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

2

CONTENTS

ABBREVIATIONS 3

INTRODUCTION 4

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

specific pathological conditions)

1.3 Approaches to prevention and rehabilitation of ecologically-dependent

diseases of children

77

8

13

CHAPTER 2. MATERIALS AND STUDY METHODS 17

CHAPTER 3. SANITARY-HYGIENIC CHARACTERISTICS OF THE STUDIED

AREAS.

3.1 Sanitary - hygienic characteristics of the studied towns in the Sverdlovsk

region

3.2 Sanitary - hygienic characteristics of Novomoskovsk of the Tula region

20

21

39

CHAPTER 4. EXAMINATION RESULTS OF THE CHILDREN IN THE

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

43

4353

58

CHAPTER 5. RISK GROUPS DEPENDING ON THE HEALTH OF CHILDREN

AND DEGREE OF ENVIRONMENTAL STRESS OF THEIR RESIDENCE

63

CHAPTER 6. MEDICAL-ECOLOGICAL REHABILITATION OF CHILD

POPULATION FROM ENVIRONMENTALLY UNFAVOURABLE ZONES

75

CONCLUSION 83

CONCLUSIONS 85

LITERATURE 86

APPENDIX 102

ABBREVIATIONS

3

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

INTRODUCTION

4

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 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.

5

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 rehabilitation to rest homes and sanatoriums. The methodical educational materials for children and parents were issued.

Regulations issued for the protection.

6

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.

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.

7

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.

“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

8

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 socio-economic 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 4- years 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, 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

9

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 20 th century infant mortality from asthma 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:

10

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 *

Pathology form

Prevalence

On average in RussiaIn the areas of ecological

trouble

Allergic diseases

Food allergies at an early age

35

70

180

400

11

Asthma

Respiratory allergies

Recurrent bronchitis

Vegeto-vascular dystonia

Gastritis and gastroduodenitis

Nephropathy

Chronic diseases of the nose, sinuses

Chronic tonsillitis

Chronic otitis

Encephalopathy

10

48

6

12

60

33

21

116

7

30

24

122

94

144

180

187

31

239

9

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,

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

12

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].

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

13

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

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

14

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;

• creation of integrated medico-ecological databases according to "marker" nosological groups of

different territorial-administrative levels (from regional to federal);

15

• 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 means

of the RF subjects, companies and organizations engaged in technological improvements, grants and

funds aimed at solving the major humanitarian problems [81].

Conclusion

16

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.

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

17

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.

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

18

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].

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.

19

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 "Mini-

expert-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 (ICD-

10). 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.).

CHAPTER 3. Sanitary-hygienic / Characteristic of the Studied areas

20

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. Two-

thirds 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, %

2000 2001 2002 2000 2001 2002 The Russian Federation 18819,8 19123,6 19481,2 77,9 76,2 74,5

21

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 86The Central Federal District 1597,1 1543,9 1524,0 77,6 77,2 77,5The 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

that lead to the overall environmental

burden to the population

Exposed population quantity (million

people) and % of average regional quantity.

1Integrated chemical burden (formed by

water, air, soils of residential areas, food)

2, 9 million people., 64%

2 Biological burden and connected with it

risk of infectious diseases due to

microbiological contamination of drinking

1,95 million people., 50%

22

water, food)

3Radiation dose burden (due to all dose-

forming factors)

2,55 million people, 45%

4Noise pollution in residential zones 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.

Cities

Pollutionchemical biological

drinking

waterair soil

drinking

water, soil

Kamensk-Uralskiy + + + +

Cushva + + + +

Pervouralsk + + + +

Revda + + +

Krasnouralsk + + +

Irbit + + +

Verhnya Tura + + +

Artyomovskiy + +

Nizhniy Tagil + +

Sysert + +

Tavda +

23

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

(Zs)

Water

(Ktox)

Nizhniy Tagil 8.5 13.3 3.4

Pervouralsk 7.7 20.2 1.39

24

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

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).

25

Table 3.5

Ranking of the surveyed areas of the Sverdlovsk region according to the integrated lead indexes on the

population.

TerritoryPopulation

number

Complex load index

The amount of substances normalized on the basis of organoleptic indicator of

harmfulness

The amount of substances

normalized on the basis of

sanitary-toxicological

indicator of harmfulness

Artemovsk 22116 1 1Bogdanovich 7973 1 1Verhnya Salda 46678 1,7 2,16Ivdel 7633 1 1Irbit 22500 3,5 4,4Kachkanar 49900 2,33 1Krasnouralsk 19898 1 4,6Cushva 34158 2 1,5K. Uralskiy 18497 2,81 2,2Nevyansk 26600 1 2Nizhniy Tagil 371000 1 3,4Pervouralsk 50000 1 1,39Revda 55000 1 3,2Sysert 9746 1 1Turinsk 6421 3 10

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

26

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;

• 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

1 Residual aluminum in drinking water after coagulation refers to the second class of danger.

27

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 Nizhniy Tagil Pervouralsk RevdaKamensk

UralskiyKrasnouralsk

From stationary sources

210,983 6,353 102,397 30,241 88,673

From

vehicles 14,208 6,295 105,175 7,861 1,257

In all 225,191 12,648 2,778 38,102 89,93

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,

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.

28

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 carcinogens-

mutagens 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

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

29

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).

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).

30

N. Tag

il

Pervou

ralsk

Bogda

novic

h

V. Sald

a

Artemov

skiy

V. Pish

ma

Kushva

Kachka

nar

Revda

Krasno

uralsk

Navya

nsk Ivdel

0123456789

10

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

Total index of air pollutants on the population (Ksum)1996 г. 1997 г. 1998 г. 1999 г. 2000 г.

Nizhniy Tagil 9,0 6,5 6,1 8,5 8,5

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

API

31

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.

Area

Aggregate index of load of atmospheric pollutions on the population (AICLAP,

THI / person)

1996 г. 1997 г. 1998 г. 1999 г. 2000 г.Krasnouralsk 0,326 0,310 0,332 0,29 0,3Revda 0,2 0,2 0,15 0,2 0,16Kachkanar 0,139 0,148 0,140 0,140 0,14Nizhniy Tagil 0,068 0,063 0,049 0,06 0,062K.-Uralskiy 0,023 0,023 0,043 0,028 0,029Karpinsk 0,005 0,033 0,04 0,04 0,03Cushva 0,078 0,051 0,023 0,03 0,054V.Tura 0,0015 0,011 0,008 0,008 0,0087

32

Bisert 0,002 0,007 0,008 0,02 0,0082V.Salda 0,006 0,0052 0,0065 0,004 0,004N.Salda 0,005 0,004 0,0065 0,001 0,003Pervouralsk 0,0023 0,004 0,0042 0,015 0,015Sysert 0,002 0,002 0,003 0,0023 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.

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

33

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

Area

Soil

contamination

relative index

(Br)

Pollution levelPopulation number

(people)

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

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

34

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

Area

Soil contamination

relative index

(Zsum)

Pollution levelPopulation

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

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

35

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.

