1
THE RUSSIAN ACADEMY OF MEDICAL SCIENCE
THE STATE ESTABLISHMENT SCIENTIFIC RESERCH INSTITUTE OF
HUMAN ECOLOGY AND HYGIENE OF THE ENVIRONMENT NAMED
AFTER A.N. SYSIN
Printed as manuscript
SOBOLEV VLADIMIR ANATOLEVICH
THE SCIENTIFIC GROUND OF THE SCREENING EXAMINATIONS AND
CURATIVE MEASURES AMONG THE CHILDREN LIVING ON
ECOLOGICALLY UNFAVOURABLE TERRITORIES
14.00.33 Public health and health service
Specialities: 14.00.07 Hygiene
Thesis for the degree of the Candidate of Medical Sciences
Scientific advisers: I.E. Zykova, Ph.D. (Medicine)
L.F. Kiryanova Ph.D. (Biology)
Moscow, 2008
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CONTENTS
ABBREVIATIONS
3
INTRODUCTION
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CHAPTER 1. REVIEW OF THE LITERATURE. HEALTH STATUS OF
CHILDREN AS A CRITERION OF SOCIOHYGIENIC WELFARE OF THE
POPULATION
1.1 The socio-economic factors and their impact on the children’s health.
1.2 Ecology and sickness rate of children (factors and the development of
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7
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specific pathological conditions)
1.3 Approaches to prevention and rehabilitation of ecologically-dependent
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diseases of children
CHAPTER 2. MATERIALS AND STUDY METHODS
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CHAPTER 3. SANITARY-HYGIENIC CHARACTERISTICS OF THE STUDIED
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AREAS.
3.1 Sanitary - hygienic characteristics of the studied towns in the Sverdlovsk
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region
3.2 Sanitary - hygienic characteristics of Novomoskovsk of the Tula region
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CHAPTER 4. EXAMINATION RESULTS OF THE CHILDREN IN THE
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SVERDLOVSK AND TULA REGIONS
4.1 Examination results of children in the Sverdlovsk region
4.2 Children examination using bioresonance diagnosis method
4.3 The results of children examination in Novomoskovsk of the Tula region
CHAPTER 5. RISK GROUPS DEPENDING ON THE HEALTH OF CHILDREN
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53
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63
AND DEGREE OF ENVIRONMENTAL STRESS OF THEIR RESIDENCE
CHAPTER 6. MEDICAL-ECOLOGICAL REHABILITATION OF CHILD
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POPULATION FROM ENVIRONMENTALLY UNFAVOURABLE ZONES
CONCLUSION
83
CONCLUSIONS
85
LITERATURE
86
APPENDIX
102
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ABBREVIATIONS
VRT - vegetative - resonance test of bioresonance diagnostics
SHM – sanitary-hygienic monitoring
SOP – stable organic pollutants
ASIS - automatic state information systems
PAHs - polycyclic aromatic hydrocarbons
API - air pollution Index
Ksum. - total index of air pollutants on the population
AIC- aggregate index of complex load of air pollutants on the population
Br - soil contamination relative index
Zsum - soil contamination average total index
Zp - snow cover contamination average total index
MPC - maximum permissible concentration
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INTRODUCTION
Human health is one of the important indicators of well-being of society, precisely reflecting the nature
of economic and social developments in the country. The high level of morbidity and mortality indicates
the current crisis, the need for in-depth study and adoption of urgent measures to improve the health of
the population [61]. Particularly alarming in the trend among children, whose bodies are in the stage of
growth and on interaction even with minimal adverse environmental factors react by pathological
development.[68, 6, 7]
The increased sickness rate of children in Russia (on the basis of clinical examination in 2002) was
recorded for all categories of diseases according to the report “On the health status of children in Russia
during the period from 1992 to 2002”. [7, 51] According to the government statistics, the sickness rate
of child population is increasing annually by 4-5 %. At the present time no more that 10 % of children of
senior preschool age and no more than 5 % of children of older adolescents can be considered
completely healthy. Almost 60% of children have chronic diseases. In separate industrialized regions of
Russia up to 40 % of pathological changes of health are due to harmful effects of air pollution and water
pollution, soil, poor quality of food, production environment, level of medical care and life conditions.
Significant contribution of environment factors to the development of various types of pathology of
children makes it necessary to develop a system of medical and ecologically rehabilitation of children
living in ecologically disadvantaged areas. To form high risk groups among children’s population to carry
out adequate medical and preventive measures it is necessary to take into account the relationship
between the health status of children and factors of environment, which to some extent are indicators
of risk. In this regard, it seems topical the introduction of noninvasive methods of screening of diseases,
allowing to draw significant numbers of children and develop a system of approaches to their recovery.
In 1998 at the initiative of a number of environmental experts (Federal Environmental Fund of Russia,
Association of environmental funds of the RF), doctors (Children’s Republican Clinical Hospital, Research
Institute of Transplantation and Artificial Organs), sociologists (Center for the Protection of Children and
Adolescents “Preodolenie”). There was established Ecorehabilitaion Health Сentre “Green House”. Its
primary objective is the realization of the principle of human medical skilled care of every child or
teenager. With it all it was proposed that a special attention would be given to children living in
disadvantaged, in terms of ecology, regions. Modern methods of diagnostics, qualification of clinicians
of various specialities allowed to work out the original technologies of diagnostics treatment, prevention
and rehabilitation of children living in adverse environments.
The study was carried our within the framework of the All-Russia Public Movement “Children – the
future of Russian”. Funding of the program “Sanatorium rehabilitation of children from areas of
ecological trouble, suffering from chronic diseases for 2000-2002”, was provided at the expense of the
Federal Environmental Fund of Russia, the regional public organization “Hematologists of the world to
children”.
Environmental Safety Policy provides for a comprehensive solution of the three key tasks: prevention
and reduction of environmental pollution, protection and restoration of natural complexes,
rehabilitation of the health of the population living in ecologically unfavourable territories.
Significant improvement of ecological situation in the coming years doesn’t seem possible, so in this
situation the only effective way to oppose anthropogenic environmental factors is medical-ecological
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rehabilitation, allowing to minimize the risk and harm to human health in large industrial cities.
Recommendations of the State Duma to the RF Government and to the subjects of the Federation in
letter № 3.13-684 of 26.08.98 indicate the necessity to implement rehabilitation programs.
Statistics show and increasing number of diseases of the musculoskeletal and endocrine systems,
mental and nervous disorders, chronic respiratory diseases, infectious and parasitic diseases, disorders
of the immune status, malignant tumors of children. Taking into consideration that environmental
factors contribute significantly to the development of pathological processes of children, there is a need
for early preclinical diagnostics and development of a system of medical - ecological rehabilitation of
children living in ecologically unfavorable areas.
The purpose of the study: the scientific justification of the use of rational methods of screening and
medical-ecological rehabilitation of children living in ecologically unfavourable areas (for example,
settlements in Sverdlovsk and Tula regions).
Objectives:
1. Analysis of the sanitary conditions of the selected areas.
2. Screening and in-depth survey of children in the selected locations to form high-risk groups with
ecologically dependent violations of health.
3. Evaluation of information of non-invasive autonomic-resonance electro-diagnostic test (VRT),
used as a method of prenosological diagnostics to form risk groups among child’s population.
4. Development of a different approach to the choice of the principles bringing into a healthy state
of child’s population of ecologically unfavourable areas.
Scientific novelty of the study.
It was been development and tested in practice an integrated approach, based on screening tests of the
child’s population living in ecologically unfavourable areas, to indentify children having a high risk of
ecologically dependent diseases in order to carry out a set of preventive and curative measures in
accordance with a risk group.
Practical significance and implementation of the research results.
The obtained results are recommended for use in practical work of health authorities to rehabilitate
children from areas of ecological trouble, evaluation of sanitary-hygienic state of the environment and
social conditions of environment where children live on the basis of the high prevalence of certain
diseases, as well as for assistance to health service in conducting consultations and survey of children in
their regions. A survey of children with the help of non-invasive method of bio-resonance diagnostics
(VRT) allows to screen at the optimal time and thus significantly reduce, the time and cost to indentify
prenosological and chronic diseases of children.
The results of the studies are used to develop “Medico-ecological rehabilitation of the population sub
program” under the program “Environmental Protection in Tula region in 2001-2005”. The devised
method of organizing and conducting health measures is implemented in several other regions
(Arkhangelsk, Moscow, Yaroslavl regions, Primorsky Kray, the Republic of Karelia, and Khakassia) with
the participation of the State Enterprise “International Children’s Center”, which is one of the
participants in the federal target program “Development of All-Russia children’s centres “Eaglet” and
“Ocean””. In 2001-2005 2,638 children were sent to get some rest and health-environmental
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rehabilitation to rest homes and sanatoriums. The methodical educational materials for children and
parents were issued.
Regulations issued for the protection.
Population peculiarities in ecologically unfavourable areas form the specific structure of infant morbidity
and determine the severity of pathology.
A rational approach to screening to identify child’s pathology in view of ecological trouble areas allows
to determine risk groups and to develop an adequate strategy for bringing into a healthy state and
preventing ecological diseases of children.
It is advisable to use non-invasive method of bio-resonance diagnostics (VRT) to determine the extent of
toxic load on the body while examining large numbers of children in ecologically unfavourable areas.
Personal contribution of the author.
The author was personally involved in the conduct of all sections of the work: development of the
research program, formulation of goals and tasks grounding for the used methods, the organization of
the children survey, collecting materials, carrying out statistical processing, analysis and discussion of
results.
Testing of the work.
The results are reported at:
 Scientific and practical conference “Modern problems of ecology and health of children” in
Novomoskovsk, 2001, with the participation of the medical institutions (Russian State Medical
University, Institute of Pediatric Hematology and others) and public organizations;
 Scientific and Practical Conference “Ecology and health of children” in Moscow, 2002.
 International Conference “Theoretical and clinical aspects of bio-resonance and multiresonance
therapy” in Moscow, 2004.
 XV Moscow International Homeopathic Conference “Development of a homeopathic method in
modern medicine”, 2005.
Volume and structure of the thesis.
The work is described in 111 pages of typewritten text, consists of introduction, 6 chapters, resolution,
conclusions, bibliography, annexes. The literature index contains 135 works, including 103 domestic and
32 foreign authors. Illustrative material is presented in 6 chapters of the thesis in 27 tables, 20 figures.
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CHAPTER 1. REVIEW OF THE LITERATURE. HEALTH STATUS OF CHILDREN AS A CRITERION OF
SOCIOHYGIENIC WELFARE OF THE POPULATION.
1.1. Socio-economic factors and their impact on children’s health.
1.2. Ecology and sickness rate of children (factors and the development of specific pathological
conditions).
1.3. Approaches to preventions and rehabilitation of ecologically-dependent diseases of children.
1.1 Socio-economic factors and their impact of on children’s health. Studies of factors affecting health,
showed that about 50% account for socio-environmental conditions and lifestyles, 18-25% - biological
and genetic, 10-20% - climatic and environmental influences, 10-15 % - health organization (68,72], i.e.
social and environmental factors are leading among other reasons that affect health.
It is known that economic growth indexes cannot be the only indicators of society development. At
present, the formation of a social state became a state philosophy of European countries with a social
market economy. In Russia the transition to a market economy extremely strained social problems and
led to an abrupt decline in population living standard which focuses the results of the state in social
policy. According to Goscomstat of Russia, in 2000 in Russia 30,2% (nearly one third of the population),
had cash incomes below the subsistence level. The standard of living, i.e. the extend of the vital
interests of the people and their preferences, is one of the most important integral characteristics of the
socio-economic system. At 29th UN Statistical Commission Session in February 1997 was approved the
minimum national social data set recommended by the Working Group on International Statistical
Programs and Coordination of the UN Economic and Social Council, half of them (7 out of 14) are health
and hygienic indicators [27].
Children’s health is the most important integral indicator of their well-being in specific social conditions
and reflects an integrated system of material and spiritual relationships that exist in a society. Every
aspect of public policy is reflected in one way or another on the medical characteristics of the children’s
population. In the period of a social and economic crisis first of all suffer the least socially protected
sections of a society which include children as well. In the early 90-s children of Russia were the first to
take the blow of “shock therapy”. Splash of morbidity and mortality of children signaled the public about
the viciousness of the new adopted guidelines of the socio-economic transformations. In 1993 the infant
mortality rate rose sharply to 19,9 per 1000 births (in 1990 – 17,4 per 1000). In the Russian Federation
1990-1998 are characterized by a steady deterioration of the health status of children and teenagers. Of
the total number of children born in 1998 only 20% can be considered healthy, 44% are at risk and 35%
were born sick [12]. Children at the age of 0-14 years old had frequency of hyperthyroidism 3,8 times as
many, diseases of the musculoskeletal system and connective tissue 2,2 times as many, anemia 2,2
times as many, diseases of the circulatory system 2,1 times as many, allergic diseases by 71,4%,
neoplasms by 74,1%. Maximum growth rates of the diseases’ number are found among teenagers. The
frequency of anemia has increased 3,8 times more, diseases of the endocrine system – 2,8 times,
diseases of the musculoskeletal system – 2,6 times, diseases of the digestive system-1,9 times, allergic
diseases – 1,6 times, diseases of the circulatory system – 1,9 times. The number of children with
functional disabilities and chronic diseases significantly increased. Reactive states and psychopathies, as
a response to the negative impact of environmental factors, have grown in children by a third.
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“Trofologichesky syndrome” – disharmonic physical development, reduction of functional reserves,
delay of sexual development becomes typical for teenagers [6,7]. In subsequent years (1999-2003) the
situation with children’s sickness rate has not only improved but continued to deteriorate: there was
marked increase in sickness rates for all major classes of diseases [76]. Statistics of morbidity of
population, including children are generally based on visits of doctors. Clinical examination results most
fully characterize a picture of health status of the population. Clinical examination allows to identify not
only chronic and acute diseases with clinical manifestations but also early, preclinical forms proceeding
without violating of organs and systems function. [19, 51, 99]. It should be noted that a five-year period
of 1991-1995 had the lowest socio-economic indicators for the period of 1966-2000 [76]. At that time
Russia’s government was forced to admit that during conducting economic reforms accompanied by
declining living standards of the population consequences of their impact on children’s conditions were
not taken into account, compensatory and protective measures were not held in necessary volume.
Among the most significant social (non-medical) conditions and factors impacting negatively on
activities of medical services of children’s health protection determining the main trends in dynamics of
indicators of their health status are lack of funding of health and medical science, the adverse socioeconomic conditions of the majority of the population, continuing environmental degradation in many
regions.
As mentioned above, children’s health can serve as an indicator of social welfare, and the State’s
attitude to children determines the degree of its civility. The instability of the social economic situation
of recent years has noticeably worsened the situation of children, possibilities of a family, the state
concerning their livelihoods and development. This has resulted in deterioration of the main indicators
that determine the health of the child population.
A vivid illustration of the role of social factors in forming health, physical development and functional
status of children are the results of the study carried out by the Institute of Social Hygiene Economics
and Management of Health, N.A. Semashko RAMS. Survey of parents of 1100 children (Muscovites of 4years old attending kindergartens) clearly demonstrated in influence of a social status of families on a
child’s health – the distribution of ratings indicates a worse situation of health among those children
who are brought up in the economically less advantaged families. Social differences affect the
prevalence of harmful habits in a family, recreation and sport activities: the proportion of children
travelling to resorts with their parents, as well as involved in sport activities twice as big among
wealthier families. Socio-economic status of a family affects not only a level of physical development of
a child, but also his progress at school, an opportunity to visit additional classes (music, foreign
languages), i.e. the process of comprehensive development of a child [32, 98, 48].
1.2. Ecology and sickness rate of children (factors and the development of specific pathological
conditions).
Adverse social and economic factors, increased sharply in recent years, mental stresses and demands to
the mechanisms of stress-stability not only adults but also children and teenagers significantly affect
their mental health. For example, territorial analysis of areas of Volgograd has shown that visiting
doctors by children in connection with mental disorders is higher in regions with low per head income of
the working population [66, 97].
Mental health of children begins to develop in the prenatal period. Exposure of mother to heavy metals,
polycyclic aromatic hydrocarbons leads to a violation of a reproductive function, complicated childbirth,
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may cause neurotoxic effect on a fetus. The consequence of this may be a subsequent decline of
cognitive functions of a child and his intellectual development [65, 90, 121].
Child’s body is more sensitive to the action of harmful factors including carcinogenic. Moreover their
impact can begin as early as a prenatal period of development of an organism, when a mechanism of
the so-called transplacental carciongenesis is switched on. It should be also indicated that children’s
malignant tumors are among medical and geographical health criteria of population used in assessing an
ecological status of a territory. Areas with excess child’s cancer incidence rate in 1,5-2 times are referred
to zones of extreme ecological situation in 2 or more times – the zones of ecological disaster. As
additional indicators of an ecological condition of a territory the data of the violation of women’s
reproductive function (a complication of the course and outcome of pregnancy), are used a frequency of
low birth weight (less than 2500 g), etc. [37], as the state of the reproductive function is the most
important biological and social indicator of women’s health. Her condition is affected by many factors,
including factors of production and environment, socio-economic indicators of life and etc. [87, 83, 122,
127]. As epidemiological data show there is a strong connection between a violation of women’s
reproductive function and cancer risk of posterity. Thus, according to a large national study it was found
a trustworthy connection between children’s cancer risk and pathology of the pregnancy. Parents’ work
under the influence of harmful factors also significantly increased the risk of cancer with children. In this
connection it should be noted that a profession is often a marker of social status of a man [85, 86].
Speaking about the role of various factors in forming children’s health we must not forget that Russia is
divided into climatic, administrative and economic regions, sharply different in accordance with levels of
development. Natural and climatic conditions have a tremendous impact on living standards in Russia,
because the territory is crossed by several climatic zones. In adverse climatic and environmental
conditions of emergency a child has an additional stress of functional systems which contributes to the
formation of hidden and then apparent deviations in health status and imbalance to physiological
standards of central Russia [15, 93]. These data revealing the fundamental biosocial regularities of
formation of health directly indentify the need and urgency of solving social problems related to
livelihood of children, including these items in the strategic documents on development of the country
and close monitoring of their practical realization at all levels [49]. This is especially important that the
negative effect of harmful environmental factors on a child’s body appears more actively on an
unfavourable social background [91, 92, 31].
Children’s health is one of the most sensitive indicators of the change in environmental quality. As the
level of pollution is increasing the number of children in the population with ecological changes of
health is increasing too. [114, 115].
The reaction of a child’s organism to an impact of unfavourable environmental factors is sufficiently
non-specific and is characterized by reduction of immunologic reactivity and deterioration of general
health indicators. Moreover sensitivity of children to suck an effect is particularly enhanced during
critical periods of their growth and development. It is the highest with the embryo, newborn and a child
of an early age [102, 128, 133].
WHO studied a part of environmentally caused diseases among children of the European Regions [96].
The results convincingly showed that about one-third of all children and teenager’s morbidity (0-19
years old) can be attributed to unsafe and unhealthy environmental conditions [127, 131, 134, 130,
132]. The United States face similar problem. The USA in the 20th century infant mortality from asthma
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doubled, significantly increased the child’s leukemia and brain tumors. Encephalopathies got a wide
spreading. [124, 135].
Due to the urgency of the problem, WHO had established a special subdivision dealing with the problem
of “environment – children’s health”. In 2003 this problem was declared the main theme of World
Health Day. Currently the major studies to assess the impact of pollution on children’s health are
focused on solving of the following tasks:
 Assessment of air pollution and air quality of homes as a risk factor for asthma and other allergic
diseases of children;
 Revelation and evaluation of chemical and physical risk factors development of leukemia and
brain cancer of children;
 Revelation and evaluation of an impact of chemical risk factors including SOP, lead and mercury
on the neuropsychiatric status of the child;
 Revelation and evaluation of an impact of chemical risk factors on an endocrine status and a
reproductive system of a child.
As a rule, children more than adults, spend time outdoors. Because of the physiological needs of a
child’s organism, children are basically more physically active which is accompanied by an increase in
pulmonary ventilation [117]. Air pollution by various toxicants even at low concentrations leads to an
increase of level of their effects on a child’s organism [104, 105, 111, 129].
Under the influence of xenobiotics children suffer various clinical manifestations which are determined
by a class of substance dangerous a duration of exposure as well as age and individual sensitivity (106,
107, 110, 112).
Clinical spectrum of environmentally determined syndromes and diseases is extremely wide, and their
detection and differential diagnosis are extremely challenging. Children living in areas of ecological
trouble, together with general deterioration of health indicators showed increase in the frequency of
allergic diseases (allergodermatozy, food allergy), the respiratory organs (acute pneumonia and
bronchitis, bronchial asthma), congenital malformations, diseases of the nervous system, gastro intestinal
tract,
kidneys,
and
ENT-organs,
there
endocrinopathy,
stunted
physical
and
neuropsychological development (Table 1.2.1).
According to leading experts involved in the study of the health status of children in regions of ecological
trouble, all these manifestations characterize the environmental maladaptation syndrome [13, 100]. It is
known that the physiological adaptation abilities of a child's organism to rapidly changing environmental
conditions is lower than of adults’. Growing child's organism is most sensitive to external influences. This
primarily refers to children of the first years of life,
Table 1.2.1
Comparative analysis of the main forms of pathology of children (per 1000 people) in the areas of
ecological trouble and on average in Russia *
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Prevalence
Pathology form
On average in Russia
In the areas of ecological
trouble
Allergic diseases
35
180
Food allergies at an early age
70
400
Asthma
10
24
Respiratory allergies
48
122
Recurrent bronchitis
6
94
Vegeto-vascular dystonia
12
144
Gastritis and gastroduodenitis
60
180
Nephropathy
33
187
Chronic diseases of the nose, sinuses
21
31
Chronic tonsillitis
116
239
Chronic otitis
7
9
Encephalopathy
30
50
* According to U.E. Veltischev’s data, 2000. quote from: [101].
when the most intensive development of the organism occurs. As the physical mass during the growth
of a child increases his body accumulate various xenobiotics selectively depositing in certain tissues and
organs. It’s connected with physiological characteristics of a child's organism: increased permeability of
skin and blood-brain barrier, mucous membranes of the respiratory and digestive systems, the low
acidity of gastric juice, immaturity of liver enzyme systems, low glomerular filtration rate of kidneys,
immaturity of a system and general immunity [33, 116].
With increasing concentration of xenobiotics, intensity or time of exposure of physical and biological
factors and their combinations with each other, adaptive systems of a body begin to work with greater
congestion, there is a failure of strain compensation and a state of exhaustion or depletion of separate
systems take place. This condition is called "anthropo-ecological exhaustion" and is characterized by
failure of adaptation mechanisms to transition to a disease [13]. It creates a basis for greater sickness
rate of child’s population and a growth of environmentally caused diseases. Prolonged exposure of low
concentrations of xenobiotics on the body of a child has a genotoxic, metabolic and carcinogenic effects,
fermentopathic membranopatological action [14, 5]. A major feature of a child’s organism is existence
of critical periods of growth and development when sensitivity of a child's body to external pathogenic
factors (xenobiotics, physical factors) is increasing. As a result of increasing body weight of a child
nonmetabolized xenobiotics are constantly accumulated in his body (polychlorinated compounds,
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dioxins, heavy metals, etc.) selectively depositing in certain tissues and organs. The embryo, newborn
and a child of an early age have the highest sensitivity to chemical agents. Placenta has a sufficiently
high permeability for these substances, which creates conditions for their accumulation in fetal tissues
[44]. Birth defects and development anomalies can be the result of it [74, 36, 79, 80]. There is a direct
link between air pollution (suspended solids, sulfur dioxide, carbon monoxide, nitrogen dioxide) and the
frequency of stillbirths in industrial cities [23].
Investigation of the role of metals in the genesis of various diseases of children shows that some metals
are uniformly distributed in various organs (chromium, manganese, cobalt, nickel, arsenic, selenium).
Other metals (cadmium, mercury) cumulate; in renal tissue [30, 58, 63, 70, 108, 119, 109]. The kidneys
are the main organ egesting endogenous and exogenous toxins. It has been found a high risk (absolute,
relative, attributive) of forming of nephropathy and abnormalities of urinary organs of children living in
a region polluted with heavy metals salts [62]. Accumulation of lead and cadmium in biological media of
a child's body with immune imbalance contribute to a chronic disease of a gastrointestinal tract, kidney
and urinary tract infections of children [81, 57, 59, 95, 126].
The immune system is one of the major homeostatic systems of a body and largely determines a degree
of human health and its adaptive capabilities [24]. Child's immune system can be regarded as a sensitive
indicator reflecting environment pollution [67, 50.113].
This primarily refers to a body of children of the first years of life, when the most intensive development
is carried out. In the process of a child’s growth and increase of physical weight, many xenobiotics are
accumulated in his body, and they are selectively deposited in certain tissues and organs. Critical periods
of development of the immune system are established, when the impact of xenobiotics leads to a
change or distortion of immune reactions that leads to allergies, or to the oppression of the immune
reactions, ie formation of secondary immune deficiencies [1, 2, 45].
In numerous studies conducted in different regions of the country, the relationship between the level of
