Hygiene of Children and Teenagers

1. The girl, aged 14 years, has deviations in physical development. Her body height is below average, excess of body mass is of II degree. In the anamnesis: adenoid disease, rheumatic disease with infrequent exacerbations. Recently she has had complaints of colicy pains in the epigastric area, feeling of gravity, dryness in the mouth, nausea, vomiting, sometimes repeated. The diagnosis of gastritis has been established. What health group does this child refer to?

*А. 3rd

B. 1st

C. 2nd

D. 4th  

Е. 5th

2. The estimation of degree and harmonicity of physical development of children and teenagers is carried out by anthropometric, physiometric and somatoscopic researches. What parameters refer to physiometric indexes of physical development?

*А. Vital capacity of the lungs

B. Body weight

С. Form of legs and thoracic cavity

D. Body length

Е. Secondary sexual signs

3. To common measures of hardening the following refers:

А. Physical training, walk, rubdown

В. Gargle of the throat, physical training, proper clothes

С. Rational nutrition for energy supply, physical training

*D. Creation of the optimal thermal regimen, proper clothes, walk, physical training

Е. Creation of the optimal thermal regimen in groups, physical training

4. In a classroom sized 6 х 10 m2 six light sources are placed equipped with filament lamps 150 W each. The illumination on the workplaces changes within the limits of 70–80 lux. Make the hygienic estimation of artificial lighting.

*А. Artificial lighting of the classroom is irregular and poor: illumination on the workplaces is low

В. Artificial lighting of the classroom is uniform: illumination on the workplaces is low

С. Artificial lighting of the classroom is irregular, but sufficient: illumination on the workplaces is sufficient

D. Artificial lighting of the classroom is uniform and sufficient: illumination on the workplaces is sufficient

Е. Artificial lighting of the classroom is uniform and sufficient: illumination on the workplaces is low

5. The girl, aged 8 years, has a body height of 135 cm (+1.5), body mass –38.5 kg (+2), size of the thoracal cavity –67 cm (+1.2). Make the estimation of body height and harmonicity of the child's development.

А. The child is high and harmonic

В. The child is of average body height, and harmonic

*С. The child is low and harmonic

D. The child is of average body height and disharmonic

Е. The child is high and disharmonic

6. A school classroom is equipped with desks of "E" group. The schoolboys of the class have a body height of 148–160 cm. Estimate and justify the appropriateness of school desks for this class.

А. T hey fit perfectly

В. The group desks "E" correspond to body height of 146–160 cm

С. The group desks correspond to body height of 161–174 cm

*D. The class is equipped with inappropriate desks, since desks of group "E" correspond to body height of children up to 130 cm,

Е. Desks of group "E" are necessary for body height of 131–145 cm

7. The regimen of children in a middle group was characterized by the following: 1) alternation of activities — sleep, meals, wake, 2) a 2-hour day sleep, 3) two walks. Does this regimen correspond to the age possibilities of children?

*А. Yes, it does

В. No, it doesn't due to alternation of activities

С. No, it doesn't due to duration of daysleep

D. No, it doesn't due to number of walks

Е. No, it doesn't due to duration of walks

8. By results of medical-pedagogical control of the physical training lesson in the 9th form a physiological curve was drawn describing a step-by-step increase of pulse rate at the beginning of the lesson, increase of pulse rate by 80 % during the main part of the lesson. Make estimatation of organization of a physical training lesson.

А. The lesson is arranged correctly

B. Physical load is poor

С. Physical load is excessive

D. Physical load is sufficient

*Е. There are long intervals between exercises

9. For estimation of school maturity of 6–7-year-old children the assessment of level of mental development is carried out on the basis of morphologic and functional psychophysiological criteria. What parameters  determine the level of mental development of children?

А. Biological age

В. State of the central nervous system

С. State of health

*D. Kern-Iracek test

Е. Interrelation of exitation and inhibition processes in the brain

10. In the spontaneous market the desks of handicraft production are suggested. The desks are made of mild types of wood, the cover has a regulated declination (from 1 up to 45˚), height of desktop is 0.8 m, height of seat – 0.5 m, distance of seat is positive. What pathology can occur in children who will use this desk for home studies?

*А. Left-side scoliosis

В. R ight-side scoliosis

С. Platypodia

D. Anemia

Е. Hypermetropia

 

 

Examples of Situational Tasks

TASK 1

On interrogation of patient A., aged 26 years, a plasterer, it has been revealed that he has breakfast and supper at home, but dinner — in the dining-room of the building company. The patient stated that on 11 June, two hours after dinner he felt bad and went home. At home pains occurred in the stomach area, he had vomiting, weakness. The patient paid attention to the fact that taste of juice, which he had drunk at dinner was not good. Objective information: body temperature is 37, pulse rate — 76/min., breathing — without features. The stomach is soft. There is slight morbidity in the stomach area. Diarrhea is not present. The patient feels nausea and notes astringent taste in the mouth.