Territory Zp Contamination levelKachkanar 317,96 Extremely dangerous

Pervouralsk 141,55 Dangerous

Krasnouralsk 5,55 Permissible

Nizhniy Tagil 3,6 Permissible

Kushva 1 Permissible

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

36

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)

Selection Years Samples studies

37

place

According to sanitary-chemical

indexesSalts of heavy metals

Total Above MPC

% Unsatisfactory

Total Above MPC

% Unsatisfactory

Soil in the sites of agricultural products production

1996 270 79 29,3 142 74 52,1

1997 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

Development

territories soil

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

Including childcare establishments

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

38

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.

Territory In all samples, %

Contamination with lead samples,

%

Contamination with mercury

samples, %

Contamination with cadmium

samples, %

V.Salda 100 80 80 -

Tavda 100 - 100 -

Pervouralsk 96 92 - -

Revda 65 50 - 30

Sysert 62,5 100 - 100

Krasnouralsk 50 50 - 50

Kachkanar 40 - - -

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.

39

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.

40

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,

t/year

Hazard class,

MPC

Mg/m3

Excess of MPC

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

41

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 0,1-

0,3 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 m 3 of polluted

wastewater were thrown down into surface reservoirs, which is 4.3 million m 3 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

42

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.

43

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.).

Under a year 1-3 years 4-7 years 8-14 years 15-17 years05

1015202530354045

Boys Girls

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).

19,9

17,5

17,311,6

6,9

5

3,8

3,3

2,7

0,5

11,5

Nervous system

Alimentary digestive canal

ENT-organs

Endocrine system

Musculoskeletal system

Respiratory organs

Allergic diseases

CVS (cardiovascular system)

Urinary system

Genitals organs

Others

44

PathologyAbs.

numberPrevalence index*

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)

Total 2890 2081 (1955-2214)

In the parentheses 95% is a confidential interval

Fig.4.1.2. The pathology structure of the examined children of the Sverdlovsk region.

45

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.

DiseasesNumber of

cases

Share in the structure

(%)

Vegetative-vascular dystonia,

Astheno-neurotic syndrome, neurotic reactions

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

46

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.).

Under a year

1 - 3 years 4 – 7 years

8 – 14 years

15 -19 years

05

10152025303540

Boys Girls

Age

%

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).

Under a year

1 - 3 years 4 – 7 years 8 – 14 years

15 -19 years

0

5

10

15

20

25

30

Boys

Girls

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.

Under a year

1 - 3 years 4 – 7 years 8 – 14 years

15 -19 years

05

101520253035

Boys Girls

Age

%

47

Fig.4.1.5. Age and gender structure of the group of children diagnosed with hydrocephalic syndrome.

Under a year

1 - 3 years 4 – 7 years 8 – 14 years 15 -19 years0

5

10

15

20

Boys Girls

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

48

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% (Kamensk-

Uralskiy) 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.

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 (31-2 REG - reoencephalogram3 EEG - electroencephalogram4 ECHO-EGV – echoencephalogram of vessels5 CT – computerized tomography

49

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%. Hepato-billiarno-

pancreatic pathology was in the second place with significant differences in the towns (27-41%). 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 asteno-

neurotic 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

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).

50

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.

Under 1 1 - 3 years old

4 – 7 years old

8 – 14 years old

15 years old and older

0

5

10

15

20

25

Boys Girls

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

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

51

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-infective-

protection 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

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

52

thyroid gland. It’s taken into account the presence of concomitant severe pathology of early-age

children.

Kushv

a

N.Tag

il

Krasno

uralsk

V.Tura

Nevian

skSald

a

Kachk

anar

Ivdel

Karpins

k

Sosva

0%

10%

20%

30%

40%

50%

60%

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, vegetative-

vascular 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.

4.2. Children examination using bioresonance diagnosis method.

53

As mentioned above, one of the objectives of this study was to study the information content of non-

invasive 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%.

Table 4.2.1

54

Comparative data of children’s examination with methods

of clinical diagnosis and bioresonance method (VRT) (absolute number of children)

PathologyClinical

Diagnosis

Diagnosis

VRT

Respiratory system 238 168

Nervous System 205 151

Cardiovascular system 29 19

Endocrine system 167 121

Urinary system 30 19

Digestive system 280 207

Helminthic invasion 92 68

Allergic diseases 41 28

Bronchial asthma 22 16

Healthy 74 80

Total 1178 877

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);

c) false negative results (pathology is detected by modern diagnostic methods and is not detected by

VRT);

55

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 Definition %

Sensitivity The ratio of true positive results to the amount of true positive and

false-negative results (percentage of patients revelation using the

VRT method among the children whose disease is determined by

clinical exanimations).

72,9

Specificity The ratio of true negative results to the amount of false-positive 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.

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

56

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.

V.Tura

Nevyansk

V.Salda

N.Tagil

Karpinsk

Ivdel

Sosva

0

200

400

600

800

1000

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).

N.Tagil

V.Salda

Krasno

uralsk

Nevya

nsk

V.Tura

Kachk

anar

Sosva

Ivdel

0

200

400

600

800

1000

heavy metals

common

‰

57

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).

V.Tura

V.Sald

a

Kachk

anar

Nevya

nsk

Krasno

uralsk

Karpins

k

Sosva

Ivdel

0

200

400

600

800

1000

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).

Hevya

nsk

N.Tagil

Krasno

urlsk

Kachk

anar

Sosva

0

200

400

600

800

1000

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).

58

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).

Under 1 1 - 3 years old

4 – 7 years old

8 – 14 years old

15-190

10203040506070

Boys Girls

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).

59

Table 4.3.1.

The prevalence of different types of pathology

among the examined children in Novomoskovsk (for 1000 patients)

PathologyAbs.

numberThe 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

complaints for frequent headaches, increased irritability, neurotic reactions, sleep disturbance

dominated.

60

29.4

26.410.9

10.1

7.5

4

3.7 3.6

1.7

0.4 2.3

nervous system

locomotor apparatus

alimentary canal

allergic

respiratory organs

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).

61

Table 4.3.2.

Age and gender structure of the examined children with diseases of the nervous system.

Age Boys Girls Abs.number %

Under one year 3 7 10 3,3

1 - 3 years old 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%.

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

62

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

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

63

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 The Sverdlovsk region The Tula region

respiratory organs 464,0* 118,1

nervous system 413,2* 324,7

digestion organs 365,0* 120,0

endocrine system 240,5* 40,9

64

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).

Under 1 1 - 3 years old

4 – 7 years old

8 – 14 years old

15 years old and older

0

10

20

30

40

age

%

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

65

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 flat-

foot 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.

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

66

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

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.

