Lesson number 1

Topic of the lesson: The subject of human hygiene and ecology. Fundamentals of General Ecology.

question: The subject of human hygiene and ecology.

The subject "Hygiene and Human Ecology" is a complex discipline that combines the knowledge of three sciences: hygiene, ecology and human ecology. These sciences are closely related.

Hygiene is part of the complex of medical sciences. The main goal of hygiene is the prevention of diseases, therefore a healthy person is at the center of hygiene study. The term hygiene comes from the Greek word for healthy. Hygiene is the foundation of preventive medicine.

Hygiene- it is a science that studies the influence of the human environment and production activities on human health and develops optimal, scientifically grounded requirements for the living and working conditions of the population.

Ecology- it is the science of the relationship between organisms and the environment, of the cycle of substances and energy flows that make life possible on Earth.

Thus, both hygiene and ecology study the influence of environmental factors on the body. Hygiene operates with hygienic concepts and terms and relies on knowledge of environmental laws. Hygiene and ecology emerged as independent sciences in the second half of the 19th century.

Currently, the science of ecology is divided into two main sections: general and specific.

General ecology studies the general laws of the relationship of organisms and their communities with the environment in natural conditions.

Private ecology studies narrower issues and is divided into subsections: soil ecology. hydrospheres, applied, social, human ecology. Most actively developing human ecology.

Human ecology studies the general laws of the relationship between nature and society, examines the interaction of man with the environment.

Unlike human ecology, hygiene considers the places of direct human habitation - a dwelling, an enterprise, a settlement, etc.

Hygiene objectives:

1. To develop measures for the prevention of diseases in large teams, united by common working conditions.

2. To investigate the influence of all conditions of human existence on health in order to develop scientifically grounded measures to eliminate or reduce the influence of negatively acting factors and enhance positively acting environmental factors.

3. Changing the environment in accordance with human needs (improving working conditions, food, home improvement, etc.).

4. Substantiation of hygienic environmental standards.

Question 2: Methods of hygienic research .

1. Sanitary inspection method- this is an examination and description of an object of the external environment (enterprise, dwelling, canteen, school, etc.) with the preparation of an act on the compliance of the premises with its purpose.

2. The method of laboratory research- physical, chemical and biological research in order to obtain objective data for the assessment and characterization of environmental factors.

3. Experimental method- study of the influence of environmental factors on the human body in artificially created conditions.

4. Method of physiological observations - study of the functional state of organs and systems of the human body in various conditions. Based on the results obtained, the necessary preventive measures are justified and developed.

5. Method of clinical observation - it is used to assess the health status of the population under the influence of negative environmental factors. To assess the state of health, tests are used: biochemical, immunological and others.

6. Sanitary statistical method used in assessing the levels of morbidity, physical development of children and adolescents, demographic indicators of the natural movement of the population.

7. Epidemiological method- includes the study of changes in the health of the population under the influence of internal and external factors and the analysis of medical accounting and reporting documents during one-time or long-term observations with the subsequent calculation of health indicators.

E.L. IGAY

Hygiene and Human Ecology

(lecture course)

Study guide for teachers and students

educational institutions of secondary vocational

education enrolled in medical schools and colleges

Minusinsk, 2012

Foreword
Section 1. Subject of hygiene and human ecology
	Introduction. Subject and content of hygiene, ecology and human ecology
	Fundamentals of General Ecology
	Environmental factors and public health
Section 2 Environmental Hygiene
	Atmospheric air and its physical properties
	The chemical composition of the air and its hygienic significance
	Ecological importance of water
	Hygienic value of water
	The ecological significance of the soil
	Hygienic value of the soil
Section 3. Ecological and hygienic problems of nutrition
		Human nutrition and health. The value of the main nutrients in ensuring the vital activity of the body. The role of vitamins and minerals. Basics of a balanced diet. Diet
		Sanitary and hygienic requirements for catering units of medical and prophylactic institutions. Hygienic requirements for the quality of food. Food poisoning
		Diseases associated with the nature of the diet. Curative and therapeutic-and-prophylactic nutrition
Section 4. Influence of production factors on the state of health and human activity. Classification of the main forms of labor activity
		Basic concepts of occupational hazards and occupational diseases. Hygienic Requirements for Optimizing Working Conditions for Women and Adolescents. Industrial injuries and measures to combat it.
		Occupational hygiene of medical personnel in medical institutions
Section 5. Urboecology, ecological and hygienic problems of dwellings, medical institutions
		Features of the formation of the urban environment. The main measures for the improvement of the environment in populated areas. Hygienic requirements for living quarters.
		Hygienic requirements for medical institutions
Section 6. Healthy Living and Personal Hygiene
		Components of a healthy lifestyle (HLS) and ways of their formation. Methods, forms and means of hygienic education
		The basics of personal hygiene of a healthy person.
Section 7. Hygiene of children and adolescents.
		Anatomical and physiological features of childhood and adolescence. The state of health and physical development of children and adolescents. School maturity.
		Hygienic requirements for the layout, equipment and maintenance of children's institutions.
Literature

FOREWORD

Nurses with knowledge in the field of ecology can provide effective assistance in the process of treatment, bringing to the population ecological ideas about the mechanism of origin of painful conditions. Knowledge of hygiene will help to navigate in choosing rational recommendations for correcting health and developing sanitary skills among the population, skillfully using hygiene rules when implementing measures to reduce the negative effects of harmful factors and enhance the positive influence of others on maintaining and strengthening health.

In the proposed textbook, the main issues of human ecology and hygienic knowledge are consistently and easily presented in the form of lectures, compiled in an accessible form for presentation and understanding.

The methodological basis for the preparation of the manual was the Model program of the academic discipline "Hygiene and Human Ecology", developed in accordance with state requirements for the minimum content and level of training of graduates of the basic (advanced) level of secondary vocational education for the specialty 060101 "General Medicine", and 060109 "Nursing. ... The manual is compiled in accordance with the State educational standards of secondary vocational education for the specified specialties. In accordance with the State Educational Standard, designed for 40 hours of theoretical classroom studies, the manual includes 20 lecture topics on human hygiene and ecology.

The lectures are divided into 7 sections.

Section 1 sets out the foundations of general ecology and, in particular, human ecology, as a place of his habitation, respiration, nutrition, water consumption, etc. Ecological factors and their impact on human health are illustrated. In contrast to ecology, hygiene studies the effect of these factors on health and develops recommendations for improving living conditions and preventing diseases. The issues of practical implementation of hygienic norms and rules are dealt with by sanitation, which determines the level of a person's sanitary culture.

The second section is devoted to the environmental characteristics of air and its hygienic value. Attention is paid to the problems of growing air pollution. The ecological significance of water for humans, in particular of individual water sources, and their hygienic characteristics are illustrated. The importance of soil for human health from an ecological and hygienic point of view, acting through the food chain, is revealed.

Particular attention is paid to nutritional problems in Chapter 3. The features of modern nutrition in conditions of hypodynamia, the structure of a balanced diet, the mechanisms of occurrence and features of food poisoning are analyzed.

Taking into account the high intensification of labor in modern medical institutions, nurses should be well aware of the provisions of labor protection, the influence of production factors on human health and life, hygienic requirements for rational work and rest. Chapter 4 is devoted to these questions.

The ecological and hygienic features of living in modern cities and dwellings, their role in the onset of pathology, especially in children, are analyzed in Chapter 5. Hygienic problems of medical and preventive institutions are also noted.

Chapter 6 is devoted to the most urgent problem of the state and health care - the formation of a healthy lifestyle. The components of a healthy lifestyle, methods, forms and means of their hygienic education are being studied.

Section 7 discusses the anatomical and physiological characteristics of children and adolescents, methods of optimizing the daily routine of children of different ages. Enough attention is paid to the hygienic requirements for the planning, equipment and maintenance of preschool and educational institutions.

Each topic contains a list of control test questions to clarify the level of students' perception of the material.

The list of references includes legal documents and basic literary sources on topical problems of hygiene in a presentation that is accessible to students of average professional level of training.

The manual is designed for teachers of the discipline "Hygiene and Human Ecology" and students of secondary medical institutions by specialties 060101 General Medicine and 060109 Nursing... It is assumed that the teacher will independently determine the amount of educational material presented during the theoretical lesson, taking as a basis the lecture material of this collection. At the same time, the material not included in the content of the lesson can be offered to students as a basis for extracurricular independent work, for which it is rational to use additional literature from the attached list.

Section 1.SUBJECT OF HUMAN HYGIENE AND ECOLOGY

Topic number 1: INTRODUCTION. SUBJECT AND CONTENT OF HYGIENE, ECOLOGY AND

HUMAN ECOLOGY.

Terminology and structure of the discipline

The role of ecology and hygiene in the system of sciences that study the natural environment.

Ecology and hygiene tasks.

Hygienic research methods.

Hygienic regulation.

BE ABLE TO:

Use the knowledge gained in educational work

Definition of the concepts of ecology, human ecology and hygiene. The subject and content of ecology, human ecology and hygiene.

The relationship of ecology, human ecology and hygiene and their place in the system of medical and biological sciences. Ecology and hygiene tasks. Sanitation.

The main historical stages in the development of ecology and hygiene.

Basic laws of hygiene.

Hygienic research methods and hygienic regulation.

The role of the paramedical worker in educational work with the population.

Definition of the concepts of ecology, human ecology and hygiene. The subject and content of ecology, human ecology and hygiene.

Ecology(Greek - the doctrine of the house) is the science of the relationship between the plant world and animal organisms and the communities formed by them with each other and with the environment. The term "ecology" was proposed by the German scientist E. Haeckel in 1866. In general, the problems of large ecology cover all questions of the vital activity of all living organisms. Therefore, in relation to the subjects of study, ecology is subdivided into the ecology of any living being - microbes, plants, animals, etc.

We are interested in human ecology, which studies the influence of environmental factors on humans and, in turn, the influence of humans and groups of people on the environment. Closely connected with her medical ecology, which studies human diseases caused by a polluted environment and how to prevent them. The health of the population in any territory is the best indicator of the state of its habitat.

The concept of "hygiene" goes back to ancient times. Hygieia - the daughter of the god of medicine Asclepius, portrayed as a beauty with a cup in her hand, entwined with a snake - the goddess of health, who healed with the sun, water and air, keeping the body clean. Her other sister - Panacea - treated with drugs.

Hygiene(Greek - healthy) is a field of medicine that studies the influence of living and working conditions on a person's health, his working capacity, life expectancy and develops measures for the prevention of diseases, improving the living and working conditions of a person, maintaining his health and prolonging his life.

The relationship of ecology, human ecology and hygiene and their place in the system of medical and biological sciences. Ecology and hygiene tasks. Sanitation.

Human ecology is a part of ecology - that is, of all life on Earth. If the science of ecology studies the ways of life and survival of all living things on Earth, then human ecology studies how to survive for humans, especially in an era of overpopulation and increasing pollution of the Earth. The problem of human ecology is the search for methods of moral and spiritual education of a person so that he realizes his place in nature and does not spoil it. Medical ecology is an integral part of human ecology, which studies human environmental diseases.

If for a person ecology is place of residence with every second communication with surrounding factors - microclimate, air, water, food, etc., with which the body is in constant contact and struggle for survival, then hygiene is a tool that examines the impact of human living conditions in an ecological environment, how they affect his health, performance, life expectancy, and on the basis of this study develops recommendations for reducing the risk of harmful environmental influences on health.

Sanitation Is the practical implementation of hygiene standards and rules. If hygiene is a science with recommendations for maintaining and improving health, then sanitation is a practical human activity, with the help of which the fulfillment of hygienic rules is achieved. But in life "I know and do / but do not do" or "I do not know and do not do" - this is the level of a person's sanitary culture.

Using hygiene knowledge, sanitation helps a person survive, prolong life and reproduce.

In the relationship of these disciplines, you can navigate using the following mottos: "ECOLOGY - LIVE!", "HYGIENE - I KNOW HOW TO DO!" and "SANITATION - AND I DO THIS!".

Another example of the relationship between these disciplines: a mosquito bite is ecology; I know that it can cause malaria, I need to be vaccinated - this is hygiene; slapping / not slapping him, getting / not getting vaccinated against malaria - this is sanitation.

Therefore, all our subsequent lectures will be structured from three directions or sections: ecological section - the study of environmental factors and their properties; in the hygiene section - the study of the impact of these factors on human health and the sanitation section - familiarization with recommendations on ways and methods of limiting these harmful effects and the development of useful skills.

The training of a modern paramedic, midwife or nurse in modern conditions is unthinkable without hygienic knowledge, which is closely related to the ecological worldview, prevention and clinical medicine. Hygienic knowledge relates to nutrition, labor, hospitals, healthy lifestyles, etc. Having learned them, you will understand that hygienic recommendations for the formation of a healthy lifestyle come first, and then medicines.

Therefore, a medical professional in the field of human hygiene and ecology must know:

the main environmental factors of the environment acting on a person in the places of his residence and work;

patterns of influence of these factors on human health;

methods of sanitary and hygienic assessment of environmental factors in the environment of which a person lives and works in order to anticipate the appearance of a disease and give recommendations on how to avoid or reduce the health risks of exposure to factors;

methodology of sanitary and educational work and be able to carry it out among people, taking into account environmental factors and the corresponding sanitary and hygienic recommendations.

In the process of studying hygiene, you will learn that a significant part of the population lacks basic environmental knowledge, which determines the development of a particular disease in a particular person. Based on the knowledge of anatomy, physiology, biology and other subjects that you study at school, you will receive the knowledge (and preferably, the beliefs!) Necessary for your preventive activities, which will help fight diseases, give recommendations on the formation of a healthy lifestyle and yourself stay healthy and serve as a role model.

The main historical stages of the development of ecology and hygiene

The origins of hygiene are in ancient times. In ancient Greece, in the temples, much attention was paid to the climate, washing, steaming, fasting. The heyday of hygiene - in ancient Rome - baths of 12 hectares, the whole day was spent in it in gymnastic exercises, conversations. In the Middle Ages - the decline of hygiene. Hygiene is revived in the 19th century.

Hygiene began to develop intensively from the middle of the 19th century with the growth of capitalism, which led to the accumulation of people in cities, the growth of harmful production and the increasing frequency of large epidemics of cholera, plague, and typhus. Systematic research in the field of hygiene began.

Max Pettenkofer(1818-1901), German scientist-doctor, the founder of hygienic science: introduced an experiment into hygiene, turning it into an exact science. By proposing to improve the environment, he outlined ways to prevent many diseases. For the first time he drew attention to personal hygiene as an important factor in many diseases: "how much a person owns personal hygiene - such is his path through life and such is his speed to death"

In Russia, hygiene as a system of skills originated earlier than in the West. Peter 1 introduced a system of medical and sanitary support for the Army, since in all the armies of the world a large number of soldiers died not in battles, but in diseases (cholera, dysentery, typhus).

In the development of hygiene, the founders of Russian health care, the therapist M.Ya. Mudrov and obstetrician S.G. Zybelin

It is necessary to know about the activities of three domestic scientists who played a fundamental role in the development of domestic hygiene.

A.P. Dobroslavin(1842-1889) - created the first department of hygiene (1871) at the St. Petersburg Military Medical Academy; published the first Russian textbook on hygiene, began to publish the magazine "Health", opened the first experimental hygiene laboratory, organized the Russian Society for the Protection of Public Health and Women's Medical Education in Russia; developed the basics of communal hygiene.

F.F. Erisman(1842-1915) - founded the Department of Hygiene at Moscow University (1882), the Hygienic Institute with a city sanitary station for the study of food, water and soil; developed problems of school hygiene and food hygiene; published a three-volume hygiene manual.

G.V. Khlopin(1863-1929) - a student of Erisman, put hygiene on compulsory laboratory research and experiment, published guidelines on the basics of hygiene and general hygiene.

