Vol 65, No 4 (2021)

Федеральный научный центр гигиены имени Ф.Ф. Эрисмана — головной гигиенический институт Российской Федерации, ведёт свою историю с основания 15 февраля 1891 г. при гигиенической лаборатории Императорского Московского университета Московской городской санитарной станции. Её создателем и первым руководителем был один из основоположников отечественной гигиенической науки и санитарной практики профессор Фёдор Фёдорович Эрисман.

Introduction. Preservation and growth of the country population is the top national priority in the Russian Federation. A contemporary approach focuses on several especially urgent demographic issues that can be resolved, among other things, due to public healthcare systems becoming more efficient. The present research work is vital due to the necessity to achieve target medical and demographic parameters fixed in the national and federal projects and regional programs. These parameters include life expectancy and mortality caused by cardiovascular and oncologic diseases. 

The goal of this work is a development of new approaches for the complex evaluation of potential management reserves of health population indicators and the prognosis of efficiency of targeted activities performed within public healthcare systems and aimed at increasing life expectancy through reducing mortality among the population caused by cardiovascular diseases and oncologic diseases. 

Material and methods. The work dwells on solving a “direct” task in the “medical activities — morbidity — mortality” triple analysis system; the solution involves predicting changes in morbidity and mortality under preset, planned, or scenario changes in parameters related to the public healthcare system. We modelled cause-and-effect relations in the above system, applying mathematical statistics techniques (correlation-regression analysis and factor analysis) with the consequent medical expertise of obtained results. 

Results. These procedures allow assessing health losses and spot out priorities in activities performed within the public healthcare system as well as ranking managerial decisions, already taken or only planned, as per their efficiency, taking into account territories; sex and age structure of the population; diseases, their subclasses and gravity; specific activities performed within the public healthcare system (prevention, diagnostics, or treatment). We should stress that the most significant potential management reserves of reducing mortality are achieved on territories with maximum mortality levels due to reserves for the reduction in it; these reserves are manageable due to prevention and early diagnostics. 

Conclusion. Research techniques and results described in the present work can be used in practice to achieve target parameters fixed by national and regional priorities and to select an optimal set of activities aimed at reducing mortality among the population.

Introduction. One of the mechanisms for implementing the state policy targets in achieving wellbeing, improving the quality and duration of active life, reducing mortality, including at working age, is to reduce risks and eliminate factors that contribute to the development of obesity.

The aim of the study is a hygienic assessment of the indicator of the primary morbidity of obesity in the population of the Moscow Region, the Central Federal District (CFD), the Russian Federation (RF). 

Materials and methods. The research materials were the databases of the regional information fund for social and hygienic monitoring of the Moscow Region for 2011–2019 (2020). The study was performed by a retrospective comparative analysis of intensive indicators of the primary morbidity of obesity in three age groups, calculated for 100 thousand cases of the corresponding age. 

Results. Obesity of the population of the Moscow Region occupies a significant share in the structure of diseases of the endocrine system, eating disorders and metabolic disorders. Among children, the incidence is 34.1% of all diseases of this class, among adolescents – 44.2%, adults-21.4%. The incidence of obesity among all age categories of the population of the Moscow Region is significantly lower than the level of the same indicator for the Central Federal District and for the Russian Federation, excluding the period 2011–2014, when the incidence of adolescents in the Moscow Region was higher or at the level of the indicator values for Russia. In 2019. among the 18 subjects of the Central Federal District, the Moscow Region occupies the 16^th rank position in descending order of the value of the indicator of obesity among adolescents and adults for the first time. The lowest indicator for the Central Federal District is established among children. 

Conclusion. The implementation of the measures of the federal project “Strengthening Public Health” aimed at providing the population with a full, balanced, rational diet will reduce the risk of alimentary diseases, including obesity. 

Introduction. Against the background of socio-economic transformations and the digitalization of education, the health indicators of students are changing, which requires in-depth research. 

Aim of the study: based on the longitudinal observation of the health of schoolchildren, to identify the patterns of its formation for the scientific justification of improving the medical care of students. 

