Human personal hygiene and the environment. Question: Subject of hygiene and human ecology. Basic laws of hygiene
CHAPTER 3 ENVIRONMENT AND ITS HYGIENIC IMPORTANCE. HUMAN HYGIENE AND ECOLOGY
3.1. HYGIENIC CHARACTERISTICS OF ENVIRONMENTAL FACTORS. HUMAN HYGIENE AND ECOLOGY
To use the preventive method of achieving the goal of hygiene, it is necessary to know the causes of diseases and premature wear and tear of the body. Since most of these reasons are the result of the interaction of the body 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 “human beings”. environment».
Environment(OS) is a very capacious concept. IN 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 the antipode to the internal environment of man. In this regard, modern terminology should be clarified.
From a hygienic point of view, the environment is a set 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 of his existence.
Natural elements include air, water, food, soil, radiation, flora and fauna. The social elements of a person’s environment are work, everyday life, and the socio-economic structure of society. Social factors largely determine Lifestyle person (for more details, see Chapter 13).
The concept of the environment (natural and artificial) includes the concepts of external and industrial environment.
Internal environment, as noted by I.P. Pavlov, is the internal content that provides nervous and humoral regulation mechanisms. The internal environment of the body is a collection of fluids (blood, lymph, tissue fluid) that wash the cells and pericellular tissue structures that take part in metabolism.
Under external environment one should understand the part of the environment that is in direct contact with the epithelium of the skin and mucous membranes, and also affects all types of human receptors that perceive the world individually, due to its characteristics. The state of the external environment is purely individual for each person.
Concept environment is wider. It is not individual, but general for an entire population, population. In the process of long-term evolution, man 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 disease.
In the environment, concepts such as habitat and production environment are distinguished.
Habitat- a complex of interconnected abiotic and biotic factors located outside the body and determining its vital activity (Litvin V.Yu.).
Work environment- part of the environment formed by natural and climatic conditions and professional (physical, chemical, biological and social) factors affecting a person in the process of his work activity. Such an environment is a workshop, a workshop, an auditorium, etc.
Unmodified natural environment- not changed as a result of direct or indirect human influence, society is part of the natural environment, characterized by the properties of self-regulation without the corrective influence of man. Such an environment ensures the normal functioning of the human body.
Modified (polluted) natural environment- an environment that has been changed as a result of its unreasonable use by a person in the process of activity and has a negative impact on his health, performance, and living conditions. In relation to the named environment, there are concepts identical in meaning: anthropogenic, anthropogenic, technogenic, denatured environment.
Artificial OS- directly or indirectly, intentionally or unintentionally, an environment created by man for the temporary maintenance of his life and activities in artificially created confined spaces (spaceships, orbital stations, submarines, etc.).
The division of OS elements into natural and social is relative, since the former affect a person in certain social conditions. At the same time, they can change quite strongly under the influence of human activity.
OS elements have certain properties, which determine the specificity of their influence on humans or the need for them to ensure human life. In hygiene, the named 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, thereby emphasizing the subject and object of its research.
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. The animal and plant worlds differ in their biological properties.
The group of social elements also has certain properties, which are studied and assessed quantitatively or qualitatively. These properties are presented in Fig. 1.2. All of them form the so-called social environment - part of the environment that determines the social, material and spiritual conditions for the formation, existence and activities of society. The concept of social environment unites the totality of components of the social infrastructure of society: housing, everyday 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 humans through abiotic and biotic factors denatured as a result of human activity and society as a whole.
When studying the influence of the natural environment on humans, concepts such as the biosphere and its constituent elements are often used: atmosphere, hydrosphere, lithosphere.
Biosphere(gr. bios- life, sphaira- ball, shell) - the lower part of the atmosphere, the entire hydrosphere and the upper part of the lithosphere of the Earth, inhabited by living organisms, “the region of living matter” (V. I. Vernadsky). 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. Currently, the most active layer of living matter is distinguished in the biosphere - biostroma, or “the 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 designate the emerging new geological shell of the Earth. The noosphere is understood as that global shell of the planet (stratosphere, surrounding outer space, deep layers of the hydrosphere and lithosphere), into which human activity or the result of human activity extends in the age of scientific and technological progress.
In addition to such concepts as environment, biosphere, there is the concept of ecology.
Ecology(gr. oikos- house, dwelling, environment, logia- science) - biological science about the relationships 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 human society with the environment and 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 is trying to displace 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 self-sufficient 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 (sanitation) and ecology (nature conservation) differ in their ultimate goal. If hygiene through sanitation seeks, through organizational, legislative, technical and other means, to weaken anthropogenic pressure on the human environment and his health, then ecology directs its interests to the protection of the natural environment as a whole.
The need to act in close cooperation is dictated by the fact that it is impossible to solve ecological problems, using only regulatory 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 specified well-being in an unfavorable environmental situation, since the harmful influence of factors through natural elements of the environment (soil, water, etc.) due to its disintegration cannot be excluded. Clear interaction between all specialists involved in protecting people’s health is important.
Moreover, this coincides with the main provisions of the World Conservation Strategy, developed by international organizations. In particular, this document formulates the principles around which the efforts of both the world community and an individual state should be concentrated:
2. Prevent depletion of non-renewable resources.
3. Develop within the limits of the potential capacity of ecological systems.
4. Change human consciousness and stereotypes of his behavior in relation to nature.
5. Encourage the social interest of society in preserving its habitat.
6. Work out national concepts integration of socio-economic development and environmental protection.
7. Contribute to achieving unity of action at the global level. There is no doubt that humanity must definitely solve the assigned tasks. Otherwise, he will face consequences that will threaten the very existence of Man on planet Earth.
3.2. HYGIENIC STANDARDING OF FACTORS
ENVIRONMENTAL
In "Fundamentals of Legislation" Russian Federation"(1993) indicates that protecting the health of citizens is achieved through the implementation of political, economic, social, medical, sanitary and hygienic and other measures. The content of sanitary and hygiene
enical measures is primarily hygienic standardization 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 included in the social group).
Section 2.3 touched on the strategic aspects of the problem of rationing, based on the theory of hygienic rationing with its universal principles. But this does not mean that before this rationing as a way of balancing human health with environmental factors in the process of his life was absent. Humanity 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 a very difficult thing to graze in nature and not commit sacrilege.” Man, as a rule, leaves deep “notches” on Nature’s body, which subsequently poison his own life, both literally and figuratively. A powerful factor in preventing such situations is hygienic regulation.
Considering the problem of rationing in hygiene, we can distinguish several historical stages of its research: empirical, scientific-experimental and modern. However, talking about the appearance of a more or less slender rationing concepts possible since the 20s of the twentieth century, when it was developed in occupational hygiene. Based on 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 30-50s, the foundations were laid for the methodology of hygienic regulation of chemicals in the water of reservoirs, the atmospheric air of populated areas, soil, and food products. The basis of the methodology of hygienic standardization environmental quality lay the fundamental provision that MACs correspond to levels that are harmless to the human body and have neither direct nor indirect effects on the health of present and future generations.
Currently in Russia the federal executive body authorized to carry out state sanitary and epidemiological regulation, is federal Service for supervision in the field of consumer rights protection and human well-being (Rospotrebnadzor). The specified rationing is carried out in accordance with the regulations 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 (HS);
Sanitary rules and regulations (SanPiN).
In addition, the bodies and institutions of Rospotrebnadzor widely use methodological documents in their activities:
Manual(R);
Methodical instructions (MU);
Guidelines for control methods (MCM). The important point is that regulatory legal
acts concerning issues of ensuring the sanitary and epidemiological well-being of the population, adopted by federal executive authorities, executive authorities of constituent entities of the Russian Federation, local government bodies, decisions legal entities on the above issues, state standards, building codes, labor protection rules, veterinary and phytosanitary rules, must not contradict sanitary rules.
In accordance with the Federal Law “On the Sanitary and Epidemiological Welfare of the Population,” compliance with sanitary rules 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 monitor 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 hygienic standards- install-
permissible, maximum or minimum quantitative and/or qualitative values of an indicator characterizing a particular environmental factor from the standpoint of its safety and/or harmlessness to humans, legally binding for all departments, bodies and organizations.
Based on methodological principles of hygiene, the development of hygienic 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. Maymulova et al. (2006). These include:
1. The principle of harmlessness of hygienic standards (primacy of medical indications). When substantiating the OS factor standard, the specifics of its effect on the human body and sanitary living conditions are taken into account.
2. The principle of advance. It lies in the need to justify and implement preventive measures before the formation and/or impact of certain harmful factors.
3. Unity principle molecular, structural and functional changes as a basis for differentiation harmful And harmless influences. At the same time, several types of harmfulness criteria are distinguished.
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 to the environment.
Criteria characterizing psychosocial disorders- disturbance of mental functions, depression of the emotional environment, disturbance interpersonal relationships etc.
Reproductive dysfunction- changes in genetic material, effects on sperm, fertility and infertility, developmental delay, deformity and other developmental defects, etc.
Carcinogenic effect- the effect of carcinogenic substances on the body, leading to cancer.
Physiological criteria- indicators of the functional activity of all body systems.
Biochemical criteria- biochemical constants, state nucleic acids and etc.
Immunological criteria- nonspecific indicators of immunological reactivity.
Metabolic criteria: rate of metabolism and release of substances from the body; accumulation of the substance in critical organs due to the dose size; 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 test and other statistical methods of proving the reliability of the proposed hypothesis.
4. The principle of threshold action. It assumes the existence of doses (concentrations) that do not exhibit toxic or other adverse effects on the body. The existence of this principle conflicts with the concept of thresholdlessness, which is used in radiation hygiene and in establishing acceptable levels of carcinogens. Today, the concept instructions have been replaced by acceptable risk concept, which has already been mentioned.
5. Dependence of the effect on the concentration (dose) and exposure time.
6. The principle of biological modeling. The basic model for studying toxic and long-term effects is laboratory animals (mammals) with maximum reproduction of the intake (effect) of the agent being studied 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 data obtained from animal experiments to humans, the so-called safety factors. They are regulated depending on environmental objects (water, soil, atmospheric air, work area air, food).
7. The principle of separation of sanitary protection objects. When regulating chemical compounds for environmental objects, various types of adverse effects on the environment and the human body are taken into account. At the same time, types are distinguished adverse effect: general toxic, teratogenic, irritant, change in atmospheric transparency, etc.
In its turn, hazard indicators include effects: resorptive, sanitary-toxicological, reflex, organoleptic, general sanitary, migratory water (air), etc.
8. The principle of a 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 guidelines, standards, recommendations, etc., which prescribe the conditions for conducting research, the methods used, principles of assessment, etc.
10. The principle of stages in conducting research The stages and rules for forming conclusions (decisions at each stage) depend on the environmental object.
11. The principle of unity of experimental and field research(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 maximum permissible concentration in soil of DDT (from 1 to 0.1 mg/kg), zineb (from 1.8 to 0.2 mg/kg), etc. was revised (Goncharuk E.I. and al., 1999). Since the discovery of ionizing radiation, permissible levels (doses) for personnel and the public have been revised several times, also in the direction of tightening.
These principles underlie methodological approaches to substantiate hygienic standards for various elements or factors environment.
Features of hygienic regulation of chemicals
As already indicated, methodological approaches to the regulation of potentially harmful factors are determined by the characteristics of the environmental facility for which the hygienic standard is established.
For example, for atmospheric air hygienic standardization chemical substances is based on 3 harmfulness criteria formulated by V.A. Ryazanov:
1. Only that concentration of a substance in the atmospheric air is considered acceptable if it does not have a direct or indirect harmful or indirect effect on a person, and does not affect well-being and performance.
2. Habituation 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), transparency of the atmosphere and living conditions of the population should be considered unacceptable.
The main hygienic standard for atmospheric air is MPC of atmospheric pollution- this is a concentration that does not have a direct or indirect adverse effect on the present and future generations throughout life, does not reduce a person’s performance, does not worsen his well-being and sanitary living conditions.
