Population health and methods of its study. Modern research methods as the basis for correct diagnosis in medicine The essence of the standardization method

21.06.2024

HEALTH AND METHODS OF ITS STUDY

1. Social and biological factors of health.

2. The concept of prevention. Its basic principles and types.

3. Lifestyle as a medical and social factor of health. The concept of medical activity and a healthy lifestyle. The main directions and methods of promoting a healthy lifestyle. Structure of medical prevention centers. Their role in promoting a healthy lifestyle.

4.Health as an indicator of the effectiveness of medical and preventive activities.

5.Definition of health. Basic methods of its study. Health groups. Basic health indicators of the population of Russia.

6.Use of initial statistical indicators when assessing the physical development of the population.

7. Injuries are a social and hygienic problem.

8.Alcoholism, smoking and drug addiction as a medical and social problem.

9. Medical and social aspects of disability of the population. Structure and organization of work of the expert commission. The procedure for processing documents for permanent disability.

1. Social and biological factors of health.

Health and morbidity indicators are used in relation to specific groups of healthy and sick people. This obliges us to approach the assessment of a person’s lifestyle not only from biological, but also from medical and social positions. Social factors are determined by the socio-economic structure of society, the level of education, culture, industrial relations between people, traditions, customs, social attitudes in the family and personal characteristics. Most of these factors, together with the hygienic characteristics of life activity, are included in the general concept of “lifestyle”, the share of which influences health is more than 50% among all factors.

Biological characteristics of a person (sex, age, heredity, constitution, temperament, adaptive capabilities, etc.) account for no more than 20% of the total impact of factors on health. Both social and biological factors influence a person in certain environmental conditions, the share of influence of which ranges from 18 to 22%. Only a small part (810%) of health indicators is determined by the level of activity of medical institutions and the efforts of medical workers. Therefore, human health is a harmonious unity of biological and social qualities, determined by congenital and acquired biological and social properties,

and illness is a violation of this harmony.

2. The concept of prevention. Its basic principles and types.

Prevention is an integral part of medicine. The social and preventive direction in protecting and strengthening the health of the people includes medical, sanitary, hygienic and socio-economic measures. Creating a system for preventing diseases and eliminating risk factors is the most important socio-economic and medical task of the state. There are individual and public prevention. Depending on the state of health, the presence of risk factors for the disease or severe pathology in a person, 3 types of prevention are considered.

Primary prevention includes socio-economic measures of the state to improve lifestyle, environment, education, etc. Preventive activities are mandatory for all medical workers. It is no coincidence that clinics, hospitals, dispensaries, and maternity hospitals are called medical and preventive institutions.

Secondary prevention is a set of measures to eliminate pronounced risk factors, which under certain conditions (decreased immune status, overexertion, adaptation failure) can lead to the onset, exacerbation or relapse of the disease. The most effective method of secondary prevention is medical examination as a comprehensive method of early detection of diseases, dynamic observation, targeted treatment, and rational consistent recovery.

A number of experts propose the term “tertiary prevention” as a set of measures for the rehabilitation of patients who have lost the ability to fully live. Tertiary prevention aims at social (building confidence in one’s own social suitability), labor (the possibility of restoring work skills), psychological (restoring the behavioral activity of the individual) and medical (restoring the functions of organs and systems) rehabilitation.

The most important component of all preventive measures is the formation of medical and social activity and attitudes towards a healthy lifestyle among the population.

3. Lifestyle as a medical and social factor of health. The concept of medical activity and a healthy lifestyle. Main directions and methods of promoting a healthy lifestyle. Structure of medical prevention centers. Their role in promoting a healthy lifestyle.

Lifestyle, the leading generalized factor that determines the main trends in health changes, is considered as a type of active human activity. The structure of the lifestyle with its medical and social characteristics includes: 1) work activity and working conditions; 2) economic and household activities (type of home, living space, living conditions, time spent on household activities, etc.); 3) recreational activities aimed at restoring physical strength and interacting with the environment; 4) socialization activities in the family (care for children, elderly relatives); 5) family planning and relationships between family members; 6) formation of behavioral characteristics and socio-psychological status; 7) medical and social activity (attitude to health, medicine, attitude towards a healthy lifestyle). Lifestyle is associated with such concepts as standard of living (structure of income per person), quality of life (measurable parameters characterizing the degree of material security of a person), lifestyle (psychological individual characteristics of behavior), way of life (national social order of life, everyday life, culture).

The concept of medical activity and a healthy lifestyle.

Medical activity refers to the activities of people in the field of protecting, improving individual and public health in certain socio-economic conditions. Medical (medical and social) activity includes: the presence of hygienic skills, implementation of medical recommendations, participation in improving lifestyle and the environment, the ability to provide first aid to oneself and relatives, use folk and traditional medicine, etc.

Increasing the level of medical activity and literacy of the population is the most important task of the local general practitioner and pediatrician (especially the family doctor). An important component of medical and social activity is the attitude towards a healthy lifestyle (HLS).

A healthy lifestyle is hygienic behavior based on scientifically proven sanitary and hygienic standards aimed at strengthening and maintaining health, activating the body's defenses, ensuring a high level of working capacity, and achieving active longevity.

Thus, healthy lifestyle can be considered as the basis for disease prevention. It is aimed at eliminating risk factors (low level of labor activity, dissatisfaction with work, passivity, psycho-emotional tension, low social activity and low cultural level, environmental illiteracy, physical inactivity, irrational, unbalanced nutrition, smoking, consumption of alcohol, narcotic and toxic substances, tense family relationships, unhealthy lifestyle, genetic risk, etc.). A healthy lifestyle is an important factor in health (increases work activity, creates physical and mental comfort, activates life position, the body’s defenses, strengthens general condition, reduces the frequency of diseases and exacerbations of chronic diseases).

Main directions and methods of promoting a healthy lifestyle.

Formation of a healthy lifestyle is the creation of a system for overcoming risk factors in the form of active life of people aimed at maintaining and strengthening health. A healthy lifestyle includes the following components:

1) conscious creation of working conditions conducive to maintaining health and increasing performance;

2) active participation in cultural events, physical education and sports, refusal of passive forms of rest, training of mental abilities, auto-training, giving up bad habits (drinking alcohol, smoking), rational, balanced nutrition, observing the rules of personal hygiene, creating normal conditions in family;

3) the formation of interpersonal relationships in work groups, families, attitudes towards the sick and disabled;

4) respect for the environment, nature, high culture of behavior at work, in public places and transport;

5) conscious participation in preventive measures carried out by medical institutions, compliance with medical orders, the ability to provide first aid, reading popular medical literature, etc.