In 1922, for the first time in the world in the USSR, a state law "On the sanitary bodies of the republic" was issued, which obliged to observe hygiene issues at the state level and introduced state sanitary supervision. The activity of the sanitary and epidemiological service in the USSR was one of the most effective in the world.

The adoption of the new Constitution of the Russian Federation (1993) required a revision and a number of provisions in the field of ensuring the sanitary and epidemiological well-being of the population. "(1999). Currently, the sanitary legislation includes 11 federal laws, 165 regional laws and over 3 thousand sanitary rules and other regulatory legal acts.

In 2004, the Federal Service for Supervision of Consumer Rights Protection and Human Welfare (Rospotrebnadzor) was established, which is the authorized federal executive body for exercising control and supervision functions in the field of ensuring the sanitary and epidemiological well-being of the population of the Russian Federation, consumer protection in consumer goods. market. State sanitary supervision is carried out in two forms: a) preventive sanitary supervision - control over projects, construction, production of future products and b) the current sanitary supervision - day-to-day, planned and targeted over the existing facilities. Rospotrebnadzor is a unified centralized state system, the main function of which is to implement state policy to ensure environmental safety and reduce risks to public health. This includes such activities as sanitary regulation, sanitary supervision, sanitary and hygienic monitoring, state registration and certification, research and testing of substances and products that pose a potential danger to humans, etc. At the same time, the implementation of practical measures to prevent epidemics and their consequences, as well as environmental protection is entrusted to the constituent entities of the Russian Federation and is their obligation.

At present, Rospotrebnadzor unites 2,218 Centers of State Sanitary and Epidemiological Surveillance (TsGSES), which are united into 90 territorial departments - by the number of regions and 1 - on railway transport. In addition, the activities of the Sanitary and Epidemiological Service are supported by 21 research institutes (scientific centers). The main purpose of these bodies is to ensure sanitary and epidemic well-being, prevention and elimination of dangerous and harmful effects of the human environment on his health. This is ensured by day-to-day monitoring of the human environment and health and the management of the sanitary-epidemic situation in the field. The leading activity of the state sanitary and epidemiological service has recently become sanitary and hygienic monitoring to control the environment and assess the risks of the impact of various factors on the human body.

Basic laws of hygiene

The six laws of hygiene on the impact on the environment for memorization can be combined into three “negative”, two “positive” and one “technological”.

"Negative" laws:

The law of the negative impact on the environment of human activities: industrial and household. The lower the scientific and technological progress in the country, the stronger the pollution of the environment and its impact on the health of people living here.

The law of the negative impact on the environment of natural extreme phenomena - volcanoes, earthquakes, solar flares, etc.

The law of the negative impact of environmental pollution on the health of the population: whatever these pollution, they reduce immunity, cause frequent illnesses, accelerate old age and death.

"Positive" laws: ... Educationalallowance addressed to students teachers... rules hygiene, ... lecturesfor... school with coursesfor workers. ... education, ecologyhuman, ...

UNIVERSITY EDUCATION HISTORY

Tutorial

... educationalbenefitsforstudents higher educational ... Educationalallowance addressed to students universities mastering social and pedagogical professions, as well as teachers... rules hygiene, ... lecturesfor... school with coursesfor workers. ... education, ecologyhuman, ...

List of monographs of textbooks and teaching aids issued by teachers over the past 5 years

List of tutorials

... Educationalallowanceforstudents II course... Tambov: Publishing house of TSU im. G.R.Derzhavin. educationalallowance... Professional and personal development teacher and student: practice-oriented ... General Library Science: welllectureseducationalallowance 6,0 100 2008 ...

theoretical lesson number 1

Theme:

Compiled by: Maklakov I.A.

Lesson topic:Subject of hygiene and human ecology. Basic principles of hygiene

Form of organization of a training session: lecture.

Lecture type: traditional.

Lecture type: introductory.

Duration: 90 min.

The purpose of the lesson: the formation of ideas about the sciences of hygiene, ecology and human ecology, knowledge about the laws and methods of researching hygiene, the main provisions of hygiene.

Tasks:

educational:

know the definition of the concepts of ecology, human ecology and hygiene; subject and content of ecology, human ecology and hygiene; tasks of ecology and hygiene, laws of hygiene; methods of hygienic research;

know the relationship between ecology, human ecology and hygiene and their place in the system of medical and biological sciences; the main historical stages in the development of ecology and hygiene

educational:

Demonstrate academic skills and abilities, and a responsible attitude towards learning

developing:

develop the skills of note-taking, self-control of their own activities; develop attention, memory, cognitive interest;

Teaching methods: verbal - presentation, conversation; visual - demonstration of illustrations; explanatory and illustrative, discussion.

Equipment (equipment) of the lesson: informational (methodical development of the lesson for the teacher), visual - illustration "Symbol of Hygiene".

Interdisciplinary connections:History, Ecology.

Intra-subject communications: T 2. The current state of the environment. Global ecological problems, P 1. Physiological research method.

Description of the course of the lesson (table 1).

List of basic and additional literature on the topic of the lecture:

1. Arkhangelsky, V.I. Hygiene and human ecology: textbook / V.I. Arkhangelsky, V.F. Kirillov. - M .: GEOTAR-Media, 2013 .-- 176 p.

2. Crimean, I.G. Hygiene and fundamentals of human ecology: textbook. manual for stud. average prof. education / I.G. Krymskaya, E. D. Ruban. - Rostov n / D .: Phoenix, 2013. - 351 p.

Table 1

Description of the course of the lesson

n \ n

Stages of the lesson

approximate time

Stage content.

Methodical instructions

Organizing time

Purpose: to organize students for activities to achieve their goals, to create a positive emotional attitude in them

3 min.

Checking those present, the availability of uniforms, the readiness of students for the lesson, the equipping of the workplace.

Target setting. Motivation for learning activities

Purpose: to activate the cognitive activity of students, to show the importance of the topic for the future profession of a specialist

10 min.

Communication of the topic, purpose and objectives of the lesson.

Formation of motivation (Appendix 1)

Updating the basic knowledge of students

Purpose: to identify the level of residual knowledge in ecology, to form communication skills

10 min.

Updating forms

1.Front poll

Questions:

What does ecology science study?

What is hygiene?

What do ecology and hygiene have in common?

Why does a healthcare professional need knowledge of ecology and hygiene?

Presentation of new material

Purpose: the formation of cognitive interest in the academic discipline, the formation of theoretical knowledge in accordance with the purpose and objectives of the lesson.

55 minutes

Presentation of the main content of the lecture (Appendix 2) in accordance with the plan.

Lecture plan:

2 Laws of hygiene and ecology.

3 A brief history of the emergence of hygiene, ecology and human ecology.

4 Methods of hygienic research, hygienic regulation.

5 Sanitation. Prevention, types of prevention.

Comprehension and systematization of the acquired knowledge. Summing up the results of the lesson

Purpose: consolidation of educational material, assessment of students' work in the lesson as a whole

7 minutes

The teacher carries out a selective survey, answers students' questions.

Questions:

- what is the place of hygiene in the system of medical sciences ?;

What is the object of study of hygiene;

List the laws and practices of hygiene;

What is the role of Pettenkofer in the development of hygiene?

What does ecology study?

Name the founder of ecology.

List the basic laws of ecology.

Homework

Target:organizing students to find additional information

5 minutes.

Issuance and clarification of homework.

Homework:

1. Lecture notes 1.

2. Textbook Krymskaya I.G. Hygiene and human ecology (pp. 4 - 28).

3.VSRS 1.Fill in the table "History of hygiene development".

Control on P1

Annex 1

Lesson motivation

A medical worker must be able to assess the state of human health and give qualified recommendations for its preservation and strengthening.

Today, the training of specialists with secondary specialized medical education is unthinkable without deep hygienic knowledge and the development of an ecological worldview. At the same time, the practical activity of a nurse, paramedic, midwife proves that there is a close connection between hygienic thinking, preventive and clinical medicine.

The objective of this course is to identify the relationship between environmental and hygienic factors and the state of health of the population.

Appendix 2

The content of the lecture on the topic:

Subject of hygiene and human ecology ... Basic principles of hygiene .

Plan:

1. Subject of hygiene and human ecology.

2. Laws of hygiene and ecology.

3. A brief history of the emergence of hygiene, ecology and human ecology.

4. Methods of hygienic research, hygienic regulation.

5. Prevention, types of prevention.

Subject of hygiene and human ecology. The laws of hygiene and ecology. A brief history of the emergence of hygiene, ecology and human ecology.

Hygiene – a science that studies the influence of environmental factors and production activities on the human body, its health, working capacity and life expectancy in order to substantiate and develop hygienic standards, sanitary rules and measures, the implementation of which ensures the strengthening of public health and the prevention of diseases.

Hygiene objectives:

Study of natural and anthropogenic (harmful) environmental factors and social conditions affecting the health of the population;

Study of the regularities of the influence of factors on the human body or population;

Development and scientific substantiation of hygienic standards, rules, recommendations, etc .;

Maximum use of environmental factors that have a positive effect on the human body;

Elimination of adversely acting factors or limiting their influence on the population to safe levels;

Implementation and application of developed hygienic standards, rules, recommendations, instructions in human economic activity;

Forecasting the sanitary and epidemiological situation for the short and long term.

The main direction of hygiene - preventive.

The name of the term is associated with the name of the Greek mythical goddess of health Hygieia, the daughter of the ancient Greek god of healingAsclepius , she is depicted symbolically on stands, medical books, etc. in the form of a beautiful girl who holds in her hands a bowl filled with water and entwined with a snake (a symbol of wisdom).

From ancient greekhygiene means– « healing, bringing health ". The founder of hygiene is a German scientistM. Pettenhofer , who 150 years ago (1865) substantiated quantitative methods for measuring environmental factors. Pay attention to personal hygiene.

The rudiments of hygiene go back to the prehistoric period, primitive people observed hygiene. skills in home improvement, cooking, burial of the dead, etc.

It reached the greatest development in Ancient Rome (600-500 years ago BC), where water pipes and public baths were built, in Ancient Greece, Rome, Egypt, China and India - the priority of healthy conditions and healthy lifestyle, physical.

When in Europe 6-14 centuries. all sciences fell into decay, incl. medicine. as a result of the domination of religion (purity of the soul, not the body), the Middle Ages - epidemics of plague, cholera, leprosy, typhus, etc., which carried away the population of entire cities. Paris is a "city of dirt". However, even at this time, doctors expressed valuable thoughts, so the scientist and doctor of the East of the 11th century. - Abu Ali Ibn Sina (Avicenna), in the world famous work "Canon of Medicine", summarized knowledge in the field of food hygiene, housing, raising children, personal hygiene. It was he who dressed honey. workers in white coats (a symbol of purity and cleanliness).

Hygiene began to develop intensively in the 17-18 centuries, in the era of capitalism, mass diseases of workers (better prevention). As an independent science from the 60-70s. 19th century in Western Europe and Russia.

The founders in Russia - M.V. Lomonosov, Pirogov, Botkin talked about prevention. The formation of hygienic science belongs to Dobroslavin (the 1st Russian textbook on hygiene, the magazine "Health") and Erisman, the department of hyena in Moscow, a sanitary station, his works on school hygiene, food and labor hygiene).

Hygiene study is - a healthy person in close interaction with the environment (in clinical disciplines - a sick person).

Hygiene laws.

Environmental factors can have a positive or negative effect on the body, which is due to certain laws:

The law of violation of the level of human health , can manifest itself as a disease or a decrease in compensation mechanisms (immune status). The pathological effect depends on the intensity of the harmful factor - based on this, hygienic standards were justified:

maximum permissible concentration (MPC) - the concentration of a chemical substance, which, under constant exposure, do not cause changes in the state of health of a person and his offspring;

maximum permissible level (MPL) - the level of a physical factor, (for example: the level of radiation, noise, electronic field), which does not affect a person, health and his offspring.

The minimum lethal dose (MLD) is the amount of a substance or factor that causes the death of a person.

The law of the negative impact of human activities on the environment , which manifests itself to a greater extent than the lower technical level of production and the level of development of society (for example: an industrial boom in China is accompanied by intense environmental pollution, accompanied by a massive occurrence of environmental diseases; a high level of industry in Switzerland has no visible effect on the natural environment). In connection with physiological, household and industrial activities, people have a negative impact on the environment.

The laws of the negative impact, the characteristics of the natural environment on the health of the population. Vernadsky's doctrine of chemical provinces (a territory with a deficiency or excess of any substances, which is accompanied by the development of endemic diseases) was derived from this law. So the Trans-Baikal Territory is one of the iodine-deficient territories, which contributes to the development of endemic goiter, Krasnokamensk is provided with drinking water. Which leads to the development of fluorosis (an endemic disease, accompanied by changes in the enamel of the teeth, i.e. brown striation).

The law of the positive impact on the human body of the natural environment ... Natural factors: sun, clean air, water, food, contribute to the preservation and strengthening of health.

The law of the negative impact of a polluted environment on human health , which leads to a decrease in the compensatory capabilities of the body, physiological abnormalities, asymptomatic forms of the disease, the development of the disease, pathology (bronchial asthma, anemia, malignant neoplasms.

Examples: an indicator of environmental distress in the places of residence of the population is reproductive health, the impact on the course of pregnancy and newborns (violation of the immune, hematopoietic and other systems); an adverse effect of pollution on the physical development of children was noted, which is due to greater sensitivity, increased permeability of the skin, mucous membranes of the gastrointestinal tract and respiratory tract, immaturity of the immune system; the growth of pollution with chemicals and radioactive substances affects the incidence of cancer.

Hygiene is closely related to sanitation.

Sanitation (from lat. "health") - practical implementation of hygienic norms and rules.

Recreational activities are carried out by the state. the sanitary and epidemiological service (SES), in accordance with the legislation of the Russian Federation. Federal Law "On the Protection of Citizens' Health" (1993), Federal Law "On the Sanitary and Epidemiological Well-Being of the Population" (1999), etc.

In Russia, SES is headed by the State. dignity committee - epid. supervision under the President of the Russian Federation. The Chairman is the Chief State. sanitary doctor of the Russian Federation. (formerly ROSPOTREBNADZOR).

Sanitary supervision is carried out in 2 main forms:

preventive sanitary supervision carried out during the design and construction of various objects, as well as the introduction of the production of industrial products.

current sanitary supervision - inspection of existing facilities, compliance with sanitary rules and regulations (SanPiN). This includes a systematic study of morbidity and injury.

Dr. in words, the sanitary service monitors the implementation in practice of recommendations, measures developed by hygiene and epidemiology.

In matters of studying the influence of environmental factors on human health, hygiene closely interacts with environmental science, or rather, human ecology.

Ecology - a comprehensive science that studies the relationship of living organisms with each other and with their environment, the influence of nature on humans.

Term"ecology" from greekOikos (house) and"Logos" (the science). Literally "the science of the house", the organisms living in it and all the processes that make this house fit for life. Information of an ecological nature (respect, protection of nature) is already contained in the works of Hippocrates, Aristotle and others. Robert Malthus spoke about the danger of overpopulation of the planet (1789). Founder Ernst Haeckel in 1866 published the book "General morphology of organisms", where he gave a definition of ecology (the science of the relationship of organisms with the environment). Vernadsky made a great contribution, his book "Biosphere" (1926), where for the first time the planetary role of the totality of all types of living organisms was shown.

Objects of study: populations, communities, ecosystems, biosphere.

Population it is a set of individuals of one species living for a long time in a certain territory, freely interbreeding, giving fertile offspring and relatively isolated from other populations of individuals of the same species.

Community Is a set of interacting populations occupying

a certain territory, a living component of the ecosystem.

Ecosystem joint functioning of organisms and the environment in a given area (forest, lake, swamp). Ecosystems are not isolated from each other. Many species of plants and animals can be found in several ecosystems, and some species, such as migratory birds, migrate between ecosystems, depending on the time of year. The ecosystem is made up of 4 components:

Inanimate (abiotic) environment - water, gas, inanimate inorganic and organic substances.

