Профилактика инсульта. Рекомендации


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‰ˆŽ‘ Šˆ’ˆ ˆ\r“’
ˆ \r‰‰ŽŠ-\rŠ\rˆ\r’”•  Š‰ˆŒ
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 \tƒ\b\n‚ ‚ \t„  \t
\n\n‚ \t  \n\f \t.
 ‚\t‚ \nƒ ­\t\n‚ ‡\t \f
\n  †\b\t 
\t \t
\tƒ\t\b…  „\n\n, \t 
 \b\n‚ ‡\t ­ \t
­\n \t . ‚
\f\n „ 1
\t‚ \f \b\t
\b\t\t\f \b\n‚… €\n, , 
\n\f\t\n‚ ƒœ  
\f\n\t \t
 \n\f† ­\t \t. Š\t \t
\f
\n \f\t 
ƒ‚\t \f
 \n\f \t \n
50%, 
\t„ \f…
\b\n-\f\t‚…  „\n\n, 
\n \n \t\t \n\b\n  
 \n \n \f… †.
\n
\r  † \n„\n  \n\f \t
\n\f\t „\n \t
\b  \f\n 
\t
­\n \f
\n  \n\f€…  
\t
\t
\f\n  \f€….
 ƒ€ \t\t, \n­ \n\n
­€\n \f\n,  
ƒ\n ­ \n  \b\n‚…
„\n\t,  †\b \n\f \t
\n, \n\t\n€†€\f† \t
­†, \t   ­€\n
\f\n.
\r\t \b .
\n\t‚ 
…
\n‚ ƒ\t …\t\f†\t  ­
\f†€ \t\b\n \t ,
\t 
­ƒ \n ­\t\n\n‚…
\t , ­„  \t…,
  
\n\f\n ­\n ƒ\n.
­­\t\n‚… ‡­ \b…
 \n… ­\n\t\n,
\b\t ƒ\t \n \f \b\t
 \b \n\f \t 
­ …
\t
1,8

\t\n‚… \n\b\n. \t
\t, \b\t, ­
\n\n‚ ƒ  \b 9
\t
1.2. 
’ˆˆ‰’‰ˆ‘
’‰ˆ‘
\n \nƒ †\n (UK Prospective, 1998),
\n\f\n \t \n\t\n\t 
 † 
\t \n‚ \t 
\n\f \t, \n  \f\n  †‚
 \n \f\t 
\n\b\t 
\n‚ \n„\n , …\t 
„\t \f\n\n \b   \f\b ˆ
\t \n‚… …. 
\n …
\n\t \n‚…  \n… ­\n,
\b\t \n\t\n\n‚  \b \n
\t  (  \f\n  \n\n
 ƒ\n 7,0%) \n ­„ 
­ \n\t \n‚ \f\n\n 
\n\f \t.    \t, 
 \n
ACCORD 
\f­­ \n\t\n\n  
\b \n\t  ( \n\n‚ 
 ƒ\n 6%) \t\n \f 
\b\n ƒ€ \t\n\t ƒ  \b
­
\b\t\t \t \n 
\n\t \n
\n\f \t ­
\n\n† 
\t\n\n‚
\n. ˆ \n, ­€\n\n‚
\b\n†  ­ …\n ƒ\t, ­
\n\t  ­\f€\t \n
ƒ\t \n\t\n\n­€†€
\n\t (ˆ) 
ƒ \t ­
\t  \n\t\n\n\f II ( ).  ‡\t
\n\t\n\n \n„\n  (\t \b
  \n 120
 \t. \t.) ­
\n
\n† 
ƒ‚\b\n \t­ (\t \b
 \n 140
 \t. \t.) ­„ 
­ \n\t \n‚ \n„\n  \n
\f \t ­ …\n \b\t\t … \b\n-
\f\t‚…  „\n\n (ACCORD).
ž\t\n\t ­\f†€
\t­ ­ …\n ƒ\t \t„
\f\b  
 ­­\t\n‚… ­‚
\t\n. Šƒ\n\f„\n \n­ ­ 
\t
\n\n\b\n \t\t\n 
­ \t
\n\f \t. ˆ­ \n \nƒ\t
­„  \f\n\n  ƒ 
 \t­\n  ˆ, \b \n\f \t.
  \t
\n\n\b\n \t   
  \t‚ (\r) 
­ \t \n
\f \t \f
ƒ \n‚… ƒ\t ƒ‚  \n \t 
\b\n: ƒ\n\f„\n  \t\n\n
\f\n\n† \b  \n\f \t 
\f…
\n‚… \f\t‚…  „\n\n.
\n
\n\t   \f
ƒ \n‚… 
…
\n‚ ƒ\t 1
\t­ \nƒ…
 
­   ­
\n„\n†
\b\n-\f\t .
\b\n  \f
ƒ \n‚… 
…\n‚
ƒ\t ­­\b\t\t \n \f
€\t \t 
­ \n ˆ
   .
\b\n 
­€† \t\t\n 
‚… ­\n\t 
ƒ\t, ƒ\n\n
­ \n\t \n‚ \t ,
\f\n\t  ­ \n\f \t.
ˆ­ \n ƒ\t ­ …
\n ƒ\t „\t ­\t 
\n†  ­ \n\f \t.
\n\b\n \r   \n„\n 
 \n\f \t ­ …\n ƒ\t
\nƒ   ƒ\n ­ \n
\b ­ \n\t \n‚… \t
\b\n-\f\t .
1.2. …†‡…€ˆ …‡
 … ‡\t­…  \t\n \n, \n
 \t
­  
\t,  ‚\t\f­\t
€\n‚, \n
­\t\n \n \f\t\n‚
\t , ‚†€ \f€
\t\n\n  \n \n
­\t  ƒ
\r\f\r
 \n\t\b\n\r
\f
’ˆŽ‰\rˆ‰
‰Š‰™ˆˆ
\t 
\t\n\t \t
\f\t‚…  „\n\n. 
70–80
… …
­  \t \t ƒ‚  ­ \f\b\n‚ \fƒ
\t \n‚ \t \t \f€\t
\n ­ \t „\f 
\t \n\f \t 
\f\n .
\f­
\n \n  \n,
­ „ \n  \t 
\t, ­ , \b\t ­‚\n\n  \n
\t \nƒ  \t\t \n‚  
­­\f \n\n‚ \b\n-\f\t‚
 
\b\t \n\t   \n\t \n
\t \n \t 
†ƒ \f­\n \t\t
 \n„\n  \n\f \t. \t\n 
­­\t\n‚…  \n,  †
\b… 450
000
ƒ \n‚…, ƒ\n\f„ ,
\b\t ­ ­‚\n \t \b 
„‚ 10
 \t. \t.  \t \n
\f \t \t\t 
1,95
. ˆ\n\t\b\n,
\n
\n \t­\n, \t\t 
ƒ †\t\n‚  \n\f \t \f \b
\t 
\t, \n \t
\b\t\t‚ \n\f \t \t
\f\n   \t
ƒ  \t\n \f
ƒ \n‚…  „ 45
\t
\n\n† 
 \t… 
\t\n‚… \f­­. ’, \t\n\t \n‚ 
\n\f \t 
­\f­­ 
\nƒ 
\f\n \t \b  (­

\n\n† 
­\f­­ 
\n\n 
\f\n) \f \b\t 
10
 
­\n\t  „ 45
\t, \n
 

  ƒ \n‚… ­„  \t.
\t 
\t 
 ­­\t\n‚… 
 \n \t\b\n ƒ  \t\n 
\n\f \t 
\f\n \t \b ,
\b 
\f\n \t \b .
’,
 \n MRFIT  \f„\b\n
\t\n\t \n‚  \n\f \t 
 
  \t \b  \t 8,2,
\t  
   \t \b
 
–  4,4. 
 , \t\n\t
\t
\n\f \t \f\t ­ ­‚\n
\t \b  \n
„‚ 10
 \t.
\t., \n\b\n 
 \t. \t.
\t\n \b\n  ­„\t
 \f€\t\n\n‚ \f\n\n \t\n
\t \n  \n\f \t.  
\t\n \f­\n‚… \f \t\t
\n\n\n‚…  \n
­\n, \b\t  \t \n \b\n ­
‚\n\n  \n„\t \t\n\t \n‚
 \t ­ \n\f \t ­
\n \n
40%, ­\b ­ \t
\b ‡\t\n\t 
\t\n\n
\n\f \t ‚, \b   ˆ \r.
 ­
\t \n \n\n‚… ­­\t\n‚… 
 \n, ­€\n\n‚… ­\b\n
­ \t \b\n-\f\t‚…
 „\n\n 
­€† \n\t­\t\n
\n \t­, ƒ‚  \f\t\n \n  
\f†€: ­\n\n ­­\t 
\b\n‚…  ,  †\b \f\t,
ƒ\t-\nƒ \t‚, ˆ, \n\t
\n\t‚   
 , ‚‚\t …\n\f†
\f†  \n\f \t 
 \n‚…
\n
\f \n‚ \n\n  
\t
\t\t\f†€ \t­,  †\b
† ƒ „\n 
\n\t\n\f† \t­†, \n
\f†\t   \n„\n  ­
\n\f \t.
\r\t \b  
\f \t\t \b
\n  „\n ƒ‚\t \n„ 140
 \t. \t.
1.3. 
’ˆ’Š Š’ˆŽ‰\r‘
’‰ˆ‘
\t \b 
– \n„ 90
\t. \t., \t  ‡\t \f\n \f
†\t 
\n\n  \n\f \t
\f \n‚…  „\n\n.
  ­\n\t 
, …\n‚ 
ƒ\t   ƒ \n ­\b
 ‚ \n\b\n  \t †\t
 \t. \t.
1.3. ……‰­…Š …‡
\n \r
\t \f
€\t\n\n \n\b\n 
­  \nƒ
…‚… ­\t ­
\t 
\b\n† \t 
…\n\b
\b\n-\f\t ­\t . \r \f
\t \t\t\t, \b\t ‡\t\n\t  
\n‚… \n\t\f \n\t (Š) 
­ \t \b \n\f \t
ƒ \n‚… ƒ \n \b ­\t\n \n
 \n \t\b\n ƒ \n
‡ƒ  
­ \n ­ \n\n
\n‚…  \n\b… ­‚\t\n… \n 
  . \r
\f \t\n‚, 
­‚\t\n, ­€\n\n‚… ­\b\n
­ \t  „\n\n \n\n
\t   \b\n  ,
­\n\n \n ­ƒ\t
 \n„\n† \b\t\t‚ \t \n‚… 
\n\n‚…  „\n\n, \n
\f€\t\n\n
\n ­   \n
\b\t\t\f \n\f \t. ‡\t
\f 
\n\n‚… \f\t… ­
\b\n ­ \t \n\f \t ­ \t
\f\t\t ­\t\n \n  \n
\t\b\n ‡ƒ \b…  „\n\n
­\n\n Š \n \n\f\t.
 \t
„  \n (\n 

)  \t ­­\t ‚ƒ
­ \n \b    ­\t \b…
\t\n, ­„\n\n‚… 
\n\f\t
 \n‚ \tƒƒ\n. 
\b ‡\t \t \n\t\b
ƒ  ­ ()
– \n
ƒ  \b\t \t\b†€ \n\f
\n \t , ­\t\n\n\n\t
\t ­‚\t 
\t. 
\t \t ­ƒ \t \n 1/3
­
\t  ­
­\f \n\f\n 
\b\n \t.  \n \n
 \b\n‚ ƒ \n ,
\n \f
\n\b\t \n \b\t ­\n\t
 ­\n \n\b ­\t 
 ƒ\n\f„\t \n \f\t (
\n\n ). ’\n «\n ­\n
\n»,   «\n\t\b»,  ­
\n\t 
\t…  \f\b…,  \n\f\n
\t \n\t ­ \t\f\t\t 
\t\b \t \n ­   ­
\t\n\n \t \n  ­\n.
 \n\n‚ \n  
\n, \b\t\t \n\f \t 
­­
\t 
\n ­ \nƒ †
\n 11
\t \t   28,2% \f
ƒ 
\n‚… 
 \n\n  ­
\n\n†
6,8% 
\n\t \n \f­­. 
‚ \t  \b
\n\f \t ­  \f
ƒ \n‚… ƒ ­„
\n  ­\n  †\t \b\n \n
\t\t\b\n\t, , ­„  \t 

