RU2736612C1 - Method of estimating a person's meteorological sensitivity - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to diagnostics, objective assessment of dependence of human health on weather (meteorological dependence). Systolic and diastolic arterial pressure (SBP and DBP) and heart rate (HR) are measured daily, at the same time. A questionnaire and a diary of introspection are filled during the observation year. A meteorological sensitivity is determined depending on certain combinations of the obtained diagnostic parameters for the entire observation period: mild, moderate or severe.

EFFECT: method enables assessing the degree of meteorological sensitivity of any patient, healthy or having disorders of various organs and systems, regardless of region of residence, by forming unified, integral criteria.

1 cl, 2 tbl, 4 ex

Description

The invention relates to medicine, diagnostics, an objective assessment of the dependence of a person's health on changes in the weather (meteorological dependence) and can be used both independently and in outpatient and sanatorium-resort medical institutions for the subsequent development of adequate methods for the prevention of various health risks in connection with meteosensitivity of patients.

A group of ecologically dependent diseases is distinguished, which depend on a combination of environmental factors and internal factors of human health (genetic characteristics, phenotypic characteristics, lifestyle, etc.). These include diseases:

-oncological;

-asthma;

- type 2 diabetes mellitus;

- ulcerative disease;

-coronary heart disease;

-atherosclerosis;

-arterial hypertension;

-metabolic syndrome;

-urolithiasis disease;

- allergic diseases, etc.

The factors influencing the development and course of these diseases include the following:

1. Chemical pressure on the environment:

-Pollution of air (including industrial and residential premises), soil, drinking water and food.

-Toxic effects of drugs.

On the territory of the Russian Federation, more than 30 million tons of chemicals are annually emitted into the atmospheric air. In cities, against the background of exceeding the maximum permissible concentration by more than 5 times (benzopyrene, formaldehyde, nitrogen dioxide and other compounds with a pronounced toxic and oncogenic effect), more than 55 million inhabitants live, the indicators of only oncological morbidity among which are 1.5-2 , 5 times higher than among the general population.

“Six million people die a year because of poor air quality, more than 90% of the world's air is polluted” (Maria Neira, Director of the WHO Department of Public Health and Environmental and Social Determinants of Health).

2. The impact of physical environmental factors - noise, vibration, electromagnetic fields. Noise levels exceeding the MPL by 10-15 dB are considered the most unfavorable from the point of view of the development of hearing loss. With systematic exposure to high noise levels, hearing decreases after 1-2 years, with an average level - after 5-10 years.

Noise is harmful not only to the ears - it affects the entire body, causing neurological and cardiovascular diseases, malaise, headache, dizziness, nausea, excessive irritability, impaired attention and memory, decreased thinking abilities.

3. Sources of development of transmissible, natural focal infectious, viral, parasitic and insect allergic diseases:

-Transportation of ticks along "green corridors" from suburban forests to squares and parks within cities is carried out by migrating domestic and wild animals.

-Presence of cats (risk of infection of people with toxoplasma).

-Presence of dogs (rabies, leptospirosis, toxocariasis, etc.).

-Birds are also dangerous.

The spread of infectious, viral, parasitic and insect immune diseases sometimes takes on the character of an unpredictable appearance of infections. The appearance of a number of viruses in previously non-endemic territories causes a sharp exacerbation of the epidemic situation (for example, West Nile fever, in which a very high mortality rate was observed: up to 10%, almost like in smallpox). A multiple increase in the incidence was noted in years with warm winters (2010, 2012).

4. Adverse effects of climatic factors.

According to WHO estimates, climate change is currently responsible for approximately 150 thousand premature deaths in the world and 55 million person-years of disability on average per year, which is, respectively, 0.3% and 0.4% of the world's mortality and disability rates.

The main weather conditions that induce meteopathic reactions in the Moscow region are factors of terrestrial and space weather:

-Atmosphere pressure

- Ambient air temperature

-Humidity of atmospheric air

-Intensity of the electric field of the atmosphere

-Magnetic storms.

Metopathic reactions can occur in the form of the following symptoms:

- Deterioration of general well-being

- Severe fluctuations in blood pressure

-Headache

-Myalgia and arthralgia

-Cardialgia, angina pectoris.

The reasons for the deterioration of health can be the adverse effects of climate change, in particular, in the territory of the Russian Federation, such as an increase in the number of days per year with abnormal weather conditions:

-waves of heat and cold;

-cyclonic activity with drops in P _atm , PO ₂ ;

- changes in the electrical activity of the atmosphere;

-floods, droughts, hurricanes, etc.

-and also environmental pollution as a result of the transformation of substances under the influence of insolation and high temperature, forest fires.

In the Recommendations of the collective Nobel laureate for 2007 - the Intergovernmental Panel on Climate Change, in particular, measures were proposed to solve the problems of the influence of climate and weather on human health:

-study of adaptation of the population to climate change, including medical aspects,

- development of national programs of action to reduce the risks associated with weather and climate change.

The most common meteorological diseases, according to various medical studies, are:

- diseases of the circulatory system (coronary artery disease, stroke, etc.) - 82% of the total number of diseases,

- diseases of the respiratory system (COPD, bronchial asthma) - 73%,

- diseases of the musculoskeletal system and connective tissue - 72%.

A whole area of corresponding pathology was formed, called meteopathology (A.V. Mazurin. K.I. Grigoriev, 1990), which determined the formation of medical kerosology (Greek keros-weather) as a separate scientific discipline (I.I. Grigoriev. A. I. Grigoriev , K.I. Grigoriev, 1998). The reactions arising under the influence of weather factors are defined by different authors by terms such as "anemopathy", "cyclonopathy", "meteotropism", "maladaptive meteoneurosis", "meteoneurotic reaction", "meteopathic reaction", "heliometeotropic reaction", "meteosensitivity" ... This indicates attempts to reflect in the name of the term the mechanism of action of weather on a person.

However, in the scientific literature, the terms “meteotropic response” and “meteosensitivity” are more widespread - the ability of the body (primarily the nervous system) to respond to changes in weather (atmospheric pressure, wind, solar radiation intensity, etc.), geophysical and cosmic factors. This is a normal physiological reaction aimed at maintaining harmony with an ever-changing world and characteristic of all people. With the weakening of the body, illness, stress, prolonged and intense exposure to natural factors, decompensation of the functions of various systems of the body is observed, which manifests itself in the occurrence of painful (pathological) meteosensitivity - the body's response to the emerging disturbances of meteorological and heliogeophysical factors by the development of maladaptive or pathological meteopathic reactions, which manifest themselves in deterioration subjective well-being and in the formation of numerous functional disorders.

Three types of weather are commonly distinguished: clinically optimal, clinically irritating, and clinically acute. Each of these types has different health effects. The clinically optimal type of weather has a beneficial effect on the body, causes vigor, has a sparing effect and is characterized by moderate fluctuations during the day in temperature (no more than 2 ° C) and pressure (no more than 4 mbar) with low air mobility (no more than 3 m / s) ... Clinically annoying types include a complex of weather conditions in which the optimal course of one or more meteorological elements is disturbed. This is sunny and cloudy, dry and humid (relative humidity not higher than 90%) weather, when the wind speed is less than or equal to 9 m / s, temperature variability is not more than 4 ° C, and the pressure drop is not more than 8 mbar. Clinically acute types of weather include weather complexes with abrupt changes in meteorological elements, when the variability of atmospheric pressure is more than 8 mbar, temperatures are more than 4 ° C, and the wind speed is more than 9 m / s. These weather conditions include wet (more than 90% moisture), rainy, cloudy and very windy.

The development of promising methods of objective assessment of meteopathic reactions of the body is underway for their subsequent prevention and treatment:

-assessment of the body's functional reserves and the risks of developing non-communicable common diseases using verbal-communicative examination (express assessment of the severity of complaints); determination of the main anthropometric indicators (height, weight, Quetelet index); assessing heart rate variability; pulse oximetry; hemodynamic research; psychological and psychophysiological research (SAN test, Luscher test, Spielberger-Khanin scale).

Verbal and communicative examination to assess the dependence of patients' well-being on changes in weather conditions includes:

- obtaining information about the ambient temperature, atmospheric pressure, relative humidity, wind speed according to the data of meteorological services,

- obtaining information about the heliogeophysical environment (sunspot activity, flare activity, geomagnetic conditions, values of the intensity of the Earth's atmospheric field).

In the process of studying meteopathic reactions, meteopathic reactions of the body were mainly revealed in the examined patients with diseases of the circulatory system. These include, taking into account the frequency of occurrence of signs: complaints about deterioration of health - 77.2% (244 people); sharp fluctuations in blood pressure values - 58.8% (186 people); headache complaints - 37.6% (119 people); angina pectoris - 29.7% (94 people), joint pain and myalgia - 23.7% (75 people).

Identification and study of strict, scientifically substantiated criteria for meteosensitivity (meteorological dependence) would make it possible to determine promising directions for the prevention of the development of ecologically determined pathology and the therapeutic effect on it:

-application of personalized correction programs within the framework of spa treatment and prevention,

- elimination of the harmful influence of environmental factors,

-prevention of the occurrence and spread of diseases,

- early identification of their causes and conditions of development,

-forming and implementing healthy lifestyle programs,

- assessment of the severity of manifestations of meteopathic reactions,

- changes in the regulatory framework,

- individually dosed physical activity,

- interval hypoxic training,

-application of climatotherapy technologies, aero-, thalasso, speleotherapy,

-respiratory gymnastics, inhalation therapy,

-contrast shower, aqua gymnastics, hydromassage,

-therapeutic and prophylactic nutrition,

- psychological relief, relaxation psychotherapy.

