What does environmental health study. The subject of human hygiene and ecology
CHAPTER 3 ENVIRONMENT AND ITS HYGIENIC SIGNIFICANCE. HYGIENE AND HUMAN ECOLOGY
3.1. HYGIENIC CHARACTERISTICS OF ENVIRONMENTAL FACTORS. HYGIENE AND HUMAN ECOLOGY
To use a preventive method to achieve the goal of hygiene, it is necessary to know the causes of diseases and premature wear of the body. Since most of these causes are the result of the interaction of the organism with environmental factors, then, as mentioned earlier, the subject of hygiene research is the patterns of the influence of the environment on human health, and the object of research is “man-environment”.
Environment(OS) - the concept is very capacious. V last years it received a slightly different sound, since it replaced the concept "external environment", which has long been used in all the classical works of our predecessors as an antipode to the internal environment of man. In this regard, it is necessary to clarify the modern terminology.
From a hygienic point of view, the environment is a combination of natural and social elements with which a person is inextricably linked and which influence him throughout his life (see Fig. 1.2), being an external condition or environment for his existence.
Natural elements include air, water, food, soil, radiation, flora and fauna. The social elements of the human environment are work, life, socio-economic structure of society. Social factors largely determine Lifestyle a person (for more details, see Chapter 13).
The concept of the environment (natural and artificial) includes the concepts of the external and production environment.
Internal environment, as noted by I.P. Pavlov, is the internal content that provides the nervous and humoral mechanisms of regulation. The internal environment of the body is a collection of fluids (blood, lymph, tissue fluid) that bathe cells, pericellular structures of tissues that take part in the implementation of metabolism.
Under external environment should be understood as part of the environment that is in direct contact with the epithelium of the skin and mucous membranes, as well as affecting all types of human receptors that perceive the world around them individually, due to their characteristics. The state of the external environment is purely individual for each person.
concept environment is wider. It is not individual, but common to the whole population, the population. In the course of a long evolution, a person has adapted to a certain quality of the natural environment, and any changes in it are not indifferent to his health, up to the appearance of a disease.
In the environment, such concepts as habitat and production environment are distinguished.
Habitat- a complex of interrelated abiotic and biotic factors that are outside the body and determine its vital activity (Litvin V.Yu.).
Work environment- a part of the environment formed by natural and climatic conditions and professional (physical, chemical, biological and social) factors affecting a person in the course of his labor activity. Such an environment is a workshop, workshop, auditorium, etc.
Unmodified natural (natural) environment- unchanged as a result of direct or indirect human influence, society is a part of the natural environment, characterized by the properties of self-regulation without the corrective influence of a person. Such an environment ensures the normal functioning of the human body.
Modified (polluted) natural environment- the environment changed as a result of its unreasonable use by a person in the process of activity and negatively affecting his health, working capacity, living conditions. In relation to the named environment, there are concepts identical in meaning: anthropogenic, anthropic, technogenic, denatured environment.
Artificial OS- directly or indirectly, intentionally or unintentionally, the environment created by man for the temporary maintenance of his life and activities in artificially created enclosed spaces (spaceships, orbital stations, submarines, etc.).
The division of OS elements into natural and social is relative, since the former act on a person in certain social conditions. At the same time, they can change quite strongly under the influence of human activities.
OS elements have certain properties, which determine the specifics of their influence on a person or the need for them to ensure the life of people. In hygiene, these properties of natural and social elements are usually called environmental factors, and hygiene itself can then be defined as the science of environmental factors and their influence on the human body, thus emphasizing the subject and object of its study.
Natural elements are characterized by their physical properties, chemical composition or biological agents. So, air - temperature, humidity, speed, barometric pressure, oxygen content, carbon dioxide, pollutants harmful to health, etc. Water and food are characterized by physical properties, chemical composition, microbial and other contaminants. The soil is characterized by temperature, humidity, structure and chemical composition, bacterial contamination, and radiation - by the spectral composition and intensity of radiation. Animal and plant world differ in biological properties.
A group of social elements also has certain properties that are studied and evaluated quantitatively or qualitatively. These properties are shown in fig. 1.2. All of them form the so-called social environment - part of the environment, which determines the social, material and spiritual conditions for the formation, existence and activity of society. The concept of the social environment combines a set of components of the social infrastructure of society: housing, life, family, science, production, education, culture, etc. The social environment plays a leading role in the process of reducing the level of public health due to the impact on a person through abiotic and biotic factors denatured as a result of human activities and society as a whole.
When studying the influence of the natural environment on a person, such concepts as the biosphere and its constituent elements are quite often used: atmosphere, hydrosphere, lithosphere.
Biosphere(gr. bios- a life, sphaira- ball, shell) - the lower part of the atmosphere, the entire hydrosphere and the upper part of the Earth's lithosphere, inhabited by living organisms, "area of \u200b\u200bliving matter" (Vernadsky V.I.). He also created the doctrine of the biosphere (1926), although the term was proposed by the Austrian scientist E. Suess back in 1875. Improving the doctrine of the biosphere, V.I. Vernadsky substantiated and developed it even more. At present, the most active layer of living matter is isolated in the biosphere - biostroma, or "film of life," as the scientist called it. In 1935 Academician V.I. Vernadsky, in connection with the rapid development of scientific and technological progress, proposed a fundamentally new term "noosphere" to denote the emerging new geological shell of the Earth. The noosphere is understood as that global shell of the planet (the stratosphere, the surrounding outer space, the deep layers of the hydrosphere and lithosphere), where the activity or result of human activity spreads in the age of scientific and technological progress.
In addition to such concepts as the environment, the biosphere, there is the concept of ecology.
Ecology(gr. oikos- house, dwelling, environment, logia- science) - the biological science of the relationship of plant and animal organisms and the communities they form between themselves and the environment. modern ecology, or social ecology, intensively studies the patterns of relationships between human society and the environment and the problems of its protection. In recent years, both in our country and abroad, the so-called human ecology. Moreover, it is so active that it tries to push other disciplines. This is primarily due to too loose use of terminology and the lack of a sufficient number of competent specialists in this field.
Hygiene and human ecology
Despite the above, in recent years, hygiene has closely interacted with human ecology. Ecology is independent biological first of all, science, therefore both sciences differ in their methodology, object and subject of research, regulatory framework etc., which is clearly seen from Table. 3.1 (Mazaev V.T., Korolev A.A., Shlepnina T.G., 2006).
Table 3.1. Hygiene and ecology (scientific analysis)
In this regard, the main tasks of the applied sections of hygiene (sanitary) and ecology (nature protection) differ in their ultimate goal. If hygiene, through sanitation, seeks, through organizational, legislative, technical and other means, to ease the anthropogenic pressure on the human environment and human health, then ecology directs its interests towards protecting the natural environment as a whole.
The need to act in close cooperation is dictated by the fact that it is impossible to decide ecological problems, using only normative legal instruments of environmental protection without ensuring the sanitary and epidemiological well-being of the population. And vice versa, it is impossible to ensure the indicated well-being in an unfavorable ecological situation, since the harmful influence of factors through the natural elements of the environment (soil, water, etc.) due to its disintegration is not excluded. Clear interaction of all specialists related to the protection of human health is important.
Moreover, this coincides with the main provisions of the World Strategy for Nature Conservation, developed by international organizations. In particular, this document formulates the principles around which the efforts of both the world community and the individual state should be concentrated:
2. Prevent the depletion of non-renewable resources.
3. Develop within the potential capacity of ecological systems.
4. Change the consciousness of a person and the stereotypes of his behavior in relation to nature.
5. Encourage the social interest of society in the preservation of its habitat.
6. Develop national concepts for the integration of socio-economic development and environmental protection.
7. Contribute to the achievement of unity of action at the global level. There is no doubt that humanity must necessarily solve the tasks set. Otherwise, consequences await him that will endanger the very existence of Man on planet Earth.
3.2. HYGIENIC REGULATION OF FACTORS
ENVIRONMENT
The Fundamentals of the Legislation of the Russian Federation (1993) states that the protection of the health of citizens is achieved through the implementation of political, economic, social, medical, sanitary and hygienic and other measures. The content of the sanitary-hygienic
measures is primarily hygienic regulation those factors that influence, shape, support and, unfortunately, often worsen and shorten a person's life, negatively affecting his health. The leading role of hygiene in the implementation of sanitary and hygienic measures lies in the fact that only hygiene, unlike other sciences that also study the “man-environment” system, normalizes the state of human health, taking into account the influence of all elements of the environment: natural, social and production(the latter are part of the social).
In Section 2.3, the strategic aspects of the rationing problem were touched upon, based on the theory of hygienic rationing with its universal principles. But this does not mean that before that there was no rationing as a way of balancing human health with environmental factors in the course of his life. Mankind has long understood the need to regulate certain factors in the "man - environment" system, which is explained in the wonderful words of the French writer J. Saperviel: "It is very difficult to graze in nature and not commit sacrilege." A person, as a rule, leaves deep “notches” on the body of Nature, which subsequently poison his life both literally and figuratively. A powerful factor in preventing such situations is hygienic regulation.
Considering the problem of rationing in hygiene, several historical stages of its research can be distinguished: empirical, scientific-experimental and modern. However, to talk about the appearance of a more or less slender rationing concepts it is possible since the 20s of the twentieth century, when it was developed in occupational health. On the basis of this concept, presumably, the theory of hygienic regulation subsequently appeared (see Section 2.3).
First, in the USSR, and then in other countries, the concepts of “maximum permissible concentrations” (MPC) of the content of harmful substances in the air of the working area were introduced into sanitary legislation. Somewhat later, in the 1930s and 1950s, the foundations were laid for the methodology of hygienic regulation of chemicals in the water of reservoirs, atmospheric air in populated areas, soil, and foodstuffs. At the heart of the methodology of hygienic regulation environmental quality there was a fundamental provision on the compliance of MPC with harmless levels for the human body, which do not have either a direct or indirect effect on the health of present and future generations.
At present, in Russia, the federal executive body authorized to carry out state sanitary and epidemiological regulation, is the Federal Service for Supervision of Consumer Rights Protection and Human Welfare (Rospotrebnadzor). The specified rationing is carried out in accordance with the regulation approved by the Government of the Russian Federation. State sanitary and epidemiological regulation is implemented through the bodies and institutions of Rospotrebnadzor in accordance with the tasks assigned to them on the basis of regulatory legal acts, which are state sanitary and epidemiological rules. These include:
Sanitary Rules (SP);
Sanitary standards (SN);
Hygienic standards (GN);
Sanitary rules and norms (SanPiN).
In addition, the bodies and institutions of Rospotrebnadzor widely use methodological documents in their activities:
Manuals(P);
Guidelines (MU);
Guidelines for control methods (MUK). An important point is that regulatory legal
acts relating to issues of ensuring the sanitary and epidemiological welfare of the population, adopted by federal executive authorities, executive authorities of the constituent entities of the Russian Federation, local governments, decisions legal entities on these issues, state standards, building codes and regulations, labor protection rules, veterinary and phytosanitary rules, should not be contrary to sanitary rules.
In accordance with the Federal Law "On the Sanitary and Epidemiological Welfare of the Population", compliance with sanitary regulations is mandatory for citizens, individual entrepreneurs and legal entities. The presence of bodies and institutions with such broad legal powers, endowed with the right to establish sanitary rules and control their implementation, is a powerful tool for ensuring the sanitary and epidemiological well-being of the population.
Using the opportunities provided, the modern sanitary service is developing hygiene standards- install-
permissible, maximum or minimum quantitative and/or qualitative values of an indicator characterizing one or another environmental factor from the standpoint of its safety and/or harmlessness to humans, legally obligatory for all departments, bodies and organizations.
Based on the methodological principles of hygiene, the development of hygiene standards is also carried out taking into account private principles of hygienic regulation, which are systematized and presented in the fundamental work of A.M. Bolshakova, V.G. Maimulova et al. (2006). These include:
1. The principle of harmlessness of the hygienic standard (primacy of medical indications). When substantiating the standard of the OS factor, the features of its effect on the human body and on the sanitary conditions of life are taken into account.
2. The principle of advance. It consists in the need to justify and implement preventive measures until the moment of formation and / or exposure to certain harmful factors.
3. Unity principle molecular, structural and functional changes as a basis for differentiation harmful and harmless impacts. At the same time, there are several types of criteria for harmfulness.
General biological criteria of harmfulness- reduction in average life expectancy, impaired physical development, changes in the activity of the central nervous system (CNS), impaired ability to adapt in the environment.
Criteria characterizing psychosocial disorders- violation of mental functions, oppression of the emotional environment, violation interpersonal relationships etc.
Reproductive dysfunction- changes in genetic material, effects on sperm, fertility and infertility, developmental delay, deformity and other malformations, etc.
Carcinogenic effect- the effect on the body of carcinogens, leading to the occurrence of cancer.
Physiological criteria- indicators of the functional activity of all body systems.
Biochemical criteria- biochemical constants, state of nucleic acids, etc.
Immunological criteria- nonspecific indicators of immunological reactivity.
Metabolic Criteria: the rate of metabolism and excretion of a substance from the body; accumulation of the substance in critical organs due to the magnitude of the dose; reaction of enzyme systems, etc.
Morphological criteria- destructive and dystrophic changes in cellular structures; shifts in the enzymatic systems of cells, etc.
Statistical criteria: the coefficient of variation; Student's criterion and other statistical methods of evidence of the reliability of the put forward hypothesis.
4. The principle of threshold action. It assumes the existence of doses (concentrations) that do not show toxic or other adverse effects on the body. The existence of this principle is in conflict with the concept of non-threshold, which is used in radiation hygiene and in establishing acceptable levels of carcinogens. Today, the instructions of the concept have come to replace acceptable risk concept, which has already been mentioned.
5. The dependence of the effect on the concentration (dose) and exposure time.
6. The principle of biological modeling. The basic model in the study of toxic and long-term effects are laboratory animals (mammals) with the maximum reproduction of the intake (influence) of the agent under study on the human body, taking into account differences in the sensitivity of humans and animals, etc. In short, the model must be adequate to obtain reliable results.
When extrapolating to humans data obtained from animal experiments, the so-called safety factors. They are regulated depending on the objects of the environment (water, soil, atmospheric air, air of the working area, food).
7. The principle of separation of objects of sanitary protection. When rationing chemical compounds for environmental protection objects, various types of adverse effects on the environment and the human body are taken into account. At the same time, there are types adverse action: general toxic, teratogenic, irritant, change in the transparency of the atmosphere, etc.
In turn, harmful indicators include effects: resorptive, sanitary-toxicological, reflex, organoleptic, general sanitary, migratory water (air), etc.
8. The principle of the limiting indicator of harmfulness (the principle of taking into account the "weak link", "bottleneck").
9. The principle of standardization of conditions and methods of hygienic regulation. It is regulated by methodological guidelines, standards, recommendations, etc., which prescribe the conditions for conducting research, the methods used, the principles of evaluation, etc.
10. The principle of phasing in research Stages and rules for the formation of conclusions (solutions at each stage) depend on the object of the environment.
