MINISTRY PUBLIC HEALTH of UKRAINE

CRIMEAN MEDICAL UNIVERSITY

Named by S.I.Georgyevskiy

DEPARTMENT OF THE GENERAL HYGIENE

AND ECOLOGY

GENERAL HYGIENE AND MEDICAL ECOLOGY

TEXTBOOK

FOR STUDENTS MEDICAL FACULTY

SIMFEROPOL

2004
 The textbook is developed by the employees of the department of general hygiene with
ecology of the Crimean state medical university according to the Program on general hygiene for
the students of medical faculties (Kiev, 2002) and reflects the basic questions of discipline.
The manual is designed for the students 3 and 4 courses of medical faculty and 2 course
dentist faculty.

The authors: professor S. Shibanov, docents G. Neuimina, assistant I. Butirskaya / Editor prof.
S.Shibanov.
Simferopol, 2004.

CONTENT
Introduction ………………………………………………………….P.
THEME 1. THE SUBJECT AND TASKS OF HYGIENE AND ECOLOGY……P.
THEME № 2. HYGIENE OF THE ENVIRONMENT.
HYGIENIC STANDARTIZATION ADVERSE FACTORS IN OBJECTS
OF ENVIRONMENT.
THE INFLUENCE QUALITY OF THE ENVIRONMENT ON THE HEALTH
OF THE POPULATION …………………………………….……………………..P.

SECTION “HYGIENE OF NUTRITION”

THEME 3. PRINCIPLES OF SANITERY EXAMINATION FOOD PRODUCTS.
SANITARY EXAMINATION OF MILK……………………………………………P.
THEME N 4. HYGIENE OF NUTRITION. PRINCIPLES OF THE
RATIONAL NUTRITION. PREVENTION ALIMENTARY DESEASES………….P.
THEME N 5. VALUE VARIOUS NUTRIENTS IN NUTRITION. ROLE OF
PROTEINS, FATS, CARBOHYDRATES…………………………………….……P.
THEME N 6. VALUE OF VITAMINS AND MINERAL SUBSTANCES
IN NUTRITION……………………………………………………………………..…..P.
THEME N 7. FOOD POISONINGS. THE REASONS, CLINIC,
PREVENTION…………………………..……………………………………………P.
THEME N 8. THE HYGIENIC REQUIREMENTS TO THE ENTERPRISES
OF PUBLIC NUTRITION. A TECHNIQUE OF SANITARY INSPECTION
OBJECTS OF PUBLIC NUTRITION……………………………………………….P.
Final lesson on hygiene of a feed…………….. ……………………………………..P.

SECTION “MUNICIPAL HYGIENE”

THEME N 9. HYGIENIC REQUIREMENTS TO MICROCLIMATE………......P.
THEME N 10. WEATHER AND HEALTH. GELIOMETHEOTROPIC
REACTIONS. CLIMATE AND ACCLIMATIZATION……………………………..P.
THEME N 11. CHEMICAL COMPOUND OF ATMOSPHERIC AIR.
ACTION OF ITS COMPONENTS ON THE PERSON. PROTECTION
ATMOSPHERE POLLUTION………………………………………………………P.
THEME N 12. VALUE OF SOLAR RADIATION. HYGIENIC
REQUIREMENTS TO ILLUMINATION……………………………………………P.
THEME N 13. HYGIENIC REQUIREMENTS TO QUALITY
OF DRINKING WATER……..……………………………………………..………..P.
THEME N 14. HYGIENE OF WATER SUPPLY. METHODS
IMPROVEMENT QUALITY OF WATER………………………………………….P.
THEME N 15. HYGIENIC VALUE OF GROUND.
HYGIENE OF THE OCCUPIED PLACES. HYGIENIC DEMANDS TO
CLEANING OCCUPIED PLACES FROM WASTE PRODUCTS…………………. P.
 Final lesson on Municipal hygiene…………………………………………………….P.

SECTION “HOSPITAL HYGIENE”

THEME N 16. HYGIENIC REQUIREMENTS TO HOSPITALS……………………P.
Instruction for independent work. Sanitary - hygienic inspection hospitals…………..P.

SECTION " HYGIENE OF WORK"

THEME № 17. SUBJECT AND TASKS HYGIENE OF WORK.
PHYSIOLOGY OF WORK. PROFESSIONAL HARMFUL FACTORS AND
OCCUPATIONAL DISEASES. PROFESSIONAL DUST PATHOLOGY AND ITS
PREVENTION ……….………………………………………………………………….P
THEME № 18. HYGIENE OF WORK AT ACTION PHYSICAL
PROFESSIONAL HARMFULL FACTORS (NOISE, VIBRATION,
ELECTRO-MAGNETIC FIELDS)……….……….…………………………..………….P.
THEME № 19. RADIATION HYGIENE AND ECOLOGY…………....……………….P.
THEME № 20. INDUSTRIAL TOXICOLOGY AND
TOXICOLOGY OF AGROCHEMICALS…………………………………..…………….P.
Final lesson on "Hygiene of work" and "Hospital hygiene "………………………….P.

SECTION “HYGIENE OF CHILDREN AND TEENAGERS”

THEME № 21. PHYSICAL DEVELOPMENT CHILDREN AND
TEENAGERS AS CRITERION OF HEALTH……….…………………………………….P.
THEME № 22. HYGIENIC REQUIREMENTS TO CHILDREN'S
PRESCHOOL ESTABLISHMENTS AND SCHOOLS…………………………………….P.
THEME № 23. HYGIENIC REQUIREMENTS TO LEARNING,
PHYSICAL TRAINING AND HARDENING CHILDREN AND TEENAGERS.
HYGIENE OF CHILDREN’S NUTRITION…………..………………..…………………..P.
Instruction for independent work for the students. Sanitary inspection
comprehensive schools and children's preschool establishments…..…………..…………....P.

SECTION “HYGIENE OF THE HOT CLIMATE”.

THEME № 24. HYGIENIC CHARACTERISTIC OF THE HOT CLIMATE,
ITS INFLUENCE ON THE ORGANISM OF THE PERSON.
HYGIENE OF NUTRITION, HYGIENE OF WORK, PERSONAL HYGIENE AND
HYGIENE OF LIVING ROOMS IN CONDITIONS OF THE HOT CLIMATE.…………..P.

EXAMINATION QUESTIONS AND TASKS for examinations in common hygiene with

medical ecology at medical faculty………..…………………………………………………..P.
INTRODUCTION.
THE PURPOSE AND TASKS OF LEARNING GENERAL HYGIENE AND MEDICAL
ECOLOGY AT MEDICAL FACULTY.

The purpose of study hygiene and ecology at medical faculty is the formation at the future
doctor hygienic thinking – it means understanding interrelation of health with quality (degree of the
level of pollution) environment – it is necessary condition scientifically proved systems protection
of health, healthy way of life, effective public and individual prevention of various diseases.
During study hygiene and medical ecology the students should take possession of such
knowledge:
1. To know methodology, basic laws of a hygienic science and common laws connection
health with the factors and conditions of environment.
2. To know an origin, property and laws influence basic natural and technogenic factors of
environment and social conditions on ecological situation and health of the population.
3. To know methodology of study influence of the factors and conditions of environment on
health of various groups of the population, to know qualitative and quantitative parameters of
hygienic estimation condition of an environment and its influence on health of the population.
4. To know methodology and principles hygienic reglamentation hamful factors in
environment, organization and contents of preventive and current sanitary supervision behind
treatment-preventive establishments, inhabited and other objects sanitary - municipal purpose,
establishments of nutrition, children's and educational establishments, enterprises of industrial and
agricultural manufacture.
5. To know bases of a healthy way of life, personal hygiene and balanced diet, to be able to
prove the recommendations for prevention of various diseases

In the future professional activity hygienic knowledge and the practical skills are necessary
for the doctor in the following situations:
1. At differential diagnostics of diseases, definition the scheme of treatment, treatment-
preventive mode and medical-labour examination.
2. In work on professional orientation, professional training and employment of the persons
with a different level of health.
3. At estimation and maintenance sanitary - hygienic and antyepidemic mode of treatment-
preventive establishments, establishments of preschool, school and professional training,
establishments of public catering and others.
4. For optimization conditions of a life, education, training, work, prevention intrahospital and
other infections, substantiation the recommendations on personal hygiene, balanced diet.
5. At development and realization complex programs of prevention various diseases.
6. In work on propaganda of medical knowledge and hygienic education of various groups of
the population.
THEME № 1. THE SUBJECT AND TASKS OF HYGIENE AND ECOLOGY.
HYGIENE AS MEDICAL SCIENCE.
In medicine it is possible to allocate 2 areas: medical and preventive. It are in
organic unity and supplement each other, but are separate scientific disciplines. Object
studying medical medicine is the ill person, its aim is diagnosis and treatment diseases.
The preventive medicine or "hygiene" (from Greek - " bringing health ") studies
healthy person (individual health) or health of the collectives people, population of region
or the country (population health) with the purpose preservation or strengthening health.
Experts in this area refer to as doctors - hygienists or health officers (abroad - doctors
public health).
Task studying hygiene in medical university is formation at the future doctor
hygienic thinking, which means:
- to be able to connect occurrence of disease at the separate person or at the
certain population of people with influence factors of environment, industrial or household
environment, with sanitary conditions of life
- to be able to develop the appropriate actions for prevention negative influence
adverse factors of environment on health.
The factors influencing on health of the population.
It agrees to the data the World Health Organization (WHO), the health of the
population of any country of the world depends from the following reasons:
1) On 48-53 % - from social and economic conditions in country or region and a
mode of life person (physical training, smoking, etc.)
2) On 18-20 % - from the genetic factor (spreading hereditary illnesses in
population)
3) On 17-20 % - from quality (degree of pollution) environment
4) On 8-10 % - from level of development and quality of medical aid.
So, improvement quality of environment theoretically can give in two times biggest
effect, than all clinical medicine. It shows significance preventive medicine or hygiene in
strengthening population health.
Concept “hygiene”
Hygiene is the medical science, studying the influence factors of an environment on
organism of the person and public health with the purpose to substantiation hygienic
specifications, sanitary rules and actions for preservation and strengthening health of the
person and prevention diseases.

THE HISTORY BECOMING AND DEVELOPMENT HYGIENE.

All centuries-old history of hygiene can be divided conditionally into 2 periods:
Empirical hygiene (skilled hygiene) - gradual accumulation hygienic knowledge
by people from time primitive society on the basis of own experience or by experience of
the previous generations (the use and preservation various food, water from different
water sources, arrangements habitation in different district etc.). The further development
empirical hygiene has received in a slaveholding society, in many respects under influence
of religious instructions - the Ancient East, Babylon, Greece, Rome. During Middle Ages
because of developing inquisition in Europe the centers of medical science have moved
from Europe to East (works of Avicenna or Ibn-Sina).
The period empirical hygiene was finished by time of Revival in Europe (15
century), opening a microscope and a nature of infectious illnesses (16-17 centuries).
The period scientific - experimental hygiene - period studying the harmful factors
influencing on health of the person, in natural and experimental conditions and
development scientifically-grounded preventive recommendations.
 The first known scientific work on hygiene - Italian doctor B. Ramattcini –
"Reflections about illnesses of handicraftsmen" - there were described working conditions
of 52 trades (17 century). In Russia the president of the Petersburg medico-surgical
academy A. Frank (18 century) has issued the multivolume book - " Full system of medical
police ".
The first faculty hygiene in territory of Russian empire was opened in 1863 at the
Kiev university, in 1865 - in St. Petersburg. Oustanding hygienists in Russia before
revolution - N.A.Dobroslavin and F.F.Erisman. In the Soviet period outstanding scientists -
hygienists - academicians A.N.Sysin, A.N.Marzeev, L.I.Medved.
On Ukraine oustanding scientists now work: acad. J.I.Kundiev (director scientific
research institute hygiene of work), аcad. E.I.Goncharuk (ex-rector National medical
university), аcad. A.M.Serdjuk (director Ukrainian scientific hygienic centre).

SUBJECT HYGIENE
Subject studying hygiene - health of the person and environment in it complex
interaction.
The environment in a broad sense - everything, that surrounds the person and
influences on him.
In hygiene as environment it is understood 4 objects, which first of all have effect on
organism of the person:
1) Atmospheric air and air of working zone,
2) Water of reservoirs and drinking water,
3) Ground
4) Foodstuffs.

PRIMARY TASKS OF HYGIENE:

1. Studying natural and anthropogenic factors of the environment influencing on the
person - their sources, the reasons of occurrence, ways of influence on the person, the
basic quantitative and qualitative characteristics.
In hygiene all variety factors of the environment influencing the person, shares on:
- Physical factors (noise, vibration, radiation),
- Chemical (various chemical substances),
- Biological (microbes, viruses, biological agents etc.),
- Psychogenic (information – high level negative information can give illness or even
death of the person),
- Social (level of life, conditions of rest, etc.)
2. Studying the influence of factors of environment on organism (in natural or
laboratory experiments).
3. Scientific substantiation and development hygienic specifications, rules and
recommendations for decrease or elimination influence harmful factors and strengthening
action positive factors.
4. Introduction hygienic recommendations in practice, check it efficiency and the
further perfection.
5. The scientifically-grounded forecasting sanitary situation in concrete region or the
country on the nearest and remote prospect on the basis of multifactorial mathematical
modelling.
THE BASIC SECTIONS OF HYGIENE
The contents of hygiene as science is determined by the list of its basic sections:
 General hygiene (propaedeutics of hygiene)
 Hygiene of nutrition
 Municipal hygiene
 Hygiene of environment
  Hygiene of work
 Hygiene of children and teenagers
 Hygiene of treatment-and-prophylactic establishments
 Hygiene of extreme situations
 Military hygiene
 Hygiene of hot climate
 Radiating hygiene
 Other sections - transport, sports hygiene etc.

METHODS HYGIENIC RESEARCHES

Alongside with the methods used in other medical sciences - physical, biochemical,
physiological, morphological, hygiene has a number of specific methods of research:

1. Epidemiological method - studying health of the population on basic quantity

indicators as integrated criterion quality of environment.
The BASIC QUANTITY INDICATORS of POPULATION HEALTH
а) Demographic - death rate, birth rate, natural increase, average life expectancy etc.,
b) Parameters of morbidity (common sick rate, morbidity etc.),
c) Physical development – (weight, height) - is especial important at children and
teenagers,
d) Disablement (invalid) of the population (amount of invalids in population, reasons
(diseases) of invalidity, etc).
2. Method of sanitary inspection. The very first method in hygiene - sanitary
inspection of object (for example, eating house with drawing up the act of sanitary
inspection).
3. Method of sanitary examination - examination civil-engineering designs of
objects to correspond hygienic requirements, examination food stuffs (comparison
parameters of product to requirements of state standards and the decision on opportunity
realization food product).
4. Method of hygienic experiment - studying action the harmful factor on
organism of animals in laboratory experiment with modelling conditions of real influence on
the person with revealing sensitive systems, limit and invalid levels of influence - basis of
hygienic reglamentation harmful factors.

COMPOSITION ENVIRONMENT And BIOSPHERE

ENVIRONMENT BIOSPHERE
1.Athmosphere air 1. A troposphere-
( Air in premises (rooms)) low layer of atmosphere 10-18km
2.Water of reservoirs and 2. Hydrosphere - up to 11km
Drinking water
3. Ground 3. A litosphere - up to 12 kms
4. Food stuffs

CLASSIFICATION FACTORS of ENVIRONMENT

HYGIENIC ECOLOGIC
1. Physical (noise, vibration, EMF, radiation etc.) 1. ABIOTIC (nonliving nature)
2. Chemical (various materials, steams, gases) 2. BIOTIC (alive nature)
3. Biological (macro- and Micro-organisms, 3. Anthropogenic (technogenic)
bioactive materials)
4. Psychogenic (psycho- Physiological)

THE STATE SANITARY INSPECTION AND ITS STRUCTURE

Hygiene is the scientific part of preventive medicine.
Sanitary is the practical part of hygiene – it aim is the application hygienic
requirements in practice and the control it performance.
For it in each country there is the special public service, supervising observance the
sanitary legislation. In the USSR and on Ukraine such special public service named
sanitary-and-epidemiological service (SES) and is part of Ministry Public Health of the
country.
Bases of the sanitary legislation.
SES in the work is guided by Laws, State standards, Sanitary norms and rules,
Lists of the maximum permissible concentrations of harmful substances in objects of
environment, instructions and orders of Ministry Public Health and the Main state sanitary
doctor of the country or region.
The basic document for SES on Ukraine - the Law Ukraine 1994 "About sanitary
and epidemiological well-being of the population of Ukraine ".
KINDS OF STATE SANITARY INSPECTION:
1) PREVENTIVE - it is carried out at designing, construction and delivery objects by
sanitary examination projects and sanitary inspection of building object on conformity to
hygienic requirements. Also it is carried by hygienic normalization harmful factors in
environment.
2) CURRENT - check observance hygienic requirements at functioning object,
control levels pollution of environmental or industrial environment, application economic,
administrative or criminal sanctions concerning infringers of the sanitary legislation.
STRUCTURE SANITARY-AND-EPIDEMIOLOGIC SERVICE OF UKRAINE
Heads this section of public health services the Main state sanitary doctor of
Ukraine - the first deputy minister of public health services of Ukraine. The Main state
sanitary doctor of Ukraine submit the Main state sanitary doctors Republic Crimea,
districts, cities, city and rural regions.
The main state sanitary doctor is responsible for sanitary-and-epidemiological well-
being of the population of the region according to the Law on sanitary and epidemic well-
being of the population of Ukraine. He in submission has special establishments - sanitary-
and-epidemiological stations (SES).
Establishments of sanitary-and-epidemiological service
For realization the state sanitary inspection there are special establishments -
sanitary-and-epidemiological stations which share on Republican (Ukraine and Crimea),
district, city and regional (in cities and rural areas). Basic structural divisions SES -
sanitary-and-hygienic department (branches hygiene of nutrition, hygiene of work,
municipal hygiene, hygiene of children and teenagers), epidemiological department and
the appropriate laboratories.

STRUCTURE SANITARY - EPIDEMIOLOGICAL SERVICES OF UKRAINE

MAIN STATE SANITARY DOCTOR of UKRAINE

Main sanitary - epidemiological management Ministry Public Health of Ukraine

Main state sanitary Main state sanitary doctors of Crimea, Hygienic research
doctors of of areas, Kiev and Sevastopol scientific institutes
Departments of cities and areas (urban and village)
(Ministry of defence Desinfection and antyplague ststions
Ministry of Internal
Affairs, etc.)

STRUCTURE SANITARY - EPIDEMIOLOGICAL STATION

Sanitary - hygienic Epidemiological Desinfection
Department department department
Branches: branch especially Branch prophylactic
Hygiene of nutrition dangerous infections disinfection, desinsection
Hygiene of children and antyepidemical and deratization
teenagers branch Branch chamber disinfection
Municipal hygiene Branch infections and sanitary Processings
Hygiene of work Branch of evacuation and
Sanitary Laboratory Bacteriological disinfection
Тoxicologic laboratory Laboratory
Radiologic branch

BASES OF THE COMMON ECOLOGY.

Ecology is the biological science studying mutual relation of alive organisms in

nature among themselves and with inhabitancy, structure and functioning biological
systems (populations).
Ecology ( bionomics ) is divided in such sections:
AUTECOLOGY - the section of a bionomics which studies all ecological aspects in
respect of the separate representative of kind of alive organisms. Autecology studies action of
the factors of the environment on each alive organism. Thus an investigated organism are
considered outside of link with other living entities of the given ecological system.
SYNECOLOGY studies communities of various alive organisms. For example:
community microorganisms, plants, animal and their interaction with each other, and also
with the inorganic environment.
In ecology to hygienic concept "environment" approximately there corresponds
concept "biosphere", but biosphere - wider concept.
Concept about biosphere and its structure.
The term "biosphere" was entered in 1875 by the Austrian scientist E. Zjuss. The
doctrine about biosphere as complex multicomponent planetary system, was created by
V.I.Vernadsky.
Biosphere - sphere of life on the Earth, it enter:
- Troposphere - layer part of atmosphere (height - up to 25 kms)
- Ground - litosphere (depth - up to 10 kms)
- Hydrosphere (depth of oceans - up to 12 kms).
Ecosystem is a collection of all living together organisms and also factors of the
environment, in which they live.
Any ecosystem consists of two parts:
1 part is named as biocenosis. It is all alive organisms of ecosystem.
2 part is named as biotope. It is a part of earth surface, with particular physicochemical
properties, on which the biocenosis lives (Tabl. 1).

Table 1
Ecosystem

biocenosis biotop
 Sorts of the ecosystems
Table 2

1.Microecosystems - small stream, glade.

2. Mesoecosystems -sea, wood, pond, river.
3. Macroecosystems - ocean, continent.
4. Global ecosystems - biosphere as a whole.
Larger ecosystems include smaller ecosystems.

biospher
ee

continent
ocean
sea wood pond glade

sea stream

river
 Environment – a wider concept. The environment consists of biocenosis, biotope
and also physical, chemical, biological, anthropogenous factors ( forces ), operate on
living organism (Tabl.3).

Table 3
Environment

biocenosis biotope Abiotic Biotic

Anthropogenic factors

ECOLOGICAL FACTORS:
а) аbiotical (factors of lifeless nature)
b) biotical (mutual relation of alive organisms, trophic circuits etc.)
c) Anthropogenous (are connected to activity of the man)
The action on alive organism depend from intensity of ecological factors which can
act as:
- irritable - cause adaptive reactions,
- Signals - testify change of other factors of environment,
- Modifiers - cause morphological changes,
- Terminators - stop or oppress ability to live of an organism
Rule of limiting ecological factors. The more value of the separate ecological
factor keeps away from zone of optimum for the given kind, the more it oppresses ability to
live and refers to limiting.
Ecological niche - set of the ecological factors providing normal ability to live of the
given kind of organisms.
Ecosystem - set of in common living kinds of alive organisms and conditions of
their existence.
Biocenos - set in the certain territory homogeneous ecological factors and kinds of
alive organisms, consists of 2 parts: 1) ecotop - set аbiotical factors, 2) biocenosis - a
complex of alive organisms.
The basic parameters of ecosystem:
а) Qualitative - specific variety ecosystem, amount of kinds
b) Quantitative - quantity of individuals of each kind.
Everyone ecosystem is in a condition of mobile - stable balance - homeostasis.
Gradual change parameters ecosystem under influence of any factors - succession.
The laws existing ecosystems
The law of ecological optimum (Tabl. 4): Vital activity organisms, their quality and
quantity conditions of life depend on different factors of Environment. Zone of ecological
optimum - a range of the ecological factor, optimum for ability to live of the given kind of
alive organisms. Above and below of the ecological factor in zone of optimum there are
zones (points) pessimum (oppressions life).
The range of zone optimum under each ecological factor for the given kind of
organisms refers to ecological valency of a kind.
Ecological spectrum of a kind it is a set of ecological valencies under different
ecological factors. On breadth of an ecological spectrum all kinds share on evrybiontable
(for example, evrythermal) - has a wide spectrum and stenobiontable - has a narrow
ecological spectrum.
The zone of ecological optimum is a zone of comfort for living organisms, when
Environment factors acts favourably on animals and plants. Quantity and quality of organisms
in this zone is greatest.
 The zone of pessimum (depression) - is behind (low or high) the zone of optimum. The
factors of Environment act unfavourable on animals and plants. The indexes of quantity and
quality of organisms are lower in this zone.
The critical point of life - it is the meaning of factor of Environment. In this point life is
impossible.
Table 4

law of optimum

40

35

30

25
quantitative organism

20

15

10

5 factors of Environment

0
critical point zone depression zone optimum zone depressium critical point

The law of trophic chain. The trophic chain is the chain transmission of substance or
energy from low -organized organisms to high –organized organisms in ecosystems (Tabl. 5).
First level of trophic chain - is level of producents - / plants /.
Second level is the level of consuments 1 order (herbivorous animals).
Third level is the level consuments 2 order (carnivorous).

Table 5.
TROPHIC CHAIN

people and consuments 2 order( carnivorous) Third level

consuments 1 order ( herbivorous ) Second level.

producents ( plants ) First level

The law of accumulation of polluting substances in trophic chains.