…\n‚ ƒ\t.
ž\t\n\t  \b\n‚… \n
\t\n‚… „ ­ \t \n\f 
\t ­ \n\t\b  
­ 
\n  \b\n‚… \n\t\tƒ\t\b…
­­\t \f\b\n 
\n
\n\n‚…  \n… (­ ƒ
\n\t \f‚… 
\n\t \n‚…),
\r\f\r
 \n\t\b\n\r
\f
’ˆŽ‰\rˆ‰
‰Š‰™ˆˆ
 †\b… ƒ  60
\t. ƒ  ­  \nƒ † 
\n \n\t \f ­ 
\n, \b\t ­„  \n„\n
 \t\n\t \n  \tƒ‡ƒ
\b \n\f \t \n
68%. „\n
\f  ‡\t\n\t 
ƒ­\n
\t \t­ Š   ­„
\n \f\n „\f\n\n \n 
\n\n \t\n\n (Š) 
­ …
2,0–3,0, \t‚  \f\t \t\t
\b\t  . ˆ\n\n ­ \f\t
\b ­„\n ­\f 
‡\t ­\n „\n „\t ­\t
 \n \t\n\n \n \n
 \b \n\f \t 
\n\f\t
\b­\n  \n.  
\n ­\n\t\n ‡\t\n\t Š
­\n   ­\n\t 
 
 \t \n\f \t (ƒ  6%
), 
\t
  \n„\n \t\n
\t \n  
 \n… 
\f\b
\t ­\n\t 
\n‚ \t\n
\t† \n\f \t ƒ‚  \n ‚„\n\n‚.
ˆ… 
‡\t, \n ­
\t
­ \n ­  
…
­\b\n ­ \t \n\f \t 
\t \n‚ 
\f\b\t  \b\n‚… \t
,  †\b \n\f‚
(\t, ­\t\n\n‚  ­\n‚,
\n„\n \t\t  „ \f
\b, \t\b \t \n‚ ­
, \t\n‚ ‡ƒ  
\n\n)
\f‚ (, …\n‚ 
ƒ\t). 
\t ‚  \t\n\t
­\n\t 
­\t\f†€ \tƒ
‡ƒ    ƒ  \b \f \f
\n\n‚ \t . 
\t
ƒ \n‚… 
\f\n\n‚  \t\n\t
 \t 75
\t, \t†€… …\n
\b \b\n \n\t\t\b\n\t†, ,
…\n‚ ƒ\t 
†€… 
† ‚ƒ  „ \f\b 35%.
\t ƒ \n‚… \n  \t
\n\t , \n †€…,  , 
­ \n\t \n‚… \t .
  †\t \f\n \n
‚\n  ­ \n\f \t ­
\t ˆ,  „\n \tƒ
  „ \f\b, \t\b
­„\n \t \n  ­\n, ­
­ \t \n  ­\n,  
 \t \n  , ‡\n
\t,  \t\n\n ­\t,
­\t  \t \n  ­\n, \n
 „­\n ­,
\t‚\t  \n \n, \t 
\t‚. Š\n \fƒ\t \n ­\f€
\t \n ­ \r 
\n  \f\b \t \t\n\f \n
ˆ \n ­ \f\b\n.
\n
™ ƒ\n \t\n ‚ \n
 \f
 \t 65
\t 
…
­\b\n ­\n\n \t
­€†  \n ­\f 
­ \nƒ…\t ž.
\n\t \f \b\n 
\n (Š 2,0–3,0) ­ \n ­\n
\n  \n\f\t  ­
\n\t ‚  
­\n\t
\f\n\n  \n\f \t ­ \f
\n\n\t 
ƒ­\n\t \b\n.
\n\t 
­\t\n\n‚
 ­\n, \n \t
1.3. 
’ˆ’Š Š’ˆŽ‰\r‘
’‰ˆ‘
,  \f\t \n\n\b\t  \t 
\n\f† \t­† \n   
\t„\n   \f\n Š
\t \t
\t­ ­\t:
ƒ­\t‚ – 2,0–3,0, …\n\b
\n   \n„\n  \n
\f \t \n\f\t ­\n\t
\t‚ ˆ 
­œ \n\t
ST 
\tƒ  „ \f\b
  \n\t\b \n\t.
 \n\t€  ­ \f\b\n 
\n (FDA, \rš, 2011) \n
­ 
\n ƒ\t\n, \t\n€ 
 \f
­‚… \nƒ\t \tƒ\n, 

   
\n 
­\n
­ \t \n\f \t \f
ƒ \n‚… 
\n\n† 
\n ­\n
\n ƒ\t\n 
 300
 
\f\t
  
ƒ  \n \b\t
\t \n\f \t   \t\n‚… ‡ƒ 
\n \b\n \b\t\t ƒ … 
\t\b\n (RE-LY, 2009). ‰  \f \t\t
­‚\t\n ­\t\t 
 \b 
­\n\t, \t‚… \nƒ… ­ 
\b\t ƒ\t\n 
 150
 2

\n   2
… \t, \t
  ­\t
€\n \n \n\b
\n\f \t ­
\n\n† 
\f­­, ­
\n†€ \n, ‡\t \b  \t
  357
ƒ \n‚….  ­ \n
\f\t\b\n ‚ ƒ\t\n 220
 ‡
\t\n\t ­
\n\n† 
\f­­,
­ \f\b \n, ƒ‚  ­\t
, 
 \b…  „\n\n
  \n„. Š\n ­ \tƒ \n
\f„\n Š ( \n…„\n
‡\t ­\t  
\t­\t\b 
­\n ‚ 65%) 
\f­­ \b\n
\n ­
\n\n† 
ƒ\t
\n \t\t\t\b \n\b‚… …„
\n \n ­ \f\b\n.
\r \r \r \r

 \t \n\tœ  \b\t†
\b\n, 
\t„ ­\b\n 
\t\b\n
­ \t \b \n\f \t.
\b\n ­ \t \n\f \t 
€† \n\t\tƒ\t\n‚… ­­\t
\n‚\t \n
­\n\n \r, ‡
\t\n\t \t \f\b  

\f­\n‚… \n\n\n‚…  
\n, ƒœ\n…, 
ƒ€  „
\n\t, 55
\b  (
\n\n \f„
\b\n) ƒ \b\n-\f\t ­\t .
 ‚  ­\n\t\n \t\n
\n„\n \t\n\t \n  ˆ
32%.  ‡\t \n \nƒ †  \f€
\t\n\n  \n \n
\b\t\t\f \f\t
\t,  \n\n\n \n
\t \n \n\f \t, \b \n\f 
\t, \n
\t\b\n \t\n\n 
\f \b\n†
\b\t\t‚ \b \n\f \t.  
\n\b  \n WHS («
 „\n€\n»)  †\b  39876
„\n€\n
45
\t 
\t, \n … 
\n\n
\n\n   ƒ\f \n
ƒ \n, \n \b 
\f
\n ­\t . Ž 10
\t ­ 
„\n\n ­ \r (100
/\f\t
) \n ƒ‚  \t\b\n \n„\n 
ˆ, \n
\f\n  \t\n\t \n‚ 
\n\f \t \n
17%. ž\t ­  
\b\t
24%- \f\n\n  \b
 \n\f \t \n
\n \n \b\n \t\t
\t\b \n\b \t\n \n
24%
\r\f\r
 \n\t\b\n\r
\f
’ˆŽ‰\rˆ‰
‰Š‰™ˆˆ
 \b \n\f \t. 
\n  ­\f­­  , \b\t ­
 \t\b \t \r 
\t\n
\n  \b \n\f \t ­
 \t \f
„\n€\n 65
\t 
\t ­
\n \b , ­ ­, …\n
ƒ\t, 
\t„ ­ 10
\t\n 
\n\n \t 
ˆ \n \n \b
10%. \b\n  \b\n \n\n ‡
\t\n\t \r,  †\b†€ 
ƒ\n\t ­\f­„\t ˆ \f
\f„\b\n
\n \f
„\n€\n) 
\n\t  \f
„\n
€\n (\n
\n \f
\f„\b\n), \n\b\t \n
\n \f\t\n \n.
’ ƒ, \n‚ \n
\n
\n‚… ­\b \n\n‚…  \n, 
­ \n \r 
… ­\b\n
­ \t \f
‚…   \t
 \f\tƒ \n‚.  ‚ \r
), 
\t \b  
\n\n‚… … (\n
\f\t ƒ‚\t ­ \n‚ \f
\f„\b\n \t
\t 
„\n€\n \t 65
\t 
\b \f\n\n \b\n-\f\t
 (\n\n\n 
­€†  ‚
SCORE), \t
\t ­ƒ \t \n 6–10%
 „\n\n 
ƒ „ \t \t.
™ ƒ\n\t \n\n\b\n \f…
\n\t\n\t,   \n\t­, \t
  \b\t\n  \r,   ­\b\n ­
 \t 
­ \n ­ \n\n
\n‚…  \n… \n \n .
-\n\f ­\t \t \b\n\t
\n\n\b\n \tƒ\t\n‚… \n\t
\n\t \f
ƒ \n‚… 
\n\t\f\n\t \n‚
   \n\b ­ \n 
 \n ­\t    ­\n
\t . 
‡\t \t „\n
\t\n\t ­\n\t  „ 65
\t 
­\t\b  , 
\t„ 
­\t\n‚ \t\n \n\n‚… \t, 
\n\n ­\t ,  \n„\n…
\n\b\n\t, 
\t„ †€… ­\t
­\n 
­\f \n.
  \n… ­
­\b\n ­
\t ­  ƒ‚  ­\n, \b\t \r
\n\n† 
­ ƒ \n„\t \t\n
\t \n‚  \n\f \t \n
22%. 
\f…  \t\n\t\n‚… \n\f „
 \n\t\tƒ\t\b \t­ ­ 
ƒ‚ \f€\t \n 
\f… \n\t \f‚…
\n\t \n‚… ­‚\t\n…: ACTIVE W,
\t \n  ‡\t\n\t
ƒ\n\n\n \t­  ­
 (75
/\f\t) 
\r (75–100
/\f\t
) ­\t \n, 
ACTIVE , 
\n \b\n ƒ\n\n\n \t
­ \n  
\n\t­ \r
/\f\t). 
­  
\n \b\n \n  ,
ƒ\f \n, ‡\t\n. 
\t
 \n,  †\b ƒ \n‚…
­\t­\n 
­\f 
\n, ‡\t\n\t ƒ\n\n\n
\t­ 
­ \t \tƒ‡ƒ
\b… ƒ‚\t ƒ‚  ‚. Š\n
ƒ\n\n\n \b\n  ­
 
\r ­„  \t\t\t\b
 \n\b‚ ­‚\n  
\t ƒ … 
 ‚… \t\b\n.
\r\f€\t\n\n \f \b   
\t „ \f\b\n-\b\n‚… \t\b\n
( 0,001) 
\n\f\t\b­\n‚… 
\n ( = 0,006) ­ \nƒ  ƒ
 †\t\n  ‡\t…  „\n\n (2,0%
­\t 1,6%).
1.4. 
ˆŠˆˆ‰ˆŽ‰\r‘
’‰ˆ‘
  ­\n\t 
\f  \n‚
\n\f\n 
\n\f‚ \t 
\n\f\t ­ \r. 
ƒ \n‚… 
\t
ƒ \n \t\n ­ \n
\r \t„ \f\t 
\n„\n
\b\t\t‚ \n\f \t.    \t, \f
ƒ \n‚…
 \n\b ­ \n \t
\tƒ †ƒ   \tƒ
\t\n‚ \n\t\n\t‚ (
\r) ­ƒ\t\f†\t \n„\n† \f
\n  \f\t‚…  „\n\n (
\f\t \t, \n\t \n‚ ˆ
\n\f \t), 
‡\t ­  ­…\t
 \t\b\n.
\n
ˆ­ \n \r   ­
\t … \b\n-\f\t‚…
ƒ‚\t \n\f\t   ,
\t‚… 10
\t\n \f
\n‚  ­‚\t 5%.
\r 
\nƒ … …
 
