<<
>>

Chapter 2 Base, the program, a research technique

The Northwest economic region covers two republics - Kareliya and Komi and a number of administrative areas - Murmansk, Arhangelyosky, Vologda, Leningrad, Novgorod, Pskov. The Kalininyogradsky area also gravitates to northwest region.

The area of the region occupying northern part of the Eastern Europe, makes 1677 thousand kvadyoratnyh kilometres (9,8 % from all territory of the Russian Federation). Region NaseleYonie by data for 01.01.93 years totaled 9.210.600 persons (about 10 % from all population of the Russian Federation). Population density sosyotavljaet 5,49 persons on square kilometre.

The Northwest region of Russia draws attention of many issledoyovatelej. Presence of a large centre of science - of St.-Petersburg has caused high value of the Northwest of Russia as one of the major centres on preparation of the qualified personnel, one of powerful scientifically-proizvodstyovennyh bases of the country. Scientists of a city execute a considerable quantity issledovayony in northwest economic region on various branches narodyonogo economy - geology, development and processing of minerals, mashiyonostroenie, power supply and many other things. Ecological, socially-hygienic researches have not stood aside and mediyotsinskie. The considerable quantity of works is devoted a state of health, revealing medikoyosotsialnyh risk factors of development of separate nosological forms, degree of influence of anthropogenous factors in environmental contamination. It is enough to name complex socially-hygienic researches sos -
Complex socially-hygienic researches of a state of health among children of the Novgorod area (Jurev V. K and co-workers., 1995); of Ukhta, Komi Republics (Absava T.A., 1995); the Pskov area (Krasavina L.V., 1993); Murmansk area (Gun G. E, 1994); the Arkhangelsk area (Makarova V. I, 1995).

As objects of the present research following bases of the seveyoro-western economic region have served.

The city of Novgorod. G Novgorod, as well as the Novgorod area as a whole, otyonositsja to typical areas of a nonchernozem zone of Russia located in the south of northwest economic region. The occupied space - 55.300 square kilometres. The area population by data for 01.01.93 years naschiyotyvalo 751.500 persons. Population density - 13,59 persons on square kiyolometr. The district has century history with developed natural demoyograficheskimi indicators. Now it is characterised vysokorazviyotoj by the industry which major branches are radioelektyoronnoe, chemical, derevoobrabatyvajushchee manufacture. At carrying out of meyodiko-social research in this region (Jurev V. K, Stukolkin O. N, the Physician of Century A, nechaeva E.N., 1995) by means of medicogeographical division into districts it has been established, that the most safe from the ecological point of view javyoljajutsja northern and northeast districts of a city of Novgorod. In these districts, along with the industrial enterprises (fiber glass combine, factory meyotalloizdely, the chemical combine working on a continuous cycle, deyorevoobrabatyvajushchy and television factories) and not numerous to -

rozhnymi highways the central park of rest, extensive lesyonye zones, large stadium and athletic fields settles down. In research it is included 1484 children living in specified districts of a city, that by data for 1993 makes 15,9 % from the general number of children of surveyed age group (9317 persons).

52 % of surveyed children boys have made, 48 % - girls.

Komi republic. It is located in the northeast of northwest economic region. The occupied space - 415.900 square kilometyorov. The republic population by data for 01.01.93 years totaled 1.245.700 persons. Population density - 3 persons on square kilometre. In it reyogione inspection of children of of Ukhta - second-large the centre resyopubliki Komi is spent. The Uhtinsky district is located in the central part of Komi RespubYOliki and occupies a small part of the Timano-Pechersky oil and gas province possessing various resources (coal, oil, natural gas, bauxites, titanic ores, building materials). In the thirtieth years in connection with development in rajyoone oil-extracting, and later petro-and gas-processing promyshlenyonosti has arisen Ukhta. The city located in a valley of the river of Ukhta, is characterised by an is moderate-continental climate with short cool summer and prodolyozhitelnoj in the frosty winter. The city population has developed is artificial, with appreciable vozrastno-sexual disproportions. It is bound to mass violent movings of able-bodied population to districts osvoeyonija mineral deposits in the thirtieth years. However, in process of city development there was a natural alignment of a demographic situation that has led to formation characteristic for our country
ki, that has led to formation characteristic for our country vozrastno-poYolovoj population structures. By data for 1993 in to Ukhta lived 27067 deyotej. As object for the present research 1535 children doshkolnoyogo age that makes 10,1 % from total of children given vozrasyotnoj the groups, living in Ukhta (15214 children) have served. 51,7 % of surveyed children boys have made, 48,3 % - girls.

