Professional Pathology Research Articles

Global view of haematolymphoid tumor classifications and their application in low- and middle-income countries.

The accurate diagnosis of haematolymphoid malignancies is crucial for effective cancer care, but major obstacles to diagnosis exist in low- and middle-income countries (LMICs). This article explores the global applicability of current haematolymphoid classification systems, which are predominantly derived from data generated in high-income countries (HICs). Although disproportionately burdened with poor cancer outcomes, LMICs are generally faced with limited diagnostic resources, suboptimal access to therapeutics, and inadequate healthcare infrastructure. The article highlights the challenges faced by LMICs, including inconsistent access to high-quality pathology services, limited availability of advanced diagnostic techniques, and a lack of population-based cancer registry data. It also discusses the progress made in narrowing the gap between LMICs and HICs, such as the introduction of resource-adapted classifications, improved guidance on essential diagnostic tools, and strengthening of in-country professional pathology networks. Innovative diagnostic approaches, including gene expression profiling and machine learning, represent potential solutions for improving the diagnostic accuracy in LMICs, but addressable gaps remain. Recommendations are suggested for sustainable investments in diagnostic infrastructure, capacity-building, and population-based cancer registries to enhance the global applicability of haematolymphoid classification systems and improve outcomes for patients in LMICs.

ФЕНОТИП ВИБРАЦИОННОЙ БОЛЕЗНИ В СОЧЕТАНИИ С АРТЕРИАЛЬНОЙ ГИПЕРТЕНЗИЕЙ: НОВЫЕ МИШЕНИ НУТРИТИВНО-МЕТАБОЛИЧЕСКИХ НАРУШЕНИЙ

Introduction. Comorbidity in the modern world is a predictor of a more severe course of most diseases and has a significant impact on the characteristics, course and outcomes of the disease in the structure of occupational pathology. This is characterized by an increase in clinical syndromes, a deterioration in the quality of life and disability. Purpose of the study. Optimization of diagnostics in the form of studying clinical, functional and nutritional and metabolic parameters in professional patients on a model of comorbid pathology of vibration disease in combination with arterial hypertension. Materials and methods. In the course of a single-stage open, descriptive, comparative clinical study, 431 patients were examined in the conditions of the regional center of professional pathology in the city of Novosibirsk. Patients were divided into groups: patients with isolated vibration disease (n = 104), a group of comorbid WB+AH model (n = 101), a comparison group were patients with arterial hypertension (107 patients), a control group of conditionally healthy individuals (119 people) . The study duration was 4.9 ± 0.25 years. The indicators of the main analyzers, nutritional and metabolic status, nutritional adequacy, indicators of protein, lipid, carbohydrate metabolism, adipokine status, blood 25OH vitamin D, indicators of endothelial dysfunction, RAAS components, oxidative stress and systemic inflammation were evaluated. Results and its discussion. With VP+AH, the most unfavorable metabolic status was revealed. In this group, higher levels of insulin, glycated hemoglobin, HOMA-IR index, total cholesterol, LDL, triglycerides, atherogenic coefficient were determined in comparison with the isolated WB group and the control group, respectively. The phenotype of WB and AH shows the highest concentration of resistin, significantly higher than in the comparison and control groups, against the background of low levels of adiponectin, as well as an increase in the level of free leptin against the background of a decrease in the leptin-binding receptor. In the course of bioimpedancemetry, significant deviations were found in the group of the comorbid model of HF in combination with AH in the following indicators: an increase in fat mass normalized for growth and extracellular fluid with a decrease in the parameters of lean and active cell mass and phase angle. In the group of the comorbid model of WB and AH, changes were also detected in the following indicators of the molecular endotype: an increase in markers of oxidative stress (total antioxidant status of serum, Cu/ZnSOD, concentration of free radicals, lipid peroxides, protein oxidation products), the RAAS system, markers of endothelial dysfunction (endothelin 1, nitric oxide, tissue factor) and systemic inflammation (IL1 β, MCP-1, FGF 2, cardiotrophin, MMP 1, MMP 9, pentraxin 3, neutrophil elastase). Conclusions. A variant of the comorbid model is characterized by clinical-molecular and nutritional-metabolic features in professional patients, which are caused by a multifactorial pathomorphosis of a combination of vibration disease and arterial hypertension. In this variant, indicators of worse metabolic and adipokine status relative to the compared groups, pronounced processes of systemic inflammation, oxidative stress, and endothelial dysfunction were revealed.