\n „\t ƒ‚\t ­
\n   ­ \t ­ \n
\f \t  „\n€\n 
­ \t
\n\t   \f„\b\n,
\t‚…  \b\n-\f\t‚…
 „\n\n ­‚\t  
\b…  „\n\n.
’ƒ\t\n‚ \n\t\n\t‚
\n \n\f†\t   ­ 
\t \n\f \t ­ \n 
\b\n-\f\t‚…  „\n\n.
\n\t\tƒ\t\n \t­ 
€† \r ­ \n\t\b
 \n\f\t ­ \n 
\n\f \t, 
\t„ ­ \f\n\n 
 
 \f\b… \n ­„\n\n\t
\b\n† Š, ‚  
\t\b\n 
\n‚­ \n\t 
\t\n \n\t  \n\t\f .
  ­\n\t ‚ ,
\n †€… „\n\t ­\n
\t \n, ƒ\n\n\n
\n\t\tƒ\t\n \t­ 
€†  ­  
\r ƒ 
­­\b\t\t \n   ­ \t
 \n\f \t, \b \n\t­ \r,
­„\t \f \b\n
 \n‚… \t\b\n.
1.4. ‡‹‡‰Š …‡
  \n\t, \n
\n  ‡­ 
\b  \n ƒ\n\f„  ­
\f† † „\f ­‚\n\n‚
\f\n •\r 
\f \b\n  
\b \n\f \t. 
\nƒ  \f­\n‚…
ƒ\n\n‚…  \n… (MRFIT,
ATCB, APCSC),  †\b… \n 
\t\n \t‚\b , ƒ‚  ‚ \n \t\t
\t\b \n\b ­ \t
„\f ­‚\n \f\n •\r ­­
\t\n \n ­ \t\n\t 
 \n
\b \n\f \t 
ƒ\t\n
 – „\f \n\b\n •\r ­
­\t\n ‚ ­ \t\n\t 

\b \n\f \t.
\n\t\n‚ \t,
­\f† \b, – \t, ­
 ­ \n ƒ\n„†€ \f \t\t
­\t , \b\t †ƒ \n„\n
\f\n •\r 
 ­ƒ\n ­ „
\t \n  \t \n
\t\n\t \b\n-
\f\t‚…  „\n\n. ’, ƒ †
\n \t \t‚ 
\b\t\n 
\t
\t
\f\n ­  
\n„\n† \f\n
\r\f\r
 \n\t\b\n\r
\f
’ˆŽ‰\rˆ‰
‰Š‰™ˆˆ
•\r \n
13% 
­„  \f\n
\n  ˆ \n
 \n
 
 \n\b\f† ­
\t\f ƒ‚  \n\n‚ \t\t\n‚. 
‚  \n ƒ‚  ­€\n‚,
\n\n, \t\b\n ­ \t
ˆ \n WOSCOP ƒ‚  ­
‚, ­€\n\n‚ \f\b\n†   \t
\t\n 
­\b\n ­ \t. 
\n
 †\b  \f„\b\n 
\t 45–64
\t
\f€\t\n\n ­‚\n\n‚ \f\n
•\r 
 
\t\f\t\t 
\n\n
­\n\n\n ˆ.
\n\b\n ­
\t\t\n 
 40
/\f\t 
\t\b\n
\t \t\n \n„   
\t \t
ˆ \r 
\b\t\t\f \n\t \n ˆ
35%. \n \b\n‚ \n\n‚ ƒ‚ 
­ \f\b\n‚ 
­‚\t\n ­ ­ 
\n \t\t\n. 
\n ­ 
\t \t ƒ\n‚ \t\n  
\f­
\n‚  \n (4S, HPS) ­
\t\b
\n ­ \t ˆ \r 
\t\t\n 
­\t\t\n ‚ 
­\n\t 
\n\n ­\t 
\n„\n \t\n\t \n  
\b \n\f \t \n
19–32%. 
\f 
\t\t 5
\t\n \b\n \t\t\n
 40
/\f\t ƒ\n\f„\n \n„\n
\t\n\t \n  ­ \n\f 
\t \n
25% (p 0,0001).  ‡\t 
\b \n\f \t ƒ‚ € \n„
30%) ƒ \f€\t\n\n \n‚
\b\t\t \t \b
\n\f \t. 
\n 
­ \n… \n
\n\n‚… ­ ƒ \n\t \f‚…
 \n JUPITER (2008) ƒ‚ 
 †\b\n‚ ­\t\b ‚ \f„
\b\n‚ (
\t 50
\t 
\t) 
„\n
€\n‚ (
\t 60
\t 
\t), \f

\t‚… \n ƒ‚  \n
\b\n-\f\t‚…
ƒ \n, \n
­… \t\n,
  ­‚\n \n\n\t
‚\b\f\t\t \n \r-\t\n
ƒ  (2,0
/   ‚).   \n
 ƒ \n‚ ­ \f\b  \f
\t\t\n 20
/\f\t   ­ ƒ. 
\t\b\n
\t\n \nƒ †\n \f
­ \f\b…
\f\t\t\n \t\b\n \t\n
\n„\n \b\t\t‚ \n\t \n ˆ,
…  \f\b ˆ, \n\t \n \n\f 
\t 
…  \f\b \n\f \t – \n
\n\n \n ­\t \n‚
 \n\b\n ­\n‚… ­\t
­ ‚   ‚… † \b\t†\t
 \f†€: ƒ€ •\r 5,0
 / ,
•\r ­­\t\n \n ­ \t\n\t
3,0
 / , •\r ­­\t\n ‚
 ­ \t\n\t � 1,0
 / ( 
\f„\b\n) 
 / (  „\n€\n),
\t ‚ 1,7
 / .
  \t
­ ­\b \t­
­€† \f… ­­\t (ƒ
\t, \n\n 
‡\tƒ) 
\t \n\f \t \n \n.   
\n ­ „†\t.
\n
\b\n 
­€† \t\t\n 
­ \n\n 
\n\n† ƒ „
\n, \n­ \n\n\f \n
\n„\n •\r,
\n\f\t   ­\b\n ­
 \t \b \n\f \t
­\n\t 
\n\n ­\t 
   \t\n, ­„\n\n‚
‚ \f\t‚ , \t
  …\n‚ ƒ\t.
1.5. 
‰Š\r’’ˆ”‰
Š‰™ˆˆ
  •ˆŠ™‰“”•
’‰ˆ‘•
ƒ\t‚ \f\t ƒ‚\t ­ \n‚
  ­\n\t 
­\t 
, \n
­  \t
\t \b\n
­\t€\n ­ \n\f \t
\n \t\n.
\n „\t ƒ‚\t ­ \n ­
\n… \n\b\n… •\r ­­\t
\n ‚ ­ \t\n\t, \n
\t\n\t 
­ \t \n\f \t
­\n\t 
\n\n‚ \n\f\n
 \n \n.
 \n­\n\t \t\t\n
  \n„\n\t 
… ­€†
\t\b  ‚… \n\b\n •\r \f\t
ƒ‚\t ­ \n‚ \f ­ 
­\b \t.
1.5. …Œ…ˆŽ ‡ 
­‘ ‹’Ž‘ …‘
 \b ­\t\n \t \t
\b \t\n ‡\t\n \n‚… \t
  \n\f\t\n\n \n\n \t  
\f‚ \n\n \t \f
\t 
\f \b\n  \n\f \t. 
\n\b \n\b‚ \t\n‚
\t\n …\t\f\t \n„\n 
\n   \n„\n \t 
\t \t \n \t\n. \n, \b\t
\n\n‚ \n\f\n \n†\t, \n\b\n
60%- \f\n\n ­\t \n
\n \t, \n\n\n 
­€†
\t\t\n \n. \r\n\n
‚ \n  \t\n \n\n‚… \t
\f€\t \t 
­€† \f­ \n
 \f \t\f \n\n, ­
‡\t \n\b \n\b‚ \b
\t\t \t\n, \n\b\n 
70%- \f„
\n \t.
  \n\n\n‚…  
\n, \f \t\t‚ \t‚… \n\b  ­\f
ƒ \t 
., ­\n\t
 , \b\t ­ \t\b ‚­ \n\n
\t\n ‡\n\t‡\t „\t 
­ \n\t \n \f\n\t 5
\t\n 
\f\f \t\n \n\b\n \t\b (
\b \n\f \t, ˆ 
\t) ­

\n\n† 
\n\t\n \t­, ­
 \n‚… …\f\b… …,
\n ­‚†€… 3,0%. \b 

\n\n   \n\t \n‚…
­‚\t\n \t\n ‡\n\t‡\t
 
\n­ \t 
\t\n\t\n.
 \n…,  ­  \t
 \n \n ‡\t\n\t 
ƒ
­\n\t \f…  \t \t 
­\t\n‚… ­\n\t (CREST, 2010),
ƒ\n\f„\n, \b\t \f\f \t\n \n\b
\n \t\b (\b \n\f \t, ˆ
\t) ­
\f \t\t  30
 \nƒ †\n, \t 
ƒ  \t \n\n‚
 \t\f\t ­ƒ \t \n
\n \b\t\t. ’ \n \n,
\n\n (­­\n\n‚) \n\f \t‚
\b€   ­ ‚­ \n\n \t\n
\t\n, \b\t 
 \n \f€\t\n
\n \f…\f  \b\t „\n ­\n\t.
\t \n
\t\b\n\n‚ ­\f€\t
­\n\t\n‚… \t \t \n
\n\n‚…
\t… \t\t  ­. ’, 
\t\n, \b\t ­‚  \n ­

\n\t \n \n ‡\t\n\t ‡\n
\t‡\t 
\n\t\n \t­
­  
\n 
\n 80

 ­  \t \t, , 
\n, \f€\t   «\n\n\n»
\n\t­\t\n\n \t­, ­
\r\f\r
 \n\t\b\n\r
\f
’ˆŽ‰\rˆ‰
‰Š‰™ˆˆ
   \b… \n\f
\n 
‚ƒ\b\n \n\n\b  \r.

‡\t \t\t\n‚ 
\n‚ \tƒ\t\n‚
\n\t\n\t‚ \n ­  . 
\t
„
 \n\n  \n ­ ,
\b\t \n \b\t\t \n\f \t \f
­\n\t
­\t\n‚ \t\n, ­ \f\b†€…
\t\n\f† \n\t\n\f† \t­†,
\f€\t\n\n \n  
\t \t \n
1% 
, \t  \b\t\t ­­\f
 \n‚…  „\n\n ‚ 
\n  †\b
\t \nƒ…\t ­ \f†€  \t 
\n \n\t\n \t­. 
\t, ­ \t\b ­  ­
\n \t\n ‡\n\t‡\t \f
„\n
€\n \f\tƒ \n.
\n
\n\t‚ 
­\t\n‚ \t
\n‚ \t\n  „\n‚ ƒ‚\t ƒ 
\n‚ \n
­\t \f… 
\f‚… \t  \n\f \t
\t\t\t\f†€  ƒ
 „\n 
\n\t\n \t
­. Š\tƒ ­\t\n‚… ­\n\t
  \t\n \f 
 „\n \n‚\t \n
\n 
ƒ\n‚… \t\n, „\n\n\n‚…
­­\t, \f… \n\f \n‚…
\t,  †\b \n\n\f† ­
† 
… 
­  ­\f‚
­\f€\t \n\n\n 
  ­\n\t.
  \t\n ‡\n\t‡\t
­ \t\f\t\t ­\t­\n 
\n\f\t ­ \n \r, \t
 