In accordance with the orders of the Ministry of Health of the Russian Federation, promoting a healthy lifestyle is the responsibility of every medical worker. In this case, methods of oral, printed, visual (pictorial) and combined propaganda are used.

The method of oral propaganda is the most effective. This is the most popular, economical, simple and organizationally accessible method. It includes the following means of propaganda: lectures, conversations, discussions, conferences, club classes, quizzes.

The method of printed propaganda reaches wide sections of the population. It includes articles, health leaflets, memos, leaflets, wall newspapers, magazines, booklets, brochures, books, slogans.

The visual method is the most diverse in terms of the number of tools included in it. They can be divided into 2 groups: natural objects and visual means (volumetric and planar).

The combined method is a method of mass propaganda in which there is a simultaneous impact on the auditory and visual analyzers.

Structure of medical prevention centers. Their role in promoting a healthy lifestyle.

Medical prevention centers are the scientific, methodological and coordination link in organizing the promotion of a healthy lifestyle in republics, regions, territories, cities and districts. They are under the authority of the health care committees of administrative territories. Main activities: consultations with residents of the region on health issues and disease prevention; formation of hygiene skills, competent hygienic behavior; combating unhealthy habits; overcoming health risk factors; preventive treatment; formation of a healthy lifestyle among the population.

Medical prevention centers have rooms for: rational nutrition, physical education, mental hygiene and mental hygiene, household hygiene, prevention of unhealthy habits, marriage and family relations, genetics (marriage and family), vocational guidance, regulation (auto-training), etc. The centers coordinate the organizational and methodological activities of all medical institutions (polyclinics, dispensaries, SSES centers, etc.) on issues of promoting a healthy lifestyle, providing educational, methodological and information literature.

Introduction

Part I

Chapter 1. Demographic indicators

1.1 Age structure of the population

1.2 Dynamics of population reproduction indicators

Chapter 2. Population morbidity indicators

2.1 Causes of death

2.2 Population use of treatment and preventive medical institutions

2.3 Disability indicators

Chapter 3. Statistical research methods

3.1 Standardization method

3.2 Average values and criteria for diversity of variation series

3.3 Ranking method

3.4 Relative risk indicator

3.5 Ratio indicator

Chapter 4: Event Planning

4.1 Action plan for the city administration, treatment and preventive medical organizations, educational organizations for the prevention and prevention of gastrointestinal diseases

4.2 Action plan for training students “Anti-tobacco hygienic education of youth”

Part 2

Conclusion

Bibliography

Applications

Introduction

In contrast to the fundamental, clinical and hygienic sciences, “Public Health and Healthcare” is largely more dynamic in its development and must timely and objectively reflect political and socio-economic reforms, since the impact of their results on the health of the population and the organization of medical and social care very significant and does not require proof.

The educational and scientific discipline "Public Health and Healthcare" is designed to ensure the formation of the student's analytical thinking, his career guidance in order to develop skills in assessing the health status of the population as a whole and its individual groups, in searching and developing the main directions for restoring the health of the population, in analyzing and assessment of the activities of medical organizations, their structural divisions and individual doctors.

The core sections of the discipline at present are: population health, the factors that determine it, methods of studying public health, epidemiology, risk factors and prevention of the most important socially significant diseases, optimal organization of the system of protection, promotion and restoration of health, basics of economics, planning, financing and clinical management, including the rational use of health care resources and ensuring the quality of care.

Critical problems of the health status of the population of Russia encourage us to teach the future doctor not only to be able to analyze and evaluate, but also to look for and propose rational ways to improve the quality of medical care, improve measures to protect, strengthen and restore the health of both the population as a whole and its individual groups. All this poses corresponding tasks for improving the program and methods of teaching “Public Health and Healthcare” to future doctors and nursing managers.

As an analysis of sample and work programs for training graduates of medical universities in clinical disciplines has shown, teaching is more focused on the study of the disease itself: its etiology, pathogenesis, differential diagnosis, treatment and prevention, forecasting the development of the disease and associated disability.

health population morbidity medical

Part I

Chapter 1. Demographic indicators

1.1 Age structure of the population

Age structure of the population- distribution of the population by age groups.

To assess the general state of the age structure of the population, a large distribution of the population into three groups (0-14 years, 15-49 years, 50 years and older), expressed as a percentage, is used.

Having analyzed information about the age structure of the population and presented it graphically, we can conclude that the structure is stationary, since the shares of children and people aged 50 years and older are equal (see Fig. 1.1).

Figure 1.1

1.2 Dynamics of population reproduction indicators

Fertility- the process of childbirth in a specific population of people over a certain period of time.

Mortality- the process of natural reduction in the number of people due to deaths in a specific population over a certain period of time.

Natural increase- The difference between the birth rate and death rate of the population (per year) characterizes the process of population reproduction.

Fertility(synonym - fertility, from Latin fertilis - fertile) - should be considered as the biological ability of a woman, man, married couple to conceive and give birth to living children.

Infant mortality is the mortality rate of children during the first year of life (0 - 12 months).

Data on the dynamics of demographic indicators of the city of N. (see Fig. 1.2) allow us to assess their level.

Figure 1.2

So we can say that in recent years the birth rate and natural increase in the city of N. have increased, based on the data in Fig. 1.2 it can be assumed that this is due to an increase in fertility levels and a decrease in infant mortality rates. However, despite the positive dynamics of population reproduction indicators in recent years, the level of many of them remains below average (birth rate, fertility), and mortality (including infant mortality) remains at an average level, which causes a negative indicator of natural population growth in recent years years.

Chapter 2. Population morbidity indicators

2.1 Causes of death

The main causes of death among the adult population are diseases of the blood system, accidents, injuries, poisoning, and malignant neoplasms (see Fig. 2.1).

Figure 2.1

The main cause of death of children in the first year of life are conditions that arise in the perinatal period (see Fig. 2.2).

Figure 2.2

2.2 Population use of treatment and preventive medical institutions

General morbidity- this is the frequency and prevalence of all registered cases of diseases for which the population first applied to outpatient clinics in a given year.

Primary incidence - frequency of diseases diagnosed for the first time in life (newly identified in life) during the year, calculated per 1000 population.

Prevalence - the frequency of all diseases, both newly identified in a given year (primary incidence), and chronic diseases identified earlier, but for which patients applied in the current year, or were identified through medical examinations.

Data on primary incidence and prevalence among different age groups of the city of N. and the region are presented in Fig. 2.3.

