3

Abbreviations
biologically active food биологически активная
BAA БАД
additives добавка
BP blood pressure АД артериальное давление

BMI body mass index ИМТ индекс массы тела

центральная нервная
CNS central nervous system ЦНС
система
образовательная
EO educational organization ОО
организация
FIC frequently ill children ЧБД часто болеющие дети

FL federal law ФЗ федеральный закон

генетически
GMF genetically modified foods ГМП модифицированные
продукты
инфекции, связанные с
health care-associated
HAIs ИСМП оказанием медицинской
infections
помощи
MO medical organization МО медицинская организация
medical and preventive лечебно-профилактическая
MPO ЛПО
organization организация
maximum permissible предельно-допустимая
MPC ПДК
concentration концентрация
Methodological
MR MP методические рекомендации
recommendations
предельно-допустимый
MPL maximum permissible level ПДУ
уровень
внутрибольничные
MPO nosocomial infections ВБИ
инфекции
natural illumination коэффициент естественного
NIC КЕО
coefficient освещения
дошкольная
pre-school educational
PEO ДОО образовательная
organization
организация
нормы радиационной
RSS Radiation safety standards НРБ
безопасности
санитарные правила и
SanRaR sanitary rules and regulations СанПиН
нормы
SR sanitary rules СП санитарные правила

TMN Total microbial number ОМЧ общее микробное число

Всемирная организация
WHO World Health Organization ВОЗ
здравоохранения
 4
Practical lesson 1
Hygienic assessment of drinking water quality
Purpose of the lesson: study of regulatory documents for assessing quality
water and self-determination of some indicators of water quality.
Equipment of the lesson: samples of water ,distilled water, regulatory
documents on water; test tube kits, flask, beaker, funnel, pH meter, sheet of
white paper, glass plate.
Methodical instructions
The following basic documents are available for standardizing the quality
of drinking water:
1. Sanitary rules and regulations (SanRaR) 1.2.3685—21 «Hygienic standards
and requirements for ensuring the safety and (or harmlessness) of
environmental factors for humans».
2. State standard 2761–84 «Sources of centralized drinking water supply.
Hygienic, technical requirements and selection rules».
3. SanRaR2.1.3684-21 «Sanitary and epidemiological requirements for the
maintenance of the territories of urban and rural settlements, for water
bodies, drinking water and water supply to the population, atmospheric air,
soils, living quarters, the operation of industrial, public premises, the
organization and implementation of sanitary -anti-epidemic (preventive)
measure» (in them section: IV. Sanitary and epidemiological requirements for
the quality of drinking and household water supply).
The main international document, the recommendations of which are
accepted as the basis for the development of national normative documents of
sanitary legislation in the field of drinking water protection, is the «Guidelines
for drinking water quality control» developed by the WHO (World Health
Organization).
The general global trend in the development of a system of regulatory
requirements for the quality of drinking water is characterized by an increase in
the number of monitored indicators, which is due to the intensive pollution of
water bodies with wastewater containing a significant amount of hazardous
components for humans. First of all, this concerns a wide range of organic
compounds, including pesticides, herbicides, intermediates and final products of
organic synthesis, motor oils, toxic metals (barium, cadmium, mercury,
antimony, etc.).
Of great hygienic importance is the regulation of limiting the content in
drinking water of the products of interaction of organic pollutants with
disinfectants used for disinfecting water, in particular, volatile organohalogen
compounds such as chloroform, carbon tetrachloride and others that may have
carcinogenic action.
The most responsible in sanitary and epidemiological terms is the
centralized drinking water supply.
Centralized water supply provides water to the population through a
 5
distribution pipe network for household needs.
The main hygienic criteria that determine the quality of drinking water
(the suitability of drinking water for drinking and domestic purposes) include:
1. epidemic safety (microbiological and parasitological indicators);
2. radiation safety; it is characterized by radiological indicators:
2.1. screening indicators (specific total alpha - activity and specific total beta
- activity),
2.2. radionuclides (radon and ∑radionuclides);
3. chemical composition harmlessness is determined by generalized indicators
and the content of harmful chemicals that are found in natural waters and of
anthropogenic origin (entering and forming in water during its processing in
the water supply system, as well as entering water supply sources in as a
result of human economic activity).
4. favorable organoleptic properties (organoleptic indicators) - determined by
their compliance with special standards and standards for the content of
substances that affect organoleptic properties.
Selected indicators of drinking water quality are presented in Table 1.
Characteristics of individual indicators of water quality
Total microbial number (TMN) - allows you to estimate the total
microbial contamination of water
Generalized coliform bacteria indicate inadequate water treatment, post-
treatment secondary contamination, or excess nutrients.
E. coli (Escherichia coli, E. coli) is an indicator of fecal contamination of
water.
Enterococci are sanitary indicative conditionally pathogenic
microorganisms; they are a generally accepted additional indicator of fecal
contamination of drinking water.
Coli-phages characterize water contamination with enteroviruses.
Additional microbiological indicators: pathogens of intestinal infections
of bacterial and viral nature, - are determined in case of exceeding the
permissible levels of contamination of one or more basic indicators, as well as
for epidemic indications:
— Quick responseх,
— Instant reply.
The pH value (pH) ─ is a value that characterizes the content of hydrogen
ions in water, i.e. the acidity (reaction) of aqueous solutions. The reaction of
water is preliminarily determined in order to obtain a general, rough idea of the
chemical composition of water. Natural water is usually slightly alkaline. An
increase in alkalinity indicates an influx of other waters to the source, and this is
also observed during flowering of reservoirs. The acidic reaction of water occurs
as a result of the presence of humic substances or the penetration of industrial
wastewater containing acids into the source.
Water with a pH below 4 is considered to be highly acidic, and above 10
as highly alkaline.
 6
Table 1
Regulatory requirements for the quality of drinking water
Centralized Decentralized
Indicators
water supply water supply
1. Microbiological and Parasitological Indicators
Main Factors
Total microbial number (TMN) - the number of Not more
100
colony-forming units (CFU) in 1 cm3 than 50
Generalized coliform bacteria
Absence Absence
in CFU /100cm3
Escherichia coli (E. coli)
Absence Absence
- in CFU /100 cm3
Enterococcus- in CFU/100 cm3 Absence Absence
Coliphages- the number of plaque forming units
Absence Absence
in100 cm3
Cysts and oocyts of pathogenic protozoa
Absence Absence
in 50 дм3
Additional Indicators
Pathogens of intestinal infection of bacterial na-
Absence Absence
ture in 1 дм3
Pathogens of intestinal infection of viral nature
Absence Absence
in 10 дм3
2. Generalized Indicators
Hydrogen exponents,units рН 6—9 6—9
Total mineralization (dry residue),
not more 1000 not more 1500
мg /dm3
General hardness, meq/ dm3 not more 7,0 not more 10,0
Oil products in total, meq/dm3 not more 0,1 —
surfactants
not more 0,5 —
anionic, мg/ dm3
3. Chemical Substances
Aluminium(Al, total), мg/l 0,2 0,2
Molybdenum(Mo, total), мg/l 0,07 0,07
Iron (Fe, total), мg/l 0,3 0,3
4. Organoleptic characteristics
Smell, points not more 2 not more 3
Taste, points not more 2 not more 3
Color, degrees not more 20 not more 30
Turbidity, мg/l (in kaolin ) not more 1,5 not more 1,5
5.Radiological Indicators
Specific Total alpha –activity reference level
0,2
in Bq/kg
Specific total beta activity,control level in Bq/kg 1,0
Radon,intervention level in Bq/kg 60
∑radionuclide interference level
1
in relative units
 7
The dry residue of water gives a general idea of the substances dissolved
in water. It is obtained by evaporating 1 liter of filtered water and drying the
residue at + 110 ° C to constant weight.
It is considered to be good drinking water if the dry residue does not
exceed 1000 mg/l. Higher values, if they are not related to geological conditions
(high content of a certain group of salts in the soil), suggest that salts are formed
due to the entry of foreign pollutants into the water.
Chlorides are a relative indicator of water pollution, and changes in their
content are associated, as a rule, with the ingress of polluted waters into the
source. Human and animal excrement, especially urine, as well as kitchen waste,
contains a lot of sodium chloride. The combined presence of an increased
content of chlorides and ammonia in water indicates that the water is
contaminated with urine. The ingress of flood and rain flows into the reservoir
(with a low content of chlorides) indirectly indicates the pollution of reservoirs
with mud, which is carried away from the surface of the earth into the reservoir.
Sulfates and phosphates. With an increased content of sulfates and
phosphates in the water of reservoirs for a given area, they can be considered as
an indirect indicator of organic pollution. Sulfur is an integral part of protein
bodies, which, upon decomposition and subsequent oxidation, give sulfuric acid
salts, and phosphates are a characteristic feature in urine and feces water. The
main impact of sulfates is that, when they are high, they spoil the taste of water
and can cause a laxative effect in some people. Phosphates do not occur in clean
waters, because are quickly assimilated by the soil, therefore, their presence in
the water speaks of a strong fecal contamination of the water source.
Water hardness depends on the content of salts of alkaline earth metals -
calcium and magnesium.
The physiological significance of stiffness is small. Very hard water can
cause a laxative effect in a person accustomed to soft water. Hard water cannot
be viewed as a valuable source of calcium: 100 g of milk contains the same
amount of calcium salts as 1 liter of water with a hardness of 24 °.
Vegetables and meat do not boil well in hard water, because the protein
substances in their composition form insoluble compounds with alkalis, which
prevent the penetration of water into the protein substance. Legumes, when
boiled in hard water, perceive water relatively less, become hard, lose their taste
and their digestibility decreases.
Sanitary rigidity is of great importance. Hard water is inconvenient for
washing the body, because it gives insoluble compounds with alkaline
albuminates and fatty acids found on the surface of the skin. When soap is used,
insoluble compounds are formed, which are deposited in the hair and complicate
the washing process. With hard water, much more soap is required, since the
formation of foam does not occur until insoluble lime and magnesia salts fall out
of the water.
Water with a high hardness is not suitable for industrial purposes (eg in
the textile industry). Hard water is especially unsuitable for feeding hot water
boilers: when boiling water, large scale is formed due to decomposition and
 8
precipitation of bicarbonate salts of Ca and Mg, which creates a danger of
explosion and excessive consumption of fuel.
Water hardness can serve as an indirect sanitary indicator of water
pollution: the latter can lead to its increase, because one of the reasons for the
increase in hardness is the decomposition of organic substances, as a result of
which carbon dioxide is formed, which promotes the leaching of hardness salts -
calcium and magnesium from the soil. Water hardness can also increase due to
the ingress of alkaline wastewater (calcium and magnesium) into the source.
There are three types of stiffness:
— total hardness is the hardness of raw water due to all compounds of
calcium and magnesium (sometimes iron and manganese);
— constant hardness ─ water hardness after one hour of boiling, depending
on the presence of various salts that do not precipitate during boiling.
These are mainly calcium and magnesium sulfates and chlorides. Of
these, calcium sulfate is of particular importance, which gives the greatest
scale during boiling;
— removable hardness ─ water hardness, eliminated by one-hour boiling of
water, which is explained by the destruction of bicarbonates of calcium
salts, less magnesium, and sometimes also iron, and their conversion into
insoluble carbon dioxide salts (monocarbonates), which settle on the walls
of blood vessels in the form of limescale. Thus, the removable stiffness is
the arithmetic difference between the total and constant stiffness.
The general hardness is normalized, but the removable hardness is also of
practical interest, for example, when choosing a dose of a coagulant.
Iron salts are usually found in the form of bicarbonate. Ferrous water is
harmless to the body, however, a high iron content spoils the taste of water,
gives it an unpleasant odor and reduces transparency, due to the conversion of
iron oxide under the influence of atmospheric oxygen into iron oxide hydrate,
which falls out in the form of a brown precipitate. Economically, water with a
high iron content is unfavorable in that it forms rusty stains on linen (during
washing), on faience washbasins, bathtubs and harms water pipes due to the
deposition of iron oxide on the walls of the hydrate and the massive
development of ferrous bacteria in the pipes, which is strong narrows the lumen
of the pipes.
Fluorine in water is of interest in connection with its effect on the
condition of the teeth. Excess fluoride in the water causes fluorosis (speckling or
mottling of the enamel). In severe cases, it is expressed in enamel hypoplasia
and even complete destruction of tooth crowns. A very low concentration of
fluoride can contribute to the development of tooth decay. Replenishment of the
deficiency and removal of excess fluorine is carried out, respectively, by
fluoridation and defluorination of drinking water at waterworks. It is also
recommended to use fluoridated salt in the diet, include seafood, sea fish, tea in
the menu.
Iodine. Artesian waters are richest in iodine and waters of fresh surface
water bodies are the poorest. Food is the main source of iodine. Reduced iodine
 9
content in the external environment contributes to the development of endemic
goiter. The iodine content in water is considered as an indicator of its content in
the external environment: if there is little iodine in water, then there will be little
iodine in the soil, and in food products, and in plants, and, ultimately, in humans
and animals. Prevention of iodine deficiency in endemic regions is carried out
by iodizing table salt, because salt is the most common food product, and by
adding iodcasein to bakery products, include sea fish and seafood in the menu.
Lead, copper, zinc, arsenic, mercury, chromium and other elements get
into the water from reservoirs and vessels in which the water is stored
(accidental impurities) and from industrial wastewater. These compounds are
harmful to the body, and therefore their content in water should not exceed the
maximum permissible concentration.
The research results proved the possibility of a gonadotoxic effect when
the aluminum content in water is more than 0.5 mg / l, the effect of molybdenum
on the activity of enzymatic systems; the ability of lead to exert neurotropic,
embryotoxic and teratogenic effects. An increased content of beryllium causes
inhibition of erythropoiesis, a decrease in the activity of enzymes, dystrophic
changes in the parenchymal organs; arsenic has a neurotropic effect, damages
blood vessels, heart, kidneys, digestive organs; polyacrylamide has a neurotropic
effect and effect on the immune system; selenium causes damage to the nervous
system, liver, kidneys, decreased reproductive function, teratogenic and possibly
carcinogenic effects.
SanRaR 2.1.4.1074-01 «Drinking water» provides hygienic standards for
the content of harmful substances in drinking water (MPC - maximum
permissible concentrations and TAC - approximate permissible levels), the
limiting hazard indicator (sanitary-toxicological or organoleptic) and hazard
class substances:
Class 1 - extremely dangerous;
Class 2 - highly hazardous;
Class 3 - dangerous;
Grade 4 - moderately dangerous.
Ammonia is the end product of the first stage of decomposition of protein
substances - mineralization and the beginning of the second stage - their
nitrification. Nitrification of ammonia takes place with subsequent stages of
conversion of ammonia into salts of nitrous acid (nitrites) and then nitric acid
(nitrates), therefore they are conventionally united by one name: «pollution
triad».
The presence of ammonia indicates fresh water pollution, nitrites indicate
a comparative old pollution of the water source, nitric acid salts are an indicator
of a longer period of pollution of the source.
The presence of only ammonia in water can be accidental, and if it is not
detected during repeated analysis, then, obviously, the water is no longer
polluted. If, along with ammonia, nitrites and nitrates are found in the water, we
can talk about constant, long-lasting pollution of the water source. The presence
of only ammonia and nitrates in the water indicates the periodic nature of the
 10
ingress of contaminants into the reservoir.
It should be borne in mind that ammonium salts are sometimes found in
pure, mainly groundwater as a result of the recovery of the salt contained in the
soil. Therefore, the presence of ammonia in the water of these water sources, in
the absence of other signs of pollution, does not always indicate the poor quality
of the water. The presence of ammonium salts is also not an indicator of organic
pollution of bog waters, where their increased content is due to the decay of
plant protein.
The content of nitric acid salts (nitrates) in water is also of independent
interest. The consumption of water, rich in nitrates, causes the development of
nitrate methemoglobinemia in infants who are on artificial feeding (dilution of
milk formulas). This is a serious disease, expressed in pathological phenomena
from the mucous membranes of the eyes, lips and skin (blue), intestines and
sometimes the cardiovascular system. The main symptom of the disease is the
appearance of methemoglobin in the blood: nitrates, entering the gastrointestinal
tract of children, are restored under the influence of microflora into nitrites,
which, being absorbed into the blood, lead to the formation of methemoglobin.
The presence of the latter reduces the ability to supply tissues with oxygen
Water temperature is of great physiological and hygienic significance.
The temperature of drinking water is an active factor influencing the functions
of the gastrointestinal tract, the central nervous system and is capable of causing
certain responses from the activities of various organs and systems.
The most favorable drinking water temperature is + 7 ° С ... + 12 °С.
Water at a higher temperature, especially above 15 °C, does not have a
refreshing effect. Water with a temperature below 5 °C is hazardous to health,
because can cause colds, interfere with gastrointestinal digestion, etc. Very cold
water, used immediately after taking hot food, can cause a violation of the
integrity of the enamel of the teeth.
Smell, taste, presence of flavors are the signs that determine the good
quality of water.
Water samples for the determination of odor, taste, taste and color are not
preserved. The determination is made no later than 2 hours after sampling.
Good quality water is odorless. Odorless water is water whose odor does
not exceed 2 points. The smell makes the water unappetizing. A quantitative
assessment of the smell of water is given in table 2.
Some odors are associated with organic pollution of the water and give
reason to consider it epidemic suspicious.
Smells can be of natural (natural) and artificial origin. Natural odors arise
during the flowering of reservoirs, associated with the decomposition of organic
substances of plant origin; peaty, boggy soil also imparts a certain smell to the
water. Smells of artificial origin are associated with pollution of water bodies
with industrial wastewater, wastewater from cesspools, chlorination of water,
etc.
The smell of water is closely related to its taste. There are four main taste
sensations: salty, bitter, sour, sweet. All other tastes are called flavors. The
 11
nature of the flavors is expressed by definitions: fishy, metallic, chlorine, etc.
The strength of the gustatory sensation depends on the concentration of
the irritant and the temperature of the water.
Drinking water usually has a pleasant refreshing taste, without any foreign
aftertaste. A quantitative assessment of the taste and taste of water is given in ta-
ble 2.
Табle 2
Quantification of odor / taste and taste in water
Score in Odor / taste inten- The nature of the manifestation
points sity and taste of the smell of taste and aftertaste
0 No Smell / taste and taste are not perceptible
Smell / taste and taste are not perceived by the consumer, but
1 Very weak
are detected in laboratory research
Smell / taste and taste are not perceived by the consumer, but
2 weak
are detected in laboratory research
Smell / taste and taste are easily noticed and lead to disap-
3 noticeable
proval of the water
Highly Smell / taste and taste attract attention, make you refrain from
4
distinct drinking
Smell / taste and taste are so strong that drinking water is not
5 Very strong
suitable
The taste of water often depends on the increased concentration of some
mineral salts in it. Iron salts in an amount of more than 0.5 mg / l give water an
inky taste, salts of heavy metals - astringent, sulfuric acid and phosphate salts in
an amount of more than 100 mg / l - a bitter taste, with a chloride content of
200-300 mg / l water acquires a salty taste, and at a concentration of more than
500 mg / l - a clearly salty taste. A taste from chlorine remaining after disinfec-
tion of water is possible.
Water pollution with organic matter of animal origin gives the water an
unpleasant taste.
A change in the color of objects in the external environment is often one
of the important signs of their sanitary condition. Color is one of the hallmarks
of an object's appearance.
Drinking water is colorless. The color of water depends on many reasons.
Swampy waters have a yellowish tint due to the admixture of humic
substances. An admixture of clay gives the water a milky hue, iron salts - a
greenish one.
The color of the water often depends on the intensive reproduction of
microorganisms and lower plants. The discharge of industrial and domestic
wastewater leads to a change in the color of natural waters. Water color is the
reason for the rejection of water use
Independent work
To independently determine the physicochemical and organoleptic
properties of water (samples 1, 2).
I. Determination of water color. The color of water depends on the
 12
chemical compounds dissolved in it. Quantitatively, the color of water is
determined by comparing the test water with the scale of standard solutions
(standards) and is expressed in conventional degrees of this scale. Tap water
should have a color of no more than 20°.
In sanitary practice, the color of water is most often determined
qualitatively.
Determination method. Compare filtered water (sample 1) over a sheet of
white paper with distilled water in another cylinder (sample 2). The research
results are expressed by the following characteristics: colorless, light yellow,
dark yellow, brown, etc.
Analysis results: sample 1 _____________________________________
sample 2 _____________________________________
II. Determination of the degree of turbidity of water. The turbidity of
water depends on its solids content.
A qualitative characteristic of the degree of turbidity of water is carried
out by eye, descriptively (transparent, slightly opalescent, opalescent, slightly
turbid, turbid, very turbid), as well as in terms of the intensity and appearance of
the sediment (flocculent, silty, sandy, gray, brown, black; insignificant , large,
very large - while measuring its thickness).
Determination method. Pour well-mixed unfiltered water into a colorless
beaker (cylinder) and examine it over a well-lit sheet of white paper. For control,
pour distilled water into a similar vessel.
Analysis results: sample 1 _____________________________________
sample 2 _____________________________________
III. Determination of pH (water reaction). The hydrogen index of water
reflects the concentration of hydrogen ions in it. The normal reaction of water is
from slightly acidic to slightly alkaline (6-9). Water with a pH below 4.0 is
considered highly acidic; strongly alkaline - above 10.0.
Various quantitative methods can be used to determine the reaction of
water.
Determination method.
1) By universal test strip. To do this, pour the test water into a test tube and
immerse an indicator strip of paper in it. After 5 minutes, remove the strip
and set the pH of the water on the scale on the indicator paper case.
2) Using a pH meter (ionometer), a more accurate determination of the
concentration of hydrogen ions in water is carried out.
Collect a sample of liquid, about 50 g, into a clean container, for example,
into a glass. Open the lid of the device and turn it on by sliding the button at the
top of the device. Numbers will appear on the display.
Immerse the tester in the tested liquid no deeper than 2-3 cm, stir gently
and wait about 30 seconds until the readings stabilize. The data can then be read.
Analysis results: sample 1 _____________________________________
sample 2 _____________________________________
 13
IV. Determination of the smell of water is carried out quantitatively by
determining the intensity by a five-point system (Table 2). In a qualitative
assessment, the smell of water is determined by the terms: earthy, swampy,
pharmacy, putrefactive, chlorine, hydrocarbon, fish, hydrogen sulfide, etc. In the
same way, the smell of heated water (up to 60°) is determined.
Determination method. Take a wide-necked flask with a capacity of 250-
300 ml, pour 100 ml of test water into it, close the flask with a watch glass and
shake, making rotational movements. Remove the watch glass and smell the
nature and intensity of the smell from the first presentation.
Analysis results: sample 1 _____________________________________
sample 2 _____________________________________
V. Determination of foreign tastes in water. The taste of water can only
be determined with known good quality water. In doubtful cases, the water
should be boiled, cooled to 15–20 ° and only then tasted.
Determination method. To determine the taste, pour water into your
mouth in small portions, hold in your mouth for a few seconds and determine
the taste without swallowing it. Estimates of the nature and intensity of the taste
of water are given in table. 2.
Analysis results: sample 1 _____________________________________
sample 2 _____________________________________
Conclusion:___________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
 14
Practical lesson 2
Hygienic assessment of the microclimate
in medical and educational organizations, residential premises
The purpose of the lesson: the study of sanitary and physical methods of
research and hygienic assessment of the physical properties of the air
environment. Determination of the temperature regime, relative humidity, air
velocity in the room.
Equipment of the lesson: thermometers for measuring the temperature of the
air, Assman's psychrometer, psychrometric hygrometer of the humidity and
temperature type, kata thermometer, cup and wing anemometers, distilled water,
barometer.
Methodical instructions
Environmental factors can have favorable and unpleasant effects on
people's well-being and health. Depending on the nature of the factors, they can
be divided into physical, chemical and biological. Temperature, humidity and
movement of the air around us, atmospheric pressure, electromagnetic and ra-
dioactive radiation, noise, vibration and a number of other factors characterize
the physical properties of the air environment together. These factors form mi-
croclimate in residential, educational, medical and other premises.
Indicators of microclimate in various rooms (according to SanRaR
1.2.3685-21 "Hygienic standards and requirements for ensuring safety and (or)
harmlessness of environmental factors for humans") are presented in Table 1
Table 1
Indoor microclimate indicators

Temperature, Relative humidity, Air velocity,

Name of the room
°С % m/s

Study rooms 18 – 24 40 – 60 0,1

not >60
Depends
Room of medical and preventive for rooms of the
on the type 0,1-0,2
department(mpd) cleanliness
of room
class А and B
Living room
-The cold period of the year is the
optimal 20 – 22 30 –45 0,15
permissible 18 –24 30 – 60 0,2
- The warm period is the
optimal 22 – 25 30 – 60 0,2
permissible 20 – 28 30 – 65 0,3
The air of residential and public buildings is characterized by a higher
stability of microclimate and chemical composition indicators compared to at-
mospheric air and air of industrial premises. But in case of deterioration of phys-
 15
ical and chemical parameters of the air environment of residential and public
buildings, there is an increase in the uncomfortable state of people, a decrease in
working capacity, which is associated with a violation of the processes of heat
exchange of the body with the external environment, a change in the functional
state of the nervous system, external respiration and some other body systems.
For a correct assessment of microclimatic conditions in medical and pre-
ventive organizations (MPO), a doctor needs to know the types and devices that
measure the physical properties of the airless environment, know the methodol-
ogy for determining these indicators and make a reasonable hygienic assessment
of the results obtained.
Determination of air temperature
Temperature is a physical quantity that characterizes the thermal
(chemical) motion of particles of matter (atoms and molecules).
The temperature is measured using thermometers, which can be of
different types. According to the method of determining the temperature, there
are liquid (alcohol or mercury), mechanical, electrical, gas, infrared, etc.
According to the type of temperature being determined, thermometers are
maximum, minimum and measuring.
Maximum thermometers (usually mercury thermometers) are arranged in
such a way that they retain the readings of the highest temperature, despite its
subsequent decrease.
Mercury thermometers are more common, since they are more accurate
and allow measuring temperatures in the range from -35 °C to +357 °C.
Minimum thermometers are most often alcohol thermometers with a glass
needle-pointer installed in a position that corresponds to the minimum of the
observed temperature. With the help of alcohol thermometers, low temperatures
up to –130 ° C can be measured.
Measuring thermometers can be both mercury and alcohol. They show the
temperature at a given time and are used, among other things, to measure air
temperature.
In cases where it is necessary to know the entire dynamics of fluctuations
in indoor air temperature during a day or several days, a thermograph is used.
When assessing the temperature regime in the room, the temperature is
measured at six points: at the outer wall, in the middle of the room and at the
inner wall at a height of 0.1 m and 1.5 m from the floor. Then the readings of the
thermometers are summed up, divided by the number of measurements and the
average air temperature is obtained.
In addition, temperature changes in the room are evaluated.
The horizontal temperature drop is defined as the difference in air tem-
perature at the inner wall and at a distance of 0.5 m from the outer wall. It
should be no more than 2 °C.
The vertical temperature drop is defined as the difference in air tempera-
ture at a height of 1.5 m from the floor (at the inner wall or in the middle of the
room) and 0.1 m from the floor. It should be no more than 2.5 °C.
 16
The average daily air temperature is derived from a number of observa-
tions (morning, afternoon, evening, night) by simply dividing the total sum of
temperatures by the number of observations.
Determination of air humidity
The following concepts are used for the hygienic characteristics of air
humidity:
A - absolute humidity – the amount of water vapor in one cubic meter of
air (water vapor density). Since the density is proportional to the pressure, the
absolute humidity can be characterized by the partial pressure of water vapor,
expressed in millimeters of mercury;
M - maximum humidity – the elasticity of water vapor when the air is ful-
ly saturated with moisture at a given temperature, expressed in millimeters of
mercury (Application 1);
K - relative humidity – the ratio of absolute humidity to maximum, ex-
pressed as a percentage.