Producers (producers) autotrophic organisms that produce organic matter from simple inorganic substances with the participation of solar energy with the release of oxygen - green plants.

Consumers (consumers) consume ready-made organic substances, but they do not bring the decomposition of organic substances to simple mineral components. Consumers of the first order (herbivorous) and the second, third, etc. are distinguished. orders (predators).

Reducers (decomposers) organisms that mineralize dead organic matter to simple inorganic compounds suitable for producers.

People, together with their cultivated domestic animals, form a grouping of organisms that interact with each other and with the environment. This is also an ecosystem. All ecosystems of the Earth, including the human, are interconnected and form, in their totality, a single whole-biosphere.

These two sciences study the same phenomena, namely, the influence of environmental factors on a person, etc. assess the role of various factors in shaping the health of the population.

The level of human health depends on the influence of environmental factors, which are divided into 3 main groups:

1) natural factors - include atmospheric air, solar radiation, natural background radiation, vegetation, microflora, water and soil. The body has developed adaptation mechanisms to these factors.

2) social factors - factors related to the way of life, moral and social foundations, peculiarities of life, incoming information.

3) anthropogenic factors - arise as a result of human activity (anthropos - Greek man). They represent physical, chemical and biological factors arising from industrial activities, agricultural transport, etc. A person has no adaptation mechanism to these factors.

Human interaction with the environment considers a separate direction - human ecology. The term appeared in 1972 at the 1st UN meeting on env. environment.

The subject of ecology is the environment.

The basic laws of ecology were formulated by the American ecologist B. Commoner (1974):

1 law "Everything is connected with everything" (ecological chains)

2 law “Everything must go somewhere” (conservation of matter);

3 the law "Nature knows best" (the natural version of phenomena is the best);

Law 4 “Nothing is given for free” or “You have to pay for everything” (what is taken away or spoiled must be returned or corrected).

So, hygiene and ecology have common goals of study: the influence of environmental factors. environment on human health. Hygienists develop preventive measures, ecologists - environmental legislation, form an ecologist. worldview.

II ... Hygienic Research Methods (MGI)

Hygiene methods are divided into 2 large groups:

methods evaluating environmental factors.

methods that assess the body's response to these factors.

They all include:

Sanitary inspection method - a description of the object in which its hygienic characteristics are given (epidemiological sanitary state, etc.).

Laboratory method:

a)physical research method , allows you to assess the microclimate of the room (changes in temperature, humidity, noise, vibration).

b)sanitary-chemical method which is used for - analysis of chemical composition, air, water, food, etc.

v)bacteriological methods, which are used in the assessment of bacterial contamination of air, water, soil, food (E. coli, salmonella);

G)toxicological method, used in experiments to identify the effect of substances on animal organisms, to establish the MPC.

Clinical observation method carried out during professional examinations, dispensary observation, etc.

Physical observation method .

Sanitary statistical method (mortality, fertility, morbidity, level of physical development).

All studies are carried out on the basis of GOST, TU, SanPiN (sanitary rules and norms), etc. NMD.

All methods are combined into a concept -hygienic diagnostics , its purpose is to identify violations of human adaptive mechanisms and assess the state of his adaptive systems.

III ... Prophylaxis

The goal of hygiene is the development and implementation of primary medical prevention.Prophylaxis - is a complex of measures (political, economic, legal, medical, environmental., Etc.) to preserve and strengthen the health of the population, its longevity. elimination of the causes of diseases, improvement of working conditions, life and recreation of the population.

There are three levels of prevention:

active offensive prevention (providing a favorable environment, healthy lifestyle);

prenosological, incl. assessment of risks to human health (real and potential);

defensive or passive (prevention of disease progression, disability)

Distinguish between personal and public.

There are several types of prevention:

Primary assumes the prevention of the occurrence of diseases (either the complete elimination of the harmful factor, or the reduction of its effect to a safe level).

Secondary provides for early diagnosis of diseases in persons exposed to harmful environmental factors. Wednesday.

Tertiary is aimed at preventing deterioration in health. A set of measures (treatment and rehabilitation) has been developed to prevent complications that may arise in the course of an already developed disease.

Greek mythical goddess of health Hygieia

CHAPTER 3 THE ENVIRONMENT AND ITS HYGIENIC IMPORTANCE. HYGIENE AND HUMAN ECOLOGY

CHAPTER 3 THE ENVIRONMENT AND ITS HYGIENIC IMPORTANCE. HYGIENE AND HUMAN ECOLOGY

3.1. HYGIENIC CHARACTERISTICS OF ENVIRONMENTAL FACTORS. HYGIENE AND HUMAN ECOLOGY

To use a preventive method to achieve the goal of hygiene, it is necessary to know the causes of diseases and premature wear of the body. Since most of these reasons are the result of the interaction of the body with environmental factors, then, as mentioned earlier, the subject of hygiene research is the regularities of the influence of the environment on human health, and the object of research is “human-environment”.

Environment(OS) is a very capacious concept. In recent years, it has received a slightly different sound, since it replaced the concept "external environment", which has long been used in all the classical works of our predecessors as an antipode to the inner environment of a person. In this regard, the modern terminology should be clarified.

From a hygienic point of view, the environment is a combination of natural and social elements with which a person is inextricably linked and which influence him throughout his life (see Fig. 1.2), being an external condition or environment of his existence.

Natural elements include air, water, food, soil, radiation, flora and fauna. The social elements of the human environment are labor, everyday life, the socio-economic structure of society. Social factors largely determine Lifestyle a person (for more details see Ch. 13).

The concept of the environment (natural and artificial) includes the concept of the external and industrial environment.

Internal environment, as noted by I.P. Pavlov, is an internal content that provides nervous and humoral mechanisms of regulation. The internal environment of the body is a collection of fluids (blood, lymph, tissue fluid) that wash cells, pericellular structures of tissues that take part in the implementation of metabolism.

Under external environment one should understand the part of the environment that is in direct contact with the epithelium of the skin and mucous membranes, and also affects all types of human receptors that perceive the world around them individually, due to their characteristics. The state of the external environment is purely individual for each person.

Concept the environment is broader. It is not individual, but common for the whole population, population. In the process of long evolution, a person has adapted to a certain quality of the natural environment, and any changes in it are not indifferent for his health, up to the appearance of a disease.

In the environment, concepts such as habitat and work environment are distinguished.

Habitat- a complex of interrelated abiotic and biotic factors that are outside the body and determine its vital activity (Litvin V.Yu.).

Work environment- a part of the environment formed by natural and climatic conditions and professional (physical, chemical, biological and social) factors that affect a person in the process of his labor activity. Such an environment is a workshop, workshop, auditorium, etc.

Unchanged natural (natural) environment- a part of the natural environment unchanged as a result of direct or indirect human influence, society, characterized by the properties of self-regulation without corrective human influence. Such an environment ensures the normal functioning of the human body.

Altered (polluted) natural environment- the environment changed as a result of unreasonable use of it by a person in the process of activity and negatively affecting his health, efficiency, living conditions. In relation to the named environment, there are concepts identical in meaning: anthropogenic, anthropic, technogenic, denatured environment.

Artificial OS- directly or indirectly, intentionally or unintentionally, an environment created by man for the temporary support of his life and activity in artificially created enclosed spaces (spaceships, orbital stations, submarines, etc.).

The division of the elements of the environment into natural and social is relative, since the former act on a person in certain social conditions. At the same time, they can change quite strongly under the influence of human activities.

OS elements have certain properties, which determine the specifics of their influence on a person or the need for them to ensure the life of people. In hygiene, the named properties of natural and social elements are usually called environmental factors, and then hygiene itself can be defined as the science of environmental factors and their influence on the human body, thus emphasizing the subject and object of its research.

Natural elements are characterized by their physical properties, chemical composition, or biological agents. So, air - temperature, humidity, movement speed, barometric pressure, oxygen content, carbon dioxide, pollutants harmful to health, etc. Water and food are characterized by physical properties, chemical composition, microbial and other contaminants. The soil is characterized by temperature, moisture, structure and chemical composition, bacterial contamination, and radiation - by the spectral composition and intensity of radiation. The fauna and flora are distinguished by their biological properties.

A group of social elements also has certain properties that are studied and evaluated quantitatively or qualitatively. These properties are shown in Fig. 1.2. They all form the so-called social environment - a part of the environment that determines the social, material and spiritual conditions for the formation, existence and activity of society. The concept of the social environment unites the totality of the components of the social infrastructure of society: housing, everyday life, family, science, production, education, culture, etc. The social environment plays a leading role in the process of decreasing the level of health of the population due to the impact on humans through abiotic and biotic factors, denatured as a result of human activity and society as a whole.

When studying the influence of the natural environment on humans, concepts such as the biosphere and its constituent elements are often used: atmosphere, hydrosphere, lithosphere.

Biosphere(column bios- life, sphaira- sphere, shell) - the lower part of the atmosphere, the entire hydrosphere and the upper part of the lithosphere of the Earth, inhabited by living organisms, "the area of ​​living matter" (Vernadsky V.I.). He also created the doctrine of the biosphere (1926), although the term was proposed by the Austrian scientist E. Suess back in 1875. Improving the doctrine of the biosphere, V.I. Vernadsky substantiated and developed it even more. Currently, the most active layer of living matter is isolated in the biosphere - biostrome, or "the film of life," as the scientist called it. In 1935, Academician V.I. Vernadsky, in connection with the rapid development of scientific and technological progress, proposed a fundamentally new term "Noosphere" to indicate the emerging new geological shell of the Earth. The noosphere is understood as that global shell of the planet (the stratosphere, the surrounding space, the deep layers of the hydrosphere and lithosphere), where the activity or the result of human activity spreads in the century of scientific and technological progress.

In addition to such concepts as environment, biosphere, there is the concept of ecology.

Ecology(column oikos- house, dwelling, environment, logia- science) - the biological science of the relationship between plant and animal organisms and the communities they form between themselves and the environment. Modern ecology, or social ecology, intensively studies the patterns of the relationship of human society with the environment and the problems of its protection. In recent years, both in our country and abroad, the so-called human ecology. And so actively that it is trying to squeeze other disciplines. This is primarily due to the too loose use of terminology and the lack of a sufficient number of competent specialists in this area.

Hygiene and human ecology

Despite the above, in recent years, hygiene has been closely interacting with human ecology. Ecology is independent biological first of all, science, therefore both sciences differ in their methodology, object and subject of research, regulatory framework, etc., which is clearly seen from Table. 3.1 (Mazaev V.T., Korolev A.A., Shlepnina T.G., 2006).

Table 3.1. Hygiene and ecology (scientific analysis)

In this regard, the main tasks of the applied sections of hygiene (sanitation) and ecology (nature protection) differ in their ultimate goal. If hygiene through sanitation seeks through organizational, legislative, technical and other means to weaken anthropogenic pressure on the human environment and his health, then ecology directs its interests to protect the natural environment as a whole.

The need to act in close cooperation is dictated by the fact that it is impossible to solve environmental problems using only normative legal instruments of the environmental order without ensuring the sanitary and epidemiological well-being of the population. And vice versa, it is impossible to ensure the specified well-being in an unfavorable environmental situation, since the harmful influence of factors through the natural elements of the environment (soil, water, etc.) due to its disintegration is not excluded. It is important to have a clear interaction of all specialists related to the protection of human health.

Moreover, this coincides with the main provisions of the World Conservation Strategy, developed by international organizations. In particular, this document formulates the principles around which the efforts of both the world community and an individual state should be concentrated:

2. Prevent the depletion of non-renewable resources.

3. Develop within the potential capacity of ecological systems.

4. Change the consciousness of man and the stereotypes of his behavior in relation to nature.

5. Encourage the social interest of society in preserving its environment.

6. Develop national concepts for the integration of socio-economic development and environmental protection.

7. Promote global unity of action. There is no doubt that humanity must definitely solve the assigned tasks. Otherwise, consequences await him, which will jeopardize the very existence of Man on planet Earth.

3.2. HYGIENIC NORMALIZATION OF FACTORS

ENVIRONMENT

The "Fundamentals of Legislation of the Russian Federation" (1993) indicates that the protection of the health of citizens is achieved through the implementation of political, economic, social, medical, sanitary and hygienic and other measures. Substantive part of sanitary and hygiene

measures is primarily hygienic regulation those factors that influence, form, support and, unfortunately, often worsen and shorten a person's life, negatively affecting his health. The leading role of hygiene in the implementation of sanitary and hygienic measures lies in the fact that only hygiene, unlike other sciences that also study the "person - environment" system, normalizes the state of human health, taking into account the influence of all elements of the environment: natural, social and production(the latter are part of the social).

Section 2.3 touched on the strategic aspects of the problem of rationing, based on the theory of hygienic rationing with its universal principles. But this does not mean that before that, rationing as a way of balancing human health with environmental factors in the process of his life was absent. Humanity has long understood the need to regulate certain factors in the "man - environment" system, which is explained in the wonderful words of the French writer J. Saperviel: "It is very difficult to graze in nature and not commit sacrilege." A person, as a rule, leaves deep "notches" on the body of Nature, which subsequently poison his own life both in the literal and figurative sense. Hygienic regulation is a powerful factor in preventing such situations.

Considering the problem of standardization in hygiene, several historical stages of its research can be distinguished: empirical, scientific and experimental, and modern. However, talking about the appearance of more or less slender rationing concepts possible since the 1920s, when it was developed in occupational health. On the basis of this concept, presumably, the theory of hygienic regulation appeared later (see Section 2.3).

First, in the USSR, and then in other countries, the concept of "maximum permissible concentration" (MPC) for the content of harmful substances in the air of the working area was introduced into sanitary legislation. Somewhat later, in the 30-50s, the foundations of the methodology for the hygienic regulation of chemicals in the water of reservoirs, the atmospheric air of populated areas, soil, and food were laid. The methodology of hygienic regulation is based on environmental quality there was a fundamental provision on the compliance of MPCs with levels harmless to the human body, which do not have either a direct or indirect effect on the health of the present and future generations.

Currently, in Russia, the federal executive body authorized to carry out state sanitary and epidemiological regulation, is the Federal Service for Supervision of Consumer Rights Protection and Human Welfare (Rospotrebnadzor). The specified rationing is carried out in accordance with the regulations approved by the Government of the Russian Federation. State sanitary and epidemiological regulation is implemented through the bodies and institutions of Rospotrebnadzor in accordance with the tasks assigned to them on the basis of regulatory legal acts, which are state sanitary and epidemiological rules. These include:

Sanitary Rules (SP);

Sanitary Standards (СН);

Hygienic Standards (GN);

Sanitary rules and norms (SanPiN).

In addition, the bodies and institutions of Rospotrebnadzor in their activities widely use methodological documents:

Manuals (P);

Methodical instructions (MU);

Methodological guidelines for control methods (MUK). The important thing is that regulatory legal

acts concerning the issues of ensuring the sanitary and epidemiological well-being of the population, adopted by federal executive bodies, executive bodies of the constituent entities of the Russian Federation, local self-government bodies, decisions of legal entities on these issues, state standards, building codes and regulations, labor protection rules, veterinary and phytosanitary regulations, should not contradict sanitary rules.

In accordance with the Federal Law "On the Sanitary and Epidemiological Welfare of the Population", compliance with sanitary rules is mandatory for citizens, individual entrepreneurs and legal entities. The presence of bodies and institutions with such broad legal powers, vested with the right to establish sanitary rules and monitor their implementation, is a powerful tool for ensuring the sanitary and epidemiological well-being of the population.

Using the provided opportunities, the modern sanitary service develops hygiene standards- install-

admissible, maximum or minimum quantitative and / or qualitative values ​​of an indicator characterizing a particular factor of the environment from the standpoint of its safety and / or harmlessness to humans, legally binding on all departments, bodies and organizations.

