Health. The influence of social factors on the epidemic process Prevention of infectious diseases

Introduction

Disease caused by human immunodeficiency virus (HIV)

Tuberculosis

Viral hepatitis

Anthrax

Helminthiasis

Conclusion

List of used literature

Introduction

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

Social diseases are human diseases, the occurrence and spread of which largely depend on the influence of unfavorable conditions of the socio-economic system. To S. b. include: tuberculosis, sexually transmitted diseases, alcoholism, drug addiction, rickets, vitamin deficiencies and other malnutrition diseases, some occupational diseases. The spread of social diseases is facilitated by conditions that give rise to class antagonism and exploitation of workers. Elimination of exploitation and social inequality is a necessary prerequisite successful fight with social diseases. At the same time, socio-economic conditions have a direct or indirect impact on the occurrence and development of many other human diseases; The role of the biological characteristics of the pathogen or the human body should also not be underestimated when using the term “social diseases”. Therefore, since the 1960-70s. the term is finding increasingly limited use.

In connection with the aggravated problem of socially significant diseases, the Government of the Russian Federation issued Resolution No. 715 of December 1, 2004, Moscow “On approval of the list of socially significant diseases and the list of diseases that pose a danger to others”

The Resolution includes:

1. List of socially significant diseases:

1. tuberculosis.

2. infections that are predominantly sexually transmitted.

3. hepatitis B.

4. hepatitis C.

5. disease caused by the human immunodeficiency virus (HIV).

6. malignant neoplasms.

7. diabetes.

8. mental disorders and behavioral disorders.

9. diseases characterized by high blood pressure.

2. List of diseases that pose a danger to others:

1. a disease caused by the human immunodeficiency virus (HIV).

2. viral fevers transmitted by arthropods and viral hemorrhagic fevers.

3. helminthiases.

4. hepatitis B.

5. hepatitis C.

6. diphtheria.

7. sexually transmitted infections.

9. malaria.

10. pediculosis, acariasis and others.

11. glanders and melioidosis.

12. anthrax.

13. tuberculosis.

14. cholera.

Let's consider some of the most common and dangerous diseases from the above list, included in the 1st and 2nd groups.

1. Disease caused by human immunodeficiency virus (HIV)

HIV infection, like a fire, has now engulfed almost all continents. In an unusually short time, it has become the number one problem for the World Health Organization and the UN, pushing cancer and cardiovascular diseases into second place. Perhaps no disease has asked scientists such serious mysteries in such a short period of time. The war against the AIDS virus is being waged on the planet with increasing efforts. Every month, new information about HIV infection and its causative agent is published in the world scientific press, which often forces us to radically change our point of view on the pathology of this disease. There are still more mysteries. First of all, the unexpectedness of the appearance and the speed of spread of HIV. The question of the reasons for its occurrence has not yet been resolved. The average and maximum duration of its latent period is still unknown. It has been established that there are several varieties of the AIDS causative agent. Its variability is unique, so there is every reason to expect that further variants of the pathogen will be discovered in different regions of the world, and this can dramatically complicate diagnosis. More mysteries: what is the connection between AIDS in humans and AIDS-like diseases in animals (monkeys, cats, sheep, cattle) and what is the possibility of integrating the genes of the causative agent of AIDS into the hereditary apparatus of germ cells? Next. Is the name itself correct? AIDS stands for acquired immunodeficiency syndrome. In other words, the main symptom of the disease is damage to the immune system. But every year more and more data is accumulated proving that the causative agent of AIDS affects not only the immune system, but also the nervous system. Completely unexpected difficulties are encountered in developing a vaccine against the AIDS virus. The peculiarities of AIDS include the fact that it is, apparently, the first acquired immunodeficiency in the history of medicine associated with a specific pathogen and characterized by epidemic spread. Its second feature is the almost “targeted” defeat of T-helper cells. The third feature is the first human epidemic disease caused by retroviruses. Fourthly, AIDS is not similar in clinical and laboratory characteristics to any other acquired immunodeficiencies.

Treatment and Prevention: Effective treatments for HIV infection have not yet been found. At present, at best, we can only delay the fatal outcome. Special efforts need to be focused on preventing infection. Modern medications and measures used for HIV infection can be divided into etiological, affecting the immunodeficiency virus, pathogenetic, correcting immune disorders and symptomatic, aimed at eliminating opportunistic infections and neoplastic processes. Of the representatives of the first group, preference should, of course, be given to azidothymidine: thanks to it, it is possible to weaken clinical manifestations, improve the general condition of patients and prolong their life. However, recently, judging by some publications, a number of patients have become refractory to this drug. The second group includes immunomodulators (levamisole, isopripozine, thymosin, thymopentin, impreg, indomethacin, cyclosporine A, interferon and its inducers, tactivin, etc.) and immunosubstitutes (mature thymocytes, bone marrow, thymus fragments). The results of their use are quite questionable, and a number of authors generally deny the advisability of any stimulation of the immune system in patients with HIV infection. They believe that immunotherapy may promote unwanted HIV reproduction. Symptomatic therapy is carried out according to nosological principles and often brings noticeable relief to patients. As an illustration, we can refer to the result of electron beam irradiation of the main focus of Kaposi's sarcoma.

The basis of the modern fight against HIV infection should be the prevention of its spread. Here, special attention should be paid to health education to change behavioral and hygiene habits. In sanitary educational work, it is necessary to reveal the ways of transmission of the disease, especially emphasizing that the main one is sexual; show the harmfulness of promiscuity and the need to use condoms, especially during casual contacts. Individuals at risk are advised not to participate in donation, and infected women are advised to abstain from pregnancy; It is important to warn against sharing toothbrushes, razors and other personal hygiene items that may be contaminated with the blood and other body fluids of infected people.

At the same time, infection is impossible through airborne droplets, through household contacts and through food. An important role in combating the spread of HIV infection belongs to the active identification of infected people through the use of test systems to determine antiviral antibodies. This definition includes donors of blood, plasma, sperm, organs and tissues, as well as homosexuals, prostitutes, drug addicts, sexual partners of patients with HIV infection and those infected, patients with sexually transmitted diseases, primarily syphilis. Serological testing for HIV should be carried out by Russian citizens after a long stay abroad and foreign students living in Russia, especially those arriving from regions endemic for HIV infection. An urgent measure to prevent HIV infection remains the replacement of all syringes with disposable syringes, or at least strict adherence to the rules of sterilization and use of regular syringes.

AIDS is one of the most important and tragic problems that arose before all of humanity at the end of the twentieth century. And the point is not only that many millions of people infected with HIV have already been registered in the world and more than 200 thousand have already died, that every five minutes on the globe one person is infected. AIDS is a complex scientific problem. Even theoretical approaches to solving such a problem as cleaning the genetic apparatus of cells from foreign (in particular, viral) information are still unknown. Without solving this problem, there will be no complete victory over AIDS. And this disease has raised many scientific questions...

AIDS is a severe economic problem. The maintenance and treatment of sick and infected people, the development and production of diagnostic and therapeutic drugs, conducting fundamental scientific research, etc. already cost billions of dollars. The problem of protecting the rights of AIDS patients and those infected, their children, relatives and friends is also very difficult. It is also difficult to resolve the psychosocial issues that arise in connection with this disease.

AIDS is not only a problem for doctors and healthcare workers, but also for scientists of many specialties, statesmen and economists, lawyers and sociologists.