11. The principle of unity of experimental and field studies(hygienic, medical, epidemiological, etc.).
12. The principle of relativity of the norm. It fully complies with the universal principle of hygienic regulation - dynamism. For example, with the advent of more sensitive assessment methods, the MPC in soil was revised for DDT (from 1 to 0.1 mg/kg), cineba (from 1.8 to 0.2 mg/kg), etc. (Goncharuk E.I. and et al., 1999). Since the discovery of ionizing radiation, the permissible levels (doses) for personnel and the public have been revised several times also in the direction of tightening.
These principles underlie the methodological approaches to the justification of hygienic standards for various elements or factors environment.
Features of hygienic regulation chemical substances
As already stated, methodological approaches to the normalization of potentially harmful factors are determined by the characteristics of the OS object, for which the hygienic standard is established.
For example, for atmospheric air hygienic regulation chemicals is based on 3 criteria of harmfulness formulated by V.A. Ryazanov:
1. Only that concentration of a substance in the atmospheric air is recognized as permissible, which does not have a direct or indirect harmful or indirect effect on a person, does not affect the well-being and state of working capacity.
2. Addiction to air pollutants should be considered as an adverse effect.
3. Concentrations of chemicals in the atmospheric air that adversely affect vegetation, local climate (microclimate), atmospheric transparency and living conditions of the population should be considered unacceptable.
The main hygienic standard for atmospheric air is MPC atmospheric pollution - this is a concentration that does not have a direct or indirect adverse effect on the present and future generation throughout life, does not reduce a person's working capacity, does not worsen his well-being and sanitary living conditions.
In the atmospheric air, 2 MPCs are set: maximum single and average daily. Their development is carried out in the algorithm described in the relevant methodological documents. At the same time, it is taken into account that the average daily MPC is set taking into account the hazard class of the substance (determined by certain toxicometric parameters). In total, 4 classes are distinguished: 1st class - extremely dangerous; 2nd class - highly dangerous; 3rd class - moderately dangerous; 4th class - low-risk.
Of course, the standards for harmful chemicals in the air and in the air working area will differ, most often upward in the latter case. This is understandable, since for atmospheric air the standards are set taking into account the fact that the substance present in it will act on children, the elderly, sick people whose body resistance is not comparable to that of a healthy person. In addition, in the first case, the MPC affects a person during the day, while it acts on a worker only during a work shift.
Somewhat different patterns underlie the justification MPC in soil (MPC-soil).
MPC of an exogenous chemical substance in the soil is its maximum amount (in mg/kg of the arable layer of absolutely dry soil), established in extreme soil and climatic conditions, which guarantees the absence of negative direct or indirect effects on human health, its offspring and sanitary conditions of the population.
Therefore, the content of an exogenous chemical substance in the soil is allowed, which guarantees the absence of a negative impact on public health, both during direct contact of a person with soil, and indirectly during the migration of a toxic substance along one or several ecological chains (soil - plant - person; soil - plant - animal - man; soil - atmospheric air - man; soil - water - man
etc.) or in total for all chains, and also does not violate the processes of self-purification of the soil and does not affect the sanitary conditions of life.
To assess the degree of soil contamination in a particular situation, indicators are calculated that reflect real regional soil and climatic features. Such indicators, which are calculated on the basis of the approved MPCs for chemicals in soil, are Maximum Permissible Application Levels (MALs) exogenous chemicals into the soil and their safe residual amounts (SCR).
There are specific features of hygienic regulation of chemicals in the aquatic environment and food products. They are discussed in their respective chapters. From the above examples it is quite clearly seen that the final result of the study - MPC - is substantiated experimentally. The difference is that in order to evaluate each element of the environment to determine the allowable amount of a chemical, the content of the experiment is significantly different.
Features of hygienic regulation of physical factors
Recall that the physical factors include a fairly large list of agents that differ in the nature of origin (natural and artificial), the features of the impact on living beings, the prevalence in nature, and many other properties.
to the physical factors in the general view include solar radiation with its unique electromagnetic spectrum; physical factors of the air environment: temperature, humidity, air velocity, etc.; mechanical factors: noise, sound, ultrasound, infrasound, vibration; electric, magnetic field of the Earth, etc. Even the factors listed here, for the most part, can be of natural or artificial origin.
First about general regularities taken into account in the regulation of physical factors that bring them closer to chemical ones with respect to different elements of the environment. In the first approximation, the general can be seen in the following areas: 1. Both chemical and physical factors in their "natural form" and ratios are absolutely vital, without which life on Earth would be impossible. This can be expressed
thus: disappear from chemical composition atmospheric air oxygen or stop penetrating the earth's surface solar radiation, virtually everything on the planet would cease to exist, including humans.
2. Even vital factors of physical and chemical nature, if they deviate from the natural norm, can harm human health or the environment. Oxygen, necessary for human life, can cause severe poisoning if the patient, to whom it is prescribed for health reasons, was given too large a dose in “pure form”. Just like the ultraviolet radiation of the Sun, which is completely beneficial for humans, at “normal” doses brings both physical and moral satisfaction (“healthy tan”), while in excess it causes burns of the skin, eyes, intoxication, etc.
3. Common to the analyzed factors in most cases is the fact that hygienic standards are justified separately for the population and for the “working environment”, i.e. professional workers. In addition, it must be borne in mind that both among chemical and among physical factors there are those that have non-threshold harmful action. Among the first are carcinogens, among the second - ionizing radiation (IR).
4. Most of the standards in their various forms (maximum concentration limit, remote control, remote control, etc.) are established experimentally those. are to some extent probabilistic. But this, as mentioned earlier, fully corresponds to the theory of hygienic regulation and is applied in accordance with the principles on which it is based. Apparently, there are other common points in the evaluation
the influence of chemical and physical factors on human health and the environment, but let's turn to the differences. They, like "similarity", are, to a certain extent, relative.
1. Being within the natural boundaries, both chemical and physical factors do not harm human health. However, going beyond these limits, physical factors cause irreparably greater damage to the population of a region, country, etc. For example, deviations from the norm that occur in a certain season in some regions wind speed in the form of a hurricane cause serious Negative consequences for both nature and people. Moreover, people, having become accustomed to and attached to a certain area,
region, are forced to endure this kind of undesirable impacts, trying to adapt to them.
2. The next difference is that if a natural physical factor has taken on an anomalous characteristic (for example, a sudden increase or decrease in temperature, unusual for this season or region; significant precipitation in terms of quantity or duration, etc.), then they suffer from this hundreds of thousands and even millions of people. For anomalous "chemical disasters", regional attachment is more typical: either a certain source poisons the environment (factory, combine, highway, etc.) - in this case, a chronic process of OS disintegration of a certain scale takes place, or in case of emergency or other emergency situations, a focus is formed acute disaster. But anyway it is natural physical anomalies that are characterized by scale, while natural chemical anomalies of this magnitude are unknown to us. For clarity, let us recall one terrifying example: the earthquake in the Indian Ocean in December 2004. As a result of the ensuing tsunami, which hit the coastal regions of Indonesia, Sri Lanka, southern India, Thailand and other countries, more than 300 thousand people died. The economic, environmental and other consequences were also enormous.
3. Another and perhaps the most important difference is that a harmful chemical agent in itself causes some damage to human health and the environment. For physical factors, this is most likely an exception. As a rule, into the orbit of the anomalous physical phenomenon several OS elements are involved. The same hurricane wind removes and carries away the top layer of soil, exposing some areas of the earth's surface and sweeping others with the dust and snow carried away. Water is very often involved in such an element on one scale or another.
4. This difference can be conditionally called "the insidiousness of physics." Among the unfavorable physical factors, there are a lot of those, the harmful effect of which does not have pathognomonic signs, especially at the level of low doses. And some of them, such as AI, even acting on a person in lethal doses, do not show their presence in any way. Of course, among the chemical factors one can observe the "invisibility effect", but at high concentrations, detection will occur sooner or later. but
in the case of supramaximal doses of AI, a person simply does not survive until the moment the cause is identified. 5. The concept of risk (some call it the concept of "acceptable risk") began to develop in the process of regulation of physical factors. In fact, it arose in the field of radiology, radiation hygiene, radiobiology and other related sciences, since there were too many difficulties in the way of extrapolation of experimental data obtained in experiments on animals, as applied to humans. In this regard, it was necessary to develop completely original approaches for calculating the risk to human health when substantiating AI hygiene standards.
But it should be emphasized that in the field of regulation of chemical factors, great success was subsequently achieved. That is why, speaking about the features of hygienic regulation of individual factors, we will focus on physical and chemical ones. And as will be shown below, even in these "advanced" areas, compared to other areas, they are still far from the desired result.
In more detail, particular approaches to the hygienic regulation of physical factors (biological, mechanical, etc.) are set out in the corresponding chapters of the textbook.
It would be wrong not to touch upon a problem that is extremely acute not only for hygiene, but also for medicine in general. If we turn to the WHO definition of health already cited, then in the triad of "physical", "spiritual" and "social well-being" today there is more or less clarity regarding its first element. As for the other two components of the triad, there are great difficulties in finding acceptable approaches in order to somehow streamline the range of fluctuations from normal to disease, i.e. eventually learn to normalize these states.
If we recall the existence of three stages in the history of the formation of hygiene (empirical, scientific-experimental, modern), then we can say with a certain degree of conditionality that the sciences that should answer the question: “What is mental and social well-being and how measure them?” are still only at the initial stage. Therefore, it is worth noting that hygiene, which has made a truly giant leap in the field of regulation of physical, chemical, biological and other environmental factors, is not by chance a science. evidence.
3.3. MODERN THEORIES OF ESTABLISHING CAUSE AND EFFECT RELATIONSHIPS BETWEEN ENVIRONMENTAL FACTORS AND HUMAN HEALTH
Assessment of the state of human health in connection with the state of the environment has now become extremely relevant. Determining the role of "pollution" of the environment and the emergence of non-infectious morbidity in connection with this give an idea of the scale of the problem, the definition of priority programs and directions for the prevention of registered pathology, the establishment of cause-and-effect relationships between the state of the environment and the health of certain population groups, and the assessment of the negative effect of exposure one or another risk factor.
But before considering the actual problem of risk, it is necessary to define some terms. The concept of "pollution" means the presence in an element of the environment of an undesirable (polluting) substance in quantities exceeding the MPC, which can adversely affect human health and living conditions. At the same time, under pollutant understand any agent of a physical nature (natural, artificial), chemical substance or biological species found in the OS or appearing in it in quantities exceeding the usual (permissible) content.
Some researchers believe that the so-called environmental epidemiology is engaged in establishing causal relationships between the state of the environment and human health. This is another, most likely contrived term, exactly the same as the previously mentioned controversial terms. Without going into details, we note that we should still focus on the existing theories of establishing causal relationships between the state of the OS and its impact on human health.
We have already mentioned the existence of the so-called threshold concepts. Recall that it is based on one of the principles of hygienic regulation of the same name (“threshold principle”).
The concept of threshold has played an outstanding role in the formation and development of rationing in general and hygienic in particular. But as science developed, it turned out that it came into conflict with certain laws that could not be characterized solely within the framework of its provisions. In particular, most
Your scientists and specialists are of the opinion that ionizing radiation, many chemical carcinogens do not have a “harm threshold”. For example, the impact of one gamma-quantum on a cell of the body is enough for undesirable (harmful) consequences to arise in it, which in the end can lead to irreparable effects in the form of malignant tumors, etc.
Therefore, in the depths of the same radiation hygiene, a new concept has appeared, which has already been mentioned - the concept of risk. In the 90s of the last century, our country was actively involved in its development. At present, this concept is one of the indispensable conditions for substantiating the necessary organizational, economic, logistical, sanitary and other measures to preserve the health and sanitary and epidemiological well-being of the population.
One of the fundamental concepts in the concept of risk is the provision on risk factor.
risk factor- this is a factor of any nature (hereditary, environmental, production, lifestyle factor, etc.), which, under certain conditions, can provoke or increase the risk of developing health disorders.
The risk is divided into voluntary (driving a car); forced (synthetic substances); known (household detergents); exotic (microorganisms created by genetic engineering); chronic; catastrophic (accident); with visible benefits (hair dyes); without visible advantages (gaseous emissions from incinerators); self-controlled (car driving); controlled by others (pollution); justified (minimum in this situation); unjustified (maximum or perceived without evaluating the alternative in a particular situation).
Risk of adverse health effects- is the probability of developing undesirable effects in the population at certain levels and duration of exposure to an environmental factor. As exposure increases, the risk increases. Risk factors can be associated with a person's lifestyle, exposure to environmental factors, genetic characteristics, biological factors (body status, gender, age, chronic diseases, etc.).
The procedure for identifying causal dependence is based on the basic postulates formulated by the English biosta-
tist A. Hill. The most important criteria for the presence of causation and connection are temporal, biological and geographical plausibility (Revich B.A., Avaliani S.L., Tikhonova G.I., 2004).
Temporary Plausibility indicates that the exposure preceded the disease (with the obligatory consideration latency period).
biological plausibility is that information about the toxicological characteristics of a substance is basic for understanding the nature of its impact on human health.
Geographic plausibility indicates the relationship between the localization of cases of illness or death and the location of the source of pollution (taking into account the distance from the source of pollution, exposure routes, wind rose, topography of the area and groundwater, food sources, migration processes and population mobility, etc.).
statistical link strength between the studied factor and observed changes in health status. This connection should be strong enough to differentiate the influence of the factors under study from other possible influences; the exposure must be associated with a relatively high risk of developing the disease, and the relationship between cause and effect must be strong and statistically significant. Otherwise, it is impossible to differentiate the influence of the studied factor and other possible etiological and modifying factors;
connection specificity(certain factors - certain effects), i.e. whether a given cause leads to a specific effect. Ideally, one cause should produce one effect. However, some factors, such as smoking, can lead to a number of diseases: chronic bronchitis, lung cancer, bladder cancer, and also act as risk factors for the development of many other diseases (for example, cardiovascular system);
authenticity. The findings are based on correct setting studies that take into account interfering factors and have sufficient reliability;
dependence "exposure - effect"(the risk of development of the studied effect should increase with increasing exposure);
connection persistence(the relationship under investigation should be observed in other well-designed studies);
Reversibility (effectiveness of intervention measures) - elimination or reduction of the level of exposure to the factor under study should lead to a decrease in the risk of developing the observed effect;
analogy(correspondence of the data obtained with information about the impact of other factors close in the mechanism of action) - parallels with other well-studied cause-and-effect relationships. The considered association is consistent with other scientific data and the results obtained in the experiment.
The concept of risk applies primarily to population level. As an assessment of the health status of a population, demographic indicators are used: fertility, mortality, natural population growth, etc. The health of individual groups can be assessed by the level of physical development, various types of morbidity (children's, professional, etc.), seeking medical help, temporary and persistent disability, etc. For reliability, not absolute, but relative indicators of health are used, which make it possible to trace its changes in time and space.
Disease prevalence rate. It characterizes the state of health of a population at a particular point in time and in a particular area. It shows what proportion of the population is sick with a particular disease at the time of the study:
The value of the base 10 n can be 100, 1000, 10,000 or 100,000 and is taken depending on the frequency of occurrence of the disease. For malignant neoplasms (MN), it is always taken equal to 100,000.