67

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)

City

Diseases

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)

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)

68

*- 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, hypertensive-

hydrocephalic 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 Basic Industry (pollutants)Main types of pathology

("Environmental portrait" of a child)

Nizhniy Tagil Iron ferrous metallurgy

Chemical and petrochemical industry:

(Coal and coke dust, phenols, benzene, benzo (a)

pyrene, cyanide, hydrogen sulfide, oxides of iron,

calcium, nitrogen, carbon, sulfur, silicon,

manganese, magnesium, lead, ammonia, sulfur

dioxide, formaldehyde, methanol).

Pathology of respiratory

organs.

Organic lesions of the central

nervous system.

Krasnouralsk Ferrous and nonferrous metallurgy (coal and coke

dust, phenols, benzene, benzo (a) pyrene,

cyanide, hydrogen sulfide, oxides of iron, calcium,

carbon, silicon, sulfur, manganese, magnesium,

lead, aluminum, nickel, arsenic, copper, zinc,

alkali metals, fluorine).

Pathology of respiratory organs.

Pathology of the digestive

system.

Turinsk Pulp-and-Paper mill (calcium oxide, sulphurous

and methylsulphurous compounds, methanol,

Pathology of urinary organs

(nephropathy with the

69

phenol, chlorine, chlorine dioxide).

A critical situation for the population concerning

providing with drinking water. In water supply

there is increased content of iron, manganese,

sodium, chlorides, sulfates, and ther is low

content of fluoride.

oxalate-calcium crystalluria).

Pathology of the

musculoskeletal system (joint

hypermobility syndrome, early

calcification of the bones).

Bohdanovich Plants: refractory products, imbregnated skeper,

porcelain, building materials, furniture factory

(silicon dioxide, sulfur dioxide, compounds of

nickel, chromium, cobalt, formaldehyde, phenol,

ammonia, xylene, toluene). High level of soil

contamination of children’s institutions areas-

66.7%. The highest chemical burden – arsenic.

Excess of calcium and increased rigidity in the

underground sources of drinking water.

Pathology of the digestive

system (underweight, chronic

gastritis). Pathology of the

musculoskeletal system

(syndrome of hyper- mobility

of joints).

Novomoskovsk Chemical and petrochemical industry:

(Ammonia, sulfur dioxide, nitrogen oxides,

phenol, formaldehyde, sulfuric acid, hydrogen

chloride, ethyl acetate methanol, hydrogen

sulfide, hydrocarbons).

Pathology of the nervous

system.

Pathology of the musculoskeletal system.

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 vegetative-

vascular 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 hypertensive-

hydrocephalic syndrome. In Artemovsk percentage of children with enlarged thyroid gland was

70

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

TownsPrevalence of the nervous system

diseases

Atmosphere pollution

index

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

71

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

(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

Characteristics of the-risk group Type of specialized medical and preventive care

I Practically healthy children (control

group)

Preventive set of activities aimed at activation of geral adaptive and immune resistant abilities of

72

the body, held in organized children's groups.

II Group of formation of environmental-

dependent pathology

(Functional disorders)

Supporting therapy: detoxification, symptomatic conducted on outpatient basis.

III Group with environmental-dependent

health disturbances in the remission

state

(Monoorganic pathology with mild

pathological process and rare remissions)

Corrective therapy: pathogenetic, detoxification, symptomatic in the conditions of hospital and sanatorium-and-prophylactic institutions.

IV Group with environmental-dependent

health disturbances in the moderate

stage of clinical and laboratory

manifestation of pathological process

(Monoorganic pathology with mild or

moderate-severe pathological process

and rare remissions).

Targeted corrective therapy in hospital and specialized centres: pathogenetic, detoxification, substitution, symptomatic.

V Group with environmental-dependent

health disturbances in the stage of

marked clinical and laboratory

manifestation of the pathological process

(Unclear diagnosis, which requires in-

depth examination, multiple organ

pathology, serious tendency of the

pathological process with frequent

relapses).

In-depth examination, targeted corrective

therapy in hospital and specialized centres:

pathogenetic, detoxification, substitution,

symptomatic.

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 (%)

73

I II III IV V Ито-

го

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

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,

74

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.

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

75

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 organizational-

methodological 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;

• 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;

76

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;

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 %

Group III 13 %

Group VI 20 %

Group V 10 %

Group II 32 %

77

Ris.6.1 Medical and preventive care at risk groups of children from Novomoskovsk.

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,

230 children Healthful measures

At residence

297 children Healthful measures

At residence

119 children

Ambulant therapy

City polyclinic and RCCH

199 children Hospital

treatment

City Hospital

88 children Hospital

treatment

Republican Children’s

Clinical Hospital

Sanatorium-spa rehabilitation

673 children

Sanatorium dispensary

At residence in a green

zone

246 children

Sanatorium treatment at

climatic health resorts

427 children

78

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, age-

appropriate 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

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

79

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

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).

80

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;

0102030405060 I

II

III

IV

V

Examination period

%

Fig.6.2. The effectiveness of preventive medical care in high-risk groups of children of Novomoskovsk

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);

81

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).

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:

Environmental and living conditions estimation

Hospital Policlinic Sanatorium

Hygienic, prenosological and clinical diagnosis of violation of children’s health

Risk groups forming

Working out of medical-preventive and recreative measures complex

Evaluation of medical-preventive and rehabilitative measures effectiveness

82

• 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.

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

83

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

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

84

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 environmental-

dependent 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.

CONCLUSIONS

1. Priority risk factor for public health in the Sverdlovsk region on the basis of analysis of sanitary-

hygienic 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.

85

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.

Bibliography

86

1. Агаджанян Н.А., Кузьменко Л.Г. Антропогенное загрязнение

окружающей среды и состояние здоровья детей в некоторых регионах

России // Экопатология детского возраста. М., - 1995. - С.118 – 127.

2. Агаджанян Н.А., Бяхов М.Ю., Клячкин Л.М. с соавт. «Экологические

проблемы эпидемиологии» под ред. Агаджаняна Н.А. Москва,

«Просветитель», 2003. - 208 с.)

3. Аклеев А.В. Медико-биологические последствия хронического

облучения человека /Медицина труда и Промышленная Экология, 2005.

- №11. - С.19-24.

4. Аксенова О.И., Волкова И.Ф., Корниенко А.П., Ли В.Г. Экологически

обусловленные заболевания у населения Москвы, связанные с

антропогенной нагрузкой // Гигиена и санитария. – 2001. - №5. С.82.

5. Асанов А.Ю., Жученко Н.А., Субботина Т.И., Ижевский П.В. Оценка

учета врожденных морфогенетических вариантов и врожденных пороков

развития // Неинвазивные методы в оценке здоровья населения / Под

ред. Ю.А. Рахманина. – М., 2006.- С.164-200.

6. Баранов А.А. Здоровье детей России: научные и организационные

приоритеты. // Педиатрия. - 1999. - №3.- С. 4-6.

7. Баранов А.А., Кучма В.Р., Сухарева Л.М. Оценка здоровья детей и

подростков при профилактических медицинских осмотрах (руководство

для врачей) // М.: Династия, 2004. – 168 с.

