АНАЛИЗ ОРГАНИЗАЦИИ ПРОВЕДЕНИЯ ПРЕДВАХТОВЫХ МЕДИЦИНСКИХ ОСМОТРОВ НА УДАЛЕННЫХ ПРОМЫШЛЕННЫХ ОБЪЕКТАХ

Introduction. Preventive medical examinations, medical examination and dispensary observation play an important role in the timely detection of NCDs, risk factors for their development, effective management to improve the quality of life, preserve the health of the able-bodied population. A prerequisite for this is the improvement of knowledge and experience in the implementation of preventive work, dispensary observation of medical workers. Purpose. Scientific substantiation and development of a model for the formation of sustainable knowledge, practical skills and improvement of competence in conducting medical preventive examinations and medical examination of the adult population for all participants in the process. Materials and methods. A sociological study was carried out among employees of medical organizations, graduates of the Faculty of Medicine, an analysis of the results of the audit of medical organizations within the framework of internal and departmental control of the quality and safety of medical activities. The database was formed in Microsoft Excel, statistical analysis was carried out using IBM SPSS Statistics 19. Data is visualized using tables. Outcomes. Analysis of the results of the study revealed problems associated with the lack of competencies among medical workers — participants in the process of organizing medical examination, preventive medical examination, dispensary observation. The data obtained showed the need to improve the training of specialists in the organization and conduct of medical examinations and preventive medical examinations, dispensary observation. Conclusion. The analysis made it possible to scientifically substantiate and develop proposals for the formation and improvement of competencies in the organization and conduct of medical examinations, preventive medical examinations, dispensary observation differentially depending on the role of the participant in the process of medical examination, preventive medical examinations.

Abstract. Introduction. The organization of medical care for employees of remote industrial enterprises (remote healthcare) is an extremely important task and an urgent problem in the healthcare system as a whole. The correct organization and evidence-based approaches in the remote healthcare system will save the labor force, which forms the basis of the economic development of any country. Purpose: to evaluate the system of organizing medical care for employees of remote industrial facilities based on the analysis of the results of periodic medical examinations and medical evacuations. Research methods. The analysis of the results of periodic medical examination of a large mining enterprise in the period 2018-2021 was carried out. , and also analyzed the results of medical evacuations from industrial facilities in the period 2018-2020. (154 objects from 14 regions of the country). Taking into account the fact that the bulk of workers in remote industrial facilities are men employed in the main profile of the enterprise, women were excluded from the analysis. Results. According to the results of medical examinations, 18.6% were recognized as completely healthy in 2018, 6.6% in 2019, and 12.6% of workers in remote industrial facilities in 2021. The rest had one or another pathology. The structure of workers' diseases revealed during medical examinations was analyzed in accordance with ICD-10. In the structure of the morbidity of workers at remote industrial facilities, the first three places in descending order of rank are occupied by diseases of the digestive system, diseases of the eyes and adnexa, diseases of the nervous system (in 2018 -38.2%, 35.3%, 22%; in 2019 - 53.1%, 45.3%, 19.5%; in 2021 - 44%, 34.1% 15.8%, respectively). In addition, in 2021, the prevalence of risk factors in men and women was analyzed, the contribution of each of the factors was revealed (physical - 26.5%, smoking - 26%, alcohol - 11.1%). The number of medical evacuations was: 2,390 planned (61.5%) and 1,493 emergency (38.4%). In the structure of all evacuations of personnel of remote industrial facilities, BSK was in the lead, followed by injuries and poisoning, diseases of the digestive system and diseases of the respiratory system. The main reason for emergency evacuations was injuries and poisoning, 2nd and 3rd places were taken by BSK and diseases of the digestive system, respectively. In the group of workers under 39 years of age, the first three positions were occupied by injuries and poisoning, diseases of the digestive system and BSC, and in the group of older age intervals, BSC significantly prevailed, the second place was taken by injuries and poisoning, and the third - diseases of the digestive system. Conclusion. The results of the study and data analysis made it possible to identify the key components (human, informational, financial, educational, material resources) of remote health care and confirmed the importance and necessity of developing a unified concept of maintaining the health of personnel at industrial facilities located in hard-to-reach areas.

