DIAGNOSIS DONOZOLOGICHESKAYA (grech, diagnostikos capable to distinguish; grech, nosos a disease) — recognition of conditions of an organism, boundary between norm and pathology (between health and a disease), characterized by disturbance of balance between an organism and Wednesday. Process of statement of the donozologichesky diagnosis consists in purposeful collecting medical - physical. information and use of such methods of its analysis and processing which allow to establish extent of adaptation of an organism to conditions of the environment (see. Adaptation ) and to reveal such states which cannot be carried to the known nozol, forms of diseases yet, but are characterized by disturbance of activity of regulatory mechanisms, and in some cases and homeostasis (see). An object D. of is process of adaptation of an organism to inadequate conditions of the environment which can come to the end with one of the following outcomes: 1) full or partial adaptation by Wednesday; at the same time the homeostasis is not broken, activity of all regulatory systems proceeds in usual limits or is a little strengthened; 2) insufficient or unsatisfactory adaptation; at the same time the homeostasis of the main vital systems usually remains, but activity of regulatory mechanisms is significantly increased; 3) failure of adaptation; at the same time owing to an overstrain and exhaustion of regulatory mechanisms there is a disturbance of a homeostasis to development patol, deviations. Due to the specified outcomes of adaptive behavior of an organism distinguish the following states (versions of the donozologichesky diagnosis).
1. Borderline or transient states in which the organism can be rather long time. At the same time values of the majority fiziol, indicators are displaced in this or that party, and their new level can be considered as the corresponding klimatogeografichesky, environmental or professional norm. Similar states arise in response to subextreme influences of small intensity in the presence of a sufficient functional reserve.
2. The condition of tension, a cut is shown by mobilization of protective mechanisms and systems the hypophysis adrenal glands is followed by increase in activity of regulatory systems, including. In this state adaptation of an organism to inadequate conditions of the environment can be only short-term.
3. A condition of an overstrain, for to-rogo insufficiency of adaptable mechanisms, their inability to provide a homeostasis is characteristic.
4. Conditions of a predisease, or premorbidal states (see. Disease ), in which it is possible to allocate two stages:
a) the stage of exhaustion (astenisation) of regulatory mechanisms which is characterized by disturbance of a homeostasis with dominance of the changes yet not specific to any nozol, a form of a disease; b) a stage of actually premorbidal states representing subclinical forms (stages) of various diseases known to clinical physicians with changes in bodies and systems, characteristic of them.
D.'s concepts of are used in sports, air and space medicine, human engineering and physiology of work, however the most extensive area of their use, apparently, are mass inspections of the population. In this case so-called prescriptive screening (on the terminology accepted by WHO), i.e. inspection of the contingents of almost healthy people for the purpose of identification of the latent and not recognizable cases means. At D. screening is directed to establishment of extent of adaptation of an organism to conditions of the environment and recognition of the states preceding development of a disease. According to WHO recommendations, it is necessary to consider three types of mass inspections: epidemiol, researches, epidemiol, supervision and prescriptive screening. Epidemiol, the researches which gained already considerable distribution are directed to identification among this population of persons with a certain type of pathology, napr, with coronary heart disease, i.e. this type of mass inspections aims at identification and detailed inspection of persons with failure of adaptation. Epidemiol, supervision is directed to assessment of changes which happen in the state of health of this population of people timely to develop necessary preventive and a dignity. - a gigabyte. actions; this type of mass inspections, apparently, can be an important control facility of efficiency of the recommendations developed by results of D. by and is implemented by rescreenings of the same population.
Experience mass donozol. inspections showed that for assessment of extent of adaptation of an organism it is not enough to use traditional a wedge. - fiziol, methods. For statement donozol. the diagnosis it is necessary to estimate: 1) level of functioning of the main systems of an organism and their mutual coherence, steadiness (homeostasis); 2) rate of strain of regulatory mechanisms; 3) adaptation opportunities and functional reserves of an organism.