TECHNOLOGY LEVEL

For many years, research has been conducted on the influence of various meteorological conditions and their changes on well-being and human health in various regions of the Earth. On the basis of this, attempts are made to identify criteria for the influence of certain conditions on certain meteopathic manifestations in humans. Appropriate preventive and therapeutic measures are proposed to increase the body's nonspecific resistance to the effects of meteorological factors, mainly to prevent the occurrence of meteopathic reactions by optimizing the vegetative balance, normalizing the temporal organization of the main indicators of the cardiovascular system (see, for example, RU 2503468 C1 ( Federal State Budgetary Institution "RRC MRiK" of the Ministry of Health of Russia), 01/10/2014, Method for treating patients with neurocirculatory asthenia with increased meteosensitivity; RU 2521273 C2 (IBMI VSC RAS and RNO-A), 06/27/2014, Method for preventing meteopathic human reactions; RU 2175228, 27.10. 2001, Method for the prevention and treatment of meteopathic reactions of a person, including the intake of an adaptogenic agent; RU 2674880 C2 (LLC "Interfin"), 13.12.2018, Method for the treatment and prevention of meteorological exacerbations by the method of normoxic barotherapy in chronic fatigue syndrome; RU 2422128 C1 (FGU "Pyatigorsk GNIIK FMBA of Russia "), 27.06. 2011, Method of treatment and early (emergency) and planned prevention of meteopathic reactions in patients with ischemic heart disease, hypertension stage I-II with a syndrome of dysadaptation using the method of transcranial mesodiencephalic modulation; RU 2436498 C1 (GOU VPO SevGMU Roszdrav), 20.12.2011, Method for identifying persons with impaired adaptation to cold).

However, as a rule, such scientific developments concern only narrow-regional features and cannot serve for an integral assessment of the meteosensitivity of people living in different, different territories. In addition, such studies are usually limited to identifying correlations between individual meteorological factors and specific diseases and conditions. For example, the bulk of research concerns the problem of the formation of nonspecific resistance of the body to the effects of meteorological factors and the prevention of the occurrence of meteopathic reactions by optimizing the vegetative balance, normalizing the temporal organization of the main indicators of the cardiovascular system, the diseases of which, in general, are indeed most often weather-dependent. From 70 to 94.3% of cases of exacerbation of ischemic heart disease and arterial hypertension are associated with unfavorable weather and climatic influences (V.A. Vasin, N.V. Efimenko, A.S. Ginzburg, E.M. Dobryshman, L.I. Zherlitsina , R. I. Mkrtchyan, N. P. Povolotskaya, F. A. Pogarsky, I. A. Senik, 2006-2009).

However, in studies of meteorological dependence, less attention is paid to the direct reactions of the respiratory, central nervous and musculoskeletal systems.

According to studies carried out under the auspices of the WHO (2005), weather, meteorological and heliophysical factors are considered as external risk factors that create favorable conditions for disrupting the processes of free radical oxidation in the vascular wall, the progression of atherosclerosis and coronary heart disease (V.Z. Lankin, 1989-1997; E.I. Chazov et al., 1990-2008; R.I. Mkrtchyan, I.I. Velikanov, L.I. Zherlitsina, 2000-2009).

Using the method of "superimposed eras", the authors established a correlation between unfavorable weather conditions and anthropogenic pollution of the atmosphere, which is expressed by an increase in the integral meteopathic index (IMPI - the ratio of the sum of "responses" for tests of meteopathic reactions to the total number of tests considered). The closest relationship of IMPI according to the χ2 criterion (χ2 = 13.22; P <0.005) was established with the frontal type weather (3C, 4C), which are characterized by a changeable weather regime, as well as with cyclonic weather formed in baric depressions (3B, 4B), which often accompanied by pronounced phenomena of atmospheric hypoxia and atmospheric “stuffiness” (χ2 = 5.15; P <0.005), and with anticyclonic weather (3A, 4A), which are characterized by heat advection, atmospheric hypoxia, often with pronounced intraday fluctuations in medico-climatic modules (χ2 = 4.11; P <0.005) (Povolotskaya N.P., Granberg I.G., Efimenko N.V., Zherlitsina L.I., Istoshin N.G., Kirilenko A.A., Kortunova Z. V., Senik I.A., Slepykh V.V., 2008, etc.).

The problem of weather influences on humans is closely related to weather rhythms, variability and adaptability to processes occurring in nature. In assessing the influence of complex weather complexes on the body, not only the dynamics of atmospheric processes, taking into account their daily, day-to-day, and seasonal variability, but also the influence of heliophysical factors are taken into account. Their biotropic effect manifests itself suddenly, with less opportunities for adaptation, which together can serve as a "trigger" for the appearance of various kinds of pathological reactions and exacerbations of diseases (TI Andronova, NR Deryapa, AP Solomatin, 1982; V.F. Ovcharova, 1987; G.I.Sidorenko et al., 2006; Zherlitsina L.I., N.V. Efimenko, N.P. Povolotskaya, I.I. Velikanov, 2003-2009, and others. ). Modern social environmental conditions of the external environment make increased demands on the capabilities of the human body, which is associated with the problem of reduced adaptation. Abnormal, extreme climatic influences, sharply narrowing the range of equilibration of the organism with the external environment, lead to an inadequate response to them of homeostatic systems with the development of dysadaptive meteopathic reactions (L.H. Garkavi et al., 1990; R.I. Mkrtchyan, L.I. Zherlitsina, N.P. Povolotskaya, I.A. Senik, 2005-2009).

Meteopathic reactions to weather changes are most clearly manifested when patients move from their place of permanent residence to the unusual climatic conditions of the resort. In the initial period of acclimatization, the basal metabolic rate increases by 40-70% (Yu.V. Mandrykin et al., 2004). An increase in the reactivity of the nervous system in the initial period of physiological adaptation occurs with the prevalence of general subcortical reactions, and with increased meteosensitivity - with dysfunction of autonomic centers and dysadaptation of regulatory systems (II Velikanov, LI Zherlitsina, 1997-2009). In this regard, in order to increase the effectiveness of resort rehabilitation treatment, it is necessary to search for both universal criteria for meteorological dependence and physiological methods for early prevention of disadaptation reactions and, first of all, meteopathic reactions (MPR) in response to climatic factors.

The autonomic nervous system (ANS) plays an important role in the realization of the connection between meteorological factors and biological reactions. It was found that in meteosensitive patients, an imbalance of the ANS was expressed (predominance of the sympathetic or parasympathetic part). Clinical manifestation of MPR in patients with coronary artery disease, hypertension (HD) with dysadaptation syndrome is characterized by angina attacks, palpitations, “feeling of lack of air”, hypertensive crises, increased anxiety, sleep disturbances and other disorders.

An important role is played by the identification of meteosensitivity criteria both during residence and work in extreme conditions, for example, in the cold North or, on the contrary, in southern regions with a hot, humid climate.

The development of diagnostic and prognostic criteria for assessing the functional capabilities and adaptability of a person, methods and methods of selection for work in extreme conditions remains an urgent problem of labor physiology, aerospace, sports and military medicine. In the last twenty years, the theory and methodology of mass health monitoring has been developing on the basis of the principles of prenosological diagnostics, the creation of specialized hardware complexes, means and methods of operational collection, processing and analysis of the information received. Of great importance is the deepening of medical control during professional selection for work in various regions, which necessitates instrumental methods that allow early and clearly at the outpatient stage to objectify specific, for example, circulatory, processes controlled by the autonomic nervous system and involved in the regulation of heat exchange under various extreme conditions. temperatures combined with high air humidity and other important weather conditions.

Scientific research (Novikov V.T. and others) established the prognostic value of indicators of blood pressure, heart rate, end diastolic volume, stroke and minute volume of blood flow, mean dynamic arterial and total peripheral resistance to identify a person's resistance to physical activity. In the works of A.A. Putilov, the detection of latent desynchronosis in the human body by the ratio of heart rate and respiratory rate is revealed. In the study of A.P. Berseneva. demonstrated high information content of the statistical characteristics of the heart rate for the diagnosis of prenosological conditions of the body and determination of its adaptive reserves. Based on the results of a 6-minute cycle ergometric load with a power of 150 W, Aidaraliev A.A. et al. distinguish among the examined persons "strong" (highly resistant), "average" and "weak" (low resistance). But after a month's stay in extreme conditions, the differences between "strong" and "weak" in tolerance to a 6-minute cycle ergometric load practically leveled off.

The abundance of the proposed criteria, the lack of comparative data on their informativeness lead to the fact that it is difficult for a practitioner to navigate in this variety of proposals. At the same time, to date, no effective method for assessing the severity of meteosensitivity has been created, and there are no universal criteria for it. The current situation stimulates attempts to systematize and simplify the existing criteria with the selection of the most important, informative ones.

One of the informative methods for assessing the functional state of the cardiovascular system is the method of mathematical analysis of heart rate variability (HRV). When assessing the functional reserve of the circulatory system, it is necessary to comprehensively consider the parameters of autonomic homeostasis, and from this point of view, heart rate indicators can act as integral markers of the adaptation process in extreme environmental conditions. However, HRV research with mathematical analysis is not available everywhere.

