Diagnostics of health - nosological, prenosological, types of diagnostics according to direct indicators. Methodological bases and algorithms for diagnosing prenosological conditions The use of prenosological diagnostic methods in assessing the level of human health

The use of prenosological diagnostic methods in assessing the level of human health

Candidate of Biological Sciences, Associate Professor N.N. Sivakova

Stavropol State University, Stavropol

The problem of assessing the state of a person's individual health and monitoring changes in its levels is becoming increasingly important, especially for people subject to high psycho-emotional and physical stress, as well as for school-age children. The transition from a healthy state to a disease is usually considered as a process of gradual decrease in a person's ability to adapt to changes in the social and industrial environment, to the surrounding conditions of life. The state of the organism (its health or illness) is nothing but the result of interaction with the environment, i.e. the result of adaptation or disadaptation to environmental conditions. Various definitions of health are presented in the works of many authors.

The achievement of a certain level of functioning of the organism or its certain systems is ensured by activity. mechanisms of regulation and control. Mobilization of reserves occurs as a result of a change in the level of activity of regulatory systems, and in particular, an increase in the tone of the sympathetic division of the autonomic nervous system. With a constant deficit of functional reserves to achieve balance with the environment, a state of functional tension arises, which is characterized by a shift in the autonomic balance towards the predominance of adrenergic mechanisms. In a state of functional stress, all the main functions of the body do not go beyond the norm, but the costs of functional reserves to maintain the normal level of functioning of systems and organs increase. Such conditions, in which the nonspecific component of the general adaptation syndrome manifests itself in the form of varying degrees of tension of regulatory systems, are called prenosological. A significant increase in the degree of tension, leading to a decrease in functional resources, makes the biosystem unstable, sensitive to various influences and requires additional mobilization of reserves. This condition, associated with an overstrain of regulatory mechanisms, is called unsatisfactory adaptation. In this state, specific changes in individual organs and systems become more significant. Here it is quite acceptable to talk about the development of the initial manifestations of premorbid states, when changes indicate the type of probable pathology.

Thus, the manifestation of the disease, as a result of the failure of adaptation, is preceded by prenosological and premorbid conditions. It is these conditions that are studied in valeology and should be the object of control and self-control over the level of health. The term "prenosological conditions" was first proposed by R.M. Baevsky and V.P. Kaznacheev. The development of the theory of prenosological states is associated with space medicine, in which, starting from the first manned flights, medical control over the health of cosmonauts focused not so much on the probable development of diseases, but on the body's ability to adapt to new, unusual environmental conditions. The prediction of possible changes in the functional state in space flight was based on an assessment of the degree of tension in the body's regulatory systems. It was space medicine that gave impetus to the development of mass prenosological research in preventive medicine, contributed to progress in the field of prenosological diagnostics; subsequently, her methods became an integral part of valeology.

The science of health is integral, emerging at the intersection of biology and ecology, medicine and psychology, cybernetics and pedagogy, and a number of other sciences. It follows from this that the science of health should be based on the science of the health of a person who lives in a real complex world, saturated with stressful effects that occur when many factors of the biosocial environment change, which takes away part of his health and leads to the so-called "third state". ". The concept of the third state in assessing human health is actually based on the laws of ancient medicine, set forth more than a thousand years ago by the famous physician and philosopher Abu Ali Ibn Sina - Avicenna, who identified six states of human health:

1. The body is healthy to the limit.

2. The body is healthy, but not to the limit.

3. The body is not healthy, but not sick either.

4. A body that readily accepts health.

5. The body is sick, but not to the limit.

6. The body is sick to the limit.

Of these conditions, only the last two are related to disease. Between the two extreme levels of health (according to Avicenna) - "a healthy body to the limit" - we distinguish five transitional states with varying degrees of tension in regulatory systems: with normal, moderate, pronounced, pronounced and overstrain. The transition from health to illness occurs through overstrain and disruption of adaptation mechanisms. And the sooner it is possible to foresee such an outcome, the greater the likelihood of maintaining health. Thus, the problem boils down to learning how to determine (measure) the degree of tension in the body's regulatory systems and, consequently, manage health. At present, with the active formation of the science of health, prenosological diagnostics has become the main part of valeology, as it provides an assessment of the level of health in various functional states, develops systems for dynamic monitoring of the health of the adult population, children and adolescents of school age.

