"the place and role of the paramedic in the healthcare organization." Infection control. Introduction. Respiratory diseases in children

To provide high-quality medical care, it is necessary to ensure continuity of the diagnostic and treatment process at all stages of treatment. Here, a clear division of functions at each stage of medical care becomes important. The paramedic is the direct executor of medical prescriptions and must master the simplest resuscitation techniques. prehospital stage, provide emergency medical care in acute diseases and accidents. Paramedics work in the ambulance service, in clinical diagnostic laboratories and paramedic-obstetric stations (FAP), where they provide medical care to the rural population. A major role belongs to paramedics in the medical examination of the rural population. Its main goal is to implement measures aimed at preserving and strengthening the health of the population and preventing the development of diseases. To carry out general medical examination, personal registration of the entire population living in the service area of ​​the clinic, outpatient clinic and first-aid post is carried out.

The objectives of clinical examination are to identify persons with risk factors and patients with early stages diseases by conducting annual preventive examinations, active monitoring and improvement of patients with pathology with risk factors, creation of automated information systems and data banks on dispensary registration of the population.

The leading role in the medical examination of the population belongs to territorial clinics, and the central figure in its implementation is the local doctor or paramedic.

Stages of clinical examination:

Stage 1—registration of the population by district by conducting a census by a paramedic is carried out 2 times a year. At this stage, a survey of the population is also carried out in order to assess the state of health, detect risk factors, and early identify pathological conditions.

Stage 2 - dynamic observation of the person being examined is carried out differentiated by health group.

For patients of the 1st health group, health-improving and preventive actions aimed at preventing diseases, promoting health, improving working and living conditions, as well as promoting healthy image life.

Dynamic monitoring of persons classified as practically healthy is aimed at eliminating or reducing risk factors for the development of diseases, correcting hygienic behavior, increasing the compensatory capabilities and resistance of the body. Monitoring patients who have suffered acute diseases is aimed at preventing the development of complications and chronicity of the process. Patients with acute diseases that have a high risk of chronicity and development are subject to dispensary observation. severe complications: acute pneumonia, acute sore throat, acute glomerulonephritis and others.

The frequency and duration of observation depend on the nosological form, the nature of the process, possible consequences. For example, after acute tonsillitis, the duration of medical examination is 1 month, after acute pneumonia- 6 months.

Stage 3 - Assessing the effectiveness of clinical examination, analysis of the state of clinical work in healthcare organizations.

Analysis of dispensary work is carried out based on the calculation of three groups of indicators:

· characterizing the volume of dispensary work;

· quality of clinical examination;

· effectiveness of clinical examination.

FAP paramedics play a major role in carrying out health-improving activities, hygienic education of the rural population and promoting a healthy lifestyle. Every year, the district SES draws up a work plan to involve nursing staff in ongoing sanitary supervision, which is approved by the chief physician of the Central District Hospital and brought to the attention of all first-aid posts.

To correctly assess the level of well-being of a subject, paramedics are trained in the simplest laboratory tests, express methods and supply them with field express laboratories

The involvement of FAP paramedics in ongoing sanitary supervision has a positive effect on the quality of sanitary and health measures and helps improve sanitary condition objects.

Chronic tonsillitis is socially significant disease, due to its high prevalence among children aged 3 to 6 years (61%).

The most common ENT disease is tonsillitis (76%).

According to statistics, the incidence rate increased by almost 2.5 times by 2011, and diseases of the tonsils were and remain the most common pathology among ENT diseases.

One of the leading methods in the prevention of acute and chronic tonsillitis is timely medical examination of the population.

An analysis of literature sources on the research topic was carried out. Based on this, acute and chronic tonsillitis has been and remains the leading pathology among ENT diseases. The relevance of this topic is determined by statistical data and research results.

An analysis of statistical data was carried out. The disease mainly affects children aged 3 to 6 years, as well as persons adolescence 12-14 years old.

Ineffective implementation of measures aimed at preventing the disease, as well as timely treatment lead to many complications and disability among young and working-age people. The paramedic plays an important role in carrying out sanitary-educational, preventive and therapeutic measures.

STATE EDUCATIONAL INSTITUTION

SECONDARY VOCATIONAL EDUCATION

KASIMOVO MEDICAL SCHOOL

SPECIALTY 060101 “MEDICAL CARE”

GRADUATE QUALIFICATION WORK ON THE TOPIC:

"The role of the paramedic in the prevention of anemia in young and middle-aged children school age».

Performed:

student of group 5f2

Konkina Svetlana
Sergeevna

Kasimov 2008

INTRODUCTION.. 3

CHAPTER 1. ANEMIA.. 3

1.1. Iron-deficiency anemia. 3

1.1.1.Etiology.. 3

1.1.2.Pathogenesis. 3

1.1.3.Clinic.. 3

1.1.4.Treatment. 3

1.2. At 12 - deficiency anemia. 3

1.2.1.Etiology.. 3

1.2.2.Clinic.. 3

1.2.3. Pathogenesis. 3

1.2.4.Treatment. 3

CHAPTER 2. Analysis of the number of anemias in children of primary and secondary school age... 3

CHAPTER 3. ROLE OF THE PHYSICAL SHER IN THE PREVENTION OF ANEMIA IN CHILDREN... 3

3.1. Prevention and clinical observation for iron deficiency anemia 3

3.2. Clinical observation of B12-deficiency anemia. 3

CONCLUSION.. 3

REFERENCES USED... 3

INTRODUCTION

Many anemias in children, despite the increased interest of pediatricians in them, are still not well recognized, and pathogenetic methods of their treatment are poorly implemented in the wider world. clinical practice. Meanwhile, the study of this pathology is of great practical importance. Some forms of anemia pose an immediate threat to life or are inevitably associated with children's physical and sometimes mental mental development. Over the past 10 years in the field of hematology in connection with the introduction of biochemical, immunological, cytological, molecular genetic and physiological methods Research has made great progress. Thanks to the creation of a method for cloning hematopoietic cells in the spleen of irradiated mice, chromosome analysis, and bone marrow transplantation, the role of the stem cell as a fundamental unit of hematopoiesis has been proven. A major achievement is the fact that primary lesion stem cells for aplastic anemia. It has been proven that the reason hemolytic disease Newborns may have not only group or Rh incompatibility of the blood of mother and child, but also incompatibility with other erythrocyte antigens. The number of carriers of hemoglobin abnormalities and hereditary glucose-6-phosphate dehydrogenase deficiency in the world is enormous. Mutant variants of this enzyme have been identified. Among the Russian population there are such hereditary anomalies as heterozygous β-thalassemia, hemolytic anemia, caused by unstable hemoglobins, deficiencies of G-6-PD enzymes, pyruvate kinase, hexokinase, adenylate kinase, methemoglobin rectase in erythrocytes, etc. new data have been obtained on the structure of the erythrocyte membrane, their enzymes, the role of membrane lipids and proteins in changing the shape of erythrocytes, mechanisms for eliminating defective erythrocytes . In connection with the above, this topic seems very relevant.