According to Yu.V. Mandrykin. (Clinical and psychophysiological aspects of meteosensitivity of patients with diseases of the circulatory system: diagnostics and treatment, prevention and medical rehabilitation, dissertation for the degree of Doctor of Medical Sciences, 2003, M, 287 pp.), Among many factors of external environment that can cause meteopathic reactions, first of all, meteorological and heliophysical factors should be distinguished (see also G.T. Ermolaev, 1990, A.N. Vitchenko, 2000, K. Bucher et.al., 2000). Among them, the most important is atmospheric pressure. Its spatial and temporal distribution is the main reason for the direction of air flows, their speed and, as a result, air temperature and humidity, cloudiness, precipitation and other meteorological elements (S.S. Gavronsky, P.G. Martynyuk, 1982, and others .). In addition, there are changes in the hygrothermal regime and conditions of thermal discomfort (O.M. Prokopenko, 1982, A.M. Aringazina. K.U.Kasenov, 1985. Z.R. Zunnunov, 2000), atmospheric electricity (Borisenkov E.P. et al, 1998, 2000, etc.), periods of high solar activity and the Earth's geomagnetic field (G.V. Ryzhikov et al. 1982. SI Rapoport S.I. et al., 1997, 2001).

A number of researchers prefer combinations of changes in meteorological elements, in particular, high atmospheric pressure and high air humidity (V.F. Ovcharova, 1988, H. Swantes et.al. 1981, ME Dembert et.al. 1981, CM Bearel et.al ., 1982, J. Cohen et al., 1984).

Another group of authors (AM Aringazina. 1987, G. R. McGregor. 1999, 2001) are of the opinion that large-scale processes, the passage of atmospheric fronts, as well as disruption of solar-terrestrial connections, especially during the period of increased solar activity, can adversely affect the organism.

Meteopathic reactions in patients with diseases of the cardiovascular system are manifested by a very diverse symptomatology. In terms of severity, such disorders can range from mild, subjective changes to severe, including exacerbation of the underlying disease. It has been proved that the human body is influenced not so much by the meteorological elements themselves, but by their significant fluctuations, which require more stress from the body for adaptation (N.R. Deryapa, 1983, K.Yu. Yuldashev et al. 1986, E.V. Sumanov . 1987, N. V. Kulikova. 1997, DD Heistad. 1980, K. Bucher. 2000). The quantitative variability of meteorological and heliophysical factors is of significant importance, in particular, day-to-day fluctuations in atmospheric pressure.

The lack of a specific clinical picture creates certain difficulties in the diagnosis and differentiation of such manifestations. In some cases, a simplified representation is given, in others, complex hardware is required, which is not always available. In most cases, practitioners and researchers limit themselves to the data of a subjective anamnesis, the results of dynamic observation of a patient using the method of superimposing short-period epochs and resort to assessing a number of indirect indicators characterizing the state of meteosensitivity and the development of meteotropic reactions (V.N. Shepovalnikov, S.I. Soroka , 1998, S.A. Chernous, 2000, etc.), which reduces the quality of diagnostics.

It seems that the assessment of meteotropic reactions, meteosensitivity should be determined on the basis of regular measurements of qualitative and quantitative physiological parameters, compared using mathematical and heuristic methods of analysis with indicators of meteorological elements and geophysical activity. The solution to this problem is possible only from the standpoint of a systematic approach , which allows a comprehensive approach to assessing the state of human meteolability.

A successful solution to this problem would reduce the risk of developing meteorological diseases and conditions, their complications, improve the quality of life, and affect the patients' ability to work. It is advisable to carry out the following activities:

1. Study of the clinical picture and characteristics of meteorological reactions of healthy people and patients with various diseases of the body systems in a wide range of regions with different climatic and weather conditions.

2. Study of the influence of individual meteorological factors on the psychosomatic status of patients, assessment of their role and importance in the development of meteopathic reactions. Establishment of the most important indicators and criteria for assessing meteosensitivity, on the basis of which it would be possible to propose new ways of diagnosing it and determining the degree of meteorological reactions.

3. Development of technical means for modeling day-to-day fluctuations in atmospheric pressure, approbation of procedures for the treatment and prevention of meteosensitivity.

4. Investigation of the influence of various medical procedures on the functional state of meteosensitive patients with various diseases, determination of their mechanism of action.

Mandrykin Yu.V., 2003 (see above), identified 8 most significant signs that describe the state of meteolability. These include indicators of well-being, activity, mood, stress level, performance, the value of the "double work", the Baevsky stress index and the centralization index. The proposed integral indicator, which describes the state of the adaptive-compensatory mechanisms in general and the index of the patient's meteosensitivity, makes it possible to comprehensively and objectively assess the adverse effect of meteorological elements.

Similar studies in relation to patients with cerebrovascular diseases (CVD) were conducted by E.A. Shagdurova. (Features of meteotropic reactions in patients with cerebrovascular diseases, dissertation for the degree of candidate of medical sciences, 2011, Irkutsk, 158 p.). As you know, the causes of CVD are arterial hypertension, dyslipidemia, atherosclerosis of the cerebral and main (carotid and vertebral) arteries, coronary heart disease, impaired hemostasis, diabetes mellitus, vegetative dystonia, smoking, physical inactivity. Environmental factors also play a significant role, in particular, the processes occurring in the atmosphere - meteorological factors, solar activity and climate in general. The highest sensitivity to adverse weather conditions is observed from 42 to 80% of patients with cardiovascular and CVD, manifested by meteotropic reactions. In works devoted to meteopathies, the peculiarities of the lesion of the nervous system have not been sufficiently studied; risk factors that can become decisive in the development and progression of meteotropic reactions in patients with chronic cerebrovascular accidents remain unclear. As for the influence of meteogeophysical factors on the course of the CVZ, including the development of CVA, there is no consensus among experts. The most common clinical forms of meteotropic reactions are distinguished: combined and cerebral.

Clinical manifestations of meteotropic reactions in patients with chronic cerebrovascular accidents are mainly associated with insufficient blood supply in the vertebrobasilar basin. In addition, in meteotropic individuals, a high level of anxiety, depressive disorder, a shift in autonomic balance towards a predominance of the tone of the sympathetic nervous system, a violation of autonomic reactivity (decreased and perverted) and lack of autonomic support of activity were revealed. In the work of E.A. Shagdurova. also analyzed the variability of the main meteorological and heliogeophysical factors on the days of ACVA occurrence, determined the environmental factors influencing the development of stroke in the Baikal region. According to these data, disturbed geomagnetic conditions, sharp dynamics of meteorological parameters both from day to day and throughout the day, and not their absolute values, are of unfavorable importance. The daily fluctuations of atmospheric pressure over 8 hPa, day-to-day fluctuations in atmospheric pressure over 10 hPa and air temperature over 10 ° C are especially unfavorable. Geomagnetically turbulent environment significantly more often has an adverse effect on the development of ACVA in meteotropic individuals (p <0.01). To diagnose meteotropic reactions in patients with CVD, it was proposed to carry out a comprehensive neurological, functional, experimental and psychological study, including a test to identify persons with increased meteosensitivity (Voikhansky V.O., 2006), and to prevent the development of meteotropic reactions in patients with CVD, it was proposed to correct the established regulated risk factors using vegetotropic, vasoactive drugs, anxiolytics and antidepressants.

Although the obtained data can serve as a theoretical basis for predicting the course of cerebrovascular diseases in meteotropic individuals, planning treatment tactics and dispensary observation of this contingent of patients, creating a system for medical forecasting of meteotropic reactions, however, they, like those previously listed, are narrowly focused, referring to a specific region.

Similar studies are known for other regions (Povazhnaya E.L. Influence of climatic and weather factors of low mountains on the course of bronchial obstructive diseases: meteopathic reactions and their prevention, dissertation for a degree in medical sciences, 2004, M. , 277 p.), Where modern ideas about the principles of treatment and rehabilitation, the quality of life of patients with bronchial asthma and COPD, about the influence of climatic and meteorological factors on the territory of Northern Kyrgyzstan, the principles of meteorological prophylaxis, the possibility of EHF therapy are considered. Indicators of the function of external respiration, autonomic nervous system, surface activity of pulmonary surfactant, LPO and antioxidant protection in healthy and sick individuals in different types of weather in low mountain conditions were revealed according to the data on the number of calls for emergency medical care and hospitalizations. The frequency of meteorological stability was determined depending on the sex, age, place of residence of patients with COPD and asthma and the severity of the course of the disease according to the questionnaire survey. It was found that meteorological stability reduces the effectiveness of rehabilitation therapy in pulmonary patients, which was mainly studied based on the results of sanatorium-resort treatment. The frequency of meteorological stability is higher in women than in men; among urban residents it is higher than among rural ones; increases as the severity of the disease progresses; increases with age of patients with COPD and is consistently high in all age groups with BA.

In the dissertation of E.L. the concept of the development of the body's reactions to the influence of meteopathic effects of the atmosphere has been developed from the standpoint of the adaptation-disadaptation approach. In healthy people and meteostable patients, the reaction is physiological (compensatory-protective) and is expressed by a moderate increase in the activity of the sympathetic part of the autonomic nervous system, surface-active properties of the lung surfactant and antioxidant enzymes, mainly in hypoxic weather. In patients with meteorological stability of the 1st and 2nd degree, the reaction is of a compensatory-adaptive nature with a sharp increase in the sympathetic influences of autonomic regulation and an increase in the activity of pulmonary surfactant in the absence of development or aggravation of broncho-obstructive disorders. In patients with meteorological stability of the 3rd degree with hypoxic and spastic types of weather, progression of bronchial obstruction, reduction of the surface activity of pulmonary surfactant, imbalance in the oxidative-antioxidant and autonomic nervous systems are observed, which characterizes a pathological, dysadaptive reaction. The study established a significant correlation between the number of visits by COPD patients with air temperature, atmospheric pressure, relative air humidity and weight oxygen content in the air; BA patients - with air temperature and weight oxygen content in the air; an increase in the density of referrals of patients with COPD on days with pronounced and pronounced effects of the atmosphere of the spastic type, patients with BA - of the hypoxic and spastic types; an increase in the level of hospitalizations of BA patients on the day of the invasion of the cold atmospheric front and on the next day after it.

