Medicine

HYGIENE OF CHILDREN

HYGIENE OF CHILDREN. 

METHOD OF ESTIMATION OF THE STATE OF HEALTH  AND PHYSICAL DEVELOPMENT OF CHILDREN AND TEENAGERS. RESEARCH METHODS AND ESTIMATION OF INFLUENCING OF FACTORS OF ENVIRONMENT ON A HEALTH CHILDREN AND TEENAGERS, DETERMINATIONS OF GROUP OF HEALTH AND PHYSICAL EDUCATION.

METHODS OF STUDY OF OLD-AGE PSYCHOPHYSIOLOGICAL FEATURES OF CHILDREN AND TEENAGERS. HYGIENICAL ESTIMATION OF AN EDUCATIONAL MODE OF CHILDREN IN DIFFERENT

AGE GROUPS.A METHOD OF HYGIENICAL ESTIMATION OF EQUIPMENT AND MAINTENANCE OF EDUCATIONAL ESTABLISHMENTS  FOR CHILDREN AND TEENAGERS (PRESCHOOL, SCHOOLS,

SPECIAL EDUCATIONAL ESTABLISHMENTS).

Health of the adult human depends on its health in children’s and adolescents’ age. In particular, the average duration is longed during this century and depends on the decreasing of the children’s death and illness. According to the children’s illness we can speaking about nation’s health.

In biological respects children’s age is characterized by weak adaptation of organism to the changeable optimal state of the environment (early children’s age). With the age adaptation’s possibility is increased.

As a result of biological changes of the children’s age hygienic conditions must be changed in separate periods of children’s organism development. Hygiene of the children’s age is so different like a children’s age. Hygienic norms are differentiating according to the age. So, the hygiene of the children and adolescent is the part of the hygiene that shows the methods of health organism making. According to it the hygiene of children and adolescent is named as hygiene of the education.

Objects of the children’s and adolescents’ hygiene:

1. Dynamical (in development process) studying of the environment’s factors’ influence, including the education and studying, to the children’s and adolescents’ health.

2. Making of the scientific grounded hygienic norms and measures that further to stronger the health and better mental and physical development. In this case the hygiene has both influence: a) growth organism of child in education process with improvement adaptation possibility (steel in the wide understanding) and b) environment that is around child, in direction of it adaptation according to age changes.                       

The factors influence on development of the child’s organism.

During all children’s and adolescent age organism growths and develops every time, and passes from one stage to other. Child’s development process is made at the influence of conditional and unconditional actions of the external and internal environment. The main factors that are determining development of organism are original anatomo-physiological properties, external environment, child’s activity and education. And by the way the last one has the main role.

 The most fall effect has the constant influence on the adaptation to the changeable conditions of the environment, so the adequate pass from one stage to other. Such result may be received at the process of education with taking into account the origin and anatomo-physiologic properties of child’s organism and are given environment’s condition that these properties are demanded.

Main stages of the child’s organism development and its hygienic guaranteeing (securing, ensuring).

Work periodisation of the children’s age is grounded on the M.P.Gundobin’s and M.P.Krasnogorsky’s proposition. Here are taking into the account the main conformity of child’s organism development and properties of the education of the children and adolescent.

According to this sketch there are such age periods: 1) intrauterine, 2) neonate (0-10days), 3) infants (10days-1year), 4) kindergarten, 5) preschool (early, medial, older), 6) school (early, medial, older).

During the infant age the adaptation of the nervous system is increased and the sleep is increased too. It gives the possibility to making of the conditional reflexes, in particular the reflex of quick sleeping at the “fresh air”.

At the influence of the rational education in the child’s organism the protective function and function of adaptation to different external influences and changable conditions of the environment are developed.

The main hygienic measures that are necessary in this period are:

  Rational regime of child and long-lasting staying at the fresh air

  Guaranteeing by the rational closes, furniture and apparatus

 Systematic physical exercises

  Massage

  Steel

Systematic control by the infants’ physical development – necessary condition of their rational education.

TRAINING INSTRUCTION

on complex assessment of children’s and adolescents’ health

 

Assessment of health state is the most important role of a physician, who works with children and adolescents. It’s main importance lies in the fact, that the formation of physical and psychological human health, organism’s resistance to influence of unfavourable environmetnal factors and social contitions takes place in childhood.

The following criteria of complex assessment of the children and adolescents health state are used nowadays in everday practice of sanitary doctors, doctors of general education establishments, pediatricians, general practitioners and family doctors:

     Presence or absence of chronical diseases during examination;

     Functional state of main systems of organism;

     Level of organism resistance to unfavourable influence of environemntal factors;

     Current level of nervous and psychological, and physical development, its harmonicity.

According to listed above criteria, allocation scheme of children and adolescents by health groups was elaborated. There are 5 health groups:

First health group includes healthy children and adolescents with harmonious development and development level of organism functional systems corresponding to the age.

Second health group includes healthy children and adolescents who have functional and some morphological deviations, low resistance to acute and chroonic diseases, they are ill frequently during long period of time.

Third health group includes children and adolescents suffering from chronic diseases in compensation stage, with normal fucntional resources of organism.

Fourth health group includes children and adolescents suffering from chronic diseases in subcompensation stage with lowered funcional resources of organism.

Fifth health group includes children and adolescents suffering from chronic diseases in decompensation stage with significantelly lowered funcional resources of organism.

morbidity rate

years old

Fig. 38.1 Changes of morbidity rate of children and adolescents depending on age (morbidity rate per 1000 population of corresponding age)

 

Change of morbidity rate (see fig. 38.1) and its structure (table 1) depending on age has to be taken into account during the complex assessment of health state of children and adolescents.

Table 1

Patterns of rank distribution of diseases in different age groups

 

Rank place

Age group, years old

0–3

3–6

7–14

15–17

I

Diseases of respiratory organs

Diseases of respiratory organs

Diseases of respiratory organs

Diseases of respiratory organs

II

Diseases of nervous system and sense organs

Diseases of nervous system and sense organs

Diseases of nervous system and sense organs

Diseases of nervous system and sense organs

III

Diseases of gastrointestinal tract

Diseases of skin and subcutaneous fat layer

Diseases of gastrointestinal tract

Diseases of gastrointestinal tract

IV

Diseases of endocrine system

Diseases of blood and hemopoietic organs

Diseases of endocrine system

Diseases of endocrine system

V

Diseases of skin and subcutaneous fat layer

Infectious and parasitic diseases

Diseases of musculoskeletal system

Diseases of musculoskeletal system

Allocation of children by health groups allows to reveal people who have risk factors concerning development of pathological deviations, children with initial forms of diseases and functional deviations, and, based on received results to work out complex measures for protection and strengthening of children’s health, prevention of chronic diseases appearance.

First of all these measures must be directed on children, belonging to the second health group (children-reconvalexscents, children who are ill frequently during long period of time, with general delay and dysharmonicity of physical development due to being overweight or underweight without endocrine pathology, with bending disorders, flat feet, with functional deviations of cardiovascular system, myopia, carries, II stage hypertrophy of palatine tonsils, allergic reactions, thyriod gland enlargement of I and II stages, asthenic syndrom etc.).

Following data may be used for assessment of organism resistance: morbidity rate with temporal disability and exacerbation of chronic diseases during previous and current years, incides of nonspecific resistance (X-chromatine and geretochromatne content in the cheek mucous membrane epithelium, glicogen content in neutriphils, activity of alkaline and acid phosphotase in neutrophils, dehydrogenas in limphocytes, lysozyme and lactatedehydrohynase in saliva, level of skin bactericidal action etc.).

Assessment of functional state of organism is carried out using clinical methods and special functional tests (orthostatic sign, Martine-Kushelevskiy test), Letuvov test, step-test (РWС170) etc.).

There are favourable (sanitary, health-improving) and unfavourable (or risk factors) factors which form health and significantly influence processes of development of growing organism.

Sanitary (health-improving) factors are the follwoing:

     rational regime of daily activity;

     adequate and balanced nutrition;

     correspondence of environment to hygienic standards;

     optimal motor activity;

     tempering;

     healthy lifestyle and following of the everyday hygienic rules.

Unfavourable (risk factors) are the following:

     disturbances in day regime, educational process;

     disadvantages in organization of nutrition;

     breaches of hygienic requirements to game, educational, extracurricular and labour activity;

     insufficient or excess motor activity;

     unfavourable psychological climate in family and collective;

TRAINING instruction

on assessment of physical developent of children and adolescents

Physical development of children and adolescents is assessed based on somatoscopic (аnthroposcopic), somatometric (anthropometric) and physiometric indices with their further interpretation using method of sigmal deviations, regression scales, complex or centile methods.

There are following somatoscopic indices: condition of skin and mucous membranes, degree of fat diposity, characteristics of musculoskeletal system (bearing, form of chest, sceleton, legs and feet), also signs of sexual development (pilosis/hair distribution on armpit and pubis, mammary glands development for girls, hair distribution on face, development of larynx thyroid cartilage, voice mutation for boys) (see fig. 38.3, 38.4 and 38.5).

 

Fig. 1 Main types of bearing

(аlordotic; b – kyphotic; c correct; d – stooping; eerect)

                                                                                                                                                   (1)                                               (2)

Fig. 2 Method of measurement of normal spinal curvatures (1)

and main types of scoliosis (2)

(1–4 – length of spinal column; 2 – cervical bending; 3 – lateral bending;

аthorax right-side; btotal lift-side; cS–shaped)

Fig. 3 Forms of lower extremities

(аnormal; b – X–shaped; cО-shaped)

                                                               

Main somatometric incides are the following: body length and weight, thorax circumference and other (circumferences of head, shoulder, hip etc.), and they are determined using special anthrpometric points (see fig. 4).

Fig. 4 Special anthropometric points

а –lateral view: 1-  apical; 2 -  glabella; 3 -  occipital; 4 -  upper thorax; 5 -  styloid; 6 -  terminal; 7 -  calcaneal;b – frontal view: 1 -  apical; 2 - parietal; 3 - glabella; 4 - chin; 5 - upper thorax; 6 - middle thorax; 7 -  shoulder; 8 -  radial; 9 - styloid; 10 -  finger; 11-  upper crus; 12 - lower crus; 13 -  trochanteric; 14 – pubic.

There are such physiometric indices as muscle strength of hands, lung vital capacity, torso strength etc.

Wooden auxanometer is used for determination of body length in standing and sitting positions. Wooden auxanometer is 2 meters high pole which is fixed on 70 x 45 cm frame with folding bench at 40 cm height used for length determination in sitting position. Two columns of centimeter points are marked on the pole. Results are read according to the first column from the frame, according to the second column – from the folding bench. Movable muff with horizontal plane is fixed on the pole. This muff is lowered until it touches the parietal bone of examined person.

The examined person has to stand still, leaning with his/her back to the pole, hold heels together and toes separately and touch the stick in three points – heels, buttocks and interscapular region during examination of body length in standing position. The head of examined person must be in such position that the line connecting lower border of eye-hole and upper border of ear tragus is parallel to floor.

Medical scale is used for the body weight measurement.

Thorax circumference is measured with tape-line when patient is maximally calm, takes a forced inspiration and expiration (tape line has to pass along lower border of mammillary ring for boys and along four rib for girls at the front, and along the lower border of scapulas with arms put down - behind).

Water or pneumatic spirometer is used for determination of lung vital capacity, hand dynamometerfor determination of muscle strength of hands, torso dynamometer – for determination of torso strength. Maximum result is registered during examination in any case.

The assessment of physical development is carried out comparing individual data and regional standards of physical development (average standard values for each age and sex group which reflect level of physical development of chlidren and adolescents living in same conditions).

Assessment of physical development using method of sigmal deviations

Method of sigmal deviations with image of physical profile is used to assess the physical development comparing each individual index with weight-average arithmetical value for this index at certain age. This allows to find out this index’s actual deviation from standard values.

Then the sigmal deviation (σ) is found by division of actual value by the value of mean square deviation. This information reveals the sigma value which may vary, this value for each child may differ from average special for certain age and sex group values.

Deviations from –1σ to +1σ mean average development of this index, from –1.1σ to –2σdevelopment is below average, from –2.1σ  and belowlow, from +1.1σ to +2σ above average, from +2.1σ  and highhigh.

To draw a profile of physical development the following procedure has to be done: horizontal lines corresponding to the number of indices for further assessment are drawn and the value of received sigmal deviation is pointed on each line, then these points are connected with straight line (see fig. 5).

