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Lecture notes, cheat sheets
General hygiene. Cheat sheet: briefly, the most important
Directory / Lecture notes, cheat sheets Table of contents
1. Environment and health The history of the development of hygienic science and the concept of "hygiene". The first hygienic treatises that have come down to us belong to the great Greek physician Hippocrates (460-377 BC). Until now, not only known, but also of some scientific interest is the "Treatise on Hygiene", written by Avicenna (Abu Ali ibn Sina) (980-1037). The treatise outlines important issues of hygiene, suggests ways and means of treating and preventing diseases caused by sleep disturbance, nutrition, etc. However, hygienic science developed not only on the basis of empirical observations, but also taking into account new experimental data. The first department of hygiene at the Medical Faculty of the University of Munich in 1865 was organized by Max Pettenkofer (1818-1901). He not only investigated environmental factors (water, air, soil, food), but also created the first school of hygienists. Peter I did a lot to protect the health of the population and prevent the spread of diseases in Russia, by issuing a number of decrees on the sanitary condition of cities, on mandatory notification of cases of contagious diseases, etc. The philological origin of hygiene is associated in Greek mythology with the goddess of health (Hygieinos) - the daughter of Aesculapius. Hygiene - the goddess of health - a symbol of health. Hygiene is a medical, preventive discipline. It studies the patterns of influence of environmental factors on the body in order to prevent diseases and improve the environment itself. Environmental factors are also studied by other disciplines. The peculiarity of hygiene is that it studies the influence of environmental factors on human health. The task of hygiene as a science is to weaken the effect of negative factors and strengthen the effect of positive factors by carrying out hygienic measures. In particular, it has now been established that fluorine in the composition of drinking water has a certain effect on the development and formation of teeth. For example, concentrations of fluorine in water less than 0,7 mg/l and especially at the level of 0,5 mg/l lead to the development of caries. The water of the Volga, widely used for water consumption in the cities of the Volga region, contains fluorine at the level of 0,2 mg/l. This level of fluoride in drinking water leads to massive development of caries. 80%, and in some places - 90% of the population of the Volga cities suffer from caries. Along with such a well-known negative factor of fluorine deficiency in drinking water, its excessive concentration (above 1,5 mg/l) leads to the development of fluorosis. Fluorosis is a disease, the development of which is associated with the action of fluorine on the body as a protoplasmic poison. 2. Subject, content of hygiene, place and importance of hygiene in the activities of a practitioner The subjects of hygiene are the environment and health. The environment is a combination of elements of a physical, chemical, biological, psychological, economic, cultural and ethnic nature, The definition of health is given by experts from the World Health Organization. Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. Over the past XNUMXth century the main funds invested in health care were mainly used to solve problems that had already arisen, and not to prevent their occurrence. The emphasis was on the cure of the disease, on therapeutic help, and not on the promotion of health and the prevention of disease. There should be a reorientation of priorities. More attention should be paid to the preventive direction of the development of medicine. The task of hygiene is to make human development as perfect as possible, life to be full, and death to be the most remote. Knowledge of hygiene is necessary in the practice of doctors of various profiles: medical, pediatric and dental. It is well known that the development of various pathologies is influenced by environmental factors. If these factors are not taken into account, the effectiveness of the treatment is reduced. For example, in the field of pathology of diseases of the oral cavity, the influence of a professional factor is known. Working with certain chemicals can enhance the development of the pathological process in the oral cavity, caries, and other diseases. The development of caries is significantly influenced by such a factor as the nature of nutrition (alimentary). It is well known that tooth decay is more likely to develop in those who consume more refined carbohydrates. Currently, a significant number of diseases are known in medicine that have an environmental factor in their genesis. The course of a number of diseases is influenced by housing conditions, the consumption of water of one or another mineral composition. The doctor needs knowledge of the impact of one or another factor on the body: the alimentary factor, the nature of the water, its composition, quality. When carrying out this or that treatment using pharmacological preparations, the nature of nutrition should be taken into account, since it can weaken or enhance the effect of the drug (just like drinking water can enhance the effect or, conversely, weaken the effectiveness of the ongoing drug treatment). The development of hygiene goes in two directions. On the one hand, the process of its so-called differentiation is noted. At present, such a course as valeology, a science that studies the patterns of formation of a high level of health, has stood out from hygiene. 3. Hygiene methodology Hygiene methodology - its section, part of hygiene, dealing with the use of its methodological techniques to study the patterns of interaction between the organism and the environment. Hygiene methodology is associated with the development of hygienic standards, guidelines, sanitary norms and rules. In hygiene, there are so-called specific classical hygiene methods. These include the method of sanitary inspection, the method of sanitary description and the method of sanitary observation. In hygiene, various methods are widely used related to the assessment of factors acting on a person. Such methods are physical, chemical, which assess the physical and chemical state of the environment. In hygiene, toxicological methods are widely used, aimed at assessing the nature of the toxic effect on the body of certain chemicals. Physiological methods are widely used, not without reason hygiene is called applied physiology. Biochemical, genetic, clinical and epidemiological research methods are widely used to assess the impact of factors on certain body systems. To generalize the results obtained, statistical methods are widely used with the involvement of modern technologies. Thus, clinical and hygienic studies and laboratory experiment complement each other and constitute a single approach to hygienic studies of the environment and human health. The subject of hygiene is the environment and health. Extremely complex processes take place in the environment (ecosystem), biosphere. Some of these processes are associated with the action of factors aimed at ensuring the constancy of the quality of the environment (water, soil, atmospheric air). These are stabilizing factors. Other factors (and they can be of a natural nature or associated with human activities, the so-called anthropogenic factors) lead to a violation of the natural balance, harmony in nature. These are destabilizing factors. In ecology, there is the concept of anthropogenic exchange. Anthropogenic exchange has natural resources as an input, industrial and household waste as an output. Ecological anthropogenic exchange is extremely imperfect. It has an open, open character and is devoid of the cycle of life that is inherent in the biosphere as a whole. To characterize anthropogenic exchange, there is an indicator - its efficiency, showing the amount of natural resources used for the benefit of man. The value of efficiency today is 2%, i.e. 98% are unused natural resources, and, moreover, this is the part of the resources that acts as waste - environmental pollutants. Among these pollutants, there are substances that have a pronounced destabilizing effect, the so-called destabilizing factors. 4. Environment and health There is a close interaction between the human body and the environment. The problem of the unity of the organism and the environment is the most important. It must be said that a certain form of balance develops between the environment and the organism. This balance of the environment and the body is formed as a result of the most important mechanisms of the physiological response of the body to the effects of various factors and is carried out through the work of the central nervous system. This form of balance is the so-called dynamic stereotype, i.e., if the factor acts constantly, is of a repetitive nature, the body develops stereotyped reactions. The emergence of new factors leads to the destruction of this balance. Excessive factors pose a particularly serious danger. Changes in the dynamic stereotype are associated with a significant violation of the functions of the body: neuropsychic, stressful condition, extreme factor. The task of hygiene is to find ways and methods of forming a new stereotype. This can be achieved by appropriate changes in the external environment, as well as by improving the mechanisms of adaptation of the body. In the diagram developed by Academician of the Russian Academy of Medical Sciences Professor Yu. L. Lisitsin. The determining factor of somatic (general) health, according to experts from the World Health Organization, is style, or, as we say, lifestyle. It determines the somatic state of human health by 53%. 17% of a person's somatic health is determined by the quality of the environment, 20% is due to hereditary factors, and only 10% of somatic health is determined by the level and availability of medical care to the population. Thus, 70% of the level of human health depends on those moments that are directly related to hygiene. This is a healthy lifestyle of a person, the quality of the environment. The environment has an impact on the main indicators of the health of the population (life expectancy, birth rates, levels of physical development, morbidity and mortality). Mass surveys of large cities show a sharp change in the immune homeostasis of residents. A change in immunity indicators by 50% is noted among residents of Moscow. There is a situation indicating the so-called secondary nonspecific immunodeficiency. Hygiene is preventive medicine. What is meant by prevention? There are concepts of primary and secondary prevention. Secondary prevention is understood as a set of measures aimed at localizing and weakening the pathological process through active medical examination, anti-relapse therapy, spa treatment and therapeutic nutrition, i.e. secondary prevention is the activity that is carried out by practitioners. Hygiene is primary prevention. The basis of preventive measures is hygienic regulation. 5. Hygienic regulation A hygienic standard is a strict range of parameters of environmental factors that is optimal and harmless for maintaining normal life and health of a person, the human population and future generations. Sanitary rules, norms, hygienic standards are normative acts that establish criteria for the safety and harmlessness of environmental factors for a person in his life. Sanitary rules are obligatory for observance by all state bodies and public associations, enterprises and other economic entities, organizations, institutions, regardless of their subordination and form of ownership, officials and citizens. Hygienic standards for chemicals are set in the form of maximum allowable concentrations (MACs). For physical factors, they are set in the form of permissible exposure levels (MPL). For chemicals, MPCs are set in the atmospheric air of populated areas in the form of maximum one-time and average daily maximum allowable concentrations. MPCs for harmful chemicals in the water of reservoirs and drinking water are established. MPCs are set for the content of harmful chemicals in the soil. In foodstuffs, hazardous chemicals are regulated in the form of acceptable residues (RTA). For chemicals, the maximum allowable amounts in water are set in milligrams per 1 dm3, or 1 l, for air - in milligrams per 1 m3 air, food products - in milligrams per 1 kg of product mass. The remote controls for the impact of physical factors are also set. In particular, there is an idea of the optimal and permissible parameters of the microclimate, i.e. temperature, humidity, air velocity, etc. There are so-called physiological norms for the need for proteins, fats, carbohydrates, minerals, vitamins. Principles of hygienic regulation: 1) the principle of stages; 2) the principle of threshold. The phasing in rationing is that the work on rationing is carried out in a strictly defined sequence associated with the implementation of the corresponding stage of research. For chemicals, the first stage of these studies is the analytical stage. The analytical stage includes an assessment of the physicochemical properties: data on the structure of the chemical, its parameters - melting point, boiling point, solubility in water, other solvents. The second mandatory stage of hygienic research in establishing MPC is toxicometry, i.e., the determination of the main parameters of toxicity. Toximetry includes conducting studies to determine the parameters of acute toxicity (acute toxicometry or, more simply, acute experiments). This is followed by a subacute experiment and a chronic sanitary-toxicological experiment. 6. Hygienic regulation (continued) An important stage of toxicometric studies is the subacute sanitary-toxicological experiment. A subacute experiment makes it possible to reveal the presence of cumulative properties from the standpoint of a qualitative and quantitative assessment of this stage of action. In the subacute experiment, the most vulnerable systems of the body are also identified, which allows an objective approach to the formulation of the main stage of toxicometry, associated with the determination of toxic parameters in a chronic experiment. In the subacute experiment, there is a large set of toxicological tests that evaluate the effects of a chemical on the cardiovascular system, nervous system, gastrointestinal tract, excretory systems, and other functions and systems of the body. The most important principle of hygienic regulation is the study of the threshold nature of the action of the normalized factor. According to the threshold level of exposure in a chronic experiment, the lowest concentration that causes changes in the body of a laboratory animal is determined. Based on the results of a chronic sanitary-toxicological experiment, MPCs are established for substances, primarily those with a pronounced toxic effect. When rationing harmful chemicals in the aquatic environment, the mandatory stages of the study are the study of the effect of the substance on the organoleptic properties of water and the sanitary regime of water bodies, i.e., to establish the MPC of chemicals in water bodies, additional stages of research are introduced. At all these stages of studying the effects of harmful chemicals, threshold levels of exposure, threshold doses and concentrations are necessarily established. The limiting sign of harmfulness is determined by threshold concentrations, i.e., the lowest concentration is established, in which, first of all, the effect of a harmful chemical is manifested either on the organoleptic properties of water, or on the sanitary regime of a reservoir, or in assessing toxic properties. When establishing the MPC of harmful chemicals in the water of reservoirs, a limiting sign is identified, either organoleptic, or according to the sanitary regime, or toxicological. According to the limiting sign of harmfulness, taking into account the lowest threshold concentration, MPC is set. Thus, the defining principles of rationing are the principles of threshold and phasing. MPCs allow, on the one hand, to control the content of harmful chemicals in the environment, on the other hand, to create a so-called system for monitoring the content of harmful chemicals, that is, to monitor them in the environment. 7. Structure of the sanitary service The activities of the sanitary and epidemiological service in the Russian Federation are determined by the Law of the Russian Federation "On the sanitary and epidemiological welfare of the population". Occurring in 2004-2005 changes in the country also affected the structure of the sanitary service. The Ministry of Health and Social Development of the Russian Federation transformed the Centers for State Sanitary and Epidemiological Surveillance (TsGSEN) into territorial departments of the Federal Service for Supervision of Consumer Rights Protection and Human Welfare (TU) and federal state healthcare institutions - the Centers for Hygiene and Epidemiology (FGU). The main tasks of the territorial department of Rospotrebnadzor (TU) are: 1) state supervision and control over the fulfillment of the requirements of the legislation of the Russian Federation in the field of ensuring the sanitary and epidemiological welfare of the population in the field of consumer protection; 2) prevention of harmful effects of environmental factors on humans; 3) prevention of infectious and mass non-infectious diseases (poisoning) of the population. Functions of the territorial department of Rospotreb-nadzor: 1) state supervision and control over the fulfillment of the requirements of the Russian Federation to ensure the sanitary and epidemiological well-being of the population in the field of consumer protection; 2) sanitary and epidemiological supervision during the development, construction, reconstruction, liquidation of urban planning, industrial construction; at production, sales of products, in the operation of water supply systems, medical institutions; 3) organization and conduct of social and hygienic monitoring; 4) issuance of a sanitary-epidemiological conclusion on programs, methods, modes of education, training; 5) carrying out anti-epidemic measures, attesting the decreed contingent and exercising their control; 6) control of laboratory research and testing; 7) conducting sanitary and quarantine control. The main task of the federal government health care institutions is to conduct sanitary and epidemiological examinations, investigations, examinations, studies, tests, toxicological, hygienic and other examinations. The chief state sanitary doctor - the head of a territorial institution and the head of a federal state healthcare institution on a regional scale - is appointed and dismissed by the Minister of Health and Social Development of the Russian Federation on the proposal of the head of the Federal Service (Chief State Sanitary Doctor of the Russian Federation). Financing of expenses for the maintenance of territorial health care institutions is carried out at the expense of the federal budget. Sanitary supervision in Russia is carried out in the form of two forms. In the form of preventive sanitary supervision and current sanitary supervision. 