Based on the methodological principles of hygiene, the development of hygienic standards is also carried out taking into account private principles of hygienic regulation, which are systematized and presented in the fundamental work of A.M. Bolshakova, V.G. Maimulova et al. (2006). These include:

1. The principle of harmlessness of the hygienic standard (primacy of medical indications). When justifying the standard of the OS factor, the peculiarities of its action on the human body and on the sanitary conditions of life are taken into account.

2. The principle of getting ahead. It consists in the need to substantiate and implement preventive measures before the formation and / or impact of certain harmful factors.

3. The principle of unity molecular, structural and functional changes as a basis for differentiation harmful and harmless impacts. At the same time, several types of hazard criteria are distinguished.

General biological criteria for harmfulness- reduction in average life expectancy, impaired physical development, changes in the activity of the central nervous system (CNS), impaired ability to adapt to the environment.

Criteria for characterizing psychosocial disorders- violation of mental functions, depression of the emotional environment, violation of interpersonal relationships, etc.

Reproductive dysfunction- change in genetic material, impact on sperm, fertility and infertility, developmental delay, deformity and other malformations, etc.

Carcinogenic effect- the effect of carcinogenic substances on the body, leading to the occurrence of cancer.

Physiological criteria- indicators of the functional activity of all body systems.

Biochemical criteria- biochemical constants, the state of nucleic acids, etc.

Immunological criteria- nonspecific indicators of immunological reactivity.

Metabolic criteria: the rate of metabolism and excretion of a substance from the body; accumulation of matter in critical organs due to the magnitude of the dose; reaction of enzyme systems, etc.

Morphological criteria- destructive and dystrophic changes in cell structures; shifts in cell enzymatic systems, etc.

Statistical criteria: the coefficient of variation; Student's test and other statistical methods of proving the reliability of the hypothesis.

4. Threshold principle of action. It assumes the existence of doses (concentrations) that do not exhibit toxic or other adverse effects on the body. The existence of this principle conflicts with the concept of thresholdlessness, which is used in radiation hygiene and in setting acceptable levels of carcinogens. Today the concept has been replaced by the concept of acceptable risk, which has already been mentioned.

5. Dependence of effect on concentration (dose) and exposure time.

6. The principle of biological modeling. The basic model for the study of toxic and long-term effects are laboratory animals (mammals) with the maximum reproduction of the intake (influence) of the agent under study on the human body, taking into account the differences in the sensitivity of humans and animals, etc. In short, the model must be adequate to obtain reliable results.

When extrapolating data from animal experiments to humans, the so-called safety factors. They are regulated depending on the objects of the environment (water, soil, atmospheric air, air of the working area, food).

7. The principle of separation of objects of sanitary protection. When standardizing chemical compounds for environmental objects, various types of adverse effects on the environment and the human body are taken into account. At the same time, species are distinguished adverse action: general toxic, teratogenic, irritant, change in the transparency of the atmosphere, etc.

In turn, indicators of harmfulness include effects: resorptive, sanitary-toxicological, reflex, organoleptic, general sanitary, migratory water (air), etc.

8. The principle of the limiting hazard indicator (the principle of taking into account the "weak link", "bottleneck").

9. The principle of standardization of conditions and methods of hygienic regulation. It is regulated by guidelines, standards, recommendations, etc., which prescribe the conditions for conducting research, the methods used, the principles of assessment, etc.

10. The principle of staging in research The stages and rules for the formation of conclusions (decisions at each stage) depend on the environmental object.

11. The principle of unity of experimental and field research(hygienic, medical, epidemiological, etc.).

12. The principle of relativity of the standard. It fully complies with the universal principle of hygienic regulation - dynamism. For example, with the advent of more sensitive assessment methods, the MPC in the soil was revised by DDT (from 1 to 0.1 mg / kg), cineb (from 1.8 to 0.2 mg / kg), etc. (Goncharuk E.I. and et al., 1999). Since the discovery of ionizing radiation, the permissible levels (doses) for personnel and the public have been revised several times, also in the direction of tightening.

These principles underlie methodological approaches to substantiating hygienic standards for various elements or factors environment.

Features of hygienic regulation of chemicals

As already mentioned, methodological approaches to the regulation of potentially harmful factors are determined by the characteristics of the environmental object for which a hygienic standard is established.

For example, for atmospheric air hygienic regulation chemicals is based on 3 hazard criteria formulated by V.A. Ryazanov:

1. Permissible is recognized only that concentration of a substance in the atmospheric air, which does not have a direct or indirect harmful or indirect effect on a person, does not affect the state of health and the state of working capacity.

2. Addiction to ambient air pollutants should be considered an adverse effect.

3. Concentrations of chemicals in the ambient air that adversely affect vegetation, local climate (microclimate), transparency of the atmosphere and living conditions of the population should be considered unacceptable.

The main hygienic standard for atmospheric air is MPC for atmospheric pollution- this is a concentration that does not have a direct or indirect adverse effect on the present and future generations throughout life, does not reduce a person's working capacity, does not worsen his well-being and sanitary living conditions.

In the atmospheric air, 2 MPCs are set: maximum one-time and average daily. Their development is carried out in the algorithm described in the relevant methodological documents. In this case, it is taken into account that the average daily MPC is set taking into account the hazard class of the substance (determined by certain toxicometric parameters). There are 4 classes in total: 1st class - extremely dangerous; 2nd class - highly hazardous; 3rd class - moderately dangerous; 4th class - low-hazard.

Of course, the standards for harmful chemicals in the ambient air and in the air working area will differ, most often upward in the latter case. This is understandable, since standards for atmospheric air are established taking into account the fact that the substance in it will act on children, old people, sick people, whose body resistance is incomparable with that of a healthy person. In addition, in the first case, the MPC affects a person during the day, while it affects the worker only during the work shift.

Somewhat different patterns underlie the justification MPC in soil (MPC-soil).

The maximum concentration limit of an exogenous chemical in the soil is its maximum amount (in mg / kg of arable layer of absolutely dry soil), established in extreme soil and climatic conditions, which guarantees the absence of negative direct or sanitary living conditions of the population.

Consequently, such a content of an exogenous chemical substance is allowed in the soil, which guarantees the absence of a negative impact on the health of the population both during direct human contact with the soil, and indirectly during the migration of a toxic substance along one or several ecological chains (soil - plant - human; soil - plant - animal - man; soil - atmospheric air - man; soil - water - man

and others) or in total along all circuits, and also does not disrupt the processes of self-cleaning of the soil and does not affect the sanitary conditions of life.

To assess the degree of soil pollution in a particular situation, indicators are calculated that reflect real regional soil and climatic features. These indicators, which are calculated on the basis of the approved MPCs of chemicals in the soil, are Maximum Allowable Application Levels (MPEL) exogenous chemicals in the soil and their safe residual quantities (BOC).

There are peculiarities of hygienic regulation of chemicals in the aquatic environment and food products. They are discussed in their respective chapters. From the above examples, it is quite clearly seen that the final result of the study - MPC - is substantiated experimentally. The difference is that for the assessment of each element of the environment to determine the allowable amount of a chemical, the content of the experiment is significantly different.

Features of hygienic regulation of physical factors

Recall that physical factors include a fairly large list of agents that differ in the nature of origin (natural and artificial), the peculiarities of the effect on living things, the prevalence in nature, and many other properties.

In its most general form, physical factors include solar radiation with its unique electromagnetic spectrum; physical factors of the air environment: temperature, humidity, air velocity, etc .; mechanical factors: noise, sound, ultrasound, infrasound, vibration; electric, magnetic field of the Earth, etc. Even the factors listed here for the most part can be of natural or artificial origin.

First about common regularities taken into account in the regulation of physical factors that bring them closer to chemical ones with respect to different elements of the environment. In the first approximation, the general can be seen in the following directions: 1. Both chemical and physical factors in their "natural form" and ratios are absolutely vital, without which life on Earth would become impossible. This can be expressed

thus: disappear from the chemical composition of atmospheric air oxygen or stop penetrating the earth's surface solar radiation, practically everything on the planet would cease to exist, including man.

2. Even vital factors of physical and chemical nature, if they deviate from the natural norm, can harm human health or the environment. The oxygen necessary for a person's life can cause severe poisoning if the patient, to whom it is prescribed for health reasons, is given too much dose in its "pure form". Just like the ultraviolet radiation of the Sun, which is absolutely useful for humans, at "normal" doses brings both physical and moral satisfaction ("healthy tan"), while in excess it causes burns of the skin, eyes, intoxication, etc.

3. Common to the analyzed factors in most cases is the fact that hygiene standards are substantiated separately for the population and for the "working environment", ie. professional workers. In addition, it must be borne in mind that both among chemical and among physical factors there are those that have thresholdlessness harmful action. Among the former, these are carcinogens, among the latter, ionizing radiation (IR).

4. Most of the standards in their various forms (MPC, remote control, remote control, etc.) are established experimentally, those. are, to a certain extent, probabilistic. But this, as mentioned earlier, fully corresponds to the theory of hygienic regulation and is applied in accordance with the principles on which it is based. Apparently, there are other common points when assessing

the influence of chemical and physical factors on human health and OS, but let's turn to the differences. They, like "similarity", are, to a certain extent, relative.

1. Being within natural boundaries, both chemical and physical factors do not harm human health. However, going beyond these limits, physical factors cause irreparably greater damage to the population of the region, country, etc. For example, deviations from the norm occurring in a certain season in some regions wind speed in the form of a hurricane cause serious negative consequences for both nature and people. Moreover, people, having got used to and attached to a certain area,

region, are forced to endure such undesirable influences, trying to adapt to them.

2. The next difference is that if a natural physical factor has assumed an anomalous characteristic (for example, a sudden increase or decrease in temperature, unusual for this season or region; significant precipitation in terms of the amount or duration of precipitation, etc.), then they suffer from this. hundreds of thousands and even millions of people. For abnormal “chemical disasters”, regional attachment is more typical: either a certain source (plant, combine, highway, etc.) poisons the environment - in this case, there is a chronic process of disintegration of the environment of a certain scale, or in the event of emergency or other emergency situations, a focus is formed acute disaster. But anyway it is natural physical anomalies that are characterized by scale, while natural chemical anomalies of this magnitude are unknown to us. For clarity, let us recall one terrifying example: the Indian Ocean earthquake in December 2004. As a result of the subsequent tsunami, which struck the coastal regions of Indonesia, Sri Lanka, southern India, Thailand and other countries, more than 300 thousand people died. The economic, environmental and other consequences were also huge.

3. Another and, perhaps, the most important difference is that the harmful chemical agent itself causes certain damage to human health and the OS. For physical factors, this is most likely an exception. As a rule, several elements of the OS are involved in the orbit of an anomalous physical phenomenon. The same hurricane wind removes and carries away the top layer of the soil, exposing some parts of the earth's surface and sweeping away others with dust and snow. Water is very often involved in such an element on one scale or another.

4. This difference can be conditionally called "the insidiousness of physics." Among the unfavorable physical factors, there are a lot of those, the harmful effect of which does not have pathognomonic signs, especially at the level of low doses. And some of them, for example, AI, even acting on a person in lethal doses, do not show their presence in any way. Of course, even among chemical factors one can observe the "invisibility effect", but at high concentrations, detection will occur sooner or later. but

in the case of supramaximal doses of AI, a person simply does not live up to the moment of identifying the cause. 5. The concept of risk (some call it the concept of "acceptable risk") began to develop in the process of regulation of physical factors. As a matter of fact, it arose in the field of radiology, radiation hygiene, radiobiology and other related sciences, since there were too many difficulties in the way of extrapolating experimental data obtained in experiments on animals in relation to humans. In this regard, it was necessary to develop completely original approaches for calculating the risk to human health when substantiating the hygienic standards of AI.

But it should be emphasized that in the field of regulation of chemical factors, great success was subsequently achieved. That is why, speaking about the peculiarities of the hygienic regulation of individual factors, we will focus on physical and chemical ones. And as will be shown below, even in these "advanced" areas compared to other areas, it is still far from the desired result.

Particular approaches to the hygienic regulation of physical factors (biological, mechanical, etc.) are described in more detail in the corresponding chapters of the textbook.

It would be wrong not to touch upon a problem that is extremely acute not only for hygiene, but also for medicine in general. If we turn to the already cited WHO definition of health, then in the triad of "physical", "spiritual" and "social well-being" today there is more or less clarity regarding its first element. As for the other two components of the triad, there are great difficulties in finding acceptable approaches in order to somehow streamline the range of fluctuations from norm to disease, i.e. eventually learn to normalize these states.

If we recall the existence of three stages in the history of the formation of hygiene (empirical, scientific-experimental, modern), then we can say with a certain degree of convention that the sciences that should answer the question posed: “What is mental and social well-being and how to measure them? "are still only at the initial stage. Therefore, it is worth noting that hygiene, which has made a truly giant leap forward in the regulation of physical, chemical, biological and other environmental factors, is not by chance a science. evidential.

3.3. MODERN THEORY FOR ESTABLISHING CAUSE-EFFECTIVE RELATIONS BETWEEN ENVIRONMENTAL FACTORS AND HUMAN HEALTH

Assessment of the state of human health in connection with the state of the environment has now become extremely urgent. Determination of the role of "pollution" of the environment and the emergence of non-infectious morbidity in connection with this give an idea of ​​the scale of the problem, the determination of priority programs and directions for the prevention of registered pathology, the establishment of cause-and-effect relationships between the state of the OS and the health of certain groups of the population, and the assessment of the negative effect of exposure one or another risk factor.

But before considering the actual problem of risk, you should define some terms. The concept of "pollution" means the presence in an element of the environment of an undesirable (polluting) substance in quantities exceeding the maximum permissible concentration, which can have an adverse effect on human health and living conditions. Moreover, under pollutant any agent of a physical nature (natural, artificial), chemical substance or biological species found in the OS or appearing in it in quantities exceeding the usual (permissible) content is understood.

Some researchers believe that the establishment of causal relationships between the state of the OS and human health is involved in the so-called ecological epidemiology. This is another, most likely contrived term, exactly the same as the previously mentioned controversial terms. Without going into details, we note that one should still focus on the existing theories of establishing causal relationships between the state of the OS and its effect on human health.

It was already mentioned above about the existence of the so-called the concept of threshold. Let us recall that it is based on one of the principles of hygienic regulation of the same name (the “threshold principle”).

The concept of threshold has played an outstanding role in the formation and development of rationing in general and hygienic in particular. But with the development of science, it turned out that it comes into conflict with some laws that cannot be characterized exclusively within the framework of its provisions. In particular, most

Your scientists and specialists are of the opinion that ionizing radiation, many chemical carcinogens do not have a "threshold of harmfulness". For example, the effect of one gamma quantum on a cell of the body is enough for undesirable (harmful) consequences to arise in it, which can ultimately lead to irreparable effects in the form of malignant tumors, etc.

Therefore, in the depths of the same radiation hygiene, a new concept appeared, which was already mentioned, - the concept of risk. In the 90s of the last century, our country was actively involved in its development. At present, this concept is one of the indispensable conditions for justifying the necessary organizational, economic, material and technical, sanitary and other measures to preserve the health and sanitary and epidemiological well-being of the population.

One of the fundamental concepts in the concept of risk is the provision on risk factor.

Risk factor is a factor of any nature (hereditary, ecological, industrial, lifestyle factor, etc.), which, under certain conditions, can provoke or increase the risk of developing health disorders.

The risk is subdivided into voluntary (driving a car); forced (synthetic substances); famous (household detergents); exotic (microorganisms created by genetic engineering); chronic; catastrophic (accident); with visible benefits (hair dyes); no apparent benefit (gaseous emissions from incinerators); self-controlled (driving a car); controlled by others (environmental pollution); justified (minimal in this situation); unjustified (maximum or perceived without evaluating the alternative in a particular situation).