 Polluting substances can accumulate in plants, herbivorous and carnivorous. Polluting
substances transmit from lower level of trophic chain to high level of trophic chain. ( Tabl. 5 ).
Value studying trophic circuits for hygiene.
In it circuits due to bioconcentration can collect toxicants up to dangerous to the person
levels. Besides loss of any parts of trophic circuits under anthropogenous influence results
in disappearance of trade kinds of animals or fishes that can worsen quality of nutrition of
the population.

INTERRELATION AND DIFFERENCES HYGIENE AND ECOLOGY

Common at it 2 sciences - studying influence factors of environment on organisms,
preservation environment (inhabitancies) from degradation owing to pollution. Changes in
ecosystem sooner or later have negative effect for conditions of life or health of the
person.
Differences:
а) Different objects of research - the person (in hygiene) or alive organisms (in ecology)
b) Different methods of research in these sciences in connection with different objects of
research
c) Differences in principles normalization harmful factors (in hygiene - preservation health
of each person, in ecology - preservation the basic parameters ecosystem with possible
destruction part of organisms).

INSTRUCTION FOR PRACTICAL LESSON ON THE THEME

The educational questions:
1. History of development hygiene and ecology. The community and differencies between hygiene
and ecology. Tasks of medical ecology.
1. Main tasks and departments of hygiene. Main laws of hygiene.
3. The basic methods of hygienic researches and examples of it realization.
4. Structure of an environment and biosphere, kinds of monitoring it pollution.
5. Classification factors of environment in hygiene and in ecology.
6. The basic concepts of ecology: ecological factors, ecosystem, biocenosis, trofic chain.
7. Parameters of health of the population and factors influencing at the health of the population
8. Kinds of state sanitary supervision, structure sanitary - epidemiologic services of Ukraine,
structure sanitary - epidemiologic stantion (SES).

Algorithm of practical work of the students.

The first stage. To answer the tests of the initial control of knowledge and questions of the teacher.
The second stage. In notebook of the protocols to sketch the scheme of sanitary - epidemiologic
services of Ukraine and structure SES.
The third stage. Check of a level of knowledge under the tests of the final control. The decision
situational tasks.

Tests for the control of knowledge

1. Specify major factors determining health of the population
А. Climatic features, geographical arrangement, degree urbanization of territory
В. Social, economic, genetic, ecological, medical
С. Quality of nutrition, image of life, condition of residing, professional factors
D. An image of life, national features, religious factors, social state
Е. Age, sexual, individual, hereditary factors.

2. Among set of the factors determining health of the population, the greatest influence on
parameters of health of the population has the following group:
А. Level of development of public health services and quality of medical aid to the population
В. Level of a hereditary pathology
С. Educational level and cultures of the population
Д. Image of life and social economic conditions
Е. Degree of pollution of an environment

3. Specify densities of influence of quality of an environment on the health of the population:

А. 45-53 %
В. 17-20 %
С. 8-10 %
D. 24-25 %
Е. 15-17 %

4. What components enter into concept "environment"?

А. Air, plants, animal, water, ground
В. Abiotic and biotic factors of environment
С. Water, air, ground, food products
D. Plant, building, ground, air
Е. Water of reservoirs, air, ground

5. From what components the biosphere consists?

А. Exosphere, ionosphere, mesosphere, troposphere
В. Lytosphere, hydrosphere, troposphere
С. Air, water, ground, ecosystems
D. Autotrofical and heterotrofical organisms
Е. Space, globe

6. What parameters of health of the population are most sensitive at pollution of an environment?
А. Demographic
В. Sick rate
С. Sick rate with temporary loss of work capacity
D. Invalidization
Е. Physical development

7. What diseases concern to ecologically caused (ecopathology)?

А. Diseases which are most badly giving in to treatment in the given district
В. Most frequently meeting diseases in the given district
С. Diseases, for which the role of the factors of an environment is proved
D. Disease among the most sensitive groups of the population (children, elderly people)
Е. Diseases considerably distinguished on frequency in various regions

8. What parameters are studied at realization epidemiological method of research in hygiene?

А. Parameters of levels of pollution of objects of an environment
В. Frequency and level of infectious diseases among the population
С. Parameters and indexes of health of the population
D. Level endemical diseases in the given district
Е. Parameters of condition ecosystems in investigated territory

9. From what is the method of sanitary inspection consists?

А. Ii is study of object with drawing up of the act of hygienic inspection
В. It is sanitary inspection of object with the purpose of its closing
С. It is selection tests of objects of an environment and comparison to the specifications
D. It is study quality of object on conformity to the requirements
Е. It is realization experimental researches on animals

10. From what is the method of sanitary examination consists?

А. It is study of object with drawing up of the act of hygienic inspection
В. It is sanitary inspection of object with the purpose of its closing
С. It is selection tests of objects of an environment and comparison to the specifications
D. It is study quality of object on conformity to the requirements
Е. It is realization experimental researches on animals

11. Specify classification of the factors of environment in hygiene:

А. Biotic, abiotic, anthropogenous
В. Air, water, ground, food products
С. Chemical, physical, biological, informative
D. Dangerous, harmful, indifferent
Е. Natural and anthropogenous origin

12. Specify classification of the factors of environment in ecology:

А. Biotic, abiotic, anthropogenous
В. Air, water, ground, food products
С. Chemical, physical, biological, informative
D. Dangerous, harmful, indifferent
Е. Natural and anthropogenous origin

Sources of the information.

The basic literature:
1.Е.И.Гончарук, Ю.И.Кундиев, В.Г.Бардов и др.. Общая гигиена. Ки ї в, 2000, 2 изд.
652 c.
2. І. І .Даценко, Р.Д.Габович. Профілактична медицина. Загальна гігієна з основами екології.
Ки ї в, 1999.- 694 с.
3.І. І .Нікберг, І .В.Сергета, Л. І. Цимбалюк. Гігієна з основами екології. - Киів, 2001.- 250с
4.В.А.Боков, А.В.Лущик. Основы єкологической безопасности.- Симферополь,1998.- 224с.
5. Lectures on common hygiene and ecology. – Simferopol, 2003. - 130р.
6. Park’s textbook of Preventive and Social medicine. India, 2000. - 16-th edition. – 660p.
7. Руководство к практическим занятиям по общей гигиене и медицинской экологии. / Под
ред. Проф. С.Э.Шибанова. – Симферополь, 2003. – 260с.
The additional literature:
1.Ю.П.Пивоваров и др. Руководство к лабораторным занятиям по гигиене.- Москва,1975.-
478с.

THEME 2. HYGIENE OF THE ENVIRONMENT.

HYGIENIC STANDARTIZATION ADVERSE FACTORS IN OBJECTS OF
ENVIRONMENT.
INFLUENCE QUALITY OF THE ENVIRONMENT ON HEALTH OF THE
POPULATION.

Hygiene of environment is the section of hygiene, studying medical aspects

protection environment as scientific basis prevention adverse influences factors of
environment on the person on individual and population levels.
 Сoncepts “environment”:
1) The internal environment of organism - the internal maintenance, nervous and
humoral mechanisms regulation and maintenance gomeostasis.
2) The external environment - everything, that is outside of organism and operates on his
environments and receptors. From the point of view physiology, internal and an external
environment are very individual and dynamical for each person.
3) The environment - everything, that surrounds and influences at the person. It is not
individual, and general for a population. In hygiene the basic objects of an environment
are: atmospheric air, water of reservoirs, ground and foodstuffs.
Depending on a degree influence anthropogenous factors distinguish the following
versions condition of an environment:
1. Not changed (natural) - the part of environment, which has no anthropogenous
influence (reserves etc.)
2. Changed (polluted) - as a result of activity of the person, it can render negative
influence on health of people.
3. Artificial - environment specially created by the person (a spacecraft, a submarine etc.)
The basic sources of environmental contamination.
Natural - volcanoes, earthquakes, flooding, forest fires, typhoons etc. - the natural
extreme phenomena. Scales pollution of environment thus can be very significant, cover
the big territories and levels pollution may be more, than anthropogenous pollution.
Anthropogenous - caused by activity of the person: the industry, the atomic power
station, transport, agriculture, municipal services etc.
Major factors of environmental contamination:
- Chemical (pesticides, mineral oil, heavy metals etc.)
- Physical (noise, vibration, radiation, electromagnetic fields)
- Biological (microorganisms, biological products etc.)
Concept about pollutant of environment.
Pollutant is the any natural or anthropogenous factor, which is taking place in
environment in amounts more, than natural fluctuations, natural background or exceeding
allowable specifications for the given object of environment. Not any presence pollutant in
the environment is pollution.
Pollution - presence pollutant in the environment is higher than maximal
permissible concentration, which can render adverse influence on health of the person.
Criteria danger of environmental contamination and kinds of its monitoring.
To estimate danger of environmental contamination it is possible by the following
criteria:
- On degree excess maximum permissible concentration of pollutants in the environment -
analytical monitoring,
- On integrated parameter - state of health of the population – medical-hygienic
monitoring,
- On changes in ecosystems - ecological monitoring (in regional scales), biospheric
monitoring (on global scale).

BASIC DIRECTIONS PROTECTION ENVIRONMENT FROM POLLUTION

1. Administrative - legislative measures of the preservation of the environment on the
international, national or regional level. These measures are priority, as create a legal
base for all nature protection activity. Now there is a special direction in jurisprudence - the
nature protection right.
2. Hygienic actions - realization preventive and current sanitary inspection.
Preventive sanitary inspection - examination projects of the enterprises, capable to pollute
environment, standartization pollutants in objects of environment.
The current sanitary inspection - the control levels pollution of environment, revealing
sources of pollution and acceptance measures to decrease pollution.
3. Architectural measures - correct accommodation pollution sources for decrease
influence on especially important objects (for example, zones of sanitary protection of
water sources, functional zones in cities, sanitary - protective zones about the enterprises
etc.).
4. Medicine measures - studying parameters of health of the population, revealing,
treatment and improvement the persons having infringements of health owing to pollution
of environment. These measures allow reveal the most dangerous sources and factors
pollution of environment and the most sensitive to pollution parameters of health of the
population.
5. Ecological monitoring - studying condition of ecosystem and separate kinds of alive
organisms under action of environmental contamination with the purpose prevention
irreversible infringements ecosystem.
6. Technological measures: translation the enterprises into the closed cycle (without
emissions in an environment), change technology for decrease emissions in environment
(for example, translation motor transport into electricity), development sanitary engineering
(clearing constructions for clearing emissions in atmosphere, dumps in reservoirs,
construction ranges and stores of waste products etc.)

HYGIENIC STANDARTIZATION (REGLAMENTATION) HARMFUL FACTORS IN

THE ENVIRONMENT.
Standartization the harmful factors in the objects of environment is the important
element of preventive sanitary inspection as establishes criteria of the allowable
maintenance pollutants in objects of environment.
In hygiene there are 2 approaches to standartization (normalization) factors of
environment acting on the man:
1) For the NATURAL FACTORS (parameters of a microclimate, irradiating, ventilation
of air, demands to nutrition) – it is substantiation OPTIMAL LEVELS of it factors for
preservation and hardening health of the man or support comfortable conditions of
his life and work.
2) For the HARMFUL FACTORS in environment there are 2 concepts:
А) Concept of exception - absolute prevention entering the harmful factors in the
environment, but it can be make very rare because it mean to stop industry, transport,
power stations, etc.
B) The concept of restriction – when it is impossible to eliminate presence of the
harmful factor in environment, it is necessary to confine its content up to safe for the man
levels - hygienic specifications (normatives).

Concept about the hygienic specification (normative) of the harmful factor in

object of environment.
It is such concentration, dose or level of the harmful factor in object of environment,
which: do not produce pathological changes in organism of the man and succeeding
generations (which can be found on a modern level of development of a science) during all
time of contact with this factor (during life or working experience), and also do not
worsening the sanitary conditions life of the population.

Kinds of hygienic specifications of the harmfull factors in environment.

In each country there are own specifications of harmful factors authorized by the
state in the environment, there are also the international standards, coordinated by the
WHO and UNEP (the program of the United Nations for protection environment).
On Ukraine and in the countries of the CIS such specifications refer to maximal
permissible (concentration, dozes, levels):
 Maximal permissible concentration (MPC) - for harmful substances in water, air,
ground, food stuffs
Maximal permissible doze (MPD) - for radiation
Maximal permissible level (MPL) - for noise, vibration, electromagnetic fields
Much possible - allowable levels - for pesticides in food stuffs
Allowable residual quantities - for pesticides in ground and food stuffs.
Except for these specifications authorized by Ministry of Health, for new
substances in the beginning develop time specifications:
Tentative safe level of influence - for air,
Tentative allowable concentration - in water.

PRINCIPLES OF THE HYGIENIC NORMALIZATION HARMFUL FACTORS IN

THE ENVIRONMENT
1.Priority medical indications at establishment the specification.
At definition size of the specification only levels of its safe action at organism are
taken into account, instead of technical and economic reasons for observance this
specification.
2. Differentiation of the degree of biological answers of organism at the action
of the harmful factor.
Depending from level of the harmful factor, which influence on organism, and
resistibility of organism to harmful influence we can allocate the following levels of
biological answers:
1 - destruction of organism,
2 - illness,
3 - prepathology (violations functions of organism without clinical signs of desease),
4 - pressure adaptive and compensatory processes (functional violations unknown
aethyology),
5 - accumulation substance in bodies and fabrics without functional and clinical
changes.
Specifications must be established not above 4 level.
3. Division objects of environment for sanitary protection.
As each object of environment (air, water, ground, food stuffs) has the physical and
chemical features and different conditions of contact to organism of the person,
specifications are established separately for each object of environment.
4. Principle of the account all probable adverse influences of the normalized
factor on concrete object of an environment.
There are the most important parameters reflecting harmful action investigated
factors at quality concrete object of environment. Such parameters named attributes or
criteria of harmful action: Organoleptic, Common sanitary, Phitoaccumulative, Water
migration, Air migration, Reflex, Toxicological, etc. (see tab.)
Attributes of harmful activity at normalization harmful
factors in objects of environment
________________________________________________________
Sign of harm Kind of unfavorable activity
Organoleptic change of odour, taste, colouring etc.
Common sanitary influence on a saprophytic microflora,
processes of a self-cleaning
Phytoaccumulative accumulation pollutant in vegetative
products
Water-migration accumulation pollutant in ground waters
Air-migration evaporation pollutant in air not higher MPC
Reflective irritating activity on mucous cowers of organism
Toxicological toxical effects on organism of animal
Specific allergenic, gonadotrophic, embryotropic effects
The remote effects oncogen, mutagen effect
At learning each attribute of harm in laboratory determine threshold concentration
(TC) of pollutant to each attribute of harm, the parameter of harm from the least TC is
termed, named limiting attribute of harm and on it is proved MPC.
5. Principle presence the threshold (limit) of harmful action - the central
principle of normalization. For each harmful factor there is a threshold of harmful action -
a level at which the harmful effect are registrated (LOAEL) and a low level (NOAEL) -
when such effect is absent.
6. Principle dependence harmful effect from concentration (doze) of the
investigated factor and time of its influence. It is based on mathematical dependences
"concentration (doze) - effect" or "time - effect". Last dependence is observed at chronic
influence at presence cumulation (chronoconcentration poisons).
7. Principle laboratory experiment. Researches influence of the normalized factor
on attributes of harm will be carried out in laboratory conditions at unification and
standardization techniques for comparability the results received by different researchers.
8. Principle of aggravation. In laboratory researches are modelled the most
adverse conditions promoting the maximal display of harmful effects of the investigated
factor. It concerns to the same principle - to carry the toxicological data received on
laboratory animals, on an organism of the person.
9. Principle relativity specifications. The established specifications are not
constant and final. At occurrence new experimental data or results negative influence of
the normalized factor at the health of the population at levels, which is lower than maximal
permissible concentration, specifications are decrease.

The scheme of research toxicological attribute of harmful action at hygienic

normalization chemical substances in the environment.
One of the most difficult and expensive for research attributes of harm at
normalization is toxicological. It is investigated under the following scheme:
1 Stage. Learning physic - chemical properties normed material with the purpose search
similar materials, for which there are specifications, for an approximate evaluation levels of
toxicity and mechanisms of activity new toxicant.
2 Stage. Studying acute toxicity of substance (at one time influence- letal doses
and concentrations, threshold of acute harmfull action, etc.).
3 Stage. Studying half-acute toxicity of substance at influence on experimental
animals during 30-45 days (ability to cumulation, etc.).
4 Stage. Studying chronic toxicity of substance (during some months or years-
theshold of the chronic harmfull action).
5 Stage. Definition limit concentration or dozes on the toxicological attribute of
harm. Limit (LOAEL) and underlimit concentration (NOAEL) for the person are determined
on the basis of the received data on laboratory animals.

Hygienic normalization biological factors in an environment.

Such factors in an environment are:
1) Pathogenic activators infectious or invasive nature - bacteria, viruses, gelmints,
the elementary or their toxins
2) Allergens biological nature
Main principles normalization microbe pollution of environment.
1. Absence activators infectious diseases in the certain volumes or amount of object
of an environment.
2. Substantiation the allowable contents of microorganisms in objects of an
environment at which it are considered safe in the epidemiological attitude.
3. Use at normalization display (sanitary - indicative) microorganisms.
The display principle of normalization microbes in the environment, offered 100
years more back by R. Koh, and now remains conducting principle of normalization
microbe environmental contamination.
At a choice sanitary - indicative microorganisms as indicators of pathogenic
microbes take into account:
1) Commonplace of inhabitation in an organism of the person
2) Identical ways of hit to an environment and organism of the person (way of
transfer)
3) Higher survival rate in the environment in comparison with pathogenic
microbes, higher stability to disinfecting
4) Harmlessness for the person (inability to cause infectious diseases)
Now as indicator virus pollution of environment use bacteroifags of intestinal stick
(E.coli) - coli - fags. It on structure, survival rate, are similar for enteroviruses, causing
intestinal infections.
Various sanitary - indicative microorganisms for estimation various objects of an
environment were offered, for example, for water of reservoirs - bacteria group of
Esherichia coli (BGEC), coli - fags.
The quantitative estimation goes on a coli - index - quantity BGEC in the certain
volume of test object and coli - titr - volume of test object in which one BGEC is found out.
For example, for drinking water coli - index - up to 3, coli - titr - more than 300 ml, in
sewage coli - index - up to 1000, coli - fags - up to 1000, absence pathogenic microbes in
1 l water.(Tab. 1)

BACTERIAL NORMATIVES IN OBJECTS OF ENVIRONMENT

Tabl.1
FOR ESTIMATION WATER:
Kind of water Coli-index Coli-fag Absence patho-gen viruses
in volume of water
Drinking <3 - 10 l
For bathing < 1000 < 1000 in 1 l 1l
Sewage after clearing < 1000 < 1000 in 1 l 1l

Sanitary estimation microbe air pollution.

Display parameter microbe air pollution of rooms is common microbe number
(CMN) - quantity microorganisms in 1 m3 of air, a parameter of direct epidemiological
danger - quantity haemolytic streptococcus in 1 m3 of air. Criteria of an estimation
bacterial pollution of air of rooms – see tab. 2.
Special requirements to microbe air pollution are showed in operational, maternity
halls for preventive intrahospital infections, postoperative complications (see tab. 3).

Tabl. 2
FOR ESTIMATION AIR OF PREMICES:
Quality of air Common microbe number in 1 m3 Amount haemolytical
streptococcus in 1 m3
Clear < 2000 < 10
Satisfactory clear 2000 - 4000 11 – 40
Low polluted 4000 - 7000 40 – 120
Polluted > 7000 > 120

Tabl. 3
 FOR ESTIMATION AIR OF OPERATIONAL:
Time of definition Common microbe number in 1 m3 Amount golden sta-phylococcus
in 1 m3
Before operation < 500 0
During operation < 1000 <4

For the estimation bacterial pollution of ground used Coli-titr, titr Cl.
Perfringens, amount eggs of helmints in 1 kg.

FEATURES OF THE HYGIENIC NORMALIZATION HARMFUL FACTORS IN

VARIOUS OBJECTS OF THE ENVIRONMENT
Hygienic normalization pollutants in atmospheric air.
Pollution atmospheric air represents the greatest health hazard for the person
among other objects of an environment for the following reasons:
1) The majority of emissions harmful substances acts in air and is carried on the big
distances - plenty of the population is exposed to its influence
2) At inhalation way of receipt the big surface of lungs, penetrated capillaries is exposed to
influence - in blood quickly create high concentration pollutant and blood from lungs pass a
liver and is carried on an organism, causing poisonings
3) Except for direct negative action on organism of the person, atmospheric pollution
renders indirect negative effects on health and conditions of life of the population.
Kinds hygienic specifications in atmospheric air.
Atmosphere pollutants by influence on an organism share on 3 groups:
1) Substances of the reflex (irritating) action
2) Substances of the absorbtion (toxic) action
3) Substances of the reflex - absorbtion action
There is 2 kinds maximal permissible concentration for atmospheric air:
Maximal – single permissible concentration (MPC m.s.) - are designed for 20-30
minutes influence of irritation pollutants and are directed to prevention reflex reactions and
poisonings in people at high concentration pollutants in air (emergencies). Are established
on irritating action on mucous of eye and toxic influence. For toxic substances such
researches will be carried out on animals with carry of the data for the person.
Daily average maximal permissible concentration (MPC d.a.) are designed for
absence pathological changes at people at round-the-clock influence during all life, and
also for absence the remote effects in the subsequent generations. MPC d.a. below MPC
m.s. in view of the greater exposition (time) of influence.
Criteria harmful action at normalization pollutants in atmospheric air:
1) organoleptic (threshold concentration of pollutant on change odour, colouring,
transparence of air)
2) Reflex (threshold concentration on irritation - olfactive influence on the man or
laboratory animal)
3) Toxicological (threshold on common toxic, specific or remote effects at inhalation
action at laboratory animal)

Normalization pollutants in air of a working zone.

Air of a working zone - air of industrial and other premises, which pollution
influences at workers. At normalization term of influence pays off for 40-50 years (the
maximal seniority), therefore maximal permissible concentrations pollutants in air of
working zone a little bit above, than maximal permissible concentration in atmospheric air.
At normalization substances in air of a working zone it is studied also the opportunity of the
skin action on organism in experiments on animals.
 Normalization harmful substances in water of reservoirs.
Normalization in water depends on a kind of water use:
Drinking, household, recreational, balneological, industrial, fishing, meliorative,
transport. Depending on a kind of water use various criteria of harm are applied, therefore
maximal permissible concentration for the same substance can differ on some orders.
Hygienic specifications are established on first four kinds of water use.
At hygienic normalization substances in water of reservoirs 3 attributes (criteria) of
harmful action are studied:
1) organoleptic (limit levels on change organoleptic properties of water)
2) common sanitary (limit concentration on influence on saprofyt microflora,
oxygen mode of the reservoir, providing processes autopurification reservoir from
pollution)
3) toxicological (definition limit and invalid concentration of substance in
experiements on animals by toxic, specific and remote effects).

Hygienic normalization harmful substances in food stuffs.

As specifications pollutants in products are used MPC and MPAL (maximal
possible - allowable level - for pesticides in products). Substantiation MPC in products
demand very difficult researches, therefore while are established maximal permissible
concentrations in food for few substances.
Feature normalization in products - MPC are established with calculation the size
of ADR (allowable daily receipt harmful substance in an organism), thus it is taken into
account receipt pollutant in an organism not only with products, but also with drinking
water and air.
Attributes (criteria) harmful action at normalization in products.
1) organoleptic - influence on organoleptic properties of a product
2) hygienic - preservation food value by the major nutrients – proteins, fats, vitamins etc.
3) Technological - transformations pollutant at culinary (thermal) processing product,
formation more toxic products
4) Toxicological - studying toxic, specific and remote effects at introduction to laboratory
animal.

Hygienic normalization strange (exogenic) chemical substances (SHS) in ground.