Republic Kareliya. It is located in the northwest severo - the western economic region. The occupied space - 172.400 square kilometyorov. The republic population by data for 01.01.93 years totaled 799.600 cheyolovek. Population density - 4,64 persons on square kilometre. In this district inspection of children of of Segezha - second-large naselenyonogo republic Kareliya point is spent. The Segezhsky district is located in the centre resyopubliki Kareliya. The district is rich first of all with extensive large forests. Presence concerning the cheap electric power (system Vygsky gidroyoelektrostantsii) and immediate affinity of the largest water highway of the country (the Belomoro-Baltic channel) have brought the powerful contribution to development proyomyshlennosti district. Along with developed pulp-and-paper and derevoobrayobatyvajushchim manufacture in Segezhsky district maintains the aluminium factory largest in the country. District development has begun in the thirtieth years in svjayozi with building of the Belomoro-Baltic channel, development paper proyoizvodstva the countries. The district population, basically, has been generated isyokusstvenno, with appreciable vozrastno-sexual disproportions. As well as in
Komi to Republic it is bound to mass violent movings of able-bodied population to economically perspective districts to the thirtieth years. However, in process of formation of an infrastructure of district has occurred esyotestvennoe alignment of a demographic situation to formation harakyoternoj for our country as a whole vozrastno-sexual structure of the population. By data for 1993 in a city lived 11567 children. 850 children of preschool age that makes 13,1 % from the general number of children of the given age group (6477 persons) are included in inspection. 51,6 % of surveyed children boys have made, 48,3 % - girls.

On each of regions it is possible to consider sample volumes repyorezentativnymi (Otdelnova K.A., 1980), a parity of boys and girls in each region - comparable. Surveyed children have been parted on two age groups - 2-4 years and 5-7 years. The age period 2-4 years harakteriyozuetsja more significant changes "cross-section" anthopometrical pokayozatelej (a breast circle, body mass) also is called as the period "the first okrugyolenija". The age period of 5-7 years is characterised by more significant izmeneyonijami "longitudinal" anthopometrical indicators and is called as the period "the first vytjagivanija". Because studying of patterns of physical development in investigated regions was one of program sections issleyodovanija, has been decided to recede a little from the standard allocation doyoshkolnogo the period - 3-6 years (Jurev V. K, 1993).

The research program included a number of sections:

1. An expert estimation of a state of health of children (a clinical method).

2. An estimation of physical development of surveyed children.

3. The Mediko-social estimation of conditions and a way of life of children and families in which they live (a biographical method).

4. The Sanitary-and-hygienic characteristic of an ecological situation in regions in connection with its influence on a state of health of the children's population.

Clinical method. According to the first section of the program isyosledovanija, for the further studying of influence of a complex of mediko-social and ecological factors, it was necessary to receive the objective information on a state of health of children.

The fullest information not only on diseases, but also about patoloyogicheskih the conditions which yet have not caused diseases, give complex mediyotsinskie surveys with use of modern methods of diagnostics. However in the conditions of modern public health services far not everywhere there is a possibility to provide survey by all competent experts of a narrow profile, there is no necessary quantity of modern technics. At carrying out of planned routine inspections there is no possibility to provide presence of parents that does not allow to receive necessary volume anamnestic inyoformatsii about the child. The spent expert estimation of existing system of routine inspections of children (V.K.Jurev, 1989) shows, that surveys proyovodjatsja it is formal or are not spent at all; to 59 % of the diseases which are available for children, on routine inspections are not taped.

For the purpose of reception of the objective information on a state of health reyobenka synthesis of an individual approach with wide introduction avtoyomatizirovannyh the systems allowing is necessary both to enlarge coverage to constants moniyotoringom, and to raise objectivity and allocation doklinicheskih signs of disease with formation of groups of risk on various nosological foryomam.