The modern idea of the cardiovascular system as an indicator of the adaptive reactions of the whole organism was developed in space medicine, where for the first time the practical application of pulse diagnostics in its modern form, i.e. cybernetic (mathematical) analysis of the heart rhythm, began. This methodological approach has become one of the most important principles of space cardiology, which consists in the desire to obtain maximum information with a minimum of recording data. At present, with the help of electronic devices and computing tools, it has become possible, based on the analysis of the heart rhythm, to obtain objective data on the state of the sympathetic and parasympathetic systems, their interaction, on higher levels of regulation in the subcortical centers and the cerebral cortex.

Recognition of functional states based on the data of mathematical analysis of the heart rate requires special equipment (automated complex), certain experience and knowledge in the field of physiology and clinic. In order to make this methodology accessible to a wide range of specialists and possible for use at the pre-medical stage of control, a number of formulas and tables were developed that allow calculating the adaptive potential of the circulatory system for a given set of indicators using multiple regression equations. Sufficiently high accuracy of recognition of body states is provided by the method of determining the adaptive potential using special tables, using a set of simple and accessible research methods: measuring heart rate, systolic and diastolic blood pressure, height, body weight (weight) and determining the age of the subject. According to the calculated value of the adaptive potential, the degree of tension of regulatory mechanisms and the level of health are determined.

Of great importance is the assessment of changes in the level of health according to the adaptive potential of the circulatory system, not only in individual individuals, but also at the level of entire teams or groups of people who are affected by similar living conditions. This is possible by determining the so-called "health structure" of the team, which is commonly understood as the distribution (in percent) of individuals with varying degrees of adaptation to environmental conditions (with different values of the adaptive potential of the circulatory system). The structure of health is a very informative indicator that gives a versatile description of the surveyed group of people. It is changes in the structure of health that should be considered as a sensitive indicator of the response of the collective (group of individuals) to certain conditions of life, health-improving, preventive, sanitary and hygienic measures and other factors of the human environment.

For a number of years at the Department of Theoretical Foundations of Physical Culture of the Stavropol State University in the scientific direction "Valeology and problems of assessing human health", teachers and students have been studying the influence of various environmental factors on the health of students in educational institutions. Students of the Stavropol Territory of different ages with a total number of 3150 people were involved in research on the problem.

The studies revealed that with significant individual variability, the adaptive potential of the circulatory system carries a versatile expressed information content.

During the study of age-related changes in the adaptive potential of the circulatory system of 2800 schoolchildren aged 7-17 years, a significant deterioration in its average values with age was revealed. This age-related deterioration of the adaptive potential slowed down and even its temporary improvement was observed in groups with increased physical activity, not exceeding its optimal level. The cessation of exposure to the body increased to the optimal level of physical activity again led to a deterioration in the adaptive potential of the circulatory system. With constant exposure to the body of dosed motor loads, the age-related deterioration in the level of health occurred much more slowly. Due to the large individual variability of the adaptive potential, a change in its level in each individual can only be detected in dynamic surveys.

These observations allowed us to conclude that the adaptive potential of the circulatory system as an integral criterion of the functional state of the whole organism can be used not only to assess the adaptation of the organism to the conditions of daily activities and predict its changes, but also as a reflection of the aging process in a developing organism and deterioration of the level of health with age, the intensity of which depends on the physical activity of the student.

An individual assessment of the adaptive potential of the circulatory system and the health structure of the class (team) can be used as a criterion for the optimality of students' physical activity. Insufficient physical activity both in school and out of school leads to a faster deterioration in the health of students and the health structure of classes during the school year. Moreover, a significant deterioration in the structure of health was observed by the end of the first half of the year. Students with high motor activity, as a rule, had a higher level of health, and its structure in these classes was distinguished by better indicators.

The study of the health levels of students and the structure of the health of classes (groups) with different physical development confirmed the position that physical development is one of the main criteria for health. Students with higher adaptive abilities and in classes with a better health structure had higher physical development.

An analysis of the levels of adaptive abilities of students confirmed the position that physical fitness is also one of the main criteria for health, since the levels of adaptation of students with good physical fitness in most cases were higher.

The deterioration in the health levels of students and the structure of the health of the classes, and consequently their working capacity, was observed in all cases when the working hours of educational institutions had an excess of the length of the school day and a shortened school week (5 days), while maintaining the same weekly volume of hours as in six business days.

