Экологическая медицина = Ecological medicine. Учебное пособие

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5)  drinking water composition (presence of nitrate, chloride, nitrite, lithium), water hardness;

6)  biogeochemical features of areas (deficiency or excess of Ca, Mg, V, Cd, Zn, Li, Cr, Mn, Co, Ba, Cu, Sr, Fe in the environment);

7)  food contamination with pesticides, heavy metals, nitrogen derivatives, mycotoxins;

8)  natural and climatic conditions (rate of weather changes, humidity, pressure, wind strength and direction, level of insolation, temperature inversion, fog).

Diseases of the nervous system and sensory organs, mental disorders:

1)  natural and climatic conditions (rate of weather changes, humidity, pressure, wind strength and direction, insolation level, temperature inversion);

2)  biogeochemical features of areas (high mineralisation of soil and water with chromium, lead, mercury, aluminium);

3)  living conditions (including household electrical appliances, computers);

4)  atmosphere pollution with sulphur oxides, carbon, nitrogen, chromium, sulphur compounds, mercury, silicon dioxide, etc.;

5)  noise level, infrasound, vibration;

6)  electromagnetic fields;

7)  food contamination with chlorine, organophosphorus and other pesticides, heavy metals, mycotoxins.

Respiratory diseases:

1)  natural and climatic conditions (rapid change of weather, humidity, wind strength and direction, level of insolation, temperature inversion, fog); 2)  living conditions (including household allergens, detergents, sol-

vents, varnishes, lotions, tobacco smoke, etc.);

3)  atmosphere pollution with dust, sulphur oxides, nitrogen, carbon, phenol, sulphur dioxide, ammonia, hydrocarbons, silicon dioxide, chlorine, mercury, asbestos, cement, pollen, bacteria, fungi, etc.;

4)  contamination with organochlorine and organophosphate pesticides.

Digestive system diseases:

1)  environmental pollution by pesticides and toxic chemicals;

2)  biogeochemical features of areas (deficiency or excess of trace elements in the environment);

3)  living conditions, nutrition (including dietary fibre deficiency in food) and lifestyle;

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4)  air pollution with phenol, sulphur dioxide, chromium, dust, sulphur hydrocarbons, fluorine, nitrogen oxides, silicon dioxide, etc.;

5)  noise level, vibration;

6)  drinking water composition, its hardness.

Diseases of blood and blood-forming organs:

1)  biogeochemical features of areas (deficiency or excess of chromium, cobalt and a number of other rare earth metals);

2)  atmospheric air pollution with propylene, sulphur oxides, carbon, nitrogen, nitric acid, sulphurous anhydride, hydrocarbons, ethylene, benzene, heavy metals, organic acids (nitric, sulphuric, hydrochloric, phosphoric, etc.), ash dust of thermal power plants, state regional power plant, local boiler houses, etc.;

3)  electromagnetic fields, ionising radiation;

4)  factors of residential and public buildings (including household electrical appliances, microwave ovens, computers);

5)  drinking water composition (nitrates and nitrites);

6)  environmental pollution with toxic chemicals, chlorinated biphenyls.

Diseases of skin and subcutaneous fat:

1)  natural and climatic conditions (insolation level);

2)  biogeochemical features of areas (deficiency or excess of trace elements in the environment);

3)  vitamin deficiency and hypervitaminosis, including vitamin A; 4)  atmospheric air pollution (including oil and petroleum products); 5)  living conditions (including the use of synthetic detergents).

Endocrine system diseases, eating and metabolic disorders:

1)  natural and climatic conditions (insolation level);

2)  biogeochemical features of areas (deficiency or excess of Pb, I, B, Ca, V, Br, Cr, Mn, Co, Zn, Cu, Li, Ba, Sr, Fe, Mo in the environment);

3)  atmospheric air pollution;

4)  noise level;

5)  electromagnetic fields;

6)  drinking water hardness.

Diseases of genitourinary organs:

1)  biogeochemical features of areas (deficiency or excess of Zn, Pb, I, Ca, Mn, Co, Cu, Fe, etc. in the environment);

2)  atmospheric air pollution with carbon disulphide, carbon dioxide, butylene, ethylene, hydrocarbons, hydrogen sulphide, sulphur oxide, carbon monoxide, etc.);

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3)  drinking water hardness (including an increase in the concentration of cadmium, mercury, and silicon).

Congenital anomalies:

1)  atmospheric air pollution with sulphur oxides, carbon, sulphur compounds, fatty acids, ethylene, propylene, hydrogen sulphide, nitrogen, butylene, nitro compounds, mercury, pig iron, cobalt, manganese;

2)  environmental pollution with pesticides and toxic chemicals;

3)  noise level;

4)  electromagnetic fields;

5)  radionuclides.