The approach to the decision of problems of an individual estimation of health can be various: definition of a profile of health with a requirement establishment in konyosultatsii experts and a complex of improving actions; a choice konyosultatsii experts by direct contact of mother to the list of questions on the most widespread specialities and an immediate direction on consultation of definition of tactics of the further conducting by immediately advising expert.

If to go by definition of a profile of health the child should receive a ball estimation on each of surveyed experts and first of all to address to at what point above. At such approach the errors bound with prioritetnostju of a choice of experts as level of a ball estimation not always reflects true requirement for consultation are possible. Besides, at definition of a profile of health inspection time znachitelyono is enlarged.

In system of alternative answers mother does not contact with spetsialiyostom to which it does not have complaints. The choice of the expert is defined application
I eat solving rules under complaints of mother. Both solving rules, and questions which parents answer, should be repeatedly verifitsiyorovany, and parents should possess sufficient level of sanitary culture. Otherwise not to avoid appreciable erroneous decisions.

At an estimation of a condition of somatic health of children isyopolzovalas the automated system of screening-diagnostics "Sanus", razyorabotannaja experts St.-Petersburg state pediatricheyoskoj medical academy under the guidance of prof. V.V.Jureva, the prof. V.K.Jureva, dots. A.S.Simahodskogo, S.V.Lebedeva (1991). The system is effective sredstyovom for carrying out of mass routine inspections of the children's population. The given system is focused both on work with healthy children, and with bolyonymi and includes following blocks (subsystems): the block of the general data on the child and screening-questionnaire of interrogation of parents (it is filled with parents); the block "conditions and a way of life of the child" (it is filled with parents), the block of data dovrayochebnogo inspections (is filled with the medical personnel); the information block about reyozultatah survey by experts and tactics of the further inspection of the child (it is filled with doctors).

The given structure of the information completely corresponded to an expert medical estimation of a state of health of the child.

Key element of system is screening-questionnaire for interrogation royoditelej the child. On the basis of answers of parents, using the developed solving rules, and also data of pre-medical inspection, it was defined
Requirement for survey of the child by that or other expert in 10 basic narrow specialities of pediatrics (neuropathology, otorhinolaryngology, alyolergologija, gastroenterology, kardiorevmatologija, surgery-orthopedy, ophthalmology, nephrology, dermatology, endocrinology).

Screening - questioning of parents, pre-medical inspection of children and survey by doctors of narrow specialities were spent stage by stage and have been broken off in time.

Screening-diagnostics system "Sanus" provided the control program. The control was carried out by consecutive work of experts, the constant reference to the general part of the questionnaire. Questionnaire questions were postroeyony in such a manner that they in a little bit changed form some times vstreyochalis at different experts that allowed to supervise both correctness of answers of parents, and work of doctors. Besides, the system provided obligatory survey of an ENT-doctor, the surgeon-orthopedist, the oculist, and also zakljuchiyotelnyj survey of the pediatrist which allocated the basic and accompanying diagyonozy, defined group of health of the child. Final survey allowed to estimate quality of the passed routine inspection, to develop tactics of the further inspection and improvement of children.

Diagnoses were verified on the International classification of illnesses, traumas and causes of death of the Ninth revision (MKB - І).

All results of routine inspection were duplicated in otryvnom the coupon of the questionnaire which or remained with parents, or was transferred in put -
I will hold down an out-patient department on a residence where it was pasted in f.112/at and allowed to carry out continuity between the experts inspecting, and local service.

Thus, automated system "Sanus" has allowed realizoyovat following functionality: database creation about sostojayonii health of children; revealing of children of group of risk on 10 narrow spetsialnoyostjam pediatrics; definition of level of social risk for each child; an estimation of physical development of children, formalisation of the conclusions of experts; generating of the necessary accounting documentation.

Survey of children on 10 narrow specialities of pediatrics was spent vyyosokokvalifitsirovannye by employees St.-Petersburg state peyodiatricheskoj medical academy. Attraction to work in different regions of the same doctors allows to speak about reliability of an estimation of health deyotej and legitimacy of carrying out of the comparative analysis of the received data. At an estimation of influence of a complex of factors on health of the children's population in kacheyostve a productive sign the group of health of the child was used.

