PHYSICAL DEVELOPMENT AS IMPORTANT A nCRITERION OF ESTIMATION OF THE STATE OF CHILDREN nAND ADOLESCENT HEALTH. HYGIENIC ESTIMATION OF ORGANIZATION AN EDUCATIONAL-EDUCATE PROCESS IN nPRESCHOOL ESTABLISHMENTS AND AT SCHOOL.

THE ASCERTAINMENT OF A 6-YEAR-OLD CHILD nREADINESS FOR SCHOOL STUDIES

 

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

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

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

Objects of the children’s and nadolescents’ hygiene:

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

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

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

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

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

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

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

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

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

At the influence of the rational education in the nchild’s organism the protective function and function of adaptation to ndifferent external influences and changable conditions of the environment are ndeveloped.

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

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

  Guaranteeing by the rational closes, nfurniture and apparatus

 Systematic physical exercises

  Massage

  Steel

Systematic control by the ninfants’ physical development – necessary condition of their rational neducation.

TRAINING INSTRUCTION

on complex assessment of children’s and adolescents’ nhealth

 

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

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

     Presence or absence nof chronical diseases during examination;

     Functional state of nmain systems of organism;

     Level of organism nresistance to unfavourable influence of environemntal factors;

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

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

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

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

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

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

Fifth health group includes children and adolescents suffering from chronic diseases idecompensation stage with significantelly lowered funcional resources nof organism.

morbidity rate

years old

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

 

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

Table 1

Patterns of rank distribution of diseases in different nage groups

 

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

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

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

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

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

Sanitary (health–improving) factors are the follwoing:

     rational regime of ndaily activity;

     adequate and nbalanced nutrition;

     correspondence of nenvironment to hygienic standards;

     optimal motor nactivity;

     tempering;

     healthy lifestyle and nfollowing of the everyday hygienic rules.

Unfavourable (risk factors) are the following:

     disturbances in day nregime, educational process;

     disadvantages iorganization of nutrition;

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

     insufficient or nexcess motor activity;

     unfavourable npsychological climate in family and collective;

TRAINING instruction

on assessment of physical developent of children and nadolescents

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

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

 

Fig. 1 Main types of bearing

(а – nlordotic; b – kyphotic; c – correct; d – stooping; e – erect)

                                                                                                                                     n              (1)                                               (2)

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

and main types of scoliosis (2)

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

а –thorax right-side; b – total lift-side; c – S–shaped)

Fig. 3 Forms of lower extremities

(а – nnormal; b – X–shaped; c – О–shaped)

                                                   

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

Fig. 4 Special anthropometric points

а –lateral view: 1–  apical; 2 n–  glabella; 3 –  occipital; 4 –  upper thorax; 5 –  styloid; n6 –  terminal; 7 –  calcaneal;b – frontal view: 1 –  apical; 2 n– parietal; 3 – glabella; 4 – nchin; 5 – upper nthorax; 6 – middle nthorax; 7 –  shoulder; 8 –  radial; 9 – nstyloid; 10 –  finger; 11–  upper crus; 12 – nlower crus; 13 –  trochanteric; 14 – pubic.

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

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

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

Medical nscale is used for the body nweight measurement.

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

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

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

Assessment of physical development using method of nsigmal deviations

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

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

Deviations from –1σ to +1σ mean average development of this index, from –1.1σ to –2σ – development is below average, from –2.1σ  and below – low, from +1.1σ to +2σ – above average, from +2.1σ  and high – high.

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

                            –3σ     –2σ      –1σ        М       +1σ     +2σ    n+3σ       

Fig. 5 Profile of physical ndevelopment

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

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

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

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

Table 2

Data of individual assessment of physical development

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

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

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

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

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

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

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

Assessment of physical development using regressioscales

Usage of method of assessment of physical development using regression scales allows to overcome the main disadvantage of method of sigmal deviations – separate character nduring assessment of each somatometric index. In this case tables for nassessment include correlation between height, body weight and chest girth. This correlation allows to give more nsubstantiative assessment of physical development taking into account ninterconnected indices.

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

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

Physical development may be:

          harmonic, if determined individual indices of body weight and chest ngirth circumference have values М±1σ_R;

          disharmonic, if determined individual indices of body weight and chest girth have values from М–1.1σ_R to М–2σ_R or from М+1.1_R to М+2σ_R due to nincreased fat deposity;

          sharply disharmonic, if determined individual indices of body weight and chest ngirth have values from М–2.1σ_R and low nor from М+2.1σ_R and high ndue to increased adipopexis.

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

Fuethermore, this type of examination can determine one from four groups of physical dvelopment for this child: normal physical development – if body weight is from М–1σ_R to М+2σ_R; body weight deficiency – if body weight is nlower than М–1.1σ_R; body weight excess– if body weight is nmore than М+2.1σ_R; low height – if body length if nlower than М–2σ.