Occupational health risks during nickel electrolysis production (longitudinal epidemiological study)

Introduction. Despite the technological modernization of the nickel industry, workers employed in it continue to be at increased risk of developing occupational pathology. The study aims to assess occupational health risks in the electrolysis production of nickel according to the longitudinal epidemiological study. Materials and methods. Experts have studied the data of workplace certification, periodic medical examination (2008) and the register of occupational diseases of the Murmansk region in 2009-2021. Results. In 2008, scientists identified 3,744 chronic unprofessional diseases in 1,397 nickel electrolysis workers, among which the most common were diseases of the musculoskeletal system (23.0%). 41.9% of workers had a low, 17.7% - moderate, 16.7% - medium, 10.7% - high and 12.9% - very high category of risk for the development of professional pathology. During the next 13 years (2009-2021), the authors have diagnosed 201 chronic occupational diseases for the first time in 89 employees, mainly respiratory organs (58.7%) and musculoskeletal system (28.9%). In total, occupational diseases were formed in 6.4% of workers, including 13.6% of cleaners, 7.6% of repairmen, 6.6% of electrolyzers, 5.7% of crane drivers, 4.9% of hydrometallurgical apparatchiks and electricians. Occupational morbidity was 114.31 per 10,000 workers with the highest rates in cleaners (328.69). We have detected occupational diseases in 1.0% of workers with a low risk category, 2.8% with moderate, 6.8% with medium, 13.3% with high and 22.2% with very high. Limitations. The impossibility of completely eliminating the possibility of diagnosing an occupational disease in workers who have dropped out of the observation group to other regions of the country. Conclusion. Researchers have obtained new data on the formation of occupational pathology in the electrolysis production of nickel, taking into account the specialty of employees and the category of occupational risk. Ethics. We carry out the study in accordance with the principles of the Helsinki Declaration. The protocol and design of the study were approved by the local committee of the North-Western Scientific Center for Hygiene and Public Health of 12.05.2021, Protocol No. 35.4.

Self Assessments of the Quality of Own Life during a Viral Pandemic and War

This publication is the result of a study of the dynamics of self-assessment of quality of life indicators by young medical workers (students) against the background of the negative impact of the infodemic due to the chronic stress situation during the covid 19 pandemic, quarantine restrictions and professional communication with various patients, and the full-scale war of complete destruction that began on 24.02.22 all citizens of Ukraine. General clinical methods were used as research methods - to assess the condition of the mucous membranes, skin and somatic organs, as well as psychodiagnostic questionnaire SF36 for anonymous self-determination of the quality of one's life. The analysis of the obtained results of two hundred young medical students during 2021-2022 revealed a number of correlational dependencies from the amount of time during which they are forced to study and work against the background of the mostly negative impact of the infodemic, initially caused only by the situation of the viral pandemic and the need daily contact with various patients, and after 02.24.22 and in conditions real large-scale war and martial law. That is, already in conditions of real danger of being injured or killed during another missile attack in the rear and being infected with another viral strain of coronavirus infection due to forced daily professional contact with various somatic patients. The awareness of the presence of these two factors directly reduces their self-esteem of the quality of their own life and is, in certain situations, a sufficient factor that contributes to the formation of psychosomatic disorders as a manifestation of the initial clinical signs of somatic-emotional professional pathology, which, in particular, manifests itself in the appearance of various rashes on the skin

СЛУЖБА ПРОФПАТОЛОГИИ ФМБА РОССИИ В 2021 ГОДУ

The Occupational Pathology Service of the FMBA of Russia in 2021 is represented by medical organizations involved in conducting preliminary and periodic medical examinations, and 17 centers of occupational pathology. The chief freelance professional pathologist annually collects reports on the results of the centers of occupational pathology. In accordance with the data presented, all the centers of occupational pathology of the FMBA of Russia have been established on the basis of multidisciplinary specialized healthcare institutions. According to the data of the Centers of Occupational Pathology of the FMBA of Russia, the most common causes of medical contraindications are diseases of the eye and its accessory apparatus, diseases of the circulatory system, diseases of the blood, hematopoietic organs and individual disorders involving the immune mechanism, diseases of the ear and mastoid process, which necessitates the implementation of preventive programs in the indicated directions. One of the main functions of the center for occupational pathology is the examination of the connection of the disease with the profession and professional suitability, including in complex and conflict cases. A specialized medical commission has been established to conduct these examinations in all centers of professional pathology of the FMBA of Russia. During 2021, these medical commissions considered 11436 expert cases. Since 2011, an Industry register of persons with occupational diseases has been maintained on the basis of the A.I. Burnazyan FMBC of the FMBA of Russia, the volume of which currently exceeds 2,300 cases. The system of psychophysiological examination of the FMBA of Russia in the structure of the occupational pathology service has 35 medical organizations, on the basis of which 43781 psychophysiological examinations were conducted in 2021.

