBOM ¢e- AepaTHBHOH Pecny6JIHKH repMaHHH. B ppynny BXOAHJIH 3KcnepTbl no ncHXOJ!OPHH, COUHOJ!OPHH, PepHaTpHqec- KOH MeAHUHHe H ceCTPHHCKOMY AeJiy H3 13 CTpaH - cneuHaJJHCThl, 3aHHMa10mHeCR HCCJieAOBaTeJ!bCKOH AeRTeJib- HOCTb!O CaMOCTORTeJibHOPO, npHKJ!aAHOPO H aKaAeMHqeCKOPO xapaKTepa, a TaK~e npeAOCTaBJieHHeM MeAHUHHCKOH nOMOlliH . B npoPpaMMe B03 no oxpaHe 3AOPOBbfl npecTapeJ!btX OPPOMHOe 3HaqeHHe npHAaeTCfl 6HxeBHOpaJlbHblM HC- CJieAO BaHHflM B o6JiaCTH oxpaHbt 3AOPOBbfl npecTapeJ!brx. HH¢OpMaUHR O H=ecJieAYIDmeM: .[laBHO npH3HaHo, q To Heo6xOAHMa 6onee nonHaR 06 OTHomeHHH o6mecTBeHHOCTH (BKJ!JOqafl caMHX npecTape!lbtX) K no~HJ!blM Jl!OARM; 06 OT HomeHHH nHU, npeAOCTaBJifl!OlliHX MeAHUHHCKYID noMomb; 06 OT HOllieHHH APYPHX ppynn K npecTapeJ!bIM; 0 pa3JIHqHblX nOAXOAaX H MeTOAaX H3MeHeHHfl OTHomeHHfl o6mecTBeHHOCTH H npo¢eccHOHaJlbHbIX pa6oTHH- KOB K npecTapeJiblM . YqHTbtBafl BbillieH3J!O~eHHOe H npHHHMafl BO BHHMaHHe KOJ!HqecTBO npecTapeJiblX H epo COOTHomeHHe C 06- lliHM qHCJ!OM HaceneHHfl B 60JiblliHHCTBe CTpaH MHpa, nepeA ppynnoH CTORJia 3aAaqa o6CYAHTb H c¢opMYJIHPOBaTb peKOMeHAaUHH OTHOCHTeJibHO: MeponpHRTHH, KOTOpbte Heo6XOAHMO npoeecTH Ha HaUHOHaJ!bHOM H Me~yHapOAHOM YPOBHRX, oco6eHHO , B o6naCTH ooyqeHHfl npo¢eccHOHaJlbHblX pa6oTHHKOB, o6mecTBeHHOCTH H CaMHX npecTape!lbIX. 2 . 8 bIBOAbl 2 . 1 HccneAOBaTeJibCKafl neRTeJibHOCTb 1) OmymaeTCfl 3HaqHTeJ!bHafl HexBaTKa COOTBeTCTBYIDllieH HH¢OpMaUHH, Heo6xonHMO TaK~e o npeneJIHTb TeMbI KaK Me~ceKUHOHHbtX, TaK H caMOCTORTeJibHblX HCCJieAOBaHHH . 2) MeTOAOJ!OPHfl H pe3ynbTaTbl HCCJieAOBaHHH He BCePna KPHTHqecKH oueHHBa!OTCfl no TOPO, KaK HX HaqHHa- lOT H3yqaTb H npHMeHRTb APYPHe. Pa3pa60TKa B03 CTaHAapTH3HPOBaHHbIX MeTOAOJ!OPHH HCCJieAOBaHHH no3BQ - J!HT npoBOAHTb B PePHOHe 6onee pe3ynbTaTHBHbte Me~yHapOAHbte HCCJieAOBaHHfl . 3) Heo6XOAHMO pa3pa60TaTb CTpaTePHH no ocymeCTBneHHIO peKOMeHAaUHH, nonPOTOBneHHblX B COOTBeTCTBHH C o60CHOBaHHblMH pe3ynbTaTaMH HayqHbJX HCcneAOBaHHH. 4) Heo6xoAHMO npoeecTH HccneAosaHHR c uenb10: nonyqeHHfl nonOJIHHTenbHOH HH¢opMaUHH O noBeAeHHH KOHKpeTHb!X Ppynn npo¢ecCHOHaJlbHblX H Henpo¢ec- CHO HaJlb HblX pa6oTHHKOB B OTHomeHHH npecTapenbtX , T. e. o TOM, KaKHe B3aHMOOTHOllieHHfl ycTaHaBnHB aJOT- Cfl y OTAeTTbHblX n HU C npecTapeJ!blMH; o npeAeneHHfl Tex CBOHCTB, KOTOpbte xapaKTepH3YIOT KOHKpeTHbte nonppynnbt npecTapeJ!btX, HanpHMep, POCYAaPC TBeHHbIX n eRTene H no~HJ!OPO B03pacTa; - 94 - onpe,11enemrn pa3mPrnb1X noTpe6HocTeH KOHKpeTHbIX no,11rpynn, HanpHMep, 6a6yweK H ,11e,11yweK, onpe,11ene- HHll O)l(H,[laHHH H Ha,Qe)l(,!I, KOTOPbie CBll3bIBaIOT C HHMH, a Ta!G!<e Toro MeCTa B JICH3HH, KOTopoe OTBO,[ll!T ,11n11 ce611 npecTapenh1e; nonyqeHHll HH¢OpMaUHH o TOM, KaK nOJICHnhie nIOAH qyBCTBYJOT/OC03HaIOT ce611, KaKOMY BnHl!HHIO OHH no,11- Bep)f(eHb1, KaKOBO OTHOIIJeHHe o6m.ecTB€HHOCTH K HHM; onpe,11eneHHll, cyweCTByeT nH B3aHMOCBll3b Me)l(,!ly ueHHOCTHbIMH x apaKTepHCTHKaMH noJICHnoro B03pacTa H ,11pyrHMH u e HHOCTHbIMH xapaKTepHCTHKaMH, CBOHCTBeHHbIMH TOH HnH HHOH KynbType; onpe,11eneHHll ypOBHll 3HaHHH O CTapeHHH H npecTapenbIX, KOTOPbIMH pacnona raIOT npo¢eccHOHanbHble H Henpo¢ecCHOHanbHbie Me,[IHUHHCKHe pa60THHKH, a Ta!G!<e onpe,11eneHHll Toro, KaKHe 3HaHHll B 3TOH o6nac - TH nocne,QHHe XOTenH 6bI nonyqHTb; onpe,11eneHHll Toro, qTo 03HaqaeT "xopolllHH ypoBeHb Me,QHUHHCKOH noMOIIIH" H onpe,11eneHHll KPHT epHll ere on;ettKH; nonyq eHHll HH¢opMaUHH 06 YPOBHl!X OKa3aHHll Me,QHUHHCKOH nOMOIIIH npe c TapenhIM, HaXO,[llllllHMCll B OTBe- ,QeHHbIX ,Qn.R HHX yqpelK,IleHHl!X ( noCTOl!HHOro, ,11onrocpoqHoro npe6bIBaHHll, 6onbHHUaX), AOMa, a TaK)l(e 0 6 YPOBHe OKa3aHHll noMOIIIH npecTapenbIM, HaXOAlllllHMCll npH CMepTH; nony qeHHll HH¢opMaUHH 06 06beMax H KaqecTBe npe,11ocTaBnl!eMOH ceMbl!MH H 06111HH aMH nOMOIIIH HeTpy ,110 - cnoco6HbIM, 6onbHbIM HnH HaXOAlllllHMCll npH CMepTH npec Tapenb1x; nonyqeHHll HH¢OpMaUHH o CTOHMOCTH TaKOH noMOIIIH ,Qnll ceMeH / 061I1HH C TOqKH 3peHHll COUHanbHbIX, 3Ko - HOMHq ecKHX , $H3HqecKHX , ncHxono rHqecKHX H YMCTBeHHblX 3aTpaT; onpe,11eneHHll Toro, KaKal! MeAHUHHCKall H COUHanbHal! no,11,11eplKKa, a TaKlKe KaKHe cny)l(6bl Heo6xo,QHMbl ceMbllM H APY3bl!M ,Qnll npe,QOCTaaneHHll TaKOH nOMOIIIH; onpe,11eneHHll Tex 3neMeHTOB noMOlllH, KOTOpble ceMbH H AP Y3 bll BbinOnHl!IOT C HeOXOTOH; onpe,11eneHHll Toro, KaK COOTBeTCTBYJOIIIHe cny)l(6bI H npe,11·ocTaBn11eMall noA,QeplKKa OTBeqaeT HHAHB H,Ayanb - Hb!M nOTpe6HOCTHM "npe,11ocTaBHTen11 nOMOIIIH" H "nonyqaTenl! nOMOIIIH" (BKnJ0qa11 COUHanbHble H ncHx o - norHqecKHe noTpe6HOCTH); onpe,11eneHHll Toro, KaK H KTO HCnonb3yeT HMeIOlllffeCl! cny)l(6bI; onpe,11eneHHll Toro, Kor,11a H noqeMY HMeI0111Hec11 cnYlK6bJ He Hcnonb3YIOTCH, 2 . 2 MeponpHl!THll 1) B HaCTO.RI11ee BpeMl! T a HH¢opMaUHll, KOTOPOH pacnonaraeT KaK mHpOKal! 0 6111ecTBeHHOCTh, TaK H npo¢ec- CHOHanbHbie MeAHUHHCKHe pa6oTHHKH o: a) npouecc CTapeHHll H 6) noTeHuHanbHblX B03MOlKHOCTHX npo,QOJDKe- HHll nonHOUeHHOH )l(H3HH B npeKnOHHOM B03pacTe l!Bn>IeTCll HenonHOH HnH HeToqHQH, Heo6XOAHMO opraHH3 0 - BaTb HHTerpHpOBaHHOe o6yqeHHe B o6naCTH repoHTOnorHH ,11n11: ,QeTeH lllKOnhHOro B03pacTa; caMHx npecTape=1x, HX ceMeH H APY3eH; qneHOB ,1106poBOnbHblX opraHH3aUHH; ,11pyrHX Henpo¢ecCHOHanbHblX Me,QHUHHCKHX pa6oTHHKOB . 2) MHorHe npecTapenbJe, qneHbJ HX ceMeH H APY3bll He 3HaIOT O BC e x Tex MeAHUHHCKHX H COUHanbHblX cny)l(- 6ax, KOTopwe HaXO,[ll!TCll B HX pacnopl!lKeHHH; B CBll3H C 3THM cpoqHo Heo6XOAHMO npoBeCTH B CTpaHax KaMnaHHH no 03HaKOMneHHIO C 3THMH cny)l(6aMH, nonHOCTbIO Hcnonb3Yll npH 3TOM COBpeMeHHYJO TeXHOnorHIO CB.R3H , 3) BonpocaM repoHTOnorHH B 6onbIDHHCTBe nporpaMM B PerHOHe no o6yqeHHIO CTy,Qe HTOB npe,QOCTaBn eHHIO Me,[IHUHHCKOH noMOIIIH He y ,11en11eTCll COBCeM, nH6o y,11en11eTCll He3HaqHTenbHOe BHHMaHHe. He o6XOAHMO nepe- CMOTpeTb HnH nepeopHeHTHPOBaTb KaK nporpaMMbl OCHOBHOro, TaK H pacmHpeHHOro o6yqeHHll, BKnJOqHB B HHX Bonpocw pa3BHTHll qenoBeqecKoro opraHH3Ma, npo¢HnaKTHKH npe)l(,!leBpeMeHHoro cTapeHHll H HeTpy,11ocnoco6- HOCTH. 4) B 6onbIDHHCTBe CTpaH Me,QHUHHCKal! npe c TapenbIM cna6o pa3BHTa, eH y,11en11eTCll BTOPOCTeneHHOe BHHMa- HHe, EH Hepe,QKO OKa9bIBaeTCll cna6a11 no,11,11eplKKa co CTOPO Hbl COO TBeTCTB YIOIIIHX Ka<jle,11p YHHBep CHTeTOB, npo<jleccHOHanbHblX yqpe)l(,!leHHH H opraHH3aUHH, npe,11ocTaBnl!IOI11HX $0H,[lbl. CTy,QeHTbI, pacnonaral! B Haqane o6yqeHHll AOCTaToqHo MOTHBHPOBaHHOH Il03HUHeH , BCKOpe Y3HaIOT OT npeno,11aBaTen11 H H3 npaKTHqe CKOH ,11e11 - TenbHOC TH cny)l(6, qTo neqe6Hoe o6Cny)l(HBaHHe 6onee MOnO,[lblX B03paCTbIX rpynn HBnl!eTCll 6onee npHCTHlKHblM H Ha Hero Bbl,!1enl!IOTCll 60nbIDHe $HHaHCOBbJe cpe,QCTBa. - 95 - 5) PeAKO yaenHeTCH He06XOAHMOe BHHMaHHe aaeKaaTHOCTH H YPOBHID MeTOAOB o6yqeHHH, TexHonorHH, HC- nonb3yeMOH B nporpaMMaX o6yqeHHH o6mecTB e HHOCTli, a TaK~e npo¢ecCHOHanbHOro H BCITOMOraTenbHoro nep- COHana. Ha acex ypOBHHX Heo6XOAHMO COOTBeTCTBYIDmee PYKOBOACTBO, BHeapeHHe yqe6HbIX noco6HH anH OKa9a HHH ITOMO~ npenoaaeaTenbCKOMY COCTaey B onpeaeneHHH Tex o6nacTeH, B KOTOPbIX He06XOA11MO coeep- meHCTBOBaTb aeHTenbHOCTb, a TaK~e AnH nocT a HOBKH ueneH H KOHTponH 3a HX ocymecTeneHHeM . 6) IlpenoaaeaTenHM COUHanbHbIX AHCUHITnHH, CTYAeHTaM H3yqaID~X MeAHUHHY, cecTpHHCKOe aeno H TepanHID, HepeAKO caMHM He XBaTaeT 06pa3oeaHHH B TaKHX o6naCTHX, KaK repOHTOnorHH H MeAHUHHCKOe o6cn~eaHHe npecTapem,x; He06XOA11MO TlllaTenbHO npOAYMaTb eonpoc O TOM, KOMY npeacTOHT 3aHHMaTbCH o6yqeHHeM npe- noaaeaTenbCKoro cocTaea . 7) C03Haea,i, qTo Eepona He HBnHeTCH OAHOPOAHblM perHOHOM H qTo cymeCTBYIDT KynbTYPHbie, penHrH03Hbie H COUH8nbH0- 3KOHOMHqecKHe pa3nl{ql{,t Me)l(,[ly rocyaapCTBaMH, 6bIJ10 npH3HaHo, qTo nepea rocyaapCTBaMH-qne- HaMH HepeaKO BCTaIDT npo6neMbI' CBH3aHHbie C npouecCOM CTapeHHH H yxoAOM 3a npecTapemIMH. 3nr npo6- neMbI BKnIDqaIDT B ce6H HeTPYAOCnoco6HOCTb' COUHanbHhie nHmeHHH H HH3KHH COUHanbH0- 3KOHOMHqecKHH CTaTyc. PemeHHID 3THX npo6neM He npl{AaeTcH nepeooqepeaHoe 3HaqeHHe, a o6maH HexeaTKa cpe,(ICTB, BbI3BaHHaH HbJ- HemHHM 3KOHOMHqecKHM cna,[IOM BO BCeM MHpe, Hepe,[IKO npHBOAHT K COCTaaneHHID CKPOMHbIX 6ID~eTOB Ha cn~- 6 bl oxpaHbl 3,[\0POBbH npecTapem,x . 06ecneqeHHe 6onee BblCOKoro ypOBHH =3HH 3THX nID,[leH Morno 6bl npH- BeCTH K ynyqme HHID COCTOHHHH HX 3,[\0POBbR, COKpaTHB TeM caMbIM noTpe6HOCTH B couHanbHbIX H MeAHUHHCKHX cny)l(6ax . B 3HaqHTenbHO 6onbll!eH CTeneHH cneayeT HCITOnb30B8Tb HeoueHHMblH YHHKanbHblH OilblT npecTap e - n blX, HX B03MO)l(Hb!H BKna,[\ B pa3BHTHe o6mecTBa. cna6oCTHM npecTapenbIX, a HX AOCTOHHCTBaM H cnoco6HOCTHM. 3. PeKoMeHAaUHH 3 . 1 HaUHOHanbHblH epoeeHb 1) Heo6XOAHMO ocymecTBnHTb HHTerpHpoeaHHoe o6yqeHHe npecTapem1x, qneHoa HX ceMeA H Henpo¢eccHo- HanbHbIX MeAHUHHCKHX pa60THHKOB C TeM, qTo6bI MaKCHManbHO Hcnonb30BaTb HMeID~ecH 3HaHHH H, B qacTHoc- TH, AnH Toro, qTo6bI HaceneHHe MOrno H3Bneqb nonb3Y H3 nporpaMM npo¢HnaKTHqecKOH H nepeHqHoH Me,[IHKO- c aHHTapHOH ITOMO~ . l:lonee Toro , cpeACTBa MaCCOBOH HH¢opM8UHH ,[10n)l(Hbl 6b1Tb 3 aAeHCTBOBaHbI B MeponpHH- THX no caHHTapHOMY npocaemeHHID o6me.CTBeHHOCTH . 2) Heo6XOAHMO nepecMOTpeTb nporpaMMbl o6yqeHHH npo¢ecCHOHanbHblX MeAHUHHCKHX pa60THHKOB Ha ,[\HnnoM- HOM H ITOCTAHilnOMHOM YPOBHHX C TeM, qTo6bi 6onb111ee BHHMaHHe B HHX 6 bIJ10 yaeneHO npecTapenbIM . 3) Heo6XOAHMO pa3pa60TaTb nporpaMMb1 THna "MeponpHHTHH- HccneaoeaHHH", HanpaeneHHbie Ha o6ecneqeHHe HHTerpaUHH npecTapemIX B HX AOMamHee OKp~eHHe Ha 803MO)l(H0 6 onee npO,[IOn)l(HTenbHblH nepHOA e peMeHH, a Ta!OKe Ha nnaHHPOBaHHe nporpaMM MeAHUHHCKOH H couHanbHOH ITOMOllH . Heo6XOAHMO aKTHBHO CO,(\eHCTBOBaTb Hcnonb3 0BaHHID Ha npaKTHKe pe3yn bTaTOB 3 TOr o Hccne,[\OBaHHH H nnaHHPOBaHHH. 4) HayKa O noeeaeHHH aon~Ha BHOCHTb 6 onbWHH BKnaa 8 H3yqeHHe H HccneaoeaHHe ¢YHKUHOHanbHOH cnoco6- HOCTH pa6oTaTb H yqHTbCH He3aBHCHMO OT B03pacTa. 5) Heo6XO,[\HMO npOBO,[\HTb H3yqeHHe pa3nl{qHbIX Kyn bTYP AnH nyqmero IlOHHMaHHH Il03HTHBHbIX H HeraTHBHbIX acneKT OB npouecc a cTapeHHH. 6) IlpH ocymecTaneHHH nporpaMM ,(\On)l(Hbl OblTb onpeaeneHbI H YAOBneTeopeHbI noTpe6HOCTH qneHOB ceMeH H APYrHX nHU , OKa3b!BaIDmHX ITOMOillb 6onbHblM H/HnH HeTPYAOCITOC06HbIM npecTapemIM. 7) IlpH nnaHHPOBaHHH HaUHOHanbHblX nporpaMM ynyqmeHHH YPOBHH )l(H3HH nepeooqepe,[IHOe BHHMaHHe cne,[lyeT yaenHTb IlOMOIIIH npecTapemIM. 1) )lnH AOCTl{)l(eHHH HaUHOHanbHblX ueneH no coeepweHCTBOBaHHID MeAHUHHCKOH ITOMOIIIH npecTapemIM Heo6xo- AHMO y6e,(IHTb npaBHTenbCTBeHHbie H HenpaBHTenbCTBeHHbie o pr a HH3aUHH 8 Heo6XOAHMOCTH pa3pa60TKH Me)l(,[\y- Hapo,(\HbIX nporpaMM COBMeCTHblX aeHCT BHH ; Hanp HMep , BaJKHO HanaAHTb OOMeH HH¢opMauHe>I O KOHUeilUHHX H pe3ynbTaTax HCCneaoeaTenbC KOH ,[leRTenbHOCTH ( BKnIDqaH AaHHbie O nonbITKaX ocymeCTBneHHH n porpaMM ) , a TaK)l(e 06 yaaqHblX MO,[lenHX . 3 . 3 B03 1) B03 Heo6XOAHMO pa3pa60TaTb AanbHeAmyID aonrocpoqHyID n p o rpaMMy , o pH eHTHpoeaHHYID Ha o6ecneqeHHe ¢H3HqecKoro, YMCTBeH Horo H couHanb Horo 6narococToRHHH npecTapem,x. - 96 - 2) B03 AOJIJl(Ha CTHMynttpOBaTb pa3BHTHe H AanbtteHmee COB epmeHCTBOBatttte MeTOAOnorHH ttccneAoBaHHH npo - uecca CTapeHH.R c TeM, 'IT06bl o6ner'!HTb cpaBHHMOCTb pe3ynbTaTOB Hal.lHOHanbHb!X ttccneAOBaHHH . Heo6xo - AHMO yqpeA HTb TeXHH'IeCKHe KOHCynbTaTHBHbie rpynnbl HJIH noArpynnbI B03 An.fl paccMOTpeHH.R pa3nH'!Hb!X ac- neKTOB ¢tt3H'!eCKOro OKpY)KeHH.R npecTapeJiblx , IlCHXOCOI.IHanbHb!X ¢aKTOPOB no~ttnoro B03pacTa (BKnw'Ia.R nctt- XOCOI.IHanbHb!e acneKTbl YXOAa Ha neHCHW' T. e. KaK cneAye T roTOBHTbC.R K YXOAY Ha neHCHW) ' a Ta=e )'.In.fl 01.1eHKH 3 MOI.IHOHanbHb!X noTpe6HOCTeH npecTapenbIX . 3) B03 ADn~Ha o6ner<IttTb o6MeH sttatttt.RMH no 6ttonortt'!eCKHM H ncttxoco1.1ttanbHblM npo6neMaM npecTapem,rx nyTeM COTPYIIHH'IeCTBa B opraHH3al.lHH cneuttanbHblX Me~yHaPOAHblX KYPCOB H ceMHHapoB. Pa6oqaR rpynna no cpegcTBaM npegynpe)!(,11eHHR HHBaJIH,O;HOCTH cpegH npecTape.nbIX KinhH , 16- 19 HOH6pH 1981 roga - 97 - ICP/ ADR 024(S) 24 HOH6pH 1981 roga OPl1rHHAJ1 : AHfJ111fiCKHl1 /laHHOe coae111aHHe Pa6oqej:r rpynnhl 5bLTI O C03B aHO PerHOHaJibHbl M 6KJpO B COTPYAHHqecTBe C npaBHT e.nb- CTBOM ~egepaTHBHOH Pecny6nHKH fepMaHHH H MYHHllHITaJIH T eTOM r. KinbHa. Ha COBe l!laHHH npHCYTCTBOB£nH cne11HanHCTbl 8 o6naCTH MeAHI-lHHbl' TeXHHKH' ncHxono r HH ' COllHOnorHH ' TeopeTHqecKHX' npHKnaAHblX H aKaae- MHqecKHX HccnegoeaHHH, a TaK)l(e nHua , 06ecneqHaaw111He noMOlllb H nonb3YIDIIIHeCH ew . 8 qHcno yqacTHHKOB B0l1111H COTPYAHHKH WTa6- KBapTHPbl B03 H PerHOHaJibHOro 6KJpo . 03 HaKOMHTbC.R C .a;aHHblMH O COCTOHHHH 3,D;OPOBb.R npecTape.JibIX H HX cnoco6HOCTH BbIIIOJIHflTb Ka.JK.,ll;O,[I;HeBHble q,yHK=; 03Ha KOMHTbCR C gaHHblMH 06 ycnOBHHX lKH3HH npecTapenbtx ; o5CYAHTb Me)!(,11yHapOAHYW KnaCCH(pHKaUHW HHBaJIH,O;HOCTH , HeTpygocnoco6HOCTH H paccTpOHCTB (MKHHP)a H ee 3HatteHHe ; o6CYAHTb gaHHble O qacTOTe cnyqaea H pacnpocTpaHeHHOCTH HHBanH,O;HOCTH B nOJIGl.llOM B03pacTe , B qacTHOCTH noKOMOTOPHblX, ncHx=ecKHX H ceHCOPHblX HapyweHHH , a TaK)l(e MHO)l(eCTBeHHblX paCCTPOHCTB; n poaHanH3HPOBaTb HOBbte MeTOAbl npegynpe)!(,11eHHH HHBaJIHAHOCTH YKa3aHHblX naTonorHH cpegH npecTape - JlblX Ha nepBl-NHOM , BTOPl·P·IHOM H TpeTH4:HOM YPOBH..RX . Y)l(e g aaHo 803 npHgaeT oco6oe 3HaqeHHe eonpocy npegynpe)!(,11eHHR HHBanHJJ;HOCTH cpegH npecTape.nbtX . IlpHHRTHe 803 CTpaTerHH no AOCTH)l(eHHW 3AOPOBbH gn.R acex K 2000 rogy' npoaegeHHe B xoge pa50Tbl TpHgUaTb nepBOH ceccHH PerHOHaJibHOro KOMHTeTa 803 (EepnHH , 1981) AHCKYCCHH Ha TeMY: " :1eAHUHHCKHe H COUHaJib Hble npo6neMbl HHBanH,O;oB" ' 06'bHBneHHe 1981 raga Me*AyHaPOAHblM rogOM HHBaJIHAOB (Mrl1) - ace 3TH co6b(THH HegaaHero npolll1loro no3BOnHnH npHBneqb BHHMaHHe K s=HOCTH pacwHpeHHH pa60Tbl B 3TOH o6nac TH . IlpoaegeHHe Mfl1 HMeeT oco6oe 3HaqeHHe gnR npegynpe)!(,11eHHR HHBaJIHAHOCTH H pea6HnHTaUHH npe- CTapenhrx B Ea pone 8 CBH3H C ABYMH C06blTHHMH' HaMeqeHHblMH Ha 1982 rag : npa3AHOBaHHe Me)!(,11yHapogHoro AHH 3AOPOBbR nag geBH30M " IlonHOUeHHaR lKH3Hb 8 nO)l(HnQM B03pacTe" H npoeegeHHe 8ceMHpHOH AccaM5neH OpraHH3aUHH 06'beAHHeHHbIX HaUHH no npo6neMaM cTapeHHH. /lHCKYCCHH OnpegeneHHe ITOHHTHH " npegynpe)l(J1eHHe HHBanHgHOCTH" 8 caMOM Haqane AHCKYCCHH 6bLJlO peweHO paccMaTpHBaTb ITOHHTHe "npegynpe)!(,11eHHe HHBanHAHOCTH" 8 o qeHb lllHPOKOM CMbJCne H nogpa3yMeeaTb ITOA HHM "cpegcTBa npegynpe)!(,11eHHR HnH 6 opb6bl c HeraTHBHblMH nocnegCTBHRMH 6one3HeH " . Pea6HnHTaUHH - B TPaAHUHOHHOM CMblCne - AOn)l(Ha TpaKTOBaTbCH KaK "cpegCTBO npegynpe)!(,11eHHH gononHHTeJibHOH HHBaJIHAHOCTH HnH pa3BHTHH cy111ecTBYWllleH HHBaJIHAHOCTH", 0 CHOBHble gaHHble EblTb ITQ)l(HnblM - He 3 HaqHT 6 b1Tb HHBaJIHAOM , XOTH CTaTHCTHqecKHe gaHHhle H npaKT=ecKHe Ha6n}QtleHHH roeopH T O TOM, '!TO ITO)l(Hnb(e ITIQJ:IH lllHpOKO npegcTaaneHbl 8 rpynnax HHBaJIH,0;08 . ITpecTapenbIX MO)KHQ nop;pa3,UeJIHTb Ha .aa e Ka TeropHH : 11 MOJIO.ll,bJe TIO>KHJlbie JI}Qll;H 11 H. 11 CTapbJe [lQ)KHJlbie n}QtlH"' K KOTOpblM npHHagne)l(aT 1'1JyTIITbl ITHU 8 B03pacTe 60 - 74 neT H 75 H 6onee neT. CornacHO ga HHblM 3ITHAeMHonorHqecKHX HccnegoeaHHH, 40% ITHU, HaXOAHII\HXCH 8 803paCTHOH rpynne OT 60 AO 74 neT , He cqH- TawT ce6H HHBanH,O;aMH. CoOTBeTCTBYWlllaH UHq,pa AITH ITHU 8 803pacTe 75 neT H CTapwe COCTaBnHeT 20 - 25% . a Me)l(J1yHapogHaH KnaCCH(pHKaUHH HHBanHAHOCTH , HeTpygocnoco6HOCTH H paccTpOHCTB . 1980 r . !Ke Heaa , 803 , _ 98 - Tipo6neMb1 no)ICHJlblx nJQne H - 3TO He npo6neMb1, B03HHKaKJitHe B p esynhTaTe 6onesHH , cKopee - 3TO npo6neMbl' CBll3aH HbJe C OTC YTCTBHe M B0 9MOJKHOCTH ce611 o6cny,J(HBaTb. B OT,D.enbHb!X o6naCTllX HMeJOOll,leCll 3nH,D.eMirnnorH'!eCKHe )laH HbJe He,a.ocTaTO"!Hbl j B ,a.pyrHX - 3TH )laHHble HaKonneHbJ , HO He Hcnonh3YIOTCll HnH He HHTepnpeTHPYIOTCll B uen11x OKa9aHHll B03,D.eHCTBHll Ha o6~eCTBO. P acCTPOHC TBaM, Be,D.YIIIHM K H9DnllUHH noJKHnblX nJQneH B o6~eCTBe, cne,a.yeT y,a.enl!Tb oco6oe BliHMaHHe, T.K. 3TOT ¢aKT Op "!aCTO Bb!3WBae T HnH ycyry6n11eT nCHXH"!eCKHe HapyweHHl! . Iln11 yKpenneHHll nCHXH"! eCKoro 3/lOpOBbll H npe,a.ynpe)l()leHHll ¢H9H"!eCKHX paccTpOHCTB BaJK HO , "!T06b! n OJKHnblM nJQnllM 6 blJlH o6ecne"! eHbJ MaK - CHManb Hble B03MOJKHOCTH KaK llflll cnyxosoro 06~eHH11, Ta K H awnonHemrn BH3yanbHblX 3a)la"!. TepMHHonorH11 Ilnll 06MeHa HH¢OpMauHeH , KacaKIJleHCll 6onesHeH, HHBanH,D.HOCTH, HeTpy,a.ocnoco6HOCTH H paCCTpOHCTB , HYJKHa e/lHHa11 TepMHHonormi. B 3TOM nnaHe MKHHP npe11cTaan.11eT co6011 aecbMa ueHHhlH XOTll H npo6HbJH HH CTpyMeHT. Cpe.a.a "aHyTpeHHllll" H "a HelliHllll" - HrpaeT TaKy!O JKe Ba)l(HYIO ponb B npe,a.ynpe)!(,D.eHHH HHBanH,D.HOCTH, KaK H ,a.pyrHe Mepbl H cpe)lCTBa nOMOIIIH . 3a"!aC TYIO Mepbl, HanpaaneHHble Ha npe,a.ynpe)IOJ,eHHe HnH pea6HnHTaUHJO, XOTll He B 3TOM 3aKn!O"! aeTCll HX rnaBHall uenb, BblnDnHll!OT uenbJH KOMl"lneKC ¢YHKUJ-IH. Hcnonb30BaHHe pasnH'IHblX MeTOAOB, H B "!aCTHOCTH 0,[J,HOro H 3 lGIX, nOJIY'{HBWero Ha3BaHHe - "nHTaHHe Ha Konecax" , - rrpaKTHKyeTCff He TOnbKO .z:tJIR Tor o, "!T06W o6ecne"!HTb noJICH!lblX nJQneH nHTaHHeM, HO H llflll Toro. "!T0 6 bl nOMO"! b ycTaHoaneHH IO COUHanbHbJX KOHTaKTOB, pa3BHTb B nJQn.llX "!YBCTBO y sepeHHOCTH . 3TO He06XO/lHMO y "leCTb npH paspa60TKe CHCTeM OKa - saHHll nOMOIIIH H opraHH3auHH 06Y"!eHH11 nepCOHana. BKna)l KoH¢epe HUHH n o cecTpHHCKOMY o6cny,KHBaHHIO H Me)lHK o -coUHanbHblM acneKTaM oxpaHbl 9/lOPOBbll n pecTapenb1x Pa6oTa ,a.aHHOH KoH¢epeHUHH npoxo11Hna O/lHOBpeMeHHO c sace11aHH11MH Pa6o"!e11 rpynnb1. H.llnH Y"!aCTHe npe11cTaBHTenH 19 rocy11apcTB - "!neHoB Eapone11cKoro perHoHa. Y"!aCTHHKH Ko H¢epeHUHH npHmnH K e,a.HHOMY MHeID!IO OTHOCHTenbHO Toro, "!TO O)lHa H3 r n aBHblX 3a)la"! Me11cecTep H pa60THHKOB COI.IHanbHblX cnyiK6 9aKn!O"!aeTCll B co11elkTBHH pa3BHTHIO HaUHOHanbHbJX nporpa MM nepBH"!HOH Me,D.HK O-caID!TapHOH noMOIIIH. no BCeH BepOllTHOCTH, ,a.nil 3Toro Bnpe,a.b Heo6XO/lHMO y11en11Tb n peH~eCTBeHHOe BHHMaHHe HeHH)lHBH,D.y anbHOMY no.a.xo,a.y , OCHOBaHHOMY Ha Hcnonb90BaID!H Me)lHUJ-IHCKOH nOMOIIIH, a TaKOMY no,a.xo,a.y, KOTOp WH o6ycnosneH COI.IHanbHOH CTPYKTYPOH , nonHTHKOH 3,a.paaooxpaHeHHll H 6onee IIIHPOKHMH COUHanbH0-3KOHOMH"!eCKHMH ycnOBHllMH cospeMeHHOro o6~eCTBa. K rp y nnaM BWCOKoro PHCKa npHHa,a.neJl(aT He TOflbKO nJQnH c ¢H9H"!eCKHMH He,D.OCTaTKaMH, HOH nonyn.l!UHH, lKHBYIIIHe B He6naro - np HllTHblX COUJ-lanbH0-3KOHOMH"!eCKHX ycnoBH.llX . Me,a.cecTpbl H pa60THHKH COUHanbHblX cnyiK6 AOflJl(Hbl n p H- HHMaTb Y"!aCTHe B COOTBeTCTBYKIJIHX MeponpHllTHllX, BKJIJO"!all Te H3 liHX, KOTOpwe npe,a.ycMaTpHBa!OT pa3BHTHe CO TP Y/lHH'!eC TB a C Henpoq,eccHOHanbHblMH pa60 THHKaMH. ,llonrocpO"!HOH nOMOII\H. oc o6eHHO o6cnyJKHBaID!IO 6 onbHblX repHa TpH'!eCKHX H ncHxorepHaTpH'leCKHX OT)leneHHH, cne11yeT y11en.11Tb nepBOO"!epe)lHOe BHHMaHHe . ilpH onpe,a.eneHHH CTaH,D.apTOB npe,a.ocTaBnl!eMOH nOMOII\H cne.a.yeT Y"!HTWBaTb KaK Ka"!eCTBeHHble, TaK H KOnH- "!eCTBeHHble acneKTW 3TOH noMOII\H. ilpH opraHH3aUHH 06Y"!eHHll Ha acex YPOBHIIX cne,a.yeT nepHOpHeHTHPOBaTb Y"!e6Hble nporpaMMW C y"!eTOM Heo6XO/lHMOCTH co.a.eHCTBOBaTb pa3BHTH IO "!enOBeKa H YKPenneHHIO ero 9AOP0Bbll Ha KOMM)'HanbHOM YPOBHe. Me.a.cecTpw AOflJl(HW OKaSWBaTb co,a.eHCTBHe MeponpH.llTHllM n o 09HaKOMneHHIO HaceneHH.ll C qlH9HOnorJ-!lleCKHMH, coUHanbHblMH H ncHxonorH"!eCKHMH acneKTaMH npouecca cTapeHH11. BblBO,D.bl H peK OMeH,D. aUHH HaUHOHanbHbJH ypoBeHb 1) Cne,a.yeT npoaecTH HCCne.a.oBaHHll no H9Y"!eIDIIO B09AeHCTBHll BHemHeH cpe)lbl Ha "!enoseKa. "!TO He06XOAHMO Aflll BbmBneHHll Tex ¢aKTOpOB cpe.a.w , OT KOTOPWX 3 aBHCHT Yfl Y"!W eHHe Ka"!eCTBa JKH31lli HHB anH,D.OB. 2) Cne,a.yeT COAeHCTBOBaTb npoae.a.eHHIO Ha Y"!HblX Hccne.a.oaaHHH a o6naCTH no,a.rOTOBKH cneUHanHCTOB H npoc se~eHHll WHPOKOH o6~eCTBeHHOCTH no BonpocaM npe,a.ynpe)!(,D.eHHll HHBanH,D.HOCTH H ocy~e CTBneHHll COO TBeTCTB YIOUIHX MeponpHllTHH . 99 - 3) B Tex o6naCTRX, rge gaHHble OTCYTCTBYIOT, cn egy eT npHJI0"°1Tb MaKCHMYM ycHnHH ana npoBeg eHHR 3nttaeMHonoruqecKHX uccnegoBaHHA no BonpocaM HHBanttaHOCTH H HeTpygocnoco6HocTH cpegu npecTapenwx, BKnlO'!aR npoBegeHHe rpynnOBblX H npogonbHb!X HccnegoBaHHH. TaM, rge gaHHble HMeIOTCR, cneayeT COBep- we HCTBOBaTb H yKpennRTb CHCTeMbI MOHHTOPHHra MeHRKl!IIHXCR MOgeneA. CY111eCTBYIOWHe gaHHb!e AMJKHbl nog- Bep r aTbCR oueHKe c Hcnonb30BaHHeM MK11HP, npuqeM oco6oe BHHMaHHe cne;:.yeT ygenHTb nCHXHqecKHM H ¢u3 uqecKHM paccTpOHCTBaM. 4) Cne;:.yeT opraHH30BaTb npoBe;:.eHHe HayqHbIX uccnegoBaHHA no oueHKe ponH nporpaMM CKPHHHHra pa3nH'IHblX B03paCTHb!X rpynn B paHHeM pacno3HaBaHHH cny't{aeB 3a6oneBaeMOCTH H HHBanttaHOCTH cpegH Wttp OKHX cnoeB HaCeneHHR, 5) Cne;:.yeT onpe;:.enHTb H KOHKpeTH3HPOBaTb ponb 6puragbl nepBH'IHOH MeAHKO- caHHTapHOH IlOMOWH H pa60THHKOB OTgenbHb!X AHCUHilnHH CHCTeMbI IIMCII, KOTOPYIO OHH npH3BaHbI HrpaTb B npe;:.ynpell(tleHHH HHBanua- HOCTH H HeTpygocnoco6HOCTH . 6) CnegyeT npH3HaTb 3HaqeHHe caMOilOM011111 H CTHMYnHpOBaTb ee Hcnonb30BaHHe B Ka'leCTBe KOMU O- HeHTa TepaneBTHqecKoro npouecca. 3aMe Ha npo¢eccHoHanbHOH noMOa.H, BaJKHO, o;:.HaKO, qTo6b! Mepb! CaMono11111 He paCCMaTpHBanHCb KaK 7) CnegyeT ygenRTb BHHMaHHe MHOrOAHCUHilnHHapHOMY H Mell(I:IHCUHnnHHapHOMY xapaKTepy npo6neM, n OCKMbKY cpe;:.H npecTapenbIX MHOJKeCTBeHHaR HHBanHAHOCTb CKopee npaBHJIO, qeM HCKnlO'!eHHe. 8) EcnH B03MOJKHO, cnegyeT npOBOAHTb oueHKY noTpe6HOCTeH H pecypCOB npecTapenwx B AOMaWHHX yc nO BHRX, nocKonbKY Oilb!T rOBOPHT O TOM, qTO HaH6onee TOqHbJe pe3ynbTaTbl aaeT oueHKa, npOBOAHMaR B 3HaKOMOM OKpy-~eHHH, 9) )lrIR Toro, qTo6w oueHHTb B03geHCTBHe anbTepHaTHBHhlX BMeWaTenbCTB H npaBHnbHO HX aapecoBaTb, He 06XOAHMO npHMeHHTb CHC TeMY' KOTOpaa 5bl TOqHo onpegenana BMeWaTenbCTBO B nnaHe ero pa3nH'IHMbIX KOMilO HeHTOB . 3TO OTHOCHTCR K npo¢HJiaKTH'leCKHM MepaM, npOOBAHMblM cpegH Tpygocnoco6Horo HaceneHHR, a TaKJKe K MepaM BMewaTenbCTBa, neqeHHR H OKa3a HHR n OM011111 HHBanH;:.aM . 10) Cne;:.yeT CTHMYnHpOBaTb npoBegeHHe AHCKYCCHH BO BpeMR COOTBeTCTBYI011111X 3ace;:.aHHH B OTHOWeHHH MKl1HP H COOTBeTCTBYIOWeH TepMHHonorHH, pa3pa6oTaHHOH ana nocnegoBaTenbHoro HCnOnb30BaHHR CHCTeMbl B OTgenbHb!X CTpaHax . 11) Cne;:.yeT H3yqaTb pe3ynbTaTbl npaKTH'leCKOro npHMeHeHHR MKl1HP ana BblRBneHHR ee cna6b!X H CHnbHbIX CTOPOH. 12) Cne;:.yeT no6Yll(tlaTb cooTBeTCTBYIOWHe opraHH3aUHH B Kall(I:IOH CTpaHe K Hcnonb30Ba HHIO MKHHP a u enax o5ecneqeHHR B03 gaHHblMH, Heo6xo;:.HMbIMH ana npoBegeHHR oueHKH. 1 3 ) []pH npHMeHeHHH MKl1HP cnegyeT y;:.enR Tb oco6oe BHHMaHHe KaTeropHRM npo6neM, c KOTOPblMH CTanKHBa!OTCR OTgen bHble nm-1a ( a He HX p aC CTP OHCTBaM, HeTp ygocno c o6 HOCTH H T.;:.. ) . YpoBeHb B03 14) CnegyeT pa3BHBaTb KOHTaKTbl H MexaHH3Mbl COTpygHHqeCTBa C yqpe)l(AeHHRMH CHCTeMbl 0 praHH3aUHH 0 6 '.begHHeHHblX HaUHH H HenpaBHTenbCTBeHHb!MH opr a HH3aLO-IRMH B o6nacTH npegynpe)l(AeHHR HeTpy..ocnoco6HOCTH H pea6HnHTaUHH , 15) CnegyeT onpegenHTb HayqHbJe ueHTpbI, 3aHHMa1011111eca Hccne;:.oBaHHRMH H o6o6weHHeM ;:.aHHbIX, Ka- cawwuxca HHBanttaHOCTH, H CTHMYnHpOBaTb HX K COTPYAHHqecTBY , 16) B 1982-83 rr . a rocy;:.apcTBax-=eHax cne;:.yeT npoBecTH pa6oTy no pacWHpeHH10 061,eMa 3HaHHA a o6nacTH npe;:.ynp€Jl(AeHHR HeTpygocnoco 5 HocTH H pea6HnHTaUHH , 17) CnegyeT co;:.eHCTBOBaTb HCnonb30BaHHIO anbTepHaTHBHblX cpe;:.cTB BMewaTenbCTBa npH p eanH3aUHH n p o rpaMMbl no npe;:.ynpell(tleHHIO HeTpygocnoco6HOCTH H pea6HnHTaUHH, a xoaaweA 8 CeabMY!O 06111YIO nporpaMM)' pa60Tbl (1984-89) . 18) CnegyeT npoBeCTH oueHKY pe 3 ynbTaTOB Hcnonb30BaHHR MKl1HP, BKnlO'!aR pe3ynbTaTbl, nonyqeHHble MeJKnpaB HTen bCTBe HHb!MH o pr a HH 3 aUHRMH. 19) Cne;:.yeT pa3pa60TaTb CHCTeMY KnaCCH¢HKaUHH BttaOB BMewaTenbCTB C yqeTOM cywecTBYIOWeH Mell(tly HapogHOH KnaCCH¢HKaUHH MeAHUHHCKHX npoue;:.yp (*eHeBa, 1978 ) , 6ygyweA KnaccH¢HKaL0-1H n oco5HH ana XHpypruqecKHX o nepauui1 H MKl1HP . 100 Ha1.1HoHanhHhlM ypoBeHh H y poBeHh B03 20) Y'IH ThlBall CBOIO ponh B ,nene HH<POPMHPOBaHHll nOJKH.JlblX n!QlleM O MeponpHllTHllX , KaCa!OIIIHXCll HX, H B 'laCTHOCTH ,neJJTenbHOCTH, HanpaBneHHOM Ha AOCTH)l{eHHe COI.IHanbHOM 1.1enH - "s,nopOBbe Anll Bcex K 2000 ro,ny", cpe,nCTBa MaCCOBOM HH<j,OpMal.lHH AOn)l(HbJ, r,ne 3TO B03MQ)l(HO, co,neMCTBOBaTb npoBe,neHHIO Mep no AOCTH)l(eHHIO yKasaHHblX 1.1ene11, BblCTynall B Ka'leCTBe paBHOnpaBHblX napTHepoB, a He npOCTO tta6n!QllaTeneM. KOHKpeTHble MeponpHllTHll 21) B cnyqallX, KOr,na B03 HMeeT B CBOeM pacnopJl)l(eHHH HH<j,OpMal.lHIO O MeTo,nax npe,nynpe)l(_neHHll COCTOllHHM, BPeAHblX ,nnll 3AOPOBhll IlQ)l{HnhlX n!QlleM, HanpHMep COCTOllHHll ,nenpeCCHH, ncHXH'leCKHX paccTpOMC TB H HHKOHTHHeHI.IHH, ee cne,nyeT HeMe,nneHHO HanpaBnllTh B rocy,napCTBa-qneHbl. 22) B cnyqanx, Kor,na CTpaHb1 pacnonaraJOT HH<POPMal.lHeM o MeTo,nax rrpe,nynpe)l(_neHHll Bpe,nHhIX ,nnll 3AOPOBhll q,aKTOPOB, B 'laCTHOCTH q,aKTOPOB, Bbl3b!BaeMbrx HapY111eHHllMH 9PHTenbHblX H cnyxOBblX <PYHKI.IHM, B03 AOn)l(Ha C06HpaTb, 0606111aTb H pacnpocTpaHllTh 3TH ,naHHble, a TaK)l(e ,naHHble, KaCalOIIIHeCll HcnonhSOBaHHll TexttH'leCKHX cpe,ncTB noMOIIIH, 23) B Tex cnyqallx, KOr,na HH Ha YPOBHe B03, HH Ha Hal.lHOHanbHOM YPOBHe HeT HHKaKOM HH<j,OpMal.lHH 0 MeTo,nax npoq,HnaKTHKH H ne'leHHll, cne,nyeT Ha OCHOBe COTPYAHH'leCTBa npe,nnpHHllTh Hay'{Hble Hccne,no- BaHHJi , a B03 - co6HpaTb, o6Cy)l{AaTb H pacnpocTpaHllTh CBe,neHHJi o pesynbTaTax 6opb6bl c TaKHMH COCTOllHHllMH, KaK HanpHMep, xPOHH'leCKH HH3KOe KpOBllHOe ,naBneHHe, n O)l{HQe CTap'leCKOe cna6oyMHe, na,neHHll H xPOHH'leCKHe 6onH. - 101 - OXPAHA ITCH]{],fl!ECKoro 3llOPOBbR - 103 - Pa6o4a.R rpynna IIO H3MeH.RlOIIUIMC.R MOAe.JUIM noee,.n;eHHJI, ae,11ym,HM K caMoy6uHcTay lCP/ MNH O36(S) 26 HOH6pH 1981 roaa Aq>HHbl, 29 Ce HTR 6p.R - 2 OKT.R6p.R 1981 roAa OPIITHHAJI : AHr Jl1111CKllli 1. BeeAeHHe CoeemaHHe 6bIAO CO3B8HO EeponeHCKHM perHOHBAbHbW 6ropo B03 no npHI'AameHHID npaBHTeAbCTBa rpeUHH, Ha HeM npHCYT CTB0B8JIH apeMeHHhie KOHCYJibT8HTbl H3 ABCTpHH, Be.JibrHH, B eHrpHH, rpeUHH, -UaHHH r HTaJIHH, HHAepABHAOB, CoeAHHeHHOro KopoAeBCTBB H IDrOCABBHH, A BB Ha6AIDAaTeAJI OT rpeQHH, a TalCJ<e npeACTBBHTeAH MeIAyHapOAHOH aCCOUHBUHH no npo¢HABKTHKe Ca Moy6HHCTB, MeXAYHBPOAHOH ¢eAepaQHH CAyx6 HeOTAOXHOH no- MOfilH, Bbl3bIBaeMbIX no TeAe~Hy, Bce,mpHOH ¢eAepaUHH oxpaHbl IlCHXH'leCKoro 3AOPOBbJI H Bce MHPHOrt accou1rn- UHH IlCHXH8TOpOB. Pa6o'laJI rpyrrna rrpoaHaAH 3HPOBaAa H o6o6maAa OCHOBHble TeHAeHQHH pa3BHTHJI caMoy6HHCTB H IlOilblTOK CaMoy6 HHCTB; npoaeJia AHCKYCCHIO OTHOCHTeJibHO AOCTOBepHOCTH H o6oCH0B8HHOCTH OTMe4eHHblX TeHAeHuHH; paCCMOTpeAa CK pbITble ¢aKTOpbI; npoaH8AH3HpOBaAa npOBOAHMble B HBCTOJ!filee BpeMJI HCCAeAOBBHH.fl B 3TOH o6A8CTH; H npeAAOXHAa O'lepeAHOCTb npoeeAeHHJI HCCAeAOBaTeAbCKHX pa6oT. Pa6o'laJI rpynna o6cyAHAa T8KXe CTpaTerHIO npO~HJI8KTHKH caMoy6ttH CTB, BKJI1048.R COOTBeTCTByromee pacCMOTpeHHe 3TH4eCKHX eonpocoa, H Bblpa3HAa 03a6o'leHHOCTb B CBJl3H C Heo6 xOAHMOCTbID coeepmeHCTBOBBHHJI nporpaMM o6y'leHH.fl HBCeAeHHJI. 1) Ca Mo y6 HHCTBB H nOilblTKH caMoy6 HH CTB CAeAyeT pacCMBTPHBBTb OTAeAb HO. XoT.R 3TH BHAhl ,.n;eHcTBHli CB.R38Hhl Me~AY co6oH, Me~AY HHMH ru.t:elOTC.R cymecTae HHbie AeMorpa~Hl.leCKHe , COUH8Jib Hhle H KJIHHHl.leCKHe p83JIHllH.R. 2) He npeAAaraIDTCJI HHKBKHe H3MeHeHHJI B onpeAeAeHHe caMoy6imCTBa, COAepxamH eCJI B MexAyHapOAHOH KABCCH¢HKBQHH 6oAe3HeH (MKE) , a TBK~e B TPBAHUHOHHYID npoueAypy paccAeAOBBHHJI B eeponertCKHX CTpaHax. 3) TepMHH 11 IlOill,ITKa Ca Moy6HH CTBa 11 OX BB TbIBBeT ace CAY 'IBH HaMepeHHOf'O HaHeCeHHR ce6e noepeXAeHHrt HAH c .JiyttaH OTpaB.JieHHH, He 3aaepmHBmHeCH ¢aT8.JibHhlM HCXOAOM. 2.1 CaMoy6 a rtCTBa 4) Pa6ot.1aJ1 rpynna OTMeTH.Jia' 4TO OHa KOH¢HAeHIU18..IJ:bHO HCilO.Jib30B8.i'I8 o<f>HUH8JibHble CT8THCTH1..leCKH e ,.!18H - Hhle O caMoy611HcTB8X B eaponeHCKHX CTpattax A.JIH oueHKH TeH,.a;eHUHH. IIJITCTB0 B8Tb HCIIOJib30B8HKIO 3TliX ,.!I;S HHblX . BO3MO~Hble om H6KH He AOAXH bl npe- 5) EbIAH paCCMOTpeHbl CAeAyIDmHe TeHAeHmrn, Tpe6yromHe ABAbHefimePO H3y'leHHJI H 06'bJICHeHHJI: a) yeeAH'leHHe CAy'laee caMoy6art CTB B 60AbfilHHCTBe eeponeHCKHX CTpa H, HX oco6eHHO BbICOKHH ypoeeHb B BeHrpHH H ceeep HbIX paHOHBX IDrOCABBHH; 6) cyme CTBeH HOe COKpameHHe CAy 'laeB CaMoy6 HHCTB B AHrAHH H Y3AbCe, a TBKXe B rpeUHH 38 IlOCAeA- HHe ABS AeCHTHJieTHHj B) cpaBHHT eAbHO HH3KHrt no cpaBHeHHID C ApyrHMH CKB HAHHBBCKHMH CTPBHBMH ypoeeHb CaMoy6afiCTB B HopeeraH ; r) H.Merom.ee MeCTO COKpamettHe C.Jiyttaea caMo y6uHcTB TIOilC.MJlhlX xeH.IIIHH B 60.JibmHHCTBe eaponeHCKHX CTpatt ; - 104 - A) HllelOl!le e Me CTO COKpa~ eHHe 4HCA8 CAy4aeB caMoy6HfiCTB B3pOCJlhlX JIIOAeH MOAOAOro B03pa c Ta B 6oAbfilHHCTBe eBponeHCKHX CTpaH. 