Estimation of physical development of children. For an estimation received pokazate - pour physical development tables tsentilnogo type soyoglasno to methodical references "Anthopometrical screening have been used at mass routine inspections of children" (L, 1991) and "Preventive maintenance cardiovascular zaboleyovany at children's and youthful age" (SPb., 1992).

The medical estimation of results of measurements depended on the received data in tsentilnyh intervals. In a single-step estimation it is accepted to carry to variants of norm the measurements carried to 3-5 intervals, that is in a zone from 10 to 90 tsentilej. Position of results of measurement in a zone of 2nd interval pozyovoljaet to speak about the "lowered" indicator, in a zone of 1st interval - about "low". Accordingly, position in 6th interval speaks about "raised" pokazateyole, and in 7th interval - about "high". Tactically it is necessary to consider, that zones of 2nd and 6th intervals are the basis for including of the child in groups "nabljuyodenija the local pediatrist" and, accordingly, to 2nd group of health; zones 1го and 7th intervals testify to necessity deepened diagyonostiki for differentiation of possible diseases. Presence 3 internal tsentilnyh the zones entering into borders of average or normal indicators (zoyony 3-5), allows to supervise earlier and thin shifts in development and a food of the child at dynamic measurements. At an estimation of indicators isyopolzovalas the following scale:

- TSentilnyj interval N 1 (to 3 tsentilja) - area of the "low" indicators meeting no more, than at 3 % of healthy children;

- TSentilnyj interval N 2 (from 3 to 10 tsentilja) - area "lowered" pokazayotelej, healthy children meeting at 7 %;

- TSentilnye intervals NN 3, 4, 5 (from 10 to 90 tsentilja) - area of "averages" poyokazatelej, inherent 80 % of healthy children;

- TSentilnyj interval N 6 (from 90 to 97 tsentilja) - area "raised" pokayozatelej, healthy children meeting at 7 %;

- TSentilnyj interval N 7 (above 97 tsentilja) - area of the "high" indicators meeting no more, than at 3 % of healthy children.

All possible range of a variation of changes is represented as follows:

- TSentilnaja zone N 1 (more low 3 tsentilja) - low indicators;

- TSentilnaja zone N 2 (3-10 tsentili) - the lowered indicators;

- TSentilnaja zone N 3 (10-25 tsentili) - indicators below averages;

- TSentilnaja zone N 4 (25-75 tsentili) - average indexes;

- TSentilnaja zone N 5 (75-90 tsentili) - indicators above averages;

- TSentilnaja zone N 6 (90-97 tsentili) - the raised indicators;

- TSentilnaja zone N 7 (above 97 tsentilja) - high indicators.

In the presence of one of anthopometrical indicators in the first or the seventh tsentilnom a corridor the child concerned group of disturbances fizicheyoskogo developments. According to I.I.Bahraha and R.I.Dorohova's (1975) scheme, all children without ozhiyorenija and oligotrophies have been carried to one of three somatotipov: mikro - meyozo - or macrosomatic. Reference of the child to one of somatotipov proyoizvodilos according to the sum of numbers of areas or "corridors" tsentilnoj shkayoly, received for length of a body or body mass.

At a score to 9 child concerned to microsomatic tiyopu (physical development below an average); at the sum from 10 to 16 points
(Inclusive) - to mesosomatic type (physical development an average); at the sum from 17 points and more - to macrosomatic type (physical razviyotie above an average).

For each child the harmony physical razvi - tija was defined. Harmony definition was spent on the basis of the same results tsentilnyh estimations. In case the difference of numbers of areas between two poyokazateljami did not exceed 1, the child concerned group of children with harmonious development; if this difference made 2 - development was considered disgarmonichyonym and if the difference was equaled 3 and more, development was considered sharply disgarmoyonichnym.

For the purpose of an estimation of a condition of a food of children the parity of mass of a body and length of a body was defined. The estimation was spent on special group of the tables which lines represent rows tsentilnyh mass distributions teyola in relation to certain length of a body. By analogy with resulted above tsentilnoj a scale, hit of required size of mass of a body in area of 1st koyoridora allowed to carry the child to group of children with "very low" food; in area of 2nd corridor - with a "low" food; in area of 3rd corridor - with pitayoniem "below an average" etc.