On the issue of taking into account new factors in the pathogenesis of occupational hearing loss (on the example of transport workers)

Introduction. In the period from 2013 to 2021, industrial enterprises saw a reduction in jobs that did not meet sanitary and hygienic requirements for the level of exposure to noise, vibration, illumination, microclimate parameters and electromagnetic fields on the workers' bodies. However, the proportion of unfavorable workplaces that do not meet the standards for noise levels remains the largest, which determines the peculiarities of the structure of the occupational pathology of workers in the Russian Federation: professional pathology of the hearing organ - professional sensorineural hearing loss - remains in the first place. The transport industry is among the sectors of the economy with the most significant indicators of occupational diseases exceeding the average Russian indicator. The study aims to analyze additional causes of pathogenetic significance in the development of professional hearing loss using the example of employees of the driving professions of railway transport and flight professions of civil aviation aircraft. Materials and methods. We have analyzed the state of the auditory function in members of locomotive crews of JSC Russian Railways for 2017-2021 according to the Territorial Administration of Rospotrebnadzor for Railway Transport and persons of flight professions of civil aviation aircraft of the Russian Federation for 2010-2020 according to the data of the Federal Center for Hygiene and Epidemiology. Results. Professional sensorineural hearing loss prevails in the structure of occupational morbidity of railway and aviation transport workers. Despite the absence of excess in-cabin noise levels, the leading professional group for hearing loss in railway transport are locomotive drivers and assistants, in civil aviation - aircraft commanders and co-pilots. The complexity of the professional activities of persons of these professions, a high degree of responsibility for the safety of transportation of passengers and cargo, readiness to act in non-standard conditions, loads on visual and auditory analyzers, create a high degree of labor intensity that causes chronic stress. The factor of chronic stress causes a violation of adaptive mechanisms and causes a number of complex neuro-reflex and neurohumoral shifts in the body, as a result of which labor intensity need to consider as a pathogenetically significant factor in the development of professional sensorineural hearing loss. Conclusions. Chronic sensorineural hearing loss is a priority occupational disease in persons of driving and flying professions, it is registered even in persons working in conditions of regulatory levels of industrial noise and a high degree of labor intensity. It is necessary to discuss the possibility of including labor intensity indicators as an additional etiological, pathogenetically significant factor in the expert criteria for establishing the connection of hearing loss with professional activity.

ФУНКЦИОНАЛЬНОЕ СОСТОЯНИЕ ЖЕВАТЕЛЬНЫХ И ВИСОЧНЫХ МЫШЦ МУЗЫКАНТОВ, ПРОФЕССИОНАЛЬНО ИГРАЮЩИХ НА ПОПЕРЕЧНОЙ ФЛЕЙТЕ, ПО ДАННЫМ ЭЛЕКТРОМИОГРАФИИ

Flautists are at risk of developing muscular and joint pain. While playing the flute muscles of the maxillofacial region do not work physiologically. In addition, the musicians stay in an asymmetrical posture for a long time and often experience stress during performance. All these factors can affect masseter and temporal muscles and consequently lead to temporomandibular joint dysfunction (TMD).
 The aim of research was to investigate the state of the temporal and masseter muscles of flautists by means of electromyography in comparison to the control group.
 Electromyography of the temporal and masseter muscles was performed in 30 flautists and 30 control subjects aged 18 to 35 with the BioEMG from the BioPAK complex (BioResearch, USA). Electromyography at rest registered increased bioelectric potential of the temporal and/or masseter muscles in a subgroup of flautists who play more than 3 hours a day in 37.5% of cases. In a clench test both musicians and control subjects showed asymmetrical work of masticatory and temporal muscles, while in the control group, symmetry below 50% was noted only in the work of the temporal muscles. Synergy between temporal and masseter muscles less then 50% was 1.3 times more common in the control group than among flute players though right-sided disorders were more common in flute players.
 Electromyography of masticatory muscles is an important stage in a comprehensive examination of the TMJ condition, however, this method cannot be used as the single one or decisive one to diagnose the professional pathology of flautists.