                                              -     -      -        М       +1σ     +2σ    +3σ 

Body length

 

 

 

 

 

Body weight

 

 

 

 

 

Chest circumference

 

 

 

 

 

 

Fig. 5 Profile of physical development

Method of sigmal deviations allows to determine the level of each separate index of physical development and its proportionality based on the profile data. If values of deviations correspond to one sigma - the physical development is proportional, if the values of deviations are two and more sigmas – the physical development is disproportional.

The conclusion about physical development of a child has to be the following while using method of sigmal deviations: Physical development of Petrenko І., 10years old, is average (below average, low, above average, high) accroding to the body length, average (below average, low, avobe average, high) according to the body weight, average (below average, low, avobe average, high) according to the ches girth, proportional (disproportional)”.

Example: it is necessary to assess the physical development of 10-year-old boy Petrenko with 129 cm body length, 37 kg body weight and 61 cm chest girth.

During self-training task the data about this pupil (surname, sex, age, health state) are drawn into the protocol, then according to the example (table 2) the column “Pupil” is filled with data of examined pupil concerning body length, body weight and chest girth.

Table 2

Data of individual assessment of physical development

Indices of physical development

Pupil

Standard

Difference between actual and standard values

Value of sigmal deviation

Assessment

М

s

Body length, cm

129

137.3

5.6

– 8.3

– 1.48 s

Below average

Body weight, kg

24

33.4

6.0

– 9.4

– 1.56 s

Below average

Chest girth, cm

61

67.5

4.8

– 6.5

– 1.35 s

Below average

After that, using the table 3, the sex and age of examined pupil are found, coresponding standard values of separate indices (body length and weight, chest girth) of physical development: average arithmetical weighted value (М) and mean square deviation (s) and drawn into the table 2 (see columnStandard”).

After that, the difference between actual and standard values is calculated for each index. In our example, body length of 10 years old boy is 129 cm, standard value of this index (М) is 137.3 cm, difference between them is 129 – 137.3 = –8.3 cm.

Received difference is divided by s (in our example it’s value is 5.6 cm) and sigmal deviation is found: –8.3 : 5.6 = –1.48s. And, at last, the assessment of physical development according to each index is substantiated based on value and indication of sigmal deviation.

In our example, taking into account that sigmal deviation is –1.48s, physical develpment of a boy according to the body length is under average.

Using mentioned above sequence, data of physical development according to other indices are analyzed.

Based on received results the conclusion is substantiated. In our example the conclusion is following: Physical development of 10 years old Petrenko I. According to the body length and weight, chest girth is below average, proportional.

There are such main disadvantages of this method of physical development assessment as indices are assessed separately and level of their correlation is not taken into account. At the same time certain values of body weight and chest girth correspond to certain body length of an organism, and physical development has to be proportional. This disadvantage can be removed using method of physical development assessment by regerssion scales, complex and centile methods.

Assessment of physical development using regression scales

Usage of method of assessment of physical development using regression scales allows to overcome the main disadvantage of method of sigmal deviationsseparate character during assessment of each somatometric index. In this case tables for assessment include correlation between height, body weight and chest girth. This correlation allows to give more substantiative assessment of physical development taking into account interconnected indices.

First stage of the physical development assessment using regression scales tables includes search of group (developmnt is average, below average, above average, high, low) to which the child body length is attributed.

Then the body weight and chest girth indices corresponding to actual height are compared with actual indices of examined people. For this, it is necessary to subtract standard value of examined index from value of actual development of this index and the received result is divided by sigma-regression (σR) for each examined index.

Physical development may be:

          harmonic, if determined individual indices of body weight and chest girth circumference have values М±1σR;

          disharmonic, if determined individual indices of body weight and chest girth have values from М-1.1σR to М-2σR or from М+1.1R to М+2σR due to increased fat deposity;

          sharply disharmonic, if determined individual indices of body weight and chest girth have values from М-2.1σR and low or from М+2.1σR and high due to increased adipopexis.

If the method of regression scales is used for the physical development assessment the conclusion has to be the following: Physical development of 10 years old Petrenko I. is average (above average, high, below average, low) according to the body length, harmonic (disharmonic, sharply disharmonic) according to the body weight and chest girth.

Fuethermore, this type of examination can determine one from four groups of physical dvelopment for this child: normal physical developmentif body weight is from М–1σR to М+2σR; body weight deficiencyif body weight is lower than М–1.1σR; body weight excessif body weight is more than М+2.1σR; low heightif body length if lower than М–2σ.

 

Assessment of physical development using complex method

 

Complex method of the physical develoment assessment includes both peculiarities of morphological and functional state of the organism and correspondence of the organism biological development to his chronological age (table 4).

Table 4

 

Assessment criteria of physical development of children and adolescents

(using complex method)

Level of biological development

Diagram of dependence of biological development, morphological and functional state

Morphological and functional state of the organism

Body weight, chest girth (М±sR)

Functional indices

 

Corresponds to the age

 

 

Harmonic

М±sR

М-s

and more

 

Ahead of chronological age

 

Disharmonic

М–1,1sR...М–2sR

due to body weight deficiency

М+1,1sR...М+2sR

due to increased adipopexis

М–1.1s...

М–2s

 

Behind the chronological age

Sharply disharmonic

М–2,1sR  and low

due to body weight deficiency

М±2,1sR  and more

due to increased adipopexis

М–2.1s

and low

 

At first, biological age of a child has to be determined based on the body length and annual body length increase, number of permanent teeth, secondary signs of sexual development, time of ossification of hand bones and compared with chronological age. Depending on the received data the biological age may be corresponding to the chronological age, ahead of or behind the chronological age.

Next stage of the complex method is assessment of morphological and functional state of the organism according to regression scales, age and sex standards of the functional indices development. Physical development may be:

          harmonic, if determined body weight and chest girth values are М±1σR or from М±1.1σR and functional indices have deviations from –1σ  and more;

          disharmonic, if determined body weight and chest girth values are from М-1.1σR to М-2σR or from М+1.1σR to М+2σR due to body weight deficiency or increased adipopexis and functional indices are from –1.1s to –2s;

          sharply disharmonic, if determined body weight and chest girth values are from М-2.1σR and low or from М+2.1σR and more due to body weight deficiency or increased fat deposity and functional indices are from –2.1s and lower.

If complex method is used for assessment of physical development the conclusion has to be the following: Physical development of 10 years old Petrenko I. is average (above average, high, below average,low), harmonic (disharmonic, sharply disharmonic), biological age corresponds to chronological age (ahead of chronological age, behind ones)”.

Level of biological development is determined based on correlation between its main signs and age and sex standards (tables 5 and 6) while using complex method of the physical development assessment.

 

Level of physical development according to the body length may be determined using regression scales or method of sigmal deviations.

As in a previous case there are five criteria of physical development according to the height: high, avobe average, average, below average, low.

Regression coefficient (Ry/х) reveals the value by which value of body weight (kg) or chest girth (cm) changes while body length increases or decreases by standard measurement unit (cm). Sigma-regression (sR) allows to determine the value of the individual body weight and thorax girth deviation from standard data of body length.

Assessment tables (regression scales according to height) are drawn using regression coefficient and sigma-regression. These tables allow to determine harmonicity of the organism development according to morphological indices. Comparing actual values of body weight and chest girth with their standard values for certain age and sex it is possible to identify level of the physical development harmonicity.

Difference between actual and standard values of the physical development index is divided by sigma-regression and the value of sigmal deviation is received, which allows to determine the level of harmonicity of the schoolchild’s physical development.

Assessment criteria of the organism physical development using regression scales are presented above. If a child has deviation of body weight from standard values more than ±3sR he/she should bee sent to the doctor-endocrinologist for further advice.

Method of standard sigmal deviations is used for assessment of functional indices by complex method.

Example: it is necessary to assess the physical development of 11-year-old girl with 148 cm body length, 37 kg body weight, 71 cm chest girth, 8 cm annual body length increase, she also has 20 permanent teeth and secondary signs of sexual development are the following: Ма1. Р1. Ах1. The doctor’s actions during physical development assessment include such steps.

First of all, the doctor has to compare data of examined girls with standards of biological development for 11 years old girls to determine level of biological development (table 5).

The values of examined girl must be the following: body length – 142.8±7.1 cm, annual body length increase – 6-8 cm, 21±3 permanent teeth, secondary signs of sexual development – Ма1. Р0.1. Ах0.1 according to the standards of biological development for 11 years old girls. In our example, indices of this girl’s biological development correspond to standard values. It means that level of biological development corresponds to chronological age.

Then assessment tables according to regression scales (table 8) are used for assessment of physical development. According to the table data this girl’s height corresponds to average, her physical development according to the body length is average. Next stepusing values of sigma-regression to find values of body weight and chest girth which this girl must have according to her height. According to the regression scales tables data body weight has to be 40.4 kg, sigma regression (sR)5.37 cm for 11 years old and 148cm height girls. Difference between actual and standard values is 37 – 40.4 = –3.4; value of the sigma regression deviation is –3.4 : 5.37= –0.63sR. These data reveal that this girl has harmonic development according to the body weight comparing to the height.

Correspondence of chest girth to body length of this girl is calculated in the same way. Chest girth has to be 70.7 kg, sigma-regression (sR)4.92 cm for 11 yeas old girls with 148 cm. Difference between actual and standard values is 71 – 70.7 = 0.3; value of sigma-regerssion deviation is 0.3 : 4.92= 0.06sR. This means that physical development of this girls is harmonic according to the chest girth comparing to her height.

If physical development is disharmonic or sharply disharmonic it is necessary to point the cause of revealed morphological and functional disorders (due to being overweight or underweight, small chest girth) and substantiate recommendations concerning physical development correction (increasing or decreasing of the food intake energy content, usage of other food products, implementation of active physical training, sport etc.).

 

Assessment of physical development using centile method

 

Centile method, opposed to traditional ones allows to assess physical development signs varying according to the normal distibution law. Centile method is effective non-parametric instrument to describe their distribution briefly which may have right-sided or left-sided asymmetry.

Essence of centile method means comparing of actual value of each separate index of the physical development to sorted series. These sorted series include 100 interval ranges of examined index. Probabilities of an index belonging to each of these intervals are equal, but sizes of those centile intervals are unequal in absolute units.

For determination of physical development level 7 fixed centiles are used: 3rd, 10th, 25th, 50th, 75th, 90th and 97th and corresponding 8 centile intervals:

          1st interval (below 3%) – very low indices;

          2nd interval (from 3% to 10%) – low indices;

          3rd interval (from 10% to 25%) – reduced indices;

          4th and 5th intervals (from 25% to 50% and from 50% to 75% correspondently) – average indices;

          6th interval (from 75% to 90%) – increased indices;

          7th interval (from 90% to 97%) – high indices;

          8th interval (above 97%) – very high indices.

Individual assessment of morphologicl and functional indices is carried out using single-measured assessment scales which include double-amplitude peaks (maximum and minimum values), centile tendency (median of sorted series) and 8 centile intervals. Such approach allows to determine both separate characteristics of the somatometric signs development and level of physical development harmonicity taking into account the fact, that 4th and 5th centiles of nomorgam correspond to harmonic physical development, 3rd and 6thdisharmonic, 1st, 2nd, 7th and 8thsharply disharmonic due to being overweight or underweight.

 

TRaiNING INSTRUCTION

on hygienic assessment of health state and physical development among organized children collectives

 

Comparative assessment of physical development level in different organized collectives or the same collective during study in modern school is carried out based on the determination of difference of main health state indices and physical development values using methods of mean arithmetic values comparison, algebraic number distribution and square deviation comparison, and correlation method.

While using method of mean arithmetic values comparison only indices of health state and physical development of similar age and sex groups have to be compared. First of all it is necessary to establish difference between mean values of comparative groups by using Student's test (t) calculation according to the following formula:

t =  ;

where: М1 and М2 - mean arithmetic-weighted values of comparative groups;

  m1 and m2 - errors of mean arithmetic-weighted values.

Assessment of Students test (t) includes the following parameters: if t value exceeds 3, than differences of mean values are valid (p<0.05), if t value does not exceed 3 - differences between mean values are invalid (p>0.05).

Example: deep medical examination was carried out among 10 years old schoolchildren in towns B. and K. Following physical development indices were revealed during this examination:

     in town В.: average body length of boys is 156.00±0.72 cm, average body weight – 44.40±0.38 kg.

     in town К.: average body length of boys is 151.00±0.58 cm, average body weight – 43.20±0.73 kg.

Assessment of validity of differences between schoolchildren’s body length and weight in mentioned above towns is carrying out by following way:

For body length:                   t =  =  = 5.6;

For body weight:                  t =  =  = 1.3.

10-year-old schoolchildren in town К. are significantly shorter than schoolchildren in town В. Additional research is necessary to identify main causes of this phenomenon.