Risk of harmful effects on health- This is the likelihood of developing undesirable effects in the population at certain levels and duration of exposure to an environmental factor. As the exposure increases, the risk increases. Risk factors can be associated with a person's lifestyle, exposure to environmental factors, genetic characteristics, biological factors (body status, gender, age, chronic diseases, etc.).

The procedure for identifying a causal relationship is based on the basic postulates formulated by the English biostatus.

by A. Hill. The most important criteria for the presence of causation and connection are temporal, biological and geographical plausibility (Revich B.A., Avaliani S.L., Tikhonova G.I., 2004).

Temporary likelihood indicates that the exposure preceded the disease (with mandatory latency period).

Biological plausibility consists in the fact that information about the toxicological characteristics of a substance is basic for understanding the nature of its effect on human health.

Geographic plausibility indicates the relationship between the localization of cases of illness or death with the location of the source of pollution (the distance from the source of pollution, exposure paths, wind rose, topography of the area and groundwater, food sources, migration processes and population mobility, etc.) are taken into account.

strength of statistical connection between the studied factor and the observed changes in health status. This relationship must be strong enough to differentiate the influence of the factors under study with other possible influences; exposure should be associated with a relatively high risk of disease development, and the relationship between cause and effect should be pronounced and statistically significant. Otherwise, it is impossible to differentiate the influence of the investigated factor and other possible etiological and modifying factors;

relationship specificity(certain factors - certain effects), i.e. does the given cause lead to a specific effect. Ideally, one cause should produce one effect. However, some factors, such as tobacco smoking, can lead to a number of diseases: chronic bronchitis, lung cancer, bladder cancer, and also act as risk factors for the development of many other diseases (for example, the cardiovascular system);

reliability. The conclusions obtained are based on the correct formulation of the study, take into account interfering factors and have sufficient reliability;

exposure-effect relationship(the risk of developing the studied effect should increase with increasing exposure);

persistence of communication(the investigated relationship should be observed in other well-designed studies);

Reversibility (effectiveness of intervention measures) - elimination or reduction of the level of influence of the investigated factor should lead to a decrease in the risk of developing the observed effect;

analogy(correspondence of the obtained data to the information about the influence of other factors, which are close in the mechanism of action) - parallels with other well-studied cause-and-effect relationships. The considered association is consistent with other scientific data and results obtained in the experiment.

The concept of risk applies primarily to population level. As an assessment of the health status of a population, demographic indicators are used: fertility, mortality, natural population growth, etc. and persistent disability, etc. For reliability, not absolute, but relative indicators of health are used, which make it possible to trace its changes in time and space.

Disease prevalence rate. It characterizes the state of health of the population at a particular moment in time and in a certain territory. It shows what proportion of the population is sick with one or another disease at the time of the study:

The base 10 n can be 100, 1000, 10,000 or 100,000 and is taken depending on the incidence of the disease. For malignant neoplasms (MN), it is always taken equal to 100,000.

In addition to the prevalence, what matters is speed the occurrence of new cases of the disease being studied at the moment. For this, the incidence rate is used. It characterizes the intensity of changes in the state of health, i.e. the rate of transition of members of the population from the state of "healthy" to the state of "sick", and is determined by the formula:

When analyzing the state of health of the population, general and special indicators (coefficients) of morbidity and natural movement of the population (fertility, mortality, natural growth) are also used.

Common odds give an integral assessment of the process. They are strongly influenced by other factors etiologically related to the disease under study (for example, the composition of the population by age, sex). It is no coincidence that they are called rough, and in order to obtain comparable and reliable data, they additionally carry out standardization compared coefficients according to a single standard to exclude the influence of age-sex and other differences in the compared groups.

There are 3 types of standardization: direct, indirect and reverse. The choice of one method or another is determined by the nature of the data that are available. The most accurate is the indirect method, and the least accurate is the reverse. The reverse applies only in cases where there is no data on the age structure of the compared groups and the age composition of patients or deceased.

Special (partial) coefficients reflect the frequency of events for certain categories, for example, in certain sex-age groups.

All of the above indicators can be obtained from the materials from the statistical reporting.

Using the above and other indicators, the main indicator is determined - risk or absolute risk (P), which measures the likelihood of an adverse event (illness, mortality, etc.) in one person over a certain period of time (more often - 1 year):

In this case, the determination of the risk of certain diseases is carried out by comparing indicators in population groups exposed and not exposed to the studied impact. To quantitatively characterize the impact of potentially dangerous exposures, an absolute or relative comparison of health indicators in the groups of exposed and unexposed persons is used. The absolute comparison is determined based on the difference in risks (RR), while for the relative, the relative risk (RR) is used.

Risk Difference (RR) also called attributive risk. This is the difference in the risk value in exposed (exposed, P e) and non-exposed (P o) groups:

RR = R e - R about.

The RR indicator indicates how much the morbidity (mortality) increases due to the influence of the studied factor. This information makes it possible to determine the priority areas of action for both the state in general and health care in particular.

Relative risk (RR) calculated from the ratio of these quantities:

OP = R e / R about.

Relative risk is an intense measure and reflects the increase in the exposed probability of occurrence of events compared to the background.

The considered indicators of RR and RR are informative only if the compared groups are in a “pure experimental field”, i.e. differ only in the presence or absence of the studied factor and its influence on human health. If this condition is not met (there are "interfering" factors: age, gender, bad habits, etc.), then the indicator is used to take them into account - standardized relative risk (RR). To study mortality, the standardized mortality rate (SOS) is used. The definition of COP is based on an indirect method of standardization.

When calculating the risk of deterioration in the health status of the population from the impact of various environmental factors, the concepts are used "Attributive fraction for exposed persons"(AFe) and "Attributive faction for the population"(AFn).

AFe (additional risk) shows the proportion of diseases in the exposed group due to the influence of the unfavorable factor under study.

It is calculated using the formulas:

This value reflects excess morbidity (mortality) that could have been prevented if an effective

factor. So, for example, if mortality from lung cancer among smokers is: (10.8 - 1.0) / 10.8 x 100 = 90.1%, this means that over 90% of deaths from lung cancer in smokers are the result of smoking.

Attributive faction for the population (AFn)- population additional risk, characterizes the incidence caused by a risk factor for the entire population, and not only in the group of exposed persons. That is, both the biological effect of the factor under study and the proportion of the exposed population are taken into account:

where f- the proportion of exposed faces among the population.

AF n shows the proportion of cases of the disease among the entire population attributed to the effect of the factor under study, which can be eliminated in the event of a complete cessation of its influence on the population.

In addition to the terms considered in the concept of risk and its actual calculations, such a concept as "Exposure".

"Exposed"(person, object). If we are talking about a person, then the type of contact with a risk factor, the route of entry of a harmful substance into the body (action on the body), the duration and intensity of action, the characteristics of accompanying factors: physical, chemical, etc.

In establishing cause-and-effect relationships in the "person - environment" system, certainty and a clear understanding of the meaning of some more definitions are important. In particular, there should be clarity in the concepts: "impact", "disease", "healthy", "sick", etc.

When establishing a causal relationship, two types of research can be carried out: transverse and longitudinal.

Cross-sectional studies(cross-sectional studies) describe the distribution of the health characteristics of the studied group at a certain point. Examples of cross-sectional studies are population censuses, medical examinations of certain population groups, etc.

Longitudinal studies provide for the study of the frequency with which the persons of the compared groups (populations) pass from the state of "healthy" ("alive") to the state of "sick" ("deceased"). At

This type of research uses two main research designs: cohort and case-control.

Cohort study involves the study of the processes of morbidity (mortality) in cohorts of persons exposed and not exposed to the studied impact. A distinctive feature of this study is the correspondence of its direction to the time vector "exposure - disease". The design of the cohort study is presented in table. 3.2.

Table 3.2. Presentation of data from cohort studies

These data are used to determine the risks for each of the groups: exposed a and unexposed with:

and also get the value of the relative risk:

In cohort studies, case-control studies are used to analyze the causes of rare diseases or diseases with a long latency period, as well as in cases where the hypothesis of a link between a risk factor and a specific disease is not convincingly supported. The way of evaluating the data in this case is somewhat different (Table 3.3).

Table 3.3. Case-control data presentation

With this method of research, the assessment of the relative risk is the odds ratio (OR). It is the quotient of dividing the chances of being exposed in patients (a / b) by a similar indicator in healthy people (c / d):

Having familiarized ourselves with the basic conceptual apparatus of the risk concept, let us consider the basic diagram of the health risk analysis (Fig. 3.1).

Fig. 3.1 it follows that the process of the likelihood of development and the severity of adverse effects presupposes the existence of the following stages:

1. Hazard identification.

2. Assessment of the "exposure (dose) - response" relationship.

3. Assessment of exposure (impact).

4. Characteristics of risk, etc.

Hazard identification: collection and analysis of data on all sources of pollution of the research object, identification and determination of harmful factors, selection of priority chemicals for research.

Rice. 3.1. Human health risk analysis diagram

Assessment of the "exposure (dose) - response" relationship. Reflects a quantitative relationship between exposure and response

organism. It is important to remember two extreme manifestations of the harmful effect: carcinogenic and non-carcinogenic. They have a different geometric shape of the dose-response relationship.

For non-carcinogens, this is an S-shaped (sigmoid) curve, the left branch of which is aligned with the abscissa at the point corresponding to the zero effect, since these agents cause risk only when thresholds or safe exposure levels are exceeded (Fig. 3.2).

As for carcinogens, then, as already mentioned, they have no threshold, therefore their dose-effect relationship passes through zero, i.e. there is no risk only if the value is zero. To assess the risk parameters of carcinogens, linear extrapolation of the lowest dose established in the experiment or epidemiological studies to a zero dose is performed (Fig. 3.3).

Carcinogenic potential factors are slope factor (SF) and unit risk (UR). The first reflects the degree of increase in carcinogenic risk with increasing exposure dose and is measured in mg / kg -1. A single risk characterizes the carcinogenic risk associated with a concentration of a substance in the air of 1 μg / m3 or in drinking water of 1 μg / L. It is calculated by dividing SF by body weight (70 kg) and multiplying by the volume of pulmonary ventilation (20 m3 / day) or daily water intake (2 L).

If there is information about UR and SF, it is possible to predict the individual (additional to the background) risk of developing cancer with different routes of entry of the carcinogen.

Rice. 3.2. Dose-response relationship for non-carcinogenic factors

Rice. 3.3. Establishment of factors of carcinogenic potential

Depending on the route of receipt, single risks are determined by the formulas:

If we know the size (N) of a population exposed to a substance at a known concentration, then we can calculate population risk- the number of additional (to the background level) cancer cases in this population:

For occupational exposures, formulas are adjusted to reflect differences in exposure factors. So, under the condition of an 8-hour working day and 40 years of work experience (with 240 working days a year and an average value of pulmonary ventilation per shift of 10 m 3), the unit risk (1W p) will be:

From here we can calculate individual risk development of cancer for work experience:

where WITH- the average concentration of a chemical for the entire period of production activity.

The assessment of the risk of developing non-carcinogenic effects for individual substances is carried out on the basis of the calculation coefficient danger:

When characterizing non-carcinogenic effects in the case of combined or combined exposure to chemical compounds, calculate hazard index(1 o). If there is a simultaneous intake of several substances in the same way (inhalation, oral), the calculation is carried out according to the formula:

where K oi is the hazard coefficient for the individual components of the mixture of exposure substances.

If the active substances are supplied simultaneously by several routes, as well as with multi-level and multi-route exposure, the risk criterion is total hazard index:

where: I oi - hazard index for individual routes of entry or individual routes of exposure.

The calculation of hazard indices is carried out taking into account critical organs (systems), since in the case of a mixture of substances acting on the same organs or systems of the body, the most probable type of their combined action is summation (additivity).

From the data presented, it is quite clear that the methodology for assessing the risk to public health due to the effect of the environment seems to be a rather complex tool in practical use. But today it is a mandatory procedure, no matter how difficult it is to implement. The risk assessment methodology is widely used by international organizations (WHO, EU) to establish indicators of the quality of atmospheric air, drinking water, food products, assess health damage from air pollution from vehicles, energy enterprises, etc.

In Russia, the development of research on this problem was most developed after the joint decree of the Chief State Sanitary Doctor of the Russian Federation and the Chief State Inspector of the Russian Federation for Nature Protection dated November 10, 1997 “On the use of risk assessment methodology for managing the quality of the environment and public health in the Russian Federation ".

The risk assessment methodology has become one of the most important tools for social and hygienic monitoring (SHM). The results of risk assessment open up new possibilities for predicting adverse changes in the health status of the population and are a prerequisite for the development and recommendation of risk management measures, i.e. on the management of systems of legislative, technical and regulatory decisions aimed at eliminating or significantly reducing the risk to public health (Onishchenko G.G., 2005).

In recent years, a number of official and regional scientific and methodological documents on risk assessment have been published. The Chief State Sanitary Doctor of the Russian Federation approved the “Guidelines for assessing occupational health risks for workers. Organizational and methodological foundations, principles and assessment criteria "(P2.2.1766-03) and" Guidelines for assessing the risk to public health when exposed to chemicals that pollute the environment "(P2.1.10.1920-04). As part of the Scientific Council of the RAMS and the Ministry of Health and the SR on human ecology and environmental hygiene, there is a problem commission "Scientific foundations for a comprehensive assessment of the risk of environmental factors on health", whose task is to coordinate scientific developments in this area, as well as - together with Rospotrebnadzor of the Russian Federation , Ministry of Health and Social Development of the Russian Federation - implementation of the development of scientific and methodological support for practical work on risk assessment.

As for the real activity in the field of risk assessment methodology, in accordance with the existing legislation, only accredited risk assessment bodies. Unfortunately, there are not so many such organizations. According to the report "The results of the activities of the Federal Service for Supervision in the Field of Consumer Rights Protection and Human Wellbeing in 2006 and the Tasks for 2007", as of 01.01.2007, the number of subdivisions for the maintenance of SHM was 86, including 36 independent ones. according to the risk assessment - 2 and 2, respectively. This once again confirms the complexity of the problem under consideration.

Thus, today in Russia there is a fairly formalized two-tier system for the implementation of the methodology for assessing the health risk of the country's population, including scientific, methodological and practical levels.

3.4. HEALTH AS A FUNDAMENTAL CRITERION FOR ASSESSING HUMAN WELL-BEING AND ENVIRONMENTAL STATE

3.4.1. Methodology for studying public health

The problem of studying the phenomenon of health is important not only for medicine, but also for humanity as a whole. So far, only one definition has been given, which was proposed by WHO experts (see Chapter 1). It exists, but this formulation is not entirely accurate in the system "a person and his health - environment". It is no coincidence that when considering this problem, it is stated that it is very difficult to define the concept of “public (human) health”. This is true, but there are encouraging successes.

Analyzing the definitions of health that exist at this time, we can conclude that in a certain sense they can be grouped by semantic features.

In terms of definitions, first of all, the philosophical content of the concept of "health" is revealed, which was formulated by K. Marx: "Disease is a life constrained in its freedom", implying that by health in this case, the absence of disease should be understood. The second type of definitions to some extent details the above definition. This includes the above-mentioned WHO wording, which states not only the absence of disease, but also the presence of "... complete physical, mental and social well-being ...".

Both aspects of the phenomenon of health in general philosophical, methodological terms, apparently, are fair and have the right to exist, but the question arises - how to use them in practice? After all, the conceptual apparatus in both cases does not lend itself to quantitative assessment available to the doctor. And this already contradicts the very essence of hygienic science, which, as already emphasized, has the status of evidence, i.e. quantitative discipline. Therefore, with particular intent, one should

consider another methodological approach in determining the phenomenon of health.

The essence of the third group of definitions of health is that its supporters consider this concept either as process("Health is a process ...", or how condition("Health is a state ...").