The 283 А>G (BsmI) VDR gene polymorphism as a predictor of osteoporosis complicated by chronic pyelonephritis in aluminum production workers

Introduction. In the structure of the morbidity of workers in the aluminum industry the leading place are occupied by bone and joint pathology and disorders of mineral metabolism, caused by prolonged exposure to toxic fluoride compounds. The study of the molecular genetic basis for the development of changes in bone metabolism and concomitant pathology of the kidneys in chronic occupational intoxication with fluorine compounds will make it possible to establish an associative relationship between the polymorphism of certain genes and the likelihood of developing these diseases. The aim of the study was to determine the significance of detecting BsmI VDR polymorphism as a predictor of osteoporosis associated with chronic kidney disease in workers of the main professions of aluminum production on the basis of clinical and genetic analysis. Materials and methods. Based on molecular-genetic and clinical methods, a comprehensive study of the prevalence of fluorine osteopathy was carried out with the determination of bone density parameters in 217 workers in the main professions of aluminum smelting under conditions of chronic exposure to high doses of fluorine on the body and in the comparison group (57 individuals) without occupational pathology. Results. When examining workers, it was established that the frequency of registration of BsmI VDR polymorphism genotypes corresponded to the Hardy-Weinberg law. It was determined that the GG VDR genotype is a predictor of osteoporosis (p=0,0034), and carriers of the AA genotype are resistant to its development (p=0,0001). An associative relationship of the heterozygous AG VDR genotype with the development of chronic occupational intoxication with fluorine compounds was revealed (p=0,0232). It has been shown that osteoporosis associated with chronic kidney disease is associated with the G allele of the GG VDR genotype. Conclusions. In the structure of professional pathology of metallurgists employed in the production of aluminum, against the background of hyperplastic changes in bone tissue due to an increase in its mass, there is a significant decrease in mineral density (p=0,0047). The allelic specificity of the VDR gene associated with the development of toxic osteopathies was revealed. The GG genotype is associated with the development of osteoporosis. A high degree of association of the AG genotype (p=0,0232) with fluoride intoxication was shown. Osteoporosis associated with chronic kidney disease is associated with the GG VDR genotype and the G allele of the 283 A>G (BsmI) VDR polymorphism, which determines progressive disorders of mineral metabolism and aggravates the course of fluorosis in workers. Ethics. The examination of aluminum production workers was carried out in the hospital of the Research Institute for Complex Problems of Hygiene and Occupational Diseases in strict accordance with the ethical principles of conducting scientific and medical research with human participants, developed on the basis of the Helsinki Declaration by the World Medical Association "Ethical principles of conducting scientific medical research with human participants" with amendments of 2013, "Rules of Clinical Practice in the Russian Federation" approved by the Order of the Ministry of Health of the Russian Federation No. 266 dated 06/19/2003. The collection of clinical history data was carried out during an oral questionnaire face to face with a written informed consent to participate in the study and analysis of medical histories according to 025/u-87 form.

Feasibility and acceptability of telepathology system among the rural communities of Bangladesh: A pilot study.

ABSTRACTContext:Telepathology is a promising tool for remote communities to receive pathology services where professional diagnosis services are inadequate.Aims:We aimed to clarify how effective telepathology was when compared with conventional pathology service among rural communities of Bangladesh.Methods and Materials:We conducted a cross-sectional study in suburban and rural areas of Bangladesh between June and August 2020. We enrolled 117 participants who received both telepathology services from Thakurgaon Eye Hospital and conventional pathology service experience. The participant’s satisfaction with the accessibility and perceptions were statistically compared. In addition, we summarized descriptive statistics using the frequencies and percentages of participants’ responses.Statistical Analysis Used:Wilcoxon’s Signed-rank test using SPSS statistic software version 25.00.Results:Among the study participants, service cost, travel cost, travel time, waiting time, and travel distance were significantly higher for conventional pathology than telepathology (P < 0.001). The majority of participants (94%) were satisfied with the telepathology experience; however, one out of 117 participants was dissatisfied with this service when their travel distance was far away (≥50 km). Among the participants, 91.5% thought that telepathology service was effective for their treatment, and 98.3% wanted to continue this service in their community. On an average, participants saved 58% (95% CI, 53.4–61.5) of cost using telepathology rather than conventional pathology service.Conclusions:Remote under-resourced communities received professional pathology services with less time-consuming and significantly lower costs using the telepathology approach. Where pathology services are absent/insufficient, telepathology is efficacious for primary diagnosis, screening, and referral through professional pathologists for the satisfactory treatment of unreached communities.