… ­‚\t\n… 
­ 
\n ‡\n\t‡\t \n\n \r
­\n  
\b\t \n\n
\n\t\tƒ\t\n ­­\t.
 \t\b ‚­ \n\n
\t\n ‡\n\t‡\t ­
­\t\n‚… \t\n… \n \n
70% ­
\n\n‚ \f­ \n \n
\n   60% ­
\n\n‚ \n
 „\t ƒ‚\t  ƒ\n
\t€\t \n \tƒ\n\n‚… ­\n\t
­  ­­\f \n‚…
\b\n-\f\t‚…  „\n\n
\t \n 3%.
 \t\b ‚­ \n\n 
\t\n \t\n †\n \n ƒ
\n\n \n­ \t 
\t\n\t
\n „\t ƒ‚\t \n\n
\t€\t \n \tƒ\n\n \f­­ ­
\n\t 
­\t\n‚ \t\n
\n \n 70% ­
\n\n‚ \f­ 
\n \n\n   60% ­
\n
\n‚ \n ­ \n \b ­
\n 
\f  
‚
 ­­\n\n‚… \b\n-
\f\t‚…  „\n\n.
ž\t\n\t \t\n \t\n\t
\n   \t\n\t‚ ‡\n\t
‡\t \f
­\t\n‚… ­\n\t,
†€… ‚  ­­
\n\n‚…  „\n\n, \n \f\b\n.
­\f \n\n‚ \n\n   ‚
 \n ­\t\n \t\n
\t  \n \n\f\t.
\b\f II.
\r\f\r
\f
\n\n\b
\f

\n\f
,
\f
\f\f

 \n\t\b\n\r

\f\r
2.1. \t  ­€ ‚€
\n\t\n  \f\t
\n‚… \t  (\f\n,
\f­\tƒ \n   \n‚… \n­\t,
„\n, \r, ­\n) 
\n …\n ƒ\t \n\f\t
\t
„ ,  
… ­\b
\n ­ \t \b \n
\f \t, …\t \n­\t\n\n ­ 
\t
„ \n\t\n \t \t
(
 †\b\n \t \t
\f\n
\n„\n ­\tƒ \n   )
\n \t \fƒ\t \n‚… \t \t.
’, \t\f\t\t\f†\t  \n, ­
\n\t, \b\t \n„\n ,
\f \b\n \b \t\n\t
­„\t \f\n\n 
­\t\n \n\f \t. ’„ \n ƒ‚ 
­\n \n\n\n‚… 
­‚\t\n, \n… ‡\t\n\t
\n  , ƒ †\n 
\t‚ 
\f \b\n \b \t
\n\t   \t\b\n ­ \t
\n\f \t  ­\n\t 
\r.
’
\n \n, ­ \nƒ…\t 
\n\f\t \n\t ƒ „\n, \t
 ­  „\t ƒ‚\t ­\n
\n \b \f \t‚ . ’,
\t \n
\n\n‚ \t †
€ \r,  †\b  
 ­†,
­„\t \f\n\n \b\t\t‚
­\t\n \n\f \t.  ­\b
 \f \f\b\t \b\t „\n, ƒ€
\n \n\t\n, ­\f­„\t ­
\n
 ­\n\t, ­\n \n
\f \t, \nƒ… \n\t\t \n 
\n\t ­\t\t \f\n,
ƒ\t ­\n \f\n, \n
 \t \f \t , ­
\n\t, \f \b\t \b\f† \t
\n\t 
­ \n \b ­ 
\n \t \f\n … 
2.2. …†‡…€ˆ …‡
\n\t­\t\n\n \t­  \t
\n … \n   ­
\n\t 
­\n\n\n‚ \n\f \t
.
\r \n \f \t\t \t\n 
 ƒ  ­\t\n\n\f \b
\n† \t\n\t \n‚  ­\t\n
\n\f \t \f\n\t \n
19%, 
„\n ƒ †\t\n  \t \t
25%. ’,   ­\t€\n \n
­\t\n \n\f \t 
 
­€†
\n\t­\t\n\n \t­ \nƒ…
 ­ \b\t  45
ƒ \n‚… 
‚\n\n‚ . 
\n\n‚ \t
\n 
­­\t\n‚… \n\n\n‚…
­ ƒ \n\t \f‚…  
\r\f\r
 \n\t\b\n\r
\f
’ˆŽ‰\rˆ‰
‰Š‰™ˆˆ
\n, ­\t \n‚ 
\t\b \n
\t\b\n ­ \t  \t
­ \n 
… \b\n \t
\n‚… (… \t, … \t 
\n) 
\t­ƒ\n‚… (\n­)
\f\t, 
\t \b 
– 
ƒ\n
 
ˆ.
ˆ\t ­ \n\t \n
­  \t
­\n\n   ‡­\t
\n, \t‚ 
\n\t \n ­­
\t\n  \n MOSES (2005)
ƒ\n\f„ ­\f€\t ­ ­
\n\n\n‚ ­\n‚
\n\t\n\t   (\n­\n)
­ \t ­\t\n‚… \t‚…
\b… \n\f\n 
ƒ€\n (\n\t  \n
 , \t\n\t\n \b
\t – ’ˆ) \f
­\n\t 
.
\t
„
 
 \n PRoFESS (2008)
ƒ \n \t \t\n 
 \t­ ­
\n\n† 
ƒ
\n ­ ƒ \n ­   \n

­\t\n \n\f \t 
\f… 
\f \n‚… \n\f\n.  †\t,
\b\t ‡\t ƒ‚  ƒ\f  \n \nƒ 
­ \n\t \n \f  (
\n 
\t \b  „\f \f­
­ \t  4
 \t. \t.) , 
„\n, \n\t\t\b\n  \t \n\t†
 \n.  ­ \t
­\t\n‚… \n\f \t \n \n \n
\t­\t\n\n \b\n ­ƒ\t\f\t
 \n† ­\n \f
\t‚… \n\t\n‚… \t\t 
\n†  \n\n‚…  „\n\n
(ˆ 
\n­\n \b\n \t).
’, ­
\n\n‚ ­­\t\n‚…  
\n (HOPE, PROGRESS, MOSES),
­\n\n ˆ (
\t \b  

ƒ\n 
\n‚ \f\t) 
  ­„
 \f\n\n   \n‚…
 „\n\n 
\b\n-\f\t
\t. \t\n \n ­  \t
\b\n ­ \t ­\f­„
\n  \n ­\n
­\t \b… \n\n ‚…
\f 
.
\n
\r\n„\n ­‚\n\n  
\n\f\t   ­ \t
­\t\n \n\f \t 
\f… 
\f\t‚… \n\f\n ­  
\b \n\f \t   ’ˆ ­\f\t
­‚ 24
\b \t
\n\b  ­ 
\n \n \b… ­\t.
 
\t, \b\t ­  ­\t
\n\t \n
ƒ \n‚…  
 
\n\n, \t 
\t\f\t\t
\t, \n\n \n 
\t … ­\n\t 
\n\f \t   ’ˆ, \t‚ \nƒ
… \f€\t \t \n„\n .
ƒ †\t\n‚  ‚ \f\n 
\t­\n \n„\n \n ­ \n‚
 „\n‚ ƒ‚\t \n\f 
\n‚, \n ­  \f\t
\n \n„\n  ­ƒ 
\t \n \n
 \t. \t.
Š­\t \n‚ \n\t\n‚ 
„ \n ­ \n - \n\b\n
\n  \b\t \n\t \n‚… ­‚
\t\n. ˆ†€ \n\n‚ \f‚†\t
­\f€\t \t
\n\n\b\n \f
\t 
… ƒ\n 
2.3. 
’ˆ’Š Š’ˆŽ‰\r‘
’‰ˆ‘
‚ƒ ­­\t 
 ‚
\f\n   „\n‚ ƒ‚\t \n\f
 \n‚ \n
\n\n 
 \b… \t 
…\n
\t ­­\t, ­\b…
…\t\t ­\n\t (\t\n‚
ƒ… \n‚… \t, ƒ
\n ­\b 
, …\n‚
ƒ\t).
2.3. ……‰­…Š …‡
\r  † ­ \t ­\t\n
\b \n\f \t 
\t­
\t\b ­\t ­ \f\t 
 ­\t \n\t\tƒ\t\b…
­­\t, \t †€…  \n
\n‚ \f­­‚: Š 
\tƒ\t\n‚
\n\t\n\t‚. ‚ƒ \t   \n
  \t \t \t
 
\t: \nƒ  \t\n‚ \t
‡ƒ /\tƒ,  †\f†€
­€ \f,  ­\t\n
ƒ \n \n\f \t, \n \b 
ƒ\n‚… \t\n, ­\n\t
\n \b ­\t­\n 
\n\n† \t
  \n \t.
\n\t€  
\n\f ‚ƒ
  \n\t\tƒ\t\b \t
­ „\n  \n ƒ \n‚… ­
­ \f ­\t\n\t\b\f 
…\n\f \t \n\f \t:
‡ƒ \b 
\n‡
ƒ \b ( †\b \t\tƒ
\t\b, \f\n\n‚ 
\f, 
\t
\b  – ­\t\n\n‚). ƒ\n‚
­… ƒ­\b\t \f\b\t \f€…
\t, ­ †€… \t\t\f \n
\t\tƒ\t\b \t­.
\r  \n
 

\r\b\t  \n\t
\n\n ƒ \n ‡ƒ ,
 † \t ­…\t 20–30%
… \b… \n\f \t,  \t
 \t \nƒ\n‚… ƒ \n
. \n 
­ \n  \f\b
\n\n ƒ \n‚… \t \n\t
\b , 
\b\t\t  \f\b
– ­\t 
 \b\n‚…  ­\n, 
\t\t
– \f
\n \n
­\t\n\b\n‚ \tƒ 
„ \f\b. ˜ \f\b‚ \tƒ‚ …
\t\n‚    ­\n\t 
\t‚
ˆ, \t 
…\n\b „ \f\b
\f\n 
\f \t\t \n\n
­„\n,  
 \t\n\n 
­\t.
  \n\t ­\n\t, ­\n…
‡ƒ \b \n\f \t (žˆ),
 † ­ \t ­\t\n \n
\f \t  „\n‚ ­ \f\b\t ­„\n\n\n\f†
\n\t\f \n\t\n\f† \t­†. ­\t
‚ƒ  \t \n (\n

), \n\n\b‚    \t 
\n ­ ­  \f†€… \t\n…:
­\t\n\n   ­ \n ,
\t‚ ˆ,  „\n\n\n‚ \tƒ
 ˜ (­ 
\t\b\n \n \n
\t\b \t \n‚ \t\n
\n \t \t
­\t\n\n‚  ­\n‚ .
 ­\t\n\n, \t 
   †\t \n\n‚ 
\t  ­\t\n žˆ. 
\n
\b \n\n‚…  \n\b…  \n…
\r\f\r
 \n\t\b\n\r
\f
’ˆŽ‰\rˆ‰
‰Š‰™ˆˆ
­\n\t\n ‚ \t­
\t\b ‡\t \n (­
\n
\n† 
­ ƒ) 
\t\n\n ­ 
\t \tƒ‡ƒ \b…  „\n\n
 ­\n\t 
\n\t\b
: \t\n\f\t \n„\n \t\n\t 
\n  \n
68% 
ƒ †\t\n \n„
\n „\n \b\t\t‚ \n\f \t 
\f­­ \n\t  
1,4% \f
­\n\t,
­ \f\b… \n. \n\n
\n \b\t\t \t\n\t \n ƒ
­\n‚: „\n \b\t\t ƒ …
\t\b\n \t  1,3% 
\n
\n 
1% ­ ­ \n ­ ƒ
  \r.
\t \t ‡\t\n\t
\r ­  
… \t\b\n ­
\t \n \fƒ\t \n‚ ­
\n
\n† 
\n. \n  \f \t\t
\t… ­‚\t\n ­ \n„\n \t\n
\t \n  \n
21% ­
\n\n†
\n \n\t\f \n\t\n €\t‚
­\n\t \n\t ­
 \b\n Š.
 † ‡\t\n ­ \t
\n\f \t \f
­\n\t 
\t \n
\t ­\t \n ­\f 
 \t\t ­ ­\t  Š
\t
3,0. \f \t\t‚   
\n \t \t\f†\t 
\f€\t\n
\n \n„\n ‡\t\n\t Š
­ ­\t  Š \n„ 2,0. 
„
\n†, \t\t\b\n \n\b\t \n  
­\n\t \t \fƒ\t­\t\b
\f\n Š, \b\t \f‚\t \n
\t\n\t ­ ­ \t\b
 \t­.
 \n„\n\t ­\n \t­
Š (\n\f \n \n­\n\t,
\f†€ „ \f\b\n-\b\n‚
\t\b\n, \t\f\t\t „\n\t
\f \n \n\t  Š, \b\t‚ ­
\n, \n) ­­\t ‚ƒ
 \t \r ƒ ƒ\n \r
 ­ .  \n \b\t
\n ­
\n\n† 
\n\t­ \r
\f \b\t \t\n\t \n‚  
\t\b\n \n
50% ­ \nƒ  ƒ
†\t\n 
– 2%. 
\n\t€ 
\n (\rš)  \n\b ­ 
\n ƒ\t\n 
 150
 