Figure 2.3

Having looked at the dynamic situation in the city of N. in recent years, we can conclude that during the year we studied, the indicators of primary incidence and prevalence increased significantly (see Fig. 2.4).

Figure 2.4

The structure of the general morbidity according to visits to the clinic of the entire population in the year under study (Fig. 2.5; Fig. 2.6) allows us to conclude that in the current year, most often the population first went to the clinic with complaints of respiratory diseases (40.8% ); poisoning injuries, etc. (11.9%); diseases of the skin and subcutaneous tissue (6.1%).

If we talk about prevalence, then most often clinic specialists encounter respiratory diseases (22%); circulatory system (14.2%); digestive organs (7.7%).

Figure 2.5

Figure 2.6

This morbidity pattern has developed on the territory of the city of N. due to the difficult environmental situation, the lack of housing for the population, unsanitary living conditions, the influx of emigrants, the almost complete lack of opportunities for physical development, as well as the rapid development of industry.

2.3 Disability indicators

In the year under study, 1,050 people living in the city of N were diagnosed with disabilities for the first time. Of the total number of all registered cases, 126 people became disabled in the first group, 630 in the second group, and 294 in the third group.

The increase in the rate of primary disability (see Fig. 2.7) can be explained by the same reasons as the increase in general morbidity and mortality of the population.

People living in the city who are at risk due to health conditions cannot withstand unfavorable social and living conditions, ecology, etc.

Figure 2.7

Most often in the city, disability is caused by diseases of the circulatory system (see Fig. 2.8), diseases of another etiology (not specifically shown in Fig. 2.8 - other diseases), and malignant neoplasms.

Figure 2.8

Chapter 3. Statistical research methods

3.1 Standardization method

Condition for applying the standardization method.

The method is used when comparing intensive indicators in populations that differ in composition (for example, by age, gender, profession, etc.).

The essence of the standardization method.

It allows you to eliminate (eliminate) the possible influence of differences in the composition of populations on any basis on the value of the compared intensive indicators. For this purpose, the composition of populations on this basis is equalized, which subsequently makes it possible to calculate standardized indicators.

Standardized indicators are conditional, hypothetical values; they do not reflect the true dimensions of phenomena. Standardized indicators indicate what the values of the compared intensive indicators would be if differences in the composition of populations were excluded.

Purpose of the standardization method.

The standardization method is used to identify the influence of the factor of heterogeneity in the composition of populations on any basis on the differences in the compared intensive indicators.

Stages of calculating standardized indicators stage.

Calculation of general and private intensive indicators:

general - for aggregates as a whole;

private - based on differences (gender, age, work experience, etc.).

First, we determine the general indicators of patients with periodontal disease in the cities of N. and M., using the data in Table 3.1.

City N.: 12,000 x 100/100,000 = 12 per 100 city residents;

City of M.: 10,860 x 100/100,000 = 10.86 per 100 city residents.

Then we find the indicators of patients with periodontal disease depending on the age of the patients in each city (see Table 3.2).

Table 3.1

Distribution of residents of the cities of N. and M. and patients with periodontal disease by age groups

	Number of inhabitants	number of patients with periodontal disease	Number of inhabitants	Number of patients with periodontal disease


50 and older

Table 3.2

Stage II.

Definition of the standard, i.e. selection of the same numerical composition of the environment on a given basis (by age, gender, etc.) for the populations being compared. As a rule, the sum or half the sum of the numbers of compositions of the corresponding groups is taken as the standard. At the same time, the standard can be the composition of any of the compared populations, as well as the composition of any other population based on a similar characteristic. For example, when comparing mortality in a particular hospital for two emergency departments, the patient composition of any other emergency hospital can be chosen as the standard. Thus, one way or another, the environmental conditions are equalized, which makes it possible to calculate new numbers of the phenomenon, called “expected values”.

We take as the standard the sum of all residents for each age group in both cities (see Table 3.3).

Table 3.3

stage.

Calculation of expected absolute values in standard groups based on group intensive indicators calculated at stage I. The final numbers for the populations being compared are the sum of the expected values in the groups (see Table 3.4).

Table 3.4

Stage IV.

Calculation of standardized indicators for compared populations. The general standardized indicators of patients with periodontal disease in the cities of N. and M. are determined.

City M.22,400 x 100/200,000 = 11.2 per 100 city residents;

City N.10,760 x 100/200,000 = 5.38 per 100 city residents.

stage.

Comparison of the ratios of standardized and intensive indicators (see Table 3.5), formulation of the conclusion.

Table 3.5

The incidence of periodontal disease in the city of N. is higher than in the city of M. This morbidity pattern between the two cities has developed due to the fact that in the city of N. there are significantly more elderly people, among whom this disease is most common. If we compare among younger age groups, then the indicators of the city of N. will be much better than the indicators of the city of M.

3.2 Average values and criteria for diversity of variation series

Variation series- these are numerical values of a characteristic, presented in rank order with frequencies corresponding to these values.

V- option, a separate numerical expression of the characteristic being studied;

p- frequency (“weight”) of variants, the number of its repetitions in the variation series;

n- total number of observations (i.e. the sum of all frequencies, n=p);

Vmax and Vmin- extreme options that limit the variation series (series limits);

A- series amplitude (i.e. the difference between the maximum and minimum options, A = Vmax - Vmin).

Table 3.6

Results of measuring the body weight of children in the city of N. born to women aged 35 years
Body weight (in kg) V	Number of children p











		å Vp= 173	å d 2 p= 12,78

M = åVp /n = 173/50 = 3.46 (kg);

s = Ö åd 2 p /n = Ö 12.78/50 = ± 0.26 (kg);

C V = (s / M) x100 = (0.26 /3.46 x 100) = 7.5%.

Children born to women aged 20-29 years had an average body weight of 3.2 kg (s = ±0.3 kg, C v = 9.1%, m = ±0.03 kg).

Comparing the data among the two age groups, we can say that among mothers in the age group over 35 years old, the weight of children is significantly greater than among mothers 20-29 years old. Also, with increasing age of mothers, the mean deviation and coefficient of variation decrease.

3.3 Ranking method

In order to develop measures to reduce occupational morbidity among shipyard workers, doctors from the production department of the clinic conducted a study of the effect of work experience on the decrease in hearing acuity in riveters (Table 3.7).

Table 3.7

To solve the problem, only the rank correlation method can be chosen, because The first row of the attribute “work experience in years” has open options (work experience up to 5 years and 25 or more years), which does not allow the use of a more accurate method - the method of squares - to establish a connection between the compared characteristics. The sequence of calculations is outlined in the text, the results are presented in Table 3.8:

Each of the rows of paired characteristics is designated by “x” and “y” (columns 1 - 2).