Measurement of length of a body, masses of a body, head and breast circles provoyodilos average medical workers of preschool institutions.

The mediko-social estimation of conditions and way of life of children and families, in koyotoryh they live

Health of the child can be surveyed in various aspects: sotsiyoalno-biological, sociopolitical, economic, moralnoyoesteticheskom, psychophysiological, etc. In our problem entered to survey health of children basically from socially-biological positions. The main things predyoposylkami for this purpose is that it is impossible to define health and illness voyoobshche, and it is necessary to speak about health and illnesses of people. And it obliges podhoyodit to the person not only as to a biological, animal organism, but also as to a being biosocial. Health of the modern person acts reyozultatom natural evolution of kind Homo sapiens in which gradually nayorastajushchee influence was occupied with social factors, their role for 10000 of development of a civilisation has increased in every respect. The person receives health in izvestyonom sense as nature gift, he has inherited from the animal ancestors priyorodnuju a basis, the behaviour program in this world. However, in process sotsialiyozatsii health level changes either in one, or in other party, nature laws are shown in the person, the unique form inherent only to the person. Biological it is never shown in the person in purely natural kind - it is always mediated by the social.

Problem of a parity social and biological in the person - a key to understanding of the nature and character of its health, its illnesses which should be treated as biosocial categories. Health and illnesses of the person on sravyoneniju with animals is new, mediated social quality.

Social conditionality of health proves to be true mnogochislenyonymi mediko-social researches on which basis it was possible to calculate approximately, that health is caused: in 50 % - conditions and a way of life, in 20-25 % - a condition of external environment, in 20 % - genetiyocheskimi factors and in 5-10 % - public health services condition. In this connection, tseyolju the present section of research was - to establish influence mediko-soYotsialnyh factors on a state of health of children of compared regions.

The program of socially-hygienic research of a family has been put in a basis of mediko-social inspection of the child and his family, razraboyotannaja prof. O.V.Grininoj (1977) and adapted for a children's contingent. This program included a number of sections (the appendix 1).

1. The period before conception of the child.

Questions have been included in this section of the program characterising: nayolichie at mother of abortions till a birth of the given child; smoking of mother to bereyomennosti; abusing alcohol mother, the father; presence at them hronicheyoskih diseases; age of parents; presence (one year prior to offensive beyoremennosti) professional harmfulnesses at mother and the father, long primeyonenie hormonal agents before pregnancy.

2. The pregnancy period.

The given section included following questions: smoking of the pregnant woman, including "passive" smoking; abusing the woman during time beremennoyosti alcohol; a pregnancy current, in particular presence of an early toxicosis,
Late toxicosis, threat of an abortion, threat of a pre-natal becoming infected of a foetus, other complications and somatic diseases; whether was bereyomennost desired or the woman tried to get rid of it; application during pregnancy of hormonal preparations.

3. The labours, the first year of a life.

This section included the questions defining: presence of complications in sorts (a birth trauma, an asphyxia, an icterus of newborns, etc.); mass of a body of the child at a birth; a prematurity; donoshennost; perenoshennost; priyomenenie obstetric grants in sorts ("Cesarean section", obstetric forcepses, vakkum-ekstraktsija); duration of sorts; later the first applying to a breast; time of an excommunication from a breast.

4. Conditions of a life and education of the child.

At the analysis of this section following questions were considered: whether the family in which the child having many children is brought up is, "full"; a family financial position; living conditions; an alcoholic life of a family; "passive" kuyorenie the child; presence in a family of invalids; "lying" patients, serious onkoyologicheskih the patients sick of mental diseases; presence of serious psychological stresses in the anamnesis at the child; observance by the child of a regimen of day, a dream, walks; "zhelannost" the child.

All questions listed above have been generalised in two special blocks of the program "Sanus" - the block "risk Mediko-social factors" and the block "the Socially-hygienic characteristic of the child and a family, in which it vospiyo
tyvaetsja "also are brought in the questionnaire. The specified blocks have been filled by parents on all children who were examined by experts.