6) Pa6048R rp y nna OTM e THAa H8AH4H e CBH3H MeXAY H3MeHeHHHMH B COllH8 AbHhlX B 3KOHOMH4eCKHX ycAOBanx H H3Me He HHHMH B qa cTOTe COBepma eMhlX ca:t.1oy6 HHCTB. Te H3MeHeHH.R B o6mecT e e, KOTopwe, n o eceB eepOH T HOCTH, MoryT npHBe CTH K COllHBJibHOM H30A.RUHH 66.Jibmero qHcJia JmU, MOryT BbI 3 B8Tb TSKJKe H pOCT 4HCAa C8Moy6HHCTB . 7 ) HID<e cAeAylOIIIH e rpynnhl paccMa TpHB8AH Cb B K84eCT Be B8XHolX rpynn Bhl COKO r O pH CK8 npH npoBeAeHHH 3KCIIepHM€HTOB DO npoq>liJI8KTHKe CaM.oy6HliC T13: a) AHll8, CTP8A810lllHe OT AenpeCCH BHblX COCTOHHHH; 6) nauHeH Tb!, HSXO.ll,HmH eC.R H a JieqeHHH B IICMXH8 TpHqeCKHX 6 0.JlbHllllB X ; B) AHlla , COBepmHBmHe llOllhlTKH C8Moy6HH CTB; r) 8AI<OrOAHKH. 2.2 IlOllhlTK8 C8MOV6 Htt CT B8 8) Do BCett Be pOHTHO CTH, llOllblTKH C8MO y6 HttCT B HeAOOlleHHB8lOTCR B 3H84HTeAbHO 6bAbmefi CTeneHH, HexeAH caMoy6nHcTea; HCC JI€.ll,0B8HHH, npoBe.ll,e HHble B o6mHHBX, roeop.RT O TOM, qTQ OT 0.ll,HOM TpeTH AO DOJIOBHHW AHll, CO BepmHBIDHX llOllblTKH caMoy6nttCTB8' HHKOrAa He pa CCK83bIB8lOT 06 3TOM (j)aKTe BP84Y. 9) TeM He Me ttee , npaKTHq ecKM BO e cex eeponelicKHX CTpattax, r.ll,e DO.ll,06Hhle CJiyQBH CB.R 3 8Hbl C HaceJie- HM e M' IlO,llBepJKeHHblM PH CKY' OTM€4€Hbl CJie,11,yromH e TeH,lleHUHH pa 3BHTH.fl IJOilbITOK ca.Moy61:111 C T B B 60JibHHQHhIX yC.JIOB HJIX: a) o6mee KOAH4e CTBO llOllhlTOK c aMoy6Hfi CTB llO CTOHHHO yMeHbmaeTCH B llOC AeA HHe AB8All8Tb AeT; 6) B OTHOmeHHH llOAPOCT KOB H B3pOCAhlX JDOAefi MOAOAOr o B03pacTa OTMe4eHO H8H60Abme e y BeAH4eHHe H H8HBhlCmee 4H CAO TIOA06Hh!X CAyqaeB. 10) Hau 60Abmee 4H CAO llOllhlTOK CaMoy6 HttCTB npHXOAHT CH Ha 6eAHhle ropOACKHe paHOHhl, rAe Bhl COKH TaKXe H .ixpyrne llOK8 38TeAH COllH8AbHOH Ae3opraHH38llHH . ConHaAbH0-3KOHOMHqec iCE e H3MeHeHHH, B peayAbTaTe KOTOphlX ceMbH OK83hlB8lOTCR B OCTPOM CTpecCOBOM llOAOXeHID!,MOry T npHBeCTH K pocTy 4H CA8 llOilhlTOK cavoy6uilcTB . 11) HaH60Abfil8R 030604eHHOCTb 6hlA8 BhlpaxeHa Pa6o4eH rpynnofi B CBH3H C TeM, 4TO npo(j)eccHO HBAbHhle MeAHllHHCKHe pa60THHKH B 6oAbHHll8X H BHe HX 04eHb 48CTO He HMelOT llOArOTOBKH H 4eTKOro npeACTSBAeHHH 0 AeHCT BHHX B CAY48HX llOllhlTOK C8MOy6HttCTB . 3To HSXOAHT OTpaxeHHe B 6ec4yBCT BeHHOM OTHOmeHHH C HX CTOpOHW K naueeHTaM, KOTOPLIX OHH .JieQST. 12 ) YMeHbmeHHe HCllOAb30B8HHH yrAn, 8 3H84HT H H8AH4HH y rapHoro ra3a, He CK8 38A0Cb Ha ypoBHe C8MO- y6HttCTB, paBHO K8K H M8 CCOBOe yBeAH4eHHe BhlTIHChlBaeMblx AeKapCTB He MOXeT 6hlTb o6bH CHeHHeM yneAH- 1leHHJJ QBCJl8 CJJyqaeB HaMepeHHhlX OTPSBJieHHli . 2 .3 KTO AOAXeH HeC TH OTBeTCTBeHHOCTb? 13) OnpeAeAeHHe, oneHKa, Ae4eHHe H llOCAeAe4e6Han TIOMO~b TeM AHllSM, KOTOphle COBepmHAH IlOllblTKY C8MO- y6BHCT B8 HAH MOryT ee coaepmBTb, He AOAXHhl 6hlTb AeAOM OAHHX AHmb TICHXHSTPOB . ~e4allU<e Bp84H AOAXHI>I ChlrpaTb B 3TOM onpeAeAeHHylO pOAb, IlOtt KOAbKY MHOrHll ll0llhlTK8M CaMoy6HttCTB H CBMOy6nttCTB8M npeAIDeCTByeT KOH CyAbT8llHH y Bp848 38AOAro AO HX COBepmeHBJl. 06mHH8 TaKXe AOAXH8 HeCTH onpeAeAeH- HylO AOAlO OTBeTCTBeHHOCTH, npeAOC TSBAHH B pacnopnxeHHe HaCeAeHHH M8KCHM8AbHhle B03MOXHOC TH B noAy4e - HHH nepBH4HOH MeAHKO-C8HHT8pHOH llOMO~H . 14) RH OABH H3 BH,ll,OB npo(j)HA8KTHKH c aMo y6 HttCT B He npHHe C 04eBH,ll,HhlX 3(j)(j)eKTHBHhlX peayAbTSTOB. llpe.ixc TOHT e~e lolHOroe CAeASTb B o6ASCTH COBepmeH CTBOB8HHH cymeCTBYIOlllHX CAyx6 B oneHKH HO BblX MOAeAeH MeAHTIHHCKOH llOMOfilH . - 105 - 3. I) Heo6 xOAHMO pa3pa6oTaTb (,JJI(,J ycoaepmeH CTBOB8Tb nporpaMMbl o6y 4 eHHJI B o6JIBCTH npocj>HJIBKTHKH CBMO- y6 aiiCTB 11 lIOnblTOK c a,10y6HiiCTBB AJIJI ecex rpynn npocj>ecCHOHBJibHblX pa60THHKOB C TeM. 4T06bl nOAHJITb Ka'leCT BeHHblH ypoeeHb MeAHUHHCKOH lIOMOlll,ll, OKB3bIBBeMOH cymecTeyromHMH CJIY* 6BMH. 2) IIporpaMMb( CB Hl1TBpHoro npoceemeHHJI HaceJieHHJI AOJl*Hbl BKatW'lBTb 11Hcj>OpMBUHro O npl1411HBX (,J cpeACTeax npocj>HJISKTHKH caMoy 6HiiCTB 11 nonblTOK c aMoy6HHCTB C TeM, 4T06bl pa3BHB8Tb nepBH'lHyro MeAHKO-CBHHTSPH YID noMomb e Ayxe AJIMa-ATHHCKOH AeKJiapauHH• 8 a AJIMa -ATa, 1978 - IIe peuqHa.11 MeAHKo- c aHu1•a pHa.11 noMomb. 0 T4eT o Me*AYHapoAHOii KOHcj>epeHuuu no nepBH'lHOH MeAHKO- CS HHTBPHOH noMOillH, ]KeHeea, BceMHpHa.11 op r aHH38UHH 3ApaaooxpaHeHHH, 1978. - 107 - IlJIAHHPOBAHHE CEMbH MeJKAyHapoAHan KO H¢e p e HUHR B03 / Mllll,ll n o JlOArOTOBKe Y e,.n; nu;HH CKOI"'O n e p c0Ha.11a B o6JiaC TH n JiaH npoaa HH JI ce M&H Ilapnx 1 6-11 IIlOJIR 1981 roAa - 109 - ICP/MCH 0 25(S) UNFPA RMI / 79 P05 30 OKT R6pn 1981 roAa OPHrHHAJl: ¢PAHUY3CKJ,[~ B pa6oTe KoH<l>epeHUHH npHHRJIH yqacTHe npeAc TaBHTeJIH 22 CTpaH, CO TPYAHHKH MUIUl, mT a6 -KaapTHpb1 B03, CO TPYAHHKH Eaponeijc Koro H BocToqHocpeAH3 e MHOMopcKoro perHOHaJibHbrx 6ropo B03 , ~,llHOOH, IDHECKO H APYr ID< MeJKAy HapoAHblX o praH H38UHH, TaKHX KaK MexAyHapOAH8R ¢eAepauan raHeKoJioroe H a Ky mepoa H MexAy- HapOAHan ¢ eAe paUHR o6meCTB peryJIHp0B8 HHR qacJieHHOCTH HapOAOHaceJieHHR . ,!lHCK YCCHR B XOAe nepaoij qa c TH pa60Tbl KoH¢epeHUHH 6blJIH paccMOTpeHhl CJieAyromne eonpoc •r: co ape MeHHOe OTHO- meH He K o6yqeHmo IlJl8HHp0B8HHR ceMbH B HeC KOJlbKHX npeACT8BJieHHhlX Ha KoH¢epeHUHH CTpaHax; npo6JieMbr, B03HHKaromne B XOAe npe nOA8B8HHR p 8 3JIHqHblX acneKTOB UJl8HHPOB8HHR ceMbH (AH8rH03 o6mHHbl, UCHXOCOUH- a JihHble H TeXHHt.t eC KHe acneKTbl' a TalCJle acn e KT bl' C BJl3aHHbie C opraHH:J8IJ;HeH 06 yqeHHJI H o a;eHKa MeponpH.11- THH); pOJib JKe HmHH B IlJ18HHp0B8HHll ceMbH. 0 6 cyAHB BBeAeHne K CTpaTe rHRM UJl8HHpOB8HHR nporpaMM Ta- KOH nOArO TOBKH, yqaCTHHKH KoH¢epeHUHH npHCTyUHJIH K pa6oTe B rpynnax H onpeAeJIHJIH 38AaqH p83JIHqHhlX KaTeropHH nepCOH8Jl8 3Ap aaooxpa HeHHR B o6JI8CTH UJl8HHp0B8HHR ceMbH, BHeCJIH npeAJIOlleHHR K8K n o OC HOB- HOH UOArOTOBKe, T8K H no IlOBhIIlleHHro KB8JIH$HK8UHH B o6JI8CTH UJl8HHPOBBHHR ceMbH, paCCMOTpeJIH CTpaTe- r H:e, KOTOpblX CJieAyeT npHAepJKHB8TbCR AJIR peaJIH38UHH 3THX npeAJIOJKeHHH H C$Q pMyJIHp0B8JIH peKOMeHA8UHH. B blJIII npeAcTaBJie Hbr 06pa3 m1 yqe6 HblX noco6nij. w, HaKo HeU , 6blJI npeAJIOlleH npoeKT y q e6 Horo PYKOBOACTBa, npeAH83Haqemroro AJIR np e n OA8B8TeJieH, pacKpb1Baromero, B qac THO CTH, AeTaJIH npeUOA8B8HHR/ H3yqeHHR o npe - AeJie HHhlX IlCHXO CO UHaJi bHhlX acn eKTOB nJI8HHpoaamrn ceMbH ' H 6 bIJIH BbIHeceHbl npeAJIOJKeHHR no A8JibHe HmeM y ero ycoaepmeH c TaoaaHHro. YqaCTHHKH KoH¢epeHUHH npH3H8JIH TOT ¢aKT, 4TO o6yqeHHe epaqeij, MeAHUHH CKHX cecTep , aKymepoa H Apyroro nepcoHaJia 3A p aeooxpaHeHHJt nJI8HHpOBaHmo ceMbH B TO M BHAe, B K8KOM OHO ocymeCTBJIJteTCJt B HB CTOJtmee epeMJt' JtBJIJteTCJt A8JieKO HeyAOBJieTBOpHTeJib HblM B 6oJibMHH CTBe npeACT8BJieHHblX Ha KoH¢epeHUHH CTpaH. OcHOBHble n porpaMMbl noArOTOBKH o6 bJqHo npeAyCMaTpHaaroT KpaTKOe TeopeTHqecKoe 03 H8KOMJieHHe CTyAe HTOB C KJIHHnqe CKHMH ac n eKTBMH n p OT HB03aqaToqHhlX cpeACTB , CTepHJibHOCT H HJIH a6opTa. BbrJia OT - MeqeHbl MHOI"'He HeAOCTaTKH KaK B rrpaKTHt.teCKO H IlOA r OTO BKe , TaK H B npe n OA8B8H HH TaKIIX npeAM8TOB K8 K ceJCcyaJibHOCTb, IICUXOJIO I"'HJI napbl H CO IUIOJIO I"'HJI, K p OMe Toro O'PM84:aJ10Cb O T CYTCTBHe COO TB8TCTBYIOmeH IIOA- roTOBK H B o6JiaCTH yc T a HOBJieHHJI KO HTaKT OB M8~AY M8A HilHH CKHM nepcoHaJIOM H T8MR, KTO o6pamaeTCR 3a KOHCYA bT a QHRMH H TIOMOmbro. TeM He MeHee 6 blJIH CAeJiaHbl coo6meHHR O PRAe 3KCnepHMeHTOB B o6JiaCTH MHOrOAHCUHilJIHH8pHO H nOArO- TOBKH Ha nOCTAHilJIOMHOM YP OB He, B XOAe KOTOpOH y q a mnecJt noJiy qaroT npeKpaCHble H8Bb1Kll 6 pHr 8AHOH pa60Tbl H qe TKOe npeACT8 BJieHHe O pOJIH KaJKAOro 4JieHa 6 pHr8Abl 3ApaaooxpaHeHHR! OTBeTCTBeHHOCTb 38 npHeM, HH- $QpM8UHro, KJIIDIHqecKHH OC MOTP , npeAilHC8HHJt, DOCJieAyromee Ha6JiroAe HHe 38 D8UHeHT8MH HT - A · YqacTHHKH KoH¢epeHUHH npH 3 H8JIH BaJKHblM B ,uo6oij A8HHOH o 6mHHe IlOl11>IT8TbCJt npHBeCTH B COO TBe TCT• BHe o mymaromne cJt noTpe6HO CTH' 0 KO T OPblX OblJIO 3aJtBJieH O OOIUHHOH ' H npennaraeMble CJIYJKObl. _ 110 _ C.11e.JJ,OB8TeJ1hHO' He06XO,llIHIO o6ecne•mTh TSKOe DOJIOJCeHHe' npn KOTOpOM Me.JJ,HllHHCKHH nepCOHaJJ no.11y- qa.11 6hl He TOJlbKO KJIHHH'leCKy10 DO.JJ,rOTOBKy' HO H MOr 6hl opneHTHpOB8TbCJl B ycJJOBH.fIX OKpyJCa10meil o6cTa- HOBKH BO BpeMJl pa60Thl, BCTpe'IBTbCJl C BJIHJlTeJJhHhll,lH JllO.ll,b>IB .ll,8HHOH o6mBHhl H 'ITO Han60.11ee BaJCHO, npnc - .llYlllliB8TbCJl K MHeHmo JCeHlilliH, OT DOMODIH KOTOphlX 38BHCHT npaBHJlbHOe pery.11HpOB8HHe HHTepBaJIOB MeJC.JJ,Y 6e- peMeHHOCTJll.m. YqacTHHKH KoHc)>epeH!lHH Bh!CK838JIH Ml!eHne OTHOCHTeJlbHO Toro' QT06hl nporpal,ll,lhl DO.JJ,rOTOBKH pa3pa6a- ThJB8JIHCb B TeCHOM COTPYAHH'leCTBe C 'lJJeHaMB 6pnra.JJ, nepBH'lHOM Me.ll,HKO - CaHHTapHOH DOMODIH , a TaKJCe QT 0 - 6h! OCHOBHOe BHHMSHHe B 3TKX nporpa>0<ax 6w.110 y.JJ,e.11eHo DOTpe6HOCTJlM Hace.11eHBJl, Y'l8CTHHKH KoHc)>epeHllBH CO'IJIH BaJCHhl>I DO.JJ,'lepKHYTb He06XO.ll,lillOCTb npoBe.JJ,eHHJl oneHKH BMeCTe C pa- 60THIIB8MH OCHOB HhlX c.11yJC6 3.JJ,paBooxpaHeHHJl D03T8llHO C HCDOJlb30B8HHeM DO.ll,XO.ll,Jl!IIBX .ll,J!Jl 3TOro BHCTpy»eH- TOB n npone.JJ,yp. Ilpn COCTaBJJeHBH npe.ll,JIOJCeHnH, K8C8lODIBX CJl DO.ll,rOTOBKH B 06.11aCTH DJl8HHpOB8HHJl ceMhH .ll,J!Jl p83JIH'l- HhlX KaTeropHH n epcOHaJJa 3.JJ,paBooxpaHeHHJl, B03HHK8eT PM TP YAHO CTeH, OT.JJ,eJJbHhle H3 KOTOphlX CBJl38Hhl C DOJIHTH'leCKIDrn npo6.11eMa>rn H BX BJIHJlHHeM Ha .JJ,eJJTeJlbHOCTb H pa3BHTHe c.11yJC6 B CTpaHe; C npo6.11eMaMH KYJlhTyphl' pe.11nrnn' JKH3HeHHhlX neHHOCTeH' KOTOpbie onpe.JJ,eJJJllOT .ll,J!Jl ce6Jl B3pOCJlbie H p0..!1,HTeJIH; C HH.ll,H- BH.JJ,ya.11bHhn.m npo6.11eMaMB pa60THHKOB 3.ll,p8BOOXpaHeHHJl' KOTOphle He npHBhlKJlll o6cyJK.ll,8Tb npo6.11eMhl ceKcya.11b- HOCTH, YAOBOJlbCTBHli, JCeJJaHHJl 1rneTb .JJ,eTeH H T,.ll,, l1.>1elOT MeCTO TaKJCe H npo6.11eMhI yqe6Horo xapaKTepa, B03HHK8l0ll!Be B CBJl3H C 60.llblllHM 'IHCJIOM CTy.JJ,eHTOB, OTCYTCTBHeM MaTepHanbHOH 6a3bl H HeAOCT8TKOM BpeMeHH ns-sa JKeCTCKHX paMOK TP8AHUHOHH011 nporpaMMbl. llT06hI npeO.JJ,OJleTb Bee 3TH Tpy,llHOCTH' Heo6xO.ll,HMO npeJC,4e Bcero pemaTb COllH8JlbHhle H 3KOHOMH'leC- KHe npo6.11eMhl, Bh!TeKa10mne H3 yc.110BHH npOJCHBSHHJl HaceJJeHHJl; co6np8Tb HH<l>op>1anmo, OC HOBSHH YJO Ha 06- mecTBeHHOM MHeHHH; o6y'l8Tb npeDO.ll,8B8TeJJeH onpe,4e.11JlTb DOTpe6HOCTH 06D1HHhl H opr8HH30BhlB8Tb o6yqeHHe T8Klill o6pa30M, 'IT06hl CTy,lleHThl caMB MOr.llH B HeM y qacTBO B8Th; a TBKJC e o6y'l8Tb CTy,lleHTOB pa3BHTIDO He TOJlbKO 3H8HHH H H8Bh!KOB, HOH Bhlpa60TKe COOTBeTCTBy10mero OTHOmeHHJl K npo6.11eM8M, KOTOpoe 6y,4eT co- ,4eHCTBOB8Tb HX pemeHHlO, PeKOMeH,ll81lHH 06mne coo6 pa>CeHHH 1. Ilpn DO.JJ,rOTOBKe nepCOHS.118 3,llpaBOoxpaHeHHJl He06XO.ll,HMO y qHThlB8Tb HHJCe c.11eJCy,omee: DOJIHTHKy, npo- BO.ll,HMYJO H8DHOH8JlbHhlM npaBnTeJJhCTBOM B OTHOmeHHH DJl8HHpOB8HHJl ceMbH , D0Tpe6HOCTH , 0 KOTOphlX 6hlJIO 38- JlBJleHO o6mHHOil, pO.llb H 38,llaqn nepcoea.11a, DpH3B8HHOro YAOBJleTBOpJlTb 3TH D0Tpe6HOCTH, a TaKJCe yc.110BHJl , B KOTOphlX ,ll8HHhlH nepcoea.11 ,llOJIJCeH pa6oT8Tb. i. 06yqeene nepcoaa.11a 3,llp8BOOxpaeeHHJl ,llOJIJCHO YBJl3hlB8TbCJl C D0Tpe6HOCTHMH 06!11BHhl H ,llOJIJCHO 6h1Tb l'H6KHM, MOTHBHPOBaHHe 3. 06'beKTOM MOTHBHPOB8HHJl AOJlJKHbl CT8Tb o6meCTBeHHOCTb' BJlHJlTeJlbHble rpynnbl HaceneHHJl' JlHl.la' OT- BeTCTBeHHbJe sa DpHHJlTHe pemeHHil, H yqpelK,tleHHJl , ocymecTBJlJlJODUie DOArOTOBKY, QT06bl COAeHCTBOB8Tb Ha H81.1HOH8JlbHOM H MeCTHOM ypOBHJlX nyqweMY DOHHM8HHJO DOTpe6HOCTeH 060UiHbl B o6naCTH oxpaHhl 3AOPOBbJl c eMbH H npeHMY!lleCTB DJ18HHPOB8HHJl ceMbH, a T8KJKe npaBHJlbHOH OpHeHTHPOBKe nporpaMM DOArOTOBKH nepco- Hana 3AP8BOOxpa HeHHJl. 3Toro MOJKHO AOCTHrHyTb, HCDOJlb3YJl cpeACTBa M8CCOBOH HH~OPM81.1HH, cne1.1H8JlbHO c npor paMMHP OB8HHbie 8YAHOBH3Y8JlbHbJe MaTepHanbJ, a T8KJKe nyTeM opraHH381.1HH ceMHHapOB H pa60'IHX COBe- maHHH AJll! BbJIIJe0603Ha'leHHblX rpynn H T ,A, KpoMe Toro, npeDOAaBaTeJlJlM CJleAyeT ycTaHOBHTb DPJlMOH KOH- TaKT C JlH1.18MH, OTBeTCTBeHHblMH 38 DPHHJlTH e pemeHHH, <!T06bJ CBOeBpeMeHHO HX C~OPMHPOB8Tb H Ha'laTb C HHMH AHanor. 4 • .lLn.Jl npeno,4aBaTe.11en c.11e,4yeT opraHH30B8Tb MellU!HCllHDJIHHapHhle HenpepbIBHMe nporpaMMh! IIO,llrOTOBKH (BKJllO'l8Jl Kypc>t ycoBepme HCTBOB8HHH), 'IT06hl nepHO,llH'leCKH o6 HOBJIJlTb HX 3H8HHJl H CO.JJ,ettCTBOB8Tb DOHHMa- HIDO H ocymeCTBJleHmo 6pHra,4Hoil pa60Thl. 111 s. flogrOTOBKa npenogasaTeneti gom,rna OCYllleCTBil l!T bCII Ha npeeMCTBeHHblX YP OBHIIX WIii '-!ero HaAO o6ec ne'-IHTb COOTBeTCTBYIDWYID MaTepHanbHY~ 6a3y KaK Ha perHOHanbHOM , TaK H Ha MeCTHOM ypOBHIIX . 6. B xoge nogrOTOBKH npenogaBaTenH AOilll<Hbl Ha npaKTHKe [103HaKOMHTbCII C l!CH3Hb~ OOIUHHbl H ee noT- p eO HOCTIIMH paooTal! OOK O GoK C '-!IleHaMH 3TOH MeCTHOH OOll!HHbl, flpenogasaTen11M cnegyeT npH06peCTH HaBblKH pa60Tbl C '-lneHaMH OOIUHHbl H ee PYKOB OAHTenRMH. 7. flpenogasaTenH gonll<Hbt nony'-laTb nogroTOBKY no MeTogonorHH ooy'-!eHHH c o pHeHTa uHeti Ha o npegen e - HKe rrpo6neMbt" ee peweHHe, CnegyeT TaKJl<e ygenHTb oco5oe BHHMaHHe sonpocaM npenogasaHHH / H3y'-leHHII MeTOAHKH, gawweH B03MOJl<HOCTb CTygeHTaM npH0 6pecTH npaKTH'-leCKHe HaBblKH pa3BHTb HHTYHUHID, H oco3- HaTb He06XOAHMOCTb YBal!<aTb npasa '-!enosexa. )J.rrn .tOCTHJl<eHHII 3TOro HYJKHbl COOTBeTCTBYIDtUHe y '-leTHbte pecypcbt. 8. )l.n11 ycTaHosneHHII ny'-IIUHX KOHTaK TOB C nogpOCTKaMH npenogaBaTenH AOilll<Hbl yMeTb pa315HpaTbCH B n po6neMax H oTgenbHbtX acnexTax npo6neM n ogpocTxos H HX cexcyanbHOCTH . OpraHH3aUHH n ogr oTOBKH 9. MaTepHan y '-leoHblX nporpaMM, nocs11weHHblX nnaHHpOBaHHID ceMbH, gOnl!<eH nog6HpaTbCH TaKHM o5pa- 30M, '-IT OObl CTYAeHTbl Hay'-!HnHCb o npegenl!Tb npo6neMbt 061UH Hbl H pewaTb HX C y'-le TOM CO UHanbHO-xynbTyp- HblX H 3KOHOMH'-!eCKHX acneKTOB nnaHHPOBaHHH ceMbH, )l.n11 3TOH uenH cnegyeT ocol5o nog'-!epKHYTb 3Ha'-!e- HHe ycTaHOBneHHII KOHTaKT OB C HaceneHHeM, a TaKJl<e npos egeHHe nogroTOBKH WIii OCYllleCTBneHHII nporpaMM H HX o ueHKH. 10. flogrOTOBKa s o6nacTH nnaHHPOBaHHII ceMbH AOnl!<Ha OblTb HHTerpHpOBaHa s HeCKOnbKO AHCUHilnHH , HO sceo6wa11 KOOPAHHaUHH nogroTOBKH AOnll<Ha o cywecTBill!TbCH OAHOH o npegeneHHOH nporpaMMOH, '-!TO o6ecne'-IHT nonHbtH oxsaT 3TOr o sonpoca. 11 . B xoge nogroTOBKH HeOl5XOAHMO npeAyCMOTp e Tb COOTBeTCTBywwee speMII H MaTepHanbHY~ 15a 3y WIii Toro , '-ITOObl Ha npaKTHKe no3HaKOMHTb CTygeHTOB C OOIUH HO H , g aTb HM B03MOJl<HOCTb o npegenHTb ee noTpel5- HOC TH H npHHl!Tb y'-l aCTHe B npaKTH'-leCKHX Mepon pHHTHHX no oxa3aHHID MeAHKO - caHHTapHOH [IOMOWH , 12. flogroTOBKa AOill!<Ha o ueHHBaTbCII He TOilbKO C TO'-IKH 3peHHII 3HaHHH , nony'-!eHHblX CTygeHTaMH, HO, npe)l<Ae scero , HX cnocooHOCTeH BbtnonHHTb 3aga'-1H, OTHOCHWHeCII K o 6naCTH nnaHHPOBaHHII ceMbH, 13. flpH OCYllleCTBneHHH nogrOTOBKH nepcoHana 3gpasooxpaHeHHH , ol5ecne'-IHBawweti osnageHHe HaBbtKaMH, cnegyeT HaH6onee 3c!>¢eKTHBHO, 3KOHOMHO Hcnonb30BaTb MeCTHbte pecypCbl. MeJ1<Ay HapOAHOe CO TP YAHH'-leCTB O 14. CnegyeT CTHMynHpOBaTb ycTaHOBneHHe KO HTaKTOB Me)l<Ay CTpaHaMH, BCll '-l eCKH cogetiCTBOBaTb pa3BH- TOH KOO PAHHaUHH 3THX KO HTaKT OB , TeM caMblM ol5ec n e '-IHBal! OOMeH o nbtT OM H, no B03MOJl<HOCTH , COTPYAHH'-!e - CTBO B pa3pa60TKe nporpaMM H B a npo6aUHH y'-le6HblX MeTOAOB H MaTepHanOB . - 113 - !UIAHHPOBAHl1E 3)]PABOOXPAHEHID! 11 OUEHKA Ero PA60Tb1 PaOoqaR rpynna no nnaHHposaHHJO 3ApasooxpaHeHHR H ynpasneHHJO HM i\4)lU!hl, 26-28 OKTR0pR 1981 roAa Bse,aeitHe - 115 - ICP/SPM 028!S) 17 AeKa0pR 1981 roAa OPHrHHAJl: AHr.ffilflcI<Hn Ue.nb A8HHOA PaOoqeA rpynm.1, B COCTaB KOTOpoA BOm.lIH BPeMeHHble KOHCynbTaHTbl H3 10 rocyAapCTB - tUteHos EsponeAcKoro perHoaa, a TaKie npeACTaBHTenu KaH� H ClllA, cocToRna s TOM, qToObI oOtyAHTb aoapocbl Hcnonb3osaHHR npouecca ynpasneHHJI pa3BHTHeM HaUHOHaJlbHoro 3ApasooxpaHeHHJt (IIYPH3) c yqeTOM �eneA peaJlH3aUHH CTpaTerHH no AOCTHieHHIO 3AOPOBbR MR scex K 2000 rOAY, B03MOIHble pesynbTaTbl npH­ MeHeHHR IlYPH3 AnR rocyAaPCTB - qneHOB EsponeAcKoro perHoHa, a TaKie a.i:teKBaTHOCTb PYKOBOARIIIHX npHH­ UHllOB OCYlJleCTBneHHR IlYPH3, onyOnHKOBaHHblX B03 s 1980 rOAY (AOK}'MeHT PDWC/REP/3). 3TH npHHUHnbl nosaonRroT paspaOoTaTb TaKoA noAXOA K opraHH38UHH ynpaaneHHR 3ApaaooxpaHeHHeM, KOTOpbl8 BKrooqaJl ObI uenbli!: KOMnneKc COUHaJlbHl>DC, nonHTHqeCKHX, 3KOHOMHqecKHX H MeAHKo-caHHTapHblX Mep H COAeAcTBOBaJl Obi nOCTeneHHOMY cosepmeHCTBOBaHHID CYlJleCTB�meA npaKTHKH nnaHHpoaaHHR H ynpasneHHR, 6blnO npH3HaHo, OABaKO, qTo MOieT B03HHKHYTb HeoOxoAHMOCTb B aAanTaUHH 3THX npHHU}iDOB K noTpeOHOCTRM espone8CKHX CTpau. YqaCTHHKH rpynn&l npumnH K 3aK.ruoqeuHIO, qTQ OCHOBHblMH npoOneMaMH, pemeHHe KOTOPbIX TPeOyeT paspaOOTKH TaKHX npHHUHnoa, RBnRIDTCR cneAYIOllllle: yqaCTHe noTpeOHTeneA; MeICeKTOPaJlbl!ble CBR3H B oo­ naCTH nnaHHPOBaHHR 3ApasooxpaHeHHJt; pacnpeAe.neHHe OTBeTCTBeHHOCTH Ha HBUHOHaJlbHOM/cyOHaUHOHaJlbHOM/ MeCTHOM ypOBHRX; npaBHObHOe COOTHOmeHHe Me�y ueHTPaJlH3aUHeH H AeueHTPaJ!H3QUHe8; C03HaTenbHOe OT­ HomeHHe noTpeOHTe.neA noMOmH H paOoTHHKOB 3ApaaooxpaHeHHR K aonpocaM CTOHMOCTH noMomH; C03AaHHe He- 00XOAHM08 CTPYKTYPbl H onpeAeneHHe q,yHK!Udt CHCTeM nnaHHPOBaHHJI 3ApaaooxpaHeHHR H ynpaaneHHR HM H T,A, paCCMOTpeTb B03MOil!ble pesyn&TaTbl npHMeHeHHJI IlYPH3 C yqeTOM CTpaTerHH PerHOHaJlbHOro Oropo; npoaHaJlH3HPOBaTb npoOne= pa3BHTHR npouecCOB nnaHHpOBaHHR 3ApaaooxpaHeHHJI H ynpa,aneHHR; onpeAeJIHTb MeTOAOnoruqecKHe noAXO,[l,bl, cooTBeTCTBYKllltHe ycnoBHRM B rocyAapcTsax - qneHax Espone8- CKoro perHoHa, H oqepeAHOCTb npoBeAeHHJI HayqHblX HCCneAOBaHH8 Ha HaUHOHaJlbHOM yposae; onpeAenHTb OCHOBl!ble sonpocbl Hcnonb30B aHHJI IlYPH3, KOTOpble cneAYeT pacCMOTpeTb B XOAe TeMaTH­ qecKHX AHCKYCCHH Ha TPHAUaTb BTopoA ceCCHH EaponeKCKoro perHOHaJlbHOro Oropo (KoneHrareH, 1982); AaTb peKOMeHAaUHH no KrooqeBblM sonpocaM, KOTOPble AOnIHbl Ob!Tb pacCMOTpel!bJ B XOAe pat50Tbl KOHq,e­ peHUHH no OYPH3, 3annaHHpoaaHHOH Ha 1984 roA MR oueHKH pe3yn&TaT0B paOoT&l,AOCTHruyT&IX nocne Espone8CKOH KOHq,epeHUHH no nnaHHpoBaHHIO HaUHOHaJlbHOro 3ApasooxpaHeHHR (6yxapecT, 1974). JlHcxyccHR Ilpe�e scero yqaCTHHKH fpynm.1 paCCMOTpenH 3aAaqH, BbITeKaJOIIIHe H3 PerHOHaJlbHOK CTpaTerHH no AOCTHieHHIO 3AOPOBbR AJUI scex K 2000 rOAY, KOTOpaR t5&11Ia pa3pat5oTaHa s 1980 rOAY (AOK}'MeHT EUR/RC30/8). UeJU, CTpaTerHH COCTOHT B TOM, qToObI COAe8CTBOBaTb pa3BHTHIO o0pa3a IH3HH, OnaronpHRTHOro MR 3AO­ P09bR, B KaqecTse nepaooqepeAHhlX oHa onpeAeJUleT TaKHe 38,llaqu, KaK }'MeH&meaHe qucna npeAOTBpaTH- MblX Oone3He8 H oOecneqeHHe BCeM AOCTynHoA a.i:teKBaTHOH MeAHKo-caHHTapH08 nOMOlllH C aKueHTOM Ha nepsuq­ H}'IO MeAHKO-CaHHTapH� noMomb, 0TpHuaTeJlbHblMH acneKTaMH MeAHKo-caHHTapH08 noMOlllH, OOlllHMH AnR es­ pone8cKHX CTpaH, RBnRIDTCR cneAYIDlllJfe: HepaBHOMepHOCTb s OXBaTe CJIYI0aMH, cnHmKOM (5onbmOH aKUeHT Ha AOporocToRmyro TexHonorH10, HecooTBeTcTa�maR nepaHqHaR MeAHKo-caHHTapHaR noMom&, cnaOoe npHBneqeHHe HaceneHHR K yqacTHIO B MCil H HeAOCTaTKH B nnaHHPOBaHHH, B XOAe AHCKYCCHH Ob!no npeMoieHo paCCMOT­ peT&: AOK}'MeHT IlYPH3 C TQqKH 3peHHR era npHMeHHMOCTH K CHTYauHH B KaJll'J:IOH OTAen&H08 CTpaHe; HeoOxOAKMOCTb npoaepKH PYKOBOARmHX DPHHUHDOB npHMeHHTen&HO K pa3nuqHblM CTpaHaM, pa3nHqHbJM oOnaCTRM npoOne= H Ha pa3nHqHbJX a,[tMHHHCTpaTHBHblX YPOBHRX; HeoOxOAHMOCTb onpeAeneHHR perHOHaJlbl!blX H HaUHOHaJlbl!blX 38,[taq B peaJlH38UHH CTpaTerHH no AOCTHieHHIO 3AOPOBbR MR Bcex H noKa3aTene8 MR oueHKH nporpecca B pemeHHH 3THX 38,llaq C ucnon&- 30BaHHeM npHHUHnos H MeTOAonorHH IlYPH3; HeOOXOAKMOCTb onpeAeneHHR KOMneTeHUHH H MexaHH3MOB ynpasneHHJI MR pa3BHTHJI COOTBeTCTB�lllHX KaAPOB; 3HaqeHHe nonHTHqecKHX o0R3aTen&CTB, oOecneqHBakl!JIHX OCYlJleCTBneHHe OYPH3, BKnroqaR �HoroceKTO­ PaJlbH� KOOPAHHaUHIO; - 116 - no3HUHJO paOOTHHKOB 3ApaaooxpaHeHHR H oco6eHHO BpaqeH, BnHRJOmy,o Ha npHHRTHe perHOHMbHOH CTpa- TerHH; nocTORHHO B03pacTaJOD1He ~HHaHCOBWe TPYAHOCTH B oOnaCTH MeAHKo-caHHTapHOH noMomH. nocneAoBaamaR 3aTeM AHCKyccHR 6b111a cocpeAOTo4eHa Ha Tpex rpynnax aonpocoa. 1. YqaCTHe noTpe6HTenR B nnaHHPOBaHHH MeAHKo - caHHTapHOH noMODIH xapaKTepH3yeTCR B rocyAapcT- aax -qneHax 6onhmOH HepaBHOMepHOCTblO. CYTCTBHe TaKOBoro. YqHTWBaR ponb nepaHqHOH MeAHK O-CaHHTapHOH TTOMODIH B AOCTHJKeHHH 3AOPOBbR AnR acex, Heo6XOAHMO 6onee aKTHBHO npHBneKaTb K yqac THJO B MCTT lKHTeneH 6nH3ne*~HX paAOHOB, COOTBeTCTBYID- mHM o6pa30M opHeHTHPOBaTb PYKOBOARmHX pa60THHKOB, a TaK*e MaKCHMMbHO HCnOnb30BaTb ace cpeACTBa Mac- COBOH HH~OpMaUHH Ha HaUHOHMbHOM H MeCTHOM YPOBHRX . 2. Me*ceKTopanbHOe COTPYAH=ecTBO CBR3aHO C 6onbmHMH TPYAHOCTRMH, HO OHO HMeeT pema~ee 3Ha- qeHHe AnR ycnemHoro OCYllleCTBneHHR nnaHHPOBaHHR. YqHTbraaR TOT ~aKT, qTo CnY*6bJ 3ApaaooxpaHeHHR OKa3WBaJOT orpaHHqeHHOe B03AeHCTBHe Ha 3AOPOBbe H AO=HW YBR3WBaTbCR C MeponpHRTHRMH B o6nacTH npo- caemeHHR, =HIIIHOro CTPOHTenbCTBa, nepeB030K HT . A . , AnR Toro, qToOw OHH HMenH MaKCHMMbHOe B03AeA- CTBHe, HeO OXOAHMO oco6oe BHHMaHHe B oOnaCTH nnaHHPOBaHHR 3ApaaooxpaHeHHR YAenHTb ~OPMaM opraHH3aUHH, HH~OpMaUHOHHOH H APYrOH AeRTenbHOCTH. KOOPAHHHPYJODIHe yqpellt,lleHHR Ha acex YPOBHRX, HaUHOHMbHhlli ueHTP MeAHKo-caHHTapHOH HH~OpMaUHH, HaUHOHMbHaR ceTb pasBHTHR 3APaBooxpaHeHHR, a TaK*e AeHCTBeHHWH H ueneHanpaaneHHb!H IlOAXOA K a=Hb]M npo6neMaM 3APaBooxpaHeHHR paCCMaTpHBaJOTCR B KaqecTBe pemaJODIHX 3neMeHTOB MexceKTOpanbHOro COTPYAH=ecTBa . 3. IlnaHHPOBaHHe TpeOyeT npoqHOH opraHH3aUHOHHOH CTPYKTYPbl H AO=Ho OCYllleCTBnRTbCR B COOTBeT- CTBHH C nonHTHqecKHM / aAMHHHCTpaTHBHblM YCTPOHCTBOM 3aHHTepecoaaHHOH CTpaHb1; OHO AO=Ho npOBOAHTbCR npH yqaCTHH PYKOBOAHTeneH CHCTeMbl MeAHKo-caHHTapHOH noMOOIH. TTpeeMCTBeHHOCT b MOAenefi ynpaaneHHR Mellt,lly rocyAaHCTBaMH-qneHaMH noMoraeT H36exaTb HenpOAYMaHHWX BOnJOHTapHCTCKHX nOAXOAOB K CHCTeMaM nnaHHPOBaHHR . Ba*Hb!MH npeAnOCblJIKaMH AnR ~YHKUHOHHPOBaHHR CHCTeMbl RBnRJOTCR: o6R3aTenbCTBa KaK no- nHTHqeCKHX AeRTeneA, TaK H CTapmHX PYKOBOAHTeneA; TOqHaR H 3~eKTHBHaR CHCTeMa pa3MemeHHR c peACTB; HaAne*~ee KOnHqecTBO KBMH~HUHPOBaHHWX COTPYAHHKOB B oOnaCTH nnaHHPOBaHHR . Bonee Toro, CHCTeMa AO=Ha 6WTb HHTerpHpOBaHa KaK c TOqKH 3peHHR nOnHTHqecKoA, TaK H ~HHaHCOBOH H aJlMHHHCTpaTHB- HOH; OHa AO=Ha COAeHCTBOBaTb yqacTHJO noTpeOHTeneH, paOOTHHKOB 3ApaaooxpaHeHHR B OKasaHHH Men H Me xceKTOPMbHOMY COTPYAHHqeCTBy; 3Ta CHCTeMa AO=Ha ObJTb nporpeccHBHOH KaK C TOqKH 3peHHR ee ~YHK- UHOHHPOBaHHR , TaK Hee B03MO*HOCTeH TOqHo H rH6KO pearHpOBaTb Ha B03HHKaK111He noTpe6HOCT H. PyKOBOARDIHe IlPHHUHnhl AnR ITYPH3, HeCMOTPR Ha HX COAep*aTenbHOCTb H pauHoHanbHOCTh, no BCeH ae- PORTHOCTH, 6onbme nOAXOART AnR rocyAapcTa-qneHOB C ueHTpanHSOBaHHOH CHCTeMOH H pa3BHBa10meHCR 3Ko- HOMHKOH . ITpHHUHnhl AO=Hbl nepHOAHqecKH BbJBepRTbCR, qT06bl OHH MornH OTp=aTb HOBWe B3rnR,[lbl B oOnac- TH nnaHHPOBaHHR . 3TH npHHUHnhl cneAyeT Aanee pacnpocTpaHHTb Ha KOHKpeTHbJe CTpaHW HnH rpynnbl CTpaH, HMeJOD1He aHanorHqHble nonHTHqecKHe / aJlMHHHCTpaTHBHble CHCTeMbJ. B XOAe OCYllleCTBneHHR 3THX npHHUHnOB noTpe6yeTCR npeoAoneTb TPYAHOCTH, B03HHKaJODIHe B npouecce nepeXOAa OT nnaHHPOBaHHR CnY*6 3Apaaooxpa- HeHHR, KaK TaKOBWX, K nnaHHPOBaHHJO 3ApaaooxpaHeHHR B uenoM. K~eecR HeCOOTBeTCTBHe Mellt,lly ueHT- panH3MOM H AeueHTpanHsauHeH MO*HO H36exaTb nyTeM 6onee qeTKOro H3no~eHHR Tpe6oaaHHH B ~OPMYnHPOBKe npHHUHTTOB. KpoMe Toro, cneAyeT o6paTHTb BHHMaHHe nHU, npHMeHR,omHX 3TH npHHUHnhl, Ha Heo6XOAHMOCTb n pHcnoca6nHBaTb HX K CHTyauHH, B03HHKa10mefl B CBR3H C orpaHttqeHHb!MH pecypcaMH H MeHRJOmeHCR H,D;eonorH- eA. H, HaKOHeu, cneAyeT oco6o BblAenHTb UHKnHqHb!H xapaKTep nporpaMMHPOBaHHR H Heo6XOAHMOCTb opHeH- TaUHH Ha 6YAYII1ee . PeKoMe HAallHH EaponeHCKOMY perHoHanbHOMY 5,opo B03 peKoMeHAOBatto: CTHMYnHpoBaTb npHMeHeHHe ITYPH3 K KOHKpeTHb!M npo6neMaM B PRAe CTpaH Ha pasn== aJlMHHHCTpaTHB- HblX YPOBHRX H COAeHCTBOBaTb C03AaHHJO HaUHOHMbHblX PYKOBOARmHX npHHUHnoa; BblCTynaTb B KaqecTBe cnpaaoqHo-HH~OpMaUHOHHOro ueHTpa AnR HccneAOBaHHH, pacKpWBaJOmttX, KaKHM o6pa30M B HaCTORmee BpeMR CTpaHbl pemaJOT npo6neMY nnaHHPOBaHHR H KaKHe HaUHOHMbHble TTOAXO,[lbl HC- nonb3YJOTCR eaponefiCKHMH cTpaHaMH npH pemeHHH a=HbJX y npaane=ecKHX npo6neM, TaKHX, KaK npHBne- qeHHe o6mecTBeHHOCTH, yqaCTHe pa60THHKOB 3ApaaooxpaHeHHR , MexceKTOPMhHOe COTPYAHttqeCTBO, co- UHMbHWH aHanH3, nnaHHPOBaHHe KaApoa, MOAenHpOBaHHe H npHMeHeHHe cuettapHeB; npononxaTb C nOMOmhJO ceTH COTPYAHHqaJODIHX ueHTPOB HCCnenoBaHHR, HanpaaneHHbJe Ha pemeHHe Kn,oqe- BblX npoOneM OCYllleCTBneHHR ITYPH3, TaKHX KaK o5ecneqeHHe MeXaHH3MOB, CTHMYnHpyJOOIHX MHOroceKTO- panbHOe COTPYAHHqecTBO B xone nnaHHPOBaHHR 3ApaaooxpaHeHHR, npeAOTBpameHHe KOH~HKTOB, COBep- meHCTBOBaHHe OHXeBHOpMbHblX acneKTOB nnaHHPOBaHHR H npHBeAeHHe B COOTBeTCTBHe CHCTeM - 117 - nnaHHPOBaHHH H OIDAJl(eTHPOBaHHH, ocywecTBneHHe KOOPAHHHPOBaHHOH nonrocpoqHoH nonHTHKH 8 oonaCTH 3,!\paBooxpaHeHHH BO BCex CTpaHaX C pb!HOqHOH 3KOHOMHKOH H T.,!I.; coaeHCTBOBaTb ITYPH3 nyTeM npoBe,!\eHHH COBewaHHH H HHb!X MeponpHHTHH, BKnIDqaH TeXHHqecKHe H apy- rHe KOHcynbTaUHH, ocymeCTBneHHe nporpaMM H OKa3aHHe nOMOIIJ.ll rocyaapCTBaM- qneHaM B pa3pa60TKe HaUHOHanbHOH CTpaTerHH no AOCTHJKeHHlO 3AOPOBbH anR Bcex . B uenoM MO~Ho cqHTaTb cymecTBYIDIIJ.lle PYKOBOAHIIJ.lle npHHI.1Hnb1 ITYPH3 snonHe noAXOAHWHMH anR rocy- IT03TOMY, BMeCTO Toro , qTOObl npeanaraTb OT,!\enbHhlM CTpaHaM pa3pa60TaTb HOBb!H KOM- nnexc npHHUHnOB, npHcnocoOneHHb!X K HX KOHKpeTHb!M noTpe6HOCTHM , rocy,!lapCTBaM- qneHaM peKOMeH,!lyeTCH: C<POPMYnHp OBaTb HaUHO HanbHble CTpaTerHH no ,!\OCTHJKeHHJO 3AOPOBbH ,!lnH scex , OCHOBaHHb!e Ha KOH11en- I.1HHX . ITYPH3 ; npo,!\OJDKaTb noneBble HCTTblTaHHH B pa3n=Hb!X oOnaCTHX npooneMbl H Ha pa3nHqHb!X a,!\MHHHCTpaTHBHb!X YPOBHHX onpe,!leneHHblX acneKTOB npHMeHeHHH ITYPH3 WJH no,!\Aep~KH CTpaTerHH no AOCTHJKeHHJO 3AOPOBbH WlR scex H, ecnH Heoe5XOAHMO, no,!\rOTOBHTb Oonee KOHKpeTHb!e AOKYMeHThl no 3TOMY sonpocy; onpe,!lenHTb nepBooqepeaHb1e oonaCTH AnH ocymecTBneHHH AeHCTBHH B oOnacTH ynpaBneHHH 3APaBooxpa- HeHHeM C uenbID pa3BHTHH ITYPH3 (no B03MO~HOCTH C Hcnonb30BaHHeM npHKna,!\Hb!X HayqHb!X Hccne,!loBa- HHH, MO,!lenHpOBaHHH H cueHapHeB WJH AOCTHJKeHHH 3,!\0POBbH anR Bcex B Kaqec TBe BCnOMOraTenbHb!X HHCTPYMeHTo s ) ; COAeHCTBOBaTb BKnIDqeHHID ITYPH3 , B KaqecTBe OTAenbHoro npeAMeTa, B nporpaMMbI ooyqeHHH H no,!lro - TOBKH; y KpennHTb CBH3H Me~y CHCTeMOH Me,!\HKo - caHHTapHOH nOMOIIJ.ll H POACTBeHHb!MH CHCTeMaMH. PeKOMeH,!lyeTCH npeacTaBHTb BblWenepeqHcneHHb!e TeMbl Ha paCCMOTpeHHe TPHAUaTb BTOPOH cecCHH EBpo- neHC KOro perHOHanbHOro OIDPO B 1982 rOAY H EBponeHCKOH KOHq,epeHUHH no nnaHHPOBaHHID 3,!\paBooxpaHeHHH H ynpaBneHHID HM s 1984 roay HaPHAY co cneAYIDIIJ.llMH sonpocaMH: HCCne,!\OBaHHH , pa3pa60TKa H no,!lrOTOBKa B o6naCTH npHMeHeHHH ITYPH3; HOBble MeTOAOnOrHH, npHMeHHMble K ITYPH3; pe3ynbTaTbI cpaBHHTenbHbIX HccneAoBaHHH no Hcnonb30BaHHID ITYPH3; y xpenneHHe HaUHOHanbHblX ueHTPOB pa3BHTHH 3,!lpaBooxpaHeHHH H perHOHanbHb!X ueHTPOB pa3BHTHH 3APaBooxpaHeHHH ; p aCCMOTpeHHe PYKOBOAHIIJ.llX yKa3aHHH no ITYPH 3 WlR KOHKpeTHb!X CTpa H. - 119 - nPO$ECCHOHAJlbHAR rnrnEHA - 121 - KOHCYJlbT8THBHOe co eemaHHe no DOArOTOBKe nepc0Ha.11a B o6JiaCTH npog>ec CHOH8JibHOH rnrHeHbl lCP/IYKH OlO(S) 17 HoR6pR 1981 roaa BeArpaA, 24-26 HffiHR !981 roAa 0Pl1DIHAJI: AHr Jll1HC!Olli KOHCyAbTaTHBHOe coaemaHHe 6WAO CO3BaHO EaponeHCKHll perHOHaAbHblM 6ropo 803 B COTPYAHH'-leCTBe C apaBHTeAbCTBOM IOrOCAaBHH. Ha c oaemaHHH npHCyT CTBOBaAH BpeMeHHWe COBeTHHKH H3 II CT paH EaponeH- CKoro perHOHa, apeACTaBHTeAb KOMHCCHH EaponeHCKHX coo6mecTB H ABS Ha6AIDA8 T0JIJI H3 JOrocAaBHH . paCCMOTpe HHe COBpeMe HHOH IlOArOTOBKH aepCOHaAa B o6AaCTH ap0$0CCHOHaAbHOH rHrHe HW B rocyAapCTBax- t{Jle Hax ; BWRBA0HHe Il0Tpe6HOCT0H B IlOArOTOBKe aepCOHaAa B o6AaCTH apo$eCCHOHaAbHOH rHrHeHw; OilP0A0AeHH0 KOHKpeTHWX o6AaCTeH, no KOTOpblK AOJIJlHa apOBOAHTbCR IlOArOTOBKa aepCOHaAa B o6AaCTH apo$eCCHOHaAbHOH rHrHeHw ; paCCMOTpeHHe IIOJIHTHKH rIO,.llrOTOBKH B ceeTe HOBbIX TeXHOJIOrHH H HOBhlX TeH,D;eHUHii B 06.JiaCTH npo<J>ec- CHOH8JlbHO~ rHrHeHhl . ,llHCKyCCHR B XOAe AHCKyCCHH 6 blAH paCCMOTpeHW MeponpHRTHJI' apOBOAHMble B rocyA8PCTBaX - '-1AeH8X B COOTBeTCTBHH C apeAAHilAOMHOH H IlOCTAHilAOMHOH IlOArOTOBKOH aepcoHaAa B o6AaCTH apo$eCCHOH8AbHOH rHrHeHbl. Y'-ISCT- HHKH coaemaHH.R KOHCT8THp088JIH ~aKT, 4TO npo~eCCHOH8JibH8.R rHrHeHa RBJI.ReTCH MeX,.llHCUHOJIHHBPHhIM npe,.llMe- TOM H 4TO n e pcoHaJI, 38HHThlii B 3TOH o6JISCTH AO.U:eH rroJiy48Tb HeKOTOpyro llOArOTOBKY no eceM CBH38HHhlM C H0H o6AaCTRM. Oc o6oe BHHMaHHe 6WAO yAeAeHO 6pHraAHOMY MeTOAY pa60Tbl B o6AaC TH npo$eCCHOHaAbHO H rHrHeHbl H IlOArOTOBKe '-IAeHOB 6pHraAbl B COO TBeTCTBHH C H3MeHeHHHMH B pa6o'-leM apouecce H B OKpyxaromeH cpeAe Ha npOH3BOACTBe, a TaKJKe C HOBblMH 3 HaHHJIMH, noAy'-leH HblllH B pe3yAbTaTe AOCTHXeHHH $YHAaMeHT8Ab- HOi'i 6 HOJIOrHH H TeXHHKH. 