Attempts of Integration of Solutions for Disabled People

Radomska Szkoła Wyższa w Radomiu Radom University in Radom

Annual Reports of Education, Health and Sport 9781329900516

Edited by

Iwona Czerwińska Pawluk Radosław Muszkieta Hanna Żukowska Wiesława Pilewska Mariusz Klimczyk Walery Zukow

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Open Access

Radom 2013 Radomska Szkoła Wyższa w Radomiu Radom University in Radom

Annual Reports of Education, Health and Sport 9781329900516

Edited by

Iwona Czerwińska Pawluk Radosław Muszkieta Hanna Żukowska Wiesława Pilewska Mariusz Klimczyk Walery Zukow

Open Access

Radom 2013

1 Scientific Council prof. zw. dr hab. geo. Z. Babiński (Poland), prof. zw. dr hab. med. T. Chumachenko (Ukraine), prof zw. dr hab. techn. R. Cichon (Poland), prof zw. dr hab med. N. Dragomiretskaya (Ukraine), prof. zw. dr hab. med. V. Ezhov (Ukraine), prof. zw. dr hab. geo. J. Falkowski (Poland), prof. zw. dr hab. med. A. Gozhenko (Ukraine), prof. zw. dr hab. geo. M. Grodzynskyi (Ukraine), prof zw. dr hab. I. Grygus (Ukraine), prof. zw. dr hab med. A. Gudyma (Ukraine), prof. zw. dr hab. med. S. Gulyar (Ukraine), prof. zw. dr hab. med. W. Hagner (Poland), prof zw. dr hab. med. I. Karwat (Poland), prof zw. dr hab. med. M. Kyryliuk (Ukraine), prof. zw. dr hab. med. Y. Limansky (Ukraine), prof. zw. dr hab. geo. A. Melnik (Ukraine), prof. zw. dr hab. med. V. Mizin (Ukraine), prof. zw. dr hab. med. B. Nasibullin (Ukraine), prof zw. dr hab. geo. O. Obodovskyi (Ukraine), prof zw. dr hab. med. I. Samosiuk (Ukraine), prof zw. dr hab. med. L. Shafran (Ukraine), prof zw. dr hab. med. I. Shmakova (Ukraine), prof zw. dr hab. med.A. Svirskiy (Ukraine), prof zw. dr hab. O. Sokolov (Ukraine), prof. zw. dr hab. med. V. Stebliuk (Ukraine), prof zw. dr hab. S. Yermakov, (Ukraine), prof, dr hab. med. A. Avramenko, doc. PaedDr. Elena Bendikova, PhD. (Slovakia), prof. dr hab. K. Buśko (Poland), dr hab. med. E. Gozhenko (Ukraine), prof. dr hab. H. Knapik (Poland), dr hab. R. Muszkieta (Poland), prof. dr hab. med. W. Myśliński (Poland), prof. dr hab. M. Napierała (Poland), prof. dr hab. M. Pastuszko (Poland), prof. dr hab. K. Prusik (Poland), prof. dr hab. M. Zasada (Poland), dr med. L. Butskaia (Ukraine), dr I. M. Batyk (Poland), dr M. Cieślicka (Poland), dr med. M. Charzynska-Gula (Poland), doc. dr n. med. V. Cherno (Ukraine), dr med. K Cywinski (Poland), dr med. I. Czerwinska Pawluk (Poland), dr biol. S. Dolomatov (Ukraine), dr med. M. Dzierzanowski (Poland), dr med. M. Hagner-Derengowska (Poland), dr med. B. Jędrzejewska (Poland), dr med. U. Kazmierczak (Poland), dr med. K Kiczuk (Poland), dr Z. Kwaśnik (Poland), dr med. T. Madej (Poland), dr med. E. Mikolajewska (Poland), dr D. Mikolajewski (Poland), dr med. B. Muszynska (Poland), dr med. A. Nalazek (Poland), dr med. N. Novikov (Ukraine), dr med. K. Nowacka (Poland), dr med. G. Polak (Poland), dr med. P. Prokopczyk (Poland), dr med. A. Radziminska (Poland), dr med. L. Sierpinska (Poland), dr Daves Sinch (Republic of India), doc. dr A. Skaliy (Ukraine), dr T. Skaliy (Ukraine), dr B. Stankiewicz (Poland), dr med. E. Trela (Poland) Editorial Board Stefan Adamcak (Slovakia), Pavol Bartik (Slovakia), Elena BendAkova (Czech Republic), Janusz Bielski (Poland), Krzysztof Buśko (Poland), Mirosława Cieślicka (Poland), Jerzy Eksterowicz (Poland), Włodzimierz Erdmann (Poland), Tomasz Frołowicz (Poland), Attila Gilanyi (Hungary), Igor Grygus (Ukraine), Halina Guła-Kubiszewska (Poland), Paweł Izdebski (Poland), Sergii Iermakov (Ukraine), Tetyana Iermakova (Ukraine), Jana Jurikova (Czech Republic), Vlastimila Karaskova (Czech Republic), Jacek Klawe (Poland), Mariusz Klimczyk (Poland), Alicja Kostencka (Poland), Frantisek Langer (Czech Republic), Eligiusz Madejski (Poland), Jiri Michal (Slovakia), Ludmila Miklankova (Czech Republic), Emila Mikołajewska (Poland), Viktor Mishchenko (Ukraine), Stanisław Mocek (Poland), Mirosław Mrozkowiak (Poland), Radosław Muszkieta (Poland), Anna Nalazek (Poland), Marek Napierała (Poland), Jerzy Nowocień (Poland), Piotr Oleśniewicz (Poland), Władysław Pańczyk (Poland), Wiesława Pilewska (Poland), Miroslava Pridalova (Czech Republic), Krzysztof Prusik (Poland), Krzysztof Sas-Nowosielski (Poland), Aleksandr Skaliy (Ukraine), Tetyana Skaliy (Ukraine), Ewa Sokołowska (Poland), Błażej Stankiewicz (Poland), Robert Stępniak (Poland), Aleksander Stuła (Poland), Naoki Suzuki (Japan), Mirosława Szark-Eckardt (Poland), Maciej Świątkowski (Poland), Hrychoriy Tereschuk (Ukraine), Hryhoriy Vasjanovicz (Ukraine), Mariusz Zasada (Poland), Tetyana Zavhorodnya (Ukraine), Walery Żukow (Poland), Hanna Żukowska (Poland) Advisory Board Zygmunt Babiński (Poland), Yuriy Briskin (Ukraine), Laszló Csernoch (Hungary), Kazimierz Denek (Poland), Miroslav Dutchak (Ukraine), Karol Gcrner (Slovakia), Kazimierz Kochanowicz (Poland), Jerzy Kosiewicz (Poland), Stanisław Kowalik (Poland), Tadeusz Maszczak (Poland), Mikolaj Nosko (Ukraine), Jerzy Pośpiech (Poland), Eugeniusz Prystupa (Ukraine), Robert Szeklicki (Poland), Jitka Ulrichova (Czech Republic). Reviewers: prof. zw. dr hab. geo. Z. Babiński (Poland), doc. PaedDr. Elena Bendikova, PhD. (Slovakia), prof. zw. dr hab. med. T. Chumachenko (Ukraine), prof. zw. dr hab. techn. R. Cichon (Poland), prof. zw. dr hab. med. N. Dragomiretskaya (Ukraine), prof. zw. dr hab. med. V. Ezhov (Ukraine), prof. zw. dr hab. geo. J. Falkowski (Poland), prof. zw. dr hab. med. A. Gozhenko (Ukraine), prof. zw. dr hab. geo. M. Grodzynskyi (Ukraine), prof. zw. I. Grygus (Ukraine), prof. zw. A. Gudyma (Ukraine), prof. zw. dr hab. med. S. Gulyar (Ukraine), prof. zw. dr hab. med. W. Hagner (Poland), prof. zw. dr hab. med. I. Karwat (Poland), prof. zw. dr hab. med. M. Kyryliuk (Ukraine), prof. zw. dr hab. med. Y. Limansky (Ukraine), prof. zw. dr hab. geo. A. Melnik (Ukraine), prof. zw. dr hab. med. V. Mizin (Ukraine), prof. zw. dr hab. med. B. Nasibullin (Ukraine), prof. zw. dr hab. geo. O. Obodovskyi (Ukraine), prof. zw. dr hab. med. I. Samosiuk (Ukraine), prof. zw. dr hab. med. L. Shafran (Ukraine), prof. zw. dr hab. med. I. Shmakova (Ukraine), prof. zw. dr hab. O. Sokolov (Ukraine), prof. zw. dr hab. med. V. Stebliuk (Ukraine), prof. zw. dr hab. S. Yermakov, (Ukraine), prof. dr hab. med. A. Avramenko, prof. dr hab. K Buśko (Poland), dr hab. med. E. Gozhenko (Ukraine), prof. dr hab. H. Knapik (Poland), prof. zw. dr hab. geo. A. Melnik (Ukraine), prof. dr hab. R. Muszkieta (Poland), prof. dr hab. med. W. Myśliński (Poland), prof. dr hab. M. Napierała (Poland), prof. dr hab. M. Pastuszko (Poland), prof. dr hab. K. Prusik (Poland), prof. dr hab. M. Zasada (Poland), prof. dr hab. med. W. Zukow (Poland), dr I. M. Batyk (Poland), dr med. L. Butskaia (Ukraine), doc. dr n. med. V. Cherno (Ukraine), dr M. Cieślicka (Poland), dr med. I. Czerwinska Pawluk (Poland), dr biol. S. Dolomatov (Ukraine), dr med. N. Novikov (Ukraine), doc. dr A. Skaliy (Ukraine), dr T. Skaliy (Ukraine), dr B. Stankiewicz (Poland), dr med. E. Trela (Poland) E d i t o r s - i n - C h i e f Anatoliy Gozhenko Walery Zukow C o - e d i t o r s Radosław Muszkieta Marek Napierała A s s o c i a t e E d i t o r s Iwona Czerwinska Pawluk Mariusz Klimczyk Mirosława Cieślicka Adam Szulc S e c r e t a r y Bartłomiej Niespodziński

© The Author(s) 2013. This articles is published with Open Access at Annual Reports of Education, Health and Sport of Radomska Szkoła Wyższa w Radomiu, Poska, Radom University in Radom, Poland Open Access This articles is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.

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Publishing House: Radomska Szkoła Wyższa w Radomiu, Radom University in Radom Str. Zubrzyckiego 2 26-600 Radom Tel.: +48 48 383 66 05 [email protected] Printing House: Radomska Szkoła Wyższa w Radomiu, Radom University in Radom Str. Zubrzyckiego 2 26-600 Radom Tel.: +48 48 383 66 05 [email protected] ISBN 9781329900516

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2 Content:

Introduction...... 5

Podgorna V. V., Romanchuk A. P. Pattern of spontaneous breathing and development of physical qualities of elementary school pupils. [in] Czerwińska Pawluk Iwona Ed., Muszkieta Radosław Ed., Żukowska Hanna Ed., Pilewska Wiesława Ed., Klimczyk Mariusz Ed., Zukow Walery Ed. Annual Reports of Education, Health and Sport 9781329900516. RSW. Radom. 2013. 7-14. ISBN 9781329900516. © The Author(s) 2013. This articles is published with Open Access at Annual Reports of Education, Health and Sport. RSW. Radom. Poland.

Jaworska Iwona, Wrońska Irena. Poziom wiedzy o zaćmie wśród pacjentów = Level of the knowledge about cataract amongst patients. [in] Czerwińska Pawluk Iwona Ed., Muszkieta Radosław Ed., Żukowska Hanna Ed., Pilewska Wiesława Ed., Klimczyk Mariusz Ed., Zukow Walery Ed. Annual Reports of Education, Health and Sport 9781329900516. RSW. Radom. 2013. 15-28. ISBN 9781329900516. © The Author(s) 2013. This articles is published with Open Access at Annual Reports of Education, Health and Sport. RSW. Radom. Poland.

Sharma Balkishan, Wavare Rajshekhar. Academic stress due to depression among Medical and Para-medical students in an Indian medical college: Health initiatives cross sectional study. [in] Czerwińska Pawluk Iwona Ed., Muszkieta Radosław Ed., Żukowska Hanna Ed., Pilewska Wiesława Ed., Klimczyk Mariusz Ed., Zukow Walery Ed. Annual Reports of Education, Health and Sport 9781329900516. RSW. Radom. 2013. 29-38. ISBN 9781329900516. © The Author(s) 2013. This articles is published with Open Access at Annual Reports of Education, Health and Sport. RSW. Radom. Poland.

Napierala Marek, Zukow Walery, Maczynska Ewa. Exercise and respiratory and cardiovascular diseases. [in] Czerwińska Pawluk Iwona Ed., Muszkieta Radosław Ed., Żukowska Hanna Ed., Pilewska Wiesława Ed., Klimczyk Mariusz Ed., Zukow Walery Ed. Annual Reports of Education, Health and Sport 9781329900516. RSW. Radom. 2013. 39-58. ISBN 9781329900516. © The Author(s) 2013. This articles is published with Open Access at Annual Reports of Education, Health and Sport. RSW. Radom. Poland.

Pykhtieieva E.G. Studies of the metaUothionein role In the body protecting from the effects of heavy metals in violation of the adaptation mechanism = Исследование роли металлотионеинов в защите организма человека от воздействия тяжелых металлов при недостаточности адаптационных механизмов. [in] Czerwińska Pawluk Iwona Ed., Muszkieta Radosław Ed., Żukowska Hanna Ed., Pilewska Wiesława Ed., Klimczyk Mariusz Ed., Zukow Walery Ed. Annual Reports of Education, Health and Sport 9781329900516. RSW. Radom. 2013. 59-72. ISBN 9781329900516. © The Author(s) 2013. This articles is published with Open Access at Annual Reports of Education, Health and Sport. RSW. Radom. Poland.

Żukowska Hanna, Szark- Eckardt Mirosława, Kuska Michalina, Napierała Marek, Zukow Walery. Comparison of somatic and motor skills 14-16 years old boys from selected secondary schools Bydgoszcz = Porównanie cech somatycznych i zdolności motorycznych 14-16 letnich chłopców z wybranych gimnazjów Bydgoszczy. 73-100. [in] Czerwińska Pawluk Iwona Ed., Muszkieta Radosław Ed., Żukowska Hanna Ed., Pilewska Wiesława Ed., Klimczyk Mariusz Ed., Zukow Walery Ed. Annual Reports of Education, Health and Sport 9781329900516. RSW. Radom. 2013. 59-72. ISBN 9781329900516. © The Author(s) 2013. This articles is published with Open Access at Annual Reports of Education, Health and Sport. RSW. Radom. Poland.

Gozhenko A I, Masevich Y V, Nasibullin B A, Zukow W. Features of clinical and morphologic manifestation of severe violations of cerebral circulation in people living in hypogeomagnetic conditions = Особенности клинико-морфологических проявлений острых нарушений мозгового кровообращения у лиц, находящихся в гипогеомагнитных условиях. [in] Czerwińska Pawluk Iwona Ed., Muszkieta Radosław Ed., Żukowska Hanna Ed., Pilewska Wiesława Ed., Klimczyk Mariusz Ed., Zukow Walery Ed. Annual Reports of Education, Health and Sport 9781329900516. RSW. Radom. 2013. 101-112. ISBN 9781329900516. © The Author(s) 2013. This articles is published with Open Access at Annual Reports of Education, Health and Sport. RSW. Radom. Poland.

Loyko I. I. The effectiveness of different types of GERD correction, depending on the symptoms, in patients operated for peptic. [in] Czerwińska Pawluk Iwona Ed., Muszkieta Radosław Ed., Żukowska Hanna Ed., Pilewska Wiesława Ed., Klimczyk Mariusz Ed., Zukow Walery Ed. Annual Reports of Education, Health and Sport 9781329900516. RSW. Radom. 2013. 113-120. ISBN 9781329900516. © The Author(s) 2013. This articles is published with Open Access at Annual Reports of Education, Health and Sport. RSW. Radom. Poland.

Skiba A. V., Zukow W. Employment of persons with disabilities in marine ports = Трудоустройство лиц с ограниченными возможностями в морских портах. [in] Czerwińska Pawluk Iwona Ed., Muszkieta Radosław Ed., Żukowska Hanna Ed., Pilewska Wiesława Ed., Klimczyk Mariusz Ed., Zukow Walery Ed. Annual Reports of Education, Health and Sport 9781329900516. RSW. Radom. 2013. 121-142. ISBN 9781329900516. © The Author(s) 2013. This articles is published with Open Access at Annual Reports of Education, Health and Sport. RSW. Radom. Poland.

Kotyuzhynskaya S., Gozhenko A., Zukow W. Specific features of the condition lipid transport system of blood plasma in patients with essential hypertension and type 2 diabetes in atherosclerosis = Особенности состояния липидтранспортной системы плазмы крови у больных гипертонической болезнью и сахарным диабетом 2 типа при атеросклерозе. [in] Czerwińska Pawluk Iwona Ed., Muszkieta Radosław Ed., Żukowska Hanna Ed., Pilewska Wiesława Ed., Klimczyk Mariusz Ed., Zukow Walery Ed. Annual Reports of Education, Health and Sport 9781329900516. RSW. Radom. 2013. 143-154. ISBN 9781329900516. © The Author(s) 2013. This articles is published with Open Access at Annual Reports of Education, Health and Sport. RSW. Radom. Poland.

3 Bulavenko O., Lyovkina O. Peculiarities of the contents of sex hormones in the blood of women of reproductive age with the primary stress- induced infertility. [in] Czerwińska Pawluk Iwona Ed., Muszkieta Radosław Ed., Żukowska Hanna Ed., Pilewska Wiesława Ed., Klimczyk Mariusz Ed., Zukow Walery Ed. Annual Reports of Education, Health and Sport 9781329900516. RSW. Radom. 2013. 155-162. ISBN 9781329900516. © The Author(s) 2013. This articles is published with Open Access at Annual Reports of Education, Health and Sport. RSW. Radom. Poland.

Cieślicka Mirosława, Brzózka Patrycja, Pilewska Wiesława, Ciesielska Natalia, Nalazek Anna, Zukow Walery. Effect of aerobic training on the health of women frequenting to fitness clubs = Wpływ treningu aerobowego na zdrowie kobiet uczęszczających do klubów fitness. [in] Czerwińska Pawluk Iwona Ed., Muszkieta Radosław Ed., Żukowska Hanna Ed., Pilewska Wiesława Ed., Klimczyk Mariusz Ed., Zukow Walery Ed. Annual Reports of Education, Health and Sport 9781329900516. RSW. Radom. 2013. 163-178. ISBN 9781329900516. © The Author(s) 2013. This articles is published with Open Access at Annual Reports of Education, Health and Sport. RSW. Radom. Poland.

Ciesielska Natalia, Jelonek Agata, Łysiak Norbert, Nalazek Anna, Cieślicka Mirosława, Zukow Walery. Ways of coping with stress among nurses Intensive Care and Anesthesiology = Sposoby radzenia sobie ze stresem wśród pielęgniarek Intensywnej Terapii i Anestezjologii. [in] Czerwińska Pawluk Iwona Ed., Muszkieta Radosław Ed., Żukowska Hanna Ed., Pilewska Wiesława Ed., Klimczyk Mariusz Ed., Zukow Walery Ed. Annual Reports of Education, Health and Sport 9781329900516. RSW. Radom. 2013. 179-190. ISBN 9781329900516. © The Author(s) 2013. This articles is published with Open Access at Annual Reports of Education, Health and Sport. RSW. Radom. Poland.

Kołłątaj Barbara, Szakuła Justyna, Kołłątaj Witold, Wrzołek Katarzyna, Karwat Irena Dorota. Problem uzależnienia od Internetu wśród uczniów szkół ponadpodstawowych w Lublinie = The problem of Internet addiction among secondary and upper secondary school students in Lublin. [in] Czerwińska Pawluk Iwona Ed., Muszkieta Radosław Ed., Żukowska Hanna Ed., Pilewska Wiesława Ed., Klimczyk Mariusz Ed., Zukow Walery Ed. Annual Reports of Education, Health and Sport 9781329900516. RSW. Radom. 2013. 191-224. ISBN 9781329900516. © The Author(s) 2013. This articles is published with Open Access at Annual Reports of Education, Health and Sport. RSW. Radom. Poland.

Cieślicka Mirosława, Kuźniewska Ewa, Stankiewicz Błażej, Zukow Walery. The impact of training on physical fitness development volleyball court and somatic training athletes build volleyball = Wpływ treningu siatkarskiego na rozwój sprawności fizycznej i budowy somatycznej zawodniczek trenujących siatkówkę. [in] Czerwińska Pawluk Iwona Ed., Muszkieta Radosław Ed., Żukowska Hanna Ed., Pilewska Wiesława Ed., Klimczyk Mariusz Ed., Zukow Walery Ed. Annual Reports of Education, Health and Sport 9781329900516. RSW. Radom. 2013. 225-240. ISBN 9781329900516. © The Author(s) 2013. This articles is published with Open Access at Annual Reports of Education, Health and Sport. RSW. Radom. Poland.

Cieślicka Mirosława, Dix Barbara, Zukow Walery. The impact of kayaking training on physical fitness and somatic construction at the stage of preparatory training = Wpływ treningu kajakarskiego na sprawność fizyczną i budowę somatyczną zawodników na etapie treningu przygotowawczego. [in] Czerwińska Pawluk Iwona Ed., Muszkieta Radosław Ed., Żukowska Hanna Ed., Pilewska Wiesława Ed., Klimczyk Mariusz Ed., Zukow Walery Ed. Annual Reports of Education, Health and Sport 9781329900516. RSW. Radom. 2013. 241-254. ISBN 9781329900516. © The Author(s) 2013. This articles is published with Open Access at Annual Reports of Education, Health and Sport. RSW. Radom. Poland.

Pilewska Wiesława, Pilewski Robert, Zukow Walery Characteristics of body composition highly qualified dancers and dancers Latin American style of dance sports in light of typology of somatic Wanky and Kretschmer = Charakterystyka budowy ciała wysokokwalifikowanych tancerek i tancerzy stylu latynoamerykańskiego sportowego tańca w świetle typologii somatycznej Wankego i Kretschmera. [in] Czerwińska Pawluk Iwona Ed., Muszkieta Radosław Ed., Żukowska Hanna Ed., Pilewska Wiesława Ed., Klimczyk Mariusz Ed., Zukow Walery Ed. Annual Reports of Education, Health and Sport 9781329900516. RSW. Radom. 2013. 255-266. ISBN 9781329900516. © The Author(s) 2013. This articles is published with Open Access at Annual Reports of Education, Health and Sport. RSW. Radom. Poland.

Wiech Monika, Prusik Katarzyna, Kortas Jakub, Bielawa Łukasz, Ossowski Zbigniew, Prusik Krzysztof, Zukow Walery. Changes in the ranges of motion in the joints of the upper and lower extremities in elderly people under the influence of the Nordic Walking training = Zmiany zakresów ruchów w stawach kończyn górnych i dolnych u osób starszych pod wpływem treningu Nordic Walking. [in] Czerwińska Pawluk Iwona Ed., Muszkieta Radosław Ed., Żukowska Hanna Ed., Pilewska Wiesława Ed., Klimczyk Mariusz Ed., Zukow Walery Ed. Annual Reports of Education, Health and Sport 9781329900516. RSW. Radom. 2013. 267-276. ISBN 9781329900516. © The Author(s) 2013. This articles is published with Open Access at Annual Reports of Education, Health and Sport. RSW. Radom. Poland.

Kamrowska-Nowak Maria, Byzdra Krzysztof, Majchak Katarzyna, Stępniak Robert, Zukow Walery. The Results of the Checks in the Women's Heptathlon Training During a 10-year Training Cycle = Wyniki kontroli treningu w siedmioboju kobiet w trakcie 10-cio letniego cyklu treningowego. [in] Czerwińska Pawluk Iwona Ed., Muszkieta Radosław Ed., Żukowska Hanna Ed., Pilewska Wiesława Ed., Klimczyk Mariusz Ed., Zukow Walery Ed. Annual Reports of Education, Health and Sport 9781329900516. RSW. Radom. 2013. 277-300. ISBN 9781329900516. © The Author(s) 2013. This articles is published with Open Access at Annual Reports of Education, Health and Sport. RSW. Radom. Poland.

4 Introduction

We hope that a varied program of the Annual Reports of Education, Health and Sport will answer your expectations. We believe that the Annual Reports of Education, Health and

Sport will contribute to raising the knowledge, skills and abilities of doctors, therapists, physiotherapists, nurses, psychologists, biologists, researchers, practitioners and health workers interested in rehabilitation, physiotherapy, tourism and recreation.

Annual Reports of Education, Health and Sport, corresponding to the modern challenges of global health specialists collect articles from those areas of the leading centers of renowned foreign and domestic. Many of them present state of art in their field. This will be particularly valuable for young doctors in the specialization, and students.

Welcome to familiarize yourself with this issue all relevant hazards and health, life and safety at work in tourism, recreation, rehabilitation, physiotherapy, nursing organization to work safely and missions in these conditions, the influence of environmental conditions on public health.

Authors from abroad and the country will present an overview of contemporary challenges and solutions in these areas. The issue concerns the text of the wider work for human health, tourism, recreation, physiotherapy, nursing, wellness and rehabilitation, including the economics of health care.

5 © The Author(s) 2013. This articles is published with Open Access at Annual Reports of Education, Health and Sport. RSW. Radom. Poland Open Access This articles is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited. [fe e }

6 Journal of Health Sciences (J of H Ss) 2013; 3(5): 7-14

The journal has had 4 points in Ministry of Science and Higher Education of Poland parametric evaluation. Part B item 683.

УДК 612.21+373.3+796.012.1 PATTERN OF SPONTANEOUS BREATHING AND DEVELOPMENT OF PHYSICAL QUALITIES OF ELEMENTARY SCHOOL PUPILS

Podgorna V.V., Romanchuk A.P.

Southukrainian national pedagogical university n.a. K.D.Ushinsky, Odessa, Ukraine (65020, Ukraine, Odessa, Staroportofrankovska str. 26), e-mail: [email protected]

This article is published with open access at Licensee Open Journal Systems of Radom University in Radom,

Poland

Abstract. Recognizing the importance of formation of school-aged children physical fitness connected with using of methods and approaches of physical culture the goal had been set in this work is to determine a connection between measures of pattern of spontaneous breathing and level of separate motion qualities development for children who are studying at elementary school. The modern multifunctional method was implemented in research which is the spiroartheriocardiorhythmography (SACR) allowing to estimate function of spontaneous breathing by the measures of breathing pattern. Thanking to this the expressed deviances was discovered in breathing pattern connected with development of separate physical qualities. At this rate the development of endurance is connected with 5 parameters of breathing pattern, adroitness - 3, quickness and strength - by 2 and one with flexibility. The most important of all breathing pattern's parameters is breathing-in duration index which at increasing forecasts level of endurance not below the average in 86% of all cases. Same measure in 100% of cases forecasts development of adroitness which is at level above the average in 71% of all cases. In 67% of cases of increasing of volume inspiratory rate the level of quickness level above the average is determined, and in 43% of decreasing of volume expiratory rate cases the development of quickness is at low level. Same factor significantly limits the development of strength abilities which in 57% of its registration cases are at low level of development. Increasing of ratio between inspiratory and expiratory duration significantly limits the development of flexibility, in 58% of cases is at level below the average and average level. Taking into consideration the data obtained it is should be noted that development of separate physical qualities is clearly connected with breathing pattern. At this from the one hand means and approaches of movement education have influence on formation of corresponding pattern and from the other hand the pattern of spontaneous breathing determines the opportunities of development of separate physical qualities.

7 Keywords: pattern of spontaneous breathing, physical qualities, pupils.

Actuality. Each age time of germination of child has own particularities in organization and functioning of separate systems and organs which are change with allowances made for inherited conditions and environmental factors influence, including with reference of exercises [5]. One of the most sensitive functions of body is a function of external respiration, which perhaps first reacts for external factors which unconditionally significantly limits opportunities for its research [2]. The volume characteristics of this function are more stable. However their value for diagnostics of functional condition of body is significantly limited and find certain place only at diagnostics of bronchopulmonary system's diseases only at level of determination of restrictive and obstructive processes [6]. With appearance of new technical solutions in diagnostic equipment it is became possible to clearly determine spontaneous breathing function in the field which on a par with reactivity for environmental factors characterizes certain stable mechanisms of oxygen supply for body [4]. It is also should be added that thanking to complex organization the particularities of breathing find reflection in functioning of cardiovascular, endocrine, nervous, and alimentary systems and with implementation of specialized approaches they able to control the psycho-emotional condition of human. There are many metabolic processes connected with phases of breathing [1]. Taking into account all the said it is possible to consolidate that particularities of spontaneous breathing are reflection of antecedent components of metabolism and their correction could significantly change the flow of later ones. Recognizing the importance of formation of school-aged children physical fitness connected with using of methods and approaches of physical culture the goal had been set in this work is to determine a connection between measures of pattern of spontaneous breathing and level of separate motion qualities development for children who are studying at elementary school. Materials and methods of research. To achieve the goal being settled 93 pupils were discovered (28 girls and 65 boys) of 8-10 years old, studied at elementary school №65 of Odessa. Investigation include testing of physical qualities, implemented with using of tests and

8 standards according to state program of movement education for elementary schools of I-III grades. Assessment was done by 12-grade system acting in Ukraine. For analysis of results obtained we used the distribution of later ones by levels of development: above the average (5) - grades 11-10, average (4) - grades 8-9, below the average (3) - grades 7-6, low (2) - grades 4-5. Functional condition of children's breathing system were discovered with implementation of modern multifunctional method - spiroartheriocardiorhythmography (SACR) allowing to estimate function of spontaneous breathing by the measures of breathing pattern. According to SACR results the levels of range deviations were analyzed for values which were characterized as extremely balanced (at insertion to range from 25 to 75 centiles), medium stressed (from 5 to 25 and from 75 to 95 centiles) and expressively stressed (from 0 to 5 and from 95 to 100 centiles). Execution of acknowledge experiment had allow to determine the particularities of pattern of spontaneous breathing and development of major physical qualities for junior pupils. The distribution of obtained values of breathing pattern for examined group of children is represented in Table 1 with allowances made for sex and age distributions calculated during more recent investigations.

Table 1 The distribution of obtained values of breathing pattern for examined group of children 8-10 years (%) <5 5-25 25-75 75-95 >95 T insp, s 9 19 49 19 3 T exp, s 8 20 46 18 8 Vt, l 3 27 48 15 6 Vt /Tinsp, l/s 6 17 53 18 5 Vt /Texp, l/s 5 23 51 14 8 Tinsp/Texp 8 18 52 16 6 BR,1/ min 4 20 48 20 6

As we can see from the table almost by all parameters of spontaneous breathing pattern distributions of values were correspond to expected ones. Particular attention was given to values which were higher than expected 5% in tested group of children and which evidenced about extreme deviations of measured parameters (in range of <5% and >95%). Exactly that was a 9 reason for analysis of development of movement qualities for children who has their parameters of breathing pattern in specified limits. The results of analysis of development of physical qualities of children with allowances made for approach offered before are represented in Fig. 1. Taking into consideration modal estimations of separate movement qualities it is should be noted that most of children from this group have following parameters on the above the average development level: quickness (53%), strength (45%), adroitness (48%), the flexibility is prevailing at the average level of development (39%), and the parameters of endurance development are significantly prevail on the low level (41%).

Fig. 1. Distribution of development levels for physical qualities of pupils of 8-10 age old where a is a quickness, b is a strength, c is an endurance, d is a flexibility and e is an adroitness;2 is a low level ,3 is a below the average level, 4 is a average level, 5 is a above the average level

On the basis of this the most numerous subgroups were determined consisting from pupils with limit deviations in pattern of breathing. Namely: children with expressively prolonged inspiration, with expressively shorted and expressively prolonged expiration, children with low volume tidal , with high volume tidal of inspiration rate, low volume tidal of inspiration rate, pupils with tendency to broncho-obstructive syndrome and with tendency to restriction as well as pupils with expresses bradypnoea. Distribution of development levels of common physical qualities with allowances made for specified limit deviations of spontaneous breathing is represented in Table 2. Analyzing data shown in Table 2 it is should be noted that only 6-10 pupils of all number of investigated pupils had expressed deviations by separate parameters of breathing. That's why 10 for further analysis we were used percentile approach which is allow to operate with small selections and balance type of distribution of parameter in group. The table has painted squares where distinguishes from group distribution of separate qualities development levels are non-significant or same as group at all, represented in first string of table of data. Regarding other data it is possible to consolidate absolutely evidentially about distinguish of it from group. First of all it is should be pointed for expressed deviations in pattern of breathing concerned with development of separate physical qualities which could be completely fairly used at forecasting of development of later ones. Thus, with development of endurance 5 connected parameters of breathing pattern, 3 for adroitness, 2 for quickness and strength and one with flexibility.

Table 2. Level of development of physical qualities of elementary school pupils with allowances made for expressed deviations in pattern of spontaneous breathing (%) Physical qualities and levels of development endurance quickness strength flexibility adroitness

Indicators of 1) x> x> x> x> whole group 17 15 27 41 53 23 177 45 28 8 18 35 39 14 13 48 33 13 7 | Tinsp,s 29 57 14 o o I Texp, s 40 20 020 | Texp, s 33 33 33 o |Vt, l o o t Vt/Tinsp, l/s o I o I Vt/Texp, l/s 4 14 o 4 14 o I Tinsp/Texp 33 o I o t T insp/Texp 14 I BR, 1/ min 33 5o 17 o 8 1 o

11 Higher level of endurance is forecasted by decreasing of breathing frequency while staying calm and by increasing of inspiration and expiration duration with more expressed relative prevailing of expiration duration. In separate cases high level of endurance is forecasted by expressed decreasing of expiration duration but less significantly well at such values tidal of expiration duration it is quite often (in 40% of cases) low and below the average level of endurance is forecasted. The most important of all pattern's parameters the inspiration duration factor is which at increasing in 86% of all cases forecasts level of endurance not below the average which is significantly differs from data in group. The same parameter forecasts development of adroitness in 100% of all cases, which is at above the average level in 71% of all cases and at the average level in 29% and variants of decreasing of adroitness is absent at all. The same level of occurrence has the forecasting of development of adroitness by decreasing of breathing frequency while staying calm which forecasts level of adroitness above the average in 83% of all cases and the average level in 17% of all cases. It is should be noted separately that at relative increasing of expiration duration the level of adroitness development is very limited which is important regarding to distinguishes of breathing pattern specific for development of endurance. The informative enough is that any of specified parameters of breathing pattern is not significant for development of quickness, strength and flexibility. Taking into consideration data of group investigation of breathing pattern's factors limiting influence for development of physical qualities is quite clearly determined by other factors of the later one. By development of quickness evidences about a fact that expressed increasing of volume tidal of inspiration rate and decreasing of volume tidal of expiration rate to a greater or lesser degree limit development of quickness. Thus, in 67% of all cases increasing of volume tidal of inspiration rate determines level of quickness which is below the average and in 43% of decreasing of volume tidal of expiration rate cases development of quickness is at low level. The attention should be given to the fact that mentioned above parameter of breathing pattern significantly limits development of strength abilities which in 57% of its registration cases are at low level of development. Less expressed but quite significant influence on development of strength abilities the index of breathing capacity has which in 50% of cases forecasts insufficient development of strength. At development of flexibility the parameters of ratio inspiration and expiration duration are quite differed that is increasing of this parameter of breathing parameter is significantly limits development of this physical quality and in most cases (58%) at below the average and average level is.

12 Conclusion. Taking into consideration data obtained it is should be noted that development of separate physical qualities is quite clearly connected with breathing pattern. At this from one hand means and approaches of movement education at development of separate physical qualities influence on formation of corresponding pattern and from the other hand pattern of spontaneous breathing determines opportunities of development of later ones. From these positions by our opinion it is necessary to pay attention for those parameters of breathing pattern which significantly limits development of physical qualities as it shown on example of quickness, strength, flexibility and in a less degree adroitness. The implementation of specialized breathing exercises and corrective respiratory gymnastics is possible allowing increasing opportunities of development of separate physical qualities. Characterizing data obtained in a whole it is should be noted that offered supposition got certain confirmation which require further research both regarding forecasting of separate physical qualities development and regarding methodical provision of corrective measures.

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References

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13 6. Bowler SD, Green A, Mitchell CA (1998) Buteyko breathing techniques in asthma: a blinded randomised controlled trial. Med J of Australia; 169: 575-578.

This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited.

Conflict of interest: None declared.

Received: 15.02.2013. Revised: 15.03.2013. Accepted: 18.05.2013.

14 Journal of Health Sciences (J of H Ss) 2013; 3(5): 15-28 The journal has had 4 points in Ministry of Science and Higher Education of Poland parametric evaluation. Part B item 683.

POZIOM WIEDZY O ZAĆMIE WŚRÓD PACJENTÓW Level of the knowledge about cataract amongst patients

Iwona Jaworska, Irena Wrońska

Katedra Rozwoju Pielęgniarstwa. Uniwersytet Medyczny w Lublinie Cathedral of the Development of the Nursing. Medical University in Lublin

Autor do korespondencji Author for the correspondence Iwona Jaworska

email: [email protected]

Słowa kluczowe: zaćma, badanie, wiedza, edukacja.

Keywords: cataract, examination, knowledge, education.

Streszczenie

Wprowadzenie: Wiedza na temat chorób jest bardzo istotnym czynnikiem, wpływającym na stan zdrowia człowieka. W szczególności dotyczy to takich chorób, jak zaćma, która dotyka obecnie wielu ludzi, powodując utratę wzroku. Problem ten jest jednak odwracalny, o czym nie wie wielu dotkniętych nią pacjentów. Brak wiedzy o objawach zaćmy może prowadzić do lekceważenia pojawiających się problemów ze wzrokiem. Dlatego podjęto próbę zbadania poziomu wiedzy mieszkańców miasta i wsi na temat zaćmy, chcąc sprawdzić, czy poziom wiedzy społeczeństw wiejskich jest wyraźnie niższy od społeczeństw zamieszkujących miasta. Pozwoli to na określenie zasięgu i grupy docelowej dla kampanii informacyjnej o zaćmie. Cel pracy: Celem pracy było zbadanie poziomu wiedzy na temat zaćmy wśród pacjentów placówek Podstawowej Opieki Zdrowotnej będących mieszkańcami Radomia i podradomskich wsi. Materiał i metoda: Badanie ankietowe przeprowadzono wśród 100 pacjentów POZ regionu radomskiego.

15 Wyniki badań: Analiza uzyskanych wyników wykazała brak statystycznie istotnej zależności pomiędzy miejscem zamieszkania a poziomem wiedzy o zaćmie. Jednak generalnie poziom wiedzy o zaćmie jest stosunkowo niski. Ponad połowa badanych nie wie, czym jest zaćma, a 37% respondentów nie potrafi wymienić choćby jednego potencjalnego objawu tej choroby. Dodatkowo 41% badanych deklaruje zupełny brak wizyt u lekarza okulisty. Wnioski: W badaniach stwierdzono brak statystycznej zależności pomiędzy miejscem zamieszkania a częstotliwością wizyt u lekarza okulisty, wiedzą o czynnikach ryzyka, objawach i leczeniu zaćmy oraz gotowością do poddania się operacji w przypadku zdiagnozowania zaćmy. Stwierdzono także niski poziom wiedzy ogółu badanych, co wskazuje na potrzebę działań edukacyjnych, skierowanych do wszystkich członków społeczeństwa, niezależnie od miejsca zamieszkania czy tez innych uwarunkowań demograficzno-społecznych.

A bstract

Introduction: The knowledge about illnesses is a crucial factor, affecting the medical condition of the man very much. In particular it is regarding such illnesses, as cataract which is hurting many people at present, causing loss of the eyesight. However this problem is reversible what many patients touched with it don't know about. The lack of knowledge about manifestations can conduct cataract for disregarding appearing problems with the eyesight. Therefore an attempt to search the level of the knowledge of city dwellers and villages were made about cataract, wanting to check, whether the level of the knowledge of country societies is clearly lower than societies inhabiting cities. It will allow for determining the reach and the target group for the information campaign about cataract. Purpose: the aim of the study was to investigate the level of knowledge of cataracts among patients of primary health care as the inhabitants of Radom and podradomskich villages. Material and method: a survey was conducted among 100 patients ITEM 430 region. Results of research: analysis of the results showed no statistically significant relationship between place of residence and the level of knowledge about zaćmie. However, the overall level of knowledge of zaćmie is relatively low. More than half of the respondents do not know what is a cataract, and 37% of respondents unable to name even one potential symptom of this disease. In addition, 41% of respondents declare the complete lack of visits to the specialist. Conclusions: In studies found no statistical relationship between place of residence and the

16 frequency of visits to an eye specialist, knowledge about risk factors, symptoms and treatment of cataracts and a readiness to undergo surgery for diagnosis of cataracts. It was also a low level of general knowledge.

WPROWADZENIE Wiedza na temat chorób i ich profilaktyki stanowi istotny czynnik wpływający na stan zdrowia człowieka. W szczególności dotyczy to takich chorób, jak zaćma - choroby dotykających ogromnej rzeszy ludzi, ale za to choroby, w której utrata wzroku jest odwracalna. Obecnie szacuje się, że na świecie problem zaćmy dotyka ok. 27 mln ludzi w różnym wieku. Z zaćmą żyje też ponad pół miliona Polaków [1].

Najczęstszą postać zaćmy stanowi tzw. „zaćma starcza”. W okulistyce stanowi ona jeden z najczęściej diagnozowanych problemów i jednocześnie jest ona główną przyczyną ślepoty [2]. Zaćma to choroba polegająca na częściowym lub całkowitym zmętnieniu soczewki oka. W zależności od stopnia zaawansowania można wyróżnić zaćmę: niedojrzałą, dojrzałą, przejrzałą oraz zaćmę Morgagniego [3]. Zaćma związana z wiekiem dotyczy w jednakowym stopniu obu płci, jej początki mogą występować po 40 roku życia, a ujawnia się z reguły około 50-60 r.ż., znacznie obniżając jakość ich życia [4]. Szacuje się, że u ponad 40% ludzi po 75 r.ż. występuje poważne pogorszenie widzenia, u 90% zaobserwować można zmętnienie soczewki [3].

Zapobieganie postępowi zaćmienia soczewki polega na stosowaniu najczęściej w formie kropli do oczu rozmaitych preparatów farmakologicznych mających na celu poprawę metabolizmu soczewkowego [5,6]. W przypadku zaćmy związanej z wiekiem zmętniałą soczewkę usuwa się operacyjnie, wszczepiając w jej miejsce soczewkę sztuczną. Leczenia zaćmy i spowodowanej nią ślepoty składa się dwóch elementów: 1. Operacyjnego usunięcia zmętniałej soczewki metodą fakuemulsyfikacji, 2. Optycznego skorygowania zmniejszonej mocy łamiącej oka bezsoczewkowego [3].

17 Zaćma jest czynnikiem w znacznym stopniu pogarszającym jakość życia ludzi starszych, chociaż w chwili obecnej można ją usunąć w każdym wieku. Przeciwwskazaniem do przeprowadzenia zabiegu operacyjnego może być jedynie stan ogólny i psychiczny pacjenta [1]. Dlatego tak istotny jest poziom wiedzy pacjentów na temat tej choroby, możliwości jej diagnozowania i leczenia. Wiele bowiem osób może nie zdawać sobie sprawy z przyczyn pogarszającego się widzenia oraz z tego, że jego ostrość można przywrócić. Z tego względu podjęto próbę zbadania poziomu wiedzy na temat zaćmy losowo wybranych pacjentów placówek Podstawowej Opieki Zdrowotnej w Radomiu oraz oceny, czy stan wiedzy o tej chorobie jest słabszy wśród mieszkańców wsi.

CEL PRACY Celem pracy było zbadanie poziomu wiedzy na temat zaćmy wśród losowo wybranych pacjentów placówek Podstawowej Opieki Zdrowotnej będących mieszkańcami Radomia i podradomskich wsi. Główny problem badawczy stanowiło pytanie: Czy poziom wiedzy o zaćmie wśród pacjentów POZ zależy w istotny sposób od miejsca zamieszkania? Pytanie to wyznaczyło problemy szczegółowe: 1. Czy miejsce zamieszkania wpływa na częstotliwość wizyt u lekarza okulisty? 2. Czy wiedza mieszkańców wsi o czynnikach ryzyka, objawach i leczeniu zaćmy jest w istotny sposób słabsza od wiedzy mieszkańców miasta? 3. Czy potencjalna gotowość do zgody na operację zaćmy jest determinowana miejscem zamieszkania?

MATERIAŁ I METODA Badaniom poddano 100 osobową grupę pacjentów losowo wybranych placówek Podstawowej Opieki Zdrowotnej Radomia i powiatu radomskiego. Badania prowadzono w listopadzie 2010 roku przy zastosowaniu metody sondażu diagnostycznego. Wykorzystano niestandaryzowany kwestionariusz ankiety własnej konstrukcji, obejmujący 19 pytań (3 pytania otwarte, 15 pytań skategoryzowanych, 1 pytanie skategoryzowane z kafeterią otwartą). Badania były całkowicie dobrowolne i anonimowe.

W kwestionariuszu przewidziano jednak tzw. metryczkę, która pozwoliła na pozyskanie wiedzy dotyczącej cech demograficzno-socjologicznych respondentów. Pozyskane w ten sposób dane wskazują, iż w grupie badawczej najliczniej reprezentowane były osoby w wieku

18 51-60 lat (32%) oraz w wieku 41-50 lat (28%), najmniej zaś było respondentów najmłodszych - w wieku poniżej 30 lat (8%) oraz w wieku 31-40 lat (15%) (wykres 1).

Wykres 1. Wiek respondentów

Wykres 2. Poziom wykształcenia respondentów

Badani prezentowali różny poziom wykształcenia, w ogólnym zarysie odzwierciedlający poziom wykształcenia Polaków. Najliczniejsza grupa respondentów legitymowała się wykształceniem średnim (46%) i zawodowym (32%). Znacznie rzadziej ankietę wypełniały osoby z wykształceniem podstawowym i wyższym (po 11%) (wykres 2).

19 Wykres 3. Miejsce zamieszkania badanych pacjentów

Z punktu widzenia celów prowadzonych badań najistotniejsze jest jednak pozyskanie danych zarówno od mieszkańców miasta, jak i mieszkańców wsi, przy czym ta ostatnia grupa było nieco liczniej reprezentowana w badaniach (wykres 3).

Uzyskane wyniki poddane zostały analizie statystycznej testem chi-kwadrat Paersona. Zmienną stanowiło miejsce zamieszkania. Za poziom istotności statystycznej przyjęto wartość p < 0,05.

WYNIKI BADAŃ Częstotliwość wizyt u lekarza okulisty nie jest w istotny statystycznie sposób zależna od miejsca zamieszkania (p>0,05) i jest stosunkowo wysoka. 38% ogółu badanych (37,8% mieszkańców miast i 38,2% mieszkańców wsi) bada wzrok co najmniej raz w roku, a 16% robi to dokładnie ze wskazaniami lekarza okulisty. Warto jednak podkreślić, iż 41% respondentów w ogóle nie kontroluje wzroku (tab. 1).

20 Tabela 1. Częstotliwość wizyt u okulisty zależnie od miejsca zamieszkania Częstotliwość wizyt u ogółem mieszkańcy miasta mieszkańcy wsi okulisty: n % n % n % Co najmniej raz do roku 38 38,0 17 37,8 21 38,2 Ściśle wg wskazań lekarza 16 16,0 7 15,6 9 16,4 okulisty Raz na dwa-trzy lata 5 5,0 3 6,7 2 3,6 W ogóle nie chodzę 41 41,0 18 40,0 23 41,8 Razem 100 100 45 100 55 100 chi-kwadrat = 0,487 df = 3 p>0,05

Tabela 2. Umiejętność określenia definicji zaćmy ogółem mieszkańcy miasta mieszkańcy wsi Zaćma polega na: n % n % n % postępującym mętnieniu oka 43 43,0 19 42,2 24 43,6 postępującym zaniku nerwu 15 15,0 6 13,3 9 16,4 wzrokowego nie wiem 42 42,0 20 44,4 22 40,0 Razem 100 100 45 100 55 100 chi-kwadrat = 0,278 df = 2 p>0,05

Bardzo wiele spośród badanych osób w ogóle nie wie czym jest zaćma. 42% respondentów przyznaje się do tej niewiedzy, zaś 15% uważa, że zaćma jest chorobą polegającą na postępującym zaniku nerwu wzrokowego. Pozostali (43%) podali prawidłową definicję zaćmy (tab. 2), można jednak z dużym prawdopodobieństwem przyjąć, że pewien odsetek tej grupy zrobił to przypadkowo, zakreślając pierwszą odpowiedź z listy. Brak istotności statystycznej uzyskanej wartości testu chi-kwadrat (p>0,05) pozwala przyjąć, że niski poziom wiedzy o chorobie nie jest uwarunkowany miejscem zamieszkania.

Tabela 3. Czynniki ryzyka zaćmy według respondentów ogółem mieszkańcy miasta mieszkańcy wsi Czynniki ryzyka zaćmy n % n % n % Wiek powyżej 50 r. ż. 61 61,0 28 62,2 33 60,0 Długotrwałe stosowanie leków w tym 8 8,0 4 8,9 4 6,7 kortykosteroidów Choroby metaboliczne np. 21 21,0 8 17,8 13 23,6 cukrzyca Inne 11 11,0 8 17,8 3 5,5 Nie wiem 36 36,0 14 31,1 22 40,0 Razem 137 137,0 62 137,8 75 135,8 chi-kwadrat = 4,464 df = 4 p>0,05 *ze względu na możliwość wyboru kilku odpowiedzi wyniki nie sumują się do 100%

21 Znaczny odsetek mieszkańców Radomia i okolic (36%) nie posiada żadnej wiedzy o czynnikach ryzyka zaćmy, przy czym również w tym przypadku poziom wiedzy nie jest zależny w sposób istotny statystycznie od miejsca zamieszkania (p>0,05). Najbardziej znanym czynnikiem ryzyka zachorowania jest wiek. 61% badanych zdaje sobie sprawę z tego, że choroba ta dotyka przede wszystkim osoby starsze. 21% respondentów wskazało również na choroby metaboliczne (np. cukrzyca) jako czynnik ryzyka, 11% na takie czynniki, jak: zakażenia śródmaciczne (np. różyczka), zaburzenia genetyczne w chwili urodzenia i choroby matki podczas ciąży, zaś 8% wśród czynników ryzyka wymieniło także długotrwałe stosowanie leków, w tym kortykosteroidów (tab. 3).

Tabela 4. Wiedza mieszkańców Radomia i okolic o wczesnych objawach zaćmy ogółem mieszkańcy miasta mieszkańcy wsi Wczesne objawy zaćmy n % n % n % Ból oka 13 13,0 5 11,1 8 14,5 Nieostre widzenie 54 54,0 25 55,6 29 52,7 Zjawisko olśnienia przy 9 9,0 4 8,9 5 9,1 patrzeniu na źródło światła Konieczność częstej zmiany 12 12,0 9 20,0 3 5,5 okularów Swędzenie oka 5 5,0 1 2,2 4 7,3 Nie wiem 37 37,0 15 33,3 22 40,0 Razem 130 130,0 59 131,1 71 129,1 chi-kwadrat = 6,187 df = 5 p>0,05 *ze względu na możliwość wyboru kilku odpowiedzi wyniki nie sumują się do 100%

Wiedza badanych osób o pierwszych objawach zaćmy nie jest w istotny statystycznie sposób zależna od miejsca zamieszkania (p>0,05). Niezależnie od tej zmiennej większość respondentów (54%) za najważniejszy objaw choroby uznaje spadek ostrości widzenia. O zjawisku olśnienia podczas patrzenia na źródło światła słyszało 9% badanych. 13% badanych uważa, ze ból oka może być objawem zaćmy, a według 12% taki objaw może stanowić uczucie konieczności częstej zmiany okularów. Jednak aż 37% nigdy nie słyszało o żądnych objawach tej choroby (tab. 4).

22 Tabela 5. Wiedza mieszkańców Radomia i okolic o późnych objawach zaćmy ogółem mieszkańcy miasta mieszkańcy wsi Późne objawy zaćmy n % n % n % Zaczerwienienie oka 13 13,0 6 13,3 7 12,7 Łzawienie oka 10 10,0 6 13,3 4 7,3 Kolory stają się wyblakłe 18 18,0 7 15,6 11 20,0 Postrzegane są jedynie kontury dużych 43 43,0 19 42,2 24 43,6 przedmiotów Nie wiem 40 40,0 19 42,2 21 38,2 Razem 124 124,0 57 126,7 67 121,8 chi-kwadrat = 1,299 df = 4 p>0,05 *ze względu na możliwość wyboru kilku odpowiedzi wyniki nie sumują się do 100%

Zmienna miejsca zamieszkania nie ma statystycznie istotnego wpływu (p>0,05) na rozpoznawanie późnych objawów zaćmy. 40% ogółu badanych przyznaje się do całkowitej niewiedzy w tym zakresie, zaś 43% za późny objaw zaćmy uważa coraz silniejsze „zacieranie” widzenia aż do sytuacji, w której postrzegane są jedynie kontury dużych przedmiotów. Dodatkowo badani wymieniali takie późne objawy choroby, jak zaczerwienieni oczu (13%), łzawienie (10%), czy też blaknięcie postrzeganych kolorów (18%) (tab. 5).

Tabela 6. Możliwość wyleczenia zaćmy w opinii respondentów ogółem mieszkańcy miasta mieszkańcy wsi Możliwość wyleczenia n % n % n % jest uleczalna 78 78,0 36 80,0 42 76,4 nie jest uleczalna 4 4,0 0 0,0 4 7,3 nie wiem 18 18,0 9 20,0 9 16,4 Razem 100 100,0 45 100,0 55 100,0 chi-kwadrat = 3,496 df = 2 p>0,05

Badani mieszkańcy Radomia i okolic (niezależnie od miejsca zamieszkania p>0,05) w znacznej większości (78%) zdają sobie sprawę z tego, ze zmiany widzenia w zaćmie są odwracalne. Pomimo tego niepokoi fakt, że 18% nie wie nic na ten temat, zaś 4% jest przekonanych o nieuleczalności choroby (tab. 6).

23 Tabela 7. Reakcje respondentów w przypadku stwierdzenia u siebie wczesnych objawów zaćmy W przypadku stwierdzenia ogółem mieszkańcy miasta mieszkańcy wsi objawów zaćmy: n % n % n % Poszłabym / poszedłbym do 62 62,0 29 64,4 33 60,0 lekarza okulisty Poszłabym / poszedłbym do 26 26,0 11 24,4 15 27,3 lekarza rodzinnego Brak odpowiedzi 11 11,0 5 11,1 6 10,9 Nie wiem 1 1,0 0 0,0 1 1,8 Razem 100 100,0 45 100,0 55 100,0 chi-kwadrat = 1,155 df = 3 p>0,05

W przypadku stwierdzenia u siebie wczesnych objawów zaćmy 62% badanych mieszkańców Radomia i okolic zgłosiłoby się do lekarza okulisty, zaś 26% odwiedziłoby najpierw lekarza rodzinnego. Pomimo pewnych różnic procentowych w zachowania respondentów zamieszkujących miasta i tereny wiejskie, zależność ta nie jest istotna statystycznie (p>0,05). Pomimo iż tylko1% badanych nie wie, jak zachowałby się w takiej sytuacji, to warto zauważyć 11% respondentów, którzy nie udzielili na to pytanie odpowiedzi. Można przypuszczać, że jest to grupa osób, która nie zna objawów zaćmy (tab. 7).

Tabela 8. Reakcje respondentów w przypadku zdiagnozowania zaćmy W przypadku ogółem mieszkańcy miasta mieszkańcy wsi zdiagnozowania zaćmy: n % n % n % Zapisałabym / zapisałbym się na pierwszy wolny 85 85,0 37 82,2 48 87,3 termin operacji Zapisałabym / zapisałbym się na odległy termin 13 13,0 7 15,5 6 10,9 operacji Nie zdecydowałabym / zdecydowałbym się na 2 2,0 1 2,2 1 1,8 operację Razem 100 100,0 45 100,0 55 100,0 chi-kwadrat = 0,505 df = 2 p>0,05

Wysoka świadomość możliwości wyleczenia zaćmy nie pozostaje bez wpływu na skłonność badanych do poddania się leczeniu. Aż 85% respondentów w sytuacji zdiagnozowanej choroby bez wahania zapisałoby się na pierwszy wolny termin operacji. Tylko 13% zwlekałoby z poddaniem się leczeniu operacyjnemu, zaś 2% deklaruje brak zgody na podjęcie takiej interwencji. Na te zachowania badanych osób nie ma żadnego wpływu miejsce zamieszkania (p>0,05) (tab. 8).

24 DYSKUSJA Wiedza o chorobie składa się na świadome decyzje, które dotyczą rzeczywistych zachowań zdrowotnych. Brak wiedzy może prowadzić do lekceważenia wielu objawów choroby. Dlatego podjęto próbę zbadania poziomu wiedzy mieszkańców miasta i wsi na temat zaćmy. W podjętych i prezentowanych badaniach chodziło przede wszystkim o zidentyfikowanie obszarów, które wymagają szerokiej kampanii informacyjnej, a także określenie elementów warunkujących wiedzę społeczeństwa o tej chorobie. W szczególności starano się dociec, jaki jest wpływ miejsca zamieszkania na poziom wiedzy pacjentów placówek Podstawowej Opieki Zdrowotnej mieszkających w Radomiu i okolicznych wsiach.

Przystępując do badań przyjęto wstępną hipotezę o występowaniu zależności pomiędzy miejscem zamieszkania badanych pacjentów a poziomem ich wiedzy o zaćmie. Jednak analiza uzyskanych wyników zmusza do odrzucenia tej hipotezy. Test niezależności chi- kwadrat Pearsona przy wszystkich badanych zmiennych nie wykazał statystycznie istotnych różnic zależnie od miejsca zamieszkania. Również A. Kotowski, badając mieszkańców województwa łódzkiego nie stwierdził zależności pomiędzy miejscem zamieszkania a udziałem w akcjach profilaktycznych [7].

Zaćma to choroba soczewki oka, polegająca na częściowym lub całkowitym jej zmętnieniu, co sprawia, że soczewka traci swą przejrzystość [3]. Jednak wiedza przeciętnego pacjenta nie obejmuje takie definicji i ponad połowa respondentów w badaniach własnych albo przyznaje się do całkowitej niewiedzy, czym jest zaćma, albo też podaje całkowicie błędne określenie choroby. Również badania przeprowadzone w 2010 roku przez CBOS na grupie pacjentów po operacji zaćmy oraz na grupie osób oczekujących na taką operację, pokazały bardzo niski poziom wiedzy społeczeństwa o tej chorobie [8]. Skoro zatem osoby dotknięte chorobą prezentują niski poziom wiedzy o niej, trudno oczekiwać, aby pozostali członkowie społeczności pacjentów posiadali szeroką wiedzę.

Ponad połowa badanych mieszkańców Radomia i okolic potrafi wymienić podstawowy czynnik ryzyka zaćmy, jakim jest wiek. Jednak w dobie coraz częstszego stosowania kortykosteroidów, niepokoi fakt niskiej świadomości wpływu tej grupy leków na ryzyko wystąpienia zaćmy. Jak bowiem donosi M. L. Kowalski [9] na podstawie badań R. G. Cumminga i in. [10] istnieje wykazana statystycznie zależność pomiędzy przyjmowaniem

25 wziewnych kortykosteroidów a ryzykiem zachorowania na podtorebkowy typ zaćmy. Tymczasem w grupie badanych pacjentów POZ z takiej zależności zdaje sobie sprawę zaledwie 8% respondentów.

Niewiele ponad połowa (54%) badanych pacjentów kojarzy nieostre widzenie z zaćmą. Można zatem przypuszczać, że zmniejszanie ostrości widzenia wielu pacjentów zlekceważy, chociaż stosunkowo wysoka częstotliwość wizyt u okulisty może pozwolić na szybką diagnozę choroby. Skoro jednak 41% badanych w ogóle nie odwiedza okulisty i nie potrafi wymienić choćby jednego objawu zaćmy to szanse na utratę wzroku w tej grupie pacjentów są bardzo wysokie. Co jednak ważne 78% respondentów wie, że utrata wzroku w zaćmie jest odwracalna, a w przypadku wystąpienia problemów ze wzrokiem 88% badanych deklaruje natychmiastową wizytę u lekarza (okulisty lub rodzinnego), co jest pozytywnym akcentem w prowadzonych badaniach. Większość badanych bez wahania poddałoby się również leczeniu operacyjnemu.

Brak odnośnych badań w literaturze przedmiotu nie pozwala na porwanie uzyskanych wyników z liczniejszymi grupami pacjentów, bądź też z pacjentami pochodzącymi z innych regionów Polski. Badanie przeprowadzone przez CBOS [8], były prowadzone na zlecenie prywatnej firmy i obejmowały wyłącznie osoby chore, u których z pewnością poziom wiedzy o chorobie jest wyższy niż w grupie osób, które nigdy z tą chorobą się bezpośrednio nie zetknęły. Dlatego zaznacza się wyraźna konieczność przeprowadzenia ogólnopolskich badań dotyczących stanu wiedzy społeczeństwa o zaćmie. Już jednak na podstawie prezentowanych w niniejszym artykule wycinkowych badań można wskazać na potrzebę szeroko zakrojonej kampanii informacyjnej. Największą skuteczność miałaby zapewne kampania medialna, jak bowiem donoszą badacze ponad 80% społeczeństwa uzyskuje informacje na temat zdrowia przez media [11,12]. Konkludując należy też zauważyć, że wobec niskiego poziomu wiedzy pacjentów POZ, duże wyzwanie stoi przed pielęgniarkami środowiskowymi, które w ramach konieczności pełnienia funkcji edukacyjnej i promocji zdrowia [13], powinny we współpracy z lekarzem rodzinnym, informować pacjentów o objawach, ryzyku i postępowaniu w przypadku stwierdzenia objawów takich chorób, jak zaćma.

WNIOSKI 1. Miejsce zamieszkania nie wpływa na częstotliwość wizyt u lekarza okulisty.

26 2. Wiedza mieszkańców wsi o czynnikach ryzyka, objawach i leczeniu zaćmy nie jest w istotny sposób niższa od wiedzy mieszkańców miasta. 3. Potencjalna gotowość do zgody na operację zaćmy nie jest determinowana miejscem zamieszkania. 4. Istnieje potrzeba szeroko zakrojonej kampanii informacyjnej, dotyczącej przede wszystkim objawów zaćmy i zachowania w przypadku ich stwierdzenia. 5. Kampania medialna powinna być skierowana do ogółu społeczeństwa, niezależnie od miejsca zamieszkania, a zatem najbardziej skuteczna powinna być tym przypadku kampania medialna.

Open Access

PIŚMIENNICTWO

[1] Iwaszkiewicz-Bilikiewicz B. Zaćma (cataracta). Geriatra 2008;2:252-254. [2] Fletcher A. E., Vijaykumar V., Selvaraj S., Thulasiraj R. D., Ellwein L. B., The Madurai Intraocular Lens Study III. Visual functioning and quality of life outcomes. Am J Ophthalmol 1998;125:26-35. [3] Szaflik J., Izdebska J., Zaleska A. Zaćma - najczęstsza przyczyna uleczalnej ślepoty. Przew Lek 2000;2(10):78-86. [4] Oleś M., Oleś P., Toczołowski J., Klonowski P. W kierunku psychomedycznych wyznaczników poczucia jakości życia u chorych z zaburzeniami widzenia. Sztuka Leczenia 2003;1 (9):29-36. [5] Kańska J. Okulistyka kliniczna kompendium. Wrocław: Wyd. Urban & Partner; 2006. [6] Litwin M., Bryg H. Wybrane zagadnienia okulistyczne. Kraków: Wyd. ZamKor; 2005. [7] Kotowski A. Badanie ankietowe nt. wiedzy i potrzeb mieszkańców województwa łódzkiego w zakresie profilaktyki chorób, przeprowadzone metodą CATI. Podsumowanie. Łódź: Wyd. IQ Laboratorium; 2010. [8] CBOS. Ogólnopolskie badanie na temat wiedzy o zaćmie. Warszawa: Alcon; 2010.

27 [9] Kowalski M. L. Stosowanie kortykosteroidów wziewnych a ryzyko zaćmy. Alergia Astam Immunol 1997;2 (3):155-156. [10] Cumming R. G., Mitchell P., Leeder S. R. Use of inhaled corticosteroids and the risk of cataracts. New Eng J Med. 1997;337:8-14. [11] Szymczuk E., Zajchowska J., Dominik A., Makara-Studzińska M., Zwolak A., Daniluk J. Media jako źródło wiedzy o zdrowiu. [12] Vordermark D., Kolbl O., Flentje M. The Internet as a source of medical information. Investigation in a mixed cohort of radiotherapy patients. Strahlenther Onkol 2000;176 (11):532-535. [13] Steciwko A. Wybrane problemy służby zdrowia w Polsce, [w:] Medycyna rodzinna. Sloane P. D., Slatt L. M., Cutris P. (red.). Wrocław: Wyd. Urban & Partner; 1998:59-64.

Conflict of interest: None declared.

Received: 15.02.2013. Revised: 15.03.2013. Accepted: 19.05.2013.

28 Journal of Health Sciences (J of H Ss) 2013; 3(5): 29-38 The journal has had 4 points in Ministry of Science and Higher Education of Poland parametric evaluation. Part B item 683.

ACADEMIC STRESS DUE TO DEPRESSION AMONG MEDICAL AND PARA-MEDICAL STUDENTS IN AN INDIAN MEDICAL COLLEGE: HEALTH INITIATIVES CROSS SECTIONAL STUDY

Balkishan Sharma, Rajshekhar Wavare

Dr. Balkishan Sharma Ph. D. Corresponding Author Associate Professor of Biostatistics, Department of Community Medicine, Sri Aurobindo Medical College and P. G. Institute, Indore, (M. P.), India; E-Mail: [email protected] & [email protected] Phone:(0731) 423101 and, Fax:(0731) 4231010

Dr. Rajshekhar Wavare M. D. (Community Medicine) Co-Author Professor & Head of Department, Department of Community Medicine, Sri Aurobindo Medical College and P. G. Institute, Indore, (M. P.), India; E-Mail: raj wavare@rediffmail .com Phone:(0731) 4231010 and Fax:(0731) 4231010

A bstract: Introduction and aim: Stress is usually a precursor to anxiety and anxiety is usually a precursor to depression, can reduce the efficiency of healthy individuals. This study is aimed to observe the levels of depression, leads to stresses and its effect on vital parameters during academic curriculum. Materials and Methods: A prospective cross-sectional study is designed which conducted at Sri Aurobindo Medical College and P. G. Institute, Indore, (M. P.) India. 132 final year MBBS and Physiotherapy students of academic year 2012-13 were selected as subjects. The height, weight, pulse rate and blood pressure were taken before and during pre-university examination. Zung’s scale was used for assessment of depression. Results: There was highly significant difference in vital parameters [PR (t=7.86, P<0.001), SBP (t=5.39, P<0.001) and DBP (t=3.92, P<0.001)] during examination. The depression level was high as Extreme major depression was observed in 7.9% of boys and 11.8% of girls from MBBS and 10.7% of girls from Physiotherapy. SDS Index of depression was more in girls as compared to boys. Conclusion: It was observed that academic examinations for Medical and Para-medical students are stressful and produce changes in vital parameters which affected their academic performance. Academics and examinations are the most powerful stressors in Medical and Para-medical students. ACADEMIC STRESS DUE TO DEPRESSION AMONG MEDICAL Key Words: Depression, Stress, Anxiety, Stressor, Pulse rate and Vital Parameters. Abbreviation: PR-Pulse Rate, SBP- Systolic Blood Pressure, DBP-Diastolic Blood Pressure and SDS-Standardized Depression Scale

Introduction: Depression is a disorder of aware of fearfulness of examinations and mood involves varying levels of sadness and especially about practical examination in a despair associated with stress. Depression has professional college. Whether it is a test or an received a lot of attention in the media and is annual promotion examination, it does cause far more widely accepted today than it has to loose some sleep which leads to anxiety and ever been in the past. The term “stress” was depression. It is confirmed the general firstly employed in the 1930’s by the impression that there is a considerable amount endocrinologist Hans Selye [1]. Stress is a of stress among medical students [10] and the response to any event which is perceived to perceived stress was significantly higher alter or threaten our well-being and is a among female students [11]. cognitive (thought) process; is the body's reaction to a change that requires a physical, High levels of perceived stress existed in the mental or emotional response. Indian first and second year undergraduate medical education system resembles colonial legacy: students [12]. Negative affect, depressive educational structure, curriculum design and mood, and salivary cortisol were elevated pattern of examination [2]. But too much during exams [13]. Stress, depression, and stress can cause a lot of discomfort and can troubled relationships may have synergistic get in the way of being able to focus and inflammatory effects: loneliness, subclinical achieve. depression, and major depression enhance As a college student all have a lot of demands inflammatory responses to an acute stressful on them, which it can be difficult to balance. event [14]. Too much stress pooled with other Stress is a term in Psychology and Biology, psychological factors can be damaging and which in the more recent decades, has become can disrupt normal functioning of the students. a common place of popular parlance [3]. It may lead to further psychological Studies suggest that high levels of stress and complications causing psychological psychological morbidity occur in health care morbidity. Subjective experience of stressors profession students [4]. Considerable research in students can lead to poor quality of life, has investigated stressors and psychological condensed self-esteem resulting in lower self morbidity in medical, dental and nursing confidence, compromised ability to cope with students [5-9]. However, few studies have daily life problems and may influence been undertaken in physiotherapy students. student's academic performance [15-16]. This study explores different levels of Students that drop out of professional depression acquired stresses and institutions actually do not lack intellectual psychological morbidity in undergraduate ability, but emotional problems and poor medical and physiotherapy students. motivation lead to failure [17]. Stressors experienced by third-year medical radiation Depression is actually a particular pattern of sciences students during their clinical disturbing psychological and physiological education have been reported [18]. reactions that occur when an environment event threatens important motives. Depression Various physiological studies have shown that leads to stress which is caused by an existing depression leads to stress and which can affect stress-causing factor or "stressor." All are the physical health even the vital parameters.

