Use of methods of prenosological diagnostics. Methodological bases and algorithms for diagnosing prenosological conditions Criteria for prenosological diagnostics of health status

When assessing health, nosological diagnostics, presonic diagnostics and health diagnostics by direct indicators are used.

The advantage of presonological diagnostics is that with its help, people who need health-improving measures or changes in environmental conditions are quickly and inexpensively identified.

However, the state of adaptive potential identified during prenosological diagnostics, although to a certain extent characterizes health, is rather the result of the interaction of the organism with the environment.

One can imagine a person with a high level of health, but caught in an extreme industrial or domestic situation. There will be a breakdown in adaptation, despite significant reserves of functions.

The quantitative assessment of individual health remains one of the most urgent tasks of modern medicine. To solve it, many different methods have been proposed, but only a few of them have received practical application.

The conceptual basis of all these methods is the theory of adaptation.

The view of health as a "successful adjustment" has become widespread and forms the basis of most modern methods of its assessment. This approach requires the use of stress tests.

The idea of ​​using adaptability as an integral indicator of health arose in the 70s. Health is understood as the body's ability to adapt to environmental conditions, and disease occurs as a result of a breakdown in adaptation.

The adaptive reactions of the body were supposed to be assessed mainly by the parameters of the circulatory system. Later, it was proposed to measure the amount of health by the physiological reserves of the body, that is, the maximum performance of systems while maintaining the qualitative limits of their functions in response to stress, most often in the form of physical activity.

Recently, there has been a clear trend towards an integrative assessment of health by including indicators of psychosocial adaptation in the calculation of indices. This refers to such a state of the body and such a form of life activity that provide an acceptable life span, its necessary quality and use the method of three scales: physical, mental and social satisfaction.

To date, various versions of automated programs for the quantitative assessment of health have been developed, which are widely used in preventive examinations of the population. However, most researchers admit that the diagnostic and prognostic significance of the proposed methods, as well as the information content of the indicators used in them, have not been studied enough.

Evaluation of the information content of the most common methods led to the conclusion that they mainly or almost exclusively reflect a decrease in adaptive capabilities only in connection with the pathology of the cardiovascular system (CVS).

With regard to the pathology of other systems, the diagnostic algorithm of the methods does not provide them with sufficient efficiency. Apparently, this is due to the fact that almost all the studied methods are based on indicators of the cardiorespiratory system.

Undoubtedly, the CCC plays a leading role in ensuring adequate adaptation of the body to the environment. However, the assessment of health based on indicators of the functioning of any one system of the body can hardly be exhaustive.

The value of the integral indicator of health strongly depends on the state of the cardiovascular system and is insensitive to changes in the functional state of other systems. A promising direction for improving integrative methods for quantitative health assessment is associated with an increase in their specificity and diagnostic efficiency.

It is quite obvious that the indicators that characterize the mechanisms of self-organization of a living system - adaptation, homeostasis, reactivity, etc. - best of all quantitatively reflect the level of individual health.

As indicators of health, it is preferable to use the key characteristics of the manifestation of health, since they reflect the result of the activity of the entire complex integral functional system of the body.

One of the main problems in assessing the state of health is to measure the level of health, in fact, to determine the "price" that each person pays for health. Modern medicine has innumerable possibilities for diagnosing and treating the most complex diseases. The unique equipment for nuclear magnetic resonance and echography makes it possible to study a living organism at the cellular and molecular level and detect violations in the microstructure of tissues and organs. A huge number of pharmacological agents have been created that effectively act both on the body as a whole and selectively on individual systems and organs. Fantastic successes in surgery and transplantation open the way to the replacement of almost any diseased organ.

At the same time, at least three impasses in modern medicine should be pointed out. Firstly, it is the inability to provide assistance to all patients for purely economic reasons (the high cost of diagnostic procedures, drugs and operations). Secondly, medicine can only help a person survive (and then only for a certain limited period), but in principle it is not able to restore lost health to people, if we understand it as the ability to continue in full their industrial and social activities and personal life. Thirdly, medicine, despite the formal proclamation of the principles and objectives of disease prevention, actually deals only with people who are already sick and in need of medical care. This means that she does not know how to predict and prevent diseases, but only passively waits until a healthy person turns into a patient requiring her attention.

The acceleration of technological progress, the increase in man-made impacts on the environment, the global automation of production, the significant increase in the stressfulness of the modern lifestyle increase the risk of developing diseases and make everyone a potential "patient" of medical institutions (or healers). This puts at the forefront of the problem of health its prognostic aspect: the need to predict the individual trajectory of movement from health to illness.

If in relation to diseases there is a well-developed and generally accepted nomenclature (classification) of diseases, then until recently health did not have appropriate classifications. Modern psychological and physiological approaches have been formed in connection with the problems of the so-called "third state", when a person is not healthy and not sick as a result of long-term chronic stress and long-term adaptations. Of particular importance is the identification of prenosological conditions that occur on the verge of normal and pathological conditions and are characterized by an increased expenditure of functional reserves.

The term "prenosological conditions" was included in the Great Medical Encyclopedia in 1978, and a new section appeared in the doctrine of health, called "prenosological diagnostics", which, based on the provisions of the theory of adaptation, studies methods for classifying and measuring health levels. It includes the most diverse states of the body with different levels of functional reserves, varying degrees of tension of regulatory mechanisms, different reactivity, changes in the plasticity and stability of vital systems.

The functional reserves of the body, which can be distinguished at different levels - from cells to complex functional systems - are considered an integral criterion for human adaptation and health.