Antibiotic resistance poses a significant threat to public health, that can lead to reduced effectiveness of many therapies, increased morbidity, longer hospitalization times, increased deaths, and additional costs for health care systems. Unreasonable use of antibiotics may result from a lack of adequate knowledge about antibiotic therapy and a lack of knowledge of the risks associated with antibiotic resistance, both among medical personnel and patients. The primary objective of the study was to verify the opinion of medical personnel on the risks associated with antibiotic resistance. The study was conducted in 2023 among 605 Polish sanitary workers. An anonymous survey designed specifically for the purpose of the study was used. The survey was made available on the Internet through the Trade Unions of Pharmacy Workers and directly to hospitals with the support of local authorities. The majority of respondents were women (77.36%). The largest group consisted of individuals over 40 years of age (55.04%). More than half of the respondents were nurses (56.20%), and every fourth of the respondents was a physician (23.64%). Most respondents consider antibiotic resistance to be a very serious (24.13%) or extremely serious (30.75%) problem. The problem of antibiotic resistance on a global scale was mentioned, especially in the opinions of physicians and nurses (p < 0.01), people working in the profession for over a year (p < 0.01), and people with a specialization or undergoing specialist training (p = 0.00). Similarly, these groups most often indicated that antibiotic resistance poses a problem in their workplace. The main problems of antibiotic resistance were the use of antibiotics in farm animals (36.69%), the pressure on patients to take antibiotics (38.84%), and the prophylactic use of antibiotics (43.15%). Medical personnel consider antibiotic resistance a somewhat serious problem, although not all agree in this regard. The risk of antibiotic resistance is much more seriously assessed by physicians and nurses, as well as by people with specializations or undergoing specialization training. Knowledge about antibiotic resistance should be further spread among all groups of medical personnel.

The importance and role of scientific medical autopsy in opinion of medical staff. Introductory results from the querend

Introduction. Cardiovascular diseases (CVD), in particular, arterial hypertension (AH), remain the leading cause of demographic losses in society due to the risk of complications such as coronary heart disease and myocardial infarction, being not only a medical but also a socio-economic problem affecting the professional fitness and loss of health of employees. In the conditions of production teams, high blood pressure can serve as a selection criterion. Despite a significant amount of research on hypertension, its dynamics among workers in various industries has not been sufficiently studied from the perspective of seasonal fluctuations. The study aims to evaluate the prevalence of high blood pressure among workers in the transport industry, taking into account seasonal fluctuations, based on the results of pre-shift medical examinations to improve the effectiveness of preventive measures. Materials and methods. The authors have analyzed the records of the database of the electronic medical examination system (KAP ESMO), manufactured by LLC "KVAZAR" (Russia), which conducted a pre-shift medical examination for 8 years (2016–2023) at one of the enterprises of the transport industry. They also analyzed seasonal fluctuations in the number of detected cases of systolic blood pressure exceeding 140 mmHg and/or diastolic blood pressure exceeding 90 mmHg at a pre-shift medical examination (PSME). Experts calculated the coefficients of arterial hypertension (CAH) using the formula: CAH=(Number of employees with BP≥140/90 mmHg. Total number of employees who passed the PSME in a month)×100. Data processing was performed using MS Excel 2013. The analysis of the normality of the distribution of the studied variables was carried out using the Kolmogorov–Smirnov criterion. The seasonal differences were analyzed using the Kruskal–Wallis criterion for independent samples. The researchers applied the t-test for independent samples of detailed comparison of paired differences between months. The information value of the feature was assessed using the p-level. The critical significance level (p) was assumed to be 0.05 when testing statistical hypotheses. Results. An analysis of the data showed that more workers with hypertension are identified in the autumn-winter period than in the spring-summer period. Statistically significant differences by month were confirmed by the Kruskal-Wallis criterion (p&lt;0.001). The AH coefficient is higher in the cold months than in the summer, which indicates the need for increased monitoring of the condition of employees during this period and timely preventive measures. The introduction of CAH made it possible to take into account the influence of the sample and objectively assess the dynamics of AH in the team. The detected fluctuations in hypertension may influence the decision of a medical professional on admission to work. If the number of detected cases of hypertension increases, but the number of suspensions from work remains stable, this may indicate the formal nature of medical examinations. Thus, it is necessary to introduce automated health assessment systems and increase responsible attitude to the results of the pre-shift medical examinations. Limitations. The analysis was carried out solely on the basis of data from the automated system of pre-shift medical examinations (CAP ESMO), which excludes the possibility of comparison with data from traditional medical examinations. The sample under study is dominated by men, which reflects the specifics of the industry under study, but limits the possibility of extending the results to enterprises with a gender-balanced team. Conclusion. The revealed patterns of seasonal fluctuations in hypertension must be taken into account when developing corporate health programs and planning preventive measures. The introduction of automated medical systems increases the objectivity of medical monitoring and minimizes the influence of subjective factors on the part of medical staff, which is essential for maintaining professional health and reducing the risk of complications of cardiovascular diseases. Ethics. The study was conducted in compliance with the ethical principles of medical and scientific research. All data was obtained from the database of the electronic medical examination system in compliance with the principles of anonymity and confidentiality. The study did not require additional intervention and did not involve any changes to the standard procedures of the PSME.