2. Tuberculosis

Among diseases related to social diseases, tuberculosis occupies a special place. The social nature of tuberculosis has been known for a long time. At the very beginning of the 20th century, this disease was called “the sister of poverty,” “the proletarian disease.” In old St. Petersburg on the Vyborg side, the mortality rate from tuberculosis was 5.5 times higher than in the central regions, and in modern conditions the material well-being of people plays an important role in the occurrence of tuberculosis. As shown by a study conducted at the Department of Public Health and Healthcare of St. Petersburg Medical University named after. acad. I.P. Pavlova, and at the end of the 20th century, the financial and material situation of 60.7% of tuberculosis patients was defined as unsatisfactory.

Currently, the incidence of tuberculosis in developing countries is much higher than in economically developed countries. Despite the enormous achievements of medicine in the treatment of patients with tuberculosis, this problem continues to remain very relevant in many countries. It should be noted that our country has made significant progress in reducing the incidence of tuberculosis over a certain period. However, in the last decade of the 20th century, our position on this issue noticeably weakened. Since 1991, after many years of decline, the incidence of tuberculosis in our country began to increase. Moreover, there is a rapid rate of deterioration of the situation. In 1998, the number of newly diagnosed tuberculosis patients in the Russian Federation more than doubled compared to 1991. In St. Petersburg, the incidence of active tuberculosis (per 100,000 population) increased from 18.9 in 1990 to 42.5 in 1996. A number of epidemiological indicators are used to characterize the effectiveness of tuberculosis control.

Morbidity. As noted above, the number of patients newly diagnosed with active tuberculosis has tended to increase in recent years.

Of the total number of patients newly diagnosed, 213 were men, and almost half of them were 20-40 years old. More than 40% of those identified were isolated from TB, and in more than 1/3 already advanced forms of tuberculosis were detected for the first time. Firstly, all this indicates an unfavorable epidemiological situation for tuberculosis, and secondly, that the asocial part of society (homeless people, alcoholics, people imprisoned for crimes) makes up a significant part of the contingent of newly diagnosed tuberculosis patients. When counting first-time cases, the following are not included:

a) patients registered in another region;

b) cases of relapse of the disease.

Soreness. Indicators of morbidity, in connection with the success of treatment of patients with tuberculosis, and during the period when there was a 5-fold decrease in incidence, decreased only 2-fold. That is, this indicator, with successful work to reduce tuberculosis, changes at a slower pace than the incidence rate.

Mortality. Thanks to advances in the treatment of tuberculosis, the mortality rate from tuberculosis has decreased by 7 times over a 20-year period. Unfortunately, in recent years, positive changes in reducing the prevalence of tuberculosis as a social phenomenon have stopped and, on the contrary, there are even negative trends. The mortality rate from tuberculosis in the Russian Federation more than doubled, amounting to 16.7 per 100 thousand population in 1998.

World experience, as well as the experience of our country, has shown that the most effective treatment and preventive institution for working with tuberculosis patients is an anti-tuberculosis dispensary. Depending on the service area, the dispensary can be district, city, or regional. The anti-tuberculosis dispensary operates on a territorial-precinct principle. The entire service area is divided into sections, and a TB doctor is assigned to each section. Depending on local conditions (the number of registered persons and foci of tuberculosis infection, the presence of large industrial enterprises, etc.), the population in one TB area can range from 20-30 thousand to 60 thousand. It is important that the border of several therapeutic areas clinics and one TB site coincided, so that the local TB doctor worked closely with certain general practitioners, pediatricians, and general practitioners.

In the structure of an anti-tuberculosis dispensary, the main part is the outpatient link. In addition to the usual offices (doctors' offices, treatment room, functional diagnostics office, it is very desirable to have a dental office. Naturally, an integral part is a bacteriological laboratory and an X-ray office. Some dispensaries have fluorographic stations. In addition, there may be hospitals.

The dispensary carries out all work to combat tuberculosis in the area of ​​​​operation according to a comprehensive plan. It is very important to participate in the implementation of such a plan not only from medical institutions, but also from other departments. Real success in reducing the incidence of tuberculosis can only be achieved through the implementation of the interdepartmental Tuberculosis program, which was also developed in St. Petersburg. The main part of the comprehensive plan consists of sanitary and preventive measures:

Organization of timely identification of patients and revaccination of uninfected;

Organization of timely identification of patients and mass targeted preventive examinations;

Improvement of foci of tuberculosis infection, housing arrangements for bacilli carriers;

Labor placement of patients;

Sanitary educational work.

A significant place in the comprehensive plan is occupied by new methods of diagnosis and treatment of patients, inpatient and sanatorium treatment, and training of doctors in phthisiology.

There are several ways to identify tuberculosis patients. The main place is occupied (80% of all identified patients) by identification when patients seek medical help. The role of clinic doctors here is very important; as a rule, the sick person goes there first. Targeted preventive medical examinations play a role. Observation of contacts and data from pathological studies occupy an insignificant place. The latter method indicates shortcomings in the work of treatment and prevention institutions for tuberculosis.

An anti-tuberculosis dispensary is a closed institution, i.e. the patient is referred there by a doctor who identifies such a disease. When tuberculosis is detected in any medical institution, a “Notification of a patient diagnosed with active tuberculosis for the first time in his life” is sent to the anti-tuberculosis dispensary at the patient’s place of residence.

The doctor at the anti-tuberculosis dispensary organizes a thorough examination and, when the diagnosis is clarified, registers the patient with the dispensary.

In our country, tuberculosis prevention is carried out in two directions:

1. Sanitary prevention.

2. Specific prevention.

Means of sanitary prevention include measures aimed at preventing infection of healthy people with tuberculosis, at improving the epidemiological situation (including current and final disinfection, education of hygienic skills in tuberculosis patients).

Specific prevention is vaccination and revaccination, chemoprophylaxis.

To successfully reduce the incidence of tuberculosis, significant state allocations are required to provide housing for bacilli carriers, for sanatorium treatment of patients, to provide free medicines to outpatients, etc.

WHO's leading strategy to combat tuberculosis is currently the DOTS program (an abbreviation of the English words “Directly observed treatment, short-course”, which can be translated as “controlled chemotherapy of shortened activity”). It includes sections such as identifying infectious tuberculosis patients seeking medical care through analysis of clinical manifestations of pulmonary diseases and microscopic analysis of sputum for the presence of acid-fast microbacteria; prescribing two-stage chemotherapy to identified patients.

As the main specific goal of the fight against tuberculosis, WHO puts forward the requirement to achieve recovery in at least 85% of new patients with infectious forms of pulmonary tuberculosis. National programs that succeed in achieving this have the following impact on the epidemic; The morbidity of tuberculosis and the intensity of spread of the infectious agent immediately decreases, the incidence of tuberculosis gradually decreases, and drug resistance develops less frequently, which makes it easier to treat patients in the future and makes it more accessible.

By the beginning of 1995, approximately 80 countries had adopted the DOTS strategy or begun to adapt it to their conditions; About 22% of the world's population lives in regions where the DOTS program is implemented, and many countries have achieved high tuberculosis cure rates.

The adoption of the Russian Federation Law “On the Protection of the Population from Tuberculosis” (1998) proposes the development of new conceptual, methodological and organizational approaches to the formation of a system of outpatient and inpatient anti-tuberculosis care. Stopping the exacerbation of the problem of tuberculosis in the changed socio-economic conditions in Russia is possible only by strengthening the role of the state in the prevention of this infection, creating a new concept for carrying out and managing anti-tuberculosis measures.

Preventive measures are carried out in all outbreaks, but first of all in the most dangerous ones. The first priority is hospitalization of the patient. After inpatient treatment, patients are sent to a sanatorium (free of charge).

Persons who were in contact with patients are observed in the anti-tuberculosis dispensary according to the 4th group of dispensary registration. They are given chemoprophylaxis and, if necessary, vaccination or revaccination with BCG.