Assessment of level of functioning should be made taking into account power information and temporary bonds between an organism and Wednesday and between separate systems of an organism. At the same time it must be kept in mind that the level of functioning is defined by existence of two target programs: specific and individual. The first is directed to preservation of a look, the second — to ensuring survival of an individual in these specific conditions. Depending on rates of power consumption on external functioning or on ensuring processes of recovery biol. the system or has advantages concerning survival of a look (dominance of power consumption for internal processes of recovery), or has advantages concerning individual adaptation by Wednesday (at increase of energy expenditure for external work). Variations of energy flows in an organism, changes of their distribution to external work or on recovery processes occur in connection with information flows and are characterized by a certain temporary organization. Normal changes of energy flows do not cause disturbance of a homeostasis, and activity of regulatory mechanisms completely counterbalances all changes caused by interaction of an organism with Wednesday. The daily periodical press fiziol, functions and the related daily fluctuations of power exchange can be an example of such equilibration. At donozol. states tension of regulatory mechanisms can be insufficient for preservation of a homeostasis, but the level of functioning of the separate systems having the vital value can remain in normal limits. At the same time compensation of power disturbances is provided in an organism thanks to the corresponding reorganization of temporary coordination of functions and change of information flows. The limit of compensation is at the same time and border between states donozol. disturbances and diseases.
Rate of strain of regulatory systems of an organism, on modern representations, is defined by a condition of c. N of page, the subcrustal centers and activity of system a hypophysis — adrenal glands, and also a condition of systems of humoral regulation. Tension of regulatory mechanisms can be estimated on increase in level of functioning of separate bodies and systems, on strengthening of synchronization fiziol, functions and to involvement in process of adaptation of the increasing number of systems and bodies, and also directly on shift of a vegetative homeostasis and hormonal balance (in particular, on increase at blood of maintenance of catecholamines and corticosteroids). In applied physiology some simplified methods of assessment of tension of regulatory systems providing operating medical control behind a condition of the person are used. The mathematical analysis of a cordial rhythm allowing to characterize a ratio of activities of sympathetic and parasympathetic parts of century of N of page, and also activity of the subcrustal centers is applied to this purpose (R. M. Bayevsky, 1972, 1976). The condition of mineralokortikoidny function of adrenal glands and activity of simiatoadrenalovy system can be estimated on the content of sodium and potassium in saliva (T. D. Semenova, 1971). In a computed result of correlation bonds between various fiziol, indicators it is possible to judge extent of synchronization and mobilization of functional systems in an organism. These simplified methods play an important role at the organization of mass inspections of almost healthy people in conditions of production. In the course of adaptation of an organism to inadequate factors of the environment the homeostasis of complete system remains thanks to activation of regulatory systems which rate of strain can be at the same time various. With the extraordinary force of the factor influencing an organism or at rather long influence of subextreme factors there is an overstrain of regulatory systems, and then and their exhaustion. Disturbance of a homeostasis, development of premorbidal states and diseases is result of it. The specific result of process of adaptation of biosystem in inadequate conditions of the environment depends on adaptation opportunities of an organism and its functional reserves.
Assessment of adaptation opportunities of an organism can be carried out as on the basis of initial gene and phenotypical features of an individual, and by results of overseeing by dynamics fiziol, functions in the course of adaptation of an organism to various loadings, W. h to extreme and subextreme influences. Portability is significantly connected by the person of various loadings with initial constitutional signs, characteristics of century of N of, specific features of hormonal regulation. It is considered, in particular, at professional selection (see). Various load tests and tests are widely applied in the expert purposes to identification of functional reserves and range of adaptive reactions of various systems. Assessment of adaptation opportunities by means of special tests is applied in aircraft, astronautics and some other areas. At the same time one of important properties of adaptable mechanisms — their plasticity, i.e. ability to be reconstructed on the new level of functioning more adequate to conditions of the environment is considered. The systems having high ductility can quickly be recustomized and rather easily adapt to influences of small and medium intensity. Systems of inert type can keep long enough the set level of functioning even at average and strong influences. These features of regulatory systems shall be considered at assessment of adaptation opportunities of an organism in relation to specific influences.
