Illness: causes and predisposing factors

It is possible to propose the following classification of the main causal factors leading to health disorders. At the same time, it takes into account the importance of the action of these factors both in the previous period of life and at the present time.

First of all, it is necessary to discuss any form and origin of the deficiency of essential conditions for optimal development.

1. Deficiency of essential development factors
   • Orphanhood or life in an antisocial family, stress, abuse or degradation of dignity.
   • Inadequacy and suboptimal balance of nutrition in utero or in subsequent periods of postnatal life.
   • Hypokinesia or a "sedentary" way of life.
   • Deprivation of sleep.
   • Diluted development environment, lack of communication, new impressions, training, abandonment.
   • The presence of aggressive factors in the development environment
2. Dysfunctional epidemiological situation.
   • High risk of violence.
   • A natural endemic feature of the region of residence.
   • Ecological disadvantage of the region, dwelling, water, air, food.
   • Influence of bad habits (smoking, alcohol, drugs), early sexual life, eating disorders and the regime.
3. Unfavorable heredity.
4. Illness, which has arisen as a result of the transferred diseases, including intrauterine, or trauma.

Another approach to the classification of the determinants of ill health may be considered to be by their origin in connection with the will or regardless of the will of the person, for example, at the will of the parents or because of conditions beyond the control of the family dictated by the state and laws of society. On this basis, it becomes possible to isolate "autopathogenies", "parentopathogenies" and "sociopathogenies".

Sociopathogenies include:

1. war, terrorism, violence;
2. transport and man-made disasters, accidents;
3. disintegration of families and refusals of children;
4. poverty and starvation;
5. Insufficiency and disorganization of dwellings, sources of drinking water, heating systems, water supply and sewerage;
6. uncontrolled habitat chemicals, including air, water and food;
7. inadequate or limited access to health care and prevention;
8. restrictions on the accessibility of education and low level of health education for the general population;
9. primitivization of life values, propaganda of violence, enrichment at any cost, irresponsible sexual relations, etc .;
10. open or hidden advertising of auto-aggressive behavior (smoking, alcohol).

Very close to "sociopathogenies" are many voluntary forms of behavior. They are referred to as "autodestructive" behavior. Some scientists call them, as opposed to "sociopathogenies," "autopathogenies." This voluntarily chosen behavior, accompanied by changes in the properties of the personality and leading to a high risk of chronic diseases and shortened life. There are only a few such important forms of behavior, but the damage to their health exceeds that of violence, accidental injuries and uncontrolled infections.

Autopathogenies include:

1. suicide;
2. self-healing;
3. smoking;
4. alcohol;
5. drug addiction and substance abuse;
6. erratic sexual behavior;
7. hypodynamia;
8. inadequate food behavior.

Consider the main determinants of "unrealization" or loss of health from the group of "sociopathogenies".

[1], [2],

Sociopathogeny

Violence

It happens almost everywhere. In 2002, in the report of WHO Director-General Gro Harlem Brundtland, there were such impressive facts:

1. Every year more than 1.6 million people die due to various forms of deliberate violence;
2. an average of 2233 people commit suicide on a daily basis; this is one suicide every 40 s;
3. Every day 1424 people are killed in interpersonal conflicts (one kill every minute);
4. Every day 849 people are killed in intergroup or interethnic, interreligious, interstate conflicts (35 people every hour); only in armed conflicts of the first year of the new millennium more than 300,000 people were killed.

The level of murders in Russia is very high. The probability of dying from violent death during life for a newborn in Russia is 1: 4, while in England - 1: 30, and in Sweden - 1: 50. The tendency to growth is also killing children. Only parents unintentionally or intentionally kill annually from 200 to 1000 or more of their own children.

Children who die as a result of accidents are an indicator of the degree of their actual neglect, which has origins in the organization of the life of the society, where parental responsibilities recede in the background for the tasks of obtaining food and money.

