Environment&Health (Dovkillia ta zdorovia)

4-11

Authors: СЕРДЮК А.М., СКАЛЕЦЬКИЙ Ю.М., РИГАН М.М.

Objective: The aim of the work was to draw attention of the community to the problem of potentially preventable harm to the patients in health care institutions and to determine the main directions in the formation of the system for provision of patients’ safety. Material and methods: We performed the analysis of the international experience and the best practices of separate countries on the creation of a safer health care system for the patients. We studied a regulatory framework of the Ministry of Public Health of Ukraine on the formation of the quality management system for medical care. One of its main tasks is to ensure the safety of medical services. We evaluated the state of patients’ safety in domestic hospitals. Results and discussion: It was established that, at the political level, there was a lack of attention to the problem of patients’ safety, ignoring of the international experience and the experience of separate countries in prevention of unintended harm to the patients, underestimation of the risks of the processes of health care system reform to the patients’ safety, which led to a multiple increase of the in-patient mortality in recent years. To a large extent, this is due to a rapid increase in the level of postoperative mortality (in separate public health institutions 30 and more times greater) and, as a result, there is an increase in the risk of death of the adult population during in-patient medical care from 1.0 • 10-2 to 1.4 • 10-2. In domestic hospitals, the prevalence of indictment culture with an emphasis on the punishment of medical workers who made mistakes in providing of medical care, rather than a search of the root causes of the problem, has been revealed. Directions, approaches and tools for the prevention of the defects in medical care and their consequences have been proposed.

19-25

Authors: ДОБРЯНСЬКА О.В., ВОЛОЩУК О.В.

Objective: We determined a role of self-appraisal in health formation of people of different age. Materials and methods: We applied sociological, psychological and mathematical methods in the work. We developed the health self-appraisal questionnaire. The respondents of different age were surveyed. The integral indicators (health self-appraisal index) for the assessment of subjective component of health were used. Results: Health self-appraisal of people of different age is different: the highest health rate was noted in young people (under 25 years old). In a mature age group, the self-appraisal of health among women was higher in comparison with men. We determined the increase of self-appraisal of health in men older than 61 years in contrast to women of this age who had its decrease. In women aged 25-44 years, the integral index of health self-appraisal was characterized with low criteria. And it was evaluated with high criteria in elderly people irrespective of gender. Conclusions: At the health assessment of people of different age, it is very important to take into account its subjective component. Low self-appraisal of health is a risk factor for the formation of unhealthy forms of behavior among both young and elderly and old people, which means a need to determine the psychological state of the respondents with disabilities in self-appraisal.

34-39

Authors: ГУЩУК І.В., ГІЛЬМАН А.Ю., КУЛЕША Н.П.

Objective: We presented a socio-hygienic assessment of the state and dynamic changes in the demographic situation, incidence and prevalence of diseases among the population of the Rivne region. Materials and methods: Analysis of the incidence was performed on the basis of the data collected in 16 districts, the oblast center and 2 cities of oblast significance over 2013-2017. In the study, we used epidemiological and medico-statistical methods. Results: The systematization and analysis of main data, characterizing the demographic situation in terms of fertility, mortality and natural population growth of the oblast have been carried out. In the context of all regions and 3 cities, the state of general morbidity and mortality in the oblast has been studied by main nosological groups of NCD and the incidence of tuberculosis. The data have been systematized and analyzed in the context of the corresponding age groups of the adult and children's population. Conclusion: In the region in 2013-2017, the birth rates had a steady tendency to decrease from 15.1 in 2013 to 12.4 in 2017. There is an increase of the mortality in children born alive aged under 1 year by 5.2%, which indicates the need to improve the quality of medical care in maternity hospitals. As in previous years, diseases of circulatory system, respiratory system, endocrine system, blood-forming organs and neoplasms are the most common ones among the population of the oblast. By nosological groups in the mortality structure, mortality of circulatory system diseases takes first place (72.4%), of neoplasms takes second place (13.9%), of injuries and poisonings - third place (5.1%), of diseases of digestive system - fourth place (3.1%), of respiratory diseases - fifth place (1.6%).