Meteorological stability reduces the effectiveness of complex rehabilitation using traditional physiotherapeutic methods. Positive results of rehabilitation under the conditions of a specialized rehabilitation center are reliably less frequently observed in meteorological patients with COPD (by 17.8%), BA patients in adults (by 20.6%) and children (by 15.0%) than in meteostable patients.

In order to diagnose individual manifestations of meteopathic reactions in patients with COPD and asthma, E.L. it is proposed to conduct an in-depth dynamic study using a self-observation diary, spirometry, peak flowmetry, determination of autonomic tone.

Khasanov M.Kh. in his dissertation "Influence of unfavorable weather conditions of a big city on the development of myocardial infarction in meteorological patients with cardiovascular diseases" (for the application for academic degree of candidate of medical sciences, Dushanbe, 2007, 120 pp.) emphasizes the influence of temperature variability and relative air humidity, atmospheric pressure, weather instability in general for the development of acute coronary events. The seasonal dynamics of the incidence rate and deaths from myocardial infarction in Dushanbe is shown. Research methods were used in the work: hygienic, sociological, epidemiological, clinical, laboratory, statistical. It was found that among the meteorological factors, atmospheric pressure has the greatest hygienic significance in this group of patients, which changes to 23 mbar in 6 hours during the day and up to 35 mbar between days. The development of myocardial infarction is influenced by its day-to-day variability exceeding 13 mbar. Autumn-winter (November, December), spring (March, April) periods of the year are the most unfavorable for the health of patients with coronary artery disease, while the coefficient of weather instability is 66-71%, which should be considered as an unfavorable climate factor.

When systematizing these studies, an indicative scheme of medical assessment of local weather conditions (Dushanbe) was developed and recommended, where they are divided into four types of weather in terms of the sum and dynamics of meteorological indicators, activity of atmospheric processes, the degree of human friendliness: 1 - very favorable, 2 - favorable, 3 - unfavorable, 4 - extremely unfavorable weather. This classification is based on taking into account meteorological factors that have important physiological significance (intraday and interday variability of atmospheric pressure, air temperature, wind speed), as well as dangerous and especially dangerous phenomena (showers, thunderstorms, squalls, dust storms) that correspond to certain indicators of heart attack. myocardium.

Specific measures of treatment and prevention of conditions of meteosensitive patients with ischemic heart disease and myocardial infarction are also given.

A similar study is presented in the dissertation of Vasilyeva G.S. "Hygienic assessment of weather, climatic and geophysical risk factors in the formation of the environment in the inhabitants of the Republic of Sakha (Yakutia): On the example of patients with cardiovascular diseases" (CVD), for the competition of academic step. PhD in Biology, Yakutsk, 2002, 154 p. This work concerns a region with the opposite weather conditions to the previous one. Thus, the most typical climatic factors characterizing the living conditions of the indigenous population in the Far North are cold with a significant range of fluctuations of other meteorological elements, "light starvation" during the polar night and "light excess" during the polar day, increased activity of cosmic radiation, frequent geomagnetic indignation, etc. All these factors for non-indigenous people act exclusively as extreme ones and impose special requirements on the adaptation process. The impact of unfavorable external factors is compensated by physiological and adaptive mechanisms, which, as a rule, are sufficiently developed among the aborigines of these areas and are not sufficiently active among the non-indigenous population (T.I. Andronova et al., 1982; V.A. Matyukhin et al., 1999; L.E. Panin, 1979). Nevertheless, the increasing man-made impacts, changes in the diet and living conditions of northerners, along with extreme geographic conditions and heliogeophysical factors, cause the development of a dysadaptation syndrome in indigenous and, especially, non-indigenous people, which further provokes the formation of chronic diseases. The cardiovascular system, experiencing enormous loads, is one of the first to be involved in adaptation to extreme external conditions, while more than 50% of patients with cardiovascular diseases respond to changes in weather conditions (I.I. Grigoriev et al., 1997; Yu.V. Mandrykin et al., 1999). According to LS Polikarpov (1986), 34.3% of “healthy” residents react to the change of weather and geophysical factors in the Far North, and among patients with AH their number increases to 49.6%.

Vasilyeva G.S. bioindication typification of weather and climatic conditions of Yakutia was carried out according to the degree of its influence on biological objects (on the example of CVD in Yakutsk) and the forecast of "medical" types of weather for the prevention of meteotropic complications was justified. 5 medical and ecological zones of Yakutia have been identified. Each zone has a special weather and climatic regime, characteristic only for this territory and having its own uncomfortable set of meteorological elements that affect the human body. At the same time, in each subregion of Yakutia, the duration of the periods of change of day and night, white nights, polar days and nights sharply differ. Also, 4 main medico-climatic types of weather were identified, depending on the frequency of complications of cardiovascular diseases, a strategy of preventive measures was developed to reduce the incidence and mortality of the population of the Far North from CVD.

Bioindication of the frequency of meteotropic complications in patients with coronary artery disease, hypertension and CVD of northerners on days with different weather conditions made it possible to identify 4 main medical and climatic types of weather: 1 - extremely unfavorable; II - unfavorable; III - relatively favorable, IV - rather favorable. Each type of weather is characterized by a specific set of weather classes. At the same time, frequent changes in the medico-climatic types of weather, active phases of the synoptic process (cyclone intrusion, anticyclone formation) are significant risk factors in the development of meteotropic CVD complications in Yakutsk residents. For the first time, prognostic ecological and meteo-geophysical tables were derived as the basis for correcting the living environment to reduce cardiovascular accidents in patients with coronary artery disease, hypertension and CVD.

The distinguished "medico-ecological" types of weather, compiled on the basis of the analysis of standard meteorological weather forecast, make it possible to predict the habitat for patients with CVD for the next few days, respectively, determining the possibilities of prevention.

However, the studies listed above relate to solving the problems of assessing meteosensitivity either in patients with specific diseases or in patients living in certain climatic zones, which determine the specifics of their meteosensitivity and the classification of various types (types) of weather, but are not universal, integral for different regions and patients. with disorders of various body systems.

The inclusion of a survey in determining the degree of meteosensitivity is known from a study conducted in Tuapse, with the definition of meteosensitivity criteria (Using expert methods to assess the parameters of meteorological dependence, chapter 3 p. 38-49, http://elib.rshu.ru/files_books/pdf /rid_92942cc1bef64bef9a71d12ffecddd4d.pdf). A medical classification of weather is proposed, three options for meteotropic effects:

Option 1 - synoptic processes;

Option 2 - dynamic weather changes;

Option 3 - the trend of meteorological elements.

Variant 1 occurs at high P _atm with a cold front. There are changes in intraday temperature, a decrease in humidity, an increase in the intensity of the electric field of the atmosphere. Meteosensitive people experience headaches, pains in the region of the heart, sleep disturbances, interruptions in the work of the heart, dizziness, dysuric disorders, irritability. Option 2 - a warm front, a decrease in P _atm , a high air temperature. Meteosensitive people experience shortness of breath, fatigue, sweating, interruptions in the heartbeat, lethargy, apathy, and headaches. Option 3 - a cold front passes, cyclonic activity becomes more active, significant changes in temperature and air pressure occur. Meteosensitive people have a tendency to paradoxical reactions, a decrease in the level of compensatory-adaptive mechanisms, complaints of pain in the heart, dizziness, tinnitus, fatigue, and swelling.

Favorable weather conditions for humans are:

-wind speed 0 m / s;

- cloudiness 0 points;

- air temperature 22 ° С;

-impulses of the electromagnetic field no more than 11 V / m per day;

- pressure variability 0 hPa / day;

- relative humidity 47%.

The above indicators help people:

-determine the most suitable climate;

-Choose the most suitable season for spa treatment;

-determine health-improving treatment measures that are favorable for people with various diseases;

- to identify methods of treating meteorological dependence, climatic factors that improve human health and life, methods of preventing meteopathy;

-determine the optimal conditions for people with certain diseases;

- to reveal the degree of meteosensitivity.

In accordance with the above study, in Tuapse, 108 people were surveyed to determine the degree of meteosensitivity. Questionnaires were compiled, according to which it was supposed to identify the types of meteosensitivity of people in% ratio with various diseases. Of the 108 people interviewed, they determined which type of weather was more favorable to whom. The first group of questions during the survey revealed the effect of weather on the body (“Does the weather affect your mood, performance, health?”). The second group of questions concerned the identification of the body's reactions to solar activity ("Do you notice the influence of solar activity on any vital processes? If yes, on which ones?"). There was also an unfavorable feeling in rainy weather (“Does rain affect your mood?”). The deterioration of well-being was found out with various changes in the temperature regime in the ambient air, as well as intense heat and extreme cold ("Does the change in the temperature regime affect your well-being? If yes, how? Do you notice a strong drop in air temperature, a strong increase in air temperature?" ). According to the survey, it was found that weather changes do not equally affect the well-being of different people. This is due to the individuality of meteorological reactions, as well as the age and individual sensitivity of the organism.

However, this study also shows an assessment of meteosensitivity only in a particular region, not possessing the universality of the criteria, in addition, it reflects only the subjective well-being of the respondents, without taking into account the objective factors characterizing their state of health.