Methodical manual on preventive medical examination and medical examination of certain groups of the adult population, in-depth medical examination for citizens who have suffered a new coronavirus infection (COVID-19). Version 1 (13.04.2022)

Background: Sleep deprivation is a frequent outcome of nightshift work, a probable human carcinogen. However, social, cultural, and technological changes have contributed to spread sleep deprivation also among the general population. We reviewed the literature on sleep disorders in adults associated with lifestyle, environmental, and workplace conditions unrelated to shift work aiming to: 1. identify sleep depriving factors during the pre-placement medical examination of night shift workers; and 2. recognize potential sources of confounding and bias in epidemiological studies of shift workers. Methods: We searched public repositories of publications in English or with an informative English abstract up to January 2024. We used standard tools to assess the quality of the selected studies. Results: Overall, we identified 134 papers. Our review confirms that poor sleep quality and sleep deprivation are highly prevalent and result from multiple non-occupational factors as well as occupational factors other than shift work. Physical activity, coffee and alcohol intake, eating habits, lifestyle, and work-related stress were most frequently investigated (67/134 publications). There is sufficient evidence that aging, female sex, family responsibilities, caffeine intake, smoking, poor mental and physical health, and work-related stress can impair sleep quality and reduce sleep duration. Contradictory findings and the possibility of reverse causation due to the predominance of cross-sectional studies prevent drawing conclusions regarding other potential risk factors. Conclusions: Non-occupational causes of sleep disorders shall be assessed during the pre-placement examination as well as when monitoring the health status of night shift workers or evaluating shift work-related health outcomes.

The use of Telehealth is well established in Australian retrieval service settings to aid assessment and management of patients requiring aeromedical transportation and to provide support to clinicians at remote facilities. Telehealth ensures prompt advice and treatment for critically ill and injured patients and can facilitate a resuscitation until the retrieval team arrives. There is scant information regarding the knowledge, skills and abilities required of Telehealth professionals, despite the universal recognition of it requiring a complex skill set, comprehensive understanding of technology and mastery of retrieval medicine. We share the experiences of the South Australia Ambulance Service MedSTAR Emergency Medical Retrieval Service preparing an education programme focussed on the psychometric skills in Telehealth. Our programme realistically simulates Telehealth and coordination systems in use across South Australia, provides in-depth hands-on practice for medical and nursing staff that incorporates teamwork, communication, technical and critical thinking skills and culminates with a mixed-reality simulation scenario and formal debrief.

We monitored a large-scale implementation of the Simple Amplification-Based Assay semi-quantitative viral load test for HIV-1 version I (SAMBA I Viral Load=SAMBA I VL) within Médecins Sans Frontières' HIV programmes in Malawi and Uganda, to assess its performance and operational feasibility. Descriptive analysis of routine programme data between August 2013 and December 2016. The dataset included samples collected for VL monitoring and tested using SAMBA I VL in five HIV clinics in Malawi (four peripheral health centres and one district hospital), and one HIV clinic in a regional referral hospital in Uganda. SAMBA I VL was used for VL testing in patients who had been receiving ART for between 6months and ten years, to determine whether plasma VL was above or below 1000 copies/mL of HIV-1, reflecting ART failure or efficacy. Randomly selected samples were quantified with commercial VL assays. SAMBA I instruments and test performance, site throughput, and delays in communicating results to clinicians and patients were monitored. Between August 2013 and December 2016 a total of 60889 patient samples were analysed with SAMBA I VL. Overall, 0.23% of initial SAMBA I VL results were invalid; this was reduced to 0.04% after repeating the test once. Global test failure, including instrument failure, was 1.34%. Concordance with reference quantitative testing of VL was 2620/2727, 96.0% (1338/1382, 96.8% in Malawi; 1282/1345, 95.3% in Uganda). For Chiradzulu peripheral health centres and Arua Hospital HIV clinic, where testing was performed on-site, same-day results were communicated to clinicians for between 91% and 97% of samples. Same-day clinical review was obtained for 84.7% across the whole set of samples tested. SAMBA I VL testing is feasible for monitoring cohorts of 1000 to 5000 ART-experienced patients. Same-day results can be used to inform rapid clinical decision-making at rural and remote health facilities, potentially reducing time available for development of resistance and conceivably helping to reduce morbidity and mortality.