environmental contamination by anthropogenic chemicals and morbidity of children in traced [125, 4,
11, 47, 46].
In large industrial cities with high levels of air pollution the frequency of abnormalities in the physical
and neuro-psychological development of children, allergic diseases, the manifestations of secondary
immunodeficiency, chronic inflammatory or degenerative diseases, cancer is increased [77, 8, 94, 18, 56,
43, 31].
In the centers of metallurgy disease incidence of children with chronic diseases of the respiratory,
digestive and central nervous system, skin, eyes, including allergic diseases is 40% higher than in the
relatively "clean" areas and cities [69, 17, 123].
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Ecologically unfavourable areas are characterized by a high frequency of endocrinopathy, most often it
comes to thyroid disease [75]. Chronic somatic diseases, the presence of chronic foci of infection in
otolaryngology and urinary tract infections, manifestations of secondary immunodeficiency or allergy
are found with 40% of children [84].
It is shown that in zones of ecological tension and crisis, where there are elevated levels of atmospheric
pollution by hydrogen sulfide, hydrocarbons, ammonia, sulfur-fluoride gas, there is a backlog of children
in physical, neuro-psychological development, there is a high prevalence of chronic disease 3-4 times
larger than disease incidence of children of "clean" regions [22, 118].
Diagnosis of environmentally dependent diseases of children consists in comparing of data on
environmental contamination by xenobiotics with indicators of hypersensitivity of a child's body. It
should be taken into account the age reactivity and possible hereditary predisposition of a child to an
illness. The complexity of ecological and hygienic diagnosis of disease of children is that this may not be
specifically expressed morbidity associated with the change in the reactivity of a child's body. On the
other hand, it may be non-specific manifestations of a specific origin, due to the influence of factors that
have tropism to different organs and systems. And finally, it can be diseases caused by indirect effects of
exogenous factors that have become pathogenic under the influence of the environment [42].
Establishment of cause-effect link between an illness of the child and an action of a certain chemical
agent is an important and challenging task. A child who is suspected of environmentally dependent
disease is to be carefully clinically examined with skin test, functional and load tests, a full clinical
analysis of blood, urine and in accordance with testimony - determination of xenobiotics and their
concentrations in biological fluids and substrates (blood, urine, hair, precipitated teeth removed polyps
and tonsils). It has become topical the use of new technologies to identify the causes of health
deterioration by examining the results of socio-hygienic and ecological monitoring of the factors
stipulating for the reduction of public health, as well as the mathematical prediction of the risk of
disease in the childish population [34, 35, 47]. To confirm the causal role of xenobiotics in a disease of a
child modern techniques of molecular biochemistry, genetics and immunology are used. Now such
methods are available only to clinical institutions, general hospitals and children's ecopathologi centres
[28, 29, 75, 38].
1.3 Approaches to prevention and rehabilitation of ecologically dependent diseases of children.
From the above there is a need for targeted state and regional programs of prevention and
rehabilitation of children with ecologically dependent pathology as the right of a child to health
protection. The legal basis for the creation of these programs are the following regulatory documents of
international and state level: The UN Convention on the Rights of the Child (1990); World Declaration on
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the Survival, Protection and Development of Children (2000); Constitution of Russia (1993) ; Basic Laws
of Russia on Health Care № 5487-1 (1993), the Law "On Basic Guarantees of the Rights of a Child in
Russia", the Law "On Sanitary and Epidemiological Welfare of Russia; RF Government Resolution of 29
December 2001 № 916 "About the all-Russia system of monitoring of the state of physical health,
physical development of children, teenagers and youth”; Concept of demographic development of the
RF for the period up to 2015 (Government Decree of 24.09.2001. № 1270-p); RF Government Resolution
dated June 1, 2000 № 426 "On Approval of the sanitary-hygienic monitoring" (as amended on April 29,
2002). It should be emphasized that the above mentioned documents are only a small part of the legal
framework upon which is based the scientific, medical and organizational activities aimed at improving
the health status of children. A presidential program "Children of Russia" has been working sinece 1993.
In 2003, the subprogram “A Healthy Child" is included in it and is financed. It says in particular: "The
impact of environmental and socio-psychological factors, the intensity of which in the past decade has
increased immensely, leads to the fact that children’s health is assessed as catastrophic. In the subjects
of the RF the proportion of healthy children is from 4 to 10 percent. One of the reasons for the
progressive deterioration of children’s health, especially infants and teenagers, is the inefficiency of
ongoing preventive and rehabilitative measures aimed at preserving and strengthening physical and
mental health of children and teenagers, adaptation to changes in social, economic, ecological,
educational environment".
The problem of progression deterioration of children’s health is multifaceted. According to the above
data, the imperfection of the legislative regulation of children's health protection, the negative effects
of socio-economic changes in the country, the ambiguity of organizational changes in the field of health
care, etc. have been focused in it. So far as the problem is interdisciplinary in nature, for its
comprehensive solution it is necessary to attract structures of different profile and the level from
federal, regional to non-governmental organizations and funds, which aim to protect public health. The
decisive condition is to be a systematic approach in which each block of the system is interconnected
with its other components, has clearly defined objectives and methods of their solution.
An important system unit is the existence of well-organized and structured dynamic information base
which tasks include the following [34, 35]:
• monitoring of environmental pollution both according to individual pollutants of classes I and II
toxicity and according to their total effects (in the case of single direction of pathogenic action);
• choice of diseases that can serve as markers of ecological trouble in the region;
• periodic refinement of the relationship between morbidity and the nature and level of chemical
pollution of the environment;
15
• creation of integrated medico-ecological databases according to "marker" nosological groups of
different territorial-administrative levels (from regional to federal);
• medico-ecological ranking of territories in accordance with various degrees of threat to health;
• dynamic risk assessment and forecast of changes in health status of children in accordance with a
changing environmental situation;
• assessment of effectiveness of natureprotective measures.
This system is to operate within the SHM, as directly corresponds to its tasks, and it is to lean on existing
automatic state information systems (ASIS) “Health – Environment”. In addition it provides the basis for
the following units, namely: the territorial arrangement of priorities in solving environmental problems
and the formation of groups of high risk of development of ecologically dependent diseases of children.
Together with forming these blocks the first priority is to define the criteria and ranking problems [53].
Thus, a formation of high-risk groups taking into account the existing harmful factors, and pathological
conditions caused by them proposes a development of criteria which depend on the specificity of a
harmful factor (content in environmental objects, route of entry, etc.), the nature of pathology caused
by it, child population groups which are most affected by its influence, etc. As a result, it defines the
principles of clinical examination, rehabilitation and prevention of ecologically dependent diseases of
children. Thus, the overall system of program activities for the prevention of ecologically dependent
diseases of children can be represented as follows:
1. Improving the legislative, regulatory, organizational, scientific-technical and economic base of
prevention
2. Creation of an information base - a system of paired registers according to environment condition and
population health of different territorial-administrative levels on the basis of monitoring of the
environment and health.
3. Formation of high risk groups of children of ecologically dependent pathology.
4. Medico-prophylactic and medico-biological activities.
Clearly, each block requires detailed work and linkages with other blocks. For some compounds, such as
lead that carries a serious health threat to children there is a special program "Protecting the
environment from lead pollution and reduce of its impact on human health" [81]. The materials above
illustrate a complexity of the problem and the need for an integrated approach to its solution. To
resource ensuring of such programs financial means of the federal budget are attracted as well as
16
means of the RF subjects, companies and organizations engaged in technological improvements, grants
and funds aimed at solving the major humanitarian problems [81].
Conclusion
A great number of literature devoted to the impact of environmental factors on children's health shows
the actuality and diversity of the problem. Improvement of health or medico-ecological rehabilitation of
children from areas of ecological trouble is the rehabilitation and expansion of children's adaptive
capacities of an organism, increase of its resistance to multiple environmental factors and, in conditions
of living in a city. To implement it to improve health or medico-ecological rehabilitation of children from
areas of ecological trouble, it is necessary to create the conditions and implementation of a complex of
measures aimed at protecting and strengthening children's health, broadening of their adaptive
resources [21]. Despite efforts at different levels (federal, regional, etc.) and in different directions,
there is no improvement of health of children’s population - statistics say quite the contrary. Worsening
socio-economic status of large population groups requires a differentiated approach at working out and
implementation of prevention and rehabilitation programs to various social groups including children, as
well as taking into consideration socio-economic, environmental and climatic characteristics of a region.
Taking into account the fact that the effect of harmful environmental factors is more active on the
socially disadvantaged background, one of the priority is the task of not only medical but also social
rehabilitation of children. For successful implementation of hygiene and preventive measures to reduce
the influence of harmful factors on human health it is required awareness of population and
preparedness of medical personnel, i.e. ecological and sanitary education and public education. It is also
important cooperative efforts of scientists, physicians, ecologists, hygienists, a combination of
theoretical and practical approaches for effective rehabilitation of children from ecologically
unfavourable areas [90]. Medico-ecological rehabilitation of children living in zones of ecological
trouble, should take into account specific harmful factors and severity of their consequences. So it is
necessary to determine a burden of the most important toxicants, in particular, heavy metals, and
diagnosis of pathology. On the base of the accurate diagnosis it is possible to develop a strategy and
tactics of preventive and rehabilitative measures.
17
CHAPTER 2. MATERIALS AND STUDY METHODS
The object of the study was the child’s population living in settlements of the Sverdlovsk (19 towns) and
Tula (Novomoskovsk) regions, which are characterized as ecologically unfavourable territories. In the
Sverdlovsk region examinations of children were conducted by two teams of pediatricians on two
routes: the 1 st route included the towns: Revda, Pervouralsk, Kamensk-Uralskiy, Artyomovskiy,
Bogdanovich, Irbit, Turinsk, Tavda, Cushva, the 2 nd route passed across the towns: Ivdel, Karpinsk,
Sosva, Kachkanar, Krasnouralsk, Verhnya Tura, Nizhniy Tagil, Verhnya and Nizhnya Salda, Nevyansk. (The
map of the Sverdlovsk region showing the towns where the surveys of children took place (Appendix 1).
According to the State report "On the sanitary-epidemiological situation in the Sverdlovsk region in
2003" the most disadvantaged localities, from the point of view of the environment condition are towns
included in the study: Nizhny Tagil, Kamensk-Uralskiy, Krasnouralsk, Pervouralsk, Revda, Bogdanovich,
Artyomovskiy, Verhnya Salda, Irbit, Ivdel [25].
The surveys were carried out in the period of 2000 - 2003 by a visiting group of pediatricians, experts of
a number of leading children's hospitals and research institutes of Moscow. Comprehensive survey was
carried out: by a cardiologist, endocrinologist, gastroenterologist, neurologist, orthopedist,
dermatologist, neonatologist, electro diagnostics experts. Along with outpatient examination the
examination included both consultations and treatment of children in hospital. Epidemiological
ecological examination included a comparative multigrop analysis of the results of clinical examination
of children executed according to one methodological protocol. This examination was conducted by the
search screening method. Patients with certain medical problems are usually exposed to this method.
Contigents of children for the examination were formed in accordance with directives of local
pediatricians who participated in this study. A preliminary briefing was conducted with doctors. It
targeted them to select children on the basis of ecologically dependent disease: often and prolonged ill,
chronically ill and children who need advice of narrow outline specialists as well as children with
polisimptomatik that doesn’t not fit the nosological form. Administration and health authorities
included in the examination of the towns participated in the organization of medical examinations of the
child’s population. Mass media (press, TV) announced about conducting medical examinations of
children and teenagers by a Moscow group of highly qualified doctors. In this regard, both children with
the direction of medical institutions, and children whose parents decided to bring them to the survey
themselves, came to the examination. It should be emphasized that the examined contingent was not
representative to a children's population of the regions because it was a "condenced" selection with the
predominance of children with chronic diseases.
In the Sverdlovsk region in 19 towns in 2003, 3183 children of all age groups (from 0 to 17) were
examined. The number of consultations was 5565.
18
In Novomoskovsk of the Tula region in 2000 medical experts examined 933 children of all age groups
(from 0 to 17). The number of consultations was 1642. In the outpatient department of the Republican
Children's Clinical Hospital (RCCH) of Moscow fifteen children with a diagnosis of bronchial asthma were
re-examined, thirteen children were hospitalized for verification of the diagnosis. In the Tula region
organization of medical examinations of children was carried out base on the Novomoskovsk Children's
Hospital with the participation of local health authorities.
The clinical examination consisted of examination of a child, study of a history of medical records and a
survey of parents, consultations of other specialists when it was necessary. As a result of the
examination "Health passport" was filled in. It included: passport data (name, surname, date of birth,
address), information about parents (date of birth, education, occupation), extracurricular activities
(participation in circles, sports activity and others), a list of previous diseases, information on medical
examinations, recommendations on health improvement (residential treatment, hospitalization in a
specialized medical facility, spa treatment, etc.) (Appendix 2).
Then on the base of the examination the final diagnosis was formed, and recommendations for in-depth
examination, treatment and preventive measures were given. Conclusions about a child’s health
included the diagnosis (main and concomitant diseases). Assessment of a child’s health was conducted
in the light of previous diseases, existing chronic diseases, functional status of the leading systems, the
level and nature of functional and mental development (questionnaire in Appendix 3).
In the Sverdlovsk region in addition to a comprehensive clinical examination, 953 children were
examined using vegetative resonance test (VRT) for prenosological diagnosis and evaluation of modified
adaptive processes. Child's body hypersensitivity to heavy metals was determined. Vegetative
resonance test (VRT) is one of methods of electro-punctural diagnostic which is a further development
of electro-punctural diagnostic of P. Foll. It allows to carry out an integrated assessment of human
health, revealing itself as changes in adaptive processes [52,53,54]. Electropunctural diagnostics were
applied for examination of children in the Sverdlovsk region in the light of the preliminary hygienic
characteristic of the towns were the children lived. This method is the result of synthesis and in-depth
development of methods and electro-punctural and bioresonance diagnosis. This method is based on
the correlation between changes of the electrically conductive properties of the measuring points and
the functional state of the corresponding organs and systems. When interpreting the data obtained by
this method, the standard terminology for this method of classification was used. The term "toxic
encumbrances" means an indication of the presence of unfavourable factors of different nature:
chemical, physical, biological, on the principle of "yes-no" [103].
19
Usage of the method of VRT is shown for: 1) the integral functional assessment of organs and systems
condition, 2) topical diagnosis of pathological process with the help of proper preparations 3) etiological
diagnosis with the help of various nosodes.
While forming diagnosis test data, computer processing, medical history and clinical examination were
taken into account. In processing of the examination results the status of various body systems was
etimated: nervous, cardiovascular, endocrine, digestive, respiratory, urinary. In all groups, an analysis
indicating the content of toxic metals was carried out. All patients with positive reaction for mercury,
lead, cadmium, chromium, molybdenum and cobalt were included in this group.
The survey of children by the method of electro-punctural diagnostic (VRT) was conducted on the "Miniexpert-PK" apparatus using computer software of IMEDIS allowing, to determine the degree of damage
of various organs (License № 99-03-000420 of 29 December 2005; Health Ministry of the Russian
Federation approved for use in medical practice, № 99/96, 2000).
953 children were examined (children and teenagers aged from 1 year to 17). Taking into account the
nature of the screening examination, a survey was conducted only on the control points of the
examination with subsequent computer processing. When analyzing the results there were taken into
account: the complaints of the child, the information obtained from the parents, the results of physical
examination, specialists consultaions. It should be noted that for all methods of diagnosis there is an
inherent mismatch between the sensitivity and specificity, i.e. an increase in sensitivity will be
accompanied by a decrease in specificity.
As a result of clinical examination were formed groups of children with high risk of chronic disease
development and living in adverse social and ecological conditions. The children selected during the
examination were sent to a commission to decide the issue of rehabilitation in the specialized
sanatorium departments. First of all children with chronic main disease, living in adverse social and
environmental conditions were selected. Sanatorium treatment of the patients was carried out in
specialized departments of sanatoriums.
Diseases were coded according to the International Classification of Diseases of the 10 th revision (ICD10). The prevalence indexes of all diseases and some of their types in examined groups were calculated.
Processing of the resulting examination data was carried out using statistical methods (programs Excel,
SPSS., etc.).
20
CHAPTER 3. Sanitary-hygienic / Characteristic of the Studied areas
The factors determined the choice of children screening areas in this study were: the presence of
sanitary-hygienic characteristics of the territories excluding an additional hygiene surveys,
environmental adversity of territories [25, 26]. Hygienic criteria for choosing areas of children
examination were as follows:
• High multi-component burden of environment;
• availability of substances of the first and second class of danger in the environment;
• adverse health and demographic indicators that 2-3 times or more as big than the baseline in the
republic (high morbidity including certain kinds of pathology);
• active growth of cancer sickness rate (the Sverdlovsk region takes the first place in the Russian
Federation according to cancer sickness rate level of children);
• the need for highly specialized pediatric care to people living in remote from health centres areas.
The selected areas that meet the above conditions included 19 industrial cities in the Sverdlovsk region
with the presence on their territories, ferrous, nonferrous metallurgy and mining industries and the
town Novomoskovsk of the Tula region - the centre of the "great" chemistry. Health problems are
mostly related to environmental pollution defined by the negative impact of industry primarily ferrous
and nonferrous metallurgy and automobile transport. Industry is responsible for more than 80% of the
volume of pollutants coming into the atmosphere from all stationary sources recorded in Russia. Twothirds of the volume of pollutants are discharged by enterprises of electric power engineering,
nonferrous and ferrous metallurgy, oil industry. Indexes of the emission of pollutants into the
atmosphere in the Russian Federation included in the study of the areas in 2000-2002 are presented in
Table 3.1.
Table 3.1
Emissions of pollutants into the atmosphere in the Sverdlovsk and Tula regions in 2000-2002.
[Goskomstat Russia data]
Subject of the Russian
Federation
Emitted pollutants (thousands
of tons)
Caught and
neutralized, %
21
2000
2001
2002
2000
2001
2002
The Russian Federation
18819,8
19123,6
19481,2
77,9
76,2
74,5
The Ural Federal District
4562,3
4864,6
5570,9
74,7
73,4
66,7
The Sverdlovsk region
1470,7
1407,1
1221,1
86,5
86,8
86
The Central Federal District
1597,1
1543,9
1524,0
77,6
77,2
77,5
The Tula region
210,0
208,2
168,9
78,3
77,3
78,2
Accumulation of extremely dangerous toxic chemical compounds in the environment relates to a
number of prior contemporary problems connected with threat to environmental condition and to
public health. Persistent organic compounds: organochlorine pesticides, dioxins and dioxin-like
compounds, polycyclic aromatic hydrocarbons (PAHs), have high toxicity, are resistant to degradation,
are characterized by bioaccumulating, accumulation in ecosystems of water and land.
3.1 Sanitary- hygienic characteristics of the studied towns in the Sverdlovsk region.
According to the official statistics, the Sverdlovsk region is among the regions of the Russian Federation,
leading on account of the volume of harmful emissions into the atmosphere. Socio-hygienic monitoring
data showed that in the Sverdlovsk region about 3 million people live in areas with unfavourable
sanitary and hygienic conditions and are heavily influenced by various environmental stresses (chemical,
biological, noise, radiation, etc.), which stipulates in its turn, a low level of the population health.
According to the degree of influence on the level of the population health and population quantity
affected by adverse effects, environmental risk factors are ranked in the following order of priority on
ecologically unfavourable territories of the Sverdlovsk region (Table 3.2).
Table 3.2.
Ranking of the major groups of risk factors of the environment for health of the Sverdlovsk region
population.
Rank n \ n
The main groups of environmental factors Exposed
population
quantity
(million
that lead to the overall environmental people) and % of average regional quantity.
burden to the population
1
2
Integrated chemical burden (formed by 2, 9 million people., 64%
water, air, soils of residential areas, food)
Biological burden and connected with it 1,95 million people., 50%
22
risk
of
infectious
diseases
due
to
microbiological contamination of drinking
water, food)
Radiation dose burden (due to all dose- 2,55 million people, 45%
3
forming factors)
Noise pollution in residential zones
4
1, 2 million people.,
29%
Extranormative pollution is typical for air, drinking water, soil and food grown on land close to cities.
Priority risk factors to human health associated with pollution of environment in the studied towns, are
presented in Table 3.3.
Table 3.3
Priority risk factors to human health associated with pollution of environment in the studied towns of
the Sverdlovsk region.
Pollution
chemical
Cities
biological
drinking
water
drinking
air
soil
water, soil
Kamensk-Uralskiy
+
+
+
+
Cushva
+
+
+
+
Pervouralsk
+
+
+
+
Revda
+
+
+
Krasnouralsk
+
+
+
Irbit
+
Verhnya Tura
+
Artyomovskiy
+
+
Nizhniy Tagil
+
+
+
+
+
+
23
Sysert
+
Tavda
+
Turinsk
+
Ivdel
+
+
V. and N. Salda
+
Kachkanar
+
Nevyansk
+
Karpinsk
+
Complex chemical burden
Over 64% of the population of the Sverdlovsk region (or 2.81 million people, including 469 thousand
child’s population) live in the condition of a complex chemical burden.
Negative impact on health has chemical contamination of drinking water (over 2,4 million are exposed
to the effect), air (about 3,2 million people), soil (about 3 million) and food (about 1,6 million).
The ranks of the risk factors of chemical burden:
Chemical burden with drinking water ………………………………….. 1
Chemical burden with atmospheric air ………………………..……2
Chemical contamination of soil ……………………………….…….3
Chemical load with food ………………………………………….…….4
Table 3.4
Complex chemical burden on the population in ecologically unfavourable towns of the Sverdlovsk region
in 2000
Area
Air (Ksum)
Soil
Water
24
(Zs)
(Ktox)
Nizhniy Tagil
8.5
13.3
3.4
Pervouralsk
7.7
20.2
1.39
Revda
2.9
23.35
3.2
Kamensk-Uralskiy
2.6
9.42
2.2
Krasnouralsk
1.4
7.78
4.6
Ksum - the total index of air pollution (the permissible level at Ksum ≤ 1);
Zc – the total index of soil pollution with substances of the 1 and 2 danger class (permissible level at Zc ≤
16);
Ktox - the total index of contamination of drinking water with substances, normalized according to
toxicological indicator of unhealthiness (the permissible level at Ktox ≤ 1).
Chemical burden on the population related to the quality of drinking water.
The largest contribution (52.6%) to the pollution of water makes housing and communal services, 85%
of the volume of wastewater do not meet normative standards. The average content of specific
pollutants (some toxic metals, oil, nitrogen, etc.) in rivers Iset, Chusovaya, Pyshma is significantly higher
than permissible levels, 6 major rivers of the area are included in the list of the most polluted water
objects of the Russian Federation. Over 3.5 million people are provided with water from centralized
water supply systems, of which about 2.4 million people use water that does not meet sanitary
standards according to organoleptic indexes, and more than 1.3 million people – according to sanitary chemical (in particular organochlorines, a group of nitrogen, heavy metals, etc.). Another one million
people use water for drinking from non-centralized sources and its quality does not meet hygienic
requirements by sanitary - chemical parameters (organoleptic properties, nitrates, oil, etc.) in 30% of
cases and epidemiologically dangerous – in 25%. Approximately 15% of centralized water supply sources
do not meet sanitary rules and norms for water quality. The share of sources that do not have sanitary
protection zones was 12,9% (1999 -11.4 %) in 2000. A critical situation for providing population with
drinking water has been created in the surveyed towns: Irbit, Turinsk, Kamensk-Uralskiy, Pervouralsk
where drinking water is often supplied according to a certain schedule. Chemical contamination of
drinking water is the major of ecological and hygienic risks affecting people's health and demographic
situation which ultimately causes significant economic damage and ultimately unnecessarily high social
25
loss. The main agents of adverse effects on human organism are organochlorine compounds that are
formed during disinfection of drinking water with chlorine. Disadvantaged with respect to
organochlorine compounds remain the towns of the region using surface sources for centralized water
supply: Verhnya Salda, Kamensk-Uralskiy, Kachkanar, Krasnouralsk, Nizhny Tagil, Verhnya Tura, Ivdel,
Pervouralsk, Revda, Tavda (Table 3.5).
Table 3.5
Ranking of the surveyed areas of the Sverdlovsk region according to the integrated lead indexes on the
population.
Complex load index
The amount of substances
Territory
Artemovsk
Bogdanovich
Verhnya Salda
Ivdel
Irbit
Kachkanar
Krasnouralsk
Cushva
K. Uralskiy
Nevyansk
Nizhniy Tagil
Pervouralsk
Revda
Sysert
Turinsk
Population
number
22116
7973
46678
7633
22500
49900
19898
34158
18497
26600
371000
50000
55000
9746
6421
The amount of substances
normalized on the basis of
organoleptic indicator of
harmfulness
normalized on the basis of
1
1
1,7
1
3,5
2,33
1
2
2,81
1
1
1
1
1
3
1
1
2,16
1
4,4
1
4,6
1,5
2,2
2
3,4
1,39
3,2
1
10
sanitary-toxicological
indicator of harmfulness
26
Under groundwater of the Urals is characterized by relatively low fluorine content - up to 0.5 mg / liter.
The analysis results of about 2000 water samples from the of centralized water-supply and
noncentralized water supply sources have shown that practically all the population of the area uses
drinking water with low fluoride content that contributes to the high rate of tooth decay.
Calcium excess and increased hardness in the underground sources of drinking water is observed in
Artemovsk, Bogdanovich and Kamensk-Uralskiy regions, which increases the risk of urolithiasis, leads to
a violation of water-salt metabolism state, early calcification of bones, stunted growth of the skeleton of
children. More than half of the water supplies of serve water with high content of iron and manganese.
Verhnya Tura, Irbit, Ivdel, Cushva, Turinsk are particularly unfavourable in this respect. Periodically there
is an excess of residual aluminum in drinking water (Tavda etc.). It was revealed unfavourable influence
on the health of the population using drinking water containing aluminum in concentrations of 5.0 mg / l
for a long time1, in 2002, according to the estimation of risk to public health in urban areas of Nizhniy
Tagil (Leninsky and Tagilstroevskiy), Pervouralsk (village Dinas and district Tehgorod), Krasnouralsk,
Cushva, Sysert), it was found that the water route of priority pollutants takes by importance the 2-nd –
3-rd places.
As a result of coming with drinking water:
• fluoride - in low concentrations increases the risk of dental caries: for the last three years in average
more than 1,5 million cases are registered among the population of the area;
