Том 98, № 6 (2019)

Introduction. Among medical workers, both in the Russian Federation and in foreign countries, a significant number of people with chronic diseases are identified. This problem is already noted among medical students. In such a situation, an effective system of examination of the professional fitness of medical workers is necessary. Its goal is to prevent specialists with health disorders from working in harmful and dangerous conditions, which create a real risk of progression of existing diseases.

Material and methods. The authors analyzed the regulatory acts of the Russian Federation, determining the procedure for the examination of the professional working ability of medical workers. The adequacy and possible effectiveness of these acts were evaluated on the basis of the practical experience of the occupational physician.

Results. The existing system of medical examinations of applicants of medical schools does not allow to assess the risk of deterioration of their health disorders in the process of possible future work. Periodically, there are situations when a student with a health disorder receives training in a medical specialty, the work in which will then be recognized as contraindicated. The current system of examination of professional fitness in a number of cases allows the adoption of obviously illogical decisions concerning medical workers. This is possible both with regard to the prohibition to perform hazardous work, as well as with regard to the permission to perform them.

Conclusion. Normative acts in this area need for substantial reforms. Medical examinations of enrollees and students of medical schools should be able to determine the risk deterioration of health in the event of exposure to all harmful occupational factors typical for medical workers. The increased intensity of the labor process must be included in the list of harmful occupational factors, under the influence of which expertise is necessarily carried out for th eoccupational suitability. When employing medical workers, the examination of professional fitness should be based on a risk-oriented approach.

Introduction. One of the main reasons for the complaints of the population about the poor air quality is an unpleasant odor.

The purpose of this study was to determine the sources of emissions into the air of harmful pollutants with an olfactory effect on the basis of a comprehensive analysis of official materials: complaints of the population, data on weather conditions, the results of the determination of pollutants at automatic stations, urban situation, data on atmospheric emissions of pollutants of the main enterprises and calculations of their dispersion.

Material and Methods. The database included a map materials, 2171 meteorological data, 576 complaints, more than 100 thousand data about air pollution, information about the emission sources of pollutants and their dispersion for 13 industrial enterprises. The principles of geostatistical analysis, (inverse) weighted distance method, time-series study were used to process the data.

Results. As a result of the time-series analysis of complaints about the presence of odors in the air, taking into account the recorded wind directions, there were determined areas of the alleged location of sources of emissions of pollutants with olfactory effect. They were the territories located mainly to the South, North-West, and North (smell of hydrogen sulfide), to the West and South (chemical smell) of the residential zone. The time- series analysis of hydrogen sulfide concentrations and recorded wind directions showed that possible emission sources are located to the South of the residential zone. Assessment of the composition and volume of emissions of pollutants of enterprises and calculation of their dispersion made it possible to establish the main source of release of pollutants with the smell of hydrogen sulfide to be the landfill of municipal solid waste. For the chemical smell, both other substances and directions of the sources can be defined approximately.

Conclusion. The proposed approaches allow determining the areas of the location of the sources of emissions of harmful pollutants with olfactory effect into the air, and in some cases, the priority enterprise.

Introduction. The level of air pollution in the areas of traffic flows is influenced by fuel combustion processes. Among air pollutants, special attention should be paid to methane. Methane is formed during the combustion of liquid fuels and is a precursor of formaldehyde. Formaldehyde is synthesized in the presence of catalysts. Its concentration exceeded the maximum permissible limits.

The aim of the study is the hygienic assessment of additional aerogenic risk to public health due to formaldehyde, formed during the operation of the road-car complex (RCC).

Material and methods. The calculation of the amount of methane entering the air during the operation of vehicles from fuel combustion is determined in accordance with the EMEP/EEA emission inventory Manual (2016).) The concentration of the studied pollutants is determined in accordance with the Order No. 273 of 06.062017 «Methods of calculation of dispersion of emissions of harmful (polluting) substances in the air». RCC is classified according to the intensity of traffic from 500 to 7,000 vehicles per hour. Risk calculation was carried out on the basis of guidance 2.1.10.1920-04 «Guidelines for assessing the risk to public health when exposed to chemicals that pollute the environment». The concentration of formaldehyde in ambient determined in accordance with the methodical instruction 4.1.1272-03. Statistical analysis was carried out using the Excel 2016 application package.