Goal of the work– study of the incidence of anemia in children and the development of preventive measures to prevent them.

Job objectives:

· Consider theoretical basis this topic,

· Study educational and methodological literature concerning both the diseases themselves and their prevention.

· Analyze the incidence of anemia.

· Develop preventive measures for these diseases.

Object of study: children with iron deficiency anemia and B 12 deficiency anemia.

This work consists of three parts. The first part outlines the theoretical basis for the occurrence and complications of these anemias. The second part contains an analysis of the incidence and the dynamics of its development over the past three years. The third part provides recommendations for the prevention of these diseases.

When writing this work, regulatory documents in the field of health care, educational and methodological literature were used.

CHAPTER 1. ANEMIA.

IN childhood All types of anemia can arise or manifest, however, anemia associated with a deficiency of substances necessary for normal hematopoiesis, primarily iron, clearly predominates (up to 90%). At the same time, separate clinical forms Anemias usually develop as a result of various influences and have a complex pathogenesis. In our country, anemia occurs on average in 40% of children under 3 years of age, in 1/3 at puberty, and much less frequently in other age periods.

This is due to the high growth rate of a child in the first years of life and an adolescent, accompanied by a proportional increase in the number shaped elements and blood volume and high erythropoiesis activity.

The entire bone marrow of the child is involved in the process of hematopoiesis; the body constantly requires a large number of iron, complete protein, microelements, vitamins.

Therefore, even minor feeding disorders, infectious effects, use medicines, which inhibit bone marrow function, easily lead to anemia in children, especially in the second half of life, when neonatal iron reserves are depleted.

Long-term sideropenia causes deep tissue and organ changes, the development of hypoxia and disorders of cellular metabolism.

In the presence of anemia, the child’s growth slows down, its harmonious development is disrupted, intercurrent diseases are observed more often, foci of chronic infection are formed, and the course of other pathological processes is aggravated.

1.1. Iron-deficiency anemia

1.1.1.Etiology

The cause of iron deficiency is an imbalance in the direction of a predominance of iron consumption over intake, observed in various physiological conditions or diseases.

Increased consumption of iron, causing the development of hyposideropenia, is most often associated with blood loss or with its increased use in certain physiological conditions (pregnancy, period rapid growth). In adults, iron deficiency usually develops due to blood loss. Most often, constant small blood losses and chronic hidden bleeding (5 - 10 ml/day) lead to a negative iron balance. Sometimes iron deficiency can develop after a single massive loss of blood that exceeds the iron reserves in the body, as well as due to repeated significant bleeding, after which the iron reserves do not have time to recover.

Various types of blood loss leading to the development of posthemorrhagic iron deficiency anemia are distributed in frequency as follows: in the first place are uterine bleeding, then bleeding from the digestive canal. Rarely, sideropenia can develop after repeated nasal, pulmonary, renal, trauma bleeding, bleeding after tooth extraction and other types of blood loss. IN in some cases Iron deficiency, especially in women, can be caused by frequent blood donations from donors, therapeutic bloodletting for hypertension and erythremia.

There are iron deficiency anemias that develop as a result of bleeding into closed cavities with a lack of subsequent reutilization of iron (pulmonary hemosiderosis, ectopic endometriosis, glomic tumors).

According to statistics, 20 - 30% of women childbearing age Hidden iron deficiency is observed, and iron deficiency anemia is found in 8-10%. The main cause of hyposiderosis in women, in addition to pregnancy, is pathological menstruation and uterine bleeding. Polymenorrhea can cause a decrease in iron reserves in the body and the development of hidden iron deficiency, and then iron deficiency anemia. Uterine bleeding most increase the volume of blood loss in women and contribute to the occurrence of iron deficiency conditions. There is an opinion that uterine fibroids, even in the absence menstrual bleeding, can lead to the development of iron deficiency. But more often the cause of anemia with fibroids is increased blood loss.

The second most common factor causing the development of posthemorrhagic iron deficiency anemia is blood loss from the digestive canal, which is often hidden and difficult to diagnose. In men, this is generally the main cause of sideropenia. Such blood loss can be caused by diseases of the digestive system and diseases of other organs.

Iron imbalances may accompany repeated acute erosive or hemorrhagic esophagitis and gastritis, gastric ulcers and duodenum with repeated bleeding, chronic infectious and inflammatory diseases of the digestive canal. With giant hypertrophic gastritis (Menetrier's disease) and polypous gastritis, the mucous membrane is easily vulnerable and often bleeds. Common cause hidden, difficult to diagnose blood loss is a hiatal hernia, varicose veins veins of the esophagus and rectum with portal hypertension, hemorrhoids, diverticula of the esophagus, stomach, intestines, Meckel's duct, tumors. Pulmonary hemorrhages - rare reason development of iron deficiency. Iron deficiency can sometimes lead to bleeding from the kidneys and urinary tract. Hypernephroma is very often accompanied by hematuria.

In some cases, blood loss various localizations, which are the cause of iron deficiency anemia, are associated with hematological diseases (coagulopathies, thrombocytopenias and thrombocytopathies), as well as with vascular damage due to vasculitis, collagenosis, Rendu disease- Weber - Osler, hematomas.

Sometimes iron deficiency anemia, caused by blood loss, develops in newborns and infants. Children are much more sensitive to blood loss than adults. In newborns, blood loss may be a consequence of bleeding observed during placenta previa or its damage during cesarean section. Other difficult-to-diagnose causes of blood loss during the neonatal period and infancy: bleeding from the digestive canal during infectious diseases intestines, intussusception, from Meckel's diverticulum. Much less often, iron deficiency can occur when there is insufficient intake of iron into the body.

Iron deficiency of nutritional origin can develop in children and adults with insufficient iron content in the diet, which is observed with chronic malnutrition and starvation, with dietary restriction with therapeutic purpose, with monotonous food with a predominant content of fats and sugars. Children may experience insufficient iron intake from the mother's body as a result of iron deficiency anemia during pregnancy, premature birth, with multiple births and prematurity, premature ligation of the umbilical cord before the pulsation stops.

For a long time, the main cause of iron deficiency was considered to be the lack of hydrochloric acid in gastric juice. Accordingly, gastrogenic or achlorhydric iron deficiency anemia was distinguished. It has now been established that achilia can only have an additional significance in disrupting the absorption of iron in conditions of increased need for it in the body. Atrophic gastritis with achylia occurs due to iron deficiency caused by decreased enzyme activity and cellular respiration in the gastric mucosa.

Inflammatory, cicatricial or atrophic processes in the small intestine and resection of the small intestine can lead to impaired iron absorption.

There are a number physiological conditions, in which the need for iron increases sharply.

