Mandatory Medical Examinations Research Articles

Tuberculosis Disease Among Nonimmigrant Visa Holders Reported to US Quarantine Stations, January 2011–June 2016

US-bound immigrants and refugees undergo a mandatory overseas medical examination that includes tuberculosis screening; this exam is not routinely required for temporary visitors applying for non-immigrant visas (NIV) to visit, work, or study in the United States. US health departments and foreign ministries of health report tuberculosis cases in travelers to Centers for Disease Control and Prevention Quarantine Stations. We reviewed cases reported to this passive surveillance system from January 2011 to June 2016. Of 1252 cases of tuberculosis in travelers reported to CDC, 114 occurred in travelers with a long-term NIV. Of these, 83 (73%) were infectious; 18 (16%) with multidrug-resistant tuberculosis (MDR TB) and one with extensively drug-resistant tuberculosis (XDR TB). We found evidence that NIV holders are diagnosed with tuberculosis disease in the United States. Given that long-term NIV holders were over-represented in this data set, despite the small proportion (4%) of overall non-immigrant admissions they represent, expanding the US overseas migration health screening program to this population might be an efficient intervention to further reduce tuberculosis in the United States.

Vibration disease: assessment of erectile function and androgen balance

The article presents the data on the effect of vibration disease caused by exposure to local vibration on the state of male sexual function. The presence of erectile function in subjects with vibration disease, depending on its severity, is shown, which indicates the role of local vibration in the formation of erectile function and raises the problem of early prevention and timely treatment of identified disorders. Interaction disturbances in the hypothalamic-pituitary-gonadal system were identified in men with vibration disease caused by exposure to local vibration. Mandatory periodic medical examinations of enterprise employees whose work involves exposure to local vibra tion should be carried out once every 5 years at the occupational pathology center of a constituent entity of the Russian Federation (according to Order of the Ministry of Health of Russia No. 29n dated January 28, 2021). When conducting such medical examinations, we recommend involving neurologists and urologists-andrologists and expanding the list of instrumental research methods to include methods for assessing erectile function.

Terminology Issues in the Field of Genetic Research

Due to the intensive development of genetic research, the availability of genetic testing is increasing, including those based on genome-wide sequencing offered by private and public laboratories. Genetic testing can be used to identify the cause of the disease in patients with suspected hereditary (orphan) diseases and as a screening tool for healthy people, for example, if expectant parents planning to have children are carriers of hereditary diseases, to identify the risks of hereditary oncological diseases and multifactorial diseases, for pharmacogenetic testing, as well as for non-medical purposes, for example to determine the «ethnic origin». In addition, genetic research can be used to identify individuals, including in criminology and for genomic registration, determination of paternity and other kinship. This review paper analyzes some issues of terminology in the field of genetic research, including their results, as well as the legal basis for the genetic certification of the population of the Russian Federation, the use of the terms «genetic passport», «genetic profile» and «genomic passport», «genomic profile» and provides recommendations for improving the use of relevant terms such as standardizing the requirements for the preparation of a report/conclusion on the results of a genetic study and resolving the issue of the medical nature of the full-genome sequencing process. In addition, the practice of using the term «genetic passport» in federal acts, as well as domestic and foreign literature and media publications, is analyzed. Not only does the paper reveal the concept of complete genome sequencing, but also provides cases of mandatory medical and biological examination, including complete genome sequencing.

Criteria for identifying the risk group for obstructive sleep apnea syndrome in operator professions