K = A ∙ 100% (1)
M
The relative humidity of the air is usually de-
termined using a stationary August psychrometer
(psychrometric hygrometer) (Figure 1) or an aspira-
tion Assman psychrometer (Figure 2).
In the hygrometer, 2 thermometers are in-
stalled on the panel: «dry» and «wet», the reservoir
of which is wrapped in a thin cloth, the end of it is
lowered into a vessel with distilled water. Water
evaporates from the surface of matter .The more in-
tense of the surface, the drier the air. Since the eva-
poration of water is associated with the cooling of
the body from which it evaporates, a wet thermo-
meter will indicate a lower temperature than a dry
one. The readings of the «dry» and «wet» thermo-
meters are determined 30 minutes after the device is
installed.
According to the psychometric table located
on the instrument panel, the relative humidity of the
air is determined. To do this, in the column «Dry Figure 1
thermometer readings», the temperature determined by the dry thermometer is
found, in the line «the difference between the readings of dry and wet thermo-
meters», the resulting temperature difference is found. Relative humidity is indi-
cated at the intersection of the corresponding row and column.
 17

Meaning Of Terms:
- Григрометр ВИТ-2 → hygrometer vit-2
- Психрометрическая таблица → Psychrometric table
- Скорость аспирации → Aspiration rate
- Показ.сухого термом. → Display of dry term.
- Разность показаний термометров → Difference in the
readings of thermometers
- Относительная влажность → Relative humidity
Absolute humidity is less indicative than relative hu-
midity. Absolute humidity gives an idea of the absolute con-
tent of water vapor in the air, but does not show the degree
of its saturation. At the same absolute humidity, the satura-
tion of water vapor can be different depending on the air
temperature.
Therefore, relative humidity and saturation deficiency
are of the greatest hygienic importance, which give a clear
idea of the degree of saturation of the air with water vapor
and allow us to judge the intensity and rate of evaporation
of sweat from the surface of the body at a particular temper-
ature.
∆A = M - A — saturation deficiency — the differ-
ence between maximum and absolute humidity (in mmHg).
Relative humidity is usually determined using psyc-
hrometers and hygrometers
The station psychrometer consists of two identical Figure 2
measuring thermometers mounted side by side in an open
 18
case. The backup of one of the thermometers is wrapped in a thin cloth, the end
of which is lowered into a vessel with distilled water.
With the power of a «wet» thermometer, water evaporates the more inten-
sively the air is dried. Since the evaporated water is associated with the cooling
of the body with which it evaporates, this wet thermometer will show a lower
temperature than a dry one.
The indications of the «dry» and «wet» thermometers are determined 30
minutes after the installation of accessories. Further, according to the formula
Rainier calculate the absolute humidity:
А = f – а (td– tw) ∙ В (2)
where f — is the maximum voltage of water vapor in the humid temperature on
the thermometer (mm Hg. );
а — psychrometric coefficient, which depends on the air velocity and is
determined by special tables or decided flat 0,00074 for atmosphere
and 0,0011 for closed-by-mastani;
td — dry thermometer temperature (MKS);
tw — temperature of the wet thermometer (°C);
B — is the barometric (atmospheric) pressure (mmHg).
Next, the relative humidity is calculated using the formula (1).
The aspiration psychrometer operates on the same principle, but has a rea-
sonable design and appears more painfully accurate. Its thermometers are en-
closed in metal tubes, through which the measured air is uniformly blown using
a small wind-up vent located at the top of the accessories honor. Such a device
of the psychrometer provides protection of thermometers from external dis-
charge and guarantees a constant speed of air movement around the thermome-
ters.
The aspiration psychrometer can be used to determine the humidity and
temperature of indoor and outdoor air.
The absolute humidity when working with the Assman psychrometer is
calculated by the Sprong formula:
В
А = f – 0,5 (td– tw) (3)
755
where А — is the absolute humidity at a given temperature (mmHg);
f — is the maximum voltage of water vapor at the temperature of a wet
thermometer (mmHg);
td — dry thermometer temperature (MKS);
tw — temperature of the wet thermometer (°C);
B — is the barometric (atmospheric) pressure (mmHg).
Relative humidity is determined by the same formula as when working
with a station psychrometer.
Also, relative humidity can be determined by special tables designed for
the August psychrometer, or by graphs for the Assman psychrometer.
 19
A simplified method for determining air humidity is based on the fact that
with a difference in the readings of dry and wet thermometers of 1 ° C, the rela-
tive humidity decreases by 10% of the full saturation value (100%).
Determination of air velocity
The air velocity of less than 1 m/s is not felt by a person,
exceeding 1 m/s is perceived as wind.
Low air velocities (up to 1 m / s) are determined using a
catathermometer or a thermoanemometer (indirect method).
Determination of the air velocity exceeding 1 m / s is carried out
using an anemometer (direct method).
Catathermometer (Figure 3).
With the help of a catathermometer, very weak air currents
are determined. The device is an alcohol thermometer with a
cylindrical or spherical tank. First, the cathathermometer is heated
in a water bath. The air velocity is estimated by the cooling rate of
the catathermometer from 38 to 35°C.
Anemometers (Figure 4) are used in meteorological studies in
the open atmosphere to record air velocities
from 1 to 50 m/s.
They come in two types: cup and Figure 3
winged.
The receiving part of the device is a mill in the
form of hemispheres (cup) or light aluminum plates
(impeller). The rotation of the hemispheres is transmitted
to the speed counter. The arrow indicates the distance
traveled by the air flow. The device has several dials.
When recording readings, the values of thousands,
hundreds, tens and units of meters of the path traveled by
air masses are sequentially read. The observation time is
usually 120 s. The average wind speed is determined by
the ratio of the distance to the time of observation.
If the mechanism is connected to an electric
tachometer, the device immediately shows the wind speed
at the moment, without additional calculations, which
Figure 4 allows you to monitor changes in wind speed in real time.
Independent work
Task 1.
Evaluate the temperature regime in the room.
When measuring air temperature, we have thermometers away from heat
sources, direct sunlight and increased air flows. It should take 10 minutes from
the moment the thermometer is installed until the readings are taken.
When determining the uniformity of the temperature regime, we measure
at least 5-6 points of the room: 3 horizontally and 2 vertically. Horizontally, the
thermometers are installed at a distance of 0.2 m from the outer wall, in the
 20
middle of the room and at a distance of 0.2 m from the opposite wall, vertically -
at a height of 0.1 and 1.5 m from the floor.
The obtained values should be entered in Table 2, calculate the average
room temperature and temperature differences.
Table 2
Room temperature regime
Horizontal levels Horizontal
Vertical levels,
Middle of 0.5 m from the temperature
m Inner wall
the room outer wall difference
1,5
0,1 —
Difference t
— —
vertically
t 1 + t 2 + t 3 + t 4 + t 5 + t6
Average air temperature: t = =
6
Task 2.
Determine the relative humidity of the air in the room.
1) Determine the relative humidity using a psychrometric hygrometer (August
psychrometer).
To do this:
1) fill the feeder with distilled water;
2) install the hygrometer in an upright position at eye level;
3) measurement should be carried out 30 minutes after installation;
4) take readings on "dry" and "moistened" thermometers;
5) calculate the temperature difference;
6) according to the psychrometric table, determine the relative humidity of
the air.
2. Calculate the absolute and relative humidity of the air using the formulas:
А = f – 0,0011 (td– tw) ∙ В =
A
K= ∙ 100 % =
M
3. Calculate the relative humidity of the air by a simplified method:
K = 100 - 10 (td– tw) =
Table 3
Method for Thermometer readings Relative humidity
determining (t, °C) determined by:
air humidity «dry» «wet» table formula simplified method
Hygrometer
psychrometric
 21
Task 3.
Determine the air velocity with an anemometer.
1) Record the initial meter readings.
2) Install the anemometer vertically.
3) Simultaneously turn on the anemometer mechanism and stopwatch.
4) Keep the anemometer in the air stream for two minutes.
5) Turn off the mechanism and stopwatch, record the final meter reading.
6) Divide the difference of counts by the exposure time.
Таble 4
Anemometer Small Arrow Small Arrow Exposure Air flow
Big arrow
Reading (thousands) (hundreds) time. velocity m/s
Final
countdown
The initial
countdown
The difference
of counts
Conclusion:_____________________________________________________
_______________________________________________________________
Application 1
Maximum water vapor voltage depending on air temperature
(millimeters of mercury column)
Теmp Tenths of a degree
(ºС) 0 1 2 3 4 5 6 7 8 9
11 9,84 9,91 9,98 10,04 10,11 10,18 10,24 10,31 10,38 10,45
12 10,52 10,59 10,66 10,73 10,80 10,87 10,94 11,01 11,08 11,16
13 11,23 11,30 11,38 11,45 11,53 11,60 11,68 11,76 11,83 11,91
14 11,99 12,06 12,14 12,22 12,30 12,38 12,46 12,54 12,62 12,71
15 12,97 12,87 12,95 13,04 13,12 13,20 13,29 13,38 13,46 13,55
16 13,63 13,72 13,81 13,90 13,99 14,08 14,17 14,26 14,35 14,14
17 14,53 14,62 14,72 14,81 14,90 15,00 15,09 15,19 15,28 15,38
18 15,48 15,58 15,67 15,77 15,87 15,97 16,07 16,17 16,27 16,37
19 16,48 16,58 16,67 16,79 16,89 17,00 17,10 17,21 17,32 17,43
20 17,54 17,64 17,75 17,86 17,97 18,08 18,20 18,31 18,42 18,54
21 18,65 18,76 18,88 19,00 19,11 19,23 19,35 19,47 19,59 19,71
22 19,83 19,95 20,07 20,19 20,32 20,44 20,56 20,69 20,82 20,94
23 21,07 21,20 21,32 21,45 21,58 21,71 21,84 21,98 22,10 22,24
24 22,38 22,52 22,65 22,78 22,92 23,06 23,20 23,34 23,48 23,62
25 23,76 23,90 24,04 24,18 24,33 24,47 24,62 24,76 24,91 25,06
26 25,21 25,36 25,51 25,66 25,81 25,96 26,12 26,27 26,43 26.58
27 26,74 26,90 27,06 27,21 27,37 27,54 27,70 27,86 28,02 28,18
28 28,35 28,51 28,68 28,85 29,02 29,18 29,35 29,52 29,70 29,87
29 30,04 30,22 30,39 30,57 30,74 30,92 31,10 31,28 31,46 31,64
30 31,82 32,01 32,19 32,38 32,56 32,75 32,93 33,12 33,31 33,50
 22
Practical lesson 3
Hygienic assessment of the light regime
in medical and preventive and educational organizations
The purpose of the lesson: to study the hygienic requirements for natural and
artificial lighting of premises and methods of its assessment.
Equipment of the lesson: compass, tape measures, luxmeters.
Methodical instructions
Almost the entire life of a person, except for the sleep period, takes place
in light conditions. Vision brings a person up to 85% of information about the
surrounding world. Rational lighting prevents, first of all, the development of
visual fatigue. Lighting that meets hygienic requirements creates favorable
conditions for visual work, improves visual functions:
— visual acuity – the ability to distinguish small details at a distance;
— contrast sensitivity – the ability to distinguish brightness;
— stability of clear vision – the ability to distinguish the contours of small
details for a long time;
— the speed of visual perception, defined as the minimum period of time
required to distinguish the object of work;
— the visibility of an object or the ability of the eye to clearly distinguish an
object, etc.
Ultraviolet rays of sunlight have a bactericidal effect.
The lack of lighting worsens the functions of vision, reduces mental and
physical performance, lowers gas exchange, nitrogen, mineral, daily
metabolism; changes hematopoiesis; affects the synthesis of vitamin D, the well-
being, psychological state of a person, the activity of the central nervous and
cardiovascular systems; promotes the development of myopia in children.
Lighting that meets hygienic requirements should provide:
- a quantitatively sufficient degree of illumination, optimal for work and
human well-being,
- a qualitatively constant value in time, uniform in space and the absence of
shadows,
- no excessive brightness within the working area,
- absence of direct and reflected brilliance.
Illumination refers to the density of the luminous flux incident on the
surface. It is defined as the ratio of the luminous flux to the area of the
illuminated surface. The unit of illumination - lux (lux) is the illumination of a
surface of 1m2, on which a luminous flux equal to 1 lumen (lm) is equally
distributed.
In the hygienic assessment of illumination, it is necessary to take into
account the nature of the work performed: the minimum dimensions of the
object of discrimination (6 categories of visual work are established: I- VI), the
contrast of the background with the object and the background reflection
coefficient. Additionally, they take into account: the increased risk of injury, the
 23
distinction of details on fast-moving surfaces, the duration of visual work during
the shift, the perception of objects from a long distance.
Simultaneous natural and artificial lighting is called combined.
Combined lighting is called simultaneous
- side and top natural lighting and/or
- general and local artificial lighting.
Methods for assessing natural lighting of premises
Indoors, natural lighting consists of direct, diffused and reflected light.
Depending on the location of the windows, it can be side, top or combined.
The level of natural illumination depends on the light climate
(geographical latitude of the area, time of year and day, weather), the degree of
transparency of the atmosphere, the density of buildings, the nature of
landscaping (the distance from the building to the trees should be at least 15 m,
and to the bushes - at least 5 m). Also, the illumination is influenced by the
features of the room: the size and shape of window openings, the design and
number of windows, the width of the piers, the size and depth of the room, the
transparency and cleanliness of window panes (the frequency of cleaning of
window panes is at least twice a year), the coloring of surfaces (light tones are
recommended, tables in educational classes should be the colors of natural wood
or light green).
The amount of natural light, in particular the insolation mode, is
significantly influenced by the orientation of windows in parts of the light (in
classrooms – optimally to the south, east, southeast).
Insolation is understood as the illumination of a room or territory with
direct sunlight.
The calculation of the duration of insolation is carried out according to
insolation charts or solar maps.
The established duration of insolation for premises of different purposes is
presented in Table 1.
The absence of insolation in the classrooms of computer science, physics,
chemistry, drawing and drawing is allowed.
For hygienic assessment of the level of natural illumination, various
indicators are used:
─ the light coefficient – LC
─ depth (coefficient) of laying;
─ angle of incidence;
─ opening angle;
─ absolute illumination - measured by a luxmeter and gives an idea of the
illumination only at the time of measurement;
─ relative illumination – expressed as ―natural illumination coefficient‖
(NIC) and more accurately characterizes natural lighting .
 24

Table 1
Normalized duration of continuous insolation
Duration of
Geographical
Rated rooms insolation, Calendar period
latitude of the area
not less than
Doshk. images. Northern zone
2,5 h
organizations - (north of 58° s. w.) from 22nd April
group, game; Central zone to 22 August
2h
Images. organizations - (58° s. w. - 48° s. w.)
classrooms and
classrooms; from 22nd
Southern zone
medical institutions - 1,5 h February
(south of 48° S. w.)
chambers (at least 60% of to 22 october
the total number)
Northern zone
2h
(north of 58° s. w.) from 22nd April
In 2- and 3-room
Central zone to 22nd August
apartments, where at least 1,5
(58° s. w.- 48° s. w.)
2 rooms are insulated
Southern zone From 22 February
1,5 h
(south of 48° S. w.) to 22nd october
Determination of the light coefficient
The light coefficient (LC) is the ratio of the area of the glazed surface of
windows to the floor area. It is expressed as a fraction, the numerator of which is
one, and the denominator is the quotient of dividing the area of the room by the
surface area of the glasses.
The hygienic assessment of natural illumination according to the LC has
certain limitations, since it does not take into account the probability of shading
windows by oppositely standing buildings, trees, etc. The light coefficient may
correspond to the optimal value, but the natural illumination in this case may be
insufficient.
It is generally assumed that sufficient natural illumination is achieved
when the value of the light coefficient for
 residential premises up to 1:10,
 classrooms and laboratories - up to 1:4, 1:5•
 hospital wards - up to 1:7.
Determination of the depth of the premises
The laying depth of the room, or the laying coefficient is the ratio of the
depth of the room (the distance from the outer to the inner wall) to the distance
from the upper edge of the window to the floor. Good lighting is provided when
the coefficient of laying (or depth of laying) of the room does not exceed 2.
In some cases, the depth coefficient is determined – the ratio of the
distance from the floor to the upper edge of the window to the depth of the room
is equal to 1:2.
 25
Determining the angle of incidence
The angle of incidence (АВABC) is formed by two lines, one of which
(BC), horizontal, is drawn from the place of definition (workplace) to the plane
of the window, the other (AB) - from the workplace (from the same point) to the
upper outer edge of the window, as shown in Figure 1.

Е
D
β
α B
C γ ((

К L
Figure 1
It shows the angle at which light rays fall from the window onto a given
horizontal surface in the room.
Given that the triangle ABC is rectangular: tg  АС
ВС
The value of the AC catheter is determined by the vertical distance from
the point (C) of the intersection of the horizontal line with the window plane and
to the upper edge of the window (A). The BC catheter is the distance from the
central point of the desktop surface (B) to the window (C).
Table 2
Natural trigonometric values of tangents
tg   tg   tg   tg  
0,017 1 0,249 14 0,510 27 0,839 40
0,035 2 0,268 15 0,532 28 0,869 41
0,052 3 0,287 16 0,554 29 0,900 42
0,070 4 0,306 17 0,577 30 0,933 43
0,087 5 0,325 18 0,601 31 0,966 44
0,105 6 0,344 19 0,625 32 1,000 45
0,123 7 0,364 20 0,649 33 1,15 49
0,141 8 0,384 21 0,675 34 1,39 53
0,158 9 0,404 22 0,700 35 1,60 58
0,176 10 0,424 23 0,727 36 2,05 64
0,194 11 0,445 24 0,754 37 2,47 68
0,213 12 0,466 25 0,781 38 3,07 72
0,231 13 0,488 26 0,810 39 4,01 76
5,67 80
 26
The angle of incidence at the workplace should be at least 27°. Its value
depends on the degree of remoteness of the workplace from the window. The
further the workplace is located, the smaller the angle of incidence. It also
depends on the height of the window – with an increase in its magnitude, the
angle of incidence will increase. To determine it, you can use Table 2 of the
natural values of trigonometric functions.
Determining the angle of the hole
The angle of the hole β (ABD) is formed by two lines, one of which
(AB) goes from the place of determination to the upper edge of the window, and
the other (BD) - from the place of determination to the highest point of the op-
posing building (E), tree, etc. The angle of the hole gives an idea of the size of
the area of the firmament, the light from which falls on the work surface.
First, the point D is determined on the window. To do this, one person sits
down at his desk and mentally draws a line from the surface of the table to the
highest point of the opposite building, tree, etc. At this time, the other, at the di-
rection of the first, fixes the point D on the window glass through which this line
passes. Then the DC, CB cathets are measured and tg γ:
tg γ ДС
ВС
According to the table of tangent values, the angle value is found. The an-
gle of the hole is equal to the difference of the angles found
βα – γ
The opening angle should not be less than 5°. The larger the opening an-
gle, the larger the area of the firmament we see, the more light rays penetrate in-
to the room and the higher the illumination.
Determination of the natural illumination coefficient
The NIC value gives a fairly objective assessment of the state of natural
lighting in the room, since it reflects the influence of a large number of external
and internal factors.
NIC is the ratio of the natural illumination at a given point inside the
room (EB) to the illumination at the same moment on a horizontal plane (EN) un-
der the open sky with diffused light.
ЕB
NIC = · 100%
ЕN
The NIC at each point of the room is a constant value, since the
illumination inside the room is directly proportional to the outdoor illumination.
For various rooms, depending on the nature of visual work, hygienic standards
of minimum permissible CNI are established (Table 3).
Optimal natural lighting of classrooms and laboratories is achieved at NIC
values of at least 1.5%.
Determination of the levels of natural and artificial illumination of
surfaces is carried out using a luxmeter (Figure 2). The principle of its operation
is based on the conversion of the energy of the luminous flux into electrical
 27
energy. The receiving part is a selenium photocell connected to a galvanometer.
When measuring the illumination, the photocell is placed horizontally on the
working surface.
Table 3
Natural light, side, Artificial lighting
Premises
NIC, % (general) Illumination, lux
Institutions of general, secondary vocational and higher education
Teachers' offices and rooms 1,0 300
Organizations that carry out medical activities
Procedural, manipulative 1,5 500
Operating room - 500
Offices of surgeons, obstetricians,
pediatricians, dermatologists, 1,5 500
dentists…
Reception rooms for doctors, other
1,0 300
specialists, paramedics
Pharmacies
Prescription department, manual -
300
sales departments… -
Assistant, aseptic… - 500
Prescription departments, manual
sales departments, optics, finished - 300
medicines
Determination of the coefficient of unevenness
In the hygienic assessment of the
natural lighting of classrooms, it is necessary
to take into account its unevenness in various
places of the working surface and throughout
the room.
The coefficient of unevenness is
estimated by the ratio of the highest
illumination to the lowest, measured in the
same plane. According to hygienic
requirements, it should be no more than 3:1.
The uniformity of natural lighting of
classrooms largely depends on the width of
the piers, which should not exceed half the
width of the window.
Methods of evaluation of artificial lighting of premises
When evaluating artificial lighting, light sources, lighting systems, types
of lamps, their placement, the distance between them, the height of the
suspension above the work surface, illumination in the workplace, etc. are
investigated. The spectral composition of artificial lighting should be as close as
possible to daylight.
 28
Incandescent lamps, fluorescent lamps or LEDs are used for general and
local lighting of premises. It is not allowed to use xenon lamps indoors.
Incandescent lamps are not very economical, have a low efficiency, the
spectrum is shifted to the yellow-red side, but they continue to be widely used
for lighting residential and public spaces, because they are simple in design,
cheap and easy to operate. It is not allowed to use general-purpose incandescent
lamps with a power of 100 watts or more for lighting.
The advantage of fluorescent lamps is their high efficiency: light output is
3-4 times higher than that of incandescent lamps, lower brightness, uniformity
of illumination of surfaces. The emission spectrum of fluorescent lamps is close
to daytime, which makes it possible to correctly distinguish color shades.
LED lamps combine high reliability and economy (energy consumption is
80% less than that of incandescent lamps), saturation and purity of color, but
their power is not enough to illuminate large rooms.
For general lighting of the room, do not use lamps of different types at the
same time.
In addition to the lamp itself, the lamps also include a lighting fixture,
which is used to redistribute the luminous flux in the right directions, protects
the eyes from the brilliance of the light source, and the light source itself from
mechanical damage, moisture, etc.
The basis of the hygienic rationing of artificial lighting is based on such
factors as: the purpose of the room, the nature of the activity in it, the smallest
dimensions of the parts under consideration, the distance from the part to the
eyes, the contrast between the object and the background, the required speed of
the parts, the conditions of eye adaptation, the presence of moving mechanisms
and other objects dangerous to injury.
The assessment of artificial lighting is carried out using a luxmeter: the
illumination in lux is measured (objective method), and by the specific power of
the lamps: the ratio of the power of all working lamps to the floor area in watts
per m2 is calculated (calculation method). The power standards for classrooms
are 20-21 W/m2 for fluorescent lamps and 48 W/m2 for incandescent lamps.
Measurements of illumination with a luxmeter with a room area of
15-20 m2 are carried out on a horizontal surface at 8-10 points and at 3-4 points
in smaller rooms, both under the lamps and between them. The average
illumination value is derived from the obtained data.
If the illumination measurement is carried out during the daytime, the
level of artificial illumination is calculated by the difference between the values
obtained when artificial lighting is turned on and off. The data obtained are
compared with the norms established by the sanitary rules and norms of SanPiN
1.2.3685-21 «Hygienic standards and requirements for ensuring the safety and
(or harmlessness) of environmental factors for humans», which are shown in
Table 3.
When evaluating lighting, it is necessary to know what percentage of the
illumination created in the workplace due to the local lighting system is from the
total illumination with combined lighting. It is established that this percentage
 29
should be at least 10. Under this condition, there will be no sharp contrast
between the illumination of the work surface and the surrounding space.
Otherwise, a sharp contrast contributes to the development of visual discomfort
and rapid eye fatigue in workers.
From a hygienic point of view, in order to create the best lighting
conditions, the height of the suspension of the lamps above the floor level is of
great importance.
Independent work
Task 1.
Evaluate the organization and sufficiency of natural light in the study room.

Indicators Results
Orientation of
windows

Light coefficient
The coefficient
of laying
Width of the piers

Angle of incidence

Opening angle

NIC

Coefficient of
unevenness
Flowers on the
windows
Availability of
curtains
Cleanliness of
windows
Painting of walls,
tables
Distance to trees
and shrubs
 30

Additional remarks

Conclusion

Task 2.
Evaluate the organization and sufficiency of artificial lighting in the study room.

Indicators Results

Type of lighting

Arrangement of
lamps

Blackboard lighting

Artificial
illumination (in lux)

Specific power

Cleanliness of
lamps

Additional remarks

Conclusion
 31
Practical lesson 4
Hygienic assessment of noise in classrooms
The purpose of the lesson: to study the characteristics of noise and its effect on
the human body. Determination of the noise level from various sources in the
classroom and its hygienic assessment
Equipment of the lesson: a noise meter from a multifunctional device, noise
sources, SanPiN 1.2.3685-21 "Hygienic standards and requirements for ensuring
the safety and (or) harmlessness of environmental factors for humans".
Methodical instructions
One of the physical environmental factors that adversely affect the human
body is noise — a set of non-periodic sound waves of varying intensity and
frequency.
Sound waves are mechanical vibrations of particles of an elastic medium
(gas, liquid, solid), which arise under the influence of a disturbing force acting
with an oscillation frequency from 20 to 20,000 Hz.
The main characteristics of sound waves (Figure 1) include:
- the wave propagation velocity (m/s) depends on the elastic properties of
the medium,
- frequency (Hz) is the number of oscillations per 1 second.
The frequency determines the pitch,
- wavelength (m).

Figure 1
Meaning of terms in the graph:
 Длина волны. Величина обратная частоте. Чем она больше, тем звук
ниже. → Wave length. Inverse value frequency. The larger it is, the lower
the sound.
 Амплитуда колебаний. Чем она больше, тем звук громче → Oscillation
amplitude. The bigger it is, the louder the sound.
- sound pressure (Pa).
Sound vibrations in the air lead to its compression and rarefaction. In the
areas of compression, the air pressure increases, and in the areas of
 32
rarefaction ,the air pressure decreases. The difference between the pressure
existing in the perturbed medium at the moment and atmospheric pressure is
called sound pressure.

Meaning of terms
in the graphic:
 тишина → silence
 звук → sound
 звуковое давление
→ sound pressure
 атмосферное давление
→ atmospheric pressure

Figure 2
1. The intensity (or strength) of sound I (W/m2) is defined as the amount of
energy transferred by a sound wave in one second through a 1 m2 cross-
section perpendicular to the direction of wave propagation. In other words,
the intensity of sound is the rate of transmission of sound energy through a
unit area.
The quietest sound with a frequency of 1 kHz that a human ear can hear has
an intensity approximately equal to 1 • 10-12 W / m2. The pain threshold of a
person is approximately 100 W/m2.
An increase in the strength of the sound causes an increase in its volume,
but the volume increases much more slowly than the sound pressure increases.
The auditory analyzer perceives not the difference, but the multiplicity of
changes in sound pressures, therefore, to characterize the intensity of sounds, a
measuring system has been adopted that takes into account the logarithmic
relationship between irritation and auditory perception - the bel or decibel scale.
Bel is a logarithmic unit reflecting a tenfold increase in the subsequent
intensity of sound above the level of the previous one. For example, if the sound
intensity is 10, 100, 1000 times higher than the next one, then on a logarithmic
scale it corresponds to an increase of 1, 2, 3 units.
2. The sound intensity level L (dB), also called the acoustic intensity level, is
an absolute logarithmic unit of sound intensity relative to the reference level -
the threshold of human audibility in the air.
Subjectively, the sound intensity level is estimated as loudness.
The sound intensity level in decibels is determined by the formula:
I
L=10∙lg ( I ), where
0
I – sound intensity (W/m2);
I0 – is the reference sound intensity, which is assumed to be 10-12 W/m2
by default.
102
L=10∙lg ( 10-12 ) = 10∙lg 1014 = 140 dB
 33
All the energy perceived by the ear as sound fits into 140 dB.
Noise is a collection of sounds of different intensity and frequency,
randomly changing over time, and causing unpleasant subjective sensations.
In medicine, noise is understood as any unpleasant or undesirable sound
or a set of sounds that break the silence, interfere with the perception of useful
sound signals.
By origin, noises are divided into household, street and industrial.
According to the predominance of acoustic energy in one or another part
of the spectrum, noise is divided into:
1. low-frequency (up to 500 Hz),
2. medium frequency (from 500 to 1000 Hz),
3. high frequency (from 1000 to 8000 Hz).
According to the time characteristics, there are:
• constant noise, the sound level of which changes in time by no more than 5
dBA over an 8-hour working day when measured on the time characteristic
of the noise meter "slowly";
• non-constant noise, the level of which changes in time by more than 5 dBA
over an 8-hour working day when measured on the time characteristic of the
noise meter "slowly".
Unstable noises are divided into:
- a noise fluctuating in time, the sound level of which continuously changes
in time;
- intermittent noise, the sound level of which varies stepwise (by 5 dBA or
more), and the duration of the intervals during which the level remains
constant is 1 s or more;
- pulse noise consisting of one or more audio signals, each lasting less than
1 s.
Noise always adversely affects the human body, reduces its efficiency,
worsens well-being. For example, noise of 70-90 dB is a potential cause of
dysfunction of the nervous system. Noise exceeding 100 dB has a negative
effect on hearing. And if the parameters go beyond 200 dB, then the situation is
extremely dangerous and can lead to death.
Noise is characterized by:
— a specific effect on the hearing organs. For example, in "noisy" industries,
workers may develop professional hearing loss, professional deafness or
noise sickness;
— non-specific action, which manifests itself as the initial phase of the specific
action of industrial noise, as well as under the action of transport, music and
other types of noise. With the nonspecific effect of noise, the mobility and
balance of nervous processes in the cerebral cortex are first disrupted, which
can lead to the development of extreme inhibition. If the effect of noise
continues, adverse changes in the body occur as with stress.
For industrial conditions, hygienic standards for noise, as well as for other
physical factors, are established as the maximum permissible levels (MPU) of
factors that, with daily (except weekends) work for 8 hours (but no more than 40
 34
hours a week) during the entire working experience, do not cause diseases or
health abnormalities detected by modern research methods during work or in the
long-term life of the present and subsequent generations.
The effect of noise depends on the intensity and frequency. With
increasing frequency, the harmfulness of noise increases. Permissible noise
levels are determined differentially depending on its frequency response, as well
as exposure time and the nature of labor.
For hygienic noise assessment, the sound frequency range from 22.4 to
11000 Hz, consisting of nine octave bands, is of practical interest. An octave is a
frequency range in which the upper limit of the frequency is twice as large as the
lower one (for example, 40-80; 80-160 Hz, etc.).
In practice, a logarithmic scale has been adopted as a loudness measuring
system. For sources of constant noise, sound pressure levels in octave bands
with average geometric frequencies are normalized.
The average geometric frequency of the octave band is determined by the
formula:

, where
fn – lower limit frequency, Hz;
fb – upper limit frequency, Hz
Moreover, for the octave band fb / fn = 2.
To indicate the octave, it is usually not the frequency range that is
indicated, but the average geometric frequencies. For example, for an octave of
22.4-45 Hz, the average geometric frequency is 31.5 Hz, for an octave of 45-90
Hz - 63 Hz, etc.
More often, a person is affected by non-constant noise, which is estimated
by the equivalent sound level L (Aequ.), that is, the level of constant noise,
which has the same effect on energy as this non-constant for a certain time
interval (measured in decibels of acoustic dBA).
For intermittent sources of noise sets the maximum sound level
L(Amax.), ie sound level corresponding to the maximum rate measurement,
self-reading instrument (sound level meter) in visual countdown, or the value of
the sound level exceeded for 1 % of the time measurement at check automatic
device (in dBA).
Hygienic standards for the permanent and non-permanent sources of
noise, according to SanRaR 1.2.3685—21 are presented in Table 1.
 35

Table 1
Normalized noise parameters in octave frequency bands, equivalent and maximum sound levels of penetrating noise in residential
and public buildings and noise in residential areas
For non-constant noise
For constant noise sources
sources
Purpose of
Time of Sound pressure levels, dB, in octave bands Sound Equivalent Maximum
№ premises or
days with average geometric frequencies, Hz levels sound levels sound levels
territories
L(A), D(Aecv.), D(Amax.),
31,5 63 125 250 500 1000 2000 4000 8000
dBA dBA dBA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
from 7 to
Wards of 76 59 48 40 34 30 27 25 23 35 35 50
23 hr.
1 hospitals and
from 23
sanatoriums, 69 51 39 31 24 20 17 14 13 25 25 40
to 7 hr.
2 operating - 76 59 48 40 34 30 27 25 23 35 35 50
rooms of
3 - 79 63 52 45 39 35 32 30 28 40 40 55
hospitals
Offices of
4 polyclinic - 76 59 48 40 34 30 27 25 23 35 35 50
doctors…
from 7 to
79 63 52 45 39 35 32 30 28 40 40 55
23 hr.
5 Classrooms,
from 23
72 55 44 35 29 25 22 20 18 30 30 45
to 7 hr.
6 Sports hall - 83 67 57 49 44 40 37 35 33 45 45 60
Territories from 7 to
adjacent to 83 67 57 49 44 40 37 35 33 45 45 60
23 hr.
7 hospital build- from 23
ings … 76 59 48 40 34 30 27 25 23 35 35 50
to 7 hr.
 36
To measure the noise level, special devices are used – noise meters
(Figure 3).
The noise meter consists of a microphone, an amplifier, correction filters,
a voltmeter, a display and a power supply, which work according to the
following scheme:
The sound is picked up by a sensitive non-directional microphone. The
acoustic pressure on the membrane is converted into an alternating electrical
voltage. Then, after passing through the amplifier, the signal goes to the filters
(low, medium or high volume), where the type of noise is allocated. With the
help of a detector, which is essentially a voltmeter with a scale in dB, the user
receives information about the sound pressure level.
The noise meters are equipped with frequency
correction units with switches A, B, C, D and time
characteristics with switches F (fast) - fast, S (slow) - slow, I
(pik) - pulse. The F scale is used for measurements of
constant noise, S - oscillating and intermittent, I - pulse.
In terms of accuracy, noise meters are divided into four
classes (0, 1, 2 and 3):
1) devices with the best accuracy, used as exemplary
measuring instruments;
2) devices that are used in laboratories and for field
measurements;
3) or technical measurements in production;
4) for household use, they give approximate results for
approximate measurements.
Each class of devices corresponds to a frequency
measurement range:
 noise meters of classes 0 and 1 are designed for a range
from 20 Hz to 18 kHz,
 Class 2 noise meters - from 20 Hz to 8 kHz,
Figure 3  Class 3 noise meters - from 31.5 Hz to 8 kHz.

The noise meter has three modes of operation of the device:

F — for constant noise analysis.
S — for short periodic noises.
I — for pulse noise.
According to the rules, the noise level at the workplace in the premises is
measured at at least three points. The microphone that perceives noise should be
placed at a height of 1.5 m above the floor level (or at the height of the head of a
person working while sitting). It should be directed towards the noise source and
at least 0.5 m away from the person making the measurement.
 37
Independent work
Task 1. Measure the noise level from multiple sources.
Noise level
№ Noise source
(dB)
1 Conversation

2 Alarm

3 Stomp

Task 2. Check the sound insulation level.