Journal of Health Sciences (J of H Ss) 2013; 3(5) Page 30 ACADEMIC STRESS DUE TO DEPRESSION AMONG MEDICAL These changes include increase in pulse rate Index). SDS Raw Index=(Raw Score/80 total and blood pressure. The present study was points)x100 and SDS Index=SDS Raw aimed to assess the stress due to depression Index*1.25.The score obtained was analyzed and its effect on vital parameters during by using scale of depression according to academic examination in final year medical Zung’s categorization as <50 is Normal, <60 and paramedical students. is Mild Depression, <70 is Moderate or Marked Major Depression and >70 is Severe Materials and Methods: A prospective cross or Extreme Major Depression. Pre readings sectional study is design to assess the levels of (before examination) for Pulse Rate, Systolic depression, leads to stresses and its effect on Blood Pressure and Diastolic Blood Pressure vital parameters during academic curriculum. were compared with post readings (at the time The study was carried out at Sri Aurobindo of examination). Body Mass Index was Medical College and P. G. Institute, Indore, calculated for all the students [20]. (M. P.) India. The final year MBBS and Physiotherapy students of academic year Statistics: The Data were entered into the 2012-13 appearing for university examination computer database. The responses of were selected as subjects. There were 148 frequencies were calculated and analyzed by students out of which 132 participated in the using statistical software SPSS version 11.0. study. Ethical approval was obtained from Prevalence of an outcome variable along with Institutional research and ethical committee. 95% confidence interval was calculated. Two months prior to the academic Student’s t-test for paired samples was used to examination height (cm), weight (kg), Pulse compare the mean values of study variable in rate and Blood Pressure were recorded and relation to depression. The descriptive again during academic examination the same statistics like mean and standard deviation of was repeated. The observed mean age of different study variables was calculated. The student was 21.00±2.54 years. Sixteen Zung’s self rating depression scale [19] was students were excluded from the study as they analyzed by categorization of the three levels were absent during examination. After (Mild, Moderate or Marked Major and Severe explaining the purpose of the study a or Extreme Major Depression) of depression questionnaire was provided to one student at a as presence of depression. The probability time just before the start of viva-voce and was value p<0.05 was considered as significant, asked to answer (fill up) the questions in p<0.01 and p<0.001 were considered as highly prescribed format so as to assess their significant. depression level. Results: The findings reported that in MBBS Zung’s scale was used to assess the depression the boys and girls are equally distributed level [19]. The questionnaire consists of whereas in physiotherapy 93% were girls. twenty questions where Likert Scale Format is This may be because of more number of girls used for assessment and scoring of depression opting for physiotherapy course. level. Ten questions based on positive answers and ten negative are included. Each question Table no 1 revealed the weight and height of has answer score from 1 to 4. The option for students of MBBS and Physiotherapy course. each question is (a) None or a little of the time The table 2 showed that of the total selected (b) Some of the time (c) Good part of the time subjects most of the students (58.3%) had and (d) Most or all of the time. The raw score normal weight, 19.7% were overweight (pre is converted to 100 point scale (SDS Raw obese increased category-I), 10.6% in

Journal of Health Sciences (J of H Ss) 2013; 3(5) Page 31 ACADEMIC STRESS DUE TO DEPRESSION AMONG MEDICAL underweight category and 3.8% were in girls as compared to boys during their obesity. Major proportion of boys (68.4%) and academic examination. There was no girls (58.8%) from MBBS course and (51.8%) difference between Mean Depression Score of girls from physiotherapy course were (SDS Index) in the students of MBBS and normal weight. 28.9% boys and 17.6% girls Physiotherapy course during their academic from MBBS course and (30.4%) of girls from examination (Table-3). It is confirmed from physiotherapy course were in pre obese table 4 that there is a highly significant increased category-I. 23.5% and 8.9% girls difference between before and at the time of from MBBS and physiotherapy course examination observations in vital parameters physiotherapy course were found to be such as Pulse rate (p<0.001; two tailed), underweight respectively. It was also observed Systolic Blood Pressure (p<0.001; two tailed) that 8.9% of girls from physiotherapy course and Diastolic Blood Pressure (p<0.001; two were obese. The mean Body mass index for tailed) due to examination stress in all the boys was 23.01 kg/m2 and girls 21.44 kg/m2 students from MBBS and Physiotherapy of MBBS course and 24.05 kg/m2 for boys course (Table-4). Mean pre-readings in all the and 23.95 kg/m for girls of physiotherapy students from MBBS and Physiotherapy course while 23.03 kg/m2 was observed in the course for Pulse rate, Systolic Blood Pressure total population. and Diastolic Blood Pressure were 77.52 ± 7.75 per minute, 120.29 ± 9.66 mm of The scale of depression according to Zung’s Hg and 81.07 ± 8.71 mm of Hg respectively categorization is; <50 is Normal, <60 is Mild and Mean post readings at the time of Depression, <70 is Moderate or Marked Major examination for Pulse rate, Systolic Blood Depression and >70 is Severe or Extreme Pressure and Diastolic Blood Pressure were Major Depression. It is observed in the table 3 84.73 ± 11.24 per minute, 124.76 ± 10.41 mm that 18.4% of boys and 35.3% of girls from of Hg, 83.76± 8.03 mm of Hg respectively MBBS course and 25% of girls from (Table-4). Physiotherapy were normal. It is also seen that more than half (60.5%) of boys and more than Table no. 5 shows that there was highly one-fourth (26.5%) of girls from MBBS significant difference in pulse rate among course and exactly three-fourth (75.0%) of boys before and during the time of boys and approximately one-third (30.4%) of examination (p<0.001) in MBBS course and girls from Physiotherapy had mild depression in girls of both MBBS (p<0.001) and whereas 13.2% of boys and 26.5% of girls physiotherapy course (p<0.008). The systolic from MBBS course and 25% of boys and blood pressure was found to be highly 33.9% of girls from Physiotherapy had significant statistically among boys (p<0.001) marked major depression. 7.9% of boys and in MBBS course and in girls (p<0.001) of 11.8% of girls from MBBS course and 10.7% physiotherapy course. The diastolic blood of girls from Physiotherapy suffered from pressure also showed highly significant extreme major depression (table3). difference among girls (p<0.006) in MBBS course and in girls (p<0.001) of physiotherapy The Mean Depression score (SDS Index) for course. boys was 56.50 and girls 56.29 from MBBS course and 56.25 for boys and 58.96 for girls Discussion-The present study showed that from Physiotherapy course while 57.48 was there was significant difference in vital observed in the total population. It was also parameters (Pulse rate, Systolic Blood observed from the table 4 that the Mean Pressure and Diastolic Blood Pressure) during Depression Score (SDS Index) was more for

Journal of Health Sciences (J of H Ss) 2013; 3(5) Page 32 ACADEMIC STRESS DUE TO DEPRESSION AMONG MEDICAL academic examination. It was also observed higher level of stress in undergraduate that the depression level as indicated by physiotherapy students. Zung’s self-rating depression scale was very high [19].The girls had more depression as Moreover, [33] Steenberger et al. (1993) and compared to boys. A recent research reported [34] Ronald BW (1993) opined that girls have similar findings by [11] Mohsin S. et al. reported exams, as the reason for their stress (2010) that the overall mean perceived stress than their male colleagues. [35] Mamoza MA was significantly higher among female (2008) obtained the response of stress by students and a higher level of perceived stress confirming the higher prevalence of stress in was reported by the students but with the undergraduate medical students. It was contrast that stress was not found to differ observed by [36] Everly GS and Rosenfeld R significantly on the basis of sex as reported by (1981) that stress is a psycho-physiologic [21] Supe AN (1998). Recently, the study [22] arousal occurring in the body as a result of a revealed that the depression and stress were stimulus which becomes a “stressor” by virtue found even in adolescent age. Further, the of the cognitive interpretation of the findings of study revealed that during individual. adolescent period they undergo various The study showed the impact of stress and stresses and adjustment and it depends upon depression and the authors; [3] Mannapur B et their ability to cope with stress in various al. (2010) observed that the students with places like home, school, peers and teachers psychological stress were found to be [22]. Girls had more stress as compared to involved in habits like tobacco chewing and boys and academics and examinations are smoking, as well as alcohol intake. Average the most powerful stressors in medical stress of the professional group is significantly students observed by Sharma BK et al. higher then non-professional group of students (2011) [23]. reflected in the study conducted by [37] Singh A and Singh S (2008). The prevalence of The prevalence of anxiety is much higher than perceived stress seems to be high among medical students, which tends to affect not either depression or stress, with some differences in their findings correlates except only their academic performances but also all aspects of health and the frequency of stress for age among university students, opined by [24] Khadijah S et al. (2013). Various studies seems considerable with little difference [25] Shah C et al. (2009), [10] Reem Rachel A between males and females observed by [38] Babar TS et al. (2004) which correlates (2009) and [21] Supe AN (1998) confirmed the general impression that there is a with the present study. considerable amount of stress among medical students which is common and process Furthermore, the academic examinations in oriented. Earlier, there have been a number of Medical and Para-medical students are found studies of the prevalence of depression in to be stressful due to high levels of depression university students worldwide [26-30]. followed by significant changes in vital However, different studies used different parameters which may affect their academic assessments. Recently, [31] Chen L et al. performances. The study conducted by [39] (2013) found that major depressive disorder Sajjan K and Krupa J (2005) confirms the was seen in 4.0% of Chinese university general impression that there is considerable students. In a study based on stress among amount of stress found among the physiotherapy students conducted by [32] occupational therapy students. Fazaila Sabih et al. (2013) highlighted the

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Summary of the findings: The study this study. A prospective study could be reflected that level of depression was more in carried out with a cohort of all year students in girls as compared to boys. The main stressor all the medical and paramedical colleges in the was related to academic examinations. An territory of Madhya Pradesh to look at the attempt has been made to identify the different levels of academic stress related to depression and related stress profile of final depression. year medical and physiotherapy students at the time of academic examinations. As it is Implications of the study: A high depression confirmed the general impression that there is level may affect not only academic a considerable amount of depression which performances but also all aspects of student leads to stress and produces changes in vital physical health. The stressors should be parameters in final year Medical and Para identified and discussed with individual medical students and it is common and students. As depression which impacted these process oriented. stress in colleges cannot be eliminated. It is worth advisable that teachers can and should Limitations of the study: Authors do a better job and provide review of acknowledge that this is a study with sample academics and exam schedules, more leisure of only final year Medical and Para-medical time activities, better interaction with the students appearing for university examination faculty and proper guidance, advisory services drawn from only one medical college. and peer counseling could do a lot to reduce Furthermore, the findings of this study are the depression. Interventions like reduction of based on self reported information provided levels of depression, perceived by students by students and some potential for reporting approaching exam can be planned while bias may have occurred because of student’s laying more emphasis on regular, day by day interpretation of the questions or simply reading, mock examinations and use of because of inaccuracies of responses or desire question banks could alleviate the fear, to report their emotions in a certain way. It depression and anxieties associated with the could be considered as one of the limitation of university examination.

Conflict of Interest: None Abbreviation: PR-Pulse Rate, SBP- Systolic Blood Pressure, DBP-Diastolic Blood Pressure and SDS-Standardized Depression Scale Open Access

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Table-1: Sex-wise distribution of students according to weight and height MBBS Physiotherapy Parameter Variable Boys Girls Boys Girls 35 -55 1 (2.6) 13 (38.2) 3 (75.0) 18 (32.1) Weight of Student 56-75 25 (65.8) 19 (55.9) 1 (25.0) 33 (58.9) (Kilograms) >75 12 (31.6) 2 (5.9) 0 (0.0) 5 (8.9) TOTAL 38 (100.0) 34 (100.0) 4 (100.0) 56 (100.0) 140-160 0 (0.0) 14 (41.2) 0 (0.0) 39 (69.6) 161-180 Height of Student 27 (71.1) 19 (55.9) 3 (75.0) 17 (30.4) (Centimeters) >180 11 (28.9) 1 (2.9) 1 (25.0) 0 (0.0) TOTAL 38 (100.0) 34 (100.0) 4 (100.0)* 56 (100.0) *The figure in parenthesis denotes the corresponding percentage.

Table-2: Sex-wise distribution of students according to according to Body Mass Index MBBS Physiotherapy Variable Boys Girls Boys Girls <18.5 1 (2.6) 8 (23.5) 0 (0.0) 5 (8.9) 18.5-24.9 26 (68.4) 20 (58.8) 2 (50.0) 29 (51.8)

25-29.9 11 (28.9) 6 (17.6) 2 (50.0) 17 (30.4)

>30 0 (0.0) 0 (0.0) 0 (0.0) 5 (8.9) TOTAL 38 (100.0) 34 (100.0) 4 (100.0)* 56 (100.0) The figure in parenthesis denotes the corresponding percentage

Table-3: Sex-wise distribution of students according to according to depression Level of Stress MBBS Physiotherapy

Journal of Health Sciences (J of H Ss) 2013; 3(5) Page 36 ACADEMIC STRESS DUE TO DEPRESSION AMONG MEDICAL SDS INDEX Boys Girls Boys Girls <50 7 (18.4) 12 (35.3) 0 (0.0) 14 (25.0) 51-59.9 23 (60.5) 9 (26.5) 3 (75.0) 17 (30.4)

60-69.9 5 (13.2) 9 (26.5) 1 (25.0) 19 (33.9)

>70 3 (7.9) 4 (11.8) 0 (0.0) 6 (10.7) TOTAL 38 (100.0) 34 (100.0) 4 (100.0)* 56 (100.0) The figure in parenthesis denotes the corresponding percentage.

Table-4: Comparison between Pulse rate, Systolic Blood Pressure and Diastolic Blood Pressure before and at the time of examination Before At the time of Mean Parameters LOS examination examination Difference P

Pulse rate 77.52 ± 7.75 84.73 ± 11.24 7.21 ± 3.49 7.86 P<0.001 ®

Systolic Blood Pressure 120.29 ± 9.66 124.76 ± 10.41 4.47 ± 0.75 5.39 P<0.001 ®

Diastolic Blood Pressure 81.07 ± 8.71 83.76 ± 8.03 2.69 ± 0.68 3.92 P<0.001 ®

® The mean difference is highly significant at the 0.001 level for 131 degrees of freedom. [LOS-Level of Significance]

Table-5 : Sex-wise comparison between Pulse rate, Systolic Blood Pressure and Diastolic Blood Pressure before and at the time of examination Sex Course Before At the time of Parameters examination examination P LOS

MBBS M 78.47 + 8.75 87.84 ± 10.55 5.94 p<0.001 ® Physiotherapy M 79.75 + 4.11 82.25 ± 3.86 1.89 p>0.05* Pulse rate MBBS F 76.41 + 8.15 90.94 ± 13.60 6.23 p<0.001 ® Physiotherapy F 77.39 + 6.99 79.04 ± 7.11 2.73 p<0.008 ® MBBS M 118.97 + 9.93 127.63 ± 11.78 4.63 p<0.001 ® M Systolic Blood Physiotherapy 126.25 + 11.82 128.75 ± 8.54 0.78 p>0.05* Pressure MBBS F 115.59 + 10.00 117.94 ± 10.37 1.19 p>0.05* Physiotherapy F 123.61 + 7.72 126.66 ± 7.56 4.37 p<0.001 ® MBBS M 80.11 + 6.38 82.18 ± 9.98 1.31 p>0.05* M Diastolic Blood Physiotherapy 88.00 + 5.48 85.75 ± 5.44 0.59 p>0.05* Pressure MBBS F 74.03 + 10.24 78.82 ± 7.10 2.97 p<0.006 ® Physiotherapy F 85.50 + 5.83 87.68 ± 4.69 3.46 p<0.001 ® ® The mean difference is highly significant at the 0.001, 0.006 and 0.008 levels of significance. * The mean difference isn’t significant (insignificant) at the 0.05 level. [LOS-Level of Significance] This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited.

Journal of Health Sciences (J of H Ss) 2013; 3(5) Page 37 ACADEMIC STRESS DUE TO DEPRESSION AMONG MEDICAL

Conflict of interest: None declared.

Received: 15.02.2013. Revised: 15.03.2013. Accepted: 19.05.2013.

Correspondence to:-Dr. Balkishan Sharma, Ph. D., Dept. of Community Medicine, Sri Aurobindo Medical College and P. G. Institute, Indore, (M. P.) India. Mob: 9926049820, Fax:(0731) 4231010 E-mail : [email protected]

Journal of Health Sciences (J of H Ss) 2013; 3(5) Page 38 Journal of Health Sciences (J of H Ss) 2013; 3(5): 39-58 The journal has had 4 points in Ministry of Science and Higher Education of Poland parametric evaluation. Part B item 683.

EXERCISE AND RESPIRATORY AND CARDIOVASCULAR DISEASES

Marek Napierala 1 , Walery Zukow 2 , Ewa Maczynska 2

1Kazimierz Wielki Uniwersytet, Bydgoszcz, Poland 2University of Economy, Bydgoszcz, Poland

Key words: activity; respiratory; circulatory.

Abstract

Background This paper describes the problem of the impact of physical activity on cardiovascular disease. Poor physical activity reduced the amount of blood circulating and caused a reduction in the number of red blood cells, which resulted in a reduction in physical and mental endurance of the human body. Objectives The aim was to prove that the main reason is the lack of cases to take any form of physical activity. The aim of this study was to answer the questions: 1. What are the cardiovascular and respiratory systems are most common? 2. How often accompanied by symptoms of the disease? 3. When the disease was diagnosed, and when it was taken treatment? Material and Methods The study was conducted in March and April 2010. It was attended by 105 patients undergoing treatment in rehabilitation ward in Kujavian-Pomeranian Pulmonology Center in Bydgoszcz and patients held in the outpatient rehabilitation clinic. The research method was used diagnostic survey and a questionnaire filled out for all patients suffering from diseases of the circulatory and respiratory systems. Results The results of the respiratory and circulatory system confirms that movement and all forms of physical activity are more appreciated in the treatment of cardiovascular diseases. Thanks also allowed respondents to provide answers big and positive effect of exercise on the cardiovascular system. In the treatment of respiratory diseases increased attention being paid to the pharmacological methods while ignoring the important role of physical activity. Conclusions 1. Physical activity reduces the risk of developing cardiovascular diseases and respiratory diseases. 2. Adherence to treatment by a physician reduces the symptoms being sick. 3. No makes any form of physical activity before the onset of the disease increases the risk of developing cardiovascular disease and respiratory.

Introduction A physical effort has a favorable impact on health of the man undoubtedly and it stayed repeatedly substantiated by scientists, especially in working on the cardiovascular system, which greatest health problem constituted in Poland. The meager motor activity reduced the number of circulating blood as well as caused reducing the number of erythrocytes, of what lowering the physical fitness and impairment of the body of the man were consequences. Cardiovascular diseases constituted the cause over the 50% of all deaths. At the man made out mentally from one page in the subconscious feeling the need for the move, as bases of the health lie, on the other one can see the tendency of considerable limiting efforts, causing many illnesses and posing a threat to the life. Using conveniences created by the civilization to a considerable degree a motor initiative was restricted. It leads hearts, the obesity, atherosclerosis

39 and different forms of neurosis to the occurrence of diseases associated with the progress of civilization as which among others ischaemic illness was recognised (Kuński 1985). The physical or motor activity refers to any bringing up oneself produced by the muscle spasm which cause burning additional calories. Raking leaves up, the walk or the dance are an example of the physical activity (small stick 2008). Motor possibilities are a sign of the health of the man, however the activity is a crucial factor influencing his state. Every motor activity serves molding, accumulating, supporting or restoring to health. This belief is based on many tests and publications showing the positive effect of different exercises to the body of the man and both negative consequences of the inactivity. Ones motor forms mold the efficiency essential for the life, other the endurance and the needed function in different situations of the life (Nowotny 2003). Amongst many positive factors of the increased motor activity they deserve the greater attention: the improvement in the function and the physical fitness, reducing the threat of cardiovascular diseases, reducing the threat with illnesses of the metabolism, among others obesity or diabetes (Górski 2001). Regular exercises help to prevent all heart diseases, for osteoporosis and with settling other illnesses, are a crucial element of losing the weight range or also keeping the healthy weight range. A sitting lifestyle increases the probability of the excess weight and the development of many chronic diseases (Kijek 2008). The motor activity will matter greatly in our life, is one of the best things it is possible to do which for their organism. At least with difficulty sometimes to find some time for sport it is worthwhile in order to shine a light for him at least 30 minutes per day. Regular motor exercises have a favorable influence on functioning of the mind, sense of well-being, they lower the risk of falling ill with heart diseases, build muscle power up, bones, prevent the arterial hypertension. The systematic motor activity improves our chances on healthier and to the longer life, protects us from the development of many heart diseases and their precursors, with high blood pressure whether, with high cholesterol. He prevents the seine and the breast also before the development of determined cancers, particularly cancer, rules out or controls diabetes of the II type. also prevents arthritis and he can help to relieve pain and stiffnesses at persons with this problem, protects osteoporoses from the incident of losing the chip-. Activities of all kinds suppress symptoms of depression and fears, correct largely tune and help to control the weight range (Kijek 2008). Motor exercises cause the physical, motor development at children, improve the function and the medical condition, reduce the frequency of appearing of the chest infection. The participation in organised classes contributes to the socialization of children and the psychosocial development (Eberhardt 2008). It is necessary to encourage children to like of the greatest physical activity in order to prevent factors causing osteoporosis because a mainly sitting lifestyle is one of them. He belongs, so to strengthen youthful bones, but exactly systematic physical exercises enjoy considerable influence very much to the increase in bone mass. The paucity of the movement in the childhood and in the adolescence can lead for lowering top bone mass. The lack of moving in the any century causes sudden loss of the bone tissue. At elderly people the stillness oftentimes goes hand in hand with lowering strength of muscles and the increased risk of the fall or the fracture. Physical exercises well influence for creating and keeping the bone maximum mass. At elderly people exercises prevent atrophic bone and support keeping strength of muscles and the coordination physically- muscle what lowers the risk of the fall. Therefore the physical move is recommended to persons in every century, also in the prevention of osteoporosis (Compston 2000). A right mechanical load is a basic factor having an influence on a state of the bone tissue. Effort works on this tissue through causing mechanical, gravitational stresses, as well as the muscle origin, working on the carcass in addition to the axially. A great tension prompts the structure of the bone, therefore exercises play the greater role, in the time, of which the carcass is burdened. All tests confirm the thesis that, staying in standing position, at least two hours per day more favorably works on the bone tissue, than undergoing intensive exercises for four hours lying. The activity about endurance character causes, so increase in mass as bone as for example a march, jogging, walking up the stairs (Nowotny 2003).

40 A move is one of main factors preventing abnormal spinal curvatures, because the sitting lifestyle adversely affects the state of physiological curves of the spine and the function of the muscular system. In this regard they are basic action limiting the sedentary lifestyle, increasing the general motor activity of the man, with special taking into account strengthening of the belly muscles and the back and the selection exercises, being aimed at molding of correct curves the spine. It is also important in order in the babyhood to manufacture the habit of the good posture of the body in all activities of the life, particularly the ones, in which the spine could to be overloaded (Kutzner- Kozińska 1986). In individual lifespans of the man, depending also to a large extent from the sex, motor needs appear in the different intensity. He is a general phenomenon, just enough of passage of years, the motor laziness, i.e. the reduction of the inborn need of the move. Therefore a motor activity needs being guided by its common sense while planting different forms. The selection of the move should from one side balance by its general influence our sitting lifestyle, however from the other side to level individual motor deficiencies, depending on needs of every man. Everyone can create the own model of the motor activity, in particular these forms which it is possible to cultivate are valuable through entire one's life like the skiing, swimming, the skating, the tennis, the, bicycle, kayak hiking and different sports games. Mastering the abilities associated with the given form of motor activities and systematic planting a sports discipline already for the youngest years given, creates foundations for the preservation of health (Kutzner-Kozińska 1986). The regular performance of efforts is significant supplementing the dietetic treatment of obesity. They are a universally recognised way of preventing exaggerated of assembly of the fatty tissue of high-calorie foodstuffs at people exposed by the civilization to the sitting lifestyle and the simple availability. Therefore through increasing the motor activity keeping the deuce of the energy balance without rigorous restrictions dietetic, being able to cause the deficiency of some nutrients is possible (Górski 2006). The treatment of obesity through the movement facilitates loss of the energy and prevents the decrease for basal metabolism after the dieting. Intensity of exercises should be gradually increased, but also adapted for the possibility slimming persons down. At persons demonstrating the regularity a level of oxidizing fatty acids and a sensitivity to the effect of insulin increase. A blood flow increases through the fatty tissue through exertion stimulating the adrenergic system (Eberhardt 2008). Favorable effects become visible judging changes of fat-free body weight and fat. A physical effort causes the increase in masses of muscles, applying the low-calorie diet simultaneously prevents reducing masses of this tissue. It is the most important argument starting to speak for applying the motor activity, as the element of therapy obesities (Górski 2006). At present the favored sitting lifestyle and abusing the food clearly create the imbalance of the energy in our lifestyle which can cause the obesity (small stick 2008). Many factors affect the international epidemic of the obesity, however two elements can play the key role as the passage from a country lifestyle to high of technological, urbanised existence and the property of our environment. To eat more and less to move - it is a trap for us (small stick 2008). The activity was motor and is the best method for the preservation of health besides the due trophism, of the condition and the slim silhouette. The regular training gives the body the firmness, makes feel better lowering the level of the cortisol - of hormone of the stress in blood and increasing the secretion of substances quieting down and reducing the sensitivity to pain causes - of endorphins. The multilateral favorable influence of increasing the motor activity on the medical condition of the man consists in streamlining function of organs. He also exerts the direct effect on the metabolism what keeping the balance between the quantity of energy delivered with the food and disbursed by our organism facilitates as well as contributes also to real distribution of elements of eaten food (Górski 2006). The influence of the training on the muscular system is incredibly significant because during exercises reaches for increasing the muscle mass, of keeping the good posture, since the muscular system is received in the shape of the bone structure. Our permanent care of the muscular system is an essential condition for keeping the good posture. The sitting and not very busy lifestyle doesn't not only support strengthening muscles, but also a weakness causes them, we must, so alone, in the deliberate and rational way, to manufacture power and the endurance of these muscle teams. For them more oftentimes the man leads little busy, and especially a sedentary lifestyle, in it more and more rapid pace his muscular system becomes

41 failing as well as loses the ability of the practicing stabilization of the spine. It is one of kinds of the so-called muscle atrophy known in medicine from the inaction. He seeks stabilizers of intervertebral disks passive in it which are susceptible to degenerative changes and injuries in the end for overloading the arrangement. They aren't defended by the muscle tone. The spine is defeated by shortening and stiffening and the retroflexion what unfavorably interacts with the functioning of the viscera and restricts the motor fitness. It is possible to avoid these changes or to delay them, however it requires the incessant work on its motor activity. The man along with arriving years is more and more lazy physically, to sit down on the will in the armchair or to lie down than to go for a walk or to exercise. However the ones which are able to focus themselves, make a profit disproportionately much (Kutzner-Kozińska 1986). The tendency to reducing everyday physical efforts, the aspiration to comfort or the motor laziness is a typical manifestation of the motor ageing of the man. Such lifestyle precipitates involutional processes, because the motor appropriately selected activity not only delays the ageing processes of the organism, but also improves the quality of life of persons in the older century. All motor features deteriorate (Nowotny 2003). Conducted systematically, appropriately organised exercises, including the medical inspection, do good for changes in the body of elderly people. Basic directions of action it: - the regulation of emotional states and increasing the intellectual efficiency, - improvement in the physical fitness, including powers of muscles, the suppleness, the agility, as well as the general motor efficiency, - the control of the body weight, counteracting the excess weight and obesities, - combatting the development of atherosclerosis, diabetics and the level regulation of lipides in blood, - preventing hypertension and illness of coronary arteries, - reducing the plausibility of falling ill with malignant tumours, - counteracting osteoporosis, - improvement in the activity of the immunological system (Eberhardt 2008). As a result of the ageing processes the physical fitness reduces. Lowering muscle power causes the restriction, and in the end for loss of locomotive abilities of the man what leads to the development of metabolic diseases. Therefore in Great Britain and in the United States as part of the care of geriatrics a weight training embracing even persons above 90 is conducted of the year of age, not to say 100 years. At practicing persons an increase in isometric power was stated, considerable the deceleration of loss of the muscle mass and enhancing the possibility of locomotive patients (Górski 2006). At persons about the low function and muscle power even little effort associated with activities of the everyday life, domesticity, walking up the stairs, the shopping and the career can cause the considerable tiredness and in consequence of malaise. Reducing burdening the layout of the movement is a base of a positive effect of the increased motor activity and of the viscera and depths of disorders of the homeostasis caused by efforts. Increasing strength of muscles prevents overloading the layout of the movement and degenerative changes developing against this background of this system (Górski 2006). Progress of the civilization causes a lot of new conveniences of the life, however besides modern mechanical deliveries, a plenty of threats to health creates societies. The increasing level of the mechanization of workstations causes, that she doesn't already require bigger physical efforts, oftentimes by it is unilateral, but sometimes even made in the forced position of the body. In principle the way to the work doesn't also require the strong effort from us, because most oftentimes it is ride on the elevator, automobile or bus. After work we choose passive rest most oftentimes than the actively spent time (Nowotny 2003). The physiology of the motor inactivity and the deficiency of the activity, resulting from the change of likings of the contemporary man in the Polish references was introduced exhaustively. Results of hypokinesia and principles of the prevention, are in our country widely shown by literature academic for the general public, as well as special radio broadcasts and television. Restricting the initiative poses a great and perceptible danger to the public health (Kuński 1985). About how in Poland the situation is alarming, say tests which were published in 1997, which they stated that scarcely the 7% of adults systematically practised physical exercises, in

42 unsystematically also 7%, however occasionally 12%. They from tests conclude that the 7.5% of adult Poles generally speaking doesn't practise physical exercises. It causes threats to the organism, manifesting itself with the more and more large percentage of the population being sick to diseases associated with the progress of civilization. They are it (Eberhardt 2008): - weakness, - of tendency to depressive states, - sleeplessness, - change in mood, - reluctance to act, - reducing motivation and the optimism, - worsening the self-assessment, - not-managing with the stress, - reducing the intellectual activity, - reducing the motor coordination, - worsening the visual acuity, - reducing the perception of sensory stimuli. A multidirectional influence on the body of the man exerts restricting the motor initiative, and increasing him is made conditional on the degree of immobilizing. Reducing volume of extracellular liquid and circulating blood takes place about 10 - 20% already after three up to five days from limiting the mobility. In the recumbency the part of blood is transferred from capacitance vessels of bottom body part to the central part of the cardiovascular system. Restricting the motor initiative drastically reduces the physical fitness and worsening the tolerance of orthostatic changes causes. With basic factor of lowering the function after the period hypokinesia reducing the ventricular ejection of the maximum minute volume in the end impairments of the function of the myocardium. It also seeks calcium for decalcifying of the bone structure and disrupting the resorption in the digestive tract, as well as a tolerance of carbohydrates reduces, muscle disappearances occur, an activity of enzymes reduces in muscles (Traczyk, Trzebski 1990). Reducing the physical activity, that is hypokinesia regarding not only a comfortable lifestyle. Oftentimes he/she reaches it as a result of diverse diseases, sometimes even in the form of the total stillness. Akinesia can concern the whole body, or exclusively some his installment. Consequences are therefore systemic or local. Effects hypokinesia and of systemic akinesia are more essential due to connecting them with the general medical condition. They apply in principle to all arrangements, but mainly of the cardiovascular system, where changes happen within the heart and the district circulation (Nowotny 2003). For years fortieth the 20th century is returned attention to unfavorable effects total immobilizing causes which during illness on account of the following changes, so like e.g. bedsores, blood clots of deep veins, reducing the volume of plasma, reducing volume and mass of the heart, the reduction in the number of erythrocytes in blood, densities of the bone tissue, masses of skeletal muscles, impairing the reflex from arterial baroreceptors, increased expelling with the urine of ions of calcium, potassium, sodium, magnesium and phosphates (Górski 2006). The motor recreation influences emotional states and the frame of mind of the man. Physical exercises reduce the level of fear, depression, anger as well as cause the improvement in the mood. Motor exercises are very effective in the treatment of depression, as the form of the supportive therapy. In curing briefly remaining sadness or the depression associated with the failure they can constitute the crucial element of therapy. Most quickly such symptoms yield as nervousness, nausea, feeling the tension, headaches precipitating the pulse. Also reducing fear of an open space, i.e. the agoraphobia was observed. Even one-time exercises lower the emotional stress, lower perceptible negative emotions in stress situations. Performing exercises in the group increases the number of interpersonal contacts, contributing in the process to improve the mood and to reduce the level of fear. The movement in the open provides with many positive stimuli, increases the effect of the light which is one of therapeutic methods in the treatment of depression. Yes, so changes which they steal under the influence of the recreational university class have a great importance for the medical condition of practicing persons. The activity causes the psychological stability and a sense of well being (Eberhardt 2008).

43 Systematically the planted motor activity favorably works on functioning of arrangements respiratory and circulations, and hence to the improvement in the physical fitness. The rise in the physical fitness in general is tied together simultaneously with the adaptation of both arrangements. In case of the respiratory system he/she reaches for increased leading oxygen to the organism. However assimilating by the organism oxygen is subject to the type of practised exercises. Of practicing the type aerobics they affect the rise in the physical fitness, whereas practising the bodybuilding influences for increasing muscle power (Eberhardt 2008). The move does lipid elements of plasma good increasing the concentration lipoproteids of HDL faction, reducing the content lipoproteids of LDL, VLDL and cholesterol and the level triglicerols, preventing the development of atherosclerosis in the process. During recreational efforts happening changes in blood contribute to keeping the glucose on the plateau, increasing the overall quantity of proteins, activation of non-oxidizable arrangements, increasing by the training blood volume about 15 20% (Eberhardt 2008). A physical effort exerts influence on functioning of kidneys. During intensive effort he seeks urine returned to the curtailment, a fall in expelling sodium, chlorides, sulfates, phosphates, ammonia, nitrogen takes place, however an elimination of creatine and potassium grows. At persons with the great kidney failure physical exercises don't increase the uraemic state, but correct functioning of the cardiovascular system, as well as the function, the structure and the metabolism of muscles (Górski 2006). During effort a paucity of blood flows through kidneys what is a basic factor changing their functioning. Exercises strengthening the belly muscles can cure the problems associated with the urinary incontinence appearing oftentimes at an older women (Eberhardt 2008).

Purposes of the work

Work of the author on the branch of the rehabilitation as well as the rehabilitation clinic in Kujawsko-Pomorski Center of the Pulmonology in Smukale on the Ward of the Rehabilitation she confirmed beliefs, that treating illness as an outpatient before the address hadn't carried out the majority of their staying as well as undergoing patients of no form of the motor activity, but physical exercises and respiratory made systematically reduced complaints. Showing was a purpose of research, that the lack of taking any form of the motor activity was the most frequent cause of falling ill to cardiovascular diseases and of the respiratory system. In tests they established, that ill persons which exercises recommended by the doctor carried out exactly and systematically and abode by all recommendations had a very good chance of an improvement in the frame of mind, reducing the complaint and the better condition. Also finding the answer to questions was a purpose of research: 1. What cardiovascular diseases and of the respiratory system do appear most oftentimes? 2. Most oftentimes what symptoms accompany given illness? 3. When was illness diagnosed, and when the treatment was taken? 4. How much time do sick persons devote for the treatment? 5. What frame of mind is by exercises and recommended forms of the treatment? Five research hypotheses were created, based on main research problems, of which were tried to check the rightness carrying out research. 1. The motor activity lowers the risk of falling ill with cardiovascular diseases and the respiratory system. 2. The compliance to the course of treatment by the doctor reduces disease symptoms. 3. Performing recommended exercises exactly and systematically improves the frame of mind of sick persons. 4. The lack of taking any form of the motor activity before the appearance of illness increases the risk of falling ill with cardiovascular diseases and respiratory. 5. Regular and appropriate the compliance to doctor's orders causes the improvement in the frame of mind after exercising the motor initiative.

44 Material and the testing method

In tests they used the method of the diagnostic survey consisting in the interrogation in writing. For that purpose they used the independently constructed questionnaire, as tools, containing questions concerning interesting problems. The questionnaire form was anonymous, intended for patients being treated at the hospital both clinic as well as undergoing curing on the ward. They conducted research at the turn of the March and April 2010. Patients undergoing curing on the branch of the rehabilitation in Kujawsko-Pomorski of the Center of the Pulmonology in Bydgoszcz as well as patients undergoing the treatment at an outpatients' clinic as part of the rehabilitation clinic. While carrying out research they used the fullbacks of nurses and physiotherapists. The ward was in the monument located in the suburban Smukale district amongst the undamaged nature in the specific microclimate above 180-letniego of pine forest in the Brda bend. The ward granted health benefits in the rehabilitation based on the agreement entered into with the National Health Fund from 2004. He conducted the respiratory rehabilitation for patients with chronic illnesses of the respiratory system, mainly with chronic obstructive pulmonary disease and bronchial asthma. However systemic for patients with diseases of the motor organ in the course of injuries, diseases of degenerative ponds, rheumatoid arthritis, after orthopedic and surgeon's treatments. Patients suffering from all cardiovascular diseases filled in a questionnaire and of the respiratory system. Out of examined persons women but a 54% constituted the 46% men. The age of patients developed in the following periods: up to 20 years was 3 % examined, from 21 to 40 - 8%, from 41 to 60, as far as 50%, from 61 to 80 - 34%, over 81 years had a 6% examined. The elementary education had a 5% examined, professional 31%, averages also 31%, however higher 33%. in tests I made the general test of persons in the per cent examined. It came from the village 44%, and from the city of the 56% of persons. In tests I made the general test of persons in the per cent examined. The detailed data is in table 1. Effecting the questionnaire survey enabled to get the rich source of information about the influence of a physical effort on respiratory diseases and cardiovascular diseases. A detailed data was obtained about diseases and symptoms for them accompanying and recommended exercises and other forms of the treatment. Every respondent gave also replies concerning the physical fitness and the quality of a performed physical effort. Received results will be presented with the division into the respiratory system and the cardiovascular system.

Table 1. Given metric people polled (Source: own studies, regarding remaining tables)

Metric data % N

Sex Women 46% 49 men 54% 56 With time 100% 105

Age To 20 3% 3 From 21 to 40 8% 8 From 41 to 60 50% 52 From 61 to 80 34% 36 Over 81 6% 6 with time 100% 105

45 Education Basic 5% 5 Professional 31% 33 Averages 31% 33 Higher 33% 34 With time 100% 105

Domicile Village 44% 46 City 56% 59 With time 100% 105

46 Resulth In the area of the respiratory system it results from the test of the questionnaire survey that in the group persons suffering from bronchial asthma/asthma overbalance respondents and they constitute the 40% of the whole examined, on it will inflate lungs a 18% is sick examined. At respondents bronchiectases are another identified diseases (10%), respiratory failure (10%) and other illnesses (10%) so as converting bronchitis or angina pectoris. The smaller group of examined persons suffers from emphysema pulmonary (8%) and atelectasis of lungs (4%). However nobody showed the pulmonary oedema, as one's disease of the respiratory system. Table 2 shows results. Bronchiectases are another identified diseases (10%), respiratory failure (10%) and other illness (10%) so as converting bronchitis or angina pectoris. The smaller group of examined persons suffers from emphysema pulmonary (8%) and atelectasis of lungs (4%). However, nobody showed the pulmonary oedema, as one's disease of the respiratory system. Table 2 shows results.

Table. 2. Diseases of the respiratory system

Disease % N bronchiectases 10% 13 pneumothorax 8% 10 emphysema of lungs 18% 23 atelectasis of lungs 4% 5 pulmonary oedema 0% 1 respiratory failure 10% 12 asthma 40% 50 other 10% 13 With time 100% 127

In spite of the diversity of respiratory diseases of persons of respondents, pointing at shared accompanying symptoms is possible for favored diseases. Most oftentimes respondents exchanged chronic converting cough (25%), paroxysmal dyspnea (23%) and dyspnoea at little effort (22%). Table 3 presents results concerning symptoms of respiratory diseases. Main symptoms constitute the 70% of all symptoms altogether. Respondents in the minority pointed at expectorating (11%), other symptoms (11%) so as: febrile states, a dry cough, pains of legs, fremitus of hands, high pressure, pricking chest pains, the hemoptysis, the weakness, whistles and the loss of consciousness at effort (7%). To conclude so it is possible, that irrespective of the kind of the disease of the respiratory system at examined majorities dyspnoea and cough appear, morover oftentimes also other shown above complaints accompany every illness.

Table 3. Accompanying symptoms for respiratory diseases

Symptoms % N they stalled converting cough 25% 59 paroxysmal dyspnea 23% 54 dyspnoea at little effort 22% 52 coughing 11% 26 loss of consciousness at little effort 7% 16 other 11% 26 With time 100% 233

Making the test of respiratory diseases one should point also at recommended courses of treatment. Amongst standard methods a pharmacotherapy, reducing the weight of the body, a regular physical effort, ceasing the smoking and correct feeding are favored. People polled pointed mainly at

47 the pharmacotherapy as well as exchanged other courses of treatment, not-included amongst specified of table 4. It is worthwhile paying attention to other courses of treatment exchanged by respondents, because they decide as far as 26% possible to choose from of methods. Examined persons indicated in this point on: respiratory exercises, walks, inhalations, a change of air, the jogging, the diaphragm respiration, a stay at a health resort, drainage and segmental massage. A correct diet is most rarely suggested what results certainly from the slight influence of the food on the respiratory system. Part of respondents (18%) ceased the treatment from the smoking as forms. Also a regular physical effort is one of recommended ways of advising the respiratory system with disease. This form of the treatment was indicated by the 7% of respondents.

Table 4. Recommended courses of treatment of respiratory diseases

Course of treatment % N pharmacotherapy 36% 97 reducing the weight of the body 9% 23 regular physical effort 7% 19 it will cease the smoking 18% 47 correct diet 4% 12 other 26% 69 With time 100% 267

Making the test of respiratory diseases one should point out not only to recommended courses of treatment and effects associated with them. A fact that none of respondents showed the treatment for worsening the frame of mind, as the effect prescribed, but only a small proportion of persons are the most important conclusion from collected data (4%) noticed no changes after applying the treatment. Table 5 presents the detailed data. One should notice that ways in the 50% of examined persons brought reducing the complaint to the treatment, at the 50% of persons an improvement in the frame of mind took place (25%) and better condition (25%).

Table 5. Symptoms appearing after treatments recommended by the doctor

Symptoms % N improvement in the frame of mind 25% 39 reducing the complaint 46% 71 better condition 25% 39 worsening the frame of mind 0% 0 don't notice/break changes 4% 7 other 0% 0 With time 100% 156

On account of the influence of a physical effort on respiratory diseases a quality of performed exercises is an important next aspect. To the quality of a physical effort an accuracy, a regularity and a frequency are submitted to the physical activity. Table 6 shows the membership of respondents in individual groups. Majority examined is characterized by a best quality of a performed physical effort: the 58% executes recommended courses of treatment both exactly and systematically. These persons perform exercises 3 times during the week and as a rule for them it takes no more than an hour per day, in addition focus not only on the accuracy, but also on the regularity of exercises. Persons performing a

48 physical effort on the rock bottom that is inaccurate and unsystematic constitute the least numerous group (5%) performing exercises with the frequency once during the week to a maximum 30 minutes. Nobody pointed out to the lack of exercising the motor initiative.

Table 6. Recommended courses of treatment of respiratory diseases

Way of performing exercises % N exactly and systematically 58% 61 exactly and unsystematically 28% 29 imprecisely but systematically 5% 5 imprecisely and unsystematically 10% 10 I don't perform recommended exercises 0% 0 With time 100% 105

There are at the lack of the regularity and the accuracy of a physical effort no rooms for improvement of the physical fitness and achievement of favorable effects in curing of respiratory diseases. Results are satisfactory, because the straight majority of respondents obeys recommended exercises or treatments of 3 times during the week (39%) and more oftentimes (46%). Only a 1% examined one time carries recommended forms of the treatment out during the week. Table 7 contains data.

Table 7. Frequency of performing recommended exercises or treatments

Number of exercises during the week %N 1 time 1% 1 2 times 13% 14 3 times 39% 41 more oftentimes 46% 48 With time 100% 104

It took no forms of motor activities before the appearance of illness of the 65% examined. It means that at these persons of reasons for falling ill it is possible to discern the initiative in that lack. Remaining took the 35% of respondents the following functions: indicated the 14% gymnastics, 8% the volleyball, or the basketball, 5% the fitness room, but the 3% the endurance training and runs. Also exchanged the 4% of persons walks, cycling and palmate (table 8).

Table 8. Exercises and forms of the motor activity carried out before the appearance of illness

Types of exercises and activities % N volleyball, basketball 8% 9 endurance training, runs 3% 3 fitness room 5% 6 gymnastics 14% 16 other 4% 5 make/break no locomotions 65% 74 With time 100% 113

Efficiency examined assessed comparing her with peers in the 60% on very good (10%) and good (50%). They are these are persons which before the appearance of illness all forms entertained of motor activity. Recommended forms as regular exercises and treatments performed treatments in

49 general both exactly and systematically. Examined which pointed at the response: badly (36%) and very badly (3%) before the appearance of disease they took no form of the activity, and recommended exercises and treatments were performed most oftentimes imprecisely and unsystematically. Table 9 contains the detailed data.

Table 9. Evaluation of the fitness of respondents in the comparison to peers

Evaluation %N very well 10% 11 well 50% 53 badly 36% 38 very badly 3% 3 With time 100% 105

Examined persons who to the significant improvement frame of minds appointed (as far as 49%) these are persons which most oftentimes assessed their physical fitness compared with peers on good. However polled which after effort feel satisfaction and satisfaction (20%) and feel relaxed and relaxed (13%) assessed their efficiency on very good in part of cases. To this group examined also these persons who took the motor initiative before diagnosing illness are involved. Respondents which after exercises and treatments feel tired out and weakened (14%) and very badly (5%) assessed their efficiency on bad and very bad and activities took no forms before illness. Table 10 presents the detailed data.

Table 10. Frame of mind after effort and recommended treatments

Frame of mind % N I feel relaxed and relaxed 13% 17 I feel satisfaction and satisfaction 20% 27 my frame of mind very much improves 49% 66 I feel tired out and weakened 14% 19 I feel bad very much 5% 7 other 0% 0 With time 100% 136

Respondents, exercising the motor initiative before diagnosed illness, practicing and carrying doctor's orders out systematically showed most oftentimes that they needed for the rest for 15 faces (37%), and with time for 30 minutes (39%). Persons not-abiding by doctor's orders and not-exercising the motor initiative let very rarely need for the repair hour (16%), not to say and longer (9%) (table 11).

Table 11. The amount of time needed for the repair after effort

Time % N up to 15 minutes 37% 38 up to 30 minutes 39% 40 hour 16% 16 longer 9% 9 With time 100% 103

The conducted questionnaire survey enables also to make the test of diseases of the cardiovascular system, symptoms accompanying them, courses of treatment of exercises including the

50 physical fitness of respondents and the quality performed by them. The identical form of tests in the respiratory system and the circulation lets for keeping the same form of the test, what the presentation of results of both polls is transparent, legible and possible to compare thanks to. Polled persons from the subject matter of diseases of the cardiovascular system had 7 different diseases and the possibility of showing other complaints associated with the studied arrangement to choose from. The large portion of respondents pointed out to the arterial hypertension (28%), few persons less suffer from atherosclerosis (25%) and to ischaemic illness of the heart (21%). Table 12 presents findings concerning diseases of the cardiovascular system. Remaining diseases were exchanged by the determination low figure examined. Illnesses of district veins bother 9% examined, it indicated the 7% of persons to heart defects, passed the 5% other diseases so as a cardiac insufficiency and the state after infarction. Fewest persons out of respondents have a peripheral vascular disease (3%) and cancers of the heart (1%).

Table 12. Diseases of the cardiovascular system

Diseases % N coronary heart disease 21% 32 atherosclerosis 25% 37 arterial hypertension 28% 42 heart defects 7% 11 cancers of the heart 1% 2 peripheral vascular disease 3% 5 illnesses of district veins 9% 14 Other 5% 8 With time 100% 151

Cardiovascular diseases similarly are like connected respiratory diseases with similar symptoms irrespective of the bothering kind of disease. Therefore an identification of main symptoms appearing at diseases of the cardiovascular system is possible. Respondents could point at the following symptoms: pricking chest pains, paroxysmal dyspneas, dyspnoea resting, dyspnoea exertion, breast pangs or to pass other. Table 13 presents replies of examined persons. Cardiovascular diseases similarly are like connected respiratory diseases with similar symptoms irrespective of the bothering kind of disease. Therefore an identification of main symptoms appearing at diseases of the cardiovascular system is possible. Respondents could point at the following symptoms: pricking chest pains, paroxysmal dyspneas, resting dyspnoea, exertional dyspnoea, breast pangs or to pass other (table 15). For the largest group of respondents dyspnoea is a predominating symptom of the cardiovascular exertional disease, chest pains shown by the 35% of persons, pricking appear at the 23%, and passed the 18% of respondents other symptoms so as the weakness, faints, parastesia, sleeplessness, restless legs, headaches, uncompensated pressure, spasmodic pains of calves, fast tiring oneself, pain on the course lived on, high pulse. A 15% of persons feels breast pangs, and the 9% of respondents experiences resting dyspnoea (5%) and of paroxysmal dyspneas (4%). Main, so dyspnoea which appear in different forms at almost a half is a symptom of cardiovascular diseases people polled. One should in that case direct the process of curing above all to the restriction or total liquidating this symptom and his effects.

Table 13. Accompanying symptoms for illness

Symptoms % N breast pangs 15% 27 dyspnoea exertional 35% 62 dyspnoea resting 5% 8 paroxysmal dyspneas 4% 7

51 pricking chest pains 23% 41 other 18% 32 With time 100% 177 (Source: own studies)

A pharmacotherapy comprises majority of applied courses of treatment (34%) and regular physical effort (26%). Analyzing recommended courses of treatment of cardiovascular diseases it is worthwhile attracting the attention of respiratory diseases to the frequency of individual methods and her dissimilarity in the comparison to courses of treatment. Definitely more oftentimes a regular physical effort is recommended to patients suffering from diseases of the cardiovascular system (26%), as well as reducing the weight of the body (11%) and correct diet (13%). However they more rarely point on other (5%) than exchanged procedures, passing limiting stress situations or the restrained, controlled physical activity in addition among others. Table 14 presents the detailed data.

Table 14. Course of treatment recommended by the^ doctor

Course of treatment % N pharmacotherapy 34% 96 reducing the weight of the body 11% 31 regular physical effort 26% 75 he will cease the smoking 12% 33 correct diet 13% 37 other 5% 13 With time 100% 285

The majority of applied courses of treatment brought positive effects to patients, however indicated the 2% of respondents for worsening the frame of mind. Moreover a result of the 11% of respondents for which the recommended treatment brought no effects is alarming. Negative or lack of effects of the treatment in the result applied to result perhaps from their incorrect carrying out the method by patients or improperly chosen by the doctor. One should however direct persons' which felt reducing the complaint which faded out mainly from applied pharmacology and regular physical exercises attention to the 45% above all. This latter type of the treatment caused also an improvement in the frame of mind at the 21% of persons and the better condition at the 20% of persons. These results point at the significant influence of a physical effort in curing diseases of the cardiovascular system. Table 15 presents the detailed data.

Table 15. Symptoms appearing after recommended ^ treatments

Symptoms % N improvement in the frame of mind 21% 27 reducing the complaint 44% 57 better condition 20% 26 worsening the frame of mind 2% 2 don't notice/break changes 11% 15 other 3% 4 With time 100% 131

A quality of a taken physical effort, i.e. an accuracy, a regularity and a frequency of the physical activity are factor characteristic of persons suffering from cardiovascular diseases. Table 16 shows the membership of respondents in individual groups.

52 Achieved results point at the determined majority of persons of a physical effort about the best quality performed, that is exactly and systematically (37%). The best quality of a physical effort manifests itself in performing recommended exercises with the frequency of at least 3 times during the week for minimum 45 of minutes per day. Enough the large portion of respondents is characterized by performing recommended exercises or treatments exactly, but unsystematically (30%). physical. Also persons being characterized by a weak quality of performed exercises and treatments constitute the numerous group, until indicated the 16% for the compliance to recommendations imprecisely and unsystematic. Moreover they demonstrate neither the special accuracy, nor the regularity associated with performing a recommended physical effort. 9% examined doesn't take exercises recommended him up.

Table 16. Quality of performed and recommended exercises or treatments

Quality of performing exercises % N exactly and systematically 37% 37 exactly but unsystematically 30% 30 imprecisely but systematically 9% 9 imprecisely and unsystematically 16% 16 I don't perform recommended exercises 9% 9 With time 100% 101

A frequency of recommendations carried out is a crucial factor. The result is very satisfactory, because obeys them very often, as far as 66% examined. indicated the 37%, that 3 times during the week, and 29%, that more oftentimes. The 5% only applies recommended forms of the treatment one time during the week. Visible data in table 17.

Table 17. Frequency of performed exercises or treatments recommended by the doctor

Number of exercises during the week %N 1 time 5% 5 2 times 28% 26 3 times 37% 34 more oftentimes 29% 27 With time 100% 92

Over half examined (58%) before making a diagnosis took no form of the activity. The second part examined, carried the 42% out: gymnastics (15%), walks, swimming, the cycling (12%), fitness room (7%), endurance training, runs (6%), basketball, volleyball (2%). Table 18 presents the detailed data.

Table 18. Exercises and forms of the activity carried out before the appearance of il ness

Types of exercises and activities % N volleyball, basketball 2% 2 endurance training, runs 6% 6 fitness room 7% 7 gymnastics 15% 16 other 12% 13 make/break no forms of the motor activity 58% 62 With time 100% 106

53 Respondents largely assessed their efficiency compared with peers on good (47%), and on very good (13%). Persons which they appointed to one of these replies are involved in part to of the ones examined which before the appearance of disease carried out any form of the motor activity. These persons have motivation for taking the motor initiative. However pointing at the bad fitness (33%) and very bad (7%) are these are persons which didn't make and largely exercise no motor initiatives at present. Certainly regular exercises recommended by the doctor could affect the change of coming up to the motor activity of persons from this group and the increase in their physical fitness with illness (Table 19).

Table 19. Evaluation of the physical fitness of respondents compared with peers

Evaluation %N very well 13% 14 well 47% 49 badly 33% 35 very badly 7% 7 With time 100% 105

Persons whom they didn't carry out and largely exercise no motor initiatives at present constituted the 5% examined. After a physical effort they feel bad very much. Respondents which showed that they felt tired out and weakened (25%) after performing effort most oftentimes didn't take the physical initiative through with diagnosis and recommended exercises make imprecisely and unsystematically. Health accounts are an only motive for taking a physical effort, because they don't feel satisfaction or satisfying after physical exercises, but only tiring out and weakening. Moreover they need over 30 minutes in order to recover powers after effort. Certainly regular exercises recommended by the doctor could affect the change of coming up to the motor activity of persons from this group and the increase in their physical fitness. Examined showing that they feel satisfactions and satisfaction (22%) and feel relaxed and relaxed (15%) they have motivation for taking the motor initiative and occasionally performed exercises (e.g. runs, walks, physical labours) also before illness. A physical effort gives them satisfaction and satisfaction. Results concerning the evaluation of the frame of mind after a physical effort in % examined table 20.

Table 20. Evaluation of the frame of mind after a p ysical effort

Frame of mind % N I feel relaxed and relaxed 15% 19 I feel satisfaction and satisfaction 22% 27 my frame of mind very much improves 31% 39 he feels tired out and weakened 25% 31 I feel bad very much 5% 6 other 2% 2 With time 100% 124

Respondents applying doctor's orders systematically showed that after a physical effort they needed only up to 15 minutes (46%) for repairs after effort. Persons which exercised the motor initiative before diagnosing illness belong to this group. 33% examined needs for the rest up to 30 minutes. However the 15% needs to it hour, not to say and longer (5%). Table 21 presents the detailed data.

Table 21. Needed time for the repair after effort

Time %N

54 for 15 faces 46% 48 for 30 faces 34% 36 hour 15% 16 longer 5% 5 With time 100% 105

Discussion In the area of the respiratory system and the cardiovascular system they confirm findings, that the rush and all forms of the motor activity more are appreciated in curing of diseases of the cardiovascular system. Thanks to that replies of respondents also allowed to describe the great and favorable influence of a physical effort on the cardiovascular system. In curing respiratory diseases however the greater attention is tied to pharmacological methods except for the substantial role of a physical effort. Because of that it is also hard to notice the significant influence of the motor activity of the man on the improvement in the frame of mind in the area of the respiratory system. However the unsatisfactory physical fitness lets the straight majority of respondents conclude that a physical effort is essential for correct functioning of the entire body of the man with special taking into account the respiratory system and the cardiovascular system. It deal with tests of the physical activity many researchers worldwide. In Japan Clinic of the epidemiological research in Shizuoka, examined the protective influence of the physical activity on the sleeplessness. Authors assessed the link between the physical activity and the sleeplessness in the large population (14,001 older residents). Authors obtained information about the frequency of the physical activity and the sleeplessness, but the result were located in a 95% confidence intervals. The frequent physical activity reduces the frequency of appearing of the sleeplessness, especially problems of keeping the sleep. For elderly people he makes advances 5 or more days / weeks In the activity what can help the sleeplessness to reduce (Inoue 2013). With purpose of research knead Ardabil in Iraq there was an evaluation of the efficiency of the circulation, of activity level in the health care of some variables anthropometric in the context of the sedentary lifestyle into 7-11 lukewarm boys. From 21 253 of boys of 7-11 school-age years, in this test it participated 766, where among others the test was used to the VO2max evaluation. BMI points were used for determining the status weight ranges. The test results of this test indicate to the essential link between the efficiency of the circulation and the physical activity and in the health care variables antropometric. Moreover obese students not only demonstrated lower physical activity, but also with longer time of the sitting lifestyle (Esmaeilzadeh, Kalantari, Nakhostin-Roohi 2013). Whether in it youth strength of muscles is involving a certain amount of risk cardiovascular in the more late lifespan, irrespective of the circulatory efficiency is vague (Grantved 2013). Scientists dealt with clarifying this problem from University of Southern Denmark, Norwegian School of Sciences Sport (Oslo), and Institute of Metabolic Science, Cambridge, UK. Findings imply that greater isometric power of muscles in its youth is connected with a rock bottom of risk factors at adults, irrespective of the physical fitness, the obesity and other disrupting factors. Wendy J. Bignold (2013), in his/her paper portrays anxieties of British politicians about the participation of young people in the physical activity. He points out to the need of the greater flexibility in programs of the physical education which could show the mainstream to a healthy lifestyle, both for the real accomplishment and exponential as well as in the future for the personal development of students. In order to illustrate the thesis, the paper is based on survey data in the test unicyclists conducted in a few countries. Wanting to keep the physical and mental health to late years of age one should accustom children already youngest to an active lifestyle. Findings Brown H., E., (2013) suggest that the physical activity protects from the address and of symptoms of depression. Tests embraced children of years aged 5-11 and of young people aged 12-19, they stated that tests were needed to the purpose effective implementing programs of the reduction in symptoms of depressions at children and young people through the physical activity. Carrot A., Jungiewicz M. (2008) dealt with relations between the physical activity in their youth and with quality of life in the older century. An inspection, or a lifestyle were an aim of their tests examined, associated with the physical activity before 35 year of age, affects the quality of their life on eve of the old age. 59 persons were provided with tests (30 women and 29 men) in the century of 55-64 years in the province Lesser Poland. Results allowed for stating, that level declared by respondents, diversified of their physical activity before 35. with year of age a significant influence on the quality of life had in the older century. Examined very much active in terms of physics in the past better they assess their current health and better deal the performance of activities of the everyday day with currently. Of also examining with method of the diagnostic survey (Zagroba et al. 2011) were conducted. in 2008 at Bielański Hospital in Warszawa. They embraced with 100 of them of randomly chosen nurses (94%) and of male nurses (6%) working on 12-godzinnych duty and in the single-shift system. They stated that nurses 55 presented the average level of physical activity what questions their credibility as promoters of the health. It is essential, and so taking eats encouraging action to diverse forms of the activation. Ewa Stefańska (2010) along with the team dealt with the evaluation of chosen features of a lifestyle of students of Medical University in Białystok. 320 students took part in tests (251 women and 69 men). Amongst examined not only negative eating habits, but also a low level of physical activity, and a high level of drinking alcohol of persons irrespective of the sex examined were observed. Intensifying action towards the improvement in the state of the knowledge and the change of health postures examined is necessary of students, as in the future of creators of health behaviours. The test concerning the physical activity among others was conducted in school year 2010 / 2011 at 58 municipal and country elementary schools from five randomly chosen provinces (Wolnicka, Jaczewska- Schuetz 2012). They made an appraisal of schools based on the test of anonymous questionnaire forms conducted amongst directors which concerned preventive action from the scope improvements in feeding and the physical activity amongst children and young people on premises of these schools. He is involved in extracurricular sports classes organised by the school with the whole of the 36.6% of students. However results show questionnaire forms for more and more big involving schools in educational action from the scope improvements in feeding and the physical activity amongst children and young people by hosting numerous action and healthy programs. With classes connected with the physical activity at Universities of the Third Age in Poland, a team of employees took up AWF in Warsaw (Morgulec-Adamowicz, 2011). The physical activity constituted the integral part of the UTW offer. Stated, that in academic year 2007 / 2008 UTW institutions from favors examined altogether exercised 29 391 of listeners, what men constituted only a 16.1% from. Participants were the most numerous group at the age of 60-70 (53.2%). They were among most oftentimes systematically organised recreational-sports classes: streamlining gymnastics (69%), gymnastics (64%), swimming (57%), dance (50%), gymnastics in the water (46%) and nordic walking (43%). The majority of examined UTW institutions conducts classes connected with the physical activity what indicates To the awareness of the role forms adapted for her play which in the process of the favorable ageing. According to collected data women comprise majority of UTW listeners in the more youthful retirement age what points out to the need of taking action above men directed for increasing the participation and persons 65 of year of age. For the worker in Gorzów they interested AWF oneself social-demographic of conditioning the realization of a lifestyle of the health by women (Nowak M., Nowak L., 2013). They conducted research in years 1999 and 2004 amongst 1361 women in the century 20-75, living in cities of western Poland and their participation in the recreational physical activity. Women which valued values of the health and the physical fitness for themselves were in the majority and were characterized by a long-term participation in the physical activity. Oftentimes they chose the vacation directly connected with the physical activity. In of popularizing the physical activity in our society, promoting the value of the physical activity is necessary, introducing him in the context of the life of the health. Current researches prove the constructed hypothesis on the favorable influence of a physical effort on cardiovascular diseases and respiratory. A physical effort from one side triggers favorable physiological changes in function of the cardiovascular system and respiratory, from the other side he reduces or influences modificated to factors of the threat. At least an influence of the systematic training on the respiratory system isn't so strong like to the cardiovascular system, it and in this respect it is possible to observe a lot of favorable changes. Tests of physiologists and doctors also showed that a regular physical effort was the most effective form of the treatment and the prevention of illnesses. A. Eberhart claims that endurance effort influences mainly for functional streamlining the viscera. It refers specially to the cardiovascular system and the respiration. Streamlining the activity of these arrangements is much more important than the development of muscles for the function of the organism. In the end of years 80 - of the ones in isolated tests, and in 90-tych years on a little bit wide scale, they showed that applying, exactly administered different forms of physical exercises increased the fitness of maximum consuming oxygen and corrects mechanics of the respiration (Dylewicz, Przywarska 2002). Tests conducted by Maines, Laive and Milani show, that at persons with ischaemic illness of the heart subjected to the physical training indeed a general function improved (Tylka 2002). In 1994 a position of the American Cardiological Company was published: the cardiological Rehabilitation and other action based on physical exercises, for curing the hyperlipidemia and the arterial hypertension of oases in the fight against the smoking they can reduce the mortality, to correct the physical fitness, to temper manifestations of the ischaemia of the myocardium, to delay the progression, and what's more to support the regression of coronary arteriosclerosis. (Dylewicz, Przywarska 2001, p. 9). In meta-analisis made by Powell in 1987 they demonstrated, that results 2 / confirm 3 tests relation: for them the greater motor activity is all the lower the morbidity and the mortality from the reason ischaemic

56 hearts. The epidemiological research showed that the regular physical activity lowered the coronary risk about c 50-60 % (Jagier 2001). Examining the influence of a physical effort on cardiovascular diseases and the respiratory system was a main purpose of the work. Based on the current knowledge they put forward a hypothesis, that the physical activity had a favorable influence on illnesses of the arrangement circulation-respiratory. At the work five detailed hypotheses were specified: 1. The motor activity lowers the risk of falling ill with cardiovascular diseases and the respiratory system. This hypothesis proved correct because carried out the 65% of respondents detesting the respiratory system to diseases from the side of no form of the motor activity before making a diagnosis. However 58% of persons with the diagnosed cardiovascular disease before the appearance of illness didn't also apply the motor activity 2. The compliance to the course of treatment by the doctor reduces disease symptoms. The rightness of this hypothesis was also confirmed because patients which took the treatment noticed reducing symptoms. In the case suffering from diseases of the respiratory system: noticed the 46% reducing the complaint, the 25% improvement in the frame of mind and also 25% better condition. However in case of the cardiovascular system: reducing the complaint noticed the 44%, 21% improvement in the frame of mind, but the 20% better condition. 3. Performing recommended exercises exactly and systematically improves the frame of mind of sick persons. Applying practicing exactly and systematically with the 58% of patients suffering from respiratory diseases an improvement in the frame of mind was noticed. In case of the cardiovascular system it is 37%. 4. The lack of taking any form of the motor activity before the appearance of illness increases the risk of falling ill with cardiovascular diseases and respiratory. With reference to the respiratory system the hypothesis proves correct in the 65% cases of examined persons, however in taking back to the cardiovascular system in the 58%. 5. Regular and appropriate the compliance to doctor's orders causes the improvement in the frame of mind after exercising the motor initiative. The frequency of the compliance to doctor's orders at sick persons with the respiratory system is very great because 46 % he/she applies more oftentimes than 3 times during the week, however in case of the cardiovascular system the 29% is applicable more oftentimes than 3 times during the week, and 37% of 3 times during the week. The following conclusions result from tests: 1. The motor activity lowers the risk of falling ill with cardiovascular diseases and the respiratory system. 2. The compliance to the course of treatment by the doctor reduces disease symptoms. 3. Performing recommended exercises exactly and systematically improves the frame of mind of sick persons. 4. The lack of taking any form of the motor activity before the appearance of illness increases the risk of falling ill with cardiovascular diseases and respiratory. 5. Regular and appropriate the compliance to doctor's orders causes the improvement in the frame of mind after exercising the motor initiative. Presented results can help in search for causes which have a significant influence for coming into existence of many illnesses both on the part of the cardiovascular system as well as the respiratory system. It turns out, because the lack of the motor activity is an important problem of the modern world.

Open Access

References

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Conflict of interest: None declared.

Received: 15.01.2013. Revised: 15.03.2013. Accepted: 26.05.2013.

58 Journal of Health Sciences (J of H Ss) 2013; 3(5): 59-72 The journal has had 4 points in Ministry of Science and Higher Education of Poland parametric evaluation. Part B item 683.

УДК 615.916:577.122

STUDIES OF THE METALLOTHIONEIN ROLE IN THE BODY PROTECTING FROM THE EFFECTS OF HEAVY METALS IN VIOLATION OF THE ADAPTATION MECHANISM

ИССЛЕДОВАНИЕ РОЛИ МЕТАЛЛОТИОНЕИНОВ В ЗАЩИТЕ ОРГАНИЗМА ЧЕЛОВЕКА ОТ ВОЗДЕЙСТВИЯ ТЯЖЕЛЫХ МЕТАЛЛОВ ПРИ НЕДОСТАТОЧНОСТИ АДАПТАЦИОННЫХ МЕХАНИЗМОВ

Пыхтеева Е.Г.

Украинский НИИ медицины транспорта, г. Одесса

Pykhtieieva E.G.

A bstract

We observed 145patients of hospital in Odessa and Kovel. Content of essential (Fe, Cu, Zn) and toxic metals (Cd, Pb, Hg), and the integral content of metallothioneins in the blood and urine and total protein in the urine was examined. If the concentration of toxic heavy metals (zinc, cadmium, mercury) in the blood increased, the content in the blood metallothionein also increased. Between the content of metallothionein in urine and erythrocytes there is no strict correlation. This indicates that the level of metallothionein marker in the urine is not heavy metal exposure and the initial stage of kidney damage. The appearance of metallothionein in urine is usually preceded by proteinuria. The level of metallothionein in erythrocytes can be judged on the exchange of zinc only when no exposure toxic heavy metals. Metallothionein concentration in erythrocytes below 30.0 mg / g protein, usually indicate inappropriate zinc exchange, even if the content of metal in biosubstrates lies at the lower boundary rate.

Keywords: metallothionein, heavy metals, metabolic metals

Резюме

Пыхтеева Е.Г.

Обследовано 145 пациентов больниц г. Одессы и г. Ковеля. Содержание эссенциальных (Fe, Cu, Zn) и токсичных металлов (Cd, Pb, Hg), а также интегральное содержание

59 металлотионеинов в крови и моче и общего белка в моче. Показано, что у пациентов с заболеваниями различной этиологии наблюдаются значительные отклонения микроэлементнного статуса. При повышенных уровнях токсичных тяжелых металлов (цинк, кадмий, ртуть) в крови регистрируется повышенное содержание металлотранспортного белка - металлотионеина. Между содержанием металлотионеина в моче и эритроцитах крови нет жесткой взаимосвязи. Это указывает на то, что при функциональной состоятельности почек потери металлотионеина не происходит, следовательно, уровень металлотионеина в моче является маркером не экспозиции тяжелыми металлами, а начальной стадии повреждения почек. Появление металлотионеина в моче, как правило, предшествует выраженной протеинурии. По уровню металлотионеина в эритроцитах можно судить об обмене цинка только в том случае, когда отсутствует экспозиция токсичными тяжелыми металлами. Концентрация металлотионеина в эритроцитах ниже 30,0 мг/г белка, как правило, свидетельствует о нарушении обмена цинка, даже если содержание этого металла в биосубстратах лежит на нижней границе нормы.