These include pregnancy and lactation, as well as periods of increased growth in children. During pregnancy, iron consumption increases sharply for the needs of the fetus and placenta, blood loss during childbirth and lactation.

The iron balance during this period is on the verge of deficiency, and various factors, reducing the intake or increasing the consumption of iron can lead to the development of iron deficiency anemia.

There are two periods in a child’s life when increased need in iron.

The first period is the first - second year of life, when the child grows rapidly.

The second period is the period of puberty, when rapid development of the body begins again; girls experience additional iron consumption due to menstrual bleeding.

Iron deficiency anemia sometimes, especially in infancy and old age, develops with infectious and inflammatory diseases, burns, tumors, due to impaired iron metabolism while its total amount is preserved.

1.1.2.Pathogenesis

Iron deficiency anemia is associated with physiological role iron in the body and its participation in the processes of tissue respiration. It is part of heme, a compound that can reversibly bind oxygen. Heme is the prosthetic part of the molecule hemoglobin and myoglobin, which binds oxygen, which is necessary for contractile processes in muscles. In addition, heme is integral part tissue oxidative enzymes - cytochromes, catalase and peroxidase. Ferritin and hemosiderin are of primary importance in the deposition of iron in the body. The transport of iron in the body is carried out by the protein transferrin (siderophilin).

The body can only to a small extent regulate the intake of iron from food and does not control its expenditure. With a negative balance of iron metabolism, iron is first consumed from the depot (latent iron deficiency), then tissue iron deficiency occurs, manifested by impaired enzymatic activity and respiratory function in tissues, and only later does iron deficiency anemia develop.

1.1.3.Clinic

Iron deficiency conditions depend on the degree of iron deficiency and the rate of its development and include signs of anemia and tissue iron deficiency (sideropenia). The phenomena of tissue iron deficiency are absent only in some iron deficiency anemias caused by impaired iron utilization, when the depots are overfilled with iron. Thus, iron deficiency anemia goes through two periods in its course: the period of hidden iron deficiency and the period of obvious anemia caused by iron deficiency. During the period of latent iron deficiency, many subjective complaints and clinical signs characteristic of iron deficiency anemia appear, only less pronounced. Patients note general weakness, malaise, decreased performance. Already during this period, distortion of taste, dryness and tingling of the tongue, difficulty swallowing with the sensation of a foreign body in the throat (Plummer-Vinson syndrome), palpitations, and shortness of breath may be observed.

An objective examination of patients reveals “minor symptoms of iron deficiency”: atrophy of the tongue papillae, cheilitis (“seizures”), dry skin and hair, brittle nails, burning and itching of the vulva. All these signs of impaired trophism of epithelial tissues are associated with tissue sideropenia and hypoxia.

Hidden iron deficiency may be the only sign of iron deficiency. Such cases include mildly expressed sideropenia, which develops over a long period of time in women of mature age due to repeat pregnancies, childbirth and abortion, in female donors, in persons of both sexes during periods of increased growth.

In most patients with continued iron deficiency after the depletion of its tissue reserves, iron deficiency anemia develops, which is a sign of severe iron deficiency in the body.

Feature changes various organs and systems in iron deficiency anemia are not so much a consequence of anemia as of tissue iron deficiency. Proof of this is the discrepancy between the severity clinical manifestations diseases and degrees of anemia and their appearance already in the stage of hidden iron deficiency.

Patients with iron deficiency anemia report general weakness, fatigue, difficulty concentrating, sometimes drowsiness. Headache after overwork and dizziness appear. Severe anemia may cause fainting. These complaints, as a rule, depend not on the degree of anemia, but on the duration of the disease and the age of the patients.

Iron deficiency anemia is characterized by changes in the skin, nails and hair. The skin is usually pale, sometimes with a slight greenish tint (chlorosis) and with an easy blush on the cheeks, it becomes dry, flabby, peels, and cracks easily form. Hair loses its shine, turns grey, thins, breaks easily, thins and turns gray early. Changes in nails are specific: they become thin, matte, flattened, easily peel and break, and striations appear. At pronounced changes the nails acquire a concave, spoon-shaped shape (koilonychia).

Patients with iron deficiency anemia experience muscle weakness, which is not observed in other types of anemia. It is classified as a manifestation of tissue sideropenia. Atrophic changes occur in the mucous membranes of the digestive canal, respiratory organs, and genital organs. Damage to the mucous membrane of the digestive canal - typical sign iron deficiency conditions. In this regard, a misconception arose that the primary link in the pathogenesis of iron deficiency anemia is damage to the stomach with the subsequent development of iron deficiency.

Most patients with iron deficiency anemia have decreased appetite. There is a need for sour, spicy, salty foods. In more severe cases Perversions of smell and taste (picachlorotica) are observed: eating chalk, lime, raw cereals, pogophagia (craving for eating ice). Signs of tissue sideropenia quickly disappear after taking iron supplements.

In 25% of cases there is glossitis and changes in the oral cavity. In patients they decrease taste sensations, tingling, burning and a feeling of fullness appear in the tongue, especially its tip. Upon examination, atrophic changes in the mucous membrane of the tongue are detected, sometimes cracks at the tip and along the edges, in more severe cases - areas of redness of irregular shape ("geographic tongue") and aphthous changes. The atrophic process also affects the mucous membrane of the lips and oral cavity. Cracks in the lips and jams in the corners of the mouth (cheilosis) and changes in tooth enamel appear.

The syndrome is characterized by sideropenic dysphagia (Plummer-Vinson syndrome), manifested by difficulty swallowing dry and solid food, a feeling of tickling and a sensation of the presence of a foreign body in the throat. Due to these manifestations, some patients take only liquid food. There are signs of changes in stomach function: belching, a feeling of heaviness in the stomach after eating, nausea. They are due to the presence atrophic gastritis and achylia, which are determined by morphological (gastrobiopsy of the mucous membrane) and functional (gastric secretion) studies. This disease occurs as a result of sideropenia, and then progresses to the development of atrophic forms.

Patients with iron deficiency anemia constantly experience shortness of breath, palpitations, chest pain, and swelling. The expansion of the borders of cardiac dullness to the left, anemic systolic murmur at the apex and pulmonary artery, "the sound of a top" on jugular vein, tachycardia and hypotension. The ECG reveals changes indicating a repolarization phase. Iron deficiency anemia with severe course in elderly patients can cause cardiovascular failure.

A manifestation of iron deficiency is sometimes fever; the temperature usually does not exceed 37.5 ° C and disappears after treatment with iron. Iron deficiency anemia has a chronic course with periodic exacerbations and remissions. In the absence of proper pathogenetic therapy, remissions are incomplete and are accompanied by constant tissue iron deficiency.

1.1.4.Treatment

Includes eliminating the causes of the disease, organizing correct mode day and a rational balanced diet, normalization of gastrointestinal secretion, as well as medicinal replenishment of existing iron deficiency and the use of drugs that help eliminate it. The mode is active, with sufficient time spent on fresh air. Young children are prescribed massage and gymnastics, older children are prescribed moderate sports activities aimed at improving absorption and utilization. food products, stimulate metabolic processes.