\n   \t\b\n ­ 
\t \n\f \t ­ \n\t\b 
\f
  ­­\t\n‚…  \n
\b\t  \t\n\t‚ 
\n\f ­  \t  ‡
\t\n\t \b„\n ­ \n\t
\f\t\t –  † \f 
­, \n \fƒ\t \n
­\f€\t \n ­ƒ ­
 \t žˆ \n ‚ \n. ’„
\n ­ \f\b\n \t \t ­ ‚ \b
„\n \t\n\t\t\n ‚\t
\t‚\t  \n \n ­ ­\t
\n\n‚… \n\f \t….
  ­\n\t 
, \f
\t‚… \n
\n \t
­\t\b ­\f  
€† \n (Š 2,0–3,0) 
 \b \n\f \t ƒ ’ˆ, \n\t
\fƒ\t \n‚… \t \t, \b\t \f 
\b\n  Š ƒ ƒ \n
\tƒ\t\n‚… \n\t\n\t ­
„\t ­\t\t\t ­\t\n‚ ƒ
\f \n‚ \n\f\n. Š\n \t
\t\t „\t \f€\t\n\n \f \b\t
 \t\b\n.
2.3. 
’ˆ’Š Š’ˆŽ‰\r‘
’‰ˆ‘
\n
  ­\n\t 
\b \n
\f \t   ’ˆ 
\n ƒ ­\t\n\n  \n
\f\t \n\t\f \n\t\n \t­
­€† \n\t\n\t \t\n
;   Š 2,5; \n‚ \t
­\t\b ­\n \t †\t
\n\t, †€ ­\t­
\n 
­\f Š, \n\f
\t \n\t­ \r.
ƒ\n  ­  
\r
\f \b\t  \t\b\n
\f\n, \t\b ­ \b
\n \n, 
­‡\t\f \n 
\n\f\t ­\n\t, †€
 
\t\b\n ­\t
­\n 
­\f \n.
  ­\n\t 
, \t‚ \nƒ
… \n\n ­‚\t \t
­† Š (­\t 
­
), \nƒ… \f€\t \t
\t­† \n \f \n‚ 
\n\t \b \r
\r  
ˆ\n\f \t   \t\n ‡ƒ 
­ \n
 „\n\n\n ˆ †\t
 \n\b\t, \n
 \f\b… ˆ,  „\n
… \tƒ  „ \f\b,
\t\b†\t \f
12% ­\n\t. Ž\t\t
\tƒƒ\n ‚ ­ \n\t
­\n \t\n (­
\n\n† 
­
„\n \n„\n \t\n) 
„\t \t
\t 20%  ­\n\t 
­\n-…\f\b\n‚ ˆ. \t
\n\t ‡ƒ  \nƒ  ‚ 
\t\b
\n ­ \t\n \n
\tƒ – 
­‚ 1–3
, …\t
 ‡ƒ  \t\t \f€\t\n\n‚
„ ­  \n\b\n \t ‚ ˆ
­ …\n†€ \f\n 
, \b\n \n\t\t\b\n\t  
. \r
 † ­ \t ­\t\n
\b \n\f \t 
\n\n‚…
 „\n\n \f
­\n\t 
\t‚ ˆ
\n\f\t \n\n\n ­ 
\n \r 
Š.
\n
\n\t 
\b \n
\f \t   ’ˆ, 
\n \t ˆ,  „\n\n\n
\tƒ  „ \f\b, 
\n\n 
­€† ‡…
   \f… ­ƒ
\f , \nƒ… \b\t
Š 
 ‚ \f\n Š 2,5
(2,0–3,0) 
\t\b\n \n \n 3
\r \r \t 
\t \t
\n\t\tƒ\t\b \t­ „\t
\f\n\t, \n
\n  †\b\t \t
\n\t \t ­\t\n \n\f 
\t 
\t\n‚… \tƒ‡ƒ \b…
 „\n\n \f
­\n\t 
 ­\n\n‚
­„\n .  
…  \f
\b… ­\n\n \n\t\tƒ\t\b
\t­,  \tƒ‡ƒ  ­
\t \n \t\n 
­\t\n
\n‚…  ­\n…  „\n \t
 \t\n\n‚… \t\b\n.
\r\f\r
 \n\t\b\n\r
\f
’ˆŽ‰\rˆ‰
‰Š‰™ˆˆ
 \f \b\t\t 
­ \t \t
ƒ‡ƒ \b… ƒ‚\t ­‚†\t
 \n‚ 
\t \n‚ \t
\t \b  „\n\n, ­
\t\b \t \n \t\n
­\t\n\n‚…  ­\n…  
\n\f\t \n\t\f \n\t\n \t­,
ƒ\n\n 
 \f\b… \b\t\n 
„  \t \n  \t ­\t­
\n 
\t­ Š.
\n
  ­\n\t 
\b \n
\f \t   ’ˆ, †€… 
\t\b \t \n‚ \t\n 
, \t 
ƒ \t, \n\f
\t  \b\n \t­ 
\n 
 ‚ \f\n Š 2,5
’ƒ\t\n‚ \n\t\n\t‚ 
\n\n ­\t \n  \f\t 
ƒ \t 
\n\f - ‚
 \b…  „\n\n.
\n\t 
…\n\b ­
\t\n\n‚  ­\n 
\n\f\t \b\n 
\n 
 ‚ \f\n Š 3,0
\n\t 
…\n\b ­
\t\n\n‚  ­\n, ­
\n ­\t\n‚ \n\f \t  
’ˆ \n
\n \t\n ­
\f  \n, 
… 
\b\n \n\f\t ƒ\t \r
/\f\t,   \t\f\t\t\f†\t
\f\n \n
­‚\n\n‚  
\t\b\n (\n\n‚ \n\n, \f
\t‚ \n  
\t.
  ­\n\t 
ƒ­\t\n
\n‚  ­\n ­ \t\f\t\t
\f… \t\b\n \tƒ‡ƒ 
\b…  „\n\n \n\f\t
 \t­ \n 
 ‚
\r
ƒ \t \n \f
10% ­\n\t
\b \n\f \t †\t \n
\f\n \t\t  „ \f\b
\n„\n  ‚ƒ Ÿ 30%.
Š\n 
­‚… \n\n\n‚… 
 \n, ­€\n\n \n\t 
\n \n ‡\t\n\t \n,
\r 
 ­  (WATCH) \f
ƒ \n‚…
\b\n \n\t\t\b\n\t† \n ‚
 ­\f€\t - ƒ ­­\t
\t\n\n ­ \t \n\f \t.
\n\t€  ­ „†\t  
\n ­
\n\t \n ‡\t
\n\t \n (Š 2,5–3,0) 
\r
/\f\t) 
\t\n\n \f\n
\n\b\n \t\b,  †\b \t 
\f \t (\b 
\b)
 ­\n\t 
\n  ‚
ƒ ƒ  
 ­\n\n ­\t .
\n
 ­\n\t 
\n\f \t   ’ˆ
\n\f‚ \t 

­\t ( ‚ƒ 
„ \f\b Ÿ 30%) ­\f€\t\n
\n ­  \b\n \n
\n \f\t\n \n.
\n (Š 2,0–3,0), \r,
 ­ , ƒ\n \r
 2
 
\n) 
­
2.3. 
’ˆ’Š Š’ˆŽ‰\r‘
’‰ˆ‘
   \n\n ‚ƒ„
\n (200
 2
 
\n) \f\t
ƒ‚\t \n‚ ­
‡\t\n\t
\t\b\n ­ \t \f
\n\t 
­\t.
 \f  \n ­\t ,
\f†€ 
‡ƒ \b
 „\n\n,  †\b  \n\n
­„\n \t \n  ­\n, ­
­ \t \n  ­\n,  
† \t \n  , \n\n\n‚
‡\n\t, \t\f \f \t‚, \n
\f „­\n ­,
\t‚\t  \n \n 
\t.
., \t
‚ƒ  †\t \tƒ\t\n‚ \n\t
\n\t‚. ƒ\t \n‚… \t \t
­\f€\t\n\n ­ ‚ \t
\n Š ­ ­\b \n\n‚… \n\f\n…
\n\t€  \n ­ \f\b\n.  
 \n ­ „†\t.
2.3.2. \r  \r \r
\r\b \n 
\n (\r\r \t,
\n\r\t, \r\t \b)
\r\t \t
 \f \t\t \n\b \n\n‚…  
\n \f\t\n \n, \b\t \n\t\tƒ
\t\n‚ ­­\t‚ ­ƒ\n‚ \n„\t
 ­\t\n \n‡ƒ \b
\n\f \t. \f \t\t‚ \t\n  \n
\n‚… \n\n\n‚…  \n,
\n… \n\t
\n\t\n\f† \t­†
­ ƒ \f
­\n\t, ­\n
… \n\f \t   ’ˆ, ­ , \b\t \n\t
\n\t\n \t­ ­\t 
\n„\n†
\t\n\t \n  \t \n\t 
\n \n\f \t \n
28% 
\n„\n† 
\t \n \n\f \t \n

\t\n\t 
\nƒ  \f\b\n\n‚ \n
\t\tƒ\t\n‚ \t, ­ \f
‚ 
\t\b\n ­ \t \n
‡ƒ \b \n\f \t.  \r
\n„\t  \f\t‚… ƒ‚\t 
 ­\n \t­\t\b 
 (50–1300
 
\f\t), …\t ‚
‚ (ƒ  150
) \f \b†\t 
­ƒ\b\n‚…  \n (\n\n ­„\n
„ \f\b\n-\b\n \t\t, \t\b
\n).  †\t, \b\t, \t\n, \n 
ƒ\n 
\b\t  \t \n ƒ\n
\t­ ­ \t  \r
‚ 150
, \t  ‡\t \n ­\n\t 
­ \n\t \n ­ ‚, 
 
\b…  „\n\n „\t \f \b\t.
­\n\n ­\t    \t \n
\f \n ­ ­\t \n 
 \r „\t \b\t\t 75–150
,
\t \b  
­ \n \n\n
\t\n\n  
ƒ \n 
 \n (\n
\r\b\n

ƒ  \b 30
\t
\n†† \t† \f\b\n 
\t\b\n
­ \t \n‡ƒ \b
\n\f \t \n ­\n\t 
 ­\f€\t ­ \r,  ­
­ \n  
ƒ‚\t‚, \t
 \n\n‚ ‚ƒ„\n ().
Š\n ­ \n­\n\t \r 
­  400
 