The value of each feature is replaced by a rank (ordinal) number. The order of distribution of ranks in the row “x” is as follows: the minimum value of the attribute (experience up to 5 years) is assigned the serial number “1”, subsequent variants of the same row of attribute, respectively, in increasing order, 2nd, 3rd, 4th and 5th th serial numbers - ranks (see column 3). We follow a similar order when distributing ranks to the second attribute “y” (column 4). In cases where there are several variants of equal size, the serial number is designated by the average number from the sum of their serial numbers.

Table 3.8


Work experience in years	Number of injuries	Ordinal numbers (ranks)	Rank difference	Squared difference of ranks
			d(x-y)	d 2





25 or more
			Σ d 2 = 78

Determine the rank difference d = (X - at) - (column 5).

Square the rank difference ( d 2) and get the sum of squares of the rank difference Σ d 2 (column 6).

Calculate the rank correlation coefficient using the formula:

ρ xy , where n is the number of compared pairs of options in the series X And at.

ρ xy

Define reliability of the rank correlation coefficient .

1 way. Determine the error ( mρxy) rank correlation coefficient and evaluate its reliability using the criterion t:

mρ xy

The resulting criterion t= 3.51 corresponds to the probability of an error-free forecast ( R) more than 95%

ρ xy = - 1,23; mρxy= ±0.35; t = 3,51; R> 95 %

3.4 Relative risk indicator

Based on the data in Table 3.9, we can conclude that the likelihood of gastrointestinal diseases among medical college students is very high among all nosological forms of risk factors.

Table 3.9

Incidence of gastrointestinal diseases among students of the medical college of the city of N., depending on the presence of risk factors (per 100 students)
Risk factors	Frequency of gastrointestinal diseases
Irregular eating


Unbalanced diet


Constant use of fast food

3.5 Ratio indicator

Ratio indicator: characterizes the relationship between two unrelated populations (the provision of population with beds, doctors, preschool institutions, the ratio of births and abortions, the ratio of doctors and nurses, etc.).

To obtain this indicator, two populations are needed. The absolute value characterizing one population is divided by the absolute value characterizing another, unrelated population and multiplied by a factor.

Thus, per 10,000 population of the city of N. there are 40 doctors, 86 paramedical staff, 96 beds in the year under study (see Table 3.10)

Table 3.10

Dynamics of the provision of the population of the city of N. with doctors, paramedics and hospital beds (per 10,000 population).
Indicators			Year studied
Availability of doctors
Availability of paramedical workers
Availability of beds

Chapter 4: Event Planning

4.1 Action plan for the city administration, treatment and preventive medical organizations, educational organizations for the prevention and prevention of gastrointestinal diseases

1) Conversations and individual consultations with parents/students on the prevention of exacerbations.

2) Monitoring the dynamics of health status and the dynamics of the disease during dispensary observation.

) Control of class teachers over the organization of gentle nutrition for this group of children at school.

) Conducting drug treatment under the supervision of a physician, ensuring attendance at the medical office to take medications.

) Individual conversations with parents/students to ensure a gentle diet at home.

) Anti-relapse treatment on the basis of a day hospital.

) Health improvement in sanatorium summer camps.

) Organization of a daily routine for the purpose of regular nutrition for this population group.

) Organization of healthy lifestyle groups.

4.2 Action plan for training students “Anti-tobacco hygienic education of youth”

A) By influencing a group of people:

Lecture, report;

Group conversation;

Group discussion;

Group practical training;

Course training (health school, video lectures, etc.)

The method allows you to reach a small target audience of students, most often those who are interested in this problem.

B) Methods of mass communication:

Television (TV shows);

Film;

Radio (radio broadcasts, direct lines);

Press (regional, republican, district, departmental; press conferences for journalists);

Exhibitions and museums.

C) Combined methods of propaganda:

Health Festival (children's drawing and essay competition);

Health Marathon;

Health Week (women's health);

Health Fair;

The last two methods allow not only to reach a large audience of people, but also to attract the attention of those who sometimes do not focus on this problem. The methods are also good because they are diverse, interesting, able to concentrate the attention of young people and form the correct position on a healthy lifestyle through interactive work.

Thus, work on hygienic training and education of the population, promotion of a healthy lifestyle are the main tools of prevention, important factors that directly affect the effectiveness of the therapeutic and preventive activities of medical institutions.

Part 2

Problem: High level of respiratory diseases in the city of N.

Relevance of the problem: Since the city has the highest percentage of respiratory diseases, this problem is the most significant for the city. According to WHO, the highest percentage of oncological pathologies also occurs most often in the organs of the respiratory system, which emphasizes the significance and relevance of the problem. The main pathogenetic factor of respiratory diseases is smoking, which determines the social significance of the chosen topic.

Purpose of the study: develop an action plan for the administration, medical institutions to reduce, prevent, prevent diseases of the respiratory system in the city.

Research objectives:

1) Process specialized literature on the chosen topic.

2) To study the level of various diseases of the respiratory system in the city of N.

) Identify factors contributing to the development of respiratory diseases.

) To propose an action plan for the administration, medical institutions to reduce, prevent, prevent diseases of the respiratory system.

Research program.

Unit of observation - a case of respiratory disease in a resident of the city of N.

Attributive features:

Quantitative characteristics: age, duration of disease, etc.

Effective signs: presence of respiratory system disease, stage, complications, etc.

Factor signs: gender, diagnosis, presence of bad habits, etc.

Material collection program: a questionnaire filled out by a resident of the city of N. of working age.

Questionnaire:

Hello! In order to prevent the development, improve prevention, quality of treatment and timely diagnosis of respiratory diseases, the administration of the Central District Hospital of the city of N. is conducting a survey.

We will be grateful to you for filling out the form below!

Answer options

50 or more

Do you smoke?

Number of cigarettes smoked per day:

20 or more

Do you drink alcohol?

How many times a month?

Do you play sports?

How many times a week?

Less than 2 times

Daily

Do you have a respiratory disease?

What is the diagnosis?

How long ago did you find it?

How often do you see a doctor for this disease?

Monthly

Seasonally

1 time per year

Most often contacted when:

Remission/Exacerbation

Preventive examination

Are you following your doctor's orders?

Thank you!

Material development program.

Typological grouping: grouping of residents of the city of N. by gender, by diagnosis.

