North West Public Health Research Articles

Impact of the Health Status of Workers on Their Fatigability and Vulnerability to Occupational Risk Factors

Introduction: To improve the reliability of predictive models of workers’ health risk, it is necessary to take into account individual characteristics of workers, especially their age and health status. Fatigability should be used to identify and assess vulnerability of an employee to effects of external factors. Objective: To study quantitative patterns of the relationship between the health status of workers and their fatigability and vulnerability to occupational risk factors. Materials and methods: The study was conducted in 2016–2021 and involved 751 industrial workers, 750 healthcare professionals, 193 educators, and 229 public catering employees, who underwent a medical examination and a standardized medical and environmental survey at the North-West Public Health Research Center in St. Petersburg. We assessed vulnerability of employees to such occupational factors as the workload, effort-reward imbalance, noise, microclimate, air quality, and lack of free (nonworking) time. We also assessed and compared the relative risk of vulnerability for workers with/without health disorders. Results: We established increased vulnerability to occupational risk factors in the workers with chronic diseases and health deterioration observed during the previous year. Occupational factors were ranked by the criterion of vulnerability (fatigability) for those with the impaired health status. Conclusions: Health impairments of the employees revealed in the course of periodic medical examinations induce a 1.2–2.5-fold increase in the frequency of vulnerability to most occupational risk factors. Deteriorating health causes a fold increase in the frequency of vulnerability to all occupational factors considered. All workers’ health disorders under study cause a 1.3 to 12-fold increase in vulnerability to the workload.

Features of hygienic assessment of atmospheric air quality in the area of the location of the enterprise for the production of mineral fertilizers

Introduction. The problematic environmental situation in the industrialized territories requires precise management decisions to ensure the excellent quality of atmospheric air to protect public health. Information on the atmospheric air quality is based on data from various monitoring systems: socio- hygienic, environmental, production control, as well as the results of control measures carried out by Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing (Rospotrebnadzor) and Federal Service for Supervision of Natural Resources of the Russian Federation (Rosprirodnadzor)). Materials and methods. The analysis of normative permissible emissions, sanitary protection zones projects, the results of socio-hygienic and environmental monitoring, production control, as well as carried out own laboratory and instrumental laboratory and instrumental studies of 130 samples of atmospheric air in the sanitary protection zone of the chemical industry enterprise and the nearest residential area. The research was based on the North-West Public Health Research Center and the chemical-analytical centre “Arbitrage” D.I. Mendeleev Research Institute for metrology. Results. According to various monitoring systems and the results of own research, on the territory of residential buildings, the concentrations of pollutants did not exceed the MAC, mainly corresponded to the design values. However, the ammonia content in the atmospheric air on the territory of the nearest building to the enterprise exceeded the calculated design values by three times. At the border of the industrial site of the enterprise for ammonia and diPhosphorpentaoxide, concentrations comparable to the MAC were recorded, while hydrochloric acid and gaseous fluorides were not detected either at the border of the industrial site or in the nearest residential development. Conclusions. The programs of air quality control monitoring are based on the research and analysis of the project documentation. The developed scheme for monitoring atmospheric air can be applied to assess atmospheric air quality in areas around mineral fertilizer production enterprises.

Occupational Medicine and Environmental Health in the Border Areas of Euro-Arctic Barents Region: A Review of 30-Year Russian-Norwegian Research Collaboration Outcomes.

This year marks 30 years of close collaboration between a consortium of institutions, namely, the Northwest Public Health Research Center, Saint-Petersburg (NWPHRC); the Institute of Community Medicine (ICM) of UiT (The Arctic University of Norway, Tromsø); the National Institute of Occupational Health (NIOH), Oslo; the University Hospital of Northern Norway (UNN) at Tromsø; and McMaster University (MU), Hamilton, ON, Canada. During the early years of cooperation, Dr. Chashchin was the Director of the Scientific Laboratory of the North-West Public Health Centre Branch of the NWPHRC located in the town of Kirovks in the Murmansk Region. The primary focus of this long-standing collaboration was to assess and address issues that are important for maintaining the health of the population living in the border areas of Russia and Norway and included the reduction of occupational health risks among workers employed in mining, metallurgical and machine-building enterprises located in the north-western region of Norway and the adjoining Kola Peninsula in Russia. These industrial activities constituted essential components of the local industries. The ongoing Russian–Norwegian cooperation in the field of occupational medicine is an excellent example of the effective combination of intellectual potential and research technologies of multiple countries. It has resulted in the development of a scientifically based set of measures for practical implementation, contributing to the improvement of working conditions and preservation of the health of workers employed at enterprises where the joint research was carried out.