8 nporpaMMax IlOArOTOBKH CAeAyeT Y'-IHTblBaTb yMeHbmeHHe pOAH TpaAHI1HOHHblX OCTpblX $H3H'-leCKHX , xm.m- 4eCKHX H 6HOJIOPHt.teCKHX CTpeccoa H 60Jibme BHJ1M8HH.R y,.lleJIJ1 Tb AOJi rocpo 1.1HblM H KOM6HHHPOB8HHblM 803,lleH- CTBIJJIM apeAHblX $aKTOpOB OKpy;,caromer. c peAhl Ha npOH3BOA CT Be. YcnexH, ,llOCTHrHyThle B TeXHHKe 38 IIOCJie,llHHe ABa ,lleCJITHJieTH.H, Bhl388.JIH H3MeHeHH.H 8 M.O,lle .JU I X pa60Tbl. BHHMaHHe y'-laCTHHKOB 6 b1AO o6pameHO HB Bee BO3pacTaromyro pOAb CTpecca Ha apOH3BOACTBe, IlCHXOCO~HaAb- HblX $aKTOPOB, a TaKJ<e Ha Heo6xOAHllO CT b npHcnoca6AHB8Tb ycAOBHH pa60Tbl K '-leAoBeKy, AAH y KpenAeHHJI 3AOpOBbH pa6oTaromero HaCeAeHHH. nporpaMMw IlOArOTOBKH aepCOHa~a B o6AaCTH apo$eCCHOH8AbHOH rHrHe- Hbl AOJIJl Hbl 6hlTb COOTBeTCTByromHM o6 pa 30M apHcnoco6AeHbl K H3MeHHromHMCJI noTpe6HOCTRM CA yx6 3Apaaooxpa- HeHJ:UI, B CHAY MHOrOAHCUHilAHHapHoro xapaKTepa Hay'-IHblX HCCAeAOBaHHH B o6AaCTH npo$eCC HOHaAbHOH rHrHeHbl, ,llOCTIDf(eHH.H 6HOJIOrH4eCKOH HayKH "1 TeXHHKH 838HMOCB.H38Hb[ H 838KM038BHCIDd.bl, ti.TO B C BOIO oqepe,llb OTpa - ;,caroTCJI Ha IlOArOTOBKe COOTBeTCTBywmero aepcoHaAa . 1 . B COOTBeTCTBHH C HOBblM 3 8KOHO,ll8 TeJibCTBOM' H8UHOH8.JlbHblMH H MeJKAyHapO,.llHhlMH peKOMeHASUH.HMH B 60 .Jib- filHHCTBe e aponeH CKHX CTpaH aoapocy oxpaHbl 3AOPOBbR pa60'-IHX yAe ARe TCR 3Ha'-IHTeAbHO 6oAbme BHHM8HHJI . L - 122 - 2. TexHH'-leCKHe H3MeHeHIUI B DPOMbIDIJieHHOCTli li ,ll;pyrHx BHA,8X ,D.eJITeJibHOCTH Bbl3B8.JIH He06XO..!UlMOCTb B HOBbIX DOAXOASX. 0.l(HOBpeMeHHO, HOBhle 3H8HHR OCHOBHOH 6HOJIOrHH H B03MOJKHOCTH pacno3H8B8HH.fl, npliBO~ H- lIIHX K COCTOHHHIO npe.r16one3HH (pH3HOJ10rH<1eCKHX H 61rn.norH<1eCKHX H3MeHeHHii Bhl3B8Jlli Heo6XO,llliMOCTb B nepeCMOTpe MeTO,lIOB Ha6.nro,lleHHR 38 3,lIOpOBbeM pa60<1HX. 3. IlOCT8HOBK8 ,lIHarH03a H .ne<1eHHe npocpeCCHOH8JlbHhlX 3a6o.neBaHHii Tp8,lIHUHOHHO BXO,lIHJIH B KOMD eTeHumo Bpa qeii ' pa60T8IOIIIHX B 06.naCTH npocpeCCHOH8JlbHOii rHrHeHbl. paHHero BhlRBJleHHR npH3H8KOB 6HOJ10rH<1eCKHX li3MeHeHHii Tpe6yeTCJI BCeCTOPOHHee HCD0Jlb30B8Hlie pa3Jlli<!HhlX Ha Y<IHhlX H8BhlKOB H COTpy,lIHH<l eCTBO Me)l(,lly y<1eHbl1,!H H TeXHliK8Mli, HMeIOIIIHMH caMyro pa3HYIO DO,llrOTOBK Y . 4 . Ha6J110,11aeTCR CHHJ1Cem1e ypOBHR HeKOTOpbtx TP8,lIHIIHOHHhlX OCTpbtX cpH3H<leCKliX' XliMH<!eCKHX li 6110.norH- q ecKHX CTpeCCOB, HO npM 3TOM B03HHK810T HOBhle npo6JieM.bl l:I DOJIBJUl}()TC.fl HOBble B03MOJKHO C TH ,ll,OJirocpotJH blX KOM6HHHpOBaHHhlX B03,lleiiCTBHii. 5. H3MeHeHHe B MO,lleJIRX pa60Thl li B OTHOmeHHli K pa6 oTe Bhl3B8JIH Heo6xO,llliMOCTb y,lleJIRTb BCe 60.nbme BHHMSHlUI llClIXOCOUH8JlhHhIM acneKTaM. 6 . Dpo6.neMhl npocpeCCHOH8JlbHOii rHrHeHbl H8,l1Jle)l(HT pacCMaTpHB8Tb B CBH3H C MeCTHhlMH perHOH8JlbHhlMH H H8UHOH8JlbHhlMH npo6.neMaMH o6mero 3,llpaaooxpaHeHHR li H8UliOH8JlbHOii npocpeCCHOH8JlbHOii rHrHeHhl, a TaKJKe C 06ecne <1 eHHeM TeXHHKH 6e30U8CHOCTH li 38KOHO,ll8TeJlbCTBOM . H3 3Toro c.ne,11yeT, <!TO XOTH H eCTb B03- M0)1(H0CTH K H3JIO)l(eHHIO He06XO,llliMblX KPHTepHeB ,ll8)1(e B n pe.11e.nax EaponeiicKo r o perHOHB,K8)1(,ll8JI CTpaHa 6 y ,11eT HMeTb npH c ymH e eii oco6eHHOC7H. 7. DporpaMMbl DO,llrOTOBKli ,lIOJl)l(Hbl npe,11ycMaTpHB8Tb MeponpHRTHR' KOTOphle c.ne,11 y eT npOBO,llliTb B COOTB e T- CTBIUi C 6blCTpopacTymHMH IIOTpe6HOC T.flMH ' H, KpOMe Toro, tteo6xo,n;HMO, tJT06bt H OBaJJ CliCTeMa no,ll;rOTOBKH He upe,lICT8BJIRJ18 6bt co6oii acero JIIUllb He3H8'111TeJlbHyro MO,lIH(pllK8UIDO CTapoii . Ba)l(HhlMH BOilpOC8Mli RBJIHIOTCH Ta.o,e H T8KHe BOnpOChI, K8K CTaTyc pa3JIH'IHhlX npocpeC CHii H B38HMO,lleiiCTBHH pa 3JIH<IHhlX IlO,llXO,lIOB K npo 6.ne - M~M n pocpeCCHOH8JlbHOii rHrHeHhl H BOnpocaM 6e3onacHOCTH, KOTOpwe Tpe6yroT 3H84HTeJlb HO 60.nee TlllaTeJlhHhlX nc, .. Jte,llOBB HHii . 8 . He ace cneuHaJIHCThl B 06.naCTH npocpeCCHOH8JlbHOii rHrHeHhl H TeXHHKH 6e30ll8CHOCTH ,lIOJl)l(Hhl no.nyqaTh 0,l!KHB KOBYIO cneUH8Jlll38UHIO. MO)l(HO onpe,JieJIHTb pa3Jll!<!Hhle ypOBHli 3H8HBii, Heo6 xo,JIHMhle ,l!JIJI p83JIH<!Hh!X c n e n HaJlbHOCTeii . By,11eT O,lIHH8KOBO HeBepHO KBK Tpe60B8Tb CJIHmKOM 60.nbmoii KBBJIH(pHKBUHH OT c neuHaJIHCTa 06mero npo~HJl.fl B 3 TOR o6~aCTH, T8K H cnpamHBRTh C Hero C~BIDKOM Ma~o. 9 . Ha6JIIO,ll8eTCJI Hex BaTKa pa3Jlll'IHhlX c n e uHaJIH CTOB; DPH 3TOM o6beM H xapaKTep 3TOii npo6.neMhl p83HHTCH OT CTp8 Hhl K CTpaHe. 10 . Y'IBCTHHKH rpynnw DODl,lT8Jlli Cb H8HT H pemeHHe T8KliX npo6.neM K8K npHBJle<!eHHe K 8KTHBHOMY Y'<BCTHIO pa60THHKOB COUH8JlbHOro ceKTOpa, a TSK)l(e yc TSHOBJleHH e KOHTBKTOB C pa60<1HMH , PYKOBO,lICTBOM li C 06I11HM HaCe.JieHHeM. 4TO KacaeTCR o6~eCTBeHHOro MHeHHR, TO MOXHO CK838Th, qTQ COOTBeTCTBYW~ero OC03H8HWI 1Tpu 6J1 eM npocpec CHOH8JlbHOii rHrBeHhl ,lIOCTHrHyTo He 6hlJIO. 11. Ehl.no OTMe'leHO, <!TO nporpa>U!a P83BIITHJI Ka,llpOB B 06.naCTH 6opb6hl C TOKCH'leCKHMH XHMll'leCKHMli Be- me CT B8MH, B H8 CTOHI11ee apeMJI OCYI11eCTBJ1HeM8JI PerHOH8JlbHhlM 6ropo, ,lIOCTHrJla TOH CTB,l!HH, KOrAa MO)l(HO npHCTYDHTb K COCT BBJleHmo ne.neaoii y q e6Hoii nporpa>Dlh! ,l!JIJI DO,llrOTOBKH TOKCBKOJIOrOB. IlOCKOJlbKY TOKCH- KOJIOr nrpaeT O'leHb B8XHyro p OJlb B npocpeCCHOH8JlbHOii rnrneHe, Heo6xO,lIHMO np11aeCTH DOArOTOBKY TOKCHKO- JIO r O B B COOTBeTCT BHH C DO,llrOTOBKOii ,11pyrHX c nenHBJIIICTOB B 06.naCTH npocpe CCBOH8JlbHOii rHrHeHhl. OcHOBOii ,lIJIJI 3TOro MO)l(eT DOCJly)l(HTb ,lIBJlhHemnee COBepmeHCTBOBBHHe H npHMeHeHBe C TpaTerHH, npliHRTOii ,lIJIJI pa3pa60TKH u e.neBoii yqe6Hoii npo rpa>Ulhl AJIH 06y<1eHBJI TOKCIIKOJIOrOB . 1. B ne.noM IlO,llrOTOBK8 Bpaqeii B 06.naCTli npocpeCCHOH8JlbHOii rHrHeHhl, rnrHeHHCTOB, TOKCHKOJIOrOB , Me- ,l!HllHHCKHX c ecTep ,ll0Jl)l(H8 6hlTb Haue.neHa HB IlO,llrOTOBKy cneuHaJIHCTOB, o6.na,ll8IOIIIHX KOMneTeHnHeii .JIBYX Bli,lIOB : a) KOMneTeHUHH, D0 3BOJIRIOIIl8JI npaKTHKOB8Tb HS ypOBHe OT,lleJlhHOro npe,llnpHHTHJI H y<1aCTBOB8Tb B Me);.AHCUHil.JIHHapHblX KOHCY.JihTaIIHRX, OTHOCRmMXCR K ASHH OM Y npe,.ZUIPHRTHIO; 6) KOMileTeHI.I,MR " aKKpe,.n;HTOBaHHOro cneuHaJUiCTa " H.JIM KOHCyJlbTaHTa. - 123 - Bee .,urua' nona,Jla!Ol!lHe OOA KaTeropH!O J. (6) 6y,JlyT 3aHJtTbl OOJ!Hbl>I pa6o<m,i ,Jle Hh no KaKO>!-TO KOHKpeT- HOH c neuHS..llbHOCTH . CJieAyeT TaKJl(e y,JleJIHTb BHHMaHHe no,JlrOTOBKe ,Jlpyrnx eOOTBeTe TBY!OlllHX rpynn. 2. Heo6xOAHMO rrpoeeeTH HeeJieAOBaHHe nporHOeTHqeexoro 3HaqeHHJt Ha6Jl!O,JlaeMblX 6HxeBHOpaJibHhlX H 6aoJio- rHqee KHX H3MeHeHH>I H, eJie,JlOBaTeJib HO, HX B03,JleHeTBHJt Ha 3AOPOBbe pa6oqHx. 3TO HeeJie,JlOBaHHe noeJiy- Jl(HT Ba)l(Hbl.M BKJia,JlOM B IlO,Jlr OTOBKY pa60THHKOB B o6JiaeTH npocpe eeHOH aJibHO>I rHrHeHbl. 3. Bee nporpaMMbl IlO,JlrOTOBKH pa60THHKOB B 06,rneTH npocpeeeHOHa,lbHO>! rHrHeHbl ,llOJIJl( Hbl 6b1Tb Ha e b11I1eHhl 60AbmID4 npaKTHqecKHM COAep•aHHeM, C TeY, 4T06bl OHH MOr..lIH upaBH..llbHO oueHHBBTb ~H3H4eCKHe, XHMH4eCKHe , rreID<HqeeKHe H eorrHaJibHhle <PaKTOpbl Ha npOH3BO,JleTBe, a TBKJl(e cpaKTOpbl OKpyJl(a!Ol!leH epe,llhl B TPYAOBOM npoueeee . 4. CJieAyeT OTMeTHTb oeo6 blH xapaxTep Me,JlHUHHbl Ha npOH3BO,JleTBe, npocpeeeHOHBJlb HOH rHrHeHbl, TOKeHKOJIO- rHH H eeeTpHHeKqro ,JleJia Ha npOH3BO,Jl eTBe , H eBJt3 b 3THX AHeUHilJIHH C TeXHHKOH 6e3ona eHoeTH Ha npoH3- B0ACT Be llOAJieXHT AB..llbHeiillurn HCCJieAOBSHHflM . 5. 803 ,JlOJIJl(Ha e3yqHTb Ha H6oJiee 3cpcpeKTHBHble nyTH onpe,lleJieHHJt KPHTepHeB AJIJt pa3pa6 0TKH yqe6HblX nporpaMM, HanpaeJieHHblX Ha YAO BJieTaopeHHe noTpe6 HO e Tea 00,llrOTOBKH. B TBKOM HeCJieAOBBHHH eJie,JlyeT npoeeeT H oueHKY MO,JlyJIJtpHblX H MeJl(,JlHeUHilJIHHBPHhlX Kypeoe. 803 ,Jl0JIJl(H8 npe,llrrpHHJtTb nonblTKY eTa HABPTH- 3Hp0B8Tb pa6oqne noeTbl B 3TO >! o6JiaeTH. L Pa5oqaR rpynna no npo~eCCHOHanbHbIM Bpe.a,HOCTRM B 5onbHHUaX raara, 20- 22 OKTR5pR 1981 ro.a,a - 124 - ICP/WKH 007(S) Re v. l 21 HOR5pR 1981 ro.a,a OPHrHHAJl : AHr.JIBftc ~ Ha COBemaHHH npHCYTCTBOBanH BpeMeHHble KOHcynbTaHTW H3 11 CTpaH EBponeAcKoro perHoHa, a TaK*e npe.a,cTaBHTenH Me~yHapo.a,Horo npo~coro3a cnY*amHx B o5mecTBeHHblX H CMe*HhIX o6naCTRx, Me~yHapo.a,Horo COBeTa Me,[l,HUHHCKHX cecTep H Me~yHap0,[1,HOH opraHH3aUHH o6mecTBeHHblX CnY*6. CoBemaHHe HMeno cne.a,ylOl!Uie uenH: onpe.a,enHTb, KaKHM npo~eccHOHanbHbIM Bpe.a,HOCTRM no.a,Bep*eHbl pasnHqHble KaTeropHH npo~eCCHOHanb- Hb!X pa60THHKOB H .a,pyroro nepcoHana, pa6oTaromero B 6onbHHuax; paCCMOTpeTb Bonpoc o TOM , KaKHe MeyonpHRTHR Heo6XO,[l,HMO npoBeCTH .a,nR npe,[1,0TBpameHHR nary6- Horo B03,[l,eHCTBHR Ha 3AOPOBbe npo~eCCHOHanbHblX Bpe.a,HOCTeH B 6onbHHUaX . 2. )lHCKYCCHR TiocKOnbKY TeMa o6c~eHHR 6b1J1a ,[l,OCTaToqHO o6mHpHa, y.a,anocb paCCMOTpeTb nHmb HeKOTOPble acneKTbl npol5neMbl, HMeromHe Me~yHap0,[1,HOe 3HaqeHHe. B Haqane pa60Tbl COBemaHHR 5= paCCMOTpeH TOT onb!T, KO- TOPblH B HaCTORlllee BpeMR HaKonneH B pasnHqHblX CTpaHax n o npo6neMe npo~eCCHOHanbHb!X Bpe,[1,HOCTeH B 6 onbHHUaX. B .a,anbHeAmeM Ha COBemaHHH 6blJ1H paCCMOTpeHbl HH*ecne.a,yromHe Ol5mHpHb!e TeMbl: onpe.a,eneHHe 6onee BaJKHbIX npo~eccHOHanbHblX Bpe,[1,HOC TeH; onpe.a,eneHHe OCHOBHblX npo~eCCHOHanbHhlX rpynn PHCKa; opraHH3aUHO HHble Mepbl, MeponpHRTHR B o6naCTH 6HonorHH H no oxpaHe OKPY*aromeA cpe,[1,bl, Heo6xo,[l,HMb!e .a,nR 6opb6W C 3THMH Bpe,[1,HOCTRMH; BWBO,[l,bl H peKOMeH.a,aUHH. BblCTynneHHR npe.a,cTaBHTeneA pa3nHqHb!X CTpaH Bbl.RBHnH 3HaqHTenbHYID CTeneHb e.a,HH006pa3HR npH pac- CMOTpeHHH Tex npol5neM, KOTOPble CTORT nepe.a, nHuaMH, OTBeTCTBeHHbIMH 3a oxpaHy 3AOPOBbR nepcoHana 6onbHHU . Bee BblCTynaBmHe roBOPHnH 06 aKTHBHOM ocymeCTBneHHH npO[Pa.MM Hccne.a,oBaHHH pasnHqHblX ac- neKTOB oxpaHbl 3,[1,0pOBbR pal50THHKOB 6onbHHU; He MeHbmee BHHMaHHe 6blJ10 YAeneHo He06XO,[l,HMOCTH KOHTpOnR 3a HeBblXO,[l,aMH Ha pa6oTy B pesynbTaTe 3a6oneBaHHR .a,epMaTHTOM, a TaK~e B pesynbTaTe noTeHUHanbHO onacHoro AnR ~3HH, XOTR H pe.a,Ko BCTpeqruomerocR, 3a6oneBaHHR renaTHTOM B. MHorHe npe.a,cTaBHTenH Ha COBemaHHH OTMeqanH Heo6XO,[l,HMOC Tb .a,aTb oueID<y TOH ponH, KOTOPY"' HrparoT ncHxonorHqecKHe CTpeCCbl B , THOnorHH npo~eCCHOHanbHWX sa6oneBaHHH . Bo Bcex CTpaHax *eHlllHHbl COCTaBnRWT 3HaqHTenbHYW qaCTb pa- 6oTHHKOB 6onbHHU, B CBR3H C 3THM BCTaeT .a,ononH~TenbHaR npo6neMa, CBR3aHHaR C npo~eCCHOHanbHbIMH ~aK- TopaMH, BnHRWIIIHMH Ha HCXOA 6epeMeHHOCTH. XoTR XHMHqeCKHe Bpe.a,HOCTH BCTpeqaroTCR noBCeMeCTHO, oco- 6oe BHHMaHHe y.a,enReTCR onacHOCTRM, CBR3aHHbIM C pa60TOH C H3BeCTHbIMH HnH noTeHuHanbHO B03MO*HbIMH MY - TareHHbIMH H KaHueporeHHbIMH BemecTBaMH B xo.a,e K~O,[l,HeBHOH .a,eRTenbHOCTH . OT.a,enbHb!e pa3nHqHR, HMero- maecR B CTpaHax, 6blJ1H OTMeqeffW B o6naCTH WPHAHqecKOH .a,eRTenbHOCTH, HanpaBneHHOH Ha o6ecneqeHHe YAOBn P. TBopeHHR COOTBeTCTBYIDIIIHX noTpe6HOCTeH B CHCTeMaTHqecKOH oxpaHe 3,[1,0pOBbR pa50THHKOB 6onbHHU . KpoMe Toro, no BCeH BepORTHOCTH, CY!lleCTBYIDT pasnHqHR B ,[l,&HHblX O CMepTHOCTH MeAHUHHCKoro nepcoHana B pa3Hb!X CTpaHax. 1) TIOCKOnbKY 6blJ10 ,[l,OCTHrHyTO cornameHHe OTHOCHTenbHO Toro, qTo 6onbHHUbl RBnRWTCR, B nepByro oqe- pe.a,b, yqpe~eHHRMH .a,nR nauHeHTOB, H3 /1HCKYCCHH 6blJ1H HCKnroqeHbl BonpOCbl, CBR3aHHb!e C RTporeHHblMH npHtW<HaMH sa6oneBaHHH nauHeHTOB B 6onbHHUaX, H o6c~eHHe orpaHHqHnoCb paCCMOTpeHHeM BonpocoB, CBR- 3aHHblX C npo~eCCHOHanbHblM PHCKOM AnR pa60THHKOB 6onbHHU. _ 125 _ 2) XOTH HOHH31fllYJOlllaH P�HaUHH npeACTaBnHeT co6o8 cepbe3Hbl8 H AOCTaToqHo DIHPOKO pacnpocTpaHeHHbn't B OonbHHQaX BPeAHhlA ¢aKTOp A!IH 3AOP0BbH, no MHeHHJO rpynnbl Ha npaKTHKe HOHH3HPYICJl!laH paAHaQHH Ae8cTByeT s AOnyCTHMb!X npeAenax. TeM He MeHee, BHHMaHHe 6blJIO npHBneqeHO K PYKOBOACTBY no oOme8 npaKTHKe H 3allOITe OT P�HaUHH s OonbHHuax, TOM 1, 2, 3, 4 H 5 (MOT/MAfAT3/B03, 1974-1980). KpoMe Toro, rpyn­ na BhlCKasana npeAnOflO)l[eHHe, qTo B qacTHh!X Oonb�ax He ocymecTBnHeTCH TaK08 Jl[e CTPOrml: KOHTpOnb 3a HOHB3HpYJ0111e8 p�HaQHe8, KaK B oOmecTBeHHblX Y'{pell,[leHIUIX, H qTO He Bee nOABep•eHllble PHCKY paOoqHe Ha­ XOAJ[TCH nOA HaO�eHHeM. 3) BonbHHW,I pacnonaraioT OonblJIIDI qffCflOM paOoqHJt MeCT H cny,a:�x. KOTOPhle B npOH3BOACTBeHHblX ycno­ BIUIX non�aJOT IlOA Ae8CTBHe CYJlleCTBYJ()lllero Ha npeAnPKJITHH 3aKOHOAaTeflbCTBa, Peqb H,AeT O MexaHHKaX KOTenbHhlX, cnecapHx, 3neKTpmcax H paOoqHJt npaqeqHhlX. ITo MHeHHK> rpyn=, 3TH paOoTHHKH nopo8 He HMelJT TeX npeffMYllleCTB OnaroAapH COOTBeTCTBylOllleMY HaOn�AeHmo, KOTOphle cymeCTBY= B npOMbllllJ'leHHOCTH. IT03TOMY HeoOXOAHMO oOpaTHTb BHHMaHHe Ha o6ecneqeHHe COOTBeTCTBYIOlllero Ha0nlO,[l;eHHH 3a 3THMH cny,a:�MH. 4) IlpOH3B0ACTBeHllble 3ap=eHHH HH¢eKQHOHHblMH Oone3HHMH MOJl[�O nerKO pacn03HaTb y nepcoHana, paOo­ TaK111ero B OonbHHqHhlX nanaTax, y COTPYAHHKOB naOopaTopml:, y paOOTHHKOB npHCYTCTBYKllllHX npH BCKPhlTHH, a TaKJl[e y nHU, paOoTalOIIUIX C KPOBb� H npOAYKTaMH KpOBH, B HaCTOHmee speMH HaHOOnbmaH onaCHOCTb CBH- 3aHa C BHPYCOM renaTHTa B. B03 onyOnHKOBana PYKOBOACTBO no npo¢HnaKTHKe renaTHTOBhlX HH¢eKQH8 B OTAenax reMOAHanH3a H cny,a:Oax nepenHBaHllH KPOBH (cM. CepH� TeXHHqecKHX AOKnaAOB B03, � 512, 1973). HeoOXOAHMO BblnonHJITb 3TH PYKOBOAHmHe yKa3aHHH, KPOMe Toro, B HeKOTOPhlX CTpaHaX B OTAenbHblX cnyqaHX B03HOJl[H0 HCnOflb30BaHHe naccHBH08 HnH aKTHBHOH HHMYHH3aQHH, EblJla TaKJl[e OTMeqeHa onaCHOCTb A!IH 3AO­ POBbH nepCOHana H naQHeHTOB, CBH3aHHaH c HOCHTenRMH YCTO!NHBWX K aHTH0HOTHKaH mTaHHOB, 5) Ilpo¢ecCHOHanbHhle KOJl[llble 3a0onesaHHH HBnH�TCH 00hlqHblM HBneHHeM B OonbHHQaX, OHH HoryT OhlTb pe- 3ynbTaTOH pa3Ap�eHKJI HflH anneprHH. 06hlqHbJMH pa3AP�TeflHMH HBnH�TCH XHMffqecKHe Ae3HH¢HUHPYKllllHe BemecTsa, MO�mHe cpeACTBa, TOrAa KaK anneprHqeCKHe AepHaTHThl MOrYT B03HHKaTb B pe3ynbTaTe B03AeAcT­ BHH aHTH0HOTHKOB, pe3HHOBhlX H3Ae.mu!, HHKenH, HeKoTopwx anbAerH,AHblX Ae3HH¢HUHPYK>mmt cpeACTB H ¢eHo­ THa3HHOB, Ilpo¢HnaKTHKa H OopbOa C 3THMH HBneHHHMH 3aBHCHT OT ycTaHoBneHIUI annepreHa H nOABep)l[eH­ HOro ero B03AeAcTBHIO paOOTHHJCa, OT HanHqHff swOopa COOTBeTCTBYl(IIIHX areHTOB Aliff IDt HCnOnb30BaHHH B AaHHhOC oOCTOHTenbCTBax, OT TmaTenbHOro npononacKHBaHHH BWCTHpaHHOro OenbH H OT oOecneqeHHH nepcoHa­ na HeOOXOAHMOH 3amHTHOH OAellt,tloH. 6) BpeAHhle XHMHqecKHe ¢aKTOPW KpaAHe MHOroqHcneHHbl, H rpynna YAenHna ocoOoe BHHMaHHe aHeCTeTHqec­ KHM ra3aM, QHTOTOKCHqecKHH areHTaH, XHMHqecKHM CTepHnH3YJ()IIIHM H Ae3HH¢HUHPYl<JIIHM CPeACTBaM, MHorHe semecTsa 3THX Tpex rpynn oOnaA= pasHoo6pa3HblM TOKCffqeCKHH B03AeHCTBHeM, OHH HMe�T HnH, KaK nona­ raJOT, MoryT HMeTb MYTareHHblH, KaHueporeHHblH HnH TepaToreHHbli!: xapaKTep AeHcTBHR, Ilo3TOMY 6blJIO Ow uenecoo0pa3HO B OyAymeM COKpaTHTb AO MHHHMYMa npo¢eCCHOHanbHYK> nOABep)l[eHHOCTb, KOTopaH onpeAeneHHO MOKeT B03HHKHYTb, OcoOaR 03aOoqeHHOCTb 0b1Jla Bbrp=eHa B CBH3H C npaKTHKYeMblM B HaCTOHmee speMH HCnOflb30BaHHeM QHTOCTaTHCTHqecKHX areHTOB. 7) llopo8 B OonbHHQax MOryT B03HHKaTb nogapbl, B3pWBbl, yTeqKH ra3a. 'J:aCTO 3TO HBnHeTCH pe3ynbTa­ TOM nospellt,tleHIUI MeXaHH3MOB HnH oOOPYAOBaHHH, a Ta!a(e pe3ynbTaTOM HeOCTOPOJl[HOCTH HnH HeYMem1x AeHCT­ sml: nepcoHana. 3aOnaroBpeMeHHoe H HenpephlBHoe oOyqeHHe nOABep)l[eHHoro pHCKY nepcoHana HaPHAY c pe­ rynHpHblM TeXHHqecKHM oOcnYJKHBaHHeH o60PYAOBaHHH MOrnH 6b1 cseCTH K MHHHMYMY noTeHQHanbHYK> B03HOJl[HOCTb B03HHKHOBeHHR TaKHX npoHcmeCTBHH. 8) KpoMe HOHH3HPYIOllleA P�HaQHH B OonbHl!Qax HMeeTCH uemli!: PHA APYrHX ¢H3ffqeCKHX ¢aKTOPOB PHCKa. 0HH BKn=a= B ceOH 3neKTPOMarHHTHble nonH, MHKpOBOnHhl, CTaT=ecKoe 3fleKTpHqecTBO, BhlCOKOe HanpH•e­ HHe, na3epw, mYMbl H BHOpaQH�. B Tex cnY'{aRx, KOrAa HMe�TCH XOTH Ow HeKOTopwe H3 3THX ¢H3HqecKHX areHTOB, HeoOXOAHMO co sceA TmaTenbHOCTb� o6ecneqHTb cOop HH¢opMaQHH oOo scex TaKHX HCTOqHHKaX, Ha­ n,IJV!Tb MOHHTOPHHr H KOHTPOflb 3a HHMH, a TaK•e COOTBeTCTBYl<)mee HafSn�AeHHe 3a paOOTHHKIIMH, nOAsep)l[eH­ HblMH HX B03Ae8c TBHIO. 9) fpynna npHDIJla K MHeHH�, qTo ncHXOCOQHanbl!ble ¢aKTOPW HMe= Oonbmoe 3HaqeHHe BO MHOrmt oOnaCTHX AeRTMbHOCTH no OKa3aHHK> MeAHQHHCKOH nOMOmH, MHorHe npoOneMhl CBH3al!bl HenocpeACTBeHHO C xapaKTepoM paOoThl B OonbHHQax, KOTopwe HepeAKO BWHYllt,tlaJOT cnyi,;�x AOnroe speMH Aelp;ypHTb B ycnoBKJIX, speAHO BnKJll<JIIHX Ha HX ¢H3HqecKoe H ncHXHqecKoe COCTOHHHe. 10) 'J:pe3MepHoe HCnOnb30BaHHe neKaPCTBeHHhOC cpeACTB cny,a:antHMH OonbHHQ MOJl[eT npeAcTaBnHTb co6oH cepbe3HYK> H AOCTaToqHO mHPOKO pacnpOCTpaHeHHYK> npoOneMY, nerKHH AOCTyn K MeAHKaMeHTaM, B qacTHOc­ TH, K ncHXOaKTHBHblM neKapCTBeHHblM npenapaTaM, MOJl[eT npHsecTH K ¢H3HqecKHM H ncHXHqecKHM HapymeHHRM npH BbinOnHeHHH paOOTbl, HO He Be3Ae HMe�TCR nposepeHHble AaHHhle O TaKHX cnyqaHX 3aOonesaHHR, 3no­ ynoTpe0neHHJO anKoroneM Ta1CJ1te cneAyeT YAenHTb BHHMaHHe, 11) �elllllHHbl COCTaBnR�T 3HaqHTenbHYK> qacTb paOoTHHKOB OonbHHQ, H MHOrHe H3 HHX HaXOAHTCR B so3pac- Te, OnaronpHRTHOM AnH OepeMeHHOCTH, TeM He MeHee, B npoBOAHMblX no HaCTOHmee speMH HCCfleAOBaHHRX HCXOAOB 6epeMeHHOCTH OCHOBHOe BHHMaHHe YAenHeTCR nepcoHany aHeCTe3HOnorHqecKHX cny,a:6, HeCMOTPH Ha To, qTo APYrHe areHTbl (TaKHe KaK XHHHqecKHe CTepHnH3YJOl!lHe cpeACTBa, npOTHBOonyxoneBhle neKapcTBeHHble - 126 - npenapaTbl, HOHH3Hpy10111a11 H HeOHH3HP YIOlllal! Paz:tHaUHll, a TaKJl(e HeKOTOpbt e MHKpoopr aHH3Mbt) l!Bnl!IOTCll MYTa - reHHblMH HnH TepaToreHHblMH areHTaMH. B H,!leanbHOM BapHaHTe uenecoofipa3Hee CBeCTH K MHHHMYMY KOHUeHT- pauHH 3THX areHTOB B fionbHH"IJlblX ycnOBHllX , "!eM npHfieraT b K npaKTHKe OTCTpaH eHHH ll(eHJI!HH OT HeKOTOPblX BH,!lOB pa fioT . 12 ) rpynna OTMeTHn a , "!TO XOTH paHee OCHOBHOe BHHMaHHe YAen,anocb nepcoHany fionbHHU, OTAenbHbte CTpa- Hbl C03AaBanH CBOH Cnyll(fiW 3APaBooxpaHeHHH n o TeppHTOpHanbHOMY npH3HaKy, B TaKHX cnyqa,ax fionbHHUa HBnHnacb rnaBHblM, HO He e)lHHCTBeHHblM MeCTOM pafiOTW MeAHUHHCKHX cnyll(alllHX. PafiO THHKH B ofimHHax He- pe)lKO OT)leneHbI OT CBOHX Kanner B fionbHHUax, nepeA HHMH "laCTO BCTatOT npofineMbI HeKOHTponHpyeMOH q>H - 3H"leCKOH fie3onacHOCTH H MHKPO fi HonorH"leCKHX Bpe)l HOC Te H , B03HHKalOIIIHe BO BpeMH HX pafiOTbl n o MeCTY Jl(H- TenbCTBa nauHeHT OB , 13) Hec"laCTHbie cny"laH H TpaBMbl npeACTaBnHIOT cofiol\ Ofibl"IHbJe HBneHHH B fionb HHUa x . Ocofioe BHHMaHHe fiwno npHBne"leHO K npofineMaM, CBH3aJnllilM C naneHH>IMH (HanpHMep, B pe3ynbTaTe XOJl(AeHHH B nnoXOH ofiyBH n o MOKPOMY nony), CBH3aHHb!M C B03HHKHOBeHHeM Hanp,ill(eHHH B ofinacTH cnHHhl, co cnyqaHHb!MH YKOnaMH, C HeBepHb!M ofipameHHeM co cnOJl(Hb!M ofiopy)lOBaHHeM , co cnyqaHMH q)H3H"leCKOro HananeHHH co CTOPOHbl naUHeH- TOB H HX npHHTenel\. 14) EonbHH'IHbJe ycnoBHH TpefiytOT C03)laHHH pasnH'IHb!X MHKPOKnHMaTHtleCKHX ycnOBHH nn,a pa3HOOfipa3HblX BHAOB AeHTenbHOCTH, ocymecTBnl!eMbJX B ITOMemeHHHX fionbHHU, HanpHMep, B onepaUHOHHblX, cneuHanbHb!X H30n>1Topax , OT)lenax HHTeHCHBHOH nOMOII!H, B nafiopaTOPHl!X H Ha Kyxne. Ball(HO, 'ITOfibl noTeHuHanbHO Bos - MQJl(HbJe npOTHBOpe"IHH Mell(Ay HYJK,IJ:aMH nauHeHTOB, ycnOBH>IMH pa50TW H oxpaHbl 3AOPOBbH nepcoHana 5bUIH npa- BHnbHO ITOHl!TbI, "ITOfibl 5bUIH npenrrpHH>ITbl BCe B03MOJl(Hb!e ycHnHH AnH YAOBneTBOpeHHH Tpe5oBaHHH ofieHX r p ynn nyTeM MHOrOAHCUHITnHHapHoro nonxona. CHc TeMa KOHJlHUHOHHPOBaHHH B03)lyxa, HanpHMep , MOJl(eT HrpaTb Ball( - HYIO ponb B OT)lenbHblX MeCTax, HO OHa He HBn>leTCH Heofixo)lHMOH nn,a OfimHX nanaT. B Tex MecTax , rne TaKHe CHCTeMbt AeHC TBYIOT, HX cnenyeT pa3pafiaTb1BaTb, C03AaBaTb H 3KcnnyaTHPOBaTb npH CTporoM KOHTpone q>H3H"leCKOro , XHMH"leCKoro H MHKPOfiHonorH"!eCKoro B0 3Ae HCTBHH, KOTOpoe MQJl(eT fiblTb pe3ynbTaTOM HX He - npaBHnbHOH 3KcnnyaTaUHH. B03, npaBHTenbCTBaM H npoq,eCCHOHanbHblM opraHH3aUH>I M fiwno peKOMeHAOBaHO ofipaTHTb BHHMaHHe Ha BbJ - BOJlbl Pafioqej:j rpynITbt, KOTOPbl e npHBe)leHb! B nop>l)lKe oqepe)lHOCTH. MeponpHHTHH, HeofiXOJlHMble AnH KOHTPOn>I sa npoq,eccHOHanbHblMH Bpe)lHOCTHMH B pa3BHTHH, HatlHHa>I C n onBepll(eHHOCTH HM HAO paHHero HnH no3)lHero HX B03AeHCTBHH, BKntO"lalOT HHJKecnegy1001ee. 4 . 1 C5op )laHHblX EpHraAa n o oxpaHe 3AOPOBbH pafiO'IHX AOnll(Ha cofiHpaTb H aHanHSHPOB a Tb AaHHbte O 3afioneBaeMOCTH H CMepTHOCTH nepcoHana, BKnt0t1aH q,aKTbl a5ceHTeH3Ma H Hect1aCTHblX cnyqaeB, a TaKJl(e CTaTHCTH"leCKHe gaHHbte 0 ITOBpell(AeHHHX. 3TH naHHb!e AOnll(Hbl 5b!Tb AOCTaTO'IHO geTanH3HPOBaHHblMH H nonHb!MH C TeM' "ITOfibl BO BCex B03MQJl(HWX cnyqa,ix 5wna ycTa HOBn e Ha npH'IHHHOcnenCTBeHHa>I B3aHMOCB1!3b, 'ITC MOrno fib! ofiner"IHTb npoBegeHHe npoq,HnaKTlftleCKHX MeponpH>ITHH. TipH HeofiXOAHMOCTH, HanpHMep, B cnyqa,ix aficeHTeH3Ma, cne- g yeT co6n10naTb KOHq>H,!leHUHanbHOCTb . TaKoe Hafin10neHHe >IBnHeTCH gononHHTenbHblM K caHHTapHOMY Ha)l30PY, HO HeOfiXOAHMblM MeponpH>ITHeM, B 6onbHHUe 3TH MeponpH>ITHH BKnt0t1at0T B ce5,a MOHHTOPHHr OKHCH 3THneHa, q>OpManbgerH,!la, aHeCTe3HPYJ001ero r a3a HnH KOHUeHTpauHH paCTBOPHTeneH B B03gyxe, a TaKJl(e oue HKY ypOBHeH myMa H 3neKTPOMarHHTHb!X 3MHC- CHH. KpoMe Toro , HeofiXOAHM 3prOHOMH"leCKHH MOHHTOPHHr. EonbHHUa HBn>1eTCH TaKJl(e HCTO"IHHKOM Bpeg- Hb!X OTXOAOB; IT03TOMY npouegypw ycTpaHeHHH TaKOBb!X AOnll(Hbl TmaTenbHO cofiniogaTbCH H 3q,q>eKTHBHO KOHT - ponHPOBaTbC>I . t,. 3 CaHHTapHbtH Hansop OH A01DICeH BKntO"laTb B cefi,a He TOnbKO noBCeMeCTHO npHMeH>leMoe MeAHUHHCKO e oficnenoBaHHe, npOB OAH - MOe nHfiO HenocpencTBeHHO rnaBHblM Bpat!OM B yqpell(AeHHH, nHfiO npH era KOHTpone, HOH nepeogHtleCKHH MeAHUHHCKH'.H OCMOTP, xapaKTep, TmaTenbHOCTb H nepHOAH'IHOCTb KOTOporo A01D!CHbl onpenen>ITbC>I npH oueHKe PHCKa, conpOBOJl(Aa10111ero TOT Hn H HHOH BHA pafiOTW. CofipaHHaH TaKHM n y TeM nogpofiHaH HHq>OpMaUH>I gOJDKHa HOCHTb KOHq)H)leHUHanbHbll1 xapaKTep nn,a "lneHOB fipHraAbt n o oxpaHe 3AOPOBb>I pa6ot1HX. MeTOAbl TaKoro pona MeAHUHHCKoro oficnenoBaHHH AOnll( Hbl BKn10t1aTb 5HonorH"leCKHH MOHHTOPHHr OTAenbHb!X rpynn nepcoHana. - 127 - 4.4 IToTpeoHOCTH a Ha)f'{HbfX HccnegoaaHHRX no MHeHHIO rpynru,1 AnR npoaegeHHR MHOf'HX nporpaMM HccnegoaaHHH He06XOAHM c6op AOCTOaepHbrx, T04- HblX H nonHbIX gaHHblX O COCTORHHH 3AOPOBbR nepcottana . 'lHcno nm.1, nogaepraeMbJX PHCKY B OTgenbHblX 6onbHHUaX, KaK npaBHnO , cnHWKOM HeaenHKO, 4TOObl HX HccnegoaaHHe gano 3Ha4HMble pe3ynbTaTbl. CT03- TOMY He06XOAHMO paCCMOTpeTb B03MOJKHOCTb o6~eAHHeHW! gaHHblX Ha perHOHa!lbHOH, HaUHOHa!lbHOH HnH MeJK,[ly- HapogHOH OCHOBe, npH 3TOM c6op TaKHX gaHHblX gonJKeH no3BOnHTb npOBOAHTb cpaaHeHHR nony4eHHblX pe3ynb- TaTOB. Ebl!lO Obi uenecoo6pa3HO BKnl04HTb c10ga TaKJKe rpynru,1 npOMbllllJleHHOf'O HaceneHHR, nogaepJKeHHOf'O aHrut0f'H4HblM BHAaM onacHOCTeH. KO HKpeTHble o6naCTH HccnegoaaHHH BKnI04alOT H3)f'{eHHe: gaHHblX 06 HH¢eKUHRX B 6onbHHUaX AnR cpaaHeHHR pa3nH4HblX ypOBHeH 3a6oneaaeMOCTH nepcottana ; HccnegoaaHHH 06 Hcxogax 6e peMeHHOCTH y nepcottana, pa60Ta10mero a TaKHX o6nacTRX KaK OHKono- f'HH H n a Tonof'HR, a TaKJKe y pa60THHKOB, nogaepJKeHHblX B03AeHCTBHIO XHMH4eCKHX CTepHnH3YIOWHX cpencTB ; npH4HH a6ceHTeH3Ma nepcottana ; pa3BHTHR HOBblX MeTOAOB 6Hono rH4eCK Of'O MOHHTOPHHra H MOHHTOPHHra OKpyJKa10meH cpegbl' npegaapR10- UU1X coaepweHCTBOBaHHe KOHTponR 3a npo¢eccHOHa!lbHblMH apegHOCTRMH B 60nbHHuax; CTpeccoablX CHTyauHif, COCTORHHH pa304apoaaHHOCTH H 6naronony4HblX CHTYaUHfl . 4. 5 OpraHH3aUHR npaKTH4eCKOH pa60Tbl 0THOllleHHe rpynTibl K aonpocaM onpegeneHHR, oueHKH H KOHTponR 3a npo¢eCCHOHa!lbHblMH apegHOCTRMH B 6 o nb HHuax Tpe6yeT onpegeneHHblX H3MeHeHHH B HblHelllHeH npaKTH4eCKOH pa6oTe. 0HH 6ygyT o xaaTblBaTb PRA H3 MeHeHHH, Ha4HHaR C OTHOCHTenbHO npoCTblX 3pf'OHOMH4eCKHX H3MeHeHHH, Heo6XOAHMblX AnR yny4llleHHR ocaH- KH Ha pa6o4eM MeCTe, H KOH4aR PaAHKa!lbHOH nepecTpOHKOH anMHHHCTpaTHBH OH H yrrpaaneH4eCKOH CTPYKTYP a 6onbHHuax. 4.6 KoHcynbTHpoaaHHe fpynrra ygenHna 6onblllOe BHHMaHHe HeOOXOAHMOCTH KOHcynbTHPOBaHHR no MeAHUHHCKHM aonpocaM. Otto AOJl)J(HO BKnI04aTb KOHcynbTaUHH, npegaapRIOWHe Ha3Ha4eHHe Ha pa60TY, nepHOAH4eCKHe KOHCynbTaUHH, a TaK- )J(e KO HcynbTaUHH OTgenbHblX nHU no Tpe6oaaHHIO. KaK npaBHJlO , ny4llle ace ro n nR 3T0f'O nOAXOAHT 6pHraga no o xpaHe 3AOPOBbR pa604HX. 4.7 CTpocaemeHHe no aonpocy o nacHOCTeH nnR 3gopoabR TaKoe npocaemeHHe aKn104aeT a ce6R npegocTaaneHHe Htt¢opMaUHH o Tpe6oaaHHRX , npeg~RBnReMbrx K Toil HnH HHOH pa6oTe, HO CBR3aHHblX C HeH onacHOCTRX AnR 3AOPOBbR, OHO AOn)J(HO Ha4HHaTbCR C npHXOAOM 4eno - a eKa Ha pa60TY H npOBOAHTbCR perynRpHO B Te4eHHe acero nepHoga pa60Tbl C HCnOnb30BaHHeM MeTogonOf'HH caHHTapHOf'O npocaemeHHR. OcHOBHOe BHHMaHHe cnegyeT ygenRTb KanpOBblM aonpocaM H onacHOCTRM gnR na-· UHe HTOB, CBR3aHHblM C pa60TOH, aHrutH3y HecttaCTHblX CJlyttaeB, npHMeHeHHIO cnO)J(HblX BHAOB o 6opygoaaHHR, npouegypaM PY'IHOf'O Tpyga H OKa3aHHR 3KCTpeHHOH noMOlllH, MeponpHRTHRM no 3KHnHpOBKe c nyJKamero gnR OKa- 3aHHR 3KCTpeHHOH nOMOl!lH, MeponpHRTHRM no 3KHnHpOBKe cnyJKamero AnR OKa3aHHR noMOlllH 6 onbHOMy H yMHpa10- me My . 4 . 8 Ponb B03 fpynna peKOMettnoaa11a B03 HH)J(ecneny10wee : ygenHTb AOnJKHOe BHHMaHHe 6onbHH4HOH cpege npH o6cy)l(,[leHHH aonpoCOB MHKPOKnHMaTa; CTHMYnHpoaaTb pa3BHTHe HccnenoaaHHH 06 HCXOgax 6 epeMeHHOCTH H npHBeCTH B COOTBeTCTBHe Ha- KOnneHHe MeJK,[lyHapogHblX g aHHbJX, Heo6XOAHMblX • ;.nR TaKHX Hccnen oa a HHH; opraHH30BaTb coop , TpaHcnopTHPOBKY H ygaJJeHHe 6onbHH'IHblX OTXOAOB, paccMaTpHBaR 3TH MeponpHR- THR KaK OAHY H3 nepaoo4epegHblX 3anat1; - 128 - CTHMynHpoBaTb pa3BHTHe HCCnenoBaHHH o5 YPOBHR X pa3nHqHbJx HH~eKUHH, KOTOpbIM nonBep~eH nepco- HaJJ 5onbHHIU,I; npoBeCTH nepeoueHKY HMelOII\erocn 3aKoHonaTenbCTBa o 3npaBooxpaHeHHH nepcoHana 5onbHHU H pas- pa5oTaTb, ecnH Heo5xonHMO, HOBble npaBHna, o5ecneqHBaH npH 3TOM He npOCTO neACTBHe 3aKOHa , aero peanbHoe co5n~n eHHe; 3apattee paccMoTpeTb Bonpoc o co3naHHH 5pHran no oxpaHe 3AOPOBbH pa5oqHx BO Bcex 5onbHHuax. - 129 - PA3BHTHE KAJlPOB 3UPABOOXPAHEHIDI KoHcynb TaTHBHaR rpynna no onpeAeneHHID uene/:i H opraHH3aUHH Hay'IHblX HCcneAOBaHHH B oOnaCTH noArOTOBKH pa60THHKOB 3,t(paaooxpaHeHHR npara, 28 ceHTROPR - 1 OKTR0pR 1981 roAa - 131 - ICP/ PPM 004(S) 27 OKTROpR 1981 roaa 0PlffHHAJI : AHr~cKHfl B COCTaB KoHcynbTaTHBHOH rpynilbl BOl!lllH 12 BpeMeHHblX coseTHHKOB B03 H3 9 eaponeHCKHX CTpaH H 2 COTPYAHHKa B03. CoaemaHHe ObLJlO C03BaHO PerHOHanbHblM 5wpo B COOTBeTCTBHH C nporpaMMOH pa3BHTHR KaAPOB 3Apaao- oxpaHeHHR (PK3) . Ero uenb 3aKnID'lanacb B TOM, 'ITOObl onpeaenHTb, KaKHe MeponpHRTHR Heo6xoAHMO ITPOBeCTH AnR CO,t(eHCTBHR pa3BHTHID HCcneAOBaHHH B o6naCTH ITOArOTOBKH pa6oTHHKOB 3,t(paaooxpaHeHHR B EBpOITeHCKOM perHOHe . nepeA fpyITno/:i, TaKHM o6pa30M, CTORna 3a)'.1a'!a ITpoaHanH3HPOBaTb cnOlKHBWYIDCR B EBPO ITe CHTya1.111ro, HMeR B BHAY 3aAa'IH aaHHOro HccneAOBaHHR Hero 3Ha'leHHe AnR pa3BHTHR Ka,t(pOB 3Apa- sooxpaHeHHR B rocyaapcTBax-qne11ax , KaK B ITnaHe Bb1nycKa Heo6xoAHMoro Kon11qecTBa CITe1.111an11cToB, TaK 11, 'ITO 6onee Ba.Jl(HO, B ITnaHe o6ecne'leHHR Heo6xoa11Moro ypoB HR HX IToaroTOBKH. CneayromaR 3aaaqa fpynITbl 3aKnro'!anacb B TOM, 'ITOObl OITpe.r1enHTb , KaKHe MeponpHRTHR aomKHbl Ob!Tb ITPOBe,t(eHb! B rocyaapCTBax - qneHaX H Pe rHOHanbHblM 6ropo AilR coaeHCTBHR pa3BHTHID TaKHX HccneaoBaHHH C uenbro /'.IOCTHJ!CeHHR uenH - 3AOP0Bbe anR acex K 2000 rOAY · ,QHCKyCCHR 06WHpHaR nporpaMMa AHCKYCCHH BKilID'IHna B ce6R 06cYJK,L1eHHe HMerome/:i ITepsocTeITeHHOe 3Ha'!eHHe ITpo6 - neMb! B3aHM03aBHCHMOCTH pa3BHTHR Hay'IHblX Hccneaoaamrn B o6naCTH noaroTOBKH pa60THHKOB 3)'.1paaooxpaHe- HHR H yKpenneHHR 3AOPOBbR. 06cYJK,L1anHCb TaK~e 3aAa'IH no pa3BHTHID Ka,t(pOB 3ApaaooxpaHeHHR B ITnaHe /'.IOCTHJ!CeHHR uenH - 3/'.IOPOBbe anR scex K 2000 rOAY· ,QeRTenbHOCTb, HaITpaaneHHaR, B nepayro oqepeab , Ha ITOBb!WeHHe YPOBHR IT0)'.1rOTOBKH KaAPOB 3)'.1paaooxpa- HeHHR, a He Ha yaenH'leHHe 'IHCna cITe1.111anHCTOB , Ha Y/'.IOBneTBOpeHHe B03HHKaromHx ITOTpe6HOCTeH HaceneHHR B Me)'.1H!.1H HCKOH ITOMOmH C y'leTOM HX nepsooqepe)'.1HOCTH, RBilReTCR rnaBHblM 3neMeHTOM CTpaTerHH yKpeITneHHR 3AOPOBbR . 