In atmospheric air, 2 maximum permissible concentrations are established: maximum one-time And average daily Their development is carried out using the algorithm described in the relevant methodological documents. It is taken into account that the average daily MPC is established taking into account the hazard class of the substance (determined by certain toxicometric parameters). There are 4 classes in total: 1st class - extremely dangerous; 2nd class - highly dangerous; 3rd class - moderately dangerous; 4th class - low-hazard.
Of course, standards for harmful chemicals in the atmosphere and in the air working area will differ, most often upward in the latter case. This is understandable, since standards for atmospheric air are set taking into account the fact that the substance present in it will affect children, the elderly, and sick people whose body resistance is not comparable to that of a healthy person. In addition, in the first case, the maximum permissible concentration affects a person throughout the day, while it affects a worker only during a work shift.
Slightly different patterns underlie the rationale MAC in soil (MPC-soil).
MPC of an exogenous chemical in the soil is its maximum amount (in mg/kg of 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, his offspring and sanitary living conditions of the population.
Consequently, the content of an exogenous chemical substance in the soil is allowed to be such that it guarantees the absence of a negative impact on public health both through direct human contact with the soil and indirectly during the migration of a toxic substance through one or more ecological chains (soil - plant - human; soil - plant - animal - man; soil - atmospheric air - man; soil - water - man
etc.) or in total along all chains, and also does not disrupt the soil self-purification processes and does not affect sanitary living conditions.
To assess the degree of soil contamination in a specific situation, indicators are calculated that reflect real regional soil and climatic characteristics. Such indicators, which are calculated on the basis of approved maximum permissible concentrations for chemical substances in the soil, are maximum permissible application levels (MAL) exogenous chemicals into the soil and their safe residue quantities (SRQ).
There are specific features of hygienic regulation of chemicals in the aquatic environment And food products. They are discussed in the corresponding chapters. From the above examples it is quite clearly seen that the final result of the study - MPC - is justified experimentally. The difference is that to evaluate each element of the environment to determine the acceptable amount of a chemical, the content of the experiment is significantly different.
Features of hygienic standardization of physical factors
Let us recall that physical factors include a fairly large list of agents that differ in the nature of their origin (natural and artificial), the characteristics of their influence on living beings, their prevalence in nature and many other properties.
Physical factors in the most general form include solar radiation with its unique electromagnetic spectrum; physical factors of the air environment: temperature, humidity, air speed, etc.; mechanical factors: noise, sound, ultrasound, infrasound, vibration; electric, magnetic field of the Earth, etc. Even the factors listed here can mostly be of natural or artificial origin.
First about general patterns taken into account in the regulation of physical factors that bring them closer to chemical ones regarding different elements of the environment. To a first approximation, the general can be seen in the following areas: 1. Both chemical and physical factors in their “natural form” and relationships are absolutely vital, without which life on Earth would become impossible. This can be expressed
thus: disappear from the chemical composition of atmospheric air oxygen or stop penetrating the earth's surface solar radiation, almost everything on the planet would cease to exist, including humans.
2. Even vital factors of a physical and chemical nature, if they deviate from the natural norm, can harm human health or the environment. Oxygen, essential for human life, can cause severe poisoning if the patient to whom it was prescribed for health reasons is given too large a dose in its “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. What is 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 taken into account that among both chemical and physical factors there are those that have thresholdlessness harmful action. Among the former are carcinogens, and among the latter are ionizing radiation (IR).
4. Most of the standards in their various forms (maximum permissible concentrations, maximum permissible limits, remote control regulations, etc.) have been established experimentally, those. are to a certain extent probabilistic in nature. 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 general points when assessing
the influence of chemical and physical factors on human health and OS, but let’s look at the differences. They, like “similarity,” are, to a certain extent, relative in nature.
1. Being within 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 the 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 and attached to a certain area,
region are forced to endure these kinds of undesirable impacts while trying to adapt to them.
2. The next difference is that if a natural physical factor takes on an anomalous characteristic (for example, a sudden increase or decrease in temperature, unusual for this season or region; precipitation significant in amount 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 (factory, industrial complex, highway, etc.) poisons the environment - in this case, there is a chronic process of disintegration of the OS of a certain scale, or in the event 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 Indian Ocean earthquake in December 2004. As a result of the subsequent tsunami, which hit the coastal areas of Indonesia, Sri Lanka, southern India, Thailand and other countries, over 300 thousand people died. The economic, environmental and other consequences were also enormous.
3. Another and perhaps the most important difference is that the harmful chemical agent itself causes certain damage to human health and the environment. For physical factors this is most likely an exception. As a rule, several elements of the OS are involved in the orbit of an anomalous physical phenomenon. The same hurricane wind removes and carries away the top layer of soil, exposing some areas of the earth's surface and sweeping away others with dust and snow. Such an element very often involves water on one scale or another.
4. This difference can be conditionally called “the treachery of physics.” Among the unfavorable physical factors, there are many whose harmful effects do not have pathognomonic signs, especially at the level of small doses. And some of them, for example AI, even when acting on humans in lethal doses, do not show their presence in any way. Of course, among chemical factors an “invisibility effect” can be observed, but at high concentrations detection will occur sooner or later. However
in the case of supermaximum doses of AI, a person simply does not survive until the cause is identified. 5. The concept of risk (some call it the concept of “acceptable risk”) began to develop in the process of regulating physical factors. As a matter of fact, it arose in the field of radiology, radiation hygiene, radiobiology and other related sciences, since there were too many difficulties in the extrapolation of experimental data obtained in experiments on animals in relation to humans. In this regard, it was necessary to develop completely original approaches for calculating the risk to human health when justifying hygiene standards for AI.
But it should be emphasized that great successes were subsequently achieved in the field of regulation of chemical factors. 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, it is still far from the desired result.
Particular approaches to hygienic standardization of physical factors (biological, mechanical, etc.) are presented in more detail in the relevant 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 already cited WHO definition of health, 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. ultimately learn to normalize these states.
If we recall the existence of three stages in the history of the development of hygiene (empirical, scientific-experimental, modern), then we can say with a certain degree of convention that the sciences that should answer the question posed: “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 evidentiary.
3.3. MODERN THEORIES FOR ESTABLISHING CAUSE-AND-EFFECT RELATIONSHIP BETWEEN ENVIRONMENTAL FACTORS AND HUMAN HEALTH
Assessing the state of human health in connection with the state of the environment has now become extremely relevant. Determining the role of environmental “pollution” and the emergence of non-infectious morbidity in connection with this gives an idea of the scale of the problem, determining priority programs and directions for the prevention of registered pathology, establishing cause-and-effect relationships between the state of the environment and the health of certain groups of the population, and assessing the negative effect of exposure one or another risk factor.
But before considering the problem of risk itself, it is necessary to define some terms. The concept of “pollution” means the presence in an element of the environment of an undesirable (pollutant) substance in quantities exceeding the maximum permissible concentration, which can have an adverse effect on human health and living conditions. At the same time, under pollutant understand any agent of 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 so-called environmental epidemiology is involved in establishing cause-and-effect relationships between the state of OS and human health. This is another most likely contrived term, just like the previously mentioned controversial terms. Without going into details, we note that we should still focus on existing theories of establishing cause-and-effect relationships between the state of OS and its impact on human health.
We have already mentioned above the existence of the so-called threshold concept. Let us recall that it is based on one of the principles of hygienic regulation of the same name (“threshold principle”).
The concept of threshold played an outstanding role in the formation and development of rationing in general and hygienic rationing in particular. But as science developed, it turned out that it came into conflict with some laws that could not be characterized solely within the framework of its provisions. In particular, most
Your scientists and experts are of the opinion that ionizing radiation and many chemical carcinogens do not have a “threshold of harmfulness.” 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 can ultimately lead to irreparable effects in the form of malignant formations, 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. Currently, this concept is one of the prerequisites for justifying the necessary organizational, economic, logistical, sanitary and other measures to preserve the health and sanitary-epidemiological well-being of the population.
One of the fundamental concepts in the concept of risk is the provision of risk factor.
Risk factor- this is a factor of any nature (hereditary, environmental, industrial, lifestyle factor, etc.), which, under certain conditions, can provoke or increase the risk of developing health problems.
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); no visible benefits (gaseous emissions from waste incinerators); self-controlled (driving a car); controlled by others (pollution); justified (minimal in a given situation); unjustified (maximum or perceived without evaluating the alternative in a particular situation).
Risk of harmful effects on health 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 a cause-and-effect relationship is based on the basic postulates formulated by the English biosta-
by Tistik A. Hill. The most important criteria for the presence of causation and connection are temporal, biological and geographical likelihood (Revich B.A., Avaliani S.L., Tikhonova G.I., 2004).
Temporal likelihood indicates that the exposure preceded the disease (with mandatory consideration latent 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.
Geographical plausibility indicates the connection between the localization of cases of illness or death and the location of the source of pollution (the distance from the source of pollution, exposure routes, wind rose, topography of the area and groundwater, food sources, migration processes and mobility of the population, etc. are taken into account).
strength of statistical relationship between the factor being studied and the observed changes in health status. This relationship must 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 factor under study 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 cause one effect. However, some factors, for example, 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, the cardiovascular system);
reliability. The resulting conclusions are based on the correct design of the study, take into account interfering factors and have sufficient reliability;
exposure-effect relationship(the risk of developing the studied effect should increase with increasing exposure);
constant connection(the relationship under study should be observed in other well-designed studies);
Reversibility (effectiveness of intervention measures) - eliminating or reducing the level of exposure to the factor under study should lead to a reduction in the risk of developing the observed effect;
analogy(correspondence of the obtained data to information about the impact of other factors similar in their mechanism of action) - parallels with other well-studied cause-and-effect relationships. The association in question is consistent with other scientific data and experimental results.
The concept of risk applies primarily to population level. Demographic indicators are used to assess the health status of the population: birth rate, 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, occupational, etc.), seeking medical help, time and permanent 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. Characterizes the health status of a population at a specific point in time and in a certain area. It shows what proportion of the population has 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 matters speed the emergence of new cases of a disease currently being studied. For this purpose, the incidence rate is used. It characterizes the intensity of changes in health status, i.e. the rate of transition of population members from the “healthy” state to the “sick” state, and is determined by the formula:
When analyzing the health status of the population, general and special indicators (coefficients) of morbidity and natural population movement (fertility, mortality, 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 being studied (for example, population composition by age, gender). 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, gender and other differences in the compared groups.
There are 3 types of standardization: direct, indirect and reverse. The choice of one method or another is determined by the nature of the data available. The most accurate is the indirect method, and the least accurate is the inverse. The reverse applies only in cases where there is no data on age structure comparison groups and age composition of patients or deaths.
Special (partial) coefficients reflect the frequency of events for certain categories, for example in certain sex and age groups.
All of the above indicators can be obtained from materials from 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 time (usually 1 year):
In this case, the determination of the risk of occurrence of certain diseases is carried out by comparing indicators in population groups exposed and not exposed to the studied effects. To quantitatively characterize the impact of potentially hazardous exposures, an absolute or relative comparison of health indicators in groups of exposed and unexposed individuals is used. Absolute comparison is determined based on the risk difference (RR), while relative comparison uses relative risk (RR).
Risk difference (RR) also called attributable risk. This is the difference in risk value in the exposed (exposed, R e) and non-exposed (R o) groups:
PP = R e - R o.
The PP indicator indicates how much morbidity (mortality) increases due to the influence of the factor being studied. Such information allows us to determine priority areas of action for both the state in general and healthcare in particular.
Relative risk (RR) is calculated from the ratio of these quantities:
OR = R e / R o.
Relative risk is an intensive indicator and reflects the increase in the exposed probability of events occurring compared to the background.
The considered PP and OP indicators 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 factor being studied 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 take them into account - standardized relative risk (SRR). To study mortality, the standardized mortality rate (SMR) is used. The definition of COP is based on the indirect method of standardization.
When calculating the risk of deterioration in the health status of the population from exposure to various environmental factors, the concepts are used "attributive fraction for exposed persons"(AFe) and "attributive fraction for the population"(AFn).
AFE (additional risk) shows the proportion of diseases in the exposed group due to exposure to the adverse factor being studied.
It is calculated using the formulas:
This value reflects the excess morbidity (mortality) that could be prevented if the current
current factor. So, for example, if the mortality rate from lung cancer in smokers is: (10.8 - 1.0) / 10.8 x 100 = 90.1%, then this means that over 90% of deaths from lung cancer in smokers are a consequence smoking.