1) Turn on the noise source (for example, music on the phone) and close the
door.
2) Measure the noise level using a noise meter.
3) Open the door and repeat the measurement.
4) Calculate the difference in readings. This is the isolation level.
Similarly, determine the insulation level of windows. To do this, measure
the noise level when the window is open and closed.
Noise level isolation level
№ The object of the study
L1 (dB) L2 (dB) L2 - L1 (dB)

1 interior door

2 Window

Сonclusion:____________________________________________________
______________________________________________________________
________________________________________________________________
______________________________________________________________
 38
Practical lesson 5
Medical control over the adequacy of nutrition
Calculation method for assessing the adequacy of nutrition
The purpose of the lesson: to get acquainted with the hygienic requirements for
rational nutrition, organization of nutrition in health care facilities, methods for
assessing the adequacy of nutrition.
Equipment of the lesson: menu layouts, calculators, tables of chemical
composition and nutritional value of food products; methodological
recommendations of MR 2.3.1.2432-08 "Norms of physiological needs for
energy and nutrients for various population groups of the Russian Federation",
sanitary rules of the SanRaR 2.3/2.4.3590-20 "Sanitary and epidemiological
requirements for the organization of public catering of the population"
(paragraph 7.1 - on the organization of patient nutrition in medical
organizations); order of the Ministry of Health of the Russian Federation of
23.09.2020 № 1008n "Procedure for providing patients with medical nutrition".
Methodical instructions
Nutrition is one of the most important factors determining the health of
the population and each person. Therefore, it is important for the doctor to assess
the adequacy of individual nutrition and the adequacy of nutrition of the entire
team.
For a hygienic assessment of individual nutrition, it is necessary to
analyze:
1- energy adequacy of nutrition;
2- sufficient intake of nutrients into the body.
1. Assessment of the energy adequacy of nutrition is carried out:
1.1 on the change in the individual's weight (qualitative assessment).
If the energy value of the diet corresponds to the energy consumption of a
person, his weight will not change.
To assess whether the body weight of a given person corresponds to the
recommended (taking into account age, gender and constitution) or ideal, you
can use some formulas:
- Brock-Brugsch formula:
to determine the ideal weight taking into account height (where: p -
weight, kg; L - body length, cm):
if L=155-165 cm, then p = L - 100,
if L=166-175 cm; then p = L - 105,
if L=176 and above; then p = L - 110.
- Broca's index (indicator):
mass
Broca 's index = , if the index is 0.9-1.1 - the mass is normal;
height - 100
 39
- body mass index - Ketel's BMI (sometimes it is called the body mass
index - ITM or the mass-growth index - MGI):
Маss body (kg)
BМI=
height (m2)
The optimal BMI for women is 18.7-23.8; for men - 20.5-25;
1.2 on the analysis of the energy value of the diet (quantitative assessment).
To do this, it is necessary to take into account the number of products that
have entered the body within 7-10 days. Then calculate how many products
entered the body in 1 day. Using the corresponding tables (Application 1), the
energy value of the diet is calculated and compared with the physiological norm
(Application 2).
2. Assessment of the adequacy of the intake of nutrients into the body is
also carried out by two methods:
2.1 quantitative - calculation of the intake of nutrients into the body according to
the actual diet (using the tables of Application 1) and their assessment taking
into account physiological norms (Application 2);
2.2 qualitative – according to individual symptoms of insufficient intake of
nutrients.
For example, with vitamin C hypovitaminosis, fatigue, decreased
performance, drowsiness, loosening of the gums are noted. Microsymptoms of
vitamin A deficiency are dry skin, hyperkeratosis, conjunctivitis and blepharitis,
night blindness.
To ensure the energy adequacy of nutrition and sufficient intake of
nutrients into the body, it is necessary that the food diet includes a variety of
foods: dairy, meat, fish, fruits, vegetables, cereals.
Methods of assessing the adequacy of the nutrition of the team
1. First of all, a hygienic assessment of the weekly (cyclic) menu is
carried out, for which it is necessary to evaluate the variety of breakfasts,
lunches, dinners for 7 (10) days.
Meat and fish dishes are recommended for breakfast; vegetable and dairy
dishes are recommended for dinner.
At lunch, there should be the right combination of dishes: it is not
recommended that the first and second courses be vegetable (since there will be
a low calorie lunch); side dishes are recommended to be "complex".
The menu should not include "cold" breakfasts and prohibited dishes (,
deep-fried pies, etc.).
The next day (especially breakfast) should not include dishes that were on
the previous day.
It is necessary to correctly distribute the daily calorie intake by meals: for
breakfast and dinner about 25%, for lunch - 35-40%, for afternoon tea (second
breakfast) - 15-10%.
The recommended volumes of dishes should be observed (the output of
dishes should be indicated in the menu).
The daily menu should correspond to a cyclical one (weekly or ten-day).
 40
When preparing menus in organized groups, it is necessary to take into
account the recommended range of basic food products.
According to Order No. 1008n, the diet of medical nutrition of patients
must meet the following characteristics:
- compliance of the energy value with the energy consumption of the
patient, taking into account gender and age characteristics, the level of
physical activity;
- provision of correction of impaired or lost body functions as a result of
illness in order to increase adaptive potential, including with the use of
specialized food products, including protein composite dry, vitamin and
mineral complexes (for medical reasons - enteral nutrition products);
- compliance of the chemical composition with the physiological needs of a
person in macronutrients (proteins, fats, carbohydrates) and
micronutrients (vitamins, minerals and trace elements);
- providing a diverse set of food products;
- -ensuring the power supply regime;
- -the use of technological and culinary processing of food products,
ensuring the preservation of their original nutritional value, increasing the
digestibility of food substances.
2. Assessment of compliance with nutrition standards (food set).
3. Assessment of the energy adequacy of nutrition and the adequacy of
nutrient intake (on average for 1 day for 1 child or patient).
4. It is necessary to take into account the balance of nutrition:
- the correct ratio of proteins, fats, carbohydrates, which depends on age,
gender, energy consumption. So, for teenagers from 14 to 18 years old
(boys and girls) - p : f : c = 1.0 : 1.1 : 4.8;
- sufficient intake of animal proteins (to maintain nitrogen balance). For
adults, they should make up 50% of all proteins;
- sufficient intake of vegetable oils (as a source of essential fatty acids),
which should account for up to 30% of the total amount of fats;
- the correct ratio of calcium, phosphorus and magnesium, which for the
adult population should be - Ca:P:Mg = l,0 : 0,8 : 0,4.
5. The daily energy value of the diet (taken as 100%) should be provided
mainly by carbohydrates. For example, in workers of the 1st and 2nd groups of
physical activity of the population (men and women), as well as in children and
adolescents, the daily energy value should be provided at the expense of
carbohydrates by 58%; and at the expense of proteins and fats by 12% and 30%,
respectively (taking into account that when splitting 1 gram of proteins or
carbohydrates, 4 calories are allocated, and 1 gram of fats - 9 calories).
Independent work
Task 1.
Give a hygienic assessment of the summer camp menu.
 41
Weekly Summer camp menu
day breakfast lunch snack dinner
Green onion salad with sour
Millet porridge Salad of fresh
cream. Vegetable soup with
with pumpkin. Banana, cabbage, fried fish,
mon meatballs. Meatballs with
Tea, cheesecake yogurt boiled potatoes. Rye
rice. Tea. Rye bread. 680
with jam. bread. Compote.
kcal.
Salad of fresh vegetables.
tue 505 kcal. Pickle. Beef goulash with 370 kcal. 490 kcal.
pasta. Tea. Rye bread.
Cabbage soup from kvash.
Rice porridge Apple, Vegetable salad.
cabbage with sour cream.
wed with butter. Tea, cottage Beef liver with
Cutlet with mashed potatoes.
cookies. cheese pasta. Tea.
Rye bread. Drink.
thur 537 kcal. 716 kcal. 327 kcal. 540 kcal.
Zucchini Salad of fresh
Fish soup. Potato casserole
pancakes with Kefir, vegetables. Beef
fri with meat. Dried apricot
sour cream. Tea, cookies goulash with rice.
compote. Rye bread.
bread. Compote.
sat 475 kcal. 703 kcal. 355 kcal. Rye bread.
526 kcal. Salad with beetroot and Milk,
sun Cheesecakes with walnut. Chicken soup. Rye cheesecak 580 kcal.
jam. Tea. bread. Tea. e
Hygienic evaluation of the menu
Variety of dishes
(during the day and week)
Availability of "cold" breakfasts
The presence of prohibited dishes
(okroshka, navy pasta, deep-fried pies)
Inclusion of breakfast dishes that were
for dinner the previous day

Distribution of daily calories by meals

день нед. mon tue wed thu fri sat sun
total (kcal)
breakfast (%)
lunch (%)
afternoon
snack (%)
dinner (%)
 42
Conclusion, recommendation_________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
Task 2.
Evaluate the quantitative and qualitative composition of the diet according
to the menu layout using tables of the chemical composition of food products
(Application 1) and the norms of physiological needs (Application 2), to assess
the balance of nutrition.
Preschool menu
Sauerkraut salad 35,0
Boiled potatoes with sausage 140/50,0
breakfast Rye bread 20,0
Bread with butter and cheese 30/5/10,0
tea 200,0
Pickle with meat 200,0
Meatballs with vermicelli 75/140
lunch Compote of apples, prunes and raisins 200,0
Rye bread 40,0
Wheat bread 30,0
Milk 200,0
Afternoon snack
Cookie 20,0
Cabbage rolls vegetable 160,0
Milk 200,0
dinner
Bread 30,0
Rye bread 30,0
 43
Menu layout
products mass, g energy protein fats carbohydrates
Sauerkraut 30,0
Onion 2,0
Sugar 1,0
Vegetable oil 2,0
Potato 140,0
breakfast

Butter 5,0
Sausage 50,0
Tea 0,02
Sugar 20,0
Bread 30,0
Butter 5,0
Dutch cheese 45% 10,0
Rye bread 20,0
Beef meat 1 cat. 40,0
Pearl barley 3,0
Pickled cucumbers 25,0
Potato 40,0
Carrot 15,0
Onion 5,0
Sour cream 10,0
Beef meat 1 cat 60,0
Onion 12,0
Tomatoes 5,0
lunch

Wheat flour 5,0

Butter 3,0
Meat broth 100,0
Vermicelli 35,0
Butter 8,0
Fresh apples 20,0
Raisin 5,0
Prunes 8,0
Sugar 20,0
Rye bread 40,0
Wheat bread 30,0
Milk 200,0
П.

Cookie 20,0
Fresh cabbage 105,0
Carrot 10,0
Rice 10,0
Egg 10,0
Tomatoes 5,0
dinner

Butter 8,0
Wheat flour 1 c . 2,0
Sour cream in / with 10,0
Milk 200,0
Bread 30,0
Rye bread 30,0
Total
 44
Task 3.
Evaluate the balance of nutrition:
3.1 Ensuring the daily energy value of the diet (taken for 100%):
at the expense of proteins by ______%,
at the expense of fats by _____%,
at the expense of carbohydrates by ____%
3.2 Ratio p : f : c = _______________________
3.3 b is alive. = ______% of all proteins;
rast. = ______% of all fats
Conclusion and recommendations:
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
 45
Application 1
Chemical composition and energy value of
the edible part (100 g) of some food products
(according to the book «Chemical composition of food products»
edited by A. A. Pokrovsky, M, 1977)
Mineral