6p11raAa, OTBeTCTBeHHaR 3a ,ITpeaocTaBneHHe ITepBH'IHOH Me)'.1HKo - caHHTapHOH ITOMOWH (ITMCn) , Hr paeT pewaromyro POilb B AOCTHJ!CeHHH 3/'.IOPOBbR anR Bcex K 2000 ro,t(y, ITOCKOilbKY 3)'.1paaooxpaHeHHe RBnReTCR COCTaBHO H qacTbID COUHanbHOro pa3BHTHR, a OTBeTCTBeHHOCTb 3a ITO)Ulep~aHHe 3,t(OPOBbR see B OOilbWeH CTe - ITeHH HecyT caMH ~HTenH, a He npo¢ecCHOHanbHble MeAHI.IHHCKHe pa60THHKH. B 3TOH CBR3H 6p11 r aaa ITep - BH'IHOH Me)'.1HKo - caHHTapHOH ITOMOmH MO~eT, ITO sce/:i sepORTHOCTH , ITPOBOAHTb pa60TY ITO npocaemeHHID o6mecT - BeHHOCTH H OTAenbHblX IlHI.I ITO BOITpocaM oxpaHbl 3AOPOBbR . Ka npo¢ecCHOHanbHblX Me)'.1HJ:.IHHCKHX pa60THHKOB AilR Bb!IlOilHeHHR HMH 3THX HOBblX ¢YHK!.1HH . HHKHeT He06X0)'.1HMOCTb B cosepweHHO HOBOM THne cne1.111anHCTOB . 803MO~HO 803 - OmymaeTCR HeAOCTaTOK TaKHX Hay'IHblX HCCileAOBaHHH H pa3pa60TOK, KOTOpb!e o6ecne'IHBanH Ob! Heo6xo- /'.1HMYID OCHOBY AilR ITPHHRTHR OOOCHOBaHHblX peweHHH B BOITpocax nnaHHPOBaHHR, IT0)'.1rOTOBKH H HCnOnb30BaHHR Kaapoa 3apaaooxpaHeHHR . ,QnR pemeHHR ITpo6neMb1 noaroTOBKH pa6oTHHKOB 3/'.lpaaooxpaHeHHR anR pa60Tb1 s COCTaBe 6p11raA fIMCn HeOOXOAHMO pa3pa60TaTb OOWHPHYID KO HUeITUHID HccneaoBaTenbCKOH aeRTenbHOCTH . 3Ta aeRTenbHOCTb ao=Ha HCXOAHTb H3 peanbHO cymeCTBYIDmHx B 3TOH o6naCTH ITpo6neM ,r He ao=Ha orpaHH- 'IHBaTbCR CTporHMH paMKaMH HCITOilb3yeMOH B HCCneAOBaHHRX MeToaonorHH . fpyn n a aana cneAyromee OITpe - aeneHHe Hay'IHblM HCCileAOBaHHRM B o6naCTH ITOArOTOBKH KaapoB B paMKaX nporpaMMbl pa3BHTHR KaApOB 3Apa- sooxpaHeHHR: " Juo6o/:i ITpHeMneMbIH ITpn~cc- r. c6opa, oueHKH 11 o6pa6oTKH HH¢opMau1111 ITO o npeAeneHHOH TeMe, Kacarome/:i - CR H3y'leHHR B3aHMOCBR3H pa3BHTHR KaapoB 3ApasooxpaHeHHR H yKpeITneHHR 3/'.IOPOBbR HaceneHHR ." bbLJlO paccMOTpeHO COCTORHHe HCCileAOBaTenbCKOH AeR TeilbHOCTH B 3TOH o6nacTH B EspoITe. CTBO OITY OilHKOBaHHblX Hay'!Hb!X HccneaoaaHHH , KaK ITpeacTaBnReTCR, ITOCBRmeHO BOITpocaM noaroTOBKH MeAHUHH - CKoro H cecTpHHCKoro ITepcoHana . np11 3TOM OCHOBHoe BHHMaHHe yaenReTCR BOITpocaM H3y'leHHR yqe6HblX nporpaMM, MeTOAHKH npeIToaasaHHR H KOHTHHreHTa y'lal!\HXCR . 0T'!eTbl o Hay'!HblX HCCileAOBaHHRX B o6naCTH pa3BHTHR Kaapos 3ApasooxpaHeHHR' KaK npaBHno ' He ny6nHKYIDTCR Hal.lHOHanbHblMH H Me=yHapOAHbrMH 132 - H3AaHHRMH, paccqHTaHHblMH Ha IDHPOKYID ayAHTOPHID. YqacTHHKH rpyllilbl paccKasa.rm oO H3BeCTHblX HM rrpoeK- Tax, cooOmeHHR O KOTOPblX He rryOnHKOBa.!lHCb H He llOBOllHilHCb AO cseaeHHR oOmecTBeHHOCTH. IlpearronOlKHTellbHble TeMbl Hayql{b[X HCCneaosaHHH B o5naCTH pa9BHTHR KaAPOB sapasooxpaHeHHR B EsporreHCKOM perHoHe BBHAY HeAOCTaTKa B HaCTORmee speMR rryOnHKaUHH ll0 aaHHOH TeMe rpyrrrra orrpeaenHna HeKOTOpwe oO- naCTH, B KOTOPblX HeOOXOllHMO rrposeCTH Hayq=e HccneaosaHHR. Hl{Jf{e IlPHBOllRTCR HaHOonee BaJKHbJe H3 Ta- KHX oOnacTeH HccneaosaHHH: a) 11pouecch1 orrpeaeneHHJI TeM HccneaosaHHH Ha MecTHOM yposHe; 5) MeTOAbl orrpeaeneHHR H rrporH03HPOBaHHR 0YllYmHX KOnHqeCTBeH=x H KaqecTBeHHblX IlOTpeOHOCTeA B Kaapax 3apasooxpaHeHHR; B ) orrpeaeneHHe oObeMa 3HaHHH , KOTOPblM ll01DKHbl o5naaaTb pa50THHKH rrepsHqHoH MellHKo-caHHTapHOH IlOMOlllH, a TaKJJ(e xapaKTepHblX oco5eHHOCTeH H MeTOllHKH OCYl!leCTBneHHR HeoOXOllHMblX rrporpaMM crre- UHa.!lbHOH rroaroTOBKH B 3TOH oOnaCTH; r ) pa3paOOTKa COOTBeTCTBYIDlllHX rrporpaMM noaroTOBKH rrpenoaasaTeneA H HayqHblX pa50THHKOB B oO- naCTH npocsemeHHR, BK=qaR cnocoow pemeHHR npo5neM; a) pa3pa 00TKa H oueHKa COOTBeTCTBYJallHX yqe5HbJX noco5HH; e) CllOCOObJ no,IJJJ,ep)J(aHHR ll01DKHOro npoq,eccHOHa.!lbHOro MaCTepCTBa qneHOB 5pHraAbI sapasooxpaHeHHR , saHHMaIDIDHXCR POllCTBeH- MeAHUHHe npoOneMaMH; JI() ycnOBHJI, orrpeaenRIDJIIHe TaKoe pa9BHTHe OpHraAbJ nepBHqHOH MeAHKo-caHHTapHOH noMOIDH, npH KOTO- POM OHa CTaHOBHTCR cpeaCTBOM A!lJI HerrpepwBHOro noswmeHHR KBa.!lHq>HKaUHH ee qneHoB; 9) xapaKTep HOBblX H BHAOH3MeHeHHblX B9aHMOOTHomeHHH, 3aAaq H <l>YHKUHH spaqeft, paOoTaIDJIIHX B coc- TaBe 5paraa rreps=HOH MellHKo-caHHTapHOH IlOMOlllH, H HX OCYl!leCTBneHHe; H) xapaKTep HOBblX H BHAOH9MeHeH=x B9aHMOOTHomeHHH, saaaq H <l>YHKUHH spaqeH H Henpoq,eCCHOHa.!l b - HblX paOOTHHKOB H HX OCYl!leCTB!leHHe; K) OTHOmeHHe OTllellbHblX IlHU H HaceneHHR B uenoM K OTBeTCTBeHHOCTH 38 no,IJJJ,ep)J(aHHe 9llOPOBbR; n) BHeceHHe H9MeHeHHH B aeRTe!lbHOCTb opraHH3auHH, yqpeJKAe HHH H opraHOB, OTBeTCTBeH=x 9 a pa3paOOTKy nonHTHKH, nnaHHpOB8HHe, a TaKJKe IlOllrOTOBKY H pa3BHTHe KaAPOB sapasooxpaHeHHR; M) B3aHMOCBR3b OCHOBHblX q>aKTOPOB, npoueccoB H J!BlleHHH, BllHJIJOIDHX Ha COCTORHHe noaroTOBKH KaA- POB sapasooxpaHeHHR; H) BllHRHHe MHOronpoq>HnbHOH rroaroTOBKH crreuHa.rrHCTOB H ynyqmeHHR KaqecTBa cn~O Ha yKpenneHHe 3llOPOBbR HaceneHHR; o) IlOilHTHKa B oOnacTH pa3BHTHR H opaeHTaUKH KaAPOB 3llpasooxpaHeHHJI, HX noa5opa H IlPHHJITHJI Ha pa5oTy; n) BbJJ!BlleHHe HeoOXOllHMblX npeBa.!lHPYJOJllHX MeCTHblX ycnosHA, onpeuellRIOIIIHX q>OpMHPOBaHHe H noaroToB - KY 5pHraa rreps=HOH MellHKo-caHHTapHOH IlOMOJllH; p) q,aKTOPhl, BllHRIOJIIHe Ha yqacTHe HllH HeyqacTHe Bpaqeft B HCcneaosaHHJIX ll0 sonpocy pa3BHTHR Kaa- poB 3llP8BOOXpaHeHHR. TPYllHOCTH H HepemeHHbie npoOneMbJ B opraHH3aUHH HccneaosaHHH B oOnaCTH pa3BHTHJI KaAPOB 3ApaBooxpaHeHHR l1MeIDJ11HeCR B HaCToRmee BpeMR oqeBHAHbJe rrpoOellbJ B 9HaHHJIX B uaHHOH oOnaCTH saTPYllHJIIDT B03MOlKHOCTb nposeaeHHR paUHOHa.!lbHblX H3MeHeHHH. Te l!Ce caMbJe TPYllHOCTH , ll0 sceA sepORTHOCTH, CYl!leCTBYIDT H B op- raHH3aUHH HayqHwx HccneaosaHHH . fpynna orrpeaenHna HeKOTOpbJe H3 OCHOBHblX rrpo5neM, a HMeHHO: a) CY111eCTByeT 051llHH HellOCTaTOK 3HaHHH Ha scex YPOBHJIX pemeHHR saaaq H nocTaHOBKH ueneft, onpe- aeneHHR noTpe5HocTeA H MeToaos H8Y4HhJX HccneaosaHHH B o5nacTH o5yqeHHJI spaqeft; cneayeT ocoOo OTMeTHTb TOT q,aKT, qTo naua, OTBeTCTBeHHble 3a npHHRTHe pemeHHH , qacTo He HMeIDT rrpeacTasneHHR 0 3Ha4eHHH Hayq Hbrx HCCneaosaHHH B oOnacTH pa3BHTHR KaAPOB 3Apasoo xpaHeHHR. - 133 - 6) CTpyKTypa (pl•!HaHCOBblX H aAMHHHCTpaTHBHblX yqpe)J(,IleHHH He IT03BOn>!eT pa3BHBaTb Hay'!HbJe HCcne - AOBaHHJI B KaKHx - nH6o HHblX o6naCTRX, KPOMe MeAHK0 - 6HonorH'!eCKHX. B) 0TCYTCTByeT AOCTaTO'!HOe KOnH'leCTBO COOTBeTCTBYIO!IIHX Hay'lHO-HCcneaoBaTenbCKHX yqpe)J(,IleHHH H Hay'!HblX cneuHanHCTOB AnR npoBeAeHHJI He06XOAHMblX HccneaoBaHHH, He CY!lleCTByeT TaKll<e HHKaKOH cxeMbJ npOABHll<eHHJI no cny,K6e MOnOAblX MeAHUHHCKHX pa60THHKOB' Jl<enaJOl!(HX 3aHJ!TbCJI Hay'!HblMH Hccne- AOBaHHJIMH B o6naCTH noaroTOBKH Bpa'!eH. r) qaCTO OTCYTCTByeT egHHblH opraH AnJ! npHHJITHJI pemeHHH HnH KaKan - nH6o CHCTeMa PYKOBOACTBa HccneaoBaHHRMH B o6naCTH pa3BHTHJI KaAPOB 3APaBooxpaHeHHJI . A) CTaTyc napaMeAHUHHCKOro nepcoHana npogonl!<aeT OCTaBaTbCJI HH3KHM no cpaBHeHHJO co CTaTyCOM Bpa'!eH. ilo3TOMY OCHOBHbJe MeponpHJITHJI npoBOARTCJI B o6naCTH MeAHUHHCKHX HccnegoBaHHH, Kyga H HanpaBnRJOTCJI AeHeJl<HbJe cpegCTBa. e) HccneaoBaHHR B o6nacTH noaroTOBKH Bpa'!eH noTeHuHanbHO cnoll<HbJ, H KaK sine qua non npaKTH- '!eCKHX Hay'{HblX HccneaoBaHHH, no BCeH BepORTHOCTH, noTpe6yJOT y'!aCTHJI Tex, KTO J!BnneTCJI o6~eKTOM HccneaoBaHH» . JI<) HayqHbJe HccneaoBaHHJI B o6naCTH KaAPOB 3APaBooxpaHeHHJI 3aKnJO'!aJOT B ce6e noTeHUHanbHYJO yr- po3y CTaTycy H aBTOHOMHH pa3nH'!Hb!X rpynn H AHCUHilnHH. Hoe OTHomeHHe K npoBegeHHJO TaKHX HccneaoBaHHH . 3) He CY!lleCTByeT HH nonHOCTbJO pa3pa60TaHHOH MeToaonorHH, HH BCeo6~eMJTIOmew CXeMbJ npoBegeHHJI Hay'!HblX HCCnegoBaHHH B o6naCTH pa3BHTHJI KaAPOB 3ApaBooxpaHeHHJI. H) 0TCYTCTBHe 3HaHHH, noaroTOBKH H TPaAHUHH B TeopHH npenoaaBaHHJI H B npoBegeHHH Hay'!Hb!X HccnegoBaHHH Bbl3bJBaeT OTPHUaTen bHOe OTHomeHHe K HHM co CTOpOHbl PYKOBOAHTenew cpegHero 3BeHa MeCTHoro YPO BHR, Ha KOTOPOM TaKHe HccnegoBaHHJI MoryT 6bJTb npeanpHHJ!Tbl. K) Hay'!Hhle HCCnegoBaHHJI B o6naCTH pa3BHTHJI KaAPOB 3APaBooxpaHeHHJI Tpe6YJOT COTPYAHH'!eCTBa pa3 - nH'!HbJX npoq,eCCHOHanbHb!X rpynn, KOTOPbJe npHBbJKnH pa OOTaTb He3aBHCHMO APYr OT gpyra. n) Hay'!HbJe HCcneAOBaHHJI B o6naCTH pa3BHTHJI KaAPOB 3gpaBooxpaHeHHJI Tpe6yJOT npHHJITHJI gonrocpoq- HblX o6n3aTenbCTB. M) KaK yKa3b!BanOCb Bb!IDe, HeT Me)J(,IlyHapOAHb!X H3AaHHH, noCBJ!WeHHhlX Hay'{HblM HccnegoBaHHJIM B 06- naCTH pa3BHTHJI KagpoB 3gpaBooxpaHeHHJI. Y'laCTHHKH rpynnbl y6e)J(,1leHbJ B HaCTOJ!TenbHOH Heo6xogHMOC:TH npoBeAeHHJI Hay'!HhlX HccnegoBaHHH B 06- nacTH noaroTOBKH Bpa'!eH HnH B o6naCTH pa3BHTHJI KaAPOB 3gpaBooxpaHeHHJ1 AnR pemeHHJI CY!lleCTBYJOl!IHX npoOneM . rpynna TaKJl<e Bblpa3Hna o6ecnOKOeHHOCTb no noBOAY COBpeMeHHOH CHTYaUHH B EBpone, rae Ha- Y'!HblM HccnegoBaHHJIM 8 3TOH o6nacTH , KaK H paHbme, ygenneTCJI Mano BHHMaHHJI. il03TOMY 'lneHhl rpynilbJ HaCTOJ!TenbHO peKOMettaosanH rocygapCTBaM-'lneHaM H PerHOHanbHOMY 6JOpo npeanpHHJ!Tb cnegYJQl!(He Mepbl, KO- TOphle ooecne'!HnH 6bJ nposegeHHe HccnegosaHHH, HeooxogHMb!X gnn opraHH3aUHH 3cjxj,eKTHBHOH H aeHCTBeHHOH noaroTOBKH H o6yqeHHR Kagpos 3APaBooxpaHeHHR. A. PeKOMeHgauHH EsponewcKOMY perHoHanbHOMY 6JOpo B03 1. HH<POPMHPYR rocyaapcTsa-qneHb1 06 HccneaosaHHRX a o6nacTH pa3BHTHR KaAPOB 3APaBooxpaHeHHR H no- OYJ!<AaR HX K npoBeAeHHJO COOTBeTCTBYJOl!IHX HccneaosaHHH , EsponewcKoe perHOHanbHOe 6JOpo MOJl<eT TeM CaMbJM aKTHBH3HposaTb HX y'!aCTHe 8 nogo6HOH aenTenbHOCTH H A06HTbCJI ny'lmero ee nOHHMaHHJI . 3TO MOJl<eT 6bJT b AOCTHrHyTO nyTeM nogroTOBKH H ny6nHKaUHH JICHoro H nOHJITHoro AOKYMeHTa , KOTOpblH BKnJO'!an 6bl HHq,OpMa- UHJO cneaYJOmero xapaKTepa: a) o60CHOBaHHe HeooXOAHMOCTH npoBegeHHJI Hay'!HblX HccnegosaHHH B o6nacTH nogroTOBKH spa'!eH B CBJl3H C MeHJIIO!IIHMHCJI 3aga'!aMH 3ApasooxpaHeHHR; 6) onHCaHHe cospeMeHHOro COCTOJIHHJI H npaKTHKH Hay'!Hb!X HCCnegoBaHHH B o6naCTH pa3BHTHJI KaApOB 3APaBooxpaHeHHJI B nnaHe HX uenew, MeTOAOB , KaapoB , (pHHaHCHpOBaHHR, opraHH3aUHH H pe3ynbTaToB; B) '!eTKOe H BCeo6~eMnJOWee YKa3aHHe Ha rnaBHbJe pe3ynbTaTbl npoBeAe,HHJI TaKHX HccneaoBaHHH B nnaHe pa3BHTHJI H opraHH3aUHH yqpe)J(,IleHHH H KagpoB , (pHHaHCOBOH ITOMepll<KH aonr ocpO'!HOH pa60Tbl H: T . ,[J, . ; - 134 - r) npeAJIO*eHHR OTHOCHTenbHO B03MO*HbIX HanpaBneHH11 AeRTenbHOCTH H CTpaTerm'-i ee ocymeCTBneHHR; C03AaHHR cneuHanbHblX HHCTHTYTOB no 06ecne<1eHHIO HenpephlBHbIX Hay'!Hb!X HccneaoBaHHi'I; C09AaHHR cne1.1HanbHOH CTPYKTYPbl npOABHJKeHHR no cn~6e HayqHbIX pa60THHKOB B paMKaX COBpeMeHHblX yqpellt,l).e- HHH; CTpaTerHH npHHRTHR peweHHi'I; accHrHOBaHHR cpeACTB; CTHMYnHpoBaHHR npaBHTeJlbCTBaMH Ha- Y'!Hb!X HccneaoBaHHH B o6naCTH pa3BHTHR Ka.I\POB 3APaBooxpaHeHHR BO Bcex nOAXOARWHX AnR 3 Toro ueHTpax, y qpellt,IJ.eHHRX H opraHH9al.lHRX HT.A. 2. PerHOHanbHOe DIOPO MO*eT npwaepJKHBaTbCR CBOe H OObl'IHOH npaKTHKH B o6ecne'!eHHH noaroTOBKH KaA- pOB, HanpaBnRR ycHnHR Ha opraHH9al.lHIO MHOrOAHCUHnnHHapHbIX KYPCOB B o6naCTH HayqHbIX HccneaoBaHl-ill pas- BHTHR KaAPOB 3APaBooxpaHeHHR. Coaep*aHHe TaKHX KypCOB MO*eT COOTBeTCTBeHHO OXBaTb!BaTb: ( i ) nop- roTOBKY npenoaaBaTeJiei'!, KOTOPble 6YAYT HHTCTPYKTHpOBaTb nHI.1, BXOARWHX B 6pHraAbl nepBH'IHO t:I Meamrn - caHHTapHOH nOMOWH; (ii) pa3pa60TKY MeTOAOnorHH Hay'!Hb!X HccneaoBaHHi'I . 3TO MoryT Ob!Tb noaroTOBH- TeJibHble KYPCbl HnH KYPCbl nOBbWJeHHR KBanHCI)HKaJ.IHH. K BOnpocy noa6opa npenoaaBaTeneH HaAO noaot:ITH c oco6oi'! OTBeTCTBeHHOCTblO. 3. PerHOHanbHOe 610po MOXeT C03AaTb Hay'IHYIO pa6o<tyl0 rpynny C l.leJlblO: ( i) Ha6n10AeHHR 3a pasBHTHeM HayqHbIX HccneaoBaHHi-i B o6nacTH noaroTOBKH Bpaqei'!; ( ii ) o6ecne<teHHR nepBooqepeAHOCTH HX npoBeae- HHR; ( iii) paspa60TKH Heo6XOAHMOH TeopeTH'leCKOt:I cxeMbl. E. 1. 3aHHOCTH KOToporo 6yaeT BXOAHTb coaeHCTBHe HBY'IHblM HccneaoBaHHRM B o6nacTH noaroTOBKH Bpaqei'! nyTeM: (i) onpeaeneHHR oqepeAHOCTH B HCcneaoBaHHRX B o6nacTH pa3BHTHR Ka.I\POB 3APaBooxpaHeHHR; (ii) accHr- HOBaHHR cpeACTB Ha npoBeAeHHe 3THX HccneAOBBHHH; (iii) pacnpocTpaHeHHR pe3ynbTBTOB HBY'IHblX Hccne- AOBBHHH AJIR npaBHnbHoro H KOMileTeHTHOro npHHRTHR peweHHi'I; ( i v) coaei'!CTBHR npHMeHeHHIO pe3ynbTaTOB Hay'!Hb!X HccneAOBBHHH. B COCTaB TaKoro KOMHTeTa HnH COBeTa MOryT BOHTH npeacTaBHTeJIH cn~6 3APaBo- oxpaHeHHR, OTBeTCTBeHHble 33 pa9BHTHe nepBH'IHOH MeAHKo-caHHTapHOH noMoWH; npeacTaBHTenH c~6 nep- BH'IHOH MeAHKo- caHHTBP HOH nOMOWH; npeacTaBHTeJIH CHCTeMbl o6yqeHHR Ka.I\POB 9APaBooxpaHeHHR; npeacTa- BHTenH noTpe6HTeJieH nepBH'IHOt:I MeAHKo- caHHTapHot:I noMOlllH; nHua, o6naaaKl!Uie Oilb!TOM npoBeAeHHR Hccne- aoBaHHH B o6naCTH pasBHTlli! Ka.I\POB 3ApaBOOXpaHeHHR . 2. rocyaapCTBa-qneHbJ MOryT C03AaTb CTa6HnbHYIO Ce Tb yqpellt,IJ.eHHH, OCOOblX rpynn HnH ueHTPOB' HecymHX OTBeTCTBeHHOCTb 3a: (i) npoBeaeHHe HBY'IHbIX HccneaoBaHHt:I ; (ii) noaroTOBKY Hay'!Hb!X pa60THHKOB; ( i.ii) pacnpocTpaHeHHe H nepeaaqy pe3ynbTaTOB HayqHbIX HccneAOBaHHH, B09MO*HO qepe3 cne1.1HanbHb!t:I KOMH- TeT HnH COBeT, 0 KOTOPOM roBOPHTCR BbWle B peKOMeHAallHH E.1. 3. rocyaapCTBa- qneHbJ MoryT OKa3b!BaTb coaei'lcTBHe npoBeAeHHIO MHOrOAHCJ.IHnnHHapHb!X HCcneaoBaHHH no TaKHM TeMaM KaK : 9Ha'!eHHe H9MeHeHHH B nonHTHKe B o6naCTH 3APaBooxpaHeHHR, MOAeJIH MeAHKo-caHHTapHOH nOMOJllH , OTBeTCTBeHHOCTb OTAenbHblX IlHJ.I H HaceJieHHR B uenoM 9a noA,D,ep~aHHe 9AOPOBbR . 4. rocyaapCTBa-qneHbJ MoryT paCCMOTpeTb B09MO~HOCTb Hcnonb30BaHHR HMeKl!UiXCR B B03 cpeACTB Ha onna- TY CTHneHAHaTOB Kallt,IJ.OH CTpaHbJ AJIR opraHH3aUHH HayqHblX HCCneaoBaHHi-i B o6nacTH noaroTOBKH Bpaqet:\. s. rocyaapCTBa-qneHbJ MOryT coaei'ICTBOBaTb npoBeaeHHIO KOH~epeHum'-i, opraHH3aJ.IHH COBewaHHH, pa60'IHX r pynn HT.A. no BOnpocaM Hay'!Hb!X HCcneAOBaHHt:I B o6naCTH P39BHTHR Ka.I\POB 3APaBooxpaHeHHR . 6. IlpaBHTenbCTBa H/ HnH npo~eCCHOHanbHble opraHH3aUHH MOryT CTHMYnHpOBaTb npoBeAeHHe HBY'IHbIX Hc- c neAOBaHHi-i H pa9BHTHe noaroTOBKH Bpaqei'! nyTeM: ( i) C03AaHHR cneuHanbHblX rpynn AJIR H3y'leHHR noTpe 6- HOCTeH B yqe5Hb!X MaTepHanax o6wero Ha3Ha'leHHR AJIR COBpeMeHHblX H DYAYWHX pa60THHKOB 6pHra.I\ nepBH'IHOH MeAHKO-caHHTapHOH noMoWH; (i i ) ~HHaHCHPOBaHHR BbITTYCKa H 01.1eHKH HeaoporHX H none3Hb!X yqe6Hb!X noco- 6Ht:I; (iii) ony5nHKOBaHHR pesynbTBTOB CBoeA aenTenbHOCTH. 7. B EBponeHCKOM perHOHe nepeaaqa HH~OpMaI.IHH H 06MeH elO MoryT ocymeCTBnRTbCR nyTeM perynRpHOH, 'IBCTOH H Ob!CTPOH ny6nHKaUHH KPBTKHX OT'leTOB H HX pacnpocTpaHeHHR . 0 TBeTCTBeHHOCTb 33 ocymecTBne- HHe 3TOH pa60Tbl MOryT B3RTb Ha ce6R HHCTHTYTbl, H9AaTenH H npo~eCCHOHanbHble opraHH33J.IHH. 8. B OCHOBHYIO H nocTAHnnoMH)'IO noaroTOBKY Kallt,IJ.Oro pa60THHKa 3APaBOoxpaHeHHR HaAJieJKHT BKnlO'IBTb on- peaeneHHb!H KYPC noaroTOBKH no npoBeaeHHIO HCCneaoBaHHH B o6naCTH pa3BHTlli! Ka.I\POB 3APaBooxpaHeHHJI, npH 3TOM ynop AO~eH Db!Tb caenaH Ha OI.leHKY MeAHKo - caHHTapHot:I nOMOWH. 9. PyKOBOARWHe opraHbJ, OTBeTCTBeHHble nHua H rpynnbl MOryT CTHMYnHpOBaTb n106oe Ha'IHHaHHe noTpe 6HTe- nei'I nOMOWH H aKTHBHO npHBne Ka Tb HX K nnaHHPOBaHHIO H ocymeCTBneHHIO Hay'!Hb!X HccneaoBaHHt:I B o6nacTH pa3BHTHR Ka.I\POB 3APaBooxpaHeHHR . CeMHHap no Henpeph!BHOMY 06,n;eHHJO pa60THHKOB 3gpasooxpaHeHHJ1 B CHCTeMe nepBH4HOH MeAHKo-caHHTapHOH nOMOIIIH CaH-PeMO (HTanHH), 19- 20 OKTHOPH 1981 roga - 135 - ICP/ MPM 0 19 (8) 3 HOHDPH 1981 roga 0PHfr!HAJl : AH rJJ1111CKJ1f! B pa6oTe CeMHHapa npHHRnH ,n;aCTHe 23 npegcTaBHTenH H3 15 CTpaH H 4 COTPYAHHKa B03 . Y4aCTHHKH CeMHHapa 3aHHMatOTCH B OCHOBHOM BonpocaMH noCTAHTTnOMHOH nogroTOBKH H ycosepmeHCTBOBaHHH Bpa4eH, OT - gen&HblMH npo6neMaMH nOBbl!DeHHH KBarIH¢HKaUHH MeAHUHHCKHX cecTep, a TaK*e BonpocaMH opraHH3aUHH MegH- KO- CO UHaribHblX HccnegoBaHHH H nepBH4HOH MeAHKo- caHHTapHOH nOMOWH . rnaBHaH uen& CeMHHapa COCTOHna B TOM, 4T00bl OTBeTHTb Ha Bonpoc: KaKHM o6pa30M PYKOBOAHTenb 3gpasooxpaHeHHH, OTBeTCTB eHHbIH 3a cnyi,;6y nep BH4HOH MeAHKo- caHHTapHow noMOWH (IIMCIT) , MO*eT B nnaHo- BOM nopHgKe Hcnonb30BaTb CHC T eMY HenpepbiBHOro o6y4eHH>t B Ka4eCTBe cpegcTBa peme HHH npo6neM 3gpaso- oxpaHeHHH H ycTpaHeHHH HegocTaTKOB B MeAHKo-caHHTapHblX cnyi,;Oax H B CHCTeMe npo¢ecCHOHan&HOH nogro- TOBKH? Uen&ID CeMHHapa Dbl!IO TaK*e 03HaKOMHTb ero ,n;aCTHHKOB, pa6oTaIDWHX B o6naCTH npocsemeHHH C 3aga- 4aMH EsponeHCKOH perHOHaribHOH CTpaTerHH no AOCTH*e HHID 3AOPOBbH gnH Bcex K 2000 rogy H y6egHTb HX B HeODXOAHMOCTH nposegeHHH aHarIH3a 3TOH CTpaTerHH C T04KH 3peHHH ee B03AeHCTBHH Ha nporpaMMbl o6y- 4eHHH. Es poneHCKOMY perHOHaribHOMY DIDPO B03 CeMHHap gan B03MO*HOCTb onpegenHTb, KaKOH MeTOA HnH npo- uecc MOryT Hcnon&30BaTb PYKOBOAHTenH HaUHOHaribHoro 3gpanooxpaHeHHR H y4e6Hble 3aBegeHHH npH nogro- TOBKe nepcoHana nepBH4HOH MeAHKo- caHHTapHOH noMOWH H npenogasaTenew gnH onpegeneHHH 3aAa4 o6y4eHHH H Hcnon&30BaHHH HenpepblBHOro o6y4eHHH B uenHX pa3BHTHH nepBH4HOH MeAHKo - caHHTapHOH nOMOIIO-I. ITpegbICTOP HH C03b!Ba CeMHHapa EsponeHCK HH perHOHaribHblH KOMHTeT B03 npHHHn PerHOHaJ!bHYID CTpaTerHID no AOCTH*eHHID 3AOPOBbID gnR scex K 2000 rogy, KOTOpaH no CYTH gena HBnHeTCH npoeKTOM opraHH3aUHH H pa3BHTHH nepBH4HOH MeAHKO - caHHTap HOH noMOIIIH B EnponeHCKOM perHOHe Ha npegCTOHmtte ABa gecHTHneTHH . ITo3TOMY 3Ta CTpaTe rHH HMeeT 6on&moe 3Ha4eHHe gnH opraHH3aUHH 06,n;eHHH H nogroTOBKH nepcoHana IIMCIT . IToCKOnbKY, 6on&mHH - CTBO pa60THHKOB 3gpasooxpaHeHHH , KOTOphle DYAYT HeCTH OTBeTCTBeHHOCTb 3a ocymecTBneHHe CTpaTe rHH, YJKe 3aHHTbl npaKTH4eCKOH pa60TOH H MHOrHM H3 HHX gnH peanH3aUHH 3TOH CTpaTerHH npHAeTCH OBnageTb HO - BblMH HaBblKaMH, 04eBHAHO, 4TO HenpephlBHOe 06y4em1e 6ygeT HrpaTb OCODYID ponb B Ka4eCTBe BCnOMOraTen&- Horo cpegcTBa, KOTOpoe PYKOBOAHTenH 3gpasooxpa HeHHH MOryT HCnOnb30BaTb gnR ocymeCTBneHHH CTpaTe rHH . ITo 3 TOh np1-j4HHe B03 AO=Ha ygenHTb oco6oe BHHMa HHe pa3BHTHID TaKOH CHCTeMbl HenpepblBHoro o6yqe - HHH, KOTO paH n03BOnHna Obi PYKOBOAHTenHM 3gpasooxpaHeHHH Hcnon&30BaTb ee B pa3nH4HblX ycnoBHHX H C ,n;eTOM HeOOXOAHMOCTH nepsooqepegHoro pa3BHTHH IIMCIT . TpaAHUHOHHblM ¢opMaM noBblilleHHH KBarIH¢HKaUHH B Espo nehCKOM perHOHe He XBaTaeT MHOrHX qepT , npHCymHX CHCTeMe npocsemeHHH, KOTopaH MO*eT Ob!Tb Hcnon& - 30BaHa B 3TOM nnaHe. CnegyeT npogenaTb 6on&myID pa6oTy no pa3pa60TKe H np!-iMeHeHHID npHHUHnOB nOBb(- llleHHJ! KBanH¢HKaUHH, KOTOPbie B CBOe speMH Dbl!IH onpegeneHbI KOMHTeTOM 3KcnepTO B B03 H uem1M PHAOM pe - rHOHaribHblX pa604HX rpynn, a Ta,-*e pa3nH4HblMH gpyrHMH o praHaMH, HO pegKO npHMeHHnHCb Ha npaKTHKe . Cew4ac , Korga ITMCIT B TOM BHAe , KaKow ew npHgana AnMa- ATHHCKaR AeKnapauHH , npHHHTa a Ka4ecTse CTpaTerHH no AOCTH*eHHID 3AOPOBbH gnH Bcex, EaponeHCKOe perHOHaribHOe DIDPO nogqepKHBaeT Heo6XOAHMOCTb npaKTH4eCKoro npHMeHeHHH 3THx npHHUHnos B OTHome.HHH ITMCIT, H CeMHHap B CaH - PeMo HBnReTCH nepBblM B cepHH 3annaHHPOBaHHblX MeponpHHTHh, HanpaaneHHb(X Ha AOCTH*eHHe 3TOH uenH . ITOCKOnbKY B HaCTOH111ee apeMJ! perHOHaribHaH CTpaTerHJ! HBnHeTCH B H3BeCTHOM c~1cne npegMeTOM H3y- 4eHHH B CHCTeMe HenpepbiBHOro o6y4eHHH nepco Hana nep BH4HOH MeAHKO-CaHHTapHOH nOMOIIOi, nporpaMMa pa6o- Tbl CeMHHapa COCTasneHa TaKHM o6pa30M , 4TO ero y4aCTHHKH CMOrnH npoaHanH3HpoBaTb PHA npo6neM, aHano - rH4HblX TeM , gnR pemeHHH KOTOPblX Dhl!Ia c¢OPMYnHpOBaHa CTpaTerHH, onpegenHTb 3aga4H nepcoHana ITMCIT !!O HX pewe HHID, a TaK*e onpegenHTb COOTBeTCTBYIDIIO-le HOBble HaBblKH, Heo6XOAHMble HM AnH BbinOnHeHHH 3THX 3aga4. OsnageHHe 3THMH HaBb!KaMH CTaHeT uenbID Henpepb!BHoro o6y4eHHH. - 136 - TI03TOMY 3TOT CeMHHap cny,KHT uenHM npaKTHQeCKOH nogroTOBKH K npHMeHeHHID MeTOAB HnH MeTOAOB, KO- TOPbJe 15ygyT Hcnonb90BaHb1 OpHragoH DMCD HnH PYKOBOAHTeneM 9gpaBooxpaHeHHH npH cogeHCTBHH cnyiKl5 He- npepbJBHoro ol5~eHHH nnn aHanH98 npol5neM H 9agaq DMCD B KaQeCTBe OCHOBbl nnn npoBegeHHH oueHKH SHaHHH H YPOBHR nonroTOBKH qneHOB 15pHraJlbJ H nnn onpegeneHHH KOHKpeTHblX noTpel5HOCTeH B ol5yqeHHH H nogroToB- Ke, KOTOpble cny,Kl5bJ HenpepbJBHOro oOyqeHHH noMoryT YAOBneTBOPHTb. B 3TOM nnaHe HenpepbJBHOe ol5yqeHHe HrpaeT BCnoMoraTenbHYID ponb, H 15pHraga nepBHQHOH MeAHK O-caHH- TapHOH nOMOII\H HeceT rnaBH~ OTBeTCTBeHHOCTb 98 BblllBneHHe HenocTaTKOB B npouecce ol5~eHHH H 98 HX ycTpaHeHHe. Og HaKO, noCKOnbKY MHOrHM palSOTHHKaM DMCD noTpel5yeTCH nogroTOBKa H nOMOWb npH BblTIOnHe - HHH B09nO*eHHbJX Ha HHX ol5H9aHHOCTeH, yqacTHHKH CeMHHapa BhlCKa9anH MHeHHe, QTO nHua, HeCYII\He OTBeT- CTBeHHOCTb 98 nOBblllleHHe KBanH¢HKaUHH no=Hb1,npeJKL1e Beere, 03HaKOMHTbCH C perHOHanbHOH CTpaTerHeH H ITOTpel5HOCTHMH ITMCD, a TaK*e C MeTOAaMH nogroTOBKH PYKOBOAHTeneH OpHraA IIMCD, B xoge KOTOPOH OHH OB- nageBaIDT HOBhlMH SHaHHHMH H HeOOXOAHMhlMH HaBhlKaMH. JlHmb HeMHOrHe paOOTHHKH, OTBeTCTBeHHbJe 98 He- npephlBHOe oO~eHHe, ol5nanaIDT npaKTITTeCKHM onbJTOM, HeoOxOAHMhlM Aml BhlnOnHeHHH HOBhlX 9agaq B paMKaX ITMCD. L\JU1 MHOrHX ~aCTHe HaceneHHH, Me*CeKTOpanbHOe COTPYAHHQeCTBO, OXBaT MenHKo- caHHTapHbJMH cnyiK- 15aMH KOHTHHreHTOB HaceneHHH, paHee He HMeBWHX K HHM AOCTyna, H YH9BHMblX rpynn HaceneHHH H COOTBeT- CTBYIDWaH noggep*Ka nepBHQHOH MeAHKo-caHHTapHOH nOMOII\H co CTOPOHbl CnyiKl5 MeAHKO-caHHTapHOH noMOIItH BTOPHQHOro H TpeTHQHOro YPOBHeH HBnHIDTCH cosepmeHHO HOBhlMH KOHuenuHHMH, 3TH pal50THHKH AO=Ha npe- n ogaBaTb He TOnbKO TeopHID ITMCD B TOM BHAe, KaK OHa Hsno*eHa B perHOHanbHOH CTpaTerHH, HOH npHol5- pecTH TBKOH onhlT B ol5nacTH noBhlmeHHH KBanH¢HKaUHH, KOTOPhlH noSBOnHn l5bJ HM HaXOAHTb OTBeT B npaKTH- qeCKHX CHTyauHHX Hanogol5He Tex, KOTOphle l5bIJJH CMOAenHpOBaHbl B xoge palSOTbl CeMHHapa . DpaKTHQeCKHe MeponpHHTHH CeMHHapa Yq acTHHKH CeMHHapa pasgenHnHCb Ha cnegyIDIItHe rpynnbl B COOTBeTCTBHH C npoOneMaMH, Hsno*eHHb!MH B AOKYMeHTe no perHOHanbHOH CTpaTerHH: no npol5neMaM ol5pasa *HSHH, ¢H9HQeCKOH cpeghl, COUHanbHOH naTo- n orHH, nyTHM npeogoneHHH HegocTaTKOB cnyiKl5 9gpasooxpaHeHHH, a TaKJKe no pa9pa60TKe TaKHX sneMeHTOB CTpaTerHH sgpasooxpaHeHHH, KaK: COAeHCTBHe pasBHTHID ol5pasa *H3HH, OnaronpHHTHOro nnn 3AOPOBbH, CHH*eHHe pacnpocTpaHeHHOCTH npegOTBpaTHMblX 15onesHeH H oOecneqeHHe ageKBaTHOH ITOMOWH, AOCTYITHOH H npHeMn eMoH nnn scex . B xoge paOOTbJ B paMKax nepBOH qacTH nporpaMMbl ~aCTHHKH rpynn onpegen»nH Kpyr npol5neM, c KoTo- PbIMH HM npHXOAHnOCb CTanKHBaTbCH Ha npaKTHKe, COCTaBHnH nepeqeHb STHX npoOneM C yKasaHHeM OTgenb- HblX acneKTOB STHX npoOneM H CTeneHH HX cnO*HOCTH. Bo BpeMH BTOporo STana palSOTbl yqacTHHKH CeMHHa- p a Bhll5Hpana TY HnH HHYID npol5neM)' HnH HeCKOnbKO npol5neM gnn onpegeneHHH H aHanHsa 9agaq, KOTOPbJe npHSBaHa peUIHTb OpHraga ITMCD, KOHKpeTHSHPOBanH Heol5xogHMble qneHaM OpHranbl 3HaHHH H HaBblKH, npHBOAH- n H npHMepbl ¢YHKUHH H 9agaq, KOTOphle AO=Hbl pemaTb 15pHranbl HnH OTAenbHble nHUa B KOHKpeTHb!X npol5neM- Jn,JX ol5naCTHX, Ben 3Ta pal5oTa npHsBaHa nOMOQb cosgaHHID OCHOB BCnOMoraTenbHOH cnyiKl5bl HenpepbJBHOro ol5~ eHHH, YqacTHHKH CeMHHapa npHWnH K BhlBOAY, QTO npH pemeHHH KaJKLIOH npol5neMbJ cnegyeT BKnIDQaTb B 15pHragy ITMCD npencTaBHTeneH HaceneHHH H HeMeAHUHHCKHX ceKTOPOB, TpeTbH qacTb nporpaMMbl 15b1Ila noCBHWeHa onpegeneHHID Ha OCHOBe pe9ynbTaTOB paOOTbl no nepBOH H BTOPOH qacTH nporpaMMbl acneKTOB MeTOAOnorHH H opraHHsauHH CHCTeMbJ HenpephlBHoro oO~eHHH H CBH3H '.c> TOH CHCTeMbJ c MeAHKo- caHHTapHOH Cny,K00H. HauHoHanbHaH CHCTeMa HenpepbJBHOro ol5~eHHH, npHSBBHHaH cogeHCTBOBaTb pasBHTHID nepBHQHOH MegH- Ko-caHHTapHOH noMOWH, MO~eT BblTIOnHHTb ABe rnaBHble ¢YHKUHH, DepBaH ¢YHKUHH saKnIDqaeTCH B CHCTeMa- THQeCKOM HCITOnb30BaHHH COBpeMeHHOH TexHonorHH oO~eHHH nnn BHegpeHHH HOBblX HaBblKOB H nepcneKTHB, c naBHbIM oOpasoM B ol5nacTH ol5~eHHH, snHgeMHonorHH H couHonorHH, B HaUHOHanbH~ CHCTeMY DMCD. 3 Ta pal5oTa AO=Ha npOBOAHTbCH HaPHAY C pa9nHQHb!MH gpyrHMH MeponpHHTHHMH HenpocBeTHTenbHOro xapaKTe- pa, 15es KOTOPhlX Henb3H AOCTHQb ueneH ol5~eHHH, CTOHWHX nepen oO~eHHeM KaK TaKOBblM, llJ)yraH rnas- HaH ¢YHKUHH, KOTopaH AO~Ha BhlnOnHHTbCH Ha MeCTHOM YPOBHe, saKnIDqaeTCH B oOecneqeHHH KOHKpeTHblX noTpel5HOCTeH 15pHrag IIMCD B oOnacTH ol5yqeHHH H nogroTOBKH, BKnIDQaH OKa3aHHe nOMOWH npH nposegeHHH oueHKH SHaHHH H palSOThl, H B onpegeneHHH npHQHH HeygosneTBOPHTenbHOro BblTIOnHeHHH STOH paOOThl HnH He- yg aq B AOCTHlKeHHH ueneH, CTOHWHX nepeg MeAHKo- caHHTapHOH nOMOWbID, a TaKJKe B OKasaHHH KOHcynbTaTHB- HOH nOMOWH B nene HcnonbSOBaHHH MeTOAOB OCBOeHHH HOBhlX HaBhlKOB HnH opraHH3aUHH ~el5Hb!X MeponpHHTHH, Korna STO HeOOXOAHMO. EpHragbJ nepBHQHOH MeAHKo-caHHTapHOH nOMOWH AO~Hbl osnageTb HOBblMH HaBbJKaMH H nepecMOTpeTb CBOe OTHOWeHHe K snHgeMHonorHQeCKHM. COUHOnorITTeCKHM, ~el5HbJM, KOMM)'HHKaUHOHHbJM H gpyrHM npol5neMaM, C TeM QTOl5bl nepeopHeHTHPOBBTb cnyiKl5bJ nepBHQHO H MeAHKO-CBHHTBPHOH n OMOWH Ha BbIDOnHeHHe saga'!, BbJTe- KaIDWHX HS Es p o neHCKOH perHOHanbHOH CTpaTerHH no AOCTHJKeHHID 3AOPOBbH nnH scex K 2000 rogy. DpHol5- pecTH 3TH HOBble HaBhlKH H 9aTeM cosepmeHCTBOBaTb HX MO*HO H B xoge npaKTHQeCKOH pal5oTbl B CHCTeMe nepBH'IHOH MeAHKo-caHHTapHOH nOMOWH, OAHaKO opraHbl sgpasooxpaHeHHH ITOQYBCTBYIDT Heol5xoAHMOCTb B - 137 - CHC TeMe HenpepbmHoro o6yqeHHR, KOTopaR ITOMO~eT opraHH3aUHH H pa3BHTHID nepsHqHOH MeAHKo-caHHTapHOH ITOMOII\H. B csoeH ae.RTeJibHOCTH npenoaasaTeJIH CHCTeMbI HenpepbIBHOPO o6yqeHH.R AO~Hbl PYKOBOACTBOBaTbC.R 3agaqaMH HOBOH CTpaTerHH nepsHqHQH MeAHKo-caHHTapHOH ITOMOII\H, 6bITb B Kypce npo6JieM , CTO.R~HX nepea qJieHaMH 6pHraa nepsHqHQH MeAHKo - caHHTapHOH ITOMOII\H , H cnoco6os HX pemeHH.R . 