Pregnancy pathology:

1)  atmospheric air pollution with sulphur oxides, carbon, sulphur compounds, fatty acids, ethylene, propylene, hydrogen sulphide, nitrogen, butylene, nitro compounds, mercury, pig iron, cobalt, manganese;

2)  drinking water contamination with nitro compounds, organic alcohols, sewage from synthetic rubber enterprises;

3)  electromagnetic fields;

4)  environmental pollution with pesticides and toxic chemicals;

5)  biogeochemical features of areas (deficiency or excess of microelements).

Neoplasms of the mouth, nasopharynx, upper respiratory tract, trachea, bronchi, lungs, etc.:

1)  atmospheric air pollution with sulphur oxides, carbon, sulphur compounds, fatty acids, ethylene, propylene, hydrogen sulphide, nitrogen, butylene, nitro compounds, mercury, pig iron, cobalt, manganese, nickel, chromium;

2)  environmental pollution with pesticides, toxic chemicals and radionuclides;

3)  electromagnetic fields;

4)  living conditions (including radon, asbestos, tobacco);

5)  natural and climatic conditions (air humidity, insolation level, temperature factor, dry winds, dust storms, atmospheric pressure).

Neoplasms of digestive organs:

1)  environmental pollution with pesticides and toxic chemicals, chlorinated biphenyls;

2)  atmospheric air pollution with carcinogenic, polycyclic aromatic hydrocarbons, acrolein and other photo-oxidants (nitrogen oxides, ozone, formaldehyde, organic peroxides);

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3)  biogeochemical features of areas (deficiency or excess of Ca, F, Se, V, Li, Cr, Ni, Pb, Mo, I, Fe, Mg, Mn, Zn, Co, Cu, etc. in the environment);

4)  drinking water composition (nitrates, nitrites, sulphates, chlorine containing substances, lithium, calcium), water hardness;

5)  food contamination with pesticides, metals, nitrogen derivatives, mycotoxins, etc.).

Neoplasms of genitourinary organs:

1)  atmospheric air pollution with ethylene, butylene, carbon disulphide, hydrocarbons, sulphur oxides, carbon dioxide, hydrogen sulphide, carbon monoxide, phenol, formaldehyde, lead, etc.);

2)  environmental pollution with pesticides and toxic chemicals;

3)  biogeochemical features of areas (deficiency or excess of Mg, Mn, Zn, Co, Mo, Cu in the environment);

4)  drinking water composition (chlorides).

Allergic diseases and allergoses:

1)  atmospheric air pollution with solvents, organic compounds, nickel, phenol, cresol, hydrogen sulphide, carbon dioxide, organic dust, etc.;

2)  food components (including vitamins, dyes, pesticides, antibiotics, hormones, chlorinated biphenyls);

3)  factors of residential and public buildings (including organic compounds released from polymeric materials, washing powders, organic dust, dandruff, animal hair, dust mites, indoor plants);

4)  drinking water (increased iron concentration, high hardness, water bloom products).

Medical prevention, its role in preserving human health in an environmentally unstable world. Depending on the health status, risk factors for severe disease or pathology, it is usually considered that there are three kinds of prevention: primary, secondary, and tertiary.

Primary prevention is a system of measures to prevent the emergence and impact of disease risk factors (vaccination, work life balance, good nutrition, physical activity, environmental sanitation, etc.).

Primary prevention includes social and economic measures provided by the government to improve lifestyle, environment, education, etc. Preventive activities are mandatory for all medical professionals and healthcare institutions of all levels.

Primary prevention is aimed at a possible etiological cause as a risk factor for health disorders. That is why hygiene is engaged in rationing these physical, chemical, biological factors and their combinations. These

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factors are considered to be either absent or available at safe concentrations and levels, for example, the concentration of CO2 in the air of residential and public buildings, workshops, in the atmosphere. Carbon dioxide is a natural irritant of the respiratory centre; it maintains acid-base balance in the body only at a certain concentration in the atmosphere of 0.03–0.04%. Increasing the CO2 concentration in enclosed spaces, without possible health problems, is allowed and normalised at a concentration of 0.1%. If the CO2 concentration exceeds 0.1%, it is a health risk factor and requires natural or artificial ventilation as a preventive measure.

Secondary prevention is a set of measures to eliminate pronounced risk factors, which under certain conditions (decreased immune status, overstrain, adaptive failure) can lead to the emergence, exacerbation or relapse of the disease. The most effective method of the secondary prevention is a medical examination as a comprehensive method of an early detection of diseases, dynamic monitoring, targeted treatment and rational sequential recovery.