Attributive fraction for the population (AFn)- population added risk, characterizes the morbidity caused by a risk factor for the entire population, and not just in the group of exposed individuals. That is, both the biological effect of the factor being studied and the proportion of the exposed population are taken into account:
Where f- the proportion of exposed individuals among the population.
AF n shows the proportion of disease cases among the entire population attributable to the influence of the factor being studied, which can be eliminated if its influence on the population completely ceases.
In addition to the terms considered, in the concept of risk and its calculations itself, the concept of "exposure".
"Exposed"(person, object). If we are talking about a person, then the type of contact with the risk factor, the route of entry of the harmful substance into the body (effect on the body), the duration and intensity of the action, the characteristics of associated factors: physical, chemical, etc. are studied.
In establishing cause-and-effect relationships in the “man-environment” system, certainty and a clear understanding of the meaning of some more definitions are important. In particular, there should be clarity in the concepts: “impact”, “disease”, “healthy”, “sick”, etc.
When establishing a cause-and-effect relationship, two types of studies can be conducted: cross-sectional and longitudinal.
Cross-sectional studies(cross-sectional studies) describe the distribution of health characteristics of a study group at a specific point in time. Examples of cross-sectional studies include population censuses, medical examinations of specific population groups, etc.
Longitudinal studies involve studying the frequency with which individuals in compared groups (populations) move from the “healthy” (“alive”) state to the “sick” (“dead”) state. At
In this type of study, two main research designs are used: cohort and case-control.
Cohort study involves the study of morbidity (mortality) processes in cohorts of individuals exposed and not exposed to the influence being studied. A distinctive feature of this study is that its direction corresponds to the exposure-disease time vector. The design 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 obtain the relative risk value:
In line with 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 about the presence of a connection between a risk factor and a specific disease does not have convincing evidence. The method of assessing data in this case is somewhat different (Table 3.3).
Table 3.3. Presentation of data according to case-control design
With this method of research, the assessment of relative risk is the odds ratio (OR). It is the quotient of dividing the chances of being exposed in patients (a/b) by a similar indicator in “healthy” people (c/d):
Having become familiar with the basic conceptual apparatus of the risk concept, let’s consider the basic diagram of health risk analysis (Fig. 3.1).
From Fig. 3.1 it follows that the process of the likelihood of development and severity of adverse effects assumes the existence of the following stages:
1. Hazard identification.
2. Assessment of the “exposure (dose) - response” relationship.
3. Exposure (impact) assessment.
4. Risk characteristics, etc.
Hazard identification: collection and analysis of data on all sources of pollution of the research object, identification and determination of harmful factors, selection of priority chemical substances for research.
Rice. 3.1. Human health risk analysis framework
Assessment of the “exposure (dose)-response” relationship. Reflects a quantitative relationship between the level of exposure and response
body. It is important to remember the two extremes of harmful effects: carcinogenic and non-carcinogenic. They have different geometric shapes 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 zero effect, since these agents cause a 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, therefore their dose-effect relationship passes through zero, i.e. There is no risk only if the value is zero. To assess the risk parameters of carcinogens, linear extrapolation of the lowest dose established in experiments or epidemiological studies to a zero dose is carried out (Fig. 3.3).
Factors of carcinogenic potential 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 of 1 μg/l. It is calculated by dividing SF by body weight (70 kg) and multiplying by pulmonary ventilation volume (20 m 3 /day) or daily water intake (2 L).
If information about UR and SF is available, it is possible to predict the individual (additional to the background) risk of cancer development for different routes of entry of the carcinogen.
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 using the formulas:
If the size (N) of a population exposed to a substance at a known concentration is known, then it can be calculated population risk- the number of additional (to the background level) cases of cancer in a given population:
For occupational exposures, amendments are made to the given formulas to reflect differences in exposure factors. Thus, given an 8-hour working day and 40 years of work experience (with 240 working days per year and an average pulmonary ventilation per shift of 10 m3), the unit risk (1Zh) will be:
From here we can calculate individual risk cancer development during work experience:
Where WITH- average concentration of a chemical substance for the entire period of production activity.
The risk of developing non-carcinogenic effects for individual substances is assessed based on the calculation coefficient dangers:
When characterizing non-carcinogenic effects in the case of combined or combined exposure to chemical compounds, calculate hazard index(1 o). If there is a simultaneous intake of several substances through the same route (inhalation, oral), the calculation is carried out using the formula:
where K oi is the hazard coefficient for the individual components of the mixture of influencing substances.
If active substances enter simultaneously through several routes, 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 routes of entry or individual routes of exposure.
The calculation of hazard indices is carried out taking into account critical organs (systems), since in the case of exposure to a mixture of substances on the same organs or systems of the body, the most likely type of their combined action is summation (additivity).
From the data presented it is quite clearly seen that the methodology for assessing the risk to public health due to the effects of the environment seems to be a rather complex tool in practical use. But today this is a mandatory procedure, no matter how difficult it may be to implement. Risk assessment methodology is widely used by international organizations (WHO, EU) to establish indicators of the quality of atmospheric air, drinking water, food products, assess health damage from air pollution from motor vehicles, energy enterprises, etc.
In Russia, the development of research on this problem received the greatest development after the release of a 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 environmental quality and public health in the Russian Federation "
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 opportunities for predicting adverse changes in the health of the population and are a prerequisite for the development and recommendation of risk management measures, i.e. on managing systems of legislative, technical and regulatory decisions 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 assessing occupational risks to the health of workers. Organizational and methodological foundations, principles and evaluation criteria" (R2.2.1766-03) and "Guidelines for assessing the risk to public health when exposed to chemicals that pollute the environment" (R2.1.10.1920-04). Included Scientific Council The Russian Academy of Medical Sciences and the Ministry of Health and Social Protection on human ecology and environmental hygiene operate a problem commission “Scientific basis 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 - jointly with Rospotrebnadzor of the Russian Federation, the Ministry of Health and Social Protection RF - development of scientific and methodological support for practical work on risk assessment.
As for actual activities in the field of risk assessment methodology, in accordance with 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 Well-being in 2006 and tasks for 2007”, as of 01/01/2007, the number of units for maintaining SGM was 86, including 36 independent ones, according to risk assessment - 2 and 2, respectively. This once again confirms the complexity of the problem under consideration.
Thus, today in Russia there has been a fairly formalized two-level system for introducing a methodology for assessing the health risk of the country's population, including scientific, methodological and practical levels.
3.4. HEALTH IS A FUNDAMENTAL CRITERION FOR ASSESSING HUMAN WELL-BEING AND THE STATE OF THE ENVIRONMENT
3.4.1. Methodology for studying population health
The problem of studying the phenomenon of health is important not only for medicine, but also for humanity as a whole. Until now, only one definition has been given, which was proposed by WHO experts (see Chapter 1). It exists, but this formulation is not entirely accurate in the “man and his health - environment” system. It is no coincidence that when considering this problem it is stated that it is very difficult to define the concept of “population (human) health”. This is true, but there are also encouraging successes.
Analyzing the current definitions of health, we can conclude that in a certain sense they can be grouped according to semantic features.
Part of the definitions reveals, first of all, the philosophical content of the concept of “health”, which was formulated by K. Marx: “Illness is a life constrained in its freedom,” implying that health in this case one should understand the absence of disease. The second type of definitions to some extent details the above definition. This includes the above-mentioned WHO formulation, 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 general philosophical and methodological terms are apparently fair and have the right to exist, but the question arises - how to use them practically? After all, the conceptual apparatus in both cases does not lend itself to 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-based, i.e. quantitative discipline. Therefore, special care should be taken
consider another methodological approach when defining the phenomenon of health.
The essence of the third group of definitions of health is that its proponents consider this concept or how process(“health is a process...”, or how state(“health is a state...”).
Without going into details and the inconsistency of the interpretation by different authors of the very concepts of “process” and “state”, we note that both phenomena (process, state) lend themselves to both quality(in the most general form: progress or regression), 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 “person(s) - environment” system 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 based on such an understanding of such a complex biosocial being as man is, can we further advance along the path of studying human (population) health as a criterion of social and hygienic well-being. At the same time, we must keep in mind other concepts (definitions) necessary to move in this direction.
General biological health(norm) - the interval within which 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 disability of a certain population group.
Individual health- a 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.
Present population- the number of all persons who were in a given locality at the critical moment of the census, including those temporarily residing and excluding those temporarily absent.
Resident population- persons permanently residing in a given locality, including those temporarily absent and excluding those temporarily residing.
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 present population- persons available in a given 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 activity, demographic and ethnic characteristics, way of life, value orientations, traditions, etc., uniting it as a whole with its inherent group characteristics processes of health level formation.
Cohort- a 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), start of work, 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 well-being(demographic situation, sanitary and hygienic indicators of environmental factors, lifestyle, level of medical care, social and hygienic indicators);
mental wellbeing(incidence of mental illnesses, frequency of neurological conditions and psychopathy, psychological microclimate).
Analyzing the criteria for assessing population health, we will once again be convinced that the WHO definition of the health phenomenon cannot be applied to an individual person. In addition, it is not applicable to children and young people, which is a significant drawback.
Most of the listed indicators relate to medical ones, reflecting not the actual level of health, but the prevalence of diseases (morbidity, disability, mortality), i.e. indicators of morbidity (“ill health”). It is assumed that the higher they are, the lower the level of health of the corresponding population group, i.e. and in in this case The path to assessing health goes through “ill health,” which is not part of the new approaches.
It should be noted that WHO has made an attempt to more subtly and in detail outline the criteria of social well-being, which include:
1. Percentage of gross national product spent on health care.
2. Availability of primary health care.
3. Coverage of the population with safe water supply.
4. The percentage of people immunized against infectious diseases that are particularly common among the population of developing countries (diphtheria, whooping cough, tetanus, measles, polio, tuberculosis).
5. Percentage of services provided to women by qualified personnel during pregnancy and childbirth.
6. Percentage of children born with insufficient body weight (less than
7. Average life expectancy.
8. Literacy level of the population.
It is easy to see that this, like other approaches, also tends more towards a “theoretical” assessment of health, far from quantitative. Therefore, in practice, the already mentioned ones are most often used medical indicators reflecting morbidity, mortality, etc.
The sources of information in this case are:
1. Official reports from health care facilities, health authorities, social security, registry offices, state statistics bodies.
2. Specially organized recording of morbidity and mortality in health care facilities - prospective studies.
3. Retrospective information for the period under study.
4. Medical examination data.
5. Data from clinical, laboratory and other studies.
6. Results of medical and social research.
7. Results of mathematical modeling and forecasting. In general, an integral assessment of the health status of the population
carried out in the following algorithm (Fig. 3.4).
From Fig. 3.4 it is clear that before achieving the desired result - “Population health indicators”, it is necessary to carry out many intermediate assessment actions (qualitative and quantitative analyses, 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 (linking) indicators of the population’s health status and environmental factors (Fig. 3.5).
In this case, 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 provide insight into the level of health of the population by integrating a number of indicators. In this regard, they are subject to rather strict requirements, which WHO formulated back in 1971:
Availability of data for index calculation;
Completeness of population coverage;
Reliability (data should not change in time and space);
Computability;
Acceptability of calculation and evaluation method;
Reproducibility;
Specificity;
Sensitivity (to relevant changes);
Validity (a measure of the true expression of factors);
Representativeness;
Hierarchy;
Target consistency (adequate reflection of the goal of improving health).
Shown in Fig. 3.5 algorithm for solving the problem of studying relationships in the “person (population) - environment” system 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 population health. As an example, the assessment of these levels according to certain criteria is given (Table 3.4).
Table 3.4. Approximate assessment of the level of population health
Health level | Incidence rate per 1000 population | Morbidity with temporary disability per 1000 workers | |||||||
primary | general |
||||||||
city | village | city | village | cases | |||||
Very low | |||||||||
Very tall | |||||||||
Note: 1 - disability per 1000 people; 2 - child (infant) mortality, %; 3 - overall mortality, %.