 

Assessment of physical development using complex method

 

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

Table 4

 

Assessment criteria of physical development of children and adolescents

(using complex method)

 

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

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

          harmonic, if determined body weight and chest ngirth values are М±1σ_R or from М±1.1σ_R and functional nindices have deviations from –1σ  and more;

          disharmonic, if determined body weight and chest ngirth values are from М–1.1σ_R to М–2σ_R or from М+1.1σ_R to М+2σ_R due to body nweight deficiency or increased adipopexis and functional indices are from –1.1s to –2s;

          sharply disharmonic, if determined body weight and chest ngirth values are from М–2.1σ_R and low or from М+2.1σ_R and more due to body weight deficiency or increased fat deposity and nfunctional indices are from –2.1s and nlower.

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

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

 

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

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

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

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

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

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

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

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

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

The values of examined girl must be the following: body length – 142.8±7.1 cm, annual body length increase – 6-8 cm, 21±3 permanent teeth, secondary signs of sexual development – Ма₁. Р_0.1. Ах_0.1 according to the standards of biological development for 11 years old girls. In our nexample, indices of this girl’s biological development correspond to standard nvalues. It means that level of biological development corresponds to nchronological age.

Then assessment tables according to regression scales (table n8) are used for assessment of physical development. According to the table data nthis girl’s height corresponds to average, her physical development according nto the body length is average. Next step – using values of sigma–regression to find values of body weight and chest girth which this girl must have according to her height. According to the regression scales tables data body weight has to be 40.4 kg, sigma regression (s_R) – 5.37 cm for 11 years old and 148cm height girls. Difference between actual and standard values is 37 – 40.4 = –3.4; value of the sigma regression deviation is –3.4 : 5.37= –0.63s_R. These data reveal that this girl has harmonic development naccording to the body weight comparing to the height.

Correspondence of chest girth to nbody length of this girl is calculated in the same way. Chest girth has to be 70.7 kg, sigma-regression (s_R) – 4.92cm for 11 yeas old girls with 148 cm. Difference between actual and standard values is 71 – n70.7 = 0.3; value of sigma–regerssion deviation is 0.3 : 4.92= 0.06s_R. This nmeans that physical development of this girls is harmonic according to the nchest girth comparing to her height.

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

 

Assessment of physical development using centile method

 

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

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

For determination of physical development level 7 fixed centiles are used: 3^rd, 10^th, 25^th, n50^th, 75^th, 90^th and 97^th and ncorresponding 8 centile intervals:

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

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

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

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

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

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

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

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

 

TRaiNING INSTRUCTION

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

 

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

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

t =  ;

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

  m₁ and m₂ – errors nof mean arithmetic–weighted values.

Assessment of Student’s test (t) includes the following parameters: if t value exceeds 3, than differences of mean values are valid (p<0.05), if t value does not exceed 3 – differences nbetween mean values are invalid (p>0.05).

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

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

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

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

For nbody length:                   t =  =  = 5.6;

For nbody weight:                  t =  =  = 1.3.

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

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

Validity nof differences is calculated according to the following formula:

t =  ;

where: Р₁ – number nof children n(%) in first ncomparative collective;

Р₂ – number nof children (%) nin second ncomparative collective;

m₁ – error nof Р₁;

m₂ – error nof Р₂.

Error nof percentage of children is calculated according to the nfollowing formula:

m₁ =  ;

where: m₁ – error nof Р₁;

Р₁ – number nof children (%) nin first ncomparative collective.

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

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

Preschool nage includes fourth – sixth years of the life.

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

School age, as a rule, is the period of nthe education. They are different four stages of the school age: younger – to n10-12 years, middle or adolescent – to 14-15 years, earth youth and sexual npuberty.

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

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

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

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

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

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

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

Systemic nstock of health’s state and physical development of children and adolescent nhave the various meaning.

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

Maiconformity with the low of physical development of the children and adolescent:

Maiconformity with the low of physical development of the children and adolescent:

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

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

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

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

d)          nthose who fall behind in age necessarity in motor and static functions, have ndefect of the speach, carriage, deformations of the chest, of the vertebral ncolon, of the pelvis, of the  knee joins, nflat-foot, defects of the teeth system, sings of the hypovitaminosis, decreased nquantity of erythrosites and decreased hemoglobin in the blood, discordance ithe pulse and arterial pressure, other early deviation in physical development ncourse.

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

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

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

The main measures are:

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

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

3)          nusing of the natural powers (light, air, water) and synthetic springs of the nradiation,

4)          nRational nutrition.

5)          nFavorable hygienic conditions of surrounding, accordingly clothes, furniture, nand accommodation too.