Ключевые слова: металлотионеин, тяжелые металлы, металлопатия

Резюме

ДОСЛ1ДЖЕННЯ РОЛ1 МЕТАЛОТЮНЕШУ У ЗАХИСТ1 ОРГАН1ЗМУ ЛЮДИНИ В1Д ВПЛИВУ ВАЖКИХ МЕТАЛ1В ПРИ НЕДОСТАТНОСТ1 АДАПТАТТТЙНИХ МЕХАН1ЗМ1В

Пихтеева О.Г.

Обстежено 145 пащеннв лшарш м. Одеси та м. Ковеля. Вмют есенщальних ^е, Си, Zn) i токсичних металiв (Cd, РЬ, Hg), а також iнтегральний вмют металлотюне'1 шв в кровi та сечi i загального бiлка в сечи Показано, що пацiенти iз захворюваннями рiзноi етюлогл мають значнi вщхилення мiкроелементного статусу. При пiдвищених рiвнях токсичних важких металiв (цинк, кадмш, ртуть) у кровi рееструеться тдвищений вмiст металлотранспортного бiлка — металотюнешу. Мiж вмiстом металотюнешу в сечi i еритроцитах кровi немае жорсткого взаемозв'язку. Те вказуе на те, що при функцюнальнш спроможностi нирок втрати металотюнешу не вщбуваються, отже, рiвень металотюнешу в сечi е маркером не експозицп важкими металами, а початково'1 стади ушкодження нирок. Поява металотюнешу в сечц як правило, передуе вираженш протешурп. За рiвнем металотюнешу в еритроцитах можна судити про обмш цинку тiльки в тому випадку, коли вщсутня експозищя токсичними важкими металами. Концентрацiя металотюнешу в еритроцитах нижче 30,0 мг/г бшку, як правило, свщчить про порушення обмiну цинку, навiть якщо вмiст цього металу в биосубстратах лежить на нижнш меж1 норми.

Ключовi слова: металотiонеiн, важкi метали, металлопашя

Актуальность темы

Тяжелые металлы являются не только глобальными загрязнителями окружающей среды в общемировом смысле, но и имеют особое значение для Украины, где их повышенное накопление в водоемах, почве, воздухе связано с непропорциональным развитием

60 горнодобывающей, металлургической промышленности, неэффективным использованием энергетическими ресурсами, отсутствием четкого управления транспортными потоками и т.п. [ 1 ], а также нерациональными способами утилизации полимерных материалов путем сжигания [2]. Ситуацию усугубляет тот факт, что в последние десятилетия в связи с интеграцией Украины в мировую экономику и поступлением на рынок большого количества импортной продукции, особенно продуктов питания, лекарственных средств, средств укрепления здоровья, биологически активных добавок к пище, изменилась, особенно в крупных городах, привычная для населения схема питания. Все большее распространение приобретает вегетарианство, чрезмерное увлечение морепродуктами т.п. [3]. В условиях нарастающего мирового экономического кризиса особую значимость имеют положения Глобального плана действий по охране здоровья работающих на 2008-2017 г., в котором Всемирная ассамблея здравоохранения выдвинула тезис, что здоровье работающих является необходимым предварительным условием повышения производительности труда и экономического развития [4, 5].

В последние годы благодаря усилиям гигиенистов и токсикологов случаи острых отравлений тяжелыми металлами в быту и на производстве стали чрезвычайно редкими, но в то же время экологически- и производственно-обусловленная хроническая низкодозовая нагрузка тяжелыми металлами на уровне популяции способствует обострению широкого круга патологий, связанных с нарушениями минерального обмена, которые вызывают повышенную чувствительность к аллергенам, снижение иммунитета, способствуют более тяжелому протеканию интеркуррентных заболеваний и т.д.. Для выявления такого рода проблем необходим поиск новых информативных биомаркеров, позволяющих диагностировать неблагоприятные изменения на ранних стадиях, когда их коррекция требует минимальных усилий.

В обеспечении адекватного минерального обмена и детоксикации тяжелых металлов важную функцию выполняют металлотранспортные белки, среди которых металлотионеинам по праву принадлежит важная роль, особенно в обеспечении биодоступности цинка и детоксикации и выведения целого ряда токсичных тяжелых металлов. В современной клинической медицине при постановке диагноза исследования микроэлементного статуса пациентов, не говоря уже о механизмах участия белков в процессах обмена ТМ, практически не используются. Это связано не только со специальными требованиями к аппаратуре и квалификации специалистов, проводящих такие исследования, но и с недостаточно разработанной теоретической базой, описывающей роль металлов в протекании биохимических процессов. Это касается не столько действия признанных металлов-токсикантов (РЬ, Cd, ^ ) , но, даже в большей мере, широкого круга эссенциальных и условно-эссенциальных элементов. В то же время в развитых странах Европы и США анализ на содержание тяжёлых и эссенциальных металлов при нарушении здоровья является признанной процедурой. В России этой проблемой углубленно занимается «Центр биотической медицины» Скального.

В то же время на начальных стадиях заболевания исследование содержания микроэлементного статуса в сочетании с классическими биохимическими методами позволило бы глубже понять механизмы и причины возникновения патологии, вовремя и наиболее эффективно начать процесс лечения. Поэтому было решено провести мониторинговые исследования больных с возможными предельными синдромами, которые проходят курс лечения в соответствующих стационарах.

Контингенты и методы

61 Под наблюдением находилось 145 лиц, которые проходили лечение в стационарных отделениях Областной клинической больницы г. Одессы и на базе городского районного территориального медицинского объединения г. Ковеля. Больные проходили лечение в отделениях нефрологии — 42, кардиологии — 45, эндокринологии - 43 и гемодиализа - 15 человек (52 мужчины, 93 - женщины (35,9 и 64,1 %, соответственно)). Контрольные (фоновые) показатели получены при проведении мониторинга здоровых жителей Одесского региона в течение последних 1 0 лет и отображают степень экологически обусловленной нагрузки организма металлами. Изучено содержание эссенциальных (Fe, ^ , Zn) и токсичных металлов (Cd, Pb, ^ ) , а также интегральное содержание металлотионеинов в крови и моче обследуемых по разработанной нами методике [6 ] и общего белка в моче.

Результаты и их обсуждение

Изучение влияния на организм вредных факторов производственной среды у пациентов (на основании опросов о месте работы и факторах производственной среды) позволило вывести на первое место по своей значимости физический и химический факторы (у 34,1 и 33,3 % обследованных, соответственно). Психоэмоциональная напряженность и действие биологических факторов были выделены как доминирующие только у 14,7 и 5,4 % больных, соответственно (табл. 1 ).

Таблица 1

Определение вредных факторов производственной среды по данным опросов больных

Ведущие производственные вредные факторы П оказатель Физичес Хими Психофизиологи Биологи кие ческие ческие ческие Абсолютное количество, лиц 44 43 19 7 Относительное количество % 34,1 33,3 14,7 5,4

Как указывают больные, химические вещества, связанные с их производственной деятельностью, поступали в организм ингаляционным путем - у 31,0 %, через кожу - у 25,6 %, через желудочно-кишечный тракт - у 7,8 % больных. 17,2 % больных курили.

Таким образом, можно считать, что наибольший вклад в развитие соответствующих заболеваний у обследованных пациентов вносят производственные вредности, связанные с физическими и химическими факторами. Их влияние растет с производственным стажем, а основными путями поступления токсичных веществ в организм являются ингаляционный и перкутанный.

В наших исследованиях впервые в отечественной практике были определены концентрации металлотионеина (МТ) в биосубстратах пациентов отделений нефрологии, кардиологии, эндокринологии и гемодиализа. Предпосылкой для такого рода исследований служили данные литературы о важном значении МТ в протекании основных биохимических реакций в норме и при патологии, связанных с обменом и реализацией токсического действия тяжелых металлов. Именно поэтому при проведении углубленных лабораторных исследований в крови и моче больных определялось содержание эссенциальных (Fe, Cu, Zn) и токсичных металлов (Cd, Pb, Hg), в обмене которых МТ играет важную, а иногда основную роль

В табл. 2 приведены статистически обработанные данные о содержании металлов в моче.

62 Таблица 2

Статистически обработанные данные о содержании металлов в моче

Содержание металлов, мг/л Fe Zn Cd Pb

Отделение МДУ < 1 , 1 0,2-0,4 < 0,03 < 0 ,0 0 2 < 0,03 < 0,025 Среднее 0,186 0,401 0,028 0,0030 0,0166 0,0119 Кардиология, Станд. откл. (о) 0 , 1 0 1 0,227 0,031 0,0027 0,0074 0,0072 п = 45 Дов. инт. 0,001 0,002 0,001 0,0001 0,0001 0,0001 Среднее 0,679 0,578 0,077 0,0043 0,0175 0,0145 Нефрология, Станд. откл. (о) 0 , 1 0 1 0,227 0,031 0,0027 0,0074 0,0072 п = 42 Дов. инт. 0,001 0,002 0,001 0,0001 0,0001 0,0001

Среднее 0,238 0,675 0,051 0,0050 0 , 0 1 1 2 0,0098 Эндокринология, Станд. откл. (о) 0,127 0,299 0,029 0,0045 0,0048 0,0049 п = 43 Дов. инт. 0 ,0 0 1 0,003 0,001 0,0001 0,0001 0,0001

Среднее 0 , 1 2 0 0,282 0,028 0 ,0 0 2 0,016 0 , 0 1 0 Контроль, Станд. откл. (о) 0 , 1 0 1 0,227 0,031 0,003 0,007 0,007 п = 2 0 Дов. инт. 0 ,0 0 1 0,003 0,000 0,000 0,000 0,000

Примечание: Относительная погрешность при измерении концентрации металлов не превышала 4 % (п = 3, Р = 0,95).

Приведенные в табл. 2 данные показывают существенное изменение выведения металлов у больных практически всех отделений по сравнению с контрольной группой практически здоровых людей. Обнаружено повышенное (по сравнению с контролем) выведение с мочой железа, меди и цинка (особенно у больных с нефропатиями и эндокринологической патологией) (табл. 2). Именно у пациентов этих отделений среднее содержание кадмия в моче превышает МДУ.

В табл. 3. приведены данные о содержании среднего содержания общего белка и коэффициентов корреляции между экскрецией белка и МТ с мочой. Высокие коэффициенты корреляции свидетельствуют о том, что содержание МТ в моче характеризует функциональное состояние почек.

Таблица 3

Статистически обработанные данные о содержании общего белка и металлотионеина в моче

Белок в моче, мг/л Коэффициент Общий белок МТ корреляции

Отделение МДУ < 300,0 < 0 ,1 Общий белок/МТ Среднее 162,4 0,109 Кардиология, откл. (о) 110,9 0,142 0,786Станд.

п = 45 Дов. инт. 1 ,0 0 ,0 0 1 Среднее 190,6 0,105 Нефрология, Станд. откл. (о) 110,9 0,142 0,813 п = 42 Дов. инт. 1 , 0 0 ,0 0 1 63 Cреднее 192,6 0,082 Эндокринология, Оганд. откл. (g) 123,2 0,118 0,883 n = 43 Дов. инт. 1 , 2 0 ,0 0 1 Cреднее 154,8 0,054 Контроль, Оганд. откл. (g) 110,9 0,142 0,734 n = 2 0 Дов. инт. 1 , 6 0 ,0 0 2

Примечание: Относительная погрешность измерения не превышала 10 % для измерения концентрации белка и 20 % для измерения содержания МТ (п = 3, Р = 0,95).

Среднее по кардиологическому и нефрологическому отделениям содержание МТ незначительно превышает условную норму, а для общего белка таких закономерностей не выявлено. Однако, средние по отделению значения содержания белка и МТ в моче недостаточно информативны, поэтому в табл. 4 и 5 представлены данные о количестве случаев превышения условной нормы содержания МТ и белка в моче и соответствующих коэффициентах корреляции их с концентрациями токсичных металлов.

Таблица 4

Данные корреляционного анализа содержании общего белка в моче

Число случаев с Коэффициент % от числа Отделение содержанием корреляции обследованных белка >300 мг/л Cd/белок Hg/белок Кардиология, п = 45 8 17,8 0,613 0,290 Нефрология, п = 42 1 2 28,6 0,655 0,525 Эндокринология, п = 43 1 2 27,9 0,591 0,665 Контроль, п = 2 0 3 15,0 0,378 0,456

Таблица 5

Данные корреляционного анализа содержании металлотионеина в моче

Число случаев с Коэффициент % от числа Отделение содержанием корреляции обследованных МТ > 0,1 мг/л Cd/MT Hg/MT Кардиология, 2 0 44,4 0,822 0,508 п = 45 Нефрология, 18 42,9 0,828 0,488 п = 42 Эндокринология, 14 32,6 0,623 0,585 п = 43 Контроль, 2 1 0 ,0 0,555 0,385 п = 2 0

64 Сравнение данных табл. 4 и 5 показывает, что наблюдаются более выраженные корреляции между содержанием основных металлов-токсикантов и МТ в моче, что доказывает большую информативность использования именно этого биомаркера для оценки нефротоксического действия ТМ.

Высокий процент случаев превышения МТ в моче практически во всех отделениях привел к необходимости ранжирования пациентов по содержанию ТМ в моче.

Таблица 6

Количество случаев с содержанием металлов в моче в соответствующих концентрационных диапазонах

Количество случаев, % Кардиология, Нефрология, Эндокринология Контроль, Отделение п = 45 п = 42 п = 43 п = 2 0 Те, мг/л

< 1 , 1 норма 1 0 0 1 0 0 1 0 0 1 0 0

> 1 , 1 выше нормы 0 0 0 0 Zn, мг/л меньше < 0 ,2 нормы 15,6 14,3 0 ,0 1 0 ,0 0,2 — 0,4 норма 35,6 16,7 23,3 90,0

> 0,4 выше нормы 48,9 66,7 76,7 0 ,0 Си, мг/л <0,03 норма 71,1 9,5 34,9 80,0 > 0,03 выше нормы 28,9 90,5 62,8 2 0 ,0 Сё, мг/л

< 0 ,0 0 2 норма 42,2 23,8 23,3 65,0

> 0 ,0 0 2 выше нормы 57,8 76,2 76,7 35,0 РЬ, мг/л

< 0,03 норма 97,8 92,9 1 0 0 ,0 1 0 0 ,0 > 0,3 выше нормы 2 , 2 7,1 0 ,0 0 ,0 Н£, мг/л

< 0 , 0 1 0 норма 44,4 40,5 44,2 60,0 > 0 , 0 1 0 выше нормы 55,6 59,5 55,8 40,0

Следует отметить, что по существующим в нашей стране нормам МДУ ртути в моче не должен превышать 0,025 мг/л, однако в последние годы ВОЗ рекомендует в качестве МДУ 0,010 мг/г. Ни у одного пациента концентрация ртути в моче не превышала 0,025 мг/л, поэтому в качестве граничного показателя мы приняли современные требования ВОЗ.

Поскольку концентрации ТМ и МТ в моче характеризуют, в основном, состояние выделительной системы, для оценки нагрузки и характеристики обмена ТМ были измерены содержания металлов в крови. Именно этот интегральный показатель характеризует текущее состояние поступления, распределения и элиминирования металлов.

65 Таблица 7

Статистически обработанные данные о содержании металлов и металлотионеина в крови

Содержание металлов, мг/л МТэр, мкг/г Те Zn Си Сй РЬ Отделение белка 360 1,16 30,0 0,7-1,4 < 0 ,0 1 < 0 , 1 0 < 0,025 МДУ 600 9,0 1 0 0 ,0 Среднее 458,6 3,10 1,62 0,0034 0,0516 0 , 0 1 1 2 69,0 Кардиология, Станд. откл. (о) 100,4 1,33 0,72 0,0025 0,0203 0,0066 32,3 п = 45 Дов. инт. 0,9 0,01 0,01 0,0001 0,0002 0,0001 0,3

Среднее 541,8 1 ,8 6 0 ,8 8 0,0044 0,0872 0,0133 49,0 Нефрология, Станд. откл. (о) 104,7 0,79 0,39 0,0026 0,0205 0,0076 2 2 , 1 п = 42 Дов. инт. 1 ,0 0,01 0,00 0,0001 0,0002 0,0001 0 ,2 Среднее 467,2 1,87 0,74 0,0053 0,0812 0,0094 51,3 Эндокринология, Станд. откл. (о) 93,8 0,87 0 ,2 0 0,0030 0,0270 0,0052 23,3 п = 43 Дов. инт. 0,9 0,01 0,01 0,0001 0,0003 0 ,0 0 0 0 0 ,2

Среднее 353,7 1,33 0,63 0,0035 0,0571 0 , 0 1 2 0 28,9 Гемодиализ Станд. откл. (о) 95,0 0,82 0,32 0,0017 0,0023 0,0053 11,9 п = 2 0 Дов. инт. 1,5 0,01 0,01 0,0001 0,0000 0,0001 0 ,2

Среднее 532,7 3,03 1,04 0,0040 0,0306 0 , 0 1 1 1 67,2 Контроль, Станд. откл. (о) 85,6 2,42 0,19 0,0024 0,0163 0,0062 25,1 п = 2 0 Дов. инт. 1 , 2 0,03 0,01 0,0001 0,0002 0,0001 0,4

Как показано проведенными исследованиями, хотя средние концентрации тяжёлых металлов у больных различных отделений отличаются от контрольной группы, эти данные оказались малоинформативными, т.к. высокие значения стандартного отклонения характеризуют значительный разброс значений в выборке.

Поэтому нами проведено ранжирование результатов исследования содержания токсичных металлов в крови больных (табл. 8 ).

Таблица 8

Количество случаев с содержанием металлов в крови в соответствующих концентрационных диапазонах

Количество случаев, % Кардиология, Нефрология, Эндокринология Гемодиализ, Контроль, Отделение п = 45 п = 42 п = 43 п = 15 п = 2 0 Fe, мг/л меньше <300 40,0 нормы 2 , 2 0 ,0 0 ,0 0 ,0 300-600 норма 88,9 76,2 97,7 60,0 75,0 выше > 600 8,9 23,8 2,3 0 ,0 25,0 нормы

66 Zn, мг/л меньше < 1 2 , 2 16,7 16,3 40,0 0 ,0 нормы Ввд 1 ,0 норма 97,8 83,3 83,7 60,0 95,0 до 9,0 выше > 9 0,0 0,0 0,0 0,0 5,0 нормы Си, мг/л меньше <0,7 15,6 31,0 41,9 66,7 нормы 0 ,0 0,7-1,4 норма 28,9 66,7 58,1 26,7 1 0 0 ,0 выше 9,5 0 ,0 6,7 0 ,0 > 1,4 нормы 31,1 Сё, мг/л < 0 , 0 1 0 норма 97,8 95,2 90,7 1 0 0 ,0 1 0 0 ,0 выше > 0 , 0 1 0 2 , 2 4,8 9,3 0 ,0 0 ,0 нормы РЬ, мг/л

<0 ,1 норма 1 0 0 ,0 76,2 76,7 1 0 0 ,0 1 0 0 ,0 выше > 0 ,1 0 ,0 23,8 23,3 0 ,0 0 ,0 нормы Н§, мг/л < 0,025 норма 1 0 0 ,0 95,2 100,0 100,0 100,0 выше > 0,025 0 ,0 4,8 0 ,0 0 ,0 0 ,0 нормы

Из приведенных в табл. 6 и 8 данных видно, что содержание токсичных металлов в крови и моче значительного числа больных превышает допустимые нормы. Для балансовых расчетов к этим величинам следует прибавить больных, в биосубстратах которых токсичные металлы оказываются на верхней границе нормы. Тогда картина нагрузки организма обследованных тяжёлыми металлами существенно изменяется и более полно отражает потенциальный уровень риска формирования патологии.

Если дополнительно учитывать число больных с пониженным содержанием эссенциальных металлов в биосубстратах, количество обусловленных микроэлементозом случаев возможных функциональных сдвигов гипоксического характера, развития анемии, дисферментемий достаточно значительно и составляет 30-45 % обследованных.

Повышение уровня содержания токсичных элементов в биосубстратах возможно связано с производственной деятельностью пациентов (40 % из обследованных имеют рабочие специальности) или с экологическими проблемами в регионе. Обнаруженный дисбаланс в содержании и выведении эссенциальных и токсичных элементов может также быть следствием их конкурентных взаимоотношений в организме. Такие взаимоотношения, в частности, могут проявляться в мобилизации или, напротив, стабилизации транспортных и обменных форм элементов.

Учитывая важность МТ в обеспечении комплексного ответа организма на экспозицию ТМ, было проведено исследование содержания этого белка в эритроцитах и эскреции его с мочой у больных разных отделений.

Таблица 9 67 Количество случаев с содержанием МТ в крови и моче в соответствующих концентрационных диапазонах

количество случаев, % Кардиология, Шфрология, Эндокринология Гемодиализ, Контроль, Oтделение n = 45 n = 42 n = 43 n = 15 n = 2 0 МТэр., мкг/г белка меньше < 30 2 , 2 14,3 18,6 60,0 1 0 ,0 нормы 30-100 норма 84,4 81,0 76,7 40,0 80,0 выше > 1 0 0 13,3 4,8 4,7 0 ,0 1 0 ,0 нормы MU ot., мг/л

< 0 ,1 норма 55,6 57,1 67,4 - 90,0 выше - > 0 ,1 нормы 44,4 42,9 32,6 1 0 ,0

Таблица 10

Данные корреляционного анализа содержании металлотионеина в эритроцитах

Коэффициент корреляции Cd/МТэр. Zn/М Т ф. Hg/МТэр. Отделение (кровь) (кровь) (кровь) MTэр./MTмоч. Кардиология, n = 45 0,599 0,434 0,573 0,541 Нефрология, n = 42 0,426 0,364 0,374 0,312 Эндокринология, n = 43 0,158 0,424 0,447 0,199 Гемодиализ, n = 15 0,272 0,928 0,204 -

Контроль, n = 20 0,301 0,557 0,190 0 , 2 1 1

Относительно низкий коэффициент корреляции Cd/MT (кровь) в эндокринологическом отделении может объясняться сложным характером влияния факторов гормональной природы на экспрессию синтеза МТ в эритроцитах на стадии эритропоэза, который не связан с повышенной экспозицией ТМ, в т.ч. кадмием, который более, чем у 90 % пациентов этого отделения находится в пределах нормы. Напротив, максимальный коэффициент корреляции Zn/MT (кровь) у больных из отделения гемодиализа показывает нарушение обмена цинка, а именно его дефицит, что подтверждается даными о содержании цинка в крови, которая меньше нормы у 40 % обследованных.

Tаблица 1 1

Данные корреляционного анализа содержании металлотионеина и цинка в эритроцитах с учетом и без учета концентраций токсичных ТМ______Oтделение Коэффициент корреляции Zn/MTa^ (кровь) 68 Без учета токсичных ТМ С учетом токсичных ТМ* Кардиология, п = 45 0,434 0,640 Нефрология, п = 42 0,364 0,537 Эндокринология, п = 43 0,424 0,632 Гемодиализ, п = 15 0,928 0,928 Контроль, п = 20 0,557 0,684 Примечание: из анализа исключены пациенты с превышением уровня Cd и Hg в крови

Из данных, представленных в табл. 11, следует, что по уровню МТэр. можно судить об обмене цинка только в том случае, когда отсутствует экспозиция токсичными ТМ. Если рассматривать обследуемых независимо от отделения, то существует закономерность в изменении коэффициентов корреляции 2и/МТэр. (табл. 12). Данные табл. 12 подтверждают взаимосвязь между цинкдефицитными состояниями и концентрацией МТ в эритроцитах, что позволяет рассматривать этот показатель как потенциальный биомеркер цинкдефицита.

Таблица 12 Коэффициенты корреляции между концентрацией цинка в крови и содержанием МТ в эритроцитах в зависимости от концентрационного диапазона (п = 165) Диапазон концентраций МТэр., мкг/г белка Коэффициент корреляции Zn/MTэр. Весь диапазон 0,537 0 - 1 0 0 0,633 0-50 0,689 0-30 0,703 Диапазон концентраций Zn, мг/л Коэффициент корреляции Zn/MTэр. Весь диапазон 0,537 0 - 1 0,825

Как видно из табл. 12, при содержании цинка в крови до 1 мг/л (т.е. ниже общепринятой нормы), коэфициент корреляции Zn/MTэр. Очень высок и составляет 0,825. Это свидетельствует о том, что содержание МТ в эритроцитах может адекватно характеризовать цинкдефицитные состояния при отсутствии экспозиции токсичными металлами-индукторами МТ.

Выводы

Из проведенного исследования можно сделать следующие выводы:

1. Пациенты с заболеваниями различной этиологии имеют значительные отклонения микроэлементнного статуса, что подтверждает предположение о важной роли микроэлементов в патогенезе. 2. При повышенных уровнях токсичных тяжелых металлов (цинк, кадмий, ртуть) в крови регистрируется повышенное содержание металлотранспортного белка - металлотионеина. 3. Между содержанием МТ в моче и эритроцитах крови нет жесткой взаимосвязи. Это указывает на то, что при функциональной состоятельности почек потери МТ не происходит, следовательно, уровень МТ в моче является маркером не экспозиции ТМ, а начальной стадии повреждения почек. Появление МТ в моче, как правило, предшествует выраженной протеинурии. 4. По уровню МТэр. можно судить об обмене цинка только в том случае, когда отсутствует экспозиция токсичными ТМ. Концентрация МТэр. ниже 30,0 мг/г белка, как правило, свидетельствует о нарушении обмена цинка, даже если содержание этого металла в биосубстратах лежит на нижней границе нормы. 69 Анализ взаимосвязи синтеза и выведения МТ с микроэлементным статусом пациентов, с одной стороны, позволяет проследить и в дальнейшем оценивать комбинированные эффекты сложных смесей тяжёлых металлов, которые в реальных условиях жизнедеятельности человека формируют микроэлементную нагрузку антропогенного происхождения (производственного или экологического генеза). С другой стороны, полученные результаты добавляют степень неопределенности в проблеме микроэлементозов, поскольку реализация потенциального риска относительно развития патологии зависит от направленности вектора, который является результатом взаимодействия интегральных и специфических для каждого металла патогенетических механизмов.

Open Access

Литература

1. Сердюк А.М. Гшешчш проблеми Украши на рубежi столыь / А.М. Сердюк // Гшешчна наука та практика на рубеж столыь: Матерiали XIV зТзду гшешспв Украши. 19-21 травня 2004 року (Дншропетровськ). - К., 2004. - Т.1. - С. 30-33.. 2. Большой Д.В. Металлы в полимерных материалах как гигиеническая проблема / Д.В. Большой // Сучасш проблеми токсикологи. - 2011. — № 5 (55). - С. 164-165.. 3. Исследование риска экофакторов городской среды для здоровья населения / Шафран Л.М., Тимошина Д.П., Пыхтеева Е.Г. [и др.] // Экологич. проблемы городов, рекреационных зон и природоохранных территорий. Сб. научн. ст. — Одесса: ОЦНТЭИ, 2000.-С. 337-340. 4. Здоровье работающих: Проект глобального плана действий. - Женева: ВОЗ, 2006. - ЕВ 120/28. - 28 с. 5. Beaglehole R., Bonita R., Kjellstrom T. Basic Epidemiology. - Geneva: WHO, 1993. - 175p. 6 . Шафран Л.М. Металлотионеины /Шафран Л.М., Пыхтеева Е.Г., Большой Д.В. Под редакцией проф. Л.М. Шафрана - Одесса: Издательство "Чорномор'я", 2011. - 428 с.

70 Резюме

Пыхтеева Е.Г.

Обследовано 145 пациентов больниц г. Одессы и г. Ковеля. Содержание эссенциальных (Fe, Cu, Zn) и токсичных металлов (Cd, Pb, Hg), а также интегральное содержание металлотионеинов в крови и моче и общего белка в моче. Показано, что у пациентов с заболеваниями различной этиологии наблюдаются значительные отклонения микроэлементнного статуса. При повышенных уровнях токсичных тяжелых металлов (цинк, кадмий, ртуть) в крови регистрируется повышенное содержание металлотранспортного белка - металлотионеина. Mежду содержанием металлотионеина в моче и эритроцитах крови нет жесткой взаимосвязи. Это указывает на то, что при функциональной состоятельности почек потери металлотионеина не происходит, следовательно, уровень металлотионеина в моче является маркером не экспозиции тяжелыми металлами, а начальной стадии повреждения почек. Появление металлотионеина в моче, как правило, предшествует выраженной протеинурии. По уровню металлотионеина в эритроцитах можно судить об обмене цинка только в том случае, когда отсутствует экспозиция токсичными тяжелыми металлами. Концентрация металлотионеина в эритроцитах ниже 30,0 мг/г белка, как правило, свидетельствует о нарушении обмена цинка, даже если содержание этого металла в биосубстратах лежит на нижней границе нормы.

Ключевые слова: металлотионеин, тяжелые металлы, металлопатия

l1 Резюме

ДОСЛТДЖЕННЯ РОЛ1 МЕТАЛОТЮНЕШУ У ЗАХИСТ1 ОРГАН1ЗМУ ЛЮДИНИ В1Д ВПЛИВУ ВАЖКИХ МЕТАЛ1В ПРИ НЕДОСТАТНОСТ1 АДАПТАТТТЙНИХ МЕХАН1ЗМ1В

Пихтеева О.Г.

Обстежено 145 пащешгв лiкарнi м. Одеси та м. Ковеля. Вмют есенцiальних (Fe, Си, Zn) i токсичних металiв (Cd, РЬ, Hg), а також штегральний вмiст металлотюне'1шв в кровi та сечi i загального бiлка в сечг Показано, що пацiенти iз захворюваннями рiзноi етюлогл мають значш вiдхилення мiкроелементного статусу. При тдвищених рiвнях токсичних важких металiв (цинк, кадмш, ртуть) у кровi рееструеться тдвищений вмiст металлотранспортного бiлка — металотюнешу. Мiж вмiстом металотюнешу в сечi i еритроцитах кровi немае жорсткого взаемозв'язку. Це вказуе на те, що при функцюнальнш спроможностi нирок втрати металотюнешу не вщбуваються, отже, рiвень металотюнешу в сечi е маркером не експозицп важкими металами, а початково'1 стади ушкодження нирок. Поява металотюнешу в сеч^ як правило, передуе вираженш протешурп. За рiвнем металотюнешу в еритроцитах можна судити про обмш цинку тшьки в тому випадку, коли вщсутня експозицiя токсичними важкими металами. Концентращя металотiонеiну в еритроцитах нижче 30,0 мг/г бшку, як правило, свщчить про порушення обмiну цинку, навыь якщо вмiст цього металу в биосубстратах лежить на нижнш меж1 норми.

Ключовi слова: металотiонеiн, важю метали, металлопатiя

This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License (http://creativecommons.Org/licenses/by-nc/3.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited.

Conflict of interest: None declared.

Received: 15.01.2013. Revised: 15.03.2013. Accepted: 29.05.2013.

72 Journal of Health Sciences (J of H Ss) 2013; 3(5): 89-100

The journal has had 4 points in Ministry of Science and Higher Education of Poland parametric evaluation. Part B item 683.

COMPARISON OF SOMATIC AND MOTOR SKILLS 14-16 YEARS OLD

BOYS FROM SELECTED SECONDARY SCHOOLS BYDGOSZCZ

Porównanie cech somatycznych i zdolności motorycznych 14-16 letnich chłopców z

wybranych gimnazjów Bydgoszczy

Hanna Żukowska1, Mirosława Szark-Eckardt1,

Michalina Kuska 1 , Marek Napierała 1, Walery * Żukow 2

1Kazimierz Wielki University in Bydgoszcz, Faculty of Physical Education, Poland

2 2University of Economy in Bydgoszcz, Poland

This article is published with open access at Licensee Open Journal Systems of Radom University in Radom, Poland

Słowa kluczowe: cechy somatyczne, poziom zdolności motorycznych.

Key words: somatic features, the level of motor skills.

A bstract

An aim was of conducted tests comparing somatic features and motor abilities of

14-16-years boys from chosen junior high schools of the city of Bydgoszcz.

73 548 students were examined from Bydgoszcz junior high schools at the age of

14-16 (203 in the age of 14 years, 173 - in the age of 15 years and 172 in the age of 16 years. Findings were presented tabular and graphically (along with descriptions).

Students of full-time studies participated in the realization of the research problem and in absentia of direction of the UKW physical education in Bydgoszcz.

Conclusions:

1. From compared groups of senior pupils the greatest height and the body weight characterize students 15 - years.

2. Examined from Bydgoszcz junior high schools turned out to be 14-years higher than peers from all-Polish tests, remaining groups are lower; body weight 14 and 15-years are bigger of students, however have 16-years greater body weight in all-Polish tests.

3. A 14-years group is characterized by the highest motor abilities, then 15 and 16- years.

4. The group of 14-years students achieved the higher number of points than high from all-Polish tests, remaining groups have results weaker than compared groups.

Streszczenie

Celem przeprowadzonych badań było porównanie cech somatycznych i zdolności motorycznych 14-16 letnich chłopców z wybranych gimnazjów miasta

Bydgoszczy.

Przebadano 548 uczniów z gimnazjów bydgoskich w wieku 14-16 lat (203 w wieku 14 lat, 173 - w wieku 15 lat i 172 w wieku 16 lat. Wyniki badań przedstawiono tabelarycznie i graficznie (wraz z opisami). W realizacji problemu badawczego

74 uczestniczyli studenci studiów dziennych i zaocznych kierunku wychowania fizycznego

UKW w Bydgoszczy.

Wnioski:

1. Z porównywanych grup gimnazjalistów największa wysokość i masa ciała cechuje uczniów 15 - letnich.

2. Badani 14-latkowie z bydgoskich gimnazjów okazali się wyżsi od rówieśników z badań ogólnopolskich, pozostałe grupy są niższe; masa ciała 14 i 15-latków jest większa uczniów, natomiast 16-latkowie mają większą masę ciała w badaniach ogólnopolskich.

3. Najwyższymi zdolnościami motorycznymi charakteryzuje się grupa 14-latków, potem 15 i 16-latków.

4. Grupa uczniów 14-latków osiągnęła wyższą liczbę punktów niż średnia z badań ogólnopolskich, pozostałe grupy mają wyniki słabsze od porównywanych grup.

Introduction

The biological development of the man finds fulfilment in specific, social and biological environmental conditions. Peculiarly he enters to observe disproportions of the development in the phase of the progressive development of the organism preceding the adolescence. It is obvious, so stating, that level and the quality of life of all sorts

75 social groups considerably affects effects of this development and in the process determines somatic and fitness differences of the development of the man.

Changes of civilization habits besides positive effects cause also unfavorable phenomena for the body of the man, in particular of children and young people (e.g. restricting the motor initiative, of physical effort, dietetic bad habits, attraction of various forms of the television transmission and other).

From here more and more great role of the health education of both treatments aiming at the improvement in the physical fitness of children and young people. These treatments must become a process permanent, including all process levels of raising

(Napierała 2005, p. 7).

Along with the development of the child, purchased motor abilities turn up at his life as well as a level of motor abilities rises. Motor abilities characteristic of individual stages of the ontogenesis of the organism, manifesting itself in functions and motor action, club together for the image of his physical fitness. This way the comprehended efficiency is a state of the system, deciding on the motor resourcefulness in situations, what child (as well as adult man) meets in surrounding world. The physical fitness is, so with certificate of the degree of the maturity and the function of the organism working above all in physical efforts (Przewęda 1973, p. 179).

The physical fitness of the man was a theme of observation for ages, in relation to what in practice of the physical education and sport too in good shape physically (until today still), they caught to regard people strong, fast, nimble, immune to the tiredness, agile and resourceful in motor functions, irrespective of the structure of their body, as regularities of the development and from the potential of their developmental possibilities (Gilewicz 1964).

76 In the framework of tasks of the methodology of the physical education, appointed to the somatic development conscious of regulating man, comprehending the physical fitness must be comprehended much more widely than in sport.

In sport, they caught to recognize only a degree of the preparation for specific physical efforts as the test of the physical fitness, whereas the class tutor to be interested apart from that a state of health of young people, a build, a correctness of the developmental rhythm and a potential of developmental possibilities must also. The effect of physical effort isn't decisive for the man and to it only starts to speak when is being connected with character of the build, the age and general growth indices.

Assessing the youth development according to the degree of effort available to her, one should realize it, that the same result in runs, jumps and throws of specimens about the different height and body weights doesn't mean the identity of their substantial effort

(Gilewicz 1964).

Purposes of research

Comparing somatic features and motor abilities of 14-16 years old boys were an aim of conducted tests from chosen junior high schools of the city of Bydgoszcz. After determining the current state of individual age groups results of both somatic features and motor abilities were compared among individual age groups. Comparing to all

Polish tests they made by counting T. on points according to the scale

Material and the method

They conducted research in spring (on the crisis of the April and the May) of

2012, and 548 embraced students became them from Bydgoszcz junior high schools at

77 the age of 14-16 (203 in the century of 14 years, 173 - in the century of 15 years and

172 in the century of 16 years. Groups of the calendar age were established according to principles generally applied in tests of the developmental type (Malinowski 1978).

Taking the twenty-four hour biorhythm into account, the research on the motor activity took place in hr 10.00 - 13.00.

Students of full-time studies participated in the realization of the research problem and in absentia of direction of the physical education of Kazimierz Wielki University in

Bydgoszcz game teachers and the nursing staff from examined schools. Everyone examining were trained according to instructions of tests.

For tests only healthy children were taken into consideration, without contraindications against practising physical exercises. The medical condition of examined children was based on principles of qualifying students for classes of the physical education. Findings were presented tabular and graphically (along with descriptions). In tables attendances examined slightly they differ, since not all participants could be subjected to individual tests on the test. A small number of results raising doubts or incorrect was rejected.

The somatic development of the examined population was determined based on the height and the body weight. The height of the body was measured with the help of the measure put at medical weight ranges after prior for checking them with the accuracy up to 0.1 cm. Examined he stopped in the straightened position, barefooted, with joined feet, the head was placed in the Frankfurt position (i.e. the optic-ear position, by which the horizontal line proceeds through the uphill edges of ear nodules and the bottom edge of the orbit), she could not be neither chipped nor lowered. The height was read out from the peak of the head of examined, so-called vertex. They made

78 measurements of the body weight in the morning in the presence of the school nurse and the game teacher at the medical weight range with the accuracy to 10 dag. Examined stood on the weight range barefooted in gym shorts. A physics quantity was accepted

"body weight", as more general, even though the weight of the body was checked on the personal scale acting on the principle of stretched springs; stretching it's up to the geographical place on the earth (Napierała 2005).

It is possible to make an assumption that the motricity is manifested mainly in the degree of expressing the level of the ability and motor abilities of the specimen in specific motor acts, in it in tests of the efficiency. An efficiency was accepted, as the ability of solving motor problems, and the level of the efficiency of the population was expressed with mean get in motor tests.

For determining motor abilities tests on the International Test were used of physical fitness. This test takes into account the in-depth evaluation of groups of muscles of the whole body. Mechanical elements aren't directed to none of basic sports.

Before commencing tests examined performed the warm-up, as to intensive of physical exercises. The sportswear during the test should consist of the T-shirt and pants

(if necessary light tracksuit) and of casual, without spikes or stakes, about the nonslippery sole. Tests on the overhang, pulling up and the bend are performed without the footwear. Tests on the test were conducted according to instructions of MTSF tests described through S. Pilicz et al. (2003).

The international Test of the physical fitness contains eight following tests:

1. run on distance of 50 flat

2 . long jump from the place.

3. measurement of the force of the hand.

79 4. measurement of the force relative: pulling up in the overhang on the bar - boys

5. forward and backward run on distance 4 times 10 m with the transfer operation of blocks.

6 . bend forward.

7. recumbent sit-ups in 30’ time

8 . prolonged runs: on distance of 1 0 0 0 m - boys in century 1 2 and more of years.

Results of motor abilities were subjected to a statistical analysis and calculated on points according to the scale T. The Significance of statistical differences with the help of the test a t Student was determined for independent groups. Critical values were read off on the level:

t = 0.05; t = 0.01; (Arska - Kotlinska, Bartz 1993).

Results

Table 1 presents the numerical characterization of the height of the body of 14

16 years old boys from chosen junior high schools in Bydgoszcz. On the level of the 1% a difference between the average height of body 14 and 15 years old boys demonstrates the statistical gravity which is 3.25 cm. The arithmetic mean of the height of body 15 and 16 years old boys are almost identical and is 172.83 cm and 172.43 cm appropriately and she isn't essential statistically.

80 Table 1. Numerical characterization o f the height o f the body (cm) 14-16 years old boys from chosen junior high schools in Bydgoszcz SEC. D at

AGE N X O f faces Max 3.25 4.18 * * 14 203 169.58 153 188 7.49 15 173 172.83 154 192 7.52 0.4 0.50 16 172 172.43 151 190 7.22 * (p = 0.05) * * (p = 0.01) Analyzing the results included in table 2, to notice the showing numerical characterization of the body weight of Bydgoszcz senior pupils it is possible, that differences between individual age groups aren't substantial statistically. Arithmetic mean of body weight 14, 15 and 16 years old boys is 63.38 kg, 64.19 kg and 63.14 kg appropriately.

Table 2. Numerical characterization of the body weight (kg) 14-16 years old boys from chosen junior high schools in Bydgoszcz

SEC. D at

AGE N X O f faces Max 0.82 0.83 14 203 63.38 45 91.3 8.69 15 173 64.19 35 107.0 10.26 1.05 0.99 16 172 63.14 42 96.0 9.47 * (p = 0.05) * * (p = 0.01) From the International Test of the physical fitness the long jump was a first effort right away measuring explosive strength of lower limbs (Table 3). Most poorly senior pupils came out in the test at the age of 14, achieving the arithmetic mean of the jump equal of 183.9 cm, shock from 15 years old boys for 14.75 cm. Test results at = 4.47 on the level a 1% points at the statistical gravity. On the second place boys positioned themselves from the oldest age group achieving the average 189.23 cm what compared with 15 years old boys is essential statistically on the level of the 5%.

81 Table 3. Numerical characterization of the long jump from the place of 14-16 years old boys from chosen junior high schools in Bydgoszcz (cm) SEC. D at

AGE N X O f faces Max 14.75 4 4 7 * * 14 203 183.90 109 265 29.11 15 173 198.65 117 295 34.06 9.42 2.51 * 16 172 189.23 113 291 35.53 * (p = 0.05) * * (p = 0.01) In the attempt to grip the dynamometer best senior pupils fell out of the third classes achieving the average result - 42.85. They were turn out to be good from 15 years old boys about 4.22 kG what is essential statistically on the level of the 1%. Also essential statistically differences, on the level the 5% was stated between 14 and 15 years old boys.

Table 4. Numerical characterization of Collin’s dynamometer clenching of 14-16 years old boys from chosen junior high schools in Bydgoszcz (kG) SEC. D at

AGE NX O f faces Max 4.4 2.54 * *

14 203 34.33 6 64 19.35

15 173 38.63 2 1 67 16.89 4.22 5.38 * * 16 172 42.85 18 75 25.01 * (p = 0.05) * * (p = 0.01)

82 Another trial is sitting positions from lying I put on weight 30 seconds carried out in the time. Results were presented in table 5. Most poorly senior pupils fell out of the third classes which achieved an average result 26.68 what compared with 15 years old boys (28.65) on the level a 1% gives the statistical gravity. Test results at = 0.93 between 14 and 15years old boys didn't demonstrate the gravity of statistical differences. A fact is worthy of notice, that senior pupils of the second classes even though achieved the highest high result in the test also carried out the low figure of bends which took out 2 .

Table 5. Numerical characterization of recumbent sit-ups in 30’ time of 14-16 years old boys from chosen junior high schools in Bydgoszcz (number of cycles) SEC. D at

AGE N X O f faces Max 0.52 0.93 14 203 28.13 13 40 4.83

15 173 28.65 2 42 5.91 1.97 3.31 * * 16 172 26.68 17 39 5.10 * (p = 0.05) * * (p = 0.01) In the attempt to pull up on the bar best senior pupils fell out of the third classes achieving the average result 4.83 (number of pulling up). However it is worth the attention, that both age groups 14 and 16 years old boys achieved identical maximum number of pulling up (22). Between 14 and with 15 years old boys a difference appeared statistically essential on the level of the 5%.

83 Table 6. Numerical characterization of pulling 14-16 years old boys up on the bar from chosen junior high schools in Bydgoszcz (s) SEC. D at

AGE N X O f faces Max 1.3 2.45 *

14 203 3.53 0 2 2 15.05

15 173 4.83 0 23 19.40 0.63 0.35 16 172 5.46 0 2 2 28.29 * (p = 0.05) * * (p = 0.01) According to guidelines of the International Test of the physical fitness Bydgoszcz senior pupils had three racing tests to do, of which numerical characterizations were presented in tables below. Arithmetic means of the run to 50 meters, as can be seen in Table 7, they were very similar to oneself and took out on of individual age groups 8.74 sec., 8 .6 8 sec. and 8.53 sec. what isn't essential statistically.

Table 7. Numerical characterization of the run to 50 meters of 14-16 years old boys from chosen junior high schools in Bydgoszcz (s) SEC. D at

AGE NX O f faces Max 0.06 0.45

14 203 8.74 5.6 1 2 . 0 0 1.17

15 173 8 .6 8 5.8 16.26 1.39 0.15 0.99 16 172 8.53 5.71 1 2 . 2 0 1.41 * (p = 0.05) * * (p = 0.01)

In a 1000 metres run (Table 8 ), materiality level statistical for groups on the level a 1% develops. Boys got the best high time from the third classes 213.58 sec., second place filled 15 years old boys (227.15 s), but the last place fell to 14-latkom (273.0 s) which also got the weakest time taking out of 517.0 p.

84 Table 8. Numerical characterization of the run to 1000 meters of 14-16 years old boys from chosen junior high schools in Bydgoszcz (s) SEC. D at

AGE N X O f faces Max 45.85 6.73 * * 14 203 273.00 151 517 84.48 15 173 227.15 151 367 44.23 13.57 3.14 * * 16 172 213.58 149 338 35.56 * (p = 0.05) * * (p = 0.01) On the run pendular as similarly as on the run to 50 meters we don't notice bigger disproportions (Table 9). Difference between 14 and 15 years old boys amounted to 0.2 sec. and isn't essential statistically and between 15 and 16 years old boys 0.5 sec. what gives the statistical gravity on the level of the 5%.

Table 9. Numerical characterization forward and backward run 4 x 10 of meters of 14 16 years boys from chosen junior high schools in Bydgoszcz (s) SEC. D at

AGE N X O f faces Max

0 .2 0 1 . 0 2 14 203 11.98 7.0 16.3 1.61

15 173 11.78 7.5 20.9 2 . 1 1 0.50 2.44 * 16 172 11.28 7.5 16.7 1.67 * (p = 0.05) * * (p = 0.01) In the test on the bend of the torso a 14 years old boys group was characterized by the greatest suppleness (12.87 cm), then 16 years old boys (10.27 cm). Differences among compared age groups turned out statistically to be substantial on the level of the

1 %.

85 Table 10. Numerical characterization of bend forward of 14-16 years old boys from chosen junior high schools in Bydgoszcz (cm) SEC. D at

AGE N X O f faces Max 6.75 5.55 * * 14 203 12.87 -9 71 16.54

15 173 6 . 1 2 -15 2 1 4.76 4.15 5.60 * * 16 172 10.27 -8 36 8.48 * (p = 0.05) * * (p = 0.01)

Discussion and conclusions Results of MTSF tests on boys from chosen junior high schools in Bydgoszcz counted on points according to the scale the tabulation of points finds T. oneself in table 11. Boys got the substantial amount of points at the age of 14 (405 points), then 15-year (396 points) and 16 years old boys (391 points). Only group 14 years old boys average of all-Polish scorings (50.62 point).

Table 11. Results of MTSF tests on 14-16 years old boys from chosen junior high schools in Bydgoszcz counted on points according to the scale T Boys of 14 years Boys of 15 years Boys of 16 years TESTS point point Point X SEC. X SEC. X SEC. s s s THE LONG JUMP 183.9 198.6 189.2 29.11 50 34.06 47 35.53 41 FROM THE PLACE 0 5 3 GRIPPING THE 34.33 19.35 51 38.63 16.89 50 42.85 25.01 50 DYNAMOMETER SITTING POSITIONS FROM 28.13 4.83 56 28.65 5.91 56 26.68 5.10 53 LYING I PUT ON WEIGHT PULLING UP ON 3.52 15.05 49 4.83 19.40 49 5.46 28.29 50 THE BAR

86 RUN TO 50 8.74 1.17 43 8 .6 8 1.39 36 8.53 1.41 36 METERS RUN TO 1000 273.0 227.1 213.5 84.48 46 44.23 56 35.56 58 METERS 0 5 8 Pendular 4x10 run of 11.98 1.61 47 11.78 2 .11 52 11.28 1.67 49 Meters BEND OF THE 12.87 16.54 63 6 . 1 2 4.76 50 10.27 8.48 54 TORSO AHEAD

I 405 396 391

X 50.62 49.5 48.9

Comparing the height of the body of examined boys it is possible to notice that in the group of 14 years old boys students turned out to be taller from Bydgoszcz (difference statistically essential on the level of the 5%). In remaining groups 15 and 16 years old boys students turned out to be taller from all-Polish tests, and difference statistically essential appeared at 16 years old boys.

Table 12. Comparing the height of the body of boys from Bydgoszcz junior high schools to peers from all-Polish tests (Przew^da, drummer boy, 2003). Of examining from All-Polish tests d at Age Bydgoszcz

N X SEC. N X SEC. 14 203 169.58 7.49 3643 168.20 8.52 1.38 2.53 *

15 173 172.83 7.52 2847 173.81 7.49 0.98 1 .6 6 16 2230 176.49 6.70 4.06 7.14 * 172 172.43 7.22 *

In group 14 and of 15 years old students were characterized by greater mass from Bydgoszcz. Difference between compared 14years old boys (5%), 15years old boys (1%) is statistically essential. They had greater mass 156 years old boys from all-Polish

tests and also this difference is statistically substantial ( 1 %).

87 Table 13. Comparing the body weight of boys from Bydgoszcz junior high schools to peers from all-Polish tests (Przew^da, drummer boys, 2003). Of examining from All-Polish tests d at Age Bydgoszcz

N X SEC. N X SEC. 14 3643 56.13 10.54 7.25 11.45 203 63.38 8.69 * *

15 173 64.19 10.26 2847 62.34 1 0 . 2 0 1.85 2.30 * 16 2230 66.49 9.99 3.35 4.45 * 172 63.14 9.47 *

In individual age groups it is possible to observe disproportions in the somatic development as well as motor abilities. Tests had diagnostic character, so concentrate on solving above problems on the example of the determined area and the temporal range, and therefore research hypotheses going beyond factual material included in current tests aren't also formulated. Assumptions were made about the relative genetic homogeneity examined what enables interpretation of possible developmental differences in the light of the homogeneous environment. This speculation is a justified premise on account of the small migration of the population in the region.

For ages a phenomenon of diversifying human forms in terms of the size, the

proportion of different body parts, or also forms of the reaction to environmental

factors was noticed.

88 In Poland, albeit in many respects is let the state observe area inhabited by the very homogeneous society regional and environmental diversity in terms of the build.

Enough his height is a characteristic feature of the body of the man. The height of the body is a feature polygenic, what the offspring can in relation to different direct to lean ad valorem of this feature at one's parents. Ultimate values of this feature demonstrate the big dependence on environmental conditions, especially, from the quality of feeding the progressive development in the period (Malinowski 1999).

Tests also in Poland show differences of the height depending from the education and the social structure. Similar results were observed in tests longitudinal in the

Bydgoszcz region (Napierała 2000). For them an education or a hierarchy are higher in the social structure, average heights of the body are all the higher. From all-Polish tests of the drummer boy and Przewęda (2003) as well as regional (Napierała 2005,

2008) it results that in Poland the population of cities is moderately higher than the rural population, that population nord-western Poland is higher from south-eastern.

The tendency of differences of the amount of the body among the population from

89 cities and the village is decreasing due to the migration of the urban population, especially of the one richest, into country regions in regions of cities.

Undoubtedly the standard of living affecting the development of the organism is diversified in individual regions of the country. A need of monitoring of the permanent somatic and motor development the given population exists, in order to in case of meaning changes in it following, can combat all negative trends. Regional differences appearing in Poland are reflecting disproportion in the development and the economic structure of individual territorial areas.

Comparing findings of somatic features of the region Kuyavian-Pomeranian up to all-Polish results one should notice that standard deviations of studied trademarks in the Kuyavian-Pomeranian region are smaller than in all-Polish tests what can provide about the existence of the factors determining development peculiar to the region somatic. They can it to be geographical-ecological causes and causes about character pedeutological (the sameness of the teacher education of the physical education and the sameness of educating students). The cause can lie in genetic factors (a small migration of the population exists in the region), but this fact requires

90 further research. The region can constitute a point of departure on that account to the benchmarking of all kinds (Napierała 2005, 2008).

Many researchers notice appearing of the connection of processes of growing with the motor development (Shed, Sakowicz 1987, Schoolboy 1991, Pigeon 1993,

Stupnicki, Przewęda, Milde 2003). They notice, that level of development somatic and motor can be only a tangle of predispositions diverse, mutually interpenetrating and acting with different power. Shed, Milk, Schoolboy (2000) state, that determined motricity with results of specific tests identifies himself more, especially in the period of the progressive development, with the factor of the progress of the somatic development. They dealt with establishing connections between the motricity and elements of the build (among others Przewęda 1985, Slip 1989, the Shed, Milk,

Schoolboy 2000, Figwer et al. 1993). Results of the development of somatic features don't go hand in hand with the motor development in the linear way. Tests conducted among others by Osiński (1988), Osiński, Biernacki (1993), of Schoolboy (1991,

1994) confirm this observation.

91 However according to some authors differences in somatic features between children from the city and from the village slowly fade away, because a pace of development reduces somatic children from the city and increases at country children.

Differences fading away between the somatic as well as motor development between specimens of all sorts circles, which to assign it is possible for becoming rich village, emigration of the population educated from cities as country areas neighboring bigger urbanized areas (Turnip, Smyłła 1987, Favor-Mierzejewska, Olszewska 2003), province Kuyavian-Pomeranian belongs to "typical", where else these differences appear. It is possible to suppose natural and ecological advantages don't constitute uncontaminated country areas of element being enough for getting the improvement of quality of life having an impact on development of somatic features undoubtedly.

A statement most oftentimes appearing in literature became a point of departure and the matter under discussion, that for them higher biological development all the greater motor abilities. To provide so that it can about appearing of rectilinear connections between somatic features and motor abilities. However linear umbilical ties appearing not very in the part of the trials of motor abilities induce to the indepth

92 analysis in this area of phenomena. Conducted tests show that in the part of the trials statements concerning linear connections were confirmed, especially in the group of boys. The majority of tests fell out with the benefit for examined about the higher biological development, but also diversities of results of motor abilities exist depending on type of the test, developmental age, sex and from the environment of settling. They showed that for achieving good results parameters as somatic as mass and the height of the body and the amount of fat, affecting the type of the structure undoubtedly supported and the ones next to results of motor abilities. One should consider connections of considered somatic features individually in proportion to the result of different motor abilities as they appear different forms, in different directions, so it won't be possible to establish "standard sizes". Osiński also confirms it (1988) noticing that an optimum size of somatic features is different for achieving good results in high-speed, endurance or coordinating tests.

Interests in the professional sport with the somatic structure, predictions of the development and his influence on sporting achievements to find it is possible in every sport: in the soccer (the malignant melanoma et al. 2006), in the rowing and the

93 canoeing (Line-up, Tailorbird, Mayle 1994), in karate (Sterkowicz, of Ardors 1994),

in the field hockey (Szymańska-Parkieta, Gałecka 1994), triathlon (Grądecka 1996),

for woman fencer (Borysiuk 2001), speedway sport (Kowalewska 2002), M. Zasada

(1993) in the gymnastics or the sports dance (Pilewska 2002). They are these are only

examples of sports and works taking this subject matter.

Conclusions:

1. From compared groups of senior pupils the greatest height and the body weight characterize students 15 - years.

3. A 14-years group is characterized by the highest motor abilities, then 15 and 16- years.

4. The group of 14-years students achieved the higher number of points than high from all-Polish tests, remaining groups have results weaker than compared groups.

94 Open Access

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Conflict of interest: None declared.

Received: 15.02.2013. Revised: 15.04.2013. Accepted: 31.05.2013.

100 Journal of Health Sciences (J for the Ss H) 2013; 3 (5): 101-112 The journal hassium had 4 points in Ministry of Science and Higher Education of Poland parametric evaluation. B letter item 683.

FEATURES OF CLINICAL AND MORPHOLOGIC MANIFESTATION OF SEVERE VIOLATIONS OF CEREBRAL CIRCULATION IN PEOPLE LIVING IN HYPOGEOMAGNETIC CONDITIONS

Особенности клинико-морфологических проявлений острых нарушений мозгового кровообращения у лиц, находящихся в гипогеомагнитных условиях

AI Gozhenko1, YV Masevich1, BA Nasibullin1, W Zukow 2 А. И. Гоженко 1 , Ю. В. Масевич 1 , Б. А. Насибуллин 1, W Zukow 2

1State Enterprise, Ukrainian Research Institute of Medicine of Transport, Odessa, Ukraine 2University of Economy in Bydgoszcz, Poland

1ГУ Украинский НИИ медицины транспорта, Odessa, Ukraine 2University of Economy in Bydgoszcz, Poland

Key words: hypogeomagnetic impact; acute violation of cerebral circulation; brain.

Ключевые слова: гипогеомагнитное воздействие; острое нарушение мозгового кровообращения; головной мозг.

A bstract

The authors he the basis of clinical studies (history) and morphological (automatic_dogs reports) 271 patient materials with acute disorders of cerebral circulation conducted and comparative analysis of the development of the disease process. The authors identified and number of characteristics of clinico-morphological characteristics of ACCD in individuals (165) - (and) group who were living in hypogeomagnetic conditions than others (106 patients) - II Group stationed in normal Meridian field. Special features: the authors consider lowering the average age of STROKE, due it and greater number of persons under the age of 50 years; shortening disease course, due it growth of it and daily lethality; and hemodynamic disorder background; reducing the size of destruction in the brain; the changing nature of detritus in the hearth of destruction. The authors believe that this is due it the depletion of the adaptive- compensatory mechanisms for persons in hypogeomagnetic conditions.

1 0 1 (106 больных) - II группа, находившихся в обычном геомагнитном поле. Особенностями характеристик авторы считают: снижение среднего возраста развития ACCD, за счет большего числа лиц моложе 50 лет; укорочение течения болезни, за счет роста досуточной летальности; наличие фонового расстройства гемодинамики; уменьшение размеров очага деструкции в мозгу; изменение характера детрита в очаге деструкции. Авторы полагают, что это связано с истощением адаптационно-компенсаторных механизмов у лиц, находящихся в гипогеомагнитных условиях.

They of the basic processes of adaptation of the organism it the environment is the process of synchronization of processes of individual structural elements (cells) in and large, heterogeneous, open system, which is the human body. The solution it this problem may ugh the existence of an external driver rhythm that in order to setting and uniform rhythm flow processes in the individual structural elements that motivates the development of and common system of biorhythms. Ace and pacemaker might ugh geomagnetic field (GMF) of the Earth, which, being rhythmically changing factor served ace the backdrop for the emergence and evolution of life he Earth [1, 4]. The effect of GMF he human body in order to direct and indirect mechanisms. The first is related it the influenzas of the Ionic processes occurring in the cell, and the second with effect he the rhythm of processes [2, 3, 6]. Because there is currently large number of population, which for and long time during the day is the shielding of GMF (premises of reinforced concrete, the cab vehicles, the artificial electromagnetic fields, leveling effect of GMF), the topical issue of the implications of this situation for the human body. It should ugh noted that only isolated and scattered in contemporary literature publication devoted it peculiarities of physiological and pathological processes in the human body in terms of deprivation of GMF. According is up spoken, the current study is the development of they of the bridge common in neuroscience, pathological processes - an acute violation of

102 cerebral circulation for and long staying and man under the influenzas of weak geomagnetic field. The aim of this work reveal the nature and features of clinical course of acute disorders of cerebral circulation in people arriving at different times of the geomagnetic field.

Material and methods The present study Material provided the date obtained when examining medical records and automatic reports of 271 patients, acute violation of cerebral circulation. Contingents were surveyed two homogeneous and age characteristics, above all in terms of ability, groups. The first they - 165 people were that throughout life, lived and worked in the Panel or block concrete houses, i.e. bridge of the days they were in the shielding of the geomagnetic field. Because of this group were perfectly qualified toolmakers, metalworkers-rarely assemblers, electricians, clerks offices, teachers, drivers, i.e. persons who have different attitudes it artificial electromagnetic fields, in to have fixed grades their attention he this of messages. The second group - 106 people were that throughout B sharp life, lived and worked in conditions of non-distorted magnetic fields in homes and offices from froth-transparent materials (masonry unit and shell rock, brick, adobe); professions related it the stay in the open air (fielder, milkmaid, farmer, builder). In the analysis of medical records (history) were evaluated: squares of residence, profession and squares of work, gender, age, duration of stay in the hospital, the age of acute violation of cerebral circulation (ACCD), hearth dimensions topic and defeat, macroscopic (visible) status of the circulatory system of the brain. The obtained dates were systematized and standardized statistical processing.

Results and discussion

103 According it medical records of you in the first group of men 101 people (60.4 %), 64 women (39.6). in the second group of 106 patients (73%) are male 68.91; 33-women (31.03 %). the fundamental difference in the gender composition of the first and second groups, the first group took squares only and trend it increase the percentage of women. Ace regards the age characteristics of the patients in the first group, their average age of you 51.25 ± 6.3 years, and in the second - 62.94 ± 7.80 years. The average age of men, selected in the first group and ACCD victims - 49.9 ± 5.3 years; Women-52.0 ± 6.7 years, i.e. reliable differences from Panel date, only and small trend towards rejuvenation of ACCD in men Group 1. In the second group, the average age of the men killed at the ACCD-60.55 ± 5.40 years; and women - 65.94 ± 6.3 years. Compared with the first group of patients in the second group of ACCD is reliably later. Both groups have and tendency it is violation of cerebral circulation in men at and younger age than women. Another difference between the groups of you that the first group of men younger than 50 years of you 20.17 %, second only it is 11.64 % (p < 0.05). Women younger than 50 years old in the first group were 10.1 %, respectively; and the second only 6.30 % (p < 0.05), that is, women and men, who are in conditions of deprivation of the geomagnetic field are used it reliably acute violation of cerebral circulation in active working age. Differences in the dynamics of the disease have been recorded. The persons included in the first group, stayed in the hospital an average of 5.88 ± 0.80 day, and in the second group, duration of stay in the hospital an average of 7.51 ± 0.43 (r < 0.05). The first group of and daily lethality of you determined in 25.2 % of cases, and in the second - 17.24 %. It can ugh argued that the development of ACCD in the first group is more severe in nature that could ugh due it the more severe pathological process, evidenced ace in order to the increased frequency of episodes of cerebral circulation disorders. According it medical records, previous episodes of cerebral circulation disorders in history took squares at 9.9 % of patients of Group 1 and only 3.1 % of

104 patients in the second group. Another indication of and heavy course of the disease process is recorded in medical history 90% of the total diffuse violation of hemodynamics in the of forms of swelling lower limbs, the vibrations in the alveoli, congested liver iron. Similar changes have occurred in the second group of 47.17 % of cases. According it clinical date (history), there were some differences in the nature of the violations of cerebral circulation. From 68.95 % patients of Group 1 key disease clinical diagnosis of you final ischemic stroke and 31.05 % of patients - hemorrhage. In the second group of ischemic stroke of you diagnosed at 60.57 % of patients and and brain haemorrhage from 36.43 %. Differences between groups were at the level of persistent trends. And post-mortem of you carried out it study the macroscopic (visible) of the brain. Indicators that were evaluated and the frequency of their occurrence among the members of designated groups, reflected in table 1.

According it the automatic table at 90.64 % of patients in the first group had and solidus change brain membranes, since the condition of these shells is closely connected with the exchange of intercellular vibrations, it may ugh assumed that the persons included in this group, there hassium been and stable hemodynamics in matter of the brain. Among the second group, these changes have taken squares in 3 / 4, i.e., significantly fewer people.

Table 1. Comparative characteristics of brain damage when the ACCD in ______populations of different geomagnetic conditions.______Structure of the Brain, rates Violations in groups (%%) III TMO tense is taken in SM 48.38 58.3 6.45 25.0 vascular 45.16 16.7 Wall cerebrovascular conventional 3.67 12.7 compacted 96.3 87.3 substances out of the brain hearth disasters usual 1 0 .0 45.5 105 swollen 77.5 37.9 swollen 12 , 5 16.6 Communication with pools of blood supply: a. The central part of the basin 43.9 38.25 b. Circulationmixed 28.15 47.15 c. Zone Multiple lesions 27.9 14.6 Localization ACCD left brain 41.9 52.20 right brain 29.6 19.8 brainstem 12.55 14.9 diff change 15.95 13.1

Dimensions source to 1 ,0 1 , 2 - 1,3 23,25 31,6 3,1-5,0 38,37 15,8 5,1-7,0 22,09 42,02 to 7 , 0 15,1 1 0 ,6

Study of software meninges (SM) found that nearly half of the patients in the first group there of you iron vessels, i.e. of and persistent disorder of hemodynamics. Shoe the second group - fibrosis membranes, the phenomenon is typical for age-related changes. Study of the base of the brain hemispheres and vessels major found the seal of their walls in virtually all of the first group and the vast majority of the second. Ace the average age of patients in the first group smaller than that of the second, it may ugh assumed that the background caused in order to pathological processes, including exogenous vrednostami it occur sooner than and background for development of vascular accidents. In conducting the automatic in order to the substance of the brain stretches for 89.9 % of patients have the knife in the first group and 54.5 % the second, i.e. edema-a swelling of the brain, ace and manifestation of hemodynamic parameters and background sharing water in matter of the brain, significantly more common in patients suffering from deprivation of the geomagnetic field. Study he the tops of lesions (table 1) in relation it the pools of blood, found that more often than of grades they are located in the of head offices part of the basin, somewhat frequently loess in areas of mixed blood. Feature of the first group were almost two times more frequent presence of multiple (> 2) lesions of the brain. Obviously, the overall health of the circulatory system in the patients of

106 this group is characterized in order to the presence of several weak points. With of reguards it the localization of and hemispherical, then for the second group is characterized in order to more frequent defeat the left hemisphere and the trunk, and the first-right hemisphere and diffuse changes the substance of the brain. Ace for the size of the brain lesion when the ACCD, the ace shown in table 1, bridge often among persons in hypogeomagnetic conditions, the size of the defeat, resulting in lethal outcome, ranging from 1.0 is 5.0 cm in diameter (61.62 %), while among those who stay in normal geomagnetic conditions, such and hotbed of diameter ranges from 1.0 is 3.0 cm, or from 5.0 is 7.0 cm (73.62 %) of all the cases. This lesion size mismatch could ugh due it the fact that the prolonged deprivation of GMF is and strong, continuous change substances throughout the hemisphere of the brain, leading it is irreversible destruction of it. In cases where the activity of GMF is of grades broken, ACCD of you and disaster and, depending he the individual characteristics of the organism, or die at very moderate or very large amount. The difference between the different contingents of GMF's influenzas is evident in the character of the destructive processes in the focus of ACCD. In the first group the contents of destruction in the forms of creamy, sticky mass took squares at 81.4 % of patients; and in the second group - 45.56 % surveyed in hearth of destruction of you greyish-whitish fine grain, cheesy mass. Perhaps this is due it the difference in the flow of processes of proteins metabolism in individuals of I and II groups.

Conclusions Thus, the results of our study showed that the average age of persons in the population development ACCD, staying in and hypogeomagnetic field is reduced in order to the large proportion of persons below the age of 50. Among these patients, the duration of illness prior it death is reduced in order to and larger share of and daily lethality.

107 At the alone time, it should ugh noted that the size of brain destruction from this group than among persons staying in normal geomagnetic conditions. Selected features of development and course of ACCD in people living in hypogeomagnetic conditions, allow you it is view it ace and logical outcome of diffuse disorders of adaptive and compensatory mechanisms resulting from the external environment, including the deprivation of the geomagnetic field.

Open Access This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author (s) and source are credited.