• high concentrations of calcium – increases the risk of urolithiasis, violations of water-salt metabolism,
early calcification of bones, skeletal growth retardation of children;
• increased concentrations of iron and manganese - promotes the development of allergic reactions,
blood diseases, deposition of iron compounds in organs and tissues;
• high doses of aluminum - increase the risk of hypertonia and disorders of the gastrointestinal tract. It
is confirmed that prolonged consumption of drinking water containing aluminum in concentrations of
5.0 mg / l leads to increase of prevalence of anemia among the population up to seven times, cystitis up to four times, dermatosis - two times, in comparison with the areas where the aluminum in drinking
water did not exceed 0.02 mg / l;
• Arsenic – it is forecasted to 228 cancer cases (while maintaining the forecasted level of exposure
during the whole life) among all population groups. And the highest risk is predicted in the cities, where
water supply is organized from surface sources;
1
Residual aluminum in drinking water after coagulation refers to the second class of danger.
27
• Cadmium – it is forecasted damage to renal tubules and development of toxic nephropathy - about
4315 cases among the whole population at continuing exposure throughout life.
Chemical stress associated with air pollution.
The Sverdlovsk region ranks third in Russia's total emissions of pollutants into the air, due to highly
concentrated industry in settlements, the presence of salvo and emergency releases at the unstable
mode of production, lack and inefficient work of gas-cleaning equipment. Fuel-energetic and
metallurgical complexes are making the greatest contribution to air pollution. There is worry because of
an increase of gross emissions of energetic enterprises in connection with change of fuel structure
(transition to high-zolnye types of solid fuel) as well as air pollution by automobile transport in large
industrial centres.
Over 80% (of emissions in Russia in general) of gross lead-containing industrial emissions into the
atmosphere are from enterprises of primary and secondary metallurgy of copper and its alloys.
Mentioned above enterprises are located in the Sverdlovsk region. That is why this problem is of
particular significance for this region.
The main contributors to air pollution are companies located in towns with the most unfavourable
environmental conditions: Pervouralsk, Nizhniy Tagil, Kamensk-Uralskiy, Krasnouralsk, Revda. Large air
pollutants: Revdinsk Hydro-electric power-station (HEPS) (21% of the regional emissions), Joint-stock
company "Sredneuralskiy Copper Plant (4%) (Table 3.6)
Total emissions of pollutants in some towns of the Sverdlovsk region in 1996 (tons)
Towns
From
stationary
sources
Pervouralsk
Revda
210,983
6,353
102,397
30,241
88,673
6,295
105,175
7,861
1,257
12,648
2,778
38,102
89,93
From
vehicles
In all
Kamensk
Nizhniy Tagil
14,208
225,191
Uralskiy
Krasnouralsk
Pervouralsk. The major sources of air pollution in the town are: Pervouralsk Pipe Works, Dinas, Heat
Electric generating Station (HEGS), Hrompik, The radio-television Equipment Plant, Tubular Building
Constructio’s Plant, motor transport. Priority air pollutants: dust, sulfur dioxide, carbon monoxide,
28
nitrogen dioxide, hydrogen sulfide, sulfuric acid, hydrogen fluoride, formaldehyde, phenol, lead,
cadmium, arsenic. The number of people exposed to air pollutants was 135,400 people.
Nizhniy Tagil. The major air pollution sources are the following: industrial works: Heat Electric
Generating Station (HEGS), Uralchemplast, Lebyazhka sintering plant, boiler-houses, vehicles. Prior air
pollutants: dust, sulfur dioxide, carbon monoxide, nitrogen dioxide, hydrogen sulfide, carbon disulfide,
phenol, ammonia, formaldehyde, xylene, cadmium, lead, copper, hexavalent chromium, benzpyrene.
The number of people exposed to the influence of air pollution are 349,000 people.
Kamensk-Uralskiy. The main sources of air pollution are: Tube Works, engineering plants, industrial and
domestic boiler-houses, motor vehicles. Prior pollutants: dust, hydrogen fluoride, solid fluoride, nitrogen
dioxide, sulfur dioxide, benzpyrene, copper, nickel, hexavalent chromium, carbon monoxide. The
number of people exposed to air pollutants was 176,847 people. Aluminum plants, are powerful sources
of carcinogenic risks to people living in areas of their deployment. It was found that the composition of
resinous substances released into the air with emissions of aluminum plants includes such carcinogensmutagens as chrysene, benzo (a) pyrene, benzo (a) anthracene, dibenzo (a, h) anthracene, carbazole.
The total content of only these well-known compounds in the emissions of aluminum plants exceeds the
content of benzo (a) pyrene to 10 times [78].
Krasnouralsk. The main sources of air pollution: JCS ‘Svyatogor’, a chemical plant. Prior pollutants: sulfur
dioxide, lead, arsenic anhydride. The number of people exposed to the influence of air pollutants was
23900 people. Compared with other similar towns with large industrial enterprises Krasnouralsk is
consided to be safe for air pollution but it does not quite correspond to reality. The fact is that the
integral indexes are calculated on the basis of the results of laboratory control of atmospheric pollution
load on the population. The main source of emissions into the atmosphere – Krasnouralsk Cooper
Industrial Complex emitting lead, arsenic, copper, cadmium and other contaminants. It has a favourable
position according to the wind rose with respect to the housing building of the town. In this connection
an air pollution post control located in a residential area is outside the influence of the plant emission
most of the year. Therefore the average concentration of impurities recorded at the post control, have
values mostly below acceptable standards. At the same time during the investigation conducted by the
enterprise and the health service of the town under the torch concentrations of harmful substances in
its emissions are registered. They substantially exceed the limits determined for them and are among
the largest in the region. It confirms the aggregate index (AIC). It is calculated on the basis of gross
emissions into the atmosphere. According to this index the load of air pollution of Krasnouralsk in one of
the largest in the region 0,3 THI/person (THI – technical hydrocarbon index). The report “On the
sanitary-epidemiological situation in the Sverdlovsk region in 2003”, Ekaterinburg 2004, 116 pp. In
Krasnouralsk on the background of stabilization of lead emission with industrial discharges of JSC
29
Svyatogor into the air (1999-161, 577 tons/year, 2000 – 161.436 tons/year). In realization only the
organizational and technical measures and improvement to the town allowed to achieve environmental
quality improvements. In 2000 the average lead concentration in the air of the town was two times
lower in comparison with 1999 levels (0.00028 mg/m3-1999, 0,00014 mg/m3- 2000). In particular
administrative and technical measures were conducted at JSC Svyatogor during 1997-2000. They were
directed to reducing industrial emission into the atmosphere at the expenсe of reducing productivity at
unfavourable weather conditions and wind directions to the residential area of Krasnouralsk. A similar
situation exists in Revda. The main sources of air pollution in the city are SMP (Sredneuralskiy
Metallurgical Plant), brickyard, boiler houses, vehicles. Prior air pollutants are dust, hydrogen fluoride,
sulfur dioxide, cadmium, lead, nickel, copper, arsenic anhydride. The number of people exposed to the
influence of harmful substances in the air was 60000 persons.
Sredneuralsk Copper Smelter has a favourable position according to the wind rose with respect to the
housing building of the town. As a result two posts of monitoring the atmospheric pollution are outside
the influence of the plant emissions most of the time during the year. Emissions of SMP mostly have
permanent negative effect on health and living conditions of the population of Pervouralsk, which is
located in the downwind direction with respect to SMP. In this regard, according to the integral
parameters of the atmosphere pollution load on the population in accordance with the importance of
the indicators Revda is in the second group of ten territories and according to aggregate index (gross
emissions) in the fourth place.
Priority air pollutants of inhabited territories are the following: dust, sulfur dioxide, nitrogen dioxide,
phenol, formaldehyde, benzo (a) pyrene, fluoride and hydrogen chloride, lead, manganese, cadmium,
hydrocarbons, arsenic anhydride, hydrogen sulphide, nickel, fluorides , sulfuric acid. The analysis of the
received data shows that the load of atmospheric pollution on the population of the surveyed areas
slightly decreased in 2000. These areas are: Artyomovskiy, Verhnya Salda, Cushva, Krasnouralsk,
Nevyansk, Revda). The decrease took place mainly on account of the content of dust, phenol, nitrogen
dioxide, formaldehyde, sulfur dioxide, which form the general background of the air pollution of the
populated areas at the expense of both enterprises and life providing objects of localities and motor
transport. Speaking about specific substances typical for certain specific enterprises emissions an
insignificant positive trend is observed in V. Salda (fluoride and chloride hydrogen), in Krasnouralsk
(sulfuric acid). However there is a slight increase in the atmospheric pollution load on the population in
Pervouralsk, Nizhniy Tagil. Impurities on the account of which there is an insignificant increase of their
concentration in the atmosphere relate mostly as in the first case to substances that form the general
background of air pollution, and they are also a part of industrial pollution of enterprises (dust, nitrogen
dioxide, carbon oxide, phenol, formaldehyde, hydrocarbons).
30
To access the degree of influence of air pollution on the population and to rank areas of "risk" according
to the complex effect of pollutants, it was calculated the index of relative complex load of atmospheric
pollutants on the population (API), on the basis of the facts of the laboratory testing (Fig. 3.1).
10
9
API 8
7
6
5
4
3
2
1
0
Fig. 3.1. Air pollution index in the Sverdlovsk region towns.
To access the degree of influence of air pollution on the population and to rank areas of “risk” according
to the complex effect of pollutants, it was calculated the total index of air pollutants on the population
(Ksum) on the basis of the facts of the laboratory testing (Table 3.7) as seen from the table:
• Nizhny Tagil, Pervouralsk, Ksum > 5 corresponds to very high levels of air pollution, causing a
dangerous impact on the population health, which requires urgent measures to estimate and manage
the protection of air quality and population health;
Table 3.7
Comparative data on the total load indicator of atmospheric pollution
on the population (Ksum) in the surveyed areas
Name of the
territory
Nizhniy Tagil
Total index of air pollutants on the population (Ksum)
1996 г.
1997 г.
1998 г.
1999 г.
2000 г.
9,0
6,5
6,1
8,5
8,5
31
Pervouralsk
5,0
9,4
11,5
7,0
7,7
Cushva
1,0
3,8
3,4
2,6
1,7
Bogdanovich
5,1
2,8
2,9
2,9
3,2
Kachkanar
2,4
2,4
2,8
1,2
1,9
Verhnya Salda
1,4
4,3
2,6
6,5
4,5
Kamensk - Uralskiy
9,0
7,8
2,6
2,2
2,6
Revda
3,1
9,0
2,2
3,3
2,9
Artemovskiy
0,4
1,1
1,4
2,5
2,3
Nevyansk
0,3
0,6
0,6
0,4
1,1
Ivdel
0,3
0,3
0,3
0,3
0,6
• Kachkanar, Krasnouralsk, Cushva, Nevyansk - K sum. > 1 <2 corresponds to exceed the permissible
levels of complex atmospheric pollution resulting in increased risk of negative effect on the population
health, but is not critical for the population.
• Ivdel - K Sum. <1, which corresponds to the permissible loads levels for the population.
• Artyomovskiy, Bogdanovich, Kamensk-Uralskiy, Verhnya Salda, Revda- K sum. > 2 <5, corresponds to
high level of air pollution and is the cause of additional risk to public health, requires active intervention
to assess environmental problems and health management of residential areas air.
Comparative data by aggregate index of complex load (AIC) show that in 2000 there is an increase of this
index in Pervouralsk (Table 3.8).
Table 3.8
Comparative data by aggregate index of load of atmospheric pollutions
on the population (AIC, THI/ person) on the inspected territories.
Aggregate index of load of atmospheric pollutions on the population (AICLAP, THI
/ person)
Area
Krasnouralsk
1996 г.
0,326
1997 г.
0,310
1998 г.
0,332
1999 г.
0,29
2000 г.
0,3
32
Revda
Kachkanar
Nizhniy Tagil
K.-Uralskiy
Karpinsk
Cushva
V.Tura
Bisert
V.Salda
N.Salda
Pervouralsk
Sysert
0,2
0,139
0,068
0,023
0,005
0,078
0,0015
0,002
0,006
0,005
0,0023
0,002
0,2
0,148
0,063
0,023
0,033
0,051
0,011
0,007
0,0052
0,004
0,004
0,002
0,15
0,140
0,049
0,043
0,04
0,023
0,008
0,008
0,0065
0,0065
0,0042
0,003
0,2
0,140
0,06
0,028
0,04
0,03
0,008
0,02
0,004
0,001
0,015
0,0023
0,16
0,14
0,062
0,029
0,03
0,054
0,0087
0,0082
0,004
0,003
0,015
0,0022
It took place due to dust, sulfur dioxide, nitrogen dioxide, formaldehyde. It can be seen of these
pollutants that they are typical for both separate enterprises emissions and general background of air
pollution of residential areas formed at the expence of motor transport emissions and life providing
objects. At the same time it should be marked a slight decrease of this index to 10 territories (Nizhniy
Tagil, Verhnya Salda, Artemovskiy, Cushva, Kamensk-Uralskiy, Krasnouralsk). Typical impurities at the
expence of which a load on the population in this index reduced are: suspended substances, nitrogen
dioxide, sulfur dioxide, formaldehyde, phenol, which form the general background of the residential
area and their change depends mainly on meteorological factors and weather conditions. Specific
impurities, which provided a reduction of load on the population the most significant are: fluoride and
hydrogen chloride, nickel, zinc in Kamensk-Uralskiy, iron, manganese, nickel, hexavalent chromium in
Nizhniy Tagil, hydrogen chloride, marganese, copper in the Verhnya Salda, copper and zinc in Cushva,
arsenic in Krasnouralsk. This index practically has not changed in comparison with the previous years in
Bogdanovich, Kachkanar, Revda. For the total load index of air pollution on the population (K sum.) the
situation is the same. There is some increase of the load on the population in this index in Pervouralsk,
Bogdanovich in 2000.
It is clear that the territories above are mainly in the list of the towns where there is an increase in
aggregate index of complex load of air pollutants on the population (AIC). The data analysis presented in
the table shows that there is a slight decrease of the load on the population in the index on four
territiries (Verhnya Salda, Revda, Artyomovskiy, Nizhniy Tagil). Tables 3.7 and 3.8 analysis data showed
that the most unfavourable territories in accordance with Ksum and AIC are: Pervouralsk, Nizhniy Tagil,
Verhnya Salda. The same territories, including Kamensk-Uralskiy, have been in the list of unfavourable
territories from the last 5 years. In 2002 the most unfavourable territories from the point of view of
Ksum and AIC were: Pervouralsk, N. Tagil, V. Salda, Kamensk-Uralskiy, N. Tura, Cushva.
33
Krasnouralsk, Pervouralsk, Nizhniy Tagil take first places in areas ranking according to the sum of the
coefficients of habitat contamination risk with arsenic, zinc and copper. The harmful effect of lead on
human health is combined with the effect of other industrial pollutants (copper, cadmium, arsenic,
sulfur dioxide, mineral dust).
Chemical load connected with soil contamination of residential areas
High anthropogenic load is the reason of soil pollution of populated areas, agricultural lands with
different substances including substances of the 1st and 2nd rate of harmfulness (lead, nickel, cobalt,
cadmium, etc.). In order to range region areas according to the degree of soil pollution with substances
of the 1st and 2nd rate of harmfulness taking into consideration the number of the population, Regional
Sanitary and Epidemiological Surveillance Centre calculated soil contamination relative index (Br) (Table
3.9) and soil contamination average total index (Zsum) of (Table 3.10).
Table 3.9
Territories ranking according to soil contamination
regative index (Br) regarding the population number
Soil
contamination
Area
relative index
Population number
Pollution level
(people)
(Br)
N. Salda
147,06
extremely dangerous
19 500
V. Salda
45,24
dangerous
12 800
Karpinsk
34,7
dangerous
35 002
Sysert
25,5
moderately dangerous
4 900
Pervouralsk
21,2
moderately dangerous
80 700
Bogdanovich
20,3
moderately dangerous
21 483
Arteyomovskiy
19,8
moderately dangerous
3 336
Turinsk
18,32
moderately dangerous
2 413
34
Sysert
17,3
moderately dangerous
38 450
Revda
16
moderately dangerous
63 660
Irbit
15,5
permissible
50 000
Nevyansk
14,96
Permissible
14 506
Nizhniy Tagil
10,66
Permissible
403 610
K.Uralskiy
8,1
Permissible
193 600
Krasnouralsk
6,3
Permissible
9 400
Kachkanar
6,2
Permissible
50 654
Tavda
3,8
Permissible
6 700
Ivdel
2,03
Permissible
2 709
Table 3.10
The surveyed towns of the Sverdlovsk region ranking
in accordance with the soil contamination average total index (Zsum) in 2000
Soil contamination
Area
relative index
Population
Pollution level
(Zsum)
number (people)
N.Salda
75,42
dangerous
19 500
Karpinsk
34,66
dangerous
35 002
Revda
23,35
moderately
dangerous
63 660
Artyomovskiy
22,3
moderately
dangerous
3 336
Sysert
21,9
moderately
dangerous
4 900
35
Pervouralsk
20,2
moderately
dangerous
80 700
Bogdanovich
19,8
moderately
dangerous
21 483
Krasnoturinsk
19,73
moderately
dangerous
51 486
Turinsk
18,98
moderately
dangerous
2 413
Nevyansk
16
moderately
dangerous
14 506
Sysert
15,64
permissible
38 450
Irbit
14,2
Permissible
50 000
Atryomovskiy
13,89
Permissible
8 097
Nizhniy Tagil
13,3
Permissible
403 610
Cushva
13,27
Permissible
65 465
Kamensk-Uralskiy
9,42
Permissible
193 600
V.Salda
7,82
Permissible
17380
Krasnouralsk
7,78
Permissible
9 400
Kachkanar
5,7
Permissible
50 654
Ivdel
4,97
Permissible
2 709
Tavda
3,9
Permissible
6 700
Table 3.11 presents the results of territories ranking according to a snow cover contamination average
total index in 2000. It is clear from the table that Kachkanar and Pervouralsk are the most dangerous
speaking about the environment.
Table 3.11
The Sverdlovsk region investigated territories ranking according to a snow cover contamination average
total index.
36
Territory
Zp
Contamination level
Kachkanar
317,96
Extremely dangerous
Pervouralsk
141,55
Dangerous
Krasnouralsk
5,55
Permissible
Nizhniy Tagil
3,6
Permissible
1
Permissible
Kushva
In 2000 health service studied 6 831 soil samples. 9,2% of the samples don’t meet the norms. 1193
samples were studied in accordance with sanitary-chemical indexes. 35% of them don’t meet the
hygienic norms. High level of soil contamination of childcare establishments and schools was revealed
on different territories of the Sverdlovsk region (table 3.12).
Of 941 studies of soil samples for pollution by heavy metals, 39% do not meet the standards. High soil
pollution by heavy metals was found in the V. Salda (100%), Tavda (100%), Pervouralsk (96%), Revda
(65%), Sysert (62,5%), Krasnouralsk (50%), Kachkanar (40% ). Of 827 studies of soil samples for pollution
by lead 24% do not meet the standards. High soil contamination by lead was revealed on the territories
of Sysert (100%), Pervouralsk (92%), V. Salda (80%), Krasnouralsk (50%), Revda (50%). Of 701 studies of
soil samples for pollution by mercury 3,7% do not meet the standards. High soil pollution by mercury
was revealed the territories of Tavda (100%), V. Salda (80%).
Table 3.12
The study results of soils in the Sverdlovsk region (1996 - 2000 years)
37
Selection
Years
Samples studies
38
place
According to sanitary-chemical
Salts of heavy metals
indexes
Total
Above
MPC
%
Unsatisfactory
Total
Above
MPC
%
Unsatisfactory
Soil in the 1996
sites
of
agricultural
products
1997
production
270
79
29,3
142
74
52,1
124
22
17,7
67
18
26,9
1998
109
55
50,5
79
49
62,0
1999
86
27
31,4
71
24
33,8
2000
80
27
33,8
54
20
37
1996
880
373
42,4
739
364
49,3
1997
852
326
38,3
774
285
36,8
1998
697
240
34
635
196
30,9
1999
1040
247
33,4
824
311
37,7
2000
919
334
36,3
722
295
40,9
1996
237
81
35,2
150
79
52,6
1997
201
59
34,1
162
50
30,9
1998
176
45
29,4
185
43
23
1999
205
61
29,8
160
56
35,0
2000
344
89
25,9
186
60
32,3
Development
territories soil
Including
childcare
establishments
39
Of 680 studies of soil samples for pollution by cadmium 13,5% do not meet the standards. In 2002 areas
with extremely dangerous levels of soil contamination were Krasnouralsk with a dangerous level –
N. Salda, V. Salda, Karpinsk. Pervouralsk (100%), V. Salda (100%), Krasnouralsk (100%), Kamensk Uralskiy (80%), Bogdanovich (66,7%), Kachkanar (40%). The role of soil as a source of secondary
contamination of the surface layer of atmospheric air especially increases on these territories. That
influences children’s health in their direct contact. A serious problem for the region remains the
problem of storing and processing of industrial waste especially toxic. In the region there are practically
no landfills for disposal and dumping of toxic industrial waste and municipal waste landfills in most cases
are not able to take these species. Annually about 10 million tons of toxic industrial wastes are formed.
Not more than 25% of them are neutralized and recycled. High soil contamination with cadmium was
detected on the territories of Sysert (100%), Krasnouralsk (50%) (Table 3.13).
Table 3.13
Soil contamination with heavy metals on the surveyed areas.
V.Salda
100
Contamination
with lead
samples,
%
80
Tavda
100
-
100
-
Pervouralsk
96
92
-
-
Revda
65
50
-
30
Sysert
62,5
100
-
100
Krasnouralsk
50
50
-
50
Kachkanar
40
-
-
-
Territory
In all
samples, %
Contamination
with mercury
samples, %
Contamination
with cadmium
samples, %
80
-
Bio-load is formed at the expense of unsafe drinking water (more than 800 thousand people consume
potentially dangerous in epidemiological respect drinking water), food, and soil pollution (most of all it
influences preschool age children). Of 637 samples tested in accordance with microbiological indexes
5,7% of samples do not meet the standards: of 4912 samples tested for the presence of helminths 3% of
samples do not meet the norm. Of the 89 samples tested for radioactive substances, 18% do not meet
the norm. Kamensk-Uralskiy, N. Tura, Irbit, Cushva, Pervouralsk, Bogdanovich, Sysert are the areas of
highest risk.
40
Radiation dose load. More than 3,3 million people are exposed to the effect of radiation load. Increased
individual load is typical for areas with high radon release. The main sources of collective dose of
irradiation population are natural sources and medical researches. There were no direct effects from
exposure of radiation factors to the population health in 2003. Nizhniy Tagil, Kachkanar, Irbit Karpinsk,
Ivdel, Sysert, Turin, Nevyansk are territories with increased individual radiation loads, i.e. loads
exceeding average regional. They are towns with high radon release.
3.2 Sanitary - hygienic characteristic of Novomoskovsk of the Tula region
Novomoskovsk is a large centre of Russian-made fertilizers and other chemical products. There is a large
deposit of stone gypsum, limestone, loam, near Novomoskovsk [9]. According to the resolution of the
Council of Ministers of the RSFSR of 16 September 1990 Novomoskovsk was named among 43 towns of
Russia as the town with tense environmental conditions where environmental protection measures
should be a priority.
In 1999 the total gross emissions into the atmosphere of Novomoskovsk from all sources amounted to
26,155.1 tons, of which 16,680 tons were industrial emissions, 9,475.1 tons (36,2% of the total amount
of emissions) were emissions from motor transport. Compared with 1998, the gross air emissions
increased by 920.4 tons. Total increase of emissions in 1999 in connected with increase of production
output. At Novomoskovsk hydro-electric power-station emissions increase by 961.4 tons is due to
increased delivery of heat energy, coal combustion, and also its quality lowering in sulfur content.
The largest contribution to emissions of specific pollutants contribute: “Nitrogen” - ammonia - 1975.1
tons, hydrogen chloride - 378.4 tons, sulfuric acid - 40,5 tons; "Polymercontainer” - ethyl acetate 121,7
tons. 270.8 thousand tons of pollutants a year are caught at the enterprises of the town and 266.6 tons
or 98.4% of them are recycled.
The contribution of transport to total emissions is as follows: carbon oxide - 63.8 %, nitrogen oxides 13,3 %, hydrocarbons - 97,4 %, sulfur dioxide - 25,5 %.
In Novomoskovsk of the Tula region emissions of harmful substances from stationary sources into the
air amounted to 22,6 thousand tons in 1996, 15,4 thousand tons in 1997, 15, 4 thousand tons in 1998,
16.7 thousand tons in 1999, 15,5 thousand tons - in 2000, 11.8 thousand tons in 2001.
41
In Novomoskovsk emissions of harmful substances from stationary sources into the air in 2001 were as
follows: carbon monoxide - 5,531 thousand tons, nitrogen oxides 0.541 thousand tons, sulfur dioxides
0.121 thousand tons, 0.99 thousand tons of hydrocarbons. Excess of maximum permissible
concentration (MPC) in dust, nitrogen dioxide, hydrogen fluoride, hydrogen chloride, ammonia, phenol
and formaldehyde were registered in Novomoskovsk (Table 3.14).
Table 3.14
List of substances (excess of MPC) released into
the atmosphere of Novomoskovsk of the Tula region
Substance
Substance
emission,
MPC
Hazard
class,
Mg/m3
Excess of
MPC
t/year
Dust
59,6
3
0,5
To 4 times
Nitrogen
dioxide
12,5
2
0,085
To 2 times
Ammonia
5,4
4
0,2
To 3,7
times
Hydrogen
chloride
0,3
2
0,2
To 3 times
Hydrogen
fluoride
0,008
2
0,2
To 3 times
Formaldehyde
0,006
2
0,035
To 1,7
times
Phenol
0,001
2
0,01
To 6 times
Air Pollution Index (API) in Novomoskovsk is 5,4.
According to SHM with the participation of the Sysin Institute of Human Ecology and Environmental
Hygiene of the Academy of Medical Science, studies of air pollution by organic compounds were carried
out. The results showed that in the air of Novomoskovsk there is a large amount of organic compounds.
153 organic compounds were identified in all. The basic mass of them introduce hydrocarbons, aromatic
42
hydrocarbons, aldehydes and ketones which determine total concentration of organic compounds. For
the majority of individual organic compounds (aldehydes, geksanal, chloroform, benzene, xylene,
ethylbenzene, isopropylbenzene) excess of MAC in 2-18 times was observed [10].
Water Sources of Novomoskovsk
Water supply of the city is realized at the expense of underground water sources. The water quality of
these aqufers is characterized by a high iron content, high stiffness, low content of fluorine. The low
content of fluoride in the water is evidence of its natural -deficiency in the environment and has a direct
connection with the high incidence of dental caries among the population. However, it should be noted
that for the last 3-5 years the level of fluoride in aquifers has markedly increased, although did not reach
the hygienic optimum. If in the early 90-ies the fluorine content in drinking water was at the level of 0,10,3 mg / l, then starting from 1996 - at the level of 0,4-0,8 mg / l.
The tests results of heavy metals and organic compounds content in drinking water show that there is a
problem of pollution by heavy metals: strontium, cadmium, and to a lesser extent by lead and mercury.
The presence of metals in various environmental objects give a ground to suggest that the
contamination of drinking water by metals has most likely, natural type and is connected with
mineralogical features of water-bearing rocks. We should also note a certain meaning of fertilizers used
in agriculture in increasing environmental load on the environment by cadmium. For water purification
from iron at the town municipal water supply there are iron removal plants. However a large distance of
water intakes from the town and existing intermissions in water supply is contribute to contamination
with iron washed away from water supply system. As a result the iron content in the guard network of
the town increases to 0,5-0,8 mg / l.
In 1999 as a result of revival production at the enterprises of the town 53,7 million m3 of polluted
wastewater were thrown down into surface reservoirs, which is 4.3 million m3 more than last year. This
increase hasn’t led to deterioration of water quality which is connected with efficient operation of
disposal plants "Nitrogen".
Water facilities are relatively stable in epidemic relation. It is confirmed by indicators of bacteriological
water control. At the same time because of existing deficit of drinking water in the town, water is
supplied to the population according to the schedule.
The radiation situation in Novomoskovsk
Since 1986, the territory of the Novomoskovsk region is located in the zone of radioactive contamination
because of Chernobyl accident – the IVzone. Contamination of the Tula region including Novomoskovsk
43
was 37-185 kBk/m2.]. Iodine has the same concentration – 131 kBk/m2. The dominant factor of
population irradiation from natural radiation sources is radon accumulating in indoor air (residential,
public and industrial premises). Since 1997, the average density of radioactive contamination of the soil
according to the data of State Hydrometeorological Committee does not exceed permissible levels [26].
The materials in this Chapter show that the level of anthropogenic impact on the environment and on
the urban population of the Sverdlovsk region where children were examined is significantly higher than
that in Novomoskovsk of the Tula region. Among Russian towns with intense environmental conditions,
where environmental protection measures should be a priority in the 90th years of the 20 century
Novomoskovsk held the 43d place (Soviet Ministry Resolution of the RSFSR of 16.09.1990). To some
extent it can be regarded as a control area in relation to the mentioned towns of the Sverdlovsk region.
44
CHAPTER 4. EXAMINATION RESULTS OF CHILDREN IN THE SVERDLOVSK AND TULA REGIONS
4.1. EXAMINATION RESULTS OF CHILDREN IN THE SVERDLOVSK REGION
In all, 3183 people were examined. The total number of diagnosed diseases was 6322. Most of the
children had two or more nosologies. The sex ratio in the studied children's contingent was almost
equal: 49.8% of boys and 50,2% of girls. The children’s age was from 13 days to 17 years 11 months. The
main part of the examined children (about 40%) were children of school age. Approximately 20% were
children of 4-7 years old, 5,5% - children under one year (Fig. 4.1.1.).
45
40
35
30
25
20
15
10
5
0
Boys
Under a year
1-3 years
4-7 years
8-14 years
Girls
15-17 years
Age
Fig.4.1.1. Age and gender structure of the contingent of the examined children.
Below there are generalized results of the research of the basic body systems: nervous, cardiovascular,
endocrine, digestive, broncho-pulmonary and upper respiratory tract, genitourinary, etc. Table 4.1.1 and
Figure 4.1.2 present total data for 10 cities of the Sverdlovsk region (V.Tura, Nizhniy Tagil, Krasnouralsk,
Verhnya and Niznya Salda, Cushva, Ivdel, Nevyansk, Sosva, Kachkanar, Karpinsk). The number of the
examined children in these cities was 1389 when the number of diagnosed diseases was equal to 2890.
More than half of the children had several diseases of different organs and systems. The prevalence
index was 2080.6 per 1000 examined children. Pathology of the respiratory, nervous and digestive
systems were in the lead of its structure (Table 4.1.1.).
Table 4.1.1.
The prevalence of different types of pathology of children
of the Sverdlovsk region (for 1000 examined).
45
Abs.
Prevalence index*
Pathology
number
Respiratory organs
645
464 (422-509)
Nervous system
574
413 (380-497)
Digestive system
507
365 (334-399)
Endocrine system
334
240 (216-267)
Musculoskeletal system
165
119 (101-139)
Cardiovascular system
94
68
(55-83)
Urinary system
79
57
(45-71)
Allergic diseases
109
78
(65-94)
Others
383
278 (252-307)
2890
2081 (1955-2214)
Total