The diet is indicated depending on the severity of anemia: with mild and moderate degrees and a satisfactory appetite - a varied diet appropriate for the child’s age, including foods rich in iron, protein, vitamins, and microelements in the diet. In the first half of the year - an earlier introduction of grated apple, vegetable puree, egg yolk, oatmeal and buckwheat porridge, in the second - meat soufflé, liver puree. You can use homogenized canned vegetables (puree) by adding meat products. In severe anemia, usually accompanied by anorexia and dystrophy, the threshold of food tolerance is first determined, prescribing gradually increasing amounts breast milk or mixtures. The insufficient volume is replenished with juices, vegetable decoctions, in older children - mineral water. Upon reaching the required daily amount of food, gradually change it high-quality composition, enriching with substances necessary for hematopoiesis. Limit cereal products And cow's milk, since when they are consumed, insoluble iron phytates and phosphates are formed.

Pathogenetic therapy is carried out with iron drugs (ferroceron, resoferon, conferon, actiferrin, ferroplex, orferon) and vitamins. Iron is most often prescribed orally in the form of ferrous salts, mainly ferrous sulfate, which is absorbed and absorbed most completely. Iron chloride, lactate, ascorbate, gluconate and iron sucrose are also used. Medications made from iron salts in combination with organic substances (amino acids, malic, succinic, ascorbic, citric acids, sodium dioctyl sulfosuccinate, etc.), which in acidic environment stomach contribute to the formation of easily soluble complex iron compounds - chelates and its more complete absorption. It is recommended to take iron between feedings or 1 hour before meals, as some food ingredients can form insoluble compounds with it. The preparations are filled with fruit and vegetable juices, citrus juices are especially useful. For young children, average therapeutic dose is prescribed at the rate of 4 - 6 mg of elemental iron per 1 kg of body weight per day in 3 divided doses. Most drugs contain 20% elemental iron, so the calculated dose is usually increased by 5 times. The individual dose per course of treatment is calculated in milligrams using the following formula:

Fe = P x (78 - 0.35 x Hb ),

where P is body weight, kg; Hb - actual hemoglobin level in a child, g/l. The course of treatment is usually long, the full dose is prescribed until stable normal content hemoglobin, and over the next 2 - 4 months (up to 6 months in case of severe anemia in full-term and up to 2 years of life in premature ones) a prophylactic dose is given (1/2 treatment dose once a day) to accumulate iron in the depot and prevent relapses of the disease. In case of poor iron tolerance, treatment begins with small doses, gradually increasing them, and changing medications. The effectiveness of treatment is determined by an increase in hemoglobin (by 10 g/l, or 4 - 6 units per week), a decrease in microcytosis, a reticulocyte crisis on the 7th - 10th day of using iron supplements, an increase in the iron content in the serum to 17 µmol/l or more , and the transferrin saturation coefficient is up to 30%. Parenteral iron supplements are prescribed with caution in cases of severe anemia, intolerance to iron supplements when taken orally, peptic ulcer, malabsorption, lack of effect from enteral use, since children may develop hemosiderosis. The course dose is calculated using the following formulas:

Fe (mg) = (body weight (kg) x ) / 20

Or Fe (mg) = Рх (78 - 0.35 Hb ),

where Fe (µg/l) is the iron content in the patient’s serum; Hb - hemoglobin level peripheral blood. The maximum daily single dose of parenteral iron preparations for body weight up to 5 kg is 0.5 ml, up to 10 kg - 1 ml, after 1 year - 2 ml, for adults - 4 ml. The most commonly used is iron sucrose; treatment with ferbitol (iron sorbitol), fercoven (2% iron sucrose with cobalt gluconate in a carbohydrate solution) is effective. Oral iron supplements are prescribed simultaneously with digestive enzymes to normalize acidity internal environment, its stabilization. For better digestion and absorption, it is prescribed hydrochloric acid with pepsin, pancreatin with calcium, festal. In addition, large doses are indicated ascorbic acid and other vitamins in age-appropriate dosages orally. Transfusion of whole blood and red blood cells is carried out only for vital indications (hemoglobin content below 60 g/l), since it is only a short time creates the illusion of recovery. IN Lately It has been shown that blood transfusions suppress the activity of synthesis of hemoglobin in normoblasts, and in some cases even cause a reduction in erythropoiesis.

1.2. B 12 - deficiency anemia

This type of deficiency anemia was first described by Addison in 1849, and then in 1872 by Birmer, who called it “progressive pernicious” (fatal, malignant) anemia. Causes, causing development anemia of this type can be divided into two groups:

· insufficient intake of vitamin B 12 into the body from food

Impaired absorption of vitamin B 12 in the body

Megaloblastic anemia occurs due to insufficient intake of vitamins B12 and/or folic acid. A deficiency of these vitamins leads to disruption of DNA and RNA synthesis in cells, which causes disturbances in the maturation and saturation of red blood cells with hemoglobin. Large cells - megaloblasts - appear in the bone marrow, and large erythrocytes (megalocytes and macrocytes) appear in the peripheral blood. The process of blood destruction prevails over hematopoiesis. Defective red blood cells are less stable than normal ones and die faster.

1.2.2.Clinic

In the bone marrow, megaloblasts with a diameter of more than (15 microns), as well as megalocaryocytes, are found in greater or lesser numbers. Megaloblasts are characterized by desynchronization of nuclear and cytoplasmic maturation. Fast education hemoglobin (already in megaloblasts) is combined with slow nuclear differentiation. These changes in erythron cells are combined with impaired differentiation of other cells of the myeloid series: megakaryoblasts, myelocytes, metamyelocytes, rod and segmented leukocytes are also increased in size, their nuclei have a more delicate chromatin structure than normal. In the peripheral blood, the number of red blood cells is significantly reduced, sometimes down to 0.7 - 0.8 x 10 12 /l. They big size- up to 10 - 12 microns, often oval shape, without central enlightenment. As a rule, megaloblasts are found. In many red blood cells, remnants of nuclear substance (Jolly bodies) and nucleolemma (Cabot rings) are found. Anisocytosis (macro- and megalocytes predominate), poikilocytosis, polychromatophilia, basophilic punctuation of the cytoplasm of erythrocytes are characteristic. Red blood cells are oversaturated with hemoglobin. The color index is usually more than 1.1 - 1.3. However, the total hemoglobin content in the blood is significantly reduced due to a significant decrease in the number of red blood cells. The number of reticulocytes is usually low, less often - normal. As a rule, leukopenia (due to neutrophils) is observed, combined with the presence of polysegmented giant neutrophils, as well as thrombocytopenia. Due to increased hemolysis of red blood cells (mainly in the bone marrow), bilirubinemia develops. At 12 - deficiency anemia is usually accompanied by other signs of vitamin deficiency: changes in gastrointestinal tract connections with impaired division (signs of atypical mitosis are revealed) and cell maturation (presence of megalocytes), especially in the mucous membrane. There is glossitis, the formation of a “polished” tongue (due to atrophy of its papillae); stomatitis; gastroenterocolitis, which aggravates the course of anemia due to impaired absorption of vitamin B 12; neurological syndrome that develops due to changes in neurons. These deviations are mainly a consequence of disturbances in the metabolism of higher fatty acids. The latter is due to the fact that the other metabolic active form vitamin B12 - 5 - deoxyadenosylcobalamin (in addition to methylcobalamin) regulates the synthesis of fatty acids, catalyzing the formation succinic acid from methyl malonic. Deficiency of 5-deoxyadenosylcobalamin causes disruption of myelin formation and has a direct damaging effect on neurons of the brain and spinal cord(especially its posterior and lateral columns), which is manifested by mental disorders (delusions, hallucinations), signs of funicular myelosis (shaky gait, paresthesia, pain, numbness of the limbs, etc.).