Одним из основных процессов приспособляемости организма к условиям среды обитания есть процесс синхронизации процессов жизнедеятельности отдельных структурных элементов (клеток) в целостной большой, гетерогенной, открытой системе, каковой является человеческий организм. Решением этой проблемы может быть наличие внешнего водителя ритма, который, задавая единый ритм течению процессов в отдельных структурных элементах, обусловливал бы формирование единого биоритма системы. В качестве такого водителя ритма может выступать геомагнитное поле (ГМП) Земли, которое, будучи ритмично изменяющимся фактором, служило фоном для возникновения и эволюции жизни на Земле [1, 4]. Реализация влияния ГМП на организм осуществляется прямым и опосредованным механизмами. Первый связан с влиянием на ионные процессы, происходящие в клетке, второй - с влиянием на ритмичность процессов [3, 6, 2]. Поскольку в настоящее время сформировалась большая по численности группа населения, которая длительное время в течение дня пребывает в условиях экранировки ГМП (помещения из железобетона, кабины транспортных средств, действие искусственных электромагнитных полей, нивелирующих действие ГМП), то актуальным становится вопрос о последствиях такой ситуации для человеческого организма. Следует отметить, что только единичные и разрозненные публикации в современной литературе посвящены особенностям течения физиологических и патологических процессов в человеческом организме в условиях депривации ГМП. Исходя из вышесканного, актуальным является исследование особенностей развития одного из наиболее распространенных в неврологии, патологических процессов - острого нарушения мозгового кровообращения при условии длительного пребывания человека под влиянием ослабленного геомагнитного поля. Цель работы выявить особенности характера и клинического течения острых нарушений мозгового кровообращения у лиц, пребывающих в разных условиях действия геомагнитного поля. Методы и материалы. Материалом настоящего исследования послужили данные, полученные при изучении историй болезни и протоколов вскрытий 271 больного, погибшего от острого нарушения мозгового кровообращения. Контингент обследованных составляли две однородные по половозрастным характеристикам, а главное по условиям жизнедеятельности, группы. Первую - 165 человек, составляли лица, которые на протяжении всей жизни, проживали и работали в панельных или блочных железобетонных домах, т.е. большую часть суток они пребывали в условиях экранирования геомагнитного поля. Поскольку среди лиц этой группы были слесари-инструментальщики, редко монтажники, электрики, служащие офисов, учителя, шоферы, т.е. лица, имеющие разное отношение к искусственным электромагнитным полям, мы не фиксировали свое внимание на этом моменте. Вторую группу - 106 человек составляли лица, которые на протяжении всей своей жизни жили и работали в условиях действия неискаженного магнитного поля в домах и служебных помещениях из

108 пенисто-прозрачных материалов (ракушняк, кирпич, саман); профессии, связанные с пребыванием на открытом воздухе (полевод, доярка, животновод, строитель). При анализе медицинской документации (истории болезни) оценивали: место жительства, профессия и место работы, пол, возраст, длительность пребывания в клинике, возраст развития острого нарушения мозгового кровообращения (ОНМК), топику и размеры очага поражения, макроскопическое (визуальное) состояние сосудистой системы мозга. Полученные данные систематизировали и подвергали стандартной статистической обработке. Результаты и их обсуждение. Согласно данным историй болезни в первой группе мужчин было 101 человек (60,4 %), женщин 64 (39,6). Во второй группе из 106 больных 73 - мужчины (68,91 %); 33 - женщины (31,03 %). Принципиальной разницы в половом составе первой и второй группы не было, в первой группе имела место лишь тенденция к увеличению доли женщин. Что касается возрастной характеристики больных, то в первой группе их средний возраст составлял 51,25 ± 6,3 года, а во второй - 62,94 ± 7,80 года. Средний возраст мужчин, включенных в первую группу и погибших от ОНМК - 49,9 ± 5,3 года; женщины - 52,0 ± 6,7 лет, т.е. достоверных отличий от групповых данных нет, лишь небольшая тенденция к омоложению ОНМК у мужчин 1-й группы. Во второй группе средний возраст мужчин, погибших от ОНМК - 60,55 ± 5,40 лет; а женщин - 65,94 ±6,3 года. По сравнению с первой группой у больных второй группы ОНМК развивается достоверно позже. В обеих группах имеет место тенденция к нарушению мозгового кровообращения у мужчин в более молодом возрасте, чем у женщин. Еще одно различие между группами состояло в том, что среди мужчин первой группы лица моложе 50 лет составляли 20,17 %, а во второй только 11,64 % (р < 0,05). Женщин моложе 50 лет в первой группе было соответственно 10,1 %; а во второй только 6,30 % (р < 0,05), т.е. женщины и мужчины, пребывающие в условиях депривации геомагнитного поля достоверно раньше подвергаются острым нарушениям мозгового кровообращения в активном трудоспособном возрасте. Различия зафиксированы и в динамике болезни. Лица, включенные в первую группу, пребывали в стационаре в среднем 5,88 ± 0,80 суток, а во второй группе длительность пребывания в стационаре составляла в среднем 7,51 ± 0,43 дня (р < 0,05). При этом среди лиц первой группы досуточная летальность определялась в 25,2 % случаев, а во второй - 17,24 %. Можно утверждать, что развитие ОНМК у лиц первой группы носит более тяжелый характер, что может быть обусловлено более тяжелым течением патологического процесса, о чем свидетельствует большая частота эпизодов расстройства мозгового кровообращения. Согласно данным историй болезни, предшествующие эпизоды расстройства мозгового кровообращения в анамнезе имели место у 9,9 % больных 1-й группы и только у 3,1 % больных второй группы. Еще одним свидетельством более тяжелого течения патологического процесса является зафиксированное в истории болезни 90 % обследованных диффузное нарушение общей гемодинамики в виде отечности нижних конечностей, наличия жидкости в альвеолах, застойное полнокровие печени. Подобные изменения у представителей второй группы отмечались в 47,17 % случаев. Согласно клиническим (истории болезни) данным имелись некоторые различия в характере нарушений мозгового кровообращения. У 68,95 % больных 1-й группы основным заболеванием заключительного клинического диагноза был ишемический инсульт, а у 31,05 % больных - кровоизлияние. Во второй группе ишемический инсульт был диагностирован у 60,57 % больных и кровоизлияние в мозг у 36,43 %. Различия между группами находились на уровне стойкой тенденции. При проведении аутопсий осуществлялось макроскопическое (визуальное) изучение головного мозга. Показатели, которые оценивались при этом и частота их встречаемости среди представителей выделенных групп, отражена в таблице 1. Согласно данным таблицы при проведении аутопсии у 90,64 % больных первой группы определялось изменение твердых мозговых оболочек, поскольку состояние этих оболочек тесно связано с обменом межклеточной жидкости, можно полагать, что у лиц, включенных в эту группу, имело место стойкое нарушение гемодинамики в веществе головного мозга. Среди лиц второй группы такие изменения имели место у 3/4, т.е. у достоверно меньшего числа людей. Таблица 1 Сравнительная характеристика повреждений мозга при ОНМК в популяциях лиц, находящихся в разных геомагнитных условиях

Частота нарушений Структура мозга Показатель в группах (%%) I II напряжена 90,64 77,25 ТМО берется в складку 9,36 27,7 обычные 48,38 58,3 ММО фиброзирование 6,45 25,0 полнокровие сосудов 45,16 16,7 обычные 3,67 12,7 Стенка сосудов головного мозга уплотненные 96,3 87.3 109 обычное 10,0 45.5 Вещества мозга вне очага катастроф отечное 77.5 37,9 набухшее 12.5 16.6 Связь с бассейнами кровоснабжения: а. Центральная часть бассейна 43,9 38,25 б. Зона смешанного кровообращения 28,15 47,15 в. Множественные поражения 27,9 14,6

левое полушарие 41,9 52,20 правое полушарие 29,6 19,8 Локализация ОНМК ствол мозга 12,55 14,9 диф. изменения 15,95 13,1

до 1,0 1,2 - 1,3 23,25 31,6 Размеры очага 3,1-5,0 38,37 15,8 5,1-7,0 22,09 42,02 более 7,0 15,1 10,6

Исследование мягких мозговых оболочек (ММО) показало, что у почти половины больных первой группы имело место полнокровие сосудов, т.е. проявления стойкого расстройства гемодинамики. Зато у представителей второй группы - фиброз оболочек, явление - характерное для возрастных изменений. Исследование сосудов основания мозга и крупных сосудов полушарий выявило уплотнение их стенок практически у всех представителей первой группы и подавляющего большинства второй. Поскольку средний возраст больных первой группы меньший, чем у представителей второй, можно полагать, что фоновые патологические процессы, вызванные действием, в том числе, и экзогенными вредностями происходят раньше, чем создается фон для развития сосудистых катастроф. При проведении на разрезе аутопсии вещество мозга тянется за ножом у 89,9 % больных первой группы и у 54,5 % - второй, т.е. отек-набухание головного мозга, как проявление нарушений фоновой гемодинамики и обмена воды в веществе мозга, достоверно чаще встречается в группе больных, подверженных депривации геомагнитного поля. Исследование топики очага поражения (табл. 1) по отношению к бассейнам кровоснабжения, показало, что чаще всего они локализуются в области центральной части бассейна, несколько реже - в зонах смешанного кровоснабжения. Особенностью первой группы было почти в два раза более частое наличие множественных (> 2) очагов поражения мозга. Очевидно, общее состояние сосудистой системы у больных этой группы характеризуется наличием нескольких слабых точек. Что касается полушарной локализации, то для второй группы характерно более частое поражение левого полушария и ствола, а для первой - правого полушария и диффузных изменений вещества мозга. Что касается размеров очага повреждения мозга при ОНМК, то, как следует из таблицы 1, наиболее часто среди лиц, находящихся в гипогеомагнитных условиях, размеры очага поражения, приводящего к летальному исходу, колеблются от 1,0 до 5,0 см в диаметре (61,62 %), в то же время среди лиц, пребывающих в обычных геомагнитных условиях, диаметр такого очага колеблется от 1,0 до 3,0 см или от 5,0 до 7,0 см (73,62 %) всех случаев. Такое несовпадение размеров поражения может быть связано с тем, что длительная депривация ГМП обусловливает стойкое, непрерывное изменение вещества во всем полушарии мозга, приводящее к необратимой деструкции части его. В случаях, когда действие ГМП не нарушено, развитие ОНМК носит характер катастрофы и, в зависимости от индивидуальных особенностей организма, погибает либо при очень умеренных, либо при очень крупных его размерах. Разница между контингентами с неодинаковым влиянием ГМП проявляется и в характере деструктивных процессов в очаге ОНМК. В первой группе содержимое очага деструкции в виде сливкообразной, липкой массы имело место у 81,4 % больных; а во второй группе - у 45,56 % обследованных в очаге деструкции определялась серовато-белесоватая мелкозернистая, творожистая масса. Возможно, это связано с разницей в протекании процессов белкового обмена у лиц I и II групп. Таким образом, результаты наших исследований показали, что средний возраст развития ОНМК в популяции лиц, пребывающих в условиях гипогеомагнитного поля снижается за счет большой доли лиц, не достигших 50-летнего возраста. Среди этих больных длительность болезни до летального исхода сокращается за счет большей доли досуточной летальности. Одновременно следует отметить, что размеры очагов деструкции мозга у представителей этой группы меньше, чем среди лиц, пребывающих в нормальных геомагнитных условиях. Выделенные особенности развития и течения ОНМК у лиц, находящихся в гипогеомагнитных условиях, позволяют рассматривать его как закономерный исход диффузного расстройства адаптационно-компенсаторных механизмов, обусловленных внешними условиями, в том числе и депривацией геомагнитного поля.

Open Access 110 This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.

References in transliteration 1. Vasilik P.V., Korjush I.I. - Izmenenie massy tela belyh myshej v jekranirujushhej kamere i faktory vneshnej sredy. // V sb.: Krymskij mezhdunarodnyj seminar "Kosmos i biosfera". - Krym. - 2001. - S. 85-87. 2. Uzdjanskij A.B. - O biologicheskom dejstvii sverhnizkochastotnyh magnitnyh polej: rezonansnye mehanizmy i ih realizacija v kletkah / A.B. Uzdenskij // Biofizika. - 2000. - #5. - S. 888-893. 3. Fomin N.A. - Adaptacija: obshhebiologicheskie i psihofiziologicheskie osnovy / Fomin N.A. - M.: Teorija i praktika fizicheskoj kul'tury. - 2003. - 383 s.

4. Holodov Ju.A. - Vlijanie jelektromagnitnyh i magnitnyh polej na central'nuju nervnuju sistemu / Ju.A. Holodov. - M.: Nauka, 1996. - 280 s. 5. Chernavskij D.S. Sinergetika i informacija. Dinamicheskaja teorija informacii // M.- Editorial URSS. - 2004. - 288 s. 6. Berginer V.M. Magnetic resonanse imaging in cerebrotendinous xanthomatosis: a prospective clinical and neuroradiological study // V.m. Berginer, J. Berginer, A.D. Korczjn, R. Tadmor // Neurol. Sci. - 1994. - N 1. - P. 102-108.

References in original 1. Василик П.В., Корюш И.И. - Изменение массы тела белых мышей в экранирующей камере и факторы внешней среды. // В сб.: Крымский международный семинар "Космос и биосфера". - Крым. - 2001. - С. 85-87. 2. Уздянский А.Б. - О биологическом действии сверхнизкочастотных магнитных полей: резонансные механизмы и их реализация в клетках / А.Б. Узденский // Биофизика. - 2000. - №5. - С. 888-893. 3. Фомин Н.А. - Адаптация: общебиологические и психофизиологические основы / Фомин Н.А. - М.: Теория и практика физической культуры. - 2003. - 383 с. 4. Холодов Ю.А. - Влияние электромагнитных и магнитных полей на центральную нервную систему / Ю.А. Холодов. - М.: Наука, 1996. - 280 с. 5. Чернавский Д.С. Синергетика и информация. Динамическая теория информации // М.- Едиториал УРСС. - 2004. - 288 с. 6. Berginer V.M. Magnetic resonanse imaging in cerebrotendinous xanthomatosis: a prospective clinical and neuroradiological study // V.m. Berginer, J. Berginer, A.D. Korczjn, R. Tadmor // Neurol. Sci. - 1994. - N 1. - P. 102-108.

References in English 1. Wasylyk PV, Koryush II - Changes in body weight of white mice in a shielded chamber and environmental factors. / / In Sat: Crimean international seminar on "Space and the Biosphere." - Crimea. - 2001. - S. 85-87.

111 2. Uzdyansky AB - On the biological effects of ultra-low frequency magnetic fields: the resonant mechanisms and their implementation in the cells / AB Uzdensky / / Biophysics. - 2000. - № 5. - S. 888-893. 3. Fomin NA - Adaptation: general biological and physiological bases / NA Fomin - M.: The Theory and Practice of Physical Culture. - 2003. - 383 p. 4. Colds YA - Influence of electromagnetic and magnetic fields on the central nervous system / Y. Cold weather. - Moscow: Nauka, 1996. - 280 p. 5. Chernavskii DS Synergetics and Information. Dynamic theory of information / / Moscow - Editorial URSS. - 2004. - 288. 6. Berginer V.M. Magnetic resonanse imaging in cerebrotendinous xanthomatosis: a prospective clinical and neuroradiological study / / Vm Berginer, J. Berginer, A.D. Korczjn, R. Tadmor / / Neurol. Sci. - 1994. - N 1. - P. 102-108.

РЕФЕРАТ Авторы на основании исследования клинических (истории болезни) и морфологических (протоколы вскрытия) материалов 271 больного с острыми нарушениями мозгового кровообращения провели сравнительный анализ развития патологического процесса у них. При этом авторы выделили ряд особенностей клинико-морфологических характеристик развития ОНМК у лиц (165 больных) - I группа, находившихся в течение жизни в гипогеомагнитных условиях по сравнению с лицами (106 больных) - II группа, находившихся в обычном геомагнитном поле. Особенностями характеристик авторы считают: снижение среднего возраста развития ОНМК, за счет большего числа лиц моложе 50 лет; укорочение течения болезни, за счет роста досуточной летальности; наличие фонового расстройства гемодинамики; уменьшение размеров очага деструкции в мозгу; изменение характера детрита в очаге деструкции. Авторы полагают, что это связано с истощением адаптационно-компенсаторных механизмов у лиц, находящихся в гипогеомагнитных условиях.

Ключевые слова: гипогеомагнитное воздействие; острое нарушение мозгового кровообращения; головной мозг.

This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

Received: 15.01.2013. Revised: 25.03.2013. Accepted: 01.06.2013.

112 Journal of Health Sciences (J for the Ss H) 2013; 3 (5): 113-120 The journal hassium had 4 points in Ministry of Science and Higher Education of Poland parametric evaluation. B letter item 683.

UDC 616.33/.342-002.44+616.329-008.17]-089

THE EFFECTIVENESS OF DIFFERENT TYPES OF GERD CORRECTION, DEPENDING ON THE SYMPTOMS, IN PATIENTS OPERATED FOR PEPTIC ULCER DISEASE

Loyko I.I.

Ternopil I.Ya. Horbachevsky State Medical University Department of surgery #1

Key words: peptic ulcer disease.

Abstract Results of surgical treatment of 170 patients with GERD and PU are presented. In studying the results of operational interventions for PU by GERD symptoms all patients were divided into 3 groups: control, without correction of GERD, and the two groups of comparison. One of them included patients who underwent conservative (medicational) and the second comparison group - operational (surgical) correction of GERD. Correction of GERD, regardless of type, reduces the proportion of patients with extraesophageal symptoms, thus ultimately increases the number of patients with absence of symptoms of GERD. The surgical correction of GERD in patients operated for PU is accompanied by a tendency to decrease of proportion of patients with moderate manifestations and leads to the significant decrease in the proportion of patients with severely symptomatic GERD. The effectiveness of surgical correction of GERD in patients with P U is statistically significantly greater than o f the conservative one.

113 Introduction

Gastroesophageal reflux disease (GERD) accompanies the most common chronic diseases of abdominal cavity. In particular, at chronic gastroduodenal ulcer GERD is noted in 16,1 - 71.6% of patients [1,3]. Overall, GERD with reflux- esophagitis according to different literary sources is found in 27,4-60% of patients with peptic ulcer disease (PU) [2,5]. Clinical manifestations of PU combined with reflux-esophagitis have a number of features. In particular, often the clinical picture of reflux-esophagitis masks manifestations of PU and after gastric resection in 11,6-54% of cases becomes dominant, causing unsatisfactory results of operations [4,6].

Material and methods

Results of surgical treatment of 170 patients with GERD and PU operated on clinical bases of TSMU are presented. At studying the results of operational interventions for PU by GERD symptoms, all patients were divided into 3 groups: control, which consisted of 40 patients without correction of GERD and two groups of comparison. One of them included 35 patients who underwent conservative correction of GERD using H2-histamin blockers, proton pump inhibitors, prokinetics by generally accepted schemes. The second comparison group included 95 patients who underwent surgical correction of GERD. For surgical correction of GERD in patients with PU Nissen, Dor, Toupe fundoplications, Hill and esophagogastrocruropexy procedures were used according to concrete indications. Assessment of symptoms in the patients survey was conducted using questionnaires. The nature and severity of complaints, their duration, frequency,

114 precipitating factors were assessed. Attention was focused on the presence of typical esophageal and extraesophageal complaints. The group with moderate manifestations was classified as patients with medical history of sporadic cases of heartburn, mostly after alcohol abuse or gross errors in diet, with minimal symptoms of heartburn, which, however, troubled them every day or almost every day, regardless of the nature of the nutrition regimen and physical activity. These episodes’ heartburn duration usually did not exceed one hour per day. The group of patients with severe symptoms of GERD was formed by patients whose heartburn was intense, worried them all the time. All patients of this group received antacids, antisecretory drugs or alginates for heartburn that lasted in total for at least two hours daily. Aggressive nature of the impact of alkaline duodenal contents on the esophageal mucosa forced to move patients with "bitter" regurgitation into the group of severe manifestations. The presence of dysphagia and odynophagia moved patients into the group of severe manifestation. All patients with extraesophageal symptoms of GERD, regardless of severity, formed the largest group - "with extraesophageal manifestation." The reliability of differences was assessed by Student's criterion at different levels of significance.

Distribution of patients by pre-and postoperative symptoms No Moderate Severe Extraesophageal manifestation manifestation manifestation manifestation Abs. Abs. Abs. Abs. M±m M±m M±m M±m 0 41 47 82 Preoperatively 0,58±0,58 24,12±3,28 27,65±3,43 48,24±3,83 92 32 16 30 Postoperatively 54,12±3,82 18,82±3,00 9,41±2,24 17,65±2,92

Results 115 As seen from the table. 5.1, in patients operated for PU, in the preoperative period, the frequency of moderately severe GERD symptoms fluctuated in the range of 22.11 to 27.50% and did not differ statistically significant between the groups, p>0,05. After surgery, the proportion of patients with moderate manifestation of GERD, who underwent operational and pharmacological correction of GERD, decreased; in those whom it was not carried out at all - grew in number.

Table 5.1 The effectiveness of different types of correction of GERD in patients with moderate manifestations

Groups of patients Total Preoperatively Postoperatively P Abs. % (M+m) Abs. % (M+m) Operational correction for 95 21 22,11+4,26 12 12,63+3,41 <0,10 GERD Medicamental correction for 35 9 25,71+7,39 8 22,86+7,10 >0,05 GERD No GERD 40 11 27,50+7,06 12 30,00+7,25 >0,05 correction

However, the result was not statistically significant. Only a tendency towards lower proportion of patients with moderate symptoms of GERD after surgical correction (of 1.75 times, p<0.10) was observed. However, attention is drawn to the fact that in the postoperative period, the proportion of patients with moderate manifestation of GERD after surgical correction was statistically significantly lower than in the group of patients whom GERD correction was not carried out - at 2.38 times (p<0.05). In turn, the proportion of patients with severe GERD symptoms before surgical treatment of PU was in the range of 25,71-30,00% (Table 5.2) and did not differ statistically significant between the groups (p>0,05). Postoperatively, after

116 applying the above methods for correcting GERD it also declined, and among patients whom surgical correction of GERD was performed the difference of this indicator was statistically significant - at 6.50 times (p<0,001).

Table 5.2 The effectiveness of different types of correction of GERD in patients with severe manifestations

Groups of patients Total Preoperatively Postoperatively P Abs. % (M+m) Abs. % (M+m) Operational correction for 95 26 27,37+4,57 4 4,21+2,06 <0,001 GERD Medicamental correction for 35 9 25,71+7,39 4 11,43+5,38 >0,05 GERD No GERD 40 12 30,00+7,25 8 20,00+6,32 >0,05 correction

Among patients whom GERD correction was not carried out, the proportion of patients with severe GERD symptoms after surgery for PU also decreased, but the result was not statistically significant. As in the previous case, the frequency of patients with severe GERD symptoms after operational correction of GERD was statistically significantly lower than among patients who did not undergo correction of GERD (at 4.75 times, p<0,05). Frequency of extraesophageal symptoms of GERD (Table 5.3) in patients operated on PU in the preoperative period ranged 42,50-50,53% and did not differ statistically significant between the groups (p>0,05). After surgery, operational correction of GERD contributed to a significant decrease in the proportion of patients with extraesophageal symptoms (at 6.86 times, p<0,001), after medicational - at 2.12 times (p<0,05).

Table 5.3

117 The effectiveness of different types of correction of GERD in patients with extraesophageal symptoms

Groups of patients Total Preoperatively Postoperatively P Abs. % (M+m) Abs. % (M+m) Operational correction for 95 48 50,53+5,13 7 7,37+2,68 <0,001 GERD Medicamental correction for 35 17 48,57+8,45 8 22,86+7,10 <0,05 GERD No GERD 40 17 42,50+7,82 15 37,50+7,65 >0,05 correction

Among patients whom GERD correction was not carried out, the frequency of patients with extraesophageal symptoms of GERD also decreased, but the result was not statistically significant (p>0,05). It should be noted, that the proportion of patients with extraesophageal manifestation of GERD after operational correction was statistically significantly lower than after the medicational (at 3.10 times, p<0,05), and in cases when correction of GERD was not performed at all (at 5, 09 times, p<0,001). Various methods of correction of GERD resulted in (see Table 5.4) proportion of patients with absence of manifestations increased 73.58 times after surgical correction of GERD (p<0,001), after medicational - at 15.87 times (p<0,001).

Table 5.4 The proportion of patients with absence of symptoms of GERD at different types of correction of GERD in pre- and postoperative periods

Groups of patients Total Preoperatively Postoperatively P Abs. % (M+m) Abs. % (M+m) Operational correction for 95 0 1,03+1,02 72 75,79+4,39 <0,001 GERD Medicamental 35 0 2,70+2,63 15 42,86+8,36 <0,001 correction for

118 GERD No GERD 40 0 2,38+2,32 5 12,50+5,23 <0,10 correction

As seen from the table. 5.4, the effectiveness of surgical correction of GERD was higher: the proportion of patients with absence of symptoms was 1.77 times higher than those whom pharmacological therapy was performed (p<0,001). Among patients whom the surgery for GERD was not carried out, upward tendency in the proportion of patients with absence of GERD symptoms in the postoperative period was observed (at 5.25 times, p<0,10). This result was statistically significantly lower than in groups, which underwent operational or pharmacological therapy for GERD.

Conclusions

Thus, the surgical correction of GERD in patients operated for PU is accompanied by a tendency to decrease of proportion of patients with moderate manifestations and leads to a significant decrease in the proportion of patients with severely symptomatic GERD. Correction of GERD, regardless of type, reduces the proportion of patients with extraesophageal symptoms, thus ultimately increases the number of patients with absence of symptoms of GERD. The effectiveness of surgical correction of GERD in patients with PU is statistically significantly greater than of the conservative one.

Prospects for further research

The research aimed at determining the effectiveness of different surgical procedures for GERD, depending on the surgical intervention for PU is seen promising.

119 Open Access This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.

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2. Khirurgiia (Mosk). 2007;(3):15-6. [Surgical treatment at combination of duodenal ulcers with reflux-esophagitis]. [Article in Russian] Kasumov NA.

3.Vestn Khir Im I I Grek. 2007;166(1):51-4. [Surgical treatment of gastroesophageal reflux disease combined with duodenal ulcer]. [Article in Russian] Zherlov GK, Giunter VE, Kozlov SV, Sin'ko SP, Savchenko IV.

4. Khirurgiia (Mosk). 2009;(10):15-9. [Quality of life before and after surgical treatment of duodenal ulcer]. [Article in Russian] Kadyrov DM, Kodirov FD, Khusenov BA, Kosimov KhSh.

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Received: 15.01.2013. Revised: 25.04.2013. Accepted: 03.06.2013.

120 Journal of Health Sciences (J for the Ss H) 2013; 3 (5): 121-142 The journal has had 4 points in Ministry of Science and Higher Education of Poland parametric evaluation. B letter item 683.

EMPLOYMENT OF PERSONS WITH DISABILITIES IN MARINE PORTS

Трудоустройство лиц с ограниченными возможностями в морских портах

A.V. Skiba1, W Zukow 2 А.В. С киба1, W Zukow 2

1SE Ukrainian Research Institute of Transport Medicine, Ministry of Health of Ukraine, Odessa, Ukraine 2University of Economy in Bydgoszcz, Poland

1ГП Украинский НИИ медицины транспорта МЗ Украины, г.. Одесса 2University of Economy in Bydgoszcz, Poland

Ключевые слова: трудоустройство, инвалиды, порты. Keywords: employment, people with disabilities, ports.

A bstract On the strength of conducted social and hygienic and medical and sanitary researches in ports scientific justification to criteria of possibility of use of work of various categories of disabled people in professions and positions in ports was given. Are submitted data on the organization and specific working conditions of disabled people in seaports. Comparative data on incidences with temporary disability and traumatism at employees of port and persons with limited opportunities are provided. On the basis of the analysis of organizational questions and a state of health complex actions and the directions for medical and sanitary optimization of conditions, the work organizations for the purpose of incidence and employment of disabled people are developed.

Резюме

На основании проведенных социально-гигиенических и медико-санитарных исследований в портах было дано научное обоснование к критериям возможности использования труда различных категорий инвалидов в профессиях и должностях в портах. Представлены данные об организации и специфических условиях труда инвалидов в морских портах. Приведены сравнительные данные об уровнях заболеваемости с временной утратой трудоспособности и травматизма у работников порта и лиц с ограниченными возможностями. На основании анализа организационных вопросов и состояния здоровья разработаны комплексные мероприятия и направления по медико-санитарной оптимизации условий, организации труда и организации труда с целью снижения заболеваемости и трудоустройства инвалидов.

Introduction

Employment of disabled people has always been a pressing social issue. The word "disabled" (in English the "unfit") today is increasingly being replaced by the

121 term "people with disabilities". But, unfortunately, the old term is still used in the legislation, but normative documents and press. [1]. According to UN data, there are around 450 million people with various disabilities in physical and mental development. [2]. According to the World Health Organization (WHO) in 2011 almost 15% of the world's population has some degree of disability. According to the State Statistics Committee of Ukraine, at the beginning of 1999 in Ukraine there were more than 2.5 million people who were officially recognized as disabled, that is, about 5% of the population of Ukraine. In the early 1990s, the total number of persons with disabilities was 3% (about 1.5 million people). As of January 1, 2002 the number of disabled people was already 2 million Millennium 659 h (about 5.5% of the population). [1]. And at the beginning of 2011, the number of people with disabilities was 2,709,982 people (about 6% of the population). [3]. For the purpose of social protection of people with disabilities in Ukraine has adopted a number of laws and regulations regarding the employment of these people. Medical and social problems of disability are an important area of the State and society. In a radical reform of the state, which is currently experiencing Ukraine, content changes and solutions to health and social problems of disability, the foundations of social protection of the disabled. With the cooperation of state authorities at all levels and public organizations the process of vocational rehabilitation and employment - it is very necessary and highly moral. [4]. Law "On Amendments to the Law" On the basis of social protection of disabled people in Ukraine "is installed directly to enterprises (associations), institutions and organizations regardless of ownership standard for employment in the amount of 4% of the total workforce, as if running 15 up to 25 people - in the amount of the 1st job. The practice of quoting jobs for persons with disabilities apply and abroad.For example, "in Germany, France and Hungary under the laws of the quota are subject organization with more than 20 employees in Austria and Poland - with 25 employees. In Spain, the minimum number of employees - 50. The quota for people with disabilities in Germany is 5%, France - 6% in Luxembourg quota varies from 2% to 5% depending on the form of ownership and the number of employees. In Spain and Ireland, the quota is 3%. In Japan, a quota of 1.6% to 2%". [5].

122 In some countries, in the case of "non-completion" of quotas organizations pay special contributions to the trust funds, the funds are to be distributed to the creation of jobs for people with disabilities and the adaptation of existing jobs to the needs of people with disabilities. [6]. Ukraine has 28 ocean, river and 4 of 12 fishing ports, attributed to major ports. Sea trades port - a complex production system, the effective functioning of which is possible in the inseparable connection of all units represented by diverse nature of work and on numerous professional affiliations contingent workers. Aim In view of the above, the purpose of the present work was to analyze the status of disability in the major seaports of Southern Ukraine (for example, Port of Odessa, Illyichevsk, Southern).Choosing this population was associated with the fact that seaports are a complex production system, the effective functioning of which is possible in the indissoluble connection of all units represented by diverse nature of work and on numerous professional affiliations contingent workers. Objects, contingent, methods. Contingent - disabilities, working in the ports. Methods - socio-sanitary (morbidity and injuries from VUT), hygiene (labor), health statistics. RESULTS AND DISCUSSION Address issues of disability in paid extraordinary attention because of its prevalence and the significant number of persons with disabilities. Results hygiene studies in the workplace port workers set out in published with our participation in. [7, 8, 9, 10, 11]. According to the results of the study of repeated medical examinations (CSI) in the present conditions, we have identified a number of significant shortcomings in its functioning. First of all, it should be noted that formed the beginning of the 90s the health care system, including in Industrial Medicine (Medical Unit, the guild Service), its structure and personnel potential proved to be ineffective. In fact, this system has no significant effect on the prevention of medical conditions and injuries, including professional and vocational-caused illnesses, their timely diagnosis, treatment and recovery workers, rehabilitation of sick and disabled people. With regard to the PMO, the main defects of the system were:

123 - CSI persons employed to work in hazardous and dangerous working conditions, were specially created commissions often without the involvement of a primary care practitioner, and without the involvement of all medical records; - quality of the CSI did not meet the required specification for use in hazardous and adverse working conditions, often (in certain territories and institutions from 10 to 23%) of persons admitted to general somatic and even infectious diseases have an increased risk of occupational disease pathology; - in the majority of cases, professional and vocational caused illnesses in the early stages of development is not identified, so that the impact of targeted prevention of occupational hazards and aggravation of diseases and adverse outcomes was carried out is not enough; - Lack of linkages and the principle of continuity in treatment between the guild and outpatient service, the lack of a single physician at each running (or even better - and his family), gaps in information exchange and health workers among the various entities engaged in various forms of assistance, the weak Communication treatment system and the sanitary-epidemiological service. Under these conditions a significant role institutions have begun to implement a system of voluntary health insurance. With regard to health and socio-hygienic aspects of primary disability and employment of disabled people at the water transport, these issues are published with our participation in [13, 14, 15, 16]. The studies overall incidence among all employees of major seaports of Ukraine in 2002-2008. In particular, the example Ilyichevsky Commercial Sea Port (SCPI), found that the incidence for years kept at the same level.It increased in 2007 (compared to 2006) by 12% and decreased (compared with 2005) by 2.3%.Out of the total incidence of individual nosology in 2008 are presented in Tables 1 and 2. As can be seen from the data presented in Table. 1 and 2, respiratory diseases accounted for 24.1% and take 1st place in all divisions of the port. Table 1 The structure of the total incidence of inc ividual nosology Nosology 2005 2006 2007 Diseases of the respiratory system 31.0 25.4 24.1 Diseases of the musculoskeletal system 13.4 14.7 16.2 Injuries 15,1 13.2. 15.6 Diseases of the cardiovascular system 6.9 7.9. 8.3 Diseases of the gastrointestinal tract 8 .1 9,0 7,4 Neoplasms 3.4 5.0 5.6

124 Urogenital diseases 4.1 4.7 4.2 Eye Disorders 4.7 4.0 3.8 Infectious diseases 2.5 3.4 3,6 Diseases of the skin 4.1 3.8 3,2 Diseases of the nervous system 2 . 1 1,9 1,9 ENT disease 1 ,6 1 ,8 1,3 Endocrine 0.7 0 ,8 0.9 Mental diseases 0 ,6 0 ,8 0 ,6 Complications of labor 0 ,6 1.7 2 . 2 Diseases of the blood - 0 .2 0.3

In this group, 85.9% were acute respiratory infections, which constitute 20.7% of disability days, and 39.8% of all cases of morbidity port. Such a high level due to the fact that jobs dockers tallymen, builders, plumbers, working in maintenance and cleaning are found in open areas and the impact of climatic factors and exposure lead to disease. Diseases of the musculoskeletal system gave rise to 25% in the other day and took 2nd place among all diseases. These diseases occur in all departments by persons engaged in heavy physical labor. Injuries in the ports grew by 45.1% in cases and 34.2% in days. Its structure is 82.8% of household injuries (in 2006 - 77.8%) of different degrees of severity, which has grown in comparison with 2006 by 42.8% in the days and 58.5% in the cases. Occupational injuries increased 58.8% (of 27 injuries). Diseases of the cardiovascular system take the 4th place and gave rise to 17.6% in days. Analysis of the pathology shows that 35.6% of the patients are pensioners, the number of days of disability is 19.4. This growth is due to the severity of the disease in the elderly and the aggravation of chronic diseases. Analyzing the data presented in Table. 3 should note that among the infectious diseases 54.7% of disability days belong to tuberculosis, including 2 cases of primary. 37.5% of cases as a result of viral conjunctivitis. Table 2 Overall incidence of port areas and workers dockers mezanizatorov Port Incidence of workers Incidence Dockers Beats. Districts Cases Days 1 0 0 work Cases Days 1 0 0 work weight ing days ing days diseases dockers% Terminal 1287 16471 1715.7 \,710). 7753 807.6 41 1 2 670 9363 1002.4 433 4611 493.6 49.2 Terminal 3 complex 125 2 1082 11472 1533.7 788 7514 1004,5 65.4 Terminal 5 complex 3 terminal 558 8771 1364.0 248 3382 525.9 38.5 complex 6-7 Ferry 163 3134 1437.6 58 1119 513.3 35.7 complex VM 312 3427 652.8 157 830 158.0 24.2

Malignant neoplasm occupied 57.5% of the days. In the group of cardiovascular diseases in 29.9% of cases result in hypertension and 29.2% of cases of ischemic heart disease belongs. Table 3 Incidence VUT on nosology per 100 employees Nosology 2005 2006 2007 cases days cases days cases days

Infectious diseases 1 . 1 29.5 1 .0 36.7 1 ,6 44.8 Neoplasms 0.9 39.4 1 .0 52.7 1 . 2 6 6 .0 Including malignant 0 .2 20.3 0.3 34,0 0.4 38.0 Hematopathy 0.03 1.7 0,08 2.5 0,08 3.4 Endocrine diseases 0 .2 8.3 0.3 9,0 0.4 11.5 Psychiatric Disorders 0.3 7.9. 0.3 8.9 0.3 7.9.

Nervous Diseases 1 ,6 24.1 1 . 2 19.7 1.5 22.7. Eye Disorders 3.9 54.4 3.8 52.3 3.9 45.9 ENT diseases 2 . 2 18.8 2.5 19.3. 2 . 1 15.9 B-or chem. circulation 3,2 79.2 3,2 83.3 4.5 98.0 B-or respiratory 42.7 353.3 32.5. 267.5 36.0 284.0 B-none of the digestive system 4,6 93.2 4.5 95.6 4.3 87.1 B-no skin 3.8 47.9 3,2 40.1 3.3 33.7 B-or musculoskeletal system. 10,3 153.2 10,9 155.0 12.5 190.8 B-nor of the genitourinary 2 ,6 47.6 2,9 49.4 2,9 49.7 system Including Women 2.5 48.6 3.4 58.4 3,2 62.9 Complications of labor 0 ,8 21.4 1.5 48.9 2 . 2 74.9

Traumatism 6 ,2 162.2 5.6 139.4 8 ,0 184.4 Including production 0.3 16.3% 0 .2 8 . 0 .2 -19,0

Among the diseases of the respiratory system 92.4% of cases and 85.9% of days of disability due to acute respiratory infections, 1.6% of the cases due to pneumonia. 18.5% of the cases in the group of diseases of the digestive system as a result of gastric ulcer and 12 ultradisperse cancer, including 9.9% of the first detected. Among the diseases of the musculoskeletal system 28.6% of the cases caused by osteochondrosis. Diseases of the musculoskeletal system constantly make up a 126 large group of diseases that lead to disability due to exacerbations of chronic low back pain, radiculitis, acute lumbodynia after heavy physical exertion and hypothermia. In injury prevails home and road imperfections. Occupational injuries by number of cases remains at the same level, but the increase in the number of disability days. In summary, it should be noted that the incidence in the SCPI has a tendency to increase. Among the reasons for this increase is allocated as follows: - acute respiratory viral infections (reasons - work in open areas, the use of the wet clothes, the presence of drafts in the production areas, the use of fans in loosely closed session); - injuries (accidents at work is 10.3% of the total, while it increased by 58.8%, and the reasons for it in violation of safety as a result of insufficient attention to mentoring and supervision by the heads of departments); - do not use the workers of personal protective equipment especially on terminals with high dust content, which contributes to the development of conjunctivitis, accompanied by prolonged exposure to treatment); - gastro-intestinal tract (no nutrition); - diseases of the musculoskeletal system, despite the mechanization of work (at stazhevyh workers is explained by the presence of chronic diseases since when the goods were transferred manually in subjective opinion of young workers precipitating factor is carrying separations and stowage of bulk cargoes by hand); Submitted summarized in Tables 1 - 3, the data on the incidence of workers seaports were conducted to identify risk factors for diseases of port workers and the definition of jobs, which can be operated with disabilities. With the same purpose, examined data on the incidence of people with disabilities working in the ports (Table 4). According to the Odessa sea port listed in Table 4 show that prevail disabled group III (68.0%), the average length of service among them is 28.7 years (10 to 45), continue to work in the port 13.9 % disabled. As for the Disabled - war veterans, the vast majority of this group are representatives of groups I and II (84.4%), of which 26.7% is constantly sick and bedridden patients. Especially should pay attention to the fact that the person with a disability - WWII veterans - 15.6% of people living in poor housing conditions.

127 Table 4 Indicators of the members of the "Society of the Odessa port disabled" as of ______July 2009______The members of the "Society of Disabled Section Odessa Invalids of the Great Patriotic War section Odessa Parameters Disability group Work Work in the Stay Housing r experience port health I II III(Averege) On Off I II III Suffer Good Satisfactory Bad Qty 3 20 49 28.7 10 62 13 29 4 12 11 27 9 % 4.2 27.8 68.0 - 13.9 86.1 28,9 64.4 6,7 26.7 24.4 60.0 15.6

The study procedures and criteria for employment in the commercial sea ports showed that the port workers who became disabled I, II, III group in an accident and occupational disease are transferred if they so desire, given the state of health, employed by RMI to work or normal business places (PM). Disabled Group I if they so desire, opportunity and health to perform certain types of work are DLI at home (sewing working gloves, shoe repair, programming, computer work). People with disabilities II and III are used for RMI and ordinary jobs. On the basis of socio-hygienic and health research in the ports of the South and Illichevsk was given the scientific substantiation of the criteria for the possibility of

128 employment of various categories of disabled persons in the professions and jobs in the ports. According to the research were developed: A list of jobs, positions and jobs in the ports on which work is prohibited disabled, list of trades, positions and jobs in the ports where possible the employment of people with disabilities, depending on the disease, the disability, the characteristics of the disease. These lists can be used in the organization of work on the creation of jobs people with disabilities, employment of the disabled in seaports. The lists can be used in the working relationship with the branch offices of the Fund of Ukraine on social protection of disabled people and in solving problems in the judicial practice. The developed system will simplify the procedure for job creation disabled people and their places of employment.

Conclusions 1. On the basis of the MIP is a dynamic health surveillance disabled, pensioners and workers of older age groups, the question of the possibility of continuing work in specific production conditions, developed therapeutic and preventive and rehabilitative measures 2. Analysis of incidence by age composition showed that the most common colds in young and middle-aged. Seniors are more responsible to the state of his health. However, in units where persons of older age groups account for more than half of employees (Port Control), the pensioners was a higher incidence, and many persons engaged in purely desk job. 3. S disabled directed the employment center for employment are accepted subject to the following conditions: I disabled the port group - are not accepted, disabled group II made taking into account the recommendations and conclusions of the medical unit of MSEK port on the types of works (services) required port on the RMI (RMI possible at home), and the usual jobs, disabled group III employed on regular jobs, if necessary, create RMI within the standards. 4. According to the research were developed: A list of jobs, positions and jobs in the ports on which work is prohibited disabled, list of trades, positions and jobs in the ports where possible the employment of people with disabilities, depending on the disease, the disability, the characteristics of the disease.

Open Access

129 This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.

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Введение Трудоустройство инвалидов всегда было острым социальным вопросом. Слово «инвалид» (в переводе с английского «непригодный») сегодня все чаще заменяется термином «человек с ограниченными способностями». Но, к сожалению, старый термин все еще используется в законодательных актах, нормативных документах и в прессе [1]. По данным ООН, в мире насчитывается приблизительно 450 млн. человек с различными отклонениями в физическом и психическом развитии [2]. По оценкам Всемирной организации здравоохранения (ВОЗ) в 2011 году почти 15% населения во всем мире имеет ту или иную степень инвалидности. По данным Государственного комитета статистики Украины, на начало 1999 года в Украине насчитывалось более 2,5 миллион лиц, которые официально были признаны инвалидами, то есть, около 5% населения Украины. В начале 1990-х годов общее количество инвалидов составляло 3% (около 1,5 миллиона лиц). Состоянием на 1 января 2002 года количество инвалидов уже составляло 2 миллиона 659 тысяч (около 5,5% населения) [1]. А на начало 2011 года количество людей с ограниченными возможностями составляло 2 709 982 человека (около 6% населения) [3]. С целью социальной защищенности людей с ограниченными возможностями в Украине принят ряд законов и законодательных актов относительно занятости этих людей. Медико-социальные проблемы инвалидности составляют важную область государственной и общественной деятельности. В условиях радикального реформирования государства, которое переживает в настоящее время Украина, 131 изменяется содержание и пути решения медико-социальных проблем инвалидности, основы социальной защиты инвалидов. Содействие со стороны органов государственной власти всех уровней и общественных организаций процессу профессиональной и трудовой реабилитации инвалидов - дело очень нужное и высоконравственное [4]. Законом "О внесении изменений в Закон «Об основах социальной защищенности инвалидов в Украине» напрямую устанавливается для предприятий (объединений), учреждений и организаций независимо от форм собственности норматив для обеспечения трудоустройства инвалидов в размере 4% от общей численности работающих, а если работает от 15 до 25 человек - в количестве 1 -го рабочего места. Практика квотирования рабочих мест для лиц с ограниченными возможностями применяется и за рубежом. Так, "в Германии, Франции и Венгрии под законы о квотировании подпадают организации с более чем 20 сотрудниками, в Австрии и Польше - с 25 сотрудниками. В Испании минимальное число сотрудников - 50. Квота для людей с инвалидностью в Г ермании составляет 5%, во Франции - 6%, В Люксембурге квота варьируется от 2% до 5% в зависимости от формы собственности и от количества сотрудников предприятия. В Испании и Ирландии квота составляет 3%. В Японии квота составляет от 1,6% до 2%"[5]. В некоторых странах в случае "незаполнения" квот организации выплачивают специальные взносы в целевые фонды, средства которых распределяются на создание рабочих мест для инвалидов и адаптацию существующих рабочих мест к нуждам людей с ограниченными возможностями [6]. Украина располагает 28 морскими, 12 речными и 4 рыбными портами, приписанными к основным портам. Морской торговый порт - это сложная производственная система, эффективное функционирование которой возможно в неразрывной связи всех подразделений, представленных разнообразными по

132 характеру трудовой деятельности и многочисленными по профессиональной принадлежности контингентами работников. Цель В связи с вышеизложенным, целью настоящей работы было проведение анализа состояния инвалидности в крупных морских портах юга Украины (на примере портов Одесса, Ильичевск, Южный). Выбор данного контингента был связан с тем, что морские торговые порты являются сложной производственной системой, эффективное функционирование которой возможно в неразрывной связи всех подразделений, представленных разнообразными по характеру трудовой деятельности и многочисленными по профессиональной принадлежности контингентами работников. Объекты, контингент, методы исследования. Контингент - инвалиды, работающие в морских портах. Методы - социально-гигиенические (заболеваемость с ВУТ и травматизм), гигиенические (условия труда), медико-статистические. Результаты исследований и их обсуждение. Решению вопросов инвалидности населения уделяется исключительное внимание в связи с ее распространенностью и значительным количеством лиц с ограниченным возможностями. Результаты санитарно-гигиенических исследований на рабочих местах работников портов изложены в опубликованных с нашим участием работах [7,8,9,10,11]. По результатам изучения работы системы повторных медицинских осмотров (ПМО) в современных условиях, нами отмечен ряд существенных недостатков в ее функционировании. Прежде всего, следует отметить, что сформировавшаяся к началу 90-х годов система здравоохранения, в т.ч. в промышленной медицине (медсанчасти, цеховая служба), по своей структуре и по кадровому потенциалу оказалась неэффективной. Фактически эта система не оказывает существенного влияния на медицинскую профилактику заболеваний и травм, включая профессиональные и профессионально-обусловленные заболевания, своевременную их диагностику, лечение и оздоровление

133 работающих, реабилитацию больных и инвалидов. Что касается проведения ПМО, то основными дефектами системы были: - ПМО лиц, занятых на работах с вредными и опасными условиями труда, проводились специально созданными комиссиями зачастую без участия основного лечащего врача-терапевта и без привлечения всех медицинских документов; - качество проводимых ПМО не отвечало предъявленным требованиям к работе во вредных и неблагоприятных условиях труда, зачастую (по отдельным территориям и учреждениям от 10 до 23%) допускались лица с общими соматическими и даже инфекционными заболеваниями, имеющими повышенный риск заболеваний профессиональной патологией; - в абсолютном большинстве случаев профессиональные и профессионально обусловленные заболевания на ранних стадиях развития не выявлялись, вследствие чего целенаправленная профилактика воздействия профессиональных факторов риска и утяжеления течения заболеваний и неблагоприятных исходов проводилась недостаточно; - отсутствие взаимосвязи и принципа преемственности в лечении между цеховой и амбулаторной службой, отсутствие единого лечащего врача у каждого работающего (а еще лучше - и у его семьи), недостатки в обмене информацией и состоянии здоровья работающих между различными структурами, осуществляющими различные виды помощи, слабые связи лечебной системы и санитарно-эпидемиологической службы. В этих условиях существенную роль начали осуществлять учреждения системы добровольного медицинского страхования. Что касается медицинских и социально-гигиенических аспектов первичной инвалидности и трудоустройства инвалидов на объектах водного транспорта, то эти вопросы опубликованы с нашим участием в работах [13,14,15,16]. В результате исследований общей заболеваемости среди всех работников крупных морских портах Украины в 2002-2008 гг. в частности, на примере

134 Ильичевского морского торгового порта (ИМТП), установлено, что заболеваемость в течение ряда лет держится примерно на одном уровне. Она увеличилась в 2007 г. (в сравнении с 2006 г.) на 12% и уменьшилась (в сравнении с 2005 г.) на 2,3%. В структуре общей заболеваемости отдельные нозологии в 2008 г. представлены в таблицах 1 и 2. Как видно из данных, представленных в табл. 1 и 2, заболевания органов дыхания составили 24,1% и занимают 1-е место во всех подразделениях порта.

Таблица 1 Структура общей заболеваемости по отдельным нозологиям______Нозологии 2005 г. 2006 г. 2007 г. Заболевания органов дыхания 31,0 25,4 24,1 Заболевания костно-мышечной системы 13,4 14,7 16,2 Травмы 15,1 13,2 15,6 Заболевания сердечно-сосудистой системы 6,9 7,9 8,3

Заболевания желудочно-кишечного тракта 8 ,1 9,0 7,4 Новообразования 3,4 5,0 5,6 Заболевания мочеполовой сферы 4,1 4,7 4,2 Заболевания глаз 4,7 4,0 3,8 Инфекционные болезни 2,5 3,4 3,6 Болезни кожи 4,1 3,8 3,2 Болезни нервной системы 2 , 1 1,9 1,9 Оториноларингологические заболевания 1 ,6 1 ,8 1,3 Болезни эндокринной системы 0,7 0 ,8 0,9 Психические болезни 0 ,6 0 ,8 0 ,6 Осложнения родов 0 ,6 1,7 2 , 2 Заболевания крови - 0 ,2 0,3

В этой группе 85,9% составляют острые респираторные инфекции, которые составляют 20,7% дней нетрудоспособности и 39,8% случаев всей заболеваемости по порту. Такой высокий уровень объясняется тем, что рабочие места докеров, тальманов, строителей, слесарей, рабочих по комплексному обслуживанию и уборке находятся на открытых площадках и воздействие климатических факторов и переохлаждения приводят к заболеваниям. Заболевания костно-мышечной системы дали рост на 25% в днях и занимают 2-е место среди всей патологии. Эти заболевания встречаются во всех подразделениях у лиц, занимающихся тяжелым физическим трудом. Травматизм в портах вырос на 45,1% в случаях и на 34,2% в днях. В его структуре 82,8% занимает бытовой травматизм (в 2006 г. - 77,8%) разных

135 степеней тяжести, который вырос в сравнении с 2006 г. на 42,8% в днях и 58,5% в случаях. Производственный травматизм вырос 58,8% (всего 27 травм). Заболевания сердечно-сосудистой системы занимают 4-е место и дали рост на 17,6% в днях. Анализ данной патологии показывает, что 35,6% заболевших составляют пенсионеры, число дней нетрудоспособности составляет 19,4. Такой рост патологии обусловлен тяжестью течения у лиц пожилого возраста и обострением хронических заболеваний. Анализируя данные, приведенные в табл. 3, следует отметить, что среди инфекционных заболеваний 54,7% дней нетрудоспособности принадлежат туберкулезу, в том числе 2 случая первичных. 37,5% случаев в результате вирусного конъюнктивита. Таблица 2 Общая заболеваемость работников районов порта и докеров- мезанизаторов

Районы Заболеваемость работников Заболеваемость докеров Уд. вес порта Случаи Дни На 100 Случаи Дни На 100 заболева работаю работаю ний щих в щих в докеров, днях днях % 1 1287 16471 1715,7 710 7753 807,6 41 терминал 2 670 9363 1002,4 433 4611 493,6 49,2 терминал 3 комплекс 2 1082 11472 1533,7 788 7514 1004,5 65,4 терминал 5 комплекс 3 558 8771 1364,0 248 3382 525,9 38,5 терминал 6-7 комплекс Паромны 163 3134 1437,6 58 1119 513,3 35,7 й комплекс ВМ 312 3427 652,8 157 830 158,0 24,2

Злокачественные новообразования заняли 57,5% дней.

136 В группе болезней системы кровообращения 29,9% случаев в результате гипертонической болезни и в 29,2% случаев принадлежит ишемической болезни сердца. Таблица 3 Заболеваемость с ВУТ по нозологии на 100 работающих

Нозология 2005 г 2006 г. 2007 г. случаи дни случаи дни случаи дни

Инфекционные заболевания 1 , 1 29,5 1 ,0 36,7 1 ,6 44,8 Новообразования 0,9 39,4 1 ,0 52,7 1 , 2 6 6 ,0 В т.ч. злокачественные 0 ,2 20,3 0,3 34,0 0,4 38,0 Болезни крови 0,03 1,7 0,08 2,5 0,08 3,4 Эндокринные заболевания 0 ,2 8,3 0,3 9,0 0,4 11,5 Психические расстройства 0,3 7,9 0,3 8,9 0,3 7,9 Нервные болезни 1 ,6 24,1 1 , 2 19,7 1,5 22,7 Заболевания глаз 3,9 54,4 3,8 52,3 3,9 45,9

ЛОР-заболевания 2 , 2 18,8 2,5 19,3 2 , 1 15,9 Б-ни сист. кровообращения 3,2 79,2 3,2 83,3 4,5 98,0 Б-ни органов дыхания 42,7 353,3 32,5 267,5 36,0 284,0 Б-ни органов пищеварения 4,6 93,2 4,5 95,6 4,3 87,1 Б-ни кожи 3,8 47,9 3,2 40,1 3,3 33,7 Б-ни костно-мышечной сист. 10,3 153,2 10,9 155,0 12,5 190,8 Б-ни мочеполовой системы 2 ,6 47,6 2,9 49,4 2,9 49,7 В т.ч. женской 2,5 48,6 3,4 58,4 3,2 62,9 Осложнения родов 0 ,8 21,4 1,5 48,9 2 , 2 74,9 Травматизм 6 ,2 162,2 5,6 139,4 8 ,0 184,4 В т.ч. производственный 0,3 16,3 0 ,2 8 ,2 0 ,2 19,0

Среди заболеваний органов дыхания 92,4% случаев и 85,9% дней потери трудоспособности за счет острых респираторных инфекций, 1,6% случаев из-за пневмонии. 18,5% случаев в группе болезней органов пищеварения в результате язвенной болезни желудка и 12-персной кишки, в т.ч. 9,9% случаев выявлено впервые. Среди заболеваний костно-мышечной системы 28,6% случаев заболеваний вызвано остеохондрозом. Заболевания костно-мышечной системы постоянно составляют большую группу болезней, которая приводит к нетрудоспособности за счет обострений хронических остеохондрозов, радикулитов, острых люмбалгий после тяжелых физических нагрузок и переохлаждений.

137 В травматизме преобладает бытовой и дорожный травматизм. Производственный травматизм по числу случаев сохраняется на одном уровне, зато увеличивается число дней нетрудоспособности. Подводя итоги, следует отметить, что заболеваемость в ИМТП имеет тенденцию к росту. Среди причин такого роста выделяется следующее: - острые респираторно-вирусные инфекции (причины - работы на открытых площадках; использование невысохшей спецодежды; наличие сквозняков в производственных помещениях; использование вентиляторов при неплотно закрытых дверях); - травматизм (производственный травматизм составляет 10,3% от общего, при этом, он возрос на 58,8% и причины его в нарушении техники безопасности в результате недостаточного внимания инструктажу и контролю со стороны руководителей подразделений); - не использование рабочими средств индивидуальной защиты особенно на терминалах с высокой запыленностью, что способствует развитию конъюнктивитов, сопровождающихся длительным пребыванием на лечении); - заболевания желудочно-кишечного тракта (отсутствие полноценного питания); - болезни костно-мышечного аппарата, несмотря на механизацию работ (у стажевых работников это объясняется наличием хронических заболеваний с тех пор, когда грузы переносились вручную; по субъективному мнению молодых работников провоцирующим фактором является переноска сепараций и штивка насыпных и навалочных грузов вручную); Представленные обобщённые в таблицах 1- 3 данные о заболеваемости работников морских портов были проведены с целью выявления факторов риска для заболеваний работников порта и определения рабочих мест, на которых могут работать инвалиды. С этой же целью были изучены данные о заболеваемости работающих в портах инвалидов ( таблица 4). По данным Одесского морского торгового порта приведенных в табл. 4 видно, что превалируют инвалиды III группы (68,0%), средний стаж работы у

138 них составляет 28,7 лет (от 10 до 45 лет), продолжают работу в порту 13,9% инвалидов. Что касается инвалидов - участников ВОВ, то в этой группе подавляющее большинство составляют представители I и II групп(84,4%), из них 26,7% постоянно болеют и есть лежачие больные. Особенно следует обратить внимание на тот факт, что из инвалидов - участников ВОВ - 15,6% лиц проживают в плохих жилищных условиях.

Таблица 4 Показатели членов «Общества инвалидов Одесского порта» по состоянию на июль 2009 г.

Члены «Общества инвалидов п. Одесса» Инвалиды Великой Отечественной войны п. Одесса Пока Группа Стаж Работ ают в Сост.здоровья Жилищные условия затели инвалидности работы по рту I II III (средн.) Да Нет I II III Болеют Хор. Уд. Плохие К-во 3 20 49 28,7 10 62 13 29 4 12 11 27 9 % 4,2 27,8 68,0 - 13,9 86,1 28,9 64,4 6,7 26,7 24,4 60,0 15,6

Изучение порядка и критериев трудоустройства инвалидов в морских торговых портах показали, что работники порта, ставшие инвалидами I, II , III группы в результате несчастного случая и профессионального заболевания переводятся при их желании, с учетом состояния здоровья, трудоустраиваются работать на созданные РМИ или на обычные рабочие места (РМ). Для инвалидов I группы при их желании, возможности и состояния здоровья выполнять определенные виды работ, создаются РМИ на дому (пошив рабочих рукавиц, ремонт обуви, программирование, работы на компьютере). Инвалиды II и III групп используются на РМИ и на обычных рабочих местах. На основании проведенных социально-гигиенических и медико санитарных исследований в портах Южный и Ильичевск было дано научное обоснование к критериям возможности использования труда различных категорий инвалидов в профессиях и должностях в портах. По данным проведенных исследований были разработаны: Перечень профессий, должностей и работ в портах на которых труд инвалидов запрещен; 139 Перечень профессий, должностей в портах и работ на которых возможно использование труда инвалидов в зависимости от заболевания, группы инвалидности, особенностей течения заболевания. Указанные перечни могут быть использованы в организации работы по созданию рабочих мест инвалидов, трудоустройству инвалидов в морских портах. Перечни могут быть использованы в рабочих взаимоотношениях с отраслевыми отделениями Фонда Украины по социальной защите инвалидов и при решении спорных вопросов в судебной практике. Разработанная система позволит упростить порядок создания рабочих мест инвалидов и их трудоустройства.

Выводы 1. На основании ПМО обеспечивается динамическое наблюдение за состоянием здоровья инвалидов, пенсионеров и работников старших возрастных групп, решаются вопросы возможности продолжения работы в конкретных производственных условиях, разрабатываются лечебно профилактические и реабилитационные мероприятия 2. Анализ заболеваемости по возрастному составу показал, что наиболее распространены простудные заболевания у лиц молодого и среднего возраста. Пенсионеры более ответственно относятся к состоянию своего здоровья. Однако в подразделениях, где лица старших возрастных групп составляют более половины работающих (портнадзор), у пенсионеров отмечена более высокая заболеваемость, причем у многих лиц, занимающихся чисто кабинетной работой. 3. Инвалиды, направляемые Центром занятости для трудоустройства, принимаются с учетом следующих условий: инвалиды I группы в порт - не принимаются; инвалиды II группы принимаются с учетом рекомендаций МСЭК и заключения медсанчасти порта на виды работ (услуг), необходимых порту на РМИ (возможны РМИ на дому) и на обычные рабочие места; инвалиды III

140 группы трудоустраиваются на обычные рабочие места, при необходимости создаются РМИ в пределах нормативов. 4. По данным проведенных исследований были разработаны: Перечень профессий, должностей и работ в портах на которых труд инвалидов запрещен; Перечень профессий, должностей в портах и работ на которых возможно использование труда инвалидов в зависимости от заболевания, группы инвалидности, особенностей течения заболевания.

References in original 1. Трудоустройству инвалидов дадут больше законных стимулов. Режим доступа: http://blog.liga.net/user/asamovlenko/article/9326.aspx.

2. Рузаева Е.Н. Некоторые аспекты правового регулирования труда инвалидов и лиц с ограниченными возможностями. Вопросы российского и международного трава.2012- №3-4.-С.98-108.

3. Национальный доклад о принятых мерах, направленных на осуществление Украиной обязательств в рамках Конвенции о правах инвалидов, Киев, 2012.

4. Закон «О реабилитации инвалидов Украины» вщ 06.10.2005 № 2961-IV

5. Киселев И.Я. Сравнительное и международное трудовое право: (Учебник для вузов. - М.: Дело, 1999- с. 221).

6 . Денисов В.В. Обзор законодательства других стран в сфере трудоустройства инвалидов. - Режим доступа: http:// rabota.perspektiva- inva.ru/index.php?id=113&from=search&search_terms=&p=2).

7. Свстафьев В.М., Скиба О.В. забруднення повыря на робочих мщцях докерiв- механiзаторiв у портах // Актуальш питання гшени та еколопчно! безпеки Украши (Першi Марзеевсью читання).-Кшв, 2005.-С. 275-276.

8 . Евстафьев В.Н., Скиба А.В., Шеин С.В. Электромагнитные излучения на транспорте как гигиеническая проблема // Актуальные проблемы транспортной медицины. - 2005.-№ 1.-С. 85-90 9. Евстафьев В.Н., Скиба А.В. Влияние условий труда на заболеваемость портовых работников старших возрастных групп // Проблемы старения и долголетия, IV нащональний конгрес геронтолобв i герiатрiв Украши.- К., Т.14.-приложение.- 2005.-С. 242-243.

141 10. Свстафьев В.М., Скиба О.В., Шеш С.В. та iH. Умови пращ робыниюв водного транспорту при перевантаженш шкiдливих i небезпечних вантажiв // Гшена населених мщць.-К., 2005.-Вип. 45.-С. 57-62 11. Евстафьев В.Н., Скиба А.В., Шеин С.В. Актуальные проблемы гигиены труда на транспорте // Актуальш проблеми гшени пращ, професшно! патологи i медично! екологл Донбасу.-Донецьк, “Каштан”.-2005.-С. 30-34 13. Лисобей В.А., Скиба А.В., Евстафьев В.Н. Первичная инвалидность портовых работников старших возрастных групп // Проблемы старения и долголетия. IV нащональний конгрес геронтолопв i герiатрiв Укра!ни.-К.,Т.14.-приложение.-2005.-С. 250 14. Скиба А.В. Проблемы трудоустройства инвалидов в морских портах // Актуальш питання гшени та еколопчно! безпеки Укра!ни.-К., 2006.-С. 204-205 15. Скиба А.В. Социально-гигиенические проблемы трудоустройства инвалидов в морских портах // Актуальные проблемы транспортной медицины, Одесса, 2006.-№ 3 (5).-С. 74-79 16. Скиба О.В. Актуальш питання працевлаштування швалвдв у портах // Актуальш питання гшени та еколопчно! безпеки Укра!ни.-К., 2007.-С. 164-165

Received: 15.02.2013. Revised: 25.05.2013. Accepted: 03.06.2013.

142 Journal of Health Sciences (J for the Ss H) 2013; 3 (5): 143-154 The journal has had 4 points in Ministry of Science and Higher Education of Poland parametric evaluation. B letter item 683. © The Author (s) 2013; This article is published with open access at Licensee Open Journal Systems of University Radom in Radom, Poland Open Access This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.

UDC 616.831-002+616.379-008

SPECIFIC FEATURES OF THE CONDITION LIPID TRANSPORT SYSTEM OF BLOOD PLASMA IN PATIENTS WITH ESSENTIAL HYPERTENSION AND TYPE 2 DIABETES IN ATHEROSCLEROSIS

Особенности состояния липидтранспортной системы плазмы крови у больных гипертонической болезнью и сахарным диабетом 2 типа при атеросклерозе

S. Kotyuzhynskaya1 , A. Gozhenko л , W Zukow -I С.Г. Котюжинская 1 , А.И. Гоженко л , W Zukow -i

1Odessa national medical University 2SE «Ukrainian research Institute of medicine of transport», Odessa 3University of Economy in Bydgoszcz, Poland

1Одесский национальный медицинский университет 2Украинский НИИ медицины транспорта, г. Одесса 3University of Economy in Bydgoszcz, Poland

Key words: lipid transport; blood plasma; essential hypertension; type 2 diabetes; atherosclerosis.

Ключевые слова: транспорт липидов; плазма крови; гипертоническая болезнь; сахарный диабет 2 типа, атеросклероз.

143 A comprehensive analysis showed multidirectional violations nnnngTpaHcnopTHon system of atherosclerosis patients with arterial hypertension and in patients with diabetes. It is established that patients with diffuse atherosclerosis, complicated type 2 diabetes, there is a very pronounced dyslipidemia, manifested hypercholesterolemia, increase in the number XC-VLDL, and reduced levels of triglycerides and LDL-C. The content of HDL-C usually remains within the norm. At the same time the level of atherogenicity was significantly higher in patients with coronary artery disease, which puts these patients at risk, but also evidence about the role of lipid metabolism in the pathogenesis of ischemic heart disease. Moreover, it is possible that these patients are already defeated coronary atherosclerotic process. All this allows to consider the violations of lipid exchange as one of the leading pathogenesis of atherosclerosis patients with GB and type 2 diabetes, although their role in the pathogenesis of atherosclerosis has its peculiarities.

Atherosclerosis is one of the most common diseases of our time. Over the past few years, according to the WHO, has increased significantly (75%) deaths from coronary heart disease, the leading cause of which is atherosclerosis. The complexity of the etiology and pathogenesis of atherosclerosis is that now scientists cannot name a single cause, which could be specifically relate the development of this disease process [1, 2]. It is known that prolonged exposure to elevated blood pressure to the wall of blood vessels, ultimately, can lead to dysfunction of the endothelium, resulting in the risk of atherosclerosis increases. [3]. It should be remembered that not only endothelial dysfunction contributes to the formation and progression of a cardiovascular disease, but the disease can often exacerbate endothelial damage. 144 An example of such interdependence can serve situation, which occurs in hypertension. [4]. According to the literature up to 80% of diabetic patients die from hitting the cardiovascular system [5].Among diabetic heart disease are 2-6 times more likely than the general population. According to most authors, coronary atherosclerosis in patients with diabetes mellitus (DM) is found in 70% of cases, and it affects the coronary arteries, not aorta. Analyzing the results, the researchers concluded that hyperglycemia causes corresponding hyperinsulinemia and high insulin levels, increasing the synthesis of cholesterol esters in the vascular wall, promotes arteriosclerosis. [6]. In predisposition to atherosclerosis is of great importance for the characteristic of diabetes protein glycosylation process, including cholesterol. [7]. Research objectives:

Study of features of lipid-transport system performance in patients with severe diffuse atherosclerosis in type 2 diabetes and hypertension.

Material and methods.

The study involved 81 patients with a clinical diagnosis of diffuse atherosclerosis and hypertension (Group I), aged 43-67 years (mean age 55,3 ± 2,1 years), of whom 32 (39.5%) women and 49 (60, 5%) of men. In the II group included 54 patients with a clinical diagnosis of atherosclerosis, complicated by type 2 diabetes (mean age 60,3 ± 3,1 years), of whom 35 (64.8%) women and 19 (35.2%) men. All patients were treated at the cardiology department of the Regional Medical Center inOdessa. The comparison group consisted of 33 patients with coronary heart disease (CHD), of which 11 (33.3%) women and 22 (66.7%) men aged 47-69 years (mean age 57,1 ± 4,6 years) with no clinical signs of atherosclerosis.

Studies conducted lipid-transport system enzymatic method with the use of test kits firm Cormay Diana (Poland). Measured levels of total cholesterol (TC) and triglycerides (TG) in serum and plasma cholesterol levels in the high density lipoproteins (HDL-C). The concentration of HDL-C installed after the deposition 145 fractions of low density lipoprotein (LDL) and very low density lipoproteins (VLDL) by heparin and manganese ions. The content of cholesterol in LDL-C and VLDL-cholesterol was calculated by mathematical formula Fridvalt, atherogenic index (CA) - by AN Klimov.

Statistical processing of the material was performed on a personal computer with a program «Excel». The significance of differences was assessed by t-test (differences were considered significant at p < 0,05).

Results and Discussion

The study of lipid metabolism in patients' treatment groups demonstrated significant impairment of virtually all indicators of lipid profile (table).

Table 2 Lipid metabolism in the tested groups, (M ± m) Parameters The comparison Group I Group II group (N = 54) (N = 81) (N = 33) TC, mmol / L 5,73 ± 1,12 5,09 ± 1,05 6,51 ± 0,19 * TG mmol / l 2,34 ± 0,37 ** 1,53 ± 0,67 * 2,71 ± 0,16 ** HDL cholesterol, mmol 0,86 ± 0,25 ** 1,05 ± 0,08 * 1,05 ± 0,02 * / L LDL cholesterol, mmol 3,72 ± 0,80 3,40 ± 0,82 4,43 ± 0,21 *** / L VLDL, mmol / L 1,28 ± 0,03 ** 0,68 ± 0,28 * 1,96 ± 0,06 ** KA 6,02 ± 1,77 ** 4,52 ± 1,02 * 5,37 ± 0,23 *** Note: * - Significant difference compared with patients with coronary artery disease ** - Significant difference compared with patients with essential hypertension

Total cholesterol in patients comparison group ranged from 3.6 to 8.1 mmol / l (average 5,73 ± 1,12 mmol / l), patients with type 2 diabetes from 3 to 7.3 mmol / l (average 6,51 ± 0,19 mmol / l), while the level of total cholesterol in patients 146 with essential hypertension was slightly higher reference value (5.0 mmol / L) and significantly lower than in both type 2 diabetics and comparison group. It should be noted that in all the groups surveyed showed a significant increase in the fraction of LDL-C relative to the reference values (2.2 mmol / l) on the back of moderate growth levels of LDL, VLDL, and differed significantly. Thus, the concentration of LDL-C and VLDL-cholesterol was higher in patients with type 2 diabetes compared with patients with AD and patients with coronary artery disease, and the atherogenic lipid classes was higher in patients with coronary artery disease, and in patients with essential hypertension rates of VLDL- cholesterol were within acceptable limits (1.03 mmol / l). The level of serum TG levels were highest in patients with type 2 diabetes, was within the upper limits of normal and did not differ significantly from the group of CHD patients, whereas the minimum values of TG were observed in patients with essential hypertension. Noted a downward trend of HDL-C, although values remained within acceptable limits (0.9-1.9 mmol / l) in patients with type 2 diabetes and blood pressure. Noteworthy is the fact that in the group of hypertensive patients was significantly lower than the spacecraft with respect to all groups of the study and remained within acceptable limits. CHD patients revealed a significant decrease in anti-atherogenic factors - cholesterol and increase the spacecraft, which could be a reflection of the major pathogenetic mechanisms underlying the development of coronary atherosclerosis as the cause of coronary artery disease. However, to our knowledge, in patients with type 2 diabetes is not severe hypercholesterolemia compared to the physiological norm, but the level of LDL cholesterol was significantly elevated. However, note that the level of HDL cholesterol was higher relative to the comparison group. Conclusion. Thus, our analysis revealed a complex multi-directional violations of lipid transport system in patients with atherosclerosis, hypertension, and in patients with diabetes. Found that in patients with diffuse atherosclerosis complicated by type 2 diabetes, there is a more severe dyslipidemia, hypercholesterolemia, which manifests itself by increasing the number of VLDL-cholesterol, lower triglycerides and LDL-C. The content of HDL-C usually remains within normal limits. At the same time the level of atherogenic was significantly higher in patients with 147 coronary artery disease, that the ratio of these screens patients at risk, as well as evidence of the role of lipid metabolism in the pathogenesis of coronary heart disease. Moreover, it is possible that these patients already taking place coronary vascular atherosclerotic process. All of this allows us to consider lipid metabolism as one of the leading of the pathogenesis of atherosclerosis in patients with essential hypertension and type 2 diabetes, although their role in the pathogenesis of atherosclerosis has its own characteristics

References in transliteration and English

1. Talaeva TV, brother VV Atherosclerosis: multifactorial pathogenesis of systemic and / / Ukrainsky kardiologichny magazine. - 2007. - № 5. - S. 101-111. 2. Shostak NA On the question of atherosclerosis as a systemic process of multifocal / / clinician. - 2008. - № 4. - P. 3-7. 3. Gurevich S. Current concepts of the pathogenesis of atherosclerosis [electronic resource] / VS Gurevich / / Diseases of the heart and blood vessels. Topical and controversial issues. - 2006. - Volume 1, Number 4. - Mode of access: http://www.asvomed.ru/php/content.php7id = 3193 4. Gogin EE Arterial hypertension and hypertensive disease (syndromic diagnosis and nosological diagnosis) / / therapist. arch. - 2010. - T. 82, № 4. - Pp. 5-10. 5. Mabuza NP, NN Mabuza Theoretical and morphological patterns of the pathogenesis of atherosclerosis and its major complications. New approaches to prevention and treatment of th / / Morphology. - 2009. - T 3, № 1. - S. 14-21. 6. Kholodova EA Korolenko GG Experience correction of dyslipidemia in type 2 diabetes mellitus / / Medical News. - 2005. - Number 2. - S. 34-37. 7. Titov VN Atherosclerosis as a pathology of polyene fatty acids.Biological basis of the theory of atherosclerosis. - Moscow, 2002. - 495 sec.