Background: Healthcare professionals of emergency department (ED) is particularly vulnerable to incidents of aggression from patients.Aim of the study: To determine the opinions of medical staff regarding the aggressive behavior of patients admitted to an ED and to assess the impact of incidents of aggression on the professional burnout level.Material and methods: A diagnostic survey was conducted among 102 medical employees of the ED from September 2023 to February 2024. Maslach Burnout Inventory (MBI) and self-developed questionnaire were used.Results: A group of 100% (n=102) of the respondents experienced aggressive behavior from a patient hospitalized in ED. The respondents most often experienced aggression several times a week" (38.24%; 39) or several times a month" (29.41%; 30). The main forms of aggressive behavior presented by patients were: raised voice (93.14%; 95), use of profanity (86.27%; 88), and insults (76.47%; 78). When faced with aggressive behavior, staff most commonly experienced the following emotions: stress 63.73% (n=65), anger 63.73% (n=65), and helplessness 45.10% (n=46). 47 (46.08%) members of the medical staff had a high level of emotional exhaustion, 31 (30.39%) had a high level of depersonalization, and 48 (47.06%) presented a high level of lack of personal achievement. A significant correlation was observed between negative emotions aroused in ED medical staff by patients presenting aggressive behavior and domains of professional burnout.Conclusions: There is a need to train ED medical staff how to effectively deal with anger and feelings of humiliation caused by patients' aggressive behavior.

Objective To understand the cognition and attitude of patients, medical staff and medical examination people on biobanks and their willingness to donation. Methods A cross-sectional study was conducted among 452 individuals, including patients, medical staff and people receiving health checkup at a hospital in Beijing from July to September, 2017.The questionnaire assessed the respondents′ demographic data, general knowledge about biobanking and the factors influencing their willingness to donate specimens to biobanks.Pearson′s Chi-square test, student t test or ANOVA were used for univariate analysis.Additionally, the linear regression analysis and logistic regression analysis were used for multivariate analyses. Results A total of 452 questionnaires were delivered, and the effective questionnaires amounted to 440, including 196 medical staff, 123 patients and 121 health checkup individuals.The awareness score of biobanks was significantly different among the medical staff, patients and health checkup individuals(P<0.05). After adjustment for potential risk factors, we found that the population characteristics and the experience of participation in a medical research were the independent beneficial factors of the awareness score.The percentage of the willingness of donation in medical staff, health checkup individuals and patients were 83.7%, 76.9% and 70.7%, respectively.The results of univariate analyses suggested that the population characteristics, education level, health conditions, the history of blood donation, and the experience of participation in a medical research were significantly associated with the willingness to donate(all P<0.05). Population characteristics and health conditions were independently relevant to the willingness of donation, after multivariate analyses of logistic regression. Conclusions Despite the strong willingness to donate biospecimens, patients and health checkup individuals lack knowledge of biobanking. It is apparent that we need to strengthen promotions and to encourage the ethics and humanities to improve the knowledge of biosample donation, for healthy development of hospital-based biobanks. Key words: Questionnaires; Biobanks; Cognition; Willingness to donate; Population

Often, medical staff and sometimes their attorneys mistakenly believe that HIPAA prevents disclosure of medical records to medical examiner and coroner offices. Medical examiner and coroner government offices are not covered entities. Moreover, HIPAA specifically allows disclosure to law enforcement, public health, and medical examiner and coroners. However, state and Joint Commission requirements may further impact disclosures.

Objective: to analysis of indicators of preventive medical examinations and dispenserization of the adult population of Kursk, districts and the Kursk region as a whole, development of medical and organizational measures to achieve planned indicators. Material and methods. Analysis of data from form 131 and copying of information from the summary reports of medical institutions by cluster analysis and grouping of indicators depending on the achievement of the plan, extensive indicators were calculated, the results are presented in bar charts. Results. All districts and cities of the Kursk region are divided into three clusters. The first cluster (at least one of the features must reach 100% fulfillment) included 6 districts. The second cluster (districts with the implementation of the plan from 50%) included 21 districts and three cities of the Kursk region. The third cluster (districts with the implementation of the plan up to 50%) included 1 district. Conclusion. The analysis made it possible to identify areas with a low level of completeness of coverage of the adult population with preventive medical examinations and dispenserization. In these areas, it is necessary to resume the work of volunteer detachments with the population to educate them in order to achieve the planned indicators.