Results. Methane (CH4) emission factors (mg/km), presented in the EMEP/EEA Manual, allowed determining the amount of methane emission (mg/s) per 1 km at different traffic intensities (auth./hour.) The obtained data were used to calculate the model concentrations of formaldehyde synthesized from methane. The calculated model concentrations were used to calculate additional carcinogenic and non-carcinogenic risk due to formaldehyde.

Сonclusions. The gain in motorization of the population is accompanied by an increase in air pollution in the zone of influence of road transport. However, the emission inventory does not take into account the possible transformation of the pollutants making up the exhaust gases. Incomplete information does not allow using them to predict health risk levels based on model concentrations. The results obtained allowed obtaining information about the amount of additional carcinogenic and non-carcinogenic risks created in the process of transformation of methane into formaldehyde. The most unfavorable temperature regime (0-15oC) contributing to the synthesis and slowing down the decay of formaldehyde in the atmosphere along the roads was revealed.

Introduction. Working conditions at mining enterprises, including iron ore mining, combined with the climatic conditions of the Arctic, create an increased risk of occupational diseases (OD) among miners.

The aim of the study was to investigate the risks, circumstances of the development, structure, and prevalence of OD in miners engaged in the extraction of iron ore in the Kola Polar Region.

Material and methods. The data of social and hygienic monitoring in the section “Working conditions and occupational morbidity” of the population of the Murmansk region in 2007–2017 were studied.

Results. The development of the OD in this category of miners was established to be mainly associated with the whole-body vibration (42.5%) and the severity of labor (33.2%) due to the imperfection of workplaces (66.4%). In the structure of the OD, the largest share belongs to injuries, poisoning and some other consequences of external causes (46.9%), while diseases of the musculoskeletal system occupy the second place (27.0%). The most common nosological form of OD was vibration disease (38.5%). The annual number of workers diagnosed with OD varied over a wide range from 3 to 29 people. In 2007–2015, there was a tendency towards an increase in occupational morbidity rates, and in 2016–2017, there was a sharp decrease to 7.39 cases per 10,000 workers, which cannot be explained by improved working conditions and health promoting activities.

Conclusion. To preserve the health of miners engaged in the extraction of iron ore in the Kola Arctic, it is necessary, first of all, to reduce the levels of whole-body vibration and severity of labor processes in combination with the introduction of medical methods to increase the body’s resistance to harmful industrial and climatic factors.

Introduction. Modern surgery is a complex, multifaceted area of medicine that plays an important role in the struggle for health, working capacity and human life. In recent years, in surgery, much attention has been paid to the improvement and development of new surgical equipment, including that based on ionizing and non-ionizing radiation, its application range being widened, which allows patients being provided with high-tech and less traumatic procedures. However, the use of such equipment resulted in the appearance of new adverse occupational factors of ionizing and non-ionizing nature at the workplaces of surgical team members, which can have a negative effect on the personnel. 

Material and methods. Data of x-ray and laser radiation level studies at the workplaces of medical personnel in modern operating rooms are reported.

Results. Total normalized power of the effective x-ray dose during the use of x-ray surgical unit at the workplaces of surgical teams in most cases was revealed not to exceed allowable dose rate, while in the process of certain procedures, such as vessel embolization, it can exceed allowable levels. The total annual effective radiation exposure dose of x-ray surgery teams depends on the number of performed operations, their type, complexity, and can exceed a basic radiation dose limit for A and B group personnel. The intensity of diffusely reflected laser radiation at workplaces of surgeons can significantly exceed maximum allowable levels, sometimes up to 600 times.

Discussion. Considering an ever-gaining use of high-tech equipment generating laser and X-ray radiation and increasing number of exposed medical personnel, hygienic assessment of these radiation levels at workplaces of surgical team members and development of measures to improve working conditions is an important issue for maintaining workers’ health.

Conclusion. To assess the occupational risk degree to the health of surgeons it is necessary to conduct in-depth studies of their health status.

Introduction. Currently, the main influence of adverse working conditions is manifested not only by the level of occupational morbidity and injuries but by the general state of health of employed persons. Among the most significant non-occupational exposure is tobacco smoking.