While using method of algebraic number distribution, at first physical development of each child of organized collective is assessed and the assessment group is determined for each child. After that, the percentage of children in each group is calculated.

Validity of differences is calculated according to the following formula:

t =  ;

where: Р1 - number of children (%) in first comparative collective;

Р2 - number of children (%) in second comparative collective;

m1 - error of Р1;

m2 - error of Р2.

Error of percentage of children is calculated according to the following formula:

m1 =  ;

where: m1 - error of Р1;

Р1 - number of children (%) in first comparative collective.

Method of square deviation comparison is used for assessment of health state and physical development homogeneity according to the certain index. If standard deviation (s) value is higher, double-amplitude peaks of examined indices is also higher and, as a result, higher is the degree of their variability and heterogeneity.

Correlation method allows to discover the certain correlation between characteristics of health state and physical development by calculation of correlation coefficient (r). If value of r equals to 0 the correlation between examined indices is absent. On the contrary, if value of r equals to 1, correlation between indices is very strong, absolute, functional. If values of r are from 0 to 0.3, correlation is weak; if values of are from 0.3 to 0.5, correlation is moderate, if values of r are from 0.5 to 0.7, correlation is strong, if values of r are from 0.7 to 1.0, correlation is very strong. If value r is positive, correlation is direct (if one examined index increases - another one also increases), if value of r is negative, correlation is reverse (if one examined index increases another one decreases).

Preschool age includes fourth – sixth years of the life.

Protective-physiologic function and adaptation to the changed conditions of the environment are developed in this age period more intensive. But it is important to protect child from the external infections, invasions and other unpleasant influences in this age. Properties of the preschool age cause the necessarity to spreading quantity of hygienic measures, which have the stymulised, trending-steeling, but not only protective character. Movement games, especially with ball, natural movement and special physical exercises, partly such from them that are helped to development of muscles tone, exercises in sitting position, general and special measures to steel the organism against the cold are belong to these measures.

School age, as a rule, is the period of the education. They are different four stages of the school age: younger – to 10-12 years, middle or adolescent – to 14-15 years, earth youth and sexual puberty.

Together with hygienic protective measures on children of younger school age against different environment factors great meaning to stronger their health have continuous of the rational trending and steel of the organism in everyday life (regime of the day, rational nutrition, active kind of living), and special measures (rational physical exercises, games, sport, steel against the cold and other). Increasing the role of the hygienic education that plays integral part of the school studying.  

Middle and older school age is from the prepubertal state to the puberty. That is why somebody united these periods into one.

Practice of the medical observing shows that normalization of the mode of life and work furthers to caring the life and increasing of the adolescents’ ability to work.

Hygienic education of children is actual in all periods of the childhood. Questions of the hygiene are part of the biology, zoology, anatomy, physiology, physical training, chemistry, physics etc.

Sanitary-hygienic education of schoolchildren and fighting with the pathology further to increasing of pupils studying, chouse of the profession, ability to the work, decreasing of the illnesses in adult age.

The physical development of the child is complex of the morpho-functional properties of the organism, that case its stature and formation, and stock of its physical strength and ability to the work.        

Stature and development of the child are not only increasing of the sizes and weight of the body. It is complete complex of depth quality changes that are shows not only in morphological changes but in progressive development of its functional abilities. Modern practice of the dynamic stock of the children’s and adolescents’ health includes the examination of the physical development as a necessary element of the examination.

Systemic stock of health’s state and physical development of children and adolescent have the various meaning.

As a result of statistic analysis of data about health’s state and physical development of children forming adequate indexes that are used by the doctors to marking individual physical development of children and adolescents (so named “standarts”). Studying of these indexes gives the possibility to orientation in the changes of physical state of children’s population and roles of different factors that are cased these changes. Analysis of dynamic examining of the physical development of children gives the possibility to formation the main rules of growth and development of children.

Main conformity with the low of physical development of the children and adolescent:

Main conformity with the low of physical development of the children and adolescent:

As shows the knowledge of medical monitoring to the children’s and adolescents’ development here are:

a)          those who have staying of growth between common observing. This may be observe in the period of sexual development, or may be increasing of it;

b)          those who have staying in some indexes, especial attention is necessary to children who have increased indexes;

c)           those who have discordance, or unproportional body structure; for example, sexual period, when the extremites are long and trunk is short;

d)          those who fall behind in age necessarity in motor and static functions, have defect of the speach, carriage, deformations of the chest, of the vertebral colon, of the pelvis, of the  knee joins, flat-foot, defects of the teeth system, sings of the hypovitaminosis, decreased quantity of erythrosites and decreased hemoglobin in the blood, discordance in the pulse and arterial pressure, other early deviation in physical development course.

Determined measures may be show as such complex: active (despansering) observing of the children and adolescents.  All measures must content al main sides of the studying hygiene of the children and adolescents: rational nutrition, rational regime of the day, successive studying of the carriage, treatment physical exercises, taking of the property hygiene, systematic stomatologic control and sanation of the mouth.

Comprehensive development is connection between the physical and mental work. Organization of the health psychical area is based on the age properties of physical and nervous-psychical development.

What measures are used to the physical studying of the children and adolescents?

The main measures are:

1)          rational changes through the day different kinds of the work,

2)          physical exercises as: a) different exercises that are made every day with the aim of development and prophylactic of the motor apparatus, b) motor games and walks, c) gymnastic – active and passive (massage), d) sport and tourism, e) dosed physical work,

3)          using of the natural powers (light, air, water) and synthetic springs of the radiation,

4)          Rational nutrition.

5)          Favorable hygienic conditions of surrounding, accordingly clothes, furniture, and accommodation too.

6)          Inuring habits of personal hygiene.             

If systematic physical training and tampering is combined with rational regime of day effect will be more expressed. Rational regime is such proportion between rest and any varieties of activity when harmonious correlation between excitement and braking processes of cortex permit most optimal developing of organism. Possible to divide three type of regime of the day: which spare, which exhaust, and so-called stimulating. By first type of regime, the organism percept few irritators, which are monotonous and little amplitude. Children undeveloped physically and psychologically, appear elevated morbidity (so called `hospitality` of children). By severe regime the organism accept a lot of irritators with high amplitude, and diverse. Naturally if such regime is constantly repeated it cause over-extension of central nervous system. Gradually central nervous system will exhaust and produce delay of developing.

Main elements of regime of the day for children and teenager are:    1) Sleeping;2) Food; 3) Fresh air; 4) Hygiene of body and special tampering procedures; 5) Diversity of physical activity;6) Contact with children and teenagers, adults; 7) Different varieties of studying, working practice, esthetic upbringing. 8) Participation in socially useful working, aid to family; 9)Activity for satisfaction of individual interesting;

Hygienic demands for each of main elements of the regime are different, accordingly to different age groups.

In age before school rational regime includes suitable sleeping and unsleeping duration, duty of it accordingly to rhythm of eating, organization different care program for children, fresh air walking, games, and amusements.

For age before school, rational regime in upbringing institutions gradually alters. Essential difference, in comparison with older age before school, is :  more long fresh air walking, gymnastic classes, moving games, music. Gradually intelligent activity stays more difficult and longer (calculation, mother tongue).

On the basis of investigation of reaction schoolboys on the different combinations of the main elements of regime, was recommended by hygienists such scheme, essential positions are: duration of sleeping stay more short later, from 9 years, as result of refusing from sleeping in day (it is 1-1.5 hours every day); gradually sleeping in night stay more  short too. Long fresh air walking shorten too, but  in older school age period fresh air walking must be not less then 2-2.5 hours every day,  in  weekend –half of day.

Studying – organized and planned process of mastering certain knowledge, abilities and habits. Main elements of studying have place in all age periods of upbringing but are different: sense, volume, features, methods, forms of organizations and conditions of studying on different degrees of child’s development.

 On special classes, yet in before school age, elements of studying have place in moving games. It is studying games, in a day regime in crèche, child’s home they take relatively short time. Studying in before school age, get a planned feature , carry out in every day special classes by certain program –moving games, sculpture classes, constructing from paper or cardboard, music classes. Gradually elements of game disappeared, children’s efforts increase.

Hygienic demands of school age and before school age, must provide  as surrounding, so regime of the day.

Considered, in junior before school age lesson must continue not over 15 minutes on the beginning of period and not over 20 in the end , for middle before school age lesson must continue not over 25 minutes for senior  before school age lesson must continue not over 25-30 minutes.

For senior before school age are planned two lessons with interruption between them 10-15 minutes. Here first must be lesson from calculation or mother tongue, second –drawing, sculpture, music, gymnastic. Regime of the lessons for senior before school age, must be gradually approximated to day regime of first form.

Hygienic demands to the regime of school day include such aspects of school upbringing: schedule of the day, rational organization of time after lesson, rational integration of physical and mental activity, organization of  home working preparing.

Systematic investigation of different authors by usage of direct and mediocre physiologic, psychological, pedagogical methods showed typical dynamic of mental activity of schoolchild during  common school day.

Visible decreasing of the ability for the work in schoolchild of junior school age appear after 1.5 hour of lesson, in schoolchild of  middle and senior school age appear after 2-3 hours of lesson. Pupils of senior school age, feel on the six lesson changes of capacity of the work and physiologic functions, which show weakness of excitements in brain cortex.

Concerning optimal duration of the lesson was proofed on the practice -45 minutes. In a school for children with psychological, neurological or rheumatic diseases optimal duration of the lesson 40 minutes.  As a measure, which promote and safe capacity of the work, is important organization and structure of lesson, especially in junior forms, volume and features of home work. The special investigation shows that maximal capacity of the work coincide  with  such days as Wednesday, Tuesday ;minimal capacity of the work coincide with Saturday. Concerned  oscillation of capacity of the work during  the day, peak  coincide with 2 and 3 lesson, minimum coincide with 5 and especially 6 lesson. First lesson, obviously,  is period of accustoming for studying. So, subjects which need more intelligent efforts and are not obvious, for example mathematics, foreign languages more effective teach on second and third lessons.

Investigation of different authors proofs that physical working for schoolchild is variety of active rest. It improves quality and speed of simple psychical and according verbal reactions. Special investigation express that lesson of hand working, in school working classes and lesson of physical training improve capacity of the work not only after that lessons, but after this school day. Most effective when schedule includes such lesson in Monday, Thursday, Friday; on the third lesson in junior forms; on the forth lesson in senior forms.

Evaluation of exams and investigation proof that main factors, which cause functional disturbances of pupil’s organism in exams period and before exams (changes to worse in appetite, sleeping; disturbances of equilibration between excitement and braking in cortex, loose of weight), are: regime of day is not optimal; decrease of duration active rest and sleeping; irregular eating and walking on the fresh air. Especially influence has bad emotions. The  main hygienic demands for exams are: decrease numerous of them as possible, children with psychological, neurological or rheumatic diseases must be liberated from some exams; it is for schoolchild  don’t  loose rational day regime; and at last   exams must be provided  in tranquil psychical environment.

Working training, in favor hygienic conditions, in combination    with mental activity increase the brain tone and develops muscular system: improves differentiating in moving analysator; coordination of hands; increase the maximal muscular effort; endurance to static muscular effort.

The changes of  activity during  the lesson, make limited ability of active rest of children, especially for posture of the body. Interruptions between lessons, during pupils make personal doings by their  willing, as showed investigations are necessary and very effective type of rest.

The main conditions, which promote hygienic effectiveness of interruptions between lessons are:

1.          Moving activity during interruption between lessons;

2.          Being pupils on fresh air during interruption, fresh air favor and promote quality of air surrounding and microclimate in class rooms and corridors of school buildings, because improve  through-ventilation of school accommodations.

3.          Removing over activity  of pupils during interruption, for example games such as football, basketball. In  this case  period of accustomation  to studying  will increase on beginning of the next lesson.

4.          Using third or  forth interruption for organization warm eating for pupils .

5.          Optimal duration of interruption.

Observation for effectiveness of interruption show, that duration of interruption don’t must  be less then 10-15 minutes.

Sunday ,free day from studying,  must use for being on the fresh air, with moving, for excursion  in suburban , sport training, personal doings.

Main means for fighting with over-extensions pupils from home work, which cause  disturbances of sleeping, shorten time of fresh air being, are:

1.          Rational week-schedule which suggest certain volume and features of home work from separate subjects.

2.          Perfection of organization and methods of teaching  for separate themes of subjects, such as perception of material on the lesson, by teacher correction,  take the main part in studying  process.

3.          Systematic check from tutor and  school doctor for volume of home work.

During preparing of home work, through each 40-50 minutes ought to do  10-minutes  interruptions, for active moving on the fresh air or in accommodation with opened windows. 

