Sanitary Institute Research Articles

Features of the Functioning of Transport Healthcare in 1945–1950 (Based on the Materials of the South-Eastern Railway)

The relevance of the stated topic is determined by the social significance of the successful functioning of the system of medical care for citizens to preserve and restore their health. The experience of departmental medical institutions in the previous periods of national history makes it possible to use it rationally in modern conditions along with the services of state and commercial medicine. In scientific terms, the history of the medical and sanitary service of railway transport has not yet been properly developed, as a result of which the study of the declared topic can contribute to the concretization of knowledge about the evolution and problems of the development of domestic healthcare.The purpose of the study is to reveal the features of the post–war restoration of the activities of medical and sanitary institutions of the South-Eastern Railway on the basis of archival documents and periodical press materials.Objectives: to characterize the dynamics of the development of the network of medical and sanitary institutions on the South-Eastern Railway in 1945-1950; to identify the main activities of railway medicine in the period under study; to consider the current problems of the functioning of the industry and ways to solve them.Methodology. The research was based on the principles of objectivity and historicism. To solve the tasks set by the author, the methods of historical-genetic, historical-systemic, historical-comparative, typological, retrospective were used.Results. The study of the main activities of medical and sanitary institutions on railway transport made it possible to present in historical retrospect the features of providing medical care by means of the sectoral healthcare system, which had a certain autonomy and mobility in servicing the entrusted contingent of employees and their family members.Conclusions. During the five post-war years, the transport healthcare system that operated on the South-Eastern Railway restored full efficiency, having managed to improve the material and technical equipment of medical institutions in difficult conditions and strengthen their personnel potential, which positively affected the quality of medical care.

The Problem of Restrictions when taking into Account the Covid-19 Pandemic

The Covid-19 pandemic has radically changed the way people comprehend the concept of ,,fundamental right”. Without previously planning on this, we have been witnesses to an apparent ,,violation” of some rights we do not only consider to be natural, but also mandatory for any democratic society. Being worried about the effects it might have on health, state institutions have taken the decision to restrict certain liberties, be it totally, or partially. Moreover, people have had their right to circulate limited, while others could not benefit from medical services, due to the overload that has affected sanitary institutions. Given this point of view, it is mandatory to analyze the legal boundaries that have to be taken into consideration, when talking about these decisions, so that legal matters be respected, even though, there have been some limitations put in place at the moment.

Modeling the dynamics of key integrated indicators for the COVID-19 spread in St. Petersburg

The author carried out the modeling of the dynamics of key integrated indicators for the COVID-19 outbreak in St. Petersburg, Russia. The dynamics of infection, recovery and mortality in the region was analyzed based on the monitoring data of the Coordination Council to control the incidence of the novel coronavirus infection in St. Petersburg. The analysis showed that it was possible to quickly make a shortterm forecast for the pandemic spread based on the polynomial regression of integral indicators. Through forecasting, administrative and sanitary institutions have the possibility to make suitable management decisions on the creation of normal conditions for maintaining the public health.
 For citation: Gerasimenko PV. Modeling the dynamics of key integrated indicators of the COVID-19 spread in St. Petersburg. City Healthсare. 2023;4(1): 83-89 doi: 10.47619/2713-2617.zm.2023.v.4i1;83-89.

F.F. Erisman and the State Sanitary and Epidemiological Service of Russia

Introduction. The foundations of the State Sanitary and Epidemiological Service of Russia were established by the founders of domestic hygiene. The purpose of the study is to analyze the results of the scientific, practical and publication activities of F.F. Erisman in the formation and development of the state sanitary and epidemiological service of the country. Materials and methods. A historical expert-analytical study was carried out. The materials of the analysis are the main results of the activities and publications of F.F. Erisman in the field of sanitary-hygienic and epidemiological research. Results. The spectrum of activities of F.F. Erisman laid the foundation for the development of a number of hygienic disciplines. F.F. Erisman is the author of the first domestic hygiene manuals, which made a real breakthrough and influenced the life and health of many generations of Russians, manager of large-scale sanitary inspections. F.F. Erisman laid the foundations for the experimental-laboratory and social-hygienic directions of Russian hygiene. F.F. Erisman was the founder of the Hygienic Institute at the Moscow Imperial University and the sanitary station attached to it. On the basis of this institution the Moscow Sanitary Institute was subsequently created and became as Federal Scientific Center of Hygiene named after F.F. Erisman of the Federal Service for Supervision in Protection of the Rights of Consumer and Man Wellbeing. Limitations. The limitation of the study is due to the analysis of the activities and contribution to the creation of the State Sanitary and Epidemiological Service of Russia by one, but an outstanding hygienist of the 19th century, Professor F.F. Erisman. However, this does not distort the essence of the development of the domestic medical and sanitary business. Conclusion. The scientific and managing foundations for the development of sanitary and epidemiological rules and hygienic standards, the development and implementation of state policy and legal regulation in the field of sanitary and epidemiological safety, the arrangement of sanitary and epidemiological supervision, are largely laid down in the works and activities of the outstanding hygienist of Russia - F.F. Erisman.