Carbohydrates, g

Energy value of
proteins, g substances, vitamins, мg
mg
fats, g

kcal
products

phosphor

carotene
calcium

iron
А В1 В2 РР С

us
Wheat flour
10,6 1,3 73,2 24 115 2,1 0 — 0,25 0,12 2,20 0 329
1c.
Semolina 11,3 0,7 73,3 20 84 2,3 0 — 0,14 0,07 1,00 0 326
12,6 2,6 68,0 70 298 8,0 0 — 0,53 0,20 4,19 0 329
- buckwheat
7,0 0,6 77,3 24 97 1,8 0 — 0,08 0,04 1,60 0 323
kernel
- rice 12,0 2,9 69,3 27 233 7,0 0,15 — 0,62 0,04 1,55 0 334
- millet 11,9 5,8 65,4 64 361 3,9 0 — 0,49 0,11 1,10 0 345
- oatmeal 9,3 1,1 73,7 38 323 3,3 0 — 0,12 0,06 2,00 0 324
10,4 1,3 71,7 — 343 1,6 0 — 0,27 0,08 2,74 0 322
– pearl barley 23,0 1,6 57,7 89 226 7,0 0,05 — 0,90 0,18 2,37 0 323
Peas shelled 10,7 1,3 74,2 24 116 2,1 — — 0,25 0,12 2,22 — 333
Pasta 5,6 1,1 43,3 34 120 2,3 — — 0,11 0,08 0,64 — 199
1 varieties 7,6 0,6 52,3 20 65 0,9 — — 0,11 0,06 0,92 — 233
Rye bread. 7,6 5,0 56,4 25 85 1,5 — — 0,18 0,09 1,59 — 288
Confectionery products
Granulated
0 0 99,8 2 – 0.3 0 0 0 0 0 0 374
sugar
Sugar cookies Сле Сле
7,4 10,0 76,3 20 83 1,5 0,13 0,09 1.44 0 406
ды ды
Gingerbread
4,8 2,8 77,7 9 41 0,6 0 0 0,08 0,04 0,57 0 336
custard
Dairy products
Pasteurized
2,8 3,2 4,7 121 91 0,1 0,01 0,02 0,03 0,13 0.10 1,0 58
milk.
Sour cream
20% fat 2.8 20.0 3.2 86 60 0,2 0,06 0,15 0,03 0,11 0,10 0,3 206
content.
Fat cottage
14,0 18,0 1,3 150 217 0,4 0,06 0,10 0.05 0.30 0,30 0,5 226
cheese
Kefir 2,8 3,2 4,1 120 95 0,1 0.01 0,02 0,03 0,17 0,14 0.7 59
- fat - low 3,0 0.05 3.8 126 95 0,1 – – 0,04 0,17 0,14 0.7 30
Condensed
7,2 8,5 56,0 307 219 0.2 0,02 0,03 0,06 0,20 0.20 1,0 315
milk. with sah.
Dutch cheese 23,5 30,9 — 760 424 — 0,16 0,21 0,03 0,38 0,30 2,4 380
 46
The cheese
is melting.
23,0 19,0 — 686 — — — — 0,01 0,35 — — 270
40% fat
content.
Butter
0,6 82,5 0,9 22 19 0,2 0,34 0,5 – 0,01 0,10 0,6 748
plums.
Milk След Сле Сле
0,3 82,3 1,0 12 8 0,40 — 0,1 0,2 746
margarine ы ды ды
Confectioner Сле
0 99,7 0 2 70 2 — 0 0 0 0 897
y fat ды
Sunflower
0 99,9 0 — — — — — — — — — 899
oil
Vegetables, fruits, berries
Zucchini 0,6 0,3 5,7 15 12 0,4 0,03 — 0,03 0,03 0,60 15 27
White
1,8 — 5,4 48 31 1,0 0,02 — 0,06 0,05 0,40 50 28
cabbage
Potato 2,0 0,1 19,7 10 58 0,9 0,02 — 0,12 0,05 0,90 20 83
Onion
1,3 — 4,3 121 26 1,0 2,00 — 0,02 0,10 0,30 30 22
greens.
Onion. 1,7 — 9,5 31 58 0,8 – — 0,05 0,02 0,20 10 43
Carrot 1,3 0,1 7,0 51 55 1,2 9,0 — 0,06 0,07 1,00 5 33
Ground
0,8 — 3,0 23 42 0,9 0,06 — 0,03 0,04 0,20 10 15
cucumbers
Radish 1,2 — 4,1 39 44 1,0 – — 0,01 0,04 0,10 25 20
Turnips 1,5 — 5,9 49 34 0,9 0,10 — 0,05 0,04 0,80 20 28
Salad 1,5 — 2,2 77 34 0,6 1,75 — 0,03 0,08 0,65 15 14
Beet 1,7 — 10,8 37 43 1,4 0,01 — 0,02 0,04 0,20 10 48
Ground
0,6 — 4,2 14 26 1,4 1,20 — 0,06 0,04 0,53 25 19
tomatoes
Watermelon 0,7 — 9,2 14 7 1,0 0,10 — 0,04 0.03 0.24 7 38
Pumpkin 1,0 — 6,5 40 25 0.8 1,50 — 0,05 0,03 0,50 8 29
Apricots 0,9 — 10,5 28 26 2,1 1,60 — 0,03 0,06 0,70 10 46
Cherry 0,8 — 11,3 37 30 1,4 0,10 — 0,03 0,03 0,40 15 49
Pear 0,4 — 10,7 19 16 2,3 0,01 — 0,02 0,03 0,10 5 42
Plum 0,8 — 9,9 28 27 2,1 0,10 — 0,06 0,04 0,60 10 43
Merry 1,1 — 12,3 33 28 1,8 0.15 — 0.01 0,01 0,40 15 52
Apples 0,4 — 11,3 16 11 2,2 0,03 — 0,01 0,03 0,30 13 46
Oranges 0,9 — 8,4 34 23 0,3 0,05 — 0,04 0,03 0,20 60 38
Lemons 0,9 — 3,6 40 22 0,6 0,01 — 0,04 0,02 0,10 40 31
Lingonberry 0,7 — 8,6 40 16 0,4 0.05 — — — — 15 40
Strawberry 1,8 — 8,1 40 23 1,2 0.03 — 0,03 0,05 0,30 60 41
Gooseberry 0,7 — 9,9 22 28 1,6 0,20 — 0,01 0,02 0,25 30 44
Raspberry 0,8 — 9,0 40 37 1,6 0,20 — 0,02 0,05 0,60 25 41
Red currant 0,6 — 8,0 36 33 0,9 0,20 — 0,01 0,03 0,20 25 38
Black
1,0 — 8,0 36 33 1,3 0,10 — 0,02 0,02 0,30 200 40
currant
Blueberries Сле
1,1 — 8,6 16 13 7,0 — 0,01 0,02 0,30 10 40
ды
Raisin 1,8 0 70,9 80 129 3 – — 0,15 0,08 0,5 – 276
Prunes 2,3 0 65,6 80 83 13 0,06 — 0,1 0,20 1,5 3,0 264
 47
Dried apricots
16
with bones. 5,0 0 67,5 152 12 3,5 — 0,10 0,20 3,0 4,0 278
6
(uruk)
1,0 0 3,3 13 32 0,7 0,50 — 0,01 0,03 0,30 10 18
Tomato juice 0,3 0 18,5 19 20 0,3 0 — 0,02 0,01 0,10 2,0 72
Grape juice. 0,5 0 11,7 8 9 0,2 – — 0,01 0,01 0,10 2,0 47
Apple juice 3,1 0,2 7,1 16 53 0,7 0,30 — 0,11 0,05 0,70 10 41
0,4 0 74,6 15 14 1,1 — — — 0,03 — 3,0 283
Meat products
Sheepmeat Сле
16,3 15,3 — 9 178 2,0 — 0 0,08 0,14 2,5 203
ды
Category I 18,91 12,43 — 198 2,61 — Сл. 0,06 0,15 2,82 - 187,3
97
4,6 3,0 — 164 2,6 — 0 0,52 0,14 0,4 - 255
Beef Pork Сле Сле
19,7 1,2 — 11 189 1,7 — 0,14 0,23 3,3 90
ды ды
Veal 17,4 3,1 — 10 342 6,0 — 0,01 0,12 0,19 3,0 - 124
Category I 11,7 22,8 — 40 169 1,7 — — — — — — 252
10,1 20,1 1,8 7 167 2,1 — — 0,12 0,16 1,88 — 228
Beef liver 10,1 31,6 — 6 139 1,2 — — 0,25 0,12 1,10 — 332
Sausage 12,3 25,3 — 29 161 1,7 — — — — — — 227
- dairy 16,8 18,3 — 9 178 2,4 — — 0,02 0,19 1,76 — 232
- separate 16,9 15,4 — 6 145 1,4 — — — — — — 206
Pork sausages 14,9 32,2 — 7 160 1,6 — — 0,14 0,18 1,96 — 349
18,2 18,4 0,7 16 228 3,0 — 0,07 0,07 0,15 3,70 — 241
Milk sausages 17,8 12,3 0,4 10 210 1,5 — 0,04 0,07 0,15 3,10 — 183
Beef stew 12,7 11,6 0,7 55 185 2,7 — 0,35 0,07 0,44 0,19 — 157
Fish products
Sardines 19,0 10,0 — 80 276 0,7 — 0,09 0,01 0,10 7,6 — 166
Atlantic tota
18,0 9,0 — 37 278 2,3 — total 0,12 0,36 6,9 153
mackerel l
Horse
18,5 5,0 — 64 255 0,5 — 0,01 0,17 0,12 1,3 1,5 119
mackerel
Cod Hake 17,5 0,6 — 39 222 0,6 — 0,01 0,09 0,16 2,3 –
Horse
16,6 2,2 — 20 — — — — 0,12 0,10 1,0 3,7 86
mackerel
Application 2
Norms of physiological needs for children and adolescents (per day)
proteins carbohy Mineral substances (мg)
Age Energy, fats
In ani. drates
(years) kcal total(g (g) Ca P Mg Fe Zn J
.(%) (g)
3-6 1800 54 65 60 261 900 800 200 10 8 0,10
7-10 2100 65 60 70 305 1100 1100 250 12 10 0,12
11-13
2500 75 60 83 363 1200 1200 300 12 12 0,13
(boy)
11-13
2300 69 60 77 334 1200 1200 300 15 12 0,15
(girl.)
14-17
2900 87 60 97 421 1200 1200 400 15 12 0,15
youth)
14-17
2500 75 60 83 363 1200 1200 400 18 12 0,15
(girls)
 48
Norms of physiological needs for the adult population per day
(for group I of the able-bodied population, CFA 1,4 )
proteins (g) Mineral substances (mg)
carbo
inclu
Age Energy fats hydrat
ding
(years (kcal.) Total (g) es Ca P Mg Fe Zn J
anim
(g)
als
men
18-29 2450 72 36 81 358
30-39 2300 68 34 77 335 1000 800 400 10 12 0,15
40-59 2100 65 32,5 70 303
women
18-29 2000 61 30,5 67 289
30-39 1900 59 29,5 63 274 1000 800 400 18 12 0,15
40-59 1800 58 29 60 257
Application 3
Requirements for the culinary processing of products
for the preservation of vitamin C
─ Vegetables for salads and vinaigrettes are cooked unpeeled.
─ Vegetables are placed in boiling water.
─ When making soups, different types of vegetables are put into boiling broth
or water sequentially, taking into account the cooking time of each.
─ Frozen vegetables, without defrosting, are put in boiling water and boiled un-
til ready.
─ Vegetables for cooking are dipped into boiling water (broth) in small portions
so as not to interrupt boiling.
─ Vegetables should be covered with liquid, and it should not be allowed to boil
and boil violently. Cooking is carried out in a closed container.
─ When stirring the contents, do not remove the vegetables from the liquid so
that there is no contact with air.
─ Do not digest vegetables and cook them in aluminum dishes.
─ Store hot (at +75 ° C) vegetable dishes and side dishes for no more than 2
hours. Repeated heating almost completely destroys vitamin C.
─ Rinse sauerkraut for salad quickly several times with cold water.
─ Do not store peeled potatoes in water.
─ Use the water in which the peeled vegetables were cooked (for side dishes or
mashed potatoes) to make gravy and broth.
 49
Practical lesson 6
Nutritional value and sanitary examination of basic foodstuffs
The purpose of the lesson: to study methods for determining the quality
(sanitary examination) of food products, categories of food quality;
independently determine the quality of products (bread, flour, milk, canned
food).
Equipment of the lesson: samples of products (canned food, milk, bread, flour),
a sheet of black paper; sanitary rules SanRaR 2.3.2.1078-01 «Hygienic
requirements for the safety and nutritional value of food products», SanRaR
2.3/2.4.3590-20 «Sanitary and epidemiological requirements for the
organization of public catering», SanRaR2.3.2.1324-03 «Hygienic requirements
for shelf life and storage conditions of food products».
Methodical instructions
Food products must meet the established hygiene requirements so that the
food prepared from them meets the goals of proper nutrition and excludes the
possibility of a negative impact on the health of consumers.
The products must be fresh, not contaminated, not infected, have a normal
composition and not be subject to falsifications prohibited by sanitary laws.
In order to control the supply of good-quality food to the population, a
permanent veterinary and sanitary supervision of slaughtered animals and
poultry and sanitary supervision of food products located in all procurement and
distribution enterprises has been organized. Sanitary supervision of the quality
of food products is the most important component of the general hygienic
control of nutrition in general, which includes, in addition to the studies of
quantitative and qualitative completeness of food considered in the last lesson,
supervision of places and conditions of food storage, their transportation,
culinary processing, etc.
Food products must be microbiologically and radiationally safe, contain
chemical pollutants, and have good organoleptic properties.
To determine the quality (sanitary examination) of food products, the
following methods can be used:
1) Organoleptic — evaluation of the quality of products using sensory organs:
color, smell, taste, appearance, consistency;
2) Physical — determination of temperature, specific gravity, refraction, etc.;
3) Chemical — determination of reaction, chemical composition, presence of
foreign impurities, etc.;
4) Microscopic — determination of the morphological composition of products;
the presence of parasites, etc.;
5) Bacteriological — determination of the degree and nature of microbial
contamination;
6) Biological ─ determination of the toxicity of products by animal experiments;
7) Radiometric — determination of contamination of food with radioactive
substances.
 50
Depending on the indications and possibilities, they use all numerical
methods or only some of them, but organoleptic, physical and chemical methods
of research are more often used.
The main documents on the quality and safety of food products are:
Federal Law of the Russian Federation «On the quality and safety of food
products» of 2.01.2000 № 29-FZ and sanitary rules «Hygienic requirements for
the safety and nutritional value of food products» (SanRaR 2.3.2.1078-01).
There are also: Technical Regulations of the Customs Union TR CU
021/2011 «On food safety» (as amended on 8.08. 2019); Technical Regulations
of the Customs Union «On the safety of milk and dairy products» (TR CU
033/2013); Technical Regulations of the Eurasian Economic Union «On the
safety of fish and fish products» (TR EAEU 040/2016); Technical Regulations
of the Customs Union «On the safety of meat and meat products» (TR CU
034/2013), etc.
To assess the quality of food products, the relevant Nation’sstandards
(state standards), TTC (Temporary technical conditions), RTC (Republican
Technical Conditions), TC (Technical Conditions) are used to date.
The following criteria can be used to assess the quality of food products:
A product suitable for nutrition without restrictions is a full-fledged food
product that has good organoleptic properties, is harmless to health and meets all
the requirements of the standard or technical specifications according to
hygienic indicators.
A product suitable for nutrition, but of reduced quality— is a product
that has some drawback or does not fully meet the requirements of the relevant
standard for certain hygienic indicators. However, these disadvantages do not
worsen the organoleptic properties of the food product and do not make it
dangerous to human health – for example, sour cream with a reduced fat
content, potatoes with a high percentage of waste, etc.
Conditionally suitable — a product with defects that make it impossible
to use it in the nutrition of the population without pretreatment in order to
improve organoleptic properties or neutralization. Allowing the use of a
conditionally suitable product, the doctor indicates the method of its processing
or processing, determines the persons responsible for its implementation.
Substandard is a food product that has disadvantages that do not allow its
use for the nutrition of the population (for example: low organoleptic properties,
contamination by pathogenic microorganisms or their toxins, pesticides or other
toxic substances). Substandard food products, in agreement with the veterinary
and sanitary service, can be fed to animals or transferred for technical disposal.
If food raw materials or food products deemed unfit for food are not sent for
animal feed or technical disposal, a decree of the chief state sanitary doctor of
the city (district) on their destruction is issued
Food quality indicators
Indicators of the quality of dairy products
Milk is of good quality: white with a yellowish tinge, homogeneous,
 51
without unpleasant tastes and odors. Milk with changes in taste, smell, color,
consistency, and sediment is not allowed. With an indistinct sour taste, a boiling
test is carried out: even with a slight increase in acidity, the milk coagulates.
Skimmed milk has a bluish tint, malt milk has a sediment and a grayish color.
The signs of substandard milk beverages are perekisshy, too sour, acetic
acid taste, when moldy smell and taste, viscous (except acidophilus products)
and expanded con-sistency (except koumiss, sour milk, acidophilus-yeast milk).
Sour cream benign: white or slightly yellowish, with a slight lactic acid
taste, no grains and lumps that installs with stirring in hot water;
- substandard: sour or rancid, acetic, moldy or putrid smell, foamy and
curd consistency.
Cottage cheese is benign has a sour-milk smell and taste;
- substandard – moldy, musty or sour smell, excessively sour or yeast
taste, swelling, donkey, mold.
Good-quality cheese: taste without bitterness, consistency elastic,
homogeneous, crust without cracks, mucus and mold (except for special types of
cheese);
- substandard: a musty or sour smell, a form that has melted, swollen, a
crust with cracks, mold, mucus.
Indicators of the quality of meat products
Good-quality chilled meat is covered with a dry pale red crust, slightly
moist when cut, but not sticky. Meat juice is transparent. The color on the
section ranges from light pink to dark red depending on the type, age and degree
of exsanguination of the animal. The consistency is elastic, the fossa is leveled
when pressed with a finger. Fat is dense, crumbles when crushed. The color of
beef fat is white-yellow, pork - white or white–pink. The bone marrow fills the
entire cavity of the tubular bones, it is elastic, yellow. After cooking the meat,
the broth is transparent, with a pleasant smell. In good-quality thawed meat, the
color of fat is reddish, the surface is moist, the meat has a dough-like
consistency, when pressed with a finger, the pit does not align, the broth is
slightly cloudy. Signs of a change in freshness – like chilled meat.
Substandard meat has a blackish crust, moist, sticky, slick surface. The
consistency is flabby. The pit does not fill up when pressed or fills up slowly. On
the incision, my skin is grayish or greenish in color, sticks to the fingers. Grease
of a smearing consistency with a rancid smell. The bone marrow does not fill the
bone cavity. The smell of meat and broth is sour-putrid. The broth is cloudy. To
determine the quality of meat, a ―knife" test is also made. A heated knife is stuck
into a piece of meat. If the meat is stale, then the knife taken out has an
unpleasant smell.
Boiled sausage is benign: the shell is dry, without mucus, fits snugly to
the minced meat. On the cut, the consistency is dense, juicy. The color is pink,
uniform. The pieces of bacon are white, elastic. The smell is specific to each
type of sausage.
Boiled sausage is of poor quality: sour or musty smell, donkey and mold
of the shell. When the sausage is licked in the places where the loaves are tied
 52
and in the folds of the shell, without other changes, the sausage can be used after
heat treatment. The minced meat is loose with gray areas, the fat is gray-
greenish, rancid (the gray color of the minced meat is due to a lack of nitrites,
with good organoleptic properties, the sausage is of good quality).
Fish quality indicators
The fish is benign: the eyes are convex, the cornea is transparent, the gills
are bright red, the mucus is transparent, the scales are glossy, the muscle tissue
is dense, gray-white, the meat is hardly separated from the bone. After cooking,
the broth is clear, fragrant.
The fish is of poor quality: the gills are brown, grayish-red, the eyes are
sunken, reddened, the scales easily peel off, partial protrusion of the intestines
from the anus, the meat along the spine is reddish ("tan"), the muscles are
sluggish, separate from the bones, when pressing a finger on the tissue, the fossa
does not align, the smell is putrid. After cooking, the broth is not transparent,
with an unpleasant smell. The latter is determined by the breakdown "on the
knife", stuck in the muscles behind the head.
Fat quality indicators
Good-quality fats: butter — white-cream or light yellow color, without
foreign tastes and odors, homogeneous consistency; melted cow's butter has a
soft, granular consistency, in the molten state – transparent, without sediment.
Refined vegetable oils are transparent, without sediment, odor and taste, or with
a weakly pronounced and characteristic odor of this oil; unrefined oils give a
precipitate of up to 1.5% of the total oil volume.
Low-quality fats: butter may have an unpleasant bitter taste, a sharp smell,
darkening of the surface (rancidity), a taste of lard, stearin candles, whitening,
hardening (osalivanie), greening of the mass (with prolonged improper storage
in refrigerators), the presence of mold, cheese or putrid taste, etc. If there is only
a darkened edge (staff), the oil is cleaned. Vegetable oils have an unpleasant
taste (sharp, burning, rancid) and smell. To determine the smell, the oil is rubbed
on the palm of your hand, the taste is determined at an oil temperature of about
+ 20 °C. Rancid fats not only have unpleasant tastes and odors, but they
accumulate fat breakdown products harmful to the body, lose essential fatty
acids and vitamins. Such fats are strictly prohibited in medical nutrition.
Indicators of the quality of cereals
Cereals should be dry, clean, loose, without foreign inclusions, browned,
darkened kernels, damaged due to rotting, mold formation or charring. The taste
of fresh cereals is slightly sweet. A slight taste of bitterness is allowed in
oatmeal. The smell is determined after they are heated in a clean bowl for 2
minutes. Stale, substandard cereals have bitter, sour and other unpleasant tastes,
musty and moldy odors, the presence of sand and barn pests. Pasta should not
have a taste of bitterness, mustiness, moldy and other foreign odors, and when
boiled until ready, they should not lose shape, stick together, form lumps.
Flour quality indicators
Rye flour should have a grayish-brown color, wheat flour - pure white or
with a yellowish tinge. The higher the grade of flour, the whiter it is. Good-
 53
quality flour should have a characteristic smell and a pleasant, characteristic
taste, without extraneous tastes. Good flour is soft, homogeneous, does not
contain flakes and does not cool your hands, as does raw flour. When squeezing
flour in the fist, a lump should form, which easily crumbles in the unclenched
palm (if it does not form, it means that the flour is raw or soaked).
The reddish color of rye flour indicates a large admixture of rubies, dark
brown indicates poor and long storage, infection with pests, etc. The presence of
a large number of black particles may be caused by the presence of a pupa or
ergot. Spoiled flour tastes musty and sour. Spoiled flour has a bitter taste
(depending on the presence of impurities), sweet - if obtained from sprouted
grain. When chewing, flour should not crunch on the teeth, which happens if it
contains a lot of mineral impurities.
Bread quality indicators
Bread should have a certain shape, set for this product, a smooth, even
surface without cracks, swellings, hot spots and foreign inclusions. The upper
crust should not lag behind the crumb, the lower one should contain a "temper"
(a layer of non-baked dough). The thickness of the crusts should not exceed 0.5
cm. The crumb on the cut is homogeneous, without flour layers from unpeeled
dough or old processed bread, finely porous, well baked (the hole from pressing
the palm is quickly leveled) and not sticky. The smell should be pleasant,
aromatic, characteristic of this type of bread. Musty smell is a sign of poor-
quality flour. The taste should be pleasant, without bitterness and aftertaste,
when chewing, there should be no crunch on the teeth from millstone sand or
other mineral impurities. The bitter or musty taste of bread usually indicates its
preparation from low-quality flour or the spoilage of bread from long and
irrational storage, for example, in a damp room.
Examination of canned food
Canned food, depending on the method of canning, is sold as a true
canned food or as a reserve.
True canned food is a sterile food product in hermetically sealed
containers, sterilized in special autoclaves. Preserves are non-sterilizable fish
products (sprats, herring, etc.), filled with marinade or spicy brine and
hermetically sealed in jars. There are no requirements for the sterility of the
product for condoms, and therefore they are stored for a short time and only in
the cold.
Canned food can be meat, fish, vegetable, meat-vegetable, fruit, etc.
Canned food is evaluated in accordance with GOST, for example, GOST 13534-
2015 «Canned meat and meat-growing».
The contents of the cans must correspond to the name indicated on the
label and the marking of the impressions on the bottom and/or lid of the jar.
The prints allow you to determine the nature of canned food by the
assortment number and industry index, the date of their release (date, month,
year), the number of the enterprise that released this batch and the shift number.
There are several marking options:
1) signs can be placed on the lid and on the bottom - in one row,
 54
2) the marking can only be on the lid or on the bottom - in 2 or 3 rows.
Decoding of some assortment numbers in the meat industry: 01 - beef
stew; 03 - pork stew.
In the fishing industry, assortment numbers are usually indicated by one
or three digits or letters (except P), for example:
G - keta in its own juice; B - keta in tomato sauce.
Some symbols of the index of the system (industry) in charge of which the
manufacturer is located:
M - meat industry (canned meat can also be marked: MM or MS);
D - dairy industry;
F - fishing industry.
The marking "M" can be on canned fish and seafood. "1P" is indicated on
canned fish or seaweed, "2P" - with crabs. Sometimes, in the 3rd row, the
number before the letter indicates the shift number;
AI - agricultural industry.
On some canned goods, the months are indicated by letters arranged in
alphabetical order: A - January, B - February, C - March, D- April, D - May, E -
June, W - July, I - August, K - September, L - October, M - November, N -
December (the letters Z and Y are excluded).
Independent work
Task 1. Evaluate the goodness of flour.
Evaluation of the organoleptic parameters of flour
To determine the color of the flour, pour a thin layer on black paper and
compare it with the characteristics of the flour according to the standard. In the
absence of a standard, describe visually.
The higher the grade of flour, the lighter and more uniform the color.
To determine the smell, take a small amount of flour in the palm of your
hand or a piece of paper, warm it with your breath and sniff.
The results of the analysis:___________________________________________
________________________________________________________________
________________________________________________________________
A touch test – when lowering the hand into the flour, the wet flour "cools"
the hand. When the flour is compressed, a lump forms in the fist. If the lump
crumbles quickly– the flour is dry or there is a lot of bran (bran can be spilled
when examining the color of flour). If the lump crumbles slowly and a finger
print is visible on it – flour of normal humidity. If the lump does not crumble
and the finger drawings are clearly visible, the flour is moist (humidity is more
than 15%).
The results of the analysis:___________________________________________
________________________________________________________________
________________________________________________________________
 55
Task 2. Evaluate the goodness of bread.
Evaluation of the appearance and organoleptic characteristics of bread.
The surface of the bread should be smooth, without cracks and tears. It is
not allowed that the upper crust lags behind the crumb. The thickness of the
crusts should be no more than 0.5 cm. If the upper crust is very thin and lags
behind the crumb, then the temperature of the oven was too high, the crust
formed quickly, and gases (carbon dioxide, water and alcohol vapors) when
expanding in the heated space, striving to get out, raised the upper crust. On the
contrary, a thick crust and the presence of hardening (a layer of unpeeled dough
at the bottom crust) are signs of insufficient oven temperature.
The color of the crust should be uniform, brown-brown in rye bread and
light or dark yellow in wheat.
The crumb in the section should be homogeneous (there should be no
lumps of unpeeled dough or old bread), finely porous and with gentle pressure
with a finger should quickly take its original shape. The taste should be pleasant,
without bitterness and extraneous taste. When loosening, there should be no
crunch on the teeth and mineral impurities.
The smell of bread should be pleasant, fragrant, characteristic of this type
of bread.
A musty smell is a sign of poor quality of the flour from which the bread
is baked.
The results of the analysis:___________________________________________
________________________________________________________________
________________________________________________________________
Task 3. Evaluate the quality of milk.
Evaluation of organoleptic parameters and consistency of milk
─ The color of milk is determined in a glass on a white background.
─ The smell of milk is determined in a slightly warmed-up form by the sense of
smell.
─ The taste of milk is determined at room temperature organoleptic.
─ Consistency - is determined by a "nail" sample (a drop applied to the
thumbnail does not spread) or by eye (by the flow of milk along the walls of
a glass vessel).
Analysis results:
the color of milk___________________________________________________
the smell of milk_________________________________________________
the taste of milk__________________________________________________
the consistency of milk_____________________________________________
Task 4. Decipher the impressions (markings) on canned cans and conduct an
external inspection of the cans.
 56
Examples of decoding prints:
090214 09.02.14 - production date
meat 1 01В 1-shift, 01- assortment. number, B- top grade
А 15 A is the index of the system, 15 is the number of the manufacturer
200300 20.03.- 00- production date
meat 594 594- assortment. Number
А228 A -system index, 2 shift, 28-factory number
290115 29.01.15- production date
fish 931ПО8 93- plant number, 1- shift, P08-assortment.Number
1Р 1P- fish
2- shift, 16.03.09- production date
2160309
fish P- index of the system (type of canned food)
Р078143
078- plant number, 143- assortment number
cap:
2-shift, 02.01(A 0).14- production date
202А014
fish
Bottom
P-system index, 25-factory number, 1- shift
Р251
P- index of industry,
Р150415
fish 15.04.15- production date
14351
143- assortment.number, 51-manufacturer's number
Recording of the impression on the lid:_________________________________
________________________________________________________________
The result of decoding the prints: _____________________________________
________________________________________________________________
External inspection of cans
External inspection of cans is of great importance in the evaluation of
canned food. It allows you to identify defects on cans, the presence of rust, the
shape and presence of deformation of cans, as well as the presence of swelling
(bombage) of the bottom and lid of the jar.
Bombage is distinguished between true (biological) and false.
True bombage comes from putrefactive decomposition of canned food
with the release of gaseous products of putrefaction and indicates spoilage of the
contents. At the same time, both bottoms of the jar are swollen, bend a little
under pressure and quickly restore their original position.
False bombing depends on: excessive overfilling of the jar, crumpling of
the jar, other mechanical and physical reasons not related to spoilage of
products. With false bombing, one bottom is most often swollen, when pressed,
the bottom bends slightly inward and does not quickly return to its original
position (lack of gas pressure), and if it returns, then with a crack and a pop,
which is explained by the rigidity and springiness of the walls of the jar.
Inspection results: ______________________________________________
_____________________________________________________________
 57
Practical lesson 7
Medical control over the organization of nutrition
in medical and preventive organizations
The purpose of the lesson: to study the organization of nutrition in the health
care center and the organization of medical control over it.
Equipment of the lesson: normative documents on the organization of nutrition
in health care facilities and the work of the food department: sanitary rules of the
SanRaR 2.3/2.4.3590-20 «Sanitary and epidemiological requirements for the
organization of public nutrition of the population», SanRaR 1.2.3685-21
«Hygienic standards and requirements for ensuring the safety and (or)
harmlessness of environmental factors for humans», Order of the Ministry of
Health of the Russian Federation № 1008n of 23.09.2020 "Procedure for
providing patients with therapeutic nutrition»; SanRaR 2.3.2.1324-03
«Hygienic requirements for the shelf life and storage conditions of food
products», Order of the Ministry of Health of the Russian Federation № 330 of
5.08. 2003 «On measures to improve medical nutrition in medical and
preventive institutions of the Russian Federation».
Methodical instructions
Therapeutic nutrition in health care facilities is an important part of the
treatment process and should be organized in accordance with the Federal Law
«On the Basics of protecting the health of citizens in the Russian Federation»
(№ 323- FZ, Article 39 Therapeutic Nutrition); Order of the Ministry of Health
of the Russian Federation № 1008n of 23.09.2020 «Procedure for providing
patients with therapeutic nutrition»; order of the Ministry of Health of the
Russian Federation «On measures to improve therapeutic nutrition in medical
and preventive institutions of the Russian Federation» № 330 of 5.08.2003,
SanRaR 2.3/2.4.3590-20 «Sanitary and epidemiological requirements for the
organization of public catering of the population».
According to the order of the Ministry of Health of the Russian Federation
№ 1008n of 2020, the diet of medical nutrition of patients must meet the
following characteristics:
 compliance of the energy value with the patient's energy expenditure,
taking into account gender and age characteristics, level of physical
activity;
 provision of correction of impaired or lost body functions as a result of the
disease in order to increase the adaptive potential, including using
specialized food mixtures of protein composite dry, vitamin and mineral
complexes (for medical reasons - products of mineral nutrition);
 compliance of the chemical composition with the physiological needs of
the human body in macronutrients (proteins, fats, carbohydrates) and
micronutrients (vitamins, minerals and trace elements);
 providing a diverse set of food products;
 ensuring the power regime;
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 the use of technological and culinary processing of food products,
ensuring the preservation of their original nutritional value, increasing the
digestibility of food substances.
The Order of the Ministry of Health of the Russian Federation of
23.09.2020 № 1008n «Procedure for providing patients with therapeutic
nutrition» (Application № 2) defines the nomenclature of standard diets in
medical organizations:
1. The main variant of the standard diet (SD): for example, with chronic
gastritis in remission; gastric ulcer and duodenal ulcer in remission, etc.
2. A variant of the diet with mechanical and chemical treatment: with gastric
ulcer and duodenal ulcer in the acute stage and unstable remission; acute
gastritis.
3. A variant of a diet with an increased amount of protein (high-protein diet)
(HPD): after gastric resection after 2-4 months for peptic ulcer in the
presence of dumping syndrome, cholecystitis, hepatitis.
4. A variant of a diet with a reduced amount of protein (low-protein diet)
(LPD): after gastric resection after 2-4 months for peptic ulcer in the
presence of dumping syndrome, cholecystitis, hepatitis.
5. A variant of a low-calorie diet (low-calorie diet) (LCD): with alimentary
obesity of varying degrees in the absence of pronounced complications from
the digestive, circulatory and other diseases requiring special dietary regimes;
type 2 diabetes mellitus with obesity; cardiovascular diseases in the presence
of overweight.
6. A variant of a high-calorie diet (high-calorie diet) (HCD): for tuberculosis of
the respiratory system; caseous pneumonia, etc.
Therapeutic nutrition is prescribed to patients by the attending physician
or the doctor in charge of the medical organization in accordance with the
nosological form of diseases according to the main and (or) concomitant
diagnosis - upon admission to the medical organization no later than 4 hours
from the moment of the patient's admission to the hospital. In case of a change
in the clinical diagnosis requiring a change in therapeutic nutrition, the patient is
prescribed appropriate therapeutic nutrition no later than 48 hours from the date
of the change.
Standards of clinical nutrition (per patient) approved by Prika-zami,
Ministry of health of the Russian Federation № 395н (from 21.06.2013) and №
330 (from 5.08.2003).
General management of the organization of nutrition in hospitals, medical
organizations is the main doctor or his assistant at the medical unit and medical
units – their head-ing.
In accordance with the order of the Ministry of Health of the Russian
Federation No. 330, direct supervision for the organization of medical nutrition
and its adequate use in all departments is carried out by a dietitian (if available
in the Ministry of Health). The dietitian advises the doctors of the departments
on the organization of therapeutic nutrition, advises patients on the issues of
therapeutic and rational nutrition, conducts a random check of medical histories
 59
on the compliance of the prescribed diets and the stages of diet therapy, analyzes
the effectiveness of therapeutic nutrition. The nutritionist directs the work of the
medical nurse of the dietetic, supervises the work of the food unit. He also
develops a 7-day menu for basic diets and checks daily menus, controls the
quality of incoming products, their storage conditions and terms of sale, the
correctness of culinary processing of food, compliance with its diets, participates
in the brakering of ready-made food, monitors the fulfillment of food norms,
energy values and chemical composition of diets. The dietitian monitors the
timeliness of preventive medical examinations of the employees of the food
service and canteens, etc.
The dietetic nurse monitors the operation of the food unit and compliance
with sanitary and hygienic rules by the employees of the food unit; checks the
quality of products when they arrive at the warehouse and the food unit,
monitors the correctness of the storage of food stocks, the correctness of the
bookmark of products when preparing meals, participates in the bracketing of
ready-made food, maintains medical documentation.
In hospitals with more than 100 beds, an advisory body is created – the
council for medical nutrition, which includes: the chief physician (or his deputy
for medical work), a dietitian, heads of departments, a deputy for AHH, dietary
nurses, a production manager (or chef). Other specialists may also be involved
in the work of the Council.
The main tasks of the Council:
— improvement of the organization of medical nutrition in health care facilities;
— introduction of new technologies of preventive, dietary and enteral nutrition;
— approval of the nomenclature of diets, mixtures for enteral nutrition,
biologically active food additives to be introduced in this institution;
— approval of seven-day menus, card files of dishes and a set of mixtures for
enteral nutrition;
— development of forms and plans for professional development of medical
nutrition staff;
— control over the organization of therapeutic nutrition and analysis of the
effectiveness of diet therapy for various diseases.
Quarterly, at the meetings of the Council on Therapeutic Nutrition,
questions on the organization of nutrition in health care facilities should be
heard.
According to the "Sanitary and epidemiological requirements for the
organization of public catering of the population" (SanRaR -20 ), a
responsible person may be appointed in a medical organization to carry out the
rejection of ready-made food and the selection of a daily sample, as well as (in
the absence of medical personnel) to inspect workers engaged in the
manufacture of catering products and workers directly in contact with food
products, including food raw materials, for the presence of pustular diseases of
the skin of the hands and exposed body surfaces, signs of infectious diseases.
The results of the examination should be recorded in the hygiene journal.
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Independent work
Task 1. Get acquainted with the regulatory documents on nutrition in medical
organizations.
Task 2. To study the hygienic requirements for the operation of the food unit;
the organization of quality control of incoming products and prepared food.
Proper and good-quality nutrition of patients in a medical organization
largely depends on the work of the food department.
The requirements for the organization of patient nutrition, for the
operation of the catering unit in the health care facility and cooking are
determined by the «Sanitary and epidemiological requirements for the
organization of public catering» (SanRaR 2.3/2.4.3590-20 ), by Order of the
Ministry of Health of the Russian Federation 23.09.2020 № 1008n «Procedure
for providing patients with medical nutrition»; «Hygienic requirements for shelf
life and conditions of food storage» (SanRaR 2.3.2.1324-03).
The catering unit (catering company) of a medical organization should be
located in a separate building, which can be connected by transport tunnels with
tent departments, except for the infec-tional ones. It is allowed to place the food
unit in medical buildings.
Important hygienic requirements for the operation of the food unit are:
- Provision of the food unit with cold and hot water, proper equipment for
drainage, ventilation, lighting; sufficient sanitary and technical equipment
(SanRaR 1.2.3685—21).
- The interior decoration of the premises of the food unit should be made of
materials that allow for daily wet cleaning, treatment with detergents and
disinfectants.
- The device of the food unit (composition and layout of the premises) should
ensure compliance with the principle of flowability of the technological
process, i.e. separation of the flows of raw products and finished food, dirty
and clean.
- To do this, the food department must have the necessary set of premises
(which depends on the capacity of the MPO): storerooms for dry products
(flour, pasta, cereals, etc.), storerooms for vegetables and fruits, storage
chambers (refrigerators) for perishable products (dairy, meat, fish), raw
workshops (for processing raw products), hot shop, washing dishes.
- To work with raw products and ready-made food, there must be different
marked production tables, cutting boards, knives and kitchen utensils.
- Dishes for cooking should be made of stainless steel.
- It is necessary to ensure the receipt of high-quality products, which is
confirmed by accompanying documents certifying their quality and safety.
The quality of products is also evaluated organoleptically. Information about
the received perishable products should be entered in the journal of the raw
product brakerage.
- Compliance with the conditions, rules for the storage of raw products and
finished products and the timing of their implementation.
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The terms of sale of perishable products are established by SanRaR
2.3.2.1324-03 «Hygienic requirements for shelf life and storage conditions of
food products» or are indicated in the accompanying documents for the
products.
Raw and finished products should be stored separately. For the storage of
perishable products (dairy, meat, fish), there should be a sufficient amount of
refrigeration equipment: refrigerators, cold rooms, in which the rules of
commodity production and temperature regime (+2 ... +6C) should be observed.
In order to control the risk of conditions for the reproduction of
pathogenic microorganisms, it is necessary to register temperature indicators in
refrigeration equipment and storage rooms daily (and humidity indicators in
storage rooms as well).
Ready-made food, the implementation period of which is not more than 3
hours, should be issued to the departments only after the finished food has been
rejected.
The rejection of ready-made food (checking its quality before delivery
from the kitchen to the departments by taking a sample directly from the boiler)
by a responsible person or a commission (if any), regardless of the method of
organization of nutrition (by the medical organization itself or by a third-party
organization under the contract) (clause 7.1.3 of the SanRaR 2.3/2.4.3590-20).
In case of violation of the cooking technology, as well as in case of
unavailability, the dish is not allowed to be issued until the identified
deficiencies are eliminated.
The results of the sample are recorded in the journal of the ready-made
food.
It is not allowed to leave food leftovers in buffets after it is distributed to
patients, as well as to mix food leftovers with fresh dishes.
The rules of culinary processing (cooking) must be observed: the eggs
used must be pre-processed, washing of pasta and rice side dishes is not
allowed. In order to prevent infectious diseases, food poisoning and taking into
account the nomenclature of standard diets, Application № 2 of the Order of the
Ministry of Health of the Russian Federation № 1008n (2020) it is not allowed
to cook: pasta «navy-style», okroshka, aspic dishes, fried eggs, cheese mass,
deep-fried products; or dishes prohibited in baby food: smoked meats, spicy
spices, seasonings (vinegar, horseradish, mustard, ketchup, mayonnaise), radish,
radish, marinades, nuts, mushrooms, carbonated drinks, coffee, caviar, pates,
cheese mass, cakes, sweets, sausage products (sausages, sausages, sausages)
(order of the Ministry of Health of the Russian Federation № 1008n (2020);
SanRaR 2.3/2.4.3590-20 «Sanitary and epidemiological requirements for the
organization of public catering of the population»).
It is necessary to use disposable gloves when portioning dishes, preparing
cold snacks, salads.
To control the quality and safety of food prepared at the food processing
unit of the medical facility, daily samples should be left, which are stored in
specially selected disinfected and labeled glass containers with tightly closed
 62
lids for at least 48 hours at a temperature from +2 ° C to +6 ° C.
Dishes for storing daily samples (containers and lids) are processed by
boiling for 5 minutes.
Daily samples are taken by the designated responsible person of the
medical organization (according to the 2.3/2.4.3590-20 «Sanitary and
epidemiological requirements for the organization of public catering of the
population») or by a medical professional (or, under his guidance, by a doctor).
If food is prepared at the catering department of a third-party organization
(if a contract is concluded with it), the selection and storage of a daily sample
should be carried out by a responsible employee of this third-party organization
under the direction of a medical employee of a medical organization.
At the food hall, it is necessary to fulfill the requirements for proper
washing of dishes and sanitary maintenance of premises and equipment.
Washing of tableware should be carried out separately from kitchen
utensils.
Cleaning equipment should be separate for premises of different
functional purposes.
In industrial premises, wet cleaning (with the use of detergents and
disinfectants) should be carried out daily.
For rooms of different functional purposes, there should be a separate
marked inventory, which is stored in specially designated places, moreover,
cleaning equipment for the toilet – separately.
The staff of the food unit should observe the rules of personal hygiene and
the timing of the necessary medical examinations.
In health care facilities, the requirements for transporting food to the
departments must be met.
Medical organizations should use thermos flasks or tightly closed dishes
to transport finished food products to the buffet departments.
The distribution of food to patients in medical organizations (MO) should
be carried out by designated responsible persons. It is not allowed to involve
other personnel in the distribution of food.
In the departments of the Ministry of Defense, the nurse on duty must
check daily compliance with the rules and shelf life of products stored in the
department's refrigerators.
In day hospitals with patients staying no more than 4 hours, if hot meals
are not organized, there should be rooms for eating, in which a washbasin,
refrigerator and equipment for heating food are installed.
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Practical lesson 8
Hygienic requirements for the placement, layout,
equipment and sanitary and anti-epidemic regime
of medical and pharmacy organizations
The purpose of the lesson: to study the basic hygienic requirements for the
placement, layout, equipment and sanitary and anti-epidemic regime of medical
and preventive organizations and pharmacy organizations.
Equipment of the lesson: regulatory documents regulating the activities of
medical and pharmacy organizations.
Methodical instructions
The main requirements for the placement, layout and equipment of
medical and pharmacy organizations are regulated by the following normative
documents:
1. SanRaR 2.1.3684-21 «Sanitary and epidemiological requirements for
the maintenance of the territories of urban and rural settlements, for water
facilities, drinking water and drinking water supply to the population,
atmospheric air, soils, residential premises, operation of industrial, public
premises, organization and conduct of sanitary and anti-epidemic (preventive)
measures». In these sanitary rules, the section «X is important. Requirements for
waste management», which (paragraph 157) defines the requirements for the
collection, use, disposal, placement, storage, transportation, accounting and
disposal of medical waste.
2. SanRaR 1.2.3685-21 «Hygienic standards and requirements for
ensuring the safety and (or) harmlessness of environmental factors for humans»,
which specifies the standards of various environmental factors, including natural
and artificial lighting (practical lesson 3).
3. SR 2.1.3678-20 «Sanitary and epidemiological requirements for the
operation of premises, buildings, structures, equipment and transport, as well as
the conditions of activity of economic entities that sell goods, perform works or
provide services.» These sanitary rules set out the basic requirements for the
microclimate of medical organizations and pharmacies (practical lesson 2),
accommodation, premises, air exchange, etc.
4. SanRaR 3.3686-21 «Sanitary and epidemiological requirements for the
prevention of infectious diseases» - defines the main measures for the
prevention of «health care-associated infections» (HAIs).
Medical organizations (MO) and pharmacies can be located in a separate
building or in an apartment building - subject to certain requirements.
In residential buildings (if there is a separate entrance), it is allowed to
place: women's consultations, offices of general practitioners and private
practitioners, dental offices, health and wellness, rehabilitation and rehabilitation
centers, etc.
The ventilation system of a medical organization located in an apartment
building should be (SR 2.1.3678-20) separate from the ventilation of an
 64
apartment building. But, according to SanRaR 2.1.3684-21, «it is allowed to
attach exhaust ventilation of non-residential premises to the general exhaust
system of a residential building, the emissions of which will not lead to
exceeding the hygienic standards of atmospheric air quality established for
residential areas».
Health facilities located in residential buildings must have a sanitary and
epidemiological conclusion.
It is not allowed to place medical facilities in residential buildings to
provide medical care to persons in the profiles of «Infectious diseases» and
«Pathophysiology»; persons who suffer from alcohol and drug addiction.
It is not allowed to place microbiological laboratories (departments) in
residential buildings and in built-in premises attached to them.
Magnetic resonance imaging departments (offices) are not allowed to be
located adjacent to apartments.
It is not allowed to place an X-ray department (office) in residential
buildings and children's institutions.
Placement of MO (pharmacy) in an apartment building is possible only
after the transfer of residential premises to non-residential in accordance with
the federal law «Housing Code of the Russian Federation» (Article 23).
According to SR 2.1.3678-20, additional sanitary and epidemiological
requirements are imposed on medical organizations providing dental services.
The activities of dental medical organizations located in built-in (built-in-
attached) buildings of residential and public use should not lead to excess of
hygienic standards (noise, laser radiation, etc.).
Dental medical organizations located in apartment buildings should have a
separate entrance isolated from residential premises.
The minimum number of rooms necessary for the functioning of a dental
medical organization includes: a management group, a dentist's office, a room
for employees, a toilet, a pantry.
The maximum permissible levels of laser radiation during their operation
in medical organizations should not exceed the levels regulated by the hygienic
standards of environmental factors.
Separate offices are allocated for the organization of dental reception of
children. It is not allowed to use adult reception rooms for receiving children.
To organize the reception of children, a separate toilet with a toilet bowl and a
sink is equipped.
In dental offices, the area for the main dental unit should be at least 14
m , for an additional installation - 10 m2 (for a dental chair without a drill - 7
2

m2), the ceiling height of the offices - at least 2.4 meters.