This type of megaloblastic anemia is a violation of the formation of compounds involved in DNA biosynthesis, in particular thymidine phosphate, uridine phosphate, orotic acid. As a result of this, the structure of DNA and the information contained in it for the synthesis of polypeptides are disrupted, which leads to the transformation of the normoblastic type of erythropoiesis into megaloblastic. The manifestations of these anemias are mostly the same as with vitamin B12 deficiency anemia.

The development of megaloblastic anemia is possible not only due to a deficiency of vitamin B 12 and (or) folic acid, but also as a result of impaired synthesis of purine or pyrimidine bases necessary for the synthesis of nucleic acids. The cause of these anemias is usually an inherited (usually recessive) disruption of the activity of enzymes necessary for the synthesis of folic, orotic, adenylic, guanylic and, possibly, some other acids.

1.2.3.Pathogenesis

A deficiency of vitamin B 12 in the body of any origin causes a disruption in the synthesis of nucleic acids in erythrokaryocytes, as well as the metabolism of fatty acids in them and the cells of other tissues. Vitamin B 12 has two coenzyme forms: methylcobalamin and 5 - deoxyadenosylcobalamin. Methylcobalamin is involved in ensuring normal erythroblastic hematopoiesis. Tetrahydrofolic acid, formed with the participation of methylcobalamin, is necessary for the synthesis of 5, 10 - methyltetrahydrofolic acid (coenzyme form of folic acid), which is involved in the formation of thymidine phosphate. The latter is included in the DNA of erythrokaryocytes and other rapidly dividing cells. The lack of thymidine phosphate, combined with a violation of the incorporation of uridine and orotic acid into DNA, causes a disruption in the synthesis and structure of DNA, which leads to a disorder in the processes of division and maturation of red blood cells. They increase in size (megaloblasts and megalocytes), and therefore resemble erythrokaryocytes and megalocytes in the embryo. However, this similarity is only external. The red blood cells of the embryo fully provide the oxygen transport function. Erythrocytes, formed under conditions of vitamin B12 deficiency, are the result of pathological megaloblastic erythropoiesis. They are characterized by low mitotic activity and low resistance, short duration life. Most of them (up to 50%, normally about 20%) are destroyed in the bone marrow. In this regard, the number of red blood cells in the peripheral blood decreases significantly.

1.2.4.Treatment

A set of therapeutic measures for B 12 deficiency anemia should be carried out taking into account the etiology, severity of anemia and the presence neurological disorders. When treating, you should focus on the following points:

· an indispensable condition for the treatment of B 12 - deficiency anemia with helminthic infestation is deworming (to expel the broad tapeworm, fenasal is prescribed according to a certain scheme or male fern extract).

· for organic intestinal diseases and diarrhea, enzyme preparations (panzinorm, festal, pancreatin), as well as fixing agents (calcium carbonate in combination with dermatol) should be used.

· normalization of intestinal flora is achieved by taking enzyme preparations(panzinorm, festal, pancreatin), as well as the selection of a diet that helps eliminate the syndromes of putrefactive or fermentative dyspepsia.

· balanced diet with a sufficient content of vitamins, protein, and an unconditional prohibition of alcohol - an indispensable condition for the treatment of B 12 and folate deficiency anemia.

· pathogenetic therapy carried out using parenteral administration vitamin B12 (cyanocobalamin), as well as normalization of altered parameters of central hemodynamics and neutralization of antibodies to gastromucoprotein ("intrinsic factor") or the gastromucoprotein + vitamin B12 complex (corticosteroid therapy).

Blood transfusions are carried out only when there is a significant decrease in hemoglobin and the manifestation of symptoms comatose state. It is recommended to administer 250 - 300 ml of red blood cells (5 - 6 transfusions).

CHAPTER 2. Analysis of the number of anemias in children of primary and secondary school age.

In the period from 2005 to 2007, 53 cases of anemia in children of primary and secondary school age were registered in the city of Kasimov and Kasimovsky district.

Table 1

Statistical data on the incidence of anemia in Kasimov and Kasimovsky district among children for 2005 -2007

Diagram 1

table 2

The ratio of the incidence of iron deficiency B12-deficiency anemia among children for 2005 – 2007.

Diagram 2

The ratio of the incidence of iron deficiency and B 12 deficiency anemia among children for 2005 – 2007.

From this material it is clearly seen that the incidence of anemia in children of primary and secondary school age is growing every year. This is due to parents' lack of awareness about the correct rational nutrition child and their late admission to medical institutions, and also with unfavorable conditions both the environmental and social environment. Data also show that despite the increase in incidence, the incidence rate of iron deficiency anemia is higher than B 12 deficiency anemia, this is due to the characteristics environment the area in which the population lives.

CHAPTER 3. ROLE OF THE PHYSICAL SHER IN THE PREVENTION OF ANEMIA IN CHILDREN

3.1. Prevention and follow-up for iron deficiency anemia

Primary prevention consists of consuming foods containing a lot of iron (meat, liver, cheeses, cottage cheese, buckwheat and wheat cereal, wheat bran, soy, egg yolk, dried apricots, prunes, dried rose hips). It is carried out among people at risk (for example, those who have undergone operations on the gastrointestinal tract, with malabsorption syndrome, regular donors, pregnant women, women with polymenorrhea).

Secondary prevention indicated after completion of treatment for iron deficiency anemia. After normalization of Hb content (especially if iron preparations are poorly tolerated), the therapeutic dose is reduced to a prophylactic dose (30-60 mg of ionized ferrous iron per day). If iron loss continues (eg, heavy menstruation, permanent red blood cell donation) prophylactic appointment Iron supplementation is carried out for 6 months or more after normalization of Hb levels in the blood. Monitoring of Hb levels in the blood is carried out monthly for 6 months after normalization of Hb levels and concentrations. serum iron. Then control tests are carried out once a year (in the absence of clinical signs anemia).