There are also human losses, which are designated as "disappearances" of people. Disappear and children and adults. In 2003, for example, 118,000 people disappeared, of which 24,000 were children. For comparison: the strength of the entire British army - 100 thousand people, and for the entire 4-year military campaign in Afghanistan, our losses amounted to about 15 thousand people. This is also a "sociopathogeny", i.e. Direct aggression of an unsettled society on health and human life.

Poverty

The second, unconditionally recognized group of factors at the non-medical level is poverty, hunger, lack of housing, unsanitary conditions, ignorance that lead to illness and death, and the lack of affordable medical care. Almost the entire world mortality statistics show an inverse correlation between infant mortality and per capita national income. The axiom of demographic statistics also recognizes the direct correlation of life expectancy with the national income.

In Russia, where a relatively short period of time of economic transformation did not have time to experience deep disasters with culture, education, sanitary and hygienic conditions of housing and water supply, one can see the relatively direct causality of changes in the incidence of economic conditions of life. In this case, it is not possible to exclude the role of chronic stress accompanying the process of impoverishment and a very real deterioration in the quality of medical care. According to the materials published by AA Baranov and LA Shcheplyagina (1998), only for 4 years - from 1992 to 1996 the incidence of children of preschool and school age increased:

• for diseases of the heart and blood vessels - by 59%;
• on nutrition and immunity systems - by 53%;
• tuberculosis - by 38%;
• alcoholism (child) - by 66%;
• Toxicomania - 11 times;
• addiction - 12 times.

There is no doubt that poverty, and especially poverty, is a generalized expression of a multitude of various negative factors and circumstances that pose a danger or significant risks to the health of children.

The most direct relationship between the level of material security of the family and the state of children's health is in such a determinant as nutrition. In this section, we will focus only on indicators of food security. In Russia, at the beginning of economic reforms, studies were conducted on the incidence of famine in families using the international Radimer / Cornell criteria.

Starvation in the families of Russia:

• starvation of women - 77% of all surveyed;
• starvation of several family members - 70% of all surveyed;
• starvation of children in families - 32% of all surveyed.

The most "typical" ways of adapting food to the limited material possibilities of families in St. Petersburg are to limit the variety of foods in the diet and limit the power of adults to children. For such nutritional groups as fish, fish, dairy products, fruits and vegetables, deficits are defined in 64-87% of children.

Important criteria for the spread of starvation are the findings of delays or lag in children in physical development. Disturbances in nutrition are becoming a big problem during the recruitment of young men for military service. More than 30% of new recruits receive a postponement from military service due to a lack of body weight.

Yatropathogeny (iatrogenia)

This is a very debatable on the importance, but really existing problem, which attracts more and more attention.

There are several aspects of it:

1. rarely, but a doctor can, like any other person, commit criminal acts, including negligence and inattention, leading to a dramatic outcome;
2. the doctor can make a mistake in diagnosis and in the choice of means of treatment of diseases and critical conditions; especially such errors with respect to complex and rare diseases and syndromes; even more likely errors in the use of drugs with their side effects; the number of such errors may continue to increase as the range of diseases increases, new diseases appear in medical science, the number of new medicines rapidly increases, and it becomes impossible for the practitioner to gain sufficient experience in their use;
3. there are also general circumstances that create a risk to the health of some people, regardless of medical errors, the very existence of the health service, its institutions and methods of carrying out professional activities; there is a certain negative population effect from the use of diagnostic X-rays, from ultrasound diagnostics, from carrying out preventive vaccinations, any surgical interventions and instrumental manipulations; these forms of damage to health are negligible in comparison with the positive effects of protection and restoration of health associated with the application of these methods;
4. there is also a very significant group of relatively late identified adverse outcomes from the implementation of certain diagnostic and therapeutic solutions;
5. a very special chapter of iatropathogeny begins to form accumulated data on the long-term consequences of the medical elements of prophylaxis and treatment for the fetus, newborns and young children, for which there is a special sensitivity to negligible levels of any effects, and no set of rules on the safety of medical interventions for these children do not exist yet.