In the study, Kislyak O.A. and other Correction of symptoms of meteosensitivity in patients with arterial hypertension // J. Therapy, No. 6 (24), 2018, pp. 111-120, the influence of the following meteorological factors is also shown. People with low blood pressure, patients with heart and lung diseases are most sensitive to episodes of a drop in atmospheric pressure; at the same time they experience general weakness, a feeling of lack of air, cardialgia. In patients with elevated blood pressure, an improvement may be observed due to a decrease in this indicator, however, in the case of an increase in hypoxia, drowsiness, weakness and a feeling of dissatisfaction with inspiration may also occur. With an increase in atmospheric pressure, weather conditions change, hypotonic patients feel better, and patients with hypertension may have symptoms associated with an increase in blood pressure.

This long-term study involved 16,010 individuals (mean age 51 years). The changes in blood pressure were assessed in response to such weather conditions as air temperature, daylight hours, rain. It has been shown that changes in systolic (SBP), diastolic BP (DBP) and heart rate are most pronounced in meteosensitive people, and in response to temperature changes. When carrying out the Kaplan-Meier analysis, it turned out that the “survival rate” of persons not sensitive to temperature changes was greater than that of temperature-sensitive persons, in the form of significantly larger SBP fluctuations (log rank p = 0.015). In the group of patients sensitive to temperature changes, the overall mortality was significantly higher; during the observation process, they had significantly higher SBP numbers in comparison with patients who were not sensitive to temperature changes. The authors suggested that the response to temperature changes may be one of the reasons for the high long-term variability. Considering the fact that currently high long-term variability in blood pressure is a factor influencing the prognosis and increasing overall mortality, these data are of great interest both from a scientific and a practical point of view, and can affect the selection of dosages of antihypertensive drugs.

Thus, it follows from the foregoing that, even despite drug treatment, the impact of weather factors on the human body during, in particular, sanatorium-resort treatment is not only capable of triggering the mechanisms of sanogenesis, but can also cause a breakdown in adaptation and a worsening of the course of CVD. This is especially important for patients at risk of MI and stroke.

It is known to use the analysis of time series of data in assessing meteosensitivity (Zenchenko T.A. Technique for analyzing time series of data in a comprehensive assessment of meteo- and magnetic sensitivity of the human body // Human Ecology, 2020, 2, pp. 3-11). An analysis of time series of physiological and geophysical data is carried out to determine the degree of individual sensitivity of the organism to meteorological and geomagnetic factors. The features of the daily dynamics of blood pressure indicators at time intervals of the order of 2-3 months, obtained as a result of monitoring volunteers of different sex, age, place of residence, diagnosis, are considered. The procedures for verification and quality control of initial data, identification and elimination of the possible contribution of social factors are described. The possibility of using the method of cross-correlation analysis as a visual method for identifying the relationship between blood pressure indicators and external factors, including in the presence of nonstationarity and gaps in data series, is considered. Meteorological factors are dependent on each other, and the nature of this dependence periodically changes over time, which should be taken into account in the analysis. At the same time, geomagnetic activity can be considered as a factor independent of the weather. An algorithm for a comprehensive assessment of the contribution of various external factors to the dynamics of blood pressure indicators is presented. The nature of the reaction to the action of geomagnetic activity has the form of rapid variations lasting about a day, while the response to the action of weather factors is manifested in the form of synchronization of slow waves of the rise and fall of blood pressure with a period of several days.

The general patterns and differences in the response to the action of external factors in the groups of healthy people and patients with hypertension were analyzed. The response to the action of meteorological factors is similar in these two groups, while the response of the body to the action of GMA in sick people in a significant number of cases is observed with a delay of 1–3 days. However, this method is largely in the nature of a purely scientific research, while it is required to form its applied, practical value.

As the closest analogue of the invention , a method for assessing the dependence of the reactions of the body of students on weather conditions (meteosensitivity) can be considered (Demakova LV et al. Hygienic assessment of the dependence of the reactions of the student's body on weather conditions, Electronic scientific journal "Modern problems of science and education". - 2016. - No. 6, 05.12.2016, URL: http://www.science-education.ru/ru/article/view?id=25725, date of access: 24.01.2020). During the entire study, the observation of weather conditions in the city of Omsk was carried out. Such meteorological factors as temperature, humidity and speed of air movement, atmospheric pressure, precipitation, sunrise and sunset, the length of daylight hours, phases of the moon, etc. were evaluated. A number of methods were applied to study the reactions of the body of students. To identify meteosensitivity and meteotropic reactions among students, a sociological method was applied, namely the method of questioning. Were asked such questions as: "Do you consider yourself to be meteosensitive people?", "Do you have chronic diseases?" and "Do you develop weakness, irritability, etc. when the weather changes?" The method of natural hygienic experiment includes an assessment of the adaptive potential of the cardiovascular system by the calculation method according to R.M. Baevsky (1987). The body weight and height of students were measured, blood pressure and heart rate were measured daily. The adaptive potential was calculated using the formula:

AP = 0.0011 (HR) + 0.014 (SBP) + 0.008 (DBP) + 0.009 (MT) - 0.009 (P) + 0.014 (V) - 0.27, where AP is the adaptive potential of the circulatory system in points; HR - pulse rate (bpm); SBP and DBP - systolic and diastolic blood pressure (mm Hg); P - height (cm); MT - body weight (kg); B - age (years).

According to the values of the adaptive potential, the functional state of the patient was determined: below 2.6 - satisfactory adaptation; 2.6–3.09 - tension of adaptation mechanisms; 3.10–3.49 - unsatisfactory adaptation; 3.5 and higher - adaptation failure. Also, the functional state of the student was determined for 20 days by means of the SAN test, the assessment of the psychophysiological state of students, their stress resistance, activity and communication skills by means of the Luscher color test. The stability and distribution of attention, the ability to concentrate was determined using a proofreading test.

However, this method, although it includes the assessment of several significant indicators, both objective, physiological and subjective, psychological, but concerns the assessment of meteosensitivity only in a specific region (Omsk), does not take into account the variety of meteopathic manifestations - not only from the nervous and cardiovascular systems, but also, for example, from the musculoskeletal system.

In this regard, the goals of our work were, in particular, the development of a unified valid questionnaire to determine the effect of weather conditions on the exacerbation and progression of meteorological diseases, as well as the formulation of unified criteria for assessing human meteosensitivity for the subsequent creation of personalized pharmacophysical and balneotherapy programs for prevention and treatment. meteorological disorders of health. The duration of the study emphasizes the need to collect as differentiated and complete information as possible about changes in the health status of patients during various weather conditions throughout the year.

The technical result of our invention can be considered the formation of unified, integral criteria for assessing the degree of meteosensitivity of any adult patient, healthy or having disorders of various organs and systems, regardless of the region of his residence. These criteria were obtained during long-term observation of volunteers and patients of our Center and its branches participating in a scientific study, as well as volunteers from other regions of Russia, using statistical methods, and were verified during 2019.

To achieve the specified technical result, a method for assessing the meteosensitivity of a person is proposed, including conducting an instrumental diagnostic study and an individual questionnaire. As indicators measured in a diagnostic study, systolic and diastolic blood pressure (SBP and DBP) and heart rate (HR), measured daily, at the same time, are used. As an individual questionnaire, filling out the questionnaire presented in Table 1 and the self-observation diary presented in Table 2 during the year of observation.

In this case, filling out the questionnaire includes determining the presence of the following manifestations in the state of health (PSH):

increased SBP and DBP, heart rhythm disturbances, headache, shortness of breath, allergic diseases, pain in the joints, in the liver and gallbladder, pain in the stomach, menstrual irregularities, drowsiness, insomnia, weakness, irritability, fear and anxiety, depression , as well as manifestations of herpes, acute respiratory viral infections, sinusitis, tonsillitis, pharyngitis by months of the year and depending on the subjective feeling of the influence of weather factors (PF): temperature, wind, atmospheric pressure, humidity and precipitation.

The degree of meteosensitivity is established depending on the following combinations of the obtained diagnostic indicators for the entire observation period.

A mild degree is established if day-to-day fluctuations in SBP are in the range of less than 10 mm Hg, DBP is in the range of less than 5 mm Hg, and heart rate is in the range of up to 20 beats / min.

and such changes are observed for up to 3 consecutive days in any month of the year, or up to 7 non-consecutive days in any month of the year,

in combination with the patient's overall assessment of the influence of weather factors on each of the indicators, in accordance with the questionnaire in Table 1: work capacity, well-being, emotional sphere and the frequency of exacerbations of diseases - up to 4 points,

or the patient's assessment of the influence of weather factors on each of the indicators: well-being, performance and emotional background, according to the self-observation diary, in table 2 - no more than 4 points with the presence of 1-2 subjective symptoms, for up to 3 consecutive days in any from months of the year, or up to 7 non-consecutive days in any month of the year,

in combination of the listed features with no more than two of the above PFs in no more than 2 months a year and the dependence of these PFs on no more than two of the above PFs.

It is taking into account the combination of objective and subjective signs that makes it possible to make a more accurate assessment of meteosensitivity, since separately quite wide fluctuations have both subjective and objective indicators even during the day (for example, blood pressure).