SHS - substances of anthropogenous origin, purposely (pesticides, fertilizers) or
accidentally (heavy metals, mineral oil etc.) brought by the person in ground.
Ground is a burial place of waste products and it is necessary at normalization
SHS to keep processes of autopurification, and also to prevent pollution of subsoil waters
and atmospheric air.
Maximal permissible concentration of SHS in ground is such, which at direct
contact to organism of the person (work on the ground) or at migration on ecological
circuits guarantees absence negative action on health of the person, does not break
processes of autopurification of ground and does not influence at sanitary conditions of life
of the population.
The basic attributes of harm at normalization SHS in ground
1. Organoleptic - on change organoleptic properties of air, subsoil waters, the vegetative
products contacting to ground, containing various concentration of normalized
substance.
2. Common sanitary - influence on microflora of ground and processes of its
autopurification.
3. Phytoaccumulative (translocation) - on accumulation normalized substance in
vegetative products (is not higher than maximal permissible concentration for products)
4. Air - migratory - on evaporation substance in atmospheric air above ground (is not
higher than MPC for air)
5. Water-migratory - on accumulation substance in subsoil waters (is not higher than
MPC for water).
6. Toxicological - on toxical, specific and remote effects on laboratory animals at skin or
inhalation action together with a soil dust.

HYGIENIC ESTIMATION OBJECTS OF THE ENVIRONMENT AT JOINT POLLUTION

Combination effects environment pollution on the person and living organisms
Kinds of combinated effects:
1. The combination effect - on the organism acts simultaneously some factors of
identical nature, for example, only physical (noise and vibration) or only chemical
(chemical substances).
2. Complex action - harmful factor affect the organism in different ways simultaneously
(for example, with inhalated air, with nutrition, with water, goes through a skin).
3. Combined action - action on the organism some factors of different nature, for example,
chemical materials and radiation affect.
In real conditions the organism of the person is influenced, as a rule, not by one,
and some harmful factors, thus it joint effect (Combined action) can considerably differ
from separate action of one factor.
Types of the combined action chemical substances on an organism.
1. Antagonism (less, than additive action) - mutual easing toxic effects of poisons
at joint action on an organism. Has chemical (mutual destruction of poisons) or a functional
nature (different influence on functions of systems).
2 2. Summary (additive action) - arithmetic addition separate toxic effects.
3. Potentiation (more, than additive action) - mutual sharp strengthening toxicity
each toxins at joint action.
Rules of sanitary estimation environment at joint pollution:
1. In case of antagonism at the combined action the estimation of environment
(water, air etc.) will be carried out by comparison the revealed concentration
substances to MPC of everyone found out pollutant separately.
Estimation of the object is given by formula:
C / MPC < 1, where C – found concentration of substance, MPC – its maximal
permissible concentration in the given object of environment.
Example
Ambush (pesticide) and nitrates are contained in water. Concentration Ambush – 3 mg|l ,
Concentration nitrates – 2 mg|l. MPC Ambush – 1 mg|l , nitrates – 10 mg|l. May people
drink the water ? May people utilize the water for the preparation food?
Decision
Concentration of Ambush = 3 mg|l , MPC Ambush = 1 mg|l, 3 – more 1
Concentration of nitrates = 2 mg|l, MPC nitrates = 10 mg|l, 2 – less 10
Conclusion
Concentration of Ambush is more MPC for Ambush.
Water may not drink The water does not utilize for the preparation food.

2. At summary at combinated action the estimation of environment will be carried out

under the formula of summary toxicity (formula Аverianov):
С1 С2 C3
----- + ----- + -----< 1, where C - concentration found substances,
MPC1 MPC2 MPC3 MPC - their specifications
Example
Cimbush (pesticide) and nitrates are contained in water. Concentration Cimbush – 3 mg|l ,
Concentration nitrates – 2 mg|l. MPC Cimbush – 1 mg|l , nitrates – 10 mg|l. May people
drink this water ? May people utilize the water for the preparation food?
Decision
At the use of the formula
С1 + С2  1, we have:
MPC1 MPC2

2 + 3  3,5
10 1
Conclusion
Water can not use for drink. The water can not be utilized for the preparation food.

3. In case of potentiation in the above-stated formula instead of 1 it is put 1/К (K - factor

of potentiation, i.e. in how many time amplifies toxic effect at the combined action in
comparison with separate influence of each poison).
С1 + С2 + … Сn  1 / K,
MPC1 MPC2 MPCn
Where К – increasing coefficient (factor potentiation)

Example
Ambush (pesticide) and nitrates are contained in water. Concentration Ambush – 3 mg|l ,
Concentration nitrates – 2 mg|l. MPC Ambush – 1 mg|l , nitrates – 10 mg|l. K (Incresing
coefficient) = 5. May people drink the water? May people utilize the water for the
preparation food?
Decision
Use the formula: С1 + С2 + … Сn  1/K (1 / 5)
MPC1 MPC2 MPCn

2 + 3  3,5
10 1 5
3,5 – more 1/5
Conclusion
Water may not drink. The water can not not utilize for the preparation of food.

INFLUENCE QUALITY OF THE ENVIRONMENT ON HEALTH OF THE POPULATION.

Health of the population as criterion estimation quality of environment.
Now it is conventional, that integrated criteria quality of biosphere is the health of
the population.
Concepts " health of the population ".
As it is paradoxical, till now there is no universal definition concept "health".
In medicine and in hygiene most frequently use concept health as the average size
describing a state of health of a certain population, taking place in identical social and
economic and ecological conditions.
The border between health and illness is so-called 95 % - confidential interval - at
the healthy person all investigated parameters should be stacked in a range, characteristic
for 95 % of people of the given population.
The factors determining health of the population.
If all complex of the factors influencing health of the population accept for 100 %
they are distributed so:

№ Name of the factor Specific Gravity in %%

1. MODE OF LIFE And SOCIAL 49-53 %*

ECONOMIC CONDITIONS
2. GENETICAL FACTORS 18-22 %

3.CONTAMINATION (POLLUTION) 17-20 %

ENVIRONMENT
4. MEDICAL FACTORS
(quality medical aid, development 8-10 %
network of public health services etc.)
The note: * - oscillations on the different countries

On the various data, occurrence 70 % of all diseases, 60 % defects of physical

development and more than 50 % cases of death are caused by environmental
contamination.
Kinds influence quality of environment on health of the population.
1. DIRECT NEGATIVE INFLUENCE:
1) Sharp action:
а) Specific (failures) - at people arise sharp specific intoxications owing to action the big
concentration concrete pollutant
b) Nonspecific (provoking) influence (toxic fogs - murderers - in London, photochemical
could Los-Angeles type, flashes of a bronchial asthma during the big air pollution);
2) Chronic action:
а) Specific - accumulation in the environment small amounts proof pollutants, bringing in
occurrence specific ecologic pathology:
- Illness "itay-itay" (it is hurt - be hurt) - for the first time it was described in prefecture of
Tokyo: mialgia, albuminuria, glaucoma, dystrophy, spontaneous crises, in 12 years -
death. The reason - accumulation connections of cadmium in ground, water, a fish and by
trophic circuits it hit in an organism of the person;
- Illness Minamata - in Japan - for the first time was described among fishermen and their
families in small town Minamata: at adults - a cerebral paralysis, at children - a spastic
paralysis, blindness, intellectual backwardness. The reason - hit of methyl-mercury in the
sea and than - in fish;
- Illness Usho (oil illness) - also for the first time in Japan - dimness of a skin, a rash,
defeat of eyes and the internal bodies, the remote effects (mutagen, embryothropic,
cancerogenic). The reason is the accumulation in the environment polychlorinated
connections, containing dioxines - the extremely toxic and proof substances.
Endemic illnesses (fluorosis and etc.).
b) Chronic nonspecific action pollution biosphere on health - deterioration all
parameters of health of the population, nonspecific diseases, their aggravations etc.
3. The remote and specific effects pollution of biosphere. Allergenic, gonadothopic,
embryothropic, mutagen, cancerogen effects of environmental contamination which arise
at the population in many years after influence pollutant or in the subsequent generations.

INDIRECT NEGATIVE INFLUENCE of POLLUTION ENVIRONMENT ON HEALTH of

the POPULATION
The indirect negative influence pollution expressing in influence on health of the
population or a condition of its life through ecological interrelations in a nature (for
example, at pollution of an atmosphere the level of a ultra-violet irradiation is reduced -
growth a rickets at children, acid rains - destruction a crop, transition pollutant from one
object of environment in another etc.).

Degrees biological answers of organism of people at influence of pollutted

environment:
1 - death rate, 2 - desease, 3 - functional attributes of illness without clinic (prepathology),
4 - functional shifts unknown aethiology (a pressure adaptive opportunities), 5 -
asymptomatic accumulation pollutant in organism of the person.

The basic parameters of health of the population and their use for studying
influence of environmental contamination
1) Sanitary - demographic parameters: death rate, birth rate, life expectancy etc.
For studying influence quality of environment used seldom – changes founded through
long time, it is necessary for research not less than 10 thousand population and the data
not less, than for 10 years.
2) Parameters of morbidity (sick case) - the basic parameters for research this problem,
it is important to study not the common sick rate, but on separate groups of illnesses.
3) Parameters of physical development - it is especial important at children and
teenagers. Rather sensitive exponent pollution of environment that is shown in researches
our chair in various on ecological load regions of Crimea.
4) Parameters of invalidity: in total amount of invalids on 100 thousand population, on
groups of physical inability and the reasons of an exit on physical inability. For estimation
quality of environment are used seldom (more reflects action professional harmful factors),
more often - for general characteristic state of the health of the population.

Methodical approaches to studying influence quality of environment at the

Health of the population
1) Traditional - researches go from pollution of environment - to health of the population.
Here allocate 2 main concepts:
- Factorial attribute - X - the factor (s) of environment which action on health is studied;
- Productive attribute Y - the parameter (s) of health of the population
There are 4 basic мethodical schemes of researches:
1) X - > Y Studying influence one factor of environment on one parameter of health;
2) X - > Sum Y Action one factor of environment on a complex of parameters of health;
3) Sum X - > Y Action complex of factors of environment on one parameter of health;
4) Sum X - > Sum Y Action complex of factors on a complex of parameters of health.
2) Nonconventional (inversive) the approach - use more often recently,
especially abroad. A way of researches - from a state of health of the population to
revealing the most powerful factors of the environment determining a level of health, with
the purpose of it elimination or minimization.
Concept about zones of supervision (research).
Very much important point at realization researches is a correct choice of these
zones, it is possible to decrease the level of influence other factors influencing health of
the population (social and economic, demographic, medical and others).
Zone of supervision - the certain territory on which is studied influence of
ecological conditions on health of the population.
At realization researches necessarily choose 3 zones of supervision:
1. Skilled zone - territories on which pollution of environment under the investigated factor
(complex of factors) essentially exceeds MPC
2. Zone Control № 1 - where pollution is at a level of MPC
2. Zone Control № 2 - where pollution is much lower than MPC or is absent.
Rules of a choice zones of supervision.
 The chosen zones of supervision should be identical on the following parameters:
1) By social and economic conditions and a way of life of the population, 2) By sex, age,
professional structure of the population, 3) By amount of the population.
Differ these zones should be only on levels of environmental contamination.

INSTRUCTION FOR PRACTICAL LESSON ON THE THEME

EDUCATIONAL QUESTIONS:
1. Concept “environment” and “biosphere”, it basic objects.
2. Basic sources and factors of pollution of environment. Classification adverse factors in
hygiene and ecology.
3. Criterion of estimation quality of environment and kinds of monitoring of its pollution
(analytical, medical, ecological).
4. Concept about the hygienic specifications pollutants in environment, basic principles hygienic
standartization.
5. Features hygienic standartization of the harmful factors in various objects of environment.
Limiting attributes of harmful action.
6. Hygienic standartization biological pollutants in an environment.
7. Hygienic estimation objects of an environment at simultaneous pollution by various
substances.
9. Basic parameters of health of the population and it use for monitoring quality of environment.
10. Factors, influencing on the health of the population.
11. Kinds of direct and undirect influence pollution of environment on health of the population
(sharp and chronic action, remote consequences).
12. Methodology and methodical schemes study influence of environment on health of the
population.
13. Rules of a choice zones of supervision for research influence of quality of environment on
health of the population.

Tests for the control level of knowledge

1. A quantitative parameter of the factor of environment, which is safe for the preservation of ability
to live of the man and population health, and future generations has received the name:
Hygienic specification
Hygienic factor
Sanitary specification
Level of safe influence
Parameter of the minimal safety
2. A parameter of harm action, which at establishment of the hygienic specification has received
the minimal concentration (dozes) at action it on organism or environment in comparison with other
parameters harm action, named:
Limiting parameter
Conducting parameter
Accepted parameter of sanitary safety
Sanitary parameter
Hygienic parameter of adverse influence
3. As a level of harmful influence of the adverse factor on organism, which is determined as
minimally acceptable at establishment of its hygienic specification, is:
Accumulation pollutant in bodies and fabrics, which will not cause any physiological or
biochemical deviations in their functional condition (V level)
Mortality of organism (І level)
Specific disease (ІІ level)
Not specific attributes of pathological shifts (ІІІ level)
 Temporary and partial physiological deviations of a unknown nature (ІV level)
4. The features of the hygienic standartization of the factors of environment, which is based on so-
called non-line-parabolic dependence of biological effects on a doze, is:
Definition at least two hygienic specifications (level of useful and harmful action)
Definition at least one hygienic specification (level of harmful action)
Definition at least one hygienic specification (level of useful action)
Definition least two hygienic specifications (level of safe and harmful action)
Definition two and more hygienic specifications (useful, minimally safe and harmful
action)
5. The excess MPC of toxic substance in atmospheric air makes 100. What changes in a condition
of health of the population it is necessary to expect?
Sharp poisonings
Expressed physiological shifts in bodies and systems
Increase specific and not specific morbidity
Change in a condition of health on separate functional parameters
Fatal poisonings among children
6. The pollutant of atmospheric air is referred to a class of extremely dangerous substances. What
character of its action it is necessary to consider as most possible?
Cancerogen action
Irritating action
Neurotropic action
Embryotropic action
Allergen action

7. The hygienic specification of the harmful factor in object of environment is:

А. Such level of the given factor in environment, which does not cause pathological changes in
organism during all time of influence
В. Such level of the given factor in environment, which causes pathological changes in organism
during all time of influence
С. Such level of the given factor in environment, which causes prepathology changes in organism
during all time of influence
D. Such level of the given factor in environment, which causes functional changes in organism at
the end of time of influence
Е. Such level of the given factor in environment, which does not cause irreversible changes in
organism during all time of influence

8. As the hygienic specification of the allowable contents of harmful substance in water of

reservoirs refers to as:
А. MPL (maximal permissible level)
В. MPD (maximal permissible dose)
С. MPC (maximal permissible concentration)
D. MAL (maximal allowable level)
Е. MAD (maximal allowable dose)

9. Specify correct concept "health" till WHO from the point of view of the individual - theoretical
approach.
A Condition of organism of the man, at which it is capable is high-grade to carry out the biological
and social functions
B Condition of organism of the man, when all his functions are counterbalanced with an
environment
C. Condition of complete social, biological and psychological well-being of the man
(simultaneously with absence at him illness or physical defects)
D. Conditional statistical concept, which is full characterized by a complex of demographic
parameters, morbidity, physical development, physical inability
Е. Interval, within the framework of which fluctuation of biological processes keep organism at a
level of a functional optimum

10. Specify major factors determining a condition health of the population:

A Social, economic, genetic, ecological factors
B Qualitative structure of a feed, morbidity, mortality, birth rate
C Geographical arrangement, climatic features, urbanization
D Ethnical
Е Level letality

11. What parameters of health of the population first of all are worsened under influence of
pollution of an environment?
A Demographic
B Physical development of children
C Disease
D Invalid
Е Quality of urgent medical aid to the population

12. To ecopathology of the population concern:

A Diseases most badly which are giving in to treatment
B Diseases caused by ecological conditions
C Most frequently meeting diseases in the given district
D Is latent proceeding diseases
Е Diseases amazing the majority of the population

Sources of the information

BASIC
1. Общая гигиена / Ред. Е.И.Гончарук. - Kиев, 1990, 1995 (укр.яз)..
2. Габович Р.Д. и др. Гигиена. - Киев, 1983.
3. Гигиена окружающей среды | Ред. Г.И. Сидоренко. - Москва, 1985.
4. Lectures on common hygiene with medical ecology.- Simferopol, 2003.- 130 p.
5. Соціальна медицина та організація охорони здоров,я / Під ред. Вороненка Ю.В.,
Москаленка В.Ф. - Тернопіль: Укрмедкнига, 2000.
6. Park’s textbook of Preventive and Social medicine. India, 2000.- 16-th edition. – 660p.
7. Руководство к практическим занятиям по общей гигиене и медицинской экологии. /
Под ред. Проф. С.Э.Шибанова. – Симферополь, 2003. – 260с.
Additional
1. Шандала М.Г. и др. Охрана и улучшение окружающей среды в условиях НТР. - Киев,
1982.
2. Influence of an environment on health of the man. The reports a CART. - Geneva, 1976 -
1994.
3. Журнал " Гигиена и санитария " 1980-2002гг.
4. Журнал “Довкілля та здоров,я” 1998-2003гг.
Theme: Principles of sanitary examination food products.
Actuality of a theme.
For the doctor of any speciality it is necessary to know rules of estimation quality of
food products with the purpose of strengthening and preservation of health of the man.
The biological and food value of food products is kept under condition of it high quality
adequate standard. During reception, storage, transportation or at processing the foodstuff
can be exposed to damage, pollution by chemical substances, by microorganisms and etc.
Therefore it is necessary to carry out strict sanitary supervision of food products at all
stages of it manufacture and realization.
For definition quality of foodstuff it sanitary examination will be carried out. The
doctor of any speciality should be able to reveal changes parameters of food quality:
organoleptic properties, presence of harmful impurity and reasons damage of foodstuff,
and also to establish the order of it realization.
Methods of analysis of food quality
1. Organoleptic - colour, taste, smell and consistence
2. Physical – density, temperature, etc.
3. Chemical - contents of proteins, fats, carbohydrates and others nutrients.
4. Microscopic - finding foreign substances, ova of helminths, etc. in product by microscope
5. Bacteriological - finding micro-organisms in the products
6. Biological - biological test on the laboratory animal for dangerous products
7. Radiometric - the level of radioactivity of the product
After the obtaining it data it is compare with the specifications of the product. For this purpose
there are documents, regulating the quality of products:
1) The State Standard of food product. It is the document defining necessary value of main
parameters of the given product and including unified, standard procedures of it definition.
2) Temporaly Technical Conditions of food product. It is designed for new products and includes
main parameters of the given product.

Classification of food products by quality

1. Good-quality product:
a) Standart - Product, parameters of which correspond the requirements of the State Standart
(Example: milk with fat content 3,2 %)
b) Non-standart – product have 1-2 unessential non-standart parameters. (Example: the milk with fat
lower than 2,5 %)
2. Conditionally - suitable - product demand the preliminary processing before usage (acidic
milk - is subjected for processing for kefir, curd, cheese and other milk products).
3. Bad quality - product have parameters, making it usage impossible for nutrition of man (for
example: milk with high contamination by pesticides). The further perspective of such products -
destruction or utilisation (on forage for cattle etc.)
4. Falsificated products. (“Falsificatio” – Latin word – it means deception). Properties of such
products are changed specially for deceiving the customer (example: Dilute milk with water).
Falsification of products is prosecuted.
 Substitute - Except for these categories of products quality there is another concept - the
substitute of the product - substitute of a natural product officially released by the state at lack of the
natural products (for example: margarine - substitute of cow butter). It is estimated according to the
State Standard and may belong to one of the quality categories of products.

Sanitary-hygienic characteristic of the milk and milk products

Milk is the most valuable food with high nutrition value. It is an ideal food for infant
and children. The milk protiens contains Casein, Lactatalbumin and Lactoglobulin, milk fat
is easily digestible. Carbohydrates are present in milk as lactose. Milk contains vitamins,
but vitamin С is present only in very small quantities. Human and animals milks are
compared in Table 4.

Table 2.
Nutritive value of milks
(Fod value per 100 millilitre )

Nutrients Buffalo Cow milk Goat milk Human

milk milk
Fat g 6.5 4.1 4.5 3.4
Protein g 4.3 3.2 3.3 1.1
Lactose g 5.1 4.4 4.6 7.4
Calcium mg 210 120 170 28
Iron mg 0.2 0.2 0.3 0.5
Vitamin C mg 1 2 1 3
Minerals g 0.8 0.8 0.8 0.1
Water g 81.0 87 86.8 88
Energy kcal 117 67 72 65

Milk products:

Vegetable milk is prepared from certain vegetable foods (soyabean, graundnut). It

may be used as a substitute for animal milk.
Toned milk - is a blend of natural milk and “made-up” milk. The term “Toned milk”
is in Indian coinage. It contains 1 part of water, 1 part of natural milk and 18 part of skim
milk powder. The mixture is stirred, pasteurised and supplied in bottles. Toned milk has a
composition nearly equivalent to cow’s milk. It is cueaper and wholesome product.
Cheese – Proteins 12-16%, calcium - 8OO mg, phosphorus - 400mg, fats - 25%
Sour cream - fats up to 36%.
Curds (cottage cheese) - fats - 9-20%. Proteins -12-16%.
Kefir: is slightly alcoholic and acidic, prepared by the fermentation of milk with
yeast's and Lactobacillum.
Curd. Fresh curd must be white or creamy without sour smell. Fats - 9-18%, water -
65-80 %, acidity - 20-27 Тerner.
Milk born diseases ( FAOWHO )
1.Infections of animals that can be transmitted to man:
Primary importance: Tuberculosis, Brucellosis, Streptococcal infections, Staphylococcal
poisoning, Salmonellosis, Q fever
Lesser importance: Cowpox, Foot and mouth disease, Anthrax, Leptospirosis, Tick-borne
encephalitis
2. Infections primary to man that can be trasmitted throught milk:
Typhoid and paratyphoid fevers, Shigellosis, Cholera, Enteropatogenic Escherichia coli
(EEC), Non-diarrhoeal diseases: Streptococcal infections, Staphylococcal food poisoning,
Diphtheria,
Tuberculosis, Enterjviruses, Viral hepatitis.

Sanitary-hygienic expertise of milk

DEFINITION of ORGANOLEPTIC PROPERTIES of MILK
1. Colour of milk is defined in the cylinder from a colourless glass, where pour 50-60
mls of milk.
Normal colour of milk - White yellowish shade.
The skim milk has bluish shade.
Dilute milk with water has bluish shade.
Impurity of a blood in the milk (cows diseases) - pinkish shade.
If the animal eat some plants shade of milk can be: carrots - orange shade, yellow;
beet - pinkish shade etc.

2.Consistence of milk is determined on a track remaining on walls of a flask after its

churning.
Normal consistence has a white track
Watery consistence of milk (dilute milk with water) has not a white track.
Mucous or viscous consistence of milk (in case of development of bacteria in the
milk) leave dragging track on the walls.

3. Smell. For definition of a smell 100 mls of milk pour in a conic flask. Milk is shaken
and after then is determined a smell.
Fresh milk has a milk specific smell.
Sour milk has specific acidic smell.
Putrefactive microorganisms of milk give it smell of ammonia, of hydrogen sulfide
etc.
If the milk incorrect storage or transportings it can accept differents smells:
petroleum, soap, fish, perfume etc.

4. Taste. For definition of taste an oral cavity rinse by a small amount of milk (5-10
mls).
Taste of good-quality milk has slightly sweet taste.
Watery taste - diluted water milk or skim milk
Others tastes (bitter, salty, knitting, fish) is caused by a forage animal, its illness,
extraneous impurities, incorrect collection and storage of milk.