The aim of the study was a comparative assessment of the influence of the factor "harmful working conditions" (F_wc) and the factor "Smoking" (F_smo) on the prevalence and rate of development of the most frequently diagnosed chronic diseases in industrial workers.

Material and methods. Working conditions, medical examination data and smoking status of 2810 Apatite-nepheline and copper-Nickel miners were studied (cross section study). Population risk (PR) and its annual increase (GPR) were studied in six classes of diseases: circulatory system (CS), digestive system (DS), genitourinary system (GUS), respiratory system (RS), musculoskeletal system (MSS), skin and subcutaneous tissue (SST), nervous system (NS). Morbidity factors were characterized by the duration of their exposure: harmful working conditions – work experience not related to age and duration of smoking; non – professional factors – age of employees not related to work experience and smoking; smoking-its duration not related to age and work experience.

Results. Population rates among non-smokers and smokers, in groups with the same average age and work experience, did not differ statistically, except for CS, the frequency of which is lower in smokers. It can be assumed that these data refer to "paradoxical cases" in which the F_wc effect is masked by employee turnover. In contrast to extensive indices of PR, GPR indices of the majority of classes of diseases-accurately reveal negative influence of smoking on a state of health of miners.

Conclusion. 1. For quantitative comparison of negative effects on the health of workers of F_wc and F_smo it is necessary to use indices PR of dynamics in certain experience and age groups. 2. The impact of the F_wc on the GPR is more pronounced than F_smo for MSS, RS, NS. The influence of Fsmo exceeds a F_wc for SST, CS and DS. 3. An annual gain in the risk of chronic diseases (except MSS), not differentiated by their classes, s in smokers is by 1.6 times more than in non-smokers.

Background. Human labor in the Arctic area is carried out in extreme climatic conditions creating an increased risk of developing health problems, including occupational diseases (OD).

The purpose of the study was to investigate the working conditions, the structure and prevalence of OD in the population of the Nenets Autonomous District (NAD),  the basis of the which economy is oil and gas production.

Material and methods. The data of social and hygienic monitoring in the section “Working conditions and occupational morbidity” of the population of the NAD in 2008-2017 was studied. 

Results. The most significant harmful production factors at NAD enterprises have been established to be non-ionizing electromagnetic fields and radiations, unfavorable microclimate of workplaces, noise, intensity, and the hardness of the labor process. More than half of all district employees are involved in enterprises with satisfactory working conditions. In the NAD working population, occupational pathology is diagnosed mainly in the flight personnel of civil aviation (88% of cases) in the form of sensorineural hearing loss (96% of cases). The risk of OD development among air transport workers was higher than that of the entire population of the district (RR = 4.42; CI 2.95–6.62) and those employed in oil and gas producing enterprises (RR = 23.2; CI 8.32 - 64.4). Additional occupational health risks associated with the extraction of hydrocarbons in Arctic have not been established.

Conclusion. The priority direction in the prevention of occupational pathology (mainly sensorineural hearing loss) should be the reduction of the level of industrial noise among air transport workers.

Introduction. The real electromagnetic situation in a residential area in the process of power supply network operation and health status assessment of population living in the vicinity of overhead transmission lines (OTL) of various voltages and transformer substations (TS) are of current interest. The effect of 50 Hz electric fields (EF) and magnetic fields (MF) on human health has not been sufficiently studied.

Material and Methods. Measurement and assessment of 50 Hz EF and MF levels generated by 35, 110 and 220 kV OTL and by 6 kinds of closed-type transformer substations were carried out. Chronic overstrain index was used to assess population health status. Questionnaire study data among residents in the vicinity of 110-220 kV OTL were used for calculation of chronic overstrain index.

Results. Closed-type transformer plants don’t generate EMF or exceed 50 Hz EF or MF health standards (HS). Electric field intensity levels exceeding HS were registered under 110 and 220 kV OTL. EMF health standards were not exceeded at a distance of 2 m from 110 kV OTL and 10 m from 220 kV OTL. Magnetic field induction levels did not exceed maximum allowable levels. Significant levels of chronic overstrain were revealed in residents living at a distance of under 300 m from 110-220 kV OTL.