At present, the latter circumstance is another branch of the doctrine of modifications or alterations of development that program the duration and quality of subsequent periods of life. The illustration may be remote complications from the use of corticosteroids in perinatology (Neil N. Finer 2000, Keith J. Barrington 2001, A. Dodic 2001):

• decreased ability to learn at the age of 6 years and older;
• outcome in cerebral palsy in 49% of children receiving drugs, compared with 15% in those who did not receive them;
• sites of leukomalacia in the brain substance in 23% of children receiving hormones, against 9% who did not receive them;
• myocardial hypertrophy.

There is no doubt that the relevance of the problem of iatropathogeny is progressively increasing. Even such specific aspects of this problem as the adequacy of diagnosis and the provision of medical care in critical conditions and the correctness (safety) of medicinal prescriptions are extremely socially significant. The experience of taking measures to improve emergency diagnostics and strict justification of therapeutic measures, accumulated in the USA during a specially conducted program, showed that these measures allow saving the lives of more than 20,000 patients per year. At the same time, due to erroneous or suboptimal medical appointments, 100 to 784 thousand people die every year. In comparison with losses from terrorism, the danger of medicine is 32 000% higher.

Toxic aggression on health

The next group of non-medical factors is chemical pollution of the habitat, including water, the air basin, foodstuffs and the whole household (detergents, washing powders, cosmetics, paints, plastics, etc.). The significance of environmental disasters, for all their importance, recedes to second place in comparison with them.

The shifting of attention from the danger of direct and obvious toxic effects of aggressive substances to the effects of modification or reprogramming of development with very delayed manifestations is gaining a leading significance. The concentrations of pollutants and xenobiotics in the household environment, food, cosmetics and even in medicines may be negligible, but they are sufficient to exert toxic effects on the genotype and phenotype and changes in developmental qualities.

The saturation of modern life with the factors of potential chemical aggression and the highest sensitivity of the child organism to them, especially in the intrauterine period, begins to be clarified only now. As follows from the report of the European Working Group on Habitat Studies of 14.07.2005, out of the 287 chemicals of artificial origin that we detected in the cord blood of newborns, 180 substances are well-studied carcinogens for humans and animals, 217 are toxic for developing brain and nervous system, and 208 belong to the category of teratogens that cause malformations and dysplasias. The potential effects and dangers of prenatal or postnatal exposure to the total amount of identified chemicals or their combined effects have never been studied by anyone.

The most natural environment, previously considered harmless to humans, may be unfavorable for the development of the fetus and the child with a very delayed detection of this effect during later life. This is now proven in both experimental studies and in the clinic.

Urban air as a mixture of aggressive pollutants adversely affects the fetus and leads (News Releases from the National Institutes of Health, 2005):

1. to a decrease in length and weight of the body, a decrease in the circumference of the head of the newborn;
2. to an increase in the number of chromosomal abnormalities in cord blood leukocytes:
3. at an average exposure of 4.7 / 1000 leukocytes;
4. at a large exposure - 7,2 / 1000 leukocytes.

The main mass and non-threshold toxic effects on humans:

• lead in concentrations below 100 μg per 1 liter of blood;
• radon of residential premises with a content of less than 4 pCi per 1 liter of air;
• Trihalomethanes formed during chlorination of drinking water at concentrations below 800 μg per 1 liter of water;
• tobacco smoke with passive smoking.

In relation to the fetus, the newborn and the child of the first years of life, the list of these substances must be significantly expanded. Thus, mercury and methyl mercury cause damage to the brain of the fetus and the subsequent decrease in intelligence and attention in the child, even with their insignificant concentrations in the blood of a pregnant woman. The risk of a decrease in intelligence in a child is proportional to the concentration of mercury in a woman's blood. Substances contained in ordinary plastic vessels, parts of refrigerators, plastic bottles for drinking water or lemonades can have toxic and hormone-like properties that change the rate of development and increase the risks of cancer. One of these substances is the component of plastics bisphenol A. A component of many food products, such as chips, chips, canned olives, - acrylamide combines toxic and carcinogenic properties and is able to accumulate in the body.