Material and methods. From the 1^st to the 11^a grade (2005–2015), the same students (199 boys and 227 girls) of 4 Moscow schools were examined annually with the performance of anthropometry, electrocardiography, functional tests, and questionnaire to identify complaints and anamnesis; specialist doctors carried out 25,298 examinations. In addition to the analysis of morbidity, a qualitative analysis of the course of pathological processes in students was carried out to determine positive and negative dynamics. 

Results. Over 11 years, the prevalence of functional disorders increased by 14.7%, chronic diseases by 52.8%, the frequency of visual disturbances, diseases of the musculoskeletal system, digestive organs, neurotic reactions increased; new forms of risk behaviour and information dependence appeared. An unfavourable period of development of pathological processes in schoolchildren is training in grades 9–11. Compared with the 1990 morbidity rates obtained by similar methods, there was an increase in the prevalence of functional disorders among adolescents by 2–3 times and chronic diseases by 20–70%. When comparing physical development with peers of the second half of the XX century, the observed schoolchildren increased the average values of body length and weight with a decrease in functional indicators. Distance learning during the first wave of COVID-19 in spring 2020 has increased the prevalence of computer vision, carpal tunnel syndromes, and neurotic reactions. 

Discussion. The main patterns of health formation in school ontogenesis, coinciding with the change of generations and the transition to the digitalization of education, are revealed. 

Conclusion. The study results allow predicting an increase in the prevalence of neuropsychiatric disorders, myopia, scoliosis, computer-visual and carpal tunnel syndromes. To preserve students’ health, to counteract COVID-19, a modern model of school health care is proposed.

Introduction. A significant level of dermatological morbidity requires consideration of the influence of external environmental factors on the development and progression of skin pathology.

Purpose: to assess the structure of dermatological morbidity of the population exposed to harmful environmental factors, with the definition of priority for the children’s population.

Objectives were to assess the structure of dermatological morbidity of the population exposed to harmful environmental factors, with the priority for the children’s population of the Mytishchi district of the Moscow Region.

Material and methods: statistical data on the morbidity of the children’s population of the Mytishchi district of the Moscow Region and the dermatological department of the Institute of General and Occupational Pathology of the Federal Scientific Center of Hygiene named after F.F. Erisman of the Federal Service for Supervision in Protection of the Rights of Consumer and Human Wellbeing. Data on pollution by harmful environmental factors of the district, social and hygienic monitoring data in the Mytishchi district on pollution by harmful environmental factors, using mathematical statistics methods (correlation dependence, Student’s coefficient).

Results. Residents of the Mytishchi district are exposed to adverse environmental factors, the children’s population is most susceptible to their influence. The greatest influence belongs to the pollution of atmospheric air and water.

The most common skin pathology in children includes atopic dermatitis and eczema. Statistics of inpatient dermatological care for 2017–2019 in the profile department of the Institute of General and Occupational 

Pathology of the F.F. Erisman data indicate a similar distribution of skin pathology in the adult population.

Conclusions. The obtained data require in-depth preventive examinations in organized children’s groups at regional enterprises to detect early forms of diseases and comprehensive hygienic preventive measures to improve the state of the environment in the Mytishchi district of the Moscow Region.

Introduction. The development of ferruginous quartzites of the Kursk magnetic anomaly basin is accompanied by the release of dust, which affects miners. Identification of markers of preclinical pathology of the cardiorespiratory system (CRS) is relevant.

Objective is to identify markers of endothelial dysfunction (ED) (endothelin-1 (ET-1), brain natriuretic peptide (BNP), changes in the elastic properties of blood vessels) at the preclinical stage of the development of pathology of the cardiovascular system and pathology of the respiratory organs in workers of dust occupations with different experience.

Material and methods: Medical documentation (812 persons, the period from 2008 to 2015), systematized and statistically processed. ET-1 and BNP were determined by enzyme immunoassay. The central hemodynamics was studied by the method of volumetric compression oscillometry.