Variation grouping: grouping by disease duration.

Simple table:

Distribution of the population by type of respiratory diseases in absolute numbers and % of the total
Disease	Number of cases
	Abs. number

Pneumonia
Bronchial asthma

Bronchiectasis
Oncopathology

Distribution of respiratory diseases among residents of the city of N. by gender as a percentage of the total
Disease	Number of cases


Pneumonia
Bronchial asthma
Chronic obstructive pulmonary disease (COPD)
Bronchiectasis
Oncopathology

Distribution of respiratory diseases among residents of the city of N. by age as a percentage of the total
Disease
					50 or more

Pneumonia
Bronchial asthma
Chronic obstructive pulmonary disease (COPD)
Bronchiectasis
Oncopathology

Distribution of respiratory diseases among residents of the city of N. by age and gender as a percentage of the total
Disease
									50 or more


Pneumonia
Bronchial asthma
Chronic obstructive pulmonary disease (COPD)
Bronchiectasis
Oncopathology

Study plan:

1) The object of the study is residents of the city of N. with respiratory diseases.

2) Volume of the statistical population: a sufficient number of observations.

) Population: selective, representative, in quality and quantity

) Timing of the study.

) Methods of collecting material: questionnaires.

Conclusion

In connection with the above, the departments of public health and public health in medical universities are called upon to perform to a certain extent a coordinating role (scientific, methodological and pedagogical) on the listed problems.

It is at the departments of public health and healthcare that the methodological foundations of studying, protecting, strengthening and restoring the health of the population, ensuring the accessibility, quality and safety of medical care should be taught.

In Western countries, society views a doctor not only as a professional who provides specific medical care to patients with illness, but also as a socially significant subject who ensures the preservation and strengthening of the health of the population with which he works. This applies not only to general practitioners, but also to specialized specialists, since they work with groups, “populations” of patients suffering from a certain pathology. Much attention has been paid to preventive measures, as one of the most popular, effective and cheap areas of assistance. Accordingly, the doctor now needs not only good knowledge and skills from the field of clinical disciplines, but also knowledge and skills traditionally attributed to the field of public health. Thus, public health has become one of the priority areas for training future doctors of all specialties and nursing staff.

So, back in 2003-2004. by teams of departments of the Moscow Medical Academy named after. THEM. Sechenov, in the framework of cooperation with the Open Society Institute (OSI), work was carried out to prepare exemplary programs on public health and healthcare, as close as possible in content to foreign ones.

At the same time, in Russian medical education, the training of a future doctor, even at the pre-graduate level, is divided into therapeutic and medical-preventive streams, which is not the case in foreign countries.

Bibliography

1) Application of methods of statistical analysis for the study of public health and healthcare: A textbook for practical classes / Edited by V.Z. Kucherenko. - 4th ed., stereotype. - M.: GEOTAR-Media, 2007. - . With.

2) Medic V.A., Yuryev V.K. Course of lectures on public health and healthcare. - Part I. Public health. - M.: Medicine. - 2003. - 364 p.

) Lisitsyn Yu.P. Public health and healthcare. Textbook for universities. - M.: GEOTAR - MED, 2002. - 520 p.

) Vlasov V.V. Epidemiology. - M.: GEOTAR-MED, 2004. - 464 p.

) Social medicine and health care organization (Manual in 2 volumes). Minyaev V.A., Vishnyakov N.I. and others - St. Petersburg, 1998. - 528 p.

) Social hygiene and healthcare organization (Tutorial). Kucherenko V.Z., Agarkov N.M. and others - Moscow, 2000. - 432 p.

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Mortality

Number of deaths for a given time period (year, quarter, etc.) X 1000 average population

Natural increase

Fertility - Mortality

Fertility

Number of live births per year x 1000 Average annual number of women of childbearing age 15-49 years

Infant mortality

Number of children who died during the first year of life in a given year X 1000 2/3 of those born alive in a given year + 1/3 of those born alive in the previous year

Appendix 2

Table 2.1

The main causes of death in the city of N. (absolute numbers and % of total)
Causes of death	The number of deaths in the city of N.
	Absolute numbers	in % of total
Diseases of the circulatory system

Malignant neoplasms
Digestive diseases
Respiratory diseases
Other reasons

Table 2.2

The main causes of death of children in the 1st year of life in N. (absolute numbers and % of total)
Causes of death	The number of deaths in the city of N.
		in % of total
Conditions arising in the perinatal period.
Respiratory diseases
Congenital anomalies

Accidents, injuries, poisoning

Lecture No. 1	Introduction. Contents and objectives of the discipline “Public Health and Healthcare”………………………………………………………………..... ..
Lecture No. 2	Population health as an economic category…………………….....
Lecture No. 3	Morbidity rate of the population…………………………………………………………….
Lecture No. 4	Organization of medical and preventive care for the urban population……………………………………………………………………………….
Lecture No. 5	Organization of medical and preventive care for women and children………………………………………………………………………………….
Lecture No. 6	Organization of medical and preventive care for the rural population……………………………………………………………………….
Lecture No. 7	Fundamentals of Health Economics……………………………………………………………
Lecture No. 8	Market relations in healthcare………………………………………………………
Lecture No. 9	Health insurance…………………………………………………..
	Questions to prepare for the exam……………………………………….

LECTURE No. 1

Introduction

Lecture outline:

1. Structure and content of the discipline.

2. History of the development of science.

3. Goals and objectives of the discipline.

4. Methods for studying public health.

5. The importance of discipline in developing competencies among nurses.

Over the past decades, the health of the population has deteriorated, the mortality rate has increased, and the birth rate has decreased.

To improve the current situation with the health of the country's citizens, a change in the state's health care policy was required.

Important changes have been made to the healthcare system:

1. new economic management mechanisms have emerged;

2. sources of healthcare financing have been expanded;

3. medical insurance has been introduced;

4. modernization of healthcare was carried out;

5. legal relationships in the healthcare system have been updated;

6. The “Concept for the development of healthcare until 2020” has been developed.

In the conditions of reform in the health care system, the requirements for nurses are increasing in terms of their readiness to work in conditions of competition between medical institutions.

To work effectively in the healthcare system, you need to understand and know the structure of the healthcare system, and the levels of healthcare management, have an understanding of the basics of economics, marketing and the health insurance system, and understand the system of organizing medical care to the population. Without knowledge and understanding of these issues, it is impossible to master a whole range of competencies and become a competitive specialist.