DEFINITION physical PROPERTIES of MILK

5. The dry rest is determined as quantity organic substance and sals which are found in
1 liter of milk. The dry rest determine by boiling-down water. Normal dry rest = 11 -
12,5%.
6. The Density of milk is determined with the aid of device – lactodensimeter.
Lactodensimeter is immersed in the cylinder with milk and we look density of milk on a level
of milk. For example, figure 20 designates density 1,020, figure 30 - 1,030 etc. The
Indications Lactodensimeter is added to the number 1,0. For example, the level of milk
stands on figure 30 of a scale Lactodensimeter, means, the density of milk is equal:
1,0 + 0,030 = 1,030.
The densitiy depends also on temperature of milk. For this purpose there is a
thermometer in Lactodensimeter, showing temperature of milk. If temperature of milk is
lower 20ºС, from the densitiy of milk take away number = 0,0002  degrees, lower 20ºС.
If temperature of milk is higher 20ºС, to the densitiy of milk add number = 0,0002 
degrees, above 20ºС.
Normal Density of milk at 20°C is 1,028 - 1,034

7 DEFINITION chemical PROPERTIES of MILKContents of fat - is determined by a

butyrometer.
This device has a cylindrical forms glass vessel. In device pour: 10 ml milk, sulfuric
acid, amylic spirit. Then Butyrometer put in a centrifuge. The device is centrifugated 5
minutes and after the centrifugation look at the contents of fat in milk. The isoamyl alcohol
containing milk fats is concentrated at the neck of a butyrometer with divisions, each major scale
division corresponds to 1% of fats, each small to 0,1 % of fat. Normal contents of fat – 2,5 - 3,2 %
8. The acidity is measured in Terners degrees (T). It is the quantity of ml of decinormal caustic
soda (0,1 N solution Na2CO3), which is used for titration of lactic acid in 100ml of milk at addition of
3-4 drops 1% Phenolphthaleinum. (10 ml of milk + 20 ml of water + Phenolphthaleinum, titrate
0,1N solution Na2CO3 up to a weak - pink staining. The obtained result is multiplied in 10 times.
Normal Acidity - 16-22°T (16-19°T - fresh milk, 20-22°T - fresh enough,) More 23°T - not
fresh milk. Dilute milk with water has acidity below 16°T.
Tests on Falsification milk
1. Test for definition of starches. We pour 10 ml of milk, add 1 ml of solution Iodum. The
appearance of a blue colour demonstrates the presence of starch in milk.
2. Test for definition of soda (addition of rosolov acid). We pour 5 ml of milk + 4-5 drops 0.2
% solution of rosolov acid in 96 % alcohol. If in the milk is contained soda colour of milk become
crimson-red colour (+ Test). The milk which not contain soda become yellow - pink colour (-
Test ).
Main parameters of milk under the State Standard
1. ORGANOLEPTIC PROPERTIES:
a). Colour - white with yellowish shade,
b). Smell and taste - specific lactatic,
c). Consistence – it should not be watery or tough
2. PHYSICAL PROPERTIES:
Density at 20°C - 1,028 - 1,034
The dry rest – 11 - 12,5%.
3. CHEMICAL PROPERTIES:
Contence of fat - 2,5-3,2 %
Acidity: Normal Acidity - 16-22° Terner (16-19°T - fresh milk, 20-22°T - fresh enough,)
More 23°T - not fresh milk. Diluted milk by water has acidity below 16°T.
4. BACTERIOLOGICAL PROPERTIES:
Pasteurised milk in bottles and packages:
Common microbial number in the 1 ml - 75000
Coli-index in the 1ml - 0,3
Pasteurised milk in flask's and tanks
Common microbial number in the 1 ml - 300 000
Coli-index in the 1ml - 0,3
5. Tests on Falsification milk.
 Definition addition of starches ( – )
Definition of soda ( – )
Falsificated milk has parameters:
The skim milk: colour - bluish shade, Watery consistence, The dry rest – less 11%,
Density of milk at 20°C is more 1,034
Dilute milk by water: colour - bluish shade, Watery consistence, The dry rest
less11%, Density of milk in 20°C is less 1,028, acidity below 16°T.
Addition of soda. Soda is put in milk if it acidity is more 23°T ( not fresh milk ). By it
condition acidity is lowered.. Rosolovic acid is added to falsified milk ( + Test for definition of
soda).
Addition of starches. Starches is put in Dilute milk by water in order to increase the
density and dry rest of milk. Solution Iodum is added in falsified milk ( + Test for definition of
starches ).

INSTRUCTION FOR PRACTICAL LESSON

The sample of milk in the cylinder (200 ml) is offered to each student which he should research and
give the conclusion about its quality.

PROTOCOL
Of independent work on hygienic research of milk sample.
1. Organoleptic properties:
Colour ___________________________________
Smell ______________________________
Taste ___________________________
Consistence ________________________________________
2. Density of milk: ______________________________________ The readings of lactodensimeter
______________
Temperature ________________
3. Fat content of milk - _________
4. Dry rest - _________
5. Acidity - __________________________________
Thus, the given sample of milk should be estimated as ___________________ on classification of product quality,
because: ____________________________ (to enumerate parameters which are not conforming to the St. St. and the possible
causes of deflections).

Example 1
1. Your conclusion about the sample of Pasteurised milk in bottles
Results of analysis:
Colour White yellowish
Odour Standard
Fat 2,5%
Temperature 240
the density of milk 1,030
Acidity 25°T
Number of bacteria 25000 /ml
Coli-index 2
starches 
For definition of soda ( – )
Soda 
For definition of soda ( – )
Decision
1. Temperature of milk = 24 C (above 20ºС ). 24 C - 20 C = 4 C. 4 C  0,0002 = 0,0008
2. The densitiy of milk in 20 C = 1,030 + 0,0008 = 1,0308 ( Normal Density )
 Normal Density of milk in 20°C = 1,028 - 1,034
3. Acidity - 25°T (above normal Acidity). Normal Acidity = 16-22° T
3. The rest of indexes (colour, odour, fat, number of bacteria, Coli-index) are normal.
Conclusion
Milk may concern to the Conditionally - suitable – products. From it may work up curd, cheese, kefir, iogurt

Example 2
1. Your conclusion about the sample of Pasteurised milk in bottles
Results of analysis:
Colour Bluish shade
Odour Standard
Consistence Watery
Fat 1,9 %
Temperature 10оС
the density of milk 1,029
Acidity 19°T
Number of bacteria 25000 /ml
Coli-index 2
starches -
For
Soda definition of soda ( – ) -
For definition of soda ( – )
Decision
1. Temperature of milk = 10 C (less 20ºС ). 20 C - 10 C= 10 C. 10 C  0,0002=0,002
2.The densitiy of milk in 20 C= 1,029 - 0,002 =1,027 (less then normal density )
Normal Density of milk in 20°C - 1,028 - 1,034
3. Fat - 1,9 % (less than normal value of fat). Normal fat of milk = 2,5 - 3,2 %
5. Colour - bluish shade. Normal colour of milk - white yellowish.
6. Consistence - watery. Normal consistence should not be watery or tough
4. The rest of indexes ( odour, number of bacteria, Coli-index, acidity) are normal.
Conclusion
Milk may concern to the Falsified products (Dilution milk by water). It can not be utilized.

Algorithm of practical work of the students.

The first stage. Work above the tests of the control of an initial level of knowledge and skills
The second stage. Active participation in discussion of educational questions on a theme of lesson.
The third stage. Realization of independent work on sanitary - hygienic examination of milk and
registration of the conclusion about quality of the analysed sample of milk in notebook of the
protocols.
The fourth stage. Check of a level of knowledge under the tests of the final control. The decision
situation tasks by definition of quality of milk in notebook of the protocols.
 The tests for the control of knowledge

1. As a result of veterinary inspection of animals on a milk farm 20 cows with positive reaction to a
tuberculosis are revealed. Give an estimation concerning an opportunity of use of milk from such
animals for nutrition.
- Use after pasterization at temperature 850C during 30 minutes
- Use without preliminary processing without restrictions
- Use for small cows
- Technical recycling
- Destruction

2. The student has devices: the counter Heiger, counter Eber, device Krotov, device Mishuk, device
Eber. What device he can use for definition of quality of meat?
- The counter Eber
- The Counter Heiger
- the Device Mishuk
- the Device Krotov
- the device Eber

3. In the market the milk is realized which is delivered in flaskes. A smell and taste of milk - usual,
colour white with blue shade, densities 1,015, fat content 2 %. Acidy 150 Terner. The extraneous
impurity are absent. Estimate quality of milk.
- milk is not fresh
- surrtogate milk
-falsificate milk
- Milk good quality
- Milk conditionally good

4. In laboratory for realization research the sample of milk has arrived. Such data are established:
colour, smell - without features, taste - characteristic for milk, density - 1,038, acidity – 350
Terner, fat content - 3,2 %. Determine a degree of quality of milk.
- The milk substandard
- Milk good-quality
- Milk conditional - suitable
- Milk of the reduced quality
- Milk is falsificated
 Situational tasks

1. The data of the analysis of sample of milk is: colour, smell, taste — usual. Density — 1,033 at
30 oС, fat content — 2,6 %, acidity 20 o Тerner. Give a hygienic estimation to milk.

2. The data of the analysis of sample of milk is: a smell, taste — dairy, colour — white with a
bluish shade, Consistence — liquid. Density — 1,033 at 8 oС, fat content — 2,3 %, acidity — 20 o
Тerner. Give a hygienic estimation.

3. The sample of milk from the tank show: taste, smell — a dairy, consistence — usual. Acidity —
17 o Тerner. Density at 22 oС — 1,032. Fat contents — 3,2 %. Reaction on starch and soda —
negative. Total number of bacteria in 1 ml — 120000. Give a hygienic estimation to milk.

The standards of the answers:

1. Density at 20 0С - 1,035 (norm). The fat content is raised. As density is normal, addition water is
excluded. The milk corresponds to the standard. A conclusion: milk good-quality.
2. Density at 20 0С - 1,029 (corresponds standard). The fat content is reduced. As density is not
increased, the degreasing is excluded only; as density is not reduced, is excluded only addition
water. The milk is simultaneously degreased and is diluted. A conclusion: the milk is falsificated
3. Milk good-quality, standard (bacteriological parameters of milk in flaskes and tank — 300000 in
1 ml), density at 20 0С — 1,032.
THEME: THE PRINCIPLES OF THE RATIONAL NUTRITION.
PREVENTION ALIMENTARY DISEASES.
Hygiene of nutrition - the section of hygiene studying influence on an organism of
the person factors, connected to nutrition and developing recommendations for a balanced
diet. The part of hygiene of nutrition is NUTRICIOLOGY - a science about nutrients (food
substances).
On the data the WHO, about 70 % all diseases directly or are indirectly caused by a
wrong nutrition or infringements quality of foodstuffs.
THE BASIC SECTIONS HYGIENE OF NUTRITION
- A rational nutrition - a nutrition for the healthy person for preservation and
strengthening health,
- A medical or dietary nutrition - for treatment ill patients,
- A treatment-and-prophylactic nutrition - special diets for working in harmful conditions
- chemical substances, radiation etc.
- A Preventive nutrition - for people with risk factors of development diseases (an
atherosclerosis, a diabetes etc.).

CLASSIFICATION KINDS OF NUTRITION

ON PURPOSE AND BIOLOGICAL EFFECT

Kind of NUTRITION Purpose Group Biological effect

Rational Prophylaxis of Healthy people non specific

nutritional diseases

Prophylaxis deseases Groups with rask specific

Preventive of a on multifactor factors on Diabetum
nature etc.

Treatment-and- Prophylaxis of People working in protective

prophylactic occupational diseases harm conditions

Medical (dietic) Correction violated Patients Pharmacological

metabolism
 CLASSIFICATION ALIMENTARY AND АLIMENTARY-CAUSED DISEASES
1. Initial (exogenic) alimentary diseases.
It is connected with insufficient or surplus nutrients or energy in diet. The main feature of it
is that aethyology, pathogenesis, the clinic, prevention and treatment are connected only
with nutrition.
2. Secondary аlimentary-caused diseases.
It caused by diseases of bodies and the systems, bringing to infringements mastering of a
feed, strengthening disintegration and expenses nutrients. It may be infectious, surgical,
oncological illnesses. Endogenic avitaminosises, cerebral, endocrinic adiposity or a
dystrophy.
The differentiation 1 and 2 groups is very important for the doctor, because tactics
of treatment is completely various: in the first group - only correction of nutrition, in the
second - treatment initial disease plus dietetic therapy, application biologically active
additives (BAA).

3. The diseases multifactorial aethyology, including the alimentary factor. It is

develop on a background of genetic predisposition, the nervous - emotional reasons and
other factors: an atherosclerosis, a hypertension, urine-stone and gall-stone illness, a gout,
gastric diseases, oncopathology, a diabetes. In occurrence these diseases nutrition - only
a risk factor, but not the unique reason. Prevention it is preventive nutrition, dietetic
therapy at the developed pathology.
4.The diseases connected to presence in food harmful factors.
It is food poisonings, intestinal infections, gelminthosis. Prevention it is control quality of
food products.
5. Food intolerance - set clinical reactions to a food: a food allergy (immunopathology), a
pseudo-allergy (individual reactions to separate substances), food idiosincrasy owing to
ensimopathies.

CLASSIFICATION ALIMENTARY DISEASES (1 group)

1. Illnesses and syndromes of an insufficient feed:
1. Protein-power insufficiency (PPI) different degree, alimentary marasm, a delay physical
development owing to PPI.
2. Albuminous insufficiency, including kvashiorcor.
3. Avitaminosises.
4. Mineral insufficiency: iron-deficit anemia, endemic craw (hypotyreosis), caries,
hypozincosis, hyposelenosis etc.
2. Illnesses and syndromes of an excessive feed.
1. Surplus caloric content - alimentary adiposity 1-4 degrees.
2. Hypervitaminosises A and D.
3. A syndrome surplus of proteins, fat acids.
4. Surplus mineral substances - fluorosis, selenosis, мolibden gout.

PRINCIPLES OF THE RATIONAL NUTRITION AND METHODS OF THE CONTROL IT

OBSERVANCE
It was developed by academician A.A.Pokrovski in the USSR and now is
recommended by the WHO for estimation correctness of an individual nutrition and
nutrition of the population of the different countries. It is a scientific basis of hygiene of
nutrition.
1. Conformity caloric content of nutrition to the daily energy allowance. The
main principle of the rational nutrition – the analysis nutrition begins from it.
METHODS of the control:
Caloric content of nutrition is determined:
 а) By table-settlement way (in view of a diet and under tables of food value of
products) with the help of calorimetric factors
Calorimetric factors of nutrients:
1g proteins and carbohydrates = 4 Kcal, 1g fats = 9 Kcal.
Protein gives 14 % daily calories, fats - 30 %, carbohydrates - 56 %.
b) Laboratory - burning 100 g food product in a calorimetric bomb.
Daily energy allowance .
Consists from the basic exchange + energy allowance for work + 10 % from the
basic exchange on digestion peep.
The basic exchange pays off under tables on a sex, age, growth and weight.
Ways definition energy allowance for work:
а) Table-chronometric method (on time performance of any activity),
b) Direct calorymethry (in the calorimetric chamber)
c) Indirect calorymethry (on respiratory factor = O2/CO2)

2. BALANCE of nutrients. The diet should contain all necessary nutrients:

proteins, fats, carbohydrates, vitamins, mineral substances in an optimum ratio. It
provides the best absorb and high-grade use of food substances. Examples of balance:
Ratio proteins: fats: carbohydrates (P:F:C) = 1:1:4 (the adult person), 1:1:5 (heavy
physical work), 1:0,8:3 (older persons), 1:1:3 (children).
Ratio between proteins: animals 60 %, vegetative 40 %,
Ratio between fats: animals 70-80 %, vegetative 20-30 %
Ratio between carbohydrates: the unprotected 10-15 %, protected 85-90 %.
Ratio Са: P = 1:1,5 etc.
Ways of the control: а) table-settlement, b) laboratory (proteins in products are
determined on Keildal, fats - on Sokslet).
3. Optimum regimen of diet. The food should be accepted in 4-5 hour (time
evacuation function stomach), i.e. 4-5 once a day. Reception food less, than in 2 hours it is
not optimum - gastric secretion is oppressed. A nutrition less 3-4 time is harmfull - in view
of the big appetite the person eats plenty food - hypercholesterolaemya, hyperlipaemya,
adiposity etc.
Importance receptions of food in same time + (-) 30 minutes - maintenance
conditioned reflex activity of digestion. Recommended distribution daily caloric content on
receptions of food:
Breakfast - 25-27 %, 2-nd breakfast 10-15 %, dinner 35-45 %, supper 10-20 %.
Ways of the control. Questioning about a diet and definition of caloric content of
each reception of food.
4. Good organoleptic properties food, its high comprehensibility, the
favorable conditions of reception food. It is need for maintenance normal conditioned-
reflex activity of digestion (Acad. I.P.Pavlov).
5. Safety food in the chemical and epidemiological attitude. Absence in
products chemical substances or microbes is higher than allowable levels - an opportunity
food poisonings. Now it is very important principle in view of global pollution of biosphere
by heavy metals, pesticides etc. Ways of the control: chemical and bacteriological
analyses.

THEORIES AND CONCEPTS OF NUTRITION

The hemopoietic antique theory of nutrition ARISTOTEL - HALEN (blood is a food,
transformed in intestines)
SCIENTIFICALLY PROVED THEORIES OF NUTRITION:
1. Classical theory of the balanced nutrition acad. A.A. Pokrovsky (60 years ХХ century)
2. Theory of adequate nutrition аcad. A.M.Ugolev (1975) – in addition to the theory of the
rational nutrition it is take into account membrane and endocellular digestion
3. Function - homeostatic theory of nutrition V.V.Vanchanen (1995) – also taking into
account functions and biological effects of different nutrients.
THE NONCONVENTIONAL (UNSCIENTIFIC) CONCEPTS OF NUTRITION
( Contain both rational moments and antiscientific positions)
1. Vegetarianism (veganstvo)
2. Nutrition of macrobiotics (Japan)
3. The concept "“yan" and "“in" (China)
4. Nutrition in yogi system
5. Separate nutrition on G.Shelton
6. Nutrition of the ancestors ( uncooked food, dry food)
7. Reduced nutrition (theory “ alive energy” in vegetable food)
8. Concept coefficients alimentary value E.Carise ( “ point diet ”) (Germany)
9. Complete long-lived or time starvation
10. Absolutization optimality of nutrition (Selection diet for each separate man - USA)
 INSTRUCTION FOR PRACTICAL LESSON ON THE THEME
The educational questions of a theme
1. Kinds of nutition (rational, preventive, medical, medical-preventive), it differences and
purposes.
2. The basic principles of a balanced diet.
3. The theories of nutrition. Functions of food. Concept about dietary and food status of the man,
methods of it study.
4. Methods of check observance of principles of a balanced diet at the separate man and collectives
of the people
5. Methods definition daily energy losses of organism of the man and food value products.
6. Bases of nutrition at adverse ecological conditions
7. Norms of nutrition, parameters which are taken into account at it development.
8. Classification alimentary and alimentary-caused diseases, examples, reason, displays, treatment
and prevention.

The educational tasks and concrete definition of the tasks

1. Account of adequacy of an individual nutrition (under the tables, beforehand made a
house: a kind of activity, diet), definition own energy losses under the tables, offered and made a
house, taking into account: a sex, age, kind of activity, weight of a body. (see appendices)

Methodical indicating on independent work of the students

1. DEFINITION THE DAILY SPENT ENERGY

1 ). Base metabolism calculate under table 1.
2 ). Spent energy on digestion of nutrition - 10 % from basely metabolism.
3 ). The spent energy on all kinds of activity :
A.) Calculate Base metabolism in hour. Base metabolism in hour = Base metabolism : 24 hour.
B. ) Calculate the spent energy on all kinds of activity: the energy spending on the activity =
(Base metabolism in hour) x (duration of activity ) x ( coefficient activity ). The coefficient activity is in the
Table 2
C. ) Sum up all the energy spending on the activity ( during the whole twenty-four hours ) –
( table 3 )
4). the daily spent energy = Spent energy on digestion of nutrition + spent energy on all kinds of activity
 Table 1. Base metabolism
years Base metabolism
(00) kkal of energy
Man 10-18 ( 16,6 х W) + ( 77 х H ) + 572
18-30 ( 15,4 х W ) + ( 27 х H ) + 717
30-60 ( 11,3 х W ) + ( 16 х H ) + 901
Older than 60 ( 8,8 х W ) + ( 1128 х H ) - 1071
Voman 10-18 ( 7,4 х W ) + ( 482 х H ) + 217
18-30 ( 13,3 х W ) + ( 334 х H ) + 35
30-60 ( 8,7 х W ) - ( 25 х H ) + 865
Older than 60 ( 9,2 х W ) + ( 637 х H ) - 302
NOTE: W- the weight in kilogrammes , H – height in metres

Table 2.
The coefficient activity .

activity The coefficient activity

Woman Man
I. School activity
1.1. Practical occupation:
Occupation in the theoretical chairs 1,9 1,8
Occupation in the clinic 2,3 2,2
1.2. Learning:
1.3.work at the computere 1,7 1,6
1.4.listen the lecture 2,0 1,9
1.5. Preparation of the occupations: 1,6 1,6
II. Personal hygiene:
The washing 1,4 1,6
The shower 1,6 1,7
Put on the clothes, take off the clothes 1,5 1,8
Eat 1,5 1,3
III.Domestic work:
Wipe the dust 2,7 2,7
Sweep the floor 3,5 3,5
Wash the clothes 2,5 3,3
Wash the plates and dishes 1,6 1,5
Cook the food 1,8 2,2
Wash the floor 3,5 3,7
IV. The movement:
Walk in the house 2,5 2,4
Slow walk 2,8 3,0
Middle walk 3,2 3,4
Quick walk 4,7 4,7
Walk of the stairs 6,2 6,1
Drive in the transport 1,7 1,5
VIII. The sport:
Gymnastics in the morning 3,3 2,2
Play chess 2,2 2,1
Play biliards 2,2 4,4
Aerobika ( light ) 3,1 3,2
Aerobika ( heavy ) 7,3 7,2
Play rugby, basketball 5,5 5,6
Play voleiball 3,6 3,8
Play cricket 7,0 7,1
Gymnastics ( light ) 3,5 3,5
Gymnastics ( heavy ) 7,0 6,6
Run middle 7,0 7,1
Run quick 11,0 11,0
Swimming ( at average speed ) 2,9 3,0
Swimming ( at great speed ) 6 6
Reference tennis 3-4 3-3,9
Play football 6,8 6,6
Training with traenagers 8,0 7,6
IX. The rest:
Calm siting 1,2 1,2
Watch TV 1,4 1,4
Dance ( middle tempo ) 3,0 3,0
Dance ( quick tempo ) 6,0 5,8
Sing 1,6 1,6
Read 1,7 1,7
Sew 2,1 2,2
Knit 1,9 2,0
X.The sleep 1 1

Table 3. Sum up all the energy spending on the activity ( during the whole twenty-four hours )

№ Activity duration of coefficient activity Base the energy spending on

activity metabolism in activity
( in hour ) hour
1
2
3
Sum up all the energy spending on the activity ( during the whole twenty-four hours )

NOTE: 1 minute =0,016 hour

3 minutes = 0,05 hour
5 minute = 0,083 hour
7 minute =0,12 hour
20 minute =0,33 hour
25 minute = 0,42 hour
30 minute =0,5 hour

EXAMPLE
Man, 20 years, has weight - 60 kg, the height - 1,7 m. His work during the whole twenty-four
hours: study at occupations in the clinic – 5 hour, listen the lecture - 3 hour, driving in the transport
– 2 hour, work at the computere - 1 hour, preparation to the occupations - 4 hour, sleep – 9 hour.
Calculate he spent energy during the twenty-four hours.
SOLUTION
A). Calculation the base metabolism ( table 1 ).
The base metabolism = ( 15,4 х W ) + ( 27 х H ) + 717 = 924 + 45,9 + 717 = 1686,9 kcal
Base metabolism in hour = 1686,9 kcal : 24 hour =70,29 kcal in hour .
B). Calculation the spent energy on all kinds of activity ( table 2,3 )

Sum up all the energy spending on the activity ( during the twenty-four hours )

№ Activity duration Coefficient Base the energy spending on th

of activity metabolism activity
activity in hour
( in hour ( kcal in
) hour )
1 Occupations in the clinic 5 2,2 70,3 52,270,3= 773,3
2 listen the lecture 3 1,9 70,3 31,970,3=400,7
3 Driving in the transport 2 1,5 70,3 21,570,3=210,9
4 Work at the computere 1 1,6 70,3 11,670,3=112,4
5 . Preparation of the occupations 4 1,6 70,3 41,670,3=449,9
6 sleep 9 1 70,3 9170,3=632,7
Sum up all the energy spending on the activity ( during the whole twenty-four hours ) =
773,3 + 400,7 + 210,9 + 112,4 + 449,9 + 632,7 = 2579,9kcal

D). the daily spent energy = Spent energy on digestion of nutrition + spent energy on all kinds of
activity
the daily spent energy =168,69 + 2579,9 = 2748,6 kcal

The answer: the daily spent energy = 2748,6 kcal

2. Definition necessary quantity of alimentary substances, proceeding from designed before size of the daily
allowance energy spend.