Development of hygienic properties doctrine for clothing and shoes citing previous Academicians of the Union of Soviet Socialist Republics Academy of Medical Sciences, Fedor Grigorievich Krotkov

The data on the initial testing stage of clothing, shoes, and combat equipment in the Research Testing Center of Military Medicine and Military Medical Equipmentthe replacement of the Research Sanitary Institute of the Red Army. A brief historical information about the hygienic research of materials for clothing and clothing itself in Russia was provided. The fundamental study basis of clothing and footwear conducted by F.G. Krotkov were the works of many of his predecessors scientists of the Military Medical Academy and heads of the oldest hygiene department in Russia (Professors A.P. Dobroslavin, V.A. Levashev, P.E. Kalmykov, N.F. Galanin et al.). Additionally, three research directions were formed as the clothing doctrine gradually developed. The first was concerned about the materials research for clothing creation, second was the study of the created clothing with the help of devices in the laboratory, and the third was the study of the functional state of the human body in the evaluated clothes. The role of F.G. Krotkothe first head of the hygienic department of the said institute in the formation of requirements for clothing and footwear of military personnel. F.G. Krotkov conducted a hygienic assessment of hats adopted in the Red Army in 1931; in 1932, he examined the fabrics of military uniforms; in 1935, hygienic requirements for the mountain troops uniforms were developed with his direct participation; and in 1936 ski units. A hygienic assessment of the uniform of military personnel was carried out in the shortest possible time in 1941 under his leadership. The hygienic requirements for clothing and footwear were formulated by F.G. Krotkov based on the results of these experimental studies. The relevance of the developed requirements for clothing and footwear in the present time is noted.

Professor of the department of Hygiene and medical police of the Saint Vladimir university in Kiev Vladimir Dmitrievich Orlov (1856-1915)

For the first time, the article examined the life and work of a prominent representative of preventive science before the Soviet period in Ukraine, Vladimir Dmitrievich Orlov. Two periods of his scientific and pedagogical activity that are approximately the same in duration are distinguished, i. e. the Kazan and Kiev periods. In Kazan, he received a higher medical education, formed as a scientist and teacher (1873–1893); and in Kiev, he was further formed as a man of science, no longer an assistant, laboratory assistant and assistant professor, but Professor (since 1893). At the St. Vladimir University, where Professor V.D. Orlov headed the Department of Hygiene and Medical Police (1893–1914), he first introduced practical classes (1894) and visits by students to sanitary institutions in Kiev (1895). He prepared and published "A Guide to Practical Training in Hygiene and Medical Police" (1905). In the Russian Empire V.D. Orlov was Professor-hygienist of the second generation and in teaching he devoted much to the issues of Experimental Hygiene, and less to the second faculty discipline, which was assigned to his Department, i. e. Medical Police. Dissertation work came out for the first time from the Department of Hygiene and Medical Police led by Professor V.D. Orlov. In 1912, a supernumerary assistant of the Department Yaroslav Ventselevich Rezhabek (1865–1943) defended his thesis for the degree of Doctor of Medicine; in 1913 a supernumerary assistant of the Department Leonid Orestovich Dubitsky (1865–1931), being a student of Professor Orlov, prepared a dissertation research at the Würzburg Professor K.B. Lehmann. For the first time at the Department under Professor Orlov student scientific work began to be carried out and some of them were awarded gold (Mikhail Yasnikov, 1896; Alexey Filov, 1899; Vladislav Marzhetsky, 1900; Nikolai Posudzevsky, 1903) and silver (Anatoly Vasyutinsky, 1896) medals. Keywords: hygiene, medical police, teaching, Kiev, Ukraine, the Russian Empire.

Variables Predicting Academic Success of Nursing Students: a Longitudinal Study in a Nursing Bachelor's Degree Program.

