Medical-Social Problems of Health and Interpersonal Relations of Participants in Counter-Terrorist Operations

The dissertation is devoted to a comprehensive study of the medical-social problems of health and interpersonal relations of participants in counter-terrorist operations. An organizational-functional model of medical-sociological monitoring of the health and quality of life of military personnel has been developed in the work, based on the combination of objective medical-statistical data and the results of sociological research. The author has established a statistically significant increase in the share of psychosomatic and neurological pathology in the structure of morbidity of combatants, caused by the development of emotional combat stress, as well as a connection between changes in emotional-volitional characteristics of personality and the development of complex informal interpersonal relations in the military collective, which are factors of depression and the reduction of quality of life. The obtained materials are used for the development of personalized health-restoration and rehabilitation programs and for making managerial decisions on medical support and social protection of participants in counter-terrorist operations.

The increase in the number of terrorist acts and the threat of their occurrence in any region of Russia determine the relevance of the problem of the development of socio-stress disorders arising in a combat situation or close to it (R.G. Valinurov, I.R. Valinurova, JLH. Kasimova et al.) [14,21,50,67]. The prevalence of mental disorders arising in the conditions of combat operations is the primary cause of deterioration in the health status and quality of life of participants in counter-terrorist operations. Consequently, there arises a necessity for dynamic observation (monitoring) of their health status and quality of life.

Medical-sociological monitoring of health and quality of life is a system of collection, automated processing, accumulation, storage, and analysis of information about the health status of military personnel in a correlation-regression dependence on conditions and lifestyle, with the possibility of dynamic observation and adoption of managerial decisions on the development of corresponding Target Health Programs [92].

The specificity of medical-sociological monitoring lies in the fact that one of the main elements of the structure of an integrated database is the materials of sociological research.

The sociological approach in the study of medical problems has acquired in recent years important prevalence in the works of domestic and foreign authors (A.V. Reshetnikov) [92,107].

Social problems of medicine have long occupied a leading place both in the interpretation of public health and in the organization of medical care for the population. Already at the beginning of the twentieth century, the study of diseases from a social aspect led to the necessity of developing the discipline of 'Sociology of Medicine,' and at the IV World Sociological Congress 'Society and Sociology' (Milan, 1954), a section on 'Sociology of Medicine' was organized for the first time, chaired by the domestic scholar N.I. Grechenkov.

However, until recently, the organizational foundations of medical-sociological monitoring of the health status of participants in counter-terrorist operations have not been developed; the conditions and quality of life, as well as the state of processes of medical-social rehabilitation against the background of signs of maladaptation during the transition to civilian life, have been insufficiently studied. The phenomena of depression arising in this context may serve as grounds for the manifestation of suicidal tendencies.

Taking into account these unresolved problems, we undertook this comprehensive medical-sociological study of the medical-social problems of health and quality of life of military personnel — participants in counter-terrorist operations and armed conflicts.

In this connection, the aim of this work was the scientific substantiation and development of the main directions for the restoration, strengthening of health, and quality of life of military personnel — participants in counter-terrorist operations — based on the created organizational-functional model of medical-sociological monitoring of health and quality of life.

Based on this aim, the following tasks were formulated:

1. To develop and implement an organizational-functional model of medical-sociological monitoring of health and quality of life of military personnel — participants in armed conflicts, on the basis of which an integrated database will be formed and a dynamic software product environment will be developed.

2. Based on the electronic database of monitoring, to study the main patterns of the level and structure of morbidity of combatants by referral.

3. To investigate the features of quality of life of combatants arising against the background of emotional stress and the nature of informal interpersonal relations in the military collective.

4. To develop fundamental approaches and main directions of socio-legal and medical health-restoration and rehabilitation measures ensuring the improvement of the health status and quality of life of combatants in the post-stress period.