Situation of studying institutions  for teenagers and children is caused by rational combination of such two principles:

1.          Supplying of studying institutions  for teenagers and children for optimal microclimate, fresh air, high level of social and sanitary facilities, far from city noises too.

2.          Territorial  access  for service stuff accordingly to profile  of service.

Radius  for service must be for crèche 0.5 km,  for school 1/2-3/4 km(pupils of junior  forms) and 1-1.5  for pupils of  middle and senior  forms);and 2-3 km in village –accordingly to  low  density of population.

Ground plot of studying institutions  for teenagers and children- the base for  sanitary benefits. They must be entire structure, be defended not only from  fabric or street noises, but from contamination of air and soil too. Sonority of noise must not be over then 40 decibels. For additional defense of studying institutions  for children from noise and dust, it must be situated  in center of area  on 20-30 m. and, at any rate,  not less then 15 m. from red line of building.

TECHNIQUE of ANTHOPOMETRICAL MEASUREMENTS

       Somatometrical  attributes. Growth standing and sitting measure with the help wooden restorer or metal anthropometry (fig. 20). Wooden restorer represents the rack in height up to 2 m with divisions on 0,5 sm, it is good on a strong platform. On the rack moves Mehta with plantlet. For definition of growth sitting there is on a restorer platform folding bench.

      Measurement of growth standing. Surveyed stands directly, hands on seams, socks separately. Thus it concerns the rack restorer, buttocks and interscapular area. The head should be in such position that the line which has been mentally carried out from the top edge of an ear up to the bottom edge of an eye-socket, was horizontal.

      Measurement of growth sitting. Surveyed sits on a bench rostomer, concerning its rack interscapular area and buttocks. Position of a head such, as at measurement of growth standing. Legs are bent in knee joints under a right angle. A foot lean about a floor or a support. Hands lay along hips.

   Growth standing or sitting can be measured also metal antropometr which consists of four empty tubes. Being are inserted one into another, they form a bar in length of 2 m with millimetric divisions. On the end of the top tube motionlessly muphta with a metal ruler, the second mupht with incisura through which divisions are visible, freely may move on a bar antropometr. The ruler is inserted into this mupht by the oblique end up.

At measurement of growth antropometr a position surveyed same, as at measurement of growth with the rostomer. Surveyed becomes a back to wall, antropometr establish vertically ahead it, and a ruler antropometr lower on apical point of a head. With the help metal antropometr it is possible to determine the sizes of a trunk, top and

The bottom finit enesses etc. For exact measurement use anthopometrical points; for example, at measurement of length of the top finitenesses use humeral and manual points. The mistake at measurement should not exceed 0,5 see.

Definition of body weight.

 For weighing use medical weights. To the top part there are two rods with divisions. Divisions into the bottom rod correspond to tens kgs (10, 20.), on top divisions through everyone are designated 50.  Balance before weighing should be verified. Weighing make on an empty stomach, without clothes and footwear. Surveyed becomes on middle of a platform of weights.

  Measurement of circles. For measurement of circles (heads, a chest cell), a shoulder, a hip, a shin…) - use a steel roulette or a usual centimetric tape. A circle of a chest cage measure in a condition of rest, the maximal breath and the maximal exhalation. A tape I put behind on the bottom corners scapulaes at the lifted hands. Then hands omit, and a tape, sliding off, lie under corners scapules. At men and the tape should pass children in front on overnipped territory a mug, at women on IV edge. In time, a deep breath and an exhalation the tape should follow without a delay movement of a chest cage.

Somatoscopic attributes. At survey (somatoscopia) pay attention to a condition of integuments and mucous membranes (color, cleanliness, and humidity), a degree feeting, a condition of the impellent device (skeleton, the form of a chest cage, a backbone, the form of legs and stops).

Feetling-development hypodermic fatty layer - objectively determine measurement of thickness fatty on a stomach (at a umbilical level on 5-6 Sm sideways from it and under scapula). Measured small tolstostnim compasses thickness divide half-and-half. Average count feetling at thickness fatty from 1 up to 2 sm, is lower - at thickness fatty less than 1 sm, is above the average at thickness more than 2 see.

        Skeleton. Distinguish three types of skeleton: thin, muscular and intermediate between them. Thin it is characterized by narrow shoulders and a chest cage, the small sizes of brushes of hands and a foot; thickset wide shoulders and a chest cage, in the big sizes of brushes of hands and a foot.

        Forms of a chest cage. Distinguish the cylindrical, conic, flat and mixed chest cage. A chest cage of the cylindrical form at

Examining in front and sideways looks in regular intervals advanced in the top and bottom departments, underthoracical the corner shaped forms and on size comes nearer to 90 °. The chest cage of the conic form has more

Bottom department wide and acting forward in comparison with top. Underthoracical corner big, more than 90 °. The flat chest cage usually has lengthened form; underthoracical  corner is narrowed and, it less than 90 °. At younger age frequently there are mixed forms of a chest cage. May to be combined rachitic and it is rare forms.

            Backbone. Distinguish normal, lordical, kiphotical. The normal backbone in sagital planes has the 5-shaped form. Cervical and lumbar curvature is insignificant, inverted forward, chest camber is inverted back. For lordical small cervical curvature and sharply expressed lumbar is characteristic. At kiphotical backbone all three lines are expressed sharply.

             The right and left-hand scolioses of a different degree concern to deformations but. At a scoliosis of the first degree feebly marked asymmetry of shoulders, scapulaes is marked. Defect has no proof character at a pressure of muscles is corrected. The second degree is characterized by a steady curvature of a backbone to the right or to the left, presence muscular kompensational platens. At the third degree are marked deep the curvatures accompanying with deformation of a chest cage. Beginning changes of a backbone can be found out the following simple way: will carry out with known pressing by a finger on tops awned vertebras - on a formed red strip judge deviations in a bend of a backbone.

The form of legs.

Distinguish normal, Х-shaped and 0-shaped forms of legs. At definition of the form of legs surveyed puts together, socks divided. At the correct form of a leg adjoin in the field of knee joints, at the 0-shaped form knee joints do not adjoin, at Х-sharped -оne knee joint comes for another.

      The form stops. Distinguish to stop normal, and flat. For revealing плоскостопия investigate prints stops (plantographia). With a solution метиленового dark blue with the help of a wadded tampon moisten to stop and put the child on the clean sheet of a paper unwrapped on a floor - on it there are dark blue prints. For wetting stop also it is possible to use 10 % a solution halfchlorical iron, the paper at it is moistened 10 % with a solution of tannin in spirit.

The analysis of a print stops.

 On the received print (fig. 21) stops will carry out(spend) a tangent to the most acting points of internal edge(territory). From Middle of a tangent restore a perpendicular up to external edge stops. Then calculate percentage of length of that part of a perpendicular which has passed through a print (а), to all length (б).

If the isthmus makes up to 50 % from length of a perpendicular, - stop normal, 50-60 % -flatted, over 60 % - flat.

Estimation of a degree of puberty.

 Degree of puberty of girls estimate on hairing axillary hollows (Ah) and pubis (Р), to development dairy glandula (Ма), time of occurrence of the first menstruation and establishments menstrual cycle.

   At boys take into account hairing  axillary hollows and pubis, a mutation of a voice (V), hairing  persons (Р) and development of an adam's apple (Ь). The degree of development of an attribute is defined on following system:

Hairing axillary hollows (Ah)

Ахo - hairing  is absent;

Ах1 - individual hair;

Ах2-The rare hair located on small central

 Site of an axillary hollow;

Ах3 - the rich direct hair located on all surface

Axillary hollow;

Ах4 - rich twisted hair.

Pubical  hairing (Р)

Р0- hairing is absent;

Р1 - individual hair;

Р2 - the smooth hair located on the central pubis site;

Р3 The rich direct hair in regular intervals located on a pubis surface with a precise horizontal line;

Р4 - the rich, twisted hair in regular intervals located on all

Surfaces of hips and in a direction to umbilica (man's hairing type).

Development dairy glandula(Ма)

Ма0 - dummies above overnipped a circle it is not lifted, dairy,

Some iron does not give out;

                             Ма1 - dummies it is lifted above overnipped a circle, dairy iron does not give out;

                      Ма2 - dummies and overnipped the circle acts as a cone,

dairy iron it is a little bit raised;

                      Ма3 - dummies and overnipped  a circle keep the form of a cone, iron it is lifted on the big space;

                              Ма4 - dummies rises above overnipped a circle, dairy iron it is generated.

Person’s hairing (F)

F0- hair is absent;

F1 - beginning hairing above a upper lip;

F2 -  hairing bove top  their occurrence in the field of a chin

F3- hairing distribution above a upper lip and in area chin with the tendency to merge of the specified zones, the beginning

Growth of whiskers;

F4 - clear merge of hairing  zones above a upper lip and

Areas of a chin with the tendency to submaxillary hairing

The areas, the expressed growth of whiskers.

Development of a thyroid cartilage of a throat - adam's apple (L)

L0 - absence of attributes of growth of a thyroid cartilage of a throat,

L1 - small  thyroid cartilage of a throat;

L2 - distinct extraposit.

Mutations of a voice (V)

V - a children's voice;

V - a voices mutation;

V - a man's timbre of a voice.

      Physiometrical attributes. Vital capacity easy measure with the help of the water spirometer consisting from external and internal  cylinders. On a forward wall of the internal cylinder divisions on which it is counted amounts of inhaled air (in milliliters) are put. On a cover of the cylinder there is an aperture with a rubber fuse. It open, when the internal cylinder should be lowered on a necessary bottom. Below there is a crane connecting to the internal cylinder on which put on a rubber tube with a glass mouthpiece on the end. Before work the water level should be on "0". Surveyed makes the maximal breath, having detained breath, densely. Clasps a mouth a mouthpiece and exhales in a tube all air, having excluded an exhalation through a nose. It is made 2-3 measurements, write down the greatest parameter.

       Muscular force of hands determines a manual dynamometer.

Surveyed maximum tries to compress a spring of a dynamometer at the hand extended and allocated aside. Take into account the maximal result in kgs. For the following measurement an arrow returns in zero position.

Stand-force determines with the dynamometer help (fig. 22, б). Surveyed fixes dynamometer by legs, bends down and trying it is unbent maximum, pulls hands the handle of the device which should be at a level of knees. Take into account the maximal result.

The physical development of child is a complex of the morpho-functional properties of organism, its stature and formation, and stock of its physical strength and ability to work.

Stature and development of child are not only simple increasing of sizes and weight of the body. It is complete complex of deep quality changes that are shown not only in morphological changes but also in progressive development of its functional abilities. Modern practice of the dynamic stock of the children and adolescents' health includes the examination of the physical development as necessary element of the examination.

Systemic stock of health's state and physical development of children and adolescent have the various meaning.

As a result of statistic analysis the health's state data and physical development of children form adequate indexes that are used by the doctors in marking of individual physical development of children and adolescents (the so called "standarts"). Studying of these indexes gives the possibility to orientate in the changes of physical state of children's population and roles of different factors that cause these changes. Analysis of dynamic examining of the physical development of children gives the possibility to form the main rules of growth and development of children.

To somatometric index belong length and weight of body, circumference of thorax and head, shoulder, thigh, etc. To phisiometric - muscle force of arms, legs.

To somatoscopic index belong state of skin and mucous covers, state of fat tissue, state of bone tissue (shape of chest, cord, legs and feet).

Measuring of height

a.     standing, by wooden heightmeter

b.      sitting, by wooden heightmeter

c.      standing, by antropometer

 

Scheme of plantography evaluation

a.                                  normal       b. flattened           c. flat

The main conformity with the low of children and adolescent physical development are:

1.     Rates and character of physical development of children and adolescent are caused by natural individual and heredities properties and by material conditions of life (life level, nutrition, home, the day regime, care, physical training).

2.      Especially worth the physical development of children and adolescent during the war and hunger.

3.      The whole organism and its parts grow unevenly.

4.    At the adolescent and young age the stage of the physical development has influence on heart’s rhythm, arterial pressure's level (bradycardia, youth hypertension).

5.    Sexual differentiation is noticed at the early youth period: girls at the age of 11-12 years and boys - 12-13 years old.

6.      Some author observe seasonal differences in the intensity of child’s growth, for example the growth into the length is in spring and summer, but into the weight - in autumn and winter, that depends on movement of the child.

7.    Course of the development is shown in processes of moving development, bonding, terms of teeth's appearance and in process of sexual development.

8.      Infection diseases (malaria, tuberculosis, helminthes invasions), long lasting somatic disorders, which cause the damages of substances changes, damages of digestion (rachitis, diabetus melitus, thyreotoxicosis, hypothyreosis, kidneys' disease, liver's diseases, blood's disorders), damaging of central nervous system have great influence on the physical development.