Academic failure can negatively impact on the student, the university and the nursing workforce in the short term. The aim of this study is to analyze the characteristics and predictors of academic success in two cohorts of students of a Nursing Bachelor's Degree program. This longitudinal study enrolled students who attended the Nursing Bachelor's Degree program. The Tor Vergata University includes 21 Nursing Bachelor's Degree programs at several Sanitary Institutions of the Rome area, with a mean annual recruitment of 800 students. We considered two cohorts of students beginning the program in the 2011-2012 and 2012-2013 academic years, respectively. The follow-up of these two cohorts ended in the 2017-2018 academic year. We considered socio-demographic and academic variables in the nursing field (pre-admission test grade, training exam grade in the first, second and third year and professional license exam grade). The outcome variable is academic success defined as gradua-tion on time; academic failure is defined as changing degree, delay in completion of the course, attrition and dismissal (failure to complete the studies). Data were collected at baseline (T0), at the end of the first year (T1), at the end of the second year (T2) and at the end of the third year (T3) of the course. A logistic regression was performed to identify predictors of academic success. 2,041 students were enrolled, with an average age of 22.0 years (± 4.6, 18-50); 67.4% were female. Regarding academic success, 30.6% of students graduated on time and so achieved academic success, while 69.4% failed to complete the course within the established time: 5.4% (110/2,041) changed the course, the attrition rate was 7.3%, 0.3% (6/2,041) overdue from the course for expiring of the terms, 18.0% (368/2,041) is attending the course and 38.4% (784/2,041) graduated after more than three years. Pre-admission test grade (OR: 10.0, 95% CI: 10.020-10.054) and training exam grade at the second and third years (OR: 10.0 95% CI: 10.027-10.139; OR: 10.2 95% CI: 10.171-10.294) predicted academic success. Some nursing students changed course during the last year of the program, while the training exam grade of the second and third years had predicted academic success; this is a brand new information derived from this study. In addition, we confirmed the association of age, gender, secondary school type and grade and preadmission test with academic success. For these reasons, clinical training should be improved and the quality of internship wards, as learning environments, should be monitored. Italian universities should undertake establishing the ideal cut-off in pre-admission tests to determine which students have a high probability of academic success.

Медична допомога дітям у навчальних закладах: стан, проблеми та перспективи розвитку

В статті проведено аналіз систем медичного забезпечення дітей шкільного віку, особливостей організації. Міжнародний досвід свідчить, що існують різні моделі медичного забезпечення дітей у навчальних закладах: відмінності щодо підпорядкування шкільної служби (структурам охорони здоров’я або освіти), фінансування, підготовки кадрів та найбільш — щодо профілактичної спрямованості: обсягу та терміну проведення профілактичних медичних оглядів. Всесвітня організація охорони здоров’я наголошує, що поки оптимальної моделі шкільної охорони здоров’я в світі не визначено. Загальними проблемами шкільної охорони здоров’я є недостатнє фінансування, нерівномірний доступ дітей до медичних послуг. Наведено стан медичного забезпечення школярів у країнах пострадянського простору, результати змін у галузі охорони здоров’я дітей, що стосувалися реформування системи санітарно-епідеміологічних закладів, модернізації їх функцій, створення нових вертикальних структур, функціями яких є розробка національних і регіональних програм щодо пропаганди здорового способу життя, медичної освіти та комунікаційна діяльність. Проаналізовано розвиток системи шкільної медицини в Україні з позиції «Концепції стандартів якості шкільних медичних послуг і компетенцій» Європейського союзу шкільної та університетської медицини. Окреслено перспективи шкільної медицини в Україні, а саме: потреба у розробці і запровадженні нової української моделі шкільної медицини, адаптованої до європейських стандартів, та інтегрування її у систему громадського здоров’я, що затверджено в Україні; оновлення нормативно-правової бази; розвиток кадрового потенціалу; формування нових професійних компетентностей медичних працівників шкільної медицини в Україні; посилення міжвідомчої взаємодії в питаннях допомоги збереження здоров’я дітям і підліткам, які навчаються.

Session 23 / X

Prof. V.V. Miloslavsky made a report on the Moscow institutes studying labor. Having examined the advantages and disadvantages of labor organization according to Taulor and Gilbert, the speaker outlined the work of the Central Institute of Labor with its numerous laboratories, the Institute of Professional Hygiene of the People's Commissariat for Health and the Sanitary Institute of the People's Commissariat for Health in Moscow.