Results. A significant correlation was established between the prevalence of diseases of the cardiovascular system (CCC), work experience in harmful conditions, and the peculiarities of the production process, r = 0.36–0.44; r = 0.48–0.64; the development of respiratory pathology with the production process and experience, r = 0.52–0.61, r = 0.41–0.47. The structure of morbidity is mainly formed by respiratory diseases – from 5.7 % to 40%; the third rank place (7.8–10.0%) is occupied by CCC diseases. A number of the examined patients have combined cardiorespiratory pathology (CRP) – 42.4%. The changes are more typical for highly trained workers. The study revealed: an increase in the pulse wave velocity (p = 0.037); linear blood flow velocity (p = 0.029), a decrease in arterial compliance (p = 0.031) with an increase in peripheral vascular resistance (p = 0.031), signs of ED (increase in ET-1, BNP).

Discussion. Changes in ET-1, BNP, elastic-elastic properties of the main vessels more often developed in highly trained workers. They manifested by the development of ED, occurring as an unfavourable factor in the early appearance and progression of bronchial obstruction followed by the formation of a chronic pulmonary heart, remodelling of the main vessels.

Conclusion. The study of ED is an urgent problem for studying with the subsequent optimization of therapeutic and preventive measures at mining enterprises

Introduction. Preserving employees’ health is one of the main components of corporate health and an essential factor of the social responsibility of business at the present stage of society’s development. The creation of “healthy” workplaces with the optimization of working conditions, preventive programs aimed at preventing occupational and general somatic diseases should become the main link in strengthening the health of the able-bodied population.

The purpose of the study is to provide a scientific justification and develop a modular program for preserving the health of workers of mining enterprises with various methods of ore extraction (underground and open).

Material and methods. The risk assessment of health disorders was carried out in stages: the state of working conditions, socio-demographic status were studied, behavioural risk factors were determined using questionnaires, fat metabolism was studied.

Results. The main risk factors for health disorders of employees of mining enterprises were identified: working conditions that do not meet sanitary standards (noise and vibration class 3.1–3.3, physical overload class 3.1–3.2, high work intensity), behavioural factors including smoking, overweight and low physical activity, early violation of lipid metabolism.

Discussion. Modular corporate programs have been developed to implement the principles of a healthy lifestyle (optimizing nutrition, increasing physical activity, stopping smoking, avoiding excessive alcohol consumption). The leading indicators of the effectiveness of the implementation of preventive measures are proposed.

Conclusion. The development and application of effective health-saving corporate programs are the choices of a socially responsible business aimed at solving the following tasks: preserving the health of employees, increasing their motivation to comply with the principles of a healthy lifestyle, forming a responsible corporate culture and, as a result, increasing labour productivity. Creating and maintaining a healthy working environment leading to improved socio-economic development is one of the most effective investments in human capital.

Introduction. The health of employees of harmful industries indicates its disadvantage and dependence on behavioural and occupation risk factors, promoting the formation of diseases associated with their impact. In this regard, it is essential to improve hygienic and medical-preventive measures to strengthen and restore the health of the able-bodied population, based on the use of health-saving principles aimed at developing skills for a healthy lifestyle and monitoring predictors of functional disorders of the body and the health of workers.

The purpose of the study. Implementation and evaluation of the effectiveness of preventive measures using health-saving methods to optimise the production environment and extend the longevity of workers working in harmful working conditions.

Material and methods. Two hundred eighty-two employees of the “Starooskolsky plant of automotive electrical еquipment named after A.M. Mamonov” exposed to harmful factors of the working environment were examined. The health status of employees was assessed according to the data of periodic and preventive medical examinations, medical documentation, with an assessment of the prevalence of priority classes of diseases. Behavioural risk factors (smoking, physical activity, the nature of nutrition) and associated functional indices of health disorders were studied: body mass index, biochemical indices. A health-saving program was proposed and tested, including an organisational, training and monitoring unit.

Results. The health status assessment of the workers of the studied enterprise showed the structure of morbidity to be formed by cardiovascular pathology, diseases of the spine and joints, respiratory organs, the psycho-emotional sphere, endocrinopathy, reaching almost 70%. More than half of the employees are overweight against the background of an unbalanced and irrational diet, a low level of physical activity, and lipid metabolism disorders. The introduction and testing of a preventive program developed on principles of health saving contributed to improving the health of employees and reducing morbidity. 