In addition to prevalence, it is important speed new cases of the disease currently being studied. For this, the incidence rate is used. It characterizes the intensity of changes in the state of health, i.e. the rate of transition of members of the population from the state of "healthy" to the state of "sick", and is determined by the formula:
When analyzing the state of health of the population, general and special indicators (coefficients) of morbidity and natural movement of the population (birth rate, death rate, natural increase) are also used.
General odds give an integral assessment of the process. They are strongly influenced by other factors etiologically related to the disease under study (eg population composition by age, sex). It is no coincidence that they are called rough, and in order to obtain comparable and reliable data, they additionally carry out standardization compared coefficients according to a single standard to exclude the influence of age, sex and other differences in the compared groups.
There are 3 types of standardization: direct, indirect and reverse. The choice of one or another method is determined by the nature of the data that are available. The indirect method is the most accurate, and the reverse method is the least accurate. The reverse applies only in cases where there is no data on the age structure of the compared groups and the age composition of the sick or deceased.
Special (private) coefficients reflect the frequency of events for certain categories, for example, in certain gender and age groups.
All of these indicators can be obtained from the materials of the statistical reporting.
Using the above and other indicators, determine the main indicator - risk or absolute risk (R), which measures the probability of an adverse event (illness, mortality, etc.) in one person over a certain period of time (usually 1 year):
At the same time, the risk of occurrence of certain diseases is determined by comparing the indicators in population groups exposed and not exposed to the studied effects. To quantify the impact of potentially hazardous exposures, an absolute or relative comparison of health indicators in groups of exposed and unexposed individuals is used. An absolute comparison is determined based on risk difference (RR), while relative risk is used for relative risk (RR).
Risk difference (RR) also called attributable risk. This is the difference in the risk value in the exposed (exposed, P e) and unexposed (P o) groups:
RR \u003d R e - R o.
The PP indicator indicates how much the morbidity (mortality) increases due to the influence of the studied factor. Such information makes it possible to determine priority areas for action by both the state in general and healthcare in particular.
Relative risk (RR) is calculated from the ratio of these quantities:
OR \u003d R e / R o.
Relative risk is an intensive indicator and reflects the increase in the exposed probability of occurrence of events compared to the background.
The considered indicators of PP and RR are informative only if the groups being compared are in a “pure experimental field”, i.e. differ only in the presence or absence of the studied factor and its impact on human health. If this condition is not met (there are “interfering” factors: age, gender, bad habits, etc.), then the indicator is used to account for them - standardized relative risk (RRR). To study mortality, a standardized mortality rate (SRM) is used. The definition of COP is based on an indirect method of standardization.
When calculating the risk of deterioration in the health status of the population from the impact of various environmental factors, the concepts "attribute fraction for exposed faces"(AFe) and "attribute faction for the population"(AFN).
AFE (additional risk) shows the proportion of diseases in the exposed group, due to the impact of the studied adverse factor.
It is calculated according to the formulas:
This value reflects excess morbidity (mortality) that could be prevented if the action was eliminated.
growing factor. So, for example, if the death rate from lung cancer in smokers is: (10.8 - 1.0) / 10.8 x 100 \u003d 90.1%, then this means that over 90% of deaths from lung cancer in smokers are the result of smoking.
Attribute Fraction for the Population (AFN)- population additional risk, characterizes the incidence due to the risk factor for the entire population and not just in the group of exposed faces. That is, both the biological effect of the studied factor and the proportion of the exposed population are taken into account:
where f is the proportion of exposed faces in the population.
AF n shows the proportion of cases of the disease among the entire population, attributed to the influence of the studied factor, which can be eliminated in the event of a complete cessation of its influence on the population.
In addition to the terms considered in the concept of risk and its actual calculations, such a concept as "exposure".
"Exposed"(person, object). If we are talking about a person, then the type of contact with the risk factor, the route of entry harmful substance into the body (action on the body), duration and intensity of action, characteristics of concomitant factors: physical, chemical, etc.
In establishing cause-and-effect relationships in the “man-environment” system, certainty and a clear understanding of the meaning of some more definitions matter. In particular, there should be clarity in the concepts: “impact”, “disease”, “healthy”, “sick”, etc.
When establishing a causal relationship, two types of studies can be carried out: transverse and longitudinal.
Cross-sectional studies(cross-sectional studies) describe the distribution of health characteristics of the studied group at a certain point in time. Examples of cross-sectional studies can be population censuses, medical examinations of certain groups of the population, etc.
Longitudinal studies provide for the study of the frequency with which persons of the compared groups (populations) pass from the state of "healthy" ("live") to the state of "sick" ("dead"). At
This type of research uses two main research designs: cohort and case-control.
cohort study involves the study of the processes of morbidity (mortality) in cohorts of persons exposed and not exposed to the studied effects. A distinctive feature of this study is the correspondence of its direction to the time vector "exposure - disease". The scheme of the cohort study is presented in Table. 3.2.
Table 3.2. Presentation of data from cohort studies
Based on these data, risks are determined for each of the groups: exposed a and unexposed c:
and also get the value of the relative risk:
In cohort studies, case-control studies are used to analyze the causes of rare diseases or diseases with a long latent period, as well as in cases where the hypothesis of an association between a risk factor and a specific disease does not have convincing evidence. The method of evaluating the data in this case is somewhat different (Table 3.3).
Table 3.3. Representation of data according to the "case-control" scheme
With this method of research, the relative risk assessment is the odds ratio (English Odds ratio - OR). It is the quotient of the odds of being exposed in sick people (a/b) by that of healthy people (c/d):
Having become acquainted with the basic conceptual apparatus of the concept of risk, we will consider the concept of health risk analysis (Fig. 3.1).
From fig. 3.1 it follows that the process of the probability of development and the severity of adverse effects implies the existence of the following stages:
1. Hazard identification.
2. Evaluation of the dependence "exposure (dose) - response".
3. Assessment of exposure (impact).
4. Risk characteristics, etc.
Hazard identification: collection and analysis of data on all sources of pollution of the object of study, identification and determination of harmful factors, selection of priority chemicals for the study.
Rice. 3.1. Human health risk analysis scheme
Evaluation of the dependence "exposure (dose) - response". Reflects the quantitative relationship between the level of exposure and response
organism. It is important to remember the two extreme manifestations of the harmful effect: carcinogenic and non-carcinogenic. They have a different geometric shape of the dose-response relationship.
For non-carcinogens, this is an S-shaped (sigmoid) curve, the left branch of which coincides with the abscissa at the point corresponding to the zero effect, since these agents cause risk only when thresholds or safe exposure levels are exceeded (Fig. 3.2).
As for carcinogens, as already mentioned, they do not have a threshold, so their dose-effect relationship passes through zero, i.e. there is no risk only at zero value. To assess the parameters of the risk of carcinogens, a linear extrapolation of the smallest of the doses established in the experiment or epidemiological studies to the zero dose is carried out (Fig. 3.3).
Carcinogenic potential factors are slope factor (SF) and unit risk (UR). The first reflects the degree of increase in carcinogenic risk with increasing exposure dose and is measured in mg/kg -1 . A single risk characterizes the carcinogenic risk associated with a concentration of a substance in the air of 1 μg / m 3 or in drinking water 1 µg/l. It is calculated by dividing SF by body weight (70 kg) and multiplying by pulmonary ventilation (20 m 3 /day) or daily water intake (2 l).
If there is information about UR and SF, it is possible to predict the individual (additional to the background) risk of developing cancer with different pathways of carcinogen intake.
Rice. 3.2. Dose-response relationship for non-carcinogenic factors
Rice. 3.3. Establishment of factors of carcinogenic potential
Depending on the route of entry, single risks are determined by the formulas:
If the number (N) of the population exposed to a substance at a known concentration is known, then one can calculate population risk- the number of additional (to the background level) cases of cancer in a given population:
For occupational exposures, the above formulas are adjusted to reflect differences in exposure factors. So, under the condition of an 8-hour working day and 40 years of work experience (with 240 working days per year and an average value of pulmonary ventilation per shift of 10 m 3), a single risk (1Ж p) will be:
From here one can calculate individual risk development of cancer for work experience:
where WITH- the average concentration of the chemical for the entire period of production activity.
The assessment of the risk of developing non-carcinogenic effects for individual substances is carried out on the basis of the calculation coefficient dangers:
When characterizing non-carcinogenic effects in the case of combined or combined exposure to chemical compounds, hazard index(1 o). If there is a simultaneous intake of several substances by the same route (inhalation, oral), the calculation is carried out according to the formula:
where K oi is the hazard coefficient for the individual components of the mixture of active substances.
If the active substances enter simultaneously in several ways, as well as with multi-level and multi-route exposure, the risk criterion is total hazard index:
where: I oi is the hazard index for individual exposure pathways or exposure routes.
The calculation of hazard indices is carried out taking into account critical organs (systems), since in the case of a mixture of substances affecting the same organs or systems of the body, the most likely type of their combined action is summation (additivity).
From the above data it is quite clearly seen that the methodology for assessing the risk to public health due to the influence of the environment seems to be a rather complicated tool in practical use. But today it is a mandatory procedure, no matter how difficult it may be to implement. The risk assessment methodology is widely used by international organizations (WHO, EU) to establish indicators of the quality of atmospheric air, drinking water, food products, assessment of health damage from air pollution by motor vehicles, energy enterprises, etc.
In Russia, the development of research on this issue was most developed after the release of the joint resolution of the Chief State Sanitary Doctor of the Russian Federation and the Chief State Inspector of the Russian Federation for Nature Protection dated November 10, 1997 “On the use of risk assessment methodology for managing the quality of the environment and public health in the Russian Federation ".
The risk assessment methodology has become one of the most important tools for social and hygienic monitoring (SHM). The results of risk assessment open up new possibilities for predicting adverse changes in the health status of the population and are a prerequisite for the development and recommendation of risk management measures, i.e. on the management of systems of legislative, technical and regulatory solutions aimed at eliminating or significantly reducing the risk to public health (Onishchenko G.G., 2005).
In recent years, a number of official and regional scientific and methodological documents on risk assessment have been published. The Chief State Sanitary Doctor of the Russian Federation approved the Guidelines for the Assessment of Occupational Risk to the Health of Workers. Organizational and methodological bases, principles and criteria for assessment” (P2.2.1766-03) and “Guidelines for assessing the risk to public health when exposed to chemicals that pollute the environment” (P2.1.10.1920-04). As part of the Scientific Council of the Russian Academy of Medical Sciences and the Ministry of Health and Social Development of the Russian Federation on human ecology and environmental health, there is a problematic commission "Scientific foundations for a comprehensive risk assessment of the impact of environmental factors on health", whose task is to coordinate scientific developments in this area, as well as - together with Rospotrebnadzor of the Russian Federation , Ministry of Health and Social Development of the Russian Federation - implementation of the development of scientific and methodological support for practical work on risk assessment.
As for the actual activity in the field of risk assessment methodology, in accordance with the existing legislation, only accredited risk assessment bodies. Unfortunately, there are not many such organizations. According to the report “Results of the activities of the Federal Service for Supervision of Consumer Rights Protection and Human Welfare in 2006 and Tasks for 2007”, as of 01.01.2007, the number of units for conducting SHM was 86, including independent ones - 36, according to risk assessment - 2 and 2, respectively. This once again confirms the complexity of the problem under consideration.
Thus, today in Russia there is a fairly well-formed two-level system for the implementation of the methodology for assessing the risk to the health of the population of the country, including the scientific-methodological and practical levels.
3.4. HEALTH IS A FUNDAMENTAL CRITERIA FOR ASSESSING HUMAN WELL-BEING AND THE STATE OF THE ENVIRONMENT
3.4.1. Methodology for studying the health of the population
The problem of studying the phenomenon of health is important not only for medicine, but also for humanity as a whole. So far, only one of its definitions has been given, which was proposed by WHO experts (see Chapter 1). It exists, but even this formulation is not entirely accurate in the system “man and his health - environment”. It is no coincidence that when considering this problem, it is stated that it is very difficult to define the concept of "health of the population (human)". This is true, but there are also encouraging successes.
Analyzing the currently existing definitions of health, we can conclude that in a certain sense they can be grouped according to semantic features.
In terms of definitions, first of all, the philosophical content of the concept of “health”, which was formulated by K. Marx, is revealed: “Disease is a life constrained in its freedom”, implying that under health in this case, the absence of disease should be understood. The second kind of definitions to some extent details the above definition. This includes the WHO wording mentioned above, which states not only the absence of disease, but also the presence of "...complete physical, mental and social well-being ...".
Both aspects of the phenomenon of health in the general philosophical, methodological terms, apparently, are fair and have the right to exist, but the question arises - how to use them in practice? After all, the conceptual apparatus in both cases does not lend itself to a quantitative assessment accessible to the doctor. And this already contradicts the very essence of hygienic science, which, as already emphasized, has the status of evidence, i.e. quantitative discipline. Therefore, with particular care,
consider another methodological approach in determining the phenomenon of health.
The essence of the third group of definitions of health is that its supporters consider this concept either as process(“health is a process ...”, or as condition("health is a state...").
Without going into details and inconsistency in the interpretation by different authors of the very concepts of "process" and "state", we note that both phenomena (process, state) lend themselves as quality(in the most general form: progress or regress), and quantitative(more or less) analysis. And from this point of view, this approach should be considered more acceptable. Thus, it becomes possible to apply certain qualitative and quantitative criteria in relation to the system "man (people) - environment" in specific conditions.
But in relation to a person, his health needs a clear definition: life is a “process”, and health is a “state”. Only on the basis of such an understanding of such a complex biosocial being as a person, one can further move along the path of studying human health (population) as a criterion of social and hygienic well-being. At the same time, it is necessary to keep in mind other concepts (definitions) necessary for progress in this direction.
General biological health(norm) - the interval within which the quantitative fluctuations of all physiological systems of the body do not go beyond the optimal (normal) level of self-regulation.
Population health- a conditional statistical concept that characterizes the state of demographic indicators, physical development, the frequency of premorbid, morbid indicators and the disability of a certain group of the population.
individual health- the state of the body in which it is able to fully perform its social and biological functions.
Population- a set of people living in a certain territory and capable of self-restoration of their numbers.
Current population- the number of all persons who were in the given settlement at the critical moment of the census, including those temporarily residing and excluding those temporarily absent.
Permanent population- persons permanently residing in this locality, including those temporarily absent and excluding temporary residents.
Legal population- persons included in the lists of residents of a given territory, regardless of their permanent place of residence and stay at the time of the census.
Estimated actual population- persons present in the territory at the time of the census.
Population- part of the population within a specific territory, identified according to the most characteristic socio-economic, environmental and other factors for its life, demographic and ethnic characteristics, lifestyle, value orientations, traditions, etc., uniting it as a whole with its inherent group-wide processes of forming the level of health.
Cohort- part of the population, united by a single date of occurrence of a certain event (birth, arrival in a given region or residence in a certain zone (place), beginning of labor activity, marriage, military service, etc.).
For rate population health WHO recommends the following criteria (indicators):
medical(morbidity and frequency of individual premorbid conditions, general and child mortality, physical development and disability);
social welfare(demographic situation, sanitary and hygienic indicators of environmental factors, lifestyle, level medical care, social and hygienic indicators);
mental well-being(incidence of mental illnesses, frequency of neurological conditions and psychopathies, psychological microclimate).