\f\t „\t
\t \n\n\n \n.
\n\b
\n  
\n
\n\n‚… ­‚\t\n… ­\n\t, ­
\n… \b \n\f \t   ’ˆ.
\r\f\r
 \n\t\b\n\r
\f
’ˆŽ‰\rˆ‰
‰Š‰™ˆˆ
\n\n† 
­ ƒ \t ­\n
 250
 „‚ 
\n ­
\n„\n† \t\n\t \n  ­
\t\n \n\f \t. 
\n\n† 
\r
­\n\n \t ­\n \f
­\n\t
\n\n ­\n\n\n‚  ‚ \n\f 
\t   
\n„\n \t\n
\t \n  \n\n\n \n\f \t
\n
­\t„\n 3
\t\n \nƒ †\n
21%, 
\t„ 
­ \n\t \n‚ \n
„\n  \n\t\f­ \n \n\b\n‚…
ƒ‚\t (\n\f \t, ˆ, \t, ƒ\f 
\n\n \f\t ­\t ) \n
9%. ˆ,
\n\n, 
\t\t  \n,  †
\b ƒ \n‚…, \n\n ­\n…
\n‡ƒ \b \b \n
\f \t 
­ \f\b… \t ­\n   \r,
\n ƒ‚  ‚ \n  \b ­
\f \n
\t\f­ \n ƒ\n ƒ‚\t (\n\f \t,
ˆ, \t - \f\t ­\t )
­\t„\n 2
\t.
\n\b\r\n
\f\b  
  \n\b
…  \n, ­€\n\n‚… \t
\b\n ­ \t \r\r. 
\f­\n
\n\n\t  \n CAPRIE
(1996) \f
­\n\t 
\t ‚
  \r\r  ­ ƒ‚ ƒ 
‡\t\n, \b \r, 
\f\n\n
ƒ\n\n\n \t\n\t \n 
 \b \n\f \t, ˆ 
\f
\t \t \n
8,7%. Ž\t\t \t
\f\t‚…  „\n\n \t  5,3%
 ­\n\t, ­ \f\b…  ­
 , 
\n\n 
5,8%  ­\n
\t, ­ \f\b… \r (p=0,043). Š\n
ƒ \n‚… 
\n\f \t 
\n\n  
\n  ­  ƒ‚  \n \t  \fƒ
\t \n‚: \b\t\t ­\t\n \n\b\n
\t\b \t  7,2% ­
\n\n†
7,7% 
\f­­ \r (p=0,26). 
ƒ \n‚…
ˆ ­ \b\n  ­  \b\t\t
­\t\n‚…  „\n\n \t  5,0%,
­ \b\n \r – 4,8%. ˆ
\t 
­\f­­ ƒ \n‚… 
­\b
\t  \b\n  ­ 
\n\n† 
\r ­„  
­ \n\t \n‚ \n„\n \t\n\t 
\n  \b\n-\f\t‚…  „
\n\n \n
23,8%. Ž\t\t … ­ƒ\b\n‚…
 \n ­ ­  ­  \n
­‚  \t‚ ­ \b\n \r.
 ‡\t \n„ \t \n‚  \n 
\t
\n‚ „ \f\b\n-\b\n \t\t \n
ƒ †  \b€ ­ ­ \r; „
\n‚ ‚‚­\n 
– ­ \b\n
 ­ .
 \n\n \n ­ \tƒ
\t\n‚… \n\t\n\t, \n… 
­\n\n 
\t\b\t\n\n \n,
\b­‚\t ‚­\b \n\n‚
\t. Š\n 
 ­\t
­\b\n ­­\t \n\b\t \n .
­‚\t ­ \n‚… \n\t\tƒ
\t\n‚… ­­\t ƒ\f  \n‚ \t
\n \n\b\n\n\t† ‡\t\n\t
†€… \t. 
  \f\b ‡\t
\n 
\t \n\n,  «
\t\n\t\n\t», ­ \t ­\n†\t,
\n \t\n‚, \n­ƒ\n\t ­
­\t ­\t\t\t \tƒ\t\b
‡­, 
\f
– \n\t\t\b\n ­
 \n \f\n \tƒ\t \n
­ \n\t\n\t ­
\f \t\t
 \b\n‚… ƒ\t\n‚… \t\t.
 \n\t€ \n\t \t\n \n 
\n\t\tƒ\t\n‚… ­­\t, ­
2.3. 
’ˆ’Š Š’ˆŽ‰\r‘
’‰ˆ‘
…… ­‚\t\n 
… \t\b
\n ­ \t \n\f \t: \t \f ,
 \t , ­\f , \t  

­ \t. 
\n \n\t \n 
 \n \n ƒ‚  ­ \f\b\n -
ƒ ­\f€\t ­ \r.
\t 
 \n \t\n‚.
\f ­­\t\n‚ \n­ \n
\n\t\tƒ\t\n \t­  \t
ƒ\n\n\n ­ \n \f…
  \t… … \f\b\n\n‚… ­­\t.
   
­‚ ƒ‚  \f\b\n 
 
\n CURE,  †\b 12562
ƒ 
\n‚…, ­\n… \n-Q-ƒ\f†€
 ­ \n
. (
– 9
.) ƒ   
\t­
\r ­ \t \n\n \n
(Š\r) ƒ \t ­œ \n\t
ST \n
ž.
‡\t\t  \f\n‚ 
\t \t
\b\n-\f\t‚…  „
\n\n, \n\t \n ˆ 
\n\f \t
\n ƒ\n\n\n \n\t\t
ƒ\t\n \t­ \t\n \f\n
  \n
20%. \r\f€\t\n\n \n
\n \b\t\t‚ \n\f \t \n ­ , …\t
­ \f\b…  ­ \n \t\b
 \n  „ (1,2% 
\f­­  
­  
1,4% 
\f­­ ­ ƒ).
\n\n \n ƒ\n\n
\n ­ \n \r 
 ­\n  ƒ \n‚ 
Š\r, 
­œ, \t 
ƒ ­œ \n
\t ST,  \t \n\t† \n \n 4
\n 
„ 
 ­ \t\f\t\t ­‚
\n\n  \t\b\n.
Š\t \n\f† ­† \n\t ƒ\n
\n\n \n\t\tƒ\t\n \t­
­ \t \b\n-\f\t‚…
 „\n\n ­  \n\n ‚­ \n\n
\n \n\n   \t\n \t\n
\t\n.   \t\n †\n \n
ƒ \n\n \n­ \t 
\t\n\t
\n \n\n‚… \t  ­
 
\b\t\n 
\r \n\f\t
­ \t 
, ­ \n \b
\n \t \t \n
\t\n‚… \t
ƒ  \b  \n\b… 
­‚\t\n ­€\n \f\b\n† ‡
\t\n\t ƒ\n\n\n \n\t\t
ƒ\t\n \t­ ­ \tƒ \n‚…
­ \n… \t\tƒ. 
 \n CHARISMA,  †\b
­\n\t 
‚  
\f \n‚… ƒ \n, ƒ\n
\n\n \t­  ­  
\r
\n ƒ\n\f„   ­\f€\t
­ \n\t­ \r. 
… \f…
\t\n \nƒ †\n \b\t\t \n‚…
\b\n-\f\t‚… ƒ‚\t \t
 6,8%   ƒ\n\n\n \t­
7,3%   \n\t­ \r.
’ \n
\n, 
­\f­­ ƒ \n‚… 
\t\f†€ \b \n\f \t 
ƒ\n\n\n \b\n ­„ 
\f\n\n \t\n\t \n  ­
\t\n \n\f \t \n
22% 
\nƒ 
\f \b\n \f\n\n‚… \t\b\n:
­\t 1,3%  \f\b.
  \n MATCH \n  ‡
\t\n\t ƒ\n \r 
  ­
\n\n† 
\n\t­
  ­  \f
7599
­\n\t,
­\n… 
­\t\f†€ 3
 \n‡ƒ \b \n\f \t  
\r\f\r
 \n\t\b\n\r
\f
’ˆŽ‰\rˆ‰
‰Š‰™ˆˆ
  2,5
\t\n \nƒ †\n \n
ƒ‚  \t\b\n \t\n  \b
„\f \f­­ ­
\b\t\t ˆ, 
\b \n\f \t, \t \t
\f\t‚…
­\b\n.  \t, 
\f­­ ƒ\n
\n\n \t­ \t\n
\f \b\n  \f\b „\n\f„†€…
\t\b\n: 2,6% ­\t 1,3% 
\f­
­ \n\t­. ’ ƒ, \t\f\t
\t ­ ‚ \t
 \t \n ­ \r
\b\t\n 
 ­  \n\f
\f \b\n  \b…
 „\n\n \n\b\t ­\n\n
ƒ\n  ­  
\r 
\f
\t\n\n ­\t 
 †\b\n Š\r
\n\n \f\t (\n\n
  \t\n) \t\n\t\n.
   
\n \f .
\n 
\n‚…  \n \b\n ­
  ƒ‚\t ‚ƒ„\n
(\t
 
\f\t) 
\b\t\n
\r (\t
 
\f\t) \n ­
  ­\f€\t ­ \n\t
­ \r, \n
­„  …\f
­\n\t†. ­\t, 
­‚\t
\n… ESPS2
ESPRIT ‡\t\n\t 
ƒ\n\n\n \t­ ­ 
 (400
 
\f\t) 
\b\t\n 
\r
 
\f\t) ƒ‚  \t\n ‚,
\b \n\t­ \r (50
 
\f\t).
 \n ESPS2
ƒ\n\n
\n \b\n ­ \n\n 
­„  \n„\n  ­
\t\n \n\f \t \n
37%, 

\n\n 
\r (75
 
\f\t)
– \n
Ž\t\t \b…  „\n\n
ƒ‚  \n 
… \f­­….   
\t, ­
\n\n‚ \t\n  ‡\t… 
 \n, \t\n\t \n‚  
ƒ\n\n\n \n\b\n \t\b,  †
\b \n\f \t, ˆ 
\t \t
\f\t‚…
ƒ‚\t, \t„ ƒ‚ \t\n \n„
\f­­… ƒ\n\n\n \t­,
\n\t \n
\f€\t\f†€ ­\n,
\b\t \f
«\n\n‚…» ­\n\t 

\t  \t \n \t† ­
„\t ‚‚\t «\n ƒ‚
\n», ƒ\f  \n\n‚  \n
\t\f†€ \t.
   
\b\r\b\n
\f  \r \n\b\r\n.

\n PRoFESS ­  \n\n
‡\t\n\t ƒ\n \r 
­   ­\t \n\t­
 ­  
\t\n\n 
\b\n-\f\t‚…  „\n\n \f
\n\t, ­\n… \n‡ƒ \b
 \n\f \t   ’ˆ. 
… 2,4
\t\n
\nƒ †\n ­\t\n‚ \n\f \t 
  
\f\b‚… \f­­… 
\n
\b\t\t (  9% ­\n\t). ’
„
 „\n \t 
\t\n\n 
ƒ\n \n\f \t, ˆ 
\t, 
\t\n\n‚… \f
13% ­\n\t 
… \f­­…. 
\f­­ ƒ\n\n\n
\t­ ƒ‚  \t\b\n ƒ  ‚
\b\t\t \b…  „\n\n,
…\t ƒ€ \b  \t… ­\n\t ƒ‚ 
\n\n\b\t \n‚, 
\t„ \f
6% ƒ \n‚…
\t\b  ‚„\n\n‚  \n‚ ƒ ,
­\tƒ \t\n‚ ­­\t.
\t \r 
 \n\n \n \r  \t
\n ­ \t \t 
2.3. 
’ˆ’Š Š’ˆŽ‰\r‘
’‰ˆ‘
\n \tƒ \f
­\n\t 
\b \n\f \t, ’ˆ 
 \n  \r ­ ‡\t \t \t
/\f\t. 
\b\t  \t\n
\t‚ „\n \n\n\b\n  ­
    \t ­\n. ’ ­\n
\n \f\t\f­\t (
„\n 
­„\t)
\r 
­ \t ­\t\n \n
\f \t, \n
\n„ \t \n‚ ‡\t‚
 \tƒ\t­\n\b ­\f­\f
‚ 
„ \f\b\n-\b\n‚… \t\t
\n\b†\t  ­ \n 
\f
\t\n\n ­\t.  ­ …
 ­\n\t, \t ­\f€\t
­ \r ­ \f \t \n \t
 , …\n ƒ\t,  \t
 \n\n‚ ­ \n­\n\t
\r ( , \t\n\t\t\n \n‚
\t\t), \n
\t
„  \n
 \f€\t\n\n‚… ­\f€\t
­ \t ­\t\n \n\f \t
ˆ \n, \n†€
 ­ 
­ ƒ, \t\f\t\t\f†\t.
ƒ\n \r 
­ 
 ­
\n\n† 
\r ƒ  ‡
\t\n ­  \b \n
‡ƒ \b \n\f \t, \t 
„\t ­\t\t\t ­ \n\t \n
\n \b\n-\f\t  „\n\n
\n
100
­ \b\n\n‚… ­\n\t 
,
\n ­ƒ\b\n‚ ‡\t‚ \t
\b\n
­  ( \n‚ ƒ ,  
\f„\n) \n  †\t ­\b
\n \t \t
\t \b\n.
\n \n ƒ\n \r   
­  „\t \t ­ \n\n‚
­\f€\t ­ \n\tƒ \n‚… ­
 \n… \t\tƒ, \t
\t \f
\n\t 
‚ \t\n\t† ­\t
\n‚… \t\tƒ\t\b…  „\n\n,
­‚†€  \t\b\n. \r
\b\t\n  ­  
\r ­­\b\t
\t \n \f
ƒ \n‚… 
\t‚ \n\n‚
\n, ˆ   \n\n \n
\n‚ ƒ \t\n‚ \t\n\t\n,
\t­\b\n‚… \t\f… \n \n\f
\t - ­‚\n\n  
\b…  „\n\n. \f \n\t‚
ƒ\n\n\n \t­ \n…\t
\t \f\b\n.
 \t \t
 