8. Current sanitary supervision Current sanitary supervision covers almost all areas of activity of certain institutions, facilities on the territory of a particular settlement, district, region and in general throughout Russia. Sanitary and epidemiological supervision bodies exercise control over the activities of industrial enterprises, communal facilities, kindergartens, schools, medical and preventive and other institutions. The Sanitary and Epidemiological Service is endowed with great rights to supervise the activities of certain institutions and organizations. The sanitary service monitors the implementation of sanitary rules by certain institutions, enterprises and objects. Sanitary rules are mandatory for all state and public organizations and other economic organizations, regardless of their subordination and form of ownership, as well as officials and citizens. The Sanitary Service exercises control aimed at preventing sanitary offenses. Sanitary offenses are unlawful, intentional or careless actions or omissions that infringe on the rights of citizens and the interests of society, associated with non-compliance with the sanitary legislation of the Russian Federation, including various sanitary rules and norms. Hygienic standards, developed sanitary norms and rules ensure the effective implementation of preventive and ongoing sanitary and epidemiological surveillance, the effective implementation of measures to improve the environment and improve public health. 9. Physiological and hygienic value of water Water is the most important factor in the formation of the internal environment of the body and at the same time one of the factors of the external environment. Where there is no water, there is no life. All the processes characteristic of living organisms that inhabit our Earth take place in water. Lack of water (dehydration) leads to disruption of all body functions and even death. Reducing the amount of water by 10% causes irreversible changes. Tissue metabolism, vital processes occur in the aquatic environment. Water takes an active part in the so-called water-salt exchange. The processes of digestion and respiration proceed normally in the case of a sufficient amount of water in the body. The role of water is also great in the excretory function of the body, which contributes to the normal functioning of the genitourinary system. Water is a universal solvent. It dissolves all physiologically active substances. Water is a liquid phase that has a certain physical and chemical structure, which determines its ability as a solvent. Living organisms that consume water with different structures develop and grow in different ways. Therefore, the structure of water can be considered as the most important biological factor. The structure of water can change during its desalination. The structure of water is largely influenced by the ionic composition of water. The water molecule is not a neutral compound, but an electrically active one. It has two active electrical centers that create an electric field around them. The structure of the water molecule is characterized by two features: 1) high polarity; 2) a peculiar arrangement of atoms in space. Water molecules can exist in the following forms: 1) in the form of a single water molecule, it is a monohydrol, or simply a hydrol (H2ABOUT)1; 2) in the form of a double water molecule - this is a dihydrol (H2ABOUT)2; 3) in the form of a triple water molecule - trihydrol (H2ABOUT)3. Depending on the dynamic balance between the forms, certain types of water are distinguished. 1. Water associated with living tissues - structural (ice-like, or perfect water), represented by quasi-crystals, trihydrols. This water is highly biologically active. Its freezing point is -20 °C. The body receives such water only with natural products. 2. Fresh melt water - 70% ice-like water. It has medicinal properties, improves adaptogenic properties, but quickly (after 12 hours) loses its biological properties to stimulate biochemical reactions in the body. 3. Free, or ordinary, water. Its freezing point is 0 °C. 10. Physiological and hygienic value of water. Dehydration The water content in the human body is 60% of its weight. The body constantly loses oxidative water in various ways: 1) with air through the lungs (1 m3 air contains an average of 8-9 g of water); 2) through the kidneys and skin. In general, a person loses up to 4 liters of water per day. Natural water losses must be compensated by the introduction of a certain amount of water from outside. If the losses are not equivalent to the introduction, dehydration occurs in the body. A lack of even 10% of water can significantly worsen the condition, and an increase in the degree of dehydration to 20% can lead to impaired vital functions and death. Dehydration is more dangerous for the body than fasting. A person can live without food for 1 month, and without water - up to 3 days. The regulation of water metabolism is carried out with the help of the central nervous system (CNS) and is administered by the food center and the thirst center. At the heart of the feeling of thirst lies, apparently, a change in the physicochemical composition of blood and tissues in which osmotic pressure is disturbed due to a lack of water in them, which leads to excitation of the central nervous system. Water consumption rates are determined by: 1) water quality; 2) the nature of the water supply; 3) the state of the organism; 4) the nature of the environment, and primarily the temperature and humidity conditions; 5) the nature of the work. 11. Factors that determine the organoleptic properties of water The organoleptic properties of water are formed by natural and anthropogenic factors. Odor, taste, color and turbidity are important characteristics of drinking water quality. The reasons for the appearance of odors, taste, color and turbidity of water are very diverse. For surface sources, this is primarily soil pollution coming with the flow of atmospheric water. The smell and taste can be associated with the flowering of water and the subsequent decomposition of vegetation at the bottom of the reservoir. The taste of water is determined by its chemical composition, the ratio of individual components and the amount of these components in absolute terms. This is especially true for highly mineralized groundwater due to the high content of chlorides, sodium sulfates, less often calcium and magnesium. So, sodium chloride causes the salty taste of water, calcium is astringent, and magnesium is bitter. The taste of water is also determined by the gas composition: 1/3 of the total gas composition is oxygen, 2/3 is nitrogen. There is a very small amount of carbon dioxide in water, but its role is great. Carbon dioxide can be present in water in various forms: 1) dissolved in water to form carbonic acid CO2 + H2O=H2CO3; 2) dissociated carbonic acid H2CO3 =H+HCO3 = 2H + CO3 to form the bicarbonate ion HCO3 and CO3 - carbonate ion. This balance between different forms of carbonic acid is determined by pH. In an acidic environment at pH = 4, free carbon dioxide is present - CO2. At pH = 7-8, the HCO ion is present3 (moderately alkaline). At pH = 10, the CO ion is present3 (alkaline environment). All these components determine the taste of water to varying degrees. For surface sources, the main cause of odors, tastes, color and turbidity are soil pollution coming from atmospheric water runoff. An unpleasant taste of water is characteristic of widespread highly mineralized waters (especially in the south and southeast of the country), mainly due to the increased concentration of sodium chlorides and sulfates, less often calcium and magnesium. The color (color) of natural waters often depends on the presence of humic substances of soil, plant and plankton origin. The construction of large reservoirs with active processes of plankton development contributes to the appearance of unpleasant odors, tastes and colors in the water. Humic substances are harmless to humans, but worsen the organoleptic properties of water. They are difficult to remove from water, and besides, they have a high sorption capacity. 12. The role of water in the occurrence of human diseases The relationship between the incidence of the population and the nature of water consumption has long been noted. Already in antiquity, some signs of water dangerous to health were known. However, only in the middle of the XIX century. epidemiological observations and bacteriological discoveries of L. Pasteur and R. Koch made it possible to establish that water may contain some pathogenic microorganisms and contribute to the emergence and spread of diseases among the population. Among the factors that determine the occurrence of water infections, we can distinguish: 1) anthropogenic water pollution (priority in pollution); 2) release of the pathogen from the body and entry into the reservoir; 3) stability in the aquatic environment of bacteria and viruses; 4) entry of microorganisms and viruses with water into the human body. Water infections are characterized by: 1) a sudden rise in the incidence; 2) maintaining a high level of morbidity; 3) rapid fall of the epidemic wave (after elimination of the pathological factor). Among viral diseases, these are intestinal viruses, enteroviruses. They enter the water with fecal matter and other human excreta. In the aquatic environment, you can find: 1) infectious hepatitis virus; 2) polio virus; 3) adenoviruses; 4) Coxsackie virus; 5) pool conjunctivitis virus; 6) influenza virus; 7) ECHO virus. The literature describes cases of infection with tuberculosis when using infected water. Diseases caused by animal parasites can be transmitted by water: amoebiasis, helminthiases, giardiasis. The dysenteric amoeba, common in the tropics and in Central Asia, has a pathogenic value. The vegetative forms of the amoeba die quickly, but the cysts are resistant to water. Moreover, conventional doses of chlorination are ineffective against amoeba cysts. Helminth eggs and Giardia cysts enter water bodies with human excretions, and they enter the body when drinking, with contaminated water. It is generally recognized that the possibility of eliminating the danger of water epidemics and thereby reducing the incidence of intestinal infections in the population are associated with progress in the field of water supply to the population. Therefore, a properly organized water supply is not only an important general sanitary measure, but also an effective specific measure against the spread of intestinal infections among the population. Thus, the successful elimination of the Eltor cholera outbreak in the USSR (1970) was largely due to the fact that the predominant part of the urban population was protected from the danger of its spread by water due to normal centralized water supply. 13. The chemical composition of water as a cause of non-infectious diseases The chemical composition of water. The factors that determine the chemical composition of water are chemicals that can be conditionally divided into: 1) bioelements (iodine, fluorine, zinc, copper, cobalt); 2) chemical elements harmful to health (lead, mercury, selenium, arsenic, nitrates, uranium, synthetic surfactants, pesticides, radioactive substances, carcinogens); 3) indifferent or even useful chemicals (calcium, magnesium, manganese, iron, carbonates, bicarbonates, chlorides). The chemical composition of water is a possible cause of non-infectious diseases. We will analyze the basics of rationing the indicators of the safety of the chemical composition of drinking water further. Indifferent Chemical Substances in Water Divalent or trivalent iron is found in all natural water sources. Iron is an essential component of animal organisms. It is used to build vital respiratory and oxidative enzymes (hemoglobin, catalase). An adult receives tens of milligrams of iron per day, so the amount of iron supplied with water does not have significant physiological significance. In groundwater, ferrous iron is more often found. If the water is pumped, then, combining on the surface with oxygen in the air, iron becomes trivalent, and the water becomes brown. Thus, the iron content in drinking water is limited by the effect on turbidity and color. Permissible concentration according to the standard is no more than 0,3 mg/l, for underground sources - no more than 1,0 mg/l. Manganese in groundwater is found in the form of bicarbonates, highly soluble in water. In the presence of atmospheric oxygen, it turns into manganese hydroxide and precipitates, which enhances the color and turbidity of the water. In the practice of centralized water supply, the need to limit the content of manganese in drinking water is associated with a deterioration in organoleptic properties. Not more than 0,1 mg/l is normalized. Aluminum is contained in drinking water that has undergone treatment - clarification in the process of coagulation with aluminum sulfate. Excess concentrations of aluminum give the water an unpleasant, astringent taste. The residual content of aluminum in drinking water (not more than 0,2 mg per liter) does not cause deterioration of the organoleptic properties of water (turbidity and taste). Calcium and its salts cause water hardness. The hardness of drinking water is an essential criterion by which the population evaluates the quality of water. In hard water, vegetables and meat are poorly digested, since calcium salts and food proteins form insoluble compounds that are poorly absorbed. Laundry is difficult to wash, scale (insoluble sediment) forms in heating appliances. Experimental studies have shown that with drinking water with a hardness of 20 mg-eq/l, the frequency and weight of stone formation were significantly higher than with drinking water with a hardness of 10 mg-eq/l. 14. The chemical composition of water as a cause of non-infectious diseases (continued) Bioelements. Copper is found in low concentrations in natural groundwater and is a true biomicroelement. The need for it (mainly for hematopoiesis) of an adult is small - 2-3 g per day. It is covered mainly by the daily food ration. In high concentrations (3-5 mg/l) copper has an effect on taste (astringent). The standard on this basis is not more than 1 mg / l in water. Zinc is found as a trace element in natural groundwater. It is found in high concentrations in water bodies polluted by industrial wastewater. Chronic zinc poisoning is unknown. Zinc salts in high concentrations irritate the gastrointestinal tract (GIT), but the value of zinc compounds in water is determined by their effect on organoleptic properties. At 30 mg/l, water acquires a milky color, and an unpleasant metallic taste disappears at 3 mg/l, so the zinc content in water is normalized to no more than 3 mg/l. The development of medical science has made it possible to expand the understanding of the characteristics of the chemical (salt and microelement) composition of water, its biological role and possible harmful effects on public health. Mineral salts (macro- and microelements) take part in mineral metabolism and the life of the body, affect the growth and development of the body, hematopoiesis, reproduction, are part of enzymes, hormones and vitamins. Iodine, fluorine, copper, zinc, bromine, manganese, aluminum, chromium, nickel, cobalt, lead, mercury, etc. have been found in the human body. Of the diseases associated with the unfavorable chemical composition of water, endemic goiter is primarily distinguished. This disease is widespread in the territory of the Russian Federation. The causes of the disease are the absolute deficiency of iodine in the external environment and the social and hygienic conditions of the population. The daily requirement for iodine is 120-125 mcg. In areas where this disease is not typical, the intake of iodine into the body comes from plant foods (70 micrograms of iodine), from animal foods (40 micrograms), from air (5 micrograms) and from water (5 micrograms). Iodine in drinking water plays the role of an indicator of the general level of this element in the external environment. Goiter is common in rural areas, where the population eats exclusively food products of local origin, and there is little iodine in the soil. Residents of Moscow and St. Petersburg also use water with a low iodine content (2 µg), but there are no epidemics here, as the population eats imported products from other regions, which ensures a favorable balance of iodine. Endemic fluorosis is a disease that occurs in the indigenous population of certain regions of Russia, Ukraine and other countries, an early symptom of which is tooth damage in the form of enamel spotting. It is generally accepted that spotting is not a consequence of the local action of fluoride. Fluorine, getting into the blood, has a general toxic effect, primarily causes the destruction of dentin. 