Surgical interventions, for which medical activities in anesthesiology and
resuscitation are carried out, are carried out in an operating room, a small
operating room. A separate room is equipped for the temporary stay of the
patient after the operation.
The requirements for the interior decoration of the premises are set in
accordance with their functional purpose.
 65
In offices with one-way natural lighting, dental chairs are installed in one
row along the light-conducting wall.
If there are several dental chairs in the office, they are separated by
opaque partitions with a height of at least 1.5 meters.
If there are no more than 3 chairs in the dental medical organization, the
sterilization equipment is installed directly in the offices.
Dental offices are equipped with separate or two-section sinks for hand
washing and tool handling. In the presence of sterilization and the organization
of centralized sterilization processing of instruments in it, one sink is installed in
the cabinets. In the operating unit, sinks are installed in the pre-treatment room.
Elbow or sensor mixers are installed in surgical, sterilization, and
preoperative rooms.
The premises of the dental (dental) laboratory and dental office, in which
work with gypsum is carried out, must have equipment for the deposition of
gypsum from wastewater before descending into the sewer.
In dental medical organizations with a total area of no more than 500
sq.m, in rooms of cleanliness classes B and C (except operating rooms, X-ray
rooms, computer and magnetic resonance imaging rooms), ventilation of the
premises is carried out through opening transoms or exhaust ventilation without
mechanical prompting.
In the dental laboratory, local suction and general exhaust ventilation can
be combined into one exhaust system within the laboratory premises or in the
ventilation chamber. The device of general general exchange supply ventilation
for laboratory premises and other premises of a dental medical organization,
while the supply of supply air to the laboratory premises must be organized
along a self-contained duct passing from the ventilation chamber, with a check
valve installed on it within the ventilation chamber.
Technological equipment dental laboratory, which includes sections for
cleaning the removed air from this equipment, as well as closed-loop equipment,
does not require additional local suction.
In dental laboratories, there should be local suction from the workplaces
of dental technicians, grinding motors, in the foundry above the furnace, in the
soldering room, over heating devices and work tables in the room for
polymerization of materials. The air released into the atmosphere must be
cleaned in accordance with the technological characteristics of the equipment
and materials. Local suction systems should be structurally autonomous from
the system of general exchange exhaust ventilation of dental medical
organizations.
In the rooms to which the requirements of aseptic conditions are imposed,
there must be a hidden laying of air ducts, pipelines, fittings.
The set of basic premises necessary to ensure the anti-epidemic regime
and the minimum areas of the MO premises (including the dental profile) is
regulated by SR 2.1.3678-20 (Application 1).
 66
Name of premises Area, m2
14 + 10 for each additional dental unit
Doctor's office (dentist-therapist, surgeon,
or 7 for an additional dental chair
orthopedist, orthodontist, pediatric dentist)
without installation
Oral Hygiene Cabinet 10
Dental operating unit:
- preoperative (can be combined with a
sterilization room) 6
- operating room 20
- room for temporary stay of the patient
after surgery 4
Small operating room on the territory of the
dental department:
- gateway 4
- preoperative 6
Dental laboratory: 7 (4 m2 per technician, but no more
room for dental technicians than 10 technicians in one room)
Specialized rooms: polymerization, gypsum,
7
polishing, soldering
Foundry 4
In accordance with SR 2.1.3678-20, sanitary and epidemiological
requirements are also imposed when providing services by pharmacy
organizations.
In a pharmacy organization carrying out, along with other medicines, the
sale of immunobiological medicines, accounting, storage, as well as
neutralization of vaccines unsuitable for use should be provided.
The pharmacy must have premises, equipment, inventory that allow for
the storage of immunobiological medicines and other medicines, as well as the
preservation of the quality, effectiveness and safety of medicines, during
transportation (in the case of the pharmacy of this type of activity), storage and
sale.
The ceiling height of the production premises of newly constructed and
reconstructed buildings is determined by the dimensions of the equipment and
must be at least 2.4 meters.
The pharmacy must ensure the storage of medicines in accordance with
the instructions of the manufacturer of the medicinal product.
The pharmacy should be located in an isolated block of premises in
apartment buildings, public buildings or in detached buildings.
It is not allowed to place organizations that are functionally unrelated to it
in the pharmacy.
When placing a pharmacy in an apartment building, it is necessary to have
an entrance isolated from residential premises.
Loading and unloading of materials, products, goods for a pharmacy,
 67
built-in, built-in-attached to an apartment building, attached to an apartment
building should be carried out: from the ends of residential buildings, from
underground tunnels or closed parking lots, from the side of highways. It is not
allowed to load materials, products, goods from the courtyard of an apartment
building where the entrances to the apartments are located.
The location of the premises for the manufacture of medicines should
ensure the technological flow of the production process for the manufacture of
sterile and non-sterile forms.
The airlock of the aseptic unit must have conditions for putting on sterile
overalls and hygienic hand treatment. The supply of water supply and sewerage
in the aseptic box is not allowed.
Sinks with elbow mixers (or automatic mixers) are installed in the locks
of the aseptic unit and the assistant room to wash the hands of workers. Separate
sinks for washing dishes and workers' hands should be allocated and marked in
the washing room.
In the production premises of pharmacies, the cultivation of flowers, the
use of textile curtains, carpets is not allowed.
Pharmacy premises should have natural and artificial lighting. Natural
lighting may not be available in warehouses (without a permanent workplace),
storerooms, toilets, dressing rooms, showers, household and auxiliary rooms.
General artificial lighting should be provided in all rooms.
In the absence of natural lighting in the sales halls of pharmacies,
compensatory measures should be provided (normalized indicators of artificial
illumination are taken a step higher).
General and local lighting fixtures must have protective fittings that allow
them to be wet cleaned. General lighting fixtures must have solid (closed)
diffusers.
Pharmacy premises are equipped with general exchange ventilation with
natural or mechanical motivation. In pharmacies that do not manufacture
medicines, there may be no ventilation system with mechanical motivation.
The absence of ventilation systems with mechanical motivation is not
allowed in rooms with permanent workplaces that do not have natural
ventilation.
The premises of the aseptic unit are equipped with a mechanical
ventilation system with a predominance of inflow over exhaust. The supply of
clean air is carried out by laminar flows (that is, the air moves in layers without
mixing and pulsations)
The premises in which the packaging of volatile toxic substances is
carried out must be equipped with autonomous general exchange ventilation
systems with mechanical motivation.
It is not allowed to use ventilation chambers for other purposes (storage,
use as domestic premises).
The surfaces of furniture and equipment must be resistant to detergents
and disinfectants.
Pharmacy premises should be subjected to daily wet cleaning with the use
 68
of detergents and disinfectants. Pharmacies should be provided with a stock of
detergents and disinfectants for 3 days, which is calculated taking into account
the area of the treated surfaces, the amount of equipment being processed, the
availability of household equipment to ensure sanitary conditions.
For cleaning various premises (industrial premises, toilets, dressing rooms
and showers) and equipment, separate cleaning equipment is allocated, which is
marked and used for its intended purpose. Its storage is carried out in a
dedicated place (rooms or cabinets). Rags intended for cleaning production
equipment, after disinfection and drying, are stored in a clean, labeled, closed
container.
Cleaning of cabinets, shelves in the storage rooms of medicines is carried
out as necessary, but at least once a month.
Cleaning of all rooms with the treatment of walls, floors, equipment,
inventory, lamps with the use of detergents and disinfectants is carried out at
least once a month, and in the premises of the manufacture of medicines in
aseptic conditions — weekly.
The storage of workers' outerwear and shoes is carried out separately from
workwear.
The change of sanitary clothing should be carried out as pollution occurs,
but at least once a week. In industrial pharmacies in the premises of the
manufacture of medicines, hand washing sinks are equipped with soap
dispensers, skin antiseptics, disposable towels or electric dryers.
Laundry of sanitary clothes is carried out in the laundry (washing
machine) the organization itself, or under an agreement with a specialized
organization.
An administrative and household area should be organized for eating and
storing personal belongings of employees.
Independent work
Task 1. Study the regulatory documents regulating the basic requirements
for the placement, layout and equipment of medical and pharmacy
organizations.
Task 2. Study the basic requirements for the prevention of HAIs.
According to SanRaR 3.3686-21 "Sanitary and epidemiological
requirements for the prevention of infectious diseases", the reasons contributing
to the increase in the incidence of HAIs include: unsatisfactory architectural and
planning solutions, violations in the organization of the work of the Ministry of
Defense (including exceeding the norms of the bed capacity of the wards;
violations in the operation of supply and exhaust ventilation, etc.), violations in
the sanitary and technical condition, material provision and non-compliance
with the anti-epidemic regime.
The following requirements have been established for the implementation
of sanitary and anti-epidemic measures:
- sufficient material support (including: disposable syringes, catheters,
breathing tubes, dressing material, underwear, etc.);
 69
- compliance with the rules of injection in the wards;
- provision of medical personnel with sets of replaceable clothing: bathrobes,
medical suits, hats, replaceable shoes in accordance with the equipment
report card, but not less than 3 sets of workwear per employee. It is not
allowed for personnel to be in medical clothing and work shoes outside of the
medical services;
- mandatory use of masks in all departments during the period of
epidemiological distress ;
- compliance by medical personnel with the following rules (to achieve
effective hand washing and disinfection): cut nails short, lack of nail polish,
absence of artificial nails, absence of rings, rings and other jewelry on the
hands (item 3477 SanRaR 3.3686-21);
- hygienic treatment of hands by medical workers at all stages of medical care,
for which medical personnel must be provided with sufficient effective
means for washing and disinfecting hands;
- compliance with the norms of bed capacity of wards and compliance with the
cyclical filling of wards;
- compliance with the necessary requirements for the sanitary treatment of
patients upon their admission to the MO and during their stay in it;
(More detailed questions on HAIs are set out in the chapter Hospital hygiene
in the «Hygiene: Coincise Course of Lectures»).
Additional sanitary and epidemiological requirements have been
established for the organization and implementation of measures for the
prevention of HAIs and anti-epidemic measures in dental organizations.
In order to comply with the anti-epidemic regime, the doctor must work
accompanied by paramedical personnel who carry out workplace treatment,
disinfection, as well as, in the absence of centralized sterilization, pre-
sterilization cleaning and sterilization of medical equipment and medical
devices.
All dental offices should be provided with medical equipment and
medical devices in an amount sufficient for uninterrupted operation, taking into
account the time required for their processing between manipulations in
patients…
Sterile products are laid out on the dental table at the same time (on a
sterile tray or a sterile napkin) immediately before manipulations in a particular
patient.
Under the working surface of the table (on a shelf, in a drawer), it is
allowed to place devices and devices for various dental manipulations, filling
materials.
Breast wipes are subject to change after each patient. Single-use napkins
are collected as Class B waste, reusable ones are handed over for washing.
To rinse the mouth with water, disposable or multi-dose glasses are used
individually for each patient.
Disinfection of surfaces of objects located in the treatment area
(instrument table, control buttons, keyboard, air table, lamp, spittoon, headrest
 70
and armrests of the dental chair) is carried out after each patient…
Metal products are sterilized by the infrared method: dental forceps,
dental microsurgical instruments, carbide burs, diamond heads and discs, drill
bits, channel fillers and others.
Task 3. To study the sanitary and hygienic requirements for dental medical
organizations.
Task 4. To study the basic requirements for the premises, equipment and
sanitary regime of pharmacy organizations (pharmacies).
Task 5. Consider the design documentation of a residential apartment on the
possible placement of a medical organization (for example, a dental or
pharmacy) on its premises.

Meaning of terms on the image:

 План кватиры → plan of appartment:
 Коридор → corridor
 Туалет → Toilet
 Ванная → Bath
 Кухня → Kitchen
 Жилая → living Room
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Practical lesson 9
Organization of radiation safety in X-ray rooms
and when working with open and closed radiation sources
The purpose of the lesson: to study the organization of radiation safety of
medical personnel in X-ray rooms and when working with open and closed
radiation sources
Equipment of the lesson: «Basic sanitary rules for radiation safety» (BSRORS-
99/2010) - SP 2.6.1.2612-10; «Radiation safety standards» (SRS–99/2009) –
SanRaR 2.6.1.2523-09; «Hygienic requirements for the device and operation of
X-ray rooms, devices and X-ray examinations» (SanRaR 2.6.1–1192–03 ).
Methodical instructions
Every person is constantly exposed to ionizing radiation.
Ionizing radiation is streams of photons, elementary particles or
fragments of atomic fission capable of ionizing matter.
The main properties of ionizing radiation are penetrating and ionizing
ability.
The following most significant types of ionizing radiation are
distinguished:
1. X-ray radiation is electromagnetic waves, the length of which varies in the
range from 0.0001 to 50 nanometers (between ultra-violet and gamma
radiation);
2. gamma radiation (gamma rays) is a type of electromagnetic radiation
characterized by an extremely small wavelength - less than 2⋅10-10 m, has a
relatively weak ionizing ability and a very large penetrating ability (for
example, passes through a 5 cm thick layer of lead);
Particle fluxes: beta particles, alpha particles, neutrons, protons, fission
fragments (heavy ions that occur during nuclear fission).
3. β-rays are a stream of electrons; the ionizing ability is much less than that of
α-rays, and the penetrating ability is much greater;
4. α-rays are a stream of helium atom nuclei; they have a high ionizing ability
and low penetrating power.
Ionizing radiation does not include visible light and ultraviolet radiation,
which, in some cases, can also ionize matter.
The average dose of ionizing radiation, which falls on the dose of each
inhabitant of the planet, is called the population dose.
The population dose is:
1) Natural background (0.01 mP/hour) due to natural sources: cosmic radiation
and natural radionuclides contained in the surrounding environment and
entering the human body with air, water and food. The main contribution to
the radiation dose is made by uranium-238 (U-238), thorium-232 (Th-232)
and potassium-40 (K-40). Uranium and thorium radionuclides have longer
half-lives. The main part of the irradiation from ground radiation is caused by
radon -222 and, to a lesser extent, thoron (radon -220). As a result of the
 72
decay of natural isotopes (radioactive nuclides), various types of ionizing
radiation arise.
2) Technogenically enhanced radiation background (200-400 mR/year) due to
artificial radiation sources: therapeutic and diagnostic procedures, ionizing
radiation generators, etc.
Radiation hazard (biological effect of ionizing radiation) is determined
by the following factors:
1. The whole body or some part of it is irradiated.
2. The level of radiation dose (the higher the level of absorbed doses, the higher
the damaging effect).
3. Irradiation time (the fraction of irradiation in time is important for the
prolongation of life, although the total total dose may be numerically equal to
absolutely fatal, for example, in radiologists).
4. The type of irradiation (so, α-particles do not pose a great danger with
external irradiation).
5. Radiation energy (high energy in gamma-emitters).
6. Related factors (other physical or chemical, biological factors).
Individual characteristics of the human body manifest themselves only
with small doses of radiation.
Ionizing radiation when exposed to the human body can cause two types
of effects:
1) deterministic effects of radiation exposure are clinically detectable harmful
biological effects (radiation sickness, dermatitis, radiation cataract,
abnormalities in fetal development, etc.), for which it is assumed that there is
a threshold below which the effect is absent, and above that the severity of
the effect depends on the dose;
2) stochastic (probabilistic) effects of radiation are harmful biological effects
(malignant tumors, leukemias) that do not have a dose threshold of
occurrence. The probability of their occurrence is proportional to the dose,
but the severity of the manifestation does not depend on the dose.
The main goal of radiation safety is to protect human health from the
harmful effects of ionizing radiation.
Radiation safety, according to the Federal Law of the Russian Federation
«On Radiation Safety of the population» No. 3-FZ dated 09.01.96 (as amended.
dated 07/19/2011)– is the state of protection of the present and future health of
people from the harmful effects of ionizing radiation on their health. Radiation
safety can also be defined as a set of measures aimed at limiting the exposures
of personnel, individuals from the population and the entire population to the
lowest dose levels achieved by means acceptable to society, and at preventing
the occurrence of early effects of exposure and limiting the manifestations of
long-term effects of exposure to an acceptable level.
The principle of optimization is to maintain at the lowest possible and
achievable level, taking into account economic and social factors, individual
radiation doses and the number of people exposed when using any source of
ionizing radiation.
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Principle the basic principles of ensuring radiation safety:
The principle of rationing is not exceeding the permissible limits of
individual doses of irradiation of citizens from all sources of ionizing radiation,
i.e. it is implemented by establishing hygienic standards (permissible dose
limits) of irradiation.
For employees (personnel), the average annual effective dose is 20 mSv
(0,02 Sv) or the effective dose for the period of work activity (50 years) is 1
sievert; irradiation in an annual effective dose of up to 50 mSv (0,05 Sv) is
permissible, provided that the average annual effective dose calculated over five
consecutive years does not exceed 20 mSv.
For women under the age of 45, the equivalent dose on the surface of the
lower part of the abdominal area should not exceed 1 mSv per month.
For practically healthy individuals, the annual effective dose during
preventive medical radiological procedures should not exceed 1 mSv (0,001 Sv).
The principle of justification is the prohibition of all types of activities
for the use of ionizing radiation sources, in which the benefit to man and society
does not exceed the risk of possible harm caused by additional radiation
exposure to the natural background.
For example, when conducting X-ray examinations, it should be
implemented taking into account the following requirements:
 priority use of alternative (non-radiation) methods
 conducting research only for clinical indications;
 selection of the most gentle methods of X-ray examinations;
 the risk of rejection of an X-ray examination should obviously exceed the
risk of exposure during its conduct.
The principle of optimization is to maintain at the lowest possible and
achievable level, taking into account economic and social factors, individual
exposure doses and the number of exposed persons when using any source of
ionizing radiation.
The principle of optimization or limitation of radiation levels, in X-ray
studies is carried out by maintaining radiation doses at such low levels as can be
achieved provided the necessary volume and quality of diagnostic information
or therapeutic effect is provided, taking into account economic and social
factors.
The following categories of irradiated persons have been identified:
 personnel (groups A and B).
─ Group A – professional persons working directly with sources of
ionizing radiation.
─ Group B – persons working in the premises adjacent to the premises in
which work is carried out with radioactive substances and sources of
ionizing radiation, but not directly engaged in working with them. This
also includes persons who are on duty in premises, buildings and in the
open air within the sanitary protection zone.
 the entire population, including personnel, outside the scope and conditions
of their production activities.
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Three classes of standards have been established for categories of
irradiated persons, the first of which is the main dose limits (MD) given in
Table 1.
Table 1
Main dose limits
Main Dose
Normalized
values* Personnel**
population
(Group A)
20 msv per year 1 mSv per year
on average for any consecu- on average for any consecu-
Effective dose tive 5 years, tive 5 years,
but no more than 50 mSv but no more than 5 mSv per
per year year
Equivalent dose per
150 mSv 15 mSv
year:
in the lens of the eye 500 mSv 50 mSv
the skin 500 mSv 50 mSv
Notes:
* Simultaneous irradiation is allowed up to the specified limits for all
normalized values
** The main dose limits, as well as all other permissible exposure levels of
Group B personnel, are equal to 1/4 of the values for Group A personnel.
Since the radiosensitivity of human organs varies, when calculating the
main dose limits, the most sensitive organs are distinguished, for example, the
lens of the eye, skin, hands and feet.
The effective dose for personnel should not exceed 1000 mSv for the
period of work (50 years), and for the population for the period of life (70 years)
- 70 mSv.
With simultaneous exposure to human sources of external and internal
radiation, the annual effective dose should not exceed the dose limits set in
Table 1.
To determine the radiation dose, dosimetric monitoring is carried out
using dosimeters (for personnel) and by calculation method (for patients).
The basic principles of protection against ionizing radiation are:
protection by quantity (dose), protection by distance, protection by time,
protection by screens.
Independent work
Task 1. To study the basic units of measurement of the activity of radio-
nuclides (Table 2) and requirements when working with open and closed
radiation sources in accordance with the «Basic Sanitary Rules for Radiation
Safety» (BSRRS-99/2010) - SP 2.6.1.2612-10.
The main terms, concepts and the relationship between units of
measurement are given in Table 2.
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Таble 2
Units of measurement
Value SI unit Non-systemic unit
Becquerel (Bc) –
Activity Curie (Ci)
one decay per second
of the substance (A) 1Bk=2.7·10-11Ki
(decay/sec)
Gray (Gr) is the energy
Absorbed dose (D) is the amount of of 1 Joule of any
ionizing radiation energy transferred radiation transferred to Rad (rad)
to the substance the mass of the irradiated
substance in 1 kg (J/kg)
Exposure dose (X) is a quantitative
characteristic of X-ray and gamma
Pendant 1 rad = 0.01 Gr.
radiation by the ionization effect
caused in air
Equivalent dose (HT,R) is the
absorbed dose in an organ or tissue
multiplied by the corresponding per kilogram X-ray (R)*
coefficient for this type of radiation,
WR
Effective dose (E) is a value used as a
measure of the risk of long–term
consequences of exposure to a person 1P=2.58·10--
(Kl/kg)
and his individual organs and tissues, 4Kl/kg
taking into account their
radiosensitivity.
Notes:
* Rem (biological equivalent of an X-ray) is a dose of any type of radiation that
causes the same biological effect as 1 P (X-ray) radiation.
Closed and open sources of radiation are used for practical and research
purposes.
A closed radiation source is a radiation source, the device of which
excludes the entry of radionuclides contained in it into the environment under
the conditions of use and wear for which it is calculated.
The device in which a closed radiation source is placed must be resistant
to mechanical, chemical, temperature and other influences, and have a radiation
hazard sign.
It is not allowed to use closed radiation sources in case of violation of
their tightness, as well as after the expiration of the established service life.
In the non-working position, closed radiation sources should be in
protective devices, and installations generating ionizing radiation should be de-
energized. To extract a closed radiation source from a container, use a remote
tool or special devices. When working with a radiation source removed from a
protective container, protective screens and manipulators must be used.
The premises where work is carried out on stationary installations with
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covered radiation sources must be equipped with locking and alarm systems
about the position of the source.
In case of underwater storage of closed radiation sources, systems for
automatic maintenance of the water level in the pool, signaling of changes in the
water level and an increase in the dose rate in the working room should be
provided.
When working with closed radiation sources, there are no special
requirements for the decoration of premises.
In order to ensure the radiation safety of personnel and the population, it
is necessary to:
 direct radiation towards the earth or where there are no people;
 remove radiation sources from maintenance personnel and other persons
as far as possible;
 limit the time people stay near radiation sources;
 post a radiation hazard sign and warning posters that must be clearly
visible from a distance of at least 3 meters.
An open source of radiation is a source of radiation, with the use of
which it is possible for the radionuclides contained in it to enter the
environment.
Radionuclides are divided into 4 groups according to the degree of
radiation hazard (Table. 3) depending on the minimum significant activity.
Minimally significant activity (MSA) is the activity of an open source of
ionizing radiation in a room or workplace, if exceeded, permission is required
from the state sanitary and epidemiological service to use these sources.
Таble 3
Groups of radionuclides according to the degree of radiation hazard
Group МSА Radionuclides
3
А 10 bк Pu-240
B 104–105bc Sr-91, Ra-225
C 106–107bc Sr-92, Cd-153, Os-19, U-131, Co-57
D 108bc and more Tm-170, Pd-103, Ar-37
All work using open sources of radiation is divided into three classes,
which is set depending on the group of radiation hazard of the radionuclide and
its activity in the workplace (Table 4).
The class of work determines the requirements for the placement and equipment
of premises in which work with open sources of radiation is carried out.
Тable 4
Class of work with open sources of radiation
Class of work The total activity in the workplace, reduced to group A, Bc
I More than 108
II from 105 to 108
III from 103 to 105
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A set of measures for radiation safety when working with open sources of
radiation should protect personnel from internal and external radiation, limit air
pollution and surfaces of workrooms, skin and clothing of personnel, as well as
environmental objects: air, soil, vegetation, etc. both during normal operation
and during work to eliminate the consequences of a radiation accident.
When working with open sources of radiation, it is necessary to
concentrate in one place the premises for each class of work.
The greatest danger is represented by works classified as Class I.
Class III works should be carried out in separate rooms that meet the
requirements of chemical laboratories. As part of these premises, the device of
supply and exhaust ventilation and a shower room is provided.
Class II works should be carried out in rooms arranged in a separate part
of the building isolated from other rooms. In the composition of these premises,
premises for permanent and temporary stay of personnel are allocated, a sanitary
pass or a sanitary gateway is equipped. Rooms for Class II work must be
equipped with fume hoods or boxes.
Class I works should be carried out in a separate building or an isolated
part of the building with a separate entrance only through a sanitary pass.
Working rooms are equipped with boxes, chambers or other hermetic
equipment. Premises, as a rule, are divided into 3 zones:
 Zone 1 — maintenance-free premises where technological equipment and
communications are located, which are the main sources of radiation and
radioactive contamination.
The presence of personnel in this area with the equipment running is not
allowed;
 Zone 2 — periodically serviced premises intended for equipment repair and
other work;
 Zone 3 — premises of permanent residence of personnel during the entire
shift (operator rooms, control panels, etc.).
Sanitary locks are equipped to exclude the spread of radioactive
contamination between zones.
To reduce the levels of external exposure of personnel from open radiation
sources, the following should be used:
— automation and remote control systems,
— shielding of radiation sources,
— reduction of the time of work operations.
In an organization where work with radioactive substances is carried out,
a set of measures for decontamination of production facilities and equipment
should be provided.
Floors and walls of rooms for Class II and Class I Zone 3 work, as well as
ceilings in Class I zones 1 and 2, must be covered with slightly absorbent
materials resistant to detergents. Rooms belonging to different zones and classes
should be painted in different colors. The edges of the floor coverings should be
raised and sealed flush with the walls.
For works of classes I and II, the area of the room per employee should be
 78
at least 10 m2.
Equipment and work furniture should have a smooth surface, a simple
design and a weakly sorbing coating that facilitates the removal of radioactive
contamination.
The amount of radioactive substances in the workplace should be the
minimum necessary for work.
Special requirements are imposed on the sanitary and technical system for
ensuring work with open sources of radiation, for example: the polluted air
being removed before being released into the atmosphere must be cleaned; the
air flow from working rooms, exhaust ducts must be directed from less polluted
spaces to more polluted ones. The heating of the premises should be water or air.
Basic requirements for ensuring the radiation safety of personnel
when working with open sources of radiation
1. General requirements
1) creation of working conditions that meet the requirements of NRB-
99/2009 and OSPORB-99/2010;
2) restrictions on access to work with radiation sources by age, gender,
health status, level of previous exposure, etc.;
3) knowledge and compliance with the rules of work with radiation sources;
4) the sufficiency of protective barriers, screens and distance from the
radiation source, as well as the limitation of working time with radiation
sources;
5) use of personal protective equipment;
6) compliance with established control levels;
7) organization of radiation monitoring;
8) organization of an information system on the radiation situation;
9) implementation of effective measures to protect personnel when planning
increased exposure in the event of a threat and accident.
2. Methods and means of personal protection and personal hygiene
All persons working with radiation sources or visiting facilities where
such work is carried out must be provided with personal protective equipment in
accordance with the type and class of work.
When working with radioactive substances in the open form of Class I
and during individual work of Class II, personnel must have a set of basic
personal protective equipment, as well as additional protective equipment,
depending on the level and nature of possible radioactive contamination.
The basic set of personal protective equipment includes: special
underwear, socks, overalls or a suit (jacket, trousers), protective shoes, a hat or
helmet, gloves, disposable towels and handkerchiefs, respiratory protection
(depending on air pollution).
During Class II and individual Class III work, personnel must be provided
with dressing gowns, hats, gloves, light shoes and, if necessary, respiratory
protection.
Personal protective equipment for working with radioactive substances
must be made of well-deactivated materials or be disposable.
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Those working with radioactive solutions and powders, as well as
personnel cleaning the premises in which work with radioactive substances is
carried out, in addition to a set of basic means of individual protection, must
additionally have workwear made of film materials or polymer-coated materials:
aprons, armbands, half-coats, rubber and plastic special shoes.
When moving from premises for higher-class work to premises for lower-
class work, it is necessary to monitor the level of radioactive contamination of
personal protective equipment, and when moving from zone 2 to zone 3,
additional personal protective equipment must be removed.
Radioactive contamination of personal clothing and footwear should be
excluded. In case of detection of such contamination, personal clothing and
shoes are decontaminated under the control of the radiation safety service, and if
it is impossible to clean it, they are disposed of.
In rooms for work with radioactive substances in an open form is not
allowed:
 stay of employees without the necessary personal protective equipment;
 eating, smoking, using cosmetics;
 storage of food products, tobacco products, home clothes, cosmetics and
other items that are not related to work.
When leaving the premises where work with radioactive substances is
carried out, it is necessary to check the cleanliness of workwear and other means
of individual protection, remove them and, if radioactive contamination is
detected, send them for decontamination, and the employee himself should wash
under the shower.
A special room equipped with a washbasin for washing hands with hot
water supply, isolated from rooms where work is carried out with the use of
radioactive substances in an open form, should be provided for eating.
3. Medical provision of radiation safety
Medical provision of radiation safety of personnel and the population
exposed to radiation includes medical examinations (medical examination),
disease prevention, and, if necessary, treatment and rehabilitation of persons
who have abnormalities in their state of health.
All those working with ionizing radiation sources (Group A personnel)
must undergo preliminary (upon admission to work) and periodic preventive
medical examinations in accordance with Article 34 of the Federal Law "On
Sanitary and Epidemiological Welfare of the Population" in accordance with the
procedure determined by the Ministry of Health of the Russian Federation.
Employees who refuse to undergo preventive medical examinations are
not allowed to work.
After a periodic preventive medical examination, it is advisable to allocate
groups of dispensary records in accordance with the complex of influencing
adverse factors.
When identifying deviations in the state of health of personnel persons
that prevent the continuation of work with radiation sources, the issue of
temporary or permanent transfer of these persons to work outside of contact with
 80
ionizing radiation is solved individually in each case, taking into account the
sanitary and hygienic characteristics of working conditions, the persistence and
severity of the identified pathology, as well as social motives.
During periodic medical examinations, persons requiring treatment,
persons with a high risk of radiation-dependent diseases should be identified, for
which a system of preventive measures should be implemented. Persons with
identified diseases should be referred for outpatient or inpatient treatment, and,
if necessary, for rehabilitation.
To ensure the radiation safety of patients and the population with all
types of medical radiation (preventive, diagnostic, therapeutic, research), the
following requirements must be observed:
1) Medical irradiation of patients in order to obtain diagnostic information
or therapeutic effect should be carried out only as prescribed by a doctor and
with the consent of the patient. The final decision on carrying out the
appropriate procedure is made by a radiologist or radiologist.
2) Medical diagnostic radiation is carried out according to medical
indications in cases where other alternative methods of diagnosis are not
available, cannot be applied, or are insufficiently informative.
3) During radiation therapy, all possible measures should be taken to
prevent radiation complications in the patient.
4) Departments (divisions) of radiation therapy and diagnostics should
have and use a mandatory set of mobile and individual means of radiation
protection of the patient and staff when performing medical and diagnostic
procedures.
5) Medical personnel engaged in X-ray radiological diagnostics and
therapy protect patients by maintaining their individual radiation doses at the
lowest possible level.
6) The dose received by the patient is subject to registration. The patient's
radiation doses from each X-ray radiological examination and radiotherapy
procedures should be entered in a personal list of medical radiation doses, which
is a mandatory attachment to his outpatient card.
Task 2.
To study the organization of radiation safety of medical personnel in X-ray
rooms, according to the SanPiN 2.6.1–1192–03 .
The system of ensuring radiation safety during medical X-ray
examinations should provide for the practical implementation of three
fundamental principles of radiation protection - rationing, justification and
optimization.
Ensuring radiation safety during X-ray studies includes:
- carrying out a set of measures of a technical, sanitary-hygienic, medical-
preventive and organizational nature;
- implementation of measures to comply with rules, norms and regulations in
the field of radiation safety;
- informing the population (patients) about dose loads, possible consequences
 81
of radiation exposure, measures taken to ensure radiation safety;
- training of persons prescribing and performing X-ray examinations, methods
and means of ensuring radiation safety.
The safety of work in the X-ray room is ensured by:
1) the use of X-ray equipment and equipment that create the required clinical
effectiveness while ensuring radiation safety requirements;
2) a reasonable set of premises, their location and decoration;
3) selection, placement and operation of equipment and equipment in
accordance with technical requirements;
4) the use of optimal physical and technical parameters of X-ray machines in X-
ray studies;
5) the use of stationary, mobile and individual means of radiation protection;
6) training of personnel in safe methods and techniques of X-ray examinations;
7) compliance with the rules of operation of communications and equipment;
8) control over the exposure of staff and patients;
9) implementation of production control over the implementation of norms and
rules for ensuring safety during X-ray examinations and X-ray therapy.
X-ray rooms must be accepted by the commission in accordance with the
established procedure before their operation begins. A permit for the right to
operate an X-ray cabinet is a sanitary and epidemiological conclusion issued by
the body of the state sanitary and epidemiological service.
It is not allowed to use X-ray machines and carry out work not specified
in the sanitary and epidemiological conclusion.
In institutions that have an X-ray room or an X-ray machine, the
following documentation must be available (according to San-RaR 2.6.1–-1192-
03):
1) sanitary and epidemiological conclusion on the type of activity;
2) sanitary and epidemiological conclusion on the X-ray machine as a
product that poses a potential danger to humans;
3) sanitary and epidemiological conclusion on the X-ray cabinet project;
4) technical passport for the X-ray room;
5) instructions on labor protection, including requirements for radiation
safety, for the prevention and elimination of radiation accidents;
6) sanitary rules, other regulatory and instructional and methodological
documents regulating the requirements of radiation safety.
Radiation safety of the personnel of the X-ray room is provided by a
system of protective measures of a constructive nature in the production of X-
ray machines, planning solutions, the use of stationary, mobile and individual
means of radiation protection, the choice of optimal conditions for X-ray
studies, the implementation of radiation control, compliance with the
requirements of these rules.
To work on the operation of the X-ray machine, persons at least 18 years
of age who have a document on appropriate training, who have been instructed
and tested their knowledge of the rules for ensuring safety, regulatory documents
and instructions in force in the institution are allowed.
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The administration of the institution is obliged to organize preliminary
(upon admission to work) and annual periodic medical examinations of the
personnel of group A. Persons who do not have medical contraindications are
allowed to work. The same requirement applies to persons entering courses that
train personnel to work in X-ray rooms.
If deviations in the state of health are detected that prevent the
continuation of work in the X-ray room, the issue of temporary or permanent
transfer of these persons to work outside of contact with radiation is decided by
the administration of the institution in each individual case individually in
accordance with the established procedure.
Women should be exempt from direct work with X-ray equipment for the
entire period of pregnancy and breastfeeding of the child.
The instruction system with the verification of knowledge on safety and
radiation safety includes:
1) introductory briefing – when applying for a job;
2) primary – in the workplace;
3) repeated – at least twice a year;
4) unplanned – when the nature of work changes (changing the equipment of
the X-ray room, examination or treatment methods, etc.), after a radiation
accident, accident.
Persons undergoing internship and specialization in the X-ray machine, as
well as students of higher and secondary specialized educational institutions of
medical profile should be allowed to work only after passing introductory and
primary safety instruction. For students and students undergoing training with
ionizing radiation sources, annual doses should not exceed the values
established for Group B personnel.
Registration of the conducted briefing of the personnel of the A–technical
safety group should be carried out in special journals.
Specialists (dentists, surgeons, urologists, surgical assistants,
traumatologists and others) belonging to the category of irradiated persons of
Group B personnel, trained in safe working methods, including ensuring patient
safety, and who have been instructed can participate in X-ray examinations
accompanied by complex manipulations, the conduct of which is not included in
the official duties of the X-ray room staff.
The staff of the X-ray room is obliged to know and strictly observe these
rules, the rules of labor protection, safety, radiation safety, fire safety and
industrial sanitation. The staff is obliged to report violations in the operation of
the X-ray machine, malfunctions of protective equipment and violations of fire
safety to the administration of the institution immediately. For non-compliance
with the regulations of X-ray examinations, violation of the provisions of
instructions and safety rules, officials and the administration of the institution
are held accountable in accordance with the current legislation.
It is not allowed to carry out work with X-ray radiation that is not
provided for in job descriptions, safety instructions, radiation safety and other
regulatory documents.
 83
It is not allowed to carry out quality control of installation, repair and
operation of X-ray equipment by X-ray examination of people.
An X-ray technician has no right to service two or more simultaneously
operating X-ray machines, even if their control panels are located in the same
room.
During the radiography and radiotherapy session, the personnel from the
control room should monitor the patient's condition through an observation
window or other observation system, giving him the necessary commands
through an intercom device. It is allowed for personnel to be in the treatment
room when working: an X-ray apparatus with a protective cabin; an X-ray
diagnostic apparatus with a universal table-a tripod with a swivel in the presence
of protective equipment on a screen-taking device; a bone densitometer,
mammograph and X-ray dental equipment behind a protective screen. Persons
who are not directly related to the X-ray examination are not allowed to be in
the treatment room.
The staff is obliged to know the techniques of first aid, to know the
addresses and phone numbers of organizations and persons who are informed
about the occurrence of accidents, to keep the office in order and clean, not to
allow its cluttering.
During the X-ray examination, the radiologist must observe the duration
of breaks between high voltage inclusions in accordance with the passport for
the device, monitor the choice of optimal physical and technical modes of
examination (anode voltage, anode current, exposure, filter thickness, diaphragm
size, compression, focus- skin distance, etc.), palpate with remote instruments
(detectors, etc.) and use mobile and individual radiation protection equipment in
the required volume and nomenclature.
The use of personal protective equipment is mandatory if the personnel is
in the process of conducting X-ray examinations. When conducting complex X-
ray examinations (angiography, X-ray endoscopy, examination of children,
patients in serious condition, etc.), all personnel working in the procedural (X-
ray surgery) should use personal protective equipment. When conducting
radiography in wards, mobile protective screens should be used to screen other
patients; the staff should be located behind a screen or at the maximum possible
distance from the tent X-ray machine.
In case of abnormal (emergency) situations, the personnel must act in
accordance with the instructions for the elimination of accidents.
Emergency situations in the X-ray room include:
- damage to the radiation protection of the device or cabinet;
- short circuit and breakage in power supply systems;
- closure of an electrical circuit through the human body;
- mechanical failure of the elements of the X-ray machine;
- breakdown of communication systems of water supply, sewerage, heating
and ventilation;
- emergency condition of walls, floor and ceiling;
- fire.
 84
Radiation monitoring should include:
- periodic monitoring of the radiation dose rate at the staff workplaces, in the
premises and on the territory adjacent to the X-ray treatment room;
- control of the protective properties of mobile and individual radiation
protection equipment;
- individual dosimetric control of Group A personnel;
- individual dosimetric control of persons who periodically participate in
special X-ray examinations (surgeons, anesthesiologists, etc.);
- control of patients' dose loads.
When conducting X-ray examinations, measures should also be taken to
protect against the effects of non-radiation factors: electricity, lead, etc.
The noise level from the technical equipment of the treatment room
should not exceed 50 dBA when the equipment is not working, and 60 dBA
when working.
Task 3.
To study the provision of radiation safety during X-ray pathology studies.
The placement and stationary protection of rooms for X-ray diagnostic
studies is determined by the type of X-ray equipment and the magnitude of the
workload of the device.
Dental devices with a conventional film without an amplifying screen and
panoramic devices are allowed to be placed only in the X-ray department
(office) of a general medical or dental institution.
If several devices for X-ray and dental examinations are installed in the
room, the control system should provide for the possibility of operating only one
device at a time.
When installing more than one X-ray dental device in the treatment room,
the room area should be increased depending on the type of device, but not less
than 4 m2 for each additional device.
Requirements for ventilation of rooms for X-ray pathology studies: the
multiplicity of air exchange per hour should be at least three for exhaust and 2
for inflow.
Domestic and imported X-ray equipment is allowed for delivery and
operation in the presence of a registration certificate of the Ministry of Health of
the Russian Federation and a sanitary and epidemiological conclusion.
A dental institution may conduct X-ray examinations only if there are
special permits (licenses) for activities in the field of handling sources of
ionizing radiation.
The office where X-ray pathology studies are carried out should have a set
of mobile and individual protective equipment for the patient and patients.
Persons over the age of 18 who do not have medical contraindications are
allowed to work on the X-ray machine, after training, instruction, testing of
knowledge of the safety rules of work, operating instructions in the institution
and classified by the order of the administration of the institution to the category
of group A personnel.
 85
The administration of a dental institution is obliged to ensure that constant
individual dosimetric monitoring is carried out by employees working on dental
X-ray machines.
In order to protect the patient's skin during X-ray procedures, the length of
the tube of the device should provide a skin-focal length of at least 10 cm for a
device with a rated voltage of up to 70 kV and 20 cm at higher values of the
anode voltage.
Task 4. Additionally, you can familiarize yourself with the rules of
radiation safety of patients and the public during radiological examinations
(Application 1).
Application 1
Requirements for ensuring radiation safety of patients
and the public during X-ray examinations
(from SanRaR 2.6.1.1192–03)
Referral of the patient to X-ray procedures is carried out by the attending
physician according to reasonable clinical indications. Doctors performing
medical X-ray examinations should know the expected radiation dose levels of
patients, possible reactions of the body and the risks of long-term consequences.
At the request of the patient, he is provided with complete information
about the expected or received radiation dose and possible consequences. The
right to make a decision on the use of X-ray procedures for diagnostic purposes
is granted to the patient or his legal representative.
The patient has the right to refuse medical X-ray examinations, with the
exception of preventive studies conducted in order to detect diseases that are
dangerous in epidemiological terms.
The radiologist responsible for conducting the X-ray examination is the
radiologist who makes the final decision on the consistency, scope and type of
the study, in the absence of a radiologist, the decision is made by the doctor who
prescribed the X-ray examination, who underwent radiation safety irradiation in
a medical institution licensed for the right to study.
In case of unjustified referrals for X-ray examination, the radiologist may
refuse to conduct an X-ray examination to the patient, having previously
informed the attending physician about this and having recorded the refusal in
the medical history (outpatient card).
The radiologist (or radiologist) registers the value of the individual
effective dose of the patient in the list of dose loads during X-ray examinations
(the sheet is pasted into the medical card of the outpatient patient or the history
of the child's development and in the journal of daily X-ray examinations. When
the patient is discharged from the hospital or after an X-ray examination in
specialized medical institutions, the value of the dose load is entered in the
discharge. Subsequently, the dose is transferred to the record sheet of the dose
loads of the outpatient patient's medical record (the history of the child's
development).
In order to prevent unjustified re-irradiation of patients at all stages of
medical care, the results of previously conducted radiological studies should be
 86
taken into account. When referring a patient for X-ray examination, consultation
or inpatient treatment, when transferring a patient from one hospital to another,
the results of X-ray examinations (description, pictures) should be transmitted
together with an individual card.
X-ray examinations performed in outpatient polyclinic conditions should
not be duplicated in a hospital without special need. Repeated studies should be
carried out only if the course of the disease changes or a new disease appears, as
well as if it is necessary to obtain expanded information about the patient's
health status.
When carrying out preventive medical X-ray examinations and scientific
studies of practically healthy individuals, the standard of annual preventive
radiation exposure was established - 1 mSv.
Conducting preventive examinations by X-ray is not allowed.
Radiation dose limits for patients with diagnostic purposes are not
established.
During X-ray examination, screening of the pelvic area, thyroid gland,
eyes and other parts of the body, especially in persons of reproductive age, must
be carried out. In children of early ages, the entire body should be shielded
outside the study area.
If it is necessary to provide emergency or emergency care to the patient,
X-ray examinations are performed in accordance with the instructions of the
doctor providing assistance.
When referring to sanatorium-resort treatment, the results of X-ray
examinations obtained during the observation of the patient in the previous
period should be entered in the sanatorium-resort cards. When referring to the
MSEC (medical socio-expert commission, which replaced the VTEC - medical
and labor Commission), the data of X-ray studies conducted during the patient
observation process should be attached.
When referring women of childbearing age for X-ray examination, it is
necessary to clarify the time of the last menstruation. X-ray examinations of the
gastrointestinal tract, urography, radiography of the hip joint and other studies
related to the radiation load on the gonads are recommended to be carried out
during the first decade of the menstrual cycle.
The appointment of pregnant women for X-ray examination is carried out
only for clinical indications. Studies should, if possible, be carried out in the
second half of pregnancy, with the exception of cases when the issue of
termination of pregnancy or the need for emergency or emergency care should
be resolved. When testing for pregnancy, the question of the admissibility and
necessity of an X-ray examination is solved based on the assumption that there
is a pregnancy. It is forbidden to carry out X-ray therapy for pregnant women.
Pregnant women should not be involved in X-ray examinations
(supporting a child or a seriously ill relative).
X-ray examinations of pregnant women should be carried out using all
possible means of protection so that the dose received by the fetus does not
exceed 1 mSv for two months of undiagnosed pregnancy. If the fetus receives a
 87
dose exceeding 0.1 Sv, the doctor is obliged to warn the patient about possible
consequences and recommend terminating the pregnancy.
X-ray examinations of children under the age of 12 years should be
performed in the presence of a nurse, nurse or relatives, whose duties are to
accompany the patient to the place of completion of the study and monitor him
during their conduct.
During X-ray examinations of young children, special immobilizing
devices should be used, eliminating the need for personnel assistance. In the
absence of a special device, the support of children during the study can be
entrusted to relatives at least 18 years old. All persons assisting in such studies
should be pre-equipped and equipped with personal protective equipment
against radiation.
Children under 14 years of age and pregnant women, as well as patients
who are admitted to stationary treatment and seeking outpatient or polyclinic
care, are not subject to preventive X-ray examinations if they have already
passed preventive examination during the previous year.
When using mobile and portable devices outside the rentgen cabinet (in
wards, operating rooms), the following measures should be provided:
- allocation of premises for permanent or temporary storage of X-ray
machines;
- the direction of radiation in the direction where the smallest number of
people is located;
- removing people as far as possible from the X-ray machine and using
personal protective equipment by staff and patients;
- limitation of the time people stay near the X-ray machine;
- the use of mobile protective fences.
 88
Practical lesson 10
The main indicators of the health status
of children and adolescents
The purpose of the lesson:
to study the indicators and methods of assessing the state of health
Equipment of the lesson: tables of indicators of children's health.
Methodical instructions
Human health occupies a significant place in the system of social values.
An important condition for a high level of physical and mental health of a
person, his high efficiency is the preservation and strengthening of the health of
the younger generation.
Health, as defined by the World Health Organization (WHO), is a state of
complete physical, mental and social well–being, and not only the absence of
diseases or physical defects.
A comprehensive assessment of the health status of each child is given in
the form of assigning it to one of the «health groups» with mandatory
consideration of basic criteria in accordance with the order of the Ministry of
Health of the Russian Federation «On the procedure for preventive medical
examinations of minors» (№ 514n of 10.08.2017):
1) the presence or absence of functional disorders and (or) chronic diseases
(conditions), taking into account the clinical variant and the phase of the
pathological process;
2) the level of functional state of the main body systems;
3) the degree of the body's resistance to adverse external influences (determined
by the number and severity of diseases of the upper and lower respiratory
tract, as well as acute respiratory diseases in a calendar year, which is the
basis for assigning a child to the group of «frequently ill children» - FIC);
4) the level of development achieved and the degree of its harmony (i.e.
assessment of physical development).
Also, when assessing a child's health, you can take into account a
subjective assessment of your well-being and health (usually according to a
questionnaire of children or their parents).
For an individual assessment of the health status of children and
adolescents, 5 health groups are distinguished:
I Health group — healthy minors who have normal physical and mental
development, do not have anatomical defects, functional and morphofunctional
disorders;
II Health group — minors: who do not have chronic diseases
(conditions), but there are some functional and morphofunctional disorders;
convalescents, especially those who have suffered severe and moderate
infectious diseases; with a general delay in physical development in the absence
of diseases of the endocrine system (low growth, lag in the level of biological
development), with a body weight deficit or overweight bodies; often and (or)
 89
suffering from acute respiratory diseases for a long time; with physical
disabilities, the consequences of injuries or operations with the preservation of
the functions of organs and systems of the body;
III Health group — minors: suffering from chronic diseases (conditions)
in clinical remission, with rare exacerbations, with preserved or compensated
functions of organs and systems of the body, in the absence of complications of
the underlying disease (condition); with physical disabilities, the consequences
of injuries and operations, provided compensation for the functions of organs
and systems of the body, the degree of which does not limit the possibility of
training or work;
IV Health group — minors: suffering from chronic diseases (conditions)
in the active stage and the stage of unstable clinical remission with frequent
exacerbations, with preserved or compensated functions of organs and systems
of the body or incomplete compensation of functions; with chronic diseases
(conditions) in remission, with disorders of the functions of organs and systems
of the body, requiring the appointment of supportive treatment; with physical
disabilities, the consequences of injuries and operations with incomplete
compensation of the functions of organs and systems of the body, resulting in
restrictions on the possibility of training or work; Group V of health - minors:
suffering from severe chronic diseases (conditions) with rare clinical remissions,
frequent exacerbations, continuously recurrent course, pronounced
decompensation of the functions of organs and body systems, the presence of
complications requiring permanent treatment; with physical disabilities, the
consequences of injuries and operations with severe impairment of the functions
of organs and body systems and significant limitation of the possibility of
training or work.
V Health group — minors: suffering from severe chronic diseases
(conditions) with rare clinical remissions, frequent exacerbations, continuously
recurrent course, pronounced decompensation of the functions of organs and
systems of the body, the presence of complications requiring permanent
treatment; with physical disabilities, the consequences of injuries and operations
with severe impairment of the functions of organs and systems of the body and a
significant limitation of the possibility of training or work.
The following indicators of children's health are determined in
educational organizations:
1. General morbidity (level and structure) - is studied on the basis of the appeal
of children (population) for medical care.
2. Acute morbidity (level and structure) – diseases that are detected for the first
time. For example: acute viral infections, flu, sore throat, pneumonia,
bronchitis and so on. flu, food poisoning are always acute diseases.
3. Chronic morbidity (level and structure).
4. Morbidity of children in cases, in days per 1 child.
5. The percentage of children who are often ill. The criterion for the inclusion
of children in the FIC group is the frequency of acute respiratory diseases
and diseases of the upper and lower respiratory tract per year (Albitsky V.Yu.,
 90
Baranov A.A., 1986): for children under 1 year - 4 times a year and more;
from 1 to 4 years - 6 times a year and more; from 4 to 5 years - 5 times a year
and more; older than 5 years - 4 times a year and more.
6. The percentage of long-term ill children (ill for a month or longer).
7. Percentage of children with health disorders, chronic diseases.
8. Distribution of children by health groups.
9. Distribution of children for health reasons into physical education groups
(basic, preparatory, special).
10.Percentage of children who are functionally immature for learning
(calculated from the number of six-year-olds who want to go to school).
11.The percentage of children with health disorders caused by adaptation to
preschool, to school.
12.Percentage of children in need of recreational activities.
13.Percentage of children with disharmonious physical development.
14.Health index (the proportion of people who were not ill at all during the year,
as a percentage of the number of examined).
15.Pathological lesion – the prevalence of chronic diseases, functional
abnormalities, detected mainly during preventive medical examinations (for
example, myopia).
Indicators of physical development
A. Mandatory
1) Anthropometric: body length and weight, chest circumference
(circumference) at rest, during deep inhalation and exhalation; chest
excursion, dynamometry, spirometry.
2) Descriptive: characteristics of the musculoskeletal system (posture,
presence of scoliosis), sexual development, chest shape (normal or
deformities: "chicken", "funnel", "shoemaker's chest", etc.), leg shape
(normal, x-shaped, o-shaped), foot (normal, flattened, hollow).
3) Assessment of the level and harmony of physical development.
B. Additional
- thickness of the fat fold;
- the shape of the abdomen (normal, sunken, convex, saggy).
Indicators of physical fitness for physical tests:
A. Mandatory:
1) Pull-ups or push-ups (strength) (times).
2) Speed of running at 10, 30 meters (min).
3) Throwing (tennis ball) at a distance (m).
4) Jumping in length, height from a place (m)
5) Endurance running for 1.5 minutes.
B. Additional: for static endurance (exercises «fish» or «angle») for a
time, in seconds. static balance, standing on one leg or «swallow» with eyes
closed, in seconds; flexibility — leaning forward, standing on a bench in cm
from the zero line; coordination of movements — throwing the ball against the
wall alternately with your hands for 30 seconds from 1 meter; strength
endurance — the number of sedov from the supine position.
 91
When determining the biological age (development), the following are
taken into account:
- the degree of puberty (assessed by the degree of development of
secondary sexual characteristics);
- skeletal maturity (the order and timing of ossification of the skeleton);
- dental maturity (the timing of the cutting of milk and permanent teeth is
taken into account).
The degree of puberty is estimated in girls — by the hair of the armpits
and pubis, the development of mammary glands, by the age of menstruation; in
boys — by the hair of the armpits and pubis, mutation of the voice, the
development of facial hair and the development of the stomach. In different age
periods, some indicators are leading, others are auxiliary.
The criteria for assessing biological maturity are:
1) In preschoolers and younger schoolchildren - by the number of permanent
teeth.
2) In middle and high school students - according to secondary sexual
characteristics (according to V. G. Vlastovsky).
According to the growth rate and puberty, biological development is
estimated as:
 corresponds to the calendar age;
 accelerated (acceleration);
 delayed, late (retardation).
It is not always convenient and possible to use absolute data to assess the
health status of children in children's groups, therefore, average values and
relative indicators are calculated to compare the data obtained.
The average values are used, for example, when calculating the average
life expectancy, morbidity of children in days per child.
Relative indicators include structure and level.
The structure characterizes the distribution of the whole into its
constituent parts, i.e. determines the composition of this whole or the specific
weight of individual parts in it. The indicators of the structure are usually
expressed as a percentage of the whole (to the total). For example: 12,500
illnesses (100%) were registered at the school during the year, of which 14 cases
of pneumonia, which is
14 · 100% = 0,1%
12500
The level (or prevalence) characterizes the frequency of the spread of this
phenomenon. This indicator is calculated using proportions that bring absolute
numbers to one base - 100, 1000, 10,000 (schoolchildren, residents), in relation
to which the indicator is calculated. For example:
Number of diseases
Morbidity Rate (death, new borns)
= · 1000
(mortality, fertility) Average population