Without going into details and the contradictory interpretation of the concepts of "process" and "state" by different authors, we note that both phenomena (process, state) lend themselves to both quality(in its most general form: progress or regression), and quantitative(more or less) analysis. And from this point of view, this approach should be considered more acceptable. Thus, it becomes possible to apply certain qualitative and quantitative criteria in relation to the system "person (people) - environment" in specific conditions.

But as applied to a person, his health needs a clear definition: life is a “process”, and health is a “state”. Only on the basis of such an understanding of such a complex biosocial being, which a person is, can one move further along the path of researching the health of a person (population) as a criterion of social and hygienic well-being. At the same time, it is necessary to keep in mind other concepts (definitions) necessary for advancement in this direction.

General biological health(norm) - the interval within which the quantitative fluctuations of all physiological systems of the body do not go beyond the optimal (normal) level of self-regulation.

Population health- a conditional statistical concept that characterizes the state of demographic indicators, physical development, the frequency of premorbid, morbid indicators and disability of a certain population group.

Individual health- the state of the body, in which it is able to fully perform its social and biological functions.

Population- a set of people living in a certain territory and capable of self-restoration of their numbers.

Available population- the number of all persons who, at the critical moment of the census, were in the given locality, including temporarily residing and excluding those temporarily absent.

Permanent population- persons permanently residing in the given locality, including temporarily absent and excluding temporarily residing.

Legal population- persons included in the lists of residents of a given territory, regardless of their permanent place of residence and stay at the time of the census.

Estimated Cash Population- persons available in a given area at the time of the census.

Population- part of the population within a specific territory, distinguished by the most characteristic socio-economic, ecological and other factors, demographic and ethnic characteristics, lifestyle, value orientations, traditions, etc. processes of formation of the level of health.

Cohort- a part of the population, united by a single date of occurrence of a certain event (birth, arrival in a given region or residence in a certain zone (place) of it, the beginning of labor activity, marriage, military service, etc.).

For rate population health WHO recommends the following criteria (indicators):

medical(incidence and frequency of certain premorbid conditions, general and child mortality, physical development and disability);

social welfare(demographic situation, sanitary and hygienic indicators of environmental factors, lifestyle, level of medical care, social and hygienic indicators);

mental well-being(incidence of mental illness, frequency of neurological conditions and psychopathies, psychological microclimate).

Analyzing the criteria for assessing population health, we will once again make sure that the WHO definition of the phenomenon of health cannot be applied to an individual person. In addition, it is inapplicable to children and young men, which is its significant drawback.

Most of the listed indicators relate to medical ones, reflecting not the level of health itself, but the prevalence of diseases (morbidity, disability, mortality), i.e. indicators of morbidity ("ill health"). It is assumed that the higher they are, the lower the health level of the corresponding population group, i.e. and in this case, the path to assessing health goes through "ill health", which does not apply to new approaches.

It should be noted that WHO has made an attempt to delineate more subtly and in detail the criteria for social well-being, which include:

1. Percentage of gross national product used for health care.

2. Availability of primary health care.

3. Coverage of the population with safe water supply.

4. Percentage of persons immunized against infectious diseases that are especially common among the population of developing countries (diphtheria, whooping cough, tetanus, measles, poliomyelitis, tuberculosis).

5. Percentage of services for women by qualified personnel during pregnancy and childbirth.

6. Percentage of children born with insufficient birth weight (less than

7. Average life expectancy.

8. The level of literacy of the population.

It is easy to see that this, like other approaches, also gravitates more towards a "theoretical" assessment of health, far from quantitative. Therefore, in practice, the already mentioned ones are most often used. medical indicators reflecting morbidity, mortality, etc.

The sources of information in this case are:

1. Official reports of health care facilities, health authorities, social security, registry offices, state statistics bodies.

2. Specially organized registration of morbidity and mortality in health care facilities - prospective studies.

3. Retrospective information for the study period.

4. Data of medical examinations.

5. Data from clinical, laboratory and other studies.

6. Results of medical and social research.

7. Results of mathematical modeling and forecasting. In general, the integral assessment of the health status of the population

is carried out in the following algorithm (Fig. 3.4).

Fig. 3.4 it can be seen that before reaching the desired result - "Indicators of the population's health status", it is necessary to perform many intermediate evaluative actions (qualitative and quantitative analyzes, distribution into health groups, determination of health indices, etc.).

Rice. 3.4. Integral assessment of population health (Goncharuk E.I. et al., 1999)

But an even more difficult task lies ahead at the stage of linking (pairing) indicators of the health status of the population and environmental factors (Fig. 3.5).

At the same time, it is important to take into account one important circumstance: to model the relationships in the "environment - health" system and determine its quantitative characteristics (without this, forecasting the situation is impossible), mathematical and statistical analysis is used, in which generalized health indices are used as "operational units". They provide an idea of ​​the health level of the population by integrating a number of indicators. In this regard, rather stringent requirements are applied to them, which WHO formulated back in 1971:

Availability of data for calculating the index;

Completeness of coverage of the population;

Reliability (data should not change in time and space);

Computability;

Acceptability of the calculation and evaluation method;

Reproducibility;

Specificity;

Sensitivity (to corresponding changes);

Validity (a measure of the true expression of factors);

Representativeness;

Hierarchy;

Target consistency (adequate reflection of the goal of improving health).

Shown in fig. 3.5 algorithm for solving the problem of studying relationships in the system "person (population) - environment" shows how complex and multifaceted this task is. It is within the power of only specialized scientific (research institutes) or practical bodies and institutions accredited in this field.

The end result of such studies is the determination of the level (approximate level) of health of the population. As an example, the assessment of the named levels according to certain criteria is given (Table 3.4).

Table 3.4. Rough estimate of the level of health of the population

Health level	Morbidity by referral rate per 1000 population				Incidence with temporary disability per 1000 employees
	primary		general
	town	village	town	village	cases
Very low
Very tall

Note: 1 - disability per 1000 people of the population; 2 - child (infant) mortality,%; 3 - general mortality,%.

One of the final stages of an epidemiological study of population health is a quantitative assessment of the relationship between the severity of environmental factors and the level of health.

Rice. 3.5. Identification and assessment of the relationship between environmental factors and public health

For this, mathematical modeling is usually carried out, i.e. using special methods, mathematical models are built that reflect the dependence of the level of health of the population on the factors under study. In the process of such analysis, the degree of influence of each of the studied factors on the level of population health is established.

One of the ways to make a conclusion about the degree of influence of each factor is to use the criterion of correlation-regression analysis - determination coefficient.

The advantage of this criterion is that it characterizes the relative role of each specific environmental factor in influencing the level of health. This makes it possible to rank factors according to the degree of their harmfulness and to develop prevention programs, taking into account the priority of their action.

The epidemiological study of the state of health of the population ends with the development of preventive recommendations and their implementation into practice, followed by an assessment of the effectiveness of implementation.

From the materials discussed above, it can be seen that research in the "environment - public health" system requires numerous evaluative actions that can only be carried out by large scientific or practical organizations or their complex. For smaller-scale studies, more simplified approaches can be applied, for example cohort studies.

In this case, the algorithm can be as follows - it is necessary to determine the directions of research of the state of health (Fig. 3.6).

Rice. 3.6. The main directions of research on the state of health

Having decided on the directions of research, a purposeful study of the indicators of the state of health, presented in Fig. 3.7. The interest lies in the fact that it is possible to use both individual and collective and even population approaches.

As for the comparison of the obtained indicators, indices, etc. with environmental factors, it is carried out in accordance with the settings discussed above.

3.4.2. Environmentally related diseases and methods of their diagnosis

Environmentally dependent diseases of the population include those diseases in the etiology of which environmental factors play a certain role. Often in this case, the terms are used: "ecological disease", "anthropoecological diseases", "ecologically dependent diseases", "ecopathology", "civilization diseases", "lifestyle diseases", etc. In these terms, the emphasis appears to be on the ecological or social causation of many diseases.

Rice. 3.7. Indicators of human health (population)

Depending on the nature (physical, chemical, biological, etc.), the environmental factor can play a different role in the etiology of the disease. He is able to act as etiological, causal, practically determining the development of a specific specific disease. Currently, about 20 chronic diseases of the population are reasonably associated with the impact of environmental factors (Minamata disease, caused by the pollution of mercury-containing industrial wastewater of marine and river fauna; Itai-itai disease, as a result of irrigation of rice fields with water containing cadmium, etc.) (Table 3.5).

If the environmental factor acts as the cause of the disease, then its effect is called deterministic.

Table 3.5. List of Known Environmentally Dependent Diseases

Note. * Only 40 years after the establishment of the ecological disaster, fish and shellfish of the Minamata Bay were recognized as safe for human health.

The environmental factor can act as modifying, those. change the clinical picture and aggravate the course of a chronic disease. In this case, the risk associated with a particular factor is modified depending on the presence of another factor or impact. For example, air pollution with nitrogen oxides provokes symptoms of respiratory tract dysfunction in patients with chronic respiratory diseases.

In some cases, the factor under study can have mixing effect. An example of confounding factors is age and tobacco smoking when studying the effect of atmospheric pollution on the risk of developing respiratory diseases, tobacco smoking when studying the risk of developing lung cancer and pleural mesothelioma when exposed to asbestos, etc.

Diseases can also be caused by imbalance between the internal and external environment of the body, which is especially typical for endemic diseases. The etiology and pathogenesis of some endemic diseases are well understood. For example, it was found that observed in many regions of the world fluorosis due to excessive intake of fluorides from drinking water; the occurrence of endemic goiter is associated with a lack of iodine in the environment and food and, in addition, may be the result of the action of certain chemicals that disrupt hormonal status.

Among the causes of malignant neoplasms, the leading place is occupied by food and tobacco smoking, i.e. factors associated mainly with a person's lifestyle (Fig. 3.8).

3.4.3. Environmentally related diseases as a result of the action of chemical factors

A number of signs allow the doctor to suspect the ecological dependence of the observed health disorders in the population. Causal relationships between disease and chemical exposure are often more difficult to recognize and understand than similar relationships between infectious diseases or foodborne diseases. Before analyzing the ecological causation of the disease, it is necessary to exclude the infectious or foodborne nature of the observed health disorders.

Rice. 3.8. Probable Causes of Cancer

The most characteristic signs of environmental, in particular chemical, the nature of the disease:

A sudden outbreak of a new disease. Often it is interpreted as infectious, and only a thorough clinical and epidemiological analysis can identify the true cause of exposure to chemicals;

Pathognomonic (specific) symptoms. In practice, this symptom is quite rare, since specific signs of intoxication are mainly manifested at relatively high levels of exposure. A certain combination of nonspecific symptoms is of much greater diagnostic value;

A combination of nonspecific signs, symptoms, laboratory data, unusual for known diseases;

Lack of contact transmission routes characteristic of infectious diseases. For example, people living in the same apartment with asbestos workers have a very high risk of developing tumors of the lungs and pleura, which is due to exposure to asbestos particles carried along with contaminated overalls;

A common source of exposure for all victims; the connection of diseases with the presence of chemicals in one of the environmental objects;

Detection of the dose-response relationship: an increase in the likelihood of developing a disease and / or an increase in its severity with increasing dose;

Formation of clusters (condensation) of the number of cases of diseases, usually relatively rare in the population;

Typical spatial distribution of disease cases. Geographic localization is characteristic, for example, of almost all endemic diseases;

Distribution of victims by age, sex, socioeconomic status, profession and other characteristics. The most susceptible to the disease are often children, the elderly, patients with one or another chronic pathology;

Identification of subgroups with an increased risk of disease. Such subgroups can often indicate the pathogenetic characteristics of the influencing factor;

Temporary relationship between disease and exposure to factors. It is necessary to take into account the possibility of a latency period ranging from several weeks (tricresyl phosphate - paralysis, dinitrophenol - cataract) to several decades (dioxins - malignant neoplasms);

The connection of diseases with certain events: the opening of a new production or the beginning of the production (use) of new substances, the disposal of industrial waste, a change in the diet, etc .;

Biological plausibility: the observed changes are confirmed by data on the pathogenesis of the disease, the results of studies on laboratory animals;

Detection of a test chemical or its metabolite in the blood of victims;

The effectiveness of interventions (specific preventive and therapeutic measures).

Each of the above signs individually is not decisive, and only their combination allows us to suspect the etiological role of environmental factors. This is the extreme difficulty of establishing the ecological nature of an individual's disease.

The relationship between exposure to environmental factors and health disorders can be different. The most simple

for analysis, the situation when the very fact of exposure necessary and sufficient for the occurrence of a disease (for example, a snake bite a person - the risk of death). In such situations, the background (without the studied effect) incidence rate is zero.

The impact can also be necessary but not sufficient for the development of the disease. The mechanism of chemical carcinogenesis includes several sequential stages: initiation(primary cell damage), promotion(transformation of initiated cells into tumor cells), progression(malignant growth and metastasis). If a chemical has only promoter or initiating properties, then its effect is insufficient for the development of cancer.

Another option for a causal relationship is the case when the impact enough but not necessary for the development of the disease. For example, exposure to benzene can cause the development of leukemia, but leukemia can occur without exposure to this substance.

For the development of so-called conditioned diseases, the impact of environmental factors can be not enough and not necessary. As already noted, most noncommunicable diseases have complex, multiple etiologies, and the risk of their development depends on a variety of factors. The complexity of the analysis in such situations is due to the fact that in the population, even without the studied environmental factor, there is a certain and often relatively high background level of morbidity associated with other known or unknown causes.

Population hygienic diagnostics is used to assess the environmental situation in various areas and identify health risks associated with certain hazardous enterprises or other sources of environmental pollution. Under favorable environmental conditions the absence of anthropogenic sources of adverse effects on the environment and human health and natural, but abnormal for a given area (region) natural climatic, biogeochemical and other phenomena is understood. Depending on the intensity of the influence of environmental factors on the health of the population, zones of ecological emergency and zones of ecological disasters.

The ecological state of the territories is assessed by a set of medical and demographic indicators. These indicators include perinatal, infant (under the age of 1 year) and child (at the age of 14) mortality, the frequency of congenital malformations, spontaneous miscarriages, the morbidity structure of children and adults, etc. Along with mortality and morbidity indicators, the average duration is analyzed. life, the frequency of genetic disorders in human cells (chromosomal aberrations, DNA breaks, etc.), shifts in the immunogram, the content of toxic chemicals in human biosubstrates (blood, urine, hair, teeth, saliva, placenta, human milk, etc.).

At present, in Russia there are, for one reason or another, more than 300 zones of ecological disaster, including Moscow, occupying a total of 10% of the territory, where at least 35 million people live.

Along with population hygienic diagnostics, there is also individual, with the aim of identifying causal relationships between health disorders in a particular person and potentially harmful environmental factors acting or acting in the past. Its relevance is determined not only for the correct diagnosis, treatment and prevention of diseases, but also for establishing a possible relationship "environment - health" in order to determine material compensation for damage to human health as a result of environmental or industrial factors.

Potential health effects are classified according to their severity: disastrous(untimely death, decreased life expectancy, severe impotence, disability, mental retardation, congenital deformities), heavy(organ dysfunction, nervous system dysfunction, developmental dysfunction, behavioral dysfunction) and unfavorable(weight loss, hyperplasia, hypertrophy, atrophy, changes in enzyme activity, reversible dysfunction of organs and systems, etc.).

As already noted, the reactions to external influences in the population in most cases are of a probabilistic nature, which is due to differences in the individual sensitivity of people to the action of the studied environmental factor. In fig. 3.9 shows the spectrum of the biological response of the population to the impact of environmental factors. As you can see from the picture,

in the largest part of the population, as a result of exposure to harmful factors, latent forms of diseases and prenosological conditions appear, which are not detected by mortality, seeking medical care, hospitalized morbidity. Only a targeted and in-depth medical examination is able to assess the true state of health in the exposed population. This task is designed to solve hygienic diagnostics.