Analysis of changes in regulatory framework of the russian federation on examination of relationship between diseases and profession for 40 years

The evolution of the national regulatory framework in the field of examination of connection between the disease and the profession for the period from the 80s of the twentieth century to the present is analyzed.&#x0D; Materials and methods. The regulatory framework of domestic professional pathology regarding examination of relationship between diseases and profession is evaluated&#x0D; Results. It was noted that for the specified period, in the normative acts the organizational issues of the examination of the connection between the disease and the profession did not have a satisfactory solution. A feature of most regulatory documents in the field under consideration, issued recently, is a certain logical inconsistency.&#x0D; Conclusions. To radically improve the current situation, it is necessary to immediately adopt for practical application the mandatory criteria, which prove the occupational origin of health disorders in workers.

The Interdisciplinary Approach and New Technologies in the Scientific and Clinical Development of Otorhinolaryngology.

The experience of the FMBA NMRCO of Russia in implementing the concept of an interdisciplinary approach and the use of new technologies in the diagnosis, treatment, and rehabilitation of diseases of the ENT organs is discussed. It is noted that otorhinolaryngology is closely associated with a number of basic medical sciences and related clinical disciplines, which is reflected in the structure of the center: in addition to otorhinolaryngological departments, in which high-tech surgical interventions on ENT organs are performed, there are scientific and clinical departments: maxillofacial and plastic surgery, ophthalmology and neurosurgery, as well as the country’s only center for professional pathology of ENT organs. Thus, in the general structure of the NMRCO’s medical services, the share of medical care in specialties related to otorhinolaryngology is about 40%. Several departments deal with oncological diseases of the head and neck organs. Complex high-tech surgeries of cancer patients are performed by interdisciplinary teams of maxillofacial surgeons, oncologists, otosurgeons, and neurosurgeons, and interaction with the departments of phoniatrics and physiotherapy and medical rehabilitation provides them with full-fledged postoperative rehabilitation. The NMRCO’s experience shows that the widespread introduction of an interdisciplinary approach into clinical practice makes it possible to increase the efficiency of diagnostics, treatment, and rehabilitation of patients with otorhinolaryngological pathology.

In memory of Komarov Fyodor Ivanovich (on the occasion of his centenary)

Abstract. Fyodor Ivanovich Komarov (08/26/1920 01/25/2020) was a participant in the Great Patriotic War, a prominent domestic therapist, an outstanding figure in military medicine, a Hero of Socialist Labor, an academician of the Russian Academy of Sciences, a laureate of the State Prize of the Union of Soviet Socialist Republics, an honorary doctor of the S.M. Kirov Military Medical Academy, a professor and a retired colonel-general of the medical military service. F.I. Komarovs scientific heritage is huge. Over 600 scientific works, including 33 monographs, were published by him personally and in co-authorship. Due to his comprehensive clinical background and deep knowledge of physiology and biochemistry, urgent problems of gastroenterology, cardiology, pulmonology, chronobiorhythmology and military professional pathology could be successfully solved. He made a great contribution to improve and reform the military medical service. Twenty six doctors and sixty candidates of medical sciences were educated under his leadership. Being a military doctor and holding high leadership positions, he was constantly engaged in the improvement of military medicine and military field therapy. He was also the head of medical support for the troops during the hostilities in Afghanistan, during the accident at the Chernobyl nuclear power plant and following the consequences of the earthquake in Armenia. He was elected chairman of the All-Union Society of Physicians several times. He was also a member of the Lenin and State Prize Awarding Committee under the Council of Ministers of the Soviet Union, chairman of the expert council of the Supreme Attestation Commission of the Union of Soviet Socialist Republics and editor-in-chief of the journal Clinical Medicine and an honorary member of a number of foreign academies. In 1999, he was awarded the title Man of the XX century, became a laureate of four personal prizes: M.P. Konchalovsky (1979), S.P. Botkin (1985), N.I. Leporsky (1992), V. Kh. Vasilenko (2001). For his merits to the Fatherland, F.I. Komarov was awarded the title Hero of Socialist Labor (1980) in addition to forty five orders and medals.

The Diagnostic Criteria for Chronic Endometritis: A Survey of Pathologists.