Organization of anti-tuberculosis work.

If the first principle of the fight against tuberculosis in our country is its state nature, then the second can be called treatment and prophylactic, the third principle is the organization of anti-tuberculosis work by specialized institutions, the broad participation of all health care facilities in this work.

The comprehensive plan to combat tuberculosis includes the following sections: strengthening the material and technical base, incl. equipping health care facilities, providing the necessary personnel and improving their qualifications, carrying out measures aimed at reducing the reservoir of tuberculosis infection and preventing its spread among the healthy population, identifying patients and treating them.

It must be remembered that tuberculosis is controlled, i.e. controllable, infectious diseases and the implementation of clear and timely measures to prevent tuberculosis can achieve a significant reduction in the prevalence of this dangerous disease.

3. Syphilis

Social and economic transformations in Russia in the 90s of the twentieth century were accompanied by a number of negative consequences. These include the syphilis epidemic, which has affected most territories of the Russian Federation. In 1997, the incidence of this infection increased by a total of 50 times compared to 1990, and the incidence of children increased by 97.3 times

The epidemic involved the population of all territories of the North-West region of Russia. The highest rates of syphilis incidence occurred in the Kaliningrad region. It should be noted that this region was the first territory where the HIV epidemic began. The incidence of syphilis in children in 1997 (the year of the maximum increase) in the territories of the North-West was characterized by different indicators.

They turned out to be the highest in the Novgorod, Pskov, Leningrad and Kaliningrad regions. Such territories are called risk territories. In recent years, the incidence of syphilis has begun to gradually decline, but it still remains at a high level. In 2000, in the Russian Federation as a whole, more than 230 thousand patients with all forms of syphilis were identified, including more than 2 thousand cases registered among children under 14 years of age (in 1997-1998, more than 3 thousand diseases were diagnosed annually, of which 700 800 cases among children under 1 year of age). According to the dermatovenerological dispensary, in the Leningrad region in 1990-1991. About 90 patients with syphilis were identified. In 2000, more than 2 thousand new cases of the disease were diagnosed. It should be noted that among the sick, 34% were rural residents, i.e. this problem is not only in large cities. A study of the age structure of people with syphilis in 2000 showed that the majority (42.8%) were young people aged 20-29 years (Fig. 4).

More than 20% of the structure was occupied by men and women in the age group of 30-39 years. However, the group at highest risk for the disease are persons 18-19 years old. This group, which includes only two age categories, accounted for about 10% of cases of syphilis, while other groups include 10 or more age categories of the population. 133 cases of syphilis were also identified among children and adolescents.

To what has been said, it must be added that in recent years syphilis has taken first place among the causes of abortion for medical reasons. Unfulfilled life, along with the low birth rate in general in the last decade, also characterizes the incidence of syphilis as a serious social problem. The high incidence of syphilis, confirming the changes that have occurred in the sexual behavior of the population, gives reason to predict an increase in the incidence of other sexually transmitted infections, including HIV infection.

The epidemiological situation associated with the epidemic growth of sexually transmitted diseases, including syphilis, has become so serious that it served as the topic of a special discussion at the Security Council of the Russian Federation, where a corresponding decision was made (Yu. K. Skripkin et al., 1967) . Since syphilis during an epidemic outbreak has significant features that contribute to the activation of the process, attention is paid to increasing the effectiveness of treatment, rehabilitation and preventive measures. It is noteworthy that there are many factors that provoke and contribute to the increase in the incidence of syphilis.

1st factor - social conditions: extremely low level of information about sexually transmitted diseases among the country's population; a catastrophic increase in drug use; progressive increase in alcoholism; active, immoral propaganda of sex by all types and media; economic distress of the country; a progressive increase in the number of unemployed; lack of legalized prostitution.

2nd factor: general medical situation in the country; a pronounced decrease in immunity in a significant part of the population due to impoverishment; an increase in the number of manifest forms of syphilis and malignant, atypical manifestations; Diagnosis of secondary fresh and recurrent syphilis is difficult due to the atypicality and small number of rashes, and rare visits to medical institutions; an increase in the number of patients with hidden and unknown syphilis; tendency to self-medicate a significant contingent of people.

Serious attention is drawn to the fact that antibiotics are widely used in the country for intercurrent diseases that contribute to immunosuppression and change the clinical picture and course of the syphilitic process. Syphilitic infection has undergone significant pathomorphism over the past decades. So, V.P. Adaskevich (1997) emphasizes the milder course of syphilis without the severe consequences observed several decades ago. In recent years, tubercular and gummous syphilis have become rare, as have severe lesions of the central nervous system (acute syphilitic meningitis, tabetic pain and crises, tabetic atrophy of the optic nerves, manic and agitated forms of progressive paralysis, arthropathy), gumma of the skull bones and internal organs. Severe syphilitic lesions of the liver, aortic aneurysm, aortic valve insufficiency, etc. are much less common. However, diseases of a combined nature - tuberculosis and syphilis, syphilis and HIV infection - have become more frequent.

For the purpose of more detailed information about the features of the modern syphilis clinic, V.P. Adaskevich (1997) summarized the clinical uniqueness of the symptoms of the primary and secondary periods of syphilis, characteristic of the present time.

Clinical features of the primary period are: the formation of multiple chancre in 50-60% of patients, an increase in the number of cases of ulcerative chancre; herpetic giant chancre is registered; atypical forms of chancre have become more frequent; Complicated forms of chancre with pyoderma, viral infections with the formation of phimosis, paraphimosis, and balanoposthitis are more often observed.

The number of patients with extragenital chancre has increased: in women - mainly on the mucous membranes of the oral cavity and pharynx, in men - in the anal area; Noteworthy is the absence of regional scleradenitis in 7-12% of patients.

Clinical features of the secondary period: roseola and roseola-papular elements are more often recorded; roseola rash is observed on the face, palms, and soles. Atypical roseola elements are possible in a significant number of patients: elevating, urticarial, granular, confluent, scaly. In patients with secondary fresh syphilis, the combination of palmar-plantar syphilides with leukoderma and alopecia has become more frequent.

With secondary recurrent syphilis, a papular rash will predominate in patients, less often a roseola rash. Low-symptomatic isolated lesions of the palms and soles are common; In a significant number of patients, erosive papules and condylomas lata of the anogenital area are often recorded. Pustular secondary syphilides are detected less frequently, and if they occur, they are superficial impetiginous.

Noteworthy is the predominance of cases of secondary recurrent syphilis among the treated population of patients, which is a consequence of late presentation and late detection of fresh forms.

V.P. Adaskevich (1997) and a number of authors note certain difficulties in detecting pale treponomas in the discharge of syphilides. The frequency of detection of pale treponomas in the discharge of chancre during primary syphilis does not exceed 85.6-94% and 57-66% in the discharge of papular elements during repeated studies.

Manifestations of the tertiary period of syphilis are currently rarely recorded and are characterized by the paucity of clinical symptoms, a tendency to manifestations of a systemic nature from the internal organs, with a mild course. There are almost no cases of tertiary syphilis with abundant tuberculate rashes, gummas, and significant bone deformations.

Over the past decades, there has been a marked increase in latent forms of syphilis, which, according to some data, account for 16 to 28% of all cases of the disease detected per year, which can be complicated by significant epidemiological problems.

To successfully reduce the incidence of syphilis, the need for a set of measures has been established. Timely diagnosis with identification of sources and contacts is combined with the active prescription of modern treatment in accordance with the characteristics of the patient’s body and the uniqueness of the symptoms of the process. The work carried out by many research institutes, departments of skin and venereal diseases of medical institutes, aimed at improving methods of treating syphilis, has been repeatedly discussed at congresses and international symposiums of dermatovenerologists. At the same time, recommendations and instructions were developed for the use of theoretically substantiated and practically tested methods and regimens that ensure a full therapeutic effect over many years of clinical observations.