The Sanitary-and-hygienic characteristic of an ecological situation in regions.

Hygienic estimation of a condition of ground layers of atmosphere osnovyvayolas on the analysis of total emissions of the enterprises of region (on stat.otchetnym foryomam 2TP-air), data on concentration of impurity in sublayers atmosfeyory (according to stationary and routeing posts of observation) with the account kliyomatogeograficheskoj and the meteorological characteristic of districts. The specified data have been received in regional committees of wildlife management, gidrometeoyosluzhbe, TTS GSEN.

At performance of an expert estimation distribution predpri - jaty regions on industrially-municipal zones is spent and the characteristic of total emissions on promzonam is given qualitative and koyolichestvennaja. On a basis anayoliza emissions of xenobiotics by the enterprises of districts calculation prioritetyonyh for definition in atmospheric air of impurity on stationary posts is made. For the characteristic of levels of pollution of ground layers atmospheric vozduyoha calculation of complex indicator R for each stationary and routeing post for various terms of time averaging (month and year) is carried out.

Modern methodical approaches according to a condition of atmospheric air of industrial cities are based on the analysis of total emissions predyoprijaty and an estimation of the maintenance of xenobiotics in ground layers of atmosphere.
It is known, that for objective comparison of levels of pollution ground sloyoev atmospheres in various districts of a city on all stationary and routeing posts should be defined the same bonds, characteristic for the given settlement. In this connection have been allocated priority for opredeleyonija in air of substance by calculation of criteria and danger categories (KOV і) for 60 bonds. Total emissions have been put in a basis of calculations zagrjaznitelej on districts, their daily average maximum concentration limits and factor, uchityvajuyoshchy a class of danger of substances.

The analysis of level of pollution of atmospheric air, from the point of view of its health hazard of the population, it is more expedient to spend not according to frequency rates of excess of concentration of separate impurity in ground layers of atmosphere, and on the complex indicator considering specificity of their influence on a human body and possibility summatsii of biological action of xenobiotics, at a time present at air. In this svjayozi the complex indicator paid off - the River frequency rate of excess of maximum concentration limit of substances, their class of danger, an admissibility is put In a basis of calculations povtoyorjaemosti concentration of the set level, and also quantity of substances, odyonovremenno present at air. In a kind of that accumulation biologicheyoskogo effect of influence depends on duration of the appendix of "the operating beginning", at calculation R maximum concentration limits differentiated on time are considered: suyotki, month, year. The estimation of level of pollution of atmospheric air is given on 5 positions: Admissible, weak, moderated, strong, very strong.

The hygienic estimation of a condition of water objects and conditions vodopol - zovanija was spent on the basis of the analysis of total dumps of the enterprises in prirodyonye mediums (on stat.otchetnym to forms 2ТП - vodhoz), estimations of analyses laborayotornyh the researches characterising water underground and land vodoyoistochnikov (on hydrometeorological service datas of laboratory, gorvodokanala and TTS GSEN), estimations of the organisation of the centralised water supply (according to TTS GSEN and gorvodokanala). Researches were spent with the account klimato-geografiYocheskoj, hydrological and hydro-geological characteristics of water objects of regions.

Carrying out of an expert hygienic estimation of conditions of water use has demanded distribution of the enterprises dumping sewage in nazemyonye water sources, to groups depending on a locating in relation to the central water fence and sites of the water sources used for the kulyoturno-household purposes; with an estimation on separate ingredients and the complex indicators characterising quality of water and conformity to its specifications; carrying out of a tentative estimation of self-clearing ability vodoistochyonikov; a preliminary hygienic estimation of a condition of underground waters, isyopolzuemyh for the centralised economic-drinking water supply; the analysis of the organisation of the centralised economic-drinking water supply of the population from superficial and underground water sources.

