ó㳺í³÷íà îö³íêà âïëèâó äîâê³ëëÿ íà ôîðìóâàííÿ îíêîã³íåêîëîã³÷íî¿ ïàòîëî㳿 òà îá´ðóíòóâàííÿ çàõîä³â ùîäî ¿¿ ïðîô³ëàêòèêè

Äèññåðòàöèÿ íà ñîèñêàíèå ó÷åíîé ñòåïåíè êàíäèäàòà ìåäèöèíñêèõ íàóê ïî ñïåöèàëüíîñòè 14.02.01-ãèãèåíà. - Äîíåöêèé ãîñóäàðñòâåííûé ìåäèöèíñêèé óíèâåðñèòåò èì. Ì. Ãîðüêîãî, Äîíåöê, 2006.

Äèññåðòàöèÿ ïîñâÿùåíà ïðîáëåìå óñòàíîâëåíèÿ çàêîíîìåðíîñòåé ôîðìèðîâàíèÿ îíêîãèíåêîëîãè÷åñêîé ïàòîëîãèè æåíñêîãî íàñåëåíèÿ ïîä âëèÿíèåì îêðóæàþùåé ñðåäû è ðàçðàáîòêå íà ýòîé îñíîâå äèôôåðåíöèðîâàííûõ ïðèíöèïîâ è ìåð ïî åå ïðîôèëàêòèêå.

Óñòàíîâëåíî, ÷òî íàèáîëåå çàãðÿçíåí àòìîñôåðíûé âîçäóõ íàñåëåííûõ ìåñò Âîñòî÷íîãî è Þæíîãî ðåãèîíîâ Óêðàèíû, î ÷åì ñâèäåòåëüñòâóþò íàèâûñøèå çíà÷åíèÿ òàêèõ ïîêàçàòåëåé, êàê óäåëüíûé âàëîâûé âûáðîñ âðåäíûõ âåùåñòâ â âîçäóøíûé áàññåéí (24,5-58,2 ò/êì2/ãîä), óäåëüíûé âåñ àíàëèçîâ àòìîñôåðíîãî âîçäóõà ñ ïðåâûøåíèåì ÏÄÊ (36,3-59,8%), ñðåäíåãîäîâûå êîíöåíòðàöèè êñåíîáèîòèêîâ â âîçäóøíîì áàññåéíå (âçâåøåííûå âåùåñòâà: 1,3-3,3 ÏÄÊ, äèîêñèä àçîòà: 1,7-2,8 ÏÄÊ, ôåíîë: 1,2-2,2ÏÄÊ, àììèàê: 1,4-2,6 ÏÄÊ, ôîðìàëüäåãèä: 1,3-4,2 ÏÄÊ, ôòîðèñòûé âîäîðîä: 1,1-2,1 ÏÄÊ, ñàæà: 1,2- 3,7 ÏÄÊ, 3,4 áåíçïèðåí: 2,5-12,3 ÏÄÊ). Íàèìåíåå çàãðÿçíåí àòìîñôåðíûé âîçäóõ ãîðîäîâ Ñåâåðíîãî ðåãèîíà, ãäå çàðåãèñòðèðîâàíû ñàìûå íèçêèå çíà÷åíèÿ âûøåïåðå÷èñëåííûõ ïîêàçàòåëåé, à óðîâåíü îïàñíîñòè âîçäóøíîãî áàññåéíà äëÿ çäîðîâüÿ ÷åëîâåêà îöåíèâàåòñÿ êàê áåçîïàñíûé.