48-55

Authors: ЛОТОЦЬКА О. В., ПРОКОПОВ В.О., КОНДРАТЮК В.А.

Objective: We analyzed the effectiveness of the barrier function of current technologies for the preparation of drinking water from the Dnister River and its tributaries, assessed its quality for compliance with sanitary requirements and evaluated the current schemes of water treatment and the quality of drinking water obtained from underground sources for centralized drinking water supply to the population in the Western region of Ukraine. Methods: We applied methods of analysis, hygienic monitoring, synthesis, generalization and bibliographic, comparative, descriptive ones. Results and conclusions: The water supply of the oblast centers of the western region of Ukraine was established to carry out at the expense of both surface water (Chernivtsi and Ivano-Frankivsk) and underground sources (Lviv and Ternopil). Unlike river sources, in the pipelines from the underground sources, the complex multi-stage water treatment technologies are not used because this water is much cleaner than surface water (maximum it is chlorination due to the long distances of water transport from the source to the consumer). For the production of drinking water from surface sources the traditional technological schemes are used, they consist of the following stages: water intake → reagent treatment of river water with flocculant and coagulant → settling and filtration through a quick filter → disinfection → clean water tank → water-supply system. Although, according to the expert opinions that water treatment of surface water requires more modern methods, drinking water is taken from the Dnister River or its tributaries in the Western region of Ukraine. This water is now estimated as clean or slightly contaminated for most indicators. As a result of performed measures, the population receives water, which, according to its indicators, complies with the State Sanitary Regulations and Standards 2.2.4-171-10 "Hygienic Requirements for Drinking Water Intended for Human Consumption". Considering that the main river-bed receives the pollution from the tributaries and the catchment area, it can be contended that the quality of surface water depends on the ecological state of the Dnister River basin and the degree of its pollution.

64-75

Authors: ЧЕРНИЧЕНКО І.О., БАЛЕНКО Н.В, ЛИТВИЧЕНКО О.М., БАБІЙ В.Ф., ГЛАВАЧЕК Д.О., КОНДРАТЕНКО О.Є.

Background: Nowadays prostate cancer (PC) is the second most common malignant neoplasm in males worldwide. The etiology of prostate cancer is multifactorial. The chemical environmental pollutants, including endocrine disruptors (ED) with hormonal properties, are suggested to be one of the factors which increase the PC incidence. Objective: We analyzed the literature data relating to the effect of the chemical environmental pollutants on the organism and their role in the formation of the PC incidence. Results: Despite a relatively small number of epidemiological studies, their analysis indicates an association of the risk of the development of PC in males with the exposure of the number of pesticides, polychlorinated biphenyls, dioxins, bisphenol A (BPA), phthalates, nonylphenol, and also some metals (cadmium) with known estrogenic properties. Although the mechanisms of PC induction by chemical compounds are different and not fully understandable, it is assumed that they are based on estrogenic, androgenic and anti-androgenic activity and violation of signaling ways of estrogen and androgen. The previously known typical properties of the ED effect: the critical significance of the exposure in the early (embryonic and neonatal) period of the PG development in the increase of sensitivity to carcinogenesis and increase of PC risk at aging; non-monotonous dose-response relationship and the manifestation of harmful effects at low doses’ level equivalent to human exposures were confirmed experimentally as an example of BPA. The identification of stem cells and progenitor cells of differentiated epithelial cells in the gland of developing animal and PG of the adult ones is a new achievement. Epigenetic reprogramming of these cells at the exposure of ED in the early period of PG development and their key role as a direct target in the development and increase of PC risk during aging of animals was shown. It is extremely important to obtain the similar data at the humanized PG model, created by means of xenotransplantation of normal human stem cells and PG progenitor cells to the rodents, which allows us to study the direct effect of ED on the human PG. In general, the results of the analysis demonstrate that PC is an urgent environmental-hygienic and social problem, requiring further research and solution of the issues related to the protection of the population from the harmful effects of the environmental chemical pollutants.