Analyzing the criteria for assessing population health, we once again make sure that the definition of the WHO health phenomenon cannot be applied to an individual. In addition, it is not applicable to children, young men, which is its significant drawback.
Most of these indicators are medical, reflecting not the actual level of health, but the prevalence of diseases (morbidity, disability, mortality), i.e. indicators of morbidity (“illness”). It is assumed that the higher they are, the lower the level of health of the corresponding population group, i.e. and in this case, the path to assessing health goes through "ill health", which does not apply to new approaches.
It should be noted that WHO has attempted to more subtly and in detail outline the criteria for social well-being, which include:
1. Percentage of the gross national product used for health care.
2. Availability of primary health care.
3. Coverage of the population with safe water supply.
4. Percentage of people immunized against infectious diseases that are especially common among the population of developing countries (diphtheria, whooping cough, tetanus, measles, poliomyelitis, tuberculosis).
5. The percentage of women being served by qualified personnel during pregnancy and childbirth.
6. Percentage of children born underweight (less than
7. Average life expectancy.
8. Level of literacy of the population.
It is easy to see that this, like other approaches, also gravitates more towards a "theoretical" assessment of health, far from quantitative. Therefore, in practice, the already mentioned medical indicators reflecting morbidity, mortality, etc.
The sources of information in this case are:
1. Official reports of health facilities, health authorities, social security, registry offices, state statistics bodies.
2. Specially organized registration of morbidity and mortality in health facilities - prospective studies.
3. Retrospective information for the study period.
4. Data from medical examinations.
5. Data from clinical, laboratory and other studies.
6. Results of medical and social research.
7. Results of mathematical modeling and forecasting. In general, the integral assessment of the health status of the population
is carried out in the following algorithm (Fig. 3.4).
From fig. 3.4 it can be seen that before achieving the desired result - "Indicators of the health status of the population", it is necessary to perform many intermediate evaluation actions (qualitative and quantitative analyzes, distribution into health groups, determination of health indices, etc.).
Rice. 3.4. Integral assessment of population health (Goncharuk E.I. et al., 1999)
But an even more difficult task lies ahead at the stage of linking (pairing) indicators of the health status of the population and environmental factors (Fig. 3.5).
At the same time, it is important to take into account one important circumstance: to model the relationships in the “environment-health” system and determine its quantitative characteristics (without this it is impossible to predict the situation), mathematical and statistical analysis is used, in which generalized health indices are used as “operational units”. They give an idea of the level of health of the population, integrating a number of indicators. In this regard, rather stringent requirements are applied to them, which the WHO formulated back in 1971:
Availability of data for index calculation;
Completeness of coverage of the population;
Reliability (data should not change in time and space);
Computability;
Acceptability of the method of calculation and evaluation;
Reproducibility;
Specificity;
Sensitivity (to relevant changes);
Validity (a measure of the true expression of factors);
Representativeness;
Hierarchy;
Target viability (adequate reflection of the goal of improving health).
Shown in Fig. 3.5 the algorithm for solving the problem of studying relationships in the system "man (population) - environment" shows how complex and multifaceted this task is. It can only be done by specialized scientific (research institutes) or practical bodies and institutions accredited in this field.
The end result of such studies is to determine the level (indicative level) of the health of the population. As an example, an assessment of the named levels according to certain criteria is given (Table 3.4).
Table 3.4. Approximate assessment of the level of public health
Health level | Morbidity by referrals per 1000 population | Morbidity with temporary disability per 1000 employees | |||||||
primary | general |
||||||||
town | village | town | village | cases | |||||
Very low | |||||||||
Very tall | |||||||||
Note: 1 - disability per 1000 population; 2 - child (infant) mortality, %; 3 - total mortality,%.
One of the final stages of an epidemiological study of public health is a quantitative assessment of the relationship between the severity of environmental factors and the level of health.
Rice. 3.5. Identification and assessment of the relationship between environmental factors and public health
For this, they usually mathematical modeling, i.e. built according to special methods mathematical models, reflecting the dependence of the level of health of the population on the studied factors. In the process of such an analysis, the degree of influence of each of the studied factors on the level of public health is established.
One of the ways to make a conclusion about the degree of influence of each factor is to use the criterion of correlation and regression analysis - determination coefficient.
The advantage of this criterion is that it characterizes the relative role of each specific environmental factor in influencing the level of health. This makes it possible to rank the factors according to the degree of their harmfulness and to develop prevention programs taking into account the priority of their action.
The epidemiological study of the state of health of the population ends with the development of preventive recommendations and their implementation in practice, followed by an assessment of the effectiveness of implementation.
From the materials discussed above, it can be seen that for research in the "environment - health of the population" system, numerous evaluation actions are required, which can only be carried out by large scientific or practical organizations or their complex. For smaller studies, more simplified approaches can be applied, for example cohort studies.
In this case, the algorithm may be as follows - it is necessary to decide in the directions of the study of the state of health (Fig. 3.6).
Rice. 3.6. Main directions of health research
Having decided on the directions of research, they conduct a purposeful study of the indicators of the state of health presented in Fig. 3.7. The interest lies in the fact that here it is possible to use both individual and collective and even population approaches.
As for the comparison of the obtained indicators, indices, etc. with environmental factors, it is carried out in accordance with the settings discussed above.
3.4.2. Environmentally dependent diseases and methods for their diagnosis
Environmentally dependent diseases of the population include those diseases in the etiology of which environmental factors play a certain role. Often in this case, the following terms are used: “eco-disease”, “anthropoecological diseases”, “environmentally dependent diseases”, “ecopathology”, “diseases of civilization”, “diseases of lifestyle”, etc. In these terms, as can be seen, the emphasis is on the environmental or social conditionality of many diseases.
Rice. 3.7. Human health indicators (populations)
Depending on the nature (physical, chemical, biological, etc.), the environmental factor can play a different role in the etiology of the disease. He is able to act as etiological, causal, practically determining the development of a specific specific disease. At present, approximately 20 chronic diseases of the population are reasonably reasonably associated with the impact of environmental factors (Minamata disease, caused by pollution of marine and river fauna with mercury-containing industrial effluents; Itai-itai disease, as a result of watering rice fields with water containing cadmium, etc.) (Table .3.5).
If the environmental factor acts as the cause of the disease, then its effect is called deterministic.
Table 3.5. List of known environmentally dependent diseases
Note. * Only 40 years after the establishment of an ecological disaster, the fish and shellfish of Minamata Bay were recognized as safe for human health.
The environmental factor can play a role modifying those. change the clinical picture and aggravate the course of a chronic disease. In this case, the risk associated with a certain factor is modified depending on the presence of another factor or exposure. For example, atmospheric air pollution with nitrogen oxides provokes symptoms of respiratory dysfunction in patients with chronic respiratory diseases.
In some cases, the studied factor may have mixing effect. An example of confounding factors is age and tobacco smoking when studying the effect of atmospheric pollution on the risk of developing respiratory diseases, tobacco smoking when studying the risk of developing lung cancer and pleural mesothelioma when exposed to asbestos, etc.
Diseases can also be caused imbalance between the internal and external environment of the body, which is especially true for endemic diseases. The etiology and pathogenesis of some endemic diseases are well studied. For example, it has been found that observed in many regions of the world fluorosis due to excessive intake of fluorides with drinking water; the occurrence of endemic goiter is associated with insufficient iodine content in the environment and food, and, in addition, may be the result of the action of certain chemicals that violate the hormonal status.
Among the causes of malignant neoplasms, the leading place is occupied by nutrition and smoking, i.e. factors related mainly to a person's lifestyle (Fig. 3.8).
3.4.3. Environmentally determined diseases resulting from the action of chemical factors
A number of signs allow the doctor to suspect the environmental conditionality of the observed violations of the health status of the population. Causal relationships between disease and exposure to chemicals are often more difficult to recognize and understand than those associated with infectious diseases or foodborne illnesses. Before analyzing the ecological conditionality of the disease, it is necessary to exclude the infectious or nutritional nature of the observed health disorders.
Rice. 3.8. Likely Causes of Cancer
The most characteristic signs of ecological, in particular chemical, the nature of the disease:
Sudden outbreak of a new disease. It is often interpreted as infectious, and only a thorough clinical and epidemiological analysis can identify exposure to chemicals as the true cause;
Pathognomonic (specific) symptoms. In practice, this sign is quite rare, since the specific signs of intoxication are mainly manifested at relatively high levels of exposure. Much more diagnostic value has a certain combination of non-specific symptoms;
A combination of non-specific signs, symptoms, laboratory data, unusual for known diseases;
Absence of contact routes of transmission characteristic of infectious diseases. For example, people living in the same apartment with asbestos workers have a very high risk of developing lung and pleural tumors, which is due to exposure to asbestos particles carried along with contaminated workwear;
Common source of exposure in all victims; connection of diseases with the presence of chemicals in one of the environmental objects;
Detection of the "dose-response" relationship: an increase in the likelihood of developing a disease and / or an increase in its severity with an increase in dose;
The formation of clusters (clumps) of the number of cases of diseases, usually relatively rare in the population;
Characteristic spatial distribution of disease cases. Geographic localization is characteristic, for example, of almost all endemic diseases;
Distribution of victims by age, gender, socio-economic status, profession and other characteristics. The most susceptible to the disease are often children, the elderly, patients with one or another chronic pathology;
Identification of subgroups with an increased risk of the disease. Such subgroups can often indicate the pathogenetic features of the influencing factor;
Temporal relationship between disease and exposure to factors. It is necessary to take into account the possibility of a latent period ranging from several weeks (tricresyl phosphate - paralysis, dinitrophenol - cataracts) to several decades (dioxins - malignant neoplasms);
The connection of diseases with certain events: the opening of a new production or the start of production (use) of new substances, the disposal of industrial waste, a change in diet, etc.;
Biological plausibility: the observed changes are supported by data on the pathogenesis of the disease, the results of studies on laboratory animals;
Detection in the blood of the affected chemical substance or its metabolite;
Effectiveness of intervention measures (specific preventive and curative measures).
Each of the above signs separately is not decisive, and only their combination allows us to suspect the etiological role of environmental factors. This is the extreme difficulty of establishing ecological nature diseases of an individual.
The relationship between exposure to environmental factors and health disorders can be different. The most simple
to analyze the situation when the very fact of impact necessary and sufficient for the occurrence of a disease (for example, a snake bite of a person is the risk of death). In such situations, the background (without the studied impact) incidence rate is zero.
The impact can also be necessary but not sufficient for the development of the disease. The mechanism of chemical carcinogenesis includes several successive stages: initiation(primary cell damage), promotion(transformation of initiated cells into tumor cells), progression(malignant growth and metastasis). If a chemical has only promoter or initiator properties, then its effect is not sufficient for the development of cancer.
Another variant of causal relationships is the case when the impact enough but not necessary for the development of the disease. For example, exposure to benzene can cause leukemia, but leukemia can occur without exposure to this substance.
For the development of so-called conditioned diseases, exposure to environmental factors can be insufficient and unnecessary. As already noted, most noncommunicable diseases have a complex, multiple etiology, and the risk of their development depends on many different factors. The complexity of the analysis in such situations is due to the fact that in the population and without the studied environmental factor, there is a certain and often relatively high background level of morbidity associated with other known or unknown causes.
Population hygiene diagnostics is used to assess the environmental situation in various areas and identify health risks associated with certain harmful enterprises or other sources of environmental pollution. Under favorable environmental conditions the absence of anthropogenic sources of adverse effects on the environment and human health and natural, but anomalous for a given area (region) natural, climatic, biogeochemical and other phenomena. Depending on the intensity of the influence of environmental factors on the health of the population, there are zones of ecological emergency and zones of ecological disaster.
The ecological state of the territories is assessed by a set of medical and demographic indicators. These indicators include perinatal, infant (under the age of 1 year) and child (at the age of 14) mortality, the frequency of congenital malformations, spontaneous miscarriages, the structure of morbidity in children and adults, etc. Along with mortality and morbidity, the average duration of life, the frequency of genetic disorders in human cells (chromosomal aberrations, DNA breaks, etc.), shifts in the immunogram, the content of toxic chemicals in biosubstrates (blood, urine, hair, teeth, saliva, placenta, human milk, etc.).
At the present time in Russia there are more than 300 ecological disaster zones, including Moscow, occupying a total of 10% of the territory, where at least 35 million people live.
Along with population hygienic diagnostics, there is also individual, aimed at identifying causal relationships between health problems in a particular person and potentially harmful environmental factors that have been or have been in the past. Its relevance is determined not only for the correct diagnosis, treatment and prevention of diseases, but also for establishing a possible relationship "environment - health" in order to determine material compensation for damage to human health as a result of environmental or production factors.
Potential health effects are categorized according to their severity. catastrophic(untimely death, reduced life expectancy, severe impotence, disability, mental retardation, congenital deformities), heavy(dysfunction of organs, nervous system, developmental dysfunction, behavioral dysfunctions) and unfavorable(weight loss, hyperplasia, hypertrophy, atrophy, changes in enzyme activity, reversible dysfunction of organs and systems, etc.).
As already noted, the reactions to external influences in the population in most cases are probabilistic in nature, due to differences in individual sensitivity of people to the action of the environmental factor under study. On fig. 3.9 shows the spectrum of the biological response of the population to the impact of environmental factors. As can be seen from the figure,
in the largest part of the population, as a result of exposure to harmful factors, latent forms of diseases and prenosological conditions occur that are not detected by mortality, seeking medical help, and hospitalized morbidity. Only a targeted and in-depth medical examination is able to assess the true state of health in the exposed population. This problem is intended to be solved hygiene diagnostics.
Rice. 3.9. Schematic spectrum of biological responses to environmental pollution exposure (WHO Expert Committee, 1987)
Hygienic diagnostics focuses on the identification of premorbid (premorbid) conditions. The subject of research of hygienic diagnostics is health, its value. It is carried out by a doctor in order to assess the state of adaptive systems, early detection of stress or violations of adaptive mechanisms, which can later lead to illness. The doctor cannot and should not be complacent even in the case when the patient came with certain complaints, but it was not possible to detect objective signs of the disease in him. Such people (unless they are explicit simulators) should be classified as a risk group (observations) and their state of health should be studied in dynamics.
An example of such a case is the so-called multiple chemical sensitivity syndrome (MCS). This is an ecological disease with chronic polysystemic and polysymptomatic disorders caused by environmental factors of low intensity. With this disease, the mechanisms of adaptation of the organism to the action of various factors are disrupted against the background of hereditary or acquired increased individual sensitivity to chemicals. Multiple chemical sensitivity syndrome is provoked by a wide variety of chemical compounds present in environmental objects at concentrations far below the MAC for the entire population as a whole.
The most reliable diagnostic criterion for multiple chemical sensitivity syndrome is the complete disappearance of all symptoms of diseases after the elimination of exposure to potentially harmful factors within 3-5 days (for example, when changing jobs or places of residence). Re-placement of the patient in a dangerous environment for him causes a new exacerbation of symptoms. The disease often develops in people who have had acute exposure to organic solvents, pesticides in the past. Due to the complexity of diagnosing the syndrome of multiple chemical sensitivity (especially in its early stages), these patients are often diagnosed with "neurasthenia" or "psychosomatic illness". Correct differential diagnosis of multiple chemical sensitivity syndrome is possible only with a thorough and purposeful history taking with an emphasis on past chemical exposures, using a complex of sensitive neuropsychological, physiological, biochemical, hormonal, immunological studies, biomarkers of exposure and effect (in particular, determining the content in biosubstrates harmful organic substances and heavy metals).