6)          nInuring habits of personal hygiene.              n

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Concerning optimal duration of the nlesson was proofed on the practice -45 minutes. In a school for children with npsychological, neurological or rheumatic diseases optimal duration of the lesso40 minutes.  As a measure, which promote nand safe capacity of the work, is important organization and structure of nlesson, especially in junior forms, volume and features of home work. The nspecial investigation shows that maximal capacity of the work coincide  with  nsuch days as Wednesday, Tuesday ;minimal capacity of the work coincide nwith Saturday. Concerned  oscillation of ncapacity of the work during  the day, npeak  coincide with 2 and 3 lesson, nminimum coincide with 5 and especially 6 lesson. First lesson, obviously,  is period of accustoming for studying. So, nsubjects which need more intelligent efforts and are not obvious, for example nmathematics, foreign languages more effective teach on second and third lessons.

Investigatioof different authors proofs that physical working for schoolchild is variety of nactive rest. It improves quality and speed of simple psychical and according nverbal reactions. Special investigation express that lesson of hand working, ischool working classes and lesson of physical training improve capacity of the nwork not only after that lessons, but after nthis school day. Most effective when schedule includes such lesson in Monday, nThursday, Friday; on the third lesson in junior forms; on the forth lesson isenior forms.

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

Working training, in favor hygienic nconditions, in combination    with mental nactivity increase the brain tone and develops muscular system: improves ndifferentiating in moving analysator; coordination of hands; increase the nmaximal muscular effort; endurance to static muscular effort.

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

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

1.          nMoving activity during interruption between lessons;

2.          nBeing pupils on fresh air during interruption, fresh air favor and promote nquality of air surrounding and microclimate in class rooms and corridors of nschool buildings, because improve  nthrough-ventilation of school accommodations.

3.          nRemoving over activity  of pupils during ninterruption, for example games such as football, basketball. In  this case  nperiod of accustomation  to nstudying  will increase on beginning of nthe next lesson.

4.          nUsing third or  forth interruption for norganization warm eating for pupils .

5.          nOptimal duration of interruption.

Observatiofor effectiveness of interruption show, that duration of interruption don’t nmust  be less then 10-15 minutes.

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

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

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

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

3.          nSystematic check from tutor and  school ndoctor for volume of home work.

During npreparing of home work, through each 40-50 minutes ought to do  10-minutes  ninterruptions, for active moving on the fresh air or in accommodatiowith opened windows. 

Situatioof studying institutions  for teenagers nand children is caused by rational combination of such two principles:

1.          nSupplying of studying institutions  for nteenagers and children for optimal microclimate, fresh air, high level of nsocial and sanitary facilities, far from city noises too.

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

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

Ground nplot of studying institutions  for nteenagers and children- the base for  nsanitary benefits. They must be entire structure, be defended not only nfrom  fabric or street noises, but from ncontamination of air and soil too. Sonority of noise must not be over then 40 ndecibels. For additional defense of studying institutions  for children from noise and dust, it must be nsituated  in center of area  on 20-30 m. and, at any rate,  not less then 15 m. from red line of nbuilding.

TECHNIQUE of nANTHOPOMETRICAL MEASUREMENTS

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

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

      Measurement of growth nsitting. Surveyed sits on a bench rostomer, nconcerning its rack interscapular narea and nbuttocks. Position of a head such, as at measurement of ngrowth standing. Legs are bent in knee joints under a right angle. A foot lean about a floor or a support. Hands lay along nhips.

   Growth standing or sitting can be measured nalso metal antropometr which consists of four empty tubes. Being are inserted none into another, they form a bar in length of 2 m with millimetric divisions. nOn the end of the top tube motionlessly muphta with na metal ruler, the second mupht with incisura through which divisions are nvisible, freely may move on a bar antropometr. The ruler is inserted into this mupht by the oblique end up.

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

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

Definition of body weight.

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

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

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

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

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

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

Examining nin front and sideways looks in regular intervals advanced in the top and bottom ndepartments, underthoracical nthe corner nshaped forms and on size comes nearer to 90 °. The chest cage of the conic form nhas more

Bottom department wide and acting forward icomparison with top. Underthoracical corner big, more than 90 °. The flat nchest cage usually has lengthened form; underthoracical  corner is narrowed and, it less tha90 °. At younger age frequently there are mixed forms of a chest cage. May to nbe combined rachitic and it is rare forms.

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

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

The nform of legs.

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

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

The analysis of a print nstops.

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

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

Estimatioof a degree of puberty.

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

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

Hairing naxillary nhollows (Ah)

Ахo – hairing  is absent;

Ах1 – individual hair;

Ах2-The rare hair located on small ncentral

 Site of an axillary hollow;

Ах3 – the rich direct hair located oall surface

Axillary nhollow;

Ах4 – rich twisted hair.

Pubical n hairing (Р)

Р0- hairing is absent;

Р1 – individual hair;

Р2 – the smooth hair located on the ncentral pubis site;

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

Р4 – the rich, twisted hair in regular nintervals located on all

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

Development dairy glandula(Ма)

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

Some niron does not give out;

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

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

dairy iron it is a little bit raised;

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

                              Ма4 – dummies rises above overnipped a circle, dairy iron it is ngenerated.