148 Атеросклероз является одной из наиболее частых болезней современности. За последние годы, по данным ВОЗ, значительно увеличилась (до 75%) смертность от ишемической болезни сердца, основной причиной развития которой является атеросклероз. Сложность этиологии и патогенеза атеросклероза заключается в том, что в настоящее время ученые не могут назвать одну причину, с которой конкретно можно было бы связать развитие этого патологического процесса [1, 2]. Известно, что длительное воздействие повышенного артериального давления на стенку сосудов, в конечном счете, может привести к дисфункции эндотелия, в результате чего возрастет риск развития атеросклероза [3]. Следует помнить о том, что не только эндотелиальная дисфункция способствует формированию и прогрессированию того или иного сердечно сосудистого заболевания, но и само заболевание нередко способно усугублять эндотелиальное повреждение. Примером такой взаимозависимости может служить ситуация, которая имеет место при артериальной гипертензии [4]. По данным литературы, до 80 % больных сахарным диабетом умирают от поражения сердечно-сосудистой системы [5]. Среди больных диабетом заболевания сердца встречаются в 2-6 раз чаще, чем среди населения в целом. По мнению большинства авторов, атеросклероз коронарных сосудов у больных сахарным диабетом (СД) встречается в 70% случаев, причем поражаются именно коронарные сосуды, а не аорта. Анализируя полученные результаты, ученые пришли к выводу, что гипергликемия вызывает соответствующую гиперинсулинемию, а высокий уровень инсулина, увеличивая синтез эфиров холестерина в сосудистой стенке, способствует развитию атеросклероза [6]. В предрасположенности к развитию

149 атеросклероза большое значение имеет характерный для сахарного диабета процесс гликозилирования белков, в том числе и в ЛПНП [7].

Цель исследования.

Изучение особенностей показателей липидтранспортной системы у больных с выраженным диффузным атеросклерозом сосудов с СД 2 типа и гипертонической болезнью.

Материалы и методы исследования.

Проведено обследование 81 больного с клиническим диагнозом диффузный атеросклероз и гипертоническая болезнь (I группа) в возрасте 43 67 лет (средний возраст 55,3±2,1 года), из них 32 (39,5%) женщин и 49 (60,5%) мужчин. Во II группу вошли 54 больных с клиническим диагнозом атеросклероз, осложненный сахарным диабетом 2 типа (средний возраст 60,3±3,1 года), из них 35 (64,8 %) женщин и 19 (35,2 %) мужчин. Все больные находились на стационарном лечении в кардиологическом отделении Областного медицинского центра г. Одессы. Группу сравнения составили 33 больных с ишемической болезнью (ИБС), из них 11 (33,3 %) женщина и 22 (66,7 %) мужчины в возрасте 47-69 лет (средний возраст 57,1±4,6 года) без клинических признаков атеросклероза. Исследования липидтранспортной системы проводили ферментативным методом с использование тест-наборов фирмы Cormay Diana (Польша). Определяли содержание общего холестерина (ОХС) и триглициридов (ТГ) в сыворотке плазмы и уровень холестерина в липопротеидах высокой плотности (ХС-ЛПВП). Концентрацию ХС-ЛПВП устанавливали после осаждения фракций липопротеидов низкой плотности (ЛПНП) и липопротеидов очень низкой плотности (ЛПОНП) под действием гепарина и ионов марганца. Содержание ХС в ХС-ЛПНП и ХС-ЛПОНП 150 рассчитывали математически по формуле Фридвальта, коэффициент атерогенности (КА) - по А.Н. Климову.

Статистическую обработку материала проводили на персональном компьютере с помощью программ «Excel». Достоверность различий оценивали по критерию Стьюдента (различия считали достоверными при р<0,05).

Результаты и обсуждение. Изучение липидного обмена у пациентов исследуемых групп демонстрирует значительные нарушения фактически всех показателей липидограммы (табл.).

Таблица. Показатели липидного обмена в обследованных группах, (M+m) Показатели Группа I группа II группа сравнения (n = 54) (n = 81) (n = 33) ОХС, ммоль/л 5,73+1,12 5,09+1,05 6,51+0,19* ТГ, ммоль/л 2,34+0,37** 1,53+0,67* 2,71+0,16** ХС ЛПВП, ммоль/л 0,86+0,25** 1,05+0,08* 1,05+0,02* ХС ЛПНП, ммоль/л 3,72+0,80 3,40+0,82 4,43+0,21* ** ХС ЛПОНП, ммоль/л 1,28+0,03** 0,68+0,28* 1,96+0,06** КА 6,02+1,77** 4,52+1,02* 5,37+0,23* ** Примечание: * - достоверность различий по сравнению с пациентами с ИБС ** - достоверность различий по сравнению с пациентами с ГБ

Показатели общего холестерина у больных группы сравнения находились в диапазоне от 3,6 до 8,1 ммоль/л (в среднем 5,73±1,12 ммоль/л), у больных СД 2 типа от 3 до 7,3 ммоль/л (в среднем 6,51±0,19 ммоль/л), в то

151 время как уровень ОХС у пациентов с ГБ был незначительно выше референтных величин (5,0 ммоль/л) и достоверно ниже показателей как больных СД 2 типа, так и группы сравнения. Следует отметить, что во всех группах обследованных наблюдалось значительное повышение фракции ХС- ЛПНП относительно референтных величин (2,2 ммоль/л) на фоне умеренного роста уровня ХС-ЛПОНП и различалось достоверно. Так, концентрация ХС- ЛПНП и ХС-ЛПОНП была выше у больных СД 2 типа по сравнению с больными с АД и больными ИБС, при этом уровень липидов атерогенных классов был выше у больных ИБС, а в группе больных с ГБ показатели ХС- ЛПОНП оставались в границах допустимых норм (1,03 ммоль/л). Уровень ТГ сыворотки крови был максимальным у больных с СД 2 типа, находился в пределах верхней границы нормы и достоверно не отличался с группой больных ИБС, в то время как минимальные значения количества ТГ наблюдали у пациентов с ГБ. Отмечали динамику снижения ХС-ЛПВП, хотя величины оставались в границах допустимых норм (0,9-1,9 ммоль/л) у больных с СД 2 типа и с АД. Обращает на себя внимание факт, что в группе больных ГБ КА был достоверно ниже относительно всех групп исследования и оставался в пределах допустимой нормы. У больных ИБС обнаружено достоверное снижение антиатерогенного фактора - ЛПВП и повышение КА, что может быть отражением основных патогенетических механизмов, лежащих в основе развития коронарного атеросклероза как причины ИБС. Вместе с тем, по нашим данным, в группе больных СД 2 типа нет выраженной гиперхолестеринемии относительно физиологической нормы, однако уровень ЛПНП достоверно повышен. Однако следует обратить внимание на то, что уровень ЛПВП был выше относительно группы сравнения.

Вывод.

152 Таким образом, проведенный комплексный анализ выявил разнонаправленные нарушения липидтранспортной системы у больных атеросклерозом с гипертонической болезнью и у больных с сахарным диабетом. Установлено, что у больных диффузным атеросклерозом, осложненным СД 2 типа, наблюдается более выраженная дислипидемия, проявляющаяся гиперхолестеринемией, увеличением количества ХС- ЛПОНП, снижением уровня ТГ и ХС-ЛПНП. Содержание ХС-ЛПВП обычно остается в пределах нормы. В то же время уровень атерогенности достоверно был выше у больных ИБС, что относит этих больных в группу риска, а также свидетельствует о роли нарушений липидного обмена в патогенезе ишемической болезни сердца. Причем, возможно, что у этих больных уже имеет место поражение коронарных сосудов атеросклеротическим процессом. Все это позволяет рассматривать нарушения липидного обмена как одно из ведущих звеньев патогенеза атеросклероза, как у пациентов с ГБ, так и СД 2 типа, хотя их роль в патогенезе атеросклероза имеет свои особенности

References in original

Литература 1. Талаева Т.В., Братусь В.В. Атеросклероз: многофакторность и системность патогенеза // Украшський кардюлопчний журнал. - 2007. - № 5. - С. 101-111. 2. Шостак Н.А. К вопросу об атеросклерозе как о системном мультифокальном процессе // Клиницист. - 2008. - № 4. - С. 3-7. 3. Гуревич В. С. Современные представления о патогенезе атеросклероза [Электронный ресурс] / В. С. Гуревич // Болезни сердца и сосудов. Актуальные и спорные вопросы. - 2006. - Т. 1, № 4. - Режим доступу: http://www.asvomed.ru/php/content.php7id =3193 153 4. Гогин Е.Е. Артериальная гипертония и гипертоническая болезнь (диагноз синдромный и диагноз нозологический) // Терапевт. арх. - 2010. - Т. 82, № 4. - С. 5-10. 5. Федченко Н.П., Федченко Н.Н. Теоретические и морфологические закономерности патогенеза атеросклероза и основных его осложнений. Новые подходы к их профилактике и лечению // Морфология. - 2009. - Т 3, № 1. - С. 14-21. 6. Холодова Е.А. , Короленко Г.Г. Опыт коррекции дислипидемии при сахарном диабете 2 типа // Медицинские новости. - 2005. - № 2. - С. 34-37. 7. Титов В.Н. Атеросклероз как патология полиеновых жирных кислот. Биологические основы теории атеросклероза. - Москва, 2002. - 495 с.

Conflict of interest: None declared.

Received: 15.02.2013. Revised: 15.04.2013. Accepted: 03.06.2013.

154 Journal of Health Sciences (J for the Ss H) 2013; 3 (5): 155-162 The journal has had 4 points in Ministry of Science and Higher Education of Poland parametric evaluation. B letter item 683.

PECULIARITIES OF THE CONTENTS OF SEX HORMONES IN THE BLOOD OF WOMEN OF REPRODUCTIVE AGE WITH THE PRIMARY STRESS- INDUCED INFERTILITY

O. Bulavenko, O. Lyovkina

Vinnitsa National Pirogov Memorial Medical University

Summary. We have studied the contents of sex hormones in 120 women of reproductive age with the primary stress-induced infertility. While investigating we have revealed the reduction of the progesterone and estradiol levels and increase of the DHEA- sulfate and prolactin levels. No peculiarities of the follicle-stimulating and luteinizing hormones have been found. Key words: stress-induced infertility, hormonal balance, sex hormones.

Prof. O.Bulavenko.MD, PhD.; Dr. O. Lyovkina

Introduction. The hormonal balance of a female organism plays one of the most important roles in the formation of a normal gestational process. Successful fertilization is impossible without an adequate hormonal background. The balanced hormonal system provides the normal gestational process. At the same time the hormonal system is one of the most touchy organism systems. By means of numeral investigations it was proofed that psycho-emotional stress acute or chronic may influence the hormonal homeostasis and leads to its disbalance and cascade disorders in numeral organs and systems of an organism. In the context of a primary stress-induced infertility problem which takes place during the acute and chronic stresses the biggest interest is centred around the sex hormones investigations, because disorders of a normal estrogen and progesterone balance and other sex hormones which have direct influence on the process of fertilization is one of the most

155 important and difficult manifestations of the general changes of the homeostasis balance in a female organism which occur under the primary stress-induced infertility. Aim. Our aim was to investigate the peculiarities of the progesterone, estrogen, prolactin and DHEA-sulfate contents in women with the primary stress-induced infertility. Materials and methods. We included 120 women of reproductive age without any organic pathology and no previous pregnancy in anamnesis with a diagnosis of the primary stress-induced infertility which was proofed by filling up special stress questionnaires and investigation of a stress hormone cortisol. Mean age of the investigated women was 29,6±5,2 with a range from 17 up to 42 years old. The levels of progesterone, estradiol, prolactin, DHEA-sulfate, FSH, LH were determined by the method of ELISA test systems, "Hoffman-La Roche" in the lab «Synevo». Stresses were classified according to the coding scale of the psychosocial factors causing stress and contributing to the development of exacerbation of the existing disease according to Axis IV of the Diagnostic and Statistical Manual of the American Psychiatric Association DSM-III-R. Based on these data we developed special questionnaires to identify the acute and chronic stresses in life of the studied women. Statistical data processing was performed using the program «Statistica 6,0» (Stat Soft Inc USA). Results and discussions. We revealed that indexes of progesterone and estradiol in the studied women were essentially lower than normal. The average value of progesterone was 9,78±8,08 ng/ml with a range from 0,34 to 36,03 ng/ml and the balance was displaced to its decreasing (median 7,84 ng/ml). In general the majority of the investigated women had decreased contents of progesterone. The average value of estradiol was 63,5±48,99 pg/ml with a range from 8,3 to 191,4 pg/ml. Reduction of levels of progesterone playing the key role in the normal implantation of the fertilized ovum, of course, is an unfavorable factor for the development of infertility [1-5]. As evidenced by this study of levels of estradiol, prolactin and DHEA-sulfate there is a common hormonal disbalance of sex hormones circulation in women suffering from the primary stress- induced infertility (Table I). Thus, the average value of contents of estradiol was 63,5 ± 48,99 pg/ml with a range from 8,3 to 191,7 pg/ml that is approximately 1,4 times lower than normal. However, as well as progesterone, estradiol is characterized by significant fluctuations in levels with a general tendency to decrease of its content in blood (median 42,4 pg/ml). The observed disbalance in the estradiol circulation in women with the primary stress-induced infertility confirms that these women have

156 significant changes in the hormonal homeostasis influenced by the stressful irritants, which is an unfavorable factor for pregnancy. The results of investigation of the prolactin and DHEA-sulfate contents in women suffering from the infertility confirm the general hormonal disbalance under the influence of the primary stress-induced infertility [8 ]. According to the study results it was determined that the prolactin and DHEA-sulfate levels in women suffering from the primary stress-induced infertility were significantly higher than normal. Thus, the average level of prolactin in the blood made up 25,44 ± 11,39 ng/ml with a range from 8,12 to 49,71 ng/ml which is approximately 1,8 times higher than normal. At the same time prolactin is characterized by the same tendency as progesterone and estradiol: if some women had significant fluctuations in the prolactin levels, its overall level in the studied cohort was significantly shifted upwards (median 23,2 ng/ml). This indicates the presence of a stable tendency to hyperprolactinemia in women suffering from the primary stress-induced infertility, and in view of the above features of the sex steroid circulation to a steady general hormonal disbalance. Hyperprolactinemia in women suffering from the primary stress- induced infertility is definitely an aggravating factor and considering the systematic violations of the hormonal homeostasis may be a factor that supports a pathological condition of infertility, despite the elimination of the harmful stress factors [9,10]. The above patterns were confirmed by the results of investigation of the DHEA- sulfate levels in women suffering from the primary stress-induced infertility. Thus, the average value of DHEA-sulfate level was 324,37 mkg/dl with a range from 99,0 to 515,3 mkg/dl which is about 1,3 times higher than normal. If any significant fluctuations were present in some studied women, DHEA-sulfate as well as prolactin were characterized by a tendency to the general increase of their level in the overall investigated cohort (median 343,15 mkg/dl). The increased androgen level combined with the hyperprolactinemia and reduced secretion of progestin and estrogen is a sign of a systemic hormonal disbalance in the sexual sphere which gives us a reason to consider the primary stress-induced infertility as a pathological condition causing a significant breach of the general homeostasis, deep and lasting changes in the whole body. We have also analyzed the peculiarities of the follicle-stimulating and luteinizing hormones contents in the blood of women suffering from the primary stress-induced infertility. It was found that the indexes of the follicle-stimulating and luteinizing hormones were respectively 7,1 ± 2,8 mIU/l and 9,7 ± 10,5 mIU/l. These hormones, especially LH, are

157 characterized by a complex and highly variable nature of their distribution and a lack of close relationships with the duration of infertility. Thus, the investigation of peculiarities of the sex hormones circulation in women suffering from the primary stress-induced infertility revealed a significant shift in the hormonal balance which complicates fertilization and aggravates the course of infertility. We believe that the detected changes in the hormonal balance of the infertile women should be examined not in isolation but in a complex of system changes causing psycho-emotional stress and infertility provoked by it. The primary effect of the psycho-emotional stress causing development of infertility makes a depressing effect on the sexual sphere provoking some changes in the balance of sex hormones. At the same time, the awareness of the presence of infertility in oneself is a powerful chronic negative psycho- emotional irritant which causes deep changes in the circulation of hormones, acting by a mechanism of a "vicious circle." These negative changes in the hormonal balance can act as an independent factor of infertility of the hormone infertility. This necessitates an integrated approach to the treatment of the primary stress-induced infertility which should include both the correction of the psycho-emotional condition of a woman and renewal of the normal balance of sex hormones. Removal of the psycho-emotional stress causing the development of infertility is traditionally regarded as the basis of treatment of the stress-induced infertility, but unfortunately it is insufficient in some cases, because deep and lasting changes in the hormonal balance developing under the long-term infertility can support this pathological condition interfering with the normal fertilization and implantation of the ovum. The relevance of this assumption has been confirmed by us in the investigation of the peculiarities of the contents of sex hormones in women with various duration of infertility. Significant differences were found when analyzing the characteristics of the contents of sex hormones in the blood of women with various duration of infertility. Thus, the progesterone and estradiol indexes in women with a long-term infertility (over 3 years) are lower than in women with infertility of up to 3 years (Tables II, III). The average value of progesterone in women with infertility lasting up to 3 years inclusive amounted to 11,63 ± 8,44 ng/ml with a range from 0,34 ng/ml to 36,03 ng/ml, median 9,13 ng/ml whereas in women with a long-term infertility (over 3 years) the average value of a progesterone level was almost twice lower: 5,77 ± 5,44 ng/ml with a range from 0,49 ng/ml to 22,74 ng/ml, median 4,28 ng/ml. As the table shows, women with infertility lasting more than 3 years are characterized by a significant overall decrease in the progesterone level compared to women with a short-term infertility. The revealed differences are statistically significant (p <0,001) (Table IV).

158 The similar changes were found for estradiol. The average level of estradiol in women with the infertility duration of up to 3 years inclusive was 70,9 ± 52,61 pg/ml with a range from 9,19 pg/ml to 190,70 pg/ml, median 44,33 pg/ml whereas in women with the infertility duration lasting more than 3 years the average level of estradiol was 47,34 ± 35,58 pg/ml, with a range from 8,30 pg/ml to 191,70 pg/ml, median 40,00 pg/ml. The revealed differences are statistically significant (p <0,05). Thus, with increase of the infertility duration the levels of estrogen and progestin are reducing. This evidences the more profound negative changes in the hormonal balance of women suffering from the long-term infertility. The tendency to worsening of the hormonal disbalance is also detected while investigating the peculiarities of prolactin and DHEA-sulfate levels in women with various duration of infertility. Thus, the average level of prolactin in women with infertility duration of up to 3 years inclusive was 23,73 ± 10,45 ng/ml with a range from 8,12 ng/ml to 48,45 ng/ml, median 21,12 ng/ml whereas in women with a long-term infertility (over 3 years) the average value of progesterone level was significantly (p <0.05) higher: 29,15 ± 12,54 ng/ml with a range from 8,89 ng/ml to 49,71 ng/ml, median 32,40 ng/ml. Similarly, the higher levels of DHEA-sulfate were found in women with a long-term infertility compared with women with infertility duration of up to 3 years inclusive: the average values were respectively 373,45 ± 120,87 mkg/dl versus 301,63 ± 113,25 mkg/dl, median 430,90 mg/dl versus 311,55 mg/dl. The revealed patterns are statistically significant

(p <0 .0 0 1 ). Conclusions. Thus, with the increase of the infertility duration the negative changes in the hormonal disbalance grow, appearing in the simultaneous reduction of the progestin and estrogen levels and increase of the prolactin and androgen levels. This evidences the profound systemic changes in the sexual sphere of women suffering from the primary stress-induced infertility. Obviously, the category of women with the longer infertility duration will require more intensive and prolonged therapeutic measures directed at elimination of the negative impact of a psycho-emotional stress and stabilization of the sex hormones balance.

References 1. Guerra D, Liobra A, Veiga A, Barri PN: Psychiatric morbidity incouples attending a fertility service. Hum Reprod 1998,13:1733-1736.

159 2. Domar AD, Clapp D, Slawsby EA, Busek J, Kessel B, Frezinger M:Impact of group psychological interventions on pregnancyrates in infertile women. Fertil Steril 2000, 73:805 811. 3. Edelmann RG, Connolly KJ: Psychological consequences of infertility. Brit J Med Psychol 1985, 59:202-19. 4. Demyttenaere K, Nijs P, Steeno O, Koninckx PR, Everse-Kiebooms G: Anxiety and conception rates in donor in semination. J Psychosom Obstet Gynaecol 1988, 8:175-181. 5. Sarrel P, Decherney A: Psychotherapeutic intervention for treatment of couples with secondary infertility. Fertil Steril 1985, 43:897-900.

6 . Rodriguez B, Bermudez L, Poncede Leon E, Castro L: The relationship between infertility and anxiety: some preliminary findings. In presented at the third world congress of behavior therapy Washington DC. December 8 D11, 1983 7. Jones M, Thiering P, Saunders D, Tennet C, Beaurepaire : Mood state as a predictor of treatment outcome after in vitro fertilization/embryo transfer technology. J Psychosom Res 1993, 37:481-491.

8 . Domar AD, Zuttermeister PC, Friedman R: Distress and conception in infertile women. J Am Med Womens Assoc 1999, 54:196-198. 9. Mahlstedt PP: The psychological component of infertility. Fertil Steril 1985, 43:335-346. 10. Seibel MM, Taymor ML: Emotional aspects of infertility. Fertil Steril 1982, 37:137 145.

160 Table I The quantitative indexes of the contents of sex hormones in the blood of women suffering from the primary stress-induced infertility

Average Quartile Percentile Average Minimum Maximum Variation Standard Hormone name variation Median Mode value value value Lower Upper 1 0 % 90% coefficient error coefficient Progesterone, 9,78 8,08 0,34 36,03 7,84 М* 13,49 22,32 82,60 0,74 ng/ml 4,11 1 , 1 2 Estradiol, pg/ml 63,50 48,99 8,30 191,70 42,40 М* 32,80 76,36 16,14 143,07 77,15 4,47 Prolactin, ng/ml 25,44 11,39 8 , 1 2 49,71 23,20 М* 15,92 35,62 11,73 40,95 44,75 1,04 DHEA-sulfate, 324,37 119,99 99,00 515,30 343,15 329,70 225,75 427,30 140,50 468,65 36,99 10,95 mkg/dl FSH, mIU/l 7,1 2 ,8 1 ,8 17,7 6 ,8 5,6 5,6 8 ,2 4,4 9,9 38,61 0,25 LH, mIU/l 9,7 10,5 1,3 95,5 7,8 8,9 4,7 1 0 ,6 3,6 16,5 107,55 0,96 + Multiple mode Table II The quantitative indexes of the contents of sex hormones in the blood of women suffering from the primary stress-induced infertility, with ______the infertility duration of up to 3 years inclusive______Average Quartile Percentile Average Minimum Maximum Variation Standard Hormone name variation Median Mode value value value Lower Upper 1 0 % 90% coefficient error coefficient Progesterone, 11,63 8,44 0,34 36,03 9,13 5,44 17,22 1,83 24,06 72,57 0,93 ng/ml 4,11 Estradiol, pg/ml 70,99 52,61 9,19 190,70 44,33 М* 33,70 114,47 24,58 166,33 74,11 5,81 Prolactin, ng/ml 23,73 10,45 8 , 1 2 48,45 2 1 , 1 2 М* 15,25 33,80 11,78 38,10 44,04 1,15 DHEA-sulfate, 301,63 113,25 99,00 515,30 311,55 329,70 213,30 401,10 134,20 429,70 37,55 12,51 mkg/dl

FSH, mIU/l 7,2 3,0 1 ,8 17,7 6,7 5,6 5,6 8,3 4,4 9,8 41,15 0,33 LH, mIU/l 1 0 , 2 1 2 , 1 1,3 95,5 7,7 8,9 4,9 9,8 3,8 16,7 118,56 1,33

161 Table Ill The quantitative indexes of the contents of sex hormones in the blood of women suffering from the primary stress-induced infertility, with the infertility duration of over 3 years______Average Quartile Percentile Average Variation Hormone name variation Minimum value Maximum value Median Mode Standard error value Lower Upper 10% 90% coefficient coefficient Progesterone, ng/ml 5,77 5,44 0,49 22,74 4,28 М* 1,58 7,55 0,57 10,89 94,28 0,88

Estradiol, pg/ml 47,34 35,58 8,30 191,70 40,00 М* 25,36 61,17 13,95 84,74 75,17 5,77

Prolactin, ng/ml 29,15 12,54 8,89 49,71 32,40 М* 16,86 40,20 11,65 43,44 43,03 2,03 DHEA-sulfate, mkg/dl 373,45 120,87 101,80 499,90 430,90 М* 264,60 465,80 168,20 480,90 32,36 19,61 FSH, mIU/l 7,0 2,3 3,2 14,3 7,1 М* 5,2 8,0 4,6 9,9 32,47 0,37 LH, mIU/l 8,7 5,6 2,4 28,6 8,1 3,3 4,3 11,0 3,3 16,2 63,84 0,90

Table IV Results of a non-parametric statistical analysis of differences in indexes______Rank sum Р Z-criterion is Index Infertility duration Infertility duration over U-criterion Z-criterion is p specified up to 3 years inclusive 3 years specified Progesterone 5696,5 1563,5 822,5 4,149 0,001 4,149 0,001 Estradiol 5336,0 1924,0 1183,0 2,116 0,034 2,116 0,034 Prolactin 4580,5 2679,5 1177,5 -2,147 0,032 -2,147 0,032 DHEA-sulfate 4331,0 2929,0 928,0 -3,554 0,001 -3,554 0,001 FSH 4986,5 2273,5 1532,5 0,144 0,886 0,144 0,886 LH 5006,5 2253,5 1512,5 0,257 0,797 0,257 0,797

Conflict of interest: None declared.

Received: 15.01.2013. Revised: 15.04.2013. Accepted: 05.06.2013.

162 Journal of Health Sciences (J for the Ss H) 2013; 3 (5): 163-178 The journal has had 4 points in Ministry of Science and Higher Education of Poland parametric evaluation. B letter item 683.

EFFECT OF AEROBIC TRAINING ON THE HEALTH OF WOMEN FREQUENTING TO FITNESS CLUBS

Wpływ treningu aerobowego na zdrowie kobiet uczęszczających do klubów fitness

Mirosława Cieślicka 1 , Patrycja Brzózka 1 , Wiesława Pilewska 1 , Natalia Ciesielska 2 , Anna Nalazek3 , Walery 3 Zukow

1Institute of Physical Culture University of Kazimierz Wielki, Bydgoszcz, Poland 2Cathedral and Clinic Neurosurgery and Neurotraumatology, Collegium Medicum University of Mikołaj Kopernik, Bydgoszcz, Toruń, Poland University of Economy, Bydgoszcz, Poland

Number of characters: 32 000 (with abstracts). Number of images: 12 x 1000 characters (lump sum)= 12 000 characters. Total: Number of characters: 45 000 (with abstracts, summaries and graphics) = 1,125 spreadsheets publishing.

Key words: aerobic training; health; women; fitness; club.

Słowa kluczowe: trening aerobowy; zdrowie; kobiety; klub; fitness.

Abstract

The physical activity has, because a positive effect on the cardiovascular system, respiratory system, system of the move, nervous system and secretions internal and metabolism. Purpose reduced because of diseases associated with the progress of civilization of the work also improves the medical condition. Fitness is a form of the motor recreation more and more liked and popular in our country. Both women and more and more men value this form of sport for themselves. It is possible however to ask questions, "why?". Getting information about virtues causing the fitness was an object of conducted tests that the number of his fans still raised. An attempt to enrich the knowledge about factors causing an more and more great interest in exercises was an aim of conducted tests fitness at women. Findings can be useful for promoting the activity of this type. Material and methods. Tests were conducted on the area of two clubs fitness in Bydgoszcz. One hundred women taking classes set about to filling in questionnaire fitness. Women set about to the test about the diversified age. Questionnaires of the questionnaire form were filled in independently, without the participation of the pollster. In the conducted test, a technique of the questionnaire form was applied. The questionnaire contained thirteen questions one as well as of repeated reply. Tests were conducted on the group of one hundred women. Subject of the work still unwinding it oneself and more and more popular form of spending the leisure time fitness is which. At this work taken, so an attempt to justify a still growing interest in the fitness amongst women stayed. In order to explain, what causes that it is so much liked form of the move; notions were clarified for the motor recreation and the physical activity. Also their virtues were described for the modern society. Conducted tests, on the road which were dragged out the following results: the fitness is a form simple, pleasant and available to every one of the recreation, the fitness has a lot of features motivating to the motor activity, from the aerobic training numerous psychological and physical benefits swim, a fitness is a readily available form of the recreation, adapted for persons in every century, planting this form of the recreation brings a lot of benefit. Conclusions. Aerobic trainings they develop and strengthen the blood circulation system oxygenate the organism and correct the metabolism. Regularly aerobic training persons it are pleased with much slimmer figures, better sleep, better feel and have a greater concentration, and most importantly - have more vital forces.

163 Streszczenie: Aktywność fizyczna ma, bowiem pozytywny wpływ na układ krążenia, układ oddechowy, aparat ruchu, układ nerwowy i wydzielania wewnętrznego oraz metabolizm. Poprawia również stan zdrowia obniżony z powodu chorób cywilizacyjnych. Cel pracy. Fitness to forma rekreacji ruchowej coraz bardziej łubiana i popularna w naszym kraju. Zarówno kobiety, jak i coraz więcej mężczyzn ceni sobie tę formę sportu. Można jednak zadać pytanie, „dlaczego?”. Przedmiotem przeprowadzonych badań było uzyskanie informacji o zaletach fitness sprawiających, że liczba jego fanów nadal wzrasta. Celem przeprowadzonych badań była próba wzbogacenia wiedzy o czynnikach powodujących coraz większe zainteresowanie ćwiczeniami fitness u kobiet. Wyniki badań mogą być przydatne do promowania tego typu aktywności. Materiał i metody. Badania przeprowadzone zostały na terenie dwóch klubów fitness w Bydgoszczy. Do wypełnienia kwestionariusza przystąpiło sto kobiet uczestniczących w zajęciach fitness. Do badania przystąpiły kobiety o zróżnicowanym wieku. Kwestionariusze ankiety wypełniane były samodzielnie, bez uczestnictwa ankietera. W przeprowadzonym badaniu, zastosowana została technika ankiety. Kwestionariusz zawierał trzynaście pytań jednej jak i wielokrotnej odpowiedzi. Badania przeprowadzone zostały na grupie stu kobiet. Temat pracy to wciąż rozwijająca się i coraz bardziej popularna forma spędzania czasu wolnego, jaką jest fitness. W niniejszej pracy podjęta, więc została próba uzasadnienia wciąż rosnącego zainteresowania fitnessem wśród kobiet. By wytłumaczyć, co sprawia, że jest to tak bardzo lubiana forma ruchu, wyjaśniono pojęcia rekreacji ruchowej oraz aktywności fizycznej. Opisano także ich zalety dla współczesnego społeczeństwa. Przeprowadzone badania, na drodze, których wyciągnięto następujące wyniki: fitness jest łatwą, przyjemną i dostępną dla każdego formą rekreacji, fitness posiada wiele cech motywujących do aktywności ruchowej, z treningu aerobowego płyną liczne korzyści psychiczne i fizyczne, fitness to łatwo dostępna forma rekreacji, przystosowana dla osób w każdym wieku, uprawianie tej formy rekreacji niesie za sobą wiele korzyści. Wnioski. Treningi aerobowe rozwijają i wzmacniają układ krwionośny, dotleniają organizm i poprawiają metabolizm. Osoby regularnie trenujące aerobowo cieszą się znacznie szczuplejszymi figurami, lepiej śpią, lepiej się czują i mają większą koncentrację, a co najważniejsze - mają więcej sił witalnych.

Introduction

"A move is a health" - this slogan universally is known for years. However whether we know what he/she marks and we receive money order included in it? At one time the move was an inherent element of the life. Today however, in the era of developing technologies, vehicles and computers, the level of physical activity of people in every century drops. What the level of our, physical and social mental health lowers in relation to. Because the physical activity has a positive effect on the cardiovascular system, respiratory system, system of the move, nervous system and secretions internal and metabolism. It also improves the medical condition lowered because of diseases associated with the progress of civilization, so as: heart diseases and cerebral stroke, arterial hypertension, diabetes of the II type, obesity, pains of the spine and articular complaints, osteoporosis, varicose veins of lower limbs, breast cancer, colds and depression (Cieślicka et al. 2009, Dmitruk et al. 2007, Paczuski et al. 2011). Trainings aerobic developed and strengthen the blood circulation system, ventilate the organism and correct the metabolism. Regularly training persons aerobic they are pleased with much slimmer figures, better sleep and better feel and have a greater concentration, and most importantly - have more vital forces. According to tests, below the 10% of Poles is

164 regularly active physically. In order to change it, one should support the spreading recently fashion on "healthy lifestyle", and in it and to diverse forms of the motor recreation.

The motor recreation is a physical activity, with which he can, and what's more should, to plant everyone. Particularly persons which in the daily living only a time for the work or the school and the rest find. The form of the recreation is chosen according to own likings and the age. Because it is activity which is aimed at not only providing for us the health but also pleasures (Fuerstenau et al. 2012, Żukowska et al. 2011). More and more oftentimes a fitness is a planted form of the motor recreation to which in particular women took a liking. What does an more and more great interest in the fitness cause? At this work an attempt of the answer to that question was made. As well as the attempt to prove that above the depicted form is accessible to the recreation for everyone but her regular planting bring numerous benefits. Fitness is an enough developed sport. At this work it was described, so many issues associated with her. Brief history and the significance of the motor recreation and the definition of the physical activity and her impact on health of the man were described. History and numerous types of the fitness, as well as the significance of the instructor were also described. In order to bring numerous hypotheses however they conducted research with method of the diagnostic survey with the tool a questionnaire form was which. The test was conducted on one hundred women attending classes fitness in Bydgoszcz sports clubs.

Purpose of the work

Fitness is a form of the motor recreation more and more liked and popular in our country. Both women, and more and more men value this form of sport for themselves. It is possible however to ask questions, "why?". Getting information about virtues causing the fitness was an object of conducted tests, that the number of his fans still rose. An attempt to enrich the knowledge about factors causing an more and more great interest in exercises was an aim of conducted tests fitness at women. Findings can be useful for promoting the activity of this type.

Material and methods

Tests were conducted on the area of two clubs fitness in Bydgoszcz. One hundred women taking classes set about to filling in questionnaire fitness. Women set about to the test about the diversified age. Questionnaires of the questionnaire form were fulfilled independently, without the participation of the pollster. In the conducted test, a technique of the questionnaire

165 □ miejscowość do 15 tys. mieszkańców

□ miejscowość powyżej 15 tys. mieszkańców a mniej niż 50 tys. □ miejscowość powyżej 50 tys. mieszkańców a mniej niż 10 0 tys.

□ miejscowość powyżej 10 0 tys. mieszkańców

form was applied. The questionnaire contained thirteen questions one as well as of many time reply. Tests were conducted on the group of one hundred women. Straight majority, because as far as 74%, constitute persons living in the town above 100 thousand residents. Little, because 10% examined inhabits towns above 15 thousand residents. Least however he is of persons from the town above 50 thousand and to 15 thousand residents. Ob River of the group constitute, because for the 8 % from all participants in the test. Tests were conducted on the area of Bydgoszcz clubs fitness. From above data it is possible, so dared to come to the conclusion, that the 74% of respondents lived in Bydgoszcz. Remaining the 26% inhabits nearby small towns. The age of persons which undertook the involvement in tests firmly was diversified. Woman-participants in clubs were examined fitness in the century from 18 to 50 and more years. Majority of respondents (37%) in an age bracket 26-35 years were placed. One by one 26% examined is at the age of 18-25 a 20% of participants is persons in century 50 and more of years. However fewest examined women are at the age of 36-45. Age brackets klubs participating in the poll unfold, so it is enough evenly.

Fig. 1. Domicile

On the basis of data introduced on the Fig. to No. 2. clearly one can see, that in classes fitness women of different ages participate. Starting from eighteen-year-old girls, all the way to persons after the fiftieth year of age. It is possible, so dared to state that everyone can find the class at the club fitness corresponding to not only his likings, but also the age

166 group. So the fitness is one among many of forms of the motor recreation which are allocated for persons in every century.

Fig. 2. Age examined

Results

Fig. 3. presents data how long examined women frequent clubs fitness. Straight majority, because as far as 57% of respondents, a year belongs to the club or more. Next largest group (26%), these are women which practise the fitness for 1-6 months. Smaller groups (the 11% and the 6 %) persons being involved in exercises constitute fewer than a month and for 6 - 1 2 months.

Yes large number of women frequenting the club fitness through over the year proves about the attachment to classes. It is possible, so to notice that the Fitness not only attracts a

□ 1-2 razy w tygodniu

□ 3-4 razy w tygodniu

□ 5 i więcej lot of persons, but also keeps his supporters for a long time.

Before participants in the test a question was also put: "how often you take classes fitness?". Replies on were not-introduced on the placed above Fig. 1. it can see on it, that the predominating group of experts favors the participation in classes of 3-4 times during the week. Two remaining groups constitute the similar per cent of all respondents. Persons which attend club 5 and more times during the week are a 24% examined. Being involved in classes of 1-2 times during the week it is a 19% examined.

Majority, because as far as the 81% of experts practises the fitness quite often, at least 3 times during the week. It attests to the credibility of conducted tests. Because opinions on

Fig. 3. How often you take classes fitness classes were given by persons having a frequent contact with the fitness.

Fig. 4. What encouraged you for classes fitness?

Fewest persons answered about television and the press. An Internet and announcements of the placed club took the next places. Large portion examined, because as far as 36% of persons, answered that for classes acquaintances had encouraged them. Most oftentimes whereas a variant was a reply being uttered: none from above.

168 % 50 45 40 35 30 25

2 0 15

10 5

0 1------1------r telewizja Internet prasa znajomi ogłoszenia żadne z danego klubu powyższych

It appears from this data that the fitness is a so well-known and liked form of the recreation, that doesn't need numerous advertisements. People taking classes very often encourage acquaintances setting about to the club. What the crowd of enthusiasts of this sport grows at a fast pace by. Most oftentimes however respondents claimed that none of above variants had been impulse to begin classes fitness. It proves about the ruling and still spreading fashion for a healthy lifestyle, including the fitness. The trend to the motor activity causes that people don't need many stimuli in the form of advertisements and the promotion in order to begin the adventure with the fitness. The majority of persons knows, because what classes consist in fitness and how their availability is simple.

Before pollsters an also put question about the role of the physical activity in their life stayed. Replies of respondents weren't market diversified. It has most rarely chosen the given reply, because 41% of respondents, and most oftentimes granted chose the 59%. So it is enough rather small difference. Fewest respondents answered that the physical activity was a form of spending the leisure time for them. They were next more oftentimes granted replies: the physical activity as the activity helping to lose the extra poundage and as the helping activity to carve the figure. However the most persons think that the physical activity equals with the idea for a healthy lifestyle.

169 % 70 -| 60 — 50 — 40 — 30 —

2 0 —

10 —

0 — formą spedzania pomysłem na zdrowy aktywnością aktywnością czasu wolnego tryb życia pomagającą zgubić pomagajacą zbędne kilogramy wyrzeźbić sylwetkę Fig. 5. What for you the physical activity is and what role does perform?

Respondents almost equally oftentimes chose all of possible responses. It is possible, so to state that the fitness performs functions very a lot. For taking this motor initiative persons make up their mind with the obesity or the excess weight, only a few extra poundage wanting to slim down or also to knock off. Persons thinking about improving their profile, building the appropriate amount of the muscle mass, toning up are a next group taking this type of the move bodies. Fans of the fitness oftentimes also attend classes treating them as the form of spending the leisure time, this sport can because serve the recreation and the relaxation. As many as 62 persons stated that the fitness was a way for them for a healthy lifestyle. It is evidence for the fact that this form of the recreation is appreciated most oftentimes for comprehensive action. He promotes, health because widely comprehended still fashionable recently healthy lifestyle.

In the questionnaire a question about classes was a next question, in which examined participate most oftentimes. Respondents have most rarely chosen health classes (so, as the healthy spine), reducing the cellulite, stretching (stretching) and bodies reinforcing individual parties. Most oftentimes they were given replies the ones about classes burning the fatty tissue and strengthening muscles of the whole body.

170 % /0

OU "

4U "

_ 2U " H _

iu - U 1 1 11 1 1111 1 spalających redukujacych wzmacniających wzmacniających rozciągających zdrowotnych tkankę cellulit mięśnie całego poszczególne tłuszczową ciała partie ciała

Fig. 6 . Which classes are you involved most willingly in?

It chose every of replies at least a 20% of participants in the questionnaire form. Every of the most well-known forms fitness, has, so of one's supporters. The fitness still creates, because new types of classes. So so that add variety to the motor activity as well as adapt her to persons in every century and about different preferences. Most oftentimes chosen replies concerning the most general forms fitness. They are these are classes burning the fatty tissue and strengthening muscles of the whole body. It is possible, so then again to state that enthusiasts put the fitness most oftentimes for classes about comprehensive action, benefits bringing the most.

% 90 80 70 60 50 40 30 20 10 0 ponieważ nie posiadam ponieważ potrzebuje ponieważ nie wiem jak ponieważ moge specjalistycznego motywacji ćwiczyć samemu poznać nowych sprzętu znajomych

Fig. 9. Why you prefer exercises in the club fitness than at home? (source: own tests) Fig. 7. Why you prefer exercises in the club fitness than at home?

171 The Fig. shows number 7 reasons, for which exercises are ahead of a fitness in the club independent exercises at home. Least, because 16% examined, he thinks that the fitness is more interesting for them, since lets for getting to know new acquaintances. Twenty one per cent of respondents favors the class at the club, since doesn't have a specialist equipment at home. However twenty seven percentages of persons claim that the fitness is better, because don't know how to practice oneself. The most, because as far as 78% of respondents, however answered: since I need motivation.

The class at the club has a fitness, so many features which give them the advantage over independent exercises at home. They let in the simple way widen the circle of acquaintances about similar interests. They ensure the equipment specialist, suitable for the given type of the recreation and the supervision of the qualified instructor. However the fitness is the best thing of the available class at clubs motivation for exercises.

% 80 70 60 50 40 30

2 0

0 polecenia i mila atmosfera na rywalizacja muzyka własne odbicie w doping zajęciach między lustrze instruktora fitness uczestnikami zajęć

Fig. 8 . What motivates you for the involvement in classes?

On the next graph they were introduced to the reply examined to the question: "what motivates you to taking classes?". Fewest persons participating in the test think that on classes the fitness is motivation for them rivalry between participants. Little a variant also obtained replies about the own reflection in a mirror. Quite much, because indicated the 30% of persons the music, as the fitness supporting the element. However replies obtained the most voices: orders and the doping of the instructor the fitness and the convivial atmosphere on classes.

172 It appears from data that least rivalry between participants motivates. It attests to the fact that the fitness is sport nonbased on rivalry. Each of participants practices, because for the own health, the silhouette and the physical fitness. A music is more motivating, but she doesn't also play an important role in motivating to act. As far as showed the 61% of persons, as the answer to a question orders and the doping of the instructor. The role of the instructor is, so very important in classes fitness. He is, because not only needed for instructing participants on the technique of performed exercises or the course of given classes. The instructor is also a person inducing participants to action, encouraging to the further involvement in exercises and not giving up. Most oftentimes whereas a convivial atmosphere is an appreciated element of classes on classes. He belongs, so to draw conclusions that a fitness is a sport, in which the man is most important.

% 70

zgubienie osiągnięcie ogólną poprawę stanu poprawę poprawę zbędnych idealnej poprawę zdrowia samopoczucia pewności kilogramów sylwetki sprawności siebie fizycznej

Fig. 9. What benefits do you want to achieve by planting the motor activity?

The above graph presents replies of respondents to the question: what benefits do you want to achieve by planting the motor activity?. Fewest respondents chose the reply for self confidences. It chose every of other responses more than a 30% examined. The most persons want however through classes to improve the fitness the frame of mind and the general physical fitness.

173 According to stereotypes with fans fitness there are people most oftentimes overweight wanting to bring to ruin the extra poundage or persons excessively caring about their appearance which want to achieve the perfect profile. However it isn't a truth. How it appears from above data enthusiasts don't tie the fitness, because remarks mainly to the appearance, and to the physical fitness and a sense of well-being.

Fig. 10. Whether thanks to classes you can see the fitness improvement in its silhouette?

With put next question before examined there was a question: "whether thanks to classes you can see the fitness improvement in its silhouette?". Two per cent examined answered negatively. One should however emphasize that they are these are persons, which how, results from the earlier asked question, attend classes fewer than a month. The rest of respondents answered a question affirmatively. Twenty nine procent respondents notice the musculature of their silhouette, forty five percentages of persons lost the extra poundage but the as many as eighty three per cent participating in the test bodies can see toning up and streamlining.

Above data provides the fitness about the undeniable effect of classes. Through regular exercises it is possible, because to increase the muscle mass, to burn the fatty tissue, to improve the condition of the skin and the flexibility of the body and the condition.

Respondents were also asked about a positive effect of classes fitness to the improvement in the medical condition. In this question of the 2% of persons which briefly attend classes, it also answered that he could see no improvement. However the all that mob answered affirmatively. It chose all positive replies at least for the 22% of persons. In it, least it noticed persons the improvement in the metabolism and losing the extra poundage. Very

174 much much examined however it stated that the fitness had improved their immunity as well as needled and streamlined the spine. The most, because as far as 64% examined noticed the improvement in the function of the organism.

% 70 60 50 40 30

2 0

10 ■ ■ 0 tak, tak, tak, poprawę tak, poprawę tak, zgubienie nie wzmocnienie wzmocnienie i wydolności przemiany zbędnych odporności usprawnienie organizmu materii kilogramów kręgosłupa

samopoczucia siebie Fig. 11

This data confirms a proven repeatedly positive effect of the motor activity on the health of the man. The fitness, as the form of sport based on the intense motor activity, much influences the medical condition. According to the reply of respondents, this activity corrects the metabolism and helps to lose the extra poundage. What equally worth for the health, the fitness needles and streamlines the spine clearly reducing abnormal spinal curvatures. He also strengthens the immunity and the function of the organism.

A question about the income of classes was a closing question put in the questionnaire form fitness to emotional states. Only three percentages of persons participating in the test didn't notice a positive effect of the motor recreation on emotional states. Twenty one per cent examined notices the improvement in the self-confidence, almost everyone however, because as many as ninety one per cent of respondents claims that the fitness improved their frame of mind.

175 Fig. 12. Can you see the influence of classes on the improvement in emotional states?

It results from tests that the motor activity enjoys considerable influence very much to emotional states of participants in classes fitness. Through the improvement in the external appearance and the possibility of overcoming his weaknesses he corrects the self-confidence. The most however he affects the improvement in the frame of mind. The health and the possibility of simple unloading the stress correct the soundness, because tune participants. The practicing sport increases also a secretion of endorphins called the hormone of happiness.

Conclusions

A fitness is one of recreations more liked in the today of kinds motor. The circle of amateurs as well as persons professionally dealing with this sport still grows (Napierała et al.

2009, Cieślicka et al. 2011, Cieślicka et al. 2012). An answer to a question was a main research problem: "what causes the more and more great popularity of classes the fitness as activities physical of women?" in order to solve that problem, numerous detailed research issues were stated. From them a question about the role a motor activity performs which for women was first. It results from tests that the recreation equally oftentimes is a form of spending the leisure time for fans of the fitness, with the activity helping to lose the extra poundage or to carve the figure, as well as the idea for a healthy lifestyle. He was just last of variants most willingly with given reply what provides about overbalancing the health role of the motor recreation. They also asked questions: "what does the fitness encourage beginning the activity?". Based on questionnaire forms telling conclusions were drawn about it that the fitness didn't need too many advertisements in order to get the faithful circle of enthusiasts. He is, with sport because enough known and liked which promotes itself alone. One should emphasize theses, that a lot of people a fitness sets about to clubs because of the persuasion of acquaintances. They tried also to explain, what women want to reach through the involvement in group exercises. Based on conducted tests they noticed that persons practising the fitness had a lot of expectations towards it. They want to correct the self-confidence, to achieve the perfect profile, to improve the medical condition and to lose the extra poundage. For fans of that kind of sport however an improvement in the physical fitness and frame of minds are a main purpose of the recreation. However not an improvement in the appearance, but the

176 medical condition is the most frequent aim. They also justified, why exercises in the club are better from independent exercises at home. Most oftentimes exactly a fitness is chosen in the group, since he delivers to motivation for action. And here a question next, stated in problems forces itself: "whether and in what way does the fitness motivate to the motor activity?". For exercises the music adapted for the type of classes is an one among many of motivators. The most however they motivate people. They are impulse to act, of because most oftentimes recommending and the doping of the instructor the fitness and the convivial atmosphere ruling on classes. Both an instructor and very participants are responsible for the atmosphere. It results from conducted tests that from practising the motor recreation many benefits swim. Participants in classes notice the improvement in the silhouette in the form of the bigger musculature, of losing the extra poundage. However toning up and streamlining the body are a main effect. The fitness also has a positive effect on a medical condition of participants. He helps to get rid of the unnecessary fatty tissue, corrects the metabolism, needles and streamlines the spine as well as improves the immunity. Majority examined felt the also significant improvement in the respiratory function of the organism. The physical activity also works on the psychological medical condition. Through the improvement in the appearance he helps to increase the self-confidence. Mainly however he/she works on the frame of mind - people oftentimes practicing sport are, because happier. Above explanations help to answer the main research problem. The fitness causes the more and more great popularity of classes, because many motivators for exercises which are included in the structure of the fitness and numerous swimming benefits from his regular planting. The physical activity helps, because to improve the silhouette and the medical condition, both physical and psychological. Based on conducted tests it is possible to state, that: the fitness is a form simple, pleasant and available to everyone of the recreation, the fitness has a lot of features motivating to the motor activity, from the training aerobicgo numerous psychological and physical benefits swim, a fitness is a readily available form of the recreation, adapted for persons in every century, planting this form of the recreation brings a lot of benefit.

In classes fitness people participate in every century. Group of older persons - after the fiftieth year of age constituted women as far as 20% examined. It proves with the fact that people in every century can take classes fitness. Because the fitness has a lot of forms, created in order to accommodate oneself to the preference of everyone from willing of taking the physical initiative. They also proved that the fitness firmly motivated to the movement. Most oftentimes it is motivation which people create. Because a good instructor is impulse to act

177 the fitness and the friendly atmosphere ruling during classes. Trainings aerobic they develop and strengthen the blood circulation system, ventilate the organism and correct the metabolism. Regularly training persons aerobic they are pleased with much slimmer figures, better sleep, better feel and have a greater concentration, and most importantly - have more vital forces.

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Conflict of interest: None declared.

Received: 15.03.2013. Revised: 15.04.2013. Accepted: 06.06.2013.

178 Journal of Health Sciences (J for the Ss H) 2013; 3 (5): 179-190 The journal has had 4 points in Ministry of Science and Higher Education of Poland parametric evaluation. B letter item 683.

Ways of coping with stress among nurses Intensive Care and Anesthesiology Sposoby radzenia sobie ze stresem wśród pielęgniarek Intensywnej Terapii i Anestezjologii Natalia Ciesielska 1, Agata 2Jelonek , Norbert Łysiak 3 , Anna Nalazek 2 ,

Mirosława Cieślicka4, Walery Zukow 2

1Cathedral and Clinic Neurosurgery and Neurotraumatology, Collegium Medicum University of Mikołaj Kopernik, Bydgoszcz, Toruń, Poland Radom University, Radom, Poland 3University of Economy, Bydgoszcz, Poland 4Kazimierz Wielki University, Bydgoszcz, Poland

Keywords: stress, nurses, intensive therapy and anesthesiology. Słowa kluczowe: stres, pielęgniarki, intensywna terapia i anestezjologia.

A bstract Introduction. Increased mental and physical burden of nurses working in intensive care and Anaesthesiology may affect the development of stress. One of the most serious psychological consequences of stress burnout syndrome, which according to research most commonly occurs among the nurses. Preventive action concerning birth skills to deal with situations stress are necessary to maintain mental and physical health, which has an impact on the quality of medical care provided by nurses. Aim. The aim of the work was an attempt to analyze knowledge of coping skills in situations of difficult by the nurses of the intensive therapy and anesthesiology. Material and methods. The studies covered 100 nurses from Intensive therapy and Anesthesiology in Radom. Research tool was a questionnaire survey by your own made up of 11 closed-questions. Research tool was a questionnaire survey by your own made up of 11 closed-questions. A survey is three parts. The first involved the personal data, the second was associated with the knowledge of nursing personnel with a range of knowledge about stress

179 and relaxation, the third dealt with the ability to apply knowledge and relaxation methods. Research technique was the analysis of the survey. A study carried out in 2010. Results. The concept of stress of 50% of the tested understands as the situation they cannot cope. The most common cause of stressful situations in the work of nursing personnel in the event of 29% of those polled appeared to bear responsibility for the life of another human being, with 24% of the stressful was the fact the low salary, while 16% in favour of haste accompanying during the performance of his duties. 40% of those polled believed that relaxation is a State of relaxation, while 33% as a State of emotional discharge relaxation. 64% of the examined concept understood as the process of relaxation, staff enhances the State of relaxation. The use of positive thinking has proved to be the most famous relaxation methods for 2 0 %, and 16% of the familiar were through laughter therapy. In difficult situations, 36% of those polled used the meeting and conversation with a close person 28% walk and contact with nature, 16% while it relaxes by listening to music. In the subjective evaluation on knowledge of relaxation techniques on 51% was the average, (a) in the case of 32%. 48% of those polled its relaxation techniques applied skill on average determined in situations stressful, but for the ability to a good level in favour of 34%. Conclusions. The staff has a theoretical knowledge of stress, relaxation and relaxation methods, while the average ability to use relaxation techniques in stressful situations shows the difficulties in the practical approach to the problem.

Streszczenie

Wstęp. Wzmożone obciążenie psychiczne i fizyczne pielęgniarek pracujących na Oddziale Intensywnej Terapii i Anestezjologii może wpłynąć na rozwój stresu zawodowego. Jednym z najpoważniejszych psychologicznych następstw stresu jest zespół wypalenia zawodowego, który według badań najczęściej występuje wśród pielęgniarek. Działania prewencyjne dotyczące kształtowania umiejętności rodzenia sobie z sytuacjami stresowymi są niezbędne dla utrzymania kondycji psychicznej i fizycznej, która ma wpływ na jakość świadczonej opieki medycznej przez pielęgniarki. Cel. Celem pracy była próba analizy wiedzy z zakresu umiejętności radzenia sobie ze stresem, w sytuacjach trudnych przez pielęgniarki z Oddziałów Intensywnej Terapii i Anestezjologii. Materiał i metody. Badaniami objęto 100 pielęgniarek z Oddziałów Intensywnej Terapii i Anestezjologii w Radomiu. Narzędziem badawczym był kwestionariusz ankietowy autorstwa

180 własnego złożony z 11 zamkniętych pytań jednokrotnego wyboru. Ankieta zbudowana z trzech części. Pierwsza obejmowała dane personalne, druga związana była z wiedzą personelu pielęgniarskiego z zakresu wiedzy na temat stresu i relaksacji, trzecia dotyczyła zaś wiedzy związanej z umiejętnością zastosowania metod relaksacyjnych. Techniką badawczą była analiza ankiety. Badanie przeprowadzone zostało w 2010 roku. Wyniki. Pojęcie stresu 50% przebadanych rozumie, jako sytuację, z którą nie można sobie poradzić. Najczęstszą przyczyną sytuacji stresowych w pracy personelu pielęgniarskiego w przypadku 29% badanych okazało się ponoszenie odpowiedzialności za życie drugiego człowieka, u 24% stresujący był fakt niskich poborów, natomiast 16% opowiedziało się za pośpiechem towarzyszącym im podczas wykonywania obowiązków. 40% badanych uważa, iż relaks jest stanem odprężenia, zaś 33% określa relaks, jako stan rozładowania emocjonalnego. 64% przebadanego personelu rozumie pojęcie relaksacji, jako proces pogłębienia stanu relaksu. Zastosowanie pozytywnego myślenia okazał się najbardziej znaną metod relaksacji dla 20% badanych, zaś dla 16% znajoma była terapia poprzez śmiech. W sytuacjach trudnych 36% badanych stosuje spotkanie i rozmowę z bliską osobą, 28% spacer i kontakt z naturą, 16% natomiast relaksuje się poprzez słuchanie muzyki. W subiektywnej ocenie na temat wiedzy z zakresu technik relaksacji u 51% była przeciętna, a w przypadku 32% dobra. 48% badanych określa przeciętnie swoją umiejętność zastosowania technik relaksacji w sytuacjach stresujących, natomiast za umiejętnością na poziomie dobrym opowiedziało się 34%. Wnioski. Personel posiada wiedze teoretyczną z zakresu stresu, relaksacji oraz zakresu stosowania metod relaksacyjnych, natomiast przeciętna umiejętność korzystania z technik relaksacji w sytuacjach stresowych ukazuje trudności w praktycznym podejściu do problemu.

Introduction. Connected conditions from makes are a career with significant factor affecting the health of the man. The professional environment, as the source of practical satisfaction well influence the condition of employees, when however is marked with stress, a function reaches the decrease psychological and physical of employee [1.2]. The profession of the nurse is one of the most exposed professions to the peculiar stress, the other man is his source - the patient, the team of partners and the family of the sick person [3.4].

181 The environment of nurses of the intensive care is particularly threatened with the mental strain, through the forced need to keep the permanent concentration of the attention, of the quick evaluation and the reaction and systematic observation and with numerous panic measures. Anesthesiological nurse however participating in the therapeutic team which members occupy oneself with chosen fragment of the treatment, is constantly present during the sick person. He performs the role of the information bank in order to provide integration of the care and treatments. The emotional stress can trigger the impossibility of bringing relief or the death of the patient. Keeping the man company when he suffers, competes for the life is a high doorsill for defeating and absorbing the potential of the nurse. Rising number of new devices, apparatus, increased diagnostics put more and more great requirements before the nurse and constant raising qualifications. Nurses heading for the professionalism feel discomfort, having feeling that their knowledge and abilities aren't made use of into the right way. As women they are sensitive to the way of treating them, the criticism and the low remuneration [3]. Numerous stress causing situations come across can contribute to the development of the professional stress. A team is one of the gravest psychological results of the stress concerning the professional burnout which according to conducted tests in Poland and in the world most oftentimes appears among the medical staff, mainly of nurses [1]. An Olley B.O. test was an example confirming the greatest susceptibility to the professional burnout [5], which for the evaluation 104 nurses, 83 doctors, 21 pharmacists, 10 social workers and 42 persons were embraced from the staff of the nurse's aide in. the top stair of the professional burnout. The health condition of the employee depends to a considerable degree on the ability of dealing stress situations with, and the quality of the strategy of the stress overcoming largely is conditioned from the perception and the assessment of oneself, of one's possibilities of the stress situation matter-of-fact in the context [6 , 7]. It matches from salutogenetic with concept of health of Aaron Antonovsky [8 ], which the effectiveness of the stress overcoming is conditioned in with feeling the coherence, i.e. the effect of subjective surviving the agreement with oneself and with the outside situation. The man about high feeling the coherence effectively deals the professional stress with, since notices the closest neighborhood as understandable, bright and sensible, and oneself as the resourceful person. Accepting the need for the close cooperation of nurses with patients it is worthwhile emphasizing meaning of the coherence of the effects good for the achievement of the treatment and awarenesses of the influence on very process of curing [7].

182 To the purpose of holding of the psychological and physical homeostasis the body in stress causing conditions the largest psychological societies recommend mastering relaxation techniques. In our times known there are many methods of the relaxation which they enable to lead into the state of the relaxation. It is possible to divide manners of the relaxation in simple and set methods. Amongst methods of straights positive thinking, controlling breath, laughter, gymnastics, dance, automatic massage and hydrotherapy change. However set methods concern meditation, yoga, jogging, massages, relaxation neuromuscular as well as of autogenous training. A broad spectrum of relaxation techniques is useful tools towards preventive action, they enable to mold the ability of dealing with stress situations and influence for keeping the health condition of employees [8 ]. Purpose. A test on the test of the knowledge in the scope was a purpose of the work ability of dealing with the stress, in difficult situations by nurses from branches of the intensive care and anaesthesiology. Wanting to achieve the deliberate objective they verified:

1 . with which the nursing staff has a knowledge in the scope of relaxation methods,

2 . what difficult situations the most stress nurses the most, 3. what knowledge the nursing staff has about techniques of the reduction in the stress. 4. most oftentimes what methods the nursing staff applies in stress situations. Material and methods. They conducted research into the Radom special hospital named Tytus Chałubiński at Provincial Specialist Hospital in Radom on the group of 100 nurses from Ward of the Intensive Care and Anaesthesiology. Questionnaire form of the own authorship compound of 11 closed questions of single choice was a research tool. Questionnaire form built from three parts. First included personal data, second was tied with the knowledge of the nursing staff in the scope of its knowledge about the stress and the relaxation, third whereas concerned the knowledge associated with the ability of applying relaxation methods. A test of the questionnaire form was a research technique. The conducted test stayed in 2010. Of staff for duties provided with examining of the intensive care and Anaesthesiology a work was included the Ward of the intensive care, an operating blocks and treatment rooms of the hospital in which the need of anaesthetizing patients existed. Moreover, examined granted benefits for other wards in the form of establishing to insert intravenous, of passes at central lines, inserting dialysing involvement in intensive care units, intubations and the lavage of the stomach. The staff of nurses also dealt with the sterilization and the assembly of medical equipment, of which the efficiency and the readiness were required during sudden situations.

183 Course of conducted tests on account of exceptional specificity of the work of the examined nursing staff, based on unexpected calls connected with the lifesaving of patients, was cancelled during working hours. Most oftentimes examined filled in a questionnaire before beginning duty be after.

Results. After the test of the first part of the diagnostic survey conducted with method of the survey technique a characterization of the research group was received. The examined professional community of nurses submitted in the 96% from women, about age bracket 23 - 60 of years. Having persons 31 constituted the largest group of the 40% ^ 40 of years, at which the work experience took out into 20 years. One by one a 30% of respondents is nurses with the internship up to 30 years, in century 41 ^ 50 of years, whereas 18% of respondents to

30 6 years of professional experience had a year of age. The rest part of the examined group of the 12 Bad ana cecha n = 100 Kobieta 96 Płeć Mężczyzna 4 do 30 18 Przedział wiekowy 31 - 40 40 (w latach) 41 - 50 30 powyżej 50 12 do 6 18 Staż pracy 20 40 (w latach) do 30 30 powyżej 30 12

The second part of the questionnaire verifying the knowledge of the nursing staff in the scope portrayed subject matters of the stress and the relaxation, that definition of the stress for the 50% examined formed a relationship with the situation with which it is hard for oneself to manage. Behind determining the stress as the reaction of the organism to too high requirements a 2 2 % was told, and 2 0 % stated that the stress manifested itself through the pressure of the neighborhood, where the stress is greater than the possibility. At the 4% a reply was obtained, that the stress was an unknown situation, whereas for remaining 4% examined the stress formed a relationship with the situation which in consequence will lead to

184 loss of something important. In case of the 29% of respondents the responsibility for the life of the second man triggered stress causing situations most oftentimes. A fact of receiving a low salary of the 24%, a hurry of the 16%, fear of making a mistake of the 13%, the excess of duties of the 10% and the shift work of the 8 % were also stressful. According to the 40% examined a relaxation is a state of relaxation, however determined the 33% enabling this process as situations emotional relieving. Behind lowering the emotional stress and muscle whereas a 2 1 % was told examined, and remaining 6 % described the relaxation as the state of loosening the muscle tone. Comprehending the relaxation for the 64% formed a relationship with the process of deepening the state of the relaxation, for the 19% with the habitual training at the man, but the 17% wasn't able to define the definition.

Tbl. 2. Theoretical knowledge to the theme of stress, relaxation, relaxation and stress situations in the work.

Badana cecha n = 100 Sytuacja, w której trudno sobie poradzić 50 Reakcja organizmu na wysokie wymagania 22 Sytuacja otoczenia, w której nacisk jest większy niż Definicja stresu 20 możliwości Sytuacja, doprowadzająca do utraty czegoś cennego 4 Sytuacja nieznana 4 Stan odprężęnia 40 Stan rozładownia napięcia emocjonlanego 33 Definicja relaksu Stan obniżenia napięcia emocjonalnego i mięśniowego 21 Stan rozluźnienia napięcia mięśniowego 6 Proces pogłębienia stanu relaksu 64 Definicja relaksacji Trening nawykowy u człowieka 19 brak opini 16 Odpowiedzialność za życie drugiego człowieka 29 Nieskie pobory 24 Stresujące sytuacje w pracy Pośpiech 16 pielęgniarki Lęk przed popełnieniem błędu 13 Nadmiar obowiązków 10 Praca w sytstemie zmianowym 8

The third part of the survey included data associated with the acquaintance of relaxation methods. After the test of questionnaire forms we learn that for the nursing environment it was the most well-known method of the relaxation in the 2 0 % positive thinking, in the 16% applying therapy through the laughter, the 13% controlling breath, the

10% the dance, the 7% of the gymnast and massage, 6 % hydrotherapy and meditation, 5% of

185 the yogi, 2% Jacobson’s method and the autogenous training of Schulz whereas for the 1% automatic massage. Through meetings and conversations with persons for family and friends of the 36% examined he abreacts stress situations, walks and the contacts with the nature for the 28% were shown with way to the stress. One by one listening to music favored the 16%,

12% of entertainment cultural and applied the 8 % one of methods of the relaxation. Judging the subjective look at the knowledge in the scope of relaxation techniques, at the 51% an average level was received, good 32%, low 12%, however at the 5% very good. The question studying the view about the ability of applying methods of the relaxation in difficult situations showed, that examined in the 48% averages have abilities, 34% good, 16% low, whereas 2% very good.

Tbl. 3. The acquaintance and the ability of using relaxation methods.