One of the final stages of an epidemiological study of population 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 purpose, mathematical modeling is usually carried out, i.e. Using special methods, mathematical models are built that reflect the dependence of the level of health of the population on the factors under study. In the process of such analysis, the degree of influence of each of the studied factors on the level of health of the population is established.
One of the ways to draw a conclusion about the degree of influence of each factor is to use the criterion of correlation-regression analysis - coefficient of determination.
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 factors according to the degree of their harmfulness and develop prevention programs taking into account the priority of their action.
An epidemiological study of the health status 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 is clear that research in the “environment - population health” system requires numerous assessment actions, which can only be carried out by large scientific or practical organizations or a complex of them. For smaller studies, more simplified approaches can be used, for example cohort studies.
In this case, the algorithm may be as follows - it is necessary to decide on the directions of health research (Fig. 3.6).
Rice. 3.6. Main directions of health research
Having decided on the directions of research, they conduct a targeted study of the health indicators presented in Fig. 3.7. The interesting thing is that 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 of their diagnosis
Environmentally dependent diseases of the population include those diseases in the etiology of which environmental factors play a certain role. The following terms are often used in this case: “ecodisease”, “anthropoecological diseases”, “environmentally dependent diseases”, “ecopathology”, “diseases of civilization”, “lifestyle diseases”, etc. In these terms, as can be seen, the emphasis is on the environmental or social causes of many diseases.
Rice. 3.7. Indicators of human health (population)
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. Currently, approximately 20 chronic diseases of the population are quite reasonably associated with the influence 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 an environmental factor acts as a cause of a disease, then its effect is called deterministic.
Table 3.5. List of known environmentally related diseases
Note. * Only 40 years after the environmental disaster was established, the fish and shellfish of Minamata Bay were recognized as safe for human health.
Environmental factors may 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 particular factor changes 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 factor under study may have mixing influence. Examples of confounding factors include age and tobacco smoking when studying the effect of air 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 may also be caused by imbalance between the internal and external environment of the body, which is especially typical for endemic diseases. The etiology and pathogenesis of some endemic diseases are quite well studied. For example, it has been established that observed in many regions of the world fluorosis caused by excess fluoride intake from 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 disrupt hormonal status.
Among the causes of malignant neoplasms, the leading place is occupied by nutrition and smoking, i.e. factors associated mainly with a person’s lifestyle (Fig. 3.8).
3.4.3. Environmentally caused diseases as a result of the action of chemical factors
A number of signs allow the doctor to suspect an environmental cause of the observed disorders in the health of the population. Cause-and-effect relationships between disease and chemical exposure are often more difficult to recognize and understand than those associated with infectious diseases or foodborne illnesses. Before analyzing the environmental cause of the disease, it is necessary to exclude the infectious or nutritional nature of the observed health disorders.
Rice. 3.8. Probable causes of cancer
Most characteristic features environmental, in particular chemical, nature of the disease:
Sudden outbreak of a new disease. It is often interpreted as infectious, and only a thorough clinical and epidemiological analysis makes it possible to identify the real reason exposure to chemicals;
Pathognomonic (specific) symptoms. In practice, this sign is quite rare, since specific signs of intoxication mainly appear at relatively high levels of exposure. A certain combination of nonspecific symptoms has much greater diagnostic significance;
A combination of nonspecific signs, symptoms, laboratory data, unusual for known diseases;
Absence of contact transmission routes characteristic of infectious diseases. For example, people living in the same apartment with asbestos production workers have a very high risk of developing tumors of the lungs and pleura, due to exposure to asbestos particles carried along with contaminated work clothing;
Common source of exposure for all victims; connection of diseases with the presence of chemicals in one of the environmental objects;
Detection of a “dose-response” relationship: an increase in the likelihood of developing a disease and/or an increase in its severity with increasing dose;
Formation of clusters (condensations) of the number of cases of diseases that are 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, socioeconomic status, profession and other characteristics. Children, elderly people, and patients with one or another chronic pathology are often most susceptible to the disease;
Detection of subgroups with increased risk of disease. Such subgroups can often indicate the pathogenetic characteristics of the influencing factor;
Temporal relationship between disease and exposure 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, changes in diet, etc.;
Biological plausibility: the observed changes are confirmed by data on the pathogenesis of the disease, the results of studies on laboratory animals;
Detection of the test chemical substance or its metabolite in the blood of victims;
The effectiveness of interventions (specific preventive and therapeutic measures).
Each of the above signs individually is not decisive, and only their combination allows us to suspect the etiological role of environmental factors. This is the extreme difficulty of establishing the ecological nature of an individual’s disease.
The relationship between exposure to environmental factors and health problems may vary. The simplest
to analyze the situation when the very fact of impact necessary and sufficient for the occurrence of a disease (for example, a snake bite to a person is a risk of death). In such situations, the background (without the exposure being studied) incidence rate is zero.
The impact may 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(conversion of initiated cells into tumor cells), progression(malignant growth and metastasis). If a chemical has only promoter or initiator properties, then its effects are not sufficient to cause cancer development.
Another variant of cause-and-effect relationships is the case when the impact sufficient, but not necessary for the development of the disease. For example, exposure to benzene can cause the development of leukemia, but leukemia can occur without exposure to this substance.
For the development of so-called conditioned diseases, exposure to environmental factors can be not enough and not necessary. As already noted, most noncommunicable diseases have complex, multiple etiologies, and the risk of their development depends on many different factors. The complexity of analysis in such situations is due to the fact that in the population, even without the environmental factor being studied, there is a certain and often relatively high background level of morbidity associated with other known or unknown causes.
Population hygienic diagnostics used to assess the environmental situation in various territories and identify health risks associated with certain hazardous enterprises or other sources of environmental pollution. Under favorable environmental conditions understands the absence of anthropogenic sources of adverse impacts on the environment natural environment and human health and natural, but anomalous for a given area (region) climatic, biogeochemical and other phenomena. Depending on the intensity of the influence of environmental factors on public health, there are emergency zone ecological situation and environmental disaster zones.
The ecological state of territories is assessed using a set of medical and demographic indicators. These indicators include perinatal, infant (under 1 year of age) and child (14 years of age) mortality, the frequency of congenital malformations, spontaneous miscarriages, the structure of morbidity in children and adults, etc. Along with mortality and morbidity indicators, the average duration life, the frequency of genetic disorders in human cells (chromosomal aberrations, DNA breaks, etc.), changes in the immunogram, the content of toxic chemicals in human biosubstrates (blood, urine, hair, teeth, saliva, placenta, breast milk, etc.).
Currently, in Russia there are, for one reason or another, over 300 environmental 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 cause-and-effect relationships between health problems in a particular person and current or past potentially harmful environmental factors. Its relevance is determined not only for the correct diagnosis, treatment and prevention of diseases, but also for establishing a possible connection between “environment and health” in order to determine material compensation for damage to human health as a result of environmental or production factors.
Based on severity, possible health effects are divided into: catastrophic(untimely death, decreased life expectancy, severe impotence, disability, mental retardation, congenital deformities), heavy(organ dysfunction, nervous system dysfunction, developmental dysfunction, behavioral dysfunction) and unfavorable(weight loss, hyperplasia, hypertrophy, atrophy, changes in enzyme activity, reversible dysfunction of organs and systems, etc.).
As already noted, reactions to external influences in a population in most cases are probabilistic in nature, which is due to differences in the individual sensitivity of people to the action of the environmental factor being studied. In Fig. Figure 3.9 presents the spectrum of the biological response of the population to the influence of environmental factors. As can be seen from the figure,
in the majority of the population, as a result of exposure to harmful factors, latent forms of diseases and prenosological conditions arise that are not detected by mortality, use of medical care, and hospitalized morbidity. Only a targeted and in-depth medical examination can assess the true state of health in the exposed population. This problem is intended to be solved hygienic diagnostics.
Rice. 3.9. Schematic spectrum of biological responses to environmental pollution (WHO Expert Committee, 1987)
Hygienic diagnostics focuses on identifying pre-morbid (premorbid) conditions. The subject of hygienic diagnostics research is health and its magnitude. It is carried out by a doctor in order to assess the state of adaptation systems, early detection of tension or disruption of adaptation mechanisms, which in the future can lead to illness. The doctor cannot and should not calm down even if 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 obvious malingerers) should be classified as a risk group (observation) and their health status should be studied over time.
An example of such a case is the so-called multiple chemical sensitivity syndrome (MCS). It is an environmental disease with chronic multisystem and polysymtomatic disorders caused by low-intensity environmental factors. With this disease, the body’s adaptation mechanisms 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 variety of chemical compounds present in the environment in concentrations well 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 the disease after eliminating exposure to potentially harmful factors for 3-5 days (for example, when changing place of work or place of residence). Repeated placement of the patient in a dangerous environment causes a new exacerbation of symptoms. The disease often develops in people who have had acute exposure to organic solvents and pesticides in the past. Due to the difficulty of diagnosing multiple chemical sensitivity syndrome (especially in its early stages), these patients are often diagnosed with “neurasthenia” or “psychosomatic disease”. Correct differential diagnosis of multiple chemical sensitivity syndrome is possible only with a careful and targeted 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, determination of the content in biosubstrates harmful organic substances and heavy metals).
Methods for diagnosing premorbid conditions are very diverse and include the study of a person’s 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, and the use of biomarkers. Premorbid conditions are observed in relatively large number“practically healthy” people: in
37.9% of those surveyed showed tension in their adaptation mechanisms, 25.8% had unsatisfactory adaptation, and 8.9% had a failure of adaptation.
In hygienic diagnostics, comparative assessments of health status are mandatory. Many so-called environmentally caused diseases have a polyetiological nature and a complex multi-syndromic nature. To prove their connection with environmental quality, it is necessary to establish the dependence of the risk of health problems on exposure and in parallel examine control groups that do not have clear contact with the factors being studied.
The most unfavorable consequences of the influence of chemical factors on human health are stochastic effects, those. the emergence and development of malignant neoplasms.
Oncological diseases occupy one of the first places among the causes of morbidity and mortality of the population.
The development of cancer is promoted 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 carcinogenic factors depending on the 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 as carcinogenic;
4 - agents are 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 cancer by 6.2 times, esophagus cancer by 17.2 times, and bladder cancer 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 in the United States each year.
Carcinogenic properties for humans or laboratory animals have now been found in approximately 1000 different chemical substances. Below are some compounds and production processes that pose a danger 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 for humans:
4-aminodefinyl;
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 gas;
Cadmium and its compounds;
Coal and petroleum tars, pitches and their sublimations;
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;
Domestic soot;
Shale oils;
Chromium hexavalent compound; erionite;
Ethylene oxide;
Alcoholic drinks;
Solar radiation;
Tobacco smoke;
Smokeless tobacco products;
Woodworking and furniture production using phenol-formaldehyde and urea-formaldehyde resins in enclosed spaces;
Copper smelting;
Industrial exposure to radon in the mining industry and when working in mines;
Production of isopropyl alcohol;
Coke production, processing of coal, oil and shale tars, coal gasification;
Production of rubber and rubber products;
Carbon black production;
Production of coal and graphite products, anode and hearth masses using pitches, as well as baked anodes;
Production of cast iron and steel (sinter factories, blast furnace and steelmaking, hot rolling) and castings from them;
Electrical production of aluminum using self-sintering anodes;
Industrial processes involving exposure to aerosols of strong inorganic acids containing sulfuric acid.
Such a wide range of chemical factors and industries (far from complete!) requires the doctor to have an idea, at least within the framework of this list, of the possible risk for his patients and to focus specifically on the earliest signs of possible problems in people’s health.
Other environmentally related diseases
Currently, allergic diseases have become particularly relevant 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 are aggressive. 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 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, of chemical substances and products of biotechnological synthesis. In the city of Kirishi, 47 people developed bronchial asthma due to the combined effects of protein-vitamin complexes and atmospheric pollution. Angara pneumopathy described in the literature, manifested by bronchospasm, also appears to be associated with exposure to microbial synthesis products and atmospheric pollution.
In recent years, along with “classical” allergic diseases, the attention of doctors has been attracted by environmentally caused 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 constant, throughout life, exposure to hundreds of different chemical compounds.