The theoretical basis that allows to analyze the relationship between adaptation and health processes, the nature of the adaptation process, to detect its phases, their duration, is the concept of long-term adaptation, or phenotypic adaptation (F. 3. Meyerson, 1986).

Long-term adaptation is characterized, on the one hand, by an increase in the power of self-regulation mechanisms of individual body systems, and, on the other hand, by an increase in the reactivity of these systems to control signals - mediators and hormones. As a result, the active adaptation of the captured organism to the external environment is achieved with a lower degree of inclusion of the higher levels of the regulatory "hierarchy": with a more economical functioning of the neuroendocrine regulation systems responsible for adaptation.

In cases where the body is constantly experiencing a deficit of functional reserves to achieve balance with the environment, a state of functional tension occurs, which is characterized by a shift in the autonomic balance towards the predominance of adrenergic mechanisms and a corresponding change in hormonal status.

The state of tension of adaptation mechanisms is associated with an increase in the degree of tension of regulatory systems and is adequate to an increase in the level of functioning with a sufficient functional reserve. The state of unsatisfactory adaptation is characterized by a further increase in the degree of tension of regulatory systems, but is already accompanied by a decrease in the functional reserve. In case of failure of adaptation, the decrease in the level of functioning of the system, which occurs as a result of a significant decrease in the functional reserve and depletion of regulatory systems, becomes of primary importance.

Disruption of adaptation can cause the appearance of signs of manifestation and the pathological process, which is considered to be the beginning of the disease. The transition from health to illness should be considered as a process of gradual decrease in the body's ability to adapt to changes in the social and industrial environment, environmental conditions, which ultimately leads to a decrease in social, social and labor functions. It is characterized by a manifest pathological process. The boundary of the transition from the state of health to the state of pre-disease is the level of health that cannot compensate for the changes occurring in the body under the influence of negative factors, and as a result, a tendency towards self-development of the process is formed (G. JI. Apanasenko, 2006).

As objective signs of the transition state (the third state), such a criterion as the degree of tension of adaptation mechanisms is used. There are two levels in the transition state:

Donosological, which is characterized by the tension of regulatory mechanisms;

Premorbid, which is characterized by a decrease in the adaptive capabilities of the body.

In the transition from prenosological conditions to illness, N.A. Agadzhanyan (2000) distinguishes two types of premorbid conditions:

1) premorbid states with a predominance of nonspecific changes;

2) premorbid states with a predominance of specific changes.

The transition from a nonspecific premorbid state to a specific one is due to the transformation of one of the risk factors predisposing to a certain type of pathology into a causative factor. For example, strong psycho-emotional arousal or meteotropic reactions can lead to a pronounced overstrain of regulatory systems with symptoms of headache, weakness, and heart pain.

The stated methodological approaches should be considered in the formation of the management of the state of vital resources, the creation and improvement of hardware and software systems and methods for assessing psychosomatic states, a comprehensive analysis of the individual resources of the body and personality.

Adaptive changes in regulatory mechanisms are most clearly manifested in the process of regulation of the cardiorespiratory system responsible for providing organs and tissues with oxygen and nutrients (NA Agadzhanyan et al., 1997).

The circulatory system can be considered as the leading executive mechanism, which is controlled by the central and peripheral links of neurohumoral regulation. The specificity of the regulation of cardiac activity from the side of the central nervous system makes it possible to obtain prognostic information both about the activity of the heart and about changes in the state of the body as a whole, since the nervous and humoral regulation of blood circulation change before energy, metabolic and hemodynamic disorders are detected. Myocardial-homeostatic homeostasis is closely related to the autonomic regulation of functions, the interaction of the sympathetic and parasympathetic systems, that is, with autonomic homeostasis (RM Baevsky, 1979).

If we imagine the body as a cybernetic system consisting of control (central nervous system, subcortical and vegetative centers) and controlled (musculoskeletal system and internal organs) elements, then the circulatory apparatus is the matching link between them (Fig. 8).

The transition from one functional state of the cardiovascular system can be considered as a change:

Level of functioning (UF);

Functional reserve (FR);

Degrees of tension of regulatory mechanisms (SN).

An integral indicator of the functioning of the circulatory apparatus is the minute volume of blood, the "energy price" of blood expulsion.

The functional reserve of the circulatory system is determined by the use of intense, short-term, strictly dosed physical or mental stress - functional tests (veloergometry, orthoprobe, Master's test, etc.). Physical activity is a universal test tool that can be used to evaluate the functional capabilities of the body, its hidden reserves. It is a standard that measures the energy reserve of the main functional systems of the body and, above all, blood circulation. The degree of tension of regulatory systems, including the tone of the sympathetic division of the autonomic nervous system, affects the level of functioning of blood circulation by mobilizing one or another part of the functional reserve (N. A. Agadzhanyan, R. M. Baevsky, A. P. Berseneva, 2000).

R. M. Baevsky (1979) proposed a classification of the functional states of the body, based on ideas about homeostasis and adaptation. Using a 10-point scale, it is possible to distinguish rather fine gradations of functional states in healthy and practically healthy people (Table).

Table

Similar information.

Prenosological diagnostics(it is more correct to call testing, because in fact no diagnosis is made) - a survey of relatively healthy people in order to identify risk factors for diseases. In other words, prenosological diagnostics should be understood as an assessment of the functional state of the body and its adaptive capabilities in a period when there are still no obvious signs of diseases. Prenosological diagnostics is engaged in the recognition of conditions that border between the norm and pathology.