Prevention of iron deficiency anemia comes down to good nutrition with the consumption of animal proteins, meat, fish, control over possible diseases, which are mentioned above. An indicator of the welfare of the state is the causes of iron deficiency anemia: in the rich it is post-hemorrhagic in nature, and in the poor it is alimentary.

3.2. Clinical observation of B 12 deficiency anemia

Dispensary observation is lifelong. Maintenance therapy (relapse prevention) is carried out under the control of Hb level and red blood cell content; for this purpose, cyanocobalamin is used in courses of 25 injections once a year (during remission) throughout life. Once every six months, an endoscopic examination of the stomach with a biopsy is required to exclude stomach cancer.

Proper balanced nutrition of the child plays an important role in the prevention of anemia. The paramedic must explain to the child’s parents what foods should be given to him at his age, and that the foods must contain iron, since a lack of iron leads to the development of anemia. The paramedic must conduct sanitary and educational work to prevent anemia. If anemia is suspected, the paramedic should refer the child to the pediatrician so that he can begin timely treatment of anemia. This means that, in addition to sanitary and educational work, it plays a huge role early diagnosis diseases.

CONCLUSION

Anemia (anemia) - a decrease in the number of red blood cells and (or) a decrease in the hemoglobin content per unit volume of blood. Anemia can be like independent disease, and a syndrome accompanying the course of another pathological process.

With anemia, not only quantitative, but also qualitative changes in red blood cells are observed: their size (anisocytosis), shape (poikilocytosis), color (hypo- and hyperchromia, polychromatophilia).

The classification of anemia is complex. It is based on the distribution of anemia into three groups, according to the causes of occurrence and mechanisms of development of the disease: anemia due to blood loss ( posthemorrhagic anemia); anemia due to disturbances in the formation of hemoglobin or hematopoietic processes; anemia caused by increased breakdown of red blood cells in the body (hemolytic).

The statistical data clearly shows that the incidence of anemia in children of primary and secondary school age is growing every year. This is due to the lack of awareness of parents about the correct balanced nutrition of the child and their late presentation to medical institutions, as well as unfavorable conditions of both the environmental and social environment. Data also show that despite the increase in incidence, the incidence rate of iron deficiency anemia is higher than B 12 deficiency anemia, this is due to the environmental characteristics of the area in which the population lives.

The role of the paramedic is to conduct health education to prevent anemia in children. If anemia is suspected, the paramedic should refer the child to the pediatrician so that he can begin timely treatment of anemia. This means that in addition to sanitary education work, early diagnosis of the disease plays a huge role.

REFERENCES

1. Anemia in children: diagnosis and treatment. Practical guide for doctors /Ed. A. G. Rumyantseva, Yu. N. Tokareva. M: MAKS-Press, 2000.

2. Volkova S. Anemia and other blood diseases. Prevention and treatment methods. Publisher: Tsentrpoligraf. 2005 – 162 p.

3. Gogin E. Protocol for the management of patients. "Iron-deficiency anemia". Publisher: Newdiamed. 2005 – 76 p.

4. Ivanov V. Iron deficiency anemia of pregnant women. Tutorial. Ed. N-L. 2002 – 16 p.

5. Kazyukova T.V., Kalashnikova G.V., Fallukh A., et al. New opportunities for ferrotherapy of iron deficiency anemia// Clinical pharmacology and therapy. 2000. No. 9 (2). pp. 88-92.

6. Kalinicheva V. N. Anemia in children. M.: Medicine, 1983.

7. Kalmanova V.P. Indicators of erythropoietic activity and iron metabolism in hemolytic disease of the fetus and newborn and intrauterine erythrocyte transfusions: Dis... cand. honey. Sci. M., 2000.

8. Korovina N. A., Zaplatnikov A. L., Zakharova I. N. Iron deficiency anemia in children. M., 1999.

9. Miroshnikova K. Anemia. Treatment folk remedies. Publisher: FEIX. 2007 – 256 p.

10. Mikhailova G. Diseases of children from 7 to 17 years old. Gastritis, anemia, flu, appendicitis, vegetative-vascular dystonia, neurosis, etc. Ed.: ALL. 2005 – 128 p.

11. Ellard K. Anemia. Causes and treatment. Publisher: Norint. 2002 – 64 p.

GAPOU RB Ufa Medical College

Course work
PM. 04 Preventive activities
MDK. 04.01 Disease prevention and sanitary
hygienic education of the population
“The role of the paramedic in the prevention of diabetes mellitus”

Student Alekseeva A.M.
Evaluation of the completion and defense of course work _____________
Head Galimova M.R.
October 25, 2014
Ufa, 2014

CONTENT
Introduction………………………………………………………………………………3
Chapter I. Clinical description of diabetes mellitus as one of the most common diseases in the world.
1.1 General information about diabetes mellitus……………………………………………………........5
1.2 Classification of diabetes mellitus…………………………………………..6
1.3. Etiology and pathogenesis……..……………………………………………………………...9 1.4. Predisposing factors in the development of diabetes…………...11
1.5. Clinical picture of diabetes mellitus…………………………………..13
1.6 Diagnosis and treatment of diabetes………………………………...16
Chapter II. The role of the paramedic in the prevention of diabetes mellitus.
2.1 Meal planning for type 2 diabetes mellitus……………….17 2.2 Physical activity for diabetes mellitus…………………………………20
2.3 Diet therapy………………………………………………………………...22
Conclusion………………………………………………………………………………….....25
Literature………………………………………………………………………………......26
Appendix 1………………………………………………………………………………..27
Appendix 2………………………………………………………………………………......27
Appendix 3………………………………………………………………………………..29

INTRODUCTION
Relevance of the topic:
Diabetes mellitus is an urgent medical and social problem of our time, which, in terms of prevalence and incidence, has all the features of an epidemic covering most economically developed countries of the world. Currently, according to WHO, there are already more than 175 million patients in the world, their number is growing steadily and will reach 300 million by 2025. Russia is no exception in this regard. The problem of combating diabetes mellitus is given due attention by the Ministries of Health of all countries. In many countries of the world, including Russia, appropriate programs have been developed that provide for early detection of diabetes mellitus, treatment and prevention of vascular complications, which are the cause of early disability and high mortality observed with this disease.
The fight against diabetes mellitus and its complications depends not only on the coordinated work of all parts of the specialized medical service, but also on the patients themselves, without whose participation the targets for compensating carbohydrate metabolism in diabetes mellitus cannot be achieved, and its violation causes the development of vascular complications . It is well known that the problem can be successfully solved only when everything is known about the causes, stages and mechanisms of its appearance and development.
The progress of clinical medicine in the second half of the 21st century has made it possible to significantly better understand the causes of diabetes mellitus and its complications, as well as to significantly alleviate the suffering of patients. Thanks to the introduction of non-invasive methods of outpatient determination of glycemic levels into everyday practice, it was possible to achieve its careful control; at the same time, progress in the study of hypoglycemia and patient education have reduced the risk of its development. The development of syringe pens (semi-automatic insulin injectors) and later “insulin pumps” (devices for continuous subcutaneous administration of insulin) contributed to a significant improvement in the quality of life of patients forced to bear the heavy burden of diabetes throughout their lives.