0Tcroaa - Heo6XOAHMOCTb B cosepmeHHO OTJIHqHQM OT HbIHemHero noaxoga K opraHH3aUHH HenpepbIBHOPO o6yqeHH.R B esponeHCKHX cTp a Hax. - 139 - РАК - 141 - 06oeAHHeHHOe coee111aHHe MIIC/803 no Op!'aHH3aUHII npeAAHTIAOMHOH nOAl'OTOBKH e o6AacTH OHKOAO l'HH ICP/ CAN 013 ( S) 29 MaR 1981 l'OAa oPHrHHAJI: AHr JIIDicrorn BaeAeHHe IlpeA- H noCTAHllAOMHaR llOAl'OTOBKa B o6AaCTH OHKOAOl'HH HenocpeACTBeHHO CBR3aHa co CAyx6rurn 6opb- 6M npOTHB paKa H pa3BHTHe 3THX CAyx6 B p33HhlX CT paHaX npoHCXOAHT HeOAHHaKOBO, T3K KaK 3aBHCHT OT MeCTHblX yCAOBHH B Kax..zr;oH KOHKpeTHOH CT paHe PeruoHa . Il03TOMy MOXHO CKa3aTb, qTO opraHH3ailHH npeA- AHllAOMHOH llOAl'OTOBKH B o6A3CTH OHKOAOl'Hll II ee COAe pxaHHe 0Tp3X3IOT c nenH¢HKy CTpaHw. B TO BpeMR, KaK HeKOTOphie CTpaHw yxe npHCTYllHAH K ocymeCTBAeHHIO OTAeAbHWX npo!'paMM no OHKOAOrHH, APYl'He - npe- AYCMBTpHBaIOT npoBeAeHHe TaKOH llOAl'OTOBKH B paMK3X AHCllRilAHH, AAR KOTOPWX yxe COCTaBAeHW y qe6Hwe nporpaMMhI, T3KHX, KBK !'HHeKOAOl'HR, XHPYPl'HR, BHyTpeHHHe 6oAe3HH II neAllaTpllR . Bee B 60AhmeH CTeneHH H3XOAHT npH3HaHHe TOT ¢aKT, qTQ B 60AhmHHCTBe CTpaH npH op!'aHH33UIIH npeA,4HllAOMHOH IlOArOTOBKH CAHIIIKOM MHOro BHHYSHHR YAeAHeTCH TeXHHqec KHM, BhlCOKOCneuHaJIH3HpoBaHHL[M ac- neKTaM o6yqeHHR H HeAOCTaToq110 TaKHM acneKTaM, K3K npo¢HABKTHKa, CKpHHHHI', ncHxo - conuaAbHWe (a oco- 6eHHOCTH naAAHaTHBHWe) yCAOBHR H OK33BHHe nepsuquoH MeAHKO - CaHHTBpHOH noMOmH paKOBhIM 60AhHhIM. CAe- AYeT T3KXe aKneHTHpOBBTh BHHMBHHe Ha pa3BHTHH COTPYAHHqecTBB MeXAY c nenHBAH3HpOBBHHhlMH OHKOAOrH- qecKHMH CAyx6a,rn II CAyX6aMH nepBHqffQH MeAHKO-CBHHTapHOH llOMOl!IH, a 803MOXHO H Ha HX HHTe!'pBUHH. Ilpo6AeMW TBKOH nOAl'OTOBKH snepswe o6cyxAaAHCb Ha Pe!'HOHBAbHOH KOH¢epeHUHH no opl'BHH3BilHH npe,llAHTIAOM- Horo o6yqeHHR 8 o6ABCTH OHKOAOl'HH (KpaKOB, 1972 r.), opraHH308BHHOH MeX,llyHapOAHhlM npOTHBopaKOBWM COI030M ( Ml1C) . B HBCTORmeM CoaemaHHH, op!'aHH30BBHHOM EaponeHCKHM pe!'HOHBAhHhlM 6mpo 803 H MIIC 8 COTPYAHHqeCTBe C npaBHTeAbCTBOM maeim;apHH , EsponeHCKOH op!'aHH330HeH no HayqttWM IICCAeAOBaHHRM B o6AaCTH AeqeHHR pa- Ka (EOHJIP) 11 Ligue genevoise contre le Cancer , npHHRAH yqacTHe 34 npeACTaBHTeAR H3 20 cTpa11, 12 speMeHHhlX COBeTHHKOB 803, OAHH KOHCYAhT3HT 803 H 4 COTPYAHHKB 803. B qHCAO speMeHHWX COBeTHHKOB BOIIIAH 8 OCHOBHOM AHpeKTOpa OHKOAOl'H<leCKHX ueHTpOB, pyKOBOAHTeAH HaUHOH3AhHWX y qpexAeHHH no npeAAlIIl- AOMHOH MeAHUHHCKOH llOAl'OTOBKe, AHPeKTOpa MeAHUHHCKHX mKOA, npo¢ec copa-OHKOAOl'H M9AHUHHCKHX IIIKOA, PYKOBOAHTeAH CAy~6 06111eCTBeHHOl'O 3ApasooxpaHeHHR, PYKOBOAHT9AH nporpaMM no Op!'aHH3aUHH nepBHqHOH Me~HKO-CSHHTapHoH IlOMO~ Ha KOMYyHaAbHOM ypoeHe , a TSKXe HayqHQ-HCCAeAOBaTeAbCKHe pa6oTHHKH, cnenHa- ,rH3Hpy10111necR B o6AaCTH M9AHUHH CKOl'O o6yqeHHR. UeAb CoaemaHHR COCTORAa 8 npOB9A9HHll aHaAH3a pa3Affq11wx MOA9A9H o6yqeHHR, oueHKe pe3yAhTaTOB, AOCTHrH yTwx y qpeXAeHHRMH, 33HHM3IOIIIHMHCR npe,llAHTIAOMHOH llOAl'OTOBKO H B o6A3CTH OHKOAOl'HH B CTpaHax Pe- l'IIOHa, H B awpa6oTKe peKOM9HA3llHH B OTHOmeHHH A3AhH9Hm91'0 pa3BHTHR nOAl'OTOBKH K3ApOB . .llHCltyCCHR YqaCTHHKH CoaemaHHR npoaHaAH3HpOBaAH nOAOX9HHe A9A B OTHOmeHHH npeAAHTIAOMHOH nOAl'OTOBKH B 06- ,taCTH OHKOAOl'HH 8 CTpaHaX PerHOHa H 06 CyAHAH c.teAYI01!1H9 npo6A9Mhl: L 1) pe3yAbTaThl npo BeAeHHWX 803 II MIIC o6CA9AOB3HHH COCTORHHR nOAl'OTOBKH B o6A3CTH OHKOAOrHH; 2) pOAh OHKOAOrHqeCKHX HHCTHTyTOB H A06pOBOAhHWX OHKOAOl'H<l9 CKHX accouHallHH B opraHH33UHH npeAAHilAOMHOK IlOArOTOBKH B 3TOH o6AaCTH f 3) a HaAH3 TO<leK 3p9HHR CTYA9HTa-M9AHKa, rrpaKTHKYIOlll91'0 apaqa - He cneuHaAHCTa B o6A3CTH OHKO- AOrr11z(oco6eHHO apaqa o6meH npaKTHKH) H OHKOA0 1'3-KAHHHUIICTa OTHOCHTeAbHO COCTORHHR npeAAffnAOM- HOff IlOArOTOBKH a o6AaCT H OHKOAOPH H; - 142 _ 4) HOBhle BeJIHHR B $HJIOCO$HH, TeXHOJIOrHH H MeTOAOJtOrHH MeAHUHHCKOro o6yqeHHR, MOAeJtb yqe6Hofi nporpa= no noArOTOBKe B o6JtaCTH OHKOJ1or1m; opraHH3aUHR nporpaMMhl Hee ouettKa; 5) HanpaBJteHHe AeRTeJlbHOCTH M11C, ero AOCTHJleHHR H noTeHuHaJtbHaR POJth, KOTOPYJO MOieT HrpaT b EBponeHCKOe perHOHaAbHOe 6ropo B03 B AeJte pa3BHTHR noArOTOBKH MeAHUHHCKHX CTyAeHTOB B o6JtaCTH OHKO.JIOrHH. B XOAe AHCKyCCHH 6btJIO ycTaHOBJteHO' qTO Mex.a;y ¢aKTHqeCKHMH noKa3aTeJIRMH 3clJ<l)eKTHBHOCTH JteqeHHR II BO3MOIHO AOCTHIHMhlMH noKa3aTeJIRMH 3clJ<l)eKTHBHOCTH JteqeHHR, KOTOpbtx MOIHO A06HTbCR, AOJIIHhlM o6pa30M HCnOJtb3Y H HaKonJteHHhle 3HaHHR, cymecTByeT 60JthmO >I pa3phlB, Bee 3TO JIHJJIHHH pa3 CBl!AeTeJtbCTByeT O TOM, H8C KO.JlhKO BWKHa npo6.J1eMa o6yqeHHR B 06.J1aCTH OHKO.JIOrHH H CKO.JlbKO XH3HeTI BO BCeM MHpe MOXHO cnaCTH, pacnpOCTpaHHR H HCDO.Jlb3yR yxe H&KOil.JleHHbie B 3TOll 06.Jl&CTH 3HaHHR. Pa3BHTHe H8yKH, KpOMe Toro , B 3HaqHTeJtbHO H CTeneHH cnoco6cTByeT JteqeHmo HeKOTOphlX BH,llOB paKOBhlX 6oJte3Hefi, H 3TOT ¢aKT JtHmHHH pa3 n OA TBepXABeT He06XOAHMOCTb pacmHpeHHR yCHJIHH, HanpaBJteHHhlX Ha pa3BHTHe o6yqeHHR. IlOJIHTHKa Ml1C B o6JtBCTH noArOTOBKH CTyAeHTOB no OHKOJ!Ortm OCHOBhlBaeTCR Ha noJtyqeHHhlX B pe3yJtbTB - Te attaJ1H3a ¢aKTBX, KOTOphle roaopRT O TOM, qTo BO MHOrHX CTpattax MeTOAhl noArOTOBKH KBAPOB H yqe6Hhle nporpBlOW RBJIJDOTCR Ha Bcex ypoBHRX PYAHMeHTBpHhlMH, HeBAeKBBTHhlMH HJIH HX He cymeCTByeT BOo6me. IlpH pa3pa60TKe caoefi nporpaMMbt no noArOTOBKe KB.a;pOB M11C YAeJtReT OCHOBHOe BHHMBHHe npe.a;AHnJIOMHOMy o6yqeHmo. B qacTHOCTH, HM npeTBOpJDOT CR B XH3Hb HeCKOJlbKO npoeKTOB, ueJtb KOTOphlX - npoaHBJIH3HpOBBTb, KBK nocTaBJteHO o6yqeHHe B o6JtaCTH OHKOJIOrHH B pa3HhlX CTpattax MHpa. MIIC ony6JtHKOBBJI Yqe6HHK no OH- KOJ!Ormt H npoBeJI PRA perHOHBJlhHhlX coaemaHHH B ueJtRX H3yqeHHR nyTefi H cpeACTB yJtyqmeHHR npenOABBBHHR O HKOJIOrHH. B pe3yJthTBTe HCCJteAOBaHHfi, npoBeAeHHW< B03 H MIIC B 1977-1981 rr., 6hlJta noJtyqeHa HH¢QpManHR o UOJIOieHHH AeJI B OTHOmeHmt noArOTOBKH Ka.a;poB B o6Jt8CTH OHKOJIOrHH B CTpaHax PerHOHa. Bo acex MeAilUHH- CKHX mJ<OJtax cymecTBIDT 6oJtee HJIH Mettee 06hlqHhle no caoefi CTpyKType BepTHKBJlbHbte Kypchl, rAe npenOABBB- Hae OHKOJ!Ormt MOXeT B OTAeJtbHhlX CJtyqaRX KOOPAlfHHpOBBTbCR. CTH TyThl 3aHHM8.lOTCR , K&K npaBH.JIO, npeA,llHD.JIOKHOR DOArOTOBKOH. CneUHBJIH3HpOBBHHhle OHKOJ!OrnqecKHe HH- PoJtb OHKOJIOrHqecKHX HHCTHTyTOB B npeA.a;HUJIOMHOll no.a;roTOBKe B o6JtaCTH OHKOJIOrHH 38KJIIOqaeTCR B c JteAyiomeM: yqacTHe B onpeAeJteHHH ueJtefi H 3aAaq o6yqeHHH; yqacTHe B npouecce o6yqeHHR B ueJtHX co - Aefic TBHR nOBblDleHmo 3clJ<l)eKTHBHOCTH KJIHHHqeCKOH IlOArOTOBKH; pa3pa60TKa 3K38MeHBUHOHHhlX Tpe60B8HHH H o r1e HK8 noJtyqeHHhlX pe3yJtbTaToB; nOArOTOBKB yqe6HW< MaTepHBJIOB HJIH yqaCTHe B noArOTOBKe yqe6HhlX MBT e - pnaJtoB; opr8HH38UHR nocT.a;HnJIOMHOro o6yqeHHR nepCOHaAa MeAHUHHCKHX mJ<OJI, B pe3yJtbT8Te o6cy&AeHHR BonpocoB $HJIOCO$HH, TeXHOJIOrHH H MeTOAOJtOrHH MeAHUHHCKOro o6yqeHHR H npoBeAeHHR 8HaAH38 TOqeK 3peHHR CTy,.11eHTOB - MeAHKOB, npaKTHKYJ(IIIHX Bpaqefi He OHKOJIOrHqeCKOro npo$HJIR H KJIHHHUHCTOB-OHKOJIOrOB OTHOCHTeJlbHO noCTBHOBKH npeA.a;HnJIOMHOro o6yqeHHR a o6JtBCTH OHKOJIOrHH 6hlJIO ycTa- HOBJteHo, qTo 60Jtbme BHHMBHHR CJteAyeT y.a;eJtRTh, BO-nepBhlX, npaKTHqeCKHM acneKTBM o6yqeHHR H MeHbme - ~OKUHOHHOH pa6oTe H, BO-BTopwc, nepBHqHOH MeAHKO-CBHHTBpHOH nOMOIDH H nOArOTOBKe K pa6oTe Ha KOMMy- HiWrbHOM ypoBHe BMeCTO noArOTOBKH nepcoHBJta AJIR pa60Tbl B yCJtOBHHX 60JtbHHUbl. B npooecce o6yqeHHR CJteAye T mnpe HCnOJlb3OBBTb BH,lleO3BYKOBhle cpeACTBa. IlpH nJtaHHpOBBHHH yqe6Horo npouecca BBIHO YqffTbl- BaTb TOqKy 3peHHR CTyAeHTOB. B HBCTOHfilee BpeMR Tpa,JlHUHOHHaR pOJtb OHKOJIOrHqecKHX accooHaUHH uepecMaTpHBBeTCR TaKIDd o6pa30M, q•ro 6hl 6hlJ18 npeAyCMOTpeHa BO3MOIHOCTb OKa3aHHR COAellCTBHR upoBeAeHmo MepoupHRTHH uo 6opb6e npOTHB pa- KB, o6yqeHmo CTyAeHTOB H nOBbl!IleHmo KBaJtH$HKBUHH MOJIOAblX yqeHhlX a o6JtBCTH OHKOJIOrHH. 3TH accoD;HaUHH Mo ryT BHeCTH CBOro JteUTY B ¢opMHpOB8HHe o6mecTBeHHOro MHeHHR B OTHOmeHHH npo6JteM 6opb6hl upOTHB paKa H COAeHCTBOBBTb H3MeHeHmo KOHCepBBTHBHhlX B3rJIRAOB Ha aonpOChl nOArOTOBKH B 06JIBCTH OHKOJIOrHH . BbJBOAbl H peKOMeH,l\aUHH 1. UeJtb npeA.a;HllJIOMHOH noArOTOBKH - CH86AHTb CTYAeHTB AOCTaToqHhlM o6~eMOM 3H8HHH B 06Jt8CTH 6HOJtOrHH H llBTOJIOrHH onyxoJteH, 3UH,lleMHOJIOrHH, npo¢HJIBKTHKH, nocTaHOBKH pBHHero AHBrHO3a, o6yqHTb MeTOAaM Jte- q eHHR 3JIOKaqecTBeHHhlX HeOnJta3M, a TBKJle o6ecneqHTb CBeAeHHHMil OTHOCHTeJtbHO pea6HJtHTaUHH H nocJteAYJO- mero Ha6J1IOAeHHR 3a paKOBhlMH 60JtbHhlMH. HOCTH, B oco6eHHOCTH B CHCTeMe nepBHqHoH MeAHKO-C8HHT8pHoH OOMOmH. IlOArOTOBHTb cneUH8.JIHCTa-OHKOJIOra. IlpH 3TOM He CTaBHT CR 38Aaqa 2 . BceM MeAHUHH CKHM IDKOJIBM CJte.a;yeT nepeCMOTpeTb UeJIH o6yqeHHR C y q eTOM 3a.a;aq nepBHqH Oll MeAHKo-ca- HHTapHott noMOID,H f H ayqHhlX .llOCTHJKeHHll' HaKon.neHH Oro OnhJTa Ji MeHJ110m,erOC.R OTHOmeHH.R K npo6J1eMaM OHKOJ10- rHll, - 143 - 3 . 0HKOAOrH 'leCKHM HHCTUTyTaM H YH UB epCHTeTaM c .,e,.!l y eT COTPY..!IHH'laTb B ,.!le.te opraHH3aUHH npe,ll,llJIIMOM- HOii IlO,.llrOTOBKH B 06.,,:aC TH O HKOJIOf'HH; ::>TO oco6eHHO BaJKHO A.JUI OHKO.,tornqe C KHX HHCTHT Y TOB t (" Ae paKOBble 60.tbHble npOXO,llJIT Kypc .te'le HHJI . CymecTayeT ,.!IBa OCHOBHblX nyTH opram13aum1 Ta KOH llO,.!lrOTOBKH: llO,llro- TOBKa CTy,.!leHTOB HeIIOCpe,llCTBeHHO e CTeHax HHCTHTYTOB H yqaCTHe IIepcoHa.ta HHCTHTyTa a o6y'leHHH CTy- ,.!18HTOB Me,.!IHJlHHCKHX mKOA. 4 . B yqe6Hbl8 nporpaMMbl B Ka'leCTBe HX COCTaBHOH qa CTH C.te,.!lyeT BK.UO'laTb CIIeuHa.t&Hyro llporpaMM y no llO,llrOTO BKe B 0 6.taCTH OHKOAOrHH. ITporpallOlbl IIO OHKOAOrHH Mor y T pa3AH'laTbCJI no o6~eMy llpe,llOCTaB.tJle- !<:W( B HX pa.wxax CBe,.!leHHH . C.te,llyeT llOpyqaTb rp y nne .ran H.m 0,llHOMy AHIIY (HaIIpH.Mep llpO(j)eccop y) IIpo - BO,.!IHTb pery.t1!pHbJH aaa.m3 y pOBHJI llpe,.!IAHllAOMHOH llO,llrOTOBKH B 06 .taCT H OHKOAOrHH. C.te,llyeT Ta10te o6ec- IIe<rnBaTb TeCHOe H 3 <l><l>eKTHBH08 COTP YAHU'leCTBO acero llpellO,.!laBaTe.tbCKOro COCTaBa B ,lle.te opr aHH3aUHU llO,.!lrOTOBKH B ,.!laHHOH 06.taCTH. 5 . ITpH onpe,lle.teHHH HOBbJX 3a,.!la'I cymecTBytOmHe IIporpalll>lbl llO,.!irOTOBKH ,J'.1 0 .UlHW y<rnT bJBaTb oco6eHHOCTH KIUl,llOH Me,ll~HHCKOH mxo~,. cneuH<l>HKy ux y qe6HbJX llporpalll>l, HMeromHeCJI OHKOAOrH'leCKH8 c.tyx6w H pa3HO- BH,llHOCTH 6o.te3HeH, C KOTOphl'.MH IlpUXO,.!IHT CJI H.MeTb ,.!le.to. 6 . CKOOPAHHHpoaaaaa11 llO,.!lrOTOBKB B 06.taCTH OHKOAOrHH ,llOAXHa IlpOBO,llHTb CJI Ha llOC.te,llHHX ro,.!laX o6yqe- HHJI C Tew, 'IT06bt ,.!laTb CTy,lle HTaM CTapDIHX Kypcoa onpe,.!le.teHHbJH MHHHMYM 3 HaHHH B 3TOH 06.taCTH. 7 . Mex,llyHapO,.!IHble op r aHH3aUHH (803 , MIIC ) llpH3BaHbl c wrpaTb CBOID pO.tb B ,.!le.te KOOp,llKHaUHH H CTm<y AH- p o BaHllH 06 .weHa HH<l>opwauneii B OTHOmeHHH 3a,.!IB'I o6yqeHHH H MeTO,.!IOB OU8HKH. 3THM opraHH3aJlHHM C.te,llyeT npoaHa.tH3HpOBaTb HMeromHeCJI CTpaTer,rn no BHe,.!IpeHHID HOBbJX MeTO,.!IOB o6yqeHHJI B MeAHUHHCKHX mxo.tax H COC T88HTb nepeqeffb 3THX MeTO,.llO B C TeM, QT06M mKO..W Mor .,m HX HCll0Ab30BBTb IIPH aw6ope CTpaTerHH , OT- a e qaromeii Cil8llH<!>H'leCKHM yc.tOBHHM Kllll,llOH KOHKpeTHOH mKOAbl. Yxa3aHHble opraHH3auHH ,llOAXHbl o6 paTHTb BHH- MaHHe Ha BllJKHOCTb opraHH3aUHH HHTerpHpoBaHHoro IIpeAAHilAOMHOro o6y 'leHHJI B 06 .taCTH OHKOAOrHH B Me,.!IH- UHHCKHX mxo.tax H Ha He0 6XO,.!IHMOCT b yAeAJITb oco6oe BHHMaHHe KOMMYHa.tbHbl.M ll0Tpe6HOCT HM B 06 .taCTH IIep- BHQHOH ¥0,.llHKO-CaHHTapaoH nowo mH. 8. MIIC c.,e,llyeT CllOC06 CTBOBaTb TOMy ' QT06bt ,lleKaHbl Me,.!IHUHHCKHX IDKOA H .mua' OTBeTCTBeHHble 3a coc - TBB.te HHe y HHBepCHTeTCKHX nporpaMM, npOHHK.IIRCb H,lleeH O Heo6XO,llHMOCTH o6ecneqHBaTb KOOp,llHHaUHIO B paM- Kax YH HB 8 p CHTeT CKUX nporpaMM HH(j)OpMBUHH B 06.taC TH OHKOAOrHH, KOTopyro CTy,lleHTbl-Me,llHKH no.ty qaroT npH H3y'leHHH p83AH'IHblX ,llHCUHllAHH. Pa6o4aR rpynna no pa3BHTHIO OHKOnorH4eCKHX ueHTPOB H KOMMyHanb Hb!X nporpaMM 6opb6b! npOTHB paKa B Eapone JlJoKCeM6ypr, 20-22 OKTR6pR 1981 roA a 144 _ ICP/ CAK 007(S) 30 AeKa6pR 1981 roAa OPiffHHAJl: AHr.rn,n;\CKIDl CoaemaHHe Pa6o4eH rpynnbl RBHnOCb OAHHM H3 uenoH cepHH MeponpHRTHH, opraHH30B3HHh!X PerHoHanbHhlM 6ropo n o Bonpocy opraHH33J..IHH MeponpHRTHH 6opb6W npOTHB paKa H o6ecne4eHHJO o6cnyJKHB3HHR 6onbHblX paKOM. Uenb coaemaHHR COCTORna B TOM, 4T06b! paCCMOTpeTb ¢YHKUHH H OTBeTCTBeHHOCTb OHKOnorH4eCKHX ueHTPOB H HX CBR3b C nporpaMMaMH 6opb6b! npOTHB paKa, OCYmeCTBnRe=x Ha KOMM)'HanbHOM YPOBHe , a T3K*e C o6mHMH cnYJl{6aMH 3AP3B00Xpa.HeHHR. B COCT3B rpynnbl BOlllnH pa60THHKH ne4e6Hb!X cnYJl{6, 33HRTble OK333HHeM no- MOmH 60nbHhlM paKOM, PYKOBOAHTenH OHKOnorH4eCKHX ueHTPOB, 3nHAeMHonorH B o6naCTH paKa, PYKOBOAHTe- nH o6mecTBeHHOro 3AP3BOOXpaHeHHR, HeCYmHe OTBeTCTBeHHOCTb 33 OCYmeCTBneHHe H3UHOHanbHblX KOMMyHanb- HblX nporpaMM 6opb6bi npOTHB paKa, KOHCYITbTaHT B03 H COTPYAHHKH B03. CTeneHb pa3BHTHR OHKOnorH4eCKHX ueHTPOB B Eapone H xapaKTep HX CTPYKTYPbl, AeRTenbHOCTH H CBR3eH; CTPYKTypa H ¢YHKUHli nporpaMM 6opb6b! npOTHB paKa Ha KOMM)'HanbHOM YPOBHe B paMKaX o6mefl CHCTeMbI OK333HHR MeAHKo-caHHTapHOH noMolll,H; perHCTP3UHR cnY4aea 3a6oneBaHHR paKOM H ponb perHCTP3UHH B 6opb6e npOTHB paKa; ponb OHKOnorH4eCKHX ueHTPOB B KOHKpeTHbIX acneKTax 6opb6bi npOTHB paKa; paHHHH AHarH03, MeAHKo- caHHTapHoe npocaemeHHe, nocneAYromee Ha6nroAeHHe 3a 6onb HWMH H pea6HnHT3UHR, pacnpocTpaHeHHe pe- 3YITbTaToB KITHHli4eCKHX HccneAOBaHHH, npo¢eCCHOHanbH3R ITOArOTOBKa; ponb A06poBOITbHh!X opraHH33UHH B H3UHOHanbHblX nporpaMMaX 6opb6W npOTHB paKa. Ha OCHOBe npoBeAeHHOro pacCMOTpeHHR Y43CTHHKH rpynITbl 3aTeM o6CYAHnH 9Ha4eHHe TepMHHOB "oHKorro- rH4eCKHH ueHTp" H "nporpaMMa 6opb6b! npOTHB paKa Ha KOMM)'HanbHOM ypoatte" H MeCTO K3*AOH H3 3THX KOHuenuHfl B 6opb6e npoTHB paKa H B o6ecne4eHJili nOMODIH 6onbHh!M paKOM. Oco6oe BHHMaHHe 6bLrIO YAene- HO TaKHM BonpocaM, KaK: KaKHe CITYJl{6b! cneAyeT BKJlro4HTb B nporpaMMbI 6opb6W paKa, K3K OHH COOTHOCRTCR APYr C APYrOM H K3KHM o6pa30M nporpaMMW B uenoM COOTHOCRTCR C APYrHMH acneKTaMH MeAHKo-caHHTapHOH TIOMOlll,H . MexaHH3>ful KOOPAHH3UHH H opraHH9aUHOHHb!e CTPYKTYPbl 6wnH paCCMOTpeHW B HX CBR3H C nocTaB- n eHHh!MH uenRMH, KO TOPWX Heo6XOAHMO AOCTHrHyTb B 6opb6e npoTHB paxa. 1 . HauHoHanbHaR TIOJTHTHKa B o6nacTH 6opb6b! npOTHB paKa AOJDKHa paspa6aTbIB3TbCR B paMKax nonHTHKH no OKa3aHHJO o6mefl MeAHKo-caHHTapHoA TIOMOmH. 2. TiporpaMMW 6opb6W npOTHB paKa AOJDKHhl HMeTb cneA~!IIHe UeJTH: a) o6ecne4eHHe BCeM 60JTbHWM paBHOH BWCOKOKBanH¢HUHPOB3HHOH nOMODIJ,I HaPRAY co CTHM)'JTHPOBaHHeM npHMeHeHHR YTBep*AeHHhlX npoTOKOJTOB MeAHUHHCKOH noMomH AJTR o6CJTYJKHB3HHR 60JTbHWX H M06HJTH33UHH acex HMeromHXCR B H3JTH4HH cpeACTB ne4eHHR, rAe 3TO cnyJKHT HHTepecaM 60JlbHhIX; 6) npoBeAeHHe oueHKH COCTORHHR CJTYJl{6 6opb6b! npOTHB paKa H noTpe6HOCTe H 3THX CJTYJl{6 AJTR onpeAe- neHHR o6nacTeH npo6neM, Tpe 6y~HX AOnonHHTenbHOH noMOlll,H; B) COAeHCTBHe MeAHK o - caHHTapHOMY npocaemeHHro HaceneHHR no BCeM acneKTaM 6opb6b! npOTHB paKa c OC06b!M aKUeHTOM Ha npeHMYmeCTBa paHHero ne4eHHR; - 145 - r') cogeilCTBHe 110BbIII!eHHIO KBanH<!>HKaUHH acex spaqeil H g pyrHX pa60THHKOB 3gpasooxpaHeHHfl 110 aceM ac11eKTaM 6opb6bl 11POTHB paKa c aKueHTOM Ha Heo6XO,(IHMOCTb 110CTaHOBKH paHHero ,(1Har'H03a; e) cosepmeHcTsosaHHe MeTogos paHHero pac1103HasaHHfl H ocY111eCTBneHHe 11porpaMM Maccoaoro o6cne- gosaHHfl HaceneHHfl TaM, rge TaKHe 11porpaMMbI OKa3anHCb 3cj)cj)eKTHBHbIMH; l!C) cogeilcTBHe c6opy, pac11pocTpaHeHHJO H H3y"!eHHJO CTaTHCTH"!eCKHX gaHHblX 110 11po6neMe paKa H CTH- MynHposaHHe HX HCl10nb30BaHHfl B uenf!X ycoaepll!eHCTBOBaHHfl OHKOnOr'H"!eCKHX CnYlK6; 3) cogeilCTBHe COTPY/:IHH"!eCTBY C MeCTHblMH PYKOBO,(lf!IIIHMH opraHaMH gnfl 06ec11e"!eHHfl, 110 B03MOl!CHOCTH, HaHnyqmeil 110MOIIIH 6onbHblM paKOM, HaXO,(lfllllHMCfl B goMamHHX ycnoBHflX; H) cogeilCTBHe pa3BHTHIO CnYlK6 pea6HnHTaUHH 6onhHbIX paKOM; K) OKa3aHHe 110MOIIIH pa3BHTHIO CnYlK6, 06ec11e"!HBaJ01I1HX gOCTOilHbm: yxog H3 JKH3HH; n) cogeilcTaHe Hay"!Hb!M HccnegosaHHflM H 11posegeHHJO oueHKH. 3 . HauHoHanbHaf! 110nHTHKa 6opb6bI 11POTHB paKa go=Ha BKnJO"!aTb 11onol!CeHHfl O Heo6xogHMOCTH pa3BHTHfl OHKOnOr'H"!eCKHX ueHTpOB B Ka"leCTBe 3neMeHTa HaUHOHaflbHblX 11porpaMM 6opb6bI 11POTHB paKa. 4. Heo6XO,(IHMO 11PH3HaTb TOT cj)aKT, "!TO OHKOnOr'H"!eCKHe ueHTPbl MOr'YT HMeTb gee OCHOBHbie cj)opMbl. KoMnneKCHblil OHKOnOr'H"!eCKHH ueHTP 11pegocTaBnfleT pa3HOCTOPOHH!O!O OHKOnOr'H"!eCKYIO 110M0lllb B 0,(IHOM yqpel!C- geHHH , B TO speMf! KaK KOOP/:IHHHPYIOIIIHH OHKOnOr'H"!eCKHil ueHTP Bbll10nHf!eT Te lKe caMbie <l>YHKUHH, "!TO H KOMl1neKCHblH ueHTP, 06ec11e"!HBaf! KOOP,(IHHaUHJO gef!TenbHOCTH OTgenbHblX yqpe~eHHil a 011pegeneHHOM reorpa- ~H"!eCKOM pailoHe H MOl!CeT aflbTepHaTHBHO 6hlTb 011pegeneH KaK <l>YHKUHOHaflbHblil ueHTP KOMl1neKCHOH OHKOnorH- qecKoil 110MOIIIH. 5. rnaBHbie <l>YHKUHH OHKOnOr'H"leCKOr'O ueHTpa go=Hbl 3aKnJO"!aTbCfl B pa3pa60TKe H 06ec11e"!eHHH Mep 6opb- 6 bI 11POTHB paKa, 110 B03MOl!CHOCTH, Ha caMOM BhlCOKOM YPOBHe gnfl o6cn~BaHHfl MaKCHMaflbHOr'O "!HCna JKHTe- neil; B 06ec11e"!eHHH 110,(lr'OTOBKH spaqei\ H gpyrHX pa6oTHHKOB Me,[IHKo-caHHTapHoil 110MOIIIH B o6naCTH OHKQ- nor'HH ;H B 11posegeHHH OCHOBHblX KnHHH"!eCKHX H 311HgeMHOnorH'leCKHX HCCnegosaHHil B o6naCTH paKa H pac- 11pocTpaHeHHH HX pe3ynbTaTos ; a oueHKe pe=os ne"leHHf! H 11porpaMM Maccoaoro o6cnegosaHHfl; Ha pa3- pa60TKe H OCY111eCTBneHHH Mep 11epBH"!HOH 11pocj)HnaKTHKH B COTPY/:IHH"!eCTBe C gpyr'HMH CMel!CHblMH opraHH3a- UHf!MH . 6 . rnaBHbie uenH 11porpaMMbI 6opb6bl 11POTHB paKa Ha KOMMYHaflbHOM YPOBHe go=Hbl 3aKmo"!aTbCfl B cogehcT- BHH 11epBH"!HOil 11pocj)HnaKTHKe H 110CTaHOBKe paHHero g Har'H03a 11ocpegcTBOM Me,[IHKo-caHHTapHOr'O 11pocsemeHHfl HaceneHHfl H spaqeh; B 06ec11e"!eHHH o6opygosaHHfl g nfl 110CTaHOBKH paHHero gHar'H03a H gnfl OCY111eCTBneHHfl 11porpaMM . MaCCOBOr'O o6cnegosaHHfl TaM, rge 3TO HMeeT Hay"!HOe o6ocHOBaHHe; B cogeHCTBHH HCl10nb30BaHHIO gHar'HOCTH"!eCKHX, neqe6HblX H 11ocnegy101I1HX Mep, a Ta=e Mep pea6HIIHTaUHH H C03,(laHHIO ycnosHil, 06ec11e- "!HBaJ01I1HX HaH6onee ,[IOCTOHHbIH yxog H3 JKH3HH; B 11posegeHHH HccnegosaHHil 110Tpe6HOCTeil OHKonorH'leCKHX cny,K6 , a TaKl!Ce B 11naHHPOBaHHH H oueHKe 11pegocTaBnfleMbIX CnYlK6 C 110M0lllb!O TaKHX cpegCTB, KaK per"HCTpa- UHfl paKOBbIX 6onbHblX cpegH HaceneHHfl. 7. )lrrn TOr'O' "!T06bl !1J06af! 11porpaMMa 6opb6bI 11pOTHB paKa Morna COOTBeTCTBY!OIIIHM o6pa30M OCYIIleCTBnf!Tb- Cfl, ell HYlKHa agMHHHCTpaTHBHaf! 11oggepl!CKa H 11oggepl!CKa co CTOPOHbl ceKpeTapHaTa. 8. 0HKOnOr'H"!eCKHH ueHTP H 11porpaMMa 6opb6bl 11POTHB paKa Ha KOMMYHaflbHOM YPOBHe f!Bnf!JOTCfl a paBHOH CTe l1eHH Bal!CHblMH B3aHM03aBHCHMblMH 3neMeHTaMH 6opb6bJ 11POTHB paxa . TaM, rge OCY111eCTBnflJOTCfl o6e 3TH 11porpaMMb1, OHH go=Hbr 6bITb COOTBeTCTBYJOIIIHM o6pa30M CBH3aHbI Me~y co6oil H C 06IIIHMH CnYlK6aMH Me,(IHKQ- caHHTapHOH 110MOIIIH. Heo6 x ogHMbie ,(Inf! 3TOr'O MeXaHH3Mbl 6ygyT OTnH"!aTbCH pa3H006pa3HeM B COOTBeTCTBHH C MeC THblMH YCIIOBHHMH H Bal!CHO' "!T06bl HCl10nb3yeMbre 110,(IXOgbl OTnH"!aflHCb r'H6KOCTb!O. /lnH pa3pa60TKH 110,(IXO,[lflll!HX 11porpaMM 6opb6hl 11POTHB paxa H gnfl nposegeHHfl HX oueHKH HYlKHa COOTBeTCTBY!Olllafl HHcj)OpMaUHH . Heo6xogHMO ygenHTb BHHMaHHe cosepmeHCTBOBaHH!O CHCTeM OHKOnOr'H"!eCKOH HH<!>OpMaUHH . 10 . OueHxa nporpaMM OKasaHHH OHKOnOr'H"!eCKOH 110MOIIIH HMeeT 6onbmoe 3Ha"leHHe, HO 6bIDO 11PH3HaHo, "!TO ,(Inf! n posegeHHfl aceo6meh oueHKH a HaCTOHII!ee speMH OTCYTCTByeT Heo6XO,[IHMaH MeTO,(IHKa H, "!TO a x oge 11pos egeHHH HccnegosaHHH c uenb!O oueHKH oco6oe BHHMaHHe g o=Ho 6bITb ygeneHO KOHKpeTHblM KOMIIOHeHTaM npo r paMMbI. - 14 7 - CECTPHHCKOE LIEJIO KoHCj,epe HLIIHI no cecTpHHCKOMY olScnyJKHBaHHIO H MeAHKO-caHHTapHblM acneKTaM oxpaHbl 3AOPOBbf! npecTapenbtX KenbH, 16- 19 HOf!ISpf! 1981 r o.c1a Bse.c1ett1-1e - 149 - ICP/ SPM 032(S) 21 f! Hsapf! 1982 ro.c1a OPHrHHAJl: AH rlllil-lCKl1fi B KottcpepeHUHH rIPHHf!nH yqaCTHe npe,t1cTaBHTenH 18 rocygapcTs-qneHOB, a TaKllCe speMeHHbte coseTHH- KH' a peACTaBHTenH HenpaBHTenbCTBeHHblX opraHH3aUHH' OAH H Ha6n10AaTenb' KOHcynbTaHTbl H COTPYAHHKH Pe - rHOKaJ!bKOro 610pO . B nnettapHblX 3aceAaHHf!X Kottcpepe KLJ..HH yqaCTBOBaJIH qneKbl Pa6oqel\ rpynribl [10 cpeACTBaM npeAynpelf\AeHHf! HeTPYAOCnoco6HOCTH cpeAH npecTapenbtX, cosemaKHe KOTOPOH npOXOAHnO B TO llCe speMf! . KoHcj,e peKUHf! 6bJ..[la opraHH30BaHa PerHOHanbHblM 610pO B COTPYAHH'ieCTBe c npaBHTenbCTBOM $eAepaTHBHOH Pecny6nHKH repMaHHH s Ka'ieCTBe OAHO rO H3 MeponpHf!THH cpeAHeCpO'iKOH nporpaMMbt cecTpHHCKoro Aena/aKy- wepCTBa B EsponeHCKOM perHOKe . []epeA yqacTHHKaMH KottcpepeHLJ..HH CTOf!nH cneAYIOmHe 3'1,tla'iH: paccMOTpeTb cospeMeHHOe COCTOf!HHe ceCTPHHCKOro Aena H MeAHKO-COUHaJ!bHOH pa60Tbl B o6naCTH oxpaHbl 3AOPOBbf! npecTapenbtX s cTpattax EsponeikKoro perHOHa; onpeAenHTb 06m1-1e npo6neMHbte ,o6nacTH H cyweCTBYIOmHe TPYAHOCTH; HaMeTHTb HanpasneHHf! pa60Tbl B 3THX npolSneMHblX o6naCTf!X H nyTH npeOAOneHHf! HMelOmHXCf! TPYAHOCTeH; H3y'{HTb nof!BHBWHeCf! B nocneAHHe rOAbl HOBbte MeTOAbl OKa3aHHf! MeAHKo-caHHTapHOH nOMOIUH npecTapeJlbtM (sKnlO'iaf! npaKTHKY npHBne'ieHHf! K 3TOH pa6oTe HenpocpeccHOHaJIOB); Bbtpa6oTaTb npeAJIOllCeHHf! no cosepweHCTBOBaHHIO MeTOAOB olSy'ieHHf! pa60THHKOB ABYX paCCMaTpHsaeMbtX KaTeropHH, OKa3btBalOIUHX [IQMOIUb npecTapenbtM; npeAnOllCHTb nyTH y nyqmeHHf! palSOTbl cecTpHHCKoro H MeAH!.lHHCKOro nepCOHana, a TaKllCe pa60THHKOB co- UHaJlbHblX cny;g6' 3aHHMalOIUHXCf! o6cnyllCHBaHHeM rIOllCHnblX n10Aet1 B PerHOHe . /:lHCKyCCHf! B 'iHCne o6cy-A<,!1aB WHXCf! Ha KoHc;,e peHUHH TeM 6bJ..[IH : oueHKa nonolKeKHf! nOlKHnblX nlOAeH s o6mecTBe H s ycnOBHf!X ISonbHHUhl (oco6oe BHHMaHHe rIPH 3TOM ISbJ..[10 YAeJleHO cnoco6HOCTH HHAHBHAYYMa BeCTH HOPMaJ!bHYIO nosceAHeBHYIO )ICH3 Hb) ; onpeAeneHHe [10Tpe6HOCTeH MeAHKO-COUHaJ!bHblX cnyllC6 H HeOISXOAHMblX HM pecypcos; YCTaHosneHHe [10Tpe6HOCTeH [IOllCHnblX nlOAeH B ceCTPHHCKOM YXOAe. 6bJ..[IH paCCMOTpeHbl nyTH peweKHf! HeKOTo - pwx OCHOBHhlX npo6neM, B qacTHOCTH CBf!3aHHhlX C TaKHMH f!BneHHf!MH, KaK 6one3KeHHhle COCTOf!HHf!, OAHHO - qecTBO, HHKOHTHHeHUHf! H [IHTaHHe [IOllCHnblX nlOAeH, CTpa,tlalOlllHX AeMeHUHeli . H HaKOKeu, yqacTHHKH cosema - HHf! HaMeTHJIH nyTH cosepweHCTBOBaHHf! ceCTPHHCKOro H MeAHKO-COUHaJ!bHOro o6cnyJKHBaHHf!, rIOArOTOBKH Ka,tl - pos, a TaKllCe HanpasneHHf! 6YAYmHX HCCJieAOBaHHH. Y'iaCTHHKH Ko KcpepeHUHH [IOA'iepKHYnH TOT cj,aKT, qTQ nOllCHnbie nlOAH Ke f!Bnf!IOTCf! KaKOH - TO oco60H rpyn- [IOH HaceneHHf!. 0HH - aKTHBHaf! qacTb scero HaceneHHf! CTpaHbl H HecyT [103TOMY CBOIO AOnlO OTBeTCTBeK - HOCTH . HOCTH:. flpH nnaHHPOBaHHH MeAHLJ..HHCKHX H COLJ..HaJ!bHblX cnyn<6 cneAyeT y'{HTbIBaTb CTeneHb 3TOH OTBeTCTBeH - flOllCHJlble nlOAH H HX ceMbH AOnlKHbl yqaCTBOBaTb B npouecce nnaKHPOBaHHf! . ITOllCHJlbte nlOAH BO MHOrHx CTpaHax npelf\Ae scer o HYlf\AalOTCf! s TOM, qTo6bt K HHM OTHOCHnHCb KaK K pas - HblM. 3TO nonollCeHHe rIOA'iepKHBaeTCf! B AnMa-ATHHCKOH AeKnapaUHH . YqacTHHKH KottcpepeHUHH Bbipa3HnH :-iHeHHe , qTo oqeKb qacTO rIOlKHJlbte rIIOilH ,rnnf!IOTCf! HaH6onee 6eAKblMH H yweMJieHHblMH qneHaMH cospeMeHKOro olSmecTBa . TaKoe nonollCeHHe HenpHeMJieMO HH B COUHaJ!bH0 - 3KOHOMHqecKOM, HH B nonHTH'ieCKOM nnatte . 6bJ..[10 npH3HaHO, qTo B o6naCTH oxpaHbl 3AOP0Bbf! npecTapem,x npegcTOHT eme MHO r o CAenaTb H H3MeHHTb. MHorHe MeACecTpbl, spaq1-1 H COUHaJ!bHble palSOTHHKH He rIOHHMalOT, qTQ yposeHb HX npocpecCHOKanbHblX 3HaHHH , npHHUHflbl H y6elf\AeHHf! OKa3blBalOT B03AeHCTBHe Ha HX OTHOWeHHe K npo6neMe oxpaHbl 3A0POBbf! npecTapenbIX. HeKOTOPble H3 3THX pa60THHKOB HHKOrAa He HCflblTblBalOT YAO BJleTBOpeHHR OT C03HaKHf! Toro, qTQ OHH noMoralOT - 150 - J1JOARM noHRTb 3HaqeHHe 3AOPOBoro ol5pa3a )l(),!3HH H npHHRTb ero, noMoraJOT ol5pecTH BHOBb HM coxpaHHTb He- 3aBHCHMOCTb B Tex npenenax, KOTOpbJe orpaHH'-!eHbl QlH3HqeCKHMH H YMCTBeHHblMH cnocol5HOCTRMH, a TaKJICe YPOBHeM ol5pa30BaHHH nauHeHTOB. B l50J1blllliHCTBe rocynapcTa-qneHOB MencecTpbl ace e1I1e paccMaTpHBaJOTCH KaK KaTeropHH pal50THHKOB l50J1bHH'-IHOro o6cn~BaHHR. 3TOT <jlaKT' nOAKpenneHHblii TeM ol5CTORTeJ1bCTBOM, qTo 3aqacTyJO MeJKAy 6onb- HHUe ii H HaceneHHeM CYII\eCTByeT qeTKHH B0AOpa3nen, OKa3bJBaeT OTPHUaTeJlbHOe B03AeiiCTBHe Ha pa3BHTHe BCeCTOpOHHeii nOMOIIIH npecTapeJlblM. MencecTpbl H pa60THHKH MeAHKO-COUHaJlbHblX CJ1YJIC5 He acerna BblTIOJ1- HRJOT CBOH nonoJ1HHTeJ1bHbJe o5R3aTeJ1bCTBa n o onTHMH3aUHH 06CJ1~BaHHH QlH3HqecKHX, COUHaJlbHblX H ncHxo - J10r1-NeCKHX noTpe6HOCTeii OTAeJlbHblX J1HU, ceMeii H acero HaceneHHH B uenoM. Pa3BHTHe ceCTPHHCKHX H MeAHKO - COUHaJlbHblX CJ1YJK5 AJJH nO)l(),!J1b)X JlJOAeii 1. ,ll.rrn AOCTHJICeHHH uem-1 "3AOP0Bbe AJJR acex K 2000 rony" MHOrHe CTpaHbJ nepeopHeHTHPOBanH CBOH npor- paMMbl 3ApaaooxpaHeHHH H HaqanH pa3BHBaTb CBOJO neRTeJlbHOCTb B Tpex OCHOBHblX nporpaMMHblX o5nacTRX: (a) coneiiCTBHe pa3BHTHIO o5pa3a JICH3HH, 5naronpHRTHOro AJJR 3AOPOBbR; (6) CHHJKeHHe pacnpocTpaHeHHOCTH npenoTBpaTHMblX 5one3Heii; H (a) o6ecneqeHHe acero HaceneHHH aneKBaTHoii, nocTynHoii H npHeMJ1eMoii no- MOII\bJO. CpenH npoqHx, K q11cny TaKHX MeponpHRTHii n o o6ecneqeHHJO, B qaCTHOCTH, cecTpHHCKOro 06CJ1y)l(),!BaHHH npecTapeJ1blX H OKa3aHHJO HM M€AHKO-COUHaJ1bHOii noMOII\H OTHOCRTCH: Ha nepaHqHoM YPOBHe - l5opb5a c yrpoJKaJOII\HMH 3AOPOBbJO <jlaKTOpaMH H yKpenneHHe 3AOPOBbR; Ha BTOpHqHoM YPOBHe - paHHee BblRBJ1€HHe 6one3Heii, OKa3aHHe nOMOII\H H neqeHHe nJJH cTa6HJ1H3aUHH, KOHTPOJ1H HJ1H JlHKBHAaUHH 3al5oneBaHHR, a TaKJKe AJJR npenynpell(AeHHH HeTPYAOCTIOCOISHOCTH; Ha TpeTH'!HOM ypoBHe - BOCCTaHOBHT€J1bHOe neqeHHe (BKJlJOqaR HenpepblBHYJO TIOMOII\b ) H OKa3aHHe TIOMO- II\H YMHpalOII\HM. EblllO npH3HaHo, qTo K rpynnaM BbJCOKoro PHCKa OTHOCHTCH KaK J1JOAH C QlH3HqecKHMH HeAOCTaTKaMH, TaK H JlHUa, o6e3AOJ1eHHbJe B COUHaJ1bH0-3KOHOMH'!eCKOM nnaHe. OcHOBHaR 3anaqa MencecTep H pa60THHKOB Me- ,QHKo-cOUHaJlbHblX CJ1yJK6 - coneiiCTBOBaTb peanH3aUHH HaUHOHaJlbHblX nporpaMM nepBHqHoii MeAHKO-caHHTapHoii rIOMOIIIH. nrrn 3TOro np11neTCH, no BCeii BepORTHOCTH, YAeJ1RTb OCHOBHOe BHHMaHHe He HHAHBHnYaJlbHOMY nonxony, OCHOBaHHOMY Ha M€AHUHHCKOH MOAenH, a CKOpee TaKOMY TIOAXOAY, KOTOPblli CBR3aH C COUHaJlbHOii CTPYKTypoii, nOJ1HTHKOH 3ApaaooxpaHeHHR H 6onee ll!HPOKHMH COUHaJ1bH0-3KOHOMH'!eCKHMH npo6neMaMH COBpe- MeHHOro 061I1eCTBa. 2 . 0l5cn~BaHHeM npecTapeJ1blX 3aHHMaJOTCH MHOrHe MeAHUHHCKHe H COUHaJlbHble CJ1yJK6bJ, OAHaKO QlOHAbl, BbJ- nenReMbJe Ha HX pa3BHTHe, orpaHH'!€Hbl . CaMoneqeHHe, TaK JI(€ KaK H Henpoq,eCCHOHaJlbHYJO TIOMOII\b, H€J1b9H pa3uemrnaTb B KaqecTBe aJlbTepHaTHBHblX BHnOB npo<jleCCHOHaJlbHOii noMOIIIH. B TO JKe BP€MR TBopqecKoe H 3Q}QleKTHBHOe nnaHHJ)OBaHHe COBMeCTHOH pa60Tbl C A06pOBOJ1bHblMH H Henpo<jleCCHOHaJlbHblMH pa60THHKaMH MOJKeT n03 B0J1HTb pacll!HPHTb nOMOII\b TI0)1(),!J1b)M J1JOARM. MenceCTPbl H pal50THHKH M€AHKO-COUHaJ1bHblX CJ1yJK6 AOJ1JICHbl npHHHMaTb yqacTHe B pa3BHTHH TaKoro COTPYAHH'!eCTBa, a B OTAeJlbHblX cnyqaRx H BblCTynaTb ero HHHUHa- ·ropaMH B uenRX Ol5'beAHH€HHR YCHJ1Hii AJJR pell!eHHR npo6neMbJ. MencecTpbl H pa60THHKH M€AHKO-COUHaJ1bHblX CJ1YJIC6 HecyT OC06YJO OTBeTCTBeHHOCTb 3a o6yqeHHe BCTIOMO- raTeJlbHOro H Henpo<jlecCHOHaJlbHOro nepcoHana H KOHTPOJ1b 3a ero A€RTeJ1bHOCTbJO. 3 . Oco6oe BHHMaHHe cnenye T YA€J1RTb TIOJICHJ1b)M J1JOARM, KOTOpble HaXOARTCH Ha AJJHTeJlbHOM H3J1eqeHHH, oco- 6eHHO B repHaTpHqecKHX H ncHxorepHaTpHqecKHX OTAeJ1€HHRX. HeolSXOAHMOCTb yneneHHH TaKor o BHHMaHHH AOJ1JKHa 6bJTb yqTeHa npH opraHH9aUHH pa60Tbl COOTBeTCTBYIOII\HX CJ1YJICl5. Bo MHOrHX rocynapcTsax-qneHax npol5neMe nonrocpoqHoii TIOMOII\H nO)l(),!JlblM J1JOARM He ynenReTCR AOJlllCHOro BHHMaHHH H, KaK npaBHJlO, aKUeHT nenaeTCR Ha l50J1bHHqHoe ol5cn~BaHHe npH OCJ10JKH€HHH 3a6oneBaHHH. MeAHUHHCKHM cecTpaM He06XOAHMO pa3'bHCHRTb, qTO HX OCHOBHaR 3aAaqa - coneiiCTBOBaTb nonnepl!CaHHJO onTH- MaJlbHOro YPOBHR 3AOPOBbH JlJOAeii H HX cnoc o6 HOCTH B€CTH HOPMaJlbHYJO )l(),!3Hb. Pa5oTaH Ha CBOeM yqaCTKe H pelllaH caMOCTORTeJlbHO BonpOCbl npHeMa 60J1bHblX B yqpeJKAeHHH 3ApaaooxpaHeHHR H HX BbJnHCKH H3 3THX yqpelll;[leHHii, MencecTpbl Ol5R3aHbl H€CTH nOJ1HYJO OTBeTCTBeHHOCTb 3a o6ecneqeHHe nonrocpoqHoii TIOMOII\H Ha Bcex ypOBHRX HapHAY c pa50THHKaMH APYrHX cneuHanbHOCTeii, yqacTBYJOII\HX B npouecce M€AHUHHCKoro o6cny- )l(),!8aHHH. CoseprneHHO HeOISXOAHMO TI03TOMY n onr oTOBHTb TaKHe KaApbl M€AHUHHCKHX cecTep, KOTOpbJe MOrnH l5bJ 3Q)Ql€KTHBHO o6ecneqHsaTb HenpepbJBHOCTb MeAHKO-caHHTapHOH noMOII\H nOJICHJlblM J1JOARM Ha scex 3Tanax HX 06cJ1y)l(),!BaHHH: l50J1bHHUa - AOM; AOM - 60J1bHHUa. - 151 - 4. Me,[leeeTpbJ H paiSOTHHKH Me,[IHKo-eaHHTapHblX enylKIS ,[IOnlKHbl npHHHMaTb y'-!aeTHe B OKa3aHHH ITOMOIUH YMH- pa!OUOIM. ITpH 3TOM MOlKeT B03HHKHYTb HeOISXO,[IHMOeTb B OKa3aHHH npaKTH'-!eeKoi'! H MOpanbH011 ITO,[l,[leplKKH '-!neHaM eeMbH H APY3bHM YMH pa10111ero. KpoMe Toro, 3TH paiSOTHHKH ,[IOnJKHbl OKa3bJBaTb noMOlllb H no,[l,[leplKKy seeM '-!neHaM MHOr0,[1HeUHnnHHapHOl1 15pHra,[lbl, KOTOpble ol5eene•rnBalOT ,[lonroepo'-!HYIO H Te pMHHanbHYIO noMOlllb. 5. 113aeeTHO, '-!TO KPH3HeHbJe eHTyauHH H noTepH 15nH3KHX - l!BneHHe B lKH 3HH ITO)K],[nbJX n10,[le>1 seebMa pae- npocTpaHeHHOe H 3Ha'-!HTenbHoe. He HapyruaH npaa Ka)K,[loro <1enoaeKa Ha <1acTHY10 )K],[3Hb, cne,[lyeT npoao- AHTb HaiSnlO,[leHHe 3a nauHeHTOM H OKa3bJBaTb eMY nOMOlllb H no,[l,[lepJKKy B ITO,[IOISHblX CHTyau1rnx, npHaneKaH ,[lnH 3Toro COOTBeTCTBYIOUOIX cneuHanHCTOB ITMCIT. 6. B HaCTOl!Jllee ape MR ITO)K],[nbJM , HHBanH,[laM H HeTpy,[locnocoiSHbJM n!O,[IHM 3a'-laCTYIO OKa3bJBaeTCH Hea,[leKBaT- Hal! H 15e3pa3nH'-!HaH ITOMOJllb, noe KonbKY "npHeMneMbJe CTaH,[lapTbl nOMOIIUI" e111e He,[IOeTaTO'-IHO '-!eTKO o npe,[lene - Hbl . CneuHanHCTbl scex y posHeH Me,[IHKO-caHHTapHOH nOMOIUH ,[IOnJKHbl HeCTH OTBeTeTBeHHOCTb 3a CBOH ,[leHCTBHll. Me,[IHUHHCKHe cecTpbl H paiSOTHHKH Me,[IHKO-COUHanbHblX cnylKIS ,[IOnlKHbl Ob!Tb roTOBbl onpenenHTb H oue HHTb Ka- '-!eCTBeHHbJe H KOnH'-!eCTBeHHbJe CTaHnapTbl Me/:IHKO-COUHanbHOH IT OMO JUH npecTapenbJM. 7. 0<1eHb BalKHO o praHH30BaTb npoaeneHHe npocaeTHTenbHblX MeponpHHTHH cpenH WHPOKHX cnoea HaceneHHH. 3TOMY BOnpoey cnenyeT y,[lenHTb 6onbwe BHHMaHHH , Korna pe'-!b Hl,eT 015 HH¢opMHpoaaHHH nonHTH'-!eeKHX neR- TeneH H BnHHTenbHblX nHu. CeeTpHHCKHH nepCOHan nonJKeH cone><CTBOBaTb pacnpocTpaHeHHIO cpenH Hacene- HHH caeneHHH O ¢H3HOnorH'-!eCKHX , COUHanbHblX H ITCHXOnorH'-!eCKHX acneKTax CTapeHHH C TeM, 4TOl5b! THITH'-1 - HbJe AJIH 3TOrO npouecca H3MeHeHHH aocnpHHHManHeb KaK HOpManbHblH JKH3HeHHblH npouecc. Henpo¢ecCHOHanbHbl X pa60THHKOB, 06cny,,c;1Ba10J11HX npecTapenbJX Ha l,OMY, Heo6XO,[IHMO OiSY'-!HTb OCHOBHblM HaBbJKaM OKa3aHHH ceeTpHHCKOH noMOIUH H npoae,[leHHH aoecTaHOBHTenbHOro ne<1eHHH. CnenyeT cone><CTBO - aaTb TaKlKe TOMY, '-ITOObl HenpaBHTenbCTBeHHble opraHH3aUHH OKa3bJBanH nOMOlllb B pa3pa60TKe caHHTapHo - npoc- aeTHTenbHblX nporpaMM nnR HaceneHHH. Heo6xo1,HMO o6ecne'-!HTb ITO)K],[nbJX nlO,[leH H HX ceMbH HH¢QpMauHeH o acex enylK6ax H BH,[lax ITOMOIUH c TeM, 4T Ol5bl OHH 3HanH, Kyna OHH MOryT o6paTHTbCH 3a ITOMOlllblO H cnpaaKaMH B cny'-lae Heo6xonHMOCTH. Pa3BHTHe ceCTPHHCKHX H Mel,HKO-COUHanbHblX Ka,[lpoa WIH OKa3aHHH ITOMOIUH npecTapenbJM 8 . ITpH pa3BHTHH nl0130H CHCTeMbJ nOMOU(H O'-!e Hb BalKHO onpenenHTb ponb scex Tex , KTO ol3ecne4HBaeT 3TY ITOMOJllb . '!TOObl o6ecne'-!HTb ryMaHHY!O HanpasneHHOCTb KOMnneKCHblX cnyJK6 31,pasooxpaHeHHH, Heol3xonHMO CTpe- MHTbCH K cosepweHCTBOBaHHIO neHTenbHOeTH cneuHanHCTOB Ka)K,[IOH /:IHCUHnnHHbl H pa3BHTHIO ¢opMbJ HX COTpyn - HH'-!eeTaa . BalKHO , 4TOl5bi Ka)K,[lbl>I <1neH 6pHra1,bl BbmOnHHn CBOH npo¢eceHOHanbHbJe Oi3H3aHHO CTH H KOHKpeTHbJe ¢YHK- UHH B paMKax 6pHranb1. BbmonHeHHe 0,[IHHM cneuHanHeTOM ace>< pa60Tbl npyroro HnH ee '-!aCTH MOlKHO 3anpe- THTb TOnbKO B HCKnlO'-IHT enbHblX Cny'-{aHX, Korna HeT pai30THHKa Tpe6yeMoro npo¢HnH. ITpo¢eceHOHanbHbJe H BCITOMOraTenbHble pai30THHKH 31,paaooxpaHeHHH H Me,[IHKO - COUHaJlbHhlX cnyi,;6 ,[IOnlKHhl nony'-{HTb Heo6xo1,HMble 3HaHHH H npaKTH'-!eCKHe HaBblKH CHa'-!ana B npouecce TeopeTH'-leCKOH H KnHHH'-!eCKOH nonroTOBKH , a 3aTeM B npouecce HenpepblBHOro nOBbJWeHHH KBanH¢HKaUHH HnH Ha Kypcax ycoaepweHCTBOBa - HHH, BKnlO'-!aH nanbHeHWylO npaKTH'-!eCKYIO nonroTOBKy. 