The described principles of assessment of extent of adaptation of an organism to conditions of the environment already received use in a number of the fields of medicine and applied physiology, and also at mass donozol. inspections of the population. Results of mass inspection of 1736 workers and employees of the Sibselmash plant are given as an example in tab. 1 (Novosibirsk). Three groups of persons were allocated: with satisfactory adaptation, with insufficient or unsatisfactory adaptation and with failure of adaptation (premorbidal states, diseases). As appears from the submitted data, in the greatest measure extent of adaptation of an organism to conditions of the environment is influenced by an age factor, influence of a profession and floor is less expressed. All inspected contingent was almost healthy, i.e. adequately carried out the production loading. Nevertheless from 20 to 50% of the inspected persons were characterized by insufficient or unsatisfactory adaptation, and premorbidal states or diseases (in the compensated form) are revealed in 4 — 11% of cases at persons up to 40 years and in 32 — 39% of cases — in more senior age group.
Thus, mass D. of opens a possibility of purposeful improvement of collectives by implementation of preventive and to lay down. actions through network of rest houses, dispensaries, sanatoria and with the help a dignity. - a gigabyte. actions directly at the enterprises.
At D. of major importance has use of the techniques allowing to estimate not so much the level of functioning fiziol, systems, how many rate of strain of regulatory mechanisms. Srednegruppovy values of some kardiol are presented in tab. 2. at workers 40 years, according to mass inspection at the Sibselmash plant are aged more senior than indicators. During the comparison of groups of persons, various on extent of adaptation, it is visible that on duration of a cardial cycle they statistically do not differ, and the ABP it is reliable above only in a group of persons with failure of adaptation. Insufficient or unsatisfactory adaptation to conditions of the environment is caused by tension or an overstrain, or even exhaustion (astenisation) of regulatory mechanisms. In these cases the increased stability of a cordial rhythm (reduction of the variability of cardio-intervals connected with breath) is observed. The ratio between the general and external cardiac performance changes (see. Heart, physiology ): external cardiac performance falls, its general work increases, i.e. tension of a myocardium grows, overall effectiveness of cardiac performance falls.
In a group of persons with failure of adaptation the ratio between the general and external cardiac performance is normalized against the background of disturbances of a homeostasis, in particular increase in the maximum ABP is observed. In various populations the structure of health (i.e. distribution among almost healthy people of persons with satisfactory, insufficient adaptation or failure of adaptation), apparently, is not identical. Specific values separate fiziol, indicators in various populations at this or that extent of adaptation by Wednesday will depend not only on a sex, age, a profession, but also on klimatogeografichesky conditions, specifics of production and many other factors which are subject to special studying.
Of demands creation of the special automated systems allowing to process quickly the large volume of information on the basis of the analysis of results of this processing and taking into account the criteria which are kept in memory of the car to do the conclusion about a condition of each of the studied persons. One of the most important links of such system is the data bank (archive) which shall contain materials about the state of health of individuals and collectives, and also the indicators characterizing environmental conditions, and the recommendations made by results of primary and repeated mass inspections. This system can be provided organizationally by creation of network of the large automated clinics with a high capacity which will be able to carry out periodic «viewings» of all healthy population of separate industrial and territorial complexes. On the basis of the obtained data not only individual recommendations about preservation of health and prevention of diseases can form, but also to be developed actions sots. - a gigabyte. and the productive and economic plan, the incidences directed finally to decrease and increase in labor productivity.
Table 1. Results of mass inspection of workers and employees of the SIBSELMASH plant (Novosibirsk, 1976)
Table 2. Average values (М±m) of some cardiological indicators at workers are more senior than 40 years at different extent of adaptation
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R. M. Bayevsky, V.P. Kaznacheev.