Make and substantiate the diagnosis of the disease. How to confirm the diagnosis? What documents should the doctor process in this case? Identify the hygienic measures for prophylaxis of similar diseases.

TASK 2

On examination of patient I. the following has been revealed: he is a collective farmer, aged 30, has meals at home. He gets foodstuffs, including flour, in the collective farm. On 10 May, approximately at 12 o'clock, he felt somnolence, numbness of fingers, sense of crawling of small ants, difficulty of unbending hands and feet. Then the twitch of facial muscles, difficulty of swallowing appeared. Objective information: the body temperature is 36.8˚C; pulse and breathing are without features; convulsive twitch of leg muscles; slight pain in the stomach; nausea, dizziness. For the last 2 months 3 cases of similar disease occurred in his village.

Make and substantiate the diagnosis of the disease. How to confirm the diagnosis? What documents should the doctor process in this case? Identify the hygienic and prophylactic measures in this case.

TASK 3

On examination of child T., aged 5 years, the following has been revealed: on 20 June, after dinner the middle group of kindergarten went for a walk to the field with their nursery governess and picked flowers there. The walk lasted for 1.5 hours. Having come back, the nursery governess noticed the child's face sharply turning red, hoarseness of voice and dilated pupils. Objective information: face turning red, temperature — 38˚C, pulse rate — 140; frequent breathing, dry mucous membrane of the oral cavity, hoarseness of voice, strongly dilated pupils. The child is excited, restless, having visual hallucinations.

Make and substantiate the diagnosis of the disease. How to confirm the diagnosis? What documents should the doctor process in this case? What prophylactic measures should be carried out in the nursery school?

TASK 4

On examination of patient A., the following has been revealed in order to render the first aid: the patient is 18 years old, a student, has meals in a students' canteen. From conversation with the patient it has been found out that on 18 May, he felt dryness in the mouth, difficulty of swallowing, blurring of vision. Disturbances of stool were absent. Objective information: body temperature is 36.8˚C, pulse — 70, full. The stomach is painless, soft on palpation. Pupils are dilated; there is slight ptosis, dryness of oral mucous membrane. Voice is hoarse; there is slight lowering of soft palate.

Make and substantiate the diagnosis of the disease. How to confirm the diagnosis? What documents should the doctor process in this case? Identify medical and prophylactic measures in this case.

Task 5

The child, aged 3 months, with body mass of 6 kg is fed artificially by mixture "Kid". With the purpose of rickets prophylaxis the doctor administered vitamin D. The mother did not follow the prescription strictly; instead of 3 drops she gave 10 drops a day during 3 months. The mother stated that her child had become languid, ate badly, had periodic vomiting after feeding, drank greedily; once or twice there was liquid stool. On examination the skin integument is pale, clean, the turgor of tissues is decreased, the anterior fontanelle is 1.5x1.5 cm, the mucous membranes are dry. The pathologies of internal organs are not revealed. At laboratory research a big content of calcium salts is revealed in the urine.

Identify the reason of child's state. Specify a daily dose of vitamin D. Give the necessary recommendations. How to prevent rickets in this case?

TASK 6

A group of students residing in a hostel applied to the doctor of policlinic with complaints of general weakness, somnolence, rapid fatigability, slight swelling of the gums. On inquiring it was found out that students do not have regular meals, often take canned goods and concentrates for meals. On examination the presence of gum haemorrage was revealed.

Make the initial diagnosis. What objective adequate methods of research for these students can you offer? What methods can be applied for mass examination of all students living in the hostel? Give recommendation for prophylaxis of similar diseases.

Task 7

A patient, aged 63 years, a pensioner, addressed the doctor with complaints of surplus body mass. He had the expressed signs of atherosclerosis of coronary vessels, high blood pressure. On inquiring it was found out that the patient had meals 3 times a day, avoided fatty and spicy food. The analysis of his diet revealed that the content of proteins made up 70 g, fats — 50 g, carbohydrates — 400 g a day. As for vitamin and mineral content, his ration corresponded to the norm.

Estimate the adequacy of patient's nutrition to basic principles of rational diet. What are the reasons of overweight? What group of alimentary diseases does this pathology belong to? What recommendations relating to correction of nutrition of antisclerotic orientation are necessary in this case?