The average degree of meteosensitivity is established if day-to-day fluctuations in SBP are in the range from 10 to 20 mm Hg, DBP is in the range from 5 to 15 mm Hg, and heart rate is in the range from more than 20 to 30 beats / min, and such changes are observed for 4-5 consecutive days in any month of the year, or 8-10 inconsistent days in any month of the year,

in combination with the patient's overall assessment of the influence of weather factors on each of the indicators, in accordance with the questionnaire in Table 1: performance, well-being, emotional sphere and the frequency of exacerbations of diseases - 5-7 points,

or the patient's assessment of the influence of weather factors on each of the indicators: well-being, performance and emotional background, according to the self-observation diary, in table 2 - 5-7 points with the presence of 3-4 subjective symptoms, for up to 3 consecutive days in any from months of the year, or up to 7 non-consecutive days in any month of the year,

in combination of the listed features with 3-4 of the above PFs from 3 to 5 months a year and the dependence of these PFs on no more than two of the above PFs.

A severe degree of meteosensitivity is established if day-to-day fluctuations in SBP are in the range of more than 20 mm Hg, DBP is in the range of more than 15 mm Hg, and heart rate is in the range of more than 30 beats / min, and such changes are observed for more than 5 these days in a row in any month of the year, or more than 10 non-consecutive days in any month of the year,

in combination with the patient's overall assessment of the influence of weather factors on each of the indicators, in accordance with the questionnaire in table 1: performance, well-being, emotional sphere and the frequency of exacerbations of diseases - 8-10 points,

or the patient's assessment of the influence of weather factors on each of the indicators: well-being, performance and emotional background, according to the self-observation diary, in table 2 - 8-10 points with the presence of 5 or more subjective symptoms, for at least 3 consecutive days in any of the months of the year, or at least 7 non-consecutive days in any month of the year,

in a combination of the listed characteristics with 5 or more of the above PFs for 3 or more months a year and the dependence of these PFs on 3 or more of the above PFs.

Table 1. "Meteopathy" questionnaire

Name age floor Permanent residence (permanent residence)

Tel. Email

Healthy Primary diagnosis Concomitant diagnosis

Rate the influence of weather factors on your performance in points from 0 to 10 (0 - no effect; 10 is the maximum effect).

1 2 3 4 five 6 7 eight nine ten

Rate the influence of weather factors on your well-being in points from 0 to 10 (0 - no effect; 10 maximum effect).

1 2 3 4 five 6 7 eight nine ten

Rate the influence of weather factors on your emotional sphere in points from 0 to 10 (0 - no effect; 10 is the maximum effect).

1 2 3 4 five 6 7 eight nine ten

Evaluate the influence of weather factors on the frequency of exacerbations of your diseases in points from 0 to 10 (0 - no effect; 10 is the maximum effect).

1 2 3 4 five 6 7 eight nine ten

In what months do you most often experience these symptoms?

Months 1 2 3 4 five 6 7 eight nine ten eleven 12 Symptoms Increased blood pressure Heart rhythm disorders Headache Dyspnea Allergic diseases Joint pain Pain in the liver and gallbladder Stomach pain Menstrual irregularities Drowsiness Insomnia Weakness Irritability Fear, anxiety Depression ARVI, sinusitis, tonsillitis, pharyngitis, herpes

What symptoms do you associate with the influence of the weather?

Weather factors Heat Cold Wind High atmospheric pressure Low atmospheric pressure High humidity and rainfall Any change in weather Symptoms Increased blood pressure Heart rhythm disorders Headache Dyspnea Allergic diseases Joint pain Pain in the liver and gallbladder Stomach pain Menstrual irregularities Drowsiness Insomnia Weakness Irritability Fear, anxiety Depression Herpes SARS, pharyngitis, sinusitis, tonsillitis

Table 2. Self-control diary of "Meteopathy"

No. Locality of permanent residence Geographic coordinates of s. v.d. Name or nickname floor age Profession Primary diagnosis Concomitant diagnosis Tel. Email

Rate it in points from 0 to 10 (0 is very bad; 10 is very good) What symptoms are you experiencing today? Measure blood pressure and pulse rate * date Feeling well
seizure Work
ability Emotion
monetary background
Sample
Symptoms Blood pressure Pulse Sisto
personal Diasto
personal 11.11.19 eight 7 five Headache in the temples, poor sleep 130 85 92

Note. * Measurement of blood pressure must be carried out in a sitting position. Provide support on the back of the chair, relax your legs. The measurement is taken after a 5 minute rest. The hand should lie on the table and be at the level of the heart. The measurement is carried out on the arm on which the pressure is higher. Do not talk while measuring blood pressure. For 1-1.5 hours it is necessary to exclude food intake and smoking. The lower edge of the cuff is located 1-2 cm above the elbow bend. Measure blood pressure twice with a break of 3-5 minutes. Measurements are taken every day at the same time.

Confirmation of the implementation of the method

In accordance with the proposed method was carried out daily registration of physiological indicators and symptoms shown in tables 1 and 2, followed by questioning of volunteers, in accordance with the questionnaire.

During 2018, 179 people of both sexes (102 women and 77 men), aged 40-65 years old, living in the cities of Gelendzhik (66 people, the study was carried out on the basis of the Vulan sanatorium), Krasnodar (17 people) took part in the primary study , Novorossiysk (13 people), Nadym (6 people), Barnaul (5 people), Moscow and the Moscow region (72 people) (on the basis of the Federal State Budgetary Institution of the National Medical Research Center of the Republic of Kazakhstan of the Ministry of Health of Russia).

In parallel, for each of the listed settlements and regions, during the year of the study, weather conditions were monitored in accordance with data from the website gismeteo.ru, as well as local weather stations. Patients independently performed daily monitoring of their condition: blood pressure and heart rate indicators (they kept a self-observation diary). Patients with chronic dysfunctions of the respiratory system, cardiovascular, nervous, digestive systems and musculoskeletal system (102 people, ~ 57%), and constantly taking appropriate drug therapy in connection with these disorders, during the study continued to take the prescribed Previously, medical preparations, thus, patients during the study led their usual way of life. The patients did not change their time and climatic zones during the year.

In the course of the study, the study also registered requests for medical help - ambulance, outpatient and inpatient, in cases of disorders of the respiratory, cardiovascular, digestive, nervous, musculoskeletal systems, the occurrence of infectious diseases, exacerbation of allergic conditions. On the basis of the number of such calls and the assessment of the severity of the condition of the subjects under such calls, their ranking was carried out (according to the frequency of calls and the severity of the condition) and the interrelation of the signs of health disorders revealed during monitoring was investigated under certain observed changes in weather conditions. Highlighted by us signs of health disorders were selected for monitoring and questioning as characterizing the most frequent complaints of patients with changes in the weather, based on the analysis of the prior art and our own experience of interaction with meteosensitive patients.

Quantitative data were presented as M ± SD, where M is the mean value of the indicator, SD is the standard deviation. When analyzing the data, we used the STATISTICA software package (StatSoft, versions 6.1-8.0 (USA), recommendations of O.Yu. Rebrova, 2002). Descriptive statistics were used with the analysis of the correspondence of the type of distribution of the trait to the law of normal distribution (all quantitative data were assessed for the normal distribution of the compared parameters by the Kolmogorov-Sokolov test and the equality of general variances in the selected groups by the Fisher's F test); testing statistical hypotheses; assessment of the statistical and clinical significance of the results obtained. At the end of the study, correlation analysis was performed using Spearman's rank correlation (nonparametric) and logistic regression method. The strength of the correlation was determined in accordance with the classification (Rebrov): r≤0.25 - weak correlation; 0.25 <r <0.75 - moderate correlation; r> 0.75 - strong correlation.

For the signs we selected in the questionnaire, the strength of the correlation was from moderate to strong in patients from all regions.

With the help of the analysis, a relationship was established between the frequency of seeking medical care and the severity of health disorders with a number of physiological signs and subjective disorders in patients from different regions of residence, the frequency and duration of such disorders under various changes in weather conditions. This allowed the study participants to be divided into groups, respectively, with mild, moderate and severe meteosensitivity.

On the basis of these data, recommendations for the prophylactic intake of drugs corresponding to the expected health disorders (immunomodulators, adaptogens, NSAIDs, cardiological agents, bronchodilators, etc.), adherence to the daily regimen in accordance with their the degree of meteosensitivity and taking into account the questionnaire data on the temporal distribution of the occurrence of violations - depending on the season, day (tables 1 and 2). Participants were asked to comply with these recommendations throughout 2019, while continuing to self-observe in accordance with Tables 1 and 2.

Compliance by the study participants with the recommendations led to the fact that the number of their requests for medical care in 2019 in all monitored regions decreased by 1.5-2 times (the most frequent reason for requests was violations of the cardiovascular system, least often infectious diseases).

The research carried out made it possible, regardless of the region of residence:

-Create predictive models that predict the risk of meteopathies, taking into account the combination of various weather factors.

- To study the frequency and seasonality of the increase in the risk of meteopathies.

-Explore the association of specific symptoms of meteopathies with various weather factors.

-To study the effectiveness of the differentiated correction of meteopathies using balneological procedures.

Example 1.

In the period for 10 months of 2019, from January 01 to October 31. in Gelendzhik (44 ° 36'N 38 ° 08'E) meteorological data were monitored (website gismeteo.ru, weather station Gelendzhik, monitoring of emergency medical data in Gelendzhik (6268 calls) and Novorossiysk (6937), 13205 calls in total. The databases contained information on accessibility with the diagnoses "Hypertensive crisis" (HC), "Myocardial infarction" (MI), "Acute cerebrovascular accident" (ACVI).

The pattern of symptoms and weather factors was studied using a questionnaire survey of 72 patients in 2019 at the Vulan sanatorium (Gelendzhik). The study on non-drug correction and prevention of meteopathic reactions from CVS using balneotherapeutic methods was carried out on the basis of the Vulan sanatorium (Gelendzhik) and the clinic of the National Medical Research Center of the RK Ministry of Health of Russia (Moscow).