In the parentheses 95% is a confidential interval
Nervous system
0,5
Alimentary digestive canal
2,7
3,3
ENT-organs
11,5
19,9
Endocrine system
3,8
Musculoskeletal system
5
Respiratory organs
Allergic diseases
17,5
6,9
11,6
17,3
CVS (cardiovascular system)
Urinary system
Genitals organs
Others
Fig.4.1.2. The pathology structure of the examined children of the Sverdlovsk region.
46
The resulting index of general pathology prevalence is close to the official index for the Sverdlovsk
region - 2143,5 ‰.
Chronic inflammatory diseases of upper respiratory tract dominated in the structure of respiratory
pathology.
In the structure of the prevalence of the nervous system diseases, the most frequent diseases were the
following: vegetative-vascular dystonia (VVD), astheno-neurotic syndrome, neurocirculatory syndrome,
neurotic reactions, neurasthenia. Totally, they amounted to 31,3% of the total number of children
diagnosed with neurological disorders. The second, third and fourth places respectively were given to
perinatal encephalopathy, hydrocephalic syndrome, convulsions and epilepsy (Table 4.1.2.).
Table 4.1.2.
The structure of the prevalence of the nervous system
diseases among the examined children.
Diseases
Vegetative-vascular dystonia,
Number of
cases
Share in the structure
(%)
175
31,3
Perinatal encephalopathy
122
22,1
Hydrocephalic syndrome
113
20,6
Seizures, epilepsy
40
7,9
Child’s cerebral palsy
25
5,3
Organic lesions of the nervous system
32
6,0
Enuresis
35
7,6
TOTAL
577
100
Astheno-neurotic syndrome, neurotic reactions
47
The sex ratio in the group of children suffering from the VVD, was as follows: 53% - girls and 47% - boys.
Children of 8-14 years old (65,7%) dominated in this group, children aged from 0 to 3 years were less
%
than 10% (fig.4.1.3.).
40
35
30
25
20
15
10
5
0
Boys
Under a
year
1 - 3 years 4 – 7 years
Age
8 – 14
years
Girls
15 -19
years
Ris.4.1.3. Age and gender structure of the group of children diagnosed with "vegetative-vascular
dystonia".
Age distribution in the group of children with perinatal encephalopathy was opposite, i.e. 9% were
children of 8-14 years old and 70,4% - children of 0-3 years old (fig.4.1.4).
30
25
%
20
Boys
15
10
Girls
5
0
Under a
year
1 - 3 years 4 – 7 years 8 – 14 years 15 -19 years
Age
fig.4.1.4. Age and gender structure of the group of children diagnosed with perinatal encephalopathy.
The same age picture was observed in the group of children with hydrocephalic syndrome (fig.4.1.5).
Cerebral palsy was noted with approximately equal frequency in all age groups of children: 16-28%
%
(fig.4.1.6). Boys aged 4-14 years old (63%) suffer mainly from enuresis.
35
30
25
20
15
10
5
0
Boys
Under a year 1 - 3 years
4 – 7 years 8 – 14 years 15 -19 years
Age
Girls
48
%
Fig.4.1.5. Age and gender structure of the group of children diagnosed with hydrocephalic syndrome.
18
16
14
12
10
8
6
4
2
0
Boys
Under a year 1 - 3 years
Girls
4 – 7 years 8 – 14 years 15 -19 years
Age
Fig.4.1.6. Age and gender structure of the group of children diagnosed with cerebral palsy.
Typical complaints of first year children to a neurologist were about agitated restless sleep and arrested
motor development; of children from 1 to 5 years old, respectively - bad behavior, disinhibition, poor
sleep, of children older than 6 years old - headaches, frequent fatigue, hyperactivity and violation of
attention, astheno-neurotic reactions.
Among the examined children of the first year of life perinatal CNS lesion of varying severity was often
found. In the course of a survey of mothers it was stated that the majority of children (78%) had a birth
trauma, entanglement of umbilical cord, birth asphyxia, resuscitation in the neonatal period. A large
number of children (34%) were born at the age of 30-32 weeks, weighing from 1900 to 2300 grams.
Practically, children with such pathology were discharged home from a maternity home even without
any recommendations to visit a pediatrician (Tavda, Irbit, Bisert). At the same time in larger cities
(Kamensk-Uralskiy, Pervouralsk, Artyomovskiy, Revda) the majority of children were under the
supervision of a pediatrician and neurologist and received appropriate treatment. In the course of a
survey of parents it was stated that during the first year of life most children had a diagnosis of
hypertension-hydrocephalic syndrome. Almost all children received the dehydration treatment,
moreover in half of the cases without further examination.
Parents of 2-6-year-old children more often complained of a "bad character", "tearfulness”,
aggressiveness, sleep disturbances. A more detailed survey revealed that the vast majority of children in
their history had a birth trauma, and nearly all children of the first year of life were observed by a
neurologist.
While analyzing the family situation it was revealed that the majority of problems were mostly
pedagogical or social (inadequate or increased demands on a child, cruelty to a child, scandals and fights
in the family). It was found that the lower the intellectual level of parents was the higher demands on a
49
child's behavior they presented. The most common diagnosis: "neurotic reactions" occurred in Tavda
(14,4%), Turinsk (6,0%), Irbit (4,9%), Bogdanovich (8,5%), Bisert (8,8%), Revda (9,6%).
The frequency of cephalgias was approximately similar in all towns and ranged from 3,6% (KamenskUralskiy) to 15,3% (Revda). The survey revealed that children with birth or traumatic brain injury history
has cephalgias more often. Approximately one third of children were examined in the regional children's
hospital (Ekaterinburg) and received supportive therapy. The examination revealed that the majority of
children needed in-depth survey (REG2, EEG3, ECHO-EGV4, CT5, ophthalmologist consultation) for further
diagnosis and choice of treatment.
Children of all towns suffered from hyperactivity syndrome with attention deficiency and minimal brain
dysfunction with a frequency from 4,8% to 7,3%. It is remarkable that parents of "advantaged" children
more oten complained to the hyperactivity. They were concerned with forecast of morbidity and
possible methods of correction.
Astheno-neurotic syndrome of children accured in all towns. The main complaints of parents were tearfulness, depressed mood, susceptibility, weakness, heightened fatigue, passivity of children.
However none of the children was consulted by a psychologist, psychiatrist or neuropsychiatrist. Most
children were from "bad families" and had burdened obstetric history.
Enuresis was diagnosed in all towns (from 1,2% to 6,3%), but in Pervouralsk 8% of children complained
of bedwetting and only 15% of children were examined by a nephrologist earlier. In other cases the
survey was limited only to the analysis of urine.
Tic. hyperkinesis were observed in all towns (from 0,6 to 1,7 % of children). In 16% of cases they were
combined with logoneurosis. It was found that most children had tic. hyperkinesis "debut" at the age of
5-7 years old, had seasonal exacerbations, were treated symptomatically, and only 5% of children were
fully neurologically examined.
Convulsive status occurred with a frequency of 1 to 7,9% in all towns. Almost all diagnosticated children
were additionally examined (EEG, REG, ECHO-EGV), they were prescribed picked up medication. During
the examination of children it was found at that among them neurologically healthy were only 7,1%.
Most children who applied were in need of constant surveillance of neurologist and neuropsychiatrist,
further in-depth examination and treatment.
2
REG - reoencephalogram
EEG - electroencephalogram
4
ECHO-EGV – echoencephalogram of vessels
5
CT – computerized tomography
3
50
The structure of the prevalence of diseases of the digestive system of children living in different
examined towns, was different. Pathology of upper gastrointestinal tract was noted most frequently
(31-52%). First place is occupied by chronic gastroduodenitis, gastritis and functional dyspepsia. Among
the stated pathology chronic gastroduodenitis has consistently high level: from 75 to 82%. Hepatobilliarno-pancreatic pathology was in the second place with significant differences in the towns (2741%). Among the clinical entities dysfunction of the gallbladder was most frequently diagnosed (82%),
chronic cholecystitis (1-3%), chronic pancreatitis (1,4-2,6%) and chronic hepatitis (2,9-3,3%) were
diagnosed less freguently.
Among bowels diseases there are more common functional disorders (irritable bowel syndrome, chronic
constipation - 95% of the total number of people with bowels disease).
The most common pathology of children living in ecologically unfavourable territories of the Sverdlovsk
region, are diseases of the digestive system, the characteristics of which are the early (preschool age)
manifestations of nonspecific symptom complex: heaviness in the epigastric region, nausea, belching,
rarer - pains after eating, etc. In the history of these children, as a rule, there is a similar pathology their
parents have. Children having family predisposition to gastropathology acquire it at an early age
because of prolonged xenogeneic sensitization. A child receives from his mother some predisposition to
a disease, and implements it under the influence of adverse environmental factors. Hereditary diseases
are revealed under the influence of adverse environmental factors. It is a complex reason for formation
of pathology in ecologically unfavourable territories.
It is known from literary data and own observations that gastrointestinal problems are often combined
with psychoneurological, such as neurocirculatory asthenia, neurosis-like states and neurasthenias,
minimal brain dysfunctions and hyperexcitability, consequences of natal injury [Ursova]. Children in Irbit
are of special concern. In this town psychoneurological pathology was diagnosed 2-2,5 times oftener
than it had children living in other localities of the studied area.
In-depth survey showed that all patients suffering from disorders of gastrointestinal tract had an astenoneurotic complex of complaints. Namely: deterioration of sleep, anxiety, malaise, unexplained
weakness, headaches, lower progress in studies, unmotivated subfebrilitet, etc. In addition, trophic
disorders are marked: decrease in elasticity and dryness of the skin, dystrophic changes of hair and nails,
periorbital cyanosis, the phenomenon of vegetative dystonia. The mentioned above pathology of these
organs and systems fits the symptom complex, which, in our opinion, may be a result of prolonged
anthropogenic impact and follow-toxic sensitization of a child's body.
The data analysis derived from the comprehensive survey showed that a large number of children (81%)
living in towns Sysert and Bogdanovich, along with acute respiratory-viral and children’s infections
51
suffered from acute intestinal infections. In the surveyed region there was a high percentage of children
suffering from helminthes and parasitic infections (opisthorchiasis, ascariasis, toxocariasis, giardiasis).
So, helminthiasis are observed among children aged from 4 to 7 - 41%, from 8 to 14 - 36,2% and 3% of
children and teenagers aged 15 and older (Figure 4.1.7). Salda takes the first place in the infestation 19,1%, then Nevyansk 16,2% and 15,6% Cushva. The clinical case of a child suffering from
opisthorchiasis is shown in Appendix 4.
25
20
%
15
Boys
10
Girls
5
0
Under 1
1 - 3 years 4 – 7 years 8 – 14 years 15 years old
old
and older
old
old
age
Fig. 4.1.7. Age and gender structure of helminth infestation of children in the towns of the Sverdlovsk
region.
High infestation of children with different kinds of worms shows, first of all, a low level of communal and
personal hygiene in the surveyed towns of the Sverdlovsk region. The same reasons underlie the
prevalence of skin diseases of parasitic and infection type in combination with the revealed immune
imbalance. A large number of pustular diseases was revealed in Kamensk-Uralskiy (26%), Tavda (22%),
Turinsk (18%); in the settlement Bisert 13,6% of dermatological patients suffered from scabies. A low
level of social and living conditions of the population (lack of hot water, natural gas supply in most
homes and in the orphanage) in combination with the environmentally unfavourable situation clearly
confirm the relevance of monitoring children’s health on environmentally surveyed areas.
Children with endocrinopathy amounted to the following number from the total number of the
examined children: in Nizhniy Tagil - 74%, in Krasnouralsk, Verhnya Toura, Kachkanar - 71%, in Sosva 62%, in Nevyansk - 61%, in Verhnya Salda - 59%, in Ivdel-50%, in Karpinsk - 39,5%. In the structure of the
pathology of the endocrine system dominated euthyroid diffuse thyroid enlargement (88.2%), the
genesis of which may be related to the combined effects of goitrogen of different nature: iodine
deficiency, man-made chemical stress, immune disorders. The overwhelming number (up to 95%) were
children with a small (first) degree of (WHO classification, 1994), thyroid gland enlargement. Children
with the second degree of thyroid gland enlargement amounted to 5%. It should be noted a large
number of children with pathological overweight (up to 7% of the total number of the examined
52
children), which is apparently connected with the unbalanced nutrition (insufficient intake of protein,
vitamins against a background of plentiful intake of fats, carbohydrates). A small percentage of the
examined patients (0,3%) were children with diagnosed pathology of genitals: Shereshevsky-Turner
syndrome, Klinefelter’s syndrom, cryptorchidism, etc.
Allergic diseases (exudative diathesis, food and drug allergy) were in the first place among the children
of the first year of life as well as intestinal dysbiosis, lactase deficiency, enterocolitis. The absence in the
history of parents and close relatives of similar allergic reactions may indicate acquired nature of the
disease (no initial predisposition - atopy).
In Cushva it was recorded a large number of children with various allergic disorders: pollinosis, bronchial
asthma, allergic rinokonyunktivit, food allergy. The second and third place in allergic diseases occupied
such towns as Verhnya Tura and Nevyansk.
Neonatologist examined more than 400 young children (0-3 years old). Perinatal lesion of the nervous
system of hypoxic, traumatic, infectious genesis with a lot of clinical syndromes of early and late
recovery periods was the leading sickness of children under 1 year of life. The leading was the syndrome
of intracranial hypertension. Pathology of the digestive system is in the second place according to the
frequency. As a result metabolic diseases with a primary infringement of phosphorus – calcium
metabolism (rickets) (because of lack of competence of ante – and post-natal prevention, malnutrition
of mothers and children) are in the third place in the same category of children. Children of 1 - 3 years of
life were diagnosed with a wide range of different kinds of pathology. It should be emphasized a high
frequency of pathology of ENT organs as a result of breaking of the mechanisms of anti-infectiveprotection of this group of children (first place). In the second place there was a - pathology of the
gastrointestinal tract. In the third place there were deviations in the development of neuropsychological
functions (arrested development, abnormal syndromes).
It should be emphasized that children often had a multiple organ pathology - affection of several organs
or systems. More than half of the children have several different pathological states (clinical case of a
child suffering from multiple organ pathology is shown in annex 5). In Figure 4.1.8 is shown the
proportion of multiple pathology of children in different towns of the Sverdlovsk region. First place takes
Cushva, in which 56% of the examined children suffer from several diseases, among which pathology of
the nervous system in combination with diseases of ENT organs and the endocrine system predominate.
Then comes Nizhniy Tagil (55%), where the leading pathology is also diseases of the nervous system in
combination with the pathology of the ENT organs. Krasnouralsk is in the third place (54%). Pathology of
the respiratory system in combination with diseases of the nervous system and gastro - intestinal tract
dominate in this town. And, as a rule, the affection of the digestive system (in particular, biliary
dyskinesia) is combined with symptoms of vascular dystonia. Such combination is regarded as an organ
53
manifestation of vegetative-vascular dystonia. Endocrine pathology is combined with the pathology of
the menstrual cycle, height violation. Allergic syndrome is often accompanied by enlargement of the
thyroid gland. It’s taken into account the presence of concomitant severe pathology of early-age
children.
60%
50%
40%
30%
20%
10%
0%
Fig. 4.1.8. Proportion of multiorgan pathology of children in the cities of the Sverdlovsk region.
When examining children from one family it was revealed that brothers and sisters in the family had
identical diseases. 175 children from 84 families were examined in different towns of the Sverdlovsk
region (Annex 6).
Families in which children were healthy, constituted 13,1%; families in which children suffered from
various diseases constituted 47,6% of cases. It’s taken into account the high percentage of families (39,
3%), in which brothers and sisters have an identical pathology. In one family more often (about 40%)
children suffered from the same ENT diseases (chronic tonsillitis, sinusitis, pharyngitis, adenoiditis). In
30% of cases in one family, both brothers and sisters had diseases of the digestive tract (biliary
dyskinesia, gastritis, cholecystitis, dysbacteriosis). Endocrine diseases (euthyroid goiter) of children from
one family were observed in 27% of cases. Brothers and sisters in one family in 12% of cases had allergic
diseases (atopic dermatitis) and diseases of the nervous system (perinatal encephalopathy, vegetativevascular dystonia). A child inherits a predisposition to a particular disease, and implements it under the
influence of adverse environmental factors in his early childhood because his family lives in adverse
environmental conditions. Proceeding from the given data, we can assume that the same nosologic
forms of diseases of children in one family have the same cause and indicate the existence of a
etiotropic factor for a long period of time.
54
4.2. Children examination using bioresonance diagnosis method.
As mentioned above, one of the objectives of this study was to study the information content of noninvasive bioresonant diagnostic method - vegetative resonance test (VRT) for screening of "toxic loads"
in conjunction with clinical examination of children living in conditions of high man-made pollution. This
method was used for early diagnosis of pathological abnormalities in children's health. Moreover, it
seemed appropriate to use bioresonant method both in combination with other clinical methods, and as
an independent method allowing to reveal a risk group on the basis of found changes. For this purpose,
together with pediatricians of various specialties, as indicated above, experts of bioresonance diagnosis
examined 953 children aged from 11 months to 17 years old. The total number of examinations was
2490.
When analyzing the results of the survey both a patient’ complaints and those complaints which were
made by his parents, as well as clinical observations in the form of external examination, the patient's
response to the examination , and so on were taken into account. When making a diagnosis, the history
and clinical examination data testing, computer processing were taken into account.
When processing the research results it was carried out a synthesis of the major diseases of body
systems: nervous, cardiovascular, endocrine, digestive, respiratory, urinary, ENT-organs, etc.
It is accepted that in carrying out studies to determine the diagnostic capabilities of the new method (in
this case VRT) results obtained with its help, are compared with the results of referential method (in our
study - a set of modern diagnostic methods used for making a clinical diagnosis). A number of diseases
diagnosed clinically and with VRT use are presented in Table 4.2.1. The coincidence of diagnoses made
during clinical examination and VRT was 74.4%.
55
Table 4.2.1
Comparative data of children’s examination with methods
of clinical diagnosis and bioresonance method (VRT) (absolute number of children)
Pathology
Clinical
Diagnosis
Diagnosis
VRT
Respiratory system
238
168
Nervous System
205
151
29
19
167
121
30
19
280
207
Helminthic invasion
92
68
Allergic diseases
41
28
Bronchial asthma
22
16
Healthy
74
80
1178
877
Cardiovascular system
Endocrine system
Urinary system
Digestive system
Total
The main parameters that characterize the diagnostic significance of the screening method are its
sensitivity and specificity. It should be noted that for all methods of diagnosis there is an inherent
mismatch between the sensitivity and specificity, i.e. the increase in sensitivity will be accompanied by a
decrease in specificity. In this case there are several possible options and to describe them a special
terminology is used:
a) true positive results (coincidence of the results of VRT research and the results of modern diagnostic
methods with respect to establishing the existence of pathology);
b) false-positive results (positive according to VRT and not identified by modern diagnostic methods);
56
c) false negative results (pathology is detected by modern diagnostic methods and is not detected by
VRT);
d) true negative results (absence of pathology is detected by VRT and by modern diagnostic methods).
The following VRT parameters, characterizing the relationship between clinical results and those
received with the help of VRT, using test points of measurement (Table 4.2.2) were obtained. When
processing the data using the concepts adopted for the standardization of diagnostic studies.
Table 4.2.2.
Diagnostic parameters of the VRT method
Parameter
Sensitivity
Definition
The ratio of true positive results to the amount of true positive and
%
72,9
false-negative results (percentage of patients revelation using the
VRT method among the children whose disease is determined by
clinical exanimations).
Specificity
The ratio of true negative results to the amount of falsepositive and true negative results (the percentage of
revelation of healthy children among the contingent,
determined at clinical studies as healthy).
33,8
On the base of the analysis of the results of the examinations and our own experience of applying VRT
method, and taking into consideration the sensitivity (72,9%) and specificity (33.8%) of the latter, we
can make conclusions about its definite significance and safety. Consequently, the adequacy of the
method allows to recommend it as a method of noninvasive diagnostic for screening of toxic loads and
formation of risk groups of children in ecologically unfavourable areas.
As mentioned above, bioresonance diagnostics entails the use of the term "toxic loads". At the same
time the adverse environmental factors with which a body can not cope, which aggravate its internal
environment and are important to it are tested. Chronic toxic loads along with other factors lead to the
weakening of the barrier functions of the body. Evaluation of environmental loads testing was
performed in two directions. First, a positive test itself is a sign of absolute presence of tested loads in
the habitat of the examined. And, secondly, a positive test is a sign of their damaging effect on the body.
57
The minutes of astimation of the impact of environmental factors included the definition of: loads by
heavy metals salts (lead, cadmium, mercury chromium, molybdenum, cobalt) and total infectious
sensitization. In addition, and other types of loads were analyzed: by petrochemical products,
electromagnetic and radioactive exposures. However they turned to be less important and were not
included in further processing of the material.
The examined children in different towns had differences in frequency of toxic loads at different
nosological forms of diseases. The frequency of these loads, determined by bioresonance technique
method (VRT) at organic lesions of the central nervous system, diseases of the digestive and ENT-organs,
endocrine diseases of children in the towns of the Sverdlovsk region (for 1000 examined) is shown in
Figures 4.2.1, 4.2.2, 4.2 .3, 4.2.4.
‰ 1000
900
800
700
600
500
400
300
200
100
0
heavy metals
common
Fig. 4.2.1. The frequency of toxic loads in case of organic lesions of the central nervous system of
children in the towns of the Sverdlovsk region (for 1000 examined).
‰ 1000
900
800
700
600
500
400
300
200
100
0
heavy metals
common
58
Fig. 4.2.2. The frequency of toxic stresses in cast of the pathology of the digestive tract of children in the
towns of the Sverdlovsk region (for 1000 examined).
‰ 1000
900
800
700
600
500
400
300
200
100
0
heavy metals
common
Fig. 4.2.2. The frequency of toxic stresses in case of the ENT-organs diseases of children in the towns of
the Sverdlovsk region (for 1000 examined).
‰ 1000
900
800
700
600
500
400
300
200
100
0
heavy metals
common
Fig. 4.2.2. The frequency of toxic stresses in case of the endocrine diseases of children in the towns of
the Sverdlovsk region (for 1000 examined).
59
Symptoms of pathological conditions of the examined children were diverse and, as a rule, characterized
simultaneously presence of several diseases. So, on the background of the chronic infection of limphoid
pharyngeal ring - chronic tonsillitis, adenoid vegetation, etc. - children suffered neuroendocrine
pathology, often resulted in delayed development. In its turn, the immune imbalance in the body of the
child supports fungal infection and parasitic infestation. Deficiency of minerals, micro elements,
vitamins, enzymopathies is detected by this method of bioresonance diagnosis in the form of certain
indicators - "toxic load".
Thus, the combined data analysis of clinical examination data and results of bioresonans testing gives
grounds to assume that certain types of pathology of children of the studied area were attributable to
the relevant unfavourable background of the environment.
4.3 The results of children examination in Novomoskovsk of the Tula region
In Novomoskovsk it was examined 933 children: 57% were boys and 43% girls. The greatest number of
the examined belonged to the children of a school age - 8-14 years old (54%). The next largest group
was the group of children of 4-7 years old (21%). At the age of 1-3 years - 13.5% of the examined
%
children (fig.4.3.1).
70
60
50
40
30
20
10
0
Boys
Under 1
1 - 3 years 4 – 7 years 8 – 14 years
old
old
old
Girls
15-19
age
Ris.4.3.1. The distribution of the examined children in accordance with age and sex
Out of 933 examined 88 (9,4%) children had no diseases at the time of examination and were assessed
as healthy. 76 children were not finally diagnosed because they needed a detailed clinical examination
for its verification. The total number of illness was 1030. The prevalence rate was 1103.5 per 1000
examined children (Table 4.3.1).
60
Table 4.3.1.
The prevalence of different types of pathology
among the examined children in Novomoskovsk (for 1000 patients)
Pathology
Abs.
number
The prevalence rate
nervous system
303
324,7 (289,6-364,0)
musculoskeletal system
272
291,5 (259,0-307,4)
digestive system
112
120,0 (100,7-136,6)
allergic diseases
104
111,4 (91,1-135,9)
respiratory organs
77
82,5
(65,8-104,7)
cardiovascular system
42
45,0
(32,8-61,2)
endocrine system
38
40,9
(29,2-55,6)
urinary tract
17
18,2
(10,6-29,1)
other nosology
28
30,0
(17,7-49,0)
Total
1030
1103,5 (1036,2-1173,6)
In the structure of the prevalence the leading positions were occupied by diseases of the nervous and
musculoskeletal systems. The percentage of pathology of the organs of digestion and allergy was three
times as small (Fig. 4.3.2).
Among the examined children almost 30% of diagnoses accounted for diseases of the nervous system.
The group with disorders of the central nervous system included not only 117 patients examined by a
neurologist, but not less than 1 / 3 of patients taken by doctors of other specialties. Neurovegetative
disfunctions, asthenic syndrome, masked somatopathy depressions predominated. Most often they
manifested themselves in the form of vegetative-vascular dystonia (154 children). Among them
61
complaints for frequent headaches, increased irritability, neurotic reactions, sleep disturbance
dominated.
nervous system
locomotor apparatus
alimentary canal
allergic
0.4
7.5
4
3.7 3.6 1.7 2.3
respiratory organs
29.4
10.9
26.4
10.1
cardiovascular system
endocrine system
ENT-system
unitary system
eyesight
others
Fig.4.3.2. The structure of the pathology of the examined children in Novomoskovsk.
Thirty-four children were diagnosed with perinatal encephalopathy, manifesting itself in a small brain
dysfunction (SBD), the consequence of hypoxia and mental retardation. In the examined group, with
other diseases of the nervous system (115) dominated children suffering from neurosis enuresis (33),
which raises the problem of psycho-emotional dysfunctions. In addition to the children with the listed
diseases, among the patients who applied were the following diagnoses: convulsion syndrome,
epilepticus status, child’s cerebral palsy, paresis, hyperactivity, etc. At the same time, differences were
observed in the age structure in some of the above groups: among the children with vascular dystonia
dominated students (almost 80%), and with perinatal encephalopathy - pre-school children (70%). It is
clear that the consequences of perinatal encephalopathy begin to affect already in infancy. Age and
gender structure of children suffering from diseases of the nervous system, did not significantly differ
from that among all the examined children (Table 4.3.2).
62
Table 4.3.2.
Age and gender structure of the examined children with diseases of the nervous system.
Age
Boys
Under one year
3
1 - 3 years old
Girls
Abs.number
%
7
10
3,3
22
12
34
11,2
4 – 7 years old
28
33
61
20,1
8 – 14 years old
81
85
166
54,6
15 – 19 years old
17
15
32
10,6
TOTAL
151
152
303
100,0
At the same time, the age structure of children with vascular dystonia illustrates the fact that children of
school age suffer this disease. Perhaps it is developed on the ground of environmental and emotional
stress.
The second largest was the group of children suffering from diseases of the musculoskeletal system (272
people). Among them the most common pathology was the syndrome of connective tissue insufficiency:
different types of scoliosis - 59,2%, joint diseases, manifesting in the form of arthritis and osteoarthritis,
10% of children in this group were diagnosed with these illnesses. 23% of children had a pathology of
the foot. 7% of children had diseases of the locomotor apparatus. These diseases were consequences of
different kinds of injuries. 13,8% of children formed the group with another strain of the skeleton.
Age distribution of children in the groups was identical. The largest number of children were at the age
of 8-14 years old: from 52,6 to 66,8% in individual nosological groups. At the same time, mardek sexual
differences in the groups of children with different pathologies were observed. For example, in a group
of children with scoliosis a number of boys and girls did not differ essentially: 47.7% and 52.2%
respectively. In the group of children with arthritis and arthrosis girls dominated: 69,2% against 30,8% of
boys. In contrast, among children with the consequences of injury the vast majority were boys: 73.6%.
63
Among the examined children 104 (10,1%) had allergic diseases, among them there were 54 cases of