Physical development of children and teenagers is estimated by means of somatoscopic (antroposcopic), somatometric (antropometric), and phisiometric indexes and is explained by sigmal deflection. To somatoscopic index belong state of skin and mucous covers, state of fat tissue, state of bone tissue (shape of chest, cord, legs and feet). Signs of sexual maturity (hair under arms and on the pubic area, development of mammary glands in girls, mutation of voice in youth, appearance of hair on face, development of  thyroid cartilage of larynx). To somatometric index belong length and weight of body, circumference of thorax and head, shoulder, thigh, etc. To physiometric - muscle force of arms, legs.

Valuation of physical development is made on basic individual sign and average normative meanings (normal sign of physical development) for each group of people, which live in the same conditions.

Valuation of physical development by sigmal method.

Method of sigmal deflection with graphic scene of physical development explains its actual decline from normal meanings, when we divide the factual deflection on value of the middle estimation.

The method of sigmal deflection with graphic scene of profile physical development foresees comparing of each individual sign with a middle arithmetic value for that age, that permit define its factual decline from normative meanings.

Further, with the help of dividing of factual decline on value of the middle square deflection find the sigmal decline that gives information on which value of sign distinguish factors of the child, which is researched from the middle meanings, which is typical to define age.

Processing of antropometric factors

Result of research is brought to the table. In column 1 in decreasing or increasing order are brought values of growth, weight of the body and volume of the thorax, which is met in given group and it is marked by letter 'а'.

In another column ('p') we can put the number of the accidents with 1 value of sign. In third column ('m') we write the middle meaning which is defined by multiplying a and p and dividing on number of sign ('n'). In column 4 we calculate declination of each of variant from the middle (M) and mark in column 5 - each deflection is taken to the square (d2) and multiplied to the frequency of variant (p) and divided on number of accident (n) and mark the middle square:

δ =Σ d2 x p/n.

The way of dividing d/δ one can find the sigmal decline, which shows the number of sigma on which deflect the factors of child’s research from the middle sign. The profile of physical development of child is estimated by means of sigmal meanings.

Hygienic demands to current sanitary-epidemiological school state. Hygienic demands for each of main elements of the regime are different, accordingly to different age groups.

In age before school rational regime includes suitable sleeping and unsleeping duration, duty of it accordingly to rhythm of eating, organization different care program for children, fresh air walking, games, and amusements.

For age before school, rational regime in upbringing institutions gradually alters. Essential difference, in comparison with older age before school, is: more long fresh air walking, gymnastic classes, moving games, music. Gradually intelligent activity stays more difficult and longer (calculation, mother tongue).

On the basis of investigation of reaction schoolboys on the different combinations of the main elements of regime, was recommended by hygienists such scheme, essential positions are: duration of sleeping stay more short later, from 9 years, as result of refusing from sleeping in day (it is 1-1.5 hours every day); gradually sleeping in night stay more short too. Long fresh air walking shortens too, but in older school age period fresh air walking must be not less then 2-2.5 hours every day, in weekend –half of day.

Studying – organized and planned process of mastering certain knowledge, abilities and habits. Main elements of studying have place in all age periods of upbringing but are different: sense, volume, features, methods, forms of organizations and conditions of studying on different degrees of child’s development.

On special classes, yet in before school age, elements of studying have place in moving games. It is studying games, in a day regime in crèche, child’s home they take relatively short time. Studying in before school age, get a planned feature, carry out in every day special classes by certain program –moving games, sculpture classes, constructing from paper or cardboard, music classes. Gradually elements of game disappeared, children’s efforts increase.

Hygienic demands of school age and before school age, must provide as surrounding, so regime of the day.

Considered, in junior before school age lesson must continue not over 15 minutes on the beginning of period and not over 20 in the end, for middle before school age lesson must continue not over 25 minutes for senior before school age lesson must continue not over 25-30 minutes.

For senior before school age are planned two lessons with interruption between them 10-15 minutes. Here first must be lesson from calculation or mother tongue, second –drawing, sculpture, music, gymnastic. Regime of the lessons for senior before school age, must be gradually approximated to day regime of first form.

Hygienic demands to the regime of school day include such aspects of school upbringing: schedule of the day, rational organization of time after lesson, rational integration of physical and mental activity, organization of  home working preparing.

Systematic investigation of different authors by usage of direct and mediocre physiologic, psychological, pedagogical methods showed typical dynamic of mental activity of schoolchild during common school day.

Visible decreasing of the ability for the work in schoolchild of junior school age appear after 1.5 hour of lesson, in schoolchild of middle and senior school age appear after 2-3 hours of lesson. Pupils of senior school age, feel on the six lesson changes of capacity of the work and physiologic functions, which show weakness of excitements in brain cortex.

Concerning optimal duration of the lesson was proofed on the practice -45 minutes. In a school for children with psychological, neurological or rheumatic diseases optimal duration of the lesson 40 minutes. As a measure, which promote and safe capacity of the work, is important organization and structure of lesson, especially in junior forms, volume and features of homework. The special investigation shows that maximal capacity of the work coincide with such days as Wednesday, Tuesday; minimal capacity of the work coincide with Saturday. Concerned oscillation of capacity of the work during the day, peak coincide with 2 and 3 lesson, minimum coincide with 5 and especially 6 lesson. First lesson, obviously, is period of accustoming for studying. So, subjects which need more intelligent efforts and are not obvious, for example mathematics, foreign languages more effective teach on second and third lessons.

Investigation of different authors proofs that physical working for schoolchild is variety of active rest. It improves quality and speed of simple psychical and according verbal reactions. Special investigation express that lesson of hand working, in school working classes and lesson of physical training improve capacity of the work not only after that lessons, but after this school day. Most effective when schedule includes such lesson in Monday, Thursday, Friday; on the third lesson in junior forms; on the forth lesson in senior forms.

Evaluation of exams and investigation proof that main factors, which cause functional disturbances of pupil’s organism in exams period and before exams (changes to worse in appetite, sleeping; disturbances of equilibration between excitement and braking in cortex, loose of weight), are: regime of day is not optimal; decrease of duration active rest and sleeping; irregular eating and walking on the fresh air. Especially influence has bad emotions. The main hygienic demands for exams are: decrease numerous of them as possible, children with psychological, neurological or rheumatic diseases must be liberated from some exams; it is for schoolchild don’t loose rational day regime; and at last   exams must be provided in tranquil psychical environment.

Working training, in favor hygienic conditions, in combination    with mental activity increase the brain tone and develops muscular system: improves differentiating in moving analysator; coordination of hands; increase the maximal muscular effort; endurance to static muscular effort.

The changes of activity during the lesson make limited ability of active rest of children, especially for posture of the body. Interruptions between lessons, during pupils make personal doings by their willing, as showed investigations are necessary and very effective type of rest. The main conditions, which promote hygienic effectiveness of interruptions between lessons, are:

1.Moving activity during interruption between lessons;

2.Being pupils on fresh air during interruption, fresh air favor and promote quality of air surrounding and microclimate in classrooms and corridors of school buildings, because improve through-ventilation of school accommodations.

3.Removing over activity of pupils during interruption, for example games such as football, basketball. In this case period of accustomation to studying will increase on beginning of the next lesson.

4.Using third or forth interruption for organization warm eating for pupils.

5.Optimal duration of interruption.

Observation for effectiveness of interruption show that duration of interruption doesn’t must be less then 10-15 minutes.

Sunday, free day from studying, must use for being on the fresh air, with moving, for excursion in suburban, sport training, and personal doings.

Main means for fighting with over-extensions pupils from home work, which cause disturbances of sleeping, shorten time of fresh air being, are:

1.Rational week-schedule, which suggest certain volume and features of homework from separate subjects.

2.Perfection of organization and methods of teaching for separate themes of subjects, such as perception of material on the lesson, by teacher correction, take the main part in studying process.

3.Systematic check from tutor and school doctor for volume of homework.

During preparing of homework, through each 40-50 minutes ought to do 10-minutes interruptions, for active moving on the fresh air or in accommodation with opened windows. 

Situation of studying institutions for teenagers and children is caused by rational combination of such two principles:

1.  Supplying of studying institutions for teenagers and children for optimal microclimate, fresh air, and high level of social and sanitary facilities, far from city noises too.

2.Territorial access for service stuff accordingly to profile of service.

Radius for service must be for crèche 0.5 km, for school 1/2-3/4 km (pupils of junior forms) and 1-1.5 for pupils of middle and senior forms); and 2-3 km in village –accordingly to low density of population.

Ground plot of studying institutions for teenagers and children- the base for sanitary benefits. They must be entire structure, be defended not only from fabric or street noises, but also from contamination of air and soil too. Sonority of noise must not be over then 40 decibels. For additional defense of studying institutions for children from noise and dust, it must be situated in center of area on 20-30 m. and, at any rate, not less then 15 m. from red line of building.

TRAINING INSTRUCTION

on hygienic assessment of land plot, building, training premise (school class) and conditions of pupils’ stay at the schoolhouse

Land plots for general educational establishment buildings must be located in settlement, meet sanitary norms concerning appropriate distance from points of harmful substance emission, noise, vibration, electromagnetic and ionizing irradiation. It is prohibited to locate educational establishments in sanitary-protection zones of industrial enterprises and other objects which can be potential sources of environment pollution with dangerous factors. Building at the land parcel is allowed if all technical documentation for power and water supply, sewerage, heating etc. are presented and approved by territorial establishments of State sanitary and epidemiological service of Ministry of Public Health of Ukraine.

Sanitary-protection zone width between border of school land plot and surrounding objects must be not less than 50 meters. Building of general must be located at 100-170 meters distance from driveway.

Service radius - distance from pupils’ residence to general educational establishment must be not more than 0.5 km on foot. Thus, in case of access using public transport, the most acceptable radius for pupils of I level (elementary school) is 15 minutes travel, pupils of II-III level (main or incomplete secondary and secondary or high school) – 30 minutes.

Service radius for schools of I level in rural areas must be not more than 2 km and not more than 15 minutes to school on foot. Maximum service radius of pupils of II-III level of school may not exceed 15 km.

Special transport (school bus) must be used to take pupils to educational establishment in rural areas. Pupils, who live at 3 km and more distance from school, must be served by transport with pre-determined stops. Distance from resident place to the stop of such transport must not exceed 500 meters.

Buildings of general schools are located not more than 25 meters distance from red line of the land plot. Distance from border of school plot to residential building walls with entrances and windows must be more than 10 meters.

Green protection zone (trees, bushes, laws) of 1.5 meters wide (from street side – not more than 3 meters) is provided along the perimeter of the land plot.

There is 1.2 meters high fence around the territory of educational establishment. It is allowed to use 1 meter high green fence if schoolhouse is located inside residential areas.

Green area of land plot of general education establishment must be 45-50% from its total area. Green area may be decreased to 30% if land plot is adjoin to green areas (parks, gardens, squares) or school is located in rural area.

Type of allocation and orientation of main functional premises in general establishments must provide permanent 3-hour duration insolation per day. Due to this, tall trees are planted not more than 10 meters distance from educational establishment walls with windows, bushes – not more than 5 meters distance. It is prohibited to plant thorn trees, bushes and plants with poisonous berries, grow mushrooms near the school.

Land plot of general educational establishment is divided on following functional zones: training zone, training and labour zone, training and research zone, physical training and sport zone, rest zone, economical zone, residential zone and agricultural zone (for schools in rural areas).

Data concerning content and area of certain functional zones of land plot of general school are presented in table 1.

Table 1

Contents and area of certain functional zones of land plot of general school, m2

Zone

Elementary school

Main

(incomplete secondary)

Secondary (high)

1. Training and research zone:

- area for elementary classes

200

200

400

- meteorological and geographic areas

-

50

100

- class to study outside (with covering)

-

20

30

- area for vegetables

-

800

1200

- orchard and seed-plot of flower and ornamental plants

40

100

400

- greenhouse with zoo area

-

170

170

- zoo area

-

100

100

- area of plant collection

-

70

350

- area for primary pre-conscription training

 

 

1000

i n c l u d i n g :

 

 

 

- training place for tactical training and civic defence

 

 

500

- area for grenade throwing

-

-

500

2. Physical training and sport zone:

- school stadium

with 250 m running-track and 100 m straight running-track, combined field (60 m х 28 m) for football playing, area for handball playing with two sectors for high and broad jumping etc.