Rice. 3.9. Schematic spectrum of biological responses to environmental pollution exposure (WHO Expert Committee, 1987)

Hygienic diagnostics focuses on identifying pre-morbid (premorbid) conditions. The subject of research in hygienic diagnostics is health, its magnitude. It is carried out by a doctor in order to assess the state of the adaptive systems, early detection of stress or disturbance of adaptive mechanisms, which in the future can lead to illness. The doctor cannot and should not calm down even when the patient comes with certain complaints, but it was not possible to find objective signs of the disease in him. Such people (unless they are explicit simulators) should be referred to the risk group (observation) and their health status should be studied in dynamics.

An example of such a case is the so-called multiple chemical sensitivity syndrome (MCS). It is an environmental disease with chronic polysystemic and polysymptomatic disorders caused by low-intensity environmental factors. With this disease, the mechanisms of adaptation of the body to the action of various factors are violated against the background of hereditary or acquired increased individual sensitivity to chemicals. The syndrome of multiple chemical sensitivity is provoked by a variety of chemical compounds present in environmental objects at concentrations much lower than the MPC for the entire population as a whole.

The most reliable diagnostic criterion for multiple chemical sensitivity syndrome is the complete disappearance of all symptoms of the disease after elimination of the exposure to potentially harmful factors within 3-5 days (for example, when changing the place of work or place of residence). Re-placing the patient in an environment that is dangerous to him causes a new exacerbation of symptoms. The disease often develops in people who have had acute exposure to organic solvents and pesticides in the past. Due to the difficulty of diagnosing multiple chemical sensitivity syndrome (especially in its early stages), these patients are often diagnosed with "neurasthenia" or "psychosomatic illness". Correct differential diagnosis of multiple chemical sensitivity syndrome is possible only with careful and targeted collection of anamnesis with an emphasis on past chemical exposures, using a complex of sensitive neuropsychological, physiological, biochemical, hormonal, immunological studies, biomarkers of exposure and effect (in particular, determination of the content in biosubstrates harmful organic substances and heavy metals).

Methods for diagnosing premorbid conditions are very diverse and include the study of the human immune status, the state of the regulatory mechanisms of the cardiovascular system, the processes of free radical and peroxidation (the state of antioxidant systems and lipid peroxidation), the state of enzyme systems, psychodiagnostic testing, and the use of biomarkers. Premorbid conditions are observed in a relatively large number of "practically healthy" people:

37.9% of the surveyed revealed the tension of adaptation mechanisms, in 25.8% - unsatisfactory adaptation, and in 8.9% - a breakdown in adaptation.

In hygienic diagnostics, comparative assessments of the state of health are required. Many so-called ecologically caused diseases have a polyetiological nature and a complex multi-syndromic nature. To prove their connection with the quality of the environment, it is necessary to establish the dependence of the risk of health disorders on exposure and, in parallel, to examine the control groups that do not have clear contact with the studied factors.

The most unfavorable consequences of the influence of chemical factors on human health are stochastic effects, those. the emergence and development of malignant neoplasms.

Oncological diseases occupy one of the first places among the causes of morbidity and mortality in the population.

The development of cancer is facilitated by environmental factors (chemical carcinogens, nutritional factors, ionizing radiation), genetic (hereditary) factors, viruses, immunodeficiency, spontaneous mitotic defects.

The International Agency for Research on Cancer (IARC) classifies carcinogenic factors based on scientific evidence of their carcinogenic effects in humans.

Classification of carcinogens (IARC)

1 - known human carcinogens; 2A - probable human carcinogens; 2B - possible carcinogens;

3 - agents not classified as carcinogenic;

4 - agents, probably not carcinogenic to humans.

For many types of malignant neoplasms, preventive measures are extremely effective. According to the WHO, preventive measures can reduce the risk of developing stomach cancer by 7.6 times, colon cancer by 6.2 times, esophagus by 17.2 times, and bladder cancer by 9.7 times. About 30% of all deaths from all types of malignant neoplasms and 85% of cases from lung cancer are associated with smoking. About 4000 chemical substances have been identified in tobacco smoke.

substances, 60 of which are carcinogenic. Radon makes a significant contribution to the development of cancer. Indoor exposure to this radioactive gas causes 17,000 new cases of lung cancer in the United States each year.

Carcinogenic properties in humans or laboratory animals are currently found in about 1000 different chemicals. Below are some compounds and production processes that pose a danger in terms of the development of malignant neoplasms (List of substances, products, production processes, domestic and natural factors that are carcinogenic to humans, 1995).

Substances, products, production processes and factors with proven carcinogenicity for humans:

4-aminodefinil;

Asbestos;

Aflatoxins (B 1, B 2, G 1, G 2);

Benzidine;

Benz (a) pyrene;

Beryllium and its compounds;

Bichloromethyl and chloromethyl (technical) ethers;

Vinyl chlorides;

Sulfur mustard;

Cadmium and its compounds;

Coal and petroleum resins, pitches and their sublimates;

Crude and incompletely refined mineral oils;

Arsenic and its inorganic compounds;

1-naphthylamine technical containing more than 0.1% 2-naphthylamine;

2-naphthylamine;

Nickel and its compounds;

Household soot;

Shale oils;

Chromium hexavalent compound; erionite;

Ethylene oxide;

Alcoholic drinks;

Solar radiation;

Tobacco smoke;

Smokeless tobacco products;

Woodworking and furniture production using phenol-formaldehyde and urea-formaldehyde resins indoors;

Copper smelting production;

Industrial exposition of radon in the mining industry and when working in mines;

Isopropyl alcohol production;

Coke production, processing of coal, oil and shale resins, coal gasification;

Manufacture of rubber and rubber products;

Carbon black production;

Production of coal and graphite products, anode and bottom masses using pitch, as well as baked anodes;

Iron and steel production (sintering factories, blast furnace and steel production, hot rolled products) and castings from them;

Electrical production of aluminum using self-sintering anodes;

Manufacturing processes associated with exposure to aerosols of strong inorganic acids containing sulfuric acid.

Such a wide range of chemical factors and industries (far from complete!) Requires the doctor to have an idea, at least within the framework of this list, of the possible risk to his patients and to focus precisely on the earliest signs of possible health problems.

Other environmentally related diseases

Currently, allergic diseases have acquired particular relevance in connection with the anthropogenic impact on the environment. Various types of these diseases (bronchial asthma, allergic rhinitis, dermatitis, urticaria, eczema, etc.) affect from 20 to 50% of the population of developed countries. These diseases, in fact, have become occupational for healthcare workers (allergy to drugs, medical waste, disinfectants, etc.).

Most chemicals that enter the environment are corrosive. They are sensitizing,

modifying and other types of influence. Acting as triggers (trigger- English, literally "switch"), they can provoke an allergic reaction. Table 3.6 presents a list of factors that have an allergic effect.

In some cases, the development of allergic reactions in the population is associated with combined and complex effects, in particular, chemicals and products of biotechnological synthesis. In the city of Kirishi, 47 people developed bronchial asthma due to the combined effect of protein-vitamin complexes and atmospheric pollution. The Angarsk pneumopathy described in the literature, manifested by bronchospasm, is also, apparently, associated with the effects of microbial synthesis products and atmospheric pollution.

In recent years, along with "classical" allergic diseases, the attention of doctors is attracted by ecologically caused diseases, the etiology and pathogenesis of which remain poorly understood. The emergence of these diseases is associated with the intensive chemicalization of modern society and the constant, throughout life, exposure to hundreds of various chemical compounds.

There are 2 groups of human health disorders caused by the impact of the internal environment. First group bears the name "Building related diseases (BRI)" and includes health disorders that are etiologically associated with certain indoor factors, for example, the release of formaldehyde from polymer and wood-based materials. After elimination of the harmful effect, the symptoms of the disease, as a rule, do not disappear, and the recovery process may take a long time.

The second group is called Sick Building Syndrome (SBS) and includes acute health problems and discomfort that arise in a particular room and almost completely disappear when leaving it. Sick building syndrome manifests itself in the form of headache, irritation of the eyes, nose and respiratory system, dry cough, dry and itchy skin, weakness and nausea, increased fatigue, and susceptibility to odors.

According to the WHO, about 30% of new or renovated buildings can provoke these symptoms. The development of the sick building syndrome, apparently, is due to the combined and combined effects of chemical, physical (temperature, humidity) and biological (bacteria, unknown viruses, etc.) factors.

Table 3.6. Risk factors for the development of bronchial asthma (National program "Bronchial asthma in children. Strategy for treatment and prevention", 1997)

Risk groups I Risk factors

Factors predisposing to the development of bronchial asthma	Bronchial hyperreactivity Heredity
Causal (sensitizing factors)	Household allergens (house dust, house dust mites) Epidermal allergens of animals, birds; cockroach and other insect allergens Fungal allergens Pollen allergens Food allergens Medicinal allergens Viruses and vaccines Chemicals
Factors contributing to the occurrence of bronchial asthma, aggravating the effect of causative factors	Viral respiratory infections Pathological course of pregnancy in the mother of the child Prematurity Poor nutrition Atopic dermatitis Various chemicals Tobacco smoke
Factors causing exacerbation of bronchial asthma (triggers)	Allergens Viral respiratory infections Physical and psycho-emotional stress Changes in the meteorological situation Environmental influences (xenobiotics, tobacco smoke, strong odors) Intolerable foods, drugs, vaccines

Insufficient natural and artificial ventilation of the premises, building finishing materials, furniture, irregular or improper cleaning of premises most often become the causes of the sick building syndrome.

Another syndrome, in the development of which environmental factors may play a role, is chronic

tiredness(immune dysfunction syndrome). To diagnose this syndrome, the following criteria are taken into account:

1. The role of any specific factors (for example, chronic intoxication or other chronic disease) is excluded.

2. The feeling of pronounced fatigue is noted for at least 6 months.

3. The feeling of fatigue is combined with impaired short-term memory, confusion, disorientation, speech disorders and difficulties in performing counting operations.

4. At least 4 of the following 10 symptoms are present:

Fever or chills;

Recurrent throat diseases;

Swollen lymph nodes;

Muscle discomfort;

Flu-like muscle pain;

Increased muscle sensitivity to palpation;

Generalized weakness;

Feeling of joint discomfort;

Asymmetric damage to large joints;

Headache (in the retroorbital and occipital areas);

Sleep disturbances;

Increased sleepiness (sleep more than 10 hours a day);

Chronic, often recurring rhinitis.

In the majority of patients, functional insufficiency of killer cells is found. The disease occurs in people of all age groups, but most often it affects women over 45 years of age.

Most researchers consider this syndrome to be the result of dysfunction of the immune system of unexplained etiology. Among the factors that can cause chronic fatigue syndrome are enteroviruses, herpes viruses, Epstein-Barr virus, genetic predisposition, stress, chemicals, including heavy metals, and a deficiency of antioxidant substances in the diet.

Hygienic knowledge based on life observations originated in ancient times. The first hygienic treatises that have come down to us ("On a healthy lifestyle", "On water, air and localities") belong to the pen of the great physician of Ancient Greece, Hippocrates (460-377 BC). The first city water pipes, hospitals were built in ancient Rome.

Until now, not only is it known, but also has a certain scientific interest "Treatise on hygiene (elimination of any damage to the human body by correcting various errors in the regime)", written by the great Arab-Muslim scientist, who was born in Central Asia Avicenna Abu Ali ibn Sina (980 -1037). The treatise sets out important issues of hygiene, offers methods and means of treatment and prevention of diseases caused by disturbances in sleep, nutrition, etc.

However, hygiene science has developed not only on the basis of empirical observations, but also, of course, taking into account new experimental data. Here it is necessary to recall the hygienic manuals written by the Frenchman M. Levy (1844) and the English medical scientist E. Parks. The first hygiene department at the Faculty of Medicine of the University of Munich in 1865 was organized by Max Pettenkofer (1818-1901). He not only researched environmental factors (water, air, soil, food), but also created the first school of hygienists.

Empirical knowledge about hygiene also comes to us from Ancient (Kievan, Novgorod) Rus. Suffice it to recall the well-known treatise on the life of a Russian family - "Domostroy", which sets out the basics of proper storage of food, attention is paid to the observance of cleanliness and tidiness.

Peter I did a lot to protect the health of the population and prevent the spread of diseases in Russia, having issued a number of decrees on the sanitary state of cities, on the mandatory notification of cases of infectious diseases, etc.

The special importance of preventive measures in the prevention of high morbidity was pointed out by many Russian doctors: N.I. Pirogov, S.P.Botkin, N.G. Zakharyin, M. Ya. Mudrov.

NI Pirogov wrote: “I believe in hygiene. This is where the true progress of our science lies. The future belongs to preventive medicine ”. In a speech delivered in 1873, another well-known Russian clinician, Professor G. N. Zakharyin said: “The more mature a practitioner is, the more he understands the power of hygiene and the relative weakness of treatment, therapy ... The most successful therapy is possible only with subject to hygiene. Only hygiene can triumphantly argue with the ailments of the masses. We consider hygiene to be one of the most important, if not the most important, activity of a practitioner. "

In Russia, hygiene as a course in forensic science (forensic medicine) begins to be taught at the Medical-Surgical Academy (St. and hygiene ". An independent department of hygiene at the academy and the first in Russia was opened in 1871 under the leadership of assistant professor Alexei Petrovich Dobroslavin (1842-1889). A.P. Dobroslavin organized an experimental laboratory at the department, created the first Russian school of hygienists, he wrote the first Russian textbooks on hygiene.

The Moscow School of Hygienists was founded by Fedor Fedorovich Erisman (1842-1915). In 1881 FF Erisman was elected assistant professor of the Department of Hygiene of the Medical Faculty of Moscow University. He worked a lot in the field of hygiene of children and adolescents (Erisman's universal desk is still known), social hygiene, laid the foundations for studying the influence of environmental factors on the health of the younger generation, proved that physical development can act as an indicator of the sanitary well-being of the child population.

In the Soviet period, scientists such as professors Grigory Vitalievich Khlopin, Fyodor Grigorievich Krotkov, Alexei Nikolaevich Sysin, Alexei Alekseevich Minkh, Gennady Ivanovich Sidorenko and many others did a lot for the development of domestic hygiene.

According to Greek mythology, the philological origin of hygiene is associated with the goddess of health (Hygieinos) - the daughter of Aesculapius. Hygiene - the goddess of health - a symbol of health.

Hygiene- medical, preventive discipline. She studies the patterns of influence on the body of environmental factors in order to prevent diseases and improve the environment itself. Environmental factors are also studied in 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 enhance the effect of positive factors by carrying out hygienic measures. In particular, it has now been established that fluoride in the composition of drinking water has a certain effect on the development and formation of teeth.

For example, the concentration of fluoride 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 Volga water, which is widely used for water consumption in the cities of the Volga region, contains fluorine at a level of 0.2 mg / l. This level of fluoride in drinking water leads to the massive development of caries. 80%, and in some places - 90% of the population of the Volga cities suffers from caries. Along with such a known negative factor of the lack of fluoride 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 effect of fluoride on the body as a protoplasmic poison. In particular, a high concentration of fluoride leads to changes in the formation and development of teeth. Along with the skeletal form, there is the so-called dental form of fluorosis. The optimal level of fluoride, ensuring the prevention of caries and excluding its toxic effect, is in the range from 0.7 to 1.5 mg / l. This range of fluoride doses in drinking water is set taking into account regional characteristics and some other aspects. Thus, a distinctive feature of hygiene is the rationing of factors, which we have considered with the example of fluoride.

Hygiene items are environment and health. What are they like?

The environment is a set of elements of a physical, chemical, biological, psychological, economic, cultural and ethnic nature that make up a single, continuously changing ecological system (ecosystem).

The definition of health most adequately to modern conditions is given by experts of the World Health Organization. Health is a state of complete physical, mental and social well-being, not just the absence of disease or physical defects.

