The disability among the population is one of the most important medical and social problems of the global significance. The article presents data on the epidemiology of the disability in the countries of the world. 110-190 million adults have significant difficulties in functioning - a significant degree of restriction in various spheres of life. The child’s disability accounts for 95 million children, out of which 13 million children have a “severe” form of the disability. In countries where the life expectancy exceeds 70 years, an average of about 8 years, representing 11.5 percent of total life expectancy, falls on years associated with the disability. In most countries, the demographic situation of aging of the population causes an increase in the disability among the elderly - two-thirds of the disabled belong to this age group of the population. In the total population of Russia, the share of disabled people is 9.3% - 12.3 million people, including disabled people of the working age accounting for 3 million 801 thousand people (less than a third - 30%), disabled elderly - 8 million 2,665 thousand people. (two-thirds of the total number of disabled people - 65.2%), children with disabilities include 636 thousand people (4.8%). There is noted a tendency to the decline in the primary and secondary disability of an adult (in 2000-2016) and children (2000-2014) population, but in 2015-2016 there was emerging a tendency to the gain in basic indices of the primary and repeated disability in children (the absolute number of disabled people, the level of disability). The analysis of individual programs for rehabilitation and habilitation (IPRH) of disabled people shows the greatest number of recommendations to be given about the needs of disabled people in technologies for medical and social rehabilitation and habilitation. According to the results of the reassessment of disabled persons in 2016, positive results of the implementation of the IPRH for disabled people were achieved in 48.4% of the disabled cases (among the victims of occupational accidents and occupational diseases - 63.8% of the disabled). There were noted low indices of the complete compensation and full recovery of lost functions (4-7% and 2.8-1%, respectively) and extremely low indices - for implementation recommendations for the acquisition of a profession, including new, advanced training, education and creation of a special workplace for the employment (0.2-0.8%).The solution of the problem of increasing the effectiveness of rehabilitation and habilitation activities requires a consistent integrated approach to the determination goals of the rehabilitation process in each case, depending on the cause of disability and close interagency cooperation in the implementation of IPRH for disabled persons. It is advisable to take into account the regional differentiation of the subjects of the Russian Federation in terms of the prevalence of the disability, as well as the age and gender features of the contingents of the disabled persons.

Drug reimbursement is one of the key elements of the effective health care system. The introduction of mechanisms to optimize the cost of drug provision can significantly reduce the costs of the state budget, expanding the availability of therapy and reducing long-term economic losses due to disability of the working population. The article analyses the specifics of drug provision programs in various regions of the world to determine the best practices for the purpose of subsequent introduction in the Russian Federation.

Aim. To study the effect of class III antiarrhythmic drugs (amiodarone and sotalol), and the β-blocker bisoprolol on the spectral parameters of heart rate variability in patients with different forms of atrial fibrillation (AF).Material and methods. Spectral analysis of heart rate variability of 5-minute electrocardiography intervals was used. The study included patients with newly diagnosed AF and having a duration of the disease from 6 months to 8 years. Arterial hypertension, coronary artery disease, myocardial infarction (in history), conduction disorders and type 2 diabetes mellitus were diagnosed as comorbidities. The following parameters were calculated: the total power (TP) of the spectrum, the power of very low frequencies (VLF), low frequencies (LF) and high frequencies (HF).Results. In the group of patients with newly diagnosed AF without concomitant diseases after administration of amiodarone, VLF prevails in the spectrum structure, which indicates a significant role of humoral factors in the regulation of heart rate. The power of LF, reflecting the activity of the sympathetic nervous system, prevails over HF power after administration of amiodarone. In patients with newly diagnosed AF, having concomitant diseases, sympathetic influences prevail over parasympathetic ones by 3.6 times after administration of amiodarone. In the group of patients who have reduced the number of comorbidities, the LF/HF decreases and is only 1.66 after administration of amiodarone. The decrease in the number of negative factors is also accompanied by an increase in the influence of the vagus nerve on the activity of the heart. In the study of the effects of sotalol, the LF/HF in this group was twice lower in the group of patients with long-term AF. In patients receiving bisoprolol as antiarrhythmic therapy, the proportion of LF in the group of patients with newly diagnosed AF is 2 times lower, and the proportion of HF is twice higher than in the group of patients with long-term AF.Conclusion. The effect of antiarrhythmic drugs on the spectral parameters of heart rate variability depends on the duration AF. The presence of concomitant diseases of the cardiovascular system can significantly change the effect of antiarrhythmic drugs on the spectral parameters of heart rate variability and is accompanied by an increase in sympathetic activity. In patients with newly diagnosed AF, amiodarone and sotalol cause a similar effect – the predominance of sympathetic influence; when using bisoprolol, the predominant influence belongs to the vagus nerve. In patients with long-term AF, the opposite effect of drugs is observed: the use of amiodarone is accompanied by a more pronounced influence of the vagus nerve, and bisoprolol – the predominance of sympathetic influence. When using sotalol, sympathetic influences also prevail, more pronounced in patients with newly diagnosed AF.

Analysis of the state and trends in the population, the study of age characteristics and other indicators are the basis for the formation of targeted social support programs for citizens of working age and older than working age at the level of the subject of the Russian Federation.