Caloryc content of protein makes 12-14 % from common caloryc content of nutrition.
1 gramm of protein gives 4,1 kkal of energy.
Caloryc content of fats makes 25-30 % common caloryc content of nutrition, and 1 gramm of fats gives
9,3 kkal of energy.
Caloryc content of carbohydrates makes 56 % from common caloryc content of nutrition, and 1 gramm of
carbohydrates gives 4,1 kkal of energy.

EXAMPLE
Man, 20 years, his weight - 60 kg, the height - 1,7 m. The daily spent energy = 2748,6 kcal. How
many calories, protein, fats, carbohydrates it is necessary for him?
SOLUTION
1. The protein
A). Caloryc content of protein makes 12-14 % from common caloryc content of nutrition.
100% common caloryc - 14 % Caloryc content of protein
2748,6 kcal common caloryc - X Caloryc content of protein
X = ( 2748,6 x 14 ) : 100 = 384,8 kcal content of protein
B). 1 gramm of protein gives 4,1 kkal of energy.
1 gramm of protein - 4,1 kkal
X - 384,8 kcal
X = ( 384,8 x 1 ) : 4,1 = 93,8 gramm of protein
2. The fats
A). Caloryc content of fats makes 25-30 % common caloryc content of nutrition, and I gramm of fats gives 9,3
kkal of energy.
100% common caloryc - 30 % Caloryc content of fats
2748,6 kcal common caloryc - X Caloryc content of fats
X = ( 2748,6 x 30 ) : 100 = 824,6 kcal content of protein
B). 1 gramm of fats gives 9,3 kkal of energy.
1 gramm of fats - 9,3 kkal
X - 824,6 kcal
X = ( 824,6 x 1 ) : 9,3 = 88,7 gramm of fats

3. The carbohydrates
A). Caloryc content of carbohydrates makes 56 % from common caloryc content of nutrition
100% common caloryc - 56 % Caloryc content of carbohydrates
2748,6 kcal common caloryc - X Caloryc content of protein
X = ( 2748,6 x 56 ) : 100 = 1539,2 kcal content of carbohydrates

B). 1 gramm of carbohydrates gives 4,1 kkal of energy.

1 gramm of carbohydrates - 4,1 kkal
X - 1539,2 kcal
X = ( 1539,2 x 1 ) : 4,1 = 375,4 gramm of carbohydrates

The answer: It is necessary: 93,8 gramm of protein, 88,7 gramm of fats, 375,4 gramm of carbohydrates

3. DEFINITION OF THE DAILY USE OF THE PECTINES, FATS,

CARBOHYDRATES
Calculation alimentary value of a daily ration make with the help of the offered tables of alimentary value of
products of nutrition the student fills in the appropriate columns of the table N4.
Table 4. Calculation the nutrition value of food

№ food Weight Protein Fats Carbohy kcal

(g) (g) (g) drates
(g)
Soup
1 Cabbage soup 500 4,9 11.1 33,6 260
2 Fowl soup 500 7,1 9,3 19,3 196
3 Tomato soup 500 17,6 19 33,1 373
4 Cream soup maigre 500 10,3 1,0 42,5 139
5 Milk soup 500 10,2 18,8 50,9 330
6 Fish soup 500 9,8 7,5 19,6 220
Main Courses
1 Fried fish 100 15,8 9,8 3,4 168
2 Rissole pork 60 20 33 46 484
3 Rissole beef 60 14 31 28 450
4 Roast Chicken 100 18 18 15 340
5 Fried fowl 100 36 32 28 410
6 Steak 50 19 21 18 370
7 Beef casserole 100 19 18 15 435
8 Boiled eggs ( 2 eggs ) 100 9 9,7 0,3 127
9 Fried eggs ( 2 eggs ) 100 9,0 14,3 0,9 174
10 Fried bacon end eggs ( 2 eggs ) 100 29 35 1,0 270
11 Sausage 100 10,2 16,1 1,3 162
12 Smoked sausage 100 19,2 38,4 1,9 285
Porridge
1 Oatmeal porridge 100 5 3 25 120
2 Buckwheat porridge 100 4 2,8 28 178
3 Rice ( rice porridge ) 100 8 5 29 230
4 Semolina porridge 100 2,6 3,2 14 103
Vegetable
1 Boiled Patatoes 100 1,8 0,5 18,2 91
2 Fried Patatoes 100 1,5 6,2 15,8 137
3 Chips 30 1,4 4,3 14,1 73
4 Green salad 100 2,0 8,9 12,2 125
5 Tomatoes 100 1,1 0 4.1 280
6 Cucumbers 100 0,8 0 3,2 14
7 Cabbage salad 100 1,8 0,9 5,1 35
8 Carrots salad 100 1,3 0,7 8,5 36
9 Fried marrow 100 0,6 1,4 5,1 48
Milk products
1 milk 100 2,8 3,2 4,8 58
2 Curds 100 14 2,8 3,8 232
3 Sour cream 100 2,8 20 3,2 206
4 Chees 100 26,8 0 360
5 Keffir 100 2,8 3,2 4,8 58
Fats
1 Oil 100 0 99,9 0 899
2 Butter 100 0,6 82,5 0,9 748
3 Margarin (Rama ) 100 0,3 82,3 1,0 739
Bread – stuff
1 White bread 100 7,6 0,9 50 220
Black bread 100 5,5 1,0 31 157
3 Roll 100 7,9 1,0 65 250
4 Meat patty 50 5,2 1,9 17 102
5 Patatoes patty 50 3,6 1,8 25 126
6 Pastry 50 2,7 2.8 31 142
7 Boiled Macaroni 100 12,3 3,1 65 322
Fruit
1 Apples 100 0,4 - 1,2 34
2 Oranges 100 1.0 - 9,8 39
3 Strawberries 100 0,8 - 10,4 31
Drinks
1 Tomato juice 100 1,0 - 3,4 18
2 Apple juice 100 0,3 - 11,9 48
3 Grapes juice 100 0,4 0 16,5 68
4 Tea 100 2,0 - 8,5 99
5 Coffee 100 13,9 14,4 15.2 223

EXAMPLE
Man, 20 years, his weight - 60 kg, the height - 1,7 m. He eating Rice - 50g, Steak - 170 g,
White bread - 25 g, tea - 60g. How many calories, protein, fats, carbohydrates has he?
SOLUTION ( by the table 4 )
1. He have kilocalories :
A) 100g Rice - 230 kilocalories
50g Rice - X kilocalories
X = ( 50 x 230 ) : 100 = 115 kilocalories
B) 50g Steak - 370 kilocalories
170g Steak - X kilocalories
X = ( 170 x 370 ) : 50 = 1258 kilocalories
C). 100 g White bread - 220 kilocalories
25 g White bread - X kilocalories
X = ( 25 x 220 ) : 100 = 55 kilocalories
D). 100g tea - 99 kilocalories
60 g tea - X kilocalories
X =( 69 x 99 ) : 100 = 68 kilocalories
E) Calories amounting to: 115 + 1258 + 55 + 68 = 1496

He have protein:
A) 100g Rice - 8 g proteins
50g Rice - X g proteins
X = ( 50 x 8 ) : 100 = 4 g proteins
B) 50g Steak – 19 g proteins
170g Steak - X g proteins
X = ( 170 x 19 ) : 50 = 64 g proteins
C). 100 g White bread - 7,6 g proteins
25 g White bread - X g proteins
X = ( 25 x 7,6 ) : 100 = 1,9 g proteins
D). 100g tea – 2 g proteins
60 g tea - X g proteins
X =( 69 x 2 ) : 100 = 1,4 g proteins
E) Proteins amounting to: 4 g + 64 g + 1,9 g + 1,4 g = 71,3 g

He have fats:
A) 100g Rice - 5 g fats
50g Rice - X g fats
X = ( 50 x 5 ) : 100 = 42,5 g fats
B) 50g Steak – 21 g fats
170g Steak - X g fats
X = ( 170 x 21 ) : 50 = 71 g fats
C). 100 g White bread - 0,9 g fats
25 g White bread - X g fats
X = ( 25 x 0,9 ) : 100 = 0,2 g fats
D). 100g tea – 0 g fats
60 g tea - X g proteins
X =( 69 x 0 ) : 100 = 0 g fats
E) Fats amounting to: 42,5 g + 71 g + 0,2 g = 113,7 g

He have Carbohydrates:
A) 100g Rice - 29 g carbohydrates
50g Rice - X g carbohydrates
X = ( 50 x 29 ) : 100 = 14,5 g carbohydrates
B) 50g Steak – 18 g carbohydrates
170g Steak - X g carbohydrates
X = ( 170 x 18 ) : 50 = 61,2 g carbohydrates
C). 100 g White bread - 50 g carbohydrates
25 g White bread - X g carbohydrates
X = ( 25 x 50 ) : 100 = 12,5 g carbohydrates
D). 100g tea –8,5 g carbohydrates
60 g tea - X g carbohydrates
X =( 69 x 8,5 ) : 100 = 5,8 g carbohydrates
E) Carbohydrates amounting to: 14,5 g + 61,2 g + 12,5 g + 5,8 g = 94 g

The answer: In the food are: Calories - 1496, Proteins - 71,3 g, Fats - 113,7 g, Carbohydrates 94 g

Table 6. PHYSIOLOGYCAL DAILY NEED FOR ADULT (Russia)

Group Coef Age energy Protein fats Carbo

ficie nt h ydrate

All ani mal

1 2 3 4 5 6 7 8
M E N

I 1.4 18-29 2450 72 40 81 358

30-39 2300 68 37 77 335

40-59 2100 65 36 70 303

II 1.6 18-29 2800 80 44 93 411

30-39 2650 77 42 88 387

40-59 2500 72 40 83 366

III 1.9 18-29 3300 94 52 110 484

30-39 3150 89 49 105 462

40-59 2950 84 46 98 432

IV 2.2 18-29 3850 108 59 128 566

30-39 3600 102 56 120 528

40-59 3400 96 53 113 499

V 2.5 18-29 4200 117 64 154 586

30-39 3950 115 61 144 550

 40-59 3750 104 57 137 524

V O M E N

I 1.4 18-29 2000 61 34 67 289

30-39 1900 59 33 63 274

40-59 1800 58 32 60 257

II 1.6 18-29 2200 66 36 73 318

30-39 2150 65 36 72 311

40-59 2100 63 35 70 305

III 1.9 18-29 2600 76 42 87 378

30-39 2550 74 41 85 372

40-59 2500 72 40 83 366

IV 2.2 18-29 3050 87 48 102 462

30-39 2950 84 46 98 432

40-59 2850 82 45 95 417

4. Conclusion
(variants)
a). The daily allowance energy (exceed or less) caloryc content of nutrition for one day, therefore it is
necessary to increase caloryc content of nutrition on ______ Kcal.
6). The parity of protein, fats, carbohydrates in nutrition makes: __________, but it is required 1:1:4, a
ration it is necessary to increase (to decline) (to specify what alimentary substances).
B). The regimen of nutrition answers (does not answer) the demands of a balanced diet (to specify available
infringements), therefore it is necessary ___________ (the references on change of a regimen of nutrition) are
given. For correction of nutrition it is necessary to ____________ (to specify necessary changes in nutrition).
 The tests for the control of knowledge
1. By what methods it is possible to determine caloricity of nutrition of the man?
1. Direct and indirect calorymethry
2. Laboratory and settlement method
3. Table-chronomethric method
4. Spectrophotometric metod
2. The optimum amount of receptions of food for the adult man is:
1. 2-3 times per day
2. 4-5 time per day
3. 5-6 times per day
4. In process of occurrence of feeling of famine
5. Through everyone 2-3 hours
3. A medical nutrition is developed for:
1. Diseases caused by ecological conditions
2. For nutrition of the patients in medical establishments
3. Diseases which are badly giving in to treatment.
4. The persons contacting with harmful production factors
4. At medical survey of the men - drivers at 10 % of the persons it is increased weight of a body
(weight of a body is higher 65 % than norm). What is the alimentary status:
1. Normal status (adequate nutrition)
2. becity 1-st degree
3. Obecity 2 degree
4. Obecity 3-rd degree
5. Obecity 4-th degree
5. Determine caloricity of a diet of the student, which basic exchange makes 900 Kcal, and energy
losses on all kinds of activity during day make 2100 Kcal.
1. Caloricity of a daily diet - 900 Kcal.
2. Caloricity of a daily diet - 2100 ккал
3. Caloricity of a daily diet - 3090 ккал
4. Caloricity of a daily diet - 90 ккал
5. Caloricity of a daily diet - 1545 ккал

Situational tasks

1. The doctor - surgeon 39 years per day spend 3100 Kcal. In a diet of the doctor - surgeon proteins
- 93 grammes (40 grammes of an animal origin), fats - 116 g and 300 grammes of carbohydrates.
Caloricity of a diet is 2651 Kcal. In a mode of a feed three reception of food: breakfast - 7.30,
dinner - 15.00, supper - 20.00. Distribution caloricity on receptions: breakfast - 20 %, dinner - 50
%, supper - 30 %. Determine group of intensity of work, estimate caloricity of a feed and mode of
reception of food. Give the recommendations for normal nutrition.
2. Patient Н. 63 years, has superfluous weight of a body, there are expressed attributes
aterosclerosis coronary vessels, hypertonia. 3 times per day eat, avoids fatty and sharp food.
Estimate the food status. What recommendations for correction of a feed antysclerotical orientation
are necessary in this case?
3. At the patient 53 years by growth 162 sm weight of a body 82 kg. Eats 3 times per day, diet
usual. At inspection - increased level of sugar in blood (during last 5 years). In anamnesis - the
mother was sick sugar diabetis. Estimate the food status. Give the recommendations on preventive
nutrition.
4. Give an estimation of rationality of nutrition of the citizen N, 65 years old, eating 3 times per day (at 8 o'clock in
the morning, in 16 and 20 hours), receiving 100 g protein, 100 g fats and 500 g carbohydrates. The daily allowance
energy - 2700 Kcal.
The standards of the answers:
1. The miner concerns to 4 group of intensity of work. The size of his daily energy losses makes
depending on age 3900-4300 Kcal. Caloricity of his diet will be equal = 90 х 4,1 + 65 х 9,3 + 650 х
4,1 = 3638 Kcal. The diet of the miner on caloricity does not correspond energy losses. The
regularity of reception of food is broken. The reception of food should be ordered on time, and on
frequency.
2. On energy losses the doctor - surgeon concerns to III group of intensity of work. Caloricity of his
diet does not correspond to energy losses. The qualitative structure of a diet has deviations. Total
amount of proteins (93g) in a diet corresponds to physiological norms, but contents animal proteins
below recommended norms - 43 % (instead of 55-60 %), total amount of fats in a diet sufficient
(116 g). The amount of carbohydrates in a diet is much lower than norm. Instead of 426 g it is 300.
The ratio of proteins, fats and carbohydrates in a diet is not rational: 1:1,2:3,2 at norm 1: 1:4-5. An
interval between receptions of food more than 7 hours. The conclusion: a feed of the doctor -
surgeon defective and unbalanced.
3. The food status superfluous. It is probably alimentary obecity, development ishemical cardiac
illness in connection with hypercholesterolaemya. It is necessary fractional feed (6-8 times per day)
with a ratio P:F:C = 1:0,8:3, restriction of fats and nonprotected carbohydrates for restriction
caloricity of a feed up to 2000-2400 Кcal per day. The inclusion in a feed alimentary antysclerotic
factors is necessary: irreplaceable aminoacid methyonin (cheese, cottage cheese), PNFA (vegetable
oil, fat of sea fishes), phosphatides (vegetable oil etc.), antyoxidant vitamins C, A and Е.
4. The food status superfluous. Probably it is alimentary obecity. It is necessary the exception of the
unprotected carbohydrates of a diet, fractional feed (6-8 times per day) with a ratio P:F:C = 1:0,8:3,
restriction amount of fats. Daily caloricity of a feed must be 2200 Кcal. It is necessary inclusion in a
feed sugar substitutes (sorbit, ksilit, fructoze, etc.), optimum vitamin security of a diet.
5. We begin the decision of a task from definition caloryc content of nutrition with the help of calorimetric
factors (At burning 1g of protein and carbohydrates gives 4,1 Kcal, and 1g of Fats -9,3 Kcal of heat):
100 x 4,1 + 100 x 9,3 + 500 x 4,1 = 3390 Kcal,
That exceeds the daily allowance energy (2700 Kcal). Besides the non-optimum balance of protein, Fats and
carbohydrates is observed: 1:1:5, what for the elderly people it should make 1:0,8:3.
The regimen of nutrition is irrational also: 3 aliquot (should be 4 aliquot), there are non-optimum intervals between
receptions of nutrition (between breakfast and dinner - 8 of hours, between dinner and supper - 4 of hour), These
time terms should make 4-5 hours.
The conclusion: the nutrition does not correspond to the demands of a balanced diet. It is nec essary to lower
consumption of Fats for 20g, carbohydrates - for 200g, to enter 4 aliquot power supplies with intervals 4-5 hours.
THEME VALUE VARIOUS NUTRIENTS IN NUTRITION.
FUNCTIONS OF THE PROTEINS, FATS AND CARBOHYDRATES IN
ORGANISM.
A part of hygiene of nutrition, devoted to learning the functions of food substances
(nutrients) in organism, named NUTRICIOLOGY.

STRUCTURE of FOODSTUFF:
1) Nutrients - proteins, fats, carbohydrates, vitamins, mineral substances.
2) Not alimentary substances - the substances giving to products organoleptic property
(color, a smell etc.)
3) Antyalimentary substances – antitrypsines (in wet egg protein), antivitamins
(ascorbinaza, tiaminaza), antimineral substances (phytates, oksalates).
4) Toxic substances:
а) Inherent in products - toxins of poisonous mushrooms, solanin in a potato etc.
b) Casually got pollutants from environment - pesticides, heavy metals, dioxines etc.

FUNCTIONS NUTRIENTS
Function NUTRIENTS
Energy carbohydrates, fats, proteins, organic acids etc.
Plastic proteins, mineral substances, fats, carbohydrates
Bioregulatory proteins, vitamins, mineral substances
Adaptive-regulatory proteins, water
Immunoregulatory proteins, vitamins etc.
Treatment-and- dietary products with the improved composition of nutrients
reabilitation and adequate caloricity
Signal-motivation gustatory and extractives (spice, seasoning)

ROLE PROTEINS IN NUTRITION

 Proteins carry out many very important functions in an organism: structural -
construction fabrics, protective (gamma - globulines etc.), regulative (hormones,
enzymes), transport (hemoglobin of blood), energy (14 % of daily calory).
Classification proteins by full value: high-grade and less high-grade.
Attributes of full value proteins:
1. Presence in the protein the irreplaceable amino acids in an optimum ratio. By
this criterion proteins settle down in the following order: eggs, milk, meat, a fish, a soya,
sunflower.
2. Good comprehensibility of the protein in organism. 3 groups of proteins:
а) Good comprehensibility - milk, a fish,
b) Average comprehensibility - meat, eggs (after thermal processing),
c) Bad comprehensibility - leguminous, bread, mushrooms.
3 3. High biological value. After absorbtion the most part of irreplaceable amino acids
should be used on the main functions of proteins, except for energy.

PARAMETERS VALUE PROTEINS

1. AMINOACIDIC NUMBER (AAN) in %%:

mg amino acid in 1 g of the given protein
AAN = --------------------------------------------------------- х 100 %
mg amino acid in 1 g of ideal protein

Composition ideal protein (FАО/WHO) in g on 100g of protein: Valine - 5, Leucinum - 7,

lysine - 5,5, isoleucine - 4, methionine - 3,5, threonine - 4, tryptophan - 1, phenylalanine -
6.

AAN of key products: a chicken ovum - 100 %, cow milk - 95 %, rice - 67 %, wheat - 53 %

2. INTERRELATION of irreplaceable and replaceable amino acids in protein:

The sum of irreplaceable amino acids

--------------------------------------------------- ~ 0,4 (40 %)
The sum of replaceable amino acids

3. Protein Efficiency Ratio (PER) > 2,5

 W2 - W1 W2 - mass of a body animal in the end
PER = -------------- of Experiment
B W1 - initial mass of a body
В - quantity(amount) of protein in g, received by
animal during experience

4. Net Protein Utilization - NPU > 0,7

A-U-F A - quantity of nitrogen in meal, g
NPU = ------------- U - quantity of nitrogen, discharged
A with urine, g
F - quantity of nitrogen, discharged
with faecals, g

Irreplaceable amino acids and it functions.

Irreplaceable amino acids - are not synthesized in an organism of the person and
should be received from the outside with a food. Among 20 amino acids of all for the adult
person it is 8 irreplaceable amino acids:
Methyonin, lyzin, tryptofan, leuchin, izoleuchin, treonin, valin, phenylalanin.
Methyonin. 2-3 g per day. Adjusts exchange of fats, phosphatides and cholesterol -
the antisclerotic factor. Contains in milk, in cottage cheeses, eggs, leguminous, meat,
fishes.
Lyzin. 3-5 g per day. Participates in synthesis of hemoglobin, supports nitrogenous
balance, adjusts contents Са in blood. Consists in milk, meat, fish, soya. It is not enough -
in cereals.
Tryptofan. 1,6 g per day. Stimulates growth of fabrics, synthesis blood proteins and
hemoglobin, participates in maintenance of nitrogenous balance. Consists gradually in
different food proteins.
For children in addition there are 2 irreplaceable amino acids - аrgynin and
gystidin. Conditionally irreplaceable – needs for development, metabolism, blood
formation and are synthesized in an organism, but in insufficient amount for a growing
organism since stimulate growth.
Protein norm and protein minimum.
Protein norm - necessary amount protein for the person per day for performance
all functions of protein. It is a component of the norms of nutrition of the population.
Depends on age, sex, degree of weight of work. For adults on the average it is 70-100 g
per day. The optimum ratio of animal and vegetative proteins for adults 50 : 50 %, for
children 60 : 40 %.