Methodical approaches existing for today to an estimation of anthropotechnical influence on superficial water objects and the organisation
Systems of sanitary protection of reservoirs use scientifically-proved normayotivy qualities of water as for sources rybohozjajstvennogo appointments, and used for the centralised economic-drinking water supply and recreational water use. At a substantiation admissible and definition of a real load of pollution on water object, prioritetnosti introductions giyogienicheskih references on water use improvement, a choice optiyomalnogo a complex of water security actions carry out an estimation of a sanitary condition of water object, as on separate estimated indicators (opyoredelenie excess of an indicator over its standard value), and on settlement - complex. There is a uniform scientific opinion, that the control over pollution of superficial waters should be conducted on the chosen set otseyonochnyh the indicators depending on the "know-how" and characteristic for sewage of each industry in studied region. To sozhaleyoniju, such unity is not present in relation to a complex estimation of superficial reservoirs. Methods used by various departments differ on tseyoljam, to working out principles, criteria of an estimation, volume and character of the available information, a way of formalisation of data. At a choice of a method of such estimation we made a start from well-known position, that the load on water object depends on its self-clearing ability. Last in turn opredeyoljaetsja the biocenoses established in the studied reservoir, and rate fiyozicheskih and chemical transformations arrived in it poljutantov, that is certainly bound to a hydrology of a reservoir and climatic conditions (at
Low temperatures there is a retardation chemical and biological proyotsessov). It is clear, that toxic influence on originally developed bioyotsenoz leads their qualitative and quantitative intersystem izyomeneniju, thereby changing (often slowing down) biotransformation processes, that gradually leads to appreciable deterioration of water of a reservoir on appreciable distances. It is promoted by rationing of quality of water in a water use place, that allows the enterprises to carry out dumps stochyonyh waters with insufficient degree of clearing (or even without clearing) in water vodoyoema, breaking thereby processes of its self-cleaning. In any measure niveliroyovanie these processes it is reached at the expense of carrying out corresponding saniyotarnyh actions in the second girdle of zones of sanitary protection (ZSO) at the organisation of the centralised water supply. Thereupon it is offered peyorejti from an estimation of structure and property of water in points of water use of the population to the demand of the maintenance of substances in the concentration which are not exceeding maximum concentration limit in sewage. This demand is already legalised concerning the sewage dumped in water objects in line of settlement (SanPIN \4630 / $8 і the item of a-complex estimation of water sources it has been chosen a little meyotodik, allowing to estimate both self-clearing ability of a reservoir, and quality of water in various solutions from positions of public health service and them rybohozjajstvennogo appointments.

For a river estimation, as source of economic-drinking appointment, isyopolzovalsja a pollution index - FROM (SanPIN N4630-88), providing
4 degrees of pollution. Its definition is made on the basis of degree prevyyoshenija the estimated indicators concerning four criteria of harm (organoleptic, toxicological, obshchesanitarnomu and bakteriologiyocheskomu), to their standard sizes accepted in hygiene of water supply. The total estimation is given on a limiting indicator.

Other complex indicator which has been used in work and considered demands rybohozjajstvennyh reservoirs - pollution factor - KZ, the offered V.V.Belogurovym from co-workers. (1984), allowing chisleno otseyonit the processes changing in time, characterised by many pokazateyoljami structure and property of water and waters defining quality in many points of water object. In a basis of a method authors put "tridimentionality" of concept "quality of water" (time, indicators, space). When priyonimaemye for a norm basis are defined by the most "exacting" kind of water use, the primary goal of a complex estimation is definition of the numerical characteristic of sizes of disharmony of quality of water to the established norms, i.e. definition of degree of impurity of water object. By such pokayozatel it is named by factor of impurity KZ. KZ it is peer to zero only when among all measurements of quality of water there is no breaking ustanovyolennye specifications. Integrated approach of an estimation of level of pollution by means of KZ is reached at the expense of definition on all three "measurements" of concept "quality of water": on time, on indicators and on controllable alignments (triad sumyomirovanie). In the present work the basic updating of it paid off
Indicator a-indicator focused on the account of deviations from specifications on separate ingredients. The technique gives the chance to count up not only the general KZ for water object or its site, but also generalised harakteyoristiki impurities on one any indicator on a site and on all poyokazateljam for one alignment. Normalised ingredients, it is the most frequent vstreyochajushchiesja in superficial waters (rybohozjajstvennye reservoirs), break into groups depending on a limiting indicator of harm.

1группа - the integrated indicators characterising processes samoochishcheyonija of water of reservoirs - the dissolved oxygen, BPK, HPK.