СТАНОВЛЕНИЕ И РАЗВИТИЕ НАУЧНОЙ ДЕЯТЕЛЬНОСТИ В СЕВЕРО-ЗАПАДНОМ НАУЧНОМ ЦЕНТРЕ ГИГИЕНЫ И ОБЩЕСТВЕННОГО ЗДОРОВЬЯ РОСПОТРЕБНАДЗОРА (К 95-ЛЕТИЮ СО ДНЯ ОРГАНИЗАЦИИ)

We presented results in major scientific areas being developed in the North-West Public Health Research center throughout the 95-year history of its existence. Leningrad Institute for the Study of Occupational Diseases, which was established in 1924, have developed scientific bases for diagnosis, treatment, and prevention of occupational diseases; created national school of industrial toxicology, developed procedure for hygienic regulation of harmful occupational and environmental factors in human environment. The stages of activity in the field of occupational pathology, occupational hygiene, industrial toxicology are reviewed. Currently, the research is underway to assess occupational and environmental risks to public health from exposure to harmful factors, and to improve measures to minimize them. Priorities for further development of scientific research are identified.

Current issues in ensuring the sanitary and epidemiological well-being of the Russian Arctic population

The Social Hygienic Monitoring (SGM), being the tools to ensure the sanitary and epidemiological well-being, currently does not allow to fully identify the causal relationships of environmental factors and public health. There are imperfections in the organization and conduct of the SGM, which are characteristic both in the whole country and specifically in the territories of the Russian Arctic.The researchers of North-West Public Health Research Center (NWPHRC) assessed the sanitary and epidemiological situation of the Russian Arctic for 11 years using GIS and spatial analysis methods, which simplified the identification of territories and risk indicators, as well as management decisions.At present, research work is being conducted on the creation and development of a geoportal of sanitary and epidemiological well-being in the Russian Arctic using GIS technologies and space (remote) sensing tools.he SGM currently needs to be improved. It is necessary to develop it at the interregional level using modern methods of collecting, analyzing, processing, evaluating and visualizing indicators of the sanitary and epidemiological well-being in the Russian Arctic. The authors formulated the objectives that need to be addressed in the field of sanitary and epidemiological well-being in the Russian Arctic.

THE SUBSTANTIATION OF THE VOLUME OF INVESTIGATIONS OF PHYSICAL FACTORS AT THE CONSTRUCTION SITE IN TERMS OF HYGIENIC REGULATION

The necessity of carrying out field observation of physical factor parameters (noise, infrasound, vibration) in the process of engineering-and-environmental exploration on the areas allotted for capital construction is regulated by current sanitary-hygienic documents and standards related to the construction. Capital construction objects cover industrial and nonproduction buildings and facilities, as well as linear objects: highways, railways, underground lines, pipelines. Requirements for a scope and a list of measured indices of the effect of physical factors with taking into account the purpose of projected buildings and facilities are not established in the available documents. While realizing expert activities by the inspection body at the North-West Public Health Research Center, studies of parameters of physical factor in certain fields were executed on construction allotted areas to be redundant and often useless (that is, inapplicable for further use). As regards the problem under consideration, requirements according to current sanitary-hygienic and construction regulations were analyzed. A short record of sheet review of explorations made by North-West Public Health Research Center and those undergone expert examination by the inspection body at the North-West Public Health Research Center within the period of 2014-2016 is given. A list and a scope of indices of physical factors (noise, infrasound, vibration) which should be measured in field conditions during environmental investigations of the areas allotted for construction with taking into account function and specific character of the projected object. The reported study resulted in grounding the necessity to develop “Guidelines on assessment and measurement of physical fields on the areas of engineering-and-environmental surveys” which can enhance the effectiveness of accomplished studies, to optimize the scope and to eliminate excessive requirements in designing and expert examination, and in the long run will help in saving funds invested into construction, including state budget ones.

PARTNERSHIP OF THE NORTHWEST PUBLIC HEALTH RESEARCH CENTER IN THE INTERNATIONAL PROJECTS IN THE FIELD OF ARCTIC ENVIRONMENTAL HEALTH

The article presents the main results of scientific investigations of the Northwest Public Health Research Center, obtained in 2000-2016 during the implementation of the international projects in the field of environmental health in the Arctic, local food-and-water security and diseases associated with food and water transmission routes, ecotoxicology of persistent toxic substances (PTS), evaluation of exposure of various Arctic populations (including the indigenous people) to PTS, assessment of PTS effects on the body and health risks for the population.