The study on the study of balneocorrection of meteopathic reactions of the National Medical Research Center of the Republic of Kazakhstan of the Ministry of Health of Russia included 66 people: 35 women (53%), 31 men (47%). The average age of the patients was 56.9 ± 2.3 years, the average body mass index (BMI) was 28.1 ± 0.73 kg / m². The patients were divided into 3 groups, randomized by sex, age, and disease severity. Patients of the 1st group (n = 29) received “dry” carbonic baths against the background of basic drug therapy. Patients of group 2 (n = 17) received siliceous baths with a concentration of 100 mg / l against the background of basic drug therapy. Patients in group 3 received only basic antihypertensive therapy. All patients during the study underwent a comprehensive examination, including: examination, anamnesis, ECG, measurement of office blood pressure, clinical blood test, determination of lipid profile, determination of fibrinogen, INR, 24-hour monitoring of blood pressure. The patients also kept a self-observation diary to track meteopathic conditions, in accordance with Tables 1 and 2.

The first block of studies was carried out based on the data of the emergency medical service in Gelendzhik. In the course of studies of this block, it was shown that hypertension (HD) is a marker state for assessing the influence of weather factors on the cardiovascular system (CVS), a risk model for the development of HA was developed and the periods of the year with the highest risk of developing this condition were determined.

It was revealed that the number of patients with an ambulance (EMC) diagnosed with HA correlates to the greatest extent with weather factors than the attendance with diagnoses of MI and ACVA. At the same time, only weak correlations were revealed between the HA reversibility and weather factors: atmospheric pressure, daytime air temperature, K-index. Weak correlations of the number of calls with MI and wind speed, CVA and air temperature were revealed.

Weak correlations made it impossible to build reliable predictive models. This situation is explained by the non-linear response of the body to weather factors, the presence of several adaptation phases, the absence of an unquestionably leading factor, overlapping and cumulation of periods of changes throughout the year. The revealed features required the use of other mathematical processing methods.

Using the method of hierarchical agglomerative clustering, it was revealed that the K-index of geomagnetic activity (Ed 0.82), air temperature (Ed 0.8), and atmospheric pressure (Ed 0.83) are most associated with referral for HA. This stage of research allowed us to select priority weather factors for further analysis.

Further, we conducted research to identify the most favorable periods for spa treatment. It was found that the greatest appealability for GC was observed in the spring season (33.0% more than in the summer). In addition, a short but pronounced peak of reversibility was observed at the end of October with a sharp transition to a colder season. Thus, in the last week of October 2019, the appealability for GC was 2 times higher than in July.

A predictive logit model for the development of HA was built depending on weather factors. The sensitivity of the model was 56.0%, the specificity was 77.3%. Overall accuracy 76.0%. This model is a convenient practical tool for a spa doctor and other specialists.

Using this model, it was shown that in the winter season there are no more than 75.0% of days with a low risk of HA, the spring season is 59.0%, the summer season is 89.0%, and the autumn season is 77.0%.

It was revealed that in all seasons of the year the greatest contribution to the risk of HA development is made by an increase in the K-index amplitude and atmospheric pressure. Thus, an increase in the K-index, during the period of geomagnetic disturbance, by only one point (from 3 to 4 points) increases the risk of HA by 50.0%. Change in atmospheric pressure per day by 5 mm. rt. Art. increases risk by 55.0%, temperature change by 5⁰C - by 26.0%.

The second block of studies was carried out to study the frequency and relationship between exposure and effect when several weather factors are combined. Using ARIMA analysis, short, medium and long term predictive models were developed. Validation of the model on the data on ambulance services in Novorossiysk showed high predictive accuracy (95%) for short-term forecasts.

It was revealed that the models constructed for only one leading weather factor do not provide the required accuracy in all seasons of the year, which required a transition to the creation of models that take into account the impact-effect lag and a combination of weather factors.

In the course of the study, it was revealed that the change in the appealability of blood glucose during the year varies unevenly, which makes it possible to distinguish periods: 21 days, 60 days, 6 months, 1 year, nested like "nesting dolls". When the points of the beginning of several periods were superimposed, a peak increase in the circulation with HA was observed.

The use of the developed models on the ARIMA analysis platform would make it possible, on the basis of publicly available data on air temperature, relative humidity, atmospheric pressure, K-index of geomagnetic activity, to build sufficiently accurate predictive models for dosing climatic effects, preventing meteopathies, determining the periods most favorable for spa treatment ...

The third block of studies was carried out based on the data of the questionnaire survey of patients undergoing sanatorium treatment. The greatest influence on the well-being of patients with hypertension is characterized by sharp drops in atmospheric pressure (1.7 points out of 3 maximum possible) and temperature (1.3 points), "magnetic storms" (1.9 points), as well as high atmospheric pressure (1, 2 points), the least influence is frost (0.2 points) and snow (0.1 points).

In persons who came from other regions to undergo sanatorium-resort treatment, meteopathies were most often manifested by an increase in blood pressure and headache. As in other patients with hypertension, most often symptoms occur during magnetic storms, sudden changes in atmospheric pressure, high atmospheric pressure, strong winds, and heat. Weakness is closely associated with fever. Dyspnea - with cold and damp weather.

The fourth block of studies was carried out using the data of functional and biochemical studies of patients undergoing spa treatment. As a result of this work, the effectiveness of the correction of meteopathies using balneological procedures was evaluated. According to the results of repeated examination, a slight decrease in blood pressure and heart rate was observed in all groups, however, these changes were not significant.

When assessing the clinical analysis of blood after the end of the course of treatment in the 1st group of patients ("dry" carbonic baths - SUV), a decrease in the level of fibrinogen was noted (p <005). Analysis of lipid metabolism indicators revealed a decrease in indicators in all groups, which were insignificant and unreliable.

According to the ABPM data, in all groups during the second examination, there was a tendency towards a decrease in SBP and DBP, mean BP. Pulse blood pressure increased in the group that received VTS. According to the re-examination data, in the remaining groups, this indicator decreased, which indicated an increase in the stroke volume in patients only in the group receiving SSV. At the same time, in this sample, the above-described trends did not reach the level of statistical significance.

Changes in indicators during re-examination allow us to conclude about the positive effect of the course of VTS on patients with hypertension. However, more patients are required for final conclusions.

The data of the 2019 study was also a necessary stage for the creation and training of an information system based on neural network technologies, which will soon make it possible to switch to a personalized forecast of the risk of development and correction of meteopathies both in everyday life and during spa treatment.

Thus, as a result of exposure to non-drug prophylactic factors, an improvement in the clinical condition and an increase in the adaptive potential of patients with a risk of CVD progression associated with meteorological dependence were obtained.

Example 2.

Patient K., 53 years old, participant of the 2018-2019 study, residence - Moscow. The main diagnosis: GB 2 tbsp., IHD 1 tbsp., Arthrosis of the left hip joint 1 tbsp.

He considers himself meteorological: with fluctuations in atmospheric pressure, changes in air temperature, changing seasons, he notes panic attacks, jumps in SBP and DBP by 20-30 mm Hg, sometimes pain in large joints. She is constantly taking antihypertensive therapy.

During monitoring during 2018, she applied for medical care on an outpatient basis 3 times.

Day-to-day fluctuations in the patient's SBP were observed in the range - less than 10 mm Hg, DBP - in the range less than 5 mm Hg, heart rate - in the range of up to 20 beats / min, for up to 3 consecutive days in March, 5 and 7 non-consecutive days in February and October. At the same time, the patient's overall assessment of the influence of weather factors on each of the indicators, in accordance with the questionnaire in Table 1: working capacity, well-being, emotional sphere and the frequency of exacerbations of diseases, was 4 points

The patient's assessment of the influence of weather factors on each of the indicators: well-being, performance and emotional background, according to the self-observation diary, in table 2 - was no more than 4 points with the presence of 1-2 subjective symptoms from the psychoemotional sphere, for up to 3 days in a row in March, 5 and 7 non-consecutive days, respectively, in February and October. At the same time, the listed signs were combined in the patient with one or two of the listed PSZs, respectively, in March and October, and the dependence of these PSZs was revealed, respectively, on no more than two of the above PFs (irritability in response to any weather changes, insomnia in response to increase the wind).

In accordance with the proposed method, according to the monitoring of the patient's condition, the number of calls for medical care and changes in meteorological conditions, an easy degree of meteosensitivity was established. Taking into account the data obtained, a program of preventive measures was developed for the patient, incl. balneoprophylaxis in the pre-spring period and in September, taking into account the underlying disease and the nature of exacerbations of her condition worsening, in addition, her drug therapy was adjusted (sedatives were included), as well as antioxidants (Mexidol).

A positive result - at the end of 2019, the patient, following the proposed recommendations, did not seek medical help during the period of the previously expected deterioration of the condition.

Example 3.

Patient D., 48 years old, participant of the 2018-2019 study, residence - Nadym (Yamalo-Nenets Autonomous Okrug). The main diagnosis: lateral hernia of the intervertebral discs of the lumbosacral spine L4-L5, grade 2, chronic radicular pain syndrome, grade 1 ischemic heart disease, chronic gastroduodenitis, biliary dyskinesia.

Considers himself meteorological: deterioration (increased radicular pain syndrome, pain in the region of the heart, pain in the epigastric region) with a cold snap, lowering atmospheric pressure. He almost constantly uses analgesic drugs (NSAIDs), twice a year (in spring and autumn) he undergoes courses of manual therapy and massage, physiotherapy for an underlying disease of the gastrointestinal tract.