Particular attention in the research was paid to the prognostic assessment of the adaptive potential of the circulatory system in optimizing physical activity at a physical education lesson, in the training process in groups of youth sports schools with different sports orientations, in strengthening the health-improving orientation of both physical education lessons and sports training. It is noteworthy that stable changes in the adaptive potential of the circulatory system under the influence of physical activity are detected already at the early stages of their implementation. At the same time, changes in the adaptive potential quite clearly reflect both the developmental impact of loads and the increase in tension and overstrain of the regulatory mechanisms during the development of overwork. The identified improvements in the adaptive potential were accompanied in most cases by an improvement in the results of fulfilling the control standards of physical fitness. The deterioration in adaptation to loads was often accompanied by a decrease in results.

A stable and in most cases reliable correlation was found between the average group values of the adaptive potential of the circulatory system and the average results of the control standards, mainly reflecting one or another physical quality.

An increase in the value of the adaptive potential of the circulatory system made it possible to detect overwork in physical exercises in the early stages of its development. The revealed absence of a significant improvement in the indicators of physical fitness of students during the school year with a deterioration in the adaptive potential of the circulatory system allows us to consider that physical education lessons conducted by traditionally established methods do not provide the formation of a cumulative effect in the body of a schoolchild in the development of physical activity at two physical education lessons per week with stage-by-stage change of the adaptive potential and individual adjustment of physical loads in necessary cases (with an increase in the values of the adaptive potential of the circulatory system by at least 0.25 points) led to a noticeable significant increase in physical qualities among students by the end of the academic year. The use of a predictive assessment of changes in the adaptive potential of the circulatory system in staged surveys made it possible to ensure a sustainable health-improving effect of two physical education lessons per week and significantly reduce (up to 50% during the school year) school absences due to illness by students compared to other classes.

The same step-by-step control made it possible to use non-traditional methods of conducting physical education lessons without fear of overworking of the body and overstrain of regulatory systems in students.

Studies have shown that the method of the adaptive potential of the circulatory system, with its high information content, is quite accessible in the work of a teacher, trainer and even high school students themselves and can be used to control the impact of physical activity on the student's body in order to optimize them, as well as to evaluate and predict development of physical overtraining, improving the health-improving orientation of physical education lessons and sports training.

Currently, a team of teachers, graduate students and students is conducting a scientific search for a comprehensive assessment of the psychophysical health of preschool children, schoolchildren, students and athletes using computer technology.

A system of bioeconomical psychomotor training is being introduced into the practice of physical education of schoolchildren, which has been widely used in health-improving physical culture of all segments of the population, as well as in the rehabilitation and increase in the immunological resistance of sick people.

Of great scientific interest are studies of the prognostic assessment of the functional capabilities of the body of athletes using the hardware-software complex "Varicard 1.2", which allows early detection of the processes of fatigue and overwork under the influence of training loads.

A significant advantage of the methods of prenosological diagnostics used in the studies is their wide versatile information content, ease of use in the management of the educational and training process.

Bibliography

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5. Baevsky R.M. Forecasting states on the verge of norm and pathology. - M.: Medicine, 1979. - 289 p.

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9. Baevsky R.M., Berseneva A.P., Maksimov A.L. Valeology and the problem of self-control of health in human ecology. - Magadan, 1996. - 52 p.

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The level of health is understood as a quantitative characteristic of the functional state of the body, its reserves and the social capacity of a person. A high level of health will be characterized by the optimal functioning of body systems with their maximum reserves and long-term social capacity. From the point of view of social medicine, there are three levels of health assessment:

- health of an individual (individual);
- health of small social, ethnic groups (family or group health);
- the health of the entire population (population) living in a city, in a village, in a certain territory.

Different scales are used to assess health at each of the three levels, but it should be emphasized that the most adequate criteria for each level have not yet been finally substantiated and are sometimes interpreted differently, taking into account economic, reproductive, sexual, educational, medical and psychological criteria. When assessing the health of the population in sanitary statistics, standard medical and statistical indicators are used.