While acute endometritis is a reasonably well-defined entity of ascending infection and attendant active inflammation, chronic endometritis is less well defined. As part of a broad effort to define and refine the diagnostic criteria and management of the disease, we conducted a survey of pathologists to understand the variability in diagnostic criteria and implications of the diagnosis of nonspecific, nonobstetric chronic endometritis. Members of national and international professional pathology societies were surveyed utilizing anonymous electronic surveys designed to examine diagnostic criteria, etiological understanding and treatment implications of a pathologic diagnosis of nonspecific, nonobstetric chronic endometritis. There was substantial variability among pathologists in the diagnostic criteria used for making a diagnosis of nonspecific, nonobstetric chronic endometritis, with 28.5% of pathologists using the presence of a single plasma cell for making the diagnosis. There was additional variability in the use of special stains, reporting in the presence of coexisting lesions and the hormonal stage of the endometrium. There were no differences between generalists and specialists in the diagnostic criteria used, except the significantly greater likelihood of specialists making the diagnosis in gestational endometrium. The substantial variability in diagnostic criteria for nonspecific, nonobstetric chronic endometritis among pathologists, including among gynecologic pathologists, has the potential to confound the management of patients. Standardization of diagnostic criteria for chronic endometritis is essential to understand the implications of the diagnosis.

Occupational health risk for workers in iron ore mining

Introduction. The current negative trends in the decline of the working-age population, as well as changes in the pension legislation, raise the issue of preserving the labor potential and health of the population more sharply than ever. The aim of study is to assess the occupational health risk of employees in iron ore mining with the subsequent development of management measures. Materials and methods. Jobs of priority professions were selected: creeper, sinker, GROZ, scraper winch and drilling rig drivers. The assessment of working conditions and occupational risk was carried out in accordance with guidelines R 2.2.2006-05 and R 2.2.1766-03 on the basis of materials provided by the company, as well as its own measurement results using available predictive models for assessing occupational health risk of employees. Results. The results of the study indicate that there is a high (intolerable) occupational health risk in all professions, category of evidence 1A. Aerosols, industrial noise, vibration, and heavy labor remain the leading health risk factors. The average length of professional pathology development, depending on the nosological form, was in the range of 20-30 years. Conclusions. Based on the results of the work, recommendations were given for managing occupational health risks.

Стан професійної захворюваності у Придніпровському економічному регіоні за 2015-2019 роки

The purpose of the study was to analyze the occupational morbidity in the Dnieper Economic Region, its structure in dynamics for 2015-2019, identify the main causes that lead to the formation of occupational pathology, and suggest ways to solve the problem. Material and methods. Based on the processing of the medical documentation of the clinic, the Ukrainian Research Institute of Industrial Medicine, we conducted a comparative analysis of occupational morbidity indicators in the dynamics of 2015-2019 was carried out taking into account the main forms of pathology and regional distribution. Results and discussion. The level of occupational morbidity among workers of the Dnieper Economic Region in 2015-2019 varies from 354 to 10307 cases. The leadership in the formation of professional pathology remains with the Dnipropetrovsk region, where large enterprises of the leading branches of heavy industry are located, in dangerous and harmful conditions of which a significant number of people work. In the structure of occupational morbidity, the first place is occupied by chronic obstructive pulmonary diseases of occupational etiology (31.7%), the second is cochlear neuritis (27.3%), the third is radiculopathy (23.7%), and the fourth is vibration disease (7.6%). Indicators of occupational morbidity indicate only the detection of occupational pathology. The statistics do not reflect the true situation, which is due to the imperfection of labor protection legislation, the lack of legal and economic sanctions for concealing occupational diseases, and the shortcomings of medical diagnostic and preventive work among workers. The solution to this problem, in our opinion, may consist in enhancing coordination of the entire complex of scientific and practical activities for the development and substantiation of strategies, tactics and implementation of national policies from the most important areas of occupational medicine. Conclusion. It is necessary to formulate a systematic approach to the prevention of occupational morbidity of the population, taking into account the characteristics of the current situation in the region and in the country as a whole. Comprehensive solution of problems in the health of workers, taking into account the interagency coordination of the system of measures, in the future will ensure the preservation of labor potential, prolong working life, and reduce general and occupational diseases