Scientific Novelty

Based on the materials of the dissertation, new provisions have been developed that allowed, for the first time:

- to establish a statistically significant increase in the share of psychosomatic and neurological pathology in the structure of morbidity of combatants, which is a consequence of the development of emotional combat stress in them;

- to develop a model of medical-sociological monitoring of health and quality of life of combatants, based on objective medical-statistical information and the subjective material of sociological research;

- to determine that changes in emotional-volitional characteristics of personality condition the development of complex informal interpersonal relations, which is the main cause of the development of depression and suicidal behavior of a significant share of combatants;

- to establish that the indicators of quality of life of combatants studied by the method of sociological research indicated pronounced changes in the psycho-emotional sphere, substantially worsening the mental health of military personnel.

Scientific and Practical Significance

The created model of medical-sociological monitoring of health and quality of life of participants in counter-terrorist operations is used in the system of medical support of the motorized rifle formation, which allowed the implementation of a system of dynamic medical observation of the health status and quality of life of military personnel.

The materials obtained on the assessment of quality of life of participants in counter-terrorist operations serve as the basis for making managerial decisions on the development of personalized health-restoration and rehabilitation programs and conducting restorative treatment taking into account specific types of health disorders of military personnel.

The conclusions obtained as a result of the study of the problem of health and quality of life of participants in counter-terrorist operations serve as the basis for improving medical service of this contingent and taking measures for social protection during their transition to civilian life.

Discussion of Materials

The materials of the dissertation were reported, discussed, and received approval at:

- the International Scientific and Practical Conference 'Safety, Technologies, Management' (Tolyatti, 2005);

- the Jubilee Scientific and Practical Conference dedicated to the 40th anniversary of the Military Academy of the FSB of Russia 'Actual Questions of Clinical Medicine, Preservation of Health and Rehabilitation of Employees of Special Services' (Nizhny Novgorod, 2005);

- the 40th Interregional Scientific and Practical Conference 'Actual Questions of Healthcare, Problems, Searches, Solutions' (Ulyanovsk, 2005);

- the III All-Russian Scientific and Practical Conference 'The Role of Social, Medical-Biological, and Hygienic Factors in the Formation of Health of the Population' (Penza, 2005);

- the All-Russian Scientific and Practical Conference 'Ensuring and Controlling the Quality of Medical and Social Assistance to the Population' (Moscow, 2005);

- the III Interregional Scientific and Practical Conference 'Social-Hygienic and Epidemiological Problems of Preservation and Strengthening of Health of Military Personnel and the Population' (Nizhny Novgorod, 2006).

Based on the materials of the research, 8 works and methodological recommendations have been published.

Implementation in Practice

The materials of the dissertation have been used:

- in the methodological recommendations 'Medical-Sociological Monitoring of Health and Quality of Life of Participants in Counter-Terrorist Operations and Local Armed Conflicts' (approved by the rector of the State Educational Institution of Higher Professional Education 'Nizhny Novgorod Medical Academy of Roszdrav', representative of the Ministry of Health and Social Development of the Russian Federation for the Volga Federal District, October 25, 2005);

- in the work of the medical services of the formation unit (implementation act dated June 22, 2005);

- in the work of the Nizhny Novgorod Garrison Hospital (implementation act dated July 1, 2005);

- the Center for Psychological Rehabilitation of the Motorized Rifle Division (implementation act dated June 22, 2005);

- in the work of the Nizhny Novgorod Oblast Neurological Hospital of War Veterans (implementation act dated March 13, 2006);

- in the educational process of cadets of the Military Academy of the FSB of Russia at the Department of Organization of Medical Support of Combat and Special Operations, General Troops and Humanitarian Disciplines (implementation act dated February 21, 2006).

Propositions for Defense:

1. Participation of combatants in combat and special operations is conditioned by the development of emotional stress, which subsequently manifests as a reliably significant increase in the share of psychosomatic and neurological pathology in the structure of morbidity by referral.

2. The prolonged effect of emotional combat stress on combatants is subsequently accompanied by a decline in their level of social activity and a disruption of mental health, which leads to a decrease in their quality of life. These same factors create the basis for the emergence of complex informal interpersonal relations in the military collective, exerting a substantial influence on the quality of life of combatants.

3. The integrated database of medical-sociological monitoring of health and quality of life of combatants serves as the basis for making managerial decisions on the implementation of a complex of social, legal, and medical measures within the interagency program for the restoration of health and improvement of quality of life of this contingent.