Prenosological diagnostics is an innovation in the provision of services in the social sphere. Not so long ago, such an innovation for the social protection system was computer literacy for the elderly. With the advent of wearable digital mobile devices and gadgets, it is now time for prenosological diagnostics.

The problem of assessing the state of individual human health and control over changes in its levels is becoming increasingly important. Especially for persons subject to high psycho-emotional and physical stress. The transition from a healthy state to a disease is usually considered as a process of reducing a person's ability to adapt to changes in the social and industrial environment, to the surrounding conditions of life. The state of the organism (its health or illness) is nothing but the result of interaction with the environment. This is the result of adaptation or disadaptation to environmental conditions.

The solution to the problem comes down to learning, on your own or with the help of an instructor, to determine (measure) the degree of tension in the body's regulatory systems. This allows you to manage your health. Currently, prenosological diagnostics provides an assessment of the level of health in various functional states. It helps to develop systems for dynamic monitoring of the health of the adult population, even at home, without going to a medical institution.

Devices ideal for prenosological diagnostics: VedaPulse , "ROFES" and "CardioBOS" .

To assess the level of health, a classification of the functional states of the organism of the “Traffic Light” type is used: green, yellow and red light reflects the states of the norm (Z), borderline states (Zh) and pathology (K), respectively.

Speaking about measures for correcting health and preventing diseases, one must take into account that this whole complex is used at the preclinical stage and is designed for a mass consumer who does not have medical knowledge. Accordingly, we can only talk about non-drug health correction means (nutrition, physical activity, sleep, daily routine, etc.).

The main task facing prenosological diagnostics is to answer the question of what preventive measures should be taken and when to improve health and prevent diseases. And also track the effectiveness of any wellness procedures and the dynamics of the state of health.

Various classifications of functional states

Prenosological diagnostics can be introduced and implemented as a modern technology of social services at home, in semi-stationary and stationary forms. Diagnostics as a service becomes especially relevant for NGOs that are or plan to become providers of social services.

A significant advantage of using diagnostics as a social service is the reduction of qualification requirements for staff (medical education is not required) without losing the quality of the service itself.

© Lyangasov Sergey Ivanovich, President of the APIS

(Visitors 574 all time, 1 visits today)

Ministry of Health and Social Development

Russian Federation

Voronezh State Medical Academy

them. N. N. Burdenko

Department of Physical Culture

Head of the Department, Candidate of Pedagogical Sciences E.D. Vyaltseva

TEST

FOR PHYSICAL EDUCATION

"Prenosological diagnostics"

Test

2nd year students

correspondence department groups

Faculty of Pharmacy

Sasovoi S.O.

Record book number 090899

Voronezh 2011

Introduction

The essence of prenosological diagnostics

2.Use of methods of prenosological diagnostics

Organization of the system of prenosological diagnostics

Bibliography

INTRODUCTION

The definition of the concept of "health" and to this day remains difficult. Galen divided the state of the human body into three categories: health, disease, and "neither health nor disease." Avicenna distinguished six degrees of health and disease, of which only two were related to illness. Currently, the term "health" is often interpreted as the absence of disease. The World Health Organization has defined health as a complex of physical, mental and social well-being.

Improving the level of health should become one of the priority areas of medicine. This coincides with the emerging mood in society that "being sick is not profitable." The experience of domestic and world medicine testifies in favor of an individual approach to recovery, the selection of drugs and non-drug forms of treatment. Well-known scientists of domestic and world medicine have repeatedly pointed out the need for prenosological diagnostics.

Prenosological diagnostics is a new scientific direction based on the study of prenosological conditions bordering between health and disease, using specific methods and instruments for assessing and measuring the functional state of the human body.

.ESSENCE OF PRENOSOLOGICAL DIAGNOSIS

Prenosological diagnostics - examination of practically healthy individuals in order to identify risk factors, latent and unrecognized cases of diseases. In other words, prenosological diagnostics should be understood as an assessment of the functional state of the body and its adaptive capabilities in a period when there are still no obvious signs of diseases. Prenosological diagnostics is engaged in the recognition of conditions that border between the norm and pathology.

The basis of prenosological diagnostics is the measurement of physical and physiological qualities, psychophysiological state, intellectual and personal qualities of a person, i.e. qualitative and quantitative indicators of health, adaptive capabilities of the body, and obtaining a scientifically based answer to the question of how far a person is from possible maladjustment and development of the disease.

The task facing prenosological diagnostics is to answer the question of what preventive measures and when should be taken to improve health and prevent diseases.

Prenosological diagnostics makes it possible to detect developing diseases in advance before the appearance of clinical symptoms (latent forms of the course); identify critical conditions that can lead to exacerbation of existing diseases; select a system or organ that requires priority action. It also indicates the system with the greatest degree of damage, assesses the violation of the vitamin and microelement balance and the targeted appointment of biocorrectors, monitors the effectiveness of any health procedures and the dynamics of the state of health.

Contraindications to the use of prenosological diagnostics are acute infectious diseases with a febrile syndrome, traumatic amputation of the phalanges of the fingers, congenital anomalies in the development of the limbs, age less than 4 years, severe hearing and speech impairment, impaired consciousness.

The main method of prenosological diagnostics is screening - assessment of the condition, search for a risk factor or disease by questioning, physical examination, hardware or laboratory research, or using other procedures that can be performed relatively quickly.

Research methods and techniques:

Assessment of the presence and influence of risk factors.

Assessment of physical data, functional state and adaptive potential.