Purpose of the study:
Studying the role of the paramedic in the prevention of diabetes mellitus.
Tasks:
To achieve this research goal it is necessary to study:
- etiology and predisposing factors of diabetes mellitus;
- clinical picture and features...

Chapter 14. The role of paramedical workers in the organization of medical prevention

Chapter 14. The role of paramedical workers in the organization of medical prevention

14.1. RISK FACTORS

The problem of studying risk factors for diseases and developing effective measures for their prevention should become priorities in the activities of the healthcare system and society as a whole.

Lifestyle and environmental risk factors play a large role in the formation of diseases. Analysis of data on risk factors for the population shows that among people aged 25 to 65 years, the following risk factors are most widespread:

Smoking;

Unbalanced diet;

Increased levels of cholesterol in the blood (hypercholesterolemia);

Excessive consumption of table salt;

Low physical activity;

Excess body weight;

Alcohol abuse;

High blood pressure;

Diabetes;

Psychological factors.

Smoking

Smoking is a risk factor that contributes primarily to cardiovascular diseases and cancer. It is now generally accepted that the eradication of smoking is one of the most effective measures to improve the health of the population. Many countries (USA, Finland, Iceland, Northern Ireland, Canada and others) have launched national campaigns aimed at combating smoking, which has led to a significant reduction in the number of smokers and improved public health.

One study conducted in the USA showed that the number of cases of cardiovascular diseases in people aged 45-54 years when smoking up to 20 cigarettes per day, compared with non-smokers, increases by 1.5 times, and when smoking more than 20 cigarettes - 2 times. Similar data were obtained when analyzing mortality. Thus, compared with non-smokers, people who smoke more than 20 cigarettes per day have a more than 2-fold higher risk of death from all causes.

In recent years, the number of women and girls who smoke has increased significantly. At the same time, smoking is more harmful for women than for men for a number of reasons. Being, like men, a risk factor for the development of cardiovascular, cancer and other diseases, smoking confronts them with a number of purely female problems. Thus, the risk of cardiovascular disease is especially high in women who smoke and take contraceptives. Smoking has a detrimental effect on pregnancy:

In women who smoke during pregnancy, fetal growth slows down, and the child’s body weight at birth is on average 200 g less than in children of non-smoking women;

Smoking during pregnancy increases the risk of congenital diseases in children and the risk of perinatal mortality;

Maternal smoking has a negative effect on the fetus by increasing the heart rate and slowing breathing;

Women who smoke are more likely to have spontaneous abortion and premature birth.

Thus, the fight against smoking, as the prevention of many diseases, should be given an important place. Careful scientific analysis shows that in the fight against cardiovascular disease alone, 50% of the success can be attributed to a reduction in the number of smokers among the population.

Unbalanced diet

Proper, balanced nutrition serves as the basis for the prevention of many diseases. Basic principles of rational nutrition:

Energy balance of the diet (correspondence of energy consumption to energy consumption);

Balance of the diet according to the main components (proteins, fats, carbohydrates, microelements, vitamins);

Compliance with food intake.

Excessive nutrition poses a particular danger to the spread of many socially significant chronic diseases. It contributes to the occurrence of diseases of the cardiovascular system, gastrointestinal tract, bronchopulmonary system, diseases of the endocrine system and metabolic disorders, musculoskeletal system, malignant neoplasms, etc. Conversely, there is evidence that increasing the consumption of vegetables and fiber, as well as Reducing fat intake helps prevent certain types of cancer. Excessive nutrition additionally leads to the emergence of such risk factors as high cholesterol in the blood (hypercholesterolemia), excess body weight, and excessive consumption of table salt.

Increased levels of cholesterol in the blood (hypercholesterolemia)

Cholesterol belongs to the group of fats; it is necessary for the normal functioning of the body, but its high level in the blood contributes to the development of atherosclerosis. The level of cholesterol in the blood depends mainly on the composition of food, although the genetically determined ability of the body to synthesize cholesterol also has an undoubted influence. There is usually a clear relationship between saturated fat intake and blood cholesterol levels. A change in diet is also accompanied by a change in blood cholesterol levels. In economically developed countries, more than 15% of the population have elevated blood lipids, and in some countries this figure is twice as high. Currently, a large amount of indisputable evidence has accumulated regarding the relationship between elevated blood cholesterol levels and the risk of developing cardiovascular diseases.

Excessive consumption of table salt

Excessive consumption of table salt can cause arterial hypertension. People who consume at least 5-6 g of salt per day experience an increase in blood pressure with age. Currently, in many countries, people consume salt in quantities that significantly exceed their physiological needs. Limiting salt intake is accompanied by a decrease in blood pressure. Thus, for the primary prevention of hypertension, it is necessary to limit the content in the diet.

salt intake up to 5 g per day, while simultaneously increasing the proportion of foods rich in potassium (tomatoes, bananas, grapefruits, oranges, potatoes and others), which reduce the effect of salt in increasing blood pressure.

Low physical activity

In economically developed countries, every second adult lives a sedentary lifestyle, and every day this number grows even more, especially among older people. This lifestyle leads to obesity and metabolic disorders, which, in turn, leads to an increase in the number of socially significant diseases. The influence of physical activity on the incidence and outcome of cardiovascular diseases has been scientifically proven. Physical activity has an inhibitory effect on the development of atherosclerosis.

Low physical activity combined with poor diet can lead to overweight. According to special studies, from 10 to 30% of the population of economically developed countries aged 25-65 years are obese. Excessive fat deposition leads to the development of risk factors for cardiac diseases - high blood pressure, lipid metabolism disorders, insulin-dependent diabetes, etc. There is reliable evidence that obesity causes changes in respiratory and kidney function, leads to menstrual irregularities, osteoarthritis of the lower extremities, and increases risk of developing cholelithiasis, gout. Obesity is currently becoming an epidemic in both developed and developing countries.

Reducing excess body weight and maintaining it at a normal level is a rather difficult task, but quite solvable. Controlling the quantity, composition of food and physical activity helps reduce body weight. Maintaining normal body weight is ensured by the balance of calories entering the body and utilized. Physical activity helps burn calories. It is recommended to reduce body weight gradually, avoiding exotic diets, as they usually bring only temporary success. Nutrition should be balanced, low-calorie food. However, in general, food should be varied, familiar and accessible, and eating should be enjoyable.