Badana cecha n = 100 Pozytywne myślenie 20 Terapia poprzez śmiech 16 Kontrolowanie oddechu 13 Taniec 10 Znajomość metod relaksacyjnych Gimnastyka i masaż 7 Hydroterapia i medytacja 6 Joga 5 Metoda Jacobsona i trening autogenny Schulza 2 Automasaż 1 Spotkanie i rozmowa z bliską osobą 36 Spacer i kontakt z naturą 28 Metody stosowane w sytuacjach Słuchanie muzyki 16 stresowych Rozrywki kulturalne 12 Jedna z metod relaksacji 8 Przeciętna 51 Subiektywna wiedza z zakresu Dobra 32 technik relaksacyjnych Niska 12 Bardzo dobra 5 Przeciętna 48 Subiektywna ocena zastosowania Dobra 34 technik relaksacyjnych w Niska 16 sytuacjach stresujących Bardzo dobra 2

Discussion. Workplace of nurses from ward of the intensive care and Anaesthesiology marked is stress causing numerous situations. According to Knot H. belongs to them: factors resulting from the specificity of the work (close contact with the sick person creating the risk of picking up from the patient, performing the physical labour associated with the care and with

186 proceedings diagnostic - therapeutic, contact with dirt, discharges, excrement, irregular lifestyle, work at night, shift-ness), mental strains (need to preserve the vigilance and inspections in the situation of the permanent contact with disability, pain, suffering, death, responsibility in the course of passing medicines and performances of treatments, awareness of effects of own mistakes), lack of appropriate conditions for the treatment, low wages, low professional status, bad cooperation with other members of the therapeutic team and with the patient and his family [3, 10, 11, 12, 15]. Examining Wzorek A. [3] comparing causes of the stress amongst nurses working on wards about the different specificity, demonstrated, that level of sensing the situation stressful on the ward of the intensive care he is definitely higher and makes himself different in relation to other wards. On the ward of the intensive care a death was ranked among primary sources of the stress of charge (70%) similarly in examining Tartas M. et al. [4], loss of the patient turned out to be the source of the stress (in the very notable rank for 30-43 %, big 43 - 53%) and condition of the degeneration of the health of the patient (73 - 80%). However in examining M. Suchocka [11] most oftentimes growing requirements turned out to be stressing factors towards nurses (51%), working hours (42%) and the care and the responsibility for the patient (42%). Analysis of the results in the test Gugala B. [12] presented, whereas fact of a low salary (c 90%) as the greatest factor of stressing situations in the nursing environment, however night duties (c 70%), hurry (c 70%) and excess of duties are also important factors. Similar results portray own tests where responsibility for the life of the second man (29%), low salary (24%) and hurry (16%) constitute main causes of the stress. Ramuszewicz M et al. [15] in one's research project, analysed the kind of physics problems appearing during the work from profession of the nurse. The test was conducted on 80 nurses instrumenters and demonstrated, that with the pain in the muscles or of spine a 33% contends examined, with a headache of the 2 0 %, c 1 0 % it ranked pains and cramps of lower limbs among the complaint, had a 7% sleeping disorder and weakening muscle power, however 6 % of metabolic disorders. Performing by nurses professional functions involving permanent functioning in difficult situations and with the need immediate with advising oneself with them perhaps to lead to the development of the professional burnout syndrome [13]. In the nursing environment notion the professional burnout is well-known what observation conducted in Silesia showed. knew the 59% of nurses exactly what the professional burnout syndrome is, only a given expression could hear the 23%, whereas 14% examined could hear them for the first time [14]. With confirmation, also examining can be Ramuszewicz M. et al. [15], where

187 acquaintance of the date declared the professional burnout 87% of nurses, however feeling the professional burnout had only a 17% from them. Exquisitely important, and so there are an acquaintance and an ability of using techniques of effective advising oneself with the stress in the profession of the nurse. Gugała B. [12] in one's for test verified kinds of applied strategies amongst nurses. The form of the conversation with the close person turned out for the 61% to be the method antistress, for the 55% listening to music and walks and the contact with the nature were (36%). in own tests, also similar results were get, the meeting and the conversation with close friends and family was the most popular method of dealing with in stress causing situations (36%), one by one the walk and the contact with the nature (28%) and listening to music (16%). Applying the strategy of the positive thinking for dealing problems with at the work correlates positively with professional ambitions, with readiness to for becoming involved at the work, with the attacking strategy of the problem solving and feeling the success in the profession. A test showed the high statistical gravity of this statement Basińska M. et al. [16] Subjective evaluation of relaxations examined in relation to the knowledge and the ability in order to relieve the emotional stress by applying methods into tests own was on the average level. The largest percentage examined favored applying simple methods of the relaxation i.e. the positive thinking (20%), therapy through the laughter (16%), controlling breath (13%), however from set methods of the relaxation i.e. the gymnast and massage (7%), hydrotherapy and massage (6 %), yoga (5%), the Jacobson’s Method and the autogenous training of Schulz (2%) and automatic massage (1%), used much smaller of nurses. In case of the test Ramuszewicz M. et al. [15] declared the ability of dealing stressing stations with over the 60%. To conclude from the statement of respondents it is possible, that acquaintance of professional techniques of the relaxation, as similarly as in the own test was low.

Conclusions. The staff has knowledges theoretical from the scope of the stress, the relaxation and the domain of relaxation methods, however the average ability of using techniques of the relaxation in stress situations portrays problems in the practical approach towards the problem.

References

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Conflict of interest: None declared.

Received: 05.02.2013. Revised: 15.04.2013. Accepted: 06.06.2013.

190 Journal of Health Sciences (J for the Ss H) 2013; 3 (5): 191-224 The journal has had 4 points in Ministry of Science and Higher Education of Poland parametric evaluation. B letter item 683.

PROBLEM UZALEŻNIENIA OD INTERNETU WŚRÓD UCZNIÓW SZKÓŁ PONADPODSTAWOWYCH W LUBLINIE The problem of Internet addiction among secondary and upper secondary school students in Lublin

Barbara Kołłątaj1, Justyna Szakuła2, Witold Kołłątaj3, Katarzyna Wrzołek4 Irena Dorota Karwat1

1Katedra i Zakład Epidemiologii, Uniwersytet Medyczny w Lublinie; 2Wydział Pielęgniarstwa i Nauk o Zdrowiu, Uniwersytet Medyczny w Lublinie; 3Klinika Endokrynologii i Diabetologii Dziecięcej z Pracownią Endokrynologiczno- Metaboliczną, Uniwersytet Medyczny w Lublinie; 4Dziecięcy Szpital Kliniczny im. Antoniego Gębali, Lublin.

1Chair and Department of Epidemiology Medical University, Lublin; 2student of Faculty of Nursing and Health Sciences, Medical University, Lublin; Department of Paediatric Endocrinology and Diabetology, III Chair of Paediatrics, Medical University, Lublin; 4 Antoni Gębala Children's Hospital, Lublin.

Adres do korespondencji: Address for correspondence: dr hab. n. med. Witold Kołłątaj Klinika Endokrynologii i Diabetologii Dziecięcej, Uniwersytet Medyczny, Lublin Dziecięcy Szpital Kliniczny, ul. Chodźki 2, 20-093 Lublin e-mail: [email protected] Tel. 0-81-7185-440, fax. 0-81-743-13-72

Słowa kluczowe: Internet, uzależnienie, uczniowie, gimnazja, szkoły ponadgimnazjalne

Key words: Internet, addiction, secondary schools, upper secondary schools

Streszczenie

Wstęp: Uzależnienia są narastającym problemem w krajach cywilizowanych. Wśród czynników powodujących uzależnienie psychiczne jest coraz bardziej dostępny świat wirtualnych kontaktów i przeżyć - czyli Internet. Cel: Celem pracy była próba oszacowania skali uzależnienia od Internetu wśród uczniów szkół ponadpodstawowych w Lublinie. Materiał: Badaniem objęto 916 uczniów z 9 losowo wybranych szkół z terenu Lublina (374 uczniów ze szkół gimnazjalnych, 274 z liceów ogólnokształcących, 220 z techników oraz 48 osób kształcących się w szkole zawodowej). W grupie tej dziewczęta stanowiły 43% (395 osób), chłopcy 57% (521 osób). Wiek badanych wahał się od 13 do 19 lat.

191 Metoda: Badanie przeprowadzono metoda ankietową. Zastosowano dwa narzędzia badawcze: Autorski Kwestionariusz Ankiety, złożony z 46 pytań oraz 19 Punktową Autorską Skalę Uzależnienia (19PASU). Wyniki: Z ogółu badanych 8,3% gimnazjalistów i 8,1% uczniów szkół ponadgimnazjalnych uważało się za uzależnionych od Internetu. Z danych zebranych na podstawie zastosowanych metod wynika, że odsetek takich osób wynosił: 28,4 wśród gimnazjalistów i 25,6 wśród uczniów szkół ponadgimnazjalnych ( > 6 pkt w skali 19PASU). W badanej populacji ponad piątą część (2 1 ,2 %) stanowiły osoby, które spełniały kryteria uzależnienia od Internetu, ale nie uważały się za uzależnione (18,6% otrzymało 7-12 punktów w skali 19PASU i 2,6% - 13 lub więcej punktów w skali 19PASU). Wnioski: 1. Uzależnienie od Internetu wśród uczniów szkół ponadpodstawowych stanowi istotny problem zdrowotny i społeczny. 2. Wykazano, że samoocena problemu wystąpienia zjawiska uzależnienia od Internetu wśród uczniów (8,0%) była zaniżona wobec rzeczywistej skali zjawiska. Uzależnieni stanowili: 28,4% gimnazjalistów i 25,6% uczniów szkół ponadgimnazjalnych ( > 6 pkt w skali 19PASU). 3. Wśród uczniów uważających się za wolnych od uzależnienia znalazła się duża grupa osób (ok. 1/ 5 badanych), wykazujących objawy umiarkowanego lub ciężkiego uzależnienia od Internetu. 4. Istnieje konieczność podjęcia populacyjnych badań w celu wczesnej diagnostyki uzależnień i wprowadzenia skutecznych metod profilaktyki i terapii.

A bstract Introduction: Addictions are a growing problem of civilized countries. Among the factors that cause psychological addiction are those that enable virtual contacts and experience - that is the Internet. Aim: The aim of this study was to estimate the scale of dependence on the Internet among high school students in Lublin. Material: The study involved 916 students from nine randomly selected secondary as well as upper secondary schools from the area of Lublin (374 junior high school students, 274 high schools, 220 technicians and 48 professional schools). The study population consisted of 395 girls (43%) and 521 boys (57%) aged 13 to 19 years. Method: The study was conducted using a survey method. There were used: the original questionnaire containing 46 questions as well as the 19-item Original Addiction Scale (19PASU). Results: 8.3% of secondary school students and 8.1% of upper secondary school students considered themselves to be addicted to Internet, in fact the real percentages of Internet addicted were 28.4 among secondary school students and 25.6 among upper secondary school students (19 PASU score range > 6 ). 21.2% of all students have met the criteria for the Internet addiction but have not considered themselves to be addicted (18.6% - 19PASU total score range 7-12 and 2.6% of surveyed - 19PASU total score > 1 2 ). Conclusions: 1. Internet addiction among secondary as well as upper secondary school students is an important health and social problem. 2. More than 8 % of secondary and upper secondary school students are considered to be addicted to the Internet. The percentages of addicted are: 28.4 among secondary school students and 25.6 among upper secondary school students (19PASU scores >6 ). 3. Among the respondents claiming to be free from addiction is a large group of students (about one fifth of the respondents) showing signs of moderate or severe addiction.

192 4. There is the need to take make efforts to enable early diagnosis and effective treatment of addicted.

1. W STĘP Problemy uzależnień towarzyszą ludzkości od czasów starożytnych. Jednak rodzaje uzależnień i skala zjawiska zmienia się w trakcie rozwoju cywilizacyjnego. Uzależnienie, to złożone zaburzenia zachowania, polegające przede wszystkim na wewnętrznym przymusie: a. ciągłego lub okresowego używania substancji o działaniu psychoaktywnym, b. ponawianego wykonywania pewnych czynności, c. realizacji celów w sposób dezorganizujący funkcjonowanie człowieka w rodzinie, społeczeństwie lub w sposób zagrażający zdrowiu lub życiu osoby uzależnionej. Przymus może wynikać z dążenia do osiągnięcia przyjemności (w wyniku, np. spożycia substancji psychoaktywnej), uzyskania większej akceptacji osób z najbliższego otoczenia lub unikania nieprzyjemnych doznań związanych z pojawieniem się objawów abstynencji. Trwałość raz powstałego zaburzenia i łatwość nawrotów jest osiowym objawem uzależnienia. Główne objawy uzależnienia, występujące prawie w każdym jego typie, to: a. jest częste, regularne i stereotypowe; b. ma charakter kompulsywny (związane jest z powracającym wewnętrznym przymusem); c. jest przyczyną problemów zdrowotnych, finansowych, szkolnych, zawodowych, rodzinnych; d. zachowania związane z uzależnieniem zabierają znaczną część czasu; e. trwałe i całkowite zerwanie z uzależnieniem stwarza osobie uzależnionej znaczną trudność; f. próba zerwania z uzależnieniem powoduje pojawienie się zespołu abstynencyjnego

[ 1 ]. W mechanizmie uzależnienia udział mają komponenty fizyczne i psychiczne. W uzależnieniach od leków, alkoholu, narkotyków i papierosów duży udział ma komponenta

193 fizyczna, w mechanizmie wielu innych uzależnień dominujący lub wyłączny udział ma komponenta psychiczna. Do uzależnień o dominującej komponencie psychicznej zalicza się między innymi [1-9]: a. pracoholizm, b. uzależnienie od gier komputerowych, c. uzależnienie od hazardu, d. uzależnienie od Internetu, e. uzależnienie od kupowania, f. uzależnienie manifestujące się przesadną i nadmiernie absorbującą dbałością o wygląd zewnętrzny, g. uzależnienie od nadmiernej dbałości o tężyznę fizyczną (bigoreksja), h. uzależnienie od słuchania muzyki, i. uzależnienie od telewizji, j. uzależnienie od tatuaży (tattooning), k. uzależnienie od piercingu i innych modyfikacji wyglądu ciała, l. uzależnienie of telefonu (fonoholizm), m. ortoreksję (obsesja na punkcie jakości przyjmowanego pokarmu), n. uzależnienie od opalania się (tanoreksja). Termin uzależnienie od Internetu wprowadziła do literatury naukowej Kimberly Young z Uniwersytetu w Pittsburgu [10]. Obecnie wyróżnić można następujące podtypy uzależnienia od Internetu (Kimberly Young [10], modyfikacja własna): • erotomania internetowa (w tym pedofilia, zoofilia, skrajny ekshibicjonizm ) - polega na oglądaniu i/lub rozprowadzaniu filmów i/lub zdjęć o tematyce pornograficznej lub prowadzeniu czatów i emitowaniu video online z treściami pornograficznymi; • socjomania internetowa - jest to uzależnienie od internetowych kontaktów społecznych; • uzależnienie od gier internetowych, w tym gier online; • uzależnienie informacyjne - polega na obsesyjnym przeglądaniu serwisów informacyjnych, udziale w forach dyskusyjnych; • uzależnienie od sieci - polega na odczuwaniu konieczności korzystania z Internetu i pobytu w świecie wirtualnym.

194 Jak dotychczas, nie ma pewnych i standardowych metod powszechnie zaakceptowanych, jako narzędzia diagnostyczne w rozpoznawaniu uzależnienia od Internetu. Jednymi z bardziej znanych narzędzi są skale punktowe zaproponowane przez K. Kaliszewską [11] i B.T. Woronowicza [12]. W metodzie diagnostycznej preferowanej przez K. Kaliszewską, o uzależnieniu od Internetu świadczy występowanie, co najmniej pięciu z ośmiu poniżej zaprezentowanych objawów: 1. zaabsorbowanie Internetem (uporczywe myślenie o poprzednich lub planowanych sesjach internetowych); 2. potrzeba poświęcania na korzystanie z Internetu coraz więcej czasu w celu osiągnięcia oczekiwanego stopnia zadowolenia; 3. podejmowanie bezskutecznych prób kontrolowania, ograniczania lub przerwania korzystania z Internetu; 4. występowanie niepokoju, wahań nastroju, przygnębienia lub rozdrażnienia przy próbach ograniczania lub przerwania używania Internetu; 5. pozostawanie online dłużej niż planowano;

6 . narażanie się z powodu używania Internetu na utratę bliskich relacji interpersonalnych, pracy, szkoły, kariery zawodowej; 7. okłamywanie bliskich, terapeuty lub innych osób w celu ukrycia wzrastającego zainteresowania Internetem;

8 . korzystanie z Internetu w celu ucieczki przed problemami lub poprawy obniżonego nastroju (poczucia bezradności, poczucia winy, lęku, depresji). B.T. Woronowicz, uzależnienie od Internetu (siecioholizm) proponuje rozpoznawać wówczas, gdy w ciągu ostatnich 1 2 miesięcy stwierdza się obecność, co najmniej trzech, spośród podanych niżej oznak [1 2 ]: 1. silna potrzeba lub poczucie przymusu korzystania z Internetu;

2 . subiektywne przekonanie o mniejszej możliwości kontrolowania zachowań związanych z Internetem, tj. upośledzenie kontroli nad powstrzymywaniem się od korzystania z Internetu oraz nad długością spędzania czasu w Internecie; 3. występowanie niepokoju, rozdrażnienia czy gorszego samopoczucia przy próbach przerwania lub ograniczenia korzystania z Internetu oraz ustępowanie tych stanów z chwilą powrotu do komputera; 4. spędzanie coraz więcej czasu w Internecie w celu uzyskania zadowolenia lub dobrego samopoczucia, które poprzednio osiągane było w znacznie krótszym czasie;

195 5. korzystanie z Internetu pomimo szkodliwych następstw (fizycznych, psychicznych i społecznych), o których wiadomo, że mają związek ze spędzaniem czasu w Internecie. Powyżej, krótko omówione narzędzie diagnostyczne nawiązuje do kryteriów diagnostycznych uzależnień według ICD-10 (ang. International Statistical Classification of Diseases and RelatedHealth Problem). Uzależnienie od Internetu wiąże się z pojawieniem zachowań stwarzających zagrożenie dla poprawnego funkcjonowania jednostki w społeczeństwie, niekiedy manifestuje się także działaniami naruszającymi obowiązujący porządek prawny: a. cyber-przemoc, b. pedofilia, c. hackerstwo, d. rozpowszechnianie pornografii, e. propagowanie i gloryfikowanie ryzykownych metod zachowania (grupy potencjalnych samobójców, propagowanie anoreksji), f. oszustwa internetowe, wyłudzanie pieniędzy. Problem, jakim jest uzależnienie od Internetu wydaje się narastać (może to mieć związek z coraz szerszym dostępem tego medium). Wobec braku pewnych i standaryzowanych metod powszechnie zaakceptowanych, jako narzędzia diagnostyczne w rozpoznawaniu uzależnienia od Internetu, a także wobec niedostatku aktualnych badań populacyjnych, podjęto próbę autorskiego ujęcia tego tematu i podjęcia próby oszacowania skali zjawiska w grupie uczniów szkół gimnazjalnych i ponadgimnazjalnych. na terenie miasta Lublina.

2. CEL Celem pracy była próba oszacowania skali problemu uzależnienia od Internetu wśród uczniów szkół ponadpodstawowych w Lublinie.

3. M ATERIAŁ Badaniem objęto 916 uczniów z 9 losowo wybranych szkół z terenu Lublina, w tym 374 uczniów gimnazjów (326 z gimnazjów publicznych i 48 z gimnazjum prywatnego), 274 osób z liceów ogólnokształcących (209 z liceum publicznego, 25 z prywatnego, 40 z liceum profilowanego), 220 z techników (199 z technikum publicznego i 21 z prywatnego) oraz 48 osób ze szkoły zawodowej - ryc. 1 .

196 3.1. Struktura wieku badanych uczniów w poszczególnych rodzajach szkół Wiek uczniów mieścił się w przedziale 13-19 lat. Wśród badanych, w przedziale 13-14 lat znalazło się 109 uczniów, co stanowiło 11,9% wszystkich biorących udział w badaniu, w przedziale 15-16 lat było 347 osób (37,9% wszystkich ankietowanych uczniów), w przedziale 17-18 lat - 366 uczniów (40,0% ogółu badanych) a powyżej 18 lat - 94 osoby (10,3% wszystkich badanych). Strukturę uczniów według grup wieku przedstawiono na ryc. 2 .

[Fig1 ]

[Fig. 2]

3.2. Struktura badanych uczniów według płci W badaniu uczestniczyło 395 dziewcząt (43% ogółu badanych uczniów) oraz 521 chłopców (57% wszystkich uczestników badania). 4. METODY 4.1. Organizacja i przebieg badań Badanie przeprowadzono w terminie od listopada 2011 roku do kwietnia 2012 roku. W październiku 2011 roku wystosowano pismo do Lubelskiego Kuratora Oświaty z prośbą o udostępnienie wykazu szkół ponadpodstawowych na terenie miasta Lublina. Następnym etapem badań był dobór szkół. Po wykonaniu tego zadania wystosowano pismo do dyrektora każdej szkoły, z prośbą o zgodę na przeprowadzenie badań. Po uzyskania zgody dyrektora szkoły, a w niektórych jednostkach również szkolnego pedagoga, rozpoczynano badania. 4.2. Metoda doboru grupy badanej W celu wyboru szkół do badania zastosowano metodę losowania warstwowego proporcjonalnego, ponieważ udział jednostek (uczniów) w każdej z warstw był proporcjonalny do udziału warstwy (rodzaju szkoły) w całej populacji. Na potrzeby tej pracy, wszystkie szkoły ponadpodstawowe z terenu Lublina podzielono na warstwy. Wydzielono 8 warstw: gimnazjum publiczne, gimnazjum prywatne, liceum ogólnokształcące, liceum profilowane, liceum prywatne, technikum publiczne, technikum prywatne i szkoła zawodowa. Następnym etapem było wylosowanie z każdej warstwy proporcjonalnej liczby szkół. I tak, z każdego profilu szkoły wylosowano po jednej szkole, z wyjątkiem gimnazjum publicznego, gdzie wylosowano 2 jednostki. W ten sposób stosunek liczby uczniów z gimnazjum był proporcjonalny do liczby uczniów z pozostałych szkół ponadgimnazjalnych. Kolejnym

197 etapem badań było wylosowanie w każdej szkole proporcjonalnej liczby klas z każdego poziomu kształcenia. Wyjątkiem były tu szkoły, w których każdy poziom liczył tylko po jednej klasie. Należały do nich: gimnazjum prywatne, liceum profilowane, liceum prywatne, technikum prywatne i szkoła zawodowa. 4.3. Zastosowane metody i narzędzia badawcze 4.3.1. Autorski Kwestionariusz Ankiety Narzędziem badawczym, którym posłużono się do zebrania danych był Autorski Kwestionariusz Ankiety. Kwestionariusz zawierał 46 pytań zamkniętych i półotwartych, z możliwością jednokrotnego lub wielokrotnego wyboru. Autorski Kwestionariusz Ankiety został skonstruowany w ten sposób, aby pytania w nim zawarte, w jak największym stopniu dotyczyły problemów zdefiniowanych przez Woronowicza oraz Young, jako czynniki ryzyka/objawy uzależnienia od Internetu.

4.3.2. Metoda obiektywnej oceny obecności uzależnienia W celu zdiagnozowania obecności uzależnienia od Internetu zastosowano oryginalną, 19 Punktową Autorską Skalę Uzależnienia (19PASU). Obecność uzależnienia mierzono liczbą pytań, na które ankietowani odpowiedzieli w taki sposób, iż odpowiedź może wskazywać na uzależnienie. Pytania te zostały wyosobnione z Autorskiego Kwestionariusza Ankiety i wyszczególnione w tabeli I.

[Table I]

Fakt uzależnienia został stwierdzony na podstawie sumy liczby pytań (lub grup pytań - pozycja 15, pytania 33,34,35,36), na które udzielono odpowiedzi w sposób wskazujący na istnienie uzależnienia. Interpretacja punktacji była następująca:

- 0 pkt. - brak uzależnienia

- 1 - 6 pkt. - wątpliwe uzależnienie - 7-12 pkt. - umiarkowane uzależnienie - 13-19 pkt. - ciężkie uzależnienie.

5. W YNIKI 5.1. Osoby uzależnione od komputera/Internetu w otoczeniu respondentów

198 Od badanych uczniów zebrano także informacje dotyczące występowania w ich otoczeniu osób, które mogą być uzależnione od komputera/Internetu. Na pytanie nr 45 „Czy znasz kogoś, kto według Ciebie zbyt dużo czasu spędza przed komputerem?” twierdząco odpowiedziało 303 gimnazjalistów, to jest 81% tej subpopulacji. W tej grupie, najwięcej, bo 148 osób (39,6%) było uczniów, którzy odpowiedzieli, że znają tylko kilka takich, 101 (27,0%) badanych stwierdziło, że zna wiele osób, które za dużo czasu spędzają przy komputerze, 54 uczniów gimnazjów(14,4%) zna po jednej takiej osobie, a 71 respondentów (19,0%) nie miało w swoim otoczeniu nikogo, kto zbyt wiele czasu spędza przy komputerze. Wśród uczniów szkół ponadgimnazjalnych podobny był odsetek osób, które na to pytanie udzieliło odpowiedzi twierdzącej - 450 respondentów (83% tej podgrupy). Także tutaj najliczniejszą grupę stanowiły osoby, które stwierdziły, że znają kilka osób, które zbyt dużo czasu spędzają przy komputerze - 241 osób (44,5%). Kolejną grupę tworzyli uczniowie, którzy odpowiedzieli, że takich osób znają wiele - 156 (28,8%), natomiast już dużo mniejsza grupa, bo 53 uczniów (9,8%) tego typu szkół znało tylko po jednej osobie spędzającej przy komputerze zbyt dużo czasu. Grupa licząca 92 osoby (17,0%) stwierdziła, że w swoim otoczeniu nie znają nikogo, kto zbyt wiele czasu spędza przy komputerze.

5.2. Obecność uzależnienia od komputera/Internetu u respondentów sugerowana przez członków rodziny osób ankietowanych W narzędziu badawczym uwzględniono także ważne zagadnienie dotyczące opinii bliskich i znajomych uczniów biorących udział w badaniu na temat zbyt długiego czasu spędzanego przy komputerze przez ankietowanych. Informacje te zawarto w pytaniach 24, 25 Autorskiego Kwestionariusza Ankiety. Natomiast za pomocą pytania 46 zebrano informacje od badanych uczniów, czy w ich najbliższym otoczeniu były osoby, które wyrażały opinie o możliwości wystąpienia u nich uzależnienia od Internetu. Grupa 177 (47,4%) uczniów gimnazjów przyznała, iż ich bliscy przynajmniej raz zwrócili im uwagę, iż zbyt dużo czasu spędzają przy komputerze - ryc. 3. Grupa 93 respondentów (24,9%) uwagi takie słyszała rzadko, raz lub dwa razy, natomiast odpowiedzi „Tak, wiele razy” udzieliło 84 (22,5%) osoby. Blisko dziesiąta część odpowiedziała, że nie pamięta takich uwag, co można wiązać z nieprzywiązywaniem wagi do tego problemu lub niechęcią przyznania się do takich uwag.

[Fig. 3]

199 Wśród uczniów szkół ponadgimnazjalnych, łącznie 213 (39,3%) respondentów spotkało się z uwagą członków rodziny sugerującą zbyt długotrwały kontakt z komputerem (Ryc. 4) - odpowiedzi „Tak, wiele razy” lub „Tak, raz czy dwa razy”. Wyższy był tu odsetek osób, które takie uwagi słyszały rzadko (2 2 ,0 %), w porównaniu z tymi, którzy odpowiedzieli, że wiele razy (17,3%).

[Fig. 4]

5.3. Obecność uzależnienia od Internetu u respondentów sugerowana przez osoby z kręgu znajomych ankietowanych uczniów W ocenie tego problemu wykorzystano dane w oparciu o pytanie: „Czy Twoi znajomi/koledzy, koleżanki wyrażają/wyrażali opinie, że zbyt wiele czasu „siedzisz przy komputerze?” - ryc. 5 i 6 . Wśród gimnazjalistów 32 osoby (8 ,6 %) stwierdziły, że wśród kolegów/znajomych były osoby, które twierdziły, że respondenci mają zbyt długie kontakty z komputerem/Internetem, przy czym 5,1% odpowiedziało, że uwagi takie słyszało wiele razy a 3,5%, że były one sporadyczne, raz lub dwa razy.

[Fig. 5]

Nieco inny był rozkład odpowiedzi uczniów szkół ponadgimnazjalnych na pytanie: „Czy Twoi znajomi/koledzy, koleżanki wyrażają/wyrażali opinie, że zbyt wiele czasu

„siedzisz przy komputerze”?” - ryc. 6 . Twierdzącej odpowiedzi udzieliło tu łącznie 58 badanych szkół ponadgimnazjalnych (10,7%). Niemal taki sam był odsetek osób, które stwierdziły, że od tej grupy osób uwagi dotyczące zbyt długiego przebywania przed komputerem kierowane były do nich wiele razy (5,5%) i sporadycznie (5,2%).

[Fig. 6]

5.4. Samoocena ankietowanych - poczucie wystąpienia uzależnienia od Internetu W narzędziu badawczym uwzględniono pytanie dotyczące samooceny w zakresie uzależnienia od Internetu. W odpowiedzi na pytanie 45 Autorskiego Kwestionariusza Ankiety „Czy uważasz się za osobę uzależnioną od komputera/Internetu?”, wśród gimnazjalistów

200 niewielka grupa, bo 33 osoby (8,3%) udzieliły odpowiedzi twierdzącej. Należy tu podkreślić, że prawie taka sama grupa uczniów odpowiedziała, że na ten temat nie ma zdania, czyli nie była w stanie ocenić tego problemu - ryc. 7.

[Fig. 7]

[Fig. 8 ]

Wśród uczniów szkół ponadgimnazjalnych za uzależnione od Internetu/komputera uznały się 44 osoby (8,1%). Niemal taki sam odsetek młodzieży stwierdził, że na ten temat nie ma zdania - ryc. 8 .

5.5. Obiektywne wykładniki uzależnienia od Internetu w grupie badanych osób Za obiektywne wykładniki uzależnienia od Internetu uznano twierdzące odpowiedzi na pytania wyszczególnione w tabeli I. Rozkład odpowiedzi twierdzących udzielanych przez uczniów gimnazjów przedstawiono na ryc. 9, natomiast rozkład odpowiedzi twierdzących udzielanych przez uczniów szkół ponadgimnazjalnych na ryc. 1 0 .

[Fig. 9]

Wśród młodzieży gimnazjalnej uzyskano następujące rozkłady punktacji:

- 0 pkt. - brak uzależnienia stwierdzono u 33 osób (8 ,8 % gimnazjalistów) - 1-6 pkt. - wątpliwe uzależnienie stwierdzono u 235 osób (62,8% gimnazjalistów)

- 7-12 pkt. - umiarkowane uzależnienie stwierdzono u 8 6 osób (23,0% gimnazjalistów) - 13-19 pkt. - ciężkie uzależnienie stwierdzono u 20 osób (5,4% gimnazjalistów). Wśród osób nie uważających się za uzależnione (343 osoby, 91,7% badanych gimnazjalistów) stwierdzono: - 0 pkt. - brak uzależnienia stwierdzono u 33 osób (9,6% gimnazjalistów nie

uważających się za uzależnionych; 8 ,8 % badanych gimnazjalistów)

- 1- 6 pkt. - wątpliwe uzależnienie stwierdzono u 224 osób (65,3% gimnazjalistów nie uważających się za uzależnionych; 59,9% badanych gimnazjalistów)

201 - 7-12 pkt. - umiarkowane uzależnienie stwierdzono u 73 osób (21,3% gimnazjalistów nie uważających się za uzależnionych; 19,5% badanych gimnazjalistów) - 13-19 pkt. - ciężkie uzależnienie stwierdzono u 13 osób (3,8% gimnazjalistów nie uważających się za uzależnionych; 3,5% badanych gimnazjalistów). Wśród osób uważających się za uzależnione (31 osób, 8,3 % badanych gimnazjalistów):

- 0 pkt. - brak uzależnienia stwierdzono u 0 osób - 1-6 pkt. - wątpliwe uzależnienie stwierdzono u 11 osób (35,5% gimnazjalistów uważających się za uzależnionych; 2,9% badanych gimnazjalistów) - 7-12 pkt. - umiarkowane uzależnienie stwierdzono u 13 osób (41,9% gimnazjalistów uważających się za uzależnionych; 3,5% badanych gimnazjalistów) - 13-19 pkt. - ciężkie uzależnienie stwierdzono u 7 osób (22,6% gimnazjalistów uważających się za uzależnionych; 1,9% badanych gimnazjalistów).

[Fig. 1 0 ]

Wśród młodzieży ponadgimnazjalnej uzyskano następujące rozkłady punktacji: - 0 pkt. - brak uzależnienia stwierdzono u 51 osób (9,4% badanej młodzieży ponadgimnazjalnej), - 1-6 pkt. - wątpliwe uzależnienie stwierdzono u 352 osób (64,9% badanej młodzieży ponadgimnazjalnej), - 7-12 pkt. - umiarkowane uzależnienie stwierdzono u 122 osób (22,5% badanej młodzieży ponadgimnazjalnej), - 13-19 pkt. - ciężkie uzależnienie stwierdzono u 17 osób (3,1% badanej młodzieży ponadgimnazjalnej). Wśród osób nie uważających się za uzależnione (498 osób, to jest 91,9% badanej młodzieży ponadgimnazjalnej) stwierdzono: - 0 pkt. - brak uzależnienia stwierdzono u 51 osób (10,2% uczniów nie uważających się za uzależnionych; 9,4% badanej młodzieży ponadgimnazjalnej), - 1-6 pkt. - wątpliwe uzależnienie stwierdzono u 339 osób (68,1% uczniów nie uważających się za uzależnionych; 62,6% badanej młodzieży ponadgimnazjalnej), - 7-12 pkt. - umiarkowane uzależnienie stwierdzono u 97 osób (19,5% uczniów nie uważających się za uzależnionych; 17,9% badanej młodzieży ponadgimnazjalnej),

202 - 13-19 pkt. - ciężkie uzależnienie stwierdzono u 11 osób (2,2% uczniów nie

uważających się za uzależnionych; 2 ,0 % badanej młodzieży ponadgimnazjalnej). Wśród osób uważających się za uzależnione (44 osoby, to jest 8,1 % badanej młodzieży ponadgimnazjalnej):

- 0 pkt. - brak uzależnienia stwierdzono u 0 osób, - 1-6 pkt. - wątpliwe uzależnienie stwierdzono u 13 osób (29,5% uczniów uważających się za uzależnionych; 2,4% badanej młodzieży ponadgimnazjalnej), - 7-12 pkt. - umiarkowane uzależnienie stwierdzono u 25 osób (56,8% uczniów uważających się za uzależnionych; 4,6% badanej młodzieży ponadgimnazjalnej),

- 13-19 pkt. - ciężkie uzależnienie stwierdzono u 6 osób (13,6% uczniów uważających

się za uzależnionych; 1 , 1 % badanej młodzieży ponadgimnazjalnej).

6 . DYSKUSJA W miarę postępu cywilizacji, rozwoju technik komputerowych i telekomunikacji (szybsze i pojemniejsze łącza) oraz dynamicznego spadku cen sprzętu komputerowego, problem uzależnienia od komputera/Internetu staje się zjawiskiem coraz bardziej powszechnym. Jak każde uzależnienie, ma ono korzenie zarówno w czynnikach natury wewnętrznej (cechy osobowościowe), jak i zewnętrznej. Uwarunkowania zewnętrzne, to wbrew pozorom nie tylko cena i dostępność sprzętu i łącz internetowych, ale także i czynniki środowiskowe, w tym rodzinne, rówieśnicze, szkolne rzutujące na formowanie się osobowości i kształtowanie się form komunikacji interpersonalnej (osobistej lub poprzez pośredników, np. Internet) [3, 13-17]. Każdy typ uzależnienia jest zjawiskiem niekorzystnym zarówno dla jednostki, jak i dla społeczeństwa. Dlatego ważne jest z jednej strony usprawnianie technik diagnostyki indywidualnej, jak i najdokładniejsze monitorowanie rozpowszechnienia tego zjawiska w populacjach, zwłaszcza tych najbardziej zagrożonych. Badania z zakresu epidemiologii uzależnień stanowią istotne wyzwanie dla świata nauki z uwagi na fakt, iż: a. w rachubę wchodzić może wiele uzależnień dotyczących tej samej osoby (alkohol, komputer, uzależnienie od telefonu i komputera lub uzależnienie od seksu i substancji odurzających, pracoholizm i alkoholizm, uzależnienie od hazardu i alkoholu) [18], b. uzależnienie może ulegać ewolucji [19],

c. istnieje zjawisko przechodzenia uzależnień [2 0 ],

203 d. dla wielu uzależnień nie ma opracowanych prostych i powszechnie uznanych obiektywnych mierników pozwalających na uzyskanie porównywalnych wyników badań prowadzonych w różnych ośrodkach, w różnych populacjach. To właśnie brak jednolitej definicji, czy ujednoliconych kryteriów rozpoznania uzależnienia od Internetu stanowi jeden z najistotniejszych powodów braku rzetelnej i pełnej wiedzy na temat rozpowszechnienia problemu. Pionierskie prace związane z wprowadzeniem obiektywnych kryteriów oceny uzależnienia pojawiły się już w ubiegłym wieku (Diagnostic and Statistical Manual o f Mental Disorders - DSM-IV (1994), Young (1996) i Goldberg (1997) [21,22]) ale nie zaowocowały one przyjęciem jednolitej spójnej koncepcji i wprowadzeniem powszechnie uznanych i akceptowalnych powszechnie narzędzi diagnostycznych. Kryteria DSM-IV opierały się na opisowym podejściu do problemu - rozpoznanie zespołu uzależnienia od Internetu zależne było od pojawienia się w ostatnich 1 2 miesiącach, co najmniej trzech spośród opisanych objawów. Podobne kryteria zaproponował Goldberg [22]. K.S. Young zaproponowała test (Internet Addiction Test, IAT) złożony z 20 pytań, dotyczących różnych aspektów kontaktu z Internetem, połączonych z 5 punktową skalą odpowiedzi: „Rzadko”, „Okazjonalnie”, „Dość często”, „Często”, „Zawsze”. W ten sposób siłę uzależnienia można było oceniać i porównywać stosując skalę punktową. Pomimo iż test K.S. Young nadal bywa dość często cytowany, jego wartość diagnostyczna może być podważana z uwagi na fakt, iż wśród opcji odpowiedzi brakuje „Nigdy”, co wobec konstrukcji pytań typu „Jak często pozostajesz on line dłużej, aniżeli uprzednio zamierzałeś?” lub „Jak często zaniedbujesz domowe obowiązki z powodu zbyt długiego pozostawania on-line?” może prowadzić do nadrozpoznawania uzależnienia. Wobec powyższego w ostatniej dekadzie pojawiło się wiele prób zobiektywizowania diagnostyki i oceny siły uzależnienia. Najczęściej cytowane są następujące narzędzia badawcze: • Online Cognitions Scale (OCS) z 2001 roku (Davis, Flett, Besser) - 36 pytań, każde 4 wersje odpowiedzi (7-punktowa skala Likerta oceniającą identyfikowanie się z poruszanym w pytaniu problemem) [23] • The Generalized Problematic Internet Use Scale (GPIUS) z 2002 roku (Caplan), 5- punktowa skala Likerta oceniająca identyfikowanie się z poruszanym w pytaniu problemem) [24] • Internet Dependency Test z 2001 roku (Wang), 36 pytań, 4-punktowa skala Likerta (1"hardly ever trud” i 4"almost always trud”) [25]

204 • The Internet Addiction Test (IAT) w modyfikacji z 2005 roku (Yang, Choe, Baity, Lee i Cho) [26] • The Internet Addiction Test w modyfikacji z 2007 roku (Ferraro, Caci, Amico i Di Blasi) [27] • Chinese Internet Addiction Scale (CIAS) z 2003roku, 26 pytań [28] • The Compulsive Internet Use Scale z 2009 roku (Meerkerk, Van Den Eijnden, Vermulst i Garretsen) 14 pytań, 5-punktowa skala Likerta [29]. W chwili obecnej istnieje duża swoboda w zakresie wyboru kryteriów diagnostycznych. W wielu krajach istnieją lokalne definicje uzależnienia. W Polsce, od 2001 roku, badacze chętnie stosują kryteria diagnostyczne opracowane przez: - A. Jakubika (kryteria Zespołu Uzależnienia od Internetu (ZUI)) [30] - K.S. Young (Internet Addiction Test) [31]. Zastosowanie mają także narzędzia badawcze opracowane na potrzeby poszczególnych ośrodków naukowych, jak na przykład: 45 punktowy autorski Internet Addiction Test [32]. Brak ujednoliconych kryteriów rozpoznawania i stosowane różne narzędzia badawcze, a także fakt, iż badania prowadzone są raczej na niezbyt dużych populacjach skutkują dużymi różnicami w uzyskiwanych wynikach. I tak, odsetek uzależnionych od Internetu szacowany jest na 1,5%-50% nastolatków i młodych dorosłych żyjących w różnych rejonach świata (tabela II).

[Table II]

Na tym tle wyniki niniejszej pracy: uzależnienie stwierdzane u 28,4% wśród

gimnazjalistów oraz u 25,6% wśród uczniów szkół ponadgimnazjalnych ( > 6 pkt w skali 19PASU) wydają się plasować w granicach zbliżonych do podawanych w USA [49], Rosji [48] i Łodzi w Polsce (Łódź) [32]. Z obserwacji przeprowadzonych w Krakowie [34] i Białymstoku [43] wynika, że skala problemu była znacznie mniejsza, ale i grupy badanych populacji były nieporównywalne (Białystok i Kraków - badania studenci szkół wyższych - tabela II). Własne wyniki badań prowadzą też do odmiennych wniosków, aniżeli opisane w 2009 roku przez innych badaczy z Lublina (B. Pawłowska, E. Potembska; 2009) [36]. Wymienione

205 autorki wykazały uzależnienie od Internetu u zaledwie 3,5% badanych w subpopulacji mieszkańców Lublina. Różnice wynikać mogą z doboru próby (B. Pawłowska i E. Potembska: grupa badana-519, w tym 113 (21,8%) gimnazjalistów, 206 (39,7%) licealistów, 200 (38,5%) studentów, tak więc najmniej liczna była podgrupa gimnazjalistów, którzy w badaniach własnych okazują się być najbardziej podatni na_uzależnienie), z zastosowania innych narzędzi badawczych (B. Pawłowska i E. Potembska opierały się o wyniki uzyskane z testu IAT K.S. Young) oraz interpretacji uzyskanych wyników. Wspomniane autorki przyjęły dość rygorystyczne kryteria rozpoznania uzależnienia (uzależnienie rozpoznawano u osób, które uzyskały 70 punktów w 100 punktowej skali punktacji). W badaniu własnym, odpowiadać mogłoby to pojęciu „poważnego uzależnienia” ( > 1 2 możliwych do uzyskania punktów w 19 punktowej skali oceny). W przypadku takiej interpretacji, uzyskane wyniki badań własnych wskazywałyby, że problem uzależnienia od Internetu dotyczył tylko 3,1% badanej młodzieży ponadgimnazjalnej i 5,4% młodzieży gimnazjalnej (wynik dość zbliżony do wyników opublikowanych przez B. Pawłowską i E. Potembską). W oparciu o powyższe informacje należy stwierdzić, że istnieje duża potrzeba ujednolicenia kryteriów diagnostycznych omawianego rodzaju uzależnienia. Każde ze stosowanych narzędzi badawczych, w tym IAT według K.S. Young, ma swoje niedoskonałości (chociażby te, wspomniane powyżej), stąd stałe poszukiwania nowych narzędzi badawczych i dlatego też duże nadzieje pokłada się w oczekiwanych nowych propozycjach, w tym V wersji DSM (Diagnostic and Statistical Manual of Mental Disorders) - klasyfikacja zaburzeń psychicznych Amerykańskiego Towarzystwa Psychiatrycznego), która ma ukazać się w maju 2013 [51, 52]. Uzależnienie od Internetu ma zostać również włączone do kolejnej, 11 edycji Międzynarodowej Statystycznej Klasyfikacji Chorób i Problemów Zdrowotnych (ang. International Statistical Classification of Diseases and Related Health Problems, ICD-11) - ale nie nastąpi to wcześniej, niż w 2015 roku [51]. Oczekiwanie na nowe narzędzia badawcze nie zwalnia jednak badaczy z monitorowania sytuacji, która wydaje się wysoce niepokojąca, tym bardziej, że w porównaniu z uzależnieniem od alkoholu, papierosów, dopalaczy i narkotyków, problem uzależnienia od Internetu stoi jakby trochę na uboczu zainteresowania zarówno mediów, instytucji rządowych, jak i placówek naukowo-badawczych w Polsce (kwiecień 2013 roku: wyszukiwarka PubMed - szukana fraza: „Internet AND addiction AND Poland” - 4 wyniki wyszukiwania; baza OvidMedline(R) - identyczne zapytanie: - 3 wyniki wyszukiwania, bazy

206 EBSCO szukane słowa „Internet” + „addiction” + „Poland” - po weryfikacji poprawności wyszukiwania: 8 wyników - zakres lat 2002-1013).

7. W NIOSKI 1. Uzależnienie od Internetu wśród uczniów szkół ponadpodstawowych stanowi istotny problem zdrowotny i społeczny. 2. Wykazano, że samoocena problemu wystąpienia zjawiska uzależnienia od Internetu wśród uczniów (8,0%) była zaniżona wobec faktycznej skali zjawiska. Uzależnieni stanowili:

28,4% gimnazjalistów i 25,6% uczniów szkół ponadgimnazjalnych ( > 6 pkt w skali 19PASU). 3. Wśród uczniów, którzy uznali się za wolnych od uzależnienia, znalazła się duża grupa

osób (ok. 1/5 badanych), wykazujących objawy umiarkowanego lub ciężkiego uzależnienia od Internetu. 4. Istnieje konieczność podjęcia nowych, populacyjnych badań w celu wczesnej diagnostyki uzależnień i wprowadzenia skutecznych metod profilaktyki i terapii.

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1 2 ( 1 ): 1 -6 . 30. Jakubik A. Zespół uzależnienia od Internetu. Studia Psychologica 2002; 3:133-142. 31. Internet Addiction Test. The Internet Addiction Developed by Dr. Kimberly Young, the IAT, this 20-item questionnaire measures mild, moderate, and severe levels of Internet Addiction. Wellness USF. http://www.netaddiction.com/index.php?option=com bfquiz&view=onepage&catid=46& Itemid=106 [Available 10.04.2013] 32. Zboralski K, Orzechowska A, Talarowska M et al. The prevalence of computer and Internet addiction among pupils. Postepy Hig Med Dosw 2009; 2(63): 8-12. 33. Weinstein A, Lejoyeux M. Internet addiction or excessive internet use. Am J Drug Alcohol Abuse 2010; 36(5): 277-283. 34. Augustynek A. Kryteria diagnostyczne rozpoznania zespołu uzależnienia od Internetu. http://www.psychologia.net.pl/artykul.php?level=125 [Available 10.04.2013]. 35. Peukert P, Sieslack S, Barth G et al. Internet and computer game addiction: phenomenology, comorbidity, etiology, diagnostics and therapeutic implications for the addictives and their relatives. Psychiatr Prax 2010; 37(5): 219-24. 36. Pawłowska B, Potembska E. Właściwości psychometryczne Kwestionariusza do Badania Uzależnienia od Internetu (KBUI). Badania nad Schizofrenią (2009);10(10): 310-321. 37. Yang LS, Zhang ZH, Hao JH et al. Association between adolescent internet addiction and suicidal behaviors. Zhonghua Liu Xing Bing Xue Za Zhi 2010; 31(10): 1115-1119. 38. Suhua Y, Hongjun G, Yajing T et al. The Relationship between Daily Stress and Internet Addiction of Boys from the Higher Vocational College: The Regulating Role of Social

209 Supporty. 2012 International Conference on Education Technology and Management Engineering Lecture Notes in Information Technology 2012, 16-17. [on-line] http://www.ier-institute.org/2070-1918/lnit16/v16/081.pdf 39. Poli R, Agrimi E. Internet addiction disorder: prevalence in an Italian student population. Nord J Psychiatry 2012; 66(1): 55-59. 40. Cao H, Sun Y, Wan Y et al. Problematic Internet use in Chinese adolescents and its relation to psychosomatic symptoms and life satisfaction. BMC Public Health 2011;

1 1 ( 1 ): 802. 41. Krajewska-Kułak E, Kułak W, Van Damme-Ostapowicz K et al. Uzależnienie od Internetu wśród studentów kierunku pielęgniarstwo. Probl. Hig Epidemiol 2010; 91(1): 41-47. 42. Park SK, Kim JY, Cho CB. Prevalence of Internet addiction and correlations with family factors among South Korean adolescents. Adolescence 2008; 43(172): 895-909. 43. Lićwinko J, Krajewska-Kułak E, Łukaszuk C. Internet addiction academic youth Internet addiction among academic youth in Białystok. Prog Health Sci 2011; 1(1): 124-130. 44. Ko Ch, Hsiao S, Yen JY et al. The characteristics of decision making, potential to take risks, and personality of college students with Internet addiction Psychiatry Res 2010; 175:121-125. 45. Cheung LM, Wong WS. The effects of insomnia and internet addiction on depression in Hong Kong Chinese adolescents: an exploratory cross-sectional analysis. J Sleep Res 2011; 20(2): 311-317. 46. Siomos KE, Dafoul ED, Braimiotis DA et al. Internet addiction among Greek adolescent students. Cyberpsychol Behav 2008; 11: 653-657. 47. Niemz K, Griffiths M, Banyard Ph. Prevalence of Pathological Internet Use among University Students and Correlations with Self-Esteem, the General Health Questionnaire

(GHQ), and Disinhibition. CyberPsychology & Behavior 2005; 8 (6 ): 562-570. 48. Janocha A, Klimatskaya LG. Internet Addiction Disorder in pupils and students of Krasnoyarsk (Russia) and Wroclaw (Poland). Hygeia Public Health 2011; 46(4): 448 451. 49. Moreno MA, Jelenchick L, Cox E et al. Problematic Internet Use Among US Youth: A Systematic Review. Arch Pediatr Adolesc Med 2011; 165(9): 797-805. 50. Fortson BL, Scotti JR, Chen YC et al. Internet use, abuse, and dependence among students at a southeastern regional university. J Am Coll Health 2007; 56 (2): 137-144.

210 51. Skrzypulec-Plinta V, Woronowicz BT, Wojewódzka B et al. Wolni od uzależnień behawioralnych. Regionalny Ośrodek Polityki Społecznej, Opole 2012. 52. Kupfer D. The Future of Psychiatric Diagnosis. http://www.dsm5.org/Pages/Default.aspx [Available 10.04.2013].

48; 5% 21; 2% □ gimnazja publiczne

■ gimnazjum prywatne

EU licea ogólnokształacące

□ liceum prywatne

01 liceum profilowane

□ technikum publiczne 40; 4% V5 ■ technikum prywatne 25; 3% 48; 5% 5 szkoła zawodowa

Ryc. 1. Badani uczniowie według rodzajów szkół (n; %) Fig. 1. Numbers o f students in each type of school (n; %)

211 Ryc. 2. Badani uczniowie według grup wieku (n; %) Fig. 2. The age structure o f all surveyed students (n; %)

212 Nie pamiętam 37 (9,9%)

Nie 160 (42'8%)

Так, гаг czy dwa razy 93 (24,9%)

Tak, wiele razy 84 (22,5%)

20 40 60 80 100 120 140 160 180

Ryc. 3. Odpowiedzi gimnazjalistów na pytanie: „Czy Twoi bliscy wyrażają/wyrażali opinię, że zbyt wiele czasu „siedzisz przy komputerze”?” (n; %) Fig. 3. The answers to the question ” Has it ever happened that someone in your family has suggested that you have used your computer for too long?” given by secondary school students (n; %)

213 O 50 100 150 200 250 300

Ryc. 4. Odpowiedzi uczniów szkół ponadgimnazjalnych na pytanie: „Czy Twoi bliscy wyrażają/wyrażali opinię, że zbyt wiele czasu „siedzisz przy komputerze”?” (n; %) Fig. 4. The answers to the question " Has it ever happened that someone in your family has suggested that you have used your computer for too long?” given by upper secondary school students (n; %)

214 O 50 100 150 200 250 300 350

Ryc. 5. Odpowiedzi gimnazjalistów na pytanie: „Czy Twoi znajomi/koledzy, koleżanki wyrażają/wyrażali opinie, że zbyt wiele czasu „siedzisz przy komputerze”? (n; %) Fig. 5. The answers to the question " Has it ever happened that someone from your friends has suggested that you have used your computer for too long?” given by secondary school students (n;%)

215 O 100 200 300 400 500

Ryc. 6 . Odpowiedzi uczniów szkół ponadgimnazjalnych na pytanie: „Czy Twoi znajomi/koledzy, koleżanki wyrażają/wyrażali opinie, że zbyt wiele czasu „siedzisz przy komputerze”?” [n;(%)] Fig. 6. The answers to the question " Has it ever happened that someone from your friends has suggested that you have used your computer for too long?” given by upper secondary school students [n;(%)]

216 Ryc. 7. Odpowiedzi gimnazjalistów na pytanie: „Czy uważasz się za osobę uzależnioną od Internetu?” (n; %) Fig. 7. The answers to the question „Do you consider yourself addicted to Internet?” given by secondary school students (n; %)

217 Nie mam zdania 145 (8,3%)

Nie 453 (83,6%)

Так ■44 (8,1%) 100 200 300 400 500

Ryc. S. Odpowiedzi na pytanie: „ Czy uważasz się za osobę uzależnioną od Internetu?” wśród uczniów szkół ponadgimnazjalnych (n; %) Fig. 8. Answers to the question: "Do you consider yourself addicted to Internet?" given by high upper secondary school students (n;%)

21S Oznaczenia: 1/2 - odpowiedź pierwsza lub druga 1/2/3 - odpowiedź pierwsza, druga lub trzecia 2/3 - odpowiedź druga lub trzecia 3/4 - odpowiedź trzecia lub czwarta

Ryc. 9. Liczba i odsetek uczniów gimnazjum, którzy odpowiedzieli na poszczególne pytania w sposób sugerujący obecność uzależnienia od Internetu (pytania wyszczególnione w tabeli I) (n; %) Fig. 9. Number o f secondary school students who responded to each question in a way that suggested the presence o f Internet addiction(questions are listed in Table I) (n; %)

219 Oznaczenia: 1/2 - odpowiedź pierwsza lub druga 1/2/3 - odpowiedź pierwsza, druga lub trzecia 2/3 - odpowiedź druga lub trzecia 3/4 - odpowiedź trzecia lub czwarta

Ryc. 10. Liczba i odsetek uczniów szkół ponadgimnazjalnych, którzy odpowiedzieli na poszczególne pytania, w sposób sugerujący obecność uzależnienia od Internetu (pytania wyszczególnione w tabeli I) (n; %) Fig. 10. Number o f upper secondary school students who responded to each question in a way that suggested the presence o f Internet addiction (questions are listed in Table I) (n; %)

220 Tabela I. Kategorie odpowiedzi, które uznano za obecności uzależnienia od Internetu Table I. Answers that were considered suggestive o f the possibility o f the presence o f Internet addiction L .p. Odpowiedzi, które uznano za sugerujące możliwość Treść pytania uzależnienia (numer odpowiedzi w pytaniu) Numer Numer pytania

1 17 Jak długo potrafiłbyś/potrafiłabyś wytrzymać „dzień (3)” lub „mam bez Internetu? potrzebę codziennego korzystania (4)”

2 19 Jaki wpływ na Twój nastrój ma brak kontaktu „pogarsza nastrój (3)” lub z Internetem? „powoduje rozdrażnienie lub agresję (4)”

3 2 0 Jaki wpływ na Twój nastrój ma kontakt z „poprawia nastrój (2 )” Internetem?

4 2 1 Czy korzystanie z Internetu jest Twoim „tak ( 1 )” sposobem na ucieczkę od problemów i/lub poprawę nastroju?

5 2 2 Czy miewasz poczucie, że zbyt wiele czasu „tak, zawsze ( 1 )” lub „tak,

spędzasz w wirtualnym świecie? czasami (2 )”

6 24 Czy Twoi bliscy wyrażają/wyrażali opinię, że „tak, wiele razy ( 1 )” lub „tak,

zbyt wiele czasu „siedzisz przy komputerze”? raz czy dwa (2 )”

7 25 Czy Twoi znajomi/koledzy wyrażają/wyrażali „tak, wiele razy ( 1 )” lub „tak,

opinię, że zbyt wiele czasu „siedzisz przy raz (2 )” komputerze”?

8 26 Czy zdarzyło Ci się skłamać, aby odeprzeć „tak, wiele razy ( 1 )” lub „tak,

zarzuty raz (2 )”. o Twoim zbyt częstym, zbyt długotrwałym korzystaniu z komputera?

9 27 Czy zdarza/zdarzyło Ci się zaniedbywać „tak, codziennie ( 1 )” lub obowiązki szkolne (odrabianie lekcji, nauka „tak, kilka razy w tygodniu

własna, obecność (2 )” w szkole) z powodu zbyt długiego „siedzenia

221 przy komputerze”?

1 0 28 Czy zdarza/zdarzyło Ci się zaniedbywać „tak, codziennie ( 1 )” lub obowiązki domowe z powodu zbyt długiego „tak, kilka razy w tygodniu

„siedzenia przy komputerze”? (2 )” lub „tak, kilka razy w miesiącu (3)”

1 1 29 Czy zdarzyło Ci się zrezygnować ze spotkania ze „zdarzyło mi się kilka razy

znajomymi/ przyjaciółmi, gdyż kolidowało to (2 )”, lub „często mi się to z Twoimi planami korzystania z Internetu? zdarza (3)”

1 2 30 Czy uważasz, że korzystanie z Internetu miało „tak ( 1 )” wpływ na ograniczenia Twoich kontaktów towarzyskich (brak czasu, brak chęci na spotkania)?

13 31 Czy uważasz, że korzystanie z Internetu „tak ( 1 )” doprowadziło do zerwania kontaktów z Twoją sympatią?

14 32 Czy zdarza Ci się zapomnieć o spożyciu posiłku „tak, często ( 1 )” lub „tak,

z powodu zaabsorbowania pracą z komputerem? kilka razy w tygodniu (2 )”, lub „tak, kilka razy w miesiącu (3)”

15 33, Czy zdarza/zdarzyło Ci się „zarwać” noc po to, „tak, często ( 1 )” lub „tak,

34, by: grać w gry komputerowe/sieciowe, kilka razy w tygodniu (2 )”, 35, prowadzić „czat” lub w inny sposób lub „tak, kilka razy w 36 kontynuować kontakty z innymi użytkownikami miesiącu (3)” (te pytania sieci, by pisać bloga, by korzystać ze stron zostały potraktowane internetowych z treściami przeznaczonymi tylko zbiorczo, ponieważ pytają dla dorosłych? one o „zarywanie nocy” z powodu różnych aktywności związanych z korzystaniem z sieci)

16 37 Czy zdarza Ci się, że „siedzisz przy komputerze” „tak, często ( 1 )” lub „tak,

dłużej, niż zaplanowałaś/zaplanowałeś? kilka razy w tygodniu (2 )”, lub „tak, kilka razy w

222 miesiącu (3)

17 38 Czy komputer/Internet absorbuje Cię w taki „tak, często ( 1 )” lub „tak,

sposób, iż nie przestajesz o nim myśleć nawet po kilka razy w tygodniu (2 )” odejściu od stanowiska komputerowego? lub „tak, kilka razy w miesiącu (3)”

18 39 Czy uważasz, że korzystając z Internetu, „tak ( 1 )” angażujesz się w znajomości, których by nie pochwalali Twoi bliscy?

19 40 Czy korzystasz z komputera w godzinach „tak, często ( 1 )” lub „tak,

porannych, jeszcze przed spożyciem śniadania? kilka razy w tygodniu (2 )” lub „tak, kilka razy w miesiącu (3)”

Tabela II. Uzależnienie od Internetu (UI)- statystyka - przegląd danych z dostępnego piśmiennictwa Table II. The Internet addiction - statistics - the accessible literature review

l-H M £ N <0 o ^ r o ci *73 Q Uh o Opis ć grupy diagnostyc grupy piśmienni badanej Liczebnoś badanej Pozycja o S ¡2 P£h Narzędzia

1 1,5-8,2 nieokreślona metaanaliza Europa i USA 2 0 0 0 MIX [33] 2009 2 1,31-4,5 studenci AGH 2177 Polska/Kraków 2 0 1 1 QA [34]

3 1,5-3,5 nastolatki metaanaliza Niemcy 2 0 1 0 MIX [35]

4 3,5 wiek 13-24 lat 519 Polska/Lublin 2 0 1 0 IAT [36] 2 0 1 1 5 5,0 studenci 3507 Chiny 2 0 1 0 QA [37]

6 5,0-16,85 studenci metaanaliza Chiny 2006 MIX [38] 2008 7 5,8 uczniowie 2533 Włochy 2 0 1 1 IAT [39]

8 8 ,1 nastolatki 17599 Chiny 2 0 1 1 YIAT [40]

9 10,3 studenci wydziału 232 Polska/Lublin 2 0 1 1 IAT [41] pielęgniarstwa 1 0 10,7 nastolatki 903 Korea Płd. 2008 IAS [42]

223 1 1 11,3 studenci 300 Polska 2 0 1 1 DQIA [43] Białystok 1 2 17,0 studenci 2 1 б Tajwan 2008 DIIA [44]

13 17,2 nastolatki 719 Chiny/ 2 0 1 1 CIAS [45] Hong-Kong 14 18,0 uczniowie - nastolatki 2 2 0 0 Grecja 2008 IAT [4б] 15 18,3 studenci 371 Wielka 2005 PIUs [47] Brytania 16 25,0 13-30 lat 39б Rosja/ 2 0 1 0 IAT [48] Krasnojarsk 17 25,0 uczniowie szkół 1 2 0 Polska/Łódź 2009 45IAQ [32] podstawowych, gimnazjów i szkół ponadgimnazjalnych 18 do 2 б,2 studenci i uczniowie metaanaliza USA 2 0 1 0 MIX [49] szkół średnich, wiek 12-29 lat 19 40 studenci 2 1 б Tajwan 2008 DIIA [44]

2 0 50 studenci studiów 411 USA 2007 IUQ [50] licencjackich Oznaczenia: 45IAQ - 45-item Internet Addiction Test UI - Uzależnienie od Internetu CIAS - Chinese Internet Addiction Scale DIIA - Diagnostic Interview for Internet Addiction DQIA - Diagnostic Questionnaire for Internet Addiction IAS - Internet Addiction Scale IAT - The Young's Internet Addiction Test IUQ - The Internet Usage Questionnaire MIX - różne (metaanalizy) PIUs - Pathological Internet Use scale QA - autorski kwestionariusz (bez nazwy) YIAT - Young Internet Addiction Test

Conflict of interest: None declared.

Received: 25.02.2013. Revised: 15.04.2013. Accepted: 07.06.2013.

224 Journal of Health Sciences (J for the Ss H) 2013; 3 (5): 225-240 The journal has had 4 points in Ministry of Science and Higher Education of Poland parametric evaluation. B letter item 683.

THE IMPACT OF TRAINING ON PHYSICAL FITNESS DEVELOPMENT VOLLEYBALL COURT AND SOMATIC TRAINING ATHLETES BUILD VOLLEYBALL

Wpływ treningu siatkarskiego na rozwój sprawności fizycznej i budowy somatycznej zawodniczek trenujących siatkówkę

Mirosława Cieślicka 1, Ewa Kuźniewska 1 , Błażej Stankiewicz 1, Walery 2 Zukow

1Institute of Physical Culture University of Kazimierz Wielki, Bydgoszcz, Poland 2 University of Economy, Bydgoszcz, Poland

Number of characters: 30 000 (with abstracts). Number of images: 0 x 1000 characters (lump sum)= 0 characters. Total: Number of characters: 30 000 (with abstracts, summaries and graphics) = 0,75 spreadsheets publishing.

Key words: volleyball, motor efficiency, somatic construction.

Słowa kluczowe: trening, siatkówka, sprawność motoryczna, budowa somatyczna.

A bstract The purpose of the research was to obtain information on the development of somatic and motoric children aged 10-13 years training of volleyball physical ability test in order to obtain the needed results to determine the ability of regional studies carried out by Marek Napierała in 2001. Comparison of characteristics of somatic and motor skills to regional results (Napierałą., 2005). To achieve this objective anthropometric measurements are made and used the international physical agility Test. Of the eight trials performed six selected. Pominęłam attempting to cross country skiing: at 50 meters and 600 or 800 metres due to inclement aura. The resulting research material allowed for a comparison of somatic traits as well as the level of motor skills for research results regional of the Kuyavian-Pomeranian Voivodeship, carried out in 2001 by M. Napierała. Analyzing the results obtained and the use of research findings should be regional, the following conclusions: 1 . Based on the test results it can be concluded that not all the data being compared are similar to the results of research. 2. Somatic Characteristics, such as weight and height of the body differ statistically significantly explored women's CEV group. It was noted that the development of the somatic features is properly followed by their increase with age. 3. Of the six tests carried out, four of them girls with personal research are better developed mobility capabilities. This is in the long jump, hand force measurement using dynamometer, swinging and 4 x 10 with back rest sits. Try on hands and knees bent overhang slope trunk in front have brought better results girls not engaged in sports. 4. Applications may be made for the teachers, which not all motor skills in high school sports are at the highest level. It should focus on strengthening the muscles of the shoulders which shows an attempt to overhang and shaping flexibility among girls.

225 Streszczenie

Celem badań było: Uzyskanie informacji o rozwoju somatycznym i motorycznym dzieci w wieku 10- 13 lat trenujących siatkówkę. Przeprowadzenie testu sprawnościowego w celu uzyskania wyników potrzebnych do określenia zdolności odbiegających od badań regionalnych przeprowadzonych przez Marka Napierałę w 2001 roku. Porównanie wyników cech somatycznych i zdolności motorycznych do wyników regionalnych (Napierałą M., 2005). Do zrealizowania tego celu wykonałam pomiary antropometryczne oraz wykorzystałam Międzynarodowy Test Sprawności Fizycznej. Spośród ośmiu prób przeprowadziłam sześć wybranych. Pominęłam próby biegowe: na 50 metrów oraz 600 lub 800 metrów ze względu na niesprzyjającą aurę. Otrzymany materiał badań pozwolił na porównanie cech somatycznych a także poziomu zdolności motorycznych do wyników badań regionalnych województwa kujawsko- pomorskiego przeprowadzonych w 2 0 0 1 roku przez M. Napierałę. Analizując uzyskane wyniki badań własnych oraz wykorzystanie wyników badań regionalnych należy sformułować następujące wnioski: 1. W oparciu o wyniki testu nie można stwierdzić, że wszystkie porównywane dane są zbliżone do wyników badań regionalnych. 2. Cechy somatyczne, takie jak masa i wysokość ciała różnią statystycznie istotnie badane grupy siatkarek. Zauważono, że rozwój cech somatycznych przebiega w sposób prawidłowy następuje ich przyrost wraz z wiekiem. 3. Spośród sześciu przeprowadzonych prób, w czterech z nich dziewczęta z badań własnych charakteryzują się lepiej rozwiniętymi zdolnościami motorycznymi. Dotyczy to skoku w dal z miejsca, pomiaru siły dłoni za pomocą dynamometru, biegu wahadłowego 4x10 metrów oraz siadów z leżenia tyłem. Próby zwisu na ugiętych rękach i skłonu tułowia w przód przyniosły lepsze rezultaty dziewczętom nie uprawiającym sportów. 4. Sformułowane wnioski mogą być informacją dla nauczycieli, że nie wszystkie zdolności motoryczne w szkole sportowej są na najwyższym poziomie. Należałoby się skupić na wzmacnianiu mięśni ramion co wykazuje próba zwisu oraz na kształtowaniu gibkości wśród dziewcząt.

Introduction A huge base of creating and using various methods of the evaluation of the physical fitness exists. Many researchers dealt at their works with the issue motoricity and of physical development. They were applied for the first time in the United States amongst students, since the physical education started enveloping colleges also. In 1861 Edward Hitchcock at university in Amherst initiated checking mass and the height and measurements of various parts bodies. He performed these measurements systematically through 50 consecutive years. In 1875 in Harward dr Dudley Allen Sargent commenced tests of the physical fitness amongst students. Surprising results attesting to developmental abnormalities of examined individuals, contributed to the fact that dr Sargent commenced creating rises and devices. With their help strengthening muscles during exercises was supposed to be simpler and more effective. However the turning point in tests took place after the completion of World War II. American

226 scientists used statistical methods for creating tests what was an unknown phenomenon. Then thanks to these methods, in Europe attempts to construct new gauges were commenced. In this field among others Ozierecki was a European initiator from the USSR which created the "Scale of Ozierecki" (Pilicz, 1997). Tests above motoricity apart from world researchers also Poles took. With precursors in carrying out research above motoricity in Poland L. Dudrewicz, F. Suligowski and W. Kosmowski are. They were initiated at the end of the 19th century. In the 20th century however J. Tałko-Hyncewicz undertook tests of the development of children in Cracow and completed them A. Wrzosek and B. Jasicki (Malinowski, 1976). In the interwar period S. Kopczyński, J. Bogdanowicz, M. Ćwirko-Godycki entered improved circuit races into the evaluation of the physical development at school they served to more of objective assessment (Mroczyński, 1975). Both in Poland and in the world different authors made attempts to improve existing already tests or created completely new. At the beginning of the 20th century in Poland a "Measure of the physical fitness" was most well-known J. Mydlarski. In the more late period he had his continuators among others: Trześniowski, Denisiuk, Gniewkowska (Szopa, 1996). From foreign tests which are exploited up till today, an International Test of the physical fitness and a European Test are most popular of Eurofit physical fitness. For popularities of it first a fact that repeatedly they used it in master's theses of different kind decides whether scientific (Pilicz, 1997). A physical development is nothing else as "... transformations which they take for so compound, so precise and excellent forming from the straight the cellular structure of creature a body of the adult man is which" (Bogdanowicz, 1962). Notion motoricity however explicitly isn't defined. Many is of authors a lot we find of meanings. By Demel and Skład sentence and sets "a motor activity or a human motorness are comprehending including the entirety of locomotions of the man, or- the sphere of the motor activity, with word, that's all what regarding moving of man in the space as a result of changes of putting the whole body or individual his parts towards oneself" [1970]. Tests were fulfilled on the group of girls in the century of 10-13 years attending the sports school and practicing the volleyball. An attempt to obtain information about the somatic and motor development was a purpose of research of girls practicing the volleyball. They conducted research with the help of the International Test of the physical fitness obtained information took the liberty of comparing own findings to regional findings conducted by Marek Napierała in 2001 in the province Kuyavian-Pomeranian.

Purpose of the work

227 It was a cognitive purpose of the work: Getting of information about the somatic and motor development children in the century 10 - 13 years practicing the volleyball. Conducting a fitness test in order to achieve results needed for determining diverging fitnesses from regional tests conducted by Marek Napierała in 2001. Comparing conclusions of somatic trademarks and motor abilities to regional results (Napierałą M., 2005).

Material and methods

Tests of the somatic development and motor abilities were conducted in October 2012 in the Primary School No. 31 in Bydgoszcz. In the Primary School No. 31 schoolgirls were subjected to fulfilled tests from volleyball classes IV- VI. Altogether 43 girls which were present then on classes were examined. They made measurements of the height and the body weight as well as on schoolgirls tests on a fitness test were performed. Tests of the somatic level of development were fulfilled in the cooperation with the school nurse. During performing efficiency tests teachers of the physical education offered help. Conducting research for every class lasted 2 days on account of class conditions.