Person’s hairing (F)

F0- nhair is absent;

F1 n- beginning hairing above a upper nlip;

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

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

Growth nof whiskers;

F4 n- clear merge of hairing  nzones above na upper lip and

Areas nof a chin with the tendency to submaxillary hairing

The areas, the expressed growth of whiskers.

Development nof a thyroid cartilage of a throat – adam’s apple (L)

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

L1 n- small  thyroid ncartilage of a throat;

L2 – distinct extraposit.

Mutations of a voice (V)

V n- a children’s voice;

V n- a voices mutation;

V n- a man’s timbre of a voice.

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

       Muscular nforce of hands determines a manual dynamometer.

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

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

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

Stature and development of child are not only nsimple increasing of sizes and weight of the body. It is complete complex of ndeep quality changes that are showot only in morphological changes but also nin progressive development of its functional abilities. Modern practice of the ndynamic stock of the children and adolescents’ health includes the examination of nthe physical development as necessary element of the examination.

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

As a result of statistic analysis the health’s nstate data and physical development of children form adequate indexes nthat are used by the doctors in marking of individual physical development of nchildren and adolescents (the so called “standarts”). Studying of nthese indexes gives the possibility to orientate in the nchanges of physical state of children’s population and roles of different nfactors that cause these changes. Analysis of dynamic examining of the physical ndevelopment of children gives the possibility to form the mairules of growth and development of children.

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

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

Measuring nof height

a.     nstanding, by wooden heightmeter

b.      sitting, by wooden heightmeter

c.      nstanding, by antropometer

 

Scheme nof plantography evaluation

a.                                  nnormal     b. flattened           c. flat

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

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

2.      Especially nworth the physical development of children and adolescent during the nwar and hunger.

3.      The nwhole organism and its parts grow unevenly.

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

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

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

7.    Course nof the development is shown in processes of moving development, nbonding, terms of teeth’s appearance and in process of sexual development.

8.      Infectiodiseases (malaria, tuberculosis, helminthes invasions), long lasting somatic ndisorders, which cause the damages of substances changes, ndamages of digestion (rachitis, diabetus melitus, thyreotoxicosis, nhypothyreosis, kidneys’ disease, liver’s diseases, blood’s ndisorders), damaging of central nervous system have great influence on the nphysical development.

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

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

Valuation of nphysical development by sigmal method.

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

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

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

Processing nof antropometric factors

Result of research is brought to the table. Icolumn 1 idecreasing or increasing order are brought values of growth, weight of nthe body and volume of the thorax, which is met nin given group and it is marked by letter ‘а’.

In another column (‘p’) we can put the number of nthe accidents with 1 value of sign. In third column (‘m’) we write the middle nmeaning which is defined by multiplying a nand p and dividing oumber of sign (‘n’). Icolumn 4 we calculate declination of each of variant nfrom the middle (M) and mark in column 5 – each deflection is taken to the square n(d²) and multiplied to the frequency of variant (p) and divided onumber of accident (n) and mark the middle square:

δ =Σ d² nx p/n.

The way of dividing d/δ none can find the sigmal decline, which shows the number nof sigma on which deflect the factors of child’s research from the middle sign. nThe profile of physical development of child is estimated by means of sigmal nmeanings.

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

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

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

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

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

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

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

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

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

Hygienic demands to the regime of school day include nsuch aspects of school upbringing: schedule of the day, rational organizatioof time after lesson, rational integration of physical and mental activity, norganization of  home nworking preparing.

Systematic investigation of different authors by nusage of direct and mediocre physiologic, psychological, pedagogical methods nshowed typical dynamic of mental activity of schoolchild during common school nday.

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

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

Investigation of different authors proofs that nphysical working for schoolchild is variety of active rest. It improves quality nand speed of simple psychical and according verbal reactions. Special investigation express that lesson of hand working, in school nworking classes and lesson of physical training improve capacity of the work nnot only after that lessons, but after this school day. Most effective wheschedule includes such lesson in Monday, Thursday, Friday; on the third lessoin junior forms; on the forth lesson in senior forms.

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

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

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

1.Moving activity nduring interruption between lessons;

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

3.Removing over nactivity of pupils during interruption, for example games such as football, nbasketball. In this case period of accustomation to studying will increase obeginning of the next lesson.

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

5.Optimal duratioof interruption.

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

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

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

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

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

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

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

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

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

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

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

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

 

READINESS TO LEARN AT SCHOOL. TEST THE nKERN-JIRÁSEK.

1.Medical criteria:

            –     the level nof biological development;

–         health condition at the examination moment;

–         acute illnesses within the last year

1.1.The nlevel of biological developmenmt.