8. Боголюбова И.В., Иозефович О.В., Моисеев Л.В., Наичешвили Т.Е.,

Родомская Н.А., Ружицкая Р.В., Щелкунов Н.В. Влияние экологических

факторов на физическое развитие детей // Вопросы прикладной

морфологии и хирургии. Материалы 42 региональной конференции СНО

и молодых ученых мед.вузов и лабораторий НИИ.СПб, 2002. Изд-во

СПбГМУ. – 2002. - С.98-101.

9. Болдырев В.И. «Экология Новомосковского района», Тула, 2000, 152 с.

87

10. Методы установления причинно-следственных связей между здоровьем

и факторами окружающей среды. (Заключительный отчет) // ГУ НИИ ЭЧ

и ГОС, УДК 614:312,6, № Гос. регистрации 01.9.40002799, М.,1996г.

11. Быков А.А., Ревич Б.А. Оценка риска загрязнения окружающей среды

свинцом для здоровья детей в России //Медицина труда и

промышленная экология.-2001.-№5.С.6-10.

12. Величковский Б.Т. Реформы и здоровье населения страны (Пути

преодоления негативных последствий) //М., 2001. - 36 с.

13. Вельтищев Ю.Е., Фокеева В.В. Экология и здоровье детей. Химическая

экопатология // Приложение к Российскому вестнику перинатологии и

педиатрии: лекция №9. М., 1996 С. 17-19.

14. Вельтищев Ю.Е. Этиология и патогенез экопатологии у детей //

Экология и здоровье детей под ред. Студеникина М.Я., Ефимовой А.А. -

М., Медицина, 1998 - С.18-65.

15. Вишневский В.А. Эффективность школьных оздоровительных программ

// Здравоохранение РФ. – 2004. - №2. - С. 49-51.

16. Возможности компьютеризированной электропунктурной диагностики

по методу Р.Фолля в терапии методами рефлексотерапии и гомеопатии

Методические рекомендации. //М 98/232./ Москва, 1999, 28 с.

17. Горобец П.Ю, Ильченко И.Н., Ляпунов С.М., Шугаева Е.Н.

Распространенность экологически зависимых нарушений нервно-

психического развития у детей в возрасте 4-7 лет при хроническом

воздействии тяжелых металлов в малых дозах // Профилактика

заболеваний и укрепление здоровья - 2005. - №1. С. 4-6.

18. Горобец П.Ю, Ляпунов С.М., Шугаева Е.Н. Применение теста общих

навыков ребенка для выявления нарушений нервно-психического

развития детей в промышленном городе Гусь-Хрустальный // Педиатрия.

– 2004. - №2. – С.71-76.

88

19. Громбах С.М. О критериях оценки состояния здоровья детей и

подростков // Вестник АМН СССР. – 1981.– №1. – С.29-34.

20. Гурвич В.Б., Кузьмин С.В., Никонов Б.И. и др. Реабилитация здоровья

населения на экологически неблагополучных территориях Свердловской

области // Медицина труда и промышленная экология, 2004-№ 9,-С.9-12

21. Делягин В.М., Румянцев А.Г. Медицинское обеспечение в детских

оздоровительных учреждениях.// в «Современные проблемы экологии и

здоровье детей» под ред. Румянцева А.Г. М.-2002.-С.72-78

22. Даутов Ф. Ф., Лысенко А.И., Яруллин А.Х. Влияние факторов

окружающей среды на физическое развитие детей дошкольного

возраста // Гигиена и санитария. – 2001. - №6. - С.49-51.

23. Димитриев Д.А. Влияние загрязнений атмосферного воздуха на частоту

мертворождений в промышленном городе. // Гигиена и санитария. -

2000. - № 5. -С. 7-9.

24. Димитриев Д.А., Румянцева Е.Г. Современные методы изучения влияния

загрязнения окружающей среды на иммунную систему // Гигиена и

санитария. – 2002. - №3. - С. 68-71.

25. Доклад «О санитарно-эпидемиологической обстановке в Свердловской

области за 2003 год», Екатеринбург. 2004 г., 116 с.).

26. Доклад о состоянии окружающей природной среды Тульской области в

2001 году. Тула, 2002, 95 с.

27. Ефимова М.Р., Бычкова С.Г. Социальная статистика // М., Финансы и

статистика. - 2004. - 558 с.

28. Зайцева Н.В. Диагностика и корреляция региональных экологически

обусловленных состояний у детей // Гигиена и санитария. – 2001. - №5. -

С.31-36.

89

29. Зайцева Н.В., Уланова Т.С., Плахова Л.В., Суетина Г.Н. Влияние

полиметаллических загрязнений объектов окружающей среды на

изменение микроэлементного состава биосред у детей //Гигиена и

санитария – 2004. - №4. - С.11-13.

30. Игнатова М. С. Распространенность заболеваний органов мочевой

системы у детей // Российский вестник перинатологии и педиатрии. –

2000. - №1. - С.24-29.

31. Ильченко И.Н., Горобец П.Ю., Ляпунов С.М., Шугаева Е.Н., Теплова

А.А. Разработка системы профилактических и образовательных

мероприятий по снижению влияния свинца и других токсических

металлов на нервно-психическое развитие и поведение детей – жителей

г. Подольска //Тезисы докладов научно-практической конференции

«Актуальные проблемы профилактики неинфекционных заболеваний».

М., 2005. - С.34-35.

32. Камилова Р.Т. Влияние социально-гигиенических факторов условий

жизни детей школьного возраста на уровень их физического развития

//Гигиена и санитария.-2001. - №6. - С.52-55.

33. Ключников С.О., Демин В.Ф., Кантемирова Е.А. Три типа адаптации детей

при воздействии экологически неблагоприятных факторов //

Экопатология детского возраста. - М., 1995. - С. 177.

34. Кобринский Б.А. Континуум переходных состояний и мониторинг

динамики здоровья детей // М.: Детстомиздат, 2000.- 152 с.

35. Кобринский Б.А. Информационные технологии в системе детского

здравоохранения России // Российский вестник перинатологии и

педиатрии. – 2004. - №4. - С.55-60

36. Котышева Е.Н., Болотская М.Ю., Кошкина В.С., Хрипач Л.В., Ревазова

Ю.А. Некоторые эколого-гигиенические аспекты здоровья

90

дошкольников промышленного города // Гигиена и санитария. 2004. №4-

С.55-57.

37. Критерии оценки экологической обстановки территорий для выявления

зон чрезвычайной экологической ситуации и зон экологического

бедствия // МООСПР РФ., М. – 1992. – 70 с.

38. Кузьмин С.В., Кацнельсон Б.А., Дегтярева Т.Д. и др. Принципы и

методические подходы к биологической профилактике детской

экопатологии в связи с загрязнением среды обитания токсичными

металлами // Пособие для врачей (утв. секцией по гигиене Ученого

Совета МЗ РФ 2002 г.). – Екатеринбург.- 2002. – 29 с.