Material and methods

Schoolgirls were subjected to the evaluation of the somatic development and the level of motor abilities based on the International Test of physical fitness. They made the first measurement, i.e. the height and the body weight in the study of the school nurse with her help. At this target they used the medical weight range with the moved measure. The height of the body was measured with the accuracy up to 0.1 cm. The examined person was placed I put on weight to heightmeter. One should assume the standing attitude erect, shoulders freely left along the body, clenched lower limbs with heels and lightly deployed in feet, head situated in the Frankfurt plain (Drozdowski, 1998). The body weight was determined with the accuracy up to 0.1 kg. During the measurement one should stand up in the center of the medical scale. A sportswear consisting of the T-shirt applied to examined persons and of pants without the footwear. Performing anthropometric measurements enabled to favor types of figures according to the division of Kretschmer: The athletic type is characterized by a quite strong build and a considerable musculature, the neck, barges and the chest have wider dimensions. The pyknic- type is characterized by a small skeleton, with weak musculature, the neck and lower limbs are short, wide face similarly to barges and the pelvis. People with this structure 228 have a tendency to put on weight. The leptosomatic- type is characterized by a slender build, with low body weight, face and neck a little bit are prolonged, barges and the hoop pelvis are narrow, chest relatively flat, lower limbs are slim without visible traces of the musculature (Godycki, 1956).

Dividing specimens to individual types, one should use pointers F. Curtius with using the Rohrer indicator (Drozdowski, 1982). He introduces himself as follows:

Weight of the body [g]

X = ------x of the 100%

Height of the body [cm3]

Below norms were presented:

• Leptosomatic type x- 1.27 • Athletic type 1.28 - 1.49 • Pyknic type 1.50 - x The physical fitness of girls was assessed with the International Test of the physical fitness. Before commencing tests one should perform the warm-up like for intensive exercises. The dress should comprise from the T-shirt and pants and the casual, without spikes and stakes, about the nonslippery sole (Pilicz, 2005). The test contains eight tests. Schoolgirls from SP were subjected to No. 31 six chosen. Runs were omitted: to 50 meters and 600 or 800 (depending on the age). One should perform tests in the determined order within two days. The first day is recommended to conduct the race on distance of 50 m, the long jump from the place and the prolonged run. Of the second day measurement of the force of the hand, measurement of the force relative, pendular run, sitting positions from lying I put on weight during 30 seconds and the bend of the torso ahead in standing. There is also a feasibility of all one day but one should then leave the prolonged run in the end (Pilicz, 2005). Conducted tests of the somatic development and motor abilities provided with results which were subjected to a statistical analysis. At this work essential sizes were established for the test of research material: arithmetic mean, standard deviation, coefficient of variation. Achieved results were

229 interpreted as well as provinces were compared with regional tests Kuyavian-Pomeranian conducted in 2001 by Marek Napierała at chosen schools. Statistical calculations were performed using a computer program Microsoft Excel 2003.

Results

Table 1. Numerical characterization of heights of the body of girls practicing the volleyball

Class N Min. Max Arithmetic Standard Coefficient of value value mean deviation variation

[ X ] [о] [V]

IV 15 133 158 147 7.9 0.05

V 15 139.5 165 153 7.4 0.05

VI 13 153.3 172.5 165 4.9 0.03

It results from conducted tests that the height of the body of girls practicing the volleyball demonstrates the upturn along with age. It is possible to notice a big difference among the V but VI class, where the arithmetic mean in the class V is 153 cm, however in the class VI of 165 cm. They also noticed that among these groups a big difference of standard deviations appeared. In the fifth class 7.4 cm but the arithmetic mean of 153 cm amount to the standard deviation. It means that heights of the body of individual girls deviate from the value of the arithmetic mean on average for 7.4 cm in one or into the other side. However in the sixth class this deviation is an only 4.9 cm.

Table 2. Comparing findings of own heights of the body of girls to regional findings of the province Kuyavian-Pomeranian 2001 r. M. Napierała

Own tests Regional tests Difference

230 Class N x N x [d] IV 15 147 1553 144 3 V 15 153 837 149 4 VI 13 165 973 156 9

Comparing findings own up to regional results to notice it is possible in one and in second increase in the height of the body along with age. The average of the increase of girls practicing the volleyball in all classes is higher than peers from chosen schools of the province Kuyavian-Pomeranian. It is connected probably with a specificity of the practiced sport. In the class IV, in the V- class of 4 cm, however the difference of the height is 3 cm in the class VI she is biggest and is an as many as 9 cm.

Table 3. Numerical characterization of the body weight of girls practicing the volleyball.

Class N Min. Max Arithmetic Standard Coefficient of value value mean deviation variation [ x ] [о] [V]

IV 15 26.9 52.9 37.4 8 .2 0 . 2 2

V 15 31.7 56.7 41.5 7 0.17

VI 13 43.4 57.8 50.7 4.7 0.09

Checking the body weight shows the height along with age. A big difference is observed among the V but VI class i.e. between girls 11.5 - summer and 12.5 - summer. In the group of fifth-graders the average of the body weight is 41.5 kg and in the group of sixth- grade girls this as many as 50.7 kg is. However in the class IV it is possible to notice the big divergence of results between the minimum value which is 26.9 kg and the maximum value being 52.9 kg.

Table 4. Comparing own findings of the body weight of girls to regional findings of the province Kuyavian-Pomeranian 2001 r. M. Napierała

231 Own tests Regional tests Difference

Class N x N x [d]

IV 15 37.4 1153 34.8 2 .6

V 15 41.5 837 39.3 2 . 2 VI 13 50.7 918 45.0 5.7

Table 4 comparing own findings and regional tests contains. An upturn is observed along with age. The arithmetic mean of the body weight demonstrates greater values at girls from the sports school. In the fourth class the difference is 2.6 kg, in the fifth class 2.2 kg, however in the sixth class it is largest and is 5.7 kg.

Table 5. Characteristics of types of the build

TYPE OF THE STRUCTURE GROUP LEPTOSOMATICATHLETICPICNIC N%N%N%

Class IV 1 1 73.33 3 2 0 1 6 .6 6

Class V 1 2 80 3 2 0 0 0

Class VI 1 0 76.9 3 23.10 0 0

Analyzing the percentage share of individual types of the build, in all classes a majority of the leptosomatic type is noticed. One by one in the IV- class, in the V- class of the 80%, however he amounts to the 73.33% in the VI- class of the 76.9%. How the type results from the table picnic that is tied overweight appears only at one person. Such a schedule of types of the structure is natural, persons put through an examination attend the sports school and trainings are an indelible part of their life. And so the increased motor activity causes the weight loss.

232 Table 6. Numerical characterization of results of the long jump from the place of girls practicing the volleyball.

Class N Min. Max Arithmetic Standard Coefficient of value value mean deviation variation

[ x ] M [V]

IV 15 115 190 158 22.7 0.14

V 15 143 2 0 0 172 16.3 0.09

VI 13 130 214 168 21.16 0.13

Analyzing figures of the long jump right away they notice that an increase in results doesn't appear along with age. The arithmetic mean in the fourth class is 158 cm, in the fifth class grows to 172 cm, and in the sixth class falls up to 168 cm. Biggest dispersing results watches each other between girls from the fourth class, where the standard deviation is 22.7 cm but with girls from the fifth class at the standard deviation equal of 16.3 cm.

Table 7. Comparing own findings of the long jump from the place of girls to regional findings of the province Kuyavian-Pomeranian 2001 r. M. Napierała

Own tests Regional tests Difference

Class N x N x [d]

IV 15 158 799 147 1 1

V 15 172 743 162 1 0 VI 13 168 461 163 5

No. 7 results from the table that in regional tests one can see the upturn along with age what isn't transferred into own tests. Mean of the long jump right away are higher at girls practicing the volleyball. In the class IV and V significant differences are noticed between peers whom they take out one by one 11 and 10 cm. In the sixth class however this difference is slight, because is an only 5 cm.

233 Table 8. Numerical characterization of gripping the dynamometer of girls practicing the volleyball.

Class N Min. Max Arithmetic Standard Coefficient of value value mean deviation variation [ x ] [о] [V]

IV 15 5 40 22.7 1 0 .8 0.48

V 15 2 0 50 31 6.9 0 . 2 2

VI 13 30 70 47 11.5 0.24

The above table presents the schedule of mean of gripping the dynamometer amongst girls. In the fourth class this average is 22.7 kg at individual hesitations by 5 kg up to 40 kg, in the fifth class the average takes out 31 at individual hesitations by 20 kg up to 50 kg, however in the sixth class the average takes out 47 at individual hesitations by 30 kg up to 70 kg. Observed dynamics of results appear along with age. The greatest departure from the mean appears in the class VI and is exactly 11.5 kg.

Table 9. Comparing own findings of gripping the dynamometer of girls to regional findings of the province Kuyavian-Pomeranian 2001 r. M. Napierała

Own tests Regional tests Difference

Class N x N x [d] IV 15 22.7 617 16.2 6.5 V 15 31 603 18 13

VI 13 47 374 2 0 27

The table contains No. 9 comparing of the value gripping the dynamometer of tests of own girls conducted on the group practicing the volleyball but regional examinations

234 conducted in 2001 through M. Napieral^ at elementary schools not specializing in sports practices. Mean are higher at girls from own tests and demonstrate significant differences. In the class IV this 6.5 kg is, in the class V of 13 kg but in the class VI of the as many as 27 kg. Volleyball players are characterized by greater power which undoubtedly is developed during trainings.

Table 10. Numerical characterization of the overhang on bent hands of girls practicing the volleyball.

Class N Min. Max Arithmetic Standard Coefficient of value value mean deviation variation

[ x ] M [V]

IV 15 0 32.95 10.4 10.4 1

V 15 0 19.12 7.7 5.9 0.77

VI 13 0 27.84 7.29 7.6 1.04

Mean of the overhang on the bar show the inheritance along with age. An increase in the body weight and lowering the centre of gravity at puberty can be a cause of such a state. In every of examined groups minimum values amount to 0 sec. The most dispersed value of the standard deviation appears at girls 10.5 - summer. In this group the average of the overhang amounts to 10.4 sec. Numerical values of individual girls deviate from this value on average about 10.4 sec. in one as well as into the other side.

Table 11. Comparing own findings of the overhang on bent hands of girls to regional findings of the province Kuyavian-Pomeranian 2001 r. M. Napierała

Own tests Regional tests Difference

Class N x N x [d] IV 15 10.4 985 15.4 -5

235 V 15 7.7 816 15.5 -7.8 VI 13 7.29 361 14 -6.71

Comparing the test results of both tests much lower mean are observed at girls from the sports school. In from 2001 one can see tests uptick of mean between the class IV and V and fall between the class V and VI. to sum up it is possible to state that girls practicing the volleyball are characterized smaller strength of muscles of shoulders unlike friends.

Table 12. Numerical characterization of the pendular run of girls practicing the volleyball.

Class N Min. Max Arithmetic Standard Coefficient of value value mean deviation variation [ x ] [о] [V]

IV 15 1 0 .6 6 13.78 12.04 0.84 0.07

V 15 10.51 13.36 1 1 . 8 0 .6 8 0.06

VI 13 10.39 12.03 11.32 0.52 0.05

It results from conducted tests that the arithmetic mean of the agility run demonstrates dynamics of the development. At fourth-year pupils on the level 12.04 sec. is molded, at fifth- graders amounts to 11.8 sec., and at sixth-grade girls amounts to 11.32 sec. This situation shows the enhancement of the agility capacity and high-speed from the year for the year. Values of deviation aren't defeated by a considerable dispersion. They take out one by one 0.84 in the class IV, 0.68 in the class V and 0.52 in the class VI.

Table 13. Comparing own findings of the pendular run of girls to regional findings of the province Kuyavian-Pomeranian 2001 r. M. Napierała

Own tests Regional tests Difference

Class N x N x [d] IV 15 12.04 1063 13.57 1.53

236 V 15 1 1 . 8 1 1 2 1 12.96 1.16 VI 13 11.32 1123 12.76 1.44

The above table depicts comparing mean of the pendular run. In both tests dynamics of the development are noticed. However girls practicing the volleyball achieved good results definitely. Difference between one and second amounts one by one to 1.53 sec. in the class IV, 1.16 sec. in the class V and 1.44 sec. in the class VI.

Table 14. Numerical characterization of sitting positions from lying I put on weight of girls practicing the volleyball.

Class N Min. Max Arithmetic Standard Coefficient of value value mean deviation variation

[ x ] M [V]

IV 15 1 2 27 19.5 4.2 0 . 2 2

V 15 18 32 25 3.3 0.13

VI 13 14 33 23.23 4.8 0 . 2 1

The table shows No. 13 results of mean of performed sitting positions from lying I put on weight. The average in the fourth class amounts to 19.5 repeating at individual hesitations from 12 to 27 of repeating. In the fifth class the average takes out 25 of repeating at individual hesitations from 18 to 32 of repeating. In the sixth class this average amounts to 23.23 repeating at individual hesitations from 14 to 33 of repeating. The good result was observed at girls 11.5 - summer. The greatest departure from the mean appears in the class VI and amounts to 4.8 repeating.

Table 15. Comparing findings of own sitting positions from lying with the back of girls to regional findings of the province Kuyavian-Pomeranian 2001 r. M. Napierała

Own tests Regional tests Difference

237 Class N x N x [d]

IV 15 19.5 1081 19.7 -0 .2

V 15 25 1 0 1 0 20.5 4.5 VI 13 23.23 451 21.16 2.07

Analyzing above material of tests it is possible to notice that in case of own tests the height only watches each other between class fourth and fifth. The regional test in one piece shows the height. Referring to schoolgirls at the age of 10.5 good results reach girls from regional tests than peers from the sports school.

Table 16. Numerical characterization of the bend of the torso ahead of girls practicing the volleyball.

Class N Min. Max Arithmetic Standard Coefficient of value value mean deviation variation [ x ] [о] [V]

IV 15 -17 14 4 7.7 1.9

V 15 - 1 0 13 4.7 6.4 1.36

VI 13 -18 18 7 9.4 1.34

It results from conducted tests that mean of the bend of the torso ahead demonstrate dynamics of the development along with age. Big differences between the minimum value and maximum act in the class VI. the arithmetic mean in this group is 7 cm. Values of individual schoolgirls deviate from this value on average for 9.4 cm and this greatest deviation is.

Table 17. Comparing own findings of the bend of the torso ahead of girls to regional findings of the province Kuyavian-Pomeranian 2001 r. M. Napierała

Own tests Regional tests Difference

238 Class N X N X [d] IV 15 4 814 4.6 -0.4

V 15 4.7 1046 4.9 -0 .2

VI 13 7 517 5.9 1 . 1

Putting mean of individual tests together it is possible to notice the upturn. In the class IV and the V schoolgirls from the sports school achieve poor results from peers from regular schools. In the sixth class the average of the bend is higher at girls training for 1.1 cm. Taking all groups into consideration, girls are characterized by a greater suppleness from regional tests.

Conclusions

The human motor-ness is a comprehensive notion. Along as amended outside internal changes in the human body also happen (Napierała et al.2009, Napierała et al. 2010, Cieślicka et al. 2012). It is associated with the ontogenesis. He depends on many factors in what way and how quickly will occur changes (Pilewska, 2002). For fulfilling this purpose it performed measurements anthropometric and I used the International Test of the physical fitness. Out of eight tests I carried six chosen. I omitted racing tests: to 50 meters and 600 or 800 meters on account of the not-supporting aura. Received material of tests allowed for comparing somatic features as well as the level of motor abilities to regional findings of the province Kuyavian- Pomeranian conducted in 2001 through M. Napierała.

Analyzing obtained findings own and one should formulate using regional findings the following conclusions: 1 . Based on test results it isn't possible to state that all compared data is similar to regional findings. In case of the attempt to grip the dynamometer achieved results are characterized by a considerable divergence. They proved that sixth-grade girls from the sports school were marked over power twice as bigger. It means that the influence of the training on molding the motor ability power is which brings like the most positive effects. Important differences were also noticed in case of the analysis of the results of the test on the overhang on bent hands. However they realized that training girls had achieved far more worse results in this test. In remaining, volleyball players achieved results moved close to peers from regional tests. 2 . Somatic features, so as mass and the height bodies make different statistically indeed examined groups of volleyball players. They noticed that the development 239 of somatic features proceeded in the correct way their increase takes place along with age. 3. Out of six conducted tests, in four of them girls from own tests are characterized by better developed motor abilities. It regarding the long jump right away, of measurement of the force of the hand with the dynamometer, the pendular 4x10 run of meters and sitting positions from lying I put on weight. Tests on the overhang on bent hands and ahead good results brought the bend of the torso to girls not practicing sport. 4. Expressed conclusions can be information for teachers, that not all abilities at the sports school are motorial on the high level. One should concentrate on strengthening muscles of shoulders what the test on the overhang shows and on molding the suppleness amongst girls.

References

Cieślicka M., Dix B., Napierała M., Zukow W., Motor abilities and morphological features students middle school in Powiesk, [w]: Health - the proper functioning of man in all spheres of life, (red.) M. Hagner-Derengowska, W. Zukow, Bydgoska Szkoła Wyższa, Bydgoszcz 2012, s. 131-142 Drozdowski Z., (1998): Antropometria w wychowaniu fizycznym, AWF Poznań fizycznej młodzieży polskiej wg Międzynarodowego Testu Sprawności Fizycznej Kryteria Godycki Z., (1956): Zarys antropometrii, Warszawa Malinowski A., (1976): Dziecko Poznańskie, UAM, Poznań Mroczyński Z., (1975): Dynamika rozwoju fizycznego dzieci a środowisko społeczne. Roczniki naukowe AWF, Gdańsk Napierała M, Muszkieta R, Cieślicka M, Stankiewicz B. Aktywność fizyczna dzieci w wieku wczesnoszkolnym. [w:] (Red.) Zasada M, Klimczyk M, Żukowska H, Muszkieta R, Cieślicka M., Humanistyczny wymiar kultury fizycznej. Bydgoszcz 2010 s. 87-105. Napierała M, Muszkieta R, Cieślicka M, Żukow W. Budowa somatyczna i zdolności motoryczne 15-letnich chłopców z Gimnazjum nr 25 w Bydgoszczy uprawiających kajakarstwo.[w:] (Red.) Marek Napierała, Radosław Muszkieta, Iwonna M. Batyk, Walery Żukow. Wybrane zagadnienia z teorii sportu, żywienia, rekreacji, turystyki i rehabilitacji. WWSTiZ, WSG. ORSE. Poznań - Bydgoszcz. 2009. 185-202 Napierała M., (2005): Ważniejsze uwarunkowania rozwoju somatycznego i motorycznego dzieci i młodzieży z województwa Kuyavian-Pomorskiego, Wyd. Akademii Bydgoskiej im. Kazimierza Wielkiego, Bydgoszcz Pilicz S., (1997): Pomiar ogólnej sprawności fizycznej, AWF, Warszawa Pilicz S., Przewęda R., Dobosz J., Nowacka-Dobosz S., (2005): Punktacja sprawności pomiaru wydolności organizmu Testem Coopera, Studia i Monografie, AWF, Warszawa Pilewska W., 2002 Dobór pod względem budowy somatycznej oraz poziomu zdolności motorycznych par sportowego tańca towarzyskiego reprezentujących odmienne style taneczne/, [w]: Wychowanie fizyczne i sport. Kwartalnik, Tom XLVI, Suplement Nr 1, Część 1. Wydawnictwo Naukowe PWN Warszawa 2002, s.12- 313. Szopa J., (1996): Podstawy Antropomotoryki, Wydawnictwo Naukowe PWN, Warszawa- Kraków

Conflict of interest: None declared.

Received: 25.01.2013. Revised: 15.03.2013. Accepted: 07.06.2013.

240 Journal of Health Sciences (J for the Ss H) 2013; 3 (5): 241-254 The journal has had 4 points in Ministry of Science and Higher Education of Poland parametric evaluation. Part B item 683.

THE IMPACT OF KAYAKING TRAINING ON PHYSICAL FITNESS AND SOMATIC CONSTRUCTION AT THE STAGE OF PREPARATORY TRAINING

Wpływ treningu kajakarskiego na sprawność fizyczną i budowę somatyczną zawodników na etapie treningu przygotowawczego

Mirosława Cieślicka 1 , Barbara Dix 1 , Walery Zukow 2

1Institute of Physical Culture, Kazimierz Wielki University, Bydgoszcz, Poland 2University of Economy, Bydgoszcz, Poland

Number of characters: 25 800 (with abstracts). Number of images: 0 x 1000 characters (lump sum)= 0 characters. Total: Number of characters: 25 800 (with abstracts, summaries and graphics) = 0,645 spreadsheets publishing.

Key words: kayaking training; physical fitness; somatic construction; player preparatory training.

Słowa kluczowe: trening kajakarski; sprawność fizyczna; budowa somatyczna; zawodnik; trening przygotowawczy.

A bstract Determining the condition of motor fitnesses planting children was a purpose of research canoeing on the stage of the basic training relating to not-training peers. These motor abilities which are most important from a point of view of the canoeing training were analysed. It participated in tests of 24 children going in for the canoeing. For analysing gathered research material the following indicators and statistical measures served: the arithmetic mean, the standard deviation and the gravity of differences. They made an appraisal of motor fitnesses with five of eight tests on the International Test of the physical fitness among which they were: Racing speed - time of the run on distance of 50 flat Power (strength of legs) - distance of the long jump from the place. Agility - pendular run 4 x of 10 m with the transfer operation of the block. Strength of the belly muscles - forward bends from lying I put on weight during 30 seconds. Suppleness - depth of the bend of the torso ahead with measurements of the reach of lower limbs. The run on 50 m is aimed at examining the locomotive speed, whereas pendular run 4 x10 m of the sign of the agility in the locomotive move. The long jump right away examines the sign of explosive strength of lower limbs, sitting positions from lying I put on weight during 30 p. however display endurance strength of the belly muscles bend of the torso into the fossa it is a measurement of the suppleness of the installment lędźwiowo - of sacral spine. Conducted tests allowed for making a detailed analysis of the research problem and drawing the following conclusions: 1 . the group analyzed at the work of children is characterized by a normal development of features of motor abilities.

241 2 . students practising the canoeing surpass not-training children in terms of the level of motor abilities, only proved correct in case of the part of conducted attempts. Girls from own tests had good results in a forward bend. In tests on the pendular run, of sitting positions there were better girls from lying and the long jump right away in three age groups from regional tests, and in three remaining canoeists from own tests. However canoeists came out in four tests largely of age groups better than examined from regional tests. Both girls and boys achieved definitely worse results relating to their peers from regional tests in the test on the run on 50 flat 3. canoeists demonstrated the higher speed, power and the power, however girls achieved good results in the test supplenesses.

Streszczenie Celem badań było określenie stanu zdolności motorycznych dzieci uprawiających kajakarstwo na etapie treningu podstawowego na tle rówieśników nietrenujących. Analizie poddano te zdolności motoryczne, które są najważniejsze z punktu widzenia treningu kajakarskiego. W badaniach uczestniczyło 24 dzieci uprawiających kajakarstwo. Do przeanalizowania zgromadzonego materiału badawczego posłużyły następujące wskaźniki i miary statystyczne: średnia arytmetyczna, odchylenie standardowe i istotność różnic. Oceny zdolności motorycznych dokonano za pomocą pięciu z ośmiu prób Międzynarodowego Testu Sprawności Fizycznej, wśród których znalazły się: Szybkość biegowa - czas biegu na dystansie 50 m. Moc (siła nóg) - odległość skoku w dal z miejsca. Zwinność - bieg wahadłowy 4 x 10 m z przenoszeniem klocka. Siła mięśni brzucha - skłony w przód z leżenia tyłem w czasie 30 sekund. Gibkość - głębokość skłonu tułowia w przód z pomiarami zasięgu kończyn dolnych. Bieg na 50 m ma na celu zbadanie szybkości lokomocyjnej, zaś bieg wahadłowy 4 x10 m przejawu zwinności w ruchu lokomocyjnym. Skok w dal z miejsca bada przejaw siły eksplozywnej kończyn dolnych, siady z leżenia tyłem w czasie 30 s. przejaw siły wytrzymałościowej mięśni brzucha natomiast skłon tułowia w dół to pomiar gibkości odcinka lędźwiowo - krzyżowego kręgosłupa. Przeprowadzone badania pozwoliły na dokonanie szczegółowej analizy problemu badawczego i wyciągnięcie następujących wniosków: 1. Analizowana w pracy grupa dzieci charakteryzuje się prawidłowym rozwojem cech zdolności motorycznych. 2. Uczniowie trenujący kajakarstwo przewyższają poziomem zdolności motorycznych dzieci nietrenujące, potwierdziła się tylko w przypadku części przeprowadzonych prób. Dziewczęta z badań własnych miały lepsze wyniki w skłonie w przód. W próbach biegu wahadłowego, siadów z leżenia i skoku w dal z miejsca w trzech grupach wiekowych były lepsze dziewczęta z badań regionalnych, a w trzech pozostałych kajakarki z badań własnych. Kajakarze natomiast w czterech próbach wypadli w większości grup wiekowych lepiej od badanych z badań regionalnych. Zarówno dziewczęta jak i chłopcy osiągali zdecydowanie gorsze wyniki na tle swoich rówieśników z badań regionalnych w próbie biegu na 50 m. 3. Kajakarze wykazali się większą szybkością, siłą i mocą, natomiast dziewczęta osiągały lepsze wyniki w próbie gibkości.

Introduction

242 The degree of the physical fitness of the man is dependent among others from the taken frequency of physical activity. Increasingly at present a reorientation is noticed in the way of the interpretation of the concept of the physical fitness considering the concept among others Health-Related-Fitness. It assumes that the conditioned physical fitness is functions cardio-respiratory, with the relative slenderness of the body, muscle power, the endurance and the suppleness, and all at the same time decides about the higher quality of life, preventing many health problems (Rożek 2006). Every man from a child has a natural need of the move. However very awareness of the favorable influence of the physical activity on the development it too little. One should already in initial stages of the life of the man mold abilities and motor habits which will keep him company through the entire life. The healthy child in the spontaneous way regulates its motor activity. The move and a physical effort have a stimulating effect on his development as well as to some extent bodies work on the development of the shape and the proportion. Under the influence of the motor activity a number of the fatty tissue is reduced, motivates himself blood circulation and development of capillaries, a skeleton becomes more massive (Malinowski 1987). However the lack in a young age of the incentive and conditions for systematic fulfilling this need causes for her dying down. A rationally conducted process of the physical education as well as extracurricular classes of all kinds are supposed to fulfill these tasks. This process has an intense influence to molding and the physical development and to the general motricity of the man. The classical canoeing includes events played in kayaks and one, two- and four-person and windbreakers one and double. The meeting is played on distance about the length of 200 m, 500 m, 1000 m and 10000 m. Getting the sports high level requires from 6 to 10 years of the systematic training in this sport.

The aspiration to achieving the maximum sports results requires early beginning the training process appropriately. The kind and the amount of training charges should be adapted for the developmental century of young participants. Such action lengthens the odds on the training achievement of the basic objective getting the maximum sports result in the century for adults, and at the same time full using potential options of every competitor are which. It seems that the canoeing needs bigger popularizing on account of its advantages in molding characteristics of psychophysical children and young people. Oaring on the kayak or the windbreaker requires thoroughly developed coordinating motor abilities. Practically all must have a high level, essential to stay in exceptionally little stable boat. Effective oaring requires the adaptation of activities in way appropriate to requirements of the changing environment in

243 which the movement takes place. Character of the technique of oaring and the need for her to display put high requirements in many moves, necessary to cover starting distance with regard to all keep-fit motor abilities, that is power, speeds and endurances (Rynkiewicz et al. 2009). They for for her determining use tests testing the level of motor features most oftentimes so as: the speed, power, the endurance, the power and the agility. Thanks to them it is possible in the very simple way to describe groups the level of the examined efficiency, and knowing the starting level of the efficiency next it is possible in conscious and to direct the right way with development of motor characteristics of the young man. Determining the condition of motor fitnesses planting children was a main purpose of the work canoeing on the stage of the basic training relating to not-training peers.

Purpose of the work

Determining the condition of their motor fitnesses was a main aim of conducting the research on the physical fitness of children going in for the canoeing in the initial stage of the career relating to not-training peers.

Material and methods

It conducted research at the school of the Championship of Sports No. 25 for them. of Bronisław Malinowski in Bydgoszcz. 24 students participated in tests (11 girls and 13 boys) in the century of 10 years practicing the canoeing. Obtained findings own the motor development was subjected to a statistical analysis and they compared with findings regional spreading through the province Kuyavian-Pomeranian conducted in 2001 through M. Napierała (Napierała 2005). Indicated below statistical measures were calculated:

• arithmetic mean: X I * n

• standard deviation: & =

* 1 - * 2

gravity of differences:

244 The level of motor abilities was assessed with the help of one of tests. Making choice of the test for the evaluation of the physical fitness one should do it in order to into the most accurate and most accurate way, to assess the analyzed research problem. However the international Test of the physical fitness contains eight tests for the purposes of the work 5 tests were chosen: run on distance of 50 m, the long jump from the place, pendular run on distance 4 x10m, sitting positions from lying I put on weight made in time 30 sek, bend of the torso ahead.

The run on 50 m is aimed at examining the locomotive speed. To headquarters "to places" examined will melt motionless before line starting in the position front (so-called standing start). To the signal he runs out and appointed distance which should be longer than 50 m, spends time with the high rate of speed e.g. 60 m. The result measures its height in the moment of crossing line 50 m. Flat a shot of the starting pistol or a, well visible sign can be a signal for the start for timing. Simultaneously he can run three practicing, but then each of them must have a separate time-study engineer. The area should be well prepared and appropriately marked. Weather conditions - without the exaggerated wind, the rain and extreme temperatures. A shorter time is a measure of the test from two races measured with the accuracy to 0.1 s (Pilicz et al. 2003).

Pendular 4x10 m run m of the sign of the agility in the locomotive move. A timer is needed for conducting this test, two wooden blocks about dimensions 5 x 5 x of 5 cm, the flat countryside about not a slippery surface with two lines distant from oneself against 1 0 flat Practicing stops in the position front (standing start) before line initial waiting for the signal of the start. After the signal he commences the run to the back row. Behind her two blocks are located. Performing the test he raises one of blocks, directs with it back to the starting line, puts the block behind the line, directs then again to the back-line and picks up the other block which he moves and puts this way like previous. When the block is thrown, rather than put behind the line, we recognize past its pull date the test and one should repeat her. Shoes and base, on which we carry out trial runs, cannot be slippery. From two performed tests a good time is taken down with the accuracy to 0.1 s (Pilicz et al. 2003).

The long jump right away examines the sign of explosive strength of lower limbs. To conducting this test is needed the ski jump and the beam suitable for deflecting if necessary synthetic surface from appointed with line, the measuring tape and the rake. It is possible also to conduct the test in the room. Then nonslippery base and two mattresses hard, put in length

245 one after the other are needed. In front of mattresses, in the distance of the about one subway, at right angles to their longer pivot the starting post is appointed. Practicing stands in the little straddle position with placed parallel bases on the beam or before line starting, next he lowers the torso, bends legs (half knee bend) in simultaneous with assault of both hands with fossa into the back, what performs the swing of hands ahead all over and pushing with one's legs at the same time energetically against base jumps like farthest. The length of the jump is measured from the outlined line (beams) to the closest left track jumping over the heel. If jump jumping on the performance he will fall down to the back, then the jump repeats. From

two performed jumps, is a measure of the test longer, written down with the accuracy up to 1 cm.

Sitting positions from lying it put on weight during 30 sec. examine the sign of endurance strength of the belly muscles. Practicing lies down on the back on the mattress or the rubber mattress so that legs are bent in knee joints under the executioner of 90 steps, but the foot deployed from a distance about 30 cm. Wreathed hands with fingers puts on the neck. The partner kneels down by feet lying and presses them so that they touch base with the entire sole. When they are prepared for commencing the test, to the agreed practicing signal raises the torso for the sitting position and touches with elbows of knees, and then immediately (without no recess) he returns to lying on his back and then again performs the sitting position. This function is repeated enough quickly for, he can, during 30 seconds. The back each time must return to the home position in order to enable locked fingers contact with base. Using elbows for pushing off from the mattress is unlawful. Practicing non-stop only one time performs the test. It count performed bends during 30 seconds. Their number is a measure of the test.

Bend of the torso ahead it is a measurement of the suppleness of the installment lumbal-sacral spine. Practicing stands without the footwear on the taboret or the bench so that fingers of feet are at the same time as the ski edge of the taboret. Joined feet, legs straightened in knee joints from this position practicing makes with continuous move forward bend in order to reach with fingers like most low. So one should keep the position of the maximum bend for two seconds. If training in the made bend with continuous move he will reach the

plain on which he/she is based, receives result 0 . For every centimeter sorting standing to the level - negative point. The test is past its pull date, if during the bend legs are bent in knee

246 joints. Also all sudden moves are unlawful during the bend. Two tests are performed and writes the better result.

Results

Physical fitness in individual age groups, and also lets for comparing changes happening in it. Juxtaposing own findings with regional tests of individual tests on the International Test was introduced to the physical fitness in 1-11 tables. In tables 1 and 2 findings of the race were presented on distance of 50 m of girls and boys practicing the canoeing. Girls from regional tests achieved good results in this test, the same in case of boys.

Table 1. Numerical order of the run on distance of 50 m of girls (s)

T ests A g e N X Ö D at

O w n tests 11 11.01 1.09 10 years 0 .8 2 1.46

R e g io n a l 1016 10.24 1.35 tests

* p < 0,05; ** p < 0,01; t a = 0,05; df = » = 1,96; t a = 0,01; df = » = 2,58

Table 2. Numerical order of the run on distance of 50 m of boys (s)

T ests A g e N X Ö D u

O w n tests 13 9.81 0.53 R e g io n a l 10 years 1010 9.71 1.42 0 .1 0 0 .4 2 te sts

* p < 0,05; ** p < 0,01; t a = 0,05; df = » = 1,96; t a = 0,01; df = » = 2,58

247 The agility of children participating in tests was assessed based on the pendular 4x10 m run flat Girls from own tests in the oldest groups had results more favorable, but a statistical gravity lacks differences. A big difference of average results appears in the 10- latkow group and a Gravity of differences takes 0.83 s out on the level 0.01 is amongst boys.

Table 3. Numerical order of the pendular 4x10m run m of girls (s)

Tests Age N X Ö D u

Own tests 11 13.15 0.65 10 years 0.42 1.27

Regional tests 1063 13.57 1.78

* p < 0,05; ** p < 0,01; t a = 0,05; df = » = 1,96; t a = 0,01; df = » = 2,58

Table 4. Numerical order of the pendular 4x10 run m of boys (s)

Tests Age N X Ö D u

Own tests 13 12.48 0.47 10 years 0.83 4.15

Regional 613 13.31 1.68 tests

* p < 0,05; ** p < 0,01; t a = 0,05; df = <»- 1,96; t a = 0,01; df = <» - 2,58

Numerical order of sitting positions from being in time 30 of the sec. of girls and boys. This test allowed to assess strength of the examined belly muscles. In the group of examined 10-latek canoeists girls carried a lot of repeating out from own tests. Gravity of differences on the level 0.05 appeared in the group of girls practicing the canoeing. Boys practicing the canoeing carried a lot of sitting positions out from being in the time of 30 seconds. In examined groups achieved results weren't substantial statistically.

Table 5. Numerical order of sitting positions from being in time 30 of the sec. of girls (number of repeating)

248 Tests Age N X Ô D u

Own tests 11 20.50 0.58 10 years 0.81 2.45

Regional tests 1081 19.69 5.79

* p < 0,05; ** p < 0,01; t a = 0,05; df = œ - 1,96; t a = 0,01; df = œ - 2,58

Table 6 . Numerical order of sitting positions from being in time 30 of the sec. of boys (number of repeating)

Tests Age N X Ô D u

Own tests 13 22.20 2.28 Regional 10 years 1051 21.39 5.55 0.81 0.79 tests

* p < 0,05; ** p < 0,01; t a - 0,05; df - œ- 1,96; t a - 0,01; df - œ - 2,58

249 Another motor fitness which was assessed there was a suppleness. They made it with the measurement of the depth of the forward bend. Girls from regional tests came out better in younger groups, however girls turned out to be better at older groups from own tests. Boys from own tests relating to their peers from regional tests achieved good results in every of age groups. As similarly as at girls a statistical gravity lacks differences.

Table 7. Numerical order of the forward bend of girls (cm)

Tests Age N X Ö D u

Own tests 11 5.50 1.91 10 0.92 0.95 Regional tests years 814 4.58 5.05

* p < 0,05; ** p < 0,01; t a = 0,05; df = <»- 1,96; t a = o,oi; df = <» - 2,58

Table 8 . Numerical order of the forward bend of boys (cm)

Tests Age N X Ö D u

Own 13 3.40 4.34 tests 10 years 0.87 0.45

Regional 851 2.53 4.57 tests

* p < 0,05; ** p < 0,01; t a - 0,05; df - » - 1,96; t a - 0,01; df - » - 2,58

Good results achieved the canoeing training girls aged 10. Amongst boys as similarly as at girls boys turned out to be better from own tests. In the group examined 10-latkow big

250 differences appeared and they were 4.26 cm. A statistical gravity of differences wasn't recorded in the examined group of results.

Table 9. Numerical order of the long jump from the place of girls (cm)

Tests Age N X Ö D u

Own tests 11 148.00 9.13 10 0.56 0.12 years Regional tests 799 147.44 20.28

* p < 0,05; ** p < 0,01; t a = 0,05; df = <»- 1,96; t a = o,oi; df = <» - 2,58

Table 10. Numerical order of the long jump from the place of boys (cm)

* Tests Age N X Ö D u p < Own tests 13 158.80 4.71 10 years 4.26 1.85

Regional 645 154.54 20.02 tests

0,05; ** p < 0,01; t a - 0,05; df - <»- 1,96; t a - 0,01; df - <» - 2,58

Table 11. Comparing the motricity of girls and boys

girls boys Tests

11 13 N

251 Age 10 years

Run on distance of 50 m X 11.04 9.81 D 1.213 at 2.08 Pendular 4x10 run m X 13.15 12.48 D 0.67 at 1.72 Sitting positions from being X 20.50 22.20 in time 30 of the sec. D 1.70 at 1.60 Forward bend X 5.50 3.40 D 2.10 at 0.97 The long jump from the place X 148.00 158.80 D 10 80 at 2.14

Results and discussion

The development is an inherent property of every living organism. He is defeated by permanent progressive or regressive transformations, and this pace is dependent from the lifestyle, conditions of the external environment and individual genetic properties. These transformations which such notions are connected with as: physical, somatic or motor development are subject to constant observation and tests (Napierała 2005). In the literature of recent times more and more oftentimes it is possible to meet also determining that the motricity is connected with the development motoricity of man - of motor features. Level of motor basic features so as: power, power, speed, agility, suppleness, coordination measure themselves with effects of specially selected straights of exercises. Motoricity of man, at least potentially it is easiest measurable, in fact is an unordered blend of terms assimilated from the borderland of anthropology, physiology, psychology and sociology - with the lexis widely extended by individual researchers (Cieślicka et al. 2012, Napierała et al. 2009, Żukowska et al. 2010). Physical fitness (motor) can and so differently be understood. Here wide and narrow recognitions are presented to her. In everyone however of case it concerns the evaluation of motor abilities mainly, connecting with the medical condition and certain motor abilities. It is a peculiar property of the man which the determined level of motor abilities and motor abilities conditioning performing a specific physical effort comprises more or less effectively. So she indicates the fitness for the proper and effective behavior oneself motor in different one's situation in lives. This ability isn't given us once

252 and for all and for everyone to the same degree. It is necessary to seek her and to mold so that she serves for us like longest. Thanks to the sphere of the move the man is almost always in the state of the activity in the relationship to the neighborhood. All motor behaviors are a resultant of the influence of biological-mechanical and social-cultural factors in every moment (Osiński 2000).

The conducted test of findings allows for drawing the following conclusions:

1. The group analyzed at the work of children is characterized by a normal development of features of motor abilities.

2. Students practising the canoeing surpass not-training children in terms of the level of motor abilities, only proved correct in case of the part of conducted attempts. Girls from own tests had good results in a forward bend. In tests on the pendular run, of sitting positions there were better girls from lying and the long jump right away in three age groups from regional tests, and in three remaining canoeists from own tests. However canoeists came out in four tests largely of age groups better than examined from regional tests. Both girls and boys achieved definitely worse results relating to their peers from regional tests in the test on the run on 50 flat

3. Canoeists demonstrated the higher speed, power and the power, however girls achieved good results in the test supplenesses.

References

253 Napierała M., 2005, Ważniejsze uwarunkowania rozwoju somatycznego i motorycznego dzieci i młodzieży z województwa kujawsko - pomorskiego, Wydawnictwo Uczelniane Akademii Bydgoskiej im. Kazimierza Wielkiego, Bydgoszcz

Osiński W., 2000, Antropomotoryka, AWF, Poznań

Pilicz S., (1997), Pomiar ogólnej sprawności fizycznej, Akademia Wychowania Fizycznego, Warszawa

Rożek K., 2006, Wybrane parametry wentylacyjne płuc w aspekcie poziomu zdolności motorycznych dzieci i młodzieży, Studia i monografie nr 84 AWF, Wrocław

Rynkiewicz T. et al., 2009, Kajakarstwo, trening dzieci i młodzieży, Intergraf, Poznań

Żukowska H, Szark M.,Westfeld D., (2010), Miejsce aktywności fizycznej w zdrowym stylu życia dzieci klas pierwszych ze środowiska wiejskiego (W:) Szkice z historii sportu i sprawności fizycznej, red. J. Urniaż, Olsztyn, s. 207-217.

Conflict of interest: None declared.

Received: 27.01.2013. Revised: 15.03.2013. Accepted: 07.06.2013.

254 Journal of Health Sciences (J for the Ss H) 2013; 3 (5): 255-266 The journal has had 4 points in Ministry of Science and Higher Education of Poland parametric evaluation. Part B item 683.

CHARACTERISTICS OF BODY COMPOSITION HIGHLY QUALIFIED DANCERS AND DANCERS LATIN AMERICAN STYLE OF DANCE SPORTS IN LIGHT OF TYPOLOGY OF SOMATIC A. WANKY AND KRETSCHMER

Charakterystyka budowy ciała wysokokwalifikowanych tancerek i tancerzy stylu latynoamerykańskiego sportowego tańca w świetle typologii somatycznej A. Wankego i Kretschmera

Wiesława Pilewska 1 , Robert Pilewski 12, Walery Zukow

institute of Physical Culture, Kazimierz Wielki University, Bydgoszcz, Poland University of Economy, Bydgoszcz, Poland

Keywords: sports dance, somatic structure, typological systems. Słowa kluczowe: taniec sportowy, budowa somatyczna, systemy typologiczne.

A bstract According to theoreticians' of sport the build of athletes makes making up its mind different from the build of persons not dealing with sport what material meaning has in sports activity. The build in many sports determined of specimens predestines for taking the determined motor initiative. They stated that the specificity of the somatic build of competitors was made conditional on character of the performed work and from a point of view of biomechanics is connected with the effectiveness of performed exercises. At work an attempt to describe the specificity of the somatic structure of high-qualified pairs of the sports dance was made. This problem was taken in many sports peculiar structure somatic, considered in aspects: sizes of the body (height and mass), a large impact has a proportion of internal relationships between tissue components to sports results. Material: Semi-final and final pairs of the sports dance constituted the research group, of the Polish championship of Amateurs in the style dance Latin American (20 persons). Largely the examined group had a "Sec." - class, that is comparing the master class to sports classes. In the group of women the age fluctuated within the limits of 18 - 23 years (average of 21 years). In the group of men the age fluctuated within the limits of 18 - 28 years (average 23 flies). Length of the dance internship examined developed within the limits of from 7 up to 15 years - motoricity dancers and from 6 up to 12 years of the dancer. Examined dance pairs trained from 4 to 7 days during the week counting from 1 0 to 28 of hours every week. Method: A typological system was used for the evaluation of the somatic structure A. Wanky drawn up to male teams (1954) widened through E. Kolasa to female teams (1969) and of Kretschmer. Conclusions:

255 1. According to typological system A. Wanke in the group of dancers of the Latin American style was a presented most oftentimes type of the structure: clean type V (40%) and type VH mixt up (40%). In the little per cent a type mixt up was presented VI (10%) and Ha (10%). Elements had a large stake: V (59.00%) and H (20.06%). 2. According to of typological system A. Wanky, widened through E. Kolasa to female teams in the group of dancers of the Latin American style was a presented most oftentimes type of the structure: type mixt up VI (30%) and type mixt up IV (30%). In the little per cent a type IH mixt up was presented (10%), clean type and (10%), clean type V (10%) and type VH mixt up (10%). Elements had a large stake and (45.00%) and V (30.83%). 3. According to introduced the ranking of Kretschmer in the group of dancers of the Latin American style most oftentimes was: athletic type of the build (80%). Remaining the 2 0 % constituted the pyknic type of the structure. 4. According to type introduced the ranking of Kretschmer in the group of dancers of the Latin American style presented most oftentimes of the structure was: leptosomatic type of the build (60%). Remaining the 40% constituted the athletic type of the structure.

Streszczenie Zdaniem teoretyków sportu budowa ciała sportowców różni się zdecydowanie od budowy osób nie zajmujących się sportem, co ma istotne znaczenie w działalności sportowej. W wielu dyscyplinach sportowych określona budowa ciała osobników predestynuje do podejmowania określonej aktywności ruchowej. Stwierdzono, iż specyfika budowy somatycznej zawodników uzależniona jest od charakteru wykonywanej pracy a z punktu widzenia biomechaniki związana jest z efektywnością wykonywanych ćwiczeń. W pracy podjęto próbę przedstawienia specyfiki budowy somatycznej wysokokwalifikowanych par tańca sportowego. Problem ten podjęto W wielu dyscyplinach sportowych specyficzna budowa somatyczna, rozpatrywana w aspektach: wielkości ciała (wysokość i masa), proporcji stosunków wewnętrznych między komponentami tkankowymi ma znaczny wpływ na wyniki sportowe. Materiał: Grupę badawczą stanowiły półfinałowe i finałowe pary tańca sportowego, Mistrzostw Polski Amatorów w stylu tanecznych latynoamerykańskim (20 osób). W większości badana grupa posiadała „S” - klasę, czyli porównując do klas sportowych klasę Mistrzowską. W grupie kobiet wiek wahał się w granicach 18 - 23 lata ( średnia 21 lat). W grupie mężczyzn wiek wahał się w granicach 18 - 28 lat ( średnia 23 lata). Długość stażu tanecznego badanych kształtowała się w granicach od 7 do 15 lat - tancerze i od 6 do 12 lat tancerki. Badane pary taneczne trenowały od 4 do 7 dni w tygodniu licząc od 1 0 do 28 godzin tygodniowo. Metoda: Do oceny budowy somatycznej wykorzystano system typologiczny A. Wankego opracowany na zespoły męskie (1954 r.) rozszerzony przez E. Kolasę na zespoły żeńskie (1969 r.) oraz Kretschmera. Wnioski: 1. Wg systemu typologicznego A. Wankego w grupie tancerzy stylu latynoamerykańskiego prezentowanym najczęściej typem budowy był: typ czysty V (40%) oraz mieszany typ VH (40%). W niewielkim procencie prezentowany był typ mieszany VI (10%) i HA (10%). Największy udział miały elementy: V (59,00%) oraz H (20,06%). 2. Wg systemu typologicznego A. Wankego, rozszerzonego przez E. Kolasę na zespoły żeńskie w grupie tancerek stylu latynoamerykańskiego prezentowanym

256 najczęściej typem budowy był: typ mieszany VI (30%) oraz typ mieszany IV (30%). W niewielkim procencie prezentowany był typ mieszany IH (10%), typ czysty I (10%), typ czysty V (10%) oraz typ mieszany VH (10%). Największy udział miały elementy I (45,00%) oraz V/ (30,83%). 3. Wg klasyfikacji Kretschmera prezentowanym w grupie tancerzy stylu latynoamerykańskiego najczęściej był: atletyczny typ budowy ciała (80%). Pozostałe 2 0 % stanowił pykniczny typ budowy. 4. Wg klasyfikacji Kretschmera prezentowanym w grupie tancerek stylu latynoamerykańskiego prezentowanym najczęściej typem budowy był: leptosomatyczny typ budowy ciała (60%). Pozostałe 40% stanowił atletyczny typ budowy.

Introduction The build in many sports determined of specimens predestines for taking the determined motor initiative. As a result of conducted researches in the row sports the most essential indicators of the somatic build of competitors and competitors were distinguished, characterised both with size of individual features as well as of them proportion. They stated that the specificity of the somatic build of competitors was made conditional on character of the performed work, whereas from a point of view of biomechanics connected with the effectiveness of performed exercises. With reference to the above with assignment of the work, characterizing the somatic build of individuals practising the sports dance according to typological systems was A. Wanky and Kretschmer. Through comprehending the typology of the build systematizing various kinds and types of the structure of the human body in terms of resemblances and individual differences understands one another guild [1, 5, 7]. The type of the build is conditioned genetically by inheriting the predisposition of the development of constitutional features. To genetic conditioning of the structure (predispositions), influences of the external environment overlap each other, in it important from a point of view of the physical education and sport factor of the move, being able to play back either positive or negative role. The build of the man is defined variously depending on the considered aspect and the included circuit race. However from timeouts of Hipokrates in all typological systems being based on a morphology, similar concepts are met of models of the build whether or not they are called types or also a factor of action [1 ]. With reference to characteristics of the somatic structure a possibility of taking issues of the interdependence between somatic features, but elements is a crucial element of motricity. These issues were taken in Poland already in the twentieth years

257 and are continued up to contemporary timeouts. Issues of the interdependence between various effects motor, but in the different way taken hold proportion builds are a subject of scientific studies. In their result connections of the somatic structure with the motricity are stated. A determined specificity of the build with the motricity determined is identified with results of specific tests [3.4, 6 ]. Among others the meaning connection is made a note between the level of muscle power (static) and with mass and the height of the body and the body weight slim (LBM). Relation between the height of the body, as well as relatively with LBM high level (caused mainly with development of the active tissue), was stated in test based on high-speed abilities (results in the test on the long jump from the place. A fact that the occurrence taken note didn't appear at individuals very high, being characterized by a leptosomatic build deserves the underline. Weaker results reached also signifying persons oneself with larger content of mass of fat, however positive role in achieving results in the discussed test, played back proportion bodies, particularly the length of lower limbs. The increase in strength of the association was also observed between get in with test results, but the height of the body. Diversified connections with somatic features at both the sex was taken note between results of the test being based on endurance abilities (of long race). For the basic correctness they caught here enough considerable - stronger at girls - negative connections of results of the test with mass of fat. How he underlines [3] were these are expected results, because how demonstrated conducted tests - the test on the run on distance of 1 0 0 0 m is to a considerable degree dependent on the ability of maximum consuming oxygen (VO 2 max), the one next in the biggest measuring cup correlates with the composition of the body, specifically with the proportion of the active tissue. Purpose of the work In work, a task of characterizing the somatic build of individuals practising the sports dance was undertaken.

Material and testing methods Material: Semi-final and final pairs of the sports dance constituted the research group, of the Polish championship of Amateurs in the style dance Latin American (20 persons). Largely the examined group had a "Sec." - class that is comparing the master class to sports classes. In the group of women the age fluctuated within the limits of 18 - 23 years (average of 21 years). In the group of men the age fluctuated within the limits of

258 18 - 28 years (average 23 flies). Length of the dance internship examined developed within the limits of from 7 up to 15 years - motoricity dancers and from 6 up to 12 years of the dancer. Examined dance pairs trained from 4 to 7 days during the week counting from 1 0 to 28 of hours every week. Method: In order to determine the specificity of the build of dancers at dancers of the sports dance they made the following measurements anthropometric: Measurement of the body weight Measurements longish - height of the body (B-V) - length of the neck (t-sst) - length of the torso (sst-sy) Measurements weight’s - width of bars (a-a) - width of the chest (thl - thl) - chest depth (xi - ths) - width of the pelvis (ic-ic) Tests were performed with method R. Martin according to principles of measurements anthropometric [2 ] using anthropometr, with arch-shaped compasses big, metric tape, electronic weighing scale. Based on made measurements the following rates of the build were counted out: -motoricity indicator of the torso and = motoricity/ length of the torso: height of the x 1 0 0 body/

- indicator of bars and = motoricity/ width of bars: length of the x 1 0 0 torso/

- indicator of the pelvis and = motoricity/ width of the pelvis: length of the x 1 0 0 torso/

- indicator of the chest and = motoricity/ chest depth: width of the x 1 0 0 chest Also a size of the Rohrera indicator was calculated using the formula F. Curtis in the following form: -motoricity Rohrer indicator and = motoricity/ body weight (in grams): height of the body (in cm3) motoricity/ x 100 These results served for the evaluation of the build according to the system of typological Kretschmer where: x (1.28 is characteristic of a leptosomatic type

259 The leptosomatic type is characterized by a narrow and extended build, with small weight of the body, dimensions longish predominate above weight’s. The chest is flat and narrow, barges and a pelvis are narrow, vaulting horse slender acts, in general poorly muscular. Slender general construction. 1.28 (1.49 an athletic type is characteristic The athletic type has strongly developed bones and muscles, the wide shoulder belt, narrow hips, wide and strongly vaulted chest. General strong structure. 1.47 (x is characteristic of a type picnic. Type picnic is characterized by a small skeleton, an underdeveloped musculature and a rich fatty tissue. Shapes of the silhouette are rounded off by the tendency of putting on weight. The chest is wide and well vaulted, short limbs, barges and the pelvis wide. Squat general construction [2]. For determining the type of the build of individuals practising the sports dance they used the typology A. Wanky widened through E. Kolasa. How J. Charzewski et al. [1] with method A. Wanky to determine it is possible both individual individuals, and groups or populations. One should add, that with above method populous groups of young people were characterised and of athletes. Works were taken up mainly at the Poznań Centre, as well as at other centres. Distinguished in the system A. Wanky types are characteristic into the following way of individual features of the build. Men: Type and - weak general build, long torso, narrow shoulders, on average the wide pelvis, the flat chest and the small weight towards the height. Type and - long torso, narrow shoulders, wide pelvis, barrel-shaped chest, average weight of the body towards the height. The V type - short torso, wide barges, the narrow pelvis, the flat chest and the great weight of the body towards the height. Type H - short torso, wide barges, wide pelvis, barrel-shaped chest, average weight of the body towards the height. Women: Type and - slender figure, relatively the long torso, narrow shoulders, the narrow pelvis, the deep chest and the small weight of the body towards the height.

260 Type and - debts towards the height torso, narrow shoulders towards the length of the torso, wide pelvis towards the height. The V type - short torso, wide barges, narrow pelvis, flat chest, small towards the height weight of the body. Type H - short torso, wide barges, wide pelvis, deep chest, great weight of the body towards the height [2 ]. Findings Tbl. 1. Numerical characterization of features of the somatic build of dancers of the Latin American style Features of the somatic M SD min-max V% structure Height of the body 163.13 4.33 157.1-171.4 2.66 Body weight 52.91 5.23 47.6-63.9 9.88 Length of the torso 48.77 1.18 47.1-50.7 2.42 Width of bars 36.95 1.57 36.0-41.0 4.25 Width of hips 26.80 1.18 25.0-28.5 4.41 Width of the deep cl. 25.90 1.73 23.0-28.5 6.68 Thorax depth 18.55 1.26 17.0-21.0 6.78 Rohrer indicator 1.22 0.07 1.13-1.38 5.46 Indicator of bars 75.79 3.29 71.01-83.33 4.35 Indicator of the torso 29.90 0.67 28.30-30.75 2.25 Rate of the deep cl. 71.83 5.85 64.15 - 8.14 81 63 Indicator of the pelvis 72.61 3.72 67.11 - 5.12 nn no

In tables 1 and 2 numerical characterizations of features of the structure and indicators of somatic dancers and dancers of the style of the Latin American sports dance were introduced.

Tbl. 2. Numerical characterization of features of the somatic build of dancers of the Latin American style Somatic features M SD min-max V%

Height of the body 176.21 5.72 166.8-184.8 3.25 Body weight 70.86 5.39 62.5 -79.1 7.61 Length of the torso 52.37 1.32 50.3-54.1 2.53 Width of bars 42.20 2.21 38.0-45.0 5.25 Width of hips 28.60 1.66 26.0-31.0 5.82 Width of the deep cl. 29.85 1.55 27.5-32.0 5.18 Thorax depth 21.35 1.68 20.0-25.0 7.89 Rohrer indicator 1.30 0.11 1.17-1.54 8.84 Indicator of bars 80.57 3.50 75.47-86.37 4.34

261 Indicator of the torso 29.73 0.45 28.74-30.20 1.52 Rate of the deep cl. 71.69 6.64 62.50 - 9.26 Indicator of the pelvis 67.92 4.94 59.86-75 .00 7.27

Tbl. 3. Individual numerical characterization of the typological composition of the build of dancers of both dancers of the sports dance of participants in the semi-final and the final of the Polish championship of Amateurs in the typology A. Wanky (male teams) and E. Kolasa (female teams) Typological line-up (in %)

AND AND V H Type ANDAND V H Type Dancers Dancers 1. 9.98 4.48 79.23 6.31 V 1. 55.74 13.11 13.35 17.79 IH

2. 14.17 9.39 54.54 21.90 VH 2. 34.80 12.44 37.68 15.07 VI

3. 23.37 7.45 61.15 8.04 VI 3. 35.70 10.26 42.61 11.43 VI

4. 15.08 12.05 49.78 22.09 VH 4. 16.30 7.99 64.22 11.99 VI

5. 13.29 7.02 64.66 15.04 VH 5. 72.08 8.76 9.60 9.55 AND

6. 8.95 22.22 8.90 59.93 HA 6. 64.86 9.69 14.17 11.29 IV

7. 3.44 1.69 91.50 3.37 V 7. 59.61 12.41 17.88 10.11 IV

8. 8.09 5.24 72.35 14.31 V 8. 42.96 13.68 24.27 19.09 IV

9. 10.76 7.04 68.81 13.40 V 9. 14.50 6.66 70.52 8.32 V

10. 13.79 11.82 38.14 35.24 VH 10. 53.49 15.56 13.95 17.00 VH with 12.09 8.84 59.00 20.06 VH with 45.00 11.01 30.83 13.16 IV time time

Above (tbl. 3.) an individual characterization of the typological composition of the build of competitors and competitors planting the Latin American style was presented. The presented order in accordance with the sports level of dancers and dancers - motoricity taken space for M.P. (from 1 place). According to assumptions of the presented typological system, if one of elements decides at least the examined individual represents the 6 8 % clean type. In the opposite case, a type mixt up assessed based on the largest number of two elements is characteristic of an examined specimen, in addition a symbol of the element in large most numbers presented is put on the top one spot [2 ]. Based on the conducted test placed in a score sheet, determining (taken hold in in percentage terms) typological composition of the build of competitors and

262 competitors of the sports dance, they made a note, that in the group of dancers of the Latin American style presented by individual competitors there was the clean V type (40%), type VH mixt up (40%) and in the little per cent type mixt up VI (10%) and Ha

( 1 0 %). In the analyzed group the V elements had a large stake (59.00%) and H (20.06%). For the whole of the group of the discussed dance style drawing 1 contains the test of the percentage share of individual elements.

Tancerki LA

□ I D A □ V □ H

Fig. 1. Interest-bearing share of the typological composition of the build of dancers of the sports dance of the Latin American style (semi-finalists and finalists of the Polish championship of Amateurs) according to the typology A. Wanky

The following types of the build being characteristic of competitors planting this dance style were made a note in the group of dancers of the Latin American style: presented the 30% type mixt up VI, 30% type mixt up IV, 10% type IH mixt up, 10% clean type and, 10% clean type V and 10% type VH mixt up. In the analyzed group elements had a large stake and (45.00%) and V (30.83%). Drawing 2 contains the test of the percentage share in the group of the discussed dance style.

263 Tancerze LA

□ I D A D V DH

Fig. 2. Interest-bearing share of the typological composition of the build of dancers of the sports dance of the Latin American style (semi-finalists and finalists of the Polish championship of Amateurs) according to the typology A. Wanky

Tbl. 2. Individual sizes of the Rohrer indicator of dancers of dancers and the sports dance, of Latin American style - of participants in the Polish championship of Amateurs and ranking according to the system of Kretschmer - presented results of places according to the order taken (from the top one spot) Dancers La Dancers La

Size of the Rohrer Ranking Size of the Rohrer Ranking indicator indicator

1.23 athletic type 1.23 athletic type

1.20 athletic type 1.21 leptosomatic type

1.17 athletic type 1.25 athletic type

1.28 athletic type 1.38 athletic type

1.54 pyknic type 1.19 leptosomatic type

1.33 athletic type 1.23 athletic type

1.44 pyknic type 1.13 leptosomatic type

1.24 athletic type 1.18 leptosomatic type

1.32 athletic type 1.16 leptosomatic type

1.22 athletic type 1.21 leptosomatic type

264 Table 2 (above) introduces the Rohrera indicator of dancers of dancers and the sports dance, the Latin American style and him to the size ranking in the system of Kretschmer. How he results from data presented in the style introduced table 2 in the group of dancers Latin American most oftentimes was: athletic type of the build (80%). Remaining the 20% constituted the pyknic type of the structure. In the group of dancers of the Latin American style he was a presented most oftentimes type of the structure: leptosomatic type of the build (60%). Remaining the 40% constituted the athletic type of the structure. Conclusions: 1. According to typological system A. Wanky in the group of dancers of the Latin American style was a presented most oftentimes type of the structure: clean type V (40%) and type VH mixt up (40%). In the little per cent a type mixt up was presented VI (10%) and Ha (10%). Elements had a large stake: V (59.00%) and H (20.06%). 2. According to typological system A. Wanky, widened through E. Kolasa to female teams in the group of dancers of the Latin American style was a presented most oftentimes type of the structure: type mixt up VI (30%) and type mixt up IV (30%). In the little per cent a type IH mixt up was presented (10%), clean type and (10%,) clean type V (10%) and type VH mixt up (10%). Elements had a large stake and (45.00%) and V (30.83%). 3. According to introduced the ranking of Kretschmer in the group of dancers of the Latin American style most oftentimes was: athletic type of the build (80%). Remaining the 20% constituted the pyknic type of the structure. 4. According to type introduced the ranking of Kretschmer in the group of dancers of the Latin American style presented most oftentimes of the structure was: leptosomatic type of the build (60%). Remaining the 40% constituted the athletic type of the structure.

References

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265 2. Drozdowski Z. (1998): Antropometria w wychowaniu fizycznym. Seria: Podręczniki Nr 24.AWF w Poznaniu. 3. Szopa J., Mleczko E., Żak S. (2000): Podstawy antropomotoryki. Wydawnictwo Naukowe PWN Warszawa - Kraków. 4. Cieslicka M, Napierała M, Pilewska W, Iermakov S Journal: Pedagogics, Psychology, Medical-Biological Problems of Physical Training and Sports Vol 10 Status of morphological and motor skills of girls participating in modern dance classes 2012 p. 96-104 5. Cieślicka M., Napierała M. The somatic bulid of lightweight rowes. Medical and Biological Sciences, 2009,23/3,33-38.

6 . Klimczyk M., Cieślicka M., Szark M. Somatic charakteristics, strenght and sport result In 12-19 year old pole vaulut jumpers. Medical and Biological Sciences, 2009,23/3,53-60.

7. Cieślicka M., Dix B., Napierała M., Zukow W., Somatic construction of children practicing tennis at the stage of the base training, [w]: Health - the proper functioning of man in all spheres of life, (red.) M. Hagner-Derengowska, W. Zukow, Bydgoska Szkoła Wyższa, Bydgoszcz 2012, s. 163- 172.

This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License (http://creativecommons.org/hcenses/by-nc/3.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited.

Conflict of interest: None declared.

Received: 27.01.2013. Revised: 15.03.2013. Accepted: 07.06.2013.

266 Journal of Health Sciences (J for the Ss H) 2013; 3 (5): 267-276 The journal has had 4 points in Ministry of Science and Higher Education of Poland parametric evaluation. Part B item 683.

CHANGES IN THE RANGES OF MOTION IN THE JOINTS OF THE UPPER AND LOWER EXTREMITIES IN ELDERLY PEOPLE UNDER THE INFLUENCE OF THE NORDIC WALKING TRAINING

Zmiany zakresów ruchów w stawach kończyn górnych i dolnych u osób starszych pod wpływem treningu Nordic Walking

Monika Wiech 1, Katarzyna Prusik 1, Jakub Kortas 1, Łukasz Bielawa1, Zbigniew Ossowski 1 , Krzysztof Prusik 1*2, Walery Zukow

1Plant of the Recreation and the Activity-based Tourism Academy of Physical Education and Sport in Gdańsk, Poland University of Economy, Bydgoszcz, Poland

Keywords: Nordic Walking, trening. Słowa kluczowe: Nordic Walking, trening.

A bstract The scope of the movement in the pond can be a valuable pointer for determining the functional fitness of the limb. Results of measurements goniometrycznych assessments of the impact used in progress of different physical exercises can be, of training process and the like to the body of the individual, becoming one of indicators of the degree of training. A characterization of changes of the scope of the movement in the fibular plain in chosen ponds of upper limbs is a purpose of the work and bottom at persons aged 65-75 under the influence of the Nordic Walking training. 46 women and 10 men aged 65-75, residing in Gdańsk were provided with tests. The examined group carried out the health training leaning against Nordic Walking made rich for stretching exercises (dynamic and static) during 12 weeks, with frequency 3 times during the week for 60 minutes. At the beginning and at the end of the training cycle measurements of scopes of movements in chosen ponds were conducted with SFTR method with the goniometer. Presented findings of chosen scopes of movements in ponds attest to the high level of the suppleness of examined seniors at the beginning and at the end of the training cycle, writing them down into norms for considerably younger persons. Moreover the improvement shows Nordic Walking sizes of all parameters to the effectiveness of the suggested health training in the form. Conclusions. The test results of presented tests shows that the 3-month's training program can already bring expected effects in the form of increasing the scope of the movement in ponds, leading to the improvement of quality of life and of improving the physical fitness.

267 Streszczenie

Zakres ruchu w stawie może być wartościową wskazówką dla określenia funkcjonalnej sprawności kończyny. Wyniki pomiarów goniometrycznych mogą być wykorzystywane w toku oceny wpływu różnych ćwiczeń fizycznych, procesu treningowego itp. na organizm osobnika, stając się jednym z wyznaczników stopnia wytrenowania. Celem pracy jest charakterystyka zmian zakresu ruchu w płaszczyźnie strzałkowej w wybranych stawach kończyn górnych i dolnych u osób w wieku 65-75 lat pod wpływem treningu Nordic Walking. Badaniami objęto 46 kobiet i 10 mężczyzn w wieku 65-75 lat, zamieszkałych w Gdańsku. Badana grupa realizowała trening zdrowotny oparty o Nordic Walking wzbogacony o ćwiczenia rozciągające (dynamiczne oraz statyczne) w czasie 12 tygodni, z częstotliwością 3 razy w tygodniu po 60 minut. Na początku i na końcu cyklu treningowego przeprowadzono pomiary zakresów ruchów w wybranych stawach metodą SFTR za pomocą goniometru. Przedstawione wyniki badań wybranych zakresów ruchów w stawach świadczą o wysokim poziomie gibkości badanych seniorów na początku i na końcu cyklu treningowego, wpisując ich w normy dla znacznie młodszych osób. Ponadto poprawa wielkości wszystkich parametrów wskazuje na efektywność zaproponowanego treningu zdrowotnego w formie Nordic Walking. Wnioski. Wyniki prezentowanych badań dowodzą, że już 3-miesięczny program treningowy może przynieść oczekiwane efekty w postaci zwiększenia zakresu ruchu w stawach, doprowadzając do poprawy jakości życia i polepszenia sprawności fizycznej.