THE EXPERIENCE OF JOINT WORK OF THE CLINIC OF OCCUPATIONAL PATHOLOGY (CENTER OF OCCUPATIONAL PATHOLOGY) AND THE DEPARTMENT OF THE SCIENTIFIC SUPPORT OF SANITARY AND EPIDEMIOLOGICAL SURVEILLANCE AND EXPERTISE TO ESTABLISH THE CONNECTION OF DISEASES WITH THE OCCUPATION

Introduction. The sanitary and hygienic characteristics of the patient’s working conditions made in accordance with the current regulatory documents do not contain an unambiguous conclusion about the adequacy of the occupational risk’s degree for an unambiguous justification of the relation of the disease with the occupation. In this situation a search for new methods which could help to recognize the risk degree is urgent. Material and methods. As an example of a solution of this problem, two expert examinations are given: two patients, diagnosed adenocarcinoma of the lung and exogenous allergic alveolitis were observed in the Clinic of Occupational Pathology of North-West Public Health Research Center. The key aspect of this work was a refinement of the professional risk based on data specified in sanitary and hygienic characteristics of working conditions. The methods from the R 2.2.2006 - 05. “Guidance on hygienic assessment of working environment factors and working process. Criteria and classification of working conditions” were used. Discussion. The use of the described methodology was suggested in cases when it’s necessary to estimate the effect of the combination of unidirectional substances and carcinogens in low-dose rates by the long-term exposure. The participation of the occupational hygiene’s specialists in the expertise of the connection of the disease with the profession seems to be promisingly.

PWE-123 Undergraduate Understanding Of Identification And Brief Advice For Alcohol Disorders

IntroductionThe number of deaths in England due to liver disease is rising. The North West has the highest rate of alcohol related deaths for men and women.1 Brief interventions can...

Minimum unit pricing for alcohol: policy appraisal modelling of income and socioeconomic group-specific effects on consumption, spending, and health harms

BackgroundUK legislatures are at different stages in the policy process for introducing a minimum price for alcohol. Although there is evidence about the effectiveness of such policies, political and public concern exists about the potential effects on low-income drinkers. We present appraisals of the effects of a £0·45 minimum unit price (MUP; 1 unit=8g/10mL ethanol) policy in England in 2014–15 across the income and socioeconomic distributions. MethodsWe undertook policy appraisals using the Sheffield Alcohol Policy Model (SAPM version 2.6), a causal, deterministic, epidemiological model. SAPM accounts for differential alcohol purchasing and consumption preferences for population subgroups defined, using self-reported survey data, by age, sex, consumption level, and income or socioeconomic group. We derived volumes purchased and prices paid for ten alcoholic beverage categories (beer, cider, wine, spirits, and ready-to-drink beverages [RTDs], purchased in the on trade [eg, bars] or off trade [eg, shops]) from household-level 2-week spending diaries. A 10 × 10 price elasticity matrix was estimated to describe the relation between price changes and purchasing changes (assumed to represent consumption changes). After a policy change, the elasticity matrix was used to adjust individual-level survey data on self-reported mean weekly and peak daily alcohol consumption. We modelled resulting effects on mortality and disease prevalence using functions relating consumption measures to risk of having 47 chronic or acute disorders wholly or partly attributable to alcohol. Baseline mortality and morbidity rates were those reported for England and Wales in 2005 by the North West Public Health Observatory. These rates are adjusted to account for socioeconomic variability in mortality and morbidity risk with Office for National Statistics socioeconomic group-specific alcohol-related mortality data for 2001–03. FindingsOn average, moderate drinkers purchase 36 below-MUP units per year whereas harmful drinkers in the lowest and highest income groups purchase 1610 and 712 units, respectively. The policy is estimated to have small effects on moderate drinkers' alcohol consumption (–1·6 units per drinker per year) and spending (£0·78 per year). Bigger behavioural changes are estimated to occur among harmful drinkers and these are largest in the lowest income quintile (–300 units, –£34·63) compared with the highest (–34 units, £16·35). The same pattern of results was noted in sensitivity analyses using (a) alternative elasticity matrices, and (b) population subgroups defined by socioeconomic status rather than income. A list of published sensitivity analyses undertaken with SAPM is provided in the appendix. Health benefits from the policy are also unequally distributed due to differential baseline harm risks and purchasing patterns. Lower socioeconomic groups that make up 41·7% of the population would accrue 81·8% of the reduction in deaths and 87·1% of the reduction in quality-adjusted life-years lost. InterpretationModerate drinkers, regardless of income, are only marginally affected by the policy because it chiefly targets harmful drinkers. Because they purchase more below-MUP alcohol, low-income harmful drinkers would be affected more than those with higher incomes. Policymakers must balance low-income harmful drinkers' larger consumption reductions against their greater health gains from reduced alcohol-related morbidity and mortality. Limitations of the model include supply-side responses not being considered (eg, retailers increasing prices above the MUP threshold) and the data used for adjusting baseline health risks for socioeconomic groups only relating to mortality and not being condition specific. FundingMedical Research Council and Economic and Social Research Council, UK (grant G0000043).