Principles and methods of treatment. Drugs used to treat patients with syphilis are called antisyphilitic drugs. They are prescribed after a diagnosis has been established with mandatory confirmation by laboratory data. It is recommended to start treatment as early as possible (in the case of early active syphilis - in the first 24 hours), since the earlier treatment is started, the more favorable the prognosis and the more effective its results.

Reducing the incidence of syphilis and its prevention is not only a medical task, but the state and society as a whole.

4. Viral hepatitis

Viral hepatitis is a group of nosological forms of diseases of different etiological, epidemiological and clinical nature, occurring with predominant liver damage. According to their medical and socio-economic characteristics, they are among the ten most common infectious diseases of the population of modern Russia.

The following are currently subject to official registration in Form No. 2 of the Federal State Statistical Observation in accordance with ICD-X:

Acute viral hepatitis, including acute hepatitis A, acute hepatitis B and acute hepatitis C;

Chronic viral hepatitis (first established), including chronic hepatitis B and chronic hepatitis C;

Carriage of the causative agent of viral hepatitis B;

Carriage of the causative agent of viral hepatitis C

The last five years have been marked by a significant increase in the prevalence of all nosological forms of viral hepatitis, which is associated both with the next cyclical rise and with a wide range of social living conditions of the population that contribute to the implementation of infection transmission routes. In 2000, compared to 1998, the incidence of hepatitis A increased by 40.7%, hepatitis B by 15.6% and hepatitis C by 45.1%. The rates of latent parenteral hepatitis B increased by 4.1% and hepatitis C by 20.6%. The official registration of newly diagnosed cases of chronic viral hepatitis (B and C), which began only in 1999, revealed that the rate for the year increased by 38.9%. As a result, in 2000, the country's treatment and preventive institutions identified and registered 183 thousand cases of acute viral hepatitis (including: A - 84, B - 62, C - 31, others - 6 thousand cases); 296 thousand cases of carriage of the causative agent of viral hepatitis B and C (140 and 156 thousand cases, respectively); 56 thousand cases of newly diagnosed chronic viral hepatitis B and C (21 and 32 thousand cases, respectively).

Thus, the number of all cases of viral hepatitis in 2000 exceeded 500 thousand, including the number of acute cases of hepatitis (A, B, C), occurring in manifest and latent form - 479 thousand (of which B and C - 390 thousand cases). The ratio of registered manifest to non-manifest forms was 1:2.2 for hepatitis B and 1:5.0 for hepatitis C.

The total prevalence of all forms of hepatitis B and hepatitis C per 100 thousand population is almost the same - 152.4 and 150.8. If the number of newly diagnosed cases of chronic viral hepatitis is excluded from the indicators, the values ​​will be reduced to 138.2 and 129.6, respectively. As for the prevalence of hepatitis A, it is more than 3 times less than each of the parenteral hepatitis considered.

Differences in the frequency and proportion of morbidity in children with various forms of viral hepatitis are clearly visible, which boil down to a significant prevalence of hepatitis A in children. Among parenteral hepatitis, children are 2 times more likely to suffer from hepatitis B than hepatitis C (both acute and chronic forms ).

Assessing the importance of hepatitis for public health, we also present mortality statistics: in 2000, 377 people died from viral hepatitis in Russia, including 4 from hepatitis A, 170 from acute hepatitis B, 15 from acute hepatitis C, and 15 from chronic viral hepatitis 188 people (mortality rate was 0.005%, 0.27%, 0.04% and 0.33%, respectively).

Analysis of official statistical information outlined the social, medical and demographic contours of the problem of viral hepatitis. At the same time, it is of no small importance to characterize the economic parameters of these infections, which allows us to use numbers to judge the damage caused to the economy, and ultimately make the only right choice regarding the strategy and tactics to combat them.

A comparison of economic losses associated with one case of hepatitis of various etiologies indicates that the greatest damage is caused by hepatitis B and C, which is associated both with the duration of the course (treatment) of these diseases and with the possibility of chronicity of the process.

The given values ​​of damage (per 1 case), calculated for the Russian Federation, can be used to determine the total economic losses both for the country as a whole and for its individual regions. In the latter case, the size of the error in the obtained significance values ​​will mainly depend on how different the basic parameters of damage per 1 case of disease (ratio of sick children and adults, duration of inpatient treatment, cost of a bed day, wages of workers, etc.) differ in the region and in national average.

The greatest economic losses from morbidity in 2000 were associated with hepatitis B - 2.3 billion rubles. The damage from hepatitis C is somewhat less - 1.6 billion rubles. and even less from hepatitis A - 1.2 billion rubles.

In 2000, the economic damage from all viral hepatitis in the country exceeded 5 billion rubles, which in the structure of the total damage from the most common infectious diseases (25 nosological forms without influenza and ARVI) amounted to 63% (Fig. 2). These data make it possible to characterize viral hepatitis not only in general, but also to compare the economic significance of individual nosological forms.

Thus, the results of the analysis of the incidence and economic parameters of viral hepatitis allow us to consider these diseases as one of the highest priority problems of infectious pathology in modern Russia.

5. Anthrax

Anthrax is an acute infectious anthropozoonotic disease caused by Bacillus anthracis and occurs predominantly in the cutaneous form; inhalation and gastrointestinal forms are less common.

Every year, between 2,000 and 20,000 cases of anthrax are recorded worldwide. This infection acquired particular relevance after the use of Bacillus anthracis spores as a bacteriological weapon in the United States in the fall of 2001.

Bacillus anthracis belongs to the family Bacilaceae and is a gram-positive rod, nonmotile, spore-forming and capsule-forming, growing well on simple nutrient media; vegetative forms quickly die under anaerobic conditions, when heated, or exposed to disinfectants. The spores are highly resistant to environmental factors. The main reservoir for the pathogen is soil. The source of infection is cattle, sheep, goats, pigs, camels. Entrance gate

The global HIV pandemic is a harsh reality of our time, which should be remembered by all people living on Earth. There were no analogues of epidemics and pandemics - as happened with HIV infection. Epidemics came and went. HIV infection is here to stay. According to the forecast...

Hepatitis A - highly contagious viral infection with predominant liver damage, accompanied by jaundice, diarrhea and vomiting. Sometimes severe flu-like conditions occur that last for weeks.

The problem of medical and biological patterns of the spread of sexually transmitted infections is discussed.

Advances in the treatment of malignant neoplasms. Organization of palliative care for incurable cancer patients. Prevention and treatment of tuberculosis. Methods for reducing the incidence of tuberculosis. Medical and social consequences of HIV infection

Sources of infection and routes of transmission of tuberculosis infection. Analysis of the epidemiological situation in the world and Belarus. General characteristics of the classification of patients or persons suspected of tuberculosis and who are in contact with tuberculosis patients according to WHO.

Tuberculosis in Russia Current trends in the spread of Abstract for postgraduate education. At the end of the twentieth century after long period relative well-being, the incidence of tuberculosis has increased significantly, acutely progressive forms of it have appeared, reminiscent of a “fleeting episode...

Syphilis is classified as a classic sexually transmitted disease (sexually transmitted disease). The causative agent is Treponema pallidum. Syphilis is characterized by a slow progressive course.

This file is taken from the Medinfo collection http://www.doktor.ru/medinfo http://medinfo.home.ml.org E-mail: [email protected] or [email protected]

The relevance of the problem of tuberculosis, sources of infection and routes of infection. Tuberculosis incidence statistics in Voronezh region in 1996-2000, study of epidemiological indicators. Optimization of the epidemiological surveillance system.