The Role of Polish Armed Forces in the Fight Against Epidemiological Threats (SARS-Cov-2)

First, the authors will refer to the general tasks that the armed forces are faced with in connection with the epidemiological threat. Then, the tasks and areas of Polish soldiers' involvement during the fight against the pandemic will be presented. Further, the impact of the existing threat on the functioning of the armed forces will be analyzed. Finally, based on the analyses carried out, conclusions will be drawn to boost the readiness for epidemiological threats, allowing the appropriate state security level to be achieved more effectively. The appearance of SARS-Cov-2 coronavirus, causing the COVID-19 disease in Poland, was a new and unprecedented threat posing an enormous challenge to the state security management system. Therefore, the armed forces have been involved in the fight to stop the pandemic quickly and efficiently. Primarily, the services of territorial defense forces, operational forces, and cadets were relied upon. Soldiers support the health service, carry out preventive measures, and monitor and control national borders. They participate in mitigating the effects of the crisis and in strengthening the resilience of local communities. They support the activities of local government and sanitary institutions. The evolving pandemic has become a test of military units' effectiveness and readiness taking part in the fight. military units' effectiveness and readiness taking part in the fight. This allows us to draw conclusions that are significant for the armed forces' on-going operations and define future directions concerning modernization and development.

The Weeks that Could Have Changed the Pandemic Course: on the Conflict Between Health, Economic and Personal Rights

Based on the observation of the behavior of local and national governments during the pandemics and the underlying conflicts between different actors and visions, in this contribution I briefly expose some reflections on the necessary triangulation between health, economic and personal rights and the reasons of governments reluctance to implement the measures recommended by sanitary institutions.

Zemunska bolnica (1784-2020) - kratka istorija najstarije bolnice u Srbiji

The Zemun Hospital - "Zemun" Medical Center is the oldest medical institution in Serbia that has been operating without interruption throughout its existence. Different dates have been noted in the literature related to its opening, but the one most often mentioned is February 25, 1784, and this date has been confirmed by a document found in the Zemun Magistracy. The first sanitary institution formed in Zemun was the Kontumac, which opened as early as 1730. Shortly after that, two confessional hospitals were also opened. The Serbian (Orthodox Christian) Hospital, which started working before 1769, and the German (Catholic) Hospital opened in 1758. In order to improve the work of these hospitals, a decision was made to merge them into one - the Town Hospital, when the General Command ordered the Magistracy of the Town of Zemun to pool the funds of the existing hospitals and commence work on building a new hospital building. Although financially united, the hospitals continued, for a time, to work in separate buildings. The physical merging of the hospitals was finalized in 1795. From that time to this day the Zemun Hospital has been working without interruption, even in wartime. It has today grown into a modern clinical and teaching center.

Professor Alexey S. Slepykh on the 95th anniversary

In 2019, the 95th anniversary of the famous obstetrician-gynecologist Alexey S. Slepykh, who was the head of the Department of Obstetrics and Gynecology of the Leningrad Sanitary and Hygienic Medical Institute (now North-Western State Medical University named after I.I. Mechnikov), is celebrated. The article is devoted to the biography of Alexey Slepykh, in which a trace of his research path is displayed and his clinical and teaching activity with his main achievements in the field of obstetrics and gynecology are described.

Legal perspectives on environmental health in Colombia: Towards legal pluralism?

Environmental health is a concept that emerged in the seventies by adopting an integration of the mankind and the environement in one entity. Thus, different ecologies would not exist. The evolution of environment health in colombian law commences with the enactment of the National Sanitary Code. However, environmental health issues became aftewards fragmented and scattered into the different national and regional sanitary institutions. This document aims to describe the historical evolution and jurisprudence of environmental health in Colombia. Moreover, this article proposes to apply legal pluralism so as to allow new approaches for environmental health. DOI: http://dx.doi.org/10.21017/Rev.Repub.2019.v26.a60

Detection of Bottlenecks in Hospital Processes from the XAVIA HIS System using Process Mining

Sanitary services present various challenges, one of them are bottlenecks. bottlenecks cause anomalies and eventualities in the processes flow, directly affecting the patient’s attention quality. The health organizations procure to apply a process management focusing and the usage of different technologies to improve their performance. Process mining is a technology for the process analysis, which possibilities to identify characteristics and issues associated with the execution of the process from information systems. XAVIA HIS system has the necessary characteristics to contribute to the identification of bottlenecks applying process mining techniques. This research had as objective to develop and integrates an analysis view to identify bottlenecks from the XAVIA HIS system. To fulfill the proposed objective was selected and personalized the Replay a log on Petri Net for Performance / Conformance technique of process mining on the system. The analysis view developed and incorporated to the system, will allow making an analysis of the sanitary institutions execution processes. The solution proposal benefits the professionals and patients of the hospital institutions, increasing that way the quality of the provided services.