Indicators of anthropometric data: height, weight, diagnostic anthropometric tests, goniometry, curvimetry, measurement of mobility and asymmetry of range of motion.

Indicators of the functional state of individual body systems.

Indicators of the cardiovascular system: heart rate; arterial pressure; diastolic (or minimum) pressure; systolic (or maximum) pressure; pulse pressure; average dynamic pressure; minute volume of blood; peripheral resistance.

Indicators of the functional state and reserve capabilities of the body: Martinet's test; squat test; Flack test; Rufier's test; orthostatic test; eye test; clinostatic test; endurance coefficient; Bayevsky's test; vegetative Kerdo index.

Assessment of the psychophysiological state: assessment of attention, operative memory, ability to withstand the pace of work, ability to withstand combined activities.

Manual therapy (dianostics) is a set of diagnostic measures carried out by hands using special techniques aimed at diagnosing organic and functional disorders of the musculoskeletal system.

USING PRENOSOLOGICAL DIAGNOSIS METHODS

The problem of assessing the state of a person's individual health and monitoring changes in its levels is becoming increasingly important, especially for people subject to high psycho-emotional and physical stress, as well as for school-age children. The transition from a healthy state to a disease is usually considered as a process of gradual decrease in a person's ability to adapt to changes in the social and industrial environment, to the surrounding conditions of life. The state of the organism (its health or illness) is nothing but the result of interaction with the environment, i.e. the result of adaptation or disadaptation to environmental conditions.

The achievement of a certain level of functioning of the organism or its specific systems is ensured by the activity of the mechanisms of regulation and control. Mobilization of reserves occurs as a result of a change in the level of activity of regulatory systems, and in particular, an increase in the tone of the sympathetic division of the autonomic nervous system. With a constant deficit of functional reserves to achieve balance with the environment, a state of functional tension arises, which is characterized by a shift in the autonomic balance towards the predominance of adrenergic mechanisms. In a state of functional stress, all the main functions of the body do not go beyond the norm, but the costs of functional reserves to maintain the normal level of functioning of systems and organs increase. Such conditions, in which the nonspecific component of the general adaptation syndrome manifests itself in the form of varying degrees of tension of regulatory systems, are called prenosological. A significant increase in the degree of tension, leading to a decrease in functional resources, makes the biosystem unstable, sensitive to various influences and requires additional mobilization of reserves. This condition, associated with an overstrain of regulatory mechanisms, is called unsatisfactory adaptation. In this state, specific changes in individual organs and systems become more significant. Here it is quite acceptable to talk about the development of the initial manifestations of premorbid states, when changes indicate the type of probable pathology.

Thus, the manifestation of the disease, as a result of the failure of adaptation, is preceded by prenosological and premorbid conditions. It is these conditions that are studied in valeology and should be the object of control and self-control over the level of health. The term "prenosological conditions" was first proposed by R.M. Baevsky and V.P. Kaznacheev. The development of the theory of prenosological states is associated with space medicine, in which, starting from the first manned flights, medical control over the health of cosmonauts focused not so much on the probable development of diseases, but on the body's ability to adapt to new, unusual environmental conditions. The prediction of possible changes in the functional state in space flight was based on an assessment of the degree of tension in the body's regulatory systems. It was space medicine that gave impetus to the development of mass prenosological research in preventive medicine, contributed to progress in the field of prenosological diagnostics; subsequently, her methods became an integral part of valeology.

The science of health is integral, emerging at the intersection of biology and ecology, medicine and psychology, cybernetics and pedagogy, and a number of other sciences. It follows from this that the science of health should be based on the science of the health of a person who lives in a real complex world, saturated with stressful effects that occur when many factors of the biosocial environment change, which takes away part of his health and leads to the so-called "third state". ". The concept of the third state in assessing human health is actually based on the laws of ancient medicine, set forth more than a thousand years ago by the famous physician and philosopher Abu Ali Ibn Sina - Avicenna, who identified six states of human health: a healthy body to the limit; the body is healthy, but not to the limit; the body is not healthy, but not sick either; a body easily perceiving health; the body is sick, but not to the limit; the body is sick to the limit.

Of these conditions, only the last two are related to disease. Between the two extreme levels of health (according to Avicenna) - "a healthy body to the limit" - we distinguish five transitional states with varying degrees of tension in regulatory systems: with normal, moderate, pronounced, pronounced and overstrain. The transition from health to illness occurs through overstrain and disruption of adaptation mechanisms. And the sooner it is possible to foresee such an outcome, the greater the likelihood of maintaining health. Thus, the problem boils down to learning how to determine (measure) the degree of tension in the body's regulatory systems and, consequently, manage health. At present, with the active formation of the science of health, prenosological diagnostics has become the main part of valeology, as it provides an assessment of the level of health in various functional states, develops systems for dynamic monitoring of the health of the adult population, children and adolescents of school age.

The modern idea of ​​the cardiovascular system as an indicator of the adaptive reactions of the whole organism was developed in space medicine, where for the first time the practical application of pulse diagnostics in its modern form, i.e. cybernetic (mathematical) analysis of the heart rhythm, began. This methodological approach has become one of the most important principles of space cardiology, which consists in the desire to obtain maximum information with a minimum of recording data. At present, with the help of electronic devices and computing tools, it has become possible, based on the analysis of the heart rhythm, to obtain objective data on the state of the sympathetic and parasympathetic systems, their interaction, on higher levels of regulation in the subcortical centers and the cerebral cortex.