There are 2 groups of human health disorders caused by exposure to the indoor environment. First group is called "building related diseases (BRI)" and includes health disorders etiologically associated with certain indoor factors, such as the release of formaldehyde from polymers and wood-based materials. After eliminating the harmful effects, the symptoms of the disease, as a rule, do not disappear, and the recovery process may require quite a long time.
The second group is called "sick building syndrome (SBS)" and includes acute health problems and discomfort that arise in a specific room and almost completely disappear when leaving it. Sick building syndrome manifests itself in the form of headaches, irritation of the eyes, nose and respiratory system, dry cough, dry and itchy skin, weakness and nausea, increased fatigue, and sensitivity to odors.
According to WHO, about 30% of new or reconstructed buildings can provoke these symptoms. The development of sick building syndrome is apparently due to 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 Heredity |
Causal (sensitizing factors) | Household allergens (house dust, house dust mites) Epidermal allergens of animals, birds; allergens of cockroaches and other insects Fungal allergens Pollen allergens Food allergens Drug allergens Viruses and vaccines Chemicals |
Factors contributing to the occurrence of bronchial asthma, aggravating 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 exacerbation of bronchial asthma (triggers) | Allergens Viral respiratory infections Physical and psycho-emotional stress Changes in the meteorological situation Environmental impacts (xenobiotics, tobacco smoke, strong odors) Intolerant foods, medications, vaccines |
The causes of sick building syndrome are most often insufficient natural and artificial ventilation of the premises, building finishing materials, furniture, irregular or improper cleaning of premises.
Another syndrome in which environmental factors may play a role is chronic syndrome
fatigue(immune dysfunction syndrome). To diagnose 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. A feeling of severe fatigue has been observed for at least 6 months.
3. The feeling of fatigue is combined with impaired short-term memory, confusion, disorientation, speech impairment and difficulty 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 upon palpation;
Generalized weakness;
Feeling of joint discomfort;
Asymmetrical damage to large joints;
Headache (in the retro-orbital and occipital areas);
Sleep disorders;
Increased drowsiness (sleep more than 10 hours per day);
Chronic, frequently recurring runny nose.
Most patients exhibit functional deficiency 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, the Epstein-Barr virus, genetic predisposition, stress, chemicals, including heavy metals, and a deficiency of antioxidant substances in the diet.
LECTURE PLAN: 1. Basic definitions and concepts of environmental hygiene 2. Human impact on the environment (2nd law of hygiene) 3. Impact of the environment on humans (5th law of hygiene) 4. Biological environmental factors 5. Prevention of harmful environmental effects per person. Environmental protection
PURPOSE OF THE LECTURE: To become familiar with the basic definitions and concepts of environmental hygiene, to gain an understanding of the impact of humans on the environment and the environment on humans, biological environmental factors, the main directions of preventing the harmful effects of the environment on humans and environmental protection
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Federal Law 52 HARMFUL IMPACTS OF THE ENVIRONMENT - exposure to environmental factors that create a threat to human life or health or a threat to the life of future generations. FAVORABLE CONDITIONS FOR HUMAN LIFE - a state of the living environment in which there is no harmful effect of its factors on humans and there are opportunities for restoring impaired functions of the human body. SANITARY-EPIDEMIOLOGICAL WELL-BEING OF THE POPULATION (SEWS) is the state of health of the population, the human environment, in which there is no dangerous influence on a person and there are favorable conditions for his life.
Health is a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity (WHO definition)
Basic definitions BIOSPHERE is the region of existence of living matter (V.I. Vernadsky), including the lower part of the atmosphere (aerobiosphere), the entire hydrosphere (hydrobiosphere), the land surface (terrabiosphere) and the upper part of the lithosphere (lithobiosphere). Geochemical factor on a planetary scale ECOLOGY is the science of the relationships of plant and animal organisms, the communities they form between themselves and the environment. There are general, marine, medical, applied, endoecology, human ecology, etc.
Basic definitions ENVIRONMENT - a set of components of the natural environment, natural and natural-anthropogenic objects, as well as anthropogenic objects (“On Environmental Protection” No. 7-FZ) NATURAL ENVIRONMENT - a set of components of the natural environment, natural and natural-anthropogenic objects (“On Environmental Protection" No. 7 -FZ)
DEFINITIONS: Noosphere NOOSPHERE (Greek noos - mind + sphere) is a “thinking shell”, the sphere of the mind, the highest stage of development of the biosphere, associated with the emergence and development of civilized humanity in it. This is the period when intelligent human activity becomes the main determining factor in development on Earth. The concept of the noosphere was introduced by the French scientists Leroy and de Chardin in 1927. V. I. Vernadsky developed the idea of the noosphere as a qualitatively new form of organization that arises from the interaction of nature and society. The 10 laws of hygiene are closely related to the concept of the noosphere
Erisman F.F. on environmental factors: “As for the program of the conversations ahead of us, I think we will dwell on the general living conditions, among which the primary sanitary significance belongs to the air...: the same general factor is the soil. ... The third common medium is water. ... Following this, we will move on to consider the hygienic conditions of those means and devices with the help of which a person is protected from the hostile influences of climate and weather - ... housing and clothing; ...here we will have to talk about the properties and sanitary significance of building materials and fabrics: about heating and ventilation of residential premises and public buildings, about their natural and artificial lighting, etc. ... ". “Fundamentals and objectives of modern hygiene”, 1887 Extracts)
ETIOLOGICAL FACTOR - a factor that is the cause of a health disorder and determines its nature and individual features RISK FACTOR - a factor that increases the likelihood of various health disorders (i.e., a condition) MODIFYING FACTOR - environmental factors that cause structural and functional changes in the body
Main factors shaping population health (WHO): Lifestyle - 50% Environment - 20% Heredity - 20% Healthcare - 10%
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ENVIRONMENTAL POLLUTION - the entry into the environment of a substance and (or) energy, the properties, location or quantity of which have a negative impact on the environment (No. FZ-7)
CLASSIFICATION OF ENVIRONMENTAL POLLUTION 1. by origin (2 classifications) 2. by size of territory 3. by strength and nature of impact 4. by duration 5. by source 6. by environment
CLASSIFICATION OF ENVIRONMENTAL POLLUTION: BY ORIGIN 1 NATURAL (RESULTING FROM NATURAL CAUSES) § dust storms § volcanoes § forest fires § mudflows § floods ANTHROPOGENIC (RESULTING FROM HUMAN ACTIVITY): § § § industrial enterprises, transport, thermal power plants, agriculture, waste places Gudinova
CLASSIFICATION OF ENVIRONMENTAL POLLUTION by origin 2 Chemical Physical is a change in natural chemical properties environment or the entry into the environment of substances that are not characteristic of it, or in quantities exceeding the background (natural) most common pollution: oil, heavy metals, their salts, oxides are deviations from the norm physical properties environments emit electromagnetic, radioactive, light, thermal, noise types of pollution Biological Mechanical Information ion bacteria, viruses, fungi, helminths, simple biological producers pollution with relatively inert physicochemical waste (garbage) insufficiently studied the influence of negative information on natural and built environment: disasters,
OTHER CLASSIFICATIONS OF ENVIRONMENTAL POLLUTION by size of territory by strength and nature of impact by duration and by sources by environment global (background-biosphere) regional local point background impact (impact - blow, push) - usually an accident (oil spill) permanent temporary industrial transport agricultural and household air pollution (atmospheric) water pollution (marine environment, fresh water) soil pollution
Disaster in the Gulf of Mexico: in April 2010, after an explosion and flooding, the Deepwater Horizon oil well was damaged and oil from it began to flow into the waters of the Gulf of Mexico. Explosion of the Deepwater Horizon oil platform Oil slick in the Gulf
Disaster in Japan: March 2011 Earthquake and tsunami Explosions at a nuclear power plant in Fukushima Prefecture
DEMOGRAPHIC LOAD: Human impact on the environment (anthropogenic impact), in particular, is determined by population density per 1 sq. m. territory. Overpopulation causes air pollution, lack of drinking water, and excess waste in the territory (of megacities).
CHEMICAL POLLUTION: MIGRATION OF SUBSTANCES IN THE BIOSPHERE Harmful substances in the biosphere tend to migrate - move from one environment to another. Migration occurs due to general laws cycle of substances in nature: substances move from an environment with a higher concentration to an environment with a lower concentration. On the one hand, these processes contribute to the self-purification of natural environments, on the other hand, in conditions of massive pollution, the environment’s ability to self-purify is limited and toxic and radioactive substances accumulate (deposit) in neighboring environments (air - soil - water - products). Hence the difficulty of finding the source and routes of pollution.
Migration of harmful substances in the environment Atmospheric air Water and soil
FOOD CHAINS: When a substance moves from one environment to another, the process is called migration. As a result of migration, toxic and radioactive substances accumulate in the food (biological, trophic) chains of ecosystems. The number of links in the food chain can be different: – atmosphere – water – man – atmosphere – water of reservoirs – fish – man – atmosphere – soil – plants – domestic animals – Gudinova
ECOLOGICAL CRISIS It is currently observed everywhere on Earth, especially in large cities. Associated primarily with man-made environmental pollution.
FEATURES OF THE MODERN ECOLOGICAL CRISIS: 1. Global (planetary) scale negative influences and changes 2. Intensity of expression 3. Diversity of human impacts on the environment 4. Irreversibility
IRREVERSIBILITY OF SOME CONSEQUENCES OF THE ECOLOGICAL CRISIS § Extinction of animals and plants: one animal species disappears in the world every year, one plant species disappears every day: since 1600, 226 species of vertebrates have disappeared, including over the last 60 years - 80 species, 1000 are under threat disappearance. It is believed that by the year 2000, about 1 million plant species were destroyed. § Huge areas of contaminated territory on the planet: Omsk pollution area – 2000 sq. km, the plume of the Kuznetsk basin can be traced in Taimyr, on the shores of the Arctic Ocean. § Impact on the human genome and all living things
Status of ecologically disadvantaged regions ZONE OF ECOLOGICAL EMERGENCY - sustainable negative changes are occurring in the environment, threatening the health of the population, ecological systems, and their gene pool. At the same time, all harmful activities must cease. ECOLOGICAL DISASTER ZONE - these are those areas of the territory where profound irreversible environmental changes have occurred, resulting in a significant deterioration in the health and imbalance of the ecological system. The laws “On SEBN” and “On Environmental Protection” provide for liability for environmental crimes.
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Pathways of action of environmental factors on the body: gastrointestinal tract, skin, respiratory organs. The speed and effect of exposure depends on the route by which the substance enters the body. The impact of certain environmental factors is evolutionarily fixed - that is, the body has developed a defense mechanism. Thus, when a toxin enters through the gastrointestinal tract, it undergoes natural detoxification in the liver, but when the same substance acts through the lungs, there is no such protection.
CLASSIFICATION OF ENVIRONMENTAL IMPACTS ON HEALTH BY DEGREE OF SEVERITY AND TIME OF APPEARANCE
CLASSIFICATION OF ENVIRONMENTAL IMPACTS ON HEALTH BY DEGREE OF SEVERITY BY TIME OF APPEARANCE BY DEGREE OF INFLUENCE Adverse – loss of body weight, hypertrophy, hyperplasia, changes in enzyme activity, reversible dysfunction of organs and systems. Severe (dysfunction of the nervous system, development, behavior). Catastrophic – high mortality, congenital malformations.