2группа - substances and the bonds having toxicological limitirujuyoshchy an indicator of harm (LPV) - ammonium, nitrites, copper, zinc, fluorine, cadmium, cobalt, arsenic, iron, HAVING fallen down, sevin, Cyanidums, a formic aldehyde, etc.

3группа - substances and the bonds having sanitary-toxicological LPV - Zinci sulfases, Sodium chloridums, Sodium nitritums, a potassium, calcium, magnesium, sodium, vanadium, molybdenum, lead, mercury, rodanidy, etc.

4группа - substances and the bonds having rybohozjajstvennyj LPV - nefyoteprodukty, Phenolums, etc.

KZ it is expedient to consider quarterly, for a year, for the fifth anniversary.

The received numerical value (for example, 1.98) says that soyoderzhanie in water of normalised substances on the average on 198 % exceeds maximum concentration limit or quality of water at 1.98 time is worse than the standard.

Self-clearing ability of the river was estimated by a technique, predloyozhennoj by J.V.Novikovym and S.I.Plitmanom (1992). Authors offer otseniyovat intensity of self-cleaning on a number of indicators and their parity (БПК5/БПКполн.; BPKpoln.; HPK; LPK/FPK; a solution; oxygen; Сі/Ci pores. s/r). Intensity of self-cleaning is regarded on four positions: udovyoletvoritelnaja, insufficient, low, the lowest.

Adverse influence of pollution on mezhplastovye waters in sayonitarnoj to practice is characterised by change of physical, organoleptic properties, a water chemical compound in relation to background indicators, and also occurrence of uncharacteristic impurity for natural waters.

For processing of the received data on the personal COMPUTER of type IBM PC/XT/386 following agents were used:

- The program dBase3 + versions 1.1, Ashton-Tate, USA, 1987. With its help the database for the subsequent statistical processing is generated;

- Package of applied programs of statistical data processing Statgraphics 3.0, Manugistics Inc., USA, 1988. Korelljatsionnyj the analysis was used for revealing of interrelations of quantitative signs. Regressionnyj the analysis was applied at modelling of prognosticated factors. In process modeliyorovanija the mechanism of revealing of significant factors was used, regress factors were estimated;

- Program RuleMaker (joint-stock company IT Ltd version 2.3., C.-nemep6ypr, 1992). With its help preliminary search of patterns in files danyonyh is spent;

- Package of applied programs of statistical processing of results of researches BMDP-90 of version PC90 (1990, IBM, PC/MS-DOS), Cork Technology Park, Model Farm Rd., Cork, Ireland.Элементарная the statistics (Mm, G, protsentyonoe distribution, etc.) was spent by means of the program 1D, 2D. DostoYOvernost differences of signs it was estimated under programs 3D, 7D with calculation of t-criterion Stjudenta, Fisher's F-criterion. For the decision of questions of the forecast isyopolzovalsja the step-by-step discriminant analysis (the program 7M).

- Program Microsoft Excel for Windows 4.0a, Copyright@1985 - 1993, Microsoft Corp.С by its help were spent automated tablichyonye calculations. For definition of force and character of communications of qualitative signs and character of communications of qualitative signs the analysis of tables was used soprja -

2 zhennosti with criterion calculation h.

- The block of "statistical processing" programs "Sanus". From it poyomoshchju ranging of data of questioning, clinical and obsleyodovanija children is executed.

Research was spent in 1993-95.

<< | >>
Scientific source Homich Michael Mihajlovich. COMPLEX MEDIKO-SOCIAL ESTIMATION of HEALTH of CHILDREN VISITING PRESCHOOL INSTITUTIONS, In VARIOUS REGIONS of the NORTHWEST of Russia. The dissertation on competition of a scientific degree of the candidate of medical sciences. St.-Petersburg - 1996. 1996

Other medical related information Chapter 2 Base, the program, a research technique:

  1. Chapter 7. The PROGRAM CONCEPT CHRONIC HEPATITISES At CHILDREN And TEENAGERS
  2. the Table of contents
  3. Chapter 2 Base, the program, a research technique
  4. Chapter 2 The FLUKA Monte Carlo Code