Task 1

In town N. a high level of morbidity of population with arterial blood pressure and caries is marked as compared to middle indexes in the region. To find out the reasons of this pathology growth, the researches of drinking-water are conducted. The analysis of water from an artesian well supplying the town with water revealed the following: organoleptic indexes — normal, a dry residue – 2,300 mg/l, content of chlorides – 670 mg/l, sulfates – 750 mg/l, nitrates – 42 mg/l, iron – 0.2 mg/l, fluorine – 0.8 mg/l.

Make the hygienic estimation of water. Is there any connection between the increase of these diseases with quality of drinking water? What other diseases are possible in this town? How to reduce the level of these diseases among the population?

Task 2

On analysis of morbidity of population in district T. the increased level of acute intestinal infections is revealed. On analysis of superficial water sources in this period the following is found out in the district: the smell of water is 2–3 points, taste is 1–2 points, turbidity– 1–2 mg/l, dry residue – 800 mg/l, oxidation of water – 5–6 mg O2/l, coli titr – 150–200.

Could the quality of water be the reason of growth of acute intestinal infections? What are the possible reasons of changes of water quality? What indexes of water should be investigated additionally? Identify the necessary measures for improvement of water quality in this district.

Task 3

In town K. for the last few years there was a sharp growth of morbidity of population with respiratory diseases. To find out the reasons of this phenomenon the local SES conducted the researches of the air. In mid air of the town a number of pollutants were found out, including nitrogen oxides at a level of 0.8 MPC, carbon oxide in the concentration of 0.6 MPC. At combined effect on organism these substances produce an additional effect (summation).

Make the hygienic estimation of degree of air pollution in the town. Can the air pollution in the town affect the increase of this pathology? What other risk factors have the influence on the increase of morbidity of population? What hygienic measures are necessary to decrease the air pollution?

Task 4

On analysis of water from an artesian well supplying the city with water, the following has been revealed: organoleptic indexes — normal, a dry residue is 1,300 mg/l, content of chlorides – 570 mg/l, sulfates – 550 mg/l, nitrates – 20 mg/l, iron –0.2 mg/l, fluorine – 0.8 mg/l.

Make the hygienic estimate of water. What diseases can relate to the quality of drinking-water? How to reduce the level of these diseases among the population?

Task 5

On analysis of water of the rural plumbing the following is found out: smell – 2 points, taste – 3 points, turbidity – 1 mg/l, dry residue – 2,000 mg/l, sulfates – 500 mg/l, Oxidation – 7 mg O2/l, fluorine – 0.7 mg/l, nitrates – 5 mg/l, microbe number – 80, coli index – 5.

Make the hygienic estimate of water. Is it possible to use this water for drinking? If not, what methods of improvement of water quality are required? What health disorders can the use of this water cause?

Task 6

On research of microclimate in the living quarters it has been revealed that time of cooling of katathermometer is 100 sec, factor of katathermometer – 600, effective temperature – 16.5˚EТ.

Make estimate of microclimate. What devices were used for researches? How to improve the microclimate in this room?

Task 7

On sanitary inspection of a habitable room it was found out that in a room sized 2.5 m x 4 m x 5 m two persons live; due to natural ventilation 40 m 3 air per hour enter the room. The temperature of air is 21˚C, speed of its movement is 0.1 m/sec, effective temperature – 22.5˚EТ.

Make estimate of the conditions in the room. What index should be investigated additionally?

Task 8

In a hospital operating block there is an operating room with 2 tables (area is 54 m2). Ventilation is input-extract (+4, –5). Luminosity of the operating field – 1,500 lux. General luminosity – 200 lux. The air temperature during operation is 26˚C, relative humidity – 80%. Content of CO2 – 0.15%, general microbe number in the air before the operation – 1,000 per m3.

Make the hygienic estimate of the operating block. How to improve the hygienic conditions in the operation room?

Task 9

In a nursery group room with the area of 45 m2 there are 25 children. On measuring microclimate the following has been found out: the air temperature is 18°C, relative humidity of air – 75%, the speed of air movement is 0.4 m/sec, effective temperature – 16° ET. Indexes of luminosity: coefficient of natural illumination (CNI) – 1.0%, light coefficient (LC) – 1:7, luminosity with luminescent lamps – 200 lux. Frequency rate of ventilation is once per hour. Content of CO2 – 0.23%.

Make the hygienic estimate of a group room. Give recommendation on optimization of conditions in a nursery group room.

Task 10

For building a hospital for 120 beds a site is offered with the area of 120 x 80 m, located in the residential area at a distance of 80 m from the nearest dwelling houses; the radius of policlinic service does not exceed 2 km. At a distance of 40 m from the area border there is a district motorway. A sound level in the area makes up in the daytime – 60, and at night 50 dB, in the wards – 30 dB.