DIALY NEED PROTEIN (g / kg body mass)

COUNTRY MAN 18-59 years WOMAN 18-59 years
FAO \ WHO 0,75 0,75
USA 0,80 0,80
Canada 0,77 0,69
England 1,15 1,0
Russia 0,93 – 1,7* 0,96 – 1,4*
Ukraine 0,83 – 1,53* 0,83 – 1,4*
The notes: * - In dependence on age and gravity of work

The protein minimum - necessary amount protein for maintenance of nitrogen

balance in organism – at it all protein goes on disintegration and allocation nitrogen.
Calculation: per day from an organism it is lost 6-7g nitrogen, 1 gramm nitrogen is formed
at disintegration 6,25 grammes of protein (all about 40 gramm, that is less than 50 %
protein norm). At nutrition at this level the basic functions of protein are not carried out, can
arise acquired immunodeficity.
Protein problem and ways of its decision.
On a global scale now in the world it is made 50 % necessary amount proteins for a
feed of all population of a planet. It is almost in all countries, especially with an insufficient
level of economic development and a low standard of living of the population.
Traditional ways of the decision of protein problem:
а) Increase agricultural production by extensive and extensive ways (at it is necessary to
use agrochemicals, which can collect in food products)
b) Increase preservation of a crop by chemicals
c) Wide use protein products of ocean (but it is very expensive, give allergic reactions, in
sea products can collect pollutats from sea water).
d) Allocation protein concentrates from soya, sunflower and their addition in sausages up
to 20-30 %.
Nonconventional ways of the decision of an protein problem:
а) Use microbiological synthesis (growth some microbes at oil substrates, but it is very
difficult to clean protein from substrate, and such protein can not use in food for man).
b) Search profitable ways synthesis of irreplaceable amino acids - while such chemical
synthesis very expensive.
 ROLE FATS IN NUTRITION
Structure of food fats: neutral fats (the ethers of glycerin and fat acids), fat-like
substances - phosphatides, mineral substances, fat-soluble vitamins (in some fats).
Functions of fats in nutrition: power (30-32 % daily calory, 1g fat makes 9 Kcal),
regulatory, plastic, protective (from mechanical and temperature influences), flavouring.
The characteristic of the fat acids.
Fat acids share under the contents of free (double) connections in formula on
saturated, nonsaturated and polynonsaturated.
1) Saturated fat acids (SFA) - stearin, palmytin acids in animal fats, oil and kapron - in
vegetative. Nonreactive, are acquired worse others, carry out basically power function.
Contain in the beef, mutton fat. At the superfluous use promote development
atherosclerosis due to a plenty cholesterol and absence antisclerous factors.
2) Monononsaturated fat acids (MNFA) – olein acid - contain 1 free connection in
formula, are better soaked up, basically - power function. It is in vegetative fats.
3) Polynonsaturated (PNSA) - linolev, arachidon acids (family omega-6), linolenov acid
etc. (omega-3). Have some free connections in formula. Most biologically active and
valuable among fat acids:
- regulative function - adjust exchange of cholesterol (the antisclerotic factor), reduce
coagulability of blood and permeability of vessels.
- Protective function - raise resistancy organism to infections, тoxicants, to surplus ultra-
violet rays (antioxidizers).
- Plastic - are part of walls of vessels and мielyn environments of nerves.
Suppliers of PNSA: PNSA family omega-6 contain in not refined vegetable oils,
PNSA omega - 3 - contain in fat of sea fishes (are most biologically active).
Value phosphatides.
Fat-like substances - 1 fat acid is replaced with a phosphoric acid and the
nitrogenous basis. Representatives: lecithin, kefalin. Participate in synthesis nuclein acids,
in exchange cholesterol (the antisclerous factor). A plastic role - enter into protoplasm of
cells, especially nervous system and a liver. Suppliers: liver, brain, egg yolk, butter, lard,
not refined vegetable oils.
Sterines. Share on phytosterines and zoosterines (Cholesterol). Despite of
ordinary opinion on its harm, cholesterol is very important for an organism. It has plastic
function - contains in protoplasm of cells, creates elasticity of fabrics as hydrophyl colloid
due to keeping water. Regulative function - synthesis vitamin D, bilious acids, sexual and
steroid hormones. Protective function – inactives haemolytic poisons.
 On modern representations, development atherosclerosis has multifactorial
aethiology, in a basis - infringements of a fatty exchange and increased endogenic
synthesis cholesterol, surplus alimentary cholesterol plays rather small value - an
alimentary risk factor of atherosclerosis.

VALUE OF CARBOHYDRATES IN NUTRITION

Functions of carbohydrates:
1) Power function (56 % caloric content of a diet per day), 1 g = 4 Kcal.,
2) regulatory (cellular tissue stimulates a motility and secretion of intestines),
3) Plastic (enter in structure of protoplasm and cellular membranes),
4) Protective (connect with heavy metals, cholesterol, glucose inactived cianid
poisons),
5) Flavouring - sweet taste.
Classification carbohydrates.

CHEMICAL HYGIENIC
1. monosaccharides 1. Unprotected (refined) from absorbtion
( Glucose, fructose)
2. disaccharides 2. Protected (starch)
( Saccharose, lactose)
3. polysaccharides 1. Superprotected
( starch, pectins) 1) Cellulose
2) Pectic substances

In hygiene it share on a degree of mastering:

1) The unprotected (refined) carbohydrates (mono- and disacharides – glukose,
laktose, etc.). Quickly are absorbed in organism and give energy. At the use plenty of
such carbohydrates may be alimentary odiposity, dibetes and caries.
2) Protected carbohydrates (starch). It has slow absorb in organism and give most of all
energy.
3) Superprotected: а) Cellular tissue, b) Pectin substances.
 INSTRUCTION FOR PRACTICAL LESSON ON THE THEME
Educational questions of a theme
1.Structure of foodstuff. The basic groups of nutrients.
2. Importance proteins in nutrition:
- concept about protein norm and protein minimum, attributes of full value of proteins and
protein products;
- irreplaceable aminoacids for the adult and children, representatives, role in organism, daily
need, products - suppliers;
- protein problem and hygienic estimation of ways of its decision.
3. Importance of fats in nutrition:
- classification kinds of fat acids, representatives, role in organism;
- not polysaturated fat acids, representatives, role, products - suppliers;
- phosphatides, representatives, role, products - suppliers.
- Cholesterol, functions in organism. Alimentary antysclerotic factors
4. Importance of carbohydrates in nutrition:
- hygienic classification of carbohydrates, representatives;
- hygienic characteristic of various carbohydrates.

The educational tasks and concrete definition of the tasks

1. Account caloricity and food value (amount of nutrients- proteins, fats, carbohydrates) of an
individual nutrition (under the tables, beforehand made a house, of a diet) and distribution caloricity
in %% on receptions of food.
2. With use of the table of food value of products to calculate: contents of proteins, fats and
carbohydrates in a daily diet (see previous lesson) and give itself reccomendations for correction of
the nutrition.

An estimation of a diet begin from drawing up of the menu for one day. At a feed in
networks of public catering important correctly write down the menu. At a feed at house (hostel) it
is necessary to carry out exact calculation of the used products, using the table of approximate
weight of products, which frequently are used (example: a glass – 200 ml, etc.). The above-stated
data are brought in the protocol of an estimation of an adequate feed as the table.
( See previous lesson).
The tests for the control of knowledge
1. How many percents from total of fats should make fats of a vegetative origin in a balanced diet of
the adult man?
1. not less than 30
2. no more than 30
3. it is not less 50
4. no more than 20
5. it is not less 70
2. To attributes of full value of proteins concerns:
1. optimum ratio irreplaceable aminoacids
2. convenience of thermal processing without loss of food value
3. good mastering
4. high biological value
5. performance of power function
3. Name alimentary antysclerotic factors
1. Methyonin
2. Lactose
3. PNSFA
4. vitamin C
5. Phosphatides

Situational tasks
1. The patient N., ill by bilateral pneumonia, received intensive antybacterial therapy, therefore at
him has arisen dysbacteriosis in intestines. Recommend, what changes it is necessary to bring to a
diet of the patient.
2. What products are the prevailing source phosphatides?
3. Energy losses of the miner in the age of 35 years makes 4100 Kcal. The analysis of a daily diet
has shown, that his caloricity is equal 3640 Kcal. In feed contained proteins – 100g, fats – 90g,
carbohydrates – 598g. In a mode of a feed it is the four reception of food: 1-st breakfast - 6.00, 2
breakfast - 11.00, dinner - 16.00, supper - at 20.00. Caloricity is distributed on receptions of food:
1-st breakfast - 20 %, 2 breakfast - 15 %, dinner - 40 %, supper – 25 %. Determine group of
intensity of work, estimate full value of a feed, of a diet and mode of reception of food.
The standards of the answers:
1. It is necessary to increase in a diet amount of milk products (kefir)
2. Vegatable oil, leguminous cultures
3. Group of intensity of work -4. Daily caloricity should make 3900-4300 Kcal. The diet meets to
principles of a balanced diet.
THEME: VALUE VITAMINS IN NUTRITION.
Vitamins – it is low-molecular organic substances, biologically active in very small
amounts.
Functions of vitamins:
а) regulatory - form enzymes and adjust in metabolism,
b) protective - raise resistancy an organism to the adverse climatic factors, harmful
physical and chemical influences, infections etc. (vitamin C - antioxidizer).
CLASSIFICATION VITAMINS:
WATER-SOLUBLE VITAMINS
Vitamin C - Acidum ascorbinicum
Vitamin В1 - Thiaminum
Hepatoflavin - Riboflavinum
Vitamin В3 or В5 - panthotenon acid
Vitamin B 6 - pyridoxine, pyridoxal, pyridoxamine
Vitamin В12 - cyancobolamyn
Vitamin Н - biotin
Vitamin РР - Niacinum, niacin, Nicotinamidum
Acidum folicum
LIPOSOLUBLE VITAMINS
Vitamin A - Retinolum, retinolacetat, retynal
Vitamin D - ergocalciferol (D2), cholecalciferol (D3)
Vitamin E - admixture of tocopherols
Vitamin K - admixture of naphthoquinones
VITAMIN-LIKE SUBSTANCES:
Choline Biologically fissile materials:
Inosite (B 8) Bioflavonoids
Acidum lipoicum - Vitamin U
Orotovic acid (B 15)
Vitamin В15 - pangamic acid
Carnitine
Paraaminobenzolic acid

Vitamins are formed basically in plants, and also collect in an organism of animals.
The person receives water-soluble vitamins with vegetative food, fat-soluble - with animal
and vegetative food.
Some vitamins can be synthesized in an organism of the person:
а) Vitamins group B, it is especial B 12, are formed in intestines at activity of microflora,
b) Calciferoles (vitamin D 3 - cholecalciferol) are formed in a skin at ultra-violet irradiation
from provitamine - dehydrocholesterol.
c) Vitamin A (retynol)- from betta-carotines of vegetative food in very insignificant degree
(1/6 part of requirement for vitamin A).
Kinds of the vitamin status of organism.
On a level of vitamin security of organism allocate:
1.Avitaminosis - full absence of vitamin in a feed for a long time
2.Hypovitaminosis - insufficient receipt of vitamin in an organism (about 50 % of
requirement)
3.Subhypovitaminosis - a boundary condition between hypovitaminosis and normal
vitamin state
4.Normal security vitamins in an organism
5.Hypervitaminosis - superfluous receipt of vitamins (on vitamins A and D).
The avitaminosis and hypovitaminosis can be exogenic and endogenic (secondary -
the caused infringement of absorbing of vitamins).
Methods diagnostics the vitamin status:
а) On clinic violations, characteristic for each avitaminosis on concrete vitamin (a scurvy,
etc.).
b) Biochemical methods (content vitamines in blood or urine).
c) Functional tests (skin haemorragies at vitamine-C hypovitaminosis).
The factors influencing at vitamins requirement of an organism:
Exogenic:
- A phsycho-emotional and physical overstrain
- Work at high and low temperature
- Work in mines, on Far North
- At contact with industrial poisons, at reception medicines (antibiotics)
- At work with radiation, noise, vibration,
- Smoking
- Seasonal fluctuations - there are not enough vitamins in a diet in the winter and in the
spring,
Endogenic:
- Age,
- Pregnancy and lactation
- Infectious diseases
- endocryn diseases - huperthireosis - strengthening metabolism in an organisme
- Intestinal diseases - infringement absorbtion vitamins
Value of separate vitamins.
Vitamin C - ascorbinic acid. Per day it is necessary for the adult person 75-100
mg. Functions:
- Participates in oxidation-reduction processes,
- Strengthens a vascular wall - preventive haemorragia (scurvy),
- Stimulation immunity - resistancy to infections,
- Regulation exchange proteins and carbohydrates,
- Raises resistancy to toxic substances as antioxidizer,
- Influences mastering Са (at a scurvy at children - changes in bones).
Very unstable vitamin - an ascorbinic acid easily is oxidized.
Factors, destroying vitamin C: Temperature, Access of oxygen, Catalysts (salts
of iron and cuprum - knifes, utensils), The alkaline environment, Enzyme ascorbinaza
(activated at cutting vegetables and fruit. Inactivators of ascorbinaza - salt, sugar, vinegar).
Vitamin D - complex of calciferoles.
Distinguish ergocalciferol (vitamin D 2) - it is formed in plants and cholecalciferol
(vitamin D 3) - is formed in a skin at action of ultra - violet from dehydrocholesterol.
Biological activity has the products of their oxidation formed in a liver and kidneys. At lack
of vitamin D at children - rickets, at adults - rarefication bones. Adjust absorbtion and
exchange of Са - antirachitic action. It is especially important for children.
The reasons of D-hypovitaminosis: lack of a solar irradiation (Far North, pollution of
the atmosphere, insufficient stay on fresh air, work in mines, etc.), at a feed only by
vegetative food.
Prevention and treatment of a rickets at children - introduction vitamin Dз - 500
International Units per day, preventive artificial UV irradiation (1/6 – 1/8 part of biodoze, at
rickets – ½ - ¼ biodoze).
At taking very big doses of vitamin D – D-hypervitaminosis - heavy infringements
of calcium exchange - calcinosis vessels of heart, kidneys etc. Calcinosis of coronary
vessels in the childhood at taking big doses of vitamin D - predisposition to a heart attack
of a myocardium.
Vitamin A - retynol. It is necessary for sight, growth, stimulation of immune
system. The avitaminosis - is more often at children of preschool age - haemeralopia
(night blindness) and kserophtalmya (degeneration eyes conjuctive and corneas). "
Vitamin of prosperity " - contains basically in expensive animal products - cod-liver oil and
a liver, is and in plants – betta- carotines. Per day - 1,5 - 2 mg.
Attributes A-hypervitaminosis: a headache, grow bald, infringements in a bone
fabric and in a liver, at pregnant - spontaneous abortions and uglinesses of a fruit. The
reason – taking big doses of vitamin-A preparations, less often - consumption of a liver of
a polar bear - a fatal retinol poisoning.

VALUE OF MINERAL SUBSTANCES IN NUTRITION

From 50 elements, which are present in an organism, 26 - are necessary, thus 12 of
them - macroelements, 14 - microelements.

CLASSIFICATION MINERAL SUBSTANCES

MACROBIOELEMENTS MICROBIOELEMENTS
( Content more than 10 mg/kg (Content less than 10 mg/kg
1 mg %) 1 mg %)

1. cations - calcium, potassium, magnesium, 1. NECESSARY:

sodium Iron, Iodum, fluorine, Zincum copper, cobalt,
manganese, nickel, selenium, chrome etc.
2. anions - phosphorum, sulfur, chlorine 2. Necessity not is clarified: strontium, boron,
Bromum, cadmium etc.
3.enter in organic bonds - Oxygenium, 3. TOXIC: lead, Cadmium, arsenic, Hydrargy
carboneum, Hydrogenium,

NEED MINERAL SUBSTANCES

( mg per day)
Calcium - 800 - 1500 Iodum - 0,15
Phosphorum - 1200- 3000 Copper - 1,5 - 3
Magnesium - 400 - 500 Manganese - 2-5
Iron - 15 - 18 Fluorines - 1,5 - 4
Zincum - 15 Chromes - 50-200

The characteristic separate MACROELEMENTS

Calcium. Per day - 0,8g, for pregnant, at a lactation 2g. It is especially important at
children's age - 1 - 1,5г in days.
Functions: plastic – in structure of bones, teeth (give it hardness), regulatory -
strengthening vascular wall, participation in coagulability of blood, transfer pulses in
nervous system, maintenance normal nervous - muscular excitability, is part of buffer
systems, Protective - raises resistibility to infections, renders desensibilization action
(antibiotics).
Conditions of mastering Ca.
1) An optimum ratio with phosphorus: Са: P = 1:1,5 - in milk and dairy products (cheese,
cottage cheese).
2) Presence vitamin D - improves absorbtion Са
3) An optimum ratio with magnesium – Са : Mg = 2 : 1 (for children 9:1). Magnesium -
antagonist Ca - is a lot in cereals.
4) Enough proteins in a feed - is better mastering
5) Absence plenty fats and sorrel acid - are formed insoluble substances with Ca.
 Phosphorus. Per day 1,6g, children – 3g., pregnant 3,8g.
Functions: plastic - is part of a bone fabric (elasticity), a nervous fabric
regulatory - formation phosphatides and nucleinic acids, formation buffer systems of an
organism.
Conditions of mastering: Ratio Са: P = 1 : 1,5, Enough of fats in food.
Products - sources: dairy products, a yolk of eggs, a fish, leguminous, meat

MICROELEMENTS.
The mineral substances contained in fabrics of an organism less than 1 mg - %,
necessary for an organism in minute quantities, but having very important regulation role.
The diseases, connected to infringement of microelement structure of nutrition is
named MICROELEMENTHOSIS.
The reason of occurrence - biogeochemical provinces (V.I.Vernadsky) - territories
with the abnormal contents (increased or lowered) microelements. These provinces may
be natural - are caused by features of geological formation of an earth's crust and
anthropogenous - are connected to activity of the person (heavy metals, fluorine etc.).
People in these areas with food and water receive insufficient or superfluous amount of
microelements, so there are arise ENDEMIC DISEASES (are characteristic for the certain
district).

CLASSIFICATION MICROELEMENTOSIS
( Are connected with lack or excess microelements in ground, water and food stuffs)
HYPOMICROELEMENTOSIS HYPERMICROELEMENTOSIS
MONO-HYPO MICROELEMENTOSIS MONO-HYPER MICROELEMENTOSIS
On fluorine - caries 1. NATURAL:
On Iodum - endemic struma On a molybdenum – molybden gout,
On Ferrum – ferrum-deficit anemya on a selenium - selenum toxicosis,
on strontium- strontium rachitis,
On fluorine - fluorosis,
on cadmium - cadmium nephropathy
On Iodum - Basedov illness
POLY-HYPO- MICROELEMENTOSIS 2. ANTHROPOGENIC:
On Ferrum, copper, manganese, zincum – On Hydrargyrum - illness Minamata
anemia On cadmium - illness itai - itai
On PCD - illness Usho
On lead, arsenic, pesticides dioxines,
nitrates
POLY-HYPER MICROELEMENTOSIS
On strontium, manganese,
Fluorine - Urov illness

VALUE OF SEPARATE MICROELEMENTS

Fluorine. Daily requirement is 2,5-3 mg. It adjusts exchange Ca and P. Takes part
in formation dentyn, dental enamel and bones. At lack - caries, at surplus (5 % territory of
Ukraine) - fluorosis - damage of teeth, bones, infringements of intellectual development at
children.
Iodine. Daily requirement is 0,1-0,2 mg (100-200 mcg). Participates in synthesis of
hormone of a thyroid gland thyroxin, adjusts function of this gland. At lack it is
hypothyreosis (endemic craw or mixedema). At surplus it is hyperthyreosis (Basedov
illness).
Iron. Per day - 15 mg, to women - 30 mg. Synthesis hemoglobin (60 % of all iron in
an organism), is part some oxidizing enzymes - peroxidasa, citochromes. It is a necessary
part of cytoplasm and a nucleus of cells.
Conditions of mastering: a hydrochloric acid, vitamin C.
INSTRUCTION FOR PRACTICAL LESSON ON THE THEME

Educational questions of a theme

1.Vitamins and mineral substances. Their classifications
2.Biological role and conditions of mastering of vitamins and mineral substances.
3.Physiological, natural and social factors determining need and security of organism by vitamins
and mineral substances
4.Concept about hypovitaminosis, subhypovitaminosis, avitaminosis and normal security of the
person by vitamins. The reasons of occurrence, clinical, physiological and biochemical displays.
5.Concept about mineral substances, their classification. Concept about macroelements, it functions.
Functions Ca, P, Na, condotions its mastering. Microelements (Fe, F, J, Zn etc.). microelementosis,
their classification, the reasons of occurrence, clinical, physiological and biochemical displays.
6.The basic products - suppliers of vitamins and mineral substances. Conditions of a storage and
culinary processing of foodstuff ensuring the maximal safety of vitamins and mineral substances.
7.Methods of definition vitamin C in food products and in biological liquids of the man.
8.Technique of account receipt mineral salts in оrganism with a daily diet.

The educational tasks and concrete definition of the tasks

1. Account of adequacy of individual nutrition on vitamins and mineral substances by definition of
consumed amount of mineral substances and vitamins under the tables, offered and made at house,
taking into account: sex, age, kind of activity, weight of a body, diet.

Table 1. PHYSIOLOGYCAL DAILY NEED VUTAMINS AND MINERAL SUBSTANCES FOR ADULTS

VITAMINS MINERALS

M E N

С A. E D B1 B2 B B12 Ca P Mg Fe Zn iodi
Age mg mg mg mg mg mg6 Mkg n

18- 70 100 10 2.5 1.4 1,3 2 3 800 1200 400 10 15 0,15

50 0

V O M E N
18-50 80 1200 400 18 15 1,5 2 2,5 800 1200 400 18 15 0,15
 Table 2. Calculation the vitamin and mineral value of food
Food Weig С A E B1 B2 Ca P mg Fe iodi
ht mg (carot Mg mg mg mg mg mkg
(g) in)
mg

Meat 100 0 0 0 0,08 0,14 9 178 2 -

Liver 100 33 3,8 - 0,3 2,2 5 339 9 -
Chicken 100 -- 0,04 - 0,07 0,15 10 210 1,5 -
Fowl 100 - 0,07 - 0,07 0,15 16 228 3,0 -
Sausage boiled 100 - - - 0,25 0,18 7 146 1,7 -
Sausage smoked 100 - - - 0,19 0,2 10 226 2,7 -
Eggs 100 - 0,35 - 0,07 0,44 55 185 2,7 -
Fish 100 - - - 0,1 0,1 - 310 - 100
Milk 100 1,0 0,02 - 0,03 0,13 121 91 0,1 -
Keffir 100 0,8 0.02 - 0,03 0,01 121 94 0,1 -
( iogurt )
cheese 100 2,4 0,21 - 0,03 0,38 760 424 - -
butter 100 - 0,5 - - - 22 19 0,2 -
oil 100 - - 35 - - 45 - - -
Bread white 100 - - 3,2 0,2 0,1 23 131 3,2 -
Bread black 100 - - 2,2 0,2 0,1 21 174 3,6 -
rice 100 - - 0,4 0,08 0,04 24 97 1,0 -
buckwheat 100 - 0,01 6,6 0,4 0,2 55 298 6,6 -
oatmeal 100 - - 3,4 0,5 0,1 64 349 3,9 -
cabbage 100 50 0,02 - 0,06 0,05 48 31 1,0
potato 100 20 - - 0,12 0,05 10 58 0,9
carrot 100 5 9,0 - 0,06 0,07 51 55 1,2
onion 100 10 - 0,05 0,02 31 58 0,8
Onion ( green) 100 30 2,0 0,02 0,1 121 26 1,0
beetroot 100 10 0,01 0,02 0,04 37 43 1,4
tomatoes 100 20 0.03 0,1 0,1 14 26 1,4
Peppe red (sweet) 100 250 2,0 0,1 0,08 8 16 -
orange 100 60 0,05 0,04 0,03 34 23 0,3
lemon 100 40 0,01 0,01 0,04 40 22 0,6
Apple 100 13 0,03 0,1 0,03 16 11 2,2
At the end of lesson in notebook of the protocols the students make the table:
Estimation of adequacy of an individual nutrition on vitamin and mineral structure
___________________________________________________________________________
The nutrient actual receipt with a diet per day norm of daily receipt difference
____________________________________________________________________________
Vitamins:
C
A
В1
Mineral substances:
Са
Р
Fe
F

The tests for the control of knowledge

1. Name the basic groups of mineral substances
1. microelements
2. water-soluble
3. oil-soluble
4. microelements
5. phosphatides
2. Daily need of vitamin C makes (mg):
1. 75
2. 100
3. 50
4. 60
5. 10
3. As a result of the profound medical survey of the cadets of a military school at some persons
there are the infringement of colour recognition, conjuctivitis, dryness of a skin, skin pigmentation.
For treatment similar clinical displays in a diet, first of all, it is necessary to increase the contents:
1. carrots
2. meats
3. groats
4. bread from bran
5. a fish

Situation tasks
1. The group of the students living in a hostel, has addressed to the doctor with the complaints to
general weakness, fast fatigue, haemorhage of gums. At interrogation is established, that the
students eat not regularly, frequently canned food, concentrates. The survey has shown presence
haemorhage of gums. Your preliminary diagnosis and its substantiation. What objective adequate
methods of research and inspection can offer? What methods it is possible to carry out at mass
inspection of all students living in a hostel by? Give the recommendations for prevention such
diseases.
2. What hypovitaminosis it is necessary to expect first of all at the patients long time staying on
parenteral feed?
3. What foodstuff is the basic sources Ca, daily norm. What is the ratio Са: Р: Mg.