Recognition of functional states based on the data of mathematical analysis of the heart rate requires special equipment (automated complex), certain experience and knowledge in the field of physiology and clinic. In order to make this methodology accessible to a wide range of specialists and possible for use at the pre-medical stage of control, a number of formulas and tables were developed that allow calculating the adaptive potential of the circulatory system for a given set of indicators using multiple regression equations. Sufficiently high accuracy of recognition of body states is provided by the method of determining the adaptive potential using special tables, using a set of simple and accessible research methods: measuring heart rate, systolic and diastolic blood pressure, height, body weight (weight) and determining the age of the subject. According to the calculated value of the adaptive potential, the degree of tension of regulatory mechanisms and the level of health are determined.

Of great importance is the assessment of changes in the level of health according to the adaptive potential of the circulatory system, not only in individual individuals, but also at the level of entire teams or groups of people who are affected by similar living conditions. This is possible by determining the so-called "health structure" of the team, which is commonly understood as the distribution (in percent) of individuals with varying degrees of adaptation to environmental conditions (with different values ​​of the adaptive potential of the circulatory system). The structure of health is a very informative indicator that gives a versatile description of the surveyed group of people. It is changes in the structure of health that should be considered as a sensitive indicator of the response of the collective (group of individuals) to certain conditions of life, health-improving, preventive, sanitary and hygienic measures and other factors of the human environment.

For a number of years at the Department of Theoretical Foundations of Physical Culture of the Stavropol State University in the scientific direction "Valeology and problems of assessing human health", teachers and students have been studying the influence of various environmental factors on the health of students in educational institutions. Students of the Stavropol Territory of different ages with a total number of 3150 people were involved in research on the problem.

The studies revealed that with significant individual variability, the adaptive potential of the circulatory system carries a versatile expressed information content.

During the study of age-related changes in the adaptive potential of the circulatory system of 2800 schoolchildren aged 7-17 years, a significant deterioration in its average values ​​with age was revealed. This age-related deterioration of the adaptive potential slowed down and even its temporary improvement was observed in groups with increased physical activity, not exceeding its optimal level. The cessation of exposure to the body increased to the optimal level of physical activity again led to a deterioration in the adaptive potential of the circulatory system. With constant exposure to the body of dosed motor loads, the age-related deterioration in the level of health occurred much more slowly. Due to the large individual variability of the adaptive potential, a change in its level in each individual can only be detected in dynamic surveys.

These observations led to the conclusion that the adaptive potential of the circulatory system as an integral criterion of the functional state of the whole organism can be used not only to assess the adaptation of the organism to the conditions of daily activities and predict its changes, but also as a reflection of the aging process in a developing organism and the deterioration of health. with age, the intensity of which depends on the physical activity of the student.

An individual assessment of the adaptive potential of the circulatory system and the health structure of the class (team) can be used as a criterion for the optimality of students' physical activity. Insufficient physical activity both in school and out of school leads to a faster deterioration in the health of students and the health structure of classes during the school year. Moreover, a significant deterioration in the structure of health was observed by the end of the first half of the year. Students with high physical activity, as a rule, had a higher level of health, and its structure in these classes was distinguished by better indicators.

The study of the health levels of students and the structure of the health of classes (groups) with different physical development confirmed the position that physical development is one of the main criteria for health. Students with higher adaptive abilities and in classes with a better health structure had higher physical development.

An analysis of the levels of adaptive abilities of students confirmed the position that physical fitness is also one of the main criteria for health, since the levels of adaptation of students with good physical fitness in most cases were higher.

The deterioration in the health levels of students and the structure of the health of the classes, and consequently their working capacity, was observed in all cases when the working hours of educational institutions had an excess of the length of the school day and a shortened school week (5 days), while maintaining the same weekly volume of hours as in six business days.

Particular attention in the research was paid to the prognostic assessment of the adaptive potential of the circulatory system in optimizing physical activity at a physical education lesson, in the training process in groups of youth sports schools with different sports orientations, in strengthening the health-improving orientation of both physical education lessons and sports training. It is noteworthy that stable changes in the adaptive potential of the circulatory system under the influence of physical activity are detected already at the early stages of their implementation. At the same time, changes in the adaptive potential quite clearly reflect both the developmental impact of loads and the increase in tension and overstrain of the regulatory mechanisms during the development of overwork. The identified improvements in adaptive potential were accompanied in most cases by an improvement in the results of fulfilling the control standards of physical fitness. The deterioration in adaptation to loads was often accompanied by a decrease in results.

A stable and in most cases reliable correlation was found between the average group values ​​of the adaptive potential of the circulatory system and the average results of the control standards, mainly reflecting one or another physical quality.

An increase in the value of the adaptive potential of the circulatory system made it possible to detect overwork in physical exercises in the early stages of its development. The revealed absence of a significant improvement in the indicators of physical fitness of students during the school year with a deterioration in the adaptive potential of the circulatory system allows us to consider that physical education lessons conducted by traditionally established methods do not provide the formation of a cumulative effect in the body of a schoolchild in the development of physical activity at two physical education lessons per week with stage-by-stage change of adaptive potential and individual adjustment of physical loads in necessary cases (with an increase in the values ​​of the adaptive potential of the circulatory system by at least 0.25 points) led to a noticeable significant increase in physical qualities among students by the end of the academic year. The use of a predictive assessment of changes in the adaptive potential of the circulatory system in staged surveys made it possible to ensure a sustainable health-improving effect of two physical education lessons per week and significantly reduce (up to 50% during the school year) school absences due to illness by students compared to other classes.