39. Кузьмин С.В., Кацнельсон Б.А., Хрущева Н.А. и др. Экологически

обусловленная нагрузка организма кадмием и свинцом как фактор

риска доклинической почечной патологии у детей // Экология человека,

гигиена и медицина окружающей среды на рубеже веков: состояние и

перспективы развития. (под. ред. Рахманина Ю.А.). Москва, 2006.- С.577-

581.

40. Кузьмин С.В., Привалова Л.И., Никонов Б.И. и др. Реализация системы

профилактики, диагностики и лечения экологически обусловленных

заболеваний детского населения Свердловской области, первый этап //

Материалы научно-технической конференции «Урал-экология». –

Екатеринбург, 2002. – С. 58-59.

41. Кузьмин С.В., Чеботарькова С.А., Бармин Ю.Я. Гигиеническая

диагностика экологически обусловленных заболеваний в крупном

промышленном центре // Экология человека, гигиена и медицина

окружающей среды на рубеже веков: состояние и перспективы

развития.//под. ред. Рахманина Ю.А. Москва, 2006.- С.88-92.

91

42. Курляндский Б.А. Особенности выявления причин экологически

обусловленных заболеваний у детей // Гигиена и санитария. – 2001 - №5.

С.45-46.

43. Леденцова Е.Е, Зайцева Н.В., Землянова М.А. Оценка воздействия

выбросов нефтеперерабатывающих производств на здоровье населения //

Гигиена и санитария. – 2004. - №1.- С.10-12.

44. Линева О.И., Цуркан СВ., Гильмиярова Ф.Н. Патогенетические основы

профилактики гестозов в условиях экологического неблагополучия//

Журнал акушерства и женских болезней. - 2000. -Выпуск 3, том ХПХ. -

С. 43-45.

45. Луцкий Я.М., Тоболин В.А., Неудахин Е.В. и др. Некоторые

клинические маркеры антропогенных экотоксикозов у детей

//Экопатология детского возраста. -М., 1995. – с.175.

46. Лучанинова В.Н., Транковская Л.В. Комплексная оценка состояния

здоровья детей на фоне техногенной нагрузки // Российский

педиатрический журнал. 2004. - №1. - С. 10-12.

47. Маймулов В. Г., Пацюк Н. А., Баскович Г. А. Гигиеническая оценка

влияния химического загрязнения окружающей среды мегаполиса на

состояние здоровья детей // Гигиена и санитария. - 2004. - №2. - С. 31-33.

48. Максимова Т.М. Социальный градиент в формировании здоровья

детей //. Здравоохранение РФ. - 2003. - №2. - С. 43-47.

49. Максимова Т.М. Социальный градиент в формировании здоровья

населения // М.: ПЕР СЭ, 2005. - 240 c.

50. Масюк В.С. Состояние иммунной системы у детей в районах

экологического благополучия // Российский педиатрический журнал. –

2003. - №4. -С. 52-56.

92

51. Медик В.А., Котова Т.Е., Сеченева Л.В. Особенности состояния

здоровья детей (по результатам Всероссийской диспансеризации)//

Здравоохранения РФ – 2004. - № 4. – С.46-49.

52. Методические рекомендации № 2000/47 "Биорезонасная терапия" 2000г.

53. Методические рекомендации по использованию сравнительного анализа

рисков и расстановки приоритетов в области охраны окружающей

среды. //Окружающая среда и здоровье. Сб. инструкт.-метод.документов

федерального уровня. Ч.1.М., 2001., с.135-239.

54. Методические рекомендации МЗ РФ №99/96 “Электропунктурный

вегетативный резонансный тест” 1999.

55. Мизерницкий Ю.Л. Значение экологических факторов при бронхиальной

астме у детей // Пульмонология. 2002, 12, №1 С.56-61.

56. Михайлова Е.В. Здоровье детей школьного возраста на территориях с

разным уровнем загрязнений атмосферного воздуха // Здравоохранение

РФ. – 2004. - №6. – С.25-27.

57. Мурзина М.М. Клинико-иммунологическая оценка состояния

здоровья детей, проживающих в районе размещения

медеплавильного комбината. Дис.канд.мед.наук // Уральская ГМА. -

1999. – 125 с.

58. Нежданова М.В. Влияние свинца и ртути на состояние почек у детей

// Российский педиатрический журнал. - 2004. - №4. – С.19-23.

59. Неудахин Е.В., Луцкий Я.М., Котлукова Н.П. Теоретические

аспекты экопатологии желудочно-кишечного тракта у детей //

Материалы 7-й конференции «Актуальные проблемы

абдоминальной патологии у детей». - 2000, - М., - С. 3-4.

60. Онищенко Г.Г., Самошкин В.П. Социально-гигиенический мониторинг –

государственная система наблюдений за состоянием здоровья населения

93

и среды.// Социально-гигиенический мониторинг – практика применения

и научное обоснование. Часть 1.- М., 2000.-С. 13-20.

61. Онищенко Г.Г., Рахманин Ю.А., Зайцева Н.В., Землянова М.А., Акатова

А.А. /Научно-методические аспекты обеспечения гигиенической

безопасности населения в условиях воздействия химических

факторов. //М., МИГ «Медицинская книга». 2004.-С.109-119.

62. Османов И. М. Роль тяжелых металлов в формировании заболеваний

органов мочевой систем // Российский вестник перинатологии и

педиатрии - 1996. –Т. 41.- № 1. - С. 39-40.

63. Османов И.М., Длин В.В. Экологически детерминированные

заболевания почек у детей // Российский вестник перинатологии и

педиатрии. - 2004. - №2. – С. 52-54.

64. Отчет научного комитета ООН по действию атомной радиации за 2000

год, Приложение J. Уровни облучения и эффекты в результате

Чернобыльской аварии. // М., РАДЭКОН, 2001,154 с.

65. Паранько Н.М., Белицкая Э.Н., Землякова Т.Д., Шматков Г.Г., Рублевская

Н.И., Чуб Л.Е., Головкова Т.А. Роль тяжелых металлов в возникновении

репродуктивных нарушений // Гигиена и санитария – 2002. - №1. – С. 28-

30.

66. Першин С.Е., Квартовкина Л.К. Влияние социально-экономических

факторов на здоровье и причины смерти населения // Гигиена и

Санитария. - 2004. - №2. - С. 54-55.

67. Петрова И.В., Мольков Ю.Н., Лещенко Г.М. Маковецкая А.К.

Сравнительная оценка иммунного статуса дошкольников в разных

районах Москвы // Гигиена и санитария. - 1998.- №5.-С.31-33.

68. Пивоваров Ю.П., Демин В.Ф., Князев Ю.А., Ключников С.О. Экопатология

детского возраста // М. 1995. - С. 25-31.

94

69. Пономаренко И.И. Влияние факторов окружающей среды на

формирование донозологических состояний детей // Здравоохранение

РФ. – 2004. - №5. - С.47-49.