\n  \n, ­€\n
\n ­ \t ­\t\n‚… \n\f
\n  ƒ€\n
­\n\t 
\n‡ƒ \b
\n\f \t,  †\b \n\f \t, ‚\n
\n‚ \t\n \f­\n‚… ‡\t\n
 \n‚…  \n\t\n \n‚… \t,
\f\n\n‚ 
­\t\n\n‚ \n\f \t,
\n ­\n\t\n ­\f€\t
\n ­ \r.
   \t, 
 \n (SPIRIT, WASID) ­\n
ƒ„\n ƒ­\n\t 
\f \b\n \b… ƒ‚
\t \n
\n ­ \n \n\t\f
\n\t\n \t­.
\r
  ­\n\t 
\n‡ƒ 
\b \n\f \t   ’ˆ ­ 
\n \tƒ\t\n‚… \n\t
\n\t ­­\b\t\t \n, \b Š,
\n\f\t   \n„\n 
 ­\t\n \n\f \t 
\f…
\b\n-\f\t‚…  „\n\n.
\r\f\r
 \n\t\b\n\r
\f
’ˆŽ‰\rˆ‰
‰Š‰™ˆˆ
\r (75–150
/\n), ƒ\n
 \r 25
 
­  
200
 „‚ 
\n 
 ­
75
/\n \n ­ ‚
  ­\n\b \n \t­. 
\n­\n\t \r \n\f\t
 ­   ­ .
‚ƒ ­­\t  „\n ƒ‚\t \f
€\t \n \n\f \n 
\f\b\t
­\f\t\t\f†€… \t ,
\n‚, ­\n\t 
\f…  
\n\b… …\t\t.
ƒ \n \r 
 ­ \f
\f \b\t  \b…
 „\n\n 
ƒ‚\b\n ­\t
  \t\b\n ­ \t \n
\f \t \n \n\f\t.
ƒ\n\n\n ­ \n
\r (75–325
) 
 (75
) ­\n  ƒ \n‚
\t‚ \n\n‚ \n,
 
­œ, \t 
ƒ ­œ
\n\t ST,  \t \n\t† \b
\n 
\n  
„ 

­ \t\f\t\t ­‚\n\n 
\t\b\n, 
\t„ ­  \t\n
†\n \n ƒ \n\n \n­ 
\t 
\t\n\t\n \n
\n‚… \t  \t \n\t† \b\n
, ­ \n \b\n 
\t \t \n
\t\n‚… \t…
  ­\n\t, ­\n… ­\t
\n‚ \n\f \t \n
\n ­ \r,
\n\t \t \t ­ ‚ \f \b\n
 \r   \n‚ \n
\f
 \tƒ\t\n‚ \n\t\n\t
ƒ \n ƒ\n† \f… \t.
2.4. ‡‹‡‰Š …‡
 \t \b \t
ƒ \n  
­… \t\n 
 \n  †\t \b\t \f\t\n \n\n‚
\t  ­\t\n \n\f \t,
\b\t \t„\t ­\n­ \n‚  
\b „\f ­\t\n \n\n
ƒ\f \n ­\t . ˆ \r
­\t \t ƒ \n\t\n 
ƒ \n, ƒ\f  \n\n \n\n‚
\t , \t  \b
\n\f \t \t\n\n. ‡\t\f \n„\n
 ­\t\n \n\f \t ­ \b\n
­ ­\b ­­\t
\t\t\b „\n „\t, 
\f† \b, ­ \n\f \t, 
\n\n 
\t\n‚ \t .
\n\n… \f\t… ­ 
\b \n\f \t \n\n\b\n \t\t\n
\n   \tƒ\n\n‚
­\n\t 
­‚\n\n‚ \f\n •\r,
­\f\t\t\f†€ ˆ \r 
\f  \n
\b ­ \n \t 
 † \f\n\t  \n \t  ­
\t\n‚… ƒ\f \n‚… ƒ‚\t,
… \f\t‚…  „\n\n.
 2006 \f   ­ ƒ \n
\t \f  \n SPARCL,
\n\n  † \t   \f\b
\n  ­\t\n \n\f \t \n
\b\n \t\t\n 
\n \n
„\n \f\n •\r. 
\t\b\n 4,9
\t ­
\nƒ †\n \n…  4730
\t, ­\n… \n‡ƒ \b
\n\f \t   ’ˆ 
\n \t… ˆ \r.
 \n\t\tƒ\t\b, \n\t
­\t\n\n \t­ ƒ \n‚ ­ \f\b
 \t\t\t\n (
 80
 
\f\t)
2.4. 
ˆŠˆˆ‰ˆŽ‰\r‘
’‰ˆ‘
ƒ ­ ƒ.   †\b\n 
 \n \f\n •\r ­­\t\n
\n ­ \t\n\t \f \f\b\t\n 
 \t
/ . 
\n\f ­
 \nƒ †\n \f\n •\r ­­\t
\n \n ­ \t\n\t \n  \n
\f­­ \t\t\n 
– 
\f­­
­ ƒ. 
\f \t\t, 
\f­­ \t
\n \b\n \t\t\t\b \n\b
16%) \n  \b\t\t ­\b\n
\n\b\n \t\b
– ­\t\n \n\f \t.
 \t, 
\f­­ \t\t\t\n ƒ‚ 
\t\n \n„ \b\t\t \b,
\t \n 
\n\t \n \n\f \t.
’„ \n
\n ­ \t\t\t\n
35% \n  \b\t\t \n\n‚… 
\n\n‚… ƒ‚\t. \t 
\t 
\f­
­ \t\t\n \t\b\n \f \b\n 
\b… \n\f \t (

\n\n† 
­ ƒ). ž\t \f \b
\n  \nƒ †  ­\f€\t\n
\n \f
ƒ \n‚… \t \t, \n
­\n… \b \n\f \t,
\t… .
„\n ­\b\n\f\t, \b\t
 \b…  „\n\n \n
 \n
\t
…\n \f\n ƒ€
•\r 
•\r ­­\t\n \n ­ \t\n
\t, \n
\t
\t\n\f\t‚… \n\b\n 
 \b\n. ‰\n\b\n‚  \f\b ƒ
  \t  
…\n
\b\t\t 
\f­­ \b\n 
‚\n ­\b\n\b\n‚… \n\t\n
 ­ \t­ \t\t\t\n \nƒ †
  \f
2,2% ƒ \n‚….
\n\n‚, ­ \f\b\n\n‚ 
 \n
SPARCL, ­ †\t \t\t \n
‡ƒ \b \b \n\f \t
 \t\t \n ­\n 
\n\b\n† \t\t\n 
 † ­ 
\t ­\t\n \n\f \t 
ˆ… 
‡\t, \t­†
\t\t\n \nƒ… \n\t
ƒ \n\t\f ƒ \n‚…, ­\n…
\b \n\f \t. \r \f\t \f\b\t
€ 
\t, \b\t \f
\n… ­\n\t \n\n
\t \t \n\n ­\t 
, …\n‚ ƒ\t, \f \f†\t
­\n \t , 
\t\n
 \t \n‚… \b\n-\f\t‚…
 „\n\n ­
  SCORE ­‚\t
5%, \b\t ­\f\t \n \n
\n\b\n ­ ­\b \t­.
   \t, ­‚\n\n‚ \f\n •\r \n
  \f\t \b\t\t ƒ\t \n‚
­\t   \n\n\b\n ­ ­
\b \t­. „\n ­­
„\t, \b\t ­ \n„\n \f\n
•\r ­  \t
\t­ \t\t\n ­
\t \n„\t\n\n\t† … \t:
\f \f\b\n ‡\n\t  \n \f\n
, \f\n\n‚ \n\t­\t\n\n‚
\n\t\n\t\n‚ ‡\t. 
\t 
\b \t
\n\n ƒ \n  ­
\b \n\f \t  ‚ \f
\n ­  € \n ­ \n‚,
\n\n \n ­
\t
\b\n ­ \t ˆ \r 
\f \t\t
 \n SPARCL  ƒ\n
\t„\n  \f†€… \n\b\n 
­ : ƒ€ •\r 4,0
 / ,
•\r ­­\t\n \n ­ \t\n
\t 2,5 (
„ 2,0)  / ,
•\r ­­\t\n ‚ ­ \t
\n\t � 1,0
 / (  \f„\b\n)
 / (  „\n€\n), \t 
 / .
\r\f\r
 \n\t\b\n\r
\f
’ˆŽ‰\rˆ‰
‰Š‰™ˆˆ
\n
\b\n \t\t\n 
\n\t\n\n‚
­\n„†€ ‡\t 
\n\f\t   \f\n\n 
\n\f \t 
\b\n-\f\t‚…
 „\n\n \f
­\n\t 
\b \n\f \t   ’ˆ 
\n\n‚ \t ,
­‚\n \f\n •\r ­­
\t\n \n ­ \t\n\t ‚
 / „ ­ \t\f\t\t 
\n\n ­\t .
\n\t 
\t\tƒ\t\b
\n\f \t ƒ \f\t\n \n\n ˆ \r
  \t„\n  \n
­\t\t\n ‡\t \nƒ…
\n„\n •\r ­­\t\n \n
 ­ \t\n\t \n
50% 
 / .
\n\t 
\b \n\f 
\t   ’ˆ 
†€… ˆ \r \nƒ
… \t 
\t\t\t 