Relevance. The diagnosis of obstructive sleep apnea syndrome (OSAS) is important in occupational health. The syndrome is accompanied by drowsiness during work and, thereby, creates serious prerequisites for reducing professional ability to work, the occurrence of production errors, accidents. The OSAS is closely related to clinical conditions: obesity, hypertension, cardiac arrhythmias, diabetes mellitus, which doctors take into account during periodic medical examinations when determining admission to work with harmful and/or dangerous production factors. For specialists in the operator professions, researchers consider OSAS as a threat to the health of employees and others.
 The study aims is to explore a set of criteria-based signs of OSAS risk for the scientific justification of the identification of target groups of workers subject to in-depth examination to establish/exclude this diagnosis.
 Materials and methods. We have conducted a comprehensive clinical and instrumental examination of 204 railway transport employees out of 986 examined in the hospital for expert purposes to detect increased daytime sleepiness (according to the Epworth index), OSAS, including polysomnography, cardiorespiratory monitoring (CRM). The specialists have analyzed the structure of the criteria risk signs by the method of the main components in the groups of workers of operator and non-operator professions.
 Results. According to polysomnography or CRM data, 118 employees had OSAS, including 51% of them with moderate to severe severity. Along with drowsiness and snoring , scientists have identified two groups of risk factors: 1) clinical — obesity (BMI>30 kg/m2), hypertension, diabetes mellitus, heart rhythm disturbances at night, gender; 2) professional — work experience, high intensity of work, work in night shifts. The sign of daytime sleepiness (according to the Epworth Sleepiness Scale) was insufficiently informative in both study groups. In the structure of clinical signs, the largest leading factors were: obesity, hypertension.
 Limitations. To assess drowsiness as a marker of OSAS, scientists used only the Epworth sleepiness scale; other questionnaires (for example, STOP-Bang, Stanford Sleepiness Scale, Karolinska Sleepiness Scale) were not used in this work.
 Conclusions. In operator professions, when conducting mandatory medical examinations, it is necessary to determine the risk of OSAS by a set of certain clinical and professional signs. When concluding that there is a risk of developing this condition, further in-depth examination is necessary to confirm the diagnosis.
 Ethics. The study was conducted in compliance with the Ethical principles of conducting medical research with the participation of a person as a subject, set out in the Helsinki Declaration of the World Medical Association of the last revision.

Occupational health issues and respiratory toxicity of a complex of harmful factors in electrolytic and hydrometallurgical copper production

Introduction. In recent decades, there has been a decrease in occupational morbidity at enterprises producing rough and refined copper, in the structure of which, nevertheless, bronchopulmonary pathology retains a leading position.The aim is to study the occupational risk of developing respiratory pathology in workers engaged in obtaining cathode copper by electrolysis and electorowinning methods, based on the study of working conditions of workplaces and clinical observation.Materials and methods. The object of the study were: Uralelectromed, V. Pyshma (UEM); Uralhydromed, Polevskoy (RMK). The subject of the study were 100 employees of the electrolysis shop of UEM – the 1st observation group; 102 people of the auxiliary workshops of UEM – the 2nd observation group; 92 workers of the extraction and electorowinning department of UGM – the 3rd observation group.Results. During electrolytic refining of copper, the leading harmful factors with respiratory toxicity are sulfuric acid aerosol, selenium dioxide, nickel, arsenic, and during electrovinig – sulfuric acid aerosol. Violations of ventilation function and pulmonary gas exchange were observed in 21.0 % of cases in persons of the 1st and in 15.7% of cases in patients of the 3rd observation group).Discussion. Changes in the function of external respiration (FVD) were established mainly by the obstructive type, namely, an increase in RV, FRC and RV/TLC and a decrease in FEV1, VC, FEV1/VC, FEV25-75 of mild and moderate severity were noted. The bronchodilation test revealed the reversibility of bronchial obstruction in both groups 1 and 3. Obstructive disorders and dynamic hyperventilation of the lungs in copper refining workers are probably a consequence of hyperreactivity of the bronchi in response to the irritating properties of sulfur-containing gases, arsenic and nickel compounds.Conclusion. The results of the study indicate respiratory toxicity of harmful factors in workers of electrolysis and electrovining, which corresponds to a high and average occupational risk of class 3.3 and class 3.2 assessment of working conditions and the results of mandatory periodic medical examinations.

Assessment of the state of vision of bachelor of nursing students

Vision is the most important sense organ that provides visual perception of the world around us. Nowadays, in the age of information technology, the eyes are subject to great stress in the process of study, in professional activities, in everyday life when working with computers, smartphones and other gadgets. After the introduction of the distance learning format, the load on the eyes has increased many times over. Based on this, the assessment of the state of vision of students has become an urgent topic for study. Target. Assess the state of vision of students and draw their attention to monitor the health of the organs of vision. Results. Analysis of the results of the survey showed that the majority of students observe visual impairment. Possible causes of visual impairment are: heredity and the use of gadgets. Conclusion. The results of the study draw attention to the fact that when undergoing a mandatory medical examination, it is obligatory to consult an ophthalmologist.