70. Попова Л.Ю. Гигиенические аспекты формирования патологии

мочевой системы у детей // Гигиена и санитария. – 2004- №2. - с.48-50.

71. Последствия техногенного радиационного воздействия и проблемы

реабилитации Уральского региона. (Под ред. С.К. Шойгу) / М.:

Комтехпринт, 2002.

72. Рахманин Ю.А., Новиков С.М., Румянцев Г.И. Методологические

аспекты оценки риска для здоровья населения при кратковременных и

хронических воздействиях химических веществ, загрязняющих

окружающую среду// Гигиена и санитария. – 2001. - №6. – С.5-7.

73. Рахманин Ю.А., Ревазова Ю.А.// Донозологическая диагностика в

проблеме окружающая среда- здоровье населения./Гигиена и санитария,

2004.- №6. - С.3-5.

74. Ревазова Ю.А. Здоровье и химическая безопасность на пороге ХХI века:

материалы международного симпозиума. //– СПб, 2000 - С. 75-76.

75. Римарчук Г.В., Васечкина Л.И., Абрамова И.Ю., Юрина Т.К. Аспекты

нарушения состояния здоровья у девочек-подростков из региона с

йодным дефицитом // Гинекология. - 2004. –т. 06- №3. - С.23-24.

76. Российский статистический ежегодник. 2004. Статистический сборник,

М. 2004. - 723с.

77. Сабирова З.Ф. Антропогенное загрязнение атмосферного воздуха и

состояние здоровья детского населения // Гигиена и санитария. – 2001. -

№2. - С.9-11.

78. Сайченко С.П., Гурвич В.Б. с соавт. «О связи мутагенной активности и

химического загрязнения атмосферного воздуха в селитебных зонах

вокруг Каменск-Уральского алюминиевого завода». /Сборник к 80-

95

летию службы Госсанэпиднадзора. Научные статьи сотрудников.,

Екатеринбург, 2002., С.18-23

79. Сайченко С.П., Кузьмин С.В., Никонов Б.И., Гурвич В.Б., Воронин

С.А., Кочнева Н.И. Мониторинг врожденных аномалий и пороков

развития в промышленных центрах Свердловской области // Гигиена и

санитария. - 2004. - №6. С.38-40.

80. Салдан И.П., Ушаков А.А., Никонов А.М., Плугин С.В., Карпова Т.Н.

Мониторинг врожденных пороков развития в Алтайском крае //

Гигиена и санитария – 2004. - №6. – С. 40-41.

81. Свинец и здоровье детей. Материалы симпозиума. III Конгресс

педиатров России //М. - 1998. - 57 с.

82. Селезнева Е.А., Кузьмин С.В., Никонов Б.И. и др. // Система

диагностики, лечения и профилактики экологически обусловленных

нарушений здоровья, реализуемая в Свердловской области // Экология

человека, гигиена и медицина окружающей среды на рубеже веков:

состояние и перспективы развития.// под. ред. Рахманина Ю.А. Москва,

2006 С. 641-646.

83. Сивочалова О.В., Фесенко М.А. Репродуктивное здоровье работающих //

Медицина труда. Введение в специальность // Н.Ф. Измеров, А.А.

Каспаров, М.: Медицина, 2002. - С. 350-379.

84. Скачкова М.А. Карпова Е.Г., Тарасенко Н.Ф., Лаптева Н.М., Корнеев

В.Г., Попова Е.В., Аверьянов В.Н. Состояние здоровья детей

дошкольного возраста в условиях экологического неблагополучии //

Российский педиатрический журнал. - 2005. - №3. – С. 11-15.

85. Смулевич В.Б., Соленова Л.Г., Белякова С.В. Профессия родителей как

фактор онкологического риска у детей // Российский онкологический

журнал. М.: Медицина, - 2001. - №4. - С. 43-47.

96

86. Смулевич В.Б., Соленова Л.Г., Белякова С.В. Факторы онкологического

риска у детей // Российский онкологический журнал. М.: Медицина,

2001. - №3. - С. 43-45.

87.Соленова Л.Г., Белякова С.В., Ременник Л.И., Смулевич В.Б. Нарушения

функции и онкологические заболевания репродуктивной сферы у

женщин – работниц резинового производства // Медицина труда и

промышленная экология. 1993. - №5-6. - С. 20-23.

88.Соломатин В.А. Новые методы диагностики и терапии с использованием

биологически активных точек и зон./Сб. материалов конференции

«Планета и здоровье – 2000» - М.-2000.-С.6-8.)

89. Состояние среды обитания (характеристика факторов риска)

Свердловской области. Отчет ФГУ Госсанэпиднадзора Свердловской

области. 2003.

90. Стругала-Ставик Х., Рудковски З., Пастушек Б., Омельянчик М.,

Шпаков А. Модель сотрудничества между учеными Польши,и Беларуси

в донозологической диагностике и коррекции здоровья детей

//Проблемы диагностики донозологических состояний в

профилактической и клинической медицине. Матер. Научно-

практич.конф. 17-19 дек.2003.,М.,200, с.125-126.

91. Сухарев А.Г., Михайлова С.А. Роль экологических и социальных

факторов в формировании здоровья детского населения (на примере

Республики Алтай) //М., 2000. – 192 с.

92. Сухарев А.Г., Михайлова С.А. Состояние здоровья детского населения в

напряженных экологических и социальных условиях // Гигиена и

санитария. – 2004.- №1. - С. 47-51.;

93. Токарев С.А., Буганов А.А., Уманская Е.Л., Саламатина Л.В., Романова

Г.Г. Популяционная оценка социально-биологических и

97

психологических факторов риска неинфекционных заболеваний у детей

Ямальского региона // Гигиена и санитария. – 2006. - №1. С. 53-55.

94. Узунова А.Н., Лопатина О.В., Неряхина С.В., Зайцева М.Л., Кривдин

В.М., Шарапов А.Р., Хадиева Л.Г. Особенности полового развития детей

старшего школьного возраста Челябинска – промышленного центра

Южного Урала // Профилактика заболеваний и укрепление здоровья. -

2003. - №2. - С.5-8.

95. Файзуллина Р.А. Влияние экологически неблагоприятной окружающей

среды на микроэлементный баланс детей с хроническим

гастродуоденитом // Современные проблемы геохимической экологии

болезней: 1 Межд. Симп. Чебоксары, Материалы и тезисы докладов.

Чебоксары 2001, С.79.

96. Факты и цифры ЕРБ ВОЗ/05/04, Копенгаген, Будапешт 18 июня 2004 г.

97. Филатов Н.Н., Аксенова О.И., Волкова И.Ф., Корниенко А.П., Синякова

Д.В. Социально-гигиенические проблемы формирования здоровья детей

и подростков Москвы // Здравоохранение РФ. – 2001. - №4. - С. 30-32.