9 . ITpH opraHH3aUHH npouecca (la3oaoro OOy'-{e HHH MencecTep H Me,[IHKo-eouHanbHblX pa60THHKOB B y'-{eOHbJe nporpaMMbl cnenyeT BKnlO'-!aTb HeKOTOpb!H 06"beM TeopeTH'-!eCKHX 3HaHHH B o6naeTH repOHTOnorHH M R Toro, 4TOl5bi nonroTOBHTb HX K pal3oTe C ITO)K],[nblMH nlO/:lbMH Ha nepBH'-IHOM, BTOPH'-IHOM H TpeTH'-IHOM ypoa HHX MenH- KO-eaHHTapHOH noMOJUH . Onpe,ueneHHOe BHHMaHHe B nporpaMMax ,uonJKHO Ob!Tb y,ueneHO sorrpoeaM TeopHH pa3- BHTHH <1enoaeKa, a TaKlKe npo6neMaM CTapeHHH , 3/:IOPOBbH H ponH 06111ecTBeHHOCTH. Bee pa60THHKH 3,ctpasooxpaHeHHH nonlKHbl 3HaTb H yaalKaTb 3THH'-!eCKHe, eOUHanbHO - KynbTYPHble H HC T O - PH'-!eCKHe oeo6eHHOeTH 13onbHblX. 3 TH ¢aKTOPbl HMelOT 60nbwoe 3Ha'-!eHHe npH o6eny)K],[BaHHH npecTapenbJX , H see <1neHbl 6pHra,[lbl 3,ctpasooxpaHeHHH ,[IOnlKHbl Ob!Tb B Kypee TOH 06111eeTBeHHO - HeTopH<1eeKOH OiSCTaHOBKH , B KOTOPOH npoTeKana )K],[3Hb o6enyJKHaaeMbJX HMH nlO,[leH. 10. Bee BbJWeyKa3aHHble ¢aKTOpbJ H eBll3aHHbJe C HHMH 6HxeaHopanb HbJe H COUHanbHbJe aeneKTbl MOlKHO BblHBHTb , YTO'-IHHTb H BKnlO'-IHTb B Ka'-leeTae OeHOBHO r o KOMITOHeHTa MHOrO,UHeUHnnHHapHblX nporpaMM 06y<1eHHll . - 152 - 11. B npouecce KnHHJi'!eCKOH npaKTHKH CTyneHTOB cnenyeT BOBneKaTb B MeJKAHCUHilnHHapttylO pa60TY C TeM, tJT06bl OHH nonyqHnH npencTaBneHHe O QJYHKUHJIX BCex pa60THHKOB 3npasooxpaHeHHJI H cneuHanHCTOB CMeJKHblX o6nacTeH. 3TOT acneKT MOJKHO CtJHTaTb OCHOBHblM KOMilOHeHTOM o6yqeHHJI MeTonaM 6pHranttoil pa60Tbl. 12. TIOBblllleHHe KBanHqJHKaUHH H IlOCTAHilnOMHal! nonroTOBKa MeAHUHHCKHX cecTep B o6naCTH OKa3aHHJI noMo- lllH npecTapenblM nonJKHbl coneAcTBOBaTb 60nbllleH npoq,ecCHOHanbHOH M06HnbHOCTH H HMeTb uenblO co3nattHe Ta- KOH KaTeropHH cneuHanHCTOB, KOTopaH 6b1J1a 6bl B COCTOJIHHH OKa3h!BaTb npaKTH'leCKYIO IlOMOUlb, o6yqaTb, p y - KOBOAHTb, ynpaBnHTb H npOBOAHTb Hay'lHbJe HccnenoBaHHH B o6naCTH OKa3aHHJI ceCTPHHCKOH IlOMOIIIH npecTa- pem1M, a TaKJKe KOHcynbTHPOBaTb CBOHX Kenner Ha Bcex YPOBHJIX CHCTeMbl snpaBooxpatteHHJI. 13 . Heo6XOAHMO ynenHTb BHHMaHHe nepeCMOTPY cymeCTBYIOIUHX 3aKOHOAaTenbCTB H no6HTbCH BHeceHHH B HHX COOTBeTCTBYIOUIHX nonpaBOK C yqeTOM ponH HeCTaUHOHaPHblX CnYJK6. Pa3BHTHe HayqHblX HCCnenoBaHHH 14. 'lT06bl 6onee sqxj)eKTHBHO YAOBneTBOPl!Tb HOBble noTpe6HOCTH HaceneHHJI (HanpHMep, npH KOMnneKCHOM o6cnyJKHBaHHH npecTapeJiblX H OtJeHb IlOJKHnhlX n,oneA), MencecTpb! H pa60THHKH MeAHKo-couHanbHblX CJIYJK6 nonJK- Hbl COBepUJeHCTBOBaTb CBOH npoq,ecCHOHanbHble 3HaHHJI, npHHHMall yqacTHe B npoBeneHHH nanbHel'rumx Ka'leCT- BeHHbIX, KOJ1Hl-1€CTBeHHbIX H IlPO.D;OJlbHbIX HCCne.o,oBaHHii H aHanH30B. no MHeHHIO yqaCTHHKOB, MencecTpbl H pa60THHKH MeAHKO - COUHanbHblX cnyJKl5 nonJKHbl yMeTb aHanHSHPOBaTb CBOIO C06CTBeHHYIO pa6oTy H onpenenl!Tb 061UHe npHHUHil~ BbJnonHeHHJI KaJKnOH KOHKpeTHOH QJYHKUHH cecTpHHC- KOro nena H MeAHKo- cou1-1anbHOH palSOTbl. 0HH noJIJKHbl yMeTb HCilOJib30BaTb HaYtJHble naHHbJe AJIH COBep111eHCT- BOBaHHH CBOeH nel!TenbHOCTH H onpeneneHHJI HanpaBneHHH ee pa3BHTHJI. MencecTpbl, 06nana,om1-1e COOTBeTCTBYIOUIHM Oilb!TOM, AOJIJKHbl 3aHHMaTbCJI HccnenoBaTenbCKOH pa60TOH , 'lT06bl npenocTaBneHHe repHaTpH'leCKOH IlOMOll.\H 6a3HpOBanOCb Ha COJIHAHOH HaytJHOH OCHOBe. MencecTpbl, HMelOmHe cnoco6HOCTH H CKnOHHOCTH K TaKOH pa6oTe, nonJKHbl nonyqHTb COOTBeTCTBYIO!IIYIO n onroTOBKY Ml! npoBeneHHH caMOCTOJ!Tenb=x H3blCKaHHH, KOTOpb!e JIBJITCJI BKJTaAOM B MHOronpoqJHJTbHble Hc- cnenoBaHHH B 06nacn1 oxpaHbJ 3AOPOBbll npecTapem1x. 15. MHorOAHCUHnnHHapHb!H npoeKT HCCnenoBaHHH B ol5nacTH cecTpHHCKOro nena , K ocymeCTBneHHIO KOTOpor o B HaCTOl!IJ.lee BpeMJI npHCTynHJTH 18 rocynapCTB-tJJTeHOB H KOTO.pb!H l!BJTlleTCJI 'laCTblO cpenHeCpOtJHOH nporpaM- Mbl no ceC TPHHCK OMY / aKYUJepcKOMY neny B EB p o ne, IlOMOJKeT nonyqHTb OTBeTbl Ha HeKOTOpble BOnpOCbl, IlOAHl!- T ble B xone pa6oTbl Kottq,epeHUHH. 3TOT npoeKT JT03BOJIHT paCUIJiPHTb cymeCTBYIOIIIHe 3HaHHJI H Oilb!T pa60Tbl B o6naCTH CeCTPHHCKoro nena B pe3yJibTaTe pacnpocTpatteHHJI HHqJOpMaUHH O npaBHJTbHOH opraHH3aUHH pa6o- Thi MencecTep H MeTonax ee npaKTH'lecKoro npHMeHeHHll. lleRTeJibHOCTb B paMKax npoeKTa TaKJKe npenoc- TaBJilleT MenHUHHCKHM cecTpaM npeKpacHy,o B03MOJKHOCTb np1-1015pecTH npaKTHtJeCKHH OilblT HaYtJHb!X HCCJieAOBa- HHH B 3TOH 06JiaCTH. - 153 - CTHXHflHbIE EE)lCTBilll PaOoqee cosemaHHe no roTOBHOCTH K pemeHHJO npoOneM 3ApaaooxpaHeHHR npH qpe3Bbl'lai!:llblx nonollteHHRX, cnOlltKIIIIIHXCR B CBR3H co CTHxmiHblMH OegcTBHRMH ICP/ERO 001(S) 9 MapTa 1982 roga PaOaT. 22-25 HOROpR 1981 roga OPHIT!HAJI: �PAHUY3CK!ffi llaHHOe cosemaHHe ObUIO co3saHo npH qlHHaHcosoA noggep,o:e KoMHcCHH EsponeAcKHX cooOmecTB H 6�po KOOPAHHaTopa OOH no oKa3aHH� noMOIIIH s cny<1ae cTHXHHllblX OegcTBHH, npH TeXHH'leCKOM cogeHCTBHH coTpyg­ HHqa11X11ero ueHTpa B03 no 3nHgeMHonorHH CTHXHHHblX OegcTBHH npH ITyseHCKOM YHHBepCHTeTe, 6poccenb. Ha cosemaHHH npHCYTCTBOBanH 55 spaqeA, npenogasaTeneA H pyKOBOAHTeneA 3ApasooxpaHeHHR H3 13 CTpaH, a TalCl[e npegcTaBHTenH s Me�yHapOAHblX opraHH3aUHH H B03. Uenb gaHHOro cosemaHHR COCTOMa B paCCMOT- peHHH cospeMeHHoro COCTORHHR roTOBHOCTH K pemeHHJO npol5.neM 3gpasooxpaHeHHR npH qpe3Bbl'laHl!blX nonollteHH­ RX H, B qacTHOCTH, B onpegeneHHH Mep, KOTOPble AOJDltHbl Ob!Tb npHHRTbl cpa3y nocne CTHxmiHoro OegcTBHR )l!IR! COKpameHHR qHcna cnY'{aes co CMepTenbHblM HCXOAOM, paHeHblX H YMHPalODIHX B pe3ynbTaTe nony<1eHHblX nospe�eHHH; nOBblllleHHR 3<1>4leKTHBHOCTH cny-JtO, OKa3blBalOIIIHx noMomb nHUaM, OCTaBIIIHMCR B JIG!Bb!X nocne CTHXHHHoro OeACTBHR; coxpaHeHHR cymecTBYJOllleH MeAHKo-caHHTapHOH Oa3bl HJlH oOecneqeHHR 803MOJIGIOCTeH )l!IR ee CKopeAmero BOCCTaHoBneHHR. Ilpe�e scero Y'{aCTHHKH cosemaHHR nogqepKHynH, qTo sonpoc O CTHXHHHblX OeACTBHRX cnegyeT paccMaT­ PHBaTb KOMilJ!eKCHO, T. e. Y'{HTb!BaTb He TOnbKO q1aKT caMoro npOHCmeCTBHR, HO H pa3nH'lHble acneKTbl opraHH- 3aUHH npoq1HJ1aKTH'leCKOH paoOTbl AO KaTaCTp0¢bl H gonrocpoqHOH peaOHJlHTaUHH nocne Hee. Mepbl no OKa3a- HHIO cpoqHOH noMOmH AOJlJl'.Hbl pa3pa0aTb1BaTbCR C yqeTOM yKa3aHHblX ¢aKTOPOB. BalltHO TaKllte noHRTb, qTo 3¢­ ¢exTHBHOCTb noMOIIIH 3aBHCHT OT cepbeSHOCTH nogxoga K ee opraHH3aUHH TaK •e, KaK 3<1>4leKTHBHOCTb npeseH­ THBHIIIX Mep H Mep no CHHllteHH� ypOBHR B09AeHCTBHR OeACTBHH B OygymeM 3aBHCHT OT OITb!Ta, npHoOpeTeHHOro B xo11e paOOTbl no npeogoneHH� npoOneM, Bbl3BaHHblX paHee cnY'{HBmHMHCR OegcTBHRMH. XoTR MeAHKO-caHHTaPHble npoOneMbl H RBnR�TCR oqeHb salltHblMH' OHH npegcTaBnR�T nHlllb OAHH acneKT oo­ meA 111:apTHHbl OegcTBHR. K gpyrHM npoOneMaM OTHOCRTCR npooneMbI, CBR3aHHble C BOCCTaHoaneHHeM 3KOHOMH­ KH, coxpaHeHHH MOmHOCTeH cenbcKoro X03RHCTBa H npOMblDIJleHHOCTH, noggeplltaHHeM 3aKOHHOCTH H nopRgKa, a Taxze BOCCTaHOaneHHeM COUHanbHblX CTPYKTYP· KpoMe Toro, 3<1>4leKTHBHOCTb MegHKo-caHHTapHblX Mep non- HOCTb� 3aBHCHT OT ¢YHKUHOHHPOBaHHR aAMHHHCTPaTHBHOro annapaTa, TpaHcnopTa, cpegcTB CBR3H H BCeH ce- TH CJ!YJ(O. Ilo3TOMY oqeHb BalltHO, qT00bl MeAHUHHCKHe npooneMbl pemanHCb B KOMnneKCe C gpyrHMH MeponpHR- THRHH, HanpaeneHHblMH Ha npeogoneHHe nocnegcTBHH qpe3Bbl'!aHHoro nonollteHHR. OcTaHoBHBDIHCb Ha HCcneAOBaHHRX uenoro PRAa cny<1aes, nposegeHHblX B CTpaHax CpegH3eMHOMOPCKOro OacceAHa nocne 3aMl'!eTpRCeHHH, H Ha npHMepax H3 HX COOCTBeHHOH npaKTHKH, yqacTHHKH 3aTeM nepell!nH K oOc�eHHJO pa3nH'lHblX npoOneM, B03HHKaBDIHX B XOAe npeogoneHHR qpe3Bbl'laHHblX nonollteHHH, cnOJIGIBDIHXCR B pe3ynbTaTe CTHXHHHblX OeACTBHH. IlpooneMbl Ob!nH paCCMOTpeHbl C nRTH Toqex 3peHHR nRTb� paOoqHMH rpynnaMH, KOTOpble npoaHanH3Hposa- 1lH onblT, npHOOpeTeHHblH pa3nH'lHblMH rpynnaMH nHU, a HMeHHO: nHUaMH, KOTOpble HaXOAHnHCb Ha MecTe npoHcll!eCTBHR B MOMeHT 3eMneTpRceHHR H ObUlH B COCTORHHH Ha6n�aTb peaKUH� HaceneHHR BO apeMR H nocne 6eACTBHR; nHQaMH, KOTOpble He HaXOAHnHCb Ha MeCTe npoHcmecTBHR, HO HecnH OTBeTCTBeHHOCTb 3a npHHRTHe cpoq­ HblX Mep ( HanpHMep, MeCTHble PYKOBOAHTenH 30Hbl oegc TBHR, KOTOpble npHHMH nepBble 3anpocbl 06 0Ka3a­ HHH nOMOll!H); nHuaMH, HeCYIIIHMH rnaeHy� OTBeTCTBellHOCTb 3a oomy� KOOPAHHaQH� Mep no OKa3aHH� nOMOIIIH B CTpaHe, KOTOPble ynonHOMoqeHbl o6pamaTbCR 3a noMomb� Ha Mel(tAyHapogHOM ypOBHe (HanpHMep' paooTHHKH MHHHC­ TepcTB 3gpaaooxpaHeHHR HJ?H yqpeJ1tAeHHH KpacHoro KpecTa H KpacHoro IlonyMecRua); nHQaMH, KOTOpb!e npHCbLIIH e paHOH oegCTBHR cpa3y nocne KaTacTpOqlbl BMeCTe C 6pHra11aMH no OKa3aHH� nOMOIIIH; nHQaMH, OTBeTCTBeHHblMH 3a OKa3aHHe eHemHeH noMOIIIH. B xoge oOcyl(tAeHHR CibL!lO BbIRBneHo, qTo qHcno npoOneM, CBR3aHHblX C OKa3aHHeM cpoqHOH nOMOIIIH, MOll<HO 3HaqHTellbHO COKpaTHTb, ecnH HanpaBHTb yCHJlHR no TpeM rnaBHblM HanpaaneHHRM: - 155 - - 156 - WHpe npHaneKaTb pa60 THHK OB 3Ap aaooxpaHeHH.ll K nnaHHPOBaHH~ MeponpH.llTHH n o OKa3a HH~ CP 04HOH no - M01.IU1 ; WHpe HCnOnb30BaTb M€CTHbl€ pecypCbl, KOTOpbJMH pacnonaraeT HaceneHHe, 3aHHTepecoaaHHOe B OKasaHHH cp04H OH nOMOUIH ; o6ecne4HBaTb 06me cTaeHH OCTb 6onee n on tt oA HH~OpMaUHeA OTHOCHTenb HO pacnpeneneHH.ll cpencTa, noc - TynaJO!llHx M.11 OKa3aHH.ll Cp04H OH nOMOWH, BbIW€H3nOJl(€HHbJe Tpe6oaaHH.ll ,ran.ll~TC.ll AOnonHHTenbHbJMH, H XOT.ll OHH Ba)l(Hbl npH o praHH3aUHH Cp04HOH M€AHUHHCKOH nOMOWH nocne TaKHX OCHOBHblX CTHXHAHb!X 6eACTBHH' KaKHMH' B 4aCTH OC TH .llBn.ll~TC.ll 3eMneTp.11 - C€HH.ll' 3TH Tpe6oaa HH.ll TaKJl(e npHM€ HHMbl H B cny4ae APYrHX 6eACTBHH. BbtBOAbl H peKOMeHAaUHH 1. MccneAOBaHH.ll noKa3anH, 4TO An.II nOBb!W€HH.ll YPOBH.ll 3~€KTHBHOCTH nepBOH nOMOWH ee cneAyeT npeAoc - TaBn.llTb y)l(e BO apeMJ! 6eACTBH.11; n 03 TOMY OHa AOnJl(Ha l5b!Tb COCTaBHOH 4aCTb~ nepBH4HOH M€AHK O-ca HHTap - HOH nOMOJ11H, CneAOBa TenbHO , nepc oHan 3Apaaoo xpaHeHH.ll Ha acex ypOBH.llX,pa6oTa~mHH B 30He, n OAB€pJl(e H- HOH o nacHOCTH CTHXHHHb!X 6€ACTBHH, nonJl(eH HM€Tb H€06XOAHMY~ n onr o TOBKY , KOTOpa.11 n osaonHT €MY Ael'icT- BOBa Tb B 4P€3 Bbl'!aHHb!X ycnOBH.llX, Conep=HHe nporpaMMbl TaKOH n onroTOBKH non)l(HO 6blTb paspa6oTaHO Ha oc Hoae peanhHoro o n btTa, np1-1 06p eTeHHoro a xone npeononeHH.ll 4pe3Bbl'laHHoro nonoJKeHH.11, cno)l(HBWeroc.11 a CB.ll3H c o CTHXHHHb!MH 6encTBH.llMH n ocnenttero apeMe HH. 2. MecTHall MaTepHanbHall 6a3a snpaaooxpa He HH.ll ( 6onbHHUbl' MeAnYHK Tbl ' anTeKH ) AOnJl(Hbl 6bITb c n poeKTH- poBaHbl TaKHM o6pa30M, "!T06bl OHH Morm1 cny)l(HTb npHeMHb!MH nyHKTaMH H HrpaT b ponb "ueHTPOB no cnace HH~ JKH3HH" HnH "ueHTPOB n o opraHH3aUHH neHCTBHH" Mll OKa3aHHll n OMOUIH B <rpe3Bbl'!a HHblX n on OJl(€HH.llX H KOop- AHHa UHH cny)l(6 snpaaooxpaHeHH.ll Ha Mee Tax. B Te<reHHe n e pBblX H€CKOnbKHX <racoa OHH AOn Jl( Hbl TaKJI(€ cny- JKHTb o praHH3YJO!llHMH ueHTpa MH n o c6opy H n epena4e AaHHblX, Kac a~UIHXC.ll cepbe3HOCTH H pa3Mepa MaTepHanb- Horo yme p6a tt KOnH<reCTBa Jl(€PTB. 3 . ~T06bJ B cny4ae paspyweHH.ll HnH BblXOAa H3 CTPOll MennyHKTa MOJKHO 6bln O 6bl np ononJKaTb OKa3aHHe noMo - lllH , cnenyeT npHHllTb MepbJ n o C03AaHH~ n y 6nHP YJO!llHX n y HKTOB HnH, 4TO npenno4THTenbHee uenoA ceTH ny HK- roB a paHo Hax, n o naepraKII\HXCll 6eAC TBH.llM, KOTOpbJe MoryT l5b!T b HnH He 6blTb HenpeAB HA€HHblMH, "!TO saaH- CHT OT HanH"!Hll K HHM AOCTy n a H cpencTB CB.ll3H, nosa on.ll~lllHX 6b!CTPO npHM€HHTb HOBbl e cpenc TB a BMewaTenb- CTBa B3aMeH BblWeAWHX H3 CTpOll, 4 . Jlnll noawweHH.ll 3~eKTHBHOCTH BHewHeH nOM OUIH ee He0 6XOAHMO npeAOCTaBn.llT b B COOTBeTCTBHH C KOH - Kpe THblMH sanpocaMH tt HanpaBn.llTb Ha YAOBneTaopeHHe KOHKpeTHblX noTpe6HOCTeH . XoT.11 a nepawe <racw nocne 6encTBHll noMOUlb MOJl(eT HanpaBn.llTbCll Ha YAOBneTaopeHHe npenn onaraeMhIX OCHOBHb!X n o Tp e6HOC Tetl (pa - OO Tbl n o cnaceHH~, nepaa.11 nOMOlllb, npOAYKTbl nHTaHH.11, YKPblTHe)' n~l5all cnHWK OM n ocnewH o H nnoxo opraH H- 30BaHHall pa6oTa no oKasaHH~ 4pe3Bbl'!aHHOH noMOWH noane<reT sa co6oA nHWh nononHHTenbHy~ Hepa36epttxy H xaoc. DosTOMY <rpe3Bbl'laHH O Ba)l(HO Hanpaan.llTb npeAOCTaBn.lleMY~ BH€WH~~ nOMOlllb, HCXOA.ll H3, no aos- MOJl(HOCTH, HaH6onee TO"!HOH HH~OpMaUHH, Bo MHOrHX cny<ra.11 x 6yAeT 6e3ycnOBHO ny4we OTnOJKHT b Ha 6onee n 03AHHe CPOKH nony<reHHe BHewHeH n o MOWH H TaKHM o6pa30M HCn Onb3 0BaTb ee HaH6onee s~eKTHBHb!M o6pa- 30M, <reM AeH CTBOB aTb nocneWH O . EesycnOBHO , uenecoo6pa3HO np OBOAHTb Hay 4Hbte HccnenoaaHH.ll B CTpa - Hax , nonaepra~UIHXC.ll onacHOCTH' M.ll Toro "!TOl5b! pemHTb KaKHe Mepbl nonJKHbl npHHHMaTbCll 6e30TnaraTen bHO, naJKe npH HanH"!HH HeTO"!HOH HH~OpMaUHH, H M.11 KaKHX Mep 6esycnoBHO npenno4THTenbHO HMeTb nononHHTenb- Hy~ HH~OpMaUH~, naJKe ecnH 3TO n o ane<reT sa co6ol'! H HeKOTOpy~ sanepJKKy B HX npHH.llTHH. s. 3a pai:\oHaMH, nonaepra~mHMHCll oco 6o BblCOKOMY PHCK Y 3eMneTp.11ceHHH, nonJKHO i5blTb sa6naroapeMeHHO ycTa ttoaneHo Ha6n~neHtte; rip H STO M oco6oe BHHMaHHe cnenyeT ynenHTb TaKHM acneKTaM, KaK: nnoTHOCTh HaceneHHll, reorpa~H<recKoe nonoJKeHtte, MHKp03 0 HbI, JKHnbe, ttenpo<rHbJ e cTpoeHH.ll (o 6mecTaeHHbJe SAaHw.11), . a TaKll<e apeAHOCTH OKpYJKaKI11eH cpeAbl, HCTO"!HHKOM KOTOpb!X cnyJl(aT npoMbllllJleHHbte npennpH.llTH.11, 3HeprOCHCTe- Mbl, naM6bI, Tpy6onpOBOAbl H T.A., H onacHOCTH Anll KOHKpeTHb!X rpynn HaceneHH.11. CocTaaneHHble a p esynh- TaTe TaKOH pa60Tbl "KapTbl PHCKa" AOnJl(HbJ coneHCTBOBaTb nnaHHPOBaHH~ COOTBeTCTBYJO!llHX MeponpHllTHA no npO~HnaKTHKe (yKpenneHHe HnH p eKO HCTPYKUH.11), saaKyaUHH HnH cnaceHH~. Oco6oe BHHMaHHe cnenyeT YAe- nllTb 60nbHHUaM. 6. TaKHM Jl(e o6p a3oM cneAyeT npoaecTH nepenHcb MeAHUHHCKHx pec y p coa (H H~pacTp yKTypa, o6opynoaaHHe, nepcoHan) H AepJl(aTb HX B COCTO.IIHHH roTOBH OCTH, "!T06bl o6ecne4HTb B03MOJl(HOCTb cpo<rHOH M06HnH3aUHH HMeKil\eHCll B HanH"!HH MaTepttanbHOH 6a3bl , CneAyeT nonroTOBHTb cnHCOK nnomanoK, nOAXOA.lllllHX Mll no- CaAKH aepToneTOB, ITOMHMO 3Tor o AOnJl(Ha 6blTb npoaeneHa nepenHC b CTaHnapTHb!X n o cTaBOK, o6opynoaaHH.ll, HHCTpyMeHTOB H MaTepHanOB, He06XOAHMblX nn.11 cnaceHH.ll JKepTB H OK a3aHH.ll HM s~eKTHBHOH MeAHK o -caHHTap- HOH nOMOWH . EcnH o6Hapy)l(HTCll HeAO CTaT OK a TaKHX MaTepwanax, cnenyeT npenyc MOTpeTb coopy,KeHHe cne- UHanhHblX narepei:\ a HaH6onee YA06HblX Mee Tax Ha ace i:\ Te ppHTOPHH, - 157 - 7. MepbJ no OKa3aHHIO Me,!lHKo-caHHTapHOH nOMOJUH ,(lOnJICHbl I1JlaHHPOBaTbCll He TOnbKO Ha HaUHOHa.JlbHOM ypoa - He HJlH Ha ypoaHe npOBHHUHH, HO H Ha MeCTHOM H ,o;eueHTPa.JlH30BaHHOM ypOBHllX , 'lT06bJ MO;KHO 6b1Jl0 npHCTy - nHTb K HX pea.nH3aUHH 6e3 npoMe,oneHHll nocne npHH.RTHll peweHHll. TaKoe "MHKPOI1JlaHHPOBaHHe" Tpe6yeT npe,o;aapHTenbHOro npocaeweHHll HaceneHHll, 'lTO B KOpOTKOe apeMl! nOMO;KeT C03,!laTb y MeCTHOro HaceneHHll CTHMYn K npHHl!THIO Ha ce6.R OTBeTCTBeHHOCTH 3a OKa3aHHe nOMOJUH npH qpe3BbJ'laHHblX nonoJKeHH.RX H anocne,o;- CTBHH nOMOJKeT npe,o;OTBpaTHTb C03,!laHHe TaKoro OTHOWeHH.R, Kor,o;a JKepTBbl paccMaTpHBalOT ce6H nHWb peUHnH- eHTaMH nOMOWH . 8. )lnl! npaBHJlbHOro pacnpe,o;eneHHll nepBOH nOMOIIIH H nOMOWH , nocTynaoowe i'i H3 - 3a rpaHHUbl, HYJKHa CHCTeMa YCKOpeHHOH oueHKH noTepb H YWep6a . HH¢opMaUHOHHall CHCTeMa TaKor o po,o;a, KOTOpy,o Henb3ll C03,!laTb Ha ronOM MecTe , AOnJKHa 6bJTb 'laCTblO HH¢opMaUHOHHOH CHCTeMbJ OCHOBHblX cnYJK6 3,!lpaaooxpaHeHHll. KpoMe Toro, B CB.R3H C KOMnneKCHbJM xapaKTepoM npo6neM, Bbl3BaHHblX 6e,o;cTBHeM , 60nbWOH CTeneHblO Heonpe,o;eneHHOCTH H OCTPOH noTpe6HOCTblO B CpO'lHbJX ,o; eHCTBHllX, H,o;eHTH¢HKaUHH' c6op H aHa.JIH3 ,o;aHHblX ,o;onJKHbl npOBOAHTbCll cneUHa.JIHCTaMH . MecTHOe HaceneHHe 'laCTO He MOJKeT npoaeCTH oueHKY noTepb H Ylllep6a, H no3TOMY cne- ,o;yeT npH6eraTb K noMOJUH cneUHa.JlH3HPOBaHHOro nepcoHa.na TeXHH'leCKHX cpe,o;CTB ( 3nH,!leMHonorH'teCKa.R oueHKa C nOMOIIlblO OT6opa npo6, 803,!lYWHal! pa3ae,o;Ka) . 9. l1cnon:i,3yeMb1e 8 qpe3BbJ'laHHblX nonoJKeHH.RX ,o;nll nporH03HPOBaHH.R 3nH,o;eMHonorH'leCKOH o6cTaHOBKH HH - ,o;eKCbl H noKa3aTenH (cMepTHOCTH' 3a6oneaaeMOCTH) ,o;onJKHbl 6b!T b npOCTbJMH H rH6KHMH' no3aonmootHMH cpoq- HO npHHl!Tb peweHHe. 10. Co6paHHal! Ha MeCTHOM ypoa He HH¢opMaUHll ,!lOnJKHa nepe,o;aaaTbCll Ha 6onee BbJCOKHH ypo aeHb H3 e,o;HHOro HCTO'lHHKa ' ynonHOMO'leHHoro BblUOnH.RTb 3TY ¢YHKUHIO . 3TO nOMOJKeT PYKOBO,!l.RIIIHM opraHaM Hax.tHOHa.JlbHOrO 3,o;paaooxpaHeHH.R Hanpaan.RTb H pacnpe,o;en.RTb BHeWHIOIO nOMOWb, a TaKJKe y,o;oaneTaopl!Tb pea.nbHb1e noTpe6Hoc- TH. Ha HaUHOHa.JlbHOM YPOBHe cne,o;yeT C03,!laTb cneUHa.JlbHble MexaHH3Mbl, KOTOPble 6y,o;yT OTKnOH.RTb HnH ne - peopHeHTHpOBaTb a HYJKHOM HanpaaneHHH TaKylO noMOWb, KOTOpa.R He COOTBeTCTByeT KOHKpeTHbJM noTpe6HOCT.RM . 11. ITOMOIIlb' nocTynaoowaH H3 BHeWHHX HCTO'lHHKOB HaceneHHIO' npOJKHBalOIUeMY B pai'ioHax CTHXHHHblX 6e.o;CTBIIH' ,o;om1rna COOTBeTCTBOBaTb noTpe6HOCTl!M 3Toro HaceneHH.R' a He ,o;y6nHpoaaTb MeCTHbie nlO,!lCKHe H MaTepHa.nbHble pecypcb1. 3To oco6eHHO aaJKHO AJ1 ll co6nJO,J:teHHH cTpororo KOHTpon.R 3a a~e3,o;OM ,o;o6poa onbuea, 3a 'lbeH no- MOWblO He o6pawa.nHCb. 12. 3 nH,o;eMHonorH'leCKHH Ha,!l30P (a TOM WHPOKOM CMblCne, B KaKOM OH HCTIOnb3yeTCll BO acex c¢epax 3,!lpa- BOOxp aHeHHll) l!Bnl!eTCll BaJKHOH Mepoi'i npH qpe3Bbl'!aHHblX nonoJKeHHl!X. 0,o;HaKO , 3TOT Ha,!l30p He npHHeceT ,o;onllCHblX pe3ynbTaTOB npH OTCYTCTBHH ,o;aHHWX, KaCaIOOtHXCll CHTYaUHH, npe,o;wecTBOBaawei'i 6e.o;CTBHIO. TaKHe ,o;aHHbie ,o;onJKHbl 6b1Tb 'laCTblO HH¢OpMaUHOHHOH CHCTeMbJ 3,o;paaooxpaHeHH.R ,o; aHHOr o pai'iOHa, KOTOpbie cny,o;yeT HMeTb B Ha.JlH'lHH no B03MOJKHOCTH 3a6naroapeMeHHO AO 6e.o;CTBHl! . 13. '-IT06bl yKpenHTb KOOPAHHaUHIO Me)K,!ly Me,!lHUHHCKHM H aeTepHHapHblM 3 nH,!leMHonorH't eCKHM Ha,!l30POM' pe- KOMeH,o; yeTCll npe,o;npHHl!Tb B 3TOH o 6naCTH 6onee WHPOKHe Hccne,o;oaaHHll, B 'laCTHOCTH ,!lJlll Bbl.RCHeHH.R ,o;on r oc - PO'lHblX nocne,o;CTBHH npoHCWeCTBH.R. PyKOBO,!lHTenH 3,o;paaooxpaHeHHll ,o;onJKHbl y,o;enl!Tb oco6oe BHHMaHHe BeTe - PHHapHbIM npo6neMaM , B03HHKalOWHM B CBll3H co CTHXHHHbIMH 6e,o;CTBH.RMH. 14. 3 n H,o;eMHonor>r'leCKHH Ha,!l30P He ,o;onJKeH o rpaHH'lHBaTbC.R ¢a3011 caMo r o CTHXHHHOrO 6e,o;CTBHll' a AOnJKeH npo,o;onJKaTbCll Ha npOMeJKYT O'lHOH ¢a3e BOCcTaHOBneHH.R HOpManbHbIX ycnOBHH H nocne,o;yoowei'i ¢a3e pea6HnHTa- UHH. OcHOB HblM Tpe6oBaHHeM MOJKHO C'lHTaTb o praHH3aUHIO cpe,o;He- H ,o;onr ocpO'lHOH oueHKH pe3ynbTaTOB no- MOJUH. PeKOMeH,o;yeTCll npH co,o;eHCTBHH B03 H cneuHa.nHCTOB npoaeCTH TIItaTenbHble 3 nHAeMHonorH'teCKHe HC - cne,o;oa aHH.R He,o;aBHO npoH30We,o;rnHX B 6accei'iHe C pe.o;H3eMHOro MOP!! 3eMneTpl!CeHHH . 6y.o;eT none3HbIM C03,!laTb nOCTO.RHHYIO Me)K,!lHCUHnnHHapHylO KOHcynbTaTH BHYIO rpynny, KOTOpal! n pH npoae,o;eHHH TaKHX HCcne,o;oaaHHH CMO - :iteT CO TPYAHH'taTb C PYKOBO,!lHTen.RMH 3aHHTepecoaaHHblX CTpaH. 15. B Ka)K,!lOH CTpaHe ,!lOnJICHbl 6bJTb npHH.RTbl cneUHa.JlbHble 3aKOHO,!laTenbCTBa no 3aJUHTe HaceneHHll' 8 KOTO- pb!X nepe'lHCn.RnHCb 6bJ o6H3aHHOCTH ' op raHbl' OTBeTCTBeHHble 3a HX BbinOnHeHHe H pecypCbl, npe,o;ocTaBnHe - Mble B HX pacnop,nceHHe . I 6. Ha.nH'lHe CHC TeMbl Me)K,!lyHapO,o;Horo COTPYAHH'teCTBa, KO Topal! MOllCeT 6bJTb HeMe,!lJleHHO M06HJ1H30BaHa no COOTBe TCTByoowei'i npocb6e H KO TOpa.R HaXO,!lHTCll 8 noCTOl!HHOH rOTOBHOCTH H pacnopl!JKeHHH acex CTpaH , no,o; - aepra!OWHXC.R PHCKY, MOJKeT HMeTb 6onbWYIO ueHHOCTb, 'leM c nyJK6bl CPO'lHOH nOMOWH - 17. 3¢¢eKTHBH OC Tb Me)K,!lyHapO,!lHOH noMOWH, OKa3bJBaeMOH CTpaHe , no,o;aeprHyawei'icll CTHXHH HOMY 6e,o;CTBHIO, ecTeCTBeHHO 3aBHCHT B 3Ha'lHTenbHOH CTeneHH OT C03,!laHHblX 3a6naroapeMeHHO MexaHH3MOB no o6ecne'leHHIO KOOPAHH aUHH Me)K,!ly MeponpH.RTHl!MH, npOBO,!lHMblMH pa3nH'tHblMH Me)K,!lyHapO,!lHblMH HJlH npaBHTenbCTBeHHblMH op - raHaMH , BKnlO'lHBWHMHCll 8 OKa3aHHe noMOWH, H OT 6bJCTp oro ycTaHoaneHHll C8ll3 H C 3TOH CTpaHOH . - 158 - 18. B03 AOn*Ha noArOTOBHTb PYKOBOAllllU-!€ yKa3 aHHll Anll CTpaH, nOABepralOlllHXCll onaCHOCTH , nyTeM paspa- 60TKH Mep, KOTOPbl€ AOn*Hbl ocywecTBnl!TbCll CnY*6aMH nepBH'!HOH M€AHK O- caHHTapHOH nOMOIIIH, npocjmna KTH - 4€CKHX Mep, KOTOpbJe AOn*Hbl 6b!Tb npeAnPHHl!Tbl HaceneHH€ M, H HHCTPYKUHH , KOTOPb!X cneAyeT npH,IJ;epJKl-fBaTb- Cll nepcoHany 3ApaBOOxpaH€HHll Bcex ypOBHei'I. 19. Ha cpeACTBa B03 AOn*Hbl 6b!Tb opraHH30BaHbl KYPCbl noArO TOBKH npenoAaBaTenei'! ' KOTOPble n o OKOH4aHHH 3THX KypCOB Mor yT KOHCYnbTHPOBaTb HaceneHHe n o npo6neMaM 3ApaBooxpaHeHHll, B03 HHKa~IIIHM B CBll3H c o CTH- XHHHblMH 6€ACTBHl!MH. Heo6xOAHMO pa3pa60TaTb MOAenH n oA r OTOBKH. 20. CTpaHaM n one 3HO npoBeCTH 0630P HM €~111HXCll y HHX B03MO*HOCT€H peweHHll npo6neM 3APaBooxpaH€HHll, B03HHKa10mHMH B CBR3H co CTHXHHHblMH 6e)lCTBHRMH , oueHKH H9MeHeHHH , npOH30We,D.WHX n ocne ,D,aHHOI"'O COBema - HHll. Pe3ynbTaTbl o630pa H npHM€H€HHll peKOM€HAaUH H AOn*Hbl CTaTb T€M01{ cn€AY~lllero pa6oqero COBelllaHHll. 21 . B03 AOn*Ha KOOPAHHHPOBaTb pa6oTy APYrHx M€*AYHapOAHblX opraHOB; H€06XOAHMO YT04HHTb ~YHKUHH Ka*Aoro opraHa , B qacTHO CTH, B uenl!X o6ner4€HHll A€l!TenbHOCTH npaBHTenbCTB. B COOTB€TCTBHH C san- pocaMH CTpaH B03 cneAyeT C03AaBaTb T€XHH'!€CKHe rpynnbI AnF. oueHKH M€*AYHapOAH OH nOMOIIIH H onpeAene - HHll ee COA€P*aHHll. 22 . 0TM€4all, 4TO npeACTaBHTenH HTanHH Ha COBe111aHHH npeAnO*HnH npoBeCTH nnaHHpyeMoe Ha 1982 r. p a - 6oqee COBe111aHH€ B03 n o 3TOH TeMe B HX CTpaHe C KOHKpeTHOH uenb~ OU€HKH pe3ynbTaTOB H XOAa BblnOnHe- HHll peKOMeH,IJ;aUHH , yqacTHH KH HaCTOl!lllero C0B€111aHHll C4HTa~T uenecoo6pa3Hb!M B OCTaBweecl! BpeMl! npoBeCTH H3y4e HHe COCTOl!HHll roTOBH OC TH cny*6 3ApaBooxpaHeHHll K peweHH~ npo6neM B CBll 3H C 3€Mn€Tpl!C€HHl!MH. Pe 3ynbTaTbl 0630pa AOn*Hbl nocnY*HTb OCHOBOH AHCKYCCHH Ha Cn€AYIO!l\€M pa6o4€M cose111aHHH. - 159 - <l>APMAUEBTWIECIOIE flPEITAPATbl - 161 - KoH CYAbTaTUBHOe COBe~aHHe TIO pa3pa60TKe MeyyHapoAHOii CHCTeMhl oueHKu AeKapCTBeHHhIX cpeACTB ICP/ DPM 003(S)Rev.l 6 aBrycTa 1981 roAa KoDeHrareH , 25 moHH 1981 roAa OPHrl1HAJI : AHr JlliHCIDIH 1. BBeci!eHHe KOHCYAbTaTUBHaH rpyDTia EBpODeHCKoro peruoHaJibHOro 6mpo B03 pa3pa60TaAa apeAAOXeHHe DO yqpexAe- HHIO DOA 3 rHAOH Bce>WpHoii opraHU3a[(HH 3APaBooxpaHeHHff CHCTel!£hl DPOBeAeHHH oueHKH AeKapCTBeHHhlXCpeACTB H Bhl,l!;aqu CBHAeTeAb CTB DO DPOBeAeHHH HayqHoii oueHKH (CHO) . CHCTeMa C03AaH a B COOTBeTCTBHH C HeOAHO- KpaTHhllllI DpO Cb6aMH rocyAapCTB - qAeHOB B03 06ecDequTb KaqeCTBO, 6e30DaCHOCTb H 3<1><!>eKTHBHOCTb AeKap- CTBeH HhlX cpeACTB' BhlDyCKaeMblX B MeXAyHapOAHYID DpOA8JllY. 2. UeAb - OKa3h!BaTb DOMOD(b TeM MllOroqHCAeHHh[ll( rocyA8pCTBaM - <UeHaM 803' KOTOphle He 06A8AamT AOCTaToqHhl- >W B03MOXHOCTH>W AAH oueHICH HOBhlX AeKapCTBeHHhlX c peACTB; - CDOC06CTBOBaTb pacapocTpaHeHHID BO BCex CTpaHax HOBhlX U0HHhlX M0AH[IHHCKHX DpeDapaTOB; - o6ecneqaTb ODTHMaAbHYID HaAeXHOCTb oueHKH nyTeM DpHBAeqeHHff Kee DPOBeA0HHIO Call(hlX OTihlTHhlX 3KC- nepTOB H3 pa3HhlX CTpaH; - COA0HC TBOBaTb pa3pa60TKe 6oAee eAHH006pa3HhlX CTaHAapTOB KaqeCTB8 HOBhlX AeKapCTB0HHhlX cpeACTB' DOCTyDa lllmHX B DPOA8JllY; - CDOC06CTBOBaTb 3KOHOMHH UCCA0AOBaTeAbCKHX pecypCOB H ~OHAOB KaK ~apMa[(eBTuqeCKOH.DpOll(hllJI.)[0HHOCTH, •raK H APYrHX OTpacAeii DyTeM DP0AYDP0XAeHUff HeHyxHoro AY6AHpOBaHHff AeffT0AbHOCTH. CHO He 6yAeT xapaKTepU30BaT b TOT IIAH IIHOH DpenapaT, KaK "OCHOBHOe" HAU "HeOCHOBHOe" AeKapCTBeH- HOe Cp0ACTBO . TeM He MeHee, TaKHe CHO TIOMOryT B 6yAymeM o6AerqUTb DpHHffTHe pemeHHR, KaCaIDmHXCff ocymeCTBAeHUff nporpaMMhl AeHC TBHH 803 B o6AaCTH OCHOBHhlX AeKapCTBe HHhlX cpeACTB . 3 . ITpHHllHllhl OIJeHKH '1To6bl TIOAyquTb CHO ~apMa[(eBTHqeCKUe ~upmI-II3rOTOBUTeAH AOAXHhl o6pamaTbCff K DOAP83AeAeHHID EBpo- DeHCKoro perHOHaAbHOro 6mpo 803 DO oueHKe AeKapCTBeHHhlX cpeACTB . no CBOe My xapaKTepy 3affBKH KOM- MepqecKHX DP0AllPHHTJm 6yAyT , B DpHHUHne, CXOAHhl C 3aHBKaMH Ha DOAyqeHue AHTieH3HH Ha DPOA8Jl<Y DpeDapa- TOB, KOTOpb1e HanpaBAHIDTCff HaUHOHaAbHb[ll( opraHaM HOpMaTHBHOro KOHTPOAH . CBHAeTeAbCTBO Bh!AaeTCff DOCAe aHaAH38 acex AaH HhlX B OTHOmeHHH AeKapCTBeHHOro cpeACTBa, HMeIDUlHXCff Ha MOMeHT apoBeAeHHH oueHKH . 8 pe3yJibTaTe 3Toro aHaAH38 ycTaHa BAHB8eTCH, qTo AaH Hh!H apenapaT : - HBAHeTCH AOCTaToqHO 3<1><!>eKTllBHhll,{ " 6e3oDaCIDIM DPH DpaBHJibHOM e r o Dpm<eHeHHB ; - OTBeqaeT He06XOAHMhlM CTaHAapTaM B OT HOmeHHH ero KaqeCTBa ; CHa6xeH HHCTPYKUHeli, B KOTopoli npHBOAffTCff aAeKBaTHaff II HaAexHaff HH~OpMaUHff B OTHOmeHUH ero CBOHCTB" CDOC06a DpHMeHeHuH; CTpa C03Aa HHH CBCTeMh1 HMeAOCb BBH.llY CAeAaTb ee Dpoc Toii, rH6Koli H YA06Holi B ynoTpe6AeHuu. 3Ta CHCTeMa He AOAXHa AY6AHPOBaTb HallHOHaAbHble H peruoHaJibHble CHCTeMbl OU0HKH J10KapCTBeHJn.Ix cpe,llCTB RAH DOA}<eHHTb ax : ee ueAb - COAeHCTBOBaTb 6oAee 3 <1><!>eKTHBHOMY ~YHKllHOHMpOBaHHIO 3THX CHC TeM DyTeM o6ecne- qeHHH Ha,lleXHOH R 6ecDpRCTpacTHOH oueHKH apeaapaTa Ha paHHell CT8ARH. 8 CBff3H C TeM, qTO pa3pa6oTaH- Haff CHCTeMa He HaAaraeT HHKaKHX o6H38T0 AbCTB HR Ha rocyAap CTBa-qAeHhl, RB Ha KaKHe - Au6o APYrHe CTOpo- Hhl, MOXHO HaAeeTCH, qTo ee HCllOAb30BaHHe TI03BOAHT H36exaTb PH.lla npo6AeM, B03HHKammux DpH ocymecTBAe- HHH MeponpHHTHH DO rapMOHH3a[(HH H8Il;HOHaAbHhlX 3aKOHOAaTe JibCTB B o6AaCTH AeKapCTBeHHhlX cpeACTB HAU npu - 162 - CO3 ,!laHlclH Ha,11HaIIHOHa.JihHbIX CHCTeM KOHTpOJIR. Pa6oTa B paMKax CHCTeMbl 6y,11eT ocym.eCTBJIRThCR B TeCHOM B3aHMO,ileHCTBHH C TeKymHMH nporpaMMaMl! B03 H AOnOJIHHT npOBOAHMYJO B03 ,11eRTeAbHOCTh B 06J1aCTH JleKapCT- BeHHbIX cpe,!ICTB. 4. CTpyKTypa noAµa3,!leJleHHR EPB no oneHKe JleKapCTBeHHbIX c pe,!ICTB ,ilOJIXHa 6hlTh B OCHOBHOM cxoxa co CTpyKTypoH HaUHOHaJlbHhlX opraHOB HOpMaTHBHOro KOHTPOJIR. BO,ilHTh CHJlaMH noCTORHHOro CeKpeTapHaTa. Pa6oTa no OCHOBHOH oueHKe H COCTaBJleHHIO no,11po6HbIX oTqeTOB no oneHKe 6y,11eT n opyq e Ha He3aBHCHMLw HayqH•w 3KcnepTaM, no,11nHcaaI11ID1 corJ1ameHHe c no,11pa3,11eJ1eHHeM o KOH$HAeHUHaJlbHOCTH HH~PMauHH. PemeHHR B OTHOmeHHH DOJlyqeHHbIX 3aRBOK 6y,11yT npHHID!aTbCR KoMl!TeTOM, Ta JOK e COCTOJIID.H~ H3 HeaaBHCHMhlX 3KCDepTOB, npeACTaBA.fllOIIUIX ece AHCJ:U{ILJIHHbl, yqaCTBYJOllllle B oneHKe AeKap- CTBeHHblX Cpe,!ICTB. B 3a,11aqy DO,ilKOMHTeTa, KOTOphlH 6y,11eTC06HpaTbCR 60J1ee qaCTO Ha CBOH 3ace,11aHHR, 6y,11eT BXOAHTh o6ecneqeHHe 6hlCTporo H nocJ1e,!IOBaTeJ1bHOro BhlnOJIHeHHR pa6oThl. Bhl6HpaR DOAXOARmy,o AJIR KOMHTeTa CTPYKTypy, CJ1e,11yeT yqeCTh, qTo OHa ,11O.llJl(Ha MaKCIDl8JlbHO yYeHbIDHTh BO3MOXHOCTb npe,!1B3RTblX MHeHHH npH npoae,11eHHH oneHKH. 5. Ilp01;e,'lYP•1 IlopR,!IOK no,11aqg 3aRBOK $HpMaMH-H3POTOBHTeJIHMH ODl!CaH HHXe. npe,11ycMaTpHBaJOTCR H npH npHeMe 3aHBOK OT rocy,11apCTB - qJ1eHOB. - CBe,!le HHH, Kacaro~eCH XHMHqecKoro, $apManeBTHqecKoro B npOH3BOACTBeHHOro acneKTOB, BKJllOqaR HH- $OpMaUHID O MeTo,11ax KOHTPOJIH; o6pa3Ubl roTOBo ro npo,11yKTa; - TOKCRKOAOrHqeCKHe AaHHWe H A&HHlJe ~apM&KO~OrHqeCKHX HCDhlTBHlm Ha XHBOTHLIX; - KAHHHKO-$apMaKOJIOrH q ecKHe H TepaneBTHqeCKHe AaHHJ,Je; - npoeKT HH$OpMaUHOHHOro npocneKTa O JleKapCTBe HHOM Cpe,ilCTBe, B KOTOpOM YKa3hlBaeTCR ero COCTaB, DOKa3aHHH K DpHlleHeHmo, npOTHBODOKa3aHHH, HeraTHBHoe B03,ileHCTBHe, B3aHMO,!leHCTBHe C ,11pyrHMl! npe- napaTaMH, AO3HpOBKa, a TaKXe ,11pyrHe CBe,!le HHH, HBJl-eCH BaxHhlMH npH Ha3HaqeHKH H npID!eHeHHH npenapaTa . J\D,MHHHCTpaTHBHhlH KOHTPOJlh B TeqeHne ABYX MecnneB nOCJle DOJlyqeHHH 3aRBKH CeKpeTapHaT onpe,11eAHT, HBJIHIDTCH AH npe,11CTaBJ1eHHb1e MaTepHaAhl AOCTaToqHo DOJIHbIMH AJIH Toro, qT06hl npOH3BeCTH oueHKy . B TOM CJlyqae, eCJIH CeKpeTapHaT pe- IDHT, qTQ npe,11cTaBJ1eHHhlH MaTepnaJI He,!IOCTaToqHo DOJIOH, 3aHBHTeJllO 6y,11eT coo6meHo, KaKaH HH~PMauHH OTCYTCTByeT. 3aHBHTeJllO ,11aeTCH TPH MeCHUa AJIH ,ilOChlAKH He,!IOCTEUOIIJ,HX MaTepHa.JIOB, DOCJle qero a TeqeHHe ABYX MecnneB 6y,11eT CHOBa npOH3Be,11eHa HX aAMHffHCTpaTHBHaH oneHKa. ECAH Ha 3TOM 3Tane HH~pMaUHR 6 y,11e•.r HeDOJIHOH, 3aRBHTeJlb 6y,11eT DOCTaBJleH 06 3TOM B H3BeCTHOCTh, a 3aRBKa aHHyAHpOBaHa. IloCJle OKOHqaHHH nepHOAa, npe,11yCMOTpeHHOro ,il;JIH ocym.eCTBJleHHR a,!IMHHHCTPBTHBHOH oneHKH, no,11pa3Ae- JleHBe EPB B TeqeHHe nocJ1eAYJODtHX BOCbMH MecnneB npoBe,11eT CBOID oneHKY H H3BeCTHT 3aHBHTeJIH O npHHHTOM p e meHKH . HenoJ1HaH oneHKa IlpH DOJly qeHKH HeCJIOXHhlX no CBOeMy xapaKTepy 3aHBOK (HanpHMep, BHeCeHHe MOAff$HKaUHH B yxe Bi.my - CKaeMhle npenapaTbl, JleKapCTBa o6mero Ha3HaqeHHH H H3BeCTHble COCTaBbJ) npenoAa.JiareTCH npH6eraTb K yn- pomeHHOH nponeAype oneHKH. PemeHHH IlpeAyCMaTpHBaIDTCH qeTbip e THna pemeHHH no 3aRBKaM. a) Il03HTHBHOe H 6e3yCJIOBHOe pemeHne. -163 - 6) noaHTHBHOe ll yCJIOBHOe pemeHHe ·npe,11no.11araeT' 'tTO orrpe,11e.11eHHb(e H3MeHeHHJt ,.!10.JIJl(Hbl 6b!Tb BHeCeHbl B HH<!