The same step-by-step control made it possible to use non-traditional methods of conducting physical education lessons without fear of overworking of the body and overstrain of regulatory systems in students.

Studies have shown that the method of the adaptive potential of the circulatory system, with its high information content, is quite accessible in the work of a teacher, trainer and even high school students themselves and can be used to control the impact of physical activity on the student's body in order to optimize them, as well as to evaluate and predict development of physical overtraining, improving the health-improving orientation of physical education lessons and sports training.

Of great scientific interest are studies of the prognostic assessment of the functional capabilities of the body of athletes using the hardware-software complex "Varicard 1.2", which allows early detection of the processes of fatigue and overwork under the influence of training loads.

A significant advantage of the methods of prenosological diagnostics used in the studies is their wide versatile information content, ease of use in the management of the educational and training process.

ORGANIZATION OF THE SYSTEM OF PRENOSOLOGICAL DIAGNOSIS

prenosological diagnostics examination

Despite the practical absence of special medical standards for the metrology of measurement methods, and not medical equipment, there are a sufficient number of departmental guidance documents in the field of medical metrology that could be used as a scientific and practical basis for the development of state standards in this area. In particular, this applies not only to terminology, but also to the classification of prenosological conditions, as well as a number of methods for measuring indicators of the mental, physical, physiological, biochemical, immune and clinical-somatic statuses of the body, quantitative and qualitative characteristics of the individual health of the patient as a whole.

One of the important scientific and practical problems of the real functioning of the system of prenosological diagnostics is the choice of its organizational foundations suitable for use in the Russian healthcare system, which may include the following main elements:

general organization of prenosological dispensary examination;

outpatient examination of the patient;

specialized prenosological examination of healthy and practically healthy individuals, as well as patients with combined forms of the disease;

patient self-monitoring system.

The volume and nature of the methods of dispensary examination and its frequency depend on the conditions for its implementation: minimal and more frequent - in the self-monitoring system, wider and less frequent - in outpatient settings, and maximum and rare - in a hospital setting. Dispensary examination can be primary and secondary. Primary - includes a full scope of general clinical examination and specialized prenosological diagnostics. With repeated examinations, prenosological diagnostics can be carried out at least once every six months, and a general clinical examination - at least once a year. In addition to scheduled dispensary examinations, it is advisable to additionally conduct unscheduled ones, for example, in cases of deterioration in the patient's health or to monitor the effectiveness of ongoing preventive therapy. However, it is sufficient to apply a smaller volume of diagnostic examination, depending on the nature of the changes that have appeared (favorable or unfavorable), preferably using the methods of the patient's self-monitoring system.

An outpatient examination may include the following varieties:

primary general clinical examination;

specialized prenosological examination;

patient self-monitoring system;

patient medical training system.

The primary general clinical examination can be carried out on the basis of an outpatient or health-improving medical institution for the purpose of differential diagnosis and identification of the initial, latent, erased or subclinical form of the disease of various etiologies. It is carried out according to the type of planned dispensary examination and includes anamnesis, examination with a physical examination by various specialists (therapist, surgeon, neuropathologist, otolaryngologist, ophthalmologist, dermatologist, dentist), laboratory tests (clinical blood test: hemoglobin level, erythrocyte, leukocyte, leukocyte formula, erythrocyte sedimentation rate, sugar content; clinical analysis of urine: specific gravity, reaction, protein content, sugar, sediment microscopy; analysis of feces for eggs of worms and protozoa), as well as instrumental methods: anthropometry, large-frame X-ray fluorography or fluoroscopy of the chest ; electrocardiography in 12 standard leads at rest, measurement of blood pressure by methods generally accepted in clinical practice. Based on the results of the initial general clinical examination, the attending physician issues a conclusion on the development or suspicion of the occurrence of a prenosological form of a disease of the cardiovascular system and on the indications and timing of further specialized prenosological examination, which can be carried out on the basis of the same medical institution or another that can provide the full scope of this examination. For this step, the results of the initial general clinical examination can be used.

BIBLIOGRAPHY

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.Principles and methods of mass prenosological examinations using automated systems: Abstract of the thesis. doc. dis. Berseneva A.P. Kyiv, 1991. - 27 p.

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.Prenosological diagnostics in assessing the state of health // Valeology, diagnostics, means and practice of ensuring health. Baevsky R.M., Berseneva A.P. - St. Petersburg: Nauka, 1993, p. 147.

.Valeology and the problem of self-control of health in human ecology Baevsky R.M., Berseneva A.P., Maksimov A.L. - Magadan, 1996. - 52 p.

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PRENOSOLOGICAL DIAGNOSIS OF CHILD HEALTH: METHODOLOGY, CRITERIA, RESULTS

Mikhailova L. A.

(GoU VPO "Krasnoyarsk State Medical Academy of Roszdrav", rector - MD, prof. I.P. Artyukhov)

Summary. The methodological basis of the study is the energy approach using system analysis and elements of the theory of adaptation. A method for quantifying the level of health and the degree of tension of the actuators of the functional system of oxygen transport and consumption has been proposed and tested.

Key words, children, health, health level, health assessment method.

The problem of child health and optimal approaches to its assessment is still relevant and fundamental in the scientific and practical developments of many scientists involved in age-related physiology.