The difference between fertility and mortality rates is a natural increase.

 92

Independent work
Task 1.
To study the criteria and methods for assessing the health status of children.
Task 2. Analyze the incidence in schools:
In school No. 1: 910 students, 1960 cases of diseases were registered during the
year, including 990 acute respiratory infections (OVI), 140 cases of influenza.
At School No. 2: 1150 students, 2010 cases of diseases were registered during
the year, 1010 of them were acute respiratory infections, 140 cases of influenza.
Indicator School № 1 School № 2
Number of students
Number of diseases - total
Number of acute diseases
Number of flu cases
Number of chronic problems
Average
morbidity
ARI level
The level of chronic morbidity
The prevalence of influenza%
of flu cases
(from the number of ARI)

Conclusion:_____________________________________________________

________________________________________________________________
________________________________________________________________
 93
Practical lesson 11
Methods of assessing the physical development
of children and adolescents
The purpose of the lesson: to study methods of assessing the physical
development of children.
Equipment of the lesson: centile and other tables for assessing the physical
development of children and adolescents.
Methodical instructions
Physical development is one of the criteria for assessing the health status
of children.
Physical development is a set of morphological and functional properties
of an organism that characterize the processes of its growth and maturation.
The most important of all indicators of physical development is body
length, because this indicator reflects the plastic processes occurring in the
body, is the total and the most stable.
There are 2 methods for assessing physical development:
1. individualizing (study of dynamic indicators of physical development
of individual children). Allows you to identify the features of growth,
development associated with specific living conditions (nutrition), transferred
diseases, the nature of the daily routine, etc.
2. generalizing (in a relatively short time, the physical development of
large groups of people is being followed). Statistical processing of the data
obtained makes it possible to determine the average indicators of physical
development of each age and sex group. These average indicators are age
standards of physical development. Each locality should have its own standards,
which are updated every 5-10 years.
To assess physical development, individual indicators (body length, lung
capacity, etc.) can be studied and evaluated.
A homogeneous statistical set of data for calculating the standards of
physical development is selected according to the following criteria: age,
gender, nationality, place of residence, health.
The sequence of statistical processing of the received data is usually as follows:
1. Separation by gender.
2. Separation by age. For schoolchildren, an interval of one year is
usually taken. So, the age of 7 years includes children from 6 years 6 months to
7 years 5 months 29 days.
3. Compilation of variational series of the studied indicators. When
assessing any indicator of physical development, for example, body length, data
series with an interval of one cm are compiled in each age-sex group. So, the
body length of 120 cm will include children with a height of 119.5 cm – 120.4
cm.
4. The allocation in each row of the maximum value (Mmax), the
minimum value (Mmin), the average (M). M - the arithmetic mean weighted —
 94
is a typical value of the trait that characterizes this age-sex group. The
arithmetic weighted averages of the main signs of physical development,
calculated for all the examined age and sex groups, are the age standards of
physical development.
5. Calculation of σ (sigma) - the quadratic mean (sigma deviation), or the
general sigma, characterizing the spread of individual quantities (body length –
the main feature) from the arithmetic mean.
For example:
 – deviation of each 2 –
calculations
№ growth measurement from quadratic

the average deviation
1 100 0 0
2 105 5 25
3 99 1 1
4 97 3 9
5 100 0 0 
6 102 2 4 
7 98 2 4
8 103 3 9
9 102 2 4
10 95 5 25
М  100  81
Different methods are used to individually assess the physical
development of children.
The method of sigma deviations has become widespread. Its essence lies
in comparing the physical development of an individual with the physical
development of the group of which he is a member. The indicators of physical
development (height, body weight, chest circumference) are compared with the
arithmetic mean weighted of these signs (M) for the corresponding age and sex
group. The resulting difference is divided by the corresponding sigma (σ). In this
way, deviations from the averages are expressed in sigma – sigma deviations are
obtained.
A significant disadvantage of the method of assessing physical
development by determining sigma deviations is that each sign of physical
development is evaluated in isolation.
Currently, the most common is to determine the state of physical
development of the child as a whole — by comparing the weight and
circumference of the chest with the length of the body. Such a comparison can
be carried out on the basis of regression scales.
Regression scales are evaluation tables of physical development of
children, which indicate the average variants of a combined trait (for example,
weight and chest circumference) for a given body length. Evaluation tables for
monitoring the physical development of children in Novgorod are presented in
Application 1.
 95
The tables of regression scales in each age and sex group have the
following designations:
1) in the first column, the boundaries of the sigma deviations of the five growth
groups (body length) are given. The average values are within M ± 1σ; above
average – from M+1σ to M+2σ; to high – from M+2σ and above; below
average - from M-1σ to M-2σ and to low - from M 2σ and below;
2) the second column contains growth options with an interval of 1 cm from
minimum to maximum.
3) in the third column, against the arithmetic weighted average of growth, the
arithmetic average of weight is given;
4) in the fourth column, variants of the chest circumference are given in the
same sequence.
The evaluation table shows how the indicators of weight and breast
circumference change with a change in height.
In the tables of regression scales there is an indicator σR.
The σR - sigma of regression (partial sigma) shows the possible magnitude
of an individual deviation of a trait (body weight, chest circumference)
conjugated with another (body length).
The sequence of assessment of physical development on the regression scale:
1) having found the appropriate height value in the table, determine the proper
weight and circumference of the chest;
2) then calculate the difference between these values and the data of the child's
follow-up. The degree of lag or excess is expressed in regression sig-mach,
for which the difference is divided by the corresponding partial sigma (σR);
3) next, an assessment of physical development is carried out according to a
combination of basic characteristics, first determining the group of physical
development according to the growth group.
Depending on the ratio between body length (height) and body weight,
chest circumference, physical development is estimated as:
— normal (harmonious), in which the body mass and the circumference of the
chest correspond to the length of the body or differ from the proper values
within one particular sigma (σR),
— body mass deficit, if the body mass is less than the values of the minimum
limit of the "norm" relative to the body length (less than M-1σR);
— excess body weight, if the body weight is greater than the values of the
maximum limit of the "norm" relative to body length (greater than M+2σR);
— low height.
Disharmonious is considered physical development, in which the body
weight or chest circumference lags behind the proper values or exceeds them by
1.1-2.0 σR.
Sharply disharmonious should be considered physical development, in
which the body weight or chest circumference lags behind the proper values by
2.1 σR and more or exceed the proper values by the same amount, usually due to
excessive fat deposition.
With disharmonious and sharply disharmonious development, functional
 96
indicators, as a rule, are lower than the age norm.
An example of an assessment of physical development on regression scales.
Boy, 10 years 5 months, body length 142.6 cm; weight 37 kg; chest
circumference 70 cm.
First you need to determine the age and height of the boy in accordance
with the tabular gradation (10 years, 143 cm). According to the table of
Application 1 (boys 10 years old), in column 2 we find the height of 143 cm. In
column 3, we find that the weight of 35,78 kg corresponds to this growth. The
actual weight of the boy (37 kg) turned out to be 37 – 35,78 = 1,22 kg more than
the standard one. Since the difference obtained is less than 1σ R (2,71 kg),
therefore, the weight of the boy corresponds to the height.
Next, against the height of 143 cm, we find the corresponding chest height
- 68 cm. Since the actual size of the chest (70 cm) is only 2 cm higher than the
standard one (which is also less than the partial sigma of the chest circumference
σR = 5,44 cm), it can be concluded that the chest circumference corresponds to
growth.
Consequently, the boy's physical development can be assessed as normal
(harmonious).
To assess the physical development of children (more often preschool
age), medical professionals also use centile tables.
Centile tables are compiled for each attribute of physical development
(body length, body weight and chest circumference), taking into account age and
gender (Applicatio 2: centile tables № 1, 2, 3, 4, 5, 6).
The centile scale is an ordered series of possible measurements of a single
trait for a given gender and age. This series is divided into 100 intervals
(centiles). The actual measurement result (height, weight, or chest
circumference) corresponds to a certain interval (centile) with varying degrees
of probability.
Usually, not 100, but seven fixed cents are taken to evaluate the indicator:
3, 10, 25, 75, 90 and 97th.
The initial assumption is that the age (ideal) norm is the range of the
characteristic characteristic of 50% of healthy children of this age group and
gender, i.e. normal indicators of physical development lie in the range of 25-75
cents.
Each actual indicator (height, body weight, chest circumference) is placed
in its "own" area ("corridor", zone). The doctor does not make any calculations
in this case. Depending on which "corridor" the observer got into, his
assessment is given.
In this case, the following options are possible:
1) Area or "corridor" № 1 (up to 3 cents) is an area of very low values that
occur rarely in healthy people (no more than 3%). A child with this level of
trait should undergo special counseling and, according to indications, an
examination.
2) Area or "corridor" № 2 (from 3 to 10 cents) is an area of low values found in
7% of healthy children. Counseling and examination are indicated in the
 97
presence of other abnormalities in the state of health or development.
3) Area or "corridor" № 3 (from 10 to 25 cents) is an area of "below average"
values characteristic of 15% of children of this gender and age.
4) Area or "corridor" № 4 (from 25 to 75 cents) is an area of "average values"
characteristic of 50% of healthy children and therefore the most characteristic
for this age group.
5) Area or "corridor" № 5 (from 75 to 90 cents) is an area of "above average"
values characteristic of 15% of healthy children.
6) Area or "corridor" № 6 (from 90 to 97 cents) is an area of high values
characteristic of 7% of healthy children. The medical decision depends on the
essence of the sign and the condition of other organs and systems.
7) Area or "corridor" № 7 (over 97 cents) is an area of "very high" values
characteristic of no more than 3% of healthy children. The likelihood of
changes in the pathological nature is quite high, therefore, consultation and
examination are required.
The assessment of physical development according to the centile tables
according to the currently accepted gradations is carried out as follows:
— normal — if the length, body mass and circumference of the breast-Neu cells
are in 2,3,4,5,6 "corridors" and the difference rooms "measles-dorov" of
these indicators does not exceed 1;
— the deficit of body weight if the weight was in the "corridor", which number
less than the number of "corridor", which got a rise, and time-ence between
the rooms and corridors of body length and corresponding body mass is 2 or
more (for example, the growth rates are in the "measles-Dore" No. 6, and
indices of body mass are in the "corridor" №4);
— the excess of body weight if the weight was in the "corridor", the number of
which is larger than the number of "corridor", which got a rise, and time-ence
between the rooms and corridors of body length and corresponding body
mass is 2 or more (for example, the growth rates are in the "measles-Dore"
№ 2, and indicators of body weight are in the "corridor" № 4);
— low growth if the growth rates are in the "corridor" №1.
According to the results of centile estimates of length, body weight and
chest circumference, the harmony of development and somatotype are
determined.
With harmonious physical development, the difference in the numbers of
areas ("corridors") between two of the three indicators should not exceed 1.
If this difference is 2 — the child's development should be considered
disharmonious, if the difference is 3 or more - sharply disharmonious.
In healthy children (without obesity and hypotrophy), according to the
scheme of R.N. Dorokhov and I.I. Bakhrakh, three somatotypes are
distinguished: microsomatic, mesosomatic, macrosomatic. The ratio of the child
to one of these somatotypes is made according to the sum of the area numbers
(or "corridors" of the centile scale) obtained for body length, mass and breast
circumference.
With a total score of up to 10, the child belongs to the microsomatic type,
 98
with a total of 11 to 15 – to the mesosomatic, with a total of 16 to 21 points – to
the macrosomatic.
An example of an assessment of physical development according to centile
tables.
Boy L., age 1 g. 6 months. Body length 76 cm, body weight - 10,6 kg,
chest circumference - 50 cm.
The age of the child is equal to the nearest age group "18 months". The
value 76 falls into the "corridor" № 2 (from 3 to 10 cents) and, accordingly, is
estimated according to Table 1 as low. Body weight is estimated according to
Table 3 - "corridor" № 3 - below average. The chest circumference according to
Table 5 is "corridor" № 4, corresponds to the average values.
Given the low growth rates, it is necessary to resolve the issue of the
child's education. His physical development can be assessed as disharmonious,
since the difference in estimates of chest circumference and height is 2. The boy
should be classified as a microsomatic type, since he has a sum of 9 numbers.
Independent work
Task 1. To assess the physical development of schoolchildren according to the
examination data.
Survey data On regression Scale By centile tables
Girl, 10 years 5 months.