Development of a comparative cost-effectiveness appraisal instrument for local alcohol policies: a modelling study

BackgroundAlcohol-related ill health is estimated to cost the UK National Health Service £3 billion per year, and there were over 1 million alcohol-related admissions to hospital in England (primary or secondary diagnosis) in 2010–11. Although liver disease mortality (for which the principle cause is alcohol consumption) has been falling in other northern European countries, rates in the UK continue to rise. Correspondingly, alcohol is now prominent on the UK policy agenda, and a range of new control and prevention measures have been proposed, including new powers for local authorities, as part of a focus on localism in English public health. Although many local alcohol policy interventions are supported by published evidence, there has been little exploration locally of the contextual factors that determine the optimum mix of policies for a particular area. As part of the National Institute for Health Research School for Public Health Research, we aim to localise the Sheffield alcohol policy model (SAPM) to enable appraisals of policy interventions (particularly pricing, licensing, and protocols for screening and brief intervention policies) that are specific to local population characteristics, alcohol consumption patterns, rates of harm, and existing policy frameworks. MethodsA key challenge will be obtaining estimates of key model indices from local authorities. Baseline alcohol consumption for local authorities will be estimated by pooling multiple national datasets (eg, the General Lifestyle Survey) to create sufficiently large samples for local authorities (or clusters of authorities) and by identifying local consumption surveys. Estimates of alcohol consumption derived from different survey years will need to be rebased to the latest available year before pooling with age-period cohort models that infer projected trends in alcohol consumption. Data might also need to be adjusted to account for differences in survey method. Estimates will be cross-validated with the local alcohol profiles for England (LAPE) produced by the North West Public Health Observatory. Data-pooling methods will also be used to explore whether local estimates of alcohol prices and spending, grouped by age, sex, and ethnic origin, can be derived. For alcohol availability, spatial analyses of full postcode data for all English alcohol outlets in 2003, 2007, 2010, and 2013 will be used to characterise local authorities by availability measures. After cross-validation with established local datasets on health harms and other societal effects by regression techniques, the predictive capacity of the locally adapted SAPM (SAPM-LA) to estimate localised harms corresponding to different local consumptions will be tested. When validated, SAPM-LA should help to facilitate the comparative appraisal and optimisation of a wide range of policies aimed at local reduction of alcohol harms from licensing and promotion restrictions through to targeted brief intervention strategies. Any reduction in harms will therefore be modelled on the projected reductions in consumption resulting from licensing and planning approaches to restricting alcohol supply, as well as more overtly behavioural approaches such as screening and brief interventions. Although LAPE identifies local authorities with high rates of alcohol harms (eg, Bradford and Rotherham in the Yorkshire and Humber region), most have little additional detail on accompanying local consumption patterns. A few local authorities with which we already have strong working links have undertaken dedicated surveys locally, which will provide a comparison for our baseline estimates. InterpretationThe work outlined here is a methods-only presentation and is intended to stimulate discussion and interest with front-line public health practitioners within local authorities to enable discussion of the types of intervention mixes that will be the most useful, feasible, and practicable. The locally adapted model could then be used to build the evidence case for implementation, as has been most persuasive at both national and devolved government levels. FundingMulticentre National Institute for Health Research School of Public Health Research.