Medical and demographic indicators:

a) indicators of the natural movement of the population - mortality in general and age; average life expectancy; fertility, fertility; natural population growth;
b) indicators of the mechanical movement of the population - migration of the population (emigration, immigration, seasonal, intracity migration, etc.).
2. Indicators of morbidity and prevalence of diseases (morbidity).
3. Indicators of disability and disability.
4. Indicators of the physical development of the population.

Given that the functional capabilities of the human body and its resistance to adverse environmental factors change throughout life, we can talk about the state of health as a dynamic process that also improves or worsens. In other words, we can talk about the weakening or strengthening of health depending on age, gender, professional activity, habitat (meaning the ecological and geographic position, the extreme nature of labor activity, the mini- and macroenvironment of the individual, the social status of the family and the psycho-physiological stability of the individual) . A person, losing health, begins to seek salvation primarily in medicines. At the same time, he clearly underestimates the strength of the impact on the body and the effectiveness of such factors as physical activity, rational nutrition, hardening, good sleep, massage, giving up bad habits, etc. Meanwhile, these and other significant factors are integral components of a healthy lifestyle. As they say, "a person dies not from a certain disease, but from his lifestyle." To assess the level of health of the population, timely diagnosis is necessary, as well as research using screening and monitoring.

Diagnostics is the process of recognizing and evaluating the properties, features and states of a subject or object, which consists in a purposeful study, interpretation of the results obtained and their generalization in the form of a conclusion (diagnosis).

Screening is a mass examination of contingents of the population in order to identify persons with a certain disease (certain diseases) for the prompt adoption of therapeutic and preventive measures.

Monitoring - constant monitoring of any objects, phenomena or processes. In a general sense, it is a multi-purpose information system, the main tasks of which are to observe, evaluate and predict the states of an object (subject) in order to warn about emerging critical situations or states.

Health monitoring (monitoring, monitoring observation) - long-term monitoring of the state of a number of vital body functions by recording indicators of these functions.

The way of life, lifestyle, life motivations of each person ultimately determine his health and social well-being throughout his life. Timely diagnosis and assessment of the level of health allows:

- identify weak links in the body for targeted impact;
- draw up an individual program of recreational activities and evaluate the effectiveness;
- to predict the risk of life-threatening diseases;
- determine the biological age of a person.

The concept of health, developed in space and preventive medicine, considers the transition from health to illness, from norm to pathology as a process of gradual decrease in the adaptive capabilities of the body, as a result of which various borderline states appear, which are called prenosological (R.M. Baevsky, V.I. P. Kaznacheev, 1978).

The norm is a zone of functional states, indicating the preservation of the morpho-functional status of the body with the maintenance of compensatory reactive-adaptive capabilities, working capacity and the ability to recreation under these specific conditions at a high level.

Prenosological conditions are conditions in which the optimal adaptive capabilities of the body are provided by a higher than normal tension of regulatory systems, which leads to an increased consumption of the body's functional reserves. A characteristic feature of prenosological states is the presence of an increased functional stress of adaptation mechanisms.

Premorbid conditions are conditions that are characterized by a decrease in the functional capabilities of the body. The state of failure of adaptation is characterized by a sharp decrease in the functional capabilities of the body due to a violation of compensation mechanisms.

Adaptation is a set of adaptive reactions of a living organism to changing conditions of existence, developed in the process of long evolutionary development (phylogenesis) and capable of being transformed, improved during individual development (ontogenesis).

It should be noted that the decrease in the adaptive capacity of the body is associated with a change in physiological functions. This is characterized by an increase in blood pressure, a decrease in cardiac activity. However, in prenosological conditions, the observed changes in physiological parameters, as a rule, do not go beyond the so-called clinical norm and therefore usually remain out of sight of doctors during dispensary and preventive examinations of the population. As a result, only the failure of adaptation with the development of specific nosological forms of diseases becomes the basis for therapeutic measures. In the best case, with earlier detection of the initial signs of the disease, special measures of secondary prevention can be applied. In prenosological diagnostics, a scale for assessing functional states associated with the transition from health to illness, called the "Traffic Light", has been formed. The "Traffic light" scale characterizes the indicated classes of states in a popular, understandable form.

Green (satisfactory adaptation) means that everything is in order, you can move on without fear.

Yellow (prenosological and premorbid conditions) indicates the need for increased attention to your health: you need to stop and look around before moving on. Here we are talking about the need for rehabilitation and prevention.