   The most accurate ncharacteristics of the biological age is the nstage of skeleton differentiation (skeleton age). However, the usage of that nmethod is restricted because of the danger of excessive roentgenologic nexaminations. That’s why the biological age is determined by the measuring of nbody length (with the help of sigmatic deviations method), yearly body length nsurpluses, the substitution of deciduous nteeth with permanent ones.

1.2.Health ncondition assessment.

   The most basic criteria for health condition assessment are as follows:

a)  level of nthe functional condition of main organism’s systems;

b) chronic diseases npresence or absence at the moment of examination ;

c) degree of norganism resistibility to unfavourable actions;

d) level of ndevelopment achievement and its harmony degree.

   Five health groups are ndistinguished as regard the indices of physical development and illness level. nAll criteria characterizing the child’s health are to be taken into nconsideration while determining a health group. Such complex assessment is nperformed at the examination moment, and acute illnesses are not considered. nThe organism resistibility is evaluated per number of acute illnesses and exacerbations nof chronic diseases within the last year.

2.       Psychophysiological ncriteria.

   Psychophysiological examination of children is performed for revealing nthe lag in the development of indispensable school functions: motor, analytic nand synthetic functions of cerebral cortex (Kern-Iraseque’s test and narticulative-vertibular tests (articulation quality)).

2.1.Kern-Iraseque’s test. This is an oriented test of “school maturity”; it is performed with one nchild or a group of children ( 10-15 children.) nThe test contains three tasks: a picture of a human being (a man), copying a nshort phrase of three words (“he ate soup”), copying a ngroup of dots.

   The first task is accompanied with a following ninstructions: “here please draw any man how you can”. There are no other nfurther explanations for this task. For the fulfilment of other two tasks the nreverse side of the paper sheet is used which is beforehand divided in half nwith a horizontal line.

   The second task presumes nthe copying of a short phrase of a type “he ate soup” from a special card. The nvertical dimension of letters on the card should be 1 sm and the first capital nletter – 1,5sm high. The second task is accompanied with the following task: n“Please have a look, there is something written here. You can’t write so far, nso please try to copy this; please have a good look how this is written and nplease copy that in the upper part of the sheet (show where”.

   The third task of the noriented test of school maturity presumes the copying by a child of a dots ngroup which is drawn on a specific card with 1sm distance between the dots nalong vertical and horizontal lines; the diameter of each dot should be 2mm, nand with a pentagon formed by dots with an acute angle directed down. The nfollowing instruction is added: “There are dots drawn here. Try to draw the nsimilar ones in the bottom part of the sheet (show where)”.

 

   

 

Fig.1.

RESULTS EVALUATION. Each task is ealuated from 1 (the best mark) up to 5 (the worst nmark) points.

 The picture of a man (fig.1)

1 point – the drawn figure should have a nhead, a body, extremities. The head and the body nare connected with a neck (it should be not larger than the body). There should nbe hair on the head (a hat, a cap are possible); ears; on the face – eyes, a nnose, a mouth. Upper extremities end with a hand with 5 fingers. The signs of male clothing.

2 points – the fulfillment of nall requirements as for the evaluation for 1 point. The absence of three body parts is acceptable: a neck, hair, one nfinger of a hand; but the absence of any part of the face isn’t acceptable.

3 points – The drawn figure should have a nhead, a body and extremities. Legs and arms are to be drawn with two lines. A nneck, ears, hair, clothing, hands fingers and feet may be absent.

4 points – a primitive picture nof a head with extremities. The extremeties (one npair is acceptable) are depicted with one line.

5 points – there is no clear picture of a nbody and extremities. Scrawls.

Copying of a written text. (Fig 2.)

 

 

1 point – the copied phrase is readable. nThe letters are not than double large as the origin. The letters form 3 words. nThe line is enclined from the straight line for not more than 30%.

2 points – The sentence is readable. The nsize of the letters is close to the origin, their symmetry is not obligatory.

3 points – The letters can be divided into nnot less than 2 groups. At least four letters can be read.

4 pointds –At least two letters are nsimilar to those in the original. The whole group still resembles the writing.

5 points – Scrawls.

 

 

Copying a dots group (fig.3).

 

1 point – the accurate ndepicting of the origin. Dots are drawn, not ncircles. The figure symmetry is preserved both along horizontal and vertical nlines. Any diminution of the figure is accepted, but the enlargement may be nacceptable if it is not more than half as large as the origin.

2 points – some not important violation of nthe symmetry: one dot may be behind the margins of columns or lines. The ndepicting of circles instead of dots is acceptable.

3 points – The dots group hardly resemble nthe origin. The eventual violation of the whole figure symmetry is possible. nThe view of a pentagon is preserved, it is ndirected with its top up or down.

4 points – The dots are drawn all ntogether, their grouping may resemble any geometrical figure. The dimensions nand quantity of dots do not matter. Other pictures, as e.g. lines, are not nacceptable.