-

4200

4200

- areas for sport games:

 

 

 

- volleyball and basketball

162

364

526

- area for gymnastics (1-4 years pupils)

200

200

200

- area for gymnastics (5-12 years pupils)

-

200

200

- combined area for sport games, ball throwing, high and broad jumping

480

480

480

3. Rest zone:

- areas for outdoor games for 1 year pupils

100

100

100

- areas for outdoor games for 2–4 years pupils

300

300

300

- areas for outdoor games for 5–12 years pupils

-

-

125

- areas for calm rest for 5-12 years pupils

-

-

160

 

It is useful to locate the physical training and sport zone along the land plot from North to South near the training zone but not near the windows of elementary school premises.

Areas for outdoor games with ball and throwing of sport equipment are located not more than 25 meters distance from windows of training and training and additional premises of schoolhouse building, areas for other types of physical training – not more than 10 meters distance.

Sport areas must be with hard and obligatory flat surface for trauma prevention. Running track is equipped around football ground and includes straight 100 meters running track for sprinter competition.

Pits for high and broad jumping must be filled with sand mixed with sawdust, their borders are covered with rubber except front one. Drainage systems are necessary in the design of running tracks and sport areas (for volleyball, basketball, handball).

Combined area (if they are equipped) may be paved with asphalt or cement, but football ground must be covered with grass obligatory. It is prohibited to carry out physical training in damped areas.

Areas for 1-4 years pupils must be equipped with shadow shelters, descending hills, swing, cement wall for playing with ball, benches, hard surface tracks for roller skating and bicycling, shallow swimming pool etc. 

All children must be familiar with rules of the sport inventory and equipment usage. Sportswear and shoes must obligatory be dressed during physical training at sports grounds.  

Areas for physical training are fenced with green plantations from each other. Play areas are sown with low grass if they are near the schoolhouse building.

Economical zone has separate entrance and is located near the training (training and field) zone and canteen premises. There are repair shops, storehouses, garages, garbage recipients, barn and manufacture premises in this zone. Garbage tanks are closed with lids tightly and located at not more than 25 meters distance from canteen windows and entrance on asphalted or cemented ground under the shelter.

There is an asphalt or cement surface on approaches to schoolhouse building (not more than 100 meters distance), driveway, pedestrian approaches to economical premises and outdoor public conveniences in rural schools without sewerage.

Campuses for pupils, and if required – teachers and other personnel are located in the residential area of the land plot, which must have separate entrance from the streets and driveways and be at least 100 meters far and isolated from the economical zone.

Sanitary gaps between sleeping buildings and residential zone border must be not less than 50 meters distance. Distance between sleeping buildings and motorway must be not less than 150 meters, to economical zone – not less than 100 meters. 

Areas for outdoor games of rest zone are located near premises exit and divided between pupils of each age group for their maximum usage during breaks.

It is prohibited to use enclosed court of schoolhouses for economical needs (car parking, location of furniture, equipment, spoil sheet, metal scrap and construction materials).

Training and research zone must be not more than 25% of total land parcel area. This zone may be decreased in urban schools to make room for hotbeds, greenhouses and conservatories, connected with complex of studying rooms of natural direction (biology, chemistry).

Land parcels of rural schools may be enlarged at the account of hotbeds, greenhouses, conservatories, premises for agricultural engineering, lawn-and-garden inventory storage.

Building of general educational establishment must provide optimal conditions for the pupils’ training and education, rest and nutrition. Based on the above, it is necessary to locate this building such way that lighting and insolation level of training premises would be optimal, connection between land parcel and building – the most rational.

There are compact, block (block-section) and pavilion systems of architectural and planning compositions to maintain educational establishments (fig. 1). Two last of them are the most advisable for usage in modern conditions. There are maximum three parallel classes for same age children or two parallels for adjacent age groups (1 and 2 years pupils, 3 and 4 years pupils etc.) in one section.

Fig. 1 Main types of architectural and planning compositions of educational establishment buildings

(А – compact; B – block; C – pavilion)

 

Buildings of general educational establishments must have not more than three floors. If such type of educational establishment is located in previously built four or five floor premises, rooms with minimum load are located at fourth and fifth floors.

Number of pupils in school must not exceed the projected capacity in modern educational establishments.

There are functional groups of training premises such as classrooms, study rooms, laboratories, blocks (rooms) for working education and occupational orientation, extended day rooms, physical training and sport premises, canteen premises, medical block, assembly hall, library, administrative and supplementary premises etc. in educational establishment building.

Data concerning contents and recommended area of main premises of general educational establishment are represented in table 2. Areas of premises are given taking into account that a classroom is for 25 pupils. If there are 30 pupils in a classroom in general schoolhouse, it is allowable to use the area of classrooms, universal study and specialized rooms accounting for 2.0 m2 area per 1 pupil for general classrooms and 2.4 m2 per 1 pupil – for laboratories of natural sciences.

Table 2

Contents and recommended area of main premises of general school

Name of premise

Area per one pupil, m2

Note

1. Premises for school of I level (1-4 years):

Premises for pupils of 1st year:

- classroom

2.4

 

- sleeping room

2.0

 

- game room

2.0

 

- recreation

1.0

 

- toilets

0.2

 

- cloakroom

0.2

 

Premises for pupils of 2nd-4th years:

- classrooms

2.4

 

- premises for pupils on duty (for each class)

 

wardrobe for clothes 3 m2, wardrobe for technical equipment

- sleeping rooms for pupils with health disorders

2.0

 

- workshop for working education of younger pupils (for 25 places with inventory)

3.6

6 m2

- universal hall (for physical training, rhythmics and choreography with inventory premise)

 

144 m2 +6

- checkroom for girls and boys (12-13 places)

 

18 m2 ×2

- shower rooms with lavatory

 

7 m2 ×2 (two shower cabins, 1 lavatory and 1 wash sink)

- recreation

2.0

 

- cloakroom

0.2

 

- toilets for girls and boys

0.2

 

- universal premises for extended day groups

2.4

 

2. Premises for school of ІІІІІ level (5-12 years):

Study classrooms for general subjects for 5-12 years pupils:

- classroom of Ukrainian language and literature

2.4

1 classroom per 5 classes

- classroom of Russian language and literature

2.2

 

- classroom of foreign language (on 12–13seats)

2.4

on 50% of classes

- classroom of history and social science

2.4

1 classroom per 8 classes

- classroom of geography

2.4

1 classroom per 15 classes

- classroom of math

2.4

1 classroom per 8 classes

- laboratories for group of same classrooms

-

16 m2 per 1 group

- classroom of information and computer science (with laboratory for engineering repair)

6.0

on 1 workplace near the PC

(laboratory room – 9 m2)

Laboratories of natural sciences:

- of physics and astronomy

2.8

1 laboratory per 8 classes

- of chemistry

2.8

1 laboratory per 15 classes

- of biology

2.8

1 laboratory per 15 classes

- laboratories of chemistry, physics, biology and astronomy

0.75

16 m2 per each premise

Premises for physical training and health-improving work:

- physical training halls and gyms

12 24 m

9 18 m

 

- checkrooms with shower rooms and toilets for girls and boys

 

(21 m2 + 7 m2) х 2

- inventory premises

 

16 m2 and 33 m2

Premises for primary pre-conscription training:

- classroom of pre-conscription training including laboratory assistant room and room for equipment storage

 

6 m2 + 6 m2 + 6 m2

Shooting gallery with 25 meters fire distance:

- zone for shooting

 

180 m2

- training room

 

24 m2

- cloakroom

 

9 m2

- instructor’s room

 

6 m2

- rooms for equipment storage and cleaning

 

6 m2 + 9 m2

- toilet

 

4 m2

General school premises for collective off-hour activity  and rest:

- stage hall

 

36 m2

- inventory room for pop equipment

 

12 m2

- artistic checkroom

 

12 m2×12 m2

- projection booth

 

24 m2

- broadcasting center, director’s room, room for apparatus repair

 

21 m2  (12 m2 + 9 m2)

- room for psycho-physiological relaxation

 

6 m2 for 25 % teaching staff

- disco-hall with inventory premise

 

108 m2 + 6 m2

Premises of working education and occupational orientation for pupils of 5-9 years:

- workshop of metal and wood working with premises for theoretical training and drawing

 

9 m2×2

- cloakroom

 

 

- instrument rooms of masters

 

18 m2×2

- storage premises for raw and wares

 

18 m2×2

- cutting room

 

18 m2

- workshop (classroom of service) with fabric processing and cookery including inventory room and cloakroom

 

90 m2 + 54 m2 +9 m2 +12 m2

Administrative and economical premises:

- director’s office

 

32 m2

- office of deputy director for educational work

 

12 m2 , 2 workplaces

- office of deputy director for pedagogic work

 

12 m2 , 2 workplaces

- office of deputy director for economical work

 

9 m2

- methodical room – teaching room with cloakroom

 

8 m2 per workplace;

0.25 m2 per 1 place

- psychologist room

 

12 m2

- chancellery

 

16 m2

- lecture hall for students of special and higher teaching and medical educational establishments with cloakroom

 

2.5 m2 per place

 

- library

 

267 m2 per 34 thousand storage units

- dinning hall with seats for 33% of general number of pupils in school

 

0.85 m2 per 1 place

- cafeteria with seats for 10% of general number of pupils in school

 

0.85 m2 per 1 place

- washroom near the canteen

 

24 m2 (1 wash sink per 20 places and 1 drinking fountain per 100 pupils)

- buffet table and buffet storeroom

 

16+10

Medical block:

- doctor’s consulting room with waiting room

 

18 m2 + 6 m2, one wall not less than 5 m

- medical treatment room and room for preventive vaccination

 

10 m2 + 8 m2

- physiotherapeutic room

 

18 m2

- dentist’s consulting room

 

15 m2

- logopedist’s consulting room

 

18 m2, training with group of

6-8 children

Public facilities (toilets):

- for personnel (for females and males separately on each floor)

 

each 6 m2

- room of female personal hygiene

 

3 m2 joint with female toilets

 

Quantity of pupils, educational premises, laboratories and gyms is calculated taking into account quantity of trainіng hours per one session and their employment for not less than 75% from total school hours. 

Walls of educational establishment must be smooth and provide wet cleaning.

Floor of premises of the general educational establishments must be wooden or covered with heat supported linoleum, without cracks. Floor of toilets and washrooms must be covered with ceramic or mosaic flat tiles. Cement and marble materials for flooring are prohibited in any premises.

Classrooms (study premises) for 1st-4th year pupils must be located on the ground floor in separate block isolated from another age pupils.

If there is classroom educational system in school, these classrooms must be located within one-two floors and transferring from one classroom to another should not take more than 2 minutes. Classrooms for subjects, which are studied the most are located on ground floor for 5-9 years pupils, second floor – for 10-12 years pupils. Optimal classroom quantity depending on school capacity is 2-4 classrooms per each subject.

Educational premises are not through-pass, isolated from premises which may be potential sources of noise and strange smell (workshops, gyms, assembly hall, nutrition unit etc.).

Premises for working education (workshops for wood processing and workshops for metal processing, combined workshops for wood and metal processing, service room etc.) must be isolated from other premises and located in separate blocks on ground floor of schoolhouse, or in separate buildings with cloakroom and toilet. Training and manufacture workshops are equipped for 10th-12th year pupils for labour education and occupational orientation. For this purpose their training is also held at school-to-school field industrial complex and training workshops of industrial and agricultural enterprises.

Gymnasium is located on ground floor. Its size must be sufficient to provide optimal realization of the physical training programs and organization of off-hour sport competitions.

Entrance to the gymnasium must be through-pass or directly from checkroom, or through separate corridor. Storeroom for sport equipment must be connected to the gymnasium by doors or open space with 2m ×2.2 m size. This premise floor is at the same level with gymnasium floor. Gymnasium or storeroom should also have an additional exit, leading out of the building. Gymnasium height must be not less than 6 meters.

Assembly hall must be located on the first floor. It is not recommended to use assembly hall as gymnasium.

Production canteen premises are projected taking into account peculiarities of technological equipment location. Stoves working on solid fuel may be used only in rural schools with pupil quantity not more than 80. Kitchens in schools must be designed with equipment for meal processing both from raw and half-finished products.

Dinning hall area is calculated not less than 0.85 m2 per one pupil. Maximum capacity of dinning halls is 350–490 seats. Separate exit from production canteen premises to the backyard should be in place.

Dinning halls are equipped with tables for 4–6–10 seats and chairs or stools. Distance between tables and window (door) for dispensation of food and dirty dishes reception must be 150–200 cm, between row of tables – 100–150 cm, between tables and wall – 40–60 cm. Tables must be covered with corresponding to hygienic requirements materials, easily washed, be resistant to influence of hot water and disinfectants. Wash sinks are equipped accounting for 1 wash sink per 20 seats, hand drying apparatus – 1 per 40 seats.