98. Целыковская Н.Ю. Социально-гигиенические факторы и здоровье

детей // Гигиена и санитария. - 2001. - №2. - С. 58-60.

99. Шарапова О.В., Царегородцев А.Д., Кобринский Б.А. Всероссийская

диспансеризация: основные тенденции в состоянии здоровья детей//

Росс. Вестник Перинатол. и Педиатрии.- 2004. - №1. – С.56-60.

100. Щеплягина Л.А., Римарчук Г.В., Борисова О.И. Организация

медицинского наблюдения за детьми в районах экологического

неблагополучия. Лекция 2.// Приложение к Российскому вестнику

перинатологии и педиатрии. М., 1998. – С. 25-32.

101. Экологическая эпидемиология (под ред. Ревича Б.А.) // М., Academia.-

2004. - 379 с.

98

102. Эндоэкологический статус организма детей / Сетко Н.П., Веккер И.Р.,

Сетко И.М., Сапрыкин В.Б. // Функциональные особенности системы

«мать-плод-дитя» в условиях антропогенного загрязнения среды

обитания / - М.: Медицина, 2004. – С. 95-97.

103. Юсупов Г.А., Зилов В.Г, Хадарцев А.А. Модифицированная методика

электропунктурной (энергоинформационной) диагностики в

практической медицине. Пособие для врачей, Москва. 2004, 28 с.

104. Anderson H.R., Atkinson R.W., Bland J.M. e.a. Consistency of associations

between air pollution and four indicators of acute lower respiratory disease in

London // Epidemiology. - 1999. - Abstract 244.

105. Atkinson R.W., Anderson H.R. Acute effects of particular air pollution on

respiratory admissions - results from APHEA2 project. // Epidemiology. -

2001. - V.12 - N 4. - P.S54. (Abstract).

106. Behrendt J., Norska-Borowka I. Lead microintoxication in children living in

Bytom // Epidemiology. - 1998. - V.9 - N 4. - P.140. (Abstract).

107. Bell M.L., Davis D. Reassessment of the lethal London fog of 1952: novel

indicators of acute and chronic consequences of acute exposure to air

pollution // Environ. Health Perspect. - 2001 - V.109. - Suppl.3 - P.389-394.

108. Bergomi M., Borella P., Fantuzzi G. Blood, teeth and hair: 3 different

materials used to evaluate exposure to lead and cadmium in children living in

an industrial zone // Ann Ig. - 1989. - V.1. - N5. - P.1185-1196.

109. Bradman A., Eskenazi B., Sutton P. e.a. Iron deficiency associated with higher

blood lead in children living in contamined environments // Environ. Health

Perspect. - 2001. - V.109. - N 10. - P. 1079-1084.

110. Brunekreef B. (coordinator). Effects of short-term changes in urban air

pollution on the respiratory health of children with chronic respiratory

symptoms // Report of the Wageningen Agricultural University. -

Wageningen, The Netherlands, 1993. - 54 p.

99

111. Buffler P.A. Carcinogen risk assessment guidelines and children // Environ.

Health Perspectives. - 1999 - Vol.107.- N6. - P.A286-4A288.

112. Cohen Hubal E.A., Sheldon L., Burke J.M. e.a. Children`s exposure

assessment: a review of factors influencing children`s exposure, and the data

available to characterize and assess that exposure // Environ. Health

Perspect. - 2000. -V.108. - N 6. - P. 475-486.

113. Dietert R.R., Etzel R.A., Chen D. e. a. Workshop to identify critical windows of

exposure to children`s health : immune and respiratory systems work group

summary // Environ. Health Perspect . -2000. - V. 108. - Suppl.3. - P.483-490.

114. Esteban E., Rubin C., Noonan G. e.a. Survey of pediatric blood lead in the

Russian Federation. // Epidemiology. - 1998. - V.9. - N 4. - P. 138 (Abstract).

115. Ettinger A.S., Bornschein R.L., Farfel M. e.a. Assessment of cleaning to control

lead dust in homes of children with moderate lead poisoning: treatment of

lead-exposed children trial // Environ. Health Perspect. - 2002. - V. 110. N 12.

- P. A773-A779.

116. Farias P., Hu H., Rubenstein E. e.a. Determinants of bone and blood lead

levels among teenagers living in urban areas with high lead exposure //

Environ. Health Perspect. - 1998. - V. 106. - N 11. - P. 733-738.

117. Fletcher T., Brunekreef B., Hothuijis D. e.a. Does outdoor or indoor air

pollution cause more respiratory disease? Evidence from the Central

European Study on Air Pollution and Respiratory Health (CESAR study) //

Epidemiology. - 2001. - V.12. - N 4. - P.S85. (Abstract).

118. Gemmel A., Tavares M., Alperin S. e.a. Blood lead level and dental caries in

school-age children // Environ. Health Perspect. - 2002. - V.110. - N 10. - P.

A625-A630.

119. Heinrich J., Schweinsberg F. Biomonitoring for the evaluation of a mercury

burden from amalgam fillings. Mercury determination in urine before and

100

after oral doses of 2, dimercaPto-1-propanolsulfonic acid (DMPS) and in

hair // Zentralbl. Hyg. Und Umweltmed. - 1993. - V. 194. - N 3. - P. 271-291.

120. IPCS Environmental Health Criteria 165 / “Inorganic Lead”.- Geneva: WHO,

1995. – 300 P.

121. Jedrychowski W., Whyatt R., Camann D., Bawle U., Peki K., et al. Effect of

prenatal exposure on bith outcomes and neurocognitive development

among a cohort of Polish mothers and newborns. Study design and

preliminary ambient data // European EpiMarker. – 2002. - N1. - vol. 6, p.1-6.

122. Katsnelson A., Kuzmin S., Privalova L., Jaakkola J. e.a. Individual and

environmental risk factors influencing pregnancy course, delivery outcomes,

newborn status and health of infants during the first year of life in three

industrial townships of the middle Urals, Russia // European Epimarker. -

2006. - V. 10. - N. 3. - P. 1-8.

123. Katsnelson B., Kosheleva A., Privalova L., Kuzmin S., Gurvich V., Fourman

V., Lebedeva N., Parise H. The most important individual risk factors for

chronic respiratory disease in children: analysis of ca. 6,000 questionnaires //

ISEE 2000. Twelfth Conference of the International Society for

Environmental Epidemiology Environmental Epidemiology Buffalo, New

York, USA, August 19-23, 2000. Official Journal of the International Society

for Environmental Epidemiology - Scientific Program Outline and Abstracts.

124. Landrigan Ph.J., Carlson J.E., Bearer C.F. et al. // Environ Health Perspect.

106. - 1998. - (Suppl 3). - Р.787-794.

125. Lebedeva, N., Zemlyanaya G., Fourman, V., Kislitsin, V. Modern methods of

evaluation of adverse environmental factors on public health // Social-

Hygienic Methods And Practice Of Research On Public Health And Public

Health Services, 2000, pp. 115-128.