The methods for diagnosing premorbid conditions are very diverse and include the study of the human immune status, the state of the regulatory mechanisms of the cardiovascular system, the processes of free radical and peroxidation (the state of antioxidant systems and lipid peroxidation), the state of enzyme systems, psychodiagnostic testing, the use of biomarkers. Premorbid conditions are observed in relatively a large number"practically healthy" people: in
37.9% of the surveyed revealed tension in the mechanisms of adaptation, 25.8% - unsatisfactory adaptation, and 8.9% - failure of adaptation.
In hygienic diagnostics, comparative assessments of the state of health are obligatory. Many so-called environmentally conditioned diseases have a polyetiological nature and a complex multi-syndromic character. To prove their connection with the quality of the environment, it is necessary to establish the dependence of the risk of health disorders on exposure and, in parallel, examine control groups that do not have a clear contact with the studied factors.
The most unfavorable consequences of the influence of chemical factors on human health are stochastic effects, those. occurrence and development of malignant neoplasms.
Oncological diseases occupy one of the first places among the causes of morbidity and mortality of the population.
Cancer development is facilitated by environmental factors (chemical carcinogens, nutritional factors, ionizing radiation), genetic (hereditary) factors, viruses, immunodeficiency, spontaneous mitotic defects.
The International Agency for Research on Cancer (IARC) classifies carcinogens based on scientific evidence of their carcinogenic effects in humans.
Classification of carcinogens (IARC)
1 - known human carcinogens; 2A - probable human carcinogens; 2B - possible carcinogens;
3 - agents not classified by carcinogenic ability;
4 - agents probably not carcinogenic to humans.
For many types of malignant neoplasms, preventive measures are extremely effective. According to WHO, preventive measures can reduce the risk of developing stomach cancer by 7.6 times, colon - by 6.2 times, esophagus - by 17.2 times, bladder - by 9.7 times. About 30% of all deaths from all types of malignant neoplasms and 85% of cases from lung cancer are associated with smoking. About 4,000 chemicals have been identified in tobacco smoke.
substances, 60 of which are carcinogens. Radon makes a significant contribution to the development of cancer. Indoor exposure to this radioactive gas causes 17,000 new cases of lung cancer each year in the US.
Approximately 1000 different chemicals have now been found to be carcinogenic to humans or laboratory animals. Below are some compounds and production processes that are dangerous in terms of the development of malignant neoplasms (List of substances, products, production processes, household and natural factors that are carcinogenic to humans, 1995).
Substances, products, production processes and factors with proven carcinogenicity to humans:
4-aminodefinil;
asbestos;
Aflatoxins (B 1 , B 2 , G 1 , G 2);
Benzidine;
Benz(a)pyrene;
Beryllium and its compounds;
Bichloromethyl and chloromethyl (technical) ethers;
Vinyl chlorides;
Sulfur mustard;
Cadmium and its compounds;
Coal and petroleum tars, pitches and their sublimates;
Mineral oils, unrefined and not fully refined;
Arsenic and its inorganic compounds;
1-naphthylamine technical, containing more than 0.1% 2-naphthylamine;
2-naphthylamine;
Nickel and its compounds;
Household soot;
Shale oils;
Chromium is a hexavalent compound; erionite;
Ethylene oxide;
Alcoholic drinks;
Solar radiation;
Tobacco smoke;
Tobacco products are smokeless;
Woodworking and furniture production using phenol-formaldehyde and urea-formaldehyde resins indoors;
Copper smelting production;
Industrial exposure of radon in the mining industry and when working in mines;
Production of isopropyl alcohol;
Production of coke, processing of coal, oil and shale tars, coal gasification;
Manufacture of rubber and rubber products;
Carbon black production;
Production of coal and graphite products, anode and hearth pastes using pitches, as well as baked anodes;
Production of iron and steel (sinter plants, blast furnace and steel production, hot rolling) and casting from them;
Electrical production of aluminum using self-sintering anodes;
Industrial processes associated with the exposure of aerosols of strong inorganic acids containing sulfuric acid.
Such a wide range of chemical factors and productions (far from complete!) requires the doctor to have an idea at least within the framework of this list about the possible risk for their patients and focus on the earliest signs of a possible ill-being in the state of people's health.
Other environmentally dependent diseases
At present, allergic diseases have acquired particular relevance due to the anthropogenic impact on the environment. Various varieties of these diseases (bronchial asthma, allergic rhinitis, dermatitis, urticaria, eczema, etc.) affect from 20 to 50% of the population of developed countries. These diseases, in fact, have become occupational diseases for medical workers (allergies to drugs, medical waste, disinfectants, etc.).
Most chemicals released into the environment behave aggressively. They have a sensitizing
modifying and other types of influence. Acting as triggers (trigger- English, literally "switch") they can provoke an allergic reaction. In table. 3.6 presents a list of factors that have an allergic effect.
In some cases, the development of allergic reactions in the population is associated with combined and complex effects, in particular, chemicals and products of biotechnological synthesis. In the city of Kirishi, 47 people developed bronchial asthma due to the combined effect of protein-vitamin complexes and atmospheric pollution. Angarsk pneumopathy, described in the literature, manifested by bronchospasm, is also apparently associated with exposure to microbial synthesis products and atmospheric pollution.
In recent years, along with "classic" allergic diseases, doctors' attention has been attracted by environmentally determined diseases, the etiology and pathogenesis of which remain poorly understood. The occurrence of these diseases is associated with the intensive chemicalization of modern society and the constant, throughout life, exposure to hundreds of various chemical compounds.
There are 2 groups of violations of the state of human health, due to the influence of the internal environment. First group is called "building related illness (BRI)" and includes health disorders etiologically associated with certain factors indoors, such as the release of formaldehyde from polymer and wood-shaving materials. After the harmful effects are eliminated, the symptoms of the disease, as a rule, do not disappear, and the recovery process may take quite a long time.
The second group is called "sick building syndrome (SBS)" and includes acute health problems and discomfort that occur in a particular room and almost completely disappear when leaving it. Sick building syndrome manifests itself in the form of headache, irritation of the eyes, nose and respiratory organs, dry cough, dry and itchy skin, weakness and nausea, increased fatigue, susceptibility to odors.
According to WHO, about 30% of new or renovated buildings can provoke these symptoms. The development of the sick building syndrome, apparently, is due to the combined and combined effects of chemical, physical (temperature, humidity) and biological (bacteria, unknown viruses, etc.) factors.
Table 3.6. Risk factors for the development of bronchial asthma (National program "Bronchial asthma in children. Strategy for treatment and prevention", 1997)
Risk groups I Risk factors
Factors predisposing to the development of bronchial asthma | Bronchial hyperreactivity |
Causal (sensitizing factors) | Household allergens (house dust, house dust mites) Epidermal allergens of animals, birds; cockroach and other insect allergens Fungal allergens Pollen allergens Food allergens Drug allergens Viruses and vaccines Chemicals |
Factors contributing to the occurrence of bronchial asthma, exacerbating the effect of causative factors | Viral respiratory infections Pathological course of pregnancy in the mother of the child Prematurity Poor nutrition Atopic dermatitis Various chemicals Tobacco smoke |
Factors causing an exacerbation of bronchial asthma (triggers) | Allergens Viral respiratory infections Physical and psycho-emotional stress Changing meteorological situation Environmental impacts (xenobiotics, tobacco smoke, strong odors) Intolerable foods, medicines, vaccines |
The causes of the diseased building syndrome most often become insufficient natural and artificial ventilation of the room, building finishing materials, furniture, irregular or improper cleaning of the premises.
Another syndrome in which environmental factors may play a role is chronic
fatigue(immune dysfunction syndrome). For the diagnosis of this syndrome, the following criteria are taken into account:
1. The role of any specific factors (for example, chronic intoxication or other chronic disease) is excluded.
2. The feeling of severe fatigue is noted for at least 6 months.
3. The feeling of fatigue is combined with a violation of short-term memory, confusion, disorientation, speech disorders and difficulties in performing counting operations.
4. At least 4 of the following 10 symptoms are present:
fever or chills;
Recurrent throat diseases;
Enlarged lymph nodes;
muscle discomfort;
Flu-like muscle pain;
Increased muscle sensitivity to palpation;
generalized weakness;
Feeling of joint discomfort;
Asymmetric damage to large joints;
Headache (in retroorbital and occipital areas);
sleep disorders;
Increased drowsiness (sleep more than 10 hours a day);
Chronic, recurring coryza.
Most patients have a functional insufficiency of killer cells. The disease occurs in people of all age groups, but most often it affects women over 45 years of age.
Most researchers consider this syndrome to be the result of dysfunction of the immune system of unknown etiology. Among the factors that can cause chronic fatigue syndrome are enteroviruses, herpes viruses, Epstein-Barr virus, genetic predisposition, stress, chemicals, including heavy metals, deficiency of antioxidant substances in the diet.
The essence of the science of hygiene, its differences from other sciences
Definition 1
Hygiene is a science that studies the influence of factors of the natural and anthropogenic environment on the state of human health and society. The goal of science is to reduce their negative impact on the body, with the help of preventive measures.
Hygiene, although in many ways reminiscent of medicine, has a number of important distinguishing features. Whereas the sick person is at the center of the study of medicine, hygiene puts the healthy person at the center of the study. In medicine, assistance is provided individually, while hygiene develops preventive measures in various groups (at work, at school, in production).
Throughout life, each person is exposed to many environmental factors. They can be both positive and necessary for a person, and negative, negatively affecting the health and condition of a person. All of them can be divided into four groups:
- chemical factors. This chemical compounds, which are part of the air, water and soil. They enter the body through plants, and their deficiency or excess can provoke disease.
- physical factors. This includes temperature, humidity, air velocity, atmospheric pressure, solar radiation, noise, vibration, and so on.
- biological factors. These are living organisms such as bacteria, fungi or protozoa that are the cause of many diseases.
- psychogenic factors. This category includes word, speech, writing. These phenomena cause emotions in a person, and this, in turn, has a strong effect on the body.
Ready-made works on a similar topic
- Course work Hygiene and ecology 410 rub.
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All of the above factors are closely related to the nature work activities of man and with the peculiarities of his natural and man-made environment.
Hygiene tasks
The tasks of hygiene include the substantiation of hygienic standards for environmental factors. The hygienic standard is the minimum or maximum value of a quantitative indicator characterizing the biological factor of the environment, which is acceptable for the normal functioning of the organism.
This includes the establishment of maximum permissible concentrations of harmful impurities (MPC) in water, in the atmosphere, in soil, and so on.
The science of hygiene also includes a number of independent areas:
- Communal hygiene;
- Hygiene of nutrition, labor, children, adolescents, etc.
- Gerohygiene (a science that studies the effect of environmental factors on the aging process of the body).
- personal hygiene and so on.
Methods of Science
Depending on what tasks the researchers face, a wide variety of methods of this science are used, among which the following can be distinguished:
- The method of sanitary inspection is used to study the environment. It consists in examining and describing objects in the environment, for example, an industrial plant, a canteen, a water source.
- The method of laboratory research is used in assessing the characteristics of environmental factors to obtain objective data.
- The monitoring method is used for continuous monitoring of certain environmental parameters and for their automatic registration.
- The clinical method is used during medical examinations, it can be used to find out how the body reacts to changing environmental factors. For example, visual impairment in poor lighting conditions or lung disease that develops in dusty rooms.
- Method of laboratory experiment. In this case, in the laboratory, they reproduce various environmental conditions and monitor how the body reacts to changes - negatively or positively. All data is carefully processed, and animals or volunteers act as experimental subjects.
- statistics method. It covers the health indicators of the entire population and allows you to find out the positive or negative impact of the environment on the body.
Remark 1
Do not confuse the concepts of hygiene and sanitation, these two sciences are different from each other. Hygiene is the science of the influence of life and work on human health. Hygiene involves the development of rules and regulations aimed at preventing various diseases. Sanitation is the practical implementation of hygienic standards and rules.
Health education is currently a very important area in public education. Dissemination of knowledge about the causes of most diseases and measures to prevent them helps not only to improve the environmental and hygienic education of the citizens of the country, but also to prevent most epidemics and epizootics.
In this case, the role of medical workers is significant. It is the representatives of the medical field that are the main source of reliable knowledge about diseases and remedies for them. Educational thematic conversations with the population and information bulletins are elements of the work to prevent mass diseases among the population.
Hygiene and ecology
Recently, hygiene is closely related to human ecology, sciences have both much in common and many differences. However, hygienic science is not possible without the knowledge that ecology provides.
It is worth noting that ecology and hygiene still have fundamental differences. The fact is that hygiene, through sanitation, is aimed at weakening the influence of negative factors on a person and his environment. While the science of ecology, through a branch - the science of nature protection, seeks to protect the natural environment from negative influences, including anthropogenic impact.
Both sciences must act together, this is dictated by the fact that it is impossible to solve environmental problems only with the help of legal instruments of the environmental order and at the same time not take into account the sanitary and epidemiological well-being of the population. And vice versa, it is impossible to ensure the well-being of the population in a dangerous environmental situation.
E.L. IGAI
Hygiene and human ecology
(lecture course)
Study guide for teachers and students
educational institutions of secondary vocational
education studying in medical technical schools and colleges
Minusinsk, 2012
Foreword | ||||
Section 1. The subject of human hygiene and ecology |
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Introduction. The subject and content of hygiene, ecology and human ecology | ||||
Fundamentals of General Ecology | ||||
Environmental factors and public health | ||||
Section 2 Environmental health |
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Atmospheric air and its physical properties | ||||
The chemical composition of the air environment and its hygienic significance | ||||
Ecological significance of water | ||||
Hygienic value of water | ||||
The ecological significance of the soil | ||||
The hygienic value of the soil | ||||
Section 3. Ecological and hygienic problems of nutrition |
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Nutrition and human health. The importance of basic nutrients in ensuring the vital activity of the body. The role of vitamins and minerals. Fundamentals of rational nutrition. Diet | ||||
Sanitary and hygienic requirements for food units of medical institutions. Hygienic requirements for food quality. food poisoning | ||||
Diseases associated with the nature of nutrition. Therapeutic and preventive nutrition | ||||
Section 4. Influence of production factors on the state of health and human activity. Classification of the main forms of labor activity |
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Basic concepts of occupational hazards and occupational diseases. Hygienic requirements for optimizing working conditions for women and adolescents. Occupational injury and measures to combat it. | ||||
Occupational hygiene of medical personnel in medical institutions | ||||
Section 5. Urban ecology, environmental and hygienic problems of housing, medical institutions |
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Features of the formation of the urban environment. The main measures to improve the environment of populated areas. Hygienic requirements for living quarters. | ||||
Hygienic requirements for medical and preventive institutions | ||||
Section 6. Healthy lifestyle and personal hygiene |
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Components healthy lifestyle life (HLS) and ways of their formation. Methods, forms and means of hygienic education | ||||
Fundamentals of personal hygiene of a healthy person. | ||||
Section 7. Hygiene of children and adolescents. |
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Anatomical and physiological features of childhood and adolescence. The state of health and physical development of children and adolescents. school maturity. | ||||
Hygienic requirements for the layout, equipment and maintenance of children's institutions. | ||||
Literature | ||||
FOREWORD
Nursing professionals with knowledge in the field of ecology can provide effective assistance in the treatment process, bringing to the population ecological ideas about the mechanism of the origin of disease states. Knowledge of hygiene will help you navigate the choice of rational recommendations for the correction of health and the development of sanitary skills among the population, skillfully use the rules of hygiene in the implementation of measures to reduce the negative effects of harmful factors and enhance the positive impact of others on the preservation and promotion of health.