The problem of incidence rate among workers of the main professions of the coal mining industry is traditionally considered from the perspective of occupational pathologies. At the same time, the issues of the spread of production-related somatic diseases among this category of the employable population are undeservedly left without due attention. The objective of the study was assessing the frequency of somatic pathology occurrence in workers of coal pits in the South of Kuzbass. 489 workers of the main professions of coal pits in the South of the Kemerovo region were examined (men aged 22 to 55 years, who were randomized into 2 groups according to the level of exposure to a complex of unfavorable factors of the production environment). The first group with a higher level of exposure to harmful and hazardous production factors of class 3.3 and 3.4 included 196 people: machinists of mining and technological equipment, machinists of drilling rigs, explosives; the second group with the level of danger and harmfulness of class 3.1 and 3.2 consisted of 293 workers, namely, drivers of technological motor vehicles. The study of the frequency of somatic pathology was carried out depending on the length of work experience and the age of the subjects. Each group was divided into subgroups: by the age and work experience. In group 1, somatic pathologies were detected in 52.0% of the cases, in group 2 - in 44.4% (χ2=2.772, p=0.096). In the structure of somatic diseases in the group with a higher class of danger and harmfulness, diseases of the circulatory system (38.24%), diseases of the musculoskeletal system and connective tissue (12.75%) and diseases of the nervous system (8.82%) prevailed; in the group with a lower hazard class there were also diseases of the circulatory system (33.85%), diseases of the musculoskeletal system and connective tissue (14.62%), diseases of the nervous system (12.31%). The frequency of somatic diseases is recorded in a direct linear relationship with the work experience and age of coal pit workers. Limitations. This study is limited to a sample of workers in the main professions of coal pits undergoing periodic medical examinations at the Research Institute for Complex Problems of Hygiene and Occupational Diseases. Conclusion. In the structure of somatic diseases of workers of the main professions of coal pits in the South of Kuzbass, three nosological forms occupy a leading position: diseases of the circulatory system, diseases of the musculoskeletal system and connective tissue, and the nervous system. Among the surveyed workers employed in coal pits with a higher level of exposure to harmful and hazardous production factors, a 100% incidence of somatic diseases was revealed among the respondents aged more than 41 years and with work experience over 21 years. These data should be taken into account when carrying out periodic medical examinations, preventive medical examinations, for the development and implementation of therapeutic and prophylactic measures and post-shift rehabilitation programs. Ethics. The study was conducted in compliance with the standards of the Bioethical Committee of the Research Institute for Complex Problems of Hygiene and Occupational Diseases, established in accordance with the Helsinki Declaration of the World Association "Ethical Principles for Conducting Human Scientific Medical Research" as amended in 2013 and the "Rules of Clinical Practice in the Russian Federation", approved by the Order of the Ministry of Health of the Russian Federation No. 266 of 19.06.2003. All subjects signed an informed consent to participate in the study.

Introduction.Methanol and its derivatives occupy one of the leading places among the main organic synthesis intermediates in terms of their importance and scale of production. According to experts, by 2027 the global demand for methanol can reach 135 million tons, the annual growth will be about 5.5%. However, there is little information regarding the assessment of working conditions and occupational risks for workers in modern methanol production and its derivatives.The aim of the studyis hygienic assessment of working conditions and the formation of health risks in workers of modern production of methanol and methylamines.Materials and methods.The assessment of the main adverse factors of production is given. When studying the state of health, objective indicators (the results of an in-depth medical examination) and subjective (the results of a quantitative assessment of the risks of the main pathological syndromes associated with health) are considered.Results.According to long-term observations, the concentration of harmful substances in the air of the working area, indicators of labor severity, parameters of physical factors met hygienic requirements, with the exception of industrial noise exceeding the maximum permissible level, as well as labor intensity of 1 degree. The General assessment of working conditions corresponds to the category of harmful 2 degrees (3.2). According to the results of the medical examination and quantitative assessment of the risks of health disorders in workers, the most significant were functional disorders and diseases of the circulatory system. The levels of somatic pathology on the part of the main body systems were significantly higher in apparatchiks compared to the engineering and technical personnel (ETP).Conclusions:In the production of methyl alcohol and methylamines, the main hygienic importance is the impact on workers of the complex of harmful substances of 1-IV hazard classes in low concentrations, increased levels of industrial noise, labor intensity of 1 degree. According to the subjective assessment of health and medical examination, the greatest prevalence of health risks in workers was observed from the circulatory system, and the levels of the revealed somatic pathology were statistically significantly higher in apparatchiks compared with the ETP.