CLASSIFICATION OF ENVIRONMENTAL IMPACTS ON HEALTH BY DEGREE OF SEVERITY BY TIME OF APPEARANCE BY DEGREE OF INFLUENCE Immediately occurring - the impact manifests itself immediately, allowing for relatively quick action to be taken Distant - appear much later, detected in generations
LONG-TERM EFFECTS OF ENVIRONMENTAL INFLUENCE ON HEALTH Transplacental - the factor influences through the placenta Teratogenic - the factor causes structural changes in the fetus' body, congenital developmental thresholds Mutagenic - the factor acts at the level of the chromosomal apparatus of germ cells Carcinogenic - the factor causes the growth of tumors
CLASSIFICATION OF ENVIRONMENTAL IMPACTS ON HEALTH BY DEGREE OF SEVERITY BY TIME OF APPEARANCE BY DEGREE OF INFLUENCE Environmentally-induced effects, specific lesions (Minamata disease - methylmercury, itai-itai - cadmium, “black foot” - arsenic) Environmentally dependent effects: non-specific lesions (various health disorders)
CLASSIFICATION OF ENVIRONMENTAL IMPACTS ON HEALTH BY DEGREE OF SEVERITY BY TIME OF APPEARANCE BY DEGREE OF INFLUENCE Immunological Environmentally-related effects specific lesions (Minamata disease - methylmercury, itai-itai - cadmium, “black foot” - arsenic) Respiratory Environmentally dependent effects: nonspecific lesions ( various violations health) ECOLOGICALLY DEPENDENT EFFECTS (nonspecific damage to the body) Neurotoxic Hepatotoxic Nephrotoxic Reproductive Carcinogenic
imgdescription" title="The subject of attention of hygienists are those living organisms that in one way or another can interact with" src="https://present5.com/presentation/1/78442510_167372695.pdf-img/78442510_167372695.pdf-42.jpg" alt="The subject of attention of hygienists are those living organisms that in one way or another can interact with"> Предметом внимания гигиенистов являются те живые организмы, которые так или иначе могут взаимодействовать с человеком. Обычно имеется в виду патогенная роль биологического фактора – способность вызывать инфекционные и инвазионные заболевания, Инфекционные болезни ранее уносили миллионы жизней и занимали первое место в структуре патологии, широко распространены до сих пор несмотря на все достижения цивилизации !}
Biological factors These are pathogenic agents of a bacterial (infectious) and non-bacterial nature: bacteria, viruses, fungi, helminths, protozoa. These are biological producers - products of the vital activity of organisms. The influences of biological producers on the body are diverse: from toxins that cause human food poisoning (botulism) to essential substances formed as a result of the action of beneficial microflora (vitamins, enzymes, antibiotics).
Biological pollution § This is the introduction into ecosystems of uncharacteristic species of living organisms that worsen the conditions of existence of natural biotic communities or negatively affect human health and economic activity § Occurs, as a rule, as a result of human activity § The main sources of biological pollution are waste from populated areas, hospitals, some industries, agriculture (livestock) § The main environments characterized by biological pollution are water, food products, soil, indoor air, household items § Pathogenic microorganisms act on humans, like chemicals, according to the “dose - time is an effect"
Factors that determine the spread of infectious and parasitic diseases: climate Natural climatic conditions - geographic latitude, amount of light, relief and type of earth's surface (land, vegetation, snow), average annual air temperature, humidity - all this determines the habitat of the pathogen and its vectors. Thus, in warm climates, intestinal infections and many helminthiases are common; in the north, for example, opisthorchiasis (Ob-Irtysh basin). Currently, the spread of tropical infections and invasions to the north has been noted. The population of the northern regions has no immunity against them. Doctors are not prepared for this pathology.
Factors determining the spread of infectious and invasive diseases: social factors The spread of infection is significantly influenced by the living conditions of the population, especially the density and sanitary improvement of populated areas (the presence of centralized water supply, sewerage, waste treatment), which affect the intensity of environmental pollution and the possibility of its self-purification. In the most densely populated and at the same time least comfortable areas of the planet, epidemics have always occurred, claiming millions of lives (India, water, cholera). In recent decades, due to an increase in living standards, migration of the population has increased - for permanent residence, tourism, commuting (daily from the suburbs V Big City), thereby creating additional conditions for the spread of infection over the longest distances. Gudinova
Sanitary and hygienic measures in the system of measures to prevent the adverse effects of biological factors: They are of paramount importance because they act to reduce the level of infection as an etiological factor, either eliminating it or minimizing it. These measures are carried out both in relation to the entire population and the individual. In relation to the entire population - rational planning and improvement of populated areas, housing and other objects; measures to prevent the entry of biological agents and producers into the environment; hygienic standardization measures and supervisory measures regarding the prevention of biological pollution in environmental objects. In relation to the individual - measures of hygienic education and formation healthy image life, personal hygiene, maintaining cleanliness of the body, clothing, housing, ventilation of premises, rules of food preparation, as well as strengthening the immune system ( Physical Culture, rational nutrition, prevention of overwork, sun starvation, medical examination, etc.)
imgdescription" title="Prevention is a state system of measures to protect public health and ensure optimal living conditions." src="https://present5.com/presentation/1/78442510_167372695.pdf-img/78442510_167372695.pdf-49.jpg" alt="Prevention is a state system of measures to protect public health and ensure optimal living conditions."> Профилактика - государственная система мер по охране здоровья населения, обеспечению оптимальных условий среды обитания. Профилактика составляет основу гигиены как науки. !}
Levels of prevention (WHO) INITIAL (BASIC) PREVENTION – a set of measures aimed at eliminating environmental factors leading to the development of diseases and affecting the entire population. PRIMARY PREVENTION is a set of measures aimed at eliminating specific causal environmental factors leading to the development of diseases and acting both on the entire population and on groups. SECONDARY PREVENTION is a set of measures aimed at a sick person to prevent the consequences of the disease. TERTIARY PREVENTION (REHABILITATION) is a set of measures aimed at a seriously ill person or disabled person in order to eliminate the consequences of the disease.
SYSTEM OF ENVIRONMENTAL PROTECTION MEASURES Legislative measures, hygienic standards Administrative, biological protection measures Technological and architectural planning Sanitary and technical Medical and sanitary and hygienic, hygienic education of the population
TECHNOLOGICAL MEASURES This is a change in technological methods of production processes. They are of paramount importance, eliminating or minimizing harmfulness; improving combustion; replacing fuel types for vehicles; increasing the height of the pipe for the emission of waste substances; developing other types of transport; creating closed water supply systems; reusing wastewater; recycling valuable wastewater substances
ARCHITECTURAL PLANNING MEASURES rational planning of the city, industrial area and residential zone relative to each other, taking into account the wind rose equipment of the “green wave” (traffic lights), underground passages and efficient transport interchanges compliance with sanitary protection zones of enterprises and other sources of air pollution, including garages cooperatives watering, landscaping of the city, enterprise (gas station) construction of metro, ring roads and expressways
Sanitary measures are physical, chemical, mechanical and biological methods for cleaning and disinfecting wastewater, industrial emissions and other waste.
E.L. IGAI
Hygiene and Human Ecology
(lecture course)
Textbook for teachers and students
secondary vocational educational institutions
education studying in medical technical schools and colleges
Minusinsk, 2012
Preface | ||||
Section 1. Subject of human hygiene and ecology |
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Introduction. Subject and content of hygiene, ecology and human ecology | ||||
Basics of general ecology | ||||
Environmental factors and public health | ||||
Section 2 Environmental hygiene |
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Atmospheric air and its physical properties | ||||
Chemical composition of the air and its hygienic significance | ||||
Ecological significance of water | ||||
Hygienic value of water | ||||
Ecological significance of soil | ||||
Hygienic importance of soil | ||||
Section 3. Environmental and hygienic food problems |
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Nutrition and human health. The importance of basic nutrients in ensuring the vital functions of the body. The role of vitamins and minerals. Basics of rational nutrition. Diet | ||||
Sanitary and hygienic requirements for catering units of medical institutions. Hygienic requirements for food quality. Food poisoning | ||||
Diseases associated with diet. Therapeutic and therapeutic-prophylactic nutrition | ||||
Section 4. The influence of production factors on human health and vital activity. Classification of the main forms of labor activity |
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Basic concepts about industrial hazards and occupational diseases. Hygienic requirements for optimizing working conditions for women and adolescents. Occupational injuries and measures to combat them. | ||||
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. Basic measures to improve the environment of populated areas. Hygienic requirements for residential premises. | ||||
Hygienic requirements for medical and preventive institutions | ||||
Section 6. Healthy lifestyle and personal hygiene |
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Components of a healthy lifestyle (HLS) and ways of their formation. Methods, forms and means of hygienic education | ||||
Basics of personal hygiene for a healthy person. | ||||
Section 7. Hygiene of children and adolescents. |
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Anatomical and physiological features of childhood and adolescence. Health status and physical development of children and adolescents. School maturity. | ||||
Hygienic requirements for the layout, equipment and maintenance of children's institutions. | ||||
Literature | ||||
PREFACE
Paramedical workers with knowledge in the field of ecology can provide effective assistance in the treatment process, bringing to the attention of the population ecological ideas about the mechanism of the origin of painful conditions. Knowledge of hygiene will help you navigate the selection of rational recommendations for correcting health and developing sanitary skills among the population, skillfully using hygiene rules when implementing measures to reduce the negative effects of harmful factors and enhance the positive influence of others on the preservation and promotion of health.
The proposed study guide consistently and clearly presents the main issues of human ecology and hygienic knowledge in the form of lectures compiled in a form accessible to presentation and understanding.
The methodological basis for preparing the manual was Sample program academic 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) secondary level vocational education for specialty 060101 “General Medicine”, and 060109 “Nursing. The manual is compiled in accordance with the State educational standards of secondary vocational education for the specified specialties. In accordance with the State educational standard, designed for 40 hours of theoretical classroom training, the manual includes 20 lecture topics on hygiene and human ecology.
The topics of the lectures are combined into 7 sections.
Section 1 outlines the basics of general ecology and, in particular, human ecology, as 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. The issues of practical implementation of hygienic norms and rules are dealt with by sanitation, which determines the level of a person’s sanitary culture.
The second section is devoted to the environmental characteristics of air and its hygienic significance. Attention is paid to the problems of increasing atmospheric 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 an environmental and hygienic point of view, 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 physical inactivity, the structure of rational nutrition, the mechanisms of occurrence and features of food poisoning are analyzed.
Considering the high intensification of work in modern medical institutions, paramedical workers should be well aware of the provisions of labor protection, the influence of production factors on human health and vital activity, and hygienic requirements for rational work and rest. Chapter 4 is devoted to these issues.
Environmental and hygienic features of living in modern cities and homes, their role in the occurrence of pathology, especially in children, are analyzed in Chapter 5. The hygienic problems of medical and preventive institutions are also noted here.
Chapter 6 is devoted to the most pressing 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 studied.
Section 7 discusses the anatomical and physiological characteristics of childhood and adolescence, methods for optimizing the daily routine of children of different ages. Enough attention is paid to hygienic requirements for the layout, equipment and maintenance of preschool and educational institutions.
Each topic contains a checklist test questions to clarify the level of students’ perception of the material.
The list of references includes legal documents and basic literary sources on current problems of hygiene in a presentation that is understandable for students of average professional level of training.
The textbook is designed for teachers of the discipline “Hygiene and Human Ecology” and students of secondary medical institutions in their specialties 060101 General Medicine, and 060109 Nursing. It is assumed that the teacher will independently determine the amount of educational material presented during the theoretical lesson, taking the lecture material as a basis. this collection. At the same time, material not included in the lesson content can be offered to students as a basis for extracurricular activities. independent work, for which it is rational to use additional literature from the attached list.
Section 1.SUBJECT OF HUMAN HYGIENE AND ECOLOGY
Topic No. 1: INTRODUCTION. SUBJECT AND CONTENT OF HYGIENE, ECOLOGY AND
HUMAN ECOLOGY.
Terminology and structure of the discipline
The role of ecology and hygiene in the system of sciences studying the natural environment.
Problems of ecology and hygiene.
Methods of hygienic research.
Hygienic standardization.
BE ABLE TO:
Use the acquired knowledge in educational work
Definition of the concepts of ecology, human ecology and hygiene. Subject and content of ecology, human ecology and hygiene.
The relationship between 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 standardization.
The role of the paramedical worker in educational work with the population.
Definition of the concepts of ecology, human ecology and hygiene. Subject and content of ecology, human ecology and hygiene.
Ecology(Greek - the study of the house) is the science of the relationships of flora and animal organisms and the communities formed by them among themselves 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 life 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 humans and, in turn, the influence of individuals and groups of people on the environment. Closely related to her medical ecology, studying human diseases caused by polluted environments 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 is the daughter of the god of medicine Asclepius, depicted as a beauty with a cup in her hand entwined with a snake - the goddess of health, who healed with the sun, water and air, and maintaining the purity of the body. Her other sister, Panacea, treated her with medications.