The proposed textbook consistently and clearly presents the main issues of human ecology and hygiene knowledge in the form of lectures, compiled in an accessible form for presentation and understanding.
The methodological basis for the preparation of the manual was the Exemplary program of the discipline "Human Hygiene and Ecology", developed in accordance with state requirements for the minimum content and level of training of graduates of the basic (advanced) level of secondary vocational education for the specialty 060101 "Medicine", and 060109 "Nursing . The manual is compiled in accordance with the State educational standards of secondary vocational education for these specialties. In accordance with the State educational standard, designed for 40 hours of theoretical classroom lessons, the manual includes 20 lecture topics on hygiene and human ecology.
The subjects of lectures are combined into 7 sections.
Section 1 outlines the basics of general ecology and, in particular, human ecology, as the place of its habitat, breathing, nutrition, water consumption, etc. Environmental factors and their impact on human health are illustrated. Unlike ecology, hygiene studies the effect of these factors on health and develops recommendations for improving living conditions and preventing diseases. Sanitation, which determines the level of human sanitary culture, deals with the practical implementation of hygienic norms and rules.
The second section is devoted to the ecological characteristics of air and its hygienic significance. Attention is paid to the problems of increasing air pollution. The ecological significance of water for humans, in particular, individual water sources and their hygienic characteristics, is illustrated. The importance of soil for human health from ecological and hygienic positions, acting through the food chain, is revealed.
Particular attention is paid to nutrition problems in Chapter 3. The features of modern nutrition in conditions of hypodynamia, the structure of rational nutrition, the mechanisms of occurrence and features of food poisoning are analyzed.
Given the high intensification of labor in modern medical institutions, paramedical workers should be well aware of the provisions of labor protection, the impact of production factors on human health and life, and hygienic requirements for rational work and rest. Chapter 4 is devoted to these issues.
Ecological and hygienic features of living in modern cities and dwellings, their role in the occurrence of pathology, especially in children, are analyzed in Chapter 5. There are also hygienic problems in medical institutions.
Chapter 6 is devoted to the most urgent problem of the state and healthcare - the formation of a healthy lifestyle. The components of a healthy lifestyle, methods, forms and means of their hygienic education are being studied.
Section 7 discusses the anatomical and physiological features of childhood and adolescence, methods for optimizing the daily regimen for children of various ages. Sufficient attention is paid to hygienic requirements for the layout, equipment and maintenance of preschool and educational institutions.
Each topic contains a list of control test questions to clarify the level of students' perception of the material.
The list of references includes legal documents and main literary sources on topical issues of hygiene in a presentation that is accessible for perception by students of an average professional level.
The textbook is designed for teachers of the discipline "Hygiene and Human Ecology" and students of secondary medical institutions in the specialties 060101 Medicine, and 060109 Nursing. It is assumed that the teacher will independently determine the amount of educational material presented during the theoretical lesson, taking as a basis the lecture material of this collection. At the same time, material not included in the content of the lesson can be offered to students as a basis for extracurricular independent work, for which it is rational to use additional literature from the attached list.
Section 1.THE SUBJECT OF HUMAN HYGIENE AND ECOLOGY
Topic #1: INTRODUCTION. SUBJECT AND CONTENT OF HYGIENE, ECOLOGY AND
HUMAN ECOLOGY.
Terminology and discipline structure
The role of ecology and hygiene in the system of sciences that study the natural environment.
Problems of ecology and hygiene.
Methods of hygienic research.
Hygienic regulation.
BE ABLE TO:
Use the acquired knowledge in educational work
Definition of the concepts of ecology, human ecology and hygiene. The subject and content of ecology, human ecology and hygiene.
The relationship of ecology, human ecology and hygiene and their place in the system of medical and biological sciences. Problems of ecology and hygiene. Sanitation.
The main historical stages in the development of ecology and hygiene.
Basic laws of hygiene.
Methods of hygienic research and hygienic regulation.
The role of the paramedical worker in educational work with the population.
Definition of the concepts of ecology, human ecology and hygiene. The subject and content of ecology, human ecology and hygiene.
Ecology(Greek - the doctrine of the house) is the science of the relationship of the plant world and animal organisms and the communities formed by them with each other and with the environment. The term "ecology" was proposed by the German scientist E. Haeckel in 1866. In general, the problems of big ecology cover all issues of the vital activity of all living organisms. Therefore, in relation to the subjects of study, ecology is divided into the ecology of any living creature - microbes, plants, animals, etc.
We are interested in human ecology, which studies the influence of environmental factors on a person and, in turn, the influence of a person and groups of people on the environment. Closely associated with her medical ecology that studies human diseases caused by polluted environment and ways to prevent them. The health of the population in any territory is the best indicator of the state of its habitat.
The concept of "hygiene" dates back to ancient times. Hygieia - the daughter of the god of medicine Asclepius, depicted as a beauty with a bowl in her hand, entwined with a snake - the goddess of health, who treated with the sun, water and air, keeping her body clean. Her other sister, Panacea, treated with medicines.
Hygiene(Greek - healthy) is a field of medicine that studies the influence of living and working conditions on human health, its performance, life expectancy and develops measures to prevent diseases, improve living and working conditions of a person, preserve his health and prolong life.
The relationship of ecology, human ecology and hygiene and their place in the system of medical and biological sciences. Problems of ecology and hygiene. Sanitation.
Human ecology is a part of ecology - that is, all life on Earth. If the science of ecology studies the ways of life and survival of all living beings on Earth, then human ecology studies how a person can survive, especially in an era of overpopulation and increasing pollution of the Earth. The problem of human ecology is the search for methods of moral and spiritual education of a person so that he realizes his place in nature and does not spoil it. Medical ecology is an integral part of human ecology that studies human environmental diseases.
If for a person ecology is place of residence with every second communication with environmental factors - microclimate, air, water, food, etc., with which the body is in constant contact and struggle for survival, then hygiene is a tool that studies the influence of human living conditions in the ecological environment, how they affect his health, performance, life expectancy, and on the basis of this study develops recommendations for reducing the risk of harmful effects of the environment on health.
Sanitation is the practical implementation of hygiene norms and rules. If hygiene is a science with recommendations for maintaining and improving health, then sanitation is a practical human activity, through which the implementation of hygiene rules is achieved. But in life, “I know and do it / but I don’t do it” or “I don’t know and don’t do it” - this is the level of a person’s sanitary culture.
Using hygienic knowledge, sanitation helps a person to survive, prolong life and multiply.
In the relationship of these disciplines, you can navigate with the help of the following mottos: "ECOLOGY - I LIVE!", "HYGIENE - I KNOW HOW TO DO IT!" and "SANITATION - AND THIS IS WHAT I DO!".
Another example of the relationship of these disciplines: a mosquito bite is ecology; I know that it can cause malaria, you need to get vaccinated - this is hygiene; slapping/not slapping him, doing/not vaccinating against malaria - that's sanitation.
Therefore, all our subsequent lectures will be built from three areas or sections: the ecological section - the study of environmental factors and their properties; in the hygiene section - studying the impact of these factors on human health and the sanitation section - familiarization with recommendations on ways and methods to limit these harmful effects and develop useful skills.
The training of a modern paramedic, midwife or nurse in modern conditions is unthinkable without hygienic knowledge, which is closely related to the ecological worldview, prevention and clinical medicine. Hygienic knowledge concerns nutrition, labor, hospital arrangements, healthy lifestyles, and so on. Having known them, you will understand that in the first place there are hygiene recommendations for the formation of a healthy lifestyle, and then medicines.
Therefore, a medical worker in the field of human hygiene and ecology must know:
the main environmental environmental factors affecting a person in the places of his residence and work;
patterns of influence of these factors on human health;
methods of sanitary and hygienic assessment of environmental factors in the environment of which a person lives and works in order to anticipate the onset of the disease and give recommendations on how to avoid or reduce health risks from the effects of factors;
the methodology of sanitary and educational work and be able to carry it out among people, taking into account environmental factors and the corresponding sanitary and hygienic recommendations.
In the process of studying hygiene, you will learn that a significant part of the population lacks elementary ecological knowledge, which determines the development of a particular disease in a particular person. Based on the knowledge of anatomy, physiology, biology and other subjects that you study at the school, you will gain the knowledge (and preferably beliefs!) necessary for your preventive activities, which will help you fight diseases, give recommendations on building a healthy lifestyle and yourself. stay healthy and serve as a role model.
The main historical stages in the development of ecology and hygiene
The origins of hygiene are in ancient times. In ancient Greece, in the temples, much attention was paid to climate, washing, boyfriend, fasting. The heyday of hygiene - in ancient Rome - baths of 12 hectares, the whole day was spent in it in gymnastic exercises, conversations. In the Middle Ages - the decline of hygiene. Hygiene revives in the 19th century.
Hygiene began to develop intensively from the middle of the 19th century with the growth of capitalism, which led to the accumulation of people in cities, the growth of harmful production and the increasing frequency of large epidemics of cholera, plague, typhoid. Systematic scientific research in the field of hygiene began.
Max Pettenkofer(1818-1901), German medical scientist, founder of hygienic science: introduced an experiment into hygiene, turning it into an exact science. Offering to improve the environment, he outlined ways to prevent many diseases. For the first time, he drew attention to personal hygiene as an important factor in many diseases: "as far as a person owns personal hygiene - such is his path through life and such is his speed to death"
In Russia, hygiene as a system of skills originated earlier than in the West. Peter 1 introduced a system of medical and sanitary support for the Army, since in all the armies of the world a large number of soldiers died not in battles, but in diseases (cholera, dysentery, typhoid).
In the development of hygiene, the founders of Russian health care, the therapist M.Ya. Mudrov and obstetrician S.G. Zybelin
It is necessary to know about the activities of three domestic scientists who played a fundamental role in the development of domestic hygiene.
A.P. Dobroslavin(1842-1889) - created the first department of hygiene (1871) at the St. Petersburg Military Medical Academy; published the first Russian textbook on hygiene, began to publish the journal "Health", opened the first experimental hygienic laboratory, organized the Russian Society for the Protection of Public Health and Women's Medical Education in Russia; developed the basics of communal hygiene.
F.F. Erisman(1842-1915) - founded the department of hygiene at Moscow University (1882), the Hygienic Institute with a city sanitary station for the study of food, water and soil; developed problems of school hygiene and food hygiene; published a three-volume guide to hygiene.
G.V. Khlopin(1863-1929) - a student of Erisman, put hygiene on mandatory laboratory research and experiment, published manuals on the basics of hygiene and general hygiene.
In 1922, for the first time in the world in the USSR, the state law “On the sanitary authorities of the republic” was issued, which at the state level obliged to comply with hygiene issues and introduced state sanitary supervision. The activity of the sanitary and epidemiological service in the USSR was one of the most effective in the world.
The adoption of the new Constitution of the Russian Federation (1993) required a revision of a number of provisions in the field of ensuring the sanitary and epidemiological well-being of the population. Currently, the basis of sanitary legislation as one of the main conditions for the implementation of the constitutional rights of citizens to health protection and a favorable environment is the Federal Law "On the sanitary and epidemiological well-being of the population » (1999). Currently, sanitary legislation includes 11 federal laws, 165 regional laws and over 3 thousand sanitary rules and other regulatory legal acts.
In 2004, the Federal Service for Supervision of Consumer Rights Protection and Human Welfare (Rospotrebnadzor) was established, which is the authorized federal executive body to exercise the function of control and supervision in the field of ensuring the sanitary and epidemiological welfare of the population of the Russian Federation, protecting consumer rights in the consumer market. State sanitary supervision is carried out in two forms: a) precautionary sanitary supervision - control over projects, construction, production of future products and b) current sanitary supervision - daily, planned and targeted for existing facilities. Rospotrebnadzor is a unified centralized state system, the main function of which is the implementation of state policy to ensure environmental safety and reduce risks for public health. This includes activities such as sanitary regulation, sanitary supervision, sanitary and hygienic monitoring, state registration and certification, research and testing of substances and products that pose a potential danger to humans, etc. At the same time, the implementation of practical measures to prevent epidemics and their consequences, as well as to protect the environment, is entrusted to the constituent entities of the Russian Federation and is their obligation.
Currently, Rospotrebnadzor unites 2218 Centers for State Sanitary and Epidemiological Surveillance (TSGSEN), which are united in 90 territorial departments - according to the number of regions and 1 - in railway transport. In addition, the activities of the Sanitary and Epidemiological Service are provided by 21 research institutes (research centers). The main purpose of these bodies is to ensure sanitary and epidemic well-being, prevention and elimination of dangerous and harmful effects of the human environment on his health. This is ensured by daily monitoring of the human environment and his health and the management of the sanitary and epidemic situation in the field. The leading activity of the State Sanitary and Epidemiological Service has recently become sanitary and hygienic monitoring to control the environment and assess the risks of the impact of various factors on the human body.
Basic laws of hygiene
The six laws of hygiene in terms of environmental impact for memorization can be combined into three "negative", two - "positive" and one - "technological".
"Negative" laws:
The law of the negative impact on the environment of human activities: production and household. The lower the scientific and technological progress in the country, the greater the environmental pollution and its impact on the health of the people living there.
The law of the negative impact on the environment of natural extreme events - volcanoes, earthquakes, solar flares, etc.
The law of the negative impact of environmental pollution on the health of the population: whatever these pollutions are, they reduce immunity, cause frequent illnesses, accelerate old age and death.
"Positive" Laws: ... Educationalallowance addressed to students teachers... rules hygiene, ... lecturesfor... school with coursesfor workers. ... upbringing, ecologyhuman, ...
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Tutorial... educationalbenefitsforstudents higher training ... Educationalallowance addressed to students universities, mastering socio-pedagogical professions, as well as teachers... rules hygiene, ... lecturesfor... school with coursesfor workers. ... upbringing, ecologyhuman, ...
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Hygienic knowledge based on life observations originated in ancient times. The first hygienic treatises that have come down to us (“On a healthy lifestyle”, “On water, air and places”) belong to the great physician of Ancient Greece, Hippocrates (460-377 BC). The first city water pipes, hospitals were built in Ancient Rome.
Until now, not only known, but also of a certain scientific interest, "Treatise on hygiene (elimination of any damage to the human body by correcting various errors in the regime)", written by the great Arab-Muslim scholar, born in Central Asia Avicenna Abu Ali ibn Sina (980-1037). The treatise outlines important issues of hygiene, suggests ways and means of treating and preventing diseases caused by sleep disturbance, nutrition, etc.