To preserve, strengthen and restore the health of the population, it is necessary to have an idea of the state of health of the population in the region and throughout the Russian Federation, to be able to calculate health indicators and analyze them, to know the factors influencing the state of health and methods of hygienic education and training to eliminate or reduce the impact of these negative factors.

The discipline “Public Health and Healthcare” we are starting to study is designed to give YOU the knowledge and skills necessary for a medical professional to work in the field of public health on all of the above issues.

The discipline course consists of 9 lectures and 9 practical classes.

The course in the discipline “Public Health and Healthcare” ends with an exam.

Public health and healthcare as a science studies patterns of public health and healthcare.

History of the development of science

The first stage in the modern development of public health (then this science was called “social hygiene”) is considered to be the period from the Renaissance to 1850. During this period, serious research was accumulated on the interdependence of the health of the working population, its living and working conditions.

The first systematic manual on social hygiene was Frank's multi-volume work, written between 1779 and 1819.

Doctors in 1848 and 1871 in France tried to scientifically substantiate public health measures, considering social medicine the key to improving society.

Rudolf Virchow, a hygienist from Germany during the same period, emphasized the close connection between medicine and politics.

Virchow's contemporary Neumann introduced the concept of “social medicine” into German literature. In his work published in 1847, he convincingly proved the role of social factors in the development of public health.

At the end of the 19th century, the development of the main direction of public health to the present day was determined. This direction connects the development of public health with the general progress of scientific hygiene or, with biological and physical hygiene.

England also had major public health figures in the 19th century. E. Chadwick saw the main reason for the poor health of the people in their poverty.

The development of social hygiene in Russia was most contributed by F.F. Erisman, P.I. Kurkin, Z.G. Frenkel, N.A. Semashko and Z.P. Soloviev.

Of the major Russian social hygienists, it is necessary to note G.A. Batkis, who developed original statistical methods for studying the sanitary condition of the population and a number of methods for operating medical institutions, such as a new system of active patronage for newborns, the method of anamnestic demographic studies, etc.

The main goal The science of public health and public health is the creation of a rational public health service with a high efficiency.

Objectives of science:

1. study and assessment of population health, the dynamics of its development;

2. study and assessment of factors affecting health;

3. development of methods and methods for promoting health, preventing diseases and disabilities, as well as their rehabilitation;

4. assessment of the quality and effectiveness of healthcare;

5. solving problems of management, financing and economics of healthcare;

6. legal regulation of healthcare;

7. formation of social and hygienic mentality and thinking of medical workers.

The subject of study is:

1. Public health.

2. Healthcare.

3. Factors influencing public health.

4. Medically and socially significant pathology.

· Public health – a medical, demographic and social category that reflects the physical, psychological, social well-being of people carrying out their life activities within the framework of the definition of social communities.

· Healthcare is a system of socio-economic and medical measures aimed at preserving and improving the level of health of each person and the population as a whole .

· Risk factors – potentially hazardous factors to health of a behavioral, biological, genetic, environmental, social nature, environmental and industrial environment, increasing the likelihood of developing diseases, their progression and unfavorable outcome.

· Socially significant diseases – diseases caused primarily by socio-economic conditions, causing damage to society and requiring social protection of a person.

Sections of science:

1. Sanitary statistics (public health).

2. Examination of disability.

3. Organization of medical care (health care).

4. Management, planning, financing, health care economics.

For the systematic development of the economy of any country, information about the size, age and sex structure of the population, and the determination of its forecasts for the future are of great importance.

Public health identifies patterns of population development, studies demographic processes, forecasts the future, and develops recommendations for state regulation of population size.

Of leading importance in the study of this discipline is the question of the effectiveness of the impact on the health of the population of all activities carried out by the state, and the role of healthcare and individual medical institutions in this.

Methods for studying public health

For the science of public health and healthcare, research related to improving the work of health authorities and institutions, the scientific organization of the work of medical personnel, etc. is of particular importance.

Topics of such research could be:

· assessment of the health status of various categories of citizens;

· analysis of factors influencing the development of a particular disease;

· assessment of the nature and volume of the population's needs for medical care;

· study of the influence of various factors that determine these needs;

· assessment of the effectiveness of the existing healthcare system;

· development of ways and means to improve it; drawing up forecasts for the provision of medical care to the population.

To conduct such research, public health, like other scientific disciplines, has its own research methods.

1. Statistical method allows you to establish and objectively evaluate changes in the health status of the population and determine the effectiveness of the activities of health authorities and institutions.

2. Expert assessment method allows you to make forecasts based on pre-formulated patterns, for example, it is quite possible to predict future fertility, population size, mortality, mortality from cancer, etc.

3. Historical method - This is a descriptive method. It is built on the basis of the study and analysis of public health and healthcare processes at various stages of human history.

4. Economic research method makes it possible to establish the influence of the economy on healthcare and, conversely, healthcare on the economy of society. Sources of healthcare financing and issues of the most effective use of these funds are investigated and analyzed.

To study the influence of socio-economic factors on people's health, methods used in economic sciences are used. These methods find direct application in the study and development of such health issues as accounting, planning, financing, health care management, rational use of material resources, scientific organization of labor in health care bodies and institutions.

5. Experimental method is a method of searching for new, most rational forms and methods of work, creating models of medical care, introducing best practices, testing projects, hypotheses, creating experimental bases, medical centers, etc.

6. Observation and survey method. To replenish and deepen this data, special studies can be undertaken.

For example, To obtain more in-depth data on the morbidity of persons in certain professions, the results obtained during medical examinations of this contingent are used. To identify the nature and degree of influence of social and hygienic conditions on morbidity, mortality and physical development, survey methods (interviews, questionnaires) of individuals, families or groups of people can be used according to a special program.

Using the survey method (interview), you can obtain valuable information on a variety of issues: economic, social, demographic, etc.

7. Epidemiological method. Epidemiological analysis occupies an important place among epidemiological research methods. Epidemiological analysis is a set of methods for studying the characteristics of the epidemic process in order to determine the reasons contributing to the spread of this phenomenon in a given territory and to develop practical recommendations for its optimization.

Noncommunicable disease epidemiology studies the causes and incidence of noncommunicable diseases with the goal of developing preventive measures and reducing the prevalence of these diseases.

WHO documents have repeatedly indicated that human health is a social quality, and therefore, to assess public health, WHO recommends the following indicators:

1. Deduction of gross national product for health care.

2. Availability of primary health care.

3. Coverage of the population with medical care.

Social and biological factors of health

Biological characteristics of a person (gender, age, heredity, constitution, temperament, adaptive capabilities, etc.) account for no more than 20% of the total impact of factors on health. Both social and biological factors influence a person in certain environmental conditions, the share of influence of which ranges from 18 to 22%. Only a small part (8-10%) of health indicators is determined by the level of activity of medical institutions and the efforts of medical workers. Therefore, human health is a harmonious unity of biological and social qualities determined by innate and acquired biological and social properties, and disease is a violation of this harmony.