101

126. Nishijo M., Nakagawa H., Morikava Y. Prognostic factors of renal

dysfunction induced by Environmental Cadmium Pollution // Environmental

Research., 1994; №64, P. 112-121.

127. Occupational hazards and reproduction. // Eds. K.Hemminki, M.Sorsa,

H.Vainio. Hemisphere Publishing corporation.1985. 330 p.

128. Rice D., Barone S. Critical periods of vulnerability for the developing nervous

system: evidence from humans and animal models // Environ. Health

Perspect. - 2000. - V. 108. - Suppl. 3. - P. 511.

129. Rubin CH, Esteban E, Reissman DB, Daley WR, Noonan GP, Karpati A,

Gurvitch E, Kuzmin SV, Privalova LI, Zukov A, Zlepko A. Lead poisoning among

young children in Russia: concurrent evaluation of childhood lead exposure

in Ekaterinburg, Krasnouralsk, and Volgograd // Environ Health Perspect.-

2002.- V.-110.-N6.-P.559-562.

130. Rundai P., Leonardi G., Houthuijs D.B. e.a. Early life factors as predictors of

prevalence of asthmatic symptoms among 7-11 year old children //

Epidemiology. - 2000. - V. 11. - N 4. - P. S133. (Abstract).

131. Schwartz J. Low-level lead exposure and children`s IQ: a meta-analysis and

search for a threshold // Environ. Res. - 1994. - V. 65. - P. 42-45.

132. Selevan Sh.G., Kimmel C.A., Medndola P. Identifying critical windows of

exposure for children`s health // Environ. Health Perspect. - 2000. - V.108. -

Suppl. 3. - P. 451-455.

133. Sharpe M. In harms way: childrens environmental health // J. Environmen.

Monit. 2002. - 4. - №6. P.93-98.

134. Wasserman G.A., Liu X., Lolacono N.J. e.a. Lead exposure and intelligence in

7-year-old children: the Yugoslavia prospective study // Environ. Health

Perspect. - 1997. - V. 105. - N 9. - P. 956-962.

135. Weiss B. Vulnerability of children and the developing brain to neurotoxic

hazards. // Environ. Health Perspect. - 2000. - V. 108. - Suppl. 3. - P.375-381.

102

103

APPENDIX

1. Ivdel

2. Severouralsk

3. Krasnoturinsk

4. Karpinsk

104

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

105

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.)

106

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 Occupation motherfather

6. Housing conditions: 1. Hostel

2. Communal flat

3. Separate apartment

4. Own house

107

7. Family history (chronic diseases)

____________________________________________________________________________________________________________________________________

8. Medical examination:

1. Diagnosis______________________________________________________________________________________________________________________

________________________________________________________________________________________________________________________________

2. Recommendations______________________________________________________________________________________________________________

________________________________________________________________________________________________________________________________

108

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- re-

analysis 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.

109

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.

110

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.

111

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.

112

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.

113

Curriculum Vitaeof 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 RAMSPh.D. (Medicine) N.V. Rusakov

114

RoszdravFederal Government Establishment

FEDERAL RESEARCH AND MEDICAL CENTRE ofPediatric Hematology, Oncology and Immunology

Federal Agency for Health and Social Development(FGI FNKTS DGOI "Medical)

117997, Moscow, GSP-7, Leninsky Avenue, 117Tel: (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

115

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

116

All-Russian Society of Nature Protection

ROSTECH SUPERVISION INTERREGIONAL TERRITORIAL

ADMINISTRATION OF TECHNOLOGICAL ANDECOLOGICAL SUPERVISION OF THE

FEDERAL SERVICE ONENVIRONMENTAL,

TECHNOLOGICAL AND NUCLEARSUPERVISION OF THE CENTRAL

FEDERAL DISTRICT

107031, Moscow.st. Rozhdestvenka 5 / 7.

Phone: 629-88-20, fax: 629-15-21:E-mail: cpogtn@dol.ru

Director of the Sysin Research Institute of Human Ecology and Environmental Hygiene of RAMSAcademician of RAMS

Y.A. Rakhmanin

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.

117

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 A.M. Chernykh

Senior lecturer (Medicine) N.N. Zabroda

General Hygiene Department

Kursk State Medical University

118

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) A.V. Avchinnikov

Samara State Medical Academy

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".

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.

120

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

121

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) I.E. Zykova

Ph.D. (Biology) L.F. Kiryanova

The Sysin Human Ecology and Environmental

Hygiene Research Institute of RAMS

122

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 4-

5%. 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

123

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

124

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

125

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-to-

date 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

126

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

127

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.

128

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

129

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.

130

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".

131

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

132

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

133

RF Federal

Ecological

Fund

RF Ecological

Funds Association

Health Ecorehabilitation Centre

GREEN HOUSE

HEALTH PASSPORT

134

RF Federal ecological fund

RF Ecological funds association

“Health ekorehabilitation centre

GREEN HOUSE”

Health Passport

Class

It’s filled in annually

Groups

ALLERGY (vaccine, drug, allergic diseases)

Child’s surname, name, patronymic

Birth date

Sex

B

G

Address Telephone number

Polyclinic № Telephone number

Information about parents:

Date of birth Education Place of work (occupation)

Telephone 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 DateMeasles DysenteryWhooping cough TyphoidScarlatina TuberculosisDiphtheria RheumatismChickenpoxInfectious parotitisGerman measlesInfectious hepatitis

135

Dispensary observation information

Diagnosis Registration date

Deregistration date (reason) Specialist visit monitoring

appointed came appointed came appointed came

Date Examinations data Recommendations1 2 3

Date Examinations data Recommendations1 2 3

Fluorography examinations data Laboratory examinations data

date result analysis date resultBloodUrineFaeces

Dehelmintasation ______________________________________________________________________

DateResultDateResult

Dental examinationDateFormula

Deep medical examination data1 Examination data2 Child’s age

136

3 Class, group4 Height5 Weight6 Subjective complaints7 Examinations: by pediatrician8 Rheumatologist9 Systolic pressure10 Orthopedist (surgeon)

11 Ophthalmologist12 Otolaryngologist13 Neuropathologist14 Dermatologist15 Speech therapist16 Stomatologist17 Physical development estimation18 Health status conclusion19 Physical training group20 Recommendations

Doctor’s signatures ____________________________________________________________________

(pediatrician, specialists) _______________________________________________________________

EXAMINATION BEFORE PREVENTIVE VACCINATION

Date HealthyVaccination is allowed (what

kind?)Is ill (diagnosis)

Medical rejection till

____Doctor

PREVENTIVE VACCINATION

Vaccination RevaccinationI II III I II III IV

For poliomyelitisDateSeriesFor diphtheria, whooping cough, tetanusDateSeries

137

For parotitisDate Gamma globulin injection (according to instructions)SeriesFor measles Date Date Reason Date ReasonSeriesMantu reactionDateResult

Vaccination for tuberculosis

Date DateResult 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