5 points – scrawls.

 

   Each task is evaluated nin points from 1 (the best mark) up to 5 (the worst mark). The sum of the nresults of tasks fulfillment makes the examination result.

2.2.Articulative-vertibular ntest (sounds articulation quality).

   To define the quality of the articulation, a child is proposed to nenumerate aloud the objects in a picture., the nnames of which contain sounds relating to the following groups:

1)     resonant sounds: “R” (hard and soft)

                                “L” n(hard and soft)

2)     sibilant sounds :  “S” (hard and soft)

                                “Z” n(hard and soft)

3)     harshing sounds:  G, SH, CH, SCH.

   The pictures are to be nchosen in such way that each of the mentioned sounds is at the beginning, ithe middle and at the end of words, e.g.:

 cancer – nbucket – naxe                       jackrabbit n–she-goat-cart

  riwer –mushroom n– nlantern            winter n– newspaper – hero

  showel –squirrel n– ntable                   calico– nbeads -ear

  watering ca– deer – nsalt               sieve n–gooses – lamb

 heron – nplace – npencil            bug n– ski– knife

 goat – nknight-chair                cone n– mouse -ink

  seagull – ncandle – nkey                      brush n-lizard – raincoat

(this is a nsample words set)

   For convenience the npictures can be sticked in a copy-book or a drawing album. During the testings nall defects in words articulation are to be fixed. On the basis of the results nof psychophysiological examinations, a child is considered to be not prepared nto school if he (she) receives total 9 and more points for Kern-Iraseque’s test nand if he (she) has got any sounds articulation defects. To correct the nrevealed deviations in the development of school indispensable functions, such nrecommendations can be given:

1)     exercises for the development of small muscles of hands n(modelling, embroidery, drawing) (under control of kindergarten teachers or nparents);

2)     exercises which help to eliminate articulation defects n– they are conducted by 6 years old children under logopedists control.

Indices for postponing the school enter by n6 years old children.

I.                   Illnesses nwithin the last year:

            –    infectional hepatitis;

–         pyeloneuphritis, diffuse neuphritis, glomeruloneuphritis;

–         no rheumatic myocarditis;

–         epidemic meningitis, meningoencephalitis;

–         tuberculosis;

–         rheumatism in active phase;

–         blood diseases;

–         acute respiratory viral diseases (4 and more times per nyear).

II.                Chronic nillnesses in phases of sub- and decompensation:

–         autonomic vascular dystonia by hypotonic (AP 80 nmm Mercury column) or hypertonic types (AP 115 mm. Mercury column);

–         cardiac defect (congenital or rheumatic);

–         chronic bronchitis, bronchial asthma, chronic pneumonia (at nexacerbation or absence of stable remittance within a year period);

–         ulcer disease  of stomach and duodenum, chronic ngastritis, chronic gastroduodenitis (exacerbation stage, with frequent relapses nor at not full remittance);

–         anemia (Hb = 10,7-8,0 g%);

–         adenoid vegetations, 3d stage; chronic adenoids;

–         hypertrophy of sub palatine glands, stage 3;

–         chronic tonsillitis (toxicoalergic form);

–                                   (goiters , diabetes mellitus, etc.);

–         neurosis (neurasthenia, hysteria, etc.);

–         psychic development lag; infantile cerebral paralysis;

–         cranium trauma in the current year;

–         epilepsy, epileptic syndrome;

–         enuresis;

–         eczema, neurodermitis (at broad skin alterations);

   A temporal postponing nfor school enter is also recommended for nchildren with biologic development lag:

   – height under M-1δ (per local standards of physical ndevelopment);

   – height surplus within the last year  under n4sm;

   – permanent teeth are absent.

   Thus, those 6 years old nchildren can enter school whose biological age corresponds to their passport nage (or ahead of it), with harmonic morph physiological development, with well ndeveloped language, those who refer to health groups 1 and 2, who have high nworking capacity and are qualified per Kern-Iraseque’s test as “adult”.

 

 

TRAINING INSTRUCTION

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

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

Sanitary-protection zone nwidth between border of school land plot and surrounding objects must be not nless than 50 meters. nBuilding of ngeneral must be located at 100-170 meters distance from driveway.

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

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

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

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

Greeprotection zone (trees, bushes, laws) of 1.5 meters wide (from nstreet side – not more than 3meters) is provided along the perimeter of the land nplot.

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

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

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

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

Data nconcerning content and area of certain functional zones of nland plot of general school are presented itable 1.

Table n1

Contents and area of certaifunctional zones of land plot of general school, m²

 

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

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

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

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

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

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

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

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

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

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

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

Sanitary ngaps between sleeping buildings and residential zone border must be not less nthan 50 meters ndistance. Distance between sleeping buildings and motorway must be not less nthan 150 meters, nto economical zone – not less than 100 meters.  n

Areas for noutdoor games of rest zone are nlocated near premises exit and divided between pupils of each age group for ntheir maximum usage during breaks.