Over the past XX century. the main investments in health care were mainly used to solve problems that had already arisen, and not to prevent them from occurring. The emphasis was on curing, or at least reducing ill health, on therapeutic care, rather than on health promotion and disease prevention. A reorientation of priorities should be undertaken. More attention should be paid to the preventive direction of the development of medicine.

It is common knowledge that hygiene arose out of the needs of clinical medicine. The development of hygiene was favored primarily by representatives of clinical medicine, such prominent scientists as M. Ya. Mudrov, N. G. Zakharyin, N. I. Pirogov, S. P. Botkin. Zakharyin's statement is well known: "The more mature a practitioner is, the more he understands the power of hygiene and the relative weakness of treatment - therapy." The very successes of therapy are possible only if hygiene is observed. The task of hygiene is to make human development the most perfect, life strong, and death the most distant.

Knowledge of hygiene is necessary in the practice of doctors of various profiles: medical, pediatric and dental.

It is well known that environmental factors influence the development of various pathologies. 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 the occupational 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 the diet (alimentary). It is generally known that tooth decay develops more often 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 living conditions, the consumption of water of a particular mineral composition. Working conditions contribute to the development of certain diseases, can aggravate the course of cardiovascular pathology, and have a negative impact on the development of respiratory pathology. I must say that there are diseases that are caused by the impact on the body of a professional factor. These diseases are called just that: occupational diseases.

The doctor needs knowledge of the effect of one factor or another on the body: alimentary factor, the nature of water, its composition, quality. When carrying out a treatment with the use of pharmacological drugs, the nature of the diet 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 drug treatment being carried out).

Hygiene is developing in two directions. On the one hand, there is a process of its so-called differentiation. The process of differentiation is associated with the separation of such independent branches from general hygiene as social hygiene, communal hygiene, food hygiene, occupational hygiene, hygiene of children and adolescents, radiation hygiene, military hygiene, hygiene and toxicology of polymer materials, space hygiene, aviation hygiene. On the other hand, the development of hygiene also follows the path of integration. Hygiene develops in close contact with clinical areas of medicine, therapy, pediatrics, obstetrics and gynecology and other industries.

Currently, such a course has stood out from hygiene as valeology- a science that studies the laws of the formation of a high level of health. Great attention has always been paid to the patterns of the formation of the pathological process, but insufficient attention has been paid to the problems associated with the conditions, factors and patterns that determine the conditions for the formation of a high level of health.

Hygiene methodology

Methodology of hygiene - its section, a part of hygiene, dealing with the use of its methodological techniques for studying the patterns of interaction between the body and the environment. Hygiene methodology is associated with the development of hygiene standards, guidelines, sanitary standards 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 associated with the assessment of factors acting on a person. These 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, it is not for nothing that hygiene is called applied physiology.

To assess the impact of factors on certain systems of the body, biochemical, genetic, clinical and epidemiological research methods are widely used. To generalize the results obtained, statistical methods are widely used with the involvement of modern technologies.

Methods for studying the influence of environmental factors in natural conditions. This direction is called a natural experiment. What is associated with the study of the health status of certain groups of the population living under the influence of various environmental factors. In natural conditions, it is possible to study the influence of working conditions on the health of workers. The influence of the factors of the educational process on the growing organism of the child is also studied. Clinical and hygienic research is being carried out to develop the maximum permissible concentration of harmful chemicals in the working area. Thus, clinical and hygienic research and laboratory experiment complement each other and constitute a unified approach to hygienic research of the environment and human health.

Environment and health

The subject of hygiene is the environment and health. Extremely complex processes take place in the environment (ecosystem), biosphere. Some of these processes are associated with the action of factors aimed at ensuring the constancy of the quality of the environment (water, soil, atmospheric air). These are stabilizing factors. Other factors (and they can be natural, natural or associated with human activities, the so-called anthropogenic factors) lead to a violation of natural balance, harmony in nature. These are destabilizing factors.

In ecology, there is the concept of anthropogenic exchange. Anthropogenic exchange has natural resources at the input, and production and household waste at the output. Ecological anthropogenic exchange is extremely imperfect. It is open, open and 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, which shows the amount of natural resources used for the benefit of man. The efficiency factor for today is 2%, that is, 98% is an unused natural resource, and, moreover, this is the part of resources that acts as waste - environmental pollutants. Among these pollutants, there are substances that have a pronounced destabilizing effect, the so-called destabilizing factors. These include halogenated components, rare and heavy metals, substances with an ionizing effect, and other factors. In general, these factors, by the nature of their action, can be classified as physical or chemical. Chemical compounds are a serious hazard. The action of certain chemicals can lead to the development of destabilizing, destructive processes that lead to an increasing effect. This process is out of control of the person. It exceeds the effect of natural stabilizing factors, as a result of which the development of spontaneously uncontrollable, growing destabilizing phenomena is noted. Substances and factors that have such an effect are called super-ecotoxicants. Chemicals classified in this class are rare and heavy metals, ionizing radiation, halogenated components. All of them have a special nature of the effect on the human body, expressed in damage to cell membranes, in the development of disturbances in the enzyme systems of the body, disturbances in homeostasis, leading to destructive phenomena in the human body. Ecotoxicants are characterized by high resistance in the environment, stability. They are capable of accumulating in environmental objects. The stability and ability of chemicals to accumulate in the environment ensure their migration, which is extremely dangerous for humans and their environment.

A close interaction develops between the human body and the environment. The problem of the unity of the organism and the environment is the most important problem. It must be said that a certain form of balance develops between the environment and the organism. This balance of the environment and the body is formed as a result of the most important mechanisms of the physiological response of the body to the effects of certain factors and is carried out through the work of the central nervous system. This form of balance is the so-called dynamic stereotype, that is, if a factor acts constantly, is repetitive, the body develops stereotyped reactions. The emergence of new factors leads to the destruction of this balance. So-called excessive factors pose a particularly serious danger in this regard. They lead to a violation of the dynamic stereotype. Changes in the dynamic stereotype are associated with a significant dysfunction of the body: neuropsychic, stressful state, an 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 adaptation mechanisms of the organism. In the diagram, developed by the academician of the Russian Academy of Medical Sciences, Professor Yu. L. Lisitsin, according to the experts of the World Health Organization, the factors that determine the level of human somatic health are presented. 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 human 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 for a person, quality of the environment.

The environment influences the main indicators of the population's health (life expectancy, birth rates, physical development, morbidity and mortality). Moreover, there are a number of diseases that are pronounced in nature, depending on environmental conditions. These are environmentally related diseases. These include, in particular, a disease called "chronic fatigue syndrome." This disease is based on the membrane damaging effect and the effect on the enzyme systems of chemical pollutants and ionizing radiation. The adverse effect of chemicals leads to a sharp decrease in immunobiological parameters. Mass surveys of large cities show a dramatic change in the immune homeostasis of residents. A change in immunity indicators by 50% is noted among residents of Moscow. A situation arises that indicates the so-called secondary nonspecific immunodeficiency associated with exposure to the body of a number of adverse factors, including chemicals.

Assessment of the level of health of the population living in different environmental conditions, at present, makes us talk about the existence of ecologically caused foci of diseases. These diseases are associated with the pollution of the urban environment with rare and heavy metals, to the action of which the child's body is primarily sensitive. Therefore, the study of the impact of urban environment factors on the body of the population, especially children, is an urgent task of hygienic science.

Hygiene is preventative medicine. What is meant by prevention itself? There are concepts of primary and secondary prevention. Let's start with the concept of so-called secondary prevention. Secondary prevention is understood as a set of measures aimed at localizing and weakening the pathological process through active clinical examination, anti-relapse therapy, sanatorium treatment and medical nutrition, that is, secondary prevention is the activity that is carried out by practitioners. Hygiene, on the other hand, provides primary prevention. The basis of primary prevention is the elimination of the causes and factors leading to the occurrence of pathological processes, and diseases in general by improving the natural, industrial, household environment; the formation of a healthy lifestyle aimed at increasing the body's resistance and health. Prevention should be understood not only to prevent diseases and conduct health-improving measures aimed at protecting the health of the population, but the entire set of state, social and medical measures aimed at creating the most favorable living conditions for a person, fully meeting his physiological needs.

Hygiene is a preventive discipline, and hygienic rationing forms the basis of preventive measures.

Hygienic regulation

What should be understood as a hygienic standard? Hygienic standard - a strict range of parameters of environmental factors, optimal and harmless to maintain normal life and health of a person, 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. Sanitary rules are mandatory for all state bodies and public associations, enterprises and other economic entities, organizations, institutions, regardless of their subordination and forms of ownership, officials and citizens.

Hygienic standards for chemicals are established in the form of maximum permissible concentrations (MPC). 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 permissible concentrations. MPCs are established for harmful chemicals in the water of reservoirs, drinking water. MPCs are established for the content of harmful chemicals in the soil. In food products, harmful chemicals are standardized in the form of permissible residual amounts (MRL). For chemicals, maximum permissible quantities in water are set in milligrams per 1 dm 3, or 1 liter, for air - in milligrams per 1 m 3 of air, food products - in milligrams per 1 kg of product weight. MPCs characterize safe levels of exposure to harmful chemicals in certain environmental objects.

The remote control for the impact of physical factors is also installed. In particular, there is an idea of ​​the optimal and permissible parameters of the microclimate, ie temperature, humidity, air velocity, etc. The optimal permissible amounts of nutrients are established, and their rationing takes place taking into account physiological needs. There are the so-called physiological norms of the need for proteins, fats, carbohydrates, minerals, vitamins. When establishing MPCs for harmful chemicals in the environment, certain principles of hygienic regulation are observed, which include:

1) the principle of phasing;

2) the principle of threshold.

The staging in the standardization is that the work on the standardization is carried out in a strictly defined sequence associated with the implementation of the corresponding stage of research. For chemicals, the first phase of these studies is the analytical phase. The analytical stage includes an assessment of physical and chemical properties: data on the structure of a chemical, its parameters - melting point, boiling point, solubility in water and other solvents. For analytical studies, specific methods of determination are required. The second obligatory stage of hygienic research in establishing the MPC is toxicometry, that is, the determination of the main parameters of toxicity. Toxicometry includes conducting studies to determine the parameters of acute toxicity (acute toxicometry or, more simply, acute experiments). This is followed by a subacute experiment and a chronic sanitary-toxicological experiment.

The main and main task of acute experience is to determine the mean lethal concentrations and doses of LD 50 or CL 50. The staging of acute experiments makes it possible to assess the degree of danger of chemicals, the nature of the direction of action, the vulnerability of certain systems and functions of the body. Acute experiments allow the most reasonable approach to the setting of subacute and chronic sanitary-toxicological experiments. The staging of rationing also allows, in some cases, to reduce the volume of research, using the so-called principle of rationing by analogy, i.e., the study of the indicators of the estimated toxic substance by its physicochemical properties makes it possible to find out the presence of so-called analogous substances and carry out rationing using the principle of analogy. This approach is called rationing by analogy. For substances with similar properties, that is, the regulation of which is carried out by analogy, it is mandatory to establish the parameters of acute toxicity. The presence of acute toxicity parameters also makes it possible to reduce the volume of research and save a significant amount of material resources, as well as the time spent on the experiment.

An important stage in toxicometric studies is a 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 a subacute experiment, the most vulnerable systems of the body are also identified, which makes it possible to objectively approach the formulation of the main stage of toxicometry associated with determining the parameters of a toxic one under conditions of a chronic experiment. In a subacute experiment, a large set of toxicological tests is tested, assessing the effect 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 standardized 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 standardizing harmful chemicals in the aquatic environment, the study of the effect of the substance on the organoleptic properties of water and the sanitary regime of water bodies is mandatory, i.e., to establish the MPC of chemicals in water bodies, additional research stages are introduced. At all these stages of the study of exposure to harmful chemicals, threshold levels of exposure, threshold doses and concentrations are necessarily established. The limiting sign of harmfulness is determined by threshold concentrations, that is, the lowest concentration is established in which the effect of a harmful chemical substance is first of all manifested either on the organoleptic properties of water, or on the sanitary regime of a reservoir, or when assessing toxic properties. When establishing the maximum permissible concentration of harmful chemicals in the water of reservoirs, a limiting sign is revealed either organoleptic, or according to the sanitary regime, or toxicological. According to the limiting sign of harmfulness, taking into account the lowest threshold concentration, the MPC is established. Thus, the defining principles of rationing are the principles of threshold and staging.

The established principles for the regulation of chemicals and levels of exposure to physical factors form the basis of the current sanitary legislation.

MPCs allow, on the one hand, to control the content of harmful chemicals in the environment, on the other, to create a so-called control system for the content of harmful chemicals, that is, to monitor them in the environment. MPCs are also used in the design of industrial enterprises, MPCs are laid down in projects for the construction of industrial and other enterprises.

The structure of the sanitary service

The activities of the sanitary and epidemiological service in the Russian Federation are determined by the Law of the Russian Federation "On the sanitary and epidemiological welfare of the population."

Occurring in 2004-2005 in the country, the changes also affected the structure of the sanitary service. By the Ministry of Health and Social Development of the Russian Federation, the Centers for State Sanitary and Epidemiological Surveillance (TsGSES) were transformed into territorial departments of the Federal Service for Surveillance on Consumer Rights Protection and Human Welfare (TU) and federal state health institutions "Centers for Hygiene and Epidemiology" (FGU).

The main tasks The territorial administration of Rospotrebnadzor (TU) are:

1) state supervision and control over the fulfillment of the requirements of the legislation of the Russian Federation in the field of ensuring the sanitary and epidemiological well-being of the population in the field of consumer protection;

2) prevention of harmful effects on humans of environmental factors;

3) prevention of infectious and mass non-infectious diseases (poisoning) of the population.

Functions Territorial administration:

1) state supervision and control over the fulfillment of the requirements of the Russian Federation in ensuring the sanitary and epidemiological well-being of the population in the field of consumer protection;

2) sanitary and epidemiological supervision during the development, construction, reconstruction, liquidation of objects of urban planning, industrial construction; for the production, sale of products, for the operation of water supply systems, medical institutions;

3) organization and conduct of social and hygienic monitoring;

4) issuance of a sanitary and epidemiological conclusion on programs, methods, modes of education, training;

5) carrying out anti-epidemic measures, certification of the decreed contingent and exercising their control;

6) control of laboratory research and testing;

7) conducting sanitary and quarantine control.

The main task of federal state healthcare 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 the Territorial Office and the head of the 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 inspection in Russia is carried out in two forms. In the form of preventive sanitary supervision and current sanitary supervision.

Preventive sanitary supervision provides for the development of measures related to the introduction of health-improving, preventive measures at the stage of developing projects for industrial and civil facilities, the construction of communal facilities, when developing new technologies, introducing new food and industrial products, and children's toys. It should be especially noted the effective, and not contemplative role of the sanitary service in all of the above activities. In other words, prevention, preventive sanitary supervision should always go ahead of the person, and not follow him. This is the most important role of preventive sanitary supervision. Preventive sanitary supervision on the example of the construction of certain objects ends at the stage of its acceptance. It begins with the approval of the project, control over the progress of construction and acceptance. The most important point in the implementation of preventive sanitary supervision of facilities under construction is control over the progress of hidden work. After the acceptance of the object, the current sanitary inspection begins.

The current sanitary supervision covers almost all areas of activity of certain institutions, facilities on the territory of a particular settlement, district, region and the whole of Russia as a whole. Sanitary and epidemiological supervision authorities monitor the activities of industrial enterprises, communal facilities, preschool institutions, 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 facilities. 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 illegal, guilty, intentional or reckless actions or inaction associated with non-compliance with the sanitary legislation of the Russian Federation, including various sanitary rules and regulations, infringed on the rights of citizens and the interests of society. Hygienic standards, developed sanitary standards and rules ensure the effective implementation of preventive and current sanitary and epidemiological surveillance, effective implementation of measures to improve the environment and improve the health of the population.