During monitoring during 2018, he applied for medical help (in addition to preventive courses) on an outpatient basis 5 times, underwent inpatient treatment for exacerbation of gastrointestinal disorders 2 times.

Day-to-day fluctuations in the patient's SBP were observed in the range from 10 to 20 mm Hg, DBP - in the range from 5 to 15 mm Hg, and heart rate - in the range from more than 20 to 30 beats / min, for 4-5 consecutive days in February, and in March they were detected - for 8-10 inconsistent days. At the same time, the patient's assessment of the influence of weather factors on each of the indicators, in accordance with the questionnaire in Table 1: performance, well-being, emotional sphere and the frequency of exacerbations of diseases - ranged from 5 to 7 points.

When filling out the self-observation diary, similarly, the patient's assessment of the influence of weather factors (PF) on each of the indicators: well-being, performance and emotional background, according to table 2 was 5-7 points with the presence of 3-4 subjective symptoms (headache, pain in epigastrium, in the region of the heart, in the back), for up to 3 consecutive days (February, March).

The listed signs were also combined in February-March and November with 3-4 of the listed PSZs (drowsiness, pain in the joints, in the liver and gallbladder, headache), the patient also noted the dependence of these PSZs on such PFs as a decrease in atmospheric pressure, rainy weather.

In accordance with the proposed method, according to the monitoring of the patient's condition, the number of calls for medical care and changes in meteorological conditions in the patient, the average degree of meteosensitivity was established. Taking into account the data obtained, a program of preventive measures was developed for the patient, incl. balneoprophylaxis in the pre-spring and late autumn-early winter period (the appointment of preventive measures was shifted in time by about 2 weeks), taking into account its main diseases and the nature of their exacerbations, medication and physiotherapy were adjusted (the mode of exposure was changed, while other physical effects were used factors).

Positive result - at the end of 2019, the patient, following the proposed recommendations, did not seek medical help during the period of previously expected deterioration of his condition for the main diseases (he applied only once for an emerging seasonal acute respiratory viral disease, was treated on an outpatient basis).

Example 4.

Patient V., 58 years old, participant of the 2018-2019 study, residence - Gelendzhik. The main diagnosis: GB 2 tbsp., Obesity 2 tbsp., Type 2 diabetes mellitus, moderate severity (blood glucose 10-15 mmol / l), metabolic syndrome, chronic gastroduodenitis, chronic pancreatitis.

Considers himself meteorological: subjectively - intolerance to stuffy rooms, high air humidity, changing seasons and types of weather, increased heart rate, increased blood pressure by 30-40 mm Hg, anxiety, apathy, annual exacerbations of gastroduodenitis and pancreatitis (March, October ) with inpatient treatment. He constantly takes drug therapy, once a year (July) he undergoes sanatorium-resort treatment at the place of residence (Gelendzhik).

During monitoring during 2018, she applied for medical care on an outpatient basis 8 times, in a hospital - 2 times due to exacerbation of gastrointestinal diseases, 2 times - due to endocrine disorders.

Day-to-day fluctuations in the patient's SBP were in the range of more than 20 mm Hg, DBP was in the range of more than 15 mm Hg, and the heart rate was in the range of more than 30 beats / min, and such changes were observed for more than 5 consecutive days in March, more than 10 inconsistent days in October.

At the same time, the patient assessed the influence of weather factors on each of the indicators, in accordance with the questionnaire in Table 1: work capacity, well-being, emotional sphere and the frequency of exacerbations of diseases - 8-10 points.

According to the self-observation diary, similarly, the patient assessed the influence of weather factors on each of the indicators: well-being, performance and emotional background, in Table 2 - 8-10 points, noting the presence of more than 5 subjective symptoms (depressed mood, nausea, abdominal pain , insomnia, shortness of breath, heart palpitations and others) for at least 3 consecutive days in February-March, up to 10 inconsistent days in October.

The listed signs were combined with 5-8 of the above PSZ (increased SBP and DBP, tachycardia, headache, shortness of breath, pain in the stomach, drowsiness, weakness, irritability, fear and anxiety, depression, manifestations of herpes) for 4 months of the year (February, March, October, November) and were dependent in different months from 3 to 6 of the above PF (atmospheric pressure drops (high, low, pressure change), various types of precipitation, heat, increased air humidity, periods of weather change).

In accordance with the proposed method, according to the monitoring of the patient's condition, the number of calls for medical care and changes in weather conditions, a severe degree of meteosensitivity was established . Taking into account the data obtained, a program of preventive measures was developed for the patient, incl. spa treatment in the spring and autumn, with the inclusion of physiotherapeutic effects, shown both for her metabolic disorders, and for her existing gastrointestinal diseases, the drug (metabolic) therapy and diet were adjusted.

Positive result - at the end of 2019, the patient, following the proposed recommendations, feels healthier, has lost 5 kg (the degree of obesity has decreased to 1 tbsp.), Maintains the blood glucose level below 10 mmol / l, for medical help during the period previously expected deterioration of the condition was treated 2 times on an outpatient basis (due to minor exacerbations from the gastrointestinal tract).

Thus, the use in accordance with the declared method of monitoring physiological parameters (blood pressure, heart rate) and self-questioning of the patient with the determination (assessment) of the degree of his meteosensitivity allows us to develop a differential medical approach to the choice of preventive measures for the deterioration of his condition, while being universal for different regions of Russia and for patients with disorders not only from the CVS, but also other important systems of the body - musculoskeletal, nervous, digestive, etc.).

This method will also make it possible to predict the degree of possible health problems depending on the region to which the patient is going to leave, taking into account the weather conditions there (predicted for a given period), and, accordingly, take preventive measures in time. This seems to be especially important both for patients moving to another region for permanent residence or work, and for patients wishing to receive spa treatment in one or another region.

Claims (1)

A method for assessing a person's meteosensitivity, including conducting an instrumental diagnostic study and an individual questionnaire, characterized in that as indicators measured in a diagnostic study, systolic and diastolic blood pressure (SBP and DBP) and frequency are measured daily at the same time. heart rate (HR), and as an individual questionnaire - filling out the questionnaire presented in Table 1, and the self-observation diary presented in Table 2, during the year of observation, while filling out the questionnaire includes determining the presence of the following manifestations in the state of health (PSH): increased SBP and DBP, heart rhythm disturbances, headache, shortness of breath, allergic diseases, pain in the joints, in the liver and gallbladder, pain in the stomach, menstrual irregularities, drowsiness, insomnia, weakness, irritability, fear and anxiety, depression , as well as manifestations of herpes, ARVI, syn mustache, sore throat, pharyngitis by months of the year and depending on the subjective feeling of the influence of weather factors (PF): temperature, wind, atmospheric pressure, humidity and precipitation, and set the degree of meteosensitivity depending on the following combinations of the diagnostic indicators obtained for the entire observation period: - if day-to-day fluctuations in SBP are in the range - less than 10 mm Hg. Art., DBP - in the range of less than 5 mm Hg. Art., and heart rate - in the range of up to 20 beats / min, and such changes are observed for up to 3 consecutive days in any month of the year, or up to 7 inconsistent days in any month of the year, in combination with the patient's overall assessment of the effect of weather factors on each of the indicators, in accordance with the questionnaire in Table 1: working capacity, well-being, emotional sphere and the frequency of exacerbations of diseases - up to 4 points, or the patient's assessment of the influence of weather factors on each of the indicators: well-being, working capacity and emotional background, according to the self-observation diary, in Table 2 - no more than 4 points with the presence of 1-2 subjective symptoms, for up to 3 consecutive days in any month of the year, or up to 7 inconsistent days in any month of the year, in combination of the listed signs with no more than two of the above PSZ no more than 2 months a year and the dependence of these PSZs on no more than two of the above PFs; average - if day-to-day fluctuations in SBP are in the range from 10 to 20 mm Hg. Art., DBP - in the range from 5 to 15 mm Hg. Art., and heart rate - in the range from more than 20 to 30 beats / min, and such changes are observed for 4-5 days in a row in any month of the year, or 8-10 inconsistent days in any month of the year, in combination with the patient's overall assessment the influence of weather factors on each of the indicators, in accordance with the questionnaire in Table 1: performance, well-being, emotional sphere and the frequency of exacerbations of diseases - 5-7 points, or the patient's assessment of the influence of weather factors on each of the indicators: well-being, performance and emotional background, according to the self-observation diary, in table 2 - 5-7 points with the presence of 3-4 subjective symptoms, for up to 3 consecutive days in any of the months of the year, or up to 7 non-consecutive days in any month of the year, in combination of the listed signs with 3-4 of the above PSZ from 3 to 5 months a year and the dependence of these PSZ on no more than two of the above PF; severe - if day-to-day fluctuations in SBP are in the range of more than 20 mm Hg. Art., DBP - in the range of more than 15 mm Hg. Art., and the heart rate is in the range of more than 30 beats / min, and such changes are observed for more than 5 consecutive days in any month of the year, or more than 10 inconsistent days in any month of the year, in combination with the patient's overall assessment of the effect of weather factors on each of the indicators, in accordance with the questionnaire in table 1: performance, well-being, emotional sphere and the frequency of exacerbations of diseases - 8-10 points, or the patient's assessment of the influence of weather factors on each of the indicators: health, performance and emotional background, according to the self-observation diary, in table 2 - 8-10 points with 5 or more subjective symptoms, for at least 3 consecutive days in any month of the year, or at least 7 non-consecutive days in any month of the year, in combination of the listed signs with 5 or more of the above PSZ for 3 or more months a year and the dependence of these PSZ on 3 or more of the above PF.