Health status of coal industry workers

Health status of coal industry workers

Динамика основных показателей инвалидности детей и подростков Азербайджанской Республики в условиях обязательной диспансеризации

The dynamics of the main indicators of childhood disability is important for determining guidelines in the medical, social, and economic directions of the development of society and the state. In the course of the analysis, it was revealed that during the period of the introduction of mandatory medical examination of the child population in the Republic of Azerbaijan, the increase in the number of children with disabilities in 2019 compared to 2014 was 16.1%. However, the number of children with disabilities with a primary diagnosis decreased by 17.7%. The greatest decrease in the level of primary disability was observed in the following types of diseases: diseases of the circulatory system – by 86.5%; tuberculosis – by 67.4%; respiratory diseases – by 66.8%; injuries, poisoning and some other effects of external causes – by 64.7%, etc. At the same time, an increase in primary disability among children was noted for such diseases as: mental and behavioral disorders – by 70.9%; diseases of the ear and mastoid process – by 52.6%; congenital anomalies (malformations), deformities and chromosomal disorders – by 38.6%, as well as a number of others.

Rapidly progressive silicosis: clinical observations

Diseases arising from exposure to industrial aerosols remain an urgent problem and occupy a leading position among all occupational diseases.
 Scientists present clinical observations demonstrating the development of pneumoconiosis with a relatively short work experience in contact with fibrogenic dust slightly exceeding the maximum permissible concentrations. The rapidly progressing course is characterized by the development of the disease by the type of complicated pneumoconiosis with the formation of nodular fibrosis or an increase in profusion (severity) by more than one subcategory for five years. As a rule, it develops after ten or less years of work experience in contact with high concentrations of quartz dust.
 Researchers have considered the features of the occurrence and course of silicosis in persons in contact with industrial aerosols with a high mass fraction of silicon dioxide in production conditions.We have analyzed the situations demonstrating the development of pneumoconiosis with a professional experience of less than five years in persons who come into contact with industrial aerosol in low excess of the maximum permissible concentration of quartz dust, but with a very high mass fraction of silicon dioxide.
 An important condition in the prevention of pneumoconiosis should be mandatory periodic medical examinations with digital radiography of the lungs in two projections. 
 The authors recommend performing computed tomography (CT) of the chest to persons working in contact with fibrogenic dust with a frequency of once every five years due to the fact that CT has a higher sensitivity and specificity for detecting reticular and focal seals in the lungs, as well as initial changes in the pleura.
 Ethics. The study was conducted in compliance with ethical principles and with the voluntary informed consent of the participants.

Konstytucja RP a egzorcyzmy

This article examines the determinants and consequences of the rite of exorcism from the constitutional law perspective. The study was limited to exorcism in the Roman Catholic Church due to its dominance in the religious composition of population in Poland. Exorcism is clearly a manifestation of religion, and it is argued that its performance should be subject to constraints justified by the need to protect the health and the right to humane treatment of the exorcised. Therefore, it is necessary to call for the establishment of legal restrictions, both preventive (mandatory medical consultation before performing the rite, mandatory medical examination for exorcists) and ex-post (ban on performing the rite on a given category of people). On the other hand, an absolute ban on exorcisms would violate the essence of the freedom to manifest religion and would not satisfy the requirements of proportionality.

Labor and legal aspects of preventive medicine: The ratio of private and public interest

The article is devoted to the analysis of legal norms, both directly and indirectly protecting the work capacity of employed citizens through ensuring the safety of their work. The labor legislation calls the principles of such provision the warning and prevention of hazards; minimization of damage to the health of workers. In this regard, labor law, not being an independent tool that ensures the prevention of diseases of citizens, acts as an element of the general legal mechanism of preventive medicine. The employer is obliged to implement such a mechanism through various control measures, including medical examinations of employees. At the same time, the authors emphasize that the goals of carrying out any preventive medicine measures lie in the private-public sphere, which makes it possible to maintain both the health of a particular citizen (individual health) and to identify patterns of development of public health, ways to maintain, protect and improve it. The analysis of labor-legal aspects of the correlation of private and public interests in the field of preventive medicine gives the authors the opportunity to identify two big issues. The first problem is related to the definition of the boundaries of responsibility of employers and the state (society) on issues of health protection of employees who are members of society as a whole. The second problem lies in the plane of the correlation of labor rights and obligations of employees in the field of preventive medicine with their personal rights. It is concluded that for an employer in the field of labor protection, the risk factors for the health/ill health of an employee are not general, but professional. Accordingly, the list of medical interventions (studies) carried out at the expense of the employer within the framework of mandatory medical examinations should correlate with such risks.