15. The chemical composition of water as a cause of non-infectious diseases (continued) Drinking water is the main source of fluorine intake into the body, which determines the decisive role of fluorine in drinking water in the development of endemic fluorosis. The daily diet provides 0,8 mg of fluorine, and the fluorine content in drinking water is often 2-3 mg/l. There is a clear relationship between the severity of enamel damage and the amount of fluoride in drinking water. Of certain importance for the development of fluorosis are past infection, insufficient content of milk and vegetables in the diet. The disease is also determined by the socio-cultural conditions of the population. Preventive measures against the action of fluorine can be considered: 1) the use of water with a high content of mineral salts; 2) the use of food and liquids with a high content of calcium (vegetables and dairy products), since calcium binds fluorine and converts it into an insoluble complex Ca + F = CaP2; 3) the protective role of vitamins; 4) ultraviolet irradiation; 5) defluorination of water. Fluorosis is a common disease of the whole organism, although it is most clearly manifested in the defeat of the teeth. However, with fluorosis, there are: 1) violation (inhibition) of phosphorus-calcium metabolism; 2) violation (inhibition) of the action of intracellular enzymes (phosphatase); 3) violation of the immunobiological activity of the body. The following stages of fluorosis are distinguished: Stage 1 - the appearance of chalky spots; Stage 2 - the appearance of age spots; Stages 3 and 4 - the appearance of defects and erosion of the enamel (destruction of the dentin). The content of fluorine in water is normalized by the standard, since water with a small - 0,5-0,7 mg / l - fluorine content is harmful, as dental caries develops. Rationing is carried out by climatic regions, depending on the level of water consumption. In the 1st-2nd region - 1,5 mg / l, in the 3rd - 1,2 mg / l, in the 4th - 0,7 mg / l. Caries affects 80-90% of the total population. It is a potential source of infection and intoxication. Caries leads to indigestion and chronic diseases of the stomach, heart and joints. Convincing proof of the anti-caries action of fluorine is the practice of water fluoridation. Mercury causes Minamata disease (pronounced embryotoxic effect). Cadmium causes Itai-Itai disease (impaired lipid metabolism). Arsenic has a pronounced ability to accumulate in the body, its chronic action is associated with effects on the peripheral nervous system and the development of polyneuritis. 16. The chemical composition of water as a cause of non-infectious diseases (continued) Boron has a pronounced gonadotoxic effect. Violates the sexual activity of men and the ovarian-menstrual cycle in women. Boron is rich in natural underground waters of Western Siberia. A number of synthetic materials used in water supply can cause intoxication. These are primarily synthetic pipes, polyethylene, phenol-formaldehydes, coagulants and flocculants (PAA), resins and membranes used in desalination. Pesticides, carcinogens, nitrosamines that enter the water are hazardous to health. Surfactants (synthetic surfactants) are stable in water and slightly toxic, but they have an allergenic effect, and also contribute to better absorption of carcinogens and pesticides. When using water containing elevated concentrations of nitrates, infants develop water-nitrate methemoglobinemia. A mild form of the disease can also occur in adults. This disease is characterized by indigestion in children (dyspepsia), a decrease in the acidity of gastric juice. In this regard, in the upper intestines, nitrates are reduced to nitrites NO2. Nitrates enter drinking water due to the widespread chemicalization of agriculture, the use of nitrogenous fertilizers. In children, the pH of gastric juice is 3, which contributes to the reduction of nitrates to nitrites and the formation of methemoglobin. In addition, children lack the enzymes that restore methemoglobin to hemoglobin. Salt composition is a factor that constantly and for a long time affects the health of the population. This is a low intensity factor. The influence of chloride, chloride-sulfate and hydrocarbonate types of waters on: 1) water-salt exchange; 2) purine metabolism; 3) decrease in secretory and increase in motor activity of the digestive organs; 4) urination; 5) hematopoiesis; 6) cardiovascular diseases (hypertension and atherosclerosis). The increased salt composition of water affects the manifestation of unsatisfactory organoleptic properties, which leads to a decrease in "water appetite" and restriction of its consumption. The influence of water with low salinity (desalinated, distilled water) causes: 1) violation of water-salt metabolism (decrease in the exchange of chlorine in tissues); 2) a change in the functional state of the pituitary-adrenal system, the tension of protective and adaptive reactions; 3) lagging growth and weight gain of the body. The minimum allowable level of total salinity of desalinated water must be at least 100 mg/l. 17. Hygienic characteristics of sources of centralized domestic drinking water supply Drinking water can only meet the high requirements after it has been reliably processed and conditioned. Underground and surface sources of water supply can be used as sources of water supply. Underground sources have a number of advantages: 1) they are protected to a certain extent from anthropogenic pollution; 2) they are characterized by high stability of bacterial and chemical composition. Underground water sources, depending on the depth of occurrence and relationship to rocks, are divided into: 1) soil; 2) ground; 3) interstratal. Groundwater is located in the 1st aquifer from the surface (from 10-15 m to several tens of meters). These horizons are fed mainly by precipitation filtration. The diet is not constant. Atmospheric precipitation is filtered through a large thickness of soil, therefore, in bacterial terms, these waters are cleaner than soil waters, but they are not always reliable. Groundwater has a more or less stable chemical composition. Interstratal waters lie deep (up to 100 m) in an aquifer lying between two waterproof layers, one of which is the lower one - a waterproof bed, and the upper one - a waterproof roof. Therefore, they are reliably isolated from precipitation and groundwater. This predetermines the properties of water, in particular its bacterial composition. These waters can fill the entire space between layers (usually clay) and experience hydrostatic pressure. These are the so-called pressure, or artesian, waters. The classification of waters by chemical composition (hydrochemical classes of waters) is as follows. 1. Bicarbonate waters (northern regions of the country): anion HCO-3 and cations Ca++, Mg++, Na+. Hardness = = 3-4 mg-eq / l. 2. Sulfate: SO4- anion, Ca++, Na+ cations. 3. Chloride: anion Cl-, cations Ca++, Na+. Surface sources of water supply - rivers, lakes, ponds, reservoirs, canals. They are widely used for water supply of large cities because of the huge amount of water in them (debit). In the northern regions (the zone of excessive moisture), the waters are weakly mineralized. Peat soils predominate here, which enrich the waters with humic substances. Surface sources are subject to significant anthropogenic pollution. The level of pollution with organic substances is estimated by high oxidizability. 18. Zones of sanitary protection (ZSO) of water sources Choice of a source of economic and drinking water supply. Naturally, when choosing a source, not only the qualitative side of the water itself is taken into account, but also the power of the sources themselves. Focuses on sources whose water composition approaches the requirements of SanPiN 2.1.4.1074-01 "Drinking water". In the absence or impossibility of using such sources due to the insufficiency of their flow rate or for technical and environmental reasons, in accordance with the requirements of SanPiN 2.1.4.1074-01, it is necessary to come to other sources in the following order: interstratal free water, groundwater, open reservoirs. Conditions for choosing a water source: 1) source water should not have a composition that cannot be changed and improved by modern processing methods, or the possibility of its purification is limited according to technical and economic indicators; 2) the intensity of pollution should correspond to the effectiveness of water treatment methods; 3) the totality of natural and local conditions should ensure the reliability of the water source in the sanatorium respect. Despite the existing water treatment system, it is extremely important to take measures to prevent significant pollution of water sources. For this purpose, special SSOs are established. The ZSO is understood as a territory specially allocated around the source, on which the established regime must be observed in order to protect the water source, water supply facilities and the surrounding area from pollution. According to the legislation, this zone is divided into 3 zones: 1) high security belt; 2) belt of restrictions; 3) observation belt. WSS of surface water bodies. 1st belt (strict regime belt) - the area where the water intake site and the main water supply facilities are located. This includes the water area adjacent to the water intake for at least 200 m upstream and at least 100 m downstream of the water intake. A paramilitary guard is posted here. Residence and temporary stay of unauthorized persons, as well as construction are prohibited. The boundaries of the 1st belt of small surface sources usually include the opposite coast with a strip of 150-200 m. With a reservoir width of less than 100 m, the belt includes the entire water area and the opposite coast - 50 m. With a width of more than 100 m, the 1st belt includes a strip of water area to the fairway (up to 100 m). When water is withdrawn from a lake or reservoir, the shoreline is included in the 1st belt at least 100 m from the water intake in all directions. 2nd belt (zone of restrictions) - the territory, the use of which for industry, agriculture and construction is either completely unacceptable, or is allowed under certain conditions. 3rd belt (surveillance belt) - including all settlements that have a connection with a given source of water supply. 19. ZSO for underground sources and water quality standards ZSO underground sources are installed around water wells, since the protection of impermeable rocks is not always reliable. A change in the composition of groundwater can take place during intensive water intake from a well, when, according to the laws of hydrodynamics, low pressure zones are created around the well, which can create water leakage. Changes in the composition of groundwater may also be due to the influence of external surface pollution. However, its manifestations should be expected after a long period of time, since the filtration rate is usually not more than 0,1 m per day. On the territory of the strict regime zone of an underground water source, all main water supply facilities should be located: wells and cappings, pumping units and water treatment equipment. The restriction zone is set taking into account the power of the well and the nature of the soil. This zone for groundwater is set with a radius of 50 m and an area of 1 ha, for interlayer water - with a radius of 30 m and an area of 0,25 ha. Water quality requirements Hygienic requirements for the quality of water from open water sources are set out in SanPiN 2.1.5.980-00 "Hygienic requirements for the protection of surface waters". The document establishes hygienic requirements for water quality in water bodies for two categories of water use. The first one is when the source serves for water intake, for drinking, household use and water supply of food industry enterprises. The second is for recreational water use, when the facility is used for swimming, sports and recreation. Water quality standards. 1. Organoleptic properties. The smell of water should not exceed 2 points, the concentration of hydrogen ions (pH) should not go beyond 6,5-8,5 for both categories of water use. The color of water for the first category should not be detected in a column 20 cm high, for the second - 10 cm. The concentration of suspended solids during the discharge of wastewater in the control solution should not increase compared to natural conditions by more than 0,25 mg / dm3 for 1- th category and more than 0,75 mg/dm3 for the 2nd category of water bodies. Floating impurities should not be detected. 2. The content of toxic chemicals should not exceed the maximum allowable concentrations and approximate allowable levels of substances in water bodies, regardless of the category of water use (GN 2.1.5.689-98, GN 2.1.5.690-98 with additions). If two or more substances of the 1st and 2nd hazard classes with a unidirectional mechanism of toxic action are present in the water of a water body, the sum of the ratios of the concentrations of each of them to their MPC should not exceed 1: (C1 / MPC1) + (C2 / MPC2) + ... (Sp / MPCp) J 1, where C1, Sp - concentrations of substances; MPC1, ..., MPCp - MPC of the same substances. 3. Indicators characterizing the microbiological safety of water. 20. Requirements for the quality of drinking water Water quality requirements for centralized domestic drinking water supply are regulated by the state standard - sanitary rules and norms of the Russian Federation or SanPi-Nom RF 2.1.4.1074-01. SanPiN is a normative act that establishes the criteria for the safety and harmlessness for humans of water from centralized drinking water supply systems. SanPiN applies to water intended for public consumption for drinking and domestic purposes, for use in the processing of food raw materials, production, transportation and storage of food products. Drinking water should be safe in epidemiological and radiation terms, harmless in chemical composition and have favorable organoleptic properties. The most common and widespread type of hazard associated with drinking water is caused by contamination with sewage, other wastes or human and animal faeces. Despite the fact that today there are developed methods for the detection of many pathogenic agents, they remain quite laborious, time-consuming and expensive. In this regard, monitoring of each pathogenic microorganism in water is considered inappropriate. A more logical approach is to identify organisms commonly found in the faeces of humans and other warm-blooded animals as indicators of faecal contamination, as well as indicators of the effectiveness of water purification and disinfection processes. The detection of such organisms indicates the presence of faeces and hence the possible presence of enteric pathogens. Organisms as indicators of faecal contamination The use of typical enteric organisms as indicators of faecal contamination (rather than the pathogens themselves) is a well-established principle for monitoring and assessing the microbiological safety of water supplies. Coliforms have long been considered useful microbial indicators of drinking water quality, mainly because they are easy to detect and quantify. These are gram-negative rods, they have the ability to ferment lactose at 35-37 °C (general coliforms) and at 44-44,5 °C (thermotolerant coliforms) to acid and gas, oxidase-negative, do not form spores and include E. coli species , Citrobacter, Enterobacter, Klebsiella. Common coliform bacteria according to SanPi-Nu must be absent in 100 ml of drinking water. Common coliform bacteria should not be present in treated drinking water supplied to the consumer, and their presence indicates insufficient treatment or secondary contamination after treatment. In this sense, the coliform test can be used as an indicator of the cleaning efficiency. According to SanPiN, thermotolerant fecal coliforms should be absent in 100 ml of the studied drinking water. Of these organisms, only E. coli is specifically of fecal origin, and it is always present in large quantities in the excrement of humans and animals. 21. Indicators of faecal contamination Fecal streptococci The presence of fecal streptococci in water usually indicates faecal contamination. This term refers to those streptococci that are commonly found in human and animal feces. These strains rarely multiply in contaminated water and may be somewhat more resistant to disinfection than coliforms. The ratio of fecal coliforms to fecal streptococcus more than 3: 1 is typical for human feces, and less than 0,7: 1 for animal feces. This can be useful in identifying the source of faecal contamination in the case of heavily contaminated sources. Sulfite-reducing clostridia. These anaerobic spore-forming organisms, the most characteristic of which is Clostridium perfringens, are usually present in faeces, although in much smaller quantities than E. coH. Clostridial spores survive longer in the aquatic environment than coliform organisms, and they are resistant to decontamination at inadequate concentrations of this agent, contact time, or pH values. Thus, their persistence in the water subjected to disinfection may indicate defects in purification and the duration of fecal contamination. Spores of sulfite-reducing clostridia according to SanPi-Nu should be absent when examining 20 ml of drinking water. The total microbial count is useful in assessing the effectiveness of water treatment processes, especially coagulation, filtration and disinfection, with the main task being to keep their numbers in the water as low as possible. Virological indicators of water quality. Viruses of particular concern for waterborne transmission of infectious diseases are mainly those that multiply in the intestines and are shed in large quantities (tens of billions per gram of feces) in the faeces of infected people. Although viruses do not replicate outside the body, enteroviruses have the ability to survive in the external environment for several days and months. Especially a lot of enteroviruses in wastewater. During water intake at water treatment facilities, up to 1 viral particles per 43 liter are found in water. Direct detection of viruses is very difficult. Coliphages are present together with intestinal viruses. The number of phages is usually greater than the number of viral particles. Coliphagi and viruses are very close in size, which is important for the filtration process. According to SanPiN, there should be no plaque-forming units in 1 ml of a sample. Of all the known protozoa, pathogenic for humans, transmitted through water, can be the causative agents of amoebiasis (amebic dysentery), giardiasis and balantidiasis (ciliates). However, through drinking water, the occurrence of these infections rarely occurs, only when sewage enters it. The most dangerous person is the source-carrier of the reservoir of lamblia cysts. Getting into sewage and drinking water, and then back into the human body, they can cause giardiasis, which occurs with chronic diarrhea. Possible fatal outcome. 