Hygiene(Greek - healthy) is a field of medicine that studies the influence of living and working conditions on human health, performance, life expectancy and develops measures to prevent diseases, improve human living and working conditions, preserve his health and prolong life.
The relationship between 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 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 humans 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 man, so that he realizes his place in nature and does not spoil it. Medical ecology is integral part human ecology, the study of human environmental diseases.
If for a person ecology is place of residence with every second communication with surrounding 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 an ecological environment, how they affect his health, performance, life expectancy, and based on this study develops recommendations for reducing the risk of harmful environmental effects on health.
Sanitation– this 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 with the help of which the implementation of hygienic rules is achieved. But in life, “I know and I do / but I don’t do it” or “I don’t know and I 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 reproduce.
You can navigate the relationship between these disciplines using the following mottos: “ECOLOGY – I LIVE!”, “HYGIENE – I KNOW HOW TO DO IT!” and “SANITATION – AND I DO THIS LIKE THIS!”
Another example of the relationship between these disciplines: a mosquito bite is ecology; I know that it can cause malaria, I need to get vaccinated - this is hygiene; I slam/don’t slam it, I give/don’t vaccinate against malaria – this is sanitation.
Therefore, all our subsequent lectures will be structured from three directions or sections: environmental section - the study of environmental factors and their properties; in the hygiene section - the study of the impact of these factors on human health and the sanitation section - familiarization with recommendations on ways and means of limiting these harmful effects and developing useful skills.
Training 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 issues of nutrition, labor, hospital design, healthy lifestyle, etc. Having known them, you will understand that hygienic recommendations for creating a healthy lifestyle come first, and then medications.
Therefore, a medical professional in the field of hygiene and human ecology must know:
the main environmental environmental factors affecting people in their places of residence and work;
patterns of influence of these factors on human health;
methods of sanitary and hygienic assessment of environmental factors in which a person lives and works, in order to anticipate the occurrence of disease and give recommendations on how to avoid or reduce the health risks of exposure to factors;
methods of sanitary 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 basic environmental 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 school, you will receive the knowledge (and preferably, the beliefs!) necessary for your preventive activities, which will help you fight diseases, give recommendations on the formation of a healthy image and yourself stay healthy and serve as role models.
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 the climate, washing, the guy, and fasting. The heyday of hygiene was in Ancient Rome - baths of 12 hectares, the whole day was spent in gymnastic exercises and conversations. In the Middle Ages there was a decline in hygiene. Hygiene is being revived 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 hazardous production and the increasing frequency of large epidemics of cholera, plague, and typhus. Systematic Scientific research in the field of hygiene.
Max Pettenkofer(1818-1901), German scientist-doctor, founder of hygienic science: he introduced experimentation into hygiene, turning it into an exact science. Proposing to improve the environment, he outlined ways to prevent many diseases. For the first time I drew attention to personal hygiene as an important factor in many diseases: “the extent to which a person has personal hygiene, such is his path through life and such is his speed to death.”
In Rus', hygiene as a system of skills arose 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, typhus).
The founders of Russian health care, the therapist M.Ya., played a major role in the development of hygiene. 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 publishing the magazine “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 manual on hygiene.
G.V. Khlopin(1863-1929) - a student of Erisman, made hygiene a mandatory laboratory research and experiment, published manuals on the basics of hygiene and general hygiene.
In 1922, for the first time in the world, the USSR issued a state law “On the sanitary authorities of the republic”, which at the state level obliged people to comply with hygiene issues and introduced state sanitary supervision. The activities of the sanitary and epidemiological service in the USSR were one of the most effective in the world.
The adoption of the new Constitution of the Russian Federation (1993) required the revision of a number of provisions in the field of ensuring the sanitary and epidemiological welfare 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 Welfare 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 the Protection of Consumer Rights and Human Welfare (Rospotrebnadzor) was formed, which is the authorized federal executive body to exercise control and supervision functions in the field of ensuring the sanitary and epidemiological well-being 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 single centralized state system, the main function of which is to implement 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 environmental protection is assigned to the constituent entities of the Russian Federation and is their obligation.
Currently, Rospotrebnadzor unites 2,218 Centers for State Sanitary and Epidemiological Surveillance (TSGSEN), which are united into 90 territorial departments - according to the number of regions and 1 - for railway transport. In addition, the activities of the sanitary and epidemiological service are provided by 21 research institutes ( scientific centers). The main goal of these bodies is to ensure sanitary and epidemiological 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 management of the sanitary and epidemiological situation on the ground. The leading area of activity of the State Sanitary and Epidemiological Service has recently become sanitary and hygienic monitoring for environmental control and risk assessment of the impact of various factors on the human body.
Basic laws of hygiene
For memorization, the six laws of hygiene on the impact on the environment can be combined into three “negative”, two “positive” and one “technological”.
"Negative" laws:
The law of the negative impact of human activities on the environment: industrial 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 here.
The law of the negative impact of natural extreme phenomena on the environment - volcanoes, earthquakes, solar flares, etc.
The law of the negative impact of environmental pollution on public health: no matter what kind of pollution it is, it reduces immunity, causes frequent illnesses, and accelerates old age and death.
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TEXTBOOK FOR UNIVERSITIES HISTORY
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List of monographs of textbooks and teaching aids published by teachers over the past 5 years
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theoretical lesson No. 1
Subject:
Compiled by: Maklakov I.A.
Lesson topic:Subject of hygiene and human ecology. Basic principles of hygiene
Form of organization of the training session: lecture.
Type of lecture: traditional.
Lecture type: introductory.
Duration: 90 min.
Purpose of the lesson: the formation of ideas about the sciences of hygiene, ecology and human ecology, knowledge about the laws and methods of hygiene research, the basic principles of hygiene.
Tasks:
educational:
know the definition of the concepts ecology, human ecology and hygiene; subject and content of ecology, human ecology and hygiene; tasks of ecology and hygiene, laws of hygiene; methods of hygienic research;
know the relationship between ecology, human ecology and hygiene and their place in the system of medical and biological sciences; main historical stages in the development of ecology and hygiene
educational:
demonstrate skills and abilities in academic work, a responsible attitude to learning
developing:
develop skills in note-taking and self-control of one’s own activities; develop attention, memory, cognitive interest;
Teaching methods: verbal - presentation, conversation; visual – demonstration of illustrations; explanatory and illustrative, discussion.
Equipment (equipment) of the lesson: information ( methodological development classes for the teacher), visual – illustration “Symbol of Hygiene”.
Interdisciplinary connections:History, Ecology.
Intrasubject connections: T 2. Current state environment. Global environmental problems, P 1. Physiological research method.
Description of the course of the lesson (Table 1).
List of basic and additional literature on the topic of the lecture:
1. Arkhangelsky, V.I. Hygiene and human ecology: textbook / V.I. Arkhangelsky, V.F. Kirillov. – M.: GEOTAR-Media, 2013. – 176 p.
2. Krymskaya, I.G. Hygiene and fundamentals of human ecology: textbook. aid for students avg. prof. education / I.G. Krymskaya, E.D. Ruban. - Rostov n/d.: Phoenix, 2013. – 351 p.
Table 1
Description of the lesson
n\n
Lesson stages
approximate time
Contents of the stage.
Guidelines
Goal: organize students into activities to achieve their goals, create a positive emotional mood in them
3 min.
Checking those present, the availability of uniforms, the readiness of students for class, the equipment of the workplace.
Target setting. Motivation for learning activities
Goal: to intensify the cognitive activity of students, to show the significance of the topic for future profession specialist
10 min.
Report the topic, purpose and objectives of the lesson.
Formation of motivation (Appendix 1)
Updating students' basic knowledge
Goal: to identify the level of residual knowledge on ecology, to develop communication skills
10 min.
Update forms
1.Front survey
Questions:
What does the science of ecology study?
What is hygiene?
What do ecology and hygiene have in common?
Why does a healthcare worker need knowledge of ecology and hygiene?
Presentation of new material
Goal: formation cognitive interest To academic discipline, formation of theoretical knowledge in accordance with the purpose and objectives of the lesson.
55 min.
Presentation of the main content of the lecture (Appendix 2) in accordance with the plan.
Lecture outline:
2 Laws of hygiene and ecology.
3 Short story emergence of hygiene, ecology and human ecology.
4Methods of hygienic research, hygienic standardization.
5Sanitation. Prevention, types of prevention.
Comprehension and systematization of acquired knowledge. Summing up the lesson
Purpose: consolidation of educational material, assessment of students’ work in the lesson as a whole
7 min.
The teacher conducts a sample survey and answers students’ questions.
Questions:
- what place does hygiene occupy in the system of medical sciences?;
Name the object of study of hygiene;
List the laws and practices of hygiene;
What was Pettenkofer's role in the development of hygiene?
What does ecology study?
Name the founder of ecology.
List the basic laws of ecology.
Homework assignment
Target:organizing students to search additional information
5 minutes.
Issuance and explanation of homework.
1.Lecture notes 1.
2. Textbook Krymskaya I.G. Hygiene and human ecology (pp. 4 – 28).
3.VSRS 1.Fill out the table “History of Hygiene Development.”
Control on P1
Annex 1
Lesson motivation
A medical professional must be able to assess a person’s health status and give qualified recommendations for its preservation and strengthening.
Today, the training of specialists with secondary specialized medical education is unthinkable without deep hygienic knowledge and the development of an ecological worldview. At the same time, the practical activities of a nurse, paramedic, and midwife prove that there is a close connection between hygienic thinking, preventive and clinical medicine.
The objective of this course is to identify the connection between environmental and hygienic factors and the state of public health.
Appendix 2
Contents of the lecture on the topic:
Subject of hygiene and human ecology . Basic principles of hygiene .
Plan:
1. Subject of hygiene and human ecology.
2. Laws of hygiene and ecology.
3. A brief history of hygiene, ecology and human ecology.
4. Methods of hygienic research, hygienic standardization.
5. Prevention, types of prevention.
Subject of hygiene and human ecology. Laws of hygiene and ecology. A brief history of the emergence of hygiene, ecology and human ecology.
Hygiene – a science that studies the influence of environmental factors and industrial activities on the human body, its health, performance and life expectancy in order to substantiate and develop hygienic standards, sanitary rules and measures, the implementation of which ensures the improvement of public health and the prevention of diseases.
Hygiene tasks:
Study of natural and anthropogenic (harmful) environmental factors and social conditions affecting public health;
Studying the patterns of influence of factors on the human body or population;
Development and scientific justification of hygienic standards, rules, recommendations, etc.;
Maximum use of environmental factors that have a positive effect on the human body;
Eliminating adverse factors or limiting their impact on the population to safe levels;
Implementation and application in economic activity human developed hygienic standards, rules, recommendations, guidelines;
Forecasting the sanitary and epidemiological situation for the short and long term.
Main direction of hygiene - preventive.
The name of the term is associated with the name of the Greek mythical goddess of health Hygieia, daughter of the ancient Greek god of healingAsclepius , it is depicted symbolically on stands, medical books, etc. in the form of a beautiful girl holding in her hands a bowl filled with water and entwined with a snake (a symbol of wisdom).
From ancient Greekhygiene means– « healing, bringing health." The founder of hygiene is a German scientistM. Pettenhofer , which 150 years ago (1865) substantiated quantitative methods measurements of environmental factors. Pay attention to personal hygiene.
The beginnings of hygiene go back to the prehistoric period, primitive people maintained hygiene. skills in arranging a home, cooking, burying the dead, etc.
Reached its greatest development in Ancient Rome(600-500 years ago BC), where water pipelines and public baths were built, in Ancient Greece, Rome, Egypt, China and India - priority was given to healthy conditions and a healthy lifestyle, physical education.
When in Europe 6-14 centuries. all sciences have fallen into decay, incl. medicine. as a result of the dominance of religion (purity of the soul, not the body), the Middle Ages - epidemics of plague, cholera, leprosy, typhus, etc., which carried away the population of entire cities. Paris is the “city of dirt.” However, even at this time, doctors expressed valuable thoughts, so the scientist and doctor of the East of the 11th century. - Abu Ali Ibn Sina (Avicenna), in his world-famous work “The Canon of Medicine,” summarized knowledge in the field of food hygiene, housing, raising children, and personal hygiene. It was he who dressed the honey. workers in white coats (a symbol of purity and spotlessness).