Conclusion. The recommended set of health-saving measures contributed to optimising working environment conditions, correcting the state of health of employees, and prolongation of labour longevity.

The influence of aerosols of fibrogenic action on the state of the cardiorespiratory system in dust-hazardous industries does not lose its significance over the years since the pathology of the respiratory organs gradually develops in working-age workers. Continuous medical monitoring of the health status of the working population, improvement of diagnostic research methods and their application at the early stages of exposure to harmful industrial factors will help prevent the development of occupational diseases and preserve the ability to work professional aptitude. 

Objective. To study the relationship between the state of the cardiorespiratory system and exercise tolerance based on the results of a 6-minute walk test in patients with dust pathology of the respiratory organs. 

Material and methods. 193 men with confirmed pneumoconiosis (79 people), occupational chronic obstructive pulmonary disease (58 people) and those in contact with the dust factor at work without respiratory pathology (56 people) were examined using echocardiography, spirometry, bodyplethysmography, a 6-minute walking load test with simultaneous monitoring of blood oxygen saturation (saturation) and pulse.

Results. The correlation of the results of the 6-minute test with the functional state of the cardiorespiratory system of the subjects was revealed. The oxygen saturation of the blood during the exercise test was confirmed to show a different relationship with the indices of bodyplethysmography and spirometry, characterizing the central pathogenetic moments of the formation of respiratory failure. 

Conclusion. characteristic changes in saturation during the test with a 6-minute walk make an accessible and at the same time significant contribution to the diagnosis of respiratory organs in workers of dust-hazardous occupations. 

Introduction. Analytical control of chemical contamination is essential in ensuring the safety of food products manufactured using pesticides. The development and testing of new methodological techniques for multicomponent measurement of the levels of residual amounts of biologically active ingredients are constantly in the field of view of analysts.

Research objectives. To assess the suitability of the QuEChERS methodological approaches for the determination of a wide range of pesticides of various structures and physicochemical properties (up to 50 names of active substances) in food products and food raw materials of various compositions and origins (fruits, vegetables, cereals, rice, tea, coffee, milk, eggs and their derivatives, meat, offal).

Material and methods. The measurements were carried out by tandem liquid chromatography-mass spectrometry and gas chromatography with a mass-selective detector, focused on screening and quantifying trace amounts of pesticides. The sample preparation procedure for analysis was carried out according to the QuEChERS method. 

Results. Multimethods have been created for the determination of residual amounts of pesticides in cereal grains (40 substances), fruits of vegetables and fruits (27 compounds), fruits of citrus crops (50 ingredients), 2,4-D acid in milk, eggs and by-products, fipronil and its toxic metabolite – sulfone in eggs, products of their processing (melange, dry egg white), muscle tissue and offal. The developments have supplemented the list of certified measurement methods included in the unified information fund of measurement methods of the Russian Federation.

Conclusions. The unification of analytical methods for preparing samples of food products of various composition and origin for analysis, instrumentation of analytical laboratories with liquid and gas chromatography-mass spectrometry systems expand the possibilities of introducing group methods, ensure the readiness of testing centres to perform multi-purpose tests to identify and measure pesticide levels.

Introduction. The ”healthy worker effect” (HWE) is currently understood as organized (on the part of the employer) and/or unorganized (self-selection on the part of the worker, due to the functional capabilities and state of health of workers in unfavourable working conditions, is one of the most critical problems when conducting epidemiological studies in occupational pathology. 

Purpose and objectives. Analysis of the problem in occupational health and safety, the scientific and medical terminology used in the study of the issue of occupational health and safety, taking into account the possible inversion of the effect of exposure to harmful and unfavourable working conditions taking into account this phenomenon, as well as the intensity of occupational health and safety in various professional cohorts.

Results. When conducting epidemiological studies in occupational health and occupational pathology, it is necessary to unify the scientific and medical terminology used in researching HWE and consider the possible inversion of exposure to harmful and unfavourable working conditions taking into account this phenomenon. 

Conclusions. HWE and its intensity in various professional cohorts can indirectly characterize the harmfulness and unfavorability of conditions. HWE, its degree of severity and intensity determine the need for medical and social security and rehabilitation measures in these professional cohorts.