Red (pathological conditions) shows that you can’t move on, you need to take serious measures regarding your health, you need to diagnose and treat possible diseases.

The transition from health to illness occurs through overstrain and disruption of adaptation mechanisms, and the sooner such an outcome is foreseen, the more likely it is to maintain health. The problem comes down to learning how to determine (measure) the degree of tension of the body's regulatory systems and thus manage health. According to many researchers, the diagnosis of human health should be based on theoretical general biological knowledge, including in the field of physical culture. In solving problems of diagnostics, forecasting, monitoring and evaluation of health indicators, various computer models are currently widely used.

Valeotechnology is the science of using new information technologies in solving the fundamental problems of the strategy of individual and public health. Valeotechnology allows you to integrate the methods of field and laboratory methods of research, the functional state of human body systems for the assessment, control and implementation of rehabilitation measures to improve health.

Ministry of Health and Social Development

Russian Federation

Voronezh State Medical Academy

them. N. N. Burdenko

Department of Physical Culture

Head of the Department, Candidate of Pedagogical Sciences E.D. Vyaltseva

TEST

FOR PHYSICAL EDUCATION

"Prenosological diagnostics"

Test

2nd year students

correspondence department groups

Faculty of Pharmacy

Sasovoi S.O.

Record book number 090899

Voronezh 2011

Introduction

The essence of prenosological diagnostics

2.Use of methods of prenosological diagnostics

Organization of the system of prenosological diagnostics

Bibliography

INTRODUCTION

The definition of the concept of "health" and to this day remains difficult. Galen divided the state of the human body into three categories: health, disease, and "neither health nor disease." Avicenna distinguished six degrees of health and disease, of which only two were related to illness. Currently, the term "health" is often interpreted as the absence of disease. The World Health Organization has defined health as a complex of physical, mental and social well-being.

Improving the level of health should become one of the priority areas of medicine. This coincides with the emerging mood in society that "being sick is not profitable." The experience of domestic and world medicine testifies in favor of an individual approach to recovery, the selection of drugs and non-drug forms of treatment. Well-known scientists of domestic and world medicine have repeatedly pointed out the need for prenosological diagnostics.

Prenosological diagnostics is a new scientific direction based on the study of prenosological conditions bordering between health and disease, using specific methods and instruments for assessing and measuring the functional state of the human body.

.ESSENCE OF PRENOSOLOGICAL DIAGNOSIS

Prenosological diagnostics - examination of practically healthy individuals in order to identify risk factors, latent and unrecognized cases of diseases. In other words, prenosological diagnostics should be understood as an assessment of the functional state of the body and its adaptive capabilities in a period when there are still no obvious signs of diseases. Prenosological diagnostics is engaged in the recognition of conditions that border between the norm and pathology.

The basis of prenosological diagnostics is the measurement of physical and physiological qualities, psychophysiological state, intellectual and personal qualities of a person, i.e. qualitative and quantitative indicators of health, adaptive capabilities of the body, and obtaining a scientifically based answer to the question of how far a person is from possible maladjustment and development of the disease.

The task facing prenosological diagnostics is to answer the question of what preventive measures and when should be taken to improve health and prevent diseases.

Prenosological diagnostics makes it possible to detect developing diseases in advance before the appearance of clinical symptoms (latent forms of the course); identify critical conditions that can lead to exacerbation of existing diseases; select a system or organ that requires priority action. It also indicates the system with the greatest degree of damage, assesses the violation of the vitamin and microelement balance and the targeted appointment of biocorrectors, monitors the effectiveness of any health procedures and the dynamics of the state of health.

Contraindications to the use of prenosological diagnostics are acute infectious diseases with a febrile syndrome, traumatic amputation of the phalanges of the fingers, congenital anomalies in the development of the limbs, age less than 4 years, severe hearing and speech impairment, impaired consciousness.

The main method of prenosological diagnostics is screening - assessment of the condition, search for a risk factor or disease by questioning, physical examination, hardware or laboratory research, or using other procedures that can be performed relatively quickly.

Research methods and techniques:

Assessment of the presence and influence of risk factors.

Assessment of physical data, functional state and adaptive potential.

Indicators of anthropometric data: height, weight, diagnostic anthropometric tests, goniometry, curvimetry, measurement of mobility and asymmetry of range of motion.

Indicators of the functional state of individual body systems.