 \b \n,
\t‚  †\b†\t †
ƒ „\n, ­… \t\n\f†
\t\f 
\n\t\n \b\n.
\n\t 
\n \f\n •\r
­­\t\n ‚ ­ \t\n\t
„\t ƒ‚\t ­ \n‚ \b\n \n
\n ƒ ƒ .
2.5. …Œ…ˆŽ ‡ 
…Ž‘, ‡€ˆŠŽ‘
…‹’Ž‘ …‘
 \n\t€  ­
\f \t\t \t¡…
\n\n‚… ­­\t\n‚… \n
2.5. 
‰Š\r’’ˆ”‰
Š‰™ˆˆ
 Š’ˆ”•
,
ŠŠŠŽ”•
ˆ ˆ’ˆ“”•
’‰ˆ‘•
­\n ‡\n\t‡\t 
\n .  ‡\t ­\n, \b\t \n
ƒ  ­  \t\b  \f
\f„\b\n
¢ 75
\t, 
­\n\t\n ‡\t\n\t
­ ƒ‚\t \n„  
\f \b
\n \t\b.
  \n\n \n­ \t 
\t\n\t
\n \t\n‚… \t  \t
 \t\n\t \t\n ‡\n\t
‡\t 
\b\n ­\n\t  
­\t\n‚ ‡\t\n \n‚ \t\n
\n\f\t\n\n \n\n \t 
 †
­ \t ­\t\n \n\f \t. 
\t„\n ‡\n\f \n‚… \t…\n ,
 †\b ‡ƒ ­\t† 
\n‚ 
  \t\n\t, \t  \n
\t\n† \t…\n \t\n\t\n 
\f \f\b\n†
­ ­\n\n‚… …
. \n \n\n\t, \t\f\t\t
­ ­\n\n \t
­\n\t, \t ­ ­\n
\n‚ ­   ­\b\n 
 ­\t\n\n \n\n \t
\b\n 
 \n\b ­\t. ’
\n \n, 
 \n\n\n‚…
­­\t\n‚… \n\t \n‚…  
\n (EVA-3S, SPACE, ICSS, CREST)
­\n\t\n, \b\t ­\f
\t\n\t\n ­„\n 
ƒ  ‚
 \b\t\t \n\n… ­\t­\f
 \n‚… \n\f \t   ’ˆ (­‚
30
\n) ­
\n\n† 
\t\n
‡\n\t‡\t (5,5% ­\t 3,2%
ƒ \n‚… 
 \n CREST). 
­\t, ­ ‚­ \n\n \t‚\t‚… ­
 ƒ‚  ‚ \b\t\t ˆ (2,3%
­\t 1,0% ƒ \n‚…, CREST).  ‚ 
\t„ ­\n, \b\t   ­\n\t 
„ 70
\t \t\n\t\n ­
\t\n\t „\t \t ­\f€\t,
\t    ƒ \n‚… 70
\t 
\t
 \t\n ‡\n\t‡\t ƒ‚ 
­­\b\t\t \n.
 \n\t€ \n\t \t\n\t\n 
\t \t ‚ƒ ­ \n \b
‚ …\f\b . ‚
  \b\t\t ­ \n \b \f
\n\t \t„ ‚… ƒ\n‚… \t\n:
…\n\b \b\n \n\t\t\b\n\t
  \t\n
III/IV \f\n\n \n‚…
 , ­„\n \n\n \t 
 \n\n \t, \f…\f
\t 
ƒ  ­„\n \n\n
\f , \n„\n  ‚ƒ 
 „ \f\b \n„ 30%, \n\n ˆ,
\t„  \b\n   ­\b\b\n ­\t 
. ‚\n\n‚  \t„ ­ 
†\t \t \t…\n\b   \n\t\b
\t‚,  ­\t\f†€ ‚­
\n\n ­ \n
, ƒ \f\b\n 
\b\n‚… ƒ \t , ­\t‡\n\t‡\t
\b \t\n, \n\t
\t\t \n
\t\n  †, \n„\n\t
…\f\b \t\f­, \t…\t.
 \t, \t\n\t\n ­ \f†\t
­\b…  \f\b…, \n­, ­
\t \n , ƒ\f\f
\n ­ , \t\t ’\f.
•\f\b \n ‡\t-
\n\t\n \n‚… \f\t‚… \n\t
 \f
­\n\t 
 † \n\n‚…
\t ­ \n ­\n\t 
…- ƒ ­\f€\t ­
\n\n†
\n\t\n \n\t\n \t
\t. Š\n 
\n\t€  ­
 „\t \f\b\n ­ \n\t \n‚…
\r\f\r
 \n\t\b\n\r
\f
’ˆŽ‰\rˆ‰
‰Š‰™ˆˆ
 ­‚\n\n  ­\t
\n‚… ƒ \n‚…  „\n\n 
 †
‚ \n \t ­\n\t, \t
‚ \nƒ \n \f\n\t
\n  
ƒ‚ ­\n\t ­ \f.
\n
\n\t, ­\n 
\b \n\f \t   ’ˆ 
\n 6
. 
†€ ­ \t
 \n‚ ‚„\n\n‚ \t\n‚
\t\n (70–99%), \n\f\t
‚­ \n\n \t\n ‡\n\t
‡\t,    ­­
\n\n‚…  „\n\n 
\t\n\t \n
­‚\t 6%.
  ­\n\t 
\f\n\n‚ (50–
69%) ­ \t \n‚ \t\n
\t\n ‡\n\t‡\t 
\n\f\t 
\f\b\t \n\f 
\n‚… \b\t, \t…  \t, ­ ,
ƒ\n\t, ­ \f , \b\t
 ­­\n\n‚…  „\n
\n 
\t\n\t \t„ \n ­‚
\t 6%.
 \n \b ­\n 
\t
\n ‡\n\t‡\t,  ‚­ \n
\n 
\t\b\n ­‚… 2
\n  ­ 
\n\f \t   ’ˆ ­­\b\t\t \n,
  \n\t ­\t­\n 
\n
\n \f .
\r ­\n\t 
­\t\n‚ ‚
„\n\n‚ \t\n‚ \t\n
�( 70%) 
\t\f\n\n\n‚ …\f\b
 \t\f­,   \f
\t‚… †\t
 \t‚ ‚ …\f\b
, 
\t„ \f ­\b
 ­\t­\n 
\t‚\t
­, ‚­ \n\t \t\n
\t\n\t\n.  ­­
\n\n‚… \t \t \n
\n\n‚… \t
… ­ ‚­ \n\n \t\n\t\n
\n  „\n‚ ­‚\t 6%.
 ­\n\t 
‡\t\n 
\n‚ \t\n ­\n\b\n‚… \t
 \f€\t\f\t ‚  ­
\t\n‚… \b…  „\n\n
\tƒ \n-ƒ \n \t.
Š\n \n
\n\n \n …\t
‡\t\n \n\t\n \t­
\n ­ \n, 
­\n\t\n \n\b\n
\n\n \t \t \n\b\t 
\n \n \f\t\n \n. \f \t\t‚ \n 
… \nƒ …  \n \f‚
†\t, \b\t ­\f \f 
„\t ‚­ \n\t \f
 
\t\n
‡\t\n \n \t  ­\n\b
\n‚… \t ­ \n \b ­\t\n‚…
’ˆ   \n\f \t, †€…
\n ­\t \n \n\t\n
 \b\n. 
\n\t\n\n \n\t 
\n \n\n\n  \n
(CAVATAS) \n   …‚ ‡\n
\f \n \b\n \t\n ­
\n\b\n‚… \t 
\n\n 
\n
\t\n \t­. 
… ­‚\t\n
\f­­‚ ‡\n\f \n (\n­ 
\t 
\n­ \t 
\t\n\t\n
) 
\n\t\n \b\n ƒ‚ 
\n\n‚ 16
­\n\t, ­
\n… \n\f \t   ’ˆ \n
\n \t\n
­\n\b\n‚… \t. Ž\t\t ­\t
\n‚… \n\f \t, ’ˆ, ˆ 
\t \n‚…
\b\n-\f\t‚… … 
\f­­…
ƒ‚  ­\t. ’ \n \n,  
2.5. 
‰Š\r’’ˆ”‰
Š‰™ˆˆ
 Š’ˆ”•
,
ŠŠŠŽ”•
ˆ ˆ’ˆ“”•
’‰ˆ‘•
\n\n\b\n‚… ‚ €\n\t \n
\n  \n   \n\t
\t\b\n. 
\n\t€  ‚­ \n†\t
\f \f­\n‚ ­­\t\n‚ \n
\n\n‚ ­‚\t\n.
\n
Š­\t \n \n\t\n \t
­,  †\b†€ \tƒ\t
\n‚ \n\t\n\t‚ (\r), \t\t\n‚,
 \t 
\n\f\t   … ­\n\t
\t\n ­\n\b\n‚… \t,
­\n… \n\f \t   ’ˆ.
ž\n\f \n   …\f\b
 \b\n ­\n\t 
‡\t
\n \n‚ ­\n\b\n‚ \t\n
„\t ƒ‚\t ‚­ \n\n ­ \n \b
­\t\n‚… ƒ \n‚… \n\f
\n, †€… \n
\n ­\t
 \n \n\t\n \t­
(\n\t\tƒ\t\b \t, \t
\t\n‚, \b\n , \f\t\n\n \f…
\t ).
\n\t‚ 
­\t\n‚ \t 
\t\b ­„\n \f­\n‚… \n
\t\n \n‚… \t †\t ­
‚\n\n‚  ­\t\n‚… \n\f \t.
ˆ\n\t\n \n \n­ \t  
\t\n\t\n \t\n\n\n \f\b\t
 \f \f\b†\t ƒ \n\f† \n
\f 
\t\t\b  „\n‚ \f\n\t
 ­ \f†€ \n\f \t. Š\n
   \nƒ …  \n
­\n\t\n, \b\t ­\f,
‚­ \n\n\n ­ \t\n � 50% \f­
\n‚… \n\t\n \n‚… \t, 
\t ‚ \t…\n\b \f­… ( 
97%), \n
\n ƒ\n\f„\t ­\n\t
\n‚… ­\f€\t ­ \n\t
\n \t­. ’, 
\n 
\nƒ †
\n ­\n, \b\t \b\t\t \n\f \t,
\n\f\t  \n  
\t 
­‚  ­  ­\f‚
­ \f†€ 6
. \t  14%,
\b\t\t \t\n ­
\n\n‚ \n

– ƒ  50%.  ‡\t \t\t
\n\n‚, \b\t \n
   
ƒ 
\t­\n ­\t€\t ­\t\n‚ 
ƒ \n‚ \b \n\f\n:
ƒ\t\n\n \n­ \t   \n
­ \t 
\f\t\n \t\n\t.
 \t
„  \n \n
\t\n \t­ \f\t‚… \t
 ­ \n\t\n \n‚… \t\n…
\t„ \f\n\t  ­\t\n‚… \n\f 
\t. ’, \fƒ\n   \n WASID
­\n\t , \b\t  \t \n
­„\n  \n„ 140/90
 \t. \t.
ƒ€ •\r \n„ 4
 / 
\f\t 
\n\n  ­\t\n
 \n\f \t   ’ˆ.
 \n\f \nƒ  \f­\n \n\n
\t \n\t \n ­­\t
\n \n\n\n ­‚\t\n
SAMMPRIS ƒ‚   „\n \n\t 
\n \n ‡\t\n\t \n
\n\t\n \t­ 
\n\n
 ­  ’ˆ   \n\n \f†
€ \n\f \t \f
­\n\t 
\t\n
70–99% \f­\n‚… \n\t\n \n‚… 
\t ­\t \t
„ \t­, \n
\t\n 
\n\t\n \n \n­ \t
 
\t\n\t\n. Š\f€\t  
„\n\n‚ ­ \r 325
 
\r\f\r
 \n\t\b\n\r
\f
’ˆŽ‰\rˆ‰
‰Š‰™ˆˆ
\t\n 
 ­  75
, \n\t
­\t\n\n \t­ 
­„\n
 \n„ 140/90
 \t. \t., ­ ­
\b \t­ 
\f\n\n •\r
­­\t\n \n ­ \t\n\t \n„
 / , 
\t„  ƒ
 „\n.  \n ƒ \n‚… ­
\n \t\n\t\n. ˆ \n \t
\n \n \b\n 
­  2011

 
\n\b\t \n‚ \n\n (­
‚ 30
\n) \t\t\t\b \n\b‚
\f \b\n  „\n\n (\n\f \t
\b\n-\f\t \t) 
\f­
­ \n\t\n\n\n \t \t:
14% ƒ \n‚… ­\t 5,8% ­\n\t
\f­­ \n \n\t\n 
\b\n. \n\n ­\t\t \nƒ
ƒ \n‚… 
­ „\t \nƒ †\n  
\n  \n \t \t \n
\t
 
ƒ ).
\n.
\n\t, ­\n \n\f \t
  ’ˆ  \t 50–99% \t
\n \f­\n \n\t\n \n
\t, \n\f\t ­
 \r 
 75–325
 
\f\t,
 \t \n \n\t­\t\n\n
\t­ 
 ‚ \f\n 
140/90
 \t. \t., \n„\n ƒ€
 •\r 4
 / , •\r ­­\t
\n \n ­ \t\n\t 2
 / .
‚­ \n\n \n­ \t / 
\f\t\n \t\n\t \n \t ­\f
€\t ­ \n \n\t
\n \t­ 
„\t ­
„\t \f \b\n  \n\n…
­ ­\n\n‚…  „\n\n.
ˆ\n\f \t: \n\t, \b\n, ­ \t.  . .. \r\f \n, .. 
. – .: ‰­-\n, 2009. – 288 .
\n \n‚  \n\b \n (Š). \rƒ\n / . . .. Š
\n. – 2- \n. .: \r - , 2009. – 528 .
\t\b \n .  . .. \r\f \n, .. \n\n – .:
\r\f \n .., ’\n\n .., \n .. \n\t\tƒ\t\b \t­
\b… \n\f\n  ƒ€\n. .: ŠŠŠ «\n
\n\n\n \n\t\t», 2009. – 224 .
\f\b\n \n
\n \t\b

†   \n\n
Œ‹
\n  \n\n
\r\f\r  \n\t\b\n\r \f
\t\b \n
 
\r\n  \nƒ 2011. ­\n  ­\b\t 2011
\t 60…90/16.  \f /
\n\t\f . \b\t . Šƒœ ­\b. .
’„

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