Deviations in the state of health, formed in adolescence, reduce the possibility of implementing the most important social and biological functions in adulthood. In this regard, the interest of society in the formation of health in childhood and adolescence is obvious. The literature provides information that the proportion of healthy children is no more than 10%. According to official statistics, the health status of children and adolescents living in the Russian Federation is deteriorating every year: somatic morbidity among adolescents is growing; more often

diseases of the endocrine system and eating disorders are diagnosed; diseases of the digestive system; musculoskeletal system. Growth, development and health of a child significantly depend both on endogenous factors, which include the degree of morphofunctional maturity of organs and systems, and on exogenous factors interacting with them.

(environmental) factors. The child population is the most sensitive contingent, quickly responding to any changes in the environment due to the incompleteness of growth and development processes.

The child's body is highly sensitive to the vast majority of weak physical, chemical and biological factors. At the same time, the issue of children's health, their ability to painlessly adapt to the ecological characteristics of living, the state of functional systems in the process of adaptation makes it possible to judge the possibilities of children's adaptation in extreme conditions and at the same time serves as the basis for understanding the development, course and outcomes of pathological processes.

The goal of our long-term research, begun in 1975 together with Professor Zh.Zh.Rapoport, is to develop informative methods for quantifying the level of physical (somatic) health of a teenager before the onset of initial signs of illness.

Materials and methods of research

The object of the study was children belonging to health groups I and II, i.e. who did not have chronic diseases and did not have acute respiratory infections in the last 3 months before the examination. The study involved 5129 people aged 7-11 years old, living at their place of birth in Krasnoyarsk, Zheleznogorsk, Norilsk, Khatanga settlement. Depending on the area of ​​residence (dormitory or industrial) and motor mode (normal - up to 10 thousand steps per day and increased - over 15 thousand steps per day), the children were divided into appropriate groups.

The research was carried out in autumn. The physical and sexual development of children was assessed using a standard set of anthropometric instruments that have passed metric verification and are widely used in scientific research. functional

The state of the oxygen transport and consumption system was assessed on the basis of data obtained using the Valenta+ hardware-software complex, the PA-5-01 polyanalyzer, the Model 036 photooxyhemometer, and the Type OSM-I Radiometer oximeter (Denmark). Standard tests of Rufier, Shalkov, clino-orthostatic test, forced breathing test, PWCno-test (standard specific power 1.5 W/kg of mass, excluding "negative" work) were carried out.

The received materials were processed using the application package for Windows-2000. According to the analysis using Pearson's test, it was found that the distribution of the studied values ​​corresponds to the normal one, which was the basis for using the Student's and Kolmogorov's tests to calculate the significance coefficients of differences between groups and pair correlation. Dispersion, cluster and factor analyzes, mathematical modeling were carried out.

Results and discussion

Methodology. The methodological basis of the

research is an energy approach using systems analysis and elements of adaptation theory. The energy approach is based on the following thesis: the normal functioning of the human body can only be carried out under conditions of a continuous and sufficient supply of oxygen. The efficiency of oxygen consumption is ensured by the integral function of many body systems involved in the transport and consumption of oxygen by tissues. The efficiency of energy consumption, metabolism and information flow reflects the degree of adaptive stress, compensatory shifts and the level of health in general. The functional system of oxygen transport and consumption (FSTPC) provides the body with oxygen. It is a dynamic, self-regulating organization, which, as an executive link, includes ventilation, blood

circulation, erythron, all tissues and cells of the body with their central and humoral regulation. If the first three links ("subsystems", or "executive mechanisms") ensure the fulfillment of the body's request for the required amount of oxygen, then the tissues and cells of the body, using O2 as an energy source, serve as a "comparison link" between needs and delivery.

A child's body can provide a high intensity of oxygen consumption, however, in a less economical way than an adult. According to numerous studies, including those conducted by our employees, in the process of growth and development of the child, the efficiency of the oxygen regime of the body increases, which is due to more perfect activity and regulation of respiration, blood circulation, and the erythron system. The only exception is the period of puberty, when the general age trend is temporarily disturbed. As the body develops, the natural rhythms of breathing and heart contractions decrease, and the power of the respiratory apparatus increases. Along with less efficiency, the oxygen regime in childhood is less stressed, since the conditions for extracting oxygen from the alveoli by the blood, and from the blood by the tissues, are better. In addition, the unused supply of oxygen in mixed venous blood is higher in children than in adults.

Evaluation of the efficiency of the FSTPC is primarily determined by the amount of oxygen brought in and consumed by the body, as well as the coefficient of oxygen utilization by tissues, which shows what proportion the tissues extract from the oxygen brought to them, and therefore, its value can be used to judge the additional reserves of the system.

As an integral indicator that characterizes the efficiency of the FSTPC actuators for adequate provision of tissues with oxygen, one can use such a parameter as the amount of blood from which 1 ml of oxygen is extracted -

hemodynamic equivalent, or oxygen transport efficiency factor. When calculating it, the value of the oxygen capacity of the blood, saturation of arterial blood with oxygen, reflecting the work of the external respiration system, minute volume of blood circulation, saturation of venous blood with oxygen, characterizing the level of metabolic processes occurring in tissues, is used. The use of the listed parameters of the oxygen regime of the body provides information on the state of the FSTPC actuators and the effectiveness of the work performed by the system to adequately provide tissues with oxygen.