bronchial asthma, 13 - allergies and pollinosis and 31 - atopic dermatitis. Among patients with allergic
diseases there were mostly boys (67%) than girls (33%). Age distribution of children in these nosological
groups was different: in the group of patients with bronchial asthma 28,5% were children at the age of
4-7 years old and 57,1% - 8-14 years old. Infants - children under 4 years old had atopic dermatitis (35%
of cases). 15 children were sent for examination to the out-patient department of the Russian Children
Clinical Hospital (RCCH). In general, these were children with asthma and related disorders.
An important feature of the examined contingent is a large number of children with diseases of the
musculoskeletal system, mainly scoliosis. In some cases diseases were neglected. Without questioning
the qualifications of the Novomoskovsk Children's Hospital doctors, however it’s impossible to
underestimate the support of Moscow specialists in the diagnosis of obscure cases. One girl with a cyst
of the pancreas was urgently admitted to the RCCH, where she was operated on. It was given 12 more
warrants
for
hospitalization
in
departments
of
clinical
immunology,
dermatoallergology,
gastroenterology, X-ray-surgical treatments. These children required a highly specialized medical
assistance in the RCCH, which they could not get in the conditions of Novomoskovsk.
In the outpatient department of RCCH there were examined 15 children with asthma and concomitant
pathology. In general, these were children with a moderate bronchoobstructive syndrome. It should be
noted it was clear that attacks weakened when a child left for another district. In our opinion, this fact
may to some extent characterize ecological dependence of this pathology.
To assess a social status of families a selective interrogation of 426 mothers was carried out, which
showed that two-parent families – (81.8%) predominated among the examined children. The vast
majority of families (90.5%) lived in furnished apartments, 5,7% lived in private homes and only 3.6% of
families lived in a dormitory. Among the examined children there was one child from an orphanage.
Professional occupation of parents is one of the characteristics of the social status of the family. As was
shown in chapter 1, harmful professional factors which parents are undergone at work may negatively
affect the health of children. According to the interrogation, 25.6% of fathers and 14.6% of mothers
were engaged in chemical production, a leading in Novomoskovsk. Among the parents there was fairly
high share of unemployed: 17.1% of fathers and 24.6% of mothers. It should be noted, however, a fairly
high percentage of unemployed parents. It is possible that this factor has, directly or indirectly in
combination with other factors, unexplored in this work, a strong negative impact on the state of the
nervous system of children.
It should be noted in some cases, the passivity of parents in the case of admitting children to specialized
hospitals of Moscow for in-depth examination and treatment. Even having address consultation about
64
50% of families did not bring their children for examination and treatment. This, in our view, can be
explained not only by underestimation of severity of a child’s illness, but in some cases, financial failure
of families. The apparent problem appears inability of parents in good time and actively respond to the
illness of the child, to conduct the treatments and preventive measures, independently in time pay
attention to the aggravation of the disease, which requires health education among parents.
CHAPTER 5. Risk groups depending on the health of children and degree of environmental stress of
their residence.
Worsening of socio-economic status of large populations groups requires a differential approach
to various groups when developing and implementing prevention and rehabilitation programs and
taking into account socio-economic, environmental, climatic characteristics of the region.
Among the factors that determined the choice of areas of children examination in this study were,
including, environmental adversity of selected areas and significant differences of areas in the spectrum
and intensity of impact on the population of man-made environmental factors, suggesting differences in
their consequences.
The study confirmed practical expediency of the done choice made. It’s fair to compare the received
data among themselves, because the same organizational scenario and methodical approach to
examination of children was used in all inhabited localities.
A comparison of the data on the health of children in the Tula and Sverdlovsk regions suggests that the
higher technogenic load with hazards to the environment in inhabited localities in the Sverdlovsk region
influences the level and nature of the prevalence of pathology in children’s population. First of all it
manifested itself in the fact that the prevalence of all diseases index of the Ural children almost 2 times
higher than of the children of Novomoskovsk. There are special high differences in the prevalence of
diseases of respiratory and digestion organs, endocrine and nervous systems pathology (Table 5.1)..
Table 5.1
The prevalence of different types of pathology among the examined children in the Sverdlovsk and
Tula (Novomoskovsk) regions (for 1000 examined)
Diseases
respiratory organs
The Sverdlovsk region
464,0*
The Tula region
118,1
65
nervous system
413,2*
324,7
digestion organs
365,0*
120,0
endocrine system
240,5*
40,9
musculoskeletal
118,8
291,5*
allergic
78,5
111,4
cardiovascular system
67,7
45,0
urinary tract
56,9*
18,2
Total
2080,6*
1103,5
* - P <0,01
In the Sverdlovsk region more than half of the examined children had at the same time two or more
diseases, more frequently concomitant pathology was observed (affection of several systems, organs),
and, as a rule, affection of the digestive system combined with symptoms of vegetative-vascular
dystonia. Allergic syndrome was often accompanied by an increase of thyroid gland. Among the most
gross organ pathology there was also central nervous system affection, immune and endocrine systems,
and the liver, burdened by adverse environmental and social factors of the region.
The results of the analysis of age and sex peculiarities of the prevalence of diseases of the digestive
system clearly demonstrate a progressive rise of the index at the age periods of 2 - 6 years old (51%) and
%
11-14 years old (35%), i.e. during the most intense morphofunctional changes in childhood (Fig. 5.1).
45
40
35
30
25
20
15
10
5
0
Under 1
1 - 3 years 4 – 7 years 8 – 14 years 15 years old
old
and older
old
old
age
66
Fig.5.1. Age structure of the prevalence of digestive system diseases among the children of the
Sverdlovsk region.
A study of the prevalence of gastroenterological diseases occupies a special place in the practial
pediatrics, as the gastrointestinal tract is most vulnerable to the effect of toxicants of technogenic
origin, being one of the major routes of heavy metals entering to the body. Consequently, a clear
increase in the frequency of gastroenterological pathology of children living in areas with different levels
of anthropogenic pollution, in the early and preschool age can be considered one of the peculiarities of
the analyzed diseases. The above-mentioned age periods from the point of view of the formation of
pathology of the digestive system should be regarded as critical, that should be taken into consideration
when forming groups of risk and developing preventive programs.
Every third child of preschool and school age is diagnosed as having diseases of the musculoskeletal
system and connective tissue disorders. In the structure of these diseases the main place is occupied by
incorrect posture (60%), scoliosis (8-10%), chest deformation (12-14%), flat-foot (23%). In some cities of
the Sverdlovsk region (Verhnya Tura, Salda, Nizhniy Tagil), and in Novomoskovsk of the Tula region
children with deformities of the bones, fibrous dysplasia, dysplasia of the joints, aseptic osteonecrosis
dominated. This pathology can be characterized by syndrome of a connective tissue deficiency. This
condition accounts for insufficient content in the connective tissue of a specific protein - collagen. Low
amounts of collagen may lead to functional, and in some cases to serious organic changes, which lead a
child to disability. In the first place - to hypermobility ("looseing") of joints, and as a result to
subluxation of the cervical joints of children. The instability of the cervical vertebrae is often the cause of
headaches, fatigue, inattention and, finally, asthenia of a child. Violation of posture, a formation of flatfoot pathogenetically are a consequence of the same processes as the emergence of noise in the heart,
in other words, the emergence of MAHD syndrome (minor anomaly of the heart development) because
of prolapse of the mitral valve.
As a result of the integrated examination it is noted by experts and raises concern a number of children
(up to 4% of total patients) with arrested physical and sexual development of both sexes, girls with
menstrual dysfunction, the genesis of which requires further examination (consultation in that number
of endocrinologist’, geneticist, etc.). It’s taken into consideration a high level of metabolic diseases with
a primary infringement of phosphorus-calcium metabolism (rickets), which to some extent may be
caused by insufficient correct ante-and postnatal prevention in connection with the low level of
pediatric care, unbalanced nutrition of mothers and children.
67
The lack of modern methods of diagnosis of mineral metabolism in medical institutions of rural and
urban level and timely therapeutic correction of these conditions can later adversely affect reproduction
of the population. However, we can not exclude the influence of social factors (lack of sufficient
quantities of food rich in proteins and vitamins due to many reasons, the dominanting of which are low
social level of the population), lack of educational activities and the promotion of healthy lifestyle.
It should be noted that child’s health services in rural area are presented very poorly - quite often a
doctor’s assistant gives help to children, there are no medical specialists. At the same time in larger
towns where there is a pediatric service, children are rather well examined. Therefore, their
examination turned into a detailed consultation.
A comprehensive examination has revealed the main "critical" points.
1. It’s revealed the presence of organic pathology of the central nervous system, delayed mental
development of children, which may be caused by many factors, the dominant of which are man-made
disasters, industrial accidents, radiation.
2. Children with endocrinopathies ranged from 40-74% of the total number of the examined children. In
a large percentage of these cases (up to 95%) an increase of the thyroid of the first degree, was
registered. It’s stipulated by the combined effect of goitrogen of various origins: natural iodine
deficiency, manmade chemical load, micro element imbalance, immune disorders, low doses of
radiation. Children with the 2-nd degree of the thyroid increase (WHO classification, 1994) amounted to
5%. It’s necessary to carry out differential diagnosis with autoimmune thyroiditis, which requires more
detailed examination (clinical ultrasound of the thyroid gland, hormonal spectrum, which includes the
study of antibodies to thyroglobulin, tiroksinpiroksidaze, TSH, T3, T4).
3. Perinatal CNS lesions occurred with similar frequency in all towns. Minimal brain dysfunction, which
manifested itself usually in the form of headaches, weakness, sleep disorders, etc. also took place
roughly equally in all towns. In the history of children with a small brain dysfunction, there was usually a
birth trauma or traumatic brain injury (concussion of the brain). Neurotic reactions, which manifested
themselves in the form of disinhibition (aggressiveness), on the whole are peculiar to children under 6
years old.
4. Among the systemic diseases first place in the structure of the pathology occupy functional disorders
of hepato-biliary system, the second, respectively - a violation of the genitourinary system: urinary tract
infections of various etiologies in a case-history, neurogenic bladder, enuresis, dysmetabolic
nephropathies, violations of salt exchange. Attention was attracted to identifying a large number of
children of a younger age group (0 - 4 years) revealed by specialists. The children suffered
68
undifferentiated connective tissue dysplasia, manifested itself in weakness of ligamentous apparatus, a
violation of posture, flat-foot, hypermobility of joints.
5. Most of the children of different ages had both in their case-history and at the time of the
examination symptoms of chronic infection of lymphoepithelialny pharyngeal ring: chronic tonsillitis,
adenoid vegetation, etc. In its turn, the latter aggravate, and in some cases determine the immune and
endocrine imbalances, a manifestation of what serve developmental delay, chronic inflammatory
diseases, allergic reactions. As a rule such children were often and for a long time ill and were carriers of
viral and fungal infections.
6. Presence in the studied region a high percentage of children suffering from acute intestinal infections
(81%), various pustular diseases (18-26%), fungal infections of the skin (23%), helminthes and parasitic
infections (opisthorchiasis, ascariasis, toxocariasis, giardiasis (16 - 20%), scabies (13.6%) also confirms
that they have immune imbalance. It can not be dismissed a low level of municipal conditions of the
populations of the region and lack of health education of local health and sanitary-epidemiological
service.
The structure features of child’s pathology in the surveyed towns of the Sverdlovsk and Tula regions
show the specifics of the spectrum of environmental hazards and their effects on the organism of a
child. In different towns there was their a typical for them structure of the diseases, when individual
nosological forms took place more frequently and was drawn some "environmental portrait" (Table 5.2,
5.3).
Table 5.2
The prevalence of different types of pathology of children in the towns of the Sverdlovsk region (for
1000 examined)
Diseases
City
Respiratory
organs
nervous system
digestive system
endocrine system
Nizhniy Tagil
485 (357-635)
480 (356-634)*
200 (122-308)
252 (162-370)
Verhnya Tura
494 (353-672)
434 (302-603)
240 (147-370)
253 (157-387)
Krasnouralsk
640 (527-774)*
366 (282-476)
354 (273-460)*
209 (146-290)
Verhnya Salsa
427 (303-580)
539 (400-711)*
225 (137-346)
112 (53-206)
69
Cushva
196 (94-360)
470 (301-695)
353 (209-558)
176 (80-334)
Ivdel
333 (213-493)
430 (290-615)
458 (319-636)* 402 (269-579)*
Neviansk
297 (186-448)
284 (176-434)
162 (84-283)
203 (114-335)
Sosva
118 (70-186)
320 (237-422)
170 (111-250)
235 (164-327)
Kachkanar
404 (322-505)
290 (223-377)
176 (123-244)
145 (96-210)г
Karpinsk
327 (251-425)
224 (160-304)
157(102-231)
115 (69-179)
*- Differences are significant in comparison with Karpinsk (P <0,05);
In the towns of the Sverdlovsk region a pattern of pathological conditions of children was the following.
In Nizhniy Tagil an "environmental portrait" of a child is represented with the respiratory system
pathology, organic lesions of the central nervous system (perinatal encephalopathy, hypertensivehydrocephalic syndrome, delayed psychomotor development, episindrom, muscular dystonia with a
predominance of hypotension), an increase of thyroid gland (euthyroid goiter), congenital heart failures,
myocardiopathy. In Krasnouralsk there are precisely more children with pathology of the upper
respiratory tract (chronic tonsillitis, chronic sinusitis, chronic pharyngitis, adenoiditis) and digestive
diseases (chronic gastro duodenit reactive pancreatitis, biliary dyskinesia).
Table 5.3.
Leading Industry (pollutants) and the main types
of pathology of children in the surveyed towns.
Town
Nizhniy Tagil
Main types of pathology
("Environmental
portrait" of a child)
Basic Industry (pollutants)
Pathology
Iron ferrous metallurgy
(Coal and coke dust, phenols, benzene, benzo (a)
pyrene, cyanide, hydrogen sulfide, oxides of iron,
nitrogen,
carbon,
sulfur,
respiratory
organs.
Chemical and petrochemical industry:
calcium,
of
silicon,
Organic lesions of the central
nervous system.
70
manganese, magnesium, lead, ammonia, sulfur
dioxide, formaldehyde, methanol).
Krasnouralsk
Ferrous and nonferrous metallurgy (coal and coke Pathology
dust, phenols, benzene, benzo (a) pyrene, organs.
of
respiratory
cyanide, hydrogen sulfide, oxides of iron, calcium,
carbon, silicon, sulfur, manganese, magnesium,
lead, aluminum, nickel, arsenic, copper, zinc,
alkali metals, fluorine).
Turinsk
Pathology of the digestive
system.
Pulp-and-Paper mill (calcium oxide, sulphurous Pathology of urinary organs
and methylsulphurous compounds, methanol, (nephropathy
phenol, chlorine, chlorine dioxide).
with
the
oxalate-calcium crystalluria).
A critical situation for the population concerning Pathology
of
the
providing with drinking water. In water supply musculoskeletal system (joint
there is increased content of iron, manganese, hypermobility syndrome, early
sodium, chlorides, sulfates, and ther is low calcification of the bones).
content of fluoride.
Bohdanovich
Plants: refractory products, imbregnated skeper, Pathology of the digestive
porcelain, building materials, furniture factory system (underweight, chronic
(silicon dioxide, sulfur dioxide, compounds of gastritis). Pathology of the
nickel, chromium, cobalt, formaldehyde, phenol, musculoskeletal
system
ammonia, xylene, toluene). High level of soil (syndrome of hyper- mobility
contamination of children’s institutions areas- of joints).
66.7%. The highest chemical burden – arsenic.
Excess of calcium and increased rigidity in the
underground sources of drinking water.
Novomoskovsk
Chemical and petrochemical industry:
(Ammonia, sulfur dioxide, nitrogen oxides,
Pathology
of
the
nervous
system.
phenol, formaldehyde, sulfuric acid, hydrogen Pathology of the
chloride, ethyl acetate methanol, hydrogen musculoskeletal system.
sulfide, hydrocarbons).
71
In Turinsk urinary tract disorders, multiple bone deformation were common pathology of children. In
Bogdanovich underweight, often accompanied by disorders of the digestive organs and hypermobility
syndrome joints syndrome dominated. It is noteworthy that children living in Bogdanovich had in
nosological structure erosive gastroduodenitis (18,5%), complicated by gastrointestinal bleeding (3,7%).
In Irbit there were more cases of thyroid enlargement, delayed physical development and vegetativevascular dystonia. It should also be noted that in 5.7% of children from Irbit gastroesophageal reflux
disease was revealed. Moreover, the emergence of this disease accounts for 10-11 year old children. In
Verhnya Tura more frequent were endocrinopathies (euthyroid goiter), multiple bone deformations
with weak ligamentous apparatus (scoliosis, kyphoscoliosis, subluxation of cervical vertebrae, congenital
habitual dislocation). In Salda an "environmental portrait" of a child is represented by functional
cardiomyopathies and congenital heart diseases, perinatal encephalopathy with hypertensivehydrocephalic syndrome. In Artemovsk percentage of children with enlarged thyroid gland was
maximum, as well as the widespread food allergy and of joints hypermobility syndrome. In Bisert
relatively more frequent a joints hypermobility syndrome in combination with delayed physical and
sexual development and food allergy was revealed.
It was revealed a significant correlation between the API and the prevalence of neuropsychiatric
diseases among the examined children, which can be supposedly caused by the presence in the air of
neurotoxic metals (lead, mercury, manganese, cadmium, etc.). Environmental contamination by these
metals is typical for towns with advanced ferrous and nonferrous metallurgy. The correlation coefficient
between the air pollution index (API) and the prevalence of the nervous system diseases in the
examined towns was 0.78 (p <0,04) (Table 5.4).
For Novomoskovsk of the Tula region an "environmental portrait" of a child with diseases of the nervous
system (neurovegetative dysfunctions, asthenic syndrome, hidden comatic depressions) and
musculoskeletal system (incorrect posture, scoliosis, deformities of the chest, flat foot, arthritis and
arthrosis) are typical.
Table 5.4.
The air pollution index and prevalence of the nervous system diseases in the examined towns
Towns
Prevalence of the
nervous system
diseases
Atmosphere
pollution
index
72
N.Tagil
790
8,8
Salda
539
4,5
Kachkanar
290
1,8
Krasnouralsk
366
1,4
Neviansk
284
0,33
Ivdel
430
0,46
Novomoskovsk
325
5,4
Comprehensive assessment of the relationship between environmental factors and health status of the
child’s population suggests the focus on the establishment of the risk factors and forming risk groups in
order to develop and implement adequate preventive measures. Risk markers may be indicators of
diseases prevalence, specificity of its structure, age-peculiarities of frequency of this or that pathology,
the presence in a population of diseases associated with specific influence of harmful environmental
factors, the overall unfavourable ecological situation on the studied area or the pollution of the
environment components (air, water or soil), etc. It seemed expedient from this position to carry out
the combined analysis of the received data. In the context of this task it is no less important a diagnosis
of early adverse changes in health status which have not manifested themselves in the form of a specific
nosology yet, but their revealation is important for preventing the subsequent development of a
pathological process. However, according to WHO and the Health Ministry of the Russian Federation
recommendations in order to prevent infection transmission preference should be given to noninvasive
methods of prenosological diagnosis. The combined use of prenosological diagnosis methods and
general medical examinations during the study of health status allows to diagnose groups of children
with different level of health for a differentiated approach to bringing them into a healthy state. In this
work such a noninvasive technique that gives the answer to the question, what is the load of heavy
metals to the examined group of children was the VRT method. Evaluation of the relationship between
environmental factors and health status and forming risk groups based on it requires, above all, a logical
interpretation of the existing relations of qualitative signs and quantitative indicators of the
environment state and public health. It is important to define the parameters of regional "norm of
reaction" of a man to the effect of adverse factors [73].
Formation of high-risk groups, taking into account the action of harmful factors and pathological
conditions caused by them requires the development of criteria, which depend on the specific hazard
73
(the content in the environment objects, ways of income, etc.) the nature of pathology, groups of
children most exposed to its effect, etc. In the end, it defines the principles of clinic system,
rehabilitation and prevention of environmental-dependent diseases of children. Onischenko G.G. with
co-authors offered criteria for distribution of children for risk groups, taking into account the health
status to determine a type and amount of specialized medical and preventive care [61] (Table 5.5).
Table 5.5
Children risk groups and the type of specialized health and preventive care [according to Onischenko
G.G. with co-authors., 2004]
Risk
Group
I
II
Type of specialized medical and preventive
care
Practically healthy children (control Preventive set of activities aimed at activation
of geral adaptive and immune resistant abilities
group)
of the body, held in organized children's groups.
Group of formation of environmental- Supporting therapy: detoxification, symptomatic
conducted on outpatient basis.
dependent pathology
Characteristics of the-risk group
(Functional disorders)
III
Group with environmental-dependent Corrective therapy: pathogenetic,
health disturbances in the remission detoxification, symptomatic in the conditions of
hospital and sanatorium-and-prophylactic
state
institutions.
(Monoorganic pathology with mild
pathological process and rare remissions)
IV
Group with environmental-dependent Targeted corrective therapy in hospital and
health disturbances in the moderate specialized centres: pathogenetic,
detoxification, substitution, symptomatic.
stage of clinical and laboratory
manifestation of pathological process
(Monoorganic pathology with mild or
moderate-severe pathological process
and rare remissions).
V
Group with environmental-dependent In-depth
examination,
targeted
corrective
health disturbances in the stage of therapy in hospital and specialized centres:
marked
clinical
and
laboratory pathogenetic,
manifestation of the pathological process
symptomatic.
detoxification,
substitution,
74
(Unclear diagnosis, which requires indepth
examination,
multiple
organ
pathology, serious tendency of the
pathological
process
with
frequent
relapses).
Application of these criteria to the received materials allowed to form risk groups, which varied
substantially as a percentage in different towns (Table 5.6).
Table 5.6
Distribution of children according to risk groups in a number of examined towns.
Towns
Risk groups (%)
I
II
III
IV
V
Итого
N. Tagil
11,8
20,0
15,6
20,3
32,3
100
V. Tura
9,7
20,3
34,0
16,9
19,1
100
Verhnya and Nizhnya Salda
10,3
17,3
33,1
18,2
20,4
100
Ivdel
18,3
52,1
9,9
12,7
7,0
100
Karpinsk
40,1
30,6
14,3
8,8
6,2
100
Novomoskovsk
24,6
31,8
12,8
21,4
9,5
100
These differences are naturally determined by different levels of prevalence of pathology, frequency of
"toxic burdens” by heavy metal among children examined in the towns of the Sverdlovsk region,
indicated in the table. The coefficient of Kendall rank correlation of percentage of children classified in
the high-risk groups with the general air pollution (API) is equal to 0.8 (P <0.05), i.e. to some extent they
reflect the ecological stress of the territories where they live.
The analysis of the health status of children residing in regions of high industrial load, has shown that a
special group of children was formed at ecologically unfavourable territories. This gourp can be
75
considered a risk group. These children suffer maladjustment syndrome, have multiple organ pathology,
which is undoubtedly the result of the influence of man-made environmental factors.
The results of the work and conclusions of medical specialists confirmed the rationality of the compiled
program of the comprehensive survey to identify the earliest symptoms of diseases of children from
areas of high technogenic loads. The comprehensive examination was carried out by doctors of various
specialities,
including
a
neonatologist,
neurologist,
gastroenterologist,
cardiologist,
otorhinolaryngologist, endocrinologist, dermatologist, orthopedist. Taking into account the specificity of
the effects of environmental factors on specific areas, it is possible attraction of physicians of other
specialities that will contribute to active identifying environmentally-dependent diseases. It’s obvious
that there is need for creation targeted prevention programs of child’s morbidity in the light of existing
environmental and social situation, involving a wide range of medical specialists and the mass media.
Lack of awareness of the specific of the harmful ecological factors which are peculiar to a certain area,
puts the question of purposeful propaganda of scientific knowledge on this problem among the medical
staff and people living in the zone of high technogenic loads.
76
CHAPTER 6. MEDICAL-ECOLOGICAL REHABILITATION OF CHILD’S POPULATION from environmentally
unfavourable zones
The results of the ecological and epidemiological studies have shown the need for rehabilitation of
children living in areas with high stress. In order to get this goal there has been developed a
comprehensive program of rehabilitation of children from risk groups, aimed at prenosological
diagnosis, early diagnosis of diseases, prevention of complications.
Center for Health ekorehabilitation "Green House" is the structure of the Federal Environmental Fund of
the Russian Federation, engaged in health problems of children and adolescents. "Green House" is some
kind of a laboratory for testing new modern methods of rehabilitation and strengthening the health of
the younger generation and transferring this experience to all regions of the Russian Federation. The
program involves the interaction of Centre for health ekorehabilitation "Green House" and the Russian
Children's Clinical Hospital (Moscow) with the administrative offices of areas of ecological trouble.
"International Children's Center”, the Sysin Human Ecology and Environmental Hygiene Research
Institute of RAMS. Financing of this program was provided at the expense of the Federal Ecological Fund
of the RF, extrabudgetary funds, as well as sponsorship funds within the limits stipulated in the program
“Sanatorium rehabilitation of children from areas of ecological trouble, suffering from chronic diseases
for 2000 - 2002".
This program realization consists of the following expenses: the draft development of the sanatory
rehabilitation of children, development of the protocol of children’s examination with high risk of
diseases development, training of sanatoriums departments personnel; holding organizationalmethodological meetings.
To provide successful rest and rehabilitation of children from Novomoskovsk of the Tula region,
cooperation agreements with the State Enterprise "International Children's Centre were concluded. The
Centre has long experience of sending children to holiday homes and camping sites, with the Republican
Children's Hospital, as well as the organization “Hematologist’s of the world to children".
The comprehensive target program of medical and ecological rehabilitation included prevention of
diseases, proper medical care and was based on the following principles:
• differentiation - the selection of children for health institutions depending on the state of health of the
child and the profile of health institutions;
• stages - consistent implementation of health activities in accordance with the state of health of the
child;
• continuity - the recovery should begin before a child enters a summer institution and continue after
his return to his permanent living conditions;
77
• complexity - recreational activities should optimally include various factors (nutrition, training,
psychological methods, herbal medicine, etc.).
The program of sanatorium rehabilitation of children from areas of ecological trouble is aimed at
creating a recovery system based on the selection of patients according to unified criteria of screening
examination of children living in areas with high industrial loads. Unified system clinical examination hospital – sanatorium provides:
1. to identify groups of children with high risk of disease development;
2. to examine sick children for determining the quality of compensation of underlying disease, presence
of complications;
3. to choose in accordance with medical evidence the most suitable conditions for the rehabilitation of
the child;
4. to carry out a set of measures to prevent diseases.
The purpose of the examination was to identify children with a high risk of a disease, to determine the
degree of its compensation and to prevent complications. Particular attention was paid to examination
of brothers and sisters with identical pathology and residing in the same family.
To achieve this goal:

