Если среди первоклассников абсолютно здоровыми являются 4,3% учащихся, то среди одиннадцатиклассников таких совсем нет. За время обучения в школе среди детей повышается распространенность язвенной болезни, сколиоза и близорукости. К таким выводам пришли эксперты НИИ гигиены и охраны здоровья детей и подростков ФГАУ «Национальный научно-практический центр здоровья детей» Минздрава РФ, которые проводили обследование с 2005 по 2015 годы в московских школах.Доктор медицинских наук, профессор, заведующая лабораторией научных основ школ здоровья НИИ гигиены и охраны здоровья детей и подростков ФГАУ «Национальный научно-практический центр здоровья детей» Минздрава РФ Ирина Рапопорт рассказал «Известиям», что всего клинические наблюдения проводились за 426 детьми из четырех школ, расположенных в разных округах Москвы.
На протяжении 11 лет каждый год в апреле врачи проводили обследование детей в школах. Оно включало педиатрический осмотр, трехкратное измерение артериального давления, осмотр ортопедом и офтальмологом, неврологом, оториноларингологом и кардиологом. Кроме того, проводилось анкетирование учащихся для выявления жалоб и анкетирование родителей для уточнения анамнеза функциональных отклонений и хронических заболеваний у школьников. В общей сложности было проведено более 25 тыс. врачебных осмотров и проанализировано 3,6 тыс. анкет.
В результате в первом классе к I группе здоровья, то есть к абсолютно здоровым, было отнесено 4,3% наблюдаемых школьников, а к концу школы таких учащихся не было вовсе. За этот же период произошло уменьшение отнесенных II группы здоровья (практически здоровы) с 44,4% до 34,0%. Одновременно увеличилось число детей, страдающих хроническими заболеваниями (III и IV группы здоровья) с 0 до 4,6%.
Всего с 2005 по 2015 год среди детей распространенность функциональных отклонений возросла на 14,7%, а хронических болезней — на 52,8%.
Среди функциональных отклонений самые распространенные: нарушения сердечно-сосудистой и костно-мышечной систем, органов дыхания, нервной системы и психической сферы, расстройства зрения. А среди хронических — язвенная болезнь, гастродуоденит, сколиоз, близорукость средней и высокой степени.
Ирина Рапопорт отметила, что по сравнению с началом 1990-х, то есть за 25 лет, состояние здоровья школьников по распространенности функциональных отклонений ухудшилось в 2,4–2,7 раза, а по частоте встречаемости хронических болезней на 40–70%. При этом питание в то время в детских образовательных учреждениях было хуже, чем сейчас.
— Постоянно растет учебная нагрузка, дети находятся в стрессовой ситуации в связи с подготовкой и сдачей Единого государственного экзамена и экзаменов в 9-м классе. Реорганизация учебных учреждений также сказалась на психологическом климате в школах. Все эти психологические факторы привели к увеличению распространенности психосоматических заболеваний у детей, — рассказала профессор.
Она также отметила, что частота нарушений здоровья у мальчиков выше по сравнению с девочками на протяжении практически всего периода обучения в школе. Однако к 11 классу девочки перегоняют одноклассников-мальчиков как по распространенности функциональных отклонений, так и хронических болезней.
— Это объясняется тем, что, с одной стороны, девочки быстрее включаются в учебный процесс, чем мальчики, и лучше справляются со школьной нагрузкой. Однако уже в старших классах они более усердно занимаются, чем мальчики, больше переживают из-за экзаменов, в результате у них чаще развиваются психосоматические нарушения, — сказала Ирина Рапопорт.
Президент Лиги защитников пациентов Александр Саверский отметил, что если взрослым по трудовому кодексу разрешается работать по 40 часов в неделю, то из «Санитарно-эпидемиологических требований к условиям и организации обучения в общеобразовательных учреждениях» следует, что у детей на учебу и выполнение домашней работы уходит около 47 часов.
— Для детей учеба — это то же самое, что для взрослого работа. И мы видим, что дети не просто перегружены, а работают значительно дольше своих родителей, — сказал эксперт. — У меня дочь растет, я вижу, как меняется система образования и как детям тяжело.
Директор московского центра образования «Царицыно», народный учитель России Ефим Рачевский, напротив, уверен, что состояние здоровья детей зависит не от школы, а от наследственности, питания и экологии.
— Нужно обратить внимание на то, каким воздухом дети дышат, чем занимаются дома и что едят. Школа здесь при чем? — сказал педагог.
Однако руководитель Всероссийского общества защиты прав потребителей образовательных услуг Виктор Панин придерживается противоположного мнения.
— Перед образовательной организацией стоит задача — сохранить ребенку здоровье, с которым он в нее пришел. Мы должны больше внимания уделять вопросу профилактических мероприятий в школах. Но не имея конкретной программы действий и критериев, директора школ не могут эффективно работать в этом направлении, — сказал эксперт.
Ирина Рапопорт сообщила, что данные исследования НИИ не совпадают со статистикой Минздрава:
— В министерстве картина более радужная: абсолютно здоровы 30% школьников, а имеют хронические заболевания (III группа здоровья) только 20%, в то время как наши исследования показали, что абсолютно здоровых детей в школах практически нет, а хронические заболевания выявлены у 45-60% обучающихся в зависимости от возраста.
Между тем, в пресс-службе Минздрава «Известиям» предоставили совсем иные данные — за последнее время, по информации ведомства, увеличилось число полностью или практически здоровых детей, то есть относящихся к I и II группе здоровья, до 84,6 % от всего детского населения.
По итогам 11-летнего исследования НИИ гигиены и охраны здоровья детей и подростков ФГАУ «Национальный научно-практический центр здоровья детей» Минздрава РФ издал сборник «Руководство по медицинскому обеспечению обучающихся в образовательных организациях». В нем сформулированы пошаговые рекомендации по профилактике школьно обусловленных заболеваний. В школы рекомендации не внедрены, и пока они доступны только на сайте НИИ. В то же время в Министерстве здравоохранения РФ отметили, что эти рекомендации будут учтены в работе ведомства.
Такую разницу в цифрах эксперты объясняют качеством осмотра детей в школах. В соответствии с приказом Минздрава N 1346н «О Порядке прохождения несовершеннолетними медицинских осмотров, в том числе при поступлении в образовательные учреждения и в период обучения в них» один раз в год школьники и детсадовцы проходят профилактические осмотры в поликлиниках. На основании этих обследований детей относят у той или иной группе здоровья. Однако, как отмечают эксперты, такие осмотры обычно формальны и поспешны, отсюда низкая выявляемость нарушений здоровья и, как следствие, хорошая общая статистика.
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