22. Harmlessness of water according to sanitary and toxicological standards The safety and danger of water in relation to sanitary and toxicological indicators of the chemical composition is determined by: 1) the content of harmful chemicals most commonly found in natural waters on the territory of the Russian Federation; 2) the content of harmful substances formed in the process of water treatment in the water supply system; 3) the content of harmful chemicals entering the sources as a result of human activities. MPC is understood as the maximum concentration at which the substance does not have a direct or indirect effect on the state of human health (when exposed to the body throughout life) and does not worsen the conditions of hygienic water consumption. The limiting sign of the harmfulness of a chemical in water, according to which the standard (MAC) is established, can be sanitary-toxicological, or organoleptic. For a number of substances in tap water, there are TACs (indicative allowable levels) of substances in tap water, developed on the basis of calculation or experimental methods for predicting accuracy. Hazard classes of substances are divided into: 1) 1 class - extremely dangerous; 2) class 2 - highly dangerous; 3) 3 class - dangerous; 4) 4th class - moderately dangerous. When several chemicals are found in drinking water, normalized according to the toxicological sign of harmfulness and belonging to the 1st and 2nd (extremely and highly dangerous) hazard class, excluding RS, the sum of the ratios of the detected concentrations of each of them to their maximum allowable content (MAC) should not be more than 1 for each group of substances characterized by a more or less unidirectional effect on the body. The calculation is carried out according to the formula: (C1fact / C1extra) + (C2fact / C2extra) + … + (Сnfact / Cnextra)J1, where C1, C2, Cn - concentrations of individual chemicals; Сfact - actual concentrations; Сextra - permissible concentrations. Particular attention should be paid to the stage of chlorination in the process of water treatment. Along with disinfection, chlorination can also lead to the saturation of organic substances with chlorine with the formation of helogenesis products. These transformation products, in some cases, can be more toxic than the initial ones present at the level of the maximum concentration limit of chemicals. Water safety in terms of RW pollution is determined by the MPC of the total volumetric activity of a- and b-emitters according to radiation safety standards (NRB): the total activity of a-emitters should be no more than 0,1 Bq / l (becquerel) of b-emitters - not more than 1,0 Bq/l. 23. History and modern problems of atmospheric air hygiene Atmospheric air hygiene is a section of communal hygiene. She deals with the consideration of questions about the composition of the earth's atmosphere, natural impurities to it and pollution by its products of human activity, the hygienic significance of each of these elements, standards for air purity and measures for its sanitary protection. The atmosphere is the gaseous envelope of the earth. The mixture of gases that make up the atmosphere is called air. Currently, atmospheric air hygiene defines a number of topical problems, such as: 1) hygiene and toxicology of natural pollution, especially rare and heavy metals; 2) air pollution by synthetic products: highly stable substances such as dichlorodiphenyltrichloroethane (DDT), derivatives of fluorine, chloromethane - freons, freons; 3) air pollution by products of microbiological synthesis. The atmosphere regulates the Earth's climate, many phenomena occur in the atmosphere. The atmosphere transmits thermal radiation, retains heat, is a source of moisture, a sound propagation medium, and a source of oxygen respiration. The atmosphere is an environment that perceives gaseous metabolic products, affects the processes of heat transfer and thermoregulation. The atmosphere, taking into account the distance from the Earth's surface, is divided into the troposphere, stratosphere, mesosphere, ionosphere, exosphere. The troposphere is characterized by vertical convection air currents, the relative constancy of the chemical composition of air masses, the instability of physical properties: fluctuations in air temperature, humidity, pressure, etc. As a result, the air temperature decreases with increasing altitude, which in turn leads to vertical movement of air, condensation water vapor, cloud formation and precipitation. As the altitude rises, the air temperature decreases by an average of 0,6 °C for every 100 m of altitude. Dust, soot, various toxic substances, microorganisms are constantly present in the troposphere, which is especially noticeable in large industrial centers. Above the troposphere is the stratosphere. It is characterized by a significant rarefaction of the air, negligible humidity, and an almost complete absence of clouds and dust of terrestrial origin. Here there is a horizontal movement of air masses, and the pollution that has fallen into the stratosphere spreads over vast distances. In the stratosphere, under the influence of cosmic radiation and short-wave radiation from the Sun, air gas molecules, including oxygen, are ionized and form ozone molecules. 60% of atmospheric ozone is located in the layer from 16 to 32 km, and its maximum concentration is determined at the level of 25 km. The air layers lying above the stratosphere (80-100 km) make up the mesosphere, which contains only 5% of the mass of the entire atmosphere. 24. Atmosphere as an environmental factor. Its structure, composition and characteristics Chemical composition of air The air sphere that makes up the earth's atmosphere is a mixture of gases. Dry atmospheric air contains 20,95% oxygen, 78,09% nitrogen, 0,03% carbon dioxide. Atmospheric air contains argon, helium, neon, krypton, hydrogen, xenon. The constant content of oxygen is maintained due to the continuous processes of its exchange in nature. Oxygen is consumed during the respiration of humans and animals, is spent on maintaining the processes of combustion and oxidation, and enters the atmosphere due to the processes of plant photosynthesis. As a result of intensive mixing of air masses, the concentration of oxygen in the air remains almost constant. The biological activity of oxygen depends on its partial pressure. Due to the difference in partial pressure, oxygen enters the body and is transported to the cells. Under the influence of short-wave UV radiation with a wavelength of less than 200 nm oxygen molecules. Simultaneously with the formation of ozone, its decay occurs. The general biological significance of ozone is great; it absorbs short-wave UV radiation from the Sun, which has a detrimental effect on biological objects. At the same time, ozone absorbs long-wave infrared radiation coming from the Earth, and thereby prevents excessive cooling of its surface. Nitrogen in quantitative content is the most significant component of atmospheric air. Air nitrogen is assimilated by nitrogen-fixing soil bacteria, blue-green algae, under the influence of electrical discharges it turns into nitrogen oxides, which, falling out with atmospheric precipitation, enrich the soil with salts of nitrous and nitric acids. Salts of nitric acid are used for protein synthesis. An important component of atmospheric air is carbon dioxide - carbon dioxide (CO2). Its main mass (up to 70%) is in a dissolved state in the water of the seas and oceans. Some mineral compounds, limestones and dolomites contain about 22% of the total amount of CO2. The rest of the amount falls on the animal and plant world, coal, oil and humus. Under natural conditions, there are continuous processes of release and absorption of CO2. It is released into the atmosphere due to the respiration of humans and animals, the processes of combustion, decay and fermentation, during the industrial firing of limestones and dolomites. At the same time, processes of assimilation of carbon dioxide are going on in nature, which is absorbed by plants in the process of photosynthesis. Recently, there has been an increase in its concentration in the air of industrial cities as a result of the intensity of pollution by fuel combustion products. Therefore, the average annual content of CO2 in the air of cities can increase up to 0,037%. The issue of the role of CO2 in creating the greenhouse effect, leading to an increase in surface air temperature, is discussed in the literature. 25. Atmospheric pollution and their classification Pollution of the environment, and especially air, by emissions from industrial enterprises, road transport has been a growing concern in many countries in recent years. A significant part of these emissions, combined with water vapor in the atmosphere, then falls to the ground in the form of so-called acid rain. By atmospheric pollution, we conditionally understand those impurities in the atmospheric air that are formed not as a result of natural processes, but as a result of human activity. Atmospheric pollution is divided into 2 groups: 1) earthly; 2) extraterrestrial. However, artificial pollution of anthropogenic origin has now become a priority. They are divided into radioactive and non-radioactive. Non-radioactive, or other, pollution is the topic of today's lecture. They are currently an environmental problem. Exhaust gases of motor vehicles, which make up about half of atmospheric pollution of anthropogenic origin, wear products of mechanical parts, tires and road surfaces. The composition of exhaust gases, in addition to nitrogen, oxygen, carbon dioxide and water, includes carbon monoxide, hydrocarbons, oxides of nitrogen and sulfur, as well as particulate matter. The composition of exhaust gases depends on the type of fuel used, additives and oils, engine operating modes, its technical condition, vehicle driving conditions, etc. The toxicity of exhaust gases of carburetor engines is mainly due to the content of carbon monoxide and nitrogen oxides, and diesel engines - nitrogen oxides and soot . The annual exhaust of one car is an average of 800 kg of carbon monoxide, 40 kg of nitrogen oxides and more than 200 kg of various hydrocarbons. In this set, carbon monoxide is the most insidious. Passenger car with a 50 hp engine. With. emits 60 liters of carbon monoxide per minute into the atmosphere. The toxicity of carbon monoxide is due to its high affinity for hemoglobin, 300 times greater than for oxygen. Under normal conditions, an average of 0,5% carboxyhemoglobin is found in human blood. The content of carboxyhemoglobin more than 2% is considered harmful to human health. There are chronic and acute carbon monoxide poisoning. Acute poisoning is often noted in motorists' garages. The action of carbon monoxide is enhanced in the presence of hydrocarbons in exhaust gases, which are also carcinogens (cyclic hydrocarbons, 3,4 - benzpyrene), aliphatic hydrocarbons have an irritating effect on mucous membranes (tear smog). The content of hydrocarbons at the intersections at traffic lights is 3 times higher than in the middle of the block. Under conditions of high pressure and temperature (as occurs in internal combustion engines), nitrogen oxides (NO)n are formed. They are methemoglobin-forming agents and have an irritating effect. Under the influence of UV radiation (NO)n undergo photochemical transformations. 26. Atmospheric pollution and their classification. (continuation) Oxides of nitrogen and ozone - oxidizing agents, reacting with organic substances of the atmosphere, form photooxidants - PAN (peroxyacyl nitrates) - white smog. Smog appears on sunny days, in the afternoon, with a large congestion of cars, when the PAN concentration reaches 0,21 mg/l. PANs have methemoglobin-forming activity. The main symptoms of chronic lead poisoning are lead rim on the gums (combining with acetic acid), lead skin color (golden-gray color), basophilic granularity of erythrocytes, hematoporphyrin in the urine, increased excretion of lead in the urine, changes in the central nervous system and gastrointestinal -intestinal tract (lead colitis). The second place in terms of emissions into the atmosphere is occupied by industrial enterprises. Among them, ferrous and non-ferrous metallurgy enterprises, thermal power plants, petrochemical enterprises, waste incineration - polymers are of the greatest importance. For several centuries, problems associated with air pollution by fuel combustion products have increased, the greatest manifestation of which has become the thick yellow fogs inherent in the landscapes of London and other large urban agglomerations. The event that attracted worldwide attention was the infamous London fog in December 1952, which lasted several days and claimed 4000 lives, as it had an extremely high concentration of smoke, sulfur dioxide and other pollution. Ferrous metallurgy. Dust emission per 1 ton of pig iron is 4,5 kg, sulfur dioxide - 2,7 kg and manganese 0,1-0,6 kg. Together with blast-furnace gas, compounds of arsenic, phosphorus, antimony, lead, mercury vapor and rare metals, hydrogen cyanide and resinous substances are also emitted into the atmosphere in small quantities. Emissions from non-ferrous metallurgy contain toxic dust-like substances, arsenic, and lead. During the production of metallic aluminum by electrolysis, a significant amount of gaseous and dust-like fluorine compounds is released into the atmospheric air. Upon receipt of 1 ton of aluminum, depending on the type and power of electrolysis, 38-47 kg of fluorine is consumed, while about 65% of it enters the atmospheric air. The pathogenetic aspect of the impact of atmospheric air pollution has been established - the systemic membrane-damaging effect of the main cellular structures. Understanding this process allows you to determine the system of preventive measures. Chemical pollution of atmospheric air increases the sensitivity of the body to the effects of adverse factors, including infections, especially in children with poor nutrition. 27. Hygienic regulation of harmful substances in the atmospheric air Currently, there are two approaches to the method of sanitary protection of atmospheric air. 1. Perfect production technology. This is the most effective, but at the same time expensive approach. 2. Air quality management. Its essence lies in hygienic regulation, which is currently the basis for the protection of atmospheric air. This approach has several concepts. One concept is to ration harmful components in raw materials and is unsuccessful, as it does not provide a level of safe concentrations in the atmospheric air. The other is the establishment of the maximum allowable emission (MAE) for each enterprise and, on the basis of MPE, stabilization. MPCs are concentrations that do not have a direct or indirect harmful and unpleasant effect on a person, do not reduce his ability to work, do not negatively affect his well-being and mood. According to V. A. Ryazanov: 1) below the threshold for acute and chronic effects on humans, animals and vegetation; 2) below the threshold of odor and irritant effect on the mucous membranes of the eyes and respiratory tract; 3) significantly below the MPC adopted for the air of industrial premises. It is necessary to take into account information on morbidity and complaints from the population in the zone of influence of emissions, which should not affect the living and sanitary conditions of life, and should not be addictive. MPCs of pollution in the atmospheric air are set according to two indicators - maximum one-time (MPC m. R.) and average daily - MPC s. With. (24 hours). While in most foreign countries, to establish the standard, epidemiological data on the impact of atmospheric air pollution on public health are mainly taken into account, in our country the experimental approach dominates. At the first stage of the experiment, the threshold concentrations of the reflex action are studied - the odor threshold and, in some cases, the threshold of irritating action. These studies are carried out with volunteers at special installations that ensure the supply of strictly dosed concentrations of chemical compounds into the breathing zone. As a result of statistical processing of the obtained results, a threshold value is set. These materials are then used to substantiate the maximum one-time MPC. At the second stage of research, the resorption effect of the compounds is studied under conditions of long-term exposure to experimental animals (usually outbred white rats) in order to establish the average daily maximum concentration limit. The chronic experiment in special seed chambers lasts at least 4 months. Animals must be in the cells around the clock. An important point is the choice of the studied concentrations. Three concentrations are usually chosen: the first is at the level of the odor threshold, the second is 3-5 times higher and the third is 3-5 times lower. If the test substance is odorless, then the concentrations for the toxicological experiment are calculated using special formulas. 28. Measures for the sanitary protection of atmospheric air Atmospheric air protection measures are divided into: 1) technological; 2) planning; 3) sanitary; 4) legislative. The group of technological and sanitary measures includes activities that can be carried out at the enterprise itself in order to reduce emissions. It is possible to reduce the amount of coal by rationalizing the arrangement of furnaces and improving their operation. Reducing air pollution with dust and sulfur dioxide can be achieved by enriching coal before burning: removing rock that gives a lot of dust, as well as pyrites containing sulfur. Sanitary and technical measures are associated with the use of cleaning devices. These are dust chambers, filters, Planning measures are based on the principle of functional zoning of settlements (identification of industrial zones, residential zones, etc. In some cases, sanitary protection zones are 10-20 km. The sanitary protection zone or any part of it cannot be considered as a reserve territory of the enterprise and be used to expand the industrial area.The territory of the sanitary protection zone should be landscaped.The size of the sanitary protection zones is determined in accordance with the sanitary classification of various types of industries and facilities that pollute the air with their emissions.Sanitary design standards establish 5 classes of sanitary protection zones: 1) I class - 1000 m; 2) II class - 500 m; 3) III class - 300 m; 4) IV class - 100 m; 5) V class - 50 m. At present, when addressing issues of atmospheric air protection, they are guided by the Constitution of the Russian Federation (adopted on December 12, 1993), the Fundamentals of the Legislation of the Russian Federation on the protection of the health of citizens, the Federal Laws "On the sanitary and epidemiological welfare of the population" and "On the protection of atmospheric air". Legislative measures include the establishment of MPC and SHEL for pollutants in the atmospheric air. At present, 656 MPCs and 1519 OBUVs have been established in Russia for substances polluting the atmospheric air. Measures aimed at preventing the adverse effects of atmospheric air pollution on public health and establishing mandatory hygienic requirements for ensuring the quality of atmospheric air in populated areas and compliance with hygienic standards in the placement, design, construction, reconstruction (technical re-equipment) and operation of facilities, as well as in the development of all stages of urban planning documentation are carried out purposefully on the basis of SanPiN 2.1.6.1032-01 "Hygienic requirements for ensuring the quality of atmospheric air in populated areas". 