the Passports of Health were developed;

a unified system of selection of candidates for rehabilitation was created;

Based on the examination groups of children with high risk of disease were formed;

protocols of rehabilitation of sick children in accordance with the nosological form and degree
of severity of the pathological process were develop;

a system of evaluating the effectiveness of rehabilitation was developed;

a method of training patients and their parents in the “Schools of self-control” was developed.
The program was tested in Novomoskovsk of the Tula region with experts of RCCH (Moscow). As a result
of the examination it has been carried out:
1. Distribution of children to risk groups for further examination

Children with neglected latent forms of diseases were revealed, with indeterminate diagnosis
accurate diagnosis was made;

Children with indeterminate diagnosis were sent to additional examination to specialized
medical and diagnostic centres;
78

In accordance with evidence reasons, children were sent to hospitalization to specialized
medical treatment facilities.
2. Recommendations ground for medical-preventive maintenance of children.
3. Recommendations ground for further in-depth assessment of health status.
The types and amount of specialized medical-preventive measures of 933 examined children of
Novomoskovsk were determined in accordance with the distribution of the children under five risk
groups, based on somatic diagnosis, taking into account the severity of pathological process (ris.6.1).
Group I
25 %
230 children
Healthful
measures
Group II
32 %
297 children
Healthful
measures
At residence
At residence
Group III
13 %
Group VI
20 %
Group V
10 %
119 children
Ambulant
therapy
199 children
Hospital
treatment
88 children
Hospital
treatment
City
Hospital
Republican
Children’s
Clinical
Hospital
City
polyclinic
and RCCH
polyclinic
Sanatorium-spa rehabilitation
673 children
Sanatorium
dispensary
At residence
in a green
zone
246 children
Sanatorium
treatment at
climatic
health
resorts
427 children
Ris.6.1 Medical and preventive care at risk groups of children from Novomoskovsk.
79
Sanatorium-spa treatment of children subjected to health and environmental rehabilitation was carried
out in specialized departments of sanatoriums. Sanatorium staff was trained on the base of the dietetics
department of RCCH.
According to the preliminary medical examination results groups of children were organized and
completed. Activities for their rehabilitation at the Center for Health ekorehabilitation "Green House", in
rest homes, as well as in camps located in the ecologically favourable regions were panned. Their
meeting and seeing off at airports of departure and arrival were organized. Children were placed in a
summer camp. Trips, cultural events and, in addition, special events, with emphasis on environmental
education were organized for them ((Annex 7,8).
On their arrival at the place of the rest children were examined by pediatricians, orthopedists, vertebral
neurologists, hematologists, physicians of functional diagnostics, reflex-therapists, endocrinologists,
surgeons, neurologists, nephrologists, allergists, dentists. Recommendations based on surveys that are
included in the “Passports of Health” were given to hosts directly in holiday homes and camps, as well
as medical personnel who provided ekorehabilitation activities. Treatment and preventive measures
aimed at reducing toxic loads and functional recovery of damaged organs were conducted.
In order to improve child’s health the following types of medical and ecological rehabilitation were
implemented: physical, climatic, psychological, etc.
Physical rehabilitation. The use of physical rehabilitation programs and training of fundamentals of sport
on the base of health institutions is the necessary condition for removal of psycho-emotional complexes
that children with chronic illnesses suffer. In view of physical rehabilitation according to medical
evidence children attended surgeries of massage and manual therapy, acupuncture, magnetoelectric
laser puncture, solarium, light -, of water - and mud baths, where physiotherapy was implemented. In
addition, children took broth herbal and inhalation in the study of herbal medicine. Marine bathing, as
well as classes in the pool and medical gymnastic were conducted.
Climatic rehabilitation. Beneficial effect of climatic factors on the body of a child helped to restore the
acid-alkaline balance, to normalize oxygen deficiency, which ultimately improved the basic health
indicators. Doctors-dietitians administered nutrition of full value, age-appropriate to the child and prone
to allergic reactions, a reasonable attitude to starchy foods and sweets. Children took stable
homeopathic complexes and drainage remedies of vegetable origin, multivitamin preparations, ageappropriate to the child and his loads.
For the psychological rehabilitation of children according to a special training program of Health Center
"Green House" theoretical and practical training in natural conditions were carried out with them. The
main task of educational and environmental activities is to instil love and respect for nature as a source
80
of health and preservation of harmony on the planet. An integral part of the rehabilitation program is to
develop children's understanding of healthy lifestyle and their ecological education. An educational
program "Green House" including educational supplies and textbooks, designed for children of different
ages was elaborated for this purpose.
Figurative expression "Green House" is the name of educational courses system developed for the
comprehensive school. It provides acquaintance of children with the world around them, their science
and ecological education. "Green House" is an educational courses system provided with programs
package, a set of text books and educational supplies. They are approved by the Ministry of Compulsory
and Trade Education of the Russian Federation. The programs are included in the collections of
programs for elementary school. Textbooks and a number of other educational supplies are part of the
Federal set of textbooks for educational institutions in Russia (Annex 7). As part of the educational
activities significant time was devoted to the development of children's understanding of how important
it is to maintain their own health. A series of lectures for the formation of healthy style of life was given.
Children were presented with specially prepared booklets on the subject (Annex 8).
On children's return from recreation areas they were medically surveyed at their residence. It was noted
that during the period of surveillance the children from the group of frequently ill children were rarely ill
with acute respiratory infections: 30% of them suffered once every six months, and 50% once a year.
Those who were ill once every three months stopped to be ill. In the group of children with chronic
nidyses of infection (chronic tonsillitis, adenoiditis) there were no relapses during the current year.
When preventive ENT examinations were carried out it was registered that adenoids of the treated
children decreased to the first degree, and surgical treatment wasn’t required. In the group of children
with the diagnosis: vegetative-vascular dystonia there was progress in studies, work capacity increased,
sleep normalized, weight increased, complaints of headaches disappeared, a general favourable
background appeared. After the recovery the children were out of the state of asthenia. Effective
rehabilitation of the children at the climatic resort had a positive effect on the children suffering from
atopic dermatitis. Their disease has been in stable remission for over six months . Health improvement
of children suffering from asthma occurred seasonally: children with pollinosis to the pollen of flowering
plants were taken at the flowering period to another climate. The principle of rehabilitation in this case
is: climate change - an exclusion of allergen - the disappearance of attacks of breathlessness. The
hormonic background of the children suffering from endocrinopathies (euthyroid goiter) was restored to
normal (TSH, T3, T4), general state of health improved. While examining a thyroid gland with the help of
ultrasound diagnostic a positive dynamic was registered. Hydrotherapy with mineral water provided
favourable therapeutic effects to children with gastroenterological disorders. Ultraviolet insolation on
the climatic resort leads to better absorption of vitamin D. Warm sea salt baths, quartz sand, massage
81
helped diathermy of a child's body, which led to an improvement of metabolic processes and positively
influenced the musculoskeletal system.
Evaluating of the effectiveness of rehabilitation was carried out by the analysis of feedback
questionnaires, compiled in the sanatorium by medical staff and presented to the policlinics at
residence on the return from health institutions. In 3 and 6 months after the rehabilitation measures
had been carried out outpatient cards of children (Form 112) were analyzed. After the rehabilitation
measures beneficial effect was evident judging by changing the ratio of children at risk groups - reducing
the proportion of children in high risk groups, moving them with improved health to groups with more
favourable health status. However, after 3 months there has been movement in the opposite direction,
which in 6 months became more obvious. This illustrates the need for repeated rehabilitations measures
in risk groups to the full rehabilitation of children (Fig.6.2).
The program realization gave the following practical results:

Children with untreated latent forms of diseases were revealed, with indeterminate diagnosis
accurate diagnosis was made;

Children with indeterminate diagnosis were sent for additional examinations to specialized
diagnostic and therapeutic centres: 15 children with the diagnosis of: bronchial asthma and
moderate tendency of bronchio-obstruction syndrome were examined in the outpatient
%
department of RCCH of Moscow;
60
50
40
30
20
10
0
I
II
III
IV
V
Examination period
Fig.6.2. The effectiveness of preventive medical care in high-risk groups of children of Novomoskovsk
82

According to medical reasons, children were sent to hospitalization to specialized medical
treatment facilities: 13 children were hospitalized to the department of clinical immunology,
dermatoallergology, gastroenterology, radiosurgical methods of treatments of RCCH for giving
high specialized medical care, which they could not get in Novomoskovsk. One girl was urgently
hospitalized to RCCH, where she was operated on in connection with cyst of the pancreas;

In summer camps it was conducted medico-ecological rehabilitation of children (673 children) in
accordance with the developed recommendation system (summer school sites and recreation
camps of urban and suburban type, All-Russian children's health resorts on the Black Sea coast
with a further assessment of health status);

Consultations were given to the doctors of the medical institutions, on the basis of which the
children were examined. "Manual on rational use of antibiotics, cough medicine and mucolytics
to prevent excessive allergization” was given to the medical staff.