Concept of prevention. Its basic principles and types

Primary prevention is a system of measures to prevent the occurrence and impact of risk factors for the development of diseases (vaccination, rational work and rest regime, rational high-quality nutrition, physical activity, environmental health, etc.). Primary prevention includes socio-economic measures of the state to improve lifestyle, environment, education, etc. Preventive activities are mandatory for all medical workers. It is no coincidence that clinics, hospitals, dispensaries, and maternity hospitals are called medical and preventive institutions.

The most important component of all preventive measures is the formation of medical and social activity and attitudes towards a healthy lifestyle among the population.

Lifestyle as a medical and social factor of health

Lifestyle is a leading generalized factor that determines the main trends in health changes and is considered as a type of active human activity. The structure of the lifestyle with its medical and social characteristics includes:

1) labor activity and working conditions;

2) economic and household activities (type of home, living space, living conditions, time spent on household activities, etc.);

3) recreational activities aimed at restoring physical strength and interacting with the environment;

4) socialization activities in the family (care for children, elderly relatives); 5) family planning and relationships between family members;

6) formation of behavioral characteristics and socio-psychological status;

7) medical and social activity (attitude to health, medicine, attitude towards a healthy lifestyle).

Lifestyle is associated with such concepts as standard of living (structure of income per person), quality of life (measurable parameters characterizing the degree of material security of a person), lifestyle (psychological individual characteristics of behavior), way of life (national social order of life, everyday life, culture).

Concept of medical activity and healthy lifestyle

1) conscious creation of working conditions conducive to maintaining health and increasing performance;

3) the formation of interpersonal relationships in work groups, families, attitudes towards the sick and disabled;

4) respect for the environment, nature, high culture of behavior at work, in public places and transport;

5) conscious participation in preventive measures carried out by medical institutions, compliance with medical orders, the ability to provide first aid, reading popular medical literature, etc.

In accordance with the orders of the Ministry of Health of the Russian Federation, promoting a healthy lifestyle is the responsibility of not only government bodies, but also every medical worker. In this case, methods of oral, printed, visual (pictorial) and combined propaganda are used.

The method of printed propaganda reaches wide sections of the population. It includes articles, health leaflets, memos, leaflets, wall newspapers, magazines, booklets, brochures, books, slogans.

The visual method is the most diverse in terms of the number of tools included in it. They can be divided into 2 groups: natural objects and visual means (volumetric and planar).

The combined method is a method of mass propaganda in which there is a simultaneous impact on the auditory and visual analyzers.

Health as an indicator of the effectiveness of medical and preventive activities

Any type of medical activity, a complex of health-improving, hygienic and preventive measures in individual teams and on administrative territory must be assessed from the point of view of their social, medical and economic effectiveness. The leading criterion for assessing effectiveness can only be health indicators over time (decrease in morbidity, mortality, disability, increase in the duration of working life, etc.). Efficiency is assessed as the ratio of the result obtained to the costs incurred.

In healthcare, the goal cannot be to save money on human health or to save money at the expense of health. Economic justification for treatment and preventive measures, analysis of the use of funds in healthcare are necessary to select the most optimal allocation options and achieve the best results in protecting public health. The main components of economic efficiency (or damage prevented) are as follows:

Increase in production by reducing the time lost by workers due to temporary incapacity, disability, and premature death;

Reducing losses from decreased productivity of workers weakened by illness;

Reducing additional costs for health improvement and safety in areas with harmful and difficult working conditions;

Reducing the cost of additional training for workers replacing sick and disabled people;

Reducing the cost of medical care in healthcare institutions due to a decrease in the number of patients;

Reducing the cost of social insurance for temporary disability.

If, after vaccinations (health measures, etc.), the incidence of workers has decreased by 800 working days, then economic efficiency will be the saved cost of these working days, multiplied by the cost of output for each of the 800 days.

Definition of health. Basic methods of its study.

Health is a state that ensures an optimal relationship between the body and the environment and promotes the activation of all types of human life (labor, economic, household, recreational, socialization, family planning, medical and social, etc.). The World Health Organization defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” There are other definitions, among which the health of an individual is considered as a dynamic state of preservation and development of his biological, physiological and mental functions, optimal working capacity and social activity with the longest and most active life.

The main criteria characterizing public health are:

Medical and demographic (fertility, mortality, natural increase, infant mortality, frequency of premature births, life expectancy);

Morbidity (general, infectious, with temporary disability, according to medical examinations, major non-epidemic diseases, hospitalized);

Primary disability;

Indicators of physical development;

Mental health indicators.

All criteria are evaluated dynamically. An important criterion for assessing the health of the population should be considered the health index, that is, the proportion of those who were not sick at the time of the study (during the year, etc.). You can take into account the proportion of people with chronic forms of diseases, who are often and long-term ill, etc.

Information about the state of health (morbidity) can be obtained on the basis of medical examinations, the population’s seeking medical care, the results of special sample studies, data on the causes of death, etc.

When assessing health, the population is divided into health groups:

Group 1 (healthy) - these are persons who do not have complaints, a history of chronic diseases, functional abnormalities and organic changes;

Group 2 (practically healthy) - persons who have chronic diseases in the stage of stable remission, functional changes in organs and systems that do not affect their activity and ability to work;

Group 3 - patients with chronic diseases in the stage of compensation, subcompensation or decompensation.

Purpose of the work: to master the methods of physiometric research; methods for determining the state of a person’s physical health.

1. The concept of physiometry. Determine the functional indicators of the body: vital capacity (VC), heart rate (HR), blood pressure (BP), muscle strength of the dominant hand.

2. Using the results of anthropometric measurements, determine the correspondence of your body weight to your height, determine the body proportionality index, as well as body strength, type of constitution, level of chest development, dynamometer (strength) index (DI) of the hand. Compare the data obtained with the norm and draw appropriate conclusions.

3. Perform an exercise test. Taking into account the recovery time of heart rate after performing physical activity, calculated ratio indices based on anthropometric and physiometric measurements, determine the level of your physical health.