Premises for trainings of extended day for pupils of general educational establishments are provided for 20% of total number of pupils of 1st-4th year and to 10% of total number of pupils of 5th-9th year.

Width of recreation premises is not less than 2.8 meters if there is one-side location of classrooms. Recreation premises area is calculated for each floor and is not less than 2.0 m2 per one pupil. During construction or reconstruction of general educational establishments recreation premises of hall type are prior.

Medical block must be located on ground floor and include following premises: doctor’s consulting room with area not less than 18 m2 and 5 meters length (for examination of pupils visual and hearing acuity), dentist’s consulting room with area not less than 15 m2, equipped with exhaust ventilation, medical treatment room with 10 + 8 m2 area and room for psycho-physiological relaxation with area not less than 18 m2.

Cloakrooms are located on ground floors of educational establishments, section equipment for each class is obligatory. Double lobbies with three doors must be projected in vestibules for provision of reliable heat isolation of inside premises.

Presence of independent entrances into the school for pupils of 1st4th, 5th7th and 8th9th years must be provided if block development system is used. In any other cases not less than 2 exits are equipped for permanent exploitation.

Floor stairs must have natural lighting. Footstep height must be 15 cm, its width - 30-35 cm, pitch of staircase - not more than 30°. Horizontal fence of stairs is not allowed. Stairs fence height must be 1.5 m with 0.8 meter high hand-rails. Width of stairs flight must be 1.8 meters.

 

TRAINING instruction

on hygienic assessment of equipment of school premises and school furniture

 

Equipment of school premises must meet sanitary and hygienic requirements, promote optimal support of teaching and effective teaching and educational off-hour activity. That is why classrooms and laboratories must be equipped with furniture in accordance to normative documents in force.

Furniture is matched taking into account the body length of pupils. It is prohibited to use benches and stools instead of chairs. Physiological working posture for pupils is the working posture when angle of slope of thoracic part of body to cross part equals 145°. The working posture for pupils is also inadmissible if distance from school desk surface to pupil eyes is less than 30 cm.

Fig. 39.3 Main sizes of school desk

(1 – height of the front edge of the desk; 2 – height of the back edge of the desk; 3 – width of the desk slope; 4 – width of the folding part of the desk; 5 – height of the seat; 6 – depth of the seat; 7 – width of the seat; 8 – distance of the back of the seat; 9 – distance of the seat; 10 – differentia)

Main sizes of school furniture during carrying out its hygeininc assessment are the following (fig. 39.3):

·        height of the back edge of the desk is a distance from back edge of the schooldest to the floor;

·        height of the seat is a distance from front edge of the seat to the floor and must correspond to length of crus with foot plus 1.5-2 cm for heel height. This provides low extremites flexion in hip and knee articulations at right angles and adequate bedding of foot on floor or support;

·        distance of the seat is a distance from front edge of the seat to projection of back edge of school desk slope on seat plane in horizontal plane. The distance of the seat may be zero if edges of school desk and seat are in one vertical line; positive – if edge of the seat does not reach vertical line down from back edge of the school desk and negative if down vertical line is on the seat plane. During educational activity in working posture being seating (writing, reading etc.) the optimal is negative 3-5 cm distance of the seat, during educational activity being standing (answering teacher’s questions) the optimal is positive distance of the seat (fig.4);

 

Fig. 4 Different variants of distance of the seat

 (А – negative; B – zero; C – positive)

 

·        distance of the back of the seat is a distance from back edge of folding part of the school desk to the back of the seat. This distance must exceed front-back size of the pupil thorax on width of child palm; 

·        differentia is a distance from back edge of folding part of the school desk to seat plane in vertical plane. Differentia must be equal a distance from the seat to elbow of down arm plus 5-6 cm and provide free location of arms on the school desk. If differentia is decreased too much the pupil bends forward greatly and supports on table which leads to pressure of chest and abdominal organs, ptosis of right shoulder and development of left-sided scoliosis. If differentia is increased this leads to elevation of right shoulder and development of right-sided scoliosis (fig. 5);

Fig. 5 Posture of a body if differentia size is low (а) and high (b)

·        depth of the seat is a front-back size of the seat and equals from 2/3 to ¾ of hip length;

·        height of the seat reaches lumbar spine and provides thoracic spine support on this height;

·        angle of slope of the folding part of the school desk must equal to 15° and allows the pupils to hold a book or copy-book on optimal distance (30-35 cm) from eyes under the biggest angle while head slope of the smallest, this provides permanent accommodation and prevents the myopia development;

·        relief of the seat must be correspondent to relief of hip and buttocks, little slope to back. It allows the pupils not to slide forward during main educational activity being seating.

Six special sizes of school furniture were worked out (SSRandN 5.5.2.008-01, State Standards of Ukraine 5994-93, 11015-93, 11016-93) for provision of pupils with school furniture corresponding to their body length and based on the received results range them to certain age group: #1 for pupils of 100–115 cm body length; #2 – of pupils with 116–130 cm body length; #3 – for pupils of 131–145 cm body length; #4 – for pupils of 146–160 cm body length; #5 – for pupils of 161–175 cm body length; #6 – for pupils above 176 cm body length.

Sizes of main construction elements of school furniture and peculiarities of their measurement are represented in the table 3.

Table 3

Sizes of main construction elements of school furniture

 

Number of school desk

Height group, cm

Height of the back edge of the school desk above the floor, mm

Height of the seat above the floor, mm

1

up to 115

460

260

2

116-130

520

300

3

131-145

580

340

4

146-160

640

380

5

161-175

700

420

6

above 176

760

460

There are 2-3 sizes of school furniture of certain number in each classroom (laboratory). Nowadays the transforming furniture is preferred. Correct position of children at school desks (tables) may be provide only if children with disparity of not more than 2 years are studying in one premise.

Data concerning peculiarities of the furniture distribution for schoolchildren of different age are represented in table 4.

 

Table 4

 

Peculiarities of the furniture distribution for schoolchildren of different age

 

Height group, cm

Group of furniture and marking colour

Class

1

2

3

4

5

6

7

8

9

10

11

12

up to 115

1 - orange

+

 

 

 

 

 

 

 

 

 

 

 

116-130

2 - violet

+

+

+

 

 

 

 

 

 

 

 

 

131-145

3 - yellow

 

+

+

+

+

+

 

 

 

 

 

 

146-160

4 - red

 

 

 

+

+

+

+

+

+

+

+

+

161-175

5 - green

 

 

 

 

 

 

+

+

+

+

+

+

above 176

6 - blue

 

 

 

 

 

 

 

 

+

+

+

+

 

Furniture in rectangular classrooms is located such way that distance between external wall and first row of school desks equals 0.6-0.7 m (in brick buildings this distance may be 0.5 m), between rows of double school desks (tables) - not less than 0.6 m, between third row of school desks (tables) and internal wall or wardrobes near the wall - not less than 0.7 m, between first school desk (table) and demonstration table - not less than 0.8 m. Distance from front wall with blackboard to first school desks must be equal not less than 2.4-2.6 m, from last school desks to back wall - not less than 0.65 m (if back wall is external - not less than 1.0 m), from last school desks to wardrobes standing along back edge of the wall - not less than 0.8 m, from demonstration table to blackboard - not less than 1.0 m, between teacher table and first school desks of pupils - not less than 0.5 m. The longest distance from last seat to blackboard equals 9 m, height of lower edge of the blackboard above the floor for first year pupils must be 0.7-0.8 m, for 2-4 years pupils - 0.75-0.8 m, for 5-12 years pupils - 0.8-0.9 m.

The distance from blackboard to first school desks must be increased by not less than 3 meters in transversal or square classrooms with 4 rows school desks location. This provides the angle of review up to 35°. Distance from first row of school desks to external wall must be 0.8-1.0 m, between rows of school desks (tables) - 0.6 m, from last school desks to wardrobes standing along internal wall - 0.9-1.0 m.

Pupils with decreased visual acuity must seat on first school desks of first row from wall with windows. Pupils with decreased hearing acuity seat on first and second school desks of side rows. Pupils who are ill frequently and for long periods of time seat in third (near internal wall) row of school desks.

         For prevention of bearing failure the pupils must be reseated from first row to third twice a year and vice versa. Correspondence of furniture number to the pupil body length is not disturbed in any case and visual and hearing acuity have been taken into account.

         School furniture must be marked. Marking of school furniture means 2 cm wide strip or 2.5 cm diameter circle on both sides of school desk, table and chair. School furniture of first height group is marked with orange, second – violet, third – yellow, fourth – red, fifth – green, sixth – blue colour.

Except colour marking, number marking is used on internal wall of a school desk as a fraction  to increase effective control of correct selection of furniture of certain group.

School furniture is located in classroom such way that smaller school desks are closer to the blackboard, bigger ones – farther from the blackboard.

Colour measuring vertical tape is hung on the classroom wall (door) with following marking: orange strip is 115 cm distance from the floor, violet one – from 115 to 130 cm distance, yellow one – from 130 to 145 cm distance, red – from 145 to 160 cm distance, green one – from 160 to 175 cm distance, blue one – above 175cm distance. This colour measuring tape is necessary for determination of number of furniture to each pupil in that classroom

         Workplaces in school workshops must provide correct working posture of pupils and correspond to safety requirements in full.

That is why there are 13-15 workplaces equipped with engineering tools in workshops. Engineering tools location of 75.5; 78.0 and 80.5 cm height is specified in workshops for woodworking;of 87 and 95 cm height from the floor to vices equipped with protective screens – in workshops for metalworking.

Each workplace has corbel seat or 40-42 cm height stool with 35×35 cm and 40×40 cm seat size. Supports (5 supports for each size) with 55×75 cm size and 5, 10 and 15 cm height must present in workshops for selection of corresponding furniture.

Engineering tools are located either 45° angularly or in three rows at right angle to wall with windows in workshops for woodworking. Distance between engineering tools in front-back direction must be equal not less than 0.8 m, between rows – not less than 1.2 m (fig. 6).

Engineering tools must be located so, that the light strikes on workplace from the front or right in workshops for metalworking. Distance between rows equals 1.0 m, distance from internal wall to engineering tools - not less than 0.8 m. It is the best to locate the same engineering tools in staggered rows. Distance between vices must be not less than 1.0 m.

a                                             b

Fig. 6 Peculiarities of location of training equipment in workshops for working education

(if engineering machines are located at right angle (a) and 45° angularly to windows (b))

1 – engineering tools; 2 – turning machine; 3 – drilling machine; 4, 7 – grindstone; 5 – circular saw blade; 6 – place for metal remanent storage; 8 – place for glue preparation, 9 – cutting table; 10 –table; 11 – platform; 12 – section wardrobes; 13 – shelves for board lumber; 14 – sink; 15 – fitted cupboards; 16 – blackboard

 

In workshops for 10-12 years old pupils instruments of special size # 1 must be used, for 13-15 years old pupils - instruments of special size # 2, for above 15 years old pupils - instruments for adults.

Maximum lading weight for elevation by 11-12 years old pupils is up to 4 kg, 13-14 years old pupils - up to 5 kg, 15 years old pupils: for boys - 12 kg, for girls - 6.0 kg, 16 years old – 14 and 7 kg, 17 years old - 16 and 8 kg correspondently.

Sanitary inspection of correct selection and arrangement of furniture in training premises includes analysis of presence of not less than 2-3 different number of furniture in each classroom and adequacy of their arrangement to each other, characteristics of a distance between the school desk rows, between furniture and side, front and back walls of premise, studying of provision conditions to the correct working posture and bearing, measurement of main sizes of school furniture etc.

 

 

HYGIENIC EVALUATION OF FURNITURE, TEXTBOOKS, DAY REGIME OF PUPIL AND SCHOOL SCHEDULE. HYGIENIC EVALUATION OF SCHOOL FURNITURE.

According to State Standard (SS) – SS 11015, 11016-86, during teaching process pupil’s desks and chairs of 6 types are used: 1 for the pupils with height 100-115 cm, 2 – 116-130 cm., 3 – 131-145 cm, № 4 – 146-160 cm, №5 – 161-175 cm, №6 – 160-169 cm, 7 – 170-179 cm; or letter types: A – for the pupils with high less than 130 cm, B – 130-145 cm, C – 146-160 cm, D – 161-175 cm, E – more than 175 cm.

Sanitary examination of furniture location includes analysis of chairs’ presence of not less than 3 types and their adequate localization, characteristic of distance between desk row and furniture, front, back and side walls of the class-rooms, examination of conditions of correct and convenient posture, main sizes of desk (high of tables and seats, distance between seat and back, differentiation etc.)