- body length 147 cm

- weight 44.9 kg
- chest circumference
75 cm
Conclusion

Physical development:

Girl, 12 years 6 months

- length 149 cm

- weight 57 kg
- chest circumference
72 cm
Conclusion

Physical development:
 99
Application 1
Evaluation Table Of physical development of children in Novgorod
Standing height Boys Girls
estimation 9 y.6 m. – 10 y 5 m 29dys 9 y 6 m. – 10 y5 m. 29 dys
(in sigma growth, weight, chest circum- growth, weight, chest circum-
deviations) cm kg ference, cm cm kg ference, cm
Low 124 25 62
(from М-2and 125 29 62
below) 126 23 58
127 26 62,5 126 26,5 62
128 27 66 127 21,5 60
Below
129 26,33 61,67 128 25,33 60,33
average
(from M-1σR 130 24,33 60,17 129 28 63
up to М-2) 131 28,13 63,5 130 25 58,5
131 29,5 63,29
132 34,67 67,83
132 29,3 62,25
133 31,3 65,6 133 25,5 61,14
134 29,25 66,33 134 29,32 64,18
135 29,75 63,25 135 34 61
136 31,56 65,38 136 31,14 65,07
137 33,22 65,56 137 31,55 63,04
138 32,6 65,73 138 32,58 65,5
Medium 139 31,96 66,21 139 35,5 67,17
(from M-1σR
140 33,83 68,56 140 33 64,5
up to М+1
141 32,78 66,28 141 33,8 67,6
142 34,78 68,56 142 32,29 64,44
143 35,78 68 143 35,5 67
144 37,5 68,8 144 38,93 69,29
145 35,59 65,63
146 39,83 69,75
145 37,83 71 147 40,9 70,6
146 34,75 66 148 42 67,4
Above average 147 38,06 68,06 149 39 72,5
(from М+1 148 38,1 69,4 150 45,25 74
up to М+2 149 37,4 70 151 47 65
152 47,13 72,5
153 46,1 71
Tall 154 58 88 154 39,83 69
(from М+2and
155 49 76 159 44 68
higher)
M 138,48 33,04 66,23 139,37 33,81 65,47
 5,98 - - 6,99 - -
R - 2,71 5,44 - 3,96 4,29
 100
Application2
CENTILE TABLE № 1
For boys 0 months - 17 years - body length (cm)
Cents
Ages
3 10 25 75 90 97
0 Mon. 48,0 48,9 50,0 53,2 54,3 55,1
1 50,5 51,5 52,8 56,3 57,5 58,7
2 53,4 54,3 55,8 59,5 61,0 62,1
3 56,1 57.0 58,6 62,4 64,0 65,5
4 58,6 59.5 61,3 65,6 67,0 68,7
5 61,0 61,9 63,4 67,9 69,6 70,9
6 63,0 64,0 65,6 69,9 71,3 72,5
7 65,0 65,9 67,5 71,4 73,0 74,1
8 66,5 67,6 68,9 73,0 74,5 75,7
9 67,8 68,8 70,1 74,5 75,9 77,1
10 68,8 69,9 71,3 76,1 77,4 78,8
11 69,9 71,0 72,6 77,3 78,9 80,4
12 71,0 72,0 73,8 78,5 80,3 81,7
15 72,9 74,3 76,0 81,3 83,4 84,9
18 75,0 76,5 78,4 84,4 86,5 88,2
21 77,2 78,6 80,8 86,8 88,2 91,0
24 79,4 81,0 83,0 88,4 92,0 93,8
27 81,4 83,2 85,5 92,2 94,6 96,3
30 83,7 85,2 87,5 94,8 97,2 99,0
33 86,0 87,4 90,0 97,4 99,7 101,4
36 88,0 89,6 92,1 99,7 102,2 103,9
3,5 years 90,3 92,1 95,0 102,5 105,0 106,8
4,0 93,2 95,4 98,3 105,5 108,0 110,0
4,5 96,3 98,3 101,2 108,5 111,2 113,5
5,0 98,4 101,7 104,9 112,0 114,5 117,2
5,5 102,4 104,7 108,0 115,2 118,0 120,1
6,0 105,5 108,0 110,8 118,8 121,4 123,3
6,5 108,6 110,9 113,9 122,0 124,4 126,4
7,0 110,3 113,8 117,0 125,0 127,9 130,0
8,0 116,4 118,8 122,0 131,0 134,3 136,4
9,0 121,5 124,6 127,5 136,5 140,3 142,5
10,0 126,4 129,2 133,0 142,0 146,2 149,1
11,0 131,2 134,0 138,0 148,3 152,9 155,2
12,0 135,8 138,8 142,7 154,9 159,5 162,4
13,0 140,2 143,6 147,4 160,4 165,8 169,6
14,0 144,9 148,3 152,4 166,4 178,0 176,0
15,0 149,3 153,2 158,0 172,0 178,0 181,2
16,0 154,0 158,0 162,2 177,4 182,0 185,0
17,0 159,3 163,0 168,1 181,2 185,1 187,9
Zone of the 1 2 3 4 5 6 7
(corridors, Very low low Average Higher high Very high
region) Lower than than aver-
average age
 101
Application 2
CENTILE TABLE № 2
For girls from 0 мonths – 17 years– length of body(cm)
Cents
Age
3 10 25 75 90 97
0 мonth. 47,0 48,0 49,2 52,1 53,3 54,5
1 49,7 50,7 52,4 55,3 56,9 57,7
2 52,2 53,3 55,0 58,6 59,9 60,8
3 55,1 56,1 57,9 61,5 63,0 63,9
4 57,4 58,6 60,5 64,1 65,6 66,4
5 59,9 61,0 62,8 66,4 67,8 68,8
6 62,1 63,0 64,3 68,2 69,8 70,8
7 63,7 64,2 66,4 70,0 71,6 72,7
8 65,2 66,1 67,7 71,6 73,1 75,2
9 66,5 67,5 69,3 72,8 74,5 75,8
10 67,7 68,8 70,5 74,2 75,9 77,1
11 69,0 70,3 71,7 75,7 77,1 78,3
12 70,3 71,4 72,8 76,3 78,3 79,3
15 72,2 73,6 75,2 78,8 81,2 82,4
18 74,0 75,8 77,5 82,1 84,4 86,0
21 76,0 78,2 80,0 84,6 87,4 88,8
24 78,4 80,4 82,6 87,5 90,2 92,2
27 80,8 83,0 85,4 90,1 93,0 94,7
30 83,4 85,6 87,8 92,8 95,6 97,3
33 85,9 88,2 92,9 95,5 98,2 100,0
36 88,6 90,8 95,6 98,1 100,8 102,9
3,5 years 91,0 93,4 95,6 101,0 103,9 105,8
4,0 94,0 96,2 98,4 104,2 106,9 109,1
4,5 96,9 99,3 101,5 107,1 110,6 114,0
5,0 99,9 102,4 104,9 110,7 114,0 116,5
5,5 102,5 105,2 108,0 114,5 117,1 120,0
6,0 105,3 108,0 111,0 118,0 120,8 124,0
6,5 108,0 110,5 114,0 121,7 124,4 127,4
7,0 111,0 113,6 117,1 125,0 128,1 131,3
8,0 116,6 119,4 123,0 131,0 134,4 137,6
9,0 122,0 124,4 128,5 136,7 140,6 143,8
10,0 127,0 130,0 133,8 142,5 146,6 150,1
11,0 131,0 134,2 138,6 148,6 153,9 156,8
12,0 135,2 138,4 143,0 155,1 159,3 163,5
13,0 139,5 143,1 148,0 160,3 164,3 168,0
14,0 144,0 147,4 152,4 164,2 168,0 170,6
15,0 148,1 151,6 156,3 167,0 170,3 172,6
16,0 151,7 155,0 158,3 169,0 172,0 174,1
17,0 154,2 157,3 161,2 170,0 173,1 175,5
Zone of 1 2 3 4 5 6 7
(corridors, Very low low Lower than Average Higher high Very high
regions) average than aver-
age
 102
Application 2
CENTILE TABLE № 3
For boys 0 months - 17 years - body weight (kg)
Cents
Age
3 10 25 75 90 97
0 мon. 2,4 2,7 3,0 3,7 4,0 4,4
1 3,1 3,5 3,8 4,5 5,2 5,6
2 3,9 4,3 4,6 5,5 6,2 6,6
3 4,5 4,9 5,4 6,4 7,0 7,5
4 5,2 5,6 6,2 7,2 7,9 8,4
5 5,8 6,2 6,8 7,9 8,6 9,1
6 6,4 6,8 7,4 8,6 9,2 9,7
7 6,9 7,4 7,9 9,1 9,8 10,3
8 7,4 7,8 8,4 9,6 10,3 10,8
9 7,8 8,3 8,9 10,1 10,9 11,3
10 8,0 8,6 9,2 10,6 11,3 11,8
11 8,3 8,9 9,5 11,0 11,8 12,3
12 8,6 9,1 9,8 11,5 12,2 12,7
15 9,2 9,6 10,5 12,2 12,9 13,5
18 9,6 10,2 11,0 12,8 13,6 14,2
21 10,1 10,6 11,5 13,5 14,3 14,9
24 10,6 11,1 12,0 14,1 14,9 15,4
27 11,1 11,6 12,4 14,6 15,4 15,9
30 11,5 12,0 12,8 15,1 16,0 16,5
33 11,0 12,4 13,2 15,6 16,5 17,0
36 12,1 12,8 13,6 16,0 16,9 17,5
3,5 years 12,7 13,4 14,2 17,0 18,0 18,7
4,0 13,3 14,2 15,1 18,0 19,1 20,0
4,5 14,0 14,9 15,9 19,0 20,6 21,7
5,0 14,8 15,7 16,8 20,1 22,0 23,2
5,5 15,5 16,6 17,8 21,4 23,4 25,1
6,0 16,3 17,6 18,9 22,6 24,9 27,0
6,5 17,2 18,4 20,0 24,0 26,4 29,0
7,0 18,2 19,6 21,3 25,5 28,0 31,1
8,0 20,0 21,5 23,4 28,4 31,7 35,1
9,0 22,0 23,4 25,6 31,4 35,4 39,2
10,0 24,0 25,6 28,0 35,1 39,5 45,0
11,0 26,0 28,0 31,0 39,2 44,5 50,5
12,0 28,3 30,4 34,4 43,8 50,0 57,0
13,0 31,0 33,4 39,8 49,0 56,2 63,6
14,0 34,0 35,2 42,2 54,6 62,2 70,6
15,0 37,8 40,8 46,9 60,2 65,1 76,5
16,0 41,2 45,4 51,8 65,9 73,0 82,5
17,0 46,4 50,5 56,3 70,6 78,0 86,2
Zone of 1 2 3 4 5 6 7
(corridors, very low low Lower than Average Higher High Very high
regions) average than aver-
age
 103
Application 2
CENTILE TABLE № 4
For girls 0 months - 17 years - body weight (kg)
Cents
Age
3 10 25 75 90 97
0 мonths. 2,3 2,6 3,0 3,5 3,8 4,0
1 3,0 3,3 3,7 4,3 4,6 4,9
2 3,7 4,0 4,4 5,0 5,3 5,6
3 4,4 4,6 5,0 5,7 6,1 6,5
4 5,0 5,3 5,6 6,5 6,9 7,4
5 5,5 5,8 6,2 7,2 7,7 8,2
6 6,1 6,3 6,8 7,9 8,5 9,0
7 6,5 6,8 7,3 8,5 9,1 9,7
8 7,0 7,3 7,7 9,1 9,7 10,5
9 7,4 7,7 8,2 9,6 10,4 11,2
10 7,7 8,1 8,7 10,1 11,0 11,3
11 8,1 8,5 9,1 10,6 11,5 12,2
12 8,3 8,8 9,4 11,0 11,9 12,6
15 8,9 9,4 10,0 11,7 12,7 13,3
18 9,4 9,9 10,6 12,5 13,4 13,9
21 9,8 10,4 11,1 13,1 13,9 14,6
24 10,3 10,9 11,6 13,5 14,5 15,2
27 10,8 11,3 12,0 14,0 15,0 15,7
30 11,2 11,7 12,5 14,5 15,5 16,3
33 11,5 12,1 12,9 14,9 16,0 16,8
36 11,8 12,5 13,3 15,4 16,5 17,3
3,5 old 12,4 13,1 14,0 16,3 17,8 18,6
4,0 13,1 13,9 14,8 17,2 19,0 20,0
4,5 13,8 14,9 15,8 18,4 20,4 21,6
5,0 14,9 15,8 16,9 19,8 21,9 23,7
5,5 15,6 16,6 17,8 21,2 23,6 25,8
6,0 16,3 17,4 18,8 22,5 25,1 27,9
6,5 17,1 18,2 19,9 24,0 26,7 29,8
7,0 18,0 19,3 20,8 25,3 28,4 31,8
8,0 20,0 21,2 23,0 28,5 32,2 36,4
9,0 21,9 23,3 25,4 32,0 36,4 41,0
10,0 23,9 25,6 28,0 36,0 41,1 47,0
11,0 26,0 28,0 31,1 40,3 46,0 53,5
12,0 28,4 31,4 35,2 45,4 51,3 58,8
13,0 32,0 35,3 40,0 51,8 56,8 64,2
14,0 36,1 39,9 44,0 55,0 60,9 70,0
15,0 39,4 43,7 47,6 58,0 63,9 73,6
16,0 42,4 46,8 51,0 61,0 66,2 76,1
17,0 45,2 48,4 52,4 62,0 68,0 79,0
zone 1 2 3 4 5 6 7
(corridors, Very low low Lower than Average Higher High Very high
region) average than Aver-
age
 104
Application 2
CENTILE TABLE № 5
For boys 0 months - 17 years – chest circumference (cm)
Cents
age
3 10 25 75 90 97
0 months. 31,7 32,3 33,5 36,0 36,8 37,3
1 33,3 34,1 35,4 38,0 38,9 39,4
2 35,0 35,7 37,0 40,0 40,8 41,6
3 36,5 37,3 38,4 42,1 43,1 43,8
4 38,1 38,8 39,8 43,5 44,5 45,7
5 39,3 40,1 41,1 45,0 46,2 47,4
6 40,6 41,4 42,4 46,3 47,6 49,0
7 41,7 42,5 43,4 47,5 48,9 50,1
8 42,7 43,5 44,4 48,5 49,9 51,1
9 43,6 44,3 45,2 49,3 50,7 52,0
10 44,3 45,0 46,0 50,0 51,5 52,8
11 44,8 45,6 46,6 50,8 52,2 53,6
12 45,3 46,1 47,0 51,2 52,8 54,3
15 46,0 46,8 47,9 51,9 53,7 55,0
18 46,5 47,4 48,6 52,4 54,3 55,6
21 47,0 47,9 49,1 52,9 54,7 56,0
24 47,6 48,4 49,5 53,2 55,1 56,4
27 47,8 48,7 49,9 53,5 55,6 56,8
30 48,2 49,1 50,3 53,9 55,8 57,3
33 48,4 49,3 50,5 54,2 56,1 57,7
36 48,6 49,7 50,8 54,6 56,4 58,2
3,5 old 49,2 50,3 51,5 55,0 57,1 59,0
4,0 50,0 51,2 52,4 55,8 58,0 59,9
4,5 50,8 52,0 53,3 56,9 59,0 61,2
5,0 51,3 52,8 54,0 58,0 60,0 62,4
5,5 52,2 53,5 55,6 59,1 61,3 63,8
6,0 53,0 54,4 56,0 60,2 62,5 65,1
6,5 53,8 55,2 57,0 61,3 63,8 66,4
7,0 54,6 56,2 57,9 62,3 65,1 67,9
8,0 56,1 58,0 60,0 64,8 67,0 70,8
9,0 57,7 59,6 61,9 67,1 70,6 73,8
10,0 59,3 61,4 63,9 69,8 73,6 76,8
11,0 61,1 63,0 66,0 72,1 76,2 79,8
12,0 62,6 65,0 68,0 74,9 79,0 82,8
13,0 64,7 66,9 70,2 78,2 82,2 87,0
14,0 67,0 68,6 73,1 81,8 86,2 91,0
15,0 70,0 72,6 76,3 85,7 90,1 94,2
16,0 73,3 76,1 80,0 89,9 93,6 97,0
17,0 77,0 80,1 82,9 92,2 95,5 98,4
zones 1 2 3 4 5 6 7
(Corridors, Very low low Lower than Average Higher High Very high
region) average than aver-
age
 105
Application 2
CENTILE TABLE № 6
For girls 0 months - 17 years – chest circumference (cm)
Cents
Age
3 10 25 75 90 97
0 мес. 30,8 31,8 33,2 35,7 36,4 37,0
1 32,9 34,0 35,3 37,4 38,1 39,0
2 34,6 35,7 37,2 39,1 40,0 40,9
3 36,2 37,3 38,7 40,5 41,2 42,8
4 38,1 39,1 40,4 42,1 43,2 44,3
5 39,4 40,5 41,7 43,5 44,6 45,8
6 40,6 41,6 42,9 44,9 46,1 47,2
7 41,8 42,8 44,0 46,0 47,2 48,5
8 42,8 43,7 44,9 46,9 48,3 49,8
9 43,6 44,5 45,6 47,8 49,3 51,0
10 44,3 45,2 46,2 48,1 50,1 52,0
11 45,0 45,8 46,8 49,3 50,8 52,7
12 45,5 46,3 47,3 49,9 51,4 53,3
15 46,4 47,2 48,1 50,8 52,3 53,9
18 47,1 47,8 48,7 51,3 52,9 54,5
21 47,5 48,2 49,1 51,9 53,5 55,0
24 47,8 48,6 49,5 52,5 54,0 55,6
27 47,9 48,8 49,8 53,0 54,5 56,2
30 48,0 48,9 49,9 53,3 55,0 56,8
33 48,1 49,0 50,1 53,7 55,5 57,2
36 48,2 49,1 50,3 54,0 56,0 57,6
3,5 old 48,6 49,5 51,0 54,3 56,2 57,8
4,0 49,2 50,4 51,6 55,1 56,9 58,6
4,5 49,6 51,0 52,3 55,9 57,8 59,7
5,0 50,4 51,6 53,0 56,9 58,8 61,0
5,5 50,9 52,2 53,9 57,8 60,0 62,2
6,0 51,5 53,0 54,8 58,6 61,2 63,6
6,5 52,3 53,8 55,5 59,8 62,4 64,8
7,0 53,2 54,6 56,3 61,0 63,7 66,6
8,0 54,7 56,3 58,2 64,5 67,6 70,6
9,0 56,3 58,0 60,0 68,1 71,4 75,1
10,0 58,0 60,1 62,0 71,3 75,5 78,8
11,0 59,8 62,2 64,4 74,5 78,6 82,3
12,0 61,9 64,5 67,2 77,6 81,9 86,0
13,0 64,3 66,8 70,0 80,9 85,0 88,0
14,0 67,0 69,6 73,0 83,5 87,6 91,0
15,0 70,0 72,9 76,2 85,5 89,3 92,6
16,0 73,0 75,9 78,8 87,1 90,6 93,9
17,0 75,4 78,0 80,7 88,0 91,1 94,6
zones 1 2 3 4 5 6 7
(corridors, Very low low Lower than Average Higher High Very high
region) average than aver-
age
 106
Practical lesson 12
Hygienic assessment of the lesson schedule
The purpose of the lesson:
to learn how to correctly evaluate the current lesson schedule in a hygienic way
and make it up in accordance with hygienic requirements.
Equipment of the lesson: curricula.
Methodical instructions
The educational process at the school can be organized in a five-day or
six-day academic week. The maximum allowable weekly load is shown in
Table 1.
Table 1
Hygienic requirements for the maximum values
of the weekly training (educational) load
Maximum allowable classroom
weekly workload (in academic hours)
Classes
with a 6-day week, with a 5-day week,
no more no more
1 - 21
2–4 26 23
5 32 29
6 33 30
7 35 32
8–9 36 33
10–11 37 34
When drawing up the lesson schedule, it is necessary to be guided by the
«Sanitary and epidemiological requirements for organizations of education and
training, recreation and health improvement of children and youth» (SP
2.4.3648.20), and it is also necessary to take into account changes in the weekly
and daily working capacity of students.
Modern scientific research has established that the biorhythmological
optimum of mental performance in school-age children falls on the interval of
10-12 hours. During these hours, the greatest efficiency of assimilation of the
material is noted with the lowest psychophysiological costs of the body.
Therefore, in the lesson schedule for middle and senior age students, the
main subjects should be taught in 2, 3, 4 lessons, and for younger students - in 1,
2, 3 lessons.
The mental performance of students varies on different days of the school
week. Its level increases by the middle of the week and remains low at the
beginning (Monday) and at the end (Friday) of the week.
Therefore, the distribution of the academic load during the week is built in
such a way that the largest amount of it falls on Tuesday and (or) Wednesday.
On these days, the school schedule includes either the most difficult subjects, or
 107
subjects in larger quantities than on the other days of the week. Presentation of
new material, control work should be carried out in 2-4 lessons in the middle of
the school week.
Subjects that require a lot of time for home preparation should not be
grouped into one day of the school schedule.
When drawing up a lesson schedule, you should use the scales of
difficulty of academic subjects (Table. 2), according to SanRaR 1.2.3685-21
"Hygienic standards and requirements for ensuring the safety and (or)
harmlessness of environmental factors for humans", in which the difficulty of
each subject is ranked in points.
Таble2
The scale of difficulty of academic subjects
at the level of basic general education
Number of points (by class)
Academic subjects
5 6 7 8 9
physics - - 8 9 13
chemistry - - - 10 12
History
Foreign language
Mathematics 10 13 - - -
Mathematics Geometry - - 12 10 8
Аlgebra 10 9 7
Natural study 7 8 - - -
Biology 10 8 7 7 7
Literature 4 6 4 4 7
Computer science& IКТ 4 10 4 7 7
Russian language/native language 8 12 11 7 6
geography - 7 6 6 6
Visual art 3 3 1 - -
Art World art culture - - 8 5 5
Мusic 2 1 1 1 -
Social studies
6 9 9 5 5
(including economics and law)
Теchnology 4 3 2 1 4
Technical drawing - - - 5 4
Fundamentals of life safety 1 2 3 3 3
P.E 3 4 2 2 2
 108
Independent work
Task 1.
Give a hygienic assessment to one of the current schedules (Appendix 1).
Class ______________________________
Number of study days per week ____.
Maximum permissible load _____.
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
Task 2. Make a schedule of lessons for one grade II or III level based on the
basic curriculum (adj. 2) taking into account the weekly study load for a 5-day
or 6-day week (Table 1).
Class schedule ____________________
Monday Tuesday Wednesday
1. 1. 1.
2. 2. 2.
3. 3. 3.
4. 4. 4.
5. 5. 5.
6. 6. 6.
7. 7. 7.
Thursday Friday Saturday
1. 1. 1.
2. 2. 2.
3. 3. 3.
4. 4. 4.
5. 5. 5.
6. 6. 6.
7. 7. 7.
 109
Application 1
Time table of lessons for 6, 7, 8, 9 classes
D № Time 6 Class 7 Class 8 Class 9 Class
1 8.30 –9.10 Russian lang Music Russian. lang English lang
2 9.20 – 10.00 Мusic Algebra Physics Inform-a
10.15 – 10.55 Маthematic.
Monday

3 of Phys. of Phys. k-ra Literature

4 11.15 – 11.55 English lang English Biology of Phys.
5 12.15 – 12.55 Russian lang Geography Geometry Physics
6 13.05 – 13.45 Literature Chemistry Russian. lang
7 13.55 – 14.35 Russian. lang Geography
8.30 - 9.00 Co.hr Co.hr Co. hr Co.hr
1 9.10 – 9.50 Technology English lang Algebra Phys. k-ra
2 10.00 – 10.40 Technology History Russian. lang Geography
Tuesday

3 10.50 – 11.30 Math. Geometry History Algebra

4 11.50 – 12.30 Literature Russian. lang Music Chemistry
5 12.50 – 13.30 of Phys. Literature English lang English lang
6 13.35 – 14.15 Russian. lang Technology Phys. Russian. lang
7 13.55 – 14.35 Technology Technology
1 8.30 –9.10 Geography Geography Phys. Literature
2 9.20 – 10.00 Math. Russian. English Biology
3 10.15 – 10.55 English lang language language Society
wednesday

4 11.15 – 11.55 History General Geography Algebra

5 12.15 – 12.55 Russian. lang Biology Russian. Algebra
6 13.05 – 13.45 Literature Algebra language English lang
7 13.55 – 14.35 art Society
Geometry
Literature
1 8.30 –9.10 Russian. lang English Algebra Russian. lang
2 9.20 – 10.00 art language Biology Literature
3 10.15 – 10.55 Math. History Literature Geometry
Thursday

4 11.15 – 11.55 Communic. Biology General life Chemistry

5 12.15 – 12.55 English. lang Physics activity Physics
6 13.05 – 13.45 of Phys. k-ra Geometry History History
7 13.55 – 14.35 of the Physical Algebra
K-ra
1 8.30 –9.10 History Physics Physics History
2 9.20 – 10.00 Biology Algebra Algebra Geography
3 10.15 – 10.55 Math. English English Geometry
friday

4 11.15 – 11.55 Russian. lang Literature language English lang

5 12.15 – 12.55 Literature Russian. Chemistry Russian. lang
6 13.05 – 13.45 language Algebra Physics
7 13.55 – 14.35 Computer computer
science science
1 8.30 – 9.10 G. life activity
2 9.20 – 10.00 Phys.
10.10 – 10.50
saturday

3 English lang
4 11.05 – 11.45 Algebra
5 12.00 – 12.40 Biologists
6 12.45 – 13.25 History
7
 110
Application 2
SAMPLE CURRICULUM (WEEKLY)
for educational institutions of the Russian Federation
with the Russian language of instruction
BASIC GENERAL EDUCATION
Number of hours per week
Academic subjects
5 6 7 8 9
Russian language 6 6 4 3 2
Literature 2 2 2 2 3
Foreign language 3 3 3 3 3
Mathematics 5 5 5 5 5
Computer science and ICT - - - 1 2
History 2 2 2 2 2
Social Studies - 1 1 1 1
Geography - 1 2 2 2
Physics - - 2 2 2
Chemistry - - - 2 2
Biology - 1 2 2 2
Art (music and art) 2 2 2 1 1
Technology (labor) 2 2 2 1 -
Fundamentals of life safety () - - - 1 -
P.E 2 2 2 2 2
World art. Culture (MAC) - - - - -
Total: 26 27 29 30 29

Regional component 6-day week 5 5 5 5 6

/ educational institu-
tion component 5-day week 2 2 2 2 3

Maximum permissi- 6-day week 31 32 34 35 35

ble classroom train-
ing load 5-day week 28 29 31 32 32
 111
Practical lesson 13
Methods of studying the influence of the educational process
on the body of students
The purpose of the lesson: to get acquainted with the methods of studying the
functional state of the central nervous system, mental performance of
schoolchildren and their state of health.
Equipment of the lesson: Anfimov proofreading tables, Landolt tables, Schulte–
Platonov tables, stopwatch, questionnaires.
Methodical instructions
In recent years, various modes of education have been introduced in
schools: a five-day school week not only in primary, but also in middle and old
classes without changing curricula; lessons shortened to 35, 40 minutes (instead
of 45 minutes) and double lessons (including in grades II). This leads to a
significant intensification of the educational process and, as a result, faster
fatigue of children, the development of overwork, and a decrease in the working
capacity of schoolchildren.
The degree of optimization of the educational process, the nature of its
impact on the body of schoolchildren can be judged by assessing the state of
health of children, as well as the functional state of the central nervous system
(CNS) and mental performance.
One of the objective methods of assessing the health of schoolchildren is a
questionnaire, which reflects a subjective assessment of their well-being and
health.
To study the functional state of the central nervous system and mental
performance, you can use proof-reading samples (Anfimov tables, curly tables,
special tables with Landolt rings modified by Yu.D. Zhilov) and Schulte-
Platonov tables.
1. The survey is conducted among schoolchildren or parents (for primary
school students).
The questionnaire offers questions reflecting the students' daily routine;
questions revealing unfavorable subjective feelings and questions characterizing
the student's attitude to the learning regime.
Such changes on the part of students' health as headache, abdominal pain,
significant fatigue after lessons, irritability, tearfulness, etc. indicate significant
overwork of students. This may be a consequence of the incorrect organization
of the educational process (double and shortened lessons, etc.) and the daily
routine of children and adolescents (insufficient outdoor exposure, the
predominance of a static component in free time, including daily long-term TV
viewing, short sleep duration, etc.).
The most informative are time-lapse questionnaires (adj. 1), when the
survey of children of one or more classes is carried out during the week,
indicating the duration of the components of the day.
After the study, the answers to the questions proposed in the questionnaire
are analyzed for each class.
 112
For example: 40 children (100%) filled out the questionnaire in the
classroom.
To the question: "Do you feel rested in the morning?" They answered: yes
- 18 people, i.e. 45%, rarely - 12, i.e. 30%, no - 10, i.e. 25%.
The survey should be conducted in the dynamics of the academic year (at
the beginning, middle, end of the year); it is possible to conduct a comparative
analysis of the survey data by years of study, in classes with different variants of
training modes.
2. The study of the functional state of the Central nerve-tion system
(CNS) and of mental capacity of students
a) the study of the stability of (concentration) of attention is carried out
using tables anfimova (Appendix 2).
Job when performing correction of the samples are reduced to vicencia-
niya or underline with different letters and their combinations (rings, pieces) –
usually within 2 minutes. These tables allow us to study the stability of attention
under the action of monotonous stimuli (letters).
The different number of identical letters (rings, shapes) in the lines makes
it possible to memorize and requires a lot of concentration.
Participants of the study are given tables of Anfimov and instructed:
«Here is a sheet with letters. Your task: looking from left to right lines of letters,
but not skipping lines, cross out the letters "K" and "E". Work very carefully and
as soon as possible. You will start working on the command "started". After the
"stop" command, stop and cross out the last letter that you managed to view
with a dash».
Simultaneously with the ―started‖ command, the researcher turns on the
second-domer. After two minutes of examination, the command ―stop‖ is given.
After counting the number of correctly marked signs (A), the number of
errors (d) – omitted and mistakenly crossed out signs and the total number of
viewed signs (P), the accuracy of the work (T) and productivity (E) are
calculated.
The accuracy of the work is determined by the formula:
А
Т=
А+d
The productivity of work is determined by the formula:
Е=РТ
Productivity (speed) of work is characterized by the total number of signs
viewed during a set time, the accuracy of work (quality of work) is the number
of mistakes made.
Research should be carried out in the dynamics of the school day (before
and after classes), the school week and the school year (at the beginning, middle
and end) and, if possible, in comparison: in innovative schools and in the normal
educational process.
b) when studying the mental performance of junior schoolchildren, they
use curly tables (Appendix 3).
 113
The work with the help of curly tables is performed by children within
two minutes. Previously, the children are instructed: "Look through the figures,
look for three figures among them (for example, a triangle, a flower, a circle).
Put a minus sign in the triangle, a cross in the circle, a dot in the checkbox‖" The
task is to draw on the blackboard, then erase. Tasks are changed at each
subsequent study.
The assessment of the completed task is carried out according to the
amount of work (the number of viewed figures) and the quality (accuracy) of the
work (the number of errors made in terms of 100 viewed figures). For example:
a student viewed 72 characters and made 9 mistakes. In terms of 100 zna-kov,
this will be:
Х= 9  100 = 11,1
72
Each missed line is excluded from the total number of viewed lines, but is
counted as one mistake and is added to the total number of errors.
c) the stability of attention, the volume and speed of processing visual
information (the performance of the visual analyzer) is assessed using special
tables with Landolt rings in the modification of Yu.D. Zhilov (1967)
(Appendix 4).
These tables contain 660 rings arranged randomly (22 rows of 30 rings
each). The rings have a gap in one of the directions. Each of the 8 breaks
corresponds to a certain time on the clock face (12, 13, 15, 17, 18, 19, 21, 23).
When working with a table, there can be 4 variants of its location (the numbers
of 4 positions are marked with Roman numerals on the table). When performing
a task, the specified position number should be on top.
The perceived information is evaluated in conventional units - bits. The
subjects are asked to cross out the rings with one of the breaks.
When evaluating the work performed, it is taken into account:
T is the time spent on completing the task (in seconds);
A – the number of correctly crossed out rings;
N is the number of rings with a given gap at a given position.
The number of errors n is determined by the formula: n = N – A
The indicators of N at a certain position and a given ring break are given
in the following table:
Ring break
Position
12 13 15 17 18 19 21 23
I 79 81 86 100 70 75 76 93
II 76 93 79 81 86 100 70 75
III 70 75 75 93 79 81 86 100
IV 86 100 70 75 76 93 79 81
The information processing rate (or the amount of perceived information
in s) is S (bits/s), calculated by t he following formula:
 114

S= Q–Zn
, where
T
- Q is the amount of information of the entire table (in bits)
- Z is the information lost (falling on one missing character).
If we take into account that Q = 1848.0 bits, Z = 2.8 (Z = 2.9 if the num-
ber of rings with a certain gap in the table is N = 100), then
S = 1848,0 - 2,8  n
Т
d) the study of attention switching (attention distribution) is carried out
using the Schulte–Platonov tables.
Schulte–Platonov tables (Appendix 5) are 60x60 cm in size, divided into
49 square cells, in which numbers written in black numbers from 1 to 25 and red
numbers from 1 to 24 are placed. The numbers are arranged in disorder, but so
that numbers close in magnitude are as rare as possible next to each other. The
subject consistently performs three tasks:
1) The subject searches for black numbers from 1 to 25 in Table 1;
2) The subject searches for red numbers from 24 to 1 in Table 2
3) The subject in Table 3 alternately finds, shows and names black and red
numbers: black from the beginning to the end, red from the end to the begin-
ning. The order should be as follows: 1 - black, 24 - red, 2- black, 23 - red…
The time of completion of each stopwatch task is taken into account.
The formula determines the indicator of the time of switching attention or
the coefficient of switching attention (CPV): T = C – (A+B), where
- C is the task completion time according to the mixed table 3;
- A is the task completion time according to Table 1;
- B – the time of the task according to Table 2.
To assess the shift of attention is also possible to use only the results of
the job table 3: 3 min – "excellent"; 3 to 4 min – "good"; 4 to 5 min – "satisfac-
tory"; more than 5 min – "bad", it indicates difficulties survey-when the wind
blows the job.
It is important to pay attention to the number and nature of errors. Replac-
ing numbers by color in a small amount does not make a significant difference.
If there are more than 5 of these errors, then we can talk about a weakening of
attention. A significant mistake is to change the desired order of naming num-
bers for any series. For example, some, having reached the middle of the table,
begin to name the numbers of both rows in ascending or descending order. Such
errors, if they are not corrected by the examinee after 3-4 pairs of numbers, but
continue until the end of the study, may indicate difficulties in switching atten-
tion.
Some authors (Intersectoral methodological recommendations on the or-
ganization and conduct of psychophysiological professional selection. Sver-
dlovsk, 1984) suggest taking into account only the time spent searching for
numbers (one of the tables) in red (from 1 to 24) and black (from 1 to 24) and
calculating the arithmetic mean of these time values.
 115
Independent work
Task 1. Analyze the submitted timekeeping questionnaires.
Task 2. To investigate the functional state of the central nervous system and
mental disability (before and after classes) - using the Anfimov tables. Record
the results of the survey in the protocol and calculate the accuracy and produc-
tivity of work:
Total
Number of cor- Number of Work Work
number of cha-
Time rectly marked mistakes Accuracy productivi
racters viewed
characters (A) made (d) (T) ty (E)
(P)
Before
work
After
work
Task 3. To investigate the stability of attention – using tables with rings. The
result of the study should be recorded in the protocol and calculate the speed of
information processing:

Before work After work

postion ______ position ______
Sur name, name
gap ______ gap ______
Т А n S Т А n S

Task 4. To investigate the switching of attention – using the Schulte-Platonov

tables.
The time of each task should be taken into account by a stopwatch and recorded
in the protocol, calculate the time (coefficient) of switching attention:
№ Attention switching time
Task completion time
таbles (coefficient)
1
2
3

Conclusion:_______________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
 116
Application 1
Questionnaire
sex ______, class__________, change________
№ questions Mon tue wed. thur frid Sat Sun
1 Rise (time)
2 Morning gymnastics (yes, no)
3 Breakfast (lunch) at school (yes, no)
4 Number of lessons
5 Elective at school
6 Number of hours outdoors
Lesson preparation time
7 -the beginning
-the duration
8 Attending clubs (yes, no)*
9 Reading (yes, no)
10 Help around the house (yes, no)
11 TV viewing
12 (number of hours)
13 Communication with the computer
Communication with a "mobile
14
phone"
Lunch time (start)
15 afternoon tea (start)
Dinner (start)
16 Going to bed (time)
Fatigue after school
17
(yes, rarely, no)
18 Headaches (yes, rarely, no)
19 Abdominal pain (yes, rarely, no)
20 Do you feel cheerful
Irritability, tearfulness (yes, rarely,
21
no)
In the morning you feel rested and
22
rested (yes, rarely, no)
if "yes", then specify their orientation:
sports sections, music, dancing, drawing, photography, tourism,
foreign language courses, computer courses
or other ______________________________________________________
 117
Application 2
Anfimov's table for school children
 118
Application 3
Anfimov's table for preschoolers
 119
Application 4
Таble with Rings
Last name, first name, patronymic____________________________________
Date of observation____________________________________________
position I, II, III, IV (circle the desired number)
A gap in the ring 12, 13, 15, 17, 18, 19, 21, 23 (circle the desired number)
Viewing time in seconds ________________________________________
Number of crossed-out rings ______________________________________
Number of missed rings ____________________________________
Information processing speed (bit/s)_____________________________
I

II IV

III
 120
Application 5
Schulte-Platonov tables
1
22 10 6 11 3 6 17

3 19 14 15 23 21 13

22 1 12 1 20 7 4

12 18 9 14 17 10 7

4 15 23 18 5 11 13

2 9 16 2 25 21 19

24 8 20 5 16 24 8
2
17 10 1 21 7 19 13

11 20 3 13 6 23 5

16 8 22 4 18 25 4

1 6 22 12 16 2 14

5 15 9 20 2 21 23

17 24 7 15 3 9 24

11 19 18 8 12 14 10
3
24 8 15 4 20 7 23

19 20 24 2 16 1 22

12 5 11 17 9 14 4

1 9 17 14 8 18 11

6 3 22 25 12 7 21

13 21 19 15 3 18 2

16 10 6 13 5 23 10
 121
Practical lesson 14
Quality of life assessment
The purpose of the lesson: to study the main components of the concept of
"quality of life" and indicators of its assessment; to get acquainted with the
methods of determining the coefficient of the rate of aging and the biological
age of a person.
Equipment of the lesson: height meter, scales, tonometers, centimeter tapes,
stopwatch, calculator.
Methodical instructions
According to the definition of the World Health Organization (WHO), the
term "quality of life" (short - QOL; English - quality of life, short - QOL;
German. - Lebensqualitat, socr. LQ) covers the physical, psychological,
emotional and social health of a person based on his perception of his place in
society.
There are more than 150 methods of assessing the quality of life, among
which quality of life indices, official statistics on social phenomena in the
country, sociological surveys and integral indicators characterizing the
subjective assessment of quality of life are especially common.
The main indicators by which the quality of life is analyzed:
 socio-demographic — actual life expectancy, dynamics of morbidity, fertility,
mortality;
 economic activity of the population — unemployment rate, migration of the
population and its causes;
 social tension — participation in political events, strikes, the share of the
shadow economy in GDP, the dynamics of crime.
 development of the social sphere — the share of expenditures on education,
science, health and culture in GDP, the number of students and students…
 environmental — the content of harmful substances in the atmosphere, soil,
water, food, environmental costs in GDP, contribution to environmental
protection and rational use of resources.
Quality of life indicators in different countries differ from each other, as
they largely depend on the stage of economic development.
State work on the definition and implementation of a given quality of life
is carried out through the legislative introduction of standards (indices) of
quality of life, which usually include three blocks of complex indicators.
I. The first block of quality of life indicators characterizes the health of the
population and demographic well-being, which are assessed by:
- birth rate,
- the level of life expectancy,
- the level of natural reproduction.
II. The second block reflects the satisfaction of the population with living
conditions:
- individual (wealth, housing, food, work, etc.),
 122
- social — the state of affairs in the state (justice of the authorities,
- accessibility of education and healthcare, security of existence,
environmental well-being). To assess them, sociological surveys of
representative samples from the population are used.
- The objective indicator of extreme dissatisfaction is the level of suicides.
III. The third block of indicators assesses the spiritual state of society.
- the level of spirituality is determined by the nature, range and number of
creative initiatives, innovative projects,
- the level of the moral state of society is determined by the frequency of
violations of universal moral commandments ("do not kill", "do not steal",
"honor your father and mother", "do not create an idol for yourself", etc.). As
units of measurement, data from official statistics on social anomalies that
are considered a violation of the relevant commandments are used: murders,
robberies, grievous bodily harm, abandoned elderly parents and children,
alcoholic psychoses. Where such offenses are more common, the level of
moral well-being is worse.
The indicators included in the blocks must meet the following
requirements:
1) reflect the most important social parameters that are of integral importance to
society and reflect its own sense of being prosperous or disadvantaged;
2) be unambiguously perceived by any citizen, uniting everyone with a single
understanding;
3) have sufficient sensitivity and the ability to react quickly to factors that
change the conditions of life;
4) have quantitative characteristics available for standard measurement,
providing the possibility of comparative assessment and monitoring of
dynamics.
A partial analogue of the quality of life index, which has now become
widespread and recognized, is the Human development index (HDI, human
development indicator - HDI) or, in another translation, the Human
Development Index (HDI), used by the UN since 1990. Among the main
components of the HDI are the average life expectancy at birth, the level of
education of the population and the real per capita gross domestic product
calculated taking into account the purchasing power parity of the national
currency.
In medicine, the key concept of quality of life is health. Currently, the
term "health-related quality of life" (health related quality of life, HRQL) is
widely used.
QL research is conducted in palliative medicine, cardiology,
transplantation, oncology, surgery, psychiatry, endocrinology, gerontology,
neurology and other fields of medicine.
The main directions are the standardization of treatment methods, the
examination of new treatment methods and medicines, the development of
prognostic models of the course of diseases and the economic justification of
treatment methods.
 123
There are three main components that characterize the medical aspects
of quality of life:
1) Functional abilities include the preservation of physiological functions
that provide the ability to carry out daily activities, social, intellectual and
emotional functions, and create economic security.
2) Perception includes the views of a person and his judgments about the
value of the components listed above. The perception of the general state of
health, the level of well-being and life satisfaction is important.
3) Symptoms are a consequence of the underlying or concomitant
pathology, they decrease or disappear as a result of intervention, may appear due
to side effects of drugs or the progression of the process.
Thus, despite the relativity of many criteria, the indicator of QOL is
largely determined by the patient himself. There can be no reliable assessment of
the patient's quality of life by relatives, relatives or medical staff, since they
cannot be objective. Relatives and loved ones are triggered by the so-called
"guardianship syndrome", while they usually give an exaggerated assessment of
the sufferings of the person whose health they are concerned about. Conversely,
medical professionals always note a higher quality of life than it actually is
("benefactor syndrome"). As we have already indicated, the quality of life does
not always correlate with objective data. Thus, with all possible objective
parameters, one should not forget that the main method of evaluation is the
opinion of the patient himself, since the quality of life is an objective criterion of
subjectivity.
The most well-known questionnaires for the study of QOL patients:
 European Quality of Life Study Group (EUROQOL - EuroQol Group)
 Short form of health Assessment (Medical Outcomes Study-Short Form
[MOS-SF 36]) - 8 scales, 36 questions
 Index of general Psychological Well-Being (Psychological General Well-
Being Index)
 Sickness Impact Profile
 Nottingham Health Profile - 6 parameters of experience assessment, 38
questions; 7 parameters of daily life assessment, 7 questions
 Anxiety and Depression Scale (Hospital Anxiety and Depression Scale
[HAD]); Well-Being Index (Quality of Well-Being Index [QWBI])
 Questionnaire health Mack Masters (McMaster Health Index Questionnaire
[MHIQ])
 Survey of child health (Child Health Questionnaire [CHQ])
 A questionnaire to assess quality of life in Pediatrics (PedsQL)
 Generalized rating scale of quality of life (Overall Quality of Life Scale)
 Questionnaire for assessing the quality of life of the
 The index of quality of life (Quality of Life Index)
The questionnaire should cover several aspects:
1) sufficiency of the patient's physical (functional) capabilities for self-
service, tolerance to physical, social, emotional stress, the need to have adequate
 124
sleep and rest, mobility and independence;
2) socio-economic relations of the patient (place in the family and
participation in its life, financial support and medical expenses, professional
duties, communication with friends and active recreation);
3) positive emotional perception of life (feeling like a burden to family
and loved ones, loss of control over life and over yourself, fear for the future and
hopelessness). As a result, certain requirements are imposed on the
questionnaires. They should have high validity (the ability of the methodology
to measure those parameters that are necessary for the purposes of the study)
and sensitivity (the degree of consistency of two independently obtained series
of indicators, which is characterized by the correlation coefficient).
The most important and interesting function of the questionnaire is the
possibility of analyzing the effectiveness of treatment. At the same time, it
should be remembered that the patient's subjective assessment of well-being in
no way replaces objective data.
Currently, the SF-36 questionnaire (Russian version) is used as a standard
in Russia, which has been used for more than 10 years by the world's leading
universities. The questionnaire includes 8 scales: definition of physical function
(PF), physical role (RP), physical pain (BP), vitality (VT), social role (SF),
emotional role (RE) and mental health (MN). The SF-36 questionnaire assumes
a differentiated approach to assessing the components of the quality of life,
depending on gender and age.
1. Physical function determines the ability to perform various physical activities
- from minimal (self-service) to maximum (long walking, running, sports
without restrictions).
2. The physical factor reflects the ability to perform a specific job typical for a
specific age and social affiliation (professional duties, household).
3. Physical pain that can cause a restriction of the patient's usual activity is also
taken into account by the questionnaire.
4. The General health scale evaluates the subjective perception of the previous,
present state and determines its prospects.
5. The vitality scale reflects the feeling of inner energy, the absence of fatigue,
the desire for energetic actions.
6. The social aspect determines the ability to develop, to communicate fully
(family, relatives, colleagues, etc.).
7. The emotional factor reflects the emotional status of the patient, the influence
of emotions on daily activities, relationships with others. The presence or
absence of problems at work and in the field of employment is assessed
8. The scale of mental health reveals the degree of neuroticism, a tendency to
depressive states, a feeling of peace, spiritual calm.
Improving the quality of life is either the main or additional goal of
treatment. If the disease can lead to a reduction in the patient's life, then the
quality of life becomes an additional goal. If the disease is incurable, then
improving the quality of life is a priority - this approach is used in palliative
care.
 125
Independent work
Task 1
1) Analyze the concept of "quality of life" (QL) and study 3 blocks of QL
indicators (with assessment levels and examples);
2) Find out what requirements are imposed on the indicators of quality of life;
3) Give three examples of questionnaires for the study of QOL patients.
Task 2 Calculate your biological age (BV) by the method of V.P. Voitenko.
BV(men) = 26.985 + 0.215 ADS - 0.149 ZDV - 0.151 SB + 0.723 POPS
BV(women) = - 1.463 + 0.415 ADP - 0.140 SB + 0.248 MT + 0.694 POPS
ADS (systolic blood pressure) in mmHg - measured on the right hand, sitting,
with an interval of 5 minutes. The lowest pressure is taken into account.
ZDV (the duration of holding the breath after a deep breath) in seconds -
measured using a stopwatch, three times, with an interval of 5 minutes. The
greatest value of the HFV.
SB (static balancing) in seconds is taken into account — the time that the subject
stands on his left foot, without shoes, eyes closed, hands lowered along the
trunk until the heel lifts off the floor or loses balance. Measured without
prior training, three times, with an interval of 1-2 minutes, the best result is
taken into account.
ADP (pulse blood pressure) in mmHg is the difference between ADP (systolic)
and ADP (diastolic).
MT (body weight) in kg - is determined using a scale, without shoes.
POPS (subjective assessment of health) - performed using a questionnaire.
Possible answers to questions 1-28 are "yes" or "no", to question 29 -
"good", "satisfactory", "bad" and "very bad".
1) Do headaches bother you?
2) Is it possible to say that you wake up easily from any noise?
3) Are you worried about pain in the heart area?
4) Do you think that your hearing has deteriorated in recent years?
5) Do you think that your eyesight has deteriorated in recent years?
6) Do you try to drink only boiled water?
7) Do they give you a place in public transport?
8) Do you worry about joint pain?
9) Does the weather change affect your well-being?
10) Do you have periods when you lose sleep because of worries?
11) Do constipation bother you?
12) Are you worried about pain in the liver?
13) Do you have dizziness?
14) Do you think that it has become more difficult for you to concentrate now
than in previous years?
15) Do you worry about memory loss, forgetfulness?
16) Do you feel burning, tingling, "crawling goosebumps" in various parts of
your body?
17) Do noise or ringing in your ears bother you?
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18) Do you keep one of the following medications for yourself in your home
medicine cabinet: validol, nitroglycerin, heart drops?
19) Do you have swelling on your legs?
20) Do you have to give up some dishes?
21) Do you have shortness of breath when walking fast?
22) Do you worry about pain in the lower back?
23) Do you have to use any mineral water for medicinal purposes?
24) Does an unpleasant taste in your mouth bother you?
25) Is it possible to say that you have become easy to cry?
26) Do you go to the beach?
27) Do you think that you are now as efficient as before?
28) Do you have such periods when you feel joyfully excited, happy?
29) How do you assess the state of your health?
After answering the questionnaire questions, the total number of
unfavorable answers is calculated (it can range from 0 to 29). "Yes" answers to
questions 1-25 and "No" answers to questions 26-28 are considered unfavorable,
and one of the last two answers to question 29 is considered unfavorable.
Task 3 Calculate your biological age (BV) by the method of A.G. Gorelkin and
B.B. Pinkhasov.
1) Calculation of the aging rate coefficient (CRA).
WC×BW
CRA(мan) =
HC×H ×(17,2+0,31×DYм+0,0012×DY2)
2

WC×BW
CRA(woman) =
HC×H2×(14,7+0,26×DY+0,001×DY2)
CA is the calendar age of a person in years (accuracy is not less than 0.1 years).
For example: 20 years 5 months = 20+5/12 ≈ 20,4
BW — body weight in kg, measured on a scale
H — height in meters, measured by a height meter
WC — waist circumference in cm, measured with a soft centimeter tape.
HC is the circumference of the hips in cm, measured with a soft centimeter tape.
DY — the difference of a person's years in years is the difference between the
calendar age and the age of the ontogenetic (physiological) norm for
women and men. For example: for women DY = 20,4 - 18 = 2,4.
The ontogenetic norm is the age by which, in the process of ontogenesis
(individual human development), the development and formation of the
structure and functions of all systems of the human body is completed. It is
generally recognized that this age for men = 21 years, for women = 18 years.
CRA assessment:
- from 0.95 to 1.05 inclusive - the rate of aging corresponds to the norm;
- less than 0.95 - delayed aging;
- more than 1.05 – accelerated aging.
2) Determination of the biological age (BA) of a person
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BA(мan) = CRA×(CA−21)+21
BA(woman) = CRA×(CA−18)+18
Conclusion:_______________________________________________________
________________________________________________________________
________________________________________________________________

ESTIMATED MEANS
1. Control survey on basic terms and concepts
1. Hygiene 26. Biorhythms
2. MPC 27. Meteolabile people
3. MPL 28. Methiostable people
4. Monitoring 29. Desynchronosis
5. Prevention 30. Acclimatization
6. Potentiation 31. Adaptation
7. Cumulation 32. Harmful factor
8. Deposit 33. Blastomogenic effect
9. Complex action 34. Teratogenic effect
10.Combined action 35. The pollutant
11. Combined action 36. Insolation
12. Biological factors 37. Source of water supply
13. Psychogenic factors 38. Irradiation
14. Rationing 39. Environment
15. Gonadotoxic effect 40. Water clarification
16. Convection 41. Sewage treatment plants
17. Conduction 42. Synergism
18. Self-purification of water 43. Additive effect of factors
19.Self-cleaning of the soil 44. Lithosphere
20. Coagulation of water 45. Accumulation
21. Water settling 46. Summation
22. Water filtration 47. Antagonistic action
23. Endemic diseases 48. Sanitary rules
24. Sanitary number of soil 49. Individual prevention
25. Air ionization 50. Primary prevention
2. TEST «Water as a health factor»
1. One of the main requirements for the quality of drinking water:
a) optimal content of chemicals in water
b) epidemic safety
c) the level of the hydrogen index
d) optimal water temperature
2. Contamination of drinking water by enteroviruses is characterized by:
a) colony-forming bacteria b) common coliform bacteria
c) coli-phages d) thermotolerant coliform bacteria
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3. Indicators of fresh fecal contamination of drinking water are:
a) colony-forming bacteria b) common coliform bacteria
c) coli-phages d) E. coli
4. Permissible microbial number of drinking water with centralized water
supply:
a) 50 b) 100 c) 120 g) 150
5. The main reagent used for water coagulation:
a) fluorine b) chlorine
c) aluminum sulfate d) ozone
6. Ions that cause the total hardness of water:
a) iron, chlorine, b) calcium, magnesium,
c) sodium, calcium, d) copper, magnesium
7. What is meant by the clarification of water?
a) release of water from organic pollutants
b) release of water from suspended solids
c) release of water from calcium and magnesium salts
d) release of water from microorganisms
8. Water clarification method:
a) ozonation b) boiling
c) filtration d) chlorination
9. Indicators of secondary contamination of drinking water after purification are:
a) colony-forming bacteria b) common coliform bacteria
c) coli-phages d) thermotolerant coliform bacteria
10. Trace element, the lack of which leads to the appearance of endemic goiter:
a) zinc b) copper c) arsenic d) iodine
11. Chemical compounds that cause methemoglobinemia:
a) chlorides b) nitrates c) sulfates d) fluorides
12. What intensity are flavors allowed in drinking water with centralized water
supply?
a) 0 points b) no more than 1 point
c) no more than 2 points d) no more than 3 points
13. The cause of fluorosis:
a) the use of foods with a high content of fluoride
b) the use of water with a high content of fluoride
c) the use of water with a low content of fluoride
d) the use of water with a high content of iodine
14. Prevention of endemic caries:
a) water iodization c) water fluoridation
b) salt iodization d) water defluorination
15. Moderately hazardous chemicals belong to the following hazard class:
a) 1 b) 2 c) 3 d) 4
16. To assess the effects of chemical pollutants on the body, the following
indicators are used:
a) MPC b) MPC
c) traffic regulations d) ODE
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3. Questions for colloquiums
Colloquium 1
Health and environment
1) Hygiene: definition, subject of study, main goals.
2) Conditions conducive to health problems. Specific and nonspecific
resistance of the organism.
3) The concept of the environment, biosphere (lithosphere, hydrosphere,
troposphere). Environmental factors affecting the body
4) The nature of the influence of environmental factors. Types of interaction of
harmful environmental factors in the body.
5) Types of impact of environmental factors on the body.
6) Methods for studying environmental factors.
7) Objectives (meaning) of hygiene.
8) The main problems of preventive medicine and ecology.
9) The value of the subject for the doctor.
10) Hygienic regulation: definition, meaning, General principles of hygienic
regulation.
11) Types of prevention.
12) Long-term consequences of exposure to the body of chemical and physical
environmental factors.
Colloquium 2
Hygienic characteristics of the air environment.
Soil and its hygienic significance
1) The value of the air environment. The concept of "air quality", its
definition, indicators, factors affecting it.
2) Hygienic value of the air temperature.
3) Hygienic value of relative humidity.
4) Hygienic value of air movement.
5) The influence of physical factors of the air environment on human heat
exchange.
6) Hygienic value of atmospheric pressure.
7) Electrical condition of the air environment.
8) Ionization: concept, sources, influencing factors, hygienic significance.
9) Characteristics of the chemical composition of atmospheric air.
10) Features of the impact of atmospheric emissions on the human body.
11) The value of the soil. The influence of soil on human health.
12) Mechanical and chemical composition of the soil and their hygienic
significance. Soil-forming factors. Sources of anthropogenic soil pollution
13) Self-cleaning of the soil.
14) Indicators (criteria) of soil quality of residential areas.
15) Cleaning of populated areas.
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Colloquium 3
Climate, weather and health
1) Weather: definition, indicators characterizing the weather.
2) Factors that shape the weather.
3) Hygienic value of the weather.
4) Periodic and aperiodic weather changes.
5) Meteolabile and metastable people.
6) Meteotropic reactions: definition, their characteristics, pathogenesis,
prevention
7) Medical classification of weather.
8) Types of weather according to Fedorov.
9) Climate: definition, meaning. The main climate-forming factors.
10) Construction and medical classification of climates.
11) Acclimatization: definition, physiological mechanisms.
12) Phases of acclimatization.
13) Social and hygienic measures that promote acclimatization in the conditions
of the north.
14) Social and hygienic measures that promote acclimatization in a hot climate.
15) Biorhythms and health.
Colloquium 4
Features of life in modern large cities
and their impact on public health.
(Hygiene problems of modern large cities)
1) Urbanization and problems of urban ecology.
2) Positive and negative aspects of urbanization.
3) City-forming factors and features of the formation of the environment in
cities.
4) Zoning of the urban area. The structure of modern cities.
5) Features of the formation of the urban environment.
6) Basic hygienic requirements for the planning of a residential area, quarter
(block), community.
7) Building systems.
8) Main measures to improve the environment.
9) Hygienic requirements for housing.
10) The state of the air environment in the premises. The main sources of
indoor air pollution.
11) Indicators of cleanliness of indoor air.
12) Factors that determine the hygienic conditions and ecology of the home.
13) Ways to optimize the ecology of the home.
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Colloquium 5
Food hygiene
1) The importance of nutrition for humans.
2) Biological and environmental problems of nutrition.
3) Rational nutrition: definition, principles.
4) Balanced diet.
5) Characteristics of population groups depending on energy expenditure.
6) Hygienic value of proteins.
7) The hygienic value of fats.
8) The hygienic value of carbohydrates.
9) Hygienic value of mineral salts and vitamins.
10) Food additives, dietary supplements to food: definition, meaning.
Genetically modified foods.
11) The importance in the nutrition of dairy products.
12) The importance of meat products in the diet.
13) The value in the nutrition of cereals.
14) The importance of vegetables and fruits in the diet.
15) Hygienic requirements for the menu.
16) Methods for determining the quality of food products.
17) Categories of food quality.
18) The value of therapeutic nutrition. Catering in the health care center.
19) Hygienic requirements for hospital food units.
20) Alimentary diseases: definition, classification.
Colloquium 6
Hospital hygiene
1) Types of medical organizations.
2) Classification of hospitals by profile and location.
3) The main tasks of hospital hygiene.
4) Requirements for the placement of medical facilities.
5) Hygienic requirements for the territory of hospitals.
6) Hygienic requirements for the structure, buildings and layout of the main
departments of the hospital.
7) Hygienic requirements for the premises of the Ministry of Defense.
8) Hygienic requirements for the organization of the light regime in the
Ministry of Defense.
9) Hygienic requirements for the organization of microclimate in the premises
of the Ministry of Defense.
10) Hygienic requirements for heating and air exchange equipment in MPO.
11) 11 HAIs: definition, pathogens, sources. MPO.
12) Prevention of HAIs .
13) Requirements for the sanitary maintenance of medical facilities.
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Colloquium 7
Occupational hygiene
1) Occupational health: definition, main problems.
2) Occupational hazards, their classification.
3) Features of the impact of occupational hazards on the female and adolescent
body.
4) Hygienic classification and criteria for assessing working conditions.
5) Hygiene of mental work.
6) Features of the work of medical workers of various specialties (including
dentists), in pharmacy organizations.
7) Noise, criteria of its harmfulness, indicators of hygienic assessment.
8) The nonspecific effect of noise on the body.
9) The specific effect of noise on the body.
10) Characteristics of the effect of ultrasound on the body.
11) Vibration: definition, indicators, classification.
12) Hygienic assessment of local vibration.
13) Types of adverse effects of vibration on the body.
14) Features of the biological action of ionizing radiation.
15) General issues of prevention of occupational diseases.
Colloquium 8
Hygiene of children and adolescents
1) Hygiene of children and adolescents: definition, main problems.
2) Morphofunctional features of a growing organism.
3) The main patterns of growth and development of children and adolescents.
4) Comprehensive assessment of the health status of children and adolescents,
its criteria.
5) Problems, difficulties that occur when studying at school.
6) Hygienic aspects of school maturity.
7) Prevention of myopia in schoolchildren.
8) Prevention of neuropsychiatric disorders in children.
9) Hygienic basics of the daily routine, its meaning.
10) Forms (system) of physical education of schoolchildren.
11) Hygienic requirements for the organization and conduct of physical
education lessons.
12) Hygienic requirements for the layout and equipment of preschool
educational organizations.
13) Hygienic requirements for the layout and equipment of educational
organizations.
14) Hygienic requirements for the educational process.
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4. Topics of abstracts and presentations on the section «Human Ecology»
1) Environmental problems of the region and possible solutions.
2) The cleanest (dirtiest) cities in the world.
3) The cleanest (dirtiest) rivers in the world.
4) Problems of improving the ecological environment.
5) Specially protected natural territories.
6) Problems of water pollution in various countries.
7) Problems of soil pollution.
8) Problems of radioactive contamination of the biosphere.
9) Environmental disasters of our time.
10) International environmental conferences and their importance in ensuring
environmental safety.
11) International legal provision of environmental safety.
12) Problems of collection and disposal of medical waste.
13) Implementation of environmental safety at the global and national levels.
14) Environmental problems of space exploration.
15) The role of industrial enterprises in air pollution.
16) Problems of waste collection and disposal.
17) Implementation of environmental safety at the regional level.
18) International cooperation in environmental issues.
19) The role of mobile sources of pollution in the pollution of the biosphere.
20) Activities of international environmental organizations.
5. Control survey on the section «Human ecology»
1) Definition of ecology
2) Scientists who have contributed to the development of ecology as a science
3) The doctrine of the biosphere
4) The main problems of ecology
5) Basic aspects of human ecology
6) Subject and problems of medical ecology
7) Environmental factors: their definition and classification
8) Problems of the relationship between human society and the biosphere
9) Environmental problems related to urbanization
10) Risk factors: definition, types, classification
11) Stages of risk assessment of adverse effects of environmental factors
12) Environmentally related diseases
13) Organization of environmental protection and its legal basis
14) Environmental problems of cities
15) The effect of electromagnetic radiation (EMR) on the human body.
 134
Literature
1) Karelin A.O., Alexandrova G.A. Hygiene. M.: Yurayt, 2021. 472 p.
2) Hygiene / Ed. acad. RAMS G.I. Rumyantseva. M.: GEOTAR-Media, 2009.
608 p.
3) Hygiene with the basics of human ecology / edited by prof. P.I.
Melnichenko. M., 2010.
4) Pivovarov Yu.P., Korolik V.V. Guide to laboratory classes on hygiene and
the basics of human ecology: textbook. manual for students. higher. studies.
institutions. M.: izdat. center "Academy", 2008. 508 p
5) Ilyin L.A., Kirillov V.F., Korenkov I.P. Radiation hygiene: textbook. M.:
GEOTAR-Media, 2010. 384 p.
6) Kuchma V.R. Hygiene of children and adolescents. Moscow: GEOTAR-
Media, 2008. 480 p.
7) Occupational hygiene / edited by N.F. Izmerova, V.F. Kirillova - M.:
GEOTAR-Media, 2007. 592 p.
8) Alexandrova G.A. Hygiene: Coincise Course of Lectures. Translator: Dr.
Princess Abu Bonsra. - Yaroslav-the-Wise Novgorod State University. –
Veliky Novgorod, 2022 – 201 p.
 135
Contents
Abbreviations …………………………………………………………………..3
Practical lesson 1
Hygienic assessment of drinking water quality ………………………………..4
Practical lesson 2
Hygienic assessment of the microclimate in medical
and educational organizations, residential premises ………………………..…14
Practical lesson 3
Hygienic assessment of the light regime
in medical and preventive and educational organizations ……………………..22
Practical lesson 4
Hygienic assessment of noise in classrooms ……………………………….….31
Practical lesson 5
Medical control over the adequacy of nutrition
Calculation method for assessing the adequacy of nutrition …………………..38
Practical lesson 6
Nutritional value and sanitary examination of basic foodstuffs………………..49
Practical lesson 7
Medical control over the organization of nutrition
in medical and preventive organizations ………………………………………57
Practical lesson 8
Hygienic requirements for the placement, layout,
equipment and sanitary and anti-epidemic regime
of medical and pharmacy organizations …………………………...…………..63
Practical lesson 9
Organization of radiation safety in X-ray rooms
and when working with open and closed radiation sources ………………..….71
Practical lesson 10
The main indicators of the health status of children and adolescents ..………..88
Practical lesson 11
Methods of assessing
the physical development of children and adolescents ………………………..93
Practical lesson 12
Hygienic assessment of the lesson schedule ……………………...………….106
Practical lesson 13
Methods of studying the influence
of the educational process on the body of students ……...…………………...111
Practical lesson 14
Quality of life assessment ……………………………………………………121
Estimated means …………………………………………………………127
Literature ……………………………………………………………………..134
 136

Учебное издание

Александрова Галина Александровна

Симонова Ольга Викторовна
Морозова Ольга Борисовна

ГИГИЕНА
Практическум

Переводчик: Д-р Принцесс Абу Бонсра

Alexandrova Galina Alexandrovna

Simonova Olga Viktorovna
Morozova Olga Borisovna

HYGIENE
PRACTICALS
TRANSLATOR: DR. PRINCESS ABU BONSRA

Оригинал-макет подготовлен ИМО

____________________________________________
Подписано в печать 27.12.2021. Формат 60x84 1/16
Усл. печ. л. 10,8. Уч.- изд. л. 11,2. Тираж 300 экз.
Издательско-полиграфический центр
Новгородского государственного университета
имени Ярослава Мудрого.
173003, Великий Новгород, ул. Б. Санкт-Петербургская, 41.
Отпечатано в ИПЦ НовГУ им. Ярослава Мудрого
173003, Великий Новгород, ул. Б. Санкт-Петербургская, 41.