29. The main directions and problems of nutrition of the population There are several directions in food ecology. One of these areas is associated with solving the problems of hunger on our planet. According to the Food Committee and the UN World Health Organization, an average of 10 million people die of starvation every year on the planet. The solution to the problem of hunger on our planet is carried out by: 1) by increasing the area under crops; 2) by intensifying agricultural production; 3) by using chemical, biological and other means of combating pests and diseases of agricultural crops. Another area of food ecology is related to the fact that food products in difficult environmental conditions are themselves the object of pollution and exposure to harmful chemicals - pesticides and pesticides. Rational nutrition in difficult environmental conditions should help increase the protective and adaptive capabilities of the human body. The population living in areas of environmental risk, as well as the part of the population that is affected by negative factors in production conditions, should receive special nutrition or therapeutic and preventive nutrition. This food must meet certain requirements. 1. It must contain an additional amount of vitamins. In this case, we are not talking about a large number of vitamins, but about 2-3 vitamins, and first of all it is ascorbic acid, that is, vitamin C, vitamin A and thiamine. 2. Nutrition should contain a complex of amino acids, such as cysteine and methionine, tyrosine and phenylalanine, tryptophan. 3. Nutrition should ensure the formation in the body of such compounds that have great biological activity. First of all, it is vitamin B12, choline, pyridoxine. 4. Nutrition in risk areas and therapeutic and preventive nutrition should be enriched with pectin substances that contain methoxyl groups that cause a gel-forming effect, have great sorption properties and help eliminate heavy metals, radioactive substances, autotoxins and other toxic compounds from the body. 5. In modern conditions, alkalizing diets are widely used, diets due to the inclusion of vegetables, fruits, and dairy products in them. The population living in areas of ecological risk is recommended to widely use products containing a large amount of such an amino acid as methionine. This amino acid is involved in transmethylation processes and provides detoxification function of the liver. Methionine is found in sufficient quantities in dairy and sour-milk products and cottage cheese. 30. Hygienic problems of application and use of food additives Modern nutrition is associated with the widespread use of nutritional supplements. Food additives are substances deliberately added to foodstuffs in small quantities in order to improve their appearance, taste, aroma, texture or to make them more stable during storage. These are fat antioxidants, preservatives, antibiotics, etc. There are substances that can be formed in products as a result of special methods of processing and obtaining them using smoking, ionizing radiation, ultrasound, and the use of endocrine preparations when fattening animals and birds. Food additives are handled by the World Health Organization, the Food and Agriculture Organization of the United Nations. In Russia, there are sanitary rules, special guidelines, instructions. There is such a principle: "everything that is not allowed is prohibited." Additives are strictly regulated by standards, specifications and special instructions. In Russia, the use of food additives is sharply limited, 3 artificial dyes are allowed for use, and in other countries (Belgium, Denmark, etc.) there is no list of permitted dyes at all. We do not allow the introduction of food additives in order to mask technological defects or spoilage of food products. For infants in our country, products are prepared without the use of food additives. State standards regulate the permissible content of food additives. Recently, much attention has been paid to substances that are formed during the processing of food products and can adversely affect the health of the population. A special position is occupied by the so-called trans-fatty acids (TIFA). TIFA play a significant role in the development of diseases of the cardiovascular system. The problem of TIZHK is connected mainly with the production of margarines and their use. Normally, fatty acid molecules are cis isomers. The essence of the difference between them lies in the spatial arrangement. For biological molecules, this is fatal. For example, the trans isomers that make up an enzyme can make it inoperative. Therefore, it is necessary to be wary of margarines and those products that are prepared with their use (potato chips, etc.). Natural products (meat, milk) contain TIFA no more than 2%, and in confectionery (crackers) TIFA can contain from 30 to 50% of the total fat. Donuts contain 35%, potato chips - 40%, french fries - about 40% FAFA. 31. Pesticides and nitrates in food hygiene The problem of pesticides, or pesticides and nitrates, is very topical. Pesticides are synthetic chemicals of varying degrees of toxicity used in agriculture to protect plants. According to the chemical structure, pesticides are divided into organochlorine, organophosphorus, carbamate derivatives, organomercury, cyanide, sulfur, arsenic, and copper preparations. By application, they are distinguished: for weed control - herbicides, for the destruction of microorganisms - bactericides, for the destruction of insects - insecticides, for the destruction of mites - acaricides, for the destruction of roundworms - nematicides, for the destruction of leaves before harvesting - defoliants, fungi - fungicides, etc. d. The most important criterion for pesticides is their ability to accumulate, that is, the ability to accumulate in tissues and organs. The main indicator of this ability is the cumulation coefficient. Supercumulative pesticides include those with a cumulative coefficient of less than 1, pesticides with pronounced cumulative properties have a cumulative coefficient from 1 to 3, and those with low cumulative properties - more than 5. In sanitary and toxicological terms, pesticides that have a complex of the following properties are of great danger: 1) high toxicity of the drug; 2) high stability in the environment; 3) long-term storage in soil, water, food; 4) high toxicity of substances formed as a result of decay, destruction of the drug under the influence of biological and other factors that cause transformation; 5) pronounced cumulative property of the drug; 6) methods of excretion from the body. The greatest danger is represented by pesticides that accumulate in milk; 7) pesticides capable of forming stable oil emulsions are highly dangerous. Measures to prevent poisoning by pesticides include: 1) complete exclusion of the residual content of pesticides that are stable in the environment and have pronounced cumulative properties; 2) tolerance in food products of the residual content of pesticides and their metabolites in quantities that do not have an adverse effect; 3) the use in agriculture in the production of food products of pesticides with a short half-life and the release of the edible part of the product from residual quantities of pesticides by the time of their commercial ripeness and harvest; 4) control over the strict observance of instructions for the use of pesticides and compliance with waiting periods that ensure the release of products from residual quantities; 5) monitoring the content of pesticide residues in food products and preventing exceeding the established allowable residues. 32. Nitrates in food hygiene Nitrates are a very important hygiene problem. Nitrates in food can accumulate during the cultivation of vegetable crops. Plant foods provide 70% of all nitrates. 10% of nitrate intake is associated with the consumption of animal food and 20% - with the consumption of water. Only 0,1% of nitrates is associated with pulmonary intake. According to the content of nitrates in them, food products can be divided into 3 groups. The first group includes food products containing up to 10 mg of nitrates per 1 kg of weight - milk, cheese, fish, meat, eggs, white sugar, wine. The second group - products in which the content of nitrates is from 50 to 2000 mg per 1 kg - tea, brown sugar. The third group includes products enriched with nitrate ions during their processing - sausages and semi-finished meat products, cheese. Sausage can contain up to 700 mg of nitrates per 1 kg. The intake of nitrates into the human body is associated with the danger of their biotransformation. Nitrates, having recovered in the human body to nitrites, interact with blood hemoglobin in the blood, and methemoglobin is formed, which leads to methemoglobinemia. It should be noted that such conditions are observed in premature infants who are bottle-fed due to the characteristics of enzymatic systems and intestinal microflora. Especially dangerous is the defeat of hemoglobin in the fetus in the womb (the so-called germinal methemoglobinemia), which is of great importance in the pathology of newborns. In saliva, nitrates accumulate, and the recovery process is underway: 20% of nitrates are restored in saliva. The content of nitrates is very significant in parsley, celery, early kaput, as well as those plant products that were grown indoors. It should be noted that in potatoes, 25% of all nitrates are contained in the core, i.e. more than in other parts of it, in carrots, most of the nitrates are contained in the core and stem. In everyday life, it is necessary to follow hygiene recommendations and remember that the use of aluminum utensils in the culinary processing of food greatly increases the toxicity of toxic substances. Adequate nutrition in modern conditions is based on the following principles: 1) the use of protective components in food products, compounds that improve the neutralizing function of the liver; 2) the inclusion of dietary fiber and an increase in their content up to 20 g per day; 3) optimization of the quantitative and qualitative relationship of nutrients. Nutrition should correspond to the state of health and high working capacity, contribute to a high life expectancy and the removal of old age. Nutrition should support the body's defenses against the influence of adverse environmental factors, neuropsychic overload, ensure the prevention of diseases of the gastrointestinal tract, cardiovascular system, and metabolic diseases. 33. Nutrition and health. Alimentary diseases Nutrition is a social factor, as it affects the interests of the population of the entire planet. According to WHO experts, about 500 million people are starving in the world. About 10 million people die of starvation every year. 100 ml of children in developing countries suffer from hunger. At present, a clear relationship between the nature of nutrition and health indicators has been established. Nutrition has an impact on such important indicators of public health as: 1) fertility and life expectancy; 2) state of health and physical development; 3) the level of performance; 4) morbidity and mortality. Nutritional anemia The WHO Scientific Group has defined nutritional anemia as a condition in which the hemoglobin content in the blood is below normal due to a deficiency of one or more important nutrients, regardless of the cause of this deficiency. Anemia exists if the hemoglobin level is below the value given here per 1 g or 1 ml of venous blood. Indicators in children aged 6 months to 6 years - 11 g per 100 ml of venous blood, children from 6 years to 14-12 g / 100 ml, adult men - 13 g / 100 ml of venous blood, women (and pregnant women ) - 12 g / 100 ml of venous blood and pregnant women - 11 g / 100 ml of venous blood. Prevention of anemia is a rational diet, the consumption of foods containing a sufficient amount of iron. These products include: veal liver, the content of iron in which is 13,3 mg per 100 g of the product, raw beef - 3,5 mg per 100 g , chicken egg - 2,7 mg per 100 g, spinach - 3,0 mg per 100 g of product. Less than 1,0 mg contain carrots, potatoes, tomatoes, cabbage, apples. At the same time, the content of ionized biologically active iron in these products is of great importance. Nutritional diseases characterized by malnutrition include beriberi. These include xerophthalmia associated with insufficient content or impaired metabolism of vitamin A. Obesity is one of the diseases of overnutrition. Obesity is a nutritional disease of a social nature. Every third person in developed countries suffers from this pathology. Obesity is a cause of disability and reduced life expectancy. Overweight people tend to have a life expectancy 10% lower than people with ideal body weight. Obesity contributes to the development of other pathologies: neuroendocrine diseases (diabetes), cardiovascular diseases. Moderate obesity is a risk factor for diabetes. In severe forms of obesity, the incidence of diabetes mellitus is 30 times higher. Obesity is a risk factor not only for diabetes and cardiovascular diseases, but also for infectious diseases. Obese people are 11 times more likely to develop an infectious pathology. 34. Rational nutrition Nutrition is the basic biological human need. Rational, healthy nutrition is nutrition that satisfies the body's needs for essential nutrients - proteins, fats, carbohydrates, vitamins and minerals. 1. Nutrition should be balanced in chemical composition in relation to the main nutrients - proteins, fats, carbohydrates, minerals and vitamins. This ratio of essential nutrients has been called the principle of first-order nutritional balance. The ratio of essential essential substances is also important. For proteins, this is the ratio of essential amino acids, for fats - a balanced ratio of fatty acids (marginal and unsaturated), for carbohydrates - this is the ratio of simple and complex carbohydrates, for vitamins - the ratio of various forms of provitamins and vitamins proper, the optimal ratio of macro- and microelements. The third position of the theory of rational nutrition is the idea of a rational diet, determined by the number of meals, the intervals between them, eating at a strictly defined time and the correct distribution of food for its individual meals. The fourth position in the theory of rational nutrition is determined by the digestibility or digestibility of diets, i.e. nutrition should, according to the method of culinary processing, according to the food set of products, correspond to the digestive capacity of the gastrointestinal tract, depending on age, individual characteristics, the state of the enzyme systems of the gastrointestinal a path at all stages of digestion of food: cavitary, parietal and intracellular. Nutrition should be balanced in digestibility and digestibility. A megacalorie - a million small calories, a thousand kilocalories - large calories, must be strictly balanced in terms of the content of proteins, fats and carbohydrates in it. To the greatest extent, the body's energy needs are provided by carbohydrates, then fats, and finally proteins. If the total energy value of the diet is taken as 100%, then proteins account for 12%, fats - 33%, carbohydrates - 55% of calories. Or, if in absolute terms, then in 1000 kcal there should be 120 kcal - due to protein, 333 kcal - due to fat and 548 kcal due to carbohydrates. If we take 120 kcal of proteins per unit, then the ratio of calories of proteins, fats and carbohydrates within a megacalorie will be expressed as: 1: 2,7: 4,6. The energy value of the diet in most cases should correspond to the energy expenditure of a person. In children, pregnant women, nursing mothers, emaciated convalescents, it should exceed energy expenditure. Energy costs for individuals of a homogeneous team are determined as follows: they consist of the main exchange (for an adult, it is approximately equal to 4,18 kJ, or 1 kcal per 1 kg of body weight per hour). The second element of unregulated energy consumption of the basal metabolism is the energy consumption spent on the assimilation of food - a specific dynamic action. 35. Rational nutrition (continued) The specific dynamic action of food of a mixed nature leads to an increase in basal metabolism by 10%. The sum of basic metabolism and energy costs associated with the specific dynamic action of food constitute an unregulated part of a person's daily energy costs. When determining the total energy consumption of a person, it is necessary to add to this unregulated part the energy costs of the body for the work performed during the day, related to labor activity, i.e. production, office and household work. For this purpose, the timing of the activities of groups of people of a given team is carried out, or a calculation is made using data on energy costs for various types of labor activity. There are direct and indirect methods for determining energy costs. The most widely used method for determining energy costs in modern conditions is to determine them according to special tables compiled on the basis of data on energy costs obtained by studying gas exchange. It is very important to note that energy expenditure is the basis of physiological nutritional norms, taking into account age aspects, taking into account the state of the human body, gender, climate, and living conditions. According to energy expenditure, the entire able-bodied population is divided into 5 groups. 