Sexually transmitted diseases (hereinafter in this article - STDs) is a broader term compared to the term " venereal diseases"STDs include sexually transmitted diseases.

Hepatitis B is a widespread infectious disease caused by the hepatitis B virus; in clinically significant cases characterized by symptoms acute lesion liver and intoxication.

What is syphilis? How can you become infected with syphilis? What is the probability of infection from one sexual contact without a condom with a patient with syphilis?

General clinical picture of the immunodeficiency virus, its primary symptoms and detection procedure. Possible ways of infecting a person with AIDS, measures to prevent it and prevent it. Conservative treatment disease and its effectiveness. AIDS tests.

It can be argued that the primary and main process in the development of each disease is damage, destruction, disorganization of the structures and functions of the diseased organism. All reactive, protective, compensatory, adaptive processes are always secondary, developing following damage by one or another pathogenic effect on the body.

It should be emphasized that during the development of any disease, adaptive and compensatory processes themselves become harmful to the patient and have a serious impact on his condition. Examples include the secretion of urea by the gastric mucosa and skin (sweat glands) during uremia, severe fevers and other conditions.

Hans Selye called the “stress” (tension) syndrome he described a disease of adaptation, or a disease of adaptation. By this, he emphasized that overstraining the body’s adaptive systems during illness is in itself harmful to the body and can worsen the course of the disease. The disease of adaptation also indicates that attempts to see in any disease only elements of the diseased organism’s adaptation to existence in the environment are untenable and cannot be taken seriously.

Thus, the essence of the disease cannot be reduced only to adaptation, although adaptive, compensatory processes are involved in

Part I. GENERAL NOSOLOGY

life of a sick organism and are mandatory for the life of healthy living beings in all its manifestations.

An example of a simplified interpretation of the essence of the disease in terms of molecular pathology One might call it Leinus Pauling's concept of “sick molecules.” In fact, there are no sick molecules, but there are diseases in which molecules of a composition and properties unusual for a healthy body appear. In the broad sense of the word, all diseases are molecular, but the patterns of molecular processes are mediated in animals in the biological, and biological processes in humans are mediated and in socially.

In humans, as a social being, the most important and obligatory link in maintaining health and the development of disease is the mediation of biological (physiological) processes by social factors. These processes are significantly influenced by human labor activity, which distinguishes him from animals.

The most important role of social factors in the development of pathological processes becomes obvious when studying the effect of any pathogenic causes on the human body. Essentially, they all act on the human body indirectly through the social processes surrounding it.

Indeed, the influence of social factors on the occurrence of epidemic processes (for example, hospital, water supply, military, famine epidemics) is well known. There are many professions that socially mediate the possibility of the occurrence of various diseases, the prevention of which requires special measures protection and labor regime of workers. Wars are a severe form of social mediation of mass death and morbidity of people. The effect on the human body of physical and chemical pathogenic factors (heat, cold, electricity, toxic substances, etc.), with rare exceptions (lightning strike, poisoning by poisonous mushrooms, freezing of an immobile person in the cold, etc.), is also mediated by social factors - clothing, housing, electrical appliances And etc. At the same time a whole series sources of ionizing radiation, electricity, etc., capable of causing severe illness in the body

damage created by human labor. The pathological processes resulting from this damage are also socially mediated.

It is important to emphasize that disease- it's brand new life process, in which, although the functions inherent in a healthy body are preserved, new changes appear. For example, in a healthy person, the number of newly formed cells in the body is strictly equal to the number of dead (as a result of the completed life cycle) cells. In patients with tumors, a clone of cells appears that have a high potential for reproduction, but at the same time normally functioning cellular systems are preserved. At the level of the whole organism, a new quality is a decrease in adaptability and ability to work.

Summarizing all of the above, we can give the following definition of the disease: disease- this is a complex general reaction of the body to the damaging effects of environmental factors, this is a qualitatively new life process, accompanied by structural, metabolic and functional changes destructive and adaptive in organs and tissues, leading to a decrease in the body’s adaptability to continuously changing environmental conditions and limited ability to work.

1.1.3. Disease criteria

An important criterion for the disease is patient complaints(malaise, pain, various functional disorders, etc.), which, however, do not always objectively reflect the state of the body. In a number of cases, people with increased suspiciousness and superficial, but quite widely aware of individual symptoms of a particular disease and the causes that cause them, they can misinform the doctor by telling him about their ailments and associating them with the specifics of the profession (for example, working with sources of radioactive radiation) or a certain place of residence (for example, in areas, in their opinion, of environmental distress, etc.). Students of medical universities, starting to study clinical disciplines and become familiar with the symptoms of certain diseases, often “project” them onto themselves, comparing what is written on the pages of textbooks with their own.

general well-being (“third-year illness”).

The defining criterion of the disease is the results of an objective examination of the patient using a wide range of laboratory and instrumental research methods, which make it possible to identify certain deviations from the norm and establish characteristic symptoms(signs) of disease.

The most important criteria for the disease are, as already indicated, decreased adaptability and limited ability to work. To identify a decrease in the adaptive capabilities of the body, so-called functional tests are carried out, when the body (organ, organ system) is artificially placed in conditions in which it is forced to exhibit an increased ability to function. An example is a sample with a sugar load at diabetes mellitus, various functional loads to identify abnormalities on the ECG, etc.

1.1.4. General principles
classification of diseases

There are many classifications of diseases based on different principles. Diseases are divided according to the reasons that cause their occurrence, for example, hereditary, infectious diseases, injuries, radiation sickness etc. According to another principle, diseases are classified according to the characteristics of their pathogenesis, for example, metabolic diseases, allergic diseases, shock, etc. The organ principle of classifying diseases, for example, heart disease, lung disease, kidney disease, liver disease, etc., is very popular. Age principles occupy an important place in the classification of diseases. There are diseases of newborns (micropediatrics), childhood diseases (pediatrics), diseases old age(geriatrics). A special branch of medicine is women's diseases(gynecology).

1.1.5. Pathological reaction
pathological process,
pathological condition

A pathological reaction is a short-term, unusual reaction of the body to any impact. For example, a short-term increase

blood pressure changes under the influence of negative emotions.

Pathological reactions include allergic reactions, inadequate psycho-emotional and behavioral reactions, pathological reflexes (Rossolimo, Babinsky- go, etc.).

Pathological process - a combination (complex) of pathological and protective-adaptive reactions in damaged tissues, organs or body, manifested in the form of morphological, metabolic and functional disorders.

Constant combinations or combinations of various pathological processes and individual pathological reactions of cells and tissues formed and fixed in the process of evolution are called typical pathological processes. These include inflammation, fever, hypoxia, edema, tumor growth, etc.

The pathological process underlies the disease, but is not it. The differences between the pathological process and the disease are as follows:

1. A disease always has one main etiological cause (a specific producing factor), the pathological process is always multi-etiological. For example, inflammation (pathological process) can be caused by the action of various mechanical, chemical, physical and biological factors, and malaria cannot occur without the action of the malarial plasmodium.

2. The same pathological process can cause different pictures of the disease depending on the localization, in other words, the location of the pathological process determines the clinical picture of the disease (pneumonia - pneumonia, inflammation of the meninges - meningitis, inflammation of the heart muscle - myocarditis, etc. ).

3. The disease is usually a combination of several pathological processes. For example, with lobar pneumonia there is a combination (in interrelation) of such pathological processes as inflammation, fever, hypoxia, acidosis, etc.

4. The pathological process may not be accompanied by a decrease in the body’s adaptability and limited ability to work (warts, lipoma, atheroma, etc.).