Alcohol abuse

This is one of the most pressing health problems in most countries of the world. Alcohol abuse can cause the following serious problems for the drinker:

Weakening of self-control as a result of acute alcohol intoxication, leading to violation of law and order, accidents, etc.;

Poisoning with alcohol and its substitutes;

The emergence of serious consequences of long-term alcohol consumption (risk of a number of socially significant diseases, decreased mental abilities, premature death).

In Russia, more than 25 thousand people die annually from alcohol poisoning. Acute and chronic diseases caused by excessive alcohol consumption have been widely described. Mortality from liver cirrhosis has increased in many countries in recent decades, and there is strong evidence that alcohol increases blood pressure. This defect is the leading cause of death from accidents and injuries. Alcohol abuse also causes social problems, including crime, violence, family breakdown, educational failure, problems at work, suicide, etc. Problems associated with alcohol abuse affect not only the drinkers themselves, but also their families, those around them, and society.

Special studies show that the economic losses incurred due to alcohol-related problems range from 0.5 to 3.0% of the gross national product.

High blood pressure

Approximately every fifth person living in economically developed countries has high blood pressure, but most hypertensive people do not control their condition. Doctors at the American Heart Association call hypertension "the silent and mysterious killer." The danger of arterial hypertension is that this disease is asymptomatic in many patients, and they feel like healthy people. In medicine there is even such a thing as the “law of halves.” It means that of all people with arterial hypertension, ½ do not know about their disease, and of those who know, only ½ are treated, and of those who are treated, only ½ are treated effectively.

A prolonged increase in blood pressure has a negative effect on many organs and systems of the human body, but the heart, brain, kidneys, and eyes suffer the most. Arterial hypertension is one of the main risk factors for coronary heart disease; it increases the risk of death from diseases caused by atherosclerosis. Prevention and treatment of hypertension should become the main part of a set of measures aimed at combating risk factors for cardiovascular diseases (smoking, hypercholesterolemia, physical inactivity, excess body weight, etc.).

Diabetes

This serious disease, in turn, acts as a powerful risk factor for cardiovascular diseases and other serious diseases that lead to disability. Hereditary predisposition plays an important role in the development of diabetes mellitus, so people who have diabetes mellitus in their family should regularly check their blood sugar levels. Patients with diabetes should try to get rid of other risk factors for non-communicable diseases, such as excess body weight, physical inactivity, which will contribute to a milder course of the disease. In this case, quitting smoking, normalizing blood pressure, and eating a balanced diet become especially important. Correct and timely treatment of the underlying disease will prevent the development of other concomitant diseases. Most countries in the world have special programs aimed at combating this serious disease.

Psychological factors

Recently, there has been an increasing role of psychological factors in the development of cardiovascular and other diseases. The role of stress, fatigue at work, feelings of fear, hostility, and social insecurity in the development of cardiovascular diseases has been proven.

Each of the listed factors in itself has a significant impact on the development and outcome of many diseases, and their combined effect increases the risk of developing pathology many times over. To prevent this, it is necessary to develop and implement a set of government measures to prevent diseases, reduce, and where possible, eliminate risk factors that contribute to their occurrence.

The fundamentals of the legislation of the Russian Federation on protecting the health of citizens establishes the priority of preventive measures in strengthening and protecting the health of the population. Disease prevention is the main principle of domestic healthcare.

14.2. TYPES OF PREVENTIVE MEASURES

A set of preventive measures implemented through the healthcare system is called medical prevention. Medical prevention in relation to the population can be individual, group and population (mass). Individual prevention- this is the implementation of preventive measures with individual individuals. Group- with groups of people with similar symptoms and risk factors. Population covers large groups of the population (population) or the population as a whole.

In addition, a distinction is made between primary, secondary and tertiary prevention or rehabilitation.

Primary prevention is a set of medical and non-medical measures aimed at preventing the occurrence of certain deviations in the state of health and diseases.

Primary prevention includes the following set of measures:

Measures to reduce the impact of harmful environmental factors on the human body (improving the quality of atmospheric air, drinking water, soil, structure and quality of nutrition, working, living and recreational conditions, reducing the level of psychosocial stress and other factors that negatively affect the quality of life);

Measures to promote a healthy lifestyle;

Measures to prevent occupational diseases and injuries, accidents, as well as deaths in working age;

Conducting immunoprophylaxis among various population groups.

Secondary prevention is a complex of medical, social, sanitary-hygienic, psychological and other measures aimed at the early detection of diseases, as well as the prevention of their exacerbations, complications and chronicity.

Secondary prevention includes:

Targeted sanitary and hygienic training of patients and their family members in knowledge and skills related to a specific disease (organization of health schools for patients suffering from bronchial asthma, diabetes, hypertension, etc.);

Conducting medical examinations to identify diseases in the early stages of development;

Conducting courses of preventive (anti-relapse) treatment.

Tertiary prevention, or rehabilitation,- this is a complex of medical, psychological, pedagogical, social measures aimed at eliminating or compensating for life limitations and lost functions, with the goal of restoring the patient’s social and professional status as fully as possible. This is achieved by developing a network of restorative medicine and rehabilitation centers, as well as sanatorium and resort institutions.

One of the most important components of primary prevention is formation of a healthy lifestyle(HLS), which includes favorable living conditions for a person, the level of his culture and hygienic skills, which allow him to maintain and improve health and maintain an optimal quality of life.

An important role in the formation of a healthy lifestyle belongs to its propaganda, the purpose of which is the formation of hygienic behavior of the population, based on scientifically based sanitary and hygienic standards aimed at preserving and strengthening health, ensuring a high level of working capacity, and achieving active longevity.

The most important areas of healthy lifestyle promotion should be considered:

Promotion of factors that contribute to the preservation of health: personal hygiene, occupational hygiene, rest, nutrition, physical education, sexual hygiene, medical and social activity, environmental hygiene, etc.;

Promotion of measures to prevent risk factors that adversely affect health: excess food consumption with insufficient physical activity, alcohol abuse, drug use, tobacco smoking, observance of certain ethnic rituals and habits, etc.

Various forms of propaganda are used to promote a healthy lifestyle (Fig. 14.1).

Rice. 14.1. Forms of promoting a healthy lifestyle

The primary divisions of the healthy lifestyle formation service include prevention departments (offices). They are organized as part of territorial clinics, outpatient departments of central district (city) hospitals, and dispensaries. By decision of the healthcare management body, similar units can be created in other treatment and preventive institutions.

Organizational and methodological management of the activities of prevention departments (offices) is carried out by Regional Center for Medical Prevention.

The department (office) of medical prevention is headed by a doctor (paramedic) who has appropriate training in the field of medical prevention.

The main tasks of the prevention department (office):

Ensuring interaction between the medical treatment facility and the regional center for medical prevention;

Organizational and methodological support for the activities of medical workers of medical institutions to identify risk factors, correct lifestyle, prevent

promotion of medical and hygienic knowledge, healthy lifestyle;