4. Determine the individual level of health using a set of indicators.

Guidelines for implementation

Laboratory and practical work

1. Complete the laboratory work “Determination of physiometric indicators”

1.1. Determination of vital capacity of the lungs (VC)

Progress. Set the spirometer scale to zero. Trying to stay straight, without slouching, after 2-3 calm inhalations and exhalations, take a maximum inhalation, pinch your nose and exhale evenly, as deeply as possible, into the spirometer. Repeat the measurements 3 times and record the maximum result.

1.2. Determination of hand flexor muscle strength

Progress. In a standing position, move your outstretched arm with the device to the side at a right angle to your body. The second, free hand is lowered and relaxed. Squeeze the dynamometer as hard as possible, but without jerking or making any additional movements with your arm or torso. Repeat the test 2-3 times and use the best result to evaluate the strength of the hand muscles.

1.3. Determination of heart rate (HR) from pulse using palpation method

Progress. The heart rate is most often determined by palpation on the radial artery. Using the second, third and fourth fingers of your dominant hand, feel the pulse on the radial artery of your left hand. At the same time, bend your fingers at the joints so that their nail phalanges are perpendicular to the palmar surface of the forearm. Count your pulse for a minute.

1.4. Determination of blood pressure (BP) by auscultation method N.S. Korotkova

Progress. (The work is done by two people). Sitting on a chair, the subject places a relaxed hand on the table, and place a membrane tonometer cuff on his bare shoulder. Its lower edge should be at least 1-1.5 cm away from the elbow bend. In the cubital fossa, find the pulsating brachial artery, on which place a phonendoscope (a device for listening to sounds emanating from the organs of the body). With your dominant hand, take the rubber bulb, placing your index finger and thumb on the valve, close the valve. By squeezing and lowering the bulb, pump air into the cuff, creating pressure in it above the maximum, and the pulse disappears. By turning the screw valve, slowly release air from the cuff, listening for vascular sounds appearing in the brachial artery.

Note the moment of appearance of tones corresponding to systolic pressure using the instrument reading. Continue to decrease the pressure in the cuff and listen first for the increasing strength of the tones, and then for their weakening and disappearance. Record the reading of the device at the moment the sounds disappear, which corresponds to diastolic pressure. The values of systolic and diastolic pressure are expressed in millimeters of mercury (mmHg).

1.5. Enter the results of all measurements in Table 4.

Table 4

Full Name _________________________________

2. Complete the laboratory work “Research and assessment of proportionality, strength of physique, ratio of body weight to height, level of chest development using the index method.”

2.1. Determination of body proportionality using the Pirquet index

Calculate the Pirquet index or body proportionality index using the formula:

Normally, the body proportionality index is 87-92%, and in women it is slightly lower than in men.

2.2. Determination of physique strength using the Pigneur index (1901)

Determine the strength of your physique using the Pigne index:

Pinier index = Height, cm – (Body weight, kg + OGK, cm)

The lower the index number, the stronger the body is considered. Evaluate the result obtained using Table 5.

Table 5

M.V. Chernorutsky (1929) used IP values to determine the type of constitution (physique) of a person.

According to the classification of M.V. Chernorutsky, for normosthenics the PI is from 10 to 30, for asthenics it is more than 30 and for hypersthenics the PI is less than 10.

2.2.1. Analyze the data received and determine your type of constitution according to M.V. Chernorutsky.

2.3. Determining the correspondence of body weight to height

To determine the correspondence between body weight and height, calculate the body mass index (BMI):

The normal zone is considered to be an index value between 22 and 24.

2.4. Determination of the level of chest development

Determine the level of chest development by calculating the chest proportionality index (IPPC):

An indicator from 50 to 55% corresponds to normal development, more than 56% - excellent development, less than 50% - insufficient, weak development of the chest.

2.5. Compare the data obtained with the estimated indicators and draw a conclusion about proportionality, strength of physique, type of constitution, correspondence of body weight to height and indicate your level of chest development.

3. Complete the laboratory work “Research and assessment of the degree of development of the strength of the flexor muscles of the leading hand”

Determine the degree of development of the hand muscles by calculating the dynamometer index (DI) of the hand flexor muscles:

Evaluate the results obtained using Table 6.

Enter the indicator of the obtained CI in Table 8 (column “Indices of the ratios of the subject”).

Table 6

3.1. Draw a conclusion about the degree of development of the strength of the flexor muscles of the leading hand. Compare the data obtained with the characteristics of your lifestyle (systematically attending a sports section and performing physical activity, physical inactivity, type of constitution, etc.) or with the presence of diseases.

4. Complete the laboratory work: “Determining the level of human health using a set of indicators (according to G.L. Apanasenko and R.G. Naumenko).”

To determine your level of physical health, do the following:

4.1. Do an exercise test. Before performing the test, copy Table 7 into your notebook.

Progress. Determine your heart rate at rest for 10 seconds and enter the result in Table 2. Perform 20 deep squats in 30 seconds (feet shoulder-width apart, when squatting, extend your arms forward, when standing up, lower them). Then, while sitting, count your heart rate for 10 seconds at the end of the first, second, third, etc. minutes before it recovers. Enter the results obtained in Table 7.

Table 7

FULL NAME. subject _____________________________________________

Enter the heart rate recovery time, in minutes, after 20 squats in 30 seconds in Table 8.

Table 8

(According to G.L.APANASENKO AND R.G.NAUMENKO)

4.2. Make calculations using the previously obtained results of anthropometric and physiometric measurements (Tables 1 and 4). Copy Table 8 into your notebook and enter the results of all calculations in the column “Indices of the ratios of the subject.”

4.3. Using the obtained indicators of heart rate (HR) and blood pressure (BP) at rest (Table 4), find the product of HR by systolic blood pressure (BPsyst.) and, dividing the result by 100, enter it into Table 8.

4.4. Using the data in Table 9, enter in Table 8 the points you received when determining the ratio indices. Calculate the total score and, comparing it with the values indicated in table 9, indicate your level of physical health.

Table 9

4.5. Determination of the individual level of physical health (according to E.A. Pirogova, 1987)

Progress. Using the indicators of heart rate and blood pressure (Table 4), body weight and height (Table 1), determine the individual level of physical health (IUL) using the formula: IUL = (700-3HR – 2.5 BPdiast.) + (BPsyst. - BPdiast.)/3 – 2.7V + 0.28M)/ (350 – 2.7V + 0.21R), where heart rate, beats/min – heart rate; ADsyst. – systolic blood pressure, mm. rt. Art.; ADdiast. – diastolic blood pressure, mm. rt. Art.; P – height, cm; M – body weight, kg; B – age (number of full years).

Evaluate the results obtained using Table 10.

Table 10