Тelemedicine technologies in occupational health and pathology

Introduction. The article provides legal, organizational, and medical reasons for the feasibility of introducing telemedicine technologies into the practice of occupational health and professional pathology to increase the effectiveness of preventive measures to preserve the health of the working population. Material and methods. Analytical review of data of domestic and foreign literature on modern telemedicine technologies. The aim of the study was to analyze the main directions of development and modern achievements of telemedicine to determine the possibilities for using this type of digital technology in improving the working conditions of workers and preventing professional pathology. Results. The analysis showed that to optimize the search for managerial solutions aimed at preserving the health of the working population of Russia through the large-scale use of telemedicine and information technologies, it seemed necessary: the creation and integration into a single network of telemedicine centers based on professional pathology centers in most constituent entities of the Russian Federation with the head scientific institution - the Center for Occupational Pathology of the Ministry of Health of the Russian Federation for operational coordination of activities; integrate research institutes and higher educational institutions specialized in the field of Occupational Health medicine in major medical centers. Telemedicine technologies make it possible to optimize information interaction and discussion of materials when preparing new regulatory and legal documents with the participation of the main stakeholders: the Ministry of Health, the Ministry of Labor, Federal Service for Oversight of Consumer Protection and Welfare, the Social Insurance Fund, industry unions, etc.; ensure the participation of highly qualified narrow specialists in medical commissions when making expert decisions. Conclusion. Mechanisms for improving the effectiveness of preventive work in Occupational Health using telemedicine technologies will be due to an increase in the quality of medical examinations of workers, an increase in personnel skills, an increase in information security and the speed of expert and managerial decisions, and economic feasibility.

Criteria for differential diagnostics of the bronchopulmonary pathology in employees exposed to occupational air pollutants

Introduction. In recent years the nature of the developing professional pathology of the respiratory system and the features of clinical manifestations have been proved to be determined not only by harmful factors of the working environment but also by individual characteristics of the body, such as age, state of the immune system, etc. In some cases, the differential diagnosis of various forms of bronchopulmonary pathology to date causes certain difficulties.Aim. To establish the criteria for differential diagnosis of the nosological form of the pathology of the bronchopulmonary system from the effects of occupational airborne pollutants using fluorine compounds as an example at different times of diagnosis.Material and methods. 130 patients with an established diagnosis of occupational pathology of the broncho-pulmonary system were examined. All patients were divided into 2 groups: 1 - patients with professional bronchopulmonary pathology, in whom the disease was associated with the occupation during initial hospitalization, during the continuation of work in aluminum production or no later than a year after termination of work); Group 2 - persons with occupational bronchopulmonary pathology, who were diagnosed with respiratory pathology during the period of work, and the connection of the disease with the occupation more than 1 year after termination of work. Patients underwent spirometry, body plethysmography, a 6-minute walk test, questionnaires using the COPD Assessment Test (CAT) questionnaire, and respiratory symptoms were assessed using a 4-point mMRS scale. Statistical analysis methods were performed using the STATISTICA software package - version 6 of Stat Soft Inc. (USA). Intergroup comparison of quantitative indices was carried out using the nonparametric Mann-Whitney test. Values are presented as mean and mean error. To establish the criteria for differential diagnosis, a discriminant analysis was performed.Results. The CAT score (strong COPD influence on the patient’s life) was statistically significantly worse (25.91 points) in group 2 (versus 21.85 points in group 1), as well as spirometry indices: FVC, 68.30% of due values against 79.90% and FEV1 - 62.15% against 70.88%. (p &amp;lt;0.05). As a result of discriminant analyzes, informative criteria for the differential diagnosis of occupational bronchopulmonary pathology were established: the severity of shortness of breath on the CAT questionnaire, the total score on the CAT questionnaire; the ratio of the forced vital capacity of the lungs to the forced expiratory volume in 1 minute (FVC /FEV1), the instantaneous volumetric rate after expiration is 25% FVC (MOS25), the instantaneous volumetric rate after expiration is 50% FVC (MOS50, forced expiratory volume per 1 minute (FEV1); total bronchial resistance according to body plethysmography (sRtotal), residual lung volume according to body plethysmography (RLV). The results indicate the progression of clinical manifestations of bronchopulmonary pathology even after stopping work in aluminum new production.Conclusion. The criteria for differential diagnosis of bronchopulmonary pathology from the effects of occupational airborne pollutants taking into account the individual characteristics of the body are established.