Использование непараметрического анализа данных для оценки эффективности муниципальных медицинских учреждений региона

The effectiveness of medical institutions is usually assessed by indicators characterizing the economic, medical and social aspects of their activities. Indicators of medical effectiveness (ME) reflect the achievement of certain medical results with the optimal use of available resources, both for a particular patient, and for a medical institution and the regional healthcare system as a whole. The ME estimates are relevant and in demand both by internal consumers – the management of institutions and the healthcare system, and by external consumers who finance it. To assess the ME of medical municipal institutions, it is proposed to use the Data Envelopment Analysis (DEA) of data characterizing the results of their functioning and recorded by the current system of medical statistics. This method does not require the identification of functional relationships between the results of the activities of medical institutions and the resources they consume. Aim. Determination using the method of shell analysis of data on the medical effectiveness of municipal medical institutions of the Khanty-Mansiysk Autonomous Okrug – Ugra based on standard statistical data on the results of their activities. Materials and methods. The classical input-oriented model with a constant scale of return of the Data Envelopment Analysis (DEA) method was used to evaluate the medical effectiveness. The input indicators of this model characterize the main types of resources used by the medical institution. The indicators of the total number of temporary disability sheets issued to the residents of the municipality, the completeness of coverage by mandatory medical examinations of the population of the municipality and the load indicators of hospitals and outpatient departments of the medical institution were taken as days off. To ensure comparability, input and output indicators were recalculated per 1000 inhabitants of the municipality. The evaluation of the medical efficiency of municipal medical institutions was carried out in the MaxDEA 8 Basic environment. Results. Estimated indicators of medical efficiency of municipal medical institutions of the Khanty-Mansiysk Autonomous Okrug – Ugra for the period from 2013 to 2020 are given. The estimates obtained show that more than 60% of medical institutions functioned with maximum efficiency throughout the entire period. For insufficiently efficient institutions, target values of input indicators have been determined, the achievement of which will ensure the maximum values of the effectiveness of their activities. Conclusion. Among the municipal medical institutions of the district, the functioning of which during the entire observed period of time was characterized by maximum medical efficiency, the “leaders/landmarks” institutions were recommended. The indicators of the latter can be considered by the management of the health care system of the district as indicators in the development and implementation of management decisions to support and develop both this system and the institutions within it.

Screening for familial hypercholesterolaemia in primary school children: protocol for a cross-sectional, feasibility study in Luxembourg city (EARLIE)

IntroductionFamilial hypercholesterolaemia (FH) is a frequent (1:300) autosomal dominantly inherited condition which causes premature (women <60 years, men <55 years) cardio–cerebrovascular disease (CVD). Early detection and initiation of treatment can...

Despite the large flow of scientific publications devoted to the procedure for mandatory medical examinations by minors during employment, the problems of regulatory regulation of this procedure in the Russian Federation are currently insufficiently investigated. Analyzing the norms of Russian legislation regulating the procedure for medical examinations of minors in the Russian Federation, the authors came to the conclusion that

Despite the large flow of scientific publications devoted to the procedure for mandatory medical examinations by minors during employment, the problems of regulatory regulation of this procedure in the Russian Federation are currently insufficiently investigated. Analyzing the norms of Russian legislation regulating the procedure for medical examinations of minors in the Russian Federation, the authors came to the conclusion that one of the most possible solutions to the problem of employment of adolescents associated with the passage of medical examinations by minors, or rather with the financing of this procedure, would be an increase in additional (economic) guarantees suppressing the employer's reluctance to conclude an employment contract with minors. That is why, at the legislative (federal) level, it is necessary to establish mandatory quotas of places for the employment of minors for certain types of work, which in itself is an additional guarantee of hiring this category of workers as particularly in need of social protection.