Introduction In order to hold and to accumulate the health and to prevent the appearance of illnesses the man must learn to include the move for one's everyday duties, independently for the age. Population becoming outdated and keeping her company degeneration of the level of physical activity of the population, creates the problem of universal falling into decline on the health about epidemic sizes (Sikorski, 2010), meanwhile joy from surviving the age should be the same, as the luck in earlier lifespans. The rising number of evidence proves about the fact that the pace of the ageing of the body of the man is subject to physiological alterations, mainly on the road of changes of the physical activity and dietary conditioning. These factors cause that the old age becomes happy, bright and full of new experience (Marchewka, Dąbrowski, Żołądź, 2012, Cieślicka i wsp. 2011, Napierała i wsp, 2009). The systematic physical activity is one of important factors positively stimulating the life of an elderly man, and the insufficient activity can support of motor malfunction. Although the motor activation of elderly people is a difficult task extremely, she is exquisitely important, since a better health condition of the elderly is a high level of the self-reliance and self-services, and in consequence smaller costs of the health and social care. The regular physical activity helps to stabilize universal in the older century of illness and the complaint, so as: hypertension,

268 atherosclerosis, osteoporosis, diabetes, coronary disease, as well as to bring the stress or the obesity under control, moreover lowers the risk of infection and against ruling opinions contributes to reduce pain complaints in illnesses of the arrangement of move. The physical training is regular "with cure-all, inexpensive and available to everyone, not-having of side effects, pleasing and recognised by medical circles" (Marchewka, 2012). Individuals healthily ("in an optimal way") growing old "are clear and pleased with the life, perceiving oneself as younger and not shunning from the contact with the young generation (...), without limitation of function, skillful mentally, optimistically turned towards people and taking an active part in the life of the neighborhood" (Duda, 2012). The elderly can regain willingness to plant the healthy physical activity, feeling more safely, looking more enjoyably with the fashionable equipment which they can use into the simple, safe and comfortable way (Sokołowski i wsp., 2010). Nordic Walking gives such a possibility. Nordic Walking is rhythmical and aerobic activity of big skeletal muscles, bringing numerous health benefits, through the improvement in power, power, endurance, coordination, deuce, reduction in the fatty tissue (Sikorski, 2010; Ossowski, Prusik, Kortas et al. 2010; Sokeliene, Cesnaitiene, 2011), molding the silhouette, relieving the spine, the improvement in the mood what is particularly important for elderly people (Hartvigsen, Marso, Bendig et al. 2010; Sokołówski, 2010), as well as enabling to increase the scope of the movement in ponds. He/she doesn't demand great effort and the ability in addition (Sikorski,

2 0 1 0 ). Degenerative changes of ponds are stated already before the twentieth year of age, and after the eightieth year of age are noticeable in the entire population. Degenerative changes of ponds concern all components of their structure: in the bone structure reaches to senile osteoporosis bones, causing among others lowering bone bases, cartilages and synovial capsules, trailers of tendons and muscles undergo calcifications, muscles through the slope in them contents of water become less elastic, individual muscle fibers disappear, a muscle mass reduces for the connective tissue (Zembaty, 1989). Scope of the movement in the pond, that is "articular angle between outermost locations of one body part with account second neighboring" (Erdmann, Zieniawa, 2011), can be a valuable pointer for determining the functional fitness of the limb. A fact is material, that on account of surrounding the pond with soft tissues - a synovial capsule, ligaments and with muscles, the scope of the movement is dependent from their flexibility which is quite changeable (Erdmann, Zieniawa, 2011). One should examine two kinds of the scope of the

269 movement, i.e. practicing (result of the work of the muscles responsible for making it) and passive (effect of putting outside power) (Weiss, Zembaty, 1983). Between different stretches of the human body or the bone goniometry, being cannon deals with measurements of angles of anthropometry. Dynamic goniometry deals with the scope of the movement in individual ponds of the organism (Malinowski, Bozilow, 1997). Indicating the scope of the movement in ponds is one of essential methods of estimation of the functional state and the measure of the result of a calculation of physiotherapy (Zembaty, 1989). Results of measurements goniometric assessments of the impact also used in progress of different physical exercises can be, of training process and the like to the body of the individual, becoming one of indicators of the degree of training (Drozdowski, 1987). Programming burdening in the health training of persons in the Middle Ages and older one should first try for keeping the current functional state, in the next stage whereas to aspire for achieving the greater physical fitness (Ossowski, Prusik, Prusik, 2009). General rules of the dosage of exercises in the health training without the account whether it regarding the creation of the health, of primitive or secondary prevention, are similar. Mainly endurance forms of exercises include in the duration determined, depending on health needs,, the frequency and intensity (Kunski, 2003). The physical training improving scope of the movement, suppleness, scope of bending ponds and the level of the deuce are a limiting factor number of falls, causing many fractures but in consequence of many vital complications (Marchewka, 2012). In Poland he doesn't still have uniform standards of the mobility of joints. Certain hampering divergences are met interpersonal comparing results. An age isn't taken into account examined, although changes in the motor organ happening as a result of growing old lead the mobility for impoverishing the basic function he is which, and so they conducted research method by O.A. Russe and J.J. Gerhardt - SFTR (International method of measurement and of record of movements in ponds published through ISOM- International Orthopeadic Measurements Standard). In this method norms were considered in an individual age brackets. He owes his name to the first letters determining appropriate plains in English, in which all moves are examined (Schlaaff method): -Motoricity S - sagittal - fibular plain -Motoricity F - frontal - coronal plane -Motoricity T - transverse - crosswise -Motoricity R - rotation - torsion

270 Aim of work is characterization of changes of the scope of the movement in the fibular plain in chosen ponds of upper limbs is a purpose of the work and bottom at persons aged 65 75 under the influence of the Nordic Walking training. Material and testing methods 46 women and 10 men aged 65-75, inhabited were provided with tests in Gdańsk. The examined group carried out the health training leaning against Nordic Walking. Classes were conducted in Oliwa forest during 12 weeks, with frequency 3 times during the week for 60 minutes. On every classes seniors were subjected to the current control using monitors of the action of the heart of the company Polartec, in the destination of keeping established intensity on the level 40-60 % HRmax, moreover the route of every training was registered with organising a Garmin company having a GPS. Every training individual consisted of three components: preliminary, main and final. Every warm-up was conducted with using small sticks to Nordic Walking, and for her finishing dynamic stretching and respiratory exercises were applied. A weight training and needling postural muscles were entered into the main part. In part final exercises stretching, loosening and quieting down were applied, taking the respiratory university class into account. They gave classes with constant method variable with elements of rest. They conducted research in the laboratory of a physical effort of the academy of physical education and Sport in Gdańsk in late morning hours. To the program they were passed exclusively persons without health contraindications. Decision to allow to the program a general practicioner took. The following research methods were applied: test of the references, measurement of the scope of the movement in ponds with the goniometer, test of the volume of classes in 3 monthly mezocykle training, a statistical analysis and concluding. All achieved results from measurements were written with three numbers according to the following scheme: a) From the body he/she enrolls movements of the extension and all run movements as first in the element b) He/she enrolls moves of the bend and all conducted movements to the body as last c) Home position which as a rule position 0 is °, is written inside, compound of three numbers, of element. Results The angle size in the practicing extension in the hip joint before beginning the 3- month's training cycle achieved the mean 7.7 ° and 7.5 ° appropriately in the right and left limb at examined women (the population norm of the scope of the movement in this pond is 5 °). After finishing him these values grew about close the 44%. At examined men these sizes

271 look as follows: 8.4 °in a right lower limb and 8.1 ° in left, undergoing the improvement about over the 30% and staying on the angle high level than at examined women after the finished cycle. At both of sex we observe the greater percentage improvement in the left limb, however the angle result remains better at a right lower limb. Bending the hip joint grew

about over the 1 0 % at examined women and men, however women in this respect reached

considerable values about nearly 1 0 ° both at the beginning and at the end of training cycle. Bending the glenohumeral joint at everyone examined achieved maximum correct equal result 90 ° in both measurements. We observe differences in wheedle this pond to the benefit of women in the initial and final test which they reached before commencing experiment on average 40.9 °in the right upper limb and 41.7 ° in left (the population norm of the scope of the movement in this pond is 35 °). The improvement in the scope of the movement in the glenohumeral joint at examined women took out close 3 ° in both limbs, however at men 5.2 ° in right and 4.3 ° in the left upper limb what constitutes the percentage significant difference in proportion to results achieved by women. Passive scope of the movement in the hip joint (extension) at the beginning of the cycle at examined women was about 2.5 ° bigger than practicing, however after the completion of cycle the difference increased to nearly 4 °. At men in initial tests this difference took out almost 3.5 °, in final tests grew (as similarly as at women) to 4 °. Passive bending the hip joint at the beginning of the cycle differed towards the active movement about over 3 ° at women in both limbs and about 3.4 ° and 4.2 ° appropriately in the right and left limb amongst men. In the final test at women this difference took out over 4 °. In the group of

men the recalled difference increased to 5.5 -6 °. Both practicing and passive bending the glenohumeral joint achieved the same recalled values equal of 90 °. The passive extension in this pond in the initial test differed from the practicing scope of the movement about 4.3 ° in the right limb and 5 ° in left at examined women and about 4.1 ° (laws) and 2.6 ° (left) amongst men. In the final test a difference of the size was gained 5.7 ° (laws) and 6.1 ° (left) in the female group and close 5 ° in both limbs in the male group.

Tbl. 1. Changes of the size of the scope of the movement in chosen ponds of women under the influence of the 3-month's training cycle examined and men aged 65-75. Right Difference Left Difference

Initial (°) Final (°) (%) Initial (°) Final (°) (%) Hip joint

272 Move correction/ bend -motoricity practicing

$ (n = 46) 7.7 - 0 - 10.3 - 0 - 33.7 - 0 - 7.5 - 0 - 1 0 . 1 - 0 - 34.6 - 0 - 98.6 109.2 10.7 99.2 109.5 10.4 U) ' o II 8.4 - 0 - 1 1 . 0 - 0 - 30.1 - 0 - 8 .1 - 0 - 1 0 .6 - 0 - 30.8 - 0 -

8 8 .0 97.5 1 0 .8 87.9 97.0 10.3 -motoricity passive

$ (n = 46) 1 0 . 2 - 0 - 14.3 - 0 - 40.2 - 0 - 1 0 . 1 - 0 - 14.4 - 0 - 42.5 - 0 -

101.7 113.5 1 1 . 6 102.7 113.6 1 0 .6 U) ' o II 1 1 . 6 - 0 - 14.9 - 0 - 28.4 - 0 - 11.7 - 0 - 15.2 - 0 - 29.9 - 0 -

91.4 103.0 12.7 92.1 103.0 1 1 . 8 Glenohumeral joint Move correction/ bend -motoricity practicing l> o O 1 I ■ ■ $ (n = 46) 40.9 - 0 - 90 43.8 - 0 - 90 o o 41.7 - 0 - 90 44.8 - 0 - 90 U) ' o II 38.3 - 0 - 90 43.5 - 0 - 90 13.6 - 0 - 0 37.2 - 0 - 90 41.5 - 0 - 90 11.5 - 0 - 0 -motoricity passive ■ 1 $ (n = 46) 45.2 - 0 - 90 49.5 - 0 - 90 9.5 - 0 - 0 46.7 - 0 - 90 50.9 - 0 - 90 VO o 0 o U) ' o II 42.4 - 0 - 90 48.5 - 0 - 90 14.4 - 0 - 0 39.8 - 0 - 90 46.2 - 0 - 90 16.0 - 0 - 0

Discussion Universally a fact that the physical activity does good is familiar to physiological properties of the organism - irrespective of the age, preventing or limiting limiting elderly people (Godges et al. 1993; Roach, Miles, 1991).

273 Planting the strategy of a healthy lifestyle one should plan and carry action overtaking illness out, but more than anything else assisting health (Drabik, 2006). The test results of tests presented in the present article shows that the 3-month's training program can already bring expected effects in the form of increasing the scope of the movement in ponds, leading to the improvement of quality of life and of improving the physical fitness. Morini et al. (2004) present similar effects, proposing the training about endurance character. For a statistical analysis big ponds which are most involved were chosen during Nordic Walking march. Here movements in the fibular plain were included. All values were defeated by favorable changes under the influence of the applied program. The scope of straightening out women in the right glenohumeral joint examined grew on average about over the 7.1% (practicing) and 9.6% (passive), however at men appropriately by the 13.6% and the 14.4%. They are these are values almost twice as bigger amongst men, however angle sizes achieved an almost identical result at both of sex. We observe the smaller difference within the left glenohumeral joint, where men while straightening out got the percentage good result by the 4.1%, however the angle size is lower about 3.3 ° in the active movement and appropriately 7% more and 4.7 ° less in the passive movement. Both at the beginning and at the end the practicing extension of the glenohumeral joint classifies the cycle examined women to and of an age bracket i.e. 18-40 years, although all examined qualify to the III range i.e. 61-85 years, however passive movement to the II period - 41-60 years. Angle sizes in the practicing extension of the glenohumeral joint qualify men for the II period (41-60 years), however after the completion they promote the cycle to norms right for persons at the age of 18-40. The scope passive in the first measurement of the movement qualifies men for the III period (61-85 years), however after the completion of cycle - of the II range (41-60 years). In bending in the glenohumeral joint all achieved results are correct achieving 90 ° (the maximum value for all age brackets). Towards the glenohumeral joint an extension presents the opposite situation in the hip joint, where men got values greater than women. Bigger however in percentage values women got the improvement in the practicing move about less than 4%, however the passive scope of the movement differed about close the 12%. Bending the hip joint is a difference about nearly 10 ° to the benefit of women both at the beginning as well as end of the training cycle, at least at both the scope of the movement in this direction improved the sex oneself on average about over the 1 0 % in the second measurement. Conclusions

274 The improvement in the result of angle bending the hip joint at examined women causes their promotion from the III age bracket to II. the similar improvement at men doesn't affect the change of the range. They stay in the upper limit of the norm in their age group. In case of the extension of the hip joint both examined women and men are promoted from the II age bracket to 1st century of 18-40 years). Presented findings of chosen scopes of movements in ponds attest to the high level of the suppleness of examined seniors at the beginning and at the end of the training cycle, writing them down into norms for considerably younger persons. Moreover the improvement shows Nordic Walking sizes of all parameters to the effectiveness of the suggested health training in the form.

References

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Conflict of interest: None declared.

Received: 23.01.2013. Revised: 18.04.2013. Accepted: 07.06.2013.

276 Journal of Health Sciences (J for the Ss H) 2013; 3 (5): 277-300 The journal has had 4 points in Ministry of Science and Higher Education of Poland parametric evaluation. Part B item 683.

The Results of the Checks in the Women’s Heptathlon Training During a 10-year Training Cycle

Wyniki kontroli treningu w siedmioboju kobiet w trakcie 10-cio letniego cyklu treningowego

Maria Kamrowska-Nowak 1, Krzysztof Byzdra 1, Katarzyna Majchak 1, Robert Stępniak2 , Walery 3 Zukow

1AWFiS Gdańsk, Plant of the light athletics, Poland UKW in Bydgoszcz, Institute of the Physical Culture, Poland University of Economy, Bydgoszcz, Poland

Keywords: light athletics, pentathlon of women, analysis of the results. Słowa kluczowe: lekka atletyka, wielobój kobiet, analiza wyników.

Abstract In the women's heptathlon competition consists of the complex structure of the movement. In this connection, the training process requires the development of a very wide range of body functions. For better efficiency in these activities also requires training in cooperation with scientists of different areas and the use of the achievements of the technique. The way of the use of resources of scientific knowledge for the needs of the sport is discussed in the work of many professionals. The purpose of the work on these lines was there to present the results of the implementation of the control-and how to implement workout (everything that creates a broad training load) - control and after-training effects (exam; games) a multiannual training process high-end players specializing in the heptathlon. Material and methods Study were 10-year cycle of training heptathlonist M. K-N at the stage of training of special and sports championships. Contestant was a significant success on the national stage (5-times Polish vicechampion) and in international arena (the bronze medal at the Universiade - 1991; IO in 1992 - 10th place; The World Cup in 1991 - 9th place). Measure and record the size of the training measures were made after the completion of each training unit using the method TreOB 4, and physical training conditions BPS, in the last week leading up to the best start in the series. Score in heptathlon contains a lot of information that can be used for analysis, can also be a source of knowledge to practical conduct. Next to the final outcome of the world we have for information about developments in each component of the competition. Such opportunities do not present other competitions, or other measurable sport (Maciantowicz, Kubiszewski, Wlodarczyk, 2003). In the world due to its difficulty, you can start in one annual cycle a few times. In the case of M. K-N it was from 3 to 4 times in 1, 2, 3, 5, 8 cycles, and in 4 take 5 were starts reported. The optimal number of, as can be seen from the analysis of this work is 3 starts thlonist. The best result obtains in the third startup, always at a party. The Foundation of professional control is keeping the training documentation. On the basis of the data collected we analyze in detail the records of quantitative and qualitative training, as well as their structure. The results of the analyses carried out to coach for possible revisions. Conclusions Important places in annual training system take control of training units of the heptathlon. Analyzing the training documentation, it can be concluded that among 289-512 training units. 10% of the total deals with

277 control unit. Effects control training should be scheduled prior to the start of the preparatory period, and tests and exam so chosen, to the most informed about the level of the test. Inspection process of training must be carried out systematically, giving the possibility of comparisons and analysis over a longer period of time. Any part of the period of training (subperiod, mezocycl) should have a specific group of tests.

Streszczenie

W skład siedmioboju kobiet wchodzą konkurencje o złożonej strukturze ruchu. W związku z tym proces treningu wymaga kształtowania bardzo szerokiego wachlarza funkcji organizmu. Dla lepszej efektywności tych działań szkolenie wymaga także współpracy z naukowcami różnych dziedzin oraz korzystania z osiągnięć techniki. Drogi wykorzystywania zasobów wiedzy naukowej dla potrzeb sportu omawiane są w pracach wielu specjalistów. Cel pracy Kierując się tymi wskazaniami podjęto tu próbę przedstawienia wyników kontroli wykonania - stopnia i sposobu realizacji treningu (wszystko to, co tworzy szeroko rozumiane obciążenie treningowe) - oraz kontroli efektów potreningowych (sprawdziany; zawody) wieloletniego procesu treningu wysokiej klasy zawodniczki specjalizującej się w siedmioboju. M ateriał i metoda Badaniu poddano 10-cio letni cykl treningu siedmioboistki M. K-N na etapie szkolenia specjalnego i mistrzostwa sportowego. Zawodniczka odnosiła znaczące sukcesy na arenie krajowej (5-ciokrtona wicemistrzyni Polski) oraz międzynarodowej (brązowy medal na Uniwersjadzie - 1991 r.; IO w 1992 r. - 10 miejsce; MŚ w 1991 r. - 9 miejsce). Pomiaru i rejestracji wielkości środków treningowych dokonywano po zakończeniu każdej jednostki treningowej wykorzystując metodę TreOB 4, a sprawności fizycznej w warunkach treningowych w tzw. BPS-ie, w ostatnim tygodniu poprzedzającym najlepszy start w cyklu. Wynik sportowy w siedmioboju zawiera wiele informacji, które mogą być wykorzystane do analiz, mogą być także źródłem wiedzy do postępowania praktycznego. Obok końcowego rezultatu wieloboju mamy wszak informacje dotyczące osiągnięć w każdej składowej konkurencji. Takich możliwości nie stwarzają pozostałe konkurencje lekkoatletyczne, ani też inne wymierne dyscypliny sportu (Maciantowicz, Kubiszewski, Włodarczyk, 2003). W wieloboju ze względu na jego trudność, wystartować można w jednym cyklu rocznym niewiele razy. W przypadku M. K-N było to od 3 do 4 razy w 1, 2, 3, 5, 8 cyklu, a w 4-tym zanotowano 5 startów. Optymalna liczba, jak wynika z analiz tej pracy to 3 starty wielobojowe. Najlepszy wynik uzyskiwała zwykle w trzecim starcie, zawsze na imprezie docelowej. Podstawą profesjonalnej kontroli jest prowadzenie dokumentacji treningowej. Na podstawie zgromadzonych danych szczegółowo analizujemy zapisy ilościowe i jakościowe treningu, a także ich struktury. Wyniki przeprowadzonych analiz pozwalają trenerowi na ewentualne korekty. Wnioski Ważne miejsce w całorocznym systemie szkolenia siedmioboju zajmują jednostki treningowe o charakterze kontrolnym. Analizując dokumentację treningową można stwierdzić, że spośród 289 -512 jednostek treningowych ok. 10 % ogółu zajmują jednostki kontrolne. Kontrola efektów szkolenia powinna być zaplanowana przed rozpoczęciem okresu przygotowawczego, a testy i sprawdziany tak dobrane, aby w największym stopniu informowały o poziomie badanej sprawności. Proces kontroli treningu musi być realizowany systematycznie, dając możliwość porównań i analiz w dłuższym okresie czasu. Każda część okresu szkolenia (podokres, mezocykl) powinien charakteryzować się specyficzną grupą testów.

Introduction Events are included in a heptathlon of women about the set structure of the movement. Therefore the process of the training requires molding a wide range of the function of the organism very much. For the better effectiveness of this action the training requires also a cooperation with scientists of different fields and using from achievements of the technique. Means of using stores of the scientific knowledge for the purposes of sport are discussed at works of many specialists (Burns, Gains, 1984; Platonow, 1990; Przybylski, 1997; Raczek, 1991).

278 Managing sports activity according to Naglak (1999), Sozański and Zaporożanow (1993), Platonow (1997) should be held on means of the organised control of keeping the competitor before and in the course of the competition. Here acquisitions of the technique which they let register outweigh, to draw up and to present multidirectional information about the examined competitor. With opinion of many authors (Kochanowicz, 1998; Naglak, 1991; Płatonow, 1997; Ulatowski, 1992; Zaporożanow, 1988, 1997; Ważny, 1990, 1996) managing the process of the training should aim at the operations research of all action starting from the stage of the selection, all the way to retiring. To use for the improvement in sports results it is necessary like the substantial amount of information about the state of functional possibilities of the organism and changes which in it occur under the influence of the training. Information is the most solid way of obtaining such data about reactions of the organism to training stimuli of competitors having a high level of mastery in a given sports discipline (Kochanowicz, 1995; Sozański, Kosmol, 1990; Ważny, 1981,1999). Kochanowicz (1995), Czajkowski (1988), Kozioł (1983) think that widely the understood control provides with many pieces of information describing reactions and the course of adaptation processes of the competitor to training and starting stimuli. According to Platonow (1997), Zaporożanow and Sozański (1997) the management and the in stages control should create data serving drawing up individual, model structures of the training and of starts, and at the same time to enable correction of plans of the training. In order to formulate recommendations for managing the process of the training, one should examine real, fulfilled training burdens by these competitors which achieved the sports high level appropriately (Łasiński, 1981). For the evaluation of the state of training women heptathlonist about the different degree of the progress a diversified assortment of indicators of the control is needed. Drawing such a set up seems quite difficult and complicated, because the prognostic value of many features changes depending on the age examined, of the fitness level and other factors. It is necessary for the assessment of the effects of the training, so documentation, without which it isn't possible to imagine professional managing the competitor. Based on gathered data in detail we analyze the quantitative and quality enrollment of the training, as well as their structure. Results of conducted tests let the coach the more accurate statement, what centers, about what intensity and in what time were applied by competitors. Thanks to that the coach has wide abilities of the comprehensive and reliable control and controlling the

279 process of the training. Achieved results, backed up with the test, have an appliqué considerable value (Sozański 1992). Purpose of the work Being guided by these readings here an attempt to present audit results was made at making - of the step and means of implementation of the training (everything what the widely understood training burden creates) - and of control of effects potreningowych (tests; competition) of long-term process of the training of the first-class specializing competitor in the heptathlon. Material and the method

1 0 -years cycle was put through an examination summer cycle of the training heptathlonist M. K-N on the stage of the special training and the sports championship. The competitor was significant successes in the domestic arena (5-ciokrtona of the vice-champion of Poland) and international (bronze medal on the international student's olympics - 1991; IO in 1992 - 10 place; MŚ in 1991 - 9 place). They made the measurement and the reception desk of the size of training centers after the completion exploiting every training individual method of TreOB 4, but the physical fitness in training conditions in so-called BPS, in the recent week preceding the best start in the cycle. Results Thanks to very accurate training documentation a multi-storey control, covering all time periods became possible. Most important was current observation of the adaptation process and because of those early preventing arising divergences. Degree of assumed achievements (predicted in the program) every time was compared with get effects. All disagreements immediately induced introductions to reflection and finding remedy corrections. Availing oneself of with statements of Sozański and Zaporożanow, (1993) which refer to the management and the control with training process, they stated, that among others accurate information about fulfilled training burdens and keep-fit and coordinating abilities individual, peculiar to every competitor, a training process is one of operations research main factors. One should remember that his individuality which manifests itself at the training work and activities decide on the specific character of preparing the athlete starting. Out of many features and the property of the competitor in the process of the control of the state of preparing him one should take into account only the ones which play a main role in the course of the sports fight.

280 Containing findings oneself below, they are explicit, in accordance with trends stated in literature, that a type of the training, identified by the size, the kind and the structure of burdens is a deciding factor of the sports positive development wysiłkowych. This truth finds its practical reflection in two types of the training, fundamentally different quantitatively (fig. 1 and 3, tbl. 1) and qualitatively (fig. 4 and 5, tbl. 2).

Tbl. 1. Audit results of burdens for the training in information area in the 10-years cycle summer training M. K-N, years 1986 / 98 (h, %). Number of Consolidated Cycles Storage burdens days number annual training. training. TR IN AT SEC. 1986 h 153: 03:04 121: 09:15 22:20:30 09:33:19 motoricity/ 340 439 87 % 100 79.2 14.6 6.24 1988 h 133: 15:25 98: 51:24 17:38:22 16:45:39 motoricity/ 365 488 89 % 100 74.2 13.2 12.6 1989 h 113: 28:47 93: 02:16 13:31:47 06:54:44 motoricity/ 348 468 90 % 100 81.9 11.9 6.09 1990 h 101: 31:12 70: 30:02 19:31:23 11:28:47 motoricity/ 356 512 91 % 100 69.4 19.2 11.3 1991 h 117: 13:19 91: 18:44 18:26:36 07:27:59 motoricity/ 321 459 92 % 1 0 0 77.9 15.7 6.37 1992 h 103: 54:03 84: 49:19 13:22:32 05:42:12 motoricity/ 326 438 93 % 100 81.6 12.9 5.49 1993 h 133: 45:17 106: 26:08 17:07:21 10:11:48 motoricity/ 333 493 94 % 100 79.6 12.8 7.62 1995 h 102: 02:15 84: 10:03 09:38:19 08:13:53 motoricity/ 289 427 96 % 100 82.5 9.45 8.07 1996 h 120: 56:36 98: 29:54 15:54:57 06:31:45 motoricity/ 302 491 97 % 100 81.4 13.2 5.4 1997 h 126: 05:01 98: 01:47 17:13:41 09:49:33 motoricity/ 320 479 98 % 100 78.5 13.7 7.79 Average 330 465 h 120: 31:30 94: 46:33 16:28:33 9:16:04 10 cycles

Tbl. 1 results from data, that worked a lot of training days in 1988 / 89 and it was 365 by 488 training individuals. In season 1990 / 91 356 training days were 512 training individuals. However in the Olympic year (1992) lofty number of days 321, and of training individuals was 459. In the cycle we can see the smallest number of days in season 1995 / 96 - 289, and number of trainings - 427. The average of training 10-times days of cycles amounted to 330 days by 465 training individuals on average fulfilled.

281 Fig. 1. Audit results of carrying regarding training burdens out in information area in 10-years cycle of the training M. K-N, years 1986-1998 (h).

pkt 6400 6200 6000 5800 5600 5400 5200 5000 4800 85/86 86/87 88/89 89/90 90/91 91/92 92/93 93/94 95/96 96/97 97/98

Cykle roczne

( = ) najlepszy wynik w cyklu Liniowy (najlepszy wynik w cyklu) Fig. 2. Development of results in the heptathlon in the 10-cio course summer cycle of the training M. K-N, years 1986-1998, (pkt.)

282 Test fig. 1 and 2, depicting amount of total charges (TR) in the 10 draft of cycles of the training, demonstrated the decreasing tendency (line of the TR trend). The same conclusion arises observing the line of the trend both of burdens about directed character (U), as well as special (S). Simultaneously we can see the line of the trend and results of spot achievements of results in the heptathlon M. K-N in years 1986 - 1998, about the firmly increasing tendency. He doesn't confirm, it, so of universal rule of in stages raising the volume of burdens just enough of course of the championship (Harre 1991; Sozański 1992). It confirms the theory simultaneously, that of roads to achieving a high result it is a lot, and an assumption is an element of making plans for the practice, that training strains cannot be a purpose in itself, but only with center for the achievement of the objective. An always forecast level of results is a purpose. For everyone a high individualized training process leads the competitor to it (Sozański, Poliszczuk 2003).

information area in 10-cio summer cycle of the training M. K-N, years 1986-1998 (h).

Data placed in tbl. 1 and fig. 3 depict proportion volumes of training burdens in 10-cio consecutive years of the summer cycle of the training. The lowest share of burdens about character in is visible in 4-th (69.4 %) and 2-th for them (74.2 %) of cycle, in remaining cycles participation of them in general preparation was similar c (80 %). Next large stake of burdens about character at they wrote down in 4-th (19.2 %) and 5-th (15.2 %) of cycle, and in remaining on average 12 -13%. One can see a large stake of burdens of the S in 2 -th for them (12.4 %) and 4-th (11.2 %), in remaining years hesitated from 5.4 - 8 %.

283 72:00:00 7 h 60:00:00 48:00:00 36:00:00 24:00:00

12:00:00

0 :00:00

I----- IT1 I— IT? i----- its i----- iT4 ^ ■ T 5 1-----IT(6) Liniowy (T1) Liniowy (T2) Liniowy (T3) Liniowy (T4) Liniowy (T5) Liniowy (T(6)) Fig. 3. Audit results of carrying regarding training burdens out in individual scopes of intensity (T1... T (6 )) in 10-years cycle of the training M. K-N, years 1986-1998 (h).

Fig. 4. Audit results of the proportion of training burdens in individual scopes of intensity (T1... T (6 )) in 10-years cycle of the training M. K-N, years 1986-1998 (%).

Tbl. 2. Audit results of carrying out intensity regarding burdens for the training in individual scopes (T1... T (6 )) in the 10-years cycle summer training M. K-N, years 1986-1998 (h, %).

Storage bur( ens Annual cycles T1 T2 T3 T4 T5 T6 1986 / 87 1 h 68:09:58 45:51:22 10:58:06 08:52:42 19:10:56 09:01:00

284 % 44.5 30 7.17 5.8 12.5 5.89 1988 / 89 h 55:45:05 34:23:20 12:52:44 11:51:43 18:22:33 16:35:05 % 41.8 25.8 9.66 8.9 13.8 12.5 1989 / 90 h 63:16:42 21:03:23 05:22:34 07:08:19 16:37:49 11:55:36 % 55.8 18.6 4.74 6.29 14.7 10.5 1990 / 91 h 34:19:50 28:51:17 09:33:05 12:02:35 16:44:25 12:32:08 % 33.8 28.4 9.41 11.9 16.5 12.4 1991 / 92 h 55:57:12 27:35:43 08:12:06 08:26:31 17:01:47 10:35:55 % 47.7 23.5 7 7.2 14.5 9.04 1992 / 93 h 51:48:58 23:15:14 05:35:08 05:52:45 17:21:58 12:11:19 % 49.9 22.4 5.38 5.66 16.7 11.7 1993 / 94 h 59:01:14 39:55:55 08:33:54 10:10:11 16:04:03 12:14:53 % 44.1 29.9 6.4 7.6 12 9.16 1995 / 96 h 53:52:44 24:47:16 04:56:18 07:57:14 10:28:43 08:26:34 % 52.8 24.3 4.84 7.8 10.3 8.27 1996 / 97 h 45:37:47 45:19:03 06:31:45 08:48:08 14:39:53 10:47:27 % 37.7 37.5 5.4 7.28 12.1 8.92 1997/ 98 h 53:22:27 35:43:41 07:31:56 08:29:40 20:57:17 12:35:12 % 42.3 28.3 5.97 6.74 16.6 9.98

Similarly how, in area about information character in individual scopes intensities had an amount of charges decreasing tendency (fig. 3). The exception constituted the second scope (T2), where from observation of his line of the trend, apparently growing tendency. The complexity of the process of the training conditioning achieving by the competitor the satisfying result is very complex. It regarding both of the efficiency, tactical and psychological preparation, the medical condition, character of training and starting burdens and many other parameters affecting the final result. It is necessary for that purpose to use results resulting from the control system, closely connected with the training. Then only we receive full of offenses of the specificity of the work of the specific competitor. Control of effects after training includes tests and of course sports results get during the competition. In all-year-round training M. K-N training individuals took the important place about test character. Analyzing training plans it is possible to state, that out of on average 330 training individuals 30-40 fell for tests of different type, tests and test tests. In the heptathlon, where on account of events appearing in it, to the same degree the appropriate level of all motor abilities is significant (speeds, powers, endurances) and of mechanical abilities ( 1 0 0 wb m; jump in high, into the distance; the shot put and the javelin throw), the systematic control is essential. In every part of the period training peculiar groups of tests were applied. All tests were conducted in standard conditions and by the same coach.

285 Below we quote the balance sheet applied in practice coaching in next cycles,

Test 1987 1989 1990 1991 1992 1993 1994 1996 1997 1998

4 kg hunches the 14.50 15.02 15.30 15.50 15.83 15.75 16.10 15.51 15.30 15.08 throw ahead, m 4 kg hunches the throw into the 15.82 16.20 16.40 16.60 16.80 16.70 17.35 16.45 16.30 16.66 back, m 60 m, sec. 7.45 7.28 7.15 7.10 7.03 7.10 7.14 7.40 7.30 7.41

100 m, sec. 12.26 11.93 11.62 11.50 11.44 11.79 11.74 11.98 12.01 12.02

precisely reflecting indicators of the inspection of the training, checking the level of the motricity level of training and the starting readiness (tbl. 3) in the course of analyzed annual cycles (Kamrowska-Nowak 2008). In tbl. 3 they presented, applied by the coach of Sławomir Nowak, rates of the control of motor features, get before the good result M. K-N in the given annual cycle. Such a control was applied in all examined cycles of the training before main take-offs in the last microcycle.

Tbl. 3. Indicators of the inspection of the efficiency preparation in next annual cycles M. K-N in the phase BPS

286 150 m, sec. 18.65 18.45 18.00 17.70 18.03 18.05 17.72 18.19 18.31 18.50

3- jump on both 8.10 8.30 8.35 8.80 8.45 8.40 8.30 8.05 8.38 8.57 feet, m 3- jump NN, the m 7.81 8.02 8.01 8.33 8.20 8.18 8.10 7.93 8.15 8.25

5- jump NN, the m 13.50 14.05 14.21 14.38 14.35 14.40 14.20 13.94 14.20 14.15

600 m, sec. 1.41.3 1.39.6 1.38.9 1.37.2 1.38.1 1.40.7 1.36.6 1.40.5 1.38.9 1.39.2

Five field events are included in a heptathlon: run on 100 m through hurdles, the high jump, the shot put, the long jump and the javelin throw. To rank among the most important features of the mechanical preparation belongs: the freedom, economics and the adaptation of techniques to individual features. The training of the technique consisted on constant improving and adapting the technique to the current motor potential. The inspection of mastering the technique of exchanged specializations consisted in the visual assessment of the coach, and sometimes they made rich with test of the video record. After every recording the mechanical training possible run-time errors or an improvement were discussed. In practice to the assessment of the degree of mastering the technique it is possible to use the following pointers suggested by Ozolin, Woronkin, Primakow, (1989):

□ 1 0 0 wb. m. - correct difference between the gear on 1 0 0 m but in a hurry barrierist should be smaller than 1.5 sec., □ the high jump - correct difference between the result of the high jump and the height should take bodies out 15 cm beyond the height, □ the shot put - correct difference between pushing right away and the push from glide - 1.5 m,

□ the long jump - between the long jump from 1 2 steps and from the full inrun should be a jump farther for the c 40 cm, □ javelin throw - correct difference between the group from the place and with throw should take 14 flat out from the warming-up Making an appraisal of technology in mentioned above events on the run on 100 wb m got M. K-N difference 1.07 sec.; in the high jump jumped 4 cm below the height; in the shot put - 1.5 m; in the long jump of 35 cm, and in the javelin throw of 12 flat Hence the conclusion that most badly she mastered the technique in the jump in up. From analysis of starts in the heptathlon one should assume that all the information and deliberations concerning arrangements result from analysis of get results during the competition.

287 The sports result includes a lot of information which can be used in the heptathlon for tests, can be also a source of knowledge for practical proceedings. Besides the final result of the pentathlon after all we have information concerning achievements in every storage event. Other track and field events don't create such possibilities, nor other measurable sports disciplines (Maciantowicz, Kubiszewski, Włodarczyk, 2003). In the pentathlon on account of his problem, to start it is possible in one annual cycle of little times. In case of M. K-N it was from 3 up to 4 times in 1, 2, 3, 5, 8 of cycle, and 5 starts were written down in 4-tym. Optimum number how, it results from tests of this work 3 starts multithlones. She has usually achieved good results in the third start, always on the target party.

Tbl. 4. Characterization of starts in the heptathlon in next cycles (of pt)

1 86 / 2 88 / 3 89 / 4 90 / 5 91 / 6 92 / 7 93 / 8 95 / 9 96 / 10 Annual cycles 87 89 90 91 92 93 94 96 97 97 / 98 Good result 5300 5507 6013 6279 6263 6019 6198 5941 6040 6023

Worst result 4917 4972 5710 6025 6137 -- 5815 --

Average result 5130 5325 5899 6125 6197 -- 5861 --

Number of starts 3 3 4 5 3 1 1 3 1 1

Tbl. 4 contains the set of results of starts, taking into account the best, worst and average result in the heptathlon in the given training cycle. One can see, that in the cycle 1 competitor got 5300 of pt, worst 4917 of pt, and the average result of the cycle took out 5130 of pt In the consecutive year the average rose about 200 pt (5325), where the worst result was seen 4972, and best 5507 of pt. In the 1990-th season a better high result was already get about 570 of pt (5899 pt), and good result it 6013. Two best cycles 1991 and 1992 is crowning glories and results 6279 and 6263 of pt, where the average of the first cycle was a pt about 72 lower. For two next years after one start, appropriately 6019 and 6198 of pt In 8 the cycle at three starts was get average 5861 of pt In conclusion two last cycles about the similar result, in 9 - 6040 and 10 - 6023 of pt

Tbl. 5. The best start in the heptathlon in the given cycle with specifying the scoring of individual events, 1987-98 years, ^ pt ______Difference Annual 1 86 / 2 88 / 3 89 / 4 90 / 5 91 / 6 92 / 7 93 / 8 95 / 9 96 / 10 97 / between cycles 87 89 90 91 92 93 94 96 97 98 4 th and 1 st cycle 100 m 920 991 1026 110 0 1053 1041 1072 1023 995 1036

288 wb. +71 +35 +74 -47 -12 +31 -49 -28 +41 +180 jump 736 701 736 830 855 806 771 736 806 806 up -35 +35 +94 +25 -49 -35 -35 +70 0 +94 push 713 701 800 858 827 835 896 888 858 908 they hunch -12 +99 +58 -31 +8 +61 -8 -30 +50 +145 200 m 786 862 918 966 943 896 927 891 878 852 +96 +56 +48 -23 -47 +31 -36 -13 -26 +180 jump 753 750 847 874 887 828 804 880 856 792 into the -3 +97 +27 +13 -59 -24 +76 -24 -64 +121 distance throw 588 611 726 691 747 686 774 610 700 714 with +23 +115 -35 +56 -61 +88 -164 +90 +14 +103 javelin 800 m 804 891 933 960 952 927 954 913 946 915 +87 +42 +27 -8 -25 +27 -41 +33 -31 +156 heptathlon 5300 5507 6013 6279 6263 6019 6198 5941 6040 6023 +979

Specifying the scoring of every event of the heptathlon (tbl. 5) allows for observation and the control of expected progress in individual events entering his line-up. From placed data we can see that greatest progress was recorded in 1 cycle on the run on 200 m (96 pt) and 800 m (87 pt), as well as on the run on 100 wb m (71 pt). However progress in the high jump wasn't registered (less 35 pt) and for the shot put (worse about 12 pt). Generally the result in the heptathlon was better about 207 of pt In the next season (1990) progress about 506 of pt And results were better at all storage events. The most pt, towards the previous year they got in the javelin throw (115 pt), for the shot put (99 pt) and in the long jump (97 pt). In 4 one can see the cycle the overall result improved about 263 of pt Best achieving 6279 the pt get on AMS, where in three events (100 wb m; 200 m and 800 m) corrected personal bests. The greatest scoring improvements were written down in the high jump (94 pt), of run on 100 wb m (74 pt), for the shot put (56 pt) and of run on 200 m (48 pt). The lack of the improvement and the worse result (about 35 pt) however was in the javelin throw. In 1992 they achieved good results during IO (6263 pt). They were better at individual events: javelin throw (56 pt), the high jump (25 pt) and into the distance (13 pt), and worse:

100 ppl m (47 pt), the shot put (31 pt), run on 200 m (23 pt) and 800 m (8 pt). In remaining cycles results were worse, and detailed get points during the best starts are in tbl. 5. In every result in the heptathlon (tbl. 5 and fig. 5) we can see the majority of the scoring on the run on 100 m through hurdles, next on the run on 800 and 200 flat Next it scored the shot put. A javelin throw and the high jump turned out to be the poor competition.

289 Specifying the scoring and dynamics of results gives the sure sense of direction, as for the scale, as well as of the internal structure of progress in the heptathlon of the analyzed competitor. They can it to be simultaneously premises to generalized reflections about the internal structure of the event. A record-keeping is a base of the professional inspection training. Based on gathered data in detail we analyze the quantitative and quality enrollment of the training, as well as their structure. Results of conducted tests let the coach possible corrections. Conclusions In the all-year-round system of training the heptathlon training individuals take the important place about test character. Analyzing training documentation it is possible to state, that out of 289 -512 training individuals c 10 % enforcement units occupy the whole. The control of effects of the training should be planned before beginning the preparatory period, and tests and such tests well-matched so that in the large degree they announce the level of the examined efficiency. The process of the inspection of the training must be carried out systematically, giving the possibility of comparisons and tests in the long term. Every part of the period of the training (subperiod, mezocykl) should be characterized by a peculiar group of tests.

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290 8 . Łasiński G.: Ocena efektywności obciążeń treningowych. „Sport Wyczynowy” 1981,

1 . 9. Maciantowicz J., Kubiszewski M., Włodarczyk U.: Wieloboje lekkoatletyczne. Warszawa 2003. COS. 10. Naglak Z.: Metodyka trenowania sportowca. Wrocław1991. AWF.

11. Naglak Z.: Kontrola efektów treningowych. „Sport Wyczynowy” 1999, 8 . 12. Płatonow W.N.: Adaptacja w sporcie. Warszawa 1990. RCMSzKFiS. 13. Płatonow W. N.: Obszczaja tieorija podgotowki sportsmienow w olimpijskom sportie. Kijew 1997. Olimpijskaja Litieratura. 14. Przybylski W. (1997): Kontrola treningu i obciążeń treningowych w piłce nożnej. [w:] Monografia. Gdańsk, AWF. 15. Raczek J.: Podstawy szkolenia sportowego dzieci i młodzieży. Warszawa 1991. RCMSzKFiS. 16. Sozański H. (red).: Kierunki optymalizacji obciążeń treningowych. Warszawa 1992. AWF. 17. Sozański H., Kosmol A.: Optymalizacja obciążeń treningowych jako czynnik kierowania rozwojem sportowca. „Sport Wyczynowy” 1990, 11-12. 18. Sozański H., Zaporożanow W.: Kierowanie jako czynnik optymalizacji treningu. Warszawa 1993. RCMSzKFiS. 19. Sozański H., Poliszczuk D.: Wybrane aspekty długofalowego planowania treningu w lekkiej atletyce. Bydgoszcz 2003, Wydawnictwo „Sport”. 20. Ulatowski T.: Teoria sportu. Warszawa 1992. UKFiT. 21. Ważny Z.: Współczesny system szkolenia w sporcie wyczynowym. Warszawa 1981. Sport i Turystyka. 22. Ważny Z.: Kontrola efektówpotreningowych. Warszawa 1990. RCMSzKFiS. 23. Ważny Z.: Kierunki doskonalenia metod kontroli treningu. „Sport Wyczynowy” 1996, 3-4. 24. Ważny Z.: Metodologiczne problemy trafności oceny wpływu obciążeń treningowych na osiągnięcia sportowe. „Sport Wyczynowy” 1999, 7-8. 25. Zaporożanow W.: Kontrol w sportiwnoj trenirowkie. Kijew 1988. Zdrowja. 26. Zaporożanow W., Sozański H. (1997): Dobór i kwalifikacja do sportu. Warszawa, RCMSzKFiS.

291 Wprowadzenie W skład siedmioboju kobiet wchodzą konkurencje o złożonej strukturze ruchu. W związku z tym proces treningu wymaga kształtowania bardzo szerokiego wachlarza funkcji organizmu. Dla lepszej efektywności tych działań szkolenie wymaga także współpracy z naukowcami różnych dziedzin oraz korzystania z osiągnięć techniki. Drogi wykorzystywania zasobów wiedzy naukowej dla potrzeb sportu omawiane są w pracach wielu specjalistów (Burns, Gains, 1984; Płatonow, 1990; Przybylski, 1997; Raczek, 1991).

Kierowanie działalnością sportową według Naglaka (1999), Sozańskiego i Zaporożanowa (1993), Płatonowa (1997) powinno odbywać się na drodze zorganizowanej kontroli zachowania zawodnika przed i w trakcie zawodów. Duże znaczenie mają tu zdobycze techniki, które pozwalają rejestrować, opracowywać i przedstawiać wielokierunkowe informacje o badanym zawodniku. Zdaniem wielu autorów (Kochanowicz, 1998; Naglak, 1991; Płatonow, 1997; Ulatowski, 1992; Zaporożanow, 1988, 1997; Ważny, 1990, 1996) kierowanie procesem treningu powinno zmierzać do optymalizacji wszelkich działań począwszy od etapu doboru, aż do zakończenia kariery. Do poprawy rezultatów sportowych wykorzystać trzeba jak największą liczbę informacji o stanie możliwości funkcjonalnych organizmu oraz zmianach, jakie w nim zachodzą pod wpływem treningu. Najbardziej rzetelnym sposobem pozyskania takich danych są informacje na temat reakcji organizmu na bodźce treningowe zawodników posiadających wysoki poziom mistrzostwa w danej dyscyplinie sportu (Kochanowicz, 1995; Sozański, Kosmol, 1990; Ważny, 1981,1999). Kochanowicz (1995), Czajkowski (1988), Kozioł (1983) uważają, że szeroko rozumiana kontrola dostarcza wielu informacji opisujących reakcje i przebieg procesów adaptacyjnych zawodnika na bodźce treningowe i startowe. Według Płatonowa (1997), Zaporożanowa i Sozańskiego (1997) kierowanie i kontrola etapowa powinny tworzyć zbiór informacji służący opracowaniu indywidualnych, modelowych struktur treningu i startów, a równocześnie umożliwiać korektę planów treningu. Aby sformułować zalecenia do kierowania procesem treningu, należy zbadać rzeczywiste, zrealizowane obciążenia treningowe przez te zawodniczki, które osiągnęły odpowiednio wysoki poziom sportowy (Łasiński, 1981). Do oceny stanu wydrenowania siedmioboistek o różnym stopniu zaawansowania potrzebny jest zróżnicowany dobór wskaźników kontroli. Opracowanie takiego zestawu wydaje się dość trudne i skomplikowane, gdyż wartość prognostyczna wielu cech zmienia się w zależności od wieku badanych, poziomu sprawności fizycznej oraz innych czynników. Dla oceny skutków treningu konieczna jest, więc dokumentacja, bez której nie można wyobrazić sobie profesjonalnego kierowania zawodnikiem. Na podstawie zgromadzonych danych szczegółowo analizujemy zapisy ilościowe i jakościowe treningu, a także ich struktury. Wyniki przeprowadzonych analiz pozwalają trenerowi na precyzyjniejsze stwierdzenie, jakie środki, o jakiej intensywności oraz w jakim czasie zostały zastosowane przez zawodników. Dzięki temu trener ma szerokie możliwości kompleksowej i rzetelnej kontroli oraz sterowania procesem treningu. Uzyskane wyniki, poparte analizą, posiadają dużą wartość aplikacyjną (Sozański 1992). Cel pracy Kierując się tymi wskazaniami podjęto tu próbę przedstawienia wyników kontroli wykonania - stopnia i sposobu realizacji treningu (wszystko to, co tworzy szeroko rozumiane obciążenie treningowe) - oraz kontroli efektów potreningowych (sprawdziany; zawody) wieloletniego procesu treningu wysokiej klasy zawodniczki specjalizującej się w siedmioboju. Materiał i metoda Badaniu poddano 10-cio letni cykl treningu siedmioboistki M. K-N na etapie szkolenia specjalnego i mistrzostwa sportowego. Zawodniczka odnosiła znaczące sukcesy na arenie krajowej (5-ciokrtona wicemistrzyni Polski) oraz międzynarodowej (brązowy medal na Uniwersjadzie - 1991 r.; IO w 1992 r. - 10 miejsce; MŚ w 1991 r. - 9 miejsce). Pomiaru i rejestracji wielkości środków treningowych dokonywano po zakończeniu każdej jednostki treningowej wykorzystując metodę TreOB 4, a sprawności fizycznej w warunkach treningowych w tzw. BPS-ie, w ostatnim tygodniu poprzedzającym najlepszy start w cyklu. Wyniki Dzięki bardzo dokładnej dokumentacji treningowej możliwa stała się wielopoziomowa kontrola, obejmująca wszystkie przedziały czasowe. Najważniejsza było bieżąca obserwacja procesu adaptacji i przez to wczesne zapobieganie powstającym rozbieżnościom. Stopień zakładanych osiągnięć (przewidzianych w programie) był każdorazowo porównywany z uzyskiwanymi efektami. Wszelkie niezgodności natychmiast skłaniały do refleksji oraz znalezienia sposobu wprowadzenia korekty. Posiłkując się stwierdzeniami Sozańskiego i Zaporożanowa, (1993), które odnoszą się do kierowania i kontroli procesem treningowym, stwierdzono, że między innymi precyzyjna informacja o zrealizowanych obciążeniach treningowych i indywidualnych, specyficznych dla każdego zawodnika zdolnościach kondycyjnych i koordynacyjnych, jest jednym z głównych czynników optymalizacyjnych proces treningowy. Należy pamiętać, że o swoistości przygotowania sportowca decyduje jego indywidualność, która przejawia się w pracy treningowej i aktywności startowej. Spośród wielu cech i właściwości zawodnika w procesie kontroli stanu jego przygotowania należy uwzględniać tylko te, które odgrywaj ą główną rolę w trakcie walki sportowej. Wyniki badań mieszczących się poniżej, są jednoznaczne, zgodne z trendami stwierdzonymi w literaturze, iż decydującym czynnikiem pozytywnego rozwoju sportowego jest rodzaj treningu, identyfikowany przez wielkość, rodzaj i strukturę obciążeń wysiłkowych. Prawda ta znajduje swoje praktyczne odzwierciedlenie w dwóch rodzajach treningu, zasadniczo różnych ilościowo (ryc. 1 i 3, ta b. 1) i jakościowo (ryc. 4 i 5, tab. 2).

Tab.1. Wyniki kontroli obciążeń treningu w obszarze informacyjnym w cyklu 10-cio letnim treningu M. K-N, lata 1986/ 98 (h, %).

Cykle Liczba dni Liczba jedn. Składowe obciążenia roczne trening. trening. TRWUS

h 153:03:04 121:09:15 22:20:30 09:33:19 1986/87 340 439 % 100 79,2 14,6 6,24 h 133:15:25 98:51:24 17:38:22 16:45:39 1988/89 365 488 % 100 74,2 13,2 12,6 h 113:28:47 93:02:16 13:31:47 06:54:44 1989/90 348 468 % 100 81,9 11,9 6,09 1990/91 356 512 h 101:31:12 70:30:02 19:31:23 11:28:47

292 % 100 69,4 19,2 11,3 h 117:13:19 91:18:44 18:26:36 07:27:59 1991/92 321 459 % 100 77,9 15,7 6,37 h 103:54:03 84:49:19 13:22:32 05:42:12 1992/93 326 438 % 100 81,6 12,9 5,49 h 133:45:17 106:26:08 17:07:21 10:11:48 1993/94 333 493 % 100 79,6 12,8 7,62 h 102:02:15 84:10:03 09:38:19 08:13:53 1995/96 289 427 % 100 82,5 9,45 8,07 h 120:56:36 98:29:54 15:54:57 06:31:45 1996/97 302 491 % 100 81,4 13,2 5,4 h 126:05:01 98:01:47 17:13:41 09:49:33 1997/98 320 479 % 100 78,5 13,7 7,79 Średnia 330 465 h 120:31:30 94:46:33 16:28:33 9:16:04 10 cykli

Z danych tab. 1 wynika, że największą ilość dni treningowych przepracowała w 1988/89 i było to 365 przy 488 jednostkach treningowych. W sezonie 1990/91 było 356 dni treningowych przy 512 jednostkach treningowych. Natomiast w roku olimpijskim (1992) liczba dni wyniosła 321, a jednostek treningowych było 459. Najmniejszą liczbę dni w cyklu widzimy w sezonie 1995/96 - 289, a liczba treningów - 427. Średnia dni treningowych 10-ciu cykli wyniosła 330 dni przy średnio zrealizowanych 465 jednostkach treningowych.

Ryc. 1. Wyniki kontroli wykonania dot. obciążeń treningowych w obszarze informacyjnym w 10-cio letnim cyklu treningu M. K-N, lata 1986-1998 (h).

293 pkt 6400 6200 6000 5800 5600 5400 5200 5000 4800 85/86 86/87 88/89 89/90 90/91 91/92 92/93 93/94 95/96 96/97 97/98

Cykle roczne

( = ) najlepszy wynik w cyklu Liniowy (najlepszy wynik w cyklu)

Ryc. 2. Rozwój wyników w siedmioboju w przebiegu 10-cio letnim cyklu treningu M. K-N, lata 1986-1998, pkt.

Analiza ryc. 1 i 2, obrazująca wielkość całkowitych obciążeń (TR) w przeciągu 10-ciu cykli treningu, wykazała tendencję malejącą (linia trendu TR). Taki sam wniosek nasuwa się obserwując linię trendu zarówno obciążeń o charakterze ukierunkowanym (U), jak i specjalnym (S). Jednocześnie widzimy linię trendu i wyniki punktowych osiągnięć rezultatów w siedmioboju M. K-N w latach 1986 - 1998, o tendencji mocno rosnącej. Nie potwierdza, to, więc uniwersalnej reguły etapowego podnoszenia objętości obciążeń w miarę rozwoju mistrzostwa (Harre 1991; Sozański 1992). Potwierdza jednocześnie teorię, że dróg do osiągnięcia wysokiego wyniku jest wiele, a podstawową zasadą planowania treningu jest założenie, że obciążenia treningowe nie mogą być celem samym w sobie, a jedynie środkiem dla osiągnięcia celu. Celem jest zawsze prognozowany poziom wyników. Dla każdego zawodnika prowadzi do tego wysoki zindywidualizowany proces szkolenia (Sozański, Poliszczuk 2003).

M. K-N, lata 1986-1998 (h).

Dane zamieszczone w tab. 1 i ryc. 3 obrazują proporcje objętości obciążeń treningowych w kolejnych latach 10-cio letniego cyklu treningu. Najniższy udział obciążeń o charakterze W widoczny jest w 4-tym (69,4 %) i 2-im (74,2 %) cyklu, w pozostałych cyklach udział ich w ogólnym przygotowaniu był podobny ok. (80 %). Z kolei największy udział obciążeń o charakterze U zanotowano w 4-tym (19,2 %) i 5-tym (15,2 %) cyklu, a w pozostałych średnio 12 -13%. Największy udział obciążeń S widać w 2-im (12,4 %) oraz 4-tym (11,2 %), w pozostałych latach wahały się od 5,4 - 8 %.

294 72:00:00 7 h 60:00:00

48:00:00

36:00:00

24:00:00

12:00:00

0 :00:00

l----- IT1 i----- lT2 i----- iT3 i----- iT4 ^ ■ T 5 1-----IT(6) Liniowy (T1) Liniowy (T2) Liniowy (T3) Liniowy (T4) Liniowy (T5) Liniowy (T(6))

Ryc. 3. Wyniki kontroli wykonania dot. obciążeń treningowych w poszczególnych zakresach intensywności (Ti...T(6)) w 10-cio letnim cyklu treningu M. K-N, lata 1986-1998 (h).

Ryc. 4. Wyniki kontroli proporcji obciążeń treningowych w poszczególnych zakresach intensywności (Ti...T(6)) w 10-ciu letnim cyklu treningu M. K-N, lata 1986-1998 (%).

Tab. 2. Wyniki kontroli wykonania dot. obciążeń treningu w poszczególnych zakresach intensywności (T^.T^) w cyklu 10-cio letnim treningu M. K-N, lata 1986-1998 (h, %).

Składowe obciążenia

Cykle roczne T1 T2 T3 T4 T5 T(6) 1986/87 h 68:09:58 45:51:22 10:58:06 08:52:42 19:10:56 09:01:00 % 44,5 30 7,17 5,8 12,5 5,89 1988/89 h 55:45:05 34:23:20 12:52:44 11:51:43 18:22:33 16:35:05 % 41,8 25,8 9,66 8,9 13,8 12,5

295 1989/90 h 63:16:42 21:03:23 05:22:34 07:08:19 16:37:49 11:55:36 % 55,8 18,6 4,74 6,29 14,7 10,5 1990/91 h 34:19:50 28:51:17 09:33:05 12:02:35 16:44:25 12:32:08 % 33,8 28,4 9,41 11,9 16,5 12,4 1991/92 h 55:57:12 27:35:43 08:12:06 08:26:31 17:01:47 10:35:55 % 47,7 23,5 7 7,2 14,5 9,04 1992/93 h 51:48:58 23:15:14 05:35:08 05:52:45 17:21:58 12:11:19 % 49,9 22,4 5,38 5,66 16,7 11,7 1993/94 h 59:01:14 39:55:55 08:33:54 10:10:11 16:04:03 12:14:53 % 44,1 29,9 6,4 7,6 12 9,16 1995/96 h 53:52:44 24:47:16 04:56:18 07:57:14 10:28:43 08:26:34 % 52,8 24,3 4,84 7,8 10,3 8,27 1996/97 h 45:37:47 45:19:03 06:31:45 08:48:08 14:39:53 10:47:27 % 37,7 37,5 5,4 7,28 12,1 8,92 1997/98 h 53:22:27 35:43:41 07:31:56 08:29:40 20:57:17 12:35:12 % 42,3 28,3 5,97 6,74 16,6 9,98

Podobnie, jak w obszarze o charakterze informacyjnym wielkość obciążeń w poszczególnych zakresach intensywności miały tendencję malejącą (ryc. 3). Wyjątek stanowił zakres drugi (T2), gdzie z obserwacji jego linii trendu, widać tendencję wzrastającą. Złożoność procesu treningu warunkującego osiągnięcie przez zawodnika zadowalającego rezultatu jest bardzo skomplikowana. Dotyczy to zarówno przygotowania sprawnościowego, taktycznego i psychicznego, stanu zdrowia, charakteru obciążeń treningowych i startowych oraz wielu innych parametrów mających wpływ na ostateczny wynik. Trzeba w tym celu wykorzystać wyniki płynące z systemu kontroli, ściśle powiązanego ze szkoleniem. Wtedy dopiero otrzymujemy pełen obraz specyfiki pracy konkretnego zawodnika. Kontrola efektów po treningowych obejmuje sprawdziany i oczywiście wyniki sportowe uzyskane podczas zawodów. Ważne miejsce w całorocznym szkoleniu M. K-N zajmowały jednostki treningowe o charakterze kontrolnym. Analizując plany szkoleniowe można stwierdzić, że spośród średnio 330 jednostek treningowych 30-40 przypadało na różnego typu sprawdziany, testy i próby kontrolne. W siedmioboju, gdzie ze względu na konkurencje w nim występujące, w równej mierze istotny jest odpowiedni poziom wszystkich zdolności motorycznych (szybkości, siły, wytrzymałości) oraz umiejętności technicznych (100 m ppł; skok wzwyżi w dal; pchnięcie kulą i rzut oszczepem), systematyczna kontrola jest nieodzowna. W każdej części okresu szkoleniowego stosowano specyficzne grupy testów. Wszystkie próby przeprowadzane były w standardowych warunkach i przez tego samego trenera. Poniżej przytaczamy zestawienie stosowanych w praktyce trenerskiej wskaźników kontroli treningu, sprawdzających poziom sprawności motorycznej w kolejnych cyklach, precyzyjnie odzwierciedlając poziom wytrenowania i gotowości startowej (tab. 3) w przebiegu analizowanych cykli rocznych (Kamrowska-Nowak 2008). W tab. 3 przedstawiono, stosowane przez trenera Sławomira Nowaka, wskaźniki kontroli cech motorycznych, uzyskane przed najlepszym wynikiem M. K-N w danym cyklu rocznym. Kontrolę taką stosowano we wszystkich badanych cyklach treningu przed startami głównymi w ostatnim mikrocyklu.

Tab. 3. Wskaźniki kontroli przygotowania sprawnościowego w kolejnych cyklach rocznych M. K-N w fazie BPS

296 10 97/98 ---- 5815 5861 ---- 297 - prawidłowaróżnica między rzutem z miejsca arzutem z rozbiegu powinna wynosić m. 14 - prawidłowaróżnica między pchnięciem z miejsca a pchnięciem z doślizgu - m, 1,5 14.50 15.0215.82 15.30 16.20 15.50 16.40 15.83 16.60 15.75 16.80 16.10 16.70 15.51 17.35 15.30 16.45 15.08 16.30 16.66 - prawidłowaróżnica między rezultatem skoku wzwyż a wysokością ciała powinna wynosić cm15 ponad wzrost, -między skokiem wdal z kroków 12 a skokiem z pełnego rozbiegu powinnobyć dalej o ok. 40 cm, . -. prawidłowa różnicamiędzy biegiem na 100 m abiegiem płotkarskim powinnabyć mniejszaniż 1,5 s, 100 m ppł skokwzwyż pchniecie kulą skokw dal rzut oszczepem Dokonując ocenytechniki wwyżej wymienionych konkurencjach M. K-N wbiegu na m100 ppłuzyskała różnicę 1,07 s; w skoku Tab. 4 zawiera zbiór wyników startów, uwzględniając najlepszy, najgorszy i średni wynik w siedmioboju lekkoatletycznym w W praktyce do oceny stopnia opanowania techniki można posłużyć się następującymi wskazówkami zaproponowanymi przez Z analizy startów w siedmioboju należy przyjąć,Wynik że sportowy wszelkiew siedmioboju informacje zawiera i rozważaniawiele informacji, dotyczące które przygotowaniamogą być wynikają wykorzystane z do analiz, mogąW wielobojubyć takżeze względuźródłem najego trudność, wystartować można jednymw cyklu rocznym niewiele razy. W przypadku M. K-N W skład siedmioboju wchodzi pięć konkurencji technicznych: bieg na 100 m przez płotki, skok wzwyż, pchnięcie kulą, skok w Cykle roczne 86/87 1 2 88/89 3 89/90 4 90/91 5 91/92 6 92/93 7 93/94 8 95/96 9 96/97 Średni wynik 5130 5325 5899 6125 6197 Liczba startów 3 3 4 5 3 1 1 3 1 1 Najlepszywynik 5300 5507 6013 6279 6263 6019 6198 5941 6040 6023 Najgorszy wynik 4917 4972 5710 6025 6137 w przód, m wtył, m 1990-tym uzyskano lepszy średni rezultat już o 570 pkt. (5899 pkt), a najlepszy wynik to 6013. Najlepsze dwa cykle 1991 i 1992 to 100 100 m, s 150 m, s 12.26 11.93 18.65 11.62 18.45 11.50 18.00 11.44 17.70 11.79 18.03 11.74 18.05 11.98 17.72 12.01 18.19 12.02 18.31 18.50 5-skok NN, m 13.50 14.05 14.21 14.38 14.35 14.40 14.20 13.94 14.20 14.15 szczytowe osiągnięcia i wyniki 6279 i 6263 pkt., gdzie średnia pierwszego cyklu była o 72 pkt. niższa. Przez następne dwa lata pojednym składowej konkurencji. Takich możliwości nie stwarzają pozostałe konkurencje lekkoatletyczne, ani też inne wymierne dyscypliny sportu Tab. 4. Charakterystyka startów w siedmiobojuw kolejnych cyklach (pkt.) Sprawdzian 1987 1989 1990 1991 1992 1993 1994 1996 1997 1998 600 m, sdal i rzut oszczepem. Do najważniejszych cech przygotowania technicznegoanalizązapisu magnetowidowego. zaliczyć należy:Pokażdorazowym swobodę, nagraniu treningu ekonomikę technicznego 1.41.3 omawiano orazOzolina, ewentualne Woronkina, dostosowanie błędy Primakowa, wykonania (1989):lub poprawę. 1.39.6 1.38.9 1.37.2 1.38.1 1.40.7 1.36.6 1.40.5 1.38.9 1.39.2 3-skok obunóż, m3-skok NN, m 8.10 8.30 7.81 8.35 8.02 8.80 8.01 8.45 8.33 8.40 8.20 8.30 8.18 8.05wzwyż skoczyła 4 cm poniżej 8.10 wzrostu; w pchnięciu kulą - 8.38 1,5 m; w skoku analizywrezultatów dal uzyskanych 35 7.93 cm, podczas a zawodów.w rzucie oszczepem 12 m. 8.57 Stądwiedzy wniosek, do że postępowania 8.15 praktycznego. Obok (Maciantowicz, końcowego Kubiszewski, rezultatu Włodarczyk, wieloboju2003). mamy 8.25 wszak informacje dotyczące osiągnięćwielobojowe. Najlepszy w wynikuzyskiwała każdej zwykle wtrzecim starcie, zawsze na imprezie docelowej. danym cyklu szkoleniowym. Widać, że pkt.w cyklu Wzawodniczka 1 kolejnym rokuuzyskała średnia5300 pkt., podniosłanajgorszy się 4917 o pkt., 200 a średnipkt wynik(5325), cyklu wyniósł gdzie najgorszy 5130 wynik odnotowano 4972, a najlepszy 5507 pkt. W sezonie 60 m, s 7.45 7.28 7.15 7.10 7.03 7.10 7.14 7.40 7.30 7.41 techniki do indywidualnych cech. motorycznego. Trening techniki Kontrola polegał opanowaniana ciągłymtechniki doskonaleniu wymienionych i dostosowywaniu specjalności techniki polegała do aktualnegona oceniepotencjału wizualnej trenera, a niekiedy wzbogacano najgorzej opanowała technikę w skoku w wzwyż. było to od 3 do 4 razy w 1, 2, 3, 5, 8 cyklu, a w 4-tym zanotowano 5 startów. Optymalna liczba, jak wynika z analiz tej pracy to 3 starty rzutkulą 4kg. rzutkulą 4 kg. □ □ □ □ □ starcie, odpowiednio 6019 i 6198 pkt. W 8 cyklu przy trzech startach uzyskano średnią 5861 pkt. Na zakończenie ostatnie dwa cykle o podobnym wyniku, w 9 - 6040 i 10 - 6023 pkt.

Tab. 5. Najlepszy start w siedmioboju w danym cyklu z wyszczególnieniem punktacji poszczególnych konkurencji, lata 1987-98, pkt. Różnica Cykle roczne 1 86/87 2 88/89 3 89/90 4 90/91 5 91/92 6 92/93 7 93/94 8 95/96 9 96/97 10 97/98 między 4 i 1 cyklem 100 m 920 991 1026 1100 1053 1041 1072 1023 995 1036

ppł. +71 +35 +74 -47 -12 +31 -49 -28 +41 +180 skok 736 701 736 830 855 806 771 736 806 806 wzwyż -35 +35 +94 +25 -49 -35 -35 +70 0 +94 pchnięcie 713 701 800 858 827 835 896 888 858 908 kulą -12 +99 +58 -31 +8 +61 -8 -30 +50 +145 200 m 786 862 918 966 943 896 927 891 878 852 +96 +56 +48 -23 -47 +31 -36 -13 -26 +180

skok 753 750 847 874 887 828 804 880 856 792 w dal -3 +97 +27 +13 -59 -24 +76 -24 -64 +121

rzut 588 611 726 691 747 686 774 610 700 714

oszczepem +23 +115 -35 +56 -61 +88 -164 +90 +14 +103

800 m 804 891 933 960 952 927 954 913 946 915 +87 +42 +27 -8 -25 +27 -41 +33 -31 +156

siedmiobój 5300 5507 6013 6279 6263 6019 6198 5941 6040 6023 +979

Wyszczególnienie punktacji każdej konkurencji siedmioboju (tab. 5) pozwala na obserwację i kontrolę oczekiwanych postępów w poszczególnych konkurencjach wchodzących w jego skład. Z zamieszczonych danych widzimy, że w 1cyklu największy postęp odnotowano w biegu na 200 m (96 pkt) i 800 m (87 pkt), a także w biegu na 100 m ppł (71 pkt). Nie zanotowano natomiast postępu w skoku wzwyż (mniej 35 pkt) i pchnięciu kulą (gorzej o 12 pkt). Ogólnie wynik w siedmioboju był lepszy o 207 pkt. W następnym sezonie (1990 r.) postęp o 506 pkt. A wyniki były lepsze we wszystkich składowych konkurencjach. Najwięcej pkt., w stosunku do roku poprzedniego uzyskano w rzucie oszczepem (115 pkt), pchnięciu kulą (99 pkt) oraz w skoku w dal (97 pkt). W 4 cyklu widać, że ogólny wynik poprawił się o 263 pkt. Najlepsze osiągnięcie 6279 pkt. uzyskane na AMŚ, gdzie w trzech konkurencjach (100 m ppł; 200 m oraz 800 m) poprawiła rekordy życiowe. Największe poprawy punktowe zanotowano w skoku wzwyż (94 pkt), biegu na 100 m ppł (74 pkt), pchnięciu kulą (56 pkt) oraz biegu na 200 m (48 pkt). Brak poprawy i gorszy wynik (o 35 pkt) był natomiast w rzucie oszczepem. W roku 1992 najlepszy wynik uzyskano podczas IO (6263 pkt). W poszczególnych konkurencjach lepsze były: rzut oszczepem (56 pkt), skok wzwyż (25 pkt) i w dal (13 pkt), a gorsze: 100 m ppł (47 pkt), pchnięcie kulą (31 pkt), bieg na 200 m (23 pkt) i 800 m (8 pkt). W pozostałych cyklach wyniki były gorsze, a szczegółowe punkty uzyskane podczas najlepszych startów znajdują się w tab. 5. W każdym rezultacie w siedmioboju (tab. 5 i ryc. 5) widzimy przewagę punktacji w biegu na 100 m przez płotki, następnie w biegu na 800 oraz 200 m. W następnej kolejności punktowało pchnięcie kulą. Najsłabszą konkurencją okazał się rzut oszczepem i skok wzwyż. Wyszczególnienie punktacji oraz dynamiki wyników daje pewną orientację, co do skali, jak i wewnętrznej struktury postępów w siedmioboju analizowanej zawodniczki. Mogą to być jednocześnie przesłanki do uogólnionych przemyśleń na temat wewnętrznej struktury konkurencji.

298 Podstawą profesjonalnej kontroli jest prowadzenie dokumentacji treningowej. Na podstawie zgromadzonych danych szczegółowo analizujemy zapisy ilościowe i jakościowe treningu, a także ich struktury. Wyniki przeprowadzonych analiz pozwalają trenerowi na ewentualne korekty. W nioski Ważne miejsce w całorocznym systemie szkolenia siedmioboju zajmują jednostki treningowe o charakterze kontrolnym. Analizując dokumentację treningową można stwierdzić, że spośród 289 -512 jednostek treningowych ok. 10 % ogółu zajmują jednostki kontrolne. Kontrola efektów szkolenia powinna być zaplanowana przed rozpoczęciem okresu przygotowawczego, a testy i sprawdziany tak dobrane, aby w największym stopniu informowały o poziomie badanej sprawności. Proces kontroli treningu musi być realizowany systematycznie, dając możliwość porównań i analiz w dłuższym okresie czasu. Każda część okresu szkolenia (podokres, mezocykl) powinien charakteryzować się specyficzną grupą testów.

Piśmiennictwo

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Conflict of interest: None declared.

Received: 21.01.2013. Revised: 18.03.2013. Accepted: 09.06.2013.

300 301 302 303 Publishing House: Radomska Szkoła Wyższa w Radomiu, Radom University in Radom Str. Zubrzyckiego 2 26-600 Radom Tel.: +48 48 383 66 05 [email protected] Printing House: Radomska Szkoła Wyższa w Radomiu, Radom University in Radom Str. Zubrzyckiego 2 26-600 Radom Tel.: +48 48 383 66 05 [email protected] ISBN 9781329900516

ISBN 9781329900516

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304 ISBN 9781329900516

9781329900516