Estimate the fitness of this area for building a hospital; give recommendations on layout of functional zones in the area of hospital.

 

Task 1

A worker of a chemical enterprise, aged 35 years, addressed the doctor of policlinic with complaints of bad health state, sleeplessness, defective memory, sense of anxiety and fear. Record of service in this enterprise is 5 years. On examination the asthenovegetative syndrome, asymmetrical tremor of hands, gingivitis and stomatitis in the oral cavity, black edge of the gums are revealed. In the blood lymphocytosis and monocytosis are revealed.

Make the diagnosis and stage of occupational disease. What harmful occupational factor caused the disease and why? What documents must be processed by the doctor in this case? What rehabilitation and prophylactic measures are required for the worker and the chemical enterprise on the whole?

Task 2

In a classroom with the area of 40 m2 forty pupils study. All school desks have a yellow marking. Differention of desks and chairs makes up 1/5 growth of children, distance of seat +2 cm. Light coefficient is 1/10, coefficient of natural illumination–1%, general artificial illumination–100 lux.

Give the hygienic estimation of the classroom. What functional disturbances or diseases can occur in children at such conditions? How to improve the hygienic conditions in the classrooms?

Task 3

In the hospital operating block there is an operating room for 2 tables with the area of 54 m2. Ventilation is input-extract (+4, –5). Local luminosity of the operating field–1,500 lux. General artificial luminosity –200 lux. The air temperature during operation is 26˚C, relative humidity –80%. Content of CO2–0.15%, general microbe number in the air before the operation is 1000 per m3.

Give the hygienic estimation of the operating block. How to improve the hygienic conditions in the operation room?

Task 4

At the annual prophylactic medical examination in a district policlinic the worker of agricultural chemical storehouse of agricultural enterprise complained of headaches, weakness, tenderness in the area of liver, unsteady stool, nausea. The asthenovegetative syndrome and symptoms of hepatitis were revealed in the worker. The analysis of blood in the hospital biochemical laboratory revealed the decrease of cholinesterase activity by 45%, erythropenia and leucopenia, lymphocytosis.

Make the diagnosis and stage of occupational disease. What harmful occupational factor caused the disease and why? What documents must be processed by the doctor in this case? What rehabilitation and prophylactic measures are required for the worker and storage of agrochemicals on the whole?

Task 5

On sanitary inspection of the working conditions of medical personnel in the x-ray room of policlinic it was found out that the dose of external irradiation of personnel made up 150 mRem per week, which corresponds to 7.5 Rem per year.

Give the hygienic estimation of the working conditions of medical personnel in the x-ray room. What occupational diseases are possible in personnel under these conditions? What remote effects of radiation can occur, what are their manifestations? What measures of radiation protection should be strengthened in the x-ray room?

Task 6

A hospital ward of a general type for 4 beds has the area of 20 m2. In the ward there is 1 window with the glazed area of 5m2, CNI–0.75%. A sound level at night –25 dB. Common artificial illumination –50 lux, local –80 lux. Frequency of natural ventilation is 1.5/h, concentration of CO2–0.15 %.

Make the hygienic estimation of the ward. Name the necessary measures for creation of optimal conditions in a hospital ward for patients.

Task 7

A nursery school is in the center of microdistrict. The site area of the nursery school is 20 m2 per child. 50% of the area are occupied by green plantations. The area of a group room is 60 m2 per 30 children of preschool age. CNI is 1.5 %, light coefficient–1:5, luminosity with luminescent lamps–200 lux. The air temperature is 24˚C, humidity –70%.

Give the hygienic estimation of nursery school. What is your recommendation for optimization of hygienic conditions in the nursery school?

Task 8

Estimate the physical development of a girl, aged 10 years, 125 cm in height, with a body mass of 41.1 kg. According to information of age table the normal physical development (average+- sigma) makes up: height–134.0±2.5 cm; body mass –35.1±2.2 kg. The Turner's criteria are normal.

What are the causes of these deviations in physical development? What other methods can be applied to estimate the physical development of the girl?

Task 9

To carry out the current sanitary supervision, the doctors of SES have studied the working conditions of factory workers. It has been found out that the content of dust in the air of the working area is 35 mg/m3, CO –3 mg/m3; the level of high-frequency noise is 88 dB, air temperature –25 ˚C, humidity –80%.

Draw the hygienic conclusion about the working conditions. What occupational diseases of workers can occur at these conditions, what are their diagnostics and prophylaxis?