The standards of the answers:

1. Hypovitaminosis C. For specification of the diagnosis it is necessary to inspect skin covers for
revealing haemorhage. It is necessary to determine contence vitamin C in blood and urine. The
supervision of all students living in a hostel, should be carried out with use of express trains -
methods of research, language test and definition resistancy of capillaries. It is possible to
recommend enrichment of a diet by vitamin C, application fresh vegetables and fruit, correct
culinary processing of products.
2. Vitamins D, K, group В1, A, Е.
3. Milk, cabbage, spinach. Daily norm 0,8, ratio Са:Р = 1:2 (1,5), Mg: Са = 0,5:1.
 THEME: FOOD POISONINGS.
THE REASONS, CLINIC, PREVENTION.
Food poisonings – non-contagious, are more often the sharp and mass diseases,
caused by the use of substandard food, containing microorganisms or toxins of a various
origin.
Difference from intestinal infections (dysentery, cholera etc.) – non-contagious!
(absence of transfer disease from the patient to the healthy person).
Food poisoning may be only at the person, which eat food, containing harmful
substances or microbes.

CLASSIFICATION FOOD POISONINGS:

1. ALIMENTARY POISONINGS MICROBE ETIOLOGY:

1) TOXINFECTIONS - at hit alive microbes with nutrition (E.coli, Proteus, Cl.perfringens,
Bac.cereus etc.)
2) BACTERIAL TOXICOSES - at hit microbial toxins with nutrition:
а) Staphylococcal toxicosis (Staphylococcus aureus)
b) BOTULISM (Clostridium botulinum)

2. ALIMENTARY POISONINGS NOT MICROBE ETIOLOGY:

1) BY TOXICANT PRODUCTS:
а) Toxicant mushrums (pale poganka, fly-agaric etc.)
b) Toxicant plants (beladonna, etc.)
c) Toxicant weeds (heliotrope)
d) Toxicant parts some fishes

2) BY PRODUCTS SOMETIMES OR PARTICULATE TOXICANT:

а) Stone fruits (amygdaline)
b) String bean (fasin)
c) Potatoes (solanine)

3) BY CHEMICAL MATERIALS:
а) Heavy metals - lead, copper, Zincum, Hydrargyrum etc.
b) Pesticides
c) Nitrates and nitrites
d) Alimentary additives

3. MYCOTOXICOSIS

Sort of fungi Mycotoxins Food products pathology

Aspergillus Aflotoxins nuts, coffee cirrhosis and
primary cancer of a liver
Aspergillus Ochratoxins grain, coffee Balkan epidemic nephropathy
Fusarium Trychocetens Grain 1. Fusariosis (poisoning
“drunk bread”)
2. Alimentary-toxic aleukia
Claviceps Alkaloids of ergot Grain Ergotism
Penicillium Pathulin juices, mashed potatoes Malignant tumours
4. ALIMENTARY POISONINGS NOT-INVESTIGATED ETIOLOGY
1) Alimentary paroxyzmal toxic myoglobinuria (Gaffen illness)
2) Poisoning with meat of quail
3) Urov illness (the illness Kashin - Bec) (now it is referred to poly-hyper-microelementosis
on strontium, manganese and fluorine)

1. FOOD POISONINGS MICROBE Aethyology:

1. Toxicoinfections - are caused by hit in an organism food, containing the alive
microorganisms. Specific activators it is salmonels, potentially pathogenic microflora – E.
Coli, proteus, etc.
2. Bacterial toxicoses (the old name - food intoxications) - arise at hit in organism
food products containing bacterial toxins, formed in it. Representatives - staphylococcal
toxicosis, botulism.
3. Mixed aethyology - when in food is both alive microbes and toxins - for
example, salmonels + staphylococcal toxin.

TOXICOINFECTIONS.
Product sources: meat products, especially minced (pies with minced meat), eggs
(are frequently infected by salmonels), a fish (stuffed, cooked and hot smoked), lactic
products.
Conditions when products become dangerous for toxicoinfection:

1) The reasons of hit of activators in products:

а) using ill and tired animals, wrong cutting animal carcass,
b) Wrong storage and transportation products, processing uncooked and ready products
on one board, one knife etc.,
c) Non-observance by the personnel of food objects rules personal hygiene, absence
regular physical examinations personnel, attraction to work at kitchen unknown or ill
people.

2) The reasons of duplication and preservation activators in products:

а) Wrong storage - non-observance temperature and terms of realization,
b) Insufficient thermal processing

Clinic toxicoinfections.
There are 5 clinical forms:
1) Gastroenterythic form: nausea, vomiting, dyarrea, pains in stomach
а) easy degree - 80 %,
b) average degree - 20 % (rise temperature up to 38),
c) the heavy form - 2 % - body temperature 38-40 С, decrease of arterial pressure, very
heavy intoxication.
2) Typhoid form – heavy intoxication with intermitted temperature
3) Choleric form – heavy intoxication with strong dyarrea
4) Dysentery form – dyarrea with blood in faecal masses
5) Grippe form – like grippe with gastroenterytis.

Preventivon of toxicoinfections.
Elimination the reasons of hit and duplication activators toxicoinfections in products
(see higher).
 BACTERIAL TOXICOSES
Group of food poisonings microbe aethyology, caused by the microbe toxins, which
have collected in products.
1) A staphylococcal toxicosis.
The reason - golden staphylococc, capable to produce in products eksotoxin.
Products - sources: dairy products, creams, pies, cakes, fish and meat products.
Conditions of hit staphylococcus and collect it toxine in products:
а) Staphylococcal diseases of the personnel of eating establishments - quinsy, pustular
diseases of a skin of hands,
b) Wrong storage - at room temperature, non-observance terms of realization.
Clinic: gastroenterytis at rised temperature, diarrhea seldom, in heavy cases –
infringement cardiac system, dehydrotation organism.
Prevention: physical examinations and discharge of personnel, correct storage
products, it is especial for cakes and pies in a hot season.
BOTULISM
The reason it is formation in food product eksotoxine by botulin stick - Clostridium
botulini. Features of the activator:
а) spore-making - spores maintain boiling 4-5 hours, (a stick in the vegetative form – only
15 minutes), are kept at temperature -16 0С during 14 months, maintain action of
preservatives - salts, vinegar, sugar long time,
b) obligate anaerob microbe - develops without access oxygen (canned food),
в) Under certain conditions (+ 10 - +30 0С without oxygen) is formed the strongest
neurotropic eksotoxine - a fatal doze for person 35 microgramme.

Products - sources: earlier in Germany in 19 century - cooked and blood

sausages (" sausage poison "), dry-cured and cold smoked fish, now it is especial
frequently - canned food (mushroom, vegetable conserves at domestic preparation - it is
difficult to destroy spores in domestic conditions), sometimes – dry-cured and smoked
meat, a canned meat.
Clinic of botulism.
Toxin amazes central nervous system - an oblong brain - nucleus skull-brain
nerves. Are amazed more often:
- Nucleus of nerve oculomotorius – pthosis (falling of upper eyelid at one eye) , anisocaria
(different diameter of pupils of the eyes), frustration accommodation of eyes,
- Nucleus of optic nerve - a fog, "net" before eyes, decrease of sight
- Nucleus of glossopharyngeus and hypoglossal nerve - violations of speech up to aphonia
(person can not speak), violations of swallowing (person can not drink water),
- Nucleus of facialis nerve - disappearance tonus of mimic and chewing muscles at the
one half of face,
- Nucleus of vagus nerve - increase pulse at the normal or lowered temperature,
defecation is normal or propensity to locks (as against other microbe food poisonings –
very important differential symptome!).
Then in patient may be spasms, pains in muscles, defeat of vessel, respiratory
centers in central nervous system - death. The mortality at not treatment botulism - up to
70 %, at treatment - up to 30 %.
Treatment botulism.
It is introduction antybotulinic serum or anatoxine (15000 IU, repetition in a doze
5000 IU after 5 hours). At the use suspicious product - introduction serum in a doze 2000
IU.
 Prevention botulism.
Strict observance temperature technology preparation canned food, dry-cured
fishes, meat. At the domestic conservation – make it in small banks at long time of boiling,
storage canned food at temperature less than 10 degrees.

2. FOOD POISONINGS NOT MICROBE AETHYOLOGY

1. Poisonings with poisonous mushrooms.
Poisoning by pale poganka.
The most poison mushroom. It contains ammonitotoxine and ammonitohaemolysin.
Blocks all kinds of a metabolism, first of all carbohydrate and water. Sharp gastroenteritis –
cholera-liked diarrhea - dehydrotation of organism – violations of central nervous system
and cardiac system (sharp falling the blood pressure). In blood it is gaemolysis
(destroying) of erythrocytes - pallor skin and sharp hepatic insufficiency (destroyed parts of
erythrocytes go with blood to liver) - yellowness of a skin. Death may be from a collapse at
violations of CNS.
Poisoning by fly agaric. Athypic appearance - sometimes it mask under edible
mushrooms. Contains muscarin and mycoathropin – changes m-holinolytic nervous
system. In clinic: gasthroenteritis, perspiration, tearing and salivation, expansion of pupils
of the eyes. Defeat of central nervous system as an alcoholic poisoning. Death from a
paralysis respiratory centre in CNS.

Prevention poisonings by poisonous mushrooms.

1) The population must to know poisonous mushrooms by means of sanitary -
educational work: lectures, conversations, posters, use mass media (TV, radio).
2) Control in the markets – places of sale mushrooms - sale mushrooms only under
the sanction of the sanitary medical assistant. Sale mushroom salads and mixes is
forbidden.

2. Poisonings by poisonous wild-growing plants.

Are most typical at children's age.
Plants with m - cholynolytics - atropine, giosciamine, scopolamine - beladonne,
benbane, dope. In clinic it is gasthroenteritis and expansion of pupils of the eyes
(beladonne – from Latin “beautiful woman” – in Middle centures women drop to the eyes
solution of beladonne – dark, beautiful eyes), spasm of accommodation (violation of sight
on close distance), dryness and reddening skin and mucous. At poisoning by dope,
benbane – also sight and acoustic hallucinations + oppression central nervous system
(CNS). Death - from violations of CNS. After recovery may be the remote effects on CNS –
amnesia (loss of memory), etc.
Cikuta (cikutotoxine). In Ancient Greece used for cuicide. Children use it as
tubules. Excitation, then - oppression CNS. Loss consciousness, spasms, expansion of
pupils of the eyes, cold sweat, vilations of breath, cianosis. Death in 2-3 hours from a
paralysis respiratory centre.
The wolf berries. Myserin - irritation action - bloody vomitting, a diarrhea. Daphin
- infringement CNS and cardiac system. 10-12 berries - a fatal poisoning.
Wild grapes. Brionin. Heavy gasthroenteritis, excitation, then - oppression CNS.
Death - from a collapse. A fatal doze for adults - 40 berries, for children - 15 berries.
Prevention poisonings by poisonous plants.
1) Destruction it in territory of children's preschool establishments
2) The control under children at walking in parks. Work with tutors.

3. Poisonings by products sometimes or in part poisonous.

Solanin in a potato. In growing and become green potates. Has irritating and
haemolytic action. In clinic it is gasthroenteritis of easy and average degree of weight.
Prevention – to not use become green parts of potates.
Fazin in haricot beans. Its toxine give irritation and gaemagglutination (stick of
erytrocites) action. Destruction toxine is at long thermal processing. The use haricot bean
or its flours in shops is forbidden. In case of it food poisoning it is gasthroenteritis of easy
and average degree of weight.
Amygdalin in stone fruits. Most of all - in bitter almonds, in stones of apricots,
peaches, cherries etc. In organism it breaks up with allocation cyanic acid - blockade fabric
breath. In heavy cases - loss consciousness, plentiful vomitting, diarrhea, spasmes, death
in 2-9 hours at paralysis of the respiratory center of CNS.
Prophylactic measures - to not use these products or boiling for a long time,
because toxins are termolabilic (destroy at high temperature).

4. Poisonings by salts of heavy metals.

The reasons:
а) From utensils (the zinc buckets, copper utensils, glaze on pottery),
b) From the ground polluted by heavy metal - lead (about highways)
Zinc and copper (cuprum). Basically act from utensils at storage in it sour
products. Not heavy gasthroenteritis – in intestines are formed albuminates of copper and
zinc - are not soaked up in organism - ulcering, irritating action at intestines.
Lead. It may hit in food from utensils (glaze) and ground. Poisonings are usually
chronic. In clinic - a lead triad: lead encephalopatia (violations of CNS) and polyneuritis
(vilations of perypheris NS), lead pains in stomach, lead border on gums. In blood -
bazophyl granularity in erythrocites, retyculocitosis (irritation action at blood-forming
organs), increase contents lead in urine (more than 0,04 mg / l).
Prevention:
а) hygienic reglamentation of heavy metals in products and control observance it
maximal permissible concentration,
b) prevention transition metals from container, utensils.

5. Food poisonings by agrochemicals.

5.1 Food poisonings by pesticides.
Pesticides - chemical means of protection plants from wreckers, illnesses and
weeds. Without application it is loss 50 % of a crop. Sometimes it is possible accumulation
it in products above maximal permissible concentration and development poisonings.
The reasons accumulation of pesticides in products:
а) Application non-authorized preparations (very proof or toxic),
b) Excess the established norms of the charge or frequency rate of processing,
c) Non-observance term of expectation - time between last processing plants and
harvesting.
The clinic poisonings depends on group pesticides – chlorine-organic (decrease
activity of cytochromoxidaze – enzyme of tissue breath), phosphorus-organic (decrease
activity of cholinesterase – accumulation of acetylcholine in organism), carbamates, etc.

5.2 Food poisonings by fertilizers.

Fertilizers - substances for increase productivity of plants. Nitrogen fertilizers are
most of all applied. Thus in plants can collect nitrates - in organism are restored in nitrites
and connect with gaemoglobin in erytrocites – metgaemoglobinaemia – gaemoglobin can
not transport oxygen and it is hypoxia. Are especially dangerous to children first 3 months:
1) in stomach it is not present HСl - stop restoration nitrites from nitrates.
2) chidren in this age have fetal gaemoglobin – very sensitive to nitrites
3) Low activity of enzyme metgaemoglobinreductase in children – makes
 gaemoglobin free from nitrites
At high levels nitrates in products can created nitrozo-combinations (NS) -
cancerogenic effects.

6. Food poisonings by food additives.

THE ALIMENTARY ADDITIVES AND IT CLASSIFICATION
The alimentary additives - not nutritional chemical materials, syntheticaly imported
to foodstuff with the purpose enriching of organoleptic properties, conservation products
and enriching technological processes preparation nutrition.
For learning alimentary additives and addition them in the list allowed alimentary
additives there is the Joint committee experts of FАО/WHO under the alimentary additives.
CLASSIFICATION ALIMENTARY ADDITIVES, ALLOWED To APPLICATION In the
COUNTRIES EUROPEAN UNION
Е 100 - Е 200 - stains
Е 200 - Е 300 - preservatives
Е 300 - Е 400 - antioxidants, regulators acidity
Е 400 - Е 600 - emulgents, stabilizers consistence,
materials handicapping conglomeration
Е 600 - Е 900 - amplifiers taste, flavors
Е 900 - Е 1000 - materials enriching quality of a grain and bread

Such alimentary additives are recommended EU for the blanket market, but each
country asserts the list of allowed materials.
On Ukraine the List allowed alimentary additives predicated by the Decision Cabinet
of Ministres and the addition into it new alimentary additives is admitted only under the
resolution Ministry of Helth of Ukraine.

More than 5000 chemical substances are now use as food additives - dyes,
aromatics, emulgators, preservatives, fluffers etc. Poisonings occur at application non-
authorized additives or excess it permissible amount.
Example: using food additives to sausages as paintings - nitrates (at high levels
action at the person - see higher).

3. Mycotoxicoses.
The food poisonings caused by toxins microscopic mould mushrooms on bakeries
(on grain, on flour) at storage in wet conditions. It are characteristic for a countryside - bad
conditions of storage a flour, during wars etc. - use any grain. Now it may be in connection
with a making of bread in private manufacturers from a unchecked flour.
Ergotism. At infection grain by ergot. In food can products toxins – ergotoxine,
ergotamine, ergometrine. Cause a spasm of smooth, then - other muscles.
In clinic distinguish 3 forms:
а) Convulsive - paresthesias, dizziness, spasmes, sometimes - gasthroenteritis. Duration
3-6 weeks,
b) Gangrenous (" fire St. Antonio ") - forming necrotic centers at skin with tearing away the
become lifeless sites, strong pains in these sites. In heavy cases - death in 1-2 day - at
connection secondary infection (sepsis)
c) Mixed - combination 1 and 2 forms.
Ergotism it is especially dangerous for pregnant - a spasm smooth muscles of
uterus - abortions, premature birth.
Fusarios. A poisoning with "drunk bread". The mould mushroom sort Fusarium
graminearum. In clinic - gasthroenteritis and defeat CNS as alcohol intoxication. Endemic
disease on the Far East.
 Alimentary-toxic aleukia. Up to 1944 year named - "septic quinsy". Sort Fusarium
- develops in the grain, which has wintered under snow. Deep violations of blood-forming,
leuko- and trombocytopenia. The main attribute - aleukia (in 1-2 weeks) - sharp decrease
leukocytes and erytrocites, increase lymphocites. Heavy necrotic quinsy and a sepsis.
Mortality - 50-80 %.
Аflotoxicoses. Sorts Aspergillis. On a peanut and аraxis flour, on a grain, corn,
nuts, rice at storage in damp conditions at the increased temperature. Recently was found
in Spain red wine. Cause heavy defeat of liver and have cancerogenic effect at a liver –
initial cancer of a liver (earlier - basically in Africa and Asia). Now – are often in Crimea
and on South Ukraine.

4. FOOD POISONINGS INSUFFICIENTLY INVESTIGATED AETHYOLOGY

Urov illness (Kashin – Beck illness). Now it is established, that it
hyperpolymicroelementosis (strontium rickets). Endemic disease - the river Urova in
Eastern Siberia and some other territories on the Earth. Deformation skeleton during
growth, heavy violations of exchange.
Gaffen illness. Gaffen gulf in Holland. Arise at the use of fish from some reservoirs
in some periods. The reason is not established, possible - at flowering water toxic
seaweed are formed, toxins collect in a fish.
The official diagnosis – it is alimentary paroxysmal-toxic myoglobinuria (exit of
muscular protein myoglobin in blood and in urine). Attacks of sharp muscular painsand
sharp renal insufficiency in view of мyoglobinaemia. It is necessary haemodialis.
Poisoning with meat of female quail. Sometimes - gasthroenteritis a different
degree of weight. The reason is not established.

TACTICS OF THE DOCTOR AT SUSPICION ABOUT FOOD POISONING

1. Statement the preliminary diagnosis on the basis:
а) Gathering the food anamnesis (what products eat the patient) at the patient or relatives,
b) Clinic with characteristic symptoms
2. Rendering emergency medical service under vital indications - cardiacs, respiratory
analeptics, etc.
3. Confirmation the diagnosis:
а) Gathering and sending in laboratory of hygiene of nutrition of SES the rests of food,
washing waters of stomach, emetic weights, faecalies, blood, urine.
b) Write "Accompanying direction on laboratory research" with the indication the reason of
selection test products and on what method of laboratory researches products.
4. Desintoxication therapy: washing a stomach, plentiful drink, antibiotics, droppers. At a
botulism - antibotulinic serum, anatoxine.
5. Prevention mass food poisoning – to send "Emergency notice about food poisoning" - in
SES and to inform in SES by the phone (it is especial if a poisoning on a public nutrition
establishment).
After reception of the emergency notice doctors SES within 24 hours will carry out
investigation food poisoning - sanitary inspection public nutrition establishment, honey.
Survey the personnel.
6. At the appropriate indications - hospitalization in infectious department of hospital by
first aid.
INSTRUCTION FOR PRACTICAL LESSON ON THE THEME

EDUCATIONAL questions:
1. Concept about a food poisoning. Characteristic attributes of these poisonings. Classification.
2 Aethyology, pathogenesis, clinic and prevention of food poisonings microbe nature:
- toxicoinfections;
- bacterial toxicosis;
3. Aethyology, pathogenesis, clinic and prevention of food poisonings non-microbe nature:
- by poisonous plants and mushrooms;
- by products sometimes or partially poisonous;
- by salts of heavy metals;
- by the food additives (nitrates);
- by agrochemicals (pesticides and fertilizers)
4. Aethyology, pathogenesis, clinic and prevention micotoxicosis:
- fusariosis
- ergotism
- aflotoxicosis
5. Food poisonings unknown nature, clinic, diagnostics, reason of occurrence, prevention.

The educational tasks and concrete definition of the tasks

1. To put the diagnosis of a food poisoning on the offered clinical tasks or cards of investigation of
food poisonings, to determine a product, caused it, to issue the necessary documents. (see
situational tasks).

THE APPENDIX 1
Clinical symptoms of some food poisonings microbe nature
Symptoms Toxicoinfection Staphylococcus intoxication Botulism
Temperature of a body raised or high normal or raised normal or subnormal
Headache + + +
General weakness + ++ +++
Loss of consciousness - - -
Spasmes - + +
Easing pulse + ++ ++
Cianosis - + -
Cold sweat + + -
Infringement of sight + + +++
Dryness in mouth Cavity - - +++
Nausea, vomiting +++ ++ +++
Pain in epigastrium + +++ +
Constipation - - +++
Dyarrea ++ + -
Blood in faecal masses - + -
Slime in faecal masses - + -
Duration of disease
at adequate treatment 1-3 days 1-3 days 5-20 days
Notes: +++ The symptoms sharply expressed + symptoms are observed seldom ++ symptoms
strongly expressed - symptoms, which are not observed + symptoms moderately expressed
 The tests for the control of knowledge
1. In what it is consists pathogenesis of botulism?
1. a defeat of an oblong brain
2. a defeat of cardiac system
3. a defeat of kidneys and liver
4. a defeat supreme part of a head brain
5. a defeat of respiratory system
2. What clinical forms are not characteristic for toxicoinfection?
1. Gastroenteritis
2. Typhoid-like
3. Grippe-like
4. Cholera-like
5. Dysenteria-like
6. Haemolytical
3. The city dweller gather in a wood mushrooms and also has used them in food in a fried kind. In
12 hours strong pains in a stomach, vomiting, dyarrea with blood suddenly have appeared. At the
end of the first day of disease has arisen yellowness, increase of a liver, small amount of urea. The
spasmes were observed. The death has come for the third day. What could cause disease?
1. a poisoning pale poganka
2. overcooling
3. a poisoning toadstool
4. a poisoning false opyata
5. poisoning nitrates

Situational tasks
1. The case food microbe poisoning took place on July 20 in family of one employee after the use of
fried cutlets from veal (cow week was sick and was killed without the knowledge of veterinary
supervision). The basic symptoms of disease: the incubational period 12-16 hours, high
temperature, strong pains in the field of a stomach, vomiting, dyarrea, general weakness, headache.
The most probable activator of the given poisoning?

2. In a reception of local hospital in May 2 children from one family in the age of 4 and 6 years with
the complaints to a nausea, vomiting, have arrived. The disease began soon after the use of a
potatoes welded (cooked) in whole. At survey of a potatoes used in food by family, it is revealed
much green samples. Most probable factor of a poisoning?

3. At inspection by way of the first help of the patient С., 26 years, are established: works in
collective farm, eats at home. July 20 pains in a stomach, nausea at 11.00. have appeared. In 13,00.
was vomiting. Feels poorly. The daily diet during last 3 days has made: July 18 - Breakfast - rice,
cottage cheese, tea, bread. Dinner: a soup meat, bread. Supper - sausage, coffee, bread. July 19 -
Breakfast - pies with meat, milk. Dinner - soup from fresh fish, meat with macaroni, tea, bread.
Supper - meat with macaroni (stayed from dinner), tea, bread. July 20 - Breakfast - coffee, bread.
Objectively: temperature of a body 37,80C, pulse 86 impacts minute of good filling, the Stomach is
intense and is painful at palpation. Dyarrea with slime. Put the diagnosis of a food poisoning,
determine a product, its caused.
The standards of the answers:
1. Salmonells
2. Solanin
3. Food poisoning microbe nature, toxicoinfection, caused by pies with meat.
 Methods of investigation cases of food poisonings

Materials for self-preparation.

All cases of food poisonings are exposed to the obligatory account and research them with
the purpose of establishment the reasons of their occurrence, and realization of preventive measures
for liquidation their consequences. For this purpose it is necessary to know rules and order of filling
of the documentation at detection cases of food poisonings.