Part I. GENERAL NOSOLOGY

Pathological condition is a slowly (sluggish) ongoing pathological process. May occur as a result of a previously suffered disease (for example, cicatricial narrowing of the esophagus after a burn injury; false joints; condition after kidney resection, amputation of a limb, etc.) or as a result of a disorder intrauterine development(clubfoot, flatfoot, defect upper lip And hard palate and cr.). This is, as it were, the result of a completed process, as a result of which the structure of the organ has permanently changed, atypical replacements have arisen in certain fabric or parts of the body. In some cases, a pathological condition can again turn into a pathological process (disease). For example, a pigmented area of ​​skin ( birthmark) when exposed to a number of mechanical, chemical and physical (radiation) factors can transform into a malignant tumor, melanosarcoma.

1.2. GENERAL ETIOLOGY

The term “etiology” (from the Greek aitia - cause, logos - teaching) was introduced by the ancient Greek materialist philosopher Democritus. In ancient times, this word meant the doctrine of diseases in general (Galen). IN modern understanding etiology is the study of the causes and conditions of the occurrence and development of diseases.

1.2.1. Causes of diseases

Despite the fact that from ancient times to the present day the question of why a person fell ill has been one of the main ones in medicine, unfortunately, even today etiology remains, as I.P. Pavlova, “the weakest department of medicine.” Meanwhile, it is obvious that without identifying the cause of the disease, it is impossible to determine the correct way of its prevention and treatment.

Serious scientific development etiology began only in late XIX century, thanks to the rapid development of biology and medicine in general and microbiology in particular. The starting stimulus for this was “Cellular Pathology” by R. Virchow, which substantiated the material nature of the functional disorders that occur in diseases and prompted researchers to search for specific material causes of these disorders.

The revolutionary breakthrough in microbiology, associated with the discovery of a number of microorganisms - causative agents of human infectious diseases (P. Ehrlich, R. Koch, L. Pasteur, etc.), dealt a crushing blow to age-old idealistic ideas about the causes and essence of diseases, establishing the materialistic principles of determinism . Subsequently, more and more new causes of diseases began to be identified. At the same time for a long time it was believed that the presence of a cause (a pathogenic factor) was equivalent to the presence of a disease, while the body was assigned the role of a passive object under the action of this factor. This period in the development of the doctrine of etiology is designated as the period of mechanical determinism. Soon, however, it became obvious that the presence of a pathogenic factor does not always lead to the onset of disease. It has been proven that an equally important role in this is played by the state of the body (reactivity, gender, age, constitution, individual anatomical and physiological characteristics, heredity), various kinds of socially determined (unsanitary living conditions, poor nutrition, difficult working conditions, bad habits etc.) and many other factors that either contribute to or, on the contrary, prevent the occurrence of the disease.

This is how two diametrically opposed views arose in the interpretation of problems of etiology: monocausalism and conditionalism. Representatives of monocausalism argued that only its main (i.e. one) cause (monos - one, causa - cause) is decisive in the occurrence of a disease, and all other factors do not play a significant role.

Proponents of the opposite point of view believed that the disease is caused by a complex of conditions, all of them are equal (equipotential) and it is not possible to single out any one (main) cause of the disease. This direction is called conditionalism (conditio - condition). The founder of conditionalism was the German physiologist and philosopher Max Verworn (1863-1921), who argued that “the concept of cause is a mystical concept” that should be expelled from the exact sciences. The concept of conditionalism in etiology turned out to be very persistent; to one degree or another, it was adhered to by the largest Russian pathologists V.A. Oppel, S.S. Khalatov, N.N. Anichkov, I.V. Davydovsky and others.

Chapter 1 / GENERAL TEACHING ABOUT DISEASE

From modern positions, both points of view cannot be considered as correct: mono-causalism, quite rightly highlighting the main cause of the disease, completely denies the role of the conditions in which it occurs; conditionalism, on the contrary, denies the leading role of the main (main) cause of the disease, completely equating it To other conditions, thereby making it impossible to study specific factors diseases and etiotropic therapy. The correct position in this matter is to consider the causes and conditions for the occurrence of diseases V their dialectical unity, i.e. V constant and close interaction of both while maintaining the specific role of each of them [Sarkisov D.S., Paltsev M.A., Khitrov N.K., 1997].

Modern representations about causality in pathology follow from three main provisions of materialist dialectics: 1. All phenomena in nature have their own cause; there are no causeless phenomena; the reason is material, it exists outside and independently of us. 2. The cause interacts with the body and, changing it, changes itself. 3. The reason imparts a new quality to the process, i.e. Among the many factors influencing the body, it is she who gives the pathological process a new quality.

The disease is caused by a complex of factors, but they are far from equivalent. Should be highlighted main etiological factor(producing, specific) - this is the factor in the absence of which the disease cannot develop under any circumstances. For example, lobar pneumonia occurs not only under the influence of human infection with pneumococcus. The disease is also promoted by colds, fatigue, negative emotions, malnutrition, etc. It is easy to understand, however, that without infection with pneumococcus, all of these factors will not be able to cause lobar pneumonia. Therefore, the cause of this disease, its main etiological factor, should be considered pneumococcus.

However, sometimes it is difficult to identify the cause of the disease (some tumors, mental illnesses). It has been established, for example, that a stomach ulcer develops both from irregular and poor nutrition, and from a state of neurosis, dysfunction of the autonomic nervous system, endocrine disorders. These and many other observations gave rise to the idea

information about the polyetiology of the disease. This position is incorrect. It arose as a result of our lack of knowledge about the causes of certain diseases and their variants.

As indicated, each disease has its own, unique cause. As knowledge accumulates about the causes of all types and subtypes of diseases, their prevention and treatment will improve. Many diseases, as their true causes become known, fall into new subtypes, each of which has its own separate reason. For example, there used to be a disease called “bleeding” (hemorrhagic diathesis). As the causes of individual manifestations of this disease were established, new completely independent forms of the disease characterized by bleeding (scurvy, hemophilia, hemorrhagic purpura, etc.) emerged. Similarly split into independent diseases with its causes, neuro-arthritic diathesis (gout, rheumatism, non-infectious polyarthritis, etc.).

Reasons(main etiological factors) of diseases are divided into external And internal. TO external reasons include mechanical, physical, chemical, biological And social factors, to internal ones - a violation in the genotype. The disease can also be caused by a deficiency in the environment or in the body of substances (factors) necessary to ensure normal life (vitaminosis, fasting, immunodeficiency states, etc.).

It should be noted that the presence of the main etiological factor and even its impact on the body does not always lead to the occurrence of the disease. This is facilitated or, on the contrary, prevented by a whole range of conditions.

1.2.2. Conditions for the occurrence and development of diseases

Factors influencing the occurrence and development of diseases are called conditions for the occurrence of the disease. IN Unlike the causative factor, the conditions are not necessary for the development of the disease. If there is a causative factor, the disease can develop without the participation of certain conditions for its occurrence. For example, lobar pneumonia caused by highly virulent pneumococcus can develop

Part I. GENERAL NOSOLOGY

Curl without a cold, without weakening your diet and other conditions. There are conditions that predispose to the disease or contribute to its development, and those that prevent the onset of the disease and its development. Both conditions that promote and prevent the development of diseases can be internal and external.

Internal conditions contributing to the development of the disease include hereditary predisposition to the disease, pathological constitution (diathesis), early childhood or old age.

TO external conditions factors that contribute to the development of diseases include eating disorders, overwork, neurotic conditions, previous illnesses, poor care for the sick.

Internal conditions that prevent the development of diseases include hereditary, racial and constitutional factors, for example, human species immunity to certain infectious diseases of animals. A person does not suffer from canine and cat distemper, cattle pneumonia and many other infectious animal diseases. People with sickle cell disease do not get malaria.