Methodological approaches to assessing the working conditions of locomotive crew drivers based

Introduction. A significant number of registered occupational diseases are accompanied by social and economic losses. The structure and levels of occupational and work-related diseases are cause-and-effect dependent on the quality of working conditions and the intensity of exposure to harmful factors of the production environment and the labor process. The aim of the study is to determine the safe length of work experience under the influence of a combination of adverse factors of the working environment based on the application of the methodology for assessing the health risk of workers (for example, drivers of locomotive crews of railway transport). Materials and methods . Hygienic assessment of working conditions of drivers based on the current regulatory documentation (R 2.2.2006-05 Occupational health. Guidelines for the hygienic assessment of working environment and labor process factors. Criteria and classification of working conditions; Appendix No. 1 to the order of the Ministry of Labor of the Russian Federation ofJanuary 24, 2014 No. 33n Methodology for conducting a special assessment of working conditions; SanPiN 2.2.4.3359-16 Sanitary and epidemiological requirements for physical factors in the workplace). Calculation of indicators of risk of loss to health in accordance with GOST R 12.0.010-2009 “SSBT SUOT hazard identification and risk assessment”, methodological recommendations “Assessment and forecast of professional reliability and professional risk of drivers of various vehicles” MR 2.2.0085-14, taking into account the requirements of the Manual of 24.06.2003 № 2.2.1766-03 Manual for assessing professional risk to the health of employees. Organizational and methodological bases, principles and evaluation criteria. Results. Based on the risk assessment methodology, regression formulas were developed for predicting the health loss of locomotive crew drivers and age groups were identified with a high degree of probability of their production-related and occupational pathology. Conclusions. The working conditions of drivers of locomotive crews were assessed as harmful to the second degree (3.2). The main adverse factors are noise, general vibration, microclimatic conditions, stress and severity of the labor process. The risk of loss of health calculated in accordance with GOSTR 12.0.010-2009 is defined as “High” (R=10.7). The critical age of 50years has been established for the formation of production-related pathology of the nervous and cardiovascular systems. There is a high probability of manifestation of the initial phenomena of sensorineural hearing loss at the turn of 40 years, at the age of 52-55 years (work experience of 27-30 years) — professional sensorineural hearing loss. A high probability of professional pathology formation by the age of 55 was revealed. It is justified to reduce the working shift to 6 hours (30 hours per week) or provide an additional day per week (32 hours per week).

Critical assessment of several methods of challenging the normative results of the examination of the connection of the disease with the profession

In recent years, there have been regular cases of employers and insurers refusing to fulfill their obligations to an employee affected by an occupational disease using incorrect methods of challenging the established diagnosis of an occupational disease. We analyzed pre-trial disputes and court cases in which an employer or insurer tried to avoid fulfilling their obligations to an employee affected by an occupational disease by declaring such a diagnosis unfounded without its official cancellation. The general pattern of incorrect actions by employers or insurers is stereotypical. At first, they refuse to fulfill their obligations to the sick employee on the basis of a declaration of their belief in the absence of professional pathology. If an employee tries to protect their interests in court, the employer or insurer disputes the diagnosis of an occupational disease, using various tricks to avoid objective consideration of the circumstances of the previously conducted examination of the connection of the disease with the profession. To stop the above-described practice, it is necessary to reform the legal framework in the field of accounting and investigation of occupational diseases. The procedure for considering disagreements in the field of occupational pathology diagnostics should be clearly regulated.

Working conditions and occupational pathology of Kola Polar miners

Introduction. Despite the improvement of mining technologies and personal protective equipment for employees, working conditions in the mining industry create an increased risk of occupational diseases.The aim of the studyis to compare the working conditions and features of professional pathology of miners in the production of iron, apatite and copper — nickel ore in the Kola Polar region.Materials and methods. The data of social and hygienic monitoring on the section “Working conditions and occupational morbidity” of the population of the Murmansk region in 2007–2017 were studied.Results. It was found that in 2007–2017, there was no significant improvement in the working conditions of the studied groups of employees of mining enterprises. The structure of professional pathology of miners was still dominated by vibration disease (37.0%), radiculopathy (23.8%), mono-polyneuropathy (15.5%), sensorineural hearing loss (15.5%), and among the etiologically significant harmful industrial factors — the severity of labor (54.1%), general vibration (23.8%) and noise (13.1%). During the observation period, occupational morbidity in the mining of iron and copper-nickel ore decreased significantly, while in the mining of apatite ore it tended to increase. There is no causal relationship between changes in working conditions and the level of occupational morbidity of miners.Conclusions.It is necessary to improve the quality of hygienic and clinical research when conducting a special assessment of working conditions and periodic medical examinations to obtain an objective assessment of occupational health risks for miners in the Kola Polar region.