Indicators of the cardiovascular system: heart rate; arterial pressure; diastolic (or minimum) pressure; systolic (or maximum) pressure; pulse pressure; average dynamic pressure; minute volume of blood; peripheral resistance.

Indicators of the functional state and reserve capabilities of the body: Martinet's test; squat test; Flack test; Rufier's test; orthostatic test; eye test; clinostatic test; endurance coefficient; Bayevsky's test; vegetative Kerdo index.

Assessment of the psychophysiological state: assessment of attention, operative memory, ability to withstand the pace of work, ability to withstand combined activities.

Manual therapy (dianostics) is a set of diagnostic measures carried out by hands using special techniques aimed at diagnosing organic and functional disorders of the musculoskeletal system.

USING PRENOSOLOGICAL DIAGNOSIS METHODS

Achievement of a certain level of functioning of the organism or its certain systems is ensured by the activity of the mechanisms of regulation and control. Mobilization of reserves occurs as a result of a change in the level of activity of regulatory systems, and in particular, an increase in the tone of the sympathetic division of the autonomic nervous system. With a constant deficit of functional reserves to achieve balance with the environment, a state of functional tension arises, which is characterized by a shift in the autonomic balance towards the predominance of adrenergic mechanisms. In a state of functional stress, all the main functions of the body do not go beyond the norm, but the costs of functional reserves to maintain the normal level of functioning of systems and organs increase. Such conditions, in which the nonspecific component of the general adaptation syndrome manifests itself in the form of varying degrees of tension of regulatory systems, are called prenosological. A significant increase in the degree of tension, leading to a decrease in functional resources, makes the biosystem unstable, sensitive to various influences and requires additional mobilization of reserves. This condition, associated with an overstrain of regulatory mechanisms, is called unsatisfactory adaptation. In this state, specific changes in individual organs and systems become more significant. Here it is quite acceptable to talk about the development of the initial manifestations of premorbid states, when changes indicate the type of probable pathology.

The studies revealed that with significant individual variability, the adaptive potential of the circulatory system carries a versatile expressed information content.

These observations led to the conclusion that the adaptive potential of the circulatory system as an integral criterion of the functional state of the whole organism can be used not only to assess the adaptation of the organism to the conditions of daily activities and predict its changes, but also as a reflection of the aging process in a developing organism and the deterioration of health. with age, the intensity of which depends on the physical activity of the student.

An increase in the value of the adaptive potential of the circulatory system made it possible to detect overwork in physical exercises in the early stages of its development. The revealed absence of a significant improvement in the indicators of physical fitness of students during the school year with a deterioration in the adaptive potential of the circulatory system allows us to consider that physical education lessons conducted by traditionally established methods do not provide the formation of a cumulative effect in the body of a schoolchild in the development of physical activity at two physical education lessons per week with stage-by-stage change of adaptive potential and individual adjustment of physical loads in necessary cases (with an increase in the values of the adaptive potential of the circulatory system by at least 0.25 points) led to a noticeable significant increase in physical qualities among students by the end of the academic year. The use of a predictive assessment of changes in the adaptive potential of the circulatory system in staged surveys made it possible to ensure a sustainable health-improving effect of two physical education lessons per week and significantly reduce (up to 50% during the school year) school absences due to illness by students compared to other classes.

ORGANIZATION OF THE SYSTEM OF PRENOSOLOGICAL DIAGNOSIS

prenosological diagnostics examination

Despite the practical absence of special medical standards for the metrology of measurement methods, and not medical equipment, there are a sufficient number of departmental guidance documents in the field of medical metrology that could be used as a scientific and practical basis for the development of state standards in this area. In particular, this applies not only to terminology, but also to the classification of prenosological conditions, as well as a number of methods for measuring indicators of the mental, physical, physiological, biochemical, immune and clinical-somatic statuses of the body, quantitative and qualitative characteristics of the individual health of the patient as a whole.

One of the important scientific and practical problems of the real functioning of the system of prenosological diagnostics is the choice of its organizational foundations suitable for use in the Russian healthcare system, which may include the following main elements:

general organization of prenosological dispensary examination;

outpatient examination of the patient;

specialized prenosological examination of healthy and practically healthy individuals, as well as patients with combined forms of the disease;

patient self-monitoring system.