>OpMaUHOHHblli npocneKT no npsrneHeHHJt JieKapCTBa' npeJK,11e 'teM 6y,11eT Bb(,llaHO CHO . no,11pa:i,11e.11eHHe EPB MOJKeT B OT,lleJibHblX c.11yqaJtx Tpe6oaaTb' 'tT06b! B 3TOT rrpocneKT BKJllO'taJIHCb CBe,lle Hl!Jt' KOTOpb1e or- paHH'tBBaJIH 6w cct>epy npm,eHeHllJt rrpenapaTa, B pruacax KOTopou ero ynoTpe6.11eHHe onpaa,11aHo a 6e:io- nacHo (HanpHMep, B 60.JlbHHUax). CBH,lleTeJibCTBO MOJKeT TaK>te npe,llyCMBTPHBaTb npm,eHeHHe npenapa- Ta TO.llbKO B KOHKpeTHblX ct>apMaueBTH'teCKHX ct>opMax HJIH pa:ipemaTb HCTTOJlb30BaHHe ero OT,lleJlbHblX rrpo- MbllllJleHHblX cepuu. B OT,lleJlbHblX c.11yqaJtx H C yqeTOM orpaHH'teHHOCTH KJIHHH'teCKHX ,llaHHblX B OTHOmeHHH HeKOTOpb!X rpynn Hace.11eHHJt, MOJKeT 6b!Tb peKOMeH,ll0B8HO orpaHHt{HTb npo,11aJKy .11eKapCTB8. TaKaR JKe peKOMeH,ll8llllJt MOJKeT 6b!Tb Bb!HeCeHa, Kor,11a cy111eCTByeT Heo6XO,llHMOCTb B npoae,11eHHH H8,ll30pa 38 HCI10Jlb- 30B8HHeM .11exapCTBa noc.11e ero noRB.11eHHJt Ha pb!HKe. B) BpeMeHHOe. Taxoe pemeHHe Bb!HOCIITCJt, ecJIH KoMHTeT BH,ll;HT He06XO,llID(OCTb B ,llOilOJIHHTeJibHOH HH- ct>opMaumr. TTpH 3TOM KoMHTeT HH<!>OpMHpyeT 38JtBHTeJIJt O CBOeM pemeHHH qepe3 CexpeTapnaT. 3aRBH- TeJIIO ,11aeTCJt onpe,lleJieHHb!H cpox ,llJIH Hanpaa.11eHHJt ,llOilOJIHHTeJlbHOH HH<l>OPMBUHH. B Te'teHHe meCTH Me- CHUeB noc.11e no.11yqeHHJt 3TOH HH<l>opMallHH llO,llp83,lle.11eHHe EPB coo6111aeT 3aHBHTeJIIO O CBOeM OKOH'taTeJib- HOM pemeHHH, KOTOpoe MOJKeT COOTBeTCTBOBaTb THTTaM pemeHHH a), 6) HJIH r). r) OT pHUaTeJlbHOe. ITpH Bb!HeCeHHH TaKoro pemeHHJt 38JtBHTeJIJt HH<l>op>mpywr O IIpH'tllHax, no6y,llHBmHX KollfHTeT npHHJtTb OTpHnaTeJibHOe pemeHHe. 3aRBKa aHHyJlllpyeTCJt' a OKOH'taTeJlbHOe pemeHHe BblHOCHTCJt noc.11e c.11ymaHI1Jt :iaJtBHTe.11Jt. 6. ~OKyMeHTbl CHO JtBJIJteTCJt ,llOKyYeHTOM, npe,llH83Ha'<eHHblllf AJIR mHpoKou ny6.11HKH. OHO cpaay ny6.11uxyeTCJt Ha aHr.11Hu- CKOM Jt3b!Ke H HanpaBJIJteTCJt BO ace roCy,llapCTBB - 'tJleHbl B03, aaTeM nepeBO,llHTCJt H H3,ll8eTCJt Ha ,11pyrax Jt3bl- xax. B ,llOKyYeHT B Ka'teCTBe COCTaBHOU ero qaCTH 6y,11eT BK.iilO't8TbCJt no.11Hb!H TeKCT O,ll06peHHOro HH<!>OpMa- llllO HHoro npocneKTa . B OTJIH'tlle OT 60.11bmHHCTBa HallHOHaJibHblX ,nrueH3Hll Ha BbWYCK JieKapCTBeHHblX cpe,.!ICTB ,lleHCTBHe CHO He orpaHH'tHBaeTCJt Kaxmrn-To onpe,lle.11eHHb!MH cpoKallfH, nocxo.11bKY ero aa,lla'ta - ,11aTb rrpenapa- TY H8Y'<H0 o6oCH0B8HHyro oueHxy Ha OCHOBe CBe,lleHl!H, no.11yqeHHblX B KOHKpeTHb!H nepHO,ll BpeMeHH, H ecTeCT- eeHHO , 'tTO noc.11e,llyl0lllee ycoeepmeHCTBOBaHHe .11eKapCTBa MOJKeT npHBeCTH K TOMY, '<TO 3Ta oueHKa ycTapeeT. C yqeTOM 3TOro ct>aKTa B CHO 6y,lleT yKa38HO apeMJt COCTaBJieHHJt ,llOKyMeHTa H epeMJt no.11yqeHHJt IlO,llp83,lleJieHHeM EPB ,11aHHblX OTHOCHTeJlbHO JieKapCTBeHHOro cpe,llCTB8 ,llJIJt oueHKH. 3aJtBHTeJIH, ;tte.11aro111He npO,llJIHTb ,lleHCTBHe CHO HJIH BHeCTH B Hero H3MeHeHHJt, ,.!10.JIJl(Hbl npe,11cTaBHTb ,llJIJt 3THX ue.11eu xopomo apryYeHTllPOBaHHyro 3aJtBKY, KOTOpaJt 6y,11eT npoaHaJIH3HpoeaHa B TOM JKe nopR,llKe, 'tTO H nepBOHa'taJibH8Jt. nocxo.11bKY ,11eHCTBHe CHO He orpaHH'<eHo cpoKrura, OHO B npHHUane He 6y,11eT aHHyJIHpoeaTbCJt e.11n cqe- TaTbCJt noTepJtBmHM ce.11y. Ho B HCKJIIO'<HTeJibHblX c.11yqaJtx no,llpa:i,lle.11eHHe EPB MOJKeT aHHy.11npoaaTb CHO, ec- JIH 6y,lleT o6HapyJKeHO ' '<TO HH<l>opMaJIHJt' KOTOpaJt 6bL/Ia HCilOJlb30BaHa npH ero COCTaBJieHJUI CvBepmeHHO He,llo- CTaTO'tHa, IlJIH BBOJIHT B aa6.11yJK,lleHl!e . 7. Ope,11yCMaTpHB8eTCJt npe,llOCTaBJIJtTb 38JtBHTeJIIO npaao BblCTynHTb 0,/0IH pa3 B Te'teHHe nepeo,11a oneHKH ero 38JtBKH. Taxoe c.11ymaHHe 6y,11eT B IIpHHlll(Ile npOBO,llHTbCJt CeKpeTapHaTOM, HO 38JtBHTeJib 6y,lleT HMeTb rrpaao BblCTYTTHTb nepe,11 IlO,llKOllfHTeTO~ B TOM c .11yqae, ecJIH eMy 6y,11eT coo6111eHo O B03MOJKHOM IlPHHJtTHH OTPHUaTeJlbHO- ro pemeHHJt HJIH B c .11yqae, ec.11>1 npe,llno.11araeTcJt aHHyJIHpoaaTb yJKe B&l,llaHHoe CHO . 8. MaTepH8Jlbl, npe,llCTSBJIJteMble no,llpa:i,11e.11eHH10, TBK xe KaK H ero 3ace,11aHHJt, JtBJIJt!OTCJt CTporo KOH<!>HAeH- UHBJlbHb!J,{H. 8 pacnopJtxeHHe IlO,llpB3,lleJieHHJt EPB CJie,llyeT Bbl,lleJIHTb 0.llHY .11a6opaTOPHIO ,llJIJt npoee,11eHHJt oneH- KH ct>apManeeTH'teCKHX CBOUC TB npenapaToa, MeTO,llOB 10{ H3rOTOBJieHHJt H aHaJIH3a npe,llCTaBJieHHblX o6pa:iuoa. 8 Te'teHHe ecero rrponecca oueHKH MaTep>1a.1a no KOHKpeTHOMy npenapaTy ct>aMHJIHH npOH3B0,llRIIIHX 3TY o neHKy 3KCnepTOB 6y,llyT coxpaHJtTbCJt B TaHHe OT :i aJtBHTeJIJt. noc.11e 38BepmeHHJt pa60Tbl no oue11xe I10,llp83,lleJieHHe EPB npe,llCTaBHT 3aJtBHTeJIIO OT'teT OTHOCHTeJibHO n o.11y'te HHblX pe3y.llbTaTOB H CBOHX coo6paJKeHHH Ha RX C'teT He38BHCHMO OT Toro flBAfleTCH AH OKoH qaTeAbHOe pemeHHe IlOAOXHTeAbHhlM HJIH OTPHllaTeAbHhlM. B TOM c.11yqae' ecJIH B no,11pa:i,lleJ1eHHe EPB IlOCTynJtT MaTepHaJibl OTHOCHTeJlbHO He,llOCTaTO'tHOH 6e:ionaCHOCTH .11exapCTBeHHOro c pe,11CTBa, TO noc.11e c.11y maHHJt 38JtBHTeJIJt IlO,llpaa,lleJieHHe MOXeT o6paTHTbCJt K feHepaJibHOMY ,llHpeKTOpy C npe,llJIOJKeHHeM ony6JIHKOBaTb H pacnpOCTpaHHTb COOTBeTCTBYIOIIIYIO HH<!>OpMallHIO no 3TOMY BOnpocy, KOTO pan npe,11CTaBJ1JteT HHTepec ,ll,lJt lllllpOKOU 06111eCTBeHHOCTII. - 164 - 9. 06ecne'tfeHHe 6LICTPOH o6pa60TKH MaTepna.JJOB IlpH C03AaHHH CHCTeMLJ npeAno.11ara.110Ch o6ecne'tfHTh ee 6hlCTpoe $yHKITHOHHpOBaHHe C y 'tfeTOM, ecTeCTBeH- HO , BpeMeHH, Heo6XO,l[IDIOro A.II.fl npoBeAeHH.R COOTBeTCTByiomeH Hay'tfHOH oneHKH. 3aBepmeHHe pa60T n o oneH- Ke B ycTaHOBJieHHLJe cpoKH 6yAeT rapaHTHpOBaHO . B paC'tfeT 6YAYT npHHHMaTbC.R CM.Rr'tfaJOJllHe o6CTO.RTeJibCT- Ba, npen.RTCTBYJOIUHe HOpMaJihHOMY nponecc y pa6oTbl, HanpHMep, HapymeHHe MeXAYHapOAHblX KOMMYHHKaITHOHHblX CB.fl3eH. 1 0 . CToHMOCTh oneHKJ< n ee <!>HHaHcnpoBaHJ<e IlpeAno.11araeTC.R, 'tfTO nOApa3AeJieH>1e EPB no oneHKe JieKapCTBeHHblX cpeACTB 6y,n;eT pa6oTaTb Ha npHH)ll!- ne X03pac'tfeTa. 3KOHOMH'tfe CKa.R CaMOCTO.RTeJi hHO CTh no,n;pa3,n;eJieHH.R 6yAeT AOCTHrHyTa noc Jie Toro, KaK Ha- 'tfHeTC.R pery.11.RpHoe nocTyn.11eHHe 3a.RBOK. OnJiaTa npoBeAeHH.R oneHKH CKaJibKYJIHPOBaHa TaKHM o6pa30M, qT0 6hl noKphlBaTb BCe H3,n;epxKH. 11. liH<j>opMannOHHO-IlOArOTOBHTeJihHb!H 3Tan B Te'tfeHHe 3TOro 3Tana npe.n;no.11araeTC.R HH~PYHPOBaTb rocy,n;apCTBa-qJieHhl, $apManeBTH'tfeCKHe $Hpllbl- H3rOTOBHTeJIH H APYrHe 3aHHTepecoBaHHbJe CTOpOHhl B OTHOmeHHH ,n;aHHOro npe,n;.11oxeHH.R H npoaHaJIH3HpOBaTb noJiy'tfeHHYK OT HHX HH$OpManmo . B ne.11.RX no.11y'tfeHH.R o6beKTHBHOli oneHKH AaHHOro npeAJIOXeHH.R npeAnOJiara- eTC.R pa30CJiaTb 3aHHTepecoBaHHblM CTOpOHaM nHCbMa H opraHH30BaTb BCTpeqn no 3TOMY Bonpocy B HeKOTOpblX CTpaHax H perHOHa.JlbHblX neHTpax. Ilpn COC TaBJieHHH peKOMeHAannn 6YAYT BHHMaTeJibHO H3y'tfeHLI BCTpeqHbJe H Apyrne npe,n;.11oxeHH.R, a TaKXe KPHTH'tfeCKHe 3aMe'tfaHH.R, necHTblH EaponeHCKHH CHMn03HYM no KnHHHKO- $apMaKonorH4eCKOH oueHKe npH KOHTpone 3a neKapcTBeHHblMH cpencTBaMH: neKapCTBeHHble cpencTaa AnH MnaAeHuea H neTeH MnaAwero B03pacTa WnaHreH6an, 27-30 OKTH6pH 1981 rona - 165 - ICP/ PHB 009(S) 11 HHaapH 1982 rona OPHnlHAJl: AH fJIHfiCKl1Yf necHTblH EeponeHCKHH CHMn03HYM, KaK H ace npem,J,!lymHe, 6 bl!I opraHH30BaH MHHHCTepCTBOM no nenaM Monone= H 3ApaaooxpaHeHHH ~enepaTHBHOH Pecny6nHKH repMaHHH . B COOTBeTCTBHH C paHee ycTa HOBHBmeH- CH npaK THKOH B HeM npHHHnH yqacTHe cneuHanHCTbJ-MeAHKH, npencTaBHTenH o praHOB neKapCTBeHHoro KOHTpo- nH, npencTaBHTenH MeJKIIpaBHTenbCTBeHHblX H HenpaBHTenbCTBeHHblX opraHH3aUHH H COTPYAHHKH B03. naH Hoe coae111aHHe 6b1II0 uenHKOM nocaH111eHo npo6neMe "neKapcTaeHHbIX cpencTa nnH MnaneHuea H neTeH MnaAmero B03pacTa". Uenb BCTpeqH COCTOHna B onp eneneHHH H pa3pa60TKe npHHUHnOB, KOTOPble MOr!IH 6bl 6b1Tb HCnOnb30BaHbl epa40M H npH Ha3Ha4eHHH neKapCTB neTHM, a TaKJICe opraHaMH neKapCTBeHHoro KOHTponH npH peweHHH eonpoca o uenecoo6pa3HOCTH ne4eHHH MnaneHuee H neTeH Mnanmero eospacTa CY111eCTBYIOIIU-IMH H!IH HOBblMH MeAHUHHCKHMH npenapaTaMH. 2 . BblBOAbl 06111He nonoJ1CeHHH Y4aCTHHKH coee111aHHH OTMeTHilH, 4TO 6onbmaH qacTb HMelOIIU-IXCH B HaCTOHI11ee apeMH caeneHHH O cneuH- $H4eCKOM BJIHHHHH neKapCTBeHHblX cpencTB Ha neTeH nonyqeHa B pe3ynbTaTe npaKTH4eCKoro npHMeHeHHH 3THX cpeACTB;HepenKO Hcnonh30BaHHe npenapaTOB B KnHHH4eCKon npaKTHKe OKa3blBano OTPHUaTenbHOe B03AeHCTBHe Hannon, 3AOPOBbe MnaneHuea H neTeH, B CBH3H C 4eM npoaonHnOCb H3Y4eHHe B03HHKIIIHX ocnOJICHeHHH, XOTH TaKHe HccnenoaaHHH Hano 6bl!IO npennpHHHTb Ha 6onee paHHeH CTaAHH. TaM, rne cepbe3Hbie HecqacTHbie cnyqaH He OTMe4anHCh, HccnenoaaTenbcKaH pa6oTa He npoaonHnacb aoace. Ha HacToH111ee epeMH MHOrHe neKapcTBeHHble cpencTaa He nonaepraroTCH CHCTeMaTH4eCKOMY H3Y4eHHro B nnaHe B03MOJICHOCTH HX Hcnonb30Ba- HHH neTbMH . TaKHM o6pasoM, coeepweHHO Heo6XOAHMO 3Ha4HTenb HO paCIIIHPHTb H yrny6HTb coapeMeHHble 3HaHHH 0 B03AeHCTBHH neKapcTBeHHblX cpencTB Ha neTeH, a TaKJICe Ha YTP06HblH nnon. Pe'lb HAeT, C OAHOH CTOPOHbl, 06 aK THBH3aUHH HaY4HblX HCCnenoaaHHH B o6naCTH nogpOCTKOBOH H nenHaTpH'!eCKOH $apMaKonorHH H, C gpy- roH CTOPOHbl, 0 npoaeneHHH npaKTH'leCKHX HccnenoaaHHH C uenbro oueHKH $apMaKOKHHeTH'!eCKOro neHCTBHH oT- nenbHblX neKapCTBeHHblX cpencTB H rpynn neKapCTB Ha geTeH . ITo 06111eMy MHeHHro, H3yqeHHe He6naronpHHTHoro aosneHCTBHH npenapaToB Ha neTeH Tpe6yeT He TOnbKO 60nbwero BHHMaHHH, HO TaKJICe H HOBblX nonxonoa. OTnenbHble coo6111eHHH O no604HblX 3cl><l>eKTax 06bl'IHO He co- n epJICaT caeneHHH O B03AeHCTBHH neKapCTB Ha neTeH. B 3TOH o6naCTH cnenyeT HCilOnb30BaTb MeTOA "HHTeH- CH$HUHPOBaHHOro cnoHTaHHOro MOHHTOPHHra" H CTpeMHTbCH K C03Aa HHro B pa3nH4HblX qacTHX 3eMHOro mapa ueHTPOB HHTeHCHBHOro KOHTPOnH. ITpH H3Y4eHHH He6naronpHHTHblX peaKUHH cnenyeT npenycMOTpeTb HCCneno- aaHHe B03AeHCTBHH Ha YTP06HblH nnon H rpynHbIX neTeH neKapCTB, npHHHMaeMblX MaTepHMH, a TaK;o;e CHCTeMa- TH4eCKOe HccnenoaaHHe B03MOJICHOro B03AeHCTBHH Ha poCT H pa3BHTHe pe6eHKa nnHTenbHOro npHMeHeHHH ne- KapcTBeHHblX cpencTa . KaK H B n pyrHX o6naCTHX, HccnenoaaHHH B o6naCTH npHMeHeHHH neKapcTBeHHblX cpencTB HBnHroTCH Heo6- XOAHMOH OTnpaBHOH T04KOH AnH pa3pa60TKH nonHTHKH; npH npoaeneHHH TaKHX HccnenoaaHHH eecbMa penKo H3yqaeTCH neHCTB He neKapCTBeHHblX cpencTB Ha neTeH , XO TH 04eBHgHO, 4TO MeTOAl>J neKapCTBeHHoro neqeHHH neTeH OTnH'!aroTCH OT MeTOAOB MeAHKaMeHT03HOro neqeHHH aspocnoro HaceneHHH . 3nr<1eCKHe acneKTbl HccnenoaaHHH Y4aCTHHKH coae111aHHH Bblpa3HnH MHeHHe, qTo 3TH'leCKHe npo6neMbl, CBH3aHHble C H3Y'!eHHeM B03AeiiCTBHH neKapcTBeHHblX cpencTa Ha n eTeH, He npenHTCTayroT npoaeneHHro HaY'!HbIX HccnenoaaHHH; onHaKo 3 TH npo6ne- Mb1, 6 e3ycnOBHO, o rpaHH'IHBaroT UIHpOTY H MeTOAbl HccnenoaaHHH.0CHOBHO~ npHHUHil HH$0PMHPOBaHHOro cornaCHH, - 166 - ITPHMeHHMb!H K ITIOOOMY HccneAOBaHHro Ha qenoseKe, B paBHOH CTeneHH npHMeHHM H B OT HOmeHHH AeTeH; POAH- TeITH HnH nHuo, Hec ymee OTBeTCTBe HHOCTb 38 pe6eHKa, AOIT~Hbl gaTb COOTBeTCTBy~ee o¢HUHaITbHOe cornacHe, a pe6eHKY O npeAnonaraeMOM yqacTHH B HCCITeAOBaHHH cneAyeT C006lllHTb B AOCTYITHOH AITH ero B03pacTa H ITOHHMaHHH ¢opMe . TOT ¢aKT, qTo pe6eHOK IDPHAHqecKH He MO~eT AaTb OTKa3, He CHHMaeT C HccneAOBaTenH 06H3aHHOCTH BHHMaTenbHO OTHeCTHCb K TaKOMY OTKasy HITH npoTeCTY, saHBneHHOMY pe6eHKOM, B03pacT KOTO- poro IT03BOnHeT eMY HMeTb co6CTBeHHyro ToqKy 3peHHH. MeToAonorHH HccneAoBaHHH TIOCKOITbKY OCHOBHbJe aHaToMHqecKHe H ¢H3HonorHqecKHe H3MeHeHHH npOHCXOAHT B opraHH3Me pe6eHK8 B TeqeHHe scero nepHoAa ero pa3BHTHH, H3yqeHHe MeAHKaMeHTa, npHMeHeHHe KOToporo Mo~eT oKa3aTbCH nones- HbIM B AeTCKOM B03pacTe, AOIT~HO, KaK npaBHnO, ITPOBOAHTbCH B pa3HblX B03paCTHb!X rpynnax. Yq acTHHKH COBema HHH OTMeTHnH, qTO nyTeM 6onee mHPOKOro HCITOITb30BaHHH COBpeMeHHOH TeXHOnorlIB npH pa3pa60TKe neKapCTBeHHblX cpeACTB H HeHHBa3HBHb!X MeTOAOB oueHKH MO~HO MHoro A06HTbCH, qTo6w CHH3HTb AO MHHHMYM8 ITOABep~eHHOCTb AeTeH B03AeHCTBHHM neKapcTBeHHblX cpeACTB, PHCKY H HeYA06CTBaM, CBH3aHHbJM C nposeAe- HHeM HCCITeAOBaHHH . 0 TBeTCTBeHHOCTb 38 npoBeAeHHe HccneAOBBHHH 0 TBeTCTB eHHOCTb 38 pa3BHTHe ¢YHAaMeHTaITbHblX OCHOB ITOAPOCTKOBOH ¢apMaKonorHH nonHOCTbffi neJKHT Ha yqeHbJX H Bpaqax, OAHaKO yqacTHHKH cosemaHHH HaCTOHTeITbHO peKOMettgyroT PYKOBOAHTeITHM opraHOB neKapcT- BeHHoro KOHTponn COAeHCTBOBaTb npoBeAeHHro TaKOH pa60Tbl nyTeM onpeAeneHHH npo6enoB B cymeCTBYffilllHX 3HaHHHX, KOTOpbJe cnYJl(aT ITpttqHHOH B03HHKHOBeHHH npaKTHqeCKHX npo6neM npH npoBeAeHHH oueHKH neKapcT- BeHHb!X cpeACTB AITH AeTeH . DpOH3BOAHTeITHM HOBblX neKapCTBeHHblX cpeACTB H npenapaTOB, ITOTeHuHanbHO none3Hb!X AITH AeTe11, Ha- CTOHTenbHO npegnaraeTCH B COTPYAH~eCTBe c MeAHUHHCKHMH ueHTpaMH ocymeCTBITHTb Heo6XOAHMYID AeHTenb- HO CTb B 3TOH o6nacTH, H HaqHHaTb ee ropa3AO paHbme, qeM 3TO HMeno MeCTO B npomnoM . Opratthl neKap- CTBeHHoro KOHTPOITH AO~! AOBOAHTb AO CBeAeHHH spaqe8 pesynbTaTW ITOA06HblX HCCITeAOBaHHH. B paMKax MelK,!lyHapOAHOro COTPYAH=ecTBa 3TH yqpeJK,!leHHH TaK~e AO~Hbl npoBOAHTb oueHKY cymecTBYffilllHX neKapCTBeH- flblX cpeACTB, KO TOpb1e HCITOITb3YffiTCH AnH neqeHHH AeTeH, HO B03AeHCTBHe KOTOPblX Ha 3 TY B03paCTHYID rpyn- ny paHee He H3yqanocb . .fu!ua, n ponHcbmaJO[J(He neKapCTBeHHb1e cpeACTBa QqeHb B=Ho, qTo6bJ BpaqH nyqme ITOHHITH ITPHHUHITW neKapCTBeHHOro neqeHHH AeTeH; 09HaKOMneHHe C 3THMH ITPHHUHITaMH HaAO npOBOAHTb Ha npeggHnnOMHOM H noCTAHITnOMHOM YPOBHHX, qTo ITOMO~eT BpaqaM npa- BHn bHee HHTepnpeTHPOBaTb AaHHWe O HOBb!X neKapCTBeHHb!X npenapaTax . Y MHOrHX BpaqeH HeT qeTKOro npeACTaBneHHH O TOM, HaCKOITbKO npaBHnbHO npHMeHHIDTCH Ha9HaqaeMble HMH neKapcTBeHHWe cpeACTBa, xopomo H9BeCTHbl H npo6neMbJ, CBH9aHHble C co6mO,QeHHeM AeTbMH H POAHTeITHMH npaBHn npHeMa npenapaTOB. CneAyeT, IT03TOMY, ITOMOqb spaqaM ITOHHTb H yqHTbmaTb 3TH npo6neMbJ . DpoueAypy BwgaqH peuenTOB BpaqaMH-neAHaTpaMH MO~HO ynpOCTHTb H o6ecneqHTb Oonee TOqHoe BWITOnHe- HHe npaBHn ITPHMeHeHHH neKapcTB, ecnH BWITYCKaTb B ITPOAa~ neKapCTBa B A03HPOBKe AITH neqeHHH AeTeH. E CBH9H C 3THM yqaCTHHKH cosemaHHH H8CTOHTeITbHO peKOMeHAOBanH ITPOH9BOAHTenHM neKapCTBeHHblX cpeACTB H opraHaM neKapCTBeHHOro KOHTponH npeAITPHHHTb COOTBeTCTBYJO[J(He marH B 3TOM HanpasneHHH. HaceneHHe YqacTHHKH cosemaHHH OTMeTHnH, qTo qacTO B npeAHa3HaqeHHblX AnH noTpe6HTenH npaBHnax npHMeHeHHH neKapcTB H aHanOrttqHOH AOKyMeHTaUHH He COAePJKHTCH HHKaKOH HH¢opMaUHH - nonOJKHTeITbHOH HnH OTPHua- TeITbHOH - 0 B03MO~HOCTH HCITOITb90BaHHH neKapcTBeHHOro npenapaTa AITH neqeHHH AeTeH . OpraHaM neKapcT- BeHHOro KOHTPOITH cneAyeT no3a60THTbCH O TOM, qTo6w 3 TOT HeAOCTaTOK OblJI HCnpasneH. _!(O HKpeTHbJe rpynnw neKapCTBeHHblX cpeACTB CHMI103HYM YAenHn ocoOoe BHHMaHHe PHAY KOHKpeTHb!X neKapCTBeHHblX cpeACTB AITH AeTeH, a HMeHHO npe- napaTaM, KOTOPble npHMeHHIDTCH npH AITHTeITbHOM neqeHHH aCTMbl H APYrHX ¢opM pecnHpaTOPHblX OonesHeH, a TaK~e npOTHB03nttnenT=ecKHM cpeACTBaM, aHTH6HOTHKaM, XHMHOTepaneBTttqeCKHM cpeACTBaM neqeHHH paKa H =ponoH=JO[J(HM/o6es6onHBa~M coeAHHeHHHM. KaqecTBeHHOMY MeAHKaMeHT03HOMY neqeHHro YKasaHHWX Bwme OoneaHeH MemaeT PHA ¢aKTOPOB, Ha KOTOpbJe yqaCTHHKH CHMI109HYM8 MoryT yKa3aTb. - 16 7 - 3KOHOM11KA 3m'ABOOXPAHEHIDI - 169 - Pa6oqee cosemaHHe no sonpocy CAeplUIB&HHR pocTa pacxOAOB Ha weARKo-caHRT&pHym nowo!& a cBCTewe COIUIBJl&Horo o6ecneqeHHR ICP/RPD 803(1) (S) 9 HIOHR 1981 roAa Beaa 1 2�-28 waa 1981 roAa OPfil'llliAJI: AHr JIHHC!Glli 1. B TeqeHRe no Ep8HHei wepe nocAeAHero AeCRTRAeTRR H&R6oAee pa3BRTWe CTp&HW RCllWTWBllJIH TPYAHOCTR B <l)mlaucxposaHHR ace BO3PBCTIUOIJIHX pacXOAOB Ha Ke,D;HKO-CBHRTapuym noKOlll,b, IlocKOA&Ky AOAR cpeACTB, sw..e.vrelNX Ha 3ApasooxpaHeHHe, llPOAOJUIBAB norAomaT& 3HB'IB:TeAbHO 60A&mym qacT& BBJIOBOro UB!lROR&AbHO­ ro lrpOAyxTa, CTpauw npe,lUlpUURJm IlOilWTKR p&CJCPWTb npRqRHW 3TOro RBAeHRR, Co speweHeK CTB./1O OqeBRA­ HO, qTo KHOrRe H3 3THX npR,mH RBJlJllDTCR o6mmm AAR CTpaH, HKeJOOIHX coaepmeHHO p83HWe CRCTeKW Ke,D;HKO­ CBBBTBPHOH llOKOm;H, Bwr npoaeAeH PRA KeJU;yHBPOAHWX KOHti,epeHmrit, KOTOpwe CTBBHAH Il0A&m 6oAee noAHO oneDTb CTPYKTYPY, nponeccw R pe3yA&TBTW pa3J111qHWX CHCTeK C TeK, qTo6w KOXHO 6wro Bl,l,ll;eJmTb R o6�ac­ HHTb �BKTOPW, KOTOpwe B0AYT E 6wcTpOKY pocTy pacXOAOB. Moxao cnpaseAAHBO 3aKeTRTb, qTo pe3yA&Ta­ TW lrpOAeA&RROI B 3TOK H&npBBAeHHH pa6oTW EBE OTAeAhRW>ur CTPBR&llll, TBK R COBKeCTHO, OKB3&AHCb B0Cb- 3HB'IIIITeA&HWIIH, XOTR npaqaHW pocTa Bee eme ae BllOAHe yacHeHW, HeKOTOpwe CTPBIDI npRCTymrAR K pa3pa60TEe R 3Ecne­ pHKeHTBAbHOKY OCYJlleCTBAelDD) noJIHTHltR, H&np&BAeRROH Ha CAeplUIB&HHe pocTa pacXOAOB, 3aA&qa ABHHoro cosemaHHR 3BKJIIOqaA&Cb B TOK, qTo6w o6weRRTbCR OllWTOK B o6A&CTR wexaHH3KOB, KeponpRRTlm R IlO.JIHTRltR, HCUOA&3yeMWX CHCTeKBJlll CO!lRBAhHOro o6ecneqeHHR AAH CAeplUIBBHHR pocTa pacXOAOB Ha Ke,D;HKO-CBHHTBPHYID nowoau, npa p83.JIHqHoi opr&HH3BllRH 3TOH nowoma; B TOK, qTo6w oneHHTb 3TH wexaHH3KW, KeponpRRTBR R no.DrTRKY B OTHOmeHRR HX cnoco6HOCTR CAepx&Th pOCT paCXOAOB, npa 3TOW He OTPIUt&JtCh nary6ao HB 3AO­ pos&e JDD,D;ea; R nonWTBThCR onpeAeARTb noTeH!lRBAhRO IlOAe3HWe no,ll;XOAJ,1 R YCAOBRR AAR HX npHWeHeHHR, 2. ,/lHCKYCCRR OnpeAeAeHHW0 CTPBTerHR, HanpaBAeHHWe Ha CAeplUIBaHRe pocTa oneaxa KOHxpeTHWX �aETOpos, KOTopwe B03AeHCTBYIDT Ha CTOHWOCTb, we..axo-caHHTapHoi llOKOIIIR Tpe6yeT, qTo6w KBK OTAeAhHWe �BXTOpw, pacXOAOB, AOJUIHW CT&Th pe3yA&TBTOW 0AHBXO 6oA&maa CAOEHOCTb CHCTew BeAymae K pocTy pacXOAOB, TBK R yEa- 3BHHWe CTpaTerHH, aanpasAeHHWe Ha CAeplUIB&HHe 3Toro pocTa, AOJUIHW paccw&TPRBaThCR C AOCTaToqHo ma­ POICIX Il03Hnirit, qTo6w, no wepe BO3WOEHOCTH, 6W.JIH npeAYCWOTpeHW see sepORTHWe H&IDBHCW, BO3HHKaJ001He B csa3e c npHWeHeHaew cTpaTerRH no CAePXBBBRHm pocTa pacxoAOB, ,ltAa ABHHoro Pa6oqero cosemaHHa, se­ AY-"e E pocTy pacXOAOB npHqHHW, 6w.m pacnpeAeJteHW no E&TeropRRW DOA qeTyPhiVI 06111RWH 3aroAOBltlll(H: 1) yse=eHHR B cpeACTBax H pacmapeHRe CJlyE6 BW3WB&eT IlORBAeHHe HX co6CTBeRHJ,IX noTpe6HOCTel; 2) Heo6xoAHWOCTh B HenpepWBHOK yAytUDeHHH E&qecTBB BW3WB&eT pocT ce6ecTOHWOCTH eAH� npoAyltilRR; 3) KHOrae CHCTeKW WeAffKO-CBRHTBPROH nowoma xapaxTePH3ymTCR OTCYTCTBHew EBEOi 6w TO HR 6WJIO �opww 6mAEeTHOrO KORTpOAR H .mua, 06ecneqasaJ001He KeA)rxo-caHRTBPRYID nowoou,, He HWemT COOTB0T­ CTBymmHX CTHKyAOB, qTo6w 6opOTbCR c POCTOW paCXOAOB; 4) Ha6JIIDA&eTCR OTCyTCTBHe CO3RBTeAhHOCTH B OTHomeHHe pacXOAOB, KBK cpeAH Tex, XTO np0AOCTBB­ AReT weAHKO-CBHHTBPHYID nowoou,, TBK H cpeAH Tex, XTO ee noTpe6AR0T. IlpRBeAR ABHHYID XAaCCH�HKamnD npHtmH, yqaCTHHXH Pa6oqero coaemaHHR npoBeAH oneHxy npo6AeK, CBR- 3aHRwx co CAepEHBaHHew POCTa pacxoAOB, crpymmposas npOBOAHWWe weponpHRTHR IlOA qeTwphKR 3arOAOBXIIKB. - 170 - M3 nepBoBaQa.llbHOro onncaHBJI CBCTeM MeABKO-CaHBTapHOH nOMO!Dll CTpaHru<, yqacTByi<IIIID< B Pa6oqey co- BemaHBB MOXH O npeAnOAOXBTb, QTO cnoco6HOCTb CAepxaTb pOCT pacXOAOB nOQTB neJIHKOM 3aBBCBT OT CTPYK- TYPhl CBCTeMhl' npH 3TOM rpynna' 06'be;1;1rnmo111aJ1 CTpaHhl C CBCTeMru<H' B OCHOBe KOTOpblX AellU'IT COOBa.llbBOe CTpaxoBaHne' paccMaTpnBaeTCJI KaK rpynna' HaxOAJUllaJICJI B OTHOCBTeAbHO cAa6oM noAOXeHBH r, CI<CTeMhl' oc- HOBaHHb!e Ha cono6ecneqeHHB' COCTaBAJDOT rpynny' OTHOCBTeAbHO 6oAee MOrYIJleCTBeHHyK. 0AHaKO npn 60- JJ.ee TeCHOM paCCMOTpeHHH o6Hapyx.H.mCb 3H8tlHTeJtbHbie OTJlH'lHJJ B CHCTeMax, OCH0B8HHbIX H8 COIJ;H8JibHOM CTpaxoBaHHH; HeKOTOpble BaxHbie <J>aKTOpb! OKa3aAHCb o6m.,nrn AAR o6oID< Tr<nOB CBCTeM ' a TaK*e B03HHKJIH BOnpOChl, KaCaI0111HeCJ1 xapaxTepa KPBTepr<eB, KOTOphte HaAAeXHT BCnOAb30BaTb npr, oneHKe 3<!><l>eKTBBHOCTB no- J[HTHKR, HanpaBAeHHOH H8 CAepxHBaHHe pocT a paCXOAOB. CpeAH 06111HX <J>aKTOpOB COBepmeHHO OQeBBAHhD,l OKa3aAaCb BaxHOCTb BHemHID< B03AeHCTBBH (a HMeHHO: H3Aepx:KI< Ha pa6oqyK CHAY' 06111ecTBeHeoe MHeHHe H npO<J>eccnoHaAbHaJI Hanpfill(eHHOCTb ) Ha CHCTeMbl MeAHKO- caHHTapHOH nOMOl!IH B neAOM H nOAHTI<Ky CAepXHBaHHJI pocTa paCXOAOB B qacTHOCTI<. Tipn paCCMOTpeHHB cpeACTB OCYl!leCTBAeHHJI noABTHKI< 6hL1!o pemeHO, QTO CHCTeMa AHMHTHPOBaHHJI AeHex- HhlX cpeACTB, npn nOMOJIIH KOTOPOH neHTpa.llbHOe npaBHTeAbCTBO onpeAeAJleT 06111yK cyMMy paCXOAOB , accHrHy- eT cpeACTBa OTAeAbHhD,l perHOHru< H 3<!><l>eKTHBHO o6ecneQHBaeT BCe COOTBeTCTBHJI, JIBAJleT CJI 6e3 COMHeHBJI AeHCTBeHHOH MepOH AAR CAepxnBaHHJI pocTa paCXOAOB. 0AHaKO 3Ta Hepa He 6hL1!a opHeHTHpOBaHa Ha o6ec- neqeHHe MeAHKO-CaHHTapHOH noMOl!IH, a JIHlllb JIBHAaCb 06111ecTBeHHhD,l MexaHH3MOM KOHTPOAJI paCXOAOB. Ta», rAe aaTpaThl nOMaIOTCJI KOHTPOJDO, CAepxHBaHHe pocTa paCXOAOB MOXHO npOBOAHTb Ha nAaHOBOH OCHOBe nyTeM orpaHBQeHBJI KJDOQeBh!X pacxOAOB Ha 6oAbHBllhl, TaKID< KaK KOHKI< B AOporOCTOJl.lllee o6opyAOBaHHe B nyTeM 60- Aee panHoHaAhHOro nx pacnpeAeAeHHR . ,ll,pyrne KOHKpeTHh!e MeTOAbl KOHTPOAJI aaTpaT' KOTOpb!e 6h!AB C ycneXOM ncnOAb30BaHhl, BKJDOQaAH Heo6- XOAHMOC Tb KOMlleHcHpOBaTb Tpe6yevoe yBeABQeHne B KaKOH-TO KOHKpeTHOH o6AaCTB 66AbIDHMH coxpameHHJD<H ,J Apyrn.x o6AaCTJtX. AHaAOrBQHhD,l o6pa30M cxevaTBQHO npocTaJI, HO 3<1><!>eKTHBHaJI 3KOHOMHJI cpeACTB 6hL1!a AOC THrHyTa B HeKOTOphlX CTpaHax nyTeM nepeKAaCCH<!>BKanHB KDeK, KOrAa pacXOAhl no CTaTbe OCTphle CAYQaH 6 hlAH nepeHeCeHhl Ha CTaTbID paCXOAOB no AOArocpOQHOMY npe6hUlaHBID B 6oAbHHOe. MHorHe CTpaHhl orpa- HHqHAB npneM B MeAHOHHCKBe yqe6Hhle 3aBeAeHBJI (xorAa 3TO n03BOAJIJm yqTeHHhle Ha 6yAY111ee noTpe6HOCTB BO Bpaqax) C neAbID CAepxHBaHHJI pocTa AOArocpOQHhlX paCXOAOB Ha Me,ll;HKO-CaHBTapHyK nOMOl!lb, 2 .2 OgeHxa CTa,y;apToB AAR rapaHTHH xaqecTBa KoHnennnR xaqeCTBa B CHCTeMax MeAHKO-CaHHTapHOH nOMOIIIH AOAXHa paccMaTpBBaTbCJI BO MHOrID< H3Me- p e BHJIX. BhlAO npeAAOXeHO pacc»aTpBBaTb xaqecTBO no nRTB acneKTru<: MeAHOHHCKOH AeHCTBeHHOCTHj ve- AHOBHCKOro pncxa; HeorpaenqeHHOH H 0,ll;HHaKOBOH AAR Bcex AOCTynHOCTHj YA06CTBa (orpaHBQeHHOe OXJ<Aa- HHe oqepe,ll;Hj H36exaHne, rAe B03MOXHO, 6oAn; cnoco6HOCTb 6hlCTpO eepHyTbCJI K pa6oTe); neHHOCTb Ae- Her (6AaronpBRTHaJI aAbTepHaTBBHaJI CTOBMOCTb ). B aaBBCBMOCTH OT KOHKpeTHOH npo6AeMhl acneKThl voryT ne HBBaTbCJI no pa3HOMy. He BcerAa 06J1aaTeAbHhD,l 6hL1!o npOTHBOpe=e MeXAY 6oAee BhlCOKBM xaqecTBOM B He06XOABMOCTbID CAepxH- BaTb pocT paCXOAOB . EcJIH yAyqmeHHoe xaqecTBO 6yAeT BKJDOQaTb coxpameHBe H3AHIDHHX nponeAyp, noTepb, B T,A ,, a TaK*e Bhl6op 6oAee nOAXOAJUlleH TeXHOAOrHB Ha COOTBeTCTBy,<lllU[X ypOBHJIX MeABKO-CaHBTapHOH no- MOIIIH, TO Heo6xOAHMOCTb B CAyx6ax a KOHeQHOM BTOre coxpaTBTCJI. TipHHBMaJI BO BHHMaHBe <J>aKT, qTo OnhlT pa3AHQHhJX CTpaH B KOHTPOAe KaQeCTBa OTHOCHTeAbHO orpaHB- qeH, yqacTHBKI< COBemaHBJI BHeCAB PJU npeAAOXeHBH no yAyQIDeHmO KaqecTBa. M, HaKOHen, 6hlAO noAqepKHyTo, qTo KaQeCTBO He noAPaay»eBaeT ncnOAb30BaHne HaH6oAee AOporoCTOJI- mero DOAXOAa, npn KOTOpOM npBMeHJDOTCJI HOBelilllHe TeXHBQeCKBe AOCTHJl(eHBJI. C APyron cTopOHhl, CHHJl(eHBe pacXOAOB a COOTBeTC TByi<IIIHX MOAeAID< MeAHKo-caHBTapHOH noMOIIIH nOBAeQeT aa co6oH CHHXeHne KaQeCTBa n yBeABQeHBe MeAHOHHCKOro PBCKa. K TOMY xe BocnpBJITBe xaqecTBa noTpe6nTeAmi B TeMB , KTO ero o6ecne- QBBaeT He 06J13aTeAbHO BcerAa OAHHaKOBO, B Ha TaKoe BOCnpBJITBe MOXeT pa3JIHQHhlMB nyTRMB B03AeHCTBO- naTb CAepxnBaHBe pOCTa pacXOAOB. 2.3 OneHKa 6roAxeTHbJX n ~nHaHCOBhlX CTHMYAOB n KOHTPOAb YqacTHBKB CoBemaHBJI npB3HaAB qpe3Bb!QaHHyK 3HaQBMOCTb npoBeAeHHJI BCeCTOPOHHen oneHKB B nAaHBpO- BaHBJI CBCTeMbl MeAHKO-CaHHTapH OH no»Ol!IH. 3TO 03HaqaeT, QTO OX~AaIOTCJI nocAeAC TBHJI npBHJITBJI Mep , HanpaaAeHHhlX Ha CAepxnBaHne poCTa paCXOAOB, KOTOpbie o6pa3yKTCJI Ha CHCTeMe B neAOM. BhlJIH npHBeAeHhl - 171 - MHOrotmcJieHHhle rrpK1,1ephl rrpo6JieM, B03HHKalODIHX rrpH OTCYTCTBHH COOTBeTCTByJOmero OJiaHHpOBaHHH, ace OHH o6epnyAHCb AOITOJIHHTeJibHMMH paCXOAaMH A,UI CHCTeMbI H,ra OTpa3HJIHCb Ha KaQeCTBe MeAHKO - CaHHTapHOH ITOMO- IIIH- TaK a HeKOTOpbDC CHCTeMax Ha6JIJOAaJiaCb ITJIOX aH KOOPAHHaUHH MeJKAy ceKTOprum rrepBHQHOH MeAJIKO-CaHH- T apHOH ITOMOIIIH H 60JihHHQHb!M . 3TO MOJKeT npHBOAHTb K H3JIHIIIHewy Ay6,mpoaa HHIO pa60Thl H HeHyJKHOMy pac- XOAOBamno cpeACTB' TaK xe KaK H HeaAeKBaTHOMY Jie qeHHIO ITOCJie BblIIHCKH H3 6oJibHHtlhl- TaBJIHeMhle ceKTOpy rrepBHQHOH MeAHKO-CaHHTapHOH ITOMOIIIH MH ee pa3BHTHH MoryT OTpa3HTbCH Ha 6oJibHhlX TaKHM o6pa30M' QTO Te 6yAyT OCTaBaTbCH B 3TOM ceKTope H3JIHIIIHe AOJiro. 2 . 4 OgettKa ettg>opwanHH, upeAOCTaBJIHeMoe cJiyx6 aw 3ApaaooxpatteHHH e rroTpe6aTeJI.fnl YqacTHHKH c oaemaHHH He HMeJIH eAHHOrO MHeHHH OTHOCHTeJibHO 3HaQeHHH HH<!><>pwarrHH O CTOKl,IOCTH, npe- AOCT aBJIHeMOH ITOTpe6eTeJIHM . 0AHO MHeHHe 6MAO TaKOBO, qTO, ecAH 00Tpe6eTeJIJD< npeAOCTaBHTb HH$Opwa- nmo OTHOCHTeJibHO CTOHMOCTH paCXOAOB Ha Me;i;HKO- CaHHTapHyJO ITOMOIIU>, OHH 6yAYT Tpe6oaaTb HaH6oJiee AOPO - rOCTOJDI1ero JieqeHHH OIIIH60QHO ITOJiaraH, QTO Bee , QTO CTOHT AOPOJKe, TO Jiy<mie. ~pyrae noJiaraJIH , QTO B03Ae HCTBHe HH$OpManHH O CTOHMOCTH Ha ITOTpe6HTeJIH 6yAeT, no BCeH aepOHTHOCTH, CJia6w,:, npH OTC YTCTBHH CTHKyJIO B HCITOJib30BaTb TaKyJO HH$opwarrmo. TpeTbH cqHTaAH, QTO, ecJIH HH$OpMaUHH 6yAeT OpeAOCTBBJIHTb CH 00Tpe6HTeJIHM' KBK rpyrrrre' a He HHAHBHAyBJibHO' TO pe3yJibTaThl 6 YAYT OOJIOIHTeJibHW<H. B TOM, QTO KacaeTCH HH$OpMat1HH, npeAOCTBBJIHeMOH =naM, o6ecrreQHBalOIIIHM MeAHKO-caHHTapHyro OOMOWh , TO OKB3aJIOCb, QTO B 6 oJiblllHHCTBe CTpaH, npeACT BBJie HHbDC Ha coaemaHHH, HH<!><>pMaUHH O CTOHMOCTH JieKapcT- BeHHbDC cpeACTB rrpeAOCTBBJIHeTCH apaqaM . B HeKOTOpbDC CTpaHax o6maH HH$OpManHH O CTOHMOCTH rrpeAO C- TaBJIHeTCH BCeM apaqaM, B TO BpeMH, KaK B APYrID< CTpaHax JIHIIIh Tew apaqaw, KOTOphle AOOyCKalOT 3HaQH- TeJibH&Ie OTKJIOHeHHH OT HOpMM . 11H$OpManHH O AeHC TBeHHOCTH Jie qeHHH CQHTaeT CH BaIHOH , XOTH 3a OTC YT- CTB HeM TaKOBOH qac TO ee pacnpocTpaHeHHe HeB03MOIHO . YqaCTHHKH coaemaHHH BhlCKa3aJIH MHeHee, QTO TPaAHnHOHHOe Me;i;HKO - CaHHTapHOe rrpocaemeHHe He acer- Aa HBJIHe TCH OOAXOAJDllHM· B JIJ060M CJiyqae He06XOAHM:O npHJIOJKHTb ycHJIHH, QT06hl CTKl,(YJIHPOBaTb BeAeHHe 6oJiee 3AOPOBoro o6 p a3a JKH3HH H AOOOJIHHTeJibHhle MeporrpHHTHH no 6opb6e C orracHOCTbID AJIH 3AOPOB bH AO,lll- Hhl npOBOAHTb CH OOMHMO 0$HUHaJibHhlX CJiyx6 3ApaaooxpaHeHHH. 3. 1 0 6man OOJIHTHKa 1. HaMeIHT CTHMyJIHpO Ba Tb HHTerpHpOBaHHhle CHCTe Mhl MeAHKO-CaHHTapHOH ITOMOIIIH ope COOTBeTCTByromeil KOOPAH Ha UHH H COTPYAHHQe CTB e MeJKAy ceKTOpaMH nepBHQHOH Me,JUIKO- CaHHTapH OH OOMOmH e 6oJibHHQHbW . 2 . ByAymee pa3BHTHe H ycoaepmeHCTBO BaHHe OOJIHTHKH CAepJKHBaHHH pocTa paCXOAOB AOJIIHO HCXOAHTb H3, ITO BO3MOXHOCTH, aceo6oeMJIJOmero ITOAXOAa, a He CJieAyeT OTAaB a Tb npeAITOQT e HHH qaCTHQHOMy pemeHHID npo6JieM. 3. CHCTeMa Me;i;HKO-CaHHTapHOH rrowoma Tpe6yeT nepeopaeHTHpOBKH B OOJib3Y nepBHQHOH Me;i;HKO- CaHHTapHOH nowoma. 3TOMY OOMOieT 6 oJiee aceo6oeMJIJOmHH OOAXOA K o rreHKe, OJiaHHPOBaHHID H COC TaBJie HHIO 6IDAieTa rrpa C03AaHHH COOTBeTCTByJOWHX CTHMYJIOB . 4. ~eHeJKHhle JIHMHThl, a TaKJKe APYrHe Mephl no CAe plKHBaHHIO pocTa pacXOAOB He AOJIIHhl pacc MaTpHBaTbCH JIHlllb KaK Mepbl , HarrpaBJieHHhle Ha 3KO HOMHID paCXOAOB Ha CHCTeMy Me;i;HKO-CaHHTapHOH IIOHOWH , HO HX HaAO oneHHBaTh H B OJiaHe 3$$eKTHBHOCTH B OTHOmeHHH CAe pxxBaHHH pOCTa paCXOAOB, a TaKJKe HX B03AeHCTBHH Ha COKpameHHe cpOKO B OXHAaHHH oqepeAH, Ha KaqecTBO we;mKo-caHHTBPHOH OOMOWH H Ha paCXOAM, KOTOphle He- cyT CBMH 60JibHhle H HX ceMbH . 5 . !loHCK Mep CAepxHBaHHH p OC T a paCXOAOB AOJIIeH BbDCOAHTb 3a rrpeAeJibl CHCTeM MeAHKO-CaHHTapHOH OOMO- IIIH H npa 3TOM HaAO yqHTbIBaTb Apy rHe $aKTOpbl TaKHe , KaK 3arpH3HeHHe OKpyJK aKl!leH cpeAbl H orraCHOCTH, KOTOpbW qeJIOBeK OOABepraeT ce6n CaM. 6. HaAJieJKHT 6oJiee TmaT eJibHO KO HTPOJIHPOBaTb KOAHQe CTBO H pacnpeAeJieHHe JIHU , 3aQHCJieHHbDC Ha OOAr O- TOBKY ITO rrporpaMHaH MeAHKO-CaHHT apHor o npocaeme HHH AJIH c nenaaJIHCTOB a o6JiaCTH MeAHKO- CaHHTapHOH nowoma. - 172 - 3.2 ilpocae~e,rne 1 . IlpaBHTeAbCTBa H opraHH3an:im COD;RSAbHOro o6ecneqeHHR AOJl'.J(Hhl IlWTSTbCR npocaemaTb o6mecTBeHHOCTb B OTHOmeHJm Toro, qTO COBpeMeHHSR Me.ZU,:KO-CSHHTapHaR llOMOmb B COCTORHHH CAeASTb , H qTo eH HeAOCTYllHO, He o6xOAHMO pa3bRCHRTb HeAOCTSTKH 'lliCTO TeXHOAOruqecKoro nOAXOAa K Me.ZU,:D;RHe . 