However, hygienic science developed not only on the basis of empirical observations, but also, of course, taking into account new experimental data. Here it is necessary to recall the hygienic guidelines written by the Frenchman M. Levy (1844) and the English medical scientist E. Parks. Max Pettenkofer (1818-1901) organized the first hygienic department at the medical faculty of the University of Munich in 1865. He not only investigated environmental factors (water, air, soil, food), but also created the first school of hygienists.
From Ancient (Kiev, Novgorod) Russia, empirical knowledge about hygiene also comes to us. Suffice it to recall the well-known treatise on the life of the Russian family - "Domostroy", which outlines the basics of proper food storage, pays attention to cleanliness and tidiness.
Peter I did a lot to protect the health of the population and prevent the spread of diseases in Russia, by issuing a number of decrees on the sanitary condition of cities, on the mandatory notification of cases of infectious diseases, etc.
Many Russian doctors pointed out the special importance of preventive measures in preventing high morbidity: N. I. Pirogov, S. P. Botkin, N. G. Zakharyin, M. Ya. Mudrov.
N. I. Pirogov wrote: “I believe in hygiene. This is where the true progress of our science lies. The future belongs to preventive medicine.” In an act speech delivered in 1873, another well-known Russian clinician, Professor G. N. Zakharyin, said: “The more mature the practical doctor, the more he understands the power of hygiene and the relative weakness of treatment, therapy ... The most successful therapy is possible only with hygiene condition. Only hygiene can victoriously argue with the ailments of the masses. We consider hygiene to be one of the most important, if not the most important subject of the practitioner's activity.
In Russia, hygiene as a course of forensic science (forensic medicine) begins to be taught at the Medical and Surgical Academy (St. Petersburg) right from its opening, that is, from 1798. At first, the course is called “Medical Police”, and since 1835 “Medical Police and hygiene." An independent department of hygiene at the academy and the first in Russia was opened in 1871 under the guidance of Privatdozent Alexei Petrovich Dobroslavin (1842-1889). A.P. Dobroslavin organized an experimental laboratory at the department, created the first Russian school of hygienists, he wrote the first Russian textbooks on hygiene.
The Moscow School of Hygienists was founded by Fedor Fedorovich Erisman (1842-1915). In 1881, F. F. Erisman was elected Privatdozent of the Department of Hygiene Faculty of Medicine Moscow University. He worked a lot in the field of hygiene of children and adolescents (Erisman's universal desk is still known), social hygiene, laid the foundation for studying the influence of environmental factors on the health of the younger generation, and proved that physical development can act as an indicator of the sanitary well-being of the child population.
V Soviet period for the development of domestic hygiene, such scientists as professors Grigory Vitalyevich Khlopin, Fedor Grigoryevich Krotkov, Alexei Nikolaevich Sysin, Alexei Alekseevich Minkh, Gennady Ivanovich Sidorenko and many others have done a lot.
The philological origin of hygiene is associated in Greek mythology with the goddess of health (Hygieinos), the daughter of Aesculapius. Hygiene - the goddess of health - a symbol of health.
Hygiene- medical, preventive discipline. It studies the patterns of influence of environmental factors on the body in order to prevent diseases and improve the environment itself. Environmental factors are also studied by other disciplines. The peculiarity of hygiene is that it studies the influence of environmental factors on human health.
The task of hygiene as a science is to weaken the effect of negative factors and strengthen the effect of positive factors by carrying out hygienic measures. In particular, it has now been established that fluorine in the composition of drinking water has a certain effect on the development and formation of teeth.
For example, concentrations of fluorine in water less than 0.7 mg/l and especially at the level of 0.5 mg/l lead to the development of caries. The water of the Volga, widely used for water consumption in the cities of the Volga region, contains fluorine at the level of 0.2 mg/l. This level of fluoride in drinking water leads to massive development of caries. 80%, and in some places - 90% of the population of the Volga cities suffer from caries. Along with such a well-known negative factor of fluorine deficiency in drinking water, its excessive concentration (above 1.5 mg/l) leads to the development of fluorosis. Fluorosis is a disease, the development of which is associated with the action of fluorine on the body as a protoplasmic poison. In particular, high concentration fluoride leads to changes in the formation and development of teeth. Along with the skeletal form, there is the so-called dental form of fluorosis. The optimal level of fluorine, which ensures the prevention of caries and excludes its toxic effect, is in the range from 0.7 to 1.5 mg/l. Such a range of doses of fluorine in drinking water is established taking into account regional characteristics and some other aspects. Thus, a distinctive feature of hygiene is the rationing of factors, which we have considered using the example of fluorine.
The subjects of hygiene are the environment and health. What are they?
The environment is a set of elements of a physical, chemical, biological, psychological, economic, cultural and ethnic nature that make up a single, continuously changing ecological system (ecosystem).
The definition of health most adequate to modern conditions is given by the experts of the World Health Organization. Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.
Over the past 20th century the main funds invested in health care were mainly used to solve problems that had already arisen, and not to prevent their occurrence. The emphasis was on cure, or at any rate on the reduction of ill health, on therapeutic help, rather than on the promotion of health and the prevention of disease. There should be a reorientation of priorities. More attention should be paid to the preventive direction of the development of medicine.
It is well known that hygiene arose from the needs of clinical medicine. First of all, representatives of clinical medicine spoke out for the development of hygiene, such prominent scientists as M. Ya. Mudrov, N. G. Zakharyin, N. I. Pirogov, S. P. Botkin. Zakharyin's statement is well-known: "The more mature the practitioner, the more he understands the power of hygiene and the relative weakness of treatment - therapy." The very success of therapy is possible only if hygiene is observed. The task of hygiene is to make the development of man the most perfect, life - strong, and death - the most remote.
Knowledge of hygiene is necessary in the practice of doctors of various profiles: medical, pediatric and dental.
It is well known that the development of various pathologies is influenced by environmental factors. If these factors are not taken into account, the effectiveness of the treatment is reduced. For example, in the field of pathology of diseases of the oral cavity, the influence of a professional factor is known.
Working with certain chemicals can enhance the development of the pathological process in the oral cavity, caries, and other diseases. The development of caries is significantly influenced by such a factor as the nature of nutrition (alimentary). It is well known that tooth decay is more likely to develop in those who consume more refined carbohydrates. Currently, a significant number of diseases are known in medicine that have an environmental factor in their genesis. The course of a number of diseases is influenced by housing conditions, the consumption of water of one or another mineral composition. Working conditions contribute to the development of certain diseases, can aggravate the course of cardiovascular pathology, have negative impact on the development of pathology of the respiratory system. I must say that there are diseases that are caused by the impact on the body of a professional factor. These diseases are called occupational diseases.
The doctor needs knowledge of the impact of one or another factor on the body: the alimentary factor, the nature of the water, its composition, quality. When carrying out this or that treatment using pharmacological preparations, the nature of nutrition should be taken into account, since it can weaken or enhance the effect of the drug (just like drinking water can enhance the effect or, conversely, weaken the effectiveness of the ongoing drug treatment).
The development of hygiene goes in two directions. On the one hand, the process of its so-called differentiation is noted. The differentiation process is associated with the separation from general hygiene of its independent branches, such as social hygiene, communal hygiene, food hygiene, occupational hygiene, hygiene of children and adolescents, radiation hygiene, military hygiene, hygiene and toxicology of polymeric materials, space hygiene, aviation hygiene. On the other hand, the development of hygiene is also moving along the path of integration. Hygiene develops in close contact with clinical areas of medicine, therapy, pediatrics, obstetrics and gynecology and other branches.
At present, such a course has emerged from hygiene as valeology- a science that studies the patterns of formation high level health. Much attention has always been paid to the patterns of the formation of the pathological process, but insufficient attention has been paid to problems associated with the conditions, factors and patterns that determine the conditions for the formation of a high level of health.
Hygiene methodology
The methodology of hygiene is its section, part of hygiene, dealing with the use of its methodological techniques to study the patterns of interaction between the body and the environment. Hygiene methodology is associated with the development of hygienic standards, guidelines, sanitary norms and rules. In hygiene, there are so-called specific classical hygiene methods. These include the method of sanitary inspection, the method of sanitary description and the method of sanitary observation. In hygiene, various methods are widely used related to the assessment of factors acting on a person. Such methods are physical, chemical, which assess the physical and chemical state of the environment. In hygiene, toxicological methods are widely used, aimed at assessing the nature of the toxic effect on the body of certain chemicals. Physiological methods are widely used, not without reason hygiene is called applied physiology.
Biochemical, genetic, clinical and epidemiological research methods are widely used to assess the impact of factors on certain body systems. To generalize the results obtained, statistical methods are widely used with the involvement of modern technologies.
Methods for studying the influence of environmental factors in natural conditions. This direction is called natural experiment. What is associated with the study of the state of health of certain groups of the population living under the influence of various environmental factors. Under natural conditions, it is possible to study the influence of working conditions on the health of workers. They also study the influence of factors educational process on the growing body of the child. Clinical and hygienic studies are being carried out to develop the maximum permissible concentrations of harmful chemicals in the working area. Thus, clinical and hygienic studies and laboratory experiment complement each other and constitute a single approach to hygienic studies of the environment and human health.
Environment and health
The subject of hygiene is the environment and health. Extremely complex processes take place in the environment (ecosystem), biosphere. Some of these processes are associated with the action of factors aimed at ensuring the constancy of the quality of the environment (water, soil, atmospheric air). These are stabilizing factors. Other factors (and they can be of a natural nature or associated with human activities, the so-called anthropogenic factors) lead to a violation of the natural balance, harmony in nature. These are destabilizing factors.
In ecology, there is the concept of anthropogenic exchange. Anthropogenic exchange has input natural resource s, at the output - industrial and domestic waste. Ecological anthropogenic exchange is extremely imperfect. It has an open, open character and is devoid of the cycle of life that is inherent in the biosphere as a whole. To characterize anthropogenic exchange, there is an indicator - its efficiency, showing the amount of natural resources used for the benefit of man. The value of efficiency today is 2%, i.e. 98% is an unused natural resource, and, moreover, this is the part of the resources that acts as waste - environmental pollutants. Among these pollutants, there are substances that have a pronounced destabilizing effect, the so-called destabilizing factors. These include halogen-containing components, rare and heavy metals, substances with an ionizing effect, and other factors. In general, these factors by the nature of the action can be classified as physical or chemical. Chemical compounds are a serious danger. The action of individual chemicals can lead to the development of destabilizing, destructive processes, which lead to an increasing effect. This process is out of human control. It exceeds the effect of natural stabilizing factors, as a result of which the development of spontaneously uncontrollable, growing destabilizing phenomena is noted. Substances and factors that have such an effect are called superecotoxicants. Chemicals assigned to this class are rare and heavy metals, ionizing radiation, halogen-containing components. All of them have a special effect on the human body, expressed in damage to cell membranes, in the development of disturbances in the enzyme systems of the body, disturbances in homeostasis, leading to destructive phenomena in the human body. Ecotoxicants are characterized by high stability in the environment and stability. They can accumulate in environmental objects. The stability and ability of chemicals to accumulate in the environment ensure their migration, which is extremely dangerous for humans and their environment.
There is a close interaction between the human body and the environment. The problem of the unity of the organism and the environment is the most important problem. It must be said that a certain form of balance develops between the environment and the organism. This balance of the environment and the body is formed as a result of the most important mechanisms of the physiological response of the body to the effects of various factors and is carried out through the work of the central nervous system. This form of balance is the so-called dynamic stereotype, i.e., if the factor acts constantly, is of a repetitive nature, the body develops stereotyped reactions. The emergence of new factors leads to the destruction of this balance. The so-called excessive factors pose a particularly serious danger in this respect. They lead to a violation of the dynamic stereotype. Changes in the dynamic stereotype are associated with a significant impairment of body functions: neuropsychic, stressful condition, extreme factor.
The task of hygiene is to find ways and methods of forming a new stereotype. This can be achieved by appropriate changes in the external environment, as well as by improving the mechanisms of adaptation of the body. The diagram, developed by Academician of the Russian Academy of Medical Sciences, Professor Yu. L. Lisitsin, according to experts from the World Health Organization, presents the factors that determine the level of somatic health of a person. The determining factor of somatic (general) health, according to experts from the World Health Organization, is style, or, as we say, lifestyle. It determines the somatic state of human health by 53%. 17% of a person's somatic health is determined by the quality of the environment, 20% is due to hereditary factors, and only 10% of somatic health is determined by the level and availability of medical care to the population. Thus, 70% of the level of human health depends on those moments that are directly related to hygiene. This is a healthy lifestyle of a person, the quality of the environment.
The environment has an impact on the main indicators of the health of the population (life expectancy, birth rates, levels of physical development, morbidity and mortality). Moreover, there are a number of diseases that are pronounced in nature, depending on environmental conditions. These are environmentally driven diseases. These include, in particular, a disease called "chronic fatigue syndrome". This disease is based on a membrane-damaging effect and the effect of chemical pollutants and ionizing radiation on enzyme systems. The adverse effect of chemicals leads to a sharp decrease in immunobiological parameters. Mass surveys major cities show a sharp change in immune homeostasis in residents. A change in immunity indicators by 50% is noted among residents of Moscow. A situation arises that indicates the so-called secondary nonspecific immunodeficiency associated with the impact on the body of a number of adverse factors, including chemicals.
Assessment of the level of health of the population living in various environmental conditions, currently makes us talk about the existence of environmentally caused foci of diseases. These diseases are associated with pollution of the urban environment with rare and heavy metals, to which the children's body is primarily sensitive. Therefore, the study of the impact of urban environmental factors on the body of the population, especially children, is an urgent task of hygienic science.
Hygiene is preventive medicine. What is meant by prevention? There are concepts of primary and secondary prevention. Let's start with the concept of the so-called secondary prevention. Secondary prevention is understood as a set of measures aimed at localizing and weakening the pathological process through active medical examination, anti-relapse therapy, spa treatment and therapeutic nutrition, i.e. secondary prevention is the activity that is carried out by practitioners. Hygiene is primary prevention. The basis of primary prevention is the elimination of the causes and factors leading to the occurrence of pathological processes, and diseases in general, by improving the natural, industrial, and household environment; formation of a healthy lifestyle aimed at increasing the body's resistance and strengthening health. Prevention should be understood not only as the prevention of diseases and the implementation of recreational activities aimed at protecting the health of the population, but the whole set of state, public and medical measures aimed at creating the most favorable living conditions for a person that fully meets his physiological needs.
Hygiene is a preventive discipline, and the basis of preventive measures is hygienic regulation.
Hygienic regulation
What is meant by hygienic standards? A hygienic standard is a strict range of parameters of environmental factors that is optimal and harmless for maintaining normal life and health of a person, the human population and future generations. Sanitary rules, norms, hygienic standards are normative acts that establish criteria for the safety and harmlessness of environmental factors for a person in his life. Sanitary rules are obligatory for observance by all state bodies and public associations, enterprises and other economic entities, organizations, institutions, regardless of their subordination and form of ownership, officials and citizens.
Hygienic standards for chemicals are set in the form of maximum allowable concentrations (MACs). For physical factors, they are set in the form of permissible exposure levels (MPL).