The high of the desk or chair seat is to answer the average size of the shin and foot length of pupil’s group with the same height plus 1-2 сm for high  of  thigh.

Depth of the seat which is front- back size is to be not less than 2/3 and not more than ¾ of thigh length, and type of seat has to answer thigh and buttock shape. Back of the desk or chair  have to be profiled  and support sacroileal and su bscapular regions. Back distance that is horisontal distance from the posterior edge of desk till back, have to be the average size of front- back diameter of pupil’s chest which is group of height plus 5 sm. Desk must have angle of slope 14-150. Size of the seat is determined by wrist length, volume and amount of actions during writing, by right placing of open copy-book. The distance between posterior edge of desk and vertical space of seat is to called differention.. It have to be equal with difference between hight of elbow of descended pupil’s arm, who is sitting and high of seat plus 5-6 cm.

 

 

 

 

 

 

The distance between anterior edge of  desk till anterior edge of seat in horisontal space is to called distance. It have to be negative that means that seat edge has to cover desk edge not less than 4 sm and not more than 8 sm.

Hygienic evaluation of school textbooks

Sanitary examination of printing design of school text-books include definition of general information about text-book (author, title, place and year of publication, purpose), characteristic of paper (color, peculiarities of surfaces, transparence), type (garniture, height of main strokes, thickness, distance between strokes), typing (distance between letters and words (approach) and lines (interline) length of line, width of margins, equality of print, presence of italics and petite type, density if typing), printing (distinctness, equality, peculiarities of dye), external design (weight, size, format, book letting, binding) and laboratory examinations (wood contents in paper, microbe contamination of text book etc).

 

The textbook

The lenght of line, mm

Main sizes of type

height of line letter H, mm

Thickness of main strokes , mm

Thickness of the connective trikes (horisontal and stoped

School primer

130 – 126

4,5-4;

0,5

0,5

Textbook for 1st class

130 – 126

2,8

0,5

0,45

    2nd class

130 – 126

2,3-2,52

0,3

0,15

    3 –4classes

126

2,3-2,0

0,3

0,15

    5-7 classes

113,108,98

1,75

0,25

0,15

   8-10 classes

113,108,98,95

1,75-1,7

0,25

0,15

       Weight of the textbook-for primary classes is not more than 300 g ,

       for senior classes-800g

       Interlinage- not less than 3mm

       Approsh- not less than 2mm

       Distance between letters-0.5 mm

       Typing density - 8-10 letters (for younger classes), 15 – for senior

In order to hygiene evaluation of daily time-table of children and teenagers methods of questionnaire, interviewing, chronological observation. During examination it is necessary to find information about presence and duration in daily time-table of main regimen elements (sleeping, study in school, nourishment, rest with walk out-of-doors, home-tasks preparation, home work, free-time), correctness and reasons of their interaction, accordance of health condition with age, sexual, anatomic-physiologic and functional peculiarities of organism and individual talents of child.

Hygienic evaluation of curriculum in school include examination of study regulations, schedule, and organization of classes. Control of study routine include composition of lessons time-table, lesson duration, breaks between them and classes, accordance of classes amount during the year and week with curriculum.

Main elements of sanitary-hygienic observation of classes schedule is examination of accordance of distribution and alternation of subjects during working day and week, with health condition, morphofunctional abilities of children’s organism and level of complication of subjects and character of their interaction (presence of joint lessons of some subjects, neighborhood of lessons of lessons of similar subjects of similar type activity, for example, native language and foreign language, algebra and geometry etc).

The study process is organized according to workability change principles in children and adolescents. Firstly, the workability increases, the period of comes (workability increases and leave at the same level – period of high production). After that workability decreasing period comes step by step.

The workability of pupils is low on Monday, than it increases and becomes lower at weekend again. The same regards daily studying. During the optimal workability hard subjects should be included. Reading, painting and nature studies should be organized as first lessons. Pared lessons should not be included into the timetable. Optimal time for every lesson is 45 min., during first year of studying – 35 min. It is necessary to provide breaks for 10 min. Long break after second lesson must be 30 min. It is possible to make 2 breaks of 20 minutes after second and third lessons instead of one long break. The quantity of lessons every day must be such that normal activity of brain cortex in pupils must be possible. It provides normal conditions for successful work and preserving pupils’ health. Total weekly amount of studying loading foresee obligatory amount of studying hours. In pupils of first year of studying,- 20, in second –22, in third-forth – 24, in fifth-eighth-30, in ninth- eleven – 31.

In order to define level of complication of lessons methods of group according to level of difficulty is used (1 group – mathematics, foreign languages; 2 group – chemistry, physics; 3 group – native language, history, geography; 4 group – natural science, literature; 5 group – physical training, music, labor training), or scale of rank of difficulty of school subjects (mathematics – 11 points, foreign language – 10, physics, chemistry – 9, history – 8, native language, literature – 7, natural science, geography – 6, physical training – 5, labor training – 4, drawing – 3, picture-drawing – 2, music - 1).

Hygienic evaluation of lesson organization include examination of conditions of it’s realization, peculiarities of studding presentation, methods and visual aids of teaching, level of pupil’s tiredness during teaching process, chronological observations of duration of main structure elements of the lesson (organizational part, of new material, final part).

Peculiarities of physical training in school include chronometrical observation (introducing, preparing, main (motion skills and quick game) and final parts), examination of general and motor density of the training, and level of physical condition of children, physiological curves of physical load, functional test, test with dosed physical load, modified Letunov’s test etc), control of air-thermal regimen of school environment.

Sanitary-hygienic evaluation of labor training of pupils include chronometrical observation, control of character, regimen and conditions of study, examination of accordance of workshop with pupils’ height, evaluation of functional state of children and teenagers during labor training.

 

Development of the child’s organism and factors that influence on it

During all children’s and adolescent age organism growths and develops every time, and passes from one stage to other. Child’s development process is made at the influence of conditional and unconditional actions of the external and internal environment. The main factors that are determining development of organism are original anatomo-physiological properties, external environment, child’s activity and education. And by the way the last one has the main role.

The most fall effect has the constant influence on the adaptation to the changeable conditions of the environment, so the adequate pass from one stage to other. Such result may be received at the process of education with taking into account the origin and anatomo-physiologic properties of child’s organism and are given environment’s condition that these properties are demanded.

Main stages of the child’s organism development and its hygienic ensuring.

Work periodisation of the children’s age is grounded on the M.P.Gundobin’s and M.P.Krasnogorsky’s proposition. Here are taking into the account the main conformity of child’s organism development and properties of the education of the children and adolescent.

According to this sketch there are such age periods: 1) intrauterine, 2) neonate (0-10days), 3) infants (10days-1year), 4) kindergarten, preschool (early, medial, older), 5) school (early, medial, older).

During the infant age the adaptation of the nervous system is increased and the sleep is increased too. It gives the possibility to making of the conditional reflexes, in particular the reflex of quick sleeping at the “fresh air”.

At the influence of the rational education in the child’s organism the protective function and function of adaptation to different external influences and changable conditions of the environment are developed.

The main hygienic measures that are necessary in this period are:

1. Rational regime of child and long-lasting staying at the fresh air

2. Guaranteeing by the rational closes, furniture and apparatus

3. Systematic physical exercises

4. Massage

5. Steel

Systematic control by the infants’ physical development – necessary condition of their rational education.

Nowadays the main type of pre-school institution in the city or villages is  kindergarten by 1,2,3,4, 6 and 8 groups (without of content by summer period). The number of the children in younger kindergarten groups cant be more 15 in another crech-20 and in pre-school crech-25 children. The crèche by 1-2 groups and smaller is recommended to connect with elementary school. The crèche by 2-4 groups is connected with school where is not full of classes.

The kindergarten is situated in living zone, but without uneven relief. The square of the land in crèche by 1 and 2 groups must be 45 m2 by 1 child, on the separate and comfortable populated place. Situated of the kindergarten can be in the center of the village. The land square for child’s institution must be clear and soft, in crèche by 4 groups-40m2, in crèche by 6 and more groups-25m2 by 1 child, but not less then 0,2 ha.

In condition of reconstruction the land square cant be less, but only to 25 percent. In unite crèche by 15 places and pre-school by 20 pupils the square of land must be 0,3 ha. The distance from buildings of pre-school institution to red line must be 25 m and from situated place to living houses with windows-10m, to the wall-5m.

To prevent spread of infection in pre-school institution must be the group isolation. The main room in pre-school institution is dining room or playing-room with square 2,5 m2 to 1 child.

Every group must have individual enter, bad-room and lavatory-room. For children of crèche must be places for the pram and Leigh. Also must be the kitchen, laundry and room for save of the products. For every group there are playground by square 130 m2, on which must be situated pavilion by square 30-50 m2, sandground, etc.

The main institution must to have the natural illumination. The deep it can’t be more then 6 m. The temperature of air must be 20 c, and in the lavatory room and cabinets for medical personal-22c. Regarding moisture must be 43-50% and speed of air moves –0.02-0.03 m/sec.

Play and dining rooms have the tables and chairs. There are 4 types of the tables: by 4 persons (70x70 cm.-for children 1,5-5 year old), by 2 persons, for children 1,5-4 year old, by 2 persons with boxes (children 5-7 year old) and by 1 person (45-60 cm.).

The size of furniture by children of pre-school institution.

Groups of furniture

High of the children

table

chair

High above the floor

Front-back size

Long of 1 place in table

High of sit under table

The deep of chair

High of back of the chair

A

TO 80

34

45

60-70

17

22

15

B

80-90

38

45

60-70

20

24

17

C

90-100

43

45

60-70

24

26

19

D

100-115

48

45

55-70

28

28

21

E

15-130

54

45

55-70

32

30

24

F

130

60

45

55-70

36

32

27

 

 

 

 

 

 

 

 

 

 

 

 

                                  

The toy must be big, bright, and comfortable for play and can utter sound. Among toys for children 2-3 year old must be building set, the doll’s furniture, child’s plates and dishes, pictures.

The making of the toys must use not injure materials which not content the poison and easy for clearing and disinfecting. The strict sanitary instructions for the toys for infants in arms, because they often takes then in mouth. Material for makes such toys must be plasmas, which easy clear and wash. For making of toys by children of prevent schools and crèche use the rubber like material. For children of school age like material for toys can be use the wood. The iron toys easy in use and easy makes clear, but they must be covers by enamel.

The size and mass of toys must be attitude to age of the child and the shape must be not injures for child. Maximal mass of toys for the child’s of prevent age is 400 g. and for pupiles-600 g.

The child’s toys examine by such parameters:

1. The name of toy and its short description.

2. Shape and size of toy.

3. Density and mass.

4. Description of material from which the toy is make (soil, density)

The laboratory test of density cover:

a)Wash of hot water with soap by 3 min.

b)Wash by 2 % solution of chloral lime by 3 min.

c)Act to cover by 2 min of 1 % of solution of aside.

Steady of cover is mucked by change appearance of toy by cover of special solution in touch to the toy. Full expertise of the toys is making with uses special chemical and toxicological methods: calculate of smell, steady ficsation of paint, content salt of hard metals (zinc, lead), formaldegid, monomers etc.

The child’s books in sanitary attitude must give the normal optical perception of text and illustration: the letters and other sing of books must be readied by the distance in 30-35 sm. The paper for child’s books must be white with yellow shape. Color, gray or even easy gray not use, because call soon fatigue of eyes.

For print of child’s books must be smooth paper and without buster. Also the paper must not pass the light.

Great importance has a size and presides of print. The high of precise in child’s books must be 3,5-4,5 mm, and in the first paper the precise must be larger. Precise must be clear because children can’t differ some letters, which looks like.

The distance between the wards must be 2mm. The distance between 2 strikes must be 3mm. If that distance not fulfill, the eye accommodation can destroy. Pictures must be clear and draw by different bright colors.

REFERENCES:

Principal:

1.          Hygiene and human ecology. Manual for the students of higher medical institutions/ Under the general editorship of V.G. Bardov. – K., 2009. – PP. 14-34, 71-106.

2.          Datsenko I.I., Gabovich R.D .Preventive medicine. - K.: Health, 2004, pp. 14-74.

3.          Lecture on hygiene.

additional:

1.          Kozak D.V., Sopel O.N., Lototska O.V. General Hygiene and Ecology. – Ternopil: TSMU, 2008. – 248 p.

2.          Dacenko I.I., Denisuk O.B., Doloshickiy S.L. General hygiene: Manual for practical studies. -Lviv: Svit, 2001. - P. 6-23.

3.          A hand book of Preventive and Social Medicine. – Yash Pal Bedi / Sixteenth Edition, 2003 –  p. 26-36, 92-97.

 

 

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