2. BceM opraHH38nHRM, HMelOIIUD! AeAO co c n enuaAHCTa>m MeAHKO-CSHHTapHOH nOMOlllH , a HMeHHO <!><>HAS co- nHa.JlbHOro o6ecneqeHHR, npaBHTeAbCTBa.M H HHCTHTYTSM noAAeXHT o6y'll1Tb 3TOT nepcoHaA OCHOBSM 3KOHOMHKH 3APSBOoxpaHeHHR . 3 . CTyAeHTSM-Me,.!lllKSM HSAAeXHT pa36HpaTbCR B 3KOHOlCHKe 3ApaaooxpaHeHHR. 4 . CAeAyeT CTHMyAHpOBSTb 6oAee ll!HpOKHe KOHTSKThl MeXAy 3KOHOMHCTSKH B o6ASCTH 3APSBOOXpaHeHHR H Bpaqa:l(ll C TeM, q To6w KBXASR rpynna MOr Aa 6w Aytlllle noRHMSTb n epcneKTHBhl H R3hlK Aµyr Apyra . 5. B03 AOJl'.J(HS OK838Tb COAeHCTBHR B pa3pa60TKe noµo,lUl]ll,ero yqe6Horo MBTepHaJIB AAR BLDDeynoMRHyThlX ne- AeB Ha HSilHOHBAbHOM ypoBHe . 1. B npoBeAeHHH HCCAeAOBSHHH no Bonpocy paCXOAOB Ra Me.ZU,:KO-CSHHTBPHYJO llOMO~ HSAAeXHT nepeHeCTH BHHMaHHe C npH'lliH, Bhl3hlBaKIIIHX yBeAuqeHHe CTOID[OCTH paCXOAOB Ha pa3pa6oTKy H oneHKY llOAHTHKH CAepxu- BaHHR pOCTa paCXOAOB . 2 . HaAAeXHT CAeAaTb 60AblllHH ynop HS HCCAeAOBSHHR AeHCTBeHHOCTB B 3cli<l>eKTBBHOCTB 3aTpaT Ha »eAUKO- CBHBTBPHYJO llOMOfilb B TeXROAormo 3APBBOOXpaHeHHR. oneHKa TeXHOAOrBH C BCll0Ab30B8HHeM IIIHPOKOro llOAXOAS K CHCTeMSM B neAoM; pe3yAhT8Thl HCnOAh30B8HBR pa3AUqHJ,OC MeTOAOB onABThl o6cAyXHBSHBR, npeAOCTaBAReMoro KaK OTAeAbHbll,lll AUilSKH, TaK H 60AbHHn1U1u; noAHTHKB pacnpeAeAeHBR KaAµOB 3APBBOOXpaHeHHR no cneD;Ra.JlbHOCTRM, YPOBHRM MeAHKO-CBHHTBP- HOH noMomu u reorpa~uqecKHM paHOHSM . 4 . HaAAeXHT 6oAee nOAHO HCCAeAOBSTb pOAb o6mecTBeHHOrO MHeHHR B B03AeHCTBim Ha CAepXHBBHHR pocTa paCXOAOB. 5 . HapeXHT npOAOJl'.J(HTb npoBeAeHUe HCCAeAOBBHHB B »acmTa6ax CTpSHhl, a COOTBeTCTByt<mlHe MeXAyHapOA- Hwe opraHH3an:im TBKHe, KBK EBponeHCKHH CoBeT, MOT, MeXAyHapOAHaR acconuanun conuaAb Horo cTpaxoBa- HHR , a TaKXe 003 AOJl'.J(Hhl cwrpaTb rABBRYJO pOAb B u:x CTID[y.mpOBBHJm u KOOPAHHBD;RH. Coa e ~aHHe COTPYAHHqaIDm;HX CTOPOH no H3 yqeHHID Hcnonb3oaaHHR apaqaMH MeAHJ..\HHCKOH TeXHOnorHH raara , 29-30 HIDHR 1981 roga - 173 - ICP/ RPD 8Ol(l)(S) 20 anpenR 1982 roga OPHrHHAJl: AHfJllif!CKHf! rro o6~eMY MHeHHID npo6neMa CTHMYnHpOBaHHR y apaqeA , MeAHUHHCKHX cecTep, noTpe6HTeneA H agMH- HHCTPaTHBHblX pa60THHKOB 6onee C03HaTenbHOro OTHOWeHHff K aonpocaM CTOHMOCTH MeAHI..\HHCKOro o6cnyJKH- aaHHR, a TaK~e aonpoch1 pa3pa6oTKH a 6ygy~eM pea.micT=ecKOH TeOpHH noaegeHHR pa6oTHHKa 3gpaaooxpa- HeHHR - 3TO Te oonaCTH,Ha KOTOpwe Hago o6paTHTb nepaooqepegHoe BHHMaHHe npH npoaegeHHH HayqHblX HCCfleAOBa HHH . UocKOnbKY B aonpoce accHrHoBaHHff cpegcTB aa~Haff ponb OTBOAHTCR spaqy, Hccnegoaa- HHe cnegyeT HaqaTb c H3yqeHHR ero noaegeHHR, KaK 3TO 6bl!lO peKOMeHAOBaHo a xoge Pa6oqero coae~aHHR no HayqHblM HccnegoaaHHRM B o6naCTH 3KOHOMHKH 3gpasooxpaHeHHff, COCTORBWerocR B raare C 24 no 27 ceHTR6pR 1979 roga . YqacTHHKH gaHHOro Heo¢HUHanbHOro cose~aHHR, opraHH30BaHHOro B COTpygHHqecTae C npaBHTenbCTBOM HHgepnaHgos , npHwnH K cornaweHHID OTHOCHTenbHO nposegeHHff MHOroHaUHOHanbHOro HccnegosaHHR,B xoge KOTOpo ro OCHOBHOe BHHMaHHe 6ygeT ygeneHo TaKHM aonpocaM, KaK HCITOnb30BaHHe spaqaMH B AHarHOCTH- qeCKOH H TepaneBTHqecKOH npaKTHKe KJIHHHqeCKHX BCITOMOraTe.rtbHblX cn~6 B 06CTORTe.rtbCTBax, He yrpo~a - IDm;HX ~H3HH 6onbHOro. B qacTHOCTH, npH nposegeHHH HccnegoaaHHR oco6oe BHHMaHHe cnegyeT o6paTHTb Ha cnegylOll(He qeTb~e o6nacTH : 3) Hcnonb30BaHHe TeXHOnOrHH B o6~eH npaKTHKe; ,Jo Toro, KaK 6ygeT HaqaTa pa3pa60TKa nogpo6Horo npoToKona HccnegosaHHR a BbiweyKa3aHHhIX o6nacTRx, PerHOHanbHoe 6ropo npegnpHMeT warH no sosn eqeHHID aero nposegeHHe 3aHHTepecoaaHHhIX HHCTHTYTOB C Hcnonb30BaHHeM HMeIDID;HXCff y HHX cpegCTB . CHM1103HYM no H3y,IeID!ID BnHHHHH ~aKTOPOB 3KOHOMH4eCKOH HeyCTOH4HBOCTH Ha 3/lOPOBbe M IDHXeH, 9-11 ceHTH6pH 1981 ro)la ~Be,D,eHHe - 174 - ICP/ RPD 804(2)(8) 20 anpeJUI 198 2 ro)la OPl1f11HAJJ: AHfJlliffC K11tl n aHHblH CHM1103HYM, opraHH30BaHHblH 11HCTHTYTOM MeAHUHHCKOH HH~OpMaTHKH H HCCJJeAOBaHHH CJIY*6 9)lpaBooxpaHeID!H (GSF /MED IS ) B MloHXeHe H EBponeHCKHM perHOHaJlbHhlM 6IDpO B03' HBHnCH BTOpb!M COBe111aHHeM B paMKax H9y4eHHH B3aHMOCBH3H 3KOHOMH4eCKOro pa3BHTHH H 3/lOPOBbH. B XO)le pa60Tbl CHM1103HYMa o6CYJl\[leHHID nO)lBeprnHCb HaY4Hble JlOKna.[lbl, B KOTOPbD< aHaJ1H3Hp0BaJ1HC b CTaTHCT>NeCKHe )laHHb!e O B3aHMOCBH3H MeJKAy COCTOHIDleM HaUHOHanbHOH 3KOHOMHKH H 06111HMH TeH,[(eHUHHMH CMepTHOCTH, a TaK*e MHeHHH npaKTH4eCKHX Bpa4eH B OTHOWeID!H BnHHHHH Ha 9/lOPOBbe OT)lenbHhlX nHu npo6neM 3KOHOMH4ecKoro xapaKTepa. 1. HaY4Hb!e HccneAOBaID!H CJJe,[(yeT npoBOAHTb Ha pa3J1H4Hb!X YPOBHHX (HaUHOHaJlbHOM, KOMMYHaJlbHOM, npo - MblllIJ1eHHOM, rpynnoBOM, ceMeHHOM, Hl!JlHBH)lyanbHOM) . 0AHaKO eCTb MHeHHe, 4TO Y4eHhle HHOrAa Bb!6Hpa IDT TOT HnH HHOH ypoBeHb AnH npoBe,[(eID!H HccneAOBaHHH no TOH npOCTOH np>NHHe, 4TO OH HaH6onee COOTBeT- CTByeT c~epe HX KOMlleTeHUHH. 2. HH O)lHa H3 AHCUHnnHH, B3HTaH OT)lenbHO (6YAb TO 3KOHOMHKa, COUHOnorHH , 3nH)leMHonorHH, ncHxono- r ,rn H T. ,[( . ) , He B COCTOHHHH paCKµb!Tb CJIO*HbD< B9aHMOCBH3eH, CYllleCTBYIDIIIHX MeJ!OJ;y 3KOHOMH4eCKOH AeHTenb- HOCTbID H 3AOPOBbeM. '4T06bl JlOCTHrHyTb HOBhlX ycnexoB, He06XO)lHMO C)lenaTb war BnepeA H nepeHTH K npoBe,[(eHHID MeJIOJ;HCUHnnHHapHb!X Hccne,[(OBaHHll, B OCHOBe KOTOpb!X ne=T OAHHaKOBb!e noHHTHH 0 6 H3y,IaeMOM HBneHHH, 4eTKOe npe,[(CTaaneHHe Kal!OJ;oro Y4eHoro O CMe*HbIX JlHCUHnnHHaX, a TaK*e O CHnbHblX H cna6hlX C TOpOHax,Hcnonb3yeMb!X HCCJJeAOBaTenHMH MeTO)lOB. 3. Cy111ecTByeT HaCTOHTenbHaH He06XOAHMOCTb CKHTe9HPOBaTb npoAenaHHYID AO HaCTOHI11ero BpeMeID! pa60TY no H3Y4eHHID COCTOHHHH 3KOHOMHKH H 3AOPOBbH HaceneHHH B Tex paHOHax H HaceneHHb!X nyHKTax, KOTOphle nepelllliBaIDT nepHOJlbl HeCTa6HnbHOCTH ,a TaK*e 0606111HTb pe9ynbTaThl H9y,IeHHH noBe)leHHH qneHOB rpynn, HCnhlTb!BaIDIIIHX nary6Hble B03)leHCTBHH COCTOHHHH 3KOHOMHKH ( Ha YPOBHe ~HPM, ceMbH H OTAenbHhlX KaTeropHH pa604HX). TonbKO TOrAa Mb! CMO*eM BbmCHHTb, HBnHIDTCH nH pe9ynbTaThl HCCne)lOBaHHll OAHHaKOBhlMH HnH *e nony,IeHHbJe B XOAe 3THX HCCJJeAOBaHHH npOTHBOpet;HBb!e )laHHhle 06'bHCHHIDTCH HCnonb30BaHHeM pa3J1H4Hb!X NeTOAHK HnH HeO)lHHaKOBb!M onbITOM pa60Tbl n o H3Y'l eHHID B03)leHC TBHH 3KOHOMH4eCKHX ~aKTOpOB Ha 9AOPOBbe. 1, . Henb3H paCCMaTpHBaTb KpaTKOCP04HbJe H )lOnrocpoqHbJe Hccne)lOBaHHH nHWb KaK ,[(Ba B03MO*HblX THna HC CJJe)lOBaHHH . ECJJH nepeA HCCJJe)lOBaHHeM CTaBHTCH 9a)la4a B KaKOH - TO Mepe noBnHHTb Ha nonHTHKY H npHHHTHe peweHHH, TO B 3TOM CJJyt;ae ere He06XO)lHMO npOBOAHTb C y,IeTOM 6nH*aHWHX nonHTH4eCKHX ue- neH . B TO *e BpeM/1 Heo6xO)lHMO HaC T aHBaTb Ha uenecoo6pa3HOCTH opraHH9aUHH AOnrocpoqHbD{ KOropTHb!X HCcneAOBaHHll, CJl~IIIHX uenHM pacWHpeHHH ¢yl!JlaMeHTaJ1bHhlX 9HaHHll , B CBH9H C cepbe3HhlMH H3MeHeHHHMH TexHonorH4eCKOro H ynpaaneH4eCKOro nopH)lKa , npOHCXO/lHIIIHMH B 3KOHOMH4eCKOH CTPYKType npoMb!WneHHO pa3BHThlX CTpaH. 5 . Pe3ynbTaThl Hayt;HbD< HCCJJeAOBaHHH , npeACTaBneHHhle Ha CHM1109HyMe, HMeIDT Ba*HOe noTeHI.\HaJlbHOe 3Ha4eID!e )lnH COUHaJlbHOro pa9BHTHH, 3KOHOMHKH H 3/lOPOBbH; B CBH9H C 3THM Bhl3hlBaeT CO*aJleHHe TOT ¢a K T, 4TO (3a HeKOTOPblM HCKnID4eHHeM) Bee ~e Ha6nlQllaeTCH He,[(OCTaT04HO cepbe9HOe OTHOWeHHe K 3THM n polSneMaM KaK co CTOPOHbl MeAHUHHCKHX pa60THHKOB, TaK H co CTOpOHbl WHPOKOH 01S111ecTBeHHOCTH . PeK0Mel!Jlau11H 1. B XOAe HCCneAOBaHHH cne,[(yeT COCPeAOT04HTb BHHMaHHe Ha TaKHX Bonpocax, KaK: a) B03)leHCTBHe Ha 3/lOPOBbe HaceneHHH Ba*Hb!X CTPYKTypHb!X H3MeHeHHll B 3KOHOMH4eCKOM nono*eIDIH HaceneHHOro nyHKTa HnH perHOHa, HanpHMep, nHKBHAaUHH OCHOBHoro HCT04HHKa pa60Tbl HnH, Hao6op o T, UblCTpblH 110,[('beM 3KOHOMHKH H - 175 - 6) nocne,a;cTBHR AnR 3AOP OBbR rpynn Hace.rteHHR, B n epayio O'lepe,a;b ITOABepraIDIIIHXCR a o3geHCTBHID 3KOHOMH'!eCKH X cpaKTOPOB , ii '!aCTHOCTH, 3AOPOBbH ITO)KV.JTulX pa60'IHX. 3Ta pa6oTa, CTpOBOAHMaH Ha pa3yKPynHeHHOM ( "MHKp o" ) YPOBHe, AOm1rna BKmo'iaTb nepcneKTHBHble H pe TpocneKTHBHbie Hccne,a;oaaHHH, a TalCl< e Hcc.ne,a;oaaHHH OTAe.rtbHbIX cnyqaea C HCTTOnb30BaHHeM 3CTHAe~!Hono- rH'!eCKHX H APYI'HX MeTogoa . B 6nHJ1tafunee apewi a ee paMKax cnegyeT npoaecTH MHOroHaUHOHMbHOe HC- cneA OBaHHe no OTganeHHOMY B0 3gei1cTBHID apeAHbIX cpaKTOpoa Ha 3AOPOBbe 'leflOBeKa . 2. Cne,a;yoo~ee coae~aHHe cneAyeT npoaecTH a 1982 HnH 1983 r OAY c Ue.rtbID: a) o6o6IUHTb AaHHbie, nonyqeHHble B XOAe H3y'ieHHH BnHHHHH 3KOHOMH'ieCKHX cpaKTOPOB Ha 3AOPOBbe HaceneHHH H OTAe.rtbHbIX ero KOHTHHreHTOB; H o6paTHTb BHHMaHHe nHU, OTBeTCTBeHHblX sa lpOPMYnHPO- aaHHe ITOnHTHKH , Ha B03AeHCTBHe 3THX cpaKTOPOB Ha pemeHHe MeAHKO- COUHMbHblX npo6neM nonHTHKH H 6) CAe.rtaTb 0630p ITPOBOAHMbIX H nnaHHpyeMblX Hay'iHblX Hccne,a;oaaHHH C TO'iKH 3peHHH HX noTeHUHMb- Horo BKnaAa a pacmHPeHHe o6~eMa HHcpOpMau;HH, He06XOAHMOH An~ lpOPMYnHPOBaHHR nonHTHKH; 3. PerHOHMbHOMY 6oopo cne,a;yeT c ogeHCTBOBaTb TOMY, '{T06bl Hace.rteHHe H MeAHll;HHCKHe pa60THHKH npHmnH K ITOHHMaHHID B3aHMOCBR3H Me~y COCTORHHeM 3AOPOBbR H 3KOHOMH'!eCKHMH H3MeHeHHRMH , a TaKJ!te BHe,a;pRTb MeJKCeKTOpanbHhIH TTOAXOA. .[\JIR 3TOro He06XOAHMO: a) co3gaTb Me)l{AyHap OAHblH 6 aHK gaHHblX An>I 06MeHa HH!pOPMaUHeH O TeKYIIIHX Hay'iHbIX HccneAOBaHHRX, pesynbTaTax 3aaepmeHHbIX HCCneAOBaHHH H Hcnonb3yeMbIX MeTogonorHRx; y qacTHHKH CHMTT03HYMa no- TTOJKHTe.rtbHO oueHHnH HHHUHaTHBY 11HCTHTyTa MeAHUHHCKOH HHrpop MaTHKH H HccnegoaaHHH CilYJ!t6 3Apaao- oxpaHeHHJ'I, r:pel];nOJ!tHBwero HCTTOTTb3 0 B aTb e ro B 1982 / 83 r . B Ka'!eCTB e 6aHK a AaHHb1x; 6) CTHMYTTHP OBaTb o6MeH MOAenRMH H Ha6opaMH AaHHblX Melltl];y yqeHbIMH, n p o BOARIUHMH MHOroaap11- aHTHbie a HMH3bl arperHPOBaHHbIX noKa3aTe.rteH ( " MaKPOYPOBeHb " ) , H KOHTPOnHpoaaTb X OA 3Toro OOMeHa; y 'laCTHHKH CHMTT03HyMa TTOAAeplltMH npep;noJ1teH11e 0TAe.rteHHR KOMMYHMbHOH MeAHUHHbl Y H11aepc11TeTa /llltOHa ronKHHCa , 6 anTHMOP, BblCTYTTHTb a 1982 / 83 rr. a Ka'leCTBe 6aHKa AaHHbIX H a) mHPOKO pacnpocTpaHHTb OT'ieTbl O AByx coaemaHHRX B paMKax AaHHO r o 11ccneAOBaHHH; yqacTHHKH CH MTT03HYMa ITOAAeplltanH npep;nollteHHe 11HCTHTyT a MeAHUHHCKOH HH!pOpMaTHKH ony6nHKOBaTb MaTepHMbl AaHHOro CHMTT03HYMa . Pa6o4aH rpynna n o 3KOHOMH4eCKHM acneKTaM HH¢eKUHOHHblX 6one3 HeH Tpap, 21 - 23 ceHTH6pH 1981 roAa - 17G - ICP/ESD 003 (l)(S ) 8 A~Ka6pH 1981 roAa OPHrHHAJl: AHr.Jll,lffC KIDl B COBe~aHHH, C03BaHHOM EsponeHCKHM perHOHanbHblM 6IDpo B03 B Te CHOM COTPYAHH4eCTBe C npaBHTenb- CTBOM $eAepaTHBHOH Pecny6nHKH repMaHHH, npHHHnH )"iaCTHe 3KOHOMHCTbl B o6naCTH 3ApasooxpaHeHHH, CTa- THCTHKH, 3nHAeMHonorHH, PYKOBOAHTenH o6~eCTBeHHoro 3ApaaooxpaHeHHH H APYrHe 3KCnepTbl H3 OAHHHaAua- TH CTpaH EaponeHcKoro peraoHa . HH¢eKUHOHHble 6one3HH HaH5onee nerKO noA,!laIDTCH 3KOHOMH4eCKOH oueHKe, nOCKOnbKY cnoHTaHHaH AHHa- MHKa 6one3HH H aonpOCbl npo¢anaKTHKH H 6opb5bl co MHOrHMH H3 HHX T~aTenbHO H3Y4anHCb . HeAaBHO B 3 TOH o6nacTH 6blJJ npoBeAeH PHA 3KOHOMH4eCKHX HccneAOBaHHH npH y4aCTHH B03 B HeKOTOpblX H3 HHX. B CBH3H C 3THM uenb Pa6o4eH rpynnhl COCTOHna B TOM, 4T06bl paccMOTpeTb aKTyanbHOCTb, uenecoo6pa3HOCTb H pesynbTaTHBHOCTb HCcneAOBaHHH BHPYCHoro renaTHTa, canbMOHenne3a, 6emeHCTBa H BHYTPH60nbHH4HhlX HH- ¢eKUHH; OKa3aTb KOHCynbTaTHBH~ noMO~b eaponeHCKHM CTpaHaM B TOM , 4T06bl npHAaTb 6onbme 3Ha4eHJ-rn 3KOHOMH'¾eCKOMY acneKTY B pemeHHHX, KacaID~XCH npo¢anaKTHKH HH¢eKUHOHHblX 6onesHeH H 6opb6bl c HHMH, a TaK*e BbJHeCTH peKOMeHAaUHH no o5ecne4eHHID KOOPAHHaUHH Ha MeJKAyHaPOAHOM YPOBHe. 2 .1 MeTOAOnOrHH Hcnonb30BaHHH 3KOHOMH4eCKoro H COOTHOCH~erocH C HHM KOnH4eCTBeHHoro IlOAXOAOB K H3Y4eHHJO HH¢eKUHOHHbJX 6one3HeH B HccneAOBaHHH pacXOAOB, CBH3aHHhlX C HH¢eKUHOHHbIMH 5one3HHMH H 5opb60H C HHMH, rnaaHaH npo5- neMa 3aKnID'¾aeTCH B HenpepWBHblX H3MeHeHHHX npoMe*YTKa.~ apeMeHH MeJKAy cny4aHMH sa6oneaaHHH, 4TO OTpa- ~ a eTCH Ha BenH4HHe H pacnpeAeneHHH pa3nH4HbJX CTaTeA paCXOAOB. 3a nocneAHHe rOAbl B paspa50TKe KO- nH4eCTBeHHblX 3IlHAeMHono r H4eCKHX MOAeneH HH¢eKUHOHHblX 6one3HeH 6blJJH AOCTHrHyTbl 3Ha4HTenbHble ycnexH, TIOKa3b!BaID~e AHHaMHKY pa3BHTHH 5one3HH H Il03BOnHID~e nepepacnpeAenHTb HaceneHHe no 3nHAeMHonorH- ,eCKHM KaTeropHRM. 3TH MOAenH 5esomH504HO yKa9b!BaIDT Ha KOHKpeTHble AeHCTBHR HnH MOMeHTbl BMemaTenb- c;·raa , B KOTOPble MO*H O npHHHT b Te HnH HHble Mepbl npo¢anaKTHKH HnH ne4eHHH, c TeM 4T06bl MO*HO 6wno CMOAenHpOBaTb anbTepHaTHB Hble CTpaTerHH BMemaTenbCTBa B nnaHe B03MO~HOCTeH HX oc~eCTBneHHR, 3q)Q)eK- THBHOCTH H CTOHMOC TH. 0AHaKO npHMeHeHHe AeTanbHblX xapaKTepHCTHK 3THX MOAeneH aepoHTHO Bhl30BeT Heo6XOAHMOCTb c~eCTBeHHbJX H3MeHeHHH HCXOAHbIX 3nHAeMHonorH4eCKHX AaHHblX, B TOM, 4TO KacaeTCH 3KOHOMH4eCKOH MeTOAOnorHH, TO none9HO npoaeCTH pa3nH4HR MeJKAy npHMbIMH H KOCBeH HblMH paCXOAaMH Ha 6opb5y C 6one3HbID: npHMble paCXOAbl CBH3aHbl C HCnOnb30BaHHeM pecypcoB MeAH- Ko-caHHTapHWX cny,,,c5 B o6naCTH npo¢anaKTHKH, ne4eHHH H B nepHOA Bbl3AOPOBneHHR, a KOCBeHHble pacXOAbl CBH3aHbJ C noTepHMH cpeACTB HnH COUHanbHWM o6ecne4eHHeM 3a npeAenaMH ceKTopa 3APaBooxpaHeHHR, B09HH- Ka ID~MH B pesynbTaTe sa6oneaaeMOCTH, HHBanHAHOCTH H npe:11,AeapeMeHHOH CMepTHOCTH. IlpHMbJe paCXOAW HMeIDT 5onee T04HOe Bblp3*eHHe, '¾eM KOCBeHHble paCXOAbl, H HX oueHKa AaeT ueHHYID HH¢opMaUHID KaK 06 YPOBHe cpeACT!l, Bbl,!l,eJ!ReMbJX Ha MeAHKo - caHHTapHbJe cny,,,c6bl, HCnOnb3yeMb!X B 5opb6e C KOHKpeTHb!MH 6one3HHMH, TaK Hp pacnpeAeneHHH cpeACTB MeJK,D;y pa3nH4HblMH KOMnneKCaMH CTOHMOCTH (npo- ¢ HnaKTH4eC KHe Mepw, 5onbHH4HOe ne4eHHe H T , A . ) . OueHKa KOCBeHHblX paCXOAOB HBnReTCH 6onee cno~HOH npo OneMOH . Bee OCHOBe TpaAHUHOHHO ne.JICHT IlOAC4eT npOH3BOACTBeHHWX y5b!TKOB, HaHeceHHblX nID6WMH OTpacnHMH 3KOHOMHKH B pesynbTaTe 6one3HH, HO n pH 3TOM B03HHKaeT UenwH PHA npo5neM: HanpHMep , He )"iHTWBaIDTCR paC XOAbl, CBH3aHHble C 3a5oneaaHHHMH n pecTapenblX . rnaBHblM ~aKTOPOM, onpeAenHID~M COCTORHHe 3AOPOBbR o5~Hbl, HBnR eTCH yny4meHHe Ka4eCTBa *H3HH, c n eAOBaTenbHO, Henb3R HMeT b nonHOH KapTHHbl nono*eHHR Aen, e c nH OCHOBb!BaHCb Ha KOCBeHHblX pacxoAaX , H3MepRTb BblrOAbI, non)"¾aeMb1e 3a npeAenaMH ceKTopa 3ApaaooxpaHeHHR a pe3ynbTaTe CHH*eHHR 3a6oneaae- MOCTH . OueHKa KOCBeHHblX pacXOAOB, Il03TOMY, AO=Ha npoBOAHTbCH C npHane'¾eHHeM AOnonHHTenbHblX HnH ~a CTH4HO 3aMeHHID~X npe~HHe noKaSaTenH pe3ynbTaTOB MeAHKo-caHHTapHOH AeHTenbHOCTH , He HMeID~HX Ae- He*HOro 0503Ha4eHHR. He CY111eCTBYeT oObeKTHBHoro HJJH OKOH'!STenbHOro nepeqHH paCXOAOB, KOTOPl>IA AOJDl:eH Ob!Tb BKn�qeH BO BCe HccneAOB8HHJI pa�XOAOB, no3TOMY see CMeThl pacXOAOB, CBH38HHble C Oone3Hb�, AO!Ill:Hbl OTHOCHTCH K on- PeAl!JleHHblM KOHTeKCTaM, MHoroe OyAeT 3aBHceTb OT Toro, KTO HeceT Te HJJH HHble pacXOAbI, OT Toro,oT- HOCHTCH nH 3TH pacxo;u,1 K KpaTKOCpoqHblM HJJH AOnrocpoqHblM ueHHOCTHMH H OT APYrHX aHanorHqHbJX $8XTOPOB. 2,2 OueHKa 3XOHOMH'lecxHX npoOneM HJJH paCXOAOB, CBH38HHblX C HH$eXUHOHHhlMH Oone3HHMH 3a nocneAHHe 50 neT B eBpone8CKHX CTP8H8X H ApyrHX qaCTHX MHpa HaO�aeTCH 3HaqHTMbHOe CHHllte­ HHe CMepTHOCTH OT HH$eKUHOHHblX OonesHe8. 3TOT $aKT oTp=aeT KaK y.rryqmeHHe o0ll(Hx YCJIOBIDI JICH3HH, T8K H AOCTHllteHHJI B oOnaCTH MeAHUHHbl, C APYro8 CTOPOHbl, HH$eKUHOHHble Oone3HH npOAOJDl:a�T COCTaBnHTb CY111eCTBeHH� npoOneMY MH 00ll(eCTBa, ocoOeHHO B oOnacTH 3KOHOMHKH, Bonee Toro, 3T8 npoOneMa, no BCeA BepoHTHOCTH, HeAOOUeHHBaeTCH MHOrHMH PYKOBOAHTMHMH 3APaBOOXPaHeHHH. 3TOT $8KT MO•Ho 00bHC- HHTb ue.llblM PHAOM npffqHH. B M�YH8POAH08 xnaccH$HK8UHH OonesHe8 He nepeqHcneHbl HeKOTOPhle rnaBHble HH$eKUHOHHble 3aOoneBa­ HHH, 0 H8IlpHMep rpHnn no p83Aeny "HH$eKUHOHHble H napa9HT8PHble Oone3HH 11 , AHanor=HblM o0pa30M, HeCMoT­ PH Ra HX Oonbmoe 3HaqeHHe, BHYTPHOonb!IH'IHble HJJH rocnHTanbHble HH$exuHH qaCTO He paCCM8TPHB8�TCH K8K HHfPl!KUHOHHble Oone3HH, MHOrHe xpOHHqecxHe COCTOHHHH B03HHX810T B pe3ynbTaTe HH$eKUHOHHblX Oone3He8. H81IPHMep, npHMepHO 107. cnyqaeB BHPYCHoro renaTHTa B HMe�T 38THEI08 KYPC H npHBOAJIT X UHPP09Y neqe­ HH HJJH APYrHM XPOHHqecKHM COCTOHHHJIM, n=e B Tex cnyqaHx, KOrAa 3a0oneBaeMOCTb A8HH08 HH$eKUHOHH08 Oone3Hb� HBnHeTCH HH3KOH, pacxo­ Abl Ha Hee MoryT OK898TbCH 3H8qHTenbHblMH B CBH3H C Il0CTOHRH08 HeOOXOAHMOCTb� npo$HJJ8XTffqeCKHX Mep, a Ta�e Mep KOHTPOnH H MeponpHJ!Tml B oOnacTH MeAHKO-C8HHT8PHOro npOCB�eHHJI, IlpHMepoM TOMY MO­ •eT CnyJICHTb OemeHCTBO, B OTHomeHHH HeKOTOPhlX HH$eKUHOHHblX Oone3He8, HailPHMep, C8nbMOHe.JlJie3a H OemeHCTB8 OTBeTCTBeH­ HOCTb 38 Mepbl npo$HJJaKTHKH H OopbOY C Oone3Hb� Mo•eT B03naraTbCH Ha MHHHCTepCTBO cenbCKoro X03H8- CTB8 HnH KaKoe-nHOO APyroe MHHHCTepcTBO, xax npaBHJJO, 38 npeAenSMH ceKTopa 3AP8BOOXpaHeHHJI, TaN, rAe IlPHMble pacxOAbl paccpeAOToqeHbl T8KHM o0p830M MHIIHCTepcTBa 3APaBOOxpaHeHHJI He MoryT TOqHo onpeAMHTb 00ll(HH ypoBeHb paCXOAOB. IlOMHMO IlPHMbIX paCXOAOB AOJDl:Hbl OhlTb yqTeHbl H CBH38HHble C HH$eKUHOHHblMH Oone3HHMH KOCBeHHble paCXOAbl, H3MepHeMble nHOO nyTeM oueHKH npOH3BOACTBeHHblX yOYTKOB B 3KOHOMHKe, nHOo HHblMH IlYTHMH. 3r• paCXOAbI MoryT OhlTb BeCbMa 3HaqHTMbHhlMH, HanpHMep, KOCBeHHble paCXOAl>I, Bhl3hlB8eMble BHPYCHblM renaTHTOM MOryT COCTaBnHTb CYMMY, B ABa pasa npeBblDlaJO�� TY, KOTopaH 38TpaqHeaeTCH cn�OaMH 3AP8- eooxpaHeHHJI. Kax H B cnyqae npHMblX PSCXOAOB KOCBeHHble paCXOJlbl, CBH38HHble C HH$eKUHOHHhlMH Oone3HJIMH, MOryT 38TParHBaTb Uenbdt PHA ceKTOPOB 3KOHOMHKH, HanpHMep, canbMOHenne3 Bhl3hlB8eT OonblllHe pacxo,a;1,1 K8K B 1IH111eB08 IlPOMbllll1leHHOCTH, TaK H B JICHBOTHOBOACTBe B CHJJy Toro, qTO B03HHKaeT He06XOAHMOCTb YHffqTO­ Jlo;8Tb nHll(eBble npOAYKTbl MH 38ll(HTbl 3AOPOBbH qenoeexa H B CHJJY Toro, qTQ canhMOHenne3 HBnHeTCH xapax­ TepHOH 0one3Hb� Jto;HBOTHhlX, KOTOpaH MOJto;eT Bbl3B8Tb 3HaqHTMbHb!H nSAeJto; CKOTa, HeoOXOAHMO ell(e MHOro nopa00T8Tb, qToO� MO.HO O�o npoBOAHTb CHCTeMaT=ecKHM nyTeM oueHKY paCXOAOB, CBH38HHbIX C HH$eKUHOHHblMH 6one3HHMH, qTO n03BOnHT rocyA8PCTBeHHblM AeHTenHM H PYKOBOAHTe­ MM oOmecTBeHHoro 3AP8BOOXPaHeHHJI B CTpaHax HMeTb nonHoe npeACTaBneHHe oO 3KOHOMH'leCKHX pacxoAax, CBH38HHblX C onpeAeJieHHblMH COCTOHIIHHMH, 2.3 AH8.JIH9 38TP8T H 34iciieKTHBHOCTH HJ1H 38TpaT H BYrOA npHHHTHJI XOHKPeTHWX Hep npo$HJJ8XTHKH Oones­ He8 H OopbOhl c HHMH IlporpaMMbl npo$HJJ8KTHKH H neqeHHJI HH$eKUHOHHblX 6one3HeH peAKO nOABepranHCb 8H8nH3Y C TOqKH 3peHHH 38TP8T H 3�KTHBHOCTH. fu!etmtHeCH B HanffqHH A8HHble CBH,ll;eTMbCTBYJ()T, npeJIUle BCero, 0 TOM, qTo MHOrHe IlpHHHMSeMble B _HaCTOHll(ee BpeMH Mephl no BMemaTenbCTBY HeAOCTaTOqHo 34iclieKTHBHbl B OTHOmeHHH PSCXOAOB; BO-BTOPhlX, 0 TOM, qTo ycoBepmeHCTBOB8HHble CTpaTerHH 6opb6Y MOryT HMeTb 3HaqHTMbHble npeHMYll(eCTBa K8K B nnaHe 3KOHOMHH cpeACTB, Tax H nonyqeHHJI nyqlllHX pesynbT8TOB AnH 3AP8BOOXpaHeHHH; H,.-TpeTbHX, 0 TOM, qTo npo$HJJ8KTHK8 He BcerAa OK83hlB8eTCH Oonee 3<l><!>eKTHBH08, qeM neqeHHe. IlpH- MepoM TOMY MOJto;eT cnymiTb TOT $8KT, qTo B cnyqaHx OonbHH'IHblX HH$eKUHH T8KHe HeAoporOCTOHll(He MeTOJlbl, K8k Mb!Tbe PYK H Ae9HH$eKUHH PYK HBnH�TCH A0CT8TOqHo 34iclieKTHBHhlMH H 3KOH0MffqHblMH MepaMH OopbOY C 6one3HHMH, C APYr08 CTOPOHbl, HeoOXOAHMO npoBeCTH HCCJieAOBaHHJI, C TeM, qTo6hl AOK838Tb, qTo pac- npocTpaHeHHOCTb BHYTpHOOnbHH'IHblX nepeKpeCTHbIX HH$eKumt YMeHbmaeTCH 38 cqeT BHeApeHHH AOporOCTOHll(HX CHCTeM naMHHapHblX B03AyIDHbJX IlOTOKOB, B TOM, qTo xacaeTCH BHPYCHoro renaTHTa THna B He CYll(eCTByeT 3XOHOMHqecKH 3«!i<l>eKTHBHblX 06ll(HX MeTOAOB npo$HJJ8KTHKH, B TOM, qTo xacaeTCH THna A 3KOHOMH'leCKH 3$- $ekTHBHble MeTO,llbl AOJDl:Hbl npHMeHHTbCH JIHIDb K rpynnaM BhlCOKoro PHCK8, CoBpeMeHH� nonHTHKy B OTHO- meHHH rocnHTanH38UHH B CBH3H C BHPYCHblM renaTHTOM THna A, BepOHTHO, cneAyeT nepecMOTPeTb B UMOM PHAe CTP8H B CBH3H C TeM, qTo neqeHHe B AOM8IDHHX ycnoBHHX OK83hlBaeTCH He MeHee 34iclieKTHBHblM no cpaBHeHH� C OonbHHqHblMH ycnOBHHMH, 06XOAHTCH 3HaqHTenbHO AemeBne H npHHOCH T xopo111He pe3ynbT8Tbl B nnaHe CHHllteHHH onacHOCTH pacnpocTpaHeHHH HH$eKUHH, - 178 - B oueHKe aJlbTepHaTHBHhlX MeTonoB BMemaTenbeTBa npH HH¢eKUHOHHhlX 6one3HHX npHCyTeTBYJOT nBa ac- neKTa: nepBbIH - oueHKa HH,D;HBH,D;YaJibHhlX Mep 6opb6bl; H BTOPOH - onpeneneHHe onTHMaJlbHhlX CTpaTerHH B nnaHe KOM6HHaUHH oTnenbHhlX MeTonoB BMemaTeJlbCTBa. Heo6xonHMD npoBeeTH 6onee TmaTenbHhle Heene- noBaHHR 060HX 3THX aeneKTDB Ha oeHOBe MeTonoB aHanH3a 3aTpaT- 3~eKTHBHOCTH. OueHKY enenyeT npo- BDnHTb Ha MHoronHeUHnnHHapHOH OCHDBe C )T'laeTHeM 3KOHOMHCTa, KOTOPbll1 YKa3an 6bt, KaKHM o6pa30M eHH- 3HTb no MHHHMy-Ma 3aTpaTbl no BMemaTenbeTBY, H 3nH,D;eMHonora, KDTOPbIH yKa3an 6bl Ha TD, KaK MaKeHMaJib- HD noBbleHTb 3~eKTHBHOeTb BMemaTenbCTBa. Bbll"'OW,l cnenyeT H3MepHTb, HenonbSYR ycoBepmeHeTBOBaHHble, He HMetomHe neHei,rnoro Bblpa.J!<eHHR HnH KDmNeeTBeHHble MenHKo - eaHHTapHhte noKa3aTeJlH oueHKH pe3ynbTaTOB 6opb6bi c HH¢eKUHDHHhIMH 6one3HRMH. IlpennaraeMbie eTpaTerHH nDJIJICHhl oeymecTBnHTbeH B eoOTBeTCTBHH e Beeo6beMntomeH nonHTHKOH B o6naeTH 3npaaooxpaHeHHR oTneJlbHh!X eTpaH (a qaeTHOeTH oeo6oe 3HaqeHHe noffiKHO npH,llaBaTbeR cn)'lK6aM nepBH'lHDfi MenHKO-eaHHTapHOH nOMDWH), a TaK~e B eOOTBeTCTBHH e nonHTHKOH, HanpaBneHHOA Ha 6opb6y e npyrHMH HH¢eKUHDHHhIMH 6one3 HHMH. 2 . 4 06)7'leHHe nepeoHana 3KOHo~eeKHM MeTonaM YqacTHHKH Pa6oqefi rpynrn,1 OTMeTHnH cneAYtomHe ABa ¢aKTOpa: nepBbIH saKnioqaeTeR B TOM, qTo e pa3- BHTHeM H Henonb30BaHHeM noCTOHHHD yeno~HHtomeaeH HayqHoA TeXHOnOl"'HH B03paeTaeT noTpe6HOCTb B MHOro- AHeUHnnHHapHOM nDAXDAe Ha aeex YPOBHRX npH nnaHHPOBaHHH en)'lK6 3APaBooxpaHeHHR , KaK B o6eeneqeHHH 3THX en)'lK6, TaK H B HayqHhIX HeenenoaaHHHx; H BTOpofi - B 6onbmHHCTBe eBponeHCKHX eTpaH OTeyTCTBYeT )T'lpeJK,QeHHaR HnH perynnpHaH oeHOBa AnH o6eeneqeHHR BpaqaM H BeTepHHapaM BD3MO~HOeTeA non)T'leHHH oc- HOBHDH nonroTDBKH no 3KOHOMHqeeKHM MeTOAaM. B HaeTonmee apeMR pa3pb1B, cymeeTBYIOWHA B npenOAaBaHHH AHeuHnnHH KnHHHqeeKofi MeAHUHHhl, snH,D;eMHonorHH H 3KOHOMHKH HeeKDnbKD e oKpamaeTeH, HO Bee eme OeTaeT- eH BeCbMa 3HaqHTenbHhlM . 1) Bee CTpaHbl nDJIJICHhl npHeTynHTb K onpeneneHHIO o6mero 3HaqeHHH HH¢eKUHDHHhIX 6one3Hefi' BKnioqan 6 onbHHqHble HH¢eKUHH, a Ta=e OTHOeHTenbHOro 3HaqeHHR pasnH'lHh!X THnOB 3THX 6onesHeH . B03 npennoJKH- n a npoTOKDn HeeneAOBaHHH BHpyeHoro renaTHTa, KOTOPhlH o6ecneqHBaeT YA06Hyl0 CXeMY oueHKH npHMb!X H KOeBeHHh!X paCXDADB, eBH3aHHh!X e pa3nHqHblMH eoeTOHHHHMH (CepHH TeXHH'leCKHX AOKnaADB B03 ~ 602, 1978), D OTAeJlbHhle npaBHTenbeTBa, no aeeA BepoHTHOeTH, AOJIJ!CHhl 6YAYT onpeAeJlHTb BDSMO~HOeTb Henonb30BaHHH .) TOH exeMhl npHMeHHTenbHO K yenOBHHM B eBOHX eTpaHax . 2) BceM rocyAapeTBaM eneAyeT H3b!CKHBaTb B09MO~HOCTH BHeApeHHR H paSBHTHR npoqHh!X snH,lleMHonorH- <1e eKHX MOAeneH nnR DTAenbHhlX 6one3HeH . B TaKHX MonenHX eneAyeT )T'leeTb AHHaMH'leeKHe aeneKTbl 6ones - !Hi H nOilblTaTbeH onpenenHTb AeHCTBHR HnH MOMeHTbl npHMeHeHHH KDHKpeTHhIX Mep 6opb6bi c 6onesHHMH. 3) IloeKOnbKY OilblT o6pameHHR e TaKHMH MOAenHMH orpaHH'leH H noeKOnbKY HH¢eKUHOHHble 6one3HH HMe- •JT paenpoeTpaHeHHe BHYTPH OTAenbHhlX eTpaH,EBponelieKDe perHOHaJlbHOe 610po B03 AOJIJ!CHD eOAefiCTBOBaTb o 6MeHy HH¢opMaUHeH H aHaJIHTH'leeKDH TeXHonorHeH MeJK.QY eTpaHaMH. 4) Heo6XOAHMD Ha oeHOBe Bb!WeHsno~eHHh!X 3nH,D;eMHonorH'leeKHX MOAeJleA npoBeeTH HeeneAOBaHHH aJlbTepHaTHBHhIX eTpaTerHA BMemaTeJlbeTBa B HH¢eKUHDHHble 6one3HH c npHBne'leHHeM pa3nHqHblX KDM6HHauHA HH,D;HBH,D;YaJlbHh!X Mep 6opb6bl . OueHKa AOJIJ!CHa oeHOBb!BaTbeH npeJK,Qe aeero Ha MeTOAHKe aHaJIHsa 3aTpaT H :Jc)xl>eK THBHOeTH. 5) HaY'{Hble HeeneAOBaHHH AOJIJICHbl npOBOAHTbCH e UeJlblO eoaepmeHeTBOBaHHH H pa3BHTHH He HMetomHX AeHe~Horo o6osHa'leHHH noKaSaTeJleH pe3ynbTaTOB MenHKo-caHHTapHb!X MeponpHHTHfi H eoOTHOmeHHH 3THX no- Ka3aTeneA e aJlbTepHaTHBHhlMH MeToAaMH BMemaTeJlbeTBa H CTpaTerHH. 6) OeymeeTaneHHe TaKHX MeponpHHTHfi KaK paenpeAeneHHe OTBeTCTBeHHOeTH sa npoBeAeHHe MeAHKo-ea- HHTapHhtx MeponpHHTHfi H MeponpHHTHfi B eM=Hhrx o6naCTHX, a Ta=e paexonoB MeJK,Qy eeKTDPOM eOUHaJibHOro o6eeneqeHHH, qaeTHhlM H o6meeTBeHHhlM eeKTOpaMH MO~eT noen~Tb npenRTCTBl:leM K .. !JllHl>JeHeHHIO_ H?Y!lllblX noe THJKeHHA . CneAyeT npoaeeTH HeeneAOBaHHH e UeJlblO onpeAeJleHHH TaKHX npenHTeTBHH H BDSMO~Hh!X ny- TeH HX npeOADneHHR. 7) Y'lamHeeH BblemHX yqe6Hb!X MeAHUHHeKHX (BD3MD~HD H BeTepHHapHbtx) 3aBeAeHHH H MenHUHHCKHX WKOn ycoaepmeHeTBDBaHHH Bpa'leH AOJIJICHhl oanaAeTb SHaHHHMH 3KOHOMHKH SApaaooxpaHeHHH, 'lTD eneAyeT BKntoqHTb B yqe6Hbie nporpaMMbl B Ka'leCTBe DTAenbHOl"'D npeAMeTa. 8) BBH,D;Y Heo6xonHMOCTH MHOronHCUHnnHHapHoro nOAXOAa K nnaHHpoaaHHIO H Hay'lHhlM HeeneAOBaHHHM eneAyeT eD3AaTb KpaTKOepO'lHble KYPCbl nOAl"'OTOBKH, opraHHSOBaTb eeMHHapbl H HHCTPYKTa.J!< nnn e03AaHHH y apa'leH H pa60THHKDB POAeTBeHHbIX o6nacTeH o6mero npencTaaneHHR 06 3KDHOMH'leeKHX MeTDAaX. B03 nOJIJICHa OKa3aTb eoAefieTBHe B pa3pa60TKe eooTBeTCTBYIOWHX yqe6Hb!X MaTepHaJIOB . M el!CBe,[IOMCTBeHHOe KOOp,[IHHalJ,HOHHOe cose111aHJ:f!:_ no sonpocaM 3KOHOMHKH s.z:1pasooxpaHeHHl! KoneHrareH , 10- 11 HOR6pl! 1981 ro.z:1a - 179 - ICP/ SPM 022(3)(S) 20 anpenl! 1982 ro.z:1a OPHf11HAJ1: AHrJIJ1flCKHf! 8 nocJie,[IHHe rO,[lbl B CTpaHaX EBPOnbl see 60JibWee BHHMaHHe Y.z:leJil!eTCl! sonpocaM 3KOHOMHKH 3,[lpaso- oxpaHeHHR, MHorHe Mellt,[lyHapO,[IHble opraHH3aUHH CTaJIH npe,[lnpHHHMaTb warH no pa3BHTHIO ,[lel!TenbHOCTH B 3TOH o6JiaCTH. 0,[IHaKO B HeKOTOpblX CJIY'{al!X Ha6JIJO,[laJI0Cb .z:1y6JIHPOBaHHe MeponpHl!THH, ' nepeoueHKa CHJI orpaHH4eHHOro 4HCJia HaUHOHaJibHblX cneUHaJIHCTOB HJIH OTHOCHTeJibHOe HeBHHMaHHe K HeKOTOPblM BalKHblM 06JiaCTl!M , B 3TOM Henpo,[IOJIJKHTenbHOM Heo¢HUHaJibHOM cosemaHlill npHHl!JlH Y'{aCTHe npe,[ICTaBHTenH 8 MeJK,[lyHa - pO,[IHblX, MeJKnpaBHTeJibCTBeHHblX H HenpaBHTenbCTBeHHWX esponeHCKHH opraHH3aUHH, 3aHHMaJOUIHXCl! sonpocaMH 3KOHOMHKH 3ApasooxpaHeHHll. 0HH co6panHCb AJil! Toro ' 4T06bJ: a) o6MeHl!TbCll HH¢OpMaUHeH o nocJie,[IHHX, TeKYJJ1HX H nJiaHHpyeMbIX MeponpHl!THl!X B o6naCTH 3KOHO- MHKH 3ApasooxpaHeHHl! ; 6 ) 06MeHl!TbCl! OnbITOM HCnOJib30BaHHl! CTpaTerHH aeRTenbHOCTH B 3TOH o6JiacTH H B) npeAJIO)K}ITb cnoco6bl yKpenneHHl! CBl!3eH H COTPYAHH4eCTBa. Y4aCTHHKH cose111aHHl! e,[IHHOAYWHO oao6pHJIH HHHUHaTHBY PerHOHaJibHOro 6JOpo , opraHH30Baswero 3 T Y BC Tp etty, H BbJpa3HJlH MHef-Gle, t..JTO OHa RBn.ReTCH nepBhtM IIOJie3HblM war OM Ha TIYTH K cosepweHC TBOBaHHK> CBl!3eH B 06.naCTH 3KOHOMHKH 3ApasooxpaHeHHl! Mell<;IJ;y opraHH3alJ,Hl!MH, KOTOPble OHH npe,[ICTaBJil!IOT. CosemaHHe npe.z:1no=o He3aMe,[IJIHTenbHO ocymecTBHTb CJie.z:IYIOIIIHe MeponpHl!THl!: 1. Y4aCT HHKaM CJie,[lyeT no,[lrOTOBHTb KpaTKHe cnHCKH KOHCYJlbTaHTOB , y cnyraMH KOTOpWX nOCTOl!HHO nOJib3YJOTCl! HX opraHH3aUHH B 06.naCTH 3KOHOMHKH 3,[lpasooxpaHeHHl! , BnocneacTBHH PerHoHaJibHOe 6JOpO HanpaBHT BCeM Y'{aCTHHKaM cose111aHHl! CBe,[leHHblH BOeAHHO CnHCOK KOHCYJibTaHTOB, 2. KaJK,[IOH opraHH3alJ,HH ,[IJll! peryJil!pHoro H CnOJib30BaHHH HaAJie)K}IT COCTaBHTb nepe4eHb 06.nacTeH , B KOTO- PblX OHa ocy111ecTBJ1l!eT MeponpHl!THl! no 3KOHOMHKe 3,[lpasooxpaHeHHl! ; 3 TO aacT B03MOJKHOCTb BCeM apyrHM o p raHH3aUHl!M (a) Bbll!BHTb 06.naCTH npose,[leHHH aHanOrH4HblX MeponpHl!THH , ( 6) p el!IHTb ' HYJl(Ha JIH HM ao- noJIHHTeJibHal! HH¢OpMaUHll 06 3THX MeponpHl!THl!X H ( s) paCCMOTpeTb B03MOJKHOCTH AJll! KOOPAHHaUHH HJIH COTPY.z:IHH4eCTBa, 3. PerHOHaJibHOMY OJOpO CJie,[lyeT npe,[IJIOlKHTb KaJK,[IOH opraHH3aUHH Ha3Ha4HTb COTPYAHHKa , OTBeTCTBeHHOro 3a no.z:1aepJKaHHe scex KOHTaKTOB B o6JiaCTH 3KOHOMHKH 3J:lpasooxpaHeHHl! Ha TeXHH4eCKOM / HeO¢HUHaJibHOM ypOBHe. 3 TO nOMO~eT YJ'lY'{WH Tb cymeCTBYJOIJlHe MeJK,[ly opraHH3aUHllMH CBl!3H H npeeMCTBeHHOCTb B pa6oTe H B TO JKe s p eW! He noMewaeT o¢HUHaJibHblM KOHTaKTaM MeJK,[ly opraHH3aUHl!MH . 4. Y4aCTHHKaM cneayeT HH¢0PMHPOBaTb a pyr apyra O TaKHX MeponpHl!THl!X H o6JiaCTl!X Ael!TenbHOCTH, B KOTOPblX ' no HX MHeHHJO , HaUHOHaJibHble npaBHTenbCTBa npHBeTCTBOBaJIH ow npOBe,[leHHe aonoJIHHTenbHblX HJIH HOBblX MeponpHl!THH CHJiaMH OAHOH HJIH HeCKOJlbKHX op raHH3aUHH . 5 . K aJK,[IOH o praHH3aUHH HaAJieJKHT TaK~e yKa3aTb Te HalJ,HOHaJibHble HCT04HHKH cpeacTB H rpynnbJ noTpe- OHT eneli, C KOTOPWMH OHa noa.z:1epJKHBaeT WHPOKHe KOHTaKTbl B TOM , 4 TO KacaeTCl! 3KOHOMHKH 3ApasooxpaHe- HHl!, H 4epe3 KOTO PblX OHa Morna Obi OKa3aTb noMOUlb JIIOOOH ,[lpyroA o praHH3aUHH, 3 aHHTepecosaHHOH B pacU1HpeHHH CBOHX KOHTaKTOB H CBl!3eH . 6 . Y4aCTHHKH cosemaHHl! e,[IHHOAYWHO peKOMeHAOBaJIH B03 C03BaTb aHanOrH4HOe cosemaHHe B ¢espane HJIH MapTe 1983 roaa C uenbJO: (a) OOCYAHTb pe3yJibTaTbl npo se,[leHHl! ynOMl!HYTblX BbWJe MeponpHl!THH H (6) paCCMOTpeTb nnaHbl B OTHOWeHHH KOHKpeTHWX B03MOJKHOCTeH AJll! 6yaymeA KOOPAHHaUHH HJIH COTPYAHH- 4eCTBa.