5 groups of labor intensity. The first group includes mainly mental workers, business leaders, engineering and technical workers, medical workers, except for surgeons, nurses and nurses. The second group of the population in terms of labor intensity is represented by workers engaged in light physical labor. These are engineering and technical workers, workers in the radio-electronic, watch industry, communications and telegraph, the service sector, nurses and nurses. The energy costs of the second group are 2750-3000 kcal. This group, like the first, is divided into 3 age categories. The third group of the population in terms of labor intensity is represented by workers engaged in medium-heavy work. These are locksmiths, turners, adjusters, chemists, drivers of vehicles, water workers, textile workers, railway workers, surgeons, printers, foremen of tractor and field farming teams, grocery store sellers, etc. The energy expenditure of this group is 2950-3200 kcal. The fourth group includes workers of heavy physical labor - machine operators, agricultural workers, workers in the gas and oil industries, metallurgists and foundry workers, workers in the woodworking industry, carpenters and others. For them, energy costs are 3350-3700 kcal. The fifth group - workers engaged in especially hard physical labor: underground mine workers, chippers, masons, fellers, steelworkers, diggers, loaders, concrete workers, whose labor is not mechanized, etc. This is especially hard physical labor, because energy costs here range from 3900 to 4300 kcal. 36. The role of proteins in nutrition Protein, being the most important component of nutrition, providing the plastic and energy needs of the body, Protein is the main component of the diet, which determines the nature of nutrition. Against the background of a high level of protein, the most complete manifestation in the body of the biological properties of other nutritional components is noted. It should be noted that proteins determine the activity of many biologically active substances: vitamins, as well as phospholipids responsible for cholesterol metabolism. Proteins determine the activity of those vitamins, the endogenous synthesis of which is carried out from amino acids. For example, from tryptophan - vitamin PP (nicotinic acid), the exchange of methionine is associated with the synthesis of vitamin U (methylmethionine-sulfonium). It has been established that protein deficiency can lead to deficiency of vitamin C and bioflavonoids (vitamin P). Violation of the synthesis of choline in the liver leads to fatty infiltration of the liver. With great physical exertion, as well as with insufficient intake of fats and carbohydrates, proteins are involved in the energy metabolism of the body. Lack of protein in the diet leads to diseases such as alimentary dystrophy, insanity, kwashiorkor. Kwashiorkor means "weaned child". They get sick children weaned and transferred to a carbohydrate diet with a sharp lack of animal protein. Kwashiorkor causes both persistent irreversible constitutional changes and personality changes. Alimentary dystrophy most often occurs with a negative energy balance, when energy processes include not only food chemicals that come with food, but also the body's own structural proteins. It may seem that nutritional diseases occur only when there is insufficient intake of protein in the body. This is not entirely true. With excessive intake of protein in children of the first three months of life, symptoms of dehydration, hyperthermia and metabolic acidosis appear, which dramatically increases the load on the kidneys. This usually occurs when non-adapted milk mixtures, non-humanized types of milk are used during artificial feeding. 37. Essential amino acids, meaning and need for them The most important in nutrition are essential amino acids, which cannot be synthesized in the body and come only from the outside - with food. These include 8 amino acids: methionine, lysine, tryptophan, threonine, phenylalanine, valine, leucine, isoleucine. Thus, we can assume that the number of essential amino acids is 11-12. An incoming protein is considered complete if it contains all the essential amino acids in a balanced state. By their chemical composition, proteins of milk, meat, fish, eggs approach such proteins, the digestibility of which is about 90%. Proteins of plant origin (flour, cereals, legumes) do not contain a complete set of essential amino acids and therefore belong to the category of inferior ones. In particular, they contain an insufficient amount of lysine. The assimilation of such proteins is, according to some reports, 60%. To study the biological value of proteins, two groups of methods are used: biological and chemical. The basis of biological is the assessment of the growth rate and the degree of utilization of food proteins by the body. These methods are labor intensive and expensive. The chemical method of column chromatography allows you to quickly and objectively determine the content of amino acids in food proteins. Animal proteins have the highest biological value, vegetable proteins are limited in a number of essential amino acids, primarily in lysine, and wheat and rice proteins are also limited in threonine. Proteins of cow's milk differ from breast proteins in the deficiency of sulfur-containing amino acids (methionine, cystine). According to the WHO, the ideal protein is close to the protein of breast milk and eggs. An important indicator of the quality of food protein is its digestibility. According to the degree of digestion by proteolytic enzymes, food proteins are arranged as follows: 1) fish and milk proteins; 2) meat proteins; 3) proteins of bread and cereals. Fish proteins are better absorbed due to the absence of connective tissue protein in their composition. The protein value of meat is estimated by the ratio between tryptophan and hydroxyproline. For high quality meat, this ratio is 5,8. Each amino acid from the essential group plays a specific role. Their deficiency or excess leads to any changes in the body. There are NAC balance standards developed taking into account age data. For an adult (g / day): tryptophan - 1, leucine 4-6, isoleucine 3-4, valine 3-4, threonine 2-3, lysine 3-5, methionine 2-4, phenylalanine 2-4, histidine 1,5 ,2-XNUMX. 38. Non-essential amino acids The body's need for non-essential amino acids is satisfied mainly through endogenous synthesis, or reutilization. In industry, the sodium salt of glutamic acid is more commonly used. In Japan, monosodium glutamate is called "agino motto" - "essence of taste". Food products are sprayed with a 1,5-5% sodium glutamate solution, and they retain their fresh aroma for a long time. Since monosodium glutamate has antioxidant properties, food products can be stored for a long time. In children, the need for protein is determined by age norms. The amount of protein intake due to the predominance of plastic processes in the body per 1 kg of body weight is increased. On average, this value is 4 g / kg for children from 1 to 3 years of age, 3,5-4 g / kg for children 3-7 years old, 3 g / kg for children 8-10 years old and children over 11 years old - 2,5-2 g/kg, while the average for adults is 1,2-1,5 g/kg per day. The importance of fats in the diet of a healthy person. Fats are among the main nutrients. Fats are a source of energy that surpasses the energy of all other nutrients. When burning 1 g of fat, 9 kcal is formed, while when burning 1 g of carbohydrates or proteins, 4 kcal each. Fats are involved in plastic processes, being a structural part of cells and their membrane systems. Fats are solvents for vitamins A, E, D and contribute to their absorption. A number of biologically valuable substances come with fats: phospholipids (lecithin), polyunsaturated fatty acids, sterols and tocopherols and other biologically active substances. Fat improves the taste of food, and also increases its nutritional value. By chemical composition, fats are complex complexes of organic compounds, the main structural components of which are glycerol and fatty acids. The specific gravity of glycerol in the composition of fat is insignificant and amounts to 10%. Fat composition High molecular weight saturated acids (stearic, arachidic, palmitic) have a solid consistency, low molecular weight (butyric, caproic, etc.) - liquid. In terms of biological properties, saturated fatty acids are inferior to unsaturated ones. Limiting (saturated) fatty acids are associated with ideas about their negative effect on fat metabolism, on the function and condition of the liver, as well as the development of atherosclerosis (due to the intake of cholesterol). Polyunsaturated (essential) fatty acids. PUFAs are fatty acids containing several double bonds. Linoleic acid has two double bonds, linolenic acid has three, and arachidonic acid has four double bonds. Highly unsaturated PUFAs are considered by some researchers as vitamin F. The optimal balance of fatty acids in fat can be the following ratio: 10% PUFA, 30% saturated fatty acids and 60% monounsaturated (oleic) acid. The daily requirement for PUFA with a balanced diet is 2-6 g, which is provided by 25-30 g of vegetable oil. 39. Importance of carbohydrates in nutrition Carbohydrates are the main component of the diet. Carbohydrates provide at least 55% of daily calories. (Recall the ratio of key nutrients in terms of calories in a balanced diet - proteins, fats and carbohydrates - 120 kcal: 333 kcal:: 548 kcal - 12%: 33%: 55% - 1: 2,7: 4,6). The main purpose of carbohydrates is to compensate for energy costs. Carbohydrates are a source of energy for all types of physical work. When burning 1 g of carbohydrates, 4 kcal is formed. This is less than that of fats (9 kcal). However, in a balanced diet there is a predominance of carbohydrates: 1: 1,2: 4,6: 30 g: 37 g: 137 g. At the same time, the average daily requirement for carbohydrates is 400-500 g. Carbohydrates as an energy source have the ability to be oxidized in the body as aerobic as well as anaerobically. Some carbohydrates also have pronounced biological activity. These are blood heteropolysaccharides that determine blood groups, heparin, which prevents the formation of blood clots, ascorbic acid, which has C-vitamin properties. The main source of carbohydrates in the diet are vegetable products, in which carbohydrates make up at least 75% of the dry matter. The value of animal products as sources of carbohydrates is small. The main animal carbohydrate - glycogen, which has the properties of starch, is found in animal tissues in small quantities. Another animal carbohydrate - lactose (milk sugar) - is found in milk in an amount of 5 g per 100 g of product (5%). In general, the digestibility of carbohydrates is quite high and amounts to 85-98%. So, the digestibility coefficient of vegetable carbohydrates is 85%, bread and cereals - 95%, milk - 98%, sugar - 99%. The very name "carbohydrates", proposed in 1844 by K. Schmidt, is based on the fact that in the chemical structure of these substances, carbon atoms are combined with oxygen and hydrogen atoms in the same proportions as in the composition of water. For example, the chemical formula of glucose C6 H12 O6 carbohydrates can be represented as the following classification scheme: 1) simple carbohydrates (sugars): a) monosaccharides: glucose, fructose, galactose; b) disaccharides: sucrose, lactose, maltose; 2) complex carbohydrates: polysaccharides (starch, glycogen, pectin, fiber). 40. Importance of simple carbohydrates in nutrition Simple carbohydrates. Monosaccharides and disaccharides are characterized by easy solubility in water, fast digestibility and pronounced sweet taste. Monosaccharides (glucose, fructose, galactose) are hexoses that have 6 carbon atoms, 12 hydrogen atoms and 6 oxygen atoms in their molecule. In food products, hexoses are in indigestible a- and b-forms. Under the action of pancreatic enzymes, hexoses are converted into an assimilable form. In the absence of a hormone (for example, insulin in diabetes), hexoses are not absorbed and are excreted in the urine. Glucose in the body quickly turns into glycogen, which is used to nourish the tissues of the brain, heart muscle, and maintain blood sugar. In this regard, glucose is used to maintain postoperative, debilitated and seriously ill patients. Fructose, having the same properties as glucose, is absorbed more slowly in the intestines and quickly leaves the bloodstream. With more sweetness than glucose and sucrose, fructose allows you to reduce the consumption of sugars, and hence the caloric content of the diet. At the same time, less sugar passes into fat, which favorably affects fat and cholesterol metabolism. The use of fructose is the prevention of caries and putrefactive colitis of the intestine, it is used to feed children and the elderly. Galactose is not found in free form in foods, but is a product of the breakdown of lactose. The source of hexoses are fruits, berries and other plant foods. Disaccharides. Of these, sucrose (cane or beet sugar) and lactose (milk sugar) are important in nutrition. During hydrolysis, sucrose breaks down to glucose and fructose, and lactose breaks down to glucose and galactose. Maltose (malt sugar) is a breakdown product of starch and glycogen in the gastrointestinal tract. It is found in free form in honey, malt and beer. 41. Complex carbohydrates, or polysaccharides Complex carbohydrates, or polysaccharides, are characterized by a complex molecular structure and poor solubility in water. These include starch, glycogen cellulose (fiber) and pectin. The last two polysaccharides are classified as dietary fiber. Starch. The source of starch are grain products, legumes and potatoes. Starch in the body goes through a whole stage of transformation of polysaccharides: first to dextrins (under the action of the enzymes amylase, diastase), then to maltose and the final product - glucose (under the action of the maltase enzyme). A balanced intake of starch and sugar in the diet provides favorable conditions for maintaining a normal blood sugar level. Glycogen (animal starch). It is present in animal tissue, in the liver up to 230% of the wet weight, in the muscles - up to 4%. It is used in the body for energy purposes. Its recovery occurs by resynthesizing glycogen at the expense of blood glucose. Pectin substances - colloidal polysaccharides, hemicellulose (gelling agent). There are two types of these substances: protopectins (compounds of pectin and cellulose insoluble in water) and pectins (soluble substances). Pectins have a beneficial effect on the processes of digestion. They have a detoxifying effect in case of lead poisoning, they are used in therapeutic and prophylactic nutrition. Cellulose (cellulose) in its structure is very close to polysaccharides. The human body almost does not produce enzymes that break down cellulose. The value of fiber is: 1) in stimulating intestinal motility due to the sorption of water and an increase in the volume of feces; 2) in the ability to remove cholesterol from the body due to the sorption of sterols and prevent their reabsorption; 3) in the normalization of intestinal microflora; 4) in the ability to cause a feeling of satiety. The main source of dietary fiber are grain products, fruits and vegetables. Wholemeal rye bread, peas, legumes, oatmeal, cabbage, raspberries, black currants are characterized by the highest level of dietary fiber. Most dietary fiber in bran. Wheat bran contains 45-55% dietary fiber, of which 28% is hemicellulose, 9,8% cellulose, 2,2% pectin. 3/4 of all biologically active substances are contained in bran. Adding to the daily diet 2-3 tbsp. l. bran sufficiently enhances the motor-evacuation function of the colon, gallbladder. The need for carbohydrates is determined by the amount of energy costs, i.e., the nature of work, age, etc. The average need for carbohydrates for people who are not engaged in heavy physical labor is 400-500 g per day, including starch - 350- 400 g, mono- and disaccharides - 50-100 g, dietary fiber (fiber and pectin) - 25 g. The main source of carbohydrates for children should be fruits, berries, juices, milk (lactose), sucrose. The amount of sugar in baby food should not exceed 20% of the total amount of carbohydrates. 42. Minerals. Role and importance in human nutrition Minerals are involved in all physiological processes: 1) plastic - in the formation and construction of tissues; 2) in maintaining acid-base balance (acidity of the serum is not more than 7,3-7,5), in creating the concentration of hydrogen ions in tissue, cells, intercellular fluids, giving them certain osmotic properties; 3) in protein formation; 4) in the functions of the endocrine glands (especially iodine); 5) in enzymatic processes (every fourth enzyme is a metalloenzyme); 6) in the neutralization of acids and the prevention of the development of acidosis; 7) in the normalization of water-salt metabolism; 8) in maintaining the body's defenses. More than 70 chemical elements have been found in the human body, of which more than 33 are found in the blood. In view of the foregoing, mineral substances are divided into substances: 1) alkaline action (cations) - sodium, calcium, magnesium, potassium; 2) acid action (anions) - phosphorus, sulfur, chlorine. Conventionally, all minerals are divided according to the level of content in products (tens and hundreds of mg%) and high daily requirements into macro- (calcium, magnesium, phosphorus, potassium, sodium, chlorine, sulfur) and microelements (iodine, fluorine, nickel, cobalt, copper, iron, zinc, manganese, etc.). Calcium is the main structural component of bone. Calcium in the bones contains 99% of its total amount in the body. Calcium is a constant component of blood, cell and tissue juices. Calcium is a hard to digest element. The absorption of calcium depends on its ratio with other components: fat, magnesium and phosphorus. Good absorption of calcium is observed if there are 1 mg of calcium from food per 10 g of fat. A negative effect on the absorption of calcium has an excess of magnesium, which enhances the excretion of calcium from the body; in the daily diet of magnesium should contain half as much as calcium. The daily requirement for calcium is 800 mg, and magnesium - 400 mg. Phosphorus is a vital element. The human body contains from 600 to 900 g of phosphorus. Phosphorus is involved in the processes of metabolism and synthesis of proteins, fats and carbohydrates, affects the activity of skeletal muscles and heart muscle. Included in DNA and RNA. The largest amount of phosphorus is found in dairy products, especially in cheeses (up to 600 mg%), as well as in eggs (470 mg% in the yolk). Some vegetable products are also distinguished by a high content of phosphorus (legumes - beans, peas - contain up to 300-500 mg%. Good sources of phosphorus are meat, fish, caviar. The daily need for phosphorus is 1200 mg. 43. Minerals. Role and importance in human nutrition Magnesium in the body contains up to 25 g. However, its role in the process of carbohydrate and phosphorus metabolism is well known. Magnesium normalizes the excitability of the nervous system, has antispastic and vasodilating properties, stimulates intestinal motility, increases bile secretion, participates in the normalization of female specific functions, lowers cholesterol levels, and has an antiblastogenic effect. Sulfur is a structural component of some amino acids (methionine, cystine), vitamins and insulin. It is found mainly in products of animal origin. The daily requirement for sulfur is 1 g for adults. The role of sodium chloride in the nutrition of a healthy and sick person is great. The human body contains about 250 g of sodium chloride. More than 50% of this amount is in the extracellular fluid and bone tissue, and only 10% is inside the soft tissue cells. Conversely, potassium ions are localized inside the cells. They are responsible for maintaining a constant volume of fluid in the body, the transport of amino acids, sugars, potassium, and the secretion of hydrochloric acid in the stomach. Sodium, chloride and potassium ions come with bread, cheese, meat, vegetables, concentrates and mineral water. Excreted in the urine (up to 95%). In this case, sodium ions are followed by chloride ions. Potassium-rich foods cause increased sodium excretion. And vice versa. The excretion of sodium by the kidneys is regulated by the hormone aldosterone. The daily requirement for sodium is 4000-6000 mg, for chlorine - 5000-7000 mg, for potassium - 2500-5000 mg. Biomicroelements are involved in hematopoiesis. Iron is an essential part of hemoglobin and myoglobin. 