The volume and nature of the methods of dispensary examination and its frequency depend on the conditions for its implementation: minimal and more frequent - in the self-monitoring system, wider and less frequent - in outpatient settings, and maximum and rare - in a hospital setting. Dispensary examination can be primary and secondary. Primary - includes a full scope of general clinical examination and specialized prenosological diagnostics. With repeated examinations, prenosological diagnostics can be carried out at least once every six months, and a general clinical examination - at least once a year. In addition to scheduled dispensary examinations, it is advisable to additionally conduct unscheduled ones, for example, in cases of deterioration in the patient's health or to monitor the effectiveness of ongoing preventive therapy. However, it is sufficient to apply a smaller volume of diagnostic examination, depending on the nature of the changes that have appeared (favorable or unfavorable), preferably using the methods of the patient's self-monitoring system.

An outpatient examination may include the following varieties:

primary general clinical examination;

specialized prenosological examination;

patient self-monitoring system;

patient medical training system.

The primary general clinical examination can be carried out on the basis of an outpatient or health-improving medical institution for the purpose of differential diagnosis and identification of the initial, latent, erased or subclinical form of the disease of various etiologies. It is carried out according to the type of planned dispensary examination and includes anamnesis, examination with a physical examination by various specialists (therapist, surgeon, neuropathologist, otolaryngologist, ophthalmologist, dermatologist, dentist), laboratory tests (clinical blood test: hemoglobin level, erythrocyte, leukocyte, leukocyte formula, erythrocyte sedimentation rate, sugar content; clinical analysis of urine: specific gravity, reaction, protein content, sugar, sediment microscopy; analysis of feces for eggs of worms and protozoa), as well as instrumental methods: anthropometry, large-frame X-ray fluorography or fluoroscopy of the chest ; electrocardiography in 12 standard leads at rest, measurement of blood pressure by methods generally accepted in clinical practice. Based on the results of the initial general clinical examination, the attending physician issues a conclusion on the development or suspicion of the occurrence of a prenosological form of a disease of the cardiovascular system and on the indications and timing of further specialized prenosological examination, which can be carried out on the basis of the same medical institution or another that can provide the full scope of this examination. For this step, the results of the initial general clinical examination can be used.

BIBLIOGRAPHY

.Prenosological diagnostics in the practice of mass surveys of the population. Kaznacheev V.P., Baevsky R.M., Berseneva A.P. - M., Medicine, 1980. - 208 p.

2.Assessment of the adaptive capacity of the body and the risk of developing diseases. Baevsky R.M., Berseneva A.P. - M.: Medicine, 1997. - 236 p.

.Fundamentals of general valeology. Kaznacheev V.P. Tutorial. - M.: Publishing house Institute of Practical Psychology, 1997. - P.21.

.Adaptation, stress and prevention. Meyerson F.Z. - M.: Nauka, 1981. - 278s.

.Introduction to valeology - the science of health. Brekhman I.I. - L.: Nauka, 1987. - 125 p.

.Principles and methods of mass prenosological examinations using automated systems: Abstract of the thesis. doc. dis. Berseneva A.P. Kyiv, 1991. - 27 p.

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The studies revealed that with significant individual variability, the adaptive potential of the circulatory system carries a versatile expressed information content.

An increase in the value of the adaptive potential of the circulatory system made it possible to detect overwork in physical exercises in the early stages of its development. The revealed absence of a significant improvement in the indicators of physical fitness of students during the school year with a deterioration in the adaptive potential of the circulatory system allows us to consider that physical education lessons conducted by traditionally established methods do not provide the formation of a cumulative effect in the body of a schoolchild in the development of physical activity at two physical education lessons per week with stage-by-stage change of adaptive potential and individual adjustment of physical loads in necessary cases (with an increase in the values of the adaptive potential of the circulatory system by at least 0.25 points) led to a noticeable significant increase in physical qualities among students by the end of the academic year. The use of a predictive assessment of changes in the adaptive potential of the circulatory system in staged surveys made it possible to ensure a sustainable health-improving effect of two physical education lessons per week and significantly reduce (up to 50% during the school year) school absences due to illness by students compared to other classes.

The problem of assessing the current state of individual health and monitoring changes in its level is becoming increasingly important for the population as a whole, but especially for people subject to high psycho-emotional or physical stress. Currently, there is a modern scientific approach to solving this problem from the point of view of prenosological diagnostics - a new direction in medicine and physiology, which is an integral part of valeology (Brekhman, 1987; Baevsky, Berseneva, Maksimov, 1996).