External conditions that prevent the development of diseases include good and balanced nutrition, proper organization of the working day, physical education, and in case of illness, good care for the patient.

Establishment of the main (producing, specific) etiological factor, the identification of conditions that predispose to the disease or contribute to its development, and conditions that prevent the occurrence of the disease and its development, is absolutely necessary for the development of effective measures for the prevention of diseases, reducing morbidity and improving the health of the population.

1.3. GENERAL PATHOGENESIS

1.3.1. Definition of the concept “pathogenesis”

Pathogenesis(from Greek pathos - suffering 1, genesis - origin) - pathological section

1 According to Aristotle, pathos also means damage. Chapter 1 / GENERAL TEACHING ABOUT DISEASE

3 No. 532

some physiology, studying the mechanisms of disease development. The study of the most general patterns of occurrence, development, course and outcome of diseases constitutes the content general teaching about pathogenesis. It is based on generalized data on the study of individual types of diseases and their groups (special pathology and clinical disciplines), as well as on the results of experimental reproduction (modeling) of diseases or individual symptoms in humans and animals. At the same time, the sequence of changes in the body for each disease is established, cause-and-effect relationships between various structural, metabolic and functional changes are identified. In other words, the study of pathogenesis comes down to the study of the so-called pathogenetic factors of the disease, i.e. those changes in the body that occur in response to the action of the main etiological factor and subsequently play the role of cause in the development of the disease.

Thus, if the study of etiology makes it possible to answer the question: “Why did the disease arise?”, then the final result of the study of pathogenesis should be the answer to the question: “How does it develop?”

The main (specific) etiological factor acts as a trigger for the development of the disease. The pathogenesis of the disease begins with any primary damage (R. Virchow) or “ destructive process"(I.M. Sechenov), "breakage" (I.P. Pavlov) of cells in one or another part of the body (pathogenetic factor of the first order). In some cases, the initial damage can be rough, clearly visible to the naked eye (traumas, burns, wounds, etc.). In other cases, damage is invisible without the use of special methods for detecting it (damage at the molecular level). Between these extreme cases there are all kinds of transitions. The products of tissue damage become sources of new damage during the development of the disease, i.e. pathogenetic factors of the second, third, fourth, ... order. In some cases, for example, with lead, mercury poisoning or chronic infections, the etiological factor as a trigger remains for the entire time the poison or infection is in the body.

1.3.2. Protective-compensatory
processes

An important manifestation of each disease is reactive changes on the part of cells, organs and systems, which arise, however, always secondary, in response to damage caused by pathogenic causes. These include processes such as inflammation, fever, swelling, etc.

These reactive changes in the body are designated as protective-compensatory processes, or a “physiological measure” of protection (I.P. Pavlov), as “pathological (or emergency) regulation of function” (V.V. Podvysotsky, N.N. Anichkov), " healing powers organism" (I.I. Mechnikov). During the development of the disease, the processes of damage and recovery are in close interaction, and, as I.P. pointed out. Pavlov, it is often difficult to separate one from the other.

These processes develop and occur at various levels, starting from the molecular and ending with the whole organism of a sick person. At the onset of the disease, protective and compensatory processes develop at the molecular and cellular levels. If the effect of pathogenic causes is weak and short-lived, the disease may not develop. This happens in cases of exposure to not very virulent microbes, poisons in small doses, low doses of ionizing radiation, minor injuries, etc. Significant damage causes more severe responses from the authorities and their regulatory systems.

1.3.3. The main link and the “vicious”
circle" in the pathogenesis of diseases

In the development of diseases and pathological processes, it is extremely important to determine the basic

main link in the chain of disorders occurring in the body - change in the body(one of the pathogenetic factors), determining the development of the remaining stages of the disease. Elimination of the main link in pathogenesis leads to recovery of the body. Without establishing the main link in pathogenesis, it is impossible to carry out pathogenetic therapy- a set of measures aimed at breaking the chain of cause-and-effect relationships between various structural, metabolic and functional disorders that occur in the body due to the influence of the main etiological factor, by eliminating the main link in pathogenesis. For example, stenosis of the left atrioventricular orifice serves as the main link in the chain of many subsequent disorders: dilatation of the left atrium, stagnation of blood in the pulmonary circle, dysfunction of the right ventricle, and then stagnation in big circle blood circulation, oxygen starvation circulatory type, shortness of breath, etc. Elimination of this link by mitral commissurotomy eliminates all of these disorders.

A dysfunction of an organ or system that arises during the development of a pathological process often itself becomes a factor (cause) causing this disorder, in other words, the cause-and-effect relationships change places. This situation in medicine is called a “vicious circle.” For example, sharp deterioration oxygen transport during blood loss leads to heart failure, which further impairs oxygen transport. A “vicious circle” arises (Scheme 1).

It is important to note that in many cases of the formation of vicious circles, the essence of this process lies in the disruption of negative feedback, its transformation into positive feedback, which becomes the basis for the aggravation of the pathological process [Sarkisov D.S.

Blood loss

(mass reduction

circulating blood)