Pollution of the environment with metals, in particular aluminum, contributes to its presence not only in food, but even in medicines and medical solutions. With a decrease in the functional reserves of the urinary system, the toxic effect of aluminum can occur quickly and be of the nature of a severe neurotoxic reaction, most likely in small and premature newborns. The remaining children and adults have a risk of prolonged accumulation of metal in the brain tissue with long-term detection of loss of intelligence.

Autopathogeny and parentopathogeny

Suicides

This is the most dramatic manifestation of autopathogeny. Annually in Russia suicide 55 companies end their lives, of them 2500-2800 - children. Attempted suicide is committed by about 1 million people. The frequency of completed suicide is 40 per 100 thousand per year, which is significantly higher than the rate of murder - 30-33 per 100 thousand per year - or deaths from alcohol poisoning - 25 per 100 thousand per year.

In 2000, 29,350 people died in the United States as a result of suicides. More than 90% of them had mental disorders, mainly depression, many had a drug dependence. Men die as a result of suicide 4 times more often than women, but attempts to commit suicide are performed by women 2-3 times more often than men.

In some of its parts, suicides reflect the complex interactions between the borderline states of the psychic sphere and the environment that puts the child in a state of total despair. For children and adolescents, such borderline conditions that can be recognized and treated in a timely manner should include depression, including latent, and psychoemotional disorders such as hysteria, bipolar syndrome, etc. Children who attempt suicide, usually during long term talk about the attractiveness of death. Especially high risk of suicide in cases when the child's conversations with friends form specific plans and outline the tools of suicide. Attempts to commit suicide in children are observed 50-200 times more often than completed acts. There was a significant relationship between the frequency or risk of suicide and the frequency of child involvement in physical conflicts with other children (fights), as well as manifestations of cruelty to other children or pets. There is also a clinical marker of a significant risk of suicide in schoolchildren and adolescents - juvenile fibromyalgia or chronic fatigue syndrome. Unfortunately, in real pedagogical practice and in the practice of medical observation, these features are extremely rare.

It is possible that the properties of the environment and the power of its impact on the child's inner world are so strong that they can be realized in suicide and against the background of normal initial mental health. The child finds himself in a position that, within the framework of his personal life and soul experience, is incompatible with life. And lead him into this position, usually surrounded by adults or, much less often, other children. It is terrible that there was no adult about this child who could recognize the complexity and drama of the situation and, most importantly, help the child out of it with his love and support. In very many cases of suicide of children, one can see an example of suicide provoked by adults - a family, a collective or even a society as a whole.

Smoking

Active smoking of different intensity is found in Russia in 61% of men, 36% of women, 28% of schoolchildren in the upper grades. About 62% of children smoke "passively". Smoking causes 30-35% of all diseases that lead to the death of adults. This is mediated through a significant increase in the risk of a number of diseases of the cardiovascular system and malignant neoplasms.

Under optimal conditions of life and nutrition, smoking reduces a person's life by 18 years. The combination of malnutrition and other unfavorable factors can double this figure.

It is believed that smoking makes a very significant contribution to the difference in life expectancy between men and women. At the same time, a relatively small difference in the spectrum of chronic diseases and a decrease in the lifespan of "active" and "passive" smokers has been revealed. The average level of danger of second-hand smoke is determined in 40-48% of the danger of active smoking. Regular stay in a smoky environment after 3-4 years significantly changes the spectrum of blood lipids in children of school age, increasing the overall atherogenicity index.

The prevalence of smoking largely depends on the age of the first contact of the child or adolescent with tobacco smoke. Regular stay in the room with smokers even the smallest child (1-3 years) is a factor of high risk of early smoking initiation. The first experience of smoking in school or adolescence determines the extremely rapid formation of dependence on tobacco. So, if for an adult a dependence occurs when smoking about 10 cigarettes a day for about 3 months, the adolescent has a dependence on smoking 2-5 cigarettes a day and smoking period 2-4 weeks.