Conclusions. Closed-type transformer substations do not generate 50-Hz EMF exceeding health standards. Compliance with the electrical safety requirements of overhead transmission lines (overhead line safety zones) provides compliance with the maximum allowable levels of 50 Hz electric and magnetic fields. Population health risk assessment study among the population in the vicinity of OTL is relevant.

Introduction. The most important external sources of excessive noise levels on the territories of residential development are transportation sources (road, rail, aviation).

The aim of the present study is the hygienic assessment of the acoustic situation in the areas in the zone of influence of traffic flows and currently used measures to reduce the excess acoustic impact on residential premises.

Material and methods. The studies were carried out on the territories along the roads and Railways, with different intensity of traffic flows in accordance with GOST 23337-2014 Noise. Methods of noise measurement in residential areas and in the premises of residential and public buildings, MUK 4.3.2194-07 “Methods of noise measurement in residential areas and in the premises of residential and public buildings.” Experimental studies of materials used for the construction of acoustic screens were carried out. Here were investigated window units were used to reduce external noise in the house. Sound pressure levels in octave bands (dB) and sound levels (dBA) in the sound-measuring reverberation chamber were measured in accordance with GOST 27296-2012.

Results. Exceeding the permissible equivalent noise levels at a distance from 2 to 7.5 m from the roadway of vehicles in the daytime reaches 25-32 dBA. Noise from railway transport at a distance of 25 m from the source in terms of the equivalent sound level for freight transport is of 77 dBA, maximum - 83 dBA; for cargo transport, Sapsan, Lastochka, Allegro identical data were obtained; for passenger trains, the equivalent sound level accounted for 71 dBA, for electric trains – 66-69 dBA. Exceeding the standards for octave frequencies were most often observed at low frequencies from 31.5 to 500 Hz. The air noise insulation index (dB) is higher for the concrete and wood chips material, i.e. the material with higher density. The study of the parameters of the window blocks allowed us to establish all the studied samples to provide a reduction in the equivalent noise level by more than 20 dBA, but differ in the spectral characteristics of noise damping.

Conclusion. Traffic flows create excessive noise levels in urban and rural settlements and impair the quality of life of the population. The effectiveness of existing measures aimed to mitigating noise in the source of generation by both road and rail transport has been exhausted. Acoustic screens in high-rise buildings have very limited efficiency. An option to reduce the adverse impact of external noise on public health is the construction of buildings protected from noise. Placement of buildings along the linear objects of road and rail transport should be provided at the stage of planning of quarters, the construction of such buildings should be carried out on special projects. When designing and building, special attention should be paid to the window units used and the quality of their installation. Window blocks should be selected on the basis of frequency characteristics of noise attenuation.

Introduction. There are reported air quality assessment findings in enclosed spaces in experimental conditions using two kinds of nicotine-containing products - cigarettes and electronic nicotine delivery system (ENDS), seem to be the most common types of smoking.

Мaterial and Methods. In the process of the experiment concentrations of tobacco aerosol components, i.e.: 12 chemicals and two aerosols were measured. Studies were carried out in isolated rooms under monitored microclimate parameters and uniform air mixing. Groups of volunteers using cigarettes or electronic nicotine delivery systems and the control non-smoker group participated in the study; everybody gave their informed consent for participation in the experiment. Control of background indices for comparison of air quality in rooms where tobacco products were being smoked was carried out.

Results. Our studies allowing to identify chemicals evolving into the air of enclosed rooms where “PARLAMENT Aqua Blue” cigarettes were smoked or electronic tobacco delivery systems “CRICKET Classic 3.0” were used,  to estimate total amount of chemicals in air. Prevailing chemicals affecting human health, which can be recommended for the use in calculations and air study of enclosed rooms exposed to tobacco aerosol, were identified. Estimated values of adverse chemical concentrations, air flow and air expenditure rate, resulting from experimental data allow designing ventilation system with regard to hygienic requirements based on maximum allowable concentration values for atmospheric air.

Conclusions. Suggested recommendations on calculation of ventilation parameters to produce comfortable human environment in passive smoking conditions will improve air quality in public buildings.