"Vicious circle" during blood loss

Human health is the subject of study of many natural and social sciences: biology, medicine, sociology, psychology, philosophy and many others. The study of the basics of health is largely a biomedical aspect. And yet it must be remembered that although all medical doctrines were based on two interrelated goals - the preservation of health and the treatment of diseases, in fact medicine is the science of diseases. A person is connected with relationships in society and its social structure. Therefore, it is impossible to solve health problems without taking into account wide range social factors. Let us remind you that according to foreign and domestic researchers, a person’s health depends 50% on his lifestyle. Every aspect of social work concerns and promotes health. Social workers must have a clear understanding of the phenomenon of health and a healthy lifestyle. Without such ideas social work inferior.
According to the World Health Organization: health is a state of complete physical, mental, sexual and social well-being and the ability to adapt to constantly changing conditions of the external and internal environment and the natural process of aging, as well as the absence of disease and physical defects.
Health is the ability of a person to perform his biosocial functions in a changing environment, with overloads and without losses, in the absence of diseases and defects.
Health is physical, mental and moral. Physical health is impossible without moral health.
Health is normal physical condition, i.e. a state of wholeness and freedom from physical and mental illness or disease.
There is a distinction between individual health and population health (public health). The health of an individual is associated with large fluctuations in the most important vital signs and the adaptive capabilities of the body. Between health and disease, as opposite states, there can be a so-called pre-disease, when there is no disease yet, but the body’s protective and adaptive forces are overstrained or sharply weakened, and a harmful factor that would not normally cause a disease can cause it. In addition, health does not exclude the presence in the body of a pathogen that has not yet manifested itself, fluctuations in a person’s well-being, or even some deviations from what is considered as a physiological norm. Thus, developing with age in all people atherosclerotic changes blood vessels are undoubtedly a pathological process, however, a person’s health may not be affected if these changes are expressed slightly.
In this regard, the concept of “practically healthy person", implying that some deviations from the norm observed in the body, which do not affect the well-being and performance of a person, cannot yet be regarded as a disease. At the same time, the absence visible signs impairment of health does not yet indicate complete health, since the disease, for example in the latent (latent) period, may not have external manifestations.
The state of health can be established on the basis of the subjective feelings of a particular person in combination with clinical examination data, taking into account gender, age, as well as social, climatic, geographical and meteorological conditions, in which a person lives or is temporarily located.
Public health as a characteristic of the health of members of society as a whole is not only a medical concept. It represents a social, socio-political and economic category, as well as an object social policy. Public health needs to be measured, accurately assessed, taking into account not so much its medical as its social significance. When assessing public health it is necessary systematic approach, allowing us to consider how complex it is dynamic system, containing many integrally related constituent elements and interacting with other numerous social and natural systems. This approach allows us to establish the dependence of health not only on the state of science and medical achievements in the field of prevention, treatment and rehabilitation, but also on the participation of the entire society in its formation, protection and strengthening.
When studying and assessing public health, the social, natural and biological factors that determine it are taken into account, expressing the result of their impact through a system of medical, statistical and demographic indicators. Three groups of indicators are used to characterize population health.
1. Demographic indicators, or indicators of the number, composition, and movement of the population, both in the form of migration processes and natural ones (fertility, mortality, natural population growth, average life expectancy, etc.).
2. Indicators of physical development of the population.
3. Indicators of morbidity, injury and disability.
Public health is determined by social factors that depend on social conditions— socio-economic and political development, as well as from natural conditions- the external natural environment surrounding humans. Public health indicators are influenced by numerous specific factors the reality surrounding people, among them the state of health care and environmental protection are important. TO biological factors factors that influence public health include the genetic characteristics of the population and the age and sex structure of the population.
The scientific organization of health protection for individuals, groups and the population as a whole is based on the development of a set of measures to strengthen protective and adaptive mechanisms human body, as well as on creating conditions that prevent the possibility of human contact with unfavorable stimuli, or on weakening the effect of harmful factors. In this regard, exclusively important role belongs to environmental protection, labor protection, industrial safety, anti-epidemic measures, improving the sanitary culture of the population, as well as a healthy lifestyle.
From a formal point of view, healthy image Life is a set of sustainable, healthy habits. It is rational to begin their production in early childhood, since with the right combination of a stable daily routine, proper upbringing, healthy living conditions and study, a set of healthy lifestyle habits is developed easily and firmly established for life.
A healthy lifestyle is the only means of protection against all diseases at once. Therefore, it is especially rational, economical and desirable.
A healthy lifestyle is the only lifestyle that can ensure the restoration, preservation and improvement of public health. Therefore, the formation of this lifestyle among the population is the most important social technology of national importance and scale.
A healthy lifestyle includes a culture of relaxation and interpersonal relationships, herein lies the key to successful mental and physical health care.
In the era of market relations, when working with the population, it should be emphasized that leading a healthy lifestyle and being healthy is profitable. But leading an unhealthy lifestyle and getting sick is unreasonable and ruinous.
Traditional modern medicine and the health care system, despite the high achievements of medical and biological science, turned out to be powerless in solving the health problem.
The attention of medicine is already focused on the sick person, his illnesses and their treatment until recovery, complete or incomplete, and the issues of rehabilitation, diagnosis and treatment of borderline conditions, as well as the preservation and strengthening of health - the highest good of human life, were beyond the sight of practical medicine.
Factors that increase the risk of many modern diseases (nervous tension, insufficient physical activity, irrational excess nutrition, alcohol abuse, narcotic substances and smoking), indicate their social conditioning. In this regard, the need to develop effective methods and means of prevention, early diagnosis and treatment. Significant advances have been made in the diagnosis and treatment of diseases.

Man, being a social, social being, throughout his life and labor activity continuously exposed to social factors. We can say that all human functions, unlike animals, are socially mediated. For example, thermoregulation is mediated by wearing clothes, digestion is mediated by the consumption of cooked food, reproduction is mediated by the organization of family, everyday life, etc. Social pathogenic factors include social order, wars, epidemics, famine, etc. Microsocial pathogenic factors are the negative influences of human relationships in individual teams(family, school, production). It has been established that mutual negative impact people at each other significantly reduces the ability to work and may be one of the conditions for the development of neuroses, hypertension, myocardial infarction, etc. Overcoming microsocial contradictions is one of important conditions prevention of many diseases.

The cause of mass human illnesses is capitalism as a system that generates wars, hunger and mental illness. However, in medicine in bourgeois countries this situation is ignored. Instead, some foreign scientists are trying to prove that the main cause of morbidity in modern people is a kind of gap ( social maladjustment) between biological nature man, his soul and in a modern way life, modern technology, living conditions in cities (urbanization). This allegedly leads to an increase in the number of modern diseases such as cardiovascular and mental illnesses in all highly developed countries. These diseases are called “diseases of civilization.”

In economically backward and colonial countries, diseases caused by malnutrition (hunger, vitamin deficiencies), infections and infestations also predominate.

Denial or belittlement of the role of social factors in the emergence and development of diseases has led to the desire to put in the first place biological patterns in the development of diseases in humans and to identify them with those in animals. This is how biologizing trends in medicine arose, such as “social ecology”, “human ecology” and even “medical ecology”. All these directions mistakenly equate man and his life in the environment with that of animals (ecology is the science of the connections between the animal body and the environment). Biological patterns are of great importance in the life of a healthy and sick person, but they differ significantly from those of animals, since a person lives in society and all environmental influences (even biological) are mediated through social factors and influences. The influence of the environment - biological and social - on the human body determines the state of his health or illness. The human body should be considered in inextricable connection with its habitat, both biological and social.

The social factor - labor - created speech among people, the second signaling system. A word can be both a pathogenic and a powerful healing factor. This significantly distinguishes the conditions for the occurrence of diseases in humans from those in animals. All biological, pathophysiological patterns in the occurrence and development of human diseases are mediated by his social essence.

Mental pathogenic factors

For man as a social being special meaning has a pathogenic effect on its higher nervous activity, on his psyche. Numerous cases of death from strong negative or positive emotions(fear, sad news, unexpected joy, etc.).

Strong mental effects can cause a person to go into mental shock with a drop in blood pressure and other manifestations of this condition. Possible psychogenic development of diabetes mellitus.

Various psychogenic situations - “collisions” - cause psychotic reactive states that are thus instilled. Mental influences are of great importance in the occurrence of hypertension, myocardial infarction, peptic ulcer and other diseases. Impacts on the patient’s psyche have a significant impact on the course of any disease.

Mental influences take great place in the proper organization of patient care. A sensitive, attentive, caring attitude towards the patient has a huge impact on the result of any type of treatment. A brilliantly performed operation does not guarantee the patient’s recovery in the absence of properly organized and caring care. postoperative period. The influence on the patient’s psyche is part of a special and most important branch of medicine - medical deontology(from Greek deon- due), or medical ethics.

Social diseases

human diseases, the occurrence and spread of which largely depend on the influence of unfavorable conditions of the socio-economic system. To S. b. include: tuberculosis, sexually transmitted diseases, alcoholism, drug addiction, rickets, vitamin deficiencies and other diseases malnutrition, some occupational diseases. Distribution of S. b. conditions that give rise to class antagonism and exploitation of workers contribute. The elimination of exploitation and social inequality is a necessary prerequisite for the successful fight against S. b. At the same time, socio-economic conditions have a direct or indirect influence on the occurrence and development of many other human diseases; the role of biological features pathogen or human body and with the so-called. S. b. Therefore, since the 1960-70s. the term "S. b." is finding increasingly limited use.

Big Soviet encyclopedia. - M.: Soviet Encyclopedia. 1969-1978 .

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- (from Latin Venus, genitive case Veneris Venus, the ancient Romans goddess of love) group infectious diseases, transmitted mainly through sexual contact, Syphilis, Gonorrhea, Chancroid and Lymphogranulomatosis inguinal. The term "V. b."... ... Great Soviet Encyclopedia

Books

• Russian intelligentsia and issues of public hygiene, E. I. Lotova. Russian Society for the Protection of Public Health. Creation. Main features; Epidemiological issues; Improvement of populated areas; Nutrition issues; Hygiene of upbringing and education; Hygiene and...