The parents of the examined children were given recommendations concerning therapeutic and
preventive measures in accordance with the child’s health and diagnosed pathology (Annex 8).
Thus, analysis of the hygienic sanitary situation in the territories of the examinations, prenosological and
clinical diagnosis of the health status of children living in conditions of high technological loads allow to
identify groups of high risk of pathology, to determine appropriate conditions for the improvement of
children’s health and to hold a set of preventive measures (Fig. 6.3).
Environmental and living conditions estimation
Hygienic, prenosological and clinical diagnosis of violation of children’s health
Risk groups forming
Working out of medical-preventive and recreative measures complex
Hospital
Policlinic
Sanatorium
Evaluation of medical-preventive and rehabilitative measures effectiveness
83
Fig. 6.3. An integrated approach to the development of therapeutic, preventive and rehabilitating
measures of children with ecologically-dependent diseases.
As a result, the carried out complex of medical and preventive measures includes all types of prevention
of disturbance of children's health:
• Primary prevention - the formation of a stable idea of a healthy lifestyle, observance of the day
procedure, adequate nutrition, tempering procedures;
• Secondary prevention - prenosological diagnosis of health status disturbances, identification and
elimination of early symptoms of diseases, carrying out of recreation;
• tertiary prevention - treatment of identified pathology, relapses prevention and chronic pathological
process through the complex of medical and preventive rehabilitation measures.
Governor's Special Purpose Program to provide medical assistance to children living on ecologically
unfavourable territories is carried out in the Sverdlovsk region. To avoid duplication, rehabilitation of
the examined children in the towns of the Sverdlovsk region was carried out under this program in
accordance with medical evidence and the recommendations of doctors who conducted the
examination [20, 82].
The methods of organizing and conducting recreational activities developed in this analyse, was also
implemented in other regions of Russia (the Arkhangelsk, Moscow, Yaroslavl regions, Primorsky Krai, the
Republics of Karelia and Khakassia) with the participation of the State Enterprise "International
Children's Centre”, which is one of the participants of the federal special purpose program
“Development of All-Russian children’s centres “”Orlenok” and “Ocean”. In 2001-2005 2638 children
from these regions were sent for rest and medical-ecological rehabilitation to rest homes and
sanatoriums.
84
CONCLUSION
The analysis of the results of the comprehensive examination of the child’s contingent according to the
program developed by us showed that on the studied territories in the zones of ecological trouble the
level of skilled medical care provided for mass child’s population was insufficient. The examination of
the children by medical specialists in many cases showed a lag of practical public health in provinces
from modern methodologies developed and extensively published in the periodical medical press and at
conferences. In order to detect early symptoms of diseases of children from areas of high technogenic
load the above-mentioned comprehensive survey was carried out by doctors of various specialities,
including neurologist, gastroenterologist, cardiologist, neonatologist, otolaryngologist, endocrinologist,
dermatologist, orthopedist. Taking into account the specificity of the effects of environmental factors, it
is possible to involve other medical specialists which will contribute to active identification
environmentally sensitive pathology. It should be noted that this work on a survey of children was
carried out with direct participation and active cooperation of local doctors to carry out the subsequent
continuity during dynamic, postrehabilitation observation of the stated contingent. It’s obvious the
necessity for creation of targeted programs for prevention child’s morbidity in the light of existing
environmental and social situation, involving a wide range of medical specialists and the mass media.
Lack of awareness about the specific of harmful environmental factors effect characteristic of a
particular area raises the question of targeted promotion of scientific knowledge in this field among
medical personnel and the public.
An important aspect of environmental factors effect is children's mental health break down and
therefore an urgent task of rehabilitation is psycho-correction to improve the emotional and personal
sphere and the state of the autonomic nervous system. Taking into consideration the fact that the effect
of harmful environmental factors more actively manifests itself on socially disadvantaged background,
one of the priority tasks is the task of social rehabilitation of children.
It is shown that the negative effect of harmful environmental factors on the body of the child more
actively manifests itself on an unfavourable social background. Social gradient in the formation of
children's health, identifying modern features of health formation, actually provides and determines the
trends in health and qualities of future population of the country, the realization by this contingent of
social and biological functions pre-determining the life and health of future generations [92, 31]. The
data above show urgent need for solutions in the society of social problems related to livelihood of
children, including these items in the strategic documents on development of the country and close
monitoring of their practical realization at all levels [48].
The problem of children’s health breakdown is multifaceted. As the above data show, it focused
imperfect legal regulation of children's health protection, negative effects of socio-economic changes in
85
the country, the ambiguity of organizational changes in the field of public health, etc. Since the problem
is interagency in nature, for its integrated solutions it is necessary to attract structures of different
profile and level from federal, regional to non-governmental organizations and funds that put the
problems of public health protection. The decisive condition must be a systematic approach in which
each block of the system is interconnected with the other components, has clear tasks and methods of
their solution. Formation of high-risk groups, taking into account the action of harmful factors and
pathological conditions provoked by them requires the development of criteria which depend on the
specific of a harmful factor (the content in the environment objects, ways of income, etc.) the nature of
pathology caused by it, groups of child’s population mostly affected by its effects, etc. In the end, it
defines the principles of health centre system, rehabilitation and prevention of environmentaldependent diseases of children. Bringing into a healthy state should begin before your child enters a
summer institution and it should continued after his return to the permanent conditions for him. In
order to implement sanitary-hygienic and medical-preventive measures to reduce the impact of harmful
factors on children’s health successfully it is necessary to inform population and medical personnel is to
be appropriately trained, i.e. ecological and health education is necessary.
86
CONCLUSIONS
1. Priority risk factor for public health in the Sverdlovsk region on the basis of analysis of sanitaryhygienic state of the environment is a complex chemical and biological stress associated with pollution
of water, air, soil, mostly marked in Kamensk-Uralskiy, Cushva, Pervouralsk, Revda, Krasnouralsk. In
Novomoskovsk of the Tula region chemical stress is associated with air pollution.
2. In the surveyed towns of the Sverdlovsk region the prevalence of pathology of the examined children
was significantly higher than of children of Novomoskovsk (p <0,01): the prevalence of all diseases,
respectively 2081 ‰ and 1103,5 ‰, respiratory diseases (464 ‰ and 118,1 ‰ ), nervous system (413
‰ and 324 ‰), digestive system (365 ‰ and 120 ‰).
3. Prevalence of child’s pathology and its structure in individual towns show the specifity of effects of
environmental factors, creating a certain "ecological portrait" of a child characteristic of a particular
town that may have diagnostic meaning in the formation of hypotheses about possible local factors
responsible for the emergence of diseases in the area. Specifity of influence of to environmental factors
should be considered in the formation of multidisciplinary teams of medical specialists to examine
children from areas of ecological trouble.
4. It is advisable to use non-invasive method of VRT informative with regard to specific environmental
factors effecting a human organism, for examination of large contingents both in conjunction with
clinical methods and as an independent method of prenosological diagnosis.
5. The program of medical and ecological rehabilitation is to be based on the principle of continuity
"clinical examination - hospital - sanatorium" that allows to examine children completely to identify
groups at high risk of chronic diseases, qualities of compensation of the main disease, presence of
complications and, accordingly, to recommend the most suitable conditions for recovery.
87
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103
104
APPENDIX
1. Ivdel
2. Severouralsk
3. Krasnoturinsk
4. Karpinsk
105
5. Serov
6. Gari
7. Novaya Lyalya
8. Verhoture
9. Kachkanar
10. Nizhya Tura
11. Verhnya Tura
12. Krasnouralsk
13. Kushva
14. Nizhnya Salda
15. Verhnya Salda
16. Nizhniy Tagil
17. Alapaevsk
18. Nevyansk
19. Kirovograd
20. Verhniy Tagil
21. Shalya
22. Rezh
23. Artemovskiy
24. Irbit
25. Turinsk
26. Tabory
27. Tavda
28. Turinskaya sloboda
29. Baykalovo
30. Pyshma
31. Bogdanovich
32. Kamensk Uralskiy
33. Sysert
34. Revda
35. Pervouralsk
36. Sredneuralsk
37. Verhnya Pyshma
106
38. Ekaterinburg
39. Krasnoufimsk
“Health Passport”
1. Passport details (surname, first name, patronymic).
2. Year of birth, address.
3. Information about the parents (the year of birth, education, occupation).
4. Extracurricular activities (participation in study groups, sports exercises, etc.).
5. List of diseases a child had before.
6. Medical examinations data in the dynamics
7. Recommendations for rehabilitation (residential treatment, hospitalization to a specialized medical
institution, sanatorium spa treatment, etc.)
107
QUESTIONNATIRE
Child Health Examination
1. Surname, name, patronymic of the child
2. Sex
1. male
2. female
3. Date of birth __________________________________________________
4. Address __________________________________________________________
__________________________________________________________________
5. Information about the parents:
Year of birth
education
Place of work
mother
father
6. Housing conditions:
1. Hostel
2. Communal flat
3. Separate apartment
4. Own house
Occupation
108
7. Family history (chronic diseases)
___________________________________________________________________
_________________________________________________________________
8. Medical examination:
1. Diagnosis______________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
2. Recommendations______________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
109
Appendix 4
A clinical example of opisthorchiasis.
Child Julia O., 9 years old, lives in Verhnya Salda of the Sverdlovsk region.
Diagnosis: Opisthorchiasis. Juvenile rheumatoid arthritis.
She has been suffering from opisthorchiasis since the age of 7 as a result of eating not enough fried or
poorly salted fish with metacercariae of helminth infection occurred. The beginning of the illness was
acute. Complained of fever, pain in muscles and joints, vomiting, and diarrhea. The examination
revealed tenderness and enlargement of the liver and spleen, allergic skin rash. Often pains become
acute in the form of attacks of biliary colic. There are often dizziness, headaches, dyspepsia (vomiting,
loss of appetite, intolerance to fatty food). She complains of insomnia, frequent changes of mood,
increased irritability. The complex therapy with antiworming drugs (Praziquantel), choleretic and
enzyme preparations was carried out .
To restore the impaired liver function preparations of the group of hepatoprotectors were given. In 6
months after the treatment the monitoring of the effectuality of chemotherapy was carried out- reanalysis of feces and duodenal contents examination.
Appendix 5
A clinical example of multiple organ pathology.
Clinical example 2. Child Tanya G., 3 years old, lives in Kachkanar of the Sverdlovsk region.
110
Diagnosis: Chronic tonsillitis. Dacryocystitis. Anemia. Jade. Urinary Syndrome.
She was born from the infected mother with the diagnosis: dacryocystitis. Pregnancy-first, was taking its
course with the toxicity of the first trimester, with the threat of interruption in the first trimester.
Childbearing was the first, immediate, fast, with the stimulation. Score on a scale of Angar 7 / 8.
Screamed at once. Weight at birth 3400, height - 52 cm, was born at full term. In the neonatal period
suffered from on acute dacryocystitis, catarrhal omphalitis. Since three years old against the background
of frequent ARVT adenoiditis and chronic tonsillitis developed.
At the age of 2 years recovered from acute tonsillitis with high temperature in, three weeks after which
there were complaints for enuresis. She was hospitalized with the diagnosis: acute glomerulonephritis.
She was treated in hospital for 1.5 months with antibiotics, prednisolone. Symptomatic treatment drugs that improve the metabolic processes in the kidneys. She is at the dispensary of the nephrologist.
Currently there is a period of remission.
111
Appendix 6.
The basis of the training package consists of the following publications:
1.
Зеленый дом: Методическое пособие к системе учебных курсов с экологической
направленностью для школы (авт. А.А. Плешаков). Пособие к единой системе учебных курсов
раскрывает научно-методические основы, содержание, особенности средств обучения и
методику преподавания. Пособие необходимо всем читателям, работающим по данной
программе, как в трехлетней, так и в четырехлетней начальной школе.
2. Мир вокруг нас: Учебник для начальной школы (авт. А.А. Плешаков).
Учебник помогает школьникам открывать удивительный и многообразный окружающий
мир, находить ответы на многие «почему?». Вместе с героями книги школьники познают
тайны природы, прослеживают увлекательную историю простых и привычных вещей,
учатся пользоваться компасом, знакомятся с картой и мысленно путешествуют по материкам
и странам. Учебник нацелен на развитие мышления, речи, памяти, воображения детей; с
его помощью начинается формирование важнейших понятий в области окружающей
среды, которые получают развитие в курсе природоведения последующих классов.
Красочные иллюстрации дополнены лаконичными текстами, что позволяет уже с
первых уроков вовлекать в активную работу учащихся детей. Содержащаяся в
учебнике система знаний, главным образом игрового характера, обеспечивает высокую
активность учащихся во время работы на уроке. Особое внимание уделяется
экологическому образованию учащихся.
3.
Ознакомление с окружающим миром: Тетрадь для начальной школы (авт. О.Н.
Сороцкая, А.А. Плешаков). Красочная учебная тетрадь, содержащая материалы по всем
темам программы. Предназначена для систематизации и обогащения представлений детей
о природе и общественной жизни, а также для проверки знаний и умений,
приобретенных детьми на занятиях.
4. Природоведение: (авт. А.А. Плешаков, под ред. И.Д. Зверева).Единый учебник для школ.
Отличается ярко выраженной экологической направленностью. Знакомит учащихся с
природным многообразием, помогает осмыслить важнейшие экологические связи и
нормы поведения человека в окружающей среде. В доступной для учащихся форме
раскрывает экологические проблемы на глобальном, родиноведческом и краеведческом
уровнях, помогает организации эколого-краеведческой работы со школьниками.
112
5.
Зеленые страницы: (авт. А.А. Плешаков). Своего рода научно-художественная
энциклопедия, адресованная младшим школьникам. Направлена на воспитание у
ребенка любви и заинтересованного внимания ко всем проявлениям жизни, бережного
отношения к своему природном у дому. Рассчитана на самостоятельное чтение детьми и
совместное чтение ребенка и взрослого в семье. Используется на протяжении всех лет
обучение ребенка в школе. Помогает при проведении уроков, экскурсий, факультативных
занятий, различного рода мероприятий природоведческого и экологического характера.
6.
От земли до неба: Атлас-определитель (авт. А.А. Плешаков). Впервые разработанный
специально для школы атлас-определитель позволит ученику разобраться в огромном
разнообразии
окружающих
его
природных
объектов,
узнать
названия
наиболее
примечательных растений, животных, камней, созвездий. Используется детьми во время
школьных экскурсий и уроков, прогулок с родителями, летнего отдыха.
113
Appendix 7.
Brochures on the formation of healthy lifestyle:
1. Культура и эстетика питания. Методические рекомендации./Соболев В. А., Верещагина
М.Н., Тула, «Инфра»- 2001. 72 с.
2. Спортивный массаж. /Соболев В. А., Буровых А. Н. /Тула. «Инфра».- 2001, 43 с.
3. Основы лечебной физической культуры./ Соболев В. А., Пушкарь М.П. / Тула. «Инфра».2001.- 62 с.
4. Экология души. / Программа комплексного подхода к образованию, воспитанию,
оздоровлению и развитию учащихся. / Соболев В.А. Кошеляева С.Л., Тула,
«Инфра», 2001.-48 с.
114
Curriculum Vitae
of Sobolev Vladimir Anatolyevich, born in 1962.
V.A. Sobolev graduated from the Medical Faculty of the 1-st Sechenov Moscow Medical Institute
(Medical Academy) in 1985 with a degree in medicine. Qualification - a doctor.
In 1985-1992 he worked as a researcher at the Institute of Biomedical Problems of the USSR Ministry of
Health. He was engaged in examination of astronauts and test pilots as a physician – tester of a clinical
department. He passed the selection and certification as a physician-scientist-tester to the cosmonaut
detachment.
In 1995 he studied specialization at the Russian Centre of Manual Medicine of the Russian Federation
Ministry of Health and was given a qualification of a "doctor - manual therapist, and in 2001 he was
retrained in MONICA (Moscow Regional Scientific Research Clinical Institution) according to the program
"Oscillation techniques of manual therapy." In 2001 he was retrained in the Russian Medical Academy
according to the program "Pediatrics" in the department of outpatient pediatrics with a course of
hematology, oncology and outpatient pediatrics.
According to the decision of the Federal Ecological Fund of Russia in 1998, the Health Ecorehabilitation
Centre "Green House" was established. When leading the Centre Sobolev VA developed programs of
diagnosis, treatment and rehabilitation of children living in ecologically unfavourable territories of the
Russian Federation.
In 2005 according to the solution of the Russian Academy of Natural Scinces Sobolev V.A. was awarded
for this work: the Diploma of the National Ecological Award “Ecomir” (“Ecopeace”) in the category
“Ecology and health” for the creation of the program “Healthy children are the future of Russia”. In 2006
he was awarded the Mechnikov honorary Medal “For the practical contribution to strengthening the
nation’s health”.
Since 2005 he has been working in the laboratory of clinical diagnosis of environmentally-related
diseases of the Sysin Human Ecology and Environmental Hygiene Research Institute of RAMS as a junior
researcher.
Sobolev V.A. is one of the leaders of the All-Russian public movement "Healthy children – are the future
of Russia”. He is a member of administration of the Regional Public Fund "Centre for the protection of
children and teenagers "Overcoming".
In 2003 he was elected as an advisor of the Russian Academy of Natural Sciences, section of problems of
Russia stable progress (ecology and medicine)
Sobolev V.A. is an erudite, skilled specialist. He is notable for assiduity, enjoys the confidence and
respect of his colleagues. Sobolev V.A. is the author and co-author of 9 scientific works.
Curriculum Vitae is given for the submission to the Dissertation Council Д 208.072.01 of the Russian
State Medical Academy.
Acting Director of the Sysin Human Ecology and Environmental
Hygiene Research Institute of RAMS
Ph.D. (Medicine)
N.V. Rusakov
115
Roszdrav
Federal Government Establishment
FEDERAL RESEARCH AND MEDICAL CENTRE of
Pediatric Hematology, Oncology and Immunology
Federal Agency for Health and Social Development
(FGI FNKTS DGOI "Medical)
117997, Moscow, GSP-7, Leninsky Avenue, 117
Tel: (495) 937-50-24, fax: (495) 935-55-10, e-mail: info@niidg.ru
Director of the Sysin Research Institute of Human
Ecology and Environmental Hygiene of RAMS
academician of RAMS,
Y. Rakhmanin
On application of the research results
Dear Yuriy Anatolevich!
Researchers and doctors of the Federal Research Medical Centre of Pediatric Hematology,
Oncology and Immunology of Roszdrav, leaving for ecologically unfavourable areas of the Russian
Federation to identify ecopathology and to give specialized assistance to children use in their work
methods of organizing and carrying out screening medical examinations and health measures,
developed in the thesis of the senior research assistant of the Sysin Research Institute of Human Ecology
and Environmental Hygiene of RAMS V.A. Sobolev "The scientific basis of screening examinations and
health measures among children living in ecologically unfavourable territories".
Director,
Corresponding Member of RAMS, Ph.D (Medicine)
A.G. Rumyantsev
116
Chernov V.M. 936-90-76
All-Russian Society of
Nature Protection
the Tula region
Novomoskovsk
Director of the Sysin Research Institute of Human
Ecology and Environmental Hygiene of RAMS
Academician of RAMS
Y. A. Rakhmanin
On application of the examinations results
The proceedings of the thesis of research assistant V.A. Sobolev "The scientific basis of screening
examinations and health measures among children, living in ecologically unfavourable territories" were
used in the development of subprogram “Medico-ecological rehabilitation of the population” within the
framework of the program “Environmental Protection of the Tula region for 2001 2005”.
Newmoscow department
A.S. Peregudov
117
All-Russian Society of Nature Protection
ROSTECH SUPERVISION
INTERREGIONAL TERRITORIAL
ADMINISTRATION OF TECHNOLOGICAL AND
ECOLOGICAL SUPERVISION OF THE
FEDERAL SERVICE ON
ENVIRONMENTAL,
TECHNOLOGICAL AND NUCLEAR
SUPERVISION OF THE CENTRAL
FEDERAL DISTRICT
Director of the Sysin Research Institute of Human
Ecology and Environmental Hygiene of RAMS
Academician of RAMS
Y.A. Rakhmanin
107031, Moscow.
st. Rozhdestvenka 5 / 7.
Phone: 629-88-20, fax: 629-15-21:
E-mail: cpogtn@dol.ru
On application of the examinations results
Dear Yuriy Anatolevich!
Interregional territorial administration of technological and ecological supervision of the Federal
Service on Environmental and Nuclear Supervision of the Central Federal District reports that the
materials of the thesis of research assistant V.A. Sobolev "The scientific basis of screening examinations
and health measures among children living in ecologically unfavourable territories "are used in the
implementation of a comprehensive assessment of the impact on the environment of economic and
other activity and its effects on human health.
118
Administration Deputy Manager
I.A. Bykov
REVIEW
of the abstract of the thesis for the scientific degree of Candidate of Medical Sciences of V.A. Sobolev
"The scientific basis of screening examinations and health measures among children living in ecologically
unfavourable territories" - 14.00.07 - Hygiene, 14.00.33 - Public health and health care.
The topicality of the problem is caused by health conditions of the population, high level of morbidity
and mortality indicates the current crisis, the need for urgent actions to improve the health of the
population (GG Onischenko, 2001).
For the formation of risk groups and for adequate medical and preventive measures it’s necessary to
take into account the relationship between child’s population health and environmental factors that are
indicators of risk. It seems urgent to implement noninvasive methods of screening of diseases, allowing
to involve a significant contingent of children.
Scientific novelty lies in the fact that the program which has a comprehensive approach to the
examination of the child’s population living on ecologically unfavourable territories was worked out for
the first time. It is aimed at identifying children at high risk of ecologically-dependent diseases.
The practical significance is determined by the fact that noninvasive method of bio-resonance
diagnostics is informative which allows to carry out screening in the optimum periods; significantly
reduce temporal and financial expenses both to detect early prenosological states and to confirm that
pathological processes of the examined children are chronic.
Organization of work, scope and examination methods fully meet the requirements made on the theses
for the degree of Candidate of Medical Sciences. A detailed and in depth content of the thesis is given in
the abstract. A discussion of its main results is conducted adequately. Conclusions reflect the purpose
and research problems. List of publications (6) shows the author’s activity and his abilities to
differentiate and synthesize research material.
In general, the abstract of V.A. Sobolev’s thesis, "Scientific basis of screening examinations and health
measures among children living in ecologically unfavourable territories" gives a complete picture of its
scientific, practical significance, and fully corresponds to the "Regulations ...», item 8 about theses for
the degree of Candidate of Medical Sciences, and its author deserves the award of the desired degree.
Ph.D (Medicine) General Hygiene Department
Senior lecturer (Medicine)
General Hygiene Department
Kursk State Medical University
A.M. Chernykh
N.N. Zabroda
119
REVIEW
of the abstract of the thesis for the scientific degree of Candidate of Medical Sciences of Sobolev V.A.
"The scientific basis of screening examinations and health measures among children, living in
ecologically unfavourable territories" , in specialities - 14.00.07 - "Hygiene" and 14.00.33 - "Public
health and health care".
Currently, the development of contemporary Russian society is characterized by the transformation of
socio-economic, environmental, medical and biological conditions that undoubtedly affects the health of
the population, including children. Children's health is influenced by a complex of factors, including
environmental factors. In this regard, examinations on the health of children living in ecologically
unfavourable areas are topical.
The author in accordance with the purpose and objectives of the study used a complex of modern and
adequate research methods that provide a reliable material. Selection and volume of the conducted
researches are sufficient to carry out reliable statistical processing and to get conclusions.
Development of a differential approach to the selection of principles of children’s health improvement is
an important element of children's health. This is the first time rational methods of screening
examinations, medical and environmental rehabilitation of children living in ecologically unfavourable
territories of Sverdlovsk and Tula regions were scientifically based by the author.
The results of the study have both research and great practical value. The material of the research is
published in the form of 6 scientific papers and approved at 5-scientific-practical conferences.
Thus, the thesis of V.A. Sobolev "Scientific basis of screening examinations and health measures among
children living in ecologically unfavourable territories”, is an independent qualified complete scientific
work, which contains the solution of an important scientific problem having great significance in
preserving and improving the health of children, which meets the requirements of item 8 of the
“Regulations on the procedure for conferring academic degrees” made on candidate theses, and its
author Sobolev V.A. deserves the award of the desired degree of Candidate of Medical Sciences,
speciality 14.00.07 - "Hygiene" and 14.00.33 - "Public health and health care."
Head of General Hygiene and Ecology of Man Department
Ph.D (Medicine)
Samara State Medical Academy
A.V. Avchinnikov
120
REVIEW
of the abstract of the thesis for the scientific degree of Candidate of Medical Sciences of Sobolev V.A.
"The scientific basis of screening examinations and health measures among children, living in
ecologically unfavourable territories" , in specialities - 14.00.07 - "Hygiene" and 14.00.33 - "Public
Health and Health Care".
The thesis of Sobolev V.A. is devoted to the actual and practically important issue of preventive
medicine - examination and health care of children. It is important to find out processes of the
formation and identification of problematic situations, taking into account the ecological situation in
several regions.
During the examination the author developed and used the screening system of evaluation to identify
ecological burden of health condition, which may affect the severity of the pathology manifestation. The
more important are the results of the experiment conducted during the examination, when the
instrumental method was used in conjunction with the results of the health examination by
representatives of different clinical specialities which confirms its informative content and the ability to
use for screening of sick children’s contingents. The received during the examination the author’s
conclusion about the necessity of stages and succession in the provision of rehabilitation of children is
important.
At the same time it should be noted the need for a more rigorous attitude to those used in the research
concepts, as "ecologically-dependent diseases”, ecopathology, because the spectrum of diseases that
children suffer everywhere not only in the ecologically unfavourable territories is analyzed.
A more rigorous attitude should be to the statistics - the author points out that the hygienic criteria for
selecting areas of the examination were, in particular, higher levels of morbidity 2-3 times higher than
national levels. The overall level of recorded morbidity of children in Russia in 2005 was 2,150.1% 0.
Accordingly, it is unlikely that the author found the territories in the country where 3 times higher levels
of morbidity of children (more than 6000%0) were registered. It is not enough valid the assertion about a
higher proportion of children with congenital anomalies in Nizhniy Tagil in comparison with the average
Russian level -the examined contingent in contaminated areas is not strictly representative, in general
(as it is presented in the abstract) only sick children were sent for examinations and consultations of
specialists, and among Russian children in general, the majority are healthy and practically healthy
children.
The peculiarities of the examined contingents can have an impact on the results of comparison of the
characteristics of children's health at various bases of the study.
We should also note the lack of rigour of data in Tables 3 and 4 compared with the information in the
text, as well as the need for more strict (according to ICD-10) formulation of diagnoses, and group
names of diseases.
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However, it is very important that is the first time the author scientifically based rational methods of
screening examinations and rehabilitation of children living in ecologically unfavourable areas by means
of the example of the Sverdlovsk and Tula regions. Although from the positions of hygienists in the first
place there is need for work on pollution prevention of areas where people live, the introduction of new
production technologies.
The list of publications reflects the content of the thesis.
In general, appreciating the thesis of Sobolev V.A. "The scientific basis of screening examinations and
health measures among children living in ecologically unfavourable territories," we must conclude that it
is independent and completed research in the field of hygiene and public health, topical, is executed at
the modern methodological level. Judging by its scientific and practical significance the thesis meets the
requirements of item.8 of Higher Examination Board of the Russian Federation made for candidate
theses, and the author deserves the award of the desired degree of Candidate of Medical Sciences in
specialtities 14.00.07 - Hygiene and 14.00.33 – “Public health and health care”.
Chief Research Assistant of Public Health Research Department
of the Sysin Human Ecology and Environmental
Hygiene Research Institute of RAMS
T.M. Maksimova
122
REVIEW