Ïîêàçàíî, ÷òî æèòåëè þæíûõ è âîñòî÷íûõ îáëàñòåé Óêðàèíû èñïîëüçóþò äëÿ õîçÿéñòâåííî-ïèòüåâûõ íóæä ÷ðåçìåðíî ìèíåðàëèçîâàííóþ (1,5-3,8 ÏÄÊ), ñëèøêîì æåñòêóþ (1,8-4,8 ÏÄÊ) âîäó ñ áîëüøèì êîëè÷åñòâîì õëîðèäîâ (0,9-1,5 ÏÄÊ), ñóëüôàòîâ (1,3-3,8 ÏÄÊ), êàëüöèÿ (1,5-2,2 ÏÄÊ) è ìàãíèÿ (0,9-1,7 ÏÄÊ), ñîäåðæàùóþ ñâèíåö, õðîì è ìàðãàíåö â êîíöåíòðàöèÿõ, ïðåâûøàþùèõ ãèãèåíè÷åñêèå íîðìàòèâû. Íàèáîëåå êà÷åñòâåííàÿ ïèòüåâàÿ âîäà, áåçîïàñíàÿ ïî õèìè÷åñêîìó ñîñòàâó, õàðàêòåðíà äëÿ òåððèòîðèé Ñåâåðíîãî, Çàïàäíîãî è Öåíòðàëüíîãî ðåãèîíîâ Óêðàèíû ñ íèçêèì óðîâíåì àíòðîïîïðåññèè è îïòèìàëüíûì ïðèðîäíûì ñîäåðæàíèåì ìèíåðàëüíûõ âåùåñòâ. Íàèáîëåå âûñîêèå êîíöåíòðàöèè òÿæåëûõ ìåòàëëîâ çàôèêñèðîâàíû â ïî÷âàõ Âîñòî÷íîãî è Þæíîãî ðåãèîíîâ Óêðàèíû, ãäå îíè ñóùåñòâåííî (îò 1,2 äî 3,6 ðàç) ïðåâûøàþò íîðìàòèâíûå çíà÷åíèÿ. Íàèìåíüøèé (äîïóñòèìûé) óðîâåíü áåçîïàñíîñòè ïî÷â äëÿ çäîðîâüÿ íàñåëåíèÿ óñòàíîâëåí â íåêîòîðûõ îáëàñòÿõ Ñåâåðíîãî è Çàïàäíîãî ðåãèîíîâ.

Ãèãèåíè÷åñêàÿ õàðàêòåðèñòèêà õèìè÷åñêîãî çàãðÿçíåíèÿ ïèùåâûõ ïðîäóêòîâ, èçãîòîâëåííûõ èç ìåñòíîãî ñûðüÿ, ïîçâîëèëà óñòàíîâèòü îïðåäåëåííûå ðåãèîíàëüíûå îñîáåííîñòè: íàèáîëåå âûñîêèé óðîâåíü èõ êîíòàìèíàöèè òÿæåëûìè ìåòàëëàìè (12,9-15,6% àíàëèçîâ ñ ïðåâûøåíèåì ðåãëàìåíòîâ) è ïåñòèöèäàìè (8,5-15,8%) îòìå÷åí â Âîñòî÷íîì è Þæíîì ðåãèîíàõ, â òî âðåìÿ êàê íèòðàòàìè - â Çàïàäíîì, Ñåâåðíîì è Öåíòðàëüíîì (9,0-12,8%).

Ïî èòîãàì èññëåäîâàíèé óñòàíîâëåíî, ÷òî íàèáîëåå áëàãîïîëó÷íàÿ ìàêðîýêîíîìè÷åñêàÿ ñèòóàöèÿ ñëîæèëàñü â Âîñòî÷íîì è Þæíîì ðåãèîíàõ Óêðàèíû, êîòîðûå ÿâëÿþòñÿ ñàìûìè ðàçâèòûìè â èíäóñòðèàëüíîì è ñîöèàëüíî-ýêîíîìè÷åñêîì îòíîøåíèÿõ. Îá ýòîì ñâèäåòåëüñòâóþò íàèâûñøèå çíà÷åíèÿ òàêèõ ïîêàçàòåëåé, êàê óäåëüíàÿ âàëîâàÿ ýêîíîìè÷åñêàÿ ïðèáûëü, ñðåäíÿÿ âåëè÷èíà äîõîäîâ íàñåëåíèÿ è óäåëüíûé âåñ æèòåëåé ñ âûñøèì è íåîêîí÷åííûì âûñøèì îáðàçîâàíèåì. Íàèõóäøàÿ ñîöèàëüíî-ýêîíîìè÷åñêàÿ ñèòóàöèÿ, ïî ýòèì æå ïîêàçàòåëÿì, ñóùåñòâóåò â Çàïàäíîì è Ñåâåðíîì ðåãèîíàõ íàøåãî ãîñóäàðñòâà.