APPENDIX 1
Accompanying direction on laboratory research
"“___" ________ 2007 № ______
Simferopol
(The name of the SES, where will be made the analysis)
_____________________________________________________________________________
_____________________________________________________________________________
(Name of laboratory, address)
_____________________________________________________________________________
_____________________________________________________________________________
(Name of establishment, directed test, its address, the telephone)
_______________________________________________________________________________
№ Name of a material Weight Characteristic of container Date and time sending test
(sterility, glass, polythene, cardboard and etc.) in laboratory
1
2
3

Promptness of research, what product is suspected as the reason of a food poisoning ________
_____________________________________________________________________________
( name, borrowed post directed a material for research)

At reception of tests the laboratory should give out the receipt with the indication of tests
and time of their reception.

APPENDIX 2

OBJECTS to RESEARCH And the ORDER of it DIRECTIONS In LABORATORY

The name of a material amount of a material time of a capture of test of foodstuff

_________________________________________________________________________A. the
rests of suspected food 200-300 g 1-st day
B. tests liquid or dishes or products 200-300 ml after careful hashing - //-
C. the second dishes 1-2 portions - //-
D. the meat from various parts of ink 500 g - //-
E. solution from barrels with salty products 100-200 ml - //-
F. a bird 1-2 sample - //-
G. a fish: from large - pieces from 2-3 places, from fine some copies - //-
H. canned food: open banks, not opening banks 5-10 - //-
Inspection of the personnel 1-st day
A. bacterial examples from hands, and if necessary from mouth and nose
of the personnel engaged in preparation of food - //-
B. direction of the personnel on revealing intestinal infections - //-
Objects of research from ill persons first
A. vomiting masses 50-100 g hours
B. first washing waters 100-200 ml or
C. faecal masses 50-100 g day
D. wetting 200 ml after
E. blood for crop 8-10 ml diseases
F. blood for serological researches 2-3 ml is possible from a finger 7-10 days after
disease
Section material
A. contents of a stomach 50-60 g reaction agglutination
B. a piece thin or thick intestine on 28-30 day for revealing fall of a credit of antibodies
C. a liver the first hours
D. blood of heart after section

THE APPENDIX 3

THE EMERGENCY NOTICE ABOUT FOOD POISONING

1. Diagnosis________________________________________________________________
2. Nameof ill person_________________________________________________________
3. Sex _______________________________
4.Age_________________________________________________________________
5. Address: the occupied item _________________________ area ___________________
street_______________________house___________________ Apartment _______________
6. Name and address of a place of work (study)______________________________________
7. Date:
disease_________________________________________________
Primary manipulation (revealing) _____________________________
Establishment of the diagnosis ________________________________________
Last visiting school, HIGH SCHOOL, place of work ____________
hospitalization________________________________________________
8. Place hospitalization_______________________________________________________
9. Where there was a poisoning, than the victim has poisoned
____________________________________________________________________________
10. Primary antyepidemic measure and additional data
_____________________________________________________________________________
11. Date and time of the primary notification about disease to SES _______________________
Name persons notified SES__________________________________________
Name post accepted the emergency notice ________________________
12. Date and departure time of the emergency notice _____________________________
Signature of the person sent the message in SES _____________________________
13. Date and time of reception of the notice by SES__________________________________
Registration № _________ In book № ______ SES __________________
The signature of the person sent the emergency notice _________________________
THE NOTE: It is directed in SES not later than 12 hours from the moment of an establishment of
the diagnosis.

THE APPENDIX 4

THE PLAN of REALIZATION of PREVENTIVE MEASURES

(In the given case of food poisoning)
 1. Realization of sanitary - educational work (to specify the forms).
2. Necessity of sanitary inspection of food object.
3. Necessity of inspection of the personnel of food object.
4. Necessity of withdrawal of products or closing of food object.
5. Measure on prevention of similar poisonings in home conditions.
6. Other measures.
The signature of the student ___________________________

THE APPENDIX 5

THE CHEME of the ANALYSIS of SYMPTOMS of DISEASE (FOOD POISONING)

1. Name ill person_________________________________________
2. Date, time of a beginning of disease, date of hospitalization ____________________
3. Basic symptoms: a nausea (+ -), vomiting, dyarrea, pain in the field of a stomach, temperature
of a body (0С), headache, general(common) weakness, symptoms at eyes, omission century,
expansion of pupils, dryness in a mouth, change of a vote, spasm, cyanosis, muscular pains, pain in
joints, grippe phenomenon, blood in excrement, pulse, arterial pressure, Changes of CNS.
The revealed symptoms are designated "plus" or "minus" is familiar, temperature in about 0C, is
underlined weight of disease (easy, average, heavy)
It is necessary to specify:
4. The name of manufacture or establishment, where the collection of tests, their address is
made.
5. Specification of sanitary - epidemic inspection:
- Date of a food poisoning;
- Term of occurrence of symptoms of disease after acceptance of suspicious meal;
- Description of the clinical phenomena at ill;
- Number of the injureds;
- Number hospitalized person;
- Presence of cases with fatal outcome;
- Preliminary diagnosis.
6. At presence of tests of several products it is necessary to specify, which of them is suspected
as the reason of a food poisoning.
7. Purpose of research:
- Establishment of the diagnosis;
- Last visiting of children's establishment, school, hospitalization;
8. Place of hospitalization.
9. If was poisoning - to specify, where there was a poisoning, than has poisoned.
10. Primary antyepidemic measure.
11. Date and time of the primary signal system about disease (telephone, telegraph) in SES. The
surname of the person, which has transferred the message. Who has accepted the message.
12. Date and time of sending of the notice. The signature of the person, which has sent the notice.
13. Date and time of reception of the notice SES, registration number in a magazine. The
signature of the person, which has received the notice.

The appendix 6.
CHEME of drawing up of the act of investigation of a food poisoning
1 Name of doctor, date of drawing up of the act of investigation.
2 Description of a beginning of disease
3 Clinical condition of the patient
4 Statement of the preliminary diagnosis
5 To specify amount of the persons using a suspicious product
6 To specify number ill person
7 To list a material sent for the laboratory analysis
8 To specify a place of the use of food, product.
9 To determine time past after reception of suspicious food
10 To determine, with what particularly product could become the reason of food poisoning
11 To make interrogation of the injureds with the purpose of revealing infringement
оrganoleptic properties of food
12 To specify a suspected product or place and date of its manufacture
13 To make the brief description sanitary state of object of manufacture or reception of food
14 To specify the name withdrawn product
15 To specify results of laboratory research of a product
16 To make the proved conclusion in case food poisoning
Theme: The hygienic requirements to the enterprises of public nutrition.
A technique of sanitary inspection of objects of public nutrition.

Actuality of a theme.
A urgency of the sanitary - hygienic requirements to the enterprise of public nutrition now
grows with the purpose of prevention of food poisonings, observance of rules of a storage of
products at these enterprises, control of a condition of health of the personnel working at it.
The purpose of training.
1. The acquaintance of the students with the hygienic requirements to the enterprises of public
nutrition. Acquaintance with statement of the sanitary control (in particular, behind a sanitary
condition of the enterprise) with the purposes of struggle with food poisonings. Acquaintance with
engineering and technique of realization of inspection and sanitary description of the enterprise of
public nutrition on an example of food shop. Inculcation of skills of realization of independent
inspections and drawing up conclusions and offers. To master the circuit and general technique of
sanitary inspection of object of the enterprise of public nutrition — food shop (restaurant).
2. Independent realization of the sanitary description of object of inspection under the offered
scheme with a spelling of the act of sanitary inspection.

The basic educational questions

1.Kinds of the enterprises of public nutrition
2.Sanitary requirements to the enterprises of public nutrition.
3.Hygienic requirements to a short-term and long storage of food products
4.Hygienic requirements to the personnel working with products of a feed

THE APPENDIX 1.
THE ACT OF SANITARY INSPECTION FOOD SHOP
Date ___________ 200_. Simferopol
1. Passport part
А) Who carries out inspection (surname, initials, post);
B) Together with whom;
C) At the presence of whom;
D) What object (name, subordination, address);
E) With what purpose (by way of scheduled or off-schedule inspection, preparation for work in
special conditions etc.).
2. General items of information on shop:
1) Type of shop (specialized, mixed, combined);
2) Principle of service (with the seller, self-service);
3) Number of workplaces;
4) Total working;
5) Business hours;
6) Accommodation (in a special building adapted, occupies a part of a building);
7) isolation from habitation etc.
3. Territory:
1) A site (independent, is not present);
2) Sizes, protection, gardening, covering;
3) Access roads;
4) Ways and regularity of cleaning territory;
5) Sanitary condition them at the moment of inspection.
4. Water supply and water drain (connection to common city network, local, its types).
5. Transport (what transport delivers products — kinds, presence of the specialized transport,
its condition, documentation, sanitary control, accommodation).
6. Container (amount of accumulating container for one day, its kinds, way of a storage,
condition).
7. Security by a refrigerating machinery: systems of refrigerating machineries and devices,
their capacity, accommodation, degree of security; serviceability; a temperature mode; correctness
of operation; a sanitary condition.
8. Sanitary - technical condition of premises(rooms) and equipment:
1) List of groups of premises(rooms) and set them in each group (warehouse, trade, administrative -
household, technical);
2) Condition of floors, walls, ceilings, windows, doors (serviceability, facing, plaster, colouring,
etc.);
3) Heating;
4) Ventilation;
5) Illumination;
6) Equipment and equipment ( cases, racks, shelf, pack for cabin of meat, carriage, chopping boards
and other trade stock — their serviceability, marks, ways of a storage etc.).
9. Sanitary condition of premises(rooms), equipment and stock:
1) Time and way of cleaning of premises(rooms);
2) Sanitary days (how many, when, their purpose(assignment));
3) Sanitary condition of premises(rooms) at the moment of inspection (web, dust, fly, cockroaches,
insects, etc.);
4) Contents of workplaces of the sellers (counter, under counters);
5) Gathering wastes (presence tanks with covers, their accommodation, timeliness of clearing and
disinfection;
6) Clearing, washing both disinfection of stock and equipment (ways of clearing
removed(allocated) place); the sanitary contents toilet rooms (ways of harvest(cleaning),
disinfection);
7) Stock for cleaning, its marks and storage.
10. Hygiene of a storage and sale of products:
1) Assortment (on groups);
2) Presence of the qualitative certificates and waybills with the instruction(indication) of limiting
term of realization of each product;
3) Maintenance of a separate storage of various kinds of products in appropriate conditions (correct
accommodation on warehouse premises(rooms) and inside them, observance temperature;
protection against solar beams, from adsorbtion of extraneous smells etc.);
4) Observance of target dates of realization of products (presence of products with the delayed
terms of realization);
5) High quality of products (presence at the moment of inspection of spoiled production and
products of the lowered quality — what, how many, defects);
6) Maintenance of separate sale of separate kinds of products (presence of departments, their
accommodation);
7) Observance of sanitary rules of holiday of products to the consumer (usage plugs, nipper etc.),
holiday in the appropriate packing, opportunity of pollution of products through money etc.;
8) Condition for preservation of cleanliness of products by the buyers (packing little tables for the
buyers, their contents);
9) The control of quality of products, giving to the buyer and in a warehouse (who carries out, as
frequently).
11. personal and industrial hygiene of the personnel:
1) Presence of a wardrobe, individual lockers for a storage of the top clothes;
2) Security by sanitary clothes (number of complete sets, носовые платки etc.), its contents,
condition for washing and storage. Presence of conditions for washing and disinfection of hands
(towel, soap, solution chloric, others disinfectants);
3) Cleanliness of a body and a linen;
4) Observance of the instructions for use by a toilet.
12. periodic medical surveys and inspections:
1) Regularity of passage and system of the account (percent not surveyed for last quarter);
2) Timeliness of inoculations;
3) Condition of the medical books.
13. sanitary education of the workers:
1) Timeliness of delivery and form of the account of a sanitary minimum (percent);
2) Knowledge by the separate persons of the basic questions of the program (to find out during
inspection).
14. a sanitary active. Presence of the public sanitary representatives (quantity(amount),
activity); sanitary posts (place of their work).
15. the conclusions (give the conclusion about a general sanitary condition of shop, the special
attention give to the noticed defects).
16. the offers (the ways of elimination of the established lacks, thus specify terms of
execution(performance), which whenever possible will coordinate to administration of shop).
17. the signatures.

THE APPENDIX 2.

TERMS OF A STORAGE AND REALIZATION ESPECIALLY PERISHABLE FOOD

PRODUCTS IN TRADE NETWORK AND ENTERPRISES OF PUBLIC NUTRITION
№ the name of products Terms of a storage and realization at temperature 4-80 C, hour
1. MEAT PRODUCTS
1. Meat in pieces (0,4-1,5 kg) 36
2. The meat forcemeat natural and frozen 16 (at temperature is lower 00 C 48 h)
3. Subproducts: - cooled - frozen 12 - 24
4. The pel'meni, semifinished items meat, cut (frozen) 24 (at 00 C no more 72 h)
5. Meat a bird: - cooled - frozen 48 - 72
6. Sausage, sausage from meat a bird 72 - 48
2. 2. A FISH, FISH PRODUCTS
1. Fish fried 48
2. Fish cooked 72
3. Fish stuffed 48
4. Fish smoked 72
5. Sausage fish 48
6. Fish oil 24
0
7. Paste “Ocean” at temperature –1 С no more than 72
3. 3. MILK And DAIRY PRODUCTS
1. Milk which is let out in tanks, flaskes and in bottles, packages 20
2. Cream and creamy drinks 20
3. Curdled milk, kefir, drinks from milk 24
4. Drinks from milk whey 48
5. Sour cream 72
6. Cottage cheese greasy, degreased soft, dietary 36
7. the ice-cream up to 5 days at temperature is not higher –15 0С

Algorithm of practical work of the students.

The first stage. Work above the tests of the control of an initial level of knowledge and skills
The second stage. Realization independent inspection of the enterprise of public catering
The third stage. Drawing up the act of sanitary inspection of object
The fourth stage. Decision of the tests and situational tasks on a theme.

Tests for the control level of knowledge

1. What is the basic principle of a lay-out of the enterprises of public nutrition
1. maintenance of hygienic conditions of preparation of food
2. convenience of a storage of ready production
3. convenience of realization of ready dishes
4. going of technological process
5. the sanitary - technical device of the basic premises(rooms)
2. What documents are necessary for the control of a sanitary condition of the enterprises of
public nutrition?
1. the waybills of the received products
2. a sanitary magazine of the enterprise, sanitary books
3. the plan - project of the enterprise
4. regular structure
5. the certificate of quality of products
3. What kinds of sanitary supervision behind the enterprises of public nutrition do you know?
1. sanitary - hygienic examination
2. precautionary
3. current
4. scheduled
5. universal, selective

Situational tasks
1. At check of the sanitary books of the employees of kitchen is revealed, that last medical
survey was carried out 3 months back. The analyses on bacteriological and gelmint research were
carried out 13 months back. At interrogation of the personnel is found out, that the cook N. had
been ill by follicularity quinsy. Your conclusions and further actions.
2. At inspection of a restaurant of high SCHOOL is revealed, that the boards for processing
products are not marked, are kept in lying position. Determine character of sanitary infringement.
3. At sanitary inspection of shop, at inspection of warehouse premises(rooms) it is revealed,
that the loose products (groats, sugar, flour products) in paper and linen bags were stored on a floor.
Specify the sanitary requirements to a storage of loose products in shop.
The standards of the answers:
1. Medical survey is carried out in time. The analyses on bacteriological and gelmint research
were carried out 13 months back, that is infringement of sanitary norms - the given analyses will be
carried out 1 time per one year. At the cooks N. It is necessary to take bacterial analysis.
2. The boards for processing various products should be marked and be stored in vertical
situation.
3. The loose products should be stored in warehouses on a floor with a flooring from a tree on
distance 8-10 sm from a floor.

Final lesson on hygiene of nutrition.

The basic educational questions to final lesson:

1 Subject and tasks of common hygiene. The basic methods of hygienic researches
2 State sanitary supervision in the field of hygiene of a feed, its kinds and examples of
realization
3 Methods of sanitary examination of food products and examples of their realization
4 Rules of selection tests of products for laboratory research. Classification quality food
products, examples
5 Hygienic requirements and sanitary examination of milk
6 Hygienic requirements and sanitary examination of bread and flour
7 Basic sections of hygiene of nutrition. The purpose and tasks rational, preventive, treatment
- preventive and medical nutrition
8 Norms of nutrition of the population and parameters which are taken into account at their
drawing up. Urgent problems of nutrition of the population of Ukraine in modern conditions
9 Classification alimentary and alimentary-caused diseases, role of the doctor in their
diagnostics and treatment
10 Classification primary alimentary diseases: examples, treatment and prevention.
11 Basic principles of a balanced diet of the healthy man.
12 Methods of check observance of principles of a balanced diet at the separate man and at a
feed of collectives
13 Iimportance proteins in nutrition. Attributes of full value of protein and examples various
on value proteins.
14 Irreplaceable amino acids for the adult: daily need, importance in nutrition, products –
suppliers.
15 Irreplaceable аmino acids for children: the representatives, role in оrganism, products –
suppliers.
16 Concept about protein norm and protein minimum, account protein minimum.
17 Protein problem and hygienic estimation ways of its decision
18 Importance fats in nutrition. Classification and hygienic characteristic of fat acids
19 Representatives and importance of the saturated and monounsaturated fat acids in nutrition
20 Polyunsaturated fat acids of families оmega-3 and оmega-6: the representatives, products -
suppliers, role in organism of the man
21 Phospholipids: the representatives, products - suppliers, role in оrganism
22 Cholesterol: the products - suppliers, importance in оrganism of the man
23 Alimentary antysclerotic factors: the representatives, products - suppliers, application in a
medical nutrition
24 Importance carbohydrates in nutrition. Importance unprotected (rafined) carbohydrates
Chemical and hygienic classification of carbohydrates
25 Hygienic characteristic and representatives of the basic groups of carbohydrates
26 Importance of the superprotected carbohydrates and pectin substances in nutrition.
Application it in a medical nutrition.
27 Importance vitamins in nutrition. Classification vitamins
28 Importance vitamin C, daily need, products – suppliers. Measure on preservation vitamin C
in ready food
29 Role vitamin D, way of receipt in оrganism, display avitaminosis on D its prevention.
Display and reasons of hypervitaminosis on D
30 Role vitamin A, products - suppliers. Displays avitaminosis and hypervitaminosis on
vitamin A
31 Role vitamins of group B, products - suppliers, display avitaminosis
32 Exogenic factors influencing need of оrganism in various vitamins and the account them in
a preventive nutrition of working
33 Endogenic factors raising need for vitamins and the account them in a medical nutrition
34 Artificial vitaminization of ready dishes and rules of its realization. The control of vitamin
value of a diet
35 Importance mineral substances in nutrition. Classification of the basic groups of mineral
substances and their importance.
36 Importance Са in оrganism, daily need, products - suppliers, condition of mastering
37 Importance Р and Mg in organism, daily need, products - suppliers, condition of mastering
38 Importance microelements in nutrition on an example Fluorine, Jodum, Iron. The reasons
and displays diseases, connected to changes it contents in nutrition.
39 Natural microelementosis: the reasons, classification, display and prevention
40 Anthropogenous microelementosis: the reasons, display and prevention
41 Concept about food poisonings, basic reasons of their occurrence and classification
42 Food poisonings microbe nature: versions, activators, pathogenesis, reason of occurrence
and prevention
43 Toxicoinfections: activators, products - sources, conditions of occurrence, clinical forms,
prevention
44 Bacterial toxicosis: versions, reason of occurrence, clinic and prevention
45 Staphylococcus toxicosis: products - sources, condition of occurrence, clinic and prevention
46 Botulism. Features of the activator, products - sources, pathogenesis, clinic, treatment and
prevention.
47 Food poisonings by poisonous mushrooms: the representatives, toxins, clinic and
prevention
48 Food poisonings by poisonous plants: the representatives, toxins, clinic and prevention
49 Food poisonings by products sometimes or partially poisonous: the representatives, toxins,
clinic and prevention
50 Food poisonings by zinc and copper: the reasons, pathogenesis, clinic and prevention
51 Food poisonings by lead, mercury: the reasons, pathogenesis , clinic and prevention.
52 Food poisonings by pesticides: the reasons, pathogenesis, prevention
52 Food poisonings by nitrates: the reasons, pathogenesis, clinic, prevention
53 Micotoxicosis: versions, reason of occurrence, prevention
54 Ergotism: the reasons of occurrence, toxins, clinical forms, prevention
55 Fusarios and alimentary-toxic aleykia: the reasons of occurrence, clinic, prevention
56 Aflotoxicosis: the reasons of occurrence, clinic, prevention. A problem aflotoxicosis in the
south of Ukraine and in Crimea
57 Food poisonings it is not enough investigated nature: versions, clinical displays
58 Tactics of the doctor of a medical structure at suspicion about a food poisoning
59 Rule of registration of the documentation in case of a food poisoning: the names, contents
and purpose of the basic documents
60 Hygienic requirements to the enterprises of public nutrition: principles of a lay-out, sanitary
documents, requirement to the personnel

Tests for the control of a level of knowledge

1. The milk can not completely satisfy need organism of child in:
1. phosphorus
2. manganese
3. iron
4. ftorum
5. cobalt
2. The order of realization of hygienic examination of products includes (to place under the order):
1. survey of a party
2. study of the documentation
3. definition organoleptic propeties
4. inspection of conditions of a storage
5. selection of tests for research
6. drawing up of the conclusion on a sample
7. laboratory research
8. development of measures on object
3. The sanitary doctor will carry out investigation of a food poisoning:
1. after reception of results of the bacteriological and chemical analysis of food
 2. immediately after reception of the emergency notice
3. from a beginning of the following behind the emergency notice of day
4. during 72 hours after reception of the notice
5. after decision of the diagnosis by laboratory of hospital

Situational tasks
1. The man 42 years, has almost 20 year diagnosis of alcoholic dependence. He was delivered in
clinical hospital by the friends in half-sleep condition in connection impossibility him to wake.
From words of the friends some hours back patient used plentiful amount of food. Objectively: the
patient is exhausted. At survey the sharp restriction of movement of eye apples and ataxia hands is
revealed. Deficiency what nutrients can be the most probable reason of the described condition of
the patient.
2. In Japan at the use in food a fish there is an illness Minamata. To what chemical connections this
illness is connected?
3. In the occupied item К., after failure on Chernobyl atomic station and till the present time the
level of radiation 16-20 mR\h is registered. What recommendations you can offer for rationalization
of a feed and prevention action radiation on the people living in the given occupied item.

The standards of the answers:

1. Vitamin B1 (tiamin)
2. Connections of mercury
3. To increase in a diet amount of protein, products, rich cellulose, pectin substance, Ca, K,
selenum, vitamins.

Sources of the information.

The basic literature:
1.I.I.Даценко, Р.Д.Габович. Профiлактична медицина. - Київ, Здоров'я, 1999.- 694с.
2.В I.Ципрiян та ін. Гiгiена харчування з основами нутрiциологii. Київ, Здоров'я 1999.- 56 0
3.Р.Д.Габович и др. Гигиена.-Киев,1983.- 320с.
4.Ю.П.Пивоваров. Руководство к лабораторнім занятиям по гигиене. Москва, 1983.- 254с..
5.Lectures on common hygiene and ecology.Simferopol. 2003. 130p.
6. Park’s textbook of Preventive and Social medicine. India, 2000.- 16-th edition. – 660p.
7. Руководство к практическим занятиям по общей гигиене и медицинской экологии. / Под ред. Проф.
С.Э.Шибанова. – Симферополь, 2003. – 260с.
The additional literature:
1.Е.І.Гончарук. Загальна гiгiена.- Київ, “ Вища школа ”.-1995.- 652с.
2.В.А.Покровский. Гигиена. Москва “ Mедицина ”.-1979.- 495с.
3.В.Д, Ванханен и др. Гигиена питания. -Київ “ Здоров'я.- 1980.- 353с.
4.А.А. Минх. Методі гигиенических исследований.- Москва “Медицина”.- 1971.- 584с.
5.К.С.Петровский. Гигиена питания.- Москва: “Медицина”, 1975.- 400с.
6.Г.И.Румянцев. Гигиена.- Москва, 2001.- 608с.
7.Норми фізіологічних потреб населення України в основних харчових речовинах і енергії.-
Київ, 1999.- 9с.