Of the supervisors for the applicant of the scientific degree of Candidate of Medical Sciences Sobolev
Vladimir Anatolyevich. Sobolev, Vladimir A. graduated from the Medical Faculty of the Sechenov
Moscow Medical Academy, in 1985 with a degree in medicine.
Qualification - a doctor.
He has been working at the Sysin Human Ecology and Environmental Hygiene Research Institute of
RAMS since 2005 in the laboratory of clinical diagnosis of environmentally stipulated pathology as a
junior researcher. Sobolev V.A. is a wonderful physician and organizer of clinical hygienic researches. He
is distinguished by a professional attitude to his scientific work, persistence in achieving the goal, high
level of self-discipline, responsibility for his duties. While fulfilling the thesis V.A. Sobolev independently
planned and carried out researches and their analysis. He devoted much attention to modern domestic
and foreign science literature on the investigated problem. Literate comparison of various scientific data
in the literaturary review and discussion of the work results shows the author's serious approach to the
studied questions. He mastered the methods of statistical processing and correctly used them. He
showed himself as a mature scientist. He distinguished himself as a hard-working, initiation expert.
Sobolev, VA is a qualified specialist, who is able to carry out scientific researches independently and he
deserves the desired degree of Candidate of Medical Sciences to be conferred on him, specialities
14.00.07 - "Hygiene" and 14.00.33 "Public health and health care."
Scientific supervisors:
Ph.D. (Medicine)
Ph.D. (Biology)
The Sysin Human Ecology and Environmental
Hygiene Research Institute of RAMS
I.E. Zykova
L.F. Kiryanova
123
REVIEW
of the official opponent for the thesis for the scientific degree of Candidate of Medical Sciences of
Sobolev V.A. "The scientific basis of screening examinations and health measures among children, living
in ecologically unfavorable territories" , in specialities - 14.00.07 - "Hygiene" and 14.00.33 - "Public
Health and Health Care".
Relevance of the study. Children's health determines the health of the country population as a whole.
According to the official statistics, the disease incidence of child’s population is increasing annually by 45%. Significant contribution to the negative dynamics of child’s health is made by environmental factors.
Therefore, to study the effect of these factors on children's health, development of methods for
diagnosis of pathological conditions and health and environmental rehabilitation of sick children is an
urgent task.
The scientific novelty of the research lies in the scientific basing of technology for screening
examination of children living in ecologically unfavourable territories.
The practical significance lies in revelation of the influence of environmental factors on the disease
incidence of children. The method of children’s rehabilitation is offered and its effectiveness is
estimated.
The developed methods of organizing and conducting recreational activities is implemented in several
regions of Russia: Archangelsk and Moscow regions, Primorsky Krai, the Republic of Karelia and
Khakassia, which indicates that the introduction of the results into practice.
The work is presented on 140 pages of typewritten text, consists of an introduction, 6 chapters
containing the results of own research, findings, conclusions, bibliography. Index of literature contains
135 works, including 103 domestic and 32 foreign authors. Illustrative material is presented in 6
chapters of the thesis, 27 tables, 20 figures, 7 applications. According to the results of the studies it was
published 9 scientific papers, including a monograph and 2 articles in journals, recommended by Higher
Examination Board.
The object of the examination were children living in localities of the Sverdlovsk (19 towns) and Tula
regions (Novomoskovsk): Total - 4,116 children of all age groups (3,183 children in the Sverdlovsk region
and 933 children in Novomoskovsk). The examinations were carried out in 2000-2003 by a visiting group
of pediatricians - some experts of the leading pediatric hospitals and research institutes of Moscow. The
comprehensive examination was carried out by: a cardiologist, endocrinologist, gastroenterologist,
neurologist, orthopedist, dermatologist, neonatologist, experts of bio-resonance diagnostics.
Administration and health services participated in the organization of the medical examination of the
child’s population of the towns. To assess the extent of toxic load on the body and the changes of
adaptation processes of 953 children in the Sverdlovsk region, along with the traditional clinical
124
examination, the determination of the child's body hypersensitivity to heavy metals was carried out with
the help of non-invasive method of bio-resonance diagnostics (VRT).
The statistical processing of the material was carried out.
The examination results. Non-invasive bio-resonance method (vegetative resonance test) is informative
(with regard to specific environmental factors acting on the human body) for screening large
contingents of children, both as an independent method of prenosological diagnosis and in combination
with traditional clinical methods. Organization of rational complex screening examination of children
living in ecologically unfavourable territories, allows to form groups at risk and to develop an adequate
strategy for their rehabilitation and subsequent implementation.
In the surveyed towns of the Sverdlovsk region prevalence of all diseases of children in general (2081%0
0) was significantly higher than in Novomoskovsk, and due to respiratory diseases (respectively 464% 0
and 118.1%0 of a nervous system (about 413%0 and 324%0) , digestive organs (365%0 and 120%0) (p
<0,01).
The prevalence of child’s pathology and its structure in individual towns show the specificity of the
environmental factors that create a certain "environmental portrait" of the child, which may have
diagnostic value in the formation of hypotheses about possible local factors responsible for the
emergence of diseases in the territory.
A program of rehabilitation of children from ecologically unfavourable territories has been developed
with the participation of the author. 673 children from the surveyed in Novomoskovsk took, sanatorium
rehabilitation.
Evaluation of the effectiveness of rehabilitation was done by analyzing the feedback questionnaires,
drawn up in the sanatorium by medical staff and presented to the polyclinics in residence after
returning from health institutions. Outpatient medical histories of children (Form 112) were analyzed
after 3 and 6 months after curative measures. The positive effect was evident from the change in the
proportion of children in risk groups - reducing the proportion of children in high risk groups, the
transition them to (in the case of improving health) groups with more favourable health status.
However, after 3 months it was indicated movement in the opposite direction, which in 6 months
became more manifestative. This illustrates the need for repeated healthful measures in risk groups up
to the full rehabilitation of children.
The conclusions of the thesis corresponds to the obtained research materials. There are no principle
remarks in the work.
Conclusion.
The thesis of V.A. Sobolev, "Scientific basis of screening examinations and health measures among
children living in ecologically unfavorable territories" is a complete independent examination in which
125
the use of screening examination and medico-ecological rehabilitation methods is scientifically proven.
The work fully corresponds to the demands of item 8 of the “Regulations on the procedure of awarding
scientific degrees”, approved by Government resolution of Russia № 74 of January 30, 2002, presented
to the theses for the degree of Candidate of Medical Sciences, and its author deserves the award of the
desired degree in specialities 14.00. 07 - Hygiene and 14.00.33 - Public health and health care.
Official opponent:
Head of the Division of Medical and Social Researches of the Kulakov Scientific Centre of Obstetrics,
Gynecology and Perinatology,
Honored Scientist of the Russian Federation
Ph.D. (Medicine)
O.G. Frolova
126
REVIEW
of the official opponent for the thesis for the scientific degree of Candidate of Medical Sciences of
Sobolev V.A. "The scientific basis of screening examinations and health measures among children, living
in ecologically unfavourable territories" , in specialities - 14.00.07 - "Hygiene" and 14.00.33 - "Public
health and health care".
Relevance of the thesis topic.
In the Russian Federation in general and in specific regions of the country for the past 15 years, the
health of children and adolescents has been characterized by a stable tendency towards increase of
sickness rate, spreading of chronic pathology, reducing the number of healthy children.
The reasons for this situation can be a number of factors including ecological. As it is known ecological
factors form in average up to 25% of human pathology, and in some regions the percentage of
environmentally-related diseases can be much higher.
Modern methods of molecular biochemistry, immunology and others have been developed and used to
reveal a casual role of environmental xenobiotics in various diseases of children. Now, however, such
methods are only accessible to clinical institutions, Centres for Pediatric Ecopathology having proper
standard of laboratory-diagnostic equipment and highly skilled physicians.
In this regard, the scientific basis for the use of rational methods of screening, identification of risk
groups and medico-ecological rehabilitation of children living in contaminated territories is very up-todate and important, and the subject of the thesis of V.A. Sobolev is topical.
Scientific novelty of the study is that, on the base of the author’s study of the whole complex of factors
affecting the health of children (of anthropogenic chemical contamination of environmental of various
quality and quantity contamination of soil with worms, as well as social and endemic biogeochemical
factors) V.A. Sobolev developed and carried out rational comprehensive screening examination of
children living in ecologically unfavourable territories, with the use of vegetative resonance test both as
an independent methods and in conjunction with traditional clinical methods. All this allowed the
author to form groups of children at risk objectively and to offer a differentiated approach to their
medical and environmental rehabilitation.
The reliability and substantiation of the results and conclusions don’t cause any doubts due to the
large volume of researches, integrated approach, using modern research methods and adequate
statistical methods.
Scientific and practical importance of the work.
The author has identified the priority risk factors for health of the population in the towns of the
Sverdlovsk region and in Novomoskovsk of the Tula region on the base of evaluation of sanitary-hygienic
state of the environment. It was analyzed the prevalence and structure of child’s pathology in individual
towns, children’s groups of risk were revealed, screening examinations of children with the use of
127
vegetative resonance test were carried out. All this allows reasonably and differentiatedly to carry out
medical and environmental rehabilitation of children living in ecologically unfavourable areas. In
connection with the foregoing, the results obtained by the author are of great theoretical and practical
significance for health and ecology, as well as for practical medicine.
The structure of the thesis.
The thesis of Sobolev V.A. is written in a traditional style. The work is presented on 140 pages, consists
of a list of abbreviations, introduction, the chapter with literature review, the chapter on materials and
methods of investigation, the four chapters of own research findings, conclusions, list of literature and
applications. The thesis is sufficiently illustrated by 27 tables and 20 pictures.
The problems associated with the health of the Russian Federation children living in ecologically
unfavourable areas are summarized in the introduction.
The aim and objectives of the examination are formulated on the basis of this material. They
convincingly demonstrate scientific novelty and practical significance of the thesis.
The main provisions for the defense are clearly formulated, reflect the main results of the work.
Publication and implementation of the results are very significant and important for the theory and
practice of hygiene, human ecology, public health and health care.
In the chapter "Literature Review" the author deeply and intelligently analyzes published data on the
studied problem. This allowed Sobolev V.A. to define the purpose, objectives and methodological focus
of his researches very logically and convincingly.
The chapter is written professionally, competently, in a good literary style.
In Chapter 2, "Materials and study Methods," the organization of the examination and methodology
used in this work are summarized. The understanding by the author of the thesis many-sidedness of the
problem and methodically integrated solutions of the task put by the author causes great satisfaction.
Chapter 3 presents the results of sanitary-hygienic characteristics of the towns of the Sverdlovsk region
and Novomoskovsk of the Tula region. The author was quite right choosing the criteria for examinated
areas. He selected the presence of Class 1 and Class 2 anthropogenic unhealthy chemical substances in
the environment. He took into consideration the active growth of children’s cancer sickness rate as well.
The author has studied and analyzed manmade chemical contamination of air, water and soil by a
complex of these substances in 17 towns of the Sverdlovsk region, the sources of this pollution were
revealed, endemic geochemical characteristics of the studied areas were established. V.A. Sobolev also
introduced the results of the assessment of epidemiological status of drinking water and soil, soil
contamination by helmints. It was also studied the sanitary – hygienic condition of atmospheric air and
drinking water in Novomoskovsk of the Tula region, which the author has chosen as a control town in
relation to the towns of the Sverdlovsk region.
Chapters 4 and 5 present the results of health examination of 3183 children in the towns of the
Sverdlovsk region and 933 children of Novomoskovsk of the Tula region. The author has convincingly
128
shown that great manmade contamination in the towns of the Sverdlovsk region determines 2 times
higher index of prevalence of almost all diseases of children (except for diseases of the musculoskeletal
system and allergic diseases). Moreover in the Sverdlovsk region several diseases of different organs and
systems had more than 50% of children, and in Novomoskovsk - 23%.
The author showed that the specificity of the complex of man-made chemical pollutants in different
towns causes certain types of children’s pathologies specific to the town. Thus, the leading diseases in
Nizhniy Tagil are the diseases of the respiratory and nervous systems, in Krasnouralsk - respiratory and
digestive system diseases, etc.
For Novomoskovsk of the Tula region diseases of the nervous and musculoskeletal systems of children
have a priority.
On the base of such material the author comes to the practically important conclusion that the specific
effects of factors of the environment must be taken into account when forming multidisciplinary teams
of medical specialists for examination of children from areas of ecological trouble.
The use of the vegetative resonance test showed that it is informative (in relation to the child's body
hypersensitivity to heavy metals) for screening large contingents of children both as an independent
method of prenosological diagnostics, and in combination with traditional clinical methods.
Such data are very important and promising for the solution of the corresponding problems of
preventive medicine.
The organization of the complex screening examination of children allowed the author of the thesis to
form five groups at risk and to develop an adequate strategy for their rehabilitation.
The author also found that a percentage of risk groups of children in different towns vary substantially.
It obviously again mainly proves the specific character of technical chemical pollutions of the
environment of different towns.
In Chapter 6 of the thesis the author presented a staged program of medical and ecological
rehabilitation of children living in ecologically unfavourable areas.
The basis of this program was the formation of risk groups of children for a differentiated approach to
health and environmental rehabilitation. The author rightly distinguishes the basic principle of
rehabilitation of children - the principle of succession: clinical examination - hospital – sanatorium dispensary. This approach allows us to recommend the most effective methods of rehabilitation of
children.
In the "Conclusion" the main results of the work are summarized
"Conclusions" on the thesis (6 points are capacious, quite reasonable and reflect the main points of the
work.
"Bibliography" contains 135 sources (103 domestic and 32 foreign).
The publications of the author fully reflected the scientific results of the thesis.
129
The abstract of the thesis fully reflects the content of the work.
Summarizing the above-mentioned I believe that the scientific statements, conclusions and
recommendations of this work demonstrated a high degree of justification, reliability and innovation,
and the thesis of Sobolev V.A. is a complete independent scientific work on a topical theme, in which a
number of scientific problems are formulated and solved. The totality of these problems is essential in
studying the influence of environmental factors (especially anthropogenic chemicals substances) on the
health of children living in ecologically disadvantaged areas, as well as in the field of the prevention of a
number of diseases.
However, some observations on the thesis should be made:
1) in the text there are some misprints, statistical and syntactic inaccuracies.
2) At the beginning of Chapter 5 there is some repetition of the material of chapter 4 on the prevalence
and structure of morbidity of children, which to some extent is authorized by a great importance of
these problems.
These remarks are not of fundamental importance and can’t influence the high total appreciation of the
work.
During the study of the thesis the question occured: What is the reason that the sensitivity of vegetative
resonance test, equal to 72.9% and spespecificity - 33,8%, are inversely related to each other?
Conclusion.
The thesis of Sobolev Vladimir Anatolyevich: "The scientific basis of screening examination and health
measures among children living in ecologically unfavourable territories”, is a research-qualification
work, it includes a new solution of the topical problem - the development of scientific-based
differentiatied approach to selection of principles of rehabilitation of the child’s population of
ecologically unfavourable territories on the base of studying the impact of environmental factors
complex on children's health.
Speaking about relevance, methodological level, scientific novelty and practical significance of the thesis
it is original, timely, completed research work. The thesis meets the requirements of Higher Examination
Board of the RF for master's theses, and the author (competitor) deserves the award of the scientific
degree of Candidate of Medical Sciences in specialties: 14.00.07 - Hygiene, 14.00.33 - Public health and
health care.
Official opponent
Ph.D (Medicine)
Professor of Hygiene and Human Ecology chair
Russian State Medical University of the Federal Agency on
Health Care and Social Development
V.V. Korolik
130
Confirm
Research work pro-rector of the Sechenov
Moscow Medical Academy RAMS
Academician Ph.D (Medicine)
S.V. Grachev
REVIEW
Of the leading organizations on scientific and practical significance of the thesis of Sobolev V. A.
"Scientific basis of screening examinations and health measures among children living in ecologically
unfavourable territories" presented for the scientific degree of Candidate of Medical Sciences to the
Dissertation Council D 208.072.06 at the Russian State Medical University in specialties 14.00.07 Hygiene and 14.00 .33 - Public health and health care.
Relevance of the work. Children's health is one of the most sensitive indicators, which reflect changes in
environmental quality. With increasing pollution level the number of children with environmentally
dependent changes in health status increases in the population. According to government statistics,
almost 60% of children have chronic diseases. Significant contribution of environmental factors to the
development of various types of pathology of children makes it necessary to develop a system of
medical and ecological rehabilitation of children living in ecologically disadvantaged areas. In this regard,
the reviewed manuscript, dedicated to the issue of preserving the health of children living in
environmentally unfavourable areas is scientifically relevant. Practical relevance is determined by
rational approaches to organizing screening identification of children's pathology and adequate strategy
of rehabilitation and prevention of ecologically related diseases of children. These approaches are
presented in V.A. Sobolev’s work.
Relationship with the plan of the branches of science and economy and science programs. The thesis
work was done in the laboratory of evaluation and prediction of population health of the Sysin of
Human Ecology and Environmental Hygiene Research Institute of RAMS, in accordance with the program
of research, "Development of methodology for use of noninvasive methods to assess the relation of
“The Environment - Health» № 066. The study was carried out in the framework of the All-Russian
Public Movement "Children are the future of Russia." Funding for the program "Sanatorium
rehabilitation of children from areas of ecological trouble, suffering from chronic diseases, 2000-2002"
was provided at the expense of Federal ecological fund of the Russian Federation means, the regional
public organization "Hematologists of the world to children."
The novelty of the research results, the conclusions of the thesis. In the reviewed paper it was
developed and for the first time tested in practice, a targeted program aimed at identifying children at
high risk of the environmentally dependent diseases to carry out a complex of preventive and curative
measures, in accordance with the risk group.
131
It was established that the prevalence of children’s pathology and its structure in some towns, indicate
the specificity of the environment factors which create an "ecological portrait" of the child's health,
inherent in a particular town, which may have diagnostic value in the formation of hypotheses about
possible local factors responsible for the emergence of diseases in the area. Specificity of environmental
factors influence should be considered in the formation of multidisciplinary teams of medical specialists
to examine children from areas of ecological trouble.
The conclusions are convincingly formulated and scientifically grounded on the base of the results of a
large volume of own researches and analysis of statistical and literature data. They follow logically from
the stated factual materials of the thesis and reflect the objectivity of the received scientific data. Their
trustworthiness is defined by a sufficient volume of the studied material, correct discussion of the
results, as well as using modern methods of the research, using statistical, mathematical methods using
computer program.
Significance of the results obtained by the author for science and practice. The obtained results are
recommended for use in the practice of public health authorities in order to improve health of children
from areas of ecological trouble, to evaluate sanitary-hygienic state and social conditions of
environment where children live on the basis of the high prevalence of certain diseases, as well as to
help public health to hold consultation and examination of children in residence. Informativeness of
noninvasive bio-resonance diagnostic method allows to carry out screening at the optimal time and thus
significantly reduce the time and financial cost both for the detection of early prenosological states and
for confirmation of the chronicity of pathological processes of the examined children.
The results of the examination are used:
1) during the development of subprogram “Medico-ecological rehabilitation of the population" within
the framework of the program "Environmental Protection of the Tula region in 2001-2005";
2) during the implementation of a comprehensive assessment of the impact of human economic activity
on the environment and its after-effects on health; this implementation was done by Interregional
territorial management of technological and ecological supervision of the Federal Service for
Environmental and Nuclear Supervision of the Central Federal District. Federal Research Centre of
Pediatric Hematology, Oncology and Immunology of Russia Public Health uses the methods of
organization and conducting of screening examinations and recreational activities developed in the
thesis to identify ecopathology and to give specialized assistance to children living in ecologically
unfavourable territories of the Russian Federation.
The developed technique of organizing and conducting of recreational activities is implemented in
several other regions (the Arkhangelsk, Moscow, Yaroslavl regions, Primorsky Krai, the Republics of
Karelia and Khakassia) with the participation of the State Enterprise "International Children's Centre,
which is one of the members of the federal target program "Development of All-Russian Children's
Centres “Eaglet” and "Ocean".
132
The proceedings of the thesis of Sobolev V.A. are widely reflected in the scientific literature, including
reviewed journals; they were presented at the scientific - practical conferences, including international
ones.
Assessment of the thesis. The thesis consists of introduction, literature review, the chapter devoted to
the description of the scope and methods of the research, six chapters of their own researches,
discussion of the findings, conclusions, list of reviewed literature and applications. The material is clearly
structured and presented in a good scientific language. The text is found on 141 pages of a typewritten
text.
A degree of validity of scientific statements and conclusions. The work is performed on big actual
material - over 4000 of children were examined. The results are statistically processed. Methodological
level of the thesis meets modern requirements. As a result of the examination all the tasks set by the
author have been resolved. Key provisions of the thesis are well argued, the findings correspond to the
goals and objectives. The results obtained in the study are described in 6 publications. All of the above
allows to draw the conclusion of evidence and validity of the scientific statements and conclusions in the
thesis.
The recommendations for the use of the results and conclusions of the thesis. Practical design can be
used during conducting of screening examinations of children in environmentally disadvantaged areas,
taking into account the peculiarities of environmental pollution, which form the specific structure of
child’s morbidity and determine the severity of pathology. Rational approach to organizing of a
screening identification of child’s pathology in view of ecological problems of areas is the definition of
risk groups together with the development of adequate strategy for their bringing into a healthy state.
The method of bio-resonance diagnostics (VRT) is recommended to determine the extent of the toxic
burden on the organism during the examination of large groups of children from ecologically
unfavourable areas.
Abstract of the thesis corresponds to the content.
As the comments it should be noted that not all data listed in the review of the literature are relevant to
the research, in particular, issues of regulatory legal ensuring of the development of targeted national
and regional programs of prevention and rehabilitation of children with environmentally-dependent
pathology as the implementation of child’s rights to health care. It was also necessary to indicate the
grouping of diseases according to ICD-10 in the tables describing morbidity of the examined contingents.
These comments are not of fundamental nature and do not reduce the high scientific and practical
significance of the researches.
CONCLUSION
The thesis of Sobolev Vladimir Anatolyevich "The scientific basis of screening examinations and curative
measures among children living in ecologically unfavorable territories" is a complete scientific and
133
skilled work related to the actual problem in the field of hygiene and public health and health care. The
work is fully meets the requirements of item 8 of the “Regulations on the procedure for conferring
academic degrees "Higher examination board of the Russian Federation made on candidate theses, and
the author deserves the award the scientific degree of Candidate of Medical Sciences in specialities
14.00.07 - Hygiene, and 14.00.33 - Public health and health care.
Professor of Ecology and Environment
Hygiene chair
the Sechenov Moscow Medical Academy
Ph.D. (Medicine)
A.A. Korolev
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RF Federal
Ecological
Fund
RF Ecological
Funds Association
Health Ecorehabilitation Centre
GREEN HOUSE
HEALTH PASSPORT
135
RF Federal ecological fund
RF Ecological funds association
“Health ekorehabilitation centre
GREEN HOUSE”
Health Passport
Class
It’s filled in annually
ALLERGY (vaccine, drug, allergic diseases)
Groups
Child’s surname, name, patronymic
Birth date
B
Sex G
Address
Telephone number
Polyclinic №
Telephone number
Information about parents:
Date of birth
Education
Place of work Telephone
(occupation)
number
mother
father
a) living conditions _____________________________________________________________________
b) family anamnesis (diseases) ____________________________________________________________
EXTRACURRICULAR ACTIVITIES
sports (yes, no, kind of sport) _____________________________________________________________
foreign language (yes, no) _______________________________________________________________
music (yes, no) ________________________________________________________________________
other activities ________________________________________________________________________
Previous diseases (Past medical history)
Date
Measles
Whooping cough
Scarlatina
Diphtheria
Chickenpox
Infectious parotitis
German measles
Infectious hepatitis
Date
Dysentery
Typhoid
Tuberculosis
Rheumatism
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Dispensary observation information
Diagnosis
Registration Deregistration
date
date (reason)
Specialist visit monitoring
appointed
came
appointed came
appointed came
Date
1
Examinations data
2
Recommendations
3
Date
1
Examinations data
2
Recommendations
3
Fluorography examinations data
date
result
Laboratory examinations data
analysis
Blood
Urine
Faeces
date
result
Dehelmintasation ______________________________________________________________________
Date
Result
Date
Result
Dental examination
Date
Formula
Deep medical examination data
1
2
Examination data
Child’s age
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3
4
5
6
7
8
9
10
Class, group
Height
Weight
Subjective complaints
Examinations: by pediatrician
Rheumatologist
Systolic pressure
Orthopedist (surgeon)
11
12
13
14
15
16
17
18
19
20
Ophthalmologist
Otolaryngologist
Neuropathologist
Dermatologist
Speech therapist
Stomatologist
Physical development estimation
Health status conclusion
Physical training group
Recommendations
Doctor’s signatures ____________________________________________________________________
(pediatrician, specialists) _______________________________________________________________
EXAMINATION BEFORE PREVENTIVE VACCINATION
Date
Vaccination is
allowed (what
kind?)
Healthy
Is ill (diagnosis)
Medical
rejection till
____
Doctor
PREVENTIVE VACCINATION
I
For poliomyelitis
Date
Series
For diphtheria, whooping
cough, tetanus
Date
Series
Vaccination
II
III
I
Revaccination
II
III
IV
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For parotitis
Date
Series
For measles Date
Series
Mantu reaction
Date
Result
Gamma globulin injection (according to instructions)
Date
Reason
Date
Reason
Vaccination for tuberculosis
Date
Result
Date
Result
Series
PROFESSIONAL CONSULTATION WITH MEDICAL
CONTRA-INDICATION FOR PROFESSIONS
Date
Recommendations
RECOMMENDATIONS FOR SPORTS ACTIVITY
Date
Kind of sport
Resolution
CURRENT MEDICAL CONTROL DATA
Data
Examination data
Diagnosis
Prescriptions