Alcohol-Related Brain Damage: Report from a Medical Council on Alcohol Symposium, June 2010

### Alcohol-Related Brain Damage: Challenges and Opportunities Colin Drummond National Addiction Centre, Institute of Psychiatry, King's College London, UK Alcohol is a toxic and dependence-producing substance that can damage most organs in the body, and is implicated in more than 60 different diseases (Oforei-Adjei et al. , 2007). Alcohol is now the third leading cause of ill health in Europe (Rehm et al. , 2009). In the UK, alcohol-related morbidity and mortality have been increasing over the last 30 years, and alcohol-related hospital admissions now exceed 1 million per annum in England (North West Public Health Observatory, 2011). The brain is particularly sensitive to the toxic effects of alcohol either directly, particularly in the foetus and young people, or in the context of malnutrition and thiamine deficiency leading to Wernicke–Korsakoff syndrome; or following repeated episodes of alcohol withdrawal. The precise mechanisms of alcohol-related brain damage (ARBD) remain to be fully understood and several papers in this series describe the limits of knowledge. However, enough is already known to make a significant impact on the prevalence of ARBD through relatively inexpensive preventive strategies. Yet, such preventive strategies are poorly implemented in the UK. Why is this the case? First, there has been a lack of training and clear guidance to clinicians on preventing and managing alcohol problems, including ARBD. This has resulted in low levels of identification and intervention of patients at risk of alcohol-related complications in medical and psychiatric care (Barnaby et al. , 2003; Cheeta et al. , 2008). The recently published suite of NICE guidance on alcohol-use disorders aims to improve detection, prevention and management (NICE, 2010a, b, 2011). However, effective implementation will require a significant investment in staff training to raise awareness, knowledge and skills. Secondly, there is the issue of stigma. Patients who misuse alcohol face stigma and opprobrium, …

The Northwest Public Health Information Exchange’s Accomplishments in Connecting a Health Information Exchange with Public Health

In 2007 the Centers for Disease Control and Prevention (CDC) issued a Request for Proposal for the “Situational Awareness through Health Information Exchange” project. The Situational Awareness project’s goals are to connect public health with health information exchanges (HIEs) to improve public health’s real-time understanding of communities’ population health and healthcare facility status. During this same time period the Health and Human Services’ Office of the National Coordinator for Health Information Technology released several reports identifying the growing number of communities involved in health information exchange and outlining the requirements for a Nationwide Health Information Network (NHIN). CDC saw the possibilities of using HIEs and the NHIN to accelerate the real-time sharing of clinical and facility-based resource utilization information to enhance local, state, regional, and federal public health in responding to and managing potentially catastrophic infectious disease outbreaks and other public health emergencies. HIEs would provide a unified view of a patient across health care providers and would serve as data collection points for clinical and resource utilization data while NHIN services and standards would be used to capture HIE data of importance and send those data to public health. This article discusses how automated syndromic surveillance data feeds have proven more stable and representative than existing surveillance data feeds and summarizes other accomplishments of the Northwest Public Health Information Exchange in its contribution to the advancement of the National agenda for sharing interoperable health information with public health.

Methods for Leveraging a Health Information Exchange for Public Health: Lessons Learned from the NW-PHIE Experience

The intent of this article is to provide public health and health information exchanges (HIEs) insight into activities and processes for connecting public health with clinical care through HIEs. In 2007 the CDC issued a Request for Proposal (RFP) for the “Situational Awareness through Health Information Exchange” project. The project’s goals are to connect public health with health information exchanges (HIEs) to improve public health’s real-time understanding of communities’ population health and healthcare facility status. This article describes the approach and methodology used by the Northwest Public Health Information Exchange to achieve the project’s goals. The experience of the NWPHIE Collaboration provides an organizational and operational roadmap for implementing a successful regional HIE that ensures secure exchange and use of electronic health information between local and state public health and health care entities.

Through a glass darkly: what should public health observatories be observing?

Eight regional public health observatories were launched in England in February 2000, to strengthen the availability and use of health information and to support efforts to tackle health inequalities at local level. This qualitative study was carried out by the Merseyside and Cheshire Zone of the North West Public Health Observatory to assess the needs of local users and producers of public health information. Semi-structured in-depth interviews were carried out with 42 representatives of three major groups in Merseyside and Cheshire: community groups, public-health-related professionals in the local statutory and academic sectors, and information specialists within the National Health Service. Different groups of users and producers encountered different problems in accessing health information. Community groups had significant problems accessing and interpreting health information and were concerned about tokenism and the failure of professionals to recognize lay knowledge. Professionals experienced difficulties in accessing local information from outside their agency and had concerns over partnerships failing to work together to share information. The health information specialists stressed the danger of providing information without supporting intelligence, the difficulty of keeping track of the many local sources, and the importance of having access to local authority data sources. All three groups relied on their own networks in their search for information, and these should not be overlooked in any dissemination strategy. Information requires skilled interpretation to become policy-relevant public health intelligence. This research identified major problems in the communication of lay health knowledge and in the accessibility of public health intelligence.