For chemicals, MPCs are set in the atmospheric air of populated areas in the form of maximum one-time and average daily maximum allowable concentrations. MPCs for harmful chemicals in the water of reservoirs and drinking water are established. MPCs are set for the content of harmful chemicals in the soil. In foodstuffs, hazardous chemicals are regulated in the form of acceptable residues (RTA). For chemicals, the maximum allowable amounts in water are set in milligrams per 1 dm 3, or 1 liter, for air - in milligrams per 1 m 3 of air, food products - in milligrams per 1 kg of product mass. MPCs characterize safe levels of exposure to harmful chemicals in certain environmental objects.
The remote controls for the impact of physical factors are also set. In particular, there is an idea of the optimal and permissible parameters of the microclimate, i.e., temperature, humidity, air velocity, etc. The optimal permissible amounts of nutrients are established, and their rationing takes place taking into account physiological needs. There are so-called physiological norms of need for proteins, fats, carbohydrates, minerals, vitamins. When establishing MPCs for harmful chemicals in the environment, certain principles of hygienic regulation are observed, which include:
1) the principle of stages;
2) the principle of threshold.
The phasing in rationing is that the work on rationing is carried out in a strictly defined sequence associated with the implementation of the corresponding stage of research. For chemicals, the first stage of these studies is the analytical stage. The analytical stage includes an assessment of the physicochemical properties: data on the structure of the chemical, its parameters - melting point, boiling point, solubility in water, other solvents. To conduct analytical studies, it is necessary to have specific methods of determination. The second mandatory stage of hygienic research in establishing MPC is toxicometry, i.e., the determination of the main parameters of toxicity. Toximetry includes conducting studies to determine the parameters of acute toxicity (acute toxicometry or, more simply, acute experiments). This is followed by a subacute experiment and a chronic sanitary-toxicological experiment.
The main and main task of the acute experiment is to determine the average lethal concentrations and doses of LD 50 or CL 50 . Setting up acute experiments allows us to assess the degree of danger of chemicals, the nature of the direction of action, the vulnerability of certain systems and functions of the body. Acute experiments allow the most reasonable approach to setting up subacute and chronic sanitary-toxicological experiments. The phasing of normalization also allows individual cases to reduce the scope of ongoing research, using the so-called principle of rationing by analogy, i.e., the study of the indicators of the toxic substance being evaluated by physical and chemical properties allows you to find out the presence of so-called analogue substances and carry out rationing using the principle of similarity. This approach is called normalization by analogy. For substances with similar properties, i.e., the regulation of which is carried out by analogy, it is mandatory to establish the parameters of acute toxicity. The presence of acute toxicity parameters also makes it possible to reduce the amount of research and save a significant amount of material resources, as well as the time spent on the experiment.
An important stage of toxicometric studies is the subacute sanitary-toxicological experiment. A subacute experiment makes it possible to reveal the presence of cumulative properties from the standpoint of a qualitative and quantitative assessment of this stage of action. In the subacute experiment, the most vulnerable systems of the body are also identified, which allows an objective approach to the formulation of the main stage of toxicometry, associated with the determination of toxic parameters in a chronic experiment. The subacute experiment tests a large set of toxicology tests that assess the effects of a chemical on cardiovascular system, nervous system, gastrointestinal tract, excretory systems and other functions and systems of the body.
The most important principle of hygienic regulation is the study of the threshold nature of the action of the normalized factor. According to the threshold level of exposure in a chronic experiment, the lowest concentration that causes changes in the body of a laboratory animal is determined. Based on the results of a chronic sanitary-toxicological experiment, MPCs are established for substances, primarily those with a pronounced toxic effect.
When rationing harmful chemicals in the aquatic environment, the mandatory stages of the study are the study of the effect of the substance on the organoleptic properties of water and the sanitary regime of water bodies, i.e., to establish the MPC of chemicals in water bodies, additional research stages are introduced. At all these stages of studying the effects of harmful chemicals, threshold levels of exposure, threshold doses and concentrations are necessarily established. The limiting sign of harmfulness is determined by threshold concentrations, i.e., the lowest concentration is established in which the effect of a harmful chemical is primarily manifested either on the organoleptic properties of water, or on the sanitary regime of a reservoir, or when assessing toxic properties. When establishing the MPC of harmful chemicals in the water of reservoirs, a limiting sign is identified, either organoleptic, or according to the sanitary regime, or toxicological. According to the limiting sign of harmfulness, taking into account the lowest threshold concentration, MPC is set. Thus, the defining principles of rationing are the principles of threshold and phasing.
The established principles of rationing of chemicals and levels of exposure to physical factors form the basis of the current sanitary legislation.
MPCs allow, on the one hand, to control the content of harmful chemicals in the environment, on the other hand, to create a so-called system for monitoring the content of harmful chemicals, that is, to monitor them in the environment. MPCs are also used in the design of industrial enterprises; MPCs are laid down in projects for the construction of industrial and other enterprises.
The structure of the sanitary service
The activities of the sanitary and epidemiological service in the Russian Federation are determined by the Law of the Russian Federation "On the sanitary and epidemiological welfare of the population".
Occurring in 2004-2005 changes in the country also affected the structure of the sanitary service. Ministry of Health and social development In the Russian Federation, the Centers for State Sanitary and Epidemiological Surveillance (TSGSEN) were transformed into territorial departments of the Federal Service for Surveillance in the Field of Consumer Rights Protection and Human Welfare (TU) and federal public health institutions "Centers for Hygiene and Epidemiology" (FGU).
Main tasks Territorial Administration of Rospotrebnadzor (TU) are:
1) state supervision and control over the fulfillment of the requirements of the legislation of the Russian Federation in the field of ensuring the sanitary and epidemiological welfare of the population in the field of consumer protection;
2) prevention of harmful effects of environmental factors on humans;
3) prevention of infectious and mass non-infectious diseases (poisoning) of the population.
Functions Territorial administration:
1) state supervision and control over the fulfillment of the requirements of the Russian Federation in ensuring the sanitary and epidemiological well-being of the population in the field of consumer protection;
2) sanitary and epidemiological supervision during the development, construction, reconstruction, liquidation of urban planning, industrial construction; for the production, sale of products, for the operation of water supply systems, medical institutions;
3) organization and conduct of social and hygienic monitoring;
4) issuance of a sanitary-epidemiological conclusion on programs, methods, modes of education, training;
5) carrying out anti-epidemic measures, attesting the decreed contingent and exercising their control;
6) control of laboratory research and testing;
7) conducting sanitary and quarantine control.
The main task of federal state health care institutions is to conduct sanitary and epidemiological examinations, investigations, examinations, studies, tests, toxicological, hygienic and other examinations.
Chief State Sanitary Doctor - Head of the Territorial Institution and Head of the Federal public institution health care on a regional scale is appointed and dismissed by the Minister of Health and Social Development of the Russian Federation on the proposal of the head of the Federal Service (Chief State Sanitary Doctor of the Russian Federation).
Financing of expenses for the maintenance of territorial health care institutions is carried out at the expense of the federal budget.
Sanitary supervision in Russia is carried out in the form of two forms. In the form of preventive sanitary supervision and current sanitary supervision.
Preventive sanitary supervision provides for the development of measures related to the introduction of health-improving, preventive measures at the stage of developing projects for industrial and civil facilities, the construction of communal facilities, in the development of new technologies, the introduction of new food and industrial goods, children's toys. Of particular note is the active rather than contemplative role of the sanitary service in all of the above activities. In other words, prevention, preventive sanitary supervision should always go ahead of a person, and not follow him. This is the most important role of preventive sanitary supervision. Preventive sanitary supervision on the example of the construction of certain objects ends at the stage of its acceptance. It begins with the approval of the project, control over the progress of construction and acceptance. The most important point in the implementation of preventive sanitary supervision of objects under construction is the control over the progress of hidden work. After the acceptance of the object, the current sanitary supervision begins.
Current sanitary supervision covers almost all areas of activity of various institutions, facilities on the territory of a particular locality, district, region and the whole of Russia. Sanitary and epidemiological supervision bodies exercise control over the activities of industrial enterprises, communal facilities, kindergartens, schools, medical and preventive and other institutions. The Sanitary and Epidemiological Service is endowed with great rights to supervise the activities of certain institutions and organizations. The sanitary service monitors the implementation of sanitary rules by certain institutions, enterprises and objects. Sanitary rules are mandatory for all state and public organizations and other economic organizations, regardless of their subordination and form of ownership, as well as officials and citizens. The Sanitary Service exercises control aimed at preventing sanitary offenses. Sanitary offenses are unlawful, guilty intentional or negligent actions or omissions that infringe on the rights of citizens and the interests of society, associated with non-compliance with the sanitary legislation of the Russian Federation, including various sanitary rules and norms. Hygienic standards, developed sanitary norms and rules ensure the effective implementation of preventive and current sanitary and epidemiological supervision, effective implementation of measures to improve the environment and improve public health.
The role of hygienic and environmental sciences in ensuring preventive health objectives
Hygiene- the main preventive medical discipline, focused on maintaining and improving the health of the population. The main task of hygiene is to study the influence of the environment on the health and working capacity of the population, as well as the development of appropriate recreational activities. Another task of hygiene is the development of means and methods aimed at increasing the body's resistance to possible adverse environmental effects, improving health and physical development, increasing efficiency and accelerating recovery processes after exercise.
In matters of studying the influence of environmental factors on human health, hygiene closely interacts with environmental science, or rather, human ecology, which studies the general laws of interaction between the biosphere and the anthroposystem of mankind, its groups (populations) and individuals, the influence of the natural sphere on man and groups of people.
Comprehensive section of hygienic science - environmental health studies general patterns the relationship of the human body with environmental factors of different nature (physical, chemical, biological), adaptive processes, mechanisms of interaction of the body with a complex of favorable and unfavorable environmental factors of anthropogenic origin, as well as with a complex of socially determined factors. environmental medicine combines the study of environmental factors, body factors, pathogenic factors, creates the basis for the interaction of representatives of various medical specialties. Environmental medicine is a more capacious term than environmental hygiene, its content should also reflect the clinical aspects of diseases by factors adversely affecting it, the physiological aspects of adaptation that characterize the protective, compensatory and adaptive capabilities of the body.
Currently, scientists are paying attention to the slow progress in the prevention, diagnosis and treatment of diseases in the etiology of which there is an environmental component. This is due not only to the lack or insufficiency of knowledge about the mechanisms of interaction between the human body and environmental factors at the molecular level or the factors that determine the genetic predisposition to certain diseases, but also to the strict normative approach that existed for a long time in practical hygiene, which puts emphasis on the study environmental factors, not human health and not on the analysis of the relationship between health and environmental quality.
Identification of causal relationships between the impact of environmental factors and possible changes in the state of human health is one of the tasks of hygienic diagnostics, which aims to establish a relationship between the state of the natural and social environment and the health of a population or an individual. The last direction in hygienic diagnostics, i.e., the establishment of an etiological relationship between a disease and the impact of environmental factors, has received the name "clinical ecology" abroad.
One of the most important elements of the methodology of hygienic diagnostics is the assessment of the risk of adverse effects of environmental factors on human health.
Factors that shape the health of the population
Among the factors that shape the health of the population, hygienic science distinguishes: hereditary (genetically determined factors that form hereditary diseases - hemophilia, color blindness, ataxia, albinism, etc.); endemic (due to biogeochemical features of the area, leading to the occurrence of endemic diseases - fluorosis, dental caries, endemic goiter, urolithiasis, strontium and molybdenum rickets, etc.); natural and climatic (characteristic of certain climatic zones, causing an increase in colds in a cold climate zone and skin diseases in a hot climate); epidemiological (regional features of the area, leading, in particular, to the occurrence of natural focal infections - hepatitis, cholera, etc.); professional (factors of the production process that can lead to the development of occupational diseases); social (nutrition, lifestyle, social well-being), psycho-emotional (due to the impact on a person of such frequent in recent years extreme situations) and environmental. The latter, according to the World Health Organization (WHO), form up to 25% of human pathology, and in some countries and certain regions of these countries, the percentage of environmentally caused diseases can be significantly higher. It is no coincidence that the concept of "environmental risk" was reflected in the Federal Law "On Environmental Protection" dated 10.01.2002 3 7-FZ.
It should be noted that diseases in one way or another related to the environment, i.e., caused by certain environmental parameters, can be represented by two groups. The first includes environmentally conditioned diseases - human diseases resulting from the impact of the environmental component as the ethnology of the disease. These include endemic diseases; natural focal infections; diseases caused by radiation exposure (leukemia, malignant neoplasms); acute and chronic poisoning by chemical emissions into the environment; malignant neoplasms caused by environmental pollution with carcinogens; diseases caused by the influence of biological factors, including leukemia of viral origin. The second group consists of the most numerous environmentally dependent diseases - diseases of a nonspecific nature that occur against the background of a significantly changed external environment.
At the same time, environmental causes act as triggers for pathogenetic mechanisms. This is an increase in general and childhood morbidity; an increase in the number of cases of individual nosological forms not directly related to environmental factors, but due to a decrease in the overall resistance of the organism under their influence; an increase in the frequency of pathology of pregnancy; an increase in the frequency of violations of intrauterine development of the fetus, etc.
Environment and public health
Starting to consider the issues of the impact of environmental pollution on the health of the population, it is necessary to dwell on the concept of "health". According to the WHO definition, under health is understood as a state of complete physical, spiritual and social well-being, and not just the absence of disease and physical defects, as is common in the public mind. The private value of health, from the point of view of psychophysiology, can reflect the level of physical and mental workability in the implementation of various types of labor.
The magnitude of health loss, expressed in terms of morbidity and disability, shows the violations occurring in the structures and functions of the body, as well as changes in adaptive capabilities. In biomedical research, indicators of physical development are used to assess health. Body functions are assessed in terms of physical and mental performance, and adaptive reserves - in terms of biochemical, hormonal and immune status.
The indicator of morbidity or morbidity reflects the prevalence of diseases, which is determined by the ratio of the number of diseases per year, multiplied by 1000 and divided by the population. In general, this indicator is a collective of negative health indicators, which are most often considered as indicators of health status in health statistics, especially at the population level.
Category "environment" includes a combination of natural and anthropogenic factors. The latter are factors generated by a person and his economic activity and have a predominantly negative impact on a person, his living conditions and state of health. Changes in the state of health of the population, caused by the influence of environmental factors, are methodologically difficult to study, since this requires the use of multivariate analysis.
The structure of the environment can be conditionally divided into natural(mechanical, physical, chemical and biological) and social elements of the environment(work, life, socio-economic structure, information). The conditionality of such a division is explained by the fact that natural factors act on a person in certain social conditions and are often significantly changed as a result of the production and economic activities of people. The properties of environmental factors determine the specifics of the impact on a person. Natural elements influence their physical properties: hypobaria, hypoxia; strengthening of the wind regime; solar and ultraviolet radiation; change in ionizing radiation, electrostatic voltage of air and its ionization; fluctuations of electromagnetic and gravitational fields; increased climate rigidity with altitude and geographic location, precipitation dynamics; frequency and variety of natural phenomena. Natural geochemical factors affect a person by anomalies in the qualitative and quantitative ratio of trace elements in soil, water, air, and, consequently, a decrease in diversity and anomalies in the ratios chemical elements in agricultural products of local production. The action of natural biological factors is manifested in changes in macrofauna, flora and microorganisms, the presence of endemic foci of animal and plant diseases, as well as in the emergence of new allergens of natural origin.