Assessment of the degree of tension of the executive mechanisms of the FSTPC. The degree of intensity of the work of the constituent elements of the FSTPC can be determined using the efficiency factors described by us earlier. When calculating them, the mathematical apparatus of the extremal energy principle, developed for this functional system, was applied to the model of the conditional "norm". Taking into account the most important physiological parameters of the oxygen regime of the body in combination with data on FSTPC energy consumption makes it possible to give a more objective characterization of the degree of tension of the subsystems and, therefore, to better understand the mechanisms of adaptation in this functional system. These coefficients are calculated for each individual and when calculating them, the parameters of the FSTPC are used that are characteristic for this subject: saturation of arterial and venous blood with oxygen, IOC, BCC, PO2, as well as constants: energy consumption for the production and maintenance of the structural and functional integrity of the erythrocyte and energy consumption of the circulatory system to compensate for 10% perturbation with a duration of the order of the life span of erythrocytes, calculated theoretically.

The listed efficiency factors provide information about the load on the FSTPC actuators and the "adaptation price", allowing you to quantify the excess load on each of the

subsystems. According to their values, the child can be assigned to one of the groups: “healthy” (if the deviations do not exceed ± 10%), in a state of tension (with the deviation of the coefficients within ± 11^25%) and “sick” (with the deviation of the coefficients > ± 25%).

A method for assessing the level of physical health. The development of a simple and informative methodology for assessing the health of children makes it possible to diagnose the physical (somatic) health of a child before the initial signs of the disease appear. The method developed by us is also based on the energy approach. The proposed assessment of the physical health of children is based on anthropometric studies; measuring the leading parameters of the systems involved in providing the body with oxygen (external respiration and blood circulation), as well as the body's reserve capabilities to perform physical work and restore its activity level after it. Based on the data obtained, the following indicators are calculated:

Anthropometric indicator (AP = body weight / body length);

Ventilation index (VP = vital capacity/body weight);

Cardiac index (CI \u003d (BPs-BPd) / heart rate / body surface);

Specific working capacity (UR = dynamometry/body weight);

Reserve indicator (RP = recovery time of the pulse after

loads).

The use of the relative values ​​of each of the indicators makes it possible to adequately assess the individual characteristics of the child, and also unifies the developed method for assessing health. The final score for a given child is obtained by the arithmetic sum of the scores for each indicator, i.e. the health index (HMI) of a particular child is the sum of the following sum:

IUS \u003d AP + VP + SI + UR + RP.

In this case, the sign of the points in each column is taken into account. A child for each indicator can have a different number of points, which is determined by his level of health and the harmonious development and maturation of individual functional systems. Consequently, if the development of one of the systems lags behind the physiological standards, then the final index of the level of health will be lower, and the worse the reserves of the child's body, the fewer points he will eventually score.

According to a unified statistical approach, the intervals for the health level index were determined, which are presented in Table 1.

Table 1.

Determination of the components of the coefficients and the general level of health

Indicator Indicator interval and corresponding score *)

AP, g/cm less than 160 -2 161-200 -1 201-283 0 284-324 -1 more than 324 -2

VP, ml/kg less than 2 0 2 - 15 1 16 -45 2 45 -60 4 more than 60 5

SI, l/min/m2 more than 5.8 0 5.7 - 5.3 1 5.2 - 4.4 2 4.3 - 3.9 3 less than 3.9 4

SD, % less than 25 0 25 -32 1 33 -50 2 51 -59 3 more than 59 4

RP, min more than 5 -2 5 1 4 3 3 5 2 and less 7

Score 2 or less 3-5 6-10 11-13 14 or more

Health index Satisfactory Below average Average Above average High

*) - the first line - the interval of the indicator, the second - the score.

Calculation of the ILI for children living in different environmental conditions showed that the representatives of this group, who are constantly exposed to adverse environmental factors, have a slightly different distribution (Fig. 1). The maximum number of children from

area with a high technogenic load received an assessment of its health - "below average". This class accounted for 36% of the surveyed group. This increase was due to a decrease in the number of children whose health level was assessed as "average", "above average", "high". The maximum difference is observed between the compared groups of children with an "average" level of health - 11% (p<0,01).

Ш industrial area □ residential area

Fig.1. Distribution of children (share of the total number) from residential and industrial areas.

On the abscissa - IUS: 1 - satisfactory.; 2 - below average; 3 - medium; Grade 4 - above average; Grade 5 - high.

In the group of children with increased physical activity, there is an increase in the percentage with "average", "above average" and "high" levels of health compared to the group of children with normal physical activity (Table 2). In the group of children from an ecologically unfavorable area of ​​the city, there is a predominant redistribution of children into classes with levels of health "low" and "below average", compared with a group of children from an ecologically safe area.

Table 2.

Distribution by health levels of children living in an industrial city and being on different motor

Motor

Health level

Satisfactory below average average above average high

Ordinary (clean area) 2.9 30.7 38.5 19.2 8.7

Elevated (clean area) 2.9 17.4 40.6 24.6 14.5

Elevated (industrial area) 3.9 33.2 29.1 23.6 10.2

To automate calculations for assessing the level of a child's physical health, we have developed the Express Assessment of the Child's Individual Health program, written using Delphi visual programming tools and designed to work in the Windows operating environment.

Thus, based on the energy approach and system analysis, we have developed quantitative methods for assessing the level of a child's somatic health and the systems that form it. The obtained coefficients of efficiency and economy of the oxygen regime of the body allow us to quantify the degree of load on the systems that provide the body with oxygen, and to determine the "price of adaptation" to specific conditions (environmental, load). The developed index of physical health (IPH) and on its basis the software tool "Express assessment of the child's individual health" make it possible to give a qualitative and quantitative assessment of the level of health. These approaches can be widely used for screening examinations and detailed analysis of the health status of school staff.

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