60% of iron is concentrated in hemoglobin. Another important side of iron is participation in oxidative processes, as it is part of enzymes: peroxidase, cytochrome oxidase, etc. The iron requirement is 10 mg for men and 18-20 mg per day for women. Copper is involved in the synthesis of hemoglobin, is part of cytochrome oxidase. Copper is necessary for the conversion of iron into an organic bound form, promotes the transfer of iron to the bone marrow. Copper has an insulin-like effect. Under the influence of taking 0,5-1 mg of copper in diabetic patients, the condition improves, hyperglycemia decreases, and glucosuria disappears. The connection of copper with the function of the thyroid gland has been established. With thyrotoxicosis, the copper content in the blood rises. The content of copper is highest in the liver, legumes, seafood, nuts. Cobalt is the third biomicroelement involved in hematopoiesis, which is manifested at a sufficiently high level of copper. Cobalt affects the activity of intestinal phosphatases, is the main material for the synthesis of vitamin B12 in the body. Biomicroelements associated with endemic diseases: iodine - 100-200 mcg / day (endemic goiter), fluorine - the maximum allowable coefficient in water is 1,2 mg / l, in food - 2,4-4,8 mg / kg of diet . 44. Hygienic characteristics of noise Noise is a random combination of sounds of different heights and loudness, causing an unpleasant subjective sensation and objective changes in organs and systems. Noise consists of individual sounds and has a physical characteristic. The wave propagation of sound is characterized by frequency (expressed in hertz) and strength, or intensity, i.e., the amount of energy carried by a sound wave for 1 s through 1 cm2 of a surface perpendicular to the direction of sound propagation. The strength of sound is measured in energy units, most often in ergs per second per 1 cm2. Erg is equal to a force of 1 dyne, i.e., the force imparted to a mass, weighing 1 g, an acceleration of 1 cm2 / s. The unit of sound pressure is the bar, which corresponds to a force of 1 dyne per 1 cm2 of surface and equal to 1/1 of atmospheric pressure. Speech at normal volume creates a pressure of 000 bar. The smallest amount of sound that a person perceives is called the hearing threshold for that sound. The hearing thresholds for sounds with different frequencies are not the same. The lowest thresholds have sounds with a frequency of 500 to 4000 Hz. Outside this range, hearing thresholds increase, indicating a decrease in sensitivity. An increase in the physical strength of the sound is subjectively perceived as an increase in volume, but this occurs up to a certain limit, above which painful pressure is felt in the ears - the threshold of pain, or the threshold of touch. With a gradual increase in sound energy from the threshold of audibility to the pain threshold, features of auditory perception are revealed: the sensation of sound volume increases not in proportion to the growth of its sound energy, but much more slowly. To quantify sound energy, a special logarithmic scale of sound intensity levels in bels or decibels has been proposed. In this scale, zero, or the initial level, is conventionally taken as a force (10-9 erg/cm2 h h sec or 2 h 10-5 W/cm2/s), approximately equal to the threshold of audibility of sound with a frequency of 1000 Hz, which is accepted in acoustics for standard sound. Each step of such a scale, called bel, corresponds to a change in sound strength by 10 times. If we express in white the range of sound intensity with a frequency of 1000 Hz from the threshold of hearing to the pain threshold, then the entire range on a logarithmic scale will be 14 Bel. According to the spectral composition, all noise is divided into 3 classes. Class 1. Low-frequency (noises of low-speed non-impact units, noise penetrating through soundproof barriers). Class 2. Medium-frequency noise (noises of most machines, machine tools and units of non-impact action). Class 3. High-frequency noises (ringing, hissing, whistling noises typical for impact units, air and gas flows, units operating at high speeds). 45. Hygienic characteristics of noise (continued) Distinguish noise: 1) broadband with a continuous spectrum of more than 1 octave; 2) tonal, when the noise intensity in a narrow frequency range sharply prevails over the rest of the frequencies. According to the distribution of sound energy over time, noise is divided into: 1) constants, the sound level of which during an 8-hour working day changes over time by no more than 5 dB; 2) intermittent, the sound level of which changes by more than 8 dB over an 5-hour working day. Intermittent noises are divided into: 1) fluctuating in time, the sound level of which continuously changes in time; 2) intermittent, the sound level of which changes in steps (by 5 dB or more), and the duration of the intervals with a constant level is 1 s or more; 3) pulse, consisting of one or more signals with a duration of less than 1 s each, while the sound level changes by at least 7 dB. In certain industries, in relation to professions, rationing is carried out taking into account the category of severity and intensity. At the same time, 4 degrees of severity and tension are distinguished, taking into account ergonomic criteria: 1) dynamic and static muscle load; 2) nervous load - tension of attention, density of signals or messages for 1 hour, emotional tension, shift; 3) the tension of the analyzer function - vision, the amount of RAM, i.e. the number of elements to be memorized for 2 hours or more, intellectual tension, monotony of work. The degree of hearing loss is determined by the amount of hearing loss at speech frequencies, i.e. at frequencies of 500, 1000 and 2000 Hz and at the professional frequency of 4000 Hz. There are 3 levels of hearing loss: 1) slight decrease - at speech frequencies, hearing loss occurs by 10-20 dB, and at professional frequencies - by 60 ± 20 dB; 2) moderate decrease - at speech frequencies, hearing loss by 21-30 dB, and at professional frequencies - by 65 ± 20 dB; 3) a significant decrease - by 31 dB or more, respectively, and at professional frequencies by 70 ± ±20 dB. Measures to prevent the harmful effects of noise. Technical measures to combat noise are diverse: 1) replacement of noisy processes with noiseless ones: riveting - by welding, forging and stamping - by pressure treatment; 2) careful fitting of parts, lubrication, replacement of metal parts with non-sound materials; 3) absorption of vibration of parts, the use of sound-absorbing pads, good insulation when installing machines on foundations; 4) installation of silencers to absorb the noise of the exhaust air, gas or steam; 5) soundproofing (soundproofing of cabins, use of casings, remote control). 46. Vibration and its importance in occupational health Vibration occurs during vibrocompaction, pressing, molding, drilling, metal processing, during the operation of many machines and mechanisms. Vibration is a mechanical oscillatory motion. This fluctuation is characterized by: 1) amplitude; 2) frequency. Vibration with an amplitude of less than 0,5 mm is damped by tissues, more than 33 mm - acts on systems and organs. Vibration is divided into: 1) general (vibration of workplaces), which is transmitted through the supporting surfaces to the human body; 2) local - through the hands when working with different tools (machines). The general vibration according to the source of occurrence is divided into: 1) transport (category 1), arising from the movement of vehicles on the terrain; 2) transport and technological (category 2); 3) technological (category 3). Process vibration is divided into: 1) type A - arising at permanent workplaces of industrial premises; 2) type B - arising in the workplace of warehouses, canteens and other premises where there are no machines that generate vibration; 3) type B - arising at workplaces in the premises of plant management, design bureaus, laboratories, classrooms, in premises for mental workers. Local vibration is classified according to the same principle as the general one, but its sources are different: 1) manual machines with motors (or manual power tools), manual controls for machines and equipment; 2) hand tools without motors and machined parts. There are 3 forms of vibration disease: 1) peripheral, due to the impact of vibration on the hands of workers; 2) cerebral form, or general vibration, caused by the predominant effect of the general vibration; 3) cerebral-peripheral, or intermediate, form, which is generated by the combined action of general and local vibration. There are 4 stages of vibration disease. Stage 1 is characterized by subjective phenomena (nocturnal short pains in the extremities, paresthesia, hypothermia, moderate acrocyanosis). Stage 2 is characterized by increased pain, persistent impairment of skin sensitivity on all fingers and forearm, severe vasospasm, hyperhidrosis. Stage 3: loss of all types of sensitivity, a symptom of a "dead finger", a decrease in muscle strength, the development of osteoarticular lesions, functional disorders of the central nervous system of an asthenic and astheno-neurotic nature. 4th stage: changes in large coronary and cerebral vessels. 47. Assessment of the health status of children and adolescents. Health groups The concept of the health of children and adolescents should be understood as a state of complete socio-biological and mental well-being, harmonious, age-appropriate physical development, a normal level of functioning of all organs and systems of the body and the absence of diseases. Children, depending on the state of health, can be classified into the following health groups. Group I - healthy children with normal, age-appropriate physical and neuropsychic development, without functional and morphological and functional abnormalities. Group II - children who do not suffer from chronic diseases, but have functional or morphofunctional abnormalities, convalescents, with a general delay in physical development without endocrine pathology, as well as children with a low level of body immunoresistance - often (4 times or more per year) or for a long time (more than 25 calendar days for one disease) sick. Group III - children suffering from chronic diseases in remission (compensation). Group IV - children suffering from chronic diseases in the stage of subcompensation. Group V - children suffering from chronic diseases in the stage of decompensation, children with disabilities. 1) characteristics of the health of the child population, obtaining statistical slices of health indicators and the number of relevant health groups; 2) comparative comparison of groups of children in different groups, educational institutions, different territories, in time; 3) assessing the effectiveness of preventive and curative work in children's medical institutions based on the transition of children from one health group to another; 4) identification and comparison of the effect of risk factors affecting the health of children and adolescents; 5) determining the need for specialized services and personnel. The main groups of statistical indicators used to characterize the public health of the contingent of children and adolescents are the following: 1) medical and demographic criteria; 2) physical development; 3) distribution of children by health groups; 4) morbidity; 5) data on disability. Physical development is an integral indicator (index) of the sanitary and hygienic well-being of the child population. There are 3 groups of main factors that determine the direction and degree of physical development: 1) endogenous factors (heredity, intrauterine effects, prematurity, birth defects, etc.); 2) natural and climatic factors of the habitat (climate, terrain, as well as atmospheric pollution, etc.); 3) socio-economic and socio-hygienic factors. 48 Assessment of the health status of the child population (continued) According to the WHO, if more than 80% of children belong to health groups II-III, this indicates that the population is not well. Morbidity is one of the most important criteria characterizing the health of the child population. In a broad sense, incidence refers to data on the prevalence, structure and dynamics of various diseases registered among the population as a whole or its individual groups (territorial, age, gender, etc.). Pathological afflictions - a set of diseases identified during medical examinations, as well as morphological or functional abnormalities, premorbid forms and conditions that can later cause a disease, but by the time of the examination do not yet force their carrier to seek medical help. The increase in the prevalence of severe forms of pathology largely determines the increase in the frequency of childhood disability. Disability in children (according to WHO) is a significant limitation of life, leading to social maladjustment due to impaired development and growth of the child, the ability to self-service, movement, orientation, control of one's behavior, learning, communication, work in the future. Factors affecting the health status of children and adolescents The children's population is exposed to various environmental factors. Three groups of factors play a decisive role in the occurrence of deviations in the health status of children and adolescents: 1) factors characterizing the genotype of the child part of the population ("genetic load"); 2) lifestyle; 3) the state of the environment. Social and environmental factors do not act in isolation, but in complex interaction with biological, including hereditary, factors. According to WHO, the contribution of social factors and lifestyle to the formation of health status is about 40%, environmental pollution factors - 30% (including natural and climatic conditions - 10%), biological factors - 20%, medical care - 10% . Children's health is affected by: 1) medical and biological risk factors for the period of pregnancy and childbirth of the mother; 2) risk factors of early childhood; 3) risk factors due to the conditions and lifestyle of the child. Among the biological factors in all age groups of children, the main factors that have the greatest impact on morbidity are maternal diseases during pregnancy and complications during pregnancy. Of the factors of early childhood, natural feeding and hygienically correct child care are of particular importance. 49. Indicators of physical development Under the physical development understand the totality of morphological, functional properties and qualities, as well as the level of biological development (biological age) of the organism. For children of the first year of life - every 1 month. For children from 1 to 3 years - every 3 months. For children from 3 to 7 years old - every 6 months. For children over 7 years old - every year. Therefore, a different method is used, according to which children aged 8 years and 7 months to 6 years and 8 months 5 days are classified as 29-year-old children, from 9 years 8 months to 6 years 9 months 5 days, etc. d. Further, the program of unified anthropometric studies includes the determination of a number of basic morphological and functional features from the whole variety. These include somatometric, somatoscopic and physiometric signs. Somatometry includes determining the length, body weight, chest circumference. Somatoscopy is carried out to obtain a general impression of the physical development of the subject: the type of body structure as a whole and its individual parts, their relationship, proportionality, the presence of functional or pathological abnormalities. Somatoscopy includes: 1) assessment of the state of the musculoskeletal system: determination of the shape of the skull, chest, legs, feet, spine, type of posture, muscle development; 2) determination of the degree of fat deposition; 3) assessment of the degree of puberty; 4) assessment of the condition of the skin; 5) assessment of the condition of the mucous membranes of the eyes and oral cavity; 6) examination of the teeth and drawing up a dental formula. To assess the physical development of large groups of children or individuals, 2 main methods of observation (collection of anthropometric material) are used. 1. The generalizing method (population cross-sectional method) is based on a one-time examination of the physical development of large groups of children of different ages. 2. The individualizing method (longitudinal section) is based on a single examination of a particular child or in the dynamics of years, followed by an assessment of his biological level of development. 1. Standards of physical development should be regional. 2. The statistical population must be representative, therefore, each age and sex group must be represented by at least 100 children (observation units). 3. The statistical population must be homogeneous in terms of gender, age, ethnicity, place of residence and health status. 4. Children who are registered for health reasons should be excluded from the observation group. 5. After the formation of a homogeneous and representative statistical population, a single methodology for surveying, measuring, processing and analyzing data should be applied. 