Medical activity in the health care system of workers in the Russian Federation

Medical activity in the health care system of workers in the Russian Federation

Снижение рисков сердечно-сосудистых заболеваний работников опасных производственных объектов нефтегазового комплекса

The study was conducted of the risks of cardiovascular diseases for the employees at a hazardous production facility, the main activity of which is the transportation of natural gas through the pipelines and emergency recovery work with an average number of employees of more than 12 500. According to the results of a special assessment of the working conditions, 500 out of 8449 workplaces are classified as harmful working conditions, the main harmful production factor is noise. Statistics of the occupational injuries for 2017–2019, and domestic deaths for 2015–2019 is presented. In 2019, the company achieved the goal of the concept of zero injuries, while more than 60 microtraumas are recorded and analyzed annually. Also, in the company every year on average 20 people die in everyday life over 5 years, of which approximately 50 % are due to the cardiovascular diseases, mainly at the age of 50 years and older. Risk factors: behavioral (unhealthy and unbalanced diet, low physical activity, accumulated fatigue, stress, bad habits); physiological (presence of the chronic diseases, hypertension, thrombogenic factors, inflammation factors, etc.); production (presence of the harmful and dangerous production factors, heavy work shifts); social (globalization, urbanization, population aging, low standard of living, low level of medical care, bad ecology). For assessment of the lifestyle, and identify the risk factors for the cardiovascular diseases, the company analyzes the health status of employees based on the results of mandatory periodic medical examinations, including blood pressure measurement, ECG studies, blood cholesterol levels, questionnaires, and interviews. This analysis allows to divide the employees into three groups: workers with established cardiovascular disease; workers predisposed to cardiovascular diseases; workers with unidentified risk factors for cardiovascular diseases. For each group, the measures are developed to reduce and prevent cardiovascular diseases as part of the improvement of the integrated occupational safety and industrial safety management system.

Analysis of the Socio-economic and Demographic Characteristics of Persons Subject to Mandatory Medical Examination (on the Example of the Perm Territory)

Analysis of the Socio-economic and Demographic Characteristics of Persons Subject to Mandatory Medical Examination (on the Example of the Perm Territory)

Early diagnosis of T2DM using high sensitive tests in the mandatory medical examinations for fishers, seafarers and other transport workers

Transport workers like seafarers, truck-, bus-, train- and taxi drivers and fishers have a known great inequity in health at work including high risk of developing type 2 diabetes. Their routine mandatory medical examinations use urine glucose for diabetes check with more than 50% false negatives, which should be replaced by high sensitive tests for diabetes-2, like A1C, Fasting Glucose (FPG) or Oral Glucose Tolerance Test (OGTT).

Mandatory medical examination and fingerprinting of foreign nationals in the Russian Federation.

Mandatory medical examination and fingerprinting of foreign nationals in the Russian Federation.

Grounding of Pilots: Medical Reasons and Recommendations for Prevention.

BACKGROUND: This article presents the results of an EASA-commissioned study aimed at analyzing the medical causes of grounding of a broad European pilot population and recommending measures to reduce the risk of in-flight incapacitation in commercial air transport pilots.METHOD: European National Aviation Authorities (NAAs) were requested to provide data concerning the total number of pilots that were examined, their age and license category, number of unfit pilots, and the medical causes of each case of grounding. Diagnoses were classified according to the format and definitions laid down in Commission Regulation (EU) No. 1178/2011 Part Med.RESULTS: Analyzed were 82,435 cases assessed by 6 NAAs. Of these cases, 2.1% were assessed as unfit to fly. Frequent causes for grounding a pilot were cardiovascular (19%), psychiatric (11%), neurological (10%), and psychological (9%). Cardiovascular conditions were the most frequent cause for grounding in the older age groups, with 21% in the age 51-60 cohort, 28% in the age 61-65 cohort, and 48% in those beyond 65 yr. Psychiatric and psychological diagnoses were most frequent in the age 20-40 cohort.DISCUSSION: Cardiovascular conditions were the most frequent cause for grounding. Cardiovascular diseases (CVD) are associated with modifiable risk factors. Tackling these risk factors gives aeromedical examiners the opportunity to improve the health of pilots and reduce CVD-related flight safety risks by reducing the number of pilots at risk of in-flight incapacitation. The mandatory periodical medical examination of pilots provides an excellent framework for risk prevention and follow-up of preventive measures.Simons R, Maire R, Van Drongelen A, Valk P. Grounding of pilots: medical reasons and recommendations for prevention. Aerosp Med Hum Perform. 2021; 92(12):950-955.