Secondary prevention includes not only the study of the etiological ­factor, but also the constant thorough medical examination of apparently healthy people (preventive examinations, screening). According to the ­labour process, technology hazards may be present in concentrations and ­levels exceeding the threshold value, being considered as the real risk factors for the disease occurrence. Secondary prevention includes the use of individual and collective protection against harmful factors; labour regime and the time of contact with these factors; labour mechanisation and ­automation; training of the population and working safety rules; physiotherapy; hydration regime; therapeutic and preventive (antidote) nutrition; vitamin drinks, oxygen cocktails or alkaline inhalations, etc.

Tertiary prevention is viewed as a set of measures for the rehabilitation of patients who have lost the ability to have a full-fledged life. Tertiary prevention includes:

yysocial rehabilitation (building social self-confidence and compliance); yylabour rehabilitation (the ability to restore labour skills); yypsychological rehabilitation (restoration of the personality’s be-

havioural activity);

yyhealth rehabilitation (functional recovery of organs and systems). The most important component of all preventive measures is the for-

mation of the population’s medical and social activity and attitudes to a healthy lifestyle.

Tertiary prevention (rehabilitation) is the least effective, since there is a significant health problem in the form of a work-related disease, the reduction

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of working capacity. The aim of tertiary prevention is to maintain health, prevent further progression and frequent exacerbation of chronic diseases.

The concept of “prenosological” hygienic diagnostics is introduced; its significance and role in the primary prevention of health disorders are determined. Prenosological hygienic diagnostics is a system of thoughts and actions aimed at studying adaptive reserves and establishing prenosological (i.e. pre–painful) conditions of the human body due to the influence of environmental factors. Prenosological hygienic diagnostics has the main goal to investigate and evaluate the state of regulatory mechanisms that “work” at the earliest stages of the transition from health to disease, when there are no pronounced functional and, moreover, structural disorders in the body. It is during this period that there are the most favourable conditions for taking preventive measures that can give the maximum positive effect.

PRACTICE

Determination of the correlation between environmental risk factors of living conditions and the level of primary morbidity.

Task 1: Determine the frequency of acute respiratory diseases per year.

Task 2. Determine the environmental risk group of each student’s living conditions.

ENVIRONMENTAL CONDITIONS: 1.  What part of the city do you live in?

2.  Duration of residence in this territory (years) . . . . . . . . .

3.  Is your house located in the neighbourhood of:

petrol station . . . . . . . . . . . . . . . . . . . . . . 3 railway station . . . . . . . . . . . . . . . . . . . . . 4 market, a large shopping centre . . . . . . . . . . . . . . 5 the house is located inside the block . . . . . . . . . . . . 6

4.  Next to your home:

there are green areas (squares, parks) . . . . . . . . . . . . 2 there are no green areas . . . . . . . . . . . . . . . . . 1

5.  What type of house does your family live in?

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6.  Are you satisfied with the improvement and sanitary condition

7.  Do you live in:

dormitory . . . . . . . . . . . . . . . . . . . . . . . 1 shared flat . . . . . . . . . . . . . . . . . . . . . . . 2 separate flat . . . . . . . . . . . . . . . . . . . . . . 3 private residence . . . . . . . . . . . . . . . . . . . . 4

8.  What is the living floor space per member of your family?

no . . . . . . . . . . . . . . . . . . . . . . . . . . 1 space is made available . . . . . . . . . . . . . . . . . . 2 yes . . . . . . . . . . . . . . . . . . . . . . . . . . 3

15.  Is smoking present in your living space?

yes . . . . . . . . . . . . . . . . . . . . . . . . . . 1 sometimes . . . . . . . . . . . . . . . . . . . . . . . 2 no . . . . . . . . . . . . . . . . . . . . . . . . . . 3

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Please, evaluate the results. The algorithm for processing the survey results provides for a point score in each block. Each selected answer to the question has an evaluation score, while the highest score was assigned to the answer containing information that received a positive hygiene rating. The total score allows you to attribute to a particular risk group (minimal, under attention, high-risk) according to the living conditions.

The results:

minimal-risk group – more than 25 points, under attention – from 25 to 20 points, high-risk group – less than 20 points.

Task 3. Create a database for statistical processing of results.

Note: x – the number of registered acute diseases / illnesses per year; y – the total score of the responses to the questionnaire; dx – deviations from the mean value of all registered acute diseases / illnesses in the study group; dy – deviations from the mean value of the total score on the survey group.

Task 4. Calculate the correlation coefficient using the “Pearson Square” by the formula:

r = ∑(dx dy ) ,

∑dx2 ∑dy2

where, x and y – signs between which the relationship is determined; dx and dy – deviations of each variant from the mean value calculated in the row attribute x and in the row attribute y; Σ – the summation symbol.

Determine the strength and direction of the bond using tabular data:

Task 5. Offer measures to optimise environmental and health conditions.

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