50. Methods for assessing the physical development of children and adolescents Method of sigma deviations The developmental indicators of an individual are compared with the average indicators characteristic of the corresponding age and sex group, the difference between them is expressed in sigma shares. A significant drawback of the method is the isolated evaluation of features outside of their relationship. The method of non-parametric statistics is the method of centile scales or channels, when, according to the results of mathematical processing, the entire series is divided into 100 parts. It is generally believed that values in the centile channel up to the 25th centile are rated as below average, from 25th to 75th centile - as average and above 75th centile - as above average. The method of centile scales evaluates anthropometric features in isolation, without their relationship. This method is the most widely used, as it makes it possible to identify individuals with harmonious and disharmonious physical development. Its advantage lies in the fact that it allows you to give a comprehensive assessment of physical development on the basis of a combination of signs in their relationship. Method for assessing the physical development of children according to a complex scheme Informative is a complex scheme for assessing physical development, carried out in two stages. Determine the correspondence of the biological age to the calendar (passport), ahead or behind it. At the age of up to 1 year, the most informative indicators are body length, an increase in body length over the past year, as well as (the timing of the appearance of ossification nuclei of the skeleton of the upper and lower extremities). In early, preschool and primary school age, the leading indicators of biological development are body length, annual gains, and the total number of permanent teeth in the upper and lower jaws. In middle school age, the leading indicators are body length, body length gain, the number of permanent teeth, in senior school age - body length gain and the degree of development of secondary sexual characteristics, the age of menstruation in girls. When conducting the Philippine test, the child's right hand, with the head in a vertical position, is placed across the middle of the crown, while the fingers of the hand are stretched in the direction of the left ear, the hand and hand fit snugly against the head. The Philippine test is considered positive if the fingertips reach the top of the pinna. The ratio of head circumference to body length (CO/DT ratio = 100%) is defined as the quotient of head circumference divided by body length, expressed as a percentage. 51. Methods for assessing the physical development of children and adolescents (continued) At the second stage, the morphofunctional state is determined in terms of body weight, chest circumference in the respiratory pause, muscle strength of the hands and vital capacity of the lungs (VC). As an additional criterion for differentiating excess body weight and chest circumference of age-sex norms due to fat deposition or muscle development, measurement of the thickness of skin-fat folds is used. To determine the morphofunctional state of the body, regression scales are used - to assess body weight and chest circumference, centile scales - to assess VC and muscle strength of the arms, as well as tables of thickness of skin-fat folds. First, the correspondence of body weight and chest circumference to body length is taken into account. To do this, on a regression scale, an indicator of the body length of the subject and the corresponding indicators of body weight and chest circumference are found. Then the difference between the actual and due indicators of body weight and chest circumference is calculated. The degree of increase and decrease in the actual indicator is expressed as a sigmal deviation, for which the resulting difference is divided by the corresponding regression sigma. Functional indicators (VC, muscle strength of the arms) are evaluated by comparing them with a centile scale for a given age and sex group. Averages are indicators that are in the range from 25 to 75 centiles, below average - indicators whose values are below the 25th centile, above average - indicators whose values are above the 75th centile. The morphofunctional state can be defined as harmonious, disharmonious and sharply disharmonious. A morphofunctional state is considered disharmonious when body weight and chest circumference are less than due by 10-25 centiles and more than due by 75-90 centiles due to fat deposition (the thickness of the skin-fat folds exceeds the average); functional indicators less than 25 centiles. A morphofunctional state is considered sharply disharmonious when body weight and chest circumference are less than due by 3-10 centiles and more than due by 90-97 centiles due to fat deposition (the thickness of the skin-fat folds exceeds the average); functional indicators less than 25 centiles. Thus, when assessing physical development according to a complex scheme, the general conclusion contains a conclusion about the correspondence of physical development to age. 52. Healthy lifestyle and personal hygiene issues Personal hygiene is part of general hygiene. If general hygiene is aimed at improving the health of the entire population or the health of the population, then personal hygiene is aimed at strengthening individual health. However, personal hygiene is also of public importance. Failure to comply with the requirements of personal hygiene in everyday life can have an adverse effect on the health of others (passive smoking, the spread of infectious diseases and helminth infections, etc.). Hygiene of the oral cavity. Keeping the body clean ensures the normal functioning of the skin. Through the skin, by radiation, evaporation and conduction, the body loses more than 80% of the generated heat necessary to maintain thermal equilibrium. Under conditions of thermal comfort, 10-20 g of sweat per hour is released through the skin, with heavy exertion and in uncomfortable conditions up to 300-500 g or more. Every day, the skin of an adult releases up to 15-40 g of sebum, which includes various fatty acids, proteins and other compounds, and up to 15 g of keratinized plates are shed. Through the skin, a significant amount of volatile substances are released, which are included in the group of anthropogases and anthropotoxins, organic and inorganic salts, and enzymes. All this can contribute to the reproduction of bacteria and fungi on the body. The skin of the hands contains more than 90% of the total number of microorganisms on the surface of the body. Human skin performs a barrier role, participates in gas exchange and in providing the body with ergocalceferol. Clean skin has bactericidal properties - the number of microbial bodies applied to clean skin is reduced by more than 2% within 80 hours. The bactericidal activity of clean skin is 20 times greater than that of unwashed skin. Therefore, for sanitary purposes, it is necessary to wash hands and face in the morning and before going to bed, wash the feet in the evening and wash the whole body at least once a week. It is also necessary to wash the external genitalia, which is an indispensable element of a woman's daily personal hygiene. It is essential to wash your hands before eating. Hair is recommended to be washed about 1 time per week for dry skin and 1 time in 3-4 days for oily skin using detergents. There are toilet, household, medical and technical soaps. Contacting with the epidermis, the alkali contained in the soap converts the protein part of the epidermis into easily soluble alkaline albuminates, which are removed when washed off. Therefore, frequent washing with soap of dry skin has an unfavorable effect on it, aggravating its dryness and itching, contributes to the formation of dandruff, hair loss. The amount of free alkali in soaps is regulated and in toilet soaps should not exceed 0,05%. 53. Healthy lifestyle and personal hygiene issues (continued) The addition of lanolin to the soap ("Baby", "Cosmetic") softens the irritating effect of alkali. The restoration of the acid reaction of the skin, which has a bactericidal effect, is facilitated by rinsing with compounds containing acetic acid. In the production process, toilet soaps, depending on their purpose and product group, include various dyes, fragrances, therapeutic and prophylactic and disinfectants. Hot soapy solutions (40-60 °C) remove 80-90% of the microflora from the infected surface. The cationic substances included in the SMS - degmin, diocil, pyrogem, etc., have high bacteriostatic and bactericidal properties. The bactericidal activity of sulfonols and other anionic surfactants is lower than that of cationic ones, and they are usually used for disinfection in a mixture with other disinfectants. At concentrations greater than 1%, CMC can be irritating and allergenic. Do not use SMS to soften water. The main method of hygienic care of the oral cavity is a daily double brushing of the teeth. It is necessary for the timely removal of plaque, slows down the formation of tartar, eliminates bad breath, and reduces the number of microorganisms in the oral cavity. Toothbrushes and toothpastes are used for brushing teeth. The main components of tooth powders are purified chalk and various additives and fragrances. The cleansing and massaging properties of powders are high, but their disadvantage in comparison with pastes is the abrasive effect on tooth enamel. The advantage of pastes containing significantly less chalk than powders is the ability to create a variety of compositions. There are hygienic and treatment-and-prophylactic toothpastes. Various biologically active substances (vitamins, plant extracts, mineral salts, trace elements) are introduced into the composition of therapeutic and prophylactic toothpastes, which have an anti-inflammatory, fluorine-replacing effect. The process of brushing the teeth should last at least 3-4 minutes and include 300-500 paired movements along (mainly) and across. To assess the cleanliness of the teeth and the intensity of plaque on them, it is recommended to use the so-called hygiene index, which is determined as follows. Using an iodide-potassium solution (Ki - 2 g, crystalline iodine - 1 g, H2O - 4 ml), applied to the surface of the six lower frontal teeth, the intensity of their color is assessed in points: no color - 1 point, strong brown color - 5 points. The index is calculated by the formula: Ksr = Kp / n, where Kp is the sum of points; n is the number of teeth. If Kav is less than 1,5 points - the score is good, from 2,6 to 3,4 points - bad, more than 3,5 - very bad. 54. Healthy lifestyle and personal hygiene issues. (continuation) Physical Culture. One of the most important elements of personal hygiene and a healthy lifestyle is physical education. The simplest types of physical culture should be practiced by all healthy adults and children. For people suffering from chronic diseases, exercise must be adapted. However, physical activity should be individualized and based on the real state of health, age and fitness of a particular person. To address the issue of the degree of functional readiness for physical exercises and control over their implementation, various tests have been proposed. One of them is a 12-minute test by American sports physician K. Cooper. It is based on the fact that between the distance traveled (km) and oxygen consumption (ml / kg / min) there is a relationship that reflects the functional readiness of a person. So, at the age of 30-39 years, readiness is considered poor, in which oxygen consumption is only 25 ml / kg / min, satisfactory - from 30 to 40, excellent - 38 ml / kg / min and more. Between the ages of 17 and 52, there is a relationship between overcoming and oxygen consumption, and the following relationship is typical. Based on this dependence, Cooper proposed criteria based on determining the length of the distance that the subject is able to walk or run in 12 minutes, while maintaining good general health and not experiencing severe shortness of breath, heart palpitations and other unpleasant sensations. Academician A. V. Amosov, as a test, proposed to evaluate the change in the initial heart rate after 20 squats at a slow pace, with arms extended forward and knees wide apart. If the pulse quickens by no more than 25% of the original, then the state of the circulatory organs is good, by 20-25% - satisfactory, by 75% or more - unsatisfactory. Another available test is the change in heart rate and general well-being during a normal walk up to the 4th floor. The state is assessed as good if the pulse rate does not exceed 100-120 beats per minute, breathing is free, easy, there are no discomfort, shortness of breath. Slight shortness of breath characterizes the condition as satisfactory. If already on the 3rd floor there is pronounced shortness of breath, the pulse rate is more than 140 beats per minute, weakness is noted, then the functional state is assessed as unsatisfactory. Walking The most ancient, simple and accessible type of physical activity, which has no contraindications for almost the vast majority of people, is walking. Energy consumption when walking at a speed of 3 km / h is 195 kcal / h, at a speed of 5 km / h - 390 kcal / h. During the day, each adult can walk at least 8-10 thousand steps 55. Healthy lifestyle and personal hygiene issues (continued) Morning hygienic gymnastics. The second most important element of physical culture is morning hygienic gymnastics (UGG). Unlike special types of gymnastics, UGG exercises are a complex of relatively simple, corrective, general developmental and strength movements that affect the main muscle groups of the body without much physical stress. UGG is recommended after sleep, before water procedures, preferably in the fresh air. UGG energy consumption is small and amounts to 80-90 kcal, but its value is enormous, it contributes to effective physical and mental activity throughout the working day. Hardening Hardening is understood as an increase in the body's resistance to the effects of fluctuations in air and water temperature, air humidity, atmospheric pressure, solar radiation and other physical environmental factors. When carrying out hardening procedures, it is necessary to take into account their basic principles: 1) gradualness; 2) systematic; 3) complexity; 4) an individualized mode (the nature, intensity and mode of hardening, taking into account the individual characteristics of a person - his age, gender, state of health, etc.). Air hardening. The most common form of air conditioning is aerotherapy (air baths). There are warm (temperature from 30 to 25 °C), cool (20-14 °C) and cold (less than 14 °C) air baths. When assessing the temperature regime, one should take into account the complex nature of the microclimate and focus on the effectively equivalent temperature and humidity of the air, the speed of its movement and the level of radiation. For greater efficiency, baths should be taken in the most naked form in the shade, on special sites (aerariums) that are not polluted by atmospheric emissions. An acceptable and effective form of hardening of the upper respiratory tract is sleeping in the winter in a room with an open window. Hardening with water is based on the high heat transfer of the human body, since water has a heat capacity that is much higher (10-20 times) than the heat capacity of air with the same temperature. For hardening, baths, bathing, showers, dousing, wiping, foot baths and other water procedures can be used. According to the temperature regime, the following types of procedures are distinguished: cold (less than 20 ° C), cool (20-30 ° C), indifferent (34-36 ° C), warm (37-39 ° C), hot (over 40 ° C) . Douche can be used as an independent hardening procedure (reducing the temperature from 30 °C to 15 °C) with obligatory subsequent rubbing of the body, which enhances the training effect on the vessels. 56. Clothing hygiene Currently, the concept of a clothing package includes the following main components: underwear (1st layer), suits and dresses (2nd layer), outerwear (3rd layer). According to the purpose and nature of use, household, professional (overalls), sports, military, hospital, ritual, etc. Everyday clothing must meet the following hygiene requirements: 1) provide an optimal underwear microclimate and promote thermal comfort; 2) do not impede breathing, blood circulation and movement, do not displace or squeeze internal organs, do not disrupt the functions of the musculoskeletal system; 3) be strong enough, easy to clean from external and internal contaminants; 4) do not contain toxic chemical impurities released into the external environment, do not have physical and chemical properties that adversely affect the skin and the human body as a whole; 5) have a relatively small mass (up to 8-10% of the human body weight). For the manufacture of fabric, various fibers are used - natural, chemical, artificial and synthetic. Natural fibers can be organic (vegetable, animal) and inorganic. Vegetable (cellulose) organic fibers include cotton, linen, sisal, jute, hemp and others, organic fibers of animal origin (protein) - wool and silk. For the manufacture of some types of workwear, inorganic (mineral) fibers, such as asbestos, can be used. Synthetic fibers are obtained by chemical synthesis from oil, coal, gas and other organic raw materials. By origin and chemical structure, heterocidal and carbocidal synthetic fibers are distinguished. The heterocidal ones include polyamide (kapron, nylon, perlon, xylon, etc.), polyester (lavsan, terylene, dacron), polyurethane; to carbocidal - polyvinyl chloride (chlorin, vinol), polyvinyl alcohol (vinylon, curalon), polyacrylonitrile (nitron, orlon). Air permeability characterizes the ability of the fabric to pass air through its pores, which determines the ventilation of the underwear space, convection heat transfer from the surface of the body. When determining the degree of air permeability, stVapor permeability characterizes the ability of a fabric to pass water vapor through the pores. Absolute vapor permeability is characterized by the amount of water vapor (mg) passing through 1 cm 2 of fabric for 2 hour at a temperature of 20 ° C and a relative humidity of 60%. For various fabrics, this figure ranges from 15 to 60%. Therefore, good vapor permeability of the fabric is one of the factors for ensuring thermal comfort. Author: Eliseev Yu.Yu.
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