Serving the State: Military and Public Health Practices in Bulgaria (1878–1908)

This article focuses on Bulgaria and looks at the interconnected processes of building public health services and military institutions in the late Ottoman Empire and its other Balkan successor states: Greece, Serbia, and Romania. An elite class emerged from this development that moved between the army and civil service and vice versa. The paper draws on four case studies to follow the career paths of physicians who straddled two worlds – empire and nation-state – and tried to merge Ottoman notions of modernization with a compressed version of state-led modernization, de-Ottomanization, and militarization of Bulgaria. Both the Ottoman Empire and the Balkan nation-states borrowed models from European military, medical, and sanitary institutions. Thus, these states embraced the army as the epitome of modernization with concomitant attention given to medicine as a sign of scientific advancement. Such pairing under the umbrella of progress eased the subsequent expansion of state, militarization, and nationalism. The initial public health structures were thereby influenced by visions that privileged the state’s military needs and compelled the new elites to champion nationalism. The article is grounded in archival materials, diaries, and memoirs and adds a neglected dimension to the understanding of the transition from empire to nation-state.

ДО 100-РІЧЧЯ З ДНЯ НАРОДЖЕННЯ ВИДАТНОГО НАУКОВЦЯ І ПЕДАГОГА ПРОФЕСОРА ПИЛИПЕНКА МИХАЙЛА ЮХИМОВИЧА (оглядово-історичний біографічний нарис)

M.Yu. Pylypenko was born on October 19, 1918 in the town of Valky, Kharkiv region, to a family of peasants. In 1935 he finished Valky high school. From 1935 to 1938 he studied at Valky Veterinary College. After graduating from college, for one year he worked as a veterinary assistant in Kharkiv І.І. Mechnikov Sanitary and Bacteriological Institute. He began his higher education in 1939 at Kharkiv Veterinary Institute. The training was interrupted by the Great Patriotic War. In 1940 M.Yu. Pylypenko was drafted to the ranks of the Red Army, where he served until 1944. During the war, he was seriously wounded, was admitted to hospital as hopeless, and only his youth and will power gave him the opportunity to survive and return to training. In 1947, M.Yu. Pylypenko graduated from institute. In November 1947 M.Yu. Pylypenko was approved as a postgraduate student of the Department of Cytology, Histology and Embryology of Kharkiv Veterinary Institute. But for health reasons, in 1948 M.Yu. Pylypenko suspended postgraduate study. After treatment during 1948-1952 M.Yu. Pylypenko worked at Valky Veterinary Technical School as a deputy director of educational work. In 1952, M.Yu. Pylypenko returned to the graduate course. His research related to the technology of industrial artificial incubation and the morphogenesis of organs and systems of organs of birds in the incubation and post-incubation period. In 1954, M.Yu. Pylypenko graduated from postgraduate studies, after which he was appointed as an assistant in the course of cytology, histology and embryology at Kharkiv Veterinary Institute. In 1956, M.Yu. Pylypenko defended his dissertation on "Embryonic development of chickens in the incubator" Record-39" and their transition to a post-embryonic state." The same year he was awarded a Ph.D. degree in biological sciences. In 1959, the Higher Attestation Commission approved M.Yu. Pylypenko in the academic rank of associate professor in the Department of Cytology, Histology and Embryology. Further life destiny, scientific and pedagogical activity of Mykhailo Yukhymovych were connected with the Department of Cytology, Histology and Embryology of Kharkiv Veterinary Institute, and later – Kharkiv ZooVeterinary Institute. The long-term purposeful research work gradually got closer to the defense of his doctoral dissertation in 1975 on "Thymus in the ontogenesis of ducks and their reactions to certain influences." In 1976, M.Yu. Pylypenko was awarded a doctorate degree in veterinary sciences, and in 1978 he was awarded the title of professor. Since 1979 Professor M.Yu. Pylypenko was the head of the Department of Anatomy and Cytology, Histology and Embryology of Kharkiv ZooVeterinary Institute. In 1996, due to his health, M.Yu. Pylypenko left the department and went on a well-deserved rest. On July 29, 2002, Mykhailo Yukhymovych died, leaving a clear memory of a man, a scientist, and a teacher. We always remember!