Óñòàíîâëåíà âåäóùàÿ çàêîíîìåðíîñòü ñîâðåìåííîãî òåððèòîðèàëüíîãî ðàñïðåäåëåíèÿ îíêîãèíåêîëîãè÷åñêîé ïàòîëîãèè â Óêðàèíå, êîòîðàÿ çàêëþ÷àåòñÿ â âîçðàñòàþùåì ãåîãðàôè÷åñêîì òðåíäå âñåõ åå ïîêàçàòåëåé (÷àñòîòà âîçíèêíîâåíèÿ, ðàñïðîñòðàíåííîñòü, ñìåðòíîñòü) îòíîñèòåëüíî ðàêà òåëà ìàòêè è ÿè÷íèêîâ â íàïðàâëåíèè ñ ñåâåðî-çàïàäà íà þãî-âîñòîê ñòðàíû.  îòíîøåíèè çëîêà÷åñòâåííûõ íîâîîáðàçîâàíèé øåéêè ìàòêè íàáëþäàåòñÿ äðóãàÿ ìåäèêî-ãåîãðàôè÷åñêàÿ îñîáåííîñòü - ïîâûøåíèå âñåõ ïîêàçàòåëåé ýòîé îíêîïàòîëîãèè ïðîèñõîäèò â íàïðàâëåíèè ñ ñåâåðî-âîñòîêà íà þãî-çàïàä íàøåãî ãîñóäàðñòâà.

Ïðîâåäåííûé ìíîæåñòâåííûé êîððåëÿöèîííî-ðåãðåññèîííûé àíàëèç ïîêàçàë, ÷òî âåäóùóþ ðîëü â äåòåðìèíàöèè óðîâíåé ïåðâè÷íîé çàáîëåâàåìîñòè æåíùèí çëîêà÷åñòâåííûìè îïóõîëÿìè ðåïðîäóêòèâíîé ñèñòåìû èãðàþò ñîöèàëüíî-ãèãèåíè÷åñêèå ôàêòîðû (D=72,2-76,1%), ñðåäè êîòîðûõ àáñîëþòíî äîìèíèðóþò îñîáåííîñòè îáðàçà æèçíè è áûòà (D=35,9-50,3%). Îòíîñèòåëüíàÿ ñòåïåíü âëèÿíèÿ äðóãèõ ñîöèàëüíî-ãèãèåíè÷åñêèõ ôàêòîðîâ íàìíîãî íèæå: ñîöèàëüíî-ýêîíîìè÷åñêèõ - â 1,7-2,0 ðàçà (D=20,7-25,8%), îñîáåííîñòåé ïèòàíèÿ - â 2,3-2,4 ðàçà (D=15,0-16,2%), ïðè÷åì âëèÿíèå ïîñëåäíèõ íà ÷àñòîòó âîçíèêíîâåíèÿ ðàêà øåéêè ìàòêè íåëüçÿ ñ÷èòàòü äîñòîâåðíûì.

Âíåäðåíèå ðàçðàáîòàííûõ ìåð ïðîôèëàêòèêè â ïðàêòè÷åñêîå çäðàâîîõðàíåíèå îòäåëüíûõ ðåãèîíîâ (Äîíåöêàÿ è Âèííèöêàÿ îáëàñòè) ïîçâîëèëî óìåíüøèòü ïåðâè÷íóþ îíêîãèíåêîëîãè÷åñêóþ çàáîëåâàåìîñòü æåíùèí íà 10-15%, ðàñïðîñòðàíåííîñòü èõ çàáîëåâàíèé íà 10-12% è ñìåðòíîñòü îò íèõ íà 5-8%.

Êëþ÷åâûå ñëîâà: îíêîãèíåêîëîãè÷åñêèå çàáîëåâàíèÿ, ïðîôèëàêòèêà, âëèÿíèå îêðóæàþùåé ñðåäû.

Shamray V.A. Hygienic estimation of influence of an environment on formation of an oncogynecologic pathology and a substantiation of actions on its prophylaxis. - A manuscript.

Dissertation for the Candidate of the Medical Sciences degree in specialty 14.02.01 - Hygiene. - Donetsk State medical University named after M. Gorky, Donetsk, 2006.

The dissertation is devoted to a problem an establishment of laws of the formation of an oncogynecologic pathology of the female population under influence of factors of an environment and development on this basis differentiated depending on features of an environment of principles and actions of prophylaxis of malignant neoplasms of female genesial system. By results of a complex hygienic estimation ecological (chemical and physical) and social-hygienic (social and economic, demographic, a way of life) conditions of residing of women, and also the analysis of territorial variability of parameters oncogynecologic pathologies and laws of its formation, with the help plural correlation regression, comparative and medico-cartographical analyses were the certain key external risk factors and antirisk of occurrence of malignant tumours of female genitals.

On this basis the complex differentiated was scientifically proved and entered in practice of public health services depending on features of an environment a complex of actions initial, secondary and tertiary oncogynecologic prophylaxes on nation-wide, preventive (regional, branch) and individual levels.

Key words: oncogynecologic diseases, prophylaxis, influence of environment.

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