Hygiene began to develop intensively in the 17-18 centuries, during the era of capitalism, mass diseases of workers (prevention is better). As an independent science from the 60-70s. 19th century in Western Europe and Russia.
Founders in Russia – M.V. Lomonosov, Pirogov, Botkin talked about prevention. The formation of hygienic science belongs to Dobroslavin (1st Russian textbook on hygiene, magazine “Health”) and Erisman, department of hyena in Moscow, sanitary station, his works on school hygiene, food and labor hygiene).
Object of study of hygiene is a healthy person in close interaction with the environment (in clinical disciplines, a sick person).
Laws of hygiene.
Environmental factors can have a positive or negative effect on the body, which is due to certain laws:
Law of Violation of People's Health Levels , may manifest itself as illness or a decrease in compensation mechanisms (immune status). The pathological effect depends on the intensity of the harmful factor - based on this, hygiene standards were justified:
maximum permissible concentrations (MAC) – concentrations of a chemical substance that, with constant exposure, do not cause changes in the health of a person and his offspring;
maximum permissible level (MAL) – the level of a physical factor (for example: the level of radiation, noise, electronic field) that does not affect a person’s health and his offspring.
Minimum lethal dose (MLD) is the amount of a substance or factor that causes the death of a person.
The law of the negative impact of human activities on the environment , which manifests itself to a greater extent, the lower the technical level of production and the level of development of society (for example: the industrial boom in China is accompanied by intense environmental pollution, accompanied by the massive occurrence of environmental diseases; high level industry in Switzerland has no visible impact on the natural environment). In connection with physiological, household and industrial activities, people have bad influence on the environment.
Laws of the negative impact of natural environment features on public health. From this law, Vernadsky’s doctrine of chemical provinces (territory with a deficiency or excess of any substances, which is accompanied by the development of endemic diseases) is derived. So Transbaikal region is one of the iodine-deficient areas, which contributes to the development of endemic goiter, Krasnokamensk is provided with drinking water. Which leads to the development of fluorosis (an endemic disease accompanied by changes in tooth enamel, i.e. brown striations).
The law of the positive influence of the natural environment on the human body . Natural factors: sun, clean air, water, food, contribute to the preservation and strengthening of health.
The law of the negative impact of a polluted environment on human health , which leads to a decrease in the compensatory capabilities of the body, physiological abnormalities, asymptomatic forms of the disease, the development of the disease, pathology (bronchial asthma, anemia, malignant neoplasms.
Examples: an indicator of environmental distress in places where the population lives is reproductive health, the impact on the course of pregnancy and newborns (impaired immune, hematopoietic and other systems); an unfavorable effect of pollution on the physical development of children was noted, which is due to greater sensitivity, increased permeability of the skin, gastrointestinal and respiratory tract mucous membranes, and immaturity of the immune system; increase in pollution chemicals and radioactive affects the incidence of cancer.
Hygiene is closely related to sanitation.
Sanitation (from Latin “health”) - practical implementation of hygienic norms and rules.
Health activities are carried out by the state. Sanitary and Epidemiological Service (SES), in accordance with the legislation of the Russian Federation. Federal Law “On the Protection of Citizens’ Health” (1993), Federal Law “On the Sanitary and Epidemiological Welfare of the Population” (1999), etc.
In Russia, the SES is headed by the State. Sanitary and Epidemiological Committee supervision under the President of the Russian Federation. The Chairman is the Chief State. sanitary doctor of the Russian Federation. (formerly ROSPOTREBNADZOR).
Sanitary supervision is carried out in 2 main forms:
preventive sanitary supervision carried out during the design and construction of various facilities, as well as the implementation of the production of industrial products.
current sanitary supervision - inspection of existing facilities, compliance with sanitary rules and regulations (SanPiN). This includes the systematic study of morbidity and injury.
Dr. In other words, the sanitary service monitors the implementation in practice of recommendations and measures developed by hygiene and epidemiology.
In matters of studying the influence of environmental factors on human health, hygiene closely interacts with environmental science, or more precisely, human ecology.
Ecology is a complex science that studies the relationships of living organisms with each other and with their environment, and the influence of nature on humans.
Term"ecology" from Greek"oikos" (house) and"logos" (the science). Literally, “the science of the house,” the organisms living in it and all the processes that make this house suitable for life. Information of an environmental nature (careful attitude, protection of nature) is already contained in the works of Hippocrates, Aristotle and others. Robert Malthus spoke about the danger of overpopulation of the planet (1789). Founder Ernst Haeckel published the book “General Morphology of Organisms” in 1866, where he defined ecology (the science of the relationship of organisms with the environment). Vernadsky made a great contribution with his book “Biosphere” (1926), where the planetary role of the totality of all types of living organisms was first shown.
Objects of study: populations, communities, ecosystems, biosphere.
Population is a collection of individuals of the same species living long time in a certain territory, freely interbreeding, producing fertile offspring and relatively isolated from other groups of individuals of the same species.
Community is a set of interacting populations occupying
a certain territory, a living component of an ecosystem.
Ecosystem joint functioning of organisms and the environment (forest, lake, swamp) in a given area. Ecosystems are not isolated from each other. Many species of plants and animals can be found in several ecosystems, and some species, such as migratory birds, migrate between ecosystems depending on the time of year. The ecosystem is made up of 4 components:
Non-living (abiotic) environment - water, gas, non-living inorganic and organic substances.
Producers (producers) are autotrophic organisms that produce organic matter from simple inorganic substances with the participation of solar energy with the release of oxygen - green plants.
Consumers (consumers) consume ready-made organic substances, but do not decompose organic substances into simple mineral components. There are consumers of the first order (herbivores) and second, third, etc. orders (predators).
Reducers (decomposers) are organisms that mineralize dead organic matter into simple inorganic compounds suitable for producers.
People, together with their cultivated plants and domestic animals, form a group of organisms that interact with each other and with the environment. This is also an ecosystem. All ecosystems of the Earth, including the human one, are interconnected and together form a single whole -biosphere.
These two sciences study the same phenomena, namely, the influence of environmental factors on humans, etc. assess the role of various factors in shaping the health of the population.
The level of human health depends on the influence of environmental factors, which are divided into 3 main groups:
1) natural factors – include atmospheric air, solar radiation, natural background radiation, vegetation, microflora, water and soil. The body has developed adaptation mechanisms to these factors.
2) social factors – factors related to lifestyle, moral and social principles, everyday life, and incoming information.
3) anthropogenic factors – arise as a result of human activity (anthropos - Greek man). They are physical, chemical and biological factors arising from industrial activities, transport Agriculture etc. A person does not have an adaptation mechanism to these factors.
Human interaction with the environment is considered in a separate area – human ecology. The term appeared in 1972 at the 1st UN meeting on the environment. environment.
The subject of the study of ecology is the environment.
The basic laws of ecology were formulated by the American ecologist B. Commoner (1974):
1 Law “Everything is connected to everything” (ecological chains)
2nd law “Everything must go somewhere” (conservation of matter);
3rd law “Nature knows best” (the natural version of phenomena is the best);
4th law “Nothing is given for free” or “You have to pay for everything” (what was taken away or damaged must be returned or corrected).
So, hygiene and ecology have common study goals: the influence of environmental factors. environment on human health. Hygienists develop prevention measures, ecologists develop environmental legislation, and form ecologist. worldview.
II . Methods of hygienic research (HRI)
Hygienic methods are divided into 2 large groups:
methods that assess environmental factors.
methods that assess the body's response to these factors.
They all include:
Sanitary inspection method – description of the object, which gives its hygienic characteristics (sanitary condition, epidemiological, etc.).
Laboratory method:
A)physical research method , allows you to evaluate the microclimate of the room (changes in temperature, humidity, noise, vibration).
b)sanitary-chemical method which is used for - analysis of chemical composition, air, water, food, etc.
V)bacteriological methods, which are used in assessing bacterial contamination of air, water, soil, food products (Escherichia coli, salmonella);
G)toxicological method, used in experiments to identify the effect of substances on animal organisms, to establish maximum permissible concentrations.
Clinical observation method carried out during professional examinations, dispensary observation, etc.
Method of physical observations .
Sanitary statistical method (mortality, birth rate, morbidity, level of physical development).
All studies are carried out on the basis of GOST, TU, SanPiN (sanitary rules and regulations) and other NMD.
All methods are combined into the concept -hygienic diagnostics , its goal is to identify violations of human adaptation mechanisms and assess the state of his adaptation systems.
III . Prevention
The goal of hygiene is the development and implementation of primary medical prevention.Prevention is a set of measures (political, economic, legal, medical, environmental, etc.) to preserve and strengthen the health of the population and its longevity. eliminating the causes of diseases, improving working, living and recreation conditions of the population.
There are three levels of prevention:
active offensive prevention (providing a favorable living environment, healthy lifestyle);
prenosological, on assessment of human health risks (real and potential);
defensive or passive (prevention of disease progression, disability)
There are personal and public.
There are several types of prevention:
Primary involves preventing the occurrence of diseases (either completely eliminating a harmful factor, or reducing its impact to a safe level).
Secondary involves early diagnosis of diseases in persons exposed to harmful environmental factors. Wednesdays.
Tertiary is aimed at preventing deterioration in health. A set of measures (treatment and rehabilitation) has been developed to prevent complications that may arise during an already developed disease.
Greek mythical goddess of health Hygieia
The essence of the science of hygiene, its differences from other sciences
Definition 1
Hygiene is a science that studies the influence of natural and anthropogenic environmental factors on the health of individuals and society. The goal of science is to reduce their negative impact on the body through preventive measures.
Hygiene, although in many ways similar to medicine, has a number of important distinctive features. While the study of medicine focuses on the sick person, 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, every person is exposed to many environmental factors. They can be both positive and necessary for a person, and negative, negatively affecting a person’s health and condition. All of them can be divided into four groups:
- Chemical factors. This chemical compounds, which are part of air, water and soil. They enter the body through plants, and their deficiency or excess can cause disease.
- Physical factors. This includes temperature, humidity, air speed, 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 words, speech, and writing. These phenomena evoke emotions in a person, and this, in turn, has a strong effect on the body.
Finished works on a similar topic
- Course work Hygiene and ecology 410 rub.
- Essay Hygiene and ecology 240 rub.
- Test Hygiene and ecology 190 rub.
All of the above factors are closely related to the nature of human work activity and the characteristics of the natural and man-made environment around him.
Hygiene tasks
The tasks of hygiene include the justification of hygienic standards for environmental factors. A hygienic standard is a minimum or maximum value of a quantitative indicator characterizing a biological environmental factor that is acceptable for the normal functioning of the body.
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 food, 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 the tasks facing researchers, a wide variety of methods of this science are used, among which the following can be distinguished:
- The sanitary survey method is used to study the environment. It consists of examining and describing environmental objects, for example, an industrial enterprise, a canteen, a water source.
- The laboratory research method is used to assess 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, with its help you can find out how the body reacts to changes in environmental factors. For example, blurred vision in low light conditions or lung diseases that develop in dusty rooms.
- Laboratory experiment method. In this case, in laboratory conditions they reproduce various environmental conditions and monitor how the body reacts to changes - negatively or positively. All data is carefully processed, and the experimental subjects are animals or volunteers.
- Statistics method. Covers health indicators of the entire population and allows you to find out the positive or negative impact of the environment on the body.
Note 1
The concepts of hygiene and sanitation should not be confused; 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 increase the environmental and hygienic education of the country's citizens, but also to prevent most epidemics and epizootics.
In this case, the role of medical workers is significant. It is representatives of the medical field who are the main source of reliable knowledge about diseases and means of protection against them. Educational thematic conversations with the population and health 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; the 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 its branch - the science of nature conservation, seeks to protect the natural environment from negative influences, including anthropogenic influences.
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 environmental protection and at the same time not take into account the sanitary and epidemiological well-being of the population. On the contrary, it is impossible to ensure the well-being of the population in a dangerous environmental situation.
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