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

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

Land nparcels of rural schools may be enlarged at the account of hotbeds, ngreenhouses, conservatories, premises for agricultural engineering, nlawn-and-garden inventory storage.

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

There are compact, block n(block-section) and pavilion systems of architectural and planning compositions to maintain educational nestablishments (fig. 1). Two last of them are the most advisable for usage imodern conditions. There are maximum three parallel classes for same age nchildren or two parallels for adjacent age groups (1 and 2 years pupils, 3 and n4 years pupils etc.) in one section.

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

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

 

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

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

There are functional groups of ntraining premises nsuch as classrooms, study rooms, laboratories, blocks (rooms) for working neducation and occupational orientation, extended day nrooms, physical training and sport premises, canteen premises, medical block, nassembly hall, library, administrative and supplementary premises etc. ieducational establishment building.

Data concerning contents and recommended area of maipremises of general educational establishment are represented in table 2. Areas of premises are ngiven taking into account that a classroom is nfor 25 pupils. If there are 30 pupils in a classroom igeneral schoolhouse, it is allowable to use the area of classrooms, nuniversal study and specialized rooms accounting for 2.0 m² narea per 1 pupil for general classrooms and n2.4 m² per 1 pupil – for laboratories of natural sciences.

Table n2

Contents and recommended narea of main premises of general school

 

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

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

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

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

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

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

Premises for working education (workshops nfor wood processing and workshops for metal processing, combined workshops for nwood and metal processing, service room etc.) must be isolated from other npremises and located in separate blocks on ground floor of schoolhouse, or nin separate buildings with cloakroom and toilet. Training and manufacture workshops are equipped for n10th-12th year pupils for labour education and occupational orientation. nFor this purpose their training is also held at school-to-school field nindustrial complex and training workshops of industrial and agricultural enterprises.

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

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

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

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

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

Dinning nhalls are equipped with tables for 4–6–10 seats and chairs or stools. Distance nbetween tables and window (door) for dispensation of food and dirty dishes reception must be 150–200 ncm, between row of tables – 100–150 cm, between tables and wall – 40–60 cm. nTables must be covered with corresponding to hygienic requirements materials, neasily washed, be resistant to influence of hot water and disinfectants. Wash sinks are equipped naccounting for 1 wash sink per 20 seats, hand drying apparatus – n1 per 40 seats.

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

Width of recreation premises is not less than 2.8 meters if there is none-side location of classrooms. Recreation premises area is calculated for each nfloor and is not less than 2.0m² per one pupil. During construction or reconstructioof general educational establishments recreation premises of hall type are nprior.

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

Cloakrooms are located on ground nfloors of educational establishments, sectioequipment for each class is obligatory. Double lobbies with three doors must be nprojected in vestibules for provision of nreliable heat isolation of inside premises.

Presence nof independent entrances into the school for pupils of 1^st–4^th, n5^th–7^th and 8^th–9^th nyears must be provided if block development system is used. In any other cases nnot less than 2 exits are equipped for permanent exploitation.

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

 

TRAINING ninstruction

on nhygienic assessment of equipment of school premises and school furniture

 

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

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

Fig. 39.3 Main sizes of school desk

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

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

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

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

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

 

Fig. 4 Different variants of distance nof the seat

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

 

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

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

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

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

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

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

·  relief nof the seat must nbe correspondent to relief of hip and buttocks, little nslope to back. It allows the pupils not to slide nforward during main educational activity being seating.

Six nspecial sizes of school furniture were worked out (SSRandN 5.5.2.008–01, State Standards of Ukraine 5994–93, 11015–93, n11016–93) nfor provision of pupils with school furniture corresponding to their body nlength and based on the received results range them to certain age group: #1 for pupils of 100–115 cm body nlength; #2 – of pupils with 116–130 cm body length; #3 – for pupils of 131–145 ncm body length; #4 – for pupils of 146–160 cm body length; #5 – for pupils of n161–175 cm body length; #6 – for pupils above 176 cm body length.

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

Table 3

Sizes nof main construction elements of school furniture

 

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

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

 

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

The ndistance from blackboard to first school desks must be increased by not less nthan 3 meters nin transversal or square classrooms nwith 4 rows school desks location. This provides the angle of review nup to 35°. Distance from first nrow of school desks to external wall must be 0.8–1.0 m, between rows of school desks (tables) – 0.6m, from last school desks to wardrobes standing along ninternal wall – 0.9–1.0 m.

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

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

       School furniture must be marked. Marking of school furniture means 2 cm wide strip or n2.5 cm diameter circle on both sides of school desk, table and chair. School furniture of first height group is marked nwith orange, second – violet, third – yellow, fourth – red, fifth – green, nsixth – blue colour.