The timing of the commencement of adolescent smoking is a good indicator of the child's general propensity or readiness for manifestations of "protest behavior." This is evidenced by the statistics given in the report of the Chief Surgeon of the USA (1994).

Smokers adolescents compared with non-smokers in subsequent years of life:

• 3 times more likely to suffer from alcoholism;
• 8 times more often use marijuana;
• 22 times more often use cocaine;
• much more often become instigators or victims of interpersonal or intergroup conflicts, including with the use of weapons (including firearms).

With active or even passive smoking of a pregnant woman, the toxicity of tobacco smoke can be a direct induction of a wide range of malformations and diseases in subsequent years of life. In children of mothers who smoked during pregnancy, the life span is reduced by 11.6 years. In children of the smoking father, he is less by 8.3 years. If the child has one smoking parent, his intellect by 10 years is lower by 6.4 units K}, if both parents smoke, then by 8.8 units 1 (3 compared to peers from non-smoking parents. Up to 5 years) of malignant tumors of the blood and brain system was increased 3.3 times as compared to children of non-smoking parents, and new evidence of significant growth of cerebral dysfunctions in children during smoking of a pregnant woman was obtained.In this study, smoking in combination with nebla opriyatnymi environmental factors associated with smoking increases the likelihood of children born with low brain dysfunction tripled, and only smoking, as the only causal agent to the exclusion of other factors, gives a small increase in the probability of brain dysfunction in half.

Alcohol

The aggressiveness of alcohol increases with an increase in the dose of alcohol taken inside, the frequency and duration of such abuse. Of great importance for the toxicity of alcohol are its chemical properties, i.e., the degree of purification or the quality of technological processes. The traditions of intensive use of alcohol are very strong in Russia. Per capita consumption of absolute alcohol for the year according to official data in 2002 was 7.6 liters, or 15.4 liters according to the real sum of the recorded and unaccounted sale of alcoholic beverages. In addition, beer consumption on average in Russia is 40 liters per capita per year, and in cities such as Moscow and St. Petersburg, 70 liters per year.

Alcohol is an important cause of death. Since 1996, the annual number of deaths from accidental alcohol poisoning in Russia is 30,000-35,000. For comparison, in the US, where the population is almost twice as large, about 300 people die of alcohol intoxication.

Alcohol can cause chronic lesions of the gastrointestinal tract, brain (psyche), reproductive organs, lower immunity, chronic eating disorders, chronic diseases of the cardiovascular system. Significant are indirect losses from alcoholism - murders in the state of intoxication, road and domestic injuries, the destruction of families, abandonment of own children or cruel treatment of them. But even more significant are the transgenerational effects of alcohol, i.e. The impact on children and grandchildren's health.

The main transgenerational effects are the induction of fetal alcohol syndrome and a wide range of alcohol-associated effects. Fetal alcohol syndrome and alcohol-associated effects are the most common reasons for the insufficiency of intellectual development, aggressiveness and asocial behavior of children and adolescents.

[3], [4], [5]

Addiction

Over the past 15 years, the incidence of drug addiction has increased 10.8 times, and just regular use of drugs without dependence on them - in 6.9 times. According to official statistics, in Russia there are now 2.2 million drug users, and according to unofficial data - about 8 million.

[6], [7], [8]

HIV infection

The pace of growth in Russia has come close to the pace of the African countries. In 2003, 240,000 cases were officially registered, and according to experts' estimates, there should be between 750,000 and 1.2 million. Of this, about 80% of patients are under 30 years old, but more often 15-19 years. By 2020, already predicted 14.5 million patients. The epidemic is accompanied by outbreaks of other sexually transmitted infections and an increase in the incidence of tuberculosis resistant to treatment.