The concept of health, developed in space and preventive medicine, considers the transition from health to illness, from norm to pathology as a process of gradual decrease in the adaptive capabilities of the organism, as a result of which various borderline states arise, which are called prenosological (Baevsky, Kaznacheev, 1978). As a result of generalizations of mass preventive examinations, a classification was formed that includes four classes of conditions.

Norm- a zone of functional states, indicating the preservation of the morpho-functional status of the body with the maintenance of compensatory reactive-adaptive capabilities, working capacity and the ability to recreation under these specific conditions at a high level.

Prenosological conditions, in which the optimal adaptive capabilities of the body are provided by a higher than normal voltage of regulatory systems, which leads to an increased consumption of the functional reserves of the body. A characteristic feature of prenosological states is the presence of an increased functional stress of adaptation mechanisms. Three stages of functional stress can be distinguished: moderate, pronounced, pronounced.

Premorbid conditions, which are characterized by a decrease in the functional capabilities of the body and manifest themselves in the form of two stages:

a) with a predominance of non-specific changes while maintaining homeostasis of the main vital systems of the body, including the cardiovascular system;

b) with a predominance of specific changes on the part of certain organs and systems, the homeostasis of which is disturbed, but due to the mechanisms of compensation, the manifestation of diseases can be expressed or is in the initial phase and has a compensatory character. These states occur against the background of overstrain of regulatory mechanisms.

The state of failure of adaptation with a sharp decrease in the functionality of the body due to a violation of compensation mechanisms. In this state, as a rule, various diseases are observed in the stage of subcompensation or decompensation.

Recall that adaptation- this is a set of adaptive reactions of a living organism to changing conditions of existence, developed in the process of long evolutionary development (phylogenesis) and capable of being transformed, improved during individual development (ontogenesis).

It should be noted that the decrease in the adaptive capacity of the body is associated with a change in physiological functions. This is characterized by an increase in blood pressure, a decrease in the external work of the heart. However, in prenosological conditions, the observed changes in physiological parameters, as a rule, do not go beyond the so-called clinical norm and therefore usually remain out of sight of doctors during dispensary and preventive examinations of the population. As a result, only the failure of adaptation with the development of specific nosological forms of diseases becomes the basis for therapeutic measures. In the best case, with earlier detection of the initial signs of the disease, special measures of secondary prevention can be applied.

In prenosological diagnostics, a scale for assessing functional states associated with the transition from health to illness, called the “Traffic Light”, has been formed. The “Traffic light” scale characterizes these classes of states in a popular, understandable form.

Green (satisfactory adaptation) - means that everything is in order, you can move on without fear.

Yellow (prenosological and premorbid conditions) - indicates the need for increased attention to your health: you need to stop and look around before moving on. Here we are talking about the need for rehabilitation and prevention.

Red (pathological conditions) - shows that you can’t move on, you need to take serious measures regarding your health, you need to diagnose and treat possible diseases.

Maintaining sufficient adaptive (adaptive) capabilities of the body, i.e. ensuring health is directly dependent on the functional reserves of the body, on its ability to mobilize these reserves to maintain and maintain homeostasis in changing environmental conditions (Baevsky, 1979).

The transition from health to illness occurs through stress and disruption of adaptation mechanisms, and the sooner such an outcome is foreseen, the greater the chances of maintaining health. The problem comes down to learning how to determine (measure) the degree of tension of the body's regulatory systems and thus manage health.

Summarizing the summary of the methodology for assessing the state of health from the standpoint of prenosological diagnostics, it can be noted that an individual assessment of the level of health is a much more difficult task than making a diagnosis of a disease in a patient entering a clinic. This is primarily due to the fact that medicine has vast practical experience in diagnosing diseases and an appropriate arsenal of methods and means, while the study of health has not yet gone beyond philosophical disputes and experimental studies. However, this problem is much more complicated, and it is connected with scientific and theoretical ideas about health and disease. As for pathological conditions, there is an extensive section of pathology in medicine - nosology, where a classification of diseases with corresponding symptoms and clearly defined syndromes has been developed in detail. Nothing of the kind yet exists in relation to the functional states that characterize different levels of health.