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

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

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

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

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

Each nworkplace has corbel seat or 40-42 cm height stool with 35×35 cm and n40×40 cm seat size. Supports (5 supports for each size) with 55×75 ncm size and 5, 10 and 15 cm nheight must present in workshops for selection of corresponding furniture.

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

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

a                 n                          b

Fig. n6 Peculiarities of location of training equipment in workshops for working neducation

(if engineering machines are located at right angle (a) and n45° angularly to windows (b))

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

 

Iworkshops for 10-12 years old pupils instruments nof special size # 1 must be used, for 13-15 years old pupils – instruments of special size # 2, for nabove 15 years old pupils – instruments for adults.

Maximum nlading weight for elevation by 11-12 years old pupils is up to 4 kg, n13-14 years old pupils – up nto 5 kg, n15 years old pupils: for boys – 12 kg, for girls – 6.0kg, 16 years old – 14 and 7 kg, 17 years old – 16 and 8 kg correspondently.

Sanitary inspection of correct nselection and arrangement of furniture in training premises includes analysis of presence of nnot less than 2-3 different number of furniture in each classroom and adequacy nof their arrangement to each other, characteristics of a distance between the nschool desk rows, between furniture and side, front and back walls of premise, nstudying of provision conditions to the correct working posture and bearing, nmeasurement of main sizes of school furniture etc.

 

 

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

According to State Standard (SS) – SS 11015, n11016-86, during teaching process pupil’s desks and chairs of 6 types are used: n№1 for the pupils with height 100-115 cm, №2 – 116-130 cm., №3 – 131-145 cm, № 4 – 146-160cm, №5 – 161-175 cm, №6 – 160-169 cm, №7 – 170-179 cm; or letter types: A – for the pupils with high less than 130 cm, B – 130-145 cm, C – 146-160 cm, D – 161-175 cm, E – more than 175 cm.

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

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

Depth nof the seat which is front- back size is to be not less than 2/3 and not more nthan ¾ of thigh length, and type of seat has to answer thigh and buttock nshape. Back of the desk or chair  have to nbe profiled  and support sacroileal and nsu bscapular regions. Back distance that is horisontal distance from the nposterior edge of desk till back, have to be the average size of front- back ndiameter of pupil’s chest which is group of height plus 5 sm. Desk must have nangle of slope 14-15⁰. Size of the seat is determined by wrist nlength, volume and amount of actions during writing, by right placing of opecopy-book. The distance between posterior edge of desk and vertical space of nseat is to called differention.. It have to be equal with difference betweehight of elbow of descended pupil’s arm, who is sitting and high of seat plus n5-6 cm.

 

 

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

Hygienic evaluation of school textbooks

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

 

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

       for nsenior classes-800g

       nInterlinage- not less than 3mm

       nApprosh- not less than 2mm

       nDistance between letters-0.5mm

       Typing ndensity – 8-10 letters (for younger classes), 15 – for nsenior

Iorder to hygiene evaluation of daily time-table of children and teenagers nmethods of questionnaire, interviewing, chronological observation. During examination it is necessary nto find information about presence and duration in daily time-table of mairegimen elements (sleeping, study in school, nourishment, rest with walk nout-of-doors, home-tasks preparation, home work, free-time), correctness and nreasons of their interaction, accordance of health condition with age, sexual, nanatomic-physiologic and functional peculiarities of organism and individual ntalents of child.

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

Maielements of sanitary-hygienic observation of classes schedule is examination of naccordance of distribution and alternation of subjects during working day and nweek, with health condition, morphofunctional abilities of children’s organism nand level of complication of subjects and character of their interactio(presence of joint lessons of some subjects, neighborhood of lessons of lessons nof similar subjects of similar type activity, for example, native language and nforeign language, algebra and geometry etc).

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

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

Iorder to define level of complication of lessons methods of group according to nlevel of difficulty is used (1 group – mathematics, foreign languages; 2 group n– chemistry, physics; 3 group – native language, history, geography; 4 group – nnatural science, literature; 5 group – physical training, music, labor ntraining), or scale of rank of difficulty of school subjects (mathematics – 11 npoints, foreign language – 10, physics, chemistry – 9, history – 8, native nlanguage, literature – 7, natural science, geography – 6, physical training – n5, labor training – 4, drawing – 3, picture-drawing – 2, music – 1).

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

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

Sanitary-hygienic nevaluation of labor training of pupils include chronometrical observation, ncontrol of character, regimen and conditions of study, examination of naccordance of workshop with pupils’ height, evaluation of functional state of nchildren and teenagers during labor training.

 

REFERENCES:

Principal:

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

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

3.          nLecture on hygiene.

additional:

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

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

3.          nA hand book of Preventive nand Social Medicine. – Yash Pal Bedi / Sixteenth Edition, 2003 –  p. n26-36, 92-97.