Task 10

For construction of hospital per 120 beds the site is offered sized 120 x 80 m, located in relation to a residential area in such a way that the nearest dwelling houses are at a distance of 80 m, the radius of policlinic service does not exceed 2 km. At a distance of 40 m from the site border there is a district motorway. A noise level on the site makes up in the daytime –60, and at night –50 dB, in hospital wards –30 dB.

Estimate the appropriateness of this site for building the hospital. Give recommendations on placing the functional zones on the hospital area.

Task 11

A woman-worker of agricultural hothouse addressed the doctor with complaints about permanent headaches, sleeplessness. On examination the astenovegetative syndrome, signs of peptic ulcer of the stomach, the decrease of cholinesterase activity in the blood by 30% were revealed in the woman.

Make the diagnosis of occupational disease? What harmful factor influenced the organism? How to confirm the diagnosis by the conditions of work? What documents must be processed by the doctor in this case? What rehabilitation and prophylactic measures are required for the worker and the hothouse economy on the whole?

 

LITERATURE

Books in Inglish

 

1. Lectures on common hygiene and medical ecology. S.Shibanov. — Simferopol, 2003.— 160 p.

 

2. Park’s textbook of Preventive and Social medicine. India.— 23th edition.— 660 p.

3.Hygiene and Ecology. V.G.Bardov et al. – Винница, 2009. – 688с.

4. Short textbook of Hygiene and Ecology for foreign students. Pivovarov Y.P., Alsabounchi A.A. – Moscow> 1999, 2002, 2006.

5. Mahajan & Gupta. Textbook of Preventive and Social Medicine. – India. 4 th edition.

6. Jekels Epidemiology, Biostatistics and Preventive Medicine & Public Health.

7. Influence of environment on health of the man. Reports of WHO.— Geneva, 1976 — 2014.

 

2. Books in Russian

 

Гигиена окружающей среды. / Ред. Г. И. Сидоренко.— Москва, 1985.

Руководство к практическим занятиям по общей гигиене и медицинской экологии. / Под ред. Проф. С. Э. Шибанова.— Симферополь, 2003.— 260с.

 Журнал " Гигиена и санитария " 1980-2017гг.

В. А. Покровский. Гигиена. Москва, “Mедицина”.— 1979.— 495с.

А. А. Минх. Методы гигиенических исследований.— Москва, “Медицина”.— 1971.— 584с.

Г. Н. Новожилов, О. П. Ломов. Гигиеническая оценка микроклимата.— Ленинград,1987.— 110с.

Никберг И.И. Гигиена больниц.— Киев, 1993.— 235с.

Румянцев Г.И. Общая гигиена.— Москва, 1998.— С. 253-328

I.I.Даценко, Р.Д.Габович. Профiлактична медицина.— Київ, Здоров'я, 1999.— 694с.

Е.И.Гончарук, В.Г.Бардов Г.И.Румянцев. Общая гигиена. Київ, " Вища школа", 2000 652с.

Е.И.Гончарук. Руководство к практическим занятиям по коммунальной гигиене.— Москва, 1990.— 236с.

Р.Д.Габович. Гигиена.— Киев, 1983.— 320с.

В.Войффен. Больничная гигиена. Минск, 1984

Р.П.Венцель. Внутрибольничные инфекции.— Москва, 1970

Д.Лошинци. Внутрибольничные инфекции.— Москва, 1978

Маненко А.К., Сахновская Н.И. Гигиена медицинских учреждений.— Киев, 1982

В.К. Овчарова. Работа и здоровье медицинских работников.— Москва, 1985

В.Ф.Кириллов и др. Руководство к практическим занятиям по радиационной гигиене.— Москва, 2001.— 223с.

Кириллов В.Ф. и др. Радиационная гигиена.— Москва, 1988.— 237с.

Ильин Л.А., Кириллов В.Ф. Радиационная гигиена.— Москва, 1999.— 384с.

Ильин Л.А., Кириллов В.Ф. Радиационная безопасность и защита.— Москва, 1996.— 336с.

Г. Н. Сердюковская и др. Гигиена детей и подростков.— Москва, 1986.— 420с.

В. И. Берзинь и др. Руководство к практическим занятиям по гигиене детей и подростков.— Киев, 1989.— 120с.

Шибанов С.Э., Михайлов В.В. Руководство по гигиене жаркого климата.— Симферополь, 2000.— 50 с.

Лысенко А.Я. Руководство по тропическим болезням.— Москва, 1983.

Кошелев Н.Ф. Гигиена водоснабжения и питания в условиях жаркого климата.— Ленинград, 1975.— С. 5-19.

 

 

Attachment 1