Санітарно-гігієнічні установи Всеросійського земського Союзу в Період Першої світової війни

Санітарно-гігієнічні установи Всеросійського земського Союзу в Період Першої світової війни

Determinants of Health Status and Public Policies Implications – Lessons for Romania

The primary aim of this study is to assess the actual impact of healthcare public financing on population health status, while controlling for other non-financial health determinants. There are plenty of heterogeneous studies dealing with the negative or positive effects of different products consumption (e.g. sugar, alcohol, tobacco, fruits, vegetables, etc.) on people’s health. Starting from the relevant ones, we kept for our models those non-financial variables with public available data, used as control variables. After performing variable selection, we ranked the actual impact of different public expenditures categories on health status change, using simple and multiple regression fixed-effects techniques on a panel dataset regarding the European members of OECD (ranging from 1970 to 2014). Our results show that financing preventive care has the strongest positive impact on the health status, followed by auxiliary (ancillary) services. Administrative expenditures for the healthcare system do not have a significant influence, suggesting there is available room to enhance the effectiveness and performance of sanitary institutions management. Our results also show that life expectancy is negatively affected by the consumption of alcohol and sugar, in a decreasing order. These results were then connected with Romanian realities regarding health care financing and people’s consumption habits. In strong connection with our findings and these realities, this study provides, as a final part, a set of policy recommendations useful for Romanian public authorities in designing their policies, as well as for other interested non-governmental actors.

Care program for disability and social vulnerability of The Foundation of Disability Attention - Sant Joan de Déu (FAD-SJD)

Introduction : Population aging and high prevalence of chronic diseases cause high prevalence of patients at home with functional and cognitive disabilities. The support to disability requires care teams addressed to recovery the essential activities of daily-life, improve autonomy and fully exercise citizenship rights. The support needs related to disability at home are partially covered by the public resources at present available in Spain, and also by frequent limitation of socio-family support network. On the other hand, in our society there is a high prevalence of people in situations of social vulnerability related mainly to the lack of training and job opportunities. The Foundation of Disability Attention - Sant Joan de Deu (FAD-SJD) linked to the Hospital Order of San Juan de Dios, was created with two main objectives: to provide cares to disabled patients, and give support to people in situation of social vulnerability. Brief description of the practice change implemented: Since 2012, FAD-SJD proposes a pattern of care, based on nursing supervision of home care to disability, coordinated with public health care and social resources. Objectives : To provide the necessary support to disabled people based on the values of hospitality, respect, quality, responsibility and spirituality. To reinsert people in situation of social vulnerability, by means formation and job opportunities as caregivers of disabled people. Targeted population and stakeholders : Patients: Disabled people with criteria of support needs. Target population of reintegration: People in situation of social vulnerability, reversible by means of specific training and labor reintegration. Stakeholders: Sanitary and social institutions, both public and private, foundations dedicated to social vulnerability. Highlights (innovation, Impact and outcomes): Innovation: a) Care pattern providing support professionals to disability, coordinated and supervised by a nurse, according to the model of case management; b) Training program for disability care addressed to people in situation of social vulnerability, selected by a social entity (Caritas); c) Program of labor reintegration program through the FAD-SJD job offers. Impact: a) Improvement of the quality of life of disabled people; b) Reduction of social exclusion of vulnerable people. Results: Between January and October 2016, a total of 465 disabled patients received care: 121 at-home patients; 138 people living in religious communities; and 200 in mental health. The mean age of people was 77’4 years, 67’2% were women, the most common pathologies were dementia, organic failure, metabolic disorders and neurodegenerative diseases. The main interventions were support to daily and instrumental activities, and care in mental health. The most common causes of cancellation of care program were patient's death and economic difficulties. During this period of time, 161 persons were formed and 79 achieved their labor reintegration. Comments on sustainability : The funding comes from collaboration agreements with social entities and University (Caritas, SJD Teaching Campus, SJD Social Work, grants, ...), and the contribution of disabled patients. Comments on the transferability : We consider that the project is reproducible in other